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Update Telehealth

Unfortunately with Covid19, we are back to telehealth for the time being. If you have some issue that requires a physical examination please discuss with my staff. With masks and distancing a face to face appointment is manageable. For other patients, we will defer routine breast examinations for a recall date in September or October. Remember this is intended to protect all patients and staff and their families, but particularly those patients who are immunosuppressed.

Please endeavour to be set up for Doxy.me with an appropriate device. This is far preferable to a phone call. Please allocate the time and be in the right physical and mental space for a discussion. Have a pen and pad ready for any notes and have questions prepared and support people sitting with you. Having a consultation whilst driving or walking the dog is not ideal and will be unlikely to result in a quality outcome.

Most have so far been supportive of this process. Please note that telehealth should not be regarded as an inferior consultation and it should not be expected to be discounted. The consultation still requires expertise, thought, a letter to the GP or referring doctor and more work from my administrative staff faxing and posting scripts and investigation requests than usual. We have also had numerous requests for letters for work and travel exemptions that take time. Your understanding at this time is much appreciated

Telehealth

Dear all, given the current situation -our rooms have moved to teleconferencing or phone calls for appointments unless there is an extreme need for a face to face appointment. This is with the intention of protecting; 1) the patients, who may be at higher risk of significant infection from age or. being immunocompromised, and; 2) the staff, because we cannot guarantee backup if we fall ill.

There is government funding to bulk bill patients deemed at risk of COVID 19. This funding does not realistically support the cost of a private practice in the medium term and we may still need to charge you a private fee rather than use the bulk bill consultation code depending on the time of the consultation, the need to post scripts, dictate letter and so forth.

With regard to the choice of teleconferencing or phone, I would much prefer to ‘see the patient’ by video. I am using encrypted software (doxy.me) for privacy. This will work best on a computer, especially with a direct Ethernet connection rather than WiFi although the latter is reasonable.

These consultations are intended to be equivalent to a room consultation, without the examination. Please take the time to eliminate distractions at home so you can get the most value from your consultation. I recommend you have a pad and pen ready, with prepared questions as you might when you normally come to the rooms.

The Doxy.me will also work with any smartphone. We can either email the link to your computer or SMS it to your phone. All you need to do is accept the link. Please contact Melissa if you have any concerns by phone or email.

I am hoping this will only be short term, although I can see the advantages in the future for telehealth when a short chat is required without an examination.

Good luck, stay well and #stayathome. Shane

Covid-19

Dear all , this is a difficult and stressful time for all- whether patients, families or health providers, united also by a risk of catching the same virus that has plagued many areas of the world.

For many this will be a common cold experience. for some, a more significant health event. At a community level common sense ‘social distancing’ (> 1.5 m) and hand washing are our best defences against a (too) rapid escalation of the infection in Melbourne. The slower the rate of infection, the better chance hospitals and GP practices will have to help you. I think working from home if feasible is wise for all and minimising public exposure particularly in groups.

At a personal level, this is stressful for everyone. Be compassionate and supportive of friends and strangers. If you are age >70, have a chronic condition or have a weakened immune system there is the opportunity through Medicare to videoconference or phone conference appointments whilst this crisis lasts. We may utimately encourage all patients to avail themselves of this service while the crisis lasts. Please email or call us to discuss this in more detail.

I would recommend those elderly patients or those on chemotherapy or with advanced cancer go to greater lengths to physically isolate at home when you can. Have one or two key family or friends who can provide support including delivery of essentials. Stay connected with others via the phone or Facetime or Facebook. Join an on-line book club or watch music or shows on line. Keep up physical exercise with regular walks, gardening. Please update your influenza vaccination.

Regarding my patients on follow-up who would be regarded as being in remission, I would regard your risk of serious infection as the same as others with the same age and health. I would suggest you take the usual precautions we should all take.

The situation is fluid and we can keep you updated on this website. There is an informative webinar posted on Youtube by my infectious disease colleague Assoc Prof Pat Charles https://youtu.be/rK0dBMvqLhc

GenieCanHelp….this App looks good

Called GenieCanHelp. (looks like a neat way to keep all your meds, appointments, contacts together. Many of my patients are older and not all are IT literate (I hope that offends no one). They are however often accompanied by caring family or friends, who may be happy to store such info on their smartphones.. just a thought.

SABCS 2017

sorry I haven’t posted for a while , New Years resolution-post more. I did tweet from SABCS if someone wants to follow my twitter feed at conferences. If I can see I have some interested followers it will motivate me to tweet more when I am away.

It was an interesting conference, and also was the first time it snowed in San Antonio for 28 years.

The medical highlights included more data supporting the use of CK4/6 inhibitors in advanced ER+ breast cancer, this time Monaleesa 7 (I was an investigator in this study) showing the benefit of ribociclib in premenopausal women with advanced breast cancer (ABC) , combined with goserelin and letrozole. This adds to a number of studies in post -menopausal women receiving any of the three inhibitors (ribociclib, abemaciclib and palbociclib). Ribociclib is now available for post-menopausal women with ABC through an access program. Pre-menopausal women would need a BSO (ovary removal) to gain access. There will be a study (PATINA) opening soon for patients with ER+ Her2+ ABC .

There was a meta-analysis (collected data from  many  studies) supporting the use of dose-dense chemotherapy as adjuvant therapy even in ER+ early breast cancer. previously such approaches at least in my practice were confined to triple negative early breast cancer.

There was some surprising randomised data supporting the use of acupuncture in the management of joint symptoms of patients receiving aromatase inhibitors (letrozole, anastrozole, exemestane).

There was lots of new science particularly focussing on immunotherapy(IO)  in breast cancer. only a subgroup of patients seem to benefit from IOs and we need to understand who can benefit from single agent PD1 inhibitors (checkpoint inhibitors) and who might derive benefit  from IO doublets or combinations with chemotherapy. My colleague Sherene Loi (Peter Mac) presented some interesting data on IO added to trastuzumab in patients with Her2+ve ABC previously treated with trastuzumab showing activity in a group of patients.

I am heading to the European meeting in March and may have more for you then.Cheers Shane

ENHANCE. a breast cancer rehab program

A patient of mine gave me the good oil on this; I am sure Epworth won’t mind if I promote this. It is covered under private insurance and is specific to breast cancer (sorry anyone else, breast paves the way for others to follow!). A physical and psychological assessment is performed and subsequently patients can participate in an exercise program and counselling if needed. It is a great way to follow up the challenges of early breast cancer treatment and hopefully will be a vanguard for other centres to follow.  See ENHANCE

 

Meal Train

dear all

Meal Train..this looks a great new website that creates a meal roster for someone ill, that family and friends can contribute to.

   Step 1

Identify a friend who could use a little support and enter their name, email address, and where to drop off meals.

   Step 2

Enter the dates meals would be helpful.

   Step 3

Enter your friend’s food likes, dislikes, allergies, and the best time to drop off a meal.

   Invite Others

Invite friends, family, congregation members via email, facebook, twitter, newsletters, and more.

new PBAC approvals pertuzumab and trastuzumab emtasine

POEMS study

Hi all. 

It has been a while since last comments. San Antonio was a bust with me recovering from flu. Anyway, one of the best recent study outcomes was the POEMS study (http://www.nejm.org/doi/full/10.1056/NEJMoa1413204). This randomised study demonstrated conclusively that the hormonal implant goserelin can protect the ovarian function and therefore fertility during chemotherapy. This has huge ramifications for women receiving chemotherapy who still want to bear children or those wanting to avoid an early menopause. It is not government funded and will cost about between 700-1800$ depending on the length of the chemotherapy course.

It generates a temporary  menopause or hibernation of the ovaries if you prefer. Side effects may include hot flushes, mood disturbance and loss of libido.

Spring thought of the day ..apps

dear all, it occurred to me how useful the smartphone would be  as  a patient management tool. That statement  may be a no-brainer but  i think it is well known how under utilised our IT systems are. Having a quick trawl through the Apple App Store (I am sure there is an Android equivalent for pretty much well everything!), there are some  free apps that can track medication lists/doses and provide reminders when scripts are due. Apps such as Evernote are great;  recordings of consultations can be kept (I hate my voice on tape but never  mind) and results can be photographed and stored. This apps can be connected to similar computer-based applications that are password protected.

Finally, the good old calendar with alarms can be used for appointments. I must say I love the Week Cal app as it nicely shows the whole week which the Apple Cal isn’t so brilliant at.

Over time , the various patient or consumer resources will become app friendly. I note with interest that there is a BreaCan Navigator app.

Happy Spring. Shane