Category: Uncategorized

  • Skin Cancer

    Dr Jay Chelladurai offers Skin Checks and Skin Cancer procedures at Central Coast Skin Cancer Clinic, East Gosford

    Which of these are Melanoma?

    The middle ones are Melanoma. As you can see, 2 moles which may appear very similar can be very different. One can be a deadly melanoma and another can be a harmless condition called Seborrhoeic Keratosis or sometimes even just a freckle.

    Who needs skin cancer checks?

    • People with a fair skin.
    • People who have spent time in the sun.
    • People who have many moles.
    • People who have lots of freckles.
    • People who have previously had a skin cancer.
    • People who have a family member who may have had a melanoma or another skin cancer.
    • People who have had radiotherapy.
    • People who have had an organ transplant.

    What Happens at a Skin Check Consultation?

    Just as the name suggests. Check your skin. The doctor will greet you. Ask a few questions to better understand your risk of skin cancer. Then it would be the stage of skin examination. You would need to undress, usually down to your underwear. Lie on a bed. The doctor would examine your skin from head to toe/toe to head aided by bright light +/- magnification. Some moles would need to be felt by touching, to see if it is thick or raised. Each suspected mole would further be examined with a special device called dermatoscope (skin microscope). Some times photos of some moles may be taken to be stored to explain to you or for future comparison for interval change.

    What if I am not comfortable to undress?

    Unfortunately a thorough skin examination would not be possible without undressing. You can bring in your partner/parent/children if that may help. You can ask for a chaperone (usually a nurse) to be with you during the examination. Or you can elect to only have part of your skin examined, in which case, potentially dangerous skin cancers may not be picked. Contrary to some beliefs, a dress penetrating camera is not used.

    How often do I need a Skin Check?

    It depends on multiple factors. Your skin colour, your sun exposure, your age, number of moles/freckles you have. The higher the risk, the more often you would need. Most people are advised to have a check once a year. Some may need 6 monthly. Some may not need a check for 3-4 years. You will be advised about your next visit during the consultation.

    How do I prepare for a Skin Check?

    Most often, you do not need any specific preparation. But some of these would be very helpful

    • Wearing clothings that can be easily removed and worn back can make the process easy.
    • Avoid wearing make up. Some make up materials can be hard to wipe away and can make evaluating some moles very difficult.
    • Remove nail polish if possible. Some nail changes from underlying cancers may not be visible if covered by nail polish
    • If you had to have fake tan, try to schedule a skin check 3-4 weeks after so the skin can be examined better.
    • If you have very dry skin, applying some good moisturisers can be helpful.

    What happens if an abnormal mole is found?

    We will explain to you about the mole as to what it could be. Then offer management pathways as 

    • Asking you to self monitor until your next planned visit.
    • Come back for a follow up in an earlier interval eg 3 months instead of the usual 12 months.
    • Have pictures of the mole taken to monitor the progress.
    • Some moles can be treated with a process called Cryotherapy
    • Some moles may need to be further ascertained by a process called Biopsy.
    • Some moles may need to be completely removed by a process called Excision

    Will I die if I get a skin cancer?

    Most skin cancers are slow growing and do not spread until they have become really big. However, there are some skin cancers such as melanoma that can be deadly if not treated. So they are not entirely harmless, if that makes sense.

    The commonest skin cancers are squamous cell cancers and basal cell cancers. Then the melanoma. Most common of the melanoma are early stage melanoma or melanoma in-situ. Most early stage melanoma once removed, the never come back. And generally once we find a mole is a melanoma we almost always do a further procedure to take some more skin around it (Wide Local Excisio) to make sure there are no more melanoma cells in the vicinity. 

    However, for some cancers, especially advanced melanoma, we would need to refer you for further treatment.

  • Railway Medicals

    Dr Jay Chelladurai is an Authorised Health Practitioner. He provides Railway Medicals Cat 1,2 and 3 at The Surgery Kincumber.

    Please ring the practice to make this appointment. Do not make online appointment. Make sure you inform if it for Cat 1, Cat 2 or Cat 3. This process requires a long appointment and an appointment with the nurse as well.

    Step 1

    Before Consultation

    1. Fill the relevent 2 forms online, print and bring them with you
    2. Book appointment and have hearing assessment done at Connect Hearing Umina.
      • Hearing test is necessary for all. We have liaised with Connect Hearing in Umina. Please organise your appointment with them and inform them that you will be following up with us for railways medicals. They will then forward your hearing assessment reports directly to us.
    3. Please ring The Surgery Kincumber on 43696777 to make appointment. Explain to staff about what category assessment you need.
    4. Request referral forms for blood test for HbA1c, Cholesterol and Kidney functions for Cat 1 and 2 as well as for ECG for Cat 1. Having these tests prior to consultation will speed up the signing off process. These tests can be done at any pathology provider such as Douglas Hanley Moir or Laverty Pathology.

    Step 2 

    Consultation with nurse 

    Cat 3 (15 mins) to Cat 1 and 2 (45mins)

    • Vision assessment
    • Breath Alcohol Test
    • Urine Drug Screen
    • Height, weight, Blood Pressure (only for Cat 1 and 2)

    Step 3 

    Consultation with doctor

    Cat 3 (15 mins) to Cat 1 and 2 (45 mins)

    • Clinical examination. Cat 1 and 2 or Cat 3
    • Colour Vision assessment (Cat 1 and 2)
    • Australian Cardiovascular Risk Assessment (Cat 1 and 2)
    • Psychological Evaluation (Cat 1 and 2)
    • Sleep Apnoea evaluation (Cat 1 and 2)
    • Referral for ECG (Cat 1), Blood test for HbA1c, Cholesterol, kidney functions (Cat 1 and 2), if not already done.

    Step 4

    Final Signing Off by doctor

    • After completion of clinical examination, hearing report (Cat 3)
    • After completion of clinical examination, hearing, blood and ECG (Cat 1 and 2)

    Latest and further information can be found at National Transport Commission website. If any links in this page are not working, the relevant forms can be accessed from this page.

  • Yellow Fever Vaccination

    Yellow Fever Vaccination is available at The Surgery Kincumber. Yellow Fever Vaccination is required for Travellers/visitors to certain countries in South America and Sub Saharan Africa who are over 9 months of age. We are a government accredited Yellow Fever Vaccination centre. We offer Yellow Fever Vaccine to our own patients as well as patients from other practices.

    Vaccination Process.

    The vaccination is by one injection in the shoulder.

    • Number of doses: 1
    • Presumed immunity after: 10 days

    Passport information is required to be entered in the special vaccination booklet.

    You will be provided with evidence of Yellow Fever Vaccination in the internationally recognised format.

    Please remember to bring your passport for this appointment

    Yellow Fever Vaccine – STAMARIL

    What is it?

    Attenuated 17D strain Yellow Fever (Live) Vaccine in a freeze dried form.

    Manufacturing process?

    Virus is propagated in specific pathogen free chick embryos.

    Who must not have it?

    • People who have severe allergic reaction to egg or chicken.
    • Children under 6 months of age.
    • People with reduced immunity.
    • Symptomatic HIV positive people
    • Pregnant or breast feeding women
    • People with disease of thymus or have their thymus gland removed.
    • People who are currently unwell with an infective process.

    Other considerations:

    • Yellow fever vaccination can not be done within 4 weeks of another live vaccine.
    • Yellow Fever Vaccination can however be done at the same time with other live vaccines.

    Common Side Effects:

    • Headache – 18%
    • Tiredness – 16.6%
    • Injection site pain, swelling, bruise – 14%
    • Fever 8.3%

    Rare Adverse Reactions:

    • Yellow Fever Vaccine Associated Neurotropic Disease (YEL-AND), a potentially life threatening condition of the nervous system
    • Yellow Fever Vaccine Associated Viscerotropic Disease (YEL-AVD) previously known as Febrile Multiple Organ System Failure

    Yellow Fever

    What is it?

    A potentially deadly illness presenting in a wide range from hardly any symptoms at all. Some people can fever, muscle pain back pain, headache, nausea and vomiting losing for 3-4 days. In a smaller number of people, they can go onto have severe fever, and failure of multiple organs leading to bleeding, jaundice and can lead to death in about 50% .

    Treatment?

    There are no specific treatments. Management is mainly supportive.

    How to prevent?

    Having Yellow Fever Vaccine, general mosquito bite prevention strategies.

    Where is the disease present?

    The disease is present in many South American countries as well as Sub-Saharan African countries. The latest list of Yellow Fever endemic countries can be found here.

    Yellow Fever Virus

    What is it?

    It is a micro-organism belonging to Arbovirus (arthropod/insect born) group of viruses belonging to a group called Favivirus. It is carried by day biting mosquitos. Monkeys and humans can remain as reservoirs for the mosquitos to transmit the infection.

    References
    1. Therapeutic Goods Administration STAMARIL Australian Product Information
    2. Work Health Organisation – Yellow Fever Information
    3. Center for Disease Control USA – Yellow Fever
    4. New South Wales Health – Yellow Fever Fact Sheet
  • Q Fever Vaccination

    Who is this vaccine for:

    • Abattoir workers
    • Vets/ Students
    • Farmers
    • Cat, Dog breeders
    • People who handle cattle

    Vaccination Process

    Dr Jay Chelladurai offers Q-Fever vaccination at The Surgery, Kincumber. Please ring the surgery on 4369 6777to get more information and book appointment process. Please do not make online appointment. 2 appointments must be made 7 days apart. 1st a long one (30 mins) and the second a standard appointment (15 mins)

    • Number of Doses: 1
    • Immunity After: 14 days

    1st Appointment

    • Need to get information about need for the vaccine
    • Get any information about previous Q-Fever infection or contact
    • Explain process about Q-Fever vaccination
    • Administration of Q-Fever Skin test
    • Referral for blood test. (Blood tests MUST be done on the day of test)

    2nd Appointment

    • Checking the blood test results
    • Check for any reaction at the site of administration of the vaccine
    • Skin test MUST BE checked on the 7th day
    • If the blood test as well as the skin test are negative, then 
    • Administration of vaccine
    • If the blood test was negative, but the skin test was partially positive, then would need a further skin test.
    • If either blood test or skin test comes positive, then certified as immune.

    About the vaccine Q-Vax

    What is it?

    Inactivated Coxiella Burnetti

    How is it made?

    It is a purified suspension of formalin inactivated Coxiella burnetti prepared from the Phase 1 Henzerling strain of the organism grown in the yolk sacs of embryonated eggs. Trace amounts ovalbumin (< 1 mcg) may also be present

    Who MUST NOT have it?

    • Anyone who has had laboratory confirmed Q-Fever infection
    • Has positive or equivocal antibody when tested by serology
    • Vaccinated
    • Has anaphylaxis to eggs
    • Immuno compromised

    Side Effects

    • Pain at injection site (48-95%)
    • Redness over injection site (33-58%)
    • Headache (43.9%)
    • Tiredness (42.7%)
    • Joint pain (24.6%)
    • Vaccinated people can have severe injection site reaction as well as post Q-fever like symptoms lasting a few days

    Q-Fever – The bug

    Caused by a bacteria called Coxiella burnetii. The bacteria infects domestic and wild animals including cats, dogs, cattle, kangaroos and camels through ticks. The ticks excrete the bacteria in their faeces. Coxiella burnetti can infect humans by inhaling, eating (from handling contaminated objects) as well as through broken skin and mucosa. It can survive at 4oC for more than a month and can survive unto 600C. It can survive in air, soil and dust.

    Q-Fever – The disease

    People who have contracted Q-fever can have a spectrum of conditions from being totally unaware of the infection to severe flu like illness but can also affect liver (causing jaundice), affect the heart, cause severe pneumonia needing ICU care. Some people can also have long term illness leading to tiredness, weight loss as well as pain.

    References
    1. Seqirus, Q-Vax Q-Fever Skin Test (Aust R 100517 & 100518) – Product Information
    2. Department of Health, Commonwealth of Australia Immunisation Handbook – Q-Fever
    3. Ananthanarayan and Paniker’s Textbook of Microbiology 2005