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The highly visible but easily neglected form of cancer
2018-08-03

Summer is here and the outdoor types are ready to put on their new swimwear to head to the beach for water fun and to acquire a healthy tanned look. When it comes to sun protection, ladies tend to be more conscious of the need and will apply sunscreen products to avoid getting burnt. Men on the other hand might take a more cavalier approach. Even if people do the right thing and apply sunscreen before heading out into the sun, do they remember to replenish it during their outdoor activities?

 

Sun exposure is indeed helpful for the body to manufacture vitamin D but that can be achieved by sun tanning for just over 10 minutes. Long exposure to the sun, without proper sun screening, could easily cause sun burn. In a worst-case scenario, it could cause skin cancer, which is becoming more common. The Hong Kong Cancer Registry’s 2015 statistics show that non-melanoma skin cancer was the seventh most common form of cancer, with more than 1,000 cases every year. Excessive absorption of UV rays due to prolonged exposure to the sun is the leading cause of skin cancer. This means one cannot be too careful when spending time in the sun.

 

The most common form of skin cancer is basal cell carcinoma. It accounts for more than half of the clinically diagnosed cases. It occurs more commonly on the head, the neck and the hands, i.e. the parts of the body that are more often uncovered. An early symptom is the presence of a slightly protruding bump that may not be visually detectable. Affected people might dismiss such growths as pimples or boils. Even if they are suspicious of the cause of the growths, they may find reasons to rationalise it and won’t seek medical advice until the growths fester or the symptoms deteriorate.

 

Recently, I saw an expatriate chef who had a 2-3cm dark red bruise mark on his forehead. He thought it was bruising from a bump. As he is taking long-term blood thinning medication, he didn’t pay the bump much attention even when the bruising didn’t fade after a few days, as he thought the medication had slowed the healing of the blood vessels. It was only when the red patch grew much bigger and the pain did not go away, that he went to seek medical help. As the doctor suspected skin carcinoma, he was referred to me for a further check-up.

 

A biopsy is needed to diagnose skin cancer. If it’s a small growth, all affected tissues can be removed at the same time as the biopsy, in effect to kill two birds with one stone. However, if the growth is large, cutting it off together with the skin tissues 2-3 mm around the growth in order to remove all the malignant tissue will create too big a wound. It will affect a person’s appearance,  so cosmetic surgery is also required. In the initial consultation, surgical specialists face a challenge to determine how much skin tissue to cut away for biopsy before it is confirmed to be a carcinoma.

 

Other skin cancer types, other than basal cell carcinoma, are squamous-cell carcinoma and malignant melanoma. All three can spread, and malignant melanoma is particularly tricky to deal with, because it can spread to the lymph nodes or the brain, the liver or the lungs at an early stage, making treatment more difficult, and thus increasing the mortality rate. This means early discovery is paramount.

 

Skin cancer can be hereditary. It is advisable for people who have family members succumbing to skin cancer to visit a dermatologist and get a full-body skin spots record for future comparison and reference. We may not remember clearly when certain colour spots appear on our body, or whether their shape or size has changed. Doing a full-body colour spot record will help lower the risk of wrong diagnoses and enable early action when skin tissue anomalies are detected.

 

Tips for preventing skin cancer:

  1. Choose sunscreen which effectively blocks UVA and UVB rays. UVA rays can penetrate glass or clothing. They are rated by a factor of 5* and it is recommended to use products with at least a 3* factor. For UVB, factor higher than SPF30 is preferred.
  2. Your sunscreen lotion should be water-proof.
  3. There are physical or chemical sunscreen products. For physical sunscreen products, choose those containing titanium dioxide or zinc oxide, which have less allogenic side effects or irritants; for chemical sunscreen, it is advisable to choose those that contain Avobenzone.
  4. Apply sunscreen half an hour before heading out into the sun, and re-apply every two hours, or immediately after sweating, washing or bathing.
  5. Use umbrellas, wide-brimmed hats and sun-glasses (that sit as close to the face as possible to filter the amount of light entering the eyes, and the lenses should fully cover the eye region). Wear long-sleeved tops and long pants (impenetrable by light) which is more effective than using sunscreen.
  6. The sun is strongest between 11 am and 3pm. Avoid outdoor activities during this period.
Consult your dermatologist for sunscreen product recommendations.

The above information is provided by Dr. Alec Fung Ho Chuen and Dr. Henry Kwan Tim Lok.

The highly visible but easily neglected form of cancer

Summer is here and the outdoor types are ready to put on their new swimwear to head to the beach for water fun and to acquire a healthy tanned look. When it comes to sun protection, ladies tend to be more conscious of the need and will apply sunscreen products to avoid getting burnt. Men on the other hand might take a more cavalier approach. Even if people do the right thing and apply sunscreen before heading out into the sun, do they remember to replenish it during their outdoor activities?

 

Sun exposure is indeed helpful for the body to manufacture vitamin D but that can be achieved by sun tanning for just over 10 minutes. Long exposure to the sun, without proper sun screening, could easily cause sun burn. In a worst-case scenario, it could cause skin cancer, which is becoming more common. The Hong Kong Cancer Registry’s 2015 statistics show that non-melanoma skin cancer was the seventh most common form of cancer, with more than 1,000 cases every year. Excessive absorption of UV rays due to prolonged exposure to the sun is the leading cause of skin cancer. This means one cannot be too careful when spending time in the sun.

 

The most common form of skin cancer is basal cell carcinoma. It accounts for more than half of the clinically diagnosed cases. It occurs more commonly on the head, the neck and the hands, i.e. the parts of the body that are more often uncovered. An early symptom is the presence of a slightly protruding bump that may not be visually detectable. Affected people might dismiss such growths as pimples or boils. Even if they are suspicious of the cause of the growths, they may find reasons to rationalise it and won’t seek medical advice until the growths fester or the symptoms deteriorate.

 

Recently, I saw an expatriate chef who had a 2-3cm dark red bruise mark on his forehead. He thought it was bruising from a bump. As he is taking long-term blood thinning medication, he didn’t pay the bump much attention even when the bruising didn’t fade after a few days, as he thought the medication had slowed the healing of the blood vessels. It was only when the red patch grew much bigger and the pain did not go away, that he went to seek medical help. As the doctor suspected skin carcinoma, he was referred to me for a further check-up.

 

A biopsy is needed to diagnose skin cancer. If it’s a small growth, all affected tissues can be removed at the same time as the biopsy, in effect to kill two birds with one stone. However, if the growth is large, cutting it off together with the skin tissues 2-3 mm around the growth in order to remove all the malignant tissue will create too big a wound. It will affect a person’s appearance,  so cosmetic surgery is also required. In the initial consultation, surgical specialists face a challenge to determine how much skin tissue to cut away for biopsy before it is confirmed to be a carcinoma.

 

Other skin cancer types, other than basal cell carcinoma, are squamous-cell carcinoma and malignant melanoma. All three can spread, and malignant melanoma is particularly tricky to deal with, because it can spread to the lymph nodes or the brain, the liver or the lungs at an early stage, making treatment more difficult, and thus increasing the mortality rate. This means early discovery is paramount.

 

Skin cancer can be hereditary. It is advisable for people who have family members succumbing to skin cancer to visit a dermatologist and get a full-body skin spots record for future comparison and reference. We may not remember clearly when certain colour spots appear on our body, or whether their shape or size has changed. Doing a full-body colour spot record will help lower the risk of wrong diagnoses and enable early action when skin tissue anomalies are detected.

 

Tips for preventing skin cancer:

  1. Choose sunscreen which effectively blocks UVA and UVB rays. UVA rays can penetrate glass or clothing. They are rated by a factor of 5* and it is recommended to use products with at least a 3* factor. For UVB, factor higher than SPF30 is preferred.
  2. Your sunscreen lotion should be water-proof.
  3. There are physical or chemical sunscreen products. For physical sunscreen products, choose those containing titanium dioxide or zinc oxide, which have less allogenic side effects or irritants; for chemical sunscreen, it is advisable to choose those that contain Avobenzone.
  4. Apply sunscreen half an hour before heading out into the sun, and re-apply every two hours, or immediately after sweating, washing or bathing.
  5. Use umbrellas, wide-brimmed hats and sun-glasses (that sit as close to the face as possible to filter the amount of light entering the eyes, and the lenses should fully cover the eye region). Wear long-sleeved tops and long pants (impenetrable by light) which is more effective than using sunscreen.
  6. The sun is strongest between 11 am and 3pm. Avoid outdoor activities during this period.
Consult your dermatologist for sunscreen product recommendations.

The above information is provided by Dr. Alec Fung Ho Chuen and Dr. Henry Kwan Tim Lok.
Focal Liver Lesions that can be safely managed and monitored at the primary care setting (Part 4)

Simple hepatic cysts are very common, its prevalence had been reported to be as high as 15-18% in CT series. (10) On USG they appear as anechoic, homogeneous fluid filled lesion with smooth margin. CT would likewise show well-demarcated, water- attenuated smooth walled lesions without contrast enhancement. Most simple hepatic cysts are asymptomatic, incidental findings. However, the larger ones could cause pain or compressive symptoms—these can be treated surgically or by aspiration followed by sclerotherapy.

With atypical findings, clinicians should be alerted about possibility of
1) biliary cystadenomas (irregular walls and internal septation on USG; heterogeneous septations, irregular papillary growths and thickened cyst walls on CT) as malignant transformation was possible and they must be surgically excised.
2) polycystic liver disease (similar features of cysts on USG and CT but extensive in number)—this entity tends to be much more symptomatic and may even be associated with polycystic kidney disease. Early referral to surgeon or transplantation team should be considered.
3) hydatid cyst (thick calcified wall on USG with hyper- or hypoechoic content and presence of daughter cysts; hypodense lesion with hypervascular pericyst wall and endocyst wall on CT)—caused by Echinococcus granulosus infection, it is more common in sheep grazing areas and not commonly seen in our locality. However it is worth considering in foreign patients and they should be referred for treatment.

Conclusion

Detection of FLLs had become more and more often and the trend will likely continue in the future. Some of them can be safely managed at the primary care settings. Family physicians are encouraged to acquaint with the imaging findings of different lesions and identify the high risk patients, in order to safely manage some benign conditions at the primary care setting.

The above information is provided by Dr Chik Hsia Ying, Barbara

Focal Liver Lesions that can be safely managed and monitored at the primary care setting (Part 3)

Focal nodular hyperplasia (FNH)

FNH is a rather common (0.3-3%), usually asymptomatic liver lesion.(9) It was postulated to be caused by injury to the portal tract resulting in arterial to venous shunts, which in turn causes hyperperfusion and oxidative stress, triggering a response from hepatic stellate cells that produce the typical central scar.

On CT examination a typical finding is a ‘spoke- wheel” central scar; it should be homogeneously hyperdense during arterial phase and hypo- or isodense during portovenous phase. (3) If the diagnosis could not firmly established after a CT scan, especially if it could not be differentiated from hepatocellular adenoma, referral to a specialist is recommended for further opinion. MRI would usually provide more information but rarely, biopsy alone could differentiate the two conditions.

Since FNH are mostly asymptomatic and stable, surgical treatment is seldom indicated. Malignant transformation and rupture are extremely rare (those could be adenomas mistaken as FNH to begin with). Females taking OC pills with no intention to stop treatment are advised to undergo annual USG for 2-3 years, other patients with a firm diagnosis of FNH do not need regular imaging as follow up.

 

Hepatic Haemangioma

Hepatic haemangioma is the most common benign liver tumour, with prevalence of 0.4-20% reported. (4) It is a benign vascular liver lesion of unknown etiology. Females (5:1) are much more commonly affected though a direct causal relationship with female hormone could not be established. Most are asymptomatic unless large in size but rarely, a giant haemangioma could cause consumptive coagulopathy and disseminated intravascular coagulation.

USG by an experienced ultrasonographer with the finding of a hyperechoic liver mass with well-defined rim and intranodular vessels is considered diagnostic and reliable; CT examination is only indicated if the USG findings are ambiguous—classical features was peripheral nodular enhancement and progressive centripetal fill-in. Owing to its vascular nature, biopsy is contraindicated.

Surgical treatment for haemangioma is rarely necessary, but specialist referral should be made if the lesion was large and asymptomatic or growing in size. Small haemangioma with classical features do not need regular imaging for monitoring.

References:

  1. Smith-Bindman R, Miglioretto DI, Johnson E et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems. 1996-2010. JAMA 2012;307:2004-9.
  2. Lee KH, O'Malley ME, Haider MA, Hanbidge A.AJR Am J Roentgenol. 2004 Mar;182(3):643-9. Triple-phase MDCT of hepatocellular carcinoma.
  3. Marrero JA, Ahn J, Rajender Reddy K. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014; 109(9): 1328-47
  4. Shaked O, Siegelman ES, Olthoff K et al. Biologic and clinical features of benign solid and cystic lesions of the liver. Clini Gastroenterol Hepatol 2011;9:547-62
  5. Hernandez- Nieto L, Brugeuera M, Bombi J et al. Benign liver-cell adenoma associated with long-term administration of an androgenic- anabolic steroid(methandienone). Cnacer 1977;40:1761-4
  6. Labrune P, Trioche P, Duvaltier I et al. Hepatocellular adenomas in glycogen storage disease type I and III: a series of 43 patients and review of the literature. J Paediatr Gastroenterol Nutr 1997;24:276-9
  7. Bunchorntavakul C, Bahirwani R, Drazek D et al. Clinical features and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther 2011;34:664-74
  8. Bioulac-Sage P, Taouji S, Possenti L et al. Hepatocellular adenoma subtypes:the impact of overweight and obesity. Liver Int 2012;32:1217-21
  9. Karhunen PJ. Benign hepatic tumours and tumour like condition in men. C Clin Pathol 1986;39:183-9
  10. Oto A, Tamm EP, Szklaruk J. Multidetector row CT of the liver. Radiol Clin North Am 2005;43:827-48

The above information is provided by Dr Chik Hsia Ying, Barbara

Focal Liver Lesions that can be safely managed and monitored at the primary care setting (Part 2)

Confirmed FLL

When confronting a FLL, the following algorithm is useful as a guide:
algorithm for investigation of FLL

After excluding high risk patients and suspicious lesions like hepatocellular carcinoma, liver metastasis and cholangiocarcinoma, FLL would be either solid, cystic or haemangioma with classical appearance on imaging. All suspicious lesions should have been referred to a specialist at this stage.

 

Solid benign FLLs

Hepatocellular adenoma

Considered a rare benign liver tumour, the incidence varies from 0.007-0.012% with a prevalence in females taking oral contraceptive pills and often regress after cessation of OC pills. (4) There is a causal relationship between the development of liver adenomas and sex hormones disturbance. Along this line, usage of anabolic androgen steroids has also been implicated in the development of liver adenomas in male. (5) Specific diseases like glycogen storage disease (GSD) and metabolic syndrome are also more prone to developing hepatocellular adenoma. (6,7)

On CT scan, a hepatocellular adenoma should be well demarcated with peripheral enhancement and usually homogeneous rather than heterogeneous. It could be hypodense (if steatotic) or hyperdense (after haemorrhage). MRI (especially using hepatospecific contrast agent) has been shown to be superior in not just diagnosis of the adenoma but distinguishing different subtypes-- particular variant such as telangiectatic hepatocellular adenoma (THCA) was found to be more symptomatic with higher malignant potential. It is thus recommended that all hepatic adenomas should be referred to a specialist, if it was opined that THCA was the case, an aggressive approach would usually be adopted. (3)

The main concern about hepatocellular adenoma was its propensity to haemorrhage and malignant change. Most of such complications occurring in lesions larger than 5cm. Hence these benign tumours tend to be treated surgically, especially THCA. When managing such patients, it is important to advise on stopping all hormone use and weight reduction. After specialist consultation, those deemed low risk in haemorrhage, rupture and malignant transformation (<5cm) can be monitored at the primary care setting, with imaging every 6 months for 2 years then annually depending on growth and stability of the lesions.

Pregnancy in patients with hepatocellular adenoma is a more complicated issue—as the frequency is low and data lacking. Growth of the adenoma is to be expected but pregnancy is not absolutely contraindicated in all patients especially with smaller tumours. The treatment must be individually devised by a team of surgeon, obstetrician and hepatologist. (8)

References:

  1. Smith-Bindman R, Miglioretto DI, Johnson E et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems. 1996-2010. JAMA 2012;307:2004-9.
  2. Lee KH, O'Malley ME, Haider MA, Hanbidge A.AJR Am J Roentgenol. 2004 Mar;182(3):643-9. Triple-phase MDCT of hepatocellular carcinoma.
  3. Marrero JA, Ahn J, Rajender Reddy K. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014; 109(9): 1328-47
  4. Shaked O, Siegelman ES, Olthoff K et al. Biologic and clinical features of benign solid and cystic lesions of the liver. Clini Gastroenterol Hepatol 2011;9:547-62
  5. Hernandez- Nieto L, Brugeuera M, Bombi J et al. Benign liver-cell adenoma associated with long-term administration of an androgenic- anabolic steroid(methandienone). Cnacer 1977;40:1761-4
  6. Labrune P, Trioche P, Duvaltier I et al. Hepatocellular adenomas in glycogen storage disease type I and III: a series of 43 patients and review of the literature. J Paediatr Gastroenterol Nutr 1997;24:276-9
  7. Bunchorntavakul C, Bahirwani R, Drazek D et al. Clinical features and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther 2011;34:664-74
  8. Bioulac-Sage P, Taouji S, Possenti L et al. Hepatocellular adenoma subtypes:the impact of overweight and obesity. Liver Int 2012;32:1217-21
  9. Karhunen PJ. Benign hepatic tumours and tumour like condition in men. C Clin Pathol 1986;39:183-9
  10. Oto A, Tamm EP, Szklaruk J. Multidetector row CT of the liver. Radiol Clin North Am 2005;43:827-48

The above information is provided by Dr Chik Hsia Ying, Barbara

 

Focal Liver Lesions that can be safely managed and monitored at the primary care setting (Part 1)

Introduction

Whether initiated by clinicians or patients, imaging of the abdomen had been more and more often performed for various indications. A study in the U.S. found that during the period 1996- 2010, the use of CT examinations had tripled and that of MRI had quadrupled. With high prevalence of hepatitis B virus infection in Hong Kong and better public education on surveillance of the carriers, the need and increment in the use of liver imaging is probably even more so than the above figures. On the other hand, the imaging modalities and methods had also gotten more sophisticated over the years thus increasing their diagnostic yield.

All these factors meant that the discovery of a focal liver lesion (FLL) in an asymptomatic patient, or with irrelevant complaints, is now encountered by our general practitioners at an unprecedented rate.  It is therefore important for them to make the correct decision about what to do about these patients and when to refer them to a specialist.

 

Evaluation of patients with a FLL

A detailed history and physical examination is mandatory—the gender and age, hepatitis B carrier status, the use of oral contraceptive pills, alcohol consumption and personal or family history of liver disease or primary tumours all help to identify the subgroup of high risk patients. History of weight loss is always significant. These riskl factors should prompt further investigation and specialist referral at a lower threshold.

Regarding liver imaging findings, the author finds it of upmost importance to personally review the films, it is even of more relevance nowadays that many cross border patients would bring along films of variable, sometimes of dubious quality and each must be individually appraised.

A satisfactory CT for the investigation of a FLL meant a triple phase one using multidetector scanner (MDCT) with high injection rate of contrast which allows faster scanning with more uniform hepatic enhancement. (2,3) “Triple phase” refers to the plain, late arterial, portovenous and delayed phases for characterization of liver lesions. Of note is that sometimes abdominal CT examination (for example plain or double phase contrast CT) was ordered for other complaints and incidental detection of FLL warrants a dedicated triple phase CT or even an MRI for diagnosis.

MRI for liver should include the same triple phases as a CT examination; the intravenous contrast agent used, however, differs—gadolinium is commonly employed but newer generation hepatospecific agent like gadoxetate disodium (PrimovistTM) provides more information regarding the nature of the FLL. MRI is also superior in diagnosing fatty infiltration which can sometimes masquerade as a liver lesion on USG or CT. Magnetic Resonance Cholangio- Pancreaticography (MRCP) is also valuable for appraising suspected biliary lesion or to define the relationship between a liver mass and the biliary tree.

More sophisticated or invasive investigative tools should be initiated by a specialist rather than at a primary care setting. They should be reserved for high risk patients with ambiguous findings.

References:

  1. Smith-Bindman R, Miglioretto DI, Johnson E et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems. 1996-2010. JAMA 2012;307:2004-9.
  2. Lee KH, O'Malley ME, Haider MA, Hanbidge A.AJR Am J Roentgenol. 2004 Mar;182(3):643-9. Triple-phase MDCT of hepatocellular carcinoma.
  3. Marrero JA, Ahn J, Rajender Reddy K. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014; 109(9): 1328-47
  4. Shaked O, Siegelman ES, Olthoff K et al. Biologic and clinical features of benign solid and cystic lesions of the liver. Clini Gastroenterol Hepatol 2011;9:547-62
  5. Hernandez- Nieto L, Brugeuera M, Bombi J et al. Benign liver-cell adenoma associated with long-term administration of an androgenic- anabolic steroid(methandienone). Cnacer 1977;40:1761-4
  6. Labrune P, Trioche P, Duvaltier I et al. Hepatocellular adenomas in glycogen storage disease type I and III: a series of 43 patients and review of the literature. J Paediatr Gastroenterol Nutr 1997;24:276-9
  7. Bunchorntavakul C, Bahirwani R, Drazek D et al. Clinical features and natural history of hepatocellular adenomas: the impact of obesity. Aliment Pharmacol Ther 2011;34:664-74
  8. Bioulac-Sage P, Taouji S, Possenti L et al. Hepatocellular adenoma subtypes:the impact of overweight and obesity. Liver Int 2012;32:1217-21
  9. Karhunen PJ. Benign hepatic tumours and tumour like condition in men. C Clin Pathol 1986;39:183-9
  10. Oto A, Tamm EP, Szklaruk J. Multidetector row CT of the liver. Radiol Clin North Am 2005;43:827-48

The above information is provided by Dr Chik Hsia Ying, Barbara

Impacted wisdom teeth

Wisdom teeth usually erupt when a person is at the age of 18 to 25. In the process, some wisdom teeth may not have enough space to fully emerge, resulting in impacted teeth. This is more common for wisdom teeth on the lower jaw.

Partial eruption of a wisdom tooth may cause accumulation of plaque around the soft tissue surrounding the crown. Pericoronitis may develop. Symptoms include pain, fever, swelling and/or limitation of mouth opening. Medication can be prescribed to treat the inflammation and to relieve pain for the short term. For long-term management, it requires meticulous oral hygiene and regular monitoring, or surgical extraction of the impacted wisdom teeth.

Prevention is better than cure. As impacted wisdom teeth are difficult to clean and food debris will cause plaque build-up in the gap between an impacted tooth and the adjacent molar, there will be high risk of caries or periodontal disease affecting both teeth. Therefore, surgical extraction of an impacted wisdom tooth is usually recommended as a preventive measure.

Radiographic examination is mandatory to assess the difficulty of surgery and ascertain the positions of the inferior alveolar nerve and the impacted tooth. If the nerve and the tooth are too close, there will be greater risk of trauma on the nerve. The risks and benefits must be weighed up prior to surgery. In some cases, coronectomy is a preferred treatment to minimize risks. It involves surgical removal of the crown of an impacted wisdom tooth, leaving the root untouched. Alternatively, the impacted tooth can be extracted by experts such as oral maxillofacial surgeons.

The above information is provided by Dr Ting Pong Jor, Joyce

Headaches may originate from spinal problems?
 

Headache is common for many of us leading a fast-pace life. People deal with it nonchalantly –  "I have a headache again today. I’ll pop a pain killer for that". Have we ever wondered, though, what actually causes the headache? Fatigue, flu or lack of sleep?

Did you know that headaches may be linked to the spine? There are different types of headaches, such as migraine, tension headache, cervicogenic headache or hypertension headache. 

Cervicogenic headache is caused by issues linked to the neck structures and/or soft tissues, most often related to the misalignment of top 3 cervical. 

The common symptoms of cervicogenic headaches are:

1. The pain intensity is mild to medium, which usually lasts a few hours 

2. Neck muscle spasm 

3. Neck movement affects the pain

4. Tension on both sides of the head

5. No symptoms of light sensitivity or nausea

Cervicogenic headache can be cured if the real causes are clearly identified. With chiropractic therapy, treatment starts with ensuring proper alignment of the cervical spine, relaxing neck muscles and freeing the associated nerves from compression. This type of headache can be cured with minimum efforts. 

The above information is provided by Dr Luk Ka Bo, Janis. 

Pesky Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a complicated medical syndrome, which means much more than just cysts in the ovaries. It interferes with our hormones, which may lead to excessive body hair, acnes, irregular menstrual cycles and trouble with getting pregnant. It is also associated with an increased risk of high blood sugar, high blood pressure, heart disease and cancer of the womb. If you have irregular mense, acne prone skin or hair growing above the upper lip or below the naval, then you should be alerted and consult a doctor to see whether there is a hormone problem going on.

PCOS cannot be completely cured, but treatments are available to deal with the symptoms. For example, BPO or Adapalene acne cream may be prescribed for external application to alleviate acne problem. It is easy to apply and they have minimal side effects. However, as the hormonal level isn’t addressed through such treatment, recurrence is likely when medication is discontinued. Another option is taking oral contraceptive pills to balance your internal hormone level. This will improve the androgen-related symptoms such as acnes and excessive body hair growth.

For severe acne problem, doctors may prescribe oral or topical antibiotics, but the problem of antibiotic resistance should not be overlooked. If you wish to avoid antibiotics, LED phototherapy can be used to treat acnes by controlling sebum secretion and bacteria overgrowth, which are two key contributing factors of acne problem. It is an FDA approved, safe and effective treatment for acnes.

If you are trying to get pregnant, you should discuss with your doctor on ovulation induction. Clomid is a drug which can stimulate the ovary to release an egg regularly each month, so to increase the chance of conceiving. In terms of diet, PCOS ladies don’t respond as good to insulin. You should avoid food with high sugar content or refined carbohydrates which would stimulate insulin secretion and aggravate androgen-related symptoms (such as acne and body hair problems).

Our health is in our hands. Healthy lifestyle is very helpful for maintaining hormonal balance. Exercise more and maintain a healthy low-sugar high-fibre diet, and you will be healthier and more beautiful naturally.

The above information is provided by Dr Ting Sze Man

About Periodontitis

Do you suffer from Periodontitis?

Bad breath, inflamed and bleeding gums are often early signs of periodontitis. In the worst cases, toothache and receding gums will occur. If nothing is done, teeth will begin to loosen and fall out, hampering chewing and digestive functions and ultimately impairing overall health.

Early treatment is the best cure

Periodontitis sufferers usually don’t seek early treatment and miss treatment windows. Most seek help in the mid to late stages of the disease when symptoms such as sore gums, loose teeth or toothache affect sleep quality. Sufferers may think gum bleeding is a result of over-vigorous tooth brushing and hope for improvement by gentler brushing. Some may try mouthwash to improve the condition, or blame the symptoms on “heatiness” and take herbal tea for a cure. Others may go to a Physician instead of a dentist, thinking it’s a sign of something wrong with the body.

However none of these responses get to the root of the problem. They may help to suppress the symptoms but they don’t tackle periodontitis head on. Worse still, they delay effective treatment. It only becomes more complicated, and costlier, to treat in later stages when the gums are inflamed. Even if the stop-gap measures provide some relief, they will not prevent gum recession. So it’s paramount to seek treatment as soon as symptoms such as gum bleeding show up.

How can dentists help?

Early treatment is the key for tackling periodontitis. Dental specialists will examine a patient’s family health history as well as dental and lifestyle habits. They will look at whether there are signs of gum bleeding, whether the patient smokes, or if periodontitis, diabetes, cardio-vascular diseases run in the family. They will also check if a patient uses interdental brushes or dental floss. After initial checks, dentists will make a detailed examination, using a probe to check the pocket around each tooth, or use X-ray to measure bone loss, in 2D in most cases or 3D in more complicated cases.

In the event of tooth loss, rehabilitative treatments such as crowns, bridges and implants will be adopted. Implants involve inserting a titanium screw into jaw bone. Within six to eight weeks, the screw fixture will be integrated with the surrounding bone.  Patients should maintain good oral hygiene not only for natural teeth but also around dental implant to prevent infection of the supporting bone and gum.

Are implants the ultimate solution?

Some people think that their dental problems are solved by having an implant and they continue with bad habits such as smoking, drinking or not brushing teeth. Within a few years, there will be bone loss. The prosthesis will appear to be firmly in place in the early stages of gum and bone deterioration as the screw implant is fixed into the bone socket. However, by the time the prosthesis is loose, deterioration will be at an advanced stage.

To avoid this, patients must cut off the bad habits that led to periodontal disease and return to the dentist for regular check-ups after an implant to detect bone loss problems as soon as they happen.

Annual check and scaling is a must

Prevention is better than cure. This applies to periodontal disease as much as any other ailment. A visit to the dentist every six months to a year is advisable, including a scaling to remove plague and tartar when needed.

Dental care is in our own interest. No one cares about our own teeth more than ourselves. So we must be judicious with oral hygiene and maintain good habits to keep our teeth in good condition.

Information from Dr Clive Fung Kin Yue, Specialist in Periodontology 

Cholesterol level has nothing to do with physique

It is commonly thought that high cholesterol only occurs to overweight people, or it is purely linked to dietary habits. Let’s find out more about cholesterol in order to keep it at a healthy level.

Cholesterol is an essential building block for the human body. It is involved in the production of some hormones, vitamins and heat, and helps to maintain body temperature. LDL (low-density lipoprotein) cholesterol is generally described as “bad cholesterol”, whereas HDL (high-density lipoproteins) cholesterol is “good cholesterol” that helps the body recycle bad cholesterol. Excessive bad cholesterol in the body may cause fat deposits to form in different parts of the blood vessels and form blockages. This elevates the risks of triggering severe ischemic cardio-vascular diseases such as coronary heart disease, stroke and peripheral arterial occlusive disease. As well, high levels of triglyceride is also linked to atherosclerosis.

A high number of high cholesterol cases are caused by unhealthy dietary and lifestyle habits (for example, long-term high-fat diet, sedentary lifestyle and abdominal obesity). But there are also skinny people having high cholesterol levels. Cholesterol comes from what we eat. However, the liver also produces bad cholesterol if it has processed high fat intake and hear (high carbohydrate), which explains why some people still suffer from high cholesterol despite maintaining a simple diet, and genetics is also an important cause too. If a patient cannot seem to lower the cholesterol level even with good dietary habits, adequate exercise and a healthy lifestyle, the doctor will prescribe different cholesterol control medications such as statin. People with high cholesterol should closely monitor their blood pressure and blood sugar level to avoid having all three indicators at high-risk levels.

Information provided by Dr Bernard Wong Bun Lap, Cardiologist
Handy tips for weight control

Q: Is it advisable to get prescription weight control medications from doctors to lose weight?
A: Doctors in general don’t casually prescribe weight control medications. Doctors will first get a full picture of a patient’s health, to see if pre-existing medical conditions lead to obesity – for example, hypothyroidism, excessive production of adrenocorticotropic hormone or Polycystic Ovarian Syndrome can lead to weight gain, and certain psychotic conditions and psychotropic drugs could also cause weight gain. If obesity is not linked to medical conditions, doctors will advise patients to first try maintain a balanced diet and exercise regime for weight control.

Q: How do we define obesity?
A: There are different standards and indicators for obesity internationally. The most common indicator is Body Mass Index (BMI). For Asians, a BMI higher than 23 is considered overweight, whereas BMI above 25 is considered obese. Men with a waistline exceeding 90 cm, or women with waistline exceeding 80 cm, are also considered obese.

Q: What are the recommended dietary rules for weight control?
A: There are many dietary tips around the world. The simplest one is calorie counting. Simply put, when the energy intake from food is higher than the energy expended, the residual energy will be stored as fat in the body. By the same token, if the energy output is greater than the energy intake, then body fat will be burnt to supply what the body needs.

Q: Is strict dieting an effective means for losing weight?
A: Eating less will of course reduce weight gain, but when dieting is discontinued, body weight could easily rebound, and the body is more prone to weight gain from then on. That’s because dieting reduces not only body fat but also muscle mass. Even when the body is still, energy is spent at Resting Metabolic Rate (RMR). The greater the muscle mass, the higher the RMR. When muscle mass is lessened, RMR slows down and the body burns less energy, so it’s much easier to gain weight. So it’s necessary to take resistance training to maintain body mass when trying to lose weight.

Q: Are aerobic exercises such as jogging the best form of exercise for losing weight?
A: The best weight loss exercise is a combination of aerobic and resistance training. Aerobic exercises can burn fat and enhance cardiovascular functions while resistance training can maintain muscle mass and raise RMR. Resistance training is safer than aerobic exercise, as data show the number of incidences of death or injuries resulting from resistance training is lower than that of aerobic exercises. Some aerobic exercises such as jogging could lead to joint straining, and there are greater risks of dehydration and fall too.  

Q: High intensity interval training (HIIT) is all the rage now. Is it effective for weight loss?
A: HIIT is a form of interval resistance training, with aerobic exercise elements included. The advantage of HIIT is that it can be done in shorter duration and has higher intensity. It’s not only effective for losing weight, but also helps to enhance cardiovascular strength. Compared to pure aerobic exercise, HIIT is more effective for losing weight.

Information provided by Dr Samuel Chan Hoi Chung