Sudden Cardiac Arrest and Sudden Cardiac Death - Are They The Same?

What is Sudden Cardiac Death?

Sudden Cardiac Death refers to sudden, unexpected death caused by sudden cardiac arrest. It is estimated to be responsible for all deaths caused by heart disease.

Sudden Cardiac Arrest occurs when the electrical system of the heart malfunctions and becomes highly irregular. This in turn causes the heart to beat dangerously fast. Subsequently, ventricular fibrillation might occur with the end result being blood not being delivered to the body. Reduced blood flow to the brain will result in unconsciousness and emergency treatment is required.

Heart attacks, as the term is used in a traditional sense, refers to the situation where heart tissue fails to receive sufficient nutrients and blood flow due to blockages to one or more of the arteries supplying the heart, resulting in eventual cardiac tissue damage. With sufficient cardiac tissue damage, the electrical system of the heart will malfunction and that eventually leads to cardiac arrest.

Cardiopulmonary Resuscitation (CPR) and electrical defibrillation remain the mainstay of Emergency treatments for cardiac arrests.

CPR is a manual technique using repetitive chest compressions and manual assisted breathing to maintain sufficient oxygen and blood flow to the brain until a normal heart rhythm is restored. Defibrillation refers to the deliverance of an electrical current as an electric shock to the heart in an effort to reset the electrical rhythms therein and restore normal heart rhythm.

What Are the Symptoms of Sudden Cardiac Arrest?

Symptoms vary and can include:

• A racing heart beat
• Unexplained dizziness and giddiness
• Chest pain

Sometimes, cardiac arrest can occur without prior symptoms.

What Causes Sudden Cardiac Death?

Sudden Cardiac Death are caused by abnormal heart rhythms called arrhythmias, the most life threatening of which is ventricular fibrillation - an erratic and disorganized firing of impulses within the ventricles of the heart. If left untreated, ventricular fibrillation can cause brain death within minutes.

What Are the Risk Factors of Sudden Cardiac Arrest?

Risk factors include:

• History of previous cardiac events, especially if significant cardiac tissue damage has occurred.
• 6 months after an initial heart attack
• Coronary Artery disease
• Smoking
• Hypertension
• High cholesterol levels
• Family history of heart disease
• A cardiac Ejection fraction of <40%
• Congenital heart defects
• Recurrent syncope and fainting
• Heart Failure

• Hypertrophic cardiomyopathy - a condition where heart muscle is thickened without proper electrical connectivity
• Biochemical abnormalities, such as fluctuations in potassium and magnesium levels from use of other drugs (eg diuretics like Frusemide)
• Obesity
• Diabetes Type II
• Recreational drug use

Can Sudden Cardiac Death Be Prevented?

The following steps are recommended:

• Speak with your Doctor if you have any known risk factors and have a full medical assessment.
• Perform the necessary diagnostic tests such as a simple bedside electrocardiogram (ECG) or transthoracic echocardiogram.
• Determine your ejection fraction.

Ejection Fraction (EF): EF is a measurement of the percentage (fraction) of blood pumped (ejected) out of the heart with each beat.

It is usually measured during a transthoracic ultrasound echocardiogram and usually ranges from 55% - 75%.

An EF <40% predisposes a patient to sudden cardiac arrests.

• Lifestyle changes. These include quitting smoking, losing weight, exercising regularly, low fat diets etc.
• Control diabetes, hypertension and cholesterol levels.
• Medications as prescribed by your doctor.
• In certain situations where abnormal cardiac rhythms occur sporadically, and implantable cardioverter-defibrillator (ICD) can be inserted.

An ICD is a small machine similar to a pacemaker designed to correct arrhythmias once detected. It constantly monitors the heart rhythm and detects abnormal cardiac rhythms and records them. When it detects abnormal cardiac rhythms, it delivers a small electrical shock to cardiac tissue to reset the heart back to its normal rhythm. These events are then recorded and can be viewed by the attending doctors at a later date for further analysis and adjustment of the ICD.

ICDs are used for survivors of sudden cardiac arrests and for patients who require constant monitoring of their hearts due to existing conditions causing abnormal heart rhythms.

• Interventional Surgery such as angioplasty for patients with coronary artery disease or bypass surgery can be performed to reduce the risk of SCDs. For patients with congenital abnormalities or cardiomyopathies, surgical intervention will likely be needed to correct any underlying abnormal cardiac rhythms.
• Other non-invasive procedures like cardioversion electrically or catheter ablation techniques can also be used.
• Socially, speaking with family members who are at risk of SCD is the first step to preventing the occurrence of SCDs.

Can Sudden Cardiac Arrest Be Treated?

Cardiac arrests require immediate action. If CPR and defibrillation is performed adequately during the initial few minutes of onset, survival is estimated to be as high as 90%.

What Should I Do if I Witness Sudden Cardiac Arrest?

• Call the emergency helpline and activate an ambulance immediately.
• Perform CPR if you are trained.
• Use a defibrillator if available and you are trained.
• Post CPR, have patient transferred to hospital at the earliest possible time.

Sudden Cardiac Death and Athletes

Do be aware that cardiac death can also occur in athletes. The usual scenario being that of runners participating in social marathons and collapsing in the process.

Hence, do not take the risk. See your doctor for the relevant investigations.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

x

An Understanding of Hiatal Hernia

The term “Hernia” draws origin from the Greek latin word which means “tear” or “rupture”. Anatomically it refers to any abnormal protrusion of the abdominal contents.

A “Hiatal Hernia” therefore refers to the abnormal protrusion of the Gastrointestinal Tract through the opening (hiatus) within the diaphragm.

There are two main types of hiatal hernias: sliding hiatal hernias, and paraesophageal hiatal hernias.

Sliding hiatal hernias form when the stomach and the adjoining oesophagus slide up into the chest cavity through the diaphragm. It is more common.

Paraoesophgeal hernias are less common and it occurs when a portion of the stomach squeezes past the diaphragm and is lodged and strangulated in place beside the oesophagus. Such hernias can be asymptomatic but dangerous because the portion of stomach that is strangulated above the diaphragm will have a compromised blood supply.

In most cases, hiatal hernias are asymptomatic but sometimes patients might experience heartburn or reflux. While the two conditions appear to be linked, they do not independently cause the development of the other.

In some cases of heartburn, patients might experience chest pain instead and this can be confused with chest pain caused by cardiac issues.


Causes

Often, the cause remains unknown. However, any condition predisposing to an increased pressure within the abdomen such as pregnancy, obesity, coughing or straining during bowel movements, and/or congenital situations such as a larger hiatal opening will predispose a person to developing one.


Population at risk for developing Hiatal Hernias

There’s a predisposition for women, overweight individuals, and patients above fifty years of age to develop this condition.


Diagnosis

A hiatal hernia can be diagnosed with a specialized X-ray called a barium swallow that allows a doctor to see the esophagus or with endoscopy. The procedure involves the patient swallowing a radio-opaque liquid and having X-Rays of the chest and abdomen taken while in the erect posture. The radio-opaque liquid will outline the stomach lining and oesophagus, thereby demonstrating the presence/absence of the condition.


Treatment

If asymptomatic, no treatments are necessary. However, should the stomach become strangulated and there is a risk of vascular compromise to the stomach, surgery is usually needed to rectify the problem.

Other associated symptoms such as reflux disease, heartburn and chest discomfort should be treated accordingly.


When is Hiatal Hernia surgery necessary?

Surgery is indicated when the hernia becomes strangulated and the blood supply becomes compromised.

Surgical intervention for hiatal hernias is often performed laparoscopically (ie keyhole surgery) and is a day procedure. A camera and surgical tools are inserted via keyhole incisions into the abdomen and the surgeon will manipulate the surgical tools to reduce the hernia and possibly tighten the diaphragmatic hiatus. The procedure is usually done as a day procedure, involves smaller incisions, and has less pain and scarring compared to open surgery.

Most patients will be able to ambulate and walk around the next day. There are no dietary restrictions post surgery and patients resume regular activities after a week or so. Complete recovery will take up to a month and the patient should avoid hard labour and heavy lifting.


When Should I Call the Doctor About a Hiatal Hernia?

Speak with your doctor if you are symptomatic. It is difficult to diagnose and symptoms include chest pain, recurrent nausea and vomiting, poor bowel movements and non-specific symptoms like a funny sensation in the middle of the chest.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What Is Dementia?

What is dementia?

Dementia is a condition that afflicts the brain. The mental abilities of dementia patients decline as the illness causes brain cells to die at a faster rate than normal. These patients experience memory loss, deteriorating mental abilities, and personality changes.

There are two main types of dementia: Alzheimer’s disease and multi-infarct dementia. Alzheimer patients experience a gradual decline in their mental abilities as the illness progresses. There is no known medical cure for the disease. On the other hand, multi-infarct dementia may result from a series of strokes in the brain.

Who is at risk?

Dementia is an illness that affects elderly people In Singapore, approximately 6.2% of elderly people aged 65 years and above have dementia.

What are the Symptoms?

The disease generally progresses through three stages. Specific symptoms are associated with each stage, namely:

• Stage 1: Mild Dementia
• Forgetfulness
• Repeating himself/herself
• Odd behaviour
• Social Withdrawal
• Agitation
• Lethargy
• Difficulty with organisation of daily activities

• Stage 2: Moderate Dementia
• Obvious memory lapse
• Odd behaviour (e.g. Neglecting personal hygiene, getting lost, forgetting names of familiar people and objects)

• Stage 3: Severe Dementia
• Difficulty with performing familiar tasks (e.g. Personal care)
• Impaired speech
• Inability to comprehend conversation
• Unable to recognise family members
• Disorientation of place and time
• Poor judgement 
• Difficulty with abstract thinking
• Personality change

What should I do?

Consult your doctor If you or your relative manifest memory loss.

It is important to recognise that caring for dementia patients is emotionally and physically challenging. Your doctor can assist you in establishing a supportive environment by putting you in touch with allied healthcare professionals who can help.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

What Is Alzheimer’s Disease

What is Alzheimer’s Disease?

Alzheimer’s is a progressive disease that destroys your mental functions. It causes the degeneration of brain cells, and leads to a steady decline in memory and mental function. Alzheimer’s disease is the most common cause of dementia.

What are the Symptoms?

The disease progresses at a different rate from one patient to another.

At the early onset of Alzheimer’s, patients notice increasing forgetfulness and mild confusion. You may find yourself having difficulty remembering things and/or organising your thoughts. You may not realise that something has changed even when there are noticeable changes in your family members, friends, and colleagues.

Advanced patients manifest increasing memory lost, including the loss of recent memory. They may undergo a change in personality and behaviour. These patients may also experience depression, delusions, and a loss of inhibitions. Important mental functions like the ability to read, dance, sing, enjoy music, and tell stories are usually lost at an advanced stage of the disease.

What Causes Alzheimer’s Disease?

The causes of Alzheimer’s disease are not yet understood. It may be caused by genetic changes. It may also be caused by a combination of factors, such as genetic makeup, lifestyle, and environmental factors.

Risk factors may include:

• Age, particularly after age 65
• Family History
• Down Syndrome
• Gender, with women at a higher risk
• Cognitive Impairment
• Head trauma
• Lifestyle choices, particularly obesity, smoking, high blood pressure, Type 2 diabetes, low fibre diet

When do I seek Medical Advice?

Based on the information you provide and test results, your doctor will make an informed judgement about whether you have Alzheimer’s disease. A definitive test for Alzheimer’s disease does not exist.

Doctors rely on various tests in the diagnosis of Alzheimer’s disease, including:

• Physical exam to check neurological health. He may test your reflexes, muscle tone, sense of hearing and sight, coordination, and balance.
• Blood tests
• Neuropsychological tests to assess memory and thinking skills
• Brain imaging

What are the Treatment Options?

Although Alzheimer’s disease is irreversible, there is a range of treatment options available that may help the patient adjust to living with the disease.

• Medication to help manage cognitive changes and behavioural symptoms
• Creating a supportive environment that strengthens routine habits
• Exercise
• Nutrition
• Supplements like the Omega-3 fatty acids, ginkgo, and Vitamin E

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Home Care for Bed Bound Patients

To witness a family member or loved one bed bound is an emotionally draining experience. To be unable to do much to help their suffering and to provide the best of care makes the feeling worse. This article strives to offer some solutions and understanding for the layperson caring for bed bound patients.

Bed bound patients face a variety of issues, from manpower support, mental illnesses like depression, basic cleanliness and hygiene, bed sores, to chronic diseases like hypertension. Of this list, manpower issues usually rank highest.

Most bed bound patients in Singapore stay at home and are looked after by family members. Over time, this can take an exhausting toll on family members and an understanding of home-based care will be of immense aid to family as well as patient.


Understand the Cause for becoming bed bound

A patient can become bed bound for a multitude of reasons. A fracture of the spine, paralysis and coma post trauma, surgery, head injury, end of life causes, old age and the commonly encountered cerebrovascular accident are all situations which can cause patients to become bed bound. Understanding the causes can help prevent the problem from happening in the first place, while adjusting the care for such patients will improve the quality of life for these patients.

Common problems

Nursing Issues

• Ulcers or bedsores: Pressure ulcers and bed sores, if left unchecked, can cause serious complications over time.
• Basic Hygiene and Cleanliness. Basic cleaning of patients, regular change of diapers, monitoring of bowel movements, are all important but physically very demanding.

Medical Issues

• Muscle atropy. After prolonged periods of inactivity, muscles eventually lose their strength and muscle weakness sets in, making it a vicious cycle. The bed bound patient becomes more bound to the bed with the passing of each day.
• Frequent Infections: Due to the sitting / lying posture, the lungs cannot fully inflate with each breath and hence respiratory infections are common. Due to the long term use of diapers, the urinary tract becomes easily infected.
• Mental Illnesses. It is common for patients who are bed bound to become depressed. Love, care and attention, frequent companionship and empathy will go a long way in treatment of these patients.
• Insomnia. It is common for bed bound patients to have poor sleep. 

General Issues due to lack of activity:

• Bed bound patients usually report a loss of appetite, loss of interest in all things big and small, and a general decline amongst all functions. .

Challenges for the Caregivers

Caring for a bed bound patient is challenging. With the passage of time, the daily grind of caring for the bed bound patient will take its toll on the caregiver.

Enforcing personal hygiene, administering the correct medications, serving proper foods, ensuring regular exercise, and providing companionship for bed bound patients are but the basic fundamentals required.

To go beyond the above, turning the bed bound patient every 2-4 hours to prevent bed sores round the clock, suctioning and cleaning the airway, feeding through tubes, dressing open skin sores and wounds, care for urinary catheters are all farther challenges faced by caregivers faced with patient who have complicated medical problems.

It is hence normal for a caregiver to feel overwhelmed at some stage, resulting in high levels of caregiver stress. Thus, the provision of manpower, simply an extra pair of hands, will make a big difference when it comes to home care.


Risks faced by bed bound patients

Common risks include:

• Development of bed or pressure sores which worsen if left untreated.
• Formation of blood clots in the veins of the lower limbs. If these clots break off and get lodged in the heart, lungs or brain, it can cause farther complications. 
• Muscle Atropy
• Frequent infections and complications from the general lack of activity.

As an aside, do note that bed sores rank highest where nursing care is deficient. It usually begins with a mild redness to the skin but if left unchecked, the bedsores will infiltrate deeper into the skin layers and can erode the skin all the way down to bone if left unchecked.


Do's and Don'ts

• Perform daily skin inspection to check for reddening of the skin, especially in bony areas like knees, hips, shoulders, ears, tailbone, and buttocks.
• If a bed sore is identified, cushion it immediately and seek medical help if the skin is broken.
• Keep skin clean and dry. Clean the skin with mild soap and water; pat dry.
• Moist the skin: Use body lotion to keep the skin lubricated. Use powder to dry the folds of the skins, such as armpits and under the breast.
• Bedding and linen should be changed daily. In case of bed wetting, change the wet sheets immediately.
• Keep the patient hydrated.
• Have a balanced diet: A healthy and nutritious diet is very important to boost the patient’s immunity. Keep a diary to record all meals taken.
• Exercise the patient: To prevent muscle weakness, exercises should be done, keeping in perspective the patient’s condition. If the patient can walk a little, help him/her walk around as per convenience.
• Massage: Deep massages can help prevent blood circulation-related complications. Light massages are ideal for painful muscles and prevention of bedsores.
• Positioning: Reposition the patient every 2 hours. Never drag the patient; always lift.
• Keep limbs elevated: Both hands and legs should be kept a little elevated to prevent swelling and help blood circulation.

What to do in case of bedsores?

Unless experienced or trained, the first contact of bedsores should be handled by medical professionals as far as possible.

However, for first response, the best treatment of bed sores is to leave it open to air and to alleviate any pressure on the bed sore as much as possible.

With enough experience with the type of dressings to be used, the caregiver should learn from each episode and become familiar with the available treatments and methods used to clean bed sores.

The best method of treatment bed sores is prevention. So constant vigilance is the key.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Alzheimer’s and Dementia - Are They The Same?

Alzheimer’s Disease and Dementia are two different diagnoses. They are not the same. While both have often been confused with one another, they are two distinct entities.

What is Dementia?

“Dementia” refers to a group of symptoms inclusive of impaired thinking, memory loss, and is often associated with cognitive decline with aging.

While Alzheimer’s Disease is one of the causes for Dementia, “Dementia” can also be caused by other problems like Parkinson’s, Huntington’s Disease of Creutzfeldt - Jakob Disease (CJD).

Depending on the cause, Dementia can be reversible.

What is Alzheimer’s Disease?

Alzheimer’s Disease is a common cause of dementia totalling up to 70% of cases. Symptoms of which include impaired thought, speech and confusion. While these symptoms are common to all dementia patients, Alzheimer’s Disease is a disease that results in brain tissue destruction. This can be confirmed by extensive and sequential brain imaging.

Alzheimer’s is irreversible. It is a form of disease that is degenerative and incurable.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.

Adult Nocturnal Enuresis (Adult Night Urination)

Adult Nocturnal Enuresis, literally translated to involuntary voiding of urine at night by adults, is a subject that is not often discussed or brought up voluntarily by patients.

It is, however, a very real medical problem and should be looked into.

Causes

Adult Nocturnal Enuresis can be caused by a variety of factors.

Family history appears to play a significant role with Adult Nocturnal Enuresis. Patients with one or both parents who suffer from the problem have a significant chance of developing the problems themselves.

A deficiency in Anti-Diuretic Hormone (ADH) production can also cause adult nocturnal enuresis. ADH is a hormone produced by a portion of the brain called the hypothalamus and acts to decrease the amount of urine produced, A deficiency in ADH will hence result in an increase in urine production and trigger urination.

Diabetes Mellitus can also cause an increase in urine production leading to nocturnal polyuria or urination in the night.

Patients with anatomically small bladders with smaller functional bladder capacities also suffer Adult Nocturnal Enuresis simply because the functional bladder capacity is smaller.

In other cases, overactive bladder muscles can trigger Adult Nocturnal Enuresis. This can be secondary to use of bladder irritants like alcohol and caffeine, or use of certain medications like hypnotics and psychotropic drugs like Selective Serotonin Reuptake Inhibitors.

Causes of Secondary Nocturnal Enuresis include any other medical issues that irritate the genitourinary system. Eg Urinary Tract Infections, Prostate enlargement / cancer etc


Seeing your Doctor

Prior to initiating treatment, your attending doctor will want to determine the cause of your nocturnal enuresis. Hence, it is important to document certain important issues:

• Timing of normal voiding during the day
• Timing of accidents
• Drinking patterns
• Nature of beverage consumed
• Nature of urinary stream (do you dribble?)
• Any existing medical problems
• Any accompanying symptoms (eg fevers etc)

Your attending doctor will then take a full clinical history and go through the list of medications you are on to identify any drugs that might cause nocturnal enuresis as a side effect. Following which, a full physical examination will be performed and your doctor might request for a urine sample for lab analysis. Thereafter, your doctor might order specific investigations like uroflowometry or post void residual urine measurements via ultrasound to evaluate bladder function.


Management

Many simple changes in the bedroom setting can help alleviate adult nocturnal enuresis. Use of waterproof mattress covers or sheet protectors makes nursing care easier. Wearing adult diapers or absorbent briefs help prevent leakage of urine. Skin care products like barrier creams help prevent skin irritation due to prolonged exposure to urine. Behavioural modifications like limiting fluid intake during late afternoon or in the evenings will reduce the amount of urine produced at night.

In situations where nocturnal enuresis are a symptom of an underlying condition, then treatment of the underlying condition remains paramount in managing nocturnal enuresis.


Surgical Treatment

Surgical treatment for adult nocturnal enuresis is limited and you should discuss this thoroughly with your healthcare provider before making a decision to undergo surgery for the condition.

Options include:

• Sacral Nerve Stimulation: This causes the bladder to become less active and hence result in fewer episodes of micturition. 
• Cystoplasty: This is a surgical procedure to increase bladder capacity and reduce bladder instability. 
• Detrusor Myectomy: This is also a surgical procedure which aims at strengthening bladder contractions while reducing the frequency of bladder activity. 

Pharmaceutical Treatment

Drugs like Desmopressin mimic ADH, causing the kidney to produce less urine. Anti-cholinergic medications have also demonstrated some success with treating adult nocturnal enuresis but anti-cholinergic drugs carry with them side effects that might affect patient compliance.

About The Author

Dr Lau Tzun Hon is a resident housecall doctor at CMY Medical. He received his MBBS (Hons) from Sydney University in 2001 and has served in the both private and government restructured hospitals prior to commencing his practice in Home Care.

While in the Government Restructured Hospitals, Dr Lau served primarily in the Department of Accident & Emergency Medicine and Anaesthesia. Upon entering the Private sector, Dr Lau worked in both public and private A&E departments before venturing into Home Care.

Over the years, he has developed a strong passion to maintain and  enhance the quality of life for patients under his care.  A strong believer that healthcare does not need to be financially straining, Dr Lau often delivers more value beyond expectations.