Covering up on the beach

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I was recently reminded of a media story concerning a young Australian woman who flew half way around the world to sit on a French beach wearing her Burka. The recollection happened whilst I was walking past Bondi Beach in Sydney where there was not a Burka in sight!


Aside from the reason for her international actions - which I am neither privy to or in a position to pass judgment on - I do admire her for "Covering Up" under the blue skies of a Mediterranean beach. I would however, challenge her choice of colour, black not being my first choice for a covering. In fact I suspect that she must have been gently simmering under the French sunshine. But if you go back several decades when Roman Catholic Nuns had no choice but to wear similar gear whilst administering to souls throughout the Australian outback. Not that wearing black was a health risk per se, just hellishly hot! Those Catholic Sisters actually succumbed to a more insidious killer that still remains a deadly scourge in many parts of the world - Typhoid!


But I digress!


Summer is almost upon us here in the southern hemisphere and we do need to re-visit the annual alarm over the devastation power of sunshine - not only in the form of Global Warming - but also upon our human skin!


Even if you have the "best" skin in the world when you're young, believe me, it will get old and you won't appreciate what the sun did to it in those earlier decades. THE SUN IS INCREDIBLY POWERFUL. It's the equivalent of thousands of Thermo-Nuclear reactions occurring every minute which are pumping out radiation that will destroy anything that falls into it's gravitational field of influence. Thankfully the Earth is in the Goldilocks position - not too close to fry to a cinder, and not too distant to freeze into an ice-block.


But just because the Earth "got lucky", doesn't mean that rubbing sun screen on your skin will protect you 100% against the sun's rays. It's like believing that airbags will save you in a high speed accident. They might reduce the harm, but 100%????


Avoiding direct exposure to the suns rays when they are most powerful is the best option. Don't expose yourself to the sun for more than a few minutes at a time between the hours of 10am and 4pm. If you do then make sure you're fully covered up with appropriate clothing (preferably not black), use high protection sunblock on any exposed areas, wear a broad rimmed hat and UV protection sunglasses.

What's white and makes your face itch? Answer: Dandruff.

Tweet I've been working out at a rural GP practice about 110km (about 70 miles) east of Perth here in W Australia. It's a great time of year to visit the country as the crops are coming up and the countryside looks FANTASTIC. Most people are saying that it's the best start to the farming season for 50 years. But not the farmers themselves - all they say is "have you seen the price of wheat? Gorn through the floor mate!" But then, have you ever met a farmer who's truly satisfied with farming .... until the money is in the bank!
Country folk are a great bunch of people, but they suffer the same problems as most other communities and they suffer the same kind of tragedies too.
One patient came in to see me and I immediately thought to myself that I've seen that face before!
In fact I'd never seen the person before in my life. What I had recognized were the obvious signs of Seborrhoeic Dermatitis. This presents as a classical flakey, itchy, red rash in the Naso-Labial folds of the face, in the eyebrows and often in the ears and on the chin too. (see my diagram below)

The cause? A fungal infection of the scalp that we often call DANDRUFF!

By using an appropriate shampoo, not only do you clear up the fungal infection but you cure the rash on your face too!

Talk to your GP about it: they'll know what to prescribe.

Hygiene for the outer ear

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Small children and infants are often aware of their ears when they get a head cold and end up with an earache.

Many air travellers become aware of their ears as the aeroplanes gain altitude, or descend from cruising altitude when the cabin air-pressure changes and eardrums begin to "pop".

But most of us go through life never thinking about our ears until we begin to lose our hearing!

From the diagram above there are two main areas of the hearing apparatus (classically we talk about three, but who's going to be picky) The two areas are:

• From the Pinna where many people hook their glasses onto, to as far as the ear drum.
• From the Ear drum to the inner end of the Eustacian Tube which open into the back of the nose.

Today I'm just concerned about the hygiene of the outer part of the ear from the ear drum out. For some reason, people like to stick things in their ears, most notorious of all are cotton buds. Many's the GP and ENT specialist who's had to retrieve the end of the bud when it comes unstuck with the external ear canal. Hair grips are another villain of the peace. These metal instruments can end up scratching the lining of the canal and allowing bacteria to get to places where they shouldn't get.

Why do people stick things in their external canals? Mainly to relieve an itch they find difficult to scratch. Many of such people also have dandruff of other eczema like conditions. For those people I suggest a trip to the local pharmacy to buy a mild Cortisone based cream. By wiping some of this with a finger tip into the external canal you can relieve the itch/scratch cycle and then there's no need for anything else. If itching persists then visit your Doc to get some appropriate ear drops.

Another reason people use cotton buds is to dry their ears! For these patients I recommend using a Tissue Spear to gently dry the external canal. These can easily be made by twisting the corner of a piece of tissue or toilet paper and making it into  a pears shape. That can then safely, and gently, be pushed into the canal and help dry the contents. If you want a bit of extra "oomph" then use a hair dryer (on low power) held about half a meter away from your ear. (Make sure it's not on HOT as that can prove to be extremely uncomfortable).

But prevention is better than cure so if you don't want to get water in your ear when showering etc, then use a plug of Blue-Tack - it's works like a dream!

Aussie Spiders - Reputation is worse than their bite!

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Red Back Spider - Courtesy Sydney Morning Herald

My next door neighbour was telling me the other day that she'd been bitten by an insect on her foot. Apparently it "blew up" immediately and her Doc told her that she had developed cellulitis and started her on antibiotics.

A few thoughts stirred in my ageing brain, but I quickly moved on from the inappropriate prescription of antibiotics, to musing on insect and spider bites in this Great Southern Land called Australia. 

When the young bride and I first arrived down under we were regaled with stories of the most venomous snakes in the world, spiders the size of smartie with enough toxic venom in them to kill a horse - and all of these creatures are to be found in your backyard or under the toiler seat!! I also vividly remember a certain visiting Bishop develop a visible blood lust when called upon to deal with a large Tarantula which was holding court in our bathroom. The poor creature was drowned in Mortein by our Special Forces Prelate! I later learned to love those large, hairy arachnids who love nothing more than to dine on mosquitoes. Those buzzing, pesky insects, which can make an evening barbecue a living nightmare, are much more of a health risk than any spider is - just think Ross River Virus, Dengue fever ... even Malaria.

As far as spiders go Australia does have an impressive array of them and it's worth remembering that all spiders kill their victims (mainly insects) with a venom. But we shouldn't fear them as much as we do - apart from perhaps a couple of well known villains. Compared to we humans, even the most "dangerous" spider must be seen as veritable pussy cats!

Top of the list of "good idea to avoid" spiders is the Funnel Web.

Courtesy Australian Geographic

This is an aggressive little critter and if you think you've been bitten by one of these then you should pop along to your local hospital for prompt attention. The Neuro-Toxin they produce can have some very unpleasant side effects. The good news is that there is an anti-venom and secondly, no one has died from a Funnel web spider bite since modern first aid was introduced. In fact in the history of New South Wales only 13 deaths have been recorded.

One other spider you shouldn't poke a stick at is the Red Backed Spider - photo at top of the page. These lovely creatures live in a tangled we, are easy to spot and just enjoy eating other insects. Even the male of the species can be devoured by his mate in the course of mating (who said life is easy for we men?)
They certainly carry a huge punch but rarely leave their tangled fortress.

Problems occur when people/kids try to catch them, try to pick them up or think they are dead in the skimmer box of swimming pools. You will know if they've bitten you as the bite is very painful. Apply some ice, pop the offending insect into a bottle and head off to the local Hospital for the anti-venom. No one has died from a Red Back bite since the anti-venom has been available.

Here's a spider that has a lousy reputation for no reason at all! 

Courtesy Museum of Victoria

This is the White Tail Spider. It has a reputation of causing nasty flesh eating ulcers - but thankfully, the poor arachnid is seemingly innocent. In a study of 100 cases of identified white tail spider bites, not one of the patients suffered any loss of flesh!! Why devour a human when there are a billion flies to eat locally!

Just to put things in perspective:

On average:

• Two people die from snake bites each year
• Three people die from shark attacks each year.
• Ten people die from Bee Stings each year.
• Between 80 and 100 women die each year as a result of domestic violence
• 1153 people died on the roads in 2014

There have been no deaths from spider bites since 1979

and there are far more spiders than humans out there!

Buying time with CPR - you CAN save lives!

Tweet I've just attended a 2 day workshop on Advanced Life Support and Advanced Trauma Life Support run by Western Australia's Rural Health Organization. Believe me, it was intense and hugely informative. I don't think I've pumped out that much adrenaline role-playing emergency scenarios in a long, long time! I came away with a greater confidence that even as a GP with nearly four decades of experience that I can do more to help the people I care for in emergency situations.

But there is something that everyone can do that can help save lives - CPR

Effective CPR buys time! Crucial time that allows an ambulance, or someone with a Defibrillator (and all airports, large urban shopping centres, gymnasiums etc now have them readily available) to arrive. Getting a Defibrillator onto a collapsed person who's not breathing - AS SOON AS POSSIBLE - provides that person with the maximum chance of survival.

Remember: maintaining circulation with CPR is the only tool we have when someone collapses outside of a hospital environment. And the big difference to survival is a DEFIBRILLATOR.

All Defibrillators are really smart machines: all you have to do is place the pads on the patients chest and switch the machine on. It will diagnose what's going and tell you exactly what to do.

So the message is simple:

1. Learn effective CPR to buy TIME
2. In the DRSABC algorithm you will learn, probably the most important thing to do is SEND FOR HELP which in real life is to say:

 "Call for an Ambulance and see if there's a Defibrillator in this place"

 You can make a difference. Effective CPR buys time, but a Defibrillator saves lives.

Is there such a thing as Safe Sex?

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Cunning little critters

"It's been going on since Adam was a Lad"  my dear old Mum used to say - sex that is! Talk to any (well nearly any)  hormonally charged young man or woman and they'd probably say it's the best thing on the planet. That was until mobile phones and virtual reality spoiled it all! For us of a more measured generation who are still used to answering/not answering land-lines, it's still way up there as one of the best experiences life has to offer.
The trouble with sex is, well, it really is THAT good and as a result advertising promotes the idea that the more you get the better it must be. Just think of all those boozey beer adds with beautiful young people eyeing each other off. They certainly don't look like they're heading to the library to study together. And I needn't mention those erotic adverts for what appears to be a jeweled ribbon appearing out of a model's buttocks and sold for a fortune as a 'thong' or 'G'string.
Selling bulk sex reminds me of why Vitamin supplements appear to be so popular. The promoters of such supplements appear to work on the idea that if a little is great to keep the human body healthy, then a Mega-Dose will be even better! Sadly, neither appears to be the case.
But back to sex. If it's so good then what could be wrong with it?
Call me old fashioned, but from my reading of the literature over the decades it seems to me that the safest/best sex is had in monogamous relationships and not by spreading it around with every consenting adult you can find. Why?

Because sex can be a real health risk!

• Chlamydia - can make females sterile by irreversibly damaging their 'tubes'.
• Syphilis - an ancient scourge that can even kill or send you mad!
• Gonorrhea - another ancient scourge making a big comeback
• Herpes - as one wit said "Not only love lasts forever - Herpes does too!"
• Hepatitis B - can develop into a potentially life threatening disease.
• Genital warts - now linked to the development of Cervical cancer and the target of a new vaccination program for young people
• HIV - a sexually transmitted disease that has spread globally and still defies any cure

Then of course we must consider what coitus is also about - as well as all those nice fuzzy bits - the making of babies ... AKA conception.

If a male has vaginal sex with a woman there is always the potential for conception. Period (no pun intended)

This has been brought home to me in the last two weeks when I've seen one woman conceive who was on the pill and another who conceived who'd had her "tubes tied" 3 years previously! Believe me, those spermatozoa are devious little critters who will always find a way to a friendly egg.

So the next time you think about some recreational procreation/horizontal folk dancing or whatever the current epithet is, just beware that you may be leaving with more than just a happy memory - you may be changing your life (or someone else's) forever.

Giving Hope to the Hopeless

Tweet I really wanted to write 'Hope-Less' because 'Hopeless' makes you immediately think that the person in front of you is a complete idiot. Whereas 'Hope-Less' suggests that they are devoid of nearly all coping mechanisms and have forgotten what hope really is. And believe me, that is a truly tragic state - especially when you see that lost look in a young kid's eyes.

It's vital we break the circle of despair

Otherwise we consign the next generation, and then the next generation to repeating the mistakes of their parent(s).

Most people are ignorant of what it's like to be in a situation where there is no job, your boyfriend has left you with 2 toddlers and run off with his ice addicted new partner. That your parents separated when you were young and you haven't heard of your father since. Or that your Mum's around, but what with the price of "smokes" and what's left of  the pension going on rent, food and medicines "she's not much help". And your so-called friends all smoke, most take drugs and most of them are pretty "hopeless" too. Yeah, you'd like to get away and make a new start but where do you go?

Believe me, in some areas of all countries that is the constant story seen by family GPs. That, and those who are on sickness benefits because of bad backs/depression/chronic pain ...who attend your surgery like a flock of worn out folk and each and every one of them looking 20 years older than they really are. Even the infants in their prams look confused at the behavior of the person who's wheeled them in on that particular day. 

Checking out their medical records you see a long list of anti-depressants: sporadic correspondence from psychologists/psychiatrist which start out optimistic and then segue into frustrated pessimism. These poor people find it so hard to change because every day they see and do the same things. As one person was heard to say: the definition of insanity is when you keep doing the same thing and expect a different outcome.

But the family Doctor is one person who can play a big part in their lives. These people attend our surgeries on a very regular basis. There is one treatment that we can give them which I suspect is one thing that they never get anywhere else - SELF RESPECT

Here's my suggestion: find time to tell these lost and damaged souls that they are worthy of our time, they do have value and they should learn to respect themselves even when other idiots try to put them down. I challenge some patients to do just one simple act - lift their heads and look up. Instead of seeing the rubbish and detroitus on the pavement, they'll see some trees, see the sky and maybe even hear a bird sing. It's only one little thing but if they persist it will become a habit ....  a habit of looking for HOPE. And dear God, some of these people need that in their messed up lives.

Your Secret Support - and how to improve your sex life!

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We use it every day as soon as we get out of bed, and in fact many people use it when they're asleep too. It's one of the most neglected muscles in our body but when it fails to do it's job properly it can make our lives a misery!

I'm talking about the Pelvic Floor.

The pelvic floor is a sheet of muscles that support all the contents of our pelvis: which means -

• The bladder
• The rectum and it's faecal contents
• and in women, the uterus and ovaries too

When the pelvic floor lets you down then controlling your urine can be a challenge when coughing, sneezing, straining or even just standing up! For those with loose bowel motions, a weak pelvic floor means that soiling your pants can be an embarrassing problem which may lead to social isolation as well. And when the bottom literally falls out of your pelvic floor, your uterus will often fall out too leading to a utero-vaginal prolapse!

Most of these condition are preventable by good personal care. For most people this means a lifelong approach to daily pelvic floor exercises and being aware of:

• Avoiding constipation and/or straining with a bowel motion
• Avoiding persistent heavy lifting
• Treating chronic coughs and straining
• Watching your weight and losing it if you're too heavy

So how can I improve the strength of my pelvic floor?

The first thing to do is to identify which muscles they are. After all, if you haven't used them for decades it's highly unlikely you know where they are in the first place! My suggestion is that the next time you go to the toilet to pass urine, try to stop mid-stream. When you do that, you're using your pelvic floor muscles and they are th emuscles you need to focus on.

Once you've identified them, it's time to exercise them. That's simple:

Squeeze and hold for 5 seconds and then relax - don't forget to include the muscles around your back passage too! Repeat for 5 slow squeezes and try to repeat three or four times a day. It's that simple and you can literally do these exercises anywhere and no-one will know what you're doing!

If you keep this up then after a few weeks you'll be aware that control of your urine will improve. And for ladies, as your pelvic floor muscles get stronger you'll be able to squeeze your vagina as well which brings me to the bit about your sex life .....

Beating the Drum for the Country Docs

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It can be lonely out there

Rural Health - the real challenge.

As you may know, I took a few years off from clinical medicine as the emotional strain from caring for patients was hard enough, but running a practice was even harder! Now I've chosen to return to Family Medicine, but this time as a Locum GP, and I've chosen to help patients in the rural community. And it's been great!

Firstly, country people are different and have different problems. They're different in that they're more 'forgiving' and they're more thankful:  I had four 'Thank You' cards from one practice after just one three week Locum! But they face their own challenges too. Obesity is a big issue - excuse the pun - and is only compounded by the sense of inertia that occurs in small country towns. With the obesity of course comes Type II Diabetes with all it's insidious complications. 

Then there's a big issue with Chronic Pain Syndromes and the use of powerful analgesics that are being used to control them. It's a real challenge in such a short period of time to educate such patients on pain modulation, alternative treatments and the ancillary lifestyle modifications availabe. The resources needed are limited - professionals such as myself, clinical Psychologists and dieticians are nearly all FIFOs which makes continuity of care a real challenge.

And that leads to the one constant gripe of so many rural patients - with the inevitable question being asked "How long are you here for?" They feel that they are constantly having to repeat their stories to new faces (and despite computerised medical records, getting up to speed in 15 minutes in a complicated history is a tough gig even for someone with years of experience)  and many patients have literally given up trying merely limiting their consultations to requests for 'a new script'!

Our full time GP colleagues are bearing an enormous load in very isolating circumstances. I can fully understand why a female GP graduate with a young family would find it daunting to embark on a career in a remote rural practice. She would face so many professional and domestic stresses for which there are few practical answers. One may be to utilise the skills, knowledge and experience of those retired GPs who are looking for that something extra in life rather than playing bowls or embarking on another cruise, and developing an efficient, effective mentoring service!

Another would be to support groups such as the Australian Doctors Spouse Network that's been established to support Fellowship spouses in their un-ending merry-go-round of moving from hospital to hospital over their 6 to 10 year training. This group are aware of the challenges their partners face - perhaps Rural GPs Spouses can work with them to build support for their craft too.

Because at the end of the day, we're there to supply Health and Wellness information to our patients. We're there to support our patients when they're struggling. We're there to be their advocate when they have nowhere else to turn and to constantly remind them how special they are and why health is such a valuable commodity. 

At the end of the day it's all about our patients, and we can't do that properly unless we look after our Rural Doctors too.