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Osteoporosis: Not just for the elderly. Why you might need a bone density scan

Missy Tysoe October 11, 2017

Osteoporosis: Not just for the elderly. Why you might need a bone density scan.

When we hear the word “osteoporosis” we often dismiss the idea that we have anything to worry about – at least until we hit 70, right? Wrong.Osteoporosis is a bone disease that affects more than 1 in every 3 women and 1 in every 5 men. There are many risk factors that affect both men and women of all ages, such as previous  fractures, certain medications, lack of sunlight, insufficient calcium and hormone imbalances. Add other lifestyle habits such as smoking and drinking alcohol to the mix and the risk is higher again. Certain medical conditions can play a role too, even those that you may not suspect are related to your bone density, such as digestive malabsorption (tummy problems). Reliance Chiropractor, Dr Angus Steventon explores our frequently asked questions about this silent disease.

What is osteoporosis?

66% of Australian men and women over the age of 50 have low bone mineral density, and most don’t realise. The most severe form of this, osteoporosis, affects over 1 million Australians. Osteoporosis is a condition in which bones become thinner, more fragile and more likely to break, even as a result of a minor fall, a bump or sneeze. Fractures caused by osteoporosis can be life threatening and may result in significant ongoing pain and long-term disability. Osteoporotic fractures are so common that in Australia 1 fracture occurs every 3.5 minutes, which probably equates to about 2 fractures since you’ve been checking out the Reliance website, and 395 fractures by the end of today.

Osteoporosis is a condition in which bones become weak and brittle

Osteoporosis is a condition in which bones become weak and brittle

Who is at risk?

Some of the risk factors for poor bone density and osteoporosis are well known, like having a family history of osteoporosis, low dietary calcium, low vitamin D, being female, or early menopause. Most people don’t realise that there are many other risk factors, such as not doing enough exercise or smoking. There are a number of factors that can affect young people as well as older people, such as excessive alcohol intake, being underweight, thyroid conditions, lower hormone levels,  long-term use of some medications such as corticosteroids and antidepressants, some chronic diseases (e.g. rheumatoid arthritis, chronic liver or kidney diseases) and malabsorption conditions such as coeliac disease and inflammatory bowel disease.

What should I do?

If any of the risk factors mentioned above apply to you or your family you should book an appointment to speak with your GP on 43 041 333 or via the appointuit app on our homepage. In particular, anyone who experiences a broken bone from a minor bump or fall should be investigated for osteoporosis. Osteoporosis is not just an “old lady disease”. Almost a quarter of all people with osteoporosis are men, and we have seen many men and women in their 50’s diagnosed with osteoporosis.

Osteoporosis is a silent disease and often remains undiagnosed, even when a fracture has occurred, particularly if it is in the upper back. The good news however is that osteoporosis can be prevented, diagnosed and managed if action is taken early. Regular exercise, consuming enough bone-healthy nutrients, avoiding negative lifestyle habits, identifying your risk factors, having a non-invasive and pain-free bone density scan, and taking osteoporosis medication if prescribed, are key steps for prevention and treatment. Within our network of Reliance Health Clinics we have a number of Allied Health Professionals, such as dietitians, exercise physiologists, physiotherapists and chiropractors who can help you take those steps.

How can I check my bone density?

Riverside Medical Imaging, located within the Reliance GP Superclinic at West Gosford, conducts bone density scans— the gold-standard for measuring bone density and diagnosing osteopenia and osteoporosis. This simple scan measures the density and quality of your bones— usually at the hip and spine— and takes approximately 10-15 minutes. Ask your GP for a referral to Riverside Medical Imaging (RMI), then visit the RMI desk at the GP Super Clinic or call (02) 4323 9200 for an appointment.

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6 Tips to prevent Sports Injury

Missy Tysoe August 30, 2017

Safe Sport – How to prevent injury in 6 simple steps

Who doesn’t love sport! We do! Probably because of the endorphins (happy hormones) released in your brain from doing exercise – but we will save that for another day. Unfortunately, sport comes with the risk of injury.  The good news is, 50% of sports injuries are preventable – that’s half if you do the maths!

Sports injuries are caused by direct impact, or the overuse of, the body part than it is structurally “designed” to withstand. There are two types of sports injuries: acute and chronic. An injury that occurs suddenly, such as falling and spraining an ankle, is known as an acute injury. A chronic injury on the other hand, is caused over a longer term overuse of the muscle or joint.

The most common injuries are;

  • joint sprains— knee, ankle, shoulder and finger injuries
  • muscle strains—hamstring, calf, quadricep
  • tendon injuries—achilles, patella and gluteal tendon pain
  • bone overuse injuries—such as ‘shin splints’ or stress fractures (particularly in the lower limbs. The impact of repeated jumping or running on hard surfaces can eventually stress and crack bone
  • mild concussions – symptoms include dizziness, headache and memory loss

6 Steps to avoid sports injury

Most sports injuries are caused by shocking the body by not warming up before strenuous activity. Other causes of injury are the incorrect use of equipment and insufficient safety precautions. Competitive or professional athletes are most at risk as their intense training regimes can strain certain muscles through overuse.
It is difficult to prevent all injuries due to the unpredictable nature of sports but it is possible to take these steps and reduce your risk of an injury.


Warm Up

The warm-up is the most important and effective way to reduce injury because it gradually increases the blood flow to the muscles, which in turn increases flexibility and reduces the risk of strain.
A good warm-up session be at least 5-10 minutes long and involves gently stretching muscles or softly exercising (walking or jogging). It is best to start the warm-up slowly and build up gradually to a more brisk and energetic pace i.e. walking briefly before building up to a jog.
Once you’re warmed up, you can do some gentle stretches to lengthen the muscles and tendons. Pay particular attention to the muscles you will be using most during your sport or exercise (i.e. focus on legs for soccer, or focus on arms/shoulders/core and back for rowing. Most sports will incorporate many muscle groups).


Fuel your body with the right things

The body performs at its optimum level when it is hydrated, so drink plenty of water.
Once again, everyone is unique and you need to ensure you are getting what YOUR body needs. I keep a food diary of what I eat (I use an app called Myfitnesspal, which counts macros as well as micronutrients). I like to think of this as a fuel gage, like we have in the car, it helps me see what type of fuel sources might need topping up. On days where I am training strength and lifting heavy weights for example, I try and get as much magnesium as possible to help with muscle recovery. Magnesium can be found in dark leafy greens, nuts, seeds and fish. Many women are low in iron, and I find my iron levels fluctuate with my hormones – so on days where I am feeling light headed I will aim to eat food sources rich in iron – red meat, seafood, beans, and dark leafy greens. If I am preparing for a sprint training session, I will try and increase my Vitamin B intake for high energy levels – mostly found in animal products like meat, poultry and seafood. It is also available in supplement form.
Everyone is different and over time you will get to know what your body needs. Reliance offers dietary advice via our nutritionist, call 43 041 333 to see a GP and get a referral.


Use  protective equipment

Protective equipment is important to prevent injury and ranges for each sport – it might be the right helmet for biking, a mouth-guard for football, shin pads in hockey, boxing gloves or protective head gear, or even simply the right shoes for running. The correct shoes can offer support to the foot and ankle, helping to prevent twisting and injury.
Everybody has a unique bone structure, and in some cases (like my own) you may need to see a podiatrist or chiropractor to assess your posture, knees or feet and ensure you are wearing the right equipment, shoes or orthotic shoe inserts for your body. Allied health professionals are available at Reliance – call 43041 333 to see a GP and you can get a referral to our podiatrist, chiropractor, physiotherapist or x-ray services all under the one roof.
Protective head gear is obviously extremely important, as helmets protect the skull and the brain from damage. This is vital in contact sports where the head may be knocked and risk concussion or serious head injury.


Get your technique right

By practicing good form and technique you can reduce the risk of injury to muscles, tendons and bones. You should consult your coach, a PT or a physiotherapist to ensure you are using the right technique to get the most out of your body with the least risk of injury. This is also important in the gym, where incorrect form can lead to repetitive strain or injury. It also helps with the skill and ability to help you excel at what you’re doing.


Know your limits 

It’s important to listen to your body and know your physical limits. When first start something new like a new sport, your body may not be used to using or stretching the muscles required, so build up your pace slowly. If you are injured, give your body time to recover and seek medical advice as to when you can return – you will do your body more harm than good by training on an injury, and it may lead to long term irreversible damage.

Cool down

While warming up increases blood flow, cooling down helps eliminate waste products like lactic acid which can build up and cause pain after an intense game or work-out. After your game, spend at least 5-10 minutes walking (or another soft exercise) to return your heart rate to a normal pace. The cool-down also helps your blood flow return to normal and replace oxygen and nutrients. This is essential for muscle recovery.
After walking you also wish to do some gentle stretching exercises to lengthen the muscles and maintain your flexibility and agility (which is vital in some sports). This may also prevent muscles feeling stiff and bulky as they increase in strength and size.


Medical attention for any injury is vital – visit an emergency department for urgent matters, or for mild injuries come and see a doctor. At Reliance we have a range of allied health professionals available under the one roof at both our Wyong and West Gosford clinics with access to chiro, physio, podiatry, nurses and xrays. We also have the excellent GP Dr Fady Malak with a background in orthopedics, who specialises in sports injury and his consultations are fully bulk billed. Call 43041333 to book. 

Author: Melissa Tysoe


Reliance Health Staff & Medical Practioners

Australian Physiotherapy Association – Sports Injuries Retrieved 30 August from website

Sports Medicine Information How can I avoid a sports injury?  Retrieved 30 August from website

American Medical Society for Sports Medicine Overuse injuries, burnout in youth sports can have long-term effects (2014) Retrieved 30 August from website


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Tags: bone bursitis gym health injury joint muscle muscle tear prevention sports injury tendon tendonitis warmup workout

Gastro Outbreak – how to eat and treat

Missy Tysoe May 16, 2017

Gastro Outbreak – how to eat and treat

Update August 4 2017: Over 1900 cases reported to emergency departments in NSW. Read more here.

A local nursing home has been in lockdown after an outbreak of gastroenteritis on the Central Coast. Doctors at Reliance have treated an increased number of patients over the last two weeks, and provide some quick facts below to help you stay safe from the virus, and how to treat the virus.

Gastro is a virus that causes vomiting and diahhrea, and may lead to severe dehydration. Gastroenteritis can be caused by a number of different germs including:

  • viruses (for example norovirus, rotavirus, hepatitis A)
  • bacteria (for example Salmonella, Campylobacter, Shigella)
  • parasites (for example Giardia, Cryptosporidium)
  • Toxins (produced by bacteria, found in food etc)

Gastro should only last a few days and is usually treated by rest and keeping up fluids. It doesn’t usually require medication.


  • nausea and/or vomiting
  • diarrhoea, sometimes containing blood
  • stomach pain/cramps
  • fever
  • generally feeling unwell, including tiredness and body aches.


  • Drink plenty of clear fluids, for example juice diluted 1 part to 4 parts water, to prevent dehydration. Avoid undiluted fruit juice and soft drinks as they may increase dehydration and diarrhoea. Rehydration drinks that replace fluids and salts are available from chemists. Intravenous fluids may be needed in severe cases of dehydration.
  • Drink plenty of fluids such as plain water or oral rehydration drinks (available from pharmacies) to avoid dehydration. Dehydration is especially dangerous for babies and the elderly.
  • Avoid anti-vomiting or anti-diarrhoeal medications unless these are prescribed or recommended by a doctor. Probiotics can aid recovery of the gut. 

If you experience severe or prolonged symptoms you should visit a doctor, call 43041333 to book an appointment. Or book online through appointuit app It is advised to see a doctor if you suspect your baby has been infected, as small children are more suspectiple to dehydration and other complicvations resulting from the illness.


Gastro Outbreak – how to eat and treat

BRAT Diet – treating a stomach bug

While you have the infection

When you catch a bug that causes acute infectious gastroenteritis (gastro), your stomach and intestinal tract become inflamed, causing diarrhoea, nausea, vomiting, abdominal cramping and pain. This commonly reduces appetite and sufferers will not feel like eating. It is important to keep fluids up and slowly try to eat small meals to regain your energy. Reliance doctors recommend the BRAT diet, which stands for “bananas, rice, apple sauce and toast”. Bland foods  are typically recommended to avoid irritating the stomach. The banana and rice portions of this diet are higher in fibre, leading to more solid stools and a decrease in the frequency of diarrhoea


  • Start on a BRAT diet – bananas, rice, apple sauce and toast” and after 24 hours move to resume eating a normal diet with a mix of fruits, vegetables, meat, yogurt, and complex carbohydrates.
  • Drink plenty of water or electrolyte drinks (sports drinks)
  • Raw foods such as meats, poultry and eggs can contain bacteria that cause gastroenteritis. Keep raw foods separate from cooked and ready-to-eat foods (for example salads) to prevent cross-contamination. Store raw meat below ready-to-eat food in the refrigerator and use separate chopping boards and knives for raw and ready-to-eat foods.
  • Cook foods thoroughly to a temperature of 75 °C or until meat juices run clear and are not pink.
  • Keep cold food below 5 °C and hot food above 60 °C.
  • Avoid caffeine and alcohol for several days, as these can worsen dehydration.
  • Avoid preparing or handling food for other people until symptoms have resolved. If you must prepare or handle food, thoroughly wash your hands beforehand to reduce the risk of spreading the infection to others.


  • Wash and dry your hands thoroughly after going to the toilet.
  • Immediately remove and wash any clothes or bedding contaminated with vomit or diarrhoea using detergent and hot water.
  • After an episode of diarrhoea or vomiting, clean contaminated surfaces (for example benches, floors and toilets) immediately using detergent and hot water. Then disinfect surfaces using a bleach-based product diluted according to the manufacturer’s instructions.
  • Clean carpet or soft furnishings contaminated with diarrhoea or vomit immediately using detergent and hot water and then steam clean.
  • Wash and dry your hands thoroughly after changing nappies, going to the toilet, cleaning up vomit or diarrhoea, or handling animals, and before eating or drinking. If hand-washing facilities are not available use an alcohol-based gel.


  • Avoid contact with people who have gastroenteritis symptoms.
  • Do not go to work or school for at least 24 hours after symptoms have finished, or 48 hours if you work in or attend a high risk setting, such as health care, residential care or child care, or handle food as part of your job.

How gastroenteritis is spread?

You might get it from food, water or contact with an infected person (or contact with vomit/faeces). Infectious gastro can be easily spread.

Gastro is spread when germs come into contact with your mouth. This can be by:

  • drinking or eating something contaminated with germs or toxins
  • contact with an ill person, or microscopic amounts of faeces (poo) or vomit from an ill person. This may occur directly by close personal contact, or indirectly by touching contaminated surfaces such as taps, toilet flush buttons, toys or nappies. The germs then pass from your hands to your mouth
  • handling pets and other animals.

When people get gastroenteritis they often assume that the last meal they ate gave them food poisoning, but often it  symptoms usually begin 1 to 2 days after you have taken in the germ, depending on which type you have been infected with.

Gastroenteritis prevention

To reduce your risk of catching or spreading gastro, wash your hands well after using the bathroom or changing nappies, and before preparing or eating food.

If you have gastro, it’s best to stay home (away from work, school or childcare) until the symptoms have been gone for at least 24 hours.

See a doctor immediately if you experience;

  • gastro for more than 2-3 days,
  • dark urine, or trouble passing urine
  • light headedness,
  • or a temperature.

Call 43041333 to book an appointment. Or book online through appointuit app


NSW Health


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Tags: central coast diarrhoea doctor fever gastro outbreak stomach bug temperature tummy bug virus vomit vomiting

Asthma & Allergies – As spring peaks, so do allergens

Missy Tysoe September 12, 2016

Asthma & Allergies – As spring peaks, so do allergens

The beginning of spring welcomes warmer weather, but for many asthma sufferers it can also bring seasonal triggers associated with asthma attacks and hayfever. While the two are very different – patients who suffer from asthma are more likely to suffer from allergies. Here, we answer some common questions asked by our patients..

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What is Asthma?

Asthma is a disease that restricts the airways – the breathing tubes that carry air into our lungs.  Asthma is a disease that effects the airways – the breathing tubes that carry air into our lungs. Airways are sensitive most of the time but for people with asthma, the muscles can constrict or become inflamed, making it difficult to breathe. Symptoms include; wheezing – a continuous, high-pitched sound coming from the chest while breathing, coughing, tightness in the chest, and shortness of breath.

Asthma Quick Facts

  • Over 2 million Australians have asthma – that means around 1 in 10 people suffer asthma
  • Asthma and allergies are closely linked. Asthma is more common in people with allergies.
  • Adults of any age can develop asthma, even if they did not have asthma as a child.
  • Some people have asthma during childhood, but later have very few or no symptoms as adults.
  • Many preschool children who wheeze do not have asthma by primary school age.
  • Indoor and outdoor pollution (including moulds, gases, chemicals, particles and cigarette smoke) can increase the risk of developing asthma.
  • Athletes can develop asthma after very intensive training over several years, especially while breathing air that is polluted, cold or dry.

What is Hayfever? How is it different to the flu?

Hay fever (allergic rhinitis) is an allergic response to triggers such as pollen, dust, pets and other allergens. The body responds by producing histamines, resulting in cold and flu-like signs and symptoms, such as a runny nose, itchy eyes, congestion, sneezing and sinus pressure and headaches from the inflammation of sinus membranes. In prolonged cases, Hayfever can lead to middle ear infections.

However, unlike a cold, hay fever isn’t caused by a virus, it is not contagious and is remedied with different medication or treatment. You can usually tell the difference by the colour of your mucus – hayfever mucous is generally clear whereas flu mucus can be yellow or green and signals an infection. Hayfever is usually an immediate reaction, wheras a flu will take 3 or more days to develop.

Why does Spring trigger asthma?

Pollen: For asthma and allergy sufferers, the onset of spring brings allergens – the biggest one being pollen. Pollen is a potent allergen found in plants that can travel through the air and inflame airways – triggering asthma attacks and hay-fever.

Pet Dander: As pets shed their winter coats this can leave pet dander (shed skin, feathers of fur) which can trigger asthma and allergies. This can also create more dust – another major trigger of asthma attacks or hayfever.

Dust: Dust mites may increase from dander from pets can occur year-round (perennial). Symptoms to indoor allergens might worsen in winter, when houses are closed up.

Fungi: Spoors from indoor and outdoor fungi and molds

Weather: The change in weather and higher humidity is the main reason for more pollen in the air, but it can also mean we are outdoors more and so more exposed to outdoor allergens. At the warmer end of spring we may start getting thunderstorms – the gusty winds that accompany thunderstorms stir up mold and fungal spores, and pollen.

Prevention and Treatment:

Nasal sprays, decongestants and antihistamines can reduce the symptoms of hayfever. Ventolin and inhalers are used to treat asthma, but in both cases, it is important to see your Doctor before using medication as you will need to ensure it is not a misdiagnoses of the flu, asthma, allergies or an underlying intolerance to something in your diet or lifestyle.

Here are some steps you can take to reduce the triggers:

  1. Try to stay indoors whenever the pollen count is very high. The counts usually peak in the mornings and in wind. Some weather forecasts will indicate the pollen count for the day.
  2. Clean the air filters in your home often. Also, clean bookshelves, vents, and other places where pollen or dust can collect. Those who are prone to attacks should vacuum around twice a week in peak seasons.
  3. Wash your hairafter going outside, as allergen can collect there.
  4. Brush you pets regularly (or have a groomer brush them) so they do not build up shedding skin or fur.
  5. Household items like air purifiers and damp-rid can assist in keeping airborne triggers at bay.
  6. Additional triggers include: some aspirin medications, some blood pressure medications, cigarette smoke, and crying. In some cases asthma may be triggered by vigorous exercise, but can be avoided by warming up.

An asthma flare-up can become serious if not treated properly, even in someone whose asthma is usually mild or well controlled. A severe flare-up needs urgent treatment by a doctor or hospital emergency department.

If you are experiencing any of the above symptoms please see a doctor 43 041 333.

Sources: The mayo clinic organisation, Asthma foundation

Author: Melissa Tysoe | Stakeholder Engagement & Marketing Officer | Reliance Health

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Tags: allergens allergies asthma australian children doctor flu hayfever kids medical puffer spring

R U OK? 4 Symptoms of Depression

Missy Tysoe September 8, 2016

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Today marks the annual R U OK Day – an initiative to start conversations around the country, to encourage people to speak out about depression and mental illness. If you are suffering from depression, it’s ok to tell your doctor – we are here to help. Our Doctors here at Reliance are experienced in dealing with mental health, and there are mental health plans available, including bulk billed options of money is an issue. Call 43 041 333 to take the step and talk to a doctor today, or book online

Sometimes, the hardest part is telling someone – that’s why we are encouraging aussies to take the first step and ask the people around them, R U OK?
Perhaps you’re doing just fine and it’s someone else you’re worried about. Here are some simple signs and symptoms to look out for.
1. Changes in their physical appearance. Looking tired or ill, constantly feeling run-down. Eating more or less than usual, drinking excessively, or having difficulty up keeping their normal hygiene (not showering regularly, sleeping a lot).
2. Changes in mood. Seeming snappy, agitated, anxious or worried. Losing interest or ability to perform tasks they previously enjoyed or managed.
3. Changes in behaviour. Being withdrawn, cancelling plans, avoiding social contact, seeming distracted or “too busy” with other tasks to attend social events.
4. Changes in expression. While some people may mask their struggle by making excuses or appearing to act happy, there may be subtle signs that they are suffering. This may include; being sensitive and taking things personally, negative expressions, criticising their self or their work, and mention of over-thinking, or difficulties sleeping.

If you have noticed two or more of these things in a friend, family or colleague, it’s time to start the conversation. Spread the word and forward this link on to those you care about. It could be the little bit of encouragement they need to start a life-changing conversation.

For more information and resources, go to

If you or someone you care about is suffering from depression,  call 43 041 333 and talk to a doctor today, or book online


Author: Melissa Tysoe | Stakeholder Engagement & Marketing Officer | Reliance Health


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