Really Doc?!:Medical Myths, Facts and Tips

A Must Have Health Guide For Every Family

MEDICAL MYTHS, FACTS and TIPS

Dr Bina Kurup

Dr Bina Kurup

MBBS (S), M Med (Family Med) (S), MCGP(S)

“Dr Bina has penned a most readable, interesting, and sometimes even amusing, book! It is timely and very appropriate…and I would highly recommend this very useful book...”

Dr Alfred WT Loh CEO, WONCA (World Organization of Family Doctors)

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Really Doc?!

MEDICAL MYTHS, FACTS and TIPS

DR BINA KURUP

MBBS (S), M Med (Family Medicine) (S), MCGP(S)

(Asian Edition)

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First Published October 2011 Published by DR BINA KURUP Copyright Š 2011 by DR BINA KURUP ISBN 978-981-08-9274-6 Typeset and Cover design by : Rank Books Printed in Singapore This book is an original work by the author. All Rights Reserved.

No part of this publication may be reproduced in any language, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the copyright owner.

Condition of Sale

This book is sold subject to the condition that it shall not, by way of trade or otherwise, be lent, resold, hired out or otherwise circulated without the copyright holder’s prior consent in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.

Disclaimer

The author, publisher or anyone involved in the writing or production of this book shall not be responsible, or in any way liable, for the continued currency of information or for any errors, omissions or inaccuracies in this publication whether arising from negligence or otherwise howsoever, or for any consequences arising therefrom.

The author also expressly disclaim any and all liability to any person whosoever in respect of any loss, damage, death, personal injury or other consequences whatsoever, howsoever caused or arising, suffered by any such person by their use of, or reliance upon, in any way, the information contained in this publication.

The materials in this book are not intended to replace professional medical care or attention provided by a qualified practitioner. It cannot, and should not be used as basis for diagnosis or choice of treatment for an individual.

The mention of any product, services or treatment should not be considered as endorsement by the author or publisher.

Readers are advised to consult their respective doctors and healthcare professionals regarding specific management strategies for their own medical conditions.

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DEDICATION This book is DEDICATED to MY FAMILY especially: My Husband, C.Nandakumar • Dependable • Driven • Dynamic

Thank you for your love, support and faith.

Thank you for enriching my life in more ways than you can imagine!

My Children, Reshmi, Nishanth, Shonit and godson, Magesvaran • Caring • Considerate • Cheerful

Thank you for your thoughtfulness, cheerfulness, love and uniqueness.

Thank you for making my life complete!

My Mother, Sarojini Kurup • Silent • Strong • Stoic

Thank you for providing me with a solid education and a strong foundation in values for life.

Thank you for making me what I am!

MY FRIENDS Always helpful, reliable and supportive.

Thank you for adding that extra dimension of fun, love and meaning in my life!

MY PATIENTS The Inspiration for this book.

Thank you for making me strive to constantly improve myself, so I can better care for you!

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FOREWORD Dr Bina Kurup, a very experienced Family Physician, has written a very clear and simple medical book which is most readable by any layman.

I would recommend this book to any lay person who wants to know about many of the common ailments confronting the general population.

It is systematically written; so one could even use it as a reference book for a quick reading and explanation.

The myths she quoted are commonly known to our public but many do not know that they are myths with no scientific basis.

It is not meant to be comprehensive; hence the details need to be complemented by the layperson’s Family Physician or Specialist.

I wish to congratulate Dr Kurup for writing this book with the lay person in mind.

Dr Lee Suan Yew JP.BBM.BBM(L) MBBChir(Cantab), FRCP(Glasgow), FCFP(S)

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FOREWORD The practice of medicine, particularly family medicine, is especially challenging in an environment or society rich in well-established cultures and traditions as in Singapore. Many of these traditional beliefs in the prevention of ill health, or the promotion of good health, as well as in the “correct� approach to treatment have deep-seated roots in the religious and cultural background of the general public. Most of such beliefs are handed down over the centuries by word of mouth within families, clans and communities.

It is timely and very appropriate then that a family doctor, with over twenty years experience working in both government polyclinics and in private practice, should take the time to author a book with the goal of debunking some commonly accepted health myths, as well as clarifying commonly-held health beliefs and misconceptions. She has also included in the book some basic scientific health information together with useful self-help health tips and first aid information for common emergencies.

Dr Bina Kurup has penned a most readable and interesting book in this regard and has kept the lay public very much in mind when she approached each of the topics in the book.

All readers will find her approach and explanations very easy to understand and interesting, sometimes even amusing, and indeed a very useful book for their general health enquiries.

I would highly recommend this book to anyone keen on developing a greater understanding of their health and wellbeing from a medical perspective.

Dr Alfred WT Loh, CEO World Organization of Family Doctors ( Wonca ) And Founding Partner The Raffles Medical Group, Singapore vi Now At www.rankbooks.com Copyright Rank Books. Order

FOREWORD Health is important to all of us. Yet we may not take good care of our health. Often the reason is we do not know how to do it. Sometimes it is because we have misconceptions on what are the right things to do. And we often do not think that it is our very duty to do so. Dr Bina Kurup’s book will go a long way to empower each of us to look after our health better.

Dr Bina Kurup has looked after patients for two and a half decades as a family physician. In the conversations with them, there were many opportunities that surfaced for her to note misconceptions on health matters. In her gentle ways, she sought to correct the misconceptions and also provided tips for patient self care.

She has decided to compile the commonly encountered misconceptions together with the correct information and also have provided tips for patient self care. This is truly a labour of love.

This book will be valuable to keep close by to check on health facts, correct misconceptions, and most of all learn in small doses patient self care over time. I commend this book to every one who has an interest in doing something positive to their health and who wish to be kept informed of what are the misconceptions to put right.

Associate Professor Goh Lee Gan Professorial Fellow, Division of Family Medicine, Department of Medicine Yong Loo Lin School of Medicine, National University Health Systems

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ACKNOWLEDGEMENTS The process of writing this book has been an exciting personal journey for me.It has always been my dream and desire to author books that will have a positive impact and help all reading it improve their lives in some way or other. Apart from Divine Grace, for which I am always grateful for many things in my life, there are a few I would like to record my sincere thanks to.

My deep appreciation goes to the three distinguished Doctors who had all readily agreed to write the forewords and book reviews despite their own busy schedules.

All are highly respected Family Doctors who have made major contributions to the medical scene in Singapore, with the greatest impact felt in the area of Primary Care. All are incredibly busy in their professional lives and yet have taken the time to go through my work, given invaluable advice and insight and written most kind and encouraging words. In this regard, I am deeply honoured and gratified.

Dr Lee Suan Yew A most distinguished and respected doctor, and ex-President of CFPS, who despite his high standing in society, is always so approachable, warm and kind!

Thank you for writing the foreword and completing it in such quick time. Your kind words had been a motivation for me from the beginning, when you said I was on the right track and the ‘book is sure to sell well’!

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Dr Alfred Loh Highly respected as President of WONCA and ex-President of CFPS, always polished, and professional!

Thank you for writing the foreword and book review and even taking it along with you on your trip just to complete it on time. Your encouragement that the book is on track with what is needed by the lay public and that it will do well was indeed a morale booster.

A/Prof Goh Lee Gan Easily regarded as the Father of Family Medicine in Singapore and himself an accomplished writer, teacher and mentor!

As immediate past head of Division of Family Medicine in NUS (National University of Singapore), immediate past President CFPS and office bearer in many other professional bodies, like SMA and SMC, you are exemplary of what a great Family Doctor should be!

Thank you for spending your invaluable time, going through my work and for writing the foreword. Appreciate the hours you spent on the phone, just to discuss my work and provide suggestions for improvements.

Dr Ajith Damodaran A well-established, experienced and most personable Family Doctor with whom I share common principles of what it takes to make a good Family Doctor. Thank you for your patience and taking the time to painstakingly go through my work.

Thank you also for your editorial advice and expert opinions, which I sincerely value.

Last but not least I would like to thank my family for their support, faith and love. In particular I am most grateful to my husband, Nanda.

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Nanda Thank you for always believing, and making me believe, that I am the best in whatever I do. Your own personal mottos especially that of self-confidence, hard work and sincerity are inspirational, being some of the very same values that have helped me see my book to completion.

Sincerely appreciate the keen interest and enthusiasm you have shown throughout the preparation of this book.

Thank you for your love, support and for ‘just being there’ all these years!

My lovely children, Reshmi, Nishanth and Shonit and godson, Magesvaran You are the reasons that have made my life more meaningful and worthwhile.

Thanks for the fun times we had talking over and about the book and the great help you all were with the computer work!

Your enthusiasm and interest in my work has always convinced me that this book just must come to print!

Finally, I would also like to thank KC Goh from Rank Books for his most professional work, efficiency and advice on design and layout that has helped make this book look good!

CFPS: College of Family Physicians, Singapore WONCA: World Organisation of National Colleges and Academies SMA: Singapore Medical Association SMC: Singapore Medical Council

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ABOUT THE AUTHOR Dr Bina Kurup is a Consultant Family Physician in active practice, with more than 25 years of clinical experience.

She was granted the Public Service Commission (PSC) Merit Award to read Medicine in the National University of Singapore (NUS) and graduated with the MBBS degree in 1983.

She was also in the pioneer batch of doctors to be awarded the Masters of Medicine (Family Medicine) (Singapore) in 1993.

Dr Bina has a keen interest in teaching and continuing education. She is actively involved as tutor, mentor, preceptor and examiner, at both undergraduate and post graduate medical levels, in both the NUS Medical faculty, as well as the Duke-NUS Graduate Medical School.

Her interest in languages is expressed both in the spoken and written forms.

She was in the editorial committee for an in-house newsletter and was responsible for writing regular feature articles targeted at the lay person. She has contributed several health related articles for magazines and the newspapers. xii Now At www.rankbooks.com Copyright Rank Books. Order

She has also authored several chapters in the book “Handbook for Primary Care Doctors”, a joint project of The Primary Health Division, Ministry of Health, The Division of Family Medicine, NUS and the College of Family Physicians, Singapore. In addition, she has made significant contributions and written on health topics for another handbook for doctors in a Private Group Practice.

Dr Bina is equally versatile with the spoken languages, being competent and fluent in Hokkien, Malay and Tamil.

This she believes is extremely important in her work where communication is key to a good doctor-patient relationship!

Writing this book has been a long cherished dream, (in fact, ever since the age of eight, when one of her poems was published in a magazine for school children!) and one that unites her twin passions of communication through language and education.

It is Dr Bina’s fervent wish that every individual will take personal responsibility for their own health. This she believes must start from being well, and correctly, informed and knowledgeable about health related issues.

‘Health is Wealth’ and ‘Your Health is in Your Hands’ are two important dictums she hopes to stress and share with her readers.

This book has truly been a labour of love for Dr Bina who sincerely wishes and truly believes, that all who read it will surely benefit in some way or other! xiii At www.rankbooks.com Copyright Rank Books. Order Now

INTRODUCTION Keeping your mind and body in good health is ultimately your responsibility.

Your doctor or health care partner is just that… a partner, working together with you, for the good of your health in the long-term.

Now, more then ever, individuals are indeed taking a greater role in their health. They read up, check the internet, counter check with relatives, friends and with non-orthodox practitioners before they decide, if at all, to visit their doctor.

In the light of a major slew of information, a lot of which are gleaned off the internet, it is extremely important that the individual is able to differentiate between reliable advice and unsubstantiated claims.

In addition, myths and misconceptions abound to further confuse the individual who is desperate for a quick safe cure for his ills.

Often the myths are based on ‘hand-me-down’ beliefs from well-meaning relatives and friends. In some instances, these ‘housewife tales’ and ‘home remedies’ may actually work as they are based on observation from years of experience.

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Though most of these myths may be harmless and just require simple explanation, there are some practices that can actually be harmful or detrimental to one’s health.

This book is mainly to clarify some of the common myths and misconceptions that my patients have brought up in my many years of clinical experience. I have included some basic useful information about the specific conditions, together with practical tips that you can do to take care of yourself. It is also important to know at which point professional help should be sought. The section on ‘When to see your Doctor’, will highlight useful pointers, so that you are aware of when and why you should see your doctor in each specific condition.

This volume will cover some commonly consulted problems that we as doctors see almost every day. They are the common health problems that most would have had at some time or other in their lifetime.

I have subdivided the conditions into acute, chronic and general problems.

Acute conditions are generally those that are shortterm ailments, though some may be recurrent or be prolonged. For ease of discussion, they are grouped into three sections viz. Common Infections, Common Aches and Pains and First Aid Myths and Misconceptions.

Chronic conditions are the long standing medical problems that require long-term follow up and care.

Here, some of the commonest conditions, all of which have a significant impact on health and wellbeing, will be discussed. These include Hypertension, Diabetes and xv At www.rankbooks.com Copyright Rank Books. Order Now

Asthma. Epilepsy is included, as not only is it common enough, but it is also amongst one of the frequently misunderstood conditions.

Under the General section, I will cover some common misconceptions about Drugs in general and specific drug groups like antibiotics, steroids and supplements.

I will also share with you some key personal health beliefs, or Mantras, that I have found to be very useful, and that I’m sure will be of help to you too.

Further, to make your reading even more worthwhile is the section on ‘Maximizing your Consult with your Doctor’. It will show you how you can get the most of the usually short consultation time you have with your doctor.

Prioritizing your health, understanding and being kind to your own body, will go a long way towards helping you enjoy life in the best of health and for the longest possible! For this, discerning knowledge, informed choices and motivation is key!

After all… “YOUR HEALTH IS IN YOUR HANDS” Here’s a toast “TO YOUR GOOD HEALTH!”

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CONTENTS Forewords by a) Dr Lee Suan Yew JP.BBM.BBM(L)

v

Acknowledgements About the Author Introduction

ix xii xiv

PART 1: ACUTE CONDITIONS

1

• INFECTIONS

5

Chapter 1 Common Cold/ ‘Flu’

7

Chapter 2: Diarrhea

13

Chapter 3 ‘Sore Eyes’/Styes

21

Chapter 4 Urinary Tract Infections (UTI)

27

Chapter 5 Chickenpox/Shingles

35

• ACHES AND PAINS

41

Chapter 6 Headache

43

Chapter 7 Backache

49

b) Dr Alfred WT Loh, CEO, Wonca vi c) A/Prof Goh Lee Gan vii

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Chapter 8 Joint Pains

57

Chapter 9 ‘Stomach’ Pains

65

• FIRST AID

71

Chapter 10 Burns and Scalds

75

Chapter 11 Cuts and Lacerations

79

Chapter 12 Sprains and Strains

83

Chapter 13 Nose Bleeds

87

First Aid Box - What should be in it!

91

PART 2: CHRONIC CONDITIONS

97

Chapter 14 Hypertension

101

Chapter 15 Diabetes Mellitus

113

Chapter 16 Asthma

131

Chapter 17 Epilepsy/Fits

139

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PART 3: GENERAL

147

Chapter 18 Pills in General

151

Chapter 19 Antibiotics

157

Chapter 20 Steroids

161

Chapter 21 Vitamins and Supplements

165

Chapter 22 ‘Huh, You Mean Docs Fall Sick Too?!’ 174

Do doctors have any secrets for

their personal wellness?

Chapter 23 Maximising Your Doctors Consult

179

Conclusion

185

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CHAPTER 1: COMMON COLD/‘FLU’

Part 1 ACUTE CONDITIONS

• INFECTIONS • ACHES AND PAINS • FIRST AID

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INFECTIONS

ACUTE CONDITIONS

A

cute conditions generally refer to medical problems that have either a rapid onset or those that don’t usually last long.Many confuse the term ‘acute’ to mean severe, when actually it refers to the time frame of a particular medical condition, rather than its severity.

On the other hand, though acute conditions are generally short term, they can be recurrent as with some of the problems to be discussed e.g. diarrhea and headaches.

This, the first section of the book, will look into the misconceptions and myths surrounding some of the most common conditions seen in the GP’s clinic.

For ease of discussion, they have been divided to cover common infections, aches and pains and first aid problems.

These are all health issues that would have affected each of us at some time or other in our lives.

As doctors, we see a wide spectrum of patients whose approach and response to their illness can vary greatly. This ranges from those who do nothing to those who do too much when afflicted!

In some instances, old wives tales and grandma’s advice may just work, and as long as it does no harm, you may opt to follow such advice. However, in some other situations, following such practices

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CHAPTER 1: COMMON COLD/‘FLU’ may actually delay your recovery or lead to unnecessary complications.

So, how do you decide who to follow and what to do? This is where you will find this book extremely helpful, as the relevant facts of each condition will be discussed, to help dispel the myths and misconceptions more clearly. The section on selfcare will elaborate on what you can do for yourself and it is this, together with your doctor’s treatment that will ensure a speedy recovery in most cases.

After the section on First Aid myths, I have included a brief note on the contents of a first aid box, as well as what your medicine chest should contain. This was done as I feel it is important that every household has a properly stocked first aid kit and medicine box. One never knows when the need may arise, and it is certainly best to be prepared in any case.

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CHAPTER 1: COMMON COLD/‘FLU’

INFECTIONS • • • • •

COMMON COLD / ‘FLU’ DIARRHEA ‘SORE EYES’ / STYES URINARY TRACT INFECTIONS (UTI) CHICKENPOX / SHINGLES

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INFECTIONS

INFECTIONS

I

nfections form a very common reason for consultation with a doctor.

Presence of an infection is usually suggested by the occurrence of fever, together with other symptoms, specific to the organ or system affected.

However, it is important to remember that not all patients with infections will have a fever. Relatively minor infections like the cold, diarrhea or sore eyes are often not accompanied by fever. On the other hand, the elderly, the diabetic or the immune compromised may have serious infections but be unable to mount a fever response.

Conversely, there are inflammatory conditions like Rheumatoid Arthritis and SLE1, as well as certain types of cancers like leukaemia and lymphoma, that may present with fever, without an associated infection.

In the next few chapters, I will be discussing some of the commonest infections seen in the GP’s clinic. Almost everyone would have experienced a cold, diarrhea or sore eyes at some time or other in their life. Many seem to have their own ideas about how best to manage these infections and often will try home or non-orthodox remedies first before seeing a doctor.

I am sure you will identify with some of the common myths and misconceptions presented and be considerably enlightened by the facts and tips shared.

1

SLE: Systemic Lupus Erythematosus

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CHAPTER 1: COMMON COLD/‘FLU’

CHAPTER 1 COMMON COLD/ ‘FLU’ MYTHS • • • • • • •

“Doc, I got caught in the rain last night! I think that’s why I’ve got the cold today!”

“I’m sneezing so much…I better not bathe till I’m well!”

“Doc, I just took my flu jab last month! How can I still get the flu now?”

“Doc, my runny nose has lasted a week…don’t you think I should take antibiotics?”

“But Doc, the mucus from my nose is yellow...I’m sure I need antibiotics!!”

“I take my Vitamin C supplements so regularly…how come I still get the cold?”

“Doc, I’ve got sinus!”...where the patient equates any case of runny nose as ‘sinus’.

FACTS The ‘common cold’ and ‘flu’ are terms often used interchangeably by many. Most people take it to mean anything from having one, or a combination, of symptoms like runny nose, cough or sore throat.

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INFECTIONS In actual fact, though both are infections (and so are not related to, nor caused by, weather or cold temperatures), they are separate entities caused by distinctly different types of viruses.

An infection with the Influenza virus (i.e. flu) usually makes you feel more ill and is the more serious of the two. It has greater potential for complications, like pneumonia (chest infection), encephalitis (brain infection) and even death!

There are several strains of the Influenza virus and they are classified into three groups viz. A, B and C.The strain types keep changing frequently through mutation, and hence you can come down with the flu several times in the year, and this despite being vaccinated! The flu vaccine will usually protect you against three strains each time, but has to be given annually for it to be effective.

But as all vaccines can only protect you against a specific virus and strain, it can be clearly seen why the flu vaccine alone cannot protect you against all causes of the common cold or cough!

The mucus from the nose in common cold infections can be yellow and can sometimes last up to a week. However, being viral, antibiotics do not work against them. In some cases though, antibiotics may be prescribed by your doctor, if he suspects a secondary bacterial infection.

Though Vitamin C, and other antioxidants, is generally good to boost immunity, it alone cannot prevent a cold. However, some studies have shown that once you are down with the flu or common cold, ensuring an adequate intake of Vitamin C

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CHAPTER 1: COMMON COLD/‘FLU’ may actually help you recover faster! But as most vitamins and minerals can be obtained naturally from well balanced meals, it is usually not necessary, nor is it recommended, that you take too much of these supplements!

SELF CARE TIPS • It is very important to maintain good personal hygiene, with regular hand washing and daily baths. This helps to both prevent, as well as minimize, the spread of viral infections. Do not touch your face, especially your mouth, nose or eyes, with unwashed hands.

Other members of your household should similarly be encouraged to wash their hands thoroughly and regularly, with soap and water.

• If you need to blow your nose or cough out your phlegm, use tissues instead of handkerchiefs. Dispose of used tissues straight away into closed bins.

• Adequate rest and minimizing stress, helps to boost your natural immunity, which in turn helps you to fight these infections better.

• Ensure adequate fluid intake. Consuming at least 8 glasses of water or fluids a day is generally recommended.

• Generally, you can eat what your appetite dictates, unless your doctor advises dietary restrictions specific to your condition (e.g. you may be advised against consuming cold drinks and certain fruits if you have a ‘bronchitic’ cough).

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INFECTIONS •

You should avoid doing vigorous exercises or strenuous physical activities when you are down with the flu or fever.

There is an increased risk of damage to the heart e.g. myocarditis, which can even prove fatal!

WHEN TO SEE YOUR DOCTOR •

Prolonged symptoms of runny nose or cough, especially if it lasts for more than one week.

Your doctor will have to exclude sinus or chest infections if your symptoms are prolonged. He will also assess the need for antibiotics after a thorough examination which may involve blood tests or Chest and Sinus X-rays.

•

Runny nose with significant headaches or pain over the cheeks.

This may indicate a sinus infection, which usually warrants more aggressive treatment with antibiotics and even steroids or nasal sprays.

•

Runny nose with ear symptoms.

Both the common cold and sinusitis can sometimes be complicated by middle ear infections. This is because the opening to the Eustachian tube, which is the tube from the middle ear that helps to equalize pressure with the external environment, is close and just next to the back of the nasal passage. This explains the ease with which germs can travel from the nose to the ears!

•

Blood stained mucus or prolonged duration of green phlegm.

In this case, a course of antibiotics may be needed. More 10

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CHAPTER 1: COMMON COLD/‘FLU’ serious infections like pneumonias or tuberculosis may also need to be excluded.

• If you feel ill, breathless or if there is significant weight loss.

Here, more serious complications like chest infections or sinister conditions, like cancer, need to be excluded.

Did You Know...?

The sinuses are actually air pockets or hollow spaces found within the bones of the face. There are four such pairs, all of which drain into the nasal passage. This explains why the common cold and sinus infections are so closely related. In both, a runny nose with nasal discharge is the common presenting symptom. However, they are not actually one and the same thing!

11

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