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