Spring 2012 capital medical clinic 1 Civic Parade Canberra ACT 2600 Telephone: 6234 5678 Facsimile: 6345 6789 Email: email@example.com Dr Julian GALAH
MB BS (UNSW), Dip OBS RCOG
Julian established the Capital Medical Clinic in 1995. He has a special interest in sports medicine and is the team doctor for the Canberra Cannons Rugby team.
Dr Tiny ABBEY MB BS Hons (Syd Uni), FRACGP
Tiny works in the practice on works mornings and Thursday afternoons. He has a special i nterest in weight management and has two small children.
The surgery is open: Monday-Friday 8 am – 12 noon 4 pm – 6 pm Saturday 9 am – 12 noon Sundays, Public Holidays closed
Please ring 6234 5678 for an appointment. If you need more time with the doctor, please tell the receptionist when you make your booking. Urgent medical problems will always be dealt with promptly.
We are happy to visit you at home if you are too sick to come to the surgery. Please ring 6234 5678. Capital Medical Clinic is a fully accredited general practice.
Not all pain is the same P
ain is complex and different types of pain exist. In general, pain is a sensation that you feel because nerves - which are like electric wires - send information about potentially damaging stimuli to your brain from the body. There are two main types of pain. The most common type is nociceptive pain, which simply means pain caused by a painful event. It occurs when, for example, you twist your ankle and pain receptors at the ends of nerves in the ankle where the damage occurs are switched on. Nociceptive pain is usually time limited, meaning that when the tissue damage heals, the pain typically resolves. Nerve pain (also called neuropathic pain) is pain caused by damage to the nerves themselves. The nerves behave abnormally, for instance by telling your brain that pain is happening even after damage has healed. Assessing whether pain is nociceptive or neuropathic can be difficult and sometimes they occur together. Nerve pain is often described as: yy Burning yy Crawling yy Electric shock or shooting yy Freezing yy Stabbing
Causes of nerve pain The common causes are: yy Diabetes: the nerves of the feet are often affected yy After shingles (postherpetic neuralgia): shingles is caused by the chickenpox virus and can damage nerves yy Irritation of a nerve in the face (trigeminal nerve) causing one-sided facial pain Other causes include pain after limb amputation, spinal cord injury, cancer, back pain and multiple sclerosis.
Treat pain early All pain should be treated as early as possible. This helps to reduce the impact
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Sometimes pain is due to damage or injury to a nerve (nerve or neuropathic pain)
on quality of life and lowers the risk of pain becoming chronic (persisting for 3 months or more). Non-medication strategies that can help control the pain include stress reduction, good sleep hygiene, physiotherapy, psychological therapy, transcutaneous electrical nerve stimulation (TENS) and alpha-lipoic acid. Certain medications may help such as those also used for epilepsy and depression, strong analgesics (pain killers) and capsaicin skin ointment. Milder analgesics (paracetamol) or non-steroidal anti-inflammatories (NSAIDs) usually only help nociceptive pain. Speak to your your doctor who will help you set realistic goals and discuss strategies to improve your function and quality of life, such as the ability to do your usual activities of daily living, as well as reducing the pain itself. Speak to your doctor or complete the online survey at www.nervepain.com.au.
Inside this issue... Are you treating your hayfever effectively?
Hepatitis C - the risk factors
Recipe: Baked vegetables with fetta & dates
Putting the squeeze on stress incontinence
The impact of family break up on children
YOUR FREE COPY Please take it home with you
Nutrition Baked Vegetables with Fetta and Date
How do you deal with hayfever? H
ayfever (allergic rhinitis) affects an estimated 3.1 million adults and c hildren in Australia. However, recent research indicates that many sufferers may be missing out on the best possible treatment. If not treated adequately, hayfever can significantly impair your quality of life including disturbed sleep, difficulty concentrating at work and feeling tired and miserable. Hayfever also occurs in an estimated 75-80% of asthma patients, making them particularly vulnerable.
What is hayfever? Serves 6
Preparation time: 15 minutes Cooking time: 80 minutes
Ingredients 2 whole beetroot 2 red onions, cut into wedges 4 carrots, sliced 1cm thick on diagonal 1 eggplant, chopped into 2cm pieces ½ cauliflower, broken into florets 1kg pumpkin, skinned and cut into 4cm pieces 2 tablespoons olive oil 2 teaspoons balsamic vinegar or glaze 6 fresh dates, stoned and quartered 100g reduced fat feta cheese 2 teaspoons toasted sesame seeds ¼ cup coriander leaves
Method Preheat oven to 2000C. Wrap beetroot in foil and bake for 45 minutes. Put the onions, carrots, eggplant, cauliflower and pumpkin in a large wide shallow baking dish. Add oil, season and toss so the oil lightly coats the vegetables. Bake for 35 minutes or until vegetables are tender. Remove from the oven, peel beetroot and cut into chunks. Place the vegetables in a large serving bowl. Drizzle with balsamic vinegar and toss lightly. Place dates and fetta on top, sprinkle with sesame seeds and coriander.
Many people with hayfever are not g etting effective treatment
Hayfever occurs when your body’s immune system is sensitive to harmless pollen, dust and other particles (allergens) that enter the nose. This creates an allergic reaction (inflammation) that causes a blocked nose and increased mucus production. Other symptoms of hayfever include: yy sneezing yy throat tickling or itchiness yy cough yy red, watery eyes yy headaches Hayfever is common during the spring and summer seasons when grass, tree and weed pollens peak. However, around half of all sufferers experience hayfever all year round.
What to do The first important step is to identify your allergens and then decrease exposure by, for example, staying indoors on high pollen days and r educing dust at home. Drugs that help to reduce symptoms include: yy non-sedating antihistamines: mainly control sneezing and itching yy decongestant nasal sprays: provide quick relief, but don’t use for more than 2-3 days yy intranasal corticosteroids (INCS): reduce inflammation in the nose Of these, INCS are the most effective for symptom relief, particularly for runny and blocked noses, but it’s vital to talk to your doctor about correct usage. Desensitisation (immunotherapy) is a long term treatment that gradually exposes your body to increasing amounts of allergen by repeated injections, making your immune system more tolerant. Speak to your GP or go to www.allergy.org.au or www.nationalasthma.org.au for more information.
The silent danger of hepatitis C M
any people infected with hepatitis C don’t actually know they are infected or feel ill. However testing is important if there’s a risk you have it. You need to know if you’re infected to avoid passing it on to others. In addition, you may be missing out on effective treatments.
increased risk of liver cancer.
People who may be at risk
Hepatitis C is caused by a virus entering the body through blood contact such as a syringe or unsterile tattoo needle. It causes swelling (inflammation) in the liver. While one in four infected people clear out the virus, the rest develop a chronic infection that can cause long term liver damage. This is a slow-acting process. After 15 years more than half of chronic infections have symptoms. In some it takes up to 40 years or more. Symptoms can include:
yy IV drugs users yy Those who have received donated blood before February 1990 yy People on haemodialysis (kidney machine) yy Healthcare or public safety worker swith a known exposure from a syringe injury yy People who are HIV-positive. yy If your mother had hepatitis C when you were born.
1,000kJ (250Cal) Protein 12g; Total Fat 12g; Saturated Fat 3g; Carbohydrate 25g; Total Sugars 20g; Sodium 235mg; Potassium 1130mg; Calcium 155mg; Iron 2.5mg; Fibre 8g.
yy yy yy yy yy yy yy
yy Lifestyle changes including reduced alcohol, healthy diet and regular exercise yy Symptom relief such as good sleeping habits and sedatives for tiredness yy Drugs that can remove the virus from the body including interferon and antivirals yy Liver transplant surgery in severe cases.
© Recipe and images kindly provided by Sanitarium Health and Wellbeing.
Severe damage can cause liver failure (stops performing normal functions). There is also an
Tiredness Loss of appetite, weight loss Nausea, vomiting Soreness: upper right side stomach Fever Moodiness, depression Joint pain
The main treatments for hepatitis C are:
For more information speak to your GP or visit www.hepatitisaustralia.com
Women’s Health Putting a hold on stress incontinence S
tress incontinence is a leak of urine during activities such as sneezing, coughing, lifting or playing sport. Unfortunately, many people mistakenly think it’s normal or are too embarrassed to seek professional help.
Dr. LOL! Trouble with maths A patient is wheeled into the emergency room. The nurse on duty asks “On a scale of zero to ten, with zero representing no pain and ten representing excruciating pain, what would you say your pain level is now?” She shook her head. “Oh, I don’t know. I’m not good with maths!”
Stress incontinence in women is due to your pelvic floor muscles being weakened. Common causes are pregnancy, menopause, increased age, being overweight and constipation. Stress incontinence can also occur in men – particularly after prostate cancer surgery. The pelvic floor muscles are located between your coccyx (tailbone) and pubic bone. They wrap around the urethera, the tube through which urine flows out of your bladder. The muscles help keep the urethrea closed until you are ready to pass urine. When the muscles are weak, increased pressure (stress) in the abdomen causes urine to be released involuntarily.
Speak to your GP There are many treatments available such as yy Lifestyle changes. Weight loss, increased fitness and reduced constipation all help yy Pelvic floor exercises. They make the muscles stronger and are the most effective treatment (see below) yy Specific drugs normally used for d epression. They are considered less effective
yy Surgery. May be considered if other measures are not successful In come cases, stress incontinence occurs with urge incontinence caused by an overactive bladder. This may require additional treatment.
Pelvic floor exercises The exercise involves an inward and upward squeeze of the muscles. It is essential to do the exercises correctly. You may need help from your doctor, a physiotherapist or nurse to learn this. Once you have learnt the technique, pelvic floor exercises can be done up to 10 seconds each time and repeated frequently throughout the day. It can take 3-4 months of doing the exercises to get the muscles strong again. For more information www.continence.org.au.
Vegetarian eating. Myth vs research A
recent Newspoll survey found that 7 out of 10 Australians have made the decision to eat less meat and more plant-based foods. Yet Myth
misconceptions about vegetarianism persist. A report in the Medical Journal of Australia recently described the common myths: What the research says...
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A meat-centred diet is healthier
Plant-based diets may actually be associated with less risk of developing heart disease, colorectal cancer, type 2 diabetes and obesity
There is not enough protein in a vegetarian diet
Vegetarians do eat less protein compared to meat eaters; however the amount still easily meets the recommendation for healthy living
Vegetarians have low iron levels
Iron-deficiency isn’t more common in vegetarians although they do have lower iron stores in the body. Low iron stores may actually be associated with reduced risk of heart disease and type 2 diabetes
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Only dairy contains enough calcium
Vegans (who don’t eat dairy) can get enough calcium by eating Asian greens, almonds, fortified soy, calcium-set tofu, rice and oat milks
Vegetarian eating is not safe in pregnancy
There are no significant health differences in babies born to vegetarian mums, as long as you have a diet providing the right amounts of nutrients
Vegetarianism is not suitable for children
Growth is similar in both meat-eating children and vegetarian and vegan children. Once again, it just requires a planned and balanced diet
_______________________________ Med. Practice____________________ _______________________________
For more advice on vegetarian eating, speak to your doctor or go to www.daa.asn.au.
Drawn 1 December 2012
If you get sick at night or on the weekend, ring 6234 5678. Your call will be connected directly to the Canberra After Hours Locum Medical Service.
Immunisation for the good of all
very parent’s uppermost thought when deciding about immunisation is the welfare of his or her own child. The best medical advice is that the protection provided by immunisation outweighs the risks, which are usually minor. Your child is further protected when community vaccination rates are high, as this reduces the risk of exposure to infection. This has been seen recently with the major decline in cases of rubella or German measles (see below). In the majority of cases, immunisation causes mild symptoms only. In very rare cases, more serious complications can result. However, these are outweighed by the risks from not being vaccinated.
Disappearing disease Forty years after immunisation for rubella was introduced, the experts say the disease has effectively disappeared in Australia, with the exception of imported cases. Similar achievements are being seen with chickenpox. This infection usually causes mild symp-
Our friendly reception staff, Molly, Dolly, Polly and Holly are available to make bookings or help in any way.
Are your child’s vaccinations up-to-date?
toms, but serious complications such as lung and brain infection can occur. In recent years hospitalisations of children with chickenpox up to age 4 have decreased by 63% in Australia. This equals 1,100 hospitalisations avoided. But this good news doesn’t mean we can be complacent. Currently only 9 out of 10 children are immunised. We must continue to improve immunisation levels to further reduce childhood infections. If not, infection rates will rise again in the community. For more information speak to your GP, visit www.immunise.health.gov.au or ring the Immunise Australia hotline on 1800 671 811.
Supporting kids with family break-ups O
ne third of all marriages in Australia end in divorce. However the impact on children can be minimised if the divorce is handled well.
Separation and grief Family break-up causes grief similar to when a loved one dies. In the case of divorce, the child may experience a similar level of loss created by the change in their family environment. This can lead to changes in a child’s behaviour at home, at childcare or in school. These behavioural changes can be negative, but may also involve being excessively good. Moods can also vary – children may seem fine one day, only to be upset or angry the next.
create more confusion. At the same time, don’t criticise the other parent as this may add to your child’s distress. Parents should sit down together with their children to give the same message and this may be required on multiple occassions. In particular, give reassurance that even though your marriage is finishing, your relationship with your child isn’t and the child isn’t to blame for the break-up.
Everyone needs support It is important to look after yourself as well through s upport from relatives, friends or a health professional. As a result, you’ll be better able to support your child.
How to tell children
Ask your GP for advice or contact your local parenting helpline:
Don’t underestimate your child’s ability to understand what is happening. Sparing your child’s emotions by not explaining may only
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We do not issue repeat prescriptions or pathology results without seeing the patient. Please make an appointment to see the doctor for these services. All patient information and medical records are strictly confidential. If you have any complaints about your care, please speak to your doctor. If you wish to take the matter further, you can contact the Health Care Complaints Commission on 1800 999 888.
You can contact your doctor by ringing during surgery hours. Emergency calls will always be put straight through.
As well as routine consultations, the following services are available: yy yy yy yy yy yy yy yy yy yy
Home visits Check-ups Family planning Pap smears Pregnancy tests Ante-natal care ECG: heart check Spirometry: lung test Vaccination: children, travel Minor surgery: stitching cuts, removing moles, skin cancers yy Liquid nitrogen ‘freezing’ therapy for sunspots, warts yy Acupuncture yy Sports medicine
All eligible patients are bulk-billed. Please bring your Medicare card with you to the surgery. The private consultation fee is $65 which is payable at the time of your visit. Workcover accounts are sent direct to your employer or the insurance company.
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