Enrolling little one for PREP - they want immunisation certificate, action plans for asthma...

[LadyCroft]

We have literally just moved into our long term rental having been in a holiday rental since we arrived last month. It has been hectic.

 

I have just got to the stage where we have only just decided to settle down in this area for 12 months to start and we have been to see the local schools and enrolled in the closest one as I don't have a car.

 

The school have told us we need to get our little one's UK immunisation record transferred to an Australia Immunisation Certificate which I have been told can be done by the nurse at the GP office. We have had no need to visit a GP as yet so off I went to the nearest one that had an appointment today and does "Bulk Billing" as I was told this is what you should do when you have a Medicare card as they just claim the money back directly themselves.

 

Anyway, we waited for 1 hour to be seen (having made an appointment) and when we were seen we didn't get any prescriptions but an Asthma Action Plan and a whole list of follow up appointments with physio, dietician and a potential referral to an allergy clinic miles away if I want any medication to be prescribed for my little one's egg allergy.

 

My head is spinning. I was told I don't pay for any of the Asthma related stuff as it is covered but I am not sure what is happening with the food allergy referral. I don't think the GP could really understand me so I showed him copies of our UK repeat prescriptions and the red book of immunisations to try and explain what I was banging on about (I am Scottish which seems to be hard to understand sometimes) so I asked a few times in a few different ways so I could understand what was happening but I still feel lost.

 

Apparently over here the school need an Asthma Action Plan which involves a full, ongoing treatment of the childs asthma including help with teaching him to breath properly, eat well and returning for updates with the nurse/GP to manage the asthma. All of this is covered by the clinic visa bulk billing. Sounds amazing as this did not happen in our old UK GP surgery.

 

The main issue is that the GP could not prescribe anything for the egg allergy and just told me to tell the school not to give him egg. I was saying he needs medication (anti histamines) if he is accidentally exposed to egg (say he accidentally tasted something with mayo or ate someone's ice cream that was made with egg or anything like that - these things happen in school when they KNOW not to share food but someone else has something that looks yummy) but he just kept saying "Well he can take Clarytin if he wants" but he is only 5. THe only way for them to prescribe is apparently if he needs an Epipen and then they can do an Anaphylaxis plan of some sort.

 

I am now facing starting again with his allergy to egg and asthma treatment that took ages to sort origin\lly in Scotland.

 

Is this usual? I mean is this the usual plan of action?

 

I also still need to go see the nurse to have the immunisation record officially changed over from the red book to the Australian immunisation record.

 

My head is spinning now - it just seems to be one thing after another but if this is the way things have to be done then great but I just didn't realise what we were in for.

 

THanks for any advice on this.

[rosiew]

In Australia you usually buy anti histamines over the counter at the chemist. We do not get such a wide range of things on prescription - often only things that can only prescribed by a doctor. As your little one's allergy is not life threatening (by the sound of it, sorry if it is) then the doctor won't be involved - and Claratyne comes in child strength.

 

Go and have a chat to the pharmacist at your local pharmacy. You will pay retail. That is I suspect what the doctor was trying to explain to you.

[Jurls]

Hi Ladycroft,

 

I will PM you, I work for one of the Asthma Foundations so I can advise you what is recommended by us as best practice. Best practice is for everyone to have an asthma action plan. Certainly schools require this, they require plans for all medical conditions so they have instructions on what medication is required and how often etc. Same with allergies.

 

With the immunisation record, I actually rang the immunisation line direct and sent them copies of the info and they transferred ours. Didn't have to go through a Dr at all. That was a few years ago though, don't know if they still do it.

[KazzE]

Where are you? Maybe someone could recommend a good clinic. The one I use has most things on site including pathology, specialist nurses etc

 

Yes this is all normal and all designed to ensure the school are well informed about your child's health and how to manage any medical conditions.

 

Aussies do seem to find it hard to understand a Scottish accent I don't know why but they do. Was the Doctors first language English?

 

could you go back and see another Doctor and maybe write out exactly what it is that you need?

maybe go to a different bulk bill clinic?

 

it probably will not take that long to get sorted out but it is coming up to Xmas so I would try and at least get appointments booked in and it should all be done before he starts school.

 

hope you get it all sorted out soon.

[Jurls]

In Australia you usually buy anti histamines over the counter at the chemist. We do not get such a wide range of things on prescription - often only things that can only prescribed by a doctor. As your little one's allergy is not life threatening (by the sound of it, sorry if it is) then the doctor won't be involved - and Claratyne comes in child strength.

 

Go and have a chat to the pharmacist at your local pharmacy. You will pay retail. That is I suspect what the doctor was trying to explain to you.

 

 

Although this is true, Schools don't like medical conditions and giving medicine without written instruction. In a case of mild allergy, there is an Allergy Action Plan available on the ASCIA site and best practice would be to ask the GP to complete this. Explain to GP that the school have asked for it to meet their policies. The Allergy Plan will name the antihistamine so then the school will be happy as they have written instruction to go with the medication.

http://www.allergy.org.au/images/stories/anaphylaxis/2013/ASCIA_Action_Plan_Allergic_Reactions_2013.pdf

[LadyCroft]

Thanks for the replies. Sorry my post was a bit of a rant but we are not long back from the appointment and it is still annoying me that I felt I wasn't really listened to or understood. No, the GP's 1st language was not English but I think the problem was that I don't understand why he can't prescribe me an antihistamine when I clearly told him the school will NOT administer anything that is not clearly labelled by the doctor with a label and has an action plan from the GP.

 

I am going to print off that green form, thanks, and take it to a different clinic so I can ask them directly to complete it stating that the school have asked for it to be done this way.

 

Thanks for the help. I feel a little bit better now.

[nic1171]

Speak with the nurse direct and they will update your vaccination history to include what extras are needed such as hep b

[Incata]

Buy Liquid Phenergan for the allergy. It is available over the counter and is the equivalent of liquid piriton. My son is an anaphylactic and it is the first thing we give him when he has a reaction. We have asked UK friends and relatives who are coming over to bring a bottle of liquid piriton with them as we find it does not make him sleepy after we give it to him, which makes it easier to assess the development (or otherwise) of the reaction. We give him anywhere between 50 - 100% of the maximum recommended daily dose for his age and weight, depending on how bad the reaction is. We only use the epipen if his airway starts to be compromised. This is what we were told to do by our UK specialist.

 

However, Australia is very backward when it comes to dealing with allergies. They do not (in WA at least), have specialist paediatric allergists. They just have normal allergists who have little, if any, understanding of the difference between adult and child allergy. In terms of treatment, they go straight for the epi-pen, which due to its effect on the heart, is much more high risk than starting with an anti-histamine and waiting to see if that reverses the reaction. The Australian medical profession even think it is strange to use an anti-histamine (even though it is histamine that is causing the problem). I have had to explain this to both an Australian trained doctor and an Australian allergist, who both conceded that actually it made a lot of sense, but is not the way they are trained.

 

The way the referral will happen is this: You will be referred to a specialist who will tell you that he does not believe your child has an allergy unless he has seen the reaction himself, even if you have all the paperwork evidencing it from the UK. He would therefore like to retest your child, at huge expense to you, and huge profit to himself. The money is only partially refunded by medicare, leaving you severely out of pocket.

 

When this happened to us, I looked the specialist in the eye and told him very quietly that I had paperwork from the top paediatric allergist in the UK, confirming that my son had the allergy I stated he had, and that the UK specialist himself had conducted a food challenge test and witnessed the reaction my son had. I then told the specialist that if he wanted to retest my son, then I expected it to happen in a fully equipped hospital department, with resus equipment on hand (and not just in his office, which he seemed to think was appropriate). I then told him that he had better have a damn good lawyer as I would be suing him for negligence the minute my son reacted. I pointed out that as my UK specialist was more highly qualified than he is, that he would not have a leg to stand on and it would cost him an awful lot of money. The doctor looked stunned as apparently over here it is not the done thing to stand up to doctors and give them what for.

 

I then asked him if he had any questions. He did not and then meekly stated that he did not think that after all, it was necessary to re-test my son, that he would do the prescription for an epipen and sign the appropriate anaphylaxsis action plan.

 

We still got dinged $175 for the consultation, but at least it was not the $400 - $500 they originally wanted to do the skin prick tests (which my son does not react to - he only reacts if he actually eats the product).

 

In addition, you need to be aware, that to get epi-pens on medicare (where you get to pay approx $33 (can't remember the exact amount), rather than the $100 they normally cost (over the counter), you have to have the original prescription written by an allergy/immunology specialist (and they don't consider UK specialists count).

 

We now have UK trained doctors treating me and my family as we have found their standards and knowledge to be higher than their Australian equivalents. We have also found that UK doctors treat us and equals and will discuss options with us and don't expect to be treated as Gods. We have an absolutely excellent GP now who I cannot speak highly enough of. I have nothing but the highest respect for the UK doctors and specialists we have used, but little other than contempt for the Australian ones we have experienced. I would point out that we have only seen UK and Australian doctors, so I have no experience of doctors of other nationalities.

[Jurls]

Here it is generally recommended to use a second generation antihistamine (claratyne, zyrtec etc) to minimise risk of drowsiness. They don't advise using first generation antihistamines (phenargen etc) because of drowsiness potentially masking reactions.

 

Sorry to hear you've had such a battle. Your experience in WA has not been the same as mine in ACT. We had a reaction, saw a GP who did a basic RAST test and then referred us to an immunologist at the hospital. All of the testing we've had and clinics we go to are bulk billed. I've found it fairly straightforward and it's more about risk management with the schools I think although schools management seem to vary.

 

There's a Facebook group called Anaphylaxis and Allergy Friends Australia which is quite supportive in recommending immunologists etc

 

 

ETA - just rereading your post....we treat allergies with antihistamine, the epipen is for anaphylaxis. We carry an epipen for one identified food and antihistamines to a number of other identified foods. I wouldn't use an epipen for an allergic reaction but once the airways are closing and we're looking at anaphylaxis I certainly would use it and wouldn't be mucking around with antihistamines. Our referral to a specialist was due to the severity of my son's first reaction in conjunction with the RAST. I think they only refer severe reactions here, otherwise it is managed by the GP, parent and antihistamines along with a green allergy action plan for school. Which is why ASCIA have two plans, one for allergy and one for anaphylaxis. That's been my experience anyway and sounds more in line with your UK experience?

[Petals]

We have literally just moved into our long term rental having been in a holiday rental since we arrived last month. It has been hectic.

 

I have just got to the stage where we have only just decided to settle down in this area for 12 months to start and we have been to see the local schools and enrolled in the closest one as I don't have a car.

 

The school have told us we need to get our little one's UK immunisation record transferred to an Australia Immunisation Certificate which I have been told can be done by the nurse at the GP office. We have had no need to visit a GP as yet so off I went to the nearest one that had an appointment today and does "Bulk Billing" as I was told this is what you should do when you have a Medicare card as they just claim the money back directly themselves.

 

Anyway, we waited for 1 hour to be seen (having made an appointment) and when we were seen we didn't get any prescriptions but an Asthma Action Plan and a whole list of follow up appointments with physio, dietician and a potential referral to an allergy clinic miles away if I want any medication to be prescribed for my little one's egg allergy.

 

My head is spinning. I was told I don't pay for any of the Asthma related stuff as it is covered but I am not sure what is happening with the food allergy referral. I don't think the GP could really understand me so I showed him copies of our UK repeat prescriptions and the red book of immunisations to try and explain what I was banging on about (I am Scottish which seems to be hard to understand sometimes) so I asked a few times in a few different ways so I could understand what was happening but I still feel lost.

 

Apparently over here the school need an Asthma Action Plan which involves a full, ongoing treatment of the childs asthma including help with teaching him to breath properly, eat well and returning for updates with the nurse/GP to manage the asthma. All of this is covered by the clinic visa bulk billing. Sounds amazing as this did not happen in our old UK GP surgery.

 

The main issue is that the GP could not prescribe anything for the egg allergy and just told me to tell the school not to give him egg. I was saying he needs medication (anti histamines) if he is accidentally exposed to egg (say he accidentally tasted something with mayo or ate someone's ice cream that was made with egg or anything like that - these things happen in school when they KNOW not to share food but someone else has something that looks yummy) but he just kept saying "Well he can take Clarytin if he wants" but he is only 5. THe only way for them to prescribe is apparently if he needs an Epipen and then they can do an Anaphylaxis plan of some sort.

 

I am now facing starting again with his allergy to egg and asthma treatment that took ages to sort origin\lly in Scotland.

 

Is this usual? I mean is this the usual plan of action?

 

I also still need to go see the nurse to have the immunisation record officially changed over from the red book to the Australian immunisation record.

 

My head is spinning now - it just seems to be one thing after another but if this is the way things have to be done then great but I just didn't realise what we were in for.

 

THanks for any advice on this.

 

Its quite normal for a new doctor to do all the checks etc and I have never heard of taking antihistamines just in case. Epipen yes for those with serious allergies. I am allergic to mould which is everywhere and I have not been prescribed anything for my allergy just to treat my asthma when it occurs.

 

If you are not happy with the doc you can always seek out another.

 

I do not go to a bulk billing practice as I like to see the same doc all the time.

 

As for tests for allergies they are done at Frankston hospital, that is where I went and also if they need any more intensive tests then you have to go up to one of the city hospitals. I did not have to pay for my tests.

[LadyCroft]

Thanks for the advice. I appreciate it. We have been referred to a private allergy Dr and it would cost a lot of money to go to him to get tests done etc when all we need is permission to give him his antihistamines at school. It may not even be the case that he will be exposed to egg at the school as they have advised that no one is permitted to hand out cake any more as it contains egg/traces of nuts and they don't allow old egg cartons to be brought in for arts and crafts any more. That is way more than they ever did at his UK nursery.

 

Anyway, we are going to take him to a different GP having phoned around a few and have found one that charges but then you claim it back from Medicare but they seem happy to help with the forms as they have to do them for school children with allergies/asthma fairly often. I think there must be quite a few UK families in this area who have had to get their medication confirmed for the school.

 

Feeling much better now that I know how things work a bit better thanks to you all.

 

A special thanks for the green allergy form. THat is exactly what we needed.

[fairystar32]

I brought my letter from my regular UK doctor stating I neded an epi pen, it was accepted and I have never had an issue getting one, every year for the last 4 yrs.

They do have to ring up and get a code.

t.

 

 

 

 

 

 

In addition, you need to be aware, that to get epi-pens on medicare (where you get to pay approx $33 (can't remember the exact amount), rather than the $100 they normally cost (over the counter), you have to have the original prescription written by an allergy/immunology specialist (and they don't consider UK specialists count).

 

 

[Incata]

I brought my letter from my regular UK doctor stating I neded an epi pen, it was accepted and I have never had an issue getting one, every year for the last 4 yrs.

They do have to ring up and get a code.

 

You are very lucky. The first GP we used tried that and it was not allowed so we (my son and I as we are both anaphylactics) had to be referred to specialists for the original prescription. Once we had that our GP was/is allowed to prescribe epipens if ours have either expired or been used.