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Ghost writing – Manly Daily


Heather Wiseman was commissioned to ghost write a weekly health column, published in the Manly Daily, on behalf of Dr Harry Nespolon, a GP who chairs Sydney North Shore and Beaches Medicare Local. In keeping with the Medicare Local’s core objective, the columns aimed to help local people stay healthy and out of hospital.

Heather interviewed Dr Nespolon for the articles, writing up his stories and clinical insights for a lay readership. Occasionally, Heather interviewed other health professionals on the Medicare Local’s board and ghost wrote columns on their behalf.

Each article achieved a reader-rating on a scale from one to five.

 

Child’s feverish fit gives mum a scare

28 March 2015
Article Rank: FIVE OUT OF FIVE “Excellent article”
HOLLY was surrounded by adoring grandparents, aunts and uncles at her first birthday but the party girl herself was miserable.
She had a runny nose, kept clinging to her mother, Suzie, and was teary.
Suzie commented Holly seemed hot.
She did the right thing, stripping Holly out of her hot party dress and giving her paracetamol.
A week later Holly still had the sniffles and a slight temperature but she had no sign of a rash and her illness didn’t seem unusual.
Then, without warning, Holly’s body stiffened and started to jerk. Her face went bright red and she seemed to be holding her breath. Holly was having a fit.
Suzie called the ambulance but, by the time she was connected, Holly’s body had relaxed and she was breathing again.
When the ambos arrived, Holly seemed perfectly fine, but Suzie was distraught.
Ambulance staff reassured Suzie that Holly was OK, but the mum decided to take Holly to hospital to make absolutely sure.
After a two-hour wait, Suzie was told Holly had just experienced a febrile convulsion and was fine to go home. Hospital staff suggested that she visit her GP.
Suzie burst into tears as she was recounting her story at my surgery.
She said Holly was convulsing for about 15 seconds, but it felt like an eternity.
I explained that febrile convulsions were fairly common in children under two.
One in 30 in this age group experiences them and the vast majority don’t have any underlying problem.
Some children under two will have a fit when their temperature reaches 38.5 degrees, but most children can experience higher temperatures without fitting.
Generally, it is a minor problem that many babies experience but if the seizure goes on for a long time, the child looks sick after the convulsion or their fever persists, they need to get to hospital.
Any child older than two who has a prolonged convulsion should also be taken to hospital. If any child is still fitting after three minutes, call an ambulance.
We don’t know exactly why febrile convulsions occur. They are different from an epileptic seizure, but with both conditions you take the same approach to keep the fitting child safe.
Put the child on their side and don’t try to stop the fit by restraining them.
Don’t try to stick your finger or anything else into their mouth because they are not going to swallow their tongue.
For further information see: www.rch.org.au/kids info/fact_sheets/Febrile_ convulsions_frequently asked_questions/

 

Smash cake and vaccinate

21 March 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
Ghost written on behalf of Dr Penny Adams
MY GORGEOUS granddaughter Lucy is now 14 months old. Through my daughter, I’m becoming quite clued-up on the latest talk in mothers’ groups.
The old conversation about when to introduce solids has ramped up a bit. Now the hot topic is whether to have a cake smash for your one-year-old (you basically let the child loose with their first-birthday cake and take as many cute, messy photographs as possible).
There’s another new concept doing the rounds with new mums and dads too, and while it’s not as much fun, it’s definitely more important. It’s whether or not to have their child vaccinated with the meningococcal B vaccine, which became available in March last year.
There are 13 types of meningococcal disease, but in Australia, the greatest risk is from types B and C. About 10 years ago the meningococcal C vaccine was added to the government-paid vaccination program for all infants at one year of age and this has had a big impact. Of the 143 cases of meningococcal disease reported in Australia in 2013, only eight were type C.
The biggest issue now is type B. While it is relatively rare – there were 104 cases in 2013 – its effects can be catastrophic, causing death, brain damage, loss of limbs and loss of hearing.
While you can catch the disease at any age, the peak incidences occur in children aged 0-5 and teenagers aged 15-19. The vaccine for type B is effective but it’s expensive and it’s not paid for by the government. For details on the signs and symptoms of meningitis and more information on vaccinations visit meningitis.com.au. For general childhood immunisation information, visit immunisation.health .nsw.gov.au
You can vaccinate at any age. If you start before six months you need three shots and they can be given in combination with the two-, four- and six-month vaccinations. If you wait until after six months, you only need two shots. Either way, you also need a booster, between age of one and two.
Each vaccination costs $150, so three shots and booster can set families back about $600. You may be able to claim some from your private health fund.
Quite a few mums who visit my surgery were interested to see what my daughter and I would decide, in terms of vaccinating Lucy, before they committed to giving their babies the vaccine. If Lucy had been in day care, I would have been keen to vaccinate her before she turned six months. But because she wasn’t, I thought it reasonable to wait until she was older than six months. That way she only needed two vaccination jabs, rather than three, plus the booster.
Fever is a common side effect from the vaccine, so I made sure Lucy had paracetamol before she had the vaccination, and then a second dose four hours later.
I advise all parents to vaccinate their babies and it’s important for 15-19-yearolds as well, particularly if they go to boarding school or on school camps.
I’ve heard of people paying hundreds of dollars for a professional cake-smash photo shoot, so they have gorgeous, fun photos that will inspire smiles for many years to come.
The photos I have of Lucy’s cake smash are the cutest I’ve ever seen and I’m planning to put them up in the surgery.

 

Positive approach vital in senior years

14 March 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
Ghost written on behalf of Dr Stephen Ginsborg
TODAY is the start of NSW Seniors Week – the perfect time to remind our elders that having their senses in tiptop condition will help them get the best out of life.
Achieving this is much easier than you think.
If you have had a chronic health condition for more than six months, your GP can draw up a management plan as you may be eligible for Medicare-funded sessions from allied health services. Depending on your needs, these might be with an interesting mix of health professionals.
Hearing is one sense that we tend to neglect. It’s a natural part of ageing and can creep up on you. If you’re older than 60, treat yourself to an annual trip to the GP to have your ears checked for wax. It is so easy to have it removed and it can open up a whole new world. Once you’re wax-free, see an audiologist to have your hearing checked.
Pensioner concession card holders are eligible for free hearing services through the Department of Health’s hearing services program (1800 500 726).
Each year, see an optometrist to have your eyes checked. I’ve heard many seniors say they can’t afford to have their eyes tested, but visits to your optometrist once a year for people aged 65 and over are bulk billed.
They are crucial for early detection of degenerative eye diseases such as macular degeneration and glaucoma. Aside from reading and being able to drive safely, improving your vision also helps to reduce your falls risk.
Keep in mind that if you get up from a chair and you fall back into it, this can be a warning sign leading to a real fall. It’s a good idea to see an occupational therapist or physiotherapist so they can advise on your falls risk, check out any aches and pains and advise on an exercise program.
Exercise is key to achieving healthy bones because the impact of any fall is significantly worse if you have osteoporosis. Ask your GP for their view on your osteoporosis risk and whether you need tests.
Staying mobile is vital to remaining independent. If your feet are causing you grief or if you’re experiencing difficulty walking, talk to your GP about the need to see a podiatrist, particularly if you have diabetes.
With age we can lose our sense of taste and interest in food, especially if people are cooking for one. A dietitian will have a range of ideas to help you achieve your ideal weight or manage diabetes. Ask your GP for a referral.
Seniors inevitably fare better when there’s a mix of health professionals as part of their care. Work with your GP to figure out which experts can meet your individual needs.
With a bit of teamwork from health experts, you’ll be in prime condition to get the best out of life.

 

It always pays off to read the fine print

7 March 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
GEORGE, 48, is one of my most thorough and organised patients. He enjoys getting deep into the detail of almost everything.
When he arrives at my surgery, he inevitably has a typed list of issues he would like to discuss. He very sensibly always brings an up-to-date list of any prescription medications he is taking.
For some time, George and I had been working on reducing his cholesterol. Given his strong family history of heart disease, we decided it was time to start on a cholesterol lowering medication.
Two weeks later, George was back in the surgery with the consumer medicines information sheet in his hands. It was covered in yellow highlighter.
Consumer medicines information sheets should be folded up inside your medication box. They can be a great source of useful information for patients. Unfortunately, many of my patients throw their consumer medicines information away without a second thought. George, of course, had read his very carefully and prepared a series of questions.
He’d noticed reference to a placebo group and understood that this was a “control” group of people who had been given sugar tablets, rather than the real medication, when the medication’s effectiveness and side-effects were being tested. The incidence of headaches was slightly higher in the placebo group, than the group of people on the drug, so he wondered whether the drug might reduce headaches as well as reducing cholesterol.
His wife, who’d had headaches for many years, was keen to give them a try.
I explained to George that the results highlighted that his new prescription medication didn’t give people headaches, which is quite different to curing them. His wife wouldn’t benefit from taking the medication and it would be unwise for her to ever take someone else’s prescription medication.
George also wanted to know more about the incidence of muscular aches and pains which were listed in the side effects. He’d been hit on the thigh by a cricket ball at the weekend and three days later he was still finding the bruised area painful.
George was starting to wonder whether his new medication was making some of the injury worse.
I was able to reassure George that the muscular pain caused by an injury was different to the muscular aches and pains experienced by some patients who take the cholesterol-lowering drug.
To search a drug’s consumer medicines information visit: www.tga.gov. au/consumer-medicinesinformation-cmi

 

Put safety first when planning a trip away

28 February 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
JOHN, 40, had never been one to splash out when he travelled.
He’d always felt most comfortable staying in youth hostels and flying cattle class, even though he had a well-paying job.
Having recently married Phuong, 38, who had two children, John and his new family were planning a trip to Vietnam so he could meet his wife’s relatives.
The family planned to spend four weeks away.
I explained to John that he and his family would need quite a few immunisations to prevent them from diseases such including hepatitis A and B, tetanus, pertussis (whooping cough) and diphtheria, and measles, mumps and rubella.
Because Phuong’s family lived in a farming area, we also discussed vaccinating for Japanese encephalitis, rabies and the need for malaria prevention.
Phuong asked whether the family’s injections were going to be expensive.
She volunteered that although she had been living in Australia for 20 years, the concept of travelling back to where she was born made her feel safe and she didn’t feel she needed any vaccinations at all.
While deciding whether or not to be vaccinated before you head overseas is a personal decision, there are some countries where you must have a Yellow Fever immunisation, so check with your GP.
As it turned out John and Phuong decided against travel immunisations.
They also decided against buying travel insurance, which was another mistake.
When I next saw Phuong, she said the main saving grace from their holiday was that the children had a great time and both stayed safe and well.
Unfortunately, she contracted hepatitis A from eating local street food.
She’d become so sick that the family decided to cut their trip short and paid to bring their flights forward.
Then, a few days before leaving, John was involved in a motor bike accident.
He had to have plates and screws put into his ankle so he could get home, which required an unexpected and horrendously expensive stay in hospital.
You often hear the old mantra that if you can’t afford travel insurance, you can’t afford to travel.
While it might seem harsh, there’s a lot of truth in it.
For further information on travelling safely visit: smartraveller.gov.au or check with your GP, making sure you don’t leave it too late before you travel for your vaccines to be effective during your trip.

 

Common thyroid problem

21 February 2015
Article Rank: FIVE OUT OF FIVE “Excellent article”
ROSE, 60, came to see me in a bit of a huff. She was annoyed because her daughter, Sarah, had insisted that she come, even though Rose was convinced she was fine.
Sarah had noticed that Rose had been putting on weight, but Rose said it was probably just fluid retention because she wasn’t eating any more than usual. Sarah had also noticed that her mother was sleeping more, and seemed irritable. She kept telling Rose she wasn’t herself.
Rose looked surprised when I asked about her hair and skin. She said her hair had become dry and brittle and she was worried it was thinning. She’d also just recently decided to try a new moisturiser because her skin was so dry. She couldn’t figure out why her usual brand wasn’t working.
We decided to do a simple blood test, which confirmed my suspicions – Rose was having trouble with her thyroid, which is not uncommon. An ultrasound confirmed her thyroid looked perfectly normal, so the problem wasn’t being caused by a tumour.
Your thyroid sits at the front of your neck, just below your Adam’s apple. It is a small gland that can cause trouble if it is not functioning properly.
Thyroid hormones regulate metabolism, so they have a significant impact on weight and energy levels.
Patients with an overactive thyroid, producing too much hormone, have hyperthyroidism. Their heart rate speeds up, they tend to sweat more and their metabolic rate picks up, which means they typically lose weight. They often feel anxious and have trouble sleeping.
The other extreme – hypothyroidism – is more common. That occurs when an underactive thyroid produces too little hormone, typically causing fatigue and weight gain. Symptoms can also include dry skin, hair loss, constipation and depression. Hypothyroidism is more common in women than men.
As you’ve probably figured out by now, Rose had hypothyroidism, which can be treated very easily with medication. Taken at the correct dose, it has no side effects. Rose will need to take it for the rest of her life.
I explained to Rose that there is a really tiny gland in our brain called the pituitary gland, and asked her to imagine the pituitary sending little keys from your brain down to the thyroid. The keys plug into your thyroid and turn hormone production up according to what your body needs.
When you have hypothyroidism, antibodies attack your thyroid gland, clogging up the ‘key holes’. The pituitary gland sends increasing signals that there is not enough of a hormone called thyroxine, but the thyroid remains blissfully unaware.
Thyroid hormone medicine overcomes the problem by saving the thyroid from having to produce any hormones at all. It works so effectively that patients usually notice a change in their symptoms.
Hyperthyroidism can be a more difficult problem to fix, but some patients are lucky and respond to medication that suppresses the hormone the thyroid produces.
With the thyroxine medication Rose soon felt back to happy busy self.
See your GP if you or someone else notices symptoms.

 

Preparation is important

14 February 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
AS is always the case at this time of year, I’ve seen quite a few couples who are hoping to have babies in 2015.
Tahnee, 30, was keen to chat about what she needed to do to prepare. She’d heard about folate and knew she might need some vaccinations, but she was keen to learn the detail so she felt confident and as ready as possible to become pregnant.
Although Tahnee had been vaccinated against chickenpox as a child, and rubella (German measles) when she was 15, there was no guarantee that those shots were still protecting her.
I explained that she’d need a blood test to check whether or not booster shots were required.
Tahnee said she’d never heard of anyone getting rubella so the need for vaccination seemed odd.
But if a pregnant woman gets rubella, especially early in her pregnancy, there is about a 50 per cent chance the child will develop significant side effects, including eye problems or deafness.
There are similar issues for babies whose mothers contract chickenpox, so it’s important to be protected before conceiving so you reduce the risk.
The other thing Tahnee needed was 5mg of folate each day for at least three months in the lead up to falling pregnant to reduce the risk of her baby being born with spina bifida. Folate, also called folic acid, occurs naturally in foods like spinach, bananas and legumes. of how much Tahnee consumes through food, she can take a commercial vitamin preparation to make sure she is getting enough.
Tahnee was an ideal weight for her height. Being overweight can make it more difficult to conceive, particularly as you get older.
If you’re thinking of taking up private health insurance before you have your baby, make sure you’re clear on the waiting time and exclusion periods and factor them in planning.
If you decide to go through the public system, you have the option of seeing an appropriately trained GP who works alongside the hospital doctors and midwives.
This program is called the Shared Antenatal Care program, and it’s open to women assessed as being medically suitable and who plan to deliver at Royal North Shore Hospital or Manly Hospital.
If your GP offers shared care, it’s a great way of making sure you have a familiar face by your side.
For further information download the NSW Health booklet, “Having a Baby”, from: www.health.nsw. gov.au/kids/pages/havinga-baby

 

Hard facts will move you

7 February 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
THERE’S a lot of truth to the saying that if you don’t move it you’ll lose it — and the fact is we generally don’t move enough anymore.
Gone are the days when we would get up to change the channel or get out of the car to open the garage door.
Now, we sit down and poke at a remote control. We can throw the washing into a drier, rather than pegging it out, we tend to park close to where we shop to avoid having to walk.
Some of us even hire dog walkers.
Many have reached a stage where the amount of incidental movement we achieve each day is really very small.
I was reminded a while ago that this problem isn’t limited to people who work in offices. One of my patients, Bob, 44, is a carpenter and, like many of my patients, he is finding it difficult to lose weight.
He was impressed by the number of personal fitness tracking devices he saw in catalogues over Christmas and asked me whether they were a fad, or they helped.
I showed Bob the fitness device that I wear around my wrist to remind me how little I move each day unless I make a concerted effort.
I told him that even when I work a 10-hour day, I usually only walk 7000 steps, which is well short of the 12,000 steps I would need to walk in order to lose weight.
Most people need to dedicate time to exercise, even if it’s just to waking, in order to decrease their cardiovascular risk factors.
Bob argued that as a carpenter, he had a physical job and so he knew he was getting heaps of exercise. But it wasn’t that simple.
He tended to sit in his car supervising his apprentices and calling them on his mobile when he needed to talk.
I said it didn’t matter whether he bought a $20 pedometer or a $250 personal fitness device, it would be interesting to get a realistic idea of how much he was moving and if it was enough.
On his next visit, Bob said he was shocked by just how little he moved each day. On a really good day he was doing only 9000 steps, which would explain why he wasn’t losing weight.
Bob adopted one of my favourite mantras, which is “if you don’t measure it, you can’t manage it”.
Now that he could count his footsteps, and realised that he had to walk 10,000-12,000 steps a day just to maintain his weight, he was making a special effort.
He stopped calling his apprentices on the phone and started getting out of the cab. He now takes the dog for a walk each day. He also makes a point of avoiding lifts and escalators, and climbs the stairs instead.
Lots of good studies show that exercise decreases cardiovascular risk factors, so ultimately being fit is more important in terms of your wellbeing than being slim.
When you’re fit, you also feel better, so you might even enjoy life more.

 

So many ways to ease the pain

24 January 2015
Article Rank: FOUR OUT OF FIVE “Very interesting article”
Ghost written on behalf of Errol Lim (physiotherapist)
MAUREEN, 60, was finding it more difficult than ever to help out with the caring of her grandson, Charlie.
Lifting Charlie into his pram, walking up and down stairs, and squatting down to play or pick things up were actions that were causing significant knee pain.
She loved spending time with Charlie and resented that so much physical pain was leaving her fatigued by the end of the day.
Having been referred by her rheumatologist, Maureen explained that she had had persistent knee pain for 15 years, which had become more intense over the past 12 months.
Taking paracetamol didn’t make much difference, although oral anti-inflammatory medication and a cortisone injection had provided some relief in the past.
Maureen’s knees were tender when touched and she experienced sharp pain when bending. X-rays showed that she had moderate degeneration of the joint in her knees, but it wasn’t severe enough to warrant a joint replacement. That was on the cards in the next five to 10 years however, if her symptoms worsened.
Maureen knew she had osteoarthritis in her knees and she figured there wasn’t much she could do about it, aside from taking painkillers.
Osteoarthritis is a disease that causes degenerative changes to the bone and cartilage. What causes it isn’t fully understood, but the joint gets worn down and the reduced protection of the joint surfaces leads to pain.
There was good news though and Maureen was very pleased to hear it.
There was a lot she could do to keep her joints healthy and prevent any need for surgery.
As is the case for many people who experience joint pain, Maureen had lost muscle strength and tone.
Her limited movement had also led to her gaining 10kg over the past 10 years.
There is a significant amount of research which now shows that if you are overweight or obese and have osteoarthritis, the best way to improve function and reduce pain is by losing weight. Adding a safe exercise program designed just for you can help even more.
Helping patients to lose weight and exercise often requires the support of a multidisciplinary team, which can include a dietitian, a physiotherapist and an exercise physiologist.
It’s not unusual for patients living with persistent pain to also have depression and anxiety, so seeing a psychologist might be necessary to support significant lifestyle and behavioural change.
Maureen didn’t need psychological support. She was highly motivated to get better, because she wanted to play with Charlie and not rely on others for support as she got older. So we organised for her to have a cortisone injection, to reduce her pain levels enough so that she could tolerate exercise.
We developed an exercise program for Maureen which enabled her to build her strength up slowly. She was doing a lot of work to strengthen her buttocks and hamstrings, including squats, and watching the alignment of her hips and knees when going up and down steps.
A dietitian helped her to continue to eat food that she likes, in smaller portions, and to include other healthy food in her diet that she hadn’t considered trying.
Over the next three months, Maureen lost 6kg and felt significantly less pain when she walked up stairs or tried to squat to reach down to the floor.
She found herself enjoying the exercise, as she could feel her strength increasing. Having learned how to manage the problem herself, she was in a great position to continue keeping herself and her joints healthy, with exercise by keeping weight off. She is on track to avoiding any need for surgery.
If you’re experiencing pain from osteoarthritis, remember that with the support of a professional team, you may find solutions aside from taking pain killers.

 

Put off procrastinating

17 January 2015
WHETHER it’s New Year’s Eve or a birthday that ends with a zero, I’ve noticed how significant milestones are in many of my patients’ lives.
Milestones are great when they give people a deadline for improving aspects of their health, but they’re not so great when they’re used to justify procrastination.
Jessica, 29, came to see me recently having had a social new year with friends.
It soon became apparent she’d been comparing herself to her peers and feeling horribly inadequate. With her 30th birthday coming up in October, she’d decided to use that milestone as a motivating force.
She wanted to lose weight, for a friend’s wedding the following year, having put on 6kg over the past five months.
Because she’d been drinking much more over the holiday period, she’d started smoking again, so she was going to give up smoking when she turned 30, too.
What I found fascinating was that Jessica was happy to wait 10 months.
I asked her why and she confessed it was all a bit daunting and she didn’t know where to start.
We enjoyed a bit of a laugh before getting down to some serious discussion.
Jessica was keen for me to prescribe weight-loss pills. She’d had them in the past and found them effective in suppressing her appetite.
Her enthusiasm dampened, however, when I reminded her they have side effects and can lead to your weight going up and down.
Jessica said her mother had been focused on losing weight slowly over the past year, largely by counting calories and being mindful of portion sizes.
We discussed how many calories each day Jessica could avoid simply by not drinking white wine and she decided to talk to her mum for some practical inspiration and to see if they could go walking together.
I suggested that it might be sensible to try and lose weight at the same time as giving up smoking, because it’s not unusual for people to substitute smoking for food and gain weight.
Every cigarette you smoke causes you damage, so there’s nothing to gain by waiting 10 months to give up. However, doing both can take a lot of dedication.
Jessica liked the idea of starting the new year focused on exercising more, losing weight and giving up smoking. She was inspired by knowing she would sleep better, feel better about herself and have something really worth celebrating by her 30th birthday.

 

Talking is the best medicine

10 January 2015
Article Rank: THREE OUT OF FIVE “Interesting article”
THE first thing that Clare, 16, said once she’d taken a seat in my consulting room was that she didn’t want her mother to know she’d come to see me.
Clare understood that as a 16-year-old, she was legally entitled to her medical consultations being kept strictly confidential. I promised Clare that I would not tell her mother anything without her consent.
That is important, as it helps to ensure that young people feel comfortable to access health care when they need it. If they don’t, there are potentially serious implications for their longterm health.
On the flip-side, patient confidentiality as it affects young adults can also cause great angst for parents, particularly if they are concerned about illicit behaviour or their child’s mental health.
It’s not unusual for parents to call, asking whether their child has come to see me or what they’ve come to see me for. Each time, I need to explain that I’m not legally able to divulge this information.
Clare was adamant that her mother was a conservative and judgmental person who wasn’t interested in anything that happened in Clare’s life except for ensuring she got good grades, and said her mother flew off the handle easily.
Clare said she was feeling depressed. She’d been having painful, heavy periods and was feeling extremely self-conscious about her acne. She had a friend with the same symptoms who had been prescribed the oral contraceptive pill and Clare was hoping that might be the answer to both of her issues as well.
Clare dreaded the idea of discussing this with her mother, as she was concerned her mother would jump to the wrong conclusions.
I took Clare’s medical history and we had a detailed discussion to ascertain the state of her mental health – we agreed that she wasn’t clinically depressed, but she was clearly feeling very sad and stressed. I wrote Clare a script for the oral contraceptive pill and commended her on having taken responsibility for looking after her health.
I also encouraged her to reconsider having an honest and open discussion with her mother.
Young adults are often surprised that their parents don’t react in the way they expect them to, and most children would like them to be active in their life.

 

Reduce hazards of heat

20 December 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”
I WAS concerned to see Edna, 88, in my waiting room. She was dressed to the nines, as usual, but she had a gash across her forehead and her right wrist was in plaster. She looked shaken and stressed.
It turned out Edna had fainted at home. She had hit her head on the coffee table and tried to break her fall with her right hand.
Edna lives alone, but fortunately has a great social life. Just after her fall, a friend had popped in to collect her for a game of bridge and taken her to hospital.
Having been stitched up, X-rayed and put in plaster at the hospital, she’d taken the advice of a clever intern to come in to see me for a medication review. I took Edna’s blood pressure. It was quite low. Blood tests ordered by the hospital showed her potassium was low as well.
When we looked through her medication, the pieces started to come together.
Having had a heart attack about 15 years ago, Edna was on a number of blood pressure tablets, including a diuretic, which prevents fluid retention.
Edna had inadvertently been doubling her dose, as she’d been taking two different brands of the diuretic.
This would have left Edna quite dehydrated and lowered her blood pressure.
Edna was relieved to have a reason for having fainted, but I was confident that the medication was only part of the story.
We chatted for a while and I learned that in the afternoon, Edna’s small flat gets drenched in hot westerly sun. She has no airconditioning and relies on a small fan to keep cool.
Edna has always been a stickler for dressing properly. For Edna, that means a long-sleeved blouse, a tailored skirt, stockings and enclosed court shoes, even in the heat of summer.
As I suspected, she dressed this way regardless of whether she was planning to stay at home or head out with friends. She joked that she never knew when the Queen might pop in.
When I asked about how much fluid Edna drank each day, she said she had a few cups of tea. She said she knew she should drink more water, but she’d lost faith in her waterworks and disliked having to rush to the toilet many times a day.
Older patients are particularly at risk during hot weather of fainting and feeling unwell. They don’t have as much fluid reserve as they did when they were younger and they don’t tolerate the heat as well. Some medication that doesn’t impact on blood pressure in winter can affect how their body is able to regulate heat in summer, leaving elderly people dehydrated.
While fainting may not in itself be serious, for elderly people, a fall can be catastrophic. If you have an elderly friend or relative who is feeling faint on a regular basis, it’s important to go to the doctor and get a medication review, and think about whether there needs to be any changes on the hot summer days.
Edna could see that it didn’t help being dressed to the nines, sitting near a little fan and not drinking much.
Two weeks later, Edna came back so I could check her blood pressure. It was back to normal and she was looking much more comfortable in sandals and a cool, cotton sundress.

 

Beating work stress

13 December 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”
IT’S not uncommon for patients to want me to fill out a workers’ compensation certificate because of an incident that has left them feeling stressed at work.
Just recently, George, 58, arrived in my surgery saying his boss had given him a poor performance review and he was feeling extremely stressed.
He worked for a large company where it was rumoured there would be job cuts before Christmas and George was feeling vulnerable.
Having had a successful career at the company for 25 years, he was now worried that his age would make it very difficult for him to get another job.
As for many people now, work was closely tied to George’s general wellbeing.
It was a large part of how he defined himself and how he believed his family and friends saw him. It was central to his self-esteem.
George said he had started lying awake at night wondering how he’d keep his kids at uni if he lost his job.
He had also played out how he would handle those conversations that seem to inevitably occur when you meet people and they ask your name, where you live and what you do.
Retirement at 65 wasn’t an option for George, let alone becoming unemployed at 58.
WorkCover seems to spring to mind for many of my patients during times of work stress. I think, in part, they feel that a WorkCover claim will highlight to their employer the depth of their concern or angst.
It’s a cry for help and a way of showing their employer how much they are suffering, but in reality, making a claim is often a stressful process in itself.
What’s more, George’s work-related stress isn’t the type of work-related injury or disease that is eligible for workers’ compensation.
WorkCover will only accept claims for psychological injury if there is medical evidence to prove that work has caused an employee to suffer from a definable psychological or psychiatric disorder.
You can only use accepted medical terminology when making a claim – the word “stress” isn’t acceptable – and that compensation isn’t payable for an injury caused by an employer’s “reasonable action”.
George and I discussed whether there was anything reasonable about his performance review, and he conceded that his sales figures were down and he hadn’t been performing to his usual standard.
By the end of our chat, George had decided that the trust was at the core of the problem.
He didn’t trust his boss not to make him redundant because of his age and his boss no longer seemed to trust George to be driving sales as strongly as he always had.
When trust breaks down, it can be hard to get back, but there’s a lot to be said for trying to rebuild it with a one-on-one chat. George took a few days of personal leave so that he had time to think.
When he went back to work, he met with his boss, acknowledged his poor performance and explained how insecure he was feeling about his role. He was hugely relieved to find there was no plan to fire him and despite his performance he was still considered a valuable employee.
George’s morale skyrocketed and I have no doubt his performance will too.
The longer that issues like this remain unresolved, the more likely they are to worsen. Over time, they can develop into psychological problems.
It’s often better to deal with work-based conflict upfront and consider your options if it can’t be resolved.
Ultimately, you can do yourself a great deal of damage staying in a place where you dread going to work every day.
Stress can affect your health. That’s an important part of the equation to weigh up when considering whether to stay in your job or start looking for another.
Further information: workcover.nsw.gov.au

Diet may need a grain check

6 December 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”
THERE seems to be an endless procession of people who come through my surgery feeling tired, but about six months ago I saw one young woman who stood out from the rest. Tilly, 18, was as white as a sheet.
A gluten-free diet can lead to a person looking more vibrant and having more energy.
Tilly said people had been commenting on her pallid skin for years, but she hadn’t thought about it much.
She was more conscious of the dark circles under her eyes and struggled to keep up with the demands of school and a social life, but no-one had ever taken her exhaustion seriously.
I did a blood test, which highlighted how low Tilly was in iron. She ate a balanced diet, which included red meat, but she was quite thin and severely anaemic.
I suspected something was interfering with Tilly’s ability to absorb nutrients, so we organised another blood test for coeliac disease.
In the lead-up, Tilly faced the coeliac challenge, which meant she had to eat at least four slices of wheat-based bread every day for six weeks. It can be a very unpleasant process for people who have pronounced reactions to gluten.
But Tilly sailed through it, enjoying her daily diet of fresh bread.
Having enough gluten is important to make sure tests are accurate. The blood test relies on picking up antibodies, which occur because coeliac disease is an autoimmune condition that damages the small intestine.
She had none of the classic symptoms – bloating, nausea, constipation or diarrhoea – but her antibody level was high. Her diagnosis was confirmed with a gastroscopy, which showed just how much damage had occurred to the villi that line the small intestine. We rely on these tentacles to absorb nutrients, but Tilly’s had been flattened and no longer doing their job well.
Tilly had coeliac disease and would have to remove all gluten from her diet by avoiding all wheat, rye, barley and oats.
According to Coeliac Australia, one in 70 Australians has coeliac disease, but about 80 per cent of these haven’t been diagnosed.
It’s possible that many of these people, like Tilly, could eat gluten without feeling pain or discomfort.
But that’s not to say that the disease isn’t doing damage. Even without symptoms, it is associated with gastrointestinal cancers, osteoporosis, infertility and other significant health problems. A strict glutenfree diet decreases that risk.
Tilly wasn’t overjoyed about following a gluten free diet, particularly given how hard it can be to avoid crosscontamination. She was shocked to find gluten in the most unexpected places, from soy sauce and vegemite, to icing sugar to tins of flavoured tuna.
She said shopping took her twice as long, because every time she picked up a tin or a packet she had to read the fine print.
I saw Tilly for a check-up just last week and I was impressed to see how healthy and vibrant she looked. She had some colour back in her face, had filled out a little and said she now had energy to burn.
Going gluten-free and doing it properly required a major effort, but she felt so much better she was confident it was all worth it.
Coeliac Australia 1300 458 836

 

Joy lies in caring for others

29 November 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”
IT WAS mid-December last year when Maria came to see me. She’d just turned 40 and thought she should get some blood tests done.
As she was leaving, I wished her a merry Christmas. A look of sadness crossed her face and I could see she was holding back tears. I asked her why.
She said Christmas reminded her of how much she missed her parents, who had passed away many years ago. She was feeling sad about not having a partner with whom to share Christmas. She’d had a tough year, having lost her job, and was feeling financially stressed.
For the past five years, she had spent Christmas alone.
While Christmas can be a fun and joyful time of year, Maria is not alone in finding that it stirs great sadness.
For many people, it’s also a time of significant stress. I see it in my practice with divorced couples struggling to negotiate who will have the children on Christmas Day and elderly people who live a long way from their adult children and grandchildren.
Conflict increases in some families, who feel under pressure at Christmas because finances are tight and demand is insatiable.
I wasn’t at all surprised to learn that the days leading up to Christmas and New Year’s Eve are the busiest time of year for Lifeline’s 24hour crisis support line.
At this time of year, start thinking about how you can make Christmas a less distressing time for people in your lives, whether or not they are direct family.
Plan an extra place at your Christmas table for someone who might otherwise spend the day alone.
If there’s potential conflict ahead, in terms of where children will spend Christmas Day, try to negotiate a solution well in advance.
Mustering some goodwill in advance might help to avoid fighting in front of children on Christmas Day. Just for one day!
If elderly relatives live a long way away, find someone who might be able to help organise a surprise Skype session, pitch together with relatives to buy a return flight, or plan a joint phone call so lots of people can chat and send their love.
Christmas should ultimately be a time of goodwill. It’s easy to get carried away with gifts and focus on food but a little bit of effort can bring an enormous amount of joy and happiness to someone who might be feeling vulnerable.
Take some time to stop and think about who might have had a tough year, or who might be feeling isolated or lonely, and start planning how you can bring a smile to their face.
Lifeline: 13 11 14

Food poisoning can have lasting effect

22 November 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”

IT WAS clear as the young couple walked into my consulting room that they were not in great shape. Daniel, 28, looked a bit green around the gills and his girlfriend Larissa, 30, looked tired and washed out.
It was Monday morning and they had been to a barbecue over the weekend. Larissa said they had started to feel sick about four or five hours after eating – as had three of their friends – and things had gone downhill from there.
Daniel had woken up at 3am, violently ill. Every time he tried to drink water he threw up.
After a few hours, he started to feel faint. Larissa, who had vomited a few times and had mild diarrhoea, started to worry.
She decided to take him to hospital, where doctors said he had food poisoning. They saw he was severely dehydrated and started him on some intravenous fluids and medication to stop him from vomiting. After a few hours, Daniel started to feel better. After spending Sunday morning on a drip being rehydrated, he had been sent home and told to check in with me.
Having had such a rough time, Daniel and Larissa were keen to understand why they had been sick. They weren’t convinced it was food poisoning, because they had eaten the same things and only Daniel had become violently ill.
Larissa joked that maybe it was because she was tougher and Daniel had man flu but I reassured them that some people fight off some bugs better than others.
We decided the culprit was probably the chicken salad that the couple had taken to the party on the back seat of their car.
They would normally have put it in a portable cooler but they were expecting to get to the party in less than half an hour. After a few diversions it turned out that the chicken salad was left in the hot car for more than two hours before being placed outside on a table, and by the time they got around to eating it another two hours had gone by.
To keep cooked food safe, make sure it stays below 5C and that it is not left at room temperature for more than two hours.
I explained that Daniel would probably have loose bowel motions for up to two weeks, so he needed to keep his fluids up.
While some people like to take fluid containing electrolytes, just plain water will do as long as you are able to keep it down. And It’s best to avoid eating dairy products until at least 24 hours after diarrhoea has stopped.
I explained that was because almost all food poisoning or gastroenteritis was viral, so antibiotics would not help and could potentially make it worse.
Like Larissa, as long as you can keep fluids down, you can usually manage food poisoning at home rather than having to seek medical care. It will usually pass in a few days. But if you cannot keep fluids down or you are still vomiting after 24 hours, it’s time to see your doctor.

FOBT check can help detect bowel cancer

15 November 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”

TONY, 51, had been my patient for many years, but he didn’t come to see me often. A man of few words at the best of times, he was never particularly forthcoming about what was wrong. He was a private man who found discussion of personal matters confronting, so when he started our consultation by mentioning that he’d been sent a FOBT, I had my first clues as to what might be worrying him.
FOBT stands for faecal occult blood test, which is a screening test for bowel cancer. It detects small amounts of blood in a bowel motion, which may signal bowel cancer before more obvious symptoms become evident.
The National Bowel Cancer Screening Program sends the tests to people from the age of 50, because the earlier bowel cancer is detected, the easier it is to treat and the better the patient’s long-term health outcome.
Tony said he didn’t think he needed to do the test when it arrived in the mail, because he felt fine, and so he had thrown it away.
But over the past four months, he’d noticed a change in his bowel habits, was feeling tired and had lost 1kg without exercising or dieting. He said he kept thinking back to the test and wondering whether maybe he should have done it.
I reassured Tony that he was right to come for a check-up. While seeing blood in your bowel motion is a warning sign that should be investigated, it’s not a symptom experienced by that everybody with bowel cancer, particularly in the early stages of the disease.
Sometimes, patients don’t get any early warning signs at all, which is why it is important to do the FOBT test, even if you have no symptoms. But the symptoms Tony described did warrant investigation.
Tony agreed to do the faecal occult blood test, which unfortunately returned a positive result. I referred him for a colonoscopy. This is the best way to check for polyps, small growths of abnormal tissue.
Tony had three polyps, which were all removed during the colonoscopy and sent for testing. One was found to be malignant. He had another operation to remove a piece of bowel and within six weeks was back to normal again.
Bowel cancer is the second most common cancer diagnosis affecting Australian men before they turn 85 (prostate cancer is the most common). Fortunately, because we detected and treated Tony’s cancer early, it wasn’t a death sentence, and his long-term prognosis is excellent.

Dying with dignity is better

8 November 2014
Written on behalf of SNSBML board member, Dr Stephen Ginsborg
Article Rank: FIVE OUT OF FIVE “Excellent article”

MY patient Jim, 83, was an ex-smoker with advanced lung and heart disease.
He knew his health was failing, but had been putting off talking to his family about his end-of-life wishes.
Discussions about dying can be confronting, but they are important.
It may mean that terminally ill patients are able to die at home, rather than in hospital, if that is their wish.
It may also relieve the pressure on relatives if they have to make health decisions on a loved one’s behalf.
In an ideal world, we would all have this difficult conversation with our loved ones well in advance.
Jim agreed to talk to his wife Sue and his daughter Kate as he neared the end of his life. To help him make informed decisions, I gave him a booklet called My Health, My Future, My Choice, which explains the many issues to be considered.
It gave Sue and Kate the chance to learn for the first time what Jim thought about being resuscitated, what level of intervention he wanted and when he wanted them to make decisions on his behalf. Jim used the enclosed Advance Care Plan to document his decisions.
Like 50 per cent of Australians approaching end of life, Jim’s wanted to die at home. Only about 20 per cent do so, partly because of a shortage of palliative care services.
Dying at home is only an option for people who have a supportive family and a GP who can do home visits with a palliative care team.
Jim presented me with a signed copy of his Advanced Care Plan, saying he wanted to “die well”.
For Jim, this meant dying comfortably at home, with support from medical professionals, surrounded by his family.
He asked whether I would help him to achieve this, and I agreed. The following winter, Jim had two serious episodes of pneumonia.
In line with his plan, we arranged for his medical treatment to occur at home, rather than in hospital.
A mobile X-ray service visited Jim and took a chest X-ray, to confirm his diagnosis and guide treatment. A physiotherapist gave Jim breathing exercises.
A nurse gave daily intravenous antibiotics. Friends and neighbours helped wash sheets and cook meals.
Jim recovered, but the infections took a toll. He had heard pneumonia can be a dying person’s best friend.
“I’ve had enough,” Jim told me and his family.
“Next time, I don’t want antibiotic treatment.”
When Jim went down with another infection, everyone was ready.
A hospital bed was delivered to make sure he was comfortable and easier to nurse. Palliative nurses visited and gave support. Medications were prescribed to keep Jim comfortable.
Jim’s palliative nurse said he died with his family by his side.
“They are devastated that he has gone,” she said. “But they all agreed that he had died a good death, with dignity, just as he had wanted.”

Seeking best medical help at right time a hard call

Saturday 1 November 2014
Article rank: THREE OUT OF FIVE “Other readers say: Interesting article”

WHEN parents have a sick child over the weekend or at night, it can be difficult to work out whether to go to hospital, have a GP visit them at home, or wait until their medical practice opens.
There is no need to panic at every childhood illness.
Obviously, if it’s an emergency, you need to call 000.
But when it’s not an emergency, and your child is unwell or crying in pain, it can be a struggle to know which way to turn. You don’t want to panic, or be complacent.
It’s tempting to feel all medical issues need to be sorted out instantly, but I encourage my patients to stop and think about what doctors are likely to do.
Many medical conditions will wait and usually they can be treated more efficiently during working hours. Even if you have a minor broken bone, at 6pm on a Sunday it is much more efficiently sorted out the next day, saving you many hours of waiting in Accident and Emergency.
If you’re not confident to make the decision about what type of medical help you need, you can get advice over the phone (healthdirect 1800 022 222).
If you can wait for a doctor to visit, call your GP for their after hours service. The National Health Service Directory (nhsd.com.au) lists doctors’ hours and location, and details of nearby hospitals and pharmacies, which is handy if you’re away from home. The site also has an app you can download to a smartphone.
Just the other week, I had a mother, Sue, who came to see me one morning with her daughter, Bridget, 3. Bridget had had the sniffles during the day, due to an upper respiratory tract infection, and at 2am she started crying.
Sue checked her body thoroughly and did not find any sign of a rash, but Bridget’s temperature was 38.5C.
After an hour of Bridget howling, Sue called a locum service. She was annoyed it was going to take three hours for a doctor to visit, so she decided to wait until my practice opened.
It turned out Bridget had an ear infection, which can be incredibly painful.
That’s distressing for any parent, but the best solution is to reduce their fever and pain with a dose of paracetamol.
I explained to Sue that if a GP had come to visit her house, paracetamol would have been their best answer, too. She left my practice planning to stock up on paracetamol.
No-one expects parents to be doctors, but it’s important not to panic at the first sign your child is sick, and to be realistic about how severe their illness is.
If you have a child with a recurrent problem that concerns you, then consider working with your GP to devise a plan that outlines symptoms, what your reaction should be and when you need to seek medical advice.
That kind of planning is particularly important for people with asthma, which my patient, Christina was reminded of recently.
She had taken her asthmatic son Sanj, 5, to the hospital in the middle of the night many times over the past 12 months. Each time, after a long wait, they had been sent home. Because he wasn’t admitted, Christina felt she shouldn’t have bothered going.
Then last week, Sanj got a mild respiratory tract infection. He woke up at 2am short of breath and wheezing, so Christina gave him his medication. But after half an hour, Sanj was finding it even harder to breathe. Christina decided to wait, but two hours later she realised he was desperately unwell, so she raced him to the hospital. Fortunately Sanj survived, but the outcome could have been different.
With hindsight, Christina wished she had driven to the hospital when it first became clear that Sanj wasn’t improving.
It’s not fair to expect parents to always pick the perfect time to stay at home, or go to hospital. It can be a hard call to make. Remember, children can go from being very well, to very sick, in a short period of time. So, if you’re worried, don’t run risks.
FURTHER INFORMATION: For a free local After Hours Medical Help directory, call 1300 798 307. Information on where to access local after hours medical assistance: afterhourshelp.com.au Medical advice: healthdirect 1800 022 222 National Health Service Directory: nhsd.com.au

Any mother can suffer with postnatal depression

25 October 2014
Article rank: FIVE OUT OF FIVE “Excellent article”

MICHELLE, 31, was happily married and had just had her first baby after a textbook pregnancy and labour.
Speak to your doctor if you suspect you might have post-natal depression.
But when she arrived at the surgery with baby Summer for her six-week postnatal visit, she was subdued.
Michelle had opted to have Shared Antenatal Care throughout her pregnancy, which meant she continued to see me for care, as well as midwives and doctors at Royal North Shore Hospital. That continuity of care meant I knew Michelle well.
She and her husband Mark lived in a gorgeous house near the beach. She had loads of friends in the area and a great relationship with her mother, who lived nearby. Life seemed pretty perfect, but when I asked Michelle how she was feeling, she burst into tears.
Michelle said Mark kept complaining about the house being a mess and dinner not being organised. He couldn’t understand why she achieved so little each day. Her mother wanted to take care of Summer, to give Michelle a break, but Michelle resented the offer because it made her feel inadequate and like she wasn’t coping.
Even though Summer only woke once in the night, Michelle wasn’t sleeping properly. She said she was feeling overwhelmed at a time in her life when she should have been blissfully happy. She was having trouble bonding with Summer and was convinced she wasn’t a good mother.
Michelle spent the whole day at home and only went out to buy groceries. She did nothing other than breastfeeding and changing nappies. She was scared if she went out, Summer might get sick and had become socially isolated. There were times when she couldn’t get Summer to stop crying and she felt like hitting her, and even though she would never hit Summer, her thoughts were making her feel guilty.
I suggested she might be experiencing postnatal depression, which surprised her. She thought it affected people with no support and who were in crisis; she was a high-achieving careerwoman with ample support.
But postnatal depression can affect any mother and Michelle had many symptoms.
Michelle agreed to answer a series of simple questions health professionals use to screen people for postnatal depression, which showed she did indeed have postnatal depression.
She decided to try cognitive behavioural therapy and supportive psychological therapy, and I saw her regularly over the following three weeks. She wasn’t happy with her rate of improvement and so decided to try antidepressant medication. Within four weeks she felt significantly better and for the first time felt able to give Summer the loving relationship she needed.
Once Mark adopted the view that Michelle had a high-pressure job, too, he came home expecting to give her a break, rather than expecting dinner, and they were both much happier.
Michelle was also more comfortable to let her mother take Summer occasionally so she could exercise and see friends. This small change made a dramatic difference to her mood. She felt that she could be herself.
Two years later, when Michelle was pregnant with her next baby, we remembered her previous experience, prepared for it and monitored her closely.
This time, she had a baby who woke her far more frequently and she often felt exhausted. Fortunately, she didn’t develop post-natal depression.

Monitor moles regularly and slap on the sunscreen

18 October 2014
Article rank: FOUR OUT OF FIVE “Other readers say: Very interesting article”

IT WAS Monday morning and I had two very red-faced patients sitting in the waiting room. They weren’t embarrassed or hot under the collar. They were regretting bad cases of sunburn, having enjoyed the first weekend of glorious weather we’ve seen in ages.
If you love soaking up the sun on Manly Beach it’s a good idea to have your GP do a skin check once a year.
A serious case of sunburn often prompts patients to come in for skin checks, even though it is long-term exposure to the sun that causes melanoma and much more common nonlethal skin cancers.
Obviously, cancers don’t appear the instant you get burned. It’s important to remember too that melanoma can affect skin that rarely sees the sun at all.
It is a good idea to have your GP do a skin check once a year. If you identify significant skin cancer early, you can have it removed and live a long and happy life. The outcome can be very different if there is a delay.
My first sore and sorry patient, Todd, 30, had been enjoying the sun and surf since his early teens. His wife was worried about a spot in the middle of his back because it had changed over the past few months. Before his next visit, he asked his wife to draw a circle around it. Luckily it was just a skin tag.
I was pleased to hear that Todd’s wife was keeping an eye on his back and other parts that he couldn’t see. He regularly did the same for her. Any change in the colour, shape or size of a mole is a sign that it needs to be checked, and it’s hard to monitor moles on your own.
Much to Todd’s surprise, I was more concerned about the sun-damaged skin on his face, where he didn’t have any moles at all. He had some small red areas on his forehead with flaky, dry skin. He’d been applying moisturiser, but they hadn’t gone away. They were sun spots which, if left untreated, would eventually become nonlethal skin cancers. We helped prevent problems by burning them off with dry ice.
My next patient was fairskinned Seamus, 35, who was in a great deal of pain. He’d been sunburnt rarely and had always been keen to “slip, slop, slap”. But over the weekend, he’d forgotten his sunscreen.
Seamus was covered in freckles but there was one lesion between his toes which stood out. It was much darker than his freckles. It had lots of different shades and irregular borders. Seamus hadn’t noticed it and didn’t know whether it was growing or not.
I sent it off for testing. Seamus was devastated to learn the spot was a melanoma. As someone who was rarely in the sun without an enclosed shoe, he couldn’t fathom his bad luck.
Fortunately, it was a very shallow melanoma, which was completely removed and Seamus didn’t need any further treatment. He visits me every six months, as we need to monitor his skin closely, and his partner regularly monitors moles that Seamus can’t see.

Quitting smoking can take a few goes – don’t lose heart

11 October 2014
Article rank: THREE OUT OF FIVE “Other readers say: Interesting article”

SUSANNAH, 37, was fed up with people insisting she give up smoking. For 10 years her sister had been nagging her to give up. She had offended Susannah by refusing to let her drive her nieces anywhere. She did not trust Susannah not to light up in the car.
Many people struggle for years to give up smoking.
Susannah was also feeling hounded in her own home. She was in a messy dispute with the body corporate, because others in her unit block had complained about her smoking on the balcony. She confessed this made her so angry it made her feel like smoking more.
Adding to the pressure was that she had a new boyfriend, who happened to be very fit and health-conscious, and also unimpressed with her addiction.
Now, sitting in my surgery, Susannah had more confronting news coming her way. She came to me as a new patient, wanting a script for the contraceptive pill, which I wasn’t prepared to write for her. Susannah was unhappy to learn that given her age and her smoking history, taking the pill would increase her risk of stroke.
Susannah’s father had been a smoker. Just two years ago he had died, way too young, of tongue cancer. Susannah was well aware of the dangers of smoking, and like many smokers, she’d tried to give up many times.
She would manage to stop smoking for a while, but then she would cave in and have just one cigarette. She registered that setback as failure and went back to smoking again.
As annoyed as she was with being badgered, she could see that it was time to try to give up again. While her health should have been her main motivation, she was more concerned about her new relationship. She could see herself with this man long term, she wanted to have a baby in the next few years and she would never allow herself to smoke through a pregnancy. Smoking was also costing her a fortune and she was desperate to save for an overseas holiday.
I was able to reassure Susannah that many smokers have two or three goes at giving up before they succeed. And while there are many different ways to give up, one is not necessarily better than any other.
Susannah had gone cold turkey with her previous attempts, but she was now open to other options. Some of her friends swore by various forms of nicotine replacement, including sprays, gums and patches, while others had invested in expensive psychological programs, acupuncture or hypnosis. Her aunt had success with medication, which had stopped her desire to smoke.
One thing that definitely does make a difference is having professional support. While your GP can provide that, I encourage anyone giving up to contact Quitline. Quitline coaches can help you understand your smoking triggers, habits and routines, and work out the best way for you to quit. They’ll support you over the phone, through the interactive Quit Coach website and by sending you a Quit Pack with information and tips. The Quitline website even has an online calculator, to help you work out exactly how much money you’ll save.
In addition to having support, it also helps if you give up at a time when you’re feeling resilient. Coping with withdrawal symptoms is likely to be harder if you’re already going through a stressful event.
I’m not sure whether Susannah will succeed in her latest attempt to give up, or not, but the important thing is that she’s going to give it another go. There are no miracles, there is no easy way and grit and determination are definitely required.
I’m sure Susannah will be more likely to succeed with her boyfriend, her sister and her doctor by her side.
Call Quitline on 13 78 48 or visit www.quit.org.au.

Simple ways to stay in shape

4 October 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”

I WAS in the fruit and veg section of the supermarket when one of my patients, Samantha, stopped for a chat. After a quick exchange about our dinner plans, she was keen to give me an update on how her husband was tracking with his weight.
Steve’s weight had crept up from 85kg to 110kg over the past five years and Samantha had been deeply concerned about it.
Like many professionals, Steve often went to business dinners and lunches where he tended to lash out in terms of what he ate and drank. After work, he was often mentally exhausted, and keen to just sit and watch TV.
Steve had once been a reasonable rugby player, and while he had never played for the Sea Eagles, he was very fit. Samantha said he would never admit it, but she could see he was finding the walk up Sydney Road from the Manly ferry more difficult.
Each year he had had to buy a new suit. He was finding it harder to get in and out of an airline seat. But he was resolute in resisting Samantha’s attempts to keep his calorie intake down.
The proportion of people who are overweight in Manly, Pittwater and Warringah is higher than the average for both NSW and Australia. Being overweight doesn’t have the same serious health implications as being obese. However, it does put you at risk of becoming obese, like Steve, if you don’t change your diet and do more exercise.
One way to get a sense of whether you’re overweight is by calculating your body mass index (BMI), which factors in your weight relative to your height.
It’s easy to work out using the Heart Foundation’s online calculator, or you can ask your GP to calculate it for you.
Your waist measurement is another important part of the equation. A waist greater than 94cm for men, or 80cm for women, increases your risk of developing a chronic disease. Combined with your BMI, this will help you understand whether your weight is in the healthy range.
Part of the challenge we face locally is our selection of tempting restaurants. If you are keen to eat out, visit the Australian Government’s Shape Up Australia website (shapeup.gov.au) for tips on how to make healthy choices. It explains healthy portion sizes and how to reduce your calorie intake.
Swapping chips for a salad and asking for fish to be grilled can make a big difference. So too can opting for Thai stir-fries instead of dishes with coconut milk and limiting your alcohol intake.
If you have private health insurance, explore whether your coverage includes healthy lifestyle programs that will support you to achieve a healthy weight.
The good news is that, at this stage, the north shore and beaches has the lowest obesity rate of any Medicare Local region in Australia. But given that 36 per cent of residents across the region are overweight, we need to act now on lifestyle factors.
Steve didn’t act until he felt a pain in his chest, while climbing stairs. Fortunately, it had nothing to do with his heart, but it gave him a fright, and he started to share Samantha’s concern about his long-term health.
Standing with her trolley brimming with fresh fruit and veg, Samantha said she and Steve had enjoyed a lovely day pacing out the Manly to Spit Bridge walk and then catching the bus back home.
A healthy meal was the next treat on their agenda.

Prepare now for difficulties of age

27 September 2014
Article rank: THREE OUT OF FIVE “Other readers say: Interesting article

STEVE, 71, had been an architect and won many prizes for his innovative work.
He was an incredibly clever man, but for some time his memory had been failing him.
He often needed his wife, Tammy, to help him find his way back from the shops he’d been going to all of his adult life. He struggled to remember what television show he’d watched in the morning.
Tammy’s memory was fantastic, but over the past 10 years she had become more bent over and every morning she woke up with pain in all of her joints. She had been a Grade A tennis player in her day, but arthritis was making it more difficult for her to take care of Steve.
For 35 years Steve and Tammy had lived in their own unit. I understood how much they loved their home, but I had been encouraging them to find more supportive accommodation. Like many other people in their situation, the idea horrified them and they resisted it totally.
They didn’t even warm to the idea after a few scares. Steven went missing one evening, and Tammy got a call from the police, saying they’d found him wandering and unable to find his way home.
It wasn’t until Tammy tripped over, broke her hip, and had to go to hospital that their daughter, Madeline, understood just how vulnerable her parents were. Madeleine, who lived in Melbourne, was unable to organise any respite accommodation for her father. She had to take leave from her high-pressure job, pack up her children and head to Sydney while Tammy rehabilitated.
Madeline had been reluctant to pressure her parents out of their home, but she could see they were vulnerable and she couldn’t stay to help them forever. She soon had Tammy on board with the idea of finding somewhere for Steve, where Tammy could possibly move into later.
Head in hands, in tears in my surgery, Madeline had discovered how complicated and stressful it can be to find supported accommodation.
In the end, I was able to help Madeline by calling in the federally funded Aged Care Assessment Team (ACAT). They helped Steve access respite care and organised a carer’s package to help Tammy with her cleaning and shopping.
Madeline and Tammy were disappointed with where Steve ended up, but the places they preferred had long waiting lists. These are very hard decisions that people tend to delay.
If Tammy and Steve had their time again, I know they would have done things differently. The outcome for my patients is always much better when they engage ACAT early, so they get good advice. Then they’re better equipped to plan ahead.
Further information: www.myagedcare.gov.au/ eligibility-and-assessment

A diabetes diagnosis can catch you by surprise

20 September 2014
When I broke the news to Denise, 49, that she had type 2 diabetes, I could understand her reaction. She shook her head and said: “That’s just not fair”.
She was the right weight for her height, played tennis and considered her diet to be healthy.
She had no symptoms, except that she was lacking her usual energy.
Denise thought the disease only occurred in people who were overweight, which is also not true (though being overweight does increase your risk).
The thing with type 2 diabetes is that you can have it and just not know.
The chance of you becoming a diabetic increases as you age.
Having parents with diabetes means you are at higher risk.
Diabetes is caused by problems with insulin, a hormone that is produced by the pancreas.
As you get older, the production of insulin begins to fall away.
High blood sugar causes serious problems, including blindness and damage to kidneys, heart and blood. Diabetes cannot be cured, but having Denise and I took a close look at her lifestyle and found it wasn’t as healthy as she’d thought.
Three years after her diagnosis, Denise still doesn’t need tablets or insulin injections. She has lost 5kg, is fit and feels fantastic.
Visit: diabetesaustralia.com.au

Asthma sufferers breathe easier with sound advice

6 September 2014
Article rank: THREE OUT OF FIVE “Other readers say: Interesting article”

FORMER Olympic swimmers Grant Hackett and Dawn Fraser, have asthma. So too does retired English footballer, David Beckham. It’s pretty clear that managed properly, asthma doesn’t need to prevent you from playing sport or exercising. But over the years I’ve had many fit, young patients who have put themselves at risk because they don’t want to accept they have this chronic disease.
My 18-year-old patient, Rob, resented having been diagnosed with asthma as a child and wanted to believe that he had grown out of it. Over the past few months, he’d had a series of colds which had made his breathing so bad he was waking up at night. He was using his Ventolin puffer two or three times during a game of football and every other time he experienced symptoms. We worked out he was using his puffer about eight times a day.
Like many other people, Rob tends to think of asthma as being a pretty trivial kind of illness, but the reality is that about 400 Australians die because of asthma each year.
People with very mild asthma who have symptoms only a few times a year can usually manage simply by taking their Ventolin puffer to relieve symptoms. However, as a rule of thumb, anyone who uses their Ventolin more than twice a week to relieve symptoms should be on a preventer. Preventers are usually inhaled steroids, which over time will reduce the inflammation, swelling and mucus in your lungs. To work effectively, they need to be taken every day, regardless of how well you feel and whether or not you’re experiencing asthma symptoms.
Rob didn’t like the idea of taking medication every day when he felt fine. But not taking his preventer meant he was developing a tolerance to his Ventolin, which is a reliever puffer. He needed to take more and more reliever to relax the muscles inside his lungs, which is dangerous.
Rob and I filled out an asthma management plan to help him manage his asthma better. It outlines how he needs to adjust his medication, depending on his symptoms, and spells out when to call an ambulance. I also confirmed he was using his inhaler correctly, because many people with asthma haven’t mastered using it correctly. He promised me he would try his reliever for a month to see how he would feel.
When I last saw Rob, he said he hadn’t realised just how much his asthma had been affecting his life. He has stuck his asthma management plan on the fridge, takes his preventer regularly and only has a few puffs of reliever before he plays football. All being well, I won’t need to see him again for six months.
For more information about asthma, visit nationalasthma.org.au

Keeping a medication list could save your life

23 August 2014
Article rank: FOUR OUT OF FIVE “Other readers say: Very interesting article”

BERYL, 69, is taking five different medications. Fortunately, she’s very careful to take her tablets correctly.
Beryl came to see me after being discharged from hospital. She had been started on a new tablet, but couldn’t remember its name.
So, I asked her to bring all of her medications to me for review.
The instant Beryl tipped her boxes of tablets onto my desk I realised she was lucky to be alive. She had been taking two different brands of warfarin – Coumarin and Marevan – thinking that they were two different drugs. In effect, she had been taking a double dose, which could cause spontaneous and severe bleeding.
Beryl isn’t the first person to make this mistake.
Medicines have two names – their brand name and their chemical, or generic, name. The brand name is usually the bold name on the box.
The generic name is usually printed in smaller type under the brand name. Often it’s harder to pronounce. This is the one that you should try to remember.
Pharmacists may offer you a generic medication because it is less expensive.
It’s fine to accept the generic, but remember that the box and tablet might look different to what you are used to, despite being the same drug.
Prescribing problems can also arise when doctors don’t know what medications you are taking.
If you have an unexpected visit to hospital or see a new GP, doctors will rely on you to remember your medication and medical history. That can be difficult, but you can make this easier and safer.
Pull out your medicine box and get ready to take notes. Write down the generic name, the brand name, the dose and why you are taking the medication. Then keep your list safe in your wallet or purse. Make sure you keep it up to date. This could save you a visit to the hospital or even your life.
Next time you’re off to visit your GP, take all of your medications along for review. Don’t forget to include any alternative medications, like St John’s wort.
Fortunately, now Beryl’s health is back on track and she is more confident about taking her medications.
Sydney North Shore and Beaches Medicare Local has developed a health diary to help you keep track of medications, appointments and conditions. Phone 1300 798 307 for your free copy.

Ways of spotting the signs

16 August 2014
Article Rank: FIVE OUT OF FIVE “Excellent article”

I UNDERSTOOD why my patient was confused. His wife functioned quite effectively in a high-pressure job in advertising. She left the house early for work, dressed smartly in a tailored suit. She was popular at work – often the life of the party – and loved by her friends. She seemed happy enough and looked to be in perfectly good health.
But my patient was deeply concerned, that despite appearances, his wife had become an alcoholic.
Her drinking had slowly crept up over time, influenced by the culture of taking clients out for long lunches. At night, she had a glass of wine as she cooked dinner and a couple of glasses as they ate together. Health realised that when factoring in her drinking over lunch, she was consuming more than a bottle of wine every day; sometimes more when socialising on weekends. We worked out that she was drinking about 60 standard drinks a week.
The National Health and Medical Research Council recommends alcohol consumption should not exceed 28 standard drinks per week for men and 14 standard drinks per week for women.
There’s obviously a big difference between a standard drink and a classic Aussie glass of wine. In a standard normal 750ml bottle of wine there are seven and a half standard drinks, not four.
His wife never seemed particularly drunk and it is not like she was staying out late and getting into drunken brawls. She denied she had any problem with alcohol and was angry he had suggested it. But there is no doubt her drinking was significantly increasing her lifetime risk of alcohol-related disease or injury.
There are a range of views on what defines an alcoholic, but there is a simple four-question test which can help people identify whether they have a problem with alcohol. Known as the CAGE Questionnaire, it requires simple yes or no answers to the following four questions:
1. Have you ever felt you should cut down on your drinking?
2. Have people annoyed you by criticising your drinking?
3. Have you ever felt bad or guilty about your drinking?
4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (ie, an eye-opener)?
Two or more ‘yes’ answers is considered clinically significant, which flags that it is important to discuss your alcohol consumption with your GP.

Prevent falls in the home

9 August 2014
Article rank: THREE OUT OF FIVE “Other readers say: Interesting article”

ONE of my fit 70-year-old patients broke her jaw in two places a while ago.
Reduce the chance of debilitating falls by keeping active and healthy and removing trip hazards around the home.
All of a sudden she went from being well and taking care of herself to being admitted to hospital for surgery. She had to change her diet completely and put her life on hold for six weeks.
How did she end up with such a terrible injury? She walked out her back door and tripped on her hose.
Another patient who was in her 80s endured two years of pain after experiencing a crush fracture of one of her lumbar vertebrae. She tripped on a bath mat.
The simplest things can cause falls in the home, leading to serious injuries, and people older than 65 are at the highest risk.
New research shows that patients injured in falls spend an average of 15 days in hospital.
We know that hospital is not always a safe place to be, given the increased risk of blood clots and infections.
Prevention is definitely better than cure and there is a lot you can do to make yourself safer.
The most obvious thing is to have a good look around your house for dangers, and to remember many might not be immediately obvious. (I know many people who have fallen over their dog.)
Ask adult children or friends to help you, as a fresh eye is better placed to spot everyday dangers.
Talk to your GP, who might help you access professionals to help, such as Aged Care Assessment Teams or an occupational therapist.
Also be aware that if you are taking a large number of medications, you’re at greater risk of significant drops in your blood pressure, so it is important to have one regular GP who is aware of all medications you are taking.
Be particularly mindful of the risk of falls when changing your medication or the dose, and keep in mind that sleeping tablets, particularly benzodiazepines, antidepressants, antipsychotics and some pain killers can be associated with a significant increase in falls risk.
Your GP might also check your blood pressure, both when you’re lying and standing, and assess your bone health.
Exercise, such as tai chi, is also an effective way of preventing falls, but build up gradually if you’re not very physically active.
To find a falls-prevention exercise class tailored for seniors, call Sydney North Shore and Beaches Medicare Local on 1300 798 307.

Three steps to combat fatigue

2 August 2014
Article rank: FOUR OUT OF FIVE “Other readers say: Very interesting article”
I HAD a patient in her late 20s who popped in to see me a while ago, saying “Harry, I’m tired”. I didn’t doubt her for a minute.
While she felt exhausted she did not look particularly exhausted, just like many other patients who stream through my clinic each day with the same complaint. Often they’re convinced some serious medical condition must be at play.
Tiredness can be caused by a range of conditions, including thyroid problems, anaemia, coeliac disease and depression, so see your doctor if you are worried. Some medication can cause tiredness, too.
Doctors should take a thorough history, examination and may do blood tests to exclude any serious illness. The older you are the more likely it is to be a medical problem.
But the good news is that medical problems are rarely the cause. It’s also unlikely that changing your diet or taking vitamins will make any difference.
I got chatting to my tired patient and learned she was in a difficult relationship and an uninspiring job. She was troubled by all three of the issues that keep most of my tired patients awake at night: money, work and relationships.
She was surprised to learn that most people need eight hours of good-quality sleep a night in order to wake up refreshed. And some of the things we do at night, in order to wind down, can really work against us.
When you’re stressed, it can be tempting to have a few drinks to help you relax. But research has shown that even relatively low amounts of alcohol can produce poorquality sleep.
Watching TV or spending hours on the internet can make things worse too, stimulating your mind and keeping you out of bed late.
Here is a three-point challenge that might just turn your life around.
For two weeks, try setting yourself an alarm for when you need to be in bed, rather than just one to get you up in the morning. Hit a bottle of sparkling mineral water rather than anything alcoholic in the evening. And resist the urge to turn on the telly. Instead, put on your joggers and go for a walk.
Longer term, work out the specific things that are making you stressed and do your best to resolve them. That might involve some tough decisions, or getting some help from a psychologist, but reducing stress will improve your quality of sleep.
I have seen a difference in my young patient. She changed her job and relationship, stopped drinking and has lost weight. She’s not tired. She’s happy and enjoying life.

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