GINA Assessment of Asthma Control allows you to self assess your level of control based of these 4 SIMPLE QUESTIONS

In the past 4 weeks, have you had

  • Daytime asthma symptoms more than twice a week?
  • Any night waking due to asthma?
  • Reliever needed for symptoms more than twice a week?
  • Any activity limitation due to asthma?

If you say YES to 0 of these questions, your level of asthma control is WELL-CONTROLLED

If you say YES to 1-2 questions, your level of asthma control is PARTLY-CONTROLLED

If you say YES to 3-4 questions, your level of asthma control is UNCONTROLLED

Download TELEME mobile to chat with a nurse practitioner to learn how to use your inhaler



Breasts contain tissues of varying consistency due to fatty, glandular and connective tissue. You may feel some lumpiness during changes in your menstrual cycle caused by extra fluid in your breasts. Breast tissue also changes with age, becoming fattier and less dense as you get older. A breast lump is a mass that develops in the breast which may be discovered during self-examination (read our article on Breast Self-Examination Technique).

Causes of breast lumps:

  • Fibroadenoma
  • Fibrocystic disease
  • Breast cysts
  • Milk cyst (galactocele)
  • Mastitis (common during breast feeding)
  • Lipoma
  • Breast cancer

How are breast lumps assessed by the doctors?

Most patients should have a TRIPLE ASSESSMENT which consists of:

  1. Clinical assessment by the doctor
  2. Imaging (ultrasound and/or mammography)
  3. Pathology (cytology and/or histology)

How are breast lumps diagnosed?

Most breast lumps are benign and not cancerous. Proving that a lump is either cancer or not cancer requires some (or all) of the following imaging tests:


  1. Mammogram: Mammography uses low dose x-rays to examine the breasts taking either two single images or two tomosynthesis images known as 3-D mammography (read our article on Breast Mammogram – What to Expect). 
  2. Ultrasound: Breast ultrasound uses sound waves to create pictures of the inside of the breasts which may be difficult to see with mammongraphy. It can also help to determine whether a breast lump is solid or fluid. 
  3. Ultrasound-guided or Stereotactic (X-ray guided) biopsy: For this procedure, a thin sampling needle is used to remove some tissue from the breast lump for evaluation under a microscope by a Medical Pathologist to give a definite diagnosis by looking for cancer cells.

Download Teleme’s mobile app and ask any health questions



Primary liver cancer is cancer that starts in the liver and is either Hepatocellular Carcinoma or Intraductal Cholangio Carcinoma.


Risk factors

Most liver cancers occur around the age of 60-85 years. It is common in Asians especially Chinese males. Other risk factors include:

  • Previous infection from Hepatitis B or Hepatitis C
  • Excessive alcohol consumption
  • Severe fatty liver disease
  • Liver scarring (cirrhosis)
  • Iron overload disease such as haemaochromatosis or alpha 1 antitrypsin deficiency
  • Being overweight or obese
  • Family history


Most symptoms come late when the cancer has progressed. These symptoms include:

  • Unexplained weight loss
  • Yellowing of the skin or white of the eyes (called jaundice)
  • Loss of appetite or energy (easily tired)
  • Itching of the whole body
  • Pain or discomfort of the right side of your abdomen
  • Pain or discomfort on the right side of your shoulder
  • Swollen tummy (ascites)


You will need to do some tests to be able to get the diagnosis of cancer type, to stage the cancer (to see if there is cancer spread outside the liver) and to plan for treatment:

  • Blood tests (blood count, liver function, Hepatitis virus serology, cancer markers)
  • Ultrasound liver (and maybe liver biopsy)
  • MRI / CT scan
  • PET scan

Treatment Options

The treatment depends on many factors such as type and stage of cancer, where the cancer is located, the severity of the disease and how much normal liver function is present. The options include:

  • Surgery (liver resection)
  • Local ablation therapy (Radio Frequency Ablation, Micro Wave Ablation, Cryotherapy or HIFU)
  • Locoregional Chemo / Radio Therapy (Trans Arterial Chemo Embolisation or SIRT)
  • Systemic Chemotherapy
  • Systemic Targeted Cancer Drugs such as Sorafenib (Nexavar) or Lenvatinib (Lenvima)


If you have risk factors mentioned above, you should take steps to live a healthier lifestyle.

  • Avoid excessive alcohol intake
  • Take Hepatitis B vaccination
  • Eat healthy and do regular exercise to get into your ideal weight range
  • If you’re are a Hepatitis B or C carrier, do blood tests and liver ultrasound regularly (twice yearly)
Download Teleme’s mobile app and ask any health questions



What are tantrums?

Tantrums represents a child’s way of communication being upset in the absence of matured language or expressive skills. They can involve sudden bursts of anger, frustration and disorganised behaviour. The child may demonstrate cats of crying, screaming, kicking, falling down, flailing about or running around. Sometimes, they may hold their breath, vomit, break things or get aggressive. It is also a learned behaviour.

Click below to watch a video on how to deal with tantrums

Why do tantrums happen?

Tantrums are very common in children aged between 1-3 years because at this age, the child’s social and emotional skills are only just starting to develop at this age. Children have not learnt enough words to express their emotions yet.

There are some factors which may make a child more likely to throw a tantrum:

  • Stress, hunger, tiredness or being overstimulated. In these situations, a child is more likely to throw a tantrum
  • Situations that children just can’t cope with. A child may not be able to do a puzzle or had a toy taken by another child
  • Each child has different ways of reacting to being upset or frustrated

How to reduce the chance of tantrums

Here are some things you can do to make tantrums less likely to happen:

  • Reduce stress or tiredness. Let your child sleep when he/she is tired.
  • Tune in to your child’s feelings. Help your child manage his/her feelings in a calm manner
  • Identify tantrum triggers so that you can prepare ahead. If your child throw tantrums when you do grocery shopping, it might help to go after your child has had a nap and a snack.
  • Talk about emotions with your child. For example, ‘Did you throw your puzzle because you were upset you could not fix it? What else could you have done?’

How to handle tantrums

Sometimes tantrums will happen, no matter what you do to avoid them. Here are some tips to handle tantrums:

  • Stay calm and do not get angry because it will make the situation worse. Keep your voice calm and avoid showing your emotions of frustration or anger
  • Acknowledge your child’s feelings to prevent the behaviour getting more out of control. It also gives your child a chance to calm down
  • Wait out the tantrum but stay close to your child so that he/she knows you are around
  • Try not to give in to what your child wants but instead reason with him/her
  • Do not give rewards to manage the tantrum as it will send a wrong message to the child
  • Be consistent and calm in your approach

Click below to watch a video on 5 tips to handle your child’s tantrums

Download Teleme’s mobile app and consult Ms Katyana, Psychologist
Ms Katyana

Ms Katyana




When you suspect that your child may have some behavioural issues, you need to know what symptoms to look out for.

Autism Spectrum Disorder (ASD) is characterised by ‘persistent deficits in social communication and social interaction across multiple contexts, including deficits in social reciprocity, nonverbal communicative behaviours used for social interaction and skills in developing, maintaining and understanding relationships’.

More than half the children would have the diagnosis by the age of 6 years and over 90% diagnosed by the age of 12 years.  Boys are affected more often than girls.


Definition (DSM-V Criteria)

  • Persistent deficits in social communication and social interaction across multiple contexts
  • Restricted, repetitive patterns of behaviour, interests or activities
  • Symptoms must be present in the early developmental period but may not become fully manifest until social demands exceed limited capabilities or may be masked by learned strategies in later life
  • Symptoms can cause clinically significant impairment
  • Disturbances are not better explained by intellectual disability and Global Developmental Delay (GDD)

What are these repetitive patterns of behaviour?

  • Stereotypes or repetitive motor movements, use of objects or speech
  • Insistence on sameness, inflexible adherence to routines or ritualised patterns of either verbal or non-verbal behaviour
  • Highly restricted, fixated interests that are abnormal in intensity or focus
  • Hyperactivity to sensory input or unusual interest in sensory aspects on environment

Click below to watch a video on 10 early signs which may suggest ASD

There are 3 levels of severity in ASD

Level 1: Requires support

  • Without support in place, deficits in social communication cause noticeable impairments
  • Difficulty initiating social interactions and clear examples of atypical or unsuccessful responses to social overtures of others
  • May appear to have decreased interest in social interactions
  • Inflexibility of behaviour causes interference with function
  • Difficulty switching between activities
  • Problems of organisation and planning hamper independence

Level 2: Requires substantial support

  • Marked deficits in verbal and nonverbal social communication skills even with support
  • Limited initiation of social interactions (reduced responses to social overtures from others)
  • Inflexibility of behaviour, difficulty coping with change or other repetitive behaviours appear frequently enough t be obvious to the casual observer
  • Difficulty changing focus or action

Level 3: Requires very substantial support

  • Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning resulting in limited initiation of social interactions
  • Minimal response to social overtures from others
  • Inflexibility of behaviour, extreme difficulty coping with change or other repetitive behaviours markedly interfere with functioning in all spheres
  • Great distress when changing focus or action

Take your child to a child psychologist or therapist for assessment if you have any concerns.

Download Teleme’s mobile app and consult Ms Katyana, Psychologist.

Ms Katyana

Ms Katyana