Friday, September 30, 2011

Hay fever

Hay fever is a fairly common problem with one in five people being affected by it, and there's no known cure! Put simply, the grass pollen is the gamete of the grass and is trying to mate with the lining of your nose and eyes: and neither your nose nor eyes are very pleased with the idea and consequently react to the promiscuous pollen!

The problems is that if you suffer from hay fever, then this happens every year and every time your neighbour decides to cut his lawn. So, apart from closing your windows and hoping that you can reduce the volume of pollen trying to inflame your nostrils and irritate your conjunctiva, then you may have to rely on symptom control to make life more comfortable. This would include

  • Nasal steroid sprays
  • Non sedating anti-histamines
  • Very short term nasal decongestants
  • Others such as intra-nasal Cromolyn sprays: Singulair

For those who are looking for longer term solutions for their children, then there is the choice of "Immuno-therpay" in the form of weekly subcutaneous injections or sub-lingual drops for three to five years! And getting little children to have weekly "shots" is a big ask for most parents. 

Sublingual - under the tongue - therapy has been around for a long time and up until now been a weekly treatment, in season and out of season. But there may be some relief to this regime as according to an article in the September issue of Pediatric Allergy and Immunology the therapy may not have to be all year round, at least not after the first year. 

The researcher found that in the first year, continuous therapy was 20% better than the coseasonal therapy - therapy given before and during the hayfever season. In the following years however, both therapies produced similar results. This isn't a cure, but should make life a little more comfortable, less intrusive and less expensive for all concerned. Talk to your treating doctor about it. 

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Wednesday, September 28, 2011

Good news for female coffee drinkers

I recently wrote an article on the multiple health benefits of physical activity: according recent research, coffee may be chasing exercise in the health benefits stakes!

A Harvard School of Public Health researcher has just released data following a group of 50,000 women over 10 years and found that those who drink 2 to 3 cups of coffee a day had a 15% decrease in the risk of depression. For those who drank 4 cups per day the rate was 20% risk reduction!

As usual, there are still questions to be asked. As the results were "observational" and not "double blind" studies, the results will be good for promoting further debate and research, but not good for basing Public Health standards on. Also, the group were women with an average age of 63, so there is no data on the weaker sex! They will, no doubt, sip on their red wine and hope that they have chosen the right beverage for them.
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Monday, September 26, 2011

Faith in good health

Here's a report that probably wont make it to the front pages of most newspapers. It's a literature review on the impact of spirituality/religiosity on mortality, and comparing it with other health interventions.

What the researchers from Sao Paolo in Brazil did was to identify 25 well recognized Health interventions and then performed a Medline review for these interventions for the years 1994 to 2009: they then did a similar review for studies on religiosity and spirituality  for the same period. They came up with 28 meta analyses and found that people with a higher religiosity/spirituality had an 18% reduction in mortality. This was better than 60% of the other Health initiatives.

To put this into context, having a religious or spiritual belief is as effective as taking a Statin or aspirin for heart disease, and is more effective than having airbags in cars or undergoing colo-rectal screening for bowel cancer.

Whilst I have no doubt that this report will not convince those who find it hard to "believe" that science is more than a well informed mystery, it certainly does put some hard facts behind the idea that we could all do with a little more "faith" sometimes!
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Thursday, September 22, 2011

It's a bugs life!

Ever had the feeling that you shouldn't have done something really dopey? Well, when it comes to decision making, you may not be in as complete control as you thought you were. And that brilliant immune system of ours that's supposed to detect and delete all those germs that threaten our existence: has the "enemy" infiltrated it and is it quietly controlling how it functions?

The answer to both those questions is literally under the microscope, and the particular microscope of Prof Eric Denkers, a Veterinary Immunologist in the USA. He's been studying a ubiquitous germ called Toxoplasmosis gondii, that he charmingly describes as " especially promiscuous parasite", and which infects all warm blooded animals and most of the human population. Most of the time is quietly co-habits with its host organism, living peacefully within muscle or brain cells. However, if the host's immune system is deficient, then it can cause serious problems.

But it also has the ability to alter brain chemistry with jaw dropping results! In rats, for instance, it alters their brains activity in such a away as to make them fearless of cats - not a particularly smart move - as the cats always win and eat the infected rats allowing the Toxoplasmosis to enter and live in its favoured breeding ground, the intestine of the cat!

But it's influence on the immune system that has attracted Dr Denkers attention. In the past it was thought that Toxoplasmosis just sealed itself off from the surrounding environment and lay dormant. Now it appears that it actually modulates the immune cells ability to release a chemical known as a Cytokine, and which is the key to creating an inflammatory response. Too many Cytokines are not good for Toxoplasmosis as they attract more immune cells and that may lead to eradication of the organism. Too little Cytokines and the body's survival could be threatened from other infective organisms. It appears that Toxoplasmosis plays the immune system like a violin!

The up-side to all this is that this research is revealing how the immune system operates and the various "chemical signaling" systems that it uses in order to control and contain infection, and this will lead to new treatment options in the future.

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Wednesday, September 21, 2011

Hallucinations, vegetables and memories.

I was "grazing" through Medscape the other day - it's one of my online medical education resources - and came across the following case presentation: "A 12-year-old boy presented for psychiatric evaluation. He was referred by his school nurse because he had been describing complex visual hallucinations to his classmates. He reported seeing cartoonlike scenes of zucchini dressed like cowboys shooting at each other and eggplants dressed like clowns engaged in slapstick and acrobatic activities. He knows that these visions are not real and finds them mildly amusing and somewhat entertaining rather than threatening. He has had the visions intermittently, several times daily, over the past 3 months. The visions are purely visual and not accompanied by music, voices, or other sounds."

My mind went back to student days when I was attached to a psychiatric hospital and one of the patients was building a 12ft carrot for some reason that I now forget! But it reminded me that hallucinations happen, and when you first meet someone who is having them, you are almost convinced that they might be telling the truth! One long distance truck driver I looked after was overdoing the "uppers and downers" and was admitted to our small country hospital with hallucinations. When I visited him, he pointed out the window to the little men who were running along the telegraph wires and some were even riding small bicycles: I found myself looking out the window to see if I could see them too!

According to the authors at Medscape: "Hallucinations or perceptions in the absence of identifiable external stimuli are thought to reflect psychosis and underlying serious psychopathology. Hallucinations in children may reflect normal development or response to psychosocial stress, but it is important to rule out an underlying physical illness as well as to evaluate for psychiatric conditions."

The young lad at the beginning of this piece was found to have a small benign lesion in his brain that was removed at surgery and ended his hallucinations. His story had a happy ending, but many others suffer from life long psychoses that require medication and for them, life is not so funny.
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Tuesday, September 20, 2011

Chondroitin Suplhate gives a helping hand!

Our hands are amazing structures: works of art really. They have the ability to perform amazingly fine work, and yet when clenched into a fist, can bludgeon a man to death! For most of us though, they fulfill our need to grip, squeeze, hold and manipulate objects without ever having to think about them. Until, that is, they start to malfunction at which point we suddenly realize how precious normally functioning hands are.

Inflammatory arthritis affects many joints of the body and the hand is one of the more common sites that it can flare in. Generally speaking there is no "cure" for the problem, but relief can be found from divers treatments:
  • Simple analgesia such as paracetamol
  • NSAIDs
  • Steroid joint injections
  • Disease modifying medications for those with Rheumatoid Arthritis
The "market" for alternative treatments is fairly healthy too with promoters offering, amongst other things,  copper bracelets and magnets to help sufferers cope with their pains and morning stiffness.

One of the alternative therapies - Chondroitin Sulphate - has just been found to help in reducing pain in inflammatory arthritis of the hand, which is good news indeed. But before you scour the Net for your supple of Chondroitin Sulphate for your painful hands, here are a few more points to consider:

  • It took 3 months of treatment before its beneficial effects appeared: NSAIDs work almost immediately.
  • The size of the trail was relatively small and would need a much larger trial to confirm the findings.
  • It had no significant impact on morning stiffness of the hands.
  • It did not improve the grip strength in the hands.
  • Chondroitin Sulphate is generally well tolerated but does have a mild anti-coagulant effect so sohuld be used with care by those already on "blood thinners".
But bearing all that in mind, if I had stiff painful hands and was looking for an extra 10% of relief, I'd be searching the Net right now!

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Monday, September 19, 2011

Shoulders - you're 'armless without them!

Being a rugby tragic, I was both despondent and delighted with Australia's loss to Ireland at the weekend. Despondent, because the Aussies played without much passion and delighted because the "young bride" is .. Irish! Reading all the comments in this mornings papers, I was concerned that injuries are already starting to play their part in the competition, and in particular, the Australian Captain was reported as having an MRI on a suspected shoulder injury, which thankfully, is not thought to be serious.

The shoulder joint is a very mobile, and inherently an unstable joint between the Humerus - which is the bone of the upper arm - and the Scapular, or shoulder blade. Together they form a part of the Shoulder Girdle along with the Clavicle - or collar bone - that also articulates with the Scapular, but is also relatively unstable though far less mobile than the "humero-scapular" joint. The purpose of the Shoulder Girdle is to provide a support and brace for the arm as it carries out it's various essential functions to feed and forage for the rest of the body.

The shoulder joint allows the arm to move in many directions and there are muscles attached that provide the power and dexterity to achieve such movements. As I sit here typing I am aware that most of the activity in my shoulder muscles is occurring in the pectoral muscles, which are tending to pull my shoulders forwards in a "hunched" fashion. In fact, I am pretty sure that the muscles that are intended to pull my shoulders back must be fairly flimsy by now, as most of the work I perform these days is in front of me,  and unless I consciously think about it, my shoulder posture has become .... "rounded", to use polite terminology!

Also, as a callow youth, I too indulged in contact sport and can remember injuring both shoulders as a result: put past injury together with current poor posture and the result can be pain, limitation of movement and even the need for surgery. Luckily for me, after such surgery to one shoulder some years ago, I met a physiotherapist - Justin Barich - who gave me some fairly basic points on posture and some exercises to do for the rest of my life, that have helped me avoid having to undergo surgery on the other injured shoulder, because, believe me, shoulder surgery can be very, very painful!

The moral to this tale: respect and protect your shoulders, and if you do need advice on how to maintain good balance in your shoulder muscles, then talk to someone who has the right experience and that, for me, is an accredited sports physiotherapist.

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Thursday, September 15, 2011

Cow juice, not malt extract.

Its going to be a challenge, but I think it's worth a try!

One of the biggest worries that parents have about their teenage offspring is about them drinking alcohol. I do not subscribe to the prohibition idea, but I am passionate about responsible drinking: but like most things with young people, if you take something away from them, then you have to offer an alternative.

Now we all know that alcohol and teenagers can be like putting a match to petrol, but we should also remember that the long term implications of alcohol also include cancer as well as the many other social disasters that accompany its abuse.

So here's the challenge: how to make milk more attractive to teenagers, especially young women,  because a recent Harvard University Study published in the American Journal of Clinical Nutrition found that milk-drinking teenage women, were also likely to be milk-drinking adults, and they have a 43 percent lower risk for type 2 diabetes compared to non-milk drinkers.

Just by making the choice to have three servings of low fat milk a day instead of alcohol will reduce your risk of cancer and type II diabetes: now that seems to be a pretty good choice to me.

Now lets get smart and work on convincing the teenagers that it was their idea in the first place!
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Wednesday, September 14, 2011

Kangaroo Care

I'd never come across this expression before, but having just seen a mob of grey marsupials bounding through the bush just north of Perth, my eye was caught by the expression when reading about how Mums are a tad better at reducing their "Prem" babies perception of pain than Dad's are, when using "Kangaroo Care".

Firstly, the research comes from the McGill University School of Nursing in Montreal, and Dr. C. Celeste Johnston who looked at how babies reacted to having blood taken in the Premature Baby Unit of the Maternity hospital. They reviewed the babies responses when having blood taken from a heel prick, with the babe being held by either Mum, Dad or just lying in the cot. They graded the facial expressions of the babies and gave them a score out of 21.

Now to the Kangaroo Care: this is so simple,it's beautiful! The baby just wears a nappy and is held against Mum or Dads bear chest whilst the two of them are wrapped in a sheet - so the baby feels the warm skin of a parent - just like Skippy!

In fact there was very little difference between the two parents when it came to who "won", but they were both well ahead of the poor mite being left in the cot and having the procedure performed all on  it's little lonesome.

I didn't see any record of whether the fathers had hairy chests, which would be an interesting variable to throw into any statistical analysis, but in the authors case, that wouldn't be an issue anyway! But the joy of the findings should encourage all parents to nourish and nurture the physical contact that is so rewarding to both parent and child!


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Monday, September 12, 2011

Stroke prevention and the hope of a cure

I read in todays newspaper that scientists have extracted Stem Cells from dental pulp and implanted them into the brains of "stroke induced" rats! Apparently the results were excellent (only a 9% mortality rate - which I presume is acceptable for ratus ratus) - and the hope is that in about 5 years they will start some human trials to see if these results can be replicated (presumably without the 9% mortality rate!)

Considering that somewhere in Australia someone is suffering from a new stroke every 10 minutes, it is important that we don't wait 5 years before we do something about it, and thus reduce the life-long physical and emotional burdens that both sufferers and carers have to carry. In dollar terms the cost is $2,4 billion annually, but in terms of human suffering the "costs" eat into the very fabric of all lives that are affected.

The risk factors that we can have an impact on in order to reduce the chance of having a stroke are below - and you will hopefully recognize most of them!

  • high blood pressure
  • cigarette smoking
  • high cholesterol
  • obesity
  • lack of physical activity
  • diabetes
  • alcohol
  • irregular pulse (atrial fibrillation)

There are some risk factors that you cannot change and they are:

Age: the older you are the higher the risk
Gender: the male of the species is at greater risk
Family history of stroke: you can change your friends, but ....

Lets make sure that the health care messages gets out there:we face a choice between engaging with a healthy life and living it to the full, or being passive observers who buy every "pup" that is sold to them and then suffering all the consequences.

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Thursday, September 8, 2011

Bath Salts don't wash

I see that there is a new so-called "Recreational" drug rearing it's ugly head in the world: one of the names it's given is "bath salts" and apparently it's like cocaine - in other words, apart from the artificial high it gives, it also burns holes in the septum of your nose, puts your blood pressure up and if you're really into alternative life-styles, it certainly delivers, because it can kill!

Why is it that we humans need stimulants to augment our lives? I know that there are probably many answers that would include "escape", "fun", "its my life", "not hurting other people" .. that are trotted out to cover the harsh reality of drug abuse and addiction and all that it brings with it. Alcohol is way out in front when it comes to harm caused by an addictive drug, and yet alcohol has been part of the human experience since men and women came to live in communities. Opiates and their derivatives have certainly been on the scene for a couple of millenia: but the potent "designer" drugs of the last couple of decades are scary in their potency, and have been created by those who only wish to profit from the dependency of others.

But the answer is not to condemn those who take addictive stimulants, but rather to offer an alternative that gives them a "natural rush", and is inclusive rather than exclusive. There is no one answer, and we shouldn't waste time looking for one: rather there are thousands of answers for thousands of situations. What is needed is love, care and nurturing at a young age, followed by good example and a willingness to forgive mistakes and encourage hope that life does hold a promising future for everyone, even though getting there can be a tough journey.

The precious commodity we sell is life, and the sales pitch is hope: get marketing!
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Wednesday, September 7, 2011

Toddlers and ear infections

One of my grandsons has a green nose, common to so many little boys at this time of year with all the winter coughs and colds. He's also been tugging on his ears, is producing a couple of more teeth and generally is "doing it tough". One of the challenges for little ones with noses blocked with thick green mucous, is that it also tends to block the Eustacian tubes that lead up to the inner, working parts of the ear. Block this tube with infective mucous and there is the real chance that the poor infant will go on to get a middle ear infection - otitis media. If the infection progresses, then pus can build up inside the ear and cause bulging pressure on the ear drums: and that means a lot of pain! Ideally, the best way to treat this is by cleaning out the nose and letting the middle ear fluid drain out via the Eustacian tube and "problem solved". Unfortunately, little people do NOT like having their noses cleaned, and so they commonly get middle ear infections. However, most Ear Nose and Throat specialist do not give antibiotics for such infections as by the time they start to work, most infections are starting to resolve of their own accords. The principal of treatment is to drain the nose, use simple analgesia and inform the parents that they face a couple of interrupted nights sleep! For those who have recurrent ear infections then the ENT specialist may suggest inserting Grommets into the ear drums to allow simple drainage of any collecting pus, should the infant continue to be a recurring problem. The important thing is to get the right advice and not to necessarily "reach for the antibiotic" straight away: so if you think your child may have an ear ache, ask your GP to check it out: and work out out a sleep roster with your spouse because one of you is going to miss some zzzzz time!
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Monday, September 5, 2011

Accidents in the home

Most of us would live in the belief that home and hearth are the safest places in the world: WRONG.

Look at these facts from Kidsafe SA:

  • In 2005–2006, 22,865 children 0–4 years of age were
    admitted to hospital for injury across Australia.
  • More children die from injury in Australia (36%), than
    from cancer (19%) and diseases of the nervous system
    combined (11%) (ABS 2006
  • Children 0–4 years of age are most vulnerable to being
    injured in the home and backyard. More than half of
    unintentional deaths and injuries in this age group occur
    in the home and backyard, with 55% of these inside
    the home and 45% in the backyard (Shannon, Brashaw,
    Lewis & Feldman 1992).
 Having moved into the years when the "nest" has finally achieved that "splendid isolation", we had slipped into a false sense of security: until the "littlies" arrived 24hours ago! In that time one of them has walked through a plate glass window, thankfully without any harm - apart from that caused to his parents eardrums: and he and his sister then slipped on the bathroom floor with resounding "clouts' to their heads, resulting in more damage to their parents ears.

The good news is that they are healthy and well with no residual injuries: but it does highlight the fact that rearing toddlers is a full time job for the fit and the active; and that it only takes a split second of inattention and things can go terribly "pear-shaped".

Not only must parents constantly check their homes for potential danger zones and hazardous chemicals: grandparents too must work on reducing risks for their precious grandchildren, even if they only call for afternoon tea, so that they can enjoy the delights that these little people do bring into our lives.

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Thursday, September 1, 2011

Egg allergy and immunizations

Statistics throw up some interesting facts:

  • In 2005/6 the poultry industry produced some 195 million dozen eggs.
  • 1 in 20 infants will develop an allergic response to eggs
  • 80% of those children will grow out of the problem by the time they reach school age.
  • Major reactions to eggs - such as Anaphylaxis - are fortunately extremely rare.

Many of the vaccinations we use these days are cultured using chicken eggs and although they go through a stringent purifying process, they do retain traces of egg protein (or Ovalbumin as it is called). In the current climate where influenza pandemics seem to threaten the world on an almost annual basis, concerns have been raised as to the safety of Influenza vaccines in those people with a known egg allergy.

Well the good news is that after a review of 17 studies and more than 2600 egg allergic patients, it seems that bad reactions are a rarity. The vast majority of those who received the vaccines suffered no more than the general population and when reactions did occur, they were of a mild to moderate nature - local soreness, hives and some wheezing. This is good news as influenza can be a killer with some of the recent emerging viruses having a 20 to 30% kill rate.

What this means for those with an egg allergy is that it is safer to have the vaccine under appropriately specialized medical supervision, than to not have the vaccine at all. People with previous reactions to egg protein need to inform their Physicians so that the vaccine can be given in a medical setting and the patient observed for 30 minutes after the vaccine. For those who have previously had an anaphylactic type reaction to eggs, then they should seek the guidance of a specialist Immunologist before they undergo immunizations containing egg protein.

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