May 2013 - Pindara Private Hospital
Transcription
May 2013 - Pindara Private Hospital
The Pindara Private Hospital Newsletter. Published by Pindara Private Hospital Pindara Private Hospital Allchurch Ave, Benowa QLD 4217 07 5588 9888 Issue 1 May 2013 Fax: (07) 5588 9811 Web: www.pindaraprivate.com.au Major Development set to start at Pindara Private Pindara Private Hospital is set to grow to a 316 bed private hospital next year, following a decision by Ramsay Health Care to commence the next stage of development at this premier Gold Coast hospital. The development costing over $30 million will see a further 56 private patient rooms and a new state-of-the-art kitchen, added to the facility making it one of the Coast’s largest private hospitals. With increasing demand for surgery, the development will also include two new operating theatres - one of which will be a hybrid theatre featuring cutting- edge imaging. This will be the first of its kind on the Gold Coast. Above: Artist’s impression of the new Hospital wing to be built as part of the Stage 2 redevelopment This is the second major development to take place on the campus following the opening of stage one in December 2010 and follows the purchase of extra land to enable the expansion. It is part of a master plan for the campus which will see the hospital grow to over 443 beds including the conversion of existing accommodation to 100% private rooms. “Ramsay’s ongoing investment in increased bed and theatre capacity at this hospital will provide the necessary infrastructure for us to better service the growing healthcare needs of the Gold Coast community. Ramsay Health Care CEO Chris Rex said this next stage of development would bring the hospital one step closer to Ramsay’s overall vision for the Pindara campus. “Pindara Private Hospital is one of Ramsay’s flagship hospitals. The clinical services at this hospital are second to none Inside and with the support of new services and state-of-the-art equipment it is providing a premier healthcare service to the Gold Coast community,” Mr Rex said. “We are also very pleased to be investing in a project that will inject funds into the local economy and create jobs on the Gold Coast.” The new 56 beds will be established in a new wing over two levels on Allchurch Avenue. One of the new wards will be dedicated to neurosurgery, a specialty in which Pindara has established a strong reputation. Palazzo Versace popular with new mums Oncoplastic Surgery Pindara Private CEO Trish Hogan said the new development would be welcomed by the staff and doctors. “Since the completion of our stage one development and the introduction of new services like neurosurgery and paediatrics, Pindara has continued to go from strengthto-strength. These new facilities will further enhance the services we can provide to the community,” Ms Hogan said. “We are particularly excited to be putting in a hybrid theatre as part of this next stage of development. This is a relatively new concept in operating theatres and puts together imaging facilities that can be traditionally in a catheter laboratory with what is used in a traditional operating theatre.“ 3T MRI Scanner at Pindara Orthopaedics Feature Relief for migraine sufferers New faces @ Pindara Palazzo Versace popular with new mums PRODUCTION & MATERIAL Pindara Private Hospital Medical Matters is produced by the Pindara Private Hospital Marketing Department. If you do not wish to receive this magazine or other material from the Pindara Marketing Department or to provide feedback, make enquiries or to submit material please contact: Robbie Falconer T: 07 5588 9144 E: [email protected] Pindara Private Hospital Marketing Department Gold Coast mothers are spoilt for choice with the range of luxury postnatal packages now offered by Pindara Private Hospital. Combined Regal Suite/Palazzo Package Pindara Regal Suite packages now give new mothers an automatic upgrade to Palazzo Versace. Mums staying in a Regal Suite will spend two nights in Hospital (three nights for a caesarean delivery) followed by two nights at Palazzo Versace followig discharge where they will have 24 hour support from a trained midwife. Only mothers who are medically fit will be eligible to transfer to the Versace. Palazzo Platinum Package If a Regal Suite is not available, mothers still have the option to spend two nights at Palazzo Versace with around-theclock midwife support, once they have been declared medically fit for discharge after day two post delivery (day three for caesarean). Pindara Professional Centre 8-10 Carrara St Benowa QLD 4217 Pindara Private Hospital CEO, Trish Hogan said the Palazzo Package gives new mothers and their partners a time to gently transition from hospital to home. GP CPD Education “New parents can now relax and bond with their new baby, outside of a hospital environment, secure in the knowledge they have a trained midwife just outside their door should they require advice or assistance,” Trish Hogan said. Pindara Private Hospital runs a comprehensive program of FREE RACGP approved education events throughout the year. Details of upcoming events are available on the Hospital’s website. Once at Palazzo Versace, parents can relax in style and comfort and enjoy full access to all Palazzo Versace services and facilities as well as special postnatal spa treatments. Extended stay and extended family rates are also available by contacting the hotel directly. Pindara Private Hospital’s luxury post natal packages including Regal Suite and Palazzo PlatinumPackages are available on request after admission to the Maternity Unit. These packages can not be pre-booked and availability is dependent upon demand. Out of pocket expenses will be incurred i.e. these pakaages are not rebatable through a health fund. Visit www.pindaraprivate. com.au and click on the GP Education Registrations button. To register simply click on the Register online button or download the relevant registration form and fax it back to 07 5588 9444. For more information, visit our website www.pindaraprivate.com.au First sod turned on Stage 2 Pindara Private Hospital marked the commencement of its Stage 2 redevelopment with a ceremony to turn the first sod, on the site of the new Stage 2 Hospital wing. The ceremony, held on 2 May 2013, was officiated by Mr Danny Sims, Chief Operating Officer Ramsay Health Care and the Gold Coast Mayor, Cr Tom Tate. Mr Sims said Ramsay Health Care adopted a staged approach to development to ensure their Hospitals continue to service the needs of patients and the medical community, both during construction and into the future. Above L-R: Mr Lloyd Hill, Queensland State Manager Ramsay Health Care; Mr Danny Sims, Chief Operating Officer Ramsay Health Care; His Worship the Mayor, Cr Tom Tate; Dr Andrew Cary (Deputy Chairman Pindara Medical Advisory Committee; and Mrs Trish Hogan CEO Pindara Private Hospital. He said, this staged approach was particularly significant for Pindara. “Pindara is an old facility but a very busy one, in terms of occupancy - a staged expansion of this site provides the only opportunity to upgrade the Hospital’s internal infrastructure - a prerequisite to its further growth - without compromising existing services. ” “This project will add a new kitchen as well as 56 patient beds and two operating theatres. The new kitchen is an essential addition, as existing facilities can not adequately service the needs of an increased volume of patients, generated as this stage and further stages of the Master Plan are implemented.” Once complete, Ramsay’s multiphase Master Plan for Pindara will see the Hospital increase in size and capacity to accommodate more than 440 patient beds, thus becoming the largest private hospital on the Gold Coast. The first stage of redevelopment at Pindara, completed in 2010, transformed the Pindara campus into one of the busiest private health care precincts on the Gold Coast. It is expected Stage 2 will further enhance that reputation. Above: Dr Patrick Tsang (Haematologist, Gold Coast Haematology & Oncology); Mrs Helen Planing (Liaison Manager, South Coast Radiology) and Dr Steven Stylian (Haematologist and Oncologist, Gold Coast Haematology & Oncology) pictured with Mr Danny Sims, Chief Operating Officer Ramsay Health Care. Right: Dr Darryl Gregor (Ophthalmologist) and the Lady Mayoress Mrs Ruth Tate. Construction of Stage 2 will begin in May 2013 with a 14 month construction timeframe leading to completion of the development in August 2014. Protection long term to be sure with ESSURE By Dr Andrew Cary As a busy Obstetrician, nothing gives me more satisfaction than assisting a woman to complete her family. Once her family is complete though, it is ideal that I am able to provide a non-invasive method of permanent protection that truly ticks all the boxes - i.e. it is safe, minimally invasive and known to be the most successful of all sterilisation techniques. Hysteroscopic Essure Tubal Occlussion is the no-cut technique of guiding, placing, and deploying an Essure device into the tubal lumen through the tubal ostia via the uterine cavity. The only instrument inserted during the operation is the small uterine telescope known as a hysteroscope. This procedure is performed as a day case and requires the lightest of anaesthetic. No laparoscopy is required meaning there will be mostly no pain and much less risk. The major added benefit of this procedure, is that this form of sterilisation has failure rate of < 1 in 1000, meaning it is much more effective. Three Dimensional Ultrasound is my preferred method of visualising the device placement at three months post technique. I often combine Essure procedures with the third generation Novasure Ablation technique. This combination is a very safe, effective and non-invasive way of achieving both sterilisation and control of menorrhagia in one operation that requires a short, light anaesthetic, from which the patient recovers rapidly. The procedure is performed at Pindara Hospital or Pindara Day Procedure Centre. Dr Andrew Cary Suite 10 Pindara Place 13 Carrara St BENOWA QLD 4217 Tel: 07 5597 3770 Fax: 07 5539 5508 www.drcary.com.au Pregnancy may well be the most influential and consequential phase in a human’s life1 By Dr Timothy O’Dowd The incidence of obesity has doubled in the last twenty years. Sixty percent of Australians are overweight and thirty percent are classified as obese. Our sedentary lifestyle and excess energy intake are known contributors. It is also well know that obesity is associated with several health risks, e.g. Diabetes type 2, cardiovascular disease and some cancers such as breast cancer, arthritis and others. Being overweight or obese is particularly unkind to women in the reproductive age group. Not only does it make them more susceptible to pregnancy complications such as hypertension, diabetes and operative delivery, it also reduces their conception rates. Compounding this, the baby/ies of an overweight mother is/ are more likely to miscarry, have a congenital abnormality, or unfortunately suffer stillbirth or neonatal death. Pregnancy care staff find clinical examinations, including ultrasound and foetal heart rate monitoring, more difficult in overweight women; and care around the time of confinement can present more difficulties for attendants. The children of overweight and obese mothers are themselves more likely to be obese in childhood and adolescence. Scientific investigation into the “foetal origins of disease” and epigenetics suggest that many health issues are directly related to the uterine environment of the developing foetus. Factors thought to impact on the developing foetus, include the type and quality of the mother’s nutrition; her exposure to pollutants, drugs and infections; and her health and stress levels. It is further suggested, these factors permanently influence the functions of the baby’s brain, heart, liver and pancreas - organs that ultimately determine the individual’s susceptibility to disease, its appetite and metabolism, and even its intelligence and temperament. This, it is argued, makes the nine months of pregnancy the most consequential period of our lives. Routine weighing of pregnant women seems to have disappeared in the last 10-20 years. Indeed, the Royal College of Obstetricians in UK advises against routine weighing during pregnancy, citing that it may be confronting and may be of dubious benefit. That argument aside, obesity is a significant risk factor to the health of the mother and therefore to her unborn child; and, while the nine months of pregnancy is not a time to recommend formal dieting, it is important that weight gain during pregnancy is well managed to ensure it remains within the Institute of Medicine recommendations - regardless of the BMI category of the pregnant woman. Given that, in Australia, thirty-five percent of pregnancies are unplanned, many women will commence pregnancy outside their ideal BMI. Any pre-conception advice should discuss weight and efforts should be made to assist women attain their ideal BMI prior to conception. 1 “Origins: How the 9 months before birth shape the rest of our lives” ... Annie Murphy-Paul 2010 Dr Timothy O’Dowd Suite 1 Pindara Place 13 Carrara Street BENOWA QLD 4217 Tel: 07 5539 6333 Fax: 07 5539 6455 Dr Gary Swift elected as new GCMA president Queensland Fertility Group founding partner and senior specialist, Dr Gary Swift is the newly elected President of The Gold Coast Medical Association Inc (GCMA). The membership-based organisation represents the broad interests of the local medical community and maintains strong links and communication between the Federal and State AMA jurisdictions, as well as other Regional Local Medical Associations. Forty and Heavy Periods the easy solution By Dr Michael Flynn Things change for a woman after she reaches the age of forty. The lucky ones have a normal regular period until the age of 50 and then just stop. Unfortunately there are not many lucky women! More common is the gradual loss of control over the years, while many suffer “flooding” and cramping and having to purchase heavy duty sanitary items. Fortunately there are answers! While the pill, nonsteroidal medication and cyclokapron are the mainstay when fertility is demanded and childbirth not yet finished, most women dislike continuing the pill (especially if their partner has had a vasectomy). The levonorgestral intrauterine device or Mirena IUCD is often a simple in-rooms procedure that decreases period loss in many women. It is inserted after ultrasound assessment that no uterine anomalies are present. For the best no period rates endometrial ablation definitely comes out on top. From a simple day surgical procedure lasting a couple of minutes most women have no periods and no further worries about that time of the month. Its reproducible results and back to work the next day make it the “easy solution for 40 and heavy periods.” Dr Swift said he was honoured to be elected President. “The GCMA also plays an important role in promoting communication between the medical profession and the wider community. “As the Gold Coast enters an exciting era of growth with new and improved health care services being or about to be commissioned, we see our role growing in significance,” he said. Ovarian Cancer By Dr Benjamin Bopp Ovarian Cancer is a very heterogeneous group of diseases that have different possible aetiologies and behave differently depending on the histological diagnosis. 70% of intraepithelial ovarian cancers and epithelial tumours arise in the distal FALLOPIAN TUBE, hence the recent trend to prophylactic salpingectomy at hysterectomy. This also explains the slightly protective effect of tubal ligation in reducing the risk of ovarian cancer. Fertility treatment or drugs DO NOT INCREASE the RISK of OVARIAN CANCER; the increased risk is associated with the infertility not the treatment. Taking the OCP reduces the risk of ovarian cancer by 50%. Having babies early and taking the OCP reduces the risk of ovarian cancer by 70%. The prophylactic removal of ovaries at hysterectomy in women (even post-menopausal) INCREASES the risk of cardiovascular disease and stroke probably more than it reduces the risk of ovarian cancer – we should discuss KEEPING the ovaries and removing the TUBES. The results from an American trial SHOW NO BENEFIT IN SCREENING for OVARIAN CANCER with ULTRASOUND and CA125 in asymptomatic populations. Dr Benjamin Bopp Dr Michael Flynn Suite 5, Pindara Place Suite 3, Pindara Place 13 Carrara Street 13 Carrara Street BENOWA QLD 4217 BENOWA QLD 4217 Tel: 07 5564 8011 Tel: 07 55 392797 Fax: 07 5564 8022 www.drmichaelflynn.com.au Fax: 07 55 649124 [email protected] NEW SCREENING GUIDELINES FOR Gestational Diabetes By Dr Justin Nasser Gestational Diabetes is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. A diagnosis of GDM is made if one or more of the following glucose levels are elevated: Fasting glucose ≥ 5.1mmol/L The Australasian Diabetes in Pregnancy Society (ADIPS) originally formulated recommendations for the testing and diagnosis of gestational diabetes mellitus (GDM) in 1991. In the light of more recent evidence, ADIPS has elected to revise these guidelines1. 1 hr glucose ≥ 10.0mmol/L 2 hr glucose ≥ 8.5mmol/L The strongest evidence is derived from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, published in 2008. This was a large, blinded, multinational, multi-centre study that examined pregnancy outcomes for women with intermediate degrees of glucose intolerance and reported a strong correlation between increasing maternal glucose levels at 20 - 32 weeks gestation and a range of adverse maternal and foetal outcomes. No trial has defined the optimal treatment targets, however, the following self monitoring blood glucose treatment targets are suggested: Fasting capillary blood glucose (BG): ≤ 5.0mmol/L 1 hour BG after commencing meal: ≤ 7.4mmol/L 2 hour BG after commencing meal: ≤ 6.7mmol/L In general, at least 2 elevated levels, at a given testing time, in 1 week, after consideration of dietary factors, should be a prompt to consider additional therapy. Additionally, there has been a change in the demographics of women becoming pregnant and an increase in the rate of type 2 diabetes mellitus (DM) in the Australian community, resulting in more women of childbearing age having abnormalities of glucose tolerance, including undiagnosed DM, detected for the first time during pregnancy. Women diagnosed with GDM should have a 75g 2 hr OGTT, preferably at 6-12 weeks post‐partum. Recommendations for early testing for GDM for women with high risk(s) The new recommended diagnostic criteria will increase the prevalence of GDM from around 10% of pregnancies to around 13% of pregnancies. Women, not known to have pre-existing glucose abnormalities, but at high risk of GDM should have a 75 g OGTT at the first opportunity after conception, with venous plasma samples taken fasting, one hour and two hours. Women at high risk but with a normal OGTT at booking should have a repeat OGTT at the usual time of 24-28 weeks gestation; however, an OGTT should be performed at any earlier time during pregnancy if clinically indicated. High risk factors for GDM • Previous GDM • Previously elevated blood glucose level • Ethnicity: Asian, Indian, Aboriginal, Torres Strait Islander, Pacific Islander, Maori, Middle Eastern, non-white African • Maternal age ≥40 years • Family history DM (1st degree relative with diabetes or a sister with GDM) • Obesity, especially if BMI > 35 kg/m2 • Previous macrosomia (baby with birth weight > 4500 g or > 90th centile) • Polycystic ovarian syndrome • Medications: corticosteroids, antipsychotics Recommendations for routine testing for GDM All women not known to have GDM, should have a 75g OGTT at 24–28 weeks gestation. (The glucose challenge test lacks both sensitivity and specificity and is no longer part of the diagnostic algorithm). Women diagnosed with GDM should have regular ongoing surveillance as they have an approximate 30% risk of a recurrence of their GDM in a subsequent pregnancy and up to 50% risk of developing type 2 DM within 10-20 years. 1. Nankervis A, McIntyre HD, Moses R, Ross GP, Callaway L, Porter C, Jeffries W, Boorman C, De Vries B for the Australasian Diabetes in Pregnancy Society. Australasian Diabetes In Pregnancy Society (ADIPS) Consensus Guidelines for the Testing and Diagnosis of Gestational Diabetes Mellitus in Australia. (Version: 14 February 2013) Dr Justin Nasser Obstetrics and Gynaecology, Gynaecology, Fertility/IVF Suite 9, Level 2 Pindara Place 13 Carrara Street BENOWA QLD 4217 Tel: (07) 5597 5344 Fax: (07) 5597 5376 Dr Nasser has a special interest in high-risk pregnancies, infertility and management of pap smear abnormalities. He has subspecialty qualifications in Obstetric and Gynaecological Ultrasound plus Reproductive Medicine and Infertility. Noninvasive prenatal testing for FOETAL ANEUPLOIDY By Dr Ben Bopp Noninvasive Prenatal Testing (NIPT) is a new blood test which uses cell-free foetal DNA from the placenta in maternal serum to screen for foetal chromosomal abnormalities (trisomy 21, trisomy 18, trisomy 13 and monosomy X). Studies have demonstrated the clinical validity of maternal plasma DNA sequencing for the detection of foetal trisomy 21 in HIGH RISK women. DNA-based NIPT is a highly accurate screening method for trisomy 21. NIPT is now being commercially offered in Australia by overseas-based laboratories. At present, NIPT is costly and time consuming with results taking 10 to 14 days to return. NIPT should not be routinely offered to low-risk women or in multiple pregnancy as it has not been sufficiently evaluated in these groups. This situation may change in the future with the results from ongoing studies and the expected decline in the price of NIPT (currently about $1500.00). A positive NIPT test result still requires the detail and precision of the genetic information available via amniocentesis or chorionic villus sampling. All women with an abnormal result on NIPT should have genetic counselling and be offered invasive testing for confirmation of the diagnosis. Put simply, this new test: – is available and heavily promoted but has no role, at this stage, as a screening test for low risk populations; – is expensive and time consuming and needs confirmation with a conventional invasive test (amniocentesis or CVS). Pertussis vaccine in pregnancy By Dr Drew Moffrey The 10th edition of The Australian Immunisation Handbook details a shift in the recommendations for the pertussis vaccine in pregnancy. This change was instigated from an increasing number of pertussis outbreaks caused by both a drop in immunisation coverage and waning immunity. Pertussis infection in the first few months of life is associated with a high morbidity and mortality. The childhood schedule of 2, 4, and 6 months of age is aimed at reducing these early cases. The first dose of DTPa can be safely given as early as 6 weeks and this has been suggested to prevent an additional 8% of pertussis cases. The new guidelines now recommend the pertussis vaccine be offered during the third trimester between 28 – 36 weeks. Placental transfer of antibodies provides direct protection from mother to infant. Pre pregnancy and post-partum vaccination is recommended if the patient does not wish to have the vaccine intra-partum. Vaccinating against pertussis in pregnancy provides an infant with maternal antibodies which peak approximately one month after vaccination. By administering the vaccine to pregnant women between 28 – 36 weeks gestation an infant will receive the highest level of circulating antibodies. This provide protection during the early weeks until an infant commences their childhood immunisations. The frequency of administering an adult dTpa booster is not as clear cut. The new Australian guidelines say that the patient should receive a booster if more than 5 years have elapsed since the last. Possible benefits may accrue from giving the booster every pregnancy at shorter intervals but there is insufficient evidence to judge the risks and benefits of the increased frequency of the boosters. The Centre for Disease Control and the American College of Obstetricians and Gynaecologists have realised their guidelines stating that a booster should be given every pregnancy. Influenza vaccine continues to be recommended for pregnant women especially for those that will be in their second and third trimesters during the winter months. It has long been used and proven to be safe in pregnancy. The patients are able to receive the vaccine at any gestation. There is no optimal timing but ideally prior to flu season. It is suggested in Queensland that March and April is optimal. You are able to vaccinate with any of the current vaccines as they all have similar safety profiles. Take Home Points: • Immunise pregnant women with dTpa between 28-36 weeks. • Repeat booster of dTpa if more then 5 years since last booster. • Immunise pregnant women with influenza vaccine at any gestation, ideally prior to flu season. • Influenza vaccine is recommended annually. • Both vaccines considered safe, influenza has long been used in pregnancy. Dr Drew Moffrey Suite 9, Level 2 , Pindara Place 13 Carrara St Benowa, QLD, 4217 Phone : 07 5597 5344 Fax : 07 5597 5376 www.drdrewmoffrey.com.au New screening technique offers hope to MIGRAINE SUFFERERS Gold Coast Cardiologist, Dr Ross Sharpe is helping a select group of migraine sufferers regain control of their life, through a simple procedure that closes a hole in their heart. Key to Dr Sharpe’s success is not his expertise in the procedure to close a Patent Foramen Ovale (PFO or hole in the heart); rather a new cutting-edge, screening process that identifies the specific patient most likely to benefit from a PFO closure. His results speak volumes. Of the patients screened and selected for closure 95% have experienced a complete cure of their migraines or a reduction in migraine pain after they have had their PFO closed. Dr Sharpe said he was encouraged and excited by his successful outcomes; however, while he was growing in confidence about the accuracy of his technique and was satisfied with the patient outcomes, he readily acknowledged not everyone will benefit from a PFO closure to mitigate migraine. Dr Sharpe also acknowledged there were doubters amongst his colleagues. “As in any new area of science, there are those who do not believe in new work – in relation to this work – I ask that they look at the results, consider the patient outcomes and consider the potential importance of a procedure that helps a migraine sufferer,” he said. “I now have 66 patients who are migraine free after having a PFO closure. These patients were screened and identified as being likely to benefit from what is a relatively simple procedure. All of these patients are now either completely cured of their migraines or are enjoying a reduction in migraine pain since their procedure,” he said. “In anyone’s language this is a great result and an exciting breakthrough for migraine sufferers.” Dr Sharpe regularly receives positive testimonials from grateful patients. “I recently heard from a 75 year old woman whose life has been turned around after the closure of her PFO. She is now free from migraine and is so happy she can finally start to enjoy her life without pain,” he said. In his journey to develop his new technique Dr Sharpe has drawn on a body of knowledge of PFOs gained during his early days as a Registrar, when he scrutinised existing evidence for signs of a link between Patent Foramen Ovale (holes in the heart) and strokes in people under the age of 65. His subsequent research revealed a high incidence of people under 65 who have a stroke also have a Patent Foramen Ovale (PFO). This early interest in PFOs led him to explore the possibility of a link in a particular type of patient, between migraines and PFOs. Dr Daniel de Viana Breast and Endocrine Surgeon BreastCare, Lot 8, Level 6, Premion Place Cnr Queen & High Streets, SOUTHPORT QLD 4215 Tel: 07 5532 3455 Fax: 07 5532 3499 Dr Daniel de Viana is a Breast and Endocrine Surgeon whose private practice offers the following services: • Surgical management of benign breast conditions • Surgical management of malignant breast disease • Reconstructive Breast Surgery (Oncoplastic breast surgery) • Cosmetic breast surgery • Thyroid surgery Dr De Viana is a Visiting Medical Officer at Pindara Private Hospital and Breastscreen Queensland. He is the current President of the Australasian Society of Breast Diseases. www.breastcare.com.au Dr Ross Sharpe 2 Drury Avenue Southport QLD 4215 Tel: (07) 5531 1424 Fax: (07) 5532 9890 Younger women and breast cancer: a different disease? By Dr Daniel de Viana In 2013, it is expected that almost 15000 women will be diagnosed with breast cancer. Around 5% or 800, will be younger women, under the age of 40. This is a substantial figure but only a small proportion of the total number of younger women who present to their general practitioner (GP) with breast symptoms. This creates the dilemma of dealing with, in an appropriate and timely manner, the often non-specific breast symptoms that this group of women develop. It is no wonder that a significant number of medicolegal cases involving GPs are related to delayed diagnosis of breast cancer in younger women. Unfortunately, sometimes women in this age group presenting with breast symptoms are often dismissed as having a benign problem without further consideration. Any equivocal or unexplained symptom in this age group deserves at least an ultrasound of the breast. Ultrasound is superior to mammography in assessing benign versus malignant features of any lump. Mammography can be used in the under 40s but the denser tissue in this age group limits sensitivity and there will be a higher false positive rate in the interpretation of any change. Further management depends on suspicion. At a minimum any unexplained symptom should be followed up with a short term clinical review. If there is any further concern with the presentation in the younger patient, an MRI should be considered as the gold standard investigation. This should be timed with the patients cycle, ideally day 7-10 to reduce the background noise due to hormone changes. There is no rebate for MRI of the breast unless the patient has a very strong family history, for example three relatives with breast cancer and the patient is under the age of 50. MRI should also be used selectively as there is a significant rate of false positivity particularly in the premenopausal breast, although it does have very high sensitivity. Contrary to popular belief, the relative number of younger women with breast cancer is not increasing compared with the total number of cases, but has remained relatively static. The under 40s age group often present with larger and higher grade tumours. The rates of node positivity in these patients are higher and typically the cancers are more commonly oestrogen receptor (ER) negative. As a result, the disease free survival in this group of patients is lower. Surgical options in this group are similar to those available in other age groups. Many choose lumpectomy, given that this combined with radiation provides the same survival rates as mastectomy. Given that larger tumours are more common in the under 40s age group sometimes lumpectomy may not be feasible at initial presentation. There is an increasing trend to offer these women chemotherapy prior to surgery (neoadjuvant chemotherapy) to try to shrink the tumours and allow breast conservation. This approach has proven to be safe with no significant difference in survival compared with surgery up front. In fact complete pathological remission with no tumour seen in the excision specimen can be achieved in 10-20% of cases and a significant reduction in tumour bulk can be seen in a majority of cases. Rates of over 40% in complete pathological response have been seen in some HER-2 positive breast cancers that are more aggressive and historically have had a poorer prognosis (refer Image 1). Larger numbers of women are choosing mastectomy over lumpectomy and also electing to have a contralateral prophylactic mastectomy with combined immediate reconstruction. This trend, as a personal choice, has increased over the last decade and does have the advantage of reducing the long tail of surveillance required for younger women developing breast cancer. Also, of late, there has been Image 1: Pre and post neoadjuvant increase in the rate of chemotherapy changes on MRI showing nipple preservation complete remission of tumour with subcutaneous mastectomy, where feasible, on a case by case basis. This allows a superior cosmetic result and optimises the psychosocial well being of these patients. No significant reduction in local or distant control has been demonstrated with this approach (refer Image 2). Image 2: Post operative results of nipple preserving (subcutaneous) mastectomy providing good cosmesis without compromising safety The more aggressive and less hormone sensitive disease seen in the younger patients means that chemotherapy will often be offered, providing a significant improvement in survival. This produces a number of significant issues for these women including the management of fertility, dealing with a change in body image and the management of early menopause and associated symptoms. This requires a multidisciplinary approach in the perioperative management of these patients with not only breast surgeons and oncologists but also gynaecologists, psychologists and other health care professionals. The risk of infertility after chemotherapy is age related with women under 35 less likely to be affected and also dependent upon the type of agent used. Pregnancy after breast cancer has not been shown to increase the risk of recurrence as a whole; however, the data here is limited and caution should be taken especially for higher risk and ER positive women. Finally, dealing with high risk, family history patients requires referral to specialist clinics experienced in providing screening services for these patients, as well as being able to provide genetic counselling and options for surgical prophylaxis for these patients. It is essential that management of these patients is individualised, minimising their risk so that they do not live a life of perpetual fear. Dr Daniel de Viana, Visiting Medical Officer, Pindara Private Hospital; Visiting Medical Officer, Breastscreen Queensland; Tel: 07 5532 3455 www.breastcare.com.au ONCOPLASTIC SURGERY the third choice for breast cancer By Dr John Gault Lumpectomy or mastectomy are no longer the only two surgical options for the management of breast cancer. Oncoplastic surgery introduces a third option, which enables the surgeon to offer breast conserving surgery to those women who previously were destined to have a mastectomy. Oncoplastic Surgery brings together the best and latest techniques in surgical oncology to achieve wide, tumour free margins, along with the best principles of plastic surgery, to optimise cosmetic outcomes. As Oncoplastic surgery allows wider margins, its use can result in a decreased recurrence and improved survival rate, whilst maintaining or improving the shape of the existing breast. There are numerous Oncoplastic techniques that can be used, depending on the size of the tumour relative to the breast and to the position of the tumour. Level 1 Oncoplastic volume displacement techniques are useful if < 20% of the breast is to be resected. Level 2 Oncoplastic mammaplasty volume displacement techniques are used when 20-50% of breast volume is to be resected. Mammaplasty volume displacement techniques are used for larger tumours or when the tumour is situated in a position in the breast where the simple methods are not suitable. The remaining breast tissue is refashioned and the nipple-areola is relocated into a better position. The result is smaller, but normal shaped breasts. When significant breast ptosis or excess breast volume is corrected during these procedures, surgery to opposite healthy breast can provide good symmetry and cosmetic results. Simple volume displacement techniques are used to move healthy breast tissue into the area where the tumour has been excised, thus filling the space left by the tumour and distributing the volume loss to the whole breast, as demonstrated in the illustration below. Oncoplastic volume replacement techniques: Volume replacement techniques are used when removal of a large tumour does not allow a satisfactory cosmetic result. If inadequate breast tissue is present, local tissue flaps can be used for partial breast reconstruction. When mastectomy is required, it may be possible to preserve the breast skin, and in some cases the nipple as part of a breast reconstruction. Dr John Gault Oncoplastic Breast Surgeon Gold Coast Breast, Melanoma and General Surgeon, Dr John Gault has extensive experience in Oncoplastic Surgery performing hundreds of breast cancer operations each year. Dr Gault has recently taken over the Ashmore Road practice of retired General Surgeon Dr Graeme Langsford. Dr Gault operates at Pindara Private Hospital. Dr Gault trained in the UK before relocating to Australia in 1994. He moved to the Gold Coast in 2008 where he set up the Breast, Oncoplastic and Melanoma Clinics for the Gold Coast district at Robina Hospital. Dr John Gault 122 Ashmore Road Benowa QLD 4215 Dr Gault has been involved in teaching medical students, surgical registrars and breast fellows. For consultations please: Telephone 07 5539 3999 Fax: 07 5539 3993 QFG Gold Coast celebrates 12 years of operation Queensland Fertility Group (QFG) Gold Coast is celebrating its twelfth year as a provider of the highest quality IVF and Assisted Reproductive Services. Post grad certificate in Neurosurgery Nursing Coming to Pindara Pindara Private Hospital is a step closer to becoming a centre of excellence in Neurosurgery with the introduction of a post graduate certificate course in neurosurgery nursing, to train specialist nurses in its neurosurgery unit. Pindara’s neurosurgery unit opened almost two years ago and from day one, the unit’s team aimed to develop a centre of excellence in Neurosurgery. The Hospital recruited a highly experienced team of specialist nurses and five of the Gold Coasts leading private Neurosurgeons, Doctors Leong Tan, Teresa Withers, Neil Cochrane, Ellison Stephenson and Paul Poulgrain to run the Unit. Best practice procedures and standards were successfully integrated to ensure the unit’s special needs patients received the highest standard of care. Part of the team’s vision was to offer specialist neurosurgery nurse training. Pindara C.E.O Mrs Trish Hogan said this plan was close to fruition with news the Australian Catholic University has confirmed they will offer a post graduate certificate in neurosurgery nursing, in partnership with Pindara. The practice commenced in 2001 with a scientist and a nurse and four very enthusiastic doctors. Twelve years on, it has grown to include six clinicians, two receptionists, three scientists, a manager, counsellor and five nurses and industry best success rates have consistently been achieved. Located at Pindara Place on the Pindara Private Hospital Campus, the unit has also experienced progressive growth despite fluctuating economic conditions. The latest step has involved a merger with the national Virtus Health group which includes QFG , IVF Australia and Melbourne IVF. This merger ensures the Gold Coast unit has access to the latest technology and benefits from economies of scale achievable only through being part of a larger organisation. QFG Gold Coast founding partner and senior specialist Dr Swift said it was an exciting time to be involved in an industry capable of bringing so much joy and fulfilment to otherwise childless couples. For any discussion or appointments related to fertility matters please contact: Dr Gary Swift Suite 4, Pindara Place 13 Carrara St Benowa, QLD 4217 “Nurses undertaking the Pindara Post Graduate Certificate in Neurosurgical Nursing will be required to complete four subjects - two through the Australian Catholic University and two to be completed at Pindara,” Mrs Hogan said. Tel: 07 5564 6017 “Pindara’s dedicated Neurosurgeons, Allied Health team and the Hospital’s Education team will deliver the lectures.” Gold Coast QFG fertility specialists: The course is set to commence in Semester 2 - July 2013. Fax: 07 5564 7940 www.drgaryswift.com.au Dr Michael Flynn Dr Andrew Cary Dr Tim O’Dowd Dr Ben Bopp Dr Miriam Lee 07 5564 8011 07 5597 3770 07 5539 6333 07 55 392797 07 5564 6886 Orthopaedics Feature O RT H O PA E D I C S U R G E RY & S P O RT S MEDICINE CENTRE G O L D C O A S T C el l u l ar T he r apy & B io lo gic al A lt e r nat ive s t o T K R ORTHOPAEDIC SURGERY & SPORTS MEDICINE CENTRE D r C h r i s t o p h e r Ve r t u l l o Recently, novel therapy options have become available for the injectable management of knee The Shoulder Clinicosteoarthritis, which when combined The Knee Clinic with existing operative techniques, offer a potential alternative to joint replacement. THINGS TO CONSIDER DR CHRISTOPHER VERTULLO DR TERRY HAMMOND WHAT IS THE COST OF MSC INJECTIONS? At this stage, the harvest and separation of MSC’s is not covered by either Medicare or Private Health Insurance. However, if an other procedure, such as an arthroscopy or microdrilling procedure is also required, the total costs are reduced. WHAT IS THE RISKS? The risks appear to be relatively low as the injection consists of the patients own concentrated cells. Infection would be the most severe complication, but is fortunately rare. The creation of Hyaline Cartilage remains the “holy grail” of regenerative musculoskeletal medicine. Currently, micro-drilling or autologous chondrocyte implantation of Grade IV osteoarthritic lesions only allows healing with fibro-cartilage. Fibrocartilage has poor loading capabilities & limited survival of 4-5 years. Recent studies have raised the possibility of hyaline cartilage formation in both human & animal studies with a combination of injectable cellular therapies of MSC’s/ PRP, hyaluronic acid injections, subchondral micro-drilling techniques and limb mal-alignment correction by way of osteotomy. Mesenchymal Stem Cells are a emerging cellular management tool for managing osteoarthritis, the exact mechanism of actions remaining The Knee with Clinic HOW IS IT DONE? DR CHRISTOPHER VERTULLO ORTHOPAEDIC SURGERY unclear. Mesenchymal stem cells (MSC’s) are partially committed mesodermal The sequence is: 1) MSC harvest 2) MSC’s & SPORTS MEDICINE CENTRE stems cells, which usually surround small blood vessels, that can differentiate to separation in an sterile lab 3) Re-injection into the joint. Usually multiple injections are required , create bone as osteoblasts, adipose tissue as adipocytes and cartilage as with cryopreservation in between. chondrocytes. MSC’s differ from embryonic stem cells, as embryonic stem cells ORTHOPAEDIC SURGERY can differentiate into any cell type. MSC’s can only differentiate into & SPORTS MEDICINE CENTRE CAN IT BE DONE WITH OTHER mesodermal cellsThe lines, which fortunately Shoulder Clinic produces all musculo-skeletal tissues, OPERATIONS? DR TERRY HAMMOND ORTHOPAEDIC SURGERY making them a powerful potential joint regeneration tool. Mesenchymal stem Yes, usually it is performed with arthroscopy & SPORTS MEDICINE CENTRE cells can be derived from a number of sources, including the bone marrow, the subchondral micro-drilling and osteotomy if peripheral blood (Peripheral Blood Progenitor Cells ) after drug induced bone required. An aligned stable knee is required. marrow stimulation and finally adipose tisssue via liposuction. The abdominal fat in most adults contained millions of MSC’s and when harvested using WHO ARE CANDIDATES? The use of MSC’s is currently investigational, modified liposuction techniques, allows the injection of a very concentrated however patients with focal Grade IV solution of MSC’s into the damaged joint. The best method remains uncertain osteoarthritic lesions, low BMI’s and correctable at this stage. malalignment appear to be the best candidates. HOW DOES IT WORK? The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found. By injecting the MSC’s into the knee, it is hoped the MSC “differentiates” into a chondrocyte, but it depends on the local environment or matrix to form onto, hence micro-drilling is often undertaken simultaneously. Another more likely mechanism of action is the role of the MSC as a paracrine regulator, releasing of local anti-inflammatory mediators such as Interleukin. Studies of the MSC injection in isolation injection versus placebo are currently underway. T H E K N E E C L I N I C @ OSSM 8 C A R R A R A S T R E E T B E N O WA G O L D C O A S T 4217 0755970338 K N E E .C L I N I C @O S S M . C O M . AU Orthopaedics Feature A/Prof Christopher Vertullo Dr Terry Hammond OSSM Ground Floor Pindara Professional Centre 8 - 10 Carrara Street Benowa, QLD, 4217 Tel: 07 5597 0338 Fax: 07 5527 9568 www.knee-surgeon.net Sub-Speciality: Knee Surgery MBBS FRACS (Orthopaedics) OSSM Ground Floor Pindara Professional Centre 8 - 10 Carrara Street Benowa, QLD, 4217 Tel: 07 5597 6024 Fax: 07 5597 5798 www.terryhammond.com.au Sub-Speciality: Surgery of the shoulder Adjunct Professor Christopher Vertullo’s special interests include complex knee ligament reconstruction, minimally invasive rapid recovery knee replacement, complex arthroscopic surgery and meniscal repair, osteotomy and biologic cartilage restoration. Dr Vertullo graduated from Medical School at the University of Queensland and is a Fellow of both the Royal Australasian College of Surgeons and the Australian Orthopaedic Assoc. He completed Clinical Fellowships at the University of Toronto and Duke University. He is a member of the Australian Knee Society, the Asia Pacific Orthopaedic Sports Medicine Society and currently serves on the Knee Committee of the International Knee, Arthroscopy and Sports Medicine Society, and is a member of the Federal Knee Prosthesis Advisory Group. Dr Vertullo is an Associate Professor at Bond University and an Adjunct Professor at Griffith University. He is a Basic Science Examiner and Clinical Skills Instructor for the Royal Australasian College of Surgeons. Dr Vertullo has a strong interest in research and has presented over 50 papers at local, state and international meetings. Orthopaedic Surgeon, Dr Terry Hammond specialises exclusively in surgery of the shoulder. Dr Hammond graduated from the Queensland Medical School in 1986, completed his orthopaedic training in Perth and undertook upper limb fellowships in Canada, USA and England before returning to the Gold Coast. Dr Hammond has a special interest in arthroscopic surgery of the shoulder but also specialises in all conditions of the adult shoulder including reconstructive surgery and joint replacement. Dr Hammond’s rooms are situated on the ground floor of Pindara Professional Centre. Arthroscopic Shoulder Surgery By Dr Terry Hammond Until recently most shoulder operations were done as open procedures. Although excellent results are still achieved with open operations arthroscopic surgery offers significant advantages. Morbidity is often significantly reduced, rehabilitation is quicker and the use of arthroscopy allows diagnosis of conditions that would have previously been missed. In my practice at least 90% of shoulder operations now involve arthroscopic surgery. Relevant operations include:- Acromioplasty and Subacromial Decompression Traditional open techniques require excising the deltoid off the acromion. This can be avoided by arthroscopic surgery. Recovery is then much quicker and patients have no specific restrictions on their activities post-operatively. AC Joint Excision Osteolysis of the distal clavicle (in young athletic patients) and osteoarthritis of the AC joint (older patients) can require excision of the distal clavicle. When done arthroscopically patients do not require any post-operative restrictions on their activities. Rotator Cuff Repairs Small supraspinatus tears and subscapularis tears are ideal cases for arthroscopic repair. Larger tears are often best repaired with an initial arthroscopic procedure combined with a small open incision. Arthroscopic Shoulder Stabilisation Patients with recurrent shoulder dislocation are often ideal candidates for arthroscopic stabilisation. This has a very high success rate with minimal morbidity. However patients with a large fracture of the anterior glenoid (bony Bankart lesion) are not candidates for arthroscopic surgery and an open procedure is required. Further information regarding shoulder surgery – including detailed patient information, operative videos and information sheets which can be downloaded can be found on www.terryhammond.com.au. Orthopaedics Feature Dr Angus Nicoll Suite 402, Level 4, Pindara Specialist Suites 29 Carrara Street Benowa, QLD, 4217 Tel: 07 5597 3927 Fax: 07 5597 5019 www.gcos.biz Sub-Speciality: Hip and Knee Surgery Hip Arthroscopy at Pindara Private Hospital By Dr Angus Nicoll Recent improvements in technology and surgical techniques have ensured the field of hip arthroscopy is growing in importance. Indications for hip arthroscopy include loose bodies, labral tears, chondral injuries and impingement. There is a limited role for hip arthroscopy in diagnosing unresolved hip pain. In general, hip arthroscopy is not reliably beneficial to the patient with established osteoarthritis of the hip. Good to excellent results can be expected with careful patient selection. For example, around 80% of patients treated with a labral tear will report a successful outcome. Characteristic features of intra-articular hip pathology include difficulty with torsional / twisting activities, discomfort with prolonged hip flexion (e.g. sitting), catching with resisted flexion to extension (e.g. rising from a seated position) and relatively well tolerated straight plane activity. Plain films are examined and often MRI arthrogram will greatly assist in the diagnosis, although it is not uncommon for the final diagnosis to be only established at arthroscopy. Specific hip positioning systems for use with operating tables and portal guide systems have been developed to minimise risks. Hip specific cannulas, portals, electrothermal probes, shaver blades, burrs and suture anchor systems have improved the efficiency and efficacy of the procedure. Hip arthroscopy typically involves a day or overnight stay. In the post operative period, protected weight bearing with crutches is often advised for 2 - 4 weeks, early range of motion exercises are beneficial; weight training and sporting activities are avoided for 1 month. Previously, many patients from the Gold Coast area were referred to Brisbane for hip arthroscopy surgery. Latest generation techniques, hip positioning equipment and instrumentation systems are now available at Pindara Hospital. Orthopaedic Surgeon, Dr Angus Nicoll provides complete orthopaedic care including joint replacement, arthroscopy, acute sports injury and trauma for hips, knees and shoulders. Dr Nicoll was born, raised and educated on the Gold Coast. He completed a degree in Medicine at the University of Queensland in 1993 and then commenced specialist training on the Orthopaedic Program within Queensland. He graduated in 2001. Dr Nicoll then undertook a Fellowship in Injuries and Joint Replacement of the Hip and Knee in Sheffield, England and Cardiff, Wales in 2002. Further specialist experience was gained in Italy, Germany and Switzerland in 2003. Dr Nicoll commenced private practice in 2005 and his private practice surgery is conducted at Pindara Private Hospital. Memberships • Fellow of the Royal Australian College of Surgeons • Fellow of the Australian Orthopaedic Association • Australian Medical Association Hospital Admitting Rights • Pindara Private Hospital Orthopaedics Feature Reverse Shoulder Arthroplasty By Dr David Christie The management of elderly patients with a damaged or irrepairable torn rotator cuff is a significant problem, because the condition causes severe pain and the inability to use their shoulder for everyday activities. Large or massive rotator cuff tears, involving multiple tendons, will often lead to Glenohumeral joint osteoarthritis over many years (Cuff Arthropathy). Treatment of Cuff Arthropathy using a conventional shoulder replacement results in highly variable success rates. Functional outcome is often poor and insufficient dynamic joint stabilization can lead to superior humeral head migration with destabilisation of the glenohumeral rotation, and thus inadequate range of movement. Reverse shoulder arthroplasty was developed specifically to allow restoration of a stable, pain-free joint, with sufficient strength and movement to achieve a functional outcome with damaged rotator cuff. It reverses the normal relationship of the scapular and humeral components (artificial ball is attached to the glenoid and the socket is placed onto the humerus) such that the shoulder centre of rotation is moved medially. This allows the three muscles of the Deltoid group to compensate for the rotator cuff deficiency by providing the stability required to allow a more normal functioning rotation of the shoulder joint. Dr David Christie Suite 402, Level 4, Pindara Specialist Suites 29 Carrara Street Benowa, QLD, 4217 Tel: 07 5597 3127 Fax: 07 5597 5019 www.gcos.biz Sub-Speciality : Knee and Shoulder Surgery Dr David Christie is an Orthopaedic surgeon with special interests in disorders of the Shoulder and Knee. He performs arthroscopic, reconstructive and arthroplasty surgery as well as trauma surgery in these specialised areas. Indications: Appropriately used in people aged 65 years or older who have significant pain and little or no shoulder movement who have no option for surgical cuff tendon repair. Dr Christie undertook specialist training 1.Rotator cuff-deficient shoulder with severe arthritis (Cuff Arthropathy) – most common undertake opportunities to learn new and 2. Complex Proximal Humeral Fractures internationally to incorporate into his 3. Revision of Failed Standard Shoulder Replacement in Queensland graduating with his fellowship in 2004. He continues to improved arthroscopic surgical techniques practice. 4. Failure of rotator cuff surgery Dr Christie commenced private practise in 5. Proximal Humeral Tumour 2005 which is conducted at Pindara Private Contraindicated for young or physically active people and patients without functioning Deltoid muscles due to Axillary nerve palsy. Reverse shoulder arthroplasty has significantly improved the quality of life of many elderly patients with deficient rotator cuff tendons by providing a reliable and pain-free solution with restoration of reasonable shoulder movement range. Dr Stephen Sprague Suite 5, Level 3 Pacific Private Clinic 123 Nerang Street Southport, QLD, 4125 Hospital. Dr Andrew Letchford Suite 3C, Level 4 Pacific Private 123 Nerang Street Southport, QLD, 4215 Tel: 07 5527 1818 Fax: 07 5526 4788 Tel: 07 5532 1755 Sub-Speciality: Hip and Knee Surgery Fax: 07 5532 1785 Special Interests: Hip and knee arthroplasty (joint replacement) and orthopaedic trauma. Sub-Speciality: Hip and Knee Surgery Orthopaedics Feature Dr Paul Robinson Brockway House 82 Queen Street Unicondylar Knees By Dr Paul Robinson Southport, QLD, 4215 Tel: 07 5528 6640 Fax: 07 5528 6637 Sub-Speciality: Knee and Shoulder Surgery Orthopaedic Surgeon Dr Paul Robinson has a special interest in knee and shoulder surgery – arthroplasty and arthroscopy. Dr Robinson has extensive experience in orthopaedics, gained during a career that spans more than 40 years. He originally studied medicine at the University of Queensland before undertaking the Birmingham Accident Hospital and Orthopaedic Training Scheme in Britain. He was appointed a Fellow of the Royal College of Surgeons of Edinburgh in General Surgery in 1973 and a Fellow of the Royal College of Surgeons in Orthopaedics in 1976. Dr Robinson held the roles of Director of Orthopaedics – Royal Brisbane Hospital from 1975-1977 and Orthopaedic Surgeon for Gold Coast Hospital and all private hospitals on the Gold Coast from 19772001. Currently, he is a Senior Orthopaedic Surgeon at Pindara Private Hospital. Dr Robinson completed the Workcover Training and Evaluation of Permanent Impairment through the University of Sydney 2004 and is currently a Board member of Workcover Tribunals in Queensland. He has undertaken Workcover evaluations for New South Wales since 2003 and for all insurance companies including GIO and Allianz since that time. He undertakes Workcover evaluations for Queensland Workers’ Compensation on a weekly basis. In the past three decades there has been a significant evolution within the understanding of arthroplasty of the knee with a dramatic improvement in implant design and surgical technique. This involves not only the total joint, but also more recently the unicondylar knee. At the recent Academy meeting, it was stated that 53% of arthritic knees are suitable for unicondylar replacements. This allows the patient to preserve 2/3 of the knee and thus resulting in better kinematics and in this instance “less is more” for over 50% of patients requiring arthroplasty. The indications are anteromedial arthritis with an intact ACL, PCL and medial collateral ligament. Full thickness cartilage loss medially and a correctable deformity demonstrated radiographically with generally a valgus stress view. In general, the state of patellofemoral joint, chondrocalcinosis, obesity, age and activity level are not contraindications to a medical unicondylar replacement. The only certain contraindications are the presence of inflammatory arthritis or a history of a previous high tibial osteotomy, although this latter can also be modified. Unicondylar replacement is a minimally invasive technique that preserves the cruciate mechanism and normalises contact forces and pressure in the patellofemoral joint preserving, in general, the preoperative range of movement. Morbidity and mortality is decreased. In the Oxford there is very little use of cement and the revision rate diminished such that the 10 year survival of these prostheses is now up to 98%. Dr Aneel Nihal Dr Aneel Nihal is an internationally trained Orthopaedic Surgeon who specialises in foot and ankle disorders including: • acute foot and ankle sprains & fractures; • bunion and hammer toe correction; • Achilles tendon disorders; • dance and sports-related foot and ankle injuries; • arthritis affecting big toe, foot and ankle; • ankle ligament instability; • tendon transfer for foot drop; • adult flat foot and other foot deformity corrective surgery; • diabetic foot; • in-grown toe nail; and • revision surgery for complex foot and ankle problems. Suite 206, Level 2, Pindara Specialist Suites 29 Carrara Street Benowa, QLD, 4217 Tel: 07 5564 6877 Fax: 07 5564 6441 www.gcfootandankle.com Sub-Speciality: Foot and Ankle Surgery Special Interests: Orthopaedic trauma He also offers general orthopaedic trauma and fracture management. www.pindaraprivate.com.au 16 CONSULTATION & CARDIAC TESTING Dr Guy Wright-Smith Interventional Cardiologist Dr Shailesh Khatri Cardiac Testing Exercise Stress Echocardiography Dobutamine Stress Echocardiography Echocardiography (Bulk Billed) Exercise Stress Testing Holter Monitoring Event Loop Recording Reported ECG Pacemaker Testing Interventional Cardiologist Dr Geoffrey Trim Cardiologist Electrophysiologist Dr John Meulet Echocardiography Services also available: Cardiologist Electrophysiologist ROBINA – HQ Building Ground Floor, 58 Riverwalk Avenue MURWILLUMBAH – QML Unit 3,12 Queen Street Dr Stirling Carlsen Cardiologist Dr Ben Hunt www.cardiac-centre.com.au All appointments (07) 5598 0322 Hope Island Central Shop 13 340 Hope Island Road HOPE ISLAND QLD 4212 Pindara Specialist Suites Suites 507-510, Level 5 29 Carrara St BENOWA QLD 4217 Robina Suit 8, H.Q. Building 58 Riverwalk Ave ROBINA QLD 4226 Cardiologist Electrophysiologist Fred McKay House Suite 7A, Dr Level 7 42 Inland Drive TUGUN QLD 4224 Ballina Day Surgery Suite 3 46 Tamar St BALLINA NSW 2476 Puberty Blues By Dr Scott Blundell Janice brings her six year old daughter Suzie, in for a consultation. Janice is concerned Suzie has begun to develop breasts and wonders if her daughter could be consuming too much oestrogen (as she has a taste for chicken and soy ice cream) or - she asks - are girls staring puberty earlier these days? Puberty follows a predictable course. In girls its onset is announced by the development of breast/areolar tissue (thelarche), followed by pubic hair (adrenarche) and finally menarche. In boys the earliest sign is an increase in testicular volume (>3mL) followed by penile growth and then pubic hair. There was a significant drop in the age of onset of puberty between the 19th and mid-20th century. Whether or not a decline in age has continued into this century is contentious. Large studies suggest minimal change in the onset of puberty in boys compared to the mid-20th century. In girls however, thelarche (Tanner breast stage II) looks to be occurring more than 12 months earlier. Confusing the issue further, the timing of Tanner Breast Stage III and menarche appears not to have changed. The age definitions of precocious puberty have remained unchanged. Precocious puberty (PP) is the onset of secondary sexual characteristics before eight years in girls and nine years in boys. It is categorised as central (CPP), driven by the hypothalamicpituitary axis; peripheral caused by excess secretion of sex hormones or gonadotrophins from a peripheral site, or exogenous oestrogens (creams, lavender or tea tree oil, etc); or partial such as thelarche (isolated breast development) or adrenarche (isolated pubic hair). The majority of cases are of central origin, most of which in girls are idiopathic. In contrast most cases of CPP in boys have an organic cause. PP results in rapid bone maturation with reduced final adult height. Investigation and treatment aims to identify any pathological causes as well as preserve final height. History and examination seeks to identify the presence of oestrogenisaton (breast tissue) and androgenisation (pubic hair, body odour, acne), the Tanner stage of puberty and any recent growth acceleration. The presence of headaches, abdominal pain/swelling or café au laits may point to a pathological cause. Additional information on the timing of the parent’s pubertal development and potential exogenous steroid is useful. At six years of age Suzie fits the criteria of PP and warrants further investigation. While it is thought soy baby formulas might delay involution of breast tissue in infants, Janice can rest assured there is no evidence that her daughter’s taste for chicken or soy ice cream have caused this to occur. Leading Steps Paediatric Clinic Suite 405, Level 4, Pindara Specialist Suits Benowa 29 Carrara St Benowa, QLD, 4217 Tel: 07 5564 9668 Fax: 075591 8063 www.leadingsteps.com.au Diagnosis of prostate cancer made easier with 3T MRI Scanner at Pindara South Coast Radiology’s new 3.0T highfield strength multi-parametric MRI (mpMRI) prostate imaging service at Pindara Private Hospital is leading the way in early detection of prostate cancer. Cited by the Australian Institute of Health and Welfare as the most common cancer diagnosed in Australia (excluding non-melanoma skin cancers) prostrate cancer is the second greatest cause of cancer deaths in men¹. With more than 20,000 Australian men diagnosed per annum, early detection and management is vital in the fight against this elusive disease. Today, thanks to advancements in MRI technology and new intensive research into the role of MRI in the diagnosis of prostate cancer, there is new hope to detect prostate cancer early. Pindara Private Hospital Urologist, Dr Scott McClintock who has previously presented in conjunction with South Coast Radiology, at the Queensland branch Urology and Radiology meetings regarding MRI prostate imaging, said the mpMRI technology is not only useful in the diagnosis of prostate cancer but also offers substantial benefits in assisting with the ongoing management of prostate cancer. Dr McClintock said the mpMRI examinations have already made a great impact on patient management in the short time the service has been available. The new multi-parametric mpMRI enables the prostate to be considered through different MRI imaging techniques, which deliver both morphological and functional information. These techniques include: T2 Weighted – This refers to the high spatial resolution and structural information which are captured by two viewpoints. Diffused Weighted Sequences - Captures images where signs of cancer are demonstrated by the differences in water molecule mobility. The water movement can reveal microscopic details about tissue architecture, either normal or in a diseased state. Dynamic Contrast Enhancement - Assess the changes in vascular characteristics These three sequences combined allow the mpMRI to identify and localise a tumour with 90% certainty. This service has been available at Pindara Private Hospital since September 2012 and can be used by patients referred by their Urologists. The cost to the patient for this service is $550 and currently there are no Medicare rebates for this service. ¹ Australian Institute of Health and Welfare (AIHW) Cancer in Australia: An overview, 2008. AIHW Cat.no. CAN 42. State-of-the-art 3.0T high field strength MRI at SCR Pindara This new MRI scanner complements our MRI service provided at Southport, 103 Nerang Street (GP referral) Robina, HQ Building (GP referral) Tugun, John Flynn Hospital (Specialist referral) For further information on our MRI service please contact SCR Medical Liaison, Helen Planting and Kim Wiggill on 55808588 www.scr.com.au www.scr.com.au Green Light Laser Therapy at Pindara Benign prostatic hyperplasia (BPH) Almost half the male population over the age of 60 suffer from benign prostatic hyperplasia or BPH. This age-related enlargement of the prostate gland is not malignant but causes a number of troublesome urinary symptoms. As the prostate grows, it compresses the urethra subsequently interfering with the normal flow of urine. Pindara Private Hospital Urologists are offering Green Light Laser Therapy as an option to treat benign prostatic hyperplasia; a condition that affects almost half the male population over 60. Introduced just over one decade ago, GreenLight™ laser therapy is now tried and tested and known to offer patients many advantages over the conventional Transurethral Resection of the Prostate (TURP) procedure. Not only is GreenLight™ laser just as effective as the TURP procedure, it is less invasive, has fewer side effects and causes less trauma than its conventional counterpart. GreenLight laser is a non-contact procedure. Rather than surgically excising sections of the enlarged prostate gland, a skilled urologist uses the GreenLight laser to vapourise and coagulate the tissue. The procedure involves inserting a single-use laser fibre into the urethra via a cytoscope (a smaller bore cytoscope is used than in a TURP procedure). Once in-situ, the fibre is swept over the surface of the obstructing tissue while a side-firing beam of high powered energy vapourises a layer of tissue and heat-affects the underlying 1-2mm of tissue. This process is repeated until the obstructive tissue is removed. Simultaneous sealing the tissue results in an almost bloodless field and causes less trauma which translates into reduced morbidity in patients. Recovery is quicker - post procedure irrigation is not required, catheters are removed earlier as natural urine flow is rapidly restored in most patients and fewer post procedure complications arise - and patients return to normal activities quicker. Length of stay in hospital is reduced from the usual two to three-nights following a TURP to typically just an overnight stay. The ‘coagulating effect’ of the GreenLight laser is also good news for patients who take anti-coagulant medication. Traditionally drugs such as Warfarin, Plavix or Aspirin must be stopped prior to a TURP operation because of the increased risk of bleeding; however, stopping the medication can increase other vascular risks. This is particularly relevant as the population who are most likely to be on anticoagulants are the same over-60 year olds who typically suffer from BPH. GreenLight Laser Therapy can generally be used on those who would previously have been treated with a TURP; however, not all patients with urinary flow problems are suitable candidates. GPs are encouraged to refer patients to a urologist for a clinical evaluation to determine the best method of treatment. For a list of Urologists at Pindara Private visit Our Specialists page at www.pindaraprivate.com.au BPH symptoms include frequent urination, a weakened urinary stream, the need to get up at night to pass urine and a feeling that the bladder has not been completely emptied. Historically, BPH has been treated with medication, in the early stages, or by having an operation known as a transurethral resection of the prostate (or TURP) if the condition becomes more severe. Transurethral Resection of the Prostate (TURP) TURP is the conventional treatment for BPH and it provides long-lasting relief of symptoms. The surgery involves cutting away slices of the enlarged gland to relieve the pressure on the urethra at the neck of the bladder; however, the operation involves staying in hospital for 2-3 nights and because of the risk of bleeding in the post-operative period, it is necessary to stop taking blood thinning medication prior to surgery. PINDARA UrologISTS Dr Scott McClintock 07 5531 2255 Dr John Pisko 07 5532 7655 Dr Neil Smith 07 5532 4333 Dr Charles Chabert 07 5597 6293 Dr Christopher Tracey 07 5532 4644 Permanent reduction of axillary hyperhidrosis A New Innovative Technique using Slim-Lipo. By Dr Dilip Gahankari, FRACS (Plastic) FRSC (Edin) Excessive underarm perspiration is a common problem that tends to occur in late adolescence. It can occur due to over stimulation of the sympathetic nervous system; and in some cases specific foods, anxiety, stress, and emotional stimuli, can further aggravate the problem. SLIM Lipo™ is a new technique for treating excessive axillary sweating. In this approach energy produced by a laser beam delivered through extremely small incisions (2-3 mm). Laser energy destroys sweat glands (permanent axillary sweat glands reduction) and produces results that have proven to be better than ones used previously. Benefits of this method being: very small incisions, extremely quick recovery time, less tissue trauma and ability to do the procedure with local anaesthesia in an office setting. Adding mechanical suction-curettage at the end of the laser ablation assures a more successful end result. A combination of laser ablation technique and mechanical suction curettage are being combined to assure a higher success rate for the patient that range from 85-95%. Alternative Treatments: Treat with conservative measures such as antiperspirants, Botulinum Toxin, then to surgical interventions if conservative treatments have proved to be of limited success. Endoscopic Thoracic Sympathectomy (ETS) is not recommended for patients suffering only from excessive armpit sweating. Improved surgical methods treat different types of focal hyperhidrosis, but involve bigger scars. Compared to the conventional methods, SLIM Lipo™ procedure, is arguably a one time procedure with predictable results and in our experience, with minimal down time and fewer risks. GPs can refer patients to Dr Dilip Gahankari by calling 07 5539 4611; alternatively, patients can contact the practice directly to arrange a complimentary consultation with our clinical nurse coordinator. Advanced Aesthetics believe they are the only clinic on the Gold Coast, to provide SLIM Lipo™ treatment. Dr Dilip Gahankari Plastic and Reconstructive Cosmetic Surgeon Suite 305, Level 3, Pindara Specialist Suites 29 Carrara Street Benowa, QLD, 4217 Tel: 07 5539 4611 Fax: 07 5539 6199 www.iplasticsurgeon.com.au Dr Dilip Gahankari is a specialist Plastic and Reconstruction Surgeon with more than 15 years surgical experience at the highest standard. His private practice encompasses a balance of plastic, reconstructive and cosmetic surgery. He is dedicated to delivering the natural look and specialises in minimal scar plastic surgery of the face, breasts and body. His main interests in reconstructive surgery include breast reconstruction, hand surgery and head and neck reconstruction. Dr Gahankari trained as a British Association Plastic Surgical Fellow at the prestigious Canniesburn and Glasgow Royal Infirmary Hospitals, Scotland and was awarded the FRCS fellowship in General Surgery through The Royal College of Surgeons of Edinburgh in 1999. He was then invited to join as a Hand Surgery Fellow at the Princess Alexandra Hospital in Brisbane and underwent further training as a Head and Neck and Burns Fellow at the Royal Brisbane Hospital. He was awarded the FRACS, fellow of the Royal Australasian College of Surgeons, in Plastic Surgery in 2003. Advanced Aesthetics Plastic Cosmetic Surgery & Laser Centre Breast • Breast Enlargement • Breast Reduction & Lift • Breast Reconstruction • Male Breast Reduction Face • Face Lift • Neck Lift • Prominent Ears • Eyelid Surgery • Nose Reshaping • Brow Lift Body • Tummy Tuck • Liposuction • Labiaplasty • Hand Surgery • Body Lift Surgery • Skin Cancers & Melanoma Laser • Liposculpture (SlimLipo) • Hair Removal • Veins • Scars • Sun damage • Facial Rejuvenation Skin Health & Beauty • Wrinkle Treatments • Injectable Fillers • Excessive Sweating • Microdermabrasion • Facial Peels • Skin Needling • Skincare • Hyperbaric Oxygen Therapy • All Beauty Treatments Ph 07 5539 4611 | www.iplasticsurgeon.com.au Pindara Specialist Suites, Level 3, Suite 305, 29 Carrara St, Benowa QLD John Flynn Hospital, Tugun Qld The Surgical Weight Loss Centre Patients who choose weight loss surgery can expect to lose on average 67% or more of their excess body weight. In comparison, the average weight loss achieved with diet and lifestyle changes is usually 10% or less and unsustained. Weight loss surgery offers effective treatment for obesity related health problems. It can put Type 2 Diabetes into remission. It can cure hypertension. It can alleviate sleep apnoea, gastro-oesophageal reflux, high cholesterol and depression. It can overcome polycystic ovarian syndrome, improve fertility and reduce the rates of preeclampsia and gestational diabetes. The Surgical Weight Loss Centre is a multi-procedural centre where the choice of surgery is tailored to the needs of the patient. The three most commonly performed weight loss operations in Australia are laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric banding. and is more effective than gastric banding. However, gastric bypass produces better results in patients who have severe gastrooesophageal reflux disease. Gastric banding is also considered a valid Dr Jorrie Jordaan option for patients who do not have severe obesity. The risk associated with weight loss surgery is quite low. For instance, the risk associated with a sleeve gastrectomy is comparable to gallbladder surgery and is lower than a joint replacement. Weight loss surgery gives safe, effective, sustained results. Dr Jorrie Jordaan Sleeve gastrectomy and gastric bypass achieve equal weight loss and improvements in health. Suite 2.05, Level 2 Pindara Specialist Suites A sleeve gastrectomy is often the most suitable option for patients as it carries a slightly lower risk than gastric bypass Tel: 07 5556 8888 Fax: (07) 5527 8226 www.surgicalweightlosscentre.com.au www.JordaanSurgical.com.au 29 Carrara St., Benowa QLD 4217 www.SurgicalWeightlossCentre.com.au The new look Layt Clinic The Layt Clinic has recently relocated from Benowa to newly constructed rooms at 16 Harvest Court, Southport (behind Trade Secrets at The Brickworks, Southport). The exciting new premises is now the head office for Plastic, Reconstructive and Cosmetic Surgeon, Dr Craig Layt. Dr Craig Layt has been providing Plastic, Reconstructive and Cosmetic Services on the Gold Coast since 2000 and prior to this, he worked in leading hospitals throughout Melbourne and Queensland. The services available at the new Southport clinic have broadened and now also cater for patients that require skin cancer assessment and treatment. We understand that many General Practitioners take care of their patients skin cancer monitoring and excision but other Practitioners prefer not to do this, so we now offer this service for them. Dr Layt works closely with the doctors in The Layt Clinic and other medical professionals. He is also involved in training Surgeons, Doctors and Medical Students. Dr Layt is the past president of the Australasian Society of Aesthetic Plastic Surgeons and continues his education through attending both national and international meetings. Dr Layt also provides services in the Northern Rivers Region from the Ballina Clinic. For referrals please contact Dr Craig Layt at The Layt Clinic 16 Harvest Street Southport QLD 4215 Tel: 07 5597 4100 Fax: 07 5597 6100 www.drlayt.com Dr Craig Layt Plastic and Reconstructive Cosmetic Surgery Dr Craig Layt is a fully qualified and highly experienced reconstructive and cosmetic plastic surgeon, reknowned for his honest and downto-earth approach and his ability to create beautiful, natural-looking enhancements. Dr Layt graduated from the University of Queensland Medical School in 1988. He then undertook his general surgery training at the Princess Alexandra, Mater, and Greenslopes Hospitals in Brisbane and the General Hospital in Townsville; and trained in Plastic and Reconstructive Surgery at the Royal Brisbane Hospital, the Princess Alexandra and Mater Hospitals. Dr Layt then furthered his medical expertise working along side Melbourne’s leading Fellow Plastic Surgeons in Reconstructive and Plastic Surgery at the Royal Melbourne Hospital, Royal Children’s Hospital, Austin and Repatriation Medical Centre, and St. Vincent’s Hospital. Dr Layt is the past President of the Australasian Society of Aesthetic Plastic Surgeons (2010 until July 2012), during this time he was actively involved in organising post graduate education for Plastic Surgeons in the specialised field of Aesthetic Plastic Surgery. He is also an International active member of the American Society for Aesthetic Plastic Surgery. Dr Layt continues to be involved in the education of Medical Students and doctors training in the specialty of plastic surgery. Dr Layt is highly credentialed in all areas of Plastic, Reconstructive and Cosmetic Surgery and is dedicated to a high standard of patient care and the achievement of excellent results. Dr Layt and his staff pride themselves on excellent service, strict confidentiality and outstanding results. He insists that each patient fully understand the benefits, risks, and limitations of the procedure they have selected before undergoing surgery, in order to maximise patient satisfaction. Dr Layt ’s private practice has been offering high quality plastic surgery and aesthetic care services to the Gold Coast and northern New South Wales since 2000. New services at Gold Coast Haematology and Oncology Gold Coast Haematology and Oncology (GCH&O) is leading the way in the treatment of complex cancer patients on the Gold Coast with the introduction of new services at Pindara Private Hospital. Since opening the new rooms on the northern end of the Gold Coast in 2011, GCH&O has expanded their services to include apheresis and autologous stem cell transplantation at Pindara Private Hospital. The local availability of these important treatment modalities delivers many benefits for patients, who would otherwise be required to travel to a capital city to receive treatment or follow-up care. To date, a number of patients have received apheresis treatment at the Pindara Oncology Clinic; and a number of leukaemic patients and difficult oncology cases GCH&O specialists Dr Steven Stylian and Dr Patrick Tsang have received care in the Pindara Oncology Ward. To ensure the complex needs of these patients are met, Pindara Oncology Ward and Oncology Clinic nursing staff have undergone specialised training. GCH&O specialists, Haematologist Oncologist Dr Steven Stylian and Haematologist Dr Patrick Tsang, are pleased to welcome Oncologist, Dr Andrew Cameron to their team. Together these doctors will provide a 24 hour service to patients from all areas of the Gold Coast and Northern New South Wales through rooms at both Pindara Private and John Flynn Private Hospitals. F or consultations with Gold Coast Haematology and Oncology (GCH&O) specialists Dr Steven Stylian, Dr Patrick Tsang or Dr Andrew Cameron please contact: Gold Coast Haematology and Oncology Suite 101, Level 1, Pindara Specialist Suites, 29 Carrara Street, BENOWA, QLD 4217 Tel: 07 5597 1305 Fax: 07 5597 1205 Email: [email protected] www.gcho.com.au Pindara Oncology Clinic Pindara Private Hospital is proud to offer specialised Oncology and Haematology services through the Pindara Oncology Clinic. The 12 chair Clinic is dedicated to administering outpatient chemotherapy as well as other day-only treatments. These include: • Apheresis, • Blood Transfusions, • Venesections, • Non-cytoxic infusions such as Intragam, • Aredia, Zometa, Iron and Remicade, • Monoclonal and biological therapies, and Portacath and PICC care and education. The Pindara Oncology Clinic is linked to the Pindara Private Hospital Oncology ward which means patients travelling long distances, who require treatment on consecutive days, are able to be admitted into the ward for the duration of their treatment at the Clinic. If required, day patients, who become unwell during their treatment at the Oncology Clinic, are also able to be conveniently admitted into the hospital. This immediate access to the Pindara Oncology ward means patients receive prompt and appropriate care. Pindara Oncology Clinic is run by compassionate, friendly and helpful staff who offer patients high quality service and care. Nursing staff are specialised trained in the administration of chemotherapy and apheresis. The Clinic features: • Comfortable reclining chairs. • Close proximity to Haematology and Oncology specialists, pathology services and Hudsons Coffee shop. • Easy access parking. • Great location in the Pindara Specialists Suites. The Pindara Oncology Unit is open 8.00am - 6.00pm, four days each week - Tuesday, Wednesday, Thursday and Friday. For further Information please telephone: (07) 5588 9504 ANNOUNCING NEW MEDICAL ONCOLOGIST DR. ANDREW CAMERON DR. STEVEN STYLIAN MB.BS.BSC.FRACP (MEDICAL ONCOLOGY) FRACP (CLINICAL HAEMATOLOGY) DR. PATRICK TSANG MB.BS.FRACP FRCPA CLINICAL AND LABORATORY HAEMATOLOGIST DR. ANDREW CAMERON MB.BS. FRACP MEDICAL ONCOLOGIST AND PALLIATIVE CARE Actively servicing the whole of Northern NSW and Gold Coast Regions in: • ClinicalHaematology •MedicalOncology •Apheresis • StemCellTransplantation • PalliativeCare • • • • All urgent referrals accommodated BULK BILLING AVAILABLE TO ALL PATIENTS AFTER THE FIRST VISIT Covering all areas in Haematology and Oncology Leading edge treatments available, including management of acute disorders such as Leukaemia • Offering 24hr availability and care for all patients • Telehealth Conference Available NewJohnFlynnHospitalofficenowopenservicingthe SouthernGoldCoastandNorthernNSWregions. Pindara Private Hospital ALLDOCTORSNOWACCEPTINGNEWREFERRALS. Pindara Specialist Suites Suite 1.01, Level 1 PindaraHospital 29 Carrara St JohnFlynnHospital BENOWA QLDSuites 4217 Pindara Specialists SuiteTel: 1.01,5597 Level 11305 Fax: 5597 1205 29 Carrara Street, BENOWA QLD 4217 Fred McKay House Suite 6B, Level 6 42 Inland Drive, TUGUN QLD 4224 Ph:55971305 Ph:55971305 Fax: 5597 1205 Email: [email protected] Fax: 5597 1205 NOW ACCEPTING New faces @Pindara Dr David Deller Respiratory and Sleep Medicine Dr Sam Dowthwaite Ear Nose and Throat , Head and Neck Surgery Suite 401, Level 4, Pindara Professional Centre Pindara Specialist Suites, 8-10 Carrara St 29 Carrara St, Benowa, QLD, 4217 Benowa, QLD, 4217 Tel: 07 5630 2002 Tel: 07 5539 4676 Fax: 07 5636 0122 Fax: 07 5539 4756 ENT/ Head and Neck Surgeon Dr Sam Dowthwaite, has a subspecialty interest in head and neck oncology and microvascular reconstructive surgery. He recently returned from fellowship training in London, Ontario, Canada where he was the head and neck reconstructive fellow under the supervision of Professor John Yoo. This invaluable experience has given him comprehensive training in all aspects of head and neck oncology and reconstruction, including facial reanimation and transoral robotic surgery. Respiratory and Sleep Medicine Physician, Dr David Deller has extensive experience in the management of all general respiratory conditions including emphysema, chronic bronchitis, asthma, interstitial lung disease, sarcoidosis, bronchiectasis, pulmonary infection and pleural diseases. In addition to general respiratory medicine, he also has a special interest in lung cancer and interventional bronchoscopy including endobronchial ultrasound (EBUS) and has launched the Gold Coast’s first comprehensive EBUS service. He is the only private physician performing these procedures in the region. Dr Andrew Cameron Medical Oncologist and Palliative Care Dr Dan Robinson Ear Nose and Throat , Head and Neck Surgery Gold Coast Haematology and Oncology Pindara Professional Centre Suite 101, Level 1, Benowa, QLD, 4217 Pindara Specialist Suites, Tel: 07 5630 2002 29 Carrara Street, Fax: 07 5636 0122 BENOWA, QLD 4217 ENT/ Head and Neck Surgeon. Tel: 07 5597 1305 Fax: 07 5597 1205 Gold Coast Haematology and Oncology welcomes Dr Andrew Cameron (Medical Oncologist and Palliative Care) to private practice. As of June 2013, Dr Cameron will practice as a general medical oncologist, with a special interest in gynaecological and gastrointestinal oncology. He developed this interest when completing his fellowship at the NHMRC Clinical Trials Centre at the University of Sydney in these tumour groups as well as his Masters in Clinical Trials Research. He will be instrumental in initiating inaugural trials on the Gold Coast. Dr Cameron’s practice is patient-focused, with an emphasis on enabling patient understanding of the medical issues affecting their life. He has extensive experience in palliative care medicine and offers patients, their families and friends, respect, compassion and understanding in a very distressing time. Dr Cameron is a keen and caring practitioner, with a passion for team-work and communication. He is available to provide information and support about his patients, enabling all involved to provide the best care for his patients. 8-10 Carrara St Dr Dan Robinson, has a primary Interest in rhinology, rhinoplasty with a specific interest in nasal airway pathology and facial cutaneous malignancy. He is also interested in the full spectrum of facial plastic surgery whilst maintaining a general interest in ENT including paediatrics, snoring and tonsillar disease. Dr Scott Blundell Paediatrician Dr Drew Moffrey Obstetrics and Gynaecology Leading Steps Paediatric Clinic Suite 9, Level 2 , Pindara Place Suite 405, Level 4, Pindara 13 Carrara St Specialist Suits Benowa Benowa, QLD, 4217 29 Carrara St Tel: 07 5597 5344 Benowa, QLD, 4217 Fax: 07 5597 5376 Tel: 07 5564 9668 www.drdrewmoffrey.com.au Fax: 075591 8063 Dr Moffrey has extensive experience in all areas of Obstetrics and Gynaecology, and in particular high risk obstetrics and gestational diabetes. www.leadingsteps.com.au Dr. Scott Blundell has extensive experience in Paediatric Intensive Care, Neonatal Intensive Care, as well as renal and neurological specialty areas. His special interests include Endocrine disorders, Renal conditions, Neurological conditions, Neonatology, all aspects of general paediatrics. Also a qualified physiotherapist Dr. Blundell has worked for two years as a paediatric physiotherapist at the Children’s Hospital at Westmead prior to commencing medical training. He is also accredited in Advanced Paediatric Life Support (APLS). Dr Ben Hunt Cardiologist and Cardiac Electrophysiologist The Cardiac Centre Suites 507-510, Level 5, Pindara Specialist Suites 29 Carrara Street BENOWA QLD 4217 The Cardiac Centre Hope Island Central Shop 13 340 Hope Island Road HOPE ISLAND QLD 4212 Tel: 07 5598 0322 Fax: 07 5591 6775 The Cardiac Centre is pleased to welcome Cardiologist and Cardiac Electrophysiologist Dr Ben Hunt to their practice. Dr Hunt has a special interest in atrial fibrillation, heart rhythm disorders, ablation of arrhythmias and implantation and management of pacemakers and defibrillators. Dr Hunt will base his practice at the Cardiac Centre’s new rooms at Hope Island. The Hope Island practice will offer cardiac consultation and non-invasive cardiac testing. Dr Hunt will also consult at the Pindara Private Hospital and Ballina rooms. Prior to commencing private practice at Pindara Private Hospital, Dr Moffrey held the position of Deputy Director of Obstetrics & Gynaecology at Logan Hospital - a busy unit delivering more than 3600 babies a year. Dr Moffrey also has experience in urogynaecology and advanced laparoscopy. New rooms for Dr Danielle Ghusn Breast & Endocrine Surgeon, Dr Danielle Ghusn has relocated to rooms in the Pindara Specialist Suites Building. For consultations please telephone 07 5598 0644. Dr Danielle Ghusn MBBS (QLD) FRACS Pindara Specialist Suites Suite 2.10, 29 Carrara Street Benowa QLD 4217 Tel: 07 5598 0644 Fax: 07 5598 0666 Provider No: 2074707W Prescriber No: 885819 Pindara Private Hospital ABN: 51 005 288 095 Allchurch Ave., Benowa QLD 4217 Tel: (07) 5588 9888 | Fax: (07) 5588 9811 Disclaimer: No part of this publication may be reproduced or copied in any form by any means without prior written permission from the author of the article and/or Pindara Private Hospital.