Virtual Doctor

Grand Opening of SHING MEDICAL BOUTIQUE

2008-03-07T23:15:00.000-08:00

I'm proud to announce the Grand Opening of SHING MEDICAL BOUTIQUE in Beverly Hills. If you live in the LA area or visit the area and need my services, visit http://ShingMedicalBoutique.googlepages.com for more information.

Myth on testosterone

2007-11-27T02:39:00.000-08:00

Testosterone is just a male sex hormone, right? Well, it makes a boy a boy and a man a man. There's no doubt about it. However, testosterone is much more than that. Recent research indicates that it also affects many other bodily functions. Testosterone maintains the integrity of the cardiovascular system, hematological system, immune system, nervous system, musculoskeletal system, metabolism, skin health, and of course the reproductive system. The list goes on. Therefore, testosterone can reduce morbidity or mortality from heart disease, high blood pressure, anemia, cancer, infections, dementia, osteoporosis, weakened muscles, diabetes, aging skin, and sexual dysfunction, etc. It's associated with general well-being and longevity. If you need testosterone therapy, make sure it's a natural or bio-identical hormone. Synthetic hormones may actually cause harm as we learned the hard way from hormone replacement therapy in menopausal women.

Andropause: is it real?

2007-11-26T21:14:00.000-08:00

Believe or not, as men age they do experience andropause. But it appears more subtle and gradual than menopause in women. As we discussed before, many hormones peak around age 20. These hormones decline slowly afterwards. Testosterone usually is low enough around age 45 that many men experience problems. The symptoms tend to be vague such as fatigue, insomnia, amnesia, exercise intolerance, decreased muscle mass, dejection, depression, anxiety, anger, paranoia, impotence or lack of strong erections, premature ejaculations, decreased libido, etc. Your primary care doctor and even your endocrinologist may tell you that your testosterone level is normal. New research and common sense show that "normal" may not be the same as "optimal". One good example is men's height. From 5-foot 5 inches to 7-foot 5 inches may be considered "normal", but the "optimal" height may be around 6-foot. For testosterone level, the optimal level may be the high normal among the 20-year old men: 800. For free testosterone, it's 244. The current laboratory normal ranges, 280-800 for total testosterone and 47-244 for free testosterone, are almost certainly too wide to be clinically useful. Please note: different laboratories adopt different standards of testing and thus different ranges. Ask people at www.BioIdenticalHormoneSociety.com to locate a doctor to help you in your community.

Bones and osteoporosis

2007-11-23T02:34:00.000-08:00

Contrary to common belief, bones are dynamic organs that constantly renew themselves. Osteoporosis is a significant decrease in bone density. It makes the bones prone for fractures. Osteoporosis is more common in people with fair complexion. Besides exercise and balanced diet, I recommend people take extra calcium (1200 to 1500 milligrams daily) and vitamin D (3000 to 5000 international units daily). You can start taking them at any age over 15 years (weighing 40 kilograms or more). Younger or lighter children should take dosages under a doctor's guidance. If you have kidney failure, you need a different vitamin D and ask your nephrologist. When you reach 45, you should have your hormone levels checked and balanced with natural hormones. When you're 55 (for women) or 65 (for men), you should have a bone density test. You may need additional therapies if indicated such as calcitonin and Fosamax (or equivalent). If you can't tolerate Fosamax and have severe osteoporosis or a history of fracture related to bone loss, you may be eligible for intravenous infusion of zoledronic acid once a year. External hip protectors can also be used for selected people.

Cancer and its risk factors

2007-11-23T01:17:00.000-08:00

Cancer is simply a disease due to excessive cell growth. Normal cell growth and development are tightly controlled by neural and hormonal mechanisms. Cancer usually originates from one cell which is out of control. It involves abnormal changes in its DNA (genetic material). This process usually takes years or even decades. The tendency to develop certain types of cancer can be passed on to the offspring. However, environmental or lifestyle factors are very important. These can be physical, chemical or biological. The major risk factors are ionizing radiation (from X-ray, gamma-ray, nuclear material, etc.), smoking or other forms of tobacco use, ultraviolet (from excessive sunshine, tanning bed, etc.), aromatic compounds (from benzine, smoked, grilled, broiled and fried food, etc.), other industrial materials such as certain dyes and asbestos, certain heavy metals such as arsenic, infection from biological pathogens such as human papilloma virus, biological toxins, prolonged non-healing wound or mechanical irritation, excessive alcohol or caloric intake. Host factors are mainly immune deficiency or suppression from viral infections or certain medical therapies.

Risk factors for heart disease

2007-11-23T00:38:00.000-08:00

Here we're mainly concerned with the coronary artery heart disease. The major risk factors we know so far are high cholesterol and saturated fat diet, smoking, diabetes, high blood pressure, overweight and obesity, sedentary life style, excessive alcohol intake, narcotic abuse, familial high blood cholesterol, and certain blood disorders such as sickle cell disease (a genetic problem) and polycythemia (too many red blood cells). Other factors such as mental stress and inflammatory diseases are less well defined and still controversial. These risk factors are also applicable to ischemic stroke and peripheral artery diseases.

Can diet affect my heart?

2007-11-22T23:54:00.000-08:00

The heart can develop many diseases. But artery blockages in the heart (coronary artery heart disease) is becoming increasingly important globally. High cholesterol and saturated fat diet is a major risk factor. A medium-sized egg yolk provides about 300 milligrams of cholesterol which is the maximum daily allowance for an adult. If you have familial high blood cholesterol, you should take less than this. Saturated fat is mostly from animal sources. Most plant-based oils contain unsaturated fat which is beneficial for cholesterol control. Some fish oil is also desired. Trans fat (in hardened vegetable oil) is harmful. Learn to read food labels. Try to count your cholesterol and saturated fat intake on a daily basis. However, some labelings may not be accurate especially those from small operations or imports. So you need to have some basic understanding of nutrition and ingredients in the food you consume. This dietary principle is applicable to ischemic stroke and peripheral artery diseases as well.

Sexual dysfunction

2007-11-11T06:00:00.000-08:00

Sexual dysfunction in men (mostly erectile dysfunction or impotence, or premature ejaculation) or women (mostly low libido or lack of lubrication) can have many causes. In general, if you're very young with normal sexual function previously, the problem is most likely due to stress, anxiety, depression, fatigue, malnourishment, general illness, or a combination of these factors. If you don't have any of these factors, your doctor may consider vascular and neural factors such as arthrosclerosis and diabetic neuropathy. Treatment of the underlying cause may eliminate sexual dysfunction. If the underlying cause can't be eliminated, some medications on the market such as Viagra, Levitra, and Cialis may be helpful even in women. These medications are contraindicated in people on nitroglycerin type of medications because your blood pressure may bottom out. Before you try these medications, however, I recommend you have your hormones tested because you may have hormonal imbalance. Once your hormones are balanced with natural hormones, you may not need these medications since your sexual function may come back naturally. Other treatment modalities such as suppositories, injections, vacuums, pumps or implants for men are less satisfactory and may have serious side effects.

Human papilloma virus vaccination

2007-11-11T05:12:00.000-08:00

Human papilloma virus (HPV) can cause cervical cancer in women. Theoretically it may also cause penile or anal cancer. This virus can be transmitted sexually. Other modes of transmission is also possible. Currently available vaccine against it can prevent cervical cancer significantly, although not 100 percent. Females between ages 9-26 years are officially recommended to have this vaccine. But I personally recommend it to anyone, male or female older than 9 years. Both males and females can be carriers of the virus and pass it on to their sexual partners. Some families may be reluctant to get vaccinated. HPV vaccine should be treated like any other vaccine and not be put on the back burner. However this vaccine does not prevent other sexually transmitted diseases (STD) such as human immunodeficiency virus (HIV) infection, hepatitis B or C, gonorrhea, chlamydia, trichomoniasis or genital herpes.

Drug abuse

2007-11-11T04:54:00.000-08:00

Modern drug abuse takes many forms: street drugs, over-the-counter or prescription drugs, glue, antifreeze; the list goes on. Most of these drugs are narcotics or some form of alcohol that can give you "high". Trying to get "high" is a dangerous practice. Overdose or withdrawal can be fatal sometimes. Get professional help as soon as you can! These habits can be fatal, obviously. Life is miraculous and precious, so don't destroy it! Be a faithful guardian and manager of your own life!

Is alcohol good for my heart?

2007-11-11T04:34:00.000-08:00

There's some evidence that a drink a day may be beneficial to cardiovascular health. Some may say one or two but I emphasize one. However this is not a general recommendation for people to use alcohol since alcohol can cause significant health and social problems. You certainly should not binge. You should not accumulate and drink a lot on one occasion even if you haven't been drinking for a month. In addition, you should not drink if you have a problem controlling how much you drink. Nor should you drink if you have a liver problem such as fatty liver, hepatitis C or cirrhosis.

Tobacco

2007-11-11T04:14:00.000-08:00

Consuming tobacco in any form is detrimental to your health: bronchitis, coronary heart disease, stroke, claudication, gangrene, lung cancer, oral cancer, head and neck cancer, bladder cancer, you name it. So stop doing it! Or don't start! Occasionally you may see glamorous cigarette commercials or cigar parlors, but don't be attempted! Develop better habits! Smoking is a terrible way to lose weight.

Do I exercise too much?

2007-11-11T03:22:00.000-08:00

There's no doubt that exercise helps burn calories and lose weight. Exercise can also tune up all the bodily and mental functions, be it blood pressure, muscle strength, metabolism, immunity, mood, etc. However, overdoing it can be harmful. Acute and chronic injuries should be prevented if possible. Know your own body. Gradual progression in exercise quantity and intensity is important. Cross training is better than a single sport to prevent repetitive injuries. Warm up may prevent sprains and strains in some circumstances. If you have major health problems or a family history of sudden death, you should consult your doctor for medical clearance before you begin vigorous exercise. Do not exercise in extremely cold or hot environment. Breaks and salty hydration are necessary if you sweat a lot. Headache, drowsiness and severe fatigue are indications of overheating and/or dehydration.

Diet, weight and health

2007-11-11T01:52:00.000-08:00

Learn to read food labels. Watch what you eat and how much. It's not that you can't touch this or that. Rather it's the serving size that matters the most for calorie monitoring. Nowadays, overeating and overweight are a major health problem even in developing countries. In some parts of the world, people try to gain weight because chubbiness is a symbol for health, wealth and prosperity. Even diabetes is considered a status symbol in some regions. In the US, people often say that you can't be too rich or too thin. This cliche is only half correct. Being too thin is harmful. Your ideal weight relative to your height is the best. It also depends on your body frame and muscle mass. It should be higher if you have a large body frame or muscle mass, and vice versa. If you're trying to lose weight, you still should take 800-1200 calories a day depending on your height and gender. Adequate protein intake is essential to maintain your lean body mass and bodily function. Vegetables and fruits are important. A multivitamin pill a day is recommended.

What about an animal bite?

2007-11-11T01:30:00.000-08:00

Animal bite tends to cause infection, so you should seek medical attention as soon as possible. The animal may need to be tested for rabies if not vaccinated against it. If the animal is not available for the test, you may need rabies vaccination. If you have immune compromise, you may need immune therapy. Rabies is a serious viral infection that may cause dementia, paralysis and death. If rabies is ruled out, you may still need antibiotics to prevent bacterial infection. Antivenin may be needed for some bites such as snake bite. If broken teeth are suspected, an X-ray test may be necessary. You may have to be hospitalized if the care is delayed and the infection is severe.

Is it a spider bite?

2007-11-07T23:57:00.000-08:00

You notice a red and itchy area on you skin. Is it a spider bite? Unless you see a spider biting you or nearby, most of the time it's not a spider bite. There're many kinds of bugs in the environment. Most of the time, the bug bite will go away on its own without any treatment. Over-the-counter hydrocortisone may help ease the itch. But if the itch is severe and the redness is expanding with a central pustule, it's time to seek medical attention. You doctor usually will take a specimen and send it to a laboratory for bacterial studies. If not ruptured on its own, the infection site may need to be drained with a lancet. In the meantime you will be prescribed an antibiotic empirically. Based on the study results your doctor may switch to or add another antibiotic. With some hard-to-treat infections, your doctor may try quite a few different antibiotics. In severe cases you may need to be hospitalized and given intravenous antibiotics.

Tan without aging your skin?

2007-10-31T20:46:00.000-07:00

In ancient times, fair complexion was associated with wealth and prosperity. That's probably because the rich didn't have to work in the fields that much. This view still exists today in some traditional societies. In many developed countries nowadays, however, the reverse is true, probably because the rich can afford to travel or sunbathe on the beach and the poor have to work indoors. Excessive ultraviolet from sunshine ages your skin more quickly. You may be prone to develop wrinkles, brown or black spots and plaques, spider veins, and skin cancers including malignant melanoma (very aggressive). High-number sunblocks are important but I don't recommend sunbathe or go to salons for tanning. I think tanning lotion is a much better alternative. Or you may wish to rebel against the faddy view on skin color. You can take some vitamin D to prevent its deficiency. For adults, 5000 IU vitamin D per day is considered safe but no more than that. Multiple vitamins usually contains up to 1000 IU vitamin D. If you have kidney failure you need a different type of vitamin D. Ask your nephrologist.

Aesthetic medicine

2007-10-31T19:02:00.000-07:00

Aesthetic medicine is a field that helps you achieve better looks with medical means. It involves surgery or medications. Chin or breast augmentation or reduction, tummy tuck, liposuction, rhinoplasty, face lift, vein-stripping, other plastic procedures, and laser surgeries are available. Medications include botulinum toxin A and fillers. Medical laser has many systems and configurations that vary in function and mechanism. In general, newer generations of laser technology offer better and safer treatment. Laser can be used for spider veins, acne, hyperpigmentation, tattoo removal, scar reduction or elimination, hair removal or reduction, skin rejuvenation, and cellulite, etc. The most popular brand for botulinum toxin A in the US is Botox. Botox can relax wrinkles on the forehead, around the eyes, on the eye lids, lips, cheeks, nasolabial folds, chin and neck. Currently popular fillers in the US include Restylane, Juvederm and Radiesse. The fillers are used to augment your lips, cheeks and chin. They can also reduce or eliminate groves or scars. Other modalities such as dermoabrasion and chemical peels are also available. In general I do not recommend sandpaper-type abrasion or strong chemicals because of possible side-effects and significant down time. Sclerotherapy is used for veins larger than spider veins but smaller than surgically removable ones. Hair transplant en block or individually (newer and better technique) is mainly for eyebrows, sideburns and scalp. In any event, some of the treatments are permanent, while others are temporary or semi-permanent.

Anti-aging

2007-10-31T16:43:00.000-07:00

The concept of anti-aging is not new. Since ancient times, people have been trying to find ways to delay aging or even rejuvenate. Modern medicine offers some strategies. Diet, exercise, sleep, relaxation, avoidance of harmful substances or habits, health maintenance, disease prevention, hormonal balance, early diagnosis and treatment, convalescence, and aesthetic procedures. It seems that DNA is responsible for aging. It degenerates gradually and after an X number of replications it stops functioning. Then the cell dies in a biological process called apoptosis (programmed cell death). With the current genome research, it may be possible one day to slow down the aging process by maintaining DNA health as long as possible. Turtles must have better longevity genes than dogs since turtles live much longer. Some trees can live over a millennium and they must have excellent longevity genes.

Hormonal imbalance

2007-10-31T15:20:00.000-07:00

Symptoms are overlapping for many hormonal imbalances. One theory for this phenomenon is that nature has its own "insurance". If one hormone is out of balance, another hormone may somehow compensate for its function. The symptoms are many and can be vague such as chronic fatigue, sleep disturbance, decreased libido, depression, anxiety, poor concentration, lack of motivation or ambition, body ache or fibromyalgia, headache, immune compromise, exercise inefficiency, weight loss or gain, decreased or increased appetite, dry skin/hair/nails, etc. The best way to find out what hormonal imbalance you have is through blood tests. Other tests may not be as reliable. Full hormone panel is recommended for fast and definitive diagnosis. If your primary doctor or endocrinologist are unfamiliar with or reluctant to order the tests for you, try to find a local doctor knowledgeable in bio-identical hormone replacement. Search the Web for www.BioIdenticalHormoneSociety.com and ask for a referral. You should expect to see improvement in 6 to 12 weeks once on treatment.

Bio-identical hormone replacement

2007-10-31T14:33:00.000-07:00

Hormones are made to serve as messengers to cells so that the cells may function properly. Around age 20 many hormones reach their peak levels and gradually decline afterwards. Many people experience hormonal imbalance around age 35 especially around age 45. Some popular synthetic hormones may have severe long-term side-effects as studies have shown. In the last several years, bio-identical or natural hormones have gain traction in hormone therapy. Natural hormones have no or minimal side-effects if used appropriately. Synthetic hormones are usually dispensed from standard pharmacies. Natural hormones are usually made in compounding pharmacies. If you're on any hormone replacement therapy, make sure to ask your doctor you're using natural hormones. Sex hormones (testosterone, estrogen and progesterone), thyroid hormones (T3 and T4), insulin, cortisol, growth hormone, etc. are known to be beneficial when balanced.

The ideal primary doctor!

2007-10-30T23:27:00.000-07:00

The ideal primary doctor should be knowledgeable in medicine and health. S/he should feel comfortable gathering comprehensive medical history, doing a comprehensive physical examination, making a working diagnosis (if final diagnosis is not available), and managing the the issue at hand. The doctor should feel comfortable doing common office procedures when indicated. S/he should refer the patient promptly if the problem is not diagnosed after two attempts or out of the scope of practice. Your primary doctor should invite you to participate in decision making whenever possible. S/he should respect and honor your wishes when appropriate medically, morally and legally. Your doctor should accommodate the same day appointment and urgent care. S/he should speak with you directly for important medical consultations. Your doctor should inform you of your test results whether normal or not.

How to search for a doctor?

2007-10-30T22:26:00.000-07:00

First you should look for a primary doctor. Your primary doctor is responsible for your overall medical care and coordination of your care. For adults, your primary doctor should be a family physician or internist who practices primary care. For children, the primary doctor should be a pediatrician or family physician who does primary care. If you need care from other specialists, your primary doctor can refer you. Primary care should not be obtained from other specialists, however. Some urgent care facilities may also provide primary care if they choose to do so and are staffed with family physicians, internists or pediatricians. You can find a primary doctor through family members, friends, colleagues, neighbors, etc. Your last resort will be phonebooks, the Internet, other media, or a hospital referral operator.

When do I need a doctor?

2007-10-30T19:51:00.000-07:00

It sounds like a silly question, but it's not. When you're sick with something you can't take care of yourself, you need a doctor. When you're healthy, you need to see a doctor once a year in general to go over your health maintenance issues. Before you travel to high-altitude regions or foreign countries, you also need medical advice. When you're planning to become pregnant or when you're already pregnant, you need see a obstetrician, or a family physician with an obstetric practice. When you're about to have a baby, your baby will need a pediatrician or a family physician who takes care of babies. If you're a student, athlete, commercial driver or pilot, etc., you may be required to have a physical on a regular basis.

Do I need a doctor?

2007-10-30T19:27:00.000-07:00

I'm healthy. Do I need a doctor? You may ask yourself from time to time. Yes, of course. Even if you're a doctor yourself, you still need another doctor to take care of you sometimes. Different from ancient times, a modern doctor is responsible for not only diagnosis and treatment but also prevention. You may read the Internet and try to be your own doctor. You still need professional help since the medical information is very complicated with full of pitfalls. Besides, your doctor would have more independent judgment than yourself.