Asthma Part 3: Special Patient Populations

Children Below 5 Years of Age

Asthma is difficult to diagnose in children below 5 years of age. As the airways of children are naturally small, wheezing, when audible, can be confused between asthma and simple upper respiratory tract infections.

To add to the confusion, fast acting medications like Beta2 Agonists will relieve wheezing in children irrespective of whether they have asthma or not.

Your primary physician might elect to treat your child with long term medications like inhaled corticosteroids after weighing the risks vs the benefits of the drug. They will do so especially if the asthma proceeds beyond 6 years of age.

Inhaled corticosteroids are the preferred drug of choice for young children, Montelukast and Cromolyn being the other options available. Treatment is usually prescribed over a trial period between 4-6 weeks and stopped if no benefits are seen during that period of time.

Side effects of inhaled corticosteroids in very young children include slow growth across all ages. However, poorly controlled asthma also reduces a child’s growth rate. Hence, your primary physician will discuss the risks and benefits of commencing inhaled corticosteroids with you before commencing the medication.


Elderly Patients

Polypharmacy in elderly patients makes treatment in this group challenging. Commonly used drugs like Beta Blockers (for hypertension), aspirin and other NSAIDs (for analgesia) are all contraindicated in the treatment of asthma.

All elderly patients are advised to inform the doctor of all the medications currently consumed.

Side effects from asthma treatment like long time consumption of corticosteroids at high doses include development of osteoporosis and diabetes. Discuss management strategies with your primary physician before commencing these medications.


Pregnant Women

Pregnancy is complicated by asthma because the foetus requires an adequate oxygen supply above and beyond that required by the mother. Asthma also increases the risk of other complications of pregnancy, pre-eclampsia, pre-mature birth and low birth weights notwithstanding.

It is more beneficial to take asthma medicines while pregnant than to risk having an asthma attack. Discuss your Asthma Action Plan with your attending physician if you’re pregnant or planning a pregnancy. Whatever your asthma control may be, continued monitoring and control of your asthma throughout your pregnancy is essential.


Athletes and Growing Children

Physical activities can trigger asthma.

There is a range of medications that may help prevent asthma during exercise. These include:

• Short-acting Beta2-agonists - These are inhaled often before physical activity and have a duration of action up to 2-3 hours.
• Long-acting Beta2-agonists - These are inhaled and have a duration of action up to 12 hours. However, tolerance to these medications can develop and with prolonged use, the duration of action of the drug will be reduced.
• Leukotrienes -.These are often consumed orally hours before physical activity and can relieve symptoms of asthma.

It is important to slowly ease into exercise and not to over exert unnecessarily. A simple warm up prior to exercise, proper clothing and warm down post exercise will all aid in controlling asthma.

With proper control, asthmatics can participate in any physical activity or sport they wish.


Surgical Patients

Asthma is a significant risk factor for general anaesthesia. Tracheal intubation, for example, can trigger an asthmatic attack.

Patients are advised to inform the surgeon and anaesthesia team prior to surgery to pre-empt problems.

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.

Asthma Part 2: The Medical Consult

Asthma is diagnosed in the primary care setting by a comprehensive medical history, family history, a physical examination and lung function tests.

Your primary care physician will determine the severity of your asthma which in turn will affect the treatment you require.

Referral to a Respiratory Specialist in the following situations:

• Subspecialized tests are needed to confirm the diagnosis of asthma
• There is a history of a life threatening asthma attack
• Treatment for specific allergies 
• Polypharmacy (Multiple medications) is needed to control your asthma

Important Points To Mention During Your Medical Consult

Important points to bring up during your medical consult include:

• A Family history of asthma and allergies
• Frequency of asthmatic attacks.
• Timing of asthmatic attacks, especially if it occurs only during certain times of the year, day, or in certain places.
• Triggers of asthma specific to you
• Related conditions when experiencing an asthmatic attack, like a concurrent upper respiratory tract infection, reflux disease, stress, sleep apnoea etc

Physical Examination

Physical examination would include:

• Auscultation by your primary physician to listen for wheezing in the lungs
• Examination of the upper airways, sinuses and upper nasal passages for existing upper airway diseases
• Examination for other signs of allergic conditions eg eczema

Diagnostic Tests For Asthma

Lung Function Tests

Lung Spirometry is a type of Lung Function Test that measures the amount of air you inhale and exhale and the speed thereof.

Some respiratory specialists will use medications to “treat” existing asthma and repeat the lung function tests again to see if there is any improvement. This is usually done if chronic asthma is suspected. It is also done when the diagnosis of asthma is unclear.


Associated Tests For Asthma

Other tests performed by respiratory specialists may include:

• Allergy testing
• Perform Bronchoprovocation tests to “trigger” a controlled asthmatic attack.
• Chest X-Rays
• Electrocardiograms (ECGs) .

Asthma In Young Children

Many children develop asthmatic symptoms before 5 years of age and it is difficult to diagnose asthma in young children because the symptoms often present together with many other childhood diseases.

Reason is because children have small airways to begin with. Any respiratory condition with mucus production, for example, will further narrow their airways causing wheezing to be audible, thereby mimicking asthma. As the child grows older, the airways enlarge, and wheezing no longer becomes audible.

However, asthma should be suspected if:

• One or both parents have asthma
• Other allergic conditions eg eczema is present
• A history of pollen allergy or hay fever is present
• Wheezing is audible even when the child is healthy

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.

Asthma Part 1: An Overview

Asthma is a chronic lung disease that causes inflammation and narrowing of the airways in the lungs. Recurring periods of wheezing, chest tightness, shortness of breath, and coughing are all hallmarks of asthma.

Asthma affects people of all ages, but most often starts during childhood.


Overview

Asthmatics have inflamed airways in their lungs. Inflamed airways are narrowed and very sensitive, thereby reacting very stronging to inhaled allergens.

When the airways react, the muscles around them tighten, narrowing the airways causing reduced airflow into the lungs. The swelling can and will progress, farther narrowing the airways. Associated with this process is the increased production of mucus, a thick, sticky fluid that farther narrows the already narrowed airways.

These reactions result in the symptoms of asthma - Wheezing, chest tightness, shortness of breath, and coughing.

Asthmatic symptoms are often mild and spontaneously resolve or are easily treated with minimal treatment. However, in some cases, it can progress and become worse, resulting in what is commonly known as an asthmatic attack.

Hence, treating symptoms of asthma early is paramount. By the time an asthmatic attack ensues, emergency care is required and if left untreated, asthma can be fatal.

There is no cure for asthma. However, with proper and thorough ongoing treatment, asthma can be managed and sufferers of asthma can and will continue to lead normal and active lives.


Populations At Risk

Most often, asthma starts during childhood but it can affect all ages.

Young children who frequently suffer from respiratory infections are at highest risk of developing asthma. Other risk factors influencing the development of asthma include being atopic (having multiple allergies), eczema, or, as mentioned above, having parents who are also asthmatic.

Boys have a higher risk of developing asthma compared to girls. However, once adulthood is reached, there are more female asthmatics compared to their male counterparts. As a sum total, most people with asthma have allergies.

Another significant population with asthma are industrial workers who come into contact with chemical irritants or industrial pollutants in their workplace. This population develops occupational asthma, a contentious disease label.


Causes of Asthma

A multitude of causes for asthma have been documented so far. These include :

• Genetic causes, especially atopic individuals or asthmatic parents
• Childhood Respiratory Infections
• A multitude of airborne allergens have been implicated

Signs and Symptoms of Asthma

Common signs and symptoms of asthma include:

• Coughing 
• Wheezing.
• Chest tightness  
• Shortness of breath.

Coughing caused by Asthma is often worse at night, disrupting sleep. Wheezing is a squeaky, whooshy sound that is audible with each breath. Chest tightness and shortness of breath can and is often confused with cardiac causes and can result in undue stress to the patient.

Having one or more of the above symptoms do not automatically diagnose asthma. Proper lung function tests, history taking and a physical examination by a health profession is the only way of confirming asthma.

The type and severity of symptoms of asthma suffered by the patients though determines the management of the disease. Because symptoms vary over time, asthmatics need to be aware of their own symptoms and fluctuations thereof, and seek treatment early because while mild symptoms can be simply annoying, severe symptoms can seriously limit daily routines and exercise, and very severe symptoms can potentially cause death if untreated.

Treatment is now available to prevent the onset of asthma in known asthmatics.


Triggers Of Asthma

These include:

• Allergens - dust, animal fur, cockroaches, mold, and pollens from trees, grasses, and flowers etc.
• Chemical Irritants - cigarette smoke, air pollution, chemicals, workplace dust, sprays etc.
• Medicines - NSAIDs (eg aspirin) and B-Blockers (eg Atenolol).
• Upper respiratory infections
• Physical activity - exercise can trigger asthma.

This list is not exhaustive. Each asthmatic is unique and it is best if you seek advice from your health professional.


Prevention Of Asthma

Asthma can’t be cured. But you can prevent it. Following these simple steps will go a long way in managing asthma.

• Educate yourself about asthma. Empower yourself. 
• Have an Asthma Action Plan and follow through with it. 
• Follow your physician’s medicine regime
• Identify the triggers that cause your asthma and avoid them
• Document progression of your asthma
• Regular visits to your treating physician

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.

Skin Conditions and Eczema

The term “Eczema” refer to the group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is known as atopic dermatitis, or atopic eczema.

An estimated 10% to 20% of infants and about 3% of adults and children in the U.S are afflicted with eczema. Infants that develop eczema usually outgrow the condition by ten years of age. However, some individuals continue to be symptomatic throughout life.


Symptoms

Eczema causes itch that might be experienced globally all over the body.

Affected areas usually appear very dry, thickened, or scaly. In fair-skinned people, these areas may initially appear reddish and then turn brownish in colour. Among darker-skinned people, eczema can affect pigmentation, making the affected areas lighter or darker.

In infants, the itchy rash can produce an oozing, crusting condition that often erupts on the face and scalp, though eczematous patches may appear anywhere.


Causes

Causes of eczema are unknown, but it's believed to be an overreaction of the immune system to an irritant.

Families and bloodlines that are genetically prone to allergies have a predisposition to develop eczema.

In some patients, eczema arises only on exposure to the irritative substance. These can include household products like soaps and detergents, animal dander, and other common industrial products.

Stress has been implicated in making existing eczema worse.


Diagnosis

Diagnosis is clinical and made by the bedside. There are no specific tests for “eczema” though tests for substance allergies are available.


Treatment

Treatment aims to control the symptoms of itching and prevent infections. Moisturizing creams and lotions are recommended and these should be applied after bathing while the skin is still damp. Cold compresses can also be used to relieve itching.

Medicinal products like hydrocortisone 15 creams and other prescription creams available from your doctor can help control the inflammation. If an infection sets in, your doctor might prescribe antibiotics.

For further symptom control, antihistamines are sometimes prescribed. Other more advanced forms of treatment include phototherapy with UV radiation and use of cyclosporin for very severe cases.


Prevention

The following will help prevent outbreaks of eczema:

• Frequent Moisturization of skin.
• Avoidance of sudden temperature and humidity change.
• Avoidance of sweating or overheating.
• Reduction of stress.
• Avoidance of scratchy materials such as wool.
• Avoidance of harsh soaps, detergents, and solvents.
• Avoidance of any known foods that cause outbreaks.

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 Thalassaemia

Thalassaemia is an inherited blood disorder caused by a genetic defect. The condition causes the body to produce abnormal haemoglobin in red blood cells, which in turn causes anaemia.

Haemoglobin within red blood cells is important because it is the primary molecule that carries oxygen around the body. Hence, the lack of functional haemoglobin causes a malfunction in oxygen carrying capability.


Types of Thalassaemia

There are two types of thalassaemia: Alpha thalassaemia and Beta thalassaemia.

Patients with Alpha thalassaemia carrying one faulty gene will experience no observable effect. Patients with two faulty genes experience mild anaemia. Patients with three faulty genes will result in chronic anaemia requiring regular blood transfusions. Four faulty genes are incompatible with life.

Patients with Beta thalassaemia can be divided into several forms. Beta thalassaemia major,  also called BTM, requires regular blood transfusions and is the most serious. Beta thalassaemia intermedia, also known as BTI or non-transfusion dependent thalassaemia or NTDT, is a milder form of the condition and the severity differs between individuals, from mild anaemia to the need for regular blood transfusions.

Carriers of either Alpha or Beta Thalassaemia genes may not know their carrier status and can only confirm it by blood testing.  Knowing one’s carrier status is important for people planning to have children, as thalassaemia is an inheritable disease.

People of Mediterranean, Middle Eastern, African or Asian descent are more likely to be carriers. Thalassaemia is common in these regions because it helps to protect the carriers against malaria.


Causes of Thalassaemia

Thalassaemia is a genetic disease and cannot be transmitted from one person to another.


Treatment for Thalassaemia

The most common treatment for beta thalassaemia major (BTM) is to have regular blood transfusions every four-to-six weeks to reinfuse functional haemoglobin in the body. This treatment can raise iron levels in the body to dangerous levels, risking heart, liver and hormone problems. Chelation may be performed to reduce iron levels in such situations. .

Bone marrow transplants may cure thalassaemia in young individuals below the age of sixteen but potential cases should be considered individually.

Stem cells in umbilical cord blood transfusion have also been used for thalassaemia treatment.

For Beta thalassaemia intermediate (BTI) patients, treatment will depends on the severity of a person's symptoms. This can range from folate supplements to blood transfusions.

People with BTM are recommended to have a diet high in calcium and vitamin D and to take regular weight-bearing exercise to help strengthen their bones.


Complications of Thalassaemia

• Hypersplenism 
• Delayed puberty 
• Stunted growth
• Irregular heart rhythms 
• Hepatitis, Hepatic Cirrhosis
• Osteoporosis

Thalassaemia Myths

It is important to know the truth about thalassaemia and not to succumb to many myths surrounding the disease. Here are a few samples of misleading information.

Asymptomatic parents will not pass the disease to their children.
Myth: Faulty genes can be transmitted vertically from parent to child.

If only one parent is a carrier, the child will not inherit the genetic disorder.
Myth: As long as one parent is a carrier, every child has a chance of inheriting the genetic disorder and can only be confirmed with blood evaluation

Routine blood tests during a person's lifetime would have demonstrated carrier status.
Myth: Only specific blood tests for thalassaemia detect carrier status.

If a baby is a carrier, he or she will get ill later in life.
Myth: Carriers do not develop full blown thalassaemia but will have a chance of passing the faulty gene to subsequent generations. .

If both parents are carriers, the 25% chance of a child having the disorder would mean one out of four babies will be ill.
Myth: Every pregnancy should be considered as an independent event for statistical evaluation. Hence every baby born has a 1 in 4 chance of inheriting the disease.

Thalassemia will not occur in the Caucasian population.
Myth: While thalassemia occurs more frequently in certain ethnic groups, it has also been found in caucasians. .

It is imperative that I keep my carrier status a secret.
Myth: Blood relatives often carry similar genes. Hence sharing one’s carrier status can increase awareness and understanding amongst the community.

My child is only a carrier so I will not discuss it with him.
Myth: It is important to inform a child of his/her carrier status because the faulty gene can be transmitted to future generations.

Only women need screening tests.
Myth: Both sexes need to be tested as a combination of genes is inherited by a child.

Marrying someone from a different ethnic background avoids children being affected.
Myth: Parents of any background have the potential to pass on carrier status or thalassaemia

Being a carrier protects against malaria.
Partly true: Thalassaemia carriers have a certain degree of protection against malaria.

Thalassaemia can be caught from blood transfusions.
Myth: Thalassaemia is a genetic disorder. It is not transmitted through blood transfusions.

Thalassaemia needs to be treated with iron supplements.
Myth: Use of supplements should be done under medical advice.

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.

Type 2 Diabetes And Managing It

Diabetes is a life-long disease that affects the way your body handles glucose in your blood.


Causes

Insulin, a hormone produced by the pancreas, facilitates the movement of glucose absorbed from food in blood into cells.

Patients with Type II diabetes have insulin resistance and the normal metabolism involving insulin becomes disrupted. .

In the initial phase, the pancreas will compensate by making more insulin to maintain normal metabolism but eventually, due to inadequate compensation, sugar will build up in the blood.

Causes of type 2 diabetes include:

• Genes. Certain individuals have a genetic predisposition to develop type 2 diabetes
• Obesity. Obesity causes insulin resistance.
• Metabolic syndrome. People with insulin resistance often have a group of conditions including high blood glucose, extra fat around the waist, high blood pressure, and high cholesterol and triglycerides.
• Hepatic Causes. Liver abnormalities can cause abnormally high blood sugars
• Abnormal beta cells. Abnormal pancreatic beta cells (the cells that produce insulin) can cause Diabetes Type II

Risk Factors and Prevention

• Age: 45 or older
• Family members with Diabetes
• Ethnicity: African-American, Alaska Native, Native American, Asian-American, Hispanic or Latino, or Pacific Islander-American are all predisposed to develop Diabetes Type 2
• Heart and blood vessel disease
• High blood pressure, even if it's treated and under control
• Low HDL ("good") cholesterol
• High triglycerides
• Being overweight or obese
• Gestational Pregnancy
• Polycystic ovary syndrome (PCOS)
• Depression
• A sedentary lifestyle
• Smoking
• Stress
• Insufficient or excessive amounts of sleep

What Can You Do?

• Lose weight. 7% to 10% of weight loss can cut your risk of type 2 diabetes by half.
• Exercise. Moving muscles use insulin. Thirty minutes of brisk walking a day will cut your risk by almost a third.
• Eat right. Avoid highly processed carbs, sugary drinks, and trans and saturated fats. Limit red and processed meats.
• Quit smoking.

Symptoms

• Excessive thirst
• Excessive amounts of urine
• Blurry vision
• Increased irritability
• Tingling or numbness in your hands or feet
• Feeling tired all the time
• Poor wound healing
• Recurrent yeast infections

Getting a Diagnosis

Blood tests can be performed to determine diabetic statuses.

A1C: This gives an indication of the sugar control over the last 3 months from the point of blood evaluation.

Fasting plasma glucose: This gives a direct measure of the blood glucose level at the point of blood evaluation. .

Oral glucose tolerance test (OGTT): This evaluates how your body handles excessive sugar.


Long-Term Effects

Over time, high blood sugar can damage and cause problems with your:

• Heart and blood vessels
• Kidneys
• Eyes
• Nerves, which can lead to trouble with digestion, the feeling in your feet, and your sexual response
• Wound healing
• Pregnancy

The best way to avoid these complications is to manage your diabetes well.

• Take your diabetes medications or insulin on time.
• Check your blood glucose.
• Eat right, and don't skip meals.
• See your doctor regularly to check for early signs of trouble.

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 Roseola

Roseola, a common infection affecting children less than 2 years of age, is a mild infection characterised by fever, rash, and generalized irritability in infants.

Two common strains of herpes virus cause roseola. Duration of disease can last beyond a week in some cases.

Roseola typically isn't serious. However, in some cases, uncontrolled high fevers can result in complications.

Treatment of roseola includes bed rest, fluids and anti-pyretic medications.


Symptoms

Roseola can be dormant in the child up to a week or 10 days. Once the disease erupts, the symptoms include:

• Fever. Roseola typically starts with a sudden, high fever greater than 39.4 C. Other symptoms experienced include a sore throat, runny nose or cough. Swollen lymph nodes can also occur. The fever usually lasts 3-5 days. 
• Rash. Once the fever subsides, a rash typically appears — but not always. The rash consists of many small pink spots or patches, are generally flat, and usually has a global distribution all over the body. The rash, which isn't itchy or uncomfortable, can last from several hours to several days before fading.

Other signs and symptoms of roseola may include:

• Irritability in infants and children
• Mild diarrhea
• Decreased appetite
• Swollen eyelids

When To See A Doctor

Seek immediate medical care if the child has a seizure due to uncontrolled fevers.


Call your child's doctor if:

• The fever is uncontrolled. 
• The illness is prolonged and unresolving after a week

Call your doctor

If immunocompromised, contact your doctor. Monitoring for a possible infection will be necessary.


Causes

The most common cause of roseola is the human herpes virus 6, and in rare cases, herpes 7.

It is spread via respiratory secretions or saliva. Hence children in close contact with other children become infected easily.

Roseola is contagious even if no rash is present. Hence the disease can spread insidiously.


Risk Factors

Older infants are at greatest risk of acquiring roseola because their immune system is still developing. Newborn babies receive antibodies from their mothers that protect them in the first 6 months of life. Hence, the most common age of infection is between 6 to 15 months.


Complications

1.  Seizures in children

Uncontrolled fevers can result in seizures in children. This often presents as a brief loss of consciousness, jerking of limbs, and or temporary loss of bladder or bowel control.

Although frightening, febrile seizures in otherwise healthy children are generally short-lived and are rarely harmful. However, seek medical care if unsure.


Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.

2.  Concerns for immunocompromised individuals
Immunocompromised individuals, for example, those who have recently received a bone marrow or organ transplant, may contract roseola as a new infection or due to reactivation of the dormant virus in their body.

These patients may experience potentially serious complications from the infection, such as
pneumonia or encephalitis.


Preparing For Your Appointment

Prior to seeing the doctor, encourage your child to rest and drink lots of fluids.


Tests and Diagnosis

Diagnosis is usually clinical though a blood test can be done to check for antibodies.


Treatments and Drugs

Most children spontaneously recover within a week of the onset of the fever.

Medications to control fever can be used for symptom control.


Prevention

Avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever subsides.

Most patients are immune by the time they are of schooling age. However, basic hand washing is recommended to prevent the spread of the disease.

Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. Infected adults however can pass the disease to children.

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 Constipation

When bowel movements are difficult or happen less often than normal, constipation has developed. Everyone will experience it at some point in life and it is usually harmless.

The normal length of time between bowel movements varies widely from person to person, ranging from bowel movements three times a day to once or twice a week.

However, having no bowel movement for three or more days will usually result in stool becoming hard and difficult to pass.


Symptoms

• Fewer bowel movements than usual
• Straining to evacuate stool
• Hard and/or small stools
• Experiencing Tenesmus - a sensation of incomplete evacuation
• Abdominal swelling and tenderness
• Vomiting with reduced appetite

Causes

• Medications containing calcium or aluminum
• Dietary changes
• Colon cancer
• Excessive consumption of dairy products
• Eating disorders
• Irritable bowel syndrome
• Neurological conditions such as Parkinson's disease or multiple sclerosis
• Physical inactivity
• Dehydration
• Laxative abuse
• Pregnancy
• Haemorrhoids
• Narcotics, anti-depressants, and iron supplements
• Stress
• Hypothyroidism

Diagnosis

Doctors can order certain investigations to find the cause for constipation. For example:

• Blood tests to check hormone levels 
• Imaging studies like Barium studies to look for any blockages in your colon
• Colonoscopy 

What Should I Do If I Am Constipated?

• Unless instructed otherwise, drink two to four extra glasses of water a day 
• Warm fluids in the morning
• Increase fruits and vegetable intake
• Prunes, bran and cereal can help

When Should I Call My Doctor?

Call your doctor if:

• Constipation is a new problem for you
• Bloody stools develop
• Unexplained loss of weight associated with constipation
• Painful bowel movement
• Constipation beyond 2 weeks
• Pencil thin stools

Can I Prevent Constipation?

• Eat a well-balanced diet with plenty of fiber. 
• Drink lots of water
• Avoid caffeine
• Avoid milk if it causes constipation in you
• Exercise regularly.
• Be prompt to evacuate. Go to the bathroom when you feel the urge.

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.

Influenza

Overview

Influenza is a viral infection that attacks your respiratory system — your nose, throat and lungs. Influenza, “the flu”, is a viral infection that attacks your nose, throat, and lungs.

In most cases, influenza resolves spontaneously. However, severe complications occur in certain people.

These high risk populations include:

• Children under 5
• Adults older than 65
• Nursing home Residents
• Pregnant women 
• Immunocompromised People
• Chronically ill Patients
• The Obese (BMI >40)

The best defense against influenza is to be vaccinated against it.


Symptoms

Runny nose, sneezing and sore throat. The difference between colds and the flu, however are marked. Colds usually develop slowly while flus are sudden.

Common signs and symptoms of the flu include:

• Fever over 38 Deg C
• Generalized aches and pains
• Rigors and Chills
• Headache
• Dry, persistent cough
• Fatigue and weakness
• Nasal congestion
• Sore throat

When To See A Doctor

If you have flu symptoms and are at risk of complications, see your doctor right away. 

Consumption of antiviral drugs within the first 48 hours can reduce the length of your illness and help prevent complications.

Causes

Flu viruses are transmitted via directly through the air. Carried by droplets of water in the breath, whenever an infected individual coughs, sneezes, or even talk, the virus spreads. Inhalation of these infected droplets results in infection. 

Infected individuals are contagious for about a week to 10 days after symptoms appear. 

Understand that the viruses are constantly evolving and changing. Hence, previous infections do not fully protect against new strains of the influenza virus.

Risk Factors

Factors that may increase your risk of developing influenza or its complications include:

• Age. The very young and very old are at increased risk. 
• Living conditions. Patients in facilities that recycle air or have other occupants in close proximity are at increased risk. 
• Weakened immune system. Cancer treatments, anti-rejection drugs, corticosteroids and HIV/AIDS all weaken your immune system making it easier to be susceptible to the flu.
• Chronic illnesses. Chronic conditions, such as asthma, diabetes or heart problems, may increases your risk of influenza complications.
• Pregnancy. Pregnant women, especially in the second and third trimesters and 2 weeks after delivery are at a higher risk. 
• Obesity.

Complications

These include:

• Pneumonia
• Bronchitis
• Asthma flare-ups
• Heart problems
• Ear infections

Treatment

Often, rest and fluids are sufficient for management of the flu. Doctors might prescribe an antiviral medication if you present early. These drugs may shorten the duration of illness and reduce the likelihood of developing serious complications.

Side effects of these Antiviral medication side effects may include nausea, vomiting and other more serious complications like hallucinations. As a result, it has been recommended that further studies be performed on antiviral drugs.

Self-Management

If you do come down with the flu, these home measures will ease your symptoms:

• Consume clear fluids.
• Get sufficient Rest..
• If necessary, painkillers like paracetamol can be used for symptom control

Prevention

The Center for Disease Control and Prevention recommends annual flu vaccination for everyone over the age of 6 months.

Each year's seasonal flu vaccine covers three or four influenza viral strains anticipated to thrive in the upcoming season.

Infection Control

• Wash your hands. Frequent Handwashing is strongly recommended. 
• Contain coughs and sneezes. Wear a mask or cover your mouth when coughing or sneezing
• Avoid crowds. Avoid crowded areas as the flu virus is spread through air

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 Gastroenteritis

“Gastroenteritis” refers to inflammation and infection of the Gastrointestinal tract, commonly known as the “stomach flu” and is often associated with diarrhoea and vomiting.


Symptoms

Watery Diarrhoea, vomiting, stomach pain, abdominal cramps, fever, nausea and headaches are all known symptoms of Gastroenteritis.

As a secondary consequence, patients can become dehydrated. Clinically, patients will experience dry skin, dry mouth, feeling light headed and thirst.


Stomach Flu and Children

Children and toddlers dehydrate faster than adults. The child that constantly complains of persistent diarrhoea, nausea/vomiting and presents with dry skin is likely dehydrated. For toddlers, watch for dry and fewer diaper counts throughout the day.

Children with gastroenteritis should be kept at home away from school or day care centers until all the symptoms abate. It is best to have a full medical consult before returning to school.

There are vaccines available against viruses that cause Gastroenteritis. Do enquire with your attend physician.


Causes  of Gastroenteritis

There are many ways gastroenteritis can be spread:

• Contact with someone who has the virus.
• Contaminated food or water.
• Unwashed hands after going to the bathroom or changing a diaper.

Most commonly, Gastroenteritis is caused by a virus, either of the rotavirus or norovirus strains.

Rotavirus is the world's most common cause of diarrhea in infants and young children. Norovirus is the most common cause of serious gastroenteritis and also foodborne disease outbreaks in the U.S.

Bacteria, on the other hand, such as E.Coli, Campylobacter and Salmonella can also trigger severe Gastroenteritis. They can be spread by unwashed hands after toileting, poorly cooked poultry, eggs, poultry juices, and even through live poultry.

Another common bacteria of the shigella strain, is often found in day care centers as it typically spreads via contaminated food and drinking water.

Parasites can also cause gastroenteritis, but it's not common. Parasites like giardia and cryptosporidium spread via contaminated swimming pools or contaminated water.

Other less common causes of gastroenteritis include:

• Heavy metals (arsenic, cadmium, lead, or mercury) in drinking water.
• Eating a lot of acidic foods, like citrus fruit and tomatoes.
• Toxins that might be found in certain seafood.
• Medications such as antibiotics, antacids, laxatives, and chemotherapy drugs.

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.

Chickenpox

Chickenpox is a common childhood viral illness that is characteized by the formation of itchy, red blisters all over the body.


Signs and Symptoms of the Chickenpox

The most recognizable sign of Chickenpox is its characteristic rash. However, other symptoms prior to the development of the rash include:

• Fever
• Headache
• Loss of appetite

The rash itself undergoes three different phases:

• Formation of red or pink bumps all over your body.
• Rupture and/or leakage of infectious fluid from the Bumps.
• Scab formation and healing.

Patients will be contagious until all the bumps have scabbed over.

Causes of Chickenpox

Chickenpox is caused by a virus from the Herpes family called Varicella-Zoster. Most cases are transmitted via direct contact with an infected person’s body fluid. These include:

• Saliva
• Coughing
• Sneezing
• Contact with blisters

At Risk Population

Previous infection, vaccination, or vertical immunity passed from mother to newborn (immunity lasts about three months from birth) reduces risk. Anyone who has not been exposed may contract the virus. Risk of infection also increases under any of these conditions:

• Recent contact with an infected individual.
• Under 12 years of age.
• Adults residing with infected children.
• Spending time in a school or childcare facility with infected individuals.
• Immunocompromised individuals.

Diagnosis

Diagnosis is often clinical. See your doctor for confirmation. If the attending physician is unsure, farther lab investigations are also available to ascertain diagnosis.

Complications

Seek medical attention if the following conditions develop::

• Eyes become affected by the Rash.
• Rash becomes infected.
• Systemic symptoms like shortness of breath or dizziness develop.

Populations most at risk include:

• Infants
• Elderly patients
• Immunocompromised individuals
• Pregnant women

Affected pregnant women may bear children with birth defects, including:

• Poor growth
• Small head size
• Eye problems
• Intellectual disabilities

Treatment

Most forms of treatment for Chickenpox concentrates on symptomatic and supportive care and infection control. Because it is caused by a virus, the body’s immune system needs time to heal. Infection control measures should also be instituted to prevent spread of the disease.

In the event of an unbearable itch, antihistamines can be used.  Itching can also be soothed by:

• Bathing in lukewarm water
• Moisturizing lotions
• Comfortable clothing

High-Risk Patients

Antiviral drugs may be prescribed to those who experience complications from the virus, or who are at risk for adverse effects. Note though that these antiviral drugs do not cure chickenpox. Instead, they make the symptoms less severe, and make your body more likely to heal faster.

Duration of Disease

Most cases of chicken pox resolve within 10 days or so.

Chickenpox Immunity

Once exposed, most people become immune to the virus for their lifetime. However, in later stages of life, the varicella virus may re-emerge as Shingles during adulthood if the patient’s immune system is compromised.

Prevention

A chickenpox vaccine is available and should be given to the child between 12 and 15 months of age. A booster is given between age 4 and 6. 

Adults can opt to take the vaccination though efficacy is reduced.

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.

Bronchiolitis

Bronchiolitis is a common childhood disease found in children less than 2 years of age, often affecting infants aged between 3-6 months. It can affect up to one in three children within their first year of life.

It is a condition that results in inflammation of the bronchioles, the smallest airways in the lungs and presents with coughing, wheezing, shortness of breath with secondary difficulty in feeding.

It is caused by the Respiratory Syncytial Virus in 70% of cases and is much more common in the winter months in Temperate countries.

Treatment for Bronchiolitis is often supportive and symptomatic.


Signs and Symptoms

Coughing, Wheezing, Shortness of breath over one to two days, followed by crackles and/or wheezing are typical presentations of Bronchiolitis.

After the episode, it is common for the airways to remain sensitive for several weeks, leading to recurrent cough and wheezing.

Severe signs of the disease include:

• Poor feeding (less than half of usual fluid intake in preceding 24 hours)
• Lethargy
• History of apnea
• Respiratory rate >70/min
• Presence of nasal flaring and/or grunting
• Severe chest wall recession
• Cyanosis

Causes

The Respiratory Syncytial Virus is responsible for up to 70% of cases. Other viruses include the common influenza virus, coronavirus, adenovirus, rhinovirus, and other respiratory viruses.

Some studies have suggested a connection between voluntary caesarean births and bronchiolitis. This link becomes more prominent in studies done amongst premature babies, those with low birth weights and/or congenital heart defects.

On a lighter note, studies also show evidence that breastfeeding provides some protection against bronchiolitis.

Diagnosis

Diagnosis of Bronchiolitis is clinical. A chest X-ray is useful to exclude bacterial pneumonia but it is not indicated in routine cases. Testing for specific viral strains can be done but has a low risk -  benefit ratio as identifying the virus has little effect on management.

As bronchiolitis is often caused by a virus, antibiotics are not indicated unless a superseding bacteria infection occurs. Some studies have shown that as low as 6% of affected infants develop superseding bacteria infections concurrently.

Prevention

Basic procedures like handwashing, avoiding exposure to symptomatic individuals, good hygiene and maintain a strong immune system are the best forms of protection against the Respiratory Syncytial Virus. Breast milk contains antibodies from the mother and hence confer immunity to the infant, especially during the first month of life. Immunizations for premature infants are also available but it should only be administered to infants that meet specific criteria.

Treatment

High flow oxygen therapy with a high flow device that can provide precise flow/FiO2 and medical grade vapor forms an important part of the management of bronchiolitis.

As mentioned, treatment for Bronchiolitis is primarily symptomatic and supportive. Some drugs like Bronchodilators have been used with a fair margin of success.

Bronchodilators

Inhaled Epinephrine has been shown to reduce total length of Hospital stay when compared to Salbutamol. Salbutamol, on the other hand, when administered via the inhalation route, has also been shown to reduce initial hospital admission rates in some studies but has no no clear effect on the length of hospital stay.

The routine use of bronchodilators in children with bronchiolitis is however not recommended as there has been no clear effect on any important outcomes in children but carries with it a small risk of potential adverse effects from the administered drugs and hence should be used with care and under medical supervision.

Currently other medications do not yet have evidence to support their use.  Antiviral drugs like Ribavirin have not been shown to be effective. Administration of Antibiotics in the event of a complicating bacterial infection will have no effect on the underlying viral infection. Corticosteroids also have not shown proven benefits in Bronchiolitis.

Epidemiology

90% of the people affected are between 1 and 9 months old. Bronchiolitis is the most common cause of hospitalization up to the first year of life especially during winters in temperate countries.

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.

Vaccination Before Travelling

Of Honesty, Travelling, and the Spectre of Illness

Let us be honest with ourselves.

Satiation of our wanderlust is one of the most fulfilling things we can do in life. Yet, at the same time as we traverse the globe, we are exposed to a multitude of illnesses.

Vaccination, is our protection.

Vaccinations

Travel vaccines or travel immunizations, simply put, are injections taken by travelers whose intended destinations may prove to be biologically ... unsavory.

These vaccinations expose the body to deactivated germs or particles thereof, thereby causing the body to produce immunity against the targeted pathogen and conferring protection against future infections if exposed.

Because the germs are deactivated and or are only particles thereof, the vaccination process does not cause the body to fall ill.

In truth, travel vaccines are safe and effective.

When does One Need Vaccinations?

Broadly speaking, there are three types of vaccinations:

Routine Vaccines

These are the standard child and adult immunizations recommended for the general population as recommended by the Ministry of Health.

Recommended Vaccines

These are travel vaccinations that are recommended when there is intention to travel to countries with intermediate to high risk profiles for certain diseases that might otherwise not be endemic in the patient’s country of origin.

Required Vaccines

These are vaccinations that are mandatory by law prior to legal entry to the intended destination. Examples include the yellow fever vaccine prior to traveling to parts of Africa or South America, and the meningococcal vaccine when traveling to Saudi Arabia during the haji.

So, Which Travel Vaccines Will I Need?

Here’s a list of vaccinations that are not routinely covered by standard immunisation schedules:

• Hepatitis A
• Hepatitis B
• Typhoid and paratyphoid fever
• Meningococcal disease
• Yellow Fever
• Rabies
• Japanese Encephalitis

Do you require all of the above? Or only some of the above?

It is best to consult a health professional before making such decisions and more importantly, to do your research prior to travel simply because a traveler that intends to backpack or go camping in a country will have a very different risk profile compared to a traveler who intends to stay in a 5-star hotel throughout their stay.

Note also that some travel immunisations might require a series of innoculations over a period of time - eg Hep B. Hence, it is best to be aware of the timeline prior to traveling and consult your health professional early.

Also, always inform your health professional of the following:

Your current health

If you are taking any chronic medications or have existing illnesses, it is important that your health practitioner be made aware prior to administering any vaccines. 

Also inform of any allergies you might have - some vaccines cannot be administered if you have an allergy to egg white, for example. 

Immunization history

Your immunisation history will prove invaluable - some vaccines only require booster shots instead of having patients undergo the entire protocol if there has been previous vaccinations. 

Itinerary

Where you’re travelling, duration of travel, time of year, accommodation arrangements, and or other special activities should all be made known to your health professional. 

Ultimately, it's up to you to decide whether or not to see a doctor about recommended vaccinations.

What Steps Should I Take to Protect Myself While Traveling?

Common sense about basic hygiene would form the very foundation of self protection. Basic sanitation, drinking bottled water, and avoiding food from dubious sources, keeping insect repellants handy etc all protect against illnesses while traveling. 

The important thing is knowledge about the target destination. Forewarned is forearmed. Educate yourself. 

Where Can I Get More Information About Travel Vaccinations?

Most center for disease control websites in developed countries will have the standard recommendations for travel vaccines specific to different countries. Visit your local website today.

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.

Chronic Cough

Common causes of chronic cough include asthma, allergic rhinitis, sinus problems,esophageal reflux, medications eg ACE inhibitors, and whooping cough. In rare cases, inhalation of foreign objects into the lungs (usually in children) can also cause chronic cough. It is important to see a doctor when a chronic cough is present. The following are common causes of chronic coughing.

• Cigarette smoking - the most common cause of chronic cough.
• Asthma - a disease of the airways that result in difficulty breathing or wheezing. Some asthma sufferers have chronic cough as their only symptom. Some may even have normal lung functions tests. This is often referred to as cough-variant asthma. Asthmatic symptoms can be aggravated by cold air, exposure to air pollutants, pollen, smoke, or perfumes.
• Gastroesophageal reflux disease (GERD) refers to acid reflux, or backward flow, of stomach acid and other contents into the esophagus. This can result in spasms of the airways that in turn can cause shortness of breath and coughing. In some instances, acid reflux can be so severe that substances can be inhaled (aspirated) into the lungs and cause similar symptoms as well as damage to lung tissue. In some individuals, no sensation of heartburn is felt and their only symptom may be chronic cough.
• Sinus problems and postnasal drip also causes chronic cough due to the backflow of mucus down the back of the throat. This condition can be difficult to detect. Sometimes a CT scan of the sinuses is necessary for diagnosis. Affected individuals often complain of a "tickle in their throat" and frequent throat clearing.
• Infections such as bronchitis or pneumonia can cause acute cough or a chronic cough. These infections can be caused by viruses, bacteria, or fungi. For asthmatics, viral upper respiratory infections often result in a prolonged cough even after the infection has cleared. 
• Bronchitis is also a common cause of a chronic cough and is often associated with coughing up blood (hemoptysis).
• Whooping cough (pertussis) is an acute, highly contagious respiratory infection caused by the bacterium Bordetella pertussis. It can cause violent, rapid, constant coughing and be fatal in young children. Whooping cough commonly affects infants and young children, but can be prevented by immunization with the pertussis vaccine. In adults, whooping cough can be a cause of chronic cough.
• Chronic cough in children is uncommon. Foreign materials obstructing the airways of the lungs, asthma, and allergies are the usual suspects and patients need to be evaluated by a pediatrician.
• Certain medications, notably ACE inhibitors (enalapril [Vasotec], captopril [Capoten] etc.) used in treating high blood pressure can cause chronic cough.
• Less common causes of chronic cough include allergies, tumors, sarcoidosis, congestive heart failure, and/or other lung diseases such as chronic obstructive pulmonary disease (COPD) or emphysema. Lung diseases also can cause coughing up blood.

If chronic cough persists, it is important to be evaluated by a doctor. 

What Are The Different Types Of Chronic Coughs?

There are several different types of chronic (or persistent) cough.

• A persistent dry cough is a cough that does not produce any mucus, irritating to the lungs and throat, and may be a sign of a viral infection or sinus problems.
• A chronic wet cough is a cough that produces mucus (sputum), and depending on the color, may indicate a bacterial infection or fluid in the lungs (congestive heart failure).
• A stress cough is a reflexive spasm of the airways caused when you are under stress. It usually produces no mucus and is not generally related to infections.
• A 'barking' cough is usually found in children, and may be associated with croup or other viral illness. The harsh, barking sound of a croup cough is caused by a swollen windpipe (trachea).
• A cough that causes a 'whooping' sound after the cough may be indicative of a serious infection and should be evaluated by a doctor. Whooping cough (pertussis) is a highly contagious respiratory disease that can be deadly for babies under 1 year of age.

What Kinds Of Doctors Treat Chronic Coughs?

Family practitioners in the primary care sector or internist will be able to diagnose the cause of your chronic cough. 

Patients suffering from constant cough may be referred to different specialists if the underlying cause of the chronic cough is severe or cannot be found.

A pulmonologist is a lung specialist who treats diseases of the airways. An allergist is an allergy specialist who may treat chronic cough due to allergies. Gastroenterologists specialize in diseases of the digestive tract and can treat chronic cough due to conditions such as gastroesophageal reflux disorder (GERD). Cardiologists specialize in diseases of the heart and circulatory system and may treat persistent cough that can be a secondary symptom of heart disease.

How Is Chronic Cough Treated?

The treatment of chronic cough is directed at the underlying cause. 

In severe cases of chronic cough a healthcare professional may prescribe codeine or other similar narcotic medications - these act as cough suppressants.

The following are examples of treatments for chronic cough caused by medications, conditions, or diseases.

• Asthma: Inhaled bronchodilators and inhaled steroids are given to decrease inflammation of the airways and reduce wheezing. This reduces chronic cough. In some cases, short-term oral steroids are prescribed to relieve chronic cough.
• Gastroesophageal reflux disease (GERD): Treatment for chronic cough caused by GERD includes avoiding foods that increase reflux, avoiding lying down after meals, elevating the head while sleeping, and taking medication such as famotidine (Pepcid), cimetidine (Tagamet), ranitidine (Zantac) omeprazole (Prilosec, Prilosec OTC), lansoprazole (Prevacid, Prevacid 24-Hour), rabeprazole (Aciphex), pantoprazole (Protonix), esomeprazole (Nexium) to decrease stomach acidity.
• Sinus problems and postnasal drip: Use of decongestants such as pseudoephedrine (Sudafed) or antihistamines such as diphenhydramine (Benadryl) may improve symptoms of post nasal drip, which causes a persistent, nagging, cough. Inhaled nasal steroids are also very effective in treating allergic rhinitis (hay fever), a common cause of cough. Additionally, other nasal inhalers like ipratropium bromide (Atrovent) can relieve post nasal drip. Antibiotics may be prescribed if the cause is determined to be sinusitis.
• Infections: Bacterial pneumonia and bronchitis are typically treated with antibiotics such as cephalosporins, azithromycin (Zithromax), and other antibiotics. If the pneumonia is close to the chest wall, inflammation of the surface of the lung can cause pain. This is known as pleurisy and pain relievers (analgesics) can be helpful. Cough suppressants are used with caution in these situations because clearing the lung of the infected mucus by coughing helps clear the infection and suppressing the cough reflex is counter-productive. Suppressants, however, are given more for symptomatic relief.. Note though that most forms of bronchitis in adults are caused by viral infections. Therefore, treatment is much the same as that of the common cold, inclusive of rest, fluids, pain relievers, and humidification. Expectorant cough medicines containing guaifenesin can be helpful in alleviating discomfort. Sometimes, it is hard to differentiate a viral from bacterial bronchitis, and antibiotics will be prescribed by the doctors as a precaution. In some cases, asthmatics can produce green mucus that looks infected. Your doctor send the sputum sample to a lab to be  examined.
• Medications: Hypertensive patients with chronic cough that are on blood pressure medicines called ACE inhibitors (angiotensin converting enzyme), for example, enalapril (Vasotec), captopril (Capoten), lisinopril (Zestril, Prinivil), etc. should talk to their doctor about switching medications. Patients should not stop taking medicine on their own because a marked elevation in blood pressure can result from discontinuation. A newer generation of ACE inhibitor like medicines called ARBs (angiotensin receptor blockers, for example, valsartan [Diovan], losartan [Cozaar], etc.) can be alternatives as they are less likely to cause chronic coughing. There are also other options available for treatment of blood pressure.

Are There Home Remedies For Chronic Cough?

Certain Home Remedies will be of benefit. These include:

• Staying hydrated. Fluids will thin secretions.
• Gargle with warm saltwater to help cleanse the throat and rid it of mucus.
• Elevate your head with extra pillows at night to ease a chronic dry cough.
• Inhale steam in a shower or use a humidifier to relieve dry cough.
• Cough drops may soothe an irritated throat.
• Do not smoke or use tobacco products.
• Avoid inhaled irritants such as smoke, dust, or other pollutants.
• Honey often can be an effective treatment for a persistent cough. Add honey to hot tea, or even grape juice.
• Ginger, prepared as a tea, is often used to help reduce symptoms of chronic cough and clear the nasal passages.
• Other herbs such as eucalyptus or mint are often used to relieve cough symptoms.

Can Chronic Cough Be Prevented?

• Don't smoke, as smoking is the most common cause of chronic cough.
• Talk to your physician about managing your asthma, postnasal drip, or GERD to avoid chronic cough symptoms.
• Stay away from others known to be sick with bronchitis or pneumonia.
• Eat fruit. Research suggests that diets high in fruit fiber and flavonoids may prevent chronic productive cough.
• Make sure you and your child gets the whooping cough (pertussis) vaccine.

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.

Hand, Foot, and Mouth Disease (HFMD)

What Is Hand, Foot, and Mouth Disease?

HFMD is a highly contagious disease caused by viruses. These viruses can spread via person to person contact either through direct contact via unwashed hands or surfaces contaminated with faeces from an infected individual or it can be transmitted through contact with an infected person’s saliva, stool or respiratory secretions.

HFMD often causes blisters or sores in the mouth and a rash on the hands and feet. The infection can affect people of all ages, but it usually occurs in children under age 5. It is generally a mild condition that goes away on its own within several days.

What Are the Symptoms of Hand, Foot, and Mouth Disease?

Symptoms of HFMD include:
fever
poor appetite
sore throat
headache
irritability
painful, red blisters in the mouth
a red rash on the hands and the soles of the feet

Fevers and sore throats are usually the first symptoms of hand, foot, and mouth disease. The characteristic blisters and rashes show up later, usually one or two days after the fever begins. Symptoms usually resolve within 10 days or so.

What Causes Hand, Foot, and Mouth Disease?

Hand, foot, and mouth disease is often caused by a strain of coxsackie virus, most commonly coxsackie virus A16. The coxsackievirus is part of a group of viruses called Enteroviruses. In some cases, other types of Enteroviruses have been implicated.

These viruses spread easily from person-to-person. Your child, or even you may contract hand, foot, and mouth disease through contact with an infected person’s:

• saliva
• fluid from blisters
• feces
• respiratory droplets that are sprayed into the air after coughing or sneezing

Hand, foot, and mouth disease can also be transmitted through direct contact with unwashed hands or any surface containing traces of the virus.

Who Is at Risk for Hand, Foot, and Mouth Disease?

Young children have the highest risk of getting hand, foot, and mouth disease. This risk increases if they attend day care or school as viruses can spread quickly in these facilities. Children usually develop immunity to the disease after being exposed to the viruses. This is why the condition rarely affects people over age 10. However, it’s still possible for older children and adults to get the infection, especially if they have weakened immune systems.

How Is Hand, Foot, and Mouth Disease Diagnosed?

HFMD is diagnosed clinically by the bedside. Your attending physician will be able to perform a thorough examination prior to making the diagnosis.

Sometimes, the doctor may take a throat swab or stool sample that can be tested for the virus. This will allow them to confirm the diagnosis via laboratory evaluation.

Is Hand, Foot, and Mouth Disease Treated?

In most cases, the infection will spontaneously resolve within seven to ten days. However, your doctor may recommend certain treatments to help ease symptoms until the disease has run its course. These can include:

• prescriptions of over-the-counter topical ointments to soothe blisters and rashes
• pain medication, such as acetaminophen or ibuprofen, to relieve headaches
• medicated syrups or lozenges to ease painful sore throats

Certain home treatments can also provide relief from hand, foot, and mouth disease symptoms. You can try the following home remedies to help make blisters less bothersome:

• Suck on ice or popsicles.
• Eat ice cream or sherbet.
• Drink cold beverages.
• Avoid citrus fruits, fruit drinks, and soda.
• Avoid spicy or salty foods.

Swishing warm salt water around in the mouth may also relieve the pain associated with mouth blisters and throat sores. Do this several times a day or as often as needed.

Prognosis for Hand, Foot, and Mouth Disease?

Symptoms usually resolve within 7-10 days and immunity against the virus develops with no sequelae.

However, in rare cases, the infection might become complicated and last beyond 10 days. In such instances, you should seek medical advice instead of attempting home therapies.

How Can Hand, Foot, and Mouth Disease Be Prevented?

Good personal hygiene is the best defense against hand, foot, and mouth disease. Regular hand-washing greatly reduces the risk of contracting this virus.

Teach your children how to wash their hands using hot water and soap. Hands should always be washed after using the restroom, before eating, and after being out in public. Children should also be taught not to put their hands or other objects in or near their mouths.

It’s also important to disinfect any common areas in your home on a regular basis. Get in the habit of cleaning shared surfaces first with soap and water, then with a diluted solution of bleach and water. You should also disinfect toys, pacifiers, and other objects that may be contaminated with the virus.

If your child or you experience symptoms such as a fever or sore throat, stay home from school or work. You should continue avoiding contact with others once the telltale blisters and rashes develop. This can help you avoid spreading the disease to others.

How long are you contagious?

Persons with HFMD are most contagious during the first week of the illness. They can sometimes remain contagious, though to a lesser degree, for a few weeks after symptoms go away. Your child should stay at home until her symptoms resolve. They may then return to school, but still needs to try and avoid close contact with their peers, including allowing others to eat or drink after them. They also need to wash their hands frequently and avoid rubbing their eyes or mouth, as the virus can be transmitted through body fluids.

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.

Dengue Fever

Dengue Fever is a painful, debilitating, mosquito-borne disease caused by any one of four closely related dengue viruses.

An estimated 390 million dengue infections occur worldwide each year, with about 96 million resulting in illness. Most cases occur in tropical areas of the world, with the highest density of cases clustered in the following areas:

• The Indian subcontinent
• Southeast Asia
• Southern China
• Taiwan
• The Pacific Islands
• The Caribbean (except Cuba and the Cayman Islands)
• Mexico
• Africa
• Central and South America (except Chile, Paraguay, and Argentina

Dengue fever is transmitted by the bite of an Aedes mosquito infected with a dengue virus. The mosquito becomes infected when it bites a person with dengue virus in their blood. It does not spread directly from one person to another person.

Symptoms of Dengue Fever

Symptoms of Dengue usually begin four to six days after initial infection and last for up to 10 days. These  may include:

• Sudden, high fever
• Severe headaches
• Pain behind the eyes
• Severe joint and muscle pain
• Fatigue
• Nausea
• Vomiting
• Skin rash, which appears two to five days after the onset of fever
• Mild bleeding (such a nose bleed, bleeding gums, or easy bruising)

Occasionally, symptoms are mild and can be mistaken for those of the flu or other viral infections. Younger children and people who have never had dengue tend to have milder cases than older children and adults. However, serious problems can develop in either case . This can include dengue hemorrhagic fever, a rare complication characterized by high fever, damage to lymph and blood vessels, bleeding from the nose and gums, enlargement of the liver, and failure of the circulatory system. The symptoms may progress to massive bleeding, shock, and death. This is called dengue shock syndrome (DSS).

People with weakened immune systems as well as those with second or subsequent dengue infections are believed to be at greater risk for developing dengue hemorrhagic fever.

Diagnosing Dengue Fever

Dengue is readily diagnosed through blood testing. Samples should be taken after 4 days of symptoms though newly developed rapid test kits are also available. 

Treatment for Dengue Fever

There is no specific medicine to treat dengue infections. Primary treatment protocols include aggressive hydration, fever and pain control, and supportive care with routine blood monitoring. In event of severe complications, patients should be referred to the hospitals for further treatment. 

Preventing Dengue Fever

There are no available vaccines to prevent dengue fever at this stage. The best way to prevent the disease is to prevent bites by infected mosquitoes, particularly if you are living in or traveling to a tropical area. This involves protecting yourself and making efforts to keep the mosquito population down.

For self protection:

• Stay away from heavily populated residential areas if possible.
• Use mosquito repellents, even indoors.
• When outdoors, wear long-sleeved shirts and long pants tucked into socks.
• When indoors, use air conditioning if available.
• Make sure windows and door screens are secure and free of holes. If sleeping areas are not screened or air conditioned, use mosquito nets.
• If you have symptoms of dengue, speak to your doctor.

To control the mosquito population, get rid of places where mosquitoes can breed. These include old tires, cans, or flower pots that collect rain. Regularly change the water in outdoor bird baths and your pets' water dishes.

If someone in your home gets dengue fever, be especially vigilant about efforts to protect yourself and other family members from mosquitoes. Mosquitoes that bite the infected family member can spread the infection to others in your home.

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.

Tuberculosis

Overview

Tuberculosis (TB) - a disease that has plagued humans since the Neolithic times. This, is an age old enemy.

Two organisms cause tuberculosis -- Mycobacterium tuberculosis and Mycobacterium bovis.

The Ancient Greeks called TB "Phthisis" to reflect its wasting character.

Come the 17th and 18th Century, TB was suspected to be responsible of up to 25% of all deaths in Europe.

The 19th Century saw the bacteria that caused TB being isolated but no effective treatment was available until the mid 20th century.

Yes, TB is an age old enemy.

Causes of TB:
TB is transmitted via air droplets from infected individuals. Once inhaled, the bacterium invades the lungs and subsequently erode lung tissue.
Risk factors for TB include the following:

• HIV infection,
• low socioeconomic status,
• alcoholism,
• homelessness,
• crowded living conditions,
• diseases that weaken the immune system,
• migration from a country with a high number of cases,
• and healthcare workers.

Tuberculosis: Symptoms and Signs

TB might not surface clinically until the disease is advanced. Even then, symptoms can be vague - weight loss, mild fever, and a productive cough. Often, these symptoms are misinterpreted or misdiagnosed as other illnesses.

Any close contact with infected individuals should be referred to a doctor and tested for tuberculosis.
Tuberculosis: Diagnosis

• Chest X-ray
• Mantoux skin test, otherwise known as the tuberculin skin test (TST orPPD test).
• Sputum testing for acid-fast bacilli. This is the gold standard for TB diagnosis. 

Tuberculosis: Treatment

TB treatment is normally done on an outpatient basis. The treating doctor will prescribe several courses of medications that might last for as long as 6-9 months. It is essential that you complete your course of treatment to totally eradicate the disease.

Public health concerns should also be prioritized as exposure to other people will harm the community as a whole. Social responsibility should be observed by infected individuals. All exposed individuals to the patient should under the appropriate investigations such as a Chest X-Ray and/or the Mantoux test for farther evaluation.

Tuberculosis: Prevention

Controlling the disease in infected individuals, and controlling the disease within the community.Infected individuals should consume and complete the full course of prescribed medications while vaccinations like the Bacille Calmette-Guerin (BCG) vaccine stops the spread of TB in the community.

Tuberculosis: Prognosis

As long as the treatment protocol is observed and completed in its entirety, a normal lifestyle and lifespan is the norm.

TB is a treatable disease with the chance of total cure. Do not let it ruin your life.

Seek treatment now.

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.

Flu or Cold Symptoms?

You feel unwell. You’re coughing, your throat is sore, your nose is runny, you have a headache.

Do you have the cold or the flu?

This is important, because if you have the cold, it’ll pass. If you have the flu, and you don’t do anything about it, there’s that nasty possibility of that thing Doctors call “Progression of Disease” happening. i.e. Your “flu” might result in a Pneumonia, hospitalization, or worse.

So, what are the symptoms of the common cold?

A sore throat, which usually goes away after a day or two.
A runny nose alternating with nasal congestion and a cough by day 4 to 5.
For adults, occasionally a fever develops. For Children, fevers commonly occur.

How long do cold symptoms last?

One week. You will be contagious from Day One to Day Three. So stay at home and rest.

If, however, your symptoms do not subside by a week, you might possibly have a bacterial infection. i.e. You might need antibiotics, an allergy or a sinus infection.

What then, are the symptoms of flu?

Flu symptoms mimic the cold but are more aggressive and severe. The onset is usually more rapid and the experience intense. In severe cases, patients with the flu will experience nausea, vomitting and diarrhoea.

To Differentiate between the Two …

Symptoms	Cold	Flu
Fever	Occasional, if present, usually mild.	Common, and lasts 3 to 4 days.
Headache	Occasional.	Common.
General Aches, Pains	Slight.	Severe.
Fatigue, Weakness	Sometimes.	Common, and can last 2 to 3 weeks.
Extreme Exhaustion	Never.	Commonly experienced with onset of illness.
Stuffy Nose	Common.	Sometimes.
Sneezing	Usual.	Sometimes.
Sore Throat	Common.	Sometimes.
Chest Discomfort, Cough	Mild to moderate; hacking cough.	Common; can become severe.
Complications	Sinus congestion; middle ear infection.	Sinusitis, bronchitis, ear infection, pneumonia; can be life-threatening.
Prevention	Wash hands often; avoid close contact with anyone with a cold.	Wash hands often; avoid close contact with anyone who has flu symptoms; get the annual flu vaccine.
Treatment	Decongestants; pain reliever/fever reducer medicines. If symptoms persist, see your doctor.	Medical Review recommended.

When do I call the doctor with flu or cold symptoms?

Call your doctor if you have any of the following severe symptoms:

• Persistent fever lasting more than three days
• Painful swallowing secondary to a sore throat
• Persistent coughing
• Persistent congestion and headaches

In some cases, you may need immediate medical attention. Call your doctor if you experience any of the following:

• Severe chest pain
• Severe headache
• Shortness of breath
• Dizziness
• Confusion
• Persistent vomiting

In children, additional signs of an emergency are:

• Difficulty breathing or rapid breathing
• Bluish skin color
• Not drinking enough fluids
• Lethargy and failure to interact normally
• Extreme irritability or distress
• Symptoms that were improving and then suddenly worsen
• Fever with a rash

How to prevent flu or cold symptoms?

• Handwashing. 
• Rub the hands with warm soapy water for at least 20 seconds before rinsing.
• In addition, get a flu vaccine to prevent seasonal influenza. 
• Antiviral medicine may also help prevent flu if you have been exposed to someone with flu symptoms.

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.