eFrenzconnect Health and Wellness

Endoscopic Thoracic Sympathectomy (ETS) for Hyperhydrosis

2006-03-19T20:22:00.000+08:00

ETS is a minimally invasive procedure i.e. surgery that use small instruments and cameras to allow entry into the body with miniscule incisions. This ensures minimal discomfort to the patients.
ETS is the only procedure available that provides permanent cure for hyperhydrosis. It is safe and effective and the hospitalization stay is short (12-24 hours). The patient will return to normal daily routine within a short period of time.

Details of ETS

The patient is put under general anaesthesia. An incision is made below both the armpits.

The endoscope equipment (tiny fiber optic camera) is inserted after the lung on the side of surgery is collapsed. This is to allow better visualization of the sympathectic chain.

The appropriate level is identified and cauterized. Once the surgery is completed, the instruments are removed and the collapsed lung on side of surgery is reinflated. Wound is sutured.

The scarring is minimal and return to regular activity is usually within a week.

Complications of ETS

There is no operation that is without complications. In any surgery, there is a small risk of bleeding and wound infection. For ETS, pneumothorax (air remaining in the chest cavity) may occur. This usually is minimal and does not require any treatment.

Horner’s syndrome may occur. This occurs when the nerve is inadvertently injured resulting in decreased facial sweating, drooping of the eyelid and small pupil on same side of the injury. This is rare i.e. <1% and is unlikely to happen when an experienced surgeon performs the surgery.

Side effect of ETS

Compensatory sweating is observed in patients following ETS. The patients may experience increased sweating of the back, thighs and the legs. Most are not troubled by this side effect. Only about 3% experience more severe compensatory sweating.

The patient may also experience gustatory sweating i.e. increased sweating while eating certain food e.g. hot and spicy food. This is also an uncommon phenomenon following ETS.

Keywords: sympathetic nervous system, hyperhydrosis, endoscopic thoracic sympathectomy (ETS)

Treatment Options For Hyperhydrosis

2006-03-12T20:10:00.000+08:00

The treatments available include:

1. Non-surgical options
a. topical and oral medications
b. iontophoresis
c. botulinum toxin injection

2. Surgery

The non surgical options are not permanent and must be done on a continual basis when the effect wears off. Surgery is the only permanent cure.

Medical Treatments

1. Topical medications

The physician may recommend over the counter antiperspirants. However, if this does not control the excessive sweating, prescription antiperspirants may be recommended. They may have to be applied several times a day. These include:

a. aluminium hexahydrate in alcohol
b. tannic acid solution
c. glutaraldehyde solution.

However, these are strong solutions and may cause redness, itchiness or even swelling of the skin and the effectiveness may wear off with repeated applications.

2. Oral Medications

Antianxiety medications and even antidepressant medications may help to reduce the stress induced sweating. The oral medications that may be useful include tranquilizers and anticholinergics. However, these medications may cause dry mouth, blurred vision or difficulty with urination.

3. Botulinum Toxin

It effectively blocks the nerves that trigger the sweat glands. However, it takes several injections to achieve the desired results and is painful, costly and the results will last for only several months only.

Surgery
The surgery is a minimally invasive procedure. It involves permanently cutting the nerves that carry the messages from the sympathectic system to the sweat glands with the patient under general anaesthesia. The success rate is 95-98 %.

Next: Surgical procedure - endoscopic thoracic sympathectomy (ETS) for hyperhydrosis

Keywords: sympathetic nervous system, hyperhydrosis, endoscopic thoracic sympathectomy (ETS)

No Sweat - Help Is At Hand For Sweaty Palms

2006-03-06T07:03:00.000+08:00

Sweating is a natural, physiological way of regulating our body heat particularly in response to the hot and humid weather for those living in the tropical regions.
Sweating is controlled albeit involuntarily by the sympathetic nervous system that innervates the sweat glands and this system maintains five million sweat glands throughout the body and two-thirds of these are located on both hands.

However, excessive sweating in the absence of such conditions can occur and be a problem. This disorder of excessive sweaty is called hyperhydrosis.

Hyperhydrosis tends to affect the palms, feet, armpits and even the face. Mildly stressful situations, consuming spicy foods or mere physical exertion can trigger excessive sweating causing discomfort and inconveniences. At its extreme it can be hazardous. The cause of hyperhydrosis is unknown but is believed to be secondary to hyper-excitability of the sympathetic nervous system.

Hyperhydrosis can pose severe occupational, social and even emotional distress. Patients suffering from hyperhydrosis may encounter it in different circumstances i.e. be it at their workplaces, homes or social occasions, and in activities e.g. executives requiring face-to-face interaction with their clients, individuals socialising with friends and acquaintances, students or secretaries smearing their work papers, assemblers handling electrical contacts, mechanics handling tool etc.

In some cases, the situation has gotten so bad that patients may even avoid contacts like shaking hands for fear of putting off their business acquaintances, friends or mates. A simple handshake can therefore be emotionally stressful and this may aggravate the sweatiness and may lead to a loss of self-esteem. Hyperhydrosis may also contribute to skin diseases such as athlete’s foot and contact dermatitis.

As this problem does not appear to pose serious health risks, people tend to seek home-brewed remedies which do not address the root of the problem. The good news is that help is at hand (pun-pun) and in the upcoming articles we will examine the options available, including treatments and surgery, to overcome this problem.

Keywords: sympathetic nervous system, hyperhydrosis

What are the treatments for varicose veins?

2006-02-26T05:09:00.000+08:00

This depends very much on the severity of the condition.With medication and stockings, the symptoms of cramps or pain can be controlled. Unfortunately, once diseased, varicose veins can only be cured with surgery.
The type of surgery depends on the distribution of the incompetent valves.

The most common method is to remove the varicose vein from the groin to the knee by passing a wire stripper and pulling the vein out through a small cut at the knee. An alternative is endovenous ablation of the varicose veins. A laser or radiofrequency fibre is passed up the vein from the knee to the groin and the vein is destroyed from within. The advantage of endovenous therapy is smaller wounds and less bruising after surgery. There is theoretical advantage of recurrence of varicose veins from vein regrowth at the groin. Varicose veins in the calf are then removed through small cuts. Surgery can be done under general or regional anaesthesia and there is an option of the patient returning home on the same day.

Injection sclerotherapy is a method of destroying unwanted veins by injecting them with a drug called a sclerosant. This method can be used for both fine as well as large veins. Inflammation of the injected veins, pigmentation and recurrence can be a problem. Another alternative to unsightly fine veins is laser treatment

Keywords: varicose veins, deep vein thrombosis

High Pressure In The Veins Of The Leg

2006-02-19T10:23:00.000+08:00

What are the long term effects of the high pressure in the veins of the leg?
This leads to leakage of fluid out of the blood vessels resulting in leg swelling, this is called lymphoedema. The veins in the skin also swell to become reticular veins, telangiectasia (spider-like veins). The red blood cells also leak out into the tissue around the blood vessels. Red blood cells contain the pigment haemoglobin which is rich in iron. The iron stains the surrounding skin black. This is called pigmentation.
A rash can also develop, it is called stasis eczema. This is a scaly rash that develops around the ankles. With time, the skin can become weepy and crack eventually becoming a venous ulcer. Such ulcers are at times difficult to treat. After healling, they tend to come back again.

What are the reasons for treating varicose veins?

Varicose veins have a functional as well as a cosmetic effect. They are located usually over the inner aspect of the calf. When they stand out like bunches of grapes, their unsightliness prompts sufferers to cover up with a long skirt or pants.
These can be easily removed with surgery. However, when pigmentation starts to occur, these skin changes persist even after surgery.
Cramps can occur at night after a long day of standing or walking. These cramps are usually experienced in the calves.
The ankles may swell and this gets better with raising the legs up or wearing a pressure stocking.
Sometimes, there is a length of varicose vein at the ankle or foot that has thinned out the overlying skin so much that the skin breaks and bleeding can occur from the vein itself. The bleeding can be frightening, but is not life-threatening.
If eczema occurs, surgical treatment of the varicose veins can prevent the rash from occurring.

Next: What are the treatments for varicose veins?

Related article

Keywords: varicose veins, deep vein thrombosis

Varicose Veins And Spider Veins-Treatment For Every Type

2006-02-14T10:10:00.000+08:00

Varicose veins are common and thought of as innocuous. However, it is a known cause of nocturnal calf cramp and heaviness of the legs. They are unsightly and a common cause of leg ulcers.People with varicose veins are usually unaware of their long term effects.

What are varicose veins?
These are dilated and tortuous veins found on the legs.

Who is at risk of developing varicose veins?
Both men and women can develop varicose veins, women more than men. The varicose veins are located on the inner aspect of the calf but can also be found on the thighs and the back of the knees. Women first notice the varicosities after the birth of their children, and they tend to worsen with each birth order.
There are instances where varicose veins appear in the teens. This occurs when a person is born without valves in the veins of the leg.
There are also people who have been afflicted with deep vein thrombosis in the past (deep vein thrombosis is a condition when blood clots in the deep veins of the leg), they can develop varicose veins in the superficial veins later on.

What are the veins in the legs called and what is their function?

Every person has two sets of veins in their legs, the superficial and deep veins. The latter can be found just under the skin. The former is deep within the muscles of the leg.
The superficial veins have two systems, the long or great saphenous vein and the other the short or lesser saphenous vein. Each can be affected in varicose veins.
Varicose veins in the lesser saphenous system can be found at the back of the calf or the outer aspect of the calf. The great saphenous system is more commonly affected than the lesser saphenous vein, causing varicose veins over the inner aspect of the calf or thigh.
The superficial and deep veins are there to carry blood from the legs back to the heart. However, it would appear that blood from the legs has to travel against gravity.
Hence, there are many valves in both the superficial and deep veins of the leg to assist in this function. These valves act by preventing blood from going back down to the feet as they allow only one way direction of flow, up towards the heart. This movement of blood occurs when we walk, since the muscles surrounding the deep veins will help to massage the blood upwards. When the muscles relax, the valves prevent blood from going back down to the feet.

What happens to blood flow in the leg veins when there are varicose veins?

Because the valves are not allowing one direct flow, these valves are described as incompetent. Each time the person stands up, the blood from the top flows back down towards the feet. Hence, the pressure in the veins of the feet builds up.

Next: What are the long term effects of the high pressure in the veins of the leg?

Keywords: varicose veins, deep vein thrombosis

Celebrating Our 50th Through Healthy Aging

2006-01-27T07:00:00.000+08:00

For those of us celebrating half-century of existence, doctors say we should consider early-detection screenings that might help us to reach the next milestone. When we were young and healthy, a general checkup once every four to five years sufficed. However when we reach 50, we need to plan for more regular checkups screening for things that are more likely to occur with age.

Because of concern for cardiovascular disease tests should include for signs of diabetes as well as high blood pressure and cholesterol. There are also screens for cancer e.g.
colon cancer - at age 45-50 most adults should consider an initial colonoscopy. For the "average risk" person, a stool occult blood sampling can be conducted annually.
prostate cancer - men over 50s are encouraged to have an examination through the back passage. Additionally, a prostate-specific antigen (PSA) blood test can detect the disease at an early stage.
breast cancer - women should consider commencing their annual mammography at age 40 or earlier when there is a family history and follow up by regular checkups thereafter.

Bones also requires attention particularly for postmenopausal women and bone density screening can help to detect for signs of osteoporosis.

Do check with your doctor about what lifestyle change is necessary to stay healthy. Maintain your weight, exercise and eat wisely are steps in the right direction.

The doctors have kindly extended their invitation for us to touch base with them through Ask A Consultant Forum.

Cheers

Keywords: high blood pressure, diabetes, cholesterol,impaired glucose tolerance, exercise and diet, osteoporosis

Help ! there's a swelling in my neck

2005-11-24T21:13:00.000+08:00

I would put my neck out (forgive the pun) and say that lumps in the neck are either lymph glands/nodes or from the thyroid gland.

Lymph gland swellings are usually at the side of the neck, both right or left. Lymph glands are drainage portals that sieve out infections. For example, if you have a sorethroat or an ear infection, this can lead to a tender or painful lymph gland swelling. However, lymph gland swellings can also happen in more serious conditions - for example lymphoma (lymph gland cancer) or cancers in the head and neck like nasopharyngeal (nose) cancer.

On the other hand, if you have a swellling in front of your neck that bobs up and down when you swallow, you can bet your last dollar that that is coming from the thyroid gland.

The thyroid gland is a butterfly shaped gland that lies in front of the neck, below the Adam's apple, that produces hormones (thyroxine) to control body metabolism. An enlarged thyroid gland is called a goitre.

Sometimes only part of the thyroid gland is enlarged or there may be a lump arising from the thyroid gland. This is medically called a 'thyroid nodule'. Thyroid nodules are commoner in women than in men. In the usual age group of 20 - 50 years, most thyroid nodules (80%) are benign (non-cancerous). In the extremes of ages - children or the elderly, there is a high chance of the nodule being cancerous and therefore should be removed.

If you think you have a thyroid nodule, see a specialist. He will do the following ...

1. send you for an ultrasound. This is a non-radiation examination, that does not require any injection. The ultrasound will confirm that the nodule is coming out of the thyroid gland and give other information like how many nodules there are, their sizes, whether the nodules are solid or contains fluid (cystic), whether there are calcium deposits (which can be a bad sign).

2. do a blood test to check the thyroid hormones. This will additionally tell if medicine is needed to normalise thyroid function (see previous post)

3. do a thyroid uptake scan. This would involve injection of a low radioactive substance that concentrates in the thyroid gland. This helps give further information about the nodule - ie, whether it is 'hot' - lower chance of cancer, brisk uptake of the radioactive substance or 'cold' - low uptake of the radioactive substance and a 20% chance of cancer.

4. do a fine needle biopsy of the nodule. This isn't as bad as it sounds. A very fine needle, smaller than the one taken to draw a blood sample, is used, under local anesthesia, to make several pokes into the thyroid nodule. The cell material extracted is smeared on slides and sent to the histo-pathologist to read and conclude if cancer is present. No cuts, no stitching, an office procedure that should take no longer than half-an-hour.

Only with the above, can an appropriate decision be made about whether the nodule needs to be surgically removed

Keywords: lymph gland, thyroid gland

Metabolic Syndrome - waz that ?

2005-11-20T20:50:00.000+08:00

The metabolic syndrome is a term coined to explain the co-occurence of high blood pressure, diabetes and cholesterol problems in a person. Think about it - do you know anyone who has a big waist ('central obesity' - more than 90 cm in men and 80 cm in women),who also has hypertension or high blood pressure, a low level of the good cholesterol component (HDL-c) and a high triglyceride or bad fat level ? The last feature is the presence of diabetes or the pre-diabetes state of impaired glucose tolerance (IGT). This person has a high chance of developing heart attacks and diabetes if he/she has not already got it.

With the concept of the metabolic syndrome, it's now accepted that all these do not congregate in the same person 'by chance'. He/she has the metabolic syndrome. Treatment of the syndrome is by treating each and all of the individual components gone wrong.The simplest way is by weight reduction through regular exercise and diet !

Keywords: high blood pressure, diabetes, cholesterol,impaired glucose tolerance , exercise and diet

Power Medications for Rhinitis & Sinusitis

2005-11-01T19:56:00.000+08:00

Giving medications is only one of several options in the management of rhinitis. Before deciding on the most appropriate treatment to prescribe, I will first have to determine the cause of rhinitis: allergic, non-allergic, infectious, occupational, hormonal, or drug-induced. After that, I decide if there are any non-drug and non-surgical methods that may be used to alleviate the symptoms. For example, if a patient is allergic to house dust mite, or cat’s dander, he should be encouraged to clean up his bedroom environment or to keep the cat out of the bedroom. Besides avoidance and environmental control measures, there is also surgery, immunotherapy and neutralization therapy to help in resolving the patient’s symptoms.Three main groups of nasal medications:

1. Oral antihistamines (e.g. Kestine): These act by competitive inhibition of H1 histamine receptors in the nasal mucosa. Blockade of histamine action results in alleviation of block nose, runny nose, and sneezing/itchiness. However, antihistamines do not have a similar effect on the 3 primary nasal symptoms. They are very effective in relieving runny nose, sneezing and itchiness, but less so with block nose. Furthermore, antihistamines block the action of antihistamine, but not the other mediators of allergic inflammation such as bradykinin and prostaglandin. Although symptom relief with antihistamines are significant, steroids offer more in terms of superiority in clinical effectiveness.

2. Steroid nasal sprays (e.g. Nasacort nasal spray): The word “steroids” often creates fear in patients. Such a fear is understandable as many patients are aware of the multitude of undesirable side-effects that is associated with long term oral steroid therapy. However, the use of steroid nasal sprays and short term oral steroid therapy are legitimate options to consider in patients with rhinitis and sinusitis.

3. Oral and spray decongestants: They act by causing vasoconstriction of the erectile tissues found in the nasal septum and turbinates. This results in improving nasal airway patency and lowering nasal airway resistance. Spray decongestants are very effective in unblocking the nose, working rapidly within minutes of administration. However, they do little to relieve runny nose, sneezing and itchiness. Unlike steroid nasal sprays, spray decongestants should not be used for more than 2 weeks because of the development of rhinitis medicamentosa, where the spray itself causes nasal inflammation.

Combination therapy works better!

Decongestants are commonly used in combination with antihistamines and topical steroids. Combination therapy is used for the following reasons:

1. Complementary mode of action on different symptoms: Antihistamines (like Kestine) and steroid nasal sprays (like Nasacort nasal spray) work better on runny nose, sneezing and itchiness, but decongestants work better on block nose.

2. Opposing mode of action on unwanted side-effects: First generation antihistamines cause sedation while oral decongestants produce mental stimulation and alertness.

3. Better distribution of nasal spray: Nasal sprays are poorly distributed in a blocked nose. Preliminary treatment with a decongestant spray for 3 to 5 minutes before administration of steroid nasal spray allows the latter to be more effectively delivered and distributed in the nasal cavity, resulting in better clinical effectiveness.

Keywords: rhinitis, sinusitis, antihistamines

Osteoporosis Talk for Corporate Client

2005-10-31T22:45:00.000+08:00

Dr Low Chee Kwang recently held a lunch time talk on Understanding and Preventing Osteoporosis for one of our corporate clients.

The talk was well attended and participants had the opportunity to measure their bone mineral density.

Dr Low also provided tips on how to keep one's bones in tip top condition.

Keywords: osteoporosis, bone mineral density, corporate health talk

Prevention Of Osteoporosis

2005-10-21T21:17:00.000+08:00

Osteoporosis is a common disease. It can be prevented if you start the following measures as early as possilbe

You need to take balance diet with foods that contain high calcium such as soya bean milk; egg. Try to avoid preserved foods; fast foods or over cooked food where all the nutrients are destroyed.

If you are unable to take normal diet; you should take calcium and vitamin D supplement.

You need to exercise regulary; at least 4 times a week. Walking at 7 to 7.30 am or 6 to 6.30 pm is good as explosure to sun light will synthesize vitamin D from the skin. Exercise make your bone stronger

Avoid coffee; tea and stop smoking or taking drugs that contained steroid.

Identify A Silent Killer

2005-10-21T21:02:00.000+08:00

Osteoporosis is a silent killer as it reveals itself only after fractures have occurred. Identify this killer by a simple bone mineral density test

Fractrue of the hip is very common in elderly people after a minor trauma. After fracture hip; elderly people develop complications such as pneumonia; bed sore; urinary tract infection and deep vein thrombosis. 25% of elderly patients die because of these complications which are due to prolonged bed ridden. Only one of out 4 elderly patients is able to walk after surgery. The other 50% require aid for ambulation and depend on other people to help them in daily activities.

Osteoporosis can be identified by a simple test; bone mineral density measurement. Early treatment will help to prevent fracture which is the sequalae of osteoporosis.

Finger Pain & Snapping

2005-10-17T19:56:00.000+08:00

Many people who use their hands alot for repeated motions common complain of pain at the base of the finger or at the back of the proximal interphalangeal joint. If it is left untreated; the finger will snap open from a closing fist. It is a common condition called trigger finger

Trigger finger is due to flexor tendons are being caught at a circular ligament before the base of the finger. Thickening of the ligament is due to repeatd fiction between the tendon and the ligament.

If it is early; cure can be achieved with injection together with avoiding all the repeated motions.

If it recurs after injection; permanent solution is to release the ligament using minimally invasive technique.

Severe Backache Following A Minor Fall: Immediate Relief

2005-10-16T19:58:00.000+08:00

Many elder people complain of experiencing sudden excruciating back pain following a minor fall. They are unable to move as the back is frozen due to severe pain. They suffer acute compression fracture of the vertebral body.

Patients are often crying in pain as slight movement of the spine will cause excruciating pain. They are often carried to the hospital by ambulance.

Immediate pain relief and gaining of full mobility can be achieved with a percutaneous procedure, vertebroplasty.

Needle is inserted into the fracture site under x rays control; bone cement is injected which fixs and consolidates fracture immediately. Patient feels like miracle has happened as pain relief and return to function are immmediate

Curve Back & Short At Old Age: Prevention

2005-10-16T19:38:00.000+08:00

Many elderly people complain that they become shorter and their back gradually curve forwards when they are getting older. More importantly, they suffer chronic backache that affect their daily activities. It can be prevented if you prevent osteoporosis.

Osteoporosis is a silent disease. You only know you have osteoporosis when a minor injury cause a fracture. Unfortunately; the fracture happens in the spine and cause multiple compression fractures affecting many vertebral bodies. Collapse of height of vertebral body at multiple levels cause shortening of height; curving of body forwards and chronic backache.

Prevent osteoporosis by taking balance diet; taking calcium and vitamin supplement and exercise regularly.

If you are more than 40 of age or have risk factors such as family history of osteoporosis; early menopause; ovaries remove at young age due to disease; taking medications such as steroid; I would advised you to do a bone mineral density measurement.

If you bone mass is low (BMD T score of -1 to -2.50) or osteoporosis (BMD T score of less than negative 2.5); you need medication to strengthen your bone.

Keywords: bone mineral density, osteoporosis, bone

Looks DO matter - even for kids

2005-10-14T23:42:00.000+08:00

Do looks matter, even for kids? Should we consider surgery in kids to improve on their looks?
Just ask any person with bat ears, adult or child, how they endured all the teasing while growing up. All because their ears look different from others.

A simple surgical procedure is all it takes, to transform a child's life. In bat ears, the cartilage that forms the majority of the shape of the ear (conchal cartilage), is flat and not bent backwards, resulting in a flat and featureless ear, just like a bat's. Surgery to correct bat ears involve an incision at the back of the ear, and sculpturing the cartilage and fixing it in such a way as to pin the prominent ear back. It needs surgery because some permanence is required (cartilage has "memory" - it may sometimes spring back)

This ear pin-back operation, or otoplasty, should be done as soon as the kid is conscious of it before he goes to school. It can also be done in adult-hood.

Undergoing plastic surgery should not be misconstrued as indulging in a frivolous luxury. Just ask any kid (or for that matter, any adult), with bat ears.

Looks DO matter

2005-10-14T23:18:00.000+08:00

We often say that what is inside is more important than what is outside. A person's character and personality rank matters more than outward appearance (and for religious believers, the soul above all else). Are looks therefore important? Should one undergo anything to enhance one's looks? Everybody is beautifully and wonderfully made, both inside and outside. Looks DO matter...it matters in getting a job, in progressing in one's career, perhaps also in relationships. It is a reflection of what is inside.

A common complaint for example is the presence of eyebags. If you have eyebags, you tend to look older and more tired than you actually are. Perhaps you are in a job that requires people to trust that you are AWAKE and ALERT in handling their deals. Having prominent eyebags surely convey the impression that you have not slept enough and perhaps, maybe, you may not be up to scratch to deal with the job at hand. This may, who knows, cause you to loose the deal. Or the eyebags betray your real age, and you really want to look younger.

Surgery affords the most effective and quickest way to remove eyebags. Using the laser to remove the eyebags help to ensure that bleeding is kept to the absolute minimum. This translates into quicker recovery and shorter down time. We are talking about the potential of being able to get back to work after a few days.

When you look better after removing those eyebags, you will feel better, and you will live better. It will influence and impact upon(for the better) your personality and character, boost your self-confidence and improve your opportunities.

Looks are not the most important thing in life, but they DO matter.

I Cannot Wear Beautiful Pointed Shoes

2005-10-14T20:34:00.000+08:00

Many ladies complain of pain over inner aspect of the base of big toe once they wear pointed shoes. There is a painful lump at the inner aspect of the base of the big toe. The big toe is also deviated outwards. It is a classical presentation of hallus valgus.

Hallus valgus is a common condition. It can run in the family. Ladies are more affected as they wear fashionable pointed shoes. The big toe is deviating outwards. In many occasions; it is overriding the second toe. There is always a painful bunion over the inner aspect of the base of big toe. Wearing shoe is extremely painful. However many people will cover the deformity with wearing shoes which in turn aggravating the condition. There are 2 solutions. One is to wear shoes which are round and broader. Another solution is to improve the appearance and function of the foot with corrective surgery. After surgery, wearing fashionable point tip shoes is no longer a problem.

My Knee Locked After An Injury

2005-10-14T20:20:00.000+08:00

Many active persons complain of knee locks frequently after an injury.The thigh muscles also become smaller. A classical symptom of meniscus injury

Meniscus is a moon shaped cartilage that situated between the thigh and shin bones. It helps to distribute pressure in the knee. It is easily injured following a twitching injury to the knee. The knee becomes swollen due to bleeding in the joint. Walking is painful and causes limping. After a week; the thigh muscle is getting smaller. The knee locks frequently as the knee suddenly unable to move due to the torn portion of the meniscus jamps in the joint. The only treatment is to do an arthroscopic examination. Depending on the position of the tear, the meniscus can be repaired or the torn portion can be removed. It is a long term solution for an active person and can return to preinjury activities or sports

Non Invasive Procedure: ESWT

2005-10-13T21:46:00.000+08:00

Extracorporeal shock wave therapy refers to the clinical use of shock waves for treatment of common orthopedic conditions. It is used an alternative to surgery.

In 1989, shock wave therapy was introduced for clinical use for treatment of non union of fracture and slow healing fractures. Success in this area led to extend its uses on other chronic disorders, like Tendinitis, shoulder calcification and heel spurs.

It works to alleviate pain by the following mechanisms:

1. Shock waves stimulate the metabolic reaction of tissue, causing development of fibers and/or change in membrane permeability

2. Shock waves create cavitation bubbles which break down and change the consistency of calcific deposits

3. Shock waves induce an analgesic effect by over-stimulating the axons (Gate-control Theory), thereby increasing a person’s pain threshold.

It is used safely for the following conditions

1.Non union of fracture
2.Tendinitis calcarea
3.Tennis elbow
4.Golf elbow
5.Heel spurs
6.Heel cord pain

ESWT is recommended for patients suffering from chronic pain, who have not responded to conservative treatment for a period of three months.

ESWT is a non-invasive procedure. Patients are treated on an outpatient basis. The average treatment time is about 30 minutes and the procedure is performed in most cases without using local anesthesia.

ESWT therapy usually consists of 1-3 sessions, during which low energy shock wave blasts are administered to the point of pain – normally 2000 blasts. Localization of the treatment area is accomplished using fluoroscopy; ultrasound and bio-feedback.

Success rates for ESWT are good to excellent. ESWT is a legitimate and useful non-invasive therapy for people suffering from chronic pain and an alternative to surgery.

Cervical Spondylosis: Prevention Is Better Than Cure

2005-10-13T20:58:00.000+08:00

Neck pain in middle age and above is very common as most people have degeneration of cervical spine which is called "Cervical spondylosis". It can be prevented if you take goof care of your neck when you are young.

It is a chronic degenerative condition of the cervical spine that affects the vertebral bodies (bone spur); intervertebral disks (disk herniation), as well as the contents of the spinal canal.

Spondylosis progresses with age and often develops at multiple interspaces. It is the most common cause of progressive spinal cord and nerve root compression. The symptoms include neck pain and stiffness; pain and numbness along the upper limb; weakness of the upper limb muscles.

If untreated and allow to progress to advanecd stage; it will affect the lower limb ; bladder and bowel functions resulting in weakness, impaired fine motor coordination to quadriparesis and sphincteric dysfunction (eg, difficulty with bowel or bladder control).

Do not allow yourself to develop cervical spondylosis. Prevent it by keeping your neck straight all the time during activities such as reading; using computer. Use a pillow with suitable height to keep your neck straight when you sleep.

If you have any neck pain or stiffness that last for more than 2 weeks; I will strongly advise you go seek attention to find out the cause of your neck pain.
MRI will accurately diagnose your condition.

In early stage; you will recover with medications; therapy and keeping correct posture.

In late stage with neurological symptoms; surgery to decompress the spine; freeing the nerves and stabilization of the spine will acheive long term remission.

What to screen and when to screen

2005-10-09T22:15:00.000+08:00

There are headlines screaming out at you every day about getting your health screening done. But, I guess for most people, there is no real concern about the health screening nor do they have a clue what to screen for.

Health screening aims to identify disease in so called “well” individuals through physical examinations, tests and other procedures that can be easily applied.
Just yesterday, the Straits Times reported on how preventive medicine is so much cheaper and better in its outcomes. For the individual, it adds years to their lives and for the community and country, preventive medicine is the most cost effective and when diseases are detected, they are also usually early which means treatment outcomes are better and more likely to yield positive results at lesser costs.
This is where health screening really comes in. However, screening must be based on evidence that it leads to better outcomes. For mass screening, obviously, there should be also be evidence of cost effectiveness. This means that the disease to be detected can be picked up easily and early enough so that early treatment leads to better clinical outcome and results.
All these benefits may not always be intuitive to the individual, eg when hypertension is detected and treatment instituted, the patient is unable to appreciate the fact that if the blood pressure is well controlled, then he is at much lower risk of heart disease or stroke. However, if he does have a stroke later on in life despite adequate blood pressure control, then it is so easy to declare that controlling the blood pressure is not important! If we look at this in perspective, we must remember that good control reduces the risk of developing the complication but it does not reduce it to nought.
It is also probable that with adequate blood pressure control, the stroke may have been delayed or be less severe than if the blood pressure was out of control. What we cannot prove here is that if the blood pressure is left untreated, than he will have a stroke earlier, since it would be unethical not to treat the patient.
Before one starts on health screening, there are some tips to remember. No screening test is 100% sensitive and specific. False positive results can arise, causing anxiety and requiring further tests while false positive results may give a false sense of security. Hence, I would recommend that one discusses the tests with a medical practitioner for proper evaluation.

Understanding Prostate Cancer

2005-10-09T18:52:00.000+08:00

Prostate cancer is the No. 1 cancer in men in the USA. The incidence of prostate cancer has been rising in Singapore. It is currently the 5th most common cancer in men in Singapore. The incidence rises with age. Testosterone and dietary fat may be a contributing cause of prostate cancer. Vegetables and soya may have a protective effect.

Warning signs appear only after prostate cancer has progressed to an advanced stage. Symptoms include urinary dribbling; inability to urinate; difficulty starting or stopping the urinary stream; frequent urination, especially at night; blood in the urine; pain or burning while urinating; and persistent pain in the lower back, pelvis, or upper thighs. Most of these signs could also be a result of such benign conditions as infection or prostate enlargement.

As with all cancers, early detection of prostate cancer is essential. Men over 50 are urged to have examination of the prostate through the back passage by a doctor annually. A blood test for prostate specific antigen (PSA) can also detect the disease at an early stage.

When cancer is suspected, the diagnosis is confirmed by obtaining a sample of the prostate and examining this under a microscope. Using a technique of passing Ultrasound waves through the back passage, it is now possible to visualize the prostate and take a sample of the prostate with a thin needle . This is known as ultrasound-guided prostate biopsy.

Once cancer is confirmed, Surgery or Radiation therapy are the primary treatments for prostate cancer still confined to the prostate. Surgery involves removing the diseased prostate and reestablishing the continuity of the urinary tract. This may be performed traditionally by open surgery or by keyhole surgery with or without the assistance of a robot.

Radiation may be given externally or in the form of radioactive wires that are removed after they have done their work. Radioactive seeds may also be implanted into the prostate. These remain permanently in the prostate. Hormonal therapy is used when disease has spread. This removes the effect of the male hormone testosterone on the cancer causing it to stop growing and even shrink in size. This can be achieved by injections or surgically removing the testes. Chemotherapy is used only when other treatments cannot be used or have failed.

Keywords: prostate cancer, dietary fat, testosterone

Restoring Nature's Beauty

2005-10-04T19:52:00.000+08:00

Everybody is beautifully and wonderfully made. Unfortunately, sometimes disease or injuries mar that beauty. October is Breast Cancer Awareness month, a month where ladies are reminded to do regular breast examinations.

But what happens when there is cancer, and the breast needs to be removed? Breast Cancer is the commonest cancer amongst women in Singapore. Because of improved and more widespread screening like annual mammograms and ultrasound surveillance, breast cancer is increasingly being picked up in younger women.

The mainstay of the treatment of breast cancer is breast removal surgery, or mastectomy, in conjunction with adjuvant therapy, either chemotherapy or radiotherapy.

When faced with the prospect of needing a mastectomy, do not despair, because that beauty need not be gone forever...it can be restored and reconstructed. Preferably with your own body tissue.

Breast removal and reconstruction techniques have so evolved that now, the end result is really very close to the original. Several refinements in surgical techniques have contributed to the restoration of nature's beauty, performed within a reasonable space of operation time of 4 to 6 hours.

Skin-Sparing Mastectomy - means that the Breast Resection Surgeon removes as little skin and nipple as is possible, and the Plastic and Reconstructive Surgeon is able to utilise the remaining breast skin pocket to help shape the new breast.

Simultaneous and Immediate Breast Reconstruction - means the breast reconstruction is performed at the same operation as the mastectomy. Simultaneous when the donor tissue is performed at the same time as the removal surgery, thus saving almost 2 hours of operation time.

Shortening the operative time translates into reduction in facility costs, reduction in exposure to general anaesthesia time with resultant quickened recovery time.

No doubt Breast Reconstruction means additional surgery, but that additional surgery is worth the discomfort and cost in the long-run.

Moody, Tired, Irritable ... Blame Your Thyroid !

2005-09-28T10:28:00.000+08:00

Thyroid ? Oh ! Is that the same as tonsils or thymus ? Oh yes ! that's due to a lack of iodine isn't it ?

Actually, the thyroid (pronouced thigh-roid) is a gland (an organ that produces hormones) that sits in front of one's neck - of course not outside it !. It's covered by your skin and fat and muscle and just behind it is the voice box and swallowing tract. So there's no way, it can be caused by you shouting or using your voice too much !

Thyroid problems may be functional in nature or structural. The former indicates hormonal imbalance - the hormones produced by the thyroid are simply (and unimaginatively) called T4 (thyroxine) and T3 ( I forget, the name's too long!). Functional problems mean that the hormones are either too high (produced excessively by an over-active thyroid gland) too low (from an underactive or under-performing gland) in the blood. Functional problems affect how you feel and function, because thyroid hormones control body metabolism- your weight, your body temperature (hot or cold) and your energy.

Structural thyroid problems are simply whether the thyroid gland is enlarged or whether there are lumps (nodules) in the thyroid gland.

In an overactive thyroid condition, called hyper-thy-roid-ism, the symptoms can be quite troubling - heart racing or palpitations, hand or finger (even leg) tremors, nervousness, anxiety, feeling unduly tired, an active mind that keeps one from sleeping at night, menstrual disturbances, feeling hot and sweating even during cool weather, losing weight or keeping the weight off despite a healthy appetite ( a women's wish-come-true). Diagnosis is confirmed by a blood test for the hormonal level. Treatment can be either

1. taking medication - anti-thyroid drugs orally, daily for a course of 18 months to 2 years.
2. surgery, where most of the thyroid gland is removed under general anesthesia, leaving just the right amount behind; or lastly
3. radio-active iodine, which is taken usually, just once, as a pill or a glass of liquid. The iodine makes a bee-line to the thyroid gland and the radiation kills off the tissue, with no spill-over effects on the rest of the body.

Hypo-thyroid-ism is an under-active thyroid condition. You would feel extremely lethargic - both physically tired as well as mentally slow, forgetful, sleepy, putting on weight because of a low metabolic rate, bloated, aches and pains, a slow heart and pulse rate, dry skin and hair, constipationa and menstrual disturbances. Oh yes, and not to forget, feeling unduly cold compared to others in the same room.

Something triggers the immune system to attack the thyroid gland to make it underactive. The treatment is simply to replace what the thyroid gland is no longer producing - giving thyroxine in an appropriate dose, by tablets, for the rest of the life. Fortunately, replacement is simple. The tablets are without side effects. It may take about 6 months to get the dose right, and after that, it is checking the blood levels of thyroxine every 6 months with a visit to the doctor's.

More about structural thyroid problems in another posting ! stay tuned !

Keywords: thyroid, metabolism, palpitations

Sugar, Spice and All Things ... Sweet !

2005-09-10T09:08:00.000+08:00

Isn't that what diabetes is all about ? Pronouced die-a-bee-tis, short for diabetes mellitus, quite a mouthful. Well, yes and no. People know it as high blood sugar, the Chinese and Malays call it 'sweet urine'; medically it is an uncurable, chronic condition that affects the metabolism of carbohydrates/starches (that's what sugar is), fats and protein .....

There are many types of diabetes but people are familiar with the 2 most common forms - Type 2, previously known as adult-onset diabetes or non-insulin-dependant diabetes; and Type 1, or juvenile-onset, insulin -dependant diabetes.

Other types of diabetes are
gestational diabetes - diabetes happening in pregnancy
diabetes coming on from pancreas destruction (pancreatitis), for example due to excessive alcohol intake
drug-induced diabetes - brought on by certain medication like steroids
diabetes associated with other hormonal disorders - thyroid overactivity (hyperthyroidism), growth hormone excess (acromegaly), steroid hormone excess (Cushing's syndrome)
diabetes associated with some genetic conditions like Down's syndrome or Turner's syndrome

Some salient points on diabetes, to take note of

1. Type 2 diabetes is the most common form of diabetes. In both Type 1 and Type 2 diabetes, certain individuals are at risk because of genes and inheritance. There is then a trigger from the environment that makes it happen. This, in Type 2 diabetes, is a lifestyle that is sedentary leading to overweight. In Type 1 diabetes, the trigger can be a virus attack that activates the immune system to destroy the pancreas

2. In type 1 diabetes, insulin is absolutely necessary and the only way to give insulin at present, is by injections - usually 2 - 5 times a day ! Type 1 diabetes can affect both young children as well as the elderly. In type 2 diabetes, control is by a combination of dieting and exercise to lose weight, meal planning involving choosing the right classes and amounts of food to eat; as well as oral tablets and sometimes even, insulin.

3. The classic symptoms of diabetes are a feeling of extreme thirst, frequent urination, weight loss despite a good appetite, feeling unduly tired, blurring of vision and sometimes noticing ants around one's urine in the WC. However, most people with Type 2 diabetes, dont' feel it at all.

4. Because a lot of people don't feel the high blood sugar (hyperglycemia) effect of diabetes on themselves, the aim is not so much to make one feel better, but to prevent the complications that start to take a toll after years of diabetes. These complications affect the eyes leading to blindness, nerves and blood vessels to the feet leading to leg amputations due to wounds that get infected, kidneys leading to kidney failure, heart attacks and stroke. In men, an equally feared complication is impotence, now more kindly called 'erectile dysfunction'!

5. However, to make point 4 worse, some people first notice they have diabetes when they get its complications. This sadly and frighteningly means that they had diabetes for a good many years without knowing it, probably because they never had an annual !

6. The good news however, is that you can master (though not cure) the condition and gain an upper hand over it, rein it in and prevent the complications through good control of diabetes and its associated blood pressure and blood cholesterol problems !

Dr Kevin Tan
Consultant Endocrinologist
Keywords: pancreas, steroids, dieting, exercise, insulin, diabetes

Introduction

2005-09-10T09:00:00.000+08:00

Hi,

I'm the new addition to this health team of bloggers ! Here to help you with your questions and concerns about diabetes, thyroid problems, calcium and bones, testosterone (you know, the macho-hormone), growth hormones (both in kids and aging), weight problems, high blood pressure and high cholesterol. Ever heard of the pituitary or adrenal glands ?
This is the whole field of endo-cri-no-lo-gy ... which is what I do !

Send your questions and I'll try my best to answer them !

Hope to hear from you

Dr KT
Keywords: diabetes, thyroid, bones, calcium, cholesterol, aging, blood pressure, insulin, pituitary glands, adrenal glands,

Know Your FA(:-c)Ts!

2005-09-09T08:23:00.000+08:00

My friend told me he has lost 7 kgs and was thrilled. I was thrilled for him too, as it was a step in the right direction. So, I whipped out my laptop and said, "Let's take a look at your BMI!" BMI stands for Body Mass Index. And we keyed in the facts, and the answer read " BMI = 29". And it meant that he was hovering just below the threshold of obesity. He asked, what will it take to be classified as normal, so we did a "goalseek" by setting the target of 25 for BMI, and the answer was : " You need to loose another 7 kgs!: He can start first by reducing intake of food by about 300 calories daily and or by exercising more. And as the program also tracks the amount of calories consumed, we selected one of our favourite food items, "ham ", and queried for a breakdown of calories. To our surprise, we found that it contains 34% fats, with the remaining percentage comprising proteins. So in a double whammy sort of way, it dawned on us that not only we need to watch our weight, we need also to be aware of the amount of fats we are consuming. We ran out of time as we need to go for a meeting. We will continue after we return on what to do next.

In the meantime, do you know your fats? You can drop us a line and share with us your insight.

Neck Pain

2005-09-07T23:29:00.000+08:00

Most neck pain is caused by activities that result in repeated or prolonged movements of the neck's muscles, ligaments, tendons, bones, or joints. This can result in a strain (overstretched or overused muscle), sprain (injury to a ligament), spasm of the neck muscles, or inflammation of the neck joints. These activities include painting a ceiling, sleeping with your neck twisted, slouching, or staying in one position for a long period of time.

Neck pain can occur from the bottom of the head to the top of the shoulders. It may spread to the upper back or arms & may cause limitation of neck and head movements. It is common in middle age & older adults. More than 50% of people older than 50 years old have suffered neck pain.

Less frequently, neck pain is caused by injury, such as whiplash that occurs in a motor vehicle accident; a fall from a ladder, infection in the neck, narrowing of the spinal canal in the neck (cervical spinal stenosis), or rheumatoid arthritis.
The symptoms include feeling of a "kink," stiffness, or severe pain in the neck. The pain may spread to your shoulders, upper back or arms, or it may cause headache. There are difficulties in moving or turning the head and neck. Pain that shoots down the arm; numbness, tingling and weakness in the arm suggest pressure on the spinal nerve roots.
If your neck pain is long-lasting (chronic), it may be difficult to cope with daily life and subsequently lead to fatigue, depression, and anxiety.
If neck pain is acute and very severe or is persistent and does not improve after a week, it is important to evaluate the neck with X-ray, magnetic resonance image (MRI), computed tomography (CT) scan to check the neck bones, spinal discs, spinal nerve roots & the spinal cord.
Neck pain that occurs suddenly and recently (acute pain) can be relieved by reducing the pain with ice and non steroidal anti-inflammatory drugs (NSAIDs); improving neck movement and flexibility with exercises or physical therapy and avoiding further neck injury by changing activities and body mechanics, such as sitting up right or sleeping with a pillow 4 inches high. Most neck pain caused by activities goes away within 4 to 6 weeks.
Chronic neck pain is first treated the same way as acute neck pain. Medications, such as muscle relaxants; or antidepressants may be needed in addition to pain relieving drugs. Physiotherapy stress management and relaxation techniques are effective.
Surgery is rarely required to treat neck pain. It may be considered if neck pain is caused by pressure on the spinal nerve roots, a severe injury that has broken a bone in the spine (vertebra), a tumor, or a condition such as cervical spinal stenosis (narrowing of the spinal canal).

Keywords: muscle, ligaments, tendons, rheumatoid arthritis, spinal nerve roots

Rotator Cuff Tears

2005-09-04T19:37:00.000+08:00

Rotator cuff tear is a commnon disability affecting the shoulder. It happens in workers who do overhead activities such as painting, stocking shelves or construction or athletes such as swimmers, pitchers and tennis players.

It is most common in people who are over the age of 40. It may occur in younger patients following acute trauma or repetitive overhead work or sports activity. It may also happen with another injury to the shoulder, such as a fracture or dislocation.

Rotator cuff tear is a common cause of pain and disability affecting the shoulder joint in adult. The rotator cuff is made up of four muscles and their tendons. These combine to form a cuff over the upper end of the arm bone or head of the humerus. These four muscles are supraspinatus, infraspinatus, subscapularis, and teres minor which originate from the "wing bone" or scapula and together form a single tendon unit that inserts on the greater tuberosity of the humerus. The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. Most tears occur in the supraspinatus but other muscles may be involved.

Symptoms

Acute pain usually follows trauma such as a lifting injury or a fall on the affected arm. More commonly, the onset is gradual and may be caused by repetitive overhead activity or by wear and degeneration of the tendon. Pain is in the front of your shoulder that radiates down the side of your arm. At first the pain may be mild and only present with overhead activities such as reaching or lifting. It may be relieved by pain relieving medications. Over time; the pain may become noticeable at rest. There may be pain when you lie on the affected side and at night. Other symptoms may include stiffness and loss of motion. You may have difficulty using your arm to reach overhead to comb your hair or difficulty in placing your arm behind your back to fasten the hook of the bra.

When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm.

Diagnosis

The signs of a rotator cuff tear include atrophy or thinning of the muscles about the shoulder; pain when you lift your arm; pain when you lower your arm from a fully raised position; weakness when you lift or rotate your arm and crepitus or crackling sensation when you move your shoulder in certain positions

X-rays of a shoulder with a rotator cuff tear are usually normal or show a small spur. An MRI can distinguish between a full thickness (complete) tear of the tendon and a partial tear. It can show if the tear is within the tendon itself or if the tendon is detached from bone. In some circumstances, an arthrogram, in which dye is injected into the joint, may also be helpful.
Treatment Options

If the tear is partial, non-surgical treatment can provide pain relief and can improve the function of your shoulder. Non surgical treatment include:
• Rest and limited overhead activity
• Use of a sling
• Anti-inflammatory medication
• Steroid injection
• Strengthening exercise and physical therapy

It may take several weeks or months to restore the strength and mobility to your shoulder.

Surgery is indicated if nonoperative treatment does not relieve the symptoms. Surgery may also be considered if the tear is acute and painful, if it is the dominant arm of an active individual or if you need maximum strength in your arm for overhead work or sports.

The type of surgery performed depends on the size, shape and location of the tear. A partial tear may require only a trimming or smoothing procedure called a "debridement." A complete tear within the substance of the tendon is repaired by suturing the two sides of the tendon. If the tendon is torn from its insertion on the greater tuberosity of the humerus, it can be repaired directly to bone. Surgical repairs can be done on an outpatient basis.

If the acromion is thought to cause "impingement" on the tendon and lead to a tear; it is important to remove part of the front portion of the acromion as part of the procedure. Other conditions such as arthritis of the acromioclavicular joint or tearing of the biceps tendon may also be addressed.
Three approaches are available for surgical repair. These include :

Arthroscopic Repair
A fiberoptic scope and small instruments are inserted through small puncture wounds. The scope is connected to a television monitor and the surgeon can perform the repair under video control.

Mini-Open Repair
Newer techniques and instruments allow repair of a complete rotator cuff repair through a small incision, typically 4 cm to 6 cm.

These two procedures allow for smaller, less painful incisions and faster recovery time.

Open Surgical Repair
A traditional open surgical incision is often required if the tear is large or complex or if additional reconstruction such as a tendon transfer has to be done. In some severe cases, where arthritis has developed, shoulder replacement is an option. Dissolvable anchors are used and these hold stitches in place or hold stitches down to bone until the repair has healed and then are absorbed by the body. Orthobiologic tissue implants is now under evaluation for its ability to promote growth of new tissue in the body, and help with the healing process.

Rehabilitation
After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. You will be given an exercise program to help regain motion and strength in the shoulder. This begins with passive motion. It advances to active and resistive exercises. Complete recovery and return to overhead work and sports activity may take several months. A strong commitment to rehabilitation is important to achieve a good surgical outcome.

Keywords: shoulder, muscles, sports, tendon

What's the fuss about BMI?

2005-09-04T15:43:00.000+08:00

The Body Mass Index (BMI) is the standard index for relative weight and this is commonly used as a surrogate for body fat. It is calculated from the body weight in kilograms ( kg ) divided by height squared in metres. Currently, the BMI cut-off of 25kg/m2 and 30kg/m2 are taken to identify overweight and obesity respectively in accordance with the World Health Organisation recommendation.

In recent years, there has been evidence to show that Asians are at higher risk of developing cardiovascular diseases at lower BMI compared to the Caucasian population. The reasons postulated for this difference include differences in fat composition and genetics.
In keeping with this, the Health Promotion Board has recently included new BMI cut-off points as trigger points for various public health interventions and research in Singapore while maintaining the World Health Organisation recommendations of the BMI cut-offs to calssify overweight and obesity.

What does all this mean is that the BMI is a good starting point but it is only one of numerous risk factors to consider when assessing the risk of developing heart disease. Thus, if you have a not too desirable BMI, perhaps it is time to consult a doctor who would be able to assess your individual risks. On the other hand, having a desirable BMI does not mean you can slack with maintaining your weight and health through healthy eating and exercise!

R2D2 - What Is My Age?

2005-09-04T15:31:00.000+08:00

Guess what? I am not as young as I would like to be (18 again!) but suffice to say, my realage could be better. I would urge you to take the realage test if you have not done so already and it will really put your health in perspective. I guess if I have to live long, then I gonna make sure it is a good, healthy one.

So is this realage stuff rocket science? I believe that it is the first practical tool to be devised to help measure the activities we engage in and see the impact of these activities on our health.

Scientifically speaking, if one is to examine a population as a whole, then each bodily function(eg brain, kidney etc) performance declines as we age. Generally, after the age of 35 (sigh!), our body function declines about 3-6% per decade. In devising the realage test, Dr Roizen examined at least 25,000 medical literature and used these recommendations in his calculation of one's realage. Is this data good enough? Obviously, the gold standard in medicine to see the effect of one's behaviour and outcome ( in this case, the aging process) is to conduct a double blind randomised control trial. This means, take for example, the effect of smoking on the process on aging. In this type of trial, one would need to have some measures of one group of individual who are not smoking and another group to see if they smoke and follow them up for life to come up with the conclusion. These huge population studies obviously would take a long time and by the time we know these results, one generation may have gone by. Incidentally, such a population study was done which showed that smoking increases the risk of lung cancers.

Overall, Dr Roizen has looked at all the scientific evidence out there in the medical literature and ascribed to each factor certain weightage and then came up with an easy to understand number so that it will impact each one of us, i.e. our real age!.

Next - what are the factors to modify?

Aesthetic Procedures: The Informed Patient

2005-09-03T11:56:00.000+08:00

Aesthetic Procedures and Treatments: The Informed Patient

There has been much discussion about aesthetic procedures and surgery in response to Dr Ho’s article “Let market decide on aesthetic physicians” in the Straits Times dated July 16 2005. It is indeed welcome that this discussion has emerged in the mass media as it is an important issue.

Unfortunately, the article has some inaccuracies and omissions that should be addressed.

The article seems to imply that Botox and fillers are “medical devices” which are not regulated in Singapore. Botox and some fillers are approved by the FDA and HSA and thus do not fall under this category. If there are new machines that are not regulated, perhaps a mechanism for this should be implemented. One must be aware that, as it is in many fields, too much regulation also stifles innovation.

Dr Ho has rightly pointed out that there are 35 registered specialties in Singapore with specific training, examination and certification requirements. For example, a plastic surgeon goes through six years of medical school and housemanship, three years of basic surgical training and four years of advanced surgical training in plastic and reconstructive surgery. This includes an attachment in an overseas training institute approved by the Ministry of Health. A trainee is plastic surgery must acquire textbook knowledge as well as surgical skills under the supervision of experienced surgeons for many years. This includes knowledge in the reconstructive and well as cosmetic aspects of plastic surgery. By the time a plastic surgeon gets to administer Botox or do a breast augmentation, he would have seen the facial muscles and the breast tissue of many patients from the inside. In other words, the inclusion of a doctor in the specialist register of the Ministry of Health means something.

One must remember that this avenue to specialist status is also open to the “aesthetic physicians”. It is true that cosmetic surgery was once thought to be on the fringe of “true” medicine. It is through the efforts of many plastic and reconstructive surgeons throughout the world that cosmetic surgery is now a recognised branch of plastic and reconstructive surgery. We are no longer the “charlatans” we once were. Maybe the solution for the aesthetic physicians is to create the 36th specialty with 3 years of specific training, examination and certification requirements which are recognised by the Singapore Medical Council. This would be better than going for many 2-3 day courses not recognised by the authorities and solve the problem of credentialing.

I am pleased that Dr Ho has brought up the issue of private credentialing. Take the example that he used, the American Academy of Aesthetic Medicine. It is true that its membership is open to “dermatologists, cosmetic surgeons, endocrinologists, GPs, eye and ENT specialists, among others”. It is important to realise, however, that membership in this academy does not confer any special qualification upon the doctor. How does one qualify to be a member? More importantly, will members of the public assume that this appellation gives an assurance that a physician is trained in the field?

The final two paragraphs of the article seem to suggest that there is no clinical data to permit skills to be judged on outcomes. This is not true. Just looking at Botox, one is able to find over 2035 articles in refereed medical journals pertaining to this topic. One must understand, however, that research on patient outcomes in aesthetic patients is relatively difficult to undertake because aesthetic outcomes are usually pictorial and aesthetic patients are private individuals. Furthermore, the quality of an outcome can be subjective and difficult to measure.

As a group of medical professionals, we object to an overly “laissez faire” “let the market decide” attitude to medical care. There is no objection to healthy competition with a level playing field where the patient is fully aware of what procedure is being done and who is doing it. This is not the situation at this point in time. Singapore’s healthcare has gained a hard won reputation of high standards which stands it in good stead in becoming a medical hub. This is one of our differentiating factors in the face of regional competition. An overly “hands off” attitude at the expense of patient safety should not be adopted.

Sleep Apnoea – A Wake-Up Call

2005-09-02T11:49:00.000+08:00

By Dr Ong Kian Chung
Consultant Respiratory Physician

Sleep apnoea is a medical condition that has 2 potentially serious consequences: (1) excessive sleepiness in the day and (2) cardiovascular disease.
While one can possibly put up with the former (a lot of people are sleep-deprived anyway), the development of cardiovascular disease such as hypertension as a result of sleep apnoea is something most people would like to avoid.

There is now a large amount of evidence showing that sleep apnoea is independently associated with a wide spectrum of clinical cardiovascular disease (reference: Obstructive Sleep Apnoea and Cardiovascular Risk. Lancet 2005;365:1046-1053).

Evidence for a causative effect of obstructive sleep apnoea (OSA) is strongest for hypertension. It has been recommended that: "given the high prevalence of OSA in the community and its effects on the cardiovascular system, as well as the established improvement in blood pressure with treatment of OSA, symptoms of this disorder should be sought in patients being investigated and treated for hypertension." But a lot of the scientific findings and evidence of the link between sleep apnoea and cardiovascular disease are so new, not many people are familiar with this issue. How often does you doctor inquire about your sleep when you consult him or her anyway? Read on to find out more about sleep apnoea for yourself.

What is Sleep Apnoea?

Obstructive sleep apnoea (OSA) is a condition characterized by intermittent episodes when breathing is interrupted (apnoeas) due to obstruction of the upper airway during sleep.

Sleep predisposes one to narrowing - and in susceptible persons, to collapse - of the upper airway by reducing the tone of the upper airway muscles. The areas of the upper airway that are predisposed to obstruction during sleep is usually behind the soft palate and behind the tongue. Complete airway collapse during sleep is usually preceded by years of narrowing that produces snoring. Thus by the time adults with OSA come to medical attention, they have a long history of loud snoring, often beginning in childhood. When outright obstruction of the airway develops, however, the snoring is interrupted by periods of silence lasting 15 to 90 seconds, coincident with the complete cessation of airflow. During these episodes of apnoea, severe reduction of oxygen level in the body often develops until the apnoea is terminated by a brief awakening or arousal, and airway patency is restored. These events are usually accompanied by a generalised startle response, snorting and gasping. After a few deep breaths, the patient returns to sleep, only to have the cycle of events repeated as many as 200-400 times during 6 to 8 hours of sleep.

OSA is a common medical problem that affects about 5% of the population. OSA should be suspected in people who are obese, habitual snorers, sleepy in the day or have hypertension.

Obesity and Sleep Apnoea

Perhaps the most important determinant of whether one is at risk of OSA is whether one is overweight or not. OSA is present in about 40% of obese individuals and about 70% of OSA patients are obese. A recent study showed that a 10% weight gain is associated with a 6-fold increase in the odds of developing OSA and a 10% loss in weight led to a 26% decrease in the severity of OSA.

Even children are not spared. OSA was found to be moderately prevalent among obese children-namely, 13% to 36%. The severity of OSA was positively related to the degree of obesity. Blood pressure is found to be elevated in obese children with OSA and weight reduction is an effective treatment.

Typically, a person with OSA has "male-pattern" obesity with predominance of fat deposition in the central and upper parts of the body, especially the neck region. A prediction rule based on neck circumference can be used to estimate a person’s probability of having OSA (Table 1) - the thicker the neck, the higher the chance. The "adjusted neck circumference" in cm is calculated by adding 4 cm if the person has hypertension, 3 cm if the person is a habitual snorer, and 3 cm if the person is reported to choke or gasp most nights. Table 1 illustrates how the adjusted neck circumference corresponds with a person’s clinical probability of having a positive test result for OSA.

Table1: Adjusted neck circumference and corresponding clinical probability of OSA

*Calculated by adding 4 cm to actual measured neck circumference if the person
has hypertension, 3 cm if the person is a habitual snorer, and 3 cm if the person is reported to choke or gasp most nights

Consequences of Sleep Apnoea

There are 2 major consequences of OSA that should be of concern to the sufferer and these are: excessive sleepiness in the day and the link between OSA and several forms of cardiovascular disease. The first is bad enough. Excessive Daytime Sleepiness is associated with adverse effects on job performance, family relationships and quality of life and is also an important cause of motor vehicle accidents. Sleep deprivation in patients with OSA is associated with a worrying seven-fold increase in driving accidents. The second consequence of OSA is also alarming. Increasingly, OSA is identified as an independent and significant risk factor for several forms of cardiovascular disease such as hypertension, heart failure, heart, heart attacks, heart rhythm disturbances (especially during sleep) and even strokes.

OSA and the Heart

In OSA, the recurring episodes of apnoea lead to disruption of normal restful sleep and a lack of oxygen during sleep. These result in the body’s production of higher levels of stress hormones throughout the night that are deleterious to one’s cardiovascular system. To the body, this is akin to experiencing many near-suffocation episodes every night, except that the OSA sufferer is usually not aware of these recurring episodes during sleep. Not surprisingly, OSA patients have higher blood pressure during sleep – an average of 9 mmHg increase in blood pressure compared to healthy individuals without OSA, in whom blood pressure should be lower during sleep. People with mild to moderate OSA are also twice as likely to become hypertensive and people with moderate to severe sleep apnoea are almost three times as likely to become hypertensive. In people already with a "weak heart" (heart failure), undiagnosed and untreated OSA may also worsen their heart function. The good news, nonetheless, is that effective treatment for OSA is available. As mentioned above, weight reduction can significantly reduce the severity of OSA. Other established forms of treatment include continuous positive airway pressure (CPAP) and specific forms of surgery. However, in all cases, the condition has to be recognised first and the diagnosis confirmed. The standard way to confirm if one has OSA is to undergo a sleep study.

Sleep - the new vital sign?

In view of the strong association between OSA and the development and worsening of cardiovascular illness, we should be on the look out for symptoms of OSA such as loud habitual snoring, excessive daytime sleepiness/fatigue and restless or unrefreshing sleep with frequent awakenings, especially in people who are overweight with hypertension without any known secondary causes. How we sleep at night may really affect our heart health.

Written by:

Dr Ong Kian Chung
Consultant Respiratory Physician

Keywords: cardiovascular, hypertension, OSA, sleep

Diet and Colon Cancer: Opportunities For Prevention

2005-09-01T14:17:00.000+08:00

By Dr Yap Chin Kong
MBBS, MMED, MRCP(UK), FAMS, FRCP(Edinburgh)
Senior Consultant Gastroenterologist

Approximately 58-80% of cancers are caused by environmental factors and dietary factors may be involved in 35% of cancers.

Environmental factors act to promote or protect cells from mutations. Environmental factors that are linked to cancer include:

1.Smoking: lung, pancreas, bladder cancer
2.Obesity: breast, endometrium, colon cancer
3.Infection with viruses: Human Papilloma virus for cervical cancer, hepatitis B
and C for liver cancer, Ebstein-Barr virus for nasopharynx cancer.
4.Bacteria: Helicobacter pylori for stomach cancer
5.Radiation: Leukemia, thyroid cancer.

An important component of environmental factors is our diet. Dietary factors that have a protective effect include: high fiber intake, fresh fruits, vegetables; dietary factors that are linked to cancer include: high salt intake, high fat intake, smoked meats, betel nut, excessive alcohol. A lean body weight has a protective effect against cancer. Medications such as hormone replacement therapy can protect against colon cancer but promote breast cancer. Dietary supplement and anti-oxidant are attractive concepts but have not been proven to reduce cancer when used as treatment.

Cancer is the result of uncontrolled growth of cells in an organ, with the capacity to spread outside of the organ. It gradually results in interference with normal function and its consequences. The different cancers are classified according to the organ of origin. In Singapore, the top five common cancers in males are: lung, colon, stomach, liver, nasopharynx; in women: breast, colon, lung, cervix, stomach. The commonest cause of death is due to cancer, followed by heart disease. Throughout life, genetic changes (also called mutations) occur in our cells. These changes occur over time and can be inherited directly from our parents, or acquired due to the aging process and from environmental factors.

The epidemiology of colon cancer in the Asia-Pacific region varies widely. IARC statistics place New Zealand and Australia with the highest incidence rates: 55.3 per 100,000 in New Zealand and 50 per 100,000 in Australia. Some countries in South Asia e.g. Bangladesh and Sri Lanka have among the lowest rates: 1 per 100,000 in Bangladesh and 1.8 per 100,000 in Sri Lanka. In many countries, colon cancer is on the rise. Environmental and life-style factors play a role and urbanization seems to be associated with the increase. In Singapore, the incidence in the Indian race is approximately double that in Madras. Studies from Asia point to an increase in consumption of dietary meat and fat, a reduction in dietary fibre, fresh fruit and a sedentary life-style as associations with colon cancer. These data point to the presence of genetic, environmental (including diet) and life-style influences in the causation of colon cancer.

Colon cancer: detect it early

About one in twenty or 5% of people will develop colon cancer during their life-time. Colon cancer is the commonest cancer in Singapore and has doubled in the last 30 years. The rising trend is worrying and is likely related to dietary factors and an aging population.

Almost all colon cancer arise from polyps. The progression from polyp to cancer takes many years due to the accumulation of genetic mutations. Polyps that are detected and removed by “polypectomy” effectively prevents the development to cancer. If cancer has developed, detection at an early stage I and II, can result in cure in approximately 80%. The chance of cure of more advanced stage cancer (III and IV) falls to 40%. Hence early detection by screening is an attractive concept.

For the “average risk” person, several options for screening are available, starting at age 50 years. These are: stool occult blood test, sigmoidoscopy, combined stool test and sigmoidoscopy, colonoscopy, barium enema and CT colonography. The best studied and scientifically proven method to reduce the chance of dying from colon cancer is the stool occult blood test. There is a 15-30% reduction in the risk of dying from colorectal cancer. A positive test should be followed by colonoscopy. A negative test should be repeated annually. Because of false positive and negative readings, the search is on for better methods to improve on the accuracy of tests to detect early cancer. These include stool cancer markers and CT colonography. Currently, colonoscopy is the preferred method as a screening test because it examines the entire colon is considered the current “gold standard” in the examination of the colon. The benefits in reducing death from colon cancer are potentially greater than stool occult blood screening. Polyps and early cancer that are found can be removed non-surgically using snare polypectomy. If no polyps are found, colonoscopy offers “protection” against cancer for 5-10 years.

For “high risk” persons, only colonoscopy is recommended. “High risk” refers to persons with a personal or family history of colon cancer or polyps, or a personal history of inflammatory bowel disease. “Very high risk” refers to persons who may have inherited a colon cancer gene in rare genetic conditions.

Opportunities for prevention
Environmental and dietary factors are likely to influence the development of cancer over many years or even decades. Immigrants to a country have a risk of cancer that is between their country of origin and the adopted country. It is their children who acquire the cancer risk of their adopted country. Hence, environmental factors may have an effect in the early part of life and explain why adopting healthy dietary and lifestyle habits later in life have little impact on the cancer risk. For these measures to work, they probably have to be adopted for many years, starting early in life.

Logically, the strategy to reduce the problem of colon cancer is two pronged approach. The first approach is to screen “average risk” individuals starting at the age of 45-50 years (with colonoscopy as the preferred test). This approach benefits the immediate large numbers of persons who are at risk. The second approach is to adopt a healthy lifestyle and dietary habit now. This is because a good habit has to be adopted by adults before it can be passed on to our children. Although it may not affect cancer risks in adults now, it has benefits to reduce cardiovascular risk which is a major cause of death. The aim to reduce cancer risk and may not be achieved until the next generation.

Contributed By Yap Chin Kong
MBBS, MMED, MRCP(UK), FAMS, FRCP(Edinburgh)
Senior Consultant Gastroenterologist
Keywords: gastroenterology, polyps, diet, colon, cancer

Smoking and Your Lungs

2005-09-01T10:05:00.000+08:00

By Dr Ong Kian Chung
Consultant Respiratory Physician

The most prevalent form of tobacco addiction is cigarette smoking and intuitively, the lungs would have to put up with the brunt of harmful effects of the cigarette smoke that is inhaled. Among the many lung diseases in smokers, 2 major respiratory diseases are most significant, because these illnesses are almost always caused by or associated with smoking, and these diseases have major impact on the sufferer in terms of quality of life and longevity.

The 2 common and serious lung diseases in smokers are: (1) Chronic Obstructive Pulmonary Disease, and (2) Lung Cancer. While Lung Cancer is garnering a certain amount of and public awareness and media attention (Newsweek August 22, 2005 - cover story), chances are, you do not know much about the other smoking-related “lung problem” - Chronic Obstructive Pulmonary Disease (COPD). This is unfortunate, as from a general perspective, more smokers suffer from COPD than lung cancer and COPD is a deadlier disease than lung cancer (i.e. causing more deaths annually).

Chronic Obstructive Pulmonary Disease

A major public health burden

COPD is a common disease afflicting millions of people worldwide and exacting a very heavy global disease burden. Surprisingly, public awareness of this disease is lacking and many people have not even heard of it. In America and many developed countries, COPD is the 4th leading cause of death and, among the top 5 leading cause/s of death in the US, COPD is the only one that is increasing in incidence - a disparity all the more striking amid the dramatic decline in deaths from heart disease and stroke. If the present trend continues, COPD will be the 3rd leading cause of death in the US in about a decade. In 1990, a study by the World Bank and World Health Organization (WHO) ranked COPD 12th as a burden of disease; by 2020, it is estimated that COPD will be ranked 5th.

What is COPD?

COPD is an umbrella term that encompasses 2 main disorders--- emphysema and chronic bronchitis--diseases that are characterized by obstruction to air flow in and out of the lungs. Emphysema and chronic bronchitis frequently coexist. Thus physicians prefer the term COPD. Smoking is the major cause of this condition. Air pollution, exposure to industrial smoke or dust and long term inhalation of smoke from wood fires in developing countries are other minor causes.

Smoking progressively and gradually destroys the lungs and causes a decline in lung function (the capacity of our lungs to ventilate i.e. bring fresh air in from the environment and expired gases out from the body). This capacity of the lungs to ventilate can be measured by undergoing a simple lung function test known as spirometry. One of the measurements during spirometry is the FEV1 (Forced Expiratory Volume in One Second), the volume of air exhaled in the first second after a deep inhalation. For COPD patients, FEV1 is used to determine the severity of obstruction in the air passages of the lungs. In normal people who do not smoke, a loss of lung function (FEV1) is expected as one grows older (see Figure 1 below).

In smokers, the rate of decline of lung function (FEV1) is about double that of smokers. In smokers who have COPD, the rate of decline can be 4-6 times that of non-smokers, i.e., the patient has greater obstruction in the air passages and less lung function as the patient gets older. The problem is that the loss of lung function in COPD patients is so gradual that most patients with COPD do not realize that they have the illness till it is severe. By the time most patients are diagnosed to have COPD, they may have lost at least 50% of their pulmonary function. This is exactly why the Chronic Obstructive Pulmonary Disease Association (Singapore) (www.copdas.com) in cooperation with other international agencies such as the Global Initiative for Chronic Obstructive Lung Disease (www.goldcopd.com) strongly encourages smokers, especially those with symptoms such as persistent cough and/or breathlessness to undergo spirometry testing.

Who is likely to have COPD?

The symptoms of COPD can range from chronic cough and sputum ('phlegm') production to severe disabling shortness of breath. In some individuals, chronic cough and sputum production are the first signs that they are at risk for developing the airflow obstruction and shortness of breath characteristic of COPD. In others, shortness of breath may be the first indication of the disease. Individuals with COPD increasingly lose their ability to breathe. Acute infections or certain weather conditions may temporarily worsen symptoms (exacerbations), occasionally where hospitalization may be required. Bear in mind that the progression of the disease and the loss of lung function can be so gradual that, presently, many patients don't realize they have COPD till late. Hence if you are smoker or ex-smoker who is (A) Above 40 years old, with (B) Breathlessness and/or (C) Chronic cough, please consult your doctor, and preferably undergo spirometry testing to assess if you are have COPD.

Double-barrel smoking gun

Smokers with COPD are at least 2 times more likely to develop lung cancer than smokers who do not have COPD. Thus, COPD may be an additional risk factor for smokers developing lung cancer! So the message is - do not smoke and if you are a smoker, do quit for it may not be just a gun you are smoking but a double-barrel one at that.

Contributed by:

Dr Ong Kian Chung
Consultant Respiratory Physician

[Dr Ong is the President of the Chronic Obstructive Pulmonary Disease Association (Singapore)].

Keywords: COPD, spirometry, lung cancer

肢体延长

2005-08-31T21:06:00.000+08:00

肢体延长是用骨外或骨内延长器和固定技术为骨科疑难病,伤残, 肢体不等长和畸形治疗及重建肢体功能,

已经停止发育的成年人，肢体延长(增高手术)能在半年之内再长高10厘米，使许多矮个子的人圆了增高之梦，为他们创造了人生的新机会。康复后与正常人一样行走、活动、工作、生活。
人的身高是由骨骼的长度决定的，而骨骼的长度又是由骺板（生长线 Growth Plate）的软骨细胞不断繁殖而生长决定的，人到了17-20岁骺板就停止生长发育。增高手术是根据肢体组织在一定应力刺激下再生的生物原理，应用现代截骨术，在小腿或大腿把已经闭合的骨生长线重新“打开”，并在体外或体内安装一种具有牵伸作用的肢体延长器，根据组织再生能力特点，每天以1毫米的速度将肢体缓慢地延长。通过主动的功能锻炼，对截骨端产生有益的应力刺激，使骨细胞和肢体其它组织细胞不断发生分裂和增殖，从而使肢体骨与皮肤、肌肉、神经、血管等组织的数量和长度增加，达到增高的目的，近似人体的正常生长发育过程。小腿一次延长10cm，大腿为8cm。

并发症包括发生神经、血管损伤、延长骨不或迟愈合，旋转或弯曲畸形愈合, 关节软骨损害和功能障碍, 针孔感染, 永久性的切口及针孔癍痕，足下垂和延长器上细钢针折断现象

糖尿病足

2005-08-31T20:59:00.000+08:00

糖尿病足为糖尿病严重并发症，具有很强的致残性和致死性

谈起糖尿病大家都很熟悉，但说到糖尿病的并发症;糖尿病足可能很多人并不了解。以下是一个典型的糖尿病足的病例：有糖尿病史十余年，平时血糖控制不好，也不定期检查。近一年感到双足麻木，两个月前，自己剪脚趾甲时不慎将脚趾剪破，自觉不疼，出血不多就没重视，后来脚趾逐渐溃烂加重并发展到整只脚变黑坏死，最终不得不截肢才保住性命。
糖尿病足为糖尿病严重并发症，具有很强的致残性和致死性。糖尿病足坏疽是由于糖尿病血管和神经病变引起下肢异常改变的总称。因神经病变而失去感觉和因缺血而失去活力且合并感染的足，糖尿病足是指发生在糖尿病患者的踝和踝部以下的感染、溃疡和深层组织破坏。最终结局是肢端坏疽、溃疡、截肢、死亡。由于长期的糖代谢紊乱等因素，神经病变导致足部感觉下降或消失，血管硬化、管腔狭窄闭塞导致足部缺血性疼痛、皮温低，使足部易损伤、易合并感染且不易恢复，最终导致糖尿病足的发生。
由于寿命延长、肥胖、少动的生活习惯以及饮食模式改变，全球糖尿病患者逐年递增。在糖尿病诸多慢性并发症中，以糖尿病足带给患者的痛苦以及人力、物力资源的消耗最甚。据统计，在所有进行截肢手术的患者中，有40％-70％与糖尿病有关，糖尿病足的发病率、截肢率以及医疗花费也在逐年递增。这类病人的治疗费用、住院时间都明显超过其他疾病。
感觉消失是糖尿病足的主要“报警信号”。许多糖尿病患者先是足部失去感觉，容易受到外伤，在此基础上发生感染，导致糖尿病足的发生。还有一个病例更是典型, 用热水泡脚而烫伤足，这些人对泡脚的水温没有感觉，直到脚上烫起了泡才知道，但已晚矣。加强对糖尿病患者足部保健、护理知识的宣教以及定期进行糖尿病足的相关检查是非常必要的。
怎样才能有效地预防糖尿病足呢？国际糖尿病足工作组推荐以下几点：（1）每天检查足，包括脚趾间，如果患者本人不能进行这种检查，应该请家人帮助。（2）定期洗脚，仔细擦干，特别是脚趾缝的水要擦干。（3）洗脚水的温度应该低于37度。（4）避免赤足在室内外行走或赤脚不穿鞋。（5）不要用化学物质或药膏来除去角化组织。（6）穿舒适的鞋，每天检查鞋里有无异物。（7）如果视力不佳，患者不要自己处理足，如修剪趾甲。（8）对于干燥的皮肤，应该使用润滑油或护肤软膏，但是不能用在脚趾之间。（9）每天换袜子，不要穿有破损的袜子。（10）平直地剪趾甲，不要用刀修剪角化组织或胼胝，而应该由专业人员来处理。（11）患者应定期让医务人员检查足。（12）一旦出现水疱、开裂、割破、抓破或疼痛，患者应立即看医生。
如果发生了糖尿病足，应该尽早到糖尿病专科就诊。糖尿病足的治疗，一般由糖尿病专科医生、血管外科医生及糖尿病足专业护理人员共同合作完成。治疗包括：相关知识的宣教、控制血糖、控制血脂、控制感染、局部换药、血管移植、治疗性鞋袜的选择等，若经保守治疗仍无好转或患肢出现坏死, 传统的治疗方法是截肢。然而，截肢不仅影响了病人的生活质量，而且给社会和病人家庭增加了负担，大多数病人和家属都不愿意接受。最近几年，应用自体血管行下肢;小腿或足部动脉搭桥成功的保住了肢体，也挽救了性命。
总之，患糖尿病并不可怕，可怕的是患者对糖尿病相关知识一无所知。让糖尿病患者、糖尿病专科医生、糖尿病专业护士共同合作，提高患者对糖尿病慢性并发症的防范意识和自我保健意识，防患于未然，才能真正的降低糖尿病足等糖尿病慢性并发症的发生率，提高糖尿病患者的生活质量。

de Quervain's Disease

2005-08-31T20:24:00.000+08:00

It is tendonitis involving the tendons at the outer side of the wrist that operate the thumb.

The extension of the thumb out of the palm is done by muscle in the forearm through a tendon covering at the wrist that serves as a pulley. When the wrist is in various positions the thumb tendons are still able to work as usual, moving the thumb out of the palm. When the wrist is fully flexed the thumb tendons may have to turn as far as 90 degrees from a straight pull. This applies large stresses on the thumb extensor tendons as well as the pulley that holds them. Over time the tendon may swell. Pain is felt at the wrist with thumb use. This pain is usually worse with repeated hand use and is often related to work.

The origin of the problem is in the response of the tendon lining to overuse. First the lining about the tendon becomes inflamed and swollen. The lining inside the tunnel similarly becomes inflammed. There is pain each time the tendon moves and use of the thumb hurts. The condition fails to improve because the sheath becomes thickened and increases the friction against the tendon provoking the swelling within the tendon sheath.

There are several treatments for de Quervains. The first is rest and altering hand position at work. A splint that includes the thumb can provide rest for the tendons. Anti-inflammatory drugs are used to reduce the inflammation. Injection of hydrocortisone and lignocaine into the tendon sheath is used if the above methods have failed. Surgical release of the tendon sheath is used after a month or two of non-operative treatment that has failed. A small incision is made over the outer side of the wrist and the tendons are freed from the sheath.

Keywords: tendonitis, anti-inflammatory, hydrocortisone, lignocaine

Shock Wave Therapy in Orthopaedic Conditions

2005-08-31T20:20:00.000+08:00

High-energy acoustic shock wave therapy is an attractive, cost-effective and non-invasive treatment method for soft tissue orthopaedic conditions and sport injuries( e.g. tennis, golf ).

It has been scientifically proven that shock waves stimulate bone growth and promote healing of diseased tendons. These waves alter cell metabolism and generate mechanical stimuli that cause new blood vessel formation. Calcific deposits are re-sorted and degenerative tissue areas are revitalised.

Shock wave treatment can be carried out on an outpatient basis without anaesthesia. Improvement of the patient's symptoms and even complete freedom from symptoms is achieved after one to two treatments. There is also a very low incidence of adverse reactions. It is the substitute for surgery following four months of unsuccessful conservative therapy for the following conditions: tendonitis in the shoulder with or without calcifications, tennis or golfer's elbow; inflammation at the insertion of the patellar ligament; plantar fasciitis with bone spur and degeneration of the heel cord tendon.

Short wave treatment is especially useful in areas when injection of hydrocortisone is contraindicated as injection will cause rupture of the heel cord tendon or the patellar ligament.

Keywords: soft tissue orthopaedic, sport injuries, bone growth, golf, tennis

Health & Fitness..what's the difference?

2005-08-31T19:40:00.000+08:00

Dear friend,
There exists some confusion regarding the difference between health and fitness...health simply denotes the absence of disease whereas fitness implies the body is well equipped to handle cardiovascular & physical stresses, strength demands and be limber & flexible as well. For example a relatively sedentary person without disease is healthy but not fit, whereas another chap after suffering a heart attack requiring bypass surgery now runs marathons...is fit but not healthy.
The way to go is of 'cos attain both optimal health & fitness..the usual dictums apply...a judicious diet (with a healthy balance of carbohydrates, fats & proteins, low cholesterol & saturated/trans-fats), proper aerobic & strength-training exercises, nutritional supplementation (to correct for dietary deficiencies), emotional/mental/spiritual wellbeing and well-managed stress levels...
We have a panel of medical specialists who are prepared to engage you in plain talk about your concerns/queries re: medical & health issues...please feel free to participate and pick our brains...and in the process, forge a win-win relationship...afterall, 'no man is an island' yes?
Till next..here's to your health & fitness!
Doc Jen

退化性關節炎

2005-08-30T22:16:00.000+08:00

退行性關節炎(骨关节炎)是临床常见的關節退化問題，威胁着全球约１／３成年人的正常活动。

隨著人口老化，骨关节炎的发病率将上升，預計退行性關節炎，特別是對婦女所帶來的健康問題將日趨嚴重。因此确切的诊断、合理的治疗显得十分重要。

骨关节炎通常在髖關節、膝關節或手關節出現，其中膝關節炎在華人社會中最為普遍，是引致年長者行動不便的主要原因，膝關節炎及髖關節炎在婦女停經後的發病率會更迅速增長。

膝關節炎的患者會有持續性的膝關節疼痛及如下的病徵：關節活動時會發出格格聲，關節在早上持續僵硬半小時及骨刺增生

原本身體健康的老人，因關節炎而導致身體殘障的比例增高，反映了問題的嚴重性。

導致膝關節炎的三大原因分別為：身體過重、膝關節受損及工作需提舉重物。病人中有64%是身體過重，患上膝關節炎的機會比正常體重人士高出5倍。另外有26%病人,膝關節曾受損，因而出現膝關節炎的機會比常人大增7倍。有56%病人從事提舉重物工作;則多5倍機會患上膝關節炎，

骨关节炎的病因:

关节软骨和软骨下骨所受应力的改变、关节软骨和滑膜的生物化学改变以及遗传因素等在骨关节炎的发生中起着重要作用。

預防膝關節炎的方法：

1. 減輕體重 : 減輕10磅便能減低患膝關節炎的風險達50%。

2. 慎防受傷 : 職業運動員應避免身體有激烈的碰撞。一旦受傷，必須接受專科的治療及讓患處充分復原。

3. 對從事提舉重物工作人仕的建議: 僱主應為僱員提供幫助提舉重物的器械。建議工人宜採取簡單的預防措施，例如加強鍛練四頭肌，以預防關節受損。

4. 多參與任何康樂體育活動如跑步、球類運動及舞蹈，適當安全的運動有助患者康復。　　

治愈方法

治愈方法都是对症治疗，即减轻关节疼痛，改善关节活动度，减小关节功能障碍。必须根据患者情况采取个体化治疗。

一、非药物治疗
　　非药物治疗内容很多，包括患者的健康教育、自我训练、减肥、有氧操、关节活动度训练、肌力训练、助行工具的使用、膝内翻的楔行鞋垫、职业治疗及关节保护、日常生活的辅助设施等等。通过以上治疗可以减轻症状，恢复正常生活和工作。
　　膝关节炎患者常出现股四头肌肌力减弱，股四头肌肌力减弱可能是造成膝骨关节炎的危险因素之一，由于股四头肌肌力的减弱，膝关节的稳定性受到了影响，正常肌肉所应有的缓冲能力降低，因此加强股四头肌肌力的训练和有氧训练对骨关节炎病人是有益的。

二、药物治疗
　　对于大多数骨关节炎病人，轻度至中度疼痛可以通过服用止痛药控制。要警惕一些药物的消化道副作用，如上消化道出血、溃疡、穿孔等，还有药物引起的血小板凝集抑制等副作用。

　　用氨基葡萄糖和硫酸软骨素治疗骨关节炎，这两种药可以抑制损伤细胞超氧化物自由基的产生，增强关节软骨对营养的吸收，维持关节的韧性和弹性。但这些作用显效慢，

三、关节内注射治疗
　　这也是一种能够缓解关节症状的治疗方法，常用药物有透明质酸制剂和糖皮质激素，
透明质酸制剂是抑制炎症介质，如细胞激动素和前列腺素；刺激软骨基质的合成并抑制软骨降解；但止痛作用出现较慢。
糖皮质激素止痛效果出现快。但要避免医源性关节内感染，

四、手术治疗
　　骨关节炎症状十分严重、药物治疗无效的，且影响病人的日常生活，就应该考虑手术干预。
对膝骨关节炎，关节镜下关节清扫术，近期有一定的疗效，但远期效果则不能肯定。
关节置换手术对大多数骨关节炎、股骨头坏死、类风湿性关节炎病人，在缓解疼痛、恢复关节功能方面具有显著效果，要動手术的因素包括：X光证明关节损害；中到重度的持续疼痛或已造成残疾和对各种非手术治疗无效的病人。关节置换手术远期的并发症有部件的松动和磨损、骨溶解，

板機指 (Trigger Finger)

2005-08-30T22:11:00.000+08:00

手指屈肌腱在指頭基部形成結節，使得手指在彎曲而伸直時會卡在指頭基部的滑車(A 1 Pulley)，以致指節無法完全伸直；或者在伸直時會有阻力，形成類似扣板機的情形，稱之為板機指。

許多兒童在出生即有，因此被認為是先天形成的；可能與壓胎現象有關。而後天的板機指，可能與局部的發炎反應、反覆刺激或創傷有關。每一個手指都有可能發生，姆指的板機指是發生率最高的，尤其是兒童的扳機指，幾乎都發生於拇指。
　
大人的板機指以局部注射(local steroid injection)有較好的結果，但在兒童的板機指不適合打針，效果也不好。

手術是把卡住結節的滑車切開。由於手術簡單，效果顯著，適合於完全卡住或持續疼痛，其他治療方法無效的病患。

腕隧道症候群 (Carpal Tunnel Syndrome)

2005-08-30T22:05:00.000+08:00

坐辦公桌寫字、打電腦或懷孕婦女，感覺手指麻痛，木木的。動一動、甩一甩，手就好了。慢慢地怎麼動，怎麼甩也不能改善，這是罹患了腕隧道症候群 Carpal tunnel syndrome，

如果保守治療無效，就需要手術矯治。若是延誤治療時機，連手術矯治也來不及了。

很多中年婦女或懷孕婦女，常抱怨睡覺時或清晨時手部麻;痛及癢，必需要爬起床兩手甩一甩、或手抬高、或手浸泡熱水，才能舒服一點；中指、食指及大拇指兩側均有症狀，麻痛會向上延伸到前臂，另外皮膚感覺會不靈敏,肌肉力量減退，拿東西會不自主地滑掉，甚至手掌大拇球肌肉萎縮，這都是腕隧道症候群的臨床表現。

手腕掌側橫紋間有一條隧道，其中有十條肌腱及一條正中神經通過，當正中神經遭受到外來的壓迫時，就會表現出腕道症候群，原因包括骨折、過度使用腕部肌腱，造成肌腱腱鞘膜肥厚；類風濕關節炎引起的骨膜增生；懷孕時的淋巴水腫；痛風；以及糖尿病引起的神經病變。

檢查手腕時，過度彎曲及伸直均會加重症狀(Phalan's test)；敲扣腕隧道會有麻電感覺傳到橈側三指半(Tinel's sign)；手腕平放時最舒適；此時接受神經電氣生理檢查，如發現正中神經傳導速度明顯減慢，即可確立診斷。如正中神經軸突已發現變性，肌肉開始萎縮時, 需盡早手術治療，切開壓迫神經的橫腕韌帶，手術不用住院，手術後接受復健治療，可使水腫盡快消除及恢復萎縮的肌肉功能，達到最好的治療效果。手術方法包括傳統之腕隧道切開法或內視鏡腕隧道切開法.

Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis

2005-08-30T21:34:00.000+08:00

Viscosupplementation is an option for patients with painful knee osteoarthritis that involves a series of three intra-articular injections of hyaluronic acid into the joint

Knee osteoarthritis is common among elderly patients. It is characterized by loss of articular cartilage and reduction in the elastic and viscous properties of the synovial fluid. The molecular weight and concentration of the naturally occurring hyaluronic acid decrease. The loss of elasto-viscosity of the fluid decreases its lubrication and protection function of the joint and causes pain in osteoarthritis.

Viscosupplementation restores the elasto-viscous properties of synovial fluid and stimulates natural hyaluronic acid synthesis. It also has anti-inflammatory and antinociceptive properties. The effect of viscusupplement in general lasts up to 12 months.

Adverse reactions consisted of minor localized pain or effusion, which was almost always resolved within one to three days.

Keywords: knee, articular cartilage, synovial fluid, hyaluronic acid, viscosupplementation

Backache In Elderly

2005-08-30T21:27:00.000+08:00

Many elderly patients have chronic backache. They are also getting shorter and their spine are bent. They suffer from osteoporosis; a condition that commonly affects the elderly.

Osteoporosis is a skeletal disorder characterized by weakened bone strength predisposing to an increased risk of fracture. With aging and after menopause, the rate of breakdown of old bone is greater than the rate of manufacture of new bone which leads to osteoporosis. The bones become thinner and weaker and are susceptible to fractures, pain and disability. Fractures commonly occur in the hip, spine and wrist. Compression fracture affects the spine where the anterior portion of the vertebral body is compress. In many occasions, the pain is so severe that, the patient is unable to move. If the fracture affects many vertebral bodies, the spine will bend forward and become shorter. Many patients will suffer from chronic backache with deformity of the spine.

Accurate diagnosis is most important. Clinical examination and investigations need to exclude other common conditions such as tumour, spinal stenosis and prolapsed disc.

If the pain from acute compression is severe, a minimally invasive procedure vertebroplasty where bone cement is injected into the fracture sites will relief the pain and allow the patient to move and ambulate immediately.

Patients will be on mediations to strengthen the bone and the drug selected are according to the condition and needs of individual patient. Long term management of osteoporosis requires regular follow up to ensure maintaining a healthy diet with calcium supplements, proper exercises, compliant to medications and education to prevent fall.

Keywords: osteoporosis, menopause, chronic backache, spinal stenosis, calcium, prolapsed disc

Be careful when you child injured

2005-08-30T21:11:00.000+08:00

In my career as an orthopedic surgeon, I have managed many kids with the same story given by the parents. “My child fell a few years ago and we noticed his injured limb slowly deviated to one side and the deformity progressed as my kid grew.

The injured limb became smaller with pins and needles sensations”. After evaluation with X rays, they were diagnosed with an old growth plate injury.

Children are different from adult because their bone grows at a piece of cartilage at either end of the bone. The cartilage is called growth plate and is the weakest part of the bone. It is therefore easily injured. The signs and symptoms of growth plate injury are similar to fracture, dislocation, sprain and strain. If it presents like fracture or dislocation, majority will seek western treatment. As correct diagnosis can be made, the kid will recover without complications. If it presents like sprain and strain, majority will not seek western treatment. The child may apparently become well after a few weeks. However, deviation of the limb with deformity will slowly develop as one side of the injured growth plate grows slower than the non injured side. If there is a nerve running along the side of the limb that is growing faster, the nerve will be stretched and presented with pins and needles sensation along the skin supplies by the nerve. The limb is smaller because of wasting of the muscles innervated by the nerve.

Many of the parents are surprised that X-rays of both limbs are required even though the child only injured one limb. As growth plates are seen as lines on the X-rays, the diagnosis of growth plate injury can only be made after comparing the images of both sides.

Once growth plate injury is diagnosed, it must be treated properly in order to avoid uneven growth resulting in deformity. The fracture fragments must be accurately aligned and keep it in place till union takes place. Majority of the displaced fracture can be treated by closed manipulation and pinning without open surgery, a form of minimally invasive surgery. Open surgery is only indicated if the fragments can not be aligned accurately by close manipulation.

In summary; accurate diagnosis must be made and growth plate injury must not be missed when a child injured.

Keywords: cartilage, fracture fragments

Pulled Elbow in Children

2005-08-30T19:45:00.000+08:00

I often see a child who refuses to move one upper limb and the parents anxiously give a history of pulling the injured limb too hard by the hand or wrist and the injured limb appears paralyzed.

The child is suffering from pulled elbow. It is a partial dislocation of the elbow joint and is a common condition in young children under the age of five. It is often seen after a parent lifts a child by one arm up a curb or high step. The ligament that surrounds the radial head is funnel in shape after 5 year of age. Before 5 years old, the ligament is cylindrical in shape and the radial head will easily dislocate partially when pulling the limb by the hand or wrist. The child generally begins to cry immediately and refuses to use the arm and unable to move the elbow and rotate the forearm. The child hold's the arm in a position bent slightly at the elbow and holds the forearm against the abdomen.

It is important to prevent pulled elbow by avoid lifting a child by one arm from the wrist or hand only. Always remember to lift the child under the arm, from the upper arm, or both arms at a time. If it remains untreated, it may result in permanent inability to fully move the elbow.

For first aid; immobilize the injured limb. It is important to reduce the partially dislocated radial head as soon as possible by an experienced orthopaedic surgeon. When treated early; there is no permanent disability.

Keywords: joint, ligament

Heel Pain

2005-08-30T19:14:00.000+08:00

If you walk with pain at the heel or you have heel pain with the first few steps in the morning; you are suffering from a common condition; plantar fasciitis.

X rays may show a heel spur on the bottom of the heel. The plantar fascia is a tissue that encapsulates muscles in the sole of the foot and supports the arch of the foot. When walking, the plantar fascia endures tension that is two times the body weight. A percentage increase in body weight causes the same percentage increase in tension in the fascia. Due to the repetitive nature of walking, plantar fasciitis is a repetitive stress disorder caused by increase in activities and spending too much time on the feet. It can also be due to no arch support, sudden injury and using shoes with little cushion or shoes that is not flexible. Flat feet or high arches are more likely to get plantar fasciitis.

Treatment include losing weight; rest, ice, taping; arch support; stretching; anti-inflammatory drugs; lignocaine and hydrocortisone injection. Extra Corporeal Short Wave Therapy is an effective non invasive treatment. Surgery is a last resort.

Excessive running or standing, over-eating, inactivity, or wearing inflexible shoes have to avoid. Desk jobs are are a major cause of muscle atrophy and prevent the feet and legs from being flexible. Stretching the calf muscles before getting out of bed in the morning and after extended periods of sitting down at work is beneficial. You should take up swimming for exercise as there is no tension on the plantar fascia.

Keywords: heel, fascia, lignocaine, hydrocortisone, short wave therapy

Touching base with medical specialists..

2005-08-30T09:54:00.000+08:00

Dear all,
Greetings! The eFrenzconnect folks have assiduously assembled a coterie of medical specialists spanning various subspecialties that run the gamut of the medical field to cater to your queries/concerns ...please feel free to pose your queries (no matter how simplistic you may deem them!) and indulge in informal chit chat via this Forum with them. They are here to connect with you...in essence, these highly qualified specialists are here to address your 'mouse calls' (in lieu of house calls, ha, ha!) so it is tantamount to having a private array of such a team on tap whereever you are in the world! (ahem! almost as good as a Minister travelling with a personal physician!).
So..pleaaase...don't feel 'paiseh'...doctors are human after all...and let this medical chit chat forum flow...
Cheers,
Doc Jen

Real Age - Is There Any Free Cash Flow ( FCF ) ?

2005-08-25T21:09:00.000+08:00

There is a wealth of information out there about how one can lead a healthy life, ranging from the good to the bizzare. The bottomline is really what can a person sensibly do to live long and healthy. It was not so long ago that our forefathers never live beyond their forties but today, with the advent of modern science, one can live not only reasonably long but to be healthy and vigorous till the end. Longer lives do not mean much if they are not active lives.

To this end, I believe that Michael Roizen has come up with a good strategy. Incidentally, Dr Roizen is a highly respected cardiac anesthesiologist who has spent a great deal of his career dealing with the sickest of patients, those that needed coronary bypass or had blown some major blood vessels.

He realised that to CONVINCE people of the need to live healthier lives requires more than just talk. He came up with the concept of "net present value" which can appeal to those mindsets that are more dollar-and-sense attuned. What we invest ( or divest ) currently in our bodies today will determine its future payoff.

The concept of RealAge was deviced by Dr Roizen to calculate the value of different types of health behaviours and choices. In biological terms, the difference between one's calendar age and one's RealAge is a calculation of the net present value of one's health behaviours.

From a high finance perspective, what we are saying is that our mind, body and soul, in a holistic way represent our intellectual capital, and with it we hope to generate suffcient return, year in and year out, on our capital to erk out a living. However, like all resources, it is depletable ( depreciation ), and in order for us to operate as an on-going concern in tip-top condition, we need to roll-out a planned maintenance schedule ( expenses ) as well as to budget for replacement by way of incurring additional capital expenditure ( capex ). The net effect, on a periodic basis, ought to yield a positive free cash flow ( FCF ). So how we utilise our whole being determines our real age ( health ) versus the calendar's age which is the factory ( default ) setting when we first rolled-out of the assembly line. If we take good care of ourselves, the rate of depreciation will be slower, and we can conserve the economic life and even prolong it.

In the case of my colleague who had a heart attack, he may be only fifty years old but his body may actually be aging faster than that. I was struck by his reply when I remarked that he looked quite OK after his heart attack......"I look OK but inside not OK!"

I wonder how many of us are actually like that. Sounds scary!

Well, if you are interested in knowing your REALAGE, perhaps you can log on to his website at www.Realage.com and take the realage test and see if you are as old or as young as you think!

Keywords: mind, body, soul

When It Rains, It Pours

2005-08-22T14:59:00.000+08:00

For the majority of us, listening to the mantra about leading a balanced and healthy lifestyle often sounds stale and tired.

However, it is amazing that even though preventing diseases from occuring or retarding the progress of disease can be accomplished in some instances with simple techniques, most people find it burdensome and a chore to maintain such regiments on an ongoing basis. Well, it is that most diseases are such that they hit insidiously, much like a fault line accruing over time and all it requires is that little something to tip it over the threshold point and wham, it hits you in the face.

There is little incentive for most people to do the "right thing", it seems, as we cannot quantify the efficacy of these preventive measures, and the payoff is never apparent. We blissly underestimate the risk and are willing to be tricked by randomness to our own peril! The default setting is that it won't happen to me.

I guess the last week has been quite a shock for myself. One of my senior colleagues who has always been fit and "healthy" had a heart attack while he was training for the marathon. This is just incredible, I mean this guy golfs, runs and in most people's eyes, he is as fit as a fiddle. You could say he is the last person in the department one would expect to have a coronary. What is even more frightening is that he had a complete block of one of the majot arteries in the heart and the situation could have been lethal if he did not get to the hospital on time. The bottomline is this, illness is no respector of person and when it happens to a patient ( the youngest cornary patient I have seen was only 27!), I guess there is a sense of being clinical about it but when it happens to someone you work with everyday, the message becomes even scarier.

Up next, what can we sensibly do?

Keywords: heart attack , lifestyle, coronary

Limb Lengthening

2005-08-02T13:24:00.000+08:00

As a caring doctor; I can appreciate and feel the disabilities of a person whose one leg is shortened or deformed as a result of injury or diseases.

I notice that they have physical; psychological and social impairments. People close to them are also affected and feel sad for their love one as these individuals are young and suppose to be active in life; sports, recreations and work. Affected individuals feel that they are the burden of the family and society. These problems can be solved as their appearance and the function can improve with limb lengthening procedure. I feel satisfied after I see them walk better with equal limb length; the involved limb is straight after correcting deviations and deformities. Moreover; I can reassure them that their quality of life will be better as long term problems that are associated with unequal limb length such as backache; joint pain; muscle strain can be eliminated. With advances in technique; it can be done as minimally invasive procedure. The end results are more satisfying as the incisions are small and have better cosmetic results. Healing is faster and recovery is sooner as there is minimum tissue trauma.

I come across some individuals who have short status requesting to lengthen both legs to increase their height. They share that although they are healthy, they suffer because of their short stature, psychologically and socially. They feel that they do not have the same chances in life as their taller friends. Initially I will counsel them and recommend other non invasive methods. I have seen individual with height less than 120 cm. I will investigate them for genetic diseases as these individuals require genetic counseling. I admire those individuals who are very determine and have strong urge for increasing their height and belief that lengthening both legs will improve their self image and chance of success in life. They fully understand that the procedure have some price to pay such as long rehabilitation period; out of work for a year; high cost and some potential risks. I am happy to see them meet their expectation and building up their self confidence and image after all that they have gone through.

Keywords: limb, minimally invasive procedure, counseling

Big Toe Deformity

2005-07-31T22:50:00.000+08:00

Many ladies have problems of wearing pointed shoes as wearing them causing pain at a swelling over the inner aspect of the base of big toe and making the already outwards deviated big toe more outwards. They are very frustrated as they can not wear those fashioned shoe due to a condition known as Hallus valgus.

It is a condition with the big toe deviating outwards and a painful bunion at the base of the big toe. Many ladies have positive family history. Older ladies have splayed foot secondary to weak intrinsic muscles associated with increasing age.
The condition can be managed with make to measure wider shoes with broader toe box. If symptoms persist or the deformity is not acceptable; the deviated big toe can be corrected with surgery. Surgery will not only correct the big toe deformity; but also allow wearing of pointed fashioned shoes.

Keywords: shoes, posture, weight

Enjoy Pregnancy Without Backache

2005-07-31T10:50:00.000+08:00

As an Orthopedic Surgeon; I am happy to see my wife; relatives; friends and patients enjoy pregnancy without backache. I feel most satisfied after they tell me that the simple advices work. They are willing to have more babies as children give joys to them. Motherhood is very rewarding and satisfying.

I always believe that letting the pregnant ladies know the factors contributing to backache in pregnancy help them to prevent this common problem. These factors include posture; change of centre of gravity; weight gain; straightening of the curvature of the spine; fatigue; ligament laxity; expanding uterus with weakening of the abdominal muscles and pressing on the nerves.

Some of these factors can be corrected by simple advices. Try these measures if you are pregnant. I hope you enjoy your pregnancy with little or no backache.

1. Maintain good posture and avoid gaining too much weight: Wear flat and comfortable shoes. As your belly grows and your balance shifts, a pair of high heels will only throw your posture even more out of position.
2. Standing: Stand up straight with weight evenly on both feet. Keep the 'tummy and pelvis tucked in and the shoulders back. Keep one foot on a stool when you need to stand for long period as it helps to relief lower back strain.
3. Sitting: Sit well back into the chair so that the lower back is fully supported and keep the feet slightly raised off the floor on a footstool. Place a small rolled towel at the normal curve of the back. Do not cross the legs. Very soft low chairs should be avoided. Don't sit for long periods; get up and walk at least every half hour.
4. Lying: Keep the knees bent, whether lying on the back or on the side tends to reduce back strain. When getting out of bed keep the knees bent, roll onto the side and push up into a sitting position using the arms, swinging the legs out over the side.
5. Sleeping: Get a good night's rest by sleeping on the side with a pillow between the legs, or use an adjustable pregnancy wedge
6. Bending, lifting & carrying:
• Bending: Bend down into a squat when reaching into low cupboards, making beds, gardening. Make sure you put one foot in front of the other to counteract the extra weight. Always bend your knees, keeping your back straight and don't stoop.
• Lifting: Avoid heavy lifting. To lift correctly, stand close to the object, facing it, feet apart with one foot in front of the other. Always bend at the knees and not at the waist. Squat down keeping the back straight. As you lift, bring the object in as close to you as you can. Never twist your body as you lift.
• Carrying: If you have to carry heavy bags, distribute the weight evenly on each side of you. If carrying babies or small children, change from one hip to the other frequently.
7. Support: A back support belt can relieve shooting leg pain by lifting the abdomen, minimizing the weight uterus that is putting on the nerves.

To ease or relieve backache:

1. Avoid maintaining the one position for any length of time. Vary between sitting and standing throughout the day.
2. Simple exercises to strengthen and stretch muscles that support the back and legs. Lie on your back with knees bent and feet on the bed or floor. Draw in your tummy and press the small of your back down into the bed or floor. Hold this flattened position for a few seconds with normal breathing, then let go gently. Repeat ten times.
3. Swimming is a great choice for pregnant women, because it strengthens your lower back muscles and the buoyancy of the water takes the strain off your joints and ligaments.
4. Rest and a soak in warm water are often the best remedies for an aching back in normal situation. However; it is dangerous in pregnancy as immersing in water hotter than 102 degrees F can be dangerous for the baby. A hot pack on the affected area can work the wonders too.
5. A massage by a trained therapist can relax strained muscles.

However; if your backache persists, it is important to consult with your doctor to make sure that there is no damage to your discs or spine.

Keywords: pregnancy, posture, discs, weight

Balanced Approach - Healthy Lifestyle, Prevention and Medical Conditions, Treatment

2005-07-30T20:09:00.000+08:00

We came together with a group of friends to review our site. It was a pleasant and relaxed evening, but for a minor glitch on the broadband ( and as expected we improvised ), we got off to a good start and received many constructive pointers. There are 2 segments generally - one, those who seek health and wellness from a lifestyle perspective while another segment for more indepth insights on medical conditions and treatments. They would like to read postings relevant to their needs, easy to browse and read ( conversational and personable ). Generally, it was felt that the ability to reach out through this media is pretty cool. The use of tags will make it easier to reach out to the numerous micro-markets. Examples: Young Mother, Nutrition, Diet, Stress, Fitness, Depression, Weight Control, Flu, Sinus, Eczema, Insomnia, Diabetes, Pain Management, Eye, Joints.

Overtime, we hope to gather sufficient feedback and fine-tune the postings. The overall idea is to inform - of needs that may not be known, so that the audience is better empowered to evaluate and seek alternatives before deciding on whether to proceed with consultation and or treatment.

Please feel free to add your comments to this post.....cheers

Kidney Disease: Could We Prevent It?

2005-07-10T18:41:00.000+08:00

The non-communicable disease epidemic is largely related to lifestyle issues. Kidney disease is a reflection of the sum of these unchecked processes. But the situation is obviously more complicated with genetic and environmental issues interplaying in different degrees for different disease in different persons. Preventing or detecting the disease early enough for effective therapy is the best means of therapy.The answers are imperfect, but we should take what we know and apply it as much as possible until newer ground is broken.

The diagnosis of advanced kidney failure is abysmal news to any patient. 40 years ago, it meant certain death as no therapy was available to the patient. In this year 2005 this need not be so as there are means of extending the life and health of our patients by successfully substituting the function of the kidney by means of dialysis or a kidney transplant (both of which are forms of renal replacement therapy). Nevertheless, the continued need for these treatments still mean that not all our therapy for kidney disease is certain to prevent the eventual need for dialysis; it may delay it, but does not always stop it. There is much in the medical literature on the modern (and successful) therapy of kidney disease, but there are always those who will fall through the net. Preventing or detecting the disease early enough for effective therapy is the best means of therapy.

Kidney disease can take on several patterns; it can hit a previously well patient suddenly and aggressively cause rapid decline of kidney function; fortunately this is not the typical pattern for patients in the community. These patterns are usually related to ill patients following surgery or accidents or severe infections. They occur rapidly and unpredictably, and unfortunately, there is not a whole lot of things the individual can do about it given the nature of the onset and the circumstances under which they occur. The incidence of kidney failure with this disease pattern would parallel the incidence of these problems, and best discussed separately.

What would concern most readers however, is the community-type situation where this is progressive kidney disease over months to years, before the kidney eventually has so little residual function that some form of renal replacement therapy is needed. The key thing about this disease pattern is the long period of time they develop over. Sometimes there is not often an identifiable cause that started this chain of progressive kidney disease; while this does not sound too optimistic a situation, nevertheless, the key thing is the rate of disease progression is slow enough to give some opportunity for treatment if detected early enough. As it turns out, there is usually a known cause, which now brings about the possibility of controlling the known cause and preventing the kidney involvement from occurring in the first place; but even if it does occur, modern therapy does bring about some degree of control to reduce progression.

As it turns out, in Singapore, the most common cause of kidney failure, accounting for more than half of all cases of end stage renal disease, is diabetes. There are other more immune related causes of kidney disease that also produce a pattern of progressive renal failure, but these more often than not have no clear inciting factors. Smaller numbers of kidney disease are related to developmental disease of the kidney, some of which are manifest in early childhood and some later in adulthood only; smaller causes are things like systemic lupus (a form of autoimmune kidney disease), or kidney stone disease. It is important to realize the presence of these conditions (ie diabetes, or lupus, or kidney stones) do not always equate to the certainty of kidney disease. But its useful to know there is a differential risk. The lifetime risk of kidney disease in a known diabetic is estimated at 40%, while it is much lower in conditions like lupus or those with kidney stones. Even within the same disease group, there are differential risks between different populations. The risk of developing kidney failure if you were a diabetic from the Pima Indians in Arizona would be a much higher 80%. The point is predicting the development of kidney disease is an imperfect science. Nevertheless, early detection of kidney disease does give one the advantage of receiving the maximal benefit of early therapy that would at least keep the kidney involvement at bay as long as possible.

Prevention of kidney disease starts with dealing with its underlying predisposing causes. In the diabetic, the key is tight glucose control. For lupus it is the control of the underlying disease activity. And the list goes on. How each disease is dealt with is best expanded individually. Common to the thread of all kidney diseases however, is the management of other conditions that should be regularly screened for, as they potentiate the development or aggravate underlying kidney disease. The first is hypertension. The most critical element about hypertension control is that stringent control does greatly reduce the disease development and progression; the great challenge is how to do it successfully without all the problems associated with therapy. Another is a high cholesterol level. The adverse development of heart disease in a patient with high cholesterol is well known, but progressively, there is stronger data that shows that this too is an independent risk factor in the development of kidney disease. High uric acid levels is now emerging as a risk factor to the development of kidney disease. This data is relatively new. High uric acid levels in the blood was previously commonly associated with a painful joint disease called gout; but as it turns out, more than the joints can be affected, the kidney being one of them. Finally something previously less known to the public but now virtually unchallenged in the medical community, is the relation of obesity to kidney disease. Intuitively the well informed public can relate to health risks of obesity and a sedentary lifestyle to the development of heart disease, but now emerging is the relationship of this to the risk of kidney disease. Finally, it may be a new to the community that cigarette smoking too is associated with kidney disease, data that emerges over several large registries from the US and Australia. What is most interesting to emerge over these years is the interaction of these factors. In other words, the presence of several of these conditions does not merely add up to the risk of the patient with the disease, but instead they have a multiplicative effect on each other. These facts are sobering. Apart from drug treatment of these conditions, much change in lifestyle may be needed to reduce the risk and scourge of kidney disease in the community.

But if it kidney disease does develop, can something be done? It used to be a waiting game, but drug therapy has improved the prospects for our patients significantly. There is a caveat though. Therapy is maximally beneficial in early disease. This is one of the biggest problems. The kidneys are so efficient that symptoms are detected only with advanced disease. In general it takes about 90% of the kidney function to be compromised before the patient feels all the effects; leg swelling, breathlessness, weight loss, lethargy, coldness, itch or sleeplessness. The symptoms are furthermore sometimes so non specific that its easy to have dismissed them as due to a “bad day at work”. While screening for the general public is not usually considered cost effective, it makes a lot of sense to get a check when the opportunity presents itself (eg at a routine doctors visit), or if one is known to be at risk of kidney disease.

While drug therapy is critical, another aspect of therapy is dietary control. The normal kidney has the capacity to respond appropriately to a high protein meal; a high protein meal increases the local blood pressure within the kidney itself, which a normal kidney can easily adapt to to restore a normal pressure. The diseased kidney however lacks this ability, and a high protein meal leads to a high sustained pressure within the kidney which damages it further. Low protein diets can therefore play a role to reduce this stress within the abnormal kidney. They do work by other mechanisms which is not quite relevant to discuss now. Low protein diets are difficult to enforce though and one does need an obligatory protein load to remain healthy; too little protein calorie malnutrition can set in. Depending on what you usually eat, a healthy person may consume about 1.2g/kg (of body weight) of protein per day. In renal disease, a protein load of 0.6g/kg would be needed. Its difficult to appreciate the amount of protein that one actually takes. If one were honest about it, and record truthfully your usual intake over 3 days, and use that as a sample representative meal, you could calculate your protein intake from food tables, and then make an estimation of how to change it. Its best to see a dietician in order to effectively implement this, and to institute this only with your physician’s consent.

There is a lot buzzing about the lay public about preventing kidney disease. Much is not actually known or proven. Drinking water liberally is not necessarily an important preventive measure, unless one is being exposed to heavy exercise or physical activity or working in a very hot environment. It is not dangerous though in a healthy individual; it is hard to drink too much. Fish oil has been used in certain forms of established kidney disease to reduce inflammation under certain conditions. There is little on its utility in preventing kidney disease per se. Vitamins and mineral supplementation is too generalized a topic to usefully make any conclusion on its impact on maintaining normal kidney function. Conversely, excessive vitamin C consumption in particular can lead to the development of kidney stones; the devil is the details, and it is best to keep in recommended dosing schedules for the relatively healthy individually than making too much assumptions of the benefit of such practice.

The non-communicable disease epidemic is largely related to lifestyle issues. Kidney disease is a reflection of the sum of these unchecked processes. But the situation is obviously more complicated with genetic and environmental issues interplaying in different degrees for different disease in different persons. Therapy is available and continuously expanding, and brings the hope of delaying progression and reducing the need for renal replacement therapy.

Dr Stephen Chew Tec Huan
Consultant Nephrologist
Mount Alvernia Hospital / Mount Elizabeth Hospital

Keywords: glucose control, hypertension, kidney failure, diabetes, protein blood pressure

Hypertension: Stringent Control Does Mean Better Outcomes

2005-07-10T15:47:00.000+08:00

Clinicians have always dealt with the blood pressure as a “cliff phenomenon”. The working assumption is that the risks of hypertension-related damage to the body increase significantly beyond a certain threshold blood pressure.

This type of approach is quite reasonable, as treatment must be decided at a finite and measurable point. Most guidelines recognize this, and physicians start medication to treat hypertension when such threshold are crossed. The working assumption fundamentally at deciding thresholds of starting therapy is that further lowering brings no benefit. The problem really is not that it is unknown if hypertension causes complication; this is without any doubt; but really the concern is how low should one accept the threshold before treatment is initiated.

The problem is compounded because within the large group of patients with hypertension, there are patients with a greater risk than others even at apparently lower levels of blood pressure. With better understanding, we can now identify such high-risk patients who need even more stringent blood pressure control. We can list these situations. Diabetics especially with poor glucose control, patients with high cholesterol, or patients with protein in the urine or underlying kidney failure require stringent control of the blood pressure. There are now newly defined risk groups. Obese patients form such a group, and patients beyond their ideal weight especially in the “morbidly obese” range are more sensitive to the effects of hypertension. In the general population with general low risk, it is widely accepted that a sustained blood pressure in the 140/90 mmHg is high and should be treated. The higher risk groups however, require treatment even at levels lower than that, and most guidelines would recommend treatment even if the blood pressure is slightly above a seemingly normal level of 130/80.

We can fine-cut this information further. If blood pressures below 140/90 were enough to reduce risks of death or complications like heart or kidney disease or strokes, then we would not see a difference in mortality if we were to study the clinical outcomes of subdivisions of this group of patients at various blood pressures levels. As it turns out, this is not true. Patients below 110 systolic, between 110-120, and between 120-130, and 130 to 140 do have a difference in mortality rates; the higher the blood pressure, the greater the risks. As important a conclusion, the lower the blood pressure, there is a continued reduction of mortality. Furthermore, this is true across all age groups from the younger to the elderly above 80; even elderly patients may benefit from tighter blood pressure control. The benefit of treating hypertension therefore follows a continuum rather than plateaus out.

But like any data in clinical medicine, there should not be a blanket application of this data to all individual patients. The lower the target, the greater the umber of drugs required, the greater the risks of drug toxicity, adverse interactions, convenience of dosing, and the higher the cost of therapy. Without doubt any system must have upper and lower limits; the issue is how low is low going to be, and blood pressure control is one of them. At the end of the day, decisions on blood pressure targets must rest with patient and physician together. But the concepts are very interesting, as such beneficial effects of lowering the blood pressure is to such lows is new information. This information challenges practicing physicians with all the skill of their hands to achieve the best outcomes for their patients.

Dr Stephen Chew Tec Huan
Consultant Nephrologist And Physician
Mount Elizabeth Hospital / Mount Alvernia Hospital

Keywords: glucose control, hypertension, kidney failure, diabetes, blood pressure

骨质疏松症（Osteoporosis）

2005-07-09T21:56:00.000+08:00

骨质疏松症是全身性骨骼疾病, 以低骨量和骨组织微结构破坏为特征，患者的骨质下降，骨骼脆性增加和变弱，导致易发生骨折。随着年龄的增加，伴随而来的腰酸、背疼、弯腰、驼背等现象，在过去认为是自然现象而实际上是一种老年性疾病。骨质疏松的发病率在慢性病中已跃居第七位。

骨质疏松症是全身性骨骼疾病, 以低骨量和骨组织微结构破坏为特征，患者的骨质下降，骨骼脆性增加和变弱，导致易发生骨折。随着年龄的增加，伴随而来的腰酸、背疼、弯腰、驼背等现象，在过去认为是自然现象而实际上是一种老年性疾病。骨质疏松的发病率在慢性病中已跃居第七位。60岁以上的人群患有骨质疏松症超过50%，而其中女性约占80%。
成因: 骨骼是个动态的器官，身体会不停制造新的骨组织，而旧的骨组织会被分解及取代。当年龄超过三十岁以後，制造骨组织的速度会开始相对减慢，被分解的骨组织比新制造的骨组织为多，导致骨质慢慢流失。如果一个人年青时的骨质已经较少和骨质流失速度比较快的话，年老时患上骨质疏松症的机会便会增加。以下的因素亦会增加患上骨质疏松症的风险：酗酒。吸烟。缺乏运动，或长时间不能活动(如中风)。营养不良，缺乏钙质。药物（类固醇、化疗、抗痉挛剂）。内分泌疾病（如甲状腺亢奋）、癌症及发炎性肠疾。
骨质疏松症的徵状: 骨质疏松症一般没有明显的临床徵状，直至发生骨折才会被发现，骨质疏松患者的三大症状是
1. 疼痛最为常见：多为腰背酸疼，其次为肩背、颈部或腕踝部
2. 骨骼变形：脊柱骨变形，弯腰、驼背、身材变矮。
3. 骨折：骨折是骨质疏松症的并发症、常见骨折部位是脊椎骨（压缩性、楔型）引致急性背痛、逐渐变成背部弯曲及身高变矮。腕部（桡骨头）和髋骨（股骨颈）、10~20%的股骨颈骨折患者，在住院的第一年死亡，余下一半生活不能自理。
诊断: 主要依靠双能X线骨密度测量仪
预防: 以下预防方法可减低患上骨质疏松症的风险,应在幼年或青年时开始养成，效益将更大：
• 保持活跃的生活方式，定期做运动及晒太阳。根据个人的身体状况做一些负重的运动，如上楼梯和举重，已能够帮助建立骨骼的钙质储备。
• 保持均衡饮食，以确保摄取足够的钙质及维他命D。高钙低脂的鲜奶及芝士、有骨的鱼类（如沙甸鱼）及深绿色的菜都是好的选择。
• 戒烟。
• 减低或避免饮酒。
如何自救: 如果你被诊断患上骨质疏松症，你可改善生活习惯帮助自己：
• 保持正确坐下、步行和提起重物的姿势，以减轻脊骨所受的压力。
• 定期做运动可改善敏捷度和平衡能力，以减低跌倒的机会。
• 建立一个安全的生活环境，避免跌倒或摔倒。
• 依从医生的建议服用药物、进行运动及物理治疗
治疗方法: 医生会根据病情的严重性建议病人合适的治疗。骨质疏松症的药物治疗有维生素D、二磷酸盐、降钙素、雌激素等。主要是减慢骨组织分解的速度。如果发生骨折，就有可能需要进行外科手术。

Minimally Invasive Orthopaedic Surgery

2005-07-09T21:35:00.000+08:00

If you want smaller incision and the scar is not obvious. Minimally invasive surgery is the answer. It not only provide you with small scar; it also allow early recovery as there is less tissue trauma

Minimally-Invasive Orthopaedic surgical techniques are being used to treat fractures, nonunions, malunions and infections (osteomylelitis and septic arthritis).
Use of these techniques decreases the recovery and rehabilitation time because the surgical exposures including skin dissection are smaller and less damaging to the vital soft tissue structures.
These techniques are specialized and call for the use of sophisticated instruments and precise preoperative planning. The success rates with this type of surgery have been exceedingly high.
New advances in computer-assisted surgery such as using navigations, simulators, robots, and computer-assisted accuracy for measurements and image-guided surgery has made the art of Orthopaedics even more successful. It is successful in joint replacement for arthritis as well as reconstruction of fractures of bones and realignment of extremities. The new techniques allow indirect fracture reduction and fixation, with less likelihood of injury to blood flow to vital structures and less harmful to blood vessels and nerves. This leads to a faster and more complete recovery from injury.
Dr. Low Chee Kwang
Consultant Orthopedic Surgeon
MBBS, M Med Surg, FAMS Ortho
FRCS Edin, FRCS Glas
International Advisor of Royal College of Physician and Surgeon of Glasgow

Keywords: joint replacement, image-guided surgery, arthritis, fractures

Introductory comments

2005-07-09T11:31:00.000+08:00

Dear all,
Greetings from the Health & Wellness Domain!

I would be pleased to comment on health & fitness issues in general...more specifically, my bailiwick is in the medical discipline of Anaesthesiology..and if you have any queries on Relief of Pain during Childbirth, what to expect when undergoing anaesthesia for surgical procedures...what kind of surgeries you can expect to go home on the same day etc...please feel free to drop me a line...

Ciao for now,
Doc Jen

What Should I Eat?

2005-06-04T10:33:00.000+08:00

Although the diet of average Singaporeans is deemed satisfactory, the concern is on excessive consumption of energy, fat, cholesterol and sodium, based on a suvey done by the Singapore National Health Promotion Board. The concern is on the higher proportional intake of fatty and salty foods relative to protein, carbohydrate, dietary fibre, vitamins and minerals. The contemporary dietary approach is to ensure a healthy balance in the intake of protein, carbohydrate, dietary fibre, vitamins and minerals, and consume fat, cholesterol, salt and sugar in moderation.

Carbohydrates normally form 45 to 65 percent of total calories.
Carbohydrates are the body's main energy source and comprise of starches and sugars. Starches are complex carbohydrates and are found mainly in rice,bread,pasta, cereals and vegetables. Sugars are simple carbohydrates and are found in fruits, milk and foods made with sugar, such as sweets.

Complex carbohydrates and sugars from fruit and milk are preferred to simple sugars from candy and sweets. The body absorbs complex carbohydrates more slowly than it absorbs simple sugars, hence providing energy for a longer period of time. In addition, complex carbohydrates, fruit and milk provide more nutrients and fiber than sweets.

Protein comprises 10 percent to 35 percent of total calories. Proteins are essential to human life as they form the cell and its constituents.

Protein is also a nutrient found in many foods. Legumes, poultry, seafood, meat, dairy products, nuts and seeds are rich sources of protein. Grains and vegetables supply small amounts. When choosing sources of protein, note that some of these may also be rich in fat and cholesterol.

Fat comprises of 20 percent to 35 percent of total calories. Unlike protein and carbohydrates, fat is an extremely concentrated form of energy that contains little water.

Although fats have developed a bad reputation, they have important functions in the body such as helping the absorption of the fat soluble vitamins, thus helping maintain the structure and function of cell membranes and assisting the body's immune system. But too much fat can have a negative effect on health, such as increasing the risk of heart disease, diabetes and obesity.

Food contains different kinds of fat, including:
· Saturated fat. This type of fat can be found in butter, cheese, whole milk, cream, eggs, meat, poultry, chocolate, coconut, palm oil, lard and solid shortenings.
· Polyunsaturated fat. This is found in vegetable oils (safflower, corn, sunflower, soy and cottonseed oils)
· Trans fat. Most margarines and shortenings are high in trans fat. Commercial baked goods and fried foods, such as french fries, also have significant amounts of trans fat.
· Monounsaturated fat. Foods high in monounsaturated fat include nuts, avocados, olive, peanut and canola oils.

Saturated fat should not form more than 10 percent of total calories. Saturated fat is the main dietary culprit in raising blood cholesterol. To reduce saturated fat intake, limit the amount of meat, cheese, butter, whole milk, cream and eggs in your diet, along with foods made from lard, solid shortenings, and coconut oils.

Next serving: Practical Tips To Eating For Youth

Keywords: diet, cholesterol, carbohydrates, fat, protein

How Much Should I Eat?

2005-06-03T10:26:00.000+08:00

Your body burns (metabolizes) carbohydrates, protein and fat to produce energy and perform other necessary functions. This energy is measured in calories. The amount of calories you need will depend on basal metabolic rate and total daily energy expenditure.These factors in turn depend on your activity level, body size, sex and age.

For example, an older, petite, sedentary woman may need only 1,600 calories a day, but a 25-year-old woman of the same size who is very physically active may need 1,800 to 2,200 calories a day.
On average, daily calorie goals are as follows:
• 1,600 — children ages 2 to 6, most women and some older adults
• 2,000 — average adult
• 2,200 — older children, teenage girls, active women and most men
• 2,800 — teenage boys and active men • For better accuracy of your calorie requirement , we can compute using more complicated formula but will leave it for another session. For those of you who are interested, please drop in a line and we can provide with you a template.

Contributed by Dr Sophia Chew.
Next serving: What should I eat?

How Young Do You Eat?

2005-05-31T10:16:00.000+08:00

We are pleased to introduce a series of articles How Young Do You Eat? from our panel of health and wellness consultants for your reading pleasure.

Food Consumption

Eating is one of the greatest pleasures in life, at least for some of us. And it forms the cornerstone for health. When it comes to healthy eating, many people feel that “If it’s good for you, then it will taste bad!” This is simply not true. You can eat your way to youth and health and do so deliciously.

1. Eating well is important

2. Or do you have the attitude, that since we will all go one day, we should just gorge and indulge.

3. Allow me to relate to you a little tale. For the longest time, I would talk to the significant other about nutrition, blood pressure and checkups etc. However, it soon becomes obvious that my beloved probably takes better care of his car than himself. So what the wife does is to change the language. Eg Honey, you really ought to ensure that the Octane rating on that fuel is the best for your gleaming new car like eating the right type of food.

4. Or how about this one, Darling, it’s time for your 100,000 km service. The man protests - but I feel fine. I don’t need to see the doctor every year. I am not that old. Response-it’s not the years, it’s the mileage. I don’t like going. It won’t be bad, she’ll listen to your engine and check your fluids. She’ll want to check my prostate. A moment of hesitation and then the vehicular equivalent-that’s like getting your oil checked. No’ it’s not. Well, it’s like getting your radiator flushed. No, says the significant other. Well, maybe it’s not like anything else but you still have to go to the doctor. I don’t want to. Listen, sweetie, you won’t be parking your car in my garage until you go for your checkup!

Remember that even though that is true, we would want to ensure that our bodies remain young and functional for as long as possible. Even though we may age , we want to have young and healthy cells and keep all the chronic degenerative diseases at bay.

It is really simple, if you do not maintain a machine properly, and supply it with optimal fuel, it will not operate as well. I know how appalled the guys will be if I fill up their new Beemers with the lowest quality petrol.

If you take this to the cellular level, remember that the human body is no different. The human body is made up of over 60 trillion cells and the body as a whole can only perform as well as the individual cells are performing.

The cells are constantly dying and regenerating. They need apart from the basic fuels of carbohydrates, proteins and fats, they also need over 50 different vitamins and minerals in the correct ratios for optimal performance. Someone did say that the human body is a machine but it takes 50 years for the import of all the fuel we feed it to soak in. By that time, you will know whether your machinery has been maintained well or otherwise.

Before it is too late, we may want to consider some steps to steer us out of a tight spot.

Contributed by Dr Sophia Chew

Next serving: How much should I eat?

Keywords: nutrition, chronic degenerative diseases , vitamins, minerals

Value Based Management

2005-05-31T09:13:00.000+08:00

From time to time, we will like to take stock of where we are heading. This chapter serves to highlight issues that are important but somehow not in our priority list. We get lost in the worklife jungle without the benefit of guidance from a wise hand.

By including this chapter along with others, we believe the juxtaposition will work its magic.

High Blood Pressure and Kidney Disease

2005-05-31T08:54:00.000+08:00

In this posting, Dr Stephen Chew Tec Huan, a Consultant Nephrologist and Physician will take a look at high blood pressure in relation to kidney disease.

High blood pressure in the setting of kidney disease is usually more difficult to control. Patients may need on the average 3 to 4 medications to reach blood pressure targets. There are several reasons why BP control may be difficult.

1: Patients omit their medication - If omitted they will have blood pressure problems uncorrected. Some patients take their medication only after they realize that a doctors visit is coming up. However, even if their pressures become normal, they would eventually suffer from problems of period of unsustained and only intermittent blood pressure control.

2. Patients continue with a high salt diet - Restricting salt is an important measure in controlling bp. Even without adding extra salt or sauce to our meals, the asian diet tends to be high in salt. Canned foods are another potential source of salt that the patient may be taking without realizing it.

3. Other medications like erythropoeitin may aggravate hypertension - You will need to discuss with your doctor on the relative importance of the issues at hand; ie is taking the injection critical versus the need or ability to control the blood pressure. Sometimes simple medication like flu medication can aggravate hypertension.

4. Certain antihypertensive medication can paradoxically cause periodic increases in hypertension. Your doctor is the best person to discuss this with.

Keywords: blood pressure, hypertension, kidney failure, diabetes, salt

Hypertension - Blood Pressure Control

2005-05-31T07:46:00.000+08:00

We continue with Dr Stephen Chew Tec Huan, a Consultant Nephrologist and Physician, for his insight into hypertension. In this post he will share with us some pointers on keeping blood pressure under control in the pre-dialysis patients.

Hypertension is usually silent. There maybe no symptoms even in the presence of severe hypertension unless complications set in. Hypertension can occur in the absence of any other medical problems and can be an isolated problem. According to Dr Chew, it is more frequent in obese individuals, patients with diabetes, patients with kidney disease, and can occur in association with high blood cholesterol levels. Some of these occur in the individual patients at different times of their lives, and it is important that the patient knows that he has to check regularly for these problems even if they were not first detected at the time he was diagnosed with hypertension. High blood pressure is like a time bomb, it exerts its effects slowly and progressively damaging kidneys, heart, brain and blood vessels to the legs and hands, and can explode (so to speak) by showing itself when the patients develop a catastrophic complication like a stroke or heart attack.

The first step is to know your blood pressure

There are many measures of the blood pressure and it may vary taken at different postures (eg standing versus sitting), it may vary according to the time a person has taken his medication for hypertension, and even may vary depending when it is taken (clinic blood pressures may be higher than home blood pressures). Special ambulatory machines can measure the blood pressure over 24 hours, and normal non-hypertensive individuals usually have a normal dip in their blood pressure in the night. In patients with hypertension due to kidney disease, this dip is usually absent, and ironically, the blood pressure actually surges in the early hours of the morning. Several measures of the blood pressure are more important a guage of effective control than single isolated readings.

Who should measure your blood pressure?

Ideally Yourself. And At Home, In the Morning, Before Medication. There may be exceptions to this, and your doctor can best advise you. Clinic blood pressure may be misleadingly high, leading to potential overtreatment; likewise, it may be deceptively normal if measured after medication. 24 hours BP measures are inconvenient to do all the time although they are possibly the best measures of how well the blood pressure is controlled through the day.

Some useful tips to consider.
1. Buy a blood pressure machine for home use especially if you can't measure your blood pressure with your doctor over at least over several periods.

2. Try to buy machines that use an arm wrap instead of a wrist wrap; they're better indicators of your true blood pressure.

3. Bring your home machine to your doctor when you see him. He can verify the accuracy or degree of reliability of your machine.

4. Take the BP at home, rested after 5 minutes, in the morning, same arm, before medication. Record the time you took it as well. Do it for at least one week for every month. If you do it daily, all the better.

5. The ideal target blood pressure is best discussed with your doctor. In general anything above 140/90 is considered hypertension, although what your target BP ought to be should be individualised after discussing with your physician.

That's all for the moment. Do stay in-tune for more insights.

Keywords: blood pressure, hypertension, kidney failure, diabetes

Checking Hypertension With The Doctor

2005-05-29T16:09:00.000+08:00

To kick-off this chapter, we thought it to be appropriate to deal with a topic close to our heart.
We are subject to stress on a daily basis, be it our work, personal life or both. And we know how stress can have an adverse impact on our immune system. Before we let our stress levels get out of control and develop into an extreme form of auto-immune sickness, we need to understand our body and how it reacts when we unconsciously abuse it. We checked with Dr Stephen Chew Tec Huan, a Consultant Nephrologist and Physician, for his insight into hypertension and how we can cope with it.

If you think of it, the word hypertension means high blood pressure of the blood vessels. It reflects the blood pressure that is over and above a norm.

In earlier days, when blood pressure was just beginning to be measured in clinical medicine, the inclination was that hypertension need not be treated. Earlier thoughts on hypertension were "the best thing for the clinician to deal with this entity of high blood pressure was to forget about it".

How things have changed. Not only is there conclusive evidence that hypertension is associated with the development of many diseases of the blood vessels, but more importantly its treatment is associated with the reduction of these risks. And the complications are many. Heart attacks and strokes were well known complications of untreated hypertension, but the list grows and includes kidney failure and blood vessel diseases of the legs causing gangrene just to name a few.
Furthermore the emergence of new data suggests that the blood pressure targets achieved previously were inadequate to reduce these complications, and now both patients and physicians must grapple with the challenges of achieving even more stringent blood pressure targets to reduce complications effectively.

Hypertension reflects a parameter in the body and is not the actual disease itself. Although the name sounds the same (ie hypertension), the reality is that different patients with the same label of hypertension will all come out of the clinic with different medication. There are furthermore distinctly different types of hypertension. It is important to exclude coexisting kidney disease, as well as certain metabolic disease such as glandular tumors that can cause hypertension. The diagnosis and therapy of a patient with hypertension must therefore be tailored to the individual’s needs for maximum effectiveness and minimal complications from drug therapy.

Most importantly, while reducing the blood pressure to a normal level is important, there are certain abnormalities that should be looked for and treated that tend to occur commonly in association with hypertension. These are factors which by themselves can exist in isolation, but tend to cluster with hypertension, and together with it, amplify the risk of complications. These factors are diabetes, gout and high cholesterol.

Care for the hypertensive patient should include management of all these risks. Like treatment of any chronic disease, treatment is a journey and not a distinct single episode, and requires both the hands of a physician and a cooperative patient to achieve the best outcomes possible.
We hope that in future postings to cover dangers of uncontrolled high blood pressures, how to keep your blood pressure in check and dietary approaches to stop hypertension.

You should consult your doctor if you require further clarification on this topic.

Feel free to provide your feedback and we will be pleased to follow up on your comments on the next episode.

Keywords: blood pressure, hypertension, kidney failure, diabetes

Launch of Health and Wellness Program

2005-05-27T07:34:00.000+08:00

We are pleased to launch eFrenzconnect Health and Wellness program. We hope to uniquely position this program that will serve to introduce health & wellness into the realm of value based management. Measuring and managing human resources within an organisation have taken on a greater degree of urgency as the value drivers of corporates in a knowledge-based economy, have shifted towards leveraging off intellectual capital to generate shareholder value.
We will introduce the concept of wellness that will serve to optimise the psychological, social and physical well-being of individuals. In a brief poll conducted with corporate executives, an overwhelming percentage felt that it is extremely critical for an organisation to implement a holistic Health & Wellness program and that such a system should be an integral part of a performance measurement system.

To sustain interest and making it fun to visit this site, we will develop a series of e-initiatives in order for our pool of medical consultants-cum-specialists to interact seamlessly with you.

We hope to build a firm foundation from which we all can be empowered to maintain a sustainable healthy lifestyle. Thank you.