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.

Help Doc! I missed my Pill today, What should I do?i

OK, now this is what you do:

Remember the rule of 7s:

1. Always take the forgotten pill once you realize that you forgotten to do it. Do this even if it means you have to take 2 pills at a go.

2. Then take the next pill at the usual time.

3. If you missed your pill by more than 12 hours, then you should assume you may be able to get pregnant and use another form of contraception for the next 7 days.

4. If the 7 days run beyond the last hormone pill in the pack, then you should just continue with the next pack immediately without a break. Ie you will miss the menstrual period that month.

Is Wagyu Beef really Healthy?

Wagyu Beef is quickly gaining popularity amongst beef lovers in Singapore and around the globe because of its unsurpassed marbling and tenderness. When I first heard of this marbled beef, my Doctor half thought "Oh oh! So much fat! Its got to be bad for your heart!" while my Foodie half rebutted "Hey, that's got to be the shiokest, tenderest beef steak!". Imagine my joy when I read on the Internet that Wagyu was also higher in monounsaturated fats than normal beef and that it was healthy! As you know, monosaturated fats eg olive oil (which melts at a lower temperature) are better for your heart then saturated fats, eg butter.

My initial reaction was: "Rejoice! Rejoice! Now I can have my beef steak AND lower my cholesterol levels at the same time!"

But the cynic in me just could not accept this without reservations. So I began to do some research. Sad to say that the medical community has not really gotten wind of the fact that Wagyu beef is lower in monosaturated fats yet (maybe they are all too busy avoiding beef and staying healthy) so a casual search of the usual medical sites revealed no official position on Wagyu Beef.

When you look at the information from Wagyu Beef Suppliers, they will tell you that Wagyu is high in monounsaturated fats and with the ratio of monounsaturated to saturated fats of 2:1.(1) Then they go on to tell how a diet high in monounsaturated fats can lower your bad cholesterol levels. Although it seem to be the logical conclusion, one needs to be careful to and look at the whole picture before starting to eat chunks of Wagyu beef thinking that you are doing your heart a favour! Bear in mind that even though there is more monounsaturated fats in Wagyu, there is still that 30% of saturated fats! And since Wagyu is so well marbled, you are taking in a lot more fat than a normal beef steak.

So real question is: "Does eating Wagyu really lead to lower cholesterol levels, compared to eating normal Beef?". As far as I can tell, there is not enough data (available to me) to form a conclusion. I did managed to find one article (2) that addresses this issue, but it was a research paper funded by a beef supplier AND it was only done in a small population of people, so the results have to be taken with a grain of salt.

In this experiment, they had 2 groups of people with high cholesterol levels and they fed one group with lean Wagyu beef (lean but still higher in monounsaturated fats) and another group with normal US choice beef. They measured their cholesterol levels before and after 6 weeks of eating the beef. At the end of the trial, one of the conclusions was that there was no difference in the cholesterol levels of the group eating lean Wagyu compared with the group eating normal beef.(2) So it appears that Wagyu may not confer the benefits of lowering cholesterol compared to normal beef as assumed.

Even if the Wagyu does really lower cholesterol levels, there are still other ill effects of red meat that needs to be considered. There is some evidence that high consumption of red meats can lead to colon cancer. (3) Eating too much fat will also lead to obesity and consequently cause other health problems.

Conclusion

Wagyu beef suppliers would like you to assume that Wagyu is healthy because it contains more monounsaturated fats than normal beef. At this point in time, it is only an assumption and has yet to be proven. If you are suffering from high cholesterol, it is still better for you to eat fish (eg, Salmon, mackeral, sardines) which is high in Omega 3 fatty acids (3) rather then a Wagyu Steak. There is just not enough evidence to advise people to eat more Wagyu beef in order to lower cholesterol levels. Oh how I wish there was! That would be a piece of dietary advise that would be easy for a lot of people to swallow.

To read my other blog on Wagyu Beef, please click here

References:

1. Link to Wagyu article

2. Increased Beef Consumption Increases Apolipoprotein A-I but Not Serum Cholesterol of Mildly Hypercholesterolemic Men with Different Levels of Habitual Beef Intake

3. Fats and Cholesterol - The Good, The Bad, and The Healthy Diet

Doctor, Is my child Hyperactive?

"Doctor, my son is always running around and can't seem to sit still. Is he hyperactive?"

When my son was younger, he was very active and could never sit still. He would constantly be playing with toys or disturbing his friends at nursery and is always "up to something". In fact he seemed to always need stimulation. So some of my friends (from a non-medical background) proclaimed him to have ADHD (Attention Deficit Hyperactivity Disorder). I never believed them. Afterall I was the Doctor and here you have laypeople trying to tell me about health conditions? (Happens all the time, and the main culprit is my mother who still insists and telling me what to do when I fall ill, Bless her heart!)

The fact is that my son is able to sit through a whole episode of "Ultraman" completely glued to the TV. He won't move until the part when Ultraman's warning light starts beeping and when everything looks bleak, he summons up all his strenght, shoots his Killer Beam and obliterates the Monster. Then, when the credits begin to roll, he would start running around again.

Last year in Primary one, he did initially have some problems fidgeting in class and constantly disturbing his friends, but he managed to end the year with an acceptable result and even earned a certificate for best improved student. Now in Primary two, he still gets into trouble every now and but now no one would say he has ADHD anymore.

My son is active, but he does NOT have ADHD.

How common is ADHD?

As many as 40% of prescholers may be excessively active and considered to have a short attention span but only 1 in 20-30 will eventually be diagnosed as having ADHD. It is a condition more common in boys (about 6 times more common). It can present as early as infancy and seldom appears after the age of seven.

How do you recognize ADHD?

There 3 main features:

1. Inattention: This is difficulty in concentrating, following directions and forgetting instructions. If your child is able to sit down with you for 10-15 mins when you read a story or if he is able (like my son) to be glued to the TV or computer game for an extended period of time, then he probably does not have this problem even though he may seem to get distracted easily.

2. Excessive activity: Fidgeting and restless and never seems to be able to sit still. We Teochew like to say their Kah Cherng Seh Tang (Worms infesting the Backside). A child may still have ADHD even if he is not excessively active.

3. Impulsiveness: In preschoolers this may be expressed as being easily excitable, having temper tantrums, excessive crying and a tendancy to just do "stupid things" like grabbing a hot cup of Kopi or punching a strange dog. Older children may have problems completing tasks, taking turns and doing things without considering the consequences. My son for instance had a heightened sense of danger and did not take to the slides at Wild Wild Wet until much older, so he can't be said to display impulsive behavior.

Some additional considerations:

1. The symptoms must appear in at least 2 situations, eg home and school

2. The symptoms usually appear before the age of 7

3. It is important not to wrongly label the child as having ADHD because it will cause unnecessary emotional distress for the child and the family! Not all children who are inattentive, overly active and impulsive have ADHD, the symptoms must be more severe then their peers and last at least for 6 months

4. Some kids who are very bright may seem to be inattentive. But when you check their work you may realise that they have completed their tasksare looking for other things to do!

What you should do

1. If your child is a preschooler, it is useful to look at how they react in a group of their peers. If they have ADHD, their characteristics of impulsiveness, inattentiveness and inattention will be much more evident then their peers.

2. If you do find that their attention span is much shorter then their peers or that their inability to sit still is very much worse than their friends, you may want to consider having him assessed by your family doctor who may then refer the child to a child psychiatrist.

3. Even if your child does not have ADHD, it is important to always protect their self esteem and praise them for positive behaviour. When asking them to do certain tasks, be very clear and reinforce the rules frequently. It helps to get their attention when talking to them by making sure they are looking at you when you talk to them. Always make sure they understand what you want them to do.

This is just a short blog to help parents recognize if their kids have ADHD. For more information on medications and therapy, please click here

Infertility: When you should see your Doctor

"Doc, we've been trying for a baby for 2 years now, is it time for us to do some investigations?

The problem with infertility in Singapore is common. I am sure everyone knows of some couple who have been having difficulties trying to conceive. The subject is sometimes a bit of a taboo and it's one of those "What I really want to know but am too embarassed to ask the Doctor" kind of questions.

First of all let's look at some numbers:

• 1 in 10 couples experience infertility at some stage of their lives
• 60-70% achieve pregancy after 6 months of unprotected sex
• 80% conceive after 1 year
• 90% after 2 years

Bear in mind that fertility rates start dropping after the age of 35. So the older you get, the harder it is to conceive.

So we advise that most couples might want to seek professional help after trying for 2 years or sooner if the lady is above 35 years of age.

How do I get pregnant?

Now, it may be quite obvious to most people, but I have come across couples who have been "trying" to conceive for some time who after some questioning admitted that they are only having sex once every 3 months because of their work involved lots of travelling. So, the first thing if you want to have a baby is that you need to have sex AND you need to do it as frequently as 2 - 3 times a week.

The woman releases one egg (commonly) per menstrual cycle and the egg is released at around day 14 of a 28 day cycle. So the most fertile period is the few days before and after day 14. Day 14 is the 14th day after the first day of menses. When the eggs are being released, the body temperature may rise a little and there is more vaginal discharge, some women may even experience abdominal pain.

It is good to make sure that the man takes some measures to optimise their sperm quality and sperm count. One thing to note is that it takes about 3 days to get maximal sperm count so one thing would be fathers can to is to abstain from ejaculating for 3 days. There are some other factors you might want to note which are discussed in an earlier Blog.

NOTE: Even if everything is working and you do it at the right time, your chances of conceiving is still only about 20%!

3 essential things need to happen

1. The right number of healthy sperms need to be at the right place at the right time.
2. The egg must be released
   
3. The fallopian tubes must not be blocked so that the sperm and egg can meet and subsequently be implanted in the uterus

What can go wrong?

The Major causes of Infertility are:

1. Semen quality - 40%
2. Ovulatory disorders - 30%
3. Tubal problems - 30%

These are the main causes. But other less common conditions may also cause problems. For instance, the couple may have problems having sex eg impotence. Psychological factors such as stress and anxiety also play a role which is why (it is commonly said) that most pregnancies occur when the couple goes on holidays.

What you should do

If you and your spouse have been trying for 2 years and have not conceived, then there are few simple things that your Family Doctor can do for you before you visit the specialist.

For the Men

This is probably the simplest first step because it is easy to demonstrate if the sperms are viable by collecting a semen sample and sending it to the lab. If the semen is normal than we immediately know that the problem lies with the lady.

Sometimes certain drugs taken for things like high blood pressure can cause impotence and this may be the cause of the failure to conceive. A physical examination may also reveal if there is anything wrong with the testes or the penis.

For the Women

There are some simple things that can be done first by your Family Doctor. First thing is to find out if there is monthly ovulation. This can be done by taking note of the history and nature of periods. If the periods are irregular, blood tests can be done to determine if there are any hormonal problems. Sometimes, infection of the cervix can cause infertility and this is easily treated with antibiotics. I had one patient who had hypothyroidism who became pregnant when she started taking thyroid medications! If it is demonstrated that there is a failure to ovulate, then the family doctor may prescribe some oral medications to stimulate ovulation.

After the initial batch of tests, if no cause if found then the lady will need to be referred to more specialized imaging tests to look at problems such as blockage of the tubes or abnormalities in the uterus.

Conclusion

Currently, about 60% of couples who seek specialised medical help will conceive. In 10%-20% of infertile couples, all the tests will fail to demonstrate a reason for the infertility ie the Doctors don't know why they can't conceive. However, please don't ever lose hope. I have come across many couples who have been trying for years and have gone through many fertility programs without success but who fall pregnant once they simply stopped trying too hard! There is always hope as long as lady has not reached menopause.

If you like more information, please click here.

Is Aspartame (Nutrasweet) safe?

One reader recently asked me to comment on an article that alleges that Aspartame is a toxic chemical that can cause a variety of health problems.

You can click here to see the article.

There is a very short answer to this question.

The official stance of the AVA, the agency who is responsible for food safety in Singapore, is that Aspartame has been shown to be safe for ingestion for the the general public.

However, there are a minority of people who should not be taking aspartame. They are:

1. People with phenylketonuria - a genetic disease.

2. People with advanced liver disease

3 Pregnant women with high levels of phenylalanine in the blood.

Now if you don't recognize any of these terms it just means you probably don't fall into any of the categories above.

The official position of the AVA can be found here

Just one thing you need to bear in mind. This position is based on information known at this point in time. It could be proven wrong in the future. Take the issue of hormone replacement for menopausal women for instance. For many years, the experts advocated the use of hormonal drugs for menopausal women, but that position shifted when information from new research demonstrated that it may not be as safe as what they initially thought.

So the fact is Medicine is Evolving and all we can do is to base our beliefs on the latest information available.

One last piece of advise. You can't trust everything you read on the internet. And when you come across an article like the one above, please don't circulate it to all your friends before checking if the information is accurate. The most recent one I came across was one my friend sent to me on the hazards of microwaving plastic container. It turned out to be a hoax!

How to increase your HDL (good) Cholesterol

In the previous blog, we discussed about how to lower LDL which is essentially through dieting. In this blog, we will discuss ways of increasing HDL levels.

If you remember, HDL is the good cholesterol which carries the excess cholesterol in the blood and brings it back to the liver.




Here are the ways to increase HDL levels

Excercise

But we are talking aerobic excercises ie excercise until you really start panting and sweating for at least 30 mins on most days of the week. Taking a stroll in the garden for 10 minutes is not that helpful but still better then nothing. If you have heart problems, you will need to check with your doctor before you start doing strenuous excercises.

Lose Weight

Easier said than done but shedding a few kilos will increase your HDL levels.

Stop Smoking

Aside from lowering HDL levels, smoking also increases the tendency for your blood to clot as well as a host of other problems. The problem with most people is NOT that they don't know the ills of smoking, but they are unwilling to stop because they know it is difficult. It is probably the best thing you can do for yourself, your family and your wallet.

Reduce your intake of Trans Fats

Trans fats are formed when vegetable oils are hydrogenated to make them last longer and turn them into semi solid form eg margarine. Reducing your intake of Trans Fats will decrease your LDL and increase your HDL levels. You can read more about trans fats here

Increase your intake of Good Oils

Canola Oil, Avocado Oil and Olive Oils can help increase HDL levels. When buying oil for cooking at home, avoid "pure vegetable oils" because they just mean oil from a vegetable source. Instead, go for pure Canola Oil. I find Olive Oil does not complement Chinese cooking, but it is good to use good quality Olive Oils for your salads instead of Mayonnaise or other creamy salad dressings.

Alcohol or Not?

This one is controversial because it has been shown that a small amount of alcohol can raise HDL levels but too much will cause other alcohol related problems! People always say drink in moderation, but one man's moderation is another man's excess!! So when we say moderation, we mean one glass of wine 3 or 4 times a week or its equivalent. I think for some people this would be the easiest one to suggest!

Increase your intake of soluble fiber

Foods like oatbran, fruits, vegetables and legumes help to lower LDL and increase HDL. One good idea may be to replace the morning Roti Prata with cereals instead. Make sure you don't end up buying Honey Stars and Coco Pops, these are high in sugar!

So there you have it. I hope that is enough information to help you get started on a healthier LDL lowering, HDL increasing lifestyle. For more information on increasing your HDL levels you might want to check out this site.

So how do I lower my cholesterol levels?

"Ok Doc, so you tell me that LDL is BAD and HDL is GOOD. How do I lower my LDL levels and increase my HDL levels?"




Why do you have high cholesterol in the first place?

I had a 43 year old male patient this week who was sooooooo happy to find that his cholesterol levels are so good even though, he claims that he eats really unhealthy hawker food and never excercises! Then I had this 42 year old female patient who is very strict about her diet, eats rolled oats every morning, takes cholesterol lowering medications, excercises regularly and yet has a high cholesterol level.

What does this tell us? It tells us that having a cholesterol problem is not solely based on what you eat and whether you excercise. If you have a cholesterol problem, it is because your liver is not able to regulate the cholesterol levels well. Your liver actually makes cholesterol for the your body's needs. It is a neccessary ingredient for buiding and repairing body tissues. Now if your liver somehow does not get rid of the bad cholesterol quick enough then cholesterol levels in the blood rises leading to problems.

So, for those unlucky enough to have a high cholesterol problem, you need to help your liver regulate cholesterol by eating less cholesterol rich foods. About 60% of all the cholesterol circulating in your body is made by the liver and 40% comes from what you eat. So by controlling your intake of cholesterol rich food, you can significantly influence your cholesterol levels.

You are what you eat!!

There are actually two different classes of food. One you should avoid and one you should eat more of.

Ones you try to eat less

These are the food that are high in Saturated Fats. In general, cholesterol comes only from animal fats but it is also necessary to reduce Saturated fats from plant souces as well.
The list is very long, but I just give you some categories to remember:

• Egg yolks (white is ok)
• Milk products like soft cheeses, butter and cream
• Meats - Any fatty meat is bad, Sio Bak, Lard, Sausages, Luncheon meat, chicken skin etc
• Organs - Kway Chap, Foie Gras, Chicken livers etc
• Deep fried Stuff - Chips, Fries, KFC etc
• Nuts that have lots of oil, like macademia and cashews
• Coconut cream!! All the yummy lemak stuff
• Dressings- all the creamy ones like mayonnaise and thousand island
• Seafoods - Cavier, fish roe, Crab roe (hairy crab), Prawns.
• Snacks, Desserts, Pastries, Ice Cream

Ones you eat more because they help lower Cholesterol levels

• Oatmeal contains soluble fibres which help lower LDL (Good old Quaker Oats)
• Walnuts and Almonds
• Omega 3 fatty acids: There are 2 main sources. Fish such as Mackeral, Tuna, Trout and Salmon and plant sources such as Flaxseed, Walnut, Soybean oil and Canola oil

Contrary to popular belief, soybeans have not been shown to actually lower cholesterol levels

More info can be found here

When do I need to take medications?

Different strokes (pardon the pun) for different folks!! It all depends on your risk factors and how high you cholesterol is. We usually advise patients to try dieting first and if that doesn't bring the cholesterol down to an acceptable level then medications are started.

Conclusion

In this blog, we discussed about how to lower your LDL cholesterol, which is essentially through diet control. In my next blog, we will talk about how to raise your HDL levels. Remember that the old adage is true, you are what you eat!

How to read that Cholesterol Report

One of our readers wrote:

Dr, I love food, but my last cholesterol report showed that my cholesterol level is 324. Should I be concerned?






Why bother about cholesterol levels?

Think of your arteries as the piping of your kitchen sink and cholesterol as the oils that you flush down the sink everyday. If you ever have the privilege of opening up the pipe, you will get a dark sticky layer of gunk coating the inside of the pipe. This is similar to what cholesterol does to your arteries. Prolonged elevation of cholesterol will lead to narrowing of the arteries. If the arteries to the heart are blocked, you get a heart attack. If the arteries to the brain are blocked, you get a stroke.

How to read that Cholesterol Report



This is what a typical Cholesterol Report looks like. Let me highlight to you what is important.

Triglycerides

This is related to having too many calories in the diet. Calories from sugar and other carbohydrates like rice, cakes, pasta etc are converted to Triglycerides to be stored in the body.
While the link between Triglycerides and Heart Disease is not has strong as with Cholesterol, it should not be allowed to get too high as it may lead to other problems such as pancreatitis and diabetes mellitus.

What to do?

Lose weight, cut down on sweets, soft drinks and alcoholic drinks, esp Beer. Omega 3 fish oils may be of benefit. If your Triglyceride levels are very high, (>400) the Doctor may prescribe some medications to lower it.

Total Cholesterol

People always tend to look at this but usually we don't use this number to determine if you need to take medications. That is because the Total Cholesterol is made up of the LDL and the HDL, so if your LDL is low but HDL is high, you might have a high Total Cholesterol level, but it may not necessarily be bad since it is good for the HDL to be high.

HDL Cholesterol

This is what we call "Good Cholesterol". The higher the better. Less than 40 is no good. Excercise can help raise HDB Cholesterol levels.

LDL Cholesterol

This is the one that we look at to determine if you need medications. Your target LDL level depends on you and the number of risk factors you have for developing heart disease. So for example, a 60 year old man who is obese, smokes has high blood pressure and diabetes will require his LDL levels to be <100. style="font-weight: bold;">The bottomline is that the LDL levels need to be adjusted to individual needs.

The Total Cholesterol/HDL ratio

This one is useful for research purposes. But in essence if your Ratio is low is good because it shows that you have a high HDL level compared to the LDL.

Want to know what your chances of getting a heart attack is over the next 10 years?

If you have your cholesterol report and blood pressure readings, you can calculate your 10 year CardioVascular Risk by clicking here

For more information about your Cholesterol Levels, click here

New Mothers: What is this 6 in 1 Vaccination for my Baby?

One of our readers enquired about the 6 in 1 Vaccination that is available for newborns. So I thought I will just let you know about it.

The Vaccination Schedule for Singapore can be found here

Based on this schedule, your child will receive:

Birth: BCG and Hepatitis (Done at the hospital)
1 mth: Hepatitis
3 mth: DTP + Polio (Diphtheria, Tetanus, Pertussis)
4 mth: DTP + Polio
5 mth: DTP + Polio
6 mth: Hepatitis

This completes the vaccinations for the first year.

What is this 5 in 1 vaccination?

The smart scientists came up with what is known as a 5 in 1 vaccine. The 5 in 1 basically combines DTaP + IPV + Hib (Haemophilus Influenzae type B) into one vaccination. You may notice that there is a slight difference in the annotations. The "a" in DTaP stands for acelluar as opposed to whole cell vaccine. Acellular means that only purified Bacterial Parts are used in the vaccine as opposed to using the whole Bacteria. Acellular vaccines have been shown to have less side effects than whole vaccines.

IPV stands for inactivated Polio Virus as opposed to the Oral Polio which is a live virus given by mouth. The inactivated Polio Virus is incorporated into the 5 in 1 vaccine.

Haemophilus Influenzae type B (Hib) is not included in the schedule but it is an important vaccine to give to baby. Before the introduction of Hib, 10 -15 babies died in Australia each year from this disease, and 20-40% of the survivors were left with permanent neurological damage. So it is good to protect baby against this.

So as you can see, the new 5 in 1 vaccine offers many advantages over the old vaccination scheme.

So what is the 6 in 1 vaccination?

The clever scientists again made life easier for parents and doctors by coming up with a 6 in 1 vaccine. The 6 in 1 is actually the 5 in 1 plus the Hepatitis vaccine.

So instead of the old schedule where the baby needs to be given 5 injections, now the baby only needs to be jabbed 3 times. With 6 in 1 the schedule becomes:

Birth: BCG and Hepatitis (Done at the Hospital)
2 mth: 6 in 1
4 mth: 6 in 1
6 mth: 6 in 1

Less in injections means less pain and less chances for side effects to occur.

Our clinic offers packages for the new 6 in 1 as well as for the 5 in 1 vaccine. Do write to leslie.tay@gmail.com or call 67850311 for more information.

More information about childhood vaccines can be found here

What you should know about Cardiovascular Disease

Today's big health news is that Singaporeans only have a vague idea about how to prevent heart disease. So I have decided to write a series of blogs on the factors that affect the health of your heart and what you should do. Let me first start by giving you a real life scenario:



Mr M was a 42 year old patient of mine who has a history of high blood pressure and cholesterol. When I first saw him about a year ago, he was perfectly well, aside from high blood pressure and high cholesterol. He suffered no symptoms at all. He told me that he previously had an excercise stress test that showed some minor irregularities but he has not followed up on it. My advice to him was that he should go for a repeat excercise stress test and referred him to a cardiologist for follow up.

The months went by, and Mr M delayed going to the cardiologist because he felt he had no symptoms and did not want to do another stress test. I don't blame him, because in an excercise stress test, you go on a thread mill and have to run for a period of time. (How many of us like to do that?)

I finally suggested an alternative which was to do a 3D CT scan of the heart to look at the blood vessels of the heart which he finally agreed to do. An example of the 3D CT scan is shown above.

The 3D CT showed that his main artery was critically blocked and that his other 2 arteries have also narrowed. This means that at any time, he might suffer a massive heart attack. Within a week he had open heart surgery and had a 6 vessel bypass! The 3D CT scan had saved his life.

How you get a Heart Attack and Stroke

Cardiovascular problems (Cardio - heart, Vascular - blood vessels) are one of the biggest killers in Singapore. They occur when because of certain factors the blood vessels to the heart and brain narrow and eventually blood supply to these vital organs are cut off. The result is a heart attack or a stroke.

What are the Risk Factors for Heart Disease?

Below are the risk factors for Heart Disease, I like to divide them into 3 groups.

Group 1: Those things you can't do much about.

1. Male - if you are a man your risk goes up
2. Age - Men above 45 and women above 55 have higher risk
3. Genetics - If your parents have heart disease, you are at higher risk

Group 2: Those things you can do for yourself

1. Smoking - Stop smoking! Smoking dramatically increases risk of cardiovascular diseases
2. Alcohol - Too much drinking will also increase risk.
3. Obesity - Diet and Excercise and keep your weight to below a BMI of 23!

Group 3: The things you should consult your Doctor:

1. Hypertension - The silent killer, you may not feel any symptoms and the damage is gradual
2. Diabetes
3. Cholesterol levels

The bottomline is this: Prevention is better than cure and you should visit your doctor to discuss with him about how to prevent heart disease!

In the meantime, if you know your cholesterol and blood pressure readings, you may wish to calculate your 10 year risk of getting a heart attack by clicking this.

More information about Cardiovascular Risk Factors are found here

My next Blog in the Cardiovascular Health Series will touch on Cholesterol and how to read your cholesterol report.

Hepatitis B Carriers: What you need to know!

One of my patients said this to me:

Dr, I was diagnosed as a Hepatitis B carrier 2 years ago. What do I need to do?

Please listen, if you are a Hep B carrier, it is IMPERATIVE that you are regularly checked by a Doctor at least twice a year and that your spouse/partner is protected against Hep B.

Importance of Hepatitis B in Singapore

1. 4% of Singaporeans are Hep B carriers, so there are quite a lot of people carrying the virus in their bodies!

2. Of these, 25% will develop complications which may lead to liver failure and liver cancer.

3. If you are a carrier, you may transmit Hep B to someone else!

In a nutshell, if you are a Hep B carrier, there is a chance that you may develop liver cancer and that you may also spread it to others.

How to prevent spreading Hep B to others

Hep B is transmitted through bodily fluids and are transmitted through sex, sharing of contaminated needles and sharing of other things that may cause bleeding like toothbrushes, nail clippers and shavers. Make sure you don't be a HERO and donate your blood or sperm!

What to do for your family members

It is important that your spouse be screened for Hep B and receive vaccination as soon as possible. It is advisable for others in the family to be screened as well. If you are pregnant, then the baby will need special treatment at birth.

What YOU need to do for yourself

1. Find a Family Doctor and make sure you visit him every 6 months

2. You will need blood tests to check for liver problems every 6 months

3. You will need at an Ultrasound of the Liver at least every year and for some high risk patients, twice a year

4. If you are not vaccinated against Hep A you should do so.

5. Avoid alcohol as this will cause more problems for your liver

Conclusion

Hepatitis B carriers have a chance of developing liver cancer and should be seen by a doctor every six months. Their family members and other sexual contacts are also at risk and should be screened. Hep B is a bigger problem than AIDS and kills more people every year than AIDS so you should be very careful.

For Men: Dr, how come my b---s shrink when I go swimming?

One of my patients asked me this question today!

I told him that I wanted to blog the answer and asked for his permission to take a photo of the organ in question. He declined of course. I quipped that it was because he was afraid someone might recognize him just by looking at that part of the body which got his wife laughing uncontrollably AT him. Trust is such a important quality in a husband and wife relationship, don't you agree?

The function of the male testicles are to produce sperms. It so happens that they function best at a temperature just cooler then normal body temperature. So during a hot day, the scrotal muscles relax so that the testicles will dangle further away from the body and when it is cold, the scrotal muscles contract to keep the testicles warm.

Here are some things you should not do if you wish to father a child:

1. Avoid Spas!! Soaking a long time in Spas with water temperatures above 40 degrees Celsius might be really relaxing BUT it may lower your sperm count!

2. Avoid long bicycle rides while wearing tight bicycle shorts! The tight shorts and the bicycle seat keep the testicles closed to the body and may compromise sperm production.

3. Avoid long hours sitting on your chair or car! You should get up and let them dangle every now and again!

4. Avoid Smoking and Alcohol as they may affect the sperm count!

An Interesting Postulation

It is a fact that sperm production decreases in hotter climates. So could it be that our low fertility rates are due to the fact that Singapore is hot and most of our guys work long hours sitting in their offices?

While you are thinking about this, I think I will just get out of my chair and go for a quick stroll!

For more information on how to optimise your fertility rate (for men) please have a look at this interesting article from MayoClinic. Click here.

Can I get Hepatitis B from eating raw Seafood?

Doctor, I know that I can get Hepatitis B from eating raw Seafood right?

This is perhaps one of the commonest misconceptions in Family Practice. The problem is that most patients do not differentiate between Hepatitis A and Hepatitis B which are two very different diseases altogether. So here are a few points to you understand the difference.

1. Hepatitis just means inflammation of the liver. This inflammation can develop from a whole range of conditions. Hepatitis A and B refer to inflammation of the liver caused by 2 different viruses, the Hep A and the Hep B virus.

2. Hep A is the one that you get from eating contaminated food and water. (Not just seafood, any food can be contaminated with the virus). When you get Hep A, you might get jaundiced and develop fever and have flu like symptoms. Most people recover fully from Hep A but some do develop chronic hepatitis and liver damage.

3. Hep B is transmitted through contact with blood or semen. It is spread through contaminated needles (drug abusers) as well as sexual contact. Hep B has more severe consequences than Hep A. People who contract Hep B may go on to become carriers who can spread the disease to others. A person suffering from chronic Hep B may also develop liver failure and liver cancer.

4. You can vaccinate yourself against both Hep A and B. The vaccination for Hep A consists of 2 injections 6 months apart. The Hep B vaccination is 3 vaccinations at 0, 1 and 6 mths.

This is only a short article to help you differentiate between Hep A and B. For more information you may like to read this.

In my next article, I will be talking more about Hep B carriers and what screening tests are required by ALL Hep B carriers.

Treating people not diseases

Our motto "Treating people, not diseases" was an inspiration from the film, "Patch Adams" where he told his peers that when you treat a disease, you lose, but when you treat the person, you will win all the time. Most of you would have seen this film where Patch Adams (Portrayed by Robin Williams) was this eccentric Doctor who would put on a clown's nose to entertain kids who were dying.

Most Doctors shy away from incurable patients because sometimes we feel powerless in those situations and sometimes it is because we do not want to be reminded of our own mortality. But Patch was different. He focussed on the patient, not the disease, so he felt that he could still do something for the patient even though there is nothing that can be done for the disease.

"Treating people, not diseases" is an mindset we adopt to remind ourselves that we are treating not just a headache, runny nose or a cough. It helps us remember that patients are real people who work to earn a living and have families who care for them and have joys and struggles in life.

I heard it said somewhere before that people are like onions. When you peel off the superficial layers, the deeper more significant problems emerges. This happens everyday in Family Practice. Let me illustrate with a typical situation:

A 25 year old lady comes to the clinic complaining of a headache. "Treating the disease" would be to make an accurate diagnosis and then to prescribe painkillers after making sure that the headache is not an indication of some serious event. That is treating a disease called Tension Headache. There is absolutely nothing wrong with that because the doctor has done what is expected of him both legally and morally.

When we try to treat the patient, the doctor takes the extra step to establish a relationship of trust whereby the outer layers of the onion can be peeled off to reveal the real underlying problem. I frequently have patients who present with seemingly innocent symptoms who are really suffering from depression or an inability to cope with the stresses of life. Some patients present with headache because they have not slept a wink, having to stay up the whole night looking after the newborn baby!

Many of our physical problems are a manifestation of psychiatric stressors. A condition like depression often masquarades as physical symptoms such as fatique, weight loss, menstrual changes, unusual sensations in the abdomen, chest or head, bodily aches and pain, dry mouth and difficulty breathing. The condition is common in stressed out Singaporeans but it is often not recognized by both the patient and her doctor. Unless the underlying depression is treated, the physical symptoms are likely to remain.

One of the most important roles of the Family Doctor is patient education, which is why I have started this blog. Many of the conditions are much better managed when the patient understands the rationale for treatment.

Asthma management is a very good example. Most parents who do not understand the rationale behind using Preventors often stop the medication prematurely. The parents who do understand the role of preventors are more compliant to give the medication for a longer period of time which result in the child being able to live without having to suffer the symptoms of asthma frequently. (For more info on Asthma, you may like to read the Asthma Series which have just been posted)

I will be the first to admit that "Treating people, not diseases" is sometimes difficult to do. I am far from perfect. (Some patients expect us to be superhuman and are surprised when a Doctor falls sick! If you prick us, do we not bleed?) Sometimes, after a long day, I get tired and it is much easier to just see the patient, prescribe some medication and send the patient home (Which is why it helps to close the clinic and take a nap in the afternoons) We can only say that we try our best.

If you have been our patient for a while, I hope this little article will help to explain our tagline to you and I hope you feel that we have tried to live up to the values that we espouse. If you have any thoughts or comments please feel free to express them by clicking the comments link at the end of the blog!