It’ll be lonely this Christmas

For many Christmas is a time for family and celebration. However, for many others it is a difficult time and can serve as a trigger for many mental health issues.

According to the excellent charity Beyond blue over 3 million Australians are living with depression. It is normal for a person’s mood to fluctuate but to feel persistently sad is not considered normal.

Major depression or depression primarily involves a persistent feeling of low mood. The sufferer will find a lack of pleasure or enjoyment for things they might expect to enjoy or have enjoyed previously. This can interfere with a person’s daily life with reduced socialisation, poor concentration and problems in established relationships, as well as difficulty forming new ones. There can be physical changes too such as lack of energy, poor sleep and weight changes.

 

In its most severe form depression can even cause psychosis with hallucinations and feelings of low self-worth and paranoia.

 

Christmas can be a particularly difficult time for those suffering with depression as there is a cultural expectation to be merry which, understandably, they may find very difficult. This can lead to a cycle of increasing isolation and loneliness which can further perpetuate the burden of depression.

 

Similarly, for many of us Christmas is a time for happy memories but for those who are grieving or dealing with loss it can be a painful reminder of those feelings.

 

Parties and social events can also be a challenge for those with substance abuse problems. There is an increased pressure to drink and those around us who struggle with this may need more support at this time. Sometimes saying ‘just have one more drink’ can pose a really difficult situation for someone so it’s important to respect the choices of others. Excess alcohol or drug use can also lead to an increase in risk taking behaviour such as drink driving.

 

The incidence of domestic violence increases at Christmas, which no doubt has a link to the rise in alcohol consumption. There are also added financial and family stresses at this time.

 

Popular consensus is that suicide rates go up at Christmas time, when actually it’s the contrary.

However, the above discussion highlights how the festive period could be a trigger for self-harm or suicide. If you know someone who is vulnerable, or you are worries about the following can be things to look out for:

  • Sense of hopelessness and lack of positive outlook for the future
  • Multiple mentions about death and life carrying on without them
  • Deliberate avoidance of interactions with others and Isolation
  • Dramatic swings in both mood and behaviour, increased anger or aggression, intense sadness.
  • Worsening or escalating substance abuse patterns
  • Feelings of being unworthy or a burden

 

If you are affected by any of the issues above and feel like you don’t know where to turn, there are plenty of resources available.   Our emergency specialist doctors at www.myemergencydr.com  may also be able to direct you to the most appropriate service and you may find it easier to talk face to face, via video link. A friendly understanding voice can be all it can take to help you feel ready to seek help.

 

Useful links

www.myemergencydr.com

https://www.1800respect.org.au/

https://www.beyondblue.org.au/

https://salvos.org.au/

MED meets Minister Hunt

My Emergency Dr would like to thank The Health Minister Greg Hunt for giving our Melbourne staff the opportunity to spend time with him on day 16 of his 18 day ‘Walk for Autism’.  Greg was very interested to hear about the work MED has been doing with Eastern Melbourne PHN and other health services around Australia.   And what a surprise for Dr Roslyn when she picked up the call for her next patient and it was The Minister himself !!!  Greg will have walked a total of 503.6 km over the 18 days, raising money for Autism.  MED is happy to support Greg’s efforts with a donation that will assist the Abacus Learning Centre and Light Up Autism Foundation.  if you would like to make a donation too, please click on this link:
www.givenow.com.au/GHWALK

Pilot program marks milestone in healthcare

MNCLHD Integrated Care Project Officer Adam Ulrick, North Coast Primary Health Network Director System and Service Integration Steve Mann, Chief Executive Officer and Founder of My Emergency Dr (MED) Dr Justin Bowra and Seascape Medical Centre (South West Rocks) General Practitioner Dr Akram Malak

The Mid North Coast Local Health District (MNCLHD) and North Coast Primary Health Network (NCPHN) have teamed up with My Emergency Dr (MED), an Australian-owned and operated company, to commence a pilot program at South West Rocks.

This innovative pilot has been developed specifically for the South West Rocks community in collaboration with MNCLHD, MED, NCPHN, local General Practices, Japara Aged Care-South West Rocks and local pharmacies.

The pilot utilises the MED App, which is a video-based smartphone app that allows residents to call an Australian qualified Emergency Specialist Doctor (FACEM) 24/7, 365 days a year for non-life threatening health issues.

The MED Doctors are able to diagnose illnesses, provide prescriptions, requests for pathology and medical imaging and can even provide a discharge summary back to the patient’s GP.

Recent community information sessions about the pilot were well attended by locals.

The pilot commenced on 1 August and aims to reduce the amount of travel for locals with non-life threatening illnesses to hospital and enhance their access to medical advice when access to a regular GP is not available.

“The level of interest in the community is rising and it is encouraging to see so many residents obtaining a referral to use our service” Dr Justin Bowra said.

“It is important to be clear to the community and GPs that we don’t take over the long term care of the patient from their usual GP.

“We are confident that the project will be of very significant benefit to the residents of South West Rocks, and it marks a real milestone in healthcare in this country as well as a terrific example of how different stakeholders can work together to

make a difference for regional and rural Australians,” Dr Bowra said.

The pilot is due for completion at the end of January 2019.

My child has a rash

Parents worry when they notice a rash or a bump on their children’s skin. In most cases these skin conditions are caused by viral infections and shouldn’t be a cause for great concern. Most are harmless and can disappear without any treatment. Minor rashes typically are red; with flat or raised bumps or blisters that occur on the hands, feet, face, trunk or mouth. Often they are associated with a fever, either before the rash occurs or when it appears.

The easiest way to assess if a rash is something more serious is just by appearance. Placing a finger onto the skin of the rash to assess if it is blanching. This means that when pressure is placed by your finger onto the skin and when you lift your finger off the redness of the skin temporarily disappears. If the redness does not disappear when you lift your finger off or if your child has a rash of small, bright-red or purple spots or bruises that do not blanch this indicates a more serious rash. Rashes like this need urgent assessment by a doctor at your local emergency department or via the My Emergency Doctor App to beat the wait and be seen to immediately by a doctor.

There are many different causes of a rash and in nearly all cases it is not important to know which virus is causing the rash. Antibiotics do not work on viruses and are not given to children with rashes caused from viral infections.

To help you manage with your sick children and their rash at home we recommend:

  • encourage plenty of oral fluids
  • if they are uncomfortable or miserable treat their fevers with paracetamol
  • encourage rest

 

To avoid transmission of the virus wash your hands after touching any bodily fluid and avoid sharing household items like cutlery, cups, towels and toothbrushes.

Should you be concerned about your child or if they are

  • Lethargic or drowsy
  • Not drinking water
  • Have a persistent high fever that does not reduce
  • Have a febrile convulsion

 

Or if you are pregnant and concerned about transmission of the rash and illness to your unborn baby seek a review from your medical practitioner or via the experienced doctors on the My Emergency Doctor App today.

Childhood Asthma

It ain’t easy, being wheezy:

Asthma is a very common health problem in children in Australia and the winter months are when symptoms will be at their peak.

Many children, especially babies and toddlers are affected by wheezing, the predominant symptom of asthma. During these episodes they will often require the same treatment as an asthmatic. However, many of these children will not grow up to be affected by asthma.

Wheezing can be triggered by common viruses such as those causing the common cold, cold weather, exercise, cigarette smoker, house dust and pollen.

The symptoms of asthma are cause by narrowing of the airways making it harder for air to get in and out of the lungs, which produces the wheezing sound. There also may be increased about of mucus which can add to the problems.

The main symptoms of asthma are

  • Wheezing- narrowing of the airways makes it harder for air to get in and out of the lungs, which produces the high pitched whistling sound, this can be worsened by increased amount of mucus.
  • Breathing difficulties – you might notice that your child is not as active or out of breath on minimal exertion or even at rest. You may also notice them breathing fast and working harder than usual to breath.
  • Chest tightness- this is a sensation caused by narrowed airways and the increased difficulty with airflow
  • Cough – not usually a problem alone, cough may be increased during an episode of asthma and worse and night, on exertion or in the cold.

 

These alone will usually last for 2-3 days and the GP will be able to help you manage your child’s symptoms.

Signs that asthma is more serious are

  • Struggling to breath and working hard with the chest muscles, you may notice sucking movements in the chest or throa
  • Becoming very distressed, appearing exhausted or even drowsy or limp

 

These suggest more severe asthma and your child will need urgent treatment in an emergency department and you should call an ambulance, who can initiate treatment.

Asthma treatment is predominantly through the use of inhalers. When you see your GP to formulate your child’s Asthma Action plan you should be trained in the use of inhalers and spacers. A spacer is a chamber in which the inhaler is squirted into while the child breathes it in from the other end. Your child may need to have Ventolin/ salbutamol every 2-4 hours while they are unwell to relieve their symptoms.

If your child is having an asthma attack, you can initiate simple measures at home. This is known as the 4 x4x4

  1. Sit them up and be calm
  2. Shake their blue/ reliever/ ventolin inhaler and give 4 separate puffs into the spacer, asking the child to take 4 breaths after each puff. Do this calmly and slowly so the child takes nice full breaths.
  3. Wait 4 minutes and repeat this.

 

If there is no improvement call an ambulance and states that your child is having an asthma emergency.

If your child’s symptoms worsen quickly, they are unable to talk, lips turn blue or they appear exhausted, call an ambulance immediately. You should continue to repeat the 4x4x4.

In the cases where the child appears well but is wheezy and you are not sure which health services to access, you can contact myemergencydr.com. Our doctors can offer phone advice on first aid, direct you to an out of hours GP or medical centre or advise when you should take your child to hospital.

Home

https://www.asthmaaustralia.org.au/nsw/about-asthma/resources/first-aid

https://www.nationalasthma.org.au

Burns

Who doesn’t love a BBQ or candle lit room? However, burns are a common presentation to the Emergency department.

First aid for burns is often misunderstood and getting it right can make all the difference to the outcome.

  1. All burns need to be cooled as soon as possible. This is at least 20 minutes of cold, running water which can be effective up to 3 hours after the burn has occurred. The burn can extend after the initial contact so this step is vital. Never use ice or cold packs as it is the continuous flow of water that actually helps prevent the skin damage. Similarly if an irritant chemical contacts the skin, irrigation with water is needed, often for much longer times periods.
  2. Try and remove jewellery or tight clothing as the area will swell
  3. Once cooling has been done try to keep the affected area irrigated to reduce swelling
  4. Covering the burn with clean cling film may help to reduce pain before getting to hospital, it is the damaged nerve endings contact with air that often cause much of the pain. Do not put any creams, ointments, honey or butters on the burns

 

In general burns should be assessed by a medical practitioner in order to make sure the correct treatment is initiated. There are some situations where doctors may be more concerned than others and the patient may need urgent transfer for specialist care. For example, electrical or chemical burns, burns to the face or burns with high amounts of thermal energy.

Blistering of a burn is a sign that it is not superficial as the deeper layers of skin are separated, these will all need medical attention.  Burns affecting the hands, feet, joints of the arms or legs and genitalia also need urgent expert assessment.  When you are seen in the Emergency department you may also require a tetanus booster as a burn can put you at risk of tetanus infection. Most burn injuries also require follow up with the GP or burns clinic, as they can often look worse after 2-3 days and require specialist dressings.  It is important that a healthcare practitioner keeps a close eye on the healing process so they can refer to a burns expert if necessary.

As well as the burn itself, smoke exposure can be very harmful.  This can happen with both enclosed fires and with prolonged exposure such as in bushfires or industrial fires.

The lining of the airway itself can be burnt which may be suggested by singed facial hair or blackening around the mouth and nose.

There are also several poisonous gases in smoke including cyanide and carbon monoxide.

Carbon monoxide is colourless and odourless so cannot easily be detected. That is why smoke AND carbon monoxide detectors should be in every home.  Poisoning may be subtle with symptoms such as mild confusion, headache, fatigue, vomiting. In more serious cases this can progress to coma and even death.

 

If you are unsure what to do about a minor burn or concerned about smoke inhalation and you need to speak to a doctor, download the My Emergency Dr app for an urgent consultation with a qualified specialist emergency doctor 24 hours a day, seven days a week.

Love Hurts

We at myemergencydr.com recognise that things don’t always go to plan and sometimes unprotected sex does happen.

As well as the risks of unwanted pregnancy, there are sexually transmitted infections (STI) to think about.

These are very common but still seem to cause embarrassment and late presentations to medical services are frequent.

The signs and symptoms of STI’s may be subtle at first and include

  • Pain or discomfort on passing urine
  • Increased discharge or offensive smelling discharge
  • Pain or discomfort during sexual intercourse
  • Bleeding between periods
  • Heavier bleeding during your normal period

 

Left untreated these can cause pelvic inflammatory disease in women which can progress to cause severe pain, infection throughout the body or sepsis, and result in infertility.

Diagnosis of STI’s can be as simple as a urine test for disease such as chlamydia. However, sometimes a diagnosis can be made based on other features such as the presence of sores or warts. Others may require vaginal or penile swabs which are not painful but more invasive.  Blood bourne viruses such Hepatitis B or C and HIV require blood tests. Staff who work in sexual health clinics are specially trained to council you about these tests and can offer emotional support, when needed.

The treatment of STI’s is usually antibiotics and prevention of further spread. At sexual health clinics they can assist you with anonymous contact tracing and you will be treated with empathy and dignity.

If you think you have an STI, we at myemergencydr.com can assist you in finding your local sexual health clinic and provide confidential advice about the next steps. You may need to attend an after hours GP, medical centre or on occasion an emergency room and our doctors can advise about this too.

Similarly, if you are concerned about being pregnant, as a result of unprotected sex, one of our doctors can guide you to find the most appropriate health professional.

Some people may find these topics hard to talk about, at myemergencydr.com you can have an online chat with one of our doctors, which you may find easier. You will be afforded the same confidentiality as in any other health consultation.

https://www.myemergencydr.com/

http://www.health.nsw.gov.au/sexualhealth/Pages/sexual-health-clinics.aspx

Constipation & You

Constipation is a common health condition that affects adults, children and the elderly. It is the passage of hard, dry stools that are often infrequent or difficult to pass and is one of the most common health conditions that brings a patient to see their doctor for advice.

 

Constipation can be caused by many lifestyle factors that are simple to fix. Risk factors for developing constipation include:

  • A change in routine
    Normal bowel motions depended on the regular and rhythmic contraction of the bowels that is regulated by the body’s internal clock. This can be disturbed when travelling, undertaking shift work or changes in your daily routine.
  • Lack of fibre in your diet
    Fibre adds to the bulk and softens your stools. This helps the passage of material through the digestive tract making it easier to eventually pass. Good sources of fibre in your diet include fruits and vegetables, wholegrain breads and cereals.
  • Dehydration
    Insufficient water causes the poo to become hard and dehydrated and makes it difficult for the poo to move down the intestine. By drinking at least two litres of water a day you soften the stool and prevent constipation.
  • Lack of regular exercise
    Physical activity helps to relieve constipation because it stimulates the nervous system and helps the muscles and nerves in the gut to work better moving poo through the digestive tract.
  • Withholding going to the toilet
    When you ignore the urge to go it means that more water will be extracted from the stools making them more difficult to pass. If you regularly ignore the urge this makes the body less sensitive to the normal signals to alert you to go to the toilet and your gut becomes lazy causing a build up of poo in the intestine.
  • Pregnancy
    The pressure of a growing baby on the intestine combined with reduced activity and the action of hormones means that constipation is common in pregnancy.
  • Medications
    Some medications particular pain strong pain killers, iron supplements and antacids cause constipation by slowing down bowel movements. Often supplements to soften stool and provide bulk will also be prescribed to avoid constipation.
  • Illness
    Reduction in normal activity, dehydration and bed rest typically cause constipation.

 

If you are suffering from constipation or have tried home remedies without relief download our My Emergency Dr app for a confidential online consultation with an expert clinician today.

Back Pain

Low back pain is a very common problem with approximately 80% of Australians suffering from back pain during their lifetime. It is a significant and debilitating condition that impacts your quality of life and reduces ability to function. Here at My Emergency Dr we can provide you with an immediate assessment and help you to manage this disabling condition.

Back pain can occur after moving heavy objects but often is provoked without an inciting event.  It is also more common in those who are overweight, who are physically inactive or those undertaking repetitive tasks at work.

The low back supports the weight of the upper body and provides the mobility for movements such as bending and twisting. Most acute low back pain results from injury to the muscles of the back, or the ligaments, joints or discs around the spine. After an injury to the back the body reacts by causing the surrounding muscles to stiffen. Patients often experience severe pain at the site of the injury due to the surrounding inflammation.

‘Red flag’ symptoms make a doctor more concerned that there may be a serious cause for your back pain. Please let your doctor know if you have:

 

  • A history of cancer
  • Unexplained weight loss
  • A history of trauma to the area
  • A history of intravenous drug use
  • A fever
  • Loss of bladder or bowel function
  • Weakness of your limbs

 

More than 85% of patients who present to emergency with low back pain have no specific cause found and their pain improves within a few weeks of simple treatment. Our tips for a rapid recovery include:

 

  • Speak to your doctor for an accurate assessment and diagnosis
  • Use the pain medication as prescribed
  • Stay active and avoid too much bed rest as it will slow down your recovery.
  • Once your pain subsides undertake gentle stretching and strengthening exercises to prevent further episodes in the future

 

Here at My Emergency Dr we are experts in the assessment and diagnosis of back pain. Call us today for an immediate online medical assessment using the My Emergency Dr App. If your back pain causes you to develop weakness in your legs or bowel or bladder dysfunction please seek urgent medical attention.

Winter flu and you

Last year we had a horror flu season, one of the worst on record, which caused unexpected deaths and multiple admissions to hospital for patients young and old across Australia. To protect you and your family here are some simple steps you can take to minimise infection and transmission.

Spreading the illness
– Wash your hands thoroughly
– Don’t share cups or cutlery
– Cough or sneeze into your elbow
– Use tissues and dispose of them into the waste bin
– If your child is sick keep them home from daycare or school to prevent spreading the illness

To prevent influenza there is a vaccine. The flu vaccine is free for
– Children aged 6 months to 5 years
– anyone over the age of 5 years with a chronic health condition
– all Aboriginal and Torres Strait Islander people aged 15 years and over
– pregnant women (influenza vaccine can be given at any stage of pregnancy)
– people aged 65 years and over
– health workers

The evidence demonstrates that those who are vaccinated against the flu are less likely to get sick and less likely to get admitted to hospital. The vaccine also stops the spread of flu in the community and prevents those that are too young or too sick to be immunised from becoming infected. The vaccine is an inactivated (killed) virus. It will not give you the flu. Side effects of the vaccine include pain and redness at the site of injection. Less commonly, children may develop a fever or aches and pains, which last one to two days.

Vaccination remains the best protection against influenza to help keep you well this winter. To prevent becoming struck down with the flu get a flu vaccine.