Get Vaccinated now , pertussis , pandemic flu and travel vaccinations !

Despite a strong health infrastructure and vaccination programs - Australians remain vulnerable to emerging new viruses and existing old ones!
Australia is close to South East Asia, where a combination of high biodiversity, lose contact between humans and animals and changes in agricultural systems , high population densities , migration and rapid transport have made a fertile ground for new viruses. But also declining vaccination rates in Australia, and ignorance of dangers when travelling increase the risk. Resources are still much more sparse in Asia and make response to disease and control of animal reservoirs difficult. There is no passive or active Rabies vaccine available on Bali and 180 Balines died in 2010 alone of Rabies.

A number of viruses like SARS, H5N1 (bird flu) and H1N1 (pandemic swine flu )have emerged from Asia.

While WA had a raging flu season in 2009 , the one in 2010 was back to levels of previous flu seasons. Yet the UK now has full hospitals with Flu complications and we are well aware of the pertussis ( whooping cough) endemic in WA last year. H1N1 is beginning to mutate and might now become more infectious and require modification of used pandemic vaccine. The alarming levels of influenza in the UK have exhausted available stocks of flu vaccine ,the british government now has to make available stock piles of national emergency reserved pandemic vaccine!

The highly volatile genetic set up of RNA viruses makes them so very adaptable. They mutate at every replication, giving them a vast chance to develop useful change and ability to create resistance to drugs , and vaccines and chance to affect humans in new ways. The seasonal flu vaccine has to be newly cultured and filled with particles of new virus strains every year. Viruses can so jump from one species to another examples are HIV with reservoirs in primates , flu strains from waterbirds, Hepatitis C from yet unknown animal reservoir. Destruction of habitats and encroachment of human populations increase this chance presently and in future.

What can be done? Research into reservoir animals in developed countries as Australia is constantly under way, assisted by the improvements in genetic , biologic and epidemiologic science. We can now identify all viruses, understand how they emerge and spread. The World Health Organisation and richer industrial nations need to support the establishment of global scientific infrastructure for disease surveillance particularly in geographic regions where emergence of new viruses is likely, allowing a rapid and coordinated response to any new emerging infection.

We as Australians should be aware of vaccine preventable disease and continue to increase our uptake of routine vaccines already on offer like all the childhood vaccines! All Australians should consider seasonal and pandemic flu vaccine! Every traveller should attend his GP or Travel Clinic 6 weeks prior departure to discuss health and vaccination needs! All parents and grandparents of newborn or planned children should now booster against pertussis .


Sources :
- Eddie Holme , Medicus , 12 2010
- Dr Ian Barr WHO
- Maggie Fox , Medicine today 12 2010

Anti-inflammatories , Not to be taken lightly?

Anti-inflammatories , Not to be taken lightly?


Recent journalistic presentation of findings from a large retrospective Danish study has again raised concerns about Anti-inflammatories. Non steroidal anti-inflammatory drugs (NSAID) reduce locally released prostaglandine a cell hormone which causes heat , swelling , pain and redness at the side if injury / inflammation. They are widely used in the treatment of pain , fever , period control and it is well known that they can increase the risk of bleeding from the stomach and gut, especially in susceptible patients. Vioxx a selective Cox 2 (cyclooxygenase ) enzyme inhibitor was taken of the market in 2004 as it also unduly increased the risk of angina , hear attack and stroke. The reported Danish study , which run from the mid nineties till 2005 has now looked at the effect of Ibuprufen , Naprosyn, Celebrex and Vioxx on cardiovascular disease as well as bleeding. The study looked at thousands of healthy individuals with no other illnesses and their risk, if taking any of these drugs over 5 years. Data were taken from the prescription registry and death registry and than retrospectively analysed. The authors found that low dose Ibuprufen , Naprosyn and Celebrex don’t increase risk of stroke and heart disease but Vioxx ( now of the market) , Diclofenac and high dose Ibuprufen (> 1200 mg/day ) do increase risk of heart disease and stroke. They further confirmed that all NSAID’s increase risk of intestinal bleed. Vioxx more than Naprosyn and all other NSAID’s . Interesting was that all other causes of death are not increased by NSAID use and might even be reduced.
Factors which influence your risk favorably are good health, no other illnesses, younger age, infrequent and not regular use and taking NSAID’s at low doses. Remember that Aspirin, which is a NSAID too, in low dose is proven and used for over 100 years in the prevention of heart disease and certain stroke. Rheumatologist Profesor Milton Cohen coins the key question: “Why are you taking it and how long are you taking it for ?“ It is clearly safer to use simple analgesics like Paracetamol for the long term treatment of most pains and NSAID’s should be ideally reserved for the use in short inflammation flare ups of your condition, like for instance Osteoarthriti,s or should be used to get you ready for your golfing match or windsurfing session rather than taken daily. Remember to use simple strategies for your pain as well: weight loss, diet changes, appropriate exercise, support braces , proper shoes….
Your GP and Pharmacist is well aware of the changes in evidence for side effects of NSAID’s over the last 10 years and will be happy to answer your questions. If you have a history of stomach bleeding , ulcer , indigestion a increased risk of heart disease or heart failure , blood pressure or kidney disease than there should be good reasoning and supervision of a doctor / specialist if you really have to use any of above medicines.

Helko Schenk
Geraldton 13 12 2010

Male Circumcision Debate

The Male Cicumcision debate


Circumcision is the surgical removal of the foreskin form the penis for medical indications, cosmetic appearances, or religious reasons. The foreskin protects and also serves as sensory organ for the penis, yet sexual satisfaction and sensation seems not to be affected by lack or presence of the skin. Rates for the procedure vary world wide, pending on the local medical evidence, ethical and cultural reasons and range from 85 % in the states , where the Center of Disease Control and the American Academy of Pediatics recommend it as a general measure , to countries like Sweden and Finland , where the procedure is banned unless for medical or strong religious reasons. The Australia male infant circumcision rate is estimated to be between 10 – 20 %. Interestingly dutch authorities advise delay of circumcision til an age where the boy is able to make an informed decision himself. There is no doubt that circumcision is indicated for Balanitis (recurrent infection of the foreskin) and in recurrent Urinary Tract Infections especially if there are upper renal abnormalities as this prevents chronic renal damage. To prevent 1 Urine Infection in the healthy child would require 111 circumcisions. The Royal Australian College of Physicians (RACP) have recently published a guideline being neutral on circumcision but Professor Brian Morris from the university of Sydney is a strong advocate of general population wide circumcision and even opposes delay of procedure til puberty as it reduces health benefits by years and might increase trauma surgically and emotionally to boys. It seems clear that the procedure reduces risk of a number of STD’s (HIV , Syphillis , thrush , Chlamydia…) an effect which might be more marked in the developing world where these are more prevalent. IN the developed world like Australia it is in the opinion of the RACP more effective and less harmful to prevent these with safe sex practices in later life. The risk of penile cancer might be reduced but is very low in Australia anyway at 1 case in 250.000 of the population. There are statistical risks in the range of 1-4% if circumcision is performed in infancy like bleeding , loss of penis , infection, complications from surgery and general anaesthetic. These risks are lowest if it is performed in theatre environments by qualified surgical doctors. This is noteworthy as circumcision may be performed by non medical operators or not formally surgically trained doctors in Australia. It seems a wise recommendation from the college to advise doctors to discuss benefits and harms in a balanced manner and offer written information on the procedure. The decision of the parents after informed discussion must be respected and there are no right and wrong answers. Boys might grow up to regret being circumcised as well as regretting not to have undergone the procedures. Decisions by parents are made at the time based on their considerations.


Helko Schenk
Geraldton 22 11 2010

Don’t bend to Osteoporosis

The 20 October was World Osteoporosis day it’s key messages conveyed this year: ’Don’t miss the signs of a breaking spine’ ...
Vertebral fractures are under-recognized and under-treated. Early diagnosis and treatment prevent the fracture cascade and three major signs of vertebral fractures are height loss, back pain, and a stoop.

As the for O’s in osteoporosis suggest it means holes in bones or simply translates as porous bones or brittle bones. Bones are constantly built and absorbed, the balance being in favour of bone production til the age of 45 when bone absorption and therefore bone weakening begins to take the upper hand, eventually leading to osteoporosis. 2 million Australians have Osteoporosis and about 40 Australians break their hips daily, often leading to prolonged hospital stay , rehabilitation , nursing home admission or even death.

The “Australian Doctor” reported recently that 60% of women and 30% of men over age 60 have OP and noteworthy that up to 90 % of men with OP over age 70 haven’t got their condition recognized. Men also often fair worse if it comes to complications of a osteoporotic fracture. We need to do better in detecting osteoporosis before fracture and also prevent it’s occurrence in the Ist place.
Men and women with any fracture to minor trauma but also if they have other risk factors or are older than 70 should have their bone density risk assessed by their GP and bone density measured by fixed outpatient measurement or mobile units.
Osteoporosis is unfortunately silent til a fracture occurs and simple x-rays only show up signs very late. Particular risks are: women around or with early menopause, fractures to minor trauma , strong family history, steroid medications, smokers , increased alcohol consume, poor Calcium and Vitamin D intake, underweight, sedentary lifestyle and certain medical conditions like overactive thyroid, Insuline diabetes.
The other priority is lifelong prevention with appropriate Vitamin D and Calcium intake, regular exercise, alcohol intake under recommended limits, non smoking and funnily enough regular sun exposure to metabolize precursors to Vitamin D. A good diet contains milk, cheese, yoghurt, dark leafy green vegetables, tinned salmon and sardines with bones.
There are a number of treatments now available to slow bone resorption or even reverse it, including Calcium + Vitamin D , Bisphosphonates, Strontium , HRT and hormone modulators. With a positive bonescan you require discussion of prevention and treatment , need to consider measures to prevent falls and accidents and will need to have regular checks of bone density to monitor treatment.


Sources:
www.osteoporosis.org.au
www.iofbonehealth.org international osteoporosis foundation
www.abc.net.au/health
www.patient.co.uk
www.gpnotebook.co.uk

How to spot the seriously ill child

Even though , the wild flowers are out ,there are still an awful lot of tipical winter illnesses about. Now all is fine, if there is an obvious mild self limiting illness like an upper airway infection, or gastro bug and things can be managed with hydration , simplified diet, mild pain and fever killers , decongestants and other over the counter treatments. Kids particular preschool seem to go through 4-6 viral infections every winter each lasting about 3 weeks. 1 week of mild warning and unspecific symptoms, one of full blown illness and one which usually shows some resolving illness.
How to tell the minor from the bad? How does one recognize the more serious bacterial illness like chest infection( pneumonia), bone infection (osteomyelitis) , meningitis , septicaemia , surgical tummy infection or illness , kidney infection.

First Babies - take your baby to the doctors if they: vomit more than once or twice , particular bile stained (green), if they take less fluids than usual, pass much less or no urine, have blood in their stools, are drowsy , have an unusual cry , cry more and are not consolable, are more floppy than expected, if the baby shows hard laboured breathing, (pulling in neck , rib and tummy muscles when breathing) , making a wheezy noise, if the baby looks overly pale or blue , has an obvious rash, especially if it cannot be made to blanch (disappear , when pressed on it).


The older the Child , the easier illness might be spotted, as kids can often tell you what the matter is and symptoms of illness become also more obvious. Chest infection shows with bad cough, fever, sweats, shivers, being off food, and feeling generally unwell, headaches, aches and pains. The child might appear breathless, breathe fast and be blue around the lips. Bone infection different from joint ache of viral flu, shows with high fever , severe pain (child avoiding to use a limb ). Surgical illness including kidney and bladder infection presents with persistent vomiting, sudden severe belly or back pain, child prefers to be still, uncontrollable prolonged fever, fluid refusal, obvious belly swelling, bloody stools, chronic diarrhoea, blood in urine , smelly urine.
Meningitis can often start with as little as a high temperature , a generally unwell feeling or looking child , a child being more tired than usual.
Studies have shown that severe leg and limb pains, cold hands and feet (particular in the feverish child) and pale dusky , bluish skin around the lips could be early and more specific warning signs for meningitis.
Other symptoms that might occur , can be a red or purple rash. Small spots develop at first in groups anywhere on the body. They often grow to become blotchy and look like little bruises, the child could have a stiff neck , severe headache, faster breathing, dislike of bright lights, drowsiness and confusion , repeated vomiting

Mums are always right!, if in doubt get your child checked out - luckily most illness turns out minor and self limiting in children! Seek the advice from your pharmacist , GP , ED doctor , Nurse. See your after hour GP service ! Geraldton has more comprehensive care than a lot of rural towns, including permanent paediatric back up cover to all emergency services. Don’t forget the grandparents and checkout some great online patient advice sources.

Helko Schenk
20 9 2010

Sources:
http://www.patient.co.uk/health/Meningitis-Symptom-Check-List.htm
http://www.abc.net.au/health/library/default.htm
http://www.racgp.org.au/familyhealth Family Doctor Home Advisor
http://www.healthinsite.gov.au
John Murtagh “ Patient Education”

Snoring, Sleep Apnoea and Heart Disease

Obstructive Sleep Apnoea
“Snoring and Heart Disease”

It is widely accepted that overweight, smoking and lack of exercise pose risks to your cardiovascular system but snoring or even large tonsils? Yes it is true Obstructive Sleep Apnoea (OSA) a severe form of snoring , where the muscles in the throat and upper airway repeatedly collapse during sleep, is causing you to stop breathing , reducing your oxygen supply and disturbing your sleep. This often presents to the bed partner as snoring interrupted by scary pauses of breathing 10 seconds and longer. You might feel excessively sleepy during the day, your performance and drive suffers, you can become aggressive, irritable and depressed. The reduced oxygen supply, increases your heart rate , raises your blood pressure and consequently puts your heart and circulation on stress leading to chronic heart failure. Studies show that up to 25% of men and 10 % of women over 30 years might suffer significant OSA. But even 3% of children under 10 years suffer OSA, where surgical intervention like tonsillectomy can be life changing and heart saving in the long run. Risk factors for OSA are a flat round face, short and big neck , overweight , receding jaw line , enlarged tonsils (children), use of alcohol and sedating drugs , sleeping on the back and a family history of OSA. Several smaller studies have shown that treatment for OSA reduces cardiac risk, problem with this is though that patients often have other factors like overweight and might have an increased cardiac risk anyway. Physicians agree at the moment that severe OSA (30 breathing stops per hour ) especially when other heart risks are present demand treatment. There is no doubt that children with OSA benefit from tonsil- or adenoidectomy.
If you or your partner suspect OSA , than you should visit your GP , he should confirm the diagnosis by some simple questions, and refer you for sleep studies , which can be arranged by some pharmacies but also by a visiting sleep lab and are often done in your bed at home. Treatment in adults can be simple mouth guards, often CPAP , sometimes surgery, you should try and loose weight, increase exercise , stop smoking and avoid sedation and alcohol prior sleeping, sleeping on your side might also help. CPAP is a breathing apparatus supplying your airway with a constant positive pressure using a pump and room air, thus preventing collapse of your airway. You actually have a duty as driver to report significant daytime sleepiness OSA or not to the DPI, who might in turn put conditions on your driving, like to seek treatment. Treatment as unappetizing as it might seem in some forms , will guarantee you the thanks not only of your partner and neighbors but also be beneficial for your heart and lungs in the long run as well as significantly improve your overall performance – in essence snoring partners might require a little more than just elbow therapy.


drhelkoschenk.blogspot.com
Geraldton 30/8/2010

Sources:
- Pedram Imani , visiting consultant ENT surgeon presentation on OSA in children 8 2010
- Abc.net.au/health/the pulse story on OSA
- Patient.co.uk on OSA

Diabetes management

Better Management of your Diabetes


Diabetes is persistently raised blood sugar either due to the lack of insuline , the hormone produced by the pancreas , which regulates sugar levels or by increasing ineffectiveness and/ or resistance to insulin.
Raised sugar cause poor healing in tissues ( ulcers , skin infections ) , artherosclerosis (clogging up ) of blood vessels in heart , brain and limbs , small vessel disease affecting the functioning of nerves in limbs , soft tissue organs like the kidney(eventually kidney failure) or the eye (retinal blindness) Whether and how fast complications occur is dependant on early diagnosis and recognition of raised sugar, tight as possible control of sugar levels , but also management of other risk factors, worsening diabetes effects, like smoking, overweight, high blood pressure , raised cholesterol, opportunistic illness (vaccination for influenca , pneumococcal infection). Diabetics have a normal life expectancy and near normal quality of life if they are properly managed and engage in treatment, different to times before 1920 when insuline was first used and diabetes was almost a death sentence. The Management of diabetes however is very complex and different for every patient, therefore even now best done under involvement of GP’s , specialists , nurses and other health professionals , ideally via an individualised careplan for every patien,t detailing their aims in diet , weight loss, exercise, monitoring and management of contributing risk factors, visits to eye and other specialists , individualised medication treatments. A care plan seems to be a bit of ticking exercise but evidence shows that patients fair better on coordinated handling than GP management alone.

The Australia Health report 2010 shows: Diabetes will become the new health burden for Australia in the next 6 years, overtaking Heart disease , Depression and Anxiety. 275 new cases a day are diagnosed in Australia ,that is 100000 cases over the last year. This has been recognized by government and opposition alike, one assigning a considerable dollar amount to GP’s and Allied Health Services to develop personalized Diabetes care from 2012 and the other one looking at increasing rebates for all health professionals in chronic disease management. The Way forward will be the offering of Diabetes Lifestyle Clinics, uniting all GP’s and Health professionals under one roof and with one aim to manage your diabetes optimally. Panaceum Geraldton starts to run such a model clinic form 24 8 2010 , where Diabetes Nurse Educator ,Exercise Physiologist, Dietitian will review your status and advice on newest management available individualised to your diabetes all within 1 h and 20 minutes and bulkbilled on 3 episodes of care under your GP diabetes careplan. This aims at the optimal management of Foot care, diet, and Exercise and will give individualized information and advice.
It remains paramount to have annual health checks with your GP ,in particular if you have family history of diabetes, are overweight, but also after age of 45 or if you show possible diabetes symptoms like: lasting tiredness , thirst , excessive urination or Weight loss.


Helko Schenk
Geraldton Medical Group
12 8 2010sources:
- www.abc.net.au/health
- Diabetes Australia
- patient.co.uk
- GMG Editorial Lifestyle Clinic