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
    
      

Do vitamin make you fat?

      These are some of the common questions that i always heard when i worked: 

Customer  A: Hi there, I am currently controlling my weight. I am thinking of taking supplements. 

                     By the way, will these supplements make me fat?

Customer B : Fish oil is a type of oil right? Will taking fish oil make me fat?

     Actually, why do we gain weight? We usually gain weight if our input , i.e food intake ( in energy form) is more than our output. If our output is more than our input, then , we loose weight. For example, lets look at Mr K:

     Mr K 's Basal energy expenditure (BEE) is 1690kcal and this is what he eat :

Breakfast : Roti canai ( 356kcal) + Teh tarik (154kcal)

Lunch : Fried rice (550kcal) + Lime juice ( 100 kcal)

Dinner : Hokkien Mee ( 950kcal ) + Fruit juice ( 250kcal)

Total : 2360kcal

Mr K's total input is 2360kcal and his BEE is 1690kcal. There is an excess of 670kcal. If he do nothing about this excess 670kcal, it may turn into fat and he may gain weight. So, if he wants to loose weight and burn off the extra calories, he need to exercise. 

Example : Jog for 30 minutes - 273kcal

               Swim for 30 minutes - 370kcal

               Aerobic dance for 30 minutes - 204kcal

               Total : 847kcal

And therefore, he will loose weight as he spend 177kcal more than what he eat.             

Do not take more than what you need if you want to loose weight

         
So, would you gain weight if you take vitamins? 
Usually, the calorie count for multivitamin or other vitamins are less than 1 kcal per tablet. So, taking vitamins according to instruction will not make you gain weight.

You are what you eat

Acne Treatment (3)- Self care tips

      Acne is not infectious. However, it might be cause by the build-up of sebum and dead cells on the skin surface that many increase the risk of blocked follicles and thus allow the bacteria to multiply.

These are some common self care tips

1.  Wash your face two times a day with a gentle cleansing product and luke warm water.

These are some acne facial products that are available in Malaysia

    2.Wash your hands before touching your face( e.g : before applying make up)
    3. Wear little make-up and make sure you remove all the make- up before you go to bed if you are wearing make up
    4. Try not to use harsh chemical hair products and tied the hair if you have long hair.
    5. There are no evidence that certain foods ( e.g: fried foods or chocolate) many cause or aggravate acne but a good balance diets is important in maintaining good, healthy skin.

Some supplements that once can take for acne treatment

Acne treatment (2) - Common drug treatment

     After a brief introduction of the acne treatment in the last article, let us discuss more about the common  drug treatment that are available:

a) Benzoyl peroxide - Apply once or twice sparingly 20 minutes after face washing everyday.

Benzoyl peroxide works by killing the bacteria on the skin and prevent plugging up of hair follicles by dead skin. The treatment course is usually 6 weeks and the common side effects of benzoyl peroxide are :

• dry and tense skin
• burning, itching or stinging sensation 
• redness & peeling of the skin 

Some of the available products in Malaysia

Points to remember when using this product:

1) Avoid excessive sun exposure as benzoyl peroxide makes the face more sensitive to sunlight

2) Benzoyl peroxide may bleach the clothes, towels and bed linens 

3) Wash your hands  before and after the application of medication  

b)Topical retinoids - Apply sparingly once a day before going to bed. 

Topical retinoids works by reducing the production of sebum and also preventing the plugging up of hair follicles by dead skin cells. The treatment course is usually 6 weeks and the most common side effects are mild irritation & skin irritation.

Some of the available products in Malaysia

Points to remember when using topical retinoids: 

1) Avoid excessive exposure to sunlight and UV 

2) Do not use during pregnancy as this medication may cause birth defects

c) Topical antibiotics - Apply once or twice daily

Topical antibiotics works by killing off the bacteria on the skin. The treatment course is usually 6 to 8 weeks. The common side effects are: 

• skin dryness
• redness and burning sensation of the skin
• peeling of the skin

Some of the available topical antibiotics in  Malaysia

Points to remember when using topical antibiotics

1) Go to the doctor if there is prolonged diarrhoea

d) Oral antibiotics - Usually used in combination to treat moderate to severe acne


The treatment course is usually 4 to 6 months. Treatment more than 6 months is not recommended as there is risk of bacteria resistance. The commons side effects are nausea, vomiting and diarrhoea.

.

e) Oral Isotretinoin - The oral form (tablet) can only be prescribed by a dermatologist.

The treatment course is usually 4to  6 months. Some people may find that their acnes get worse in the 1st seven to ten days of the treatment as the medication is pushing out the bacteria that rested in the deeper layer of the skin. The common side-effects of oral isotretinoin include :

• Dryness and cracking of skin and lips. This can be relieved by applying moisturising cream and lip balm.
• Nosebleed due to dryness of the inside of the nose. This can be relieve by applying a thin layer of petroleum jelly to the inside of the nose
• Headaches
• Mild itching and peelings of the skin
• Inflammation of eyelids or eyes ( conjunctivitis)
• Back, muscle and joints pain. The condition may worsen during or after exercise
• Bleed or bruise more easily

Points to remember when taking this medication:
1) Isotretinoin may cause severe birth defects. Thus, contact your dermatologist immediately if you think you are pregnant.

Acne treatment (1)

     ACNE  is a very common skin disease and can affect most people at some point of their life. Although this is a common condition, dealing with it can be a hassle. While pimples might be painful and annoying, popping up times when one really want to look good is also a reason why many peoples hate it. One big pimple on the end of the nose might ruin one's day.

People with Acne may feel embarrass or shy when meeting people

Treatment of acne

       The treatment plan will depends on the severity of acne and the severity is usually determine by the doctors based on the appearance of the skin, the number of spots and the severity of inflammation :

a) Mild 

- Most people with mild acne have blackheads and whiteheads that are confined on the face.

- Usually treated with topical gel / cream like 

• Benzoxyl peroxide 
• Retinoids
• Antibiotics
• Azalaic acid

b) Moderate 

- Most people with moderate acne have a combination of whitehead, blackheads, papules and pustules that may extend to the shoulders and back.

-  Can be treated by using the topical gel/ cream above plus an oral antibiotic

c) Severe 

- Most people with severe acnes has papules and pustules as well but they also have nodules and cysts and the spread of acne may be extensive.

- This type of acne must be refer to dermatologist

These are some articles and guidelines for acne:

1) http://www.nhs.uk/Conditions/Acne/Pages/Introduction.aspx?url=Pages%2FWhat-is-it.aspx
2) http://www.acne.org.au/

Treating sore throat

     Sore throats is actually not a disease but a symptom that present due to the inflammation of the pharynx or the back of the throat. It is usually not a very serious condition and will often dissapear in 3 - 7 days. I  have many customers who wanted treatment for sore throat everyday. So, what are the treatment that is available ? 

Strepsils of course is  not the only treatment  available

1) Lozenges

- can be used to reduce the inflammation and soothe the pain. This is by far the most popular choice.

Some lozenges that are available in Malaysia 

 2) Pain Killers

-  Usually, a pain killer like paracetamol or ibuprofen will be good enough to reduce the inflammation and to ease the pain. These drugs are also very useful if one is having fever at the same time. However, if you have gastric or allergic towards NSAIDs, Paracetamol is a better choice.

Some of the pain killers that are available in Malaysia

These are some Self -care tips that can be used to reduce the pain: 

• Drink lots of water
• Rest more
• Avoid food or drink that could irritate your throat
• Avoid smoking and smoky environment
• Gargle mouthwash or salt water regularly

Some of the mouthwashes that are available in Malaysia

• Adults and older children can suck ice cubes or ice lollies 
• Drink some honey and lemon to sooth the throat

     Antibiotics are usually not recommended as most sore throats are not caused by bacteria. Even if you have bacterial infection, antibiotic is still not the first choice according to the guideline as treating minor ailments with antibiotic will cause antibiotic to be less effective in more life-threatening conditions.

Sore throat due to Bacterial infection - red swollen tonsils and white patches in the throat.  (2)

       It is better to go to the doctor if your sore throat lasts for 3-4 weeks. This is because it might be a sign for a more serious conditions like glandular fever or cancer. 

These are some articles about treatment of sore throat :

1) NHS guideline http://www.nhs.uk/Conditions/Sore-throat/Pages/Treatment.aspx

2) A good illustrational guide  http://www.medicinenet.com/sore_throat/article.htm