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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Tuesday, February 24, 2015

The List

The young bride recently bought a kitchen blender which now sits proudly on our kitchen bench. It’s a wonderful machine and apparently does amazing things. I haven’t been allowed to play with it yet, but I have eaten of the fruits of the machine and they are definitely good!
Before she bought this blessed electronic gizmo, she made a list of everything she wanted from it. She then did a search of similar gizmos in order to work out which one was best for her. Finally she checked out Choice Magazine to see what they thought and where the best bargains might be found.
By now you might be thinking that I’m going to write about healthy eating. But I’m not. This is all about that strange and sometime scary event:

 “Going to see the Doctor”

From my early years when I was on the other side of the desk, to the more recent years when we've moved around to sit next to our patients, one of the 'heart sink' moments that we Docs all experience is the patient who comes in with the dreaded “List”!

Early on in life, a visit to the Doctors is usually a fairly simple  - earaches, sore throats, rashes, soft tissue injuries etc. But as we age and things start to creak and go wrong, then many people resort to “The List”. 

But beware, sometimes “The List” can end up being a double-edged sword especially if you leave your Doctor to decide which items on the list need his/her attention immediately. This is becoming more of a problem as most patients rarely get to see their own Doc these days. The reason being that most Docs are now part-timers who work in large clinics and they’ve probably never seen you before in their lives. All they have is you, your medical history and “The List”.

So my suggestion is to take a leaf out of the young brides book and do some “due diligence” yourself.

  • Make a list of all the things you want to talk to the Doctor about.
  • Prioritise that list with the things that you’d like to get attended to first.
  • Show your prioritised list to your pharmacist or Community Nurse to get their opinion. And if you’re a little nervous about it all then take an advocate along with you - family member or friend.

Be aware that if you have more than two things on your list it is wise to make more than one appointment to deal with all your issues. Believe me, one interview will never allow enough time to properly analyse multiple problems or to allow your Doctor to explain their thoughts to you.

Finally, if you think your Doctor is not giving you adequate time or failing to treat each issue seriously, then feel free to get a second opinion. 

Ask my young bride, if you were buying a food processor you’d look around for the best deal - so why not do the same for your life!
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Tuesday, February 17, 2015

NSAIDs - the debate that continues to inflame!

A good friend of mine, who just happens to be a retired medical man, recently fell and broke his hip. Nothing too unusual for a man in his seventies, but when we visited him in hospital he was furtively hiding his pain medication in a tissue and tucking it under his pillow. “It’s an Anti-Inflammatory” he confided conspiratorially The look of  confusion on my face prompted him to continue “They might be OK for pain relief but they interfere with bone healing and I want to get back on my feet as quickly as possible”.

I have to admit to always being a little nervous about using NSAIDs - Non steroidal Anti-Inflammatory Drugs - having studied medicine during the period when Phenylbutazone, the first proper NSAID, was introduced. BTZ, as it was popularly called at the time, was later discovered to cause bone marrow depression in many of those who took them and swiftly removed from “The Market” . 

But first a piece of history:

The fascinating ability to treat fever and inflammation dates back about 2500 (400 B.C.) years ago to a time when the Greek physician Hippocrates prescribed an extract from willow bark and leaves. Later in the 17th century, the active ingredient of willow bark Salicin was identified in Europe. Acetylsalicyclic acid (Aspirin), a more palatable form of Salicin, was produced commercially by Bayer in 1899. However, the mechanism of action of anti-inflammatory and analgesic agents such as aspirin, and its later derivative Indomethacin, were not discovered until the early 1960’s when medical science was really beginning to find it’s feet. Things really changed in the seventies, when John Vane discovered the mechanism of action of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) opening the door to a pandoras box of new pharmaceuticals to treat pain and inflammation.

Since then the place of NSAIDs has become embedded in our lexicon of treatments for all things that involve inflammation and pain - especially those involving our joints. But the target tissues for these medications don’t just lie in our bones and joints, they are also to be found throughout the body in our stomachs, our kidneys, our hearts and our brains too. As time has gone by, the goal of Pharmaceutical Companies has been to develop medications that produce fewer side effects whilst maintaining their anti-inflammatory effects.

So what are the possible side effects of NSAIDs
  • Stomach ulcers
  • Raised blood pressure
  • Kidney Disease
  • Liver disease
  • Bleeding
  • Induce asthma attacks
  • Rashes, drowsiness, headaches

All of these side effects reflect the areas around the body that these medications have a collateral action upon, as well as the inflamed areas they’re principally targeted at.
A concern that I’ve had for many years is that some of these NSAIDs are now available “Over the counter” and are commonly used in children too.



The vast majority of childhood inflammations and infections will settle without the use of medications. Common sense and patience are far better treatments than rushing to the Pharmacy for a magical “quick fix” - because that is exactly where those “quick fixes” should remain, in the realms of fantasy and fairy tales!

The human body has evolved brilliantly over the millennia to deal with minor injuries, minor illnesses and local inflammations. For major stuff you should always seek medical advice, because in most cases, Doctors do know more than you do.

But let me finish by saying that although Doctors know a vast amount about the human body, they are still far, far, far away from knowing everything. My medical friend with his broken hip refused his NSAIDs because he believed that NSAIDs slowed bone healing. Well, a thorough search of all the scientific papers written on the subject came to the conclusion:

“There is no robust clinical and/or scientific evidence to discard the use of NSAIDs in patients suffering from a fracture, but equal lack of evidence does not constitute proof of the absence of an effect. The majority of the available evidence is based on animal findings and these results should be interpreted with caution due to the differences in physiological mechanisms between humans and animals. ….. Till then, clinicians should treat NSAIDs as a risk factor for bone healing impairment and (they) should be avoided in high-risk patients.” 

ScientificWorldJournal. 2012; 2012: 606404.
“Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis”
Ippokratis Pountos, 1 Theodora Georgouli, 1 Giorgio M. Calori, 2 and Peter V. Giannoudis 1, 3 , *


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