Searching for a Crohn's Doc in Melbourne, Australia

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MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 12:53 AM (GMT -7)   
Hi all,

I may be moving to Melbourne, Australia within the next year, and will need to find an excellent gastroenterologist in the area. Any Aussies out there have recommendations? Thanks!

Michael

ivy6
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Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 1:18 AM (GMT -7)   
Where do you live now, Michael?

You can't just self-refer to see a specialist here. You'll need to get a referral from a local g.p. or another local specialist.

I recommend you ask your current gastro (if you trust him / her) to recommend a doctor for you, because it would be beneficial for your care if your own doctors were friends and could communicate easily between themselves. Failing that, I suggest you make an appointment with your local gp as soon as you arrive in Australia (bearing in mind that, depending on what area you live in, it can take a while to get a gp appointment if you're new to the area) and try to get yourself referred to one of the senior gastros at the MAJOR teaching hospitals: in other words, not a shonky suburban hospital, but one that is affiliated with one of the major medical schools, such as University of Melbourne or Monash University.

Deakin has a medical school too, but it's new and not as well established, so I'd stick with Melb or Monash if I were you.

All the best,

Ivy.
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Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


ivy6
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Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 1:42 AM (GMT -7)   
ps. Re not being able to self-refer; at least, that's how it is for local public patients. It might be different for you, as I assume you'll have international citizenship and international health insurance?

I believe that some countries have reciprocal health care arrangements with Australia, especially if those countries have universal health care - ie we take care of their tourists on our NHS if they take care of ours on their NHS - so you might like to ask the Australian Embassy / High Commission and your insurance agent exactly what arrangements you'll need to make for your health care here.
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Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


ivy6
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Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 1:45 AM (GMT -7)   
Oh! And once you know that information, it might be a good idea to tell us what medications you're on, because there's no guarantee you'll be able to keep taking them if you end up being able to access subsidised medicine through our NHS.

I'm thinking, especially, of things like Remicade and Humira, which are highly regulated... and Cimzia which, as far as I know, hasn't made it onto the subsidised list here. I don't even think it has been properly approved for use in Crohn's patients here yet.
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Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 12:44 PM (GMT -7)   
Thanks so much for the helpful info!

Currently, I am taking Imuran and Entocort. My Dr. wants me to go on Remicade/Humira soon. I want to make sure I will be able to continue the drug, if I decide to go on it, in Australia. From the sounds of it, it seems that there is no guarantee??

Thanks

Michael

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 1:06 PM (GMT -7)   
Well, I'm glad you talked to us. It's good that you're doing your research before you commit to moving.

Imuran is on the subsidised list here, but you need to know that Entocort ISN'T. Chances are you may need to move over to Pred, unless you have a kindly insurance scheme, or stumble across a doctor who is able to convince the local hospital to give it to you for free. You'd need to be in a big, well-funded hospital for this, as well as lucky, and would need good reason to be on Entocort instead of Pred; e.g. dramatically reduced bone mass.

Rem / Humira will be tricky. If you were a public, local patient, you'd need to be on Imuran for at least three months, and still have a CDAI of at least 300, as well as a lot of other clinical documentation. I don't know what the procedures are for international residents, especially if they've started the anti-TNFs overseas before coming to Aus. We tend not to start treatment with these highly expensive drugs in Australia; we tend to start on pred and immunosuppressants, and only graduate up to the anti-TNFs if we're unresponsive to those older and cheaper therapies.

I think that this is something you'll need to discuss thoroughly with your doctor, Embassy and insurance company. Whatever they tell you, make them COMMIT and put it in writing, as you don't want to start Rem and lose access to it once you move here, and then end up reacting to it when you do go home and restart it.

I.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 1:23 PM (GMT -7)   
In terms of insurance, I am definitely going to go 'private.' Can you perhaps recommend a "good" private insurance company, that plays nice with crohn's patients? :)

I have been on Imuran for a while now, and over the last few months, having inflammation issues. The Entocort is helping a lot, but is not a drug I want to be on long term.

...by the way, I live in Los Angeles now....safe to assume that you live in Melbourne?

Thanks.

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 1:28 PM (GMT -7)   
No, I don't live in Melbourne. I'm reasonably familiar with the city, though.

I can't recommend a good private insurance company for you, sorry. I'm in the public system and am happy there, and have no reason to cross over.

The privately insured are in the minority here.

Definitely do that research. I'd hate for you to get over here, and get sick because you'd had to change your treatment.

btw, are you planning to become an Aust citizen, or are you just going to be visiting?

I.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 3:01 PM (GMT -7)   
I will be marrying a Melbournian before the move! :)

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 3:05 PM (GMT -7)   
Congratulations!!!

So is that "yes" on the citizenship?
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 3:08 PM (GMT -7)   
Yes, though, I haven't done much research yet in regards to the citizenship process.

MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 9:47 PM (GMT -7)   
Hi Ivy,

Imuran is on the subsidised list here, but you need to know that Entocort ISN'T. Chances are you may need to move over to Pred, unless you have a kindly insurance scheme, or stumble across a doctor who is able to convince the local hospital to give it to you for free. You'd need to be in a big, well-funded hospital for this, as well as lucky, and would need good reason to be on Entocort instead of Pred; e.g. dramatically reduced bone mass. Rem / Humira will be tricky. If you were a public, local patient, you'd need to be on Imuran for at least three months, and still have a CDAI of at least 300, as well as a lot of other clinical documentation. I don't know what the procedures are for international residents, especially if they've started the anti-TNFs overseas before coming to Aus. We tend not to start treatment with these highly expensive drugs in Australia; we tend to start on pred and immunosuppressants, and only graduate up to the anti-TNFs if we're unresponsive to those older and cheaper therapies. said...
/quote]

So, if I provide proper clinical documentation to a gastro in Melb from my current doc, would that be sufficient to receive Entocort or Remicade? Even if I have to pay full price for it?? Would you know perhaps know anyone that is currently on Remicade in Victoria that I could contact?

Thanks!

Michael

Post Edited (MichaelR) : 12/8/2009 9:52:49 PM (GMT-7)


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 10:13 PM (GMT -7)   
Entocort - I doubt it. As I said, it's $300 a bottle and the doctors would have to have good reason (and excess money in their budget - v unusual here) to give it to you, especially if you didn't have a very good reason, like imminent osteoporosis.

Rem - again, you'd need to go through the qualifications process, and you would need to discuss this with your insurance company, here and in Australia.

Contacting someone who is on Rem in Victoria wouldn't make any difference. Take my word for it: it is complicated, highly regulated, and tricky. This is a question that will need to be answered by doctors and bureaucrats, not by fellow patients.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 10:32 PM (GMT -7)   
I appreciate your response. Thanks.

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 10:43 PM (GMT -7)   
Some fun reading to get you started: The rules for prescribing subsidised Rem.

http://www.health.vic.gov.au/hsdp/infliximab_crohns.pdf

I think they're less stringent if you're willing to pay for it yourself.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 10:44 PM (GMT -7)   
ps. The link has contact details of an organisation you can ask - initially, anyway - about your eligibility for treatment.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 10:51 PM (GMT -7)   
Cool..Thanks :)

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 10:54 PM (GMT -7)   
Don't thank me yet. It made *me* go cross-eyed with boredom and confusion, and I know how the system works here!!

Have fun...

I.
Co-Moderator Crohn's Forum.

Medications for Crohn's ~~ Diet and Nutritional Therapy for Crohn's ~~ Dealing with Abscesses and Fistulae ~~


MichaelR
Regular Member


Date Joined Aug 2009
Total Posts : 34
   Posted 12/8/2009 11:17 PM (GMT -7)   
LOL....sounds like fun!! ;)

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 12/8/2009 11:29 PM (GMT -7)   
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