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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The First 2 Weeks and my 5 Survival Tips (for what they’re worth!)

 

 

So we’ve survived the first 2 weeks of our daughter’s life!

 

My husband and I are getting 6 hours of broken sleep per night (with the occasional horror night), we still manage a hug and laugh amongst our new duties, and we are completely besotted with this little soul who has literally flipped our life upside down. Our dining table downstairs has a changing station- gone are the candelabras that used to stand with pride as the centrepiece– hello wipes, Huggies and Sudo Cream! If someone comes to visit no effort is made to hide the rattles or the myriad of parenting books my husband has bought to ensure we raise a strong and independent girl! Hello new life!

 

 

If you have children you probably understand when I say I’ve learnt an incredible amount in the last 2 weeks – more than I ever have in my entire life (and I thought the first 2 weeks of internship were a steep learning curve!). I’ve learnt that being a mother is the hardest thing I’ve done and that being intelligent and determined means jack all to a newborn. Where my type A personality has helped me succeed in most other aspects of my life – studying hard, making sure everything is as perfect as it can be – it just doesn’t apply here. And no matter how many books or articles you read at 2am about cluster feeding or self-settling babies – what will be will be!

 

So all the children I’ve seen as a doctor counted for nothing when it came to my turn. I’ve reassured so many mother’s that the sleeping does improve, that providing some sort of routine does pay off and that breast feeding can get easier – but now I actually get it!

 

So I thought if I can survive the first 2 weeks I better share my very few pearls – so here are my top 5 survival tips for what they’re worth!

 

  1. Zipped suits are PURE GOLD! Bonds do a Wonder Suit that has a zip that opens from the top and bottom and let me tell you when you are changing nappies post every feed you want easy access especially at night! We use the Wonder Suit as pyjamas for Miss S and it is a godsend – dealing with 20 buttons in dim light at 2am in the morning is a great way to go completely mad!
  2. Engorged breasts hurt!!! Avent do a gel pad, which can be cooled, or heated (which you can use pre feed to assist milk flow) and let me tell you these babies straight from the freezer (in their cloth bag) on the breast soothe the pain beautifully! As GP’s we also recommend cold or frozen cabbage leaves for relief of engorgement and I would honestly use these if I hadn’t used all the cabbage to make a stir-fry with my mum!
  3. Sleep hygiene is VITAL for a baby and your sanity! Our obstetrician on day 3 post birth told us the rules for the first 6 weeks was that there were no rules – and I must say this was advice I very much needed to hear! But the only loose rule we have is trying to introduce some sleep routine consistency and it feels like it’s paying off – naps in the day occur in light, whereas nighttime is all dim light or darkness. A bedtime routine is being introduced (with some reluctance from Miss S) which involves a bath then changing into pyjamas and feeding in dim light. Most sleep gurus will suggest some sort of sleep routine and so we are giving it a go!
  4. LET GO – I was soooooo reluctant initially to leave Miss S with anyone to even have a nap. I would sit there watching my mum, aunt or husband with her – just subtly giving tips (when in reality I had no idea what I was doing either I now realize!). But I swallowed all my pride/type A-ness and accepted help and boy oh boy did life get better. I had naps, allowed my family to cook all the meals and now the freezer is full of healthy meals! And most importantly my husband and I have had moments here and there to have a hug, debrief and an odd tear! So swallow all pride and say yes to all help is my big tip!
  5. A walk a day keeps the mind and body sane. This I swear by – I was slow to get back to my walks post the emergency C section but now we are out that door every day. Miss S is rugged up, I have my sneakers on and we hit the pavement (gently) for 30 minutes at least once a day … and if things are going well we stop for a chai latte at the local café… I see the sunlight (so does she), we have fresh air, we smile at people who walk past us (and invariably someone stops for a chat when they see a new baby) and when we come home we are both new ladies!

 

So there it is – 2 weeks in and I still know next to nothing… but I sure know a hell of a lot more than I did! Imagine how much I’ll know in another 2 weeks – I’ll be some sort of epic baby whisperer by then (I wish!).

 

 

 

 

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What You Need to Know About Common Over the Counter Medications

 

It’s so easy to grab a packet of Panadol or Nurofen from the Chemist or supermarket.

 

For some reason if you can grab a medicine over the counter people assume it “must be safe.”

 

Golly gosh – anti inflammatories like Ibuprofen (brand name Nurofen) are some of my most feared drugs and in the wrong hands (or should I say body) can cause serious damage!

 

So here’s what you need to know about 2 of the most commonly used medications – and why you might want to rethink popping the packet!

 

Drug Name: Paracetamol (Commonly known as brand name Panadol)

 

Most people have taken paracetamol at some point for a headache, period pain or backache. 2 tablets here and there are fine, but are you reaching out for the stuff more often? And do you know how much is safe to take?

 

Too much paracetamol can cause liver failure –which can lead to death.

 

The recommended dose is no more than 4 grams per day, which is a total of 8 tablets. But there are so many times a patient will come into a consult and tell me they have tried 10 to 12 tablets to get rid of their headache or belly pain – which subsequently gives me a headache from anxiety.

 

There are people who try to overdose on this stuff and its availability everywhere from a 7/11 to a service station often has me worried. How can something potentially so dangerous be so easy to get?

 

In the recommended dose it’s fine (so long as you don’t have underlying liver problems) but chugging it down by the truckload (just because its on your supermarket shelf) isn’t necessarily safe.

 

 

Drug Name: Ibuprofen (Brand name: Nurofen)

 

We doctors call anti inflammatories NSAIDs (non-steroidal anti-inflammatory drugs) but you would know them as Nurofen or Voltaren.
These babies work a charm for muscular pain and inflammation. Sore ankle after netball training, period pain, neck ache or backache – this stuff can work a miracle!

 

BUT – they aren’t all the goodness you might think they are.

 

Take them on an empty stomach for a prolonged period of time and you are potentially facing gastritis, which is inflammation of the stomach lining causing pain, blood loss and even ulcers.

 

They can also cause kidney troubles as they reduce the amount of waste products filtered through the kidney. In the elderly especially we get VERY worried about causing kidney failure with these drugs.

 

So between ulcers and shutting the kidneys down – these medications aren’t as safe as you think. And look at how easily you can buy the stuff!

 

Some think rubbing Nurofen or Voltaren gel on their ankle or back is ‘safer’ – I’ve heard this arugment from patients many times! Not necessarily – firstly, you shouldn’t be using the gel and tablet form of the same drug (it’s essentially over dosing on the stuff) and secondly, the gel should only be used for the shortest term possible too. Just because you’re rubbing it on doesn’t mean it’s safer – it still ends up in the blood stream!

 

If you need these tablets – use them with food and for the shortest duration possible. If you find yourself using them a lot – its time to see your GP to work out what’s causing your pain and what else can be done!

 

 

As you can see just because the tablets are sitting on the shelf (with no prescription or discussion with the pharmacist needed) does not mean they are 100% safe. I am seriously scared of anti inflammatories (after having seen patient’s end up on dialysis with kidney failure and with ulcers in their stomach!), and you should be wary too.

 

So before you pop that foil packet today – do you need the drug? Have you got food in your belly before you swallow an anti-inflammatory? Are you taking over the recommended dose for the day?

 

And most importantly, have I made you think twice about popping another pill today?

 

 

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The Reality Post Baby Shower

 

 

This baby has been showered with love/champagne/ridiculously cute presents and cupcakes – and suddenly it all feels incredibly real – more real than it ever did before. We have a draw of nappies and baby wipes dammit – it’s really happening. It’s not just soft toys and onesies anymore.

 

I am 85% bursting with pure excitement and anticipation at meeting this little being of ours.

 

I am 10% nervous about the significant life change we are about to go through – we are a spontaneous, social couple and I know we are going to have to adapt when this baby comes along, which is fine.

 

And I am 5% completely (and utterly) terrified of the birth– so much so that most nights I will lie there just imagining the birth and all the things that could potentially occur.

 

I’m scared about my waters breaking in a public place – will I be at the counter in shop about to pay an overly posh saleswoman for my scented candle when boom – I’ve wet myself?

 

I’m scared that when I go into labor my husband will be stuck in the operating theatre and I’ll struggle to get hold of him furiously trying to explain to the nurses who pick up his phone (between contractions) that I’m about to have his child and could someone calmly communicate this to the man operating on another human?

 

And I can make myself absolutely petrified if I relive my obstetrics rotation years ago and think of all the things I saw (which I now wish I hadn’t) – gosh the memories are VIVID!

 

BUT… our obstetrician, who is a calm guru (thank goodness) and very apt at dealing with 2 pedantic doctors who ask the weirdest most intricate questions – has put my mind at peace. And keeps reminding me that there are lots of factors at play here and I certainly can’t control all of them.

 

And that’s the truth isn’t it? I have very little control over this whole ‘birthing’ process – the baby’s position, when I go into labour, where my waters will break, how the baby will descend, how my body will take the whole process– all out of my control. And honestly, that gives me some peace knowing that I’ll do my bit (with my husband’s support), the baby will do his/her’s and the obstetrician will nail it.

 

For a woman who normally likes TOTAL control with an intricately planned path I’ve had to accept on this one I just can’t have it my way. It’s been a struggle but I think I’m officially at the point of “what will be will be” with just a touch of “but if there are things I can control (like my music playlist and the drugs I receive in labour) then I will dammit” -and I think that’s the perfect mix for now!!

 

 

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So You’ve Asked Dr Google…

When a consultation opens with a patient saying, “so I know I shouldn’t have but I went on Google and…” I very gently and subtly clutch the corner of my table. I wait for the ridiculous diagnosis (or list of diagnoses!) the machine has spat at you.

 

You type in “cough, fever, nasal congestion and sore throat” and get told you have pneumonia. But I’m thinking you have the common cold and will survive this with some rest and fluids.

 

You type in “lump on bottom, painful” and get told, with no warning mind you, that you likely have bowel cancer. But I know that at 25 you most likely have a haemmoroid – and when I examine you thats what I find, something that this “Dr Google” never does.

 

I used to find it slightly insulting when a patient came to me with their list of diagnoses form the internet. I’d be thinking “gees so the 6 years I did at medical school, the gruelling internship and training on top of that to be a GP counts for nothing???” – But now, I realise that it’s just a way for you to be involved in your healthcare and perhaps it’s giving you some control when your freaking out about something you’ve found on your body.

 

A doctor often doesn’t want to know what Google said because it can shape our diagnostic opinion – either make us firm on refusing to agree with the internet or think about things that clearly do not need to be considered. Please know that 99% of the time a human doctor who listens to you, examines you and has a thinking mind is going to be better than a computer. And if you do use the internet take it all with a grain of salt- don’t lose sleep over the cancer diagnosis it spat out at you and please don’t say to me “but Google said…” when I tell you my opinion.

 

Dr Google may be open at all hours and hear your concerns at 3 in the morning when you’ve noticed a lump. But Dr Google won’t pat you on the shoulder and reassure you it’s not cancer or give you a hug when it is… Just a thought…

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The Late Doctor

People forget that I’m a patient too when I see the doctor.

 

I have also grown frustrated and irritable in the waiting room whilst the GP or specialist runs 15, 30 or even 40 minutes late.

 

I pride myself on running within 5 to 10 minutes of appointment times – BUT there are days when it blows out, when I see the list of 6 people waiting to see me and I am running half an hour late at the very least.  It makes me incredibly stressed and anxious BUT let me give you some insight into why I might be running late:

 

  1. A patient will walk into my room and tell me that they are ready to kill themselves- that today is the day they are going to do it and they just booked in to say “thanks and goodbye.”My body stiffens, my mind goes into overdrive and I know my priority for the next hour is getting this person the emergency psychiatric help they need and in that moment that one life is my priority – I’m sorry but the waiting room just doesn’t factor in.
  2. An emergency walks through the door – a man or woman comes in clutching their chest and their heart tracing shows they are having a massive heart attack. A child has critical asthma and is on the brink of going into a respiratory arrest. Or a man has cut his hand at work and there’s blood, tendons and muscles hanging into a towel carried by his mate. In every case, a doctor is needed to manage the emergency despite how booked up we are with appointments. In that moment I immediately accept that I will run an hour late (and let reception know to warn my patients) but my duty is to the person who is on death’s door and so again, I’m late.
  3. The 15 people before you have booked a single appointment – for 15 mins – when in fact they had 3 issues to discuss which no thorough GP can deal with in 15 minutes. So despite my best efforts in trying to train my patients to book appropriately sometimes their expectations in what I can do in 15 minutes is unreasonable.
  4. Phone calls – I have other doctors, emergency rooms, patient’s relatives and patient’s themselves constantly calling. So sometimes –we have to take a phone call between appointments – a relative concerned their partner will commit suicide or a patient concerned they can’t breathe – that’s a phone call you cannot ignore.

 

I must say – the majority of people are super understanding when I explain the reason for running late, but sometimes, people have too much pent up anger from their time in the waiting room and they let me know exactly how they are feeling- which is fine. But remember I’ve been there too and I understand.

 

When I feel my frustration building in the waiting room as a patient I try to remind myself that there MUST be something else going on for the doctor to be running THAT late! And now you know the types of things happening behind your doctor’s closed door perhaps your next wait won’t seem as bad either!

 

 

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