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The last 3 weeks, for us all, has been filled with making and adjusting to change. Each day has brought new problems, compromises and frustrations to our ways of working and living.
The way we deliver health care in General Practice has been overhauled to help contain the spread of CoVID-19 while still being able to provide as close to usual care of our patients as we can. We have rushed to adjust to this and now can draw breath to reflect and refine our processes.
Coronavirus
It is apparent that in the coming weeks the outbreak of Coronavirus (COVID-19) in China will spread to Australia to a significant degree. The television footage of Chinese health workers head to toe in protective suits, together with many questions yet to be answered about the virus and its health effects, has led to high levels of community anxiety. So, what should we all be doing in Busselton?
Heat Stroke
With the hot weather upon us it is time to consider the effects of high temperatures upon our health. The most dangerous of all these conditions is termed heat stroke. But what is it exactly?
Why do I need a referral to see the Specialist?
It seems such a hassle to get a referral before seeing a specialist. There’ s making an appointment to see your GP first, then the waiting to see them and then the cost of the visit to get the referral. And you still have all that to do for the specialist again!
I have just got to get to sleep!
One third of a healthy person’s life on average will be spent asleep. It’s a good thing to for as Shakespeare wrote in Macbeth:
Colds and Antibiotics: Rarely a Good Combination
One of the commonest reasons people visit the doctor over winter is for a respiratory illness with symptoms such as a sore throat, hoarseness, runny nose, sneezing, fever or a cough. Their reasons for seeking medical help are varied.
If only it was sex, drugs and rock and roll: the Modern Dilemma.
Mental health disorders are common in children and adolescents. As GPs we see an increasing number of teenagers with symptoms of anxiety and depression.
It is a good thing that these young people present for help and recent mental health promotion and increasing recognition and acceptance of these illnesses has helped make it easier for people to seek help.
So you can’t find your car keys again. You storm about the house flinging out the odd accusation that some one must have shifted them. There is a lot of eye rolling going on in those watching the performance.
After you calm down you suddenly remember, “Ah that’s right! I left them next to my bed when I came in late last night.”
In the 17th Century cutting edge medical advice to cure your warts was to:
“ Wash your hands in moonbeams in an otherwise empty well polished silver basin.”
And sometimes it worked! Then again so did spitting on your wart and rubbing it three times in the direction of a passing funeral.
Many of us will remember a time when the words “Gluten Free” were a rare occurrence in the supermarkets, restaurants and dinner parties of Australia and most likely only of interest for an unfortunate group of people who knew they had Coeliac Disease. Now it would be unusual not to know someone who claims to be gluten intolerant. A national survey in 2015 reported that 7.3% of us (excluding those with proven or suspected Coeliac Disease) reported adverse effects associated with gluten ingestion. Why the change?
For most of us the earliest and obvious sign of getting old appears when we look in the mirror. Our skin is the first to give the game away. The lines about our eyes, the brown spots that weren’t always there and the uncalled for sagging beneath our chin betray the pitiless hand of Father Time.
We know that for virtually everybody some form of exercise is beneficial no matter what your age and health. If exercise were a pill it would have greater general benefits than all of the medicines we use.
There are many barriers to people making use of the miracles of exercise. One of these is whether the type of exercise they would like to do is safe for them? When we are young and healthy we rarely give this a thought but as we enter into middle age or experience various health issues, doubts can creep in.
For centuries a variety of behaviours and illnesses in infants and toddlers has been blamed on teething. Some of these now we dismiss out of hand as our knowledge of disease has grown. Serious infections could previously be attributed to a baby teething and indeed teething would be put down on a death certificate in times gone by as a cause of death. However, today many people will still attribute their baby’s ill health to cutting teeth. How valid is this?
In the course of a week consulting as a GP it is not uncommon to see a patient, presenting with some other issue, who has a problem with acne. Often it is not mentioned, but some of our most grateful patients are those with whom we raise the issue and ask if they would like some help with managing it.
Just because it itches - it doesn't mean it's thrush!
Itching of the vulva and around the vagina is a very common symptom in women of all ages with about 10% of women seeing a doctor at some stage about a persistent itch. Many more probably are unseen and often self treat for years with variable success.
When antibiotics were first discovered and used in the 1940’s they were quite rightly regarded as miracle drugs. They allowed many simple but potentially fatal infections such as pneumonia to be cured. Their use together with immunisations, contraception and public health measures has done more for alleviating human suffering and prolonging life than anything to date.
In a typical scenario, your teenage son in a rare moment of verbosity manages to say “ Mum, I think there is something wrong with my toe.”
They then peel back their sweaty sock to display a sight you never thought possible in a first world country. There, in all its manky glory, is a red swollen big toe and if you are particularly lucky not oozing copious amounts of an unspeakable liquid.
As the Australian population ages, one of the most significant health problems we face is osteoporosis. In 2017 in WA alone 14% of the population over the age of 50 had osteoporosis. The figures become even more alarming over the age of 70 with 43% of women and 13% of men having osteoporosis.
Safe, effective treatments are out there but it can be confusing to know what’s right for you Having acne can feel embarrassing and painful. And sometimes it can be tricky to work out what's going to help and what’s going to make the breakouts even worse.
What's the Alternative?
Modern medicine prides itself on a firm commitment to scientific evidence in the assessment of the cause and treatment of disease. It is however an applied science to the deeply personal experience of every individual: this being their own body and health. This may explain why there is no shortage of opinion on how to treat illness by the public at large and specifically by those wishing to practice in alternative health care. Not all of these practitioners subscribe to the scientific method to ascertain medical fact or they may distort the method to give the appearance of scientific rigour.
Hot Flushes
Probably the most disturbing menopausal symptom is the hot flushes that usually start early on. They often settle after a year or two although for some women they can persist for much longer. If they are troubling you then it is worth seeing your doctor as they can have other causes other than the menopause and there is treatment available to relieve your distress.
The hot flushes are caused by the fall in oestrogen levels around the time of the menopause. This seems to change the body’s thermostat in the hypothalamus of the brain so that there is a more narrow body temperature range that it is willing to tolerate. Anything that slightly raises the bony temperature such as stress, alcohol, spicy foods, caffeine or a warm room can provoke a rapid and vigorous response of dilation of skin blood vessels which causes the flushing, sweating and a feeling of overheating.
Ban the Cotton Bud
You will probably never meet a doctor who has a good thing to say about cotton buds. People will stick a range of mind-boggling objects into their ear to remove wax or just give it a good scratch. The humble and innocuous cotton bud causes more trouble than all of them combined.
The skin of the ear canal is thin and delicate and the eardrum is surprisingly not that far away either. Pushing an ear bud in and rotating it repeatedly because it feels good to scratch that itch can abrade the skin setting up a painful outer ear infection. Put it slightly too far and the eardrum can be damaged and even ruptured.
Introducing Solids to Babies
On average, infants visit their GP 11 times in the first year of their life and a common query is when to introduce solids. There is often conflicting advice given by well-meaning relatives and friends as well as various websites which leads to confused parents.
Babies either born premature, with poor weight gain or special health needs then it is essential to consult a doctor or dietician to assist.
For most infants it is recommended to commence solids between 4 and 6 months of age. They should however continue to breast feed or use infant formula to the age of 12 months.
You found what in your scrotum
So you have found, gulp, a lump in your testicle.
What should you do? Run around the room hyperventilating? Keep it to yourself and hope worry will make it go away? Pretend you never noticed?
Alarming though this maybe to discover, it is rarely a cause for concern. Don’t panic but get it checked out by the doctor and put your mind at rest.
Fever in your child
The vast majority of fevers in children are caused by minor and self-resolving viral illnesses. But, rarely, they can be an indicator of more severe illness. So, when can you relax and let their natural immunity fight off the illness and when do you need to seek medical care?
PCOS
Polycystic Ovary Syndrome (PCOS) is very common with studies showing at any one time it is present in 12% to 21% of women of reproductive age. It is important to be aware of this condition as its symptoms vary between women and in up to a third of people the diagnosis is not reached until 2 years after they present to doctors with their symptoms.
Women with PCOS may have irregular periods (usually infrequent) due to irregular ovulation. This in turn can lead to delays in falling pregnant. In addition they may also show signs of high free testosterone levels in their blood with problems such as excessive and male pattern hair growth, acne and scalp hair loss. When pelvic ultrasounds are done they may also demonstrate multiple ovarian cysts, which gives the condition its name. However, each woman may show a different mixture of these symptoms and with different severity.
Anxious Children
Childhood anxiety disorders are one of the most common mental health issues in young people and can often continue in some form into their adult life. There are many helpful psychological strategies they can learn at any age to help manage their anxiety so that it becomes less of an issue.
A degree of anxiety can be a good thing in all of us by giving motivation to change and adapt to new requirements in the environment. However, if the level of anxiety is not appropriate to the situation or causes a person to avoid doing things that are in their best interest, it can become a problem.
Shield Yourself From The Death Star
Living in Australia, we are very aware of the need to protect ourselves against the harmful effects of the sun, but how does the light actually damage our skin?
Light is made up of visible and invisible components and it is the short wavelength light in the ultra-violet component (UV light) that causes the trouble. In turn this UV light is subdivided into UVA, UVB and UVC depending upon the wavelength. The most powerful of these is UVC, which is filtered out by the earth’s ozone layer and so poses no threat.
Why Losing Weight is Hard
Obesity is the major chronic health problem facing Australia. From it many other medical conditions can arise including cardiovascular disease, diabetes, arthritis and many cancers. Included amongst these is the unhappiness and despair it can cause amongst those who are overweight.
Don't Die of Embarrassment
As doctors we have all seen patients who have avoided seeking medical help out of a fear of embarrassment. Rashes in the groin, sexual problems, problems with urination, bowel issues, lumps in unusual places, fears of sexually transmitted diseases, emotional concerns, abuse at the hands of others and many more fall into this category.
Why Do Local Anaesthetics Sting?
It is one of the great ironies of life that Local Anaesthetics should cause a degree of pain before they start to work to block out further pain. Proving once again in life there is not such thing as a free lunch. But why do they sting when first injected?
The New Age of Contraception
For many years the oral contraceptive pill was the first choice for women looking for reliable and safe contraception and it remains a good choice for many. It was developed in the 1960s but over the last 10 years or so the appearance of various Long Acting Reversible Contraceptives (or LARCS) has begun to replace their position as the best choice for women of all reproductive ages. The World Health Organisation (WHO) and various other professional bodies now recommend LARCs as first line contraception for young women.
Post Natal Depression
All new parents will experience fatigue and extremes of emotion at some point but how can you tell the difference between simple tiredness and Postnatal depression (PND)?
It is common for new mothers to experience the baby blues in the first few weeks after birth. This can be crying and feeling low, but if these symptoms persist after the first month, or occur in the year after birth, this may be postnatal depression.
Who's Choosing Your Nursing Home
At any stage of your adult life it is important to put in place instructions about your future or your families future. This is even more important as you age or if you have elderly parents. The best know method of doing this is through a Will, which covers your instructions at the time of your death. To die without a Will leaves your loved ones in a difficult position that requires various legal processes to overcome the problem.
Should I have a Colonoscopy?
It depends…
Bowel cancer in Australia is the third most commonly diagnosed cancer and the second most common cause of cancer death. In 2017 it is estimated there is a 1 in 11 chance an individual will be diagnosed with bowel cancer before the age of 85. A colonoscopy is an important test in detecting bowel cancer but for most people it is not necessarily the first step.
Stress and your Locus of Control
One of the major factors contributing to psychological distress in our lives is the amount of control we perceive we have over our circumstance and events that occur. Much of what happens in our lives we can’t control: from the traffic on the road through to the loss of a loved one, life is full of uncertainty and unpredictability. There are, of course, many things well within our control such as the lifestyle we pursue and how we treat those around us.
Headaches in Children
Headaches are one of the more common reasons children visit their GP. This is not surprising given that headaches increase in frequency from affecting around 5% of preschool children and rising to around 70% of adolescents. Understandably when their child is affected by a more severe or prolonged headache, parents fear the worst diagnosis that they can imagine: this usually being a brain tumour or meningitis.
Lifestyle change: What's holding you back?
In modern societies a lot of ill health and unhappiness is partly or wholly due to poor lifestyle choices we all make. These include our diet, inactivity, alcohol consumption, cigarette use, work-life balance, sleeping habits and many more. As doctors these choices are the most difficult thing to encourage people to change and our success rates are poor.
One of the more common presentations to General Practitioners are complaints of tiredness without any particular other symptoms to suggest a cause. People will just say they feel tired all the time and don’t know why.
Most often no physical illness can be found and the tiredness is related to work/life balance issues, lifestyle factors such as insufficient sleep, life stresses and sometimes mood disorders such as depression and anxiety.
RUOK
RUOK is a suicide prevention charity in Australia, reminding people that having meaningful conversations with mates and loved ones could save lives.
Staying connected and having meaningful conversations is something we can all do. You don't need to be an expert - just a great mate and a good listener. So, if you notice someone who might be struggling - start a conversation.
Through out history, people have tried to explain illness and how it affects the workings of the body. A major philosophical advance came with the work of a French philosopher, Renee Descartes, in the 17th century. He believed that the mind and the body were separated from each other.
Just under a quarter of all adult Australian could be diagnosed with the Metabolic Syndrome, which increases the risk of premature death by 60% as well as over doubling the risk of cardiovascular disease like heart attacks and strokes as well as tripling the risk of diabetes.
Childhood eczema is very common and sometimes found in the same child as part of the allergic triad of asthma, eczema and hay fever. Unfortunately it is often under treated in children due to fears about the overuse of steroid creams. This arises from well meaning yet misguided advice given by health professionals as well as friends and family.
Many men at some stage of their life can have problems with erections. Here we are not talking about the dodgy shed you put up in the back garden, which the Council then makes you take down. No, we are talking about the sensitive subject of impotence, or to be more medically correct, erectile dysfunction.
For good or bad, Doctor Google, is a presence in all our lives. People, understandably, wish to be well informed about their health and there is a wealth of good information online. Unfortunately, Dr Google can also lead you up some strange paths. One minute you just want to know why you are getting migraines and the next some nutter with a website is suggesting Kale enemas as a cure for all your ills!
Lower back pain is very common with up to 85% of people experiencing some form of it at some point in their lives. By far the most common form of this is what doctors term acute mechanical back pain, which can last for up to 6 weeks.
Before travelling overseas, particularly to less developed countries, it is worth discussing disease prevention measures with your GP. Whether it is a visit for the first time, an old favourite holiday like a regular trip to Bali or you are travelling back to your country of origin to visit relatives: advice on health travel is important.
Pap smears are understandably an unpleasant test for many women and the 2 years in between recalls seems to come around a little too quickly for most. The good news is that from the beginning of December 2017 the interval in between is to be stretched to 5 years with women advised to start having pap smears at age 25 rather than the current 18 years.
For many women, the menopause can be a time of great discomfort with hot flushes, irritability, mood changes, sleep disturbance and loss of libido. The good news is that new medical studies and re-evaluation of old research shows that Hormone Replacement Therapy (HRT) is extremely safe and by far the best therapy to alleviate the discomfort of the menopause.
A vaccination to protect against meningococcal strains A, C, W and Y will be offered to 15-19 year olds in an Australian-first, statewide program to start in school Term 2, with the majority of vaccinations planned for Term 3.