Living with breast cancer.

Tweet I was Skyping with an overseas, and much loved member of our family the other day, and catching up with how she was dealing with her third round of chemo for breast cancer.

This lady has style and panache!

She first appeared wearing a head scarf and recounted the usual story of the trials and tribulations of what chemotherapy actually involves, and for someone who has absolutely no medical knowledge whatsoever, she now sounds like a seasoned oncology nurse trotting out technical terms and blood cell types that would make a pathology professor smile!


After a few minutes she disappeared for a few seconds and returned, resplendent, wearing her new blond wig. We got the full 360 degree view, and then with a theatrical flip, she whipped it off to reveal a near-bald dome, topped with a bit of dark fluff. The young bride next to me suppressed a gasp of shock, but we both agreed afterward that what we had seen showed courage, style and the amazing attitude that this lady has. Buts what's more, we were informed that "Chemo is great for your nails: they've never been so good"! Now this coming from a lady of fashion is high praise indeed.


I mention this because breast cancer is on the increase, but at the same time survival has never been better either: so the simple truth is that 1 in 9 Australian women will get breast cancer, and they will have to face up to the associated treatment.  If the example of our much loved family member is anything to go by, the "glass half full" approach can make the treatment period far more bearable.

Growing old gracefully.

Tweet We've all heard that the western world is facing an "aging crisis":  the projections for Australia suggest that the population aged 65 years and over, is projected to increase from  13% in 2002, to between 29% and 32% in 2101. Currently most of the media and political "noise" has focused on how this is going to impact on the economy, with a reduced work-force having to work harder and longer to cover the increasing medical costs  "caused" by the grey and wrinkled generation. 

Being a parent becomes ingrained into one's psyche, and for most of us in the senior segment of our lives, we still passionately care about how life is going to pan out not only for our children, but also for our grandchildren. So the challenge for us is to not just shut up shop and go quietly into the retirement village, but to stay active, independent, involved and as healthy as we can so that, even though many of our bodily systems that we once took for granted, now take more time to grind into action, we can actually have a good quality of life. What we definitely don't want to do is to become any sort of a burden on our children, or our children's children. If we are successful at this, then our resultant health care costs will be less and then everyone's a winner!

Well, the good news is that the scientists and researchers have actually proved that this works!! It seems that plain common sense is scientific sense too! A study called The Well Elderly 2 trial was performed between 2004 and 2009, with the write-up appearing in the June 2 issue of the Journal of Epidemiology and Community Health, and this showed that with just small, healthy lifestyle changes and involvement in meaningful activities—going beyond just diet and exercise—are critical to healthy aging. Seniors participating in the study made small, sustainable changes in their routines (such as visiting a museum with a friend once a week) that led to measurable gains in quality of life, including lower rates of depression and better reported satisfaction with life. Of course one strategy does not fit all aging persons;  going to the gym 3 times a week would drive many up the wall, and so professional input was required from a very professional group known as Occupational Therapists to help guide the participants. OTs are a largely unsung band of amazing people who do so much to help many people live meaningful lives. They were a key part of The Well Elderly 2 Trial, just as they were before in the 1997 British Well Elderly 1 Trial that has been used to help develop British pubic health policies.

My belief is that there is so much more each individual, or family, or group could do to improve their health and quality of life, and it really only involves incremental changes that are carried out over long periods of time: good quality food, no tobacco, minimal alcohol, much physical activity and so on. Our senior years should not been seen as ones of inexorable decline, but years when we can still "value add" to ourselves, our families and our communities.

 See you at the beach ....... after you've been to the museum!

Time to start kissing frogs?

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For many years, Doctors have known that most people who die from cancer, don’t die from the original tumor, but from the cancer's metastases – the new sites around the body where the tumor seeds. All cancers start from a tiny cluster of cells, but once they reach a critical size, usually only a few millimetres in diameter, they cannot grow any bigger unless they create their own blood supply: this is called angiogenesis. The theory then goes that if you can block angiogenesis, then you turn cancer from a killer, into a manageable, chronic disease, like many other chronic diseases such as psoriasis, arthritis and so on. There are already a few  drugs available that have been developed to do this, but a novel approach by researchers at Queens University Belfast, has literally hitched a ride on the frogs back!! They discovered a protein secreted by the Waxy Monkey Frog that stops blood vessels from growing, and hope that their discovery will further enhance the management of metastatic cancers.

But they didn’t just stop with the Waxy Monkey Frog: they went one step (hop?) further and discovered that a protein from the Giant Fire-bellied Toad, which does the complete opposite and actually stimulates blood vessel growth. This, they hope, would be of great value in helping people with Diabetic ulcers, wound healing and with damage caused by strokes.

The lead researcher, Professor Chris Shaw and his team are to receive one of Europe’s most prestigious awards for Healthcare and Business next week for their discoveries. It just goes to show that the answers are out there: we just have to keep looking!

PS: no frogs were harmed in these experiments and they were all released fit and well back into their environments!

PPS: Got any good frog stories?

Stem cells for damaged knees

Tweet I've always been fairly conservative in my response to those headlines in the the papers that talk of "stem cell breakthroughs", as if all of a sudden all the medical problems in the world are about to be resolved. As we should all now know, we need to take those headlines with a large pinch of salt: in fact a 15 to 20 year sized pinch of salt! But time is passing and stem cell research is now starting to appear in human clinical trials, and that means we are now getting closer to perhaps a 5 year time line: now that is exciting.

Being rather fond of the sporting life myself, and having damaged my knee playing touch rugby at an age when I should have been trying a more leisurely pursuit, I was delighted to see that knee cartilage treatment has at last reached the 21st century. Not that it hasn't been improving incrementally over the decades, but it still very much relies on surgical intervention, and that is often associated with premature arthritis in the affected joint. Many of the total knee replacements that I see now, are on joints that were treated by total menisectomy - complete removal of the damaged cartilage - around the time I started medicine some 40 years ago: and that means having major surgery at a time in life just when you didn't need it!

Courtesy of medialmeniscustear.com

Researchers at Bristol University in the UK have now received permission to start human trials on a special "meniscal bandage" that contains the patients own harvested stem cells, which are inserted into the knee joint to cover the torn knee cartilage: the trial is to last 5 years and will study the effectiveness and the safety of the procedure. If, as hoped, the trial is successful, then the implications are huge.  Europe and the US both report approximately 1 million cases each of meniscal damage each year, and over 80% of these are in people under the age of 50: the injury being a very common amongst many sporting codes such as football, Aussie rules, rugby and basketball. If the Stem Cell therapy lives up to its potential, then that means much reduced pain and suffering later in life, plus a reduced need for major joint replacement.
For all of you currently living with "dodgy" knees, then the best advice I can give you is to befriend a good sports physiotherapist, and take their wise counsel! I throw the floor open to suggestions!

A warning from Germany

Tweet It's amazing the difference a day makes!
The outbreak of the E Coli infection in Germany over the past few days has made the medical world sit up and take notice: the poor Spanish are fuming over the insult laid at the feet of their cucumbers and the Russians have banned the import of food from Europe: no-one saw this coming! But the biggest mystery of all is that this is a completely new strain of the normally passive bug that most of us carry happily in our bowel. The E Coli outbreak in Germany is very nasty indeed, and is producing a Toxin that not only kills, but causes bloody diarrhoea and shuts down kidneys as well! Another twist is that this bug is affecting mainly adults (86%) when normally its the young ones who come down with Gastro first: and women are being hit the hardest (67%)*.
E Coli infections are spread by "faecal/oral" contamination and is common in areas where there is poor sanitation, a situation that does not occur in Northern Germany. The six million dollar question for this outbreak is: "What is the source of the contamination?" At present the experts are frantically searching for an answer, and that may take time, as they have to break down the genetic code of the bacteria to help try and identify its source.
The good news is that cooking will destroy E Coli: and with winter now with us here in Australia, it's much easier to avoid those food groups that may be involved in Germany - salads, tomatoes etc. However, the chance of this deadly bacteria getting to our shores is extremely slight, but that doesn't mean we should ever compromise the contents of our food chain. This is a timely warning that we should be very aware of what we spray on our vegetables and salads in the form of manure; and we should be even more aware that using antibiotics in cattle increases the chance of antibiotic resistant organisms developing here too.
Remember: wash your hands, wash your food and then cook it! Bon appetite!

*See Germany's WHO site at http://www.who.int/csr/don/2011_05_27/en/

Are mobiles phones a Health Hazard?

Tweet An article in today's Australian paper caught my eye; it was about mobile phones and one particular sentence got me thinking: "the expert working group that classified mobiles as possibly carcinogenic noted the strongest evidence for the new classification, though limited, linked mobiles to two types of brain cancer, Glioma and Acoustic Neuroma". It then went on to say that the evidence was based on early model mobiles which are known to produce considerably more power than the newer generations of 3G mobile phones, and it's this "power" that might be associated with the increase in brain cancers seen since the '70's.
A number of thoughts flashed into my mind: the first was the late Dr Chris O'Brien OA, the Head and Neck Surgeon of RPA fame, who was such a charismatic figure helping so many others as he struggled with his own soon to be fatal brain tumour. Chris himself admitted to being constantly on his mobile phone.
Secondly, the Research information on mobile usage and brain cancer is still relatively new - probably about 20 years - and I suspect that like most demographic health information, we will have to wait for another 20 years before the picture becomes much clearer and concrete conclusions can be made.
The other thoughts that went through my mind were the non medical things that the mobile phone has brought with it, like "cyber bullying" in schools and how it has affected the dynamics within the family. My eldest - a girl, now an amazing lady - will gladly report that when she was a teenager, the only phone in our house was firmly tethered to the wall in the hallway by a wire ! If she wished to have a private conversation (virtually impossible with four devious, male siblings) was to stretch the telephone line out through the nearby front door and sit in the porch outside - which was a dead give-away, and rapidly resulted in her brothers sudden desire to go out the front to "play". But for a parent, having that ability to "oversee" our children's conversations, it enabled us to support them when they appeared distressed. By the time our youngest was a phone user, telephones were mobile, and we felt like we had been excluded from a part of his life (and maybe that's a good thing?).
A final thought was that the link between mobile phones and cancer still is extremely tenuous, and nothing near as certain as the link between cigarettes and cancer, or sun-baking and skin cancer; so I think we need to factor in "relative risks" when thinking about which issues we should be actively perusing.
My take is that those with the more vulnerable brains - that's our small, precious people - should be taught how to strictly limit mobile phone use and where possible use hands-free or a blue-tooth earpiece (as should we all). That's just after you've plastered them in sun block and told them smoking is disgusting!

Guys: you need your sleep

Tweet Apart from getting very tetchy if they don't get a decent nights sleep, there is now evidence that the male of the species will also suffer from a lower Testosterone level. Now if that doesn't get their attention, I dont know what will! In fact, according to Eve Van Cauter PhD, who has published an article in the June 1st issue of the Journal of the American Medical Association (JAMA), the lower Testosterone levels are the equivalent to aging 10 to 15 years.
What the research looked at was how poor sleep hygiene over an extended period can affect these young men. They studied a small group (which also means that these results are just an indication, and NOT Gospel fact) of students -average age 24 - and who were in good health, and followed them in a sleep study unit: they found that after 8 nights of having their sleep restricted to five hours, that their Testosterone levels decreased by 10 to 15%. The students also reported a decreased sense of well-being and had less energy - and from personal experience of young men growing up in our house, they were also probably monosyllabic and grumpy too!
All this isn't just to do with decreased sex drive and low sperm counts: about 15% of the adult working population in the US gets less than 5 hours sleep per night, and the figures are probably similar here in Australia. The consequences for safety, productivity and work-place harmony as a result of working with someone with a low Testosterone level need to be addressed. From a health point of view, testosterone is critical in maintaining healthy bones and muscles, and the resulting physical problems can impact later on in life with male osteoporosis.
Good sleep hygiene is free and effective - here are a few hints:

Treat your bedroom as somewhere to sleep (there is one exception here!).
No TV or music in the bedroom.
Alcohol does NOT help you sleep better: in fact it often makes the problem worse!
Avoid caffeine from early afternoon onwards.
Try to take your exercise early in the day: evening exercise can make it harder to settle.
If you haven't fallen asleep after 20 minutes, get up and read a book.

I would be fascinated to hear how the male in your house fares when it comes to counting sheep?