Dr Annie Marshall
Dr Marshall graduated from the University of Sydney with Honours in 2004, and after her basic hospital training did a 6 month residency in Obstetrics and Gynaecology, during which time she attained her Diploma with the Royal Australia and New Zealand College of Obstetrics and Gynaecology. Dr Marshall then moved to rural Western Australia where she undertook her General Practice training at a very busy rural practice, which included on-call obstetrics and hospital cover. During this time she completed a Diploma of Child Health through Princess Margret Hospital. She returned home to Sydney in 2010 and has continued working in General Practice while juggling life with three small children.
Dr Marshall is affiliated with the Royal Hospital for Women and RPA for the provision of antenatal shared care. While she has a keen interest in Women's Health and Paediatrics, she enjoys the diversity that general practice provides. Dr Marshall is experienced in inserting contraceptive devices including Mirena and Implanon.
What causes abdominal bloating?
Contrary to what many people believe, bloating is not necessarily due to too much gas in the stomach. Researchers have performed studies on patients who feel bloated using CT scans, and shown that they often do not have any more gas in the belly than people who have no symptoms. Excessive gas production probably plays a part, but does not explain the whole picture.
So if too much gas isn’t the main cause of bloating, then what is?
There are several different factors which may play a role:
- Too much water or liquid travelling into the small intestine. Certain food contents drag liquid into the intestines, which has been shown to cause the sensation of bloating
- Constipation and backed up stool in the colon (faecal impaction) can cause the sensation of bloating
- “Sluggish bowel,” or poor motility of the bowel – where the bowel pushes gas through very slowly
- Altered function of the diaphragm – the diaphragm is the big muscle between the chest and abdomen that moves up and down when you breathe. When you eat and drink, this muscle should relax and move upwards to make more space in your abdomen. Studies have shown that in people who bloat, the diaphragm incorrectly moves downwards, causing the belly to protrude.
Change your diet to reduce bloating
- Avoid fizzy drinks
- Some fibre supplements may help, but need to be chosen carefully. Fibres that undergo a lot of fermentation by gut bacteria can make bloating worse (e.g. whole wheat bran). The best are non-fermentable fibres such as sterculia (Normafibe)
- Trial cutting out dairy and/or gluten for one month, as conditions such as lactose intolerance and gluten sensitivity are very common causes of bloating in Australia. If you don’t feel better after one month, then reintroduce them into the diet.
- Trial a low-FODMAPs diet under guidance of a dietitian – this is a diet developed in Australia and now used all over the world for treatment of bloating. Foods high in FODMAPs increase the amount of fluid in the bowels, which in some people can lead to bloating and swelling of the abdomen. Through a process of elimination and reintroduction, the dietitian can assist you in finding out which ‘high-FODMAPs’ foods are the most problematic for you
Natural remedies that help with bloating
- Iberogast is a herbal supplement that has been shown in clinical studies to be helpful for bloating and other gut symptoms in irritable bowel syndrome. You can find it at most pharmacies.
- Kiwifruit has recently been shown to be beneficial for helping gut motility (ability of the bowel to contract and propel digestive contents). If you don’t like the fruit, you can take kiwifruit extracts instead!
Other strategies to help you with bloating
If you also have constipation, try taking regular sterculia fibre or laxatives that you find over the counter from the chemist. Usually, getting rid of the constipation helps the bloating too.
When to seek further advice or support
See your GP or gastroenterologist if your bloating is not improving with the above measures. You should also see your doctor if you have other symptoms along with your bloating such as unintentional weight loss, vomiting, being woken up at night to open the bowels or due to pain, or a change in bowel habits. These may be indicative of an underlying disorder rather than just ‘simple’ bloating.
Your doctor can perform a physical examination and may order further investigations such as blood tests, x-rays, stool specimens, or gastroscopy and colonoscopy. Your doctor may recommend other medical treatments for bloating such as prokinetics (medicines that stimulate the contraction of the gut and propulsion of gas and other contents) and medicines that change the composition of the gut microbiome in favour of more “good bacteria”.
We are pleased to advise that Rozelle Total Health has been approved to deliver COVID vaccinations to our community. The rollout will be staged as per the Dept of Health and we will be starting with the phase 1b.
Please note - We have not yet received any vaccination stock!
We are busy planning how best to deliver the vaccine to you safely and quickly so please do not phone us at this stage regarding vaccination. We will notify you as soon as we are ready to take bookings.
If you wish to discuss your personal circumstances, or need help deciding what is right for you, we recommend booking an appointment with your GP.
RTH is keeping a close eye on the upcoming release of a COVID vaccine. The indications are that approval of a vaccine is fast approaching and will start to become available in the first half of 2021.
The release of the vaccine will be completed in stages. The most vulnerable people will be vaccinated first. There will be guidelines which we will have to comply with. We continue to wait for further information from NSW Health.To receive updated information make sure you like us on Facebook. Please also share this message with anyone you know who might benefit from the information.Thank you for continuing to help stop the spread
Dr Santosh Sanagapalli is a local Rozelle husband and father, consultant Gastroenterologist, and specialist in diagnostic and therapeutic endoscopy. He enjoys providing holistic, empathetic and comprehensive care to patients with a wide variety of problems affecting the gastrointestinal tract. He has a particular focus on high quality endoscopy, reflux and disorders affecting swallowing, and the role of dietary therapies in managing digestive health. He prioritises good communication with his patients.
After graduating from UNSW, Santosh completed his training in internal medicine and gastroenterology at St Vincent’s and Concord Hospitals in Sydney. He undertook further sub specialised training in swallowing disorders at University College London Hospital, one of London’s largest and most prestigious referral hospitals. Upon his return to Sydney he was appointed staff specialist at St Vincent’s Hospital where he leads the oesophageal disorders service.
He performs endoscopic procedures (gastroscopy and colonoscopy) across the St Vincent’s Healthcare campus in Darlinghurst (both private and public) and at the Alexandria Specialist Day Hospital.
Government changes to MBS funding for telehealth came into effect on 1 October 2020.
Rozelle Total Health continues to offer care to our patients both face to face and via telehealth. We are pleased to offer this choice so patients may elect to access care in the mode that best suits their circumstances. There are some clinical settings where a face to face appointment may be required to complete the assessment. There may also be circumstances where we request you do not attend a face to face appointment (eg you or your GP may be infectious) and you will be offered a telehealth consult.
We are pleased to advise that medicare rebates remain available for telehealth consultations provided the patient has been seen in person at the practice at least once in the preceding 12 months. Private fees are applicable to all consultation and we are not able to offer routine bulk billing. The government requirement to bulk bill certain patients due to COVID has been removed and the payments to GPs for doing so have ceased.
We are a privately billing practice and the fees remain the same for both face to face and telehealth consultations. Payment is required on the day of service. Where you start with a telehealth consult but are required to attend for a face to face review on the same day - you will only be charged once.
If you have any questions or concerns please get in touch with our service team.
Rozelle Total Health
BIG CHANGES to prescriptions are taking effect in the coming weeks. Scripts will be delivered by ‘token’ to your email or mobile phone! Please make sure we have your TOTALLY up to date details here:
Charlotte is a local Mum who is focused on building long term, holistic relationships with her patients.
She always leads with kindness, is caring by nature and likes to ensure the best possible overall health and wellbeing outcomes for her patients.
Along with her experience in general practice Charlotte has an interest in Women’s health (including antenatal shared care, contraception and Implanon insertion), paediatrics and dermatology (including skin checks and excisions). She has experience administering iron infusions.
Charlotte has a Bachelor of Medical Science, Bachelor of Medicine and Surgery and is a fellow of the Royal College of General Practitioners
At Rozelle Total Health we are working very hard to ensure we can continue to look after our patients in the face of COVID19.
The situation is rapidly evolving and recommendations are changing on a daily basis. We will do our best to keep you informed based on the information we receive through the trusted channels available to us.
Our commitment to you:
RTH will strive to meet the health needs of our patients and the community, whilst respecting the importance of public health recommendations and also keeping our team safe and functioning. We believe the best way to navigate this challenging situation is to work together. We will continue to innovate and find new ways to work with you.
We ask for your patience at this very busy time.
We have been inundated with patients requesting COVID19 screening swabs. We unable to offer routine swabbing at the practice.
The most common symptoms of coronavirus are fever, sore throat, dry cough and fatigue. Other symptoms can also include headaches, nasal congestion or a runny nose. Diarrhea and nausea have also been reported as symptoms but they are less common.
Patients who have symptoms and have recently traveled overseas, or have been in contact with a known case should call 1800 020 080 who may refer appropriate cases to a local COVID-19 testing clinic (nearest to our practice is RPA). Please note this is for patients who meet the criteria of a confirmed or suspected case.
If you have these symptoms and do not meet the case definition for COVID; have not travelled or had a known contact and are otherwise well and do not need emergency care –we recommend you stay home and rest as you would with seasonal flu.
If you feel you need to consult your GP please call the reception team who will discuss how we can best care for you.
Finally - we are unable to swab patients simply because it has been requested by their workplace. This is not appropriate as per Public Health guidelines and can be falsely reassuring. If you are unwell you should not attend work. If you fit the case definition of COVID risk – you should attend the RPA clinic as above.
For advice about corona virus please call 1800 020 080. In an Emergency please dial 000 and request an ambulance.
Disclaimer: This advice is general and does not constitute personal medical advice.
Brett is a warm, empathetic and committed Senior Psychologist with over 20 years’ experience specialising in anxiety, depression, adjustment issues such as major life changes and complex trauma.
Brett utilises an individualised approach to support his clients which looks holistically at factors such as sleep, diet and stress. He works across a broad range of evidence-based modalities including Cognitive Behaviour Therapy, Schema Therapy, DBT and ACT to help clients with their individual presentations. Brett has extensive experience working in both short and long term evidence based psychological interventions.
Brett’s passion for helping individuals and families is evident through his time as a Trauma Counsellor for Medecines Sans Frontieres (Doctors without Borders), a role in which he provided individual and family therapy to traumatised adults and children.
Please phone 02 9252 1000 to book an appointment.