Detox Teas – Do They Work?

Detox teas are a controversial topic. For thousands of years, humans have been trying to rid their bodies of what they believe are toxins. Some historic “detox” practices include bloodletting, enemas, sweat lodges or saunas, fasting, and drinking herbal preparations. Some of these practices were even accepted as medical treatments before the advent of modern medicine. In the age of social media, you might have seen celebrities or even your friends posing with a pack of detox-tea on Facebook or on Instagram.

Detox teas are usually a mixture of tea leaves and other natural ingredients like berries, fruits, spices, herbs and roots.


Do detox teas actually help to detox the body?

Tea is generally considered healthy. Multiple studies over the years have shown an association with tea and health benefits including cardiovascular health, blood pressure regulation, mood regulation, mental performance and maintenance of weight and energy levels too. Tea contains tea flavonoids, polyphenols, in particular catechins and epicatechins and antioxidants which health benefits are still being studied and validated. Whether or not teas slapped with a detox label does what it actually says – remove toxins – is still very debatable. 

The additional natural ingredients may also have health benefits. Many ingredients of traditional medicine are currently being investigated scientifically, and some of them have been shown to have health benefits. 


Real weight loss or just a loss in water weight? 

Most of these detox teas do contain tea leaves, and tea does have caffeine. Caffeine is known to be a stimulant which can raise your metabolism. Caffeine can also act to suppress your appetite. Through such a mechanism, you might enter a caloric deficit by burning more calories, and eating less. This kind of weight loss is true weight loss. 

However, certain detox teas do contain supplements which act like laxatives, or medical laxatives itself. The effect of these laxatives are claimed as colon cleansing, which is often recommended as part of a detox plan. Such laxatives can cause cramping, bloating, nausea and vomiting. Dehydration and electrolyte loss can also be a concern. Such a weight loss is mainly water weight loss, and is not healthy, nor sustainable. 


Side effects or dangers of detox teas?

The detox teas that are conservative mixes of tea leaves and natural products are usually not more dangerous than regular teas. However some detox teas may include, in large amounts, natural products that have a prominent biological effect on our body. Some brands may also have additional chemical ingredients that could harm your health.

As mentioned above, diarrhea could be a side effect of these teas. These may be from the laxative effect of natural plant-based sennosides, or actual laxative medications. Excessive diarrhea can lead to dehydration and electrolyte loss, which may leave you lethargic and weak. Some compounds, including caffeine, are also diuretic, which can cause you to pass more urine than normal. Severe diarrhea and dehydration has led to death, so this is a side effect of concern. 

Appetite suppressants or stimulants like caffeine are commonly found in detox teas. Ingesting too many stimulants may leave you irritable, unfocused and jittery, similar to when you drink too much energy drinks. You may also suffer from insomnia if these teas are taken too late in the day. Illegal stimulants like ephedra and medications such as ephedrine have been found in detox teas. These may trigger heart attacks, strokes, seizures and cause even death, especially in people with pre-existing medical conditions. 

Diabetic medications that lower your blood sugar level have been found inside detox teas. People who are on detox teas may also be eating less, contributing to a lower blood sugar level. Such a situation can lead to hypoglycemia, where the sugar level in your blood is dangerously low. This can lead to sweating, confusion, shaking, loss of consciousness and even death.

Some of the herbs that are inside detox teas may have drug-drug interactions with the medications that people are currently taking, raising the levels of the medication in your body to toxic levels. Some herbs themselves if ingested in large enough quantities, may also put strain on your kidney and liver. This has the opposite of detoxing your body, poisoning your body instead. 


Are there any benefits to detox teas?

Not all detox teas are harmful. Tea itself does have health benefits. The other natural ingredients (in conservative amounts) may also serve to improve your health. But please use it with caution and moderation. These teas, if used, should be incorporated into a healthier lifestyle.


Is it healthy to consume detox teas long-term?

The manufacturers themselves do not recommend taking detox teas in the long run. If you do decide to try out a detox tea, stick to the recommended serving guide, and be vigilant about any side effects that may occur. If these side effects are causing you any discomfort, it is recommended that you stop. 


What are some recommendations for detoxing the body in place of consuming detox teas?

The human body is more than capable of clearing out waste products for the vast majority of us. This is what our bodies have evolved to do to keep us alive. Our kidneys, liver, cardiovascular system, gut and skin are all working hard every day to process all of the substances that we come in contact with, and they do a good job at it. The best thing to do is to not add additional burden to the body. 

The very fact that you are considering a detox tea means that you are willing to do something to change your lifestyle for the better. Use this motivation to kick start good habits. The detox tea can be the spearhead in the charge to a better you. 

Also read: Weight Loss Treatment

An overall healthy and balanced diet with whole grains, fish, fruits and vegetables, and less red and processed meat is a key component to a healthy life. Processed foods have been shown to be poor in nutrition, laden with salt and fat and contribute to obesity and cardiovascular disease. Unprocessed and minimally processed foods on the other hand are packed full of nutrition, keeps you full for longer and is essential for your bodily functions. Try and limit the frequency and amount of processed foods to a minimum.

Physical activity and exercise is just as important as the quantity and quality of food. The Health Promotion Board of Singapore recommends 150 minutes of moderate intensity, or 75 minutes of vigorous intensity physical activity a week. Health benefits of regular physical activity include a 20 – 50% reduced risk of premature death, incidence of coronary heart disease, type 2 diabetes, depression, stroke, high blood pressure, colon cancer and breast cancer, to name just a few. If you are just starting to get into more physical activity, it is always advisable to start slow and ramp up your physical activity slowly. This will help minimize musculoskeletal injuries. The lack of time should not be an excuse to pass on both healthier food options and exercise

It is also advisable to drink lots of water. Water makes up about 60% of our body weight and is essential for our survival. Water gets rid of wastes through urination, perspiration and bowel movements. It keeps your temperature normal, lubricates and cushions joints, protects organs and tissues and maintains the electrolyte balance in our body to name just a few. This is the form of detox that definitely has no opponents. 

Getting enough sleep every night is essential as sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health and quality of life. Sleep is the time where the body and brain heals itself and recharges for the next day. Sleep deprivation has been shown to be associated with chronic diseases, decreased mental and physical performance and even reduced immune function. 

Just remember that there are no shortcuts to a healthy lifestyle. That however should not stop you from living the best life. 

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*Parts of this article were first published in CLEO.

Dengue in the era of COVID

While the current COVID-19 pandemic continues to capture all our attention, an arguably more deadly disease which has always been endemic in Singapore continues to wreak its havoc. Often hiding behind the symptoms of COVID-19. This is dengue.

Dengue has been endemic in our shores for as long as our history. As recent as 2019, 15,998 cases of dengue were reported and a total of 20 people died from it. As frightening as these numbers may be, they pale in comparison to the situation developing this year. We are halfway through the year and already the National Environment agency has reported a cumulative total of 12,539 cases of dengue and 12 people have succumbed to the disease. 1,375 cases of dengue were reported in the week ending 20th June. That is almost 200 cases of dengue every single day. The most number of dengue cases ever reported in Singapore was 22,170 cases in 2013 and 2020 looks well placed to break this unenviable record. 


To make matters worse, as we enter the warmer months of the year, the breeding and maturation cycle of the Aedes mosquito accelerates. This means they will reproduce faster resulting in an increase in the number of insect vectors that transmit dengue. In addition, due to the shift in the strain the risk of dengue haemorrhagic fever, the deadly form of dengue, is higher as cross-immunity to different strains are only partial.

It is difficult for doctors to differentiate between the 2 diseases. Dengue and COVID-19 share many similar symptoms for example fever, muscle aches, cough, sore throat and running nose. Given the attention currently heaped on COVID-19, both the patient as well as the physician have to consciously maintain a high level of suspicion for dengue and not be swept up by the publicity.


“As long as it is not COVID” – is not OK. Furthermore, it is absolutely possible that a patient is suffering from both dengue and COVID-19 simultaneously making it even more challenging for a doctor to diagnose. As if all these were not bad enough, a final complication exists which is the blood tests for dengue are not always accurate. This was very well illustrated by a local case report of a patient who presented to his doctor with fever and muscle aches and subsequently tested positive on a dengue test. On further testing, the patient was eventually diagnosed with COVID-19 and it was discovered his initial dengue test was falsely positive. Other supporting blood tests like platelet counts and liver function tests can also show the same abnormalities in both patients who suffer from dengue and patients who suffer from COVID-19 so are also rather unhelpful.


Dengue is not spread from person to person like COVID-19. A mosquito stings a person with dengue and sucks the dengue parasite along with the blood from its victim into itself. Mosquitos do not fall sick from dengue. They fly along to another person and while stinging them, transmits the dengue virus. This means that while social distancing can protect us from COVID-19, it does nothing to protect us from dengue. Dengue can be spread as far as the mosquito can fly. 


The COVID-19 pandemic has created an almost perfect storm for dengue to spread. Just like COVID-19, there is currently no effective way to cure dengue. And just like COVID-19 the solution to the pandemic is to stop its spread. To stop the spread of dengue, we need to stop mosquitoes from breeding. This is where we all have to play our part. As much as we would like to blame the empty construction yards, the reality is it is homes that form the bulk of mosquito breeding grounds. In a single dengue cluster in Singapore, 84% of homes were found to be breeding Aedes mosquitoes. It is up to every one of us to ensure that our homes as well as common areas do not serve as breeding grounds for mosquitoes.

Quote from NEA:

Homeowners and occupants are strongly urged to do their part and pay close attention to any mosquito breeding or adult mosquitoes present in their homes, take the necessary steps to prevent or remove them, and protect themselves from mosquitos’ bites.

These include:

  1. Regularly doing the Mozzie Wipeout and removing any stagnant water in homes;
     
    • Turn the pail
    • Tip the vase
    • Flip the flower pot plate
    • Loosen the hardened soil
    • Clear the roof gutter and drains within compounds, and place Bacillus thuringiensis israelensis (Bti) insecticide inside
  2. Spraying insecticide at dark corners of the home, for example under the sofa and bed, behind the curtains and in the toilets
  3.  Applying mosquito repellent to protect themselves from mosquito bites
  4. Using mosquito screens
  5. Using spatial mosquito repellent (e.g. mosquito coil) in well-ventilated areas of the home.

NEA has published two educational videos to guide residents on the spraying of aerosol insecticide at home , and what to do if one lives in a dengue cluster area or sees mosquitoes at home.

Rapid COVID-19 Testing is available.

Dengue Vaccination – Is it suitable for you?


Next read: FAQS ON THE NOVEL CORONAVIRUS (2019-NCOV)

Also on this site: hiv test


Speak to your doctor for more information or if you have any questions regarding Dengue Rapid Testing or other Dengue related topics: Dengue in the era of COVID, Dengue Fever Symptoms? Dengue Fever What You Need to Know, Why the recent resurgence in Dengue Fever?, ZIKA IS AN STD!! – Battling the STD Stigma


DTAP Cares – Here For You, Here With You

The increase in social distancing and progressive lock down measures in Singapore and around the world during this COVID 19 season have prompted a big change in the way we care for our patients here at DTAP clinic.

The numbers around the world have been alarming as Spain and Italy have become the countries worst hit by the virus with over 6,000 deaths. The need to stay home and observe social distancing have slowed down the spread of COVID, not overwhelm the healthcare system and most importantly save lives.

At DTAP Clinic, we’ve made many numerous steady changes to our day to day operations to protect our staff and our patients.


This is what we have done at DTAP clinic 

  1. Screen everyone who makes an appointment or comes through our doors with the Ministry of Health’s criteria
  2. Check everyone’s temperature and symptoms of cough, respiratory illness
  3. See our patients on an appointment basis – this means NO OVERCROWDING, in the clinic and effective social distancing
  4. Increase frequencies of disinfecting the clinic and if a patient who saw us has any symptoms we thoroughly disinfect the clinic after the patient leaves. (Of course with the usual Personal Protective Equipment worn)

Where it is important to stay home, we are also cognizant that one can still get symptoms, need their medication refills and pick up other non covid diseases all the same.

Furthermore, the sellout of condoms around the world tells us that people staying home are resorting to millenial old, tried and tested forms of entertainment.

To further strengthen our support and commitment to our patients in these uncertain times, we have also thus done 3 more things to ensure our patients are fully cared for 


1. DTAP TELECONSULT SERVICE:

In light of the COVID-19 situation, we are offering DTAP Teleconsult. This teleconsult service allows our current patients and new patients to connect with our doctors during clinic operating hours for non-emergency consults. After assesment and consultation, we will also deliver your medications straight to your doorstep. Learn more

That’s right, our very own teleconsult service where our DTAP clinic doctors address your health concerns as much as possible in the comforts of your own home!

If it is deemed that you need a blood, urine, swab test to further confirm your diagnosis, we would then schedule you at the next most convenient time slot, AWAY FROM OTHER PATIENTS.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.

And if our doctors deem that you should require medications, again you can get them via our delivery service or our pickup service, more details below.


2. DTAP Medication Delivery Service

DTAP DELIVERY
Getting your medication on time is important. As part of our initiative to provide better patient care to our patients, we are now providing delivery service to your doorstep – Anywhere in the Singapore mainland. Learn more

If you need a refill of your medication prescription, or need to get treatment after your tests, or even get new meds after our doctors have diagnosed you,

Have no fear, together with our partners we deliver to your doorstep the very next day. 

And of course all this is within the SS644 Singapore medication delivery guidelines, where the integrity of the medication, your personal data are fully respected and protected 

So from the comfort of your own homes, you can get the essential medications you need, or if you were planning a special night with your loved one, not be caught out without your trusty blue pill even.


3. DTAP Order & Pick Up

Last but not least, for those who live and work nearby our clinics and want to drop in quickly to pickup your repeat meds, or even new medications, getting your payment done online and the items prepared would allow you to skip the queue, skip the wait and in between your busy lunch hour or schedule, you can still get your errands done, all in a heartbeat.

Stay safe amidst the current situation and remember to look out for your family and loved ones!


Saxenda

Apa itu Saxenda?

Saxenda adalah jenama ubat suntikan yang dikenali sebagai Liraglutide. Ini adalah ubat yang disahkan untuk pengurusan berat badan sebagai tambahan kepada diet dan senaman. Liraglutide tergolong dalam kumpulan ubat yang dikenali sebagai agonis reseptor peptida-1 glukagon (agonis reseptor GLP-1), juga dikenali sebagai peniru incretin. Saxenda sangat mirip dengan GLP-1, hormon yang berlaku secara semula jadi di dalam badan yang dilepaskan sebagai tindak balas terhadap pengambilan makanan dan bertindak sebagai pengatur fisiologi selera makan dan pencernaan.

GLP-1 yang dihasilkan oleh badan kita cepat dipecahkan, mengakibatkan jangka hayat yang pendek kurang dari 2 minit. Saxenda meniru GLP-1, tetapi tahan lebih lama, dengan jangka hayat sekitar 13 jam ketika disuntik. Kerana jangka hayatnya yang panjang, ia dapat bertindak pada reseptor GLP-1 lebih lama, memberikan kesan fisiologinya.

Reseptor GLP-1 boleh didapati di beberapa organ, termasuk otak, pankreas, saluran gastrointestinal, jantung, pembuluh darah dan ginjal. Saxenda berfungsi dengan mengikat reseptor di nukleus arkuat hipotalamus di otak, di mana ia merangsang rasa kenyang dan menghalang neuron kelaparan. Kerana ini, anda makan lebih sedikit, menyebabkan penurunan berat badan.


Apa kegunaan Saxenda?

Sekiranya anda gemuk, atau berlebihan berat badan dengan masalah yang berkaitan dengan berat badan (seperti tekanan darah tinggi, kolesterol tinggi, atau diabetes jenis 2), ubat ini dapat membantu menurunkan berat badan. Saxenda bertujuan untuk digunakan bersama dengan kawalan diet dan senaman.

Satu kajian yang diterbitkan pada tahun 2017 dilakukan dengan 3731 pesakit diikuti selama lebih dari 56 minggu. Pesakit sama ada mempunyai BMI 30 atau lebih tanpa diabetes, atau BMI 27 atau lebih dengan sekurang-kurangnya satu masalah perubatan yang berkaitan dengan berat badan. Pesakit-pesakit ini dibahagikan kepada dua kumpulan. Kedua-dua kumpulan diberitahu untuk mengawal diet dan senaman mereka.

Satu kumpulan diberi Saxenda dan kumpulan yang lain diberi plasebo. 1 daripada 3 pesakit yang dirawat dengan Saxenda mencapai penurunan berat badan lebih dari 10%. Pesakit yang dirawat dengan Saxenda yang menyelesaikan percubaan mencapai penurunan berat badan rata-rata 9.2% dan mengekalkan berat badan selama satu tahun. Pesakit juga mengalami pengurangan faktor risiko kardiometabolik.


Bagaimana cara menggunakan Saxenda?

Saxenda adalah ubat suntikan yang biasanya diberikan sekali sehari. Ia disuntik di bawah kulit pada bila-bila masa sepanjang hari (biasanya pada waktu pagi), dengan atau tanpa makan. Terdapat pelbagai tempat yang boleh anda suntik, tetapi biasanya, ia disuntik ke kulit di sekitar perut. Ia hadir dalam pena suntikan yang sudah siap dengan jarum pakai buang. Doktor akan mengajar anda dengan tepat cara menyuntik ubat ini, dan menggunakan tempat yang berbeza untuk disuntik setiap kali.


Siapa yang sesuai untuk penggunaan Saxenda?

Anda sesuai sekiranya anda

• berat badan berlebihan (BMI ≥27) dengan masalah perubatan yang berkaitan dengan berat badan (mis. Tekanan darah tinggi, kolesterol tinggi, atau diabetes jenis 2)

• obes (BMI ≥30) dengan atau tanpa masalah perubatan yang berkaitan dengan berat badan


Siapa yang tidak boleh menggunakan Saxenda?

Sekiranya anda sedang menggunakan insulin untuk rawatan Diabetes, Saxenda mungkin tidak sesuai untuk anda. Keselamatan Saxenda belum dipelajari ketika diambil bersama produk preskripsi, ubat bebas, atau penurunan berat badan herba lain. Tidak diketahui apakah Saxenda dapat digunakan dengan selamat pada orang yang menderita pankreatitis.

Saxenda tidak digalakkan untuk digunakan pada kanak-kanak. Keselamatan Saxenda belum dinilai dalam rawatan khusus Diabetes jenis 2 (walaupun ubat lain yang dikenali sebagai Victoza mempunyai bahan aktif yang sama).


Adakah kesan sampingan semasa menggunakan Saxenda?

Kesan sampingan yang paling biasa dari Saxenda menjejas system penghadaman dan boleh merangkumi loya, cirit-birit, sembelit, muntah, sakit perut dan perut kembung. Beberapa pesakit mungkin mengalami sakit kepala, gula darah rendah, pening, keletihan atau perubahan rasa juga. Umumnya boleh diterima dengan baik dan doktor secara beransur-ansur akan meningkatkan dos selama beberapa minggu untuk mengurangkan risiko kesan sampingan


Apakah pilihan rawatan penurunan berat badan yang lain?

Pengendalian diet dan senaman adalah kaedah utama rawatan untuk menurunkan berat badan. Bahkan Saxenda dimaksudkan untuk digunakan sebagai tambahan untuk pengendalian diet dan latihan untuk menurunkan berat badan. Terdapat ubat lain untuk mengawal selera makan dan mengurangkan penyerapan lemak atau karbohidrat dari usus juga. Anda boleh mendapatkan lebih banyak maklumat dari halaman ini https://www.dtapclinic.com/family-medicine/weight-loss-treatment/

Apa kebaikan dan keburukan Saxenda dibandingkan dengan pilihan rawatan lain?

Kelemahan utama adalah Saxenda merupakan ubat suntikan. Sebilangan besar ubat penurunan berat badan lain adalah dalam bentuk tablet oral. Walaubagaimanapun, kami tahu bahawa Saxenda adalah alat yang berkesan dalam pengurusan berat badan.

Bincangkan dengan doktor anda mengenai kesesuaian ubat untuk anda. Sekiranya anda berminat untuk mengetahui lebih lanjut mengenai Rawatan Berat Badan, sila hubungi Klinik kami atau hantarkan e-mel kepada kami di hello@dtapclinic.com untuk temu janji dengan doktor kami.

Doktor yang boleh berbahasa melayu

Dr. Taufiq at DTAP Clinic @ Somerset

1 Grange Rd,
#10-08 Orchard Building,
Singapore 239693

Telepon: +65 6262 0762

Dr. Ezlyn at DTAP Clinic @ DUO Galleria

7 Fraser St,
#B3-18 DUO Galleria (Bugis MRT), 
Singapore 189356

Telepon: +65 6976 5023

Why the recent resurgence in Dengue Fever?

An article was recently published in the Straits Times on 17th July 2019 titled “Weekly dengue cases hit 3 1/2-year high”. This is the latest in a series of news articles over the past few months reporting about the resurgence of dengue cases in Singapore. Make no mistake, dengue fever is back and it is on the rise.

The numbers so far..

According to figures released by the National Environment Agency (NEA), 666 dengue cases were recorded between 7th to 13th July 2019. This is the highest weekly total since January 2016, and brings the overall total to 7,374 dengue cases this year. This is a staggering five times more than the 1,481 cases recorded by this time last year. Sadly, dengue fever has also claimed five lives so far this year.
Our country has weathered dengue epidemics before in the past. A total of 14,209 and 8,826 dengue cases were recorded in 2005 and 2007 respectively. The highest ever single-year total was 22,318 cases in 2013, with eight fatalities. In contrast, dengue infections fell to a record 16-year low in 2017 with 2,772 cases, while 2018 had 3,285 cases.
Based on the number of cases so far this year, it is undeniably worrying that we could be heading towards another dengue outbreak.

Why the recent resurgence in Dengue Fever?

Experts believe that this is due to a combination of three main factors: The Aedesmosquito population, the strength of the virus, and immunity of the general population.
The Aedesmosquito population has been noted to be increasing over the past months, with the majority of breeding sites found in homes. Herd immunity is also generally low in Singapore and is likely to have further weakened given the low incidence of dengue cases in the past two years.

The link between Climate Change and Dengue Fever

On a larger scale, global warming may play a detrimental role in dengue transmission. A study was recently published in the journal Nature Microbiologyon 10th June 2019, stating that with rising temperatures, mosquitoes are able to thrive in places where they previously were unable to, thereby expanding the range of dengue fever. Also, warmer temperatures reduce the time taken for an Aedes mosquito to mature into a biting adult.
The study predicts that by 2050, parts of the world that may become dengue-suitable include coastal eastern China and Japan, southeastern USA, central Mexico, northern areas of Argentina, inland areas of Australia and southern Africa.
The study also forecasts that 2.25 billion more people will be at risk of dengue in 2080 compared to 2015, bringing the total population at risk to over 6.1 billion, or 60% of the world’s population.

A Recap of Dengue Fever

Dengue fever is a vector-borne disease caused by the dengue virus, and is carried and transmitted by the bite of an infective female Aedesmosquito. When a mosquito bites a person infected with the dengue virus, the virus enters the mosquito. Thereafter, it remains infective for the rest of its lifespan. Dengue fever does not spread from one person to another.
There are four types of dengue virus circulating in the world, including Singapore. This means that individuals can be infected with dengue up to four times. First-time dengue infections can be severe, especially among the elderly and those with pre-existing medical conditions. Repeat dengue infections are usually more severe, with high risk of developing dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), both of which can be fatal.

Signs and Symptoms

Up to 75% of dengue infections are asymptomatic. If symptoms do occur, they develop after an incubation period ranging from 3 to 14 days, and include the following:

  • Sudden onset high fever for 2 to 7 days
  • Severe headache with retro-orbital (behind the eye) pain
  • Joint and muscle pain
  • Nausea and/or vomiting
  • Skin rash
  • Mild bleeding of the nose and gums or easy bruising of the skin

Most people recover within about 1 week or so, but less than <5% of all cases, the symptoms can worsen and progress into DHF and/or DSS, which is a life-threatening emergency. They include the following:

  • Severe abdominal pain
  • Persistent vomiting with or without blood
  • Bleeding under the skin
  • Bleeding from the nose, mouth and gums
  • Black stools or blood in the stools
  • Clammy, cold skin
  • Restlessness or irritability
  • Fatigue

Diagnosis

Your doctor will take a detailed history, in particular, any recent travel history, as well as any contact you may have had with mosquitoes. Dengue fever is diagnosed via blood tests for dengue profile and full blood count.

Treatment

There is no specific treatment for dengue fever. Instead, treatment for dengue is mainly supportive and depends on the symptoms present. It is recommended to drink plenty of fluids in order to avoid the risk of dehydration. Those who are able to stay well hydrated, are passing urine, and otherwise feeling well, can be managed at home with daily follow-up. Paracetamol can be taken to alleviate pain and reduce fever, but non-steroidal anti-inflammatory drugs (NSAIDs) such as Naproxen and Ibuprofen should be avoided as they can increase the risk of bleeding complications.
Patients who have pre-existing health conditions, “warning signs” of severe dengue fever, or cannot manage daily outpatient follow-up, should be cared for in hospital. Intravenous fluid and electrolyte replacement, platelet and/or blood transfusions may be required.
 

Prevention

The key to reducing dengue fever transmission is by controlling the mosquito population and human exposure. On a national level, Singapore has teamed up with other countries to observe ASEAN Dengue Day, which is part of a concerted effort committed to reducing the burden of dengue fever in the region.
The NEA, various agencies and Town Councils are part of an Inter-Agency Dengue Task Force (IADTF), which works to remove potential mosquito breeding habitats containing clean, stagnant water sources in public areas and housing estates.
All members of the public are also strongly encouraged to do their part in preventing and removing such breeding habitats. The NEA advocates people to perform the Five-step Mozzie Wipeout, which is as follows:

  1. Turn the pail
  2. Tip the vase
  3. Flip the flowerpot plate
  4. Loosen the hardened soil
  5. Clear the roof gutter and place Bti insecticide inside

Some precautions that you can take to prevent getting bitten by mosquitoes are:

  • Stay in air-conditioned environment, and install structural barriers such as window screens or insecticide-treated netting
  • When in an area with mosquitoes, expose as little skin as possible by wearing a long-sleeved shirt, long pants, socks and shoes
  • Use mosquito repellent containing at least 10% concentration of diethyltoluamide (DEET), a substance that deters and repels biting insects

The above advice applies also to persons who have been infected with dengue fever.

Speak to your doctor for more information or if you have any questions regarding Dengue Rapid Testing or other Dengue related topics: Dengue in the era of COVID, Dengue Fever Symptoms? Dengue Fever What You Need to Know, Why the recent resurgence in Dengue Fever?, ZIKA IS AN STD!! – Battling the STD Stigma

Find a doctor | Make an appointment


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Is More Rice Really Better?

Last week, I was queuing with a friend at a cooked rice stall for dinner. When it was my friend’s turn to order, I noted that he ordered an additional portion of rice. He usually does not do that; in fact, he usually asks for lesser rice as he is rather health conscious.
I asked him casually if he was particularly hungry that evening. His response shocked me. He said “I am not that hungry, but I read in the newspaper that eating more rice will help fight obesity”
I was baffled. How would eating more rice help someone lose weight? My years as a doctor has taught me otherwise. In fact, I tell my patients on a regular basis to reduce their portions if they are trying to lose weight. I corrected my friend but was met with resistance. He defended his statement by saying that the article was based on a study published in a European journal and that the newspapers couldn’t possibly be wrong. Having not read the article myself, I told him I would find the article, read it, and get back to him.
That night, I went home and found the Straits Times article published 1st of May 2019, titled “More grain, less gain? Eating rice helps fight obesity: Study

After reading it, I realised that the article could be very easily misinterpreted.

Caloric balance (intake vs. output)

Weight gain or loss can be easily explained through a concept known as caloric balance (intake vs. output). It really is just an equation where
Caloric balance = Energy intake – Energy output
What this equation means is that if you expend more energy than you take in from food, you will have a negative caloric balance. After a period of negative caloric balance, you will lose weight. If you expend 500 more calories than you take in every day, you will lose about 2kg in a month.
By this logic, eating more rice would mean more calories, which would mean weight gain. So why did the article say eating rice fights obesity?
What the article did not emphasize was the above concept of caloric balance.

What it could possibly have focused more on was that eating more rice as part of your diet (versus eating more rice in general) might help fight obesity. The authors of the paper hypothesized that eating rice, as compared to eating other forms of food such as meat, would help you feel full for longer, and thus you would eat fewer calories overall. In other words, eating 500 calories worth of rice, as compared to 500 calories worth of e.g. meat, would keep you full for longer and thus you would possibly eat less. If my friend had misread this, I wonder how many more Singaporeans might have interpreted it that way as well.

Concept of Glycemic Index (GI)

On the topic of rice, another important thing to mention is the concept of Glycemic Index (GI). GI is a number assigned to carbohydrates in foods according to how they affect your blood sugar levels.
Carbohydrates with a low GI are more slowly digested, absorbed and metabolised – they cause a lower and slower rise in blood sugar. We know that spikes in sugar levels from ingesting high GI food causes your body to produce insulin in spikes as well. These insulin spikes, in the long run, can contribute to the development of diabetes.

In the National Day Rally speech of 2017, Prime Minister Lee Hsien Loong spoke about how white rice has a higher Glycemic Index than brown rice, and that we should take carbohydrates with a lower GI.  In essence, taking brown rice or whole grain rice is better than white rice.
Read: National Day Rally: 1 in 9 Singaporeans has diabetes; problem ‘very serious’, says PM Lee 
In that same speech, PM Lee also mentioned some statistics about our caloric intake. In 1998, we ate on average 2100 calories a day, which is about the right amount if you are not a very active person. Fast forward to 2010, we are taking in 2600 calories a day – a positive caloric balance of 500 calories a day. This is why the prevalence of obesity is rising in our population.

Obesity is also the largest single contributor

So why do we have to care? Obesity is a national health problem. The Singapore Burden of Diseases study found that obesity-related diseases had the largest impact on health in terms of suffering and cost. Obesity is also the largest single contributor to the national disease burden of diabetes. On the social front, obesity can affect your self-esteem and body image, causing psychological stress.
READ: Getting Heart Attack at a Young Age
The latest figures from the Ministry of Health (MOH) showed that in 2017, 36.2% of Singaporeans aged 18-69 were overweight. 13% of school-going children were overweight as well. A World Health Organisation (WHO) report in 2014 showed that in Singapore, we have the second highest overweight prevalence in South East Asia; Malays have the highest incidence of obesity, followed by Indians, then Chinese.
Obesity is a key contributor to a group of conditions known as metabolic syndrome. It includes conditions such as high cholesterol, high blood pressure and diabetes. With these chronic conditions, people are predisposed to developing many other diseases including ischaemic heart disease, heart attacks, strokes and peripheral vascular disease. It is important to note that you should go for your regular health screenings for conditions of metabolic syndrome. They can be easily picked up by your doctor. If you feel you need help in losing weight, speak to your doctor about it too.

So how can we lose weight then?

In summary, you need a caloric deficit. You can increase your caloric deficit by dieting (eating smaller portions) and eating healthier.
You can also increase your physical activity and thus energy expenditure. Inferring from the newspaper article, you could also swap out that piece of steak for some rice. Preferably brown.

Eat Well.


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How to See a Doctor in Singapore

Every year, multiple tourist transit through or visit Singapore. Many also move to Singapore for work as expatriates.
This was written to help those understand and seek help through the Singapore medical system.
Largely, it is very convenient to see a doctor in Singapore. General Practices (GPs) operate on a walk-in basis. Specialists do require an appointment but would also accept walk-in patients if they have available slots.
Now let’s get started.
You have just moved into your brand-new apartment in Singapore, happily unpacking your stuff when Oh My God all you hear a loud crash and see that your child has tripped over some boxes and knocked his head.

via GIPHY

What to Do in an Emergency:

For an emergency ambulance in Singapore, Dial 995. It will bring you to the closest Public Hospital. Unfortunately, you do not have a choice which hospital to go to.
If you wish to get to a certain hospital or because your insurance policy says you must, please contact one of the private ambulance operators instead. However, the response may not be as prompt. Here is a non-exhaustive list with their respective numbers to call.

Non-exhaustive list of Private Ambulance Operators:

Non Emergency Ambulance services 1777 (24 hours)

Here’s a overview with charges

In the event the medical emergency does not require an ambulance, then your options would then be to make your way down to the nearest
1) GP Clinic
2) Hospital Accident and Emergency Department

GP Clinic

GP clinic – To locate your nearest clinic, this can be done through a simple google search with the terms “clinic” and of course allowing location and with the simple use of a ride-hailing app such as Grab or Go-Jek or even booking a taxi, you can get to your nearest medical facility in no time.
As the GP clinics in Singapore are mostly walk-in clinics. All you need to do is just walk into the clinic, produce your child’s and or your own ID, register and wait for your turn to see the doctor. Of course, in busy clinics, waiting times can be very long.
Some GPs open late till about 10pm. There are a few 24-hour GP clinics around. There are also 24-hour family medicine clinics based at hospitals such as Concord International Hospital Family Medicine or Thomson Medical. It’s really useful to take a walk around your neighbourhood to locate your nearest GP clinic and take note of their opening hours.
If the doctor at the GP clinic you see deems that your case is more than what they can handle in the clinic setting, or warrants further investigations or observation, he or she will write a referral and get you to then proceed to the nearest accident & emergency department at the hospital. If the situation is dire, they might even call an ambulance to send you to the hospital instead

Hospital Accident and Emergency Department

Hospital Accident and Emergency Department – If you do make your own way to the emergency department of a hospital, with regards to hospitals, there are many scattered around Singapore and all of them have 24 hours accident and emergency departments. Again, all you need to do is just walk up to the registration counter, produce your child’s ID, register and wait for your turn to be called.
The first person you will see at the Emergency department is the nurse who will do a triage of your basic complaints and take your routine parameters – temperature, blood pressure etc. Do note that waiting times can be agonizingly long as the more serious cases such as those life and death ones are seen first. Arriving by ambulance (blue light) may speed up things a little as the case will be classified as critical and you’ll be brought straight into a more emergent facility such as the critical care room.

This is an exhaustive list of public hospitals in Singapore
Public Hospitals in Singapore:

Private Hospitals in Singapore:

Upon reaching the hospital, all you need to do is relax and trust the professional team of doctors, nurses, patient associates who will take your child through the steps of registration, triage, investigations, treatment and or admission. This should ease your headache and worry, all till the time till you need to settle the (frequently hefty) bill.
So, now that your child is much better, happily running around, screaming, yelling and doing all the things kids should do. Then, almost as expected after a few days he develops a nighttime cough and soon a fever and before you know it, the rest of the family are coughing non stop too!
You decide to head down to the pharmacy/chemist to see if you can get some remedies that will soothe the coughing and give you an undisturbed night of sleep

What to expect at the Pharmacy/Chemist in Singapore

GPs in Singapore are readily accessible and conveniently located around the island, opening till late hours. Hence self-medicating at a pharmacy is a practice not widely adopted. Furthermore, most medicines can only be obtained with a Doctor’s prescription.
There are very few medicines which are OTC (over-the-counter). Most of the medications you hope to obtain would still require you to at least speak to a pharmacist first. The pharmacist will understand your condition better and offer you advice on which medication may be best suited to your ailment.
The list of OTC medications you can purchase from the pharmacy without a doctor’s prescription are usually the regular cough and cold medications, pain killer and fever medications, simple creams for rashes, simple eye drops and medicines for diarrhoea and vomiting Antibiotics are unfortunately not OTC.
After spending a fortune on every possible remedy, you can find at the pharmacy and trying out every possible home remedy, the coughing in your entire family still does not seem to cease. You finally decide that you need to see a doctor

Seeing a GP/Family Physician

As you already know, most if not all GP Clinics in Singapore operate on a walk-in first-come-first-serve basis. Seeing a Doctor is as simple as walking in, registering and waiting your turn.
When it is your turn, you’ll be called in to see the Doctor and he will go through the steps of eliciting your complaints and examining you. You then wait to collect your medicines in the clinic complete payment. That’s right. You do not need to go to a separate pharmacy or chemist for your medications and treatment. All GP clinics in Singapore stock their own medicines. It’s a one-stop shop!
Simple blood and urine tests are also performed at the clinic. Your blood will be drawn by the doctor or his assistant and the tests sent to the laboratory for analysis. The results are sent back to the clinic and the clinic will contact you for a follow up to collect your results and discuss further steps in your treatment journey. Some clinics even have simple x-ray services on their premises. However, most clinics will arrange for you to have your x-rays or scans done at a separate radiology centre.
So you’ve taken the tablets, drank the syrup, had the blood tests and take your x-rays and guess what? You and your son are still coughing! You see the doctor again and he decides it is time to send you to see a specialist.

Seeing a Specialist in Singapore

As discussed earlier, You do NOT need a GP referral to see a Specialist in Singapore. Unless of course, you need to claim insurances which sometimes require a GP referral. All you need to do is to do a google search on the specialist type you’ll like to see, take note of their clinic’s telephone number, give them a call and set up an appointment to see any specialist you fancy!

If your GP does write you a referral letter, there are some advantages which I will share further. They are mainly:

  1. If your insurer requires a letter from the GP before they will cover you for your claims when seeing the specialist
  2. The GP will recommend a Specialist or a team of specialists best suited for your condition. He or she can also recommend specialists whom they have worked before or are known for their expertise in the field. For example, there may be 5 doctors who are good at seeing prolonged chronic coughs (respiratory specialists) but out of these 5, only 1 may have had further training in a hospital which specializes in tuberculosis (TB) and would be more familiar with the latest treatments and management of this condition.
  3. The GP can also communicate effectively your symptom story, the tests and treatments you have undergone, what diagnosis he is considering or has ruled out and this will help the Specialist manage your condition with greater precision.

Most Specialists will only see patients with an appointment. But they will be more than glad to see you on a walk-in basis if they are not swamped with patients at their clinic.
Getting an appointment is easy and waiting times are usually less than a week. Sometimes if you are lucky, you can even get to see the specialist on the same day itself!
You’ve seen the specialist, got diagnosed, got treated and the whole family is back to perfect health. You decide that it is time to take things easy and chill out for a bit at the weekend. So, you pack the entire family on a cooling Saturday evening to the UNESCO site: The botanical gardens, squeeze with the crowd and catch that free symphonic orchestra.
Heaven knows you need a free concert after a small fortune you just spent on medical fees. It’s a relief you have insurance. As the sun sets and your family unwinds when Oh My God, all of a sudden again, your child trips over the picnic basket and hurts his arm! Here we go again, back to part 1.

We hope that this gives you a good overview of what to expect when you require medical attention in Singapore.
If you have further comments or queries please feel free to get in touch with us at our forums or even send us an email – hello@dtapclinic.com

Take Care


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How to Quit Smoking – Smoking Cessation in Singapore

“Tobacco is the legal product which, used in moderation and exactly as the manufacturer intended, causes harm to the consumer.” – Federation of European Cancer Societies

 
Smoking is bad for you. I think that fact has been scientifically proven beyond the shadow of a doubt. Even people who continue to smoke realize this. Smoking damages the lungs. In fact, it can damage the lungs permanently. This is called emphysema. Once a person develops emphysema he will have it forever even if he stops smoking. Smoking greatly increases the risk of developing strokes and heart attacks. Smoking greatly increases the risk of developing not only lung cancer but also a variety of other cancers like stomach cancer, colon cancer, pancreatic cancer and prostate cancer.
Smoking not only harms the smoker. It has also been proven beyond a doubt that second-hand smoke damages health as much as actual smoking. According to the World Health Organisation every year almost 1 million people die as a result of exposure to secondhand smoke.
But to quit smoking is hard. This is due to the highly addictive nature of nicotine and also the fact that smokers get used to the ritual and social aspects of smoking. So while it is easy for non-smokers to say “Why is it so hard? It harms you and your family. It is expensive. It stinks! Why don’t you just stop?!” They, unfortunately, do not take into account the addictive nature of smoking. It is also difficult for non-smokers to empathize with smokers partly contributed by our health authorities’ extremely effective campaign to denormalize smoking in Singapore.
Also Read: Why Can’t Singapore Just Ban Cigarettes?
Also Read: Tobacco Past & Present

 

How to Quit Smoking (Smoking Cessation)?

It is difficult to get a smoker to quit smoking. In fact, most of them do not even think about it. So when a smoker is contemplating quitting smoking or better yet, has made the decision to want to quit, it is imperative to provide them with as much support as we can. Here in Singapore, there are multiple avenues to access such support.
 

If you are a friend or family of someone who is trying to quit smoking, learn more about what you can do for them by downloading this easy to read e-guide published by Singapore’s Health Promotion Board.

 
If you are a smoker reading this and have decided you want to quit, there are many ways you can reach out for support.
 

1) Join the I Quit Program

I Quit is Singapore’s National Smoking Cessation Program. It provides support for smokers who have the intention to quit smoking. There are many ways to sign up for the I Quit program. The easiest way is probably filling up an online form. I Quit is currently running a program that aims to get smokers to stop smoking in 28 days.
Smokers intending to quit have access to free counselling from trained and certified smoking cessation counsellors just by picking up the phone and calling the I Quit hotline known as Quitline. In fact, while signing up for the program, smokers can opt to have counsellors from Quitline call them instead.
Also, smokers on this program will receive daily SMS to keep them motivated to refrain from smoking. Smokers can also go online to the Health Promotion Board’s website and download self-help material like the Quit Fix Booklet and the I Quit Calendar. There is also community support that smokers intending to quit can reach out to via a Facebook Group known as the I Quit Club.
Just to add a little cherry on top of the Sundae, smokers who manage to remain smoke-free for 28 days will receive a $50 voucher from HPB. If he can remain smoke-free for 3 months, he will receive an additional $30 voucher. If he can make it to 6 months smoke-free there is yet another $20 voucher to be had.
 

Go down to I Quit Roadshow

Singapore’s Health Promotion Board holds regular smoking cessation roadshows. Go down to any of these road shows to see what they have to offer. You can sign up for a smoking cessation program on the spot.
Details on upcoming roadshows can be found in the I Quit Club page on Facebook.

2) Speak to a Pharmacist

Go to any retail pharmacy like Guardian or Watsons or Unity. Pharmacists are trained to provide smoking cessation counselling. They can also counsel you on the use of Nicotine Replacement Therapy. If the pharmacist feels that you require more intensive behavioural therapy or counselling or that you need to see a Doctor, they can point you in the right direction.

3) See a Doctor

See your friendly neighbourhood GP. Or visit your nearest polyclinic. Or if you are already seeing a Doctor for some other unrelated medical issues, you can always mention to him during your next follow up visit that you wish to get some help to quit smoking. Believe me, your Doctor will be thrilled and will be most eager to help you.
This is arguably the easiest way to go about it. Most Doctors are knowledgeable in smoking cessation and can counsel you on what you need. Be it accessing the national smoking cessation program known as I Quit, or referring you to a trained and certified smoking cessation counsellor or even prescribing you medicines or nicotine replacement therapy to help you quit smoking.
There are 3 so-called “pharmaceutical aids” to help you quit smoking.
The most well known is probably NRT (Nicotine Replacement Therapy). This helps smokers reduce their cravings and side effects of quitting by supplying their bodies with nicotine. It usually comes in the form of chewing gum or lozenge. They are usually taken for a duration of 2 to 3 months.
The 2 other pharmaceutical aids are tablets. One is Bupropion (Zyban) and the other is Varenicline (Champix). Both of these are tablets and can have potential side effects. They are usually taken for 3 months. They help to reduce cravings by activating certain chemicals in the brain. Please discuss with your Doctor if you can benefit from these.
 
The MOST important thing to remember is that these pharmaceutical aids work much better with behavioural intervention. In other words, do not just take the medicines. You still have to have a quit plan in place. You still have to keep yourself motivated. You still have to receive daily reminders and support to quit. You will still benefit from talking to a smoking cessation counsellor.
 
Be Strong. Take Care.


 

Top 5 Things To Do In An Event of Food Poisoning (Gastroenteritis)

There has been a number of high profile food poisoning cases this 2018 year end in Singapore & Malaysia.
 

 
Symptoms of food poisoning can range from mild to severe. Initial symptoms are usually of vomiting, loose watery stool (diarrhoea), stomach pain (abdominal colic) and fever.
Severe complications of food poisoning are dehydration and even sepsis. As vomiting or diarrhoea persists, one can get severely dehydrated – dry lips, cool extremities, dizziness and a general sense of lethargy and weakness. Furthermore, one’s heart rate would also start to go up and the blood pressure starts to fall as dehydration worsens. In the event of a strong infection, one may even develop sepsis (blood infection) that can lead to an increased rate of breathing, change in mental alertness and status.
 

Here are Top 5 Things Doctors Would Advise You To Do In a Useful to Remember Acronym. W.A.T.E.R !

 

W – Water

Hydration hydration hydration, that is always the priority for anyone who is experiencing episodes of gastroenteritis.
 

A – Avoid

Avoid dairy foods, foods which are oily or fried as these are difficult to digest and would make the diarrhoea worse. Go for the BRAT diet – Bananas, Rice, Apples, Toast
 

T – Take medication

Take medication such as loperamide, lomotil, hidrasec to control the diarrhoea symptoms. Medications such as dimenate, maxolon, ondansetron, promethazine help stave away vomiting symptoms. And lastly Buscopan and Meteospasmyl take away abdominal colic symptoms.
 

E – Ensure you are able to drink water and that vomiting has stopped.

If vomiting persists, it is advisable to consider visiting the Accident and Emergency departments or 24-hour clinics such as the Concord International Hospital for Intravenous (IV) Rehydration, IV Medications and a period of close observation and recuperation
 

R – Rest and Recharge

Like any car without fuel, when one is dehydrated or without food, lethargy and weakness sets in. Close monitoring by a trained medical professional in a comfortable environment for recovery goes a long way in preventing complications of gastroenteritis.
 
 
 
Eat Safe & Take Care.

What are the Causes of Swimmer's Ear or Outer Ear Infection?

(OTITIS EXTERNA aka Swimmer’s ear or Outer Ear Infection)
The external ear canal is the part of the ear that connects the outer ear to the eardrum. This outer ear infection takes place in the external ear canal and usually presents a sudden painful condition usually caused by bacterial infection, inflammation or sometimes fungal infection.
People who are predisposed to outer ear infection includes the young and adolescent group, people with skin conditions like eczema or psoriasis, and people with excessive ear wax production.

The natural defence mechanism of the ear canal

  • The narrow ear canal serve to reduce entry of contaminants
  • The sticky nature of the ear wax helps to maintain a harsh environment for bacteria, helping to trap fine debris and also repel water.

 

What are the Causes of Swimmer’s Ears or Outer Ear Infection?

A moist ear canal can serve as a reservoir for bacterial (most common cause) or fungal infection to seed on.
Other factors that contribute to outer ear infection:

  • Exposure to contaminated water, swimming pool or hot tubs
  • Contact with allergic or corrosive chemicals such as hair dye or spray
  • Excessive ear canal cleaning with cotton buds
  • Skin barrier impairment over the ear canal secondary to eczema/ psoriasis or abrasions secondary to scratching
  • Using ear canal devices such as earphones, hearing aids, diving caps
  • Complication from water irrigation during ear wax removal procedures

 
Concurrent infection which causes inflammation and swelling of the skin. This leads to obstruction, itch and scratching of the ear canal which will create further injury, thus worsening the condition.
 

What are the Signs and symptoms of Swimmer’s Ears or Outer Ear Infection?

  • Ear pain
  • Itch
  • Discharges from ear
  • The feeling of blocked ear
  • Reduced hearing

 
 

What are the treatments for Swimmer’s Ears or Outer Ear Infection?

The treatment goal is to control pain and treat the infection.

  • Careful cleaning of the ear canal using specialized equipment
  • Eardrops to reduce inflammation and hinder the growth of bacteria and fungus

 
With the removal of debris in the ear, this will facilitate the absorption of ear drops in the ear canal.
In addition, the doctor can place a sponge or wick in the canal if it is swollen. This will increase the delivery of ear drops into the ear canal.
 
How to take care of your ears?
It is important to avoid the ear canal from getting wet during treatment. Extra precautions should be taken while showering. Avoid swimming 7-10 days during infection is of great importance.
 
If you swim regularly, consider

  • Shake your ears dry after swimming
  • Blow dry the ears with low setting dryer held from a distance away
  • Use earplugs during swimming

 
Are there any Follow-ups?
A patient needs to be follow up 36-48 hours after treatment initiation to monitor symptoms. Sometimes, the ear may need cleansing again using specialized equipment by a doctor in addition to the installation of ear drops.
 
Most external ear infection improves within 7-10 days.
 
If you think you have outer ear infection, please speak to any of our friendly doctors at any of our clinics to discuss further, or drop us an email at hello@dtapclinic.com