What a year!

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At last: re-connected to the internet after moving home for the first time in 25 years! To be able to sit in front of a computer and write this blog is like coming up for air after being under water for too long! So much has happened to us in 2012, but it will always be a year of awe-filled memories ... and most of them are good ones!

The reason for the long delay between articles is that we did move our home from a 5 bedroom house on a 1/4 acre block near the ocean, to a 2 bedroom (the second one is for a person of small stature and no luggage) apartment near the Swan river - and we are so happy! As I sit here I have a glorious view out of the window into a tree-shaded area of beautiful greenery : looking left I can see small sailing boats on the river and through the open door I can hear the young bride tidying up "things" in the kitchen area. In this place, nothing is too far away - even the bus stop is only 3 minutes down the street and the journey into the City a mere 7 minutes of gawping up at Kings park.

But to get here was a little harder.

With all the packing and cleaning, the Y.B. was stricken with terrible sciatic pain and ended up in hospital twice. Thankfully the spinal injections worked and she is now almost pain free. About the same time, some little Varicella virus particles that had been lurking in the dorsal ganglion of my spine, decided to run amok leading to a painful outbreak of shingles which happily has now all but disappeared. Now, after 6 weeks of pain, we are gingerly beginning to get fit and mobile again.

But these interruptions will not distort all those glorious things that happened to us this year. So here's a huge thanks to the best of them:

FRANCE

 Those 7 months spent meeting some wonderful new friends will always be dear to us and we thank each one of you from the bottom of our hearts. Merci mille fois.

Then there were the people that I met through social media, my friends at HBF and my friends from home. I must give a big hug to "Mariodacatsmum" and "Mybabyjohn/Dolores" who have been faithful readers and give me regular, honest feedback. John LeCras, Ean James and Greg Clune are an amazing individuals and never fails to give 110% to everything including friendship - and I treasure their friendship - so thank you all.

Finally there is the family, the very heart of my existence. Each one of them has made me a better man because of the goodness and love they have brought into my life: and the young bride is at the very epicentre of that love and joy.

So to all of you: Peace, Joy, Love and healing this Christmas and may 2013 be a year of Blessings for you all.

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Shingles update

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I wrote a few months ago about Shingles and how increasingly common it was amongst an aging population. I even inquired at our local Pharmacist to see if the young bride and I could get a vaccination for it here in Australia - it is much more an established part of the immunization program in the US - and discovered that even if it were available - which is isn't - it would cost $600 per vaccine! So to all Australian Health Care providers and Government Departments, it's time to "Lift Your game"!

A couple of weeks later I developed the Tell-tale rash on the front of my chest , to be shortly followed by another cluster of reddish blisters on my back in the 3rd Thoracic dermatome - the area of skin supplied by the chicken pox infected nerve! I seriously considered taking anti-viral medications until I read that although the Meds will lessen the impact of the rash if taken within the first 48 to 72 hours, they probably do not have a big impact on the dreaded Post Herpetic Neuralgia - PHN.

For the first few days the mild itching wasn't a big thing, but then that was replaced by the sensation of someone having used an Acetylene blow torch on the affected area of skin. But the final indignanty was the unexpected shooting pains that began to appear day night! The good news is that a 5km jog does seem to provide enough Endorphins to temporarily reduce the sensation of pain.

The rash is beginning to abate but the PHN persists. Because the area of skin where the the pain appears to be is "normal", I have taken to thinking about those poor young women who have had acid thrown on them for so called "morality" crimes and who must be suffering so much more than I, and this makes me feel less sorry for myself and more concerned for them. My problem will pass and there will be no persisting memory. I can even take comfort from the fact that my antibodies to the Zoster virus will be boosted as a result of this bout of Shingles - but those poor women who survive these brutal attacks will be constantly reminded of their awful ordeals by the dreadful scars caused by their acid burns. My heart goes out to them all - no one deserves to suffer such pain!

Meanwhile the young bride is suffering from a Neuralgia of her own - this one caused by a couple of "squashy" discs in her lower back. So far the spinal injection hasn't worked and she awaits a second "go". If that fails then she could face back surgery to relieve the problem.

Our nervous system is an amazing part of our bodies and silently controls every organ, muscle and cell in it. But when they go wrong, all we have to rely on in many cases is our own body's repair systems and a great deal of time and patience. Medicines and surgery have some place, but their side effects can be fairly drastic too. So in order to maximize the well being of your nervous system, eat nutritious foods to nourish the neurons, and care for your spine so as to reduce the potential dangers from damaged discs. And if you're in the older age bracket, pester your Doc about getting a Zoster vaccine - especially all those people living in Oz, because the more people demand the vaccine, the more likely we'll actually find them on the Pharmacy shelves!
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Dream time

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Whilst we were away on our fantastic trip to France earlier this year I had a dream and in it I  dreamed about my father: why I do not know. In the dream he was caught up in some celebrations/party and was pushed, causing him to fall down several steps and I watched helpless from afar. My brother appeared and as we walked along I burst into tears: “Why are you crying” he said? I was unsure at first and then I realized that I wanted to be there for my father in his final suffering and be a gentle presence to him: and I grieved for not being able to do that.

I dreamed that dream in January and he came to stay with us for 10 days in March and then we went to stay with him in Ireland in June for another 10 days. We returned to Oz in July and Dad died very unexpectedly in September: it was only when I reviewed my journal of our French sojourn that I remembered my dream and was able to reflect on how that "Dream" had panned out.

I was thinking about that as I read an article on dreams and was intrigued to learn that although we know a great deal more about sleep and what happens to our brains when we dream, what dreams "are" still remains largely a mystery. The best that I could discern from the article was:

• REM -Rapid Eye Movement - sleep does not correlate with dreaming! You can dream during REM sleep, and you can dream during non REM sleep.

• Dreaming is a time of "Story Telling" and many creative people use their dreams in their creative lives.
  

And that's just about it! Apart from that, when we close our eyes we enter into the world of the unknown: but it is a familiar world and it is our world. When I discussed this article with others we all agreed that we should keep a dream journal and try and capture some of the "magic" that happens during the 30% of our lives when we sleep. When I think of the dream that I had about my Dad, it makes me feel very happy.

Perhaps I won't unlock any secrets from future dreams, but I think that there is a possibility that some of them will surprise, renew and be creative forces for good in my waking life.

Sweet dreams!

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Getting to grips with Constipation

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When I was a lad growing up in the UK, each day after breakfast- like clockwork - Dad got up from the table with daily newspaper in hand and disappeared into the toilet .... for at least 20 minutes! And wherever he went in the world, the routine was exactly the same which cannot be said of about 15% of the western world who struggle with constipation and may visit the smallest room perhaps less than 3 times per week!

Constipation is a big problem and a big strain on those who suffer from it - if you'll excuse the pun! One of the problems when talking about constipation though is to determine exactly what the problem is because one patients story may not correspond with another Doctors diagnosis! Is it difficulty passing a motion? Is having to strain to pass a motion? Is it the size or consistency of the stool? Well the correct answer is "yes ... and no.." as there is no one definition of constipation, but the experts have come up with a delightful compromise with the Rome III Consensus which is states that:
"Symptoms should include ≥ 2 of the following during at least 25% of defecations":

• Straining
• Lumpy or hard stools
• Sensation of incomplete evacuation
• Sensation of anorectal obstruction or blockade
• Manual maneuvers to facilitate evacuation
• Fewer than 3 bowel movements per week

but even using this chart, patients ideas of constipation will often differ from their treating physicians in 50% of cases!

But forming and passing a bowel motion doesn't just rely on the proximity of a newspaper and a suitable "drop-off" point!  In fact the mechanism of defaecation is still to be fully elucidated because it's a very complex process. As well as having two types of squeezing mechanisms within the colon - one for gentle mixing of the contents and the other which is much stronger to propel the motion towards the outside world - these contractions need to be coordinated so that the bowel "behind" squeezes whilst the bowel "in front" relaxes. This is all under the influence of nerves, neuro-transmitters and various hormones, and any interference in either one or some of these can lead to reduced bowel activity and hence constipation.

When it comes to diagnosing constipation, the history is useful especially when it come to medications as certain drugs are renowned for causing constipation - codeine, certain blood pressure medications called Calcium Channel Blockers and some anti-depressants - but history is only a guide, so the experts have come up with some really Hi tech and Low tech investigations which help work out the why's and the wherefores. They will also flash out what is know in their trade as the "Bristol Stool Chart" (which I won't publish here to save the blushes of those of a tender disposition) which is a pictorial depiction of various species of Stool!

When it come to treatment there are some new medications entering the "market" and which seem to be a big step forward in managing this dispiriting condition and that's great news. Old fashioned things such as Prunes do work: soluble fibre such as psyllium does work although Bran doesn't: exercise is definitely a great idea not only for bowels but for general health too - so keep moving to keep moving -: and laxatives that contain Polyethylene Glycol PEG are also effective.

But like all things medical, if you've had a constipation problem for more than 3 months you must see your Doc first before starting to self medicate - especially if you're over 40 or have a strong family history of bowel cancer when you should see your Doc at the first sign of any change in your bowel habit.
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Terrific Tomatoes

Tweet You learn something new every day! For instance, I never realized that Tomato(e) plants are related to the Nightshade plant - that of the deadly nightshade variety! But of course, "our" tomatoes don't poison us, in fact quite the opposite according to much medical research.

In years past tomatoes were thought to protect aging men from the risks of prostate cancer: sadly, this did not survive the rigors of further scientific testing and has been quietly dropped from health recommendations. Now, however, Finnish researchers have published a paper which hails the benefit of the trusty tomato - we'll drop the "e" for the benefit of our US cousins - thanks to the presence within it's lustrous red skin of Lycopene which may reduce the risk of Strokes in men. So whilst it may not benefit the contents of your pelvis, it may bolster the health of your brain!

"The results support the recommendation that people get more than 5 servings of fruits and vegetables a day, which would likely lead to a major reduction in the number of strokes worldwide, according to previous research. This may decrease costs of health care in public health," Dr. Karpp, from the Institute of Public Health and Clinical Nutrition, University of Eastern Finland in Kuopio stated. "Lycopene reduces inflammation, inhibits cholesterol synthesis, improves immune function, and prevents platelet aggregation and thrombosis and thereby may decrease the risk of stroke," he added.

So to all those down in the southern part of the globe, start planting some Tomato plants and plan to feast on them during the long summer months - there's a host of ways to do that: fresh, in salads, sun-dried, reduced to make pasta sauces - so get the recipe books out. And for our northern family, although home grown Tomatoes have better taste and flavour, there's still great benefit in the ones in the Supermarkets and even the tinned ones are packed with powerful Lycopenes. 

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Virus zaps bugs that cause "zits"

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Acne can be the scourge of the teenage years! At this critical time of life when hormones are erupting, the brain is scrambling to make those key emotional connections, all of a sudden the skin seems to erupt and scream "look how crazy I am on the outside too"! And it's not just one or two teenagers who suffer from this untimely embarrassment of spotty skin, it happens to millions of them every year.

Unfortunately, medical science has been fairly static in it's method of managing this distressing condition - not that there isn't something to offer. The standard treatment will involve lotions to clean the skin and unplug the pores, and antibiotics to reduce the surface population of causative bacteria. In females, appropriate usage of hormone contraceptive pills can have a big impact and for the most recalcitrant types there is always Roaccutane - but that's a "heavy" medicine and not without potentially serious side effects.

So when something new for the treatment of Acne comes on the radar, it should make us sit up and take notice for the better all round health of our children and grandchildren.

Researchers at UCLA and the University of Pittsburg have recently shown that the bacteria that are involved in the Acne process have their very own natural enemy in the form a a family of viruses. Propionibacterium acnes, or P Acnes to its friends, is thought to play a role in the inflammation process that leads to the angry, red "zits" that populate the teenage face when they suffer from acne. But P Acne is also susceptible to a harmless virus that lives on our skin and which invades the bacterial cell forcing it to produce more virus particles until it bursts. The hope is that if this virus can be harnessed, then one key element of the acne process may be eradicated and the impact of the condition greatly reduced. The good news is that the virus is specific for P Acnes and does not affect the other billions of bacteria that call our body home.

Like all research, when you answer one question then more appear! If the virus is present on healthy skin, then why do people get acne in the first place? The scientists are cautiously optimistic that they can answer some of these questions, but like all good basic research it does move slowly and there's still a long way to go before they can even think of trying a treatment on humans. But it's a promising lead for a condition that affects millions around the world and causes enormous "heartache" to our young people at a vulnerable time in their lives.

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Bugs, bowels and yoghurt!

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Antibiotics have been with us for over half a century now - which is a relatively short time in the evolution of mankind - and we're still learning a lot about how they work and how bacteria work against them! One of the pitfalls of taking antibiotics is that often it leads to the patient developing Diorrhoea - which, if you're already feeling sick, is not something that you want to add to your list of woes! So it would be nice if there were something that we could do to lessen the impact of Antibiotic Associated Diorrhoea (AAD): which leads me onto "what on earth is living in our insides"?

In a previous Blog I have discussed that we are not exactly who we appear to be as much of us is made up of bacteria, fungi and viruses - the genus and function of which are still taxing the minds of some very intelligent scientists around the world. There are, in fact, many more Bacterial cells than human cells in our body: someone pointed out that one way to get an idea of the ratio of human cells to bacterial cells is to look at our bodies and realize that the area below the knee of one leg would represent the number of human cells and the rest of the body the number of bacterial cells! It has also been worked out that there is about 1Kg of bacteria living in our guts and they actually supply approximately 10% of our daily nutrition as well as vital vitamins and mineral. There is also developing evidence to link the bacteria that live in our gut with cell mediated immunity, so we need to think beyond the idea that they're "just friendly germs that live in our bowel", to the idea that they are an essential part of our makeup. So if we upset the balance of "Our" bacteria with inappropriate use of antibiotics, then we are doing harm to ourselves.

First golden rule of antibiotics: only use them when they will do you more good than harm.

But if there is a real need to take them, how can we protect ourselves from the downside of AAD?

Probiotic products are "foods" that contain bacteria, and which are thought to help restore the normal bacterial flora in the bowel - although it doesn't actually work that way. Firstly there are several different strains of bacteria that make up the "probiotic" group, and like different tools for different jobs, they are not a "one size fits all" panacea - they actually need to be matched to a particular condition. And not all gut based conditions will respond to probiotics at this stage, but AAD is one of those conditions that will often benefit from taking probiotics.

Crohns disease and Ulcerative Colitis are known as Inflammatory Bowel Diseases and in CD there is evidence of an exaggerated immune response to certain intestinal bacteria, more so than with UC:  but probiotics seem to have a slightly greater beneficial effect in UC than CD - such are the mysteries of medicine!

IBS or irritable bowel syndrome, is just what it appears to be ... irritable bowel without any definite diagnostic signs. There is no compelling evidence to show that probiotics work, but it's one of those areas where it is quite reasonable to "give it a go" for a period of time to see if there is any benefit.

The use of Probiotics is a very new field in Gastroenterolgy and there will be many discoveries made that I am sure will have an impact on areas of our bodies well away from our gut tube. For now, if you need to take an antibiotic, then a trip to the supermarket to get some Yoghurt containing Lactobacillus Bifidus will probably save you taking a trip to the smallest room in the  house! But for other inflammatory bowel diseases or IBS, you should discuss with your Specialist which Probiotic might be suitable - as they will know what is the latest and best in this fast changing field.

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Pain - it's not always as simple as you think.

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I had a prolapsed disc in my lower back some years back that required surgery, and since then I have taken particular care to look after my spine - staying lean and fit, working on my core stabilizers and being careful about how I lift things. But the passage of time will often over-ride all our good habits and things still get "stiff and sore". Now I suspect, one of my facet joints is giving me some localized grief, and leaping out of bed in the morning has been replaced with a well thought out "log roll" onto my side, a steady lift to the vertical sitting position and then engaging the legs to lift me to my full 182cms in height! I have also decided to take an anti-inflammatory to get on top of the situation and to try and stop this from becoming a chronic situation.

All of this brings me on to what is pain and how do we treat it: and when does acute pain morph into chronic pain?

There's not enough room in one- or indeed several blogs - to cover the subject of Pain. For a start, one persons pain is another persons discomfort: and what type of pain do we mean - aches, shooting pains, pins and needles, burning pain - the list is enormous! And methods of treatment vary from local ice or heat: simple pain-killers to long acting Opiates: acupuncture to surgery and all stops in between, so you begin to get the idea that this is not a simple subject, so please do not think that there is a "one size fits all" solution to managing pain - like a good fitting suit, the treatment has to be tailored to the individual in order to maximize a successful outcome.

A very simplistic way to understand pain is to divide it into Acute and Chronic pain. Obviously Chronic pain lasts longer - it's usually been around for 6 months in order to be classified as such - and by that stage it's not the local problem - the arthritic knee, the neuralgia caused by that bout of Shingles that you had, or the trauma sustained in the MVA - that is the area that needs sole attention: rather it's the way the brain has taken over your perception of pain and how your brain now influences all things to do with "that pain" and which is affecting your whole life. So in chronic pain it is so important to look at the whole person and not just the injured part, and to focus the treatment more on the brain than on the injury - and that will often mean the use of a completely different set of "tools" in order to be successful.

Management of Chronic pain is a challenging subject but is one where, with the correct approach and the involvement of a whole team of people -Doctors, dieticians, psychologists, physical therapists, occupational therapists etc, and which also vitally includes the patient and his/her family - then there is a real hope that lives can be radically altered and individuals can return to a normal life which is not dominated by pain or pain-killers.

The message: If your pain is not responding to simple solutions - get professional advice. If you've been in pain for more than 6 months then you need the help of a team of Pain Experts. And remember to be patient if you don't want to remain a patient!

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A special time.

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Sometimes things happen in life which cause us to pause from the normal routine of things and reflect on the "bigger issues". My dear ole Dad died just over a week ago - yes he was a great age - but it still came as a shock. Although his mind was dimming, he was still physically pretty active for a nono-genarian and he still delighted in his greenhouse and garden.

When most of us fast forward to those last years of life we like to think that we'll "slip off the twig" in our sleep after the golden glow of a long and happy life, but for more and more people Dementia and strokes seem to blight those final years of life. So I thought I'd write down a few suggestions for how I like to be treated should I start to go Bonkers or, even worse, have a debilitating stroke or disease.

PLEASE DO NOT sit me in front of a TV from early morning! Over the years I have visited many nursing home and seen so many frail people planted in from of early morning TV with inane programs or cartoons! I would hate that even if I was mad! Find a window where I can see the world, or even better sit me in a garden where I can feel the breeze and let the flies tickle my face. If it rains, even better to feel the drops of water on my body: and does it really matter if I get a cold or pneumonia afterwards?

I've always loved trying different things so take me out to the beach, or lower me into a swimming pool: push my wheelchair to the edge of a cliff so that I can experience danger - even if it kills me! And don't worry about me being comfortable in a car - when you were kids we strapped you into seats and I'm sure you filled your nappy too on many a long trip.

Stick some ear phones on my head with music that you think I might like, pod-casts that may interest me, or just the sounds of nature on a cold and wet day. I may appear distant and dribble, but it's what happens deep inside that really counts now - and everything you do with love will be heard in the depths of my soul.

Let the little people near me - they have enormous, yet beautiful energy - and their vision often extends far beyond that of we myopic parents. If they tip me out of a chair or spill something on me - who cares - every blot will be a badge that I can marvel at, every bruise a vivid memory

Dare to believe that you can still connect with me because when I'm no longer here, I still want you to be able to maintain that connection - not for me, but for you because you will miss me just as I will be missing you.

Change for the better: helping women's hearts.

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I get a real buzz when people decide to change to a healthier lifestyle. Being a parent I have always been amazed at how you spend years telling your sons to tidy up their rooms, then along comes a girl and coyly suggests that perhaps the young lads room could do with a clean up, and hey presto, the lights come on and overnight the room turns into something a human can live in! It just goes to prove how quickly change can occur with the right stimulus.

And it's the same with health issues - losing weight, getting physically active, stopping smoking and cutting down on alcohol - there is a constant need to determine that unknown "snowflake" that starts the avalanche of change that so many need to live healthier, happier lives. The great news is that there is a veritable snowstorm of opportunities now that the Web and mobile IT devices can provide so many options and encouragement for those thinking of embarking on a healthier life.

In a paper recently published in the June issue of the American Journal of Cardiology Dr Samia Mora and colleagues demonstrated how the use of a web based program helped women with known cardiac risk factors reduce their risk profile. Not only did they become more active but their Quality of Life also improved and Dr Mora et al also demonstrated for the first time "an independent positive associations between energy, well-being and body image with Physical Activity guideline compliance" - not only were they doing more but they were feeling good about themselves too which is a win win in anyone's book. 

The program they used was the well tried Choose to Move program on the American Heart Foundation Webpage which has now been expanded as the Go Red For Women BetterU Program 

http://www.goredforwomen.org/betteru/

Reading Dr Mora's paper, there was a big difference between those who joined the program during the research period - 15,064 - and the number who completed the questionnaire emailed to them - 4003 - and the ones who completed the follow up survey after completing the 12 week course - 972! This just confirms my observation that we humans hate filling out questionnaires but it no way reduces the impact of this very important study.  Also those who did complete the surveys were in the main white and educated: just imagine the massive impact of the program when this demographic is enlarged.

But here's my take on this: a small group of Docs do a study and show that a Web based tool can have a big impact on the health and quality of life of a group of women at risk of developing heart disease. The exciting thing will be when all family physicians routinely offer such programs to every "at risk" women who comes into their Office/Surgery for advice. The family physician still has a vital role to play, but their impact can reverberate for a further 12 weeks if the patient has the options of signing up for the Go Red for Women BetterU program as Dr Mora suggests.

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Reference: Lieber SB, Redberg RF, Blumenthal RS, Gandhi A, Robb KJ, Mora S. A national interactive Web-based physical activity intervention in women, evaluation of the American Heart Association Choose to Move program 2006-2007. American Journal of  Cardiology. 2012 Jun

Kiwi Magic

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I recently was diagnosed with Coeliac disease which means that anything with Gluten in it causes the lining of my small intestine to get very grumpy and lose it's ability to absorb important nutrients. What this boils down to is avoiding anything with flour, wheat or cereals in it - and this includes bread a beer! Happily for me there hasn't been too much of an alteration in my diet as the Young Bride has me on a fairly strict "leash" anyway when it comes to eating healthy food. But for many, I can see that becoming "Gluten free" could be a big challenge..... but then again on the scale of "things that can go seriously pear shaped", it is a relatively minor issue.

I was reminded of this when we went shopping and as I was waiting for the YB, I sat and observed a large black van parked in the disabled zone with the number plates of "Kiwimagic". At first I thought that some selfish person was incorrectly using the bay when it dawned on me that I knew the person who owned that car and I couldn't think of a more worthy user of the disabled bay than this guy. I literally leaped out of my car to go and find this amazing man, and found him buying fresh meat at the butcher. Well actually, he wasn't doing the buying as he's a Tetra-plegic on a respirator, but his carer and driver was doing his bidding and buying the meat!

My dear Kiwi mate grinned from ear to ear - about the only muscles he can control, and ones that he uses all the time - when recounting how the Wallabies had been "flogged" by his beloved All Blacks at the weekend. He then told me that he had spent 4 weeks traveling around NZ during the Rugby World Cup and as a by-the-by that he had also spent 3 weeks in Intensive Care as a result of a clot whilst touring the "Shaky Isles". When I told him of my experience 3 years ago for 2 days in ICU he winced with genuine care and compassion, such is the generosity of spirit of his humanity.

This is a young man who many years ago was "cleaned up" by a motorist whilst waiting for traffic lights to change: a devastating accident which has left him at the mercy of a mechanical machine and the genuinely tender care of a team of care-givers that he needs 24/7. In the ensuing time he has found time to sponsor an orphanage in Asia, fund sailing adventures for fellow spinal cord victims such as himself, and give inspirational talks to school kids on how to make the most out of the precious gift of life.

For me, this man is a one in a thousand, a man whose powerlessness is his real strength and who has disarmed the world with his smile. When it comes to dealing with our minor adversities, we can all learn from him.

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Vaccinations are vital.

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In the US there is increasing concern about the prevalence and spread of West Nile Virus.This is a very nasty infection spread by Mosquitoes and which has no known treatment and currently, no obvious cure - although there are vaccines for similar mosquito-spread viruses which does give a modicum of hope for an eventual breakthrough. So far there have been 700 cases of West Nile Virus reported this year with many sufferers contracting meningitis or encephalitis. Since it first appeared in the US back in 1999, 3 million people have been infected and much research is currently being carried out into the mechanisms of the disease and ways of developing an effective vaccine.

Down in Western Australia we are battling with a much older foe - Whooping Cough - which this year has affected over 4,000 people, mainly children. This is a disaster on any public health level! Whooping cough is a contagious disease that should have been eradicated decades ago if parents had listened to professional advice and had their infants correctly immunized. Now, thanks to misinformation, there is a large group of non-immunized children in the community that has provided fertile ground for the spread of this potentially deadly disease.

Whooping cough is not just a bad cough that sounds like a "Whoop": it is an awful illness where the sufferer coughs, vomits, goes blue and is exhausted for sometimes up to 6 months! For most of my professional career it was a rarity to come across an isolated case, but over 4,000 officially confirmed cases in less than 12 months has returned it to centre stage. Yes, there is a significant group of older people who can suffer from a less severe form of Whooping Cough as their childhood immunity has waned over the decades, but the only reason their immunity has waned is because they failed to keep up to date with their immunizations!

It is imperative that all parents vaccinate their children against the infectious diseases of childhood that are known to put their lives at serious risk, and if you have any doubts then seek professional advice from those who know about how serious these infectious diseases are. It is just as important that all adults maintain a good level of immunity to community acquired infectious diseases too because when you protect yourself, you break a link in the progression of the disease to another. Again, if you have any concerns, ask someone who knows about infectious diseases and not someone who heard something about a neighbour who read a magazine article .......

In the US much effort is now going into finding an effective vaccination against West Nile Virus - a relatively new disease for that country. Lets hope that when it does arrive, it is rapidly and effectively used in the communities where it is most needed.

Vaccinations save lives: and when you get vaccinated, it's not just your life you're saving, you're protecting your neighbour too.

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Coeliac Diseae - a serial problem with Gluten!

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Coeliac Disease affects about 1 in 250 people in Australia although it is estimated that 75% of those affected are unaware that they have a problem! So is this an alarming health issue or the proverbial storm in a tea cup? The answer, like the condition itself, is still very much a mystery yet to be solved.

Coeliac happens when the body's immune system decides that it doesn't like Gluten - a protein found in wheat barley and rye and all foods that are made from these grains - and as a result damage occurs to the parts of the intestine where these foods are absorbed. As a result of this damage, not only is the absorption of gluten affected but also other important nutrients such as vitamins and minerals. If this damage occurs at an early age, or if diagnosis is delayed for a very long period, then "Mal-absorption" diseases can occur such as Osteoporosis, peripheral nerve damage and liver disease.

Why this sensitivity happens is still not clear: there does appear to be a genetic basis for the problem although not every one with the affected genes actually develops Coeliac disease, and the current thinking is that there are other environmental conditions contributing to the development of the condition.

Many cases of Coeliac are completely silent - in other words, those affected have no symptoms whatsoever: others will suffer from abdominal pain, bloating and diarrhoea too.

Diagnosis is made by biopsy of the affected part of the bowel. This is a relatively simple procedure conducted by a specialist in a hospital setting. Tiny pieces of the bowel are harvested and viewed under a microscope: if present, Coeliac will show itself by a loss of the tiny, hair-like projections covering of the lining of the bowel and which are essential for efficient absorption of nutrients from digested foods.

There is no cure for Coeliac, but like most chronic diseases there is very effective management of the condition that allows for normal health and a normal lifespan. The exciting challenge is to exclude Gluten from ones diet and replace it with other food groups according to the individual tastes of the person with the condition. These days there are a plethora of alternatives to Grain based foods and all food packaging in Australia must show whether the contents contain Gluten.

Also there are many online support groups and organizations:

http://www.coeliac.org.au/
http://www.mayoclinic.com/health/celiac-disease/DS00319

The upside of getting a diagnosis of Coeliac is that you think more carefully about what you eat, and you are challenged to discover different ways of preparing your food: a little bit of what I would call the agony and the ecstacy of living.

If you have any favourite recipes or advice you'd like to send in, I'd be very happy to publish them.

PS there is no gluten in Champagne!

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Whose got Attitude?

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 I just stumbled across the following quote:

“Attitude is a little thing that makes a big difference.” Sir Winston Churchill {1874 -1965}


And it seems that a lot of people don't have a very good attitude towards good health. I also read today that only 10% of American adults get "enough" exercise: combine that with the number of people still smoking cigarettes (have they been living in another universe for the past 10 years and missed all those terribly graphic health warnings on packets of their favourite poison?). And top that off with the vast number of people who are overweight or obese and the outcome will be far more devastating than the Global Financial Crisis, and cost even more in order to dig our way out of the massively increased costs to our health care services.

But it's not just having a "bad attitude" to physical health issues that can make our lives miserable: we need to foster an "Attitude of Gratitude" too. Most of us who are still conscious have been blessed with so many good things in life, yet I suspect that most of us - me included - have failed to pause and give thanks for the great times we have had. Yes, bad things do happen to good people - that's part of the bargain - but good things happen too: loving spouses, good kids and grand kids, a job or hobby where we can use our gifts, being able to support your favourite football/baseball/basketball/rugby team .... the list is endless.

And then there is this awesome world we live in with all it's wonders and delights. I would think that just about everyone on this planet has experienced at least one glorious sunrise or sunset in their lives or seen a rainbow after a shower - simple wonders and delights and they're all free.

Winston was right: “Attitude is a little thing that makes a big difference” and if we chose to change our attitude to one of gratitude then not only will we enjoy life a bit more fully, we'll be able to live it a bit more healthily too, AND we might just leave this world in a bit better condition than we found it when we arrived.

Have a great week! 

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Asthma needs to be treated seriously and treated well.

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Asthma can be a terrible scourge. An asthmatic attack is like having to breath through a thin straw 24 hours a day  because of the changes that happen to the network of tubes that make up the lungs.

Asthma is a combination of inflammation and muscular contraction affecting the tubes - or bronchioles - within the lungs. The inflammation is to the lining of the tubes, and when the lining gets thicker then the lumen - or open part of the tube where the air travels through - has to get narrower. The inflammation also affects the quality of the mucous produced by the lining: instead of having a watery consistency it becomes thicker and more sticky not only making it difficult to clear from the lungs, but also leads to plug formation which can block some of the smaller airways.

In asthma, the circular muscle that controls the diameter of the Bronchioles become thicker and more sensitive to varying stimuli such as cigarette smoke, viruses, chemicals, exercise etc. And it's this combination of narrow inflamed tubes and increased sensitivity to stimuli that can move an asthmatic with reasonably comfortable breathing to someone seriously struggling to breath in an Emergency Department. Thankfully, we now have very effective medications that can help prevent most of these serious consequences of Asthma, but the concern is that patients are not getting the best treatment through lack of "compliance" - not taking their medications properly - or as in the case of some children, they are being given inappropriate treatment.

The medications we have for preventing asthma are based on Steroids, and these are nearly always given by inhaler, though they can be supplemented by oral medication if control is poor and the symptoms bad. Another type of anti-inflammation medication which is not a Steroid, is know as a Leukotrene Receptor Antagonist - LTRA's - and these usually come in tablet form. LTRAs are not "first choice" meds, but can be added to inhaled steroids if the steroids are not giving maximum control.

To relieve the spasm of the thickened circular muscle, Doctors have been using Salbutamol for over 50 years. The problem with salbutamol is that it only lasts about 4 hours, but his has been overcome by a more recent medication known as Salmeterol that is known as a Long Acting Beta Agonist, and its the combination of long acting Beta Agonists and inhaled steroids that has been used in adult Asthma regimes for many years. But this is NOT the ideal for 90% of childhood asthmatics.

Asthmatics should be controlled where possible by Inhaled Steroids: and the least effective dose is the preferred dose. If the inhaled steroid is not sufficient then there are three step-up options for poorly controlled asthmatics on inhaled corticosteroids:

adding a long-acting beta2 agonist
adding a leukotriene receptor antagonist
increasing the dose of inhaled corticosteroids.

The addition of a leukotriene receptor antagonist is the preferred option for children with ongoing activity-related asthma. Long-acting beta2 agonists are not recommended for children
five years or younger.

If you are an asthmatic, or your child is an asthmatic, you should have a written Asthma Management Plan which needs to be reviewed and updated by your treating Doctor on a regular basis. If you don't have an Asthma Plan, get one: it could save your life.


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Jetting off home.

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Sorry about the silence, but we've been moving back to Western Australia which has meant packing up one house, traveling half way around the world and then moving back into our pristine "old" house. Then the roses needed pruning and the hedge needed a trim, and all that before our eldest son arrived with a friend for a conference here in Perth and could they stay for the weekend ..... And then there was JET LAG!

Flying from West to East always gets me: I feel good during the day and go for a jog, or prune those roses and by "beddie-byes" time my body tells me "You're ready for some serious ZZzzz's" so I lie down and go to sleep. 90 minutes later I'm wide awake and ready for action! But it's not just the sleep deprivation, it's the "bodily functions" that also have to catch up too and for we older folk, that is often more of a challenge to get back into a normal routine.

The good news is that we are having plenty of sunshine to stimulate Melatonin in the brain, and we can get out for some good physical activity and last night I slept from 1am to 6.54am and the world seems like a great place once again!

I'm told that if you turn left when you get on the aircraft and are able to stretch out on a bed and actually sleep then jet lag is not such a big issue - but then you have to refuse all the Champagne they apparently offer you if you can afford to buy Business Class tickets. (Disclosure - if an Airline would like to sponsor this blog and include free Business Class travel for the young bride and I as part of the deal, then I am prepared to negotiate a package).

At this stage there doesn't seem to be an effective way around Jet Lag, apart from sunshine, exercise and maintaining good hydration on the aircraft: if anyone knows of any new insights, please let me know so that I can spread the word.

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Reducing the fallout from Falls

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The Young Bride" and I were out for our morning jog this morning, and as she related it later, she was just thinking that the track by the lake that we were jogging on was a bit uneven and perhaps she'd better run on the nearby path! At which point she tripped over a tree root and literally "came a cropper"! Needless to say I was extremely proud of the way that she rolled as she fell, thus distributing the bruises and sprains over several parts of her body, instead of focusing on one area which may have led to a broken bone! Even more impressive was the way she gazed at her skinned knee and just got up and carried on: I think her attitude to pain makes me understand why she had the babies and I looked on!

But falls come completely out of the blue, and often when you least expect them - and most of them happen in the home! As we age and become less flexible and "bouncible", falls can prove life-threatening and the more we can do to help prevent and prepare for them, the less likely they are to irreversibly change our lives in a bad way.

Firstly the human factor, and there are three elements here: the brain, the muscles and the bones.

Part of preparing for any form of exercise, be it a walk, jog or cycle ride should include the thought bubble - "What should I do if ..". What the Young Bride did was to roll as she fell - something we had discussed in the past - so as to distribute the "energy of impact" over a wider area of her body. You still get the pains and the bruises, but they pass: if you just stick your hands out, you're just as likely to snap your wrists and end up in plaster for 6 weeks and all that rehab afterwards. Or even worse, it could be a fractured hip which will put you in hospital or even underground!

Secondly, maintaining muscle tone is very important as your muscles will act as "Shock absorbers", in other words they will let you down a bit more slowly and again reduce that energy of impact. And finally, maintaining bone strength will help reduce fracture risk. Having strong bones happens through constant use and good nutrition - and that includes adequate Calcium intake and healthy Vitamin D levels - if you're not sure what this means for you, then check with your family Doc.

Then routinely run a check list for home safety: carpets, cables and debris on staircases etc. Remember that you might keep the place as you want it, and you may well know where the dangers lurk, but a well meaning family member or care-giver can "move things" and that could just lead you to take a wrong step in the dark and fall "base over apex"!

Summary: Prepare yourself by keeping as fit and strong as you can. When preparing for exercise, have an "emergency exit" plan - roll as you fall. And check your home environment on a regular basis for potential "man/woman traps". Pride may come before a fall, but a little forethought might just save your pride!
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Hand Foot and Mouth - post script

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I recently wrote a Blog on Hand Foot and Mouth Disease and said that although it can be a serious disease - but rarely fatal - infants can occasionally become very ill due to dehydration from having lots of painful mouth ulcers. In these situations, the ulcers can make it impossible to hold food, drink or even saliva in their little mouths and they can end up in hospital on IV fluids. In the vast majority of cases the infection passes and all is well!

But over the past couple of days, there have been worrying reports of a widespread outbreak of a "mystery" infection in China, and the SE Asian countries. This infection appears to have been caused in part by an Entero virus from the same family as the one that causes Hand Foot and Moth disease. In the Cambodian outbreak however,  the death rate amongst infants has been terrifying with about 60 dead and only a couple surviving so far. In this new outbreak, the classical rash on the hands, feet and in the mouth have often been absent and the children are presenting with serious brain swelling (encephalitis) and then die from destruction of the small alveoli (air sacs) in the lungs.

But although this is a terrible thing for the children and families affected, when put into perspective against the rate of hospitalization for Dengue Fever in the same period (over 5,000) then the magnitude of the challenge becomes a little more clear.

This is still an evolving story but one that we need to keep an eye on.

The message: we need to be vigilant, especially when it comes to the smallest and most defenseless in our communities. If you think you have a sick child, get a professional to check them out. As I've said on many occasions, it's far better to come home from an emergency department with a red face, then leave your child there with a white one!
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How does your child "measure up"

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I was listening to an E-Lecture on abnormal growth in children and was struck by a few facts that I didn't know before. Firstly, it's not where you are born in this wonderful world that matters, but how things are in the home. According to a big International study completed by the WHO on children in various parts of the world, if they are given the optimum start in life, then those children all have the potential for normal growth and development for both height and weight - relevant to their age.

It's back to those critical first five years of life when so much potential can be developed, or so much permanent damage can be done.

The second point that registered was that "Hormones" play a relatively small part in the growth equation: much more important factors are Genes, Nutrition, and a healthy, positive domestic environment. From my experience, parents who bring their child in to see me and say they think Johnny is very small, "Could it be his hormones Doc?", the simple answer is it almost certainly isn't. The answer is usually there in front of you, with both parents being short, or perhaps the smell of tobacco/alcohol coming from the parents clothes!

The only way to determine whether the child has a definite "growth" problem is to have accurate growth charts and if you're interested in recording these yourself, then instead of using the back or the laundry door to mark with a pencil (it's always so hard to unscrew the doors and taken them to the Doctors surgery!) download the WHO charts from the CDC and then if necessary you can email them to your Doc for comment - after 6 to 12 months!

http://www.cdc.gov/growthcharts/who_charts.htm

But when it comes to measuring the child, it must be accurate:

Bare feet together: back flat against the wall: head up and looking straight ahead: bring the horizontal marker down till it touches the top of the head and note the height. THEN, get them to step away for a second and then repeat the process. The results should be within 3 to 4 mm of each other to be accurate. NB if your child wants to be "taller", then measure in the morning as the discs in the spine are more hydrated/thicker, meaning that the spine will be longer and your child "taller"!

Isolated measurements have no real meaning: what is much more important is the Velocity of Growth, and this will only become apparent over time, so the earlier accurate measurements are started, the sooner any anomaly will become apparent. But growth is not a smooth process and is affected by stresses of illness, social and domestic problems and poor nutrition. Even when these episodes have passed, it may take 3 to 4 months for growth to "catch up", which in nearly all cases it will do so.

Finally, if your child wants a rough estimate of how tall they will be by the time they have finished growing - assuming they live a healthy life within a normal domestic environment - then it's down to genetics.

      For boys: add 13cms to the height of the mother and then average that number with the height of the father.

      For girls: subtract 13cms from the height of the father and average that number with the height of the mother .

Remember that this is only an indicator and can vary up to 8.5cms either side of the resultant number.

Listening to the lecture highlighted the fact that investigation of growth issues in children is a slow process, but we can minimize many of those problems by making sure that our young children have good nutrition early in life, and that we raise them in a nurturing environment: something that needs to be done 365 days of every year. And for that to happen, we all need to lend a hand.

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Commense sense v dieting.

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Hands up everyone who remembers the Israeli army diet! Or maybe the cabbage soup diet? Diets come and go and still the average weight seems to be going in the wrong direction -upwards! News recently has cast a shadow over the Atkins diet that has been one of the few long term "survivors" in the competitive world that is Dieting, with a report suggesting a potential increase in the risk of cardiovascular disease in those who use such a low carbohydrate, high protein way of eating. In no way do I endorse the diet, but on reading the report, the only diet history was taken at the beginning of the study and the average follow up was 15 years: as one critic wrote - "Who eats the same food for 15 years?"

But the problem is not Dieting, it's that we tend to eat too much of the wrong sort of food, and we in the so called "first world" are drowning in a sea of food. It appears that no-one can go to the Mall to shop without stopping for a Jumbo Cappuchino and one of those massive muffins: or if you are of Anglo Saxon origins your choice may be chips with gravy washed down with a caramel milkshake! Governments, Nutritionalists, Foodies and Healthy Lifestyle lobbies are all united in promoting the ideal of eating good quality foods in the correct portion size - and that means lots of veggies, salads and fruit. Go easy on the red meat as most people only need to eat it once or twice a week unless your a female of childbearing age, and plump for more fish and chicken.

Here are some helpful tips:

Don't go for the Big Bang weight loss approach - they usually blow up in your face! In fact it'll be  your waistline that will blow up even faster over the longer term!

Fish is fabulous - get it fresh where you can, but tinned tuna, sardines and salmon are great "take-aways".

If it's fried, try and imagine all that fat searching out your coronary arteries and making it's home there!

If you need to reward yourself after a heavy session shopping, then have an Espresso coffee - it's the new health food and no calories!

When thinking of healthy pre-packed food, try oranges, apples or any fruit or nuts in the fresh food section.

If your belt is running out of holes, eat 2 mouthfulls LESS each meal. Over 6 months you will have saved on tens of thousands of calories and you might even need a new, SMALLER belt!

Don't drink sodas, water is cheaper, fresher and no chemical colouring or calories!

Of course if you have current health issues then you will need to discuss your eating plan with your treating Physician.

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Screening for Macular Degeneration

Tweet Age Related Macular Degeneration  (ARMD) is a common eye problem, and in some cases will progress to legal blindness, so where possible, we should try to nip it in the bud!

There are two types of ARMD, the so called "Dry" variety and the "Wet" type. The good news is that the early stages of ARMD don't usually cause any serious problems, and the other good news is that there are treatments now that can control the more serious "Wet" variety. But the "not so good" news is that there is no current cure for either types and no specific active treatment at all for the "Dry" variety!

The disease is caused by problems with the lining at the back of the eye where light entering the eye is turned into electrical impulses and transmitted to the brain in order to reach "consciousness".  In the direct "Visual Axis" of the eye where we do most of our seeing, there is an area known as the Macular, which is where there is a massive concentration of our light receptors. When these are damaged by ARMD, then we lose vision in that area - leaving a blanked out area smack bang in the middle of our vision!

Early detection is important and one of the tools that are used is the Amsler Grid.

Amsler Grid

 

By using this grid areas of distortion to our vision can be detected. If you wear glasses for reading then wear them whilst doing the "test". View the grid by holding it in your normal viewing position and cover one eye and stare at the central spot. In the normal situation the grid should remain a grid with all the lines straight and all of the grid visible. Further investigation may be necessary is

• Any of the lines look wavy, blurred or distorted.
• If any areas are missing or there are dark areas in the grid.
• If you cannot see all corners and sides of the grid.

And remember to test both eyes.

 

If you do notice a distortion then get a Specialist check up as you might have early stages of ARMD. For those who do test positive, there is a specific combination of Vitamins that you can take that may reduce the risk of progression by 25% - but discuss this with your treating Doctor.

For the more serious Wet ARMD, new generation drugs can control the disease, and can conserve sight - so please don't take any risks, get your eyes checked: they're very precious!
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Unsolved mysteries of the brain.

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During the course of a week I read of lot of medical articles and am amazed at the variety of research that goes on about how our bodies actually work. Also, during the week, the young bride and I take to our bikes and try and see as much as we can of the great outdoors and all the glorious things that are "out there". These two diverse processes are all computed in my brain, and I'm finding it tough to reconcile the two!

During the week I read of how Psychologists at Concordia University report that they have found where the " Love and Desire related areas" are in the brain. They go on to detail the specifics of their studies and then discuss the structural areas of the brain involved - for those interested, they are the Insula and the Striatum.

Part of my early years of medicine involved teaching anatomy and performing human dissection, so I have some insight into what the brain looks like, and it's an odd structure - usually described as grey and white matter - and notable for only all the waves and grooves on the surface. The experts tell us that our emotions and memories are created by Neuro-transmitters and hormones - chemical substances - that have different cause and effects in various parts of the brain.

Now here's my problem: I see the world in glorious colour, I hear music from birds and symphonies, I read great prose and poetry and when I think of love not even words can capture what I am feeling. When I look at a brain - the real thing, not those colour enhanced, 3D images generated by computers from brain scans - I see an amorphous, grey, jelly-like ovoid mass with lots of wrinkles on the surface: no colour, no words, no poetry, no love .... and I wonder how it all got in there and why?

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You are more than you think you are!

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We are not what we appear to be, and by that I don't just mean that our "less-than-film-star looks" not correlating with our sparkling personalities. When we look at ourselves in the mirror we see "Me", but that "me" also is host to an incredible array of bacteria, fungi and viruses - we are one living, walking bio-sphere of extraordinary life forms - nearly all of which are working together for the common good .... keeping us healthy and alive!

Researchers are only now discovering the incredible array of bacteria that live in our mouths, our gut, our airways and on our skin. And then there are the fungi that normally live in our gut tube: apparently these self same fungi will "appear" in the vagina of pregnant women because there is a need for them in the soon-to-be-delivered baby who will need these "milk-splitting" organisms to help them absorb the proteins found in maternal milk. In non-pregnant women, these fungi are not found in the vagina.

Then there are bacteria teeming on our skin. These feed on the sebum produced by our skin cells and which then produce a film that helps to "water-proof" it. Meanwhile in the gut there are essential bacteria that help with the absorption of important vitamins and without which we'd all suffer serious deficiency syndromes. As for viruses, the experts are only now looking at what these "friendly" viruses do as they do invade our cells, but for what purpose is still not clear. They might have a role in priming our cell mediated immunity, but much more research needs to be done before the picture becomes clear.

The important point for this evolving field is that when we use "Broad Spectrum" antibiotics we actually destroy huge populations of these friendly bacteria and contrary to the long held assumption that they return after the antibiotics have been withdrawn, that might not actually be the case. Young children who have had repeated courses of antibiotics are at greater risk of developing immune system problems such as Eczema and Asthma - now thought to be associated with the loss of these gut based bacteria.

And in a quirky way of using this information to fight pathological infections, Doctors are already treating a nasty infection of the bowel caused by over use of antibiotics and and resulting in an "overgrowth" by a germ called C Difficile. They have found that the best way to treat this nasty bug is not with stronger antibiotics but to use a "Faecal Implant"! They take a sample of stool from a healthy person and give it via a suppository into the infected person and it "works like a dream". Now they are purifying the process to remove the "Yuk" factor, but the theory and practice are solid and so are the results!

The message here is that we need to think not twice, but long and hard every time we consider using antibiotics and what the collateral damage may be both in the short and in the longer term. We need to consider not only our biosphere, but the global biosphere too. You are more than you think you are!
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Back pain - a little patience needed.

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Have you ever gotten out of the chair, or a car and been locked into immobility by sudden, unexpected back pain? It's excruciating when it happens and you feel so powerless. Or perhaps you've been doing lots of lifting and then felt a searing pain shoot down a leg and into the foot, again leading to inability move and sure signs of sciatica!

Low back pain is common, and it HURTS. When it happens we want to get out of pain as quickly as we can and get back to "normal" without having to have anything "serious" done. That will often mean a visit to the Doc to get a diagnosis and find out "what's wrong". And here there is often a desire to get an Xray or a scan done ASAP to make sure it's not serious. Well, according to the experts, having that Xray or having that scan will not make the slightest bit of difference to treatment options or outcomes in the vast majority of cases. In fact most Xrays and scans are a real waste of precious Health Dollars.

These experts tell us that in the first 6 weeks after suffering from low back pain, with no "Red Light" symptoms, there is no need to perform any radiological screening as nearly all these cases will settle with appropriate, conservative physical therapy. Red light issues are serious progressive neurological disturbances and fear of serious other underlying conditions such as osteomyelitis.

So if and when you do get a severe back pain, don't pressure your Doc into sending you for "Scans"as in all likelihood it will be wasting not only your time but his time too: and by being patient you will save precious health dollars. Without complications back pain will settle in due time, and while it is, put that time to good use by learning how to care for your back for the rest of your life!
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Migraines - a real headache to treat!

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If you think you've had a migraine headache, you probably haven't because migraine headaches are so bad that you'd never be in any doubt that you've had one. With a Classic Migraine, not only do you get a crashing, one sided headache, but you often get a "visual disturbance" - such as spots before the eyes or partial loss of vision -, you can't bear to be in the light and often you vomit too: so all in all, they're awful!

But not all Migraines are classic and often it will take an expert to determine whether you are a migraine sufferer or not as there are no specific blood tests to say "yes or no" to a diagnosis. It is however, more common to suffer from them if a family member also suffers from them too. For most people when they get a migraine headache, all they want to do is to crawl into a darkened room and lie down until it passes. For most this may be for a few hours, but for some the hell can last a lot longer so it is very important to know that things can be done to help settle them or even better, to prevent them.

But the news here is not that great. For migraine attacks there is a group of medications known as Triptans - but these are not often used/made available to patients in some European countries, hence only 10% (Denmark) to 35% (France) of migraine patients use Triptans. These medications are seen as "rescue" medications that should be an essential tool in helping to stop a Migraine in its tracks. And for those who suffer frequent migraines and who should be using preventative medications, the news is not much better: drugs such as propranolol, valproate, topiramate, where you'd anticipate seeing a response of at least a 50% reduction in migraine frequency, in reality this is more likely to be around a 40-50% reduction. And preventative treatment is further compromised because people often stop these medications because of side effects or just poor compliance.

In view of the fact that about 2% of the adult population are thought to suffer from migraines, there seems to be a huge opening for effective rescue and preventative medications for this crippling condition. I hope there is someone listening ....

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Alzheimers Disease - a special request

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I got an email this week from a man called Michael Ellenbogen. It's about Alzheimer's Disease which most of us have already heard about, but rarely think about unless it directly impacts our lives through a loved one or someone within tour immediate community. But listen to a little of what Michael has to say:

"Many people think Alzheimer’s disease affects our senior generation, but they are so wrong. I started having symptoms at age 39. They refer to people like me as having Young Onset Alzheimer’s Disease, or YOAD. Not many people are even aware of YOAD. My wife, who is in the medical field, was not even aware of this. The only people who seem to know about it are the caregivers and the people affected, who will most likely pass away within 8 – 10 years. A new person is diagnosed with Alzheimer’s every 68 seconds. By 2050, that number will be every 33 seconds. As of today, there is NO cure or any way to slow its progression. Even worse, this disease will bankrupt our health system if we do not act now." 

Michael went on to ask for help to spread the word, and to seek to get all of us to act before we too might become swallowed up in the "nothingness" that Alzheimer's Disease leads to.  There are no simple, immediate solutions, but without doubt there is an answer, or maybe several answers, "out there", and we need maintain the enthusiasm that already exists within the Medical Research Community if we are to find effective treatments within the lifetime of Michael and others like him.

So what can we do?

First and foremost - reduce your risks. Stay healthy, stay active and stay involved. Use your brain in as many ways as you can and surround yourself with people with similar aims as yourself - and here I think there is enormous potential for Social Media to play an ever increasing role for those who live more isolated lives.

Keep yourself informed. There are many interesting avenues of research and treatments being developed all the time and they need to be critically evaluated: don't be afraid of voicing your opinion because it might just be the missing link in a long chain of productive inquiry.

Become actively involved in raising awareness of the challenge before us all. Rattle the can or just donate to registered organizations that are already doing great work in this difficult field. And always be prepared to offer support to family or neighbours whose lives have been burdened by this most difficult of diseases.


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Croup - scary but rarely dangerous.

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Human Para-Influenza virus

With the change of seasons comes a spike in viral infections. Currently in Oz, especially in the West, we are seeing some significantly low temperatures heralding the real onset of the winter months: but being such a brilliant place, at least we know that we will still get some wonderful weather on most days!

But with winter come those infectious diseases that are "stirred up and spread around" in our schools, Kinders and child care centres, and then brought home to be shared with the rest of the family. One of those infections caused by the LTB virus (proper name of laryngo-tracheo-bronchitis virus) or a para-influenza virus can lead to sore throats, coughs and in little children, Croup!

Croup is one of those illnesses whose "bark is worse than it's bite", but in little children under five and even more so in babies, listening to them cough and wheeze can be very distressing and even frightening for both child and parent. We adults can have a sore throat and cough and easily put up with the swelling that results in our larynx without too many difficulties, but the smaller the patient the more significant that swelling becomes, and in tiny tots, small swelling can have big consequences.

The good news is that nearly all children with croup can be happily treated at home: all that's required are simple measures and lots of cuddles and reassurance. The onset is usually the same as with a normal cold - they're a "bit off" and then they feel hot and may complain of a sore throat. It's when the sun goes down that things can start to warm up with perhaps a spike in temperature and the onset of a barking cough. Paracetamol in the appropriate dosage can ease the temperature, help relieve the discomfort and might allow child and parent to get some sleep. During the day the child often "bounces back", but when the sun goes down again, the symptoms may recur. The body's immune system will deal with the infection and it will settle down of its own accord in 2 or 3 days.

For those with more severe symptoms, these children may require a Steroid Syrup to help reduce the swelling in the Larynx in order that they can breath more easily. Antibiotics will make no difference to the illness as antibiotics have no place in the treatment of viral infections. If your child has some of the following symptoms, then they should be seen by a Doctor:

• They make noisy, high-pitched sound when BREATHING IN (stridor)
• They drool or have difficulty swallowing
• They become irritable
• If they are obviously struggling to breathe
• If the skin goes blue/grey around the nose, mouth or fingernails
• Has a fever of 39.5 or higher

The treating Doctor will be able to make the diagnosis after examining your child and further investigations are not usually needed. If the Stridor is severe, they may admit the baby to give them humidified oxygen and medication until the swelling has settled, but most will be allowed home on medication.

Whilst the scientist haven't found any obvious benefit from "Humidifiers" at home, in my experience they do seem to make the child more comfortable - but do make sure that they are safe and away from little hands! But in the end it's Mums magic that is probably the best, with lots of cuddles and love: come to think of it, most Dads are pretty d*mned good at that too.
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It's a funny world.

We got up early and went for a jog through the forest this morning - pause for more information re the word "jog": for us it means lots of gasping, legs that often feel like they have 20kg weights attached to them, wondering whether to worry about that disturbing ache in the knee, or whether it might be easier to breathe if one stared ahead instead of at the ground! But here's the good bit: this "jog" is interspersed with moments where we stop, perhaps to cross a road where we often pray for a stream of passing traffic to appear, or just to marvel at the absolutely, awe-inspiring, gobsmackingly beautiful thing which we call nature. The trees have become a gorgeous umbrella of shade over tracks softened by leave mould, which is far kinder to older feet than concrete or tarmacked roads. Young deer are often seen staring at these two strange people people panting past, red squirrels scurry up trees (probably sniggering beneath their fur) to warn their friends of two wearied road warriors and rabbits hurry into the ascending undergrowth of ferns and briar. It gets me every time - the glory of the whole thing.

Then I sit and look at my lap top to "catch up" on events in medicine and the world at large: and it's depressing. There is such a huge gap between reality and our perception of it in urban society with all our needs and demands for "this and that". One thing nature teaches is that as well as the beauty of it, it's not always pretty, things can go badly wrong and it is fragile: and yet it is constantly changing and constantly renewing itself. Whilst in our "advanced" societies we seem to want to achieve a permanent state of perfection NOW and for pain to be banished for ever.

So my thought for the weekend is for all of you who can, go for a walk in the park/garden/forest/beach/desert and reflect on how much you have already and be thankful for it: accept that you can't hold onto "now"; that to fully engage in life means being flexible and that suffering happens and you will need to be ready to deal with it. Tough times will come - that's the way the world works - but it's how we respond to those tough times that marks us out as the genuine article ... a human being.

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Are older men wiser when it comes to sun protection?

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Apparently not much changes with men as we age: we still continue to believe that we're invincible! Well perhaps as far as looking after our skin, according to some recent research that I read today.

Older men are not good at protecting their skin from the sun and are at greater risk from developing skin cancer according to the report. The "Silver Surfers" reasoning goes like this: "I need a bit of sunshine and at my age, why bother with all this sun protection?". Well, I still vividly recall one of my first patients who was a melanoma sufferer and not all the gold in the world would get me to swap places with that poor guy! The good news is that early detection and treatment of melanomas - before they have spread to the lymph glands - has a 98% survival rate at 5 years, which in anyones book is pretty damned good!

So for all of those testosterone charged senior males who still know where their abdominal muscles are and love to flex them, here's a few tips.

Over the age of around 60 yrs you're going to lose subcutaneous fat and your skin is going to become more fragile; thus it needs all the help you can give it. Too much UV rays will damage the skin further and raise the real risks of developing sun related cancers. Think of your skin in the follwoing way: imagine a bucket, and once you've filled that bucket with water, it can't take any more. The skin is your "bucket" and the sun is the "water" and by the time you've got to 60 you will almost certainly have filled your "bucket" and you need to "turn the tap off", in other words avoid the sun's powerful rays.

So go outside and enjoy the great outdoors before 10am and after 4.00pm. If you have to go out in between those times make sure that you "cover up". Get into the habit of putting sunblock on exposed skin after you've brushed your teeth in the morning - summer and winter. Wear a hat with a wide brim: there are some really good ones around so take time to browse the shelves until you find one that makes you smile! Wear long sleeved skirts and slacks and if you're invited out during the day always try to find a good spot in the shade - you'll meet a lot of other interesting people there!

And if you notice something on your skin that has changed shape or colour, or bleeds easily, then please don't ignore it - get it checked by a professional and not your golfing buddy!

The sun is the most powerful structure in our planetary life and we should treat it with the greatest of respect - just like you'd like to be treated yourself!

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