Our practitioners are able to manage all common childhood health issues. They can provide nutritional advice (including breastfeeding advice), immunisations and assessment of growth and development.
They are able to assess and provide management advice on issues such as bed wetting and delayed toilet training and behavior problems.
If your child has allergy or you think your child has an allergy, our doctors and dietician can make an assessment and provide tailored advice and management.
No matter how positive or optimistic your usual nature might be, being told you have cancer turns your world upside down, at least for a while. The first reaction is usually one of shock, or surrealism, “This can’t be happening to me!” You might have had dozens of routine screening tests, never really expecting one to come back with bad news, or you might finally have an explanation for symptoms you have been experiencing.
Once you are told the likely diagnosis, you will initially have a million questions:
“Why me?”
“How did this happen?”
” What does this mean to me and my family?”
“What are my chances of recovery?”
“What specialists will I need to see and what treatments will they recommend?”
“What else can I do to improve my chances of a cure or remission?”
You may also feel many conflicting and intense emotions: fear, anxiety, despair and hope.
You will be faced with a barrage of tests and information, which can be confusing and have you feeling scared and powerless. The advice you are given and the decisions you make will determine what treatment you have, and this will in turn help to determine your future. It is important for you to know that you are not powerless. The more information you have, the more confident you will feel to engage in the decision-making process. Obviously you will rely heavily on the experience and advice of your medical experts, but once you have that information, you are the one who will have to make the final decisions and give informed consent for any treatment.
Immediately after diagnosis, your doctors will guide you towards treatment options with a variety of goals:
These “cancer-specific treatments” will be recommended by your GP, surgeon, medical oncologist or radiation oncologist.
It is possible that you will also be offered treatments which fall outside of the mainstream biomedical “surgery, chemotherapy, radiotherapy, immunotherapy” set. More commonly though, in my experience, people find they have to proactively hunt around outside of established mainstream cancer services for advice on the additional treatments they can use to help make the cancer treatment process easier and, possibly, more effective.
Advice on whether a cancer-specific treatment is warranted at all, or which combination of chemotherapy is right for your particular cancer, or which radiotherapy or surgical procedure is best in a particular case is a matter for individual assessment. It is also a fast-moving field where new treatments come along all the time, and clinical trials are conducted to test them. If new treatments prove themselves in clinical trials to be superior to existing treatments they will become part of the generally accepted treatment protocol.
In my experience, patients will attend our clinic at a variety of stages along their cancer journey.
There are those patients who see our doctors and other practitioners regularly for their usual health screening or disease management, and we may have detected their cancer as part of their regular healthcare process. We may have arranged the investigation of symptoms such as a lump or pain or a change of bowel habit that led to a cancer diagnosis.
Where we are involved in a patient’s care from the outset, we are able to guide them to the right specialists and integrate and interweave adjunctive therapies safely throughout their cancer-specific treatment including preparation and support throughout treatment.
In many cases, patients seek us out because they have already been diagnosed with cancer and want a plan for getting through treatment. Some patients are able to work with their general practitioner to put together an integrative plan, but unfortunately some patients encounter resistance or hostility to the suggestion of some treatments that are considered to be outside of the “mainstream”.
Then there are the patients who have been through cancer-specific treatment without integrative support and find their way to us because they are struggling with their recovery. Treatment has left them feeling fatigued, drained, depressed and depleted.
With the right information and professional guidance, you can protect yourself from some of the negative impact of cancer treatment on your physical and emotional health.
There are many lifestyle changes, activities and adjunctive or “complementary” therapies that you can apply alongside your specific cancer treatments that will make things easier for you by relieving or preventing side effects, improving the effectiveness of specific treatments or helping you to rehabilitate physically and emotionally.
EXCERPT FROM “THE CANCER RECOVERY GUIDE” by Prof Kerryn Phelps AM
I have been suffering lower back pain for some time. I admit I’m about 20kgs overweight, but could this really be affecting my back?
Being overweight definitely contributes to back pain. Excess weight, particularly if it is carried in your mid-section, creates an abnormal posture of the spine and puts an extra strain on the muscles and ligaments in your lower back. Osteoarthritis of the spine is also a common cause of low back pain and is more common in people who are overweight. A physiotherapist can help you with exercises to strengthen the muscles in your back and core. Our dietician Jaime can help you with an eating plan for weight loss, and our acupuncturist Amanda can help pain management with acupuncture.
I have heard that it’s possible to manage back pain (or any chronic pain) using a type of thinking. Could you explain how this works please?
There is growing concern about the use of strong pain medication for chronic low back pain. Strong motivation to get better and an optimistic outlook are known to improve results for people with chronic back pain. Psychological treatment to learn pain management skills (such as pain distraction and relaxation/stress management techniques) is also beneficial. Research tells us that mindfulness meditation and cognitive behavioural therapy often work better than pain medications and other medical treatments for chronic back pain. Dr Lucy Herron has a special interest in mindfulness.
I sit for long periods at my desk each day and always leave work with an aching back. Is there anything I should be doing to help myself during the day?
Prolonged sitting is hard on your back. Even though you have a job that requires you to be at your desk for long periods, there are some things you can do.
For years, I’ve been a jogger but now my back pain is so bad I can’t run anymore. I thought I was doing the right thing by exercising and now I learn I’ve been harming myself. What are some good exercises for people with back pain who want to remain fit?
You can’t necessarily blame the jogging for your back pain. I would suggest you get an individual exercise program from a sports physiotherapist or exercise physiologist. Generally speaking though, it is essential to keep your muscles well-toned and your level of aerobic fitness up. Find types of exercise that challenge you but do not cause pain. For example walking, some swimming strokes, aquafitness, Tai Chi and yoga (the instructor will need to know you have back problems) can keep you moving. Make sure you do a series of gentle stretches before and after exercise.
Is it better to choose a chiropractor, an osteopath or a regular physiotherapist to get help for an aching back?
There is no simple answer for this question. Some people find that a particular approach or a specific health professional is able to help them with their back pain where others might find that a different approach works for them. Most people with mechanical low back pain find a combination of physical “hands on” therapy, analgesia, back exercises and back care instruction most helpful. First try to confirm the cause of your back pain.
When would a doctor recommend surgery for back problems such as a prolapsed disc? How successful is back surgery?
The majority of people (around 90%) with a prolapsed disc get better without surgery. You would need an MRI and a surgical opinion if your symptoms were still causing problems after 3 months or if there were signs of significant pressure on a nerve. Surgery involves removing the protruding part of the disc to make more room for the nerve being compressed, and it has a high rate of success in expert hands. If you have difficulty with bowel or bladder function, decreased sensation around your genitals, or progressive leg weakness, this may be an indication of a medical emergency. These days, minimally invasive surgical techniques are used where the scar is very small and recovery is expected within weeks. If you are considering surgery, talk to your surgeon at length about the technique, possible dangers and expected recovery time.
For years in my youth, I sunbaked and now I’m paying the price. I’m 70 and the spots vary in size and in colour from beige to grey to dark brown! It looks awful. Surely there is a solution?
There are various cosmetic techniques to remove pigmentation from sun-damaged skin. Options include topical peels, laser, IPL (intense pulsed light), dermabrasion and bleaching creams. A regular skin check for early signs of skin cancer will be essential for you too. One of our GPs can assess you and a cosmetic dermatologist can advise you on the best approach for your skin type.
Is there a way of treating keratosis pilaris?
It’s a common genetic condition where there are rough follicular spots, which may be skin-coloured, red or brown. It is usually on the upper arms, but can be on your back, thighs, cheeks and forearms. Use a non-soap cleanser and rub the affected area gently with a pumice stone or exfoliating sponge in the shower or bath. Then moisturise regularly. Topical retinoid creams may help.
I get terrible reactions to mosquito bites. The other day, my hand blew up and my wrist looked like a pie. I take an antihistamine, which does help with the swelling, but is there anything else I can do?
Some people do react to mosquito bites worse than others. The main strategy is to avoid being bitten, so make sure there are insect screens on your doors and windows, and wear long sleeves and pants when mosquitos are about. Eliminate standing water around your home. You can apply a mild hydrocortisone cream to the sting and take an antihistamine to calm down stronger allergic reactions.
How do I know if a painful rash on my side is shingles?
Shingles is caused by the varicella-zoster virus and is characterised by clusters of painful tiny blisters along the distribution of a nerve. It is caused by reactivation of the chickenpox virus. Pain can persist once the rash subsides. Definitive diagnosis is by a swab testing for virus in the fluid sampled from a blister. Get to your GP within 72 hours of the rash occurring to start treatment with anti-viral medication. Ask about a vaccine available for older adults.
I have white spots on my chest. Are these sun spots? Should I be worried?
White spots could be anything from vitiligo to pityriasis alba. It could also be fungal, dermatitis or sun-related. Obviously, it’s best for your GP to look at it.
I’m 33 and have a pimple on my face that won’t go away. It’s been there for a few weeks now. Is it likely to be skin cancer?
It might be a pimple or a sebaceous cyst. If you are concerned about a lump or a mole that has changed, or a sore that doesn’t heal, you need to see your GP to have it assessed and also have a general skin check.
I don’t sunbake and I protect myself from casual sun exposure, but I do have sunspots. Do I still need to get them checked regularly for skin cancer?
Check your own skin or have a friend do it every three months. Don’t forget tricky areas such as underarms, hands and feet, ears and scalp. An annual skin check with your GP is an important preventative measure. If any sunspots grow, change colour, or itch or bleed, see your doctor urgently. Skin cancer risk rises if you have fair skin, a history of sunburn, abnormal or irregular moles, a family history of skin cancer, weak immunity, or you are ageing. Your sun exposure in childhood has a delayed effect in later years.
I’ve read that having wrinkles on your face is a sign of thin bones. Is this true and, if so, what should I do about it?
Researchers at the Yale School of Medicine tested this theory on women within three years of menopause. They found that the firmer the skin on the face and forehead, the greater the bone density, and more wrinkles meant lower bone density. At this stage, it is just an observation, so bone density testing is still the best way to assess the risk of fracture from osteoporosis.
Many people suffer common gut conditions without even realising it. These conditions can cause a number of symptoms that are often overlooked, like:
Human beings have known for many, many years that the gut is important for the digestion of food and the absorption of food. But we’re now on the threshold of a major revolution in the way we think about the gut and its relevance to our health. Only now are we beginning to realise the marvelous complexity of the gut and its functions. The functioning of the gut not only governs the absorption of nutrients, but also modulates the immune system, influences brain function and can also affect other parts of the body, such as the skin, muscles and joints.
In our practitioners Dr Phelps, Dr Lee, and Jaime’s new book ‘The Mystery Gut’, they explain the latest science behind gut health, how to work out what’s going on, and what to do about it. Dr Phelps, Dr Lee and Jaime decided to write the book after seeing firsthand the dramatic improvement in people’s lives when they address their ‘mystery gut’.
Call us to discuss how you could rejuvenate your ‘mystery gut’. Contact details here .
People often hear the terms “iron deficiency” or “anaemia”, but what do these terms mean and why is it important? Some research studies have quoted up to 20% of the Australian female population having iron deficiency.1 For women post-pregnancy, this proportion is even higher and can be cause for a number of symptoms. But how do you know if you are “iron deficient”? Then, most importantly, if you are iron deficient, what can you do about it?
We asked Dr Natasha Feingold, an experienced GP who frequently treats iron deficiency at the Bourke Street Clinic, to answer a few questions about this condition and find out what the buzz is all about.
“Iron deficiency is EXTREMELY common. We see it in General Practice everyday and it’s something that can have a significant impact on your life,” says Dr Feingold. “There is a difference between iron deficiency and anaemia: iron deficiency means you don’t have enough iron in your system, which is what’s needed to make healthy red blood cells. Anaemia is when you don’t have enough red blood cells, but it can be caused by all kinds of things, not just iron deficiency.”
Symptoms of iron deficiency include:
– Lethargy
– Headaches
– Dizziness
– Shortness of breath
– Chest pain
– Pale skin
– Palpitations
– Brittle nails
– Painful, inflamed tongue
Research studies suggest that two out of five Australians are having an inadequate amount of iron in their diet2.
“If you have any of the symptoms mentioned, it’s important to have a fasting blood test to check what your haemoglobin and iron levels are,” says Dr Feingold. “If you are iron deficient, it’s also important to investigate what is causing the iron deficiency.”
Being deficient in iron means one (or more) of these three things:
Dr Feingold has a word of warning, “When I discover that someone is iron deficient, it is of utmost importance to me that each possibility is investigated. I think a lot of patients are just told to go on some iron supplements without properly identifying the actual cause.”
Figuring out why someone is iron deficient includes things like reviewing one’s diet, doing more blood tests (and sometimes stool tests), and sometimes having a camera look inside the gastrointestinal tract. The practitioners at Bourke Street Clinic are well-versed in following up patients who are found to be iron deficient and/or anaemic.
“While we are investigating the cause, it is still very important that iron deficient patients supplement their intake with either tablets or an infusion,” says Dr Feingold.
At Bourke Street Clinic, we are one of the few General Practices in Sydney who can perform our own iron infusions for our patients. Our doctors not only assess you and provide the infusion, but they also monitor you throughout the infusion to ensure your safety. The entire process takes about 30 minutes and many patients can come in on their lunch break and go straight back to work or home without it disrupting their schedule. Public hospitals also offer iron infusions, however, it can take up to half a day to get the procedure done.
“Improving your iron can have amazing effects on one’s health. We are seeing more and more research come out about better outcomes in pregnancy, heart failure, and ADHD, just to name a few conditions,” adds Dr Feingold. “Not only can it boost your energy levels but it can help prevent further complications that can make you really sick. Iron supplementation is such an easy fix, yet some patients aren’t aware that this type of treatment can be done in a general practice setting.”
If you are interested to talk more about iron deficiency and its treatment, don’t hesitate to make an appointment to talk to Dr Natasha Feingold about the process and whether you are an appropriate candidate for an iron infusion.
Reference:
1: Ahmed F, Coyne T, Dobson A, McClintock C. Iron status among Australian adults: findings of a population based study in Queensland, Australia. Asia Pac J Clin Nutr. 2008; 17(1): 40-47.
2: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.008~2011-12~Main%20Features~Iron~402#2
In today’s busy world with the juggle of work, personal and family commitments, it is VERY commonplace to find yourself asking, “Why am I so tired all the time?”
Dr Natasha Feingold is a well-respected GP at Bourke Street Clinic who has extensive experience with her patients asking this very question so we asked her to shed some light on this very important topic.
“Almost everyday a patient comes in asking me why they are so exhausted. I think it’s easy to blame lethargy on modern society and ever increasing levels of stress, but I also think it’s important that patients find a good, thorough GP who can investigate their symptoms,” said Dr Feingold.
Some common causes of tiredness include:
– Thyroid dysfunction
– Iron deficiency
– Anaemia
– Depression
– Menopause
– Sleep apnoea
– Heart disease
– Diabetes
– Hormone deficiencies/abnormalities
– Medication side effects
“Some patients tell me that they have had blood tests done and they were all normal, so they were told that there’s not much more a doctor can do. Unfortunately, some of these patients haven’t been asked about their sleep patterns, their diet or even their mental health, which can all contribute significantly to their energy levels. It’s also very important to me that my patients get a proper work up which might include tests that are more specialised, if necessary.”
At Bourke Street Clinic, we pride ourselves on listening to our patients and making sure no stone goes uncovered when investigating their complaints. We also work as a multidisciplinary team with our dietician, psychologist and other local allied health professionals to ensure that you are getting the best, most holistic care possible.
“The greatest part about working at Bourke Street Clinic is that I am able to spend a great deal of time with my patients. We are not the type of practice that promotes churning through patients. All the practitioners here share a strong commitment to understand the needs of our patients and provide compassionate, good quality health care.”
If you are looking to take charge of your health, Dr Natasha Feingold is currently accepting new patients and would be happy to speak with you about your tiredness and how we can diagnose and improve your symptoms.
