Coeliac Diseae - a serial problem with Gluten!

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Coeliac Disease affects about 1 in 250 people in Australia although it is estimated that 75% of those affected are unaware that they have a problem! So is this an alarming health issue or the proverbial storm in a tea cup? The answer, like the condition itself, is still very much a mystery yet to be solved.

Coeliac happens when the body's immune system decides that it doesn't like Gluten - a protein found in wheat barley and rye and all foods that are made from these grains - and as a result damage occurs to the parts of the intestine where these foods are absorbed. As a result of this damage, not only is the absorption of gluten affected but also other important nutrients such as vitamins and minerals. If this damage occurs at an early age, or if diagnosis is delayed for a very long period, then "Mal-absorption" diseases can occur such as Osteoporosis, peripheral nerve damage and liver disease.

Why this sensitivity happens is still not clear: there does appear to be a genetic basis for the problem although not every one with the affected genes actually develops Coeliac disease, and the current thinking is that there are other environmental conditions contributing to the development of the condition.

Many cases of Coeliac are completely silent - in other words, those affected have no symptoms whatsoever: others will suffer from abdominal pain, bloating and diarrhoea too.

Diagnosis is made by biopsy of the affected part of the bowel. This is a relatively simple procedure conducted by a specialist in a hospital setting. Tiny pieces of the bowel are harvested and viewed under a microscope: if present, Coeliac will show itself by a loss of the tiny, hair-like projections covering of the lining of the bowel and which are essential for efficient absorption of nutrients from digested foods.

There is no cure for Coeliac, but like most chronic diseases there is very effective management of the condition that allows for normal health and a normal lifespan. The exciting challenge is to exclude Gluten from ones diet and replace it with other food groups according to the individual tastes of the person with the condition. These days there are a plethora of alternatives to Grain based foods and all food packaging in Australia must show whether the contents contain Gluten.

Also there are many online support groups and organizations:

http://www.coeliac.org.au/
http://www.mayoclinic.com/health/celiac-disease/DS00319

The upside of getting a diagnosis of Coeliac is that you think more carefully about what you eat, and you are challenged to discover different ways of preparing your food: a little bit of what I would call the agony and the ecstacy of living.

If you have any favourite recipes or advice you'd like to send in, I'd be very happy to publish them.

PS there is no gluten in Champagne!

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Whose got Attitude?

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 I just stumbled across the following quote:

“Attitude is a little thing that makes a big difference.” Sir Winston Churchill {1874 -1965}


And it seems that a lot of people don't have a very good attitude towards good health. I also read today that only 10% of American adults get "enough" exercise: combine that with the number of people still smoking cigarettes (have they been living in another universe for the past 10 years and missed all those terribly graphic health warnings on packets of their favourite poison?). And top that off with the vast number of people who are overweight or obese and the outcome will be far more devastating than the Global Financial Crisis, and cost even more in order to dig our way out of the massively increased costs to our health care services.

But it's not just having a "bad attitude" to physical health issues that can make our lives miserable: we need to foster an "Attitude of Gratitude" too. Most of us who are still conscious have been blessed with so many good things in life, yet I suspect that most of us - me included - have failed to pause and give thanks for the great times we have had. Yes, bad things do happen to good people - that's part of the bargain - but good things happen too: loving spouses, good kids and grand kids, a job or hobby where we can use our gifts, being able to support your favourite football/baseball/basketball/rugby team .... the list is endless.

And then there is this awesome world we live in with all it's wonders and delights. I would think that just about everyone on this planet has experienced at least one glorious sunrise or sunset in their lives or seen a rainbow after a shower - simple wonders and delights and they're all free.

Winston was right: “Attitude is a little thing that makes a big difference” and if we chose to change our attitude to one of gratitude then not only will we enjoy life a bit more fully, we'll be able to live it a bit more healthily too, AND we might just leave this world in a bit better condition than we found it when we arrived.

Have a great week! 

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Asthma needs to be treated seriously and treated well.

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Asthma can be a terrible scourge. An asthmatic attack is like having to breath through a thin straw 24 hours a day  because of the changes that happen to the network of tubes that make up the lungs.

Asthma is a combination of inflammation and muscular contraction affecting the tubes - or bronchioles - within the lungs. The inflammation is to the lining of the tubes, and when the lining gets thicker then the lumen - or open part of the tube where the air travels through - has to get narrower. The inflammation also affects the quality of the mucous produced by the lining: instead of having a watery consistency it becomes thicker and more sticky not only making it difficult to clear from the lungs, but also leads to plug formation which can block some of the smaller airways.

In asthma, the circular muscle that controls the diameter of the Bronchioles become thicker and more sensitive to varying stimuli such as cigarette smoke, viruses, chemicals, exercise etc. And it's this combination of narrow inflamed tubes and increased sensitivity to stimuli that can move an asthmatic with reasonably comfortable breathing to someone seriously struggling to breath in an Emergency Department. Thankfully, we now have very effective medications that can help prevent most of these serious consequences of Asthma, but the concern is that patients are not getting the best treatment through lack of "compliance" - not taking their medications properly - or as in the case of some children, they are being given inappropriate treatment.

The medications we have for preventing asthma are based on Steroids, and these are nearly always given by inhaler, though they can be supplemented by oral medication if control is poor and the symptoms bad. Another type of anti-inflammation medication which is not a Steroid, is know as a Leukotrene Receptor Antagonist - LTRA's - and these usually come in tablet form. LTRAs are not "first choice" meds, but can be added to inhaled steroids if the steroids are not giving maximum control.

To relieve the spasm of the thickened circular muscle, Doctors have been using Salbutamol for over 50 years. The problem with salbutamol is that it only lasts about 4 hours, but his has been overcome by a more recent medication known as Salmeterol that is known as a Long Acting Beta Agonist, and its the combination of long acting Beta Agonists and inhaled steroids that has been used in adult Asthma regimes for many years. But this is NOT the ideal for 90% of childhood asthmatics.

Asthmatics should be controlled where possible by Inhaled Steroids: and the least effective dose is the preferred dose. If the inhaled steroid is not sufficient then there are three step-up options for poorly controlled asthmatics on inhaled corticosteroids:

adding a long-acting beta2 agonist
adding a leukotriene receptor antagonist
increasing the dose of inhaled corticosteroids.

The addition of a leukotriene receptor antagonist is the preferred option for children with ongoing activity-related asthma. Long-acting beta2 agonists are not recommended for children
five years or younger.

If you are an asthmatic, or your child is an asthmatic, you should have a written Asthma Management Plan which needs to be reviewed and updated by your treating Doctor on a regular basis. If you don't have an Asthma Plan, get one: it could save your life.


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Jetting off home.

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Sorry about the silence, but we've been moving back to Western Australia which has meant packing up one house, traveling half way around the world and then moving back into our pristine "old" house. Then the roses needed pruning and the hedge needed a trim, and all that before our eldest son arrived with a friend for a conference here in Perth and could they stay for the weekend ..... And then there was JET LAG!

Flying from West to East always gets me: I feel good during the day and go for a jog, or prune those roses and by "beddie-byes" time my body tells me "You're ready for some serious ZZzzz's" so I lie down and go to sleep. 90 minutes later I'm wide awake and ready for action! But it's not just the sleep deprivation, it's the "bodily functions" that also have to catch up too and for we older folk, that is often more of a challenge to get back into a normal routine.

The good news is that we are having plenty of sunshine to stimulate Melatonin in the brain, and we can get out for some good physical activity and last night I slept from 1am to 6.54am and the world seems like a great place once again!

I'm told that if you turn left when you get on the aircraft and are able to stretch out on a bed and actually sleep then jet lag is not such a big issue - but then you have to refuse all the Champagne they apparently offer you if you can afford to buy Business Class tickets. (Disclosure - if an Airline would like to sponsor this blog and include free Business Class travel for the young bride and I as part of the deal, then I am prepared to negotiate a package).

At this stage there doesn't seem to be an effective way around Jet Lag, apart from sunshine, exercise and maintaining good hydration on the aircraft: if anyone knows of any new insights, please let me know so that I can spread the word.

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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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