Life @ DTAP With Lynn Lai, Head Clinic Supervisor

My typical day as the Head Clinic Supervisor starts with checking the frontline WhatsApp group chat for any MC/urgent leave at 6am, after which I would have to do some roster management and activate covers to ensure that the day’s operations are not affected in all our clinics across Singapore.

Work then officially starts at 8am for me at the Raffles Place branch, one of our clinics that is located just a stone’s throw away from the main office, making it convenient for me to pop by the office whenever meetings are called for. Like all my frontline staff, I’d also have to do hands-on work in the clinic, be it patient registration, chaperoning, preparing and running lab specimen, billing, stock take and ordering, etc., to constantly keep myself engaged with the frontline operations.

This allows me to better understand the patient process and the difficulties faced so that I can communicate better with the frontline and backend teams to resolve those issues raised, hence improving patient experience. Whenever possible, moving around clinics managing assets, checking in with the ground staff and assessing their job skills and knowledge are also some of my tasks.

However, what I found most thrilling and fun were projects involving the opening of new clinics and starting up new services. From discussion of services to be provided, to preparing and procuring all assets, clinic stocks and opening various accounts necessary, as well as setting up the clinic and preparing for the licensing inspection and training new staff, all these have to be carefully thought through, planned and coordinated with the various departments first before execution. To see a clinic rise from nothing till the day it starts operations and play its role in the community is simply exciting.

Our company’s vision is “To be the preferred healthcare provider in Asia” through our mission of  “Providing comprehensive, holistic care in a caring & collaborative environment that bridges primary & secondary healthcare”.

We are always looking to do something new, and we are doing pretty well with the constant spearheading of services across all fields and testing methods with faster turnaround times that are not provided by the primary healthcare sector in Singapore or sometimes even Asia.

All our clinics have a niche interest in an area of medicine, for e.g. if a patient needs a proper ear wax cleaning and the Robertson branch does not have the service, the attending doctor can simply refer the patient to our Raffles branch that provides the Aural Toilet, and if a patient prefers to have a HIV test done anonymously, our Robertson branch can attend to the request with appointments being made relatively quickly. With that, our patients, even those coming from as far as India, would always come back to us because we are able to cater a wide range of quality services. It’s really a joy to see that we have become their preferred and trusted healthcare provider even if it means them having to travel a long way here.

To have so many supporters coming from around Asia, we are also looking to expand, and with that, we’ll always need to hire more staff. To the people who are looking to join the family, there will always be opportunities to learn. In our company, no position stands alone. Aside from learning the ropes of the position that you’ve applied for, you’ll also get the chance to learn the skills of the other roles too. It’s going to be an exciting journey ahead, that I can guarantee.

Life @ DTAP With Xilyn Wong, Marketing Associate

As a marketing associate in DTAP, I connect patients in need of our services to our clinics through the use of social media platforms and online channels. 

I schedule the latest health and medical news or updates on our social media platforms, draft press releases and creative briefs and manage the workflow of new marketing content and collateral and paid marketing campaigns. I come up with exciting and innovative campaigns to better educate the public so they have the power to make informed decisions about their health. I take, create and edit images and videos for DTAP’s marketing initiatives. 

As a society driven by digital technology, digital marketing has a big influence on people’s behaviours, habits and purchases. DTAP prides itself on being the first to explore more efficient and innovative solutions to provide the best care for our patients. As part of the marketing team, I need to stay alert and on top of the trends in this ever-changing and evolving digital marketing scene. I enjoy working in this fast-paced environment where we are constantly moving forward and closer towards our common goal – To be the preferred healthcare provider in Asia. 

I believe that good values build a great company culture. In the marketing team, there is a positive culture of leadership and mentoring. Even as we move at a fast pace, my mentors will take the time to sit and discuss or brainstorm about any issues we face at work. 

My advice for a job seeker who’s thinking about applying with us? To just be yourself. 

What surprises my friends most about my job? A medical group having a Facebook and Instagram account! We post medical articles written by our doctors together with graphics to help our visitors learn more about or understand their conditions better. We post daily health tips to encourage our readers to take charge of their health and commit to a healthier lifestyle. 

U=U: Science, Not Stigma

Sexual transmission of HIV can be stopped. While there are many barriers to ultimately reaching this goal, one of the most exciting and recently validated concepts resulting from large-scale studies is that of U=U, or Undetectable = Untransmissible.

U=U means that people living with HIV (PLHIV) with a suppressed/undetectable viral load have effectively no risk of transmitting the virus to their sexual partners. The landmark trial of HPTN 052, and subsequent PARTNER, and Opposites Attract studies showed that no linked HIV transmissions were detected between thousands of serodiscordant couples (where one partner is known HIV-positive and one is HIV-negative) as long as the viral load remained undetectable throughout the relationship. This was demonstrated for both heterosexual and homosexual couples, and the greater acceptance of the science has potentially vast implications for personal and public health, social and behavioural norms, and even legal matters.

In order for someone living with HIV to reach undetectable viral load, they will need to be on daily antiretroviral therapy (ART) for at least 3-6 months, and must continue on the medication to maintain viral suppression. Treatment as Prevention (TasP) has been strongly advocated for many years now by HIV specialists and other healthcare providers, but the science and messaging has finally caught up. And for PLHIV, growing awareness and acceptance of U=U will hopefully serve to reduce stigma and discrimination, as well as improve compliance to treatment and follow up.

In 2014, UNAIDS launched the 90-90-90 program which aims to diagnose 90% of all HIV-positive individuals, provide antiretroviral therapy to 90% of the people diagnosed and achieve viral suppression for 90% of those treated by 2020. Current estimates from the Ministry of Health are that only 72% of people living with HIV in Singapore know their status, out of which 89% are on treatment, with the proportion of people on treatment who had achieved viral suppression fairly high at 94%. While the latter two figures are encouraging, more needs to be done to improve HIV testing and diagnosis. Local data shows that only 23% of HIV cases are currently being detected via voluntary screening, while 41% of HIV cases are diagnosed in a late stage.

With over 6,000 people in Singapore currently diagnosed as living with HIV, this means that close to 2,500 are estimated to have the infection without knowing their status. With U=U being a reality, getting at-risk individuals tested and on treatment as early as possible is essential in our fight against HIV. For those who already know their HIV-positive status, there is now additional cause to adhere to ART, as doing so will protect potential future partners from potential transmission.

While U=U is great news overall, there are certain caveats we must remember. For U=U to be considered effective, PLHIV must have an undetectable viral load for a duration of at least 6 months on follow up. Furthermore, studies which have shown that over a quarter of HIV-positive gay and bisexual men in a serodiscordant relationship did not have an accurate understanding of their current viral load, with around 20% of men who believed they were undetectable actually having a detectable viral load. As such, regular condom use and testing is still strongly recommended, as is the wider uptake of Pre-Exposure Prophylaxis (PrEP). It’s also important to note that U=U only applies to HIV infection, so precautions should still be taken against other more common sexually transmitted infections (STIs) such as chlamydia, gonorrhea, and syphilis.

U=U is a simple but important message based on a foundation of scientific evidence. The campaign makes a strong case for adherence to treatment and follow up, and allows PLHIV and the community to understand that they can live long, healthy lives, have children, and enjoy relationships without having to fear passing the infection to others. It will hopefully bring us a few steps closer to achieving the UNAIDS’ 90-90-90 target and help to reduce the stigma still faced by many living with HIV today.


Dr. Jonathan Ti is a GP at DTAP @ Robertson clinic. He has a special interest in sexual health and HIV, and is a co-author of the Community Blueprint to End HIV-transmission and AIDS in Singapore by 2030, and part of the National PrEP Taskforce.

Life @ DTAP with Dr Grace Huang

A day in clinic typically begins at 8 or 9am. I see a diverse variety of patients at our Robertson Walk clinic, where in addition to regular GP services, we provide Men’s health, Women’s health, Sexual health services and Anonymous HIV Testing

Besides consulting for the usual common ailments, many patients come for sexual health screening/STD testing and anonymous HIV testing. I also see patients for men’s health issues like erectile dysfunction or low testosterone, as well as women’s health issues like menstrual abnormalities or contraceptive counselling. On a daily basis, I see patients for potentially sensitive health issues which many feel awkward or are hesitant to talk about and see a doctor for.

One of the most fulfilling aspects of my job is being able to reassure patients, normalise their concerns and provide them with a safe space to open up and approach these issues and get treatment.

In between seeing patients, I also answer questions pertaining to various health topics on our clinic’s online forum and write health-related blog articles to contribute to the clinic blog, both of which are part of our initiatives to increase awareness about men’s health, women’s health and sexual health issues which still tend to be under-recognised in Singapore.

With our vision of being patients’ preferred healthcare provider in Asia, DTAP strives to provide comprehensive, holistic care in a caring and collaborative environment that bridges primary and secondary healthcare. It is exciting to be part of a team that seeks to stay at the forefront of medical developments. The medical team at DTAP continually strives to improve the services we can offer our patients, from rapid STD testing, to the latest treatments for various men’s and women’s health conditions. 

If the above interests you and you are an open-minded individual with the passion to serve and be an advocate for men’s health, women’s health and sexual health, we do welcome you to find out more about being part of our dynamic team.

Dr Grace has a keen interest in Women’s health and wellness medicine. She believes communication is the key to empowering patients through facilitating a better understanding of their own health and medical issues and is always more than glad to address and allay her patients’ concerns.

Dr. Grace Huang is currently practising at our Robertson Branch

Staying at home but still having a fever?

What Tests Can I Do For My Fever?

A DTAP Stay Home Series Part 3

We touched on the COVID19 situation and the active steps one can take to minimize and prevent infection risks on our past two articles.

Furthermore in our last article we also delved deeper into some of the situations one may face whilst at home, running out of needed medications or even repeated sneezing and scaring away every around. 

But wait, I don’t need further medications, I don’t need to get my sneezing checked but I have this fever which I am worried about. What should I do doc? 

Fever is one of the classic symptoms of one’s body responding to an infection. It is a signal that the immune system is reacting to a foreign invader. These foreign invaders can be anything from the seasonal Influenza Viruses, upper respiratory tract bacterial infections, Dengue fever, the dreaded COVID19 virus or even worse, the most feared HIV virus.

Before we get carried away, let’s explore the facts behind each of these concerns and hopefully we can provide you a handle on how to get these concerns further addressed. From the recapitulation of COVID19, to upper respiratory tract infections and last but not least prolonged fever from possible HIV. 

COVID 19 

Let’s start with a short recap of COVID 19, from the WHO-China joint COVID 19 mission, it was studied that those who are at great risk of severe disease and death include those above 60, those with underlying chronic conditions. And of course as previously discussed, the risks of COVID19 include travel to at risk countries including China, especially Wuhan and Hubei provinces, South Korea, Iran and Northern Italy as of March 2020.

Practically the same advice shared previously of personal hygiene and avoidance of crowded places and even ordering in the medications you need delivered to your home would still stand.

Also read: STAYING AT HOME AND ORDERING IN (A PIZZA) YOUR MEDICATIONS

Upper Respiratory Tract Infections 

Secondly if it were an upper respiratory tract infection caused by other viruses or bacteria, it would be good to have your doctor assess you especially if there are symptoms of fever, cough, sore throat or runny nose. In the current climate, these symptoms would warrant one to get extended rest at home with a doctor’s note (medical certificate) for at least 5 days. When we get an infection in the upper respiratory tract – nasal passages or throat, it is usually caused by either a bacteria or virus.

SYMPTOMS OF A COLD

A cold is a viral infection of our respiratory tract, and there are more than 200 types of viruses which can cause this. It is also a gradual Onset.

SYMPTOMS OF FLU

Sudden onset. Contagious after coming into contact with droplets. The FLU virus can cause a lung infection called pneumonia.

So doc, i’ve heard alot about antibiotics as well, can I just get them prescribed to me for my fever?

Antibiotics however only work against bacteria infections.

Instead of taking too many unnecessary medications, you can get tested to see if you have the flu or a bacterial infection.

Point of care testing is convenient, accurate and gives you an answer in 15mins. Furthermore for those at risk or diagnosed with Influenza (above 60 or have chronic diseases) – antivirals can be prescribed. These include XOFLUZA (a one off treatment) or TAMIFLU and lastly if it is likely a cold, vitamin C and zinc are shown to aid in recovery.

And last but not least, especially for those at risk, please do not forget your twice yearly flu vaccinations (Northern and Southern hemisphere strains respectively) and 2 different jabs for a lifetime protection against Pneumonia.


Fever from HIV

But that being said, what happens then if one’s fever is still persistent and there were concerns from a recent sexual exposure? Especially if it was a causal partner and or someone you met overseas?

The CDC page tells us that HIV is spread when anal or vaginal sex, without a condom occurs with someone who has HIV. The other way HIV is spread is through the sharing of needles or syringes, or even equipment used to prepare drugs for injection with someone who has HIV. Some studies have shown that HIV can survive in a used needle for up to 42 days depending on environmental factors. Temperature etc.

In rarer cases, HIV can be spread through oral sex.

The main transmission medium of HIV however is through fluids and these are predominantly blood, vaginal fluid, semen and even saliva. Here are some statistics from medical studies that have been done. And as you can see, needle sharing, needle use has the highest risk followed by anal intercourse.

Ultimately all these statistics mean nothing, if the concern is still there and there is an exposure, the best thing to do for an ease of mind would be to speak to your doctors and decide whether the Rapid HIV test is something necessary for you.

In summary, there are many causes of fever. In the current climate, fever persisting for more than 5 days can be worrisome. And common things being common, in the absence of a travel history, it is most likely due to an upper respiratory tract infection arising from a cold, influenza or even bacteria. The likelihood of COVID19 is low, but one must also keep a suspicion for infections such as dengue and in the rarest of events HIV. Seeing a doctor early would help you get some point of care tests done with results almost immediately to guide your clinical care and most importantly give you a peace of mind.

Take care, stay safe.


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  • References
  • Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
  • Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
  • Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
  • Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
  • Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006


Oral Gonorrhea / Throat Gonorrhea – What do you need to know

What is Gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) that is caused by a bacterium known as Neisseria gonorrhoeae. It thrives in warm and moist areas like the genital tracts, mouth and anus.

Gonorrhoea is a common STD in Singapore. MOH reports an incidence rate of 33.4 per 100,000 population in 2016.

What are the symptoms of Gonorrhea infection?

In men, up to 60% of patients with urogenital Gonorrhea might not have any symptoms (asymptomatic). Symptoms of urogenital Gonorrhea in male may include:

  • Discomfort, itchy along the urinary tract
  • Painful urination
  • Penile discharge
  • Testicular Pain (Epididymitis)

In women, up to 70% of patients with urogenital Gonorrhea might not have any symptoms (asymptomatic).

Symptoms of urogenital gonorrhea in female may include:

  • Vaginal itch, discharge or bleeding
  • Painful urination
  • Abdominal/Pelvic Pain
  • Pain during sexual intercourse

What are the complications of Gonorrhea infection?

Untreated Gonorrhea infections for females can lead to Pelvic Inflammatory Disease with abdominal pain and abnormal vaginal bleeding. It can cause infertility if the sexual organs are scarred by the infection. Gonorrhea can also lead to multiple complications during pregnancy for the infected mother and can even be passed on to her baby.

For men, untreated Gonorrhea infection can result in scarring of the urinary tract and urinary obstruction. Testicular/Epididymal infection can also cause infertility if left untreated.

What is Oral/Throat Gonorrhea and how is it transmitted?

Oral/Throat Gonorrhea is the infection of the pharynx by the same bacterium and it is commonly transmitted through oral sex. It is an oral STD.

How common is Oral/Throat Gonorrhea and what are the symptoms?

A recent study in 2016 has estimated the prevalence of throat Gonorrhea infection to be as high as 30% for straight woman, 15.5% for straight men and 17% for homosexual men.

The most common presentation of throat Gonorrhea is a sore throat. Some patients may have swollen neck lymph nodes. However, the majority of patients do not present with any symptoms at all.

Oral ulcers are not a presentation of throat Gonorrhea. If oral/peri-oral ulcers are present, other STDs such as Herpes and Syphilis need to be considered.

I do not practice oral sex. Why should I be screened for Throat Gonorrhea?

Throat Gonorrhea transmission can occur even in the absence of reported oral sex.

Even though the majority of throat gonorrhea are asymptomatic, in 0.5% to 3% of infected patients the bacterium can penetrate the mucosae and enter the bloodstream, leading to a widespread infection. This blood-borne invasion (Disseminated Gonococcal Infection) can lead to to a variety of dangerous conditions including:

  • Multiple joint inflammation
  • Tendon Sheath inflammation
  • Skin dermatitis
  • Joint Infections

Hence, even in the absence of oral sex or symptoms, patients with new or multiple sex partners or a sex partner with a diagnosed STD should go for STD screening.

How is Gonorrhea screening performed?

Gonorrhea Testing. NAAT (Nucleic Acid Amplification Test) is routinely performed to detect N.gonorrhoeae. The doctor will swab the suspected area of infection (throat/anus/vagina) or request a urine sample for diagnosis of gonorrhea infection. It has been shown to be superior to traditional methods of culturing the bacteria with far more rapid results.

How is Gonorrhea treated and how can I prevent Gonorrhea infection?

Gonorrhea is treated with a single antibiotic injection and a course of oral antibiotics.

Gonorrhea transmission can be prevented by observing safe sexual practices. This includes the use of barrier protections like condoms or dental dams, cutting down the number of sexual partners as well as ensuring regular STD screening for both the patient and their sexual partners.

Next read: WHAT IS ANTIBIOTIC RESISTANT GONORRHEA OR SUPER GONORRHEA?


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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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International Women’s Day 2020: “Each for Equal – An Equal World is an Enabled World”

International Women’s Day (IWD) which is on 8th March is a global celebration of women’s achievements. On IWD, we commemorate the political, social and economic accomplishments of women and continue to strive to raise awareness about issues relating to women’s empowerment. It is both a time for celebration as well as to push for progress and change. 

This year’s IWD theme is “Each for Equal. An equal world is an enabled world.” 

IWD 2020 is about building a gender equal world and pushing for gender equality across various aspects of society – in the government, workplace, boardroom, media etc, and recognising that gender equality is essential for economic success and for communities to thrive. Through our individual choices and actions, we can create change and move towards a gender equal society. 

At DTAP, we are firm advocates of women’s rights and empowerment. As an equal opportunity employer, DTAP believes in gender equality in the workplace and provides all employees, male and female alike, with equal opportunities to grow and excel. 

As a doctor working at DTAP, I am personally proud and glad to have had the privilege of working in a supportive and nurturing work environment, where female employees can excel in their careers, whilst continuing to fulfil their equally important family roles as mothers, wives and daughters. DTAP also strives to provide a safe and friendly workplace for women, where we know that our interests are protected and are able to focus on giving our utmost best in providing patient care. 

DTAP’s advocacy of women’s rights goes beyond the workplace. We have always believed in and will continue to push for equality in healthcare provision through our women’s health service. At DTAP, we support women’s right to choice through the provision of professional medical support for family planning. We also seek to enable women to take charge of their health by raising awareness and educating patients about female health issues. DTAP aims to provide a women’s health service where our female patients can feel safe, supported and empowered to take charge of their health. 

As we celebrate International Women’s Day 2020, DTAP looks forward to continuing to empower women and pushing for greater awareness about women’s health issues through our women’s health service. We look forward to working together with you to forge a gender equal world.


Dr Grace Huang

MBBS (Singapore), MRCP (UK), Cert. Men’s Health, Academy for Men’s Health (Singapore)

Dr Grace has a keen interest in women’s health and has a broad range of experience from working in subspecialty departments across various tertiary hospitals, ranging from Neurology, Rheumatology, Endocrinology, Cardiology, Geriatrics Medicine to Emergency Medicine, amongst many others. She believes that communication is the key to empowering patients through facilitating a better understanding of their own health and medical issues and is always more than glad to address and allay her patients’ concerns.

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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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Low Testosterone & Low Libido

Having low levels of testosterone or Testosterone Deficiency Syndrome is common and can occur in about 1 in every 200 men under the age of 60 and 1 in 10 men over the age of 60. Commonly the symptoms may be subtle and thus can be easily overlooked as “Oh, it’s just part of aging.”

As men age, levels of testosterone drop by about 1-1.5% each year after age of 30 but not all males experience the drop in levels. It is known from studies that the more overweight you are, the faster the decline in the levels of testosterone. In addition, it has been shown in studies that low testosterone levels are associated with cardiovascular risks like coronary arterial disease and metabolic syndrome including type 2 diabetes.


Effects of having low testosterone:

  • Regression of some features of male sexual characteristics
  • Low mood or irritability
  • Poor concentration
  • Low energy, feeling tired
  • Hot flushes and sweats
  • Decreased libido
  • Reduced beard or body hair growth
  • Low semen volume
  • Gynecomastia
  • Reduced muscle strength
  • Fracture (osteoporosis)
  • Erectile dysfunction

It has been shown in some studies that supplementation of testosterone in those with low testosterone levels can increase their libido. 


Causes of low testosterone

Generally the causes of low testosterone can be classified into testicular (Primary) and Hypothalomo-pituitary (Secondary) causes.

Primary

  • Age-Related Testosterone Deficiency
  • Chromosomal: Klinefelter syndrome – Congenital;
  • Undescended testes
  • Surgery: bilateral orchiectomy
  • Trauma
  • Infection: mumps orchitis
  • Radiotherapy/chemotherapy/drugs (spironolactone, ketoconazole)

Secondary

  • Idiopathic hypogonadotropic hypogonadism
  • Pituitary microadenoma (<1 cm) or macroadenoma (>1 cm)
    • Functional or non-functional: in men typically macroprolactinoma
  • Other causes of hypothalamic pituitary damage: surgery, radiotherapy, trauma, infiltrative disease such as haemochromatosis

Treatment options

Lifestyle modifications – diet and exercise

It has been shown in studies that resistance weight training can increase levels of testosterone. Reducing body fat has also been shown to increase levels of testosterone. There are some studies show high-intensity interval training (HIIT) is more effective in reducing body fat than steady-state cardio.

Medications: Testosterone Replacement

There are several formulations available for replacing testosterone. The choice of which formulation to use is largely patient preference.

  1. Slow releasing formulation injections – generally given every 10-12 weeks as an intramuscular injection. Some people prefer that as they only need to get 1 injection once every 3 months or so rather than to take medication daily.
  2. Short acting formulation injections – these injections are given once every 1 to 3 weeks. Most of the time, patients learn to inject themselves.
  3. Gels or capsules – generally capsules are taken twice daily and gels are applied once daily. Gels are preferred by some as it is only used once daily and also in some cases, those who used the injectable form experience swings in their symptoms especially when it approaches the time for the next dose. But as the gel is applied daily, the levels of testosterone remain relatively stable and thus avoid the swing. However, gels may not be suitable for a person with an active lifestyle as the testosterone in the gel may not have enough time to be absorbed before they commence their exercise or when they shower after the exercise.

Next read: 7 TESTOSTERONE BOOSTING FOODS THAT YOU CAN FIND IN THE SUPERMARKET

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