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.

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


Swallowing Semen: What You Should Know

What is semen made of?

Semen consists of several fluids which are produced by various glands. Actual sperm cells make up only a very tiny portion of semen volume. The bulk of semen is made up of prostatic fluid, secreted from the prostate gland, seminal fluid which contains fructose, proteins and fatty acids and bulbourethral fluid from the bulbourethral glands. Semen contains protein and a multitude of other components such as fructose, citric acid, zinc, cholesterol etc. 

What is the usual color and consistency of semen?

Normal semen may have an off-white or slightly yellow tint. It is usually jelly-like in consistency, but may be slightly clumpy or more liquid in nature. But semen with a pronounced yellow or green colour may indicate an infection and a visit to your doctor is warranted. If there is blood in your semen (red or brown) please see a doctor as well.

Is semen safe to ingest?

All the components in semen are fully edible and digestible, so semen is generally safe to ingest. However, swallowing semen could prove dangerous if you suffer from a rare allergy to semen (known as “human seminal plasma hypersensitivity”), in which case you could develop a bad or potentially even life-threatening reaction. 

What happens if you swallow semen?

Swallowed semen is digested by the digestive enzymes in your gastrointestinal tract, the same as any other food which you ingest. Contrary to some urban myths, there is no risk of pregnancy from swallowing semen. 

What does semen smell or taste like?

Semen has been said to normally smell like ammonia, bleach, or chlorine due to the alkaline nature of semen. Semen can taste mildly sweet, salty or bitter. But the smell and taste can differ from person to person, and even from week to week, depending on your hydration status, hygiene, health and your recent food consumption.

However, if the semen smells or tastes abnormally strong, and is associated with discomfort on ejaculation or other urinary symptoms, it could be a sign of an infection, please see a doctor then.

Is it true that semen has dietary health benefits?

While semen does have a high percentage of protein for its weight, it is likely that you have to consume a large quantity in order for it to have dietary health benefits.

Semen also contains other components like sugar, sodium, citrate, zinc, chloride, calcium, lactic acid, magnesium, potassium and urea, but due to the small volume of semen, the dietary health benefits are likely insignificant.

Semen as a mood booster?

While there are no studies that can definitively make the link between ingesting semen and better mood, it is known that semen does contain trace amounts of endorphins, estrone, prolactin, oxytocin, thyrotropin-releasing hormone and serotonin, which can potentially affect your mood.

Rather than looking at semen as a mood booster, it is known that engaging in sexual activity in general is linked to a decrease in depression.

Will swallowing semen make you gain weight?

The amount of calories in semen is likely to be insignificant – containing less than 10 calories.

Does swallowing increase your risk of an STI?

When it comes to the risk of contracting STIs, it doesn’t matter whether you spit or swallow. Exposure to body fluids like pre-ejaculate fluid, semen, vaginal fluids or skin lesions like genital ulcers places one at risk of contracting STIs. This risk is further amplified if you have poor oral hygiene or wounds like cuts or ulcers in your mouth. 

What are the common STIs that can be transmitted through oral sex?

STIs can be transmitted through skin-to-skin contact, which includes oral-to-genital contact, or through contact with infected mucosa membranes and body fluids. Here are some of the common STIs which one may be at risk of contracting through oral sex.

Chlamydia and Gonorrhea are two common bacterial infections that can be transmitted through oral. Someone with throat Chlamydia or Gonorrhea may experience a sore throat but some individuals may have no symptoms at all and can continue to spread this infection to sexual partners. 

Syphilis can be transmitted during oral through contact with infected ulcers and if left untreated, can potentially affect multiple organs in the body including the brain and eyes.

Herpes (caused by the herpes simplex virus) can be transmitted either from an infected genital ulcer or oral cold sore or by skin-to-skin contact in an infected but asymptomatic individual. Genital herpes causes painful blisters and ulcers in the genital region. 

Human Papilloma Virus (HPV) can be transmitted as well. Some strains of HPV cause genital warts, while others increase the risk of various cancers such as cervical cancer, oral cancer or penile cancers.  

Many people tend to worry about HIV but the risk of HIV transmission through oral sex is actually extremely low, although unique circumstances like the presence or wounds or blood may increase this. 

Is it possible to be allergic to semen?

Yes. Semen allergy or seminal plasma hypersensitivity is a rare allergic reaction to proteins found in a man’s semen. While it usually affects the person exposed to it, it can also been shown to affect the person producing it.

Some common symptoms of sperm allergy are redness, swelling, pain, itching, and a burning sensation in the vaginal area. Symptoms usually start about 10-30 minutes after contact with semen. They may not be confined to the vaginal area; they can occur in any area that has contact with semen, including the skin and the mouth. Symptoms can last for a few hours or a few days.

This allergy is rare. However, if you do experience such symptoms, speak to your doctor about it.

This article is written by: Dr Grace Huang & Dr Chester Lan

Also on this site: std check, HIV Clinic Singapore

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:

DTAP Teleconsult
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!


Staying at home but sneezing?

The Patient Journey
A DTAP Stay Home Series Part 2


In part 1 of our series, we shared a bit on the statistics surrounding COVID 19 and some simple steps one can take in minimizing the spread of germs. This centered around the whole idea of preventing droplet spread. And because of this, many of us have opted to stay at home and even work from home.

In fact, droplet spread stems from coughing and sneezing and the droplets which contain viruses tend to stay on surfaces and ultimately persist for up to 24 hours. That is why the 2 biggest health recommendations were to wear a mask if you are coughing or sneezing to prevent the spread of germs via the droplets AND the washing of hands especially after touching surfaces outside. 

At team DTAP, not only have we encouraged each and everyone of our staff to maintain and work on their personal hygiene, we have also taken the active step to further increase the frequency of sterilization at our clinics. In fact this was a snapshot of our recent communiqué with our staff.

Our main priority always is to protect our staff and patients. If anyone is found to have fever and upper respiratory tract symptoms (coughing, running nose etc), the prerogative as per the Ministry of Health (MOH) Singapore’s recommendations is, for that member of staff to be on unfit for work status for 5 days and resting at home.

The rationale behind such a thinking is that if the infection causing the upper respiratory tract infection was the garden variety, ample rest would allow the body to recover. However, if the opposite were true and if this was indeed a COVID 19 infection, time would unmask this as the index person would have a persistent fever, signs of airway infection and even breathing difficulties.

The WHO-China report tabulated 56,-000 cases and found that almost 90% had fever as presentation, 7 in 10 had a dry cough, slightly less than half of those polled had lethargy and fatigue and only 5 in a 100 had upper airway nasal symptoms such as runny nose, blocked nose or even sneezing.

So if you are caught up at home in this period of MC5 (5 days of unfit for work) or even on a Stay Home Notice or Quarantine Order (see first article in series), there’s no need to fret as you allow your body to rest and recuperate.


But what happens when you continue to sneeze during this period, and, despite sanitization efforts, you worry that others may look at you funny and steer away from you?

Let’s delve deeper into what causes one to sneeze; when irritants or infective agents such as bacteria or viruses irritate the airway, chemicals are produced by the body to activate the mucus producing glands resulting in a “runny nose”. These chemicals also activate the nerve endings in the nose and result in one getting an “itchy nose” and ultimately an “AH CHOO”, sneeze !

Although the medical literature has reported that only 5% or 5 in a 100 cases of COVID 19 have concurrent symptoms of sneezing, running nose or blocked nose, I am sure that the persistence of your nasal symptoms may alarm you.

When you speak to one of our doctors, in the absence of fever (I will share more in our next article part 3 of our series on the persistence of fever), we will try to understand your travel and contact history and also see whether there are any known irritants you may have come into contact with recently that could signify an allergic cause of sneezing.

Sneezing is usually significant and caused by an allergy when,

  • There is an observable pattern of sneezing, especially coming into contact with certain environments
  • When it starts to affect your daily quality of life – going to work tired and drained, suffering the symptoms on a day to day basis – watery eyes, clogged nose

Based on these symptoms and history, the next step often is to figure out what allergies you might be suffering from – Take an allergy test!

This can be done with a few ways mainly either through a comprehensive blood test or through a skin prick test.

After the tests are done, a report (sample above for blood test IgE) is produced. This report will be discussed with you and the type of allergen as well as degree of allergy will be identified.

Also read: HOW DO I STOP SNEEZING? – ALLERGY FROM CLEANING


Knowing your allergy is the first step to finding an active plan in dealing with the allergy.

This active plan will be individualized and customised specific for your needs and lifestyle. But they might involve anything from Immunotherapy, avoidance of allergens, to even carrying around an Epipen with you in view of serious life threatening allergies.

Remember, if you are staying home and still sneezing, the chances of it being COVID19 is low if you had no contact with anyone from the infectious clusters locally or abroad. But if you are sneezing at home and persistently especially in the morning, it could well be an allergy that can be further investigated and treated.

Stay safe, dispose your used tissues in the bins and remember to keep sanitizing your hands!


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Staying at home and ordering in (a pizza) your medications.

The DTAP Experience
A DTAP Stay Home Series Part 1


The recent COVID-19 infection has gripped the world. With countries such as China, South Korea, Iran, Italy and the cruise ship Princess Diamond all badly hit. The infection rate has been fast and furious with global infections soaring to more than 85,000 cases and nearly 3000 deaths worldwide as of 1st March 2020.

On the local front, Singapore has been fortunate to keep the total cases at 102. With zero deaths, more than 72 discharged from hospital and less than 1 third remaining in hospital. 

These encouraging numbers in Singapore are brought about by Quarantine Orders (QO) – to isolate suspected carriers or close contact of carriers and also Stay Home Notices (SHN) – for Singaporeans, PRs and Long term pass holders who have been in mainland China, Daegu or Cheongdo in South Korea in the last 14 days, to stay at home at all times. 

On the ground, how this has translated to us as a healthcare group on the ground has been a lot of behind the scenes hard work, sweat and meticulous changes.

I remember when news first disseminated on the night before CNY eve (23rd Jan) that Singapore had its first case, I stayed up late into the middle of the night to review the facts and prepare our team as best as we can operationally. 

Being at the frontline of Singapore’s healthcare provider community, our core priority was to protect our patients, protect our staff and most importantly the general public.


Everyone that stepped through the doors were asked travel screening questions –  especially travel to China then, had their temperature taken and given a mask. 

And if they had done so in the last 14 days and exhibited symptoms of fever, cough or breathlessness, they would be brought to a separate isolation room for assessment to prevent mingling with other patients. On our own, we also would have taken precautions with personal protective equipment. And if they were suspected to be infected, we would then call an ambulance for transfer to the NCID.

We had also increased the number of hand sanitizers across the waiting areas for our patients and complete sanitization of the isolation room after each patient and for our own consult rooms. I personally wiped down the door handles, seat and table surfaces regularly after each patient.

This period of uncertainty resulted in 3 distinct situations. The first one resulted in a surge of patients coming for a longer duration of the refill of their prescriptions. 

The second situation saw an increased number of patients coming in to get their Fever and Flu symptoms checked out (i’ll share more on this in the next article, a patient’s journey in getting their Flu or recurrent sneezing symptoms checked out and even the benefits of a Flu/Pneumonia vaccination). These were patients who often self medicated previously and rested but were now worried during the COVID 19 situation. 

And the third situation was one where our patients, especially those who worked from home during this period, did not want to mingle too much in public, contacted us for an offsite refill of their medication prescriptions.

We put in place many measures to protect our patients. From the stringent operational changes, proactive screening of our patients, minimizing the mingling of patients – spacing out of patient appointments, to increased regular sanitization of the clinic. 

But there was still the third situation and group of patients who needed their medications but were not willing or able to come down to the clinics.  And we had to do right by them and not allow their health to suffer in light of the COVID 19 Dorscon Orange precautions.

We thus took the active step at team DTAP to put in place a robust medication delivery system – DTAP Delivery. This system is aligned with the Singapore Standards – SS644 guidelines for the supply and delivery of medication. This robust framework ensures the a) integrity of the medication delivered b) confidentiality of one’s medical records, medications and c) ease and accessibility for our patients. Here at team DTAP, we spared no expense to ensure that our patients always received the medical care that they need and in a timely manner.

You can explore our medication delivery service further here: DTAP Delivery

DTAP Delivery Service

Last but not least, in view of the recent COVID19 happening during the Chinese New Year, I will leave with you my dear readers a short acronym H.U.A.T to stay safe during this heightened medical situation.

Help keep a lookout for your friends and family. If they are unwell with a cough flu or cold, encourage them to put on a mask and seek medical attention

Understand news from the right channels. Alot of fake news out there aimed to cause panic. Gov.sg has a whatsapp account with regular updates

Avoid fear mongering, keep calm and carry on life as per usual

Take necessary precautions – Hand sanitizing, Putting on Masks

Take Care!



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What You Need to Know about Wuhan virus – 2019 novel coronavirus (2019-nCoV)

By now, we have all heard about the outbreak of a new virus in China that has infected more than 600 people and claimed at least 17 lives, while spreading to other countries around the world. As of today (24th Jan), Singapore has three confirmed cases of the 2019 novel coronavirus (2019-nCoV), also known as the Wuhan virus. Other countries which have confirmed cases include Japan, Korea, Thailand, the United States, Taiwan, Saudi Arabia and Vietnam. Disease modeling experts from Imperial College, London suggest that case numbers reported by China are conservative, issuing a report on Wednesday (22nd Jan) stating that 4000 people could currently be infected.

Its emergence on our shores has fueled fears of a deadly epidemic reminiscent of Severe Acute Respiratory Syndrome (SARS) in 2003, H1N1 influenza in 2009, and Middle East Respiratory Syndrome (MERS) in 2012. 

Here’s what you need to know about WuHan Virus:

What is the WuHan Virus and how did it happen?

The Wuhan virus belongs to a family of viruses known as coronavirus, which include SARS and MERS. These viruses, named for the crown-like spikes on their surfaces, infect mostly bats, pigs and small mammals. But they mutate easily and can spread from animals to humans, and from one human to another.

The outbreak is understood to have originated in December in Huanan Seafood Wholesale Market in Wuhan, the largest city in central China with a population of 11 million people. It is thought that wild animals are the source of the virus. Chinese scientists believe that the virus might have jumped from bats to snakes, which were then sold in the market, and subsequently transmitted to humans. 

How is the WuHan Virus spread?

The WuHan virus is believed to spread much like the common flu does – by droplet and contact, for example coughing, kissing or saliva contact. For now, virologists say that the Wuhan virus is likely not as infectious as the SARS virus, with a current reported 2% death rate. But there are concerns that the virus could further mutate to become more lethal.

What are the symptoms and when do you suspect that you have it?

Seek medical help or go to A&E immediately if:

  1. You have fever OR cough OR upper respiratory symptoms OR breathlessness, and
  2. You have travelled from mainland China within the past 14 days, or
  3. You have visited a hospital in mainland China 14 days before onset of illness, or
  4. You have had close contact with a confirmed or suspected case of Wuhan virus

Are there drugs or vaccines to treat or prevent Wuhan virus?

There is no vaccine to protect against coronaviruses. There is also no specific treatment to cure illnesses caused by coronaviruses. Patients receive supportive treatment at hospitals and generally recover on their own after some time. 

You should consider getting a flu vaccine if you are travelling to places where there are confirmed or suspected cases to prevent you from contracting influenza symptoms that may mislead screening authorities at temperature checkpoints.

What can I do to protect myself against the WuHan Virus?

  1. Wear a surgical mask if you have flu-like respiratory symptoms 
  2. Even if you have no symptoms, you can wear a surgical mask if you are going to be going out in public and having person-to-person contact
  3. It is advised that surgical masks will suffice and there is no need to use N95 masks
  4. Take the same protective measures you would take against the flu: wash your hands frequently with soap, cover your mouth with tissue paper or your hands when coughing or sneezing, and stay away from people who are sick
  5. See a doctor if you feel unwell

Should I cancel my trip to China?

According to the latest travel advisory issued on Thursday (23rd Jan) by the Ministry of Health (MOH), Singaporeans should avoid travelling to Wuhan. China has imposed a travel halt in Wuhan as all flights out of the city have been cancelled and trains, buses and ferries suspended.

MOH reminds the public to continue to exercise caution and pay close attention to personal hygiene when travelling to the rest of China. MOH advises that all travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell, and also inform their doctor of their travel history.

Lastly..

According to the World Health Organization, the Wuhan coronavirus is an emergency in China but is not yet a public health emergency of global concern. However, as the situation is rapidly evolving, all of us should continue to stay abreast with the latest updates and news reports. 

Stay safe!
[This article is written on 23rd January 2020]


武汉病毒知多少?- 新型冠状病毒
中文版: https://www.dtapclinic.com/articles/武汉病毒知多少?-新型冠状病毒/

Where To Buy Nicorette Gum In Singapore

Quitting smoking can be very difficult. This is because the nicotine found in cigarettes is highly addictive.

When smokers stop smoking, their bodies crave the nicotine and this leads to many uncomfortable symptoms including:

  1. Irritability and/or depression
  2. Tingling in hands and feet
  3. Nausea and tummy cramping
  4. Cold sweats
  5. Sore throat and coughing
  6. Difficulty sleeping
  7. Difficulty concentrating
  8. Anxiety
  9. Weight gain

READ: Tobacco Past & Present


Nicotine replacement therapy (NRT)

Nicotine replacement therapy (NRT) has been shown to be an effective adjunct to help people quit smoking. NRT is a safe way to deliver nicotine to the body in place of smoking cigarettes. It therefore reduces the severity of nicotine withdrawal symptoms making the quit journey more tolerable.

In Singapore, NRT is available as chewing gum and patches.

The only brand of NRT available in Singapore is Nicorette. Nicorette chewing gum comes in an Icy Mint flavour. It also comes in 2 strengths – 2mg and 4mg.

READ: Why Can’t Singapore Just Ban Cigarettes?


How do I choose which strength to use?

If you smoke one or more packs of cigarettes (20 cigarettes) per day – use the 4mg strength

If you smoke less than one pack of cigarettes (20 cigarettes) per day – use the 2mg strength


How many gums can I chew in a day?

You should chew a gum each time you have the urge to smoke. As time goes by, you should need fewer and fewer gums.

A recommended weaning program is:

First 12 weeks – 8 to 12 gums per day

Then reduce to 4 to 6 gums per day over 2 weeks

Then reduce to 1 to 3 gums per day over another 2 weeks

Then gradually reduce to zero gums


How do I chew Nicorette gum? Do I just chew it non-stop?

Chew the gum until you the flavour becomes strong. Then place the gum between your teeth and cheek. The nicotine from the gum will be absorbed through your cheek. When the flavour fades, chew the gum again. Keep repeating these steps for 30 minutes. After which the gum can be disposed of. When you have the urge to smoke again, chew another new gum.


What is the price of Nicorette gums?

The price of Nicorette Icy Mint gums at our clinics in Singapore are:

  • 2mg
    • 30 pcs – $28.50
    • 105 pcs – $82.00
  • 4mg
    • 30 pcs – $42.00
    • 105 pcs – $119.00

Nicorette is also available for delivery via our medication delivery service. 


Need more help to quit?

Join the Singapore’s Health Promotion Board I Quit program.

Call 1800 438 2000 to talk to trained consultants to help you through your quit journey. Sign up for the 28 days quit program and get rewarded for staying smoke free: https://www.healthhub.sg/programmes/88/IQuit

Speak to your doctor today for more information regarding Nicotine replacement therapy (NRT).

Next read: How To Quit Smoking – Smoking Cessation In Singapore


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Responsible Drinking Over The Festive Season

It’s the most wonderful time of the year.. 

Happy holidays to one and all! While it is the season to be jolly, it is also the season where one may tend to consume too much alcohol. It is important to keep in mind not to drink too much. Excessive alcohol intake in one sitting can lead to intoxication, impaired judgement and negative physical behaviour such as drink driving and unsafe sex. Chronic alcohol overuse can lead to an increased risk of liver disease, some cancers, unintentional injury and social problems. 
 


How much is too much?

​​​​​​​If you drink alcoholic beverages, do so in moderation. According to Singapore’s Health Promotion Board (HPB), women should limit themselves to one standard drink a day and men to two standard drinks a day. A standard drink contains 10 grams of alcohol, and is equivalent to:

  • 330 ml (one can) of beer (158 kcal)
  • Or 100 ml of wine (140 kcal)
  • Or 30 ml of hard liquor (89 kcal)

 


Alcohol and Cardiovascular health

There is a paradox regarding alcohol and cardiovascular health. It is true that alcohol in low to moderate amounts has a cardioprotective effect. However, excessive alcohol intake can cause high cholesterol and high blood pressure, leading to an increased risk of heart attack, heart failure and stroke. In men, erectile dysfunction can sometimes be the first sign of impending cardiovascular problems.
 


The Asian flush

The dreaded Asian flush, the bane of many and frequently a source of embarrassment. To understand why some people turn tomato red after just a few alcoholic beverages, we first need to understand the basic chemistry of alcohol metabolism.
Alcohol or ethanol is broken down initially by the enzyme alcohol dehydrogenase into acetaldehyde, a highly toxic compound that contributes to the hungover feeling. In most people, acetaldehyde is subsequently converted by the enzyme aldehyde dehydrogenase into harmless acetate and water. 
Approximately 70% of East Asians (Han Chinese, Japanese and Korean descent) have a mutated or altered form of the aldehyde dehydrogenase 2 (ALDH2) gene. This causes reduced activity of aldehyde dehydrogenase, therefore such people take a much longer time to completely digest alcohol. As more toxic acetaldehyde circulates in the body, it leads to facial flushing and other symptoms such as headache, lightheadedness, nausea and palpitations. In other words, if a person experiences the Asian flush, it is the body’s way of signalling to stop drinking and start hydrating instead. 
 


3 common facts about drinking alcohol

Fact 1: Women have a tendency to get drunk faster than men.
 
This is true. A woman’s body typically takes longer to process alcohol. This is because women have a different fat-to-muscle ratio and a smaller blood volume than men. Women also have lower levels of the enzyme alcohol dehydrogenase, which begins the initial metabolism of alcohol in the stomach. Hormonal changes during a woman’s menstrual cycle can also affect alcohol absorption.
 
Fact 2: Alternating with non-alcoholic drinks will help to slow down alcohol absorption.
 
This is true. Drinking slowly or alternating with non-alcoholic drinks such as water, soda water or diet cordials will reduce the rate of alcohol consumption and also slow down alcohol absorption.
 
Fact 3: Drinking more non-alcoholic drinks after alcohol consumption will help to cure a hangover.
 
This is true. A person who is having a hangover is likely to be dehydrated and deficient in electrolytes such as sodium and potassium. Drinking plenty of water, sports drinks or coconut water can help to replenish the fluids and electrolytes, and helps to speed up the recovery from a hangover.
 


3 common myths about drinking alcohol

Myth 1: Mixing different types of alcoholic drinks gets you drunk quicker. 
 
This is false. The level of alcohol in one’s blood is what determines the likelihood of a person to get drunk. Therefore, the type of alcohol or mixing different types of alcohol does not make a difference. What is more important is the amount of alcohol being consumed. Drinking a lot of any type of alcohol can lead to dehydration, intoxication and a nasty hangover.
 
Myth 2: Eating oily food before consuming alcohol will help keep one sober.
 
This is false. Drinking on a full stomach only delays the rate of absorption of alcohol into the bloodstream, as the fat content in oily food helps to coat the stomach lining. However, it does not prevent one from eventually getting intoxicated if the alcohol intake is high.
 
Myth 3: Taking a cold bath or drinking hot coffee will help one to sober up.
 
This is false. While showers, fresh air and hot coffee or tea might feel a little refreshing, none of these things will help to sober a person up. Only time can help a person to sober up. It takes the body approximately one hour to eliminate the alcohol from one standard drink. 
Coffee contains caffeine, a stimulant that helps one feel more alert and awake. It does not speed up the process of alcohol metabolism. You may mistakenly think that the hangover has resolved, but when the effects of caffeine fade, extreme lethargy starts to kick in, which can result in potentially fatal consequences while driving or operating machinery.
 


Tips for responsible drinking and avoiding getting drunk

 

  • Learn to say no. Do not be influenced by your friends or social circumstances. Focus on socialising and conversing with friends instead of drinking.
  • If you must drink, drink slowly and do not treat alcohol as a thirst quencher.
  • Avoid engaging in drinking games.
  • Always stay hydrated and alternate your drinks with non-alcoholic drinks such as water, soda water or diet cordials.
  • Avoid pre-mixed drinks with added sugars, or mixing alcohol with energy drinks as they can be higher in calories.
  • Never drink on an empty stomach. A light and nutritious snack or meal before a drinking session can help slow down alcohol absorption.
  • Avoid salty food as they can make you thirsty and reach out for more drinks.
  • Light beer and wine spritzers have a lower alcohol and calorie content and are good ways to reduce overall alcohol intake.

Therefore, the next time you raise that wine glass during your round of merrymaking, please think about regulating your amount of alcohol consumption, and drink responsibly. 
Cheers!
 


 

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Movember: 13 FAQs On Mental Health And More For The Community.

Mental Health Don’t Discriminate.

As part of the Movember series on Mental Health & Suicide Prevention awareness, Dr Tan & Partners (DTAP Clinic) has team-up with the counsellors in Oogachaga to come out with 13 FAQs on Mental health and other health concerns for all the Men in the community!

The Questions are from Counsellors of Oogachaga. The Answers are from Doctors in DTAP Clinic in Singapore & Malaysia.


Q1: What can I do to maintain a good mental health status?

Dr Taufiq: There are many ways one can do this. Let me list a few and elaborate a bit on them.

  • Share your feelings – talking about how you feel is a good form of release and prevents you from bottling up your feelings only for it to affect you negatively later on.
  • Be physically active – Exercising and being active improves blood flow and release endorphins which helps to promote a positive mood.
  • Eat healthy – Clean and healthy food keeps your body healthy. With a healthy body, you can stay mentally healthy too.
  • Ask for help – if you have come to a point where you are not sure of what to do or how to control your emotions, seek help. Oogachaga has professional counsellors that can help you with your issues.

Q2: My anxiety often keeps me awake at night and I find myself irritable and moody the next day. How can I work on my sleeping schedule?

Dr Taufiq: To improve sleeping schedule you need to practice good sleep hygiene. Here are some tips:

  1. Have a regular routine that you do before sleep like brushing your teeth, drinking water etc.
  2. Avoid watching tv in bed. The bedroom should be reserved for sleep and sex only.
  3. Don’t take caffeinated drinks before you go to bed.
  4. Fix a time at which you go to bed.

#DidYouKnow: In generalised anxiety disorder, feelings of anxiety overwhelm and affect one’s daily functioning and life….

Posted by Dr Tan & Partners on Tuesday, May 28, 2019
8 Ways to Cope with Anxiety

Q3: Do I have to come out as bisexual if I don’t have a partner of the same gender?

Dr Taufiq: Try not to be too worried about labels. If you are not partnered right now, it’s a good time to focus on yourself. Pick up a new hobby, learn a new skill, socialize, make new friends. When the right person comes along then it is good, if not you will still be able to live the best life that you can.


Q4: It’s stressful to hear my colleagues say nasty remarks about the queer community. How can I manage to work in a homophobic environment and maintain good relationships with my colleagues?

Dr Taufiq: You need to establish whether your superior and your company is LGBTQ friendly and open to all sexuality. If they are, then speak to your superior to share how you feel about the situation. See if he or she can find a way to make the work environment more comfortable for all. Your superior may also be able to mediate the discussion between you and your colleagues to talk about this issue and clear up misconceptions and unhappiness.

However, if the workplace or your superior is not LGBTQ friendly or open to discussion, then it might not be wise to approach them to talk about this. I suggest speaking to a counsellor from Oogachaga to find out how best to deal with such situations.

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Q5: Is being gay a mental illness or an emotional problem?

Dr Julian Ng: Being gay is NOT a mental illness or an emotional problem. A gay person is simply a male who has a romantic interest in another male, just like heterosexuals who have a romantic interest in the opposite sex.

Just like how someone may like someone with long hair or a great smile or a good sense of humour while another person may prefer other characteristics, being gay is NOT something that one can change or have control. It is simply a difference in interest.


Q6: Why do people attempt suicide when they appear to feel better?

Dr Julian Ng: Some people attempt suicide because they have lost hope while others simply want to stop the pain. Sometimes they hide away their pain so that their loved ones would not worry. We have also heard of cases where someone has already made up their mind but just wants to spend their final hours with their loved ones with the thinking that at least their loved ones will have that final happy memory to remember them by. 

In addition, some may feel better when they are in the company of their loved ones/ friends but when they are alone, the sense of loneliness/ hopefulness comes back.


Q7: I am currently in a heterosexual relationship, can I still identify as bisexual?

Dr Julian Ng: Definitely! Just because you are in a heterosexual relationship, it doesn’t change your sexuality. Sexuality is the emotional, romantic, and/or sexual attractions with whom you build your relationship with.


Q8: How do I know if I am feeling depressed and need to seek help?

Dr Guna: It’s common for one to feel down at times but if you feel hopeless and it just won’t go away, you may have depression. Depression symptoms vary from one to another but in general, you will be able to identify some of them.

Common symptoms of depression are:

  • Loss of interest in daily activities – You have stopped feeling joyful and do not find pleasure in things you used to.
  • Feelings of helplessness and hopelessness – you will start thinking that nothing is going to make anything better, in fact, you might not even try.
  • Anger or irritability – your usual threshold level is no longer high. Anything and everything will make you agitated.
  • Appetite or weight changes. Significant weight loss or weight gain
    Self-loathing. You harshly criticize yourself and blame every mistake on you.
  • Sleep changes. Either insomnia, with frequent early awakenings, or oversleeping.
  • Loss of energy– You would feel you body has been glued to the ground. Too tired even for small activities such as having breakfast or even bathing.
  • Reckless behaviour – You will want to live life dangerously or they would say YOLO!
  • Concentration problems– Trouble focusing, making decisions, or remembering things.
  • Unexplained aches and pains. 

You will need to seek help when you think something is definitely off in your lifestyle. No one will know better about you other than yourself. Despite trying some life modifications, meditations and everything in the book, if you still notice things are not getting better, then it is time to seek professional help. 

Depression is an illness that falls under the category of mood disorders. Unlike the normal mood changes or occasional…

Posted by Dr Tan & Partners on Friday, May 3, 2019
5 Ways to Fight Depression

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Q9: What can I say to medical professionals who have misgendered me?

Dr Guna: Misgendering is on the rise. Whilst some are on an adventure figuring out themselves, they too have to deal with the public that may unknowingly misgender them. So what should you do? Should you just lash out and scream, ITS MA’AM or just let it slide? Here are some tips for you!

You may consider the following if you would like to correct them:

  • Is it going to be a one-off meeting? If it is, it might be better to save your saliva. Think about it, why waste your time with one person. 
  • How are they going to react? To be honest, there are still some aggro dude bro doctors out there. They might react in the weirdest way possible. So, save yourself some trouble.
  • Your emotional capacity. This is the most important step. If you have reached your BS level for the day, just go with it. If you can rectify the mistake, why not! Make them understand that you have found yourself and you will be pleased if they can stop misgendering you!. 

Despite being in the future, some still go through hard times in the doctor’s office, especially when they are being called with their “dead” names. 

It’s vitally important for trans people to get the healthcare they need while being treated fairly and with respect. Discrimination against trans people in medical offices and hospitals occurs on a daily basis and not many know this. However, many of these people are standing up for themselves and taking action so other trans patients don’t have to suffer through the same ordeal in the future. 

In the end, the choice is always up to you. Some would love to guard their mental health and emotional capacity very carefully. For others, it might be the opposite. It’s really a personal choice and it’ll have to be your decision. Good luck!

For a  better counselling on how to handle such situations, you may look for Oogachaga. This is a community-based, non-profit, professional organisation working with lesbian, gay, bisexual, transgender, questioning and queer (LGBTQ+) individuals, couples and families in Singapore since 1999. 

Oogachaga

Q10: Is it possible for me to get pregnant even though I am on hormone replacement therapy (HRT)?

Dr Guna: HRT generally means taking medications to stimulate certain types of hormones. One of them being testosterone. Testosterone greatly reduces your ability to become pregnant but it does not completely eliminate the risk of pregnancy. Transgender men can become pregnant even while on testosterone. Being said that, if you are sexually active, you do have chances of getting pregnant.  If you think you may have become pregnant, stop your hormone therapy and see a doctor soon as testosterone can endanger the fetus. 

If you do want to have a pregnancy, you’ll have to stop testosterone treatment and wait until your doctor tells you that it’s okay to start trying for a little one.

You should bear in mind that taking testosterone will definitely reduce the chances of one to get pregnant. So, do plan ahead. There are a variety of options from IVF to surrogacy. You also have the option of egg freezing which you can consider prior to starting the hormone therapy. All these options have a high price range, so always plan ahead! 

You can also visit any fertility centres for a better explanation regarding your fertility status. 


Q11: I identify as a transgender man and have not gone for gender-affirming surgery. I find it hard to use male toilets in public and in work for fear of being outed. What can I do?

Dr Guna: This is a very tricky question as many opinions and suggestions are made available out there. To be very honest with you, no one should ever tell what should you do. You first must be comfortable with yourself for you to be comfortable in public. It’s not going to be easy to be out of your comfort zone whilst the public is continuously judging you. 

In Malaysia, back in 2018, Deputy Minister in the Prime Minister’s Department Fuziah Salleh, has urged the transgender community to use the disabled toilets if no unisex toilets are available nearby. This is something to ponder on. Let’s face it, some transgender male, are afraid of using the males toilet as they are worried they might be physically abused, which has happened many times. If they have decided to use the female toilets, the female users might fear for their safety. What much can the transgender community do if they are not given a chance to even breathe properly? 

Another option that I would suggest is, get in touch with your local support group. Discussing matters such as this will help you figure out some better and brilliant ideas as most of them would have pretty much gone through similar things in their life.


Q12: How can I deal with my mental health without the use of medication?

Dr Julian Hong: Top 5 Tips!

  1. Speak to your doctor, get a thorough assessment, sometimes some conditions require medications for treatment and sometimes you can work with your trusted healthcare professional to aim to wean down the medications.
  2. Speak to a counsellor/psychologist.
  3. Get support from your close friends or family, do not be afraid to reach out!
  4. Pick up a new hobby or create an exercise plan – exercise is known to prevent and also help reduce the occurrence of mental health conditions.
  5. Always remember you are not alone and help is but a phone call away!

Q13: Is talking about suicide a bad idea and might be interpreted as an encouragement?

Dr Guna: This question is one of the most famous myths around. People who take their lives don’t want to die, they just want to stop hurting. Most suicidal individuals give ample warning signs or signals of their intentions. Recognizing these warning signs and knowing how to respond when you spot them is the best way of prevention. You can always play a role in suicide prevention by pointing out the alternatives. Showing that you care will help them immensely. If all else fails, getting a doctor or psychologist involved will the best option. 

Suicide warning signs include:

  • Feelings of helplessness, hopelessness, and being trapped. The belief that things will never get better or change
  • Talking about suicide – such as “I wish I hadn’t been born,” “If I see you again…” and “I’d be better off dead.”
  • Seeking access to objects that could be used in a suicide attempt
  • Unusual focus on death, dying, or violence.
  • Feelings of worthlessness, guilt, shame, and self-hatred.
  • Desire to be left alone.
  • Saying goodbye to people as if they won’t be seen again.
  • A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to attempt suicide.
  • Taking unnecessary risks as if they have a “death wish.”

If you are advising a friend that is suicidal, always remember to never say things like: “You have so much to live for,” “Your suicide will hurt your family,” or “Look on the bright side.” Although these are the statements you would want to tell, but there is no point in arguing with them. Always listen to them, and let them speak. Do not interrupt them. Never say suicide is wrong. They know it’s wrong and that’s why they are seeking help. If you think you have no idea how to handle such a situation, help by directing them to a support group. 

Dr Julian Hong: Talking about suicide does not cause suicide. In fact, when it is out in the open, you get to find support and even address the root cause of the suicidal thoughts which more often than not needs a medical evaluation.

Figures from Samaritans of Singapore – In Singapore, Suicide is the leading cause of death for those aged 10-29. There are 2.5 times more deaths from suicide than transport accidents in 2017. 361 lives were lost to suicide in 2017. Males account for more than 66.2% of all suicides in 2017

If you are a loved one who knows of a young person struggling with their mental health, these are some warning signs to look out for (adapted from SOS Singapore)

Talk

  • “My family will be better off without me”
  • “My life is meaningless anyway”
  • “If you don’t love me, I’ll kill myself”

Actions

  • Giving away treasured possessions and saying goodbye
  • Researching suicide methods
  • Writing suicide notes (including emails/diaries/blogs)

Mood

  • Emotional outbursts
    (anger, sadness, irritability, recklessness)
  • Loss of interest
  • Anxiousness or feelings of shame

For immediate help – Call 999 or the Samaritans of Singapore (SOS) at 1800-221-4444 (Both operate 24/7). Stay on the phone with them until someone comes to you. Or, head down to the Accident & Emergency (A&E) Department of the nearest hospital for someone to attend to you.

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Speak To A Professional Counsellor

Speaking to a professional counsellor is helpful as counselling therapy allows the individual to talk about their personal issues and feelings in a confidential, non-judgemental and safe environment.

The counsellor works together with the individual on their issues to help them achieve greater insight into self-understanding, improved relationship with self and others and better control over their life. Counselling provides the individual with different perspectives on their current issues, make sense of past experiences and help them understand how it affects the present, the person they are today.


Oogachaga

Oogachaga is a community-based, non-profit, professional organisation working with lesbian, gay, bisexual, transgender, questioning and queer (LGBTQ+) individuals, couples and families in Singapore since 1999.

They strive forward with a mission to enable lesbian, gay, bisexual, transgender, questioning and queer (LGBTQ+) individuals to make informed decisions that strengthen them and to help them achieve a fulfilling life.

Oogachaga’s team of professional counsellors come from diverse backgrounds, all of whom adopt an LGBTQ-friendly approach that is guided by gay-affirmative practice.

Their services:

  • Hotline, WhatsApp and Email Counselling
  • Professional Counselling
  • Professional Training
  • Corporate Engagement
  • Support Groups

For professional help or counselling, speak to the counsellors at Oogachaga!

For other resources, please see www.congregaytion.com

X.O.X.O



ESWT Treatment For Shoulder Pain

Watch as Dr Edwin Ong, Resident Doctor, Dr Tan & Partners (DTAP clinic) talks about ESWT, Extracorporeal Shock Wave Therapy,  as an effective treatment for shoulder pain.
Shock Wave therapy is a safe, quick and non-invasive treatment using energy from sound waves to activate the self healing properties of the body and accelerate the recovery process.
It does so in a number of ways: 

  1. Firstly, through a process known as cavitation, Shock Wave therapy stimulates the production of fibroblasts and tenocytes. These are the cells responsible for the healing of connective tissues such as tendons. The end result is tissue regeneration.
  2. Secondly, the Shock Waves stimulate microscopic circulation and therefore metabolism within the treatment area, which promotes healing and the breakdown of calcification deposits, also known as spurs.
  3. Lastly, Shock Wave therapy diminishes pain by over-stimulation of the nerves that send pain signals to the brain.

Shoulder Pain

It works for a variety of causes of shoulder pain including rotator cuff tendinitis and frozen shoulder.

Rotator cuff injury

Repetitive overhead arm movements, heavy lifting or other forms of trauma can strain the rotator cuff tendons and lead to tendinitis. Tendinitis can also develop due to chronic degeneration. The pain is felt mainly when raising the arm outwards and upwards from the body. When tendinitis is present, there is an increased risk of a rotator cuff tear occurring. The tear can be partial or complete and results in weakness when trying to raise the arm.

Frozen shoulder

Also known as adhesive capsulitis, this is a condition in which the movement of the shoulder becomes severely restricted due to the growth of abnormal bands of tissue (called adhesions) between joint surfaces and a lack of synovial fluid to lubricate the joint. Frozen shoulder commonly occurs between the ages of 40 to 60 and can occur after a rotator cuff impingement, a tendon tear, or even minor injury. The problem usually resolves on its own, but this can take up to three years.
To conduct the treatment for shoulder pain, we place the treatment probe over the affected area and deliver the required number of shocks. The treatment for shoulder pain is tolerable. Most patients will need about 2 to 3 sessions each 2 weeks apart.
If you are suffering from shoulder pain and requires tratment for shoulder pain, speak to your Doctor and ask if Shock Wave therapy is right for you.
Please call or visit our Siglap Branch or drop us an email at hello@dtapclinic.com for an appointment.