Meningococcal B vaccinations

How many of you guys have prescribed the meningococcal B vaccination? It’s called Bexsero.

I had a mother come in asking for it. I didn’t know much about it but luckily I had some brochures handy and articles that I could present to her.

Here are some key points:

  • 200 – 250 cases of meningococcal occur each year. The majority of these cases are due to meningococcal B. Meningococcal C has declined since the 2003 immunisation schedule.
  • The immunisation covers 76% of strains of Meningococcal B in Australia
  • There is a cost involved (approximately $137)
  • You are required to take either 2 or 3 doses and a booster shot is also offered
  • A common side effect is post-vaccination fever

Let me know if there was anything else you’ve heard out there which also needs to be discussed with parents.

More information can be found at: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/85A6879534C02B4DCA257B640002F38E/$File/ATAGI-advice-bexsero.pdf

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Getting Exposure

Does anyone know how it is that people start reading a blog? Does the author tend to comment on other websites and hope that those people reading that website will venture over to this part of town. I know when I comment on a post I want it to be worthwhile and not just a random promotion but I know I’m at a point where I want people to see what’s written here and give me their thoughts. I think that time will come when I write a piece that I know I need to tell the world. For now I’m happy writing for myself and those few who chose to follow this blog. I hope one day I can compile a list of stories and interesting consultations from over the years.

Interesting Case of the Day
Today I was presented with a 6 year old who had 2 cystic lumps over the upper eyelid and the lower eyelid. It was initially treated as a stye and managed with antibiotics. The practice point in this presentation is that a stye needs to have an associated hair follicle in the area that’s affected. This was close but not part of a hair follicle. This was in fact a chalazion or meibomian cyst and the treatment is different. You can confirm their presence by inverting the eyelid. Once I knew what it was I advised mum to apply warm compresses on it (for 5-10 minutes approximately 3 times a day). This is the definitive treatment and baby shampoo can be used to prevent recurrence when applied over the eyelid. In the instance where it is infected, oral antibiotics may be used. If there is no improvement then of course you’ll need to make a specialist referral to remove the cyst. Sometimes we just have to look a little closer.

Offended?

So today I was faced with an unusual situation. I was due to see my next patient and went out into the waiting room to call her. It wasn’t long after 5pm so the waiting room was pretty empty. When I called her name she stood up and walked towards me and continued walking beside me for a few steps. I introduced myself and then she blurted “sorry I thought I was seeing a female doctor… you know because of my lady problems. I specifically asked reception for a lady doctor”. I stopped, turned around and walked towards reception. I acknowledged the request but was puzzled. Could I not handle this situation? Why did she wait until half way down the corridor to tell me she wanted a female doctor? I honestly don’t know. Anyway, I asked reception about the mix up and they said they’d sort it out.

I felt a little awkward. I know it’s not me but sometimes it makes you wonder what it means to be equal. Why is it that I somehow can’t handle a situation that I have been trained to tackle.

Just something different today.

Chest Pain

What are your stories of patients coming in with chest pain?

I was presented with a 60yo male last week who reported 4/10 pain in his chest, slight shortness of breath during the day and weakness in the arms. The pain felt like a lump in his chest and he is known to have a significant history of indigestion.

I trialled some mylanta and did an ECG and here I was looking at a man with what seemed to be a minor MSK chest pain reporting significant ST elevation in the posterior leads of his ECG.

I had no idea how this was managed in the GP setting but I did everything I needed to do whilst the ambulance was being called. What a rush! Oxygen on despite normal sats. GTN spray and aspirin given. IV cannula in and morphine pushed through. When the ambulance arrived there was still some ST elevation and we sent him on his way to the cath lab.

The next day after the weekend I found out he had 2 stents put in and is awaiting bypass surgery. What do you know. A life saved. Sometimes it’s better to go with your gut and look because more things are missed by not looking than not knowing.

This is the first time I had to transfer anyone to hospital but boy was it a rush. Let me know if you have any misleading presentations of chest pain yourselves.