The less famous virus(es)

There is only one virus dominating the news this year, rightly so as it devastates the world.

However there are multiple other viruses that we do have the means to take control of. The group of viruses that cause liver inflammation (hepatitis) are particularly harmful.

Last week the World Health Organisation (WHO) marked World Hepatitis Day on the 28th July.

https://www.who.int/campaigns/world-hepatitis-day/2020

The WHO have less than ten days in the calendar they use for raising awareness so they consider Hepatitis an important global condition. This year’s theme is a “Hepatitis Free Future”. The WHO report that there are 290 million people living with viral hepatitis and don’t know it.

There is a dual approach to achieving the goal of elimination by 2030. Increasing immunisation rates will prevent people from ever getting infected and testing and treatment will reduce the number of infected individuals who can spread it to others.

There are five Hepatitis viruses named A, B, C, D and E. B and C are the most common and cause the most deaths. There are effective immunisations against Hepatitis B and in the last few years highly effective treatments for Hepatitis C have been developed. Both Hepatitis B and C can be transmitted via sexual partners and blood contaminated objects such as needles or razors. However Hepatitis B is more commonly transmitted from mother to baby which makes child immunisation an important method of prevention.

In Australia an immunisation for Hepatitis B is part of the childhood schedule and the first dose is given within 24 hours of birth (as recommended by WHO) to reduce the risk of mother to baby transmission. This is the case for many other countries as well but only 42% of children globally have access to a birth dose.

Putting into context how harmful Hepatitis B and C are they cause over a million deaths each year, while COVID-19 at the start of August 2020 was just under 700,000 deaths.

Next time you see your doctor ask whether you would benefit from Hepatitis tests and immunisations for yourself and your family.

Dr Amit Patel

Salmonella Outbreak

On the 21st March 2019 news of a salmonella outbreak in the South East of Australia was made public. Eggs originating from a farm in Victoria are thought to be the source of multiple cases of illness caused by salmonella. The farm has been quarantined and eggs originating from there have been recalled.

Salmonella is a type of bacteria which has a large number of strains (sub-types). The strain causing most of the cases of current illness is Salmonella Enteriditis. If you have the illness the symptoms are similar to gastroenteritis but can be worse. The symptoms are likely to include fever, headache, diarrhoea, abdominal pain, nausea and vomiting.

The NSW Health website has a list of affected egg products and this can be found at this link:

https://www.health.nsw.gov.au/Infectious/alerts/Pages/enteritidis-eggs-2018.aspx#

If you have any eggs at home they should be checked for the brand, date and stamp. If you have eggs that match any of those in the list (see link above) they should be disposed of or returned to the place of purchase for a refund.

According to the Food Safety Information Council there are 4.1 million cases of food poisoning in Australia each year. Some of these cases could have been avoided through simple measures such as thorough cooking, good hand washing and keeping raw meat and fish separate from other food in the fridge. In the case of eggs, which are the source of the current outbreak, poached eggs, mayonnaise and aioli contain egg which isn’t fully cooked and are therefore higher risk items for causing illness.

If you are concerned you might have food poisoning caused by salmonella or any other cause you should seek medical attention from your family doctor.

Aspirin – What’s New?

Aspirin is one of the world’s most used medicines of the present time and also one of the oldest. It has been available in a manufactured form since the late 19th century and has been used in various forms for centuries before that as derivatives of the bark from willow trees.

Put simply, aspirin thins the blood and this is a major benefit for stroke and heart attack prevention which are both usually caused by blood clots by stopping these from forming. The downside of this thinning action is that it can also make a person more likely to bleed and this risk and the aforementioned benefit have to be balanced against each other. I often get asked by patients where they should be taking it, and if they are already taking it whether they should continue or stop.

There was a new analysis published in the Journal of the American Medical Association in January this year. It is not a new trial but a review of all the relevant research done already. It concludes from reviewing the data of 13 trials covering approximately 165,000 individuals that although aspirin is helpful in reducing the number of strokes and heart attacks in people who have never previously had one the increased bleeding effect outweighs the potential benefits. This only applies to people who have never had a heart attack or stroke, which is therefore termed primary prevention. Secondary prevention with aspirin advice remains the same: if you have previously had a heart attack or a stroke the risk of a further episode is high and so the benefits of taking aspirin to stay in good health outweigh the risks.

In conclusion the case for not using aspirin as a (primary) preventative measure has been strengthened by the new analysis.

Declaration & disclaimer

I have no affiliation with any makers/suppliers of aspirin. The above is not a substitute for medical advice and you should consult your family doctor to discuss your own particular health situation.

Dr Amit Patel

Weight Loss

The start of a New Year is a time for change, a time for new beginnings. These are often in the form of new year’s resolutions. There are various things people choose: quitting smoking, quitting alcohol or might involve relationships.

If you are a smoker quitting smoking is the best thing you can do for your health but I will be posting about that another time. Today’s post is about weight loss. In all the places I have worked as a family doctor weight loss advice is a common request.

Everyone knows they should cut back on calories (or kilojoules if you prefer) and also exercise more. They should be done in that order as well. If you put less energy in then there’s less calories you have to burn to maintain your weight or reduce it. If it is so well known why is it so hard? More of us are overweight or obese than ever before and most attempts result in failure.

Like with anything else, don’t give up is the first thing to say. Secondly it is important to focus on reducing “energy in” (food & drink) and increasing “energy out” (physical activity). Most diets/plans/approaches have this basic principle hidden somewhere. One of the most dramatic non surgical weight loss achievements I have seen was someone who tried Lite n’ Easy (an Australian meal planning service). This company designs meals controlled in size and calorie content, so that you don’t overeat, and delivers them so that you don’t need to prepare anything. The person who reported the success found it expensive so couldn’t continue with it.

Increasing physical activity is best done in stages, walking to the shops rather than taking the car, walking to the train station instead of being dropped off by car. Beyond changes in daily habits I’ve seen lots of people do well with youtube videos. Dr Oz has exercise videos, Joe Wicks has short workouts and so does Shaun T. There are others that might suit you better. Choose an instructor you like and stick to them. There are short videos to begin with and longer ones for when you are ready.

What about medicines and supplements? Doctors can be prescribe medicines such as duromine which helps suppress appetite or orlistat which prevents fat absorption but these can be expensive and should only be used as part of a broader weight loss plan. Shelves at pharmacies are full of supplements but these often contain caffeine and other stimulants and again can be expensive over time.

Organisations/groups like Weight Watchers or weight reduction clubs are good for providing moral support. Writing a plan and keeping a diary is helpful as well. Write what your target is, when you want to achieve it by and why. The diary could be a short daily entry recording what went well and what could be.

Sometimes there can be an underlying medical problem contributing to being overweight so it’s worth talking to a doctor or a dietitian. If your weight has been increasing for a long time and bariatric surgery might be the only option then this needs to be discussed with your doctor as well.

Trying different changes and making multiple small changes are likely to yield results more than relying on one thing alone.

Good luck if you are aiming to lose weight this year!

Dr Amit Patel

Declaration and disclaimer: I do not have any affiliation with any of the companies or individuals described above. This post is not a substitute for medical advice. You should not make any sudden drastic changes to your lifestyle without speaking to your doctor first

Alcohol and taking control

It’s the holidays, which for many people means time to relax often with a drink. Australia has lots of famous and historical associations with alcohol. Beers, wine, rum, they’re all popular Australian drinks.

However it is too easy to drink an unsafe amount.

Government health guidance describes standard drinks and how many you should have in a week. Labels on the alcoholic drinks tell you how many SDs are in the drink.

What is the right amount?

This link to the Australian Government Department of Health website states a safe amount is two standard drinks a day to avoid long term harm to health. This applies to both men and women.

http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/content/guide-adult

What do you do when you have been drinking more than this?

Life events, particular friends, easy access, lots of factors can lead to an increase in consumption and for some people it can remain high beyond the trigger event.

I’ve helped multiple people regain control of their drinking. It can be very difficult and some people are more prone to addiction than others but I have found that it is helpful to think about what you are gaining rather than what you are losing or giving up. Examples of what you might be gaining are a better quality of family life, more control of your work and usually less alcohol usually means an improved financial situation.

Where to start ?

Hello Sunday Morning

https://www.hellosundaymorning.org

Hello Sunday Morning is an online service which is growing in popularity through it’s easy to use website and Daybreak app giving people information and support to help them achieve their goals in either reducing or stopping drinking.

GP/Family Doctor

Your GP should be your first point of call in accessing local services to help you reduce or stop drinking. Some services need a referral, many don’t but it’s helpful to speak to a health professional to make a plan on how to proceed.

If you live in Sydney, East Sydney Doctors have a dedicated clinic called Clean Slate for safely stopping drinking through a home detox approach.

http://www.eastsydneydoctors.com.au/services/drug-and-alcohol-problems/category/clean-slate-clinic

AA (Alcoholics Anonymous)

This is one of the oldest and best known services for stopping drinking. There are meetings everywhere and if one group doesn’t suit you there will be another one nearby. Each one has a different vibe so it’s worth trying more than one. You can find your nearest meeting at:

https://aa.org.au/meetings/find-meetings/

Smart Recovery

Smart Recovery is a health promotion charity that has a group meeting approach and is an alternative to AA. They have groups for all forms of addictive behaviour. You can find your nearest meeting on their website:

Declaration and disclaimer: I do not have any affiliation with any of the services described above. This post is not a substitute for medical advice. You should not make any sudden drastic changes to your drinking without speaking to a healthcare professional first

Dr Amit Patel


Meningitis Immunisations

In this blog post I want to look at the meningitis B immunisation which is relatively new.

In the last month (Dec 2018) a few times I have had parents of young children asking me about whether they should pay for the Meningitis B immunisation for their children.

Just to recap, if you didn’t read my profile, I’m a full time family doctor/GP with experience working in Sydney and other locations along Australia’s East Coast.

Initially I stayed neutral and said I can prescribe it if they would like it and they have it in stock in the pharmacy next door but at A$125-A$150 dose it is their choice. There is coverage for four types of meningitis, ACWY but not B, in the Government funded National Immunisation Program (NIP).

I asked colleagues what they were doing when asked the same question. One took a proactive approach and said he recommended it on the basis that it’s extra protection and used the analogy of having insurance to describe having the extra immunisation to parents. The other colleague took the opposite approach and said the pharmaceutical company who manufactures the immunisation is just trying to scare parents into spending more money through it’s website and its TV ad campaign. The link to the official website for the recent campaign is: http://www.knowmeningococcal.com.au.

After hearing both these views I decided to adopt some of the first colleague’s approach and describe extra protection and recommend having the immunisation. To support this I have started showing them the Department of Health data on the number and types of meningitis cases if they want to see it from:

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-meningococcal-W.htm

Like all statistics they can be viewed in different ways. One view is that the overall number of cases of Meningitis B per quarter is small and spread across the country but the consequences if affected by the disease can be severe and life threatening.

The Department of Health also have an information for the public page at:

http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-meningococcal-W-info-public.htm

Obviously it would be much easier if the various levels of Government involved in the NIP decided to fund it nationally, however the last official statement was that it was under consideration. South Australia Health have decided not to wait and their publicly funded Meningitis B initiative began in July 2018.

In conclusion I would agree with what the TV campaign says, speak to a doctor who knows your family best and have a discussion about how to proceed.

Declaration and disclaimer: I have no association with any pharmaceutical companies. This blog post is not a substitute for medical advice. See your own doctor to discuss your particular situation and needs.

Dr Amit Patel

The Journey Begins

Thanks for joining me!

Today I launch my Medical News & Views blog. 

As a family doctor I have noticed increasing numbers of patients go online for information before coming to see me so I want to share some of my experience for anyone to read whether they are coming to see me or a different doctor.

Dr Amit Patel

Good company in a journey makes the way seem shorter. — Izaak Walton

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