HSiiilyE'*Ar YOUR DOCTOR197 High StreetC€nbourne 3977P: (03) 5991 1222F: (03) 5996 8243W: www.caseymedical.com.au

Dr Sam Auterl Maas Bsc D/p(obsr)RcocFRACGP APMCOG

Dr Guenter Oechsle MaBs DRANzcoGFRACG P Gnd DipN ut& EnvM ed

DrTom Everitt Maas DipRAcoG FRAcGp

Dr Roger Smlth /t aBS(Hons) FRACAq

Dr Kfm Teo MBBS DFA Nzcoc FRACGq

Dr Brett Oglfvie MBBs DRANzcoa FRAccp

Dl Robyn Newnham MBBS(Hons) DipRAcoC

Dr Amanda Osborne MBBS FRAccpDr Ratna Vaska MBBS FRAccpDr Justin Curan MBBS(Hons) FRACGq DcH

Dr Bims Gurusinghe Maas aMedscFRACGP

Dr Clffford Morrison MBBs BMedsc FRAccpDr Sugunendra Thevasagayam MaasFRACGP

Dr Sharlene (Xueling)Tan MBas(Ho's,BMedSci.DCH FRACGP

Dr Wifson Zhang MB Bs DcH FF'r'.ccp

Dr Jason Ha Maas B Medsci FRAccp

DrTlan Tu MBBS

ONLINE APPOINTMENTSWE have introduced the convenience ofonline appointment bookings 24hr3 a day,7 days a we6k. You can book an appointmenreither through our NEWWEBSITE www.caseymedical.com.au, lhrough the 1st availablecom.au mobile app, or directlythrough "l st availabb.com.au. A Likelt's quick, simDle and it's free. .JBULK BILLINGCHILDFEN UNDER 16 BULK BILLED AT ALLTIMES, includlng atter hours, weekends andpubllc holidays. Health Care cardholders witlbe bulk billed Monday - Friday untilTpm, fee$apply thereafter, weekends and public hotidays.

PELVIC FLOOR FETIABILITATIONTHERAPYInnovative incontinence treatrnent for bothmale and iemale patients. Paiients remain fullyclothed, seated comfortably on a chair whichprovides stimulation to vital muscles whichcannot be activated lhrough manual pelvic floorexercrse alone.

SURGERY HOURS AND SERVICESWeekday opening hours changeCONSULTATIONS by appointment:Monday to Friday 8am-€pmSaturday and Sunday gam-spmPubllc holidsys As posted

FOR AFTER-HOUFS please attL.nd theEmeJgency Department of either DandenongPublic Hospital, David Streei. Dandenong, OhFranksbn Hospital, Hastings Foad, Frank$on,OR The Valley Private Hospital, cnr police anoGladstone roads. Mulgrave, OB Casey Hospital,Kangan St., Berwick. For regular patients ofC€sey Medical Cenlre a doctor mav be reacneoby phoning 1902 213 035. Charges for this catlwill be at a rate of $5.50 per minute charoed toyour phone account.

HOME VISITS during surgery hours can bearranged for emeruencies or if a pati€nt isunable to travel. Please contact lhe centrebetore noon if possible to make appropriatearrangements.

ls detoxification a myth?l.ri llr(, ,i,,,1 ,i , ii ;rr 1 ;r,./r, It.lillilrji lirirr,lr,ij1l ,,1 ,/i,rr. ,|r, rI,., 1..;r r /:) . ir ';ir,. ,rrr: i',r, 'l;, '"i,ir :,r'ii ),. )a t i ,::t .i it r.t r' ,,,tr 1l

I t.)l:1t .t:-,t),rrr. i,.lltirr r,l

Sbll, you should not give in to the promisesof detoxification that have become louder inthe wellness industry recently. Before yousqueeze out another drink from a couple ofkilograms of lruits or you go to a clinic forbowel irrigation, you should know that theprocess of detoxification is being done byyour body all on its own without any helpwhile you are reading this.

The basic premise of these 'detoxification'promises is that you lollow various diets,from fasting to consuming exclusively fruit,fruit julces, vegetables, and waterThey alsootfer all kinds of herbs and supplements inaddition to enemas to, in the advertisements'words, remove material dislodged inthe colon:

The reality is simple. If poisons and toxinswere actually piling up in your body andcould not be removed, you would be deador in need of serious medical intervention.The liver, kidneys, skin and lungs all removetoxins naturally, every second of every day.

Most manufacturers and people that providethese supplements, diets and services donot state the exact toxins that detoxilicationgets rid of. lf they did, you could easity getit measured before and after to see theefiicacy of what they are offering.

So where is the evidence you might ask?Well, there actually is no concrete orparticular dala to support these servicesand diets. While some people claim to feelbetter after detoxitication diels, that canbe explained. In part it is because highlyprocessed foods with sugar and solid foodsare avoided.

Studies have shown that these diets lowerthe basal metabolic rate in your body toconserve energy. The weight loss achievedis from lluid loss from low carbohydrateintake and bowel movements that are morefrequent in these diets. When you start anormal diet again. you will rapidly regainthe weight lost. Detoxification diets thatdrastically reduce protein intake can causefatigue. Mineral and vitamin deficiencies canalso occur if you fast long term. lf you usedaily laxatives, this can lead to a disruplionin native intestinal flora (the good guys) andeven a misbalance in your body! acid-base,which can lead to serious health problemsrequiring urgent medical attention.

As tor colon cleansing, faecal matter doesnot stick to your colon's walls as advertised,Furthermore, colon cleansing can causebloating, nausea, cramping, vomiting, andin some rare cases even perforation if doneinadequately and not by a doctor.

lf you still want to consider detoxitication,please consult your doctor before starting.Remember, the body defends itself efficientlyon itsown.You can simplyachieve permanentresults by eating a normal, heallhy dietbased on vegetables and fruits, lean sourcesof proteins and whole grains, along withproperfluid intake, a normalamount of sleep,regular exercise, and adhering to medicalcheck-ups as recommended by your doctor.

Sugar is lhe latest villain hrndering ourpursurt of heallhier iiestyles thanks to itspotential as a catalyst lor obes ty diabelesand heart disease. An ncreasing numberof health profess onals are warn ngconsurners oi the polential r sk posed tous by diets high in sugar.

Future health professionals andnutritionists may look back andagree sugar is lhe single worstingredient in modern diets, thanksto its impact on our metabolismand contribution to a sharp spikein the incidence ol certain diseases.

While some commentators contend sugar,iike most foods, is fine in moderation,opponents are increasingly vocal aboutthe health dangers posed by sugar andhigh-fructose corn syrup.

It's easy to forget sugar wasn't an ever-present part of Western diets untilcomparatively recently, thanks to theindustria| satron of sugar cane farming.Sugar consumption rose with the increasedavailability of chocolate, ice cream andlollies in the mid-1gth century and received

a turther boost when sott drinks appearedin the 1880's pioneered by Dr Pepper and

Coca-Cola.

lronically, the post-war refrigeration boomenabled consumers to consume moresott drinks at home. while the invention offrozen fruitjuice concentrate, with its hiddencargo of sugar, became a cornerstone ofbreakfast. Breakfast solidified its status

as a health battlefield whenmarketers included sugar in

breakfast cereal to tap intochildren's tastes. The debut

of highjructose corn syrup inthe 1970s saw further increases in

sugar consumption, coinciding with aninexorable rise in instances of diabetes(virtually unknown to hospitals in the1950s) and obesity.

Sugar's 7 deadly sinsAnti-sugar campaigners point to sevenmajor problems associated with powdered

sugar and the less visible but even morewide-spread highJructose corn syrup:

1, Sugar contains no essential nutrientsand is bad for your teeth.

2. Sugar is high in fructose, which canoverload your liver, triggering non-alcoholic latty liver disease.

3, Sugar can cause insulin resistancepaving the way for diabetes.

4. Sugar promotes tats in the body.

5. Sugar can be highly addictive due to itsmassive dopamine release in the brain.

6. Sugar is a leading contributorto obesityin children and adults.

7 Sugar raises your cholesterol and canlead to heart disease.

Part of the problem in managing oursugar intake is rt turns up everywhere in

our modern diet. A lurking, ever-presentingredient in foods we don't commonlyassociate with sugar; bread, breakfastcereal, yoghurt, fruit juice, smoothies,tomato and BBQ sauce, mayonnaise, andeven in salad dressing.

A sweet menaceScientists and nutritionists once considered

sugarto be relatively benign.At worst, it was

a source of 'empty calories'and contributed

to tooth decay. Faslforward and sugar has

taken the mantle of modern-day health'super villain' by storm. Opponents label it'toxic'and if you haven't cut down on sugaryourself, you are sure to know someonewho has. Unfortunately, sugar hasn't proven

to be dangerous because of its calories, itsproblem lies deeper - in its biochemistry.

Please consult your doctor for advice on

diet-related issues.

Electronic cigarettes are strsssing your heartNew research suggests thal e crgaretlesmay significantly disrupl a smokeas heartrafe and stress the lmrnune syslern.

Electronic cigarette use is on the rise. Morecommonly referred to as vaprng, e-cigarettesmoking is promoted as a risk-freealternative to smoking tobacco. Allhoughmost physicians agree that inhaling watervapour is preferable over toxic smoke, thelong{erm heallh etfects of e-cigarettes arestill unknown.

It does appear that switchang to ane-cigarette is eftective in helping tobaccosmokers quit. A 2016 Cochrane reviewof all available research determined thate-cigarette use was no bener than using a

nicotine patch. Although the authors of thereview delermined that e-cigarettes did notpose any threats to overall health short-term, they cautioned lhat long-term healthrisks were still unknown.

In order to explore the potential lorlong-term health risks, researchers aremeasuring subtle changes in the body schemistry. Inslead of waiting years to seeif e-cigarettes are harmlul, scientists areexploring all potential early warning signs-

Most recently, a team of researchers fromthe University ol Calilornia, Los Angeles(UCLA) examined a group of healthy menand women aged 21 to 45. The study

compared 19 control participants to 16

individuals who smoked e-cigarettes atleast once a day, every day, for over a year.

The researchers sought to determinewhether e-cigarette smoking disruptedthe heart's natural rhylhm and/or causeddamaoe to tissues and blood vessels.To examine whether e-cigarettesdisrupted the heart's natural cadence,researchers calculated the Heart RateVariability (HFIV) of smoking and non-smoking participants.

Previous studies in tobacco researchhave concluded that tobacco candisrupt the body's heart rate. Thisdisruption is important because itincreases a person's potential fora heart attack. Worryingly, theirfindings suggest that e-cigarettescontaining nicotine can also disruptthe body's ability to regulate heart rate,suggesting lhat use of e-cigarettes poses

a sionificant risk to heart health.

To validate their findings, the researcherscompared specific cholesterol proteinsin the blood stream. They examined thecholesterol proteins for signs ol stress.Although the tests were not specific forthe etfects ol e-cigarette smoking, theyare considered a good general indicatorof stress.

Alter analysing results ol the two groups,

the researchers concluded that thee-cigarette group not only experlencedgreater heart rate variability, but also that

their blood stream had an increasednumber of stress-induced proleinsThese results mirror results from past

studies of long{erm tobacco use, andare therefore a short-term sign oIlong-term damage.

Although the size of the studiedpopulation suggests the study maynot be generalisable, the lindingsadd to the growing list of health risksposed by e-cigarette use. Until scientists

investigatefurther, health officialssuggestthat e-cigarettes should be avoidedwhenever possible.

Your doctor can provide you with supportand assistance if you are trying to quitsmoking. Speak to one ot our stafi today.

Retetences1.l\,loheimani RS, Bhelraratana M, Yin F, et al.

Increased Cardiac Sympaihetic Activity andOxidative Slress in Habitual Eleclronic Cigarette Users: lmplications for Cardiovascular Rrsk.

JAMA Cardiol. Published online February 01,2017. d o i : 10. 1 001 / i am ac atd io.201 6. 5303

2. Hartmann-Boyce J, McRobbie H, Bullen C,el al. Electronic cigarettes tor smokingcessation. Cochrane Database ol SystematicReviews 2016, lssue 9.Art. No.:CD010216 dorfi I oaz 1 4 6 5 1 I 58. C D01 021 6. P0 b3.

- DtD YOU t(N0Wl ....,:,:

@@@@ ee@@e@ HPV: what you needto know...MEC IB OREA V I H V V J OG S UOU O G K

PTXQPYUMA J B J IHBBLHDOPOWYZNV J MCNCMTQX X T O EZC I LEWP NJVH SD I CQOZWB S NOSD I ABE T E SOPU PA IOXIUNSFEO IYNDGODS NV GW R N V I L L A I N O M G T T W H Y U G O NANTAENXNQQN B H T BYLGTOKS I I

CST UZ SJTX LP E CAWCCP ZV I T Z SH I M J K BUYR TS I ME H CXRXOOG BGO Q J T S H A P G A P P B R H KWW P B P V N NLOJ J KF IHMYEHOT ECF IAEF E IIEVF LWYGQCAK H P IRSOCYFT INKSYS UR I VF J AC B AC B FCN LTAM FOTDWXSOADE HYO LWAOT F ED I S EMEXOMS SENT I FWPH L F I RAUWF CSRXBME TABO L I SMP J OAAYORS T JOOKZQN IARBTE ID IGIANNCX IALZY BU ZKC WORTGK IHTUQTZJODJ IWESOTCURF F NCTNE IRTU NN I

DXP TAQQL P VWWWE H YS Z ACD GQG

Human papillomavrrus. or l'lPV as i rs nroreqenera ly knowr-r. is a common r.,irus thaispreads easily thi'orgh d rect sk N to sk n:or ta: rrJ;sec:s boll Taies dno t6'rnles

The virus has over 100 known strains. Mosttypes of HPV are harmless: there are nosymptoms and the virus disappears withoutyou even knowing it was there to begin with.Other strains of HPV are the cause of wartsthat appear on your hands and feet.

Another forty varieties affect the genitalregion and are classified as Sexuallynansmitted Infections (STls). Genital HPVtypes are classilied either as high or lowrisk. High risktypes can cause certain typesof cancers in the genilal region, such ascervical or anal cancer, whereas low-risktypes are the cause of genital warts.

Infection typically occurs atterthe lirst sexualencounter and anyone who has engaged inany type of activity involving genital contactcould get genital HPV Infection rates varyconsiderably between population groupsand geographic regions; however it isestimated that up to 80o/" of the generalpopulation will be infected with at least onetype of genital HPV at some point duringtheir life.

It took more than twenty years, from thetime it was first proposed that strains ofHPV were associated with cervical cancer,for scientists to create a safe and eftectivevaccine that protects against the wart andcancer causing strains of HPV

Studies have shown that aerobic training,specifically a three day per week walkingprogram for 12 months, signilicantlyincreases hippocampal volume in healthy,

older adults. Put another way, it reversesage-related volume loss to the hjppocampusby approximately two years. Furthermore,another recent study shows that aerobicexercise of 120 minutes per week is alsobeneficial for increasing h ippocampalvolume in older adults that have started toshow signs of mild cognitive impairment.

With an aging population, the number ofpeople affected by dementia is expected torise lrom an estimaled 46.8 million in 2015

worldwide, to 13'1.5 million people by 2050.Exercise has been found to be a simple, lowrisk and cost elfective way to help preventmental decline associated wjth ageing. soit's important that you get up and active toprotect your brajn.

Speak to your doctor about specific aerobicexercises that may be suitable for you.

Refercnce1. len Brinke LF, Bolandzadeh N, Nagamatsu LS,

et al. Aerobic exercise increases hippocampalvolume in older women with probable mildcognative impairmenl: A 6-month randomisedcontrolled lrial. Btitish Joutnal ol SpottsMed ic ine. 201 4; 49(41 24A-254. doi:10. 1136/bisporls-201 3'0931 84.

AEROBIC

BRAIN

CHEMISTRY

CHOLESTEROL

CIGARETTE

DIABETES

DIET

EXERCISE

FITNESS

FRUCTOSE

HEART

HERBAL

HIPPOCAMPUS

INFECTION

METABOLISM

NUTRIENT

OBESITY

PLANT

POISON

REMEDY

SMOKING

STRAIN

SUGAR

TOBACCO

TOXIN

IREATMENT

VACCINATION

VILLAIN

VIRUS

WORT

Brain benefits of exerciseExefcrse is caii{rqorised as either aeroitloof afaeToDtc alqo airrTeni IeSeilfair reveir:iiJ..'ralrts to the brai f lronr a-ortb c exe'ii:.rl

Aerobic exercise gets your heart pumprngwith the goalof improving yourcardiovascularfitness. Aerobic exercise includes activitiessuch as walkrng. jogging. biking, etc.Anaerobic exercise (resislance training)alms to increase your strength, power, andmuscle mass by using short bursts of energy.Anaerobic exercise includes activities suchas weightlifting and sprinting.

There are a wide variety of reasons toexercise, including improved fitness andweight control, as well as a reduced riskof heart disease, stroke, and diabetes.However, the benefits of exercise on theageing brain has been gaining attention.Becently it has found that physical activitycan also help protect your brain as you age.

Research has revealed that both types ofexercrse enhance cognitive performanceand the abiljty to adapt to change in healthy,older adults by positively affecting the regionof the brain called the hippocampus. Thehippocampus is believed to be responsiblefor memory, emolion and spatial navigation.Age-related changes and damage tothe hippocampus are often associatedwith dementia.

To prevent infection occurring in lhe firstplace, the HPV vaccination is provided freeof charge, and delivered through schoolsin Australia, to all males and females aged12-13 years. The vaccine is given as threeinjections over a period of six months and itis important to comDlete the full course - toensure lhe best possible protection.

In 2008, the man who first proposed thelink between HPV and cervical cancer wasawarded the Nobel Prize in Physiology andN4edicine. lvledical professionals believethe vaccine has prevented hundreds ofthousands of cases of cervical and oralcancer worldwide, saving countless lives.

Yourdoctor can advise you further aboutthevirus, symptoms, prevention and treatment.Speak with one of our staff about makingan aooointment.

have identified three areas where its activeingredients may pose issues for patients:

s When swapping to prescription anti-depressants:to avoid the risk of serotonintoxicity (tremors, sweating, agitation,conlusion, muscle spasms and diarrhea),withdraw slowly and stop St John's Wortentirely for one-week before commencingprescribed medication.

. When taking the oral contraceptivepill: St John's Wort can stimulate thebreak down of the pills'oestrogen andprogestogen components, increasing risksot an unplanned pregnancy.

r When taking prescription antidepressants:St John's Wort shares a common activationmechanism with many antidepressants.Taken in conjunction can increase the riskof serotonin toxicity.

As always, please consult your GP beforetaking any unprescribed medication asit may produce side effects if taken incombination with other medication.

PRACTICE UPIIATE

Nature's little helper:St John's Wort::i )t,t t \il1,ti iIttlr)la.iri) t)t:tijt,tl|ttttttijt.iirir ,ii 1irr .,i,r lvr: rrl IIr.,l);iIirI,. !,r,rl,1Jvr1,'

This useful little plant, with its jaunty yellowflowers has proven to be a mainstay in herbalmedicine. lt is used for treating complaintsas diverse as depression, anxiety, abdominalpains, alcoholism, earaches, menopause andinsomnia.The key to its healing reputation lieswith two key active ingredients; hypericin andhyperforin. Both have antibiotic propertieswhile hypericin is also thought to increasedopamine levels.

Today StJohn'sWort is one of our best-knowherbal remedies and is widely available inthe health supplemenl and vitamin sectionsot pharmacies and health tood outlets.

While the herbal community has embracedSl John's Wort, its adoption by mainstreammedicine has been hindered by a lack ofclarity around the correct dosage level andongoing uncertainty as to how it interactswith other drug treatments.

While St John's Wort can be a usetul littleplant when taken in moderation. studies

SPINACH AND RICOTTA ROLLS

Method

1. Preheat oven to 200 degrees Celsius.

2. In a saucepan, heat two tbsp water

and add onion, garlic and spinach -cover with lid and cook for five minutes

until spinach has wilted. Flemove from

heat until cooled.

3. In a mixing bowl combine spinachmixture, ricotta cheese, nutmeg,

oregano and egg * mix well until

all combined.

4. Work with tour sheets of pastry at atime. Spread out two sheets of pastry

on the bench and brush lightly with

olive oil. Top with another two sheets

of pastry and brush with oil again.

5. Spoon spinach mixture along length

of pastry and roll up to create onelong pastry roll. Repeal with remaining

tour sheets.

6. Brush lightly with egg mixture and

sprinkle with poppy or sesame seeds.

7 Cut into individual mini rolls and ptace

on lined baking tray.

8. Bake for 15 minutes or until crisp.

DOCTOR'S LEAVEDr Jason Ha 29 Aptil2017 lo7 May 2017

Dr Tian Tu 2. Aptil2017 lo 7 Malf 2017

BEAUWSERVICESCasey Medical Centre's Beauty Therapyroom provides the irllowing services:. Facial rejuvenation - Anti-wrinkle

injections Dermal Fillers. Facial treatments and Droducts. Waxing. Eyebrow & Eyelash Tinting. Eyelash Extensions

GIFT VOUCHERS, Bsauty Servicesbrochure and oricelist are available for allBeauty Services lrom reception or checkour website.

WEBSITEPlease visit us at www.caseymadical.com.au and you can meet our medicalstafi, find out the latest news, learn aboutthe history of CMC and our Beauty Room.

FEESOur lee for a standard consultation is

$70, the Medicare rebate is $3705. ForHCC holders bulk billing will be availableweekdays from 8am to 7pm only. Feesapply thereafter, weekends and publicholidays.

Children under 16, Aged Pensioners andVeterans Afiai6 card holders will be bulkbilled at all times.

Workcover & TAC patients: Non cardholders will be charged an out of pocketfee of $20. After hours tees for non cardholders $30, and card holders $20.Patients will need to settle account onthe day ot service. The account is notclaimable from Medicare, Workcoveror TAC.

PRIVACYThis practice is committed to maintainingthe confidentiality ot your personal healthinformation. Your medical record is aconfidential document. lt is the policyot this practice to maintain security otpersonal health information at all timesand to ensure that this information is onlyavailable to authorised membeF of staff.

RESULTS. REFERRALS &PRESCBIPT]ONSTost results (provided only it medicallyappropriate) can be organised betweenMon-Fri, gam-spm. Ongoing specialistreferrals requested without an appointmentmay altract a $10 lee. There will be anadministration tee of $2 il these need to befaxsd or mailed. Repeats of most ongoingscripts require an appointment. Pleasemsntion to the receptionist that it is onlytor an ongoing scripl trom your doctor asthe visit will then be bulk billed.

aix1 tbsp olive oil

1 clove garlic, crushed

1 egg

54vow\t

1 onaon, diced

2large bunches spinach, leaves chopped

(ends discarded)

2509 tub low fat ricotta cheese

8 sheets filo pastry

1 tsp grated nutmeg

'| tbsp dried oregano

1 egg, whisked (for brushing)

Poppy or sesame seeds