Tips for conquering Constipation

Tweet It's not a topic of polite conversation, but as the saying goes "Constipation Happens"!

In these days of bowel screening for Colon Cancer, any change in bowel habit is worthy of investigation, but for the majority of people with "sluggish" bowels, how to treat constipation is still more of an art than a science: so in order to help improve the situation, here are a few thoughts on the subject.

The body has a natural reflex to empty the bowel and this occurs usually about 15 to 20 minutes after a meal and is known as the Gastro-Colic reflex. In other words, if you put food in the top end of the gut tube, you will need to clear some space lower down, in order to make room for the waste material from this meal when it comes through. The problem is that in these modern, busy times with all the rush and "things to do", we often suppress this urge, and like most things, if not used properly, it gets a little "rusty"! But the reflex is always there, even when not used, and it can be reactivated. So, if constipation is a problem, then chose a meal that you might regularly have time after, and then about 15 minutes after eating, go to the little romm with a book or magazine and sit and wait to see if you can feel that reflex wanting to work. If after say 5 minutes, nothing has happened, then repeat after the next appropriate meal. With patience, you should be able to become aware of your bowel wanting to empty.

The next thing is to make sure that your bowel has enough residue in it for the gut to actually grip on: and the best foods for this are vegetables, wholemeal grains, nuts and fibrous fruits. Processed and packaged foods are often just "dissolve in your mouth and disappear in the bowel" materials that will not help in resolving constipation! A good suggestion is to keep a food diary in order to help you become aware of what you actually eat on a daily/weekly basis: once you know, then you can make appropriate, healthy changes.

Exercise is yet again a really good "get out of goal" card for most things that ail us: and yes, it does help with constipation too!

When it comes to things that help the bowel work more efficiently, the following treatments might be of help:

• Treatments that help soften the stool: Coloxyl tablets from the Pharmacy.
• Treatments that help make the gut contract more strongly: such as Senna, and Phenopthalein that is found in certain medications.
• Treatments that ferment in the bowel such as Lactulose.
• Treatments that lubricate the gut such as Liquid paraffin and Glycerin suppositories.

Needless to say, if you have any health condition such as Diabetes; or are on any medications, antibiotics or anything else for any acute or chronic illness; or you are pregnant, then you should consult a Doctor before taking any medication for constipation.

Making sport safer for our Children

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When we think of sport, we think of fit athletes running around exuding good health: and that is true to a large extent, but as with all good things there is often a downside; and with sports the downside is injury. The figures for Australia are not healthy reading: according to the Australian Bureau of Statistics,

• There were 42,452 sports and recreational related injuries in the year 2002 - 2003.
• Although there were a greater number of females >15 involved in sport, 74% of hospitalizations due to sports related injuries were males.
• The most dangerous sports per capita for 15 yrs olds and over were wheeled motor sports, followed by roller blades/skateboarders/skaters, Aussie Rules and horse related sports.
• Sports injuries cost Australia $1.83billion in 2003.

One of the inconsistencies about modern sport is that our approach to athletes - and by this I mean all those who are involved in sporting activities - is "upside down", with mature athletes getting more appropriate training and preventative advice than our young athletes do. With the trend towards specialization at an early age, we are now seeing "overuse" injuries - previously the domain of professional athletes - which now account for approximately half of all youth injuries reported. According to US Prof James Andrews MD, an Orthopedic surgeon, the major problems are:

1. Improper technique
2. Ill fitting equipment
3. Training errors
4. Coach and parental pressure
5. Failure of early injury recognition

When you think that following an ACL injury and repair (repair of the anterior cruciate ligament in the knee),  Xray imaging of the knee taken 10 years after the repair,  will show the early changes of arthritis, (and we are seeing more and more players in their early 20's having such repairs), then the specter arises that today's sporting heroes may well be facing joint replacements in their 40's, just when their children are reaching adolescence! As well as reducing the quality of life to the sufferer, it doesn't do much to project the image of a "healthy role model" for their offspring.


 The problem being that with young people, their muscles and ligaments haven't "caught up" with their inherent skills and levels of physical activity. The way forward is not prohibition, but through education: education of parents, education of schools, education (and accreditation of) sports coaches, and involvement of sports Physicians in the process, so that everyone involved is focused on the best possible outcome for the players, and then for the sport.

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Cough supressants - 19th Century style!

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With the influenza season in full swing here in the southern hemisphere, the problem of how to treat those ticklish coughs is with us again. Go back a hundred years and you would have been offered a cough medicine containing .... Heroin (and made by the pharmaceutical giant Bayer, which is still alive and well 100 years later: after a sometimes chequered history!) However, science has caught up with Heroin, a very powerful narcotic that still has a focused place in medicine, for the treatment of severe intractable pain in situations such as Palliative care. It's weakened cousin Codeine was still used as a cough linctus  into the late 20th century, but it too does have a number of problems when used as a cough syrup: problems such as drowsiness, hallucinations, constipation; and when it falls into less ethical hands, then it can result in dependence and addiction!

Heroin nevertheless, is a fantastic cough suppressant: and these days we have nothing that matches its effectiveness to get rid of those persistent paroxysms of coughing. I would hazard a guess to say that nothing that you buy "over the counter" at the pharmacy will make one iota of a difference to you, should you succumb to a viral cough. They may soothe for the short time as they pass through your mouth and throat, and they might help dry up a post nasal drip that leads to your cough: but as a true cough suppressant, they just lack the clout to deal with it.

Should you have a dry tickle that is causing you to loose sleep, then sometimes one of the inhalers that are used to treat Asthma may be of benefit; but these are prescription medications and you will have to attend your treating Doctor for an assessment. The good news is that the vast majority of viral coughs are self limiting and need no special treatment. For those with a productive cough, the last thing you need is a "suppressant", as it is important to expectorate the mucous, otherwise it could become a site for secondary infection if it stays "down in the lungs".

But back in the 19th century, they did seemed rather fond of using heroin, or morphine, at the drop of a hat! One soothing syrup for infants troubled with teething, was Mrs. Winslow's Soothing Syrup, and contained over 20 mg of pure morphine in each 20mls - which would tend to render most infants senseless, rather than soothe them ! But at that time, narcotics were still deemed "legal" and were part of the fabric of society with their opium dens and the fashionable use of laudanum! Thank God for progress!

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Women smokers at greater health risk

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No one can escape the fact that smoking damages health and can lead to heart disease and cancer. And yet, one sub population of people - young women - continue to smoke in increasing numbers!

Now there is evidence to suggest that these are the very ones who should NEVER SMOKE as women appear to be at greater risk from developing heart disease - a 25% increase - when compare to the male of the species. Women also have twice the risk as men of developing lung cancer, so there is a real need to target this group to reduce the number of smokers, and reduce the deadly impact of these diseases on them.

A recent article in the Lancet reviewed studies between January 1, 1966, and December 31, 2010, and looked at 86 trials, involving over 3 million women, so the information they gleaned is not without statistical impact. That there is a 25% increased risk in women over men is a fact: why there is an increase is more difficult to discern. Is it because women absorb the toxins in tobacco more efficiently; or is it due to a more potent toxicity of the chemicals found in cigarette smoke, on women?

Whatever the reason, one thing is certain: prevention is far more effective, far less painful, and far less costly than having to treat heart disease or lung cancer.

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Coffee flavoured sunblock?

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Well, well, well: the little coffee bean seems to be the super-star of all things that are good for you.

First it was reducing the risk of certain cancers: then it was helping with dementia and age related diseases, and now you can live out your fantasies, plaster it on your skin and thus reduce the risk of developing non melanotic skin cancers. That's on top of it previously known effect, that if actually swallowed and savoured, it also reduces the risk of skin cancers! The mind wonders to sitting on a palm-fronded beach, sipping on your favourite caffeinated beverage and then massaging the dregs on your skin, all in the joyful knowledge that you're actually doing your skin a double dose of good.

"Caffeine might become a weapon in prevention (of skin cancer) ......... and also acts as a sunscreen and directly absorbs damaging UV light," said Allan Conney, director of the Susan Lehman Cullman Laboratory for Cancer Research in the US.

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Curry to help with the runs?

Tweet I have to apologize for the heading of this article: I promise to "try harder" next time; but I was drawn to this latest "Curry based" research, especially after the young bride reported that she thought that she was getting tendinitis in her Achilles after a recent jog we did. 

Now, both of us are rather fond of curries, but we have always been wary of eating them if we have a long jog planned for the next morning, for obvious reasons: but perhaps we have been wrong, as according to the scientists, eating curry might reduce the risk of getting those inflamed tendons.

Nottingham researchers have suggested that Curcumin, the yellow ingredient in Tumeric, could help people with the inflammation associated with tendinitis and arthritis. Currently, such sufferers often depend on NSAID anti-inflammatory medications - and these are known to increase blood pressure and have adverse effects on the lining of the stomach.

However, Ali Mobasheri, DPhil, of the University of Nottingham’s School of Veterinary Medicine and Science, one of the lead researchers, cautioned that, "Our research is not suggesting that curry, turmeric, or Curcumin are cures for inflammatory conditions such as tendinitis and arthritis. However, we believe that it could offer scientists an important new lead in the treatment of these painful conditions through nutrition." He and his colleagues investigated how Curcumin works in a series of laboratory experiments, and showed that it can block the effects of the chemical that lead to inflammation, confirming the role that it might play in helping to manage these conditions.

Curcumin has been used for centuries in traditional Indian medicine to help with irritable bowel disease and is currently being investigated for possible roles in the treatment of liver cirrhosis and some types of cancer.

Far from suggesting that we add Tumeric to all our meals; if adding a little "spice to life" helps ease those aching tendons and joints, it would certainly be an improvement on burning a hole in your stomach or giving yourself blood pressure!

source: Medscape news

Does a lunchbox keep your childs food safe?

Tweet Here's a fact that you may not have come across, but according to the OzFoodNet, there are over 5.4 million cases of gastroenteritis, or food poisoning, each year in Australia, which is a fairly significant number in anyone's book. And for all of us who have suffered from "Gastro", it's definitely something that we would like to avoid at all costs: and I suspect that is doubly so for all parents of young children who wish to prevent their "littlies" from coming down with a dreaded dose of diorrhoea and vomiting. Well check your child's school lunch box, especially during the summer months, as the food in them may not be as healthy as you'd hoped!

According to a study just published in Paediatrics, the journal of the American Academy of Paediatrics, over 90% of food in lunch-boxes of pre-school Toddlers attending Texas child care centres were deemed to be stored at an "unsafe" temperature: and this included those that had been provided with a ice block to keep them cool. Here are their findings:

• 39% had no ice pack
• 45% had one ice pack

Of the perishable food within the lunch boxes, 88% was at room temperature!
Only 1.6% of the perishable food was within a safe temperature range.

What these figures suggest, is that there is room for improvement in the way we package food for our children's school meals: and certainly, parents and schools need to look at the "cold chain of storage"of their child's school lunches, so that they can reduce the risk of developing food poisoning.

As one young mother said when hearing these results: "No more chicken sandwiches"!

Source: http://pediatrics.aappublications.org/content/early/2011/08/04/peds.2010-2885.abstract

Maintaining a healthy physique in the later decades

Tweet I remember that the last time Sylvester Stallone tried to enter Australia he got into "difficulties" with Customs and Immigration because he was bringing in some "illegal" substances. These turned out to be, again if my memory is correct, injectable Testosterone - a performance enhancing drug - that was for his personal use: and that use was to help maintain his muscle bulk. Well, according to press photographs, the testosterone has worked, and is one of the few treatments available for the inevitable muscle loss that accompanies aging. This muscle loss, known as Sacopaenia, begins around the age of 40 and becomes more pronounced after the age of 75: all the "motor" muscles lose bulk, speed and strength. In fact, scientist now believe that this process is similar to that which occurs in the pathological disease of Muscular dystrophy, because they have deciphered the role that Calcium plays in both process and the method by which it gets into, and out of, muscle cells.

Most of us associate Calcium with bones, but it's a much more ubiquitous chemical in the body and is found in many cell types - especially skeletal and heart muscle. If you can't control the status of calcium within you muscle cells, then it fails and weakens - a finding that the experts at Columbia University Medical Center have confirmed with their research. Apparently it's all to do with leaky ryanodine receptors according to Andrew R. Marks, M.D., chairman and professor of physiology and cellular biophysics and lead reasearcher for the team, who has been studying these receptors since 1989.

 He and his colleagues have developed a drug that stabilizes these receptors - well in mice anyway - and they are currently trialling a similar drug for heart failure, because  these same receptors leak in this condition too.

But back to Sylvester: "Most investigators in the field of aging have been saying that the way to improve muscle strength is to build muscle mass, using such therapies as testosterone, growth hormone, and insulin-like growth factor-1," says Dr. Marks. "But an increase in muscle mass is not necessarily accompanied by an increase in muscle function. Our results suggest that you can improve muscle function by fixing leaky calcium channels. And in fact, treating aged mice .... enhanced muscle strength without increasing muscle size, at least during the four-week treatment period."

So for all of you who got sand kicked in your face earlier on in life, if the experts come up trumps, you might just get your own back when it comes to retirement time.

 Story source: Science Daily Aug 3rd 2011

Potty training: when to start?

Tweet I suppose it must be the fact that we're looking after the grandchildren that has made me ponder on the big questions in life: and probably one of the biggest for all "new parents" is:

When do I potty train my little angel?

From distant memory, I seem to recollect that with child number one, everything was so new and seemed so difficult, and we were so immature and confused by this little human who was nothing like anybody we had ever met before: tiny, totally dependent, and who cried for Australia at the most illogical times! As well as that, we felt really inadequate because peers of mine reported with smug smiles that "their child" slept all through the night the day after they brought "it" home from hospital, and that they had potty trained their infants by the age of 6 months! History reveals, that 3 days after bringing their pride and joy home, they were up 3 times a night for the next 2 years: and the hope of potty training disappeared within 2 weeks, not to reappear for a further 12 months!

By the time number four had come along, we were much more experienced at all this child rearing challenge and we had reached the conclusion that as long as the child was toilet independent by the time they reached high school, then we would be happy! I am pleased to report that he was. But scientists have now put a figure on the age when parents should introduce toilet training to their infant: the experts have declared that "Toilet training should be started when both the child and parents are ready. Both the American Academy of Pediatrics and the Canadian Paediatric Society recommend starting when a child is 18 months old and shows interest in the process."

I like the bit where they state that both the child and the parents should be ready: and although there are no studies to assess the various merits of different types of potty training, it may well be that the carrot and stick approach doesn't give high achieving parents an edge, when it comes to attaining toilet independence for their budding high achieving child; because "In reality, toilet training is a complex process that can be affected by anatomic, physiologic and behavioural conditions."

So 18 months seems like a good ball park figure: the experts seem happy with it: but at the end of the day, it's really up to the parents and infant: good luck!

The lost romance of broken bones!

Tweet It's not surprising that many people feel disconnected from medicine these days: a great deal of the "romance" seems to have gone out of it! I was ruminatinig on this thought whilst keeping up to date on the latest ideas involving how best to manage broken bones.

There was a time when a broken wrist was called a Colles Fracture - after a famous Irish surgeon in the early 19th century, who described the clinical presentation of such injuries long before the invention of Xrays. A Colles fracture classically occurs when someone trips, and falls with their arms out-stretched in front of them, leaving a "dinner fork"deformity caused by the fracture! Now that's something we can all understand and relate to: but the modern terminology is a DRF - or Distal Radial Fracture!

DRF has now "consumed" another lesser known, but equally colourful wrist fracture, the Chauffeurs Fracture! Back in the days before electronic ignition for motor cars, the driver -and in more affluent society, this meant the Chauffeur - had to start the motor with the use of a "Crank" handle. With a hefty turn of the handle, the motor usually spluttered into life. However, it was very important to be very careful, otherwise the engine had a nasty habit of giving a "kick" backwards: this caused the handle to fly back over and fetch the back of your wrist a mighty clout, leading to an almost dinner spoon deformity!

Then there were the Game-Keepers thumbs: these injuries were originally described by a Doctor Cambell in 1955, and arose frequently in Scottish game-keepers who dispatched their rabbits to their eternal reward, by gripping the neck of the poor, furry beast, between finger and thumb and then breaking it! This, naturally, dispatched the bunny, but also lead to injuries to the perpetrators thumbs because of the violence of the action. Ligaments ruptured and bone flakes were torn off bones. Today, our experts talk of "an insufficiency of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb": where's the romance in that!

I suppose that the upside to this loss of colourful names, is a massive improvement in our ability to accurately diagnose and treat these fractures; and to treat them appropriately according the the relevant situations of the person attached to them.

Tea, Coffee and MRSA infections

Tweet One of the scourges of modern medicine is the increasing frequency of antibiotic resistant germs: one of the most well known of these is the Methacillin Resistant Staphylococcus Aureus: better known as MRSA. Once thought to be only found in the hospital setting, we now know that it is also well established in the wider community; although in the majority of cases, it seldom progresses to serious "systemic" infections.

The most common site to find MRSA is in the nose: and obviously, it's fairly easy to detect it there with standard swabs, but the problem has been to find antibiotics to kill, or reduce it's population, and one of the major concerns of health authorities is that no appropriate antibiotics have appeared in the last 10 years to fight these infections! Time,perhaps, for the Boffins to sit down and have a hot cuppa and have a think up new ideas: and that's just what some of them have done. Eric Matheson MD and his colleagues at the Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina published an article in this months Annals of Internal Medicine that showed that hot tea and coffee drinkers had a fifty per cent reduction in the levels of MRSA in their noses, compared to the non tea and coffee drinkers.

It appears that tea does have anti-microbial activity, and it's not just due to the steam coming out of the cup!! Previous researchers have reported that green tea extact has a beneficial effect on MRSA found in the pressure sores of patients in nursing homes: and that mist-inhaled "tea extract" reduces the level of MRSA in the infected sputum of those with chronic lung disorders!

But at this stage, no-one is sure how this happens: it doesn't seem to work with cold tea - perhaps because the concentration of bug busting chemicals isn't high enough - but it's not due to a "placebo" effect either, because they tested all their results against a control with nothing in it! But a 50% reduction in bacterial colonies is pretty impressive, and it seems that the good old cuppa may be another one of those "common sense" things that we can all benefit from, in our life long challenge to maximize our health.

Chronic NSAID use increases heart risk in over 50's

Tweet Recent research from the INVEST study, published in the July 2011 issue of the American Journal of Medicine, have shown that taking anti-inflammatory medication on  a long term basis can double the risk of heart attacks in the over 50's. And it's not just the newer types of NSAIDs (Non-Steroidal Anti-Inflammatory) that appear to be the cause, older types of medications such as Ibuprofen and Naproxen were included in the study.

The study highlights the problems the elderly, and their physicians, face with the use of all medications and their potential for mild to life-threatening side effects: the full "suite" of side effects may not be known until many decades after the medications have been released onto the market. Also, many elderly patients suffer from degenerative arthritis, low back pain and rheumatoid arthritis; and all of these conditions have an element of inflammation which could respond positively to NSAIDs.

One of the outcomes, from my perspective, is that NSAIDs should ideally, only be used for a short period of time anyway, because if they aren't resolving the acute inflammation then they shouldn't be used long term: and the study showed that intermittent users were at no higher risk than non users. There are other disease modifying agents that can be used in chronic inflammation and advice should be sought from Specialists with skills in those areas.

Message: NSAIDs are useful medications that work well short term: chronic use can lead to a range of  complications and should only be used under the strict guidance of a Physician with skills in this area.

Mood Disorders: making a difference

Tweet I was reminded of how each of us can have an impact for good on anothers life, following a phone call I received the other day.

A young man, whom I have known for a long time has struggled for years with a mood disorder: but he has made enormous strides in helping himself by acknowledging that he does have a problem, by seeking professional help AND taking that advice: albeit, as with most mood disorders, the individuals journey is often a roller-coaster of "one step forward, two steps back" and "two steps forward and one step back"!

When we last met, he was almost obsessively reading about his condition and attending meetings that ... discussed his condition! Now, information may be power, but obsession can lead to isolation, so I made a casual remark that it might be a good idea for him to do some regular physical exercise, as there is no doubt that physical activity can have an excellent impact on mood disorder. I also gave him a book on the siege of Lenningrad, - which was a bit "tongue in cheek", to illustrate how relative  the difficulties of life really are!!

I forgot all about this conversation as work buried, and life absorbed me, until last night. Out of the blue I got a phone call from this wonderful guy to say that he'd just finished a 22km "Fun run" and was thinking of "doing" a marathon later in the year! "And by the way, I've joined a running club", which was the icing on the cake as it meant that, although he might be obsessing with running now, he was engaged with a group of like minded, health conscious people who from my experience, tend to be pretty well grounded and know how to enjoy themselves as well as running "painfully" long distances.

It just goes to show, that a little encouragement, or some simple positive advice can make a difference: so if the opportunity arises, then dare to be a force for good.