Author Archives: Aifric Boylan

Certain health problems are quite easy to self-diagnose- head colds, sore throats, period pain and migraine, to name a few. But as we all know, many work-places and universities request a medical certificate if you take a day off. Up till now this meant having to queue up in a doctor’s surgery, just to get a piece of paper confirming what you already knew! However, the good news is that you can now get medical certificates online for quite a variety of minor illnesses!

So, in what situations can an online doctor provide a medical certificate? Well, the key point is that a physical examination must be unnecessary- in other words, it must be a condition where the history alone gives the doctor enough information to make the diagnosis.

Here are 5 common examples:

• The common cold and other mild viral illnesses: most of us can recognise the typical signs of a common cold which include a runny or congested nose, tiredness and maybe a mild sore throat or cough. As long as there are no signs of a more serious respiratory infection, an online doctor can usually provide a medical certificate.

• Sore throat: another common ailment, which is viral 80-90% of the time, and will usually get better by itself after a few days. An online doctor’s certificate can be a helpful solution. However, if you’re unable to swallow or if you feel very unwell, you’ll need to see a doctor in person.

• Gastroenteritis or food poisoning: these conditions usually present with vomiting, diarrhoea and sometimes tummy cramps, and generally settle with rest and rehydration. If there are worrying symptoms such as more severe pain or dehydration, assessment by a doctor in person may be advised.

• Migraine: this is a common reason for patients to seek an online medical certificate. However, it’s important that the headaches have previously been confirmed as migraine by a doctor- so, if it’s your first episode, or if you’ve never spoken to a doctor about your headaches before, it is more appropriate to attend a doctor in person.

• Period pain: many women experience menstrual pain which is severe enough to cause absence from work. There are numerous potential treatments for this problem, so it’s worth speaking to a doctor about it. But an online medical certificate can certainly be a helpful solution from time to time.

There are many other minor ailments that may cause you to miss work or uni- so if you feel you’re not sick enough to see a doctor in person, but need a medical certificate, consider discussing the symptoms with an online doctor before making that tiresome trip to the local surgery!

When minor illness strikes, the common sense approach is to take some time off to rest and recover. That’s all well and good, but many employers or universities will ask for a medical certificate- which often involves a stressful scramble to get a doctor’s appointment the same day. In many cases, this can be hard to manage, not to mention the fact that a waiting room is the very last place you want to be when you’re sick! But thankfully,  it’s now possible to see an online doctor such as Dr Sicknote, and obtain a medical certificate without leaving  the comfort of home. So, here are the top 5 reasons to try an online doctor the next time you are feeling under the weather:

1-      Sick leave gets used appropriately:

Seriously, it’s called sick leave for a reason! So the best place to be is at home, resting and recovering more efficiently.

2-      Less spread of infection:

Illnesses such as the common cold and viral gastroenteritis are highly contagious. When you are at the peak of your symptoms it is easy to pass infection to others. Getting a medical certificate from an online doctor avoids this unnecessary spread of germs!

3-      Saves time:

Commuting time and queueing time are removed from the equation. It’s a 5 minute consultation with an online doctor. You don’t even need to leave your bed!

4-      Saves money:

Getting a medical certificate from an online doctor may work out cheaper. This does depend on what your regular GP usually charges, and which online service you choose. And of course, the cost of transport to see the doctor is removed from the equation too!

5-      Saves Medicare :

Every time a patient chooses to get a medical certificate online, Medicare is no longer paying the bill- and this saves taxpayers’ money. It also frees up appointments for people who are possibly more unwell.

So the next time you’ve got a common cold, sinusitis, viral gastroenteritis, sore throat, migraine, bad period pain, or any other minor illness, don’t forget the online option for your medical certificate!

 

1-     It can be caused by a number of different viruses-  Coxsackievirus A16 is the most common cause and Enterovirus 71 is the second-most common. Because more than one virus can lead to Hand Foot and Mouth disease, unfortunately it’s possible to get it more than once!!

2-     Usually it occurs in children less than 5 years old, but can occasionally occur in older kids or adults

3-     Symptoms usually start 3 to 7 days after catching the virus and can last from 7 to 10 days. The common signs and symptoms include:

• high temperature (fever)
• sore throat
• blisters inside the mouth, on the tongue, palms of the hands, fingers, soles of the feet and nappy area (these blisters are not itchy like chickenpox blisters)
• reduced appetite (drinking and eating may be painful because of the mouth blisters)
• tiredness

4-     It is NOT the same as “Foot and Mouth disease” which affects livestock such as cattle.

5-     It is highly contagious, and is spread by exposure to fluid from inside the blisters, from the nose, mouth or chest, which are spread from sneezing and coughing. It may also be present in a child’s bowel movements for several weeks after the infection. Spread of the virus is lessened by washing hands after touching bodily fluids, and not sharing items such as cutlery, drinking cups, towels, toothbrushes.

6-     Children should stay home from school or child care until the fluid in the blisters has dried up.

7-     Hand Foot and Mouth disease is NOT dangerous to pregnant women or their unborn babies

8-     Complications are very rare, but viral meningitis/encephalitis are possible- therefore if a child with Hand foot and mouth disease develops severe headaches, neck stiffness or becomes sensitive to light, they should be immediately assessed by a doctor.

9-     There is no specific treatment. Because it is a virus, antibiotics will not work. Pain relief can be given for mouth blisters. Ask your pharmacist or family doctor about what medicines are helpful. It’s important to ensure a child is well hydrated- so plenty of fluids are advised. The blisters dry naturally- they should not be pierced or squeezed.

10-   A vaccine has been developed but is not yet widely used or available.

For more information go to:

• your family doctor (GP) or Maternal and Child Health Nurse
• www.rch.org.au/kidsinfo/fact_sheets/hand_foot_and_mouth_disease_coxsackie_virus
• www.health.vic.gov.au/ideas
• www.cdc.gov/hand-foot-mouth/index.html

Slapped Cheek Syndrome is one of those slightly odd viruses that crops up in schools and childcare facilities from time to time- and it seems to be doing the rounds in the past few weeks. It is caused by a virus called Parvovirus B19 (you may have heard of dogs and cats being infected with Parvovirus, but it’s a different strain). Parents and carers often have quite a few questions, so here are some of the key points:

Symptoms and spread:

• It mainly affects children aged 4-10 years old, though anyone can get it if they’ve not had it before.
• Many people who are infected show no symptoms (i.e. it’s often a “silent” infection), and symptoms may vary quite a lot from child to child.
• It’s spread by breathing in or swallowing coughed or sneezed fluid droplets from an infected person.
• Symptoms can take between 4 and 14 days to appear after catching the virus.
• First symptoms can include fever, tiredness, headache, stomach upsets, aches and pains, sore throat and a runny nose- this is when the virus can be spread to others, mainly through saliva, coughs and sneezes.
• A bright red rash may appear on the cheeks 3 to 7 days after getting the virus- hence the name. Once this “slapped cheek” rash appears the child is no longer likely to be infectious to others. Though it may look a little alarming, these children can return to childcare or school, if they feel well enough.
• Some children may also develop a rash on their bodies- this often forms a pink lacy pattern on the skin, and can come and go for several weeks. It may be mildly itchy.

Treatment:

• Fever, aches and pains may be controlled with Paracetamol (Panadol) or Ibuprofen  (Nurofen).
• Antibiotics do not help because Slapped Cheek Syndrome is caused by a virus. If there is itch, an antihistamine may be useful.
• And as with any illness, if a child seems particularly unwell, they should be seen by a doctor.

Complications:

• Complications are rare.Occasionally, joint swelling and pain may develop in the hands and feet. This is more common in teenagers or adults, and will usually pass within a few weeks.
• If for some reason a child’s immune system is not functioning properly- for example, children on long term steroids, chemotherapy, or who have had an organ transplant- slapped cheek syndrome can be more serious. Equally, if a child has a blood disorder such as sickle cell anaemia or another severe anaemia ( a very low blood count), the infection can be more dangerous. Children with any of these issues who are exposed to slapped cheek syndrome, or who develop symptoms, should see a doctor immediately.

Infection in Pregnancy:

• Pregnant women who are exposed to Slapped Cheek Syndrome should ask their doctor to check if they already have immunity to Parvovirus B19 by performing a blood test.
• Thankfully, most pregnant women who are infected with Slapped Cheek Syndrome will be absolutely fine, as will their babies. However, infection in the first 20 weeks of pregnancy can cause an increased risk of miscarriage, and between weeks 9 and 20 weeks of pregnancy it can lead to foetal complications- thus it’s vital to seek medical advice and follow up.

 

For more information on Slapped Cheek Syndrome check out:

http://www.rch.org.au/kidsinfo/fact_sheets/slapped_cheek_or_fifth_syndrome/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/slapped-cheek-disease

by Dr Aifric Boylan

Fever causes fear- particularly in parents of young children. But is fever itself a dangerous thing? The answer is, almost never. And yet it often causes a lot of worry and stress.

In children most infections are viral and thus will get better by themselves. When an infection is present, the body’s thermostat (located in the brain) naturally raises body temperature to a higher set-point. The chills and shivering that may follow serve to increase muscle activity- this is the body’s way of heating itself up, to try and reach the new temperature set-point. According to the Royal Children’s Hospital, a body temperature above 38C indicates that fever is present in a child.

Misunderstanding of fever can lead to “fever phobia”, which may in turn lead to overly aggressive treatment, including unnecessary antibiotics. So what are people afraid of? Research has shown that around 90% of parents think fever itself can cause harmful side effects- including seizures, brain damage, coma, blindness and death! Thankfully, with the exception of febrile seizures, fever doesn’t cause any of these things. Febrile seizures (also known as febrile convulsions), whilst highly unpleasant, are generally not dangerous, and in any case, there is little evidence that anti-fever medications can do much to prevent them.

So, does this mean that fever shouldn’t be taken seriously? Of course not! There are certain situations, signs and symptoms, that do need careful management- these are explored in a helpful information fact sheet by the Royal Children’s Hospital- see link below. Medication to reduce fever can certainly help a child feel more comfortable. But in many cases, it’s simply not necessary to medicate, particularly if the child is otherwise well and active. The point is, the fever itself is not of concern.

Unfortunately, “fever phobia” can be harmful in its’ own right. Studies show that more than half of parents dose their children too frequently with medications such as Paracetamol or Ibuprofen, when they have a high temperature. This unintended overdosing puts children at risk of liver and kidney injury. Large numbers of caregivers say they use sponging with cold water to reduce fever, a practice which is pretty ineffective and can be unpleasant for the child, and may even cause harm by reducing the body’s ability to naturally lose heat, as it causes constriction of  blood vessels in the skin. Some parents have also been known to sponge children down with alcohol solutions- this can cause toxicity by passing through the child’s skin, and thus should never be used.

It’s important to note that fever is not the same thing as hyperthermia. Hyperthermia happens when there is too much heat from a source outside the body, such as when a young child is forgotten in a car on a hot day. Unlike fever, hyperthermia is dangerous, and can lead to serious harm, even death. It’s quite possible that some of the fear around fevers comes from a false connection in people’s minds between these two different issues.

With regard to treatment, fever-reducing medications should only be given as needed, and can be stopped once bothersome symptoms have resolved, or when the child feels more comfortable. Giving combinations of Paracetamol and Ibuprofen, or alternating them, is not recommended routinely, as it is known to increase the chance of giving the wrong dose of one or other of the medications. And there is certainly no need to wake a sleeping child to give a dose of medication to bring down a fever (though in studies, around 80% of caregivers said they would do this!). Finally, as always, adequate fluid intake is essential.

For more information on fevers in children go to http://www.rch.org.au/kidsinfo/fact_sheets/Fever_in_children/

 

By Dr Aifric Boylan

It’s quite a few years since I was a junior doctor, doing marathon hospital shifts. But I still remember the awful shivery tiredness at 4AM- running from ward to ward, grabbing cups of bad instant coffee every few hours to keep my brain fired up. And then there was the exhaustion the following day- driving home with the window rolled down to keep myself awake after 30 straight hours of work without sleep. It was always obvious to me that it was a very unhealthy lifestyle.

Shift work is any job that is undertaken outside normal daylight hours (it doesn’t have to be overnight to qualify as shiftwork- for example, a gym instructor who works early mornings and evenings would qualify as a shift worker). The effects on health probably rise in part from disturbances to “circadian rhythm” – which is basically the night and day chemistry of our bodies, closely related to exposure to light. But there are also the social effects of shift work- the pressure on relationships and family life, and the simple practicalities of what to eat when it’s 4AM and the only food to be had is calling to you seductively from a vending machine!

In 2007 the World Health Organisation classified shift work as a “possible carcinogen” or cancer causing health risk. Research suggests a link between shift work and breast cancer-and there is limited, though inconsistent evidence for links with other cancers, such as colon cancer. It also appears there may be a higher risk of heart disease, obesity, hypertension, and type 2 diabetes. Some studies indicate an increased risk of preterm delivery, gastrointestinal disorders and mental health problems among shiftworkers. However, the bottom line is that more research is needed in many of these areas to confirm the associations. Injuries and accidents also seem to occur more frequently amongst shift workers-  with an estimated increase of 15% on evening shifts and 28% on night shifts.

For many people, shift work is just a passing phase, for others it will be a long term way of life.  Whilst the science may not yet be definite, it does appear that shift workers are more prone to quite an array of health issues. What to do about it? Well, a responsible employer will schedule shifts to reduce the negative impact on workers- most countries have specific guidelines and laws on this. Steps to maximise physical fitness and healthy eating would seem sensible. Given the possible increased cancer risk among shift workers, smoking should certainly be avoided like the plague. And in terms of the impact on social and family life, shift workers may benefit from more proactively planning their time off, to nurture their friendships and relationships. Certain medications, such as Melatonin may also help with triggering sleep.

Anyone whose job involves long term shift work would be wise to have a good check up with their GP every year or two- with assessment of fasting blood sugar, blood pressure and weight measurement -and to discuss any concerns they may have regarding sleep, mental health or other health issues. Like so many things in life, when it comes to being a shift worker-being proactive is always better than being reactive!

by Dr Aifric Boylan

Let’s cut to the chase on the common cold- does anything actually help it? There are many products on the market that claim to. Unfortunately, the truth is that none of them make a great deal of difference-but some may offer a little relief. So here is the low down based on studies:

 

• Antihistamines– common brands include Zyrtec and Clarityne.

Pros: shown to reduce overall symptoms on day 1 & 2 of a cold, but little help after that.

Cons: some people may experience side-effects, such as feeling drowsy.

 

• Analgesics: commonly Panadol or an anti-inflammatory such as Nurofen.

Pros: may reduce fever, aches and pains a little.

Cons: no effect on how long the cold lasts or on runny nose/nasal stuffiness;

 

• Ipratropium nasal spray– a common brand is Atrovent.

Pros: can reduce runny nose, but not blockage/stuffiness.

Cons: may cause dryness, irritation or mild bleeding from the nose.

 

• Nasal saline rinses/sprays–  a common example is Fess.

Pros: because it’s just salty water, side effects are unlikely, and it may help runny nose/blockage a little.

Cons: studies so far have not been large enough to confirm a benefit.

 

• Steroid Nasal Sprays– common examples include Flixonase, Nasonex and Avamys.

There is no evidence that these help, though better studies are needed.

 

• Decongestant nasal sprays– common brands include Dimetapp, Otrivin & Sudafed sprays.

Pros: may make a small difference to stuffy/blocked nose.

Cons: may cause side effects such as dryness or irritation.

 

• 3 in 1 combination tablets with painkiller, decongestant & antihistamine-

there are several brands available- for example Sudafed PE + allergy and pain relief.

Pros: may reduce overall symptoms and improve recovery time, in adults and older children.

Cons: potential for side effects, from any of the 3 components.

 

• Vitamin C

Pros: taking regular daily doses may reduce the duration of the common cold, but it won’t stop you getting colds in the first place, and won’t reduce severity of symptoms if you do catch a cold.

Cons: Consistent preventive dosing would be needed and the benefits are little if any.

 

• Zinc tablets/capsules:

Pros: if taken in the first 1-2 days of a cold, these might reduce how long a cold lasts.

Cons: benefits are slight, and it should never be used in spray form as it can lead to permanent loss of one’s sense of smell

 

• Other methods: There is little or no evidence to support many herbal or complementary treatments such as Chinese Medicine, garlic, or echinacea. In many cases, more research of a higher quality  is needed. Homeopathic remedies do not work.

 

 “Sorry doc, I hope this isn’t a waste of your time” is a commonly heard phrase in our daily clinics. This is normally followed by an awkward look as though the patient is embarrassed to raise the troubling question that they can’t get out of their head. Today we have access to a world of information in the palm of our hand which is truly amazing- but for some reason, this seems to provide more questions than answers at times. Indeed, “Dr Google” has become a well-known phrase for using Google Search to find the answer to any medical dilemma. As GPs we understand this, and a fundamental part of our job is to discuss our patients’ concerns and reassure them when the need arises.

Remember we will often have been patients or anxious parents ourselves, so we know exactly how it feels when you or your loved ones have symptoms and are worried about what could be wrong. It is human nature to think of the worst possible conditions- and it is often at this time that we look for answers and reassurance. Often at this time, we turn to our GP. As a GP, providing a reliable, understanding point of view is just as important as knowledge of how to diagnose and treat conditions. At Dr. Sicknote we provide online medical certificates and other services, but should you have any specific concern or worry, we will always listen to you and answer to the best of our ability.

So remember, the next time you have a question or concern that you just can’t get out of your head, don’t ask Dr Google, ask your GP. It’s never a waste of our time.

by Dr Ali Zavery

These days we are all used to dodging pedestrians who are too absorbed with their smartphones to bother watching where they are going. Over the past week, you may have noticed higher numbers of such people, wandering about the streets with their heads down and eyes glued to their screens. If so, you’ve probably had your first glimpse of the new phenomenon that is “Pokémon Go”. Pokémon Go is an “augmented reality game” –an app which superimposes a game onto the real world. Players walk the streets trying to catch Pokémon characters that pop up on their screen- and they are awarded in-game candies or stardust for successful “catches”. The game tends to result in groups of players flocking to certain public places- wherever the Pokémon characters are to be found.

Anyway, as with most things in life, this new craze is not without health risks- there are already reports of physical injuries, with people getting so engrossed that they have ambled blindly into walls, ditches and oncoming traffic!  Worryingly there have also been reports of people playing the game whilst driving, and even cases where petty criminals have used it to identify or lure “muggable” targets who are so focused on the virtual world they forget to pay attention to risks in the real world!

There are, however, some potential health benefits to this new hobby- it’s fair to say that a lot of previously sedentary gamers will now take to moving about and will easily hit their “10,000 steps a day” without trying very hard! And who knows, they may end up exploring and interacting in their cities and communal urban spaces in new positive ways.

With every passing year the blurring of lines between the real and the virtual continues. Most kids now grow up with devices as standard extensions of their brain and body. This technology can allow them to ask questions, store information, entertain themselves, and constantly communicate in real time with friends (or strangers!) if they so wish. They also have the ability, from an early age, to carefully craft a particular image of themselves and to project this “avatar” to the world via social media.  And this is only the start- most people agree we are still at the very edge of what is possible with this technology.

Healthcare, just like all other aspects of life, will become more accessible in this real-meets-virtual way. In fact, the Pokémon Go generation will undoubtedly expect it to- as part of the way they live. At Dr Sicknote we are a group of real-world “traditional” family doctors- but we are also part of a virtual heath team. We now live in the devices of our patients alongside Facebook, Snapchat, and Pokémon Go! The doctor- patient relationship is such a personal thing, that the big challenge will be to provide people with the healthcare they need (and increasingly now expect), in this online virtual world. But we must also hold on to the real human connections behind these virtual interactions- and that is what we, as a team of online doctors, intend to strive for.

Dysmenorrhoea is a medical term for period pain that is bad enough to affect a woman’s usual daily activities. Sometimes I think non-sufferers don’t fully understand just how bad dysmenorrhoea can be.  As a GP I have seen women and girls reduced to total misery on a monthly basis- with fainting, vomiting, diarrhoea, and agonising abdominal and thigh pain. Often, even with bedrest, hot water bottles and painkillers, the symptoms for the first few days of a period can be almost unbearable. And then there is the depressing knowledge that this horror will return again and again.

Certain risk factors for dysmenorrhoea have been identified. It occurs less often in women who have had their children earlier in life, and in women who exercise more. It is more common in women whose periods start before the age of twelve, women who have a low body weight or who are obese, and in women who are smokers- especially girls who start smoking in their early teens.

So what can be done about it? Well, it’s important to see your doctor to exclude underlying causes- such as endometriosis, fibroids, adenomyosis or pelvic infection. There may be a need for a physical examination, testing for STIs (sexually transmitted infections), and sometimes a pelvic ultrasound scan.

To help with the pain, anti-inflammatories, also known as NSAIDs, are often a good place to start (assuming you have no contraindications to these meds- always check the patient information leaflet if unsure). These include Ibuprofen (Nurofen), Diclofenac (Voltaren) and Mefenamic acid (Ponstan). Mefenamic acid can reduce the heaviness of periods too. But here’s an important fact that a lot of women don’t know- anti-inflammatories will minimise pain only if they are taken very early in a period, or just prior to a period- before prostaglandins get a chance to form in the uterus (womb).

So, what are prostaglandins? Well, in dysmenorrhoea, the uterus works harder than normal to shed its lining and the resulting contractions lead to pain. The hormone-like compounds that cause these contractions are called prostaglandins. If you prevent prostaglandins forming in the first place, by taking an anti-inflammatory, the pain may be a lot less. However, once prostaglandins have formed, the “period genie” is well and truly out of the bottle, and the pain can be hard to reverse.

If you want to reduce period pain to a minimum, anti-inflammatories need to be in your system as soon as possible when the period begins, and ideally some hours beforehand. This may involve careful tracking of period patterns to stay one step ahead of the game each month- but it can be really worth it. Smartphone apps can be helpful with tracking, or just an old fashioned calendar!

The contraceptive pill or an intrauterine device such as the Mirena coil, can be helpful. These options obviously make sense if a woman also needs birth control, and are worth discussing with a GP.

So here are the take home messages- consider EARLY use of anti-inflammatories, try to exercise more, avoid smoking, maintain a healthy weight, and consult your doctor to exclude underlying problems, and perhaps to explore further treatment options.

by Dr Aifric Boylan