Dr Donna Robinson

STDs can affect people from all ethnicities, races and ages, but adolescents and young people are the most impacted. Estimates suggest that even though youth make up only 25t% of the sexually active population, nearly half of all STD cases occur in people aged 15 to 24.

It is important that people in this age group receive comprehensive preventative care to ensure that they are well educated on the transmission of these diseases, how to prevent them, testing and treatment. However, there are factors like stigma and lack of access to information or services that can prevent young adults from getting the help and information they need to make sure that they have good sexual health. Providers and services need to be open about talking about these subjects and initiating the conversation about having healthy sexual interactions. 

Getting tested for STDs and STIs are one of the most important tools for prevention and treatment. Early detection is a key aspect of being tested as many STDs have no early symptoms, yet they can cause major problems in the future such as infertility and early treatment. Getting treatment early on can help minimise those effects. 

Sexually transmitted diseases/infections can be spread through contact with any body fluids: blood, semen, saliva (only for herpes). They can also spread through contact with infected skin, like sores in the mouth. The exposure to infected skin and body fluids is increased when sexually active. Illicit drug use can also spread STIs, due to sharing needles. 

Unprotected sex, multiple sex partners and illicit drug use as well as poor awareness on sexual health increase the risk of STDs. However, STDs are treatable and curable. Being conscious of the 5 Ps and awareness on sexual health can prevent these diseases, leading to a happier and healthier life. 

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Medical Health Insurance Thailand

The medical care provided in Thailand has always been of exceptional quality. Thailand has high quality hospitals in every single province, public and private, especially in Bangkok. All of these hospitals and other medical clinics are easily accessible; most of them have 24 hour services, or are open for up to 10 or 12 hours and are in convenient locations all around Thailand. Some even provide special after hours services, home treatment services, and emergency hotlines. Simply calling into the hospital will allow one to book an appointment with ease. When one reaches the age of 60, they worry about health insurance and ensuring that they get the best healthcare possible. In other countries, it may be that healthcare is expensive or inaccessible. However, in Thailand the standard of healthcare and its price as well as accessibility is of great quality and convenience to the patient.

Depending on ones income and the standard of treatment required, one can choose their hospital according to their needs. However, the standard of medical care in local and regional government hospitals are of high quality, providing services at a high standard at an affordable price. Government hospitals like Chulalongkorn, Ramathibodi, and Siriraj can provide exceptional care and are some of the best hospitals in the world. For example Chulalongkorn Hospital has an evening clinic that opens at 16:30 hours which generally has significantly less waiting time and Siriraj also has introduced a new private hospital called Siriraj Piyamaharajkarun, which can fulfil every medical need.

Healthcare Thailand

Thailand is the leading country in SE Asia for JCI accredited hospitals with 66 of them and is fourth leading in the world. JCI (Joint Commission International) accreditation is only given to hospitals with performance, structures, and functions with high quality standards. Hence, JCI certified hospitals will provide the best medical care and protocol.
This allows all people: young and old to be able to receive the best quality of healthcare. The concerns that come with being over 60 is that one is at risk for many illnesses, and taking precautionary and preventative steps as well as treating illnesses so that the patient is living a healthy life is essential. The following aspects in the Thai medical system ensure that people over 60 are given the best possible medical care.

Availability of generic drugs

Availability of generic drugs

Generic drugs are widely available in Thailand. Generic drugs are duplicates of brand-name drugs that have exactly the same dosage, intended use, effects, side effects, risks, and strength as the original drug. Their pharmacological effects are exactly the same as their brand-name equivalents. They automatically inherit approvals as well as the original drug has already been approved for certain treatments or diseases, hence it is much cheaper to manufacture generic drugs and the cost is lower as well. When buying medication, it can be cheaper to opt for the generic drug option and can reduce the medical bill by a significant amount. Many pharmacies even ask if you would like to buy the generic drug or brand name, otherwise one can inquire as well as almost all pharmacies have both options.


Vacccinations Thaialnd

Many people come to Thailand for easier access to medicines and vaccinations and for their low-cost. Cost of vaccines in Thailand are generally much cheaper, such as a rabies shot in US could be around $200 but be as low as $11 here. We encourage people to take their vaccines in Thailand unless they can get them for free of charge in their home country. This can allow people over 60 to save a significant amount on their medical bill.

Laboratories in Thailand

The quality of laboratories and testing is excellent as well, with most of the labs being ISO certified, such as N health lab, whose testing passes every possible international quality standard. With almost every lab, medical test reports are emailed or sent to you electronically, but with government hospitals you may have to go retrieve it. This is beneficial as you can get your results quicker electronically, even if you are overseas or travelling.

Health insurance

Given that you can pay for many aspects of your own healthcare when in Thailand then insuring for high risk in patient is important so that you have the health cover when you need it.

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Measles vaccination

Welcome back to Bangkok and welcome to Thailand to new families and individuals! It’s an exciting time of year. Everyone is getting ready to return to school, to begin university, to get back into their normal work routine. It is an incredible time to meet new people and to reconnect with friends who may have travelled over the summer months or stayed in Bangkok. Socially, this is great. However, from a healthcare perspective, this can really be quite troublesome.
Not only are common colds and the flu likely to spread should one individual have them, we have a new problem on the rise around the world >> Measles.

According to Unicef, 98 countries reported an increase in measles cases in 2018. Measles is a highly contagious viral illness, that can prove life threatening. It’s airborne, spread through the tiny droplets exhaled from the nose and mouth when an infected person coughs or sneezes. With just one cough from an infected individual able to infect 9 in 10 people within two hours, you can begin to see how contagious measles really is. An individual can be contagious up to four days before the rash occurs up until around 3-4 days after the rash has been present.

With school children playing together or being in classrooms all day, it’s incredibly easy for airborne bugs to spread. So far, having just enough people vaccinated in a given country has kept it at bay but with more people travelling and in highly-crowded areas (i.e. schools, universities, airports), this may not last too long. And as we have seen, Measles is indeed on the rise again, particularly in countries such as the USA, France, NZ and here in Thailand.

Measles outbreak

Anyone who has not received two doses of the MMR vaccine is at risk. In children, the vaccination schedule is as simple as two injections of the combined MMR vaccine (Measles-Mumps-Rubella vaccine). The first dose is given at the age of 1 and the second dose between the ages of 4-6 years old. The MMR vaccine is available at the MedConsult Clinic for only 671B.

The latest vaccination available MMRV (MMR + Varicella) vaccine is also now available here at MedConsult. This provides lifetime immunity against Measles, Mumps, Rubella and Chickenpox (Varicella) with two doses provided at 1 year and between 4-6 years. If you are an adult who has not had the MMR vaccinations, the WHO recommends that you are vaccinated. Although, measles predominately affects young people aged between 20-40 years and often presents more severely in this age group. The vaccination schedules involve two injection schedule given 4 weeks apart from each other, and you can have these at any age.

It seems like you’re getting needles every other day as a kid, so many of us just assume we’re immune to most vaccine-preventable diseases. Because both doses are given before the age of 6, it can be quite difficult remembering whether you, or whether your child, actually had two doses.

Measles vaccination

In the shadow of the current outbreak, that’s got a few people wondering: what if I wasn’t vaccinated?
For people who don’t know their status or just want to make sure they’re protected, the simplest thing to do is just to get another dose of vaccine. If you’re immune from having had the vaccine or having had the disease, then your immunity stops any of those viruses from multiplying and you don’t have increased risk of fever or other things.

There is a laboratory test that can be done to determine if you have immunity or not. For MMR immunity, this involves three tests (to test immunity of Measles, Mumps and Rubella separately). The important thing is, don’t hesitate and get in contact today if you aren’t sure whether your MMR immunity, or your child’s MMR immunity, is up-to-date. Please feel free to email us ( [email protected] ), give us a call 02-018-7855, book an appointment and quote Expat
Life in Thailand ( or simply walk-in to MedConsult today and tell us Nick sent you, to make sure you’re all up-to-date on your vaccines or to get vaccinated.

Dr Donna Robinson (MBBS, MRCP, MRCGP, DRCOG, Dip Occ Medicine, Thai Medical Licence)

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Depression is often diagnosed as a prolonged episode of severe sadness often accompanied by disinterest and disengagement in activities which once provided enjoyment. Sadness itself is a common and healthy human emotion, most often experienced after disappointment, loss or personal stress. Negative emotions may return in bouts, but in most cases they diffuse overtime. Sometimes however, this sadness can manifest into something deeper and more entrenched. This can begin to affect your overall outlook, lifestyle and relationships, indicating the onset of depression. It is important to realise that depression is not uncommon and comes in many forms, each of which can be treated through introducing positive changes into your lifestyle as well as clinical means, if needed. Remember that these negative feelings will pass and there is a wide network of support and advice which you can tap into. One common cause of depression is hormone imbalances: Changes in the balance of hormones may trigger major depression in certain people, especially during menopause or during and after pregnancy. As a doctor, I can’t help but listen to my patients, learn from them and at times in my life feel the lows.


Why should you treat depression?

Depression can last months, and the reality is we have to get on with life and work, live and interact with others even when our moods are low, so treatment is important. Not only that, depression affects brain function. There are three parts of the brain that appear to play a role in major depression: the hippocampus, amygdala, and prefrontal cortex. The hippocampus is located near the centre of the brain. It stores memories and regulates the production of a hormone called cortisol. The body releases cortisol during times of physical and mental stress, including during times of depression. Problems can occur when excessive amounts of cortisol are sent to the brain due to a stressful event or a chemical imbalance in the body. In a healthy brain, brain cells (neurons) are produced throughout a person’s adult life in a part of the hippocampus called the dentate gyrus. In people with major depression, however, the long-term exposure to increased cortisol levels can slow the production of new neurons and cause the neurons in the hippocampus to shrink. This can lead to memory problems.

The prefrontal cortex is located in the very front of the brain. It is responsible for regulating emotions, making decisions, and forming memories. When the body produces an excess amount of cortisol, the prefrontal cortex also appears to shrink.The amygdala is the part of the brain that facilitates emotional responses, such as pleasure and fear. In people with major depression, the amygdala becomes enlarged and more active as a result of constant exposure to high levels of cortisol. An enlarged and hyperactive amygdala, along with abnormal activity in other parts of the brain, can result in disturbed sleep and activity patterns. It can also cause the body to release irregular amounts of hormones and other chemicals in the body, leading to further complications. Many researchers believe high cortisol levels play the biggest role in changing the physical structure and chemical activities of the brain, triggering the onset of major depression. Normally, cortisol levels are highest in the morning and decrease at night. In people with major depression, however, cortisol levels are always elevated, even at night.


Ways to cope with depression in your daily life 

Reaching out and staying connected is an important first step in the healing process to overcome depression. Dwelling on negative thoughts by yourself can make it difficult to maintain a healthy perspective, and you can often benefit from opening up to those close to you. However, the very nature of depression makes this especially difficult, as it’s common to want to withdraw and isolate yourself from others. If you feel as though you have nobody to turn to, remember that there are always opportunities to meet new people and make new connections. Continual engagement in activities which make you happy is another way of introducing positivity into your life. Getting outside of the house and involving yourself in societies or events which you used to enjoy can greatly uplift your mood, even if you don’t feel up to it beforehand. 

Daily exercise and maintaining a balanced diet are beneficial to your physical and mental health. ‘When you exercise, your body releases chemicals called endorphins. These endorphins interact with the receptors in your brain that reduce your perception of pain.’ Endorphins also trigger a positive feeling in the body, helping to alleviate depression. Exercising in a group or with a friend can help motivate you as well as encourage you to meet new people and step outside of your comfort zone. Diet plays an essential role in emotion and mood, thus if you do not consider yours carefully, your symptoms could be exacerbated. During depressive episodes, it is not uncommon to crave sugary snacks or comfort food rich in refined sugar and carbohydrates. Consequently, excess consumption of these foods often lead to
a crash in mood and energy. Instead, try to increase your intake of citrus fruits and leafy greens, which have a high vitamin B content, as a deficiency may be linked with depression.

When to seek professional help
After taking steps towards leading a more positive lifestyle, if you notice your depression worsening it may be time to seek professional help. It is always important to remember that depression can be treated and that here are several avenues of treatment which can be recommended to you. Most treatment plans involve several different methods and adopt a holistic approach to alleviating depression. Many types of antidepressants are available to you to treat depression. The most common are Selective Serotonin Reuptake Inhibitors (SSRIs). These are often the first drugs given to patients as they generally have fewer unwanted side effects. ‘An imbalance of serotonin may play a role in depression. These drugs fight depression symptoms by decreasing serotonin reuptake in your brain.’ However there is now a range of other medicines, so I tell patients if they experience any side effects, switch to another medicine. Cognitive Behavioural Therapy (CBT) aims to help you deal with overwhelming problems or emotions through speech therapy and changing the way you think and behave. Sessions are usually arranged weekly and they aim to look for practical ways to improve your state of mind on a daily basis. During the sessions you learn how to work with your therapist to understand what changes need to be made in your lifestyle in order to counter unhelpful thoughts and behaviours. There are some online CBT courses that some of my patients have found to be really useful and they can be free.

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How many times have you eaten something and thought ‘could I be allergic to that?’ It’s not surprising that this is a common worry of ours as allergies are indeed really quite common and considered to be on the rise. It’s not exactly known what might be causing the rise in allergies around the world – it may be that we are less exposed to germs as children or it could just be that, with better food packaging, we are more easily able to identify what might have caused us to feel unwell after eating something.

Nevertheless, eating foods that you are unknowingly allergic to can leave you feeling generally unwell, can affect your concentration and mood and, in some cases, can lead to more serious long-term consequences. It’s also really quite important from a medical perspective to distinguish whether you are allergic to something or whether you just have an intolerance to it. Knowing which one of these two health impacts will determine how you can best avoid any immediate symptoms and long-term consequences.

So what is an allergy?

An allergy is when our body has an inappropriate or exaggerated response to any particle (usually to a certain food or a certain air particle). Our body thinks that the ‘particle’ is something that definitely shouldn’t be inside us and as a result, rejects it. As your body rejects the ‘particle’, you may feel symptoms such as:

• Sneezing • Runny nose • Reddened, itchy, watery eyes • Wheezing and coughing • Difficulty breathing (in the case of an anaphylactic reaction) • Red, itchy rashes • Exacerbation of eczema or asthma symptoms

What’s the difference between an allergy and food intolerance?

The key difference is that with a food intolerance, your body is not actually rejecting the food/particle. Instead, your body does not know how to deal with the food once it’s inside your gut. Usually, when we eat food, our digestive system breaks food down into smaller pieces so that we can absorb nutrients. If you have a food intolerance, your digestive system might just not have the correct ‘tools’ (i.e. enzymes) to break this particular food down into smaller pieces and the undigested food leaves you feeling unwell. You may have symptoms of:

• Bloating • Migraines/headaches • Feeling under the weather • Stomachache • Irritable bowel So the symptoms of an allergic reaction and a food intolerance are really quite similar. The one difference is that being exposed to one tiny drop of something that you allergic to could immediately trigger all of the symptoms above. With a food intolerance, it’s usually the more of the food you eat, the more unwell you feel. Generally speaking, the symptoms of a food intolerance appear with slower onset after eating the food (i.e. about 1-4 hours after consumption).

How do you develop allergies?

You can either be born with allergies or you can develop allergies at any given point in your life. Allergies are more often first discovered in young children but it is not uncommon for adults to develop them and be ‘diagnosed’ with a certain allergy later in life. The reason that we allof-a-sudden can develop allergies during adulthood is not exactly known – it’s thought to be because our immune systems gradually begin to weaken. If you were previously allergic to something as a child or teenager and ‘outgrew’ this allergy, you are greater risk of developing an allergy again later in life.

Common allergies include:

• Pollen from grass and trees, also known as ‘hay fever’ • Dust mites • Animal dander/dandruff • Food – particularly nuts, dairy products, shellfish, and eggs • Insect bites and stings • Medication; e.g. Ibuprofen, aspirin, penicillin, and various antibiotics • Latex • Mould • Household chemicals such as detergents and hair dyes

How do you develop food intolerances?

Food intolerances are mostly explained by when our body lacks that certain ‘tool’ to break down food that we discussed earlier. Lactose intolerance is the perfect example of this – a person is lactose intolerant if they do not have lactase, the enzyme that breaks lactose down. However, sometimes, it can be caused by a condition called ‘Irritable Bowel Syndrome’, a chronic condition where our bowel just doesn’t ‘agree’ with certain foods.

So do I have an allergy or an intolerance?

If an exclusion diet does not alleviate your symptoms or if you receive a negative allergy screening test, you should consider consulting a doctor to exclude any more serious causes of regular stomach cramping/pain and stomach upset. Sometimes stress and other environmental factors can cause symptoms similar to a food allergy or food intolerance.

Do I have an allergy or intolerance?

I am experiencing symptoms such as abdominal bloating and pain, excess gas, diarrhoea/ constipation regularly.

I have symptoms within 1 hour of eating this food.

Food intolerance I roughly know what food might be causing my symptoms.

Food allergy I know what food might be causing my symptoms.

If you’re unsure, start by excluding the more common foods that people have intolerances to (i.e. gluten, lactose etc.) and observe how you feel.

Start by trying to exclude this food from your diet for at least 2 weeks. Re-introduce the food after 2 weeks and see if your symptoms come and go.

food Allergy Panel Screening (i.e.g all shellfish)

Specific IgE Food Allergy Test for i.e. prawns OR Skin Prick Test

Allergy testing

The allergy evaluation begins with a thorough history to look for possible triggers of the symptoms that you are experiencing or have experienced. In cases in which there is no clear trigger, allergy testing for multiple foods or allergens can be preformed. There are two main ways that you can have allergy testing done – the skin prick test or by one simple blood test. A skin prick test involves placing a small drop of a protein extract (the ‘allergen’) on the skin (usually the forearm) and a small prick is made in the skin through the drop.

The size of the swelling (the ‘wheal’) is measured after 10-15 minutes. Skin prick tests can be slightly uncomfortable (itchy) but are usually well tolerated, even by small children. Local itch and swelling normally subside within 1-2 hours. The skin prick test is considered to be more convenient and you can get the results in 20 minutes, but if a severe reaction to an allergen such as peanuts then blood testing is safer. The second option is allergy testing by one simple blood test. You can either select an allergy test for one specific food, for a group of similar foods (i.e. seafood) or opt for 20 common foods allergy (IgE) panel test or 20 common food and 20 common inhaled allergens panel test (IgE). This involves taking a small blood sample which is sent to a laboratory. Then you just need to wait for the result which you will receive by email shortly after. This is recommended for more serious allergies.

What can I do If I am allergic or intolerant to something?

Allergies and food intolerances can be quite an annoyance. Avoiding allergies and food intolerances, or the symptoms, can be achieved by various means. The simplest way is to avoid contact or exposure to the specific food as much as possible. However, this can be very difficult at times! When the actual allergen cannot be avoided, Dr Donna notes that the symptoms of allergies can also be mitigated through the use of anti-allergy medication, also known as antihistamines, which work by calming your body’s immune system’s response to the allergen and therefore lessen the symptoms they cause.

Two common antihistamine/ anti-allergy medications that are usually available over the counter are Zyrtec and Claritin (Loratidine). Both have similar effects and are considered relatively safe to use.

If you have any questions at all, please do not hesitate to contact Dr Donna or her staff at MedConsult Clinic who will always be pleased to help or provide advice.

Allergy test Typical cost (Baht)

Allergy Test for 1 Specific Food or Inhaled Allergen (i.e. for peanuts, for tuna, etc.)
900.00 – 1,800.00

Allergy Test for a Food Group Panel (i.e. for Seafood Panel: Tuna, Prawns, White Fish, etc.)
1,500.00 – 3,000.00

Allergy Test (IgE Test) for 20-panel Common Foods: Egg White, Egg Yolk, Milk, Wheat Flour, Rice, Sesame, Soya Bean, Peanuts, Hazelnuts, Beef, Pork, Chicken, Shellfish Mix, Fish Mix, Crab, Shrimp, Lobster, Blue Crab, Chocolate, Glutamate

Allergy Test (IgE) for 20-panel Common Foods and 20-panel Common Inhaled Allergens: Egg White, Egg Yolk, Milk, Wheat Flour, Rice, Sesame, Soya Bean, Peanuts, Hazelnuts, Beef, Pork, Chicken, Shellfish Mix, Fish Mix, Crab, Shrimp, Lobster, Blue Crab, Chocolate, Glutamate Tree Mix, Beefwood, Acacia, Oilpalm, Mixed Grasses, House Dust Mites Mix, Cockroach, Cat, Dog, Cage birds, Guinea pig, Mouse, Rabbit, Hamster, Mould Mix1, Mould Mix2, Candida 4,500.00

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Menopause”. A bittersweet word that symbolises the ending of an era. The monthly menstrual cycles that have caused our emotions to fluctuate, are finally coming to a slow and steady halt. For some women, menopause occurs naturally between the ages of 45-55, with changes in menstrual cycles and/or mood being noticed years before having the final period.

However, others may experience another type of menopause which is known as premature menopause. This is diagnosed when women begin to go through menopause in their early 40s. It is safe to say that menopause may trigger significant changes in both a woman’s physical and mental state. Some of these changes can be quite uncomfortable and cause disruption to a woman’s life.

In this article, we’ll explore what menopause is, what may happen during menopause and finally, the various treatment options to help manage the symptoms (and when you may want to consider these). If you are reading this article, and find that you are experiencing symptoms, it is important to understand that you are not alone in this experience – many women go through the similar struggles and hurdles of menopause to what you may be experiencing, and there are various ways to help manage these.

Most women face natural menopause usually between the ages of 45-55 years old. The most noticeable changes usually occur during the transition from perimenopause to menopause. For those who are wondering, perimenopause usually begins when a woman is in her 40s, but sometimes it can even begin in the 30s.

During perimenopause, the ovaries stop releasing eggs and levels of progesterone decline while oestrogen levels remain generally stable. For most women, this difference between hormone levels, otherwise known as oestrogen dominance, can cause serious discomfort and include symptoms such as;

• Breast swelling and tenderness
• Mood swings
• Lack of sleep
• Irritability
• Weight gain

During perimenopause, testosterone levels may also declineand some of the symptoms may be significant in some women. Although they may be more subtle than those of low progesterone, they include;

• Loss of sex drive

• Depression

• Decreased sexual response

• Lower energy levels

Once perimenopause reaches its final stages and you begin to transition into menopause, the oestrogen levels in your body significantly decrease by approximately 30%-60% (from your pre-menopausal oestrogen levels). Ultimately, this will cause substantial symptoms which often include;

• Hot flushes

• Night sweats

• Lower energy levels

• Mood swings

• Depression

• Headaches and confusion

The approach of and beginning of perimenopause and menopause can seem rather daunting.

However, it is important to know that mild symptoms can usually be managed by maintaining a healthy lifestyle, staying active and just generally keeping a positive mindset and knowing that there are options there to help you manage symptoms if you feel that these are hindering your daily life.


Although natural menopause is the most common form, some women experience what is called premature menopause. This occurs when women experience menopause in their early 30s or 40s. Not only does premature menopause occur earlier, but it also happens significantly faster than normal menopause.

Premature menopause can be caused by several conditions, including chronic stress, autoimmune disease and nutrition deficiency. Although some women may experience early menopause due to unknown reasons; for example, it is thought that an erratic, unhealthy lifestyle may be linked to premature menopause.

To see whether you are experiencing premature menopause, there are several hormone tests that can help you know exactly what is going on with your body, and whether you are experiencing premature menopause or ovarian failure.

The key test to establish whether you are experiencing menopause is called Follicle Stimulating Hormone (FSH) Blood Level Measurement. Essentially, a sample of blood is taken and if the results show high levels, it means your ovaries are not producing enough oestrogen. This indicates that your body is entering the stage of medicine. Below you will see how your FSH levels may be interpreted;

• Pre-Menopausal: 3-20 mlU/ml

• Perimenopause: Above 10-12 mlU/ml

• Menopause: 30-40 mlU/ml

Additionally, measuring oestrogen levels in the blood can also indicate whether you are experiencing menopause. If your oestrogen level falls below 25 pg/ml, this is usually considered in the menopausal range. Below is a guide that focuses on the oestrogen level that would be seen in each situation.

• Normal: 25-75 pg/ml

• Menopausal: 25 pg/ml or below, along with high FSH levels

• Menopausal experiencing symptoms: 50pg/ml or below It is important to note that there is not one test to ‘diagnose menopause’ – rather, the results of several hormone level tests (ie FSH, oestrogen, etc.) accompanied with the symptoms that you are experiencing can strongly indicate that you may be experiencing menopause.

Both premature menopause and natural menopause can severely affect a woman’s overall persona and mood. A naturally happy and energetic person can begin to feel depression and tidal waves of tears. Disturbed nights can begin to become a regular occurrence due to waking up hot and bothered.

Sleep deprivation can become a serious issue and can sometimes affect one’s day-to-day life as well as relationships with others. It is important to know that if you feel that perimenopause/menopause is interfering with your life, you are recommended to seek medical advice.

There are many treatment options which involve simple lifestyle changes (ie avoiding certain foods to reduce the occurrence of hot flushes, eating foods which contain phytoestrogens such as whole grains, soy and legumes), symptom management or hormone replacement therapy. Treatment options will be discussed further and in more detail in part 2 of this article.


Email: [email protected] Tel: 02 018 7855


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Diabetes Blood Type 2

Type 2 diabetes is growing to become a common disease amongst people who struggle to live a healthy, balanced lifestyle. It is a disease that causes your blood glucose (sugar) levels to be higher than normal, meaning your body is not using insulin properly. Insulin works to keep your blood glucose level normal and healthy, if it fails to do this, it is called insulin resistance. This essentially means that the pancreas cannot continue to produce extra insulin to keep the blood glucose levels healthy.


Type 2 diabetes can be caused through multiple reasons, however, the most important is simply, lifestyle. An unhealthy lifestyle can be detrimental to a person’s physical and mental wellbeing. From a lack of exercise to the problem of obesity, these issues can strengthen the chances of type 2 diabetes being a large component in someone’s everyday life. A lack of exercise is a substantial contributing factor towards the cause of type 2 diabetes.

A limited amount of physical activity in a person’s daily routine means that muscle cells lose their sensitivity to insulin, which controls blood glucose levels. So, not only does it increase the risks of type 2 diabetes, it’s also detrimental to the physical and mental health of someone. This can affect someone’s mental well being, which can eventually lead to a lack of motivation, happiness and confidence.

To combat the bad habit of having a limited amount of physical activity in your daily routine, there are a few easy solutions to make this doable, as well as preventing type 2 diabetes. Joining a gym or scheduling workouts in advance will ensure that you are receiving the right amount of physical activity to guarantee that your muscle cells stay receptive to insulin. Another way to stay active is to participate in sporting activities. This is a less strenuous, and perhaps more enjoyable way of keeping fit. Not only does it allow the body to receive its daily intake of exercise, but it can open doors to many social opportunities.

Blood Example

Although a lack of exercise is one of the leading causes of type 2 diabetes, an unhealthy diet is the fundamental cause of the disease. Unhealthy meal choices, for example, foods with high levels of carbohydrates, sugar and calories, which are missing the fundamental fibres, nutrients and minerals work to raise the chances of type 2 diabetes. In this day and age, unhealthy, high carbohydrate and calorie dense foods have become easily available as they are often inexpensive and quick to order. Although these foods hold a certain amount of convenience, and generally taste quite good, they are processed, artificial, and harmful to the body.

When these high carbohydrate and calorie dense foods are eaten, the digestive system breaks down the carbohydrates into sugar, which then enters the blood. This causes the pancreas to produce more insulin to keep up with the high levels of blood glucose levels. As mentioned before, over time the pancreas will be unable to continue to produce high levels of insulin. This consequently, will result in a higher chance of type 2 diabetes, which will develop over time. For people who wish to prevent type 2 diabetes, or who already have the disease and wish to reverse it, a solution includes the low-carb meal plan. Essentially, a daily routine that involves the intake of meals with low levels of carbohydrate will improve blood glucose levels in the short term.

The low-carb meal plan will also work to achieve weight loss in the long term, as well as reduce the risk of heart disease. Although the low-carb meal plan is beneficial and can help prevent and revert type 2 diabetes, it can also be harmful if initiated while treating your type 2 diabetes with insulin. Following the low-carb meal programme can

put you at risk of hypoglycaemia, which is essentially when blood glucose levels are too low. To ensure that this does not happen, please make it a necessity to consult your GP before beginning the low-carb meal plan. They will help you regarding the adjustments of your insulin intake, which will reduce the risks of low blood glucose levels. There are many low-carb meal plans that you can follow online, however, it is always useful to do your own research on foods with low carbohydrate levels. It’s important for your health to remain educated and aware of what your body is intaking. This will help to prevent the risks of type 2 diabetes, and overall improve your physical and mental health.

To become aware regarding how well you are controlling your diabetes, the HbA1c test is a very important blood test. The HbA1c essentially indicates blood glucose levels from the past two to three months. It measures the amount of glucose that is being carried by the red blood cells in the body and is the most common way that type 2 diabetes is diagnosed. To undergo this HbA1c test, a blood sample is taken from the patient’s arm, and is the used to produce a reading which will determine whether your blood glucose levels indicate pre diabetes or a diagnosis of diabetes. According to the World Health Organisation (WHO), the

following diagnostic guidelines for diabetes are:

  • HbA1c below 42 mmol/mol (6.0%): Non-diabetic
  • HbA1c between 42 and 47 mmol/mol (6.0-6.4%): Impaired glucose regulation (IGR) or Pre diabetes
  • HbA1c of 48 mmol/mol (6.5%) or over: Type 2 diabetes If your HbA1c test returns a reading of 6.0-6.4%, that  indicates pre diabetes. Your GP should advise certain  lifestyle changes that can help prevent the risk of type 2 diabetes.

Dr Donna Robinson is a UK qualified, trained and experienced doctor. She has been a resident of Thailand for over 25 years and is one of the few foreign doctors to hold a Thai Medical Licence.


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Alcohol grams per drink

As the new year rolls around, the idea of a “new year’s resolution” becomes more realistic than ever. Local gyms start to become more appealing and a green smoothie a day seems to sound better than a morning cup of caffeine. Old habits of eating takeout and watching TV until midnight with a beer handy start to sound like a distant memory.

A new year, a clean slate, a time to become the version of yourself you always wanted to be. The idea of “health is wealth” should begin to take precedence in you mind. It’s time to start the new year, and what better way to do this than to set yourself some goals which will work to improve your health both physically and mentally. Although new year’s resolutions may be perceived as daunting, this article will provide simple solutions and advice that will allow goals to become possible and give you a sense of achievement when the positive benefits begin to show.


Improving fitness levels, daily exercise, joining a gym … one of the world’s most popular new year’s resolutions. It is known that the benefits of having a healthy level of fitness can be life changing. Your overall mood will improve, your memory will become sharper and the levels of concentration you will be able to sustain throughout the day will be more than impressive. Furthermore, through the act of physical activity, blood pressure levels will drop and the risk of health conditions and diseases will decrease. Daily physical activity will also work to prevent the risks of heart problems, type 2 diabetes, and a range of other cardiovascular diseases that could harm the body. However, having the motivation to improve your fitness levels, as well as sustain these fitness levels can seem like the world’s greatest challenge. It requires time management, commitment and perseverance, but it is definitely possible.

A few ways to make the routine of regular exercise sound a little less strenuous could involve finding a workout buddy. This buddy could be your husband, wife, best friend, or anyone who shares the same goals as you do. Having someone by your side when working out will be more fun, less serious, and give you something to look forward to. The idea of teamwork and a team effort will provide moral support and hopefully motivate you further to continue to pursue your new year’s resolution of keeping fit. On the other hand, if you prefer to workout alone, joining a gym or scheduling workouts in advance may help you will time management and make

regular exercise a more possible component in your daily routine. Another way to stay active is to participate in sporting activities. Playing sport can be enjoyed by everyone, despite their athletic abilities.

Not only does it allow the body to receive its daily intake of exercise, but it can open doors to many social opportunities. From recreational participation, to extremely competitive tournaments, sport will allow you to meet new people, make lifelong friends, as well as keeping your body healthy and strong. This exercise can vary from a walk in the park to a quick session of your preferred sport with friends. It’s vital to maintain an active daily routine.

Quit smoking

Another resolution that has been tackled by many throughout the years. It’s a habit that everyone wishes to stop, but is one of the hardest to shake off. There are many remedies that are said to aid and encourage the act of quitting smoking, these vary from joining support groups and participating in hypnosis therapy, to taking matters into your own hands and finding a self-help book. Another recommendation to combat this new year’s resolution is to try prescription medication that is generally used to treat a nicotine addiction. One option in this direction is CHAMPIX Varenicline Tartrate. This works as a nicotinic receptor and stimulates nicotine receptors more weakly than nicotine itself does. Another alternative can be Bupropion. This also works to decrease the amount of smoking per individual by reducing cravings and other withdrawal effects that come with a more limited amount of smoking. These types of solutions can help to make your new year’s resolution of quitting smoking seem more achievable and not just a hopeful goal in the distant future. However, like any form of medicine, it should be taken with care a doctor should be consulted to provide any information or cautions prior.



As we all are aware, the month of December is a time of reflecting on the past year, planning ahead for the new year, and of course, parties. From Christmas brunches, to New Year’s Eve night, it is a easy to assume that alcohol will be involved. As you wake up on New Year’s Day with your head pounding and stomach churning, you mutter the words, “I’m never drinking again”, into your pillow.

There it is, another new year’s resolution that is taken on by many. This particular resolution can vary in degree from quitting drinking completely to only limiting yourself to a few drinks on weekends or special occasions. Some people may quit or limit their drinking because they simply feel it is not a necessity in their lives. Others may make this change because the idea of drinking themselves into oblivion doesn’t seem too appealing anymore.

Now, there’s no denying that a bit of alcohol here and there isn’t fun and a nice way to unwind. A chilled glass of wine at dinner, a beer and TV with some mates, what’s not to enjoy about that? These are fine, it’s just when you become dependant upon alcohol to unwind or have a good time out is when there is a problem. If you feel as though you might be heading in this direction, these simple steps can help you overcome your resolution during the new year. Below you will find what we like to call a “moderate drinking plan”. It involves nothing too crazy and will only work to benefit you overall.

A moderate drinking lan

• Set a realistic goal for your alcohol use. Decide ahead of time how much and how often you would like to drink.

• Start with a non-alcoholic drink to quench your thirst. When you’re at a social event make sure you have a non￾alcoholic drink to start. Thirst can make you drink more alcohol than you need. This also helps you become more mindful of your drinking.

• Don’t drink on an empty stomach. Make eating part of the experience. Hunger can also make you drink more alcohol than you need.

• Alternate alcoholic and non-alcoholic drinks. Don’t have all your alcoholic drinks at once, or you may be tempted to drink more than you planned. Instead have at least one glass of water before each alcoholic drink.

• Avoid heavy drinking situations. Some situations are associated with heavy drinking, and it may be difficult to stick to your plan. Learn to recognise and avoid heavy drinking situations.

If following someone else’s plan doesn’t work for you, there are other ways to achieve limiting your consumption of
alcohol. A fun and unique way to do this would be to create your own rehab. Not only is this personalised but you can change it to adapt to your daily routine and lifestyle. The idea of your own rehab simply involves being so physically busy that you can’t get a hold of alcohol or you are too distracted to even think about alcohol.

This could involve joining a sport team or gym, going on hikes, or even participating in daily classes that gives you an incentive. For some people, this form of a solution may not work due to a limited amount of time or just a disinterest in the idea. Another solution is looking to benzodiazepines. This can be seen as useful for people who have a problem with alcohol and limiting the amount they intake daily. Essentially, benzodiazepines help people deal with the withdrawal symptoms that people may face when attempting to limit or completely cut out their intake of alcohol.

It is important to find balance in your lifestyle, more importantly, a healthy balance. Time must be taken to enjoy all aspects of life, from travelling to indulging in delicious foods. Fitting in time to exercise and manage your fitness levels should not come as a burden. It is important to blend in the idea of a healthy lifestyle into your daily routine and remain educated when it comes to sustaining positive mindset throughout your journey. Hopefully, the new year can mean a positive change for many people that will be sustained long enough to enjoy the positive effects.

Happy New Year.

email: [email protected]

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