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.

Clinic Hours during the Holidays

Our clinic will be closed from Hari Raya Haji, 20th Dec till Christmas Day, 25th Dec 2007. We will resume operations on 26th December as usual.

Happy Holidays!

Welcome MiB/MHC members!

A very warm welcome to holders of MHC-MiB cards!

We look forward to providing for the healthcare needs for your whole family! You can learn more about our clinic by clicking here

Other Health Benefits cards that we accept:

• Advantage Health Benefits
• CHS
• AIA
• GE Primecare
• Staffcare
  
• IHP
• AVIVA

Gout: Please be careful during the Festive Period!

It's the end of the year and the time for parties and feasting! I don't think I would be doing my duty as your Family Doctor if I d0 not gently remind our patients who may be suffering from gout to remember to eat in moderation as all that rich food and alcohol may just trigger another gout attack!

What is gout?

Gout is one of the oldest disorders known to humans. Those suffering from gout may console themselves that they are in the same company as some of the greatest men in history, namely Alexander the Great, Kublai Khan, Michelangelo, Martin Luther, Isaac Newton and Henry VIII.

Gout occurs because of the build up of uric acid crystals accumulating in the joints, usually of the big toe, the hands and some other large joints. Uric acid is a by-product of purines (a protein) and it is the kidney's job to get rid of excess uric acid by passing it out through the urine. If you suffer from gout and there is an excessive overload of uric acid in the blood which the kidneys cannot get rid of fast enough, uric acid crystals will start to form which are then deposited in the joints. And that is when you limp into the clinic with excruciating pain.

Who gets gout?

Like many diseases, it is hard to say who will or will not get gout. But there are a few factors which puts you on a higher risk of developing the disease. It seems to run in families and occurs more often in men then women. It is also associated with obesity and high blood pressure. Just because you indulge in rich food and alcohol does NOT necessarily mean that you are going to develop gout. However, if you do suffer from gout, then the rich food and alcohol may trigger another attack.

What are the triggers?

1. Purine rich foods:

• Red meat and organ meats like liver, kidneys (ie Kway Chap, Pate, Foie Gras)
• Shellfish eg scallops, cockles, prawns, crabs
  
• Tinned Fish eg sardines, ikan bilis, herrings
• Legumes eg dried beans, peas
• Meat extracts and gravies eg Bovril
  

2. Alcohol

3. Medications eg Diuretics

4. Trauma: Injuries, surgery or starvation

What should I do?

During an acute attack, you should rest in bed with a cold compress. Your GP can also prescribe some painkillers or even give you an injection if the pain is severe.

For most people gout occurs occasionally. So aside from eating purine rich food in moderation, there is no need for regular medications. Weight loss and drinking lots of water do help to prevent attacks. However, if you suffer from several attacks every year, you should ask your doctor about preventive medications. Repeated gout attacks can affect the joints in the long term.

A word on Tofu

There is a little bit of confusion over whether people who suffer from gout should take tofu or not. Beans are moderately high in purines but one study has suggested that though tofu does raise the uric acid levels a little, the effects are negligible.(1) Based on the finding, my opinion is that tofu may be a suitable protein alternative between attacks, but is best still avoided during an acute attack.

1. Yamakita J., et al. (1998). Effect of tofu (beancurd) ingestion and on uric acid metabolism in healthy and gouty subjects. Adv Exp Med Biol, 431, 839-42.

Reference:
Murtagh, Patient Education 4th Edition, McGraw Hill Press

Happy Deepavali!

Here's wishing our Hindu friends a very Happy Deepavali!

Please note that the clinic will be closed on during the Deepavali Holiday on 8 Nov 2007.

Recommended Vaccinations for the Elderly

Singapore has a very effective vaccination program for our children and most parents are very diligent about vaccinating their kids. However, when it comes to the elderly, there is much room for improvement. I hope this article will encourage you all to get your parents and grandparents to the GP to get their vaccinations done.

The elderly, especially those with chronic diseases like diabetes, asthma or other medical conditions do benefit a lot from vaccinations. It is a fact that influenza and pneumonia are the leading causes of death in the elderly. These diseases can be prevented by giving a simple vaccination.

So what are the recommended vaccinations for the elderly?

1. Influenza Vaccine

The "Flu" vaccine is giving yearly and is useful for preventing the "Flu" which often leads to lung infections and eventual hospitalization. It is recommended for all adults above 50 years old or adults of any age with medical problems.

More info HERE

2. Pneumoccal Vaccine

This vaccination is recommended for those above above 65 years of age or adults of any age with medical problems. It is useful to prevent the elderly from developing lung infection (pneumonia). A second dose is given after five years for people with medical problems or if the first dose was given before the age of 65.

More info HERE

New Vaccine against Herpes Zoster to be released soon!

Perhaps you know of someone who had Herpes Zoster or what is commonly called "Seh Zhua" (Appearance of the Snake). It is a painful condition that affects the skin in a certain part of the body and even when the condition subsides, patients can be left with constant pain (post herpetic neuralgia). The Good News is that there is a new vaccine which has been approved which should be available soon in Singapore. It is recommended for adults above 60 years of age and only one dose is needed. I will write more about Herpes Zoster when the vaccine becomes available.

Conclusion

If you have elderly living in your household, do encourage them to visit the GP to get their vaccinations done. These vaccinations are recommended for the HEALTHY elderly but especially so for those who have medical problems. Remember that vaccinations are potential life savers!

Reference: The Singapore Family Physician Vol 33 (3) July-Sep 2007 "Value of Vaccination"

Selamat Hari Raya Aidil Fitri!

Wishing all our Muslim patients a Selamat Hari Raya!

Our clinic will remain open this weekend as usual in case you need medical attention.

Health Screening Packages: No Later! Later!

By now everyone should be familiar with the Health Promotion Board's ad campaign where the man keeps saying "Later! Later!". The take home message being that when it comes to your Health, you should be more diligent and not leave it till later.

Just as your car needs regular maintenance, you also need regular check ups especially as you get older. Chronic diseases like hypertension, diabetes and high cholesterol can creep up on you without your knowing and early prevention can save you from developing diseases like heart attack and strokes later in life.

In my opinion, health screening is best done in consultation with your GP who can tailor the package to your needs. Doing a "blanket" screening with everything thrown in is not helpful. For example, if you are a young and relatively fit individual, all you need may be to have your blood pressure and cholesterol checked. Doing a Lung Spirometry test if there is no breathing difficulty or history of asthma is really not necessary. Whereas if you are older and have a history of hypertension, diabetes and a family history of heart attacks, then an Excercise Stress Test may be what you require. So the bottomline is this: Work with your GP to tailor a Health Screening Package to your needs!

Our clinic offers different health screening packages depending on your needs. These are basic packages from which we can add on different other tests if required. Do drop in if you have any questions regarding your need for a health checkup.

Remember, don't leave it till "Later! Later!"



Click Image to Enlarge

Immunization Packages

Please Click to Enlarge

Our Pneumococcal Packages work out to be $135 nett per injection and can be purchased through the Baby Bonus.

Wow Doc, these Traditional Pills really work!

Just the other day a young lady asked me this question:

Hey Doc, I have been taking these pills from the Philippines and it really works! I lost 5 kg over the last month! BUT, my heart has been beating really fast and I sometimes get a headache. Do you think it is safe? They only cost me six dollars!

Let me answer the question indirectly by highlighting this recent report by the Health Science Authority concerning adverse reactions to traditional medicines.

You all may be aware of the drug called Viagara right? Viagara is the trade name the drug sildenafil. It acts by dilating the blood vessels in the penis and is useful in men with problems with sustaining an erection.

Well, the HSA reported that two illegal "traditional" herbal remedies were found to contain sildenafil. The first one was unabashed about what its capsule could potentially do for its customers. It was called "Santi Bovine Penis Erecting Capsule". (Bovine=Bull) With 32mg of sildenafil per capsule (Viagara has 50mg), it is no wonder that this "Herbal" medication could produce a Bovine sized result. The second was "Urat Madu" which contain 48mg of sildenafil. Both of these medications were reported to have caused eye problems in their unsuspecting users.

There was another drug called "Asam Urat Flu Tulang" which was used as a pain killer. One young female patient was reported to develop drug reaction to the capsule. The lab tests reveal that the capsules contained diclofenac (a commonly prescribed painkiller), dexamethasone (a steroid) and paracetamol. Little wonder it works!

The Bottom Line

Sometimes a particular herbal medication works because the medication has been spiked with known western medications. The problem is that there is poor quality control in the production of the pills so you will never know what will happen to you because of impurities. The other problem is that if you take a "Herbal" medication thinking that just because it is "Herbal" and it cannot harm you, then you might be in for a rude shock.

So my advise is to make sure you know what you are taking and don't fall for something that is both "cheap" and "effective" and can only be bought from certain obscure sources. It might cost you more than you think.

Source: Adverse Drug Reaction News, HSA, Aug 2007 Vol 9 No. 2 Pg 8

Want a Painless injection? Cough!

If there is one thing that most people fear most about seeing the Doctor, it is the possibility of getting an injection. So great is the fear, especially in kids, that parents sometimes use it as a threat to get their kids to behave themselves in the clinic.

A lot of the pain is psychological and stems from the fear itself. I sometimes give myself an injection when I feel really sick. At first it was very difficult because we have a built in mechanism that makes it difficult to inflict pain on oneself. But after you get over the psychological barrier, it is actually quite painless.

So the first thing about having a painless injection is to overcome the psychological barrier itself. This is easier said than done. Thankfully, there are other techniques that can help.

1. Cough

Surprised? I certainly was when I watched this on "Brainiac" last night. This discovery may make the fear of needles a thing of the past! The latest study published in the British Medical Journal found that the pain of injection is significantly reduced when the patient coughs hard at the time of the injection. It is thought that coughing increases blood pressure which in turn reduces the perception of pain. Not convinced? Try getting a friend to pinch your arm. Then ask him to do it again, but this time cough hard. Can you feel the difference? Link to BMJ article

2. Local Anaesthetics

This works very well for kids. The only drawback is that the anaesthetic cream is applied and you have to wait for half an hour to an hour before the skin becomes numb. Works well especially if their eyes are also covered at the same time so that they can't see what is going on.

3. Distraction

This was the old method I used before I discovered the cough method. Essentially, I tell patients to relax and think of their favourite things or simply tell them something startling, for example, that there is a Gorilla standing behind them. Works pretty well, but the mother-in-law standing behind them may not be very happy being called a Gorilla. But you get the idea. The other way to distract is to pinch or tap the skin just prior to the injection. By the time the injection goes into the skin, the skin is still processing information about the tapping, so the pain information going to the brain from the needle has to contend with a narrow bandwidth, ie a traffic jam, so to speak.

Conclusion

The fear of injections is a thing of the past! Next time you need to get a jab, cough hard when the injection goes in. But please warn the Doctor first because he might miss the spot if you suddenly start jerking your body about!

Help Doc! My Baby's Belly Button Sticks out!

Umbilical Hernia in a 8 week old Baby

Many parents get very anxious when they see a protruding belly button in their newborn babies. I guess all parents want their babies to come out perfect and when there is something not quite right we get rather anxious, especially so for first time parents.

There is a funny little story told about the difference between the first time, second time and third time parents. The story goes like this....

With the first baby, when the pacifier drops onto the floor, the parent picks it up, washes it with baby safe dishwashing liquid, pops it in the sterilizer before giving it back to the baby. With the second child, the parent picks it up, rinses it under the tap and pops it back in the baby's mouth. By the time they have their third child, they simply pick it up, pop it into their own mouths and gives it to the baby.

This story brings home one very important point and that is that knowledge and experience empowers. So for the first child, parents are very careful about everything because they don't know enough. By the third child, parents have enough knowledge and experience to be able to discern what is important and what's not.

Another way to get knowledge and experience is to learn about it from other people which is why you are reading this blog.

Anyway this baby first came to the clinic at 8 weeks of age with a protruding Belly Button. This is a condition known as an Umbilical Hernia. What happens is that there is a small defect in the muscle wall that allows some of the intestines to pop out, thus forming the hernia.

Umbilical Hernias are very common. As the baby grows, the defect in the muscle wall gets smaller and by 12 months, most hernias would disappear. Larger hernias may take longer to disappear. If by the age of 4 the hernia is still present, then a minor operation may be required to fix the defect in the muscle wall.

There is a small chance that the bowels in the hernia gets stuck so that the contents of the hernia cannot be pushed back into the abdomen. When that happens, the baby needs to be seen by a doctor straightaway. Thankfully, such cases are not common.


Umbilical Hernia in same Baby now 3 months old

As you can see from these 2 pictures that were taken 1 month apart, the hernia is already noticeably smaller. The baby's parents are obviously relieved and happy.

Conclusion

Umbilical hernias are very common and most will resolve by themselves. There is no need to do anything unless they persist past 4 years of age.

Reference:

Murtagh, Patient Education 4th Ed, McGraw Hill Companies, 2005

Latest Update:

I saw the baby again and now the belly button is normal!

Our Clinic accepts IHP, AIA mediguard, CHS, AVIVA Card holders

Our Clinic welcomes IHP, AIA Mediguard, CHS and AVIVA Card Holders.

Schizophrenia: It's NOT about Split Personalities

I had one patient who came into the clinic behaving rather "Siow" (mad). She believed that the CIA was after her because she had some secret information that would reveal something about the PAP which will cause the ultimate collapse of the government. The patient was a homemaker. She claims the CIA were waiting for her outside the clinic to nab her and I had to help her or else this information will be lost forever. We got her husband to bring her to IMH where she was treated with an anti-psychotic drug. A few months later, she stopped having such delusions. She has been well since and has returned to work. (The details have been altered to protect the identity of the patient)

Schizophrenia is often misconstrued as having a split personality like the classic Dr Jekyll and Mr Hyde. As you can see from the story above, it is anything but that. A more accurate portrayal of Schizophrenia would be the character of the great economist, John Nash played Russell Crowe in the movie "A Beautiful Mind". In that movie, John Nash was under the delusion that he is part of a group of elite scientist on a mission to decode the German cryptic communications .

Rather then thinking of Schizophrenia as one person with 2 different personalities, it is perhaps better to think of Schizophrenia as a person who has his feet in different realities. It may be akin to a person who is so immersed in the Virtual Universe of "2nd life" or other forms of role-playing games, that the online persona is as real as the real world outside.

Who does it affect

It tends to occur in both men and women from ages 15 to 25 and 1 in 100 people will have it to some degree. It tends to run in families.

How do I tell if my friend may be Schizophrenic?

There are 4 features to look out for:

1. Hallucinations and Delusions: When I was working with the recalcitrant Schizophrenics in Australia, a lot of the women there thought they were the Virgin Mary. The men thought they were Jesus. One day one "Jesus" met another one who also claimed to be "Jesus". Now they worked out that both of them can't be "Jesus" so one managed to persuade the other one that he was the real "Jesus" and the other fella was his most trusted disciple "Peter". The both of them then went about happily preaching to the rest. I never really found out what happened with "Jesus" met his mother, the Virgin Mary.

2. Periods of Low Activity: Sometimes in between periods of Hallucinations and Delusion, they sufferer may under go periods where they are flat. They don't talk much, don't have much motivation to do anything and don't express their emotions.

3. Disorganized speech and thinking: This is one of the key aspect of Schizophrenia. You might have come across "Siow" people who come up to you to beg for money while you are having a meal at a coffeeshop. They either talk to themselves a lot or when they talk to you it is hard to follow their train of thought.

4. Grossly Disorganized Behaviour: Again you will also be familiar when these "Siow" people exhibit bizarre behaviours like scolding an invisible person, exposing themselves or other "silly" and socially unacceptable behaviour.

What all this means for you, the sane person?

It must be emphasized that Schizophrenia can be treated and the patient can actually live a normal life again! I think a lot of people have the misconception that once you became insane, you are basically a "gone case" for the rest of your life. So if you spot any of the behaviors in your friend or family members, do seek help early.

What you can do

For Early Psycosis

There is a Early Psychosis Intervention Program which you can receive help from a multidisciplinary team of Drs, psychologist, social worker etc. The website is at www.epip.org.sg
In doubt, bring your friend to see your Family Doctor for the initial assessment who can even start some simple medications before referring you to the EPIP.

For Acute Cases

For cases where the sufferer is likely to 1. Harm others, 2. Harm himself or suicidal or 3. The behavior is severely disorganized, the person should be sent to the hospital for to be hospitalized. Any of the major hospitals should be able to handle the problem.

The Mental Disorders and Treatment Act

This act gives the power to a medical officer to admit and detain the person for a period of 72 hours.

Can Schizophrenia be cured?

One third of cases have favorable outcomes. One third have intermittent relapse of their symptoms and the rest remain chronically disabled despite treatment.

More information can be found at the EPIP website