Shoulder Pain

Shoulder pain is common in our community. In younger people, shoulder pain is more likely to be due to an accident or injury. However, as you get older, natural wear and tear occurs in the shoulder joint and the rotator cuff tendon. Over time, this may become persistent pain. The good news is that with appropriate treatment shoulder pain will improve so you can get back to doing the things you enjoy.

Most problems in the shoulder involve the muscles, ligaments, and tendons, rather than the bones. Symptoms can include pain, instability or reduced movement. The following are reasonable steps to take to manage shoulder pain in the first instance

· Heat or cold packs may help provide you with temporary relief of pain and stiffness.

· Medications such as paracetamol and low dose anti-inflammatories can be helpful in controlling pain while you work to maintain and restore movement and function

Should your pain be severe or if it worsens over time you should undergo an assessment of your shoulder joint by an experienced health practitioner. Health practitioners who treat shoulder pain are trained to investigate and identify the exact cause of the condition or injury causing the pain and will be able to provide you with a treatment and management plan.

Should you have an injury that requires medical assistance download the My Emergency Dr app to connect to a Specialist Emergency Doctor for an urgent health assessment and treatment. Available from https://www.myemergencydr.com

Measles and you

Measles is a contagious viral illness which presents with the tell tale symptoms of a very high fever followed by a red blotchy rash that erupts over the whole body. Often there are associated symptoms such as a cough, runny nose, fatigue or sore red eyes.

In Australia most people are vaccinated against measles. This vaccination is based around two doses of the virus which then provides the patient with life- long immunity. Unfortunately for the very old or young or those without a competent immune system they cannot have the vaccine and rely on herd immunity from the community (in other words, most people being vaccinated) to protect them.

There is no treatment for measles. Antibiotics do not work as the illness is viral. Most people who have measles recover fully with rest, fluids and analgesics to treat the discomfort and ease the fever. Occasionally, measles develops into a serious disease that requires urgent treatment and can even be life threatening. Spread of measles occurs by people coughing or sneezing. It is highly contagious. In order to reduce the spread of measles patients should remain at home until fully recovered.

If you’ve been in contact with someone with measles and you are not immune (you have not been immunised or have not ever had a measles infection), there are different treatment options. Speak with our team of doctors to discuss your options – download the My Emergency Dr app to connect to a Specialist Emergency Doctor for an urgent health assessment and treatment. Available from https://www.myemergencydr.com

 

Simple Analgesia

Everyone experiences pain at some time. It might be the result of an injury, operation or a result of chronic degenerative changes to your body. Conditions like headache, infection, arthritis and other health problems can cause pain and, left unchecked, may interfere with your ability to sleep, work and enjoy life.

We have come a long way from the original ‘grin and bear it’ or ‘no pain, no gain’ approach. To help relieve or control your pain we recommend following this step-bystep approach that is the same for adults or children.

When you experience an injury cells of the immune system travel to the injured area to help it recover – this causes warmth, redness, swelling and pain. By using simple measures initially this may help to alleviate pain due to the inflammation. Steps you can take include resting the affected area, elevating and applying ice or application of a compression bandage to the injured area in an attempt to reduce swelling.

If these simple measures fail consider using over the counter pain relief medication available from your chemist or grocery store. For mild to moderate pain associated problems, such as back pain or headaches, simple painkillers such as paracetamol and anti-inflammatory agents such as ibuprofen or aspirin are the best way to relieve the symptoms. It is important that you consider the potential side effects of any medications, especially pain relief medication, so you can weigh up the advantages of taking them against the disadvantages.

If you have allergies, chronic illness or are on any other medicines always check first before taking these medicines. The pharmacist can help in giving medication advice in these cases. If your pain persists or you are concerned call My Emergency Dr now to access the best possible healthcare from your own home.

Anxiety

Whilst anxiety symptoms can be hard to identify, with 25% of the population having experienced anxiety at some point in their life, it most likely at some point you may have experienced it too. Anxiety symptoms are wide ranging and include physical and psychological symptoms. You may notice your heart racing, your palms getting sweaty or simply just a dry mouth. These can leave you to feel powerless and worried that the symptoms may recur causing you to have difficulty concentrating and pervasive fear.

On it’s own anxiety isn’t a problem – it’s a natural inbuilt defence mechanism that the body uses to respond to danger. It boosts your heartbeat and breathing, allowing you to pump oxygenated blood to your muscles as your body prepares to fight or flee. A handful of anxiety in itself is useful – allowing you to push to study hard for an exam, race to get the last bus or alert you to the fact that you may be in danger.

However anxiety is more than just feeling stressed or worried. When anxious feelings do not pass or occur without a reason this is a manifestation of anxiety as an illness. If untreated it may impact adversely on a person’s life. If you are experiencing symptoms of anxiety on a more frequent basis and it is preventing you from functioning normally at home or in the workplace you are not alone. Anxiety disorders are the most common mental health disorders, affecting up to 20% of Australians every year.

If you or someone you know are dealing with frequent panic attacks, finding that anxiety won’t go away or is preventing you from functioning at home or work; it might be time to tackle the issues or speak to a health professional. By talking about your anxiety symptoms with a doctor you will be medically assessed and assisted with a care plan to manage your anxiety. It may take time to feel better, but getting professional help can support you in managing anxiety and reduce its effects on your life and wellbeing.

If some of these symptoms are impacting on your life and you need to speak with an experienced medical professional download the My Emergency Dr app. We have doctors on hand experienced in assessment and management of anxiety and will be able to help you better manage your anxiety.

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/

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.