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Q. I’ve been a contact lens wearer for more than 10 years. I’ve worn both hard and soft lens, and I’m currently using monthly disposable lenses. In the last 3 months, I’ve started experiencing a twitch in my upper left eye lid and my left eye become watery. It doesn’t happen everyday, but on some days, the twitching can go on all day and my eye becomes so watery, my tears overflow and I look like I’m crying. I’ve stopped wearing eye makeup after consulting my GP, and I am quite religious about cleaning my lenses and not wearing them for long periods of time. But the twitching and watering have persisted. Is this common in long-term contact lens users or could this be an eye - or worse, nerve - problem?
A. Twitching of the eyelids can be due to stress, eye strain or eye irritation. In a contact lens wearer, a common cause especially in the presence of tearing is allergy or overwear syndrome where surface inflammation or erosions continue to irritate the eye even after removal of contact lenses. The diagnosis is made by examining the eye under the slit-lamp. If this is the cause, then lubricant eyedrops are helpful and contact lens wear should be stopped for a period ranging from 1 week to a few weeks. In more severe cases of allergic conjunctivitis, anti-allergy eyedrops will be prescribed. Thereafter, once the eye is fit for contact lens wear again, a change in contact lens or contact lens solution may be indicated to prevent similar occurrence.
Clinical A/Prof Heng Wee Jin
Head, Cornea Service
The Eye Institute |
Q. A good friend recently contacted mycoplasma and was ill and weak for almost three weeks. Can you tell me more about this disease? From what I understand it’s a respiratory infection like pneumonia or bronchitis. How does one contact it and how contagious is it? My friend had to undergo a blood test - is this the only way to test for mycoplasma? How would I know if I have mycoplasma and not the common flu?
A. Mycoplasmal pneumonia is caused by Mycoplasma pneumoniae, a small micro-organism different from common bacteria. This condition was traditionally classified as an “atypical” pneumonia but this term has little practical use today as it is not easy to tell it apart for the “typical” bacterial pneumonias. It can start with fever, cough and chest pain that is worse on inspiration as well as non-specific symptoms like headaches, muscle aches and poor appetite. Rarely, mycoplasmal pneumonia can cause symptoms affecting other organs such as the skin or the brain. The usual course of untreated mycoplasmal pneumonia is 10 to 14 days. Most people will recover, especially with appropriate treatment. Macrolides like clarithromycin or quinolones like levofloxacin are the drugs most commonly effective against the organism. The chest x-ray is likely to show shadowing seen in pneumonia.
Mycoplasmal pneumonia is an infectious disease and is transmitted from person to person during coughing or sneezing. Not everyone infected will come down with pneumonia although they may have some of the above symptoms. Only 3 to 10% will develop pneumonia, some are asymptomatic and others may have flu like symptoms. The spread is slow and is encouraged by close contact and the attack rate is highest among young adults.
Several methods are available to test for a pneumonia caused by M. pneumoniae. The diagnosis may be confirmed by either testing respiratory secretions for the presence of the organism or by a blood test to look for an antibody response. However, these tests are rarely done because pneumonias caused by the common organisms including M. pneumoniae are now grouped as “ community acquired pneumonia” and standard treatment will usually include drugs that will treat this organism as well.
It is unlikely that the common flu will be mistaken for mycoplasmal pneumonia as it usually will not have changes on the chest x-ray. Milder cases of mycoplasma infections will recover even if untreated.
Dr. Kong Po Marn
Senior Consultant
Dept. of Respiratory medicine
Tan Tock Seng Hospital |
Q. My 59-year-old husband is very forgetful and easily anxious these days. He refuses to go to the doctor and has not seen one for at least 5 years. Now, he puts things away in unusual places and can't recall our neighbour’s names. He even forgets everyday tasks, such as walking our dog of 10 years. He retired with 35 years service in the advertising industry where he did video editing work. But now he can't do that at all. How can I convince him to get help? Besides becoming increasingly forgetful, what are the early signs of Alzheimer's? Is there anything that might cause these symptoms besides Alzheimer's and can it be treated successfully?
A. Dementia is a disease of the brain that results in progressive irreversible deterioration of memory, intelligence, behaviour and function. Alzheimer’s disease is a degenerative brain disease that is the most common cause of dementia worldwide. The most important risk factor for Alzheimer’s disease is age, and the vast majority of Alzheimer’s disease starts after the age of 60. Other causes of dementia include strokes (vascular dementia), chronic alcoholism, brain infections, brain tumours and vitamin B12 deficiency. Two other conditions that are common in the elderly can also mimic dementia: depression (“pseudo-dementia”) and severe hearing impairment. Besides memory loss, other early signs of dementia include difficulty performing familiar tasks, problems with language, disorientation to time and place, poor or decreased judgment, problems with abstract thinking, misplacing things, changes in mood or behaviour, changes in personality and loss of initiative.
You are justified in your concerns that the cognitive and behavioural changes described in your husband are not part of normal aging. While some degree of cognitive slowing may occur with age, this should not be severe enough to affect one’s accustomed social and occupational functioning, nor result in behavioural changes, as in this instance. This strongly suggests the need to exclude underlying diseases rather than attributing these symptoms to the aging process.
In your husband’s case, the age of onset is somewhat atypical for Alzheimer’s disease, especially if there is no family history of dementia. Another important consideration is the onset and duration of symptoms. An acute onset of forgetfulness may suggest an illness like stroke. Likewise, if the duration is short (weeks to a few months), confusional states (also known as delirium), which are often attributable to potentially reversible causes such as medications, infections, tumours, traumatic brain injury, strokes, seizures and metabolic causes, would need to be excluded. It is strongly advised that your husband seek early medical consultation to achieve an accurate diagnosis of his cognitive symptoms. The prognosis ultimately depends on the underlying cause, and the availability and timing of treatment (generally, the earlier appropriate treatment is rendered, the better the prognosis).
Dr Lim Wee Shiong
Consultant
Memory Clinic
Department of Geriatric Medicine
Tan Tock Seng Hospital |
Q. My brother tripped over a step and fell down a flight of stairs in October last year. Immediately after the fall, I could see that his left ankle was extremely swollen. We advised him to get an X-ray immediately. Fortunately, the X-ray showed no fractures. He was prescribed Ibuprofen and given a tube of analgesic cream to take home. Three days later, the swelling showed no sign of improvement. The bruises were still obvious. Frustrated, my brother decided to visit a Chinese sinseh instead. As expected, the sinseh “massaged” and “twisted” the ankle. The swelling went down a little the next day and he could walk better.
Five months down the road, today, my brother’s ankle remains swollen, and it gets worse after a day of walking (he no longer seems to enjoy the mobility of that ankle). Even when he exercises, an ankle guard has to be worn. Are there any remedies out there that we have yet to explore, or does my brother have to live with a “damaged” ankle the rest of his life?
A. Ankle injuries are very common. It sounds like the patient had a severe sprain. He probably tore his lateral ankle ligaments, which is usually the case when there is a lot of bruising. The initial treatment of ankle injuries is the most important aspect of treatment. It can be summarised as:
P
R
I
C
E |
Protect the injured ankle with either a brace or even a cast if necessary
Rest the affected ankle
Ice the ankle to reduce swelling and pain
Compression helps in reduction of swelling and pain as well. This can be done with turigrips or crepe bandaging
Elevation is also important in reducing swelling |
It is obvious from the recommended initial treatment that pain and swelling are the major issues. Once the pain becomes bearable, we usually start rehabilitation – physiotherapy to strengthen the injured ligaments and surrounding muscles. It can take three to four months for the patient to return to sports after a major sprain, provided he is treated early. I would suggest that he consults an orthopaedic surgeon for further assessment. Although the lateral ligaments are the most commonly injured ligaments, there are a lot of other structures that can be damaged and this is best evaluated clinically.
Dr Yegappan M
Consultant
Department of Orthopaedic Surgery
Tan Tock Seng Hospital |
Q. I am a 52-year-old male who smokes approximately a pack of cigarettes a day. I drink occasionally. I have no medical ailments, except for this constant ringing in my ears for the past month. I would often hear a buzzing sound in my ear, though not persistently. On top of this, I seem to be losing my sense of balance at times. For example, if I were to stand up abruptly, I will need to balance myself first before I can start walking. I used to be able to use the ski machine (aka elliptical cross trainer) at the gym with ease but I am unable to do that now. After spending just 10 minutes on the machine, I would start feeling dizzy. May I know what has caused this condition?
A. Ringing and buzzing in the ears is often a symptom of underlying hearing loss, so to begin with, so a hearing check is definitely advised. Sometimes the hearing loss is part of a bigger problem within the inner ear, causing balance problems as well. Since you have both ringing and balance problems, an ENT consultation is advisable. There are quite a few conditions presenting in this way, and depending on which one you have, the treatment options are quite different.
Although, in this instance, heavy smoking and drinking may not be directly related to the problem, they are nonetheless lifestyle habits which invariably lead to medical problems or exacerbations of medical problems. Therefore I would encourage you to make a lifestyle change in the interests of health.
Dr Yeo Seng Beng
Senior Consultant
Department of Otorhinolaryngology (ENT)
Tan Tock Seng Hospital |
Q. I am a woman in my late fifties. Recently, I seem to be having problems with controlling my bladder. For the past week, I had noticed that I have been frequenting the washroom more often than usual. There is hardly any difference in my daily fluid intake. I am not an avid coffee drinker, though I have a cup of Japanese green tea every day. I find that my bladder starts getting full every two hour or so in the day. I cannot even sit through a two-hour show at the cinema! At night, I also have to wake up to visit the washroom. In fact, there was once when I wet my bed I am married with two grown-up children. They are aware of my condition and have advised me to seek medical opinion. I have heard about urinary incontinence, but I am under the impression that it only afflicts the very elderly. Do I have to consult a medical specialist for the symptoms that I am experiencing? In the meantime, are there any over-the-counter remedies that I can try? How about traditional Chinese medicine?
A. Your symptoms sound very much like those of overactive bladder, a condition characterised by urgency (inability to hold your bladder), frequency (going to toilet to urinate frequently), and urge incontinence (leakage of urine accompanying urgency).
Overactive bladder is a common condition, reported to affect around 15-17% of the population worldwide. Its causes to date are unknown. Other conditions that mimic its presentation include urinary tract infections, stones in the urinary tract, and rarely early cancerous change within the urinary tract.
Treatment of overactive bladder is often initiated on the basis of the patient's clinical complaints once these other more serious conditions have been excluded. Treatment is primarily in the form of anti-cholinergics, which act to relax the bladder and help it retain larger amounts of urine, thereby cutting down the number of times the patient will experience the need to go to the toilet and improve her control of urination. Traditional Chinese medicine may be helpful in this condition, but there is to date no substantial evidence in the medical literature for urologists to advocate its use.
Dr Gerald Tan
Registrar, Urology Unit
Department of General Surgery
Tan Tock Seng Hospital |
Q. I am 21 years old, have just completed my NS training and am waiting to enrol in the university. I exercise regularly and I have no other health problems, except for a recent surge in dreaming when I sleep at night. I have noticed that when I turn in earlier than my usual sleeping time, I tend to have more dreams – not that these dreams have any themes in particular. However, it is annoying because they tend to disturb my sleep. On top of that, for a split second, I feel that my body’s stiffened up and I cannot seem to immediately move my arms. I have absolutely no idea what has brought about this condition and I am utterly vexed by it. Not only am I not well-rested in the night, I am starting to develop a phobia for sleep. I cannot afford to make mistakes at my work and this loss of sleep is not helping. May I know where I can seek professional advice or treatment (if any) for my current condition?
A. It seems that you do lead a healthy lifestyle, which is good. Your dreams are usually not reflective of your life or future and are merely random snap shots of your experiences or fantasies. Being woken up by nightmares or bad dreams are common, but if you are awaken by choking sensations or gasping episodes during sleep, that can be indicative of obstructive sleep apnea (this, you need to consult a doctor). If you find that you are woken up during sleep and cannot move, that is known as sleep paralysis. It is a phenomenon during sleep and is believed to be one of the rarities showing that sleep and wakefulness might overlap each other. If your sleep quality is affecting your daily life, you should consult a sleep doctor soon.
Dr Kenny Peter Pang
Consultant
Department of Otorhinolaryngology (ENT)
Tan Tock Seng Hospital |
Q. My father is 54 years old this year. He is a regular smoker and drinks occasionally. He does not exercise regularly. Of late, he has been complaining of a “creepy crawly” sensation travelling up and down his legs. The intensity of the “movement” increases when he just gets out of bed. He can also feel it when sitting down or when his legs are at rest. He has no other chronic health problems, though he had undergone a pinhole surgery to remove his gallbladder, about three years ago. This sensation comes and goes sporadically and we have no idea what the triggering factors are. May we know what causes this “creepy crawly” sensation and are there any medications or supplements that my dad can take in order to alleviate the condition?
A. The “creepy crawly” sensation over the legs described is non-specific. It could be due to a variety of causes, including neurological, endocrine or metabolic abnormality, e.g. diabetes or lumbar spondylosis (lumbar degeneration). The fact that it occurs while sitting down or at rest appears to point to a neurological or metabolic cause. He should consult a neurologist to evaluate his symptoms further – this may require blood tests and X-rays.
Dr Sarbjit Singh
Senior Consultant
Orthopaedic Surgery
Tan Tock Seng Hospital |
Q. I am a healthy 50-year-old homemaker with no notable vices. I swim about two to three times a week. Recently, I have been experiencing numbness and a tingling sensation in my fingers. My fingers feel tight when I try to clasp them. When doing household chores, I used to be able to wring the water out of the cloths. But now, I cannot seem to wring the cloths with as much strength. I have seen a specialist about my problem and he is quite sure that it is Carpel Tunnel Syndrome (after a series of tests). What other options do I have, besides surgery (as suggested by my doctor) to treat the problem? Will taking vitamin B complex help to ease the discomfort?
A. The symptoms you described are typical of Carpal Tunnel Syndrome of the hand, which occurs commonly in middle-aged females. This condition is characterised by pain and numbing or tingling sensations in the hand, caused by compression of a nerve in the carpal tunnel at the wrist. The diagnosis is usually confirmed by an EMG (nerve conduction test). The treatment could be medical or surgical. Medical treatment using vitamin B complexes is helpful in alleviating symptoms for mild to moderate cases. If this does not relieve symptoms in three months, or in severe cases, a decompression of the nerve can be performed under local anesthesia to treat the condition.
Dr Sarbjit Singh
Senior Consultant
Orthopaedic Surgery
Tan Tock Seng Hospital |
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