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 (https://www.recipecommunity.co.uk/baby-food-recipes/broccoli-nuggets/3filth5r-5e853-726950-cfcd2-wdltafsv) 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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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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The Flu Vaccine – Worth a Shot?

 

Our clinic just received its supply of Government funded flu vaccines (insert hands up emoji here). It got me thinking – how many people know who is eligible to receive the free Govenmernment funded flu vaccine ? And why might you still want to get the jab even if you have to pay for it?

 

Lots of patients will say that they don’t get the vaccine anymore because they “had it once and got the flu straight after.” I swear I say this a thousand times in flu season – “the vaccine CANNOT give you the flu.” It is not a live vaccine – we do not inject any of the live virus into your body. It dose make your body mount an immune response (that’s how all vaccines work) so you may experience some muscle aches (but most likely you will just have a sore arm). What is MORE than likely (if you do get sick a few days after it) is that you were incubating some sort of virus before you got jabbed, and the illness declared itself coincidentally in the few days after and you blamed the poor vaccine, when it fact you should be blaming the snotty guy at work who doesn’t wash his hands – ever! A reminder also that like any vaccine, the flu vaccine isn’t 100% effective and covers 3 or 4 strains of the flu virus (depending on which vaccine you get) when there are in fact many other strains in the community. Despite the fact it isn’t the magic bullet the vaccine does reduce the risk of flu by about 50 to 60% in the general population – and trust me if you’ve been in bed for 2 weeks with aching muscles and fevers you’ll take anything you can get to reduce your risk of getting it again.

 

There are certain people who get the flu vaccination for free in Australia- anyone over 65, Aboriginal and Torres Stait Islander people, pregnant women and patients with chronic medical conditions such as asthma (where the flu can trigger severe flares) or diabetes (where the immune system is suppressed). There are many other conditions that qualify for the Government funded vaccine so it is worth checking with your GP if you have a chronic medical illness. If you are fit and healthy then you can still get the vaccine- you just have to pay for it (between 15 to 20 dollars). I get it every year – I would be stupid not to in my line of work. I couldn’t tell you how many people I see in the flu season with the classic fevers and aches who look like they’ve walked straight from a steam room into my office – I’m talking sweaty, clammy, “death warmed up” kind of look. If you’ve had the flu before you will do anything to get the vaccine. And before you say “I’ve had the flu and it wasn’t that bad”– the flu is NOT a cold- they are caused by completely different viruses. A cold is often something like rhinovirus or human metapneumovirus whereas the flu is caused by viruses like Influenza A, B or H1N1 (also known as swine flu) – completely different nasties. The flu is debilitating – muscle aches, high fevers, runny nose, headaches, low appetite for up to 4 weeks – you are house if not bed bound. It can lead to pneumonia and even death in the vulnerable (infants, elderly, immunocomporomised to name a few). The flu isn’t the sore throat and headache you had for 5 days last week – it’s much much more than that, trust me.

 

I’m terrified of needles (yes, no joke!). Happy to jab my patients but if you come near me with a needle I will hyperventilate a little (and try very hard to hide it) which sometimes makes me  bit woozy and faint (I know, could it be any more dramatic?!). But guess what I’m doing this week? Yep, getting a flu shot because for me, a young mum, I can’t afford 4 weeks off and I certainly can’t be bringing the flu home to my little girl. A quick jab in the arm versus 4 weeks in bed – up to you!

 

If you would like to read more about the Influenza vaccine, including vaccination of children, check out http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-influenza

 

 

 

 

 

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A Healthy Spin on a Comfort Meal Version 1 – Tuna Mornay

 

 

Tuna mornay is a love of mine – it holds a special place in my heart… alongside twiggy sticks (I know I know!), smoked salmon and goats cheese. It’s a meal I yearn for when I’m celebrating something or when I’m devastated and need a pick-me-up. But MY tuna monray isn’t like yours- I can assure you. It’s one of the healthiest and easiest meals I make and lasts in the fridge for 2-3 days feeding the entire family – Miss S included.

 

If you follow me on Instagram you’ll have seen it in my posts – I make it often – so I thought it was time to share how I do it. So here it is – the Preeya twist on tuna mornay.

 

Firstly, tuna mornay (or my version of it sans white sauce and other fancy bits) is a very healthy vegetable packed meal that only needs one pot. Tuna is so good for you – rich in omega 3 hence, great for the heart and the brain of little ones especially. If you’re attempting to adopt the Mediterranean diet, because of all its wonderful evidence-based health benefits including reduced risks of cancers and heart disease, then it’s a wonderful meal for you because it contains seafood, is loaded with vegetables and uses olive oil as the cooking base.

 

What you will need:

Step 1 – Pick 2 425g cans of tuna (this makes a mammoth quanitity to last for 2-3 days, if you don’t need this much only use 1 can). It doesn’t matter what type of tuna you pick – either spring water or olive oil will do but ensure you don’t pick a flavoured one – we can add that ourselves! You will also need 1 or 2 cans of creamed corn (you can get this from the canned vegetable area at the supermarket) – 1 can for a small batch, 2 for large. In the recipe you might find some other bits I add sometimes.

 

Step 2 – Look in your fridge, veggie patch and pantry – what veggies do you have? I always use what I have – the half chewed broccoli sitting in the crisper is perfect, so are the tomatoes in the garden! Sometimes I’ll use cauliflower I have sitting around and other times I’ll use some celery, mushrooms and tomatoes. Grated zucchini is always easy and fabulous. Use what you have but make sure you add at least 3 types of veggies and one that adds some crunch like celery. I hear the critics already – “tomato in a tuna mornay??” – it’s a great addition – adds some additional moisture and sweetness!

 

Be creative with the veggies especially if you have kids. I tend to blitz my broccoli and cauliflower (if I’m using it) in the thermomix before I add it to the pot – it makes it like a cous cous and makes the mornay thick and creamy!

 

Step 3 – Always add peas and corn – it’s just how I roll.

 

Step 4 – Be creative with your grain! Doesn’t HAVE to be pasta. I sometimes add brown rice (cooked before I throw it in to the mix) but more often than not add quinoa which is just lovely and adds a nice texture! You can use wholegrain pasta or even chickpeas. Sometimes I don’t add a carbohydrate at all – usually because I’ve put in so many veggies there is no room. It’s always just as delicious!

 

The actual steps I follow:

 

  1. I heat olive oil in a fry pan and fry off onions (brown or red) until browned – about 5 mins
  2. I add the tuna (with the olive oil or spring water drained beforehand) and just brown it slightly for another 4 mins
  3. In go ALL the veggies I have – the spinach, tomatoes, peas and corn, cauliflower – whatever it is I chuck it in now. Stir it all in and give in another 2-3 mins.
  4. Add your binder of the dish (some fluid!) – the creamed corn! If you have a load of veggies you might need 2 cans – but 1 is usually enough. Once the binder is in – chuck you grain in now – whatever it is: pasta, quinoa – this is its moment to join the party!
  5. SOMETIMES I add a soup packet (cream of chicken or celery) to bind it further but I rarely need this. If you do choose to add a cream of chicken soup pick one with low salt (especially if your child is going to eat this).
  6. Add your herbs – I normally add parsley and spring onion from the garden but play around –there are no fixed rules – try what you have!! Parsley goes beautifully in this though as does basil.
  7. Pepper – of course!!! Be careful with salt ESPECIALLY if your child is going to eat this. I don’t add any if Miss S is going to have this for dinner – which is always given she loves the stuff!!
  8. Once it’s all bound, shove it in an oven dish – 2 cans of tuna gives you lots of food so you will need a big tray – sprinkle some cheddar cheese on top and pop it in the oven on 180 degrees for 20 mins until the cheese is golden on top! Don’t freak out – I know there isn’t any white sauce nor bread crumbs but trust me this is delicious! People don’t realise that adding something like white sauce to a meal is adding extra calories you don’t need.

 

And that’s it – you have a healthy tuna mornay!! You may be skeptical – is this even delicious? Hell yes it is – the veggies give it texture and sweetness, the cheese gives it the edge and the tuna is the hero as it should be!

If you have a serve for dinner this meal will give you at least 2 serves of veggies easily. Imagine how good it is for kids! I can hear you saying “Preeya this isn’t really a strict recipe with steps to follow” – I know but this is how I cook – it changes every time and you have a framework now to work off.

 

The wonderful thing about my mornay, like all my cooking, is there are no set rules – play around, try things out, chuck in as many good tasty things as you can! Try a comfort meal without the naughty things like white sauce – it can be just as delicious and good for you!

 

If you like this – I’ll pop up some of my other healthy versions of comfort food – lasagne, pasta sauce, shepard’s pie, enchiladas!! The possibilities are endless!!! Check out my Instagram feed for other healthy food ideas!!

 

 

 

 

 

 

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A Peek Inside Our Medical Kit for India

 

I’m a type A packer – I’m talking lists, repeated cross checking with the lists, caressing of the lists – I love the lists!! My type A personality flourishes when it comes to holiday packing.

 

I tell all my patients that if they are going to travel overseas they need to pack a medical kit and if travelling to the developing world then the medical kit needs to be more extensive.

 

So here is a look in our travel kit for India – I use the term “kit” very loosely – it’s a plastic bag filled with an abundance of ammunition in case we get unlucky. In addition to the medications I’ve packed Milton’s tablets for sterilising Miss S’s utensils and bottles (seriously handy for travel!) and water purification tablets just in case.

 

 

  1. The Basics

 

These are the things people sadly tend to forget (and you will kick yourself trust me!) – the every day items that you take for granted at home. Paracetamol when you have a headache, a fresh bandaid when your child falls over and grazes their knee. The basics should go on every holiday with you!

 

What I packed – Paracetamol and Ibuprofen (both for Miss S and ourselves), antihistamine tablets for adults (to stop my allergic husband from ruining the entire trip with his sneezing), bandaids.

 

 

  1. Traveller’s Diarrhea Essentials – incase it hits (insert worried face here)

 

Traveller’s diarrhea is common and affects up to 50% of international travellers. Nausea, vomiting and diarrhea are horrendous but it’s the dehydration as a result that is the big killer. Hydration solutions are essential- we have effervescent tablets and jelly in our medical kit this time in case Miss S gets hit. Food and water safety is key when it comes to avoiding traveler’s diarrhea (I can’t emphasise this enough!!!) but if you get unlucky anti-diarrhoea tablets (NEVER use these in children as they can have severe bowel complications) and an anti spasmodic agent like Buscopan, for that awful crampy belly pain, can help. You should always see your GP before you travel to countries where traveller’s diarrhea are likely to hit (South East Asia, India, Africa etc) for antibiotics you might be able to take with you in case – antibiotics can help as more than half of traveller’s diarrhea cases are bacterial in nature.

 

What I packed – Ciprofloxacin and Azithromycin for traveller’s diarrhea (for the adults), Azithromycin (for Miss S), antispasmodic agent, Loperamide, hydration solutions (both tablet and jelly), Weetbix – if something super simple is needed for Miss S (yes it is going in the medical kit area!!)

 

  1. Sun and mosquito safety

 

Another big one people tend to forget! Sun cream (make sure it’s water resistant and OK for children if you have them!) and mosquito repellant are VITAL. For some reason people don’t consider these as vital components of the medical kit – to me they are perhaps more important than some of the antibiotics you can take. Severe sunburn on a holiday is dangerous and malaria can be lethal – so put your insect repellant and sun cream purchase high on the agenda!

 

DEET repellant is the tropical strength stuff you can buy from the chemist. For Miss S we have the cream version to apply (not to the hands as they put these in their mouth), a mosquito net to place over her cot (Kathmandu sells these) and 50+ suncream for her (and a version for us). We have tailored our trip for Miss S (and are not travelling to high risk malaria areas) because there are no antimalarial drugs for her and having seen malaria as doctors we were not willing to take the risk so our itinerary sticks to low risk areas only. Again a visit to the GP before you travel is a great way to find out if you are going to high risk malaria areas, in which case you might need preventative medication.

 

What I packed – 50+ suncream for the entire family, DEET insect repellant, mosquito net, citronella candles, hats and sunglasses for the 3 of us.

 

  1. The “Just In Case”

 

You don’t know when a cold will hit so I take things for the dreaded “in case we get a cold on holiday” scenario. For adults that’s some form of decongestant tablets lest it strikes before we have to fly. For Miss S that means a bit more – the FESS nasal suction, eye wipes and Vicks are also coming along. A thermometer takes minimal room and you won’t regret packing it if someone gets sick and whilst I really want to take my stethoscope and entire diagnostic kit (did I mention I’m type A haha) I’m refraining (and I think my husband would secretly unpack it even if I tried). BUT we do have comprehensive travel insurance (please don’t go anywhere without it!!) and we have checked the English speaking hospitals that will see children in each place we are visiting – it pays to be prepared.

 

 

 

So I know what you’re thinking – how do you have room for all this? A few less dresses packed (I know the sacrifices we make!!) – but I won’t miss the dresses if I’m bent over the toilet bowl! And whilst I have fingers and toes crossed we won’t need anything from the medical kit – it’s ALL there if we do!!

 

 

 

 

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Dear Wobbly Bits…

 

A girlfriend recently commented that she envied my “body confidence” especially after having had a child. I was shocked. Me, body confident? Upon asking her how she had come to this conclusion she commented that through the Wholesome Doctor blogs and Instagram she had noted that I judged healthy on so many other things other than appearance and that surely that translated to being “very confident” with how I looked.

 

So I feel like I have to clear this up lest you also see me like this.

 

I am a woman.

 

I am a normal, mortal, sometimes horrendously self-judging woman.

 

I have cried numerous times over my body post child birth. I have squeezed my abdominal subcutaneous fat (you know the wobbly bit under the belly button that just appears post child birth) several times and pondered whether 1000 sit up, hour long planks or plain old surgery will fix it. I have looked in the mirror in my “old” clothes and felt my heart sink at the new me – “give it another month Preeya, it will fit perfectly again” – I’ve said this for the last 6 months mind you.

 

My body is different. I know I’m healthy – my body mass index (BMI) is clearly in the healthy range, my waist circumference is well below the 80cm cut off the Heart Foundation sets for women (its 94cm for men by the way). I eat fruit and vegetables, I do some form of exercise almost every day and I know my blood pressure and cholesterol are A-OK. But hey, I do have low moments about my body image – they aren’t frequent but they happen. Sure I’m healthy BUT the White Suede dress I pine after looks much better on someone who is classified as underweight by the BMI index, so of course I have moments of self-doubt.

 

I know a lot of people say this– but my husband and I have been blessed with a healthy, divine, sometimes very cheeky daughter. We have a roof over our heads and job security. And shouldn’t that be enough? Should I also yearn to have my “kind of” flat stomach back? Should I pine after my old physique knowing full well that I have nurtured another human life for 9 months, breast fed it for 6 and managed to stay reasonably (I stress the word reasonably) sane? How much do I really want? Sometimes I feel I’m pushing my luck by also wanting my old body back.

 

We know that eating disorders amongst the adolescent population are a real problem, particularly amongst girls. The American Academy of Paediatrics suggests to reduce the risk of these issues in their children parents should not talk about their own weight or their children’s and that the main focus should always be on promoting a healthy overall lifestyle as opposed to focusing on weight or diet too much. So the moment Miss S arrived my husband and I made a pact that I wouldn’t talk about my body low moments in front of Miss S – because that’s often how it all starts. So our 6 month old hasn’t heard any of it! Doesn’t mean when the bedroom door closes and I’m choosing an outfit for a wedding that I don’t have a small vent to the mirror or my husband!!

 

So please don’t for a moment mistake my “health confidence” for “body confidence!” Having said ALL of that though I truly am content in who I am and I think my contentment predominantly stems now from my love of motherhood. I’m juggling motherhood with work and I feel like I’m doing OK at both whilst remaining a decent mother, wife, daughter and friend– and that’s the main thing that matters to me if I’m truly honest. In reality my body has very little to do with my overall self-confidence and self worth – I’d rather be healthy, and I am. So to the extra wobble under my belly button – we have a love hate relationship. I know you brought with you the most divine creature in my universe but you make the clingy dresses sit a touch tighter now! But I’m sure we can work it out… I won’t be grabbing you in front of Miss S saying “look at this, its gotta go”… rather I’ll point out that you’re a part of me (just like my neurotic mind) and that’s the way it is so that Miss S will grow up striving for health as opposed to a dress size and ultimately love herself regardless of how the dress falls on her waist line.

 

 

 

Let there me more body love, more love for the unique bodies that we all are. Please share with a friend who you know needs a pep in her step when it comes to her less loved body bits!

 

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The Exercise Excuses

 

When I start mentioning to patients that weight loss and exercise might help their knee osteoarthritis, diabetes or blood pressure control I get hit with “but…” very quickly. The excuses come thick and fast.

 

I thought I would share the 5 common excuses I hear as a GP and why they usually aren’t valid. If you’ve ever uttered these words when it comes to exercise (even to yourself) then let me very gently rebut you and perhaps even change your mind!

 

“I can’t run because my joints hurt”

 

My joints don’t stop me from running- instead it’s my over active brain that has no idea what to do whilst my legs are moving. I find running utterly boring and have never been able to go past 10 minutes. If you can’t run because of your joints or because you’re brain cannot accept this mundane form of exercise then fine – but don’t let that be your ticket to “well I don’t need to exercise.” I don’t expect you to run through ankle instability or plantar fasciitis – but I do expect us to find an alternative way you can get moving and shaking that your joints will accept.

 

Sore joints, wobbly knees and whining feet can all cope with low impact exercises like cycling or swimming. Strength training like yoga or pilates may be just what your joints are craving. For patients who have a tough time finding exercise that suits them we involve exercise physiologists who can develop a program that suits the patient.

 

Running isn’t the ONLY form of exercise remember?

 

“I don’t have the time to attend gym classes”

 

I understand this – being a time poor mother and GP I can identify with this one. But it’s all a matter of compromise– do you sacrifice 30 minutes of extra sleep in the morning to get to the 6am class? It means a little bit of preparation before bed– packing a bag of work clothes and going to bed a touch earlier – but it can be done. Or do you say no to 1 or 2 evening social engagements this week and attend a class instead? That’s how I made it work prior to being a mother.

 

I remind my patients constantly that the gym isn’t the only place they can attend group physical activity. There are groups who meet in the park, personal trainers who run group sessions and if you have friends they might be keen to join you for an interval sprint session.

 

“I don’t have time to exercise… FULL STOP”

 

Nope – don’t believe you. When patients say this to me I get an average day timetable from them. 99% of the time I can find a pocket where they have picked couch time or social events over exercise. This is my forte – sneaking exercise in when I can – so I don’t buy the excuse of lack of time.

 

I bet anything that you spend SOME time in front of the TV. Most of my patients admit they watch a favourite program either once or twice a week. Boom – there’s the window. Pop a treadmill, exercise bike or cross country trainer in front of the TV and promise yourself that you will not watch your show without being on that machine (The Bachelorette is even more enjoyable if you burn calories at the same time!!). Or if you have pockets of time here and there grab a skipping rope – 3 x 10 minute sessions are perfect! If you have someone at home with you, try what my husband and I do and have a quick boxing session – excellent for fitness and any venting!

 

So time poor isn’t going to cut it with me. As a new mother who is working and trying to maintain a half decent home I don’t let that excuse enter my mind, so you shouldn’t either.

 

“I don’t feel confident swimming”

 

As a water challenged being I hear you but swimming is an excellent form of cardiovascular exercise for people with joint issues (because it’s low impact) and asthma (indoor heated pools can be very lung friendly for those whose asthma is worse with cold air). You don’t need to Ian Thorpe it down the fast lane for swimming to count as exercise – a doggy paddle or breast stroke (and yes I’m talking head remains ABOVE the water!!!) counts too (as does briskly walking up and down the pool or attending an aqua aerobics class). If you don’t feel comfortable in bathers – a big t-shirt will save your dignity – as will going at non-peak times (something I tell my body conscious patients).

 

Despite all the reluctance to get into bathers – swimming is a fantastic form of exercise!

 

“I can’t afford a gym membership or personal trainer”

 

I hear this one a lot. And quite frankly it’s the weakest excuse of them all. You don’t NEED a gym or a personal trainer to exercise. You need motivation – you need to chuck your sneakers on, chuck out the excuses and go for a walk, run or cycle. Grab your partner, a friend, a group of friends and use them to help motivate you. You don’t need to pay someone to yell at you to run – tell your motivated friend that you REALLY want to join them for their weekend hike or cycle for the next month – they will end up pushing you a bit without you (or your wallet) knowing about it.

 

I remember telling a newly diagnosed type 2 diabetic patient of mine that weight loss would greatly help her diabetes control (if not reverse the diabetes completely). She recruited 3 girlfriends, all in their late 60s, and they would walk around the local lake 4 days a week – rail, hail or shine. Not only did she significantly improve her diabetes control, but another member of her walking group (who was also my patient) lost enough weight to come off 1 of her blood pressure mediations! Now these ladies proved you don’t need a gym or a PT behind you – just a good group of friends who are willing to chuck their sneakers on!

 

 

So ditch the excuses. I’ve heard them all before – and my response usually involves the line “I’m busy too BUT I manage to do at least 30 – 60 minutes of something active 6 days of the week” – and that’s the truth. So before you put your pajamas on tonight or sit down to watch some TV – is there anyway you can sneak in something active? And is that voice in your head that was very free with the excuses finally silent?

 

 

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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 Definition Of “Healthy” (from a GP’s Perspective)

 

Everyone wants to be “healthy.” What is the definition of healthy though – is there a clothing size? A specific weight we should aim for? Is there a magic supplement or vitamin that automatically makes us healthy? The answer is no – determining health is so much harder than just looking at a person, their clothing size or their weight.

 

Last year at the Australian Fashion Week there was uproar when a particular model took to the catwalk – the comments and tweets came thick and fast – “Oh she is so unhealthy.” The very people who were labeling her “unhealthy” and hence, determining what the definition of “health” was were not part of the health profession and the same people who place pictures of size 6 women with thigh gaps and 6 packs in our faces. See the problem?

 

You are likely not healthy if you are too thin or if you are overweight or obese. So let’s clear this up.

 

A male or female who walks in my consultation room with a very low body mass index (BMI) is equally as concerning to me as a patient who is obese. Being seriously underweight (through restriction of food, purging, not eating at all or excessive exercise) can lead to issues with fertility (women for instance, will not have regular periods), nutritional deficiencies (like iron) and osteoporosis (where the bones become brittle).

 

You can be seriously underweight and have a cholesterol of 8, which is very high and not healthy. By the same token neither is being overweight or obese – it carries risks of high blood pressure, diabetes, heart disease and high risk of certain cancers.

 

Health to me is the general “vibe” of an individual – yes, I’m talking The Castle and Mabo type of “vibe.” What’s your blood pressure, cholesterol, weight, height, body mass index? What do you eat – and do you eat a bit of everything in moderation? Do you exercise – how much and how often? Do you smoke? (Please say no!) Do you drink alcohol – and if so how much? And what’s your mood like – do you think you could be depressed or anxious? That’s the stuff I want to know to gauge whether or not you’re healthy. And here’s a hot tip mental health is just as vital as the body stuff.

 

I am not looking at your six pack or bicep size. And I certainly won’t think you’re any healthier for purposely cutting out foods groups like dairy and meat for no particular medical reason.

 

There really is no concrete measure for “health” or “healthiness.” But as GPs we make those assessments every day. So am I healthy? I do something active every day, I eat fruit, vegetables, protein, carbohydrates and drink plenty of water. I love my wine and on occasion will have more than the 2 standard drinks I should but, hey I’m human!

 

I guess you need to ask yourself the same questions. Are you doing everything you can to reduce your risk of chronic diseases like high blood pressure, type 2 diabetes and high cholesterol? Are you active? Do you make an effort with your diet – do you eat enough? Or too much?

 

So finally, yes I think my vibe is somewhat “healthy” – is yours?

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