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Asked 2020-03-30 11:54:19 UTC

Are cloth masks useful?

Now that we have a shortage of masks, is a cloth mask any good at all? Does it offer any percenta...

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What is considered fever? Forehead, ear, oral all give different readings. If we go to a doctor, 37.5 ear temp is not considered a fever. So what are the readings we should take note for each devices?

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My mum has been having this rising feeling of food/acid regurgitating after her evening dinners. As a result, she throws up very often every night. It has been going on since last Jan.

Her doctor says it could be just acid reflux but I am concerned since it has been going on for qu...

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Answered 2020-01-07 11:36:43 UTC

Hi @Mr_J, the sequence of symptoms you experienced is not uncommon. To go for a work-out with that neck ache, your body would typically use compensatory muscle groups of the...

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Hello @deliriousg">@deliriousg, very good question. In fact I was just speaking to a respiratory physician who brought up this topic. Cloth and water-repellent fabric masks are as helpful as...

Answered 2019-08-21 23:07:58 UTC

Dr. Dinesh Guna

Hi @WangXiuYing89 thats a great question! Eye care professionals recommend eye checks every 1 to 2 years depending on your background and age. If you experience eye tiredness, headaches after...

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Gambling Addiction: Effects on the Psychological Well-Being of Individuals Gambling addiction is unspoken and undetected in most people yet has far-reaching consequences on persons and their families if not diagnosed.It has been shown that a gambling habit can have many negative psychological, physical, and social repercussions. Pathological gambling and problem gambling have been re-classified by DSM-5 to be behavioural addiction. Individuals with problem or pathological gambling should seek help early to beat the habit and recover from the disorder without hitting rock-bottomProblem gamblers experience feelings of despair when they realise how quickly their life savings are disappearing without being able to stop themselves. Individuals with problem or pathological gambling should seek help early to beat the habit and recover from the disorder without hitting rock-bottom.A technique called "cognitive restructuring" may be helpful to some individuals who find themselves struggling with these addictions, but our main objective should be prevention!What is a Gambling Disorder?Most people might think that gambling is just for fun. But unknown to them, the underlying fact is that gambling can become a problem that, if left untreated, will lead to compulsive behaviour called gambling disorder.In some people, gambling is not anymore for fun, but it becomes an addiction. Just like an alcoholic that craves more alcohol, gamblers crave gambling just the same way. Little did they know that this compulsive behaviour can lead to financial problems, personal relationships, and work.People can notice that people with gambling disorders often lie and hide their behavior. For example, they can lie to their families and other people to cover their compulsive gambling. They may even turn to others to seek financial assistance to support their habit.Gambling addiction in Singapore ranks high because more than half of its gamblers are elderly. However, it may be a direct result of several factors, such as retirement, lack of opportunities to socialize during their youth, death of relatives or loved ones, and illnesses that lead them to turn to gamble.How does the brain get addicted to gambling?Gambling addiction refers to the uncontrollable urge to gamble, despite knowing the severe consequences. Countless instances proved gambling addiction had negatively impacted a person's financial situation, family relationships, and mental and physical health. Recently, it was determined as an addiction.The same as drugs or alcohol, gambling excites the brain's reward system, and this has the potential possibility to lead to addiction. In addition, it's been noticeable that gambling disorder shares many diagnostic criteria with those of drug dependence. Some of them are withdrawal, tolerance, unsuccessful quit attempts, and significant disturbances in life.Located deep inside our brain is an area that sits in the centre and is called the ventral tegmentum. It is considered the brain's reward centre and has been involved in the processing of rewards. For example, whenever a person with a gambling disorder watches a video about gambling or participates in mock gambling, scientists notice changes in blood flow in some brain regions that indicate which parts are more active. The finding concluded that those people who suffered from gambling disorders have lesser activation in their reward pathways.The finding explains why they are craving ways to stimulate their reward system. It may include a higher dose of drugs for people involved in drug addiction and increased betting until the last dollar drop for problem gamblers.How do you stop gambling addiction?First and foremost, you have to accept that you have a gambling problem. Second, we can't deny the fact that doing this takes tremendous strength and courage, mainly if you've been into it for quite a long time. However, don't forget that others have successfully overcome their gambling problem and started to rebuild their lives. In that case, it only means that you, too, can break the habit.Here are some but highly effective steps on how to stop gambling addiction:Replace uncomfortable feelings with healthier thinking - when do you gamble? Is it when you are lonely or alone? After an argument with your boss or colleague, or wife? Regardless of your reasons, gambling is undeniably a way to eradicate unpleasant feelings or emotions. But don't forget that there are healthier ways to manage your unpleasant emotions and relieve the feeling of loneliness. Instead, you can do exercise, relaxation techniques, read, or spend quality time with your loved ones who do not gamble or take up a new hobby.Seek professional help from experts - certain factors trigger gambling problems such as stress, anxiety, depression, and abuse of illegal substances. It would be best if you seek the assistance of experts to stop gambling for good.Make a decision - for all we know, gambling doesn't happen without you being conscious about it. For gambling to happen, you have to choose to gamble. In case an urge to gamble suddenly occurs, stop and ponder on the consequences. Tell yourself that you are a new person, a new human being. Or better yet, call someone immediately to help you find something else to do so you can divert that feeling.Final WordsCounselling can also be a significant help for those affected family members. It can help you identify your family's strengths that you can use to overcome compulsive gambling. Remember that those individuals known as problem gamblers are at a high risk of committing suicide. Therefore, it is paramount not to take gambling addiction lightly.Although their families and friends should support compulsive gamblers, the final decision will still lie on them to quit gambling addiction. Singapore has various gambling addiction Healthline that can assist them in overcoming the gambling problem.In case you or one of your family members have a compulsive gambling problem, you can contact the following gambling addiction hotline:1. Gambling Helpline: 1800-6-668-6682. Recovery Support Group Meetings WE CARE Community Services 11 Kampong Bugis Singapore, 338988 For further inquiries, you can call: +65-6471-53463. National Council of Social Services (NCSS)Ulu Pandan Community Building170 Ghim Moh Road, #01-02 Singapore279621Tel #: 6210 2500Fax #: 6468 10124. National Council on Problem Gambling510 Thomson Rd, #05-01 SLF Complex, Singapore 298135Tel #: +65 6354 81545. The Silver Lining Counselling Centre11 Playfair Rd, Singapore 367986Tel #: +65 6749 04006. Arise2Care Community Services5 Harper Rd, #02-01/A, Singapore 369673Tel #: +65 6909 0628

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Women’s Health

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Fertility: What You Need to Know Fertility is fundamental to human life and the impairment of fertility, like many diseases, is an epidemic plaguing much of the developed world. The latest Singapore Census 2020 has found a continued decline in Total Fertility Rate to 1.1 (note: a minimum of 2.0 is required to replace our own population). As a society, the failure to produce more babies is a result of many factors, including the personal choice not to have children. However, for those couples who actively attempt to conceive but to no avail, they face the medical disease — infertility. About 80-90% of (young) healthy fertile couples will conceive within one year if they have intercourse regularly without contraception; half of the remaining 10-20% will be able to conceive in the second year of trying, that leaves about 5-10% of couple in need of medical help for infertility.What determines fertility for a couple?So, what is infertility? By definition, it is the inability of a couple to conceive naturally through normal sexual activity, after 1-2 years of trying. For younger women under 35 years of age, up to 2 years of trying may be considered, whereas the older woman above 35 years old should not try for too long before seeking help (in general, they should see a specialist if there is no success after 1 year or less). This is because aging is an irreversible insult to fertility, hence women of different age groups should be attended to with different levels of urgency. The above does not apply to couples who have known impediments to their fertility; they should see a suitable fertility specialist to start treatment (or at least monitoring) immediately. The Big 5Infertility as a disease, baffles even the medically-trained, let alone the lay person. In order to break down this complex condition for easier understanding, the factors that affect fertility may be grouped into 5 categories: Egg, Sperm, Womb, Tubes and Pelvis.The Egg:All the eggs that a woman will ever have are stored in her ovaries, in an immature form. After puberty, these eggs will be “recruited” in batches every month to be matured and ovulated (released for fertilisation). It is important to know if the amount of egg reserve is adequate to see the woman through her reproductive life and also whether the ovulation “mechanism” is working well to ensure an egg is released every month.The Sperm:Being the only measurable contribution by the male partner, the sperm count is an essential tool to evaluate the reproductive health of the male. We are interested to know if the amount of sperm produced in each ejaculate is adequate, the ability of each sperm to swim (towards the egg) and their shape (quality). The Womb:This is the vessel that will carry the pregnancy. Any disruptions to the womb wall (fibroids, adenomyoma, etc) and the womb lining (denudation, polyps, scarring, etc) will affect the ability to carry a pregnancy.The Tubes:The fallopian tubes are appendages of the womb that allows the sperm to swim towards the ovaries (eggs) and to transport the fertilised egg back to the womb for implantation. These delicate structures are crucial for natural pregnancy, but are easily damaged / blocked by medical conditions of the pelvis.The Pelvis:The pelvis is the environment where the female reproductive organs are located. This enigmatic factor is difficult to assess and often is overlooked when attention is not focused on it. The most common disease affecting this part of the female body is endometriosis. This results in chronic inflammation of the reproductive environment, leading to 2 main symptoms: pain and infertility.At what age does infertility start?When left to natural aging, a woman (who is born with all the eggs she will ever have in her lifetime) will start to experience a sharp drop in fertility potential after the age of about 35 years onwards, assuming she does not have any other medical conditions causing infertility. This accelerated decline in quantity and quality of eggs will taper off into a continued decline into menopause, which occurs around 50 years of age for most women. Hence even in the absence of diseases affecting the reproductive system, aging alone will lead to irreversible infertility.How can you check your fertility?Fertility is not something that a woman can assess for herself at home, at least not in a comprehensive manner. Here is a checklist that is useful to consider when deciding whether to see a fertility specialist (a gynaecologist who specialises in infertility):Have you been trying to conceive without success for at least 1 year?Are you 35 years old and above?Do you have irregular menstrual cycles?Do you have any painful symptoms such as pain / cramps / discomfort during menses, intercourse, passing urine / passing motion, or chronic pelvic pain that may not be related to any activity?Have you had any surgery or procedure done in the pelvis before? Do you have any difficulties having intercourse (inability to penetrate, erection problem, painful, lack of sex drive, etc)?If your answer is “yes” to any of the above questions, then it is best that you consult a fertility specialist. In particular, any painful conditions are best evaluated by an endometriosis specialist. For women who are single, not trying to conceive yet or just want to have a snap shot of their fertility status, may also come forward to do a simple bedside evaluation to assess the Big 5.Final WordsFor the healthy young couples, not affected by any obvious symptoms or diseases, we encourage them to try to conceive naturally for at least 1-2 years, before seeking fertility assessment. For those who screen positive with the above checklist, do consider coming forward for an early assessment. A healthy and active lifestyle with balanced diet and maintenance of optimum weight for both partners will be central to achieving a healthy pregnancy. While we focus our efforts on getting a pregnancy, let’s not forget about enjoying the journey and maintaining the strong foundations of the relationship, which will see us through the challenges that may arise along the way!

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Can I get that ‘Hollywood’ smile with Veneers? A frequently asked question from friends and family at gatherings – ‘I really want that perfect smile we see in movies! Should I do veneers?’Other subsequent frequently asked questions to follow as the gathering continues (outside of working hours)… ‘Will my teeth not get sensitive if the dentist shaves it down’?‘What happens when my veneers come off?’‘Does it last for life?’‘What if I don’t like the shape and colour of my veneers?’Well, today we are going to answer these frequently asked questions about veneers so you can make a sound decision in the pursuit of that Hollywood smile! What exactly are Veneers? Veneers are thin porcelain shells cemented on the front side of your teeth (Think of acrylic nails except that they are for teeth). There are 2 main materials for Veneers: Porcelain and Composite Resin. As a shell, it gives more freedom to change the shape, colour and size of your natural teeth by shaving down the outer layer in order to make room for the veneers to sit on top, without looking bulky.Heres an idea of how many shapes alone teeth can have: Composite Resin, is a cheaper option but it generally does not last as long. It can also be premade and altered when applied onto teeth. Commonly used in non dental outlets such as beauticians which is technically illegal in Singapore though commonly done overseas. Porcelain veneers on the other hand, are superior in shine and longevity though more expensive as they are custom made with a dentist and dental laboratory. A wide variety of colours and shapes are available with digital mock ups that can be done to show you the before and after, before you even start! Porcelain versus Composite Veneers: What are the considerations? In which cases should you consider doing veneers?Mainly to improve teeth that have been irreversibly damaged in one way or another, that can compromise the aesthetics of a healthy looking smile! Here a few examples: Internal stains that cannot be removed or improved with teeth whitening Damaged teeth from trauma (Fracture, fall, )To close gaps in teeth without going through orthodontic treatmentsIf you are considering lengthening your teethWhen are veneers not recommended? Active teeth grinding/clenchingUncontrolled gum diseaseTooth decay Badly worn/broken down toothOverall misalignment of teethHeavy coffee drinker/smoker, as it may cause discolouration at marginsWhat is the process of getting Veneers? What do we recommend in keeping your tooth and veneers healthy?1. 6 monthly cleaning -helps prevent stains (e.g tea, wine, cigarettes) from accumulating at margins2. Avoid eating on hard foods with veneers (e.g nuts, ice)3. Avoid grinding your teeth, wear a night guard if you have night time grindingWhat are some other alternatives to veneers?1. Crowns: These are similar to veneers in the way they are made, however they involve more removal of natural tooth structure! These are usually done when the tooth is more worn down or have been root canal treated!2. Whitening: There are 2 options for this - first where it is done in the clinic chairside by the dentist, while the other is given to you as a home application in a tray! However, whitening has its limitations as it picks up stains a lot easier from coffee/tea/cigarette! You may be advised to do whitening before your veneers are placed to enhance the results!Read more on whitening here! I hope this article has answered some of your questions before you decide to begin on your journey to achieve your best smile!

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Women’s Health

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How Long Does It Take to Recover from Keyhole Surgery? Laparoscopy, also known as keyhole surgery, is a common surgical procedure used to evaluate and treat the organs inside your abdomen and pelvis. It’s minimally invasive and requires only small incisions on the skin of the tummy, to introduce the specialised equipment to conduct the surgery. A long thin tube with high-intensity light source and telescopic lens system connected to an external high-resolution camera allows the surgeon to assess the state of the internal organs. Other similarly shaped equipment may be introduced to conduct a wide variety of treatment; in the woman, common procedures done with laparoscopy include testing of fallopian tube patency, removal of scar tissue, cysts, fibroids, or even whole organs such as diseased ovaries and womb. Does keyhole surgery allow you to go home faster?Laparoscopy is the preferred route for most gynaecological surgeries nowadays, as it confers the benefits of better vision for the conduct of finer surgery, less pain, faster recovery and less scarring / infection, compared to traditional open surgery. The typical post-op stay for laparoscopy is between 1-3 days, whereas open versions of the same surgery typically requires the patient to stay at least 2-3 days, sometimes up to a week, especially if complications arise.How long does the pain last after keyhole surgery?The post-op pain is significantly lower in laparoscopy than open surgery, because the amount of pain is proportionately related to the size of the skin incision. When there is less pain, patients are more likely to be able to start to move around, reducing the risk of spontaneous blood clots forming in the legs (which is a well-described risk of open surgery). How long does it take for keyhole wounds to heal?The wounds also heal faster for laparoscopy (typically fully healed within 1-2 weeks), compared to open surgery, which may take 2-3 weeks for the skin to be fully healed. The scars of laparoscopy are aesthetically more appealing and less likely to develop into unsightly keloids, compared to wounds of open surgery.Are you awake for keyhole surgery?Laparoscopy (keyhole surgery) is usually performed under general anaesthesia, which means that you’ll be total asleep during the surgery and will not feel anything during the surgery, nor have any memory of what took place during the procedure. Once the operation is complete, the general anaesthesia is reversed and the patient will wake up immediately, before being moved out of the operating theatre, to the recovery ward for observation.What are the key differences between laparoscopy and open surgery?Laparoscopy has superseded traditional open surgery for most of the common gynaecological procedures today. This is because of the benefits discussed above, plus others summarised here:Better visualisation of the pelvic organs, so that fine surgery is possible, with less damage to adjacent structures, less bleeding, less internal scarring and lower infection ratesSmall incisions with less pain and faster healingLess pain also allows the patient to start walking earlier and discharge soonerHowever, laparoscopy requires appropriate training and experience to achieve the desired effects of the surgery, equal or better than open surgery. There is also greater reliance on quality of the surgery equipment, which have to be maintained regularly by the hospital.Final wordsAfter laparoscopic surgery, you may wake up feeling some tenderness in your belly button and see some dressings on your tummy, to protect the keyhole incisions. The gas used during the surgery can also make you feel bloated or uncommonly, some shoulder-tip pain. These are usually self-limiting and should resolve by the time you discharge home.Your doctor will prescribe the necessary antibiotics or pain relievers to ensure that your recovery is smooth and uncomplicated. After the surgery, you should pay attention to your body during the period of recovery. If you feel any side effects, write them down and discuss them with your doctor.

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Sexual intercourse after mRNA COVID Vaccination? Vaccine linked cardiac arrest with 16 year old Singaporean maleA 16-year-old boy in Singapore was reported to have gone into cardiac arrest six days after his first dose of Pfizer's BioNTech/Comirnaty Covid. The cardiac arrest happened during a weightlifting session, with the patient being reported to be taking some supplements. However, the latter has not yet been determined whether or not it is related.Myocarditis has been observed to be a rare side effect that the 16 year old teenager suffered from after his mRNA vaccine. Click here to learn more about mRNA COVID Vaccine related Myocarditis. Guidance on strenuous physical activity after COVID vaccinationThe recent update by the Ministry of Health in Singapore recommends no strenuous activity for at least 7 days after individuals receive their first and second dose of COVID-19 vaccines. What exactly is strenuous physical activity and what category does sex fall under?How do we define strenuous physical activity?The target heart rate during strenuous activity usually reaches between 77% and 93% of the maximum heart rate as defined by the CDC.A person's intensity level can be determined by calculating their Target Heart Rate (THR) – that is, how many beats per minute (BPM) they would need to reach a state of being comfortably tired after one hour running on a treadmill or swimming laps. For an average 40 year old healthy man whose max heart rate is 180 BPM , his THR ranges from 138 BPM (77% of 180) to 167 BPM (93% of 180)Examples of strenuous physical activities as listed by Singapore's Ministry of Health includes swimming, cycling, running, lifting heavy weights, competitive sports or physical education, and playing ball or racket games.However, it is important to understand that your exercise tolerance depends largely on an individual's fitness level.What's my exercise tolerance?One way of determining how hard you're working out is through Borg Rating of Perceived Exertion (RPE). The RPE scale ranges from 1-10 with 10 being maximum effort on a given activity; above 7 would be considered a "strenuous activity".As an alternative, a simple indicator of when an activity is strenuous is using the talk test. It is when an individual is not able to “say more than a few words without pausing for a breath”.Does Sex fall under the strenuous activity category?Sex is indeed a workout and really does burn calories, but is not as intense of an exercise session. Men burn 101 calories in one sexual activity on average and this does classify sex as mild to moderate exercise.Heart rates in men rarely go above 130 BPM during intercourse and systolic blood pressure does not go over 170.5 - so don’t expect yourself to have the same tolerance when doing other exercises that are more intensive than your typical bedroom activities with someone special.With that said, don't take this as medical advice and start pushing the boundaries! It is worth repeating that exercise tolerance varies in individuals, and you are the best person to gauge yourself.So, as a quick summary, sex is mostly not a strenuous activity but do remember to pace yourself.Contraindications of the Vaccine and Erectile Dysfunction medicationAt the time of writing, there are currently no reports of contraindication between the COVID vaccines and Erectile Dysfunction medications like Viagra or Cialis.Again, it's important to know your tolerance and your pace. If this means resting your body before getting back in the act, then make sure to listen to your body and let it recuperate.Lastly, always speak to your doctor if you're unsure about getting back into different physical activities after your COVID Vaccination.--This article was adapted from Sire - Singapore's digital men's health clinic. Click here to view the original article

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Breast cancer- common, but curable In conjunction with the World Breast Cancer Awareness Month, Dr. Tan will be sharing a brief summary on basic screening for cancer, updating on modalities for screening during the talk. In addition, she will also be speaking about personalised treatments for breast cancer; as well as overall cancer prevention which is applicable for everyone.

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OBES Congress 2021 The 6th OBES is back virtually with the theme of "Journey of Obesity through the COVID-19 Pandemic” . It will be focusing on people living with obesity in these troubled times. The year of 2020 started us on a harrowing journey through the global pandemic, and 2021 has shown us that our destination may be farther than we thought. Life is off-kilter; change comes swiftly and without warning. We invite you to be travel companions to people living with obesity, to navigate the COVID-19 landscape together – adjusting, adapting and acclimatizing to the ever-evolving challenges faced.

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Latest developments in Hypertension and optimising Blood Pressure control Hypertension is an established risk factor for cardiovascular disease. The 3 main vascular beds involved include cerebral, coronary and peripheral regions. Complications in any of these areas could result in significant morbidity and mortality.Will good hypertension control mitigate these cardiovascular complications? How do we do surveillance for those at risk. All these will be discussed together with several larger than life cases.

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Key note address — Innovation in clinical practice catalyzed by COVID-19: the road ahead for Primary care

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Updates in the management of Hyperlipidemia & tackling Statin Myths Hyperlipidaemia is a very common problem in primary care and is also a significant chronic disease. Many GPs faced the challenges to start their patients on treatment due to many patient factors. Through this webinar, I would like to dispel some of the statin myths so that GPs are better equipped to educate their patients. I will also share the updated reference target in different patient groups and discuss my management approach using different classes of drugs including the new PCSK9 inhibitors for different types of patient profiles.

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Moving towards better patient outcomes in chronic disease management with the help of pharmacogenomics Primary care provides patients with immediate care at the first line of treatment. GPs prescribe medications based on standard therapy and dosing guidelines and medication change or dose modification takes place if the patient is unresponsive or experiences side effects. This conventional “trial-and-error” process of drug optimization is associated with increased cost, and subjects patients to risk of adverse drug reactions (ADRs). Pharmacogenetics offers personalized medicine based on genetic profile for optimal medication choice, reducing unnecessary healthcare utilization, ADRs and polypharmacy. We have conducted a study in private GP practices in Singapore, exploring of feasibility of using pharmacogenetic testing and clinical decision support software (CDSS) in the management of patients with ≥1 common chronic diseases. The primary outcomes were adequacy of DNA in the samples collected by GPs and the number of clinically actionable variants among participants. The pharmacogenetic test panel was selected based on accuracy, speed of delivery and cost. Testing of the DNA was provided by the Genome Institute of Singapore using an Illumina array. Data on the selected single nucleotide polymorphisms were incorporated into the CDSS. Seven GPs from six private practices took part in the study. In my presentation I will discuss our findings and the next steps.

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