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

The 4 hour rule , urgent and out of hour care in Geraldton

The 4 hour rule , which has been called the greatest health reform in 20 years has arrived in Geraldton form April 2010. The WA Health services has set a target of 98 % of patients arriving at an Emergency Department ,have to be seen , treated , transferred for further care, admitted or discharged within 4 hours. But the 4 hour rule is more . The 2 years Geraldton Hospital has to reach the target, involve a phase of measurement , monitoring patient flows from ED and in the Hospital , a phase of review and options for improvement, followed by a phase of implantation of changes and re measurement. The large Perth Hospitals have started working with the 4 hour rule process since April 2009 and have already shown great improvement in reduced patient waiting times , better flows and less ambulance blockades of ED entries. Geraldton Hospital has to look at it specific difficulties like growing population, permanent doctor and nurse shortages, distance to tertiary specialist hospitals and services, partial reliance on RFDS and transport issues for transfers to Perth. It’s ever hard working staff in all departments and managerial levels is required to come up with specific solutions for Geraldton rural circumstances and specific conditions as the solutions from success in larger city hospitals or the UK, where the 4 hour rule is worked for some years now cannot be blindly copied due to our specifics of thin population, large distances , low density of nursing and doctor staff. Speaking for the 4 hour rule is that it will commit health service , WA government and commonwealth to make available funds, it involves all hospital staff and consumer (patient) advisors , it is easy understood by clients and patient, it seems a good process to review and improve flows in existing setups, and it has already lead to improvements in the city hospitals of WA and that it is always better to envisage change than to sit it out. Against it might speak the initial increased work load for already stretched hospital staff, the temptation for managers to design targets around existing inadequacies as a senates committee review highlighted in Canberra this year , the lack of staff , and resources which is especially gross in rural Hospitals the increased workload it might present to rural GP’s in already busy surgeries, when patients are earlier discharged as the Rural Doctors Association says. What options have Geraldtonians got to seek urgent or unplanned as well as out of hour care? It is always advisable to ring your practice or dentist Ist thing in the morning and to make clear that you need to see a doctor or nurse urgently that day. Most practices will accommodate you, as they keep slots or even run nurse clinics or doctor on call clinics for that purpose. One practice runs Saturday morning clinics , and plans to extend this to 5pm-9pm weekdays, funding and interest provided. Other practices might follow suit. SJOG operates an out of hour clinic weekdays 6 pm to 10 pm and 9 – 10 pm on Weekend days. You can phone for advice on self limiting illnesses or directions where to attend by ringing health direct on 1800 022 222 or got to www.healthdirect.org.au. Your trusted pharmacist will also able to advice you, further Fountains and Sunset Pharmacy are open 8am – 8pm every day. And you could go to ED or be taken there by an ambulance, but please only use them for non walking and absolute emergencies. Some patients have to wait longer than others as the ED staff applies clinical Triage ( sorting ) criteria to determine the urgency and timely need of care, this being the reason why a cough or toothache, waits longer than a chest pain or road trauma , which might require immediate attention. Please keep in mind that all hospital staff always works hard within given resources and set frameworks and is aiming to provide best possible care. Finally consider to enrol at Durack’s for nursing training or become a mature medical student in Perth to bolster staff numbers for the future in truly rewarding and guaranteed never out of job careers.

Helko Schenk
28 6 2010
Sources :
www.health.wa.gov.au/fourhourrule
http://www.healthdirect.org.au

South African Travel Fever

"Veels geluk maatjies!" (best of luck friends/mates)

The Soccer fever has gripped the world and thousands of Australians will flock with the rest of the world to the “Cradle of Mandkind" to cheer their teams. Thousands more will just travel to experience this beautiful land, not to mention the large South African originated workforce and their families in WA, who might return for a visit to their home country this year , often falsely presuming their immunity against African grown illnesses. South Africa is one of the leading economies in Africa with Ist world facilities in all cities of the worldcup. The risk of contracting illness if restricting itinerary to major centres will therefore be low. However the consideration of a minimum prevention programme like the Seasonal and pandemic Flu vaccine , Tetanus Booster , Hepatitis A , Typhoid, oral Travel diarrhoea vaccine (Dukoral) as well as carrying of Diarrhoea medication and oral rehydration treatments would be highly commendable. Drinking of tap or even fresh water is generally not recommended if for the risk of contracting a travel diarrhoea which is your highest health risk travelling to SA, but there is also danger of contracting Hep A , in north eastern provinces even Schistosomiasis. There was a measles outbreak with 6000 cases 2009 alone in all SA provinces and the country still has one of the highest world wide incidences of TB and drugresistant TB. Rabies is common in all provinces and bites scratches by dogs , foxes , mongoose, jackals in fact all animals should be taken serious and post bite prophylaxis within 24 hours should be sought from medical centres. 18% of the countries population and 50% of sexworkers are HIV positive so safe sex practices are always adviced. Travel to northern provinces of Limpopo, Mpumalanga , North Eastern Kwa Zulu and the Kruger Park makes mosquito bite precautions ( spray , nets , long sleeve / leg shirts trousers) as well as malaria prophylaxis paramount. Have a travel health insurance in place as care in outside areas can be substandard and transport and care in centres or evacuation back to Australia might be necessary and expensive in case of acute illness or accident.
Crime rates are of the highest level in South Africa, have good personal security strategies in place and use good common sense. Avoid travel on commuter trains and Bus taxis, lock your car if travelling at all times especially in cities, (leave valuables (handbags,mobiles) locked in the trunk of your car), and (do not stop on highways to sitesee) Don’t visit townships uninvited and unaccompanied. Check out the government website http://www.smarttraveller.gov.au/ with good Travel and Health advice for SA.
Indirect Travel via other countries might make Yellow Fever vaccine for entry into SA as well as re-entry into Australia compulsory. In summary have a great time this year in South Africa and good luck to the Socceroos, but seek a health and vaccination check from your GP or Travel Clinic before you go and see your GP or ED doctor, if you develop anything more than a minor illness on your Return.

"Hamba Gashle Umgani!" (go well our friends)

http://drhelkoschenk.blogspot.com/
Geraldton 12 6 2010

Sources.:
http://www.travax.com/
http://www.istm.org/
http://www.smarttraveller.gov.au/
http://drhelkoschenk.blogspot.com/
Southafrican friends and colleagues

When Acid strikes

The feeling of fire rising behind the chest also called heartburn caused by the upwards flow of stomach acid into he gullet (oesophagus) in medical terms called “reflux disease” seems to be incredibly common in western society . Some rate it’s occurrence up to 20 % of adult population. 1:10 adults suffer heartburn daily.
The stomach produces acid to help digest food. The bottom of the gullet is protected by a sphincter or valve muscle, which keeps acid out of the food pipe and let’s food through into the stomach. Stomach cells are especially protected from the acid , but oesophagus cells are less so . If there is a mismatch between acid production , stomach pressure ( pregnancy , overweight) and sphincter function, acid can flow back ( reflux) and lead to irritation of the gullet, causing heartburn , bad oral smell, rotten teeth, but even chronic cough and if severe chest pain. If this is a rare occasion, you can treat your self with antacids like Mylanta or Gaviscon. You should see your doctor if symptoms are severe or frequent , not settling but especially if you loose weight, without wanting to, feel excessively tired, feel that food is getting stuck in your gullet.
The doctor will take a history and either advice on lifestyle , diet changes and or treat you with effective medication to suppress acid production ( Proton pump inhibitors , Histamine 2 receptor blockers). Sometimes if there are other risk factors or the story is not typical refer you for a an endoscopy ( camera test ) to check on your gullet. Treatment and testing might be required to prevent and exclude scarring of oesophagus or ulcers of the same and even rare cancerous changes due to chronic heartburn ( acid irritation). The camera test can show oesophagitis( inflammation ) or sometimes no changes (endoscopy negative reflux disease) which doesn’t mean you imagine your symptoms. Surgeons recognize ,that some gullets are very sensitive to even smallest amounts of acid and therfore causing symptoms even without surface changes of the gullet.
You can help , by stopping to smoke , avoiding excess meals or alcohol intake, identifying triggering foods (caffeine, spices, chocolate). It sometimes helps to avoid eating in the hours before sleep or even lifting the head end of the bed with the aid of bricks or books under the bedposts.

Helko SchenkGeraldton 1 3 2010

Insomnia , Sleep problems

Insomnia , difficulty to fall asleep, maintain sleep, or early waking seem to be incredibly common , in fact repeated studies have shown that up to 30 % of the Australian population suffer or perceive to suffer from poor sleep. Sleep deprivation is used as psychological torture but yet few people have died in the natural world of lack of sleep. Sleep , length and needs are often overrated and lead to anxiety and worry which in turn reinforce sleep disturbance – a very vicious cycle to break. Sleep need vary hugely between people and generally fall from 17 hours in babies to 8 hours to 30y-somethings and less than 6 hours in the elderly. Important is a fresh and regular awakening.
A number of reasons for sleeplessness are accepted, age might be a normal cause, medical reasons like the need to pass water more often overnight, pain , breathing problems , medicines taken for other conditions , smoking before bed time, excess and late use of alcohol and drugs, stress , bereavement, anxiety , depression can all cause poor sleep. Have a chat with your doctor , or get some information to explore sleep hygiene and causes you can correct yourself like room temperature , comfortable bedding , darkness of room and reduced noise exposure. Good leaflets are available at
www.patient.co.uk “Insomnia”, “Sleep problems”
www.abc.net.au/health pulse series “INsomnia” ,”Do natural Sleep Pills work?”
Australian Sleep association “Insomnia & Sleep health”
Advice on good Sleep hygiene can be found there or in discussion with your Doctor/psychologist. Simple things to remember is not to worry about sleep, to stay active , not to take naps, have a bedtime routine, No to coffee , nicotine, tea , chocolate and other stimulants. If not able to sleep get up read a boring book or watch a boring programme , drink a hot malty or milky drink and return when tired.
Medications while effective in the short term (sedating antihistamines , benzos…) have side effects , quickly become useless and some can lead to rapid addiction and dependence. Modern ones especially if used with alcohol (Zopilone/ Zolpidem) can have bizarre side effects but might still be safer to use. (Night walking)

Beware natural therapies of unproven effect and composition, While prescription Melatonin (Sleephormone) might have a place in treatment of severe jet lag or psychiatric illness , over the counter melatonin is severely diluted and propably not effective. Some Antidepressants are sedating and might be a safe option but should be reserved for underlying emotional issues , which if improved can better sleep dramatically. Try to self diagnose , better sleep routine and hygiene but see your doctor if you suspect underlying medical , emotional issues as discussed above .

Geraldton 9 2 2010

Pregnancy and Travel

Giving the right advice to the pregnant woman keen to travel requires appropriate mix of caution and bravery, simply as this is a phase of great risk and there is a lack of controlled studies on the effects of travel , vaccinations … on pregnant women.

It is clearly sensible to discuss travel plans well in advance (6 weeks) with your GP / Obstetrician/ Travel Medicine Doctor.


Some Contraindications to travel especially abroad are:
Obstetric Factors
- complicated present or past pregnancy
- preterm labour
- retarded intrauterine growth
- twin pregnancy
General Medical Factors
- High Blood Pressure
- Diabetes
- Cardiac Arrhythmias
- High risk of blood clots (Vein thrombosis)
Hazardous Destinations
- a good travel doctor has access to information regarding general warnings
- www.cdc.gov/travel
- www.smarttraveller.gov.au
General and pre-travel information
- Geraldton travel clinic: www.gmgn.com.au/travelclinic.html




Most international Airlines carry pregnant women up to 32-35 weeks, but require a letter stating your fitness to travel and confirming date of delivery. It is also wise to carry all pregnancy documentation, Blood group, medical history , antenatal record .
The Oxygen pressure in air plane cabins is reduced , which is generally not a problem but might become if you pregnant and also anaemic or have sickle cell disease. To prevent blood from clotting in veins hydrate well, do regular in travel exercises of legs, wear below knee compression stockings.

Vaccinations should bare some exceptions - were risk of catching the true illness outweighs the harms of vaccine - be generally avoided in pregnancy. Advice on vaccination has to be based on a thorough medical and vaccination history, up to date knowledge of destination health risks. Vaccination for Diphteria Tetanus, seasonal and pandemic Flu, Hepatitis A + B, Pneumococcus , Typhoid could be considered in pregnancy.
BCG(tuberculosis), Mumps Measles Rubella, Chickenpox – vaccines are contraindicated. Tricky is the decision on Yellow fever vaccination.
The most popular travel souvenirs are common viral infections and particularly diarrhoea and vomiting in pregnancy. Persistence with oral rehydration are important to avoid particular risk of shock , metabolic illness , preterm labour in pregnancy. (Buy oral rehydration packs from your travelclinic or pharmacy!) It is not clear if anti diarrhoea medicines like immodium are safe , but they have been used in pregnancy. Only certain antibiotics can be used in pregnancy.

Malaria is a significant risk to mother and baby, avoid travel to malaria areas if possible! Mosquitos seem to be attracted to the pregnant due to increased skin temperature and higher CO2 production. Screens , Bed-nets sensible clothing , staying indoors at night and the sparingly use of insect repellents seems advisable. DEET (the commonest repellent) particularly if applied thick to large areas of skin get’s absorbed , and even travels the placenta into the babies blood. Discuss oral antimalarials with your doctor.
Other travel issues are common ailments and discomforts of pregnancy, ready access to medical facilities, safety of national blood supplies, availability of anti D for rhesus negative mothers.


Helko Schenk
Geraldton 26 1 2010

Stomach pain in children

”My belly hurts” is an all to common complaint in children, and a puzzle to parents and medical professionals alike. Causes reach from surgical and medical to anxiety and school avoidance. Careful listening and detailed attention to history and presenting symptoms by parents and doctors can help to sieve the serious from the not so serious. If there is an obvious mild self-limiting illness like an upper airway infection or gastro bug and things can be managed with simplified diet , hydration , warm water bottles and mild pain killers in a not so unwell child, there is not so much worry. Note that only 1 in 15 children with acute (new onset ) of abdominal pain require surgical admission and only 60 % of these require specific therapy including surgery. Yet 1% of children, most commonly in the 10-12 year olds will develop acute appendicitis ( inflammation of the appendix) Warning signs for acute surgical or medical tummy ache are:
- persistent vomiting especially if bile stained ( yellow / watery)
- sudden onset of severe pain
- pain in one location
- pain away from the central abdomen (the belly button area)
- significant and persistent Weight loss
- child prefers to be still
- fever especially prolonged and not controllable
- fluid refusal
- obvious swelling / lumps of the abdominal wall (Hernia)
- bloody stools
- chronic ( over days ) diarrhoea ( frequent soft – watery stools)
Lack of an obvious simple explanation and any or more of above red flag presentations should lead to a visit of GP or after hour service. The Physician will familiarize himself with the parents and child , ask a lot of questions , do a simple physical examination, including some basic tests like Urine bedside testing , stool testing to help him differentiate between simple self limiting causes and the ones like Appendicitis , urinary infections , diabetes , gastroenteritis , abdominal and genital trauma (especially in boys), even chest infection which require treatment or admission to hospital.
Even trickier is the recurrent abdominal pain of childhood , intermittent quiet severe tummy pain or cramps for hours or days between long periods of no symptoms at all. Only 8% of these more chronic presentations eventually reveal some organic (medical, surgical ) pathology. These chronic pains are often over investigated , when attention to detail and history could safe the child from unnecessary sometimes in itself stressful tests. Most chronic pains are better managed with simple medications , dietary modifications, as well as reassurance. Conditions include stomach migraine of childhood , Irritable bowel, constipation , and mesenteric adenitis ( abdominal lymphnode swelling of childhood), anxiety , bullying. Similar red flags as for acute pain apply though, others are:
- age less than 5
- mouth ulcerations
- skin disease around the rectum

It seems to be even harder to keep the good from the bad in chronic pain but studies show that significant time of school and no significant weight loss suggest a non organic cause.
Good communication between parents , GP, specialists, child and family is essential for a good outcome.

Helko Schenk
11 1 2010

Spiders- , dog- and other bites

The November edition of the Australian Family Physician was dedicated to bites. Australia is home to 10000 spider species , including the world’s most poisonous one the funnel web , luckily only of touristic interest for us smiling West Australians but an absolute medical emergency and should be treated like a snake bite if attacked by one over east. Our most commonest cause for help sought is the red back spider bite. Easily diagnosed if bite witnessed, but sometimes missed in kids who might just present with irritability sweating and localized pain as fang marks are missing. Red back spider antivenom is reserved for bites causing severe pain or general illness . There have not been any deaths since 1950ies . Recent studies have not been able to show a link between white tail spiders and ulcerated wounds, it seems that it is more likely in Australia to suffer ulcer due to trauma , infection or poor perfusion . But who knows what spiders are still out there. A much bigger problem seem to be dog bites , 35-42 of Ozzie house holds own dogs and 2 % of the population are annually bitten , almost 100000 patients require treatment for dog bite and 13000 in hospital. Biggest risk factors for dogbites seem to be :
- male gender of victim
- children less than 5 years
- household’s own dog
- male unsterilized dogs
The worst offenders by far are doberman’s , german shepherds , Rottweilers and pit bull terriers responsible for 31% of all bites. Lesson clearly has to be never to leave children alone with dogs under any circumstance. Educate your kids to approach dogs with caution, and strictly under adults supervision, leave feeding dogs and puppy rearing bitches alone, avoid territorial dogs. Watch for signs of infection ( redness, inflammation, pus collection or discharge) Get a tetanus shot ! Cat bites are particularly nasty as sharp teeth can penetrate deeper structures lead to joint infection , tendon and vascular injuries even they appear as minor puncture marks on the surface only. The worst by far ar human bites ( attack and love bites) which almost always become infected and also need a chat to the ED DR or GP as there could be concerns re Hepatitis B / C and HIV , which might need prophylactic treatment. Remember rabies and seek immediate medical attention , if you are bitten or scratched by animals when abroad , however lovely they might look. Did you know that Australian bats can transmit a lyssa virus a near identical and as deadly as the rabies virus. Now sleep tight and don’t let the bed bugs bite and if they do (which they do more often even in 4 star hotels again) get the professional pest controllers in and don’t try to treat them yourself as they apparently have grown resistant to a number of pesticides .


Helko Schenk
Geraldton Medical Group
4 12 2009

To Screen or not to Screen

Cancer remains the number one cause of disease and death in Australia. The government now invests in 3 cancer screening programmes for Cervical Cancer , Breast Cancer and Bowel Cancer .
Screening Tests are not diagnostic tests ,rather they are designed to detect populations which are at higher risk of having cancer , who would benefit from further diagnostic (definite ) tests. If you have symptoms like a breast lump , rectal bleeding , weight loss, fatigue …, than you should talk to your doctor and not have a screening test.
Screening tests should be acceptable by the wider population , easily repeatable should not falsely under diagnose cancers , but also not falsely over diagnose cancers, an effective treatment for condition should be available.
While there is no doubt that screening for above conditions saves lives , this might come at a price and some media and government hype should better be avoided.
For 2000 women screened over 10 years for breast cancer 1 life is saved , 10 women are unnecessarily treated , 200 women receive alarming false positive results and need further tests. Cervical Cancer screening (2 yearly PAP smears) have reduced cervix cancer deaths from 4/100000 women in 1991 to 1.9 deaths per 100000 women in 2008. Prostate cancer screening currently requires 48 men to be unnecessarily treated for one life to be saved. Unnecessary treatment is emotionally and physically traumatic can lead to pain , infection impotence or even death.
Bowel cancer screening might work but had a difficult start so far in that 400000 faulty screening tests have been sent out since it was rolled out earlier this year , which now have to be recalled , new ones be sent out , which surely will cause a lot of grief in the affected. The decision to undergo cancer screening or not should not be taken lightly , screening works but comes with a price tag. Your decision should be informed , which you can achieve by discussing pro’s and cons with your doctor, or the use of decision aids explaining the outcomes of screening. Medicine and Screening cannot provide 100% guarantees. Patients and Doctors are put in a difficult position especially as government bodies push for pay of doctors being linked to performance percentages. The linking of population screening rates to practice pay could make doctors biased in their provision of pre screening information and push patients to screening , who if informed might not go for it and consequently suffer unnecessarily.

Cancer Screening Decision Aids:
http://bowelcancerscreening.csiro.au
www.cancerscreeningdecision.org ( bowel)
www.mammogram.med.usyd.edu.au

Helko Schenk
16 11 2009
Sources:
- Australian Doctor 6 11 2009
- Australian Family Physician 4 2009

Remember , remember to give for MO-vember

November has become Mo vember (portmanteau of 'Moustache' and 'November) in Australia and now all over the world. Things have become big since 30 men met in an eastern state aussie pub in 1999 coming up with the idea to bring back old testosterone driven fashion of a moustach , have some fun and at the same time collect money for a good charitable purpose. Since 2003 the event is run by the movember foundation of Australia a non for profit charitable organisation with the aim to change the face of mens health , get men talking about their health, and raise funds for the prostate cancer foundation as well as for beyond blue (national depression initiative). 125,000 Australians have collected 16 million Dollar for both organisations through Movember in 2008 already and all the while only spending 9% of the takings on running of the campaign, note most australian charities spent about 18% on running costs!. The idea and the positive outcome has taken off so well that now 6 countries run the event and thousands of international supporters are spread over the globe, the 2nd donation in support of my Mo growing this Movember came from the highlands of bonny old Scotland where my naked face seems all but forgotten.
Mo Bros, supported by their Mo Sistas, start Movember (November 1st) clean shaven and then have the remainder of the month to grow and groom their moustache. During Movember, each Mo Bro effectively becomes a walking billboard for men’s health and, via their Mo, raises essential funds and awareness for above Movember supported charities.
Money collected is spent by beyondblue and the prostate cancer foundation in Supporting the beyondblue info line for the”Don’t beat about the bush!” campaign , on the Funding of Indigenous Men’s Sheds/Spaces and the support of Men’s Sheds , in campaigns enhancing the awareness of prostate cancer and the risk of depression/anxiety , Funding new research into the link between depression and men’s cancers but also very concrete research projects into prostate cancer, biopsy tissue banks, prostate cancer treatment studies and countless more beneficial causes.
You can support the good cause by becoming a Mo Bro/Sista for a month and grow a beauty on your lip as well as actively promote men’s health and collect money for above charities Most Mo Bro and they supporting Mo Sista’s work in teams promoting themselves via email and posters. If you feel less fashionably challenged you can simple go to au.movember.com search for the mo team of your choice and donate generously and have a chuckle following the growth of natures works of mo-art. Alternatively you could support Eric , Mick, Nicholas and myself from the “Midwest GP Motivated” -team or link straight to http://au.movember.com/mospace/208817/ for donations.



Helko Schenk
Geraldton Mo-dical Group
3 11 2009

WEBSITES:

www.beyondblue.org.au
www.prostate.org.au
au.movember.com
au.movemberfoundation.com
http://en.wikipedia.org/wiki/Movember

Infertility and your lifestyle

Fact : 15 % of Australian couples in their reproductive age encounter problems to conceive naturally – have a fertility problem. Seems shockingly high to you , they obviously don’t talk about it. Causes for infertility are 40% female and 40 % male in origin, so see the doctor as a couple if things don’t work out.
If you meet the right one have sex regularly every 3 days or so , sperms survives 3-7 days the egg for 24 hours only. Timing of intercourse around ovulation probably doesn’t work and stresses couples out. And stress including at work definitely has a negative effect on conception and sex life. To much relaxation in the use of alcohol over recommended limits or use of cannabis , cocaine affects sperm quality as well as ovulation. The same goes for smoking. Don’t leave family planning to late, the biological clock is ticking!! Women and men have the highest ability to conceive in their early twenties, above age 35 the chance to conceive drops in both sexes to half. 17 in 20 couples wanting children conceive in their Ist year of trying, 19 in 20 in the 2nd year. So see your doctor for a review as a couple after one year of regular intercourse. You need to visit your GP earlier if you have other medical problems, are over age 35 , have erratic , disturbed or no periods at all.
Moderate exercise is good for male and female fertility , excessive exercise suppresses ovulation and overheats testes and so negatively affects chances. Needless to mention that anabolic steroids but also other medications, including natural remedies can affect sperm counts and egg delivery. Other factors likely with negative effect on male sperm are regular hot bathing, sauna attendance, tight underwear. Prevent STD’s by using condoms as they reduce male and female fertility in later age. Aim for a medical optimum weight (Body mass index 20-25) particularly if you a women as your ovulation might be impaired otherwise. Good news for “tearoom junkies” , coke , coffee or tea have no effect on family planning.
Women should take folic acid when wanting to fall pregnant , seek vaccination against flu , chickenpox and rubella prior pregnancy. Both partners should aim for a healthy and relaxed lifestyle , have a good balanced diet, avoid environmental poisons ( lead , radiation, pesticides, toxic chemicals ) ,plan for a family early and don’t forget to have regular sex.

Helko Schenk
Geraldton Medical Group
29 9 2009

Sources:
- GP lecture by fertilitynorth 16 9 09
- http://www.patient.co.uk/
- http://www.gpnotebook.co.uk/
- www.access.org.au

When work is burning you out!

A study of work related injuries in Australia showed that 6 % of all injury claims in 2005 were related to mental stress but as much as 21 % in dollar funds of injury moneys spent were awarded to stress related work injuries , as mental health problems tend to be more expensive and lengthier to treat. Stress at the work place is pending on personal factors, professional standards and requirements and organisational factors of the employing business. “Stressful” usually means an inability to cope or borderline competence to deal with work demands. What some see as stressful others see as challenges and exciting opportunities. A measure of stress helps to stay awake, makes us to concentrate and with some laughter we can all overcome the sinking feeling, when the week is beginning, known as Mondayitis. To much and persistent stress will raise adrenaline levels permanently , prevents relaxation and consequently lead to exhaustion , poor productivity , burnout , depression and might lead to High Blood Pressure, Hear disease , low immunity and even cause cancer. Recognize Burnout in yourself and others!:
1. Emotional exhaustion , inability to engage fully with many aspects of the job ,
2. Depersonalisation , tendency to depersonalise those with whom one is forced to interact , all tasks become simply part of a routine.
3. Perceived or real Lack of personal accomplishment at work
How to halt burnout? It is clearly now recognized and laid down in Australian health and safety laws that the employer has a duty by supervising organisational structures to prevent constant excessive hours , the regular taking home of work , conflicting demands , unrealistic goals and targets , constant pressure. It is naturally in the interest of any business and in the interest of productivity to look after their employees.
At a professional level learn to recognize if stress or failure to cope is due to lack of skill ( competence deficiency) which can be corrected by up skilling and learning , delegation to appropriately skilled colleagues. Try to remain open to changes and learn to see them as challenges rather than hurdles. Discuss stressors timely and openly with colleagues and line management. How do others manage it?
At a personal level , look after yourself, take regular time out ( breaks , holidays), have a hobby , social life and friends , enjoy your kids and wife while they are young and there for you, take up regular physical exercise, keep a sense of humor and regularly laugh at work an incredible productivity riser.
Don’t Selfmedicate! It’s so easy to fall for a reward chocolate or a drink which soon become more than 2 on a busy days evening.
Don’t be afraid to make changes if you not comfortable at your job look how you can do it better if you cannot improve or get positive feed back don’t be afraid to even leave it.
Value strong and healthy relationships with your colleagues, clients, friends , family
Find a GP and see them once a year for a health check and if stress overcomes you , to be an objective observer and advisor to find your way through it as well as help you through the treatment should have it gone to far.
Helko Schenk
Geraldton Medical Group
31 8 2009

Sources:- “When work is stressing you out” ABC.net.au/health 7/05- “7 tips to prevent burnout” Professor Rowe 8/09 Medical Observer- “compassion fatigue and burnout” AFP 6/05- “ Burnout” patient.co.uk

Eat Fish and live longer

Regularly eating oily fish or regularly taking fish oil capsules have long been advocated by the National Heart Foundation or Royal College of General Practitioners. The evidence is now mounting that essential omega 3 polyunsaturated fatty acids are useful in the prevention of ischaemic heart disease ( angina , heart attacks) as well as in the treatment of the same. It now seems also that Fish oil is effective in the treatment of heart failure ( heart muscle weakness) , Omega 3 fatty acids ( DHA and EPA ) are essential fatty acids , which cannot or only partially be produced in the human body. Their concentration is high in breast milk and 30 % of brain mass is built by these omega 3 fatty acids. The Bodies highest concentration of these acids is found in the retina ( the nervous membrane at the back of the eye) .
The effect of taking fish oils or eating oily fish has been investigated in a number of large population studies like the Nurses Health Study US , or in systematic reviews of trials Fish oil seems to reduce bad fats like triglycerides and cholesterol , it also reduces inflammation factors like CRP and might so have a double effect on arterosclerosis the underlying pathology of vascular heart disease. One Scottish Health authority went that far to permit prescription of oily fish on standard NHS scripts. The National Heart Foundation Australia now recommends inclusion of fish oil capsules on Medicare PBS scripts.
The Anti-inflammatory effect of fish oil has been shown to a lesser degree in the treatment of rheumatoid arthritis.
There is evidence that certain diseases like dementia , diabetes , inflammatory conditions ( Asthma , Rheumatoid Arthritis ) mouth and oesophageal cancer , cancer of the colon and ovary cancer are reduced in fish eating populations , but these need more research to be recommended. The judge is also out on fish oil and ADHD , children brain development , children and aggressive behaviour.
Prevention requires 500 mg of omega 3 acids (equals 2 standard fishoil capsules) and treatment of heart disease needs 3 standard doses. Alternatively eat 3 meals of oily fish a week (mackerel , atlantic salmon even canned, canned tuna , herring or sardines. Not so good as rich in mercury are shark , swordfish , merlin rays , cat fish. Pregnant women or children should eat mercury rich fish only once a forthnight or avoid at all.
What ever you do don’t pan fry or deep fry the fish as this destroys the essential fats and also loads the fish dinner with bad fats. So why don’t settle for a poached, baked, grilled or gently steamed fish meal with lemon and batter sauce , a glass of white wine and enjoy while doing your health good.

Helko Schenk
Geraldton Medical Group
17 8 2009

Older people on 'drugs cocktail'

Nearly half of over 65s are taking five or more drugs, and without regular reviews this may be both dangerous and costly to them and Medicare.
Inevitably people do get put on more drugs when they get older because they suffer from more chronic conditions - this is often the right thing to do, but the problem is we don't necessarily know how these drugs are going to work in combination and lots of people are not taking them as prescribed.
A british study showed 60% of 500 polled believed they may be suffering side-effects from the drugs, but many did not tell a doctor.
Many of these drugs are on repeat prescriptions, and could have been prescribed for conditions the patient no longer has.
The The Royal Pharmaceutical Society of Great Britain polled 457 people aged 65 and above on their medications - which included prescriptions, drugs bought over the counter and herbal medications.
The Studies conclusion urges, all older people to request a medication review from their doctor and pharmacist.
The same study shows one in five are not taking medications as prescribed, and one in seven do not take their pills at the recommended time.
The medication of older people has long been an area of concern: the combination of ageing bodies less able to cope with drugs, treatment by multiple doctors ( a particular problem in Australia where patients are often not registered with one practice alone) treatment for multiple conditions, and known problems in adhering to the instructions, all raise the risk of side effects.
As many as 17% of hospital admission are due to these adverse reactions, and it is estimated that over three-quarters of these "are predictable and preventable",
A team of of a well-trained professionals (Pharmacist and GP ) could potentially pick up problems. Medicare has long recognized this and funds a yearly comprehensive medication review in team work between your GP and Pharmacist. Both conduct an interview with you , the GP often does some tests or collects results of recent investigations and copies these into a letter to your pharmacist requesting a Medication Management Review. In Medicine it’s true that 2 cooks are often better than one.
GPs are excellent at prescribing, but they are not always so good at knowing when to stop, and they may not always have the time to conduct a thorough review. That's where the well-trained pharmacist has a key role.
It is vital to inform your GP and Pharmacist if you take over the counter medications , vitamins , trace elements or alternative medicines. It pays to stick with one General Practice and one Pharmacy so they both have a comprehensive understanding of your problems, allergies and treatments. Discuss your eligibility for a Home Medicines Review on your next visit to your Doctor or Pharmacist!

Helko Schenk
GMG
29 7 2009

Safe Surfing for your Health

The Internet can be as misleading as it can be helpful if you are looking for some advice in health matters. It only has to be viewed critically as you would do with the news or even newspapers. Now nearly anybody is able to produce a website , the code of practice is very much depending on the author/’s. Use your common sense , healthy judgement and follow some basic rules. Who runs the website is it a not for profit organisation, government body (sites ending in .gov or .org) or a commercial enterprise (often .com)
Is the site based on evidence and scientifically proven , good quality research or just based on theory and isolated stories. Is the content balanced or is it’s view on esided , research further into claims made. Is the authors / organisation name and qualification given? Conflict of interest does the site branding one product only? is it sponsored by a pharma company, does it claim to provide cure and to sell you something?
Alarm bells should ring :
- personal testimonies
- one study only used as proof
- treatment based on secret formulas
- treatment claimed to be a cure for everyone
- treatment works immediately
- treatment available from one source especially over the net only
- Beware of self diagnosis and self prescription

Shortly beware sites , which sound to nice to be true and discuss contents or treatment if in doubt with your doctor , pharmacist or nurse only be patient we try to keep up to date but information needs to sieved even by professionals.
Usually Highly regarded organisations like hospitals , royal colleges , acknowledged patient self help organisations can be trusted but don’t loose your healthy scepticism.
Some examples of good sites:
- www.racgp.org.au has a family doctors home advisor and is searchable for the contents of www.betterhealth.vic.gov.au, www.healthinsite.gov.au 2 other very good websites
- www.patient.co.uk comprehensive and searchable evidence based patient and even professional information on all sorts.
- www.drsref.com.au under patient has a free link to Prof. John Murtagh’s Patient advice book , one of the greatest patient educators of present Australian medicine.
- www.allergy.org.au
- Www.rheumatology.org.au
- www.agpn.com.au (Australian General Practice Network)
- www.national asthma.org.au
- …….
Sources:
- Kidney Health Australia
- Google Australian links Patient Information

Conflict of interest:
“Dr Schenk surfs daily, and still get’s anxious on the view of a patient with piles of net printouts”.

Helko Schenk, 6 7 2009

Asthma

Winter brings the typical sounds of dry cough, wheeze and shortness of breath back to the doctor’s waiting rooms. These symptoms can be caused by asthma, which remains common: 1 in 9 adults and one in six children suffering from it in Australia. Asthma is caused by inflammation of the airways, the cause of which is not known. This inflammation produces increased mucus plugging up the airways and also constriction of airway muscles further tightening smaller airways. Genetic factors can make asthma more likely , but asthma is also more common in hay fever and eczema suffers pointing in some cases towards allergy - so sometimes discussing allergy testing with your doctor might be worthwhile. Common triggers for asthma can be infections , pollen, exercise, smoking, drugs , fumes, chemicals , emotions, animal fur dust , dust mites even foods. Funny enough asthma is less common in children mixing and not overprotected from seasonal colds. Asthma might be more common, if your immune system is bored. Asthma usually cannot be cured, but symptoms and crisis can be managed and prevented. Many Olympic champions have asthma. Few Asthmatics might be lucky and have their specific allergies cured by desensitation therapy more and more available in general practice. Most people with asthma use at least 2 inhalers, little aerosol spray bottles or medicated powder delivery systems. Inhalers can be relievers, short-acting medicines opening up the airways. If symptoms more recurrent than preventers are used, steroid medications relieving inflammation at airway level. Long acting bronchodilators work like relievers but act up to 12 hours. Asthma sufferers sometimes have to use short courses of steroid tablets and there is now also an immune modulator available which can be used continuously in difficult to control cases. Many asthmatics tend to overuse their relievers , rather than using their preventive medicines. Medication use , inhaler technique , symptom control need regular checking by your asthma nurse or GP maybe as part of an asthma care plan appointment. Efficiency should be regularly controlled with spirometry - a computerized breathing test. Every asthmatic should have a specifically tailored asthma management plan entailing information to recognize symptoms and helping him to self-manage asthma , prevent and treat crisis. So it is not good enough to rock up at the local emergency department in desperation, but you should see your doctor or nurse at least yearly for an asthma check. Discuss Stop smoking if you still do and don’t forget the annual flue and 10 yearly pneumococcal vaccine.

Sources:
- www.nationalasthma.org.au
- Www.abc.net.au/health
- www.patient.co.uk
- www.medicareaustralia.gov.au


Helko Schenk
Geraldton Medical Group
8 6 2010

Swine flue Myths and Common Sense

If you listened to the news in the last week , you could well have been made believe , that the biblical plagues are hitting us all at once. Now while it is reasonable to show some concern, preparation and planning, it is important to keep things in perspective .

An apparently complete new strain of influenza virus, with characteristics only shown in other human, bird, and pig viruses seems to be behind a flu outbreak originating from Mexico. This new modification of the already known H1N1 virus gets transmitted by droplets between humans and causes the usual flu symptoms of fever , runny nose, congestion, sore throat or cough. There has been so far only a single death outside Mexico in a toddler travelling from Mexico, a significant number of deaths attributed to swine flue in Mexico were propably due to alternative causes, there hasn’t been a single case confirmed in Australia so far, most cases of flue outside Mexico have been reported as mild. The virus is responsive to Tamiflu and Relenza (medications), which both are stockpiled sufficiently in Australia. More so simple hygienic measures, would help to contain the spread of the virus, should he hit Australia. Currently you are only at risk if you have travelled to Mexico, USA and Canada during the last 7 days or have been in close contact with confirmed and or propable cases of swine flue. Should you develop above mentioned flu symptoms and be at risk:
- stay at home keep your social distance to others , wear a mask when around others. , (Masks seem to work - even surgical ones!)
- talk to a medical professional ideally over the phone, before you go and see them, this helps reduction of spread
- Make yourself known on arrival to reception staff, so you can be issued a mask and kept at a distance.
- Rest , drink plenty of fluids , take simple analgesics and over the counter medicines
- Keep cough and sneezing etikette (cover up)
- Wash your hands regularly, clean surfaces regularly

Pending circumstance and local situation, there will be different pathways to access tests and treatment ,via an extra set up flue clinic next or through our public health unit or local GP clinics and a combination of above. Antivirals , which have arrived in Geraldton, will be distributed only where indicated, following strict clinical guidance on a need basis and only under the supervision of our local public health unit. This is currently indicated for confirmed cases as well as close contacts of cases within 48 hours of sympoms or contact only..
Find Further information :
- Swine Influenza Hotline 18 02 007
- Health Direct: 1800 022 222
- www.health.gov.au or www.flupandemic.gov.au
Seasonal Flue vaccine remains recommended ,even though the new virus is likely not covered by it.
It remains safe to eat pork and drink corona , well within safe recommended limits, that is.
Sources:
- Dr Maris Giles from Public Health Geraldton- Dep. Of Health WA
- Australian Medical Association on Swine Flu
- Above websites
- Interview with Prof Raina Mcintyre on ABC Health

Helko SchenkGMG
4 5 2009

Little gland - big problems?

The thyroid gland is composed of fatty tissue wrapped around the wind pipe just below the voice box. This gland produces thyroid hormones, which regulate the metabolism in nearly every organ and can put your metabolism in over or under drive pending need. No wonder that failure or malfunction of such a busy organ is incredible common. Alone 850.000 Australians are affected by thyroid disease, 7.5 % of women and 1.5% of men. Luckily thyroid conditions are usually not life threatening and respond very well to treatment. The Thyroid can under produce (Hypothyroidism) or over produce hormones (Hyperthyroidism) it can swell up and form lumps (goitre) and even turn cancerous, again a very rare and often very manageable condition(only 5% of all felt lumps are cancerous).
A lump in the thyroid gland is usually obvious to the patient and should lead to a trip to the GP, who examines the neck , recommends simple blood tests to measure hormone levels , sends for an Ultrasound of the neck or special nuclear studies. A physician will often be involved in the early phases of thyroid disease.
Signs of cancer
- lump in the neck
- hoarse voice / cough
- difficulties swallowing
Hypo- and Hyper- states of the thyroid gland particularly need monitoring during pregnancy , when metabolic demand is great and need for the right hormone levels is important for baby’s development as well as mums metabolism. All Babies are screened for it after delivery. Malfunction can arise spontaneously, can be caused by autoimmune stimulating or destructive disease, extreme lack of iodine, certain medications.
Symptoms of Hypothyroidism:
- tiredness
- weight gain
- dry swollen skin, dry coarse hair
- feeling cold
- mental and mood slowing
- constipation
- irregular , heavier and lighter periods
With Hypothyroidism - the metabolism slows down and eventually the cholesterol and sugar levels as well as blood pressure go up , the heart develops angina and can fail the hair falls out, the patient can end up in coma.
Hyperthyroidism:
- Weight loss , increased appetite
- Nervousness agitation
- Tremor , anxiety
- Rapid pulse
- Sweating , heat sensitivity
- Diarrhoea
If extreme cases the heart can race , angina , or heart failure occur.
Both function failures can be treated with hormone replacement or drugs which slow the thyroid down, sometimes with radio iodine which selectively kills thyroid cells or even surgery to remove excess gland tissue. In any case should the starting of hormone replacement be based on blood test and not un-qualified guessing relying on above vague symptoms, urine or saliva tests. It should be warned against the use of natural hormones or unnecessary use of thyroid hormone for lifestyle purpose or even excess iodine intake. To much hormone leads to brittle bones, risk to the heart, but it also means that other potential conditions hiding under above symptoms could go undetected. Food these days contains plenty of iodine and even increased need during pregnancy should be covered.

Sources:
- www.abc.net.au/health Thyroid disorders
- John Murtagh , Patient Education
- Www.patient.co.uk patient and patient plus
- BBC News ‘thyroid disorders misdiagnosed’
- The Lancet 2005 vol 365 ‘Hair loss and cardiovascular health’
- Australian Family Physician Vol 36 No 7 2007 ‘ thyroid lumps and bumps’

Helko Schenk
Geraldton 9 4 2009

Grumpy old Men - Male Menopause – fact or fiction

Women suffer it and get treated successfully for it, why not men too? Symptoms attributed to male menopause are:
- increased abdominal fat
- weaker muscles
- decreased motivation
- fatigue
- moodiness and irritability( grumpy old men),
- depression
- lack of concentration
- declining sexual interest erection difficulty

Fact is that from the 50ies onwards testosterone levels decline by about 2% yearly, testosterone is a hormone produced in the testis controlling facial hair, penile growth muscle gain and fat distribution. Some doctors claim that steady fall in hormone levels is responsible for above listed symptoms. Libido and Sexuality might decline with age anyway - no real correlation with testosterone levels has been proven. So it could only make you feel better, but not actually help.
Studies looking at benefits of testosterone replacement are inconclusive , some have shown increase in bone mass and strength as well as muscle mass. Testosterone is a risk factor for prostate cancer and long term studies on the safety of hormone replacement in men are limited.
Testosterone can cause breast cancer, kidney and liver damage, high blood pressure, worsen diabetes and migraines, anxiety and acne to name only some unwanted effects.
Testosterone supplementation is currently not recommended for older men with normal or low normal hormone levels. Replacement might be warranted for older men with markedly decreased hormone levels, regardless of symptoms and in men with mildly decreased levels and symptoms of testosterone deficiency. According to some experts, men who experience above age specific symptoms, lead unhealthy lifestyles (smoke, to much alcohol, not enough exercise, overweight) also chronic diseases of older age (diabetes , heart disease , depression) add to their symptoms. Saying this - discussion of above symptoms with your GP can be life saving, like for instance secondary erection difficulty is now a recognized warning symptom for small blood vessel disease and is known to precede heart attacks and strokes, so should prompt your good GP to explore heart risk factors and maybe put you on the tread mill. And there are alternative treatments for age or lack of testosterone related symptoms pending the underlying pathology ranging from Antidepressants to Viagra.
So does it all grind down again to do more exercise , stop smoking , drink sensible ? Probably right! but your doctor will help you to determine if you suffer an underling condition worth treating. Medicare currently only funds treatment of testosterone deficiency if there are 2 proven low testosterone blood levels. Options for replacement are tablets , injections ,implants, patches , gels. One thing for sure -beware of busily advertising and business hunting big private mens health clinics! You better off with your local doctor and specialist , as they know you better and are able to look at your health overall.

Sources:
- www.abc.net.au/health
- www.gpnotebook.co.uk
- www.patient.co.uk
- Australian Family Physician 6 6 2003

Helko Schenk
Geraldton Medical Group
Geraldton 30 3 2009

Flue shots need higher uptake

Influenza or common flu is lurking around the corner. Not long to go til june when the annual flue season starts and brings sudden onset fever , severe headache, sore throat , runny nose , fatigue, general aches and pains , congestion in lungs, nose and throat and even death for some of us. Not forgotten yet the disastrous flu season 2007, when we had the lowest vaccination uptake yet in Australia followed by the most severe influenza season since national reporting was started in 2001 Everybody remembers the death of the 4 west Australian toddlers. So now is the time to get vaccinated. Vaccines have arrived to pharmacies and GP surgeries. Free vaccines are available for the 6 month to 4 year old ones as well as the pensioners over 65 years and indigenous adults over 50 years of age and indigenous adults 15-45 years of age. Vaccination is also recommended for anybody else with underlying significant health problems (Asthma , Bronchitis, Heart disease, Cancer, Immuno-supression like HIV), Pregnant women, who’s IInd and IIIrd trimester falls into the flue season June til September, Parents and families of high risk children under the age of 2.
But also everybody else benefits much like the community as a whole from being vaccinated against the flu. 80% of the over 65 year old population is taking the flu shots up every year, they are aware of the usefulness of the vaccine and have tolerated it well over the years. Only 20 % of the lower risk general population between 4 and 65 is having the jab every year. 50% of which have it just because their employer pays for it or pays for their time needed to get it. A wise and very smart move from these companies, as it keeps their sick days down and saves bucks later during the season. Why do the rest don’t have it? , it costs money (about 20 $ for the script, and most GP’s bulkbill costs for prescribing/giving the shot anyway). Some feel it might give them the flu, not possible as the flue vaccine is a dead virus material vaccine. I’m to healthy to get the flue – sure thing til it hits you one season, and anyway there is clear evidence that countries with a higher general uptake of flu vaccine have a lower sick rate in the general and lower death rate in the elderly population.
So come on Midwest get vaccinated these 2 months!

Important Facts:
- Vaccination is required yearly as the virus changes
- Side effects and allergic reactions are rare
- Soreness redness at injection site in 20 %
- Flue like illness for a day or so in 1 % only
- Current Minor illness is not a reason to avoid vaccine

How can you avoid getting the flu?:
- cover your face if coughing and sneezing
- chew with your mouth closed
- use a paper tissue to wipe your nose
- wash your hands regularly especially before preparing food
- stay at home til signs of illness settle( runny nose , cough, fever)
- avoid mixing with large crowds of people if influenza is about
- Young children and people with chronic conditions should see their doctor early with illness

Sources:
- www.abc.net.au/health
- Australian Family Practitioner 10th October 2008 “INfluenca”
- www.patient.co.uk “influenza immunisation
- www.public.health.wa.gov.au leaflets for diseases A-Z

Helko Schenk
Geraldton 12 3 2009