Karri Family Clinic is a KKH Partner in Asthma Care

We are happy to announce that Karri Family Clinic is now part of the KKH Partners in Asthma Care programme which will allow for our clinic to work with the KKH specialists to jointly manage bronchial asthma conditions among children.


Prof Chay Oh Moh, Chairman, Division of Medicine, KKH delivering the lecture on New Guidelines and Treatment Options in the Asthma Management of Children

I had the opportunity to attend the first seminar and workshop last Saturday in order to get updated on the latest developments in paediatric asthma care and managed to meet with the specialists and the nursing staff there.

This programme is an important step in the development of Asthma care in Singapore. Despite being a country with one of the best healthcare in the world, Singapore has the third highest rate of Asthma deaths after Russia and Uzbekistan. Having received my medical education from Australia, where one in four children suffer from Asthma, I am very familiar with the well developed system of Asthma care there. Compared to them, we still have much room for improvement, which is why we are keen to support KKH in their push for better Asthma Care in Singapore.

As a Partner of the KKH Asthma Care program, Karri Family Clinic is committed to:

• Embrace the practice of evidence-based care in accordance with practice guidelines
• Participate in regular CME programmes organised by KKH
• A two-way sharing of medical information on integrated care patients

The benefits to our patients are:

• Our clinic will be able to communicate with your KKH specialist concerning the management of your child's asthma.
• When required, we will be able to Fast Track your appointment at KKH so you don't have to wait for weeks for your first appointment.
  
• Our clinic will be able to directly admit your child to KKH without having to go through the Children's Emergency Dept.
• Your child will continue to be enrolled in the Asthma Club, ie patient support group after discharge from KKH
  

Developments in the near future (2009)

• Direct referral for skin prick testing
• Priority access to KKH Pulmonary lab for Lung Function Tests
• Be able to send our patients to KKH for patient education programmes

As part of the programme, our Clinic will provide step down and continued care for patients who have been discharged from KKH. To faciliate this, we will need to introduce some new practices to our Clinic so that new patients coming from KKH will sense the continuity of care. Some of these practices will have our kids taking the Childhood Asthma Control Test when they come for their regular Asthma checkups and also a Written Asthma Action Control Plan to remind parents how to step up their Asthma medications when there is an exacerbation.

You can read about the KKH partners in Asthma care program here


Dr Jenny Tang, Head of the Respiratory Medical Service demonstrating the use of spacer devices

Remember that good Asthma control means that the child will not have any wheeze or cough and be able to be active in sports without ever getting short of breath. In other words, an Asthmatic child will be like any other child except for the fact that they might need to take some medications. This is the gold standard for Asthma care and it is achievable.

With this new partnership, we now have additional resources to help our patients achieve good Asthma control.

To read my other articles on Asthma, please click here

How to prevent Head Bumps aka Baluku

Just saw this kid with a baluku (head bump) about 3 days after he initially bumped his head against the wall. The parents were understandably worried about the greenish colouration which had appeared around the eyes.

Now, if I were to write a handbook for new parents, one of the topics that would definitely be in the book would be a short article called "How to prevent that Baluku". You know, these Balukus are entirely preventable and it is really very simple.

Balukus appear because the impact of the hard surface on the head causes injury to the soft tissue between the skull and the skin. These injured soft tissue starts to bleed and it is the accumulated blood under the skin that causes the appearance of a bump.

So what you need to do is to stop the bleeding and you can prevent the baluku from appearing. The next time your child accidently hits his head, just get a towel and apply firm pressure onto the spot where the injury had occurred. If an ice pack is available, use that and apply firm pressure to the spot for at least 10 minutes.

What happens is when you apply pressure, you stop the bleeding and an ice pack helps the blood vessels to constrict. After 10 minutes, the body's own mechanism would have stopped the bleeding so you can stop pressing.

I have two young kids and they never have the problem of balukus so you can take it from me as a parent as well as a doctor that this works very well.

So say goodbye to the baluku for good!

One word of caution, if it is a very hard knock, you should still bring your child to see the doctor to see if there is any serious head injury. You can read more about it in my earlier post by clicking here.

Quoted in Today Paper's article on Gout

Just to remind our gout sufferers to be careful as we approach the festive season! Below is the article in Today Paper highlighting that gout can be quite a serious illness even in a young person and what you can do to reduce the chances of getting an attack.



Click here to read my post on Gout.

Cervical Cancer Vaccination FAQs

One of the latest development in our fight to prevent cancer is the recognition that certain infections can predispose a person to developing cancer later in life. I have written about the role of Human Papilloma Virus in the development of cervical cancer in an earlier post.

I have been getting many emails and phonecalls about HPV vaccination because of the recent media exposure, so I have compiled a list of the FAQs below:

Q: I am 20 this year and have been sexually active. Do I still need the vaccination?

A: The vaccination works on the premise that Cervical Cancer usually follows an infection of the cervix by the Human Papilloma Virus (HPV). This virus is transmitted during sexual intercourse, so the best time to have the vaccination is before the start of sexual activity so that we can prevent the infection from taking place.

However, there are several strains of the virus that causes Cervical Cancer and even though you have been sexually active, you might not have been exposed to all the strains, so it is still beneficial to get yourself vaccinated as the vaccine protects against several strains of the HPV.

Q: According to the brochure, this vaccination is for women between 10 to 25. I am 26 this year, does that mean I cannot take the vaccination?

A: As women get older, their chances of being exposed to the HPV increases so the cost effectiveness of the vaccine decreases. Actually the ideal age for vaccination is around 12 years of age before girls become sexually active. In fact, Britain has recently introduced mass vaccination for all girls between 12 to 13 years of age.

However, it does not mean that when you celebrate your 26th birthday, the vaccine suddenly becomes ineffective, as if something magical happens to your body when you turn 26. It is merely the age whereby our Ministry of Health has chosen based on the cost effectiveness of the vaccine. The age group may differ in different countries. In Malaysia for instance, the vaccine is recommended for women from 10 to 45 years of age. So what it really boils down to is for each individual patient to decide for themselves whether to take the vaccination.

Q: If I take the vaccination, does it mean I don't have to do my Pap Smears anymore?

A: No, you will still need to do your Pap Smear regularly because the vaccination only covers about 70% of the viruses that cause Cervical Cancer. It is by no means a 100% guarantee that you will never get Cervical Cancer but it does reduce your chances significantly.

Q: What is the vaccination schedule like?

A: The vaccination is given at 0, 1 and 6 months.

Q: Does the vaccination offer lifetime protection?

A: At the moment no one really knows yet because the vaccine is very new. It might turn out to have lifelong protection or they might find that a booster dose is required a few years after the first course of vaccination.

Q: How much does it cost to have the vaccination?

A: Each vaccination costs $210. Our clinic offers a package for all three jabs for $580 which includes the consultation fee and GST.

If you have further questions about this vaccination, please write to leslie.tay@gmail.com

More products found to be tainted with Melamine

The AVA has just added 7 more products that have been found to contain unaccepted levels of melamine. Please take note that these are not necessarily products that you would associate with milk. Things like corn snacks may also use whole milk powder in the manufacturing process. The AVA assures us that one has to take quite a large amount eg a 30kg child needs to take 50 packs of Mallow Dippers before it gets to toxic levels.

It is still best to avoid any China made food products until this whole thing is over.

More information can be found here

Link to my previous post, Melamine Poisoning - What Parents should know


Sshmallows Mallow Dippers Strawberry Flavour


Dutch Lady Banana Flavoured Milk


Dutch Lady Honeydew flavoured milk


House of Steamed Pototo - Potato Cracker


House of Steamed Potato - Potato and Tomato Cracker


Corn Snacks - Butter Corn Flavour


Corn Snacks - Cheese Flavour

Photos from AVA website

Primetime Morning Interview on Chickenpox

Here's my interview on Channel News Asia's Primetime Morning on 23 September 2008.

More information on Chickenpox!



Links:

Channel 5 news on Chickenpox
My article about Chickenpox

Melamine poisoning: What Parents should know

I am sure a lot of parents are anxious about the issue of Melamine poisoning and want to know how to find out if their children are suffering from Melamine poisoning. So this is just a short post to let you all know a little more about what is going on and what to do.

What is Melamine and how did it get into our food products?

Melamine is a chemical that they use to make plastics. I remember that we used to have unbreakable plates and bowls that were made with Melamine and they are still being used in a lot of places today. Melamine as a plastic is very safe, but it becomes a problem when it is eaten.

Because Melamine is high in nitrogen, unscrupulous people have added it to milk which have been diluted with water in order to fool the detection devices into thinking that it is normal milk. This is because the devices do not actually detect protein itself, but the nitrogen content in the protein. So when the milk farmers sell their milk to the middlemen, these middlemen dilute the milk with water and add Melamine so that they can sell more volume of milk to the big producers like Sanlu. These producers then sell their milk products to make things like infant formula, chocolates, ice cream etc.

In Singapore, the AVA has positively detected Melamine in 3 products so far. These are:


White Rabbit Creamy Candies


Dutch Lady Strawberry Flavoured Milk


Yili Fruit Bar

Photos from AVA

I think we might be seeing more product warnings as the AVA conducts their check. As a precaution, they have also started to recall food products which use China sourced milk as one of their ingredients. These can be anything from chocolates, candies, yoghurt etc. It would be wise to avoid these products until the dust settles.

How to know if my child is affected by Melamine Poisoning?

Melamine affects mainly the kidneys because it is mainly excreted by the kidneys. So when high levels of Melamine are eaten, they start to precipitate in the kidneys causing kidney stones. The usual symptoms of kidney stones are pain in the back and sometimes blood in the urine.

Sometimes, melamine can also cause Acute Renal Failure (ARF) which is probably the cause of death in those infants in China. ARF is usually diagnosed with a blood test which is done because the patient is very sick and is admitted to hospital. There are really no concrete signs but you might notice that the child is very sick and vomiting constantly and the urine output might be very much reduced. At any rate, most parents can tell when there is something very wrong with their child and should just bring them to see the doctor.

Do note that you do have to take a moderate amount of Melamine it starts to become a problem. So in China, it was the infants who have been fed daily with tainted infant formula over several months who are affected. If you just drank a bottle of Dutch Lady Strawberry milk or had one Yili fruit bar, it should not cause any problems so there is no point in worrying about it too much. In doubt, please check with your doctor.

Conclusion

It would be wise to avoid any product that contain milk that has been sourced from China at the moment. However, you should not be too concerned if you or your child has taken only a small amount of any of the 3 products listed. If on the other hand, your child has been taking, say, the Dutch Lady Strawberry milk in large amounts over several months, then it may be prudent to bring him to the doctor who might do an Xray and blood test for the child.

LINKS

News about Melamine scandal click here
Read about the banned products in the AVA website

Chickenpox cases are on the rise.

Here's the Channel News Asia report on the rising number of Chickenpox cases in Singapore which was shot right here at Karri Family Clinic last Sunday evening.

Here are the main points and some additional points not covered by the news:

1. The number of cases of Chickenpox cases in Singapore has risen by 25% over the last year
2. Many parents are still resistant to vaccinating their children because many believe that it is a "rite of passage" for the child.  However, if you think about it, when you were a kid, everybody had Chickenpox, nowadays, it is no longer universal.  This is because of the introuduction of the Chickenpox vaccine. 
3. Contrary to popular belief, Chickenpox can sometimes cause complications like brain infections, lung infections and even death. Again contrary to popular belief, Chickenpox does not have to be a "normal" part of life.
4. The risk of complications in Chickenpox is highest in infants less than one year old and in adults older than 20 years. Adults tend to get a more severe form of the disease.
5. Some children do still get Chickenpox after the vaccination, but it is important to note that at least 70% to 90% of them don't ever get the disease.  And if they do get the illness, it is very mild and the risk of complications is very much reduced.
6. Women who are planning to get pregnant should consider getting themselves vaccinated if they have not had chickenpox before.  This is because if they do get chickenpox during the first half of pregnancy, the child has an increased risk of severe deformity.  If they get Chickenpox around the time of delivery, the infant may also develop infantile Chickenpox which can cause death in 31% of infants
7. Scarring is quite commonly seen after Chickenpox.  Although it is not life threatening, the scars can be prominent and can cause long term emotional distress as seen with the lady in the video.
8. The side effect of the vaccination is minimal.  Children may get a bit of fever and pain at the injection site. There are some cases where they actually develop a very mild form of Chickenpox following vaccination but this is uncommon.

I hope that these facts will help to clarify your understanding of Chickenpox.  It is important to rely on facts to make decisions that affect your family rather than basing it on hearsay.  If you have other concerns about the Chickenpox, please write in!

I have covered some other points in my previous post on Chickenpox.  Please Click here to read it.

Karri Family Clinic to be featured on Channel News Asia tonight

We have just done the filming on Sunday for a story on Chickenpox in our clinic. You will be able to catch the clip of myself and one of our patients being interviewed concerning Chickenpox on Monday night's Primetime News on Channel News Asia at 9.00pm and 10.00pm!

Update: 9 Sep 2008

My apologies it was aired on Channel 5 news at 9.30pm and CNA Singapore Tonight at 10pm.


Kids playing in the Clinic


Being interviewd by Margaret Perry


Patient relating her personal experience with Chickenpox


Kids receiving Chickenpox vaccination

Adult Vaccination Schedule: Prevention is better than Cure!

One reader wrote to me asking for a table of Adult Vaccination for quick reference. There is currently no official Schedule from MOH so this table is a proposed schedule that I modified from an article by Dr Lam Mun San of Infection & Vaccination Consultants, Mt Elizabeth Medical Centre which was published in the Singapore Family Physician.

I think that as Adults we frequently miss vaccinations because of a few reasons:

1. We are not aware that we need them.
2. There is no legal requirement to do so unless you are going overseas or if you require them for your work.
3. Most people are scared of injections, so it is one thing to bring your child for vaccinations but when it comes to yourself, you cringe!

So hopefully, this post will deal with the issue of ignorance. And if you are scared of injections, maybe you should read my other post on "How to have a painless injection".

Click to Enlarge



What else would you like to know?

More about injections for the elderly, click here
More about vaccinations, click here

You can now use your Baby Bonus Card at the clinic!

Great News!

If you have been issued your Baby Bonus card from OCBC or Standard Chartered Bank, you can now use it at our clinic to pay for your Baby's medical expenses including vaccination packages.

My Interview on Adult Vaccinations in TODAY paper

I was interviewed on TODAY on the important vaccinations for adults.

The problem with adult vaccinations is that there is no compulsion to get them done and a lot of adults don't even know that certain vaccinations exist. For example, there is a new vaccine against Cervical Cancer which is recommended for girls between 9 to 26 years of age. But there is a general lack of awareness of such a vaccine.  Similarly, the Ministry of Health also recommends for the elderly to get vaccinated against pneumococcal disease and influenza. But again, there are a lot of elderly who do not get their vaccinations done.

Below is the article, please click on the image to read.

Quoted in Today Paper on Ear Wax

Reminder for parents whose kids might be having problems with Ear Wax.

Cholesterol lowering strategies of Cardiologists who love food!

Now when it comes to preventing heart attack, the Cardiologists are the experts. These are the guys who see people with clogged arteries day in and day out. So it goes without saying that of all people, they should know how to look after their arteries more than anyone else.

During my recent in-camp training, I managed to catch one such specialist buying a plate of bee hoon with a fried egg and a slice of luncheon meat for breakfast. So, naturally, I had to ask him: "Wha, you Cardiologist, eat like that ah? Not afraid of high cholesterol?". He casually told me that indeed his cholesterol levels were high and admitted that he couldn't help it since he LOVED food too much. BUT, he added, he was taking an anti-cholesterol pill which kept his LDL cholesterol levels well below the recommended levels.

Comon', we Doctors are human too. It is one thing to tell our patients what they should do. But when it comes down to things that make us happy, like food, one has to do what is practical. So although the Doctors can tell you what you should be doing in an ideal world, the real secret lies in how they behave themselves, right?

This is what we medical professionals advise our patients: In order to prevent heart disease, you have to:

1. Excercise 5 times a week at least half and hour of brisk walking each time.
2. Check your cholesterol levels and keep it under control.
3. Get rid of your belly fat
4. Stop smoking
5. Eat a healthy diet with lots of fruits and vegetables.
6. Reduce animal fats and oily foods like Tempura, well marbled beef, foie gras, ice-cream, desserts, Char Kway Teow, Hokkien Mee, KFC, Burgers.........
7. Make sure you manage your blood pressure and diabetes

Now compare that list to what the Cardiologists focus on for themselves:

1. Don't smoke
2. Eat all the good stuff but make sure your cholesterol levels are under control. If need be take a pill call a "statin"to lower cholesterol.

What does this tell you? It tells you the difference between the best thing to do and what is practical to do. It also highlights the importance of Cholesterol levels to the development of heart disease. So although all the other factors are important, the 2 things that are achievable and has the highest "benefit to sacrifice" ratio, is smoking and cholesterol.

In the past, we understood that high levels of cholesterol flowing through the blood vessels slowly start being deposited onto the walls of the artery forming plagues. As these plagues get larger, they reduce the area of the lumen (the hollow space in the artery) thus restricting blood flow to the heart. When the blood flow is severely restricted, the heart muscle is starved of blood and you get a heart attack.

So, lowering the cholesterol levels will lower your chances of developing these plagues.

But now the medical community also know that most heart attacks do not occur gradually. Instead, something happens to suddenly block the flow of blood. This occurs when a plague becomes unstable and suddenly ruptures, thus causing an instant blockage.

Here is where the "statins" come in. Not only do "statins" reduce the level of cholesterol in the blood, it has the added function of stablilizing the plague, thus preventing plague rupture. This explains why my friend the Cardiologist, monitors his blood cholesterol levels every 6 months and takes a "statin" to reduce his cholesterol levels to even lower than what is required, because when it comes to cholesterol, the lower the better.

So what should you do?

Well, if you are able to follow the first 7 points, then it is great for you. But if you can't because you love food too much and you don't have time to exercise even once a week, let alone 5 times a week, then, do what our Cardiologist friends do and stop smoking (if you are a smoker) and quickly go get your cholesterol levels checked!

To read my other posts on Cholesterol, please click here.

Disclaimer: This article is not meant to be a scientific dissertation, but merely to provide some off-the-cuff information for our readers. In doubt, please seek advise from your Doctor. Not all Cardiologists are like my two foodie friends. I am sure that most of them lead quite a healthy lifestyle.

My Interview with Straits Times on Home First Aid Kits

I was asked to comment about the necessity of having a well stocked First Aid Kit at home. I hope the article will be useful for you when you set up your own First Aid Kit.

Interviewed in Shape Magazine

Ever had burning questions you always wanted to ask you Doctor? Questions like how come Doctors can be fat? Or why is the clinic closed in the afternoon?

I was asked these series of questions and you can read some of my answers in the magazine article.

Click on the images to enlarge:


Cover Page

Karri Family Clinic: A CDMP-GP clinic for the Integrated Screening Programme

The Health Promotion Board has launched the Integrated Screening Programme (ISP) which encourages all Singaporeans aged 40 years and above who are previously well to be screened for the following diseases:

- Diabetes
- High Blood Pressure
- High Blood Cholesterol
- Obesity

And for Women specifically:

- Breast Cancer
- Cervical Cancer

If you are above 40 years old, you will receive an invitation letter to present yourself at any of the CDMP-GP clinics to have your screening tests done at a subsidized rate.

With your letter you can have your blood tests done for around $8 and the Pap Smear test is $10 and Mammography is $50. A normal consultation charge of $18 will still apply.

Karri Family Clinic is proud to support the integrated health screening programme and we look forward to be of service to you and your family.

New Baby Bonus Card: Submit your option forms by 30 June 2008

I realize that a lot of parents are still not very sure about the upcoming changes in the Baby Bonus Scheme. So here is a short post to let you know what is happening.

From 15 August 2008, parents wishing to make use of their Baby Bonus to pay for their child's medical bills can do it by simply using their Baby Bonus Card at our Clinic.

Two new banks have been appointed to take over the CDA accounts, viz OCBC and Standard Chartered. Parents can expect to earn higher interest at the new banks and also benefit from the more streamlined approach to paying their medical bills. Karri Family Clinic is an approved institution for the Baby Bonus and you will be able to use your new Baby Bonus Card at our Clinic like an ATM card using the NETS machine. The Baby Bonus Card may be used to pay all your medical bills at our clinic including vaccination packages, surgical procedures as well as the usual consultation and medications.

It is important to note that DBS will no longer be the managing agent for the CDA accounts as of 31 July 2008. Existing trustees of CDA accounts should have already been sent a kit which will include an option form for you to choose one of the two banks. The dateline for submission of this form is 30 June 2008. Once you have submitted the form, the bank will send you the Baby Bonus Card with the PIN number before August 2008. You will be able to use the card at our clinic from 15 August 2008.

If you do not submit the option form by 30 June, your CDA account will automatically be transferred randomly to one of the two banks by 7 August 2008. And you will need to apply for your Baby Bonus Cards from the appointed bank separately.

Parents of newborns after 1 June 2008 can open their accounts with one of the two new banks directly and you can use your Baby Bonus Card even if it is your first child. This would be most useful for paying for the vaccinations your baby will need.

So if you have not already done so, please submit your option forms by 30 June 2008.

We look forward to be of service to you.

For more information please visit the Baby Bonus Website by clicking here

You can read the press releases and FAQs here

Check out the OCBC Baby Bonus site

Dengue Rash: When do you suspect it is Dengue?

Day 3: Rash is resolving

This boy first came to the clinic on Tuesday with a widespread rash over the whole body. He had been treated with antibiotics for a sorethroat two weeks before and it was initially thought that the rash might have been due to antibiotics even though he had finished the course of antibiotics two weeks ago.


Day 2: Widespread rash with "islands of sparring"

The next day, the boy's rash got worse and you can see from the picture below how the rash covered almost the whole leg with just little areas of normal skin. This is known as a widespread rash with "islands of sparring" and is one of the ways a Dengue rash might look like.

A blood test was done which confirmed that the Dengue IgM was positive. This indicates that the child is having Dengue fever. However, the platelet count was still in the safe range, so the child is being managed at home but has to come to the clinic for daily blood tests to monitor the platelet count.

The child is otherwise quite active and the fever has subsided.

Parents can learn a few valuable lessons from this case:

1. Always seek medical attention if your child has a rash with fever.
2. Never assume a rash is due to antibiotics
3. Most Dengue cases can be managed at home and don't need hospitalization

For more info on Dengue click here

For my previous articles on Dengue please click here

Confirmed case of Dengue in our Area

We have just confirmed one case of Dengue in a patient from Blk 862A today. The child developed a rash all over the body which was initially thought to be due to an allergy. But blood tests eventually confirmed it to be due to Dengue.

Please be extra vigilant to check around your area for stagnant water and to take measures to prevent your family members from being bitten by the mosquitos.

More info on Dengue fever can be found here

Welcome TMAsia Life card holders!

We would like to extend a warm welcome to all TM Asia Life card holders!

We hope to be of service to you and your family!

We are open on Labour Day

Our clinic will be opened from 8.30am to 12.30pm this Labour Day.

Welcome Parkway Shenton Card Holders!

Our clinic now accepts Parkway Shenton Card Holders. We welcome you to the clinic and hope to be of service to you and your family.

Hand, Foot and Mouth Disease (HFMD) on the Rise

There has been a an increase in the number of HFMD cases this year so parents please be on the alert!

The Ministry of Health also reports that there is a higher circulation of the EV71 strain which is the strain of virus that caused the deaths of 2 young children in 2000/2001. The predominant strain is still the Coxsackie A16 virus which only causes a mild illness so the vast majority of children will make a full recovery.

HFMD is mild in most cases with the child developing fever, sore throat and red spots and blisters on the hands and feet and ulcers in the mouth. They just need to be isolated and most of them will recover fully. However in some rare instances, the illness can get very severe and affect the lungs, brain and heart.

The danger signs to look out for are:

- Drowsiness, disorientation, irritability and fits
- Severe Headache and neck stiffness
- Breathlessness or turning blue
- Dehydration

If you notice any of these signs, you must seek medical attention immediately.

More about what to do if your child has HFMD can be found in my previous post by clicking here

The MOH press release dated 8 Apr can be found here

New Season Flu Vaccination is Now Available!

We have just received our stock of Flu Vaccines.

This is the latest 2008 Southern Hemisphere strains.

Update on Dengue Fever

You have probably read in the news today an article about Dengue and also about the outbreak in Brazil. The article is actually talking about how we can be expecting an outbreak in around 3 years' time and how the government is preparing for it. So it is not a cause for panic although we should be still diligent about making sure that we do not allow mosquitoes to breed and also to be on a constant lookout for the symptoms that are consistent with Dengue.

According to NEA's dengue website, the number of cases we are seeing this year is around the same as this time last year and there is certainly no peak in the number of cases. In our clinic, we have not had any confirmed cases of Dengue recently.

There is also some good news ahead. The Straits Times reports that there will be a quick Dengue Test kit available to GP clinics in June. That will mean that it will be easier to detect Dengue earlier. Currently the available test kits can only detect Dengue after day 5 of the illness. The ability to detect Dengue fever earlier will mean that the NEA will be able to control the mosquito breeding grounds earlier to stem the spread of the illness.

Click here to read more on Dengue

Welcome Alliance Medinet - AXA & Great Eastern Cardholders

We would like to extend a warm welcome to all holders of Alliance Medinet: AXA and Great Eastern (Platinum and Gold) card holders.

We look forward to serve you and your family.

More information about our clinic can be found by clicking this link.

New Asthma Guidelines: Take the Online Asthma Test!

One of the big problems in treating asthma is that patients tend to underestimate the severity of their asthma.

For example: One mother came with her 5 year old asthmatic son and said that the child has been coughing at night maybe only twice a week. Obviously, she is under the impression that night coughs twice a week is considered mild and not action need to be taken. The fact is that night coughs are considered serious enough to warrant further evaluation if they occur more than twice per month!

So in this short post, I would like to outline for you the criteria for which you should be seeking medical help to manage your asthma.

With the latest innovations in asthma management, the bar for good asthma control has been raised. It is no longer good enough for you or your child to be able to survive on that blue puffer. The current criteria for good asthma control is defined as:

• No daytime symptoms (twice or less/week)
• No limitation of daily activities, including exercise
• No nocturnal symptoms or awakening because of asthma
• No need for reliever treatment (twice or less/week)
• No exacerbations
• Normal or near normal lung function results

From this you can see that the criteria for good asthma control is quite stringent! The good news is that with modern medications, it is possible to achieve good control of asthma.

Now there is a quick and simple way of determining if you need to see your doctor about your asthma. All you need to do is answer 5 simple questions and add up the score. They even have a special set of questions for your child.

You can take the test by visiting www.asthmacontrol.com

A score >= 20 means your asthma is well controlled and you can maintain or step down on your medication

A score of <20>means you will have to seek medical advise on how to control your asthma better


You can read the other Asthma posts HERE

Reference:
Clinical Practice Guidelines: Management of Asthma. MOH 1/2008

The Flu Situation in Hong Kong

Many parents have been asking me about the flu situation in Hong Kong in which 3 school children have died so far. As it is the school holidays, there are many who are heading to Hong Kong for holidays and want to know if they should vaccinate themselves against the flu.

MOH has a recent press release on the influenza situation in Hong Kong and Singapore. You can read it by clicking here.

Here is what I think are the important things to note:

1. The influenza season this year is no different from the previous years and the strains of influenza viruses are the usual ones and not the dreaded Bird Flu strain or SARS virus. We know the usual influenza strains can have severe effects on the young children, the elderly and those with chronic illnesses, so although the death of the children is tragic, it does not signal that we are dealing with a situation like SARS all over again.

2. There has not been any increase in the number of flu cases in Singapore and the ones that have been detected are the expected influenza strains. These are the Influenza Type A H3N2, H1N1 and also Type B strains. These are the strains that are covered by the latest Flu vaccinations. (Remember that Bird Flu is the H5N1 strain)

3. Influenza is a self limiting illness in the healthy adults, so there is no need to rush to get yourselves vaccinated. However, the MOH does advise that those who require vaccinations are

• Elderly persons above 65 years of age
• Children from 6 mths to 5 years of age
• Persons with heart, lung, kidney problems or diabetics
  
• Pregnant women in their 2nd and 3rd trimesters

4. The question that most parent pose now is "How long does it take for the vaccine to take effect?" Well the short answer is around 2 weeks. Bear in mind that even if the vaccination was given a few months before, the protection level is still only 70-80%. There is no hard and fast rule, but my advise would be that if you can avoid going to a place like Hong Kong where it is the peak flu season now, then don't go. If you have to go, there is no harm giving your child the influenza vaccine even if it is less than 2 weeks before your trip.

Click here to my previous post on Influenza

A few thoughts on Breastfeeding

The issue of breastfeeding vs bottle-feeding is really interesting. When I was a baby (so I am told), formula milk was touted as the ideal nutrition for babies. The addition stuff that was added into the milk was believed to enhance the baby's growth and well being. On top of that, it costs more to formula feed your baby, so there was also the issue of prestige involved.

Fast forward a few decades and the whole thinking has been reversed. Breast milk is now recognized as the better milk for babies. How we managed to come to the belief that Humans can create something better than what God has already provided, baffles me. It's almost like arguing that 3rd party spare parts are better than the original for your prized BMW.

Benefits of Breastfeeding

It is well recognized nowadays that breastfeeding confers many benefits for babies which includes:

1. Protective effects against illnesses like diarrhoea, lung and ear infections.

2. Protecting the child against the development of allergies like asthma, eczema and rhinitis.

3. Reducing the risk of obesity.

4. Some possibility that it may reduce the risk of developing diabetes.

5. Some link between the protective effect of breastfeeding and the development of certain cancers.

6. Better performance in tests of cognition.

7. Benefits to the mother like helping to reduce the mother to her pre-pregnancy weight as well as getting the uterus to return to its normal size. There is also evidence that breastfeeding also reduces the risk of breast cancer and perhaps ovarian cancer.

So how many mothers in Singapore actually breastfeed?

But the issue is not that mothers don't know about the benefits of breastfeeding. The majority do. But the problem is that a lot of mothers have (or think they have) an inability to produce adequate breast milk and also that most of them have to return to work after the maternity period which makes it difficult to continue breastfeeding.

In Singapore 95% of mothers actually do initiate breastfeeding, but at 2 months only 50% are still breastfeeding . By 6 months, this drops to only 21% which compares unfavorably with other developed countries like the US (33%) and Australia (45%).

Encourage Exclusive Breastfeeding for the first 6 months

Knowing the benefits of breastfeeding, the current drive is to encourage exclusive breastfeeding for the first 6 months of the infant's life. (This is the recommendation for healthy full term infants. The requirements for infants with special needs will need to to individualized)

For the first 6 months of life, healthy infants only need breastmilk and nothing else. There is no evidence that weaning the child at 4 months has any demonstrable benefits. Even after introducing complementary foods, the mother is encouraged to breastfeed the child until 12 months of age. Of course, if the child is not gaining weight appropriately while being exclusively breastfed, then medical help should be sought.

Do I need to give my baby extra water?

Another common question is whether babies need to be given extra water. The answer is no, not even in a hot climate like Singapore. Breast milk provides all the fluids needed in the first 6 months for the infant who is fed on demand. Giving the baby extra water may cause it to reduce its intake of milk and there is also a risk of water intoxication if too much is given. Babies who are ill or have diarrhoea will of course need medical attention.

OK, I want to Breastfeed, where can I find support?

So, you've decided to breastfeed your child? Great! You can find more information on support groups and other useful stuff at the Association for Breastfeeding Advocacy website.

Reference:

Dietary Guidelines for Children and Adolescents for the Healthcare Professional. Health Promotion Board 2007

Chinese New Year Opening Times

Happy Year of the Rat to all our Chinese readers!

Our Clinic will be opened till 2pm on the Eve of Chinese New Year and we will be closed on the first two days of the New Year. We will be opened as usual from Saturday 9th Feb.

Lady Doctor available for consultations on Friday Nights

We are happy to announce that we now have a lady doctor who will be available for consultation on Friday nights.

Dr Serene Ang started her education at CHIJ and Catholic Junior College before winning a Local Merit Scholarship to study Medicine at NUS. She went on to obtain her Masters Degree in Family Medicine in 1998. After leaving the public hospital system, she has been working as a Family Doctor since 1996. Dr Ang brings her experience in the areas of Women's Health, Dermatology and Paediatrics to Karri Family Clinic.

With her many years of experience, we are confident that your family will continue to receive the best care possible from Karri Family Clinic.