Pregnancy and Vaccines

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.

  1. 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.
  2. 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.
  3. 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 syndromeCongenital 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 32nd week of each pregnancy) and Flu vaccine

  1. 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.

  1. 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

Testosterone Deficiency Syndrome

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:

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?

  1. Weight loss and management of chronic disease. – If men succeed in losing weight, their testosterone levels may recover.
  2. 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

Dengue Fever

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:

  1. Sudden onset of fever for 2 to 7 days (usually high fever > 38.5C)  
  2. Severe headache with retro-orbital (behind the eye) pain
  3. Joint and muscle pain
  4. Skin rashes (usually after 4-5 days) which often itch.
  5. Nausea and vomiting
  6. 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

Lip Dermatitis

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


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

  1. Internal factors are due to an inherent characteristic of the person. Most common example is atopicdermatitis (eczema which can run in the family)
  2. 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 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

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


  1. Pain over finger or palm area
  2. Difficulty with finger movement
  3. 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

  1. Rest
  2. Pain and anti-inflammatory medications
  3. Splinting
  4. Steroid injection
  5. 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

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.


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.


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.


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

Lifestyle and home remedies

  1. 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.

  1. 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.

  1. 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.

  1. Use heat or cold compress to manage pain.


  1. Topical cream: Over the counter cream such as Deep heat gel or Voltaren gel for mild cases.
  2. Pain medication: Try paracetamol as first line oral medication. If not better, your doctor may give NSAIDS (eg, ibuprofen, naproxen, Arcoxia)
  3. 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:

  1. 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
  2. Lubrication injections. Injections of hyaluronic acid may offer pain relief by providing some cushioning in your knee.
  3. Acupuncture. Some studies indicate that acupuncture can relieve pain and improve function in knee osteoarthritis.
  4. 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 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.


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.


  1. Protein

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

  1. 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.

  1. 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.

  1. 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.

  1. 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: 

  1. Oral or injectable bisphosphonate
  2. Strontium Ranelate
  3. 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.



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.


There are many theories about how bunions develop, but the exact cause is unknown.

Factors likely include:

  • Inherited foot type
  • Foot injuries
  • Deformities present at birth (congenital)

Risk factors

  • These factors might increase your risk of bunions:
  • High heels.
  • Ill-fitting shoes.
  • Rheumatoid arthritis.
  • Heredity.


Although they don’t always cause problems, bunions are permanent unless surgically corrected. Possible complications include:

  • Bursitis. This painful condition occurs when the small fluid-filled pads (bursae) that cushion bones, tendons and muscles near your joints become inflamed.
  • Hammertoe. An abnormal bend that occurs in the middle joint of a toe, usually the toe next to your big toe, can cause pain and pressure.
  • Metatarsalgia. This condition causes pain and inflammation in the ball of your foot.

Conservative treatment

Nonsurgical treatments that may relieve the pain and pressure of a bunion include:

  • Changing shoes. Wear roomy, comfortable shoes that provide plenty of space for your toes.
  • Padding and taping or splinting. Use over-the-counter, non-medicated bunion pads. Also, your doctor can help you tape your foot in a normal position. This can reduce stress on the bunion and alleviate your pain.
  • Shoe inserts. Padded shoe inserts can help distribute pressure evenly when you move your feet, reducing your symptoms and preventing your bunion from getting worse. Over-the-counter arch supports can provide relief for some people; others require prescription orthotic devices.

Surgical options

If conservative treatment doesn’t provide relief from your symptoms, you might need surgery.

Cold Sore

Cold Sore

Why Doesn’t Everyone Get Them?

About two-thirds of us have been infected with the HSV-1 virus. It usually comes via well-meaning kisses from relatives or romantic partners. So why do only an unlucky few get cold sores? The answer may be in your genes. Most people who get cold sores share genes that may relate to how HSV-1 acts in your body. This could be what causes outbreaks.

HSV-1 lives in your nerves. It’s pretty quiet most of the time, but you may have triggers that bring it out of hiding — and cause cold sores.

What Are The Triggers?

  1. Recurrence may be triggered by:
  2. Viral infection or fever
  3. Hormonal changes, such as those related to menstruation
  4. Stress
  5. Fatigue
  6. Exposure to sunlight and wind
  7. Changes in the immune system

How To Ease The Discomfort:

Apply a cold sore ointment. It must be applied frequently and may shorten an outbreak by a few hours or a day.

  1. Use lip balms and cream. Protect your lips from the sun with a zinc oxide cream or lip balm with sunblock. If your lips become dry, apply a moisturizing cream.
  2. Apply a cool compress. A cool, damp cloth may reduce redness, help remove crusting and promote healing.
  3. Apply pain-relieving creams or pain medication. Over-the-counter creams with lidocaine or benzocaine may offer some pain relief.

There’s no cure for HSV infection, and the blisters may return.

See your doctor when you have cold sore as antiviral medications can help cold sores heal more quickly and may reduce how often they return.

Also try to avoid known trigger to prevent cold sore recurrence.

Swimmer’s Ear

Swimmer's Ear

Swimmer’s ear, outer ear infection or otitis externa is an infection in the outer ear canal.  It’s often brought on by water that remains in your ear after swimming, creating a moist environment that aids bacterial growth. Putting fingers, cotton swabs or other objects in your ears can damage the skin lining your ear canal causing otitis externa.

Signs and symptoms

  • Itching or pain in your ear canal
  • Slight redness inside your ear
  • Mild discomfort that’s made worse by pulling on your outer ear
  • Drainage of clear, odorless fluid or pus
  • Decreased or muffled hearing
  • Swelling in the lymph nodes in your neck
  • Fever


  • Excess moisture in your ear. Heavy perspiration, prolonged humid weather or water that remains in your ear after swimming can create a favorable environment for bacteria.
  • Scratches or abrasions in your ear canal. Cleaning your ear with a cotton swab or hairpin, scratching inside your ear with a finger, or wearing headphones or hearing aids can cause small breaks in the skin that allow bacteria to grow.
  • Sensitivity reactions. Hair products or jewelry can cause allergies and skin conditions that promote infection.

Risk factors

  • Swimming
  • Swimming in water with elevated bacteria levels, such as a lake rather than a well-maintained pool
  • A narrow ear canal — for example, in a child — that can more easily trap water
  • Aggressive cleaning of the ear canal with cotton swabs or other objects
  • Use of certain devices, such as headphones or a hearing aid
  • Skin allergies or irritation from jewelry, hair spray or hair dyes


For most cases, doctor will prescribe eardrops that have some combination of the following ingredients,

  • Acidic solution to help restore your ear’s normal antibacterial environment
  • Steroid to reduce inflammation
  • Antibiotic to fight bacteria
  • Antifungal medication to fight an infection caused by a fungus

If your ear canal is completely blocked by swelling, inflammation or excess discharge, your doctor may insert a wick made of cotton or gauze to promote drainage and help draw medication into your ear canal.

If your infection is more advanced or doesn’t respond to treatment with eardrops, your doctor may prescribe oral antibiotics.

The doctor may also give you pain medication for the pain and fever.

During treatment, the following steps will help keep your ears dry and avoid further irritation:

  • Don’t swim or scuba dive.
  • Avoid flying.
  • Don’t wear an earplug, hearing aid or headphones before pain or discharge has stopped.
  • Avoid getting water in your ear canal when bathing. Use a cotton ball coated with petroleum jelly to protect your ear during a bath.


  • Keep your ears dry. Dry your ears thoroughly after exposure to moisture from swimming or bathing. Dry only your outer ear, wiping it slowly and gently with a soft towel or cloth. Tip your head to the side to help water drain from your ear canal. You can dry your ears with a blow dryer if you put it on the lowest setting and hold it at least a foot (about 0.3 meters) away from the ear.
  • Swim wisely. Watch for signs alerting swimmers to high bacterial counts and don’t swim on those days. Also use ear plug while swimming.
  • Avoid putting foreign objects in your ear. Never attempt to scratch an itch or dig out earwax with items such as a cotton swab, paper clip or hairpin. Using these items can pack material deeper into your ear canal, irritate the thin skin inside your ear or break the skin.
  • Protect your ears from irritants. Put cotton balls in your ears while applying products such as hair sprays and hair dyes.

(Dr Lee Chong Han. Source Mayo Clinic and WebMD)