Epilepsy Care Group Singapore Awareness Association: Survey reveals new safety warnings on antiepileptics not received by pregnant women

Antiepileptic drugs and the potentially harmful effects on unborn children has hit the headlines as a survey reveals many women have not received the new safety warnings about the dangers of taking it during pregnancy.

In an exclusive story from the BBC, it has been revealed that out of the 475 women under 50 currently taking Epilim (sodium valproate) nearly 70% had not received the new warnings. These new warnings, known as the Valproate Toolkit, were launched in February 2016. Created by the European Medicines Agency (EMA) the aim of the toolkit was to improve patient information about the risks of neuro-developmental disorders in unborn children.

The data extracted from a survey of 2,000 women and girls, commissioned by three charities — Epilepsy Society, Epilepsy Action and Young Epilepsy — also demonstrated that one in six women taking the drug were not aware of the negative affects it may have on the development and/or physical health of an unborn child. In the UK alone about 20,000 children have been affected by antiepileptic medicines (valproate medicines) since the 70s.

A public hearing concerning sodium valproate will take place on 26 September at the EMA’s London offices in Canary Wharf. The survey results will be presented during this hearing, which is the first time the agency’s safety committee has held a public hearing as a part of a safety review of a medicine.

During this session, women will be able to recount their personal experiences of taking the medication to the agency’s safety committee. The hearing will be focus on three main areas: the risks of the medication in pregnancy, the current measures in place to reduce the risks of using valproate in pregnancy and the measures that should be taken to reduce the risks associated with the medication and its use in pregnancy.

The Medicines & Healthcare Products Regulatory Agency (MHRA) in the UK explained that valproate was constantly reviewed and warnings surrounding the medication were updated as and when new data were made available. “The results of the survey are important in helping us understand the effectiveness of the measures taken to date in the UK. We want to encourage all women to have access to the valproate toolkit materials that we made available in February 2016,” the agency said to the BBC. “We constantly monitor the safe use of valproate and support this latest review by the European Medicines Agency on the use in pregnancy and women of childbearing age.”


Dr. Howard Marans: Arthroscopic Surgeon at Your Service

Anyone who has had an injured knee, or any joint for that matter, realizes the importance of having normally-functioning skeletal system. Just the simple but often-taken-for-granted ability to walk without experiencing knee or ankle pains can be an elusive privilege for many who have severe orthopedic conditions that require surgery. Thanks to medical technological advancement, people who have these conditions can resort to arthroscopic surgery which Dr. Howard Marans routinely undertakes at his clinic.


Arthroscopic surgery simply involves the use of a tiny camera called an “arthroscope” to allow the surgeon to see inside a joint. Thus, the camera enables Dr. Marans to conduct accurate diagnosis of any orthopedic condition and provide the proper treatment of various joint problems. In contrast to open surgery, arthroscopic surgery is a minimally invasive process which is why it is much more preferable than open surgery.


Some of the advantages of arthroscopic surgery include the absence of large incisions, thereby allowing the patient to recover fast even without having to stay in a hospital after the operation. As such, bleeding and infection are also minimized with this kind of procedure. Recovery time is also shorter as a result of the minimal invasive nature of the procedure.


Arthroscopic surgery is used often in injuries involving such joints as the shoulders, knees, hip, wrist and spine, although it can be used for any joint of the body. Ligament tears and damaged cartilage on the knee can be repaired using this procedure. Dislocated or impinged shoulders, including rotator cuff tears can also be healed through this means.


This procedure is frequently used on larger joints to treat certain conditions. Dysplasia of the hips and other conditions, carpal tunnel syndrome of the wrist and herniated discs and other spine conditions are routine procedures done through arthroscopic surgery.


Sticks and stones may break our bones; but the handy camera — of course, in the presence of an experienced doctor such as Dr. Howard Marans – can undo whatever injury they may cause. Bones may not need a selfie; but a happy and healed patient deserves one after a successful surgery.

3 Treatment Options for Wrist and Hand Arthritis by Howard Marans MD

Arthritis Treatment Options

hand-surgery-caIn general terms, arthritis is an inflammation of the joints. The daily occurrence is not uncommon. In the United Sates, millions of people handle the daily symptoms of arthritis in a variety of ways. When arthritis affects hands and wrists, normal activities may become painful and difficult to perform. Depending on the degree of degenerations, numerous arthritis treatment options are available to help relieve the symptoms.


  1. Pain Management

When joints are inflamed or stiff due to arthritis, pain management may be the first focus in the various arthritis treatment options.


– Anti-inflammatory, pain-relieving drugs may be used either by a prescription or over the counter.

– Corticosteroid injections to help reduce and control inflammation which will allow for more flexibility within the joints. The steroid injections will be inserted into the wrist areas.

– Anti-rheumatic medication or analgesic to help reduce symptoms and modify the disease.

– Bracing and immobilization to help protect the wrist area by limiting movement. The limitation will help reduce the pain while performing daily activities.


  1. Exercise and Health

Exercising is another important factor in combating the effects of arthritis.


– Maintain a healthy weight. Even a few extra pounds can increase the pressure on any joints. Discuss the ideal weight with the primary health care professional.

– Physical therapy may be prescribed as part of the arthritis treatment options to help gain flexibility in the joints.

– Daily exercise to help restore or improve range of motion in the wrist area while strengthening the muscles in the arm.

– Get enough rest each night or consider taking a daily nap to help combat fatigue. The symptoms of arthritis may leave a person feeling extra tired. Without proper rest, the symptoms may increase creating more problems.


  1. Surgery

When non-surgical methods have been exhausted or the degree of degeneration is too severe, surgery is the next step in the treatment process. Surgical arthritis treatment options usually fall into one of three categories.


– The removal of the arthritic bone also known as a proximal row corpectomy. The procedure will help combat the painful symptoms of the disease.

– Fusing the arthritic bones together in order to make one solid bone. The procedure may be a partial fusion method which will still allow for minimal movement and reducing pain. If the degree of degeneration is extensive, a full fusion of the bones is utilized. The full fusion eliminates painful symptoms by removing all wrist motion.

– Complete joint replacement may be used as a treatment method. A prosthetic joint will help a person recover range of movement within the wrist.


Before considering any arthritis treatment options, an accurate diagnosis should be obtained from a leading orthopedic doctor. Dr. Howard Marans understands all the symptoms affecting an arthritis sufferer. With over twenty years of experience, Dr. Marans strives to get each patient back to normal, daily activities free from painful symptoms.


Treatment Options For Arthritis

Working with various insurance companies, including PPO, Dr. Marans, and his friendly staff will help each person receive the highest level of care. Striving for an optimal outcome with each patient without creating an overwhelming financial burden. Please click below to schedule your consultation or call us at 714.979.8981.

What Does Tennis Elbow Treatment Usually Cost by Howard Marans MD

Tennis Elbow Treatment Cost

Tennis elbow is a medical condition creating pain and soreness around the outer part of the elbow. Repetitive motion is generally the cause of the damage to the tendons which attach the forearm and elbow muscles. Tennis elbow treatment cost will vary with each individual. From the type of treatment to the degree of damage, numerous factors need to be considered.


Non-Surgical Approach

The biggest factor to consider when estimating tennis elbow treatment cost is the type and coverage amount of the primary health care provider. Health insurance coverage is different with each individual patient. Depending on the type of coverage, co-pays and deductibles, health insurance will lower the amount of out of pocket costs for both surgical and non-surgical treatment methods.


Under most circumstances, using non-surgical methods is less expensive with a faster recovery rate. The non-surgical treatment approach has a high success rate with a majority of tennis elbow sufferers.


– Rest of the injured area is the least expensive way to help combat the symptoms of tennis elbow. By reducing activities or participating in sports, the elbow will have a chance to heal.

– Applying ice packs to the elbow to help reduce swelling and pain may be done at minimal costs.

– Another form of low-end tennis elbow treatment cost is the use of pain relievers. Pain medication may be purchased over the counter or by a prescription to help reduce symptoms associated with tennis elbow.

– Brace or other support aids are a lower tennis elbow treatment cost. In some cases, the cost is under $25.

– Cortisone injections to help reduce swelling and elevate pain are an effective method to treating tennis elbow with the minimum cost involved.

– Physical therapy is one of the higher non-surgical treatment cost for tennis elbow. Each session may run an uninsured patient over a $100. When four or five weeks of sessions are ordered, this form of tennis elbow treatment cost can add up quickly. The benefits often outweigh the costs by helping a patient reduce the painful symptoms and help restore range of movement.


Surgical Approach

When non-surgical methods fail to yield the desired results, surgery may be the next step in the treatment process. Depending on the type of health insurance coverage, surgery the tennis elbow treatment cost may be in thousands of dollars. Arthroscopy and open surgery are usually the two methods used to fix issues associated with tennis elbow. With most patients, the surgery for tennis elbow involves one of the following:


– The removal of inflamed tissue away from the tendon

– Providing a release for the tendon through an incision

– Repairing the tear in the tendons


Treatment Cost Tennis Elbow

The surgical method used to correct the medical issue depends on the degree of injury. When arthroscopy is used, the total cost may be lower than with traditional open surgery. If the surgery option requires the use of an anesthesiologist, the tennis elbow treatment cost will increase and an overnight stay in the hospital may need to be factored into the final expense.


The best way to determine tennis elbow treatment cost is to begin with an accurate diagnosis. Dr. Howard Marans will give a patient a complete explanation of the all available treatments with desired expectations for each approach. Please click below to schedule your consultation or call us at 714.979.8981.

Kaiser health, wellness facility coming to Elk Grove – Richard Isaacs MD

On June 16, Kaiser Doctors and area leaders broke ground at what will eventually be the new Promenade Medical Office Building in south Elk Grove.

The two-story, 67,000- square-foot Kaiser Permanente facility will be designed to focus on matters affecting patients’ mind, body and soul.

It will feature a 50-meter outdoor sports track that will be part of a 4,000-square-foot Sports Medicine Center where athletes can be evaluated and rehabilitated.

In addition to the sports center, the medical office will also house adult medicine, pediatrics, women’s health, health education, radiology, laboratory and pharmacy services.

The building is scheduled to open in late 2011.

Elk Grove Mayor Sophia Scherman, Vice Mayor Steve Detrick, city council member Pat Hume, Dr. Richard Isaacs, M.D., and Dr. Lisa Liu, M.D., broke ground where the new facility will be built.

“Your presence in Elk Grove means more quality health and wellness for our residents,” Scherman said in a speech before they broke ground.

Dr. Isaacs and Dr. Liu also addressed the crowd.

Liu said the building will be “thoughtfully designed” with soothing colors, local artwork and a coffee bistro inside.

“We’re committed to making our facility a one-stop shop,” she said.

The new office will have a Healthy Living store where members can buy health and wellness equipment.

“We’ve been looking forward to this for quite some time,” Isaacs said. “Driving through the community, we’re aware of the economic impact in this area.”

Liu echoed that statement in her speech, saying, “I’m sure it won’t be long until this facility is surrounded by retail stores and restaurants.”

The building will be adjacent to the vacant Elk Grove Promenade Mall site where construction halted due to developer General Growth Properties undergoing bankruptcy.

When Scherman addressed the crowd, she discussed the unfinished mall behind her. “Although there is no set date, the mall will open,” Scherman said; “hopefully, within two years, it will be completed.”

Kaiser is thinking about the future, Isaacs said.

“We’re really hoping this will stimulate this part of the region,” he said.

In the past 10 years, Kaiser has added 30,000 new area patients. This new facility will be able to accommodate the health needs of current and future members.

Since 1999, Kaiser began phasing out the use of polyvinyl chloride (PVC) plastic in construction and implemented more environmentally friendly construction materials in their building designs.

The Promenade Medical Office Building will be built so that solar energy panels can be added in the future.