Tuesday, April 24, 2007

Alert! Hand, Foot and Mouth Disease is on the rise!

If you have been following the news, you would note that the number of HFMD cases has been on the rise this year. This is consistent with the increased number of cases that we are seeing in our clinic. So parents please be on a high index of suspicion if your child develops a fever, mouth ulcers and rash on the hands and feet.

Here are some important information about HFMD you should know:
  • It is usually a mild and self limiting illness
  • The incubation period ie the time of when the child is exposed, to the time he develops the illness, is about 3 to 5 days
  • It usually affects children under 5 years of age
  • The features are multiple ulcers in the mouth and spots on the hands and feet. Sometimes there may be spots on the buttocks as well
  • It is spread by direct contact through droplets, saliva, faeces or blister fluid from the infected person.
  • The lesions resolve in 3-5 days and there is no scarring
Please note that several years ago, there have been a series of deaths caused by the EV71 virus. So far this year, the predominant strain is the Coxsackie A16 virus which usually causes a mild illness.

What you should do:
  • Consult your doctor immediately if the child has a fever and has been exposed to HFMD or if you see rashes or mouth ulcers.
  • Isolate the affected child so he/she does not spread the illness to other kids
  • Wash hands with soap before eating and going to the toilet
  • Cover mouth and nose when coughing or sneezing
  • Maintain good air circulation
  • Clean all toys and appliances that may be contaminated by the affected child
  • Do not share eating utensils
  • Do not return to school until certified fit by your doctor
If in doubt, always seek medical advise.

Channel News Asia Report Here

Depression and Suicide

I have never met Ms X. She was a Chinese National who married a local Singaporean man. My first contact was with her newborn and I was curious that it was the grandparents who were the main caregivers. During their second visit for the baby's vaccination, I found to my horror that Ms X had committed suicide. She had been suffering from post-natal depression.

I think one of the most devastating things in life is to find out that someone you know has committed suicide. And it doesn't have to be someone you know very well. I remember when Leslie Cheung committed suicide, I was somehow affected by the news even though I can't even remember watching any of his movies. Last year, a friend of mine whom I had shared some makan adventures with was found dead at the bottom of his HDB flat. I cried, even though I did not really know him that well.

These suicides were a culmination of months of depression. They could have been helped. In Singapore, it is reported that there is one case of suicide everyday.

It is important to be able to recognize that your friend, colleague or family member may be suffering from depression and quickly get them assessed by the Doctor. It can potentially be life saving.

How to recognize Major Depression
(Modified from the DSM IV criteria)

Five of the following symptoms have to be present for at least 2 weeks:

1. Depressed mood
2. Diminished interest or pleasure in all or most activities
3. Significant weight loss or gain, or decrease or increase in appetite nearly every day
4. Unable to sleep or sleeping too much
5. Slowing of mental or physical activity or agitation
6. Fatigue or decreased level of energy
7. Feeling of worthlessness or inappropriate guilt
8. Poor concentration or indecisiveness
9. Recurrent thoughts of death or suicide


If you think that someone you know might be suffering from major depression, it is important that you seek medical help ASAP. The patient can be helped with medication and therapy. This is especially important if the patient has expressed a desire to commit suicide which should never be taken lightly. If the doctor determines that the patient may indeed be at risk of suicide, he has the legal authority to detain the patient in a medical facility (IMH) against the patients' wishes. Friends and family members thus have a very important role to play in preventing suicide by being able to recognize the symptoms of major depression.

Monday, April 09, 2007

For Women: Help Doc! I am losing my hair

Hair loss (Alopecia) in women is often more devastating than men. While society can accept balding men, it does not offer the same courtesy to women. Hollywood may still have leading men like Sean Connery, but I can't remember ever seeing a bald lady superstar.

There are many reasons why women lose hair. The most important thing is to understand the reason for the underlying hair loss. Some hair loss is reversible while others are not.

Here are some interesting facts about hair
  • We produce around 1km of hair per month
  • There are on average 100,000 hairs on our heads
  • About 50-100 hairs are shed everyday
  • Hair that is shed takes 3-5 years to replace
  • At least 25% of hair must be shed before we notice the hair loss
  • Abnormal shedding is when the hair clogs up the shower drain or you see clumps of hair on the pillow
There are many different causes of hair loss in women

Androgenetic Alopecia (Inherited hair loss)

This is the most common cause of hair loss in both men and women. By the age of 60, 50% of women would have noticeable hairloss. This is also caused by male hormones (Women do produce some male hormones). The pattern of hair loss is different from the men. Women do not lose their frontal hairline and the hair loss affects the crown of the head (the top). There are treatments available for this form of hair loss but it is controversial and it is best to discuss this with your doctor.

Alopecia Areata (Patchy hairloss)

In this type of hair loss, women (and men) may find that there is one patch of clean normal scalp surrounded by normal hair. It looks as if the barber accidentally shaved off the hair on that part of the scalp. This condition usually recovers spontaneously after 12 months, but there are some medications and treatments which may help to shorten the recovery process

Diffuse Alopecia (Universal hair loss)

Sometimes severe stress can cause hair loss. Classically this type of hair loss is seen in women after pregnancy. It usually occurs 2-4 months after the stressful event. Aside from giving birth, other events such as severe illness or surgery, accidents, severe dieting and weight loss etc can also cause this form of hair loss. The good news is that spontaneous recovery can be expected in 6 months. Medications such as minoxidil can be used to help accelerate the process.

Certain medications can also cause hair loss. The obvious ones are the drugs used to treat cancer. The less obvious ones are drugs used to treat gout, gastric pain, worms, arthritis etc. You should check with your doctor if you suspect that your hair loss is caused by a certain drug.

Other Conditions

There are also a number of medical conditions that can cause hair loss such as hypothyroidism, anaemia, polycystic ovarian syndrome etc. Your doctor would be able to confirm the diagnosis by doing blood tests and other investigatons.

The bottomline

It is important to get to the root (pun intended) of the problem. Understanding the cause of the hair loss is the most important first step in treatment. There are some medications available from your doctor that can treat hair loss. So it is important to seek expert medical opinion before seeking other treatment options for your hair.


Murtagh, John Patient Education 4th Ed 2005 McGraw Hill Australia

Thursday, April 05, 2007

We are closed on Good Friday

The clinic will be closed on Good Friday. Consulation times as usual on Saturday and Sunday.

To read my thoughts on Good Friday, please click here

Tuesday, April 03, 2007

For Men: Help Doc! I am getting BALD!

This is probably every man's nightmare.

I remember looking at my own scalp last year and wondering if my hair was a little thin on top. Of course, with my medical knowledge, I told myself that it is unlikely since I don't have any predecessors who are bald and that the area I felt my hair was thin was not typical of male pattern baldness.

But it was a whole different story emotionally. When it comes to issues of the heart, we tend to behave irrationally. I was gripped by the fear that one day I might end up with a "Chrome Dome" and being able to use my head to reflect the sunlight into a dark room. Worse than that, I remembered that my Maths Lecturer in RJC used to grow his hair really long on one side and use it to cover the bald area. The students used to giggle in class when those strands of hair lift off the bald part and swing 180 degrees to end up dangling over the shoulder.

What is the Cause? And what do Eunuch's have to do with it?

Male pattern baldness tends to run in families. So there is not much you can do to prevent it. However, it is prudent to let your doctor have a look at your scalp to determine if there may be other causes for your hairloss. For example, you might be suffering from a fungal infection which may be causing the hair to drop off. This is a condition that can be easily treated with medications.

Male pattern balding is caused by too much testosterone circulating in the body. There are androgen receptors on the scalp which react to the high level of testosterone resulting in hair dropping off. These are found in high density in the forehead and crown area of the scalp which explains why men start to bald in those areas. Male pattern baldness is unheard off amongst Eunuchs (Men who have been castrated), since they have very low levels of testosterone. However, castrating oneself in order to protect one's hair is a bit extreme. And besides, when you castrate yourself, you lose your sexual drive, so what's the point of looking attractive?

So what are my options?

Male pattern baldness is an incurable condition. Most men come to accept it as a natural part of their lives and some like Yul Brynner and Vin Diesel even embrace it. In fact, they actually look more sexy bald than when they have hair.

Other men like William Shatner (Capt Kirk) and Ted Danson (Becker) prefer to wear toupees to hide their bald spot. Incidentally, if you are interested in moviestars who are secretly wearing wigs, please click here.

Are there any medical treatments?

There are only two medical treatments that have been found to be effective in reducing hairloss.

The first is a medication known as minoxidil. It is a lotion that is directly applied to the scalp. The other is a tablet known as finasteride. Both have to be taken for life. Once you stop medications, the hair loss resumes. These are prescription medications which are available from your Family Doctor who will be the best person to advise you on whether they are suitable for your condition.


If you have inherited the gene from your forefathers then your hairloss is inevitable. Those that really want to keep their hair can do so by taking regular medications. The best time to start taking medications is before you lose too much hair as it is easier to retain the hair you have rather than to replace the ones you have lost. If you have a problem with male pattern baldness and want to do something about it, you should visit your Family Doctor to discuss different treatment options.