The Delicacies of Discussing Fertility


Asking any couple when they will have a baby is the equivalent to opening Pandora’s box whilst naked with no protective eye wear on – it’s a total no go zone, and extremely dangerous. There is a possibility the couple have been trying for 2 years and are currently saving their pennies for their first round of IVF. There is also a chance they don’t want children and no one should have to justify their personal choices. Years ago, a friend said to me “you and Will should have kids”– little did he know we were 3 weeks post miscarriage and I was still suffering physically; my tears as we walked into the wedding marquee were the reason you don’t ever broach the subject. What I’ve learnt about fertility and trying to conceive is that anxiety levels heighten very, very quickly. I’ve also witnessed the subtle fertility competition that exists; the “trying to conceive” race amongst friends and colleagues– the “we got pregnant without trying” people versus those who have to try a little bit harder. My word of advice – don’t ask about kids, when someone will have kids, when they will “try,” unless they start the conversation – just don’t.


When Will and I decided we were ready to start adding to our family I saw my GP, had my blood work done and got told to “give it a crack”. I remember the day I stopped taking the pill – it was a momentous occasion; suddenly we were saying we were ready to take this thing to the next level (little did we really know what the next level really was by the way!).


The minute we stopped contraception we wanted to be pregnant. Not tomorrow, not next cycle – today. For years I had been compliant with the pill, freaking out constantly that I was pregnant if I felt a strange niggle or was a day late. I had spent years avoiding, like the plague, the one thing I now desperately desired. To this day I think it’s interesting that we spend years avoiding something then desperately want it; a switch very suddenly flicks! I spend years helping women with contraception as a GP, finding the right option to prevent pregnancy and then suddenly we throw it in the bin, hoping she conceives instantly. Of course, nothing happened the first cycle for us; my poor mother listened as I questioned my ability to conceive. I found myself uttering words like “I’ve never been able to envision myself pregnant, maybe that’s a sign” and “I always knew something would be wrong with me.” My mother gently pointed out that in her day no one worried – people just cracked on. What mum didn’t realise is that everywhere I went I was forced to question my fertility. After 2 months of “trying” I recall driving to work when an IVF centre played their advertisement on the radio, “have you had trouble conceiving? Has it been 3 months?” I felt like the woman was talking directly to me, were they targeting me? And were we having “trouble”? Like a lot of times in my life, my GP hat blew up on my head and ruminating Preeya shone through. The truth was nothing was wrong with me at all – but all the advertising was excellent fodder for my wound-up mind to feed on! I know I am not alone here – patients often come in seeking reassurance after hearing people’s stories of conceiving easily or these same radio ads. Back in the day I’m sure there wasn’t the pressure to be fertile and conceive quickly – people just persisted. Now though every tabloid cover highlights somebody’s fertility issues or struggles with IVF and the radio constantly tells us trying for 3 months is too long – it’s no wonder lots of women start to get anxious before they even attempt to conceive.


When you’re desperate to get pregnant you see pregnant women everywhere. When I went to the supermarket it was a pregnant woman who got my park, when I was busting for the toilet at an event it was a pregnant woman who took longer in the cubicle, when I walked down the main street all I saw was prams and babies taking over my footpath. “Did they know how lucky they were?” I kept asking myself. I distinctly recall a patient who came to see me asking for a termination of pregnancy when we were “trying” (FYI I have never had an issue with treating these women as a GP because I am very much of the view a woman has a right to choose on these matters). Suddenly though I was slightly jealous – she didn’t want a baby (and that was her choice) but I was desperate for one; why was the universe torturing me like this?


Women (and men) can get very, very anxious about fertility. It is not unusual for a woman in her 20s or 30s to ask me if she should have special fertility testing done because she is keen to get pregnant soon. For most heterosexual couples it’s crack on and see how you go – 92% of couples will conceive within 12 months and 98% within 2 years. There are some women however, we refer early for fertility assistance (this doesn’t always mean IVF, there are lots of other options). This includes women with a history of polycystic ovarian syndrome and irregular cycles, women who have unusual pelvic anatomy, or who have had previous surgery on their pelvis and women who have had recurrent miscarriages. We also refer women over 35 earlier for input from a fertility specialist because we know that the earlier we intervene the more chance there is of a successful pregnancy. For older women we also consider doing a blood test that looks at the ovarian reserve; the test is called anti- Mullerian hormone (AMH). We don’t do this test for everyone and it does incur an out of pocket cost, but for those women who might be older and are concerned about whether or not they have eggs left this test can help plan.


With my GP hat on, and for a very practical moment, if you are planning a pregnancy the first step is seeing your GP for blood work to check things like your immunity to rubella and to talk about potential extra testing prior to conceiving (there are now genetic carrier screening tests available for conditions like cystic fibrosis you can do). If you get the green light to “try” then sex every second day in the week before ovulation increases chances of conceiving (days 7 to 14 for women with a 28-day cycle). The husband who says sex 4 times a day is the only way to get pregnant is lying, trust me! I end up telling my patients to relax and not let sex become a chore. When you decide to start a family, suddenly sex isn’t just sex anymore – it has a purpose and lots of couples start to find that very stressful understandably. If after 6 to 12 months (depending on age and other factors) things haven’t been successful then is the time to speak to a fertility specialist and talk through the options, of which there are many!


In our case, after 3 months we did get pregnant but sadly, it ended in a miscarriage. Just as we were emotionally recovering in Greece, lazing on beaches, trying every potential gyros combination known to man and contemplating life, Miss S decided to make her entrance. Despite all the insight I now have, if we ever decide to have a second child I can’t say that I won’t get equally stressed and catastrophise!


We all have different journeys when it comes to fertility; there is no “right way” when it comes to starting a family. For same sex couples the journey can be even more complex looking for potential donors or surrogates. At the end of the day, if we choose to have children we just want to share the love we already have with another soul– it doesn’t matter how we get there, or how long it takes, and it certainly isn’t a competition.



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PCOS – More Than a Little Acronym


I’m going to blow your mind – polycystic ovarian syndrome (PCOS) has little to do with the ovaries.

PCOS is a common, but often misunderstood condition. 12–21% of women of reproductive age will suffer from it and despite the small acronym the diagnosis has many implications.

The syndrome, despite the name, is more about the body’s metabolism and how it deals with insulin as opposed to the ovaries. Whilst most people’s minds jump to overweight women with excessive hair growth when they think of PCOS, take a look at Victoria Beckham – a very slender woman who has struggled with the condition. There may be friends or family members who have the condition that you are not aware of – remember how they said to never judge a book by its cover?

Here are the main things you should know:

  1. The disorder has 3 characteristic features and you only need 2 to be diagnosed. Irregularities of menstrual cycle, high levels of testosterone (with features like excessive hair growth or elevated levels on a blood test) and characteristic features of the ovaries on ultrasound are the 3 criteria. The ovaries are not essential to diagnosis, so everyone harping on about them can be very misleading! You can be diagnosed with the condition and have perfectly normal ovaries on an ultrasound.
  2. The ‘cysts’ everyone refers to are actually follicles in the ovary. A follicle is where the eggs are made and when a woman ovulates there is one lucky follicle (usually!) that gets to release an egg. People often ask me “what will happen to the cysts? Do they get surgically removed or burst?” The image that many of my patients have in their mind of a huge ovary with pimples all over it isn’t necessarily correct – and the follicles don’t need removal.
  3. Insulin resistance is the main issue in PCOS. This means that the body needs more insulin to keep the blood sugar levels normal. It is the high levels of insulin that cause a lot of the problems in PCOS. It is the reason why patients have a much higher risk of both type 2 and gestational diabetes. The higher insulin levels also stimulate more testosterone production which can cause the excessive hair growth and acne that many PCOS patients struggle with. Ongoing monitoring for diabetes in patients every 2-5 years is recommended and for women with PCOS who are pregnant, we screen for gestational diabetes earlier on.
  4. Before we can diagnose you with PCOS we need to do blood tests to exclude other conditions like thyroid disease. If you meet the criteria for diagnosis (for instance you have excessive hair growth on the lip or tummy and long menstrual cycles) you don’t always need an ultrasound. Remember you only need 2 out of the 3 criteria to be diagnosed. Having said that, most of my patients who meet the criteria still want the ultrasound for peace of mind and to know exactly what they are dealing with – and that’s fine too.
  5. Patients with PCOS can have problems with fertility, with irregular ovulation and menstrual cycles some patients need assistance to conceive or take longer. I see lots of patients panic about this – please know that many with PCOS go on to have successful pregnancies with no assistance. For others, some help may be needed and early referral to a fertility specialist can be arranged.
  6. Patients with PCOS are at a higher risk of conditions such as depression and anxiety. Mental health is an aspect to PCOS that often gets ignored. Struggling with weight, excess hair and concerns about fertility can be stressful and talking to someone like your GP can help.
  7. Women with increased time between menstrual cycles have an increased risk of endometrial cancer, as there is too much oestrogen exposure to the lining of the uterus called the endometrium. Some women with PCOS can have months and months between periods as opposed to regular monthly bleeds. Controlling the menstrual cycle with some form of contraception (there are many options!) is key to protecting against endometrial cancer because it provides the uterine lining with some progesterone and not just constant oestrogen.


For women who are overweight when diagnosed, losing 5 to 10% of body weight can have wonderful benefits for regulating menstrual cycle, improving fertility and reducing diabetes risk. So, the minute we diagnose someone a lifestyle review is high on the agenda.

Of course, for some weight loss can be very hard to achieve (or not indicated if their weight is already in the healthy range) and that is when other options can be used to manage the condition. Given the main issue is insulin resistance (and high levels of insulin) lifestyle factors like regular exercise and a good diet are key to managing the condition. For some women using type 2 diabetes medications such as Metformin can also help. Given that women with PCOS are at increased risk of type 2 diabetes it is crucial that women get ongoing monitoring of their cholesterol and sugars – it is this aspect to the condition that many women are not aware of!

I am currently managing 11 women with this condition as a GP and each woman has different concerns about her PCOS. For one patient the excessive hair growth affects her confidence significantly. For another the thought of having issues conceiving in the future causes her major anxiety. I work with all my patients very closely to achieve lifestyle shifts that can help – we work towards regular exercise, a good diet and aim for a weight in the healthy range and in some instances, we use medication as well. Every woman with PCOS has a different journey.

When you hear the acronym PCOS from now on think insulin resistance, diabetes risk and mental health issues– not such a small acronym after all is it?



A version of this was initially published by Dr Preeya Alexander on Women’s Fitness online.



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My Favourite Healthy Toddler Snacks (that Miss S loves!!)



  1. Dried mango

This is literally just dried fruit and the sugar content is only the natural sugar in the fruit (if you buy the right brands). Miss S loves it- it’s a clean snack so she can eat it on the go without causing a mess. Perfect for on-the-go snacking.

  1. Cucumber slices

I peel the skin off and give this to Miss S in her snack box. Cucumber is wonderful – high in fibre, low in sugar. Another great clean hand-held snack. And FYI I peel it because Miss S won’t eat it with the peel on – if your toddler will eat it with the skin on go for it!

  1. Cheese sticks

I buy the Beqa stringers and Miss S will munch through these when we are out and about. She doesn’t drink much milk currently so her dairy intake comes from cheese and yoghurt. A cheese snack is an easy way to get dairy into a toddler

  1. Yoghurt pouch

The greatest treat for Miss S – high in calcium and you can buy brands with a low sugar content (aiming for less than 10 grams of sugar per 100 grams). You can also freeze them so they can be a great snack on a hot day! When I freeze them I simply cut open the packet and give Miss S a yoghurt block to play with outside – fun, messy and healthy!

  1. Sultanas and dried peel

I often put this in Miss S’ snack box so she can eat it on the go. I buy the sultanas with fruit peel combined in it. A great source of fibre and again, if you buy the right brand and read the labels you can get products with no added sugar.

  1. Frozen peas and corn

You might think this is strange but try it! Fun for kids, not overly messy and seriously good for them! A fun way to get some extra veg in.

  1. Frozen berries

A hit in our house. Miss S loves frozen blackberries and blueberries. Again – no added sugar (other than what is in the fruit) and high in fibre. Warning – can be messy!!

  1. Fruit and veg chopped up

Simple I know but lots of my patients don’t think about this when their kids want a snack. Chop up celery, carrots and let kids dip it in hommus. Cut up apple, pears, banana are also wonderful snacks. It doesn’t have to be a muesli bar or biscuits all the time!

  1. Banana chips

Lots of banana chips have added honey or maple syrup but there are several brands that have lower sugar contents than others so you need to read the label and pick the right ones. These are a good clean snack on the go for kids and Miss S will now request these; a real hit!

  1. Cherry tomatoes + grapes + blueberries snack box combo

I often do this for Miss S in her snack box. I always chop up grapes and cherry tomatoes in half or quarters (please always cut these before giving them to kids under 3 as they are a choke risk and children have died from consuming these whole). I often put this combination in her snack box and she loves it!

  1. Kale chips

Honestly, I love these and now Miss S does too! When I make spicy ones for the adults I also make some for Miss S. I coat hers in some lemon juice and garlic powder. She loves the crunchy snack (they can get messy because they crumble!) and it’s a great way to get veggies in!

12. Broad Beans

My mum always used these as a snack when I was little and now I do the same with Miss S. I buy frozen broad beans, blanch them in hot water and once they are cool they are an easy vegetable snack! A great way to increase vegetable content in your toddler’s diet (and your own because trust me they are very more-ish).



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My “Chickpea/Veggie Deliciousness” Recipe


This is an easy, healthy go- to meal that can last the family for a couple of days (if you really want it to last add an extra can of chickpeas and tomatoes!).


What you will need:

1 x 800 gram tin of diced or crushed tomatoes – whichever you prefer

1 x 400 gram tin of chickpeas – vital to rinse these before you use them (or you can soak your own overnight, I often make this on the fly so need quick and easy can chickpeas)

1 medium sized zucchini chopped into 2cm pieces

1 brown onion chopped

3-4 cup mushrooms chopped into chunky slices

Spices: What I use varies every time but this batch has Cayenne pepper, Moroccan spice and cumin (and it is a delicious batch)

Greek style feta to sprinkle on top

Lemon zest – literally just a little bit, about the size of a 50-cent coin finely chopped

Handful of coriander

4 free range eggs



  1. Heat olive oil in a fry pan, brown the onion for 4-5 minutes
  2. Next add zucchini and mushrooms – let these soften slightly for 5 minutes
  3. Add the chickpeas, can of tomatoes and lemon zest. Also add the spices you have chosen– I add a fair sprinkle of cumin, a dash (very little because Miss S eats this) of Cayenne pepper and a generous sprinkle of Moroccan spice. No salt is added as Miss S eats this and it’s better for all of us.
  4. Allow this to simmer gently for 30-35 minutes, occasionally stirring. I simmer this for at least half an hour to soften the zucchini and mushrooms.
  5. Once satisfied with the consistently – crack 4-5 eggs on top of the mixture and close the lid of the pan. Allow this to cook for 5-6 minutes. I tend to only do this duration as I like the eggs to remain slightly soft. If you like them cooked through then cook for longer.
  6. Finally, once the stove is off sprinkle with crumbled feta and coriander.
  7. I serve this with couscous or roti wraps (which are awesome to dip in) and can highly recommend Greek style yoghurt on the side!



The doctor in me loves this dish because it contains loads of vegetables, it is a vegetarian dish (so excellent for cholesterol), contains no additional salt (hence, excellent for blood pressure control) and has an abundance of protein without containing meat. Chickpeas are also a source of iron so if you are vegetarian this is a great meal to increase iron intake. The working mum in me loves this because it is easy to make, contains ingredients I always have at home and it lasts us 2 days usually so I am off the hook for cooking. The mother in me loves this because Miss S will demolish this with cous cous and yoghurt and it’s so good for her. An easy, healthy, delicious family meal!


Let me know what you think! And if you create it please share and tag me!



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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 ($File/full-publication-myths-and-realities-5th-ed-2013.pdf) or speak to your GP.


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