Dear @Ian 

I am sorry to hear of your injury. Injuries to the biceps femoris have indeed been reported in isolation or with concomitant injuries to the adjacent ligaments within the knee. You seem to describe a Grade 4 injury - Complete muscle injury with discontinuity and retraction. While surgical repair is generally advocated to restore the native anatomic features to minimize loss of function and strength, there is still no consensus on optimal management with regard to successful return to sport. This is perhaps why you had been advised against surgery.

Hamstring injuries are the most common injury in sports. Unfortunately, they are associated with long rehabilitations and have a tendency to recur. In isolated injuries, he treatment is conservative, with the use of anti-inflammatory drugs in the acute phase followed by a muscle rehabilitation program. Proximal avulsions have shown better results with surgical repair. 

In general, conservative therapy is indicated for single-tendon acute proximal tendon avulsions or multiple tendon lesions with less than 2 cm of retraction. 

Surgical treatment is the best option for ischial apophysis avulsions in skeletally immature patients, avulsions with the HS bone fragment, and proximal avulsions of the entire HS complex. Surgery is also indicated in patients with avulsions in one or two tendons and retractions greater than 2cm. In recreational athletes or inactive patients, surgery is indicated only if the patient is symptomatic.

With the information you have given, you have mentioned a retraction of 70mm = 7cm. You also mention that you are not an elite athlete. Decision for surgery or primary rehabilitation in your case is a difficult and challenging one that needs to be made in a shared and mutual manner with your physician. I hope this helps with some clarification at least.

Hi @sickboiboi although muscle aches are part and parcel of exercise, pain is also the first sign an injury may be developing, some of which could permanently impair your ability to exercise. As a general rule of thumb, one should rest during aches like these. If pain persists despite a period of rest, then a consultation and examination with your doctor may be required.
 
It is also best to adapt your fitness regime to your own needs as everyone's body is different. If you find a lot of aching in a certain muscle group with your current regimen, you may want to explore focusing on other unrelated muscle groups and/or cycling between them to facilitate rest (e.g. cardio-legs training, and upper body-strength training). Hope this helps!

@fiona sorry for your present condition. It can be an allergic reaction. Some foods or dust from your home or clothes or insect ocean cause this condition. If the condition is really too much itching and grows very rapidly then it would be Urticaria. In normal allergic condition you need antihistamine or anti allergic medicine.But in Urticaria you must need to take some Low dose steroid with antihistamine drugs.
I would like to suggest you to go nearest GP chamber and take medicine if this condition is intolerable.
Take care.Hope your quick recovery.

Dear @angella ,

I am sorry to hear of your accident. You indeed have a fractured clavicle (collarbone). I am not quite sure what they meant by a 'fissured scapula'. Clavicle fractures can be treated conservatively - by an arm sling if there no open wounds, skin is not tented and/or if you have no injuries to the blood vessels and nerves in the area. Having said that, there are studies that show that collarbone fractures with significant displacement and shortening will result in some functional deficit (i.e. weakness in shoulder movement etc) if left to heal on their own. I would suggest a repeat X-ray within 2 weeks of the initial injury and a review by an Orthopaedic Surgeon to discuss the progress and the options available to you. I hope this helps!

A very good day to you
GERD is a complex condition that requires  proper investigation into the causes of both the acidity within the stomach and the mechanisms of the reflux of the acid into the stomach.
Thereafter, using this information, the diet and lifestyle modification that is required can be formulated. This goes a long way in relieving the symptoms.
Further to that would be very effective medication that would help with both acid reduction and the anti-reflux mechanism.
It is also important that a gastroscopy is done to confirm the diagnosis and to look for causes and complications of GERD like inflammation, ulcers and pre cancerous changes. To achieve this, it would frequently require biopsies during the gastroscopy. Helicobacter Pylori bacteria within the stomach is also an important cause will be tested for as well. There are other important tests like the pH and pressure monitoring or even the traditional barium swallow that can give further information on the diagnosis and severity of the disease. 
With all this information at hand, it can improve the symptoms and manage GERD very well.

Dear @PG ,

Thank you for your question.

Before medical professional suggest any form of therapeutics, we usually would advise to evaluate to ascertain the cause behind a symptom. In this context, gynaecomastia is a presentation of some possible underlying issue which needs to evaluated for and investigated.

The causes of gynaecomastia are varied and it includes ( list not exhaustive),

Since Liver and Kidney issues could be , at times, be a reason behind gynaecomastia, I would strongly advise you to see your family physician at the earliest before commencing any supplements on your own. The reason being, supplements are processed by the liver and kidneys and we would not want the supplements to negatively affect these two vital organs.

Hope this helps.

 

Dear @joheet 

Thank you for your question. Indeed, sitting for long hours and working is one of the common causes why people develop a stiff and sore back. From the symptoms that you have described, it appears like that pain is limited to the lower back without any radiation of pain or an 'electric' sensation running through the legs, which is good. That means that it is less likely that there is any form of nerve impingement. The fact that you get temporary relief from standing, walking and foam rolling also clues in to the fact that a large component of your pain is muscular in origin.

While it is going to be the new norm that a significant number of people will be working from home, I think it is good to consider augmenting our home environment and our practices to suit this 'new norm'. First of all, I would advise you to take breaks every 1-2 hours or so of sitting to do gentle stretching to 'loosen' your back muscles. Injuries to the back usually happen when the spine is stiff. Sudden movement of a stiff spine often causes injury which results in pain. Pain that leads to even more stiffness. Therefore, in order to break this vicious cycle, regular stretching is useful. You can find some simple stretching exercises on the Internet. Regular yoga  or pilates classes may be useful to improve flexibility too, if you can afford the time. Once you have incorporated the regular stretching to your routine, you can then transit to adding further exercises to strengthen your back muscles. 

Apart from these exercises, having good back care habits are important. For example, bending the knees to lift objects from the floor rather than bending the back. Sitting with a good posture while typing. Having a good back support on your chair.

I hope these tips will be useful for you!

Dear @Aiden 

Thank you for your question and I am sorry to hear of your plight. Am I correct to say that you had made an uneventful recovery since your hip replacement and this pain that you are feeling is something new that you are experiencing in the last 2 months? There can be several causes for the symptoms that you are describing. These can be broadly classified as intra-articular (from inside the prosthetic joint) and extra-articular (from outside the joint i.e. muscles, tendons,  bone spurs etc.). Sometimes while the pain is felt at the hip, the problem can be somewhere else, most commonly the spine. This is what we call 'referred pain'. However, from what you have described in your post it does not see like this pain is of spinal origin. You have not mentioned any redness in the area or fever which is great because we can rule out infection. A physical examination by a doctor and some basic imaging like an X-ray of the joint may be useful as a starting point to evaluate your pain. However, further imaging such as MRI (excellent for soft tissues like muscles and tendons) or CT (excellent for bone and to assess alignment of the hip joint) may be needed if the X-ray do not reveal anything. My advice would be to take a break from the long walks and get the physio to do a basic assessment of the movements of your hip as well as the strengths of the major muscles around the hip joint. It would be best to get the surgeon who did your hip replacement to have a look at you if at all possible. 

Hi @Fiqah thats an interesting question! However, no medications (including antiretrovirals) have been proven in clinical studies to prevent (as relevant to your question) nor treat the COVID-19  virus to date. In fact, patients with HIV can have impaired immune systems, and may be at increased risk of poorer outcomes if they catch the infection.

Hi @Kelly  acne has many contributing factors, including genetics and hormones. Hormones as you alluded to commonly lead to acne in the teen years due to changes around puberty. That aside, hygiene and diets high in processed, suger-rich foods have also been highlighted in the medical literature as contributing causes.

It sounds like you have already adopted extensive hygiene measures, and as for diet, keeping well hydrated and minimising consumption of processed, suger-rich foods like bubble tea would be beneficial. There are several prescription medications that are vitamin A derivatives which can certainly help, however they have some considerations such as not being safe for individuals trying to get pregnant. Ultimately, given the extent of acne and scarring you describe, you may want to visit your GP for a review and detailed discussion about these potential oral treatment options that may help get the condition under control.  Hope this helps!

Hi Jess,

Sorry to hear about your compression fracture! I presume this is a compression fracture of your spine. These fractures usually are healing at 2 months so it would not be usual to be having cold sweats and symptoms at 2 months. It could be because the fracture is not healing well, or complications such as an infection or nerve compression have developed. Would suggest getting it checked by your specialist or a specialist to assess if any of these issues have developed.

Hi @Iamking Milk Thistle is a type of weed and is sometimes also called "Silymarin" which is a chemical derived from parts of the plant like its seed, and it is believed to help with liver related conditions, particularly with poisoning from some mushrooms that affect the liver ("Hepatotoxic"). However, medical-grade studies of it and the other "liver supplements" have not yielded any conclusive benefits.

That said, you're absolutely spot on! Healthy diet and exercise is the best defence for good liver health, not forgetting also the importance of managing alcohol consumption and drinking only in moderation. More about it at this link here: https://www.healthhub.sg/live-healthy/182/alcohol_health_setting_drink_limits

Other measures you can take to ensure good liver health include safe sex and ensuring your hepatitis vaccinations are up to date, these include hepatitis A vaccination if you are traveling to "high risk" regions. Speak to your GP about this especially if you're traveling to any rural regions or developing countries. Hope this helps!

A hard lump in the breast is of concern.
I would advise you to consult a doctor for proper examination and evaluation. 

Hi, thank you for the question. There is no medical evidence or medical reason linking drinking cold water/ eating cold food and menstrual cramps. Having said that, sometimes what you experience and what medical evidence and reason says might be different. Everyone's body and mind responds differently to different stimuli. So if you personally notice and experience a correlation between drinking cold water / eating cold food and making your menstrual cramps worse, then do avoid it and drink warm water and take warm food.
Soaking in a warm bath and applying a warm water bottle to your lower abdomen might help ease your menstrual cramps.

Hi, thank you for the question. Eczema and hives (urticaria is the medical term) are 2 separate conditions, although some patients suffer from both. Some patients do have chronic hives (urticaria) which means they can have it for months, or have frequent relapses without antihistamine medications (eg cetirizine).
If you get frequent relapses of your hives after stopping cetirizine, I will advise you to continue taking cetirizine daily for a few weeks and then slowly try cutting down. Cetirizine is a safe medicine to take long term.
A small portion of patients with hives have underlying conditions like liver problems, thyroid problems and other organ problems. But these are rare.
Do consult a doctor if your condition persists. 

Dear @Joseph ,

Thank you for your question. I am sorry to hear that you have been troubled by low back pain for a few years. Low back pain is a very prevalent problem across the world. There are may causes of low back pain. We would need more information about your symptoms. This coupled with the signs that we find on physical examination would then allow us to make an informed diagnosis. Since you have been troubled by the pain for a few years now, I would encourage you to see a doctor. Details on the following will be very useful for the attending doctor:

1. How did the pain start?

2. Was there any trauma/injury?

3. Is it a sharp pain or dull ache?

4. Where in the back is it located?

5. Has it always been there or does it ‘come and go’?

6. At its worst, how bad is the pain from a scale of 0-10?

7. At its best, how bad is the pain from a scale of 0-10?

9. Does the pain shoot down either leg?

10. Do you have any numbness or weaknenss in either leg?

11. Do you have any trouble passing urine or motion?

12. Is your walking affected?

13. Is your sleep affected?

The most common cause of low back pain is usually an injury to muscles or ligaments of the back which usually recovers with rest and physiotherapy. With age, the spine undergoes degeneration (lumbar spondylosis) and this can cause pain too. 

 

I hope the above information is helpful. For a start, avoid lifting heavy weights and observe good posture and back care habits. You can do some core strengthening exercises (easily found off the web) as well as stretching exercises for the back while waiting to see your doctor. Take care!

Hi @Steve sorry to hear about your predicament! Sesamoiditis is inflammation of sesamoid bones at their attachments. Sesamoids are unique in that they connect with muscles via tendons, unlike most other bones that connect with each other at joints. Sesamoiditis is more common at the knee (patella/knee cap which is technically a Sesamoid, but sometimes also called tendinitis) and the bottom of the foot, although the hand has sesamoids in the region called the "Volar plate".

There are several possible causes of pain in the region you describe, apart from bony disorders like Sesamoiditis, there can also be soft tissue disorders (e.g. affecting muscle tendons or their protective layer/"tendon sheath") in the area. Common examples for the latter include trigger finger and De Quervains tenosynovitis, although one would expect the shots to have at least provided some temporary relief. You can read more about them here: https://www.health.harvard.edu/diseases-and-conditions/tendon-trouble-in-the-hands-de-quervains-tenosynovitis-and-trigger-finger

Unfortunately, it would not be possible to distinguish between them without first finding out more about your lifestyle, circumstances surrounding the start of your symptoms, aggravating factors, as well as performing an examination in-person of the affected area. However, these are fairly standard assessments and I trust your provider would already have done them, and likely came to the conclusion of sesmoiditis based on these and has offered surgery due to the lack of response to the shots.

Perhaps if there is still uncertainty surrounding this, you may want to discuss with your physician the option of performing an imaging scan such as an MRI to evaluate further. Hope this helps!

Hi @respect thats a great question! However this is still uncertain in the context of this new and ongoing pandemic. While researchers are fairly certain that the COVID-19 virus began as a zoonotic infection that likely started spread to humans from bats, it is not certain if it can spread to other animals and insects as mentioned. Ultimately, the best way to reduce your risk of catching the infection is through hand hygiene and wearing masks when exposed to others (or even animals) that are unwell.

The CDC echoes this uncertainty, and has also shared about a possible case of spread from humans to tigers/lions in a New York zoo here: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html

Hi @MANJU it is possible for mild contusions after the injury you describe, however one wouldn’t expect the pain to continue for so long in that nature. I recommend for you to see your doctor for an examination to determine if any further assessment may be required.

Hi @BusinessJing thank you for your questions! There's alot to unpack here and I will try to answer them one by one. With respect to the role of benzalkonium chloride/quat, I am not able to identify any robust studies that support these conclusions. Also, the claims of "self-disinfecting" coat that I could find from companies online also are not substantiated by any robust evidence as you rightly pointed out. 

With regards to re-infections, studies are being conducted locally and abroad to understand this risk. One consideration is that existing reports of re-infections from other countries are based on the use of early versions of COVID-19 tests that became available at the start of the outbreak. These are imperfect with high rates of false positives/negatives reported in various cross-validation studies. 

Therefore, it is possible that the patient(s) in question may have had a false negative test, whereby subsequent testing was a true positive and may have wrongly led to the conclusion of re-infection. In other words, with studies still ongoing, it is still too early to make any conclusions about this. Fortunately in Singapore, we have taken a conservative approach to guard against this by only considering patients as "recovered" after multiple consecutive negative tests.

Long-term repercussions such as pulmonary fibrosis are driven by the disease rather than the context (aside from variations in national mortality rates), and will likely be the same in Singapore as they are elsewhere. The claim about vitamin D does not appear to be based on any definitive evidence that I can find.