Tuesday, March 29, 2016

Aussie Spiders - Reputation is worse than their bite!

Red Back Spider - Courtesy Sydney Morning Herald
My next door neighbour was telling me the other day that she'd been bitten by an insect on her foot. Apparently it "blew up" immediately and her Doc told her that she had developed cellulitis and started her on antibiotics.

A few thoughts stirred in my ageing brain, but I quickly moved on from the inappropriate prescription of antibiotics, to musing on insect and spider bites in this Great Southern Land called Australia. 

When the young bride and I first arrived down under we were regaled with stories of the most venomous snakes in the world, spiders the size of smartie with enough toxic venom in them to kill a horse - and all of these creatures are to be found in your backyard or under the toiler seat!! I also vividly remember a certain visiting Bishop develop a visible blood lust when called upon to deal with a large Tarantula which was holding court in our bathroom. The poor creature was drowned in Mortein by our Special Forces Prelate! I later learned to love those large, hairy arachnids who love nothing more than to dine on mosquitoes. Those buzzing, pesky insects, which can make an evening barbecue a living nightmare, are much more of a health risk than any spider is - just think Ross River Virus, Dengue fever ... even Malaria.

As far as spiders go Australia does have an impressive array of them and it's worth remembering that all spiders kill their victims (mainly insects) with a venom. But we shouldn't fear them as much as we do - apart from perhaps a couple of well known villains. Compared to we humans, even the most "dangerous" spider must be seen as veritable pussy cats!

Top of the list of "good idea to avoid" spiders is the Funnel Web.
Courtesy Australian Geographic
This is an aggressive little critter and if you think you've been bitten by one of these then you should pop along to your local hospital for prompt attention. The Neuro-Toxin they produce can have some very unpleasant side effects. The good news is that there is an anti-venom and secondly, no one has died from a Funnel web spider bite since modern first aid was introduced. In fact in the history of New South Wales only 13 deaths have been recorded.

One other spider you shouldn't poke a stick at is the Red Backed Spider - photo at top of the page. These lovely creatures live in a tangled we, are easy to spot and just enjoy eating other insects. Even the male of the species can be devoured by his mate in the course of mating (who said life is easy for we men?)
They certainly carry a huge punch but rarely leave their tangled fortress.

Problems occur when people/kids try to catch them, try to pick them up or think they are dead in the skimmer box of swimming pools. You will know if they've bitten you as the bite is very painful. Apply some ice, pop the offending insect into a bottle and head off to the local Hospital for the anti-venom. No one has died from a Red Back bite since the anti-venom has been available.

Here's a spider that has a lousy reputation for no reason at all! 
Courtesy Museum of Victoria
This is the White Tail Spider. It has a reputation of causing nasty flesh eating ulcers - but thankfully, the poor arachnid is seemingly innocent. In a study of 100 cases of identified white tail spider bites, not one of the patients suffered any loss of flesh!! Why devour a human when there are a billion flies to eat locally!

Just to put things in perspective:

On average:
  • Two people die from snake bites each year
  • Three people die from shark attacks each year.
  • Ten people die from Bee Stings each year.
  • Between 80 and 100 women die each year as a result of domestic violence
  • 1153 people died on the roads in 2014

There have been no deaths from spider bites since 1979
and there are far more spiders than humans out there!

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Saturday, March 19, 2016

Buying time with CPR - you CAN save lives!

I've just attended a 2 day workshop on Advanced Life Support and Advanced Trauma Life Support run by Western Australia's Rural Health Organization. Believe me, it was intense and hugely informative. I don't think I've pumped out that much adrenaline role-playing emergency scenarios in a long, long time! I came away with a greater confidence that even as a GP with nearly four decades of experience that I can do more to help the people I care for in emergency situations.

But there is something that everyone can do that can help save lives - CPR

Effective CPR buys time! Crucial time that allows an ambulance, or someone with a Defibrillator (and all airports, large urban shopping centres, gymnasiums etc now have them readily available) to arrive. Getting a Defibrillator onto a collapsed person who's not breathing - AS SOON AS POSSIBLE - provides that person with the maximum chance of survival.

Remember: maintaining circulation with CPR is the only tool we have when someone collapses outside of a hospital environment. And the big difference to survival is a DEFIBRILLATOR.

All Defibrillators are really smart machines: all you have to do is place the pads on the patients chest and switch the machine on. It will diagnose what's going and tell you exactly what to do.

So the message is simple:

  1. Learn effective CPR to buy TIME
  2. In the DRSABC algorithm you will learn, probably the most important thing to do is SEND FOR HELP which in real life is to say:

 "Call for an Ambulance and see if there's a Defibrillator in this place"

 You can make a difference. Effective CPR buys time, but a Defibrillator saves lives.
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Tuesday, February 2, 2016

Is there such a thing as Safe Sex?

Cunning little critters
"It's been going on since Adam was a Lad"  my dear old Mum used to say - sex that is! Talk to any (well nearly any)  hormonally charged young man or woman and they'd probably say it's the best thing on the planet. That was until mobile phones and virtual reality spoiled it all! For us of a more measured generation who are still used to answering/not answering land-lines, it's still way up there as one of the best experiences life has to offer.
The trouble with sex is, well, it really is THAT good and as a result advertising promotes the idea that the more you get the better it must be. Just think of all those boozey beer adds with beautiful young people eyeing each other off. They certainly don't look like they're heading to the library to study together. And I needn't mention those erotic adverts for what appears to be a jeweled ribbon appearing out of a model's buttocks and sold for a fortune as a 'thong' or 'G'string.
Selling bulk sex reminds me of why Vitamin supplements appear to be so popular. The promoters of such supplements appear to work on the idea that if a little is great to keep the human body healthy, then a Mega-Dose will be even better! Sadly, neither appears to be the case.
But back to sex. If it's so good then what could be wrong with it?
Call me old fashioned, but from my reading of the literature over the decades it seems to me that the safest/best sex is had in monogamous relationships and not by spreading it around with every consenting adult you can find. Why?

Because sex can be a real health risk!

  • Chlamydia - can make females sterile by irreversibly damaging their 'tubes'.
  • Syphilis - an ancient scourge that can even kill or send you mad!
  • Gonorrhea - another ancient scourge making a big comeback
  • Herpes - as one wit said "Not only love lasts forever - Herpes does too!"
  • Hepatitis B - can develop into a potentially life threatening disease.
  • Genital warts - now linked to the development of Cervical cancer and the target of a new vaccination program for young people
  • HIV - a sexually transmitted disease that has spread globally and still defies any cure

Then of course we must consider what coitus is also about - as well as all those nice fuzzy bits - the making of babies ... AKA conception.

If a male has vaginal sex with a woman there is always the potential for conception. Period (no pun intended)

This has been brought home to me in the last two weeks when I've seen one woman conceive who was on the pill and another who conceived who'd had her "tubes tied" 3 years previously! Believe me, those spermatozoa are devious little critters who will always find a way to a friendly egg.

So the next time you think about some recreational procreation/horizontal folk dancing or whatever the current epithet is, just beware that you may be leaving with more than just a happy memory - you may be changing your life (or someone else's) forever.
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Wednesday, January 27, 2016

Giving Hope to the Hopeless

I really wanted to write 'Hope-Less' because 'Hopeless' makes you immediately think that the person in front of you is a complete idiot. Whereas 'Hope-Less' suggests that they are devoid of nearly all coping mechanisms and have forgotten what hope really is. And believe me, that is a truly tragic state - especially when you see that lost look in a young kid's eyes.

It's vital we break the circle of despair

Otherwise we consign the next generation, and then the next generation to repeating the mistakes of their parent(s).

Most people are ignorant of what it's like to be in a situation where there is no job, your boyfriend has left you with 2 toddlers and run off with his ice addicted new partner. That your parents separated when you were young and you haven't heard of your father since. Or that your Mum's around, but what with the price of "smokes" and what's left of  the pension going on rent, food and medicines "she's not much help". And your so-called friends all smoke, most take drugs and most of them are pretty "hopeless" too. Yeah, you'd like to get away and make a new start but where do you go?

Believe me, in some areas of all countries that is the constant story seen by family GPs. That, and those who are on sickness benefits because of bad backs/depression/chronic pain ...who attend your surgery like a flock of worn out folk and each and every one of them looking 20 years older than they really are. Even the infants in their prams look confused at the behavior of the person who's wheeled them in on that particular day. 

Checking out their medical records you see a long list of anti-depressants: sporadic correspondence from psychologists/psychiatrist which start out optimistic and then segue into frustrated pessimism. These poor people find it so hard to change because every day they see and do the same things. As one person was heard to say: the definition of insanity is when you keep doing the same thing and expect a different outcome.

But the family Doctor is one person who can play a big part in their lives. These people attend our surgeries on a very regular basis. There is one treatment that we can give them which I suspect is one thing that they never get anywhere else - SELF RESPECT

Here's my suggestion: find time to tell these lost and damaged souls that they are worthy of our time, they do have value and they should learn to respect themselves even when other idiots try to put them down. I challenge some patients to do just one simple act - lift their heads and look up. Instead of seeing the rubbish and detroitus on the pavement, they'll see some trees, see the sky and maybe even hear a bird sing. It's only one little thing but if they persist it will become a habit ....  a habit of looking for HOPE. And dear God, some of these people need that in their messed up lives.
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Thursday, January 21, 2016

Your Secret Support - and how to improve your sex life!

We use it every day as soon as we get out of bed, and in fact many people use it when they're asleep too. It's one of the most neglected muscles in our body but when it fails to do it's job properly it can make our lives a misery!

I'm talking about the Pelvic Floor.

The pelvic floor is a sheet of muscles that support all the contents of our pelvis: which means -

  • The bladder
  • The rectum and it's faecal contents
  • and in women, the uterus and ovaries too

When the pelvic floor lets you down then controlling your urine can be a challenge when coughing, sneezing, straining or even just standing up! For those with loose bowel motions, a weak pelvic floor means that soiling your pants can be an embarrassing problem which may lead to social isolation as well. And when the bottom literally falls out of your pelvic floor, your uterus will often fall out too leading to a utero-vaginal prolapse!

Most of these condition are preventable by good personal care. For most people this means a lifelong approach to daily pelvic floor exercises and being aware of:

  • Avoiding constipation and/or straining with a bowel motion
  • Avoiding persistent heavy lifting
  • Treating chronic coughs and straining
  • Watching your weight and losing it if you're too heavy
So how can I improve the strength of my pelvic floor?

The first thing to do is to identify which muscles they are. After all, if you haven't used them for decades it's highly unlikely you know where they are in the first place! My suggestion is that the next time you go to the toilet to pass urine, try to stop mid-stream. When you do that, you're using your pelvic floor muscles and they are th emuscles you need to focus on.

Once you've identified them, it's time to exercise them. That's simple:

Squeeze and hold for 5 seconds and then relax - don't forget to include the muscles around your back passage too! Repeat for 5 slow squeezes and try to repeat three or four times a day. It's that simple and you can literally do these exercises anywhere and no-one will know what you're doing!

If you keep this up then after a few weeks you'll be aware that control of your urine will improve. And for ladies, as your pelvic floor muscles get stronger you'll be able to squeeze your vagina as well which brings me to the bit about your sex life .....
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Saturday, January 9, 2016

Beating the Drum for the Country Docs

It can be lonely out there

Rural Health - the real challenge.

As you may know, I took a few years off from clinical medicine as the emotional strain from caring for patients was hard enough, but running a practice was even harder! Now I've chosen to return to Family Medicine, but this time as a Locum GP, and I've chosen to help patients in the rural community. And it's been great!

Firstly, country people are different and have different problems. They're different in that they're more 'forgiving' and they're more thankful:  I had four 'Thank You' cards from one practice after just one three week Locum! But they face their own challenges too. Obesity is a big issue - excuse the pun - and is only compounded by the sense of inertia that occurs in small country towns. With the obesity of course comes Type II Diabetes with all it's insidious complications. 

Then there's a big issue with Chronic Pain Syndromes and the use of powerful analgesics that are being used to control them. It's a real challenge in such a short period of time to educate such patients on pain modulation, alternative treatments and the ancillary lifestyle modifications availabe. The resources needed are limited - professionals such as myself, clinical Psychologists and dieticians are nearly all FIFOs which makes continuity of care a real challenge.

And that leads to the one constant gripe of so many rural patients - with the inevitable question being asked "How long are you here for?" They feel that they are constantly having to repeat their stories to new faces (and despite computerised medical records, getting up to speed in 15 minutes in a complicated history is a tough gig even for someone with years of experience)  and many patients have literally given up trying merely limiting their consultations to requests for 'a new script'!

Our full time GP colleagues are bearing an enormous load in very isolating circumstances. I can fully understand why a female GP graduate with a young family would find it daunting to embark on a career in a remote rural practice. She would face so many professional and domestic stresses for which there are few practical answers. One may be to utilise the skills, knowledge and experience of those retired GPs who are looking for that something extra in life rather than playing bowls or embarking on another cruise, and developing an efficient, effective mentoring service!

Another would be to support groups such as the Australian Doctors Spouse Network that's been established to support Fellowship spouses in their un-ending merry-go-round of moving from hospital to hospital over their 6 to 10 year training. This group are aware of the challenges their partners face - perhaps Rural GPs Spouses can work with them to build support for their craft too.

Because at the end of the day, we're there to supply Health and Wellness information to our patients. We're there to support our patients when they're struggling. We're there to be their advocate when they have nowhere else to turn and to constantly remind them how special they are and why health is such a valuable commodity. 

At the end of the day it's all about our patients, and we can't do that properly unless we look after our Rural Doctors too.

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Tuesday, March 3, 2015

Thoughts on long distance air travel

Normally when we take to the air we travel from our home town of Perth in Western Australia and head West towards Dubai and Europe. This time we're going in the other direction and I'm actually typing these words, whilst I sit on the beach at Coogee NSW (and yes it's beautiful!). But tomorrow we continue our eastern adventure by taking wing to Los Angeles, a distance of 12,065 Kms or 13 hours flying time!

The biggest challenge for me is boredom. Flying tends to make one dozy anyway (and they keep turning down the lights to simulate nighttime) so actually being productive is always difficult. Once you've watched 3 movies in a row, the thrill of it beings to pall rapidly.

So I shall be taking a good book which I intend to at least open if not actually finish. I will take a notebook with me to record all those quirky things that happen when you're locked in with 350 total strangers (the good wife excluded of course)  in a metal tube at 37,000 feet, and I will get up and walk around as much as I can to stop the joints seizing up completely.

I usually start prepare for long distance travel some weeks before by working on my overall fitness and in the final week I try and do a little extra so that when I get on the plane my body will be craving sleep more than usual - despite the often cramped conditions back in "Stowage". Don't try and use alcohol as a means of getting to sleep, it will only make you feel lousy when you wake and will dehydrate you more too.

On the day of the flight I will put on my knee-length compression socks and wear them until I get into the shower at my destination. This is to reduce the risks of DVT's on such long haul flights. Because the air is drier at high altitudes I will take some lubricating drops for my eyes and some sesame seed oil to spray into my nose to keep those membranes protected to.

Once we're up, up and away then I'll drink plenty of water at regular intervals, get up and march up and down the aisles, and finally I do some stretches at the back of the aircraft - always designed to get some mystified looks from unsuspecting fellow travellers, or start up great conversations with fellow contortionists!

I also try to identify "coughers" - both in airports and on board - who may be infected with any contagious disease, by covering my face if they are near. I have also taken to wearing disposable plastic gloves when I use the communal toilet as the hygiene of others can sometimes be less than ideal.

After arrival and the obligatory shower, we go for a long walk before we go to bed and promise ourselves to be patient with each other for the next few days as the jet lag wears off.

But most of all I intend to have a ball in Seattle!

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