Wednesday, August 15, 2007

A Doctor's Ramblings

I was actually thinking about killing this blog since there have so few readers. But then I figured maybe the information could be useful to someone. The truth is, medicine is no fun without the people factor. Just providing information is really kind of boring. Kind of like attending a lecture. I actually had a lecturer who was so incredibly boring he talked himself to sleep. Seriously ! Not that many noticed. Most of the lecture hall was asleep anyway. Those who were awake and tried to pay attention noticed he had stopped talking for a while. The hall was kind of dark so it wasn't too obvious. But after a while of silence, we realised the guy had fallen asleep !

Oh well. Anyway, I won't kill this blog for now. It would be a whole lot more fun if people actually asked questions. But I can't give proper advice anyway cos it is better to see someone in person since a lot of the diagnosis is sometimes just gut-feel, and I can't do that since this blog would then be consutrued as self-advertisement.

Incidentally, I won't really be checking this blog so can you please contact me at my other blogs Grow Rich Along With Me ! or Lonely Surfer ?

Saturday, July 7, 2007


A stroke is the brain's equivalent of a heart attack. It happens when the blood flow to the brain is suddenly disrupted. There are two main ways this happens, either the blood flow is suddenly blocked , eg. by a blood clot, or by a sudden bleed in the brain. Either way, it is a medical emergency.

Sometimes, there are warning signs , where a person can have a very early stroke that is transient, and then recover. These are called transient ischaemic attacks ( or TIAs).

Many people fear they are having a stroke when they suddenly feel very giddy. There are many causes of giddiness. The form which causes the room to spin around, or make you feel unsteady, like you are on a boat, is called vertigo. Causes of vertigo can be central ( the brain) or peripheral ( the balance receptors in the ear). A sudden giddiness, loss of balance, or difficulty in coordination or walking can be a sign of a stroke. Other symptoms include sudden numbness or weakness over one side of the face, arms or legs ( usually only one-sided, because of the way the blood is supplied to the brain), difficulty seeing in one or both eyes, sudden confusion, problems in speaking or understanding speech, and a very bad headache with no known previous cause. If you or someone you know suddenly experiences these symptoms, it is best to seek medical advice quickly as stroke is an emergency.

What does a stroke do to you ?

Stroke damages the brain, affecting the entire body . The resulting disabilities can range from mild to severe . These include paralysis, problems with thinking, problems with speaking, and emotional problems.

Can anything be done ?

Yes ! Most definitely. New treatments are available that greatly reduce the damage caused by a stroke. But you need to arrive at the hospital within 60 minutes after symptoms start to prevent disability.

Can we do anything to prevent a stroke ?

There are certainly ways to reduce one's risk of having a stroke. The conditions that increase one's risk include : having high blood pressure, smoking, diabetes and being overweight. So if you have high blood pressure, take your medication regularly. If you don't, get checked for it regularly. Often, high blood pressure does not cause any symptoms and people tend to forget to take their medication, or give reasons for why their pressure is high that day eg. lack of sleep, stress etc. Whatever the reason, high blood pressure increases the risk of stroke. Don't smoke. I can't think of any real health benefits to smoking. But the bad effects are well-known. So stop ! People don't realise they have diabetes either as they seldom feel it. Get checked for it, and take the medication regularly. Maintain a sensible lifestyle of eating in moderate amounts and exercising regularly.

How is it treated ?

In the initial stages, drugs that break down the blood clot can be used. If it is done in time, the blood flow can be restored to the affected part of the brain. It can only be done if the stroke is due to a block, not if it was caused by a bleed. The doctor needs to be certain before treatment is initiated. A CT scan of the brain may be done.

Treatment after the initial stage is directed at preventing further strokes, and rehabilitation. Treatment can include drugs to control blood pressure and diabetes, and drugs to keep the blood from clotting. In some cases, an irregular heart beat can cause blood clots to go to the brain. For these cases, treatment of the heart rhythm and drugs to keep the blood "thin" ( less likely to clot) are needed. Surgery is sometimes used if there are plaques in the carotid arteries ( the large arteries that go from the heart to the brain, they are found in your neck) to remove the plaques.

Finally, rehabilitation is extremely important for a stroke patient. The intensity depends on how severe the stroke was. Patients who have had strokes are prone to depression, especially if they have been left significantly disabled as a result. Physiotherapists work with patients to help them sit up and walk . Occupational therapists help patients to cope with activities of daily living, which they may have trouble with after a stroke. For example, what used to be taken for granted like feeding or bathing themselves may now be affected. Modifications may need to be done to the home environment to make it easier and safer. Speech therapists may need to be involved as well if the patient has difficulty in swallowing or speaking. It is a long road and patients and their families need a lot of support.

In summary, it is important to be able to recognise the signs and symptoms of a stroke as early medical treatment can make a big difference. Prevention is better than cure. And once a stroke has occured, it is important to prevent recurrent strokes. Rehabilitation is extremely important in contributing towards the recovery of a patient after a stroke.

Monday, July 2, 2007

Lung Cancer

What is lung cancer ?

The most basic unit in our body is the cell. Normally, cells divide to produce new cells only when needed. When cell growth results in an uncontrolled division and proliferation of cells, eventually a mass known as a tumor forms. When this happens in the lung, it causes lung cancer.

What causes lung cancer ?

Smoking is the number one cause of lung cancer. About 90% of lung cancers arise as a result of tobacco use. The risk of lung cancer increases with the number of cigarettes smoked over time.

Other causes include passive smoking, family history, a past history of lung cancer , other lung diseases and asbestos exposure.

What are the signs and symptoms of lung cancer ?

In up to 25% of people who get lung cancer, they have no symptoms. The cancer is first discovered on a routine chest x-ray or CT scan as a solitary small mass.

The growth of the cancer and invasion of lung tissues and surroundings may interfere with breathing, leading to symptoms such as cough, shortness of breath, wheezing, chest pain, and coughing up blood (hemoptysis).

Sometimes, if the lung cancer that has spread to the bones it may produce excruciating pain at the sites of bone involvement. Cancer that has spread to the brain may cause a number of symptoms that may include blurred vision, headaches, seizures, or weakness or loss of sensation in parts of the body.

Non-specific symptoms seen with many cancers including lung cancers include weight loss, weakness, and fatigue.

When should one see a doctor?

One should see a doctor if they develop the symptoms associated with lung cancer, in particular, if they have:

  • A new persistent cough or worsening of an existing chronic cough
  • Blood in the sputum
  • Persistent bronchitis or repeated respiratory infections
  • Chest pain
  • Unexplained weight loss and/or fatigue
  • Breathing difficulties such as shortness of breath or wheezing

How is lung cancer diagnosed ?

A doctor can talk to, and examine a patient . This may reveal the presence of symptoms or signs that are suspicious for lung cancer. In addition to asking about symptoms and risk factors for cancer development, doctors may detect signs of breathing difficulties, airway obstruction, or infections in the lungs.

The chest x-ray is the most common first diagnostic step when any new symptoms of lung cancer are present.

A CT scan may be performed on the chest, abdomen, and/or brain to examine for both the primary tumour, and to check if it has spread.

Other tests include bone scans, and brochoscopy ( a scope of the lungs).

How is lung cancer treated?

Treatment for lung cancer can involve surgical removal of tumor, chemotherapy or radiation , as well as combinations of these methods. The decision about which treatments will be appropriate must take into account the the location of the tumour and whether it has spread, as well as the overall health status of the patient.

How can lung cancer be prevented?

Smoking cessation is the most important measure that can prevent lung cancer. There are many products available, such as nicotine gum, nicotine sprays, or nicotine inhalers. Minimizing exposure to passive smoking is also an effective preventive measure.

Tuesday, June 26, 2007

Exercise helps

It's been officially studied ! A recent paper in the BJGP found that exercise helps to improve the quality of life in women. It may even improve symptoms associated with menopause.

Menopausal symptoms can really affect a woman's well-being. With the recent bad press about hormone replacement therapy, alternative methods are needed as many woman may not want to take HRT. This study examined the association between exercise, the patient's body mass index, and the health-related quality of life in women of menopausal-age.

The results ? Women who were regularly active reported better health-related scores than women who were not. Obese women reported significantly higher symptom scores than those of normal weight. They also had higher attractiveness concern scores.

The data suggests regular exercise helps improve the health-related quality of life. Women with lower BMI scores reported feeling better than heavier women.

Article source : The British Journal of General Practice, Feb 2007 Vol 57/553. Exercise participation, body mass index, and health-related quality of life in women of menopausal age. Amanda Daley, C MacArthur, H Strokes-Lampard, et al.

Friday, June 22, 2007

How to lose weight and keep it off !

Weight-loss advertisements try to sell so many different things, all targeted at getting people desperate to lose weight quickly and willing to spend money rather than time and effort on it. The bad news is, they probably don't work. Anything quick and easy may work rapidly in the short-term, but is unlikely to last, and may not be good for your health either. Many who lose weight quickly through crash-dieting have found their weight just piles back on again when they stop. Sometimes, it is worse than ever. It has commonly been described as being like a yo-yo.
The advertisements don't give you the full truth. They either use models who have never been fat in their lives, or often, they use post-partum women ( those who have just delivered their babies). That doesn't work as most women naturally tend to lose some of the weight, if not all, gained during pregnancy anyway, especially if they were thin before. To take a picture one month after delivery, and 6 months later, hardly reflects the true picture. And you will notice there's always the fine print at the bottom of every product: To be used together with a sensible diet and exercise plan.
And that's the answer !! It's the sensible diet and exercise plan that works !! The funny thing is, often people aren't willing to get started by themselves, while it is free. They have to pay thousands of dollars to get someone to help them. I'm not sure whether it is because those who are willing to pay thousands of dollars are more motivated, or whether they have already paid out thousands of dollars and hence are more motivated! And the beauty industry is ever-willing to make a quick buck.
The basic facts are : If more calories go in than they are used up, the person gets fatter. If they are the same, the person remains the same weight. And if more calories are burned up than taken in, the person loses weight. That's all.
So let's look at the intake first.
That would be the food and drinks we consume. The amount and type of food has a direct impact on our weight. Most people are eating way too much today. The food portions are just too big, and maybe in a misguided attempt to not be wasteful, we stuff our faces with more than we can take, just to finish our food. Eat only till you are 80% full. Buy a smaller plate if you have to. Then you would put less food on it each time. Order a smaller portion. Share with a friend. With the days of hunting for food way behind us, there really is no need to stuff ourselves in the fear that maybe tomorrow there will be no food.
Calorie counting may be too tedious for most so the most sensible way would be simply to reduce food intake. But not drastically as the body tends to go into starvation mode when food intake is suddenly and drastically reduced, causing it to more efficiently retain whatever calories are taken in, and reducing one's metabolic rate, which is not the desired outcome. The 80% rule would be quite safe.
The type of food obviously makes a big difference. Choose food that gives you good nutrition. Chocolates and sweets do not fall into that category. There is no need to waste your calorie count on a sweet drink when water will do the job of quenching your thirst better. Stop buying processed foods and snacks. Have a fruit instead after dinner. Cut down on meats. Vegetables are healthier and cheaper. Don't fry. Grill or bake. With a little imagination, healthy food doesn't have to be boring or taste terrible. The Scandinavians eat plenty of salads and grilled meats and are all perfectly happy.
You don't have to completely change your diet. Think of yourself as having a "calorie budget". If you are going to use up some extra calories, you might as well make sure you enjoy a good meal. Don't waste it on a cheap chocolate bar just because you couldn't resist it. Save it up for the end of the week and have a nice restaurant meal.
Don't snack in front of the TV. It becomes a habit and one then tends to associate watching TV with eating. You may also be concentrating more on the program than your food, so not realizing when you are full , causing you to eat more than you should.
The trick though is to do everything gradually. A sudden withdrawal of all your favorite food and trying to switch over may cause you to crave for the foods you miss. This may lead to binge eating and a lot of guilt later. But don't delay. The commonest reason for failure in anything is procrastination. Anyone who says "I will start tomorrow", or "I will start after Christmas" probably would not start at all. Start small. But start today !
The same applies to exercise - the calorie "Out" part of the equation. I said before, do not eat in front of the TV. But by all means , exercise in front of the TV! Some people find jogging along on the road too boring. Put a treadmill or exercise bicycle in front of your TV. Target to stay on it at a moderate pace all through your TV program. Or get an exercise video and follow along. No time to exercise but have time to catch your favorite comedy? Then this would be the answer. I saw an exercise bicycle once that was linked to a TV. The cycling action of the rider generated the power to keep the TV on. It was a lot of hard work, but guaranteed to keep the cyclist exercising, especially through an exciting football match.
Any form of activity is good. What you need is sustained moderate activity, rather than short bursts of intense activity. So a brisk 30 minute walk is better than a quick 10 minute dash. Build activity into your lifestyle. The aim is to try to achieve 10,000 steps a day. It need not be done in one go. If it becomes part of your lifestyle, you need not set aside special time for exercise, so increasing your chances of actually getting some work-out. For example, take the stairs instead of the elevator. Stop one bus-stop away and walk. Park the car further away. Start doing more housework. Take up a hobby you enjoy. Not everyone likes swimming or jogging. Try dancing then! Or yoga. Whatever you like. You are more likely to stick at it if you enjoy it. Get a friend to come along.
There are no hard and fast rules to what type of exercise or what kind of food you must eat. The idea is you need to start implementing lifestyle changes. Today. Small but sustained changes are the way to go. And don't weigh yourself too often either. Any immediate weight loss is fluid loss and false reassurance. Slowly, you will start to feel better about yourself and be healthier too. When you feel good, you will look good.

So start small and slow. But start! And keep at it. Push yourself to new limits each time you achieve a new goal. Lose fat, and keep it off!

Sunday, June 17, 2007

Coronary CT angiography

What is Coronary CT Angiography ?

That's a real mouthful. It's actually a CT scan of the heart. It's a 64-slice scanner ( previously, CT scans were not detailed enough to view the coronary ( heart) arteries). It is a possible non-invasive alternative to the conventional coronary angiogram.

Why would we do this test ?

The main purpose would be to rule out coronary artery disease. In other words, if you have chest pain but the doctor is not entirely sure it is due to coronary heart disease, a clear scan would rule it out.

How is it done ?

It is done as an outpatient. You should be able to resume normal activity after the scan. Fasting for 4 hours before the scan is needed. You will be given an injection of an x-ray dye into your arm and asked to lie down. After the scan, you will be monitored for a few minutes to ensure you are well.

Who should do the test ?

  • People with an increased risk of heart attacks, eg. family history, high cholesterol, diabetes.
  • unusual chest pains that are not typical of heart disease
  • an inconclusive treadmill stress test

You have to consult your doctor first to determine if you are suitable for the test.

Thursday, June 14, 2007

Obesity and Hypertension

Information was taken from an original article first published in Singapore Medical Journal 2007; 48 (3) : 232

Comparative evaluation of obesity measures: relationship with blood pressures and hypertension by Ghosh J R, Bandyopadhyay A R

It is well-known that obesity is associated with an increased risk of high blood presure, or hypertension. But there are so many measures of obesity : eg. the Body Mass Index, waist circumference, the Waist Hip Ratio, the Waist Stature ratio , Conicity Index.

This study was done on 180 adult Bengalee Hindu men to determine which measure of obesity best correlates with a greater risk of hypertension.

The conclusion was that an increasing BMI was associated with a greater risk of developing hypertension.

BMI = your weight in kg divided by the square of your height in metres.

  • Healthy weight 18.5 to below 23
  • Overweight 23 to below 27.5
  • Obese 27.5 and above
( for Asians)

Sunday, June 3, 2007

Heart Disease

What are the causes of chest pain ?

Many people fear that they are having a heart attack when they experience chest pain. There are many different causes. Some are just inconvenient, like a muscle ache, others serious, like heartburn, and some can be life-threatening, like a blood clot in the lungs ( called a pulmonary embolism).

The chest pain from the heart is called angina. It happens when the heart does not get enough blood and oxygen. It tends to be made worse by exertion, and gets better with rest. It is usually described as a sudden crushing, squeezing, tightening, or pressure in your chest. The pain can radiate to your jaw, left arm, or between your shoulder blades. It may be associated with nausea, dizziness, sweating, a racing heart, or shortness of breath.

Who is at risk for a heart attack ?

Risk factors that cannot be modified include : age ( the older you are, the higher your risk) and gender ( males are at higher risk than women till after menopause).

Other risk factors include
  • smoking
  • high blood pressure
  • diabetes mellitus
  • high cholesterol

What tests might a doctor do ?

  • ECG ( it gives a tracing of the electrical activity of your heart)
  • blood tests to test for cardiac enzymes
  • treadmill stress ECG
  • CT coronary angiogram
  • cardiac catheterisation

How can a heart attack be prevented ?

  • Make a healthy lifestyle .
  • Achieve and maintain normal weight.
  • Control medical conditions like high blood pressure, high cholesterol, and diabetes.
  • Don't smoke.
  • Eat a diet low in saturated and hydrogenated fats and cholesterol, and high in starches, fiber, fruits, and vegetables.
  • Get at least 30 minutes of moderate intensity exercise on most days of the week.
  • Reduce stress.

What treatment is available ?

That depends on the symptoms and how severe the disease is.
If you have coronary artery disease that does not cause symptoms ( chest pain), you can be treated with either medicine or angioplasty with stenting. Surgery includes coronary by-pass surgery or minimally invasive heart surgery.

Each patient is different and the doctor will assess each situation to decide which mode or combination will be the best.

Monday, May 28, 2007

Obesity - article

Obesity ? Overweight ? Heavy bones ? What's the difference ?

The terms “overweight” and “obesity” refer to a person’s overall body weight and where the extra weight comes from. Overweight is having extra body weight from muscle, bone, fat, and/or water. Obesity is having a high amount of extra body fat. The most useful measure of overweight and obesity is the body mass index (BMI). BMI is based on height and weight .

So what causes someone to be obese ?

Many things can affect a person's weight. For example, environment, family history and genetics, metabolism (the way your body changes food and oxygen into energy), behavior and habits. Unfortunately, certain things, like family history, can’t be changed. However, other things like one's lifestyle habits can be changed.

What's the big deal ? Some people are fat, and some people are thin. Why should some people judge others for the way they look ?

Unfortunately, while that seems to be the major motivating factor for most people, young women especially, to lose weight, being overweight or obese isn’t just a cosmetic problem. It greatly raises the risk for many diseases and conditions. I'll just list some here.

  • Heart Disease
    Fatty material called plaque (plak) builds up on the inside walls of the arteries that supply blood and oxygen to your heart, narrowing them. This blood flow to your heart. Your chances for having a heart attack gets higher.
  • High Blood Pressure (Hypertension)
  • Stroke
    The buildup of fatty deposits in your arteries can cause the formation of a blood clot. If the clot is close to your brain, it can block the flow of blood and oxygen and cause a stroke.
  • Type 2 Diabetes
    This is a disease where the blood sugar (glucose) levels are too high. Normally, the body makes insulin to move the blood sugar into cells where it’s used. In type 2 diabetes, the cells don’t respond enough to the insulin that’s made. Diabetes itself can cause heart disease, stroke, kidney disease, and blindness.
  • High cholestrol. Abnormal levels of these blood fats are a risk for heart disease.
  • Cancer. Being overweight or obese increases the risk for colon, breast, endometrial, and gallbladder cancers.
  • Osteoarthritis
    This is a common joint problem of the knees, hips, and lower back. It occurs when the tissue that protects the joints wears away. Extra weight can put more pressure and wear on joints, causing pain.
  • Sleep Apnea
    Usually, they tend to snore loudly. In serious cases , a person may stop breathing for short periods during sleep.
  • Reproductive Problems
    Obesity can cause menstrual irregularity and infertility in women.
  • Gallstones
So what can one do about it ?

For most people, overweight and obesity are caused taking in more calories than they use.
More calories IN than OUT over time = weight gain
More calories OUT than IN over time = weight loss

There's no easy way out. Successful treatments for weight loss include setting goals and making lifestyle changes such as eating fewer calories and being more physically active. Drug therapy and weight loss surgery are also options for some people if lifestyle changes don’t work.
It is important to set realistic (“Do-able”) goals. Setting the right weight loss goals is an important first step to losing and maintaining weight.
Losing just 5 to 10 percent of your current weight over 6 months will lower your risk for heart disease.

The best way to lose weight is slowly. A weight loss of 1kg a week is do-able, safe, and will help you keep off the weight. It also will give you the time to make new, healthy lifestyle changes.


  1. Eat Less. The portions today are too big. Eat till you are 80% full.
  2. Eat right. Avoid obvious fat, oily fried food, artificially sweetened drinks and processed food. Take more fruit and vegetables.
  3. Stay Active ! Exercise at least 3 times a week, for 30 minutes each time. Don't take the lift. Take the stairs. Walk ! Swim ! Cycle ! Dance ! Whatever ! Sitting on the sofa in front of the TV is NOT an option !!

Tuesday, May 22, 2007

Kidney Disease

What is the test ?

A urine dipstick can be used to check for protein in the urine.

A blood test can be done to check creatinine levels.

Why do the test ?

Early detection will allow treatment to be started with the aim of preventing or delaying further progression of the disease.

Who should do the test ?

A healthy person with no symptoms may undergo opportunistic screening with urine dipstick examination
Those with risk factors such as older age ( > 50 years) , smoking, hypertension and diabetes , and a family history of kidney disease should get checked.

How is the test done ?

You just need to collect a clean-catch, midstream, and random urine specimen.
Creatinine levels are tested by a blood test.