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