Young Moms - the key to a healthier future

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There are a group of people whom I believe to be the most important people in this world, and they're our young Moms: but to use an Australian colloquial expression, I also think that they're getting the wrong end of the pineapple! They're doing it tough and we need to work out how best to help them during those challenging first 5 years as parents.

The challenge to effect positive change is that "one size" will not fit all: what may work for the affluent parts of San Franciso or Perth, will not work in rural areas of say Africa or India, but the basic principals are the same: education, health and effective mentoring.


I want to start a conversation that leads us to better ways to support our "jeunes Mamans"*, especially those who are single or living in distressed areas, and the internet gives us an opportunity to provide that support.

There are some great educators in cyberspace who can provide culturally appropriate resources for their communities so that literacy and numeracy for young Mums can be improved - and better skilled mothers offers hope for smarter, healthier kids. There is a wealth of information about health issues too - the paradox being that so many in the affluent "west" need information on how to lose weight and yet millions of less affluent "others" needs information on how to provide basic nutrition for themselves and their children: wouldn't it be good for the "Health" of us all if one group could be connected to the other - ? As for mentoring, there must be literally millions of baby boomers with some time on their hands who can provide mentoring for young women in their communities or even those in other communities. Many "grey nomads" already are committed to providing new homes and schools for less well off cultures, perhaps this could be extended to exchanging emails as well?

Another challenge is to have some level of ethics for such an enterprise and here I am impressed by the 12 steps of AA where it's "success" is based on the fact that members need to recognize a "Higher Power", and I believe that for a great number of people this has resonance. There is no doubt that one program will not appeal to everyone, but every woman who is helped to improve their own health and education will have a huge impact on their children and their future life which has great significance for the whole world over time.

I want to start a conversation whereby we can develop a Web Based resource that can be adapted to local needs of each community. What do you think? How can we make a difference? What can we establish that can easily be handed on to the next generation so that we protect the most valuable members in our Communities - our "Madres jovenes"* and their precious children.

*young Moms

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CPR and beyond.

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ECMO sounds like a drain cleaner sold by dubious door-to-door salespeople, but in fact it's an acronym for a machine that has been described as a "game changer" when it comes to heart resuscitation after a heart attack.

Extra Corporeal Membrane Transfer is the high highfaluting name of the machine, but in effect what it does is remove blood from a patients body, then remove the accumulated Carbon Dioxide from the blood, add in life-restoring Oxygen and then return the blood to the body. According to the report I read in the Australian Newspaper, the ECMO machine is widely available in SE Asia where it has been reported to have saved lives up to 7 hours after the patient was supposed to have "died"!

According to Dr Parnia who is releasing a book called "The Lazarus Effect", survival rates after a heart attack in America run at about 25 to 30% when simply CPR is used: whereas where the ECMO is used in Asia, then the survival rates run at about 70%, a result which the scientists would call "clinically significant"!

An ECMO machine is similar to the heart lung machines that are used in open heart surgery, but simplified and adapted for mobility purposes. According to Dr Parnia, these machines are "quick to fit, small enough to fit in an ambulance and relatively cheap". Although in the context of escalating health costs and the continuous challenge of where to allocate the Health Care $$'s, relative is a relative word!!

What ECMO does do is put into the spotlight is our current attitude of what works best,  and question what we mean by "best practice". For the general community - read you and me - we know that CPR is far from perfect, but not enough of us even know simple CPR despite the fact that it has been shown to save lives when used by lay people who have been taught the basic technique. CPR needs to be taught in school and refreshed in the community on a regular basis. As for ECMO, I have no doubt that in the hear future our Ambulances must be fitted with these advanced, simple to use machines, and we don't have to wait for Governments to pay for them. If you think that your "mid-life" spouse is worth saving for "old age", then why not form a local fund-raising group and talk with your Emergency Services to see if they can advance and adapt. Now there's a challenge for you!
 
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Feeding the body, mind and spirit.

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Daniel Day-Lewis has won the Oscar for best actor and for those who have seen him in Lincoln, he is a deserved winner of the prize. From now on when I think of the great Abe Lincoln, I will always see the character portrayed by DDL, who seems to disappear as his subject emerges from inside him - a truly great Actor.

And I was delighted to read that he does not intend to appear in another film for at least 5 years but will go to his farm in Ireland and learn how to be a Stone-Mason! This is the same guy who previously "disappeared" to Italy to learn how to be a shoemaker! No doubt he can afford to indulge in his pastimes, but for the rest of us mere mortals it's a great challenge to pause and consider what "craft" would we like to take on during the various stages that make up our lives.

Over the years I've attempted to learn the wooden folk flute with a modest degree of success. I gave up Irish dancing after deciding that touring with Riverdance wasn't for me - well actually I couldn't coordinate my feet with my brain fast enough! I went through a spell of oil painting which I really enjoyed, but it's a bit like golf and you need lots of time and a dedicated room to leave all your oils out between sessions. But it's something I intend to go back to.

We took up walking some years ago and that's one thing that we've been successful at keeping up and it has led us on some amazing adventures. We also intend to try canoeing now that we've moved to near the river once we've found the right teachers. Meditation is another practice that we are attempting: it's harder than you imagine as I find my mind wondering "hither and yon" during the sessions, but they say it improves with practice!

Then there are the languages of French (love it), Italian (romantic and you definitely need to talk with your arms) and Spanish (only lasted 8 weeks but the young brides Paella was delicious)

Finding new ways to use your brains, move your bodies and elevate your spirit are the very foods of life and I sincerely wish you are all having a veritable banquet! Let me know what you've tried.
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Heamachromatosis - the downside of being Ironman

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It's funny how you remember a face!

I vividly remember one that I only saw once decades ago on the wards of my Alma Mater in London. It was, and I kid you not, a bronze face on a walking, talking human being. I mention this because today's blog is on Haemachromatosis, a genetic disorder causing iron overload which, if not managed properly, can lead to Iron toxicity and permanent damage to various organs - and one of those is the pancreas: damage your pancreas and you get Diabetes. Diabetes caused in this way is often known as "Bronze Diabetes" and the man whom I saw all those years ago was suffering from that very same condition.

Haemachromatosis is one of the most common genetic disorders in Australia, affecting up to 1 in 8 persons of Northern European descent. It occurs when both parent carry a copy of a defective gene - called the HFE gene - and pass it on to their offspring who will then have a 1 in 4 chance of having problems associated with a protein responsible for absorbing Iron into the body. This faulty protein allows too much Iron to be absorbed and if undiagnosed can lead to serious organ damage.

The good news is that if someone in your family is known to have Haemachromatosis, then screening can happen at an early age and the necessary precautions to be taken, so that the toxic effects of Iron overload are managed properly.

Because the iron levels are slow to build up, Haemachromatosis is diagnosed in later life - usually in males in their 50's and 60's, and mainly a decade later in women who up to the menopause are "iron shedders" with monthly menstruation. It is rare that it presents early in life, although this can happen. The diagnosis is suspected when patients are found to have raised iron stores within the body - a test that looks for the saturation level of certain protein responsible for carrying iron around the body. If these levels are high then genetic testing is warranted.

The condition is relatively "easily" managed by frequent blood letting to drain the body of excess iron, and once this is down to acceptable levels then blood letting is usually performed every 3 to 4 months. The good news is that this blood is generally safe for transfusion uses unless there are other associated health concerns.

If left untreated then the iron can build up in critical organs

• The heart - where is can lead to heart failure or irregular heart beats.
• The pancreas - where it can lead to Diabetes
• The liver - where it can lead to cirrhosis
• Joints - leading to arthritis.
• General fatigue

Haemachromatosis is common, it is often asymptomatic until our later years and yet is eminently manageable with early intervention. Don't be cast in bronze whilst you're still alive: leave that to our Hollywood action men and women!
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Pilates for better backs

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I may have mentioned in previous Blogs that both myself and the Young Bride have had problems with our backs. The YB recently had a couple of spinal injections to relieve her pain, whilst some years ago, yours truly had a micro-discectomy to remove the fragments of a prolapsed disc that was painfully impinging on one of my lumbar nerves!

Back problems are one of the major reasons people attend their Doctors, they cause a massive amount of time lost from work, they cost the economy hundreds of millions each year and they can be bl**dy painful! So we should take back care far more seriously, and do all we can to prevent problems occurring or recurring, and that's why the YB and I have started Pilates classes with an accredited Physiotherapist. And what a learning curve it's been!

Firstly, there is no doubt that as your age increases, your flexibility decreases! Also, modern living dictates that we sit down for far too long which encourages poor posture and reduced movement at hips, knees and ankles - just try squatting down on your "haunches" and keep your feet flat on the ground! Many aged people in poor economies hold conversations and drink copious amounts of tea whilst in the "squatting" position: I could last about 60 seconds before several of my joints would scream "Masochist", and many of patients wouldn't even be able to assume the squat position!

Which leads me onto Pilates, which focuses on the "Powerhouse" area of the body - below the ribs and above the pubic area - commonly known as the abdominal muscles. And what the Pilates experts talks about  is

1. Centering
2. Control
3. Concentration
4. Precision 
5. Breathing

According to our Physio at West Perth & Mosman Park Physiotherapy the exercises are designed to activate these "stabilizers" which reduces the stress on the spine and joints of the body and help attain correct postural alignment and muscle balance.

From our first two sessions I would add laughter too as watching the YB balance on a fit ball whilst trying to raise her left arm and right leg without tumbling off was a sight for sore eyes - we both fell about laughing until we had to move onto other, less amusing exercises.

After two weeks and two lessons we are more aware of the position of our lower back whilst sitting, standing, jogging, on the scooter and even now whilst I am typing. We obviously have so much more to learn and to practice, but I suspect that although it may not be 100% preventative, it will give us more protections and help us recover faster should we suffer from renewed back problems.

I intend to make 2013 the year in which, whenever I can, I'm going to try and improve how we care for our spines and promote all those things that are known to help reduce the burden of back problems. Having strong backs is the only known predictor of reducing the frequency and pain of back problems - so we need exercises like Pilates to achieve that. We also need to look at our work stations - both at home and at work - and spend less time sitting and more time standing: which is the reason the good Lord gave us two legs and one bottom - we should stand twice as much as we sit!

For all of you who do want to start up some back exercises, PLEASE make sure that the person you get your training from knows what they are talking about - that's why I like Physiotherapists who have studied Pilates, because they really do know their stuff.

Reference:
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Dr James Watson's Novel new theory

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I think my mind runs on the chaos theory because it will often pick up on quirky facts and ideas that are currently seen as "definitely left field"!

The other day I saw a headline that has left me mulling over its contents, and thinking perhaps that it may cast a chink of light into that enormous vault that contains "Things we've yet to discover". Dr James Watson is best know for receiving the Nobel Prize for his work on the structure that we now know as the Double Helix of DNA - in other words he's a bright spark - so when he says something, it's probably worth listening!

His current theory is bound to cause controversy as it challenges one widely held public health idea on how best to "beat cancer" which is that we should all eat a diet rick in anti-oxidant containing vegetables as they help reduce the risks of certain cancers. Actually, there is (to my knowledge) no concrete data to suggest that eating lots of veggies will stop you from getting cancer: and before all vegetable loving people scream at me with loud howls of "Rubbish", I happen to be very "pro veggies" because:

• I like them.
• Fresh vegetables have less exposure to chemicals/hormones/antibiotics than meat and chicken do.
• They contain essential vitamins and minerals that are good for maintaining a high level of bodily health.
• Nuts, green teas, coffee, pomegranates, cruciferous vegetables etc all have positive health benefits that make them important ingredients in a well balanced diet.

But what Dr Watson is suggesting is that in LATE STAGE cancers, pumping extra anti-oxidants into your diet may in fact be COUNTER-PRODUCTIVE. From his studies, he believes that in such late stage situations, chemicals know as Reactive Oxygen Species - ROS - play a major role in what is called "planned cell death" - or Apoptosis. These ROS are found in all human cells that have outlived their normal "use-by" date and need to be cleared from the system before they cause any damage. The problem is that if these ROS are left unfettered in healthy, working cells then they can irreversibly damage key proteins and nucleic acid molecules [e.g., DNA and RNA]: so there needs to be a control procedure for ROS, and these are called Anti-Oxidants!

In the healthy person, taking anti-oxidants will help maintain balance within the cells and keep the ROS under control. But in cases of advanced cancer where there are a great many damaging malignant cells invading the system, the ROS need all the help they can get and that's when supplementing your nutrition with bucket loads of anti-oxidants may well be counter productive, and according to Dr Watson, it may be sending you to an early grave! He is also quoted as saying that “Unless we can find ways of reducing antioxidant levels, late-stage cancer 10 years from now will be as incurable as it is today.”

This highlights for me from his article are that firstly, there is no one magic bullet for cancer or indeed any health challenge - our bodies are far more complicated than that. Secondly, a healthy diet is vital for maintaining maximal health - and that definitely means eating a variety of vegetables, fruit and nuts - but it won't cure cancer! Thirdly, our bodies change over time and the needs of our bodies change too. And finally, that vast vault of unknowing is diminishing and it's thanks to people like Dr Watson who dare to challenge the "norm" and cast a new light in dark places. 

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Pap smears: are we doing a good job?

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Public health screening tests for things like Breast Cancer, Prostate cancer and Cervical cancer are never far from controversy. And NO screening test is a 100%, gold-plated certainty to pick up all the cases of cancer that it is designed to detect. Also, more and more malignancies are being found to have some form of environmental link -

• Smoking and lung cancer
• Alcohol and bowel/breast cancer
• Hepatitis C and liver cancer
• Papilloma viruses and Head and neck plus Cervical cancers

   so prevention is a much better approach than shutting barn doors after horses have bolted!

Also, although we tend to assume that Pap smears are a simple procedure, like getting your passport checked at immigration, from a practical point of view - both for the patient and the practitioner - they are sometimes far from easy to perform!  For instance, strange though it may seem, the Cervix is not always easy to locate by an inexperienced Practitioner who does not have their examination room set up to perform them on a routine basis. Anatomically, in a woman who is overweight and not very "agile", and who has lax pelvic structures,  it can be very difficult to directly view the cervix as it is doesn't come with a label, nor is it distinctly a different colour to the rest of the surrounding vaginal structures!

But even in those cases where the experienced person can perform the screen and send the "smear" off for cytological examination, again the results cannot be claimed to be 100% certain. However, there are certain broad guidelines that are used to reduce the risk of missing early, treatable Cancer of the cervix, and these guidelines are based on age. BUT EVEN THEN THESE GUIDELINES MUST BE TAILORED TO THE INDIVIDUAL NEEDS OF EACH WOMAN.

In 2012, the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists and American Cancer Society recommended that:

1. Cervical screening should begin at the age of 21
2. Screening should be every 3 years and not annually.
3. Screening is NOT necessary for women who have had a Hysterectomy for non-cancerous reasons.
4. Screening is not necessary for women over 65 who have had several previously normal Pap smears.

Current national policy in Australia is:

1. Routine screening with cervical smears should be carried out every two years for women who have no symptoms or history suggestive of abnormal cytology.
2. All women who have ever been sexually active should commence having a cervical smear between the ages of 18 and 20 years, or one or two years after first intercourse, whichever is the later.
3. Cervical smears may cease at the age of 70 years for women who have had two normal cervical smears within the last five years. Women over 70 years who have never had a smear or who request a cervical smear should be screened.

From a recent CDC report, it appears that many women - 22 million in fact - may have had unnecessary Pap smears. The reasons behind this massive failing are probably not limited to the US: they're just far more honest about it!

My take on all of this? Sex is literally in our DNA, but we have to be aware that casual sex can cause permanent damage! As far as cancer of the cervix goes:

• We need to improve our rates of vaccination with the most effective HPV vaccines currently available. 
• We need to educate the most vulnerable groups on how to best protect themselves with vaccination and condoms. 
• We need to screen those groups who are known to be more at risk (and at this stage I would tend to favour the American guidelines over the Australian ones). 
•  Finally, those who are screening for Cervical cancer should only be screening those at risk and there should be no place for "over-servicing" of inappropriate cases.

references:
CDC
RACOG

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