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Major Award for Best Practice Software

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Leading Australasian medical software company Best Practice Software was recognised with a major Award at the Bundaberg Regional Chambers of Commerce Business Excellence Awards on Saturday, 26th May.

Chief Operating Officer Craig Hodges said it was a great honour for the entire team at Best Practice.

“On Saturday evening I had the great honour of accepting the Professional Services Business of the Year Award at the Business Excellence Awards in Bundaberg. Judges determined that Best Practice Software met, in a joint award with a local animal hospital, the criteria of a successful business best engaged with its customers, team, products, and community” Mr Hodges said. “It’s not our systems or products or buildings or large user base in its own right that saw us win – but rather the immense contribution of a team of people, each doing their own important part in the overall picture”.

Best Practice was created in 2004 in Bundaberg Queensland, by Dr Frank Pyefinch, who brought users the benefits of a busy and successful career as a respected General Practitioner and more than a decade’s experience as Australasia’s pioneer of medical software development.

The company opened its busy Operations Hub in Bundaberg in April 2013 – the most sophisticated “nerve centre” dedicated to Medical Information Technology in the nation – and grew its team into a New Zealand operations centre in Hamilton; a modern support centre in Sydney; and a business centre in Brisbane, Queensland.

“We believe that Best Practice combines the best in people, systems and technology to help connect communities with medicine and it’s gratifying to see the panel of judges recognises the work we do and the part we play from our founding base in Bundaberg” Mr Hodges said.

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How Much Sugar Is Enough? View from a Doctor’s Desk – Dr Lisa Surman

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Sugar and healthy eating

The recent Four Corners’ episode on television discussing the obesity epidemic in Australia, and the burgeoning health-care costs associated, exposed the food, nutrition and health politics in Australia over many years and the powerful grip Big Food has on Australian food and nutrition policy. 

There have been clear links made for some time between free dietary sugars, sugary drink consumption and obesity. Evidence is strong and growing regarding the effect sugary drink taxes have in driving down consumption and incentivising manufacturers to put less sugar in their products. Taxing sugary drinks is far from the single solution to the obesity or diabetes epidemics, but is a start.

The World Health Authority (WHO) recommends adults and children limit their intake of free sugars to less than 10% of their total energy intake daily. If you are and average-sized adult with a healthy body weight, this translates to about 54 grams of sugar (approximately 12 teaspoons) per day.

Free sugars are defined as monosaccharides (glucose) and disaccharides (table sugar), added to food and drinks by the manufacturers, cooks or person. It also applies to sugars present in honey syrups, fruit juices and fruit juice concentrates. These sugars are different to those found in whole fruit and vegetables, which do not apply. Sugar added to food and drinks can have different names, all remain sugars: sucrose, glucose, corn syrup, maltose, dextrose, raw sugar, cane sugar, malt extract, fruit juice concentrate, molasses.

More than 52% of Australians are estimated to exceed these recommendations, sugars are added to processed foods and pre-packaged foods and drinks. The largest proportion of our free sugar intake comes from sugary drinks (over 50%). Australians consume more sugar-sweetened drinks than Britons who implemented a tax in 2016. Should we introduce a sugar tax, we would join 28 other countries and 7 US cities. Two years after Mexico introduced the tax, sugary drink purchases decreased by 7.6%. One 600ml bottle of sports drink contains 36g or 8 teaspoons of sugar, 600ml of coke contains 64g or 14 teaspoons of added sugar.
Sugary drinks are heavily advertised, available everywhere and promoted – they provide large numbers of kilojoules and provide no nutrients.

Changes you can make immediately to help reduce your sugar intake while waiting for some policy change include:

  • Carry and use a refillable water bottle
  • Eat fewer foods with free sugars, reduce sweets such as lollies and chocolates, cakes and biscuits
  • Don’t walk down the sugary drink aisle of the supermarket
  • Keep sparkling water or home made iced tea in the fridge
  • Avoid vending machines
  • Make some swaps – swap your cereal for a lower-sugar variety and limit the sugar you add
  • Read the labels on food – if there is more than 15g of sugar per 100g, check to see if sugar is one of the main ingredients (it will be listed as one of the first three ingredients on the ingredient panel)

Other foods high in sugar are breakfast cereals – one cup of some types of cereal can contain 30-50% of the daily sugar allowance. Many “health” foods and sugar-free recipes can be misleading – they are referring to the product being ‘sucrose-free’, but sugar derivatives such as rice-malt syrup, agave and maple syrup are still forms of sugars.

For a helpful guide for swaps, top tips, recipes and a sugary drink calculator to estimate your own intake and percentages, see livelighter.com.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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Influenza Update – View from a Doctor’s Desk – Dr Lisa Surman

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Flu shot
In past years there was a push to get your influenza vaccine done as soon as vaccine was available, usually in early March. Research has demonstrated that protection following vaccination starts to wane after three to four months, explaining the strong recommendations from the Australian health departments and the RACGP to have the vaccination closer to the expected ‘influenza season’. It is possible to track the current influenza notification statistics at immunisationcoalition.org.au. It is important to note that many people do not get tested for influenza and some delays may occur in reporting of confirmed influenza cases, but the statistics that are gathered do provide an understanding of influenza activity across Australia. To the start of 23 April, there have been 11,524 confirmed influenza notifications across Australia. Unfortunately, some pharmacies have not followed advice about timing and have been heavily promoting access to the 2018 influenza vaccine since February.  GP surgeries have now all ordered the various influenza vaccine supplies from the Health Department for those entitled to the free vaccine, but supplies have been slow and restricted for most surgeries, causing many people to worry about receiving their vaccine too late, which is not the case (even though the uncertainty about the timing of receiving the supplies is a frustration for both the GP staff and patients). Last year was the worst year on record for cases of influenza, with 248 000 confirmed cases, double the normal hospitalisations, and 1100 influenza-associated deaths. The new strain A(H3) was especially severe for the elderly, with nine out of ten deaths occurring in the over 65 year group. Two ‘super’ vaccines are now available for free to Australians over 65 years of age. These enhanced vaccines have been developed to improve the immunity offered by the vaccine. These vaccines have been available in other countries for many years, but are being introduced in Australia for the first time this year. The influenza viruses circulating change regularly and rapidly. The vaccine helps our immune system catch up with these changes. The current data suggests both influenza A and B strains are circulating at similar levels, including cases of Influenza A (H3N2).  Last year’s seasons in Australia and the United States were dominated by A/H3N2 strains, while B/Yamagata viruses predominated in Asia and a mix occurred in Europe. The A(H3N2) strain cause more severe epidemics affecting the entire population and the A(H1N1) tend to cause disease in children and young adults. The effectiveness of the seasonal vaccine varies from 40 to 70%, but last year provided only 33% overall and was not effective against A(H3N2) Despite the lack of full protection, and the possibility of getting the flu despite a vaccination, the seasonal influenza vaccine is the best way to protect against influenza viruses.  It is free for at-risk groups when supplies are available and otherwise available from GPs and some pharmacies immediately. Data suggests 56% of Australians don’t intend to get the ‘flu’ shot. Higher vaccination rates contribute to a healthy community. The strains contained in the 2018 routine vaccine : : A(H1N1) : A(H3N2) : B:a B/Phuket : B:a B/Brisbane You cannot get flu from the vaccination, but it is possible to have 1-2 days with muscle aches, headaches and occasionally mild fevers as a side-effect to the vaccination. AusVaxSafety is a national program to monitor the type and rate if reactions to each year’s new influenza vaccine in young children. In the 2017 flu season there were no vaccine-attributable serious events recorded. 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 Launches Connect + Evolve Software Roadshow

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For the first time in Best Practice Software’s history, the Product management team and Bp specialists will be travelling to Brisbane, Sydney and Melbourne to showcase their brand-new software innovation roadshow” Best Practice Connect and Evolve.

To entice Bp users, Best Practice will be offering all successful Practices 1,000 SMS credits, a Bp Sports Bag and most importantly, the chance to help shape the future of Best Practice Software.

Chief Operating Officer Mr Craig Hodges says he is excited for the roadshow to commence in the coming weeks.

Connect + Evolve (C+E) will feature an exciting design-led user think tank and software innovation roadshow, where our product experts will be engaging face-to-face with real users of Bp software products to gauge their thoughts, opinions, feedback (good and bad), and ideas for our products in their life. It is a fantastic opportunity for users to help guide the future direction of our software products,

We’ve publicly invited healthcare industry experts knowledgeable in using Best Practice products – including Practice Managers, General Practitioners, Nurses, Specialists and Allied Health professionals. Though we’ve launched the roadshow event in Australia, it’s our hope that we’ll embed C+E into our product design and development culture, and of course take the concept to our New Zealand market in the future. Mr Hodges said.

Bp advises users to secure their spot early in this fantastic opportunity to influence Bp’s product direction and software functionality enhancements into the future, as registrations are limited to 50 attendees per city.

Click here to register your interest today or for further information please phone the team on 1300 40 1111.

Roadshow dates: Brisbane: Tuesday, 1st May | Sydney: Thursday, 3rd May | Melbourne: Friday, 11th May

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View from a Doctor’s Desk – Dr Lisa Surman

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Coffee and Cancer? Keep Drinking Your Daily Coffee but Not Too Hot

A Californian judge has ruled that coffee companies must put a cancer warning on coffee products because acrylamide, chemical produced in the roasting process is a carcinogen under California law. Companies, including Starbucks, failed to show that the risk posed by acrylamide in coffee was insignificant. (Of interest, no warning is required on calorie-dense, nutrient poor fast foods and drinks which are linked to obesity. Obesity has convincing evidence linked to increased risk of cancer of the oesophagus, pancreas, bowel, breast, endometrium and kidney and probable evidence of links to gall bladder cancer and many metabolic and cardiovascular consequences).

No new study or evidence has been published or produced regarding the cancer risk of coffee.

Acrylamide is formed when certain foods, particularly plant-based foods that are rich in carbohydrates and low in protein, are cooked at high temperatures such as frying, roasting or baking, the major foods contributing to exposure are potato chips and crisps, cereal-based products such as biscuits and pastries and coffee.

Food Standards Australia does advise that we reduce our exposure to acrylamide. There is no direct evidence that it causes cancer in humans, but evidence that it can cause cancer in Laboratory animals. International food regulators are working to reduce acrylamide levels with new farming and processing techniques such as lower cooking temperatures, enzymes to reduce formation and raw materials with lower reducing sugar levels. Reducing acrylamide in some products such as coffee is difficult without changing the taste. The amount of acrylamide varies dramatically in the same foods depending on several factors including cooking temperature and time. This is the reason the Joint WHO Committee on Food Additives (JECFA) experts do not issue recommendations on how much of any specific food containing the substance is safe to consume. For further information on strategies to reduce exposure see foodstandards.gov.au or who.int food safety/acrylamide.

The International Agency for Research on Cancer (IARC) announced in 2016 that there is no conclusive evidence to show coffee increases cancer risk (reversing a 1991 conclusion when the carcinogenicity of coffee was first tested, classifying the drink then as being possibly carcinogenic to humans) after reviewing over 1000 human and animal studies. Concluding that it is unlikely that coffee has any substantial effect on the risk of developing cancers of the pancreas, bladder, prostate or breast and suggesting a protective effect against the development of liver and endometrial cancers.

Drinking coffee (moderate amounts have been defined as drinking three to four cups per day) outside pregnancy, is more likely to benefit our health rather than harm, according to the results published in the BMJ of a study undertaken by the University of Southampton in 2017. The research involved a meta-analysis of observational and interventional studies examining the associations between coffee consumption and any health outcome in any adult population in all countries and all settings. Drinking coffee beyond the amounts given was not associated with harm, but the benefits were less pronounced.

Coffee is one of the most consumed beverages worldwide. Roasted coffee is a complex mix of over 1000 bioactive compounds, some with potential antioxidant, anti-inflammatory, anti-fibrinolytic or anticancer effects, The key active ingredients include caffeine, chlorogenic acids, the diterpenes, cafestol and kahweol. The existing research has involved the associations between coffee as an exposure and a range of outcomes including all-cause mortality, cancer and diseases of the metabolic, cardiovascular, neurologic, musculoskeletal, gastrointestinal and liver systems and pregnancy.

Consumption of coffee was associated with a lower risk of specific cancers including prostate, endometrial, melanoma, non-melanoma skin cancer and liver cancer.

Coffee consumption also had beneficial associations with metabolic conditions such as type 2 diabetes, gout, gallstones, metabolic syndrome, hepatic fibrosis and cirrhosis and chronic liver disease. There also appeared to be a beneficial association between coffee consumption and Parkinson’s disease, depression and Alzheimer’s disease.

Overall, there was no consistent evidence of harmful associations between coffee drinking and health outcomes except in pregnancy, where high caffeine intake was associated with low birth weight, preterm birth and pregnancy loss. Pregnancy recommendations are to limit caffeine intake to under 200 mg per day (one mug of filter coffee is 140mg, one mug of instant coffee 100mg, one mug of tea provides 75mg, one can of cola 40mg) . There was also a small increase in risk of fracture in women, but there was some discrepancy in the evidence suggesting further research is needed.

Decaffeinated coffee is compositionally similar to caffeinated coffee. The review found consuming decaffeinated coffee provided the cardiovascular, reduction in risk of type 2 diabetes, reduced lung cancer risk and endometrial cancer. There were no harmful associations between decaffeinated coffee and any health outcome.

There is evidence that cancer can be initiated by constant irritation of body surfaces (like skin and the lining of the mouth and oesophagus) Extremely hot water can provide this irritation (drinking beverages above 65 degrees). A recent evidence review by IARC concluded that drinking hot beverages above 65 degrees C probably causes oesophageal cancer in humans, but the relative contribution on oesophageal cancer rates requires further research.

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.

BMJ article BMJ 2017:359:j5024.

cancerwa.asn.au re cancer myth:coffee,tea,hot beverages and cancer,

 

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

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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.

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When Should I get my Flu Vaccination? View from Dr Surman’s Desk

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Flu Shot

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.

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How Do I Avoid a Listeria Infection?

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Bacteria

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.

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Battling Endometriosis

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endometriosis

Endometriosis is a disorder that can cause significant distress, both physically and mentally, in women and is often misunderstood.

Lena Dunham has written a very personal account of her decision to have a hysterectomy at 31 after years of suffering with endometriosis in the recent issue of Vogue (In Her Own Words). She describes battling the disorder for ten years and undergoing nine surgical procedures and how she chose the surgery despite knowing that the surgery does not guarantee that the pain will cease, and is not a cure.

Endometriosis is estimated to affect 176 million women and their families worldwide. It is not related to lifestyle choices and affects physical, mental and social wellbeing, often affecting a woman’s ability to complete education, maintain a career, interferes with relationships, social activities and can affect fertility. Between 1% and 10% of Australian women have the condition.

A general lack of awareness by both women and health care professionals, perhaps due to “normalisation” of symptoms, results in significant delay between experiencing symptoms, diagnosis and treatment (the average is seven years).

Endometriosis is condition where tissue similar to the lining of the womb (endometrium) grows outside the womb, the hormones that usually trigger a period cause bleeding at the sites of endometrial-like tissue and causes pain. The cause of endometriosis is currently unknown, with several theories such as retrograde flow of endometrial tissue out of the womb through the fallopian tubes implanting in the pelvic cavity, genetic predisposition and other gynaecological factors and environmental exposures (such as dioxin and PCBs) all being investigated as contributing. Although endometriosis is associated with inflammation and immunological dysfunction, it has not been proven itself to be an autoimmune disorder. Some studies have linked the presence of endometriosis to the development of ovarian cancer, but the association is not definitive and the absolute risk for a woman with endometriosis is very low. The complicated nature of pain pathways is also involved, explaining why some women have advanced endometriosis with few symptoms and others very little endometriosis and severe symptoms. It is possible to have surgical treatment for endometriosis and ongoing significant pain due to the pathways mis-firing and not progression of the disease. The symptoms of endometriosis include painful periods, painful ovulation, pain during and after sex, fatigue and infertility. Diagnosis can only be made by laparoscopic (keyhole) surgery.

The International Organisation, endomeriosis.org has posted a very useful list of myths and misconceptions:

  1. Endometriosis is difficult to understand. There are many associated myths, taboos, hit-and-miss treatments, lack of awareness, a wide variety of symptoms contributing to a frustrating, painful chronic condition. Health professionals often have poor understanding of the disease and the media present varying understanding of the disease and outcomes, so women receive confusing information
  2. Severe period pain is not normal. If period pain interferes with daily life, such as going to school, work or day-to-day activities it is not normal
  3. No-one is too young to have it, and it is possible to have symptoms after menopause, particularly due to scarring and inflammation effects of the disease
  4. Hormonal treatments do not cure endometriosis. Hormonal treatments temporarily suppress the symptoms while the drugs are being taken. Surgery by an experienced gynaecologist is the only effective medical treatment
  5. Pregnancy does not cure endometriosis. Like hormonal drugs, pregnancy temporarily suppresses the symptoms, but does not eradicate the disease itself.
  6. Endometriosis does not equal infertility. Most women with endometriosis go on to have children. In general, it is believed that the likelihood of fertility problems increases with the severity of the disease and age. There are no statistics available to give a reliable indication of an individual woman’s fertility.
  7. Infertility is not just caused by endometriosis on the tubes, pelvic inflammatory disease damages and blocks fallopian tubes. Tubal endometriosis is much less common and does not always cause infertility. The mechanism by which endometriosis causes infertility remains largely unknown
  8. Hysterectomy does not cure endometriosis
  9. It is a physical, not an emotional disorder. Women with endometriosis may struggle with emotional distress associated and, as a result of, unrelenting pain and infertility
  10. Abortion does not cause endometriosis
  11. Douching does not cause endometriosis

There is no best treatment for endometriosis. Treatments will work differently for individual women. It is important to be aware of the different kinds of treatments and their possible effects, side-effects or complications. Usually a combination of treatments can be used to relieve symptoms.

There are now national support organisations worldwide. The Pelvic Pain Foundation of Australia (pelvicpain.org) website has links to the Australian Coalition for Endometriosis, the peak consumer and advocacy body representing the needs of girls and women with endometriosis in Australia. There is also a pelvic pain booklet , advice regarding pelvic muscle relaxation, and links to subscribe to the regular newsletter. Endometriosis Australia has a helpful website (endometriosisaustralia.org) containing a medical Webinar series as an educational reference and possibly has more detailed information regarding the nature of the treatment options.

To read the Lena Dunham article, see https://www.vogue.com/article/lena-dunham-hysterectomy-vogue-march-2018-issue

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

Member of Best Practice Software’s Clinical Leadership Advisory Committee,

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Heart Disease in Women: A Timely Reminder

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Heart Disease

Valentine’s Day comes with a timely reminder for heart disease in women.

Heart disease is the leading cause of death for women, with three to four times more women dying from heart disease than breast cancer in Australia.

Women having a heart attack can have severe chest pain, but many experience more subtle symptoms such as dizziness, fatigue, nausea, burning sensations similar to heartburn, discomfort in their arms, neck and jaw, shortness of breath, sweating or nausea.

The difference in the nature of heart attack symptoms between men and women often means that women present later to Hospital and, upon arrival at Hospital, recent studies in the US, UK and Australia have demonstrated that women’s symptoms can result in missed diagnoses. Women are referred less for in-hospital treatments such as angioplasty and also are referred less and attend fewer cardiac rehabilitation programmes, with poorer outcomes as a result.

Prior to a heart attack, some diagnostic tests for heart disease indicators are less accurate in women than men, women are less likely to seek help quickly for nonspecific symptoms and some health professionals are less likely to check for heart disease for so-called recent onset nonspecific symptoms.

The National Heart Foundation of Australia has developed several videos and documented personal stories to raise awareness for heart disease in women, the signs, and symptoms of heart disease at invisiblevisible.org.au

Previously each risk factor was individually measured and treated. It is now recommended that your overall risk be assessed using several measures to determine your personal risk score. Men statistically are at higher risk than women for developing heart disease in middle age, but hormonal changes after menopause and possibly increases in other lifestyle-related risk factors cause a woman’s risk of heart disease to increase over time to probably equal men. There is no single cause of coronary heart disease. Several risk factors cannot be changed, including family history, racial factors and increasing age. The good news is that others can be managed.

Heart disease risk factors that you can change include:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Physical Inactivity
  • Overweight
  • Depression, social isolation and poor social support

It is important for women, particularly at menopausal age, to have their individual risk markers assessed and their overall heart disease risk calculated. Your GP is in an ideal position to arrange the measures, review the risk factors and assist with changes that are recommended to reduce overall scores.

The website heartresearch.com.au provides overviews regarding many factors linked to heart disease and more details about definitions and diagnoses

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

Member of Best Practice Software’s Clinical Leadership Advisory Committee

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