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

Conclusion

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.

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.

References:

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

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

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.

Conclusion

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.

Sunday Night Clinic

Our clinic is opened from 6.30pm to 10pm on Sunday nights for your convenience!

Can Diabetes be Prevented?

Diabetes is a devastating disease. Anyone who has a family member with diabetes will understand this. It takes a downward course and patients will need to keep increasing their medications as the get older. For some it might get so bad that they need to inject themselves with insulin daily. Uncontrolled diabetes will also lead to a host of other problems like heart disease, kidney disease, blindness and numbness and poor circulation in the legs which may eventually lead to an amputation.

The good news is that Diabetes can be preventable if spotted early. So the question is, how do I know if I am at risk of diabetes and how do I prevent it?

You are a candidate for Diabetes if you:

1. Are overweight ie your BMI is more than 25kg/m2 BMI = Weight in kg/(Height in m)(Height in m)
2. Have high blood pressure (>140/90mmHg)
3. Have a first degree relative with diabetes
4. Had diabetes during pregnancy
5. Have polycystic ovary disease
6. Have heart disease
7. Have Cholesterol problems
8. Have Impaired fasting glycaemia (IFG) or impaired glucose tolerance (IGT)

Now the important thing I want to look at today is the last point. IFG and IGT are conditions recognized as prediabetic conditions. That is to say, people with such conditions will go on to develop diabetes if nothing is done. IFG is defined has having a fasting blood glucose level of 6.1 to 7.0 mmol/l. Diabetes is defined as having a fasting blood glucose level greater than 7.0 mmol/l. So if you have done a screening test and the test results come back and you are told you have no diabetes, it means that your fasting glucose levels are below 7 mmol/l. BUT unless the results are explained to you by your doctor, you might have a level between 6.1-7.0 mmol/l which would be overlooked.

Why is IFG and IGT important?

There have been several studies that show that early intervention in people with IFG and IGT can prevent the development of diabetes! So there is a certain group of people out there in whom diabetes can be prevented but they still may not know about it!

So what do you do?

1. If you are above 40 years of age, then you should at least know your fasting glucose levels. It is easily checked by visiting your family doctor.

2. If you have any of the risk factors above, you should check your blood glucose level at least yearly to make sure that you spot the early signs of diabetes.

3. If you have already done a screening test, see if the fasting glucose levels are in the range of 6.1-7.0 mmol/l. If it is than go visit your family doctor immediately to get it properly assessed. You might just prevent yourself from developing Diabetes and a whole lifetime of medications and complications by doing so!

For more information on Diabetes Mellitus, please click here

A Diabetic's Checklist

A 60 year old man walked into my clinic the other day to get his diabetes medication. This was the first time I am seeing him. He said he was taking a certain type of medication for the last 5 years and this has not been changed.

So I went through some preliminary questions to see how well his diabetes is being controlled.

What was your last HbA1C reading?
He replied: "What is HbA1C?"
Ok, when was your last blood test done?
He replied: "Never had any blood test"
How is your fasting blood glucose levels?
He said the last time it was tested it was a bit high
When was the last time you did a Retinogram?
He said: "What's that?"

At the end of the consultation, I told him there was quite a few things he needed to do to manage his diabetes because it was clearly not under good control.

To which he replied: "I just want to take my usual medication, that's all I need"

I hope you are shocked, because if you are not, you should be.

Diabetes affects 8.2% of the Singaporean population. Uncontrolled diabetes will invariably lead to other more critical problems like heart disease, kidney disease, eye problems and may even cause legs to be amputated. This man was heading towards an inevitable fate and he does not even know it.

Diabetes is a disease that is best managed by the patient himself in consultation with his Family Doctor and may involve other paramedical persons like the podiatrist and dietician.

Since it is such a long topic and I don't want to bore you, I will just quickly distill the most important information so that if you know of anyone with diabetes, you can sort of tell if his condition is managed properly.

Things a Diabetic Patient needs to do:

1. Ensure his Fasting Blood Sugar is between 4.0-8.0 mmol/l.

2. The HbA1C needs to be done at least twice a year or more often if necessary. The HbA1C gives an indication of how well the blood glucose level has been controlled in the last 2 to 3 months. The levels should be between 4.5-7.0%

3. The Blood Pressure must be kept below 130/80mmHg and monitored every 3 months

4. The Cholesterol levels must be checked at least yearly to ensure that it is below 2.6mmol/l or 100mg/dL

5. The BMI should kept between 18.5-22.9kg/m2. ie, he should lose weight if he is too fat!

6. A Retinogram, which is a photograph of the retina (back of the eye), should be done yearly.

7. Urine and blood tests should be done at least yearly to screen for early kidney problems

8. The feet should be checked at least yearly to screen for early nerve deterioration.

Diabetes is a progressive disease. That means that diabetics will invariably have to keep increasing medications as they age. Uncontrolled diabetes coupled with high blood pressure and cholesterol is a recipe for disasters like heart attacks, strokes and kidney failure. On the other hand, all these problems can be avoided and the person can lead an almost normal life without suffering severe disabilities if it is managed well. So it is important to MANAGE the disease from the start rather than waiting till something goes wrong.

More information about diabetes can be found here.

ALERT! Hand, Foot and Mouth Disease reported in our area

I have been seeing quite a number of Hand, Foot and Mouth Disease cases in the last 2 days and I hope parents will take note of this. Some of these suspect cases only have ulcers at the back of the mouth without the spots on the hands and feet. These are strictly speaking not HFMD but a variant known as Herpengina. Both of these conditions are caused by the same Coxsakie Virus. If your child is complaining of a sore throat and fever, please consult your Family Doctor and don't allow them to attend school

Teenage Eating Disorders: Anorexia and Bulimia

There are three main types of eating disorders that affect mainly teenaged and younger females. They are Anorexia Nervosa, Bulimia Nervosa and Binge eating. We will focus on the first 2 conditions in this blog.

Since most patients with these conditions will fail to recognize that they have a problem, I hope that this article will help you recognize the condition in the people you know so that you can help them seek medical attention. Conditions such as Anorexia Nervosa can potentially be fatal. Remember Karen Carpenter who sang "Yesterday once more"? Her death in 1983 from Anorexia Nervosa was one of the key events that brought this disorder into the limelight.

So how do you tell if a person is suffering from these disorders?

Anorexia Nervosa

People suffering from Anorexia Nervosa have an obsessive desire to lose weight through dieting and fasting leading to extreme weight loss. The condition is easy to spot. They are usually teenaged girls who refuse to eat and lose a lot of weight over a short period of time. They look haggard and they skin becomes dry and scaly. They may also be obsessively excercising and counting their calories.

It is important to note that when these people look at themselves in the mirror, they DO NOT see a thin person. ie they have a distorted view of themselves.

Bulimia Nervosa

These people are harder to spot because though they want to lose weight they are less successful than those with Anorexia Nervosa. Rather then not eat, they will secretly binge eat lots of stuff, frequently desserts, and then try to lose all the extra calories by inducing a vomit, fasting or resorting to the use of laxatives or diuretics to effect weight loss.

Bulimia usually begins later than Anorexia and affects women from 17 to 25. (Remember Princess Diana?) You may be able to spot them because they may frequently excuse themselves to go to the bathroom after eating or they might eat lots of food but fail to gain weight. They may also be always trying to lose weight and excercising. Sometimes you may be able to see erosion of the skin at the base of their fingers because they would frequently stick their fingers into their mouths to induce vomiting.

Severe and repeated vomiting may lead to loss of electrolytes which can become a medical emergency.

How to manage these eating problems.

This is a primarily a behavioural and psychological problem and there are often problems in the family relationships like crisis, sexual and physical abuse, drug and alcohol abuse that may need to be addressed. Problems with self esteem in this age group often stem from lack of acceptance from friends. It may be that they are not accepted because of their being overweight.

The disorder thus needs to be managed by a multidiciplinary team comprising the doctor, behavioural expert and dietician. Severe anorexia is an emergency and the patient may need to be warded.

In Singapore, children below 19 with eating disorders may be referred to IMH while those above 19 can be referred to SGH which has a specialised clinic dealing specifically with the disorders discussed above.

More information on Anorexia and Bulimia can be found here

Reference: John Murtagh, Patient Education, Fourth Edition, McGraw-Hill Australia

Why you should Vaccinate against Chickenpox

This is one of the commonest comments from Parents:

I think it is better for my child to get Chickenpox. We all went through it and it is more natural that way!

Sound familiar?

But I have never heard a parent say something like,

I think it is better for my child to get Meningitis or

I think it is better for my child to get Polio.

I think the main reason is that most unlike Meningitis or Polio where there might be long term serious disabilities, most parents assume that Chickenpox has no long term effects on the child.

But is this assumption true and what are the facts?

The fact is that in most cases Chickenpox is a mild disease and most children recover without long lasting effects, BUT in some cases Chickenpox can cause long term disabilities and even death.

Why you should consider vaccinating your child:

A few points for you to think about:

1. There is a small chance that your child might develop serious complications like long term brain damage from chickenpox encephalitis (brain infection) or might even die from widespread chickenpox infection. An article published in the Singapore Medical Journal gives 8 cases of chickenpox complications. (Click Here) One child died, another was left with poor memory and behavioural changes. The rest although fully recovered, went through the illness with neurological problems such that they lost their sense of balance and there are also some who suffered from kidney problems during the length of the illness.

2. Consider the child pictured above who is one of my patients. He unfortunately had chicken pox as a baby and was left with a line of chicken pox marks on his face. You might think this is only a small thing, but he certainly was very sensitive about having his picture taken, which is why he tried to cover his face with his hand. The scars are having an impact on his sense of self esteem.

3. If the child has chickenpox, it would be a week long illness where the child will be uncomfortable and also infectious. Inevitably the people whom the child have contacted prior to the illness will start to panic and wonder if their own kids have contracted chickenpox. I even had one pregnant lady who was so worried that she would get chickenpox. If you vaccinate your child against chickenpox, then you really don't have to worry about these things.

4. In adulthood, chickenpox can be very severe with the lesions covering the entire body and face. If your child does not contract chickenpox as a child, he may still get it during adulthood.

Here is another common misconception:

Even if I vaccinate my child, he will still get Chickenpox!

If this were really the case, why would we even give Chickenpox vaccinations?

The fact is:

Children who have been vaccinated have a 75%-85% chance of protection against Chickenpox and the ones who still get it have a milder disease.

One of my patients asked me:

If I get vaccinated against Chickenpox, I will get Shingles later in life!

Quite the opposite is true! And this is another reason why you should consider vaccinating against Chickenpox.

Shingles, better known in Singapore as "Seh Zhua" (Snake) is a reactivation of the chickenpox virus when the immune system is weakened. When one suffers from an episode of chickenpox, some of the virus take up residence in the body and lie domant until something occurs to reactivate it.

When you vaccinate yourself or your child against chickenpox, you are essentially giving your body a deactivated virus which does not cause chickenpox, but is still recognized by the body as chickenpox. Thus the body's immune system arms itself against this particular virus and stores the information in memory. The next time when the body gets exposed to the real chickenpox virus, it mounts an effective response so that the chickenpox virus does not have any chance of replicating in the body and causing the chickenpox symptoms.

So if you never get chickenpox, you will not be harbouring the virus in your body and thus will not get Shingles later in life.

More information on Shingles may be found by clicking this

Conclusion

Chickenpox is a disease that can be avoided. There is no compelling reason NOT to vaccinate yourself or your children. So please consider the facts and make an informed decision on your family's health!

Chinese New Year Opening Times

We would like to wish every one a very Happy and Prosperous Year of the Pig! Remember to eat moderately and avoid Suckling Pig if your cholesterol is high (well at least try not to eat too much).

Our clinic will be closed on the 1st and 2nd day of the New Year and we will be opened half day on the 3rd. The opening times are as follows:

17 Feb Sat 8.30am to 12.30pm
18 Feb Sun Closed
19 Feb Mon Closed
20 Feb Tues 8.30am to 12.30pm
21 Feb Wed Business as usual

New Vaccine that protects Women against Cervical Cancer

There is good news in the fight against Cervical Cancer. A new vaccine has been recently launched in Singapore which is designed to reduce the risk of women developing Cervical Cancer significantly.

How does it work?

There is a virus called the Human Papillomavirus (HPV) that is spread through sexual contact. About 50% of sexually active females with become infected with the HPV in their lifetimes. It has been found that infection with the virus will predispose the person to develop Cervical Cancer later in life. So if you can prevent the person from getting the infection in the first place, you can prevent the development of Cervical Cancer.

How common is Cervical Cancer?

Over 490,000 cases of cervical cancer are diagnosed annually worldwide. Up till the introduction of this vaccine, the primary way of dealing with cervical cancer was to detect it early through regular Pap Smears. It is recommended that sexually active women have a Pap Smear at least once every 3 years. When Cervical Cancer is detected in the early stages, it is easily treated. Cervical Cancer can be life threatening when detected late.

How effective is this Vaccine?

There are many different strains of the HPV. This vaccine protects against two of the most common strains that cause 70% of Cervical Cancers. Aside from protecting against Cervical Cancer, the vaccine also protects against the development of Anal and Genital Warts.

Who should get the vaccine?

It is recommended that the vaccine be given to girls 9 to 26 years of age preferably before any sexual contact.

What is the schedule like?

The vaccine should be given at 0, 2 and 6 months.

Where can I get vaccinated?

You should be able to get this vaccination at your Family Doctor or Gynaecologist.

Conclusion

This is real breakthrough against one of the commonest cancers affecting women and its introduction should see the incidence of Cervical Cancer in woman reduced significantly.

Other Resources

Link to Vaccine website
Fact Sheet on Human Papilloma Virus
Link to News Article

My Baby Won't Stop Crying!

My two kids are now 7 and 4 so nowadays,the kind of prolonged crying is usually due to tantrums which are easy to handle, because I know that they are just being naughty. But when they were newborn it was very different. I was a young medical officer in the hospital undergoing training then, and did not know as much as I know now. So when my 1 month old son, James started crying incessantly, I panicked like any first time parent would.

What Crying Means

Before my son was born, I remember being worried about being a parent. It is not as if you go for courses to prepare for such a thing. I am the kind of person who would read through the instruction manual for my handphone before using it, so I was hoping my son would come with an instruction manual! But no, parenting is "on the job" training. By the time you get proficient at taking care of your newborn, they become toddlers and you start "on the job" training again. The skills you learn are only useful for your second child, which is why by the second child, when the pacifier drops on the ground, you simply rinse it instead of sterilizing it before sticking it back into the baby's mouth.

Anyway, I learnt that looking after a newborn is pretty straightforward. They only do five things. Eat, sleep, cry, pass motion/urine and breathe. So as a parent, you only need to learn how to feed, get them to sleep, pacify their crying, change their diapers and bathe them. Now, crying is the only way the baby communicates with the parent. And at that age, the baby only communicates a few things with you. So when the baby cries, he might be saying:

1. I'm hungry, feed me Mummy
2. Time to change my diaper
3. I am in pain eg teething and colic
4. I am lonely, play with me
5. I am sick

So if you always go through the checklist, you will find some reason for the crying and rectify the problem accordingly.

What is the normal crying pattern?

Up to about 6 weeks of age, the average baby would sleep and when awake will start crying or fussing. They might cry for about 3 hours a day. By about 6 weeks they begin to have periods where they will be awake without crying. By 6 months they will be able to smile and play with you.

Infant Colic (Crying on and on and on.......)

In the first 3 months of life, the baby may have prolonged periods (more than 3 hours) of incessant crying where a cause is not found. He may look like he has abdominal pain and draws his arms and legs towards the body and cries till he is red in the face. It is a distressing condition for most parents especially first time parents or even for 2nd time parents experiencing it for the first time.

It is important to make sure your child is not sick before assuming that he has infant colic. So measure their temperature and look out for signs that the child is sick, then go through the checklist of why the child is crying. If in doubt, always bring the child to the doctor for a proper assessment.

What to do after I have gone through the checklist?

Remember the "Rule of 5 Ss" by Paediatrician Harvey Karp who rediscovered the ancient techniques of soothing the baby:

1. Swaddling: Make sure you learn how to wrap baby up firmly
2. Side or Stomach: Lie your baby on the side or stomach
3. Shushing" as loud as they cry
4. Swing (Sway) them from Side to Side
5. Sucking: Use the Nee Tu (Pacifier) or Bottle

For more information on Infant Colic, please click here

Conclusion

Remember that most cases of infant colic only lasts for up to 3 months after which things get better. Once you ensure that the baby is not sick and that everything else on the checklist is covered, DON'T STRESS! Prolonged crying is not going to cause long term harm to the baby, despite what the older folks will say about the testes dissappearing if the baby is allowed to cry for too long. Our Chinese Culture does not look favourable upon a parent who does not try to stop the baby from crying, so aside from looking after the baby, we also have to please our family members and this adds to the stress levels. Just understand that it is not your fault that the baby has colic and there is not much else that can be done except to be patient and go through it!

Reference: John Murtagh: Patient Education 4th ed, McGraw Hill, 2005

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.