I have been very affected by an email which I received from a distraught parent last week. She recounted that she had just lost her 2 year old son who succumbed to pneumococcal infection.
This pneumococcus bug can affect different parts of the body. Most commonly it can infect the brain, causing meningitis, the lungs (pneumonia), the ears (otitis media) or enter the bloodstream and cause widespread infection.
Having heard about this unfortunate case, I have been strongly urging every parent that comes to the clinic to consider vaccinating their kids from this disease. It was then that one parent also told me of another recent case of a pre-schooler who also died from the infection.
In retrospect, these tragedies might have been prevented if the kids had been given the pneumoccocal vaccination which has been available for the last few years. In Singapore it is not part of the list of compulsory vaccinations that all babies need to be given. So a lot of the time it is up to the doctors to inform their patients. In other countries like Australia for instance, all babies are required to be vaccinated from birth. I hope it is only a matter of time before the MOH adds this vaccine to the list of necessary vaccines for newborns.
In the meantime, it is up to you as parents to be aware and informed of the availability of the vaccine. A lot of information is already online, so I will not elaborate on the condition. However, I would like to let you know that these series of incidents has affect the way I look at this disease and so here are some of the things that I do now which I did not in the past:
1. Encourage parents to give the pneumoccocal vaccine from birth rather than let them wait till the age of two. The pneumoccoal vaccine is expensive, so at birth you need four jabs, but as the baby gets older, the number of jabs reduces till at two years of age, you only need one jab. I used to sympathize with parents concerning the cost of these jabs and so some parents decide to give later. However, I am now redoubling my efforts to educate and encourage parents to give it from birth.
2. In order to do this, I have decided to reduce the price of the vaccine to encourage parents to give it in the first year of life. So I have started to offer a package of 4 vaccines for $620 which works out to be $155 each. The normal price of the vaccine is $170. This price is nett so there is no GST or consultation charge if you only come to do the vaccination.
3. I am also now being extra vigilant in younger children who present with fever. There are some parents who are very resistant to the use of antibiotics and I agree that too much antibiotic use is not good. But we should also not go to the other extreme and let our children suffer from a prolonged fever. Pneumoccocal disease does respond to antibiotics, so a course of antibiotics given on suspicion of pneumoccocal disease does save lives and prevent severe disabilities. There was one instance of a 6 year old girl who did not present to the doctor until after 1 week of fever. By that time, the pneumococal bug had already got into the bloodstream and affected the kidneys. The girl is left with only 10% of kidney function and will need dialysis in the future. So as parents, a good general rule of thumb is to bring your kids to see the doctor if the fever lasts for more than three days or earlier if the child is really unwell.
So parents, if your child has not been vaccinated, please read up and be informed of the dangers of pneumoccocal disease and do let your friends know about it.
More info on pneumoccocal disease can be found here.
For info on other available vaccines, please click here.
Friday, March 20, 2026
Wednesday, February 11, 2026
Manual Therapy: We can call this Western "Tui Na"
When was the last time you suffered from a really bad back pain or neck pain?
I know a lot of patients who would visit a Chinese Sinseh for "Tui Na" (Manipulation and massage) whenever they suffer a back pain and then also come to the clinic for some painkillers and muscle relaxants.
"Tui Na" is a very effective way to release muscle spasms and re-align bones and joints which might be out of place due to pain and inflamation. However, finding a good practitioner is critical because a lot of harm can be done if the practitioner is inexperienced.
In modern medicine, we have a branch of physiotherapy that specializes in manual therapy which essentially does "Tui Na" but with a scientific understanding of the anatomy and physiology of the causes of backpain. Not every physiotherapist does manual therapy because these therapists have to go through a few more years of post graduate training in order to earn their Masters degree. In Australia, where I trained in medicine, manual therapy is a very well established practice. In Singapore, it is still in the developmental stage but there are more and more physiotherapists who are being trained to do manual therapy.
Our clinic has started referring such cases of back and neck pains to Core Concepts, a group of physiotherapists who specialise in manual therapy and sports injuries. I have asked Sylvia Ho, one of the senior physiotherapists to contribute the following article about Manual Therapy so that you are aware about this the next time you have a "pain in the neck".
What's Manual Therapy?
Article by Sylvia Ho
Manual Therapy is an area of manual medicine treating musculoskeletal conditions; conditions related to the muscles, bones, joints, connective tissues such as tendons and ligaments, spinal discs and the nervous system that enables them to all work together. Manual therapy covers a broad range of techniques and perhaps easiest to define as an approach not based on the use of electrical and/or electronic devices such as traction machines, TEN, EMG and shortwave diathermy machines.
As with most other areas of specialties, there are two broad areas of manual therapy - the techniques and the critical diagnostic analysis.
Manual Techniques
First, there are the techniques. These can range of myofascial trigger point release of tight muscles, spinal manipulation or mobilization to release tight joints, neuromuscular retraining correct the muscle activation pattern, sports taping to provide support to joints to something more basic like deep tissue massage. Manual therapy is not technique specific but rather includes a very broad range of technique to enable proper musculoskeletal functioning. This area is the most visible area and perhaps most familiar to the general public.
Critical Diagnostic Analysis
It is the second area that manual therapy comes into its own - critical diagnostic analysis. Determining what is the immediate cause of the pain is often straight forward such as a muscle strain in the back or a nerve impingement in the lumbar spine. Treatment in such cases using TENS machine on the area of pain or traction is simple and can be effective to address the immediate pain. But these treatments usually have no lasting effect as they do not address the 2nd or higher level causes of pain. It is like driving a car with a leaking radiator. The car overheats when there is no water in the radiator. Filling up the radiator solves the immediate overheating problem. But if the leak continues, the radiator will soon empty again and cause the engine to overheat.
So a manual therapist must probe further, “Why is the muscle strained?” Because of the musculoskeletal system in the human body are all interconnected, answers can sometimes be found rather far away from the pain site and not immediately intuitive. Here is an interesting case study of found at our online journal (MCR) - Mal-Aligned Rib .
Manual therapists usually work with a team of massage therapists and sports rehabilitation trainers to assist with the manual treatment and exercise rehabilitation once the root cause of the problem is diagnosed.
About Sylvia Ho
Sylvia graduated from the University of Sydney, Australia with a Bachelor of Applied Science (physiotherapy) in 1995 and subsequently obtained her Master in physiotherapy, specialising in manipulative therapy from University of Melbourne, Australia. Her current interests are in treating back and neck pain and improving sports performance through sport specific exercises. She is actively involved in educational talks to organisations such as JP Morgan, Ministry of Finance, clubs and fitness centres and is also a specialist advisor to MyHealthScanner, the region's first on-line real-time health screening tool for 27 major conditions.
You can visit Core Concepts website here
She is a regular contributer to Musculoskeletal Consumer Review
I know a lot of patients who would visit a Chinese Sinseh for "Tui Na" (Manipulation and massage) whenever they suffer a back pain and then also come to the clinic for some painkillers and muscle relaxants.
"Tui Na" is a very effective way to release muscle spasms and re-align bones and joints which might be out of place due to pain and inflamation. However, finding a good practitioner is critical because a lot of harm can be done if the practitioner is inexperienced.
In modern medicine, we have a branch of physiotherapy that specializes in manual therapy which essentially does "Tui Na" but with a scientific understanding of the anatomy and physiology of the causes of backpain. Not every physiotherapist does manual therapy because these therapists have to go through a few more years of post graduate training in order to earn their Masters degree. In Australia, where I trained in medicine, manual therapy is a very well established practice. In Singapore, it is still in the developmental stage but there are more and more physiotherapists who are being trained to do manual therapy.
Our clinic has started referring such cases of back and neck pains to Core Concepts, a group of physiotherapists who specialise in manual therapy and sports injuries. I have asked Sylvia Ho, one of the senior physiotherapists to contribute the following article about Manual Therapy so that you are aware about this the next time you have a "pain in the neck".
What's Manual Therapy?
Article by Sylvia Ho
Manual Therapy is an area of manual medicine treating musculoskeletal conditions; conditions related to the muscles, bones, joints, connective tissues such as tendons and ligaments, spinal discs and the nervous system that enables them to all work together. Manual therapy covers a broad range of techniques and perhaps easiest to define as an approach not based on the use of electrical and/or electronic devices such as traction machines, TEN, EMG and shortwave diathermy machines.
As with most other areas of specialties, there are two broad areas of manual therapy - the techniques and the critical diagnostic analysis.
Manual Techniques
First, there are the techniques. These can range of myofascial trigger point release of tight muscles, spinal manipulation or mobilization to release tight joints, neuromuscular retraining correct the muscle activation pattern, sports taping to provide support to joints to something more basic like deep tissue massage. Manual therapy is not technique specific but rather includes a very broad range of technique to enable proper musculoskeletal functioning. This area is the most visible area and perhaps most familiar to the general public.
Critical Diagnostic Analysis
It is the second area that manual therapy comes into its own - critical diagnostic analysis. Determining what is the immediate cause of the pain is often straight forward such as a muscle strain in the back or a nerve impingement in the lumbar spine. Treatment in such cases using TENS machine on the area of pain or traction is simple and can be effective to address the immediate pain. But these treatments usually have no lasting effect as they do not address the 2nd or higher level causes of pain. It is like driving a car with a leaking radiator. The car overheats when there is no water in the radiator. Filling up the radiator solves the immediate overheating problem. But if the leak continues, the radiator will soon empty again and cause the engine to overheat.
So a manual therapist must probe further, “Why is the muscle strained?” Because of the musculoskeletal system in the human body are all interconnected, answers can sometimes be found rather far away from the pain site and not immediately intuitive. Here is an interesting case study of found at our online journal (MCR) - Mal-Aligned Rib .
Manual therapists usually work with a team of massage therapists and sports rehabilitation trainers to assist with the manual treatment and exercise rehabilitation once the root cause of the problem is diagnosed.
About Sylvia Ho
Sylvia graduated from the University of Sydney, Australia with a Bachelor of Applied Science (physiotherapy) in 1995 and subsequently obtained her Master in physiotherapy, specialising in manipulative therapy from University of Melbourne, Australia. Her current interests are in treating back and neck pain and improving sports performance through sport specific exercises. She is actively involved in educational talks to organisations such as JP Morgan, Ministry of Finance, clubs and fitness centres and is also a specialist advisor to MyHealthScanner, the region's first on-line real-time health screening tool for 27 major conditions.
You can visit Core Concepts website here
She is a regular contributer to Musculoskeletal Consumer Review
Friday, January 30, 2026
New Consultation Hours
Please be advised that with effect from 1 Feb 2009, our new consultation hours are:
Mon - Fri: 8.30am to 1pm, 6.30pm to 9.30pm
Sat: 8.30am to 12.30pm
Sun: 6.30pm to 9.30pm
Mon - Fri: 8.30am to 1pm, 6.30pm to 9.30pm
Sat: 8.30am to 12.30pm
Sun: 6.30pm to 9.30pm
Wednesday, January 21, 2026
Clinic Operating Times over Chinese New Year
We wish all our Chinese patients a very Happy and Prosperous year of the OX!
Please note that our clinic will be closed on New Year's Eve (25th Jan) till Tuesday (27th Jan). We will resume operations on 28 Jan.
May you all be in good health and remember not to eat too much Bak Kwa and pineapple tarts or I will have to see you after CNY for sorethroat!
Please note that our clinic will be closed on New Year's Eve (25th Jan) till Tuesday (27th Jan). We will resume operations on 28 Jan.
May you all be in good health and remember not to eat too much Bak Kwa and pineapple tarts or I will have to see you after CNY for sorethroat!
Sunday, January 11, 2026
Vaccinations save Lives! So why are patients still so resistant?
I took my daughter to the playground last week and unfortunately Megan fell and hit her nose which started bleeding. Along came this very nice lady in her seventies who offered to help. She ran to the nearest house and got some ice and tissue paper for me and managed to comfort my little girl who was a little shocked from ordeal.
As she was comforting her, she recalled that her own daughter was as tiny as Megan was when she was in Primary 1. Of course, that daughter is now in her forties and living overseas. She came across as a really nice grandmotherly type person, so I asked how many grandkids she had. Regretfully she told me, she didn't have any. Then she went on to say that she had a son who died from chickenpox 10 years ago at the age of 36. He had caught the virus from his wife, but unfortunately for him, the chickenpox virus affected his lungs and he died from pneumonitis.
I felt saddened that such a thing could happened to such a nice lady. She told me her husband is still angry till this day and would still reminesce about the times he had with his son.
Nowadays, there is a chickenpox vaccine available, but a lot of parents are still hesitant to give their children the vaccination. The most common reason given is that they feel that chickenpox is every child's rite of passage. They themselves got chickenpox as a child, so they feel their kids should also go throught the same ordeal.
Just recently, I was also saddened to hear about the death of a 30 year old lady from Cervical Cancer. Her story can be found here. I do not know the details of her condition and it is not common for Cervical Cancer to affect such a young person so her situation may be an exception rather than the norm. However, for the general population, MOH has given the guidelines that sexually active ladies should have their Pap Smears done every 3 years so that Cervical Cancer can be detected early. And now there is also a vaccination that can prevent the girls from getting infected with the virus that can lead to Cervical Cancer. So again, this is another tragedy that could have been prevented with a vaccination.
But perhaps it is the elderly which are most often neglected when it comes to vaccinations. We all know that Pneumonia is one of the leading causes of death in the aged. This is why MOH recommends the elderly to be vaccinated with the Pneumoccal vaccine every 5 years and the influenza vaccine yearly. But the problem is that the elderly are often ignorant of this. And even if they do know about it, a lot of them do not wish to burden their kids for the extra cost of the vaccines. It really is a case of "Penny wise, Pound Foolish".
I guess some might say that life is unpredictable and that if it is your time to go, there is nothing you can do to stop it. That might be true, but for our dear granny at the playground, a simple chickenpox vaccination might just have nudged fate a little more to her side.
So the bottomline is this: Vaccinations saves lives, so make sure you and your family are up to date on all the available vaccines.
As she was comforting her, she recalled that her own daughter was as tiny as Megan was when she was in Primary 1. Of course, that daughter is now in her forties and living overseas. She came across as a really nice grandmotherly type person, so I asked how many grandkids she had. Regretfully she told me, she didn't have any. Then she went on to say that she had a son who died from chickenpox 10 years ago at the age of 36. He had caught the virus from his wife, but unfortunately for him, the chickenpox virus affected his lungs and he died from pneumonitis.
I felt saddened that such a thing could happened to such a nice lady. She told me her husband is still angry till this day and would still reminesce about the times he had with his son.
Nowadays, there is a chickenpox vaccine available, but a lot of parents are still hesitant to give their children the vaccination. The most common reason given is that they feel that chickenpox is every child's rite of passage. They themselves got chickenpox as a child, so they feel their kids should also go throught the same ordeal.
Just recently, I was also saddened to hear about the death of a 30 year old lady from Cervical Cancer. Her story can be found here. I do not know the details of her condition and it is not common for Cervical Cancer to affect such a young person so her situation may be an exception rather than the norm. However, for the general population, MOH has given the guidelines that sexually active ladies should have their Pap Smears done every 3 years so that Cervical Cancer can be detected early. And now there is also a vaccination that can prevent the girls from getting infected with the virus that can lead to Cervical Cancer. So again, this is another tragedy that could have been prevented with a vaccination.
But perhaps it is the elderly which are most often neglected when it comes to vaccinations. We all know that Pneumonia is one of the leading causes of death in the aged. This is why MOH recommends the elderly to be vaccinated with the Pneumoccal vaccine every 5 years and the influenza vaccine yearly. But the problem is that the elderly are often ignorant of this. And even if they do know about it, a lot of them do not wish to burden their kids for the extra cost of the vaccines. It really is a case of "Penny wise, Pound Foolish".
I guess some might say that life is unpredictable and that if it is your time to go, there is nothing you can do to stop it. That might be true, but for our dear granny at the playground, a simple chickenpox vaccination might just have nudged fate a little more to her side.
So the bottomline is this: Vaccinations saves lives, so make sure you and your family are up to date on all the available vaccines.
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