Archive for the ‘Boronia’ Category

Going Home To Visit Grandma

Dr Chris Davenport , TMA Boronia

 

It’s Monday morning, another busy day in General Practice filled with the usual interesting patients – for blood pressure reviews, medication repeats, women’s health discussions and children with the latest coughs and colds.

7-year-old Alice has come with her mother for a review of her eczema. It’s the school holidays and I ask what the holidays will hold for her.

“We are going on a holiday to see my Grandma,” she replies, “ She lives in Vietnam, where Mum and Dad came from and we are taking our new baby to see her”

They are leaving in a few days, travelling to stay with their grandparents and catch up with the extended family. The children had been born in Australia and this was to be their first trip “back home”. They were up to date with the Australian childhood vaccinations but no thought had been given to obtaining travel advice or vaccinations.  “As they were just going home.”

This is a common scenario, where families return to their country of origin to visit friends and relatives without seeking travel advice.  Or some families present asking for vaccines for the children while assuming that they (the adults) will be OK. They feel they know the risks, grew up in that environment, feel comfortable and assume all will be well.

However, Immigrants and their children who return to their country of origin to visit friends and relatives (VFR) are at increased risk of acquiring infectious diseases compared with other travellers.  (Heywood, et al., 2016)Several studies have shown that of all Australians returning from overseas with an infectious illness 65% are from the VFR group, whereas the VFR group only makes up 23% of Australians travelling.

VFR travellers are a large and important group as one-quarter of Australia’s population were born overseas and do travel “home” to visit family.

Their risk is higher due to several reasons.

They have a lower perception of risk as they are familiar with the destination. There is a perception of protection from prior immunity developed in childhood – an immunity that may have waned since leaving their home country.  Their children have not been exposed to the diseases and infections common in their parents’ place of origin. They are more likely to travel to resource-poor settings and have a longer duration of travel than those travelling for tourism or business. VFR travellers are more likely to have closer contact with the local population e.g. while catching up or living with extended family, close contact with large groups, the children playing and in close contact with family members. They are more likely to consume local water and less likely to be concerned with Malaria prevention. As a group, they are less likely to be vaccinated prior to travel compared with holiday traveller for the reasons mentioned above.

It is important to discuss travel and prevention of infectious disease when opportunities like this present themselves, and important too, to discuss with the adults that they may also be at risk.

 

Mekong Delta

 

 

Bibliography

Heywood, A. E., Zwar, N., Forssman, B. L., Seale, H., Stephens, N., Musto, J., . . . MacIntyre, C. (2016). The contribution of travellers visiting friends and relatives to notified infectious diseases in Australia: state-based enhanced surveillance. Epidemiology and Infection, 144(16), 3554-3563. Retrieved 1 30, 2020, from https://ncbi.nlm.nih.gov/pmc/articles/pmc5111124

 

 

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Sigiriya, Sri Lanka 

Travel Recommendation; Sri Lanka

Ayubowan Readers! “Ayubowan” is the word used in Sri Lanka to greet someone

Sri Lanka is a small Island off the south east tip of the Indian subcontinent. Measuring a total area of 65 610km, it is home to 20.5 million people (2013). Until 1972 the island was known as Ceylon, however still goes by many other names such as “The pearl of the Indian Ocean” and “The teardrop of India”. Colombo is the nation’s commercial and capital city. 

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Decompression Sickness ( The ‘ Bends ‘ )

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Prepared by TMA Member Boronia 

Decompression Sickness (DCS)  is also known as Acute Decompression Illness (ADI) or, more colloquially, as the ‘bends’ (because the pain involved can bend a person).

DCS in the setting of scuba diving or deep-sea diving, refers to an illness caused by an overly rapid ascent to the water’s surface.

During a scuba dive, the diver absorbs additional quantities of oxygen and nitrogen into the blood and tissues.  The nitrogen is dissolved into the bloodstream, where it remains during the dive.  Once a diver begins their ascent,  the surrounding water pressure decreases. If this transition occurs too quickly, the nitrogen does not have sufficient time to leave the bloodstream and be exhaled via the lungs.  Instead, nitrogen bubbles form in the bloodstream which can enter tissues throughout the body.  

Factors increasing risk of DCS

 

  • Increasing Age
  • Being female
  • Poor fitness
  • Obesity
  • Dehydration
  • Alcohol / hangover state
  • Fatigue / sleep deprivation
  • Sickness
  • Heart muscle defects
  • Ventricular wall defects
  • Airways disease (eg. asthma)
  • The rate of ascent
  • Flying after diving
  •  Repetitive dives
  • Exercise after diving

 

Symptoms of DCS

 Approximately fifty percent of divers with DCS develop symptoms within 1 hour after surfacing, 90 % within 6 hours and 98 per cent within the first 24 hours.

Generally, the sooner the symptoms develop, the more serious the DCS is likely to be.

DCS symptoms vary significantly because nitrogen bubbles can lodge in different parts of the body.  The symptoms experienced are largely determined by the where the bubbles ultimately lodge. eg.  bubbles that lodge in the joints will cause joint pain; bubbles under the skin can cause a blotchy rash/itching; bubble formation in the spine may lead to limb weakness/ paralysis, etc.

 

  • Joint pain (most common).
  • Dizziness.
  • Headache.
  •  Nausea.
  •  Vision disturbance.
  •  Skin changes (blotchy rash, itching).
  •  Disorientation.
  •  Extreme fatigue.
  •  Loss of consciousness.
  •  Hearing problems.
  •  Difficulty breathing, coughing.
  • Tingling/numbness.
  •  Muscle weakness.
  • Paralysis.

 

Early Management of DCS

Seek medical treatment as soon as any symptom of DCS  is noticed.  If available, apply 100% oxygen by mask ASAP to help relieve some symptoms and reduce oxygen-deprived tissue injury. Treat dehydration, maintain blood pressure and prevent shock.

Hyperbaric oxygen therapy in a high pressure chamber reverses the pressure changes that cause the nitrogen bubbles to form. The bubbles redissolve and can then be exhaled by the lungs.

Decompression Picture

 

Prevention of Decompression sickness 

Avoid flying within 24 hours after diving (increasing altitude during a flight will further decrease pressure in the bloodstream, hence potentially increasing bubble formation and exacerbating injuries).

  • Avoid alcohol before diving.
  • Maintain good hydration.
  • Be well rested prior to dive.
  • Avoid diving when sick/weak 
  • Dive within the limits set out in the diving tables. (Be wary of fudged diving tables.)
  • Avoid hot baths, spas and saunas soon after diving.
  • Choose dive destinations where hyperbaric chambers can be reached rapidly.
  • Know the location of the nearest hyperbaric chamber.

 

Divers’ Emergency Service (DES)

This is a free phone consultation service for diving-related medical emergencies. They can also provide the location of the nearest hyperbaric chamber.

24 Hour Hotline:

ph: 1800 088 200 (toll free from within Australia)

618 8212 9242 (if calling from  outside Australia

 

 

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Travel Health Information

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