The Extra Childhood Vaccines I Get Asked About

 

 

Most patients and parents are aware of the vaccinations available on the Government funded schedule – all Australian children are eligible to receive these for free. Diseases such as hepatitis B, pertussis (whooping cough), diptheria, polio, measles, mumps and rubella are just some of the ones we vaccinate against. BUT, there are now many other additional vaccinations available to reduce your child’s risk of disease even further – and I can tell you more and more patients are starting to use these.

 

Compiled here are the common additional vaccinations that you may want to consider for your child. All of these are available on private script (which means you have to pay out of pocket, unless you fit into the high risk group that the Government will fund the vaccination for – the criteria varies for each vaccination so you need to speak to your GP).

 

  1. Meningococcal B vaccination

 

On the Australian schedule all vaccinated children receive a Meningococcal C vaccine at 12 months (they receive this at the same time as the measles, mumps, rubella vaccine). Meningococcal is a potentially fatal disease and there are many strains; children under 5 years old are most at risk, as well as those aged 15 to 24. Being vaccinated against the C strain does NOT protect you from the other strains of the bacteria and this is where I find most patients get confused. Imagine a bug with 5 different variations – each slightly unique, a different colour or shape. I can vaccinate you against the blue circular variation, but you won’t be protected against the green square or the yellow triangle types. That’s where each vaccination is unique and covers a different strain.

The vaccine against meningococcal B is called Bexsero™ and the number of doses depends on the age you start vaccinating your child. Children under 6 months need 3 doses, however, those over 6 months only require 2. The Bexsero™ vaccine is in short supply in Australia so if you want to vaccinate yourself or your child then you might need to wait for pharmacies to get stock.

 

Personally, we vaccinated Miss S against this before she was 6 months old due to our overseas travel and our professional experiences with meningococcal – we have both seen patients with those diseases and we were not going to take the chance.

 

  1. Flu shot

Children with chronic medical conditions such as asthma and diabetes will get this funded for by the Government. For everyone else however, you have to pay and it generally costs $20-$30. The flu shot and the strains it covers changes every year (as the flu virus is constantly adapting, they have to keep adapting the vaccine). If you choose to vaccinate your child from Influenza you need to get the vaccine yearly. The first year you vaccinate your child they require 2 vaccines (IF under 9 years old) at least 4 weeks apart to mount an adequate immune response. Influenza can be lethal due to its complications such as pneumonia.

 

On a personal note, Miss S was vaccinated against this as a 1 year old – she received 2 doses 4 weeks apart. As a GP I am vaccinating more and more children against this as parents try to protect their children from the highly contagious disease.

 

  1. Meningococcal A, C, Y, W vaccine

This is a vaccination that many Australian parents are now giving their children now that the W strain is making a resurgence in Australia. Currently, the Government is funding vaccination against this strain for high school children; everyone else has to pay for the vaccination. There are 3 vaccines available –Menveo™, Menactra™ and Nimenrix™ (there is a range of doses, and target age groups). Whilst these were traditionally recommended when travelling to high risk areas, many parents are now vaccinating their children because the issue is closer to home.

 

We did vaccinate Miss S against this in 2017 – she received a single dose of Nimenrix™ (she does not need a booster dose as she is not high risk).

 

  1. Tuberculosis

The tuberculosis vaccine is one you might need to consider if travelling to an ‘at-risk’ area (India, Fiji etc) with your child. This vaccine is in short supply but if you’re planning travel to one of these countries then it’s worth speaking to a paediatric travel doctor who can assess your need for the vaccine (your GP can refer you). Miss S received this vaccination prior to our India trip as she was under 12 months old and at risk of complicated disease due to her age. It is worth noting that the vaccination is in short supply world-wide so only high-risk individuals are vaccinated currently – a paediatric travel doctor must be the one to assess you.

 

 

I hope this helps answer your questions and allows you as a family to decide which additional vaccinations you may want to consider. If you found this helpful please share it with other parents – I find this is one of the commonest areas I get asked about.

 

 

 

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Dear Patient – An Open Letter

 

 

Dear Patient,

 

It’s about time we had an honest discussion don’t you think?

 

Firstly, you’re not the first patient to say “you wouldn’t understand Preeya” when you try to justify your non- compliance with therapy, whether it be the tablet, exercise or meditation I prescribed. When you admit that you keep forgetting to take your iron tablets, how hard it is to remember your asthma puffers every day or that you’re finding it really hard to find the time to exercise; I get it. May I be completely honest without losing credibility? I had iron deficiency after breast feeding for 6 months. My iron levels were low and I was told to take a supplement by my GP (yes, I have my own GP)– I took them sporadically (insert sheepish face)– I kept forgetting, my guts hated it and I wondered if the universe had given me the nutritional deficiency solely so I would gain empathy for my patients who had the condition– well, it worked! I also have asthma – I take my inhalers 80% of the time. I counsel all my asthmatic patients that the condition is long term, cannot be cured but can be very well controlled. The preventer puffer, if you need it, is essential to keep the lungs stable – it stops the airways from over reacting to cold air, pollens, exercise – whatever your triggers are. The preventer is vital, even if you feel well, to keep the asthma under control. I give the spiel often. But when it comes to me –I am not as reliable as I would like my patients to be. I often forget my inhaler when I have been well with no symptoms. Life gets in the way. I get busy worrying about Miss S’ nappy rash, work outfits for the week, meal planning – who could give a crap about my asthma?

 

Please don’t forget I am human too. When you sit across from me and say I wouldn’t understand, I grimace, because I struggle with all the same stuff you do – taking my medication every day, fitting in exercise, not reaching out for a wine every night. Being a doctor certainly doesn’t make me the perfect patient.

 

When I talk to you about bumping up exercise to aim for 30 minutes most days, I know how difficult it can be. I face the same battle every day. I notice your face fall when I ask you how the lifestyle changes have been going (my patients and I often work on diet and exercise changes to treat high blood pressure and type 2 diabetes amongst other conditions). I am not here to judge or punish you. I am simply here to guide, motivate and help you take the steering wheel of your own health. I feel sad when you say “Preeya you don’t know how hard it is to fit the exercise in.” Do I become immune to life’s challenges because I sit in the GP chair? These days, I am very honest with my patients; I juggle (and whether I succeed or not is a different matter) my motherhood, work, home life, an attempted social life and marriage; and trust me, I struggle fitting it all in too. I cannot possibly do 30 minutes of exercise every day – so I don’t expect you to either. I do something active 5 out of 7 days most weeks and I don’t even expect my patients to do that; I only expect that you will TRY to take control of your own health will all the information and tools I give you. If you don’t succeed every time that’s OK; I don’t expect miracles. So please don’t be scared to tell me if you haven’t done a walk 3 times a week or reduced your pastry intake; being a human I face all the same challenges as you.

 

Running late makes me very stressed. I know you’re waiting out there wondering why its 2PM, your appointment was booked for 145PM and I’ve just called someone else in before you. When I look at my list on the computer and see 4 people waiting, time ticking away – I get a big knot in my stomach because I know unless someone comes in for a quick cold and sick certificate I will not make up time (and even a cold isn’t ever really a cold FYI, there’s always something else –a sexually transmitted infection, an ingrown toenail – it is never ever “just a cold”). Trust me, I know you’re in the waiting room peeved off, getting angrier as each minute ticks by. And I promise you that if I could always run on time I would, I try my very best but sometimes things get out of control. When a person comes in and answers “yes” when I ask if they have been thinking about harming themselves, that takes longer than a standard 15-minute appointment. Likewise, the new mother who comes in for mastitis but sobs, struggling to take a breath because she is just that exhausted – I can’t throw antibiotics at her and push her out the door. And that’s not the kind of GP I am anyway, which is likely why you are still sitting in my waiting room despite me running behind. So please understand, if I am running late it isn’t because I’m playing Candy Crush on my phone.

 

Whilst on the topic, there are some things that most GPs struggle with and I’m ready to tell you what leads to many of us running late (and I haven’t seen anyone share this with patients before) – “The list”. The dreaded list. When you have booked a single appointment, which is 15 minutes for most GPs, and you have a list of 5 topics you want covered, there is no way humanly possible I can take care of your period problems, acne, pap smear, breast lump and anxiety properly in a standard appointment. So please don’t be offended when I say “can we choose the 2 things that are most important to you and deal with them today?” I need time to do my job properly and do justice to all the issues on your list and if you think you might need more time book a double appointment.

 

On a more awkward topic, let’s talk money. Doctors are shocking when it comes to talking about finances and billing. But, given we agreed to an honest discussion, let’s do this. It has taken me 4 years to know my worth, even then, I often struggle with billing people. Unless we have an agreement (like you’re financially struggling or you have a health care card for instance) I will privately bill you. And please know this, I have a toddler in childcare, I have bills to pay too. The notion that all doctors are rolling in it is far from the truth – I work hard for my pennies I can assure you, so please understand that just as you pay your dentist, physio, beauty therapist, personal trainer – the service we provide as GPs is also fee for service. The money you pay at the front desk doesn’t just go into the GP pocket either – we get a percentage; the rest goes to the clinic to pay admin and room costs and from the pennies we do get we pay significant medical indemnity insurance, college and medical board fees. Having said if you tell me you are unemployed, struggling to make ends meet but you need regular appointments for your Depression – I will always agree to bulk bill you (and I have many patients in that boat).

 

A few key things I want to share with you:

  1. You never need to apologise when you need an examination of your nether regions – whether it be for a rectal examination, rash or cervical cancer screening test. I’m not ever “grossed out” – your words not mine, and you don’t need to profusely apologise as you climb onto the examination bed. Likewise, ladies, when I examine under your armpits in a breast examination (for lymph nodes) you don’t need to worry– I’m not judging you on how sweaty you are; my mind is completely preoccupied on ensuring I cannot detect a breast cancer.
  2. When you ask “door open or shut Preeya?” as you leave the consulting room my heart swells every time. It’s kind and my decision changes constantly depending on the room temperature.
  3. I don’t have all the answers all the time – no doctor can know everything and there are so many things in medicine (tummy aches, bouts of nausea, strange tingly feelings in your left big toe every Tuesday) that we can never explain and they disappear on their own. If I say “it is nothing sinister, I can assure you of that, let’s watch and wait and see each other again in 2 weeks’ time” know that I am not blowing you off – I’m using the power of time (the greatest weapon in general practice) to help us find the diagnosis. And usually, your symptoms are gone in 2 weeks anyway, and if they’re not we will look into it with whatever investigation is needed.
  4. My tissue box is there for a reason. Please don’t worry about apologising, “sorry Preeya, this is embarrassing,” as you break into tears. You’re not the first person, and you won’t be the last. Ravage the tissue box, that’s what its there for. On that note, you don’t need a medical reason to see me either. Loads of patients book an appointment to debrief, have a cry, unload their worries – that’s part of my role as a GP so don’t feel guilty. You don’t need a cold, headache, sore ear– if you’ve had a bad day at work, the marriage is crumbling – I am here.

 

Finally, you should know this. I often think about you when you leave my consulting room when the sun has set and you’ve well and truly forgotten your appointment with me. If I’m worried about your diagnosis, your mental health, your stress levels or anxiety – I think about you. You pop into my head and I think “I just hope he/she is going OK.” You’re more than a number or a ‘patient’ to me – you’re a person. Like many GPs, I don’t just switch off and forget the story you told me that day about your recent relationship troubles, bullying at work or family violence issues at home. I do think about you – a lot.

 

Perhaps now, the next time I’m running late you’ll know just how anxious I really am. Perhaps you’ll modify your list so that the 10 issues are whittled down to a more achievable 2 for a single appointment. Maybe now realise I’m just a regulation human who doesn’t have all the answers and doesn’t live the perfect “healthy” life.

 

See you soon (but for your sake, hopefully not because if you see me it means something is wrong).

 

 

Your GP, Preeya

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Preezy’s Tuna Slice

 

 

I love my tuna slice; it is so easy to make and works as both a hand-held toddler food and an adult meal. Miss S, Will and I all love it and if I make a large batch it ends up feeding us for a few days, which means a cooking break for me! The medical wins of this meal – it is fish based so excellent for cholesterol management and given you pack so many vegetables in it’s an easy way to get the 5 daily serves in (especially if you have it with salad on the side!).

 

What you need:

1 medium sized onion chopped into quarters– I use brown or red; whatever I have

Eggs – the number depends on how much veg you put in –I usually use 6 eggs because of my vegetable content. The egg is the binder so if you use loads of vegetables or you are making a gigantic slice, you may need more. When you are pouring into your baking dish at the end you want a thick biscuit mixture- like consistency so add enough egg to achieve that!

1 x 415 gram tuna can – I like to use tuna in olive oil as it gives the slice some moistness. You can use brine or spring water bases; whatever you fancy.

1 cup of milk – I use low fat

Approximately 100 grams of savoury crackers – Savoy for instance

A good handful or 2 of cheddar cheese – aim for 80 to 100 grams if you’re into measuring

Parsley (I use this as it goes beautifully with tuna and we have loads in the garden) – you can use whatever you have though– basil also works really well!

1 cup of frozen peas thawed – please note you can use whatever you like here – you can just use peas or just use corn – I use both as my family loves them

1 cup of frozen corn thawed (I throw boiling water on the cup of frozen vegetables and leave it for 5 minutes then thoroughly drain the fluid off)

1 zucchini – grated

Whatever other veg you have – I sometimes put in the following depending on what I have

2 stalks of celery chopped

4-5 mushrooms chopped

Spinach from the garden –I often chuck in loads

1 tomato chopped – be careful with more that this as it can add to much fluid to the slice

 

FYI my last batch contained 1 whole zucchini, 1 cup peas, 1 cup corn, 4 mushrooms and a handful of silverbeet– it was seriously delicious and perhaps my best batch yet!

 

I use the thermomix to make this but you don’t need to – I’ve provided both options below.

 

For thermomix kids:

  1. Chuck in the chopped onion and blitz it on speed 7 for 10 seconds
  2. Scrape down the sides, chuck in the biscuits and cheese and blitz again for 10 seconds on speed 7 (it should be a thick paste like consistency)
  3. Throw in the eggs, vegetables, herbs (literally everything else in the list up there) and season with pepper (I do not add salt as Miss S eats this)
  4. Stir on speed 3 for 1 minute or until all the ingredients are combined. Sometimes I put the speed higher just to really mix it all up.
  5. Chuck it in a lined baking tray and bake that baby on 180 degrees for 25 – 30 minutes (it should be golden brown on top)

 

If you don’t have a thermomix (and I have made it sans thermie before and it worked) just chop the onion finely instead. You will need a blender though for the biscuits and cheese for it to really work well. If you blend the onion, biscuits and cheese for the first few steps then mix in the eggs, herbs and vegetables by hand it still works beautifully!

 

I often serve this with salad on the side (Miss S gets chopped up cherry tomatoes, cucumber and lettuce) but if your child won’t eat the salad then you still know you’re getting enough goodness into them anyway through the slice. This makes a fantastic on the go meal for adults and kids.

 

Good luck – and if you try it, post it and tag me please (@thewholesomedoctor)! Love seeing what people do with my weird and wonderful recipe ideas!

 

 

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My Response to Being Told to Lose Weight

 

 

In case you have never met me, may I briefly describe myself – I am a type A, bubbly, 90% of the time content 30 year-old. I can hold a good conversation, often take it over (apologies in advance for what’s to come) and can take an excellent joke and deliver it in a mediocre fashion. I rule (I think) the kitchen with easy, toddler friendly, healthy meals. I am the one pot wonder queen who can pack enough veggies into any meal that will put Jamie Oliver to shame (sorry Jamie, I still adore you and you’re cracking accent though). I work as a GP but my defining roles are mother, wife, daughter, friend.

 

Note I didn’t mention my weight, height, hair colour (or skin colour for that matter). It’s because I don’t think those are my defining features.

 

Recently I shared an experience with my followers on Instagram. The response was overwhelming. I am a doctor with a media profile with the sole aim of promoting preventative health in a fun and dynamic manner, I am trying to inspire people to take charge of their own health. Despite being a medical professional with some idea about what is healthy and what isn’t, I was told to consider losing weight to be successful in my media journey. Read on, it gets worse.

 

Months ago, I interviewed 6 publicists via phone call to assist me with “The Wholesome Doctor” (I often refer to her in the third person to reduce my own anxiety levels; it isn’t actually me putting myself out there. I’m quite similar to Beyonce in that manner with her persona Sasha Fierce. Mind you, the similarities do not end there; all I’ll say is wait until I dance! I digress sorry, this is exactly what I meant about taking over conversations). Overall the experience was quite pleasant – the PR world is one I have never dealt with – but generally people were kind and constructive. Except one. I was told by one man that if I wanted to aspire for TV I should “review” my weight if I wanted to look “good”. He added that Carrie Bickmore from “The Project” should be my yard stick, after I had commented that being a guest on the show one day would be my dream. I adore Carrie, I really do, but I’m not trying to replace Carrie (that’s sacrilege, isn’t it?). I am a doctor trying to provide health information to people in a way that is easy to understand – I don’t think I need to look like anyone else to do that.  Instead of exploding (surprisingly my brain did not coat the walls), I laughed. I giggled in fact. My response was “I am who I am.” Those are the exact words that came out of my mouth; I knew that I would not change my appearance (or weight in particular) for anyone. I gently highlighted he had missed the purpose of my endeavors – my point of difference was that I was a doctor and that I was not attempting to compete on red carpets or Melbourne Cup marquees – I was trying to get people thinking about their health and inspire some positive change. He had missed the mark completely and I made him aware of his mistake, trust me.

 

In the 4 months since the phone call I have had time to reflect. Whilst I giggled at his comment about my weight, I later realised that if someone tells our daughter to lose weight in the future so she looks “good” I won’t cope as well; mainly because at 18 months I do not yet know how my daughter will deal with such a stupid unnecessary, yet potentially very damaging, remark. A comment like his plants a dangerous seed in the mind of a woman, or any person for that matter; “am I good enough?” Even in my case it did; I ruminated on his comments after I hung up before realising, “wait a minute, that’s ridiculous – I do not need to lose weight for TV and I won’t.” My fear, and what I see come to fruition all the time with my patients, is that not everyone can stay standing after a comment like this. Not everyone can quash the seed.

 

It got me thinking – how often do women get subjected to this sort of thing? Eating disorders affect 4% of the Australian population at any given time; 60% of those are women. As women we are almost programmed to constantly measure up to unrealistic goals and it is no wonder some of us succumb. We are programmed to strive for “thinspiration,” thigh gaps and 6 packs. And from what I can see on social media exercise only counts if you have dumb bells hanging off your ears whilst you do 300 squats. I find so many of my patients (both younger and older) strive for the picture of health presented by their Instagram or Facebook feed. Hold up, who said the size zero woman in the red bikini was healthy? Healthy doesn’t equate to how thin you are or how many green chia seed smoothies you drink.

 

For the record I am 60 kilograms and a size 10. My BMI and blood pressure are well within the healthy range. I eat 5 serves of vegetables every day but sometimes struggle with the 2 serves of fruit. I exercise most days – walking and reformer pilates are my thing or “thang” if I was trying to be more hip than what I am. My pap smear is up to date. Point is – I do not need to lose weight. Quite frankly, the suggestion this publicist made is offensive– are you questioning my healthiness or ability to be on TV because I am not stick thin? And what else do I need to change to be successful? My patients don’t require a 6 pack or thigh gap as proof of my healthiness; neither should the media. I am a real woman, I reflect the norm. Questioning my weight is not acceptable. And honestly, I don’t think Carrie would be too pleased with being used as a yard stick either (and if I knew her I’d tell her over a wine and have a giggle, but also plot to change the world for women so this type of thing didn’t happen anymore).

 

If I ever discuss weight loss with a patient it is because they are in the overweight or obese weight range and even a small amount of slow sustainable weight loss (even 5 to 10%) could improve their fertility chances in polycystic ovarian syndrome or improve their fatty liver disease or reduce their blood pressure. The discussion never, ever, revolves around appearance. When I have the tough talk with women it’s to inspire them to change their health outcomes, not to destroy them so they walk out of my room ruminating on the negative seed I’ve planted. Plus, I hope we agree I am qualified to talk about weight loss – this is part my job. It certainly isn’t in the publicist’s job description. For the record – I’ve found a gorgeous publicist since who is horrified by this story. The others in the industry I have met since are equally shocked but have conceded that this stuff “does happen.” Well hopefully not after I’m done hey!

 

It is time to look at women for who we are, not how we look. This particular publicist should have judged me on my credentials, my ability to communicate, my manner, my social presence (or lack thereof!), anything, but my weight. The media should be filled with women who look like the majority so that we feel validated. Give us something real to aspire towards. Make us feel proud and validated when we flick through our magazines or turn the TV on. Show us women with stretch marks on their belly post the birth of their child. Show us women who don’t have a flat stomach in a pencil skirt. In essence, show me normal women like me. And don’t tell me to change.

 

To the publicist who made the comment to me –I am “good” enough mate (to use your own word back at you) – and my weight, dress size and appearance has f-all to do with it (I apologise for using a modified expletive but this really called for it).

 

 

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Pap Smears (and all the upcoming changes) in a Nut Shell

 

Why do we need to do this damn test?

 

A pap smear aims to detect changes before cervical cancer develops – it essentially prevents cervical cancer as we can intervene (with surgical procedures) before the disease develops. It is important to know that UNTIL the new screening program comes in on December 1 2017 – women should still be undergoing their regular pap smears 2 yearly. So, if you are due now – get it done and don’t let anyone tell you otherwise!

 

What’s the current system for cervical cancer screening?

 

Currently it is recommended that every woman (who has ever been sexually active) in Australia gets a pap smear every 2 years. This includes women who have sex solely with women as the HPV virus is transmitted via skin to skin contact. Currently, we take a sample of cells from the cervix and it is analysed under a microscope to see if there are any changes to the cells to suggest infection with human papilloma virus (HPV) – if it is present we either monitor these women more closely (with 1 yearly pap smears) or send them off to a gynaecologist for closer assessment and potential surgery.

 

What’s the new system and how is it different?

 

On the 1st of December 2017 a new screening program for cervical cancer will be rolled out.

 

The main things you need to know (put very simply and clearly I hope!):

  1. The new screening program will be conducted every 5 years (I heard you sigh from over here ladies!!). Lots of women panic about the increased interval; “won’t you miss things?” is what I get asked. The new test is much more accurate so we know it is safer to leave women for a longer time interval.
  2. Instead of looking for cell changes, the new screening test will look for the presence of the HPV virus that causes the cell changes. See why it’s more accurate? HPV is a virus that many women and men can get infected with – most people never knew they had it. I call it the “cervix cold” to patients – most people get infected, clear the infection and have no problems. The issue however, is that the HPV virus is the cause of cervical cancer in 99.7% of cases. There are many strains but we know that types 16 and 18 are the riskiest when it comes to cervical cancer. This new test will look for the presence of the virus directly.
  3. IF your test comes back showing you have the HPV virus THEN the lab will go onto analyse the cells further to see if there are the changes present (so essentially run the pap smear test we are currently doing).
  4. The new screening program will screen women between 25 and 74. Yes, the age is going up – we used to start screening around 18 years old but we know the rates of cervical cancer in young women are extremely rare. There was a recent study that showed that women under 25 were getting no benefit from the cervical cancer screening program. It is completely safe to wait until 25 to have your first pap smear – unless you have symptoms like unusual bleeding or bleeding after intercourse – in which case everyone should seek a review from their GP earlier.
  5. Your first test should be TWO YEARS after your last pap smear test. ONLY once you have had the new screening test will you go into the 5-year interval program IF your result is normal.
  6. The new screening test will be conducted in the same manner as a pap smear (sorry girls!) – we still need to attain samples but at least it will be every 5 years if you get a normal result, as opposed to every 2 years! There is a plus in there! For high risk populations who get under- screened there is the opportunity to do self- collected samples but for everyone else it’s the same process as before.
  7. Even if you have had the cervical cancer vaccinations – you still need to get the testing done (whether it’s a pap smear or the new test as of December 1 2017). The vaccine covers only 4 strains of the virus – there are many more that can cause cervical cancer.

 

So, there you have it – the pap smear changes in a nut shell for you. Same nut, just cracked a different way if you will.

 

 

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Vaccines, Herd Immunity and “Wholesomeness” Explained

 

I am pro vaccination.

 

This shouldn’t come as a shock to you – at least I don’t think it should.

 

After posting on Instagram recently about childhood vaccination I had several direct messages that bluntly questioned my “wholesomeness.” One person actually wrote “you’re not very wholesome are you?” in response to me discussing the meningococcal B vaccination for children. When I was scrolling through the comments I thought “wow you’re questioning my wholesomeness? That’s a big call.” I was a touch offended to be honest. Do people equate “wholesome” with homeopathic natural remedies? If I prescribe a tablet to manage someone blood pressure (to prevent stroke and heart attacks) or antibiotics to treat their urinary tract infection am I somehow no longer “wholesome”?

 

 

Firstly, I’m a general practitioner who practises evidence based medicine. For those of you who just looked at that sentence and thought “she does what?” I don’t blame you! Essentially I, like most of my colleagues, rely on the evidence to direct our clinical practice – the years of studies that included thousands of people to tell us how we should safely clinically practice to help patients and prevent harm. Despite the wonderfully catchy tune of “Rock a Bye a Bear” – The Wiggles are extremely unlikely to fix your blood pressure so this intervention doesn’t fit into the category of evidence based medicine and thus I will not be prescribing it.

 

Let’s start with some blunt facts. Thanks to immunisation, diseases like diptheria and polio have virtually disappeared in Australia. Rates of meningococcal C have declined since the 1 year old vaccination was introduced on the schedule. Hospitilisations from diseases like rotavirus (which children are vaccinated again on the Australian schedule) and chicken pox are lower; much lower. It’s my job as a GP to counsel patients with the facts and let them make an informed decision.  I have patients questioning vaccination, or flat out refusing, and I try to keep an open mind, hear their concerns and address them. Everyone is entitled to their opinion – I appreciate that.

 

Let’s talk about herd immunity. Lots of people believe that despite being unvaccinated they are protected thanks to “the herd” – they essentially rely on the rest of us who do vaccinate ourselves and our children. The herd was great 20 years ago when it was strong, but with immunisation rates falling the herd immunity is dropping – it’s starting to look like a bunch of limpy meerkats as opposed to the lions you might have been envisioning. Herd immunity works on the notion that if the majority of people are vaccinated than those who are not are still protected because it’s unlikely anyone will get the stated illness and so it’s harder to contract it. If the majority of the herd is vaccinated and someone brings measles or rubella from overseas then the disease can’t spread as easily because the majority are protected. The herd is meant to protect the children who are too young to be vaccinated (children for instance don’t get the measles, mumps, rubella vaccine until 12 months) and those who cannot be vaccinated due to significant allergic reactions or underlying chronic diseases that weaken their immune system. It wasn’t designed to protect large number of people who simply choose not to vaccinate.

 

Quite frankly I don’t like being leaned on– I don’t think it is my child’s job to protect unimmunised children against vaccine preventable diseases (there are some kids who truly can’t be vaccinated due to allergies and I’m not talking about them). The burden is getting heavier and heavier to carry with the immunisation rates falling. More and more people are bringing in vaccine preventable diseases from overseas and its spreads much easier given we have a weak herd with more and more unvaccinated people in it. And that leaves us, the vaccinated ones, at risk too. No vaccine, likely any medical treatment, is 100% effective. If everyone around you has measles, despite being vaccinated you still have a chance of contracting it.

 

There are loads of myths about vaccination. The main one I have to address in my clinic is the myth that the measles, mumps, rubella vaccine (MMR) causes autism. There was a paper published in the Lancet in 1998 that made this claim – however, that paper was later retracted by the journal and an investigation into the research data was found to be fraudulent. Numerous respected bodies like the American Academy of Paediatrics have looked into these claims and there has never been a link between autism and the MMR vaccine found. The other debate is that vaccination is not natural – OK, honestly, I don’t even know what “natural” is anymore. If you drink soft drink or eat a cookie or apply moisturiser or live in a house or drive a car or use a bus or a train then none of that is natural either – they are all man-made things that would not naturally exist. So, what’s the difference? Antibiotics are not natural and yet we know they can cure diseases like tuberculosis, meningitis and whooping cough – so the same people who decline vaccination because it isn’t natural – do they decline treatment for potentially lethal but treatable diseases? Where does the line stand?

 

At Miss S’ childcare they require proof of vaccination under the Victorian Government’s “no jab no pay” policy. Whilst I hear the argument that the Government shouldn’t be able to control everything, I am honestly grateful for this initiative. I don’t want my child exposed to vaccine preventable diseases. I have seen a child hospitilised with whooping cough struggling to take a single breath – I don’t want to that to be Miss S. Will and I see our job as parents to give our daughter every opportunity in life so that she can grow up to be a kind, contributing member of society. We see our job as protecting her from harm as best as we can – yes she might graze her knee when she trips over or get a knock on her head now and then but we certainly won’t put her at risk of meningococcal or other potentially fatal diseases.

 

I know this might generate some hot debate, some eye rolling, some fury. But my medical practice (and modern medicine in general) is based on evidence, on the published medical papers that define how we as a profession practice. We can, and should, all have opinions but we must all be as informed as possible.

 

In short, please don’t question my “wholesomeness” because I am pro vaccination. And I won’t question yours because you use electricity.

 

 

If you would like to know more about some of the myths and facts related to vaccines you can refer to this resource (http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/AD34C3D063510C0CCA257D49001E73D4/$File/full-publication-myths-and-realities-5th-ed-2013.pdf) or speak to your GP.

 

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Miscarriage Unravelled

 

 

It wasn’t until we shared our story that people revealed theirs– “we had one too,” “it’s so hard, isn’t it? – it took us ages to recover,” “you never forget that baby, we certainly haven’t.”

 

I looked at my friends, and even family members, in disbelief. “You’ve had a miscarriage? How did I not know?”

 

We suffer silently. We suffer a tragic loss, perhaps the most painful kind, but we don’t share it. So many of us trudge through the darkest patch of our lives without the extended support network we would lean on in any other type of tragedy in our life. My question, why?

 

Before we conceived Miss S, Will and I had a miscarriage. Our baby was due on the 26th of December 2015, and at 5 weeks I started to bleed. I knew from the get go that the likelihood was that this was not a viable pregnancy but I had already envisioned holding this child and burying my face in his or her neck. Our world had already enveloped this little life, and now it was being ripped away. What bothered me most was that I had no control over the situation – none. I had been on all the right supplements pre-pregnancy, ensured I was as healthy as possible, done all the text book advice but it was failing and I was devastated , and angry.

 

As GP, I deal with countless pregnancies, but also miscarriages. I have women come in for the
“guess what Preeya, we’re pregnant” appointment (one of my favourites, especially when I’ve worked with a couple preconception). Unfortunately I’ve also dealt with the “something isn’t right, I’m bleeding” moment. I’ve had women have uneventful first trimesters only to have a scan at the 12-week mark that shows no heartbeat; breaking that news is heart shattering, but nothing compared to what the parents sitting opposite me are experiencing. I know this process well from a doctor’s point of view – but none of it helped me when I went through it myself.

 

I know the facts like the back of my hand. Up to 1 in 5 women experience miscarriage before 20 weeks of pregnancy – in fact the rates are likely even higher given many women miscarry without realising they are pregnant and so they think they are slightly late for their period. It is common, much more common that what people realise. Whilst there are things a pregnant woman can do to reduce risk like avoiding alcohol and smoking, in most cases a miscarriage occurs because of serious chromosomal issues within the embryo so the pregnancy is not viable. In many cases there is nothing the woman could have done. I reassure lots of patients with this where I can, but, having been on the other side the reassurance can do very little to alleviate the ruminating thoughts. It is worth noting however, that bleeding in the first trimester occurs in 20-40% of pregnancies BUT not all lead to miscarriage – many go on to have healthy uncomplicated pregnancies (the bleeding can be to cervical issues or implantation for instance).

 

After our miscarriage, I questioned for a long time if I had done something to cause it. I had not consumed alcohol or smoked but I had been to the gym and I had drunk a cup of coffee here and there. That was enough to drown me in a pool of guilt. As a GP, I have told women countless times “it is nothing you have done.” I had my husband, friends and colleagues telling me exactly the same things – “Preeya going to the gym did not cause this,” “Preeya you know full well that a cup of coffee in pregnancy is fine” “Preeya what would you say to a patient in your position? You know you didn’t do this”– but I couldn’t hear their words. Well I could, but I chose to ignore them because I was very much of view that I could have controlled it. It took me a good 4 weeks to gain some insight and realise that this issue had been out of my control. It took much longer to deal with the grief.

 

Many people are not aware of what happens when a woman miscarries. I recently heard of a horrific experience a woman in the media shared about her GP googling how to manage a miscarriage as she sat in the consulting room devastated. Let’s talk about the medical aspect for a moment; miscarriage can be managed in different ways. For some women, they have a heavier than normal period – we usually monitor the pregnancy hormone in the blood (and sometimes do ultrasounds) until it goes to zero to ensure no remnants of pregnancy remain in the uterus (this can cause pelvic infection down the track if left untreated). We call this expectantly managing the miscarriage – we let the body do its thing and monitor to ensure no complications arise. Not all women can attempt to have a natural miscarriage – they may be too far along in the pregnancy (so the contents of the uterus cannot pass through the cervix easily) or they may choose to proceed to a medical or surgical approach because the bleeding and pain are unbearable. The medical approach involves taking a medication called Misoprostol which helps to evacuate the contents of the uterus. For some they attempt to have a natural miscarriage but it fails (the pregnancy hormone remains elevated, material remains in the uterus or the bleeding is too heavy or the pain is too much) and so they can go on to have a dilatation and curettage (D and C) – a procedure performed by a surgeon to empty out the uterus. Some women go on to have surgical management straight away if they choose to or are further along in the pregnancy. That’s the crux medical stuff.

 

I had a natural miscarriage. I had a heavier than normal period and I sobbed every day for about 2 weeks. I drowned in a pool of guilt, lost dreams and the fear of it happening to us again. Thank goodness for my husband and my mother is all I will say. When I was able to face the world again Will and I decided to tell some of our friends – it was obvious something had happened in our life and people were asking if we were OK after missing several social events and being distant. I’ll be honest, I had a moment of “do we share this?” – would I be perceived as less “womanly” because I couldn’t sustain a pregnancy? These are, honestly, the types of guilty thoughts I was plagued with and I strongly suspect I am not alone. I felt somehow inadequate and ashamed. Seriously. Some women will share their experience and inner thoughts and some will not and that’s OK. I’m sharing these thoughts because as I GP I have sat in a room with women who feel their womanhood is in question, that they are to blame – and I want you to know despite all my training and knowledge I had the same inner dialogue – you are not alone.

 

I’ve had women sit across from me devastated at their loss. And only since my own experience can I truly sympathise. I don’t know why but there is some sort of comfort that comes when a person says they’ve experienced a similar loss – you look at them, I know I did, and think “that gives me some hope, maybe I will survive this too.” Recently I’ve told 2 patients that I suffered a miscarriage but now have a healthy daughter – I saw the hope on their face, I saw their shoulders go back just an inch – I had given them a glimmer of hope in a dark time and perhaps that’s the best therapy of all.

 

Sharing our stories (if we feel comfortable) can help. It’s hard as a doctor sharing our own journeys with patients– there are some of my colleagues who would look at me sharing this or my story of anxiety on my blog and think I’m pushing the boundary. There are lots who are supportive though. My personal view is that a doctor is no different to anyone else. I am not immune to anything and I don’t want to portray that to my patients. I respect the doctor-patient relationship and its boundaries but I also know that sharing the right story at the right time might just give someone the hope to get through. Sometimes it’s the human aspect of being a GP that is the best treatment – no pills or treatments, just an ear to listen to and a shoulder to lean on.

 

There should be no shame in sharing our stories of miscarriage. To the woman who might be reading this drenched in tears thinking “will I survive this?” –you will. It takes time, lots of it, and the emotional scar remains but you will survive. Boxing Day is always a day Will and I have a moment to reflect on our loss, but also be grateful for our beautiful gain in Miss S.

 

 

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“Grey’s Anatomy” Dissected

 

Myth 1: The hospital corridors are filled with Doctor McDreamy and McSteamy

 

Firstly, Dr McDreamy doesn’t exist (except for my husband of course – can we please ensure he sees this?). Secondly, if this doctor does exist he is usually over worked, exhausted and prematurely balding. In reality, the doctors roaming the hospital are more like Dr Webber – an ageing man who looks like he’s worked 20 hours every day for the past 16 years. And usually, he has done exactly that.

 

If there does happen to be the Unicorn (as I refer to them) he is usually aware of his effect on those with a beating heart, which dulls the shiny appeal. McDreamy, as true fans will know, was an all-round decent kind guy (skip the part where he had an affair whilst married to the super-hot Dr Montgomery which let’s be honest, I would have picked over Meredith- just saying). He was charmingly attractive with flecks of grey hair that gradually became more and more prominent as the seasons wore on; and somehow, he only got more attractive – the first thing that is strikingly different to real life. The other reality; the Unicorn is usually physically attractive but with serious personality flaws, or he’s just not that good at his job. This all round decent bloke who looks like George Clooney and cuts out brain tumours without breaking a sweat just isn’t how it is – sorry guys. So, before you purposely fall over to get into a hospital and snag the McSteamy, think again – you’re more likely to get a prematurely ageing moderately nice guy; but if you’re not picky, go for it!

 

Myth 2: Being a hospital doctor is glamorous

 

If only the hospital life were as glamorous as Grey’s Anatomy. I genuinely can’t remember the last time I saw a doctor in a clean pair of scrubs –there’s usually blood, urine, faeces or a portion of their lunch on there. Usually the bodily fluids are not their own; the key word being usually – after 20 hours straight in the hospital it’s hard to know sometimes. Honestly, (please don’t get upset) I don’t like Meredith Grey – I find her irritating and the notion that she is destined for greatness because her mother was a great surgeon is preposterous. I have, however, always enjoyed the producers attempts to make Meredith look slightly dishevelled but still glamorous– they chuck her hair in a low pony tail (that is somehow still perfectly wispy) like she’s just rocked up to work like any normal on-call doctor. Mate – I can tell you she looks better on her worst day then most of us in the hospital look like on our best. The lighting is the main issue – yes, I am going to blame the lights and not the ridiculous hours you work and subsequent fatigue. You could be Miranda Kerr but those hospital lights all day every day start making you look grey. I’m brown, and even I started to look grey when I worked in the hospital.

 

Christina and Meredith used to have some pretty cracking lunches in the cafeteria- they would debrief over fancy salads and smoothies. To be honest I survived on Bega cheese during my internship – the fridge in the doctor’s lounge was loaded with the stuff so constipation and reflux were a normal part of my life back then. A smoothie was unheard of – firstly, where the hell do you get it from? And secondly, if you are THINKING of leaving the hospital to get 1 you’re either on a cruisy psychiatry rotation or not doing your job properly.

 

Myth 3: These doctors can do it all – literally; have a love life, operate on the entire body and do tequila shots!

 

Perhaps the most unrealistic part of the show is the wide scope in which each doctor practises. It seems Maggie Pierce (you know Meredith’s long-lost half-sister?) can fix a fractured ankle, drill a hole in the skull, put a chest drain in and intubate the patient – all whilst whinging about the fact that the guy she likes actually likes her sister who is still in love with the ghost of her dead husband (this is not an exaggeration, this is the story line I have watched play out on my television screen). Let me tell you, in reality we doctors are all so subspecialised and constrained by bureaucracy (and medical indemnity) that no one would dare step into anyone else’s area. If Dr Hunt put a hole in someone’s skull to drain a bleed around the brain I can assure you Dr Shepherd would have strangled him – crossing territories DOES NOT happen. If you’re the orthopod fixing the leg you stay down there. They would never dare cross the threshold of the waist and fix the nerve laceration that the plastic surgeon is working on (and honesty, you don’t want them to – you want each doctor staying in their small territory of practice!). Oh and no one can intubate the patient but the anaesthetist (in between Sudoku and crosswords of course) – Dr Hunt and Dr Shepherd and every doctor in Seattle Grace throwing tubes down throats is hilarious. This multi-talented “I can operate on any part of the body” doctor simply doesn’t exist.

 

The other thing I have to mention given we often don’t talk about this as a profession (and if we do it’s on 60 minutes and generates a flicker of discussion before we go back to our old ways) –there is no way that you would ever have these numbers of women in surgical training. Grey, Torres, Robbins, Bailey, Wilson, Kepner, Grey (the little one), Shepard (the neurosurgeon sister of McDreamy– what a talented family just quietly), Edwards, Montgomery, Pearce, Teddy (the only one I’ll refer to by her first name because it’s just such a goodie – remember Christina’s mentor there for a while?) – you will never ever find this many women in surgery in the real world. Blunt Preeya for a moment – firstly, it’s a seriously hard life and part-timing with a family is nearly impossible – the women who have done it are the true Unicorns and I take my hat off to them! Secondly, it’s an incredibly hard battle in a male dominated field – do these women not get into training because they are women? Once they get in (if they ever do) do they have a very high-powered microscope on them because they are in fact a “woman”? I know that as a profession we desperately want to believe that it is all equal – but I think if we are honest we know that women in surgery cop it much much more than their male counterparts. Unfortunately, if you’re looking at the show thinking “wow women are right in there cutting shit up” – it isn’t the truth – sure there are women but they’re not flooding the air time like you might think (but then again, perhaps this is just a microcosm of a much broader issue in society).

 

Myth 4: Love is in the air in the hospital; its thick and steamy and foggy with love right?

 

Remember Izzy and Denny? He was the heart transplant patient she fell in love with. Sorry to burst the Izzy-Denny bubble (because I know how much everyone loved that story line), in reality you would be reported to the medical board for crossing the boundary with a patient. So as opposed to flash-backs and love scenes you would get a letter stating you were under investigation and there may also be hand cuffs involved (and not the good kind). Falling in love with a patient is a big no-no in the real world.

 

The best part of Grey’s for me was the social banter; the scenes at the house (when the gang all lived together back in the day) and the pub. They would get drunk and debrief on their patients and love lives. Truth be told, we used to do this – so perhaps the show is indeed based on fact! We did get drunk on most Friday nights the minute the pager stopped beeping. In hindsight (because I’m now older and wiser) it was self-medication – it was an attempt to numb the fatigue and anxiety (did I somehow contribute to that patient’s downfall? Should I have prescribed the potassium? Should I have given that patient some stronger pain relief?). The hospital I did my internship at had a doctors’ bar on the top level – I say the word “bar” loosely – it was a room with a fridge full of beer and ‘wine’, a pool table and some seriously unhygienic couches (which you would inevitably nap on during night shift waking with an itchy face from where your bare skin had touched it). My goodness the interns and residents would relish the Friday night drinks – sometimes a training physician (Alex Karev like) would join us and roam between the mere interns like a God. You would rarely see a surgical registrar in there – usually they were still actually working at 8PM on a Friday!

 

In fact, reality is the complete opposite to Grey’s Anatomy – where the show is focussed around training surgeons and their work and love life; reality is that the training surgeons don’t have one – a life that is. And for me, that’s the funniest part of this whole thing! The notion that McDreamy and Meredith would lie in bed talking and debating their marriage is preposterous. Don’t even get me started on Avery and Kepner, Owen and Christina or Owen and little Sherpard being items – this many surgeon + surgeon couples is unheard of and unsustainable (which is probably why only a quarter of them actually stayed together). If a surgeon is married to a surgeon in real life the chances of them sharing a bed and discussing anything at all is remote, trust me. One is usually going to be on call, interstate, operating, writing a paper or just making a junior doctor’s life hell – and one will be in bed thinking about all the stuff they need to do tomorrow.

 

Myth 5: CPR is easy-peasy and when a code is called smoking hot doctors run from cupboards, stairwells and cafeterias to save you

 

Will and I love watching the scenes on any show where they do CPR effortlessly – talking to each other and bouncing around the chest like Emma Wiggle on steroids (yes our family is in the Rock a Bye Bear phase – if you don’t know this reference you’re just not a true Wiggle fan and I won’t be humouring you). CPR is hard work. I can do a maximum 3-4 minutes and when I collapse next to the body I’m usually panting and sweaty – I don’t look like Kepner with her flowing hair and glistening cheeks and I’m not certainly not wearing a white coat (um no one really does I hate to tell you; and if you do most of the hospital are pissing themselves laughing at you behind your back). You can’t carry out a conversation whilst doing CPR. And you certainly don’t go as fast as they show you on the TV show – you don’t give the blood enough time to exit the heart and perfuse the brain if you’re too quick! (Let’s be serious for one moment. The compressions alone are unlikely to start the heart – the drugs we give, the shocks we deliver – that’s what gets the heart pumping again. The compressions are to keep the brain and heart muscle somewhat perfused with blood so that if we succeed with the resuscitation these organs are viable. OK, that’s the serious part over.)

 

 

There you have it – the show deconstructed for you, by someone who has worked in the system. I’m sorry to burst the bubble but Grey’s Anatomy certainly isn’t reality, it’s not even close, but truth be told I love the show, I still sometimes tune in to season 109 to see Meredith talk with her high-pitched whispery voice and Karev still act like the bad boy despite being 45 years old. A part of me, despite having worked in the system, still thinks maybe there are places where it’s like that – smoking hot doctors running around sleeping with each other and operating on the brain and ankle at the same time. Sometimes I wonder if I bombed out with the hospital I did my internship at, should I have applied to Seattle Grace instead? But deep deep down my soul who has worn scrubs flecked with urine (let’s not get into whose it was) and nursed an anxious stomach for 12 hours as I roamed from bedside to bedside as an intern knows, it just isn’t the case.

 

And I know what you’re all desperate to know, “Preeya, who would you have been on Grey’s?” – it’s a tough question and I can feel the pressure and scrutiny you will place on my answer. But if I had to choose – Dr Addison Montgomery. Nothing to do with being an obstetrician because I quite like having a life and delivering babies is seriously stressful, but because she was cool, had a kick arse name (and hair), loads of attitude and I would really like my own spin off show. Her next show Private Practice was MUCH more realistic –smoking hot doctors working in private practice together in a beachy town, sleeping with each other and still maintaining professional relationships whilst also maintain stunning hair and makeup. That show was far more realistic!

 

 

 

 

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The Anxious Doctor

 

 

I wrote the majority of this blog a few months ago, and have only now built up the courage to release it. I figure that it’s all well and good for me to carry on week in, week out about de-stigmatising mental illness BUT if I choose not to publish this blog then I’m only perpetuating the problem.

 

 

1 in 4 Australians suffer with anxiety.

 

Anxiety is the most common mental health issue in Australia.

 

Panic attacks – the tight chest, the sudden rapid onset of breathing and the foggy head – are more common than one might expect.

 

Children, adolescents, mothers, CEOs, millionaires – no one is immune.

 

I tell my patients with anxiety that there is a light at the end of the very dark and muggy tunnel. Eventually things can get better – the panic attacks die down and the negative loud voice that dominates your brain with its ruminating monologue can gradually become softer.

 

I know, as a GP, that there are different options that can help (psychology, relaxation strategies, mindfulness, medication to name a few). I know, as a GP, that by practicing good sleep hygiene sleep can come easier. I know all this because I’m a GP. But I also know this because I’ve lived through it.

 

Many times in my consulting room I have looked into the eyes of an anxious patient and said the words, “you are not alone” and “it can get a lot better.” But what I really want to say is “I 100% understand what you are talking about because I have been trapped in that foggy dark tunnel before, but I made it through and so can you.”

 

I have suffered from Generalised Anxiety Disorder. 8 years ago as a medical student trying to juggle an intense degree, relationship, social life and normal personal issues, I found myself in the dead center of a cyclone – panic attacks, inability to sleep, constant ruminating thoughts about everything that could possibly go wrong – was today the day I was going to die in the car on the way to uni? Was tonight the night I would fall asleep and not wake up? Did I have cancer that I didn’t know about? And if I did have cancer where was it?

 

It was bad. Really bad.

 

I would have panic attacks multiple times a day. Anything could trigger them. My friends and family would know how to settle them with some gentle counting to slow my breathing down. But boy did I feel like a failure – I was meant to be a high achieving successful student and here I was crumbling. It is only now I realize I was crumbling beneath my own expectations and anxiety’s hold on me.

 

I have painful memories of this time in my life. I remember driving to a friend’s house (I had been there 100 times) but being so caught up in my ruminating thoughts I got completely lost and went 20 minutes further than I should have. I arrived at her house distraught, it was the distinct moment I realised my brain had changed. I had a panic attack on her kitchen floor. I recall not sleeping a wink for nights in a row – I would lie there analysing anything I possibly could and breath a sigh of relief when, finally, the sun came up – I could now get out of bed. I will always remember the moment I walked into the GP’s room ready to address the problem – her door shut and I couldn’t utter a single word for 10 minutes because I was crying so heavily. I remember it all.

 

8 years ago I saw a health professional. I took medication. I practiced mindfulness. I kept a diary. I took up yoga. And 10 months later suddenly I started seeing the old Preeya again. I noticed the negative thoughts had dulled. The panic attacks went from daily to weekly to never. I was “me” again.

 

I often have patients walk into my room and as the door shuts I notice them clutching their hands, head hung low and the story comes pouring out. I have heard the words “I’m just not me anymore” more times than I can count. And that’s the line I connect with most – I remember when I was in my dark moments I would think “where has the fun-loving Preeya gone? How do I get her back? I’m NOT ME.” I get it. I really really get it.

 

So when something like anxiety is so common why don’t we talk about it more? Why DON’T I say to patients “hey, I know first hand what you’re going through.” Is it pride? Is it weak to admit I too have suffered from this common mental condition? As doctors we refrain from sharing too much about our personal life with our patients so as not to blur the professional therapeutic relationship – but does me sharing my own battle and normalizing a horrible experience for you hinder, or does it help?

 

When I say I know how it feels, I do. When I look back on that patch of my life I shudder but I also pull my shoulders back with a sense of accomplishment because hey, I survived it and it has definitely made me a more empathetic friend and GP.

 

So why have I shared this with you? And why now? Because after so many of you privately contacted me with your own experiences I felt it could only be of help for you to know that no one is immune. That I, the person who now treats patients with anxiety, have been there too and it certainly doesn’t make me immune to it in the future. When I sit across from you and say “this is a really difficult time” – trust me, I know what I’m talking about. But also know, that I’ve come good now, and maybe with the right help you can too. Whilst you may be stuck in a long dark tunnel I promise you there are people standing by the light who will do anything to drag you through to the other side.

 

 

 

 

If you, or someone you know, is suffering from anxiety or depression please speak to your GP. Lifeline 13 11 14 is a 24 hour counseling service available in Australia.

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Travelling? Why you should see your doctor before you pack your bathers!

We are about to head over to India, which got me thinking about what I needed to do to prep our family for the holiday. I see so many patients prepare poorly for their holidays when it comes to their health, so I thought I would share my top 6 tips with you:

 

  1. You’re thinking about outfits, how many pairs of shoes to pack (and do you really need a pair of heels on a beach holiday?– the eternal debate) and if you need bikinis and a one-piece (just in case!). So I get it, injections are the last thing on your mind. BUT – any overseas travel means you need to at least have a think about what vaccines you might need. Even the routine ones need to be updated now and then (like tetanus) and you may need specific ones for countries like India or Brazil. Hepatitis A, typhoid, cholera, yellow fever – do you need them? Often a patient will come and see me for a pap smear before their big trip and chuck in the line, “so I’m leaving in 2 weeks, do I need anything?”  Cue my internal screams of horror! Most vaccines take 6 weeks to be effective and if you need multiple injections it might be too late. So please see us a bit earlier so we have time to plan and get you as ready as possible before your trip!

 

 

  1. Travel insurance is non negotiable. And don’t just pick any old one – make sure you will be covered. If you’re pregnant are you covered? And is the baby if he or she decides to arrive early? And what about your asthma – are they happy to cover that too? Do more than just say yes to the travel agent when they ask you if you want it – investigate if you will actually be safe!

 

 

  1. I used to think I had an iron gut – “used to” being the operative words- until I found myself with a fever, dehydrated and hallucinating on a bathroom floor in Argentina. Food and water safety is something you can’t compromise on in a third world country. My 5 DON’Ts:
    1. DON’T have ice (as it’s usually tap water)
    2. DON’T drink water from the tap – only bottled or boiled
    3. DON’T eat uncooked fruit or vegetables washed in local water – a banana is OK because you peel the skin off but apples for instance where you eat the skin are a no no
    4. DON’T walk around with bare feet on the roads – there are parasites (i.e. strongyloides) that can enter through the feet (I know it’s not food related but an extra tip!)
    5. DON’T eat food that’s been sitting there at a roadside stall – if you want to try it (and I get it who travels and doesn’t experiment a touch!) make sure its served piping hot – JUST boiled/fried/cooked to give your gut the best chance

 

  1. If you take regular medications and you’ll be travelling with them ask your GP for a letter to make sure you don’t end up being questioned. Who really wants to spend time being questioned over their sleeping tablets??

 

 

  1. Take an emergency kit with you – think about what you might need as your hugging a toilet bowl. I usually tell patients to pack at least some pain relief (like paracetamol), bandaids, hand sanitizer, gastrolyte and anti-histamines if you are an allergic person. But then there are all sorts of other things you might need like antibiotics in case of bad gastro or pneumonia. Or if you are hiking Macchu Picchu you might need tablets to help with altitude sickness. See, another reason to see the doc before you hop on the plane.

 

 

  1. Mosquitoes should scare the living daylights out of you. Malaria, zika virus, dengue – these diseases are no joke. As a GP we have access to information about which countries are hot spots for which diseases and whether or not you need anti malria drugs. A few mosquito Dos:
    1. DO wear long sleeved tops and pants in a light colour at dawn and dusk (the biggest risk periods) to protect your skin
    2. DO buy the proper DEET mosquito repellant
    3. DO use a mosquito net if available at night
    4. DO (Please DO!!) speak to your doctor about whether you need anti malarial medication – there are a few available now so you have options!

 

So I know you’re excited. I know that the stuff I’ve just mentioned is incredibly boring compared to making a list of the restaurants and bars you want to visit whilst away BUT it’s more important I promise you. Getting malaria isn’t a joke – it can kill you. And getting diarrhea for 6 days because you drank the water also isn’t an ideal way to spend your beach holiday. So please book an appointment, do the boring stuff first… and then decide on which 700 pairs of bathers you’ll pack!

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