177 Burke Road Glen Iris VIC 3146

Phone: 9509 7633 Fax: 9509 6177 After Hours: 9429 5677

www. glenirismg.com.au

Glen Iris Medical Group Inc. Glen Iris Travel Health

Practice Newsletter: Spring 2015

Opening Hours **********

Monday 8.00am – 6.00pm Tuesday 8.00am – 6.00pm Wednesday 8.00am – 7.00pm Thursday 8.00am – 6.00pm Friday 8.00am – 6.00pm Saturday 8.30am – 12.00pm

Closed Sundays & Public Holidays

Medical Staff **********

General Practitioners Dr Sharon Woolf Dr Natalie Taft

Dr Lisa Prichard Dr Jane Healy

Dr Jenny Butterley Dr Diana Rattray Dr Martine Burger Dr Meredith Day

Dr Jadwiga Kapusta Dr Louis Cukierman Dr Russell Bensky

Administrative Staff **********

Practice Manager Nikki Jupp

Reception Team Rose, Devora, Jennifer,

Barb, Ana, Steph Whitney, Katherine and Emma.

Practice Nurses **********

Peta – Nurse Immuniser and General Nursing

Fiona – Asthma Education, Spirometry and Diabetes

Consultation Fees **********

Standard Consultation $85.00 (Rebate $37.05)

Long Consultation $160.00 (Rebate $71.70)

Prolonged Consultation $210.00 (Rebate $105.50)

These fees were reviewed on 2nd December 2013.

Practice Newsletter: Spring 2015

Practice Announcements We would like to welcome Emma to our reception team. Emma is studying law

and enjoys working with people.

Our practice hours remain unchanged, we are open until 7.00pm on Wednesday nights.

Melbourne Pathology collection centre hours have reduced mid-week from 8.00am to 2.30pm for the duration of the renovation. Saturday Pathology hours remain the same, 8.30am – 12.00pm.

Upcoming Doctor’s Annual Leave o Dr Diana Rattray 29-08-2015 to 29-09-2015 o Dr Jenny Butterley 26-08-2015 to 18-09-2015 o Dr Sharon Woolf 18-10-2015 to 08-11-2015 o Dr Lisa Prichard 16-12-2015 to 11-01-2015

Preventative Health – Family Medicine – Women’s Health – Aged Care - Travel Medicine – Sports Medicine

Shared Care – Sexual Health - Skin Checks Minor Surgery – Men’s Health – Implanon – Mental Health

Renovations & Extension Update

Things are moving along quickly! The day we welcome our patients through an automatic door and into our new reception area is fast approaching. We are currently plastering the new part of the building and will move into this new area in the next 4-6 weeks. There will still be some disruption for patients as we re-wire, plumb and update the older part of the practice, but we are still on track to finish this year. Melbourne Pathology will return to their normal hours of 8.00am – 4.30pm weekdays on completion of the works. Our new treatment room is nearing completion and we will start work on a new disabled toilet shortly. Thank you to our patients for their support through the renovation, especially the inconvenience of parking. Our aim throughout this project is to continue to provide care to all our patients as we did before the commencement of the renovation. Our Doctors are happy to work longer hours to ensure patients are seen when needed. We also have capacity to welcome new patients to our practice. Many of you will have visited the rented room we have across the road at Victorian Anaesthetic Group, 173 Burke Road – and we are very grateful to have this room for the duration of the project.

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About Our Practice: Important Information for Patients

Booking Long Appointments o Standard appointments are booked in 15 minute

intervals. o Our practice policy allows for long consultations with our

doctors. If you wish to discuss multiple issues during your consultation, please book a long appointment. This allows us to allocate enough time to address your health concerns and minimize long waiting times. If you have a list of issues to discuss, please present this to your doctor at the start of your consultation for prioritization.

Consultation Fees o Glen Iris Medical Group is a privately billing practice. o We ask that all accounts be paid on the day. An

accounting fee applies if not paid at the time of consultation.

Preventative Health o Our practice is committed to preventative health and

offers 45-49 year old health checks and health assessments for patients aged 75 and over.

o We also provide diabetes and pre-diabetes education, care plans, asthma education and spirometry (lung function testing). If you would like more information about any of these services, please speak with our Practice Nurse.

o Our Practice Nurses offer 4 year old health checks in conjunction with your usual doctor. This is a government initiative and there is no cost for the consultation. To be eligible, children need to have either already had their 4 year old vaccinations, or receive them as part of the consultation. This health check requires a 45 minute appointment with our nurse at a time when your usual doctor is consulting.

Travel Health o Our practice provides a comprehensive travel health

service including advice and all travel vaccinations. o It is important that you book a double appointment at least

six weeks before travelling. Please bring your travel itinerary to your consultation. We also ask that patients complete a “Pre-Travel Consultation Form”. This can be downloaded from our website at www.glenirismg.com.au or completed at the Practice prior to your consultation.

o Travel health is very complex and encompasses advice on disease prevention such as Malaria and Dengue Fever, emergency medication for infections or traveller’s diarrhoea, letters listing current medications for air travel and destination based practical travel advice to ensure health and safety.

o Patients over 50 years, and patients of younger age with a complex medical history, require an appointment for completion of travel insurance forms.

o When booking a consultation for travel health advice, please make a time when our practice nurse is also available.

DISCLAIMER: While every effort is taken to ensure the information contained in this newsletter is accurate and up to date, it is not exhaustive and not intended to replace the advice of your doctor. The information provided is for educational purposes only. Readers should always consult their health care professional for advice for their individual health care needs or concerns. My Doctor: Practice e-newsletters will not be liable for any loss or damage from misuse of the information provided. My Doctor: Practice e-Newsletters is not responsible for misleading information provided by subscribing medical practices. All practice information is approved at time of publication.

Our Prescription Policy o Appointments are preferred for the issue of

prescriptions in the best interests of our patient’s health.

o We offer a script/referral “Swift” clinic with a rostered Doctor every day. The out of pocket cost is $13.05

o At your Doctor’s discretion, ongoing medication may be prescribed without a consultation if you are otherwise regularly reviewed for the condition requiring the medication.

o A fee of $20 is charged for prescriptions issued without a consultation, or $25 if you require the script to be faxed or posted.

Our Referral Policy o Appointments are preferred for the issue of re-

referrals o We offer a script/referral “Swift” clinic with a rostered

Doctor every day. The out of pocket cost is $13.05 o At your Doctor’s discretion, re-referrals for ongoing

care or regular review with your specialist may be issued without a consultation if you are otherwise regularly reviewed by your Doctor.

o Referrals from a general practitioner are valid for 12 months. You should always ensure your referral is valid prior to attending for a specialist review as referrals cannot be backdated.

o A fee of $20 is charged for prescriptions issued without a consultation, or $25 if you require the script to be faxed or posted.

Continuity of Care: o Glen Iris Medical Group encourages continuity of

care for our patients. o As all our General Practitioners are part time, there

will be some issues with providing continuity of care, particularly at short notice. However we train our staff to provide the option that provides the best continuity of care to patients as this is in the best interests of patient health.

o It can be beneficial to have a second doctor who knows you and is able to provide care when you are unable to see your regular doctor.

o If you have a chronic condition, it is particularly important to maintain continuity of care. Please speak to one of our receptionists about this when making your appointment.

From the Doctor’s desk…

THERE ARE DIFFERENT TYPES A classic migraine is preceded by warning symptoms called an “aura”. These aura symptoms last for about an hour before the onset of the actual migraine headache. They can include visual disturbances (such as flashing or flickering lights, zigzag lines, blurry vision or temporary blindness), numbness or tingling sensations. Around one in three people will experience aura symptoms.

A common migraine strikes without the preceding aura symptoms. SYMPTOMS

- Headache that lasts between 4 and 72 hours - Pulsating or throbbing pain, often just on one side

of the head

- Headache aggravated by movement - Nausea or vomiting - Sensitivity to light, sound and smell

TRIGGERS The exact underlying cause of migraine headaches is still unknown, however they may be brought on by a triggering event/s, although these event/s may not always be identifiable.

Triggers are many and varied and may include:

- Certain foods (e.g. cheese, chocolate, red wine)

- Missed, delayed or inadequate meals

- Caffeine withdrawal

- Bright light

- Strong smells

- Loud noise

- Menstrual cycles

- Oral contraceptives

- Lack of sleep, or oversleeping

- Psychological factors, such as stress and

depression

TREATMENTS

Milder Migraine The mainstay of treatment of milder migraine remains simple analgesics, such as aspirin or paracetamol, or an anti-inflammatory drug such as ibuprofen, taken as soon as possible to the onset of symptoms. A medication to control nausea and/or vomiting may be necessary.

Severe Migraine In recent years there has been a great advancement in treating more severe migraines. A group of drugs called the “triptans” of which Imigran was the first available, but 5 different drugs are now available.

In many migraine sufferers these medications can stop an attack within minutes and prevent one or two days of misery. These medications are only available on prescription, so a consultation with your Doctor is essential. PREVENTION If migraine is occurring more than once a month, or the attacks are debilitating, preventative medication should be discussed with your Doctor.

There are several medications which have proven effectiveness. These medications are taken every day to achieve ceasing or reducing frequency of migraine.

Some women with menstrual migraine benefit from taking the pill continuously without taking sugar pills.

Non-medical therapies include hypnosis, acupuncture, exclusion diets, yoga and avoiding known triggers. If you are concerned that you may be experiencing migraine headaches, please come in and talk to one of our Doctors about your symptoms and options available for you.

Migraines

Dr Jadwiga Kapusta

Migraines are one of the most common types of headaches experienced by children and adults, affecting about two million Australians. Approximately 25% of women and 8% of men suffer from migraines at some time in their lives. Migraine headaches tend to first appear in individuals between the ages of 10 and 46, and about half of all people who get migraines have a family history of them.

The prostate is a small gland, about the size of a walnut that forms part of the male reproductive system. It sits directly under the bladder. It surrounds the top of the urethra and its function is to produce seminal fluid to help protect and give energy to the sperm. The prostate gland gets bigger as a man ages and the reasons for this are not fully understood. Between the ages of 21 and 50, it almost doubles in size and then again between the ages of 50 and 80 years. Benign Prostatic Hypertrophy, or BPH, is a condition where there is benign (non-cancerous) growth of prostate tissue. It is the most common prostate condition and affects nearly all men at some stage of life, but is most common in older men. Its cause is not well understood but there may be some genetic factors. Because the prostate surrounds the urethra, enlargement can put pressure on the urethra and make it narrower.

Health Snippets

Garcinia Cambogia Supplements Garcinia Cambogia is a nutritional supplement receiving wide media coverage as the new ‘wonder weight loss product’ that claims to keep blood sugar and cholesterol levels down and block the body’s ability to store fat. But is there research to support these claims or should you save your money? The active ingredient in the product (hydroxycitric acid, or HCA) is extracted from the rind of a tropical fruit called the Malabar tamarind. Small studies have demonstrated that HCA has positive effects on reducing cholesterol and insulin levels and raises the levels of serotonin in the brain, leading to appetite suppression. A larger scale study, published in the Journal of Obesity, concluded that minimal weight loss was achieved in the short term with use of Garcinia Cambogia in conjunction with a healthy diet and regular exercise. However the results were considered ‘statistically insignificant’ due to the small size of the study populations. The largest scale study found no significant difference between those using Garcinia Cambogia and those taking a placebo. The conclusion? While some people may find these supplements useful, there is very little evidence to support the products claims of rapid weight loss.

Bee Strings Spring time is upon us again and with the blooming flowers come the bees! Most people will be stung by a bee at some point or another and the reaction caused by the sting varies from person to person. They are attracted to bright colours and strong smells. Stings often occur on the feet or arms but sometimes, bees can fly into an open can of drink and a sting in the mouth can occur. The bee stinger is very sharp and when the skin is punctured, venom from the stinger is injected, even after the bee has flown away. The immediate reaction is pain, itching and swelling which may be present for several days. For people with increased sensitivity to bee stings, inflammation of whole leg, or arm (depending on the sting location) can occur. In a severe reaction, the whole body can be affected, causing restricted breathing and even death. If you or a family member is stung by a bee, apply ice and a compression bandage to the area. The stinger should be scraped out in a sideways motion using a firm object such as a knife. Immediate medical attention should be sought in the event of a severe reaction to a bee sting.

Common Issues in General Practice:

Benign Prostatic Hypertrophy

Symptoms therefore include:

Weak and poorly directed urine stream

Difficulty passing urine, dribbling or straining

Urinary retention

Urinary urgency, frequency or nocturia (needing to urinate frequently at night)

Perineal pain, pain when urinating

Blood in the urine

A doctor can diagnose BPH by taking a thorough medical history, urine tests, an ultrasound and/or a digital rectal examination. The doctor can feel for enlargement or other issues that may warrant further investigation, such as prostate tumours. BPH is far more likely to be the cause of urinary problems than prostate cancer. Sometimes a doctor may order a blood test called a PSA, which tests for the level of Prostate Specific Antigen, a protein that is made in the prostate gland. A raised level of PSA can be linked to either BPH or prostate cancer so depending on your risk factors and symptoms, further testing including a prostate biopsy may be required. BPH does not always require treatment however, if it is impacting on a man’s quality of life, there are medication options or surgical options available which can be discussed with your doctor. The most common surgical option is called a transurethral resection of the prostate (TURP), and is used in cases where the impact on quality of life is severe.

It is a difficult subject to discuss, but it is an important conversation to have. The facts are that 85% of people die following chronic or progressive illness rather than suddenly, meaning it is important to consider the type of care you want or don’t want during that illness. If a doctor is unaware of a person’s wishes, they must treat them in the most appropriate way for their particular illness, which the person may not have wanted. An Advanced Care Plan is a process of planning for future health and personal care, where a person’s preferences are made known so that they can guide decision-making at a future time when communication of these wishes may not be possible.

Advanced Care Planning: Why is it important?

An advanced care plan in its most basic terms, describes your wishes for your medical treatment at the end of your life. It provides people over the age of 18 years with the ability to make plans and record their preferences while they are well enough to express those wishes. The process involves a discussion with yourself and your family or friends about treatment options that you would or would not be open to receiving. The three basic questions this conversation aims to answer are:

1. Who will speak for you? 2. What do you want? 3. Would it help to write down your wishes?

What are the components of an Advanced Care Plan?

Medical Enduring Power of Attorney(MEPOA)

Advanced Care Plan

Refusal of Treatment Certificate

A MEPOA is a person that you legally appoint as your decision maker if you are unable to speak for yourself.

The Advanced Care Plan states your preferences for health and personal care intended to guide health professionals to make treatment decisions based on your wishes. It may also include non-medical wishes such as spiritual care.

A Refusal of Treatment Certificate can be written to refuse a particular medical treatment, or treatment in general. It can be written only for the condition that the patient has at the time of completing the certificate and is considered legally binding.

The law does not require a lawyer to complete an advanced care directive. Your doctor can assist in this process and in ensuring that the appropriate people (e.g. family members, hospitals, medical specialists etc.) are given the documentation for future reference.

An Advanced Care Plan is only used if you are unable to make or communicate your decisions at the time. It is used as a guide, in consultation with your MEPOA if one has been nominated.

What are the benefits of an Advanced Care Plan?

You continue to have a say in your medical care, even if you become too sick to speak for yourself.

When the time comes, it provides health professionals involved in your care, with information about how you wish to be treated.

It requires you to be fully informed about your illness and your treatment options.

It assists you to clarify what is acceptable or unacceptable if your condition deteriorates.

It can be changed or revoked at any time while you still have capacity to make decisions. If you change your mind, a new plan can immediately replace an old plan.

Studies have demonstrated that an ACP can help improve a person (and their family’s) satisfaction with healthcare and reduce the symptoms of stress, anxiety and depression felt by the surviving relatives of patients who have died.

Who should consider an Advanced Care Plan? Everyone should consider having the discussion with family and friends, however it is particularly important for:

People with advanced chronic illnesses such as chronic lung disease or heart failure

People with life-limiting illnesses such as dementia or advanced cancer

People aged over 75 years

People who are about to enter a residential aged care facility

People at risk of losing competence i.e. early stage dementia, or Alzheimer’s disease

People with a newly diagnosed but significant illness such as metastatic disease or transient ischaemic attacks

People with no one who they can appoint as a substitute decision maker (i.e. people with no living family or caretakers)

People who feel that they may experience significant conflict making decisions at the time of an emergency.

If you are interested in starting this discussion, speak to your Doctor or visit www.decisionassist.org.au for more information.

Parts of this article have been adapted from Decision Assist – Advanced Care Planning in General Practice. Full papers, discussions and documents can be downloaded from www.decisionassist.org.au

Surgical Options for Weight Loss

Adjustable Gastric Banding Commonly referred to as a Lap-band, this operation involves placing a silicone ring around the very top of the stomach to create a much smaller ‘pouch (see picture 1)’. The ring can be tightened and loosened by the addition or subtraction of saline into a port located under the skin of the abdomen. When food enters the oesophagus, it is held in the small stomach pouch and gives the feeling of early ‘fullness’ or satiety on much smaller portions of food. The procedure is performed laparoscopically and is reversible. The stomach itself remains intact. It is much less invasive than other obesity surgery options and is considerably safer, however, it produces slower weight loss and requires more ongoing maintenance than other surgical options. It can take several months for the surgeon to achieve the correct ‘tightness’ to achieve the desired effect. A Lap band patient can generally expect to lose around 50-60% of their excess body weight over two years. This means, a person who is 50kg over their ‘ideal’ body weight, should expect to lose 25-30kg. Of course there are people who lose less and others who lose much more. The band is a tool, not a quick fix and requires a lifetime commitment to dietary changes. Common problems experienced include food blockages, vomiting, band slippage and erosion of the band into the stomach lining causing significant pain and the need for revision surgery.

Sleeve Gastrectomy A sleeve gastrectomy is a surgical procedure where a significant portion of the stomach is removed and a much smaller ‘sleeve’ is created (see picture 2). The volume that the stomach can handle is reduced from about two litres to 100-150mL. Therefore a very small amount of food produces feelings of satiety. Like gastric banding, good food choices are required to gain maximal effect. It is a much more invasive procedure than lap-banding, with a longer post-surgery recovery time. Patients who choose this surgery reasonably expect to lose 60-65% of their excess weight in the first twelve months. There is the risk of the sleeve stretching over time and some studies have witnessed people regaining much of their lost weight after 5-10 years.

Roux-en-Y Gastric Bypass This procedure produces a true ‘bypass’ of the stomach. Food that is consumed enters a small stomach pouch and then directly moves the small intestine which has been dissected and reattached to the small bowel. The top part of the stomach is stapled off to create the smaller stomach pouch (see picture 3). If you follow the path of the food indicated by the arrows, you can see the by-pass that occurs. This procedure produces substantial weight loss but like the sleeve gastrectomy, involves a longer recovery time. Patients can expect to lose greater than 65% of their excess weight in the first twelve months but will need to take nutritional supplements such as multivitamins for the rest of their life. It is essentially irreversible and the surgery (like any major surgery) carries the risk of major complications. None of these procedures should be considered the ‘easy way out’. Each requires a lifelong commitment to making good food choices and establishing new, healthier lifestyles.

Weight loss surgery is exploding in popularity globally as the obesity epidemic continues. For those with long term weight problems who have tried and failed a plethora of diets and pills, it is an effective and powerful way to battle the bulge and regain health, quality of life and self-confidence. It is not for everybody and each option carries significant risks but it remains the only currently available treatment that has been shown to achieve major and durable weight loss. This articles describes three commonly performed procedures, adjustable gastric banding, sleeve gastrectomy and gastric bypass (Roux-en-Y gastric bypass).