Bed-wetting

Bed wetting is a phenomenon observed at extremes of age and can sometimes be a sign of a deeper problem. Passing urine in a normal bladder hinges upon an intricate network of connections between the central/ peripheral and autonomous nervous systems. This relationship results in the storage of urine in the bladder at low pressure while maintaining a high resistance in the urinary tract to prevent leakage and a corresponding release of this resistance with contraction of the bladder when voiding is needed.

In the pediatric population, up to 85% of 5 year old children are able to control their bladder (continent). Bed wetting in this population occurs when the child does not wake up to pass urine. This can be due to one or a combination of factors such as maturational delay, genetic factors, distrubed sleep, nocturnal polyuria or detrusor overactivity. There are several other features associated with each of these conditions that caregivers can look out for if they have a child suffering from bed wetting.

For example, maturational delay causing bed wetting is associated with language and speech delay as for genetics, if 1 parent had previously suffered from bed wetting as child, his/her child has a 50% chance of also wetting the bed, this increases to 75% if both parents suffered from bed wetting. In the case of nocturnal polyuria and detrusor overactivity, care must be taken to evaluate for more sinister underlying causes such as urinary tract malformations. Most bedwetting in the pediatric population does eventually resolve spontaneously. However, if the child is passing large amounts of urine at night or has frequent urinary tract infections, further investigations and a referral to a pediatric surgeon may be required.

In the older population, bed wetting due to urinary incontinence is generally associated with a loss of function of the mechanisms required to control the flow of urine out of the bladder. Stress incontinence is a common cause and is due to the anatomical structures in the pelvic floor that usually support urethral function becoming inadequate resulting in spontaneous “leakage” of urine.

Risk factors

Risk factors associated stress incontinence include age, spinal cord injury, previous prostate surgery for men and previous vaginal births in women. Unlike the pediatric population, stress incontinence does not go away by itself, therefore, management of the condition is focused on strengthening the pelvic floor through exercise such as Kegels exercises and getting the environment ready for any “leakages” with protective pads for beds and undergarments.

It is important not to dismiss all incontinence issues in the elderly as being from stress incontinence as there are issues such as prostate cancer in men or neurological diseases that can cause symptoms of bed wetting. Therefore a thorough history and examination by your doctor in order to rule out these other causes of incontinence.

Maintaining continence is a complex physiological process that when dysregulated can result in bed wetting. While some causes of bed wetting can resolve spontaneously particularly in the pediatric population, it is important to review every case with your doctor in order to eliminate any possibility of a more sinister cause behind the bed wetting.

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. 

Join our Telegram for medical news and health tips: https://t.me/dtapclinic

*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


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:

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]


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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