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How to Help Patients Manage Hayfever

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Hayfever

Hayfever is the most common allergic disorder in Australia. It is estimated to affect 15% of the population. The symptoms can cause significant disruption to sleep, concentration, learning and daily function for children and adults. The cause is a reaction to wind pollinated tress, grasses and weeds, house dust mites, animal dander and mould spores. 

The Australasian Society of Clinical Immunology and Allergy (ASCIA) has new guidelines for managing seasonal allergic rhinitis (hayfever) and offers the following advice for hayfever sufferers:

  • Intranasal corticosteroid sprays are the mainstay of management and have a potent action on inflammation and symptoms when used regularly and need careful attention to the way in which they are used. The different brands vary in strength and effectiveness, A diagram of the effective way to use the inhalers is available at www.allergy.org.au/patients/allergic-rhinitis-haay-fever-and-sinusitis/allergic-rhinitis-treatment-plan.pdf The American Allergy Guidelines published last year recommend intranasal corticosteroids alone should be used to treat hayfever in people 12 years and over as trials have demonstrated no additional benefit from taking oral antihistamines. The earlier the spray is started after symptoms start, the quicker control is gained
  • Combination medications containing antihistamine and intranasal corticosteroid offer combined advantages and usually reduce symptoms faster
  • Antihistamine oral medications help to reduce symptoms such as sneezing, itchy and irritated eyes, but are less effective in controlling nasal blockage and dribble. The advantage of antihistamines is their flexibility
  • Intranasal saline washouts can be useful, removing the allergens, clearing the inflammatory mucus, are safe and effective and inexpensive
  • Oral leukotriene antagonists (eg Singulair) can be used for children who also have asthma, there is no government subsidy for nasal symptoms alone. Studies have also demonstrated no additional benefit in symptoms control when used with oral antihistamines in controlling symptoms than using intranasal steroids alone.
  • Effective management of allergic rhinitis is an important part of asthma management
  • Allergen immunotherapy (desensitisation) is effective in reducing the frequency and severity of the symptoms and requires a referral to a Specialist. The desensitisation involves the regular administration of commercially available allergen extracts to promote tolerance. This can be done by subcutaneous injection or liquid drops or sprays. Treatment usually occurs over 3-5 years to produce long term benefit. Individuals will experience different degrees of benefit. On average there may be a 50% reduction in symptoms and/or medication use.
  • A brief course of oral steroids (3 to 7 days) is rarely required, but may be considered with severe nasal obstruction or short term rescue from severe symptoms.
  • Depo corticosteroids are not recommended due to their short duration of effect and potential for local and systemic side-effects (eg depo-Medrol injection). These were used commonly some years ago in Australia and are still given in some countries.
  • Oral or intranasal decongestant can be used short term to control symptoms, but after 3 days can cause a rebound nasal obstruction

Unproven tests and inappropriate methods include IgG testing, cytotoxic food testing kinesiology, Vega testing, electrodermal testing, pulse testing and costly avoidance strategies. There is no Medicare rebate for these tests, these methods are not recommended by ASCIA or the WHO.

Dietary manipulation has no evidence of benefit for hayfever, food elimination eg cow’s milk or wheat is not recommended and can result in serious nutritional deficiencies in young children. Restricting dairy products is popular, but no study has demonstrated any reduction in mucus production with dairy elimination. Some cases of rhinitis associated with preservatives have been described, no diagnostic testing are available to confirm this.

Alternative medicines are not regulated in Australia. There is no Medicare or Pharmacological rebate available and no evidence to support the accuracy in diagnosing allergic disorders. The therapeutic effectiveness of acupuncture, vitamin supplements, homeopathy and physical treatments such as chiropractic manipulation has not been demonstrated.

For more detailed information about specific areas relating to allergies, see allergy.org.au

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”.

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Do You Know What Mental Health Is? View from a Doctor’s Desk – Dr Lisa Surman

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Mental health of patients

World Mental Health Day is today (October 10th) – a chance to look at how we can support our patients’ mental health. 

The Do You See What I See? campaign aims to challenge perceptions about mental illness, encouraging everyone to look at mental illness with a more positive light to reduce stigma and make it easier to seek support and help for the one in five Australians affected by mental illness every year.

The campaign has enrolled over 700 organisations asking everyone to make a #MentalHealthPromise and to take a more positive view . The promises that have been made by individuals are at 1010.org.au The website has some suggestions for promises you may like to make and a page to post your own promise and associated image.

Stigma around mental illness remains an issue for Australians, delaying or preventing people from seeking help. The misconceptions and misrepresentations about those who experience mental illness can be damaging, including references about those suffering from mental illness as being incompetent, weak or scary and appear in the media, the arts and conversations at school, work and in the home.

The majority of people affected by mental illness are able to lead contributing and independent lives in the community with treatment and support. The website encourages a different light to look at mental illness, colour and life, resilience, bravery, recovery, hopefulness, courage, contribution and more.

To learn more about mental illness, and provide valuable resources for your patients, there are several organisations with easily accessible online information:

SANE Australia at https://www.sane.org/mental-health-and-illness

Beyondblue at https://www.beyondblue.org.au/the-facts/what-is-mental-health

Headspace at https://www.headspace.org.au/young-people/what-is-mental-health/

World health Organisation at http://www.who.int/features/factfiles/mental_health/en/

To find help: see Mental Health Australia https://1010.org.au/need-help

or mindhealthconnect Guided Search Tool: https://www.mindhealthconnect.org.au/

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”.

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Mental Health Remains the Most Common Reason for a GP Visit

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Mental Health

With this month being Mental Health Month, the focus is on the importance of the mental health of our patients and the resources we can provide, which was highlighted in the Australian Health of the Nation Report. 

The recently released annual Royal Australian College of General Practitioners (RACGP) Health of the Nation Report identified the current health trends and issues for General Practice .

Patients see GPs more than any other health professional and 84% visit their GP multiple times a year. Three in every four patents report that their GP always listens carefully, shows respect and spends enough time with them.

Mental health issues such as depression, mood disorders and anxiety remain the most common health issue managed by GPs and was also identified as the health issue causing GPs the most concern for the future, followed by obesity. Mental health and obesity were the key areas the federal government should prioritise for action.

One in four Australians will face a major mental health problem in their life, mental health being the ability to think, feel and behave in a way that allows us to perform at our best – in our personal lives with family and friends, at university at work and in the community. The most common issues are anxiety and depression.

Learning to manage anxiety and/or depression can make a difference to how your patients react to stresses in life and feel calmer. There are many levels and different techniques and tips on how to achieve this :

  • Exercise regularly
  • Eat well
  • Get enough sleep
  • Practice relaxation exercises
  • Reduce alcohol and drug use
  • Spend time with friends
  • Ensure work/study/life balance
  • Use cognitive strategies to deal with stressful thoughts
  • Practice mindfulness to let go of worries
  • Engage in enjoyable and fun activities

Take the opportunity during Mental Health Month to encourage patients to reach out for further assessment, support and referral if required. There are also a host of great resources you can refer them to on the Australian Government’s Head To Health website.

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”.

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How Successful is Australian IVF? View from a Doctor’s Desk – Dr Lisa Surman

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IVF Treatment

As health professionals, it’s important to have the latest information and resources on IVF. 

A recent report published by the University of New South Wales announced that 18% of IVF cycles in Australia and New Zealand result in a live birth Of the just over 81 000 initiated IVF cycles in 2016-2017, 82.2% resulted in either a successful embryo transfer or all oocytes/embryos being preserved at subzero temperatures for use in IVF ( cryopreservation) In 2016-2017 the highest annual number of births in Australia and New Zealand IVF’s history were recorded, 15,198 babies. The proportion of IVF cycles resulting in twins and triplets is now one of the lowest rates in the world, 3.8%. The average age of women being treated with IVF is 36 years.

The report was produced after the Victorian Government announced a review into the state’s IVF laws to ensure women were getting accurate information from IVF and fertility doctors about success rates and treatment options. Each cycle is expensive, with IVF Australia figures showing patients are out of pocket as average of $ 4,707 for their first IVF cycle and $4,151 for subsequent cycles.

The IVF success rates published for Australian Fertility Clinics can be misleading The rates are given as live birth per pregnancy or per embryo transfer and do not take into account all those whose cycles did not result in an embryo transfer or those pregnancies that do not go to term. Different countries have differing laws regarding public access to fertility treatment outcomes.

Australia’s IVF success rates are assumed to be similar to those of the UK. According to the UK’s National Health Service, between 2014 and 2016 the percentage of IVF treatments that resulted in a live birth was 29% for women under 35, 23% for women aged 35 to 37, 3% for women aged 43 to 44. The Human Fertilisation & Embryology Authority is the UK Government’s independent regulator overseeing fertility treatment and research. This site provides clear outlines about the different treatments available and the associated options, including risks and results.  The HFEA is a very useful reference for Australian women as the fine details are not easily available and not mandated by laws.

The IVF success rates published for US Clinics are higher than Australian rates possible because there was a much higher rate of multiple births from the US Clinics.

For your patients planning or currently trying to start a family, a valuable resource could be The Fertility Coalition, formed by four organisations in Australia – the Victorian Assisted Reproduction Treatment Authority, Andrology Australia, Jean Hailes Research Unit and The Robinson Research Institute; and funded by the Australian Government Department of Health and the Victorian Government Department of Health and Human Services. The site provides facts about fertility for men, women, trans and gender diverse people to make the best possible decisions about having children for your circumstances, the most up to date scientific information to improve fertility. See yourfertility.org.au

For your patients choosing an IVF Clinic and about to attend the first appointment a useful guide is available here.

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”.

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Women’s Health Week – by Dr Lisa Surman

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Women's Health

For everyone working in health, Women’s Health Week is a chance for us to take stock, look at trends and find new resources to help female patients.

The Women’s Health Survey of more than 15,000 Australian women is a valuable “snapshot” of women’s health in Australia.

It reveals that while they are juggling children, the digital world, career and ageing parents,  more women are exercising ( 70.3% are doing more than 2 hours of moderate exercise weekly)  and less are smoking ( 90.5%).

However, there are concerning statistics regarding their wellbeing that, as health professionals, we need to be aware of:

  • 50.8% of surveyed women describe themselves as overweight or obese
  • 9.5% of women drink daily
  • 46.1% of surveyed women have been diagnosed with depression or anxiety by a doctor or psychologist
  • 34.5% of women reported not getting enough time to themselves on a weekly basis
  • 66.9% of women reported feeling nervous, anxious or on edge nearly every day or on more than seven days in the past few weeks

Jean Hailes for Women’s Health conducted the survey and Director, Janet Michelmore says the data demonstrates the complex demands on modern women who are either trying, or think they are expected, to do so much.

She says that time is the biggest barrier for women who are trying to make health a priority, but finding that a challenge. Social media also plays a part in the expectations of women to always appear as perfect.

You can read the whole report here.

The Jean Hailes Women’s Health Week runs all this week (3rd to 7th September) and for more information visit www.womenshealthweek.com.au.

The organisation provides free daily videos, podcasts, stories, recipes and more throughout the week.

The Jean Hailes Organisation provides practical, accessible evidence-based and reliable  information on the website and in 2016 was recognised officially as the Federal Government’s national digital gateway for women’s health.

A valuable resource, indeed, for giving the best possible care to Australian female patients.

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”.

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Headcoach for Young Men. View from a Doctor’s Desk – Dr Lisa Surman

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Maintaining mental health

One of the challenges facing GPs is keeping up to date with programs that can help our patients. 

One that we have found useful for our young male patients is a new program launched by Headspace, called headcoach, which helps them understand that mental health is just as important to understand as physical health.

Headspace has worked with some of Australia’s best athletes to find out what strategies they use to help manage difficult thoughts and feelings.  The strategies are many are varied –meditation, taking a digital detox, listening to music, spending time outdoors and writing things down.

Another great resource we have found is a newly launched podcast from ABC called Mindfully, with Sydney Swans legend, Brett Kirk exploring how to use mindfulness in different areas to become calmer and happier.

As we all know, alcohol and other drugs may feel like they help in difficult times, but can interfere with your mental health and make you feel worse in the long run.

We also know there is a strong link between what we eat and how we feel. A poor diet can increase symptoms of anxiety and depression compared with a healthy diet of wholegrains, fruit, vegetables and nuts.

Sleep improves mood, concentration and increases resilience. Reducing the things that interfere with sleep, such as noise, light and social media help improve sleep quality

Each of the various strategies have further tips and suggestions for how to achieve the goals and can be useful to refer to when talking to our young male patients:  taking time to do the things they enjoy, strategies to manage difficult thoughts and feelings, reducing alcohol, improving diet, improving sleep quality, staying connected to friends and family and staying active.

Another campaign we have found useful is, #YouCanTalk, a suicide prevention campaign aimed at giving people the confidence to respond to friends and family when they need help and guide them to the right support services. The campaign is a powerful union of beyondblue, Black Dog institute, Everymind, headspace, reachOut and R U OK?  #YouCanTalk highlights the resources available to support and access current information, programs, services and research within suicide prevention in Australia.

For more details visit headspace.org.au; and lifeinmindaustralia.com.au, the digital gateway that provides organisations and communities with the services and programs.

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”.

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Is Breast Best? A Look at Breast Feeding by Dr Lisa Surman

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Breast Feeding

Public health officials around the globe were stunned when the American delegation attending the World Health Assembly in Geneva sought to soften the resolution to encourage breast feeding, after decades of research has demonstrated that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes. It is believed that the US delegation was influenced by the interests of infant formula manufacturers, seeking to remove language that called for governments to ” protect, promote and support breastfeeding” and for policy makers to restrict the promotion of inappropriate food products to infants and children. When Equador tried to save the proposal, the US threatened trade sanctions and diminished military aid. In the end Russia introduced the measures which were introduced with most of the original wording.

Breast feeding is the optimal way to feed neonates and infants. Breast milk provides complete nutrition, is readily available, helps prevent infection and has long term benefits such as improved cognitive and neurological development and reduced likelihood of obesity. Benefits to mothers include weight loss, reduced risk of osteoporosis, ovarian cancer and breast cancer.

A study published in the Lancet in 2016 announced that “breastmilk makes the world healthier, smarter and more equal” and predicted that 800 000 child deaths a year across the world could be prevented and $300 billion in savings from reduced health care costs and improved economic outcomes for those reared on breast milk.

There is some nuance to the evidence for the benefits of breastfeeding as the benefits are not possible to disentangle from socioeconomic factors in observational studies. Scientists are not ethically able to conduct double-blind studies providing one group of infants with breast milk and the other breast milk substitute.

A small number of women are unable to breastfeed their baby and breast feeding can be difficult for many reasons. Support for breast feeding is critical, including institutional provisions, emotional support, reassurance, practical help and information. Importantly parents need support, advice, practical assistance and no judgement from professionals, community and peers.

Resources, an online forum and links to social media or a local group for breast feeding women are available at breastfeeding.asn.au

More fact sheets are also available at https://www.thewomens.org.au/health-information/breastfeeding/breastfeeding-overview

Reliable sources of information about medicine use in breastfeeding are LactMed http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT and Infant Risk Centre at www.infantrisk.com/categories/breastfeeding

For those who are unable or who chose not to breastfeed the online group at  fearlessformulafeeder.com is dedicated to providing non-judgemental support for all new parents at #ISupportYou

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

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Dry July. View from a Doctor’s Desk – Dr Lisa Surman

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Dry July

A month of sobriety every year does not reduce your lifetime risk of harm from alcohol, but does act as a circuit-breaker to help reassess your relationship with regular drinking. You may get to assess the effects it may be having on productivity, relationships and review the amount and circumstances you are drinking under (for example the automatic pouring of a larger glass of wine while cooking dinner, or sitting down to watch the television).  Research has repeatedly demonstrated that we underestimate how much we drink. A break may also highlight the social pressures we are under to consume alcohol. There has been little research into whether campaigns such as Dry July have any effect on long-lasting change in alcohol consumption, but there is some evidence from the UK of reduced consumption in the 1-2 months following participating in these campaigns. 

The short-term benefits from a month alcohol-free for regular drinkers include a more refreshing sleep. Although alcohol acts as a sedative, it is associated with increased snoring, sleep apnoea and wakening after the effect wears off at 4-6 hours. Alcohol acts as a diuretic and this effect may also interrupt sleep.

Alcohol contains significant calories and a break can be associated with weight loss and reduced restaurant bills. Although often without physical symptoms, your liver function also improves when not processing regular alcohol.

In Australia, almost 6000 deaths a year can be attributed to alcohol, with approximately 400 hospitalisations per day. Many people remain unaware that the long-term health risks associated with regular alcohol intake are not only confined to very heavy drinkers. There is a growing list of alcohol-related diseases: bowel cancer, mouth and oesophageal cancer, breast cancer, heart disease, respiratory infections, mental health problems and perhaps prostate cancer. There is also the foetal alcohol spectrum disorders occurring as a result of exposure to alcohol in the womb. Alcohol affects judgement and affects risk-taking, with injuries, vehicle accidents, drownings and violence associated.

Individual vulnerability and the context in which you drink are relevant, but in general low-risk drinking to avoid alcohol-related death is two standard drinks or less per day and a single occasion low-risk drinking is four standard drinks or less. The safest option for those thinking about pregnancy, who are pregnant and for those under 18 years old is not to drink.

The National Alcohol and Other Drug Hotline offers professional, confidential and free advice to connect you to the most appropriate services locally at 1800 250 0115 (anytime and anywhere) should you be concerned about your level of alcohol use.

Daybreak is a helpful, free App designed around a Drink Less Support Community created by the Hello Sunday Morning team, see hellosundaymorning.org for more information about the App and Facebook group promoting hang-over free Sundays, for those interested in a longer term approach to changing their relationship with alcohol.

Funds raised though Dry July are donated to cancer support organisations across Australia, with $30 million being raised for more than 75 cancer organisations since the first Dry July in 2008.

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”.

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Talking About Suicide Does Not Make It Happen by Dr Lisa Surman

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Suicide prevention

Beyond Blue have released a media statement following the recent news of high profile suicides, encouraging anybody affected to reach out for support, talk to someone you trust, speak to your GP or a mental health professional or call beyondblue Support Service on 1300 22 4636.  “Don’t stay silent if you are concerned about somebody. Ask how they are really feeling. Ask if they have been thinking about taking their own lives”.

“Mental health issues can affect anyone at any time: No one is immune,” said beyondblue Chair, The Hon Julia Gillard AC.

International recognition, excellence in your chosen career, respect from your peers and public admiration are no defence when it comes to developing a mental health condition.

Talking openly about depression, anxiety and other mental health conditions helps reduce stigma, tackles discrimination and encourages those at risk of self-harm and suicide to seek support. Eight Australians of all ages, ethnicity, religion, gender identity and socioeconomic circumstances die by suicide every day. Suicide prevention starts with recognising the warning signs and taking them seriously. Beyondblue also advises us about people who have thought about suicide have told them that the most important thing family, friends and colleagues can do is listen, show they care and offer support.

The signs beyondblue lists might include:

– expressing sense of hopelessness or no hope for the future

– isolation or feeling alone – ” No one understands me”

– aggressiveness and irritability – “leave me alone”

– possessing lethal means – medication, weapons

– negative view of self -“I’m worthless”

– drastic changes in mood and behaviour

– frequently talking about death – “If I dies would you miss me?”

– self-harming behaviours like cutting

– risk-taking behaviours – “I’ll try anything, I’m not afraid to die”

– getting affairs in order, such as making funeral arrangements

– giving away things, clothes, expensive gifts

– substance abuse

– feeling like a burden to others – “you’d be better off without me”

– talking about suicide – “sometimes I feel like I just want to die”

Visit beyondblue.org.au/get-support/have-the-conversation

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”.

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Bp Allied meet Dieticians

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Bp Allied was again represented at the 35th National Conference of Dieticians from 17th to 19th May in Sydney. Melissa and Paul had a great time meeting dieticians from around Australia. 

Winner of our Competition to win a Google Home Mini was Natalie Selever from IWC Bundaberg. Congratulations Natalie!

 

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