Pre-diabetes is diagnosed when your blood sugar level is higher than normal, but not high enough to be diagnosed as type 2 diabetes.  People with pre-diabetes usually don't have any symptoms, however they are at risk of serious health consequences.

The bad news: it increases your risk of getting diabetes, heart disease and stroke.
The good news: if addressed early enough and properly, it is reversible with lifestyle changes! 

Regular screening for diabetes and pre-diabetes is recommended every 3 years for those aged 40 years and above. If you are at higher risk you may need to screen earlier than this - discuss with your family doctor.

If you have been diagnosed with pre-diabetes, lifestyle adjustments, such as a healthy diet, increasing your physical activity and losing weight can prevent or delay the onset of diabetes and its complications.

See here for more information.

Katong Family Clinic would like to remind all seniors 65 and over to check that they have received pneumococcal vaccine. Many of you may not be aware that there are TWO types and you need to have both.

Pneumococcal disease is the leading vaccine-preventable cause of death in children and adults worldwide. It is a bacterial infection that causes pneumonia, meningitis, bacteraemia and other life-threatening illness. It can be prevented by vaccination.

The recommendation from Singapore Ministry of Health and US CDC's Advisory Committee on Immunisation (ACIP) for vaccine naive patients are as follows:

1) For healthy adults aged 65 years and above:
 Prevenar 13 (dose 1), followed by Pneumovax 23 (dose 2) 1 year later

2) For high risk individuals aged 19 and older (with cerebro-spinal fluid leaks, cochlear implants, immuno-comprosing conditions):
Prevenar 13 (dose 1), followed by Pneumovax 23 (dose 2) 8 weeks later

For previously vaccinated Pneumovax23 (PPSV23) patients, please consult your doctor for relevant advice.

This recent artlcle about diphtheria shows the importance of keeping up with our regular vaccinations. Highly contagious infectious diseases like diphtheria can quickly become a threat, even in a place which has an excellent and comprehensive childhood vaccination programme with high rates of uptake like Singapore.

There always remains a minority who cannot be vaccinated due to health problems or who travel into Singapore from places where the vaccination programme is not robust. This incident serves to show the importance of continuing to vaccinate our population even though the disease is rare.

Herd (community) immunity works to help resist the spread of a contagious disease within a population only when high proportion of individuals are protected (vaccinated) to the disease.

Come down to Katong Family Clinic where our Doctors can help discuss about improving & maintaining your general health; and also keep up to date with your vaccination status!

Menopause is generally an under-recognised and overlooked cause of distressing symptoms for women who may themselves decide to 'put up with' them, regarding them as the consequence of natural aging. However symptoms arising due to the menopause or perimenopause can and should be addressed where they are causing problems. Our experienced doctors at Katong Family Clinic will be happy to discuss treatment options with you.
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Adapted from: www.menopausematters.co.uk
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MENOPAUSE - WHAT HAPPENS?
All women will experience the menopause. Natural menopause takes place when the ovaries become unable to produce the hormones estrogen and progesterone. Menopause can also occur when the ovaries are damaged by specific treatment such as chemotherapy or radiotherapy, or when the ovaries are removed, often at the time of a hysterectomy. Ovaries naturally fail to produce estrogen and progesterone when they have few remaining egg cells; the maximum number of egg cells in the ovaries is present before birth, with a reduced number already at birth, gradual reduction from puberty, and a rapid decline from 40 onwards. With less egg cells, the ovaries become less able to respond to hormones from the pituitary gland in the brain: follicle stimulating hormone (FSH) and luteinising hormone (LH) and less estrogen is produced. Levels of FSH and LH subsequently rise and a measurement of FSH is sometimes used to diagnose menopause. The resulting low, and changing levels of ovarian hormones, particularly estrogen, are thought to be the cause of menopausal symptoms and later consequences in many women.

The term climacteric refers to the time in which the hormone levels are changing, up to the periods stopping; reducing and changing hormone levels can cause early menopausal symptoms. At this stage, there may still be enough hormones produced to stimulate the lining of the womb (endometrium) to produce monthly periods (menstruation).

Menopause means the last menstrual period. Periods stop because the low levels of estrogen and progesterone do not stimulate the lining of the womb (endometrium) in the normal cycle. Hormone levels can fluctuate for several years before eventually becoming so low that the endometrium stays thin and does not bleed.

Perimenopause is the stage from the beginning of menopausal symptoms to the postmenopause.

Postmenopause is the time following the last period, and is usually defined as more than 12 months with no periods in someone with intact ovaries, or immediately following surgery if the ovaries have been removed.

MENOPAUSE - WHEN?
The average age of the natural menopause is 51 years, but can occur much earlier or later. Menopause occurring before the age of 45 is called early menopause and before the age of 40 is premature menopause. 

Generally, women having an early or premature menopause are advised to take HRT until approximately the average age of the menopause, for both symptom control and bone protective effect.
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Late menopause may also occur but by the age of 54, 80% of women will have stopped having periods.

Though many people area aware of the LPA (Lasting Power of Attorney) fewer seem to be aware of or happy to discuss ACP (Advance Care Planning) or make an AMD (Advance Medical Directive). At Katong Family Clinic we believe it is important to plan for the future including when you may not be able to make your wishes known yourself due to illness or accident.
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As well as the LPA, which allows one to appoint donees to make financial and personal decisions in the case that one loses mental capacity, we are able to guide you through the process of applying for an AMD which is a legally binding document that you can sign if it is your preference not to have extraordinary life-sustaining treatment in the event you become terminally ill and unable to communicate your wishes and where death is imminent.

Read this article from the New Paper on April 2017.

As GPs we are the front line of primary care. We see people of all ages and walks of life who may present with anything from a common cold to a heart attack, or may have rare medical conditions that require extra care when prescribing for other illnesses.
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At Katong Family Clinic our passion is seeing and managing our patients. It is intensely rewarding when we see our patients come back and over time are able to develop a deeper relationship and understanding of the person, which is a privilege that not many doctors have.

Read this article from The Strait's Times!

Many parents to be worry about the safety of having vaccines at this special time.

Having recently given birth to our third child, it is also a topic close to my heart. Some vaccines are contraindicated in pregnancy, but others, such as the flu vaccination, are not only safe, but to be actively encouraged to protect the mother and unborn child. There is overwhelming evidence for pregnant ladies to take flu vaccinations and I personally have made sure to be up to date during each of my three pregnancies.

This time around, after reviewing the medical evidence, I also took a Tdap (Boostrix) vaccine which protects against tetanus, diphtheria and acellular pertussis (whooping cough) as I felt this offered additional protection for my unborn child in the period before he could have his first vaccines.

If you are pregnant or planning pregnancy, do make sure to be up to date with your flu vaccine and do get one if you are not. It is safe and encouraged in all stages of pregnancy. (Pregnant ladies are more prone to severe complications of the flu).
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Do make an appointment with your Family Physician or Obstetrician to discuss what vaccines are recommended and for all health concerns related to pregnancy.

- Dr Sarah Packer