15th December 2009

Falling asleep on Christmas afternoon

With over half of Australians having a traditional Christmas dinner, I thought I would explain why most of us have the habit of sitting down on the couch and fall asleep as soon as we sit down in front of the TV after the Christmas pud. The answer is of course multifactorial, but the popular reason being that poultry, i.e. turkey, contains moderate amounts of an amino acid called L-Tryptophan. This chemical once absorbed into the blood, crosses into the brain and mimics Serotonin, a neurotransmitter that causes our brains to relax and us to feel sleepy. Add to this the large carbohydrate load from the potatoes and the desserts. These initially push up your blood sugar, and then it comes crashing down just as the tryptophan hits the brain. Alcohol also suppresses brain function. You sit down and the lights go out. A large meals also diverts blood to the stomach and small intestine to help digest the food, which diverts blood away from the brain. Also stretching of the intestines sends neural signals to the brain inducing sleep. Interestingly prawns and seafood contain a different amino acid, called tyrosine, which has been shown to increase mental ability and physical performance. so may be a better option if you want to keep awake enough to play Cluedo.

9th December 2009

More about sex…

As a follow on from my previous article on low libido in women, here are a few points to discuss with your Dr.

Get checked  for concurrent illnesses, for example low thyroid function and iron deficiency are common causes of low libido. Consider if you have mild depression. Look at whether you suffer from stress or poor sleep. Check any medication you may be taking. Some antidepressants have a profound affect on sexual appetite. The oral contraceptive binds to circulating testosterone and reduces available levels, so consider low dose or progesterone only therapy. Remember alcohol reduces libido. Treatments are available, other than the not yet available fibanserin mentioned previously. Oestrogen creams and pessaries are available on prescription. Testosterone is a normal female hormone that has been found to influence libido. Testosterone creams have similar effects to oestrogens and generally improve libido. Testosterone lozenges can give exact and tailored doses and can be made individually by some local pharmacists. Testosterone implants are convenient because one implant can last for up to 9 months. Many herbal remedies make wild claims but a combination of arginine, ginsing and ginkgo biloba is the only herbal remedy to be shown in trials to be effective. Liquorice was used by the ancient Greeks. Vitamin E may be helpful.

And remember, for women, sex drive is critically dependent on being healthy and really feeling good about yourself and your relationship. There will never be anything that we'll be able to pull out of our medicine cabinet that will be more important than that. 

Little blue pill for women

A new antidepressant called fibanserin was found to be disappointing as an mood stabiliser but was found to have a positive effect on boosting women's libido. The drugs effect was announced at a conference in, where else but France on Monday. It is said to have significantly improved both sexual desire and satisfaction in women. The new drug works directly on the brain, confirming what has been known for years that the brain is the most important sex organ in women. Female low libido has been likened to impotence in men and is said to occur in up to one in four women. Current treatments have centred around hormonal balance, such as testosterone supplementation along with relationship counselling. Whilst the female libido is complex, the more cynical among us would see a drug company exaggerating an unexpected side effect for commercial purposes. Interestingly 75% of women who report lack of sexual desire don't feel that it is a problem, and for many people reduced sexual interest may be a normal physiological adaption.

10th November 2009

Move over red wine...

We have all heard that red wine reduces heart disease, but it now seems that chocolate milk may have similar properties. Apparently , according to the Spanish, regular consumption of low fat skim milk with cocoa may reduce inflammation in our arteries, leading to less atheroma formation. Atheroma is the fatty deposits that block our arteries and give us heart disease. Looking at a group of volunteers aged over 55 , Spanish researchers got participants to drink chocolate milk twice a day for 4 weeks, whilst a control group drank plain skimmed milk. The group that drank the chocolate milk had lower levels of inflammatory markers associated with artery damage and as a bonus higher levels of the “good” cholesterol fraction, HDL. Another separate study showed blood pressure dropped as much as 23% 2 hours after a cup of cocoa. Cocoa contains flavan-3-ols, which are likely to be the active ingredients.

25th August 2009

Dietary Advice

With a tick for a balanced diet we hear today of a study showing that low carb, high protein diets may increase the amount of damaging build up in our arteries. These diets have become popular in recent years, the famous example being the CSIRO diet. By increasing protein intake and lowing carbs, muscle glycogen and muscle water are reduced, which causes a fast , but usually unsustainable start to a weight loss diet. It seems that the news is now that whilst a low carb diet doesn't effect cholesterol levels , it increases the fatty plaques that build up on our arteries to cause heart attacks. The leading researcher was so alarmed that he immediately stopped the low carb diet he was following.

It seems, once again that a moderate and balanced diet, coupled with regular exercise is probably the best for most people. Interestingly the CSIRO diet was developed with the help of funding from Meat and Livestock Australia, a lobby group funded by the meat industry.

18th August 2009

Health Tourism

This weeks new jargon buzzword is Health Tourism.
Health Tourism is where you travel overseas, to somewhere like Thailand to have your cosmetic or other surgery performed for up to a quarter of the price it would cost you at home. You can browse operations, countries and get a fixed price quote in an instant over the internet. For example one site offers a range of operations from cataract removal to breast augmentation in countries such as India, Thailand and even Norway. Prices vary too, from $900 for a cataract operation in Phuket, Thailand to lap banding in Tunisia for $8000. These are significantly below Australian prices.

There are obvious risks, for example different hygiene standards and patient expectations, and not least a report highlighted by specialists in the UK. They are seeing a large number of highly resistant infections on patients returning home after having operations overseas. The new strains of superbug are much harder to control than current resistant bacteria and have reportedly killed 2 people and left 18 in other seriously ill in the last 12 months. I think the best policy is shop locally.

4th August 2009

Children Should Turn Off Predictive Text

My wife often accuses me of paranoia when I restrict the mobile phone usage of our children. That’s the thing about mobile phones. Surely that amount of radio frequency radiation close to the brain cant be healthy, and why does Finland, the home of Nokia, have more brain tumours than any other country? So I was interested to hear that Melbourne researchers have shown that mobile phone use can impair children's cognitive function. A Monash University study of more than 300 children aged 11-14 found that those who made more mobile voice calls per week performed less accurately on memory tests and associative learning tasks. They found that the accuracy of children's working memory, as well as associative learning accuracy was poorer in children who reported making more mobile phone voice calls. Students who frequently used SMS text messaging also demonstrated less accurate responses but shorter response times. They also found however that reaction time for a simple learning task, as well as response time to that task was shorter.

Interestingly it wasn't thought to be the radio frequency energy that was affecting the children, it was the pattern of using the phone, especially predictive texting, that seems to be making children less accurate. The use of mobile phones seems to be changing the way children learn and pushing them to become more impulsive in the way they behave, with predictive text messaging partly to blame for rewarding children for being fast but less accurate and encouraging them to opt for a quick fix to problem solving.

The author of the study concluded frequent mobile phone use is "unlikely" to cause any permanent damage in youngsters, but said more studies are needed that target mobile phone use on brain development.
 

9th June 2009

As Doctors we are currently being (re) reminded not to routinely prescribe antibiotics for the common colds and sore throats that seem to be upon us already this winter. Most upper respiratory infections will follow their natural course and resolve themselves without antibiotics after only a few days. Also a recent study has shown that over the counter cough and cold remedies do not really work, are a waste of money and are not recommended for children under 12 years of age due to a relatively high incidence of adverse effects. The study showed that simple remedies such as paracetamol and honey and lemon drinks worked just as well and were better tolerated by children.

2nd June 2009

Damp Squid

Swine flu seems to be what I would medically call a “damp squid”, seemingly not unlike the “year 2000 virus”. My colleagues in America tell me that they are treating it like a mild case of seasonal FLU, paracetamol, fluids and rest. School closures and mass panic are definitely not the order of the day. I still think there is a chance it may evolve stronger in a bad northern hemisphere winter, but we should all be vaccinated by then.

Of more concern, as I have previously noted in this column, is the ongoing high rates of pertussis (whooping cough), in Australia, especially in children under 5. Vaccination is safe and effective. Vaccination rates on the sunshine coast are patchy, with over 90% of children vaccinated in Nambour, to lower levels in the Beerwah and Landsborough areas. The major infection source is older adults, for example Grandparents, whose immunity has fallen. Older individuals often have atypical symptoms, commonly a persistent dry cough. A booster vaccine is available from your Doctor, so I would encourage all Grandparents of under 5’s, or “potential” grandparents to get vaccinated.

28th May 2009

Natural Remedies in the News

Two natural therapies were in the news this week. University of Queensland researchers showed that a combination of folate (a vitamin found in fruit and vegetables), vitamins B6 and B12 reduced migraines. The team gave the vitamins and a placebo to two groups of migraine sufferers for 6 months and found that disability, pain and frequency of migraines were all reduced in the folate treated group.

Also an Australian company announced that Radium Weed can cure skin cancers. This in fact is not new news as use of the Radium Weed, or Euphorbia Peplus, has been advocated by several of my patients for sunspots, skin cancers and warts for a long time. It seems particularly good at treating sunspots (solar keratosis) and those flat, slightly greasy warts that seem to increase in number with age. Just a small drop of the milky sap for a few days often sees these regressing. I have a small plant in a pot at home, that a patient gave me to try, and it certainly works. It has been widely used for this purpose since the 1800s. Now an Australian company called Peplin has formulated the sap into a gel and is having good success in early trials. The weed is common throughout the world, with different names, it is even being tested to fight leukaemia by French researchers.

14th May 2009

Colon Cancer Testing

This week we heard that the government’s colon cancer test kits, sent out to all 50, 55 and 65 year olds were faulty.

Apparently they failed to work if subject to a certain temperature, so sitting in the post in Sunny Queensland made them ineffective. Everyone who did the test will need to repeat it, with the exception of those who returned a positive result, you should have already had your colonoscopy.

The test works by detecting minute amounts of blood in the faeces. These small amounts of blood may mean that a polyp or even cancer may be present. I would encourage everyone who receives a kit to return it as 80 Australians a week die of bowel cancer, and it can be treated successfully if detected early.

What about the rest of us? If you are under 50, bowel cancer is uncommon, so screening is ineffective. The ages 50,55 and 65 were selected by the government as a pilot program and I would expect this to be expanded to 2 yearly from the age of 50 at some stage.

If you are not covered by the program your GP can arrange a FOB test (faecal occult blood test) through local pathology providers, that will usually bulk bill.
 

5th May 2009

Never mind Tamiflu, when will the Swine Flu vaccine be ready?

Flu vaccine production for the northern hemisphere flu season, starting in September has already started, containing 3 virus strains, including a H1N1 strain called A/Brisbane/59/2007 and 2 other strains, but it has no effect against swine flu. Production of this vaccine is well underway and at capacity. So with the stocks of Tamiflu already off pharmacy shelves, how, and more importantly when,  do we get the Swine Flu vaccine?

The main limiting factor seems to be egg production. Hundreds of thousands of specially fertilized eggs are needed, produced by by special units, for example at Cornell University for American production. You cant just tell the hens to lay faster! Incubation of the eggs used to be by hand but is now automated. A small hole is drilled into the egg and then the virus introduced. The eggs are incubated for 48 hrs, and they then contain enough vaccine to extract. The environment has to be highly controlled to prevent contamination.

Development of the swine flu vaccine would entail scientists taking the component surface parts (or antigens) of the H1N1 virus, i.e. the H bit and the N bit, and mixing it with a harmless but fast growing virus that grows quickly in eggs. This part, called development of a seed virus, takes about 4 weeks. Current seeding samples are from the New Zealand students.

Problems include knowing how well the hybrid virus will grow and working out how many doses are needed, which could be a mind blowing 1 billion doses, not including the worlds poorer population.

Work on a synthetic seed virus is also progressing, as well as growing vaccine in caterpillars.

The problem facing the WHO is whether we replace current vaccine production completely with swine flu vaccine, just add it to the current mix or replace one of the current strains, and of course if so, which one. Adding it to the mix sounds easiest, but a 4 strain vaccine might not be safe and would have a longer testing period.

Current Australian vaccines are made by CSL in Victoria, with alternative sources in France.  Communication from CSL estimate vaccine production will commence in early August. Of course it will be up to the government to decide how and to whom to distribute the vaccine.

29th April 2009

Swine Flu Update

As we all probably know by now , the World Health Organization (WHO) has identified a new strain of influenza A originating in Mexico and spreading to the USA. Currently people are being tested in many countries throughout the world, with 3 positive cases in New Zealand as I write. The World Health Organisation has raised its pandemic alert from 3 to 4 likely to be phase 5 imminently. This means human to human transmission has been established in more than one country. Phase 6 signifies widespread human infection.

Swine flu is a common respiratory disease in pigs, caused by the influenza type A virus. It hasn't previously infected humans. It has likely achieved this by different versions of the virus mixing in the host animal, the pig. This virus has elements of human (H1N1), swine and avian (bird) virus.

How is it spread? It is a respiratory virus spread mostly by coughing and sneezing, but the virus can last for 48 hrs on hard surfaces. It enters the body via the respiratory tract or the conjunctiva (eyes). To reduce transmission a mask and eye protection may be useful, but general hygiene measures , such as regular hand-washing and not touching your eyes and face are very important.

What are the symptoms? They are standard flu symptoms, fever, dry cough, sore throat, chills and aching limbs.

Is it dangerous? Most cases reported so far appear to be mild, although people have died in Mexico. It is probably too early to fully assess the implications.

How long is a patient infectious? For at least 7 days, and longer if respiratory symptoms persist.

How do you test for Swine Flu? Your doctor will take a nasopharyngeal swab (via the nose and throat) and send it off to the laboratory. The results are usually available within 24 hrs. Faster testing will become available if the number of cases increases.

Will the virus spread here? This seems likely, with ready global air travel, containment seems unlikely.

What treatment is available? There are two drugs to treat this virus. Tamiflu (a tablet) and Relenza (an inhalation). We have heard that the Australian government has a ready supply of these drugs stockpiled.

Will the current flu vaccine help? It may afford a small level of protection through cross immunity. It seems reasonable to have the current vaccine if you are in a high risk group, i.e. elderly or have chronic illness. Healthy people might consider it worthwhile too. A specific vaccine will take at least 3 months to develop.

If I have the symptoms what should I do? If you have travelled, or have had contact with a sick person that has travelled from Mexico, Canada or USA within the last 2 weeks, you should contact your GP to arrange testing. It is sensible to stay at home and telephone first, rather than just turning up, (or alternatively contact Sunshine Coast Public Health Unit phone 5409 6600).

22nd April 2009

Prepare before you fly: My Ten Travel Rules 

Its not new news but flying can be unhealthy. 

There are certain environmental and physiological changes that occur during routine commercial airline flight that lead to mild lowering of body oxygen and gas expansion. We are mostly all aware of the danger of blood clots in the legs  (or DVT), but when you add low oxygen, dehydration and immobility into the mix, along with exposure to that coughing passenger in the row in front and other virus’, flying can be a real hazard. Some precautions are common sense. If you have a chronic health problem you should see your GP prior to flying to determine whether it is safe.  The low oxygen conditions may exacerbate heart or lung problems and the gas expansion may cause abdominal cramps and ear problems.

 Prevention of clots is always very important. Interestingly the increased legroom in first and business class offers no protection! Higher risk of DVT occur are in overweight people, people who have had recent surgery, are on oral contraceptives, and also in cancer and some genetic conditions.

 Should you get a flu needle before you fly? Research has shown that you are most at risk from transmission of infection from close personal contact and within two rows of an infected passenger.

 How do I travel healthily? I follow My Ten Travel Rules:

1-Pack and prepare well in advance to minimise stress.

2-Boost your immune system prior to flight. Consider 1000 to 2000 mg of Vitamin C and echinacea, garlic and horseradish.

3-Drink lots of water during the flight. All flights now have water freely available so make use of it.

4-Try to avoid caffeine and alcohol (even if free) during the flight, they cause dehydration and worsen jet-lag.

5-Wash your hands often. Try not to touch your mouth and eyes all the time.

6-Prevent DVT. Get up and walk at least once per hour. Consider an isle seat. If you are in a high risk group ask your GP about taking using compression stockings, aspirin or heparin.

7-Have a flu needle before long flight i.e. to Europe.

8-Minimise jet lag. When flying east get morning sun, and wear sunglasses in the afternoon. West is opposite.

9-If you have a chronic medical condition visit your GP prior to flight.

10-Remember to see your GP for your travel vaccines at least 6 weeks prior to travel.