Tuesday, January 31, 2012

Bell's Palsy

The trouble with Bells Palsy is that you don't know if you're having a stroke or not - and that's not a very nice position to find yourself in! All you know is that one side of your face becomes paralysed over a few hours or a few days, and the best thing you can do is to get yourself to the Doctor ASAP because with quick, appropriate treatment, the vast majority of cases will resolve: albeit, some may take months to do so.

Unlike strokes, Bell's Palsy is rare over the age of 60, and is just as rare under the age of 15: but it's not a rare condition - in a country like France there are about 15,000 new cases diagnosed each year. As well as paralysis of one side of the face which can make it impossible to smile or to close the affected side's eye, patients may also experience:

Pain around the jaw, or in or behind the ear of the affected side
Increased sensitivity to sound on the affected side
Headache
A decrease in the ability to taste
Changes in the amount of tears and saliva. This cans lead to serious drying of the affected eye.

The cause of the problem is "re-activation" of the Herpes Simplex 1 virus - the one associated with cold sores - that is found in 80% of patients with Bells. Current early treatment with steroids reduces the inflammation, caused by the virus, to the nerve as it travels through a tight bone tunnel in the base of the skull, reulting in faster resolution of the facial weakness.

But for a small minority who don't get to the Doctor early enough, or for whom steroids don't work, what options do they have?

The major obstacle facing "non responders" is that the area where the pressure is casuing the nerve damage, lies in solid bone below the brain and it's not an easy spot to get to surgically. There are some centres around the world that perform this surgery, but first they have to test the nerve to see if their is "any electrical activity" left in it. If there is, then in these specialist centres, surgical intervention offers positive results.

In Japan, they are attempting to improve surgical results by applying a Hydrogel impregnated with bFGF, a nerve regeneration stimulating factor, which has led to a significant improvement in post surgical recoveries.

I think that helping people recover from the brutal effects of a paralysed face caused by Bells Palsy is enough to make everyone smile once again!
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Sunday, January 29, 2012

On heart disease and hypertension

There have been a couple of interesting papers on heart disease published in the last week. The first to have caught my eye was on "risk factors" - that golden concept that has been the bedrock of how we run our preventative health programs for heart disease. It appears that we may have to "tweak" -and tweet - it a little. Currently when we look at risk factors we project "risk" over a 10 year period, which of itself is no bad thing, but according to new results from the Cardiovascular Lifetime Risk Pooling Project, published in the January 26, 2012 issue of the New England Journal of Medicine, by the time people get into thier 40's and 50's, even though they may only have a couple of risk factors such as elevated Lipids and High Blood pressure, the risk for a lifetime cardiovascular event jumps precipitously.

I draw two conclusions from this: first we need to work hard on educating young people that they need to get their risks to zero because by the time they get to middle age, even just a couple of risks can be life-threatening. And secondly, that message must also be rammed home to all middle aged people if they want to live to a grand old age without suffering a cardiovascular event.


The second article was on resistant Hypertension and further insights that have been gathered there. According to Dr. Henry Black, Professor of Internal Medicine at the New York University School of Medicine, about 60% of patients referred to them have resistant blood pressure and they can get 60% of those down to normal ranges with aggressive treatment. That still leaves 40% to work on, but with the "rediscovery" of that age old medication Spironalactone by researchers at Birmingham Alabama, they think they can get that 40% down to 10%. So where do we look next?

Well apparently we look at our patients to see if they have a large neck and ask their spouse/partner whether the patient snores or not, because Obstrucitve Sleep Apnoea is the most common condition associated with resistant Hypertension as reported by Pedrosa RP et al from the Sleep Study unit in Sao Paulo Brazil. 

Its great when people come up with these little refinements as it helps primary physicians and patients to extend their practical knowledge before having to refer to large, busy hospital units.
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Friday, January 27, 2012

Exercise helps in Rheumatoid Arthitis

During the course of practicing medicine, I came across some amazing personalities. One of the most vivid was a Croat lady who had come to Australia many years previously with her husband and two sons to escape the conflicts in the Balkans. She was a classically trained artist who had studied in Paris and very well known in her own country; it appeared that her reputation had followed her to Australia as her pictures hung in galleries from Melbourne to Perth.

Photographs of her in her youth show her to have been a vibrant, strong, straight lady with gentle eyes. When it came to my turn to care for her, her eyes had not altered but her body had been ravaged by the destructive disease that is Rheumatoid Arthritis -RA. Whereas previously she stood about 5ft 4 in the "old language", now she was a shriveled 4ft 10 in her stocking feet: stockinged because there was no way she could put shoes on her swollen deformed feet with her withered fingers. She had already had shoulder replacements, elbow replacements, hips, knees and several finger joints replaced: and she had a God sent smile that went right to your heart.

This woman suffered enormously and yet she continued to paint with her crippled hands and still produce works of deep significance. I am honoured that she gave me some which hang with pride in our home.

I thought about her today when I read that over 40% of US RA sufferers were inactive and that over 50% were not motivated to exercise either, and I remembered the canvasses that she had painted even though she had had the majority of the joints in her painting  arm replaced!

There are about 1.3 million people in the US and over 400,000 in Australia who have been diagnosed with RA. 30 years ago Doctors did prescribe bed rest and medications for RA, but not now. And I don't mean people with RA should be running marathons; what they should be doing is talking to their Specialists and liaising with their Physical Therapist to work out a physical activity program that is tailored for them to help maintain good joint function, even whilst taking their disease modifying medications.

Each of us is a work of art: despite what we may be suffering from, lets make it a "collectors item"!
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Thursday, January 26, 2012

Sir Richard Branson - on drugs.

I read an article in the newspaper today that has got me thinking. It was on the subject of subject of "illegal" drugs, and Sir Richard Branson - never one to be a shrinking violet when it comes to giving a statement - suggested that "illegal" drugs should be de-criminalised, freeing up the Police to chase violent and organized crime. He qualified this by saying that "illegal" drugs were dangerous and were a threat to health, and that education and rehabilitation would be a better focus for users than sending them to prison where their habits would almost certainly become entrenched.

At face value there seems to be some sense in what he is saying: taking drugs is still a very bad thing to do, just like smoking, spreading STI's and abuse of alcohol - but should we send the police to their houses, or improve our health education and drug treatment programs? Countries that have de-criminalized "illegal" drugs, such as Switzerland, found that drug taking decreased; so that gives more food for thought.

Any abuse of a chemical, whether it be alcohol, tobacco, opiates, amphetamines or any mood altering drug is fraught with terrible consequences and we need to teach our children and grandchildren of the dangers associated with them, not only of the damage they do to themselves, but of the impact it has on others: no-one is an addict in isolation!

My suggestion is for people to start talking about how best to approach the problem: prohibition didn't work and criminalization has had no apparent benefit. Education has helped reduce tobacco usage in many countries and is a good template perhaps for our approach to drug users. But experience has shown that sending them to prison has not helped, and perhaps now is the time for new initiatives.

I haven't made up my mind yet, but education seems better than incarceration. Let me know what you think.
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Wednesday, January 25, 2012

Time to make a difference

Now that I've written over 130 articles on varying subjects, I think the time has come to take this Blog to the "next level".

The idea for writing these articles was so that up to date health information could get from those who "have it" - the health professionals - to those who "want it", and that's YOU. The wonderful thing about social media is that it's so ...... Social: we can interact and personalize information to help tailor it for smaller groups and individuals, as opposed to mass information that tends to be generic and fails to account for our very individual "variations"!

So I want to run a series of Surveys: nothing fancy, and on subjects that initially I will choose until there are subjects that are of interest to groups of you. The name of the game is to find out what you think you know, and also to help find out what you need to know: for example, do all birds carry bird flu or is it just chickens? At this stage I will aim to run 3 or four Surveys a year: as I said, they wont be fancy and it wont be "research" as there will be too many variables to control. What it will be, is for you - the readers, the seekers of reliable information, the ones who want to do "things" better. The outcome is that we as a group can show that by sharing information, knowledge and experience that we can have an impact on community health care at a grass roots level and that we can be a force for good.

That's the dream, but it lacks one vital thing - it needs you to help. I have over 250 followers, but to give the surveys real impact I would ask that you involve as many people as you can so that the results have more meaning, and carry greater force.

The first Survey will be coming out in the next few weeks, in the meantime it's business as usual. If you have any particular subject that you see as a "burning health issue" in our communities, and that you would like addressed, please just send me an email.

Lets change our world, and it all begins with "me". 

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Monday, January 23, 2012

Growing old "On-line" helps body and brain.

One of the challenges facing us all as we age is twin threat of social isolation and increasing frailty. Social media thankfully is helping to make a big difference here and to empower those who were previously all on their own.

Not only has modern IT allowed us to interact and keep informed like never before, but it's also helped with keeping fit. Many health  and community departments worldwide have been incorporating electronic devises such as Wii and Xbox to help with home exercise programs with great results. By having a 3D screen on the front of your home treadmill or exercise bike,  you not only have a great deal more interest in doing exercise, but also it can give you a bit of healthy competition as well! Added to that is the fact that because many newer 3D programs having you careering around corners (naturally for the more advanced users!) then balance is challenged and improved too!

Now research is showing that not only can modern IT help with physical things, but mood and personality can also be enhanced too, according to Professor and study co-author Brent Roberts from the University of Illinois. The personality trait that showed modest improvement over the course of the trial was "Openess" - or being flexible and creative, which is not a bad thing to be if you want to age gracefully. Prof Roberts took his patients through a personalize cognitive training program and not only did they improve in their cognitive skills, but there was also a significant increase in their Openess.

So for those of a greying tendency, get plugged in, get active  and stimulate your brains all in the comfort of your own home. As one gets old, life can be tough, but it can also still be exciting!
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Friday, January 20, 2012

Umbilical Stems Cells show healthy promise

Many years ago a young lad who was a close friend of my sons suffered a broken neck playing sport. He instantly became a quadriplegic and has been confined to a wheelchair for the past 16 years. Later on I had the privilege of being Physician to a Quadriplegic unit for those who could not care for themselves in the community, so I have first hand knowledge of the challenges that those with spinal injuries face.

Most of us hope that one day a cure will be found and those with spinal injuries will be able to get out of their chairs and walk. Everyone I met with a high spinal cord injury just wished for one thing - to be able to control their own bodily functions, and that means controlling their bladder and bowels without the help of others - walking was further down their wish list. Most researchers aim, not for the miracle "get out of your chair and walk" scenario, but to be able to "lower" the level of the lesion; which means that a quadriplegic would regain the use of their arms, and a paraplegic would get back the use of their legs.

Every now and then stories appear in the press which indicate that a new discovery has been made and a "break-thorough" is imminent, but most of those involved in spinal cord research know that any solution to the problem is going to be extraordinarily complex and will need many different factors to be controlled at the same time in order for progress to be made. Much is made of "Stem Cell" technology and the hope it offers, and these multi-potential cells do offer an Aladdin cave of possibilities, but put in crude terms, they are only the scaffolding and wiring of what is required. How do the nerves know in which direction to grow? How will they be able to recognize which cells to re-connect to? When will they know when to stop growing? And of course there have been ethical concerns about using Human Embryonic Stem Cells. But a recent report suggests that there may be an alternative to Embryonic Stem cells, and this would involve using stem cells derived from the Umbilical Cord, and hence overcome any ethical issues.

Hedvika Davis, a postdoctoral researcher in Hickman's lab, set out to transform umbilical stem cells into oligodendrocytes - critical structural cells that insulate nerves in the brain and spinal cord, and has developed a way of doing that using environmental as well as chemical stimulation. Whilst in theory, the injection of such cells into the damaged spinal cord might help to promote healing, the results are still a long way from being a cure for this devastating problem. But Dr Davies is more hopeful that her research will also lead to better management of  Multiple Sclerosis, a disease where nerve cells lose their Myelin covering, a process that damages their ability to transmit electrical impulses. Oligodendrocytes produce Myelin, and the hope is that these umbilical cells can be turned into cells that can help repair the cells damaged in Multiple Sclerosis.

So often often these discoveries seem like a drop in the ocean when compared to the enormous obstacles that confront them: but as a well known researcher I know often says, "That's what the ocean is made up of, a lot of drops"! 

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Tuesday, January 17, 2012

New technique for ruptured ear drums: sounds good!

When our youngest was in primary school many years ago, a female "friend" fetched him a clout across his ear - probably quite justifiably - but the result was that the force of the blow actually ruptured his ear drum! Unfortunately it didn't heal and he had to go into hospital and have a graft put over the defect. But the good news is that it all healed nicely and he's never looked back.

Now it may well be that hospitalization for such injuries may not be needed in the future if Dr. Issam Saliba of the Universit√© de Montreal gets his way. He's been developing what's been described as a "revolutionary" new way of patching such defects in an Outpatient setting. His procedure is quick, requires only a short local anaesthetic and the results have been excellent according to a report in the December 16, 2011 of the scientific journal Archives of Otolaryngology -- Head and Neck Surgery. 


A small amount of fat is taken from behind the ear under local anaesthetic, and with the addition of Hyaluronic acid to help promote normal tissue healing, is placed over the deficit. The results have been equal to the traditional methods which require a general anaesthetic, harvesting of graft tissue and then up to 10 days off work or school to allow healing to become firmly established.

Not only is this method less traumatic for children as they don't require hospitalization, the cost savings will be significant too: plus more Theatre time will be freed up as these operative procedures will now be carried out in Outpatient settings. It's all music to my ears!
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Cholesterol - the plot thickens!

All is not as simple as it may seem! First we knew that heart disease was more common in people who were overweight and who smoked, so we encouraged fat people to lose weight and stop smoking, and hey presto, the problems with heart disease started to decrease. Then we discovered that the circulating fat - Cholesterol - in the blood stream was the culprit and drugs were developed to target the problem and hey presto, low cholesterol resulted in lower rates of heart disease. Then we discovered that there were "good and bad" cholesterol - LDL being the bad guy, and HDL being the good guy. So now we're developing drugs that lower the LDL and attempt to rise the HDL.

But apparently the story doesn't stop there (will it ever?).

Scientists in Vienna have reported that HDL can also be subdivided into "Good guys and useless guys"! They have discovered the fact having a high HDL does not necessarily mean that it will be cardio-protective as sometimes HDL can be worse then useless! So more does not necessarily equate with better, and what we now need is a test to work out that if a patient has a high HDL, is it made up of the "right stuff"!

In the meantime, stay lean, stay fit, don't smoke and live to the best of oyour ability each and every day.
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Monday, January 16, 2012

Motor Cyclists, helmets and health records.

I love simple ideas that can have a big impact. But more of that in a moment, first I have to admit to a simple passion of mine that has two wheels and requires no effort of mine to propel it forward! If my mother of blessed memory were still alive she would be aghast at me for owing a motor scooter as she described them as "death traps". In fact, when I was caring for long term quadriplegic patients in a special care facility, one of the Consultants said that the only reason quadriplegic units existed was because of motor bikes!
But I love my Piaggio 250 for many reasons: it saves me a fortune on petrol/gas: the young bride always travels with me so I am constantly getting a cuddle: and it has made me a better driver because I am constantly on the alert for drivers/pedestrians/animal/any foreign object that is about to end my life, so when I am in a 4 wheeled vehicle I am now much more vigilant.

But back to the simple idea. In France they have trialled the use of special bar codes that motor bike/scooter riders have on their helmets. This bar code relates to their medical history so that should they have any accident then the attending emergency services just use their iPhone to scan the bar code and then they have all the relevant medical history they need to maximize the outcome should the driver be unconscious. Simple, easy to use and potentially life saving.

So to all 2 wheeled enthusiasts like myself who like this idea, then why not talk to your local ambulance/emergency services and see if you can create a similar service where you live.
In the meantime, make sure that your pillion keeps hugging you!
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Thursday, January 12, 2012

Kids inspire hope.

I was shown some lessons in living today. And it had nothing to do with a breakthrough in gene therapy or the latest research that shows that fruit fly have the same genetic coding as humans for sleep/wake control (which they apparently do).

I was just walking down a street and watched some kids play in a park which also had a small wooded section. Balls were kicked and games of hide and seek were acted out: some kids were brave and some were scared, but none of them worried about being "in control". They just played - or should I say - lived in the moment.

As adult we seem to lose this ability to live in the moment, and invest so much energy in trying to be "in control of our lives". This applies particularly to our health. Having personally experienced open heart surgery for coronary heart disease and knowing what it really is like to wake up in ICU, only to be told that they had to put me back to sleep because I was bleeding too much, I can empathize with all those who try to control their physical parameters in order to "reduce the risk" of suffering from health issues in later life.

But as I watched those kids play and then wander off to their homes, I thought of the "kid" inside me who also wants to live life like that and not be afraid of the next warning sign that something might be going wrong.

So this blog today is dedicated to all the kids in the world - those in short pants and those with greying hair. May you dare to live each day as it comes and not fear tomorrow, because life is precious and we cannot save it up for the future, we can only live it day by day.

Life is a gift, not a threat - rip off the packaging and enjoy the present!
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Wednesday, January 11, 2012

Surfing the net to monitor influenza

Not that long ago I wrote about how we could use social media sites to monitor the outbreaks of infectious diseases in our communities to warn other parents of the presence of infectious childhood diseases such as influenza, measles and chicken pox. Well it seems that others have been thinking along the same lines as researchers at John Hopkins in the USA have been reviewing Google Flu Trends to see if there is a link between people searching the internet for information about influenza, and actual hospital admissions to Emergency Departments for patients stricken with this infectious disease.

And what they found is that there is a connection, with an increase in people searching for information preceding a spike in admissions for flu related illnesses. This has implications for primary health care as keeping an eye on Google Flu Trends could help Emergency Departments prepare more precisely for imminent increases of patients with FLI - flu like illnesses. Traditionally, hospitals rely on pathology departments to screen for the presence of influenza in samples submitted for analysis and this can be a lengthy process: but by monitoring internet activity for influenza related searches, the information obtained can be reviewed on a daily basis. The other significant benefit is that Google is a world wide search engine, and so people who are considering travel to specific parts of the globe can check to see if influenza may be a possible threat to their health in their country of destination, and then take the appropriate precaution of immunization against influenza.

My suggestion to everyone would be to add http://www.google.org/flutrends/ to your bookmark bar, just so that you can see what is happening in your local community and in those areas of the world which you hope to visit in the near future.
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Thursday, January 5, 2012

Sex in 2012

 What better way to start a new year than with an article on Sex, the physical activity that has literally been around since "Adam was a lad"! What brought my mind to ponder the subject of sexual intercourse was a headline in our regional newspaper proclaiming that the rate of Sexually Transmitted Infections had risen in the past year and part of the reason was an increase in the number of sexual partners that teenagers were having. I think I also read, not that long ago that STIs were also on the increase amongst the "Grey Brigade" who tend to shun the use of condoms believing that "it will never happen to me".

Well let me tell you, young and old, that I have some seriously bad news for you. A quick look at the WHO statistics tells me that:

  • 448 million new infections of curable sexually transmitted (syphilis, gonorrhoea, chlamydia and trichomoniasis) infections occur yearly.
  • Some sexually transmitted infections exist without symptoms.
  • In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death.
  • Sexually transmitted infections are the main preventable cause of infertility, particularly in women. 
Please note from the above quote that only four causes of STIs are mentioned  -syphilis, gonorrhoea, chlamydia and trichomoniasis - when in fact there are over 30 different bacteria, viruses, parasites and fungi that are spread sexually and the 26 not included in this WHO list include HIV, Hepatitis B & C, Herpes, the Papilloma or wart virus etc. The number of people suffering from Hepatitis B is alarming, about 2 billion people worldwide have been infected with the virus and about 350 million live with chronic infection. And for Hepatitis C, the numbers are not as great, but the mortality is eye-opening: about 130–170 million people are chronically infected with hepatitis C virus, and more than 350 000 people die from hepatitis C-related liver diseases each year.

And if you have an untreated STI, you have a 10 times higher risk of contracting and transmitting HIV!

Sadly, women are the more vulnerable group as they can often harbor some infections without knowing that they have the disease. This is particularly so in the case of Chlamydia, the complications of which can lead to infertility and ectopic pregnancies: here's more from the WHO:

  • 10 - 40% of women with untreated chlamydial infection develop symptomatic pelvic inflammatory disease.
  • Post-infection tubal damage is responsible for 30 - 40% of cases of female infertility. 
  • Women who have had pelvic inflammatory disease are 6 - 10 times more likely to develop an ectopic (tubal) pregnancy than those who have not
  • 40 - 50% of ectopic pregnancies can be attributed to previous pelvic inflammatory disease.
The ancient diseases of Syphilis and Gonorrhoea can lead to the following problems:
  • In untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death – an overall perinatal mortality of about 40%.
  • Up to 35% of pregnancies among women with untreated gonococcal infection result in spontaneous abortions and premature deliveries, and up to 10% in perinatal deaths.
 With the mobility of people comes the increased risk for exposure to these life changing, and life threatening diseases because with literally billions of people carrying such infectious diseases, the chances of getting one through casual sexual encounters are remarkably high. So my message to young and old alike is, if you think you might "get lucky" at the next party you go to, don't be surprised if you get more than you bargained for! According to the WHO again: "The most effective means to avoid becoming infected with or transmitting a sexually transmitted infection is to abstain from sexual intercourse (i.e., oral, vaginal, or anal sex) or to have sexual intercourse only within a long-term, mutually monogamous relationship with an uninfected partner." Now that sounds like a lot of sense to me.
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