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Pregnancy and Vaccines

Recommended vaccines before Pregnancy: MMR (measles-mumps-rubella) vaccine, Varicella (chickenpox) vaccine and Hepatitis B vaccine.

Even before becoming pregnant, make sure you are up to date on all your vaccines which includes MMR (measles-mumps-rubella), Chickenpox vaccine and Hepatitis B vaccination. This will help protect you and your child from serious diseases.

Rubella is a contagious disease that can be very dangerous to your baby if you get it while you are pregnant. It can cause a miscarriage or serious birth defects. The best way of preventing this is get MMR vaccination before your pregnancy.
Hepatitis B is another contagious disease that can transmit to your baby during child birth. A baby who gets infected with the Hepatitis B virus during the first five years of life has a 15% to 25% risk for pre mature death from liver disease, including liver failure or liver cancer in the future. Hepatitis B vaccine is your baby’s “insurance policy” against being infected with the Hepatitis B virus.
If you get chicken pox during the first or second trimester, there’s a slight risk (less than 2 percent) that your baby could get congenital varicella syndrome. Congenital varicella syndrome is characterized by birth defects, most commonly skin scarring, malformed limbs, an abnormally small head, neurologic problems (like intellectual disability), and vision problems. A baby with congenital varicella syndrome may grow poorly in the womb and suffer from seizures as well as physical and mental developmental disabilities. The infection may also increase the risk of miscarriage or stillbirth.

Thus, if you are not sure if you have been vaccinated for against the above infections, make sure you have a pre-pregnancy blood test to see if you are immune to the disease.

Recommended vaccines during pregnancy: Pertussis (16 to 32^nd week of each pregnancy) and Flu vaccine

Pertussis or Whooping cough can be especially serious for newborn, it can be life-threatening. Around 20 babies die each year in the United States due to whooping cough. Another reason why it is so dangerous in babies is because they may not have any symptoms of cough, making it hard for parents and doctors to know if your baby has whooping cough. It can cause them to stop breathing and turn blue.

Thus pregnant women are recommended to receive Pertussis vaccination or Boostrix (which covers for pertussis, diphtheria and tetanus (Tdap) between the 16th to 32nd weeks of each pregnancy, regardless of the interval since the previous Pertussis vaccination. When you get the whooping cough vaccine during your pregnancy, your body will create protective antibodies and pass some of them to your baby before birth. These antibodies will provide them with some short-term, early protection against whooping cough.

Flu vaccine is totally safe during pregnancy. During pregnancy, our immune system and lung functions changes making pregnant women more likely to get seriously ill from the flu. Catching the flu also increases your chances for serious problems for your developing baby, including premature labor and delivery. Thus we would recommend flu vaccine especially during pregnancy.

** Singaporean and Permanent Resident are able to use their Medisave to pay for MMR, Hepatitis B and Pertussis (for pregnant women only) vaccines.

Testosterone Deficiency Syndrome

In male humans, testosterone plays a key role in the development of male reproductive tissues such as testes and prostate.

It also promotes secondary sexual characteristics such as increased muscle and bone mass, and the growth of body hair. In addition, testosterone is involved in health and well-being such as concentration and energy and the prevention of osteoporosis.

Testosterone Deficiency Syndrome (TDS)

Testosterone Deficiency Syndrome (TDS) or Late Onset Hypogonadism (LOH) refers to the age-related decline in testosterone levels in adult men, resulting in various symptoms. TDS may adversely affect the function of multiple organ systems and result in significant decline in the quality of life.

What causes low testosterone?

You may be born with low testosterone, or it can develop later in life, often due to age, injury or infection.

Testosterone Deficiency Syndrome (TDS) is usually due to age. As men age, the testes decline in function and testosterone secreted by them decreases, by about 0.4-2.0% every year. This is due to a reduction in the function and size of the Leydig cells of the testes.

This decline is exacerbated in men with obesity and men with poor health status such as high blood pressure, diabetes and high cholesterol.

Reduce in testosterone production can also be due to previous testicular infection, trauma, heat, hernia or surgery.

Sign and symptoms

Low testosterone may alter certain masculine physical characteristics and impair normal reproductive function. As testosterone decreases, some men may experience symptoms similar to those of menopause in women.

Signs and symptoms may include:

Erectile dysfunction
Fatigue
Decreased sex drive
Difficulty concentrating
Decrease in muscle mass
Decrease in beard and body hair growth
Development of breast tissue (gynecomastia)
Loss of bone mass (osteoporosis)
Hot flashes

You can use a scoring scale to determine how likely your symptoms is related to Testosterone Deficiency Syndrome. Just follow the link below:

http://menshealth.za.com/en/patients/check-yourself/ams-questionnaire-tool/index.php

If your score is:

50 – symptoms likely due to low testosterone
37-49 – symptoms possible due to low testosterone
27-36 – symptoms unlikely due to low testosterone
17-26 – no symptoms of low testosterone

How do we diagnose?

If you have symptoms of low testosterone, your doctor will likely do a blood test for total testosterone. We may also do albumin and sex-hormone binding globulin level to more accurately calculate the active testosterone level.

We also may offer to screen you for chronic diseases such as high blood pressure, diabetes, cholesterol and obesity.

What is the treatment?

Weight loss and management of chronic disease. – If men succeed in losing weight, their testosterone levels may recover.
Hormonal replacement – to replace testosterone:
1. Pills – painless but not suitable for long term as it can cuase liver problem. Have to take with fatty meal for better absorption.
2. Gels – painless but a potential side effect of the gel is the possibility of transferring the medication to another person
3. Injection – Most convenient. It can be given every 3-4 weeks or every 3 months depend of the preparation.

Side effects

Testosterone therapy carries various risks, including stimulating noncancerous growth of the prostate, enlarging breasts, limiting sperm production, stimulating growth of existing prostate cancer and blood clots forming in the veins.

There is no evidence that testosterone replacement causes prostate cancer in contrary to many belief it does so. The PSA may go up slight when one starts testosterone replacement but the level would stabilize after few months. Doctors do however continue to monitor PSA as part of routine test just to be sure.

As with all medicine, there is potential side effects but mostly it is safe if given correctly. Your doctor will counsel you about the side effects and what to look out for. It is also important to attend your doctor follow up appointment. Physical examination and blood test would be done at a regular interval to monitor the testosterone level and also for any side effects.

What to do and not to do during dengue fever

To Do:

Not to Do:

Rest in bed

Avoid any sports/physical activities until you have recovered

Hydrate your self

Avoid brushing your teeth to prevent gum bleeding, instead use gargle

Take simple pain/fever medicine such as paracetamol

Avoid medication such as ibuprofen, aspirin, ponstan, arcoxia as they may increase risk of bleeding

Go for your doctor appointment even if you feel better as they may need to monitor your platelet until you recover.

Do not cancel your doctor appointment even if you feel better or fever has stop. This is because the platelets usually start to drop when the fever lysed.

See your doctor if you are bleeding or bruising (bleeding from your gum, nose, urine)

Protect your from being bitten by mosquito to prevent it from infecting others.

Family members/housemates to check and remove stagnant water in your premises to prevent Aedes mosquito from breeding

Discuss with your doctor about dengue vaccine when you are well

Dengue Fever is caused by infection with a dengue virus. There are four serotypes of dengue virus (DENV1-4) circulating in the world.

Dengue is transmitted to humans by the bite of an infected Aedes mosquito. Dengue fever is not contagious and does not spread directly from person to person. A mosquito is infected when it takes a blood meal from a dengue-infected person and later transmits the virus to other people they bite.

Dengue Fever usually develops within 4 to 7 days after being bitten by an infected mosquito.

Symptoms can include:

Sudden onset of fever for 2 to 7 days (usually high fever > 38.5C)
Severe headache with retro-orbital (behind the eye) pain
Joint and muscle pain
Skin rashes (usually after 4-5 days) which often itch.
Nausea and vomiting
Bleeding from the nose or gums or easy bruising in the skin

Treatment for Dengue:

There is no specific treatment for dengue or dengue haemorrhagic fever.

Treatment for dengue is usually supportive such as simple pain/fever medicine (paracetamol), nausea/vomiting medicine and hydration. Some may need itch medicine when the rash start to appear. Your doctor may need to regularly check your blood for the platelet count until you recover.

Only in few cases where dengue patient need to be admitted for fluid and electrolyte replacement or blood (platelet) transfusions. This is when a patient is dehydrated, has very low blood pressure due to the infection or when the platelet is extremely low.

Dengue Haemorrhagic Fever/Dengue Shock Syndrome is a severe form of dengue fever that could result in death.

Precautions You Can Take:

To prevent the spread of dengue fever, you must first prevent the breeding of its vector, the Aedes mosquito. It prefers to breed in clean, stagnant water easily found in our homes. You can get rid of the Aedes mosquito by frequently checking and removing stagnant water in your premises.

Learn more ways to prevent Aedes mosquito breeding on NEA’s dengue website

A dengue vaccine has been approved for individuals aged 12 to 45 years and had dengue infection before. Individuals should consult their doctor if they wish to find out more about their suitability for the dengue vaccine.

Lip Dermatitis

Eczematous cheilitis or lip dermatitis is inflammation of the lips presenting as redness with dryness and scaling.

Causes

It is a common condition and it is usually cause by either internal factor (atopic dermatitis) or external factor (irritant or allergic contact reactions).

Internal factors are due to an inherent characteristic of the person. Most common example is atopicdermatitis (eczema which can run in the family)
External factors are due to something from outside the body. This group can be further subdivided into:
1. Irritant contact dermatitis – lip licking is the major cause of this type of dermatitis. Other common causes include cosmetics and foods epically spicy food.
2. Allergic contact cheilitis – due to allergic to certain source. Common sources of allergens include lipsticks and other lip care products, toothpastes and dental materials, foods, medications and nail varnish.

Sometimes no cause can be identified.

Treatment

Treatment will depend on the cause. Where an external cause has been identified, this should be avoided if possible. If this does not result in improvement, consider another external factor or possible internal (genetic) cause.

Moisturisers (lip balm with no fragrance and colour) can be used to reduce the dryness and scaling.

For more severe cases topical corticosteroids may be use for short period of time.

Trigger Finger

Trigger finger occurs when thickening or nodule formation of a finger tendon preventing it from gliding smoothly within its sheath.

Symptoms

Pain over finger or palm area
Difficulty with finger movement
Finger locking or popping sensation

Risk factors – repetitive use or finger injuries, diabetes mellitus, rheumatoid arthritis, carpal tunnel syndrome, Dupuytren disease, and hypothyroidism.

Diagnosis is made through history and examination.

Treatment options

Rest
Pain and anti-inflammatory medications
Splinting
Steroid injection
Surgery

Steroid injection combine with lignocaine (pain medicine) for trigger finger is simple, effective and safe. Patient with trigger finger should consider early steroid injection if rest, medicine and splinting does not resolve their symptoms as the success rate if higher if it is done earlier.

Knee Osteoarthritis

Osteoarthritis of the Knee

Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of bones in our joints gradually worn off. This causes the bones over the joints to rub against each other causing friction and thus the symptoms of osteoarthritis.

The most common joints to be affected is the knees. Hips, spine and finger joints are also commonly affected.

It is an ongoing process that cannot be reverse but there are some interventions that can help manage the symptoms and slow down the process.

Symptoms

Osteoarthritis symptoms includes painful and stiff joint/s, and loss of movement or function of the affected joint.

Risk factors

Factors that may increase your risk of osteoarthritis include:

Older age.
Being female.
Obesity.
Previous joint injuries.
Genetics
Bone deformities.

Diagnosis

Usually with physical examination and history, your doctor can diagnose a knee osteoarthritis. However sometime we might need to perform X-rays and blood test to confirm the diagnosis. Occasionally, the fluid in the joint can be aspirated to send for Joint fluid analysis to help us make the diagnosis.

Treatment

Exercising and maintaining a healthy weight are the most important ways to treat osteoarthritis.

Lifestyle and home remedies

Exercise.

Try walking, biking or swimming. Avoid running on uneven grounds or going up and down too much stairs. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. If you feel new joint pain, stop.

Lose weight.

Obesity or even being somewhat overweight increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain.

Physical therapy.

Physical therapist can work with you to create an individualized exercise program that will strengthen the muscles around your joint, increase your range of motion and reduce pain.

Use heat or cold compress to manage pain.

Medication

Topical cream: Over the counter cream such as Deep heat gel or Voltaren gel for mild cases.
Pain medication: Try paracetamol as first line oral medication. If not better, your doctor may give NSAIDS (eg, ibuprofen, naproxen, Arcoxia)
Supplement: Glucosamine, chondroitin or collagen II. Studies have been mixed on these nutritional supplements. A few have found benefits for people with osteoarthritis, while some indicate that these supplements work no better than a placebo.

If conservative treatments don’t help, we may need to consider procedures such as:

Cortisone injections. Injections of corticosteroid medications may relieve pain in your joint. We generally try to do this as little as possible as the medication can worsen joint damage over time
Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee.
Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in knee osteoarthritis.
Joint replacement. In severe cases or when other methods failed, total knee replacement is an option.

Speak to you doctor today if you are suffering from knee pain.

Osteoporosis

Osteoporosis causes bones to become weak and brittle. In osteoporotic bone, a fall or even mild stresses such as bending over or coughing can cause bone fracture.

Osteoporosis affects men and women of all races. But Asian women — especially older women who are past menopause — are at greatest risk.

Symptoms

There are usually no symptoms for osteoporosis until complication has occur.

Complication includes:

Bone fractures.
Back pain, caused by a fractured or collapsed vertebra
Loss of height over time

Screening and Diagnosis

As women are at greater risk of osteoporosis, all women 65 years old and above should consider screening for osteoporosis with a BMD scan (a low level xray).

Women below 65 year old but with high OSTA score (see below) should consider screening also.

Speak to your family doctor if you are at risk. They will determine if you need a BMD scan to meansure your bone density. It is just like a Chest X-rays or a bone X-rays, where during this painless test.

OSTA score : Age (year) minus Weight (kg)

20 and above: High risk. For BMD scan.

0-20: Moderate risk. Discuss with your doctor if you need BMD scan.

Less then 0: Low risk. No need for BMD scan.

Prevention

Protein

Protein is one of the building blocks of bone. Protein supplementation is an option.

Body weight

Being underweight increases the chance of bone loss and fractures. Excess weight is now known to increase the risk of fractures in your arm and wrist. As such, maintaining an appropriate body weight is good for bones just as it is for health in general.

Calcium

Men and women between the ages of 18 and 50 need 1,000 milligrams of calcium a day. This daily amount increases to 1,200 milligrams when women turn 50 and men turn 70.

Vitamin D

Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Exercise

Exercise can help you build strong bones and slow bone loss. Combine strength training exercises with weight-bearing and balance exercises.

Treatment options

For those who are proven to be osteoporotic on a BMD scan, treatment options are:

Oral or injectable bisphosphonate
Strontium Ranelate
Raloxifene (selective estrogen receptor modulator)Osteoporosis causes bones to become weak and brittle. In osteoporotic bone, a fall or even mild stresses such as bending over or coughing can cause bone fracture.

Bunion

A bunion is a bony bump that forms on the joint at the base of your big toe. It forms when your big toe pushes against your next toe, forcing the joint of your big toe to get bigger and stick out.