Overview Of Osteoarthritis

Osteoarthritis (OA) is a degenerative disease caused by the inflammation of the joints, resulting in thinning of the articular cartilage. Known as the most common form of arthritis, OA affects up to 10% of the adult and 20% of the elderly population​ in Singapore. The number of cases are likely to be underdiagnosed as many do not seek medical attention and attributed the condition to old age.

Osteoarthritis tends to affect joints such as the knees, hips, and spine, causing pain which worsens as the day progresses. It may also result in difficulty performing simple activities such as walking, climbing the stairs, squatting, or even kneeling. 

While there is no cure for osteoarthritis, its symptoms can be managed to help slow the progression of the disease.

Diagnosis

Osteoarthritis is mostly diagnosed by your doctor through performing a physical examination and an assessment of your medical history. Certain common symptoms such as joint pain or stiffness after a period of inactivity, also called the “gelling phenomenon”, could help identify the disease.

Pain on range of motion, and also limitation of range of motion are other common symptoms of osteoarthritis. Typically X-rays may be ordered to evaluate the status and alignment of the affected joints. Blood tests, even if ordered, will be to rule out other conditions rather than to diagnose OA.

Symptoms 

Osteoarthritis can happen in any joint, however, the most commonly affected joints are : 

• Knees
• Hips 
• Hands 
• Small finger joints
• Lower back (Spine)  

You may feel any one or more of the following symptoms at the affected joints: 

• Pain at the affected parts
• Stiffness or pain after a period of immobility or rest and more so in the mornings
• Crepitation – A sensation of grating or grinding in the affected joint caused by rubbing of damaged cartilage surfaces
• Warmth – The arthritic joint may feel warm to the touch
• Walking difficulties, including walking downstairs / down slopes, and when you walk for long distance

As the disease progresses, your pain would become more intense, and swelling may occur. Early diagnosis will help people with osteoarthritis better manage the condition.

Risk factors

While there are no direct known causes of OA, the following may contribute to it:

Age: As people get older, the risk of developing OA increases due to wear and tear of the bones, muscles, and joints. Most people over the age 60 have OA to some degree, but its severity varies. 

Gender: Females are more likely to experience OA. Decreased estrogen as experienced by post-menopausal women increases the risk of knee OA as estrogen protects the bones, specifically by reducing oxidative stress to the cartilage.

Previous Joint injury: Any broken bone, ligament tear, or general joint injury can lead to OA after a number of years.

Overuse or overactivity of joints: Utilization of the same joints repeatedly in physically demanding jobs, or in sports such as tennis or golf, may result in OA over time.

Obesity. Extra weight puts more stress on the joints, in particular of the knee, by overloading the weight-bearing mechanisms of the body. Also, the metabolic and pro-inflammatory effects of obesity have been studied as a contributing factor to osteoarthritis. 

Weak muscles or muscle loss: Joints can be displaced from the right position when there is not enough support.

Genes: People with family members who have OA are more likely to develop OA. Individuals born with other bone diseases or genetic traits may also be more likely to develop osteoarthritis.

Treatments For Osteoarthritis

Despite its prevalance affecting those over the age of 60, a recent study published in ANNALS Academy of Medicine Singapore found that 96% of knee replacements performed in Singapore are caused by osteoarthritis, and 4.8% of people who receive total knee replacements are below the age of 50.

Other treatment options include:

Weight Management

The heavier you are, the higher the load is transferred to your leg joints and higher the chance of condition deteriorating. Sometimes, it may just be a case of lifestyle modification eg diet change to include more vegetables and fruits.

Physiotherapy  

A physiotherapist can show you exercises to strengthen and increase the muscles around your joint to reduce pain. Regular exercise that you do on your own, such as swimming or walking, can be equally effective.

Oral medicine

• Paracetamol has been shown to help with mild to moderate symptoms. 
• Non-steroidal anti-inflammatory drugs (NSAIDs like Ibuprofen and Naproxen etc, typically help to relieve the symptoms. Stronger NSAIDs are available with prescription. However, NSAIDS can cause undesirable side effects like stomach upset, cardiovascular problems, bleeding problems, and liver and kidney damage. NSAIDs as gels, applied to the skin over the affected joint, have fewer side effects and may relieve pain just as well.

Injection

• High molecular weight hyaluronan injection, otherwise known as non-steroid injections, is a complex sugar used to treat OA of the knees in patients who have failed to respond to the above 2 methods. There are 2 known brands :
  Monovisc® : shown to provide relief of OA knee pain two weeks after injection. This single injection is both biocompatible and resorbable with relief lasting a few months.
  ORTHOVISC® : After three or four consecutive weekly injections, treatment can provide up to six months of knee pain relief.
  Side effects include diarrhea, headache, nausea but these effects should be temporary.
• Steroid Injections. Relief tends to last for weeks at most. Side effects due to repeated injections include risk of infection, nerve damage, thinning of surrounding skin, rupture of tendon and thinning of bone with every jab

Under the Ministry of Health’s Chronic Disease Management Programme (CDMP), you may also be eligible to claim up to S$500 from your Medisave. Fusion Medical is one of the participating CDMP GP clinics which is able to help you to check on your Medisave balance for claims purposes.  

Speak to our doctors today to know which is the best option for you.

How HPV Is Linked To Cervical Cancer

Human Papillomavirus (HPV) is one of the most common Sexually Transmitted Diseases (STDs). It is also the single largest risk factor that leads to Cervical Cancer 

There are currently over 200 strains of HPV, and some of these are high-risk strains that can cause cervical cancer.

Most HPV infections will eventually go away on their own after about 1 to 2 years, or cause genital warts which are painful but can be cured.

However, high-risk strains such as HPV 16 or HPV 18 can stay in the cervix for a long time. These strains infect your cervix and may cause the development of cancerous cells, which lead to cervical cancer.

This process can take many years, so an infection you got when you were 25 can start causing pre-cancerous changes when you’re 35, and develop into full-blown cervical cancer by 42. 

That’s why regular screening is so important because you could have a HPV infection developing without showing any symptoms at all.

How Is HPV Transmitted?

HPV is transmitted through skin-to-skin contact such as sexual intercourse, oral sex and anal sex. If you are sexually active or share contaminated sex toys, there is a high chance that you can transmit or contract a HPV infection. 

If you have multiple sexual partners or your partner has multiple sexual partners, you are also at high risk for HPV infection. Condoms do not provide 100% protection against the transmission of HPV.

If you are on long-term oral contraceptives or have a weakened immune system, you also face the increased risk of HPV infection.

Other risk factors include being sexually active from a young age, or having a history of Sexually Transmitted Diseases like herpes or chlamydia, or smoking. 

You can’t catch HPV from touching common surfaces, casual contact such as shaking hands or hugging, or from toilet seats. 

Symptoms Of HPV Infection

Most HPV infections do not show any symptoms. Even the pre-cancerous changes that take place after a persistent HPV infection may not show any symptoms.

Some strains of HPV may cause genital warts. 

Many women often only see the symptoms of cervical cancer, long after transmitting HPV and after any preventative treatment could have taken place.

This is why doctors keep stressing how essential it is for you to undergo regular screening especially if you are sexually active. If detected early, treatment can be undertaken before a high-risk HPV infection can develop into cervical cancer.

Symptoms Of Cervical Cancer

If you have cervical cancer, you may display some or all of the following symptoms:

• Bleeding between your periods or after menopause
• Bleeding after intercourse
• Periods that are heavier and last longer than normal
• Pelvic or back pain that is unusual and may not be related to your period
• Pain during intercourse
• Abnormal vaginal discharge that may be thick and foul in odour
• Pain during urination 
• Increased frequency of urination
• Constipation and feeling like stool is present despite your bowels being empty
• Urine or faeces leaking from the vagina

HPV Vaccination In Singapore

Fortunately, it is possible to get HPV vaccinations in Singapore to reduce the risk of cervical cancer. The vaccinations can protect you against 70-90% of the high-risk HPV strains that can cause cervical cancers.

In Singapore, these vaccinations are recommended for girls and women 9 to 26 years and it is recommended you take the vaccination before you first have sexual contact and have not had exposure to HPV.

Even if you are sexually active, you can still benefit from the HPV vaccinations as you may not have been infected with the high-risk HPV strains. You can check with your doctor to find out if you are suitable to receive HPV vaccinations.

Remember that HPV vaccinations do not guarantee 100% protection so you still should go for regular screening even if you have had your injection.

The different types of HPV vaccinations in Singapore are Cervarix, Gardasil and Gardasil 9. All of them require multiple vaccinations taken a certain amount of time apart. 

As of April 2019, all 13-year-old Singapore Citizens or PRs can get the HPV vaccination for free. However, this is optional and parents must opt-in for their daughters to receive the free vaccination.

Cervarix

Cervarix protects you against HPV 16 and HPV 18, two of the high-risk HPV strains that are responsible for more than 70% of cervical cancer cases.

This vaccination is approved for girls and women from 9 to 25 years old, or as advised by your doctor.

For girls between 9 to 14 years of age, you need to take two vaccinations between 5 to 13 months apart.

Females between 15 to 25 years of age need to take three vaccinations with the second vaccination between 1 to 2.5 months after the first vaccination, and the third vaccination 5 to 13 months after the first vaccination.

Polyclinics only have the Cervarix vaccination available which costs $360 excluding consultation fees and GST. You can use Medisave to subsidise the cost of your vaccination for up to $500.

Gardasil 4

Other than protecting you against HPV 16 and HPV 18, Gardasil also vaccinates you against HPV 6 and HPV 11 which can cause genital warts and lesions. 

Females between 9 to 14 years old need two injections 6 to 12 months apart, while ladies aged 15  and above require 3 vaccinations. You take the second injection 2 months after the first injection, and the third vaccination 6 months after the first one.

The cost of Gardasil varies between clinics but you can expect to pay $386 at least including GST. Gardasil 4 vaccination can be subsidised using Medisave for up to $500. 

Gardasil 9

Gardasil 9 is named as such as it vaccinates you for 9 strains of HPV. These are HPV subtypes 6, 11, 16, 18, 31, 33, 45, 52 and 58​.

The vaccination schedule is the same as that of Gardasil.

At this time, you cannot use Medisave to subsidise your Gardasil 9 vaccination even though it is the most expensive.  At Fusion Medical, 1 dose of Gardasil 9 costs S$275, 2 doses at S$525 and 3 doses at S$765.(Prices shown are before including GST)

Can Pregnant Women Get Vaccinated For HPV? 

If you’re pregnant, you’re advised not to get the HPV vaccination.

If you find out that you’re pregnant after taking one or more of the vaccinations, don’t continue with the vaccinations until after the end of your pregnancy.

Let your doctor know if you’ve inadvertently taken the HPV injections while pregnant and seek his or her advice.

Can Medisave Be Used For HPV Vaccination?

Yes, you can use up to $500 of your Medisave to subsidise your Cervarix or Gardasil vaccination if you are between 9 to 26 years old.

However, Gardasil 9 injections are not eligible for the subsidy. 

If you are using Medisave, you can also use the Medisave of your parents or spouse to make payment. Medisave deductible and co-payment rules are not applicable for HPV vaccinations.

Cervical Cancer Screening In Singapore

There are 2 main tests for cervical cancer screening which are Pap smears and HPV tests (or HPV DNA test). 

You should start going for regular screening within the first 3 years of your first sexual contact or when you are 21 years old, whichever is earlier. 

Ladies who are between 21 to 29 years old should get a Pap smear every 3 years. If you are between 30 to 64 years old, you should get a Pap smear and HPV test every 5 years, or a Pap smear every 3 years.

Once you’re 65 years old and over, your doctor may allow you to stop going for cervical cancer screening if you have had normal results in all your previous tests. But if you’re 65 years old and you’ve never had a Pap smear, you should go for it to check that you are not at risk for cervical cancer.

The purpose of the Pap smear is to detect cell changes in your cervix. The doctor uses a speculum to widen your vagina, examine it, and swabs cells from the cervix to send to the laboratory for analysis.

You might feel some discomfort or pain during your Pap smear and you should let your doctor know once you feel discomfort.

As with most medical testing, Pap smears are not 100% accurate. 

Don’t go for your Pap smear test if you’re having your period as the blood shed might affect your test results. Make sure you do your test at least 14 days after the start of your period.

If you have had a total hysterectomy (removal of the uterus and cervix) for a non-cancerous condition, you may not need to go for regular Pap smears and you should verify this with your doctor. He or she may recommend having one Pap smear done after your hysterectomy procedure.

If you had a partial hysterectomy and your cervix was not removed, or your total hysterectomy procedure was done for a cancerous or pre-cancerous condition, you will still be required to undergo regular Pap smear testing.

HPV tests, which you can start undergoing after you’re 30 years old, tests for the presence of high-risk HPV strains in your cervix.

Don’t put off your screening because early detection saves lives. Even if you have no family history of cancer, you might still be at risk of getting cervical cancer. There are no symptoms for HPV infection so you should still go for a Pap smear even if you feel healthy.

If cervical cancer is found in the very early stages, the five-year survival rate is as high as  90%. However, if you only detect it when the cervical cancer has reached Stage 4 or spread to other organs, the five-year survival rate drops to 10%.

Is Cervical Cancer Screening Required After HPV Vaccination?

Yes, it is.

Even though you’ve had the HPV vaccination, you are not 100% safe from cervical cancer. This is because the vaccine can reduce the risk of cancer by protecting you against 70-90% of high-risk HPV strains but not 100%.

Furthermore, if you got the vaccine after being sexually active, you might have already been exposed to a HPV infection. 

 

Influenza is a viral infection that is highly contagious and mainly affects the upper respiratory organs.

It is estimated by the World Health Organization that influenza (flu) kills half a million people globally every year. The worst flu pandemic in 1918 killed 50 million people worldwide.

The flu virus is easily transmitted from person to person when an infected person coughs, sneezes, or spits, and droplets produced by them land on the eyes, nose or mouth of the person nearby. Less often, a person might get the flu by touching a surface or object that has flu virus on it and then touching their faces. Influenza is at its most contagious during yearly seasonal epidemics.

People who have the flu usually recover after a few days, but for certain high-risk groups, such as pregnant women, and people over the age of 65, complications can occur, and may even cause death.

Symptoms Of The Flu

Often mistaken for the common cold in the initial infection stage, as they share many similar symptoms such as runny nose, sneezing, and sore throat. 

However, unlike the cold where symptoms tend to progress gradually, symptoms of the flu come suddenly. You may experience:

• Fever over 38 ℃ (100.4 F)
• Aching muscles
• Chills and sweats
• Headache
• Dry, persistent cough
• Fatigue and weakness
• Nasal congestion
• Sore throat

Some may experience more severe symptoms such as: 

• Trouble breathing or shortness of breath
• Pain or pressure in your chest or belly
• Sudden dizziness
• Confusion
• Severe vomiting

Seek medical help immediately if you experience any of the above symptoms. 

Treatment Options For The Flu

For most patients, medical intervention is usually not required, and your general practitioner may advise you to: 

• Get plenty of rest at home and take a few days off work.
• Consume plenty of fluids.
• Avoid physical contact with your friends and family members to prevent the infection from spreading.

Your doctor may give you some anti-viral medication if you belong to one of the following high-risk groups: 

• Children younger than 5, but especially children younger than 2 years old
• Adults 65 years of age and older
• Pregnant women (and women up to two weeks postpartum)
• Residents of nursing homes and other long-term care facilities

Patients in the above groups have a higher chance of developing complications arising from the flu. 

Who Should Get Vaccinated For The Flu?

Unless advised otherwise by your doctor, it is recommended that you go for flu vaccination even if you are healthy, especially if you live with or take care of people belonging to high-risk groups.

In Singapore, MOH has informed medical practitioners to advise their patients on the importance of influenza vaccination for the following groups of people:

• Children between six months and five years
• Adults aged 65 years or older
• Persons with chronic medical conditions

How Effective Is The Flu Vaccination

Flu vaccines are developed annually, and according to this CDC Effectiveness Report, the 2019-2020 flu vaccine reduces your chance of being infected by 50%.

Having the flu vaccination helps to rule out the differential flu diagnosis for the symptoms despite similar symptoms with COVID-19 and hence reduces the burden on testing as well as the health system.

Please contact your medical doctor to find out more about how this information affects you or your loved ones, and everyone has a different medical history, so effectiveness may vary.

Is The Flu Shot Safe For Pregnant Women?

Yes. 

Millions of pregnant women have been administered flu shots over the years with a good safety record. 

For pregnant women who would like more information, here are some studies that have been conducted on flu vaccine safety during pregnancy. 

Why Pregnant Women In Singapore Should Get The Flu Shot

Pregnant women are more likely to be susceptible to severe illness caused by the flu than non-pregnant women of reproductive age. 

Pregnant women experience changes in their immune system, heart, and lungs that make them more prone to developing severe illnesses from the flu, resulting in hospitalization. 

This 2018 study showed that pregnant women’s risks of getting hospitalized with the flu were reduced by almost 40%. 

As antibodies are passed onto the developing baby by the mother during pregnancy, the flu shot can also protect your baby for the first few months after they’re born, when they’re too young to get vaccinated.

How Much Is The Flu Vaccine In Singapore

You can get the quadrivalent (4-in-1) flu shot at any of our clinics at Fusion Medical for $37.45 Nett. Please contact us to book an appointment. 

Can You Use Medisave For Flu Shot (Please vet this section for accuracy)

Yes, Medisave can be used for flu shots for the following groups of people: 

• Persons aged 65 years or older;
• Persons aged 18 years and older and receiving long-term aspirin therapy;
• Persons who have chronic medical conditions such as diabetes mellitus, asthma, and heart disease;
• Persons who are immunocompromised;
• Persons receiving intermediate and long term care services;
• Women at all stages of pregnancy.

Fusion Medical is a Medisave accredited clinic, call us to find out more about the flu shot.

When Is The Flu Season In Singapore?

In Singapore, the flu season is generally during the cooler months with rain, such as May – July, and December – February. 

It is generally advisable to get your flu shot before the flu season starts. 

The flu vaccination is available at any of our Fusion Medical clinics located at Wheelock and Nexus. Please contact us to find out more information.