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

Prostate , to screen or not to screen - the medical view

Thanks Kevin for sharing your experience with us and Geraldton.
The prostate is a small gland which only men possess, about chestnut size , sitting at the base of the pelvis between the bladder and the rectum. It produces some of the ejaculation fluid. It seldom is cause for trouble during the first 5 decades of life but slowly tends to grow and impact on the urethra and urine flow , so that most men eventually end up with some symptoms of flow obstruction which can be treated medically or surgically if indicated and desired.
Symptoms of benign (good ) overgrowth of prostate:
- Poor urinary stream
- Hesitancy ,Difficulty to start urination
- Dribbling after urination is finished
- Frequency Urine is passed more often
- Urgency , you need to pass urgently
- Poor emptying your bladder feels poorely emptied

Sadly the same symptoms can herald prostate cancer , which makes picking it up by your symptoms alone difficult. Warning signs for prostate cancer can be pain at the base of the penis , pelvis and back , blood in the Urine.
There are currently 3 methods to screen for prostate cancer a digital examination of the rectum and prostate , a Blood-test ( Prostate specific Antigen = PSA) and ultrasound of the prostate. None of these methods seems perfect, as they all more or less under- and over diagnose cancer and therefore often lead to unnecessary intervention , pain-full biopsies , impotence , faecal and urinary incontinence and even avoidable death. All methods and current treatment might actually not improve quality of life and overall survival chance from prostate cancer. The royal college of GP’s in Australia currently recommends against a general screening of the overall population of men for prostate cancer. It seems currently wiser to aim the Screening at men with increased risk and only after thorough case to case discussion of the benefits and risks of screening with each individual man.
Opportunistic Screening should be offered to :
- men between 50 – 70 years of age
- men with strong family history of prostate cancer

Other risk factors can be:
- certain breast-cancer genes in the female part of your family
- diet high in fats and low in fruit and vegetables
- exposure to the metal cadmium

A recent study in NSW shows - PSA blood screening can potentially detect cancer early before appearance of symptoms , the frequency of late advanced stages prostate cancer has definitely fallen since it was introduced in the late 80ies. Overall death rates from prostate cancer have fallen since than as well, wether this is due to increased uptake of PSA testing or advances in urological and medical treatment has yet to be investigated in urgently needed upcoming studies.

No easy answers! ,but your doctor can help you to make the right decisions.

Helko Schenk
Geraldton Medical Group
12 2 2009

Useful sources and sometimes reading:
- www.abc.net.au/health/thepuls/stories “The prostate and the PSA test”
- Medical Journal of Australia “Prostate cancer and prostate-specific testing in New South Wales”
- Prostate Screening Policy endorsed by RACGP 2006
- “Making and informed choice about PSA screening” Ward/Gattellari Australian Family Practitioner 2001
- www.patient.co.uk “Prostate Cancer”

Smokes, booze and too many kilos

Australia’s health: “must do better” - is how the teachers would mark us, a committee of medical experts has reviewed all the best Australian and international evidence and late 2008 published a discussion paper “ Australia the healthiest country by 2020” Obesity , tobacco and alcohol are our 3 biggest problems costing Australia $6 billion a year in health costs and 13 $ billion in lost production costs. These risk factors account for a third of Australia’s disease burden. Unless we halt the trend in childhood obesity, life-expectancy of our children will fall by 2 years compared to current standards. If we tackle these risks, people would in average gain 5 extra healthy years. Prevention works! 50 years ago 75% of all Oz men smoked - now less than 20% do. Tobacco related death- and heart disease deathrates have nose- dived since. 400.000 premature death were prevented and 8.4 $ billion in cost saved, 50 times more than what was spent in antismoking campaigns, during the same time. So prevention is profitable! Systematic national /state programmes have decreased road trauma deaths by 80%. Other success stories of prevention are HIV, sexual diseases, child hood vaccination and sudden infant deaths. The report obviously appeals to the Aussies competitive nature in setting its targets:
- Reverse the rise in overweight and obesity
- Reduce smoking rates to 9% or less
- Reduce harmful drinking for all Australians by 30%
- Reduce the 17-year life expectancy gap between indigenous and non indigenous Australians
Some measures offered for consideration will not go down well with food, tobacco- beverage and hotel industries.
Smoking:Further increase tax on tobacco, all form of promotion will be banned , shops unmarked and cigarettes sold in plain packaging.
Alcohol:make low alcohol drinks cheaper by less tax and make high alcohol drinks more expensive, restrict alcohol advertising and reduce alcohol sponsoring of cultural / sporting events, lower blood alcohol limits in drink driving laws.

Obesity:high sugar high fat food should be taxed higher, regulations governing amounts of trans-fat , saturated fat and sugar should be stricter, improve food labelling, subsidize transport of healthy food to rural areas, advertising for sugary , fatty foods during children TV hours be banned, physical activity should be promoted in schools and communities, town and building planning should give more opportunity to walk, cycle , exercise and play.
In the meantime we can make better use of already available government subsidised health promotion and prophylactic initiatives, well women checks , well men checks , 45 – 49 year health checks , health care plans for people with chronic disease, health assessment for the elderly, skin checks …

Every Aussie should advance Australia’s fair (health), where he stands, you can do it!

- Australia’s health: must do better , Peter Lavelle www.abc.net.au/health
- Australia the healthiest Country by 2020 Prof. Rob Modie, Med.Journal of Australia

Helko Schenk , 26 1 2009

Blast that Verruca! - To Treat or not to Treat?

Between 1 in 10 Australians suffer from warts at any given time more commonly under the age of 20. Warts are lumps of skin overgrowing caused by viruses. They are not dangerous but can be a real nuisance, causing pain walking on them or interfere with fine tasks if located on fingertips. Rarely if they are wide spread and treatment resistant mean a weak immune-system which the doctor excludes from history / blood tests. Warts are not very contagious and simple precautions prevent spread to others and from one part of your body to another one.
o When swimming, cover any wart with a waterproof plaster.
o If you have a verruca, wear thongs in communal areas
o Don't share shoes, socks or towels.
o Don't scratch warts.
o Don't bite nails / suck fingers with warts.
o With verruca, change your socks daily.

Warts usually disappear without treatment but sometimes last for several years. Treatment might speed up recovery. Management with the best supporting evidence are: Salicylic acid, Freezing (Cryo-)therapy, Duct tape.
Salicylic Acid has to be applied in the form of wart paint (gels, cream…) daily for weeks at end. It is best done to the soaked wart, dead tissue has to be regularly rubbed away (emery board, pumice stone). Rest with application if the skin gets inflamed or sore. Protect healthy skin with Vaseline or putting a zinc tape with a hole the size of the wart onto the lesion. Acid can be combined with Freezing for improved success. Salicylic Acid is cheap and readily available and well tolerated unless you have blood flow problems or suffer diabetes. Your GP can freeze , freeze-taw–freeze warts , taking a mean of 5 treatments usually. Freezing is no more effective than acid treatment, but maybe faster. Acid cures warts in 75% of cases, Cryo in 52% of cases. But more aggressive Cryo has more local side effects (blistering , burning, scarring) Warts heal with placebo treatment (not chemical active treatment ) in ca 30% after 10 weeks!
One promising study just using duct tape to cover the warts for six days in a row than soaking and rubbing it down again before covering it again cleared 7 in 10 warts.
A chiropodist/podiatrist can give great comfort with simple surgical treatments.
Third line treatments like cutting or curetting the wart out can change a lump for a bump , cause scarring , or even spread the wart if unskilfully done. There are lots of treatments on the market and used in surgeries and skin clinics, which have not been fully investigated but definitely cost a lot.

Helko Schenk
12 1 2009

Sources :
- Warts and Verrucas www.patient.co.uk
- James Murtagh “practice tips”, “patienteducation”
- www.gpnotebook.co.uk
- “Bandolier” oxford journal of evidence based medicine
- “Australian Family Practice – To freeze or not to freeze”

Cholesterol – Why bother?

The number one killer in Australia remains heart and vessel disease ( strokes , heart attacks) , despite a pleasing reduction in deaths from coronary heart disease , as people modify their risk factors , heart and vessel disease still remains responsible for the death of 1 in 3 Australians. Cholesterol is a fat produced in our liver from fatty foods. Some fat is needed (to store and transport energy , help to absorb vitamins…) , to much fat and the wrong cholesterol (LDL cholesterol) forms patches of fatty lumps clogging up arteries . Other cholesterol (HDL) might actually prevent the clogging up of vessels. This Clogging up of arteries (hardening) eventually leads to critical obstruction of blood flow and than causes angina , heart attacks, strokes, kidney disease. It makes sense to detect risk-factors (one of which is cholesterol) before it is to late. Cholesterol and cardiovascular risk should be checked :
- 5 yearly in healthy individuals older than 45
- 1-2Yearly in patients over 45 , who also smoke, are overweight , have high blood-pressure, have a strong family history of specific heart disease
- Yearly in patients with high risk to develop heart-disease, or who already have heart-disease , diabetes, high levels of cholesterol in the family(genetic fat disease), chronic kidney disease
- Aboriginals and Torres straight islanders yearly after age 18
Mass screening for cholesterol in the population, regardless of age and risk factors is not currently recommended.
To determine your risk of heart disease , the Doctor/Nurse will ask you a number of questions and take some basic measurements (Blood pressure, Weight, abdominal circumference, ECG …) This helps to decide, wether your cholesterol level is high or low ,as this depends on a range of pre-existing risk factors. So Auntie Emilys level might be ok for her, but to high for Uncle Kevin already. Patients with raised Cholesterol but also everyone, are well advised to follow lifestyle and diet advice. :
- Keep to ideal body weight
- Eat high fibre diet
- Avoid saturated fats
- Select low – GI foods
- Eat fish twice a week
- Beware fast foods
- Take regular exercise
- Exercise relaxation
- Do not smoke
- Drink plenty of water
- Drink alcohol in small amounts only
A bit of thought and a few bucks spent on proper advice and prevention will save you hundreds on prescription and gap fees later.
If above is not leading to success, than your doctor might consider the use of medication (most commonly statins ) , which can effectively and safely reduce your cholesterol , with you, til you reach satisfactory targets. You will also benefit from treatment of other risk factors (Weight, Smoking, …) and all going well have decades left to enjoy the important things in life.

Sources
- www.heartfoundation.org.au
- Position statement on lipid management 2005 National Heart Foundation
- JOhn Murtagh Patient education prevention cholesterol and cardiovascular riskfactors
- Guidelines for preventive activities in general practice 6th edition RACGP
- General Statement for lipid lowering drugs prescribed under PBS
- www.patient.co.uk cholesterol, statin

Dr Helko Schenk, GMG, 29 12 2008

Whooping Cough and other Vaccination Matters

Most developed countries have successfully run vaccination programmes in the last 50 years, almost eradicating former killer diseases. This is thanks to parents and health care workers, scientists who always have the safety of their children and patients in focus. Vaccinating them, helps children to fight deadly diseases.
Vaccines contain weakened virus material, triggering a response, creating antibodies and immune information, storing protection for years to come. Vaccination creates natural immunity as a normal response of our immune system, without living through the pain of real illness. Immunisation is safe and has saved millions of lives.
Why than do infections sometimes return? Immunisations work less well when vaccination rates in the community fall below certain levels, the virus survives in patient groups, might be re-imported, protection from vaccines wane over years. We have to remain forever vigilant.
One dragon raising his head is whooping cough with 315 notified cases 2008 in Western Australia (threefold rise since 2007!) This seems small numbers, but the effects of whooping cough can be 6 weeks and longer lasting excruciating cough attacks, strong enough to break ribs and make some kids go blue or even stop breathing. Adults and older children have milder illnesses, which can make outbreaks go undetected. Contacts have a 80 percent chance to get the disease. Babies under 6 months are particularly affected and there have been 16 deaths in this age group and 84000 cases of whooping cough in total between 1993 and 2005 in Australia.
The reason for this is, that whooping cough vaccine only protects for 6-12 years and enough people are missing out on the vaccination during the 1st, 4th and 15th year of age. The message is simple: get your children vaccinated in time , parents planning or just been through pregnancy and even grandparents and health care workers should be re-vaccinated. Geraldton Medical Group and Batavia are just boostering all their medical staff! Babies should be kept away from sick and coughing visitors till the first course of immunisation is completed. It pays to do a pre-pregnancy visit to the GP and to use this opportunity to have rubella and chicken pox status checked as well.
Other vaccine preventable illness worthwhile discussing with your doctor:
- Tetanus
- Mumps Measles Rubella
- Polio
- annual Influenza
- 10 yearly Pneumococcus
- Hepatitis A and B in risk groups
- Cervical Cancer

Which reminds me, that we have to urgently recall this big belly bloke Mr Claus Santa for his travel vaccine check prior the 24th of this month.

Merry Christmas 2008!
Helko Schenk

Sources:
- Special thanks to Marisa Giles (Community Health) and James Quirke (Batavia Health) for facts and ideas.
- “Pertussis in Australia today” Australian Family Physician Vol 36, 1/2007
- www.public.health.wa.gov.au website public health western Australia
- “Disease Watch” 9/2008
- www.immunise.health.gov.au

Are You Fit to Fly?

The holiday season is upon us, lots of us use this time to long-haul fly overseas, Australia remaining an island on the other side of the globe for a number of destinations. It is advisable that you see your GP or even specialist before booking a flight to help you with your travel plans. You might need a letter carrying medication onto the flight(emergency medication inhalers and heart sprays, painkillers ,sickness tablets belong into your hand luggage) or a ‘fit to fly’ certificate (certain medical conditions and pregnancy). A number of countries don’t take lightly to unconfirmed carrying of drugs of addiction. Some routine vaccinations might need boostering up and the country you fly to might require specific ones. Will you need antimalarials? (Remember you are not immune against local illness if you were born outside Australia) Travellers need bigger amounts of their usual drugs prescribed. Are there special requirements for your flight (wheelchairs?, aides ? , oxygen? ) Have a routine check (Bloods , BP , general health...)done prior departure, unless you wish to experience foreign health care inside out. Plan your flights wisely, have a stop over if you frail and easily exhausted, allow for jet lag! Are you fit for your specific travel itinerary(climate, accommodation, airports and carrying of luggage) Have you got insurance covering you and your conditions (chronic or terminal illness , pregnancy) Do you carry spare glasses, batteries for hearing aids and a first aid kit ( Anti-diarrhoeas, Anti-emetics) There are a number of no no’s to flying, your doctor can advise you on.
You might not be fit to fly or need to follow specific advice with the following conditions:
- severe or unstable heart- / breathing illness (asthma , angina)
- Acute infections if ill or in fever
- A new Stroke or blood clot anywhere
- Very recent fractures
- Recent surgery
- Middle Ear infections til able to pop ear drums, Sinusitis til resolved
- Pregnancy needs fitness to fly assessment, most airlines refuse transport after 32-36 weeks
- Acute psychiatric illness, or unstable epilepsy
- Diabetes , check dose regime and adjustment with doctor
- Renal Dialysis, check availability of dialysis ahead

Drink plenty (Fluids!! Not Alcohol!!) to prevent blood clotting, keep your calfs exercising, discuss prevention of blood clots with your doctor (especially if you have a history of clots, are pregnant , overweight or have other medical problems)

When planning your itinerary you might check out these:
www.cdc.gov/travel/
www.smarttraveller.gov.au
www.immunise.health.gov.au
www.diabetesnsw.com.au
www.globaldialysis.com

And don’t forget when all is considered, planned and packed you more than likely to have a great time if not the time of your life.