06 July 2011

OSTEOARTHRITIS, KNEES

Osteoarthritis (OA), also known as degenerative arthritis, is a condition of the joint that worsens with time. It is the most common type of arthritis and there is no cure.

It is caused by wear and tear due to excessive use over the years or to old injuries in the affected joints. It commonly affects people over 60 years of age. It mostly affects the large weight-bearing joints like the knees, hips and spine, causing pain and stiffness which is worst at the end of the day. The affected person may have difficulty in walking, climbing stairs, squatting or kneeling.

RISK FACTORS

  • Family History

  • Sex ( Females are at higher risk)

  • Obesity ( 66% of obese people are at risk for Knee OA )

  • Age ( higher risk above 45 years old)

  • Joint Injuries

  • Physical Activities ( repetitive trauma to joint)

  • Ethnicity ( Asians are at higher risk )

FEATURES

Typical features include :

  1. narrowed joint space

  2. cartilage loss and damage

  3. bone spur formation

SIGNS AND SYMPTOMS

Signs and symptoms include :

  1. Joint pain and swelling

  2. Cracking sounds in joint

  3. Stiffness

  4. Difficulty in movement

70% of OA cases are that of Knee OA.

25% of sufferers are unable to perform major activities of daily living.

TREATMENT OPTIONS

  1. Lifestyle modification ( weight loss, decreased weight-bearing activity etc)

  2. Physiotherapy ( strengthening of the muscles around the joint )

  3. Oral supplements ( e.g glucosamine)

  4. Painkillers ( side effects of medications need to be managed carefully )

  5. Joint Injections ( steroids, viscosupplementation)

  6. Surgery ( for severe cases when all other treatments have failed to provide relief)

LATEST UPDATES

Viscosupplementation is indicated for the treatment of pain in patients with Knee Osteoarthritis, who have failed to respond adequately to conservative therapy and painkillers. It involves an injection into the affected knee joint. It basically replaces damaged joint fluid with a substance similar to healthy joint fluid, in order to reduce pain, improve the knee joint's natural shock-absorbing qualities and to improve mobility and function.

The response to this injection varies from patient to patient, but relief from pain is felt from 1 week to 6 weeks post-injection. Pain-relief with this injection can last from 6 months up to 1 year.

Patients can opt for either the one-time injection or the series of 3 injections on Day 1, Day 8 and Day 15. The effects of both are similar.

Prices are around $840 for the single injection,

or $280 per injection for the series of 3 injections.

References: http://www.hpb.gov.sg/diseases/article.aspx?id=568

08 June 2011

PNEUMOCOCCAL DISEASE

Pneumococcal Disease (PD) describes a group of illnesses caused by the bacterium Streptococcus Pneumoniae, also known as Pneumococcus.

There are more than 90 sub-types of this bacterium. It affects both children and adults and is a major cause of morbidity and mortality worldwide. Serious pneumococcal infections are a global health problem but are vaccine-preventable.

Worldwide, a million children die from PD each year. In Singapore, up to 70 per 100,000 children less than 5 years old are affected by PD. Pneumococcus is also the most common cause of community-acquired pneumonia (CAP) accounting for 19-25% of all cases.

TRANSMISSION

It is commonly found in the nose and throat of healthy children and adults, with as many as 4 serotypes carried at once. While not all individuals will get sick from Pneumococcus, anyone in whom the bacteria has colonized is a carrier, and can potentially infect others through airborne particles.

Although anyone can get PD, some are particularly at high-risk for the disease. They include infants, the elderly and individuals with chronic medical illnesses or weakened immune systems.

EFFECTS

After Pneumococcus colonizes in the upper respiratory tract, it can cause

  • Bacteraemia/Sepsis (infection of the blood),
  • Meningitis (infection of the membrane of the spinal cord or brain)
  • Pneumonia (infection of the lungs),
  • Otitis Media (infection of the middle ear) and
  • Sinusitis (infection of the sinuses).

TREATMENT

Prompt treatment with antibiotics is usually effective. In recent years due to the emergence of antibiotic-resistant strains, particularly to penicillin, the treatment of PD has become more challenging and may need a longer hospital stay along with expensive alternative therapy.

PREVENTION

The best way to protect against PD is through vaccination. Vaccines are generally safe and effective.

A single dose of PPSV (Pneumococcal Polysaccharide Vaccine) is protective against 23 of the most prevalent strains of the bacteria in adults. Vaccination with PPSV is recommended for:

  • People aged 65 years and above

  • Those who have a chronic medical illness such as Diabetes, heart, lung and liver diseases

  • Those who have asthma or smoke cigarettes
  • Those with a weakened immune system due to human immunodeficiency viral (HIV) infection or cancer
  • People without a functioning spleen and those with sickle cell disease

  • Residents of long-term care facilities such as nursing homes

VACCINATION

For adults
,
one single dose is usually sufficient.

  • Price of each vaccination is $80 onwards.
Children younger than 2 years old
are at a higher risk for serious PD than older children, hence vaccination with PCV (Pneumococcal Conjugate Vaccine) is recommended for them. The number of doses and the intervals between doses depend on the child’s age. It is also part of the childhood vaccination schedule recommended by the National Immunisation Registry of Singapore.
  • Price of each vaccination is $165 onwards.

CONCLUSION

Pneumococcal disease is a preventable disease with the current vaccines covering up to 90 percent of disease-causing pneumococcal strains, including the six serotypes that most frequently cause invasive drug-resistant pneumococcal infections among children and adults.

The chances of your child or parent getting infections like meningitis, pneumonia and sepsis can be greatly reduced.

Please check with our doctors for further information.

References :

http://www.hpb.gov.sg/diseases/article.aspx?id=8314

http://www.cfps.org.sg/sfp/36/362/362_unit5.pdf

22 May 2011

CERVICAL CANCER VACCINE

WHAT IS CERVICAL CANCER?
A woman’s cervix is located at the lower part of the womb. Changes can occur in these cells and in many cases, the cells return to normal on its own. However, in some cases, the cells change in an abnormal way and develop into cervical cancer. Cervical cancer can be prevented if these abnormal changes are detected and treated in its early stages. In Singapore, about 200 women are diagnosed with the disease each year, and 80 die of it, most likely because it is discovered late.

HOW CAN CERVICAL CANCER BE DETECTED?
Cervical cancer can be detected by a Pap smear. It is a screening test to check for changes in the cells of your cervix whereby cells are collected from your cervix. The process takes only a few minutes. The cells are then smeared onto a glass slide and sent to a laboratory for further processing and examination under a microscope.

Pap smears are recommended for sexually-active females from age 18 onwards. The frequency of screening is from 1-3 years, depending on risks. Most family clinics should be able to provide this service.

THE LINK BETWEEN CERVICAL CANCER AND HPV
Some types of Human Papilloma Virus (HPV) can infect the cervix, causing the cells to change. In about 90% of the infection cases, the virus clears by itself and the cells return to normal. In some cases, the infection can persist and cause the cells to grow in an abnormal way, developing into cervical cancer. Specifically, HPV types 16 and 18 causes about 70% of the cervical cancer cases worldwide.

WHAT IS THE HPV VACCINE? The HPV vaccines are targeted for use in females aged 9 to 26 years old. They are most effective in protecting against infection by the selected HPV types if given before first sexual exposure. Vaccination does not substitute for cervical cancer screening by regular Pap smears. However, new evidence shows that the vaccinations are effective in women up to 45 years of age.

It is important to know that the vaccine is not designed to protect against other HPV types (i.e. non-type 16 or 18) that cause about 1 in 3 cases of cervical cancer. It is also important to remember that the vaccination works by preventing infection by the specific HPV types – it does not treat existing HPV infections.

The vaccination schedule is 3 doses at 0, 1-2 month and 6 month interval. The Expert Committee for Immunisation in Singapore has recommended that HPV vaccinations be included in the national childhood immunisation programme.

In summary, HPV vaccinations are strongly recommended for girls and ladies from the age of 10 onwards, in particular teenagers and young adults. It should be considered for at-risk females up to 45 years of age as well.

At our clinics, we provide HPV vaccinations at the below fees:

1)Single dose -
$145 vaccination + $5 practice cost

2)Package of 3 dose (practice cost waived) -
$400 (Cervarix)
$430 (Gardasil)
Up to S$300 can be reimbursed per Medisave account.
(edit: Medisave claim upper limit has been revised to $400 per year)

* All fees are exclusive of GST.

Do drop by our clinics for any enquiries or a detailed consultation to find out more.

References :
http://www.hpb.gov.sg/diseases/cervicalcancer.aspx
http://www.hpb.gov.sg/healthscreening/article.aspx?id=8766 http://www.hpb.gov.sg/hpb2/qnahpb_faqmain.asp?strItemChoice=200511803814&strSubItemChoice=20051180393&action=SHOWTOPICS&m_strTopicSysID=2008430144324#20051180393 http://www.healthxchange.com.sg/News/Pages/Cervical-cancer-jabs-covered-by-Medisave.aspx

12 February 2011

CHILDHOOD VACCINATIONS

For the newborn and the young children, there are many infections that can make them seriously ill. Fortunately for many of these serious and very contagious diseases, there are vaccinations available.

What vaccinations do is stimulate the child's body to produce antibodies that can fight and protect the child from these infections. Some vaccinations can last a lifetime, while others may need booster shots to 'strengthen' the antibodies titre (quantity) or make the antibodies last a long time.

As in many countries, Singapore's National Immunisation Registry has provided a recommended childhood immunisation schedule. (See chart)

At birth, the first 2 vaccinations (BCG and Hepatitis B) are usually done in the hospital. The subsequent vaccinations from age 1 to 18 months can be done at polyclinics, most family clinics or paediatric clinics.

In fact, the basic vaccinations are provided free at the polyclinics. The exceptions are Hepatitis B and Pneumococcus as well as the newer combination vaccinations that come with fewer side effects and injectable Polio (included in the 5-in-1 or 6-in-1 shots). There are also optional vaccinations to consider, eg., Chicken Pox, Meningitis and Hepatitis A.

Vaccinations scheduled for age 6 years (Pri 1) and 11 years (Pri 5) are conducted in the local primary schools by the School Heath Services. However, parents can choose to opt out and have the required vaccinations done by their family doctors. For secondary school girls, cervical cancer/HPV vaccine is also recommended.

Our clinics provide vaccinations for
1) childhood
2) adult
(Tetanus, Polio, Flu, Hepatitis A&B, Cervical Cancer/HPV, Chicken Pox, etc)
3) elderly
(Flu, Pneumoccocus, etc)
4) travel
(Typhoid, Hepatitis A, Flu, Polio, Tetanus, Meningitis).

For enquiries, please call our clinics:
AMK - 6554 2918
Novena - 6254 2008
nex - 6634 4918

*Edit* - from 1st Dec 2011, there is a change in the MMR vaccination schedule. The 2nd dose of MMR should be completed by age 2 (previously during Pri 1 at age 7).

06 January 2011

CHOLESTEROL AND GLUCOSE SCREENING

In collaboration with our kind sponsors, Xepa-Soul Pattinson, we are providing
FREE Cholesterol and Glucose blood screenings
for our patients.

For the initial period, the screening promotion will only be available at
our new clinic at nex Shopping Mall #01=54/55.

Patients aged 35 years and above
can call us at Tel: 6634 4918 or visit our clinic personally for registration.
Both new and old patients are welcome.

The blood sampling, laboratory tests and review of the results only are FREE. Blood pressure readings will also be taken at the same visit.

For our patients at AMK and Novena who are interested, you can also leave your particulars and contacts with our staff in the meantime. We are planning similar screening promotions as well at a later date.

For the general population aged 40 years and older, routine health screening is recommended for diabetes, high blood pressure, high blood cholesterol and obesity. For females, additional screening is also recommended for breast and cervical cancer.

For more reading on health issues and education, we recommend patients to visit the
Health Promotion Board Online website which provides good reading material on many common diseases and conditions. http://www.hpb.gov.sg/diseases/default.aspx

Lipid (cholesterol and triglyceride)
http://www.hpb.gov.sg/diseases/article.aspx?id=772
Diabetes
http://www.hpb.gov.sg/diseases/article.aspx?id=680
High blood pressure
http://www.hpb.gov.sg/diseases/article.aspx?id=766