Why we don't smile sometimes (1)

     Was quite happy today until i met these few customers :

Customer A : Do you have these medicine?? ( showing a few types of pills without labels, indication or 
                     any  marks on the tablets)

Me              : Oh, can i know what are these for? I need to know before i can give you any medicine.

Customer A : HUH?! You don't know what are these??? Are you sleeping in class ?? How am i suppose
                     to know what are these? you are suppose to tell me. Ai.. Don't know you have license 
                     or not.

Customer B : Do you have this product ? ( a direct selling product or some unknown product or some 

                     products from overseas)

Me              : Sorry, we don't have this, if it is ok for you, i can recommend you with something that has 
                     the same active ingredient.

Customer B : What ? ! Pharmacy XYZ has this. Why your shop don't keep this. Everything also don't 
                     have. You are causing so much trouble for me.  @!%* @ ( rude words)

       I know usually we need to great customers with a smile, but, don't forget that we are humans too. When you meet with just one unreasonable people, you maybe able to ignore it; but if you encountered a few of the same kind in a row, it would really ruin one's day. 

        Now, let me explain why we can't give you your medicine, customer A:

       First of all, a pharmacist is not any "super computer" who can just scan the unknown medicine that you passed us and get the right one for you. There are so many pharmaceutical companies that produce different drugs today.Without knowing the name of the drug or the indication, we won't be able to provide you with the medicine that you want. Won't you be afraid if i just pass you some white tablets if you show me some white tablets? Won't you ask what are they? What are the danger that it will cause?? You maybe in great risk if you take the wrong medicine. So, it would be best if you could bring us the prescription =)

      About customer B,

      There are many companies that produce the same drug. It is quite impossible for us to keep products from each and every company ( especially overseas company, as some are not even imported into Malaysia). So, please try to be a little more understanding before you start opening your mouth.  

Just a joke of the day

Glucose–6–Phosphate Dehydrogenase Deficiency ( G6PD deficiency )

Customer A : My son/ daughter has G6PD , can they take this medicine??

What is G6PD ??

       G6PD is a protein found in red blood cells (rbc) that help the rbc to function normally. If there is not enough G6PD, the rbc maybe destroyed when one have fever or taking certain medicine ( haemolysis ) and this may lead to haemolytic anaemia. G6PD deficiency is a genetic- inherited - disease. The gene affecting this disease is linked to X-chromosome and so, affect males  more than females.

What are the dangers G6PD deficiency posses??

     Usually, people with G6PD deficiency have completely normal health. However, problems can occur occasionally when they are exposed to a drug or chemical that can cause a sudden attack of red cell breakdown.The affected person may feel unwell, pale and jaundiced (yellow) , have a backache and pass dark urine.  

Problems for newborn babies

      The babies with G6PD deficiency may get jaundiced in the newborn period. It is usually treated by putting the baby under a special UV light for a few days and sometimes blood transfusion. Many babies with G6PD are diagnosed because they have jaundice soon after birth. Normally, these babies will not get other complications once their jaundice have been treated, unless they took broad beans and drugs listed below. G6PD deficiency does not cause any problem in unborn child.

List of drugs that a person with G6PD should avoid: 

• Ciprofloxacin
• Dapsone
• Levofloxacin
• Methylthioninium Chloride (Methylene blue)
• Moxifloxacin
• Nalidixic Acid
• Nitrofurantion
• Norfloxacin
• Ofloxacin
• Primaquine
• Rasburicase
• Sulphonamides including Cotrimoxazole (Septrin®)

Avoid eating:

• Fava (Broad) beans

Points to remember

1) Make sure to let your Dr and pharmacist knows if you have G6PD deficiency.

2) In people with severe G6PD deficiency, haemolysis may occur in other situations, e.g : infection 

Some articles that you can read :

1) Medicinenet : G6PD deficiency

2) NHS : G6PD deficiency

3) NHS : Drugs And Chemicals To Be Avoided In G6PD Deficiency

Is Fish Oil Suitable for Pregnant lady?

Customer A : I am pregnant. Can i take fish oil?? Is it safe ??

Customer B : What are the advantages of fish oil for pregnant lady or the baby?

Omega 3 ( DHA & EPA)

Benefits of fish oil for both pregnant ladies and babies: 

       Many believes that taking DHA (docosahexaenoic acid), especially during the 3rd trimester of pregnancy can help in the development of baby's brain, eyes & central nervous system. Other benefits of fish oil includes reducing pre-term labour and delivery and increase birth weight. Also, it may decrease mother's risk of depression.

Benefits of consuming DHA

         However, currently there is not enough evidence to draw any firm conclusions that fish oil can really help in the development of cognition in babies.

Is it safe to take fish oil during pregnancy?
        There are some unpleasant effects that some mother-to-be may experience, e.g : reflux or 'fishy burps', stomach upsets and maybe fishy taste in the mouth. These are usually rare and not dangerous and usually go away with time or when you stop consuming these products. 

Some products that are available in Malaysia

There are many brands available in the market today. So, how do we choose?? 

1) The right proportion of DHA : EPA
2) Odour & taste : should be fresh and odourless ( risk of vomiting if not)
3) Mercury free

Points to remember :
When we mention fish oil in this article, we are not referring to cod liver oil. Consuming cod liver oil during pregnancy may posses a risk of developing vitamin A toxicity that is harmful to babies.

Some articles that you can read :
1) American Pregnancy Association : Omega fish oil and Pregnancy
2) Mayo clinic :  Pregnancy and fish

A joke to lighten up your day

Supplements during Pregnancy

        During my practice, there are many pregnant ladies and loving husbands who are eager to know what are the supplements that they could take and what are the importance of these supplements. These are some essential nutrients during pregnancy:

a) B 12 (> 5 mcg ) - important especially for vegetarian to prevent Megaloblastic anaemia

b) Folic acid (> 400mcg) - To reduce the incidence of neutral tube defects. 

                                      -  Diabetes patients will need a bigger dose

c) Elemental Iron (30-65mg/day )

d) Calcium  (1000-1500mg) - Vital for making baby's bone and teeth.

e) Vitamin D (10mcg) - Not enough of vitamin D can cause children's bones to soften and may lead to

                                     rickets. 

f) Vitamin C - Helps to absorb iron from food. 

Some supplements  for pregnant ladies that are available in Malaysia

                                    
                                        Iberet Folic Acid               Obimin                      Pramilet

Elemental Iron                      105mg                             30 mg                            5mg
Vitamin C                             500mg                           100 mg                         60mg
Niacinamide                           30mg                             20 mg                          10mg
Calcium Panthothenate           10 mg                            7.5 mg                           1mg
Vitamin B1                              6 mg                             10 mg                            3mg
Vitamin B2                              6 mg                             2.5mg                            2mg
Vitamin B6                              5 mg                             15 mg                            3mg
Vitamin B 12                         25mcg                              4 mg                            3mg
Folic Acid                           800 mcg                             1 mg                        500mcg
Vitamin A                                                                 3000 IU                       4000 IU
Vitamin D                                                                   400 IU                         400 IU
Calcium Lactate                                                         32.5mcg
Copper                                                                      100 mcg
Iodine                                                                        100 mcg                       100 mcg
Elemental Ca                                                                                                  250mg
Magnesium                                                                                                    150mcg
Zinc                                                                                                                 85mg


So which one is better? 

Normally i would recommend Obimin as it contain all the essential nutrients as well as high doses of vitamin B6 that is useful in reducing the symptoms of  nausea and vomitting during the first 4-8 weeks. Besides, it is the cheapest in the market.

Iberet Folic has a higher dose of iron, folic acid and vitamin B12, and thus is more useful for anaemic lady

Points to remember : 1)  Do not take several prenatal vitamins together as it may expose mother-to-be

                                     and  baby to vitamin A toxicity and this may harm the baby. 

Thanks for reading 

Some Guidelines and articles that you can read :

1) NHS: Vitamins & Supplements during pregnancy

2) The independent health news : Vitamin could help under-nourished mothers have healthier babies

A Joke to lighten up the day =)

Mercury Contamination in Fish

The cycle of mercury contamination in fish

        Generally, there are 2 types of mercury, the organic and inorganic. When the inorganic mercury from soils or rock, burning of coals, waste and other hazardous human activity enters a waterway, naturally occuring bacteria absorb it and convert it to organic mercury (methyl mercury). 

       This mercury then works its way up the food chain as large fish consume contaminated smaller fish that feed on bacteria and algae that take up methyl mercury as part of their food. Instead of dissolving or braking down, mercury accumulates at ever-increasing levels. Thus, predatory fish such as large tuna, swordfish, shark and mackarel can have mercury concentrations 10,000 times higher than those of their surrounding habitat.  Therefore, we need to be careful when choosing the fish that we are consuming.

A cartoon to lighten the day

The mercury level in different fishes

How Does Mercury harm your body??

     Once in the human body, mercury acts as a neurotoxin that will interfere with the brain and nervous system. Mercury pollution can be hazardous especially for pregnant women and young children.  Prenatal and infant mercury exposure may cause mental retardation, deafness and blindness.

       

Some Health hazards due to mercury pollution

       In Malaysia, the National Pharmaceutical Control Bureau (NPCB) requires the fish oil's mercury to be less than 0.5 ppm and  there is a centre ( SIRIM QAS International Sdn Bhd located in Shah Alam) that use Flameless Atomis Absorption Spectroscopy Technique to test for presence of mercury in the sample of fish oil : 

Some articles that you can read :
1)  Mercury level in commercial fish and shell fish
2) Mercury contamination in fish - http://www.nrdc.org/health/effects/mercury/effects.asp
3) What you need to know about mercury in Fish and Shellfish

Nappy Rash

      Did this post specially for a friend of mine who just deliver her baby. Congratulations ya my friend, you know who you are =)

A cartoon showing a baby crying due to nappy rash

       Nappy rash or diaper rash is a very common disorder  It might occurs any time but usually it occurs more frequently when the babies are between 9-12 months. It causes the baby's skin to become sore and irritated in the nappy area and the affected area are covered in pink or red spots or blotches. Nappy rash is usually cause by the contact of the baby's skin with urine and faeces in their nappy.

So, how do we treat nappy rash and what to do to prevent it??

Remember this easy ABCD rules

A= air out the skin by allowing your baby to go diaper free to reduce skin contact with feces & urine.

B = Barrier, the barrier can be created by using a paste or an ointment to protect the skin of your baby (  choose those without preservative and avoid using powder due to inhalation risk).

Some Barrier creams that are available in Malaysia

A mummy applying barrier cream for her baby

C= Clean , keep the baby's skin clean. Carefully clean the baby's bottom between diaper changes.

D= Disposable diapers. If the baby really has a nappy rash, consider using disposable diapers rather than the normal cloths one as the disposable diapers have  better absorption proterties and thus, keep the skin dry.

       Usually, a parents do not need to be too worry if the baby develope nappy rash unless the baby develops a fever > 38 ºC or has bloody stool, diarrhoea,  blisters or sores , then, you should bring your baby to the doctor. I hope this article will be able to help and congratulation again in your new born baby.

Cute Baby

Deworming

        These are some common questions that were directed to me during my practice:

Customer A:  My son/ daughter is very thin and his/ her stomach is very big, can i give him/ her Zentel ??

Customer B: It has been quite some times since i last give my son/ daughter Zentel. Can i give him/ her now??

Customer C : Can i take Zentel if i am an adult?? Zentel is not only for children right??

Worm Infections

      The most common worm infection are whipworm, roundworm, hookworms, tapeworms, threadworm  and fluke. Normally, people will get worm infection if they touch contaminated faeces, play with soil, walking barefoot, eat undercooked food like beef, pork and fish, or drink water that containing contaminated faeces.        

Life cycle of the worms

Symptoms of Worm infections:

Stomach pain, perianal itch that occurs at night as the female worms deposits their eggs, diarrhoea and vomiting, appearance of worms in the faeces as white or cream colour thread-like objects, weight loss and maybe malnutrition

Treatments

Adults and children above 2 years old : Deworming agent (e.g : Albendazole or mebendazole) once daily. 
Affected individuals should take shower each morning to wash away  the eggs deposited outside the anal during the previous night.                                                        

Some deworming agents that are available in Malaysia

Prevention :

1) Wash the hands thoroughly before preparing, handling and eating food.
2) Use disinfectant on toilet seats and bathtube

3) Cut the nails regularly.
4) Hands should be washed and nails brushed after going to toilet.

5) Children can take the deworming agent 2-3 times a year to stay worm- free.

These are some articles and guidelines that you can read for further information:

1) NHS Guide line for tapeworm infections: 

 http://www.nhs.uk/conditions/Tapeworm-infections/Pages/Introduction.aspx

2) http://emedicine.medscape.com/article/998401-treatment

p/s: The image of " life cycle of worms" is adapted from google image