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More than a hot flush
Menopause symptoms are triggered by low levels of estrogen . 1 Postmenopausal women may experience a range of symptoms related to this estrogen deficiency , including a loss of bone mineral density as well as the thinning , drying and inflammation of vaginal and vulvar tissues . 1-3
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14 JUNE 2024 ausdoc . com . au
The traumas of war : a GP ’ s survival story
Addressing the underlying estrogen deficiency related to menopause may help alleviate a range of symptoms beyond just hot flushes . 1 , 4
Scan here for a presentation by Prof . Rod Baber on managing the symptoms of menopause .
References : 1 . Saljoughian M . US Pharm 2018 ; 43 ( 1 ): 13 – 16 . 2 . Zagaria MAE . US Pharm 2011 ; 36 ( 9 ): 22 – 26 . 3 . Bhatnagar A , Kekatpure AL . Cureus 2022 ; 14 ( 9 ): e29367 . 4 . The Royal Australian and New Zealand College of Obstetricians and Gynaecologists . Managing menopausal symptoms , September 2020 .
Besins Healthcare Australia Pty Ltd ABN 68 164 882 062 . Suite 5.02 , 12 Help Street , Chatswood NSW 2067 . Office phone ( 02 ) 9904 7473 . For medical information call 1800 BESINS ( 237 467 ). www . besins-healthcare . com . au EPR-EST-PRM-2007 April 2024 .
Amanda Davey DR Michael Clements tries to avoid watching the images coming out of Gaza .
It is not because he does not care , but because of his own war story .
He has vivid flashbacks to his time in the Royal Australian Air Force and the young patients he could not save .
“ There is only so much I can deal with ,” says the RACGP vice-president .
“ As people often say , the best proponents against war are those who have been there .
“ Having been there and seen what I have seen , these images — especially of the children — break my heart .”
These days , Dr Clements runs a GP practice in Townsville , Queensland , but between 2001 and 2013 he was in fulltime military service .
Most of the experiences were positive , but Afghanistan haunts him .
“ I remember getting a call about an incoming helicopter with three children who had been seriously injured when playing with an old Russian landmine they had thought was a toy .
“ We had three very , very sick and injured children with missing limbs and abdominal wounds and lots of damage .
“ Even though I felt well prepared for what I had to do medically , I froze .
“ I remember standing there thinking , ‘ I can ’ t move .’
“ These were the worst injuries I had seen .
“ I do not know whether it was seconds or minutes before I gathered myself and did what I needed to do .”
Dr Clements and his team stabilised the patients , only to learn they would be transferred to a rudimentary hospital that was not equipped to keep them alive .
“ The children were expected to die soon after leaving us . That certainly affected me because I knew that , in Australia , or anywhere else that we had access to , we could have given them a very long life .
“ However , we could not keep them with us in our facilities , so they were on their way to an expected death .”
Dr Clements still gets flashbacks from that day , which he believes is a post-traumatic stress reaction to the “ moral injury ” of not being able to save the children .
“ I can still describe the children and their injuries perfectly : the smells , the sounds , what I was wearing .”
However , he says his experiences in the Australian Defence Force made him a better doctor , particularly in his care of veterans .
Soldiers on deployment may not show any concerning signs for years , even decades , until their trauma finally reactivates in response to another stressor .
But , he says , sometimes the trigger is not the horrors of war but the “ military machine ”.
“ Once somebody is identified for medical discharge due to mental health concerns , such as PTSD , they are usually taken away from their colleagues , friends and their job .
“ Their financial security is in question , and they think , ‘ If I am not a soldier , what am I ?’
“ The trauma actually comes from that process , and it can be quite a dehumanising process because it numericises them .”
Dr Clements is referring to the Department of Veterans ’ Affairs ’ impairment points system , which determines how much compensation veterans may be owed .
It runs from zero ( nil or negligible impairment ) to 100 ( death ).
This system became a trigger for one of Dr Clements ’ patients .
“ He attempted suicide when he got his letter from the department that said it had accepted his PTSD diagnosis and allocated 40 impairment points
‘ I can still describe their injuries perfectly : the smells , the sounds , what I was wearing .’
Dr Michael Clements in Tarin Kowt , Afghanistan , 2009 , and ( left ) with two of his children , Liam and Yasmine . towards his condition .
“ He said , ‘ How can they only allocate me 40 points ? This is my whole body , and it should be worth a lot more than that .’”
Dr Clements says suicide and suicide attempts by patients come with the work . “ It breaks my heart and makes me question why I do this job sometimes .” But there are highs in treating people whose lives are unravelling .
“ One of the benefits of being a doctor who cares for veterans is that I have got the lived experience ; I have been them ; I have seen what they have seen ,” he says .
“ The joy of general practice is that you see people at their worst and best because you see them over a lifetime .”
Reflecting on his time in the Australian Defence Force , he says he would do it again “ in a heartbeat ”.
However , five people at home also needed him .
His wife and four young children became acclimatised to his absence , to the point where they stopped asking where he was or whether he would be home for dinner .
“ I knew then it was time to leave ,” he says .
“ I had missed too many birthdays and anniversaries .”
If this news story has raised issues for you or you are concerned about someone you know , you can call the following support services : Drs4Drs 1300 374 377 ; Lifeline 13 11 14 .