OneDoctors NEW CLINIC at PUNGGOL Waterway Point

OneDoctors opens a new family clinic at
Waterway Point in Punggol (next to Punggol MRT, Exit A).

From 18 Jan 2016 onwards,
We are OPEN for consultations!

Find us at #02-17 West Wing 
(opposite Swensen's, above Starbucks and Uniqlo).
Tel: 6385 8018

Family Physicians :
Dr Soh Wah Ngee
Dr Jonathan Tan

ASTHMA CONTROL

HPV VACCINATION - CERVICAL CANCER PROTECTION

VACCINATIONS FOR ADULTS & SENIORS

Are you or your loved ones over 65 years old?

Are you or your loved ones a smoker or on long term medications like steroids?

Do you or your loved ones have chronic diseases like heart disease, diabetes, asthma, chronic bronchitis or liver disease?

If so, the following vaccinations are strongly recommended:

1) Pneumonia (Pneumoccocal 13 & 23 vaccinations) *updated
- single dose each

2) Shingles (Herpes Zoster vaccination) 
- single dose

3) Diptheria, Pertussis and Tetanus (DPT vaccination) 
- single dose every 10 years

4) Flu (Influenza vaccination) 
- single dose every year, preferably at end of the year before the northern hemisphere winter season

OSTEOARTHRITIS, KNEES

Osteoarthritis (OA), also known as degenerative arthritis, is a condition of the joint that worsens with time. It is the most common type of arthritis and there is no cure.

It is caused by wear and tear due to excessive use over the years or to old injuries in the affected joints. It commonly affects people over 60 years of age. It mostly affects the large weight-bearing joints like the knees, hips and spine, causing pain and stiffness which is worst at the end of the day. The affected person may have difficulty in walking, climbing stairs, squatting or kneeling.

RISK FACTORS

• Family History

• Sex ( Females are at higher risk)

• Obesity ( 66% of obese people are at risk for Knee OA )

• Age ( higher risk above 45 years old)

• Joint Injuries

• Physical Activities ( repetitive trauma to joint)

• Ethnicity ( Asians are at higher risk )

FEATURES

Typical features include :

1. narrowed joint space

2. cartilage loss and damage

3. bone spur formation

SIGNS AND SYMPTOMS

Signs and symptoms include :

1. Joint pain and swelling

2. Cracking sounds in joint

3. Stiffness

4. Difficulty in movement

70% of OA cases are that of Knee OA.

25% of sufferers are unable to perform major activities of daily living.

TREATMENT OPTIONS

1. Lifestyle modification ( weight loss, decreased weight-bearing activity etc)

2. Physiotherapy ( strengthening of the muscles around the joint )

3. Oral supplements ( e.g glucosamine)

4. Painkillers ( side effects of medications need to be managed carefully )

5. Joint Injections ( steroids, viscosupplementation)

6. Surgery ( for severe cases when all other treatments have failed to provide relief)

LATEST UPDATES

Viscosupplementation is indicated for the treatment of pain in patients with Knee Osteoarthritis, who have failed to respond adequately to conservative therapy and painkillers. It involves an injection into the affected knee joint. It basically replaces damaged joint fluid with a substance similar to healthy joint fluid, in order to reduce pain, improve the knee joint's natural shock-absorbing qualities and to improve mobility and function.

The response to this injection varies from patient to patient, but relief from pain is felt from 1 week to 6 weeks post-injection. Pain-relief with this injection can last from 6 months up to 1 year.

Patients can opt for either the one-time injection or the series of 3 injections on Day 1, Day 8 and Day 15. The effects of both are similar.

Prices are around $840 for the single injection,

or $280 per injection for the series of 3 injections.

References: http://www.hpb.gov.sg/diseases/article.aspx?id=568

PNEUMOCOCCAL DISEASE

Pneumococcal Disease (PD) describes a group of illnesses caused by the bacterium Streptococcus Pneumoniae, also known as Pneumococcus.

There are more than 90 sub-types of this bacterium. It affects both children and adults and is a major cause of morbidity and mortality worldwide. Serious pneumococcal infections are a global health problem but are vaccine-preventable.

Worldwide, a million children die from PD each year. In Singapore, up to 70 per 100,000 children less than 5 years old are affected by PD. Pneumococcus is also the most common cause of community-acquired pneumonia (CAP) accounting for 19-25% of all cases.

TRANSMISSION

It is commonly found in the nose and throat of healthy children and adults, with as many as 4 serotypes carried at once. While not all individuals will get sick from Pneumococcus, anyone in whom the bacteria has colonized is a carrier, and can potentially infect others through airborne particles.

Although anyone can get PD, some are particularly at high-risk for the disease. They include infants, the elderly and individuals with chronic medical illnesses or weakened immune systems.

EFFECTS

After Pneumococcus colonizes in the upper respiratory tract, it can cause

• Bacteraemia/Sepsis (infection of the blood),
• Meningitis (infection of the membrane of the spinal cord or brain)
• Pneumonia (infection of the lungs),
• Otitis Media (infection of the middle ear) and
• Sinusitis (infection of the sinuses).

TREATMENT

Prompt treatment with antibiotics is usually effective. In recent years due to the emergence of antibiotic-resistant strains, particularly to penicillin, the treatment of PD has become more challenging and may need a longer hospital stay along with expensive alternative therapy.

PREVENTION

The best way to protect against PD is through vaccination. Vaccines are generally safe and effective.

A single dose of PPSV (Pneumococcal Polysaccharide Vaccine) is protective against 23 of the most prevalent strains of the bacteria in adults. Vaccination with PPSV is recommended for:

• People aged 65 years and above
• Those who have a chronic medical illness such as Diabetes, heart, lung and liver diseases
• Those who have asthma or smoke cigarettes

• Those with a weakened immune system due to human immunodeficiency viral (HIV) infection or cancer
• People without a functioning spleen and those with sickle cell disease
• Residents of long-term care facilities such as nursing homes

VACCINATION
For adults aged 65 and above
2 injections, at least 1 year apart are recommended.

Children younger than 2 years old
are at a higher risk for serious PD than older children, hence vaccination with PCV (Pneumococcal Conjugate Vaccine) is recommended for them. The number of doses and the intervals between doses depend on the child’s age. It is also part of the childhood vaccination schedule recommended by the National Immunisation Registry of Singapore.

CONCLUSION

Pneumococcal disease is a preventable disease with the current vaccines covering up to 90 percent of disease-causing pneumococcal strains, including the six serotypes that most frequently cause invasive drug-resistant pneumococcal infections among children and adults.

The chances of your child or parent getting infections like meningitis, pneumonia and sepsis can be greatly reduced.

Please check with our doctors for further information.

References :

http://www.hpb.gov.sg/diseases/article.aspx?id=8314

http://www.cfps.org.sg/sfp/36/362/362_unit5.pdf

CERVICAL CANCER VACCINE

WHAT IS CERVICAL CANCER?
A woman’s cervix is located at the lower part of the womb. Changes can occur in these cells and in many cases, the cells return to normal on its own. However, in some cases, the cells change in an abnormal way and develop into cervical cancer. Cervical cancer can be prevented if these abnormal changes are detected and treated in its early stages. In Singapore, about 200 women are diagnosed with the disease each year, and 80 die of it, most likely because it is discovered late.

HOW CAN CERVICAL CANCER BE DETECTED?
Cervical cancer can be detected by a Pap smear. It is a screening test to check for changes in the cells of your cervix whereby cells are collected from your cervix. The process takes only a few minutes. The cells are then smeared onto a glass slide and sent to a laboratory for further processing and examination under a microscope.

Pap smears are recommended for sexually-active females from age 18 onwards. The frequency of screening is from 1-3 years, depending on risks. Most family clinics should be able to provide this service.

THE LINK BETWEEN CERVICAL CANCER AND HPV
Some types of Human Papilloma Virus (HPV) can infect the cervix, causing the cells to change. In about 90% of the infection cases, the virus clears by itself and the cells return to normal. In some cases, the infection can persist and cause the cells to grow in an abnormal way, developing into cervical cancer. Specifically, HPV types 16 and 18 causes about 70% of the cervical cancer cases worldwide.

WHAT IS THE HPV VACCINE? The HPV vaccines are targeted for use in females aged 9 to 26 years old. They are most effective in protecting against infection by the selected HPV types if given before first sexual exposure. Vaccination does not substitute for cervical cancer screening by regular Pap smears. However, new evidence shows that the vaccinations are effective in women up to 45 years of age.

It is important to know that the vaccine is not designed to protect against other HPV types (i.e. non-type 16 or 18) that cause about 1 in 3 cases of cervical cancer. It is also important to remember that the vaccination works by preventing infection by the specific HPV types – it does not treat existing HPV infections.

The vaccination schedule is 3 doses at 0, 1-2 month and 6 month interval. The Expert Committee for Immunisation in Singapore has recommended that HPV vaccinations be included in the national childhood immunisation programme.

In summary, HPV vaccinations are strongly recommended for girls and ladies from the age of 10 onwards, in particular teenagers and young adults. It should be considered for at-risk females up to 45 years of age as well.

Do drop by our clinics for any enquiries or a detailed consultation to find out more.

References :
http://www.hpb.gov.sg/diseases/cervicalcancer.aspx
http://www.hpb.gov.sg/healthscreening/article.aspx?id=8766 http://www.hpb.gov.sg/hpb2/qnahpb_faqmain.asp?strItemChoice=200511803814&strSubItemChoice=20051180393&action=SHOWTOPICS&m_strTopicSysID=2008430144324#20051180393 http://www.healthxchange.com.sg/News/Pages/Cervical-cancer-jabs-covered-by-Medisave.aspx

CHILDHOOD VACCINATIONS

For the newborn and the young children, there are many infections that can make them seriously ill. Fortunately for many of these serious and very contagious diseases, there are vaccinations available.

What vaccinations do is stimulate the child's body to produce antibodies that can fight and protect the child from these infections. Some vaccinations can last a lifetime, while others may need booster shots to 'strengthen' the antibodies titre (quantity) or make the antibodies last a long time.

As in many countries, Singapore's National Immunisation Registry has provided a recommended childhood immunisation schedule. (See chart)

At birth, the first 2 vaccinations (BCG and Hepatitis B) are usually done in the hospital. The subsequent vaccinations from age 1 to 18 months can be done at polyclinics, most family clinics or paediatric clinics.

In fact, the basic vaccinations are provided free at the polyclinics. The exceptions are Hepatitis B and Pneumococcus as well as the newer combination vaccinations that come with fewer side effects and injectable Polio (included in the 5-in-1 or 6-in-1 shots). There are also optional vaccinations to consider, eg., Chicken Pox, Meningitis and Hepatitis A.

Vaccinations scheduled for age 6 years (Pri 1) and 11 years (Pri 5) are conducted in the local primary schools by the School Heath Services. However, parents can choose to opt out and have the required vaccinations done by their family doctors. For secondary school girls, cervical cancer/HPV vaccine is also recommended.

Our clinics provide vaccinations for
1) childhood

2) adult

(Tetanus, Polio, Flu, Hepatitis A&B, Cervical Cancer/HPV, Chicken Pox, etc)

3) elderly

(Flu, Pneumoccocus, etc)

4) travel

(Typhoid, Hepatitis A, Flu, Polio, Tetanus, Meningitis).

For enquiries, please call our clinics:

AMK - 6554 2918

Novena - 6254 2008

nex - 6634 4918

*Edit* - from 1st Dec 2011, there is a change in the MMR vaccination schedule. The 2nd dose of MMR should be completed by age 2 (previously during Pri 1 at age 7).

http://www.nir.hpb.gov.sg/nir/sv/eservices/eservicesv;HPBSession=P2p4FGQXM76H2mPyHy0q4K8klhZtNwvgNb4wbgHjPdWbtbpp1npd!-269283691?ACTION=DISPLAY_IMMUNSCH

CERVICAL CANCER VACCINE

Cervical cancer vaccine is available at our clinic. The course consists of 3 doses over a 6-month period.

The vaccines are currently approved for use in females aged 10 and above. The vaccines protect against infection by Human Papilloma Virus (HPV). It is preferably given before first sexual exposure. Vaccination does not substitute for cervical cancer screening by regular Pap smears for sexually active females. MOH's Expert Committee on Immunisation (ECI) has recommended that HPV vaccines, which are clinically safe and effective, be included into the National Childhood Immunisation Programme (NCIP) for females, in order to prevent cervical cancer. (30 Sep 2010)

ST report 22/7/2010

http://www.channelnewsasia.com/stories/singaporelocalnews/view/1070877/1/.html

About the vaccine -

http://www.cervicalcancercampaign.org/ccfacts/vaccine.html

About cervical cancer -

http://www.hpb.gov.sg/diseases/cervicalcancer.aspx

http://www.hpb.gov.sg/healthscreening/article.aspx?id=8766

HFMD

The numbers of Hand, Foot and Mouth Disease (HFMD) cases are still high in Singapore. Actually HFMD cases are seen all year round in Singapore. Every now and then, however, there are outbreaks especially in places like childcare centres, kindergartens and primary schools.

According to the latest MOH figures, there are 732 reported cases of HFMD for the week 37, 12-18 Sept 2010 (compared to 157 in 2009).

HFMD is highly contagious. It is usually spread by direct contact from person to person via body fluids like saliva and nasal discharge, fecal material and fluid from the rash.

The diagnosis of HFMD is usually based on clinical symptoms, which include:

• low-grade fever
• oral ulcers
• rashes in palms, soles or buttocks
• loss of appetite and lethargy
• some may also have mild gastric flu or cough/cold symptoms

*The pictures below are taken from the Health Promotion Board website.*

The child with HFMD is usually not very sick but he should stay 'isolated' at home for 5-7 days even if the symptoms are mild. Very rarely, HFMD can develop complications especially with the EV71 virus. Seek immediate medical attention if the child is vomiting excessively, dehydrated, extremely tired or unusually irritated.

Management of HFMD is usually symptomatic. This includes 'tender loving care' from care-takers. Doctors usually prescribe:

• topical oral medication for the painful ulcers
• fever/pain medications
• anti-inflammation medications to help with recovery
• and rarely antiviral medications for the very sick or immune-suppressed patients
• medical leave for 5-7 days

Hygiene practices are of paramount importance for the infected child, care-takers and family members. Wash hands before meals and after visiting toilets. Do not share eating utensils and toys. Also remember to look out for symptoms among the family members including adults.

Lastly, send the child back to childcare or school only when there are no more:

• fever
• oral ulcers
• rashes.

Read more:
http://www.moh.gov.sg/mohcorp/diseases.aspx?id=418
http://www.hpb.gov.sg/diseases/article.aspx?id=792