Unsolved mysteries of the brain.

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During the course of a week I read of lot of medical articles and am amazed at the variety of research that goes on about how our bodies actually work. Also, during the week, the young bride and I take to our bikes and try and see as much as we can of the great outdoors and all the glorious things that are "out there". These two diverse processes are all computed in my brain, and I'm finding it tough to reconcile the two!

During the week I read of how Psychologists at Concordia University report that they have found where the " Love and Desire related areas" are in the brain. They go on to detail the specifics of their studies and then discuss the structural areas of the brain involved - for those interested, they are the Insula and the Striatum.

Part of my early years of medicine involved teaching anatomy and performing human dissection, so I have some insight into what the brain looks like, and it's an odd structure - usually described as grey and white matter - and notable for only all the waves and grooves on the surface. The experts tell us that our emotions and memories are created by Neuro-transmitters and hormones - chemical substances - that have different cause and effects in various parts of the brain.

Now here's my problem: I see the world in glorious colour, I hear music from birds and symphonies, I read great prose and poetry and when I think of love not even words can capture what I am feeling. When I look at a brain - the real thing, not those colour enhanced, 3D images generated by computers from brain scans - I see an amorphous, grey, jelly-like ovoid mass with lots of wrinkles on the surface: no colour, no words, no poetry, no love .... and I wonder how it all got in there and why?

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You are more than you think you are!

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We are not what we appear to be, and by that I don't just mean that our "less-than-film-star looks" not correlating with our sparkling personalities. When we look at ourselves in the mirror we see "Me", but that "me" also is host to an incredible array of bacteria, fungi and viruses - we are one living, walking bio-sphere of extraordinary life forms - nearly all of which are working together for the common good .... keeping us healthy and alive!

Researchers are only now discovering the incredible array of bacteria that live in our mouths, our gut, our airways and on our skin. And then there are the fungi that normally live in our gut tube: apparently these self same fungi will "appear" in the vagina of pregnant women because there is a need for them in the soon-to-be-delivered baby who will need these "milk-splitting" organisms to help them absorb the proteins found in maternal milk. In non-pregnant women, these fungi are not found in the vagina.

Then there are bacteria teeming on our skin. These feed on the sebum produced by our skin cells and which then produce a film that helps to "water-proof" it. Meanwhile in the gut there are essential bacteria that help with the absorption of important vitamins and without which we'd all suffer serious deficiency syndromes. As for viruses, the experts are only now looking at what these "friendly" viruses do as they do invade our cells, but for what purpose is still not clear. They might have a role in priming our cell mediated immunity, but much more research needs to be done before the picture becomes clear.

The important point for this evolving field is that when we use "Broad Spectrum" antibiotics we actually destroy huge populations of these friendly bacteria and contrary to the long held assumption that they return after the antibiotics have been withdrawn, that might not actually be the case. Young children who have had repeated courses of antibiotics are at greater risk of developing immune system problems such as Eczema and Asthma - now thought to be associated with the loss of these gut based bacteria.

And in a quirky way of using this information to fight pathological infections, Doctors are already treating a nasty infection of the bowel caused by over use of antibiotics and and resulting in an "overgrowth" by a germ called C Difficile. They have found that the best way to treat this nasty bug is not with stronger antibiotics but to use a "Faecal Implant"! They take a sample of stool from a healthy person and give it via a suppository into the infected person and it "works like a dream". Now they are purifying the process to remove the "Yuk" factor, but the theory and practice are solid and so are the results!

The message here is that we need to think not twice, but long and hard every time we consider using antibiotics and what the collateral damage may be both in the short and in the longer term. We need to consider not only our biosphere, but the global biosphere too. You are more than you think you are!
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Back pain - a little patience needed.

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Have you ever gotten out of the chair, or a car and been locked into immobility by sudden, unexpected back pain? It's excruciating when it happens and you feel so powerless. Or perhaps you've been doing lots of lifting and then felt a searing pain shoot down a leg and into the foot, again leading to inability move and sure signs of sciatica!

Low back pain is common, and it HURTS. When it happens we want to get out of pain as quickly as we can and get back to "normal" without having to have anything "serious" done. That will often mean a visit to the Doc to get a diagnosis and find out "what's wrong". And here there is often a desire to get an Xray or a scan done ASAP to make sure it's not serious. Well, according to the experts, having that Xray or having that scan will not make the slightest bit of difference to treatment options or outcomes in the vast majority of cases. In fact most Xrays and scans are a real waste of precious Health Dollars.

These experts tell us that in the first 6 weeks after suffering from low back pain, with no "Red Light" symptoms, there is no need to perform any radiological screening as nearly all these cases will settle with appropriate, conservative physical therapy. Red light issues are serious progressive neurological disturbances and fear of serious other underlying conditions such as osteomyelitis.

So if and when you do get a severe back pain, don't pressure your Doc into sending you for "Scans"as in all likelihood it will be wasting not only your time but his time too: and by being patient you will save precious health dollars. Without complications back pain will settle in due time, and while it is, put that time to good use by learning how to care for your back for the rest of your life!
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Migraines - a real headache to treat!

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If you think you've had a migraine headache, you probably haven't because migraine headaches are so bad that you'd never be in any doubt that you've had one. With a Classic Migraine, not only do you get a crashing, one sided headache, but you often get a "visual disturbance" - such as spots before the eyes or partial loss of vision -, you can't bear to be in the light and often you vomit too: so all in all, they're awful!

But not all Migraines are classic and often it will take an expert to determine whether you are a migraine sufferer or not as there are no specific blood tests to say "yes or no" to a diagnosis. It is however, more common to suffer from them if a family member also suffers from them too. For most people when they get a migraine headache, all they want to do is to crawl into a darkened room and lie down until it passes. For most this may be for a few hours, but for some the hell can last a lot longer so it is very important to know that things can be done to help settle them or even better, to prevent them.

But the news here is not that great. For migraine attacks there is a group of medications known as Triptans - but these are not often used/made available to patients in some European countries, hence only 10% (Denmark) to 35% (France) of migraine patients use Triptans. These medications are seen as "rescue" medications that should be an essential tool in helping to stop a Migraine in its tracks. And for those who suffer frequent migraines and who should be using preventative medications, the news is not much better: drugs such as propranolol, valproate, topiramate, where you'd anticipate seeing a response of at least a 50% reduction in migraine frequency, in reality this is more likely to be around a 40-50% reduction. And preventative treatment is further compromised because people often stop these medications because of side effects or just poor compliance.

In view of the fact that about 2% of the adult population are thought to suffer from migraines, there seems to be a huge opening for effective rescue and preventative medications for this crippling condition. I hope there is someone listening ....

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Alzheimers Disease - a special request

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I got an email this week from a man called Michael Ellenbogen. It's about Alzheimer's Disease which most of us have already heard about, but rarely think about unless it directly impacts our lives through a loved one or someone within tour immediate community. But listen to a little of what Michael has to say:

"Many people think Alzheimer’s disease affects our senior generation, but they are so wrong. I started having symptoms at age 39. They refer to people like me as having Young Onset Alzheimer’s Disease, or YOAD. Not many people are even aware of YOAD. My wife, who is in the medical field, was not even aware of this. The only people who seem to know about it are the caregivers and the people affected, who will most likely pass away within 8 – 10 years. A new person is diagnosed with Alzheimer’s every 68 seconds. By 2050, that number will be every 33 seconds. As of today, there is NO cure or any way to slow its progression. Even worse, this disease will bankrupt our health system if we do not act now." 

Michael went on to ask for help to spread the word, and to seek to get all of us to act before we too might become swallowed up in the "nothingness" that Alzheimer's Disease leads to.  There are no simple, immediate solutions, but without doubt there is an answer, or maybe several answers, "out there", and we need maintain the enthusiasm that already exists within the Medical Research Community if we are to find effective treatments within the lifetime of Michael and others like him.

So what can we do?

First and foremost - reduce your risks. Stay healthy, stay active and stay involved. Use your brain in as many ways as you can and surround yourself with people with similar aims as yourself - and here I think there is enormous potential for Social Media to play an ever increasing role for those who live more isolated lives.

Keep yourself informed. There are many interesting avenues of research and treatments being developed all the time and they need to be critically evaluated: don't be afraid of voicing your opinion because it might just be the missing link in a long chain of productive inquiry.

Become actively involved in raising awareness of the challenge before us all. Rattle the can or just donate to registered organizations that are already doing great work in this difficult field. And always be prepared to offer support to family or neighbours whose lives have been burdened by this most difficult of diseases.


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Croup - scary but rarely dangerous.

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Human Para-Influenza virus

With the change of seasons comes a spike in viral infections. Currently in Oz, especially in the West, we are seeing some significantly low temperatures heralding the real onset of the winter months: but being such a brilliant place, at least we know that we will still get some wonderful weather on most days!

But with winter come those infectious diseases that are "stirred up and spread around" in our schools, Kinders and child care centres, and then brought home to be shared with the rest of the family. One of those infections caused by the LTB virus (proper name of laryngo-tracheo-bronchitis virus) or a para-influenza virus can lead to sore throats, coughs and in little children, Croup!

Croup is one of those illnesses whose "bark is worse than it's bite", but in little children under five and even more so in babies, listening to them cough and wheeze can be very distressing and even frightening for both child and parent. We adults can have a sore throat and cough and easily put up with the swelling that results in our larynx without too many difficulties, but the smaller the patient the more significant that swelling becomes, and in tiny tots, small swelling can have big consequences.

The good news is that nearly all children with croup can be happily treated at home: all that's required are simple measures and lots of cuddles and reassurance. The onset is usually the same as with a normal cold - they're a "bit off" and then they feel hot and may complain of a sore throat. It's when the sun goes down that things can start to warm up with perhaps a spike in temperature and the onset of a barking cough. Paracetamol in the appropriate dosage can ease the temperature, help relieve the discomfort and might allow child and parent to get some sleep. During the day the child often "bounces back", but when the sun goes down again, the symptoms may recur. The body's immune system will deal with the infection and it will settle down of its own accord in 2 or 3 days.

For those with more severe symptoms, these children may require a Steroid Syrup to help reduce the swelling in the Larynx in order that they can breath more easily. Antibiotics will make no difference to the illness as antibiotics have no place in the treatment of viral infections. If your child has some of the following symptoms, then they should be seen by a Doctor:

• They make noisy, high-pitched sound when BREATHING IN (stridor)
• They drool or have difficulty swallowing
• They become irritable
• If they are obviously struggling to breathe
• If the skin goes blue/grey around the nose, mouth or fingernails
• Has a fever of 39.5 or higher

The treating Doctor will be able to make the diagnosis after examining your child and further investigations are not usually needed. If the Stridor is severe, they may admit the baby to give them humidified oxygen and medication until the swelling has settled, but most will be allowed home on medication.

Whilst the scientist haven't found any obvious benefit from "Humidifiers" at home, in my experience they do seem to make the child more comfortable - but do make sure that they are safe and away from little hands! But in the end it's Mums magic that is probably the best, with lots of cuddles and love: come to think of it, most Dads are pretty d*mned good at that too.
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It's a funny world.

We got up early and went for a jog through the forest this morning - pause for more information re the word "jog": for us it means lots of gasping, legs that often feel like they have 20kg weights attached to them, wondering whether to worry about that disturbing ache in the knee, or whether it might be easier to breathe if one stared ahead instead of at the ground! But here's the good bit: this "jog" is interspersed with moments where we stop, perhaps to cross a road where we often pray for a stream of passing traffic to appear, or just to marvel at the absolutely, awe-inspiring, gobsmackingly beautiful thing which we call nature. The trees have become a gorgeous umbrella of shade over tracks softened by leave mould, which is far kinder to older feet than concrete or tarmacked roads. Young deer are often seen staring at these two strange people people panting past, red squirrels scurry up trees (probably sniggering beneath their fur) to warn their friends of two wearied road warriors and rabbits hurry into the ascending undergrowth of ferns and briar. It gets me every time - the glory of the whole thing.

Then I sit and look at my lap top to "catch up" on events in medicine and the world at large: and it's depressing. There is such a huge gap between reality and our perception of it in urban society with all our needs and demands for "this and that". One thing nature teaches is that as well as the beauty of it, it's not always pretty, things can go badly wrong and it is fragile: and yet it is constantly changing and constantly renewing itself. Whilst in our "advanced" societies we seem to want to achieve a permanent state of perfection NOW and for pain to be banished for ever.

So my thought for the weekend is for all of you who can, go for a walk in the park/garden/forest/beach/desert and reflect on how much you have already and be thankful for it: accept that you can't hold onto "now"; that to fully engage in life means being flexible and that suffering happens and you will need to be ready to deal with it. Tough times will come - that's the way the world works - but it's how we respond to those tough times that marks us out as the genuine article ... a human being.

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