When was your last skin cancer check up?

As you may know, Australia has one of the highest rates of skin cancer in the world and the highest rates of the deadliest skin cancer – melanoma. Many people can relate to the days of sunbaking on the beach and coming home resembling a bright red lobster or spending hours outside working in the garden with a top off and no sunscreen – “working on the tan”.
Whilst our knowledge of sun protection has come a long way and we have embraced the need to “Slip, slop, slap”, many people are still at risk of developing skin cancer, either due to past exposure to the sun, their family history or simply because of their skin type. And to make matters worse, some skin cancers, particularly melanoma, may even occur in areas that don’t get much sun exposure.
So if you are over 50, have a history of high sun exposure, a family history of skin cancer, are worried about a new or changing skin spot, or you would simply like a thorough skin check up, then see the Doctors at Wellness on Wellington for a dedicated skin examination. We often get asked at the end of a consultation “Hey Doc, could you take a look at this spot?” and whilst sometimes we may be able to give reassurance that that spot is not cancer, there may be other spots that are hidden from your view (eg. Your back and scalp) or spots that you are not concerned about but we are! So do yourself a favour and book in for a dedicated skin check with your doctor.
Whilst all GPs can do a thorough skin check, several doctors at our clinic have undertaken special training in this area and are now running skin clinics. Just ask our friendly reception staff to make a booking. If any suspicious spots are noted, your Doctor may do a small skin biopsy on the day and then if a skin cancer is confirmed, they will talk with you about the options for treatment, which may include non surgical treatments like creams or freezing treatment or taking the skin cancer out in our surgery. Most skin cancers can be treated completely by your GP at our clinic, saving you time and money, however for more complex cases, you may be referred for specialist treatment. Just a note about our skin clinics: these appointments are for skin checks only and if you have any other issues you wish to discuss, we encourage you to make a separate booking with your GP.
So don’t delay, make your appointment for a skin check today! It could just save your life.

With or without you

Undoubtedly one grey area of medicine is when do teenagers deserve to be given the right to privacy with their doctor.

It is quite natural for parents – with more knowledge, insight and perspective, as well as deep love – to want to attend medical appointments with their child. But at some point, and with certain conditions in particular, teenagers need to be given the opportunity to ask questions without the embarrassment of their parent’s presence.

Interestingly, a study at the Royal Children’s hospital suggests a lot of parents are concerned about leaving their adolescent children alone with a doctor. The reasons varied but included a sense of obligation to be there for their child, a feeling that they were experts in their child’s health and could contribute, and even the fear of paedophillia – that the doctor would somehow attack their child.

The study was quite a small one and the results quite different from our experiences as doctors at Wellness on Wellington. Perhaps it is a reflection of the esteem in which we are held by our patients but almost universally parents in our clinic are willing to step outside of a consult if we ask them. In fact many make the suggestion themselves. Parents tell us that they trust us with their children’s health and that it’s important for teenagers to learn the valuable life skill of dealing with health professionals.

Teenagers, of course, vary enormously in their maturity. But a common approach seems to be for the parents to come in with their teenager and then step out when they know the main issues have been raised. Common consultations where teenagers are seen alone by the GP include mental health issues like depression; contraceptive requests or the discovery of lumps or bumps in private areas.

We take it as a great compliment that parents trust us with their kids. Whilst confidentiality rules limit how much we can tell you about the consult in your absence (unless your teenager agrees), we are grateful you realise that the wellbeing of your child is our chief priority, whether you are in the room or not.

Treatment and prevention of Osteoporosis – not all it’s cracked up to be…

Calcium supplements, with or without Vitamin D, have long been used in the prevention and treatment of osteoporosis. Certainly we know that these are vital components of a healthy body, important not only for bone health but a wide range of other physiological processes.
The recommended dietary intake for Australian’s over 50 years is currently 1300mg/day for women and 1000mg/day for men.
Evidence is emerging that supplemental calcium and vitamin D may not necessarily be a good thing, particularly in those with an adequate dietary intake. A recent study published in the British Medical Journal found that calcium supplements (with or without vitamin D) increase the risk of heart attacks in older women. A further study in Swedish women suggested that a high calcium intake (more than 1400mg/day) was associated with a higher risk of death from all causes, including cardiovascular disease. Unlike in a previous study, the addition of vitamin D did not seem to change this risk.
We know that a high calcium intake has also been associated with the formation of kidney stones as well as – wait for it – an increased risk of hip fracture! So you can have too much of a good thing. It may be that concentrating on your dietary intake, without the addition of supplemental calcium, could be the way to go.
It seems the jury is still out on how much calcium and vitamin D is needed for healthy bones without causing other detrimental effects. There appears to be plenty of research on this topic at the present, so watch this space. Until then we recommend you talk to your doctor about your individual risk and the use of supplements based on the current evidence.

Needles flying everywhere Part 2

Gardasil has been one of the great immunisation success stories of the past decade. The vaccine, which prevents HPV (human papilloma virus = wart virus) is given to teenage girls and decreases their risk of developing genital warts in general and decreases the risk of cancer of the cervix. Whilst it doesn’t completely eliminate the need for pap smears or provide 100% protection, it’s certainly quite effective.

Now Gardasil is available to boys. Wart virus can certainly affect both sexes and HPV can also cause cancer in men, particularly cancer of the penis and in some cases cancer of the anus. Boys who contract HPV can also transmit it to their partners, increasing the risk that they will develop disease or cancer.

The national Gardasil program for boys is being rolled out over the next two years.

In 2013 and 2014 all boys in Year 7 AND Year 9 will be offered the vaccine. (Boys in Year 8 this year will get next year in year 9.)  After that it will just be available to boys in Year 7. 

Unfortunately there is no government funded catchup program for boys already in Year 10 and beyond, though we can arrange private stock.

The vaccine involves three injections over a six month period. Whilst it can be given at school, we have vaccines available at the surgery and therefore we are able to administer the vaccine here if you prefer. Please discuss with reception and make an appointment.

 

Needles flying everywhere Part 1

Lots of needle news coming out this week.

First – flu vaccines have arrived.  Here are the recommendations:

You SHOULD get a vaccine if:

– you are over 65

– you have a chronic disease like diabetes, kidney problems or heart disease

– you have any ongoing lung problems like asthma, bronchitis or emphysema

– you have lowered immunity (eg you use immunosuppresant medication or cortisone)

– you have a chronic neurological problem like epilepsy or MS

– you are pregnant (This is really important. Lots of evidence that both pregnant women who get the flu AND their babies do badly compared to immunised women)

 

You should THINK about the flu vaccine if

– you work with lots of members of the public

– you have a family member who belongs to any of the groups above

– you work with people who would suffer badly from the flu eg sick or elderly people

– you would find it unacceptable to risk catching flu because it may involve a week off work or home duties

 

Flu shots are available free of charge to patients in the SHOULD group.

For other patients, we have vaccines in stock. Patients on health care cards will find it cheaper to buy a vaccine on script.

We are holding a flu-clinic at Waterford and Peppertree Hill villages on March 17th, for the residents. We may also be holding flu clinics for all our patients at the surgery – please call to find out the availability, or just see your doctor for a shot.

 

 

Rules and regulations

The Australian department responsible for regulating claims about drugs is called the TGA – the Therepeutics Goods Administration.  They control in great detail everything that drug companies can say about their products – right down to vetting every word of their product and consumer information leaflets. They also regularly review ads that these companies produce promoting their products to doctors to ensure that every single statistic and claim has been proven before being printed.

But the complementary medicine world has never been regulated. Apart from grossly misleading claims (“This herb will cure your lung cancer”), manufacturers and retailers of products like natural remedies, supplements, vitamins etc can say just about anything without any requirement to prove a word. So the claim “XXX can help restore your sex drive” is perfectly legal, since it can’t be proven false.

This isn’t an argument between natural therapies and drugs. It’s a dispute between what’s been proven and what is just claimed. Many “real” drugs have their origins in the “natural” world.   Aspirin is derived from willowbark; atropine from the plant nightshade; St John’s wart is chemically similar to the drug Prozac and digoxin was first extracted from the plant foxglove.  In all cases the natural therapy was used for years before the drug was isolated, extracted, purified and made into tablets. The plant worked – it’s just that the tablets give us a precise dose of a pure product.

Whilst drug companies have to have evidence for every claim they make, those who produce black kohosh, fish oil, tea tree oil, horny goat weed and others have no obligation to provide actual proof. Of course there are difficulties in funding proper studies for treatments that can’t be patented. But that doesn’t absolve those who sell the stuff from justifying their claims.

Fortunately the TGA have finally – after years of delay – announced they are going to review the claims that complementary product manufacturers and others can make about their products. We look forward to the legislation and hope that it will properly protect the public from false advertising by insisting that any claim made be required to be proveable and proven.

As for the overarching claim that “natural” products are safer than drugs – we think it’s nonsense. Ultimately all “chemical” treatments – whether medications or natural therapies – work on the bodies biochemistry. And a good rule is – if it’s strong enough to have good effects, it has to have side effects.

The world’s gone mad

The latest government recommendation – from the normally sensible National Health and Medical Research Council – advises that children (and presumably adults) shouldn’t eat cake when the birthday boy/girl has blown out the candles …..because the blowing could spread germs onto the cake. Instead, they suggest making a separate little cupcake with candle for the birthday child while the main cake is cut up for the other children.

Normally our practice is very keen to base advice on sound medical evidence; to read the research and to look at all the data. And we confess that in this case we haven’t done a whole of lot of scientific analysis so perhaps our conclusions are premature.

Nevertheless we wish to say – we all went to lots of birthday parties as children where the birthday kid blew out the candles, and we’ve all lived to tell the tale.

 

 

 

Your home is not a pharmacy – but for a little while it could be.

One of the more useful Medicare initiatives in recent years has been the Home Medication Management Review (HMMR or DMMR  which stands for Domestic).  Instead of you going to the pharmacy – a pharmacist will come to you.

In a HMMR the doctor identifies a patient who is at high risk of having problems with or caused by their medication. It might be somebody who is on multiple drugs (which may interact), drugs which need to be monitored closely for side-effects, somebody who has problems with vision or language or even as simple as somebody who struggles to open bottles and pop pills out of packets. It might also be someone who visits several doctors or hospitals, or someone whose medication regime has recently changed.

The doctor then refers the patient to a specially trained pharmacist who visits the patient’s home, goes through all their medications (including the same drug under different names, over-the-counter products and natural remedies).  Based on computer-generated information and their own extensive experience, they make a list of recommendations to the GP about changes to the medication list, tests that might need to be ordered, or better ways of delivering the medication (for example a Slow-Release tablet once a day instead of a regular tablet three times a day, or using pre-prepared daily medicine packs rather than taking medication out of the boxes). A copy of the report also goes to the patients regular pharmacy.

About a year ago we changed the provider of most of our DMMRs and have been very impressed by the thought and detail of his reports.

We are disappointed to hear that the College of GPs is in discussion with the government about scrapping the program.  Apparently some pharmacists have been abusing the system and the cost of the program has blown out by 50% above budget. Whilst such abuse is outrageous, we feel the vast majority of pharmacists are very good and are interested in patients well-being. It is therefore unreasonable for an otherwise excellent program to be scrapped on that basis.

We’ll keep you informed. In the meantime, if you feel that you (or a member of your family) might benefit from a formal review of your medication, please ask your doctor if you qualify. And if the initiative comes from us, please consider accepting the recommendation which will probably be a bit step towards better health.

 

Don’t panic on the pill!

One of the main reasons we set up this blog was to balance out the panic that the media likes to cause around health topics. The following has just hit the medical newspapers and we predict will be blown out of all proportion by the general media if they get hold of the story.

France has just banned the use of contraceptive pills containing the hormone Cyproterone.  In Australia that would include the brands Diane-35, Juliette, Brenda and Estelle. They are ordinary contraceptive pills, but perhaps a little better at preventing acne compared to others, which is often the reason for prescribing them.

The French ban will take effect in three months time and is due to a four-fold increase in the risk of developing blood clots on these pills compared to other types of contraceptives.

Though that sounds scary, the actual number of women affected is incredibly small.  About 300,000 women use these medications in France. In total – over the past 25 YEARS – four women are believed to have died from clots caused by these pills.

The Australian Therepeutic Goods Administration (the government body that controls drugs in Australia) have said they will look at the reasons for the French ban. It seems they are in no rush – a view we agree with.

Certainly it is worth reviewing which pill you are taking when you next see your doctor. But please don’t panic or stop taking the pill until you’ve come to talk to us first.

Forever learning

The motto of Monash university is “Ancora Imparo” meaning Forever Learning.

It’s a great motto for doctors to adopt because medical knowledge changes at a frightening rate. It’s estimated that 50% of what a doctor knows changes every five years, and certainly the speed at which guidelines and recommendations are produced, revised and replaced suggests that’s true.

So how do we keep up to date at Wellness on Wellington?  One way is to hold regular education meetings. The doctors meet twice each week and discuss difficult cases (“What should I do?”) or interesting cases (“This is what I saw…”).  Anyone who has been to a course, lecture or meeting reports back on what they learned so everyone can share in the knowledge.  If someone reads an interesting article or gets some new ideas from a specialists letter, they report back to the whole medical team.

We also bring in outside speakers as often as possible. Each of the allied health professionals who works at Wellness on Wellington is welcome to attend our clinical meetings, and once a year each of them presents at a Grand Round where they update us on advances in their field of knowledge. Examples this year will include a talk by psychologist Brenda Taylor on depressed teenagers –  “When is it sulking and when is it serious?” and by dietitian Stephen Ratcliffe on “Weight loss versus Weight maintenance”.   As GPs we are faced with and are interested in learning about just about everything!

We also have regular talks from our visiting medical specialists. For example, later this year Dr James Pang (geriatrician) will be talking about “Home vs Nursing home” – helping us make the difficult decision of when we need to recommend that patients should enter assisted care.  We also have visiting doctors from pathology and radiology companies come and update us on which tests are most appropriate for which condition.

Today, Dr Simon Craig, a specialist at Monash Medical Centre emergency department will be giving us an update on paediatric emergencies. We don’t claim to be able to handle EVERYTHING, but we believe that we have the facilities and skills to handle the vast majority of events.

As you can see, keeping up to date in medicine is almost a full-time job in itself.  Hopefully we can also find the time to put the knowledge to good use in treating our patients!