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THE OFF ICIAL JOURNAL OF THE GOLD COAST MEDICAL ASSOCIATION INC
NOVEMBER/DECEMBER 2011
ISSUE # 079
6
Gold Coast Conference marks ‘Coming of Age’
14
Management of Pneumonia in Children Outside of Hospital
19
Financial Spotlight
36
Loooking through the Lens
Dr John Corbett shares his love of photography
Images available to download for ‘getaway’ screensavers
CONTENTS
GCMA NEWS
Advertising & Editorial
enquiries: Ingrid Meehan
Medical Editorial
Committee:
Drs Peter McLaren,
Geoff Adsett,
Margaret Kilmartin
and Philip Morris
Graphic Design:
Heather Gillard
Printing:
Beaudesert Times
The off icial journal of The Gold coasT Medical associaTion inc
NOVEMBER/DECEMBER 2011
ISSUE # 079
6
14
19
36
Gold Coast Conference marks ‘Coming of Age’
Management of Pneumonia in Children Outside of Hospital
Financial Spotlight
Loooking through the Lens
Dr John Corbett shares his love of photography
Images available to download for ‘getaway’ screensavers
November/December
2011
Cover pic: The inaugural Gold
Coast Medical & Health Sciences
Conference 2011.
On behalf of the GCMA, The
Medical Link is designed &
published by: John Campbell
Communication & Marketing
P/L. Back issues can be
accessed on the GCMA website
www.gcma.org.au/themedicallink
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DISCLAIMER: The contents of articles and opinions
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editor or the Gold Coast Medical Association.
No responsibility is accepted by the publisher,
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and services advertised or otherwise appearing in
The Medical Link are not endorsed by the publisher,
editor or the Gold Coast Medical Association.
2
the medical link
Next Clinical Meeting ............................................................................................................3
Executive Committee ............................................................................................................3
Advertise in the Medical Link Journal ....................................................................................3
Membership Benefits ...........................................................................................................3
Editorial Submissions ............................................................................................................3
VIP Syndrome ........................................................................................................................4
Obituary – Dr Max Henry Williams .........................................................................................4
Senior Active Doctors Category ............................................................................................5
September Meeting ..............................................................................................................5
NEWS
Gold Coast Conference Marks ‘Coming of Age’ ..................................................................6
Euthanasia .............................................................................................................................8
Eye Clinic Team Prepares For Another Mission .....................................................................8
At Risk of Transferring a Genetic Disease? .........................................................................11
Delusions or Illusions and the Personality Disorders ..........................................................13
Management of Pneumonia in Children Outside of Hospital ..............................................14
Gut Microbiotica and our Immune System – We are what we eat .......................................15
Glaucoma............................................................................................................................16
Financial Spotlight ...............................................................................................................19
Hereditary Haemochromatosis with Elevated Serum Ferritin Levels ...................................21
Tips For Surviving Christmas ...............................................................................................22
Call For Volunteer Dr’s For Australia’s First Beach Medical Practice ...................................24
2012 – AMR’s 25th Anniversary ...........................................................................................24
Poor Sperm DNA Decreases Pregnancy Success .............................................................26
You don’t say? Patient-Doctor Non-verbal Communication Says a Lot. ..............................28
Medical Transcription for an Efficient Practice.....................................................................30
Why Patients Seek Second Opinion after Technically Successful Cataract Procedures .....31
EDUCATION & TRAINING
Bond University ...................................................................................................................33
HOSPITAL UPDATE
Gold Coast University Hospital............................................................................................34
Pindara Private Hospital ......................................................................................................35
Allamanda Private Hospital ..................................................................................................35
HEART BEAT
Looking Through the Lens ..................................................................................................36
Robert Hitchins’ Book Review .............................................................................................37
Remember When ................................................................................................................37
Heart Beat Events ................................................................................................................38
Puzzle Corner ......................................................................................................................38
Advertisers Websites ...........................................................................................................38
Advertising of medical services in The Medical Link should
comply with the same advertising guidelines recently
released in the Medical Board of Australia Code of Conduct.
These state that advertising by medical practices should:
• Be factual and verifiable
• Only make justifiable claims regarding quality and outcomes
• Not raise unrealistic expectations
• Not offer inducements
• Not make unfair or inaccurate comparisons between
your services and those of colleagues
A NOTICE TO
MEDICAL LINK
ADVERTISERS
Medical Link advertisers should comply with these guidelines
NOVEMBER/DECEMBER 2011 - issue # 079
GCMA News
Executive Committee
PRESIDENT
Dr Peter McLaren
(07) 5532 3667
PAST PRESIDENT
Prof Philip Morris
(07) 5532 7655
GP VICE PRESIDENT
Dr Margaret Kilmartin
(07) 5575 7054
SPECIALIST VICE PRESIDENTS
Dr Stephen Weinstein
(07) 5519 8319
Prof Laurie Howes
(07) 5575 7054
SECRETARY/TREASURER
Dr Geoff Adsett
(07) 5578 6866
HONORARY MEMBER
Honorary Member
Dr Claire Cuscaden
RMO Association
(07) 5575 7054
POSTAL ADDRESS
PO Box 2163, Southport,
Queensland 4215
Attention Members
The GCMA Clinical meetings are being held
in the Rex Lounge, Radisson Resort,
Palm Meadows Drive, Carrara
followed by a seafood buffet in the hotel restaurant.
There are guest speakers delivering current topics
of interest. Be sure to look out for email and fax
communications for meeting dates
to ensure your place.
SPACES LIMITED – RSVP’s ESSENTIAL
Phone: 5575 7054 or [email protected]
There is no cost for attendance by members.
Non-members are required to join GCMA.
* CME/CPD/MOPS points available
NOVEMBER/DECEMBER 2011 - issue # 079
Advertise in
the Medical Link
journal
The Medical Link journal is the official journal of
the Gold Coast Medical Association
and is distributed every second month.
If you would like to advertise your products
or services, positions vacant, rooms for rent etc,
in the Medical Link journal,
please contact (07) 5575 7054
or [email protected]
For advertising rates or previous issues,
visit the website
www.gcma.org.au/medical-link.html
Membership Benefits
The annual membership fee for 2012 is $100 plus gst. For those
organisations with five or more doctors in-house, a special membership
category is available which represents 25 percent discount on the individual
membership rate for each doctor nominated. All those nominated within
this category will be entitled to full membership benefits including invitations
to monthly sponsored dinner meetings; priority for editorial in The Medical
Link journal; a free entry in the Membership Directory; and an invitation to
an end-of-year function to include their partners. Visit www.gcma.org.au to
download membership application/renewal form.
Editorial
Submissions
I would like to personally invite all financial members to submit
articles to our Medical Link journal. Our journal goes out
bi-monthly to all Gold Coast doctors.
Our main requirements are for it to be in your area of clinical
expertise, of general interest to our members and not a form of
‘advertorial’. Images (photos and illustrations) are encouraged. I
would especially like to see some vignettes on medical practice
as it was on the ‘Coast 20-30 years ago. We also welcome articles
on your leisure interests eg cars, travel, music, sports, books,
movies, etc. There is a journalist available to assist you with
composition, if required.
For further details, contact The Secretariat on 5575 7054 or email
[email protected].
Dr Peter McLaren, GCMA President
the medical link
3
GCMA News
VIP Syndrome
By Dr Peter McLaren
(continued from the Medical Llink Sept/Oct issue)
The main reason that people strive to get to positions
of power, prestige and fame is their personality. Traits
found in these people include narcissism, sociopathy
and a wish to be in control. Their position may also
have allowed these traits to flourish. In hospital, they
may be subject to loss of prestige, power, autonomy
and privacy.
The specific problems related to their care can include:
• History taking and physical examination may be less thorough
• There may be excessive or fewer diagnostic tests
• They may be over-treated or under-treated
• The usual confidentiality rules may be waived
• There may be too many or too few people involved in their care
• Care may be by the highest ranking clinician rather than the most
qualified
• Self-indulgent demands may result in substance abuse.
They also affect the staff and facility they attend. The clinicians treating
them may be subject to:
• The temptation to divulge information to increase their own personal
status
• Being star-struck and succumbing to the patient’s strong personality
• Sharing their decision-making too much
Obituary
Dr Max Henry Williams
6th November 1940 - 28th September 2011
By Dr David Lindsay
B
When Max became a JRMO at Sydney Hospital in 1964, after graduating from the
University of Sydney Medical School, I was a Pathology Registrar and unofficial
coach of the interhospital Rugby team.
Max became an integral part of both teams immediately, endearing himself to
doctors, lift operators, porters, nursing and all manner of personnel. He obviously
impressed the doyen of physicians and member of the Board of Censors of the Royal
Australasian College of Physicians, Dr Alan McGuinness, as, in 1967 he was chosen
from amongst his peers, to be Fellow in Gastroenterology, by ‘Mac’.
In the same year he became, by examination, a Member of the Royal Australasian
College of Physicians (MRACP).
Six years later, having worked as a Fellow in Medicine and then Neurology Registrar
at “RPA”, 1968-70, then as Clinical Research Associate, in the Department of
Neurology, University of Newcastle-upon-Tyne, England,1970-72, he was elected to
Fellowship of the RACP.
In 1973, at the invitation of one of his Sydney Hospital physician colleagues, he
returned with his young, still growing family to Goulburn, country NSW. He was to
practice there, as a (the) physician-Neurologist for the region, until moving to the
Gold Coast in 1998.
Max then based himself at the Gold Coast Hospital as a Senior Staff Specialist
Physician-Neurologist, but also practised at Pindara and Allamanda Private Hospitals;
his expert opinion on headache, in particular, was widely sought and appreciated by
both colleagues and patients, who wondered at, and secretly admired, his love of
acronyms; who can forget SUNCT? Max was ‘king of the acronym’.
His company, his joie-de-vivre, and the wisdom generated by his vast clinical and
life experience, was enjoyed by his wife Lyn, and his extended family and friends,
who also knew him as a jazz lover and afficianado, and green-fingered, avid gardener.
Max taught and mentored young graduate doctors, and more recently undergraduate
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Other staff may:
• Be tempted to divulge information and collect souvenirs
• Resent the increased workload and the lack of fairness if other
patients are disadvantaged
• Either give less than or more than normal contact
Other patients may also object to loss of staff attention, loss of privacy
or resent the V.I.P. ‘jumping the queue’.
Some of the positives for the health facility itself include free publicity
from bathing in the media spotlight and the promise of future donations.
However, some of the negative effects include:
• Increased staffing levels or workload
• Decreased staff morale
• Treating the politician or health administrator as a V.I.P. may prevent
feedback going back into the system to those best-placed to effect
change.
The community might benefit from greater awareness of the particular
disease and increased funding. Kylie’s breast lump increased breast
cancer awareness tremendously as did Delta Goodrem’s Hodgekin’s
lymphoma and Michael J Fox’s Parkinson’s disease.
More on V.I.P. patient syndrome with doctors and their relatives as
patients in the next ‘Medical Link’.
medical students, and imbuing them with the same enthusiasm and compassion he
had witnessed and developed at Sydney Hospital as Registrar for ‘Mac’, and at RPA
where his equally impressive mentor was Dr John Allsop.
All this from a boy who grew up in Sydney’s west, in Parramatta, adjacent to
Cumberland Oval, home ground of his beloved Parramatta Eels, and where
Max attended the local selective State High School (Parramatta Boys High).
Unsurprisingly he was a School Prefect, and member of the 1st 15 (Rugby –not
League) in his final year.
In 1958 he attended Sydney University, first as a Veterinary Science student but,
fortunately for the medical profession and his patients, he changed to the Medical
Degree course, having successfully completed only Year one as a ‘vet’.
His career ended here at the Gold Coast but not before he had endeared himself to
another group of patients and colleagues, and established, and became the Director
of, a Stroke Unit at the Gold Coast Hospital, the first in the region.
Soon after his death Lyn travelled alone to London to personally unveil on October
30th, at The Royal Society of Medicine, an Honour Roll upon which Max’s name has
been recorded for posterity, a fitting tribute to an excellent clinician, good friend, and
a genuinely good man.
His colleagues at the Gold Coast Hospital and Gold Coast Medical Association will
miss him a lot!
We offer our condolences to Lyn, his indefatigable wife, and their extended and
loving family of children and grandchildren.
NOVEMBER/DECEMBER 2011 - issue # 079
GCMA News
Senior Active Doctors Category
By Professor Philip Morris
Dear Colleague,
We have a concerning situation regarding older doctors who wish to
give up full time practice but who want to continue to contribute to the
profession as ‘senior active’ doctors. I have written a proposal below
that addresses this issue. I would be very grateful for your support
for this proposal, or if it is not acceptable in its current form, I would
appreciate you suggesting changes that would meet with your approval.
Medical careers, like the human life cycle, have a start, a middle phase,
and a finish. Following a prolonged gestation of training, practitioners
move on to their general practice or specialist disciplines and provide
clinical care to patients, education and training to junior colleagues, and
administrative support to hospitals and other medical organisations
over decades of hard work. At some stage the doctor starts to think
of slowing down, or contemplates full retirement. These days we know
that moving from full time practice to full retirement in one step is not
a good thing – for the practitioner’s physical health and mental health,
and not for the profession either. Government policy is to encourage
older workers and professionals to stay in the workforce longer, beyond
current retirement age if possible.
Yet, despite this encouragement for older professionals to remain active
in their field, in the medical arena we have a situation that is hostile to
this happening. The new Medical Board of Australia (MBA) has no
registration category that allows older doctors to remain registered
after giving up full time general or specialist practice. Older doctors
are forced to go straight into full retirement. They are prevented from
continuing to practice in a limited capacity as a doctor. This situation
denies senior doctors the advantages of a graduated progression
to retirement. It also means that these doctors cannot use their
accumulated medical knowledge, skills and wisdom for suitable
work such as teaching, examining, mentoring, tutoring, assisting with
tribunals, and advising government, non-government, voluntary and
private/business organisations on medical matters, as well as being a
body of registered practitioners available to assist in times of local, state
and national disasters. This denies the community a precious medical
resource that otherwise would be available.
It is time this gap was filled. A new category of medical registration –
termed ‘senior active’ – needs to be developed by the MBA.
I propose the following model for the ‘senior active’ category. The
description is based on the MBA Limited Registration – Public Interest
category (MBA Registration Transitional Plan – Medical Practitioners –
Item 17, 30.6.10).
1. Senior active registration would be a limited class of registration, but
it would have unlimited duration.
2. The doctor would remain on the register of medical practitioners.
3. The doctor could participate in activities (either remunerated or
as a volunteer) that use his or her medical knowledge, skills or
wisdom outside the care of individual patients such as teaching,
examining, mentoring, tutoring, assisting with tribunals, and
advising government, non-government, voluntary and private/
business organisations on medical matters, as well as being
available to assist in times of local, state and national disasters.
4. The registrant may, without fee or reward, refer an individual to
another medical practitioner (in fully registered medical practice) for
the purposes of providing health care. The registrant may, without
fee or reward, prescribe a therapeutic substance in extenuating
or emergency situations under the following conditions: (a) the
prescription involves the renewal of a prescription provided by
another medical practitioner (in fully registered medical practice)
within the previous period of six months and does not relate to a
drug of addiction within the meaning of the relevant Poisons act,
or (b) the prescription is provided to an individual who requires
temporary relief or first-aid pending attendance on that individual by
another medical practitioner (in fully registered medical practice),
and (c) if the registrant undertakes limited prescribing as outlined
in (a) and (b) above, the registrant must, within a 12-month period
NOVEMBER/DECEMBER 2011 - issue # 079
preceding the date on which the prescription is prescribed,
have undertaken professional education activities relating to the
prescribing of therapeutic substances.
5. Maintenance of this category of limited practice would require an
annual medical check by a general practitioner for registrants over
the age of 80 years.
A category of this nature would allow senior doctors to continue to
contribute to the profession after leaving full time general or specialist
practice. This would be good for senior doctors, the profession, and
the community.
This category allows doctors the limited capacity to refer individuals
to other medical practitioners, and a limited capacity to prescribe
therapeutic substances. It is possible that the doctor could exercise
discretion and use this limited capacity to prescribe for him or herself, or
for immediate family. This level of discretion is available to all doctors in
fully registered medical practice despite the general advice from the AMA
and medical boards that doctors should not treat themselves or their
immediate family except in emergency or extenuating circumstances.
Given the limited nature of referral and prescribing allowed in the senior
active category, and the requirement to undertake relevant professional
educational activities in prescribing, I cannot see any reason to deny this
discretion to senior active doctors. To do so would raise the question
of age discrimination.
In my view the success of the category will depend on how restrictive the
practice definition is and how much it will cost doctors to be registered in
this category. The three major costs for this category will be the medical
board registration fee, the indemnity insurance fee, and professional
education expenses. If the total of these can be kept within reason (say
well below $500pa) then the category may be an attractive place for
senior doctors to maintain their registration after leaving full registration
status in their discipline and before moving to full retirement.
Your comments would be appreciated. Prof Philip Morris can be
contacted on 5532 7655
September Meeting
Guest speaker at the GCMA September meeting was Ophthalmologist,
Dr John Kearney. His most interesting topic was ‘Decade of Success
in Eyes and Australian Foreign Policy in East Timor’.
Dr Kearney has worked extensively throughout Australia and overseas
and is committed to helping
patients in disadvantaged and
Third World Communities. As
a member of the Mercy Ships
and the Pacific Island Projects,
he has travelled extensively
performing cataract and other
surgery, giving lectures and
assisting with skills transfers.
Additionally, he has worked with Aboriginal and Torres Strait Islander
health services on the Gold Coast, in Western Australia and the
Northern Territory as part of the National Trachoma and Eye Health
Program established by Dr Fred Hollows, as well as taking part in the
Dili (East Timor) Eye Clinic with the International Red Cross and World
Health Organisation.
The meeting was proudly
sponsored by Accountants
and Business consultants,
SkinnerHamilton, a local familyowned firm that is fast becoming
a leader in accounting and
business advisory services on
the Gold Coast.
(l-r) Melissa Skinner (Skinner Hamilton), Dr John Kearney, Chantell
Badenhorst (Skinner Hamilton), Dr Peter McLaren, GCMA President and
Jason Skinner (Skinner Hamilton).
the medical link
5
Conference News
Gold Coast Conference
marks ‘coming of age’
The inaugural Gold Coast Medical & Health Sciences Conference held on October 28 – 29
marked a ‘coming of age’ of the Gold Coast in the fields of medicine and health sciences.
Conference Convenor, Prof Philip Morris, said that with two established and well-recognised
medical schools and health science facilities and the opening next year of the Parklands University
hospital, the collaboration which was established to plan and present the conference was timely.
There were four Breakout Sessions during the
two day conference
“As convenor, it was a great privilege to open this inaugural Medical and Health Sciences
conference,” said Professor Morris.
It marks another stage of our regional growth in the fields of medicine and health sciences with
high quality clinical services operating from
public and private hospitals, and from specialist
consulting rooms and general practices across
our district.
“The pace of change has been dramatic – who
would have contemplated all these things just
10 years ago?
Prof Philip Morris, Dr Stephen Weinstein and
Prof Mohamed Khadra
The conference was a collaboration between
Griffith University, Bond University, Queensland
Health Gold Coast District, and the Gold Coast
Medical Association.
Professor Morris said that the combined effort
reflected in the high quality of the scientific
program covering a range of educational,
research, clinical, and service delivery topics.
Dr Mark Courtney, Mr Chris Leskew, Dr Stephen
Markey and Dr Allan Friend
“The success of this conference will set a
template for making the Gold Coast a medical
education tourism destination into the future.
“No meeting is organised in a vacuum. Money
and effort are required.
Mrs Maja Khafaji, Dr Mohamed Khafaji and
Bruce Richards (NABhealth)
Dr Margaret Kilmartin, winner of the City Fertility
luck prize giveaway pictured with Karen Cleaver
(City Fertility)
“We thank our conference partners Bond
University, Griffith University, and Queensland
Health for their support as well as our five
major sponsors for their support – John Flynn
Prof Mohammed Khateeb, Mrs Sarah CentenoKhateeb and Mrs Helen Planting
Robbie Falconer and Narelle Morrison (Pindara)
with Dr David Lindsay
Uncle Graham Dillon delivering the Welcome to
Country address
Establishing the Future of Gold Coast Medicine & Health
The Evolving Centre of Excellence in Education, Research & Clinical services
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NOVEMBER/DECEMBER 2011 - issue # 079
Conference News
Hospital, Pindara Hospital, Allamanda Hospital,
Specialist Risk Solutions, and the Gold Coast
Convention Bureau.
We also thank BreastScreen Queensland
for their support, the many other exhibitors
over the two-day event, and, of course, the
keynote speakers, symposium and workshop
presenters and those who presented free
papers and posters.”
Dr Robert Hitchins said that the conference
compared favourably with any conference he
had attended.
Prof Peter Henderson, Dr Peter McLaren, Barista
and Mr Chris Leskew (Specialist Risk Solutions)
Dr Kavita Chandra, special guest from the Fiji
College of General Practitioners and Dr Stephen
Weinstein, Program Director
Dr Lis Weinstein, Norma Swain and Matthew Sturt
(Gold Coast Convention Bureau)
Amanda Clark (Great Ideas in Nutrition) with Suja
Pillai, Griffith Medical Student
Dr John Kearney and Prof Laurie Howes
Prof Gordon Wright and Mrs Naomi Wright
Dr Paul Bennett, Denise Cutajar and Michael
Cutajar (Medeleq)
Dr Stephen Weinstein, Martin Wiltshire (Risk Key
Business Insurance) Prof Alfred Lam, Ms Melissa Leung
“I have been attending medical conferences
for more than 30 years, all over Australia and
at many locations around the world. The
programme, the venue and the catering of this
Gold Coast conference were excellent and
the convenors and organisers deserve hearty
congratulations.
“The variety of material covered in the academic
program was impressive and the quality of
the presentations reflected well on the local
clinicians and researchers involved. The visiting
speakers were all good and their contributions
were all worthwhile but the local speakers more
than held their own. The balance between local
and visiting presenters was good.
“We can be proud of our first Gold Coast
Medical Conference with the poor attendance
by local practitioners being the only sour note.
Hopefully, the non-attenders will be inspired
to attend next time when this conference is
repeated,” he said.
Abstract submitted by Paul Laurence
Chantell Badenhorst and Jason Skinner (Skinner
Hamilton) with Simon Moore (Investec)
Abstract submitted by Caitlin Milligan
Abstract submitted by Dr Frauke Warnke
NOVEMBER/DECEMBER 2011 - issue # 079
the medical link
7
News
Euthanasia
By Dr Peter McLaren
Euthanasia means a ‘good death’ , an achievement we all hope for
when our time comes. What constitutes a good death? The choice
of time? The choice of environment? The choice of company? The
absence of things unsaid? The absence of pain and suffering? The
retention of one’s dignity?
There is a move underway to alter the laws on one type of euthanasia;
that of medically-assisted suicide. The Northern Territory was the first
province in the world to legalise voluntary euthanasia using medicallyassisted suicide. Four people took advantage of these laws, the first
being Bob Dent. He used a computer controlled suicide machine
designed by Dr Philip Nitschke, a long-time campaigner for the right
of the terminally-ill to decide the timing and manner of their own death.
They all suffered from terminal cancer. They all had good palliative care.
They were all certified by two psychiatrists as not depressed at the time.
Bob Dent was supportive of and grateful for the efforts of Dr Nitschke.
Then the Federal Parliamentarian, Kevin Andrews introduced a private
members Bill into the Australian Parliament which overturned the
Territory’s legislation. Bob Dent had made a statement at the time of his
death that was quoted in parliament: “If you don’t agree with voluntary
euthanasia then don’t use it, but don’t deny me the right to use it if and
when I want,” This is in keeping with the philosopher, John Stuart Mills’
famous ‘harm’ principle: “The only purpose for which power can be
rightfully exercised over any member of a civilised community against
their will, is to prevent harm to others. His own good, either physical or
moral, is not a sufficient warrant.”
The objections to changing the present legislation include the possibility
of abuse of the laws by those with aged and infirm relatives, the ‘thin end
of the wedge’ argument that the law will eventually include those that are
disabled, that doctors should only be involved in preserving life and the
religious stance that it destroys the principle of the sanctity of life.
The Northern Territory laws in principle and in practice did not allow
for the first two objections so maybe that legislation could be built
upon. Medical hastening of death has been shown to be already quite
common, occurring covertly and outside any legal structure. Surely
that situation is equally prone to abuse? The fourth objection; that of:
‘sanctity of life’ has problems. Firstly, some members of our community
are not religious. Also, medical advances now have the ability at times
to prolong life and prolong suffering that may be both inappropriate and
already ‘playing God’.
Ultimately, there are those who, like Dylan Thomas, ‘Rage against the
dying of the light’ whereas others feel that ‘an old man greets death the
way a young man greets sleep.’ I feel that the choice of the individual
should be part of any future legislation.
(I do welcome any who have something to add to this important
discussion to submit their own thoughts to [email protected])
PROVIDING VASECTOMIES SINCE 1993
PERFORMED IN OUR SURGERY UNDER LOCAL ANAESTHETIC
DR GREG ANDERSON
5530 2822
www.goldcoastvasectomy.com.au
Suite 5 ‘Bell Place’, Cnr Bell Place and Link Way
MUDGEERABA
Eye Clinic Team Prepares For Another Mission
A local eye doctor continues to make a difference to people’s lives
overseas.
Having performed 72 eye operations in East Timor in July, Dr John
Kearney and his team are now preparing to go to Micronesia in
January to conduct similar procedures there.
Dr Kearney, with Sister Barbara
and his team, have been going
to East Timor as part of the East
Timor Eye Program for over a
decade. Over 4,000 operations
have been performed there,
including
cataracts
and
childhood eye diseases by
different teams from Australia.
“The plan is to keep returning
and operating in East Timor until
all the necessary work is done,”
he said.
“We are training up a local
doctor in various procedures,
with the aim that by 2020, the
system will be self-sustainable.
“We also have an optometry
team in place, ensuring glasses
are provided to the population.”
Dr Kearney said the changes he had witnessed over the past
decade in East Timor had been incredible, particularly in the past
few years.
8
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Dr John Kearney and his team
“The chooks and pigs are finally out of the hospital yard and they
are growing vegetables in the hospital gardens for food,” he said.
“The homes are also being tidied up and
there’s a distinct improvement in people’s
health generally.”
Dr Kearney said Ausaid had supplied
surgical equipment while the Mudgeeraba
Lions Club had donated $22,000 for
photographic equipment that enabled
consulting to be done remotely.
In January, Dr Kearney and a team of
four will travel to Micronesia where they
will spend a week doing operations and
examinations. For more information phone
Dr John Kearney on 5532 9099.
NOVEMBER/DECEMBER 2011 - issue # 079
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the medical link
11
Dr. Steven Stylian
MB.BS.BSC. FRACP (Medical Oncology) FRACP (Clinical Haematology)
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News
Delusions or Illusions and the
Personality Disorders
By Julie Le Franc Psychoanalytic Psychotherapist and Psychologist
Personality Disorders are characterised by socially abnormal feelings
and behaviours that can create a life of instability. When the DSM-IV
describes the symptoms of the various personality disorders it refers
to the pervasive pattern of those symptoms, characteristics with well
developed roots reaching deep into the unconscious. These ingrained
qualities and patterns of behaviour describe the way that person relates
to, perceives and thinks about the world and themselves. The DSM lists
ten personality disorders, grouped into three clusters.
Cluster A :
Paranoid, Schizoid, Schizotypal
disorders)
(odd or eccentric
Cluster B :
Antisocial, Borderline, Histrionic, Narcissistic (dramatic,
emotional or erratic disorders)
Cluster C :
Avoidant, Dependent, Obsessive-compulsive (anxious or
fearful disorders) (1).
The Five Factor Model of personality are broad descriptive dimensions
of personality that are; openness, conscientiousness, extraversion
agreeableness and neuroticism.
However, as a psychotherapist, simply knowing the personality disorder
diagnosis does little to explain the nature of a person’s unique,
individual problems.
History and changing accounts: During the eighteenth century insanity
was explained by the Lockean philosophical framework of enlightened
rationality: delusions or illusions, fallacious thinking led human reasoning
into the wrong (2).
By the nineteenth century the realm of unsoundness changed to moral
insanity the term used for criminals with an absence of conscience
and with no self-control or sense of ethics (2). Dr Prichard emphasised
that people with this mental disorder displayed eccentricity of conduct,
singular and absurd habits combined with a wayward and intractable
temper, with a decay of social affection and an aversion to relatives and
friends formerly beloved (2). These individuals were considered to have
normal intellectual capabilities but their behaviour was improper and
indecent.
In the twentieth century the American Psychiatric Association constituted
the psychopath as amoral, antisocial, impulsive, an irresponsible
individual satisfying their egocentric needs without concern for
consequences and had little guilt or anxiety (1). Specifically, the
psychopath displayed superficial charm with callous-unemotional traits
(eg lack of guilt, persistent lying, callous use of others, good at
persuasion due to a trait known as an absence of empathy or cold
empathy) relatively stable across childhood and adolescence, youth
and adults with a particularly severe, aggressive and stable pattern
of antisocial behaviour (3). The terms sociopaths versus psychopath
were defined as; sociopaths were thought to act within the law and
psychopaths violated the law (4).
Julie Le Franc
Psychoanalytic Psychotherapist & Psychologist
JP (Qual), B.A. Psych., Post Grad.Dip. Psych., M.A. Psychoanalytic (Melb) MAAP, MAPS,
Post.Grad. Nutritional and Environmental Medicine (ACNEM)
For the resolution of unconscious
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• Major Depressive Dissorders • OCD • PTSD • Anxiety Disorders
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• Relationship/Marital • Chronic Pain • MVA & Workcover
What causes the illness: Genes and environment have been linked
in shaping human behaviour, and psychosocial stressors have been
shown to have profound effects of a biological nature by changing the
functioning of the brain (5).
In the decade of the brain, brain research and the genetics of brain
disorders are more apparent. In fact Brain Imaging is developing the
ability to measure correlations between brain activation, psychological
states and traits (6).
With the development of functional neuroimaging lying has been shown
to activate the anterior cingulate cortex that is typically involved in tasks
that evoke cognitive conflict, and prefrontal areas important for holding
task contexts in working memory and retrieving long-term memory.
A critical part of the limbic system is the amygdala, the amygdala is
important for the generation of emotions; moral decision-making is
emotional in nature. Psychopaths lack emotions and empathy and this
can be partly explained by a volume reduction in the amygdala and
poor amygdala functioning in the psychopath. In The British Journal
of Psychiatry, frontotemporal lobar degeneration (FTLD) was linked to
complex behavioural changes in substrates of personality. The study
involved thirty participants’ that underwent volumetric brain magnetic
resonance imaging. A VBM analysis was implemented regressing
change score for each trait against regional grey matter volume across
the FTLD group. The quantitative measures of personality change
in FTLD were correlated with changes in regional grey matter. It was
established that the neuroanatomical profiles for personality traits
overlap brain circuits previously implicated in aspects of social cognition
and suggest that dysfunction at the level of distributed cortical networks
underpins personality change in FTLD (6).
References:
(1) American Psychiatric Association. (1995). Diagnostic and statistical
manual of mental disorders (4th ed.). Washington, DC: American Psychiatric
Association, 1995
(2) Prichard, J.C. (1996). Concept of moral insanity: A medical theory of the
corruption of human nature. Medical History, 40: 311-343.
(3) Frick, P.J., & White, S.F. (2008). Research Review: The importance of
callous-unemotional traits for developmental models of aggressive and
antisocial behaviour. Journal of Child Psychology and Psychiatry, 49; Issue
4, 356-375.
(4) Pickersgill, M. (2010). From psyche to soma? Changing accounts of
antisocial personality disorders in the American Journal of Psychiatry. History
of Psychiatry, 21 (3) 294 – 311.
(5) Gabbard, G.O. (2005). Mind, brain and personality disorders. Am J
Psychiatry 162: 648 – 655.
(6) Mahoney, C.J., Rohrer, J.D., Omar, R. Rossor, M.N., & Warren, J.D. (2011).
Neuroanatomical profiles of personality change in frontotemporal lobar
degeneration. The British Journal of Psychiatry. Published online ahead of
print March 3, 2011, doi: 10.1192/bjp.bp.110.082677.
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the medical link
13
News
Management of
pneumonia in children
outside of hospital
By Dr David Pincus, Consultant Paediatrician
Lucy is a three-year-old girl who is generally
healthy, but she seems to get lots of
colds when she attends kindergarten. She
has become much more unwell this time,
and clinically has evidence of pneumonia.
Her parents aren't very keen on giving
antibiotics. What should you do?
There have been significant advances in
our understanding of both the aetiology
and treatment of chest infections in children
over the last several years, particularly
with the influence of better diagnostic
techniques and the influence of the new
vaccines. A new set of guidelines have
been published by the British Thoracic
Society to reflect these changes and make the decision making
process easier (Thorax.2011;66(10):927-928).
Community Acquired Pneumonia (CAP) is a relatively common
condition. Before the pneumococcal vaccine it occurred in
approximately one in 300 children less than five years of age and
approximately one in 700 children aged 0 to 16 years. The use of the
seven valent pneumococcal vaccine led to decreased admission rates
by 19% within one to two years, and approximately 30% when it has
been used in the community for a period of time as has occurred in
Australia. The introduction of the new 13 valent pneumococcal vaccine
will decrease both the frequency of pneumonia and the proportion of
bacterial cases.
Using the new PCR techniques has meant that it is possible to
determine the aetiology of the pneumonia in the large majority of
cases. Between one quarter and one third are caused by a mixed
viral and bacterial infection. The Streptococcus is the most common
bacterial pathogen with Streptococcus pneumoniae causing 30 to 40%
of cases and group A Streptococcus contributing up to 7% of cases.
RSV is the most common virus (and tends to occur in mini epidemics
around the year on the Gold Coast). Parainfluenza and influenza are
seen during the winter months. Human metapneumovirus probably
accounts for 8 to 12% of cases and can cause quite a severe illness
similar to RSV. Viral infections are more common in children less than
one year of age. This current guideline is not recommending testing for
the aetiology of the pneumonia unless there is a severe or complicated
case.
There has been a significant move away from chest x-rays in the last
decade. Certainly there is no need for a lateral chest x-ray unless it is
impossible to determine the nature or whereabouts of a lesion seen on
an AP film. Chest x-rays are not really helpful in determining whether
the pneumonia is viral or bacterial. Obtaining blood counts and acutephase reactants such as the CRP are helpful but not diagnostic in
differentiating viral and bacterial illnesses.
A simple bedside investigation that is used a lot in the hospital
setting but less frequently in the community is the measurement of
oxygen saturation. Children with an oxygen saturation of less than
92% require oxygen therapy and even children who have saturations
in the mid-90s but significant distress will benefit from oxygen. The
guidelines emphasise the fact that many studies have shown that
physiotherapy is of no use in pneumonia. In the paediatric ward we
reserve chest physiotherapy for children with underlying conditions
such as bronchiectasis, muscular dystrophy and cystic fibrosis where
it can be helpful.
So what about antibiotics for this child? If a child is only mildly unwell
and is aged less than two years, it is appropriate to advise against
antibiotics but with a clinical review if they don't recover appropriately.
14
the medical link
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If the child is significantly unwell with pneumonia, antibiotics should
be given. Amoxil remains the antibiotic of choice. It is effective, welltolerated and cheap. There has been a trend to add in a macrolide
antibiotic in an attempt to cover Mycoplasma pneumoniae, but
a Cochrane review did not even indicate that antibiotics improve
the outcome in children with Mycoplasma lower respiratory tract
infections. Patients who were just on Amoxil had very low failures rates,
and macrolide antibiotics can be used if there is a failure of response.
A recent trial in the UK in children over six months did not show a
benefit of intravenous penicillin over oral amoxicillin, so children only
need to be admitted to hospital if they have a more serious pneumonia
and particularly if they require oxygen treatment or intravenous fluids.
So what should we do about Lucy? If she is moderately unwell with
evidence of pneumonia she should receive a course of Amoxil.
I think these new guidelines are clinically helpful and generally very
sensible. Dr Pincus can be contacted on 5564 9668.
The Evandale Practice
Associates, Psychiatrists Drs Lotz, Whittington, Katz,
Bersin and Alexander welcome Drs Adams and McAuley
and Psychologist Mr Asa Kenworthy.
Drs Adams and McAuley have special interests in psychiatry of
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Appointments are now readily available for all associates.
Mental Health Care Plan assessments and
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Bulk billing for other patients available
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Telephone: 07 5510 3122
NOVEMBER/DECEMBER 2011 - issue # 079
News
Gut Microbiotica and our Immune System –
We are what we eat
By Julie Albrecht - Accredited Practising Dietitian
The coined phrase ‘you are what you eat’ has been bandied around for
many years. It is no secret that what we eat, and how much, is reflected
in our wellbeing and health. We now have research that shows that the
food we eat, our environments and our lifestyle, all play an integral role
in disease expression through the interplay of the microbiome of our gut.
In a normal functioning gut there is a symbiotic relationship which
is dependent on the presence of non-pathogenic bacteria. These
microbes benefit both digestion and metabolism and benefit the
development of a functional immune system. Research has now
identified that there is an interaction between the host and bacteria
that may lead to the development of Autoimmune and other allergic
diseases within and outside the gut. There are a few studies that have
demonstrated that difference in gut microbiotica between healthy
individual and those with disease.
There are now studies undertaken in humans and mice that show certain
inflammatory diseases are associated with an altered microbiome
(1)
. The studies undertaken in mice provide growing evidence that
gut microbiotica can influence peripheral immune responses and
a likelihood that altered microbiome can influence the progression
of disease. The study undertaken by Kallimaki etal revealed that
genetically susceptible children with ‘normal’ colonisation did not
develop allergic disease (1). This suggests that a combination of genetic
susceptibility and an altered microbiome are necessary for disease
development. There is also mounting evidence that certain species of
gut commensals are required for the regulation of immune response,
and that changes in gut microbiotica could result in a lack of immune
regulation, outgrowth of more pathogenic microbes, and promotion of
inflammation, particularly in genetically susceptible individuals (1).
In the gut commensal bacteria, predominantly the phyla Bacteriodetes,
produce SCFA – acetate, proprionate, butyruate, through the
fermentation of complex plant polysaccharides. It is the SCFA that
have an anti-inflammatory action. In order of increasing affinity the
SCFA – acetate, proprionate and butyrate, bind with the G- protein
coupled receptor GPR43.
The anti-inflammatory effects of SCFAGPR43 have been identified in the colon, respiratory system (allergic
airway inflammation) and joints (arthritis) in mice. The microbial product,
peptidoglcan (PTGN), influences neutrophil priming, translocating
across the gut mucosa, entering the circulation and bone marrow. This
provides additional evidence of the systemic effect on the immune cells.
Gut microbes have preferences for particular energy sources. Complex
plant polysaccharides are the substrate source for beneficial microbes
and hence promote their growth over the growth of other microbes.
The digestion of complex polysaccharide cannot be achieved without
the gut commensals, highlighting the symbiotic relationship. The role
that diet plays in influencing the microbiotica of the gut is demonstrated
through the experiments done with mice. When mice, stably colonised
with human microbiome, were commenced on a Western diet – high
fat, high sugar, there was a general reduction in Bacteriodtes phyla and
increased in Firmicutes taxa, Clostridia, Bacilli and Erysipelotrichi. These
modification in microbiotica resulted in changes in gene expression and
metabolic pathways utilised by microbiotica (1). Within two weeks of
commencing the Western diet the mice had greater adiposity which
could be transferred to GF recipients following fecal transplantation (1.
(cont’d next issue)
References:
1. Jan kranich., Dendle M. Maslowski., Charles R. Mackay., Seminars in Immunology 23(2011)139 – 145.
Julie Albrecht & Associates
Provides comprehensive nutrition and dietetic services
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96 Ashmore Rd, Bundall Queensland 4217
Telephone: (07) 5592 4545
Mobile: 0411 597 357 Fax: (07) 5592 4254
www.foodbodylife.com.au
Body • L
•
NOVEMBER/DECEMBER 2011 - issue # 079
Julie Albrecht
Food
• Overweight – adult and children
• Eating Disorders
• Cardiovascular Disease –
Elevated lipid profiles / hypertension
• Paediatrics – general nutrition, FTT,
constipation, diarrhoea
• Endocrinology – diabetes, IGT, PCOS
• Gastroenterology – constipation,
diarrhoea, IBS, Malabsorptive conditions,
crohn’s disease, ulcerative colitis, NASH
• Coeliac disease
• Food chemical intolerances and allergies
• Renal disease
• Sports nutrition
• Nutritional evaluations
Team
ife
Conditions treated
the medical link
15
News
Glaucoma
By Dr Pamela Weir MBBS (hons) MRCOphth
FRANZCO, Ophthalmologist
Glaucoma has always been one of those conditions
studied by insomniac Ophthalmologists to help
them get to sleep at night. I’m not really trying to
say that glaucoma is boring. In fact, it has become
a much more exciting topic in recent years with a
clearer understanding of the disease and clever
technology to help in diagnosis and monitoring of
progression.
When I was a young Ophthalmologist, anyone with intraocular pressures
greater than 21 (the upper limit of ‘normal’) was treated for glaucoma.
We started timolol ( a beta blocker) and spent many consultations with
wheezy, depressed patients or resuscitating 80 year olds with pulse
rates of 40. Any patient who had real glaucoma, ie with cupped optic
discs and field defects usually required pilocarpine drops four times
a day. They couldn’t see anything for about one hour after the drops,
and often had an accompanying headache. Patients would gradually
develop tunnel vision over a period of years and then in their twilight
years go blind and have to be led around by their spouse. How times
have changed...
Glaucoma is a progressive optic neuropathy. Its progress is diminished
or arrested by reducing intraocular pressure.
There are many subsets of glaucoma including: Open angle glaucoma
where pressure may be high, or within normal limits (normal tension
glaucoma). Patients have accelerated optic nerve fibre loss and
may be preperimetric (no detectable visual field loss) or perimetric
(characteristic field loss).
There are many secondary glaucomas including trauma, inflammatory
and neovascular. Closed angle glaucoma where patients can present
16
the medical link
acutely with a red eye to ED and a high pressure often in the 70’s.
These patients have smaller eyes than normal which predisposes them
to angle closure.
Glaucoma is the second leading cause of blindness in the world
(second to cataracts). Many people don’t know they have it as it is
asymptomatic until it is advanced. It was a condition which could be
elusive to diagnose due to its slow progression over years, but now with
newer technology, accurate diagnosis can be at a much earlier stage.
Risk Factors
Systemic: first degree relatives affected,
race (black > white), age >40 years with up
to 15% of people affected by there 60’s.
Normal disc
Diabetes, vascular disease, systemic
hypertension, migraine and vasospasm are
all thought to be implicated.
Ocular include ocular hypertension, myopia,
thin corneas.
The use of topical or systemic steroids can
lead to increased eye pressure leading to
glaucoma.
Glaucoma
Screening
People with any risk factors should be
screened annually from the age of 40.
Patients without risk factors should have a full eye examination annually
from the age of 60.
Clinically, Ophthalmologists use a number of parameters to assess
someone for glaucoma. These include: pressures, corneal thickness,
optic disc cupping and visual fields.
(continued next page)
NOVEMBER/DECEMBER 2011 - issue # 079
News
The difficulty in diagnosing glaucoma is pressures may be normal,
optic discs may appear normal and visual fields usually don’t show any
abnormality until at least 50% of nerve fibres are lost!
Treatment
Pressure in the eye must be lowered to slow the rate of nerve fibre loss.
OCT will measure the nerve fibre layer thickness and compare it to a
normative database which is age matched. Optic discs can look normal
and the nerve fibre layer is thinned.
Eyedrops for glaucoma have come a long way over the past 10 years
with greater efficacy, less frequent dosing and a lower side effect profile.
Many patients will be controlled with drops alone. Prostaglandin drops
are the commonest. They have no systemic side effects and give
patients long black lashes and darken hazel eyes.
Not all thinning of the nerve fibre layer is due to glaucoma. Neurological
problems such as Multiple Sclerosis and Pituitary tumours can also
produce thinning.
Selective Laser Trabeculoplasty (SLT) is a simple treatment which can be
used as a first line treatment as well as adjunctive treatment with drops.
It can be repeated down the track should the pressure elevate again.
Not all OCT machines use a normative database and not all machines
do a direct point by point comparison when a patient has a repeat test.
The ‘lesser’ OCT machines which are often used by Optometrists may
be helpful to screen patients but are generally not useful for following
patients.
It is useful for patients with poor compliance whether this is due to
forgetfulness, laziness, financial reasons, arthritic reasons or ‘shaky’
reasons.
The OCT
Surgery for glaucoma is required when other options are limited and the
glaucoma is progressing. The surgery has not really changed over the
years and still involves putting a drainage hole in the eye, whether this is
done with a knife or by using a shunt system.
General health should be maximised in any disease, and glaucoma
is no exception. Poor optic nerve perfusion is thought to be an
important factor in glaucoma, especially the normal tension variety.
Reducing atherosclerotic risk factors, improving vasospastic disorders
and avoiding nocturnal hypotension in hypertensive patients by keeping
night doses of antihypertensives to a minimum are all helpful additions
to treatment.
The take home message is glaucoma is a complex group of disorders
which affects a large percentage of the population, especially the
elderly. It is difficult to diagnose in its early stages without an OCT and
requires long term follow up on a regular basis.
For more information, contact My EyeSpecialist on 07 5592 7900.
Now open at Robina Town Centre
Dr Pamela Weir
Shop 4110
I
Level 3
I
Robina Town Centre
(opposite customer Service Centre)
Specialising in:
Cataract Surgery
Macular Degeneration
Glaucoma
Eyelid Surgery
Diabetic Eye Disease
Neuro-ophthalmology
Paediatric Screening
I
Robina
I
Queensland 4230
I TELEPHONE 07 5592 7900
All urgent referrals
accommodated
Leading edge
equipment
Post operative care
Please contact one of our
Ophthalmic Assistants
for more information
NOVEMBER/DECEMBER 2011 - issue # 079
the medical link
17
The newest surgical facility
on the Gold Coast is the
Southport
Day
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As a fully licensed
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SDH aims to provide local
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SDH is very well suited to
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Pain Management
Don’t mention the war
By David Just, Godfrey Pembroke Financial Advice Specialists
Much has been written about the economic travails of many Euro Zone
countries. Greece is the obvious focus, not because of the size of
the Greek debt problem in isolation, but precisely because it is not in
isolation.
Greece is seen as a question of ‘contagion’ risk. Contagion is the risk that
any Greek default will cause a much larger chain of events to happen.
We know that Greece was not the only country running massive budget
deficits. Portugal, Ireland and Italy have been doing the same thing
for the best part of a decade and their debt size is much larger than
Greece’s as a result of much larger economies to begin with. If Greece
defaults, the international banks, the EU and IMF will start to focus on
the possibility of these other countries following suit. In an attempt to
recoup income for the risk associated with holding these countries debt,
the bankers would look to charge ever increasing interest rates in a self
defeating cycle that actually increases the likelihood of further default as
these countries simply cannot meet their repayment bills. Therefore there
is very wide pressure to ensure Greece remains afloat and attached to
the Eurozone.
There is no certain way to ensure the worst case scenario of a full blown
series of defaults does not eventuate and this small but real possibility is
what has driven the latest market dive. Opinions on solutions abound but
the most plausible seems to follow the lines of sharing the pain between
the wayward and well behaved Euro members alike. If they are to be
seen as a strong federation of economies into the future they must now
stand ready to bail out those that have been playing outside the rules laid
out for Eurozone membership.
Of course, that’s all well and good if you’re on the receiving end of
the ‘bail out’, but what about the taxpayers of the countries doing the
giving? The largest of the national economies of the member countries is
Germany. In the second half of the last decade the German government
pushed through wide ranging austerity measures and tough labour
market reforms. These reforms have led to strong growth, declining
unemployment and the prosperity that comes with being the world’s
second largest exporter despite a relative lack of raw materials.
News
Financial Spotlight
commencement of World War 1. Some terms of the Versailles peace treaty
ending that war were so economically crippling that many believe this set
the stage for the German invasion of Poland to commence World War 2.
After leading the Allies to victory in 1945, the United States began
assisting the European economic recovery with direct financial aid. US
State Department leadership under General George Marshall crafted
the Marshall Plan concept whereby sixteen nations, including Germany,
became part of the program and received administrative and technical
assistance provided through the Economic Co-operation Administration
(ECA) of the United States. European nations received nearly US$90
billion (today’s dollars) in aid. At that point in time, the benefit for the
generosity of the US taxpayer would doubtless have seemed completely
inequitable after the unimaginable loss of life that preceded it.
This is Germany’s chance to write a completely different historical
account for the 21st century. Taking their lead from the tremendous
economic outcomes much of Europe received as a result of the financial
assistance provided by stronger economies in the 1940’s and 1950’s,
the German people can go a long way to ensuring a global economic
melt-down is avoided. Yes it is unfair. Yes it will be painful. And Yes, they
should do it.
The economic benefit of averting total disaster, keeping the EU in tact
and re-shaping the economic fortunes of those recalcitrant members will
be reward enough for the future generations of the member states upon
whose shoulders so much is being loaded.
For a complementary assessment of your retirement objectives please
contact Godfrey Pembroke on 56891222 – we are here to help.
This advice may not be suitable to you because it contains general advice that has not been tailored to your personal
circumstances. Please seek personal financial, tax and/or legal advice prior to acting on this information.
IntegraVest Pty Ltd, ACN 115 467 144, are Authorised Representatives of Godfrey Pembroke Limited, ABN 23 002 336 254
Australian Financial Services Licensee and Insurance Broker. A member of the National group of companies. Registered Office
105-153 Miller Street North Sydney, NSW, 2060.
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PO Box 20
Southport BC
QLD 4215
The German economy is already one of the largest ‘net givers’ to the
EU. Any successful end to the current debt crisis will involve the German
people significantly increasing this net outgoing to support the debt
ridden economies.
Quite rightly the people of Germany are asking some seriously tough
questions. Questions like: Why should we pay more tax for 40 years,
work longer hours, retire later on less Government assistance than the
Greeks and now spend our national income on paying their debts?
Tough questions often require tough answers, so how’s this one:
Because it’s already happened to you, so now it’s your turn.
Germany’s place in the history books of the early 20th century does not
make pleasant reading. When Austria-Hungary declared war on Serbia in
1914 their treaty with Germany meant the German’s were a party to the
NOVEMBER/DECEMBER 2011 - issue # 079
Susan Howard
Adv. Dip (FS),
Dip FS
David Just
SSA, AFP,
ADFS (FP), DFA
[email protected]
www.godfreypembroke.com.au/goldcoast
Barry Van Es
Adv Dip FS (FP),
A.A.I.I
Tel: 07 5503 0755
Fax: 07 5503 0766
the medical link
19
leaders in cancer care
News
Hereditary Haemochromatosis
with Elevated Serum Ferritin Levels
Is Phlebotomy Necessary? What are the Target Endpoints?
By Hanlon Sia and Herman Lee
(MBBS, MRCP and FRACP)
Clinical and Laboratory Haematologists
HOCA Gold Coast
More than 90% of hereditary haemochromatosis
(HH) is associated with C282Y or H63D HFE
gene mutations. These result in increased
iron absorption and potential total body iron
overload. Prevalence of HFE mutations in the
northern European populations is 10% for the
heterozygous state and approximately 0.5% for
the homozygous state. Excessive iron causes
cellular injury through the generation of oxygen
radicals, which promote lipid peroxidation within
organelle membranes. Liver fibrosis, cirrhosis
and hepatocellular carcinoma are the most
serious complications of iron overload.
While the biochemical markers (i.e. tranferrin saturation [TS%] and
serum ferritin[SF] levels) may be high, the clinical penetrance (i.e.
complications of iron overload) of HH is much lower. Even in the
clinically important C282Y homozygote state, the clinical penetrance
is reported to be between 1-28%, according to different studies. Within
the C282Y homozygote population, liver cirrhosis only occurs in 1-10%,
severe cardiac siderosis is rarely seen and SF levels are normal in 50%
of female and 20% of male adults, meaning they may never require
phlebotomy. Furthermore, not all C282Y homozygotes with elevated
SF levels need phlebotomy. On the contrary, compound C282Y/
H63D heterozygotes and H63D homozygotes will only occasionally
have liver iron levels in the range that is more characteristic of C282Y
homozygotes. Liver damage has rarely been described in these
patients and when present, is thought to be the result of co-factors
like excessive alcohol use, hepatitis C infection or hepatic steatosis
associated with metabolic syndrome. A small proportion of simple
C282Y heterozygotes will have a slightly raised TS% or SF levels, but
they do not develop significantly increased iron stores in the absence
of other co-factors. Heterozygotes for H63D do not have an increased
prevalence of iron abnormalities. S65C variant have very little influence
on body iron stores, and therefore should not be tested.
Phlebotomy of HH with increased SF levels:
The normal level of TS% ranges from 15-50% for males and 12-45%
for females. The ferritin level is age and gender dependent. For
adult females the reference range is 15-200µg/L, although following
menopause, levels progressively approach the adult male level of
30-300µg/L. It is important to note that increased SF levels are not
specific for iron-overload. If SF level is disproportionately increased
compared with TS%, the presence of a reactive increase in ferritin
(which has no correlation with total body iron stores) associated with
liver disease, alcohol use, infection, inflammation or malignancy,
must be actively investigated. For instance, alcohol induces ferritin
synthesis, and the elevated SF usually reverts to baseline level after
3-4 months of alcohol abstinence. Not all HH patients develop iron
overload and not all HH patients with elevated SF levels require
phlebotomy.
The main clinical benefit of phlebotomy therapy is the prevention of
liver damage due to iron overload. Early stages of hepatic fibrosis
can reverse with phlebotomy therapy. Although the target SF level
is commonly quoted as less than 50µg/L, the clinical and survival
benefits of this has never been assessed in a randomised study of
phlebotomy therapy. One should also realise that liver cirrhosis rarely
develops in patients with SF less than 1000µg/L. The necessity of
phlebotomy must therefore be tailored to the individual.
phlebotomised to achieve iron depletion regardless of signs and
symptoms. The decision to treat C282Y homozygotes with a moderately
elevated SF of 200-1000µg/L, should consider the patient's preference
and one’s own clinical judgement, remembering that SF levels do
not rise progressively in all patients and not all patients develop
cirrhosis. Observation with regular follow-up SF measurements can be
considered as an alternative management strategy in some patients.
Liver biopsy should be considered in C282Y homozygotes with a SF
≥1000 µg/L, or if non-HH risk factors for liver disease are present, in
order to assess the relative contributions of each disease process.
Phlebotomy involves removing 500ml blood over 15-30 minutes
weekly if Haemoglobin (Hb) is >120 g/L. If Hb is ≤ 120 g/L, either a
500ml venesection every second week or weekly venesection using
lower volumes (250-400 ml/session), should be considered. It is
important to consider less frequent phlebotomy sessions if Hb is <110
g/L for three consecutive weeks.
The patient's SF level should be quantified every month, or after every
fourth phlebotomy session. Once the SF level is <200 µg/L, it should
be measured every two weeks, or after every one to two phlebotomy
sessions. The decrease in SF level with phlebotomy is infrequently
linear. In the absence of solid evidence, it may be adequate to aim for
a SF level below the upper limit of the reference range (300 µg/L for
males and 200 µg/L for females), rather than the commonly suggested
target of <50 µg/L. For patients unable to tolerate phlebotomy therapy,
it may not be required at all if the SF is <1000µg/L and there is no
organ dysfunction. Exjade, an oral iron-chelating agent, may be an
option in the future once the results of ongoing trials are published.
Phlebotomy should be discontinued once the desired target SF
level is achieved, with periodic personalised phlebotomy sessions
guided by 6-monthly SF measurements. It should be noted that iron
accumulation rates vary greatly amongst C282Y homozygotes.
The development of anaemia after a few phlebotomy sessions may
indicate that the elevated SF was not due to iron overload. The
evidence of iron overload (liver biopsy or liver MRI Ferriscan) should
be reviewed before further phlebotomy is performed.
Diet advice:
HH patients should consider the following dietary advice:
1) Avoid iron supplement
2) Consume red meats in moderation
3) Consume alcohol in moderation. Patients with evidence of liver
injury, hepatomegaly or cirrhosis should abstain from consuming
alcohol
4) Limit supplemental vitamin C to 500mg/day (vitamin C increases
iron absorption)
5) Use mineral supplements for specific deficiencies only
6) Avoid raw shellfish (risk of vibrio vulnificus infection)
References:
1) Beutler E. Iron Storage Disease: Facts, Fiction and Progress. Blood Cells Mol Dis. 2007;39:140-147,
2) Adams PC. The Natural History of Untreated HFE-Related Hemochromatosis. ActaHaematologica
2009;122:134-139,
3) Adams PC et al. Hemochromatosis and Iron-Overload Screening in a Racially Diverse Population. NEJM
2005;352:1769-78,
4) Brissot P et al. Molecular Diagnosis of Genetic Iron-Overload Disorders. Expert Rev. Mol. Diagn.
2010;10:755-763,
5) Bassett ML et al. The Changing Role of Liver Biopsy in Diagnosis and Management of Haemochromatosis.
Pathology 2011;43:433-439,
6) Bassett ML. HFE Genotyping: Maximising the Value for Hemochromatosis Patients and Families. J.
Gastroenterol. Hepatol. 2010;25:1186-1188,
7) Allen KJ et al. Iron-Overload-Related Disease in HFE Hereditary Hemochromatosis. NEJM 2008;358:221-230,
8) Beaton MD et al. The Myths and Realities of Hemochromatosis. Can J Gastroenterol 2007;21:101-104,
9) Adams PC et al. Screening for Iron Overload: Lessons from the HEmochromatosis and Iron Overload
Screening (HEIRS) Study. Can J Gastroenterol. 2009;23:769-772,
10) Adams PC et al. How I Treat Hemochromatosis. Blood 2010;116:317-325.
C282Y homozygotes with SF greater than 1000 µg/L should be
NOVEMBER/DECEMBER 2011 - issue # 079
the medical link
21
News
Tips For Surviving Christmas
By Amanda Clark, Dietitian
Beat stress…Don’t let the silly season beat you.
•
•
•
Take time out to relax and do something for yourself such as
enjoying a beach walk at sunset or treating yourself to a massage.
If you’re working right up to Christmas, delegate Christmas tasks
– people love to be involved and it takes the burden off you, for
example enlist the kids to decorate, ask guests to bring a fruit
platter or vegetables and dip.
Focus on one thing at a time – don’t get carried away with what
needs to be done tomorrow – concentrate on the here and now.
•
•
You could avoid a nasty hangover too!
For your days off keep on moving! – enlist the family and friends
for a game of cricket or Frisbee after the big Christmas lunch.
Visiting relatives and catching up with friends you haven’t seen for
a while? Make a walk date rather than a dinner date.
Keep healthy….
•
•
•
•
•
•
Don’t go to a party hungry – if you know it’s going to be deep
fried nibblies, eat a low cal snack before you go such as a low fat
yoghurt, fresh fruit or whole-wheat crackers and hummus so you
can be more discerning.
Pick up a bowl and cherries to take to festive occasions – they
don’t need much preparation and you’ll know there’s something
healthy on offer.
Watch your portions at the buffet – eat off the smallest plate you
can find and fill half of it with salad or low starch vegetables.
Eat your favourite Christmas foods. For example, if you really enjoy
trifle but aren’t too keen on stuffing, then eat according to what you
enjoy most.
When you choose that trifle – eat a small portion and really enjoy
it! Focus on the flavour, the aroma and the texture and you will be
surprised at how satisfied you are with a lot less. If it doesn’t taste
as good as you hoped, abandon it.
Pace yourself with alcohol & choose wisely – drink plenty of water
in between each alcoholic drink to space out the timing. Avoid
creamy alcoholic options and choose wine or light beer instead.
Call us for
free copies
of ‘Tips for
Education
Surviving
Pads available
Christmas’
featuring
the Portion
Perfection
Plate
For clear,
rr, concise,
realistic advice refer
to the Dietitians and
Exercise Physiologists
at
•
•
•
•
Eat a healthy, filling breakfast – like natural muesli with low fat
yoghurt and a handful of frozen berries as it will help keep hunger
at bay if lunch is going to be late.
Say ‘Oh well‘ not ‘what the hell’, the average person gains around
2kg at Christmas and doesn’t lose it later. If you overeat at one
meal, get organised and back on track for the next one.
Put on your dancing shoes! Instead of just sitting around a table,
why not put on some tunes and turn up the volume. It’ll cut down
eating time and burn some calories!
If you’re putting on the Christmas feast, only cater for the number
of people actually coming to the meal, don’t serve trifle and
Christmas pudding and pavlova and … or you can guarantee
you’ll be eating it for days after.
• 3 Practitioners
• Home visit services
• Beachf
Beachfront exercise
class
• Segmental body
composition analysis
• Practical tools and
resou
esources
• Individual consultations
• Premium & bulk billed
services available
• EPCs for diet and/
or exercise and group
diabetes referrals for
exercise welcomed
See how much is
right to eat with
Portion Perfection
By Amanda Clark, Gold Coast Adv APD
Coolangatta & Broadbeach
Ph 07 5536 6400
[email protected]
www.greatideas.net.au
22
the medical link
NOVEMBER/DECEMBER 2011 - issue # 079
News
Call For Volunteer Dr’s
For Australia’s First
Beach Medical Practice
In association with Surf Life Saving Queensland, Medical Rescue
Australia which specialises in the delivery of pre-hospital medical
services, is starting Australia’s first beach medical practice this
summer and is calling for doctors interested in providing medical
support.
They will join a mostly volunteer roster on weekends, treating minor
injuries, assisting with triage and advanced life support until the
ambulance arrives etc. The practice can be bulk billed for services
provided.
At this stage the Gold Coast-based organisation will be providing
one medical team of volunteer doctor/nurse or doctor/paramedic on
an ATV to the Surfers Paradise beach but it is expected the number
of teams and locations will increase leading up to Christmas. All
equipment is provided. Medical Rescue Australia is also assembling
a smaller group of doctors to be trained in helicopter operations to
assist the Westpac Helicopter on search and rescue missions.
Mindset Change
Waistline Change
Life Change
Stop your patient’s yo-yo dieting cycle at
the Wesley Weight Management Clinic
Heather lost 25kgs
Training in equipment, ATV driving, beach operations, and radio use
is provided, and DWS and AON status is offered so doctors can
apply for provider numbers. The group will also be implementing
Australia's first Online Cloud-based Medical Practice software
approved by Medicare which will enable real time patient record
keeping from anywhere on the beach and electronic referrals to the
emergency department or the patients GP.
It is an exciting high profile initiative that is hoped will improve safety
and care on the beach for the Gold Coast community, but also
reduce the burden on QAS and ED over-crowding this summer.
Enquiries please contact Dr Glenn McKay, telephone 0414 625 494.
Chris lost 77kgs
Felicity lost 36 kgs
2012 – AMR’s 25th Anniversary
24
the medical link
Brian lost 57kgs
Together they’ve lost almost 200kgs!
Read their stories at www.wesweight.com.au
Health Fund Reclaimable
Accept EPC Referrals
ef
Unit 8-10, 25 Upton St
Bundall
11
Gold Coast Clinic
Ph. 5570 2116
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F i tien ur c
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F R s s e ecei oday
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Personalised, Healthy Weight Loss
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As 2011 closes for another year we now
reflect upon the upcoming year where
we as an Association will celebrate our
INC. Est. 1987 25th Silver Anniversary.
Fun, friendship & education! In the mid-1980’s medical receptionists
occasionally came together for meetings and social events arranged
through local hospitals. These get-togethers were a forerunner to the
inception of the Association of Medical Receptionists (Gold Coast) Branch
in September 1987 by founder, Kadie Moyle (now Cheney) under the
suggestion of Dr Laurie Kelly from the After-Hours.
We sometimes have enquires asking us “What is the Association of
Medical Receptionists”? Since its first meeting the Association has
grown and become a well respected and highly professional body. The
Association’s aim is to provide social and moral support to our members
and to provide educational workshops and professional development
sessions on subjects of specific interest to medical receptionists. Through
these workshops we’ve able to show support to the Doctor’s in the training
and professional development of their practice staff. These educational
workshops would not have been possible without the support of our
sponsors and doctor’s throughout our 25 years who have allowed us
to tour or the use of their facilities. When I look upon the Association
membership I see it has diversified from medical receptionists to now
include managers, medical administive staff and nurses.
To celebrate our 25th anniversary we have earmarked the 8th September
2012 to celebrate this event. It will also be the date for our 2012 Biennial
Seminar. We ask that this be marked on your calendar and encouraged
your staff to attend this educational day.
For more information email us on [email protected]
Noel Sefuiva, President
NOVEMBER/DECEMBER 2011 - issue # 079
News
Poor sperm DNA decreases pregnancy success
New studies suggest that sperm with certain levels of DNA
fragmentation serve as a strong predictor of reduced male fertility.
Fertility Specialist Dr Andrew Davidson of City Fertility Centre Gold
Coast said sperm that appears to be normal using traditional semen
analysis methods may actually have extensive DNA fragmentation.
“The usual evaluation of male infertility
has typically been a semen analysis
measuring count, motility and
morphology of the sperm. However
DNA analysis is now proving to be
a valuable diagnostic tool for male
infertility as well,” Dr Davidson said.
The development of a healthy embryo
is initiated when the chromosomes
which consist of strands of DNA from
the egg come together with those from
the sperm. However, sometimes these
strands can become damaged.
Dr Davidson said it appears that if the sperm DNA fragmentation level
is greater than 30 per cent the couple are likely to have significant
reduced fertility potential, including a significant reduction in term
pregnancies and a doubling of miscarriages.
“The good news is that I have seen male patients who have
significantly improved their sperm DNA quality through following
some of the recommended treatments and go on to have successful
pregnancies with their partners,” said Dr Davidson.
It is obvious that having this information about the DNA quality of the
sperm can be extremely helpful to couples and their fertility specialists,
he said.
City Fertility Centre can undertake the one hour sperm DNA
fragmentation tests in their world class laboratories.
For more information, contact City Fertility Centre on 1300 859 116.
The causes of sperm DNA damage include drugs, chemotherapy,
radiation therapy, smoking, environmental toxins, genital tract
inflammation, testicular hyperthermia, varicoceles, hormone factors,
infrequent ejaculation and the male’s age.
Dr Davidson said depending on the cause of the sperm DNA
damage some treatments can help to improve the DNA quality. These
treatments include leading a healthier lifestyle, quitting smoking,
avoiding exposure to toxins (e.g., fertilisers, fumes) and taking a daily
supplement of antioxidants and zinc.
According to a recent fertility and sterility study by Sakkas et al, up to
eight per cent of infertile men have been shown to have high levels of
sperm DNA fragmentation.
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26
the medical link
NOVEMBER/DECEMBER 2011 - issue # 079
News
You don’t say?
Patient-Doctor non-verbal communication says a lot.
By Dr Isolde Hertess
about the doctor and the patient.
Communication skills go beyond the ability to
interact with patients verbally and to document
sufficient information.
During an interview, eye contact and positive facial expression conveys
interest and eye contact intervals should last for four to five seconds.
Longer eye contact may seem be confrontational or intimidating.
Listening without interruption means an interested doctor.
Non-verbal communication (NVC) is behaviour
that is not spoken or written communication.
It creates or represents meaning. It includes
facial expressions, postures, body movements,
gestures and the tone of our voices. From our
handshakes to our hairstyles, NVC reveals who you are as a doctor and
how you relate to other people.
One experience of NVC occurred recently during surgery when I had
to tape my suddenly broken theatre shoes with sleek. The comment
came form recovery that as plastic surgeon I could at least be wearing
a decent pair of shoes.
Approximately 70% of communication is non-verbal.
NVC impacts on the success of your communication with patients more
than the spoken word. This in turn impacts on patient care by influencing
patient satisfaction, compliance with doctor’s instructions and treatment
outcomes. As a consequence the incidence of complaints against the
doctor then increases as well.
Verbal and non-verbal communication combine to convey a message.
You can improve your spoken communication by using non-verbal
signals and gestures that reinforce and support what you are saying.
As important as it is to pay attention to your own non-verbal signals
attention, should be paid to any patient incongruent behaviours. If you
are confused about a patient’s non-verbal signals, don't be afraid to ask
questions. A good idea is to repeat back your interpretation of what has
been said and ask for clarification.
Posture, movement and appearance convey a great deal of information
Statistically the average time before a doctor interrupts a patient
telling the history is 18 seconds, only 23% of patients complete their
statements. If allowed, patients usually take 60 seconds to complete
their story if allowed to do so.
The paralinguistic communication is the tone of voice, loudness,
inflection and pitch. Words said in hesitant tone of voice might convey
disapproval and a lack of interest.
Be mindful of proxemics or the need for a person’s personal space. The
amount of personal space needed when having a casual conversation
with another person usually varies between 45 centimeters to one meter.
Asking permission to get closer is good communication.
Likewise, haptics, the communication through touch can communicate
sympathy but be wary that it does not communicate over familiarity with
your patients especially females.
There is so much expected of us as doctors and we are only human.
Some of us just seem to have a knack for using non-verbal communication
effectively and correctly interpreting signals from patients.
In reality, you can build this skill.
Finally NVC is a clue to the emotions underlying feelings. So if you are
feeling tired, hungry or stressed by financial, work or personal problems
you will be transmitting negative NVC to your patients and staff.
Take time to be aware of your emotions when you are at work and more
importantly when you come home to your loved ones who have been
waiting to see you.
Gold Coast Renal
and Hypertension Clinic
Dr Mohamed Khafaji
MBChB MRCP(UK) FRACP
Renal Physician
We welcome Dr
Khafaji to his practices at:
Pindara Specialists Suites
Level 3, Suite 310
Carrara Street, Benowa 4217
John Flynn Hospital
Level 6, Fred McKay House
Inland Drive, Tugun QLD 4224
Contact details:
Telephone 5598 0443
Facsimile 5598 0662 Email [email protected]
28
the medical link
NOVEMBER/DECEMBER 2011 - issue # 079
News
Medical Transcription for an Efficient Practice
What is Medical Transcription?
Medical transcriptionists are the miracle workers of the medical
records. They transform doctors’ verbal dictations, into polished gems
of written documentation. Pressured by tight deadlines, medical typists
have the specialist knowledge and experience to work with highly
technical recordings – that are often rushed, messy and mumbled!
Staffing Emergencies
Medical practitioners often employ medical typists on a casual or
temporary basis. As the demands of a clinic fluctuates, relief staff
are relied on during times of absence, overflow or backlog. Sourcing
experienced and well trained professionals is a big challenge – and
practice managers are wise to keep a contact list, in preparation for
staffing emergencies.
Practitioners can reduce costs by ensuring they dictate clearly, using
the following hints.
•
Dictate in a quiet area with no background noise, including other
people talking.
•
Organise any papers or reports you have to refer to, before you
start dictating.
•
Pause slightly before speaking, at the start of the recording, and
also at the end. This prevents words from being ‘clipped’.
•
Be consistent in the way you approach similar reports. This makes
it easier to transcribe your work and lessens the chance of error.
•
Spell out uncommon medical terms, including diseases, drugs, or
procedures.
For more information contact Sue on 0438 717 698.
Technology for Privacy and Convenience
Technology now allows medical dictations to be uploaded and
reviewed on Apple’s iPad, iPhone and Windows Smartphones – as
well as traditional digital recorders.
High quality typing services embrace these new technologies, and
also provide their clients with a secure server, that ensures the
protection of private information. Their clients may be provided with a
personal mailbox and password, and can directly download, upload
and send files from their iPhones. This is very useful for practitioners
who use their iPhones to dictate!
Strategies for Working with a Medical Typist
Medical transcription usually takes four hours to transcribe a single
hour of audio. Mumbled and poor quality recordings may take longer.
Gold
Coast
Heart
Centre
cardiac diagnostic testing and consultations
>
>
>
>
>
>
>
>
>
Stress Echocardiography
Transthoracic Echocardiography
Transoesphageal Echocardiography
Blood Pressure Monitoring
Exercise Stress Testing
Holter Monitoring
Event Loop Recording
TILT Table Testing
ECG Reports
Dr. John Bou-Samra
Cardiologist, Pacing and Heart Failure
Dr. Mathew Williams
Cardiologist
Ph: 07 5531 1833
Dr. Michael Greenwood
Interventional Cardiologist
Dr. Kang-Teng Lim
Cardiologist, Electrophysiologist
Dr. Jonathan Chan
Cardiologist, Multi-Modality Cardiac Imaging
Dr.Vijay Kapadia
‘Professional care with
exemplary service’
Interventional Cardiologist
30
ALLAMANDA
HOSPITAL
JOHN FLYNN
PRIVATE HOSPITAL
PINDARA
HOSPITAL
Spendelove Street
Southport 4215
Phone: 07 5531 1833
Suite 6A, John Flynn Medical Centre
Inland Drive, Tugun 4224
Phone: 07 5531 1833
Opening soon
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NOVEMBER/DECEMBER 2011 - issue # 079
News
Why patients seek second opinion after
technically successful cataract procedures
By Dr Robert Bourke
Patients referred primarily for cataract surgery
require careful preoperative evaluation for other
factors that may also be contributing to their visual
dissatisfaction. If these other factors are not
identified preoperatively, patients will experience
visual dissatisfaction after technically successful
cataract surgery. However, the pre-existing problem
can almost always be solved with careful evaluation, explanation,
education and treatment.
The advance to modern small incision cataract surgery has ensured
a safer procedure for 95 per cent of patients and has provided
improved outcomes, but, with advancing technology comes an
increase in patient expectation.
I’d like to focus on referred 2nd opinion patients who have
undergone technically successful cataract extraction, where the
treating ophthalmologist is happy with the post-operative outcome,
yet the patient remains unhappy and sources a second opinion.
Some common problems post-cataract surgery include:
•
Posterior Capsular Opacification. Clouding of the posterior
capsule causes a progressive decrease in patient’s visual acuity
post cataract surgery. The incidence of PCO is around 20%, and
can develop after cataract surgery. It can be successfully treated
in rooms with YAG laser capsulotomy.
•
Refractive Surprise. In general, most patient’s post-operative
refractive outcome is emmetropia. In patients who are unhappy
with their post-operative refractive surprise, glasses will generally
suffice. Patients unhappy with spectacle correction could consider
further surgical options.
•
Anisometropia. Anisometropia refers to an unequal refractive state
for each eye. The solution is to balance the two eyes, which can
be achieved by extracting the crystalline lens in the fellow eye,
aiming for a refractive outcome matching the refractive status of
the two eyes.
•
Vitreous Anomalies. Movement of the vitreous into the anterior
chamber (AC) can lead to reduced visual acuity. Vitrectomy is
warranted in cases where the vitreous is observed in the AC, and
the patient is symptomatic. Patients who note significant vitreous
floaters post cataract surgery, could also benefit from vitrectomy
surgery.
•
Macular Pathology. ARMD, epiretinal membrane, cystoid macular
oedoma - These pathologies require vitreoretinal expertise.
Conclusion
There are numerous reasons as to why patients can be dissatisfied
with their vision following cataract extraction and PCIOL implantation.
In all of the above listed scenarios, a solution is possible. For
any person, in any situation, education is key. The patient’s
understanding of the education provided by the Ophthalmologist
is equally important. The more education provided pre-surgery, the
better the expectation post-surgery and if complications do then
occur, the patient is ready for solutions to be provided.
A full version of this article is available at
www.visioneyeinstitute.com.au
Transforming lives on the Gold Coast
Byron,
Peta,
Nerang
Benowa
Sharon,
Simon,
Burleigh
Waters
Currumbin
Valley
Vision Eye Institute’s highly respected Gold Coast team specialise in the treatment of cataract, glaucoma, retinal
diseases and general ophthalmology, as well as providing laser vision correction and other refractive procedures.
They include Dr Robert Bourke, Dr Darryl Gregor, Dr Elizabeth Hagen, Dr Peter Heiner, Dr Frank Howes,
Dr Jim McAlister and Dr Matthew Russell.
visioneyeinstitute.com.au
Vision Eye Institute
Southport
(07) 5557 8300
Vision Eye Institute
Varsity Lakes
(07) 5570 8600
NOVEMBER/DECEMBER 2011 - issue # 079
Vision Eye Institute
Coolangatta
(07) 5589 8300
the medical link
31
THE PHYSICIAN’S “WORD OF MOUTH” UPDATE
Building bridges
between Medicine
and Dentistry
Because of the close connection between headaches, muscle tension,
and TMD problems, doctors should screen for musculoskeletal
problems commonly associated with bad dental bites, TMJ pathology,
and posture problems. Treatments are often conservative.
Doctors Screen Painful Muscles & TMD
• Quick muscle palpation exam
reveals presence of painful
muscles.
• Muscle pain is common with
TMD and jaw problems.
• Doctors now screen for TMD
and use dentists for definitive
diagnosis.
• Screen and treat TMJ/TMD
problems
Common muscle exam can
help doctors screen for TMD.
TMD is associated with headaches,
ear problems, and facial/neck pain.
Painful muscles are often the source
of TMD related head and neck pain.
The following guidelines will help the
physician perform a quick TM joint and
muscle palpation screening exam.
TM Joint: Palpate directly over joint
and on front wall of ear canal. Listen
and feel for noise during open/close.
Lat. Pterygoid: Place finger alongside
maxillary wisdom tooth area. Direct
pressure superiorly, medially and
posteriorly, into the hamular notch
anatomy behind last tooth.
• Resolve headaches of dental
bite & TMJ origin.
Med. Pterygoid: Slide finger pressure
along the medial mandible wall at level
of floor of the mouth in molar area.
• Reduce muscle tension &
other contributing factors
to migraines and tension
headaches.
Masseter: Palpate muscle using a bimanual finger grasp, one finger inside
the cheek and the other outside on
the cheek below the zygomatic arch.
Clenched teeth reveal muscle.
Scalene: Finger poke in small depressed
triangular areas above and adjacent to
the clavicle midline area. Muscles here
can pinch cervical nerves traveling to
brachial plexus creating dorsal hand
paresthesia.
Sub-occipital: Firm palpation at base
of the posterior skull reveals head/neck
imbalance.
Trapezius: Stretch by tilting head and
palpate with firm finger/thumb pressure.
Painful trigger points often refer down
the back or up side of face.
For patients experiencing headaches or
with neck and jaw pain, a quick muscle
exam with positive findings justifies a
tentative diagnosis for TMD and merits
a referral to a dentist knowledgeable
in evaluating and treating TMD.
Treatments are often conservative and
multidisciplinary.
Temporalis: Palpate sides of head using
fingers
SCM: Turn head and hold muscle
between thumb and finger and palpate
up and down its length.
For appointment referrals
[email protected]
Education & Training
Faculty of Health Sciences and Medicine
By Professor Richard Hays
Dean Faculty of Health Sciences and Medicine
This important research will create greater recognition and awareness
of CFS, reducing the stigmatisation and disbelief encountered by
individuals with this disease. The researchers at Bond University are
recognised as a world leader for immunological research for CFS and
as a leading contributor of information and shared knowledge within
the medical research community. The Mason Foundation is one of the
most significant contributor to international research in CFS.
This is a fantastic success for Bond, and demonstrates the credibility
and momentum of the CFS research platform at Bond in the highly
contested area of biomedical and clinical research.
We have also recently held a number of successful events at the
Also in September, the Faculty held the first Sports Lecture Series.
This event features the high performance coaches from three popular
sports codes. The final lecture was held on Wednesday 9 November –
visit the website for more details.
Finally, congratulations also goes out to PhD candidates Christian
Morro and Kelly Griesdale who placed first and second respectively in
the Bond University three minute thesis competition.
ROBINA
Bond University is pleased to announce that
Chief Investigators Associate Professor Sonya
Marshall-Gradisnik, Dr Donald Staines and
Professor Mieke van Driel of the Public Health
and Neuroimmunology Unit (PHANU) were
recently successful for funding from the Mason
Foundation, which is Category One funding.
The grant will fund new research into Chronic
Fatigue Syndrome (CFS) and continue to build
the CFS research platform developed over the
past three years. This grant ($831,037 - over four
years) represents one of the largest Nationally
Competitive Grants received by Bond. The research project is the
largest collaborative international CFS project to date, between Bond
University, Queensland Health, Stanford University and Incline Village
Medical Centre, Nevada.
Faculty. In September, The Australian and New Zealand Forensic
Science Society recently held a very successful public event attracting
over 200 community members. The fascinating event showcased a
2007 Brisbane murder with presentations given by the team directly
involved with the case.
PRIVATE SESSIONAL
CONSULTING ROOM
AVAILABLE AT
Close to Robina Hospital and
Robina Medical Precinct
• Prominent location with ample parking
• New, attractive medical rooms
• Available for full or half day
• With or without secretarial support
If you would like further information, or
would like to discuss options please call
5 66 777 11
For Sale …Byron Bay
Spectacular 10.4 Ha (25 acre) forest hideaway
Sustainable family weekend/holiday retreat or rural residence
15 minutes from Byron Bay • 5 minutes from Mullumbimby • 40 mins from Gold Coast
At 700 ft elevation this property has the magnificent
deep freshwater Wilson’s Creek as it’s one km southern
boundary. Predominately wet sclerophyll forest with
stands of Hoop Pine, Brushbox and Rosegum, 2 Ha
is well maintained fenced pasture. Abundant native
habitat shelters koalas, wallaby, platypus, echidna
and diverse birdlife. The residence has a private yet
panoramic easterly forest and creek aspect.
The residence is craftsman built of timbers unique to the
North Coast. The windows and doors are Australian Red
Cedar, cabinetry Rosewood, Spotted Gum and Bolleygum,
ceilings Bluegum, Pigeonberry Ash and White Walnut,
exposed beams Tallowwood, flooring Silky Oak and Spotted
Gum and the cladding wide board chamfer Brushbox.
NOVEMBER/DECEMBER 2011 - issue # 079
Water storage includes 40,000 litre rainwater, 20,000 litre
pristine creek water and unlimited creek pumping rights
with a three phase electric pump.
The residence has undergone a complete master builder
refurbishment in 2010, including new roof, solar hot
water system, kitchen, hardwood floor, light fittings and
repainted internally and externally. It now presents as a
new home.
Services include power, refuse collection, mail delivery,
satellite TV, ADSL and school bus route nearby.
A tiled low maintenance salt water pool, secure two
vehicle garage and workshop, chicken run and undercover
tractor/van space complement the residence. Rich
volcanic loam vegetable gardens are easily established.
This is a unique property and residence
reluctantly for sale by its owners of
35 years. It is ideal as a sustainable
family weekend/holiday retreat or as a
rural residence within easy commuting
range of the Gold Coast and Brisbane.
For further details or to
arrange a private inspection
please contact
0438 553 416
Offers over $1.1 m considered
the medical link
33
Hospital Update
Gold Coast University Hospital
New hospital’s ‘heart’ ready to pump
Future employees of the $1.76 billion Gold Coast University Hospital
(GCUH) were treated to a one and only glimpse inside the new facility’s
‘heart’, the Central Energy Plant (CEP) on 31 October this year.
Gold Coast Health Chief Executive Officer Adrian Nowitzke joined
current Gold Coast Health staff at the event, noting the central energy
plant is just about ready to give the hospital site life.
“The CEP is the first building on site to be completed, ready to provide
energy and power to the remaining buildings on the site,” Professor
Nowitzke said.
Main entry including Gold Coast Rapid Transit entering to the hospital
“Services to the clinical buildings must be maintained at all times; all
systems in the plant have built in redundancy to ensure a maximum
level of reliability even in the event of a major component failure,” he
said.
The plant also includes a water tank farm – five stainless steel tanks
which combined hold 2 million litres of water – to store water for
everyday use, as well as fire fighting.
Staff will be given the chance to check out other buildings first hand
as they are completed.
L to R: GCUH Project director Don Glynn, GCHSD CEO Adrian Nowitzke,
Lend Lease construction manager Ben Brown and GCHSD Executive
Director Strategic Development Mike Allsopp inspect the underground
tunnel that links the CEP to the main clinical services building.
“The plant is linked to the hospital through underground service
tunnels, providing the main hospital building with essential services
such as electricity, water, air conditioning cooling water and medical
gases,” he said.
The completion of the central energy plant marks the first opportunity
for staff to view in whole a completed building on the site. It will be the
only opportunity to view inside the plant, as once it is commissioned,
it will become home to specialised engineering staff and general visits
will not be allowed.
The CEP, known as Block P and located at the rear of the hospital
precinct, will provide enough energy to power and cool the entire 19.4
hectare hospital site.
The event formed part of essential site familiarisation for staff prior to
moving the current Gold Coast Hospital to the site in early 2013.
GCUH Project Director Don Glynn said that the CEP will be central to
the functioning of the hospital when it is operational in early 2013.
“Our emergency diesel generators and massive air conditioning
chillers can generate enough electricity to power around 1000 average
homes and cool up to 6000 homes,” Mr Glynn said.
The next buildings to be completed include Block F (Mental Health
Building) and Block E (Pathology and Education Building) both of
which are scheduled for completion in April next year.
With construction of the $1.76 billion Gold Coast University Hospital
progressing on schedule, Southport is set to become a stronghold of
public health services for the Gold Coast community.
For more information on the Gold Coast University Hospital project,
please visit www.health.qld.gov.au/gcuhospital
Welcome to the new web site
www.drjaypsych.com.au
of Dr. Julian Boulnois
Doctor, Psychiatrist, Author,
Journalist, Broadcaster, Lecturer,
Mental Health Advisor and Facilitator
Dr Boulnois’ many
years of scribbling
‘On the Other Side of the
Couch’ has led to the
creation of ‘A Selection
of Poetry’ which is a
great read for only
$10.00*
Dr Michael Read M.B.B.S is performing
VASECTOMIES & ALSO CIRCUMCISIONS on adults,
infants and boys in his clinic, as a local anesthetic procedure.
No Hospital Admission.
PHONE 55 31 11 70
FOR APPOINTMENTS
95 Nerang St Southport Qld 4215
www.vasectomyvenue.com.au
34
the medical link
For more
information
contact
Dr Boulnois
and his team on
5571 1133
*incl GST
[email protected]
NOVEMBER/DECEMBER 2011 - issue # 079
Hospital Update
Pindara Private Hospital
South Coast Radiology (SCR) and Pindara Private Hospital (PPH)
are poised to launch a new cutting edge CT scanning service on the
Hospital campus. Reportedly the first of its type in Queensland, and the
best available, the new Toshiba Aquilion Prime CT scanner is a coup for
SCR, PPH and the Gold Coast medical community.
Pindara welcomes new specialists
Dr Susan O’Mahony
Plastic and Reconstructive Surgeon
Dr Susan O’Mahony undertook her Medical Degree
at the University of Queensland and completed her
Plastic & Reconstructive Surgery training in Brisbane,
gaining Fellowship from the Royal Australasian College
of Surgeons, before undertaking a two-year Fellowship Program in Cleft
and Craniomaxillofacial Surgery in Brisbane and New Zealand.
During her training Dr O’Mahony was actively involved in surgical
research, investigating a side effect of Breast Cancer Surgery. In 2001
she was appointed to a Wellcome Trust Clinical Research Fellowship
and was awarded a Masters Degree from the University of Cambridge
in 2003. She recently completed a Doctorate at the same University.
Dr O’Mahony’s practice encompasses most areas of Adult and
Paediatric Plastic Surgery with a particular interest in Reconstructive
and Cosmetic Breast Surgery, Body Contouring, Facial Plastic Surgery,
Skin Cancer Surgery, Congenital Deformities and Otoplasty. She also
has public hospital appointments at the Mater and Royal Children’s
Hospitals in Brisbane where she specialises in the treatment of Cleft Lip
and Palate and Craniofacial Congenital Deformities.
Dr O’Mahony welcomes enquiries from her colleagues regarding their
adult or paediatric patients who require Plastic Surgical care. She can
be contacted on (07) 5597 5624.
NOVEMBER/DECEMBER 2011 - issue # 079
Dr Danielle Ghusn
Breast and Endocrine Surgeon
Dr Danielle Ghusn is a graduate from the University of
Queensland and underwent Surgical Training at the Royal
Brisbane Hospital. After this, she completed two years as
the Breast and Endocrine Fellow at a large Hospital in the UK, where she
specialised in Oncoplastic Services for breast cancer patients.
Dr Ghusn has been in practice for eight years and holds a position as
Visiting Consultant Surgeon for NSW BreastScreen. She is a member
of the Breast Section of the RACS, the Australasian Society of Breast
Disease and is a full member the Australian Endocrine Surgeons.
Dr Ghusn is interested in treating benign and malignant conditions of the
breast, breast reconstruction, thyroid and parathyroid diseases and can
be contacted on (07) 5598 0644.
Allamanda Private
Hospital
Appointment Injects Further Confidence
Healthscope’s appointment of a new General Manager for Allamanda
Private Hospital assists progress on the Gold Coast University
Private Hospital project with final negotiation nearing completion.
David Harper has joined Healthscope and will work closely on
the new private hospital to be co-located with the public Gold
Coast University Hospital which is currently under construction on
Parklands Drive opposite the Griffith University in Southport.
David was previously responsible for peri operative services at
Greenslopes Private Hospital for Ramsay Healthcare and has over
15 years experience in private and public healthcare.
Healthscope Queensland and Northern Territory State Manager of
Hospitals, Richard Lizzio, says he is confident David is the right
person for the job.
“In my experience working with David, he has the ability to achieve
outstanding operational results as well as drive excellent clinical
outcomes,” he said.
“His doctor, patient and staff satisfaction are second to none that I
have witnessed and I am extremely excited to have him on our team.”
Healthscope are currently finalising negotiations with Queensland
Health for the new large-scale hospital, with construction plans and
specialist recruitment underway.
David says the Gold Coast University Private Hospital project is an
exciting venture and one that will set the benchmark in healthcare on
the Gold Coast and throughout Queensland.
“The state-of-the-art private hospital will be unrivalled by any other on
the Gold Coast and equal to the best hospitals in Australia,” he said.
“From the design and fit-out; to the equipment, doctors, staff and
procedures available, we are determined to surpass all expectations and
set new levels of treatment and care for the people of the Gold Coast.”
Gold Coast University Private Hospital is expected to include
233 beds with the capacity for an additional 120 beds, allowing
immediate and easy expansion as needed.
“The hospital will include 11 integrated operating theatres, a hybrid
theatre and Cardiac Catheterisation Laboratory, all equipped with the
next generation of technology,” David said.
“There will also be space for at least a further four theatres, 750 car
parks, and the hospital will offer an obstetric service with a 25 bed
ward and five delivery suites.”
With the design phase due to be finalised in 2012, David expects
construction of the new hospital will start in mid 2013.
“We have an excellent team focusing on this project and we see it
as a priority for Healthscope and a necessity for the people of the
Gold Coast.”
the medical link
35
Heart Beat
Looking Through the Lens
By Dr John Corbett
I have long been a passionate amateur photographer and I have
tended in the past to blend my love of nature, gardening and flora
with the intrigue of macro photography. Evidence of this passion can
be seen on display in my neurology and sleep clinics (my ‘private’
photographic-art gallery) and I enjoy great pleasure in seeing patients
trying to identify the exact nature of the macro photos they see – good
macro images don’t necessarily give up their secrets easily.
I did enjoy a recent holiday which was planned specifically for
photographic opportunities but not of the macro kind, viz, a cruise from
Argentina to Antarctica and then on to Rio de Janiero for Carnivale.
The two destinations were polar opposites.
Antarctica proved to be the ultimate example of ‘staged’ natural beauty
and if there is ever a place to render a human seemingly insignificant,
this is it. The vast, pure, silent expanses were punctuated only by
the presence of such creatures as whales, penguins and seals.
The opportunities for photography were limitless. Icebergs floated
endlessly by and could not be more beautiful if they were carved
by a renaissance sculptor. These scenes were so spectacular as to
transform even a novice photographer readily into a master (but one
with very cold hands from time to time!).
Rio – by stark comparison – was a heaving mixture of music, singing,
dancing (samba), drama, comedy, colour, beauty and movement.
Everywhere you looked was an example of human imagination and
creativity. In the grand parade (which lasted for two full nights), every
performer, costume and float was meticulously detailed in all colours of
the rainbow creating the perfect backdrop for the city to evolve into the
world’s largest party. The infectious mood was of simple unbridled,
carefree enjoyment. Hypnotic, ear-splitting samba beats made it
impossible not to become involved and affected by the energy which
seemed to flow freely for days on end, stoked by frenzied locals and
visitors alike – believe it or not, two million people of all ages ‘party’
in wonderful, harmonious, community celebration. The nights were
lit by countless lights creating a day-time ambience and a perfect
photographic scenario – the most rank amateur of photographers
could not fail to produce wonderful shots, and no two images could
ever be the same, as no subject remained still or unchanged for long.
• Expert travel health advice
• Vaccinations - including Yellow Fever
• Anti-malarials & Insect repellents
FREE UNDERCOVER PARKING
Level 2
The Vision Centre
95 Nerang St, Southport
Queensland 4215
Website: www.travelmedicine.com.au
(Opposite Gold Coast Hospital)
5526 4444
5527 1088
36
• Travel Products
• Medical Kits
the medical link
For any person interested in photography, this holiday is an experience
of a lifetime, and one that proved to be much more easily accessible
and easily organised than we had ever expected.
For those interested in seeing some of the images from
this trip, I have posted some of my favourite shots at
www.snoreaustralia/gcma. I would be glad to share
these with any who are interested and you are free to
save them as desktop wallpapers or screensavers.
NOVEMBER/DECEMBER 2011 - issue # 079
Heart Beat
Robert Hitchins’ book review
The Emperor’s New
Drugs: Exploding The
Antidepressant Myth
By Irving Kirsch
Irving Kirsch is Professor of
Psychology at Hull in the UK
and Emeritus Professor at
Connecticut in the USA.
His published research into
placebos is highly regarded.
Before training in psychology,
he played strings in Aretha
Franklin’s backing band, which
is sufficient to get my R-E-S-PE-C-T at least. More recently, he
has examined clinical trials of
antidepressants as reported in
The Emperor’s New Drugs.
Drugs became the mainstay
of
modern
psychiatry
coincident with the theory that
neurotransmitter imbalances
in the brain, correctable by
specific drugs, caused mental
illness after those psychoactive
drugs were shown to affect
levels
of
neurotransmitter
breakdown
products
in
spinal fluid. Chlorpromazine
lowered dopamine levels so it
was postulated schizophrenia was due to too much dopamine;
antidepressants increased brain serotonin levels so depression was
due to lack of serotonin.
Using this logic, you could argue all pain is due to deficiency of
morphine or that fevers are all due to lack of aspirin. And after decades
of research, the neurotransmitter theory remains unproven.
Staring in 1995, Hirsch reviewed published clinical trials comparing
various depression treatments with placebos, and psychotherapy
with no treatment. Most studies lasted 6-8 weeks during which time
patients can improve somewhat without any treatment. Kirsch was
unsurprised to find placebos were three times as effective as no
treatment but disturbed that placebos were 75 percent as effective as
antidepressants when judged by common scales of depression.
He then obtained all data submitted to the US Food and Drug
Administration (FDA) between 1987 to 1999 about fluoxetine,
paroxetine, sertraline, citalopram, nefazodone, and venlafaxine. Drug
companies must submit all clinical trials they have sponsored but only
need two positive ones to get approval. Positive studies are published
and widely publicised while negative ones are regarded as proprietary
and therefore confidential, so remain unseen. Again, most studies
were negative and placebos were 82 percent as effective as the drugs
tested. Average difference between drug and placebo on the Hamilton
Depression Scale (HAM-D) was 1.8 points – statistically significant but
clinically meaningless. All six drugs were equally unimpressive.
This book is concise, readable, and very disturbing. Lacking
prescribing rights himself, Hirsch could be accused of ‘sour grapes’
but similar concerns are raised by Anatomy of an Epidemic: Magic
Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness
in America by Robert Whitaker (a journalist), and Unhinged: The
Trouble With Psychiatry – A Doctor’s Revelations About a Profession in
Crisis by Daniel Carlat (a psychiatrist).
Remember when...
An excerpt from the ‘First 50 Years History of the Gold Coast Medical Association’ written and published by Dr Alistair Dick
(Consultant Physician at Southport 1962 – 1993)
The Local Medical Association’s Activities. Year by Year – 1991
The mood this year was again quieter, in keeping with the economy
which was in recession. The cynical mood of the nineties was setting
in; people were more concerned with consolidating and protecting
their gains. The Executive included Dr Rob Hitchins, President, Dr Paul
Bennett, Vice President, and Dr John Sing, Secretary, all specialists,
and they tended to concentrate on the more serious issues, of which
there were plenty. To start with, the LMA members, especially the GPs,
were probably getting tired of being harangued about bulk billing
for the past seven years; it was clearly a lost cause with over three
quarters of all GP services being bulk billed. They were used to living
in direct confrontation with the Government, but now there were new
threats looming, multiple threats creating uncertainty. First there was
the ill-fated co-payment scheme, which was not resolved until March
1992. Then throughout 1991 and 1992 there was a steady stream
of reports and issues papers from the Macklin Inquiry, canvassing
various options for improving health services, mostly designed to
NOVEMBER/DECEMBER 2011 - issue # 079
reduce costs. There was talk of cutting GP provider numbers by 5900.
Back at the workplace, Quality Management and Casemix were being
introduced, complex issues which few really understood. The role of
the administrators was focussed on plans and strategies, the patients
and health workers like pawns in their game. Patients were now being
referred to as clients or consumers. The older doctors and nurses were
finding it difficult to accept their new status.
The state government was also active this year in implementing new
systems. On July 1 the old system of Hospital Boards was scraped and
replaced by a system of Regional Health Authorities. The South Coast
RHA included the Beenleigh and Beaudesert areas as well as the Gold
Coast, and was responsible for the planning and administration of not
only the hospital but all health services. Dr Hitchins was appointed as
one of seven members of the new Authority to develop its structures and
strategies, and meanwhile administrative chaos reigned.
the medical link
37
Heart Beat
soduko
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Soduko answers available in the next issue
SEPT/OCT 2011
soduko
the MEDICAL LINK
To have your community announcement considered for this page,
please contact us on (07) 5575 7054 or [email protected]
5
1
3 6 9
answers
 1 December
2011 Christmas Lights Competition – Gold Coast
Entries are now open for Gold Coast City Council’s
Christmas Lights Competition. Join hundreds of
Gold Coast residents, businesses and community
groups in lighting the city with the magic of Christmas.
For more information visit www.goldcoast.qld.gov.au
 3 December
Arj Barker - Eleven
Paradise Showroom, The Art Centre Gold Coast
Returning to Australia with his new side spilling show. Arj Barker
- Eleven will send an audience into roars of laughter as he
discusses some controversial topics in a hilarious show. Tickets
available from www.theartscentregc.com.au
 24 December
Scrooge: A Christmas Spectacular - 8pm
Gold Coast Convention & Exhibition Centre
All your favourite carols and a story for the ages. METRO
Church presents a Christmas carols event for the whole family.
Come and celebrate Christmas Eve at the Gold Coast’s premier
carols event. Visit www.gccec.com.au
 25 December
Jupiters Christmas Lunch
The Pavilion Ballroom, Jupiters Hotel and Casino.
Food and entertainment from 11am. Tickets www.ticketmaster.
com.au
 26 December
Gold Coast United Vs Brisbane Roar
Skilled Park, Robina, Gold Coast
Gold Coast United take on Brisbane Roar in the Hyundai
A-League. Be a part of the action and excitement of a live
game!!! Support your team at Skilled Park in Robina. Pre
purchase tickets www.ticketek.com to be part of the action!!
 31 December
Gold Coast New Years Eve Fireworks
The Gold Coast is a popular holiday destination. The Christmas
and New Year season brings visitors from across the world
to experience the beautiful Gold Coast. Enjoy the magical
display of lights across the sky from a various of vantage
points across Surfers Paradise, Broadbeach and beyond. Visit
www.goldcoast.qld.gov.au
puzzle
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Julie Albrecht & Associates Pty Ltd ............www.foodbodylife.com.au
Julie Le Franc Psychoanalysis Services .......www.julielefranc.com.au
KPMG ........................................................www.kpmg.com.au
Leading Steps.............................................www.leadingsteps.com.au
Malisano ....................................................www.malisano.com.au
Medeleq Pty Ltd ........................................www.medeleq.com.au
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the medical link
Monash IVF Gold Coast ..........................www.monashivf.com
Moneydoctors Pty Ltd ............................www.moneydoctors.com.au
Mudgeeraba General Practice .................www.goldcoastvasectomy.com.au
NABhealth .............................................www.nab.com.au/health
Newport Custom Shutters ......................www.newporttimbershutters.com.au
physio@home .....................................www.physioathome.net.au
Pindara Private Hospital .........................www.pindaraprivate.com.au
Q Scan ..................................................www.qscan.com.au
Skinner Hamilton Accountants & Business Consultants .www.skinnerhamilton.com.au
Snore Australia ......................................www.snoreaustralia.com.au
Southport Day Hospital ..........................www.cosmedic.com.au
The Travel Doctor ..................................www.travelmedicine.com.au
Vasectomy Venue .................................www.vasectomyvenue.com.au
Vision Eye Institute ................................www.visioneyeinstitute.com.au
Wesley Weight Management Clinic..........www.wesweight.com.au
NOVEMBER/DECEMBER 2011 - issue # 079
SCP_468
DESIGN & MANUFACTURE OF QUALITY | TIMBER SHUTTERS & TIMBER VENETIAN BLINDS
ALSO SUNSCREEN ROLLERBLINDS & ALUMINIUM SHUTTERS
BRI S BANE T. 07 3 3 6 7 2 4 9 9
F. 0 7 3 3 6 8 3 0 3 8
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GO LD C O AST T. 07 5593 4031
F. 07 5593 8429
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www.n ewp o r t s h u t t er s .co m
Medical Finance
borrow up to 100% and buy the home
you want, why wouldn’t you?
At Investec, our mortgage products provide flexibility for owner
occupiers to borrow up to 100% of the purchase price, or up to
95% of the purchase price for investment properties, without
Lenders’ Mortgage Insurance.
Enjoy the benefits of having a dedicated mortgage specialist who
can offer competitive interest rates, offset facilities and a quick
and easy approval process.
Get into your home quicker. Contact your local banker, call
1300 131 141 or visit www.investec.com.au/medicalfinance.
Home Loans • Asset Finance
Property Finance • Deposit Facilities • Goodwill & Practice Purchase Loans
E x p e r•i eCommercial
n
Income Protection & Life Insurance • Professional Overdraft
Investec Professional Finance Pty Limited ABN 94 110 704 464 is a subsidiary of Investec Bank (Australia) Limited ABN 55 071 292 594 AFSL 234975. All finance is subject to our credit assessment criteria. Terms and
conditions, fees and charges apply. We reserve the right to cease offering these products at any time without notice. Investec Professional Finance is not offering financial or tax advice. You should obtain independent
financial and tax advice, as appropriate.
NOVEMBER/DECEMBER 2011 - issue # 079
the medical link
39