Tips for a Mindful and Healthier Easter – View from a Doctor’s Desk – Dr Lisa Surman

Easter has traditionally been a time for family gatherings and abundant food, particularly high fat and high sugar offerings such as hot cross buns and Easter eggs. The abundance of food related advertisements encourage us to believe that Easter is about eating as much as possible, particularly chocolate.

Mindfulness is about being fully conscious in the moment without making judgement; and being aware of what you are eating. A start may be about being aware of portion sizes, deciding to eat a treat and indulging away from the distractions of screens, books or talking.

Look at the food and enjoy the texture, smell and taste, the muscles used to raise the food to your mouth, the texture and taste as you chew slowly. Don’t grab and eat, try to sit down and enjoy the seasonal treats. The studies show this to be a way of feeling more satisfied with the portion you have eaten, reducing the chance of over-eating and increasing enjoyment in a guilt-free way.

Plan some non-chocolate Easter treats such as an outing to the pool, the park or a bike ride.

Be aware of controlled portion sizes – try to avoid planning to “eat all you want” and avoid planning to “eat no chocolate”. Don’t skip nutritious meals for chocolate. Try fruit dipped in chocolate, chocolate drizzled popcorn or roast nuts, banana muffins with chocolate chips and hot chocolate drinks to make a little chocolate go a long way.

Dark chocolate can provide small health benefits as cocoa is rich in antioxidants. The darker the chocolate the higher the percentage cocoa and potential benefit. Unfortunately, large amounts of chocolate contain large amounts of fats, sugar and calories. Chocolate also contains small amounts of essential nutrients such as protein, vitamin E, calcium, phosphorus, magnesium, iron and copper.

Start Easter morning with a healthy and filling breakfast, swapping chocolate eggs for poached, boiled or scrambled eggs to provide low-fat protein to reduce craving;s and add in some vegetables such as tomatoes and mushrooms on wholegrain toast . LiveLighter, a programme developed in Western Australia to encourage healthier lifestyles is highlighting the benefits of eggs and features several recipes to try out and enjoy across the weekend.

Balance any extra intake with active fun and play. Some examples of walking equivalents are 6 mini Cadbury eggs (19g) requires an average woman to walk for 19 minutes and an average man 17 minutes. A Lindt gold bunny (100g) requires 112 minutes for a woman and 99 minutes for a man.

The LiveLighter website and recipes gives some examples of meal equivalents with their recipe guide for a 100g bunny the same number of kilojoules are contained in:

– a LiveLighter Steak sandwich with caramelised onions

– a healthy quick chicken pizza

– one serve of LiveLonger’s spaghetti Bolognaise

– 2 egg omelette with a slice of toast

– 2 cheese and salad sandwiches

Wishing you a happy ” and healthy ” Easter!

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

View from a Doctor’s Desk – Dr Lisa Surman

When Should I get my Flu Vaccination?

The RACGP president Dr Bastian Seidel is advising us not to get the flu vaccination too early in the season, as protection during the flu season will be less effective. He made the media announcement in response to many pharmacies this week launching campaigns that encouraged people to get their flu shots as early as possible.

Protection from vaccination is known to reduce over time and recent evidence demonstrated this to be by 6-11% per month and those over 65 years particularly have been shown to lose vaccine-induced immunity at an even faster rate. The flu season is usually between June to September, with a peak in August. The community is strongly advised to have the vaccine closer to the start of the flu season, closer to May.

The vaccine usually provides about a 60% protection from the circulating flu strains during the winter. The flu strains contained in the vaccine are chosen after assessing the circulating strains in the opposite hemisphere winters and the predictions can be poor as a result of the complicated possibilities, the nature of the influenza virus and perhaps the modern ease and frequency of travel across continents by large numbers of people. The vaccine strain can change in the 6 months between being chosen for the next winter and manufacture and distribution. The egg-grown H3N2 vaccine virus strain also changed during vaccine production for the 2017 vaccine in Australia.

There are several flu types circulating every year, the different strains posing different threats to the various age groups in the community. The different strains can be easily distinguished by laboratory tests, but not by clinical symptoms. The types of circulating virus strains are published at the end of winter from national Influenza Centres and data is reported to FluNet internationally. The WHO FluNet Summary provides real-time data on the current global circulation of influenza viruses and the vaccine effectiveness for the past season is also provided. The WHO network provides early detection of new influenza subtypes with the potential to cause a pandemic and monitors antigenic and genetic changes occurring in recently circulating influenza A and B viruses to assist the WHO in formulating the twice yearly recommendations on the most appropriate compositions of influenza vaccines. The information is available on the World Health Organisation website here.

Worldwide, influenza A and influenza B accounted for similar proportions of infections in the northern hemisphere winter of 2018.

The UK season had “Aussie flu”, influenza A ( subtype H3N2) in circulation, particularly causing serious illness and death in the elderly. The vaccine effectiveness was estimated as 39.8% for all ages , but gave no effectiveness in those older than 65 years. The Influenza B, Yamagata lineage was also circulating in similar numbers and caused significant illness in the UK and was not included in the vaccine. Children are most susceptible to the Influenza B viral strains

The Aussie Flu (AH3N2) was most prevalent last season in the USA and also caused most complications in the elderly. The US vaccine all-age effectiveness last winter was 32% for H3N2 and 10% for Influenza B Yamagata.

During the 2017 season, only 27% of all Australians were vaccinated at all, with 6% of children being vaccinated. The vaccine provided 33% protection ( 5-19% for H3N2 and 37% against H1N1 ). There were 1,100 deaths from flu-related causes – 90% were aged 65 years and over. Australia recorded 221,853 flu infections to November 2017, significantly more than other years.

This year two new vaccines are funded and recommended for those over 65 years, hoping to provide better protection than that given to the US and UK populations of over 65 year olds for winter 2018. Both contain 3 strains only for influenza A, not influenza B. The seasonal flu vaccine now contains four strains to cover all the relevant subtypes present, but protection against H3N2 infection appears to be poorer than the other strains. The benefits of better protection against the most common three flu strains appear to outweigh the potential loss of protection against the missing B strain for the elderly.

Fluzone High Dose ( contains 4 times the flu antigen. This vaccine increases antibody response, particularly against the H3N2 strain which causes more problems for older people, particularly with a complicating pneumonia.

Fluad, This vaccine contains an adjuvant to boost the immune response. It has been used overseas for some years and observational data indicates less hospitalisations and less pneumonia infections associated.

The new vaccines are not live, do not cause flu and both give more local side-effects such as painful injection sites or fever. There are no head-to-head comparisons of effectiveness and studies suggest similar results.

There is no data to support the use of different doses, nor multiple doses, with the vaccine given at each site most likely to be the one that has been made available to the Clinic.

No vaccine provides guaranteed protection, but reduces the risk of getting flu.

For very detailed information about influenza, the influenzacentre.org website is a useful resource and provides the current vaccine recommendations and surveillance report links available and the Australian Immunisation Guidelines for those who are at increased risk from influenza other than those over 65 years, such as pregnant women, those with lung and chronic diseases and with immunodeficiency states.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

View from a Doctor’s Desk – Dr Lisa Surman

How Do I Avoid Listeria Infection?

Listeria infection has been in the news recently. However, it’s important to remember that it is is rare, is caused by eating foods contaminated by the bacteria and is not usually transmitted between people.

The overall number of cases reported in Australia each year has been about 65, with between 1 to 14 confirmed cases of listeriosis reported in pregnant women each year for approximately 300 000 births.

Foods associated with infection include unpasteurised milk, dairy products made from unpasteurised milk, soft cheeses including ricotta and fetta, juices, soft serve ice-cream, tofu, tempeh, sushi, seed sprouts, chilled ready-to-eat foods like pre-packed sandwiches, pate and deli meats, pre-cut fruit, oysters, packaged salads, cold ready-to-eat chicken, sashimi, smoked salmon. And, most recently, rockmelon (grown in the Eastern States) due to soil contamination on the skin of the fruit.

Listeria infection can be dangerous to those with weakened immune systems ( the elderly, those with cancer, diabetes, liver and kidney disease) and to pregnant women and their unborn babies. Symptoms range from fatigue, headache, diarrhoea, aches and fever to meningitis and septicaemia. The symptoms occur from as early as a few days to several weeks, usually three weeks. The diagnosis is made using a blood or spinal fluid sample

There are simple guides to avoid infection including advice about food preparation, handling and storage:

– washing hands before preparing food and between raw and ready-to eat foods

– defrosting food in the fridge or microwave

– washing raw fruit and vegetables before eating (due to soil contamination)

– not using the same knives and boards for raw and cooked foods unless washed in soapy water

– cooking all foods of animal origin, including eggs

– storing food covered

– avoiding raw food after their use-by-date

– cleaning the fridge and keeping the temperature below 5 degrees, but the organism can survive and grow at low temperatures

– placing cooked food in the fridge within an hour of cooking

– when reheating food, make sure the centre is piping hot as listeria is killed by cooking food to boiling point

Foods without listeria risk include yoghurt, hard cheeses, cheese spreads and processed cheese, milk, canned and pickled foods, ready-to-eat deli meats and smoked fish heated to above 100 degrees, soft cheeses in cooked products such as pizza, hard ice-cream and gelato.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

View from a Doctor’s Desk – Dr Lisa Surman

Getting Health Screening Advice from your trusted health professional

Recently, a TV show gave the impression that having a blood test for prostate specific antigen (PSA) and digital rectal examination by a Urologist for prostate cancer was potentially life-saving, and showed a popular presenter having the screening tests done. The specific benefits and harms were not broken down, nor quantified. There was no discussion about the very well documented pros and cons to weigh up before the test and although acknowledging the risk of impotency and incontinence as a consequence of prostate surgery, it was framed as though it was a thing of the past, “The treatments are so vast these days that it’s not as bad as all that, and you’ve got to get checked. You must get checked.”

For men aged 50-69 (without a family history of prostate cancer) the benefit/harm debate for prostate screening using the PSA test is unclear and open to individual interpretation. The decision to have the screening test is a personal one and needs to be done after weighing up the benefits, harms and uncertainties of prostate cancer screening.

If you have a PSA test, you are much more likely to be over-diagnosed and over-treated for prostate cancer than have your life saved from early detection of a nasty form of the disease. This is why the Australian Government does not have a funded, organised prostate screening program and why the Royal Australian College of General Practitioners advises members not to recommend PSA screening to patients.

A digital rectal examination is no longer recommended should a man request screening for prostate cancer after being informed about the risks and benefits of testing.

The National Health and Medical Research Council (NHMRC) advises that a patient who asks a GP about the tests, should be informed of the following information calculated for men in their 60s with no first-degree relatives affected by prostate cancer who have yearly PSA tests.

The stated potential benefits are reassurance if the PSA is normal or very low, early detection and early treatment, hopefully cure. The potential harms are false positive results, with unnecessary biopsy required, false negatives, over-diagnosis and overtreatment resulting in harmful effects without any health benefit.

Potential Benefits:

  • For every 1000 men tested, 2 men will avoid death from prostate cancer before they reach 85 years. This benefit seems greater for men with a strong family history of the disease
  • For every 1000 men tested, 2 men will avoid metastatic prostate cancer before the age of 85 years

Potential Harms:

  • For every 1000 men tested, 28 men will have prostate cancer diagnosed, many of whom would have remained without symptoms for life
  • For every 1000 men treated, 25 men will have surgery or radiation because of uncertainty about which cancers need to be treated. Many would do well without treatment
  • 7 to 10 of these 25 men will develop persistent impotence and/or incontinence and some will develop persisting bowel problems from the treatment
  • For every 2000 men tested, one man will have a serious cardiovascular event, such as a heart attack because of the treatment

The advice delivered in the television series ” The medical checks you have to have” was not in line with current RACGP guidelines nor NHMRC guidelines, which do not recommend routine PSA measures without discussion, nor routine digital rectal examinations as part of screening.

To read the fine detail of the NHMRC recommendations for PSA testing in asymptomatic men, click here.

The RACGP also has a fact sheet to help men make the decision as to whether they will screen for prostate cancer at racgp.org.au and available from your GP.

Information has been developed for men with a family history of prostate cancer that is available on the NSW Health Department’s Centre for Genetics Education website at http://www.genetics.edu.au/Genetic-conditions-support-groups/prostate-cancer-screening

Andrology Australia ( andrologyaustralia.org) have very detailed, but easily understood fact sheets available with further detail about the statistics and risks of prostate cancer screening.

Dr Lisa Surman, CBD West Medical Centre, Perth, WA

Member of Best Practice Software’s Clinical Leadership Advisory Committee

Often patients spend time talking about current medical and social issues, taking valuable time away from dealing with what they have really come in to discuss. One of our solutions is to direct them to news articles on our website written by a doctor in our Practice that outline current issues and offer strategies to manage the problem and links to relevant, reputable websites.

 

After-hours healthcare changes included in Bp Data Update

Bp Premier users will see an easy transition to the new after-hours healthcare guidelines with the changes included in the latest March Data Update.

As of 1st March 2018, the Federal Government made changes to Medicare rebates introducing differential rebates for doctors providing urgent after hours care who are vocationally registered and on a pathway of Fellowship.

Announced by the Federal Minister for Health in December 2017, the changes are designed to better reflect the level of doctors’ qualification and patients will therefore receive more financial support for after-hours visits provided by qualified doctors.

To receive Best Practice Software Data Update notifications, please ensure we have your correct contact details. Call our team on 1300 40 1111 in Australia or 0800 40 1111 in New Zealand.

 

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For further detailed information regarding the Australia wide changes, visit the RACGP website.