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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Why Health Should Dictate Where you Holiday



Will and I love travelling. Prior to Miss S we smashed through Europe with backpacks (and a pillowcase of food – seriously, don’t ask!). The same backpacks took us to places like South America, India, Indonesia and Morocco. We’ve continued to travel since Miss S arrived but I can tell you the adventure dial has been turned right down whilst she is young. Despite our desires, we will not be taking her on an African safari tomorrow given the significant malaria and chikungunya risk (both mosquito transmitted diseases). We also won’t be jetting into Nepal as a family to hike to Mount Everest base camp (a dream of mine) given the potential for altitude sickness in our toddler. Planning a holiday for us now takes much more thought – how long is the flight? Is there access to easy English speaking medical care? Is there risk of malaria, Dengue and yellow fever and is it a risk we are willing to take with Miss S?


I often have patients including couples and families come in for a travel consultation, all booked and ready to go, with no idea about the health implications of their destination choice. Recently a patient of mine cancelled her trip as she was pregnant and did not realise that Fiji was on the zika virus list. I had another patient cancel flights and re-route her entire travel because she was not willing to have the Yellow Fever vaccination – it meant she could not enter several countries around her after leaving yellow fever affected areas. After a lengthy discussion about the vaccination she opted not to have this so had to change her travel plans. Many patients see cheap flight deals and book (I’ve done the same thing don’t worry) and realise only in my consulting room that they may need to take anti-malarial medication, have a Yellow Fever vaccine and consider taking tablets to prevent altitude sickness if they want to venture to certain parts of South America. The health aspect is an afterthought a lot of the time. Choosing a travel destination should be about the sites, beaches, food, culture – but taking your health, or your family’s, into account should be a big factor too.


So here it is:


Your Health Checklist to Guide your Next Holiday Destination:


Mosquitoes are more than annoying, and more than just malaria!


If you are pregnant or planning pregnancy then you should be completely avoiding areas with Zika virus (which is nearly everywhere now). By the same token males planning conception should avoid Zika areas for at least 6 months before they start trying. Unfortunately, right now nearly all the favourite baby moon spots outside Australia are Zika affected – Bali, Singapore, Fiji. Currently only Vanuatu and New Caledonia are Zika free though this might change so you need to keep an eye on this. There are not many close international destinations that are safe when pregnant so currently lots of my pregnant patients are remaining within Australia for their trip away. Now, do not let this blog deter you from your baby moon (please, its important stuff to have a chill out before life changes in a big way!!) but be careful with your destination choice.


Still talking about mosquitos, if you are travelling with young infants you should ideally avoid malaria ridden areas. Whilst the newer medications like Malarone come in paediatric formulations, between all the available medications there is nothing for infants under 5 kilograms which makes prophylaxis tricky; it’s all about mosquito avoidance but that might not be enough particularly when malaria can be lethal. Everyone knows mosquitos are malaria go hand in hand but Yellow Fever and Dengue Fever are 2 other infections that can be transmitted via mosquitos. The Yellow Fever vaccine is approved for use in children older than 9 months of age so taking a child younger than that to a Yellow Fever affected area is risky stuff. Whilst I don’t want mosquitos to be the first thought when you’re planning a holiday – they should certainly factor into the decision if you’re travelling with children!


The geographical location – is it safe?


People often don’t think about access to medical care if something goes wrong on a holiday. I know we all want to think nothing bad will happen (and I have my fingers and toes crossed for you) BUT you need to be prepared particularly if travelling with children. Whilst I recommend every single person have travel insurance it’s generally no good to you if you are in a distant remote area with your kids away from any medical assistance or easy evacuation. If you have any medical condition that is affected by climate then that should be taken into consideration when choosing a destination; are you particularly sensitive to the sun because you have lupus? Does your rheumatoid arthritis flare in cold weather? Does your dishydrotic eczema flare to the point of unbearable discomfort in the hot weather? Is your Raynaud’s disease particularly painful in the cold weather?


Also, if you carry medication with you plan for this – take enough of the stuff (we can give you increased supply if you are travelling for a long duration) and carry a medication letter with you to avoid any issues with customs.


Food safety


This is a big consideration particularly when pregnant, travelling with young kids or if you have a chronic illness that is vulnerable to traveller’s diarrhoea (like inflammatory bowel disease). I’m not saying don’t travel if you fit into any of the aforementioned categories but perhaps remote areas of Papua New Guinea with poor access to safe food and water isn’t the best idea in pregnancy (if it can be avoided). By the same token travelling to remote areas of India with an infant (where sterilising is difficult) may also be ideally avoided. We took Miss S to India as a 6-month-old – but we made sure we avoided malaria prone areas and took food and water safety extremely seriously. We purposely stayed on the worn in well-known track (despite the heavily adventurous streak in both Will and I) and it paid off. With Miss in our life we have managed to continue travelling BUT the type of travel and destinations have been dictated by her health and safety and that’s how it should be.


The flight


There are so many wonderful places we all want to visit but is it worth a day in the plane with a toddler? Our current cap is 6 hours – we just know anything beyond that with the adventurous Miss S right now would be a struggle and not worth it for us! If you are pregnant are you still allowed to fly? Every airline has a different cut off for domestic and international travel for pregnant women, and the cut off is lower with twin pregnancies so you need to be aware of this if travelling when pregnant. If you are claustrophobic or an anxious flyer take this into account too – patients often come in to the GP asking for heavy sedatives just before flying – something I am not willing to prescribe given the risk for potential error (imagine trying a drug post a beer on a plane – the consequences can be pretty hairy!). Are you better of road tripping or going on a short flight? Think about it before you book that 24-hour journey!






So yes, let the cuisine, culture, beaches and shopping opportunities all be part of the decision process when you next decide on a holiday destination. But please (pretty please) let health be a factor in there too.



If you are looking for up to date health travel information the CDC is an excellent resource and can be visited at 



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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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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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My Healthy Spin on Lasagna (that the kids and family will love – I promise!)



My bolognaise sauce is a my secret weapon – easy to make, veggie packed, seriously delicious and a meal the whole family loves (and can survive off for a couple of days so it makes me one happy mama!). I use this as a bolognaise sauce and in my lasagna.


I’m going to show you the healthier way to enjoy a favourite comfort meal, lasagna; and yes it isn’t “classic” but I promise it’s better for you (and the kids) and it’s still delicious.


What you will need:

  1. 500 grams of lean lamb mince (I use lamb not beef, I prefer the taste of lamb for this)
  2. 1 medium sized onion
  3. 1 teaspoon of crushed garlic (jar or fresh)
  4. 800 gram can of diced tomatos (and maybe an additional small can of tomatoes OR a dash of passata) – it is to keep the sauce runny and tomato-ey (not a word I am aware, stay with me though)
  5. Wholemeal lasagne sheets (you can buy this from the supermarket)
  6. Shredded cheddar (however much you like)
  7. Some olive oil
  8. Some pepper
  9. Herbs of your choice – I use whatever is in the garden; parsley, basil and spring onion usually
  10. Veggies – now this is where I give you free reign. I will always put in an entire grated zucchini, 2 medium sized carrots grated and chopped spinach (silverbeet or baby spinach – I use what’s in the garden but will aim for 2 cups of raw spinach). I sometimes add mushrooms as well. Use what you have in the garden or the fridge – trust me I cook this sauce for 4 hours so whatever you have will usually work as it all softens. Oh I also always add all the soft tomatoes I have in the house so they don’t get wasted – just chop them up and chuck them in if you have them lying around!
  11. Possible addition and up to you: Pumpkin such as half a butter nut. Sometimes I add a layer of pumpkin into the lasagna.


For the sauce:

  1. Chop that onion up however the hell you want and chuck it into a pot with olive oil, chuck the garlic in too and cook until brown and soft
  2. Chuck in the mince and brown this – usually takes 6-8 minutes.
  3. Next add your tomato cans –I often throw in a large can and a small one (I like a heavy tomato flavour) but you can use a large can and a passata jar if you have it open in the fridge. Doesn’t matter what you use as long as you have enough fluid for all the veggie you are about to add.
  4. Let this simmer for 10 minutes and use a wooden spoon to break the bits of meat down.
  5. All the veg you grated and chopped and loved – chuck it in! And season with some pepper (sometimes I also chuck in basil flakes or paprika – season away with whatever you like!). I don’t add salt – this is a meal Miss S loves so my rule is no added salt (kids in particular should avoid salt) and adults can add to their own meal as needed. (Just a quick health point – salt addition to meals quickly adds up and excessive salt intake is a contributor to high blood pressure!!).
  6. Now this is key – check the fluid status after you’ve added all those vegetables! If it looks too thick and the veg is poking out and not drowned in fluid you need to add more either in the form of another tomato can, a dash of red wine (it will cook off) or passata. Sometimes I do add a dash of red wine (no more than a 1/4 cup) and after 4 hours of cooking you can be rest assured it has burned off!
  7. Let that sauce simmer for 3-4 hours on low heat and stir occasionally.
  8. Towards the end of the cooking time throw in the herbs.


For the lasagna construction:


  1. I do layers of meat and lasagna sheets. I RARELY use béchamel – 99% of the time my lasagna doesn’t have it (it’s way healthier without it) but if it’s a special occasion I’ll throw it in. Truth is my lasagna is delicious without the high calorie white sauce and the adults and kids just don’t need it.
  2. I layer meat sauce first then lasagna sheet then meat sauce and lasagna sheet usually aiming for 3-4 layers. Always end on a meat sauce thin layer with some cheddar on top.
  3. KEY TIPS: Always ensure you have enough moisture – sometimes I will wet my hands and sprinkle some excess water to keep the lasagna juicy if the sauce is a bit too thick.
  4. POSSIBLE OPTION: Mashed pumpkin in a layer. If you want some extra veg (and kids will love this too) chop up half a butter nut pumpkin into roughly 2x2cm cubes. Boil for 10 mins approximately (until soft) and then drain the water and mash it all up. Don’t add any seasoning. Simply spread this out in a layer of the lasagna above the meat – I usually only do 1 pumpkin later somewhere in the middle of the lasagna.
  5. Once constructed and sprinkled with love and cheese bake on 180 degrees for roughly 30 – 35 mins (or until golden on top). If you’re worried the top is getting too crispy put some foil on it to protect it but to still allow the lasagna sheets to cook.


I love my lasagna because it’s a meal that lasts the family for a couple of days, everyone loves it and I know it’s healthy given how much veggie I pack in there.


As a hot tip – this is the sauce I use on pasta as bolognaise sauce. If you’re feeling like superman or woman then make a big batch and freeze it in containers. You can defrost it on busy days for pasta or chuck in on top of a baked potato (I prefer sweet potato as it’s low GI). I will often layer baked sweet potato, the sauce and then add some green peas/corn/lettuce/fresh tomato/greek yoghurt/fresh mushrooms/whatever the hell you want on top–it’s one of our favourite family go to meals on busy days!


I hope you enjoy this recipe – and if you try it, post it, and tag me so I can see your work! As usual there are no fixed rules here – use whatever veg you like, mix it up each time, and I can almost guarantee you that it will be delicious, and veggie packed and amazing!!!





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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 Truth About Iron



A lot of my patients take a daily iron supplement because they “feel tired” and a friend suggested they try it. I’ve sat on the toilet at the supermarket pondering at the sign on the back of the door, “tired? fatigued? irritable? Maybe you’re iron deficient?” – insert product placement here. Every time I see the ad I answer yes to all questions (don’t you? Who isn’t tired and irritable?) but it doesn’t necessarily mean I need iron replacement. The truth is the medication can have annoying side effects like nausea, constipation and abdominal pain – so you want to be sure you need it before you start taking it. What you need to know is, are you at risk of iron deficiency and are you getting enough iron from your diet?


Iron is vital. It plays an integral role in your red blood cells carrying oxygen throughout the body and is also required for enzyme function and energy production. Patients who are deficient in iron can therefore experience symptoms such as fatigue and shortness of breath when they exercise (because they cannot carry the oxygen around as effectively). It doesn’t mean though if you’re tired you are definitely iron deficient. What we know is that fatigue is USUALLY going to be due to lifestyle factors (poor sleep quality, not enough sleep) or stress – the studies tell us this. And IF it is something medical causing your fatigue then LOADS of other conditions from a simple virus to hypothyroidism to pregnancy to malignancy can be the cause – we can’t blame iron every time.


Having said all that – it’s worth knowing if you are at risk of iron deficiency (because maybe then you do need a blood test and replacement) and if you are getting enough in your diet.


Iron is in more than steak. If you’re vegetarian eggs are a great source – you can also get some iron from nuts (like almonds and walnuts) and legumes- but the truth is it’s better absorbed from meat. Meat (ideally lean) is the main source – chicken, beef, lamb, pork, seafood. Lots of patients are not aware but vitamin C improves the absorption of iron – so a glass of orange juice with your steak may just help your gut get more of the good stuff!! The amount of iron you need varies according to your gender and your age – for a women under 50 generally 18 mg per day of iron is recommended whereas males require 8mg per day. Want me to break that down for you? (Because let’s be honest who knows how to count the number of mg of iron you are eating!) The general recommendation is to eat 1-3 foods from iron rich groups per day. I get my iron intake from poultry (mainly chicken), fish, nuts (mainly almonds), lentils and chickpeas.


As you can imagine there are some groups of people who are at higher risk of iron deficiency due to diet factors (vegetarians, vegans), gut absorption issues (inflammatory bowel disease, coeliac disease for instance) or issues with increased demand such pregnant and breast feeding women. Mensturating women (especially those with heavy periods) are also at higher risk given they are losing blood and iron with every period.


My point is only that not everyone needs to take iron supplements and it certainly isn’t a medication I would just start taking because I feel tired (like I find lots of my patients do). Perhaps your fatigue and irritability is due to motherhood or exams or balancing work and a social life. Perhaps you’re feeling off due to a virus that is lingering. Perhaps you’re tired because you don’t get enough sleep and the sleep you do get isn’t of the best quality. Or perhaps you are deficient in iron – but there is only one way to find out – a chat with your doctor and a blood test if it is needed.



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My 5 Key Tips for Flying with Kids



Will and I have always loved travelling and have continued to trek around since Miss S joined the family. Sure, it’s different with a child (and it should be – we would never risk taking her to malaria ridden areas for instance) but you can still do it.


Whilst travelling with Miss S is wonderful – the actual flight in itself can generate a lot of anxiety – and I mean a lot. I spend up to a week planning for the long flights – snacks, toys, naps, clothes – I am not kidding – this is a military grade operation. But let me tell you – my planning and type A personality has made all our flights much easier (Will has actually said this out loud) and after flying to Greece, India, Bali I can share my top 5 tips for flying with kids:



  1. Pack a “go to bag”


The nature of this bag changes depending on the age of the child. But I am referring to the small bag of essentials (in addition to your “in case of disaster” big carry on) that stays with you for take-off, landing, turbulence. It never goes in the overhead – it’s the bag of essentials you could need at any point in the war zone of flying with kids – consider it your armory. When we went to Greece with Miss S at 8 weeks the armory had 2 nappies, wipes, nappy bags, a spew rag and a dummy. It was a large sandwich bag that we clutched onto for dear life. A new born is constantly passing motions so there were regular nappy changes – and if any clean ups were needed it was easy – take the sandwich bag and make the magic happen. Now at 14 months the go to bag is a small sack with small toys, 1 book, water bottle, 3-4 snacks, Flopsy (Miss S’ soother that she ONLY gets in the cot unless we are flying – because we will use anything and everything people!!) and wipes. This is the essential stuff. If the aircrew try and take this off me for take-off or landing I will fight to the death – this is the stuff we NEED to survive when she is locked on our lap – the bag holds the key to distraction and bargaining. And it works! Try a small bag with the essentials – ONLY the essentials in here; keep it compact!



  1. Use your weapons


On the spectrum, I’m probably on the stricter side as a parent – my mother reminds me of this a lot! Miss S does not watch TV or play with screens and eats very healthily – as you would have seen on my Instagram. BUT – anything goes in the air. I have toddler games on the iPAD in case, Will has weird games on his phone to distract her if needed (though I suspect he actually normally plays these and uses her as the scapegoat!). I pack all her favourite snacks – wholemeal apple and sultana bars, frittata, broccoli nuggets, cheese, yoghurt – it’s all in there. If she wanted a Big Mac on that plane I would probably give it to her – it won’t kill her, but an unhappy kid for 6 hours might kill us. Eat what you want little girl – let’s just get to that beach!!




  1. Pick the time carefully


Will and I used to fly for 5 hours longer through 7 different countries if we could save a couple of hundred dollars when we were younger. You just can’t put kids through that though. You know your child best so pick the flight time when you know they are easiest – even if you have to pay a bit more. We know Miss S sleeps in her cot through the night and isn’t a good night flyer so we pick day flights and it works for us. Some would say “you’re wasting a day flying” – and trust me they have, but we retain sanity (so does Miss S) and we all get there a lot happier so it’s worth it for us!




  1. Keep them comfy


Kids are more susceptible to ear troubles when the plane ascends and descends. The reason is that they have smaller eustachian tubes – this is the tube that connects the nose and middle ear so essentially ensures the middle air has air in it. Middle ear pressure equalisation is harder for kids which is why they are more prone to ear pain. It doesn’t matter what it takes, children should ideally be sucking or chewing when the plane changes altitude. When Miss S was little I would chuck her on the breast ASAP so that she would swallow and help equalise the pressure. Later it was the dummy. Now we give her a favourite snack so she chews – do whatever you can to save them the distress. Most of us have experienced painful ears in a plane – imagine being a little one with no explanation as to why it’s happening – prevention is key here!! On our way over to Bali Miss S was having huge top molars rip through her gum and had been an irritable and grumpy bear – so a dose of Ibuprofen pre- flight was a pre-emptive tactic we used which helped I suspect – you will never really know if you’re pre-emptive battle plans work but if they’re happy, and no harm is done, who cares!




  1. Go in with the right mind set


A long flight with kids isn’t easy so Will and I board that plane in battle mode- I’m fairly sure I resemble Xena as I walk onto the aircraft. I will do whatever it takes to keep Miss S happy and healthy on that flight. On the recent Bali flights we walked up and down the plane at least 10 times each – we picked spots we could stand near exit rows and let her walk around. Little tips like 2 parents not eating at the same time makes life easier – we always ask the hostess to drop the second meal later so that we are not both struggling with a baby and tray tables. Finally, it’s worth reassuring yourself that you’re taking a baby not a bomb on the plane – I remember Mum telling me this before we flew to Greece with an 8-week-old. I was worried about upsetting people with a crying baby. I distinctly remember Mum telling me Miss S was a child and despite peoples stares if she cried she wasn’t a weapon, she was a child and we had all been a child at some point. FYI my mum gives excellent pep talks! My biggest tip would be do not worry about everyone else on that flight – there are other children and parents in your position and its a finite period of time. Just do what you have to do and if your child cries no one will implode – these are exactly the words I tell myself when Miss S chucks a wobbly.


When you feel the sand beneath your toes and see the huge smile on your little one’s face in the pool you realise it was all worth it – I promise you!



After our long-haul flights, these are our go to tips. This doesn’t even broach the topic of preparing for travel with kids from a health point of view – medical kits, vaccinations etc – that’s a blog all on its own. I hope you can find 1 or 2 survival tips in here to make your next journey that little bit easier! Happy travelling!





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My Go- To Healthy Toddler Recipes


  1. Broccoli Nuggets

Miss S loves these and so do I; they are hand held so perfect for on-the-go meals (and the patches where she flat out refuses to accept a spoon!!). I use the thermo-mix to make mine (though they could easily be made without one but as a heads up you would need a blender or stick mixer). I work off this recipe ( but as usual make a few alterations to make it even healthier. I usually use 2 small broccolis or 1 and a half larger ones – the more broccoli the better!! I also reduce the amount of cheese just a touch and add copious amounts of chia seeds (they can help with constipation in kids and Miss S has been battling this for a while). If you follow the recipe word for word it’s delicious but more broccoli and chia seeds makes it even more awesome in my opinion.



  1. Frittata

If you follow me on Instagram you will know that Miss S and I are frittata fiends. I originally followed a recipe a friend gave me but honestly you can chuck anything into egg and it’s delicious. My rules – I always add a whole grated zucchini, 2 whipped eggs and some form of cheese (either a cheddar or ricotta). Anything goes from there – sometimes I add thawed peas, corn or the mixed vegetables – it depends on what I have in the freezer at the time but trust me all combinations are delicious. Sometimes I also add grated carrot; recently I added grated broccoli and it was also delicious. For some extra protein I add a can of tuna – seriously scrumptious (I have to stop myself from stealing my child’s food!). Frittata is another excellent hand-held food you can chuck loads of veggies into. It’s easy to make and very healthy– I can whip these up in 20 minutes. As a tip use a mini muffin tray so that they snugly fit into your little one’s paw.



  1. Anything with pumpkin

My child loves pumpkin so when I’m whipping something up for her pumpkin is a safe go to base. I will often boil pumpkin (sometimes with spinach, potato or broccoli) and then mash it. It’s a perfect veggie loaded base for quinoa, cous cous or pasta – I will sometimes add tuna to the sauce and mix it with wholemeal pasta – she loves it! Anything with pumpkin is a serious win – roast pumpkin, pumpkin soup, pumpkin frittata… anything pumpkin related you can think of is a win with my kid!



  1. Meat balls

Another fabulous hand-held food – high in protein and easy to sneak veggies into! I often use lamb, pork or turkey mince (turkey is really lean!). You can sneak ANYTHING into a meat ball and it remains delicious. I always put grated zucchini and carrot and will often sneak spinach or kale in as well. Egg is always my binder and I often put a sprinkle of cheese. I sometimes make these without bread crumbs BUT I’ve found that they are often moister if I do use some to help bind the mixture. A clever girlfriend once told me to blitz a slice of bread in the thermo-mix to make fresh bread crumbs, so that’s what I do – it allows me to use wholemeal bread. Sometimes I pan fry meat balls for Miss S, but I predominantly just bake them which is obviously even healthier.




  1. Stewed fruit

I make all of Miss S’ meals from scratch and this one is by far the easiest. Again, you would have seen it on my Instagram – rhubarb is always in there (we grow it in the garden and it’s very high in B complexes). I always stew rhubarb with either apple, sultanas or both. I throw all the ingredients in a pot with water (make sure you peel the apple and dice it if you use it) and boil it until it’s soft – it usually takes 20 to 30 minutes. I never add extra sugar or honey – the fruit sweetness is enough I promise you. Miss S loves this for morning or afternoon tea, on her porridge or with yoghurt. Will and I also love it for brekkie with our museli! High in fibre, no added sweetness and homemade – winning!




  1. Anything we eat

Luckily Miss S will eat most things we do- it just means when we cook we are extremely careful with salt– the rule is no salt to the meal, add it to your own plate. I make batches of baked chicken drum sticks (with honey, soy and ginger) and she loves it! Often she will eat the chicken drumsticks with cherry tomatoes, avocado or whatever other veggies we have lying around. She also eats curry – it just has to be mild or we add lots of rice with the gravy so it dilutes the heat a bit. Pasta, roast meals, tuna mornay, soups and stews- she eats it all. It’s mainly the hand-held stuff I end up making separately for her now. It’s such a win when they eat what you do– far less work and planning!!



I hope you enjoy some of our favourite go-to meals! If you need specific steps for any of these I would be happy to post the “recipe” – I use the term recipe lightly, if you look at my tuna mornay one it is more like a set of guidelines. My big tip with kids’ food – the more veggies you can sneak into their food the better, and you combine nearly anything so be creative!


Happy cooking and veggie sneaking!




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Your Pre-Pregnancy Checklist

It is an incredibly exciting time when you decide that you’re ready to “try” for a baby whether it be naturally or through IVF. You start envisioning life differently – which room will become the nursey? What will the colour scheme be? Will you have a feeding chair that is stationary or rocks? Which pram will you decide to go with? These are all mammoth decisions; I’ve been there – the planning and dreaming starts early!!


Women often get so excited with the idea of the baby (and that’s very understandable!) that they forget about the health checklist that should be ticked off before they even conceive! We call it preconception care and we know that seeing a doctor (and getting as healthy as possible) before you try to conceive leads to better pregnancy outcomes for mum and bub. Preconception consults are 1 of my favourites– I’m passionate about this stuff; to think we can improve the trajectory of a baby’s health both inside and outside the womb is amazing. You can really see my inner nerd shining through now can’t you?


Here is my checklist – if you’re thinking about pregnancy (even kind of) then this is for you. It’s not exhaustive; what every woman needs pre-pregnancy is different according to her medical and family history (particularly of genetic conditions).


  1. Are you as healthy as you can be?

I cover loads in preconception consults with my patients. Blood pressure, weight and BMI are a start– are you overweight or obese and do you need to try and lose some weight before you conceive? Even just 5-10% of your body weight? We know obesity can be dangerous in pregnancy and that if an obese woman can lose weight before she conceives she can reduce risk of complications for herself and her child. Having said that, being underweight also carries risks – actually getting pregnant can be harder. If you are underweight and not having regular menstrual cycles then discussing some weight gain pre-pregnancy to regulate the menstrual cycle might be a factor.


Do you have asthma, thyroid disease, diabetes or any medical condition that needs to be controlled carefully before you conceive to improve baby’s chances of a normal development? Common conditions like asthma can go haywire in pregnancy. It is worth making sure firstly, you are on safe medications for your asthma in case you get pregnant and secondly, that you are well controlled. Poorly controlled asthma (I’m talking lots of symptoms and Ventolin use) can have any negative impacts such as affecting the growth of the baby. Talking about medical conditions – mental well-being is equally important. If you suffer from depression or anxiety is it as well controlled as it can be? And if you are on medication is it safe in case you do get pregnant?


Are you using over the counter medications that should be avoided when pregnant? You won’t know unless you check! Lots of non-pregnancy supplements contain Vitamin A which can be harmful. I often discuss with patients stopping some supplements or changing some of their regular prescribed medications so that everything they are on is deemed safe for pregnancy. By the time you get pregnant and come in to the doctor cells have already started rapidly dividing in the embryo and unsafe medications may have had an impact – this is why we try to make the changes before conception.


There are now also genetic carrier tests we can offer for women and their partners pre-pregnancy (as a warning – these do cost money and are not currently government funded) – are you a carrier of cystic fibrosis or fragile X syndrome? Is your partner? We can now test to see if you or your partner are carriers for certain genetic conditions which means you can assess what the baby’s risk might be if you were to conceive. Ideally tests like this should be done before pregnancy so you can plan if you and your partner are carriers for a condition (it means the baby is more likely to be affected).


So that’s just the generic health stuff – I can assure you in a preconception consult I will calculate your BMI, take your blood pressure and arrange for you to have bloods…if you’re thinking “wow this is a lot” – bear with me, we’re just getting started.


  1. Are your vaccinations up to date?

If you come in and tell me you are planning a pregnancy I will always order blood tests. There are certain standard tests every woman gets like rubella antibodies, syphilis antibodies and HIV antibodies to name a few. We test everyone for these things – it is routine. The rubella test is an important one – rubella infection in pregnancy can have devastating consequences for the baby if they are also infected – vision and hearing problems as well as serious development issues. Most women are immune thanks to vaccination BUT if you’re not we ideally vaccinate you before you conceive to make sure you and your baby are protected. The rubella vaccine (MMR) is a live vaccine so pregnancy needs to be avoided for 28 days after  – see this stuff takes planning! We also check you’re up to date with things like Tetanus, hepatitis B and the flu vaccine.


  1. Are you taking the right supplements?

The recommendation in Australia is that every woman take 400mcg of folic acid and 150mcg of iodine 4 weeks prior to conceiving and ideally for the first trimester (at least). Folic acid can reduce the risk of neural tube defects like spina bifida and iodine is crucial for baby’s brain development. Some women need higher doses of folic acid (obese women and diabetic patients are 2 examples) and you won’t know if you fall into that group unless you see your doctor beforehand! Iron, vitamin B12, vitamin D – not all women planning pregnancy need these, but some do – it’s worth finding out!


  1. Are you covered?


This might sound boring but worth thinking about trust me. If you have a baby where would you have it? Which public hospital’s catchment area do you fall into and are you happy to go there? If not, do you have private health insurance so you can choose your obstetrician and hospital? If you decide to get private health insurance – are you immediately covered for pregnancy or is there a waiting time? These are the types of things you want to ideally have sorted before you get pregnant!


  1. Are you ACTUALLY ready for this?

Again, no one really wants to talk about this stuff. I raise with women the nitty gritty stuff that we know is important but no one wants to talk about. Family violence is common – far more common that what you realise I suspect. Women exposed to family violence in pregnancy have higher rates of miscarriage. So this is why I try to ask women BEFORE they conceive “do you feel safe at home?”


Having a child is hard – alone or with a partner – so planning for the life and financial changes is actually very smart – can you afford a child? If you go down to 1 income can you still pay your rent or mortgage and live? Are you or your partner going to take time off? If neither of you can afford to take time off then who have you got around to help with the baby?





So there you have it – the general checklist; like I said not exhaustive because it depends on every woman’s personal history. I know my health check list isn’t as exciting as deciding on wallpaper in the nursery or names – but I can assure you it is vital. Plan ahead, get as healthy as you can- the aim is to do everything you can to improve your (and your future baby’s) chances of a healthy successful pregnancy!





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