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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