Aged Care: room for improvement?

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Continuing on with difficult subjects as we progress towards Christmas: this time it's the subject of those infirm, aged people who will spend their Festive season in Nursing Home facilities across the world.

For over three decades I visited patients in Aged Care facilities and have witnessed a massive increase in the quality of care provided during that period of time. My first visits were to what were old houses where the bedrooms contained three or four frail aged who often spent the majority of their time in bed, and the stench of urine pervaded the whole "institution". It was not unusual for "restraints" to be used on more difficult patients, which meant that they were literally tied to their chairs; and there was always at least one patient who would call out a garbled cry with the regularity of a metronome, which in retrospect was probably "help"! Remember, this was at a time when the Berlin wall was still standing, before computers were on every desk, and the only phones were fixed to a wall!

Today in Australia, the modern aged care facility is a bright "village" type arrangement with high care units to look after the most frail residents. Each facility has to undergo regular accreditation and the standards that I observed were of the highest order. But all is not sweetness and light for the aged around the world. In 2008 the Office of Aged Care Quality and Compliance reported that there were 3947 cases probed nationally between July to December 31 2007, and this included cases of serious physical assault, medical mismanagement and failed personal care. Recently in NSW, a fire was started in a Nursing Home and lives were lost as the result of suspect arson - a man has been charged with the offense and is awaiting trial.

In the US, Amber Paley runs a website called Nursing Home Abuse which focuses on the plight of those aged relatives of ours who may be at risk, and gives practical advice on how to ensure that your family member who is no longer able to defend themselves, is treated with the dignity and respect that they deserve. As well as recording the blight of abuses that she has documented, there is also valuable educational and preventative advice on how to best protect your relatives. The Australian Government Department of Health and Aging also has a useful webpage to help those who suspect that abuse may be occurring.

It is sad that abuse occurs, but the good news is that there are 99 good people in the Aged Care business for every one that inappropriately manages their patients under their care. In fact, those who do work with the frail, the deaf, the incontinent and the demented deserve our enormous thanks and respect for what they do and how they do it. Lets give them a present this Christmas when we visit our older relatives, and give them our affirmation and thanks for sharing the final part of so many peoples final journey, with professionalism and grace.

 

Tis the season to be jolly: not drunk

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It's a strange but sad reality, that with each Christmas season, there is a spike in road deaths, suicides, violence, un-planned pregnancies ... the list is a long yet tragic one. One common denominator in all of this is alcohol. I am not a "wooze" as we say here in Oz, but I do know something about the chemistry of alcohol and its effects on the human body - particularly the brain - and alcohol can best be described as having a very narrow "therapeutic index". What this means is that, like Warfarin which we use to "thin the blood" in people with certain medical conditions, just enough is OK, but too much can be lethal: and with alcohol, if you exceed the recommended "dose", you might be putting your life at risk.

After a couple of standard drinks, the effects of alcohol become depressant and start to anesthetize the brain: too much can lead to coma and death. To counteract this drowsying effect, there is a trend amongst young people to mix alcoholic drinks, and other so called "recreational" drugs,  with Energy Drinks. This has led to a spike in Emergency Room admissions in the US, and worldwide concern amongst health care workers that the "collateral damage" from these sorts of Caffeine/alcohol/drug combinations is going to get worse this Christmas.

Apparently the rationale behind adding caffeine to alcohol is that it makes the user feel less drunk: the reality is that  "You're every bit as drunk, you're just an awake drunk," according to Mary Claire O'Brien, associate professor at Wake Forest University Baptist Medical Centre in Winston-Salem. In her 2006 study published in Academic Emergency Medicine, she showed that students who mixed energy drinks with alcohol got drunk twice as often as those who consumed alcohol by itself, and were far more likely to be injured or require medical treatment while drinking. Energy drink mixers were more likely to be victims or perpetrators of aggressive sexual behavior.

According to a report from SAMHSA in the US, "Studies indicate that excessive caffeine intake from energy drinks can cause adverse reactions, such as arrhythmias, hypertension, and dehydration. Combining energy drinks with substances of abuse raises the risk for serious, even life-threatening, injury and for the likelihood of engaging in risky behaviors, such as driving under the influence."

We need to let those young people who down their "alco pops" - or other energy drink/alcohol/drug combinations - and go out "clubbing", know that they might in fact end up dancing with death: theirs, or one of their friends.


So lets celebrate Christmas with clear heads, not hangovers: and may the only one with a red nose be Rudolf!
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New tools to fight infections.

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I know someone who has an implant known as Deep Brain Stimulator, and which has given him significant relief from advancing Parkinson's Disease. He's in his early 60's so it's enabled him to remain reasonably active and to enjoy one of the great pleasures of his life, gardening. However, recently he had a fall in the garden and cut his leg in several places, and for a time there was a real fear that if the wounds became infected, then bacteria could spread to his implant and create a Bio-film on the surface. Unfortunately, the only way in which this sort of infection could be “got rid of”, was by removing his implant. If that happened, then he would literally freeze and not be able to move. It would devastate his life.

One of the challenges of modern medicine is to be able to counter the effects of Bacteria that not only cause serious infections, but have the ability to colonize metallic surfaces and are all but resistant to every known antibiotic, and it’s this ability of bacteria to create bio-films that is the cause of the problem. But all this may be about to change.

Science reports this week of some interesting information on why bio-films become resistant to antibiotics and provide clues as to how Doctors can use this information to allow antibiotics to work effectively.

Apparently it’s all to do with the need for nourishment, without which all things will starve, including bacteria. In a bio-film, the top layer of bugs consume the food first leaving the inner bacteria literally starving, but lead researcher Dr Dao Nguyen and his team discovered that these starving bacteria are the ones that are virtually impossible to kill. Scientists have known for some time that when bacteria sense that their nutrient supply is deteriorating they “issue a chemical alarm”, so Nguyen and his team devised an experiment to see if this was also the way that the bacteria developed its antibiotic resistance: and it looks like it is.

“Our experiments suggest that antibiotic efficacy could be increased by disrupting key bacterial functions that have no obvious connection to antibiotic activity” he reports.

In another unrelated report, Nano-Scientists have produced a biodegradable particle that has an electrostatic attraction to bacterial cells, and not healthy human cells, disrupting their cell membranes and killing them. This opens up alternative approaches to treating infections without the need to use discover more powerful antibiotics.

It looks like life is going to get fairly tough for those pesky bacteria in the near future, and not before time too!
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Cholesterol control gets new boost.

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High cholesterol has been known to be a risk factor for Coronary Heart Disease for some decades now. But the sorts of medications that we take for cholesterol and what are their possible downsides has also concerned Doctors and patients alike. Well, there's some good news for those who take Statins, and also hope for a new, potential weapon in the war to rid the coronary arteries of life threatening Cholesterol plaques.

A report from the Heart Protection Study published recently in the Lancet has shown that Statins are both safe and effective when taken long term. They followed a group for five years initially and found Statin usage reduced major heart events by 23% in that period. Post study, they followed patients up for a further 11 years and found that patients maintained the lower risk rate, but there was no increase in other health areas such as cancer. So Statins do reduce risk and they don't cause Cancer - and that's got to be reassuring for the millions who take those medications.

But despite Statin usage, some people still have a coronary event, despite "doing all the right things", and some Cardiologists will often shrug their shoulders and say "Blame your genes", which is a good line, but not very helpful!

As most people know, Cholesterol is the name for a family of fats that circulate in the blood stream: and like all good families, most are OK, but some are the "bad guys". In the Cholesterol family, LDL is the bad guy and HDL the good guy. Statins generally work on lowering LDL but don't do a great deal to raise the HDL - although Roscuvastatin does a pretty good job -. Enter cholesteryl ester transfer protein (CETP) inhibitors as cardioprotective agents! These medications lower LDL but also really give a boost to HDL, and the theory then goes that this will reduce the Cholesterol plaque burden within the Coronary arteries where heart attacks are born.

Like many new classes of drugs, the first up effort wasn't the greatest and the Torcetrapib trial was rapidly brought to a premature halt. However, Anacetrapib and Evacetrapib have both been shown to hold great promise in achieving their targets of lowering LDL and raising HDL either alone or in combination with a Statin.

The big question is: will this lead to a reduction in cardiovascular "events" - heart attacks or death? Watch this space!

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Middle ear infections: Nasal Sprays beat antibiotics

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One of the downsides to medicine having access to antibiotics, is that all too often we get to use them ... for the wrong reasons! There is also the trend, covered in a previous blog, for patients to ask for a "really strong" antibiotic, instead of asking for the correct antibiotic!

I was reminded of this when reading about a study from California and recently presented at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting. In a relatively small study of children with a history of allergy, Dr. Nsouli and colleagues compared the effects of an 14 day course of antibiotics - amoxycillin and clauvulinic acid - with a 14 day course of an aqueous nasal spray containing the steroid Ceclosonide.

Their findings revealed that the Spray worked in 8 days, whereas the antibiotics took 14 days!

The problem with middle ear infections in children is a combination of size and obstruction: but it has nothing to do with the ear that we see on the side of the head - which Doctors call the outer ear. That the problem appears to lie within the external appendage is compounded by the fact that Doctors look into the Outer ear, in order to view the eardrum and thus confirm their suspicions of a Middle ear infection, which they do when we see a red ear drum bulging with fluid within the Middle ear.

Now the real reason the fluid is trapped within the Middle ear is because the Eustachian tube, that connects the back of the nose with the Inner ear is blocked - usually by the swollen, inflamed membranes of the nasal passages. But most Doctors don't look up the nose of a child because it's already blocked with yellow/green mucous,  and so patients often find it difficult to connect the idea that in order to fix the ear, you have to squirt something "up the nose"!

Dr Nsoulis study is another resource to help convince both patients and Doctors that in the case of middle ear problems, where there is a history of allergy, then inhaled nasal steroids are much the better option than repeated doses of antibiotics which, if truth be known, only lead to increased bacterial resistance of pathogens within the rest of the body: and that's not good medicine for anyone!

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Another insight into Malignant Melanoma

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The first patient I ever saw as a medical student was a Dentist in the UK who had terminal, metastatic Melanoma: it wasn't a pretty sight and one that has stayed with me for nearly 40 years! Melanoma is still on the increase and is one of the more common amongst young people: there has been a staggering 50% increase amongst women under the age of 30 since 1980, so any advance in its research and treatment is to be welcome.

Apparently there is a gene called BRAF that is implicated in the spread of Malignant Melanoma, and one of the proteins associated with that gene - P-Rex1 (sounds like a pop group) - is found in higher levels in those with advanced disease. Now scientists have developed a drug that blocks this protein which so far has had beneficial results in experimental models, and has also shown significant survival benefits in human clinical trials.

This is not the end of the story by a long way, but may be the end of the beginning for our understanding where P-Rex1 protein fits into the overall picture, and how Melanoma spreads around the body. From this scientist will be able to develop more targeted treatments so that Melanoma can join all those other cancers that are now in decline, or being managed so much better.
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Soft drinks not so kool?

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Non diet soft drinks have been around for decades in the developed world, and what was once deemed a luxury is now casually bought and consumed, often without any awareness of the action. But dieticians and health workers have been concerned for some time about the current calorie binge in the "West" and in the developing world, and it's connection to the epidemic of worldwide obesity. One element of the excess intake of calories has been the universal availability of high sugar content, carbonated soft drinks, and many health education programs are focused on reducing the consumption of such drinks.

A report out of Boston has raised another possible negative link relating to carbonated soft drinks, and this time it's an increased rate of violence amongst teenagers in those who consume large amounts of such drinks. David Hemenway, MD, professor of public health and director of the Injury Control Center at the Harvard School of Public Health, Boston, Massachusetts, and his colleagues reviewed self reported data from 2725 teenagers (self reported data always makes me a bit dubious about any conclusions drawn from them) in the Boston Youth Study: and his findings are sure to stimulate debate for some time to come.

What they found was that teenagers who consumed more than five 12oz (350mls) of carbonated soft drink per week:

• Were more likely to carry a weapon, and
• Were more likely to be violent towards siblings, dates and friends.
• Were getting insufficient sleep and 
• Were using alcohol and tobacco within the past 30 days.

And of concern was the fact that nearly one in three reported that they consumed more than five cans of carbonated drinks per week. Interestingly, the authors did not report a link with obesity.

Soft drinks not only contain carbon dioxide dissolved in water, but they also contain
high fructose corn syrup, aspartame, sodium benzoate, phosphoric or citric acid, and often caffeine, so should the link be confirmed the next question would be "Which one(s) is(are) the culprit(s)"? But we shouldn't jump to the conclusion that soft drinks must be the "root of all evil" and legislate to ban them on the findings of this self reported research. But perhaps we should try to view carbonated soft drinks as something quirky to be tried on occasion, and not the first thing to quench a thirst when walking through the Mall: in many respects, iced-water is a much better choice.
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Future shock for teenagers?

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Oh dear! A few years ago there were headlines declaring that the current generation would not live as long as their parents because of premature heart disease. I have to admit that at that the time I thought that there was an element of truth in the statement, but kept my head down when there was a "backlash" suggesting that this was too "emotional" a statement and would be counter-productive.

But it seems that Donald Lloyd-Jones, M.D., chair and associate professor of preventive medicine at Northwestern University Feinberg School of Medicine, has decided to stick his head above the parapet and declare that as far as the current generation of US teenagers is concerned, "The future is bleak"! When it came to the established risk factors for heart disease, none of the 5,547 children profiled in the study fitted the criteria for ideal cardiovascular health: now that seems scarey! But before we think that our teenagers are letting the side down, I vividly remember attending a conference 10 years ago where the lecturer went through the list of cardiovascular risks and asked attendees to keep their hands up if they fitted into each criteria. With each new criteria, more hands went down: and by the end, ther were only one or two hands left up! And these were all Doctors!

But back to the teenagers: their biggest downfall was diet, which appears to be terrible with high sodium and saturated fats. Then approximately a third of them had higher than normal cholesterol, blood sugars and were overweight or frankly obese! Amazingly, considering all the health information regarding tobacco, 25% of them reported that they had smoked in the past month.

The conclusion is not that these teenagers are a lost cause, but rather that we must look at new ways of getting health information through to them so that they can maximize their health and their lives.  This is a complex challenge and one that perhaps should start with the idea that the easy option is not always the smartest or best option.

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Can Cheese affect your Cholesterol?

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Being one of those people with very few risk factors for heart disease, but who have had stents and also by-pass surgery, I tend to be fairly fanatical about “living the great life” with lots of exercise and fantastic food prepared by the young bride! But there are a few things that I have missed and secretly yearned for over the years, and one of them is Cheese!

Don’t get me wrong: I love what I eat and I never think of it as “healthy” eating, but as awesomely delicious and nutritious food. But there’s something just a little indulgent in say a fine grating of cheese on, perhaps, a sliced zucchini slipped under the grill until it is browned and then eaten whilst still hot!

Well, maybe that little indulgence could become a hope and then a reality because some kind physician at the University of Copenhagen in Denmark has looked at the effects of cheese and butter on Cholesterol levels. The results were that Cheese caused no increase in LDL or total Cholesterol, but with those who consumed the butter had a 7% higher level of LDL. Why there is a difference between cheese and butter is yet to be decided, but it may be to do with Cheese’s relatively high level of Calcium that may affect the excretion of fat by the gut.

But be warned: this does not mean that people with known heart disease should start loading their plated with seven different varieties of Cheese: it just means that once this research has been reviewed and expanded upon, if the Danish findings are confirmed, then that little morsel of Cheese will taste even more delicious.

And finally, just a quick “pat on the back” for our cousins across the ditch - as we in Australia describe New Zealanders! Apparently Kiwi fruit is better at lowering blood pressure than the good old apple a day: so well done guys! The downside is that you have to eat 3 of them a day - and they are pretty “tart” at the best of times! I think I’ll stick to Pomegranate juice!
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Unexpected Hormone supplements?

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I remember reading a newspaper article back in the '70's about strange events in the fish population of the Great Lakes: apparently the male fish were becoming feminized and it was thought to be due to the increased amounts of Oestrogen flowing into the giant waterway from the urine of women now on the Oral Contraceptive Pill.

This fact returned to me the other day when reading an article which highlighted the possibility of a link between the increased rate of Prostate cancer with the OCP. David Margel, MD, from the Princess Margaret Hospital, University of Toronto, Ontario, Canada reported a demographic study where he and his colleagues found that in areas with the highest use of the OCP, there was an increased rate of Prostate Cancer. He also stressed that this was an "observational" study and no way intended to link the Pill to Prostate cancer, or to suggest that women should come off the Pill: but it does open a window onto an area that is murky to say the least.

There have been many environmental reports over the years on how synthetic organo-chlorines, PCBs and Dioxins have had adverse effects on fish, reptiles and amphibians. Spare a thought for the poor, confused, male Cricket Frogs in Illinois, where 9% of their confreres, instead of having two testicles, have one testicle and one ovary! And 90% of male Tiger frogs had eggs in their testes!

But can synthetic hormones that are found in the OCP find their way into the waterways and cause environmental problems? The answer is yes: but 90% of those synthetic hormones do NOT come from humans, but from cattle! Also, most of the synthetic hormones from humans do get removed from the water supply through current sewage treatment management. The problem is that the largest offenders - cattle - tend not to use toilets and their urine and faeces eventually ends up in the waterways.

Finally, the link to prostate cancer is curious as we commonly use Oestrogens to help suppress the growth of Prostate cancer, so how does this theraputic medicine become a driver of malignancy? These uncertainties should remind us that this latest study is an "Observation", and not meant to point a finger. So, for me, this report is a timely reminder that as we develop these powerful medications to help us fight disease, we should constantly be thinking of what happens to medications and their metabolites, once they have gone through the body - think antibiotics, chemotherapy medications, radioactive tracer dyes used in Radiography and now the latest medical treatments using Nanoparticles - and perhaps even more importantly, that most of these medications will have been used in farm animals for many years before they are released onto humans!
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Adolescents, Hamsters and Sex.

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  I learn something new about our bodies each day! For instance, today I discovered that our human physiology is quite similar to that of a Hamster: this interesting fact surfaced when reading a stimulating article which raises the possibility that, for young male Hamsters at least, sex during adolescence can have a lasting negative effect on the body and mood well into adulthood.

It is now becoming more clear that the developing brain remains “plastic” well into the third decade of life, and so it can be vulnerable to permanent changes as a result of negative impacts during this time. That sex can be seen to be negative may seem odd to many people who think that sex sells everything, but there is no doubt that it can be a very complex emotional and physical event in the life of an individual when their nervous system is in a state of continuing evolution.

But is appears that adolescent sex in our furry friends can have the following effects:

• Increased signs of depressive like behaviors
• Lower body mass
• Smaller reproductive tissue
• Changes to cells in the brain

This would appear to suggest that for some sexually active “teenage” Hamsters, sex can be a serious stressor. 

Whilst there is a real temptation to smile at the extrapolation of teenage Hamster sex to adolescent humans having sex, there is a serious side to the findings. The teenage years are a time when the nervous system is developing and changing very rapidly and “There is a possibility that environmental experiences and signals could have amplified effects if they occur before the nervous system has settled down into adulthood”, according to co-author Zachary Weil of Ohio State’s Department of Neuroscience in a paper delivered to the November meeting of the Society for Neuroscience.

Definitely food for thought.

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Another plaudit for Pomegranates

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It doesn't seem all that long ago that I was having a long lunch one Sunday with a delightful ex airline pilot who was extolling the benefits of Pomegranate juice. He was telling me that it had great benefits for older men faced with prostate dis-ease! Since then I have discovered that the experts also tell us that it helps with lowering blood pressure and is "anti-aging" (whatever that might mean!)

Well, now there's another benefit from this ruby juice that originally hails from the hills of Afghanistan.According to Batya Kristal, MD, MHA, from the Nephrology Department at the Western Galilee Hospital in Nahariya, Israel, patients in her renal unit who were given the juice over a one year period experienced lower blood pressure, an improved lipid profile and required less anti-hypertensive medication!

Obviously with reports like this one does have to look behind the genuine enthusiasm of the researchers, and in this case the study was small and the results would only apply to patients with severe kidney problems. Also, Pomegranate juice is high in potassium, a salt that tends to accumulate in kidney disease and if not monitored closely could lead to serious consequences.

But it is reassuring to note that the juice did lower blood pressure in people who have naturally higher blood pressures because of their kidney problems. Also, when looking at how the "Lipid profile" was affected, it seems that not only did the bad Cholesterol go down, but the good HDL Cholesterol went up: and there are few safe things that I know of that can raise the good, cardio-protective HDL Cholesterol.

So as well as flossing my teeth for good gum hygiene, taking regular effective physical activity, eating lots of salmon, veggies and fruit, but avoiding animal fat whenever I can, I will be adding 100mls of Pomegranate juice to my daily regime: perhaps it will help wash down the handful of walnuts that I have with my brekky!!

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More bad news for Marijuana

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For many years the proponents of Marijuana have said that it is essentially a “safe” recreational drug. Sadly, nothing could be further from the truth! In fact, even all currently so-called legal mood altering substances, from caffeine to alcohol, can have serious health implications.

Putting another nail in the coffin of the marijuana myth is a report in the November issue of the British Journal of Psychiatry with lead author Killian Welch saying “"It is now accepted by most psychiatrists that smoking cannabis increases an individual's risk of psychosis, and more specifically schizophrenia." But his findings go a step further and state “People with a family history of schizophrenia are particularly vulnerable to the psychotomimetic effects of the drug, and are likely at particular elevated risk of developing schizophrenia if they use cannabis."

For many young people however, a significant proportion of them would be ignorant of the fact that they had a “family history” of schizophrenia, and with the prevalence of the drug socially, may be tempted to use it. Sadly, early “experimentation” with such drugs could lead to a lifetime of mental health problems with all the emotional and social burdens that they entail.

Dr Welch study was unique in that it also found that those with a family history of schizophrenia and who used marijuana had a demonstrable reduction in size of the Thalamus, a key area of the brain, responsible for information processing: or as one headline shouted:

SMOKING POT SHRINKS THE BRAIN

I think the simple message is that nothing illegal is likely to be good for you when it comes to mood altering medications, and even if it is legal, you still need to be extremely cautious about using them.

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Alcohol and sleep disturbance

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One of my happy memories as in Intern is the ward Sister on one of the wards where I worked. In those days of open Nightingale wards with 10 patients down each side and Sister very much in charge of everything, "Frankie" ruled supreme!

One of her great delights was hidden in the linen cupboard. Here amongst the sheets and pillow slips were to be found two large Winchester bottles containing hospital grade brandy! What she did was to get the Interns to order a "wee dram" of Brandy for all the elderly ladies on the ward - and that meant 90% of the patients - which was duly administered in a cup of warm milk .... minus about 5mls of the prescribed "dose". Over a period of months she managed to fill two Winchesters that she kept for the Staff Christmas party, which was always a roaring success!!

Since then I've always been under the impression that a small drop of spirits was the least offensive form of night sedation for the elderly: but sadly recent research may be proving me wrong. What the researcher found was that sleep quality ratings were worse for those drinking alcohol compared with those who received a placebo drink in the trial. And women who drank alcohol suffered more sleep disruption than their male tipplers!

The only thing that I can say about the study was that the researchers got their subjects to drink until intoxicated, something any self respecting senior would reject with great indignity! In fact the study reinforces the serious downsides of drinking outside ones safe individual limit -as a rule of thumb that means one to two standard drinks for a woman and two to three for a man, allowing for size variations, medications, illnesses etc -.

What I'm looking forward to is the result of a trial where those with mild sleep disturbances are enrolled and one group gets the "Hot Toddy" and the other gets the Warm Milk: anyone interested?

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CPR- the Bee Gees and Nellie the Elephant!

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I've booked myself in for a refresher in CPR this week which is a skill that I think everyone over the age of 16 should have. I must admit to having a vested interest, having already needed coronary stents and then a double bye-pass before the age of 60 - and I live a healthy life! The experts tell us that for those who have a heart attack away from a hospital, the earlier CPR starts the more likely that the patient will eventually leave hospital.

But CPR isn't just jumping on someone who's collapsed and starting to heave up and down on their chest. It is critical that if it is to be effective then the rate must be correct and the depth of compression must be consistent and effective too if it is to do any good.

For some time music has been thought to be a great adjunct in getting the timing right, but should you chose "Staying' Alive" by the Bee Gees, or if you're from the UK, then "Nellie the Elephant" seems to be the ditty of choice!

Unfortunately, the experts now tell us that whilst the music might help keep you in time, it doesn't help with the correct depth of compression, so it's back to the drawing board - or should I say, the studio!
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Dry skin.

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I've just come in from doing some work in the garden, taken off my gloves, washed my hands and now my skin feels as dry as sticks!! 

One of the age old challenges that we humans have faced is how to preserve our skin in a prisitin condition. Companies have founded fortunes and dystanies on making and promoting various skin care products: each year women and increasingly men, spend billions of dollars worldwide in an attempt to keep their skin "soft and smooth" -but as the poet said: "It ain't easy"!

From the picture above you can see how complicated the whole "skin thing" is, and to imagine that a simple cream could fix all the problems that the skin has to deal with would be stretching ones imagination to the limits. 

The top layer of the skin is composed of dead cells and these are the only ones that we can directly affect: and in that respect it's a bit like "waking the dead"! The idea of moisturizing cream is to deliver water to those dead cells and trap it there so that they can rehydrate and swell, thus reducing the "fissuring" and cracking that can occur in dry conditions. Many moisturizers contain perfumes (in order to value add them -for that read, it makes them more expensive!) The problem with that is that some people are allergic to perfumes which can make "dermatitis" sufferers for instance, worse off than they were before. So in my book, the best "bang for your buck" is a simple combination of Sorbolene and 10% Glycerine: this is a good basic cream and eminently effective.

The problem we also face as we age is the loss of collagen in the lower parts of the skin. This leads to loose skin and wrinkles, and boy would I love to find an answer for that! And when it comes to loose thinning skin, one of the fashion trends of today that worries me when today's youth become the older generation of tomorrow, is the explosion of tattoos, or body art. They may look cute on healthy young skin, but believe me, in 20 or 30 years time when they begin to sag, it's not going to be a pretty picture.

So protect your skin as much as you can: use sunblock to stop the ultraviolet light damaging your dermal collagen: avoid soap where possible as that is very drying and use plenty of moisturizer. It's not the secret of eternal youth, but it will help!

If you have any special tips though that work for you - please feel free to share them: I'm all ears!

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The magic of Mozart

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Its called the Mozart Effect and now it's been found to help Colonoscopists become more efficient at detecting precancerous adenomata in the bowel.

But first the Mozart effect. This refers to a set of research results that found listening to Mozart's music may result in significant short-term improvement in spatial temporal reasoning - in other words you operate better and become more efficient in what you do!

Colonoscopists are those medical experts who spend their lives peering into the part of the body that the rest of us try to forget about: the bowel, or as the experts call it, the Colon.

An Adenoma is a small lesion that can grow in the wall of the colon and in some cases can lead on to becoming a cancer. In fact the more you have, the greater the chance that one of them will "turn" into a cancer.

A new study unveiled at the American College of Gastroenterology's (ACG) 76th Annual Scientific meeting in Washington found that adenoma detection rate increased from baseline values with music compared to without music. If you extrapolate that, then you will find more cancers earlier and save more lives, as the survival rates for the early detection of colorectal cancer exceed 90 percent.

So don't worry if your colonoscopist plugs in his headphones and appears not to hear what your saying, it's just hers or his way of saying that he's getting some help from Mozart!

PS if you listen to Mozart whilst you read this column, you're more likely to remember it too!