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

Antibiotic Resistance

     During my practice, usually there are many walk-in-customers who asked for antibiotics. These are some customers that i often encountered :

Pharmacist: What can i do for you?

Customer: I want to buy antibiotic (without prescription or some with a so called " sample")

Pharmacist : Why do you need that?

Customer A : I  want to keep it just in case if i have infection, i can take it

Customer B : I have sore throat and my doctor always give me that 

Customer C : I have toothache  

Customer D : Of course i need it. if i don't need it, i don't ask. You stupid xxxx. Do you know the function of the drugs? Where are you graduated? ( these are some rude customers, often i will just ignored them)

When i refused to sell it to them, they will start yelling or threaten me or say that they will go and make a complain. Hey people, please try to understand the function of antibiotic before you even start taking it. All the superbugs were created because of you. Try to remember that we are not there to make your life miserable or make you suffer more, we are just trying to do our job and we have the right to make the decision that we think are most appropriate. 

Some History of Antibiotics 

        The best way to understand a situation is to know its history : 

In 1941, Penicillin was created and  was called the " wonder drug' because it could control and cured many serious bacterial infections. People believed that infectious disease would become a history ; but, this is not the case. Due to the widespread use of penicillin, the bacteria began to evolve and fight back. Bacteria mutated and when they survive, they passed down the resistant trait to their offspring. Therefore, within a few years, penicillin-resistant bacteria were found. Then , new antibiotic (Methcillin) were developed to kill off these penicillin-resistant bacteria but methicillin- resistant bacterias were developed too... Stronger antibiotics were created ( Vancomycin) but , there appears again super bugs that are resistant to it.... this is like a non- ending fight between human and bacteria !! 

A cartoon of how penicillin- resistant- bacteria were formed

Why do antibiotic resistance occurred? 

        When a bacteria population were exposed to an antibiotic, the bacteria that are susceptible to the antibiotic would be killed while the bacteria that are resistant to it will survive. These resistant - bacteria would proliferate and spread. Thus, antibiotic would kill off the "weak" bacteria but increase the number of those " strong" one,  Why is this happening when the antibiotics were suppose to kill off the bacteria? These are the reasons:

1) People do not finish their course of antibitics when they thought they have recovered. When the symptoms dissapeared, they thought all the germs were killed, they will stop taking the antibiotics. But, in the real situation, the only bacteria that were killed were the weaker one, the  stronger one survive and spread. This make the same antibiotic USELESS next time when the person were infected with the same bacteria infection.  ( proof : the sample that they bring me)

Ha ha.. The bacteria lecturer giving out clue to the new bacteria

2) Take the antibitotic when it is a viral infection and not a bacterial infection e.g : common cold and flu. Virus wont be killed and they will developed into a more harmful species.

    Don't blame others when super bugs like AH1N1 were discovered. Blame yourself because it is you that created all these super bugs, because it is you who misuse the antibiotics !! 

A cartoon showing scientists discovering superbugs

Some news and articles about antibiotic resistance :
1) http://news.bbc.co.uk/2/hi/7608167.stm
2) http://news.bbc.co.uk/2/hi/health/7520689.stm
3) http://news.bbc.co.uk/2/hi/health/7050546.stm