Yittz's Clinic!!

[ice_cream]

are u sure? idk..my friend who gets bad acne..told me that this one time where she ate loooots of fruits for 3 days straight, her face started clearing up and it was "glowing" lmao

From my experience, I didn't find fruits to be very helpful (but then I'm not a real fruit fan, only have 1 or 2 fruits a day). I think it's probably the water content in the fruits which helped. But then if you avoid a high sugar diet, it will help anyway right? (At least it'll be more healthy??)

Aphraeleiss are you a dermatologist or something? Because my stupid doctor never told me all that when I went to see her (only prescribed me antibiotics which helped in the short term, but once I stopped it would be back a few months later).

With prescription medicines doxcycline, zorac, retin-A and differin, what tends to be most effective? I think zorac, retin-A and differin are retinoids? Is it ok to use more than one type at the same time? Like taking doxcycline and applying a retinoid??

[Aphraeleiss]

No, not a dermatologist. Yet. Hoping to get onto the program soon. Most derms are more concerned with treating pathological skin conditions. I doubt most of them would know the intricate details of skincare as well as someone who has a personal interest in the subject, which I do. Even derms who do mainly cosmetic work prescribe generic cleansers like Cetaphil without realizing that there are potentially irritating ingredients in it just because it's "dermatologically tested" which basically means nothing.

I wouldn't use more than one type of retinoid at any given time. Doxycycline is an antibiotic with its own side effects. I have heard of people using a retinoid with an antibiotic but it all depends on the severity and cause of the acne. Topicals can get into the system as well, but since there are different mechanisms of action in severe acne they may be synergistic. Roaccutane which is an oral retinoid tends to have systemic side effects as well, including but not limited to dry skin and depression. Retinoids must be used with caution. As I am not a qualified dermatologist I can only comment generally, especially in the absence of a thorough physical examination. I don't normally give out medical advice on forums as a rule, mainly skincare advice.

BTW, it depends on what fruit you eat as well. Fruits are high in sugar, though generally considered to be healthier than sucrose, but the metabolic pathways are similar, and so is the production of free oxygen radicals which cause damage. In general a healthy skin diet would be like the Perricone diet, with tons of oily fish, dark vegetables and fruit that are relatively low in sugar. Never managed it though. With my job I'm lucky to get fed at all, so all I eat is processed junk. Thank goodness I've got good genes.

[Han Solo]

Aphraeleisis,

Those were great posts on acne - could have swap over to become a dermatologist.

Han Solo
p/s: you must have had a great holiday?

[Aphraeleiss]

Oh yeah, did I forget to post about it? Sorry to hijack the thread. I went to Shanghai first, the Yiwu to check out the wholesale markets and the Hengdian Film Studios (fantastic palaces, but really bad transport - quite disappointed), flew to Guangzhou for more retail therapy - the wholesale markets are fantastic, then finally took the KCR to HK to visit friends and buy work shoes. I've given up on proper shoes. Black sneakers all the way. If someone writes me up for it I will tie them to a stake and burn them. I nearly died the last time I tried pumps.

And yeah, I changed my mind. I'm introducing myself to the director of dermatology next week so he can mentor me. As for where I can volunteer to tick off the box for community interest on the job application next year I haven't a clue.

[yittz]

Hey Han and Aphraeleiss where are you originally from? Derm is competitive right?

[Aphraeleiss]

I'm originally from Singapore but I've been here for over 10 years now. I had some 3-year old attacking me via PM because I commented on how I disliked Singlish or something. By the time I got the message it was 6 months old. He'd probably be 4 years old by now. LOL

Anything worth doing is competitive - hell, even GP is competitive. The applications all rank your CV and how your referees rate you, and there are special requirements like research projects, community service and personal interests. Basically the more well-rounded and interesting you seem the better the chances. I'm racking my brains trying to figure out what I can volunteer for without looking too contrived, and when I can actually find time to do it. Most volunteer jobs require at least a full day a week, and I work 1 in 2 weekends. Not to mention I work outside of Sydney and all my off days are spent travelling home to be with my family. You just can't piss anyone off in this job. Nurses have it good. I had someone swear at me because I told her a patient was not under my care and they should page someone else to review and rechart the patient's medications. Go figure.

The only specialty I know of that's not competitive is probably geriatrics. Spent the greater half of an hour shouting in someone's ear doing a mini-mental yesterday. I think she had high frequency hearing loss, couldn't hear a damn thing I said. Don't think so.

[ice_cream]

Anything worth doing is competitive - hell, even GP is competitive. The applications all rank your CV and how your referees rate you, and there are special requirements like research projects, community service and personal interests. Basically the more well-rounded and interesting you seem the better the chances. I'm racking my brains trying to figure out what I can volunteer for without looking too contrived, and when I can actually find time to do it. Most volunteer jobs require at least a full day a week, and I work 1 in 2 weekends. Not to mention I work outside of Sydney and all my off days are spent travelling home to be with my family. You just can't piss anyone off in this job. Nurses have it good. I had someone swear at me because I told her a patient was not under my care and they should page someone else to review and rechart the patient's medications. Go figure.

The only specialty I know of that's not competitive is probably geriatrics. Spent the greater half of an hour shouting in someone's ear doing a mini-mental yesterday. I think she had high frequency hearing loss, couldn't hear a damn thing I said. Don't think so.

Yay!! Derm's good...How long is the training before you become qualified?

You work outside of Sydney? Are you in your stage where you have to work in some regional area for a year or 2?

[Aphraeleiss]

5 years after getting on the program. I suspect it'll take a couple years before I actually get on though. I just happened to be allocated to a network outside of Sydney, that's all. The rural requirement is dependent on specialty. I'd kill to be in Sydney though.

[Han Solo]

Hey Han and Aphraeleiss where are you originally from? Derm is competitive right?

Malaysia.

In melbourne for the last 10 years- did a year of pre-u, then Melb uni for 6 years, then last 3 years working.

Derm is hard to get in, about as hard as opthalmology.

If you ask me to rank the difficulties of the specialties to get in then:
Opthalmology > Dermatology > Anesthetics > Surgery > Physician > ED > GP.

But there are different difficulties of the various sub-specialities within surgery and physicians.

Han Solo

[Han Solo]

I'm originally from Singapore but I've been here for over 10 years now. I had some 3-year old attacking me via PM because I commented on how I disliked Singlish or something. By the time I got the message it was 6 months old. He'd probably be 4 years old by now. LOL

Anything worth doing is competitive - hell, even GP is competitive. The applications all rank your CV and how your referees rate you, and there are special requirements like research projects, community service and personal interests. Basically the more well-rounded and interesting you seem the better the chances. I'm racking my brains trying to figure out what I can volunteer for without looking too contrived, and when I can actually find time to do it. Most volunteer jobs require at least a full day a week, and I work 1 in 2 weekends. Not to mention I work outside of Sydney and all my off days are spent travelling home to be with my family. You just can't piss anyone off in this job. Nurses have it good. I had someone swear at me because I told her a patient was not under my care and they should page someone else to review and rechart the patient's medications. Go figure.

The only specialty I know of that's not competitive is probably geriatrics. Spent the greater half of an hour shouting in someone's ear doing a mini-mental yesterday. I think she had high frequency hearing loss, couldn't hear a damn thing I said. Don't think so.

I concur on the behavior of nurses. I'm currently in ICU and yesterday, had this nurse complaining that a patient who had schwannoma and tracheostomy on ventilator, that he is being difficult and she (the nurse) implies that he has a few loose screw- directly in front of the patient who is awake and conscious.

Btw, the difficulties of getting into geriatric is not into the subspecialty but the difficulty of passing the FRACP. As you know, all physician advanced trainee just sits through one unified FRACP Part 1 and 2, which they sit after finishing their basic physician training.

Han SOlo

[Aphraeleiss]

Well, given that most people I know are doing physician's training it just doesn't look that hard. Most of my friends get on the program PG-Y3, sit the exam PG-Y4, fail a couple times, and get onto advanced training with no issues. Not that I'm actually interested.

I think I'll just wait it out and build up my CV before I get in. 1 in 5 chance of getting in, so I'm going to try for the next 5 years. One of my friends is an unaccreditted ophthalmology registrar. Another is an anesthetic registrar who's actually accreditted this year, and he's only PG-Y4. To be honest, most people get in PG-Y4 or after an unaccreditted year if they don't get in any earlier. I'm not too worried about it apart from the fact I don't want to do anymore medical terms in my lifetime. With any luck this will be my last.

I just want to move back to Sydney. Hopefully this will be my last year outside the metro area. Secondments are unavoidable, but I really can't take this driving business for much longer.

I think that there are some nurses who are fantastic, but most of them really don't look like consumer advocates even when they claim to be. I've had nurses call MET calls just to get off the hook and go off to their tea breaks. I had to handle someone with a heart rate of about 30 (she just woke up spontaneously and normalized) alone, without any help because the person who paged me went off to have her tea break and a smoke. I asked for an ECG before I came down physically, and I had to find the machine (thank goodness it was charged) and do everything myself. Geez, great care. Most of them have no clue what they're doing, at least in Australia. In the US the nurses know alot more and call MDs usually only when there is a problem.

[Suet Seung]

What to do when you're foot is asleep and that numbing or pin needle feeling takes over? Wait it out? Hit your foot?

[xcutie]

hey Dr. Han! you probably don't remember me, but i have yet, another question.

is eating too much fiber bad for you? i eat a lot of cereal that has tons of fiber in it. and i noticed that i've been getting a much larger appetite. i have to eat every hour or so, or i'll get so hungry that my stomach growls loudly. and i also poo a lot now... is the fiber doing this?

i'm so sorry if i grossed you out...

[yittz]

What to do when you're foot is asleep and that numbing or pin needle feeling takes over? Wait it out? Hit your foot?

Pins and needles, with numbing is caused by lack of blood supply to the nerves. And they start firing. It goes away when you return the blood supply, so just wait it out. I sometimes hit it, cause that sensation seems to mask the pins and needles.

[HuangYushi]

Any chance of yittz or any other (still-lurking) doctor or medical student who is into paediatrics? Thanks!

[Han Solo]

Any chance of yittz or any other (still-lurking) doctor or medical student who is into paediatrics? Thanks!

You can always ask, and yittz can always try to answer.

[Han Solo]

hey Dr. Han! you probably don't remember me, but i have yet, another question.

is eating too much fiber bad for you? i eat a lot of cereal that has tons of fiber in it. and i noticed that i've been getting a much larger appetite. i have to eat every hour or so, or i'll get so hungry that my stomach growls loudly. and i also poo a lot now... is the fiber doing this?

i'm so sorry if i grossed you out...

Fibers are good.

The reason why you need to do a lot of toileting was that you are eating more. Eating the fibers just helps with the movement of the materials in the large bowel.

In fact, eating more fibers would make it more filling for you when you eat, making it less caloric enhancing than normal.

Han Solo

[HuangYushi]

Any chance of yittz or any other (still-lurking) doctor or medical student who is into paediatrics? Thanks!

You can always ask, and yittz can always try to answer.

OK, here goes!

I have 7 students aged between 2.5 and 3 years old in an air-conditioned classroom. When one of them is unwell (runny nose, fever, cough, whatever), the others catch the bug from him quite easily.

What I have done so far:
1. Issue strict instructions: If anyone is sick, don't come to school.
2. Separate anyone who suddenly becomes unwell (nose starts to run, etc) from the other kids in the classroom. Call parents to take the kid home asap if he looks really bad.
3. Wash toys regularly, and growl like nobody's business when anyone mouths the toys. (They have all stopped mouthing, btw).
4. Seat kids who seem to catch bugs easily the farthest away from those who tend to bring the bugs to school (some kids seem to have runny noses 80% of the time!).
5. Blow runny noses, etc fanatically, and growl whenever anyone picks his/her nose or coughs into another kid's face.

With kids still coming in with runny noses, coughs, etc, what can I tell parents to do, so that their kids become stronger and more resistant to bugs?

Many thanks!

HYS

PS: A few other things:
1. No one shares food/drinks from the same container/utensil in the class.
2. All towels are changed within 30 minutes of use.
3. The classroom is a shoe-free zone, and mopped everyday.

===

EDIT: Additional Question:
Are kids with G6PD more susceptible (than otherwise normal kids) to common cold/fever/flu infections?
Thanks!

MORE:
Is there any possibility of G6PD affecting a child's physical development? Thanks!

[yittz]

OK, here goes!

I have 7 students aged between 2.5 and 3 years old in an air-conditioned classroom. When one of them is unwell (runny nose, fever, cough, whatever), the others catch the bug from him quite easily.

What I have done so far:
1. Issue strict instructions: If anyone is sick, don't come to school.
2. Separate anyone who suddenly becomes unwell (nose starts to run, etc) from the other kids in the classroom. Call parents to take the kid home asap if he looks really bad.
3. Wash toys regularly, and growl like nobody's business when anyone mouths the toys. (They have all stopped mouthing, btw).
4. Seat kids who seem to catch bugs easily the farthest away from those who tend to bring the bugs to school (some kids seem to have runny noses 80% of the time!).
5. Blow runny noses, etc fanatically, and growl whenever anyone picks his/her nose or coughs into another kid's face.

With kids still coming in with runny noses, coughs, etc, what can I tell parents to do, so that their kids become stronger and more resistant to bugs?

Many thanks!

HYS

PS: A few other things:
1. No one shares food/drinks from the same container/utensil in the class.
2. All towels are changed within 30 minutes of use.
3. The classroom is a shoe-free zone, and mopped everyday.

===

EDIT: Additional Question:
Are kids with G6PD more susceptible (than otherwise normal kids) to common cold/fever/flu infections?
Thanks!

MORE:
Is there any possibility of G6PD affecting a child's physical development? Thanks!

For G6PD deficiency:
It is quite common in Africa, Mediterranean, Middle East, and SE Asia
Cause episodes of haemolytic anaemia as G6PD def causes oxidative stress to red blood cells
Haemolysis (breaking+dying of red blood cells) tends to be more severe in the Medit type.
The attacks of haemolysis can be triggered by infection, drugs and fava beans, so it's important to treat the infection.
Between attacks, most should be fine and grow normally (not completely sure about physical dvp, Han?). I don't think they are at higher risk of infection since its only red blood cells, not white being affected.

HYS where do you operate the classroom?

Your infection control seems top notch. In terms of making them stronger, immune wise, there's not much more their parents can do if the children are getting good diet, exercise and don't have chronic disease. Previous infections builds up one's immune system and at their age they are very prone to infection - they are in the exploratory phase and their immune system is still young and learning.

All the atopy (like allergies, asthma, eczema) is believed to be attributed to a society too clean and free of infections. So some suggest to let the children get more contact with dirt and germs, what doesn't kill them makes their immune system stronger. Although infections can also affect neurodevelopment and other long term effects.

[HuangYushi]

Many thanks, yitzz!

Haemolysis (breaking+dying of red blood cells) tends to be more severe in the Medit type.
Between attacks, most should be fine and grow normally (not completely sure about physical dvp, Han?). I don't think they are at higher risk of infection since its only red blood cells, not white being affected.

Would the dying of the red blood cells lead to an imbalance of the red vs the white cells, and cause other more serious illnesses?

HYS where do you operate the classroom?

Malaysia. And yes, I have G6PD in the classroom. I do not know how severe the case is, but I'm due to meet with the parents in a couple of weeks, so I'd probably find out more about the case then.

Your infection control seems top notch. In terms of making them stronger, immune wise, there's not much more their parents can do if the children are getting good diet, exercise and don't have chronic disease. Previous infections builds up one's immune system and at their age they are very prone to infection - they are in the exploratory phase and their immune system is still young and learning.

Thanks. Now I have something to say to parents when they grumble about their kids getting sick!

All the atopy (like allergies, asthma, eczema) is believed to be attributed to a society too clean and free of infections. So some suggest to let the children get more contact with dirt and germs, what doesn't kill them makes their immune system stronger. Although infections can also affect neurodevelopment and other long term effects.

Yeah, I'm one of those who think "controlled" contact with dirt etc (through playing in the sandpit, messing in the garden, etc) is good for the children. Since this is a classroom that we're talking about, I try to schedule such activities just before the kids go home, so that they can take their baths/showers as soon as possible!

Thanks again!

HYS