Urgent COVID-19 update (evening of 22/03/2020)

regarding 'Shutdown' arrangements and Medical Practices

A letter to AMA members from NSW Branch President, Dr Kean-Seng Lim:

Dear Dr Ison

AMA (NSW) is welcoming the increased physical distancing measures introduced by the National Cabinet managing the COVID-19 crisis that take effect from midday tomorrow.

We wrote to the Premier on Friday to encourage the NSW Government to consider the evidence and to determine if further measures were required.

We have confirmed that medical services are not subject to the shutdown and therefore practices are able to continue to operate.

In addition, while we congratulate the Government for enabling greater access to Telehealth Services for some patients and some providers, we believe there is a need to broaden this to allow doctors to provide their usual care in a safer manner for both providers and patients.

It has been the AMA's position, since it first started campaigning on this issue, that there be broad access to telehealth wherever clinically appropriate.

Our colleagues at Federal AMA are continuing to lobby the Government on your behalf on this issue.

Practices should still be actively implementing social distancing and other risk management arrangements.

We are aware there is potential for a further escalation of these shutdown measures and will continue to engages with the Government in this regard.

AMA (NSW) will be providing more advice for members as soon as it is available.

Contact AMA (NSW)

P: 02 9439 8822

F: 02 9438 3760

[email protected]

PO Box 121, St Leonards NS

Coronavirus Alert

Today (12.3.2020) the WHO has declared a worldwide pandemic for COVID-19.   Please be advised that, in the public health interest of containing transmission of the virus, you should henceforth (until further notice) not attend The Wellness Clinic, or enter The Hills Private Hospital, if you have any respiratory symptoms such as sore throat, runny/blocked nose, and/or cough.   

If you have respiratory symptoms and are a recently returned traveller, 

you should telephone the COVID-19 National Hotline (24/7) on 1800 020 080 for advice about where and how to get a coronavirus test.

If you have respiratory symptoms and have had contact with a confirmed coronavirus case, 

you should telephone the COVID-19 National Hotline (24/7) on 1800 020 080 for advice about where and how to get a coronavirus test.  

If you have respiratory symptoms but are not a recently returned traveller, nor have you been in contact with a confirmed coronavirus case, 

you should self-isolate at home until you recover and/or you should seek medical attention if your condition worsens. 

Coronavirus Update to GPs as of 8/3/2020 from the Chief Medical Officer, Dr Brendan Murphy


Dear Colleagues,

I am writing to update you on the COVID-19 outbreak situation in Australia and internationally, and to outline the Commonwealth’s current and future support for the central role you are playing in our national response.

Communication

There has been a significant amount of advice and information already provided to health professionals. I recognise that the evolving nature of this outbreak has required public health advice to evolve rapidly with the emerging epidemiology. This has made it more challenging for people to keep it up to date, and has led to some confusion and a perception of inconsistency of information/information gaps.

We are addressing this and will enhance communication to primary care, starting with this letter and followed up by twice-weekly newsletters to all GPs in Australia, together with regular GP webinars.

There is the very real possibility that larger scale community outbreaks will occur across Australia, placing a significant burden on the health system, in which you play an absolutely critical frontline role.

Situation as at 8 March 2020

As you will be aware, the international situation has changed materially in the last few weeks. Cases have now been reported in over 90 countries, some with sustained widespread community transmission. Despite our success in containing the initial cases associated with travellers from China, we are now seeing the expected second wave of imported cases from a number of countries (most notably Iran).

We have evidence of limited community transmission in Sydney. New imported cases are being seen every day, some from countries not previously identified as high risk. It is no longer realistic that we will be able to prevent further importation of cases, and further local outbreaks seeded from imported cases are likely.

Disease characteristics

Before I outline to you what we are doing to improve our support of the primary care response to COVID-19, I will share with you our current state of knowledge about COVID-19.

It is clear that a great majority of people with COVID-19 infection (>80%) have mild disease, not requiring any specific health intervention. This mild disease contributes to the high transmissibility of the virus, as many people with infection will continue working and interacting with the community because their symptoms are so mild.

There is very little evidence of significant COVID-19 disease in children. Initially, it was suggested that children were less susceptible to infection, but more recent evidence supports the fact that children may be infected, in many cases without being aware of symptoms. The role children play in transmission is unknown.

The greatest concern remains the relatively small number of cases with severe pulmonary disease, some with a fatal outcome. We still don’t have certainty about the case fatality rate (CFR) for COVID-19, as the estimates from some countries appear to be over-estimated by under ascertainment of mild cases. It seems reasonable to assume a CFR of around 1% in a country like Australia with a strong health system – it may even be lower. We do know that the majority of fatal outcomes have been seen in the elderly, or people with comorbidities.

Current approach to response

At present our response, under the Australian Health Sector Emergency Response Plan for COVID-19, is focused on early identification of cases, isolation, contact tracing and quarantine where indicated – under the supervision and direction of the public health unit in each state or territory.

If more widespread community transmission occurs, the focus will shift to early detection and home isolation of cases to prevent or delay transmission, with less emphasis on identifying contacts who are generally unlikely to be very infectious, unless they themselves also develop symptoms.

We will let you know if and when such a shift in the public health response is indicated. Even in a large-scale outbreak, isolation of as many cases as possible can play a critical role in flattening the epidemic curve.

Testing

Testing for COVID-19 infection is currently focused on those people with respiratory symptoms who have a relevant travel history or who have been in contact with cases. Testing has largely been done so far by public health laboratories, but I am pleased to advise that we are working on further expanding access under Medicare to private pathology laboratories for the SARS CoV2 virus (COVID-19 virus). It is important at this time that all positive results are immediately reported to the state/territory public health unit, whose contacts are provided at the end of this letter.

Reducing exposure in health care settings

It is clear that, with increasing cases of COVID-19, there will be benefit in more sophisticated strategies to prevent the co-mingling of suspect or proven cases with other patients in healthcare settings. We have previously advised members of the community that, if they believe that they could potentially have or be exposed to COVID-19, they should phone their GP or local health service and seek advice before attending. If followed, this practice has allowed the practice or hospital to make arrangements for isolation and testing.

As case numbers increase, there is a need for new strategies. We will shortly be announcing to the community an expansion of the COVID-19 national hotline (1800 020 080). This hotline will operate 24 hours a day, seven days a week. Expansion of the national hotline is part of our strategy to support general practices manage the flow of cases.

People who believe that they may have been exposed to or have COVID-19 will be encouraged to call the national hotline to seek advice. A standard protocol for the call centre operators will be provided. We will share call centre information and the triage protocol with you shortly, as many GP practices have asked to have the same protocol available for their reception staff to ensure consistent messaging and patient disposition.

Respiratory clinics

We are also actively developing across the nation a series of COVID-19 respiratory clinics, dedicated to the assessment of suspected cases and early treatment of patients with mild symptoms. Some of these are being established by state and territory health services and we are looking at complementing these with a limited number of primary care respiratory clinics at volunteer general practices who have the appropriate infrastructure and capability. Additional infection control training and support will be provided.

The Primary Health Networks (PHNs), in collaboration with the GP colleges and other stakeholders, will be rapidly seeking interest from practices who might wish to be involved. A time-limited separate funding model will be developed, cognisant of the nature and costs of this specialised practice, and appropriate personal protective equipment (PPE) will be provided to these clinics. Rural and regional areas will need special consideration and arrangements.

Some patients will continue to contact their usual general practice and want assessment and advice from that trusted source. It will clearly be helpful for clinic reception staff to have the standard triage protocol available. Practices may choose (as per the triage protocol) to refer patients to the dedicated clinics or health services, to undertake a remote telemedicine consultation (see below) or to make safe arrangements to see the patient at the clinic or in their place of residence.

Government is currently considering the time-limited expansion of telemedicine MBS items to enable remote consultation of patients with suspected COVID-19 and at-risk patients who will not want to be exposed to COVID-19 by attending the clinic. More details on these proposed telemedicine items will be announced very soon.

PPE

Some GPs have expressed concern about the availability of PPE, in particular surgical masks, which are the appropriate PPE for use with most patients with respiratory symptoms. A further 260,000 masks from the national medical stockpile were announced this weekend on top of the 750,000 already distributed to PHNs and we will work closely with PHNs to ensure appropriate supply arrangements.

We appreciate that it can be frustrating if only small numbers of masks are distributed at any one time. Masks are in very short supply worldwide and we need to conserve them at this time until our emergency procurement plan delivers a significantly enhanced stockpile in coming weeks. We recognise the need to supply GPs who are assessing potential COVID-19 patients and are focusing our efforts there.

There has been a change to messages about what PPE is required in the clinical assessment of potential COVID-19 cases. All of the evidence currently suggests that droplet spread is the main mode of transmission and that surgical masks are effective for routine care and non-aerosolising procedures (and much easier to appropriately fit than are P2 masks). Only where there is uncontrolled coughing are P2/n95 masks needed, and general practices will generally divert such patients to hospitals at this time. For your reference, the current PPE guidelines endorsed by the expert COVID19 infection control committee are available on the Department of Health website.

Vulnerable groups

In the meeting with primary care stakeholders last week, a commitment was made on a range of initiatives, many outlined above. We are very aware that additional work is needed in the residential aged care sector and for vulnerable groups, including Aboriginal and Torres Strait Islander peoples. These have been the subject of separate planning workshops and will have their own strategies, which will be shared with you, acknowledging the roles of GPs in these areas.

Community campaign

We will also be undertaking a broad community education campaign on COVID-19. One of the important messages will be the value of standard hygiene messages (hand washing, cough etiquette, social distancing) in preventing transmission. I am sure that you will play a role in communicating that message to your patients along with general balanced information about this virus.

Please be on the lookout for our regular twice-weekly communiques where we will be providing information about respiratory clinics, pathology testing, PPE, temporary MBS telemedicine items and the like. You will also be given details of the planned weekly webinars on COVID-19 that we will be conducting.

No-one can accurately predict how the COVID-19 outbreak will develop in Australia. Our collective response has to be flexible and collaborative.

The Australian Government has committed to providing the necessary resources to support the response in whatever form it needs to take. The critical role of primary care in this response is well understood and greatly appreciated.

Finally, can I apologise for this very long letter. We doctors hate reading long correspondence but there is a lot of information to convey. We will endeavour to keep our twice-weekly newsletters on COVID-19 to one page.

Contact details for state and territory public health units

ACT – 02 5124 9213 (or 02 9962 4155 after hours)

SA – 1300 232 272

NSW – 1300 066 055

Tas – 1800 671 738

NT – 08 8922 8044

Vic – 1300 651 160

Qld – 13HEALTH (13 43 25 84)

WA – 08 9328 0553 

News

view:  full / summary

Very low carb diets - good or bad?

Posted on December 6, 2019 at 5:20 PM

According to a leading Australian food and nutrition scientist, very low carbohydrate diets should be avoided because there is convincing evidence for a detrimental effect on health.

Citing results from a large meta-analysis published in European Heart, Dr Emma Beckett says the data show that people who consume a low carbohydrate diet and reduce their intake of fibre are at greater risk of premature death. They are also at increased risk for individual causes of death including coronary heart disease, stroke and cancer. The study sheds new light on the dangers of long-term low carbohydrate diets, says Dr Beckett, a molecular nutritionist at the University of Newcastle. Specifically, it found that the overall risk of death from any cause was 15% higher in people who consumed the least amount of carbohydrates, the risk of cardiovascular death was 13% higher and that of dying of cancer was 8% higher. The reduced intake of fibre and fruits and increased intake of animal protein and saturated fat with these diets may play a role, according to the study. Similar results from a series of systematic reviews and meta-analyses reported in The Lancet suggest a 15-30% decrease in all-cause and cardiovascular related mortality when comparing people who eat the highest amount of fibre to those who eat the least. Eating fibre-rich foods also reduced incidence of coronary heart disease, stroke, type 2 diabetes and colorectal cancer by 16-24%. Dr Beckett says the evidence is already reflected in the latest Australian dietary guidelines but “the real problem is that most people don’t follow them”. “The guidelines are already specifically worded for recommending high quality carbohydrate sources from grain cereals – mostly wholegrains – along with fruit, pulses and vegetables, and reducing low-quality carbohydrates from discretionary foods,” she says. “The biggest problem is that we are not doing well at communicating this. About 50% percent of our energy needs should come from high-quality carbohydrates, 30% from fats and 20% from protein but most Australians think they need to eat more protein.” While the evidence shows that a low-carb diet can aid in weight loss, Dr Beckett warns of the “short term win of losing weight with the long-term consequences of missing out on important nutrients”. She says there is strong evidence that grain fibre in particular has a profound effect on health due to its effects on gut microbiota. A recent systematic review of 42 studies found 39 demonstrated an increase in microbiota diversity and abundance following consumption of wheat and other grain fibres as prebiotics. Potential health benefits include improved immunity and gut function, reduced inflammation, reduced risk of obesity and type 2 diabetes and potential protection from bowel cancer. There is also evidence of improved cognition and mood, according to the study. “If we are going to recommend people change their carb intake, we have to talk to them about the importance of fibre in foods because there is no evidence for fibre supplements,” Dr Beckett says. “Just your normal fruits and veg and your standard high fibre breakfast cereals and wholegrain bread are fine. You don’t need to eat mangosteen and quinoa to be healthy.”

AusDoc 22nd October 2019

There's an App for That

Posted on December 6, 2019 at 3:10 PM

Natural Cycles is the first app of its kind to be FDA-approved in the United States. The "fertility awareness" app charts a woman's fertility so she can better predict on which days she is most fertile. The app requires women to track their menstrual cycles and enter their body temperature into the app every morning upon waking.  On the basis of a study involving 22,785 women using the Natural Cycles app, the rate of pregnancies from cycles where the application erroneously flagged a fertile day as infertile was 0.5 per 100 woman-years. So for the purpose of avoiding pregnancy, overall the app showed 93% efficacy with "typical use" and 99% with "perfect use" (never having unprotected sex on fertile days). That's actually better than comparable rates for the oral contraceptive pill, which is around 91% effective.

News, Aug 10, 2018

Clinical Hypnotherapy

Posted on October 8, 2019 at 8:00 PM

There has been a growing number of patients presenting for consideration for clinical hypnotherapy so I thought it might be a good idea to oultine here a little information.   Typically these self-presenting or referred patients are wanting to overcome one or more specific challenges in their lives and are curious about how one's own mind power can be utlised to achieve their goal(s).   They may have tried other treatments with limited success or experienced treatment side effects.   They may come to me with some reservations but mostly they come with an open mind to explore their options.   Very few people these days would be so sceptical as to deny the mind-body connection.

The first thing to make clear is that hypnotisability is not a stigma of weak will or low intelligence.   Rather it is a sign of an alert, active and creative mind.   The more cooperative and imaginative you are, the better you will submit to hypnosis and the more profound the results.   Almost everyone (over 80 percent of people) can be hypnotised to some degree with 10 percent of people in the high range of hypnotisability and 10 percent in the low range.   Suggestibility testing can be done to determine where you align in this spectrum of responsiveness.

Going under hypnosis is a ‘willing’ art of achieving tremendous inner awareness, selective thinking and sensory dissociation. The best way to do this is not to do anything. Just relax your mind and body in stillness and listen to my voice guiding you.   

Please wear comfortable clothing to your hypnotherapy session. You will be reclining in an easy chair in a darkened room for approximately 30 minutes.   I am with you at all times.

To do the therapeutic work I use my voice to direct your body and mind into hypnotic trance.   Hypnotic trance is an altered state of consciousness which is natural and normal and in fact experienced by everyone everyday e.g. we are actually in a hypnotic trance when we are mentally engrossed in an activity such as watching a movie or reading a good book; e.g. when we daydream; e.g. when we "tune out" or "zone out" or when  we experience "time flies".  

When you are in hypnotic trance:

1. You are fully aware of your surroundings.

2. You are in control of your faculties.

3. You are not unconscious or asleep.

4. You don’t divulge any secrets, unless agreed to beforehand for purposes of hypno-analysis.

5. Your past is not probed, unless agreed to beforehand for purposes of hypno-analysis.

6. Your will not accept any suggestions contrary to your moral and ethical codes.

7. You are not made to do anything silly or unacceptable.

8. You are in a very comfortable state of tranquillity of mind and relaxation of body, accepting the suggestions that are beneficial to you, allowing them to sink into your subconscious mind.

9. If you consider your subconscious mind as a computer, in hypnosis it is ‘clear’ and ready to accept new and beneficial programming.

10. The programming can be done by you (as in self-hypnosis) or by the therapist with your consent.

Good to know things about after your hypnosis session:

Some people get the full benefit of hypnosis in the first few minutes of therapy while others require several sessions before they reap the benefits.

Even after the first session, you will find that the suggestions (both direct and in-direct) given under hypnosis will be unobtrusively influencing your feelings, thoughts and behaviours in a beneficial way.

You can expect to be pleasantly surprised by gentle positive changes. My suggestion is don’t challenge or rationalise, rather enjoy it and ‘go with the flow’.

I recommend to most patients that they have a trial of six sessions of half hour therapy, booked once a fortnight.   After this you should have a medical review appointment scheduled to discuss your progress and decide where to from here.

Please keep in mind if the therapeutic results are not as predicted, it suggests your subconscious mind is not ready to accept suggestions. This could be due to emotional ‘blocks’ or scars from the past, both of which may need to be explored and analysed in counselling therapy.

written by Dr Ison


Next available appointments are January 2020

Posted on October 8, 2019 at 7:40 PM

All appointments for the remainder of 2019 are now fully booked and we invite all our existing patients and newly enquiring patients to make appointments now for the New Year.   Just a reminder that one hour appointments are required for new patients having their Initial Health Assessment and for existing patients having their Annual Health Assssment.   The Wellness Clinic will be closed for Christmas after Friday 20th December 2019 (last working day) and will re-open in the New Year on Monday 13th January 2020.   Thank you.

Dr Ison on annual leave

Posted on July 14, 2019 at 8:10 PM

Dr Ison will be away overseas from July 16 - July 31, 2019.   She will be back to work on Thursday 1st August 2019.  The month of August is now fully booked.  Appointments are available from September.  For any acute care medical needs, please attend your local GP Medical Centre or Emergency Department.  Thank you. 

Welcome back in 2019!

Posted on January 20, 2019 at 6:30 PM

"Business as usual" commenced last week on Monday 14th January 2019.   Dr Ison's sessional hours are the same as in 2018 (Remember she doesn't work "Ws", that is not on Wednesdays or weekends).  Tanya is secretary on Mondays, Tuesdays and Thursdays and Kerri is secretary on Wednesdays and Fridays.  We hope all our patients enjoyed a lovely relaxing Christmas holiday break with their families and friends.   We look forward to attending with excellence to all your preventive health care needs this new year and beyond.

Festive season holiday closure

Posted on December 4, 2018 at 6:10 AM

Please be advised that Dr Ison will soon be on holiday leave from 12th December, 2018 for one month.   Secretarial staff will remain on duty, for administration only, until close of business on 22nd December, 2018.   The Wellness Clinic will then be closed, as is customary, for Christmas and New Year holidays.  We hope you enjoy a happy and peaceful Christmas holiday break in the company of family and friends!   The Wellness Clinic will resume business as usual on Monday 14th January, 2019.  Should you require medical attention whilst Dr Ison is away on leave, please attend either your local medical centre or hospital emergency department.

Genetic predisposition testing now available for the following health conditions :

Posted on July 31, 2018 at 8:50 PM

Age-related Macular Degeneration

Alzheimer’s Disease

Atrial fibrillation

Bipolar Disorder

Breast Cancer

Bowel Cancer

Coeliac Disease

Chronic Kidney Disease

Coronary Heart Disease

Crohn’s Disease

Diabetes Mellitus Type 1

Diabetes Mellitus Type 2

Gallstones

Gout

Lung Cancer

Melanoma

Multiple Sclerosis

Obesity

Oesophageal Cancer (ESCC)

Parkinson’s Disease

Primary Biliary Cirrhosis

Prostate Cancer

Psoriasis

Restless Legs Syndrome

Rheumatoid Arthritis

Scleroderma (Limited Cutaneous Type)

Stomach Cancer (Gastric Cardia Adenocarcinoma)

Systemic Lupus Erythematosus

Venous Thromboembolism.

Ref: Viamedex Genetic and Drug Testing Laboratory; www.geneticaustralia.com

53 available tests for gene carrier status

Posted on July 31, 2018 at 8:50 PM

ARSACS

Agenesis of the Corpus Callosum with Peripheral Neuropathy (ACCPN)

Alpha-1 Antitrypsin Deficiency

Autosomal Recessive Polycystic Kidney Disease

BRCA Cancer Mutations (Selected)

Beta Thalassemia

Bloom's Syndrome

Canavan Disease

Congenital Disorder of Glycosylation Type 1a (PMM2-CDG)

Connexin 26-Related Sensorineural Hearing Loss

Cystic Fibrosis

D-Bifunctional Protein Deficiency

DPD Deficiency

Dihydrolipoamide Dehydrogenase Deficiency

Factor XI Deficiency

Familial Dysautonomia

Familial Hypercholesterolemia Type B

Familial Hyperinsulinism (ABCC8-related)

Familial Mediterranean Fever

Fanconi Anemia (FANCC-related)

G6PD Deficiency

GRACILE Syndrome

Gaucher Disease

Glycogen Storage Disease Type 1a

Glycogen Storage Disease Type 1b

Haemochromatosis (HFE related)

Hereditary Fructose Intolerance

Hypertrophic Cardiomyopathy (MYBPC3 25bp-deletion)

LAMB3-related Junctional Epidermolysis Bullosa

Leigh Syndrome, French Canadian Type (LSFC)

Limb-girdle Muscular Dystrophy

Maple Syrup Urine Disease Type 1B

Medium-Chain Acyl-CoA Dehydrogenase (MCAD)

Mucolipidosis IV

Neuronal Ceroid Lipofuscinosis (CLN5- related)

Neuronal Ceroid Lipofuscinosis (PPT1-related)

Niemann-Pick Disease Type A

Nijmegen Breakage Syndrome

Pendred Syndrome

Phenylketonuria

Primary Hyperoxaluria Type 2 (PH2)

Rhizomelic Chondrodysplasia Punctata Type 1 (RCDP1)

Salla Disease

Sickle Cell Anemia & Malaria Resistance

Sjögren-Larsson Syndrome

TTR-Related Cardiac Amyloidosis

TTR-Related Familial Amyloid Polyneuropathy

Tay-Sachs Disease

Torsion Dystonia

Tyrosinemia Type I

Usher Syndrome Type I (PCDH15-related)

Usher Syndrome Type III

Zellweger Syndrome Spectrum.

Ref: Viamedex Genetic and Drug Testing Laboratory; www.geneticaustralia.com

What your genes can tell you about your addictive potentials

Posted on July 31, 2018 at 8:45 PM

Alcoholism (alcohol cravings)

Alcoholism (alcohol dependence)

Alcoholism (withdrawal seizures)

Cannabis dependence

Cocaine dependence

Cocaine-induced paranoia

Fatty food addiction

Gambling addiction

Heroin addiction

Nicotine dependence (tobacco addiction)

Salty food addiction

Sugar addiction.

For further information go to:

Ref: Viamedex Genetic and Drug Tresting Laboratory; www.geneticaustralia.com


Rss_feed