This article was written by a close friend of mine, at my request. I hope that it will help parents, family, adults and children with ADHD, and potential, not yet diagnosed sufferers of ADHD.

Dr Carmel O’Toole


What does ADHD feel like?

Having been asked what it’s like to have ADHD is a difficult and painful question to answer.
Does the person asking the question really care, or are they an ADHD sceptic and I’ll have to justify, argue, defend, or get angry. Here is my attempt to explain what if feels like to have ADHD.

Just over three years ago I was diagnosed with ADHD. I was given a prescription of Ritalin, told to take a tablet the next morning and see what happens…..

If I go back about 8 year earlier, my oldest son was diagnosed with ADHD and was prescribed Ritalin. His Doctor advised “ you will know within 30 minutes if the medication has worked”
My son took the tablet. I waited; we went outside and played cricket, and for first time my son didn’t take a swing at the first ball, and run off.
We played for twenty minutes. We had a conversation that lasted longer than one minute. None of that had never happened before in his entire life.

I take the tablet and wait…(with little hope, having seen psychologists, psychiatrists, counsellors for years and nothing has worked)….45 minutes and now I know what it’s like to have ADHD.
That because I now know what it’s like to not have ADHD.

The voices stop for the first time (and I cry).
I have one thought at a time.
I can sit, I can type a report in one sitting, I can do one task from beginning to end, I can sit in a cafe and have a coffee.
I can eat in a restaurant and not have to leave as soon as I have finished, I can wait quietly in a queue, I can listen to boring things, I don’t blurt out things impulsively, and regret it later.
I can now concentrate and remember so many things, for example, to pick up all the things I need when I leave a room; if I am making appointments, I remember to write down the name and the telephone number and other details so I will actually remember appointments and how to get to them; I can now remember what I have entered the room to get…..

These are all new to me; it feels like I was blind for 51 years, and now I can see. When my eldest son took Ritalin he could talk to me.
I take a tablet .
60 minutes later, as I am walking my youngest son to school, I ask him
“What are you doing at school today?”
He replies: “tTday we have sport and we are seeing how many repetitions of exercises we can do in a minute, push ups, sit-ups, pull-ups, last week I got to 49 sit-ups this week I want to get to 60, we have got music and we are doing a play but this play will be harder se have to learn the lines……”

I listen intently for 15 minutes with no other thoughts entering my head.

My son takes a tablet and he can talk to me for the first time , eight years later I take a tablet and I can listen to my son for the first time.
What does ADHD feel like? You really don’t want to know.


 

Mental Health Week Victoria

Dr Jane Habib

Dr Jane Habib

Dr Jane Habib

 

Dr Jane moved to Melbourne to be closer to family. She initially trained as a naturopath but was dissatisfied with the limitations of naturopathy, so she decided as a mature age student to retrain into Medicine and then, to specialise in General Practice.

She worked for some years in a large General Practice in Armidale, Northern New South Wales. Most recently, she has been doing locums in a large number of locations in Rural and Remote parts of Queensland.

She is an extremely capable and accomplished general practitioner. Dr Jane is offering an extensive range of after hours appointments. Book online via our home page. She will be offering an extensive range of after hours appointments for busy people who find 9am – 5pm appointments inconvenient.

We are delighted to welcome her to our team.

 


Welcome back Doctor Carmel

Many of you may know that Dr Carmel O’Toole was absent from the surgery for almost 3 months in 2016.
We are delighted to note is that she is back , having recovered from a very troublesome shoulder injury.
Dr O’Toole specialises in complex medical problems, integrative medicine, lifestyle counselling and psychological medicine, particularly involving stress management ,anxiety ,depression and other related issues. Because she offers longer appointments she does not usually offer the availability to book online.

However reception staff will be delighted to assist you at any time with regard to appointments . From January 2017 she is increasing her availability, so should you need to see her and if reception advise that she is booked out, ask reception to check with Dr O’Toole . She will always do her utmost to accommodate you. She will also be part of the after hours, evening and weekend rosters with Dr Jane, extending the availability and range of our comprehensive health services to you and family

 


Dr Diana Hookham Retired

Dr. Diana Hookham

 

Dr Diana retired on the 26th August 2016 after 20 years working with her close colleague and friend, Dr Carmel O’Toole and being a founding member of BHWC

She will be greatly missed by all her patients, staff and colleagues.

She is enjoying her retirement so far!!

What do we actually know about ADHD and what does it mean anyway?

Officially the title means attention deficit hyperactivity disorder. It is a disorder of brain processing. People who have this condition struggle to recognise, order, manage, and process, many forms of cognitive (brain) input. It is a complex condition that can be hard to recognise. However accurate recognition and correct treatment can make an enormous difference to the sufferer.
In years gone by it used to be called attention deficit disorder. However the change of name signalled the fact of greater understanding that the problem was not that people lacked willingness to pay attention, or that it only referred to attention, but there were other components in the disorder, including hyperactivity. However even the revised name is currently inadequate, since not all affected people show an obvious level of overactivity.
For example when I was a young graduate, we were taught that typical children with ADHD would be hyperactive. That is, they would be unable to sit still, they would find it very difficult to sit still in the classroom, and they would be constantly on the go, at home, even when playing sport, never sitting still for long, with a real difficulty focusing on tasks.

In actual fact that type of presentation is very straight forward in terms of making a diagnosis and providing treatment options to children. It is much trickier when the hyperactivity is not in the motor realm. That is to say, the person is not wandering around the room , but it may be in the intellectual sphere, which is to say, the young person or older adult may have a stream of thought is that is so rapid that they cannot process their thoughts and ideas. Coupled with this, they may have real difficultly settling down to any one subject matter to hand, and have real difficulty with attention and concentration.
Conversely, people with the condition can also sometimes have an ability to show intense “hyper focus”, such that they can show an intense concentration in a specific area for long periods of time, for example, with computer games, chess, tennis, fixing equipment or gadgets, dealing with computer problems, or intellectual ideas in a very focussed and particular area eg PhD students.

All of these things beg the question how one is to make the diagnosis if there are so many potential different features.

In addition these things are compounded by other aspects such as the personality of the young child or adult. If the person is temperamental, if they are very sensitive and finds their difficulties to be unsettling and distressing, the condition may manifest as the person being unhappy irritable unsettled and possibly quite troubled. It is very common for adolescents and teenagers who suffer from this condition to self medicate. This is often with recreational drugs and can be very problematic. If it is coupled with school failure, home life difficulties or alienation, the consequences can be disastrous.
It is well known that the prison population is over represented with ADHD sufferers, many of them never previously diagnosed.

Diagnosis

There are many tests available for ADHD. These mainly consist of validated questionnaires and assessments that can be administered by paediatricians, psychologists, psychiatrists and to a certain extent by us, your GPs.
It is important to establish that there is nothing else that is wrong at the same time, or another condition that is presenting as if the person has ADHD. This is the role of the GP.

Feedback from teachers in regard to academic performance and issues related to peer group, also is important.
There is some evidence that the use of electronic devices is making the condition more obvious and perhaps even having a role in triggering the condition in some people. It is certainly true that the proliferation of iPhones and social media means that young people are constantly able to be distracted by lots and lots of input, which they do not always have the ability to filter and manage. It can be overwhelming even for young people without brain processing difficulties.

On the other hand, being constantly bombarded with stimuli can suit some affected people very well, because for some sufferers of ADHD there is an intense craving for stimulation. For others, excess stimulation can be very unsettling. There is a school of thought that says hyper stimulation may unmask the condition. Clearly there are some aspects of social media and modern living that favours some people with ADHD, if they have a very short attention span and are able and comfortable to move rapidly from subject to subject.

Sometimes when we are seeing a young person they may have come due to concerns from parents or teachers or extended family. They may think that the person has ADHD , but the GP needs to look at the broader context. This is a condition that is inherited and it does tend to run in families. That being said it may not have been diagnosed in other siblings or previous generations.
For some of the reasons I have mentioned above, ADHD may present in an atypical fashion, or it may not have been experienced as being a problem. For example we can think of some sports people, whose rapid reflexes, quick reactions, intense speed and ability to move rapidly from point to point, favours their success. For example in tennis, AFL or other sporting areas, I regularly see people who are Stars, who I think have ADHD and who would not perform well in another arena, but in their chosen area, they are highly successful and very happy.

I have a friend who grew up in the country and he has been diagnosed as an adult with ADHD. However what he recalls from school days is running wild and playing a lot of sports and being very happy. He did not achieve his potential and was not able to pursue a University career. His diagnosis later in life has helped a lot but has also caused a lot of regret, in respect of chances that have been missed and opportunities that were not able to be taken up.
Therefore it is very important to diagnose it if it is causing a problem and if it is impeding the growth and development and fulfilment of potential of the person.
ADHD can occur at and manifest at any age. Children who are very intelligent and very relaxed may not present as having any problems. As stated previously the obviously much disrupted child is easy to diagnose and very straight forward to treat.

Who treats ADHD?

In general the formal diagnosis of ADHD must be made for a young person by a paediatrician and for those older than 16-18, by a psychiatrist. In either situation it is important that the person that you see is experienced with, and sympathetic to, the condition
This is because the medications that are used to treat it, while extremely useful for ADHD, can cause problems if used inapropriately and in the wider community. Therefore, the initiation of treatment is done by the specialist groups; however continuation of treatment or perhaps more importantly, exploring any suspicion you may have of diagnosis, can be started with your GP.

What you do if you think the child has ADHD?

Make an appointment and come in and discuss your child or adolescent. Make a longer appointment so there is time to talk through what is happening. It is not always appropriate for the young person to be present; sometimes it is more helpful for the parent/ caregiver to come in and speak to the doctor to outline history, past history, birth history, and attainment of milestones, academic performance, reports from teachers, friendship issues and things like this.

The cornerstone of diagnosis really is response to treatment. That is to say, if the person does not respond to appropriate medication, they are unlikely to have that particular diagnosis.
Treatment consists of replacing a neurotransmitter that is in relatively low supply in the brain. In other words, ADHD is essentially a brain condition. It is not that the child is lazy or destructive, deliberately being annoying, or that they are purposefully unhappy or high maintenance, defiant or difficult. The fact is, that they cannot see things through, follow complex instructions ,remember the sequence in which things are said, or pay attention long enough to understand what people are trying to communicate to them.

The other thing to say is that sufferers of this condition can have other conditions, co-existing. They may become quite anxious as a result of the continual apparent inability to meet the needs of others by failing to follow instructions. They may also be quite disheartened for the same reasons.
Adolescents may have substance abuse problems, where they have used recreational drugs such as cannabis to calm the mind and help them sleep. Sleep disturbance is a prominent feature of ADHD.

Summary

This is a long and complex subject, and the main point of this article is to say to you that if you think your child may be suffering from this condition, or indeed anyone in your family, or yourself could be suffering, make an appointment and come along. In our practice several of us particularly have a great interest in this condition and have successfully diagnosed this in a number of young people and adults.

Exploring and clarifying this question is very important and can make a world of difference to the person and the people around them. It is equally important to make sure if this is not what is wrong, to find out what really is wrong, and help the person with whatever difficulty it is that they are facing
If you have further questions or this is a subject that you want to know more about, make an appointment and we will it be pleased to explore it with you in more detail.

 

By Dr. Carmel O’Toole

A Well Woman Check is a top-to-toe check of how you are going. It is usually the sort of check up that refers to women in the reproductive phase of their life and beyond.
It includes the following elements: we record your height, weight and blood pressure. We do a breast exam (and we can teach you how to do a breast self-examination at the same time). It includes a pelvic examination, to check the uterus and ovaries and a smear test to check for cervical cancer. It can also include a check of your pelvic floor, coupled with information about how to use your pelvic floor muscles. An STD check can be done at the same time, and contraceptive advice can be provided or discussed as needed.

The Well Woman Check is an ideal opportunity for you to tell your doctor about anything that is bothering you at all, including in regard to your periods, your relationships and your overall health.
This can be a particularly sensitive and demanding issue for women who are survivors of sexual assault. If you have any worries at all, speak to your doctor and let them know what is on your mind, so they can help you.
At least one of our doctors has had training through CASA (Coalition Against Sexual Assault) and a check up like this can actually help a person begin to heal from trauma if it is conducted sensitively and appropriately.

The most important thing is to have regular check ups, because it is so important to identify problems early before they get out of hand. If you are nervous, just tell us and we will do our very best to help you.

Do you know what Hypertension is?

A lot of people think it means you are very tense, but that’s not it at all. Hypertension is what we diagnose when two levels of pressure in your vascular system (blood circulation system) are higher than they should be. The first figure is called Systolic and we like that level to be ideally equal to or less than 140. The lower figure is called the Diastolic pressure, and ideally we like that to be less than 80.

Many factors can influence a person’s blood pressure and some of these things can be temporary, for example if you are in pain or unwell your blood pressure usually rises. The situation that doctors are commonly faced with is determining whether a person’s blood pressure exceeds recommended levels for lengthy periods of time. There are many ways of resolving this difficulty, including the relatively new technology of ambulatory blood pressure monitoring.

This equipment permits us to see what your blood pressure is in your normal daily life, not just when you’re in our consulting rooms.

The surgery has recently purchased this equipment, so please ask your doctor about it, if it’s relevant to you when you next visit.

 

What’s the actual problem with having high blood pressure anyway?

Good question. The problem is that if the pressure in the circulatory system (heart and major blood vessels) is too high, the lining of the arteries can become inflamed and if left unchecked, narrowing of arteries and reduction or blocking of circulation can occur. This is one of the processes that can lead to heart attack and stroke and many other things. Also, if your blood pressure is up for a long time, your heart has to work very hard against this high pressure, and that can have damaging consequences.

 

Wouldn’t I know if I had high blood pressure?

No, unfortunately 9 out of 10 people have no idea that their blood pressure is up. And so, you could have really high blood pressure without realizing it.

 

What’s the cause of high blood pressure?

There are a number of causes for high blood pressure, and we always look for them, but in 9 out of 10 cases we can’t precisely determine the reason.

 

If I’m diagnosed with high blood pressure, does that mean I’ll have to take blood pressure tablets forever?

The short answer is no, not in every case. If we find that your blood pressure is too high, we aim to lower it to a safe level. We then embark on a lifestyle modification program in partnership with you, to see what can be achieved that may result in us being able to reduce or stop medication. The principle is that it’s important that your blood pressure is at a safe level while we take time to implement whatever other solutions are possible.

This is an ideal example of where a strong collaboration between you and your doctor can achieve a great outcome if both parties work together and if you, the patient, takes ownership of the problem.

These days everyone seems to be talking about pelvic floor exercises, but what one earth does this mean? Everyone, both men and women, have pelvic floor muscles, which essentially sit in a horizontal position (when you’re standing) between your thighs. The pelvic floor muscles form a ‘figure of eight’ shape and they encircle the anus (or back passage) behind, and for women, the vagina and urethra (where urine comes out) in front.
In primitive societies, where people squat a lot more than we do in Western society, people have much more control and strength in their pelvic floor muscles. In our society, people often have to learn how to ‘recruit’ and use these muscles.

What do these muscles actually do?
When your pelvic floor muscles have good tone, you have a far greater degree of control over toileting issues. You are less likely to feel either rushed to go to the toilet, or to feel that you can’t properly empty bowel or bladder when you’re at the toilet.
The pelvic floor muscles are also connected to the coccyx (our tail bone or very end of the spine). This means that when we contract our pelvic floor muscles, we bring our back or spine into alignment better.

How can I make my pelvic floor muscles stronger?
There are two elements here. The first is that we have to check that your brain is sending the right signals to your muscles. This is called recruitment. If this isn’t happening, nothing will happen at all, even if you are trying very hard!
Your doctor can check this with you, and we can teach you how to monitor it yourself. Secondly, once you have learnt how to recruit the correct muscles, it is simply a matter of appropriate practice to strengthen those muscles.

It has been said that 70% of 70-year-old women will have some degree of incontinence, unless their pelvic floor muscles are in good shape. We don’t even know the figures for men! As per usual, there is very little data on Men’s health issues!

So ask your doctor about it when you’re next in for your check up.

beach pic

Have you got a holiday planned for Spring or Summer?

If so, we can help you prepare for that holiday so that it is not spoilt by preventable illness. We have a variety of travel vaccines for every traveller and we can tailor the information exactly to your trip and your itinerary. We have a travel medicine form which we get you to complete and this will help us help you. In this form you’ll be asked to give as much information as you possibly can, so please give us as much detail as possible. We will go trough it with you when you come in, but having accurate information that you’ve researched beforehand makes it very efficient. Remember: don’t leave it until the last minute as vaccines take time to work. We would like you to ideally come in and see us 6 weeks before your intended departure date.

 

Click Here to Download the Form

orchid

Dr Carmel O’Toole has been doing an update in menopause management at the Jean Hailes Medical Centre in Clayton. As part of this, she recently travelled to New Zealand for the Australasian Menopause Society’s annual conference. She has come back from this conference full of enthusiasm and new ideas, which she will be sharing with other members of the medical team. Last year, she ran a successful education evening on menopause, and she is keen to repeat this if there is interest.

It’s stating the obvious but Menopause affects all women. The interesting thing is that no two women are the same. Menopause management is now seen as an opportunity for health interventions and health promotion in the midlife transition. This is because it’s not just about the symptoms that you may experience, but also about the changes that occur in our body at this time. These changes affect your heart, your blood pressure, your cholesterol, your weight, your bones and your mood! This is the time to implement a proactive wellness strategy, and all the doctors here are ready to help you do this.

For more Information on Menopause, visit Jean Hailes on the following link.   http://jeanhailes.org.au/