summer 2015

Medical Professionals direct link to programs and services at the Wesley

Wesley Kids Spotlight on The Wesley Hospital’s Children’s Services

Articles in this issue: + Meet the dedicated paediatrics team + The Wesley’s 32-year tradition of paediatrics + Insulin pump service for diabetic children + Food challenges put allergies to the test + Dealing with chronic childhood cough + Undescended testes: when to take action

Paediatric Resident Medical Officer Dr Alisa Yocom with Ben GP Networking

Dr Luis Prado and Education Director of Medical Services Welcome to the summer edition of Medilink. This edition The Wesley Hospital 2015 GP calendar is full of interesting and varied showcases the Wesley’s paediatric services and features clinical GP Referral opportunities for GPs to meet VMPs and specialists of the hospital and articles from our new Wesley Visiting Medical Practitioners who update their knowledge and skills in a number of areas of medicine. specialise in paediatrics. Advisory Service We will once again be holding two of our most popular events - our 1 2 Continuing Professional Development (CPD) CPR training day and With the amalgamation of the Royal Children’s Hospital and Mater The Wesley Hospital offers a 24/7 Wesley Women in Medicine High Tea. Children’s Hospital in South Brisbane, the Wesley is now the referral advisory service to assist GPs More than 50 GPs attended the 2014 CPR day to refresh and update largest hospital providing specialist children’s health services to in selecting the appropriate specialist in their basic life support skills through simulation and skills-based Brisbane’s northside community. Brisbane for your patients’ needs. sessions that gain five RACGP Category 2 points. Paediatrics at The Wesley Hospital has expanded over the past two For urgent referrals email gp.wesley@ On October 18, The Wesley held its inaugural Wesley Women in years and our services, based around family-centred care, include uchealth.com.au and we will reply within Medicine High Tea as a networking opportunity for the Wesley’s comprehensive inpatient and outpatient general paediatric, one hour (during business hours) with female specialists and our female GP community. The day was a appropriate specialist contact details, or sub-specialty medical paediatric, and paediatric surgical services. huge success and we have been asked to run similar events every six call 07 3232 7000 and page the Director We have a dedicated ward catering only to children and months. Keep an eye out for our next Women in Medicine event on of Medical Services on-call at any time. March 28. adolescents with resident medical officers to assist with the care 3

Welcome of our younger patients. We have continued to grow with the To assist with your enquiry please In 2015 we are increasing the number of evening events for GPs to addition of specialist inpatient paediatric services including oral provide the following patient details: attend and now run the events on Tuesday, Wednesday or Thursday food challenges for allergies and insulin pump insertion and n Clinical background nights for your convenience. Our Saturday Active Learning Modules management. n Presenting complaint will continue and our regional program for 2015 will have a vascular and cardiac focus. Please refer to our clinical education calendar on Outpatient and day patient services have also expanded to include the inside back cover of this edition. developmental paediatrics, respiratory and gastroenterology. The hospital now performs paediatric bronchoscopies, endoscopies Our sponsors If you are interested in having specialists visit your practice or would and colonoscopies. like more information on our CPD program, please contact Business Partners Development on 07 3232 7222; or via [email protected] On a final note, I would like to acknowledge the contribution that or 0428 227 372; or [email protected] or 0419 020 156. Dr Ranald Pascoe has made as the Director of Intensive Care at The Wesley Hospital for the past 20 years. Dr Pascoe steps down 4 as Director in January 2015 as he transitions into retirement but 1 Dr Pauline Joubert, Obstetrician and Gynaecologist and Dr Wen-Yi will continue in a clinical role. Ranald most recently received the Chew-Lai, Developmental Paediatrician UnitingCare Health ‘Outstanding Service to Others’ CEO award for Associate 2 Dr Jenny Gough, Breast and Endocrine Surgeon and Dr Carina Chow, his contribution. I would like to sincerely congratulate Dr Pascoe Colorectal Surgeon

on this achievement. 3 Dr Agnieszka Malczewski, Medical Oncologist and Dr Rachel Esler, Phone 07 3232 7926 Urologist Email [email protected] 4 General Practitioners Dr Tram Nguyen, Dr Christine Chen, Dr Anh To, Dr Adeline Ng, Dr Graciela Fanning, Dr Katrina Harrison

5 Director of Business and Service Innovation Wendy Zernike, Business Development Manager Vicki Goss and Events Coordinator Simone Kerger

6&7 GPs brush up on their skills at CPR Day 5

The Wesley’s Director of Intensive Care Dr Ranald Pascoe receives Outstanding Dr Denzil Gill, ICU medical officer; Prof Bala Venkatesh, Deputy Director ICU; 6 7 Service to Others Award from UnitingCare CEO Anne Cross. Dr Ranald Pascoe, Director ICU; Dr Katherine Robinson, ICU medical officer and Dr Thomas Brucklacher, ICU medical officer.

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Associate Message from Medical Professor David Coman

MBBS MPhil Director of Paediatrics FRACP Dr David Coman

Over recent years we have had significant Queensland, Griffith University and Bond Q&A with Associate incorporating the philosophy of hospital in the Fast facts Paediatrics at Wesley growth in paediatrics at The Wesley Hospital. University. No other public or private home. The average length of stay is two to Professor David Coman three days, but children are only discharged We are particularly excited about the paediatric facility provides our brand of 1:1 when it is safe for them to go home. + 900 plus admissions every year comprehensive range of inpatient and student teaching. 1. When did your involvement with the Wesley begin? How long have you been 6. What paediatric service is in most outpatient medical and surgical Research is encouraged and many of our + comprehensive range of medical and surgical services for children from birth to sub-specialty services that are now available director? demand? late teens clinicians are actively involved in clinical and for children. We have strategically grown our I began my private practise at the Wesley basic science research. General Paediatrics is the corner stone to + family-friendly dedicated paediatric and adolescent ward clinical capabilities and are well placed to Hospital in 2010 after many years of full any children’s hospital, any paediatric service, provide the highest standard of paediatric In addition some of our clinicians and nurses time work in the private sector. I have been and any paediatric sub-speciality. One of our + private rooms with ensuites care in the private sector. volunteer their time and expertise in the third the Medical Director of Paediatrics since strengths is the care provided by our general + fulltime senior Resident Medical Officer The Wesley is unique in that we are the only world to provide paediatric clinical support 2012. paediatricians and general paediatric + junior medical staff coverage private paediatric service with 24/7 and teaching for colleagues in the Western 2. What is different/special about the surgeons. emergency-room support, and dedicated Provinces of Solomon Islands. Wesley paediatric service? 7. What is your long-term vision for the + 24/7 emergency department availability onsite junior medical staff. We have five service? If you would like to discuss any aspect of our We have a comprehensive range of medical + children’s play facilities and areas that cater for adolescents junior medical staff positions to provide paediatric service, please feel free to call me and paediatric sub-specialties available in I see the paediatric inpatient and outpatient around-the-clock cover, and actively + active unit safety and monitoring system to maximise best care on 07 33715122 or email: david.coman@ our dedicated paediatric ward. One of our services at The Wesley Hospital growing encourage GP trainees to apply for these hotmail.com capabilities is we cater for the complex significantly, especially in the area of elective positions. + active university teaching programme medical needs of adolescents, a vulnerable paediatric surgery. BELOW: Dr David Coman, Medical Director of Teaching is a vital component of a mature group who get lost in the medical system. + strong social justice ties, with our doctors and nurses volunteering in the third Paediatrics, The Wesley Hospital, and Academic I would like to see a vibrant and active culture tertiary-level facility, and the paediatric The Wesley is unique in that we are the only world Lead for Paediatrics at the UnitingCare Health of clinician, nursing, and allied health private hospital with paediatric junior clinicians at the Wesley actively teach Clinical School, caring for a patient at the Helena paediatric research occurring on the campus. + dedication to clinical research to improve the health and wellbeing of children medical staff on site and a fully functional medical students from the University of Goldie Hospital in the Solomon Islands. Many of the Wesley’s paediatric Visiting emergency department capable to Medical Practitioners are actively involved in managing acute paediatric presentations. clinical and basic science research. Teaching is also an integral part of our I think there is significant room to grow the service, and we are the only hospital support of research for our Wesley children teaching medical students from UQ, Griffith with the support of generous donations via University, and Bond University. The Wesley-St Andrew’s Research Institute. 3. What are the five most common Every sick child has parents, siblings, childhood illnesses that bring kids to the grandparents, aunts, uncles, cousins, and Wesley? friends. Childhood illness touches every Asthma, bronchiolitis, febrile illnesses, family in some way, research and teaching gastroenteritis, complex care coordination. help us improve the lives of children and their families. 4. What are the five most common surgical Wesley Kids 8. Why did you become a Paediatrician? procedures? Continuing to care for children Tonsillectomy, grommets, orthopaedic Simple, it’s the best job in the world. Children surgical repair of broken bones, hernia are an amazing source of inspiration, joy, and repair. humility. I see this most of all in the children I care for with rare diseases. Children reflect Our specialities: ++ Insulin pump service 5. What is the average length of stay for the best of what’s on offer in our humanity ++ General medical conditions ++ Paediatric sleep studies kids at The Wesley Hospital? and our society - we often lose our way as ++ General/ ENT surgery ++ Oral food challenges for allergies We try to keep hospital stays to the adults. ++ Respiratory/Bronchoscopy/Gastroscopy ++ Orthopaedics minimum for children and their families, The Wesley Hospital . Ward 2W . Level 2 . Chasely Street, Auchenflower QLD 4066

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Resident paediatric doctors offer children an extra safety net

As the Wesley Hospital’s resident paediatric doctor, Dr Raymond Chuk has to be across a full spectrum of childhood ailments

Dr Chuk worked as a Senior Resident Medical Officer (RMO) in paediatrics at the Royal Children’s Hospital for 15 years before coming to the Wesley in July 2013 as the hospital’s first full-time paediatric RMO.

When he heard the Wesley needed doctors to work in the children’s ward to offer support to Paediatric specialists, nursing staff and patients, he jumped at the opportunity to take on the role.

The Wesley Hospital is the only private paediatric service to have a full-time on-site doctor who specifically looks after children. Along with the hospital’s junior doctors Dr Chuk provides the day-to-day care to support our visiting Dr Raymond Chuk, Senior Medical Officer, The Wesley Hospital Sarah Mueller RN; Pamela Watson CN; Sonia medical practitioners. “My focus is solely Broadby CNM; Julie Mackay, pastoral care and Dr Alisa Yocom RMO on children and that can range from our Paediatrics team patients in the special care nursery to “Our Visiting Medical Practitioners work “For example, they can get test results the Wesley Emergency Centre to our closely with the Wesley Emergency Centre from Wesley Medical Imaging on site in a paediatrics ward,” he said. and the children quickly get referred to the timely manner rather than having to wait a dedicated bunch right paediatric specialist. for further investigations. “We have a very streamlined service – The Wesley has a vibrant culture of putting children first emergency, endoscopy, theatre, recovery “All paediatric services are established “For more complex patients, we can are all set up for children. We have all here at the Wesley – respiratory, liaise with the patient’s GP and give a the necessary processes in place to care endocrine, developmental, more detailed summary as part of our At the Wesley, providing high quality care University of West London. “I am totally The unit has a paediatric occupational for a sick child. We have implemented gastroenterology, allergy, rheumatology coordinated care.” for children and adolescents is a top committed to the continuous improvement therapist, a paediatric dietician and Queensland Health’s Children’s Early - so GPs know we can look after their priority. paediatric physiotherapists. Dr Chuk leads a team of doctors providing and growth of the Wesley’s paediatric Warning system, not just in the paediatric patients with confidence. dedicated paediatric care. Enhancing the clinical expertise is a team service,” Sonia said. “We have a friendly and very dedicated ward, but right across the hospital to “As a private hospital we provide very of highly trained nursing and allied health This level of dedication is typical within team of nurses who work in partnership monitor children’s progress.” “We are strong on medical student staff who are experts in caring for sick with their colleagues to deliver excellent comprehensive services for paediatric education and staff training here at the the Wesley paediatric nursing staff. The Dealing with seriously ill children quickly children. care which is evidenced by consistently patients.’’ Wesley – doing a paediatric rotation team comprises 16 experienced paediatric before they deteriorate is a high priority excellent patient experience and through our paediatric service helps to Sonia Broadby has been Clinical Nurse nurses, many with post-graduate for Dr Chuk and the team. Dr Chuk said the Wesley’s paediatric feedback,” Sonia said. set our junior RMOs up for their future GP Manager of the Wesley’s paediatric unit qualifications in paediatric nursing. The service is getting busier and busier. “Children are more resilient but we want training. The Wesley works closely with (Ward 2W) since April 2013. unit has a dedicated paediatric nurse For more information contact Sonia Specialists were attracted by the support Broadby, Clinical Nurse Manager to make sure we detect early signs of the Royal Australian College of General She has 18 years experience in paediatrics educator running in-house education they get here and in the past year more Paediatrics, on 3232 7054 or 3232 7384; deterioration as they can go downhill very Practitioners for training opportunities” with a background in paediatric intensive programs and staff members have surgeons had started operating lists. fax 3232 6208 quickly. You don’t have as much warning care and paediatric retrievals, more than training in paediatric advanced life as with adults, so we have to act fast,” he “Specialists like the ease with which they seven years of management experience, support, paediatric sleep studies and said. can get things done,’” he said. and a Master of the Arts degree from the adolescent oncology.

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An established tradition 32 years of paediatrics at the Wesley The Wesley Emergency Centre Providing 24/7 care for patients ++ 19 emergency beds + Dedicated paediatric room Dr Bruce Lewis looks back over his long involvement with + services for children at the Wesley and 24/7 support for GPs ++ Latest patient monitoring equipment ++ Short wait time enhanced the access of families to the ++ 15 senior emergency doctors hospital at times of their children’s illness. In consultation with a paediatrician or paediatric ++ Treatment of a comprehensive surgeon, the diagnostic work-up including spectrum of paediatric any laboratory or imaging assessments presentations is often well underway if not completed ++ 24 hour access to senior before moving into the children’s ward. This paediatricians and access contrasts markedly with the “pre-WEC” era to dedicated paediatric when, following a phone call from a referring inpatient ward family practitioner or parent, the initial assessment by the paediatrician or surgeon would occur in the treatment room of the Call 3232 7333 children’s ward. “More sub-specialties are available now at the Wesley than ever before. All parents want their child seen as quickly as possible, not months down the track. The beauty of this campus is that, if the need for sub-specialty consultation arises, there are people from various sub-specialties who can be quickly consulted on site.’’ Senior Paediatrician Dr Bruce Lewis Since October 2012, the inpatient paediatric service has been enhanced by the The Wesley has a long tradition of Early in 1987 Dr Lewis was asked by Dr employment of full-time paediatric resident paediatrics with a full children’s ward Reg Williams, a senior obstetrician and medical officers who provide an excellent operating since the hospital opened in 1977. gynaecologist, to join a small steering added dimension to the inpatient service to committee tasked with the design of the now As the hospital’s longest serving children, their families and visiting medical approved maternity service at the Wesley. paediatrician Dr Bruce Lewis has watched staff. the paediatric service grow into the full “Reg was a driving force behind the starting Looking to the future, further growth and spectrum service it is today. of the maternity unit, from the outset the complexity is expected at the Wesley in what philosophy being to offer a comprehensive “When I moved to the Wesley campus is now the largest and most comprehensive service of the highest standard,” Dr Lewis in 1987, there were several visiting metropolitan paediatric service north of the said. “This included the location of the paediatricians seeing children in the Brisbane River. children’s ward, but the hospital did not yet caesarean section operating theatre as an integral part of the delivery suite with have an emergency department and there For referrals contact Dr Bruce Lewis on the adjacent special care nursery being was no maternity unit here, despite it being a 07 3371 5144 or fax 07 3371 5590 time of high birth numbers.” designed, staffed and equipped to handle all immediate post delivery eventualities.” Gynaecologists Dr Maurice Webb and Dr John Allan encouraged the hospital board The opening of the Wesley Emergency to plan for an expansion of the hospital Centre in 1994, known ever since as WEC, services into the areas of emergency staffed with specialist emergency physicians medicine and women’s health. and emergency nursing staff, greatly

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Insulin pump service makes life Wesley maternity patients simpler for diabetic children get extra support at home The Wesley Hospital Maternity Unit launched its Home Visiting Service this For an increasing number of children with Type One diabetes, an insulin pump – a small portable device month and mums and bubs in Brisbane are already reaping the benefits that is programmed to deliver the correct amount of insulin – has made routine needles and watching what they eat a thing of the past Wesley Maternity Unit midwife Joanne Since the paediatric insulin pump service or six injections a day or parents having to Hardcastle said the initiative provides mums began at The Wesley Hospital 12 months work out a dose or time. The insulin pump two visits to their home by a Wesley Hospital ago, paediatric endocrinologist Dr Andrew sets them free from that.’’ midwife while their baby is still less than four weeks old. Cotterill has started 25 pumps and the Dr Cotterill started an insulin pump for number is steadily rising. Georgia Marriot, 12, in October and since “Our experienced midwives provide full “An insulin pump is a way of giving insulin then his patient has had more choice and health checks for mum and baby, feeding that is simple, straight-forward and quick,” freedom. “She can eat whenever she wants support, early parenting education and he says. “It takes the worry and routine and doesn’t need to be restricted to certain most importantly, a friendly face to offer needles out of day-to-day living. types to eat,” explains her mother. encouragement.” “The insulin pump is a small device with a Most children coming to the Wesley to start Ms Hardcastle, who oversees the Home tube connected to the skin like a catheter. an insulin pump stay for one night so the Visiting Service as the Maternity Clinical It is set to drip steadily in the background device can be monitored overnight. Educator, said the team had visited 55 mums giving small, precise, variable amounts of within the service’s first three weeks of “We can provide instruction on the set up operation. insulin, mimicking the pancreas. and how the device works,” Dr Cotterill said. “It looks similar to a mobile phone and sits in “It is safer and more relaxing for the family “Our focus is to educate, support and instil the child’s pocket or on a special belt. They to have help close by if required. As follow- confidence in new mums and ensure they are can choose the colour - pink and blue are up, we can provide extra outpatient support settling in safely and comfortably with their popular – and it’s waterproof so they can go and education with one of the hospital’s baby,” she said. Wesley Maternity Unit midwife Joanne Hardcastle with Ainsley Hellen, son Alexander and newborn William swimming with it. Once connected, the only diabetes nurse educators and dietitians, “Patients say they appreciate the hands-on thing that needs to be done is to change the for example, on how to count carbohydrate support and the ability to raise any early leave hospital. Mums appreciate the extra The Wesley Hospital Maternity Home internal syringe every two days.’’ intake. parenting or child development concerns with support in their own home, which gives them Visiting Service is funded by the Queensland experienced midwives rather than guesswork Pumps are best started within a few days of “It is also reassuring for parents to know peace of mind that everything is progressing Government’s $28.9 million Mums and Bubs or ‘Dr Google’.” diagnosis of the auto-immune disease. that if future medical care is required, the well. initiative. Wesley is set up for children with insulin The service is available to all patients who “If the child starts early, even a couple of Ms Hardcastle said breastfeeding was one pumps.” give birth at the Wesley Maternity Unit and For more information on The Wesley weeks after diagnosis, they can have a of the main areas where mums needed extra live within about 25 kilometres of the hospital Hospital Maternity Home Visiting Service different perspective on diabetes, because support and patients could be referred to the at Auchenflower. contact Joanne Hardcastle on 3232 7473 they don’t have to experience injections,’’ Dr To make a referral contact Dr Andrew Maternity Unit’s dedicated Lactation Clinic if Cotterill said. “What a relief to not have five Cotterill on 07 3393 1916 or fax 3891 7445 Mums will receive two postnatal visits soon they required further assistance following the after giving birth to their baby. They can ask home visits. Fast facts Diabetes in children any questions that come to mind once they

One in 1000 primary school kids in Australia have Type 1 diabetes Cryoablation therapy now available at The Wesley Hospital Cryroablation is a new method being used for the treatment of Paroxysmal Atrial Fibrillation (PAF). One in 500 high school kids in Australia have Type 1 diabetes Unlike radiotherapy techniques, cryoablation uses Advantages of cryoablation over radiofrequency refrigerant instead of heat to isolate the pulmonary catheter ablation: 25 out of 100,000 children in Australia get Type 1 diabetes each year vein and freeze tissue to terminate unwanted ++ Performed in less time that RF ablation as electrical pathways. pulmonary veins can be isolated with a single The rate of increase in new cases of childhood Type 1 diabetes each balloon application year is three per cent. It has similar efficacy in the treatment of PAF as radiofrequency catheter ablation with a cure rate of ++ A light sedation can be used for patients with The number of children with Type 1 diabetes diagnosed each year TOP: Georgia Marriot with her insulin pump 70 per cent. high anaesthetic risk has doubled in the last 10 years. ABOVE: Dr Andrew Cotterill, pictured with Georgia ++ Patients tend to make a quicker recovery Marriot and Isabelle Newnham One in 20 chance of developing Type 1 diabetes if you have a relative with the disease. Appointments: Dr Deepak Arumugam 3858 8600 . Dr Paul West 3371 8247 . Dr Vince Deen 3876 8285

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Sleep studies put Oral test tackles parents’ worries to rest childhood allergies Up to 10 per cent of children snore and about a quarter of these The Wesley Hospital has commenced paediatric food children suffer from obstructive sleep apnoea challenges with a new service offered to children who may have outgrown a previously diagnosed food allergy Repetitive events occurring during sleep The child is attached to monitoring equipment have been shown to have a negative impact to examine their breathing and the effect Paediatric Immunologist and Allergist Dr on a child's behaviour (typically hyperactive, of any breathing problems on the child's Kim Robertson started performing oral impulsive or with poorer concentration), sleep and blood levels of oxygen and carbon food challenges at the Wesley earlier this development and school performance. More dioxide. year. “The oral food challenge is the gold severe cases can be associated with poor Parents are able to sleep in the same room standard for determining if a patient is growth and strain on the heart. as their child during the study. allergic to the food,” she explains. The best test for obstructive sleep apnoea is Working in collaboration with Genesis “We challenge children who have a history a sleep study. SleepCare, Dr Burgess is able to arrange and of reaction but are no longer positive on Dr Scott Burgess has been doing overnight report full sleep studies for children aged skin prick test for that food, indicating that Obstructive sleep apnoea refers to the sleep studies at the Wesley in Ward 2W since two years and older. Screening studies are they may have outgrown the allergy. The narrowing of the airway during sleep which May 2014. available for younger children. other patients challenged have had a mildly can cause a drop in oxygen and or disruption During the study children are managed by positive skin prick test but may have never of dreaming sleep (dreaming sleep is crucial one of our experienced paediatric nurses For urgent referrals phone Dr Scott Burgess actually eaten or reacted to that food and for learning and feeling refreshed after who has undertaken further training in sleep on 07 3177 2000 don’t want to go through life avoiding that sleep). medicine. food if they are not truly allergic. “The only way to confirm this is to expose them to the food. If the food in question

is a nut, or the child has had anaphylaxis Dr Kim Robertson with Willow, 3, during her oral food challenge before, I prefer to do the challenge in hospital rather than at home.” can be encouraging the child to eat enough With a rising number of children developing When success Children with allergies are admitted of the food to test. allergies, the service is set to keep for a morning in the Wesley children's “Older kids can get quite anxious about expanding. “A study looking at hospital ward for the procedure whereby they are coming in for a challenge. With the little admissions for anaphylaxis in the 0 to 4 really counts given incremental amounts of the food in ones, sometimes it can be difficult for year age group found that they increased question. nursing staff to encourage the child to eat by 400 per cent in the last decade” she “We use a graded process where we feed enough of the food to challenge them.” said. “In the latest study out of Melbourne the child increasing amounts of the food Dr Robertson says cow’s milk, eggs and close to 10 per cent of 12 month old children every 20 minutes,” Dr Robertson said. “If nuts are the most common childhood food there is a reaction we can recognise this reacted to a food on oral challenge.” allergies. “Egg is the most common food early and treat the reaction immediately. allergy, and the risk of anaphylaxis is low, Hygienic environments with less exposure Kids who are admitted receive one-on-one so the majority of these challenges are to infection in early childhood, modern low nursing supervision which is important performed at home. The most common fibre diets leading to reduced microbial to monitor for anaphylaxis or severe food trigger for anaphylaxis is a nut, and diversity in the gut, changed methods of allergic reaction. I am available on site at these challenges are best conducted in food processing, timing of introduction of the Wesley to see the patient at the start hospital. Other allergies are taken into and end of the challenge, and at any point allergenic foods into the baby’s diet and account, with a third of egg allergic children during the morning if there is evidence of vitamin D deficiency are some of the many also being nut allergic, and a third of reaction.’’ theories surrounding the increased rates of peanut allergic patients having an allergy to Our highly experienced team of Fertility Specialists achieve some of the Being in a hospital can help ease parents’ a tree nut. The majority of food allergies in paediatric food allergy. highest success rates in Australia with more than 85% of our patients worry that they are giving their child children are not severe and will disappear aged under 39 years having conceived within two cycles. foods that may make them sick, says Dr with time. Nut, seed and seafood allergies For referrals contact Dr Kim Robertson on Robertson, but one of the biggest hurdles are more likely to be lifelong.” 07 3232 7686 or fax 07 3232 7585 If you have any questions regarding a patient or how to refer, call12 Medilinkus on 1800 628 533 or visit www.monashivf.com the wesley hospital 13

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Dr Bhavesh Patel Undescended testes Paediatric Surgeon Surgeon Dr Bhavesh Patel looks at the best management of undescended testes

Undescended testes (UDT) or cryptorchidism More importantly the ultrasound scan does pocket created using the dartos muscle. Specific complications relate to viability of is a rather nebulous term given to the not alter management, as it is dependent on the testis. Depending on technique the Impalpable testes require localisation prior condition where testes are not present in the ability to palpate the testis. atrophy rate can be between 1-10 per cent. to further management, usually with scrotum. Inadvertent injury to the vas deferens is Treatment indications and laparoscopy. The approximate incidence of undescended quoted at 0.1 per cent. timing ++ Intra-abdominal testes are usually too testes at birth is four per cent; higher for Post operative ascent (recurrence) can high to be brought down as a single Surgery: Surgery is recommended between occur in two per cent. The procedure can be preterm infants. Spontaneous descent stage procedure. The testicular artery 6-12 months age on the basis of preserved performed again to release the contracted occurs in the majority of cases by the age of is too short to stretch through to the fertility, reduced risk of malignancy and scar tissue that is generally the cause of the three to six months. scrotum. In these cases a Fowler- torsion. Early literature recommended non-lengthening spermatic cord. Often this condition is detected at the Stephens procedure is performed; surgery at 2-13 years of age due to six-week baby check and a referral is made the testicular vessels are ligated as perception of difficulty with a smaller child Follow up to a paediatric surgeon. It is appropriate to the first stage to allow development and less anaesthetic safety. It is now refer any boy with UDT after three months of collateral blood supply from the Patients are followed at six weeks, one year accepted that earlier surgery is safe in the age. cremasteric artery and the artery to and 10 years to discuss self examination and hands of a paediatric surgeon and the vas deferens. The second stage malignancy risk. Management decisions are based on anaesthetist. procedure is performed laparoscopically distinction between a palpable versus Fertility: Histological studies have shown Summary three months later. Originally this was impalpable testis. that early orchiopexy prevents loss of germ described as a single stage procedure, ++ Testes should descend by 3-6 months. If cells that occur with increasing age. Boys A palpable testis is commonly located An example of an undescended testis. however staging the procedure allows not, a referral to a paediatric surgeon is with bilateral UDT have reduced fertility between the inguinal canal and the scrotum. a better collateral supply and reduced warranted rates of approximately 50-60 per cent. Starting with simple observation can often atrophy rate. The current atrophy rate is Unilateral UDT does not seem to result in a ++ Treatment depends on palpability, so identify the location of the testis. Gradually 5-10 per cent. significant reduction in fertility. ultrasound scans are not necessary sliding a hand down from the iliac fossa to ++ If the testis is found in the inguinal canal the groin will enable palpation of most Cancer: The association between UDT and ++ Surgery is successful in 90-100 per cent it can then be brought down with an undescended testes. The size, shape, testicular malignancy is well known. The of cases inguinal approach. tension and comparison with the other side relative risk of development of malignancy is ++ Long-term follow-up and self- are noted. A true undescended testis cannot approximately six-fold for untreated UDT; ++ The vanished testis is detected by examination is recommended to detect history of unilateral renal agenesis may also stay at the bottom of the scrotum and often Investigations seminoma being the predominant type. identifying vas and vessels ending in a malignant change as early as possible. have ipsilateral testicular agenesis. testicular remnant, which is removed springs back up to the groin. The hemi- There is no requirement for routine Performing orchiopexy early reduces scrotum is often noted to be hypoplastic in Another common complaint is of testes that malignancy risk and allows early detection. and sent for histological confirmation. laboratory work for a boy with palpable Dr Bhavesh Patel such cases, as shown in the picture. are very mobile and not always seen or felt It is advisable to teach self examination after The contralateral testis is often testes or a unilateral impalpable testis with Wesley Medical Centre the age of 10 as the lifetime risk of prophylactically fixated in the scrotum In two per cent of cases the testis is ectopic within the scrotum. The strong cremasteric a normal penis. Suite 30, Level 2 malignancy remains 1-3 per cent. to prevent future risk of torsion. and may be palpated in the perineum, thigh, reflex pulls them high into the groin. These Cases with true bilateral impalpable testes 40 Chasely St Post-pubertal boys with an undescended lateral abdominal wall or suprapubic region. are retractile testes and usually do not need warrant investigation to rule out disorders of Treatment options Auchenflower Q 4066 testis may be better treated with any procedure. The scrotum is well formed sexual differentiation. Early discussion with T 07 3333 1616 The impalpable testis may reside within the An examination under anaesthetic is in these cases. Caregivers often will notice orchiectomy due to the higher malignancy F 07 3319 6412 abdominal cavity between the lower pole of a paediatric surgeon and/or paediatric performed to enable palpation of the testis. potential. This will be discussed at the time E [email protected] the kidney and the inguinal canal. the testes down in the scrotum during a endocrinologist is recommended. For palpable testes an inguinal approach is of the consultation with the surgeon. www.betterkids.com.au Occasionally they are present in the groin warm bath. It is worthwhile observing the Imaging is also not routinely required for performed. The processus vaginalis is www.wesley.com.au obscured due to prominent suprapubic fat. child annually and only considering palpable or impalpable testes. Ultrasound Complications separated off the spermatic cord and allows In 10-15 per cent of cases the testis has intervention when the testis cannot be scans often give false results due to the mobilization and lengthening of the cord. Wound infection and haematoma are the undergone an in-utero accident; termed a brought down to the bottom of the scrotum direct pressure placed on the scrotum to This is analogous to an indirect inguinal most common complaint. The scrotal vanishing testis. In such cases the or when it is never seen in the scrotum. This gain a picture, thereby pushing the testes up hernia repair. The testis is then tunnelled wound is difficult to keep clean due to contralateral testis enlarges due to tends to be most noticeable during the into the groin. Also the cold gel triggers a through to the scrotum and placed in a frequent contact with contents of a dirty compensatory hypertrophy. A patient with a growth phase after six years of age. strong cremasteric reflex. nappy.

14 Medilink tthehe wwesleyesley hhospitalospital 15 ARTICLE

Helen Buntain Dealing with persistent or Paediatric chronic childhood cough Respiratory Physician At 28 days, cough was the predominant alternative cause for specific cough15. Some to be slower than those without asthma. Dr Helen Buntain explains why it is important to treat chronic cough symptom. In those who have a persisting individuals respond to a longer course (ie Respiratory function testing is challenging moist cough beyond six weeks would be four weeks). Left untreated, PBB is thought in those <7 years and thus not available considered abnormal. to be the first phase in the evolution of to assist diagnosis. Additional suggestive features of asthma include a positive (ii) Pertussis infection – is well known to suppurative lung disease and subsequently family history or other atopic symptoms. Katie, 18 months old, presents with a moist particulate and accumulated secretions), cause a paroxysmal and protracted cough, bronchiectasis. The pathophysiology is Inhaled corticosteroids take two to four cough that has been present for six months. and airway C-fibers (activated by bradykinin, which tends to be dry in nature. Paroxysmal not fully understood though presently is weeks to have maximal effect and thus a There have been very few cough-free days prostaglandin E2 (PGE2), capsaicin, and other cough is associated with other respiratory thought due to the combination of impaired four-week treatment trial is required to and sleep is often disturbed. She attends irritants). Both bradykinin and PGE2 are viruses. The presence of posttussive emesis mucociliary clearance and the presence assess effective. Failure of the cough to daycare and her mother complains she is found to be elevated in disease state (asthma, and inspiratory whoop modestly increase of chronic bacterial infection, causing the resolve after a four-week trial should raise always being sent home from daycare. She gastro-oesophageal reflux, allergic rhinitis). the likelihood of pertussis infection. release of mediators, such as proteases suspicions about the correctness of the looks well though has a frequent moist Additional laboratory testing should be and free radicals, causing bronchial-wall Cough and viral infections – the diagnosis. cough. collected in suspected cases for contact injury and dilatation over time. Research natural history tracing and treatment. is ongoing assessing the host immune Tracheomalacia is a reduction in the So what – it is just a cough! response in these individuals. This diameter of the trachea of > 50 per cent Acute cough in children is usually due to a (iii) Children recovering from complicated There is scant literature about persistent process has been demonstrated in other (Figure 2). There is a higher incidence viral upper respiratory tract infection (URTI). acute pneumonia or chronic cough in children over the last conditions such as cystic fibrosis and ciliary associated with cardiac anomalies During the first two to three years of a child four decades despite a reported prevalence (iv) Rhinosinusitis – defined as nasal dyskinesia. (vascular rings and Conotruncal disorders), being exposed to the greater community of 9.6 per cent in Australian children aged secretion +/- cough (wet or dry) for >10 tracheoesophageal fistula and various (daycare, kindergarten or school), they will three rural-remote clinics)9 managed 346 If PBB fails to respond to antibiotics or 6-12 years1 and higher in younger children. days. Treatment with Augmentin has been syndromes including Down’s syndrome, experience 7-10 URTIs/ year. Several studies children with chronic according to a cough recurs within months of initial treatment, Younger children frequently have viral- shown to be beneficial. Chronic symptoms VATER and CHARGE associations. have documented the natural history of cough algorithm10. Persistent bacterial bronchitis further investigation is warranted to exclude induced cough and persistent cough is (4-8 weeks) without a purulent discharge is Tracheomalacia is associated with a higher in children. A prospective cohort study of (PBB) was identified as the primary aetiology other causes15. dismissed as “it’s just another viral illnesses” usually associated with allergy. incidence of PBB 17. 256 children (aged 0–4 years) with cough for in 41 per cent (Figure 1), followed by asthma or “it’s the asthma cough” leading to parental Bronchiectasis was identified as the cause ≤28 days, without asthma, observed cough and then bronchiectasis (confirmed with B. Foreign body – should be suspected in Those with tracheomalacia have a “barky” frustration. Furthermore children are of chronic cough in nine per cent of patients resolved in 50 per cent of children within chest CT scan). Additionally there are several those with a history of choking followed 9 16 cough, similar to that heard with croup. frequently sent home from childcare/school, (Figure 1) . Goyal et al reported that 10 days and 90 per cent within 25 days4. A causes of cough unique to young children by persisting cough or non-resolving Those who present repeatedly with a barky and sleep deprivation is a real issue for the children who’s cough persists after four longitudinal community study of 600 families, (Table 1)11. These are uncommon though, pneumonia. cough +/- stridor or are still experiencing whole family2. The burden of chronic cough weeks of appropriate antibiotics have a 83 reported a mean respiratory symptom if missed, are associated with long-term croup > five years old may have in children is well documented3. Treatment per cent chance of bronchiectasis being duration of 5.5-6.8 days in children <10 years irreversible damage to the airways and Specific conditions associated tracheomalacia and warrant confirmation of of the cough is associated with a significant present on CT chest scan. old5. De Blasio et al6 and Mitra et al7 observed respiratory morbidity. with chronic cough the diagnosis. reduction in scores of depression, anxiety and Asthma is the second commonest cause complete resolution of cough within 21 days Environmental factors emotional distress in parents. Guidelines have been produced nationally and Persistent bacterial bronchitis (PBB) is of cough in children. In the early phase in 221 and 223 study participants respectively. internationally for the management of chronic 8 defined as the presence of a moist cough in of the illness the cough is “tight” and Cigarette smoke is a well documented While the majority of cough is merely A systematic review of the natural history 11-13 cough in children . A thorough history and the absence of other chest signs, resolution exacerbated by exercise or change in contributor/irritator of the airway and troublesome without consequence, it may of cough report 10-20 per cent had either a clinical examination assist in differentiating of symptoms with appropriate use of environmental temperature. Recovery with supporting those close to the patient to quit also be the sole presenting symptom of an runny nose or cough at three weeks. the possible contributors and causes. antibiotics (two weeks) and absence of an viral illnesses is often reported by parents smoking is important. underlying respiratory disease in which The physical quality of the cough provides delayed diagnosis is associated with chronic The majority of the data collected in these important information (Table 2). respiratory morbidity. studies was parent-held diaries. Rare causes of chronic cough, which if missed have significant long- Cough Type Suggested underlying process Aetiology of prolonged acute term respiratory morbidity11. What triggers cough? From this information, guidelines have defined cough/ subacute cough 1. Congenital airway abnormality – laryngeal cleft, tracheoesophageal Barking / brassy Croup Cough is a protective reflex in response to fistula, tracheal stenosis (i) acute cough as <14 days, A. Post viral or post-infectious cough Tracheomalacia foreign material in the bronchial tree and 2. Foreign body inhalation assists mucociliary clearance of secretions. (ii) subacute cough – 14-28 days and (i) Infants with acute bronchiolitis – RSV Habit cough Cough receptors are present from the (iii) chronic cough after 4-6 weeks. bronchiolitis is a common infection in those Honking Psychogenic 3. Infection – lung abscess, tuberculosis pharynx to the terminal bronchioles (as well <1 year presenting clinically with dry cough, Paroxysmal +/- inspiratory whoop Pertussis, parapertussis as the external auditory canal, pericardium, Aetiology of chronic cough tachypnoea, crackles and wheeze. The 4. Suppurative lung disease – cystic fibrosis, primary ciliary Staccato Chlamydia in infants stomach and oesophagus). The afferent median duration of symptoms is 12 days with dyskinesis, immune deficiency The causes of cough in children are different nerves regulating cough include airway 18 per cent remaining symptomatic at 21 Chronic wet/moist cough suppurative lung disease to those in adults. An Australian-based Table 1. Rare causes of chronic cough – worse in mornings (PBB, cystic fibrosis, ciliary mechanoreceptors (activated by inhaled days, reducing to nine per cent by 28 days14. multicenter study (five major hospitals and dyskinesis)

Table 2. Different types of cough and the associated condition

16 Medilink consist of a mixture of streptococcus References in children aged 0 to 4 years in primary care: a systematic 15. Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour review. British Journal of General Practice. 2002 May; GJ, Chang AB. Evaluation and outcome of young children 1. Faniran AO, Peat JK, Woolcock AJ. Measuring persistent species, Neisseria species, Moraxella 401-409 with chronic cough. Chest. 2006 May;129(5):1132-41. cough in children in eEpidemiological studies—development catarrhalis, Haemophilus influenza and of a questionnaire and assessment ofprevalence in two 9. Chang AB, Robertson CF, Van Asperen PP, Glasgow 16. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. staphylococcus15. Resistance patterns will countries. Chest 1999,115:434–9. NJ, Mellis CM, Masters IB, Teoh L, Tjhung I, Morris PS, Does failed chronic wet cough response to antibiotics predict Petsky HL, Willis C, Landau LI. A multicenter study on bronchiectasis? Arch Dis Child. 2014 Jun;99(6):522-5. doi: 2. Cohen HA, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel depend on the individual’s prior antibiotic chronic cough in children: burden and etiologies based on a 10.1136/archdischild-2013-304793. Epub 2014 Feb 12. Y, Kozer E, Pomeranz A, Efrat H. Effect of honey on nocturnal exposure, though Augmentin Duo is usually standardized management pathway. Chest 2012;142(4):943– cough and sleep quality: a double blind, randomised, 17. Masters IB1, Zimmerman PV, Pandeya N, Petsky HL, 50. adequate. placebo-controlled trial. Pediatrics 2012, 130(93):465–471. Wilson SB, Chang AB Quantified tracheobronchomalacia 10. Chang AB, Robertson CF, van Asperen PP, Glasgow NJ, disorders and their clinical profiles in children. Chest. 2008 3. Marchant JM, Newcombe PA, Juniper EF, Sheffield JK, Masters IB, Teoh L, Mellis CM, Landau LI, Marchant JM, Feb;133(2):461-7. Epub 2007 Nov 7. Stathis SL, Chang AB. What is the burden of chronic cough Why is it important to treat? Morris PS. A cough algorithm for chronic cough in children: for families? Chest. 2008 Aug;134(2):303-9. 18. Smith SM, Schroeder K, Fahey T. Over-the-counter a multicenter, randomized controlled study. Pediatrics. 2013, (OTC) medications for acute cough in children and adults in Aggressive management with airway 4. Hay AD, Wilson A, Fahey T, Peters TJ. The duration of May;131(5):e1576-83. ambulatory settings (Review) Cochrane Database Syst Rev. acute cough in pre-school children presenting to primary clearance and antibiotics for those with 11. Gibson PG1, Chang AB, Glasgow NJ, Holmes PW, 2012 Aug 15; 8:CD001831. care: a prospective cohort study. Fam Pract 2003, Katelaris P, Kemp AS, Landau LI, Mazzone S, Newcombe Figure1. Distribution of the five most frequent diagnoses, grouped according to age categories9. more established disease is known Dec;20(6):696-705. 19. Kapur N, Masters IB, Chang AB. Longitudinal growth and P, Van Asperen P, Vertigan AE; CICADA. CICADA: Cough in lung function in pediatric non-cystic fibrosis bronchiectasis: to stabilize lung function and disease 5. Leder K, Sinclair MI, Mitakakis TZ, Hellard ME, Forbes Children and Adults: Diagnosis and Assessment. Australian what influences lung function stability? Chest. 2010 19 A. A community-based study of respiratory episodes cough guidelines summary statement. Med J Aust. 2010 Mar progression . Furthermore, treatment has Jul;138(1):158-64. been documented to lead to an improvement in Melbourne, Australia. Aust N Z J Public Health. 1;192(5):265-71 2003;27(4):399-404. 20. Gaillard EA1, Carty H, Heaf D, Smyth RL. Reversible 12. Shields MD, Bush A, Everard ML, McKenzie S, Primhak of the bronchial dilatation/bronchiectasis or bronchial dilatation in children: comparison of serial high- 6. De Blasio F, Dicpinigaitis PV, Rubin BK, De Danieli G, R; British Thoracic Society Cough Guideline Group.. resolution computer tomography scans of the lungs. Eur J arrest progression of disease 20,21. Lanata L, Zanasi A: Anobservational study on cough in Recommendations for the assessment and management of Radiol. 2003 Sep;47(3):215-20. children: epidemiology, impact onquality of sleep and cough in children. Thorax 2008;63(Suppl 3):1–15. treatment outcome. Cough 2012, 8:1. doi:10.1186. http:// 21. Haidopoulou K, Calder A, Jones A, Jaffe A, Sonnappa S. 13. Chang AB: Guidelines for evaluating chronic cough Summary www.coughjournal.com/content/8/1/1. Bronchiectasis Secondary to Primary Immunodeficiency in in pediatrics: ACCP evidence-based clinical practice Children: Longitudinal Changes in Structure and Function. 7. Mitra A, Hannay D, Kapur A, Baxter G. The natural history guidelines. Chest 2006, 129(1):260S–283S. Chronic cough in children in the absence Pediatr Pulmonol. 2009 Jul;44 (7):669-75. of acute upper respiratory tract infections in children. Prim 14. Swingler GH, Hussey GD, Zwarenstein M. Duration of of other clinical signs may be the only sign Health Care Res Dev 2011, 12(4):329–334. illness in ambulatory children diagnosed with bronchiolitis. A B C of an underlying chronic lung disease or 8. Hay AD and Wilson A. The natural history of acute cough Arch Pediatr Adolesc Med. 2000 Oct;154(10):997-1000. Figure 2. By view of the trachea. A: normal trachea with ‘C’ shaped tracheal rings. B: Moderate tracheomalacia progress to a chronic suppurative lung with flattening of the anterior tracheal wall and widening of the par membranosa (posterior muscular wall). disease and bronchiectasis. Guidelines have C: Severe tracheomalacia with near complete closure of the trachea. been established to guide the investigative, treatment and referral process. It is Treatment options routine use of codeine-based medications to important to ensure complete resolution of suppress cough. a cough. Cough suppressants Inhaled corticosteroids Dr Helen Buntain The Wesley Hospital Sleep Disorders Centre There is no evidence that over-the-counter Wesley Medical Centre THORACIC & The Sunshine Coast Sleep Disorders Centre medications are effective18. A teaspoon of If the diagnosis is suggestive of asthma Ph: 1800 11 94 46 Fax: 07 3870 0233 Sessional Suites honey has been shown to be more effective and there is a positive response to Ventolin, SLEEP GROUP [email protected] 40 Chasley St QUEENSLAND than placebo in a randomised controlled inhaled corticosteroids may be indicated. Auchenflower Q 4066 trial and is safe. Antibiotics T 07 3871 3224 EEP Codeine-based medications will suppress F 07 3720 2414 ATH & SL In the presence of features suggestive of YOU BRE the cough, with associated drowsiness E [email protected] OW PBB, a trial of antibiotics for two to six weeks NG FOR H and constipation. There is no place for the is appropriate. The organisms isolated www.drbuntain.com.au PEOPLE CARI www.wesley.com.au

The Wesley Hospital and St Andrew’s War Memorial Hospital SAVE are pleased to present the annual The Wesley Hospital THE DATE Q&A Sleep Disorders Centre WITH TONY JONES

mplex sleep disorders. Come along atients with co ices for p and ask the 13 June 2015 tient serv nt and outpa brisbane convention centre Providing inpatie hard questions! The Wesley Lung Function Laboratory Dr Andrew Scott Dr John Feenstra An initiative of UnitingCare Health hospitals: Ph: 07 3870 0858 Ph: 07 3876 8405 Ph: 07 3876 9033 Tony Jones Fx: 07 3870 2608 Fx: 07 3870 3212 Fx: 07 3871 3222 ABC Journalist [email protected] [email protected] [email protected] Accredited for compliance with ASA Standard for Sleep 18 Medilink Disorders Services For e-referrals visit www.thoracicandsleep.com.au/referralsthe wesley hospital 19 Directory: General Paediatrics

General Paediatrics and Neonatology A/Prof David Coman Dr Johanna Holt Dr David Moore Paediatrician, Metabolic Physician, Paediatrician Paediatrician Clinical Geneticist Dr Johanna Holt Dr David Moore Dr David Coman is a General is a Paediatrician graduated from Paediatrician who with special the University of has worked at the interest in neonatal Queensland in Wesley Medical management and 1995. He gained Centre and The management of wide exposure to Wesley Hospital children less than general paediatrics, since 1997. Dr Holt five years of age. neonatology, trained at the Royal clinical genetics For a long period Children’s Hospital, Royal Women’s Hospital and metabolic medicine through training of time Dr Moore was on the on-call roster and North Brisbane Health District in General positions in Brisbane, Rockhampton, at the Mater Mother’s Neonatal Intensive Paediatrics, undertaking fellowships in Melbourne, the United Kingdom and Ireland. Care and now continues to practice neonatal Neonatal Medicine, and Community and medicine and general paediatric medicine in Dr Coman has an active interest in research Developmental Paediatrics. his private practice based at the Wesley. and is currently involved in multiple research She now practices across the breadth of projects aimed at novel disease discovery, paediatrics - from care of the premature Wesley Medical Centre improved diagnostic testing and treatments and newborn, to care of infants and children Level 2, Suite 22 for children with Inherited Genetic with general medical problems, and to care 40 Chasely St Disorders. of children with significant developmental Auchenflower Q 4066 He is actively involved in the teaching of problems and learning difficulties. T 07 3870 9399 medical students and paediatric trainees. F 07 3871 1089 He currently holds academic appointments Wesley Medical Centre www.wesley.com.au at The University of Queensland, Griffith Suite 41, Level 4 University and Bond University. 40 Chasely St Auchenflower Q 4066 Dr Marion Thomas Wesley Medical Centre T 07 3217 7933 Paediatrician Suite 36, Level 3 F 07 3371 1138 Dr Marion Thomas 40 Chasley St is a Paediatrician Auchenflower Q 4066 with more than 22 T 07 3371 5122 Dr Bruce Lewis years experience in F 07 3371 5590 Paediatrician paediatrics, both in www.drdavidcoman.com.au the UK and Australia. www.wesley.com.au Dr Bruce Lewis is a Paediatrician who Dr Thomas’s area of practices across speciality is children all areas of general and adolescents up paediatrics with a to 14 years, across the spectrum of general focus on newborn paediatrics with an emphasis on family- and infant medicine centred holistic care. within The Wesley She is interested in complex children with Hospital. developmental delay and special needs and He has a special interest in neonatology, early feeding and nutritional problems. general paediatrics, newborns and pre-term births. Wesley Medical Centre Suite 36, Level 3, Wesley Medical Centre 40 Chasely St Suite 36, Level 3 Auchenflower Q 4066 40 Chasely St T 3217 7004 Auchenflower Q 4066 F 3371 5590 T 07 3371 5144 E [email protected] F 07 3371 5590

20 Medilink the wesley hospital 21 Directory: Paediatric Sub-specialty

Allergy and Cardiology Developmental Endocrinology Gastroenterology Immunology Paediatrics Dr Robert Justo New Specialist New Specialist Dr Kim Robertson Paediatrician Dr Wen-Yi Chew-Lai Dr Andrew Cotterill Prof Geoffrey Cleghorn Dr Richard Muir Developmental Paediatrican Paediatric Allergist and Clinical Dr Robert Justo has Paediatric Endocrinologist Paediatric Gastroenterologist Paediatric Gastroenterologist Immunologist provided a consultative Dr Wen-Yi Chew-Lai Dr Andrew Cotterill Professor Dr Richard Muir Dr Kim Robertson service with Heart is a Developmental is a specialist Geoffrey Cleghorn is a Paediatric is a specialist in Care Partners at the Paediatrician with medical physician, is a Paediatric Gastroenterologist paediatric allergy and Wesley Hospital since a special interest recognised Gastroenterologist who began practicing clinical immunology 1998. He has extensive in children with internationally as an and Deputy Head at The Wesley and her professional experience in all fields developmental delays, expert in diagnosing of the School of Hospital in 2012. He areas of interest of general paediatric learning difficulties, and treating Medicine and has a special interest include the diagnosis cardiology. autism and attention endocrine disorders Professor of in inflammatory and management of deficit disorder. Dr Justo graduated in Medicine from the in babies, children Paediatrics and bowel disease, paediatric food and University of Queensland and trained in She has dual training in both general and adolescents. Child Health at The University of Queensland. eosinophilic oesophagitis and coeliac disease. insect allergies, eczema and allergic rhinitis. paediatric cardiology at the Hospital for Sick paediatrics and community child health He is currently the senior paediatrician in Dr Cotterill trained in adult and children's Dr Muir graduated in Medicine from the She also performs diagnostic skin prick testing Children, Toronto. He is Director of Cardiology encompassing developmental paediatrics, child the Children's Nutrition Research Centre medicine and became a paediatrician in 1988 University of Queensland and trained in and intradermal testing, as well as oral food at The Lady Cilento Children’s Hospital, with protection and population health. of The University of Queensland at the and an accredited paediatric endocrinologist Paediatric Gastroenterology at the Royal challenges and allergen immunotherapy. areas of special interest including interventional Royal Children's Hospital in Brisbane. His Other languages spoken include Malay and in 1993. He holds medical qualifications from Children’s Hospital and Mater Children’s cardiology and familial hypercholesterolaemia. research interests include the use of energy Dr Robertson’s research interests include Cantonese. Dr Chew-Lai obtained her Master the UK and Australia. Hospital. expenditure and body composition analysis in adrenaline autoinjector (Epipen) practices in Queensland Paediatric Cardiac Service of Public Health in 2011 and has undertaken He has headed up the Mater Children's a number of disease states including chronic He was the recipient of a Royal Children’s allergy clinic patients. Lady Cilento Children’s Hospital Autism Diagnostic Observation Schedule Hospital's paediatric endocrinology unit since liver disease, cystic fibrosis and general Hospital Foundation Clinical Fellowship South Brisbane Q 4101 (ADOS) training. Wesley Medical Centre 1996 and leads the public hospital transition nutritional rehabilitation. Grant and has trained extensively in all areas T 07 3870 4144 (Heart Care Partners) Level 2, Suite 30 Wesley Medical Centre of Mater and Royal Children's Hospitals' of paediatric gastroenterology including F 07 3068 1111 He has been involved in many of the historical 40 Chasely St Level 2, Suite 30 paediatric endocrinology departments ahead diagnostic and therapeutic endoscopy. E [email protected] and seminal advances in paediatric liver Auchenflower Q 4066 40 Chasely St of the opening of the Queensland Children's transplantation including the world's Paddington Medical Rooms T 07 3232 7686 Auchenflower Q 4066 Hospital in 2014. first successful living-related-donor liver 161 Given Terrace F 07 3232 7585 T 07 3232 7686 Sleep Disorders Over the years, Dr Cotterill has held regular transplant and the development of the liver Paddington Q 4064 E [email protected] F 07 3232 7585 outreach clinics at regional Queensland cut-down technique now universally known T 07 3367 1065 Dr Scott Burgess E [email protected] centres such as Bundaberg, Rockhampton as the "Brisbane Technique". Research from F 07 3367 1075 Clinical Genetics and Paediatric Sleep Physician and Gladstone where there is no local the Queensland Liver Transplant Service E [email protected] paediatric endocrinologist. Metabolic Medicine Dr Scott Burgess PhD has highlighted the importance of nutrition www.paddingtonmedicalrooms.com FRACP is a Paediatric Dr Cotterill is a past president of the in these patients and is now acknowledged www.wesley.com.au A/Prof David Coman Sleep Physician who Australian Paediatric Endocrine Group which internationally. Paediatrician, Metabolic Physician, is keen to assist with fosters a sharing of research and clinical care Professor Cleghorn has developed an Clinical Geneticist the management among paediatric endocrinologists across extensive network of associations throughout Dr David Coman has of medical and Australia and New Zealand. Asia and has a very high profile within this behavioural sleep an active interest He is an associate professor at the University region. problems in children in research and is of Queensland, sharing his knowledge with a of all ages (0 to 16 Taylor Medical Centre currently involved in new generation of doctors. 40 Annerley Road multiple research years). This may include snoring and obstructive Dr Cotterill is married with three children, Woollongabba Q 4102 projects aimed sleep apnoea, difficulties falling or staying now grown into wonderful adults. T 07 3846 3475 at novel disease asleep, restless sleep, parasomnias, narcolepsy F 07 3891 7445 discovery, improved and investigation of tiredness. Queensland Paediatric Endocrinology www.wesley.com.au diagnostic testing and treatments for children Private sleep studies may be performed at the Taylor Medical Centre with Inherited Genetic Disorders. Wesley Hospital in children aged two years and Suite 10A older following a consultation with Dr Burgess. First floor Wesley Medical Centre 40 Annerley Rd Suite 36, Level 3 Scott is dedicated to the provision of a timely Woolloongabba 40 Chasley St professional service and is available to discuss T 07 3393 1916 Auchenflower Q 4066 a patient or review urgent cases as required. T 07 3371 5122 Telehealth consultations are available for non- F 07 3891 7445 F 07 3371 5590 metropolitan patients. www.drdavidcoman.com.au T 07 3177 2000 www.wesley.com.au E [email protected] www.drscottburgess.com.au 22 Medilink the wesley hospital 23 Directory: Paediatric Sub-specialty Directory: Paediatric Surgery

Haematology & Respiratory Physicians Paediatric Surgeons Oncology New Specialist New Specialist Dr Peter Borzi ENT Surgeons Dr Helen Buntain Dr Nigel Dore Paediatric Surgeon Dr John Bashford Dr Bhavesh Patel Clinical Haematologist and Medical Paediatric Respiratory Physician Paediatrician Dr Peter Borzi is a Paediatric Surgeon with a Dr Julieanne Agnew Oncologist Paediatric Surgeon Dr Helen Buntain Dr Nigel Dore is a speciality in general surgery and paediatric ENT Surgeon The Wesley Hospital Suite 104 John Bashford is a Paediatric Paediatrician with a urology. He has been practicing at The Wesley is pleased to 101 Wickham Tce is a Clinical Respiratory Physician focus in paediatric Hospital since 1993. Taylor Medical Centre welcome Paediatric Brisbane 4000 Haematologist and with an interest in respiratory medicine. 40 Annerley Rd Surgeon T 07 3832 1244 Medical Oncologist the management Dr Dore has a special Wooloongabba Q 4102 Dr Bhavesh Patel F 07 3839 0876 with a special of children’s lung interest in asthma, T 07 3846 3915 to the hospital’s E [email protected] interest in adolescent disorders including bronchilitis and F 07 3891 7445 extensive team of and young adults. asthma, cough, pneumonia and has E [email protected] medical specialists. He has more than 20 chest infections and been practicing at the Dr James Earnshaw years experience at airway lesions in children from birth to 18 Wesley since 1998. As well as The Dr Christopher Bourke ENT Surgeon the Wesley in treating complex malignancies years of age. She has extensive experience in Wesley Hospital, he holds appointments at Ballow Chambers Dr Dore completed his medical degree at the Paediatric Surgeon in conjunction with orthopaedic and thoracic performing flexible bronchoscopy to diagnose Lady Cilento Children’s Hospital (previously 121 Wickham Tce University of Queensland and is a member of Dr Christopher Bourke is a Paediatric Surgeon specialists. airway lesions and structural abnormalities. known as Royal Children’s Hospital), Mater Brisbane 4000 the Asthma Foundation of Queensland. with a speciality in neonatal surgery and Children’s Private Brisbane, Nambour T 07 3839 4179 Dr Bashford has a particular interest in stem Dr Buntain graduated from the University thoracic paediatric surgery. Dr Bourke has been Cadogan House General Hospital, Nambour Selangor Private F 07 3831 7143 cell transplantation, multiple myeloma, and of Queensland in 1993. She commenced practicing at The Wesley Hospital since 2004. 1382 Sandgate Rd Hospital and Sunshine Coast University E [email protected] sarcoma. her paediatric training in 1996 at the Royal Nundah Q 4012 Private Hospital. Dr Bourke is a member of the Australian and Children’s Hospital, Brisbane, and was His qualifications include a Bachelor of T 07 3266 8155 New Zealand Association of Paediatric Surgeons Dr Andrew Lomas Science, Bachelor of Medicine and Surgery awarded the FRACP examination medal for Dr Patel was brought up in New Zealand and F 07 3266 8145 and the International Paediatric Endosurgery ENT Surgeon (Honours). He is also a Fellow of the Royal Paediatrics in 1998. Following this she was trained in major centres including Auckland, E [email protected] Group. 3/113 Wickham Tce Australasian College of Physicians and the awarded a Clinical Fellowship to commence Wellington and Hamilton before moving Brisbane 4000 Royal College of Pathologists of Australasia. specialist training as a Paediatric Respiratory to Australia and completing his training in Taylor Medical Centre T 07 3839 8977 Physician. During her sub-specialty training, Brisbane and Sydney. 40 Annerley Rd Paediatric F 07 3839 1672 Wesley Medical Centre Dr Buntain completed a PhD in cystic fibrosis. Rheumotology A keen teacher, he is an active senior Woolloongabba Q 4102 Level 1, Haematology and Oncology Clinic Dr Buntain was awarded her FRACP lecturer with the University of Queensland T 07 3255 2195 Dr Simon Nasser 40 Chasely St School of Medicine, a faculty member of F 07 3891 7445 (paediatrics) in 2003. Her specialist training in Dr Navid Adib ENT Surgeon Auchenflower Q 4066 the Academy of Surgical Educators with the respiratory medicine was completed in 2004, Paediatrician Suite 6, Level 9 T 07 3737 4500 Royal Australasian College of Surgeons and Dr Kelvin Choo and her PhD was awarded in 2006. Evan Thomson Building F 07 3737 4601 Dr Adib is a a co-founder of the Australasian Paediatric Paediatric Surgeon In 2007, Dr Buntain was employed as a Staff 24 Chasely St E drbashford.secretary@iconcancercare. Paediatrician Surgery Research Interest Group. Medical Specialist at the Royal Children’s Dr Kelvin Choo is a Paediatric Surgeon with Auchenflower 4066 com.au specialising in Hospital and in 2014 began practice at The He holds memberships with the Australia a speciality in neonatal, hepato-biliary and T 07 3870 4455 www.iconcancercare.com.au Rheumatology and Wesley Hospital. and New Zealand Association of Paediatric thoracic surgery as well as burns. He has been F 07 3870 4488 www.wesley.com.au has been practicing at Surgeons; Society of Paediatric Urologists practicing at The Wesley Hospital since 2004. E [email protected] Dr Buntain is a member of the following The Wesley Hospital of New Zealand and Australia (SPUNZA); societies: Australasian College of Physicians; since 2006. Dr Choo completed his training in paediatric International Paediatric Endosurgery Group; Thoracic Society of Australia; Australian surgery in Brisbane, Melbourne and in the Dr Anthony Parker Dr Adib's areas of Australia and New Zealand Burns Association Paediatric Respiratory Group; American United Kingdom. He has been a consultant ENT Surgeon interest include and the International Children’s Continence Thoracic Society; Australian Medical paediatric surgeon in Brisbane since 2004 and 225 Wickham Tce paediatric rheumatology, musculoskeletal Society. Association. holds appointments at the Mater Children’s Brisbane 4000 and inflammatory disorders, juvenile arthritis, Wesley Medical Centre Hospital, the Royal Children’s Hospital, The T 07 3831 2355 Wesley Medical Centre juvenile dermatomyositis, lupus and morphea. Suite 30, Level 2 Wesley Hospital and Logan Hospital. F 07 3831 2201 Sessional Suites Evan Thomson Building 40 Chasely St E [email protected] 40 Chasley St Taylor Medical Centre Level 10, Suite 3 Auchenflower Q 4066 Auchenflower Q 4066 40 Annerley Rd 24 Chasely St T 07 3333 1616 Dr Brian Wilson-Boyd T 07 3871 3224 Woolloongabba Q 4102 Auchenflower Q 4066 F 07 3319 6412 ENT Surgeon F 07 3720 2414 T 07 3393 2451 T 07 3870 1029 E [email protected] Suite 88, Level 5 E [email protected] F 07 3891 7445 F 07 3871 0700 www.betterkids.com.au Sandford Jackson Building www.drbuntain.com.au E [email protected] E [email protected] www.wesley.com.au 30 Chasely St www.wesley.com.au Auchenflower 4066 T 07 3371 9000 F 07 3371 9100 E [email protected] www.ent-surgeon.com.au

24 Medilink the wesley hospital 25 Clinical Education 2015 Meet our new Visiting Medical Practitioners Local CPD ALM Regional CPD Special Events Dr Hans Goossen Dr Jivesh D Choudhary Dr Joseph Schoeman The Wesley Hospital Urologist & Andrologist Cardiothoracic Surgeon General Urologist February 19 February 11 February Urology (non cancer) Dr Hans Goossen Dr Jivesh The Wesley Practice Nurses will commence Choudhary is a Hospital is pleased 25 February consulting and Cardiothoracic to welcome Dr Neurology/Neurosurgery operating at The Surgeon with Joseph Schoeman Wesley Hospital in considerable to its extensive March 17 March 14 March Week of 23 March Cairns January 2015. experience in adult team of medical Gastroentrology Infertility/Obstetric/ Gynaecology He has special cardiac surgery, specialists. interests in men's thoracic surgery, Dr Schoeman April 30 April health (erectile minimally invasive comes to the Paediatric dysfunction and penile implant surgery, surgery, heart failure and arrhythmia Wesley with considerable experience in management requiring the insertion of 16 may Peyronie's disease, male infertility), penile General Urology with a particular focus May 13 May implantable devices. Emergency Medicine and urethral reconstruction, prosthetic on incontinence in both male and female ENT surgery, and benign and malignant Originally from India, he completed his post- patients. He maintains a passion for conditions of the penis and scrotum. graduation in general surgery from Gujarat ureteric and renal calculi management, 26 May Orthopeadic Dr Goossen graduated in 1999 from University in 1994. He obtained specialist optimizing the combined use of up-to- week of 22 june 13 june the Catholic University of Nijmegen, qualifications as a cardiothoracic surgeon date endoscopic equipment with laser June 16 June Bundaberg Q&A with Tony Jones the Netherlands, with a MBBS and a (Mch) from Delhi University in 2000 and technology. Vascular Physician’s degree. In Australia, he worked as a consultant in Apollo Hospital, a As part of his holistic practice he also 695-bed internationally accredited tertiary July 15 July week of 27 july 16 July completed his Surgery and specialist offers Oncology treatment in the form Cardiology Rockhampton Practice Nurses Urology training at the major teaching care centre, for three years. of a traditional Radical Retropubic hospitals in Brisbane with a special Dr Choundhary arrived in Australia in 2003 Prostatectomy, Robotic Prostatectomy and 29 July interest in oncology, laparoscopy, stone and has worked as a consultant at the Royal Laparoscopic Radical Nephrectomy. Cardiac Audit Dinner management and urethral reconstruction. Hobart Hospital, Canberra Hospital and Dr Jo Schoeman obtained his August 6 August 22 August Subsequently he attended the University John Hunter Hospital. undergraduate degree, MBChB, at the Emergency Medicine Minimally Invasive Surgery College Hospital, London, for a two year He is involved in research and teaching University of Pretoria, South Africa, in 1993. Fellowship in the specialty of andrology, with the Critical Care Research Group, He went on to complete his first Urology 26 August focussing on male genital oncology and Plastic and Maxillofacial Queensland University of Technology (QUT) Fellowship (FCS), College of Urologists reconstruction, male infertility, prosthetic and Newcastle University. of South Africa in 2003 and migrated to September 1 September week of 7 September 12-13 September surgery and Peyronie’s disease. Australia in 2007. As a fellow at the Prince Charles Hospital, Breast and Endocrine Maryborough/Hervey Bay Private Practice Conference Dr Goossen is a member of the he was involved in heart and lung After becoming a Fellow in laparoscopic International Society of Sexual Medicine 16 September transplantation, ventricular assist device urology surgery in Melbourne, he entered (ISSM), the European Society of Sexual Thoracic and Sleep implantation and the management of private and public General Urology Medicine (ESSM), the Urological Society of patients on ECMO. practice. He was the sole urologist in October 13 October 13-16 October week of 19 October Australia and New Zealand (USANZ), the Bundaberg for five years and still visits Oncology and Palliative Care Clinical Week Gladstone In addition to his practice at the Wesley, Dr Royal Australasian College of Surgeons weekly. (RACS), and the European Association of Choundhary will be conducting peripheral 21 October 17 October CPR Training Day - Urology (EAU). clinics in Toowoomba, Armidale and Dr Schoeman is also part of the recently Surgical Audit Dinner Newcastle. opened Pelvic Medicine Centre, a new and Emergency Medicine Stoneham House unique venture at the St Andrew’s War 29 October Gynaecology/Uro/Oncology 14 Stoneham Street Wesley Medical Centre Memorial Hospital. Suite 30, Level 2 14 november 4 November Stones Corner, Q 4120 November 11 November 40 Chasely St St Andrew’s War Memorial Hospital Cardiology/Vascular Surgery Practice Nurses P 07 3847 8601 Prostate Cancer F 07 3324 2546 Auchenflower Q 4066 457 Wickham Terrace, T 1300 115 551 or 0430 130 478 Spring Hill, Q 4000 E [email protected] Vicki Goss Please note: Topics and dates E [email protected] T 07 3831 9049 Business Development Manager are subject to change www.vedantacardiacare.com F 07 3834 4399 www.wesley.com.au Phone 3232 7258 Mobile 0419 020 156 Email [email protected] Fax 3232 7932 www.wesley.com.au

26 Medilink the wesley hospital 27 Wesley Breast Clinic Urgent Referral Service

Every year more than 23,000 patients Doctor Hotline attend The Wesley Breast Clinic for 07 3232 7085 screening and diagnostic assessments. www.wesley.com.au/breastclinic The Clinic offers:

• 14 medical practitioners trained in breast health and procedures • Urgent referral service to the Diagnostic Clinic. (In most cases, patients are seen within 24 hours) • Diagnostic results delivered on the same day or next working day • Quick turnaround for routine mammograms • Saturday and after-hours screening appointments • All follow-up management is available on the Wesley campus.

Our areas of expertise include:

• Digital mammography • On-site MRI with the capability to perform MR guided biopsy • Ultrasound examinations • Fine needle biopsy and cyst aspirations • Core biopsies including vacuum-assisted core biopsies

Doctor hotline Call 07 3232 7085 or fax 07 3217 8840 for urgent appointments or email: [email protected]

FAST referrals Download referral template at wesley.com.au Click on Wesley Breast Clinic tab then follow the instructions for your practice software. Return referral via Medical Objects or fax 07 3217 8840

Patient bookings Call 07 3232 7202 for a prompt appointment or Practice enquiries on 07 3232 7067.