Archive for the ‘Toowoomba’ Category

The delayed 2016 Influenza Vaccine

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Dr Cormac Carey, Medical Director, TMA Toowoomba

With the 100th birthday of CSL coinciding with Anzac Day this month and the first zephyrs of Winter’s winds arriving it is time to look at the turmoil re this year’s rollout of the 2016 influenza vaccine which has been anything but smooth. CSL started producing influenza vaccine in 1944 along with the mass production of penicillin which was widely used by both Australian and Allied troops in the closing stages of World War Two.

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Q Fever “Gangnam Style” Toowoomba

Our Toowoomba members’ clinic has been very busy all year with Korean backpackers seeking Q Fever Vaccine prior to working at the local meat works.

This initially presented a few problems with language barriers but we have  had the Q  Fever pre vaccination questionnaire translated into a Korean format (many thanks to Jon Barrell TMA member in Daylesford Vic) .

Other News from the Toowoomba Clinic

Our Wilsonton practice has just completed a much needed makeover with new carpets and a complete repaint, which has drawn wonderful compliments from both staff and patients alike.

We have two new doctors Dr Richie Jaggi and Dr Emma Gradner-Smith also doing weekly sessions which has improved our ability to provide extra appointments.

Our nursing staff pool has also expanded and we have now have four dedicated travel medicine nurses, Natalie Webb, Rebecca Eaton , Belinda Rowney  at  the Wilsonton Medical Centre  and Emma Kropp.

New TMA  Member  at  Brookwater/Springfield

My Life Medical Group opened a new state of the art General Practice within the Mater Health Centre  at the entrance to Brookwater Golf Club earlier this year.This a rapid growth area of South East Queensland and a new direct rail line opens there very shortly.  Dr Cormac Carey is providing travel medicine  consultations  at the clinic and appointments can be made on 3199 3299.

 

Happy Q Fever Patient

Happy Q Fever Patient

Brookwater Clinic

Brookwater Clinic

 

 

 

 

 

St Andrews Hospital Practice

St Andrews Hospital Practice

 

 

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dengue fever outbreak in USA

Prepared by TMA member Toowoomba/Brookwater

For  most travellers to the USA the risk of dengue fever would low on the list of health issues,  however the following report of a dengue fever outbreak adds a sobering reminder to practice  mosquito avoidance measures even in first world countries.

According to the Texas Department of Health, 6 laboratory-confirmed, locally acquired cases of dengue fever, the first locally acquired cases since 2005, have been reported in Cameron County in southern Texas State since early November 2013. Additionally, 23 laboratory-confirmed, locally acquired cases have been reported in Martin, St. Lucie, and Miami-Dade counties in Florida State since August 2013. Sporadic cases without sustained transmission are reported in central and southern Florida State each year. Travellers are advised to practice daytime insect precautions.

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Rabies in Congo

Prepared by TMA member Toowoomba/Brookwater

In August 2013, Médecins Sans Frontières (MSF/Doctors Without Borders) started a rabies intervention in the east of the Democratic Republic of Congo after an alarming number of people were bitten by rabid dogs, and at least 10 people died. Doctors will provide PEP to people bitten or scratched by a suspected rabid dog in the Lemera region in the province of South Kivu this hyperlink.

Rabies in Congo pic

MSF teams struggle to help in an isolated area of South Kivu

After decades of conflict and instability in the Democratic Republic of Congo, measures to control canine rabies have not been implemented, and data on the size of the problem is simply not available.

“The current rabies situation now affecting humans in Lemera is exceptional and must be urgently addressed,” said Dr Jantina Mandelkow, who is leading the MSF team. “We’re doing all we can but we urge others to recognise the severity of the situation and commit resources to its containment and resolution.”

– See more at: https://rabiesalliance.org/media/news/rabies-control-measures-implemented-in-dr-congo#sthash.8vJCL33A.dpuf

MSF teams struggle to help in an isolated area of South Kivu

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Traveller’s Thrombosis

 … Prepared by Dr Cormac Carey – TMA member Toowoomba

Travellers Thrombosis or Deep Vein thrombosis (DVT) is a rare but dangerous medical problem which occurs when blood in the legs of travellers clots. The serious problems occur when the clot dislodges from the leg and moves to the heart or lungs where it interferes with their performance.

While it is several years since “Economy Class Syndrome” entered our travel jargon the recent release of newer and safer anti- clotting agents make it pertinent to reappraise our approach to this issue. In practical terms, risk factors need to be identified and their importance weighed against appropriate medical advice for each individual traveller.

Risk factors for travellers thrombosis

The following factors may increase an individual travellers’ risk of suffering a thrombosis during travel:

  • Flights longer than 5 hours
  • Family history of abnormal clotting
  • Genetic clotting disorders
  • Recent lower limb surgery
  • Recent soft tissue injury of lower limbs
  • Pregnancy or shortly after delivery
  • Recent abdominal or pelvic surgery
  • Cancer
  • Female smokers who take the contraceptive pill

Persons with more than one risk factor are at even higher risk; E.G. Use of hormone replacement therapy in a woman, coupled with a genetic predisposition can lead to a thirteen times increased risk compared to the average traveller.

Perhaps the most important risk of all is having had a past episode of a Deep Vein Thrombosis with no recognised obvious trigger.

Some travellers have no particular risk factors. In that case, exercises as described on the aircraft instruction cards, plus plenty of water e.g. 200mls per hour are sensible precautions.

Low Risk Travellers

This would include persons over 40 years of age, overweight, or who have had recent minor surgery.
This group would be recommended to do as per low risk plus flight socks or grade 1 wear compression stockings
Note that persons with diabetes should seek medical advice before wearing any compression stockings.

Medium Risk Travellers

People aged over 50 years, previous DVT or pulmonary embolism (clot on lung), recent lower limb injury, treatment for heart failure, or women who have had a baby less than 6 weeks earlier.
Consideration should be given to booking an aisle seat, and wearing grade 2 compression stockings. Such stockings provide 20-30mmHg compression and only need to be knee high. They should be tried well in advance of the flight, as they can be difficult to put on when new.

High Risk Travellers

This category includes persons who have had DVT within the past twelve months, persons with a lower limb in a plaster cast or immobilizing splint, who have had a recent stroke or heart attack or major surgery within previous three months.
In addition to exercises, fluids, and aisle seat, consideration would usually be given to taking injections of low molecular weight heparin to lessen clotting during flight. Patients already on warfarin do not need heparin as well.

Persons who are hesitant to give themselves an injection prior to a flight, or who will have trouble carrying and storing injectible medication, will be happy to know there is now a medical breakthrough. There are new oral anti-clotting agents e.g. rivaroxaban. This is a prescription medicine that has been shown to prevent deep vein thrombosis in patients following hip and knee replacement surgery. Common dose for travel is one tablet daily, on the day before the flight, the day of the flight and the day after the flight.

Like all medications including the injectible heparin there is a potential for bleeding in the event of an injury, or a risk of interactions with other medications. The treating travel medicine doctor would consider these factors.

Aspirin

There is still no evidence that aspirin is helpful in preventing DVT as it affects the platelets and stops arterial clotting, but has very little effect on clotting in the veins. Users may experience side effects and be lulled into a false sense of security. If a person has significant risk, they should be on effective anticlotting medication as noted above.

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Travel Health Information

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