How early a person starts undergoing mammogram depends on the background risk. For normal risk individuals, Hpb Guidelines recommend mammogram after 50 years old once every 2 years. However, in individuals with risk factors such as history of BRCA mutation in the family, strong family history of breast cancers, and in patients who experience symptoms, they shd undergo some form of screening at an earlier age. 

Hi @hojichatealatte 
The recurrence of the lesion on ur middle finger seems disturbing. I would advice seeing a doctor to confirm the diagnosis as it sounds like it is a wart versus callus however it is best for a doctor to see the lesion and confirm the diagnosis.  

Hi @Dan 
If your urticaria is well controlled on Telfast 180mg once a day dosage, u can up-titrate the dose by taking one and a half of the 120mg tablet to make it 180mg as a temporizing measure before your next clinic review. There are many anti-histamines that can be used in the treatment of chronic urticaria, but the choice of which depends on Clinical response and activity level (some may cause drowsiness). 

In the absence of Covid-19, sewage is usually considered odorous in general. It should be not a major concern with regards to increasing your risk of exposure to covid-19. 

Dear @Placesfaces thank you for your question! It must be difficult for your to continue your lifestyle given such disruptive sleep patterns. 

Unfortunately poor sleep can have a wide variety of causes though most cases are physiological/environmental compared to organic causes (i.e medical related illness). After eating massive meals the body does tend to become more "relaxed" or what we refer to as a "post-prandial state" which could explain why you are able to sleep better. Though this may be the case, I would not recommend having large meals and then immediately lying down/sleeping as this can potentially lead to troubling gastric related problems. If you do this, do remember to lie down after at least 1-2 hours to prevent gastric complications. 

Further, there have been multiple studies on Vitamin B itself (as a supplement) and unfortunately there isn't any conclusive data to say that it can help with insomnia. Though, low levels of vitamin B can lead to significant weakness/tiredness instead. So I can't really comment on why your sleep was better when you first started taking vitamin B. Perhaps there were other factors during this time that went unnoticed ? 

In general, it is important to rule out organic causes for poor sleep. The most common would be sleep apnea. Do you frequently wake up choking? Does your husband notice you snoring a lot and occasionally catching your breath at night? These are some questions that a doctor may ask to ascertain a potential medical cause. Other common causes include stress/anxiety/depression which can come with other unnoticed symptoms. It is also frequent in people who tend to work shifts. 

As this seems to be bothering you for a long period of time, I would recommend you consult your doctor as soon as you are able. Most medication available are merely temporizing and I would not recommend long term use for sleep unless prescribed by a psychiatrist. You could try some simple medication such as melatonin (can be bought over counter) as it has shown some benefits for sleep and has no addictive potential.  

Hi, 
I'm not a doctor but what you have sounded like UTI, better go and check it will damage your kidney if you don't. 

Dear @Kevin . Thank you for your question! It does sound like a troubling time for you; I do hope that everything remains well for you and your family especially with the number of cases in America. 

I would say that it is appropriate for you to sleep in a spare bedroom. Beyond that ensure to always use gloves when you are working, wash your hands thoroughly during working hours as well as before you leave for home and before you enter your house. It would not be out of the question to even shower before going home. As it has been found that a small proportion of people can remain asymptomatic with the virus and still spread it around, it would not be out of the question to stay somewhere else entirely. It would be best to limit your contact with your wife and especially your younger child. Though the number of serious cases amongst children have not been very high, they are at higher risk given their physiological state (poorer reserves) compared to adults.  

These measures are necessary as COVID tends to linger on surfaces as they are unable to remain suspended in the air. Hence it is more likely for you to get it from touching an "infected surface" followed by touching your face or eyes/eating/sharing food or drinks with colleagues. I hope your company has thoroughly disinfected the premises as well. 

Wishing you and your family all the best!

Hi @Iamking oh dear Im sorry to hear this! I am afraid there is quite a bit of swelling in the image, you may have a fracture and your condition requires a physical examination with a doctor for them to make that determination and create a management plan tailored to your needs accordingly. Given the severity of the pain and your being unable to bear weight on the foot, depending on the doctor’s findings on examination he may need to arrange an X-Ray for you to check if there is a fracture. 

Some may go to an emergency department for a condition like this, however I would not recommend that as the waiting time may be considerable. There are a few GP clinics that have X-Ray capabilities which you can consider to save time in case you end up needing a scan, these include the Raffles Medical Clinic at level 2 in Raffles Medical Hospital (RMH). In the mean time, try to avoid bearing weight on your foot and if the pain is severe, get help or use crutches/wheelchair (if you have any) as you make your way to the clinic. Hope this helps!

Hi @workerbee great questions! Answers as follows
1) The best thing to do, will be to wear a mask which can be cloth-based and obtained at your local CC, in alignment with our country's latest recommendations. If you do develop symptoms of a flu, such as cough, sneezing, running nose, body aches, fever, etc - see a doctor early for a review for further assessment.
2) It may be difficult to differentiate the two without seeing a doctor for an examination in the current context, unless there is a clear precedence with an established diagnosis of nasal allergy and exposure to a known trigger just prior to the onset of symptoms. To save time, you may want to try having an initial conversation with a doctor online using apps like DoctorWorld that provide video-based consultations, and the attending doctor would be able to prescribe medications and have them delivered to you if you need them. Here is a link that shares more about this: https://www.todayonline.com/brand-spotlight/doctor-will-see-you-next-app
3) The current crisis has exposed inaccuracies of some of these thermometers and fundamental flaws in some non-contact thermometers sold online that consistently produce inaccurate readings. As a general rule of thumb, a temperature more than 37.5 is considered a fever regardless of device. Small variations may occur due to calibration settings and will be indicated on the device packaging. Use the “probe” type thermometers for an accurate measurement of oral or armpit temperature, which you can purchase from established brands such as Guardian.

Hope this helps!

Dear Tan, 

What you’re describing sounds like what we call a globus or sensation of something in the throat. There are various causes and indeed, it may be due to the recovering sore throat that you felt after GA, since it seems to be a new problem and given your recent history.

Other common causes include post nasal drip or  reflux . I would advise you to watch it for now if it is not causing you too much discomfort, difficulty breathing, eating or speaking. 

However, if it persists , it would be advisable to see a doctor or even do a nasoendoscopy (can be done as a quick bedside procedure in a clinic by ENT Doctors) to have a look. Just in case there are dangerous causes. 

Hope you get better! 

Hi @Tofifee yes belly fat and measures such as waist circumference (WC) have described associations with body mass index (BMI) and abdominal obesity (AO). These translate to poor long-term health (TL;DR for the medical jargon: increased long-term risk of mortality and metabolic syndrome-related conditions such as heart disease). 

Therefore, there are plenty of health reasons to address this. Fortunately, you are young and have the opportunity to gradually work on this issue over time. Unless you have any underlying medical issues, I would start with dietary modifications to increase fruits/vegetables and decrease oily food/animal fat. If possible, incorporating some exercise in your daily routine 3-5 times a week would also be helpful, perhaps regular sessions with your friends at the gym, cycling, or group activities like team sports.

I understand you are also concerned about the cosmetic aspect of this issue. There are certainly options such as "fat freeze" which will depend on your body profile - you can speak about this in greater detail with an Aesthetic physician. However, these procedures have not been proven to help address the underlying health risks associated with this problem. Therefore, given your young age, my recommendation would be to give the diet and activity modifications a good try as these will also improve your overall health, even if you chose to proceed with cosmetic procedures in tandem.

I recommend that she gets a referral for a gastroscope to see if there is anything wrong in her stomach. 

Hi @Concerned thats a common question! The warmer temperature in Singapore this past week is a possible cause if you may have been outdoors or perspiring from activity often. Other common causes include changes in diet, perhaps if you may have been consuming more preserved food with all the social distancing measures in place. That being said, with the gastric and bloating issues, are there other symptoms like loose stools or giddiness? Other possible underlying conditions that are less likely include early onset diabetes.

If there are no other symptoms and you feel otherwise well, you may want to consider hydration and rest to observe for some time. However, if you are having other symptoms such as those highlighted above, or if the thirst/ gastric symptoms persist or progresses, you should have a physical review with a doctor. One of the tests they may consider is a fasting blood glucose test. So if you do proceed for a review, try to see them early in the morning and fast for 8 hours from the night before (avoid oral food/drink intake apart from plain water) in case they assess you and determine that you may need to go for testing.

Dear someone, covid-19 may present with mild symptoms initially. If you still feel unwell after 5 days of MC and still has some runny nose symptoms. It will be advisable to visit the same doctor who saw you previously. Do call for 995 if you have any breathing difficulty. Hope this helps.

Hi @Lucas great question! Unfortunately, this is untrue and there is no basis for that recommendation. The modelling techniques are flawed and do not reflect real-world events as they unfold, as techniques like these are purely experimental. Whereas in the real-world, there are many other considerations and factors influencing behaviour that can affect the epidemiologic "curve" and behavioural responses to measures like Quarrantine.

Such an extensive, and prolonged quarrantine  can have many unintended effects. For example, it may place many casual workers and daily-wage individuals in a desperate financial situation, in which they may choose to overlook symptoms and continue working in an effort to feed families (presenting late - spreading to more people along the way). This will be detrimental to essential public health efforts such as contact tracing to fight the infection.

Ultimately, public health measures (like quarrantine/social distancing) are most essential to "flatten the curve" - that is primarily to reduce the RATE of new infections and not the NET NUMBER when the former gets too high. The reason for this is that health systems have fixed capacity to attend to cases at any one time. If the RATE is too high i.e. people are disseminating the infections quickly and the new cases are presenting quickly and all at the same time, healthcare services will be quickly overwhelmed.

To achieve their intended effect, public health measures need to be tailored based on many factors about the target population, some of which may be dynamic in the context of an unfolding outbreak (e.g. daily inter-city transport/mobility of the population, capacity of existing healthcare services, availability of financial support, proportion of incident cases identified through contact tracing, etc). Quarrantine is a targeted measure to reduce spread from high risk individuals, however more evidence is required to justify prolonging beyond the 2 weeks, given the potential detrimental effects of extended quarrantines. More important is for individuals to be empowered in being responsible and present early to medical professionals once they are symptomatic.

For instance, quarrantine measures or even a temporary lockdown for the duration of 2 weeks (covering the incubation period reported in over 90% of reported cases) applied at the time that infections are rising quickly can be a timely response to help to reduce the RATE of infection and thereby the speed of incident cases as they turn symptomatic in the following two weeks, in certain populations. These can help to regulate the case load such that the health system would be better positioned to attend to those that are falling ill. More about this at this link: https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section11.html

Hi @Min just to clarify - what do you mean by 4th degree contact? The traditional use of the terminology refers to "degrees" of contact by rings of exposure i.e. if direct contact with a confirmed case - considered 1st degree exposure. If direct contact with an individual with 1st degree exposure but not with any confirmed case - considered 2nd degree exposure, and so on.

The asymptomatic individuals are monitored closely following the exposure to the "contact" for a duration equivalent to the incubation period of the virus in question. Should any 1st degree individual develop suggestion of infection during this time, he is reviewed by a medical professional immediately to determine the need for testing early. More information about this here: https://www.straitstimes.com/multimedia/a-guide-to-singapores-covid-19-contact-tracing-system

This serves as a method to focus contact tracing efforts and identify at-risk individuals. At the 4th degree, the risk from the index case is commensurately lower. However, in the event of an infection with community transmission, it is still possible to have contracted the infection from other cases. Therefore, it is not possible to say how likely it is for someone at the 2nd-3rd-or-4th degree of exposure to develop infection, only that those at the 1st degree are at significantly elevated risk.

Ultimately, the next step for you would be to resume life as per normal since you do not have symptoms, following MOH's guidelines for social distancing and hygiene to minimise your risk of catching the disease. If you do develop symptoms, have a low threshold to see your GP, or consider using Teleconsultation for a detailed initial discussion with a medical professional to determine the need to have a review in person. More about this here: https://www.todayonline.com/brand-spotlight/doctor-will-see-you-next-app

Hope this helps!

Hi @Jojo . Thanks for your question! 

Hmm it is possible that paracetamol is suppressing you fever.  I would say if you feel your symptoms are worsening despite medication after 2-3 days, you should go for a review. Especially if you develop symptoms suggestive of a lower respiratory tract infection such as difficulty breathing, chest pain at rest or on deep breaths, worsening cough which thick phlegm/stuck phlegm, reduce activity tolerance and escalating temperature. Another thing to look out for is a sudden loss of smell. 

If you have seen your physician I would assume he would have taken a history to check if there is a probability of COVID infection and hence it would be ok to monitor for now. You may want to consider with holding your paracetamol and checking your temperature. IF it remains between 37.1-37.5 it is still alright. Having said that, we usually look at the patient as a whole and the severity of fever is not always directly proportional to the severity of disease. 

Hope this helps! 

Hi @lynn . Thank you for your question!

I would say that you should definitely go down to see your GP. It is important to establish a timeline in cases where we are suspecting a possible drug allergy. In general, rashes relating to allergies can occur anytime between 24-72 hours after ingestion of the offending agent. In rare cases, a medication of which you previously had no allergy against can cause an allergy only a few months after. 

In this situation i would recommend review for 2 reasons
(a) If related to metformin it would require your to stop and possibly change to another drug temporarily (depending on the severity of your diabetes) 
(b) Itchy rashes around the breast or any skin folds can often be mistaken for allergies and can turn out to be bacterial/fungal infections instead or a form of eczema. Given that you are diabetic, you are at higher risk for these easily treatable skin infections. 

At times it may be difficult to discern if the rash is related to a drug or infection and most physicians would consider stopping the drug and treating at the same time. 

If Any alarm symptoms for severe allergy are present such as difficulty breathing/throat swelling/extreme eye swelling or hand/leg swelling/palpitations/chest pain, please go directly to the AnE for management as these could be suggestion of anaphylaxis (severe allergy) 

hope this helps!

Hi @Stefsz . Thanks for your question! It is definitely a concern and quite interesting. 

In general I would say that you should practice good hygiene and possibly choose to disinfect the box/container/goods even if you receive them for a local supplier. Packages often go through the hands of multiple people and can be considered as a vector for transmission (fomites). As per CDC recommendations, COVID droplets are too heavy to be suspended in the air and tend to drop onto surfaces. Hence if someone was unwell while handling you package, it is possible for it to act as a vector for transmission theoretically. However given that this is often an unsuited environment for the bacteria to remain, the risk is much lower. Unfortunately the duration that COVID remains on surfaces is difficult to determine and can range from a few hours to several days. 

Overall, practice good hand hygiene, do not touch your face when handling the product initially and be sure to dispose of the boxes appropriately and you should be good to go!

Hope this helps! 

Hi @Terrific4 thats a terrific question. Currently, front-line healthcare workers like myself are reusing masks on the basis of CDC's guidelines. The type with the elastic band that slips around the ear can be safely reused as long as it is not damp/ wet/ soiled. As an added precaution, avoid touching the mask and wash your hands thoroughly after handling it if and when you need to.

More information about this here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html

Hope this helps, and stay safe!