Medicine science, emotion, politics and money

Tweet The saga of Avastin, a drug used to help in end stage breast cancer, is a salutary warning on the pitfalls that can arise when a promising new "breakthrough" in cancer treatment collides with the reality of hard science, economics, politics and emotion.

Avastin is a relatively new medication for the treatment of solid tumours and is quite successful, in combination with other forms of treatment, when dealing with colon cancer. Avastin is in a unique class of medications, and targets the blood supply that these solid cancers "hijack" and stimulate as they grow and spread around the body.  It is also a very expensive drug and costs around $100,000 per year to treat patients.

The research was initially trialled, as usual,  on mouse models and was dramatically successful: however, when tried out in humans the results were not quite as spectacular - in fact, experts now tell us that the overall survival of people treated with Avastin is not increased at all; and the side effect profile of the drug is not patient friendly either.

Because of its initial promise in prolonging life in stage IV breast cancer, the FDA in America fast tracked it, and it has become widely used for these patients. Now, the FDA has reversed that decision in a 6 - 0 verdict, despite the drug maker and patients making a last ditch attempt to sway the verdict. This decsion has come at a time in US politics where one side is trying to introduce universal Health Care, and the other is saying that the Government is withdrawing a drug based on cost with comments such as "I shudder at the thought of a government panel assigning a value to a day of a person's life,"

Medicine can be quite messy and is not the clean cut, black and white process many of us would like it to be. When money, emotion, politics, power, and science collide, then yet again it is often the weak and the vulnerable who get crushed. My advice: make sure that the person who looks after your health is a good person who is on top of his or her game: and trust them! Your job is to live every moment of your life as well as you can until you draw your last breath: and don't die wondering.

Exercise and the lumbar spine

Tweet Having suffered from sciatica in the past, I can seriously assure you that I never want to have it again. It is a searing pain that shoots like a bolt of electricity down the back of your leg and into your foot. Even the strongest of painkillers only manage to dull  the pain, and their side effects of drowsiness and constipation often make sciatica sufferers reluctant to use them.

I underwent surgery to relieve the pain of my sciatica, and in the process lost a healthy chunk of one of my lumbar discs that had broken off and was pressing on the nerve - hence the severe pain! The good news is that I got over it all without complication and am now back jogging and cycling, but always at the back of my mind was the concern that exercise may not be helping my dodgy discs.

Well recent news out of the University of Gothenburg, presented at the annual meeting of the International Society for the Study of the Lumbar Spine (ISSLS), strongly suggests that exercise is good for the cells in those discs, at least if your a rat on a treadmill!! They have shown that rats that exercise have healthier discs than those rats that were left to their own devices and just ran around their cages! The hope is that they can repeat their findings in humans.

So, for for all of those "rats" out there, the answer is that if you want a healthy lumbar spine, get back on the treadmill, it's doing you the world of good. As for me, well, I'm going for a jog when it stops raining!

Whooping cough

Tweet I suspect that everyone of you who reads this article will never seen, or experienced whooping cough, which is why many parents in the western world are taking it less seriously than they should. This fact was brought home to me by an article in the morning paper which gave the following description of the illness as: "Whooping cough, also known as Pertussis, is an acute respiratory infection that is transmitted from person to person through respiratory droplets when an infected person talks, sneezes or coughs." Which when I read that, sounded like getting a mild cold. It did go on to state that "in young babies, infection can lead to severe health problems including pneumonia seizures and in some cases permanent disabilities or death", which did appear to give it an "edgier" feel.

But whooping cough is far nastier than these words make it appear.

Whooping cough still kills around 300,000 infants around the world each year and is one of the leading avoidable causes of death in children. The vast majority of those deaths occur in populations with poor, or non existent vaccination programs.

I have cared for patients with whooping cough, and it's a terribly debilitating disease. One family of five suffered miserably with pertussis for SIX months! They didn't have the energy to go upstairs to their bedrooms, so neighbours had dragged the mattresses downstairs for them to lie on. They were exhausted from the intractable coughing and feeling unwell: antibiotics were of no use to them, and all they could do was wait for full recovery, which eventually happened.

Because of the unfounded scare regarding the whooping cough vaccine, many people were confused and stopped vaccinating their children: children are at far greater risk of harm being driven to the supermarket in their parents car! Having our precious children protected against these "Childhood", yet killer diseases is something we should all do. If you do have genuine concerns, then talk to an expert, and, as my Mum always told me,  don't always believe everything you read in the newspaper!

Inappropriate use of antibiotics

Tweet A good friend of mine has just come back form overseas, and like a lot of international travelers, she has brought home more than just her luggage and some duty free! She has had a terrible time since she got back with a chest infection, and told me over the phone that she was "just finishing her third course of strong antibiotics".

As a doctor, I hate to hear things like that: and I'm not just talking about my compassion for a dear friend who is suffering, but more so for that fact that three different "strong" antibiotics have been used to no effect and probably for the wrong reason. Just as many chest infections are caused by viral infections as bacterial infections, and antibiotics have absolutely no effect on viruses!! In fact, giving antibiotics for the wrong reason can have completely the opposite intended effect - by that I mean that the effect of the unnecessary antibiotic is to wipe out all the bacteria sensitive to it, and leave behind all those that are resistant to it.

If you have a chest infection and are coughing up sputum, the first thing to do is to collect a sample of that sputum in a sterile container, so that it can be sent off to the Lab for analysis and to determine the sensitivity of any bacteria present to potential antibiotic treatment. These days this is a relatively quick process, but even if it takes a couple of days, your treating Doc can start you on a treatment that is likely to be successful, and once the "sensitivities" have come back, can then continue, or change medications, depending on the laboratory findings.

Trying three antibiotics in a row to see if they work is not smart medicine, and will often do more harm than good.

I sent my friend round a jar of Vicks (as a joke because laughter gets the lungs moving vigorously and helps shift sticky mucous) and suggested she try a gentle walk down the street. Today I hear that she is starting to recover, not, I am sure because it's anything to do with my suggestions, more that her own body is finally coping with the infection and almost certainly not because of any benefit from those "strong antibiotics."

"Dog eats sleeping owner's toe"

Tweet Now that's a headline to grab anyone's attention! However, it's not to be found as a banner headline on a tabloid newspaper, but in the more obscure Journal of the American Podiatric Medical Association. And it's a salutary lesson about the dangers of poorly controlled Diabetes, a disease that can be complicated by damage to the peripheral nerves and blood vessels, ultimately leading to loss of sensation and numbness.

The poor patient to whom this happened, had a pet Jack Russell who slept with her. The women awoke in the morning as usual, quite unconscious of the fact that half of her diabetic digit had been chewed off by her favourite pet. At first, all she noticed was blood on the sheets and the floor! As a consequence of her puppies night time snacking, she ended up in hospital where the long term consequence was that she underwent a lower limb amputation, which actually left her a double amputee.

This is a tragic story as well as a bizarre story. I know many people who let their small dogs sleep in their beds with them, and for the fit yet lonely, they are wonderful companions whose benefits far outweigh the negatives. But for Diabetics with altered sensation in their legs, this is a timely warning that:

       Pet dogs are still animals.

       Dogs lick things and can be a source of potentially nasty infections to open cuts and ulcers.

       Dogs chew things, and you shouldn't sleep in the same room as them.

According to the National Health Statistics for 2004/5 the prevalence rate for Diabetes was estimated to be 3.6% (or around 700,000). There is no doubt that there are more Diabetics now in 2011, so we're not talking about a small risk. Although the poor women reported in this article was a bizarre example of what can go wrong, the real issue is that Diabetes is not just a simple disease and "something to do with too much sugar": it has the potential to cause blindness, kidney failure, heart attacks and can lead to amputation of limbs and digits. We must take the major underlying causes - obesity and lack of physical activity - very seriously if we are not to be overwhelmed with the impact that this disease threatens to have on the whole of society.

Man on Fire - the disease, not the film!

Tweet My train of thought was distracted recently whilst reading about a very distressing condition called Peripheral Neuropathy. What caught my attention was the phrase "Man on Fire", which, if my memory serves me well was an action-thriller staring Denzil Washington, and what a very fine actor he is!

Firstly, more on peripheral neuropathy: this is a descriptive term that means damage to the nerves out in the "periphery" - usually the legs, and is often found as a complication of long standing Diabetes, alcoholism and exposure to toxins. However, in many cases there is no known cause, and consequently it is sometimes described as idiopathic (unknown) peripheral neuropathy. Despite all the medical jargon, what the sufferer experiences is unrelieved, excruciating burning pain in the affected areas, that may eventually lead on to complete loss of sensation. Now the loss of sensation may seem like a relief, but the problem then is that the patient can cut or graze themselves without knowing it, and this will often  lead on to infection and ulceration: and in the case of a Diabetic or an alcoholic, these two things are not conducive to improving ones health!

In the case of Diabetes, the damage to the peripheral nerves is thought to be due to damage to the tiny blood vessels that provide nutrition to the nerves themselves. In the case of Idiopathic peripheral nerve damage, we obviously don't know what the cause is. But Professor Stepehn Waxman MD PhD and his colleagues at the Yale School of Medicine have found that in about 30% of these cases there may be a defective gene involved: and this is where Denzil Washington comes in! There is a very rare medical condition called "Man on Fire" syndrome, where those afflicted sufferer life long, excruciating pain that so far has only been numbed by a cocktail of strong narcotic painkillers and antidepressants. Patients with Man on Fire syndrome have a defect in a single Gene , SCNA9 – which is expressed in sensory nerve fibers, and this is the same Gene defect identified in Dr Waxman's peripheral neuropathy patients.

The work they are doing with this damaged gene will lead to better understanding of peripheral neuropathy and holds out hope for far better management for those who suffer from it. What makes my occasionally cynical mind think that there must be a light at the end of the tunnel for those with this condition, is a press release from May 2011 which said:

" Yale School of Medicine has entered into a collaboration with Icagen, Inc. and Pfizer to explore the potential efficacy of investigational compounds as novel treatments for pain. These compounds, which were identified from an existing collaboration between Icagen and Pfizer may be useful in treating pain in people with a rare genetic disorder called ......... the “man on fire syndrome.”

Coffee the Wunderbean!

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"With pharmaceutical companies spending millions of dollars trying to develop drugs against Alzheimer's disease, there may very well be an effective preventive right under our noses every morning – caffeinated coffee," said Dr. Arendash  lead researcher at the University of South Florida in an article to be published on June 28 in the Journal of Alzheimer's Disease

Now we’ve all seen these sort of headlines over the years, of new drug breakthroughs that offer “so much hope” when used in animal models, only to be let down years later by unexpected side effects when  “trialled” on humans: but, hey, we’re talking about coffee here, and it’s been part of the human way of life for centuries, so the “side effect” profile is already well documented. So what is new about coffee?

Firstly, they’re talking about caffeinated coffee, and being an American study, they used “drip feed” coffee, so we’ll have to wait for an Italian study to let us know if the same applies to Cappuccino or espresso coffee! But it appears that there is a “secret” ingredient in coffee that helps the caffeine stimulate a growth factor called GCSF (granulocyte colony stimulating factor): GCSF is a substance greatly decreased in patients with Alzheimer's disease and has experimentally been shown to improve memory in Alzheimers mice! It appears to work in three ways:

·      First, GCSF recruits stem cells from bone marrow to enter the brain and remove the harmful beta-amyloid protein that initiates the disease.

·      GCSF also creates new connections between brain cells and

·      It increases the birth of new neurons in the brain.

All good so far: but you have to drink coffee in a “moderate” amount, and that means 3 to 4 cups a day. It doesn’t work with de-caffeinated coffee and it is not known whether this research is valid for instant coffee or other forms of our favorite beverage.

It also appears that coffee is a pretty amazing soup of all things that might be good for you: it is rich in anti-oxidants and contains compounds that are effective anti-inflammatory agents too. Recent research has shown coffee consumption decreases the risk of other nasty chronic health problems such as Parkinson’s Disease, Type II Diabetes and stroke too! It may also reduce the risk of prostate cancer and breast cancer!! Not a bad CV for a humble cup of coffee!!

Poisons Information.

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I spend a great deal of time urging people to live a healthy lifestyle, and the imagery that one conjures up is of happy, smiling people jogging through our pristine environment. In fact, there are a lot of hidden hazards “out there” - cars, searing sunshine and stingers in the ocean, to mention just a few! But as well as physical hazards, hundreds of Australian are killed each year by poisons!!

In 2008, for instance, there were 622 registered deaths due to accidental poisoning: this represents 0.4% of all registered deaths for that year. This compares with 1330 people who died as a result of deliberate overdosing with a poison or pharmaceutical substance in the same year.

For accidental overdose, it is interesting that 140 deaths were related to exposure to narcotics and hallucinogenic substances as compared to 41 deaths directly attributed to alcohol: so who called them "Recreational Drugs"? But then the social and road trauma associated with alcohol would no doubt swell those numbers considerably.

There are a lot of very nasty toxins and chemicals out there in our environment: just check your garden shed and see for yourself. Even within our houses we have cleaning fluids, caustic detergents, medicines and so on. So here’s link to an Australian website that gives helpful tips for improving home awareness, and what to do in the case of an accidental poisoning.

It’s Child Safety Australia.

Pathogens 101

Tweet There's been a lot in the news recently about deadly infections around the world. First there was the H1N1 swine flu that threatened to turn into a pandemic: luckily it turned out to be a very mild flu-like illness, and not the long awaited "big one" predicted in the media. More recently there has been the E Coli outbreak in Germany that has killed several people and left hundreds needing dialysis for kidney failure. So what do we know about these germs - or pathogens as the experts call them?

Firstly, viruses and bacteria have been around for millions of years, and Homo Sapiens is a relative new-comer, having been on the planet for about 2 to 300 thousand years. That means that viruses and bacteria have been able to adapt to the environment for far longer than we have.

Secondly, the world is awash with viruses and bacteria, in the oceans, on land and carried by almost everything that crawls and walks. The great thing is that most of them do us no harm: in fact we humans have more bacterial cells in and on us, than those cells that make up the human body. Many of them live in the gut and help with digestion: others live on the skin and provide a sort of germ "ground cover" to help protect us from those germs that might cause us harm. One of the problems with the careless use of antibiotics is that these friendly bacteria get killed by antibiotics too, leaving the ground open for those bacteria that are resistant to the antibiotic, and leading to more serious disease.

Thirdly, viruses are totaly different germs to bacteria and need a completely different approach to control. Bacteria are single celled organisms that have DNA within them, and are very similar to human cells. Viruses are more akin to chemicals, having no cellular structure, and need to enter a human cell and hijack the "production line" of that cell to produce more virus particles. Antibiotics do not work against viruses, and should never be offered or used for viral infections. Vaccines are far better at controlling viruses.

By understanding how these germs operate, strategies can be developed to help fight them: and currently, vaccination programs world-wide have probably saved more lives than all the antibiotics used in the last 70 years.

We are still a long way from getting the upper hand in the war against these virulent pathogens, as they are constantly changing and learning from other pathogens, to defeat the body's immune system. Knowing the difference between a virus and a bacteria may help more people understand that antibiotics are not a panacea for "infections" and may well lead to the terrifying situation that we breed out all the antibiotic sensitive bacteria and leave the field open to the resistant ones.

Inducing labour: DIY is not much help!

Tweet A normal healthy pregnancy lasts for 40 weeks: agreed? And the last few weeks seem to go on for months, and so the temptation to "hurry things up" has probably popped into most Mums heads at some point as they struggle around the Supermarket feeling like a beached whale. And according to a study in this months issue of the Journal "Birth", just over 50% of Mums attending a US hospital have tried to do just that.

Jonathan Schaffir, associate professor of obstetrics and gynecology at Ohio State University and lead author of the study, gave his Mums-to -be a list of of methods gathered from women 10 years previously, and which they thought might be successful, and asked them to tick which ones they might have tried.102 out of the 201 ticked a box, but they also ticked the box that said that they hadn't told their treating Doctor that they had tried something! Another interesting finding was that the majority of women got their information mainly from family and friends, and occasionally from the internet: but rarely from their Doctor.

Here's the list of suggested methods that they tried: walking, exercise, sexual intercourse, nipple stimulation, masturbation, use of laxatives, use of enemas, ingestion of spicy food, ingestion of herbal preparations, acupuncture and starvation.

Of all those, only nipple stimulation may have a basis in fact, but even if it did work, the resultant contractions can be irregular and painful and lead to more problems than positive outcomes. The reason none of these "home remedies" work, is that it is thought that the unborn baby is in charge of when labour starts! The theory goes that the babe releases a hormone that initiates the onset of labour which is then maintained by the mother's release of the hormone Oxytocin - which is also associated with nipple stimulation and lactaction.

The conclusion is that home remedies to initiate labour are still "out there", they probably don't work anyway and no-one's telling the Doctor about it! Answer:

1. For medical "things", talk to the people who have most experience, and that's probably not your mother-in-law, but your Obstetrician who has delivered thousands more babies than your much loved relation!
2. Doctors need to be empathetic towards their pregnant patients, especially in the last few weeks, and offer as much support as they can. In the end, it's in their best interests too, as the last thing they want to do is to deliver a baby to a mother who has recently swallowed a healthy swig of Castor Oil!

I wonder whether many Aussie women have tried to bring on labour with a home remedy?

Bring on Bali

Tweet The favourite daughter is going to Bali with her family on Saturday, so there is a tornado of activity with packing, last minute preparations and dealing with those unexpected hiccoughs, before heading to the land of palm trees and plaited hair!

So what preparations should families take before heading off to exotic, and not so exotic holiday destinations?

Probably the most important things to pack are sunblock,  tropical strength insect repellent and dressings for minor grazes and cuts that inevitably occur just when you thought you didn't need them! If you are intending to go to areas or countries where hygiene standards are not as stringent as here in Oz, then be prepared for a dose of the "trots". Most cases of gastroenteritis are self limiting, but it's pretty miserable to have to endure for 24 to 48 hours whilst the world falls out of your bottom!! Good personal hygiene is essential, and make sure that what you eat is well cooked: and look out for those salads and eggs/chicken that might not be cooked all the way through. The key to surviving Gastro is to keep hydrated: you can get sachets of dry powder containing all the salts that the body is losing down the toilet: you just add the powder to bottled water so that you replace not only the fluids that you lose, but also the salts, that if not replaced, leave you feeling washed out.

But in many areas of the world there are exotic diseases that require vaccination: this raises the problem of how many shots, and when to have them and what are the side effects. I always go to the CDC in the US which always has comprehensive and up to date advice for travel to all parts of the world. So here's a link to the CDC:

http://wwwnc.cdc.gov/travel/

I'll also add it to the "tool bar" on the right for future reference, check it out, especially for all those who intend to travel abroad. Unfortunately it's too late for the favourite daughter, but I have assured her that I am prepared to do a home visit if she needs it!!

Is watching TV killing you?

Tweet Scientists just love statistics! Unfortunately they can often be "massaged" into giving you the sort of answer you were looking for in the first place, but that's not what Anders Grontved, M.P.H., M.Sc., of the University of Southern Denmark, Odense, and Frank B. Hu, M.D., Ph.D., of the Harvard School of Public Health, Boston have done.

They didn't do the research themselves and come up with a conclusion, they reviewed the work of others by searching the medical literature for relevant studies from 1970 to March 2011 and found 8 studies that fitted their criteria. What they found provided some fascinating trends about why watching TV may be bad for our health.

If you watch TV for 2 hours per day there is a 20% increased risk for Type II Diabetes and a 15% increased risk for fatal or non fatal heart attacks. And the more TV you watch, the greater the risk.

Put into context for Perth (rounding out our population at 1 million for ease of mathematics) that equates to 380 fatal heart attacks and 1,760 new cases of Type II Diabetes per year.

Now I don't think for a moment that there are some deadly rays coming out of the TV screens around the world, but watching TV for extended periods of time - in the US the average viewing time is reported to be 5 hours, and it's probably fairly close to that in Australia - means you are inactive and probably eating and drinking (or being tempted to eat and drink) snacks and drinks that you don't need.  Other studies have shown that those with sedentary jobs such as drivers also have increased risk for these diseases, so the problem appears to be linked to inactivity and poor diet choices.

TV and home entertainment are entrenched in our modern way of life, but is there a better, healthier way of living with them? Do we need to watch as much TV as we do?

As a point of interest, I was just reading an article on how the brain records those powerful, emotional and sometimes scary experiences that happen during our lives, and how it is that we can remember them far more easily than the usual day to day events. Whilst reading the article I discovered that we produce about 100 new neurons each day and about 50% of them will die if we don't "use" them: and the way to hold onto them is to use your brain to perform "complex" tasks - learning a new language, reading books, learning new dance steps, exercising and so on.This means being actively involved in the process, not sitting back and watching others perform them.

Of all the time you have spent in front of the "Box", how much of it do you remember? How would you cope if you lost the use of your TV (computer games) for a week? How can we reorganize our leisure time? Everyone will have a different answer, we just need to take time and think about it.

Mood disorders and the "Four Humours"

Tweet There's a lot of black ink being spilled in the press today with regards to Prof Patrick McGorry"s Early Psychosis Intervention Centres -EPIC - being described by a US expert as a "vast untried public health experiment". I suppose that it may have something to do with the cost, $222 million to expand the scheme, but call me a softie for supporting any initiative that helps those struggling with mood disorders/psychiatric conditions, but I think that every effort must be made and every initiative tried, to lessen these black dog diseases.

It's not that we're dealing with something new: I was listening to a discussion the other day about a book written 500 years ago by an English Vicar called Richard Burton, entitled "The Anatomy of Melancholy". At that time all health problems were thought to be due to a disorder of one of the four "Humours" - Sanguine, Choleric, Phlegmatic and Melancholic. In fact the word Melancholic comes from two Latin words that mean Black Bile, and was thought to affect the brain; and the whole Humour theory dates back to the time of Hippocrates a couple of thousand years ago. In other words mental disorders have been talked about and discussed for centuries, and is not just a disease of our times.

I mention all of this because there is no simple solution. Yes we do have some medications, and the researchers are constantly looking to better understand the mysteries of the mind but there is no quick fix anywhere on the horizon. I suspect that because mood disorders have been such a constant companion of society ever since we stopped dragging our knuckles along the floor, that we've come to see it as an inevitable part of life. Thanks to people like Patrick McGorry and others, the light is now well and truly being shone on a dreadful burden that so many have to endure, and at last something is actually being tried!

Broccoli and advances in cancer research

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The young bride is a great cook, and for many years we have eaten lots of fish, fresh vegetables and occasional red meat: she also loves broccoli which, as a child, I used to detest. Now I have two good reasons to enjoy my cruciferous veggies: one is because she makes it taste so delicious and the other is because of the increasing evidence to show that it helps reduce the risk of some cancers.

 In 2008 a couple of American researchers reported evidence that eating raw cruciferous veggies – broccoli and cauliflower fall into this group – lowered the risk of developing lung cancer in smokers and former smokers: and the range of risk reduction was fairly significant ranging from a 20 to 55%. Despite that impressive figures however, the researchers stated that the evidence was still not strong enough to make a Public Health recommendation.

Now scientists have uncovered one of the chemicals in broccoli that plays a part in this preventative puzzle. Sulphoraphane, a phytochemical found in high quantities in cruciferous vegetables has for the first time been shown to selectively target and kill cancer cells whilst leaving normal cancer cells healthy and unaffected. However,  "Just because a phytochemical or nutrient is found in food doesn't always mean its safe, and a lot can also depend on the form or levels consumed," said Emily Ho, a principal investigator in the Linus Pauling Institute. "But this does appear to be a phytochemical that can selectively kill cancer cells, and that's always what you look for in cancer therapies." In fact Sulphoraphane is already in clinical trails in the management of both breast and prostate cancer.

So get out the recipe book and start adding broccoli creations to your diet, and just to give you a kick-start, here’s one from Marg Johnson!

Serves four:

Broccoli, Anchovies and chilli Tagliatelle

1 head broccoli – cut into small florets

44g dried tagliatelle

salt

¼ cup olive oil (best quality)

4 anchovy fillets, roughly chopped

1 to 2 red chillies – chopped

Freshly ground black pepper

2 tbsp flat-leaf parsley roughly chopped

1 cup grated Parmesan cheese

Simmer the florets until they are just tender. Drain them and keep to one side. Cook the pasta in salted water until just tender. Meanwhile, warm the olive oil and add the anchovies. Allow them to melt into the il and then add the chilli, pepper and the broccoli. When all is hot, add the drained pasta and mix all together. Then remove from the heat and fold through most of the parsley and cheese. Serve topped with the rest of both.

Living with breast cancer.

Tweet I was Skyping with an overseas, and much loved member of our family the other day, and catching up with how she was dealing with her third round of chemo for breast cancer.

This lady has style and panache!

She first appeared wearing a head scarf and recounted the usual story of the trials and tribulations of what chemotherapy actually involves, and for someone who has absolutely no medical knowledge whatsoever, she now sounds like a seasoned oncology nurse trotting out technical terms and blood cell types that would make a pathology professor smile!


After a few minutes she disappeared for a few seconds and returned, resplendent, wearing her new blond wig. We got the full 360 degree view, and then with a theatrical flip, she whipped it off to reveal a near-bald dome, topped with a bit of dark fluff. The young bride next to me suppressed a gasp of shock, but we both agreed afterward that what we had seen showed courage, style and the amazing attitude that this lady has. Buts what's more, we were informed that "Chemo is great for your nails: they've never been so good"! Now this coming from a lady of fashion is high praise indeed.


I mention this because breast cancer is on the increase, but at the same time survival has never been better either: so the simple truth is that 1 in 9 Australian women will get breast cancer, and they will have to face up to the associated treatment.  If the example of our much loved family member is anything to go by, the "glass half full" approach can make the treatment period far more bearable.

Growing old gracefully.

Tweet We've all heard that the western world is facing an "aging crisis":  the projections for Australia suggest that the population aged 65 years and over, is projected to increase from  13% in 2002, to between 29% and 32% in 2101. Currently most of the media and political "noise" has focused on how this is going to impact on the economy, with a reduced work-force having to work harder and longer to cover the increasing medical costs  "caused" by the grey and wrinkled generation. 

Being a parent becomes ingrained into one's psyche, and for most of us in the senior segment of our lives, we still passionately care about how life is going to pan out not only for our children, but also for our grandchildren. So the challenge for us is to not just shut up shop and go quietly into the retirement village, but to stay active, independent, involved and as healthy as we can so that, even though many of our bodily systems that we once took for granted, now take more time to grind into action, we can actually have a good quality of life. What we definitely don't want to do is to become any sort of a burden on our children, or our children's children. If we are successful at this, then our resultant health care costs will be less and then everyone's a winner!

Well, the good news is that the scientists and researchers have actually proved that this works!! It seems that plain common sense is scientific sense too! A study called The Well Elderly 2 trial was performed between 2004 and 2009, with the write-up appearing in the June 2 issue of the Journal of Epidemiology and Community Health, and this showed that with just small, healthy lifestyle changes and involvement in meaningful activities—going beyond just diet and exercise—are critical to healthy aging. Seniors participating in the study made small, sustainable changes in their routines (such as visiting a museum with a friend once a week) that led to measurable gains in quality of life, including lower rates of depression and better reported satisfaction with life. Of course one strategy does not fit all aging persons;  going to the gym 3 times a week would drive many up the wall, and so professional input was required from a very professional group known as Occupational Therapists to help guide the participants. OTs are a largely unsung band of amazing people who do so much to help many people live meaningful lives. They were a key part of The Well Elderly 2 Trial, just as they were before in the 1997 British Well Elderly 1 Trial that has been used to help develop British pubic health policies.

My belief is that there is so much more each individual, or family, or group could do to improve their health and quality of life, and it really only involves incremental changes that are carried out over long periods of time: good quality food, no tobacco, minimal alcohol, much physical activity and so on. Our senior years should not been seen as ones of inexorable decline, but years when we can still "value add" to ourselves, our families and our communities.

 See you at the beach ....... after you've been to the museum!

Time to start kissing frogs?

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For many years, Doctors have known that most people who die from cancer, don’t die from the original tumor, but from the cancer's metastases – the new sites around the body where the tumor seeds. All cancers start from a tiny cluster of cells, but once they reach a critical size, usually only a few millimetres in diameter, they cannot grow any bigger unless they create their own blood supply: this is called angiogenesis. The theory then goes that if you can block angiogenesis, then you turn cancer from a killer, into a manageable, chronic disease, like many other chronic diseases such as psoriasis, arthritis and so on. There are already a few  drugs available that have been developed to do this, but a novel approach by researchers at Queens University Belfast, has literally hitched a ride on the frogs back!! They discovered a protein secreted by the Waxy Monkey Frog that stops blood vessels from growing, and hope that their discovery will further enhance the management of metastatic cancers.

But they didn’t just stop with the Waxy Monkey Frog: they went one step (hop?) further and discovered that a protein from the Giant Fire-bellied Toad, which does the complete opposite and actually stimulates blood vessel growth. This, they hope, would be of great value in helping people with Diabetic ulcers, wound healing and with damage caused by strokes.

The lead researcher, Professor Chris Shaw and his team are to receive one of Europe’s most prestigious awards for Healthcare and Business next week for their discoveries. It just goes to show that the answers are out there: we just have to keep looking!

PS: no frogs were harmed in these experiments and they were all released fit and well back into their environments!

PPS: Got any good frog stories?

Stem cells for damaged knees

Tweet I've always been fairly conservative in my response to those headlines in the the papers that talk of "stem cell breakthroughs", as if all of a sudden all the medical problems in the world are about to be resolved. As we should all now know, we need to take those headlines with a large pinch of salt: in fact a 15 to 20 year sized pinch of salt! But time is passing and stem cell research is now starting to appear in human clinical trials, and that means we are now getting closer to perhaps a 5 year time line: now that is exciting.

Being rather fond of the sporting life myself, and having damaged my knee playing touch rugby at an age when I should have been trying a more leisurely pursuit, I was delighted to see that knee cartilage treatment has at last reached the 21st century. Not that it hasn't been improving incrementally over the decades, but it still very much relies on surgical intervention, and that is often associated with premature arthritis in the affected joint. Many of the total knee replacements that I see now, are on joints that were treated by total menisectomy - complete removal of the damaged cartilage - around the time I started medicine some 40 years ago: and that means having major surgery at a time in life just when you didn't need it!

Courtesy of medialmeniscustear.com

Researchers at Bristol University in the UK have now received permission to start human trials on a special "meniscal bandage" that contains the patients own harvested stem cells, which are inserted into the knee joint to cover the torn knee cartilage: the trial is to last 5 years and will study the effectiveness and the safety of the procedure. If, as hoped, the trial is successful, then the implications are huge.  Europe and the US both report approximately 1 million cases each of meniscal damage each year, and over 80% of these are in people under the age of 50: the injury being a very common amongst many sporting codes such as football, Aussie rules, rugby and basketball. If the Stem Cell therapy lives up to its potential, then that means much reduced pain and suffering later in life, plus a reduced need for major joint replacement.
For all of you currently living with "dodgy" knees, then the best advice I can give you is to befriend a good sports physiotherapist, and take their wise counsel! I throw the floor open to suggestions!

A warning from Germany

Tweet It's amazing the difference a day makes!
The outbreak of the E Coli infection in Germany over the past few days has made the medical world sit up and take notice: the poor Spanish are fuming over the insult laid at the feet of their cucumbers and the Russians have banned the import of food from Europe: no-one saw this coming! But the biggest mystery of all is that this is a completely new strain of the normally passive bug that most of us carry happily in our bowel. The E Coli outbreak in Germany is very nasty indeed, and is producing a Toxin that not only kills, but causes bloody diarrhoea and shuts down kidneys as well! Another twist is that this bug is affecting mainly adults (86%) when normally its the young ones who come down with Gastro first: and women are being hit the hardest (67%)*.
E Coli infections are spread by "faecal/oral" contamination and is common in areas where there is poor sanitation, a situation that does not occur in Northern Germany. The six million dollar question for this outbreak is: "What is the source of the contamination?" At present the experts are frantically searching for an answer, and that may take time, as they have to break down the genetic code of the bacteria to help try and identify its source.
The good news is that cooking will destroy E Coli: and with winter now with us here in Australia, it's much easier to avoid those food groups that may be involved in Germany - salads, tomatoes etc. However, the chance of this deadly bacteria getting to our shores is extremely slight, but that doesn't mean we should ever compromise the contents of our food chain. This is a timely warning that we should be very aware of what we spray on our vegetables and salads in the form of manure; and we should be even more aware that using antibiotics in cattle increases the chance of antibiotic resistant organisms developing here too.
Remember: wash your hands, wash your food and then cook it! Bon appetite!

*See Germany's WHO site at http://www.who.int/csr/don/2011_05_27/en/

Are mobiles phones a Health Hazard?

Tweet An article in today's Australian paper caught my eye; it was about mobile phones and one particular sentence got me thinking: "the expert working group that classified mobiles as possibly carcinogenic noted the strongest evidence for the new classification, though limited, linked mobiles to two types of brain cancer, Glioma and Acoustic Neuroma". It then went on to say that the evidence was based on early model mobiles which are known to produce considerably more power than the newer generations of 3G mobile phones, and it's this "power" that might be associated with the increase in brain cancers seen since the '70's.
A number of thoughts flashed into my mind: the first was the late Dr Chris O'Brien OA, the Head and Neck Surgeon of RPA fame, who was such a charismatic figure helping so many others as he struggled with his own soon to be fatal brain tumour. Chris himself admitted to being constantly on his mobile phone.
Secondly, the Research information on mobile usage and brain cancer is still relatively new - probably about 20 years - and I suspect that like most demographic health information, we will have to wait for another 20 years before the picture becomes much clearer and concrete conclusions can be made.
The other thoughts that went through my mind were the non medical things that the mobile phone has brought with it, like "cyber bullying" in schools and how it has affected the dynamics within the family. My eldest - a girl, now an amazing lady - will gladly report that when she was a teenager, the only phone in our house was firmly tethered to the wall in the hallway by a wire ! If she wished to have a private conversation (virtually impossible with four devious, male siblings) was to stretch the telephone line out through the nearby front door and sit in the porch outside - which was a dead give-away, and rapidly resulted in her brothers sudden desire to go out the front to "play". But for a parent, having that ability to "oversee" our children's conversations, it enabled us to support them when they appeared distressed. By the time our youngest was a phone user, telephones were mobile, and we felt like we had been excluded from a part of his life (and maybe that's a good thing?).
A final thought was that the link between mobile phones and cancer still is extremely tenuous, and nothing near as certain as the link between cigarettes and cancer, or sun-baking and skin cancer; so I think we need to factor in "relative risks" when thinking about which issues we should be actively perusing.
My take is that those with the more vulnerable brains - that's our small, precious people - should be taught how to strictly limit mobile phone use and where possible use hands-free or a blue-tooth earpiece (as should we all). That's just after you've plastered them in sun block and told them smoking is disgusting!

Guys: you need your sleep

Tweet Apart from getting very tetchy if they don't get a decent nights sleep, there is now evidence that the male of the species will also suffer from a lower Testosterone level. Now if that doesn't get their attention, I dont know what will! In fact, according to Eve Van Cauter PhD, who has published an article in the June 1st issue of the Journal of the American Medical Association (JAMA), the lower Testosterone levels are the equivalent to aging 10 to 15 years.
What the research looked at was how poor sleep hygiene over an extended period can affect these young men. They studied a small group (which also means that these results are just an indication, and NOT Gospel fact) of students -average age 24 - and who were in good health, and followed them in a sleep study unit: they found that after 8 nights of having their sleep restricted to five hours, that their Testosterone levels decreased by 10 to 15%. The students also reported a decreased sense of well-being and had less energy - and from personal experience of young men growing up in our house, they were also probably monosyllabic and grumpy too!
All this isn't just to do with decreased sex drive and low sperm counts: about 15% of the adult working population in the US gets less than 5 hours sleep per night, and the figures are probably similar here in Australia. The consequences for safety, productivity and work-place harmony as a result of working with someone with a low Testosterone level need to be addressed. From a health point of view, testosterone is critical in maintaining healthy bones and muscles, and the resulting physical problems can impact later on in life with male osteoporosis.
Good sleep hygiene is free and effective - here are a few hints:

Treat your bedroom as somewhere to sleep (there is one exception here!).
No TV or music in the bedroom.
Alcohol does NOT help you sleep better: in fact it often makes the problem worse!
Avoid caffeine from early afternoon onwards.
Try to take your exercise early in the day: evening exercise can make it harder to settle.
If you haven't fallen asleep after 20 minutes, get up and read a book.

I would be fascinated to hear how the male in your house fares when it comes to counting sheep?