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

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

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”

Summer , sun and serious skin problems

The great Australian work- and lifestyle comes with a price tag, not only on outdoor toys.
800,000 Australians see their doctor yearly for a skin cancer consultation, a huge burden ultimately to the taxpayer and all of us. Thanks to public health campaigns and increasing awareness, the sun-smart Aussie is for a long time now wearing a broad-brimmed hat, a long sleeve shirt and a high protection layer of sun screen. Skin cancer is rare in childhood but sunburn or excessive exposure to the sun in childhood is thought to be the biggest risk factor for developing skin cancer as an adult. Cancer is the disorganized and uninhibited aggressive growth of modified, previously normal cells, either damaging local structures or spreading to distant organs. Look out for each other - especially for lesions on the back of arms, neck and back. Should skin-lesions persistently change or grow over weeks and months, see your Doctor. 30% of melanomas develop from pre-existing pigmented moles.
ABCD rule of skin lesions
· Asymmetry - the shape of a cancer is often uneven and asymmetrical, not round and even.
· Border / edges of a cancer are often ragged, notched or blurred and not smooth and well-defined.
· Colour - the colour (pigmentation) of a cancer is often not uniform. So there may be 2-3 shades of brown or black.
· Diameter - cancer is usually larger than a normal mole, and continues to grow.

Cancers can start as small pink or pearly lumps on the skin. The lumps are often dome-shaped and grow at different speeds. The skin lump may crust over, form a crater and bleed sometimes. Other cancers start as a small crusted or scaly area, with a red or pink base, growing into a wart like lump.
Most skin cancers in Australia are managed by GPs, the best doctors in the world at recognising skin cancer, most are now using magnifying glasses, skin microscopes and cameras. GPs know when lesions are beyond their expertise and other doctors need to be involved. There are numerous computer programs claiming to diagnose skin cancer by linking software to a scanner. They are heavily marketed to the public. Slogans such as, ‘Be scanned be sure’ are grossly misleading. The evidence is, Patients are better off seeing their own GP or dermatologist if necessary.
So ask for a special skin check consultation with your Doctor at least once a year.
Dr. Helko Schenk