Wednesday, January 31, 2007

Taking Medications during Pregnancy

"I don't need to see any Doctors because I know I cannot take medications during pregnancy"

I had a pregnant patient recently who said that she had a friend who has been having a sore throat for 2 weeks but has been refusing to see the doctor because she claims that the doctor can't do anything because she believes a pregnant woman cannot take any medications at all.

If you believe that you cannot take any medications at all during pregnancy and refuse to seek medical attention, you may be endangering yourself and your baby. People say that one has the right to believe anything you want and that is your right. But one really has to make sure that the belief is based on facts and not hearsay. This is one of the biggest challenges in family practise because most patients have beliefs which come from various sources. Some of these beliefs are wrong and so patient education is an ongoing process.

The fact of the matter is that during pregnancy, there are some medications which will affect the developing foetus and which should be avoided. BUT, there are also medications which are shown to be safe during pregnancy. If you have say, a mild chest infection and you refuse to see the Doctor because you believe that you should not take medications when you are pregnant, that mild infection may develop into full blown pneumonia and you may become septic (germs get into the blood). Then you may need to be admitted to hospital for intravenous antibiotics. That will be more dangerous for you and your unborn child.

The bottomline is this: If you are ill, see your doctor. He will be able to properly assess the condition and tell you if the illness requires medications.

Thursday, January 25, 2007

Help Doc! I missed my Pill today, What should I do?i

OK, now this is what you do:

Remember the rule of 7s:

1. Always take the forgotten pill once you realize that you forgotten to do it. Do this even if it means you have to take 2 pills at a go.

2. Then take the next pill at the usual time.

3. If you missed your pill by more than 12 hours, then you should assume you may be able to get pregnant and use another form of contraception for the next 7 days.

4. If the 7 days run beyond the last hormone pill in the pack, then you should just continue with the next pack immediately without a break. Ie you will miss the menstrual period that month.

Thursday, January 18, 2007

Is Wagyu Beef really Healthy?

Wagyu Beef is quickly gaining popularity amongst beef lovers in Singapore and around the globe because of its unsurpassed marbling and tenderness. When I first heard of this marbled beef, my Doctor half thought "Oh oh! So much fat! Its got to be bad for your heart!" while my Foodie half rebutted "Hey, that's got to be the shiokest, tenderest beef steak!". Imagine my joy when I read on the Internet that Wagyu was also higher in monounsaturated fats than normal beef and that it was healthy! As you know, monosaturated fats eg olive oil (which melts at a lower temperature) are better for your heart then saturated fats, eg butter.

My initial reaction was: "Rejoice! Rejoice! Now I can have my beef steak AND lower my cholesterol levels at the same time!"

But the cynic in me just could not accept this without reservations. So I began to do some research. Sad to say that the medical community has not really gotten wind of the fact that Wagyu beef is lower in monosaturated fats yet (maybe they are all too busy avoiding beef and staying healthy) so a casual search of the usual medical sites revealed no official position on Wagyu Beef.

When you look at the information from Wagyu Beef Suppliers, they will tell you that Wagyu is high in monounsaturated fats and with the ratio of monounsaturated to saturated fats of 2:1.(1) Then they go on to tell how a diet high in monounsaturated fats can lower your bad cholesterol levels. Although it seem to be the logical conclusion, one needs to be careful to and look at the whole picture before starting to eat chunks of Wagyu beef thinking that you are doing your heart a favour! Bear in mind that even though there is more monounsaturated fats in Wagyu, there is still that 30% of saturated fats! And since Wagyu is so well marbled, you are taking in a lot more fat than a normal beef steak.

So real question is: "Does eating Wagyu really lead to lower cholesterol levels, compared to eating normal Beef?". As far as I can tell, there is not enough data (available to me) to form a conclusion. I did managed to find one article (2) that addresses this issue, but it was a research paper funded by a beef supplier AND it was only done in a small population of people, so the results have to be taken with a grain of salt.

In this experiment, they had 2 groups of people with high cholesterol levels and they fed one group with lean Wagyu beef (lean but still higher in monounsaturated fats) and another group with normal US choice beef. They measured their cholesterol levels before and after 6 weeks of eating the beef. At the end of the trial, one of the conclusions was that there was no difference in the cholesterol levels of the group eating lean Wagyu compared with the group eating normal beef.(2) So it appears that Wagyu may not confer the benefits of lowering cholesterol compared to normal beef as assumed.

Even if the Wagyu does really lower cholesterol levels, there are still other ill effects of red meat that needs to be considered. There is some evidence that high consumption of red meats can lead to colon cancer. (3) Eating too much fat will also lead to obesity and consequently cause other health problems.


Wagyu beef suppliers would like you to assume that Wagyu is healthy because it contains more monounsaturated fats than normal beef. At this point in time, it is only an assumption and has yet to be proven. If you are suffering from high cholesterol, it is still better for you to eat fish (eg, Salmon, mackeral, sardines) which is high in Omega 3 fatty acids (3) rather then a Wagyu Steak. There is just not enough evidence to advise people to eat more Wagyu beef in order to lower cholesterol levels. Oh how I wish there was! That would be a piece of dietary advise that would be easy for a lot of people to swallow.

To read my other blog on Wagyu Beef, please click here


1. Link to Wagyu article

2. Increased Beef Consumption Increases Apolipoprotein A-I but Not Serum Cholesterol of Mildly Hypercholesterolemic Men with Different Levels of Habitual Beef Intake

3. Fats and Cholesterol - The Good, The Bad, and The Healthy Diet

Tuesday, January 16, 2007

Doctor, Is my child Hyperactive?

"Doctor, my son is always running around and can't seem to sit still. Is he hyperactive?"

When my son was younger, he was very active and could never sit still. He would constantly be playing with toys or disturbing his friends at nursery and is always "up to something". In fact he seemed to always need stimulation. So some of my friends (from a non-medical background) proclaimed him to have ADHD (Attention Deficit Hyperactivity Disorder). I never believed them. Afterall I was the Doctor and here you have laypeople trying to tell me about health conditions? (Happens all the time, and the main culprit is my mother who still insists and telling me what to do when I fall ill, Bless her heart!)

The fact is that my son is able to sit through a whole episode of "Ultraman" completely glued to the TV. He won't move until the part when Ultraman's warning light starts beeping and when everything looks bleak, he summons up all his strenght, shoots his Killer Beam and obliterates the Monster. Then, when the credits begin to roll, he would start running around again.

Last year in Primary one, he did initially have some problems fidgeting in class and constantly disturbing his friends, but he managed to end the year with an acceptable result and even earned a certificate for best improved student. Now in Primary two, he still gets into trouble every now and but now no one would say he has ADHD anymore.

My son is active, but he does NOT have ADHD.

How common is ADHD?

As many as 40% of prescholers may be excessively active and considered to have a short attention span but only 1 in 20-30 will eventually be diagnosed as having ADHD. It is a condition more common in boys (about 6 times more common). It can present as early as infancy and seldom appears after the age of seven.

How do you recognize ADHD?

There 3 main features:

1. Inattention
: This is difficulty in concentrating, following directions and forgetting instructions. If your child is able to sit down with you for 10-15 mins when you read a story or if he is able (like my son) to be glued to the TV or computer game for an extended period of time, then he probably does not have this problem even though he may seem to get distracted easily.

2. Excessive activity
: Fidgeting and restless and never seems to be able to sit still. We Teochew like to say their Kah Cherng Seh Tang (Worms infesting the Backside). A child may still have ADHD even if he is not excessively active.

3. Impulsiveness
: In preschoolers this may be expressed as being easily excitable, having temper tantrums, excessive crying and a tendancy to just do "stupid things" like grabbing a hot cup of Kopi or punching a strange dog. Older children may have problems completing tasks, taking turns and doing things without considering the consequences. My son for instance had a heightened sense of danger and did not take to the slides at Wild Wild Wet until much older, so he can't be said to display impulsive behavior.

Some additional considerations:

1. The symptoms must appear in at least 2 situations, eg home and school

2. The symptoms usually appear before the age of 7

3. It is important not to wrongly label the child as having ADHD because it will cause unnecessary emotional distress for the child and the family! Not all children who are inattentive, overly active and impulsive have ADHD, the symptoms must be more severe then their peers and last at least for 6 months

4. Some kids who are very bright may seem to be inattentive. But when you check their work you may realise that they have completed their tasksare looking for other things to do!

What you should do

1. If your child is a preschooler, it is useful to look at how they react in a group of their peers. If they have ADHD, their characteristics of impulsiveness, inattentiveness and inattention will be much more evident then their peers.

2. If you do find that their attention span is much shorter then their peers or that their inability to sit still is very much worse than their friends, you may want to consider having him assessed by your family doctor who may then refer the child to a child psychiatrist.

3. Even if your child does not have ADHD, it is important to always protect their self esteem and praise them for positive behaviour. When asking them to do certain tasks, be very clear and reinforce the rules frequently. It helps to get their attention when talking to them by making sure they are looking at you when you talk to them. Always make sure they understand what you want them to do.

This is just a short blog to help parents recognize if their kids have ADHD. For more information on medications and therapy, please click here

Thursday, January 11, 2007

Infertility: When you should see your Doctor

"Doc, we've been trying for a baby for 2 years now, is it time for us to do some investigations?

The problem with infertility in Singapore is common. I am sure everyone knows of some couple who have been having difficulties trying to conceive. The subject is sometimes a bit of a taboo and it's one of those "What I really want to know but am too embarassed to ask the Doctor" kind of questions.

First of all let's look at some numbers:
  • 1 in 10 couples experience infertility at some stage of their lives
  • 60-70% achieve pregancy after 6 months of unprotected sex
  • 80% conceive after 1 year
  • 90% after 2 years
Bear in mind that fertility rates start dropping after the age of 35. So the older you get, the harder it is to conceive.

So we advise that most couples might want to seek professional help after trying for 2 years or sooner if the lady is above 35 years of age.

How do I get pregnant?

Now, it may be quite obvious to most people, but I have come across couples who have been "trying" to conceive for some time who after some questioning admitted that they are only having sex once every 3 months because of their work involved lots of travelling. So, the first thing if you want to have a baby is that you need to have sex AND you need to do it as frequently as 2 - 3 times a week.

The woman releases one egg (commonly) per menstrual cycle and the egg is released at around day 14 of a 28 day cycle. So the most fertile period is the few days before and after day 14. Day 14 is the 14th day after the first day of menses. When the eggs are being released, the body temperature may rise a little and there is more vaginal discharge, some women may even experience abdominal pain.

It is good to make sure that the man takes some measures to optimise their sperm quality and sperm count. One thing to note is that it takes about 3 days to get maximal sperm count so one thing would be fathers can to is to abstain from ejaculating for 3 days. There are some other factors you might want to note which are discussed in an earlier Blog.

NOTE: Even if everything is working and you do it at the right time, your chances of conceiving is still only about 20%!

3 essential things need to happen
  1. The right number of healthy sperms need to be at the right place at the right time.
  2. The egg must be released
  3. The fallopian tubes must not be blocked so that the sperm and egg can meet and subsequently be implanted in the uterus
What can go wrong?

The Major causes of Infertility are:
  1. Semen quality - 40%
  2. Ovulatory disorders - 30%
  3. Tubal problems - 30%
These are the main causes. But other less common conditions may also cause problems. For instance, the couple may have problems having sex eg impotence. Psychological factors such as stress and anxiety also play a role which is why (it is commonly said) that most pregnancies occur when the couple goes on holidays.

What you should do

If you and your spouse have been trying for 2 years and have not conceived, then there are few simple things that your Family Doctor can do for you before you visit the specialist.

For the Men

This is probably the simplest first step because it is easy to demonstrate if the sperms are viable by collecting a semen sample and sending it to the lab. If the semen is normal than we immediately know that the problem lies with the lady.

Sometimes certain drugs taken for things like high blood pressure can cause impotence and this may be the cause of the failure to conceive. A physical examination may also reveal if there is anything wrong with the testes or the penis.

For the Women

There are some simple things that can be done first by your Family Doctor. First thing is to find out if there is monthly ovulation. This can be done by taking note of the history and nature of periods. If the periods are irregular, blood tests can be done to determine if there are any hormonal problems. Sometimes, infection of the cervix can cause infertility and this is easily treated with antibiotics. I had one patient who had hypothyroidism who became pregnant when she started taking thyroid medications! If it is demonstrated that there is a failure to ovulate, then the family doctor may prescribe some oral medications to stimulate ovulation.

After the initial batch of tests, if no cause if found then the lady will need to be referred to more specialized imaging tests to look at problems such as blockage of the tubes or abnormalities in the uterus.


Currently, about 60% of couples who seek specialised medical help will conceive. In 10%-20% of infertile couples, all the tests will fail to demonstrate a reason for the infertility ie the Doctors don't know why they can't conceive. However, please don't ever lose hope. I have come across many couples who have been trying for years and have gone through many fertility programs without success but who fall pregnant once they simply stopped trying too hard! There is always hope as long as lady has not reached menopause.

If you like more information, please click here.

Tuesday, January 09, 2007

Is Aspartame (Nutrasweet) safe?

One reader recently asked me to comment on an article that alleges that Aspartame is a toxic chemical that can cause a variety of health problems.

You can click here to see the article.

There is a very short answer to this question.

The official stance of the AVA, the agency who is responsible for food safety in Singapore, is that Aspartame has been shown to be safe for ingestion for the the general public.

However, there are a minority of people who should not be taking aspartame. They are:

1. People with phenylketonuria - a genetic disease.

2. People with advanced liver disease

3 Pregnant women with high levels of phenylalanine in the blood.

Now if you don't recognize any of these terms it just means you probably don't fall into any of the categories above.

The official position of the AVA can be found here

Just one thing you need to bear in mind. This position is based on information known at this point in time. It could be proven wrong in the future. Take the issue of hormone replacement for menopausal women for instance. For many years, the experts advocated the use of hormonal drugs for menopausal women, but that position shifted when information from new research demonstrated that it may not be as safe as what they initially thought.

So the fact is Medicine is Evolving and all we can do is to base our beliefs on the latest information available.

One last piece of advise. You can't trust everything you read on the internet. And when you come across an article like the one above, please don't circulate it to all your friends before checking if the information is accurate. The most recent one I came across was one my friend sent to me on the hazards of microwaving plastic container. It turned out to be a hoax!

Thursday, January 04, 2007

How to increase your HDL (good) Cholesterol

In the previous blog, we discussed about how to lower LDL which is essentially through dieting. In this blog, we will discuss ways of increasing HDL levels.

If you remember, HDL is the good cholesterol which carries the excess cholesterol in the blood and brings it back to the liver.

Here are the ways to increase HDL levels


But we are talking aerobic excercises ie excercise until you really start panting and sweating for at least 30 mins on most days of the week. Taking a stroll in the garden for 10 minutes is not that helpful but still better then nothing. If you have heart problems, you will need to check with your doctor before you start doing strenuous excercises.

Lose Weight

Easier said than done but shedding a few kilos will increase your HDL levels.

Stop Smoking

Aside from lowering HDL levels, smoking also increases the tendency for your blood to clot as well as a host of other problems. The problem with most people is NOT that they don't know the ills of smoking, but they are unwilling to stop because they know it is difficult. It is probably the best thing you can do for yourself, your family and your wallet.

Reduce your intake of Trans Fats

Trans fats are formed when vegetable oils are hydrogenated to make them last longer and turn them into semi solid form eg margarine. Reducing your intake of Trans Fats will decrease your LDL and increase your HDL levels. You can read more about trans fats here

Increase your intake of Good Oils

Canola Oil, Avocado Oil and Olive Oils can help increase HDL levels. When buying oil for cooking at home, avoid "pure vegetable oils" because they just mean oil from a vegetable source. Instead, go for pure Canola Oil. I find Olive Oil does not complement Chinese cooking, but it is good to use good quality Olive Oils for your salads instead of Mayonnaise or other creamy salad dressings.

Alcohol or Not?

This one is controversial because it has been shown that a small amount of alcohol can raise HDL levels but too much will cause other alcohol related problems! People always say drink in moderation, but one man's moderation is another man's excess!! So when we say moderation, we mean one glass of wine 3 or 4 times a week or its equivalent. I think for some people this would be the easiest one to suggest!

Increase your intake of soluble fiber

Foods like oatbran, fruits, vegetables and legumes help to lower LDL and increase HDL. One good idea may be to replace the morning Roti Prata with cereals instead. Make sure you don't end up buying Honey Stars and Coco Pops, these are high in sugar!

So there you have it. I hope that is enough information to help you get started on a healthier LDL lowering, HDL increasing lifestyle. For more information on increasing your HDL levels you might want to check out this site.