Why Health Matters ?

A Doctor's Ramblings

2007-08-15T19:33:00.000-07:00

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 ?

Stroke

2007-07-07T01:05:00.000-07:00

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.

Lung Cancer

2007-07-02T00:40:00.000-07:00

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.

Exercise helps

2007-06-26T20:56:00.000-07:00

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.

How to lose weight and keep it off !

2007-06-22T21:18:00.000-07:00

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!

Coronary CT angiography

2007-06-17T20:13:00.000-07:00

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.

Obesity and Hypertension

2007-06-14T19:25:00.000-07:00

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)

Heart Disease

2007-06-03T10:03:00.000-07:00

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.

Obesity - article

2007-05-28T20:09:00.000-07:00

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.

Basically,

Eat Less. The portions today are too big. Eat till you are 80% full.
Eat right. Avoid obvious fat, oily fried food, artificially sweetened drinks and processed food. Take more fruit and vegetables.
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 !!

Kidney Disease

2007-05-22T21:51:00.000-07:00

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.

Ovarian Cancer

2007-05-22T21:41:00.000-07:00

What is the test ?

Ca 125 ( a cancer marker detected through a blood test), transvaginal ultrasound or pelvic examination ( done by a doctor).

Why NOT to do the test ?

The effectiveness of screening is unknown for those who are not in the high risk category. Hence routine population screening for ovarian cancer by ultrasound, the measurement of tumour markers, or pelvic examination is not recommended.

Who should do the test ?

Those with 2 or more first degree relatives with ovarian cancer and those with strong evidence of a hereditary predisposition for ovarian cancer (including women with or at high risk for hereditary breast-ovarian cancer and hereditary non-polyposis colorectal cancer) may benefit from screening. Please consult your doctor about this.

Uterine Cancer

2007-05-22T21:34:00.000-07:00

What is the test ?

Screening by endometrial sampling, or transvaginal ultrasound can be done.

Why NOT to do the test ?

There is currently insufficient evidence to screen for uterine cancers other than in women with or at high risk for hereditary non-polyposis colorectal cancer.

Who should do the test ?

Please discuss with your doctor if you feel you may be at risk, or if you have any abnormal bleeding from the vagina.

How can it help then ?

Although screening is inappropriate for the general population, early evaluation of postmenopausal bleeding ( a menstrual bleed occuring after menopause ) with use of hysteroscopy and endometrial biopsy is important for the early detection of endometrial cancer.

Lung Cancer

2007-05-22T19:31:00.000-07:00

What tests are available ?

Chest X-ray, Sputum cytology and the latest test - the low-dose spiral CT scan .

Why NOT to do the tests ?

Previous studies of screening high-risk individuals using chest X-ray and/or sputum cytology have not confirmed any benefit in terms of increasing chances of survival.

Low-dose spiral computed tomography (CT) can detect lung cancers in asymptomatic patients at the early stage2 of the disease. However, whether the detection of such so-called early stage lung cancers translate into better survival has not been demonstrated and is the subject of ongoing controlled trials.

Who should do the tests ?

Routine screening for people with no symptoms for early lung cancer is NOT recommended at the moment.

How can we help then ?

At this point in time, it is important that at-risk individuals are not misled into believing that any such screening initiatives will necessarily reduce their chances of dying from lung cancer. The only proven strategy for reducing the probability of lung cancer mortality is smoking cessation.
However, individuals who perceive themselves to be at heightened risk for lung cancer (and who are supported in that perception by their doctor) may wish to undertake a low-dose spiral CT examination, if they have been fully informed beforehand as to all costs and potential risks of such a procedure.

Visual Acuity in the Elderly

2007-05-22T19:06:00.000-07:00

What is the test ?

Screening test involves using a Snellen chart to test each eye.

Why do the test ?

In the elderly, screening and the correction of correctable eye problems helps to a restore vision and improve function. Vision problems are more likely in persons over 65 years, and they are more likely to lead to serious consequences such as accidental injuries.

Who should do the test ?

Any person age 65 years and above should be screened.

How is the test done ?

Poor vision can be easily detected by the use of a Snellen chart. Ophthalmoscopy can be used to detect ocular media opacities like cataracts.

Summary

2007-05-22T18:59:00.000-07:00

This chart and some information on have been taken from the booklet produced by the Singapore Health Promotion Board.

Prostate Cancer

2007-05-22T18:55:00.000-07:00

What is the test ?

Digital rectal examination (DRE)
DRE is a quick and reliable clinical examination of the prostate gland through the rectum with a gloved finger. DRE can pick up suspicious lumps in the prostate gland.

Prostate Specific Antigen (PSA) blood test
The PSA test can detect the onset of cancer of the prostate gland.

Both tests are used together.

Why do the test ?

Prostate cancer can only be cured if it is limited to the prostate gland and has not spread to the other parts of the body. Hence, early detection helps.

Who should do the test ?

Men above 50 years with a history of immediate family members who have had prostate cancer below 60 years of age are at high risk.

How is the test done ?

It involves both a physical examination as well as a blood test.

Osteoporosis

2007-05-22T18:39:00.000-07:00

What is the test ?

Osteoporosis can be easily detected though a painless procedure called dual-energy X-ray absorptiometry (DXA). This test measures the density or strength of the bones known as bone mineral density or BMD.

Why is the test done ?

Osteoporosis means "porous bones". It is a condition in which the bones become weak and brittle, resulting in a greater likelihood of breaking after minor trauma.
It is more common in women after menopause.

Who should do the test ?

Those with a
● Personal history of past fracture as an adult
● History of fracture in an immediate relative (especially mother)
● Low body weight & older age
● Smoke cigarettes
● Heavy alcohol intake
● Early menopause
● Surgical removal of the ovaries before the age of 45 years
● Long-term medication e.g. oral steroids, thyroid medication
● Being bed-bound for a prolonged period due to illness
● Poor health
● Low calcium intake for most of your life (< size="4">
How is the test done ?

There is a quick simple self-assessment tool called the Osteoporosis Self-assessment Tool for Asians (OSTA) .

OSTA, which is based on age and weight, groups Asian women who have reached menopause into high, moderate or low risk of having osteoporosis.

Take your age ( in years) and subtract your weight ( in kg). If <1,> 20, you are at high risk and should go for a BMD. In between, you should do a BMD if you have any of the above risk factors.

You could measure BMD once a year if you are being followed up for osteoporosis.
Frequency of screening varies from 1-5 years if you have mild decrease in your
bone mass or osteopenia and once in 5 years if your bone mass is normal.

Breast Cancer

2007-05-22T18:32:00.000-07:00

What is the test ?

- Regular mammography is the most reliable way to detect breast cancer before the lump can be felt.
- Breast Self-Examination (BSE) is breast examination done by the woman herself.
BSE should be done from age 30 onwards. BSE helps women detect changes in their breast that may arise in the interval between regular mammography.

Why do the test ?

Breast cancer is the most common cancer among women in Singapore. Early breast cancer screening will be able to detect the cancer in its early stages for effective treatment.

Who should do the test ?

All women above the age of 40 should go for mammograms.

Women in the high risk category should consult their doctor regarding the frequency
of screening. High risk women have a history of:
● Breast cancer in several close members of the same family
● Other cancers, especially cancer of the ovary and colon, as well as breast cancer, in members of the same family
● Breast cancer in a close relative under the age of 40.

How often should mammograms be done ?

1. Women above 50 years
Screening every 2 years is recommended.

2. Women between 40 – 49 years
Annual screening is recommended.

Cervical cancer

2007-05-22T02:24:00.000-07:00

What is the test ?

Screening for cervical cancer involves a Pap smear test.

Why do the test ?

Cervical cancer is the cancer of the neck of the womb (cervix). If detected early, this can be easily treated.

Who should do the test ?

All women who have had sexual intercourse should have their first Pap smear by 25 years of age. You can stop taking the Pap smear test after 65 years of age if your Pap smear taken at 65 years old and the Pap smears taken previously have been normal.

How is the test done ?

The Pap smear is a simple procedure where the doctor or nurse obtains some scrapings from the cervix using a speculum and sends them for examination under the microscope.

Sexually Transmitted Diseases - HIV

2007-05-22T02:15:00.000-07:00

What is the test ?

It is to test for HIV (Human Immunodeficiency Virus). Acquired immunodeficiency syndrome (AIDS) is the final stage of HIV infection. Some persons infected with HIV do not have any symptoms for more than a decade. They can be infectious even at this stage.

Why do the test ?

For treatment of the affected individual and prevention of further transmission of the virus to others.

Who should do the test ?

Persons at increased risk should do the test. These include :
● Those with other STIs
● Men who have sex with men
● Past or present injecting drug users
● Persons who exchange sex for drugs or money, and their sex partners
● Persons whose past or present sex partners were HIV-infected
● Persons who have had a blood transfusion or an organ transplant that had not previously been screened.

Pregnant women should be tested in the 1st trimester.

How often should screening be done?

● Persons who continue practising unsafe sex should be screened every 6 months
● Persons with recent unsafe sexual conduct should be screened at 1 month, 3 months, and 6 months interval after the last possible contact to rule out a possible initial false negative result.

Screening is done using a blood test for HIV antibody.

Sexually Transmitted Diseases - Syphilis

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What is the test ?

Syphilis is an infection that is transmitted from one adult to another through sexual contact or from the mother to her baby during pregnancy.

Why do the test ?

Many people infected with syphilis do not have any symptoms for years, but can remain at risk for late complications if they are not treated. These may include damage to the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints.

Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

In pregnant women, The syphilis bacterium can infect the baby . Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.

Who should do the test ?

Screening is recommended for those who practise unsafe sex, for example
● Those who exchange sex for money or drugs
● Those who have other STIs (including HIV) and ulcers on the genitals
● Those whose partners have syphilis.

Screening should be done 1 month after possible contact, and again after 3 months.

Pregnant women should be screened at their 1st antenatal visit.

How is the test done ?

Screening is done using blood tests.

Sexually Transmitted Diseases - Chlamydia

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What is the test ?

This test screens for chlamydia trachomatis.
Chlamydia trachomatis infection causes the following:
● Inflammation of the urethra (the tube that releases urine from the bladder) in men
● Inflammation of the cervix (the neck of the womb)
● Inflammation of the area around the uterus and ovaries.

Why do the test ?

Infection of the reproductive tract of women above the internal os of the cervix results in acute pelvic inflammatory disease.
This is can be a result of an ascending cervical infection caused by Chlamydia trachomatis . The immediate and long term effects of pelvic inflammatory disease include salpingitis, pelvic abscess, peritonitis, infertility and predisposition to tubal ectopic pregnancy.

Who Should do the test ?

Women
You should be screened for chlamydia trachomatis if have
o a new sexual partner
o a partner with symptoms of an STI
o had two or more sexual partners in the past 12 months
o a partner does not use condoms.

You should discuss how often you should be screened with your doctor. Screening
for chylamdial infection should be done about 1 week after unsafe sexual contact or a change of sexual partner.

Men
All men who practise unsafe sexual behaviours should be screened. They include those who:
● do not use condoms
● have frequent change in sexual partners
● have sex with prostitutes.

How is the test done ?

Screening can be done by obtaining tissues from the lining of the neck of the womb (cervix) in women and from the urethra in men.

Tubercolosis

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What is the test ?

You can be screened for TB with a chest X-ray.

Why do this test ?

Tuberculosis (TB) is a serious infectious disease that affects the lungs and other parts of the body.

Who should do this test ?

You do not need to go for yearly chest X-ray if you have no symptoms as the pick-up rate for TB is very low.
You should however, go for a chest X-ray if you have persistent cough for more than 3 weeks.

Close contacts ( eg relatives) of infectious TB patients should undergo screening for hidden TB infection. This helps to identify persons for treatment to prevent the progression to active TB disease. Close contacts are screened for latent TB infection using the tuberculin skin test.

Liver Cancer

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What is the test ?

The tests include:
● Serum alpha feto-protein (αFP) level. αFP, a protein in the blood is raised in hepatitis and liver cancer.
● Ultrasound of the liver including the gallbladder and bile ducts.

Why do the test ?

Liver cancer is the 4th most common cancer among Singaporean men.

Who should do the test ?

Generally, there is no need to screen for liver cancer if you are not at risk. Those with chronic hepatitis B infection, hepatitis C liver cirrhosis, and liver cirrhosis from other causes should be screened for liver cancer.

How is the test done ?

For those at risk, regular reviews are needed. αFP levels should be done every 3 to 6 months, ultrasound scan of the liver should be done every 6 to 12 months.

Hepatitis B

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What is the test ?

Hepatitis B infection is infection with the Hepatitis B Virus (HBV). Screening is done with a blood test for the HBV antigen (HBsAg) and antibody (anti-HBs).

Why do the test ?

Chronic hepatitis B infection is endemic in this part of the world. People with HBV infection may become seriously ill with or may die from liverdisease and/or from liver cancer.

Who should do the test ?

You should be screened if you are:
● pregnant
● a healthcare worker
● a person undergoing kidney dialysis
● at high risk. This includes having a family history of HBV infection or liver cancer, or
engaging in high-risk behaviour. (High risk behaviour includes having had sex with prostitutes or strangers, having many sex partners, having a sex partner who has HBV infection, drug addicts who share injection needles).

How is the test done ?

It is a blood test. It should be carried out before vaccination. some people have natural immunity. If the antibody is present, the person is immune to hepatitis B infection and vaccination is not required.

Colorectal Cancer

2007-05-20T23:59:00.000-07:00

What is this test ?

Colorectal cancer is cancer of the colon (the main part of the large intestine) and rectum (the passageway connecting the colon to the anus).

Why do this test ?

Colorectal cancer is the most common cancer among men and women in Singapore.

Who should do this test ?

If you do not show any symptoms ( eg. change in bowel habit, bleeding from the rectum) and are not considered to be at high risk, you should undergo screening for colorectal cancer from the age of 50.
If you are at high risk , you will need to go for screening at a younger age and at more frequent intervals. Please consult your doctor for advice.

You are at high risk if one or more of your close relatives have colorectal cancer or an
abnormal growth (colorectal polyps) in their large intestine.
Women who have had cancer of the womb, ovaries or breast may have a slightly higher risk of colorectal cancer.

How is the test done ?

Several different tests can be used. Each can be used alone. Usually, Faecal Occult Blood Test is used first and if positive, it will be followed by one of the other tests.

● Faecal Occult Blood Test (FOBT)
This is a test for the presence of blood in stool. When test results are positive, colonoscopy may have to be performed.

● Double-contrast barium enema
This is an x-ray examination of the large intestine using a special substance to improve images.

● Flexible Sigmoidoscopy
This procedure examines the internal lining of the lower end of your large intestine. A short, flexible, lighted tube is inserted into your rectum and slowly guided into your sigmoid colon.

● Colonoscopy
A longer, flexible lighted tube is used. This enables the entire large intestine to be examined.

Please consult your doctor about the further tests as more detailed preparation is needed before the procedure.

Obesity

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What is the test ?

Obesity is the condition where the person’s body weight is well over the normal weight for his or her height and age.

The Body Mass Index (BMI) is used to measure an adult’s body fat.
BMI = Weight (kg) Height (m) x Height (m)

Why do the test ?

Obesity can lead to many medical problems like diabetes, high blood pressure, heart
disease, stroke and several cancers.

Who should do the test ?

All persons aged 18 years and older should be screened once a year.

How do you know that you are overweight or obese?

BMI
- Healthy weight 18.5 to below 23
- Overweight 23 to below 27.5
- Obese 27.5 and above

Cholesterol

2007-05-20T21:38:00.000-07:00

What is the test ?

The cholesterol screening tests for all types of fats present in the body. This would include:
● "bad" cholesterol - low-density lipoprotein (LDL) cholesterol ;
● "good" cholesterol - high-density lipoprotein (HDL) cholesterol and
● triglyceride (TG).
Only the last test (for TG levels), requires you to fast for 10 to 12 hours.

Why do the test ?

A high blood cholesterol level means that you have more cholesterol in your blood than your body needs. The higher your blood cholesterol level is, the greater your risk of developing heart disease.

Who should do the test ?

You should be screened if you:
● are 40 years old or older
● previously had a heart attack, or stroke
● are suffering from diabetes
● have several family members with high cholesterol.

You can consider screening from age 30 years if you:
● have other risk factors for heart disease, for example, you smoke, have high blood
pressure or have family members who developed heart disease before 65 years of age

How is the test done ?

It is a blood test. You need to fast for 10 to 12 hours before the the test.
If your results are in the desirable range, blood cholesterol screening every 3 years is recommended.

Blood Pressure

2007-05-20T21:27:00.000-07:00

What is the test ?

The aim is to detect high blood pressure or hypertension. There are 2 readings : the upper one is the systolic blood pressure, and the lower one, the diastolic blood pressure. Eg. The doctor will record it as 120/80 mmHg. You may have high blood pressure if your diastolic blood pressure is at 90 mmHg or higher, and/or your systolic blood pressure is at 140 mmHg or higher. Diastolic pressure is the blood pressure when the heart relaxes and systolic pressure is the blood pressure when the heart is contracting (pumping). Your doctor will need to check it several times to confirm.

Why do the test ?

High blood pressure does not usually have symptoms ( ie you don't feel it) and so sometimes goes unnoticed until complications like heart and kidney failure sets in. These complications can often be prevented with early detection and treatment.

Who should do the test ?

If you are 40 years or older, you should check your blood pressure at least once a year. You should also have it checked regularly if you have other medical problems such as diabetes, high cholesterol or a previous heart attack.

How is the test done ?

You can ask your doctor to check your blood pressure or learn to check it yourself with an electronic blood pressure meter.

Health Screening

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In the old days, people only went to see the doctor when they felt sick. Now they are starting to see the doctor even when they feel well. They want to know if they have any risks for diseases , or if they are in the early stages of some diseases, where early treatment can result in a cure. Hence, the birth of health screening as an industry. In some countries, it's a business. You can buy health screening packages, where tests are done on every part of you - blood samples, urine samples, stool samples can all be taken, and a scope can be stuffed into practically every orifice. Everything can be seen nowadays. So what's so great about health screening ? Can you actually do anything if you are "fated" to have a certain disease ? The good news is, you can ! Prevention is better than cure. And early detection does help. There's bad news though. Not all conditions can be detected early.

So who should do health screening ?

People with family histories of certain medical conditions should go before they develop symptoms. eg, a strong family history of heart attacks, certain cancers. Most people above 40 should consider getting themselves checked at least once, and then maybe 3 yearly if no problems are detected.

Companies use health screening to determine if potential employees are suitable for the job. Others use it to determine if their employees are still fit on the job. Some jobs can be dangerous for people with certain medical conditions ( would you really want a truck driver to have a history of uncontrolled fits?) , and other jobs can be dangerous for the worker's health ( eg. industries with machines that produce loud noises would need to regularly screen their workers for hearing problems).

So what about otherwise well people who are just worried and want to get tested, just to make sure ?

There are no hard and fast rules. In some countries, you pay the money, you get the test. No problem right ? Well, there are some things you may want to look out for before deciding to do the test.

Is the test safe ? Will it harm me ?
Colonoscopy ( a scope inserted up your rear end to check the large intestine) has a small risk of perforation or bleeding. Your doctor needs to determine the risks versus the benefits of the test. Is the test easy to do ?
Testing blood for high cholesterol or high sugar, is easy. So is a Pap smear for cervical cancer.
Is the test accurate ?
No use doing a test if the results don't give you a good answer. eg. the blood test for the cancer marker for colon cancer may go up in other medical conditions, or not be raised in early cancer. So a "normal" result doesn't mean anything. Neither does a "raised" result.
Does the test make a difference?
Mammograms do detect breast cancer early enough for treatment. Pap smears detect cervical cancer in its pre-cancerous stage. Cure rates are high. So the tests are worth doing.
What is the test trying to look for ?
Some people just want to have their whole body scanned in the hope of detecting some small tumour. It doesn't work that way. Perfectly healthy people may have variations in their organs. We don't all look the same inside. This may lead to unnecessary further tests, even operations, not to mention the terrible stress the patient has to undergo while waiting for results.

So before you go for health screening, ask you doctor about the tests you are going to do. It's good to have more knowledge about your own body. And it helps if you can take steps today to prevent diseases. But you do need to understand what you are going to do.

Diabetes Melitus

2007-05-17T02:17:00.000-07:00

What is the test ?

Diabetes is a disease in which too little or ineffective insulin is produced by the organ
called the pancreas. As a result, people with diabetes have abnormally high levels of
glucose in their blood.

A blood sample is taken to check the fasting blood sugar levels.

Why is the test done ?

A high fasting blood sugar level >= 7.0 mmol/L may indicate you have diabetes. If you have an intermediate result of fasting blood glucose 6.1 to 6.9 mmol/L , your doctor will order a further test called a 75 gram OGTT.

Diabetes is associated with many complications , such as increased risk of blindness, kidney failure, heart attacks, stroke. Early detection and treatment helps to slow down or prevent the complications.

Who should do this test ?

Screening for diabetes should begin at 40 years. Screening should be considered at
an earlier age e.g. 30 years if you:
● are overweight / obese [body mass index (BMI) ≥ 25 kg/m2]
● have high blood pressure (BP ≥ 140/90 mmHg)
● have a close relative who has diabetes
● had diabetes during pregnancy
● suffer from coronary heart disease
● have abnormal lipid (fat) levels
● have previously been confirmed with a borderline high fasting blood sugar level.

How is the test done ?

You need to be fasted overnight from 10 pm. Only plain water is allowed. A blood sample is then taken and sent for analysis.

For patients with diabetes, additional tests like HbA1c, blood pressure, cholesterol levels and eye and foot screening need to be done.