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:


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