FREQUENTLY ASKED QUESTIONS
Most hernia repairs in this area are done with open surgery. There has been a large swing away from laparoscopic repair for many reasons. Robotic surgery has also been applied in this field. This question would be best answered by the specialist.
Chronic pain may occur following hernia surgery. This is uncommon but may relate to nerve irritation secondary to surgery and mesh placement. It may settle with time but usually a review by a pain specialist is the best management strategy. Prior to this its important to ensure there is no hernia recurrence.
Hernia formation is multifactorial. Genetics; collagen deficiency; heavy and repetitive lifting; previous hernia repair (same side or another location); straining ( coughing – smokers cough); constipation; and urinary obstruction.
It’s best to have the hernia assessed by a surgeon. There are a multitude of factors in deciding to repair a hernia surgically. Generally if you are medically “fit” a hernia repair can be considered.
Yes. Usually an ultrasound may help with the diagnosis but this still needs to be evaluated carefully with specialist review.
There are a number of ways to treat this but the most common method is an ERCP (endoscopic retrograde cholangio – pancreatogrpqahy) – see link under procedures for further information.
This is called the post cholecystectomy syndrome. The issue is what was the original cause of your pain; as removing the gallbladder has not helped. There are a number of other diagnoses to consider but its important to exclude CBD stones as this is easily treatable.
Small stones – these are more likely to migrate into the common bile duct
Short answer – no ; long answer – yes. Some patients later in life can develop poor biliary drainage and develop primary bile duct stones (muddy stones/sludge). We also see patients with CBD stones (bile duct stones) that may have been present since the gallbladder surgery but did not get detected/treated.
Yes – see answer to previous question regarding eating normally. The diarrhoea can be “bad “ enough that medication maybe required to reduce the diarrhoea for some time (e.g. cholestyramine)
Yes. There are patients who will realise certain foods do not “agree” with them e.g.. dairy/fatty foods etc. Some patients with irritable bowel syndrome may develop further gastrointestinal symptoms including bloating/diarrhoea and abdominal discomfort.
There is a strong genetic disposition towards gallstone disease. If a first degree relative has had symptomatic gallstones and required surgery; then chances are you will too.
The short answer is no – you don’t need the gallbladder removed. There are some patients (high risk groups) who may need the gallbladder removed as a prophylactic measure.
If you remove the stones only, further stones will develop in the gallbladder. The original problem is the reservoir (the gallbladder – where bile is stored); so therefore the gallbladder needs to be removed.
Symptoms can be related to the gallbladder – usually called biliary colic or a recent infection (acute cholecystitis). These symptoms may reoccur with further attacks; and there is also a risk of complications occurring (pancreatitis/jaundice/cholangitis). Some patients will elect to try and change their diet; lose weight but we know that recurring attacks will occur. It can be a period time before another attack occurs (weeks to months). The standard of care is that once symptoms develop the gallbladder should be removed.
GPs refer patients to multiple specialists based on the particular medical issue at hand. A Specialist is someone who has the skills to manage that particular problem. Generally there are multiple specialists available to handle a particular medical issue. Most GPs have a good working relationship with particular specialists and so therefore refer patients on that basis. You can ask your GP to refer you to a specialist of your choice. Some specialists only manage patients in the private hospital system, as they don’t hold a public hospital appointment. Dr Ahmed can manage patients both in the private and public hospital systems.
Medical records are kept private and are held on a database. We use a particular medical software (Blue Chip) which runs a paperless office. All data is backed up on external drives with a further backup on the server. We have engaged a senior IT partner to address these issues. Patients can access their medical records at any time by a written request. All written paper/material is shredded at an appropriate time.
During your initial visit with Dr Ahmed you will need to provide a complete medical history. You will need to undergo an appropriate physical examination. If you don’t wish to be examined please make let the reception staff or Dr. Ahmed know. This visit will last between 15-20 minutes. Depending on the complexity of the medical situation it can go longer.
Some patients may require more detailed investigations which Dr Ahmed will organise. These will be arranged and the results will be discussed at a subsequent visit (review consultation). A review consultation usually will last between 5-10 minutes.
If you require surgery, the potential options will be explained to you. Any procedure will be explained to you. This will include the expected results and any associated risks or potential complications. You will have the opportunity to ask questions; and even if you remember something later on ; you can call or email the practice; and Dr Ahmed will get back to you. We strive to provide excellent clear and straightforward communication.
Although complications are rare, all surgeries, especially those that involve anaesthesia, carry some risks. Dr Ahmed will outline these for you based on the specific procedure.
Our practice strives to provide written information with patient handouts/brochures and diagram. Anything that is unclear; we would certainly welcome a phonecall or email to alleviate this uncertainty.
As a medical specialist Dr Ahmed can only see patients who have a written referral. Without a referral you cannot claim your entitled Medicare benefit. Please ensure you have this letter, or that your General Practitioner or other specialist has sent the referral. Referrals can be faxed/emailed or posted. If you don’t have the referral on your appointment day; you can still be seen but won’t be entitled your receipt upon production of the referral. Dr Ahmed can see patients without a referral (overseas patients etc) but you will pay the full fee with no medicare entitlement.
The Medicare Benefits Schedule (MBS) is a list of medical services subsidised by the Australian Government. Each service covered by the schedule has an Item Number. The MBS details how much Medicare will pay for each Item Number. The Medicare Schedule Fee is what you can expect Medicare and your Private Health Insurer to pay for a particular Item Number.
A gap is the difference between the Medicare Schedule Fee and the fee charged by the doctor. It represents an ‘out-of-pocket’ expense for the patient.
No Gap (or Gap-cover) is an agreement between private health insurance companies and medical specialists whereby the health insurer covers the cost of the service with no out-of-pocket expense to the patient for the doctor’s fees.
The AMA Schedule is a list of recommended fees for medical services published regularly by the Australian Medical Association (AMA). These fees are generally higher than the MBS.
An Item Number is a code which identifies a particular medical service. These numbers are used when generating accounts for patients, Medicare and insurance companies. A single operation may involve a number of different item numbers. If you need an operation, the relevant item numbers will appear on your “Estimate of Fees.”
Depending on the operation (day surgery or overnight stays) – you will see Dr Ahmed the next day. An appointment will need to be made and Dr Ahmed would like to see you 2-3 weeks following surgery. If there are any concerns after an operation, Dr Ahmed would like to hear from you as soon as possible (please phone the rooms).
For some public patients (operated at Nepean Public) you will be seen at the postoperative clinic at Nepean Hospital. All patients operated at Blue Mountains hospital will need to be seen in the rooms.
We usually charge the AMA fee ( as set by the Australian medical Association). There will be an out of pocket expense (gap).
We do aim to look after all of our patients. We do not “turn patients” away and aim to provide a solution if there is a financial issue.
Public hospitals: Nepean Public and Blue Mountains Hospital
Private hospitals: Nepean Private
Yes. A number of a patients will prefer this. This will guarantee that Dr Ahmed will perform the operation. Our reception staff will provide you with an estimate of fees; and there will be a nominal hospital daily fee.
The registrar (doctor in training) will perform the operation. The operation may be supervised by Dr Ahmed but the hospital has the right to move patients to other operating lists without Dr Ahmed being present. Some patients will prefer to be a private patient (self paying) in the public hospital.
