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Botox

Management Team

Botox

Overview

Botox injection is a very common cosmetic procedure performed worldwide. Botox is a drug made from purified botulinum toxin, and it is the oldest and best-known USFDA approved brand from Allergan, USA.

Botox injections improve the appearance of wrinkles and fine lines by relaxing the muscles that cause them. It can also slow down the formation of frown lines, crow's feet, and all signs of ageing on the face, to reveal a creaseless, stress-free, and relaxed appearance. Botox is administered with a thin needle in a minimally invasive procedure that takes less than 30 minutes. The results usually take around a week to show and last for 4-6 months. Botox done by a trained aesthetic dermatologist can enhance the appearance by providing youthful and natural look with the right dosage.

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Bipolar Mood Disorder

Management Team

Bipolar Mood Disorder

Overview

Bipolar mood disorder, earlier known as manic-depressive illness or manic depression, is characterised by distinct periods of elevated or irritable mood and depressive mood occurring during the duration of illness. The mood symptoms and the changes in thoughts, behaviour, sleep and appetite disrupts normal life.

Cause is unknown. Risk factors include: 

  • Genetics
  • Brain structure in certain individuals

Bipolar disorder can be classified as: 

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder

Symptoms of bipolar disorder vary depending on the episode:

  • Maniac episode:
    • Very active
    • Extremely irritated
    • Excessive appetite
    • Less sleep
  • Depressive episode:
    • Feeling sad/anxious
    • Restless
    • Trouble sleeping
    • Lack of interest in everything
    • Feeling hopeless/suicidal

Bipolar disorder is generally diagnosed using:

  • Physical examination and tests to rule out other possible causes.

Therapies for bipolar disorders include:

  • Medications
  • Psychotherapy
  • Light therapy
  • Electroconvulsive therapy
  • Repetitive transcranial magnetic stimulation
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Bile Duct Stones

Management Team

Bile Duct Stones

Overview

Bile duct stones (also called choledocholithiasis) are solid particles that form in the biliary ducts. These stones can interfere with bile flow, which results in various complications and symptoms. If left untreated, they may cause pain, jaundice, or inflammation of the entire biliary system (cholangitis).

Based on the origin of bile stones, they can be classified into two categories.

  • Primary bile duct stones: These originate in the bile ducts. They are less common and usually occur in people with conditions that affect bile flow or the chemical composition of bile (e.g., chronic biliary infections or strictures).
  • Secondary bile duct stones: These typically originate in the gallbladder and then relocate to the bile ducts. The stones are usually cholesterol-based. Generally, secondary bile duct stones are more common than primary bile duct stones and are cholesterol-based.

Bile ducts can be attributed to multiple factors, including:

  • Abnormal bile composition: If bile has too much cholesterol or too little bile salts, it can lead to stone formation. Conditions like gallbladder disease, biliary cirrhosis, or chronic liver disease can affect bile composition.
  • Bile duct stricture or narrowing: A bile duct stricture or narrowing, often caused by inflammation, infection, or scarring (from previous surgeries, injury, or certain diseases), can make it easier for stones to form and become trapped in the bile duct.
  • Chronic biliary infections: Long-term infections of the bile ducts (e.g., ascending cholangitis) can increase the risk of stone formation due to changes in bile composition.
  • Other medical conditions: Diseases like cirrhosis and pancreatitis, and haematological disorders like sickle cell disease or thalassemia can also predispose individuals to the formation of bile duct stones.
  • Age and gender: Individuals over 40, especially women are at high risk of developing gallstones, and by extension, bile duct stones.

When a bile duct stone blocks the bile duct, it can cause a range of symptoms, particularly if the stone causes a biliary obstruction or leads to complications like cholangitis or pancreatitis. Common symptoms include:

  • Jaundice: This occurs due to obstruction of bile flow, resulting in bilirubin accumulation in blood, which in normal cases is excreted in bile.
  • Dark urine: This occurs due to excess bilirubin in the bloodstream.
  • Pain: When a stone obstructs bile flow, an intense pain in the right upper abdominal region referred to as biliary colic can occur.
  • Fever and chills: These are signs of cholangitis (bile duct infection), which is a potentially serious complication of bile duct stones.
  • Nausea and vomiting: These symptoms may accompany biliary colic or other complications, particularly in case of bile duct infection or inflammation.
  • Clay-coloured stools: This happens when bile (which gives stool its characteristic brown colour) cannot reach the intestine due to the blockage.

To diagnose bile duct stones, doctors may use a combination of the following methods:

  • Ultrasound: Often it is the first imaging test performed. An abdominal ultrasound can detect gallstones, and in many cases, bile duct stones.
  • Endoscopic retrograde cholangiopancreatography (ERCP): The ERCP procedure involves using endoscopy in conjunction with X-ray scanning to examine the bile ducts and pancreas. ERCP is both diagnostic and therapeutic, as it can be used to remove or retrieve stones from the bile ducts.
  • Magnetic resonance cholangiopancreatography (MRCP): This non-invasive MRI-based technique can identify stones or blockages in the bile ducts.
  • CT scan: This can also help identify bile duct stones, especially if there is suspicion of complications such as pancreatitis.
  • Blood tests: These can help identify liver dysfunction, infection, or bile stone-induced obstruction based on elevated levels of liver enzymes (e.g., ALT, AST) and bilirubin, and increased white blood cell counts.

Common treatment options for bile duct stones include:

  • Endoscopic removal (ERCP): This is the most common treatment for bile duct stones, especially if there is a blockage or infection. ERCP can be used to extract stones from the bile duct using specialised tools passed through a flexible tube inserted into the duodenum.
  • Surgery: This modality might be used to extract bile duct stones or treat complications like bile duct strictures. Cholecystectomy (removal of the gallbladder) may also be performed to prevent further stone formation in the future, as it is often the source of the stones.
  • Medications: Although not as common, medications like ursodeoxycholic acid may be used in some cases to dissolve cholesterol stones. This is typically more effective for gallstones than for bile duct stones.
  • Percutaneous transhepatic cholangiography (PTC): If ERCP is not successful or available, this procedure can be used to access the bile ducts through the skin and remove stones.

While it is not always possible to prevent bile duct stones, certain lifestyle modifications can reduce bile duct stone risk:

  • Maintaining a healthy weight: This is important as obesity is associated with enhanced formation of gallstones, which relocate to the biliary system as bile duct stones.
  • Eating a balanced diet: A low-fat and high-fibre diet can help reduce gallstone risk.
  • Managing underlying conditions: Managing pre-existing health issues, like diabetes, high cholesterol, or liver disease, can help lower the risk of bile duct stones.
  • Avoiding rapid weight loss: This is associated with increased risk of gallstone formation, hence when going for weight loss, one should aim for gradual, steady weight loss.
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Bone Density Testing

Management Team

Bone Density Testing

Overview

The weight of our entire body is borne by the bones that make up our skeletal system. Every movement needs muscles that move the bones to allow varied range of movements. The strength of the bones, particularly in the important weight bearing areas, is important in preserving health and quality of life.  

The measurement of bone density allows us to learn about the risks of bone fracture. For several reasons, some people have reduced bone density, which increases the risk of fractures and can take away the ability to lead a healthy and fulfilling life.

The bone density is measured using a technique called Dual Energy X Ray Absorptiometry (DEXA). This technique can measure several components comprising the body and bones, which allows one to decide risk of having fractures and whether specific treatment is required to improve the strength of the bones.

  • Tell you if you have reduced bone density
  • Predict you risk of having a fracture in the future
  • Measure if the bone density is improving or getting worse
  • Monitor treatment outcomes

  • Anyone with a fracture and who the doctor may suspect to have reduced bone density
  • Women after menopause, particularly if they have risk factors
  • Men over 70 years of age or earlier if they have certain risk factors
  • Patients with an X-ray of the spine showing a bone with fracture or density loss
  • Patients with back pain
  • Patients with height loss

If you are on medicines for correcting bone density, the test should be repeated once a year or once every two years at the very least. Your doctor will decide how often you need testing depending on your condition.

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Bladder Stone

Management Team

Bladder Stone

Overview

These are accumulated deposits of minerals and salts in the bladder. Bladder stones can cause urinary discomfort and can be treated in several ways.

The symptoms of bladder stones include:

  • Increased frequency of urination
  • Bladder urgency, or the sudden, intense urge to pass urine
  • Poor urine flow
  • Suprapubic pain, or pain between the belly button and pubic bone area
  • Abrupt cut-off in urinary stream

Bladder stones can be diagnosed using the following methods:

  • X-ray KUB: An x-ray of the kidneys, ureters, and bladder
  • NCCT KUB: A non-contrast CT scan of the kidneys, ureters, and bladder

Bladder stones can be treated using the following methods:

Cystolithotripsy: This is a surgical procedure to remove small- to medium-sized bladder stones

Cystolitholapaxy: This is a procedure in which a laser is used to break down the bladder stones into smaller pieces

Percutaneous cystolithotripsy: This is a minimally invasive procedure to remove bladder stones

Cystolithotomy: This is a surgical procedure used to remove large and/or numerous bladder stones. Cystolithotomy can be either open, laparoscopic, or robotic-assisted

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B

Bladder Cancer

Management Team

Bladder Cancer

Overview

This is a type of cancer that occurs when the cells in the bladder begin to grow uncontrollably. It is a relatively rare form of cancer with a variety of treatment options.

The symptoms of bladder cancer may include: 

  • Blood in the urine
  • Abnormal urination, including frequent urination, bladder urgency, and poor flow

Bladder cancer can be diagnosed using the following techniques:

  • Urine cytology: A urine test that checks for the presence of cancerous cells
  • CT urogram: A CT scan of the kidneys, ureters, and bladder
  • Ultrasound KUB: A diagnostic ultrasound to assess the kidneys, ureters, and bladder.

Bladder cancer is treatable. The following options exist for patients with bladder cancer:

  • Trans-urethral resection of bladder tumour (TURBT): A surgical procedure used to remove the cancerous part of the bladder through the urethra
  • En bloc laser enucleation of bladder tumour: This is a minimally invasive technique in which the cancerous tumour is excised using lasers
  • Radical cystectomy: This is a surgical procedure to remove the entire bladder. It also usually includes the removal of adjacent organs such as the prostate and seminal vesicles, or the ovaries, fallopian tubes, uterus, and/or parts of the vagina
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Benign Prostate Enlargement or Hyperplasia (BPE or BPH)

Management Team

Benign Prostate Enlargement or Hyperplasia (BPE or BPH)

Overview

This is a common, non-cancerous condition that may occur as a patient grows older. It is characterised by an enlargement of the prostate and is typically accompanied by urinary discomfort.

The symptoms of BPE/H are as follows:

  • Increased frequency of urination
  • Bladder urgency, which is a strong, sudden need to urinate
  • Nocturia, increased frequency of urination at night
  • Poor urinary flow
  • Straining during urination
  • Stopping and starting during urination or an intermittent urine stream
  • Feeling of incomplete urination
  • Burning sensation during urination, accompanied by fever or chills
  • Bladder stones

BPE can be diagnosed via the following investigations:

  • Digital rectal examination: A healthcare professional will manually palpitate the area around the prostrate and assess its status
  • Ultrasound KUB: An ultrasound examination of the kidneys, ureters, and bladder
  • Uroflowmetry: A test that measures the speed, amount, and duration of urination
  • Serum PSA: A blood test that checks for a protein produced by the prostate gland
  • Urinalysis: A common urine test

The following treatments are available for BPE:

  • Transurethral resection of the prostate (TURP): This surgical procedure involves removing a portion of the prostate gland. We offer both monopolar and bipolar TURP
  • Laser enucleation (LEP): A pulsed laser beam is used to remove tissue from within the prostate. It is a minimally invasive procedure. We offer LEP using two types of lasers (HoLEP and ThuLEP)
  • Laser vaporisation: A high-power green light laser is used to remove tissue from the prostate gland
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Bruxism (Tooth Grinding or Clenching)

Management Team

Bruxism (Tooth Grinding or Clenching)

Overview

Bruxism refers to the clenching, grinding, or gnashing of teeth. It usually happens subconsciously, either during waking hours or during sleep.

A combination of psychological, physical, and genetic factors has been associated with bruxism.

  • Anger, frustration, stress, anxiety, or tension may cause awake bruxism, which serves as a coping mechanism for activities involving deep concentration.
  • Sleep-related chewing activities associated with arousals may cause sleep bruxism.

The following factors have been shown to increase the risk of bruxism:

  • Stress: Increased levels of anger, frustration, and anxiety can cause the grinding of teeth.
  • Age: While bruxism is common before and during early adolescence, it usually disappears by adulthood.
  • Personality type: People that are competitive, aggressive, or hyperactive may be at an increased risk of developing bruxism.
  • Family history: People with family members who have bruxism or a history of it may develop this condition.
  • Medications and other substances: Some psychiatric medications, such as antidepressants, are associated with uncommon side effects, such as bruxism. Consumption of caffeinated beverages or alcohol, recreational drug use, and smoking tobacco may increase the risk of developing bruxism.
  • Other disorders: Some neurological disorders, such as attention-deficit/hyperactivity disorder, epilepsy, and Parkinson's disease-related dementia, and sleep-related disorders, such as sleep apnoea and night terrors, have been associated with an increased risk of developing bruxism.

The symptoms of bruxism include:

  • Loud teeth grinding or clenching (that may awaken the sleep partner)
  • Enamel erosion, leading to the exposure of the deeper layers of the tooth
  • Fractured, chipped, flattened, or mobile teeth
  • Heightened tooth pain and/or sensitivity
  • Stiffness in the jaw muscles (difficulty in opening or closing the jaw completely)
  • Soreness or pain in the jaw, neck, or face
  • Sleep disruption
  • Dull headache originating in the temples
  • Pain that feels like, but is actually not, an earache

Bruxism is diagnosed based on the presence of the aforementioned signs during routine dental examinations.

Treatment is not necessary in many cases, given that many bruxism disappears among many children without treatment and that in many adults, the teeth grinding or clenching is not severe enough to warrant therapeutic interventions. However, for cases of severe bruxism, dentists prescribe specific dental approaches, therapies/habits, and medications to prevent further tooth damage and provide relief from pain or discomfort:

  • Dental approaches: Dentists often suggest methods to prevent the wear and tear of the teeth or improving dental health; however, these may not be effective in stopping bruxism. These methods include:
    • Application of mouth guards and splints: These devices, often prepared using hard or soft acrylic materials, are fit onto the upper or lower teeth; thus, they help separate the teeth and prevent the damage caused by tooth grinding/clenching.
    • Dental correction: When the bruxism is severe, i.e., wear and tear of the tooth has led to heightened sensitivity or difficulties in chewing/eating, to repair the damage, the chewing surfaces may need to be reshaped, followed by the insertion of dental crowns.
  • Other approaches: Bruxism may also be treated using one or more of the following approaches:
    • Management of anxiety and stress: Adopting strategies that promote relaxation, such as meditation, and/or guidance from a licensed therapist or counsellor, may be effective if the bruxism is a result of psychological stress or anxiety.
    • Behavioural changes: The dentist may recommend appropriate jaw posturing/alignment and mouth and jaw exercises as behavioural changes to suppress teeth grinding/clenching.
    • Biofeedback: If changing behaviours/habits is difficult, biofeedback, i.e., the use of monitoring procedures and equipment to teach patients how they can control muscle activity in the jaw, may be effective.
  • Medications: Generally, treating bruxism using medications has not been shown to be effective; further research is needed to determine the efficacy of medications and develop effective medicines for this condition. The following medications may be used for treating bruxism:
    • Botox injections
    • Muscle relaxants
    • Anti-anxiety or anti-stress medications
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Bunion

Management Team

Bunion

Overview

A bunion, commonly known as hallux valgus or hallux abducto valgus, is typically described as a swelling or lump on the outer side of the big toe. Bunion formation is a progressive condition.

Bunions are most often caused by an inherited defect in the mechanical structure of the foot. Notably, while the bunion itself is not inherited, certain foot types render people more susceptible to developing a bunion. Bunion formation may indirectly result from wearing tight shoes that crowd the toes, which can occasionally exacerbate an inherited foot abnormality.

  • Soreness or pain
  • Redness and swelling
  • A burning feeling
  • Numbness

  • A physical examination is usually adequate to confirm the diagnosis of a bunion since the deformity is apparent at the base of the big toe or on the side of the foot.
  • Radiography (X-ray) can be performed to evaluate changes and ascertain the severity of the deformity.

Non-surgical treatment

In some cases, only observation of the bunion along with periodic evaluation and radiography is sufficient. However, in others, treatment might be essential. Early diagnosis and treatment may reduce the pain from worsening, but it cannot reverse the foot deformity. The steps that can be taken to avoid the worsening of a bunion include:

  • Changing the type of shoes
  • Additional padding of the shoes
  • Changes in daily activities
  • Pain-relieving medications, such as oral NSAIDs (nonsteroidal anti-inflammatory drugs), to alleviate joint pain
  • Applying ice to the affected region
  • Injection therapies
  • Use of orthopaedic supports

Surgical treatment

If non-surgical treatments fail to provide pain relief, your doctor may recommend a bunion surgery. Bunion surgery usually involves correcting the bunion abnormality through surgical procedures like the removal of excess bone and joint fusion.

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