End of year student parties - more than just Memories.

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The end of the College year and High School life means Celebrations with a capital "C". But the mixture of young people, hormones and alcohol can often leave them with more than just memories: Sexually Transmitted Diseases are amongst the most commonly reported infections across the globe.
In this Podcast I talk with Prof Donna Mak of the Communicable Diseases Centre in Perth, Western Australia about STDs and blood born virus infections.

I hope you enjoy.

Click HERE to download the Podcast

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Cancer Council WA talks - Protecting your Skin from the Sun

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Click HERE to download the second in my series of Podcasts recorded at the Cancer Council of WA. The subject of this Podcast is about reducing the risks of developing skin cancer  and explaining why we need to understand the UV Index. I hope you enjoy it.



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Human Papiloma Virus Vaccination and Cancer prevention

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Click HERE to listen to my latest Podcast where I talk with Emma Croager about the Human Papilloma Virus, and how vaccinations can reduce the chances of this sexually transmitted infection from triggering Cancer of the Cervix.





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Downs Syndrome

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Back in the 1960’s the British education system was the envy of the world: but it wasn’t great for everyone, especially children who had genetically inherited diseases. Those who had graduated to High School - or as the English called it, Grammar School were mainly Anglo Saxon and generally all fairly healthy. Those who suffered from genetic illnesses such as Haemophilia were admitted, yet readily identified by having to wear red armbands as a warning sign to others - but which in some cases proved to be an invitation to bullying from the less socially inclusive teenager of the time. People who suffered from other genetic conditions such as Down’s syndrome - known in those times as Mongolism because of their non Anglo-Saxon facial features - were sent to special Homes where they might have been heard, but they definitely were never seen.
So we should give our current education systems a huge pat on the back for their far more enlightened attitude to “Education” in the most inclusive sense of the word. Now, whilst schools must rightly focus on improving and guiding the young mind, it must also pass on the social skills that are essential for the smooth running of our far more pluralistic society here in the 21st century. The current high school would have pupils from many different ethnic backgrounds, and most would also have students who also have physical or mental disabilities - or as some would describe them, exceptional students! And the most common disability in this group of students is Downs Syndrome.
Downs Syndrome is a genetic disease where there are three copies of the 21st chromosome and which leads to the classical features of those with the problem, which are

• Flattened facial features
• A Small head
• A Short, squat neck
• A Protruding tongue
• Eyes that slant upwards and which are unusual for the child's ethnic group.
• Unusually shaped ears

Children with Down syndrome may also have:

• Poor muscle tone
• Broad, short hands with a single crease in the palm
• Relatively short fingers and a short thumb
• and they’re joints are hyper-flexible

In the early part of their lives, they develop as all children do, but will often take much longer to achieve their milestones of crawling, sitting and walking. But they’re also incredibly loving children too. As they continue to grow, they will often be of shorter stature than their peers, and more likely to put on weight and to become obese.
As well as the obvious external signs of Downs syndrome, these children can also have other very real medical challenges to cope with as well. Such as
Heart defects. Approximately half the children with Down syndrome are born with some type of heart defect. These heart problems can be life-threatening and may require surgery in early infancy.
Young children with Down syndrome are more likely to develop leukemia than are other children.
Infectious diseases. Because of abnormalities in their immune systems, children with Down syndrome are much more likely to catch infections, such as influenza and pneumonia.
Dementia.  Symptoms and signs of dementia may appear before age 40 in people with Down syndrome. And not only that, those who become demented also have a higher rate of seizures.
Other problems. Down syndrome patients can also get gastrointestinal blockage, thyroid problems, early menopause, seizures, hearing loss, premature aging, skeletal problems and poor vision.
These children face huge hurdles in every facet of their lives.
But there is some good news for them: about 100 years ago the life expectancy of someone born with Downs was death before the age of 10. Nowadays, people with this genetic disease can live up to the age of 50 years and even beyond that depending on the severity of their problems.
But as well as the obvious physical differences, there are mental disabilities to deal with. And this is an area where there have been great changes both for the individual and for the community as a whole.
As I said earlier, in times past, people with Downs were often sent to special “Homes” where they were kept away from the eye of the public. Today they are integrated seamlessly into the school environment, to the betterment of all concerned. But behind the scenes, there is - or at least there should be - a team of professionals supporting the individual and their families to cope with the many problems that each child faces. This team would contain some or all of the following professionals:

• A pediatric cardiologist
• A pediatric gastroenterologist
• A pediatric endocrinologist for the glandular problems
• A developmental pediatrician
• An audiologist
• A physical therapist
• A speech pathologist
• An occupational therapist
• A pediatric neurologist

As well as helping the child, parents need support too and thankfully there are many organizations around the world that are available to help those families and communities who are living with Downs syndrome whether as a patient, a family member or a school community.
Because Downs is a genetically based disorder, screening tests are available to parents during the first half of pregnancy to help confirm if their baby has Downs or not. Although the rate of Downs syndrome births rises as a woman ages - at 35 the risk is 1 in 400, but by the time the women is over the age of 45 the rate has risen to 1 in 35 - however, most children with Down syndrome are actually born to women under age 35, mainly because younger women have far more babies. Tests for Downs would generally include an Ultrasound and some blood tests looking at certain hormone levels - but the results of these combined tests are not 100% accurate and they do have a certain level of false positive results. The screening tests, by design, are much better at identifying women who may be at risk of having a baby with Down syndrome, rather than women who actually have a baby with Down syndrome.
If these combined ultrasound and blood tests suggest Downs is present, then confirmation requires that genetic material be gained from the infant in the womb and this necessitates a more invasive type of testing such as Amniocentesis, or Chorionic Villus Sampling. Research continues to seek a test that is accurate and non invasive.
There are often no easy options when Downs syndrome is diagnosed, but the paradox is that even though life can be pretty tough for all concerned, there are always so many great memories and so much laughter. And when that child’s life is cut short, as it sometimes is, then there is just as much an empty space left in the families’s and their communities hearts, as there is when any so called normal child dies too.
We still have so much to learn about Downs, and yet those with Downs teach us so much about how to be better people. We need them to become more human, and they need us to care for them - it’s not a bad arrangement really.

Family meal times - more than just nutrition.

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Recently I read an article heralding the return of family TV viewing time! Apparently we’ve been through an era where seemingly “everyone in the family” had a TV in their own room and consequently family viewing time had gone the way of the dinosaur: but not so apparently! Now we have to thank the ever present tablets - not those of the pharmaceutical variety but rather the electronic ones - that allow each family member to watch the family wide screen whilst following friends on Facebook or, miracle of miracles, actually reading a book ...on their iPad that is.

You may gather by the tone in my voice that I am perhaps a tad cynical about such amazing advances in human interactions, but just call me old fashioned, but when it comes to spending time with family, watching TV together doesn’t come very high up my list of things to do together. Don’t get me wrong, I am a total convert to the electronic age because it’s opened up so many new horizons and spaces, but the downside is that so many of those spaces have been filled with total and absolute ... well .. rubbish.

But even the suggestion that families congregating to view a common TV is important news, and tells me that family still has a huge part to play in our society. Family is not just a group of people living together, it’s also the time when we create so many templates for our children’s future in health, education and value systems and once that period of time has passed, unfortunately we cannot go back and easily fix up the mistakes we made. And realizing that family life has such a big impact on future health is why I’m a big advocate of family meal times.

There is no doubt that we live in a frenetic era far different from earlier generations, and that’s perhaps a reflection of the far higher living standards and expectations that we now enjoy. But with the need to have a nice home and a nice car - in order to provide the best education we can for our little people, this also means that we need the cash to pay for these things and as a result, where there are two parents, both often have to work, and where there is only one the pressures are even greater - and creating the time for a daily family meal together can turn out to be a major juggling act between all the demands that young parents face. But when it is done, then the benefits are huge.

Where families frequently sit down to eat together,  the children tend to eat more vegetables and are less likely to be obese, and if obesity can be avoided then so too can all the health complications that come with it. But physical health is not the whole story. Family meals are not just about the food that we eat, there is a process that has to occur in order to prepare the food and prepare the table - and by involving the children in these activities they start to “own” and be involved in the process of service as well of being recipients of the good deeds of others.

Family meal times are an occasion where that unit of people - whatever the composition by gender, race or religion - sit and share their daily activities within the boundaries of that particularly family unit’s “family rules”. These rules are often unspoken - such as telling the truth, being kind, no bad language and not fighting or shouting at each other - whilst others may base their family rules on the Judeo-Christian ethic that has survived over 2000 years and of which GK Chesterton famously once said “Christianity has not been tried and found wanting, it has been found difficult and largely left untried” - which I suspect also applies to most other major world religions too!  By having such a set of family rules each person is then subject to them .. including the parents. And this can have unexpected and yet positive benefits for everyone: for example, when one of the parents has bent the rules - it might be when a child is unjustly shouted at by a parent - then at the family meal time, if the innocent party feels secure enough to point out the injustice, this can provide the occasion for the parent to apologize for getting it wrong and asking their son or daughter for forgiveness. This is a crucial lesson for a child to learn at an early age and helps them understand and accept personal responsibility for their actions - and how sorrow and forgiveness can heal an emotional injury at source and not allow it to fester into chronic guilt or resentment.

All parents of teenagers know that the teenage years are the years of chaos - and it really is not surprising as the teenage brain is continuing to make new connections during a time when their bodies are physically changing, and at the same time surging with adolescent hormones - a guaranteed recipe for long sullen pauses or inexplicable explosive reactions. If all parents were to realize that teenage development equates with chaos not entirely of their own making, then life for both parents and teenagers could be more serene. Which brings me back to family meal times.
One of the great joys of family life is that just about everyone there is of a different age group, whilst at school for 12 years of their lives, our young people are put in classes where everyone is of the same age and at the same level of life experience. Whilst preparing for, eating and cleaning up after the family meal, the group has to cooperate with people of different ages and life experience. So when the teenager says to the parent “You don’t get it do you?” ... well perhaps they do actually get it better than the teenager thinks! The important thing is to allow the youngsters to express their thoughts in a loving secure atmosphere, within the family rules, and not get a long lecture on why they are wrong, and how they should get their act together.
Family meal times allow for parents to hear whats happened to their children during that day or week and try to understand what outside influences they’ve been under when away from home. It also calls on each member to learn how to listen, as well as to have the confidence to speak out to. And it’s also that important time when issues can be completed and not carried on as hurts for weeks, months or even years. Unfortunately, children still grow up in dysfunctional families where parents continue to pass on the negative ideas and habits they learned from their parents and which still stunt their own children’s emotional development for life.
All of this is so important for the mental health of our young people as about 1 in 3 of the whole population will experience some form of mood disorder during the course of their lives, but if they have experienced the benefits of life in a stable, happy family unit, they will be better prepared to deal with such challenges if and when they arise.
Family meals are not easy to organize in these so called modern times, but they are an essential part of a healthy society - both physically and mentally - so the effort to make it happen as often as possible will be more than rewarded with happy memories and a healthier future generation.

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Hay Fever: how to live with it in Springtime.

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It’s October here in the southern hemisphere and after a colder than expected winter in some areas, spring has well and truly arrived with newly greened trees and wild flowers blossoming in city parks and out in the vast countryside too. Whilst in Sydney recently the temperatures reached the low 30’s and a strong swirling breeze tossed hats and papers into the air. But there was something else in the air in Sydney that was making life really miserable for literally hundreds of thousands of its occupants - pollen!

Around the world there seems to have developed the great idea that London Plain Trees are fantastic for the urban streetscape. And yes they do grow quickly, and they do grow to some tremendous sizes and yes they do provide welcome shade in the long hot summers that we all like to experience. But someone forgot to tell the planners about the enormous number of dust balls that these trees produce in spring time, and which you can see as a visible cloud being swept down streets and into the noses, eyes and ears of all pedestrians in it’s path.

Sydney was coughing and sneezing, and rubbing its collective red eyes as this onslaught of nature’s desire to reproduce its species - in this case the mighty Plain tree - invaded every exposed human mucous membrane in sight! This was hay fever on a grand scale.

But although the London plain tree may be a dramatic example of how hay fever can affect whole cities at a time, it’s certainly not the only cause of the problem - not by a long way.

Grasses are everywhere, and all of us love to spend time in a park perhaps eating our lunch under the welcome shade of a tree whilst admiring the bounty of beautiful flowers planted by accommodating City gardeners - but for many this can lead to an afternoon of sneezing and itching, and for those with asthma, it may even bring on an asthma attack.

So what is hay fever and what can we do to reduce it’s impact on us at this glorious time of year?

All plants produce pollen. It’s a part of the sexual reproductive process of all plants on this planet, and plant pollen is the equivalent of our human male sperm cells. We males of the species will produce millions of sperm in the attempt to fertilze one female egg. Plants do a similar thing but in a much more public way - especially in the case of the London Plain tree - and plants do it on a massive scale! Amazingly, scientists have collected samples of ragweed pollen 400 miles out at sea and 2 miles high in the air. And it’s usually these prolific, allergy-causing plants that produce pollen in such huge quantities. For example, a single ragweed plant can generate a million grains of pollen every day. With all those pollen particles looking for someone to love, problems will invariably arise.

One zoologist humorously expressed the cause of hay fever in this way, “ he said that what the pollen is attempting to do is actually trying to mate with the inside of your nose”
The result of this plant human interaction is that our bodies rapidly respond to this foreign plant based protein invader and set off the following chain of reactions. Firstly it tries to make it more difficult for the pollen to settle on the surface of our mucous membranes by producing watery mucus in increased quantities in order to try and wash it off - hence the runny noses and watery eyes. Then it tries to literally distance itself from the invading protein by making the lining of the mucous membranes thicker - so that anything that may be trying to breach our surface defenses has further to penetrate. This leads to swelling of the lining of the nose and the conjunctiva of the eyes. And that’s why hay fever sufferers get runny congested noses and bleary watery eyes. The pollen also triggers an “allergic” response by the bodies immune system, and that leads to the itchiness  as well. For those who suffer from eczema/dermatitis caused by hayfever - usually as a response to grasses and pollens - then not only do they suffer from nose and eye problems but their skin also reacts with furiously itchy areas that are almost impossible to stop oneself from scratching.

Unfortunately we  cannot stop what nature does in abundance each year, producing tons of male plant gametes - or pollen particles - that are hungrily seeking a female partner to fuse with, but we can do somethings to reduce the impact of the resulting hayfever in our daily lives, especially in the spring time.

The first thing to try and do is to avoid going out when all those pollens are in the air - such as a on a hot windy day in springtime on a Sydney street! Stay indoors where possible and keep the windows closed: if you do have to venture out then avoid the windy times and cover your eyes and face where possible to reduce the bulk of air born particles. And once you return home then literally wash your eyes and nose with appropriate fluids to clear any pollen that may have attached themselves on to those lining, surface membranes. For the eyes, simple liquid tears will do the job and for the nose there are saline based irrigation sprays that can be brought over the counter at the pharmacy to do just this. It’s simple, safe and effective.

Some may like to get their retaliation in first by taking a non sedating anti-histamine that will block the body’s immune response to the pollen - again these are simple and safe and can be obtained from your local pharmacy.

If symptoms have started and nasal congestion is causing a problem, then try a mild steroid based nasal spray to help reduce the swelling within the nose - for short term  7 to 10 day usage this is quite safe: but if symptoms are failing to settle then a quick chat with your family Doctor would be in order.

For those who suffer an annual agony as a result of hay fever, there is the choice of de- sensitization. This is an ongoing treatment and is usually conducted over a couple of years - although some physicians do use an accelerated program with similar success rates to the more traditional method - and which aim to dampen the body’s immune response to a specific plant based protein.

Spring is a fantastic time of the year - perhaps the best time when it comes to nature putting on her glorious show for us - but there are downsides for those who suffer from hay fever. Hopefully the suggestions I have made today will help you to enjoy the best of springtime with the least amount of irritation.
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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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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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