Debating whether or not you should be getting the Flu Shot this season ? Here are 4 good reasons why you should get the flu shot

Everyone has a role to play when it comes to preventing the spread of flu and other diseases. Here’s why you should become a role model for your friends, family and colleagues:

1. The flu can be serious
An average of 2,800 Australians die from influenza and pneumonia every year.
Some people are at greater risk of influenza complications. If you catch flu, apart from feeling dreadful yourself, you risk spreading it to vulnerable people at risk of serious complications. If you come into contact with infants, pregnant women, older people or immune-compromised people while you have flu you are putting them at risk.
Apart from that, it takes an average of two weeks to recover from flu. That’s a long time for work and chores to pile up.
If you get the flu shot:
• You can avoid spreading it to at-risk people
• You can avoid feeling awful yourself
• You can avoid having to put your life on hold.

2. You can’t get sick from the flu shot
It is not possible to get the flu from getting the flu shot. The vaccine does not contain any active virus.
The vaccine contains particles of killed viruses, so it cannot cause influenza. Some people can experience side effects from the vaccine, which include pain, redness and swelling at the injection site, low grade temperature, muscle aches and/or drowsiness.
It takes about two weeks for immunity to develop after getting the flu shot, so if you do get flu soon after getting your shot, it’s because your immunity was not yet fully developed.

3. You need the flu shot every year
Influenza viruses change frequently therefore the influenza vaccine is usually updated every year (depending on the circulating strains). Having an influenza vaccine every year in Autumn is recommended, particularly for those in the high risk groups. Protection develops about two weeks after being given the injection and lasts up to a year, which makes it important to be vaccinated every year.

4. It’s free for some people
The National Immunisation Program Schedule provides free influenza vaccine for people at greater risk of influenza complications. This includes:
• All people aged 65 years and older
• Pregnant women
• Aboriginal and Torres Strait Islander people aged 15 years and older
• Everyone aged from six months and over with medical conditions that put them at risk of complications from influenza infection.
Some workplaces provide free influenza vaccine to their staff. You can also get influenza vaccine by visiting your doctor. The vaccine costs around $20 plus the cost of the doctor’s visit.
Further information on influenza and vaccination is available at: http://www.health.vic.gov.au/immunisation/fact- sheets/factsheets/influenza

Reference: health.vic.gov.au

My Emergency Dr: What makes us different?

When your loved ones fall sick and your usual GP is unavailable, where do you turn? Do you call an after hours doctor? Do you call an after hours

medical helpline? Do you get the kids in the car and drive to the local Emergency Department or the local after hours medical centre?

Or do you call My Emergency Dr?

People often ask us, ‘What’s the difference between your service and an after hours GP?’

My Emergency Dr (MED) is not an after hours GP service. And we are not a nurse helpline. We are not staffed with nurses or junior doctors. We are staffed with Emergency Specialist Doctors.

Our doctors are the experts who run the Emergency Department – they have completed years of training in dealing with every possible medical emergency, and they are Fellows of the Australasian College for Emergency Medicine, or FACEMs). Each one has passed his or her Fellowship or ‘Consultant’ Exam in Emergency Medicine. They are the doctors best qualified to deal with the full range of emergencies suffered by all patients, regardless of age or gender.

Further information about Emergency Medicine specialist training can be found here:  https://www.acem.org.au/Education-Training/Specialist-Training/Training-Program-Overview.aspx)

Timing is Everything

There’s another crucial difference: the time it takes to see the doctor. We all know that it can take hours of waiting to complete your treatment in the Emergency Department, but it’s easy to forget that it can also take hours for that visit by an after hours doctor.

It takes only minutes to download our app, register and call one of our Emergency Specialists. The typical wait time to speak face to face with one of our doctors is less than two minutes, and a typical call takes less than ten minutes. Within half an hour of your face-to-face online consultation, your prescription or x-ray order form could be in your email inbox.

My Emergency Dr. Wherever you are, we will be there.

Germ Proof Your Kids! Back to School and the bugs that live there…

So schools have been back for a couple of weeks and routines have been re-established. Sadly those routines get challenged when kids need to take time off school due to illness and working parents often struggle managing the work home commitments. According to the Centre for Disease Control in the USA, primary school children get on average 8-12 cold or flu episodes each year. Teachers and parents commonly call this “ the back to school plague”.

Why? Schools are often perfect places for germs to flourish- what one paediatrician calls a germ candystore. The confined space of the classroom is a perfect medium for “coughs and sneezes to spread diseases”.

However there are some simple rules to instil in your children with the aim of reducing their risks of infection ie germ proofing your kids. We have come up with a list of 7 simple rules:

Rule 1. Be careful at the water bubbler/fountain

Paediatrician Dr Harley Rotbart has written a book on germ-proofing children in order to reduce infection. He states that the number one source of germs in schools is not the toilets but the water bubbler. It may not get disinfected as regularly as the toilets and small kids often put their mouths on the fountain itself. To reduce your risks the water should be run a little first before drinking or preferably use your own water drink bottle. Finally, remind your kids not to share their water bottles!

Rule 2. Clean your hands properly before eating

Some schools tell their pupils to wash their hands before eating but not all schools do this. Teach your children to wash or use a hand sanitiser before they pick up food and eat: at home, at school and out and about.

Properly-washed hands reduce the occurrence of stomach problems such as vomiting and diarrhoea. Studies in the USA showed that only 28% of children know how to wash their hands properly.  A simple trick is to sing the “Happy birthday to you” song twice while washing. This helps ensure that your kids will wash their hands for at least 20 seconds. They should also make sure they clean between their fingers and under their fingernails, and use a clean paper towel or dryer to dry off. Washing with soap and water is superior to hand sanitiser if done properly.

Rule 3. Ensure the eating area is clean

Schools manage eating areas and try to keep them clean. However with the numbers of children in coming and out of the eating area, it can be challenging to keep things completely germ free. Children should eat from their own boxes or trays and avoid putting their food directly on tables.

Rule 4. Hand covering for coughs and sneezes

Teaching children to cover their mouths when they cough or sneeze reduces their chances of spreading germs. Germs can travel up to 3 metres with a simple sneeze! It can be a good idea to stock tissues in your child’s school bag. Teach them to use tissues for all coughs and sneezes and then bin the tissue straightaway, as hands transfer germs to every surface they touch.

Rule 5. Don’t believe the ten-second rule!

Many people follow the so-called ten-second rule which alleges that food is still safe to eat if it has fallen to the floor, provided that you picked it up within ten seconds. Very few studies have looked specifically at its validity, and those that have been done give conflicting results. This is because it all depends on how well cleaned the floor is, the food type and whether the food can be washed once it falls on the floor. To date it would appear that if the floor is not clean and microorganisms are present, they will transfer in less than 10 seconds. So judge your response based on what you know about the environment in which you are dining.  If you have any doubt and maybe while at school your kids should just throw the fallen food away.

Rule 6. Vaccinate your kids!

Vaccines used in Australia are safe and must pass strict safety testing on thousands of individuals in large clinical trials before being approved by the Therapeutic Goods Administration (TGA). In addition, the TGA monitors the safety of vaccines once they are in use. It is important to keep your children’s vaccinations up to date to prevent these severe communicable diseases that caused significant health issues in the previous century.

Whooping cough (bordetella pertussis) is a highly infectious respiratory illness that can cause severe illness. Severe bouts of coughing can cause vomiting, rib fractures, rupture of small blood vessels and hernias. About 1 in 125 babies aged less than 6 months who catch whooping cough die from pneumonia or brain damage. The good news is that all children are vaccinated against whooping cough, and that the vaccine is safe. But the bad news is that immunity wears off with time. So as well as vaccinating your kids, ask your GP whether you need a booster too.

The vaccine against Chickenpox is a single dose vaccine that is given up to the age of 14. Once diagnosed with chickenpox a child is infectious 2 days before the appearance of the rash and at least 5 days after the rash when it has scabbed over. If adults or pregnant women acquire this virus it can have more serious consequences, so vaccinating your child helps others too.

Rotavirus causes significant diarrhoea, and since teh rotavirus vaccine was introduced there has been a 70% reduction in hospital admissions with gastroenteritis. Vaccination is performed only once, at younger than 6 months age.

Rule 7.  Prevent Head Lice

Head lice are the curse of most preschools and primary schools, because younfg children are in close contact with each other sharing hats, hair bows or bands. Mechanical removal  (wet fine combing) is the mainstay of treatment coupled with chemical treatment. However key factors to reduce infestation are:

Teach your child not to share items that touch the head like combs or towels

Avoid activities that lead to head to head contact.

Tie your child’s hair  up preferably into plaits/braids.

Regular examination of your child’s hair and scalp thereby allowing quick treatment.

According to the Mayo Clinic, more research is needed to prove whether certain chemicals prevent lice eg tea tree, eucalyptus or citronella. Hence none of these products are endorsed for this indication by the Therapeutic Goods Of Australia or the Food and Drug Administration in the US.

Conclusion

In the end, there is no 100% guarantee that your children won’t get sick during the school term. Remember that you too as parents need to follow these simple rules at home especially when your kids are sick. Good personal hygiene and regular cleaning of surfaces is key to reducing transmission, but as a busy parent try not to become obsessed, crazy and more exhausted!

 

References

Home

https://www.cdc.gov/handwashing/

http://www.health.nsw.gov.au/Infectious/Influenza/Publications/coughs-and-sneezes.pdf

http://www.health.nsw.gov.au/immunisation/Documents/iec.pdf

http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/ITO136-cnt

http://www.health.nsw.gov.au/environment/headlice/Pages/treatment.aspx#bookmark2

http://www.mayoclinic.org/diseases-conditions/lice/basics/prevention/con-20021627

Traditional Chinese Medicine and Western Medicine: Yin and Yang?

Gong Xi Fa Cai

Traditional Chinese Medicine and Western Medicine: Yin and Yang?

As an increasing number of individuals in society seek alternatives to traditional western medicine, the important question raised is: “are these alternatives truly effective – and more importantly are they safe?”

Traditional Chinese Medicine (TCM) has been practiced in Australia since the 19th century when the Australian gold rush brought many Chinese migrants. The WHO survey of Australia in 2000 described over 1100 practitioners of Chinese Medicine graduating in that year and that there were also over 23 professional associations present that represented different aspects of Chinese Medicine. One can only assume that in 2017 these figures are now higher.

TCM is increasingly mainstream, here and overseas. In a National Health Survey in the USA in 2007, over 3 million people confirmed that they had used acupuncture in the previous year, 2.3 million practiced Tai Chi and 600,000 practiced Qi Gong.

Despite these numbers, up to now scientific analysis on the effectiveness of these therapies has been fraught with complexity: due to many factors including the differing ideologies of Traditional Chinese Medicine and Western Medicine, and the lack of prior engagement between the differing practitioner groups.

Traditional Chinese Medicine dates back 2500 years and it is based on the philosophy of Taoism. It is based on the Qi, the Yin and Yang. The Qi is the vital energy that pervades the body. The forces of Yin (negative energy) and Yang (positive energy) are balanced but when that balance becomes altered so is the Qi and an individual becomes sick. According to TCM teaching, one’s organs are part of a system called Zang Fu. Zang organs manufacture and store while Fu organs transmit and digest. The imbalance between Zang and Fu then makes the individual sick.  Unlike western medicine, TCM is customised to the individual and hence additional ingredients can be included dependent on the individual’s Yin-Yang. As a result, formulations differ from patient to patient, making it challenging to study,

TCM tries to avoid invasive methods and uses external techniques or herbal medications to help the balance Yin and Yang and allow the Qi to flow again.It encompasses many different practices: acupuncture, Chinese Herbal Medicine, Tui Na (Chinese Therapeutic Massage), Tai Chi and Qi Gong (movement and posture therapy that help with mental focus and coordinated breathing), Moxibustion (burning a herb and hence heat therapy above acupuncture point) and Cupping therapy.

Furthermore additional traditional systems of medicine exist in other Asian countries such as Kampo in Japan which was originally based on the Chinese Medicine. The Japanese Ministry of Health formally recognised the practice of Kampo and hence it is covered by National Health Insurance. Similarly throughout Asia traditional Chinese Medicine is practiced alongside Western Medicine and funded through public health insurance.

What is the evidence for Chinese Medicine?

Western Medicine has set rigorous methods by which to assess the safety and efficacy of treatments. The best accepted mode of analysis in medicine is a randomised controlled trial. This is where individuals are allocated a treatment at random and therefore by chance receive one of several clinical interventions. One of these interventions will be the new treatment under study, one may be the standard of current treatment and/or one may involve no intervention at all (what is called a placebo eg a ‘sugar pill’).  Consequently in Western Medicine when a new drug is made available, it has been assessed by a randomised control trial in a large population to demonstrate its benefit over current therapy and doses and formulations are fixed.  The problem with applying this to Chinese medicine is that the treatments are often individualised to align the yin and yang.  Even trying to assess the benefits of something as standardised as acupuncture is difficult: how do you organise a ‘placebo arm’ to the trial? Needling an individual as an obvious treatment that is hard to sham.

As a result, there are few randomised control trials with traditional chinese medicine.

Furthermore studies in Chinese are not widely available to western doctors with our limited access to translated texts. Over the last 15 years a number of studies have been performed and published in Western societies but have not involved full collaboration with Traditional Chinese Medical practitioners. Collaboration between western societies and Chinese medical practitioners needs to be encouraged if validity of treatment is to be sought.

So what does the evidence say?

Systematic reviews of acupuncture cannot reach a definitive conclusion regarding its benefits, due to the problems mentioned above. Some studies have shown that Tai Chi has benefits with respect to improving balance and stability in people with Parkinson’s disease, and improves pain management in those with arthritis of the knee and fibromyalgia.

The US government and WHO recommended that if an individual is planning to use TCM, they should alert their usual medical practitioner and check the experience of the TCM practitioner, the evidence for the therapy being offered and also not substitute it for conventional therapy.

When can Chinese Medicine help Western Medicine?

While straight comparison of TCM and Western medicine is still challenging, it is important to review how TCM can support Western medicine.

Skin Disorders

Oral and topical medications in TCM have been used for eczema/ atopic dermatitis for many years but unfortunately the randomised control trials using the formulations have been flawed.  However Xiao-Feng-San (XFS), a 13-herb formula, was studied in a randomized trial in Taiwan. 47 Patients with severe intractable Atopic Dermatitis were treated for eight weeks with oral XFS  or given placebo (n = 24). There was a significantly greater improvement in the the area of skin involvement and symptoms associated in the XFS group compared with placebo. These differences, except for the redness score, were still significant four weeks after the completion of treatment. Preliminary observational studies suggest that the combination of Chinese herbal therapy and acupuncture may be more effective than herbal therapy alone. Further controlled clinical studies are needed.

Asthma

There is increasing scientific evidence to support the use of Traditional Chinese medicine (TCM) herbal therapy for asthma with a number of differing therapies being used including anti-asthma herbal medicine intervention (ASHMI), which has received new drug approval for investigation in the US.  14 herbs make up ASHMI but a modified form of just three is also available that contains Ling-Zhi (Ganoderma lucidum), Ku-Shen (Sophorae flavescentis), and Gan-Cao (Glycyrrhiza uralensis). Preliminary data suggest that ASHMI is safe and effective for mild to moderate asthma. One trial compared ASHMI against steroid treatment which is commonly used in moderate asthma flares and found there was nearly equivalence in ASHMI to steroids. The advantage of ASHMI is that its side effect profile is not as great as steroids. Furthermore it did not appear to interact with other drugs and hence could be used along with other therapies. However while this is enticing larger trials are required to remove any effects by chance.

Low Back Pain and Arthitis

Well-designed clinical trials have found that both acupuncture and sham acupuncture are more effective than control interventions for low back pain. Similarly in over 1000 patients with knee arthritis allocated acupuncture, sham acupuncture versus physiotherapy and pain killers, the rates of success were similar for acupuncture and sham acupuncture but greater than standard therapy. The concern with these results is that the recruits for this trial may have had preconceived ideas about the benefits of acupuncture and this may have affected the results. The study demonstrated that acupuncture was safe providing clean sterile needle practices were followed.

Antimalaria Therapy

In the 1960s after many attempts to eradicate malaria, the number of cases rebounded and increased pressure existed to find treatment. In Beijing a national project was set up by the Chinese government and over 240 herbal preparations were studies with Qinghaosu (artemesinin) the most promising.  In 2005 the World Health Organisation embraced this drug in a combination therapy that is now used widely in Africa.

Other trials in drugs for Alzheimer’s disease, Leukaemia, and heart disease are all currently being explored.

The downside: Side Effects of TCM

The difficulty with Traditional Chinese Medicine is trying to ensure that each component of the herbal medicine is known, what are are its side effects and how does it interact with other conventional medication.  Cases that highlight the risks include the development of sudden kidney failure in a number of individuals in the UK, Spain, Belgium  and Japan who had taken a TCM weight loss therapy. This was confirmed to be due to the presence of toxic agents (fenfluramine and diethylpropion) which reduced the blood supply to kidneys. It appeared that therapists had not appreciated that some species of the Mu Tong plant contained these kidney toxins.

Consequently it is important that patients know the compounds they use. In China and places like Taiwan often Western and traditional chinese medicines are used concurrently and side effects understood in an Asian population. In Western countries  the interactions are not fully documented or known.

Consequently there is still a lot to be done to align the science and balance of TCM with Western Medicine. With increased collaboration, there is potential for great benefit.

 

References

http://www.uptodate.com/contents/chinese-herbal-medicine-for-the-treatment-of-allergic-diseases

http://bmjopen.bmj.com/content/3/12/e003906.full

http://www.nature.com/nm/journal/v17/n10/full/nm.2471.html

https://nccih.nih.gov/health/whatiscam/chinesemed.htm

https://nccih.nih.gov/health/whatiscam/chinesemed.htm

http://apps.who.int/medicinedocs/en/d/Jh2943e/9.3.html