Everyday Medicine with Dr Luke: Recent Episodes
Dr Luke Crantock
Conversations with colleagues exploring their special interests in medicine and bringing to you Insights, ideas and advice for your medical practice.
Barrett’s oesophagus is a common condition, named after the Australian born thoracic surgeon Norman Barrett who practised in England and laid the foundation descriptions of this condition but incorrectly concluded the abnormal columnar tissue lining was embryonic in origin due to the presence of a congenitally shortened oesophagus leading to a tubular portion of stomach being trapped in the chest. We now recognise that between 5-10 % of patients with chronic reflux disease develop columnar metaplasia as a response to repeated oesophageal acid exposure.
Long segment disease extends for more than 3 cm, short segment less than 3 cm and metaplasia at the OG junction (less than 1 cm in length) is not considered to be pathological.
Its presence informs us that our patient has GORD and alerts to the possibility of dysplastic change and malignant transformation. Although the latter is relatively unlikely in any individual the risk is real. Estimates quote 0.33 to 0.5 % risk per year, that is 1: 200 per year which is 30-125 times the average population risk. Malignant risk increases with longer lengths of Barrett’s, Caucasian males and smokers but is probably not influenced by alcohol history.
In the absence of invasive malignancy, nodular areas are removed by a mucosal stripping technique described as endoscopic mucosal resection (EMR) and remaining lengths of Barrett’s mucosa may be removed using radio frequency ablation (RFA). This ablative technique involves the use of radiofrequency energy delivered with balloon-based catheters that heats the oesophageal mucosa and destroys non dysplastic and dysplastic tissue.
Randomised control trials have demonstrated superiority over sham ablation in limiting dysplasia and metaplasia at one year. The technique is associated with a lower stricture rate and decreased post procedure morbidity than other techniques sometimes utilised in this situation such as photodynamic therapy or cryotherapy.
I was keen to have a conversation with Professor Finlay Macrae on this important subject exploring the topic of Barrett’s in more length as well as the techniques of EMR and RFA. Professor Macrae is a gastroenterology mentor, head of colorectal medicine and genetics at the Royal Melbourne Hospital and has public and private practices focusing on the management of Barrett’s oesophagus, inflammatory bowel disease and familial bowel cancer. He trained both in Melbourne and at St Marks Hospital in London. In 2016 he was awarded the Order of Australia for his work in genetics and genomics.
Professor Macrae has been delivering advanced therapeutic solutions for patients with complex Barrett’s disease for over 30 years and was therefore, an obvious choice of expert guest to discuss this topic today, it was a great privilege to have this conversation with him.
References:
Professorfinlaymacrae.com
Spechler S.et al. Barrett’s Esophagus. N ENG J Med 2014; 371:836-45
Whiteman et al. Journal of Gastroenterology and Hepatology 30 (2015) 804-820
Cancer Council Australia Barrett’s Oesophagus Guidelines Working Party. Clinical Practice Guidelines for the Diagnosis and Management of Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma. Feb 12.2015
The advent of complex therapies including biologics and small molecules has provided a new paradigm for the treatment of many immune mediated inflammatory conditions notably in rheumatology, gastroenterology (Inflammatory Bowel Disease) and also in dermatology. New dimensions of treatment can now be applied from this amazing therapeutic armamentarium at our disposal. In this podcast we will turn our attention to how this relates to management strategies in dermatology.The term ‘biologic’ refers to agents synthesised from the products of living organisms and includes monoclonal antibodies raised against cytokines including Tumour Necrosis Factor (TNF) or some of the interleukins. Contrasting these small molecules are laboratory produced and directed to inhibit the so-called JAK- STAT messaging system which was discovered to link the external world of cells with the transcription of proteins from the genetic code held within DNA. These complex molecules as a group inhibit cytokines, and thus modulate immune mediated inflammation. As they are specific in terms of their immune system action their safety profile is generally considered to be more favourable than that of traditional systemic immuno-suppressive drugs.In this conversation we talk with Associate Professor Peter Foley to expand our understanding of the place of these complex molecules in dermatologic management. In particular we will focus on psoriasis which affects 2-4 % of the world’s population with a higher prevalence in northern countries. Plaque psoriasis is the most common type encountered with its prominent feature being sharply demarcated erythrosquamous plaques. Hyperproliferation and abnormal differentiation of keratinocytes is the hallmark of psoriasis which may also manifest with arthritis in up to 30% of patients and be preceded by nail changes characterised by small but definite pits in 50-80 % of cases.Associate Professor Peter Foley graduated from Monash University in 1987 after completing a BMedSc thesis which was the first National Skin Cancer Survey. He later obtained a fellowship in dermatology in 1997 and completed an MD exploring the effects of Vitamin D on the skin. He is actively involved in research and has been principal investigator for numerous clinical trials which include more than 70 on subjects such as psoriasis, eczema, seborrheic dermatitis, rosacea and many more. He has an appointment as an Associate professor in the Department of Medicine -Dermatology at The University of Medicine and is director of research and immediate Past-President of the Skin and Cancer Foundation. He is Australia’s only councillor on the International Psoriasis Council and sits on the Board of the Photomedicine Society. Clearly, he is well credentialed to discuss current approaches to using Biologics and Small molecules in dermatologic practice and we welcome him to the podcast.References:Assoc Professor peter Foley: Foley Dermatology and associates. www.foleydermatology.com.auBiologics in Dermatology: An Integrated Review, Seghal et al. ncbi.nlm. nih.govThe Australian College of Dermatologists, Biologic Treatments Used in Dermatology www.dermoll.edu.au
Neurosurgeon Rondhir Jithoo has led an extraordinary life, growing up in South Africa with a medical father and deeply thinking anthropologist mother. He obtained his medical degree from the Nelson Mandela School of Medicine at the University of Natal and trained in neurosurgery at South Africa’s Wentworth Hospital where he received the Registrars Prize from the South African Society of Neurosurgeons and obtained his neurosurgery fellowship in 2000.
After relocating to Australia, he was awarded the Australasian Fellowship in Neurosurgery in 2004 and worked at Royal Melbourne Hospital where he developed an interest in spinal trauma, anterior spinal surgery and cranial surgery. This interest in cranial surgery took him to Frances’ famous neurosurgical epicentre in Montpellier to further his study and skills in the art of awake craniotomy.
At Montpellier Rondhir was able to develop skills reflecting the modern connectionist approach to neurosurgery which has revolutionised treatment of brain tumours. The traditional concept proposed by Paul Broca, and still taught, is that the brain is organised into different areas controlling specific functions. This localisation theory has now been disproven, and work with contributions from Montpellier has shown that the brain is organised in dynamic interactive networks capable of constantly readapting.
This connectionist approach explains why some patients can lead a perfectly normal life despite having a large tumour affecting an area of the brain previously considered crucial for brain function. The brain is able to compensate for lesions and its incredible plasticity allows it to reorganise itself to continue functioning normally. In awake craniotomy, providing lesions have not caused disability, tumours may be safely removed in real time using cortical mapping. By keeping the patient awake to verbal commands the impact of surgical resection can be carefully assessed and damage minimised.
After returning to Australia with this skill Rondhir served with the Australian armed forces in Iraq, assessing and providing acute neurosurgical assistance for battlefield traumas and is now intrinsically involved in contributing his skill and expertise to establishing and independent neurosurgical service in Darwin where he travels at repeat intervals throughout the year.
He is a head and clinic consultant of Neurosurgery at Alfred Health in Melbourne and is a member of the Victorian Audit of Surgical Mortality Committee as well as a postgraduate examiner for the Royal Australasian College of Surgeons.
I found Ron to be deeply philosophical and spiritual in his approach to the art of medicine and I’m sure you will enjoy this conversation with him.
References :
Mr Rondhir Jithoo: www.healthshare.com.au
www.alfredhealth.org.au
The health and welfare workforces deliver diverse services through many private and public organisations. Combined these services employ more than 1 million people of which there were more than 642 000 health practitioners working in their registered professions in Australia in 2020. This included 105 300 medical practitioners, 350,000 nurses and midwives, 21,500 dental practitioners and 166,000 allied health professionals.
In this podcast we will consider more generally the positions of nursing and medical practitioners and a possible future landscape.
In the five years to 2021 only the equivalent of 4200 full-time General Practitioners were added to the workforce and on average both male and female GP’s have been trending towards fewer hours per worker. The AMA’s Plan to Modernize Medicare campaign reported:
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Australia faces a shortage of more than 10,600 GP’s by 2031-32 and the supply of GP’s falling behind growing community demand.
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The demand for doctors’ services increased by 58% in the decade to 2019.
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That the most cost-effective method with the best outcomes for patients is GP led primary care. GP’s provide twice the number of episodes of care as hospitals per year for one sixth the expense.
Away from doctors the nursing and midwifery sector represent the largest workforce in the healthcare system accounting for 55% of total workforce however in a recent McKinsey survey one fifth of Australia’s registered nurses said they intended to leave the current role in the next year. Even before the pandemic a shrinking supply of nursing-school graduates and a decline in nurses migrating from other countries to Australia brought about nursing shortages.
These short-term demands are superimposed on longer-term demands caused by Australia’s population growth and aging demographic. The McKinsey 2021 Future of Work in Nursing Survey found that in addition to the figure above 41% of nurses surveyed said they were planning to move countries or leave direct-care roles entirely, leading to a calculated deficit of between 20,000 and 40,000 unfilled nursing positions. Similar results have been documented in the United Kingdom, France, Japan, USA, Singapore and Brazil.
In this podcast I was keen to pursue the workforce conditions and future strategies to manage them with Mr Murray Bruce, a young and energetic Lawyer with a welcomingly fresh set of ideas who is Director of Latrobe Community Health Service. Murray has extensive board and governance experience with expertise in strategic planning, risk management, commissioning, change management and policy development.
Please welcome Murray to the Podcast.
REFERENCES:
Mr Murray Bruce.Board Directors -Gippsland Primary Health Network.gphn.org.au
McKinsey and Company, Should I stay or should I go? Australia’s nurse retention dilemma, Sep 23rd, 2022
AMA report projects “staggering” GP shortage, Nov 25,2022
Health Workforce, Updated July 7, 2022 aihw.gov.au
RACGP-Health of the Nation, 2022 racgp.org.au
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these. Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone.Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression.A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology. In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care.It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education.Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne. Please welcome Alvin to the Podcast. References:Dr Alvin Chonghttp://spotdiagnosis.org.au/https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these.
Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone.
Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression.
A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology.
In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care.
It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education.
Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne.
Please welcome Alvin to the Podcast.
References:
Dr Alvin Chong
http://spotdiagnosis.org.au/
https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.
Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men.
Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances.
Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased.
Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment.
I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode.
Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation.
REFERENCES:
Dr Usman Riaz-www.sjog.org.au
World Health Organization-Mental Disorders. Who.int
Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov
www.beyondblue.org.au
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour.
Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men.
Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances.
Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased.
Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment.
I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode.
Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation.
REFERENCES:
Dr Usman Riaz-www.sjog.org.au
World Health Organization-Mental Disorders. Who.int
Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov
www.beyondblue.org.au
Over the past decade there has been an emergence of literature pointing to potential clinical benefits for a range of disease states through the adoption of slow breathing techniques. The popularity worldwide of the Wim Hof method adopted from eastern techniques has done much to pique interest.
Notably the belief and practice of controlling one’s breath to both restore and enhance health is not new however and has been practised for thousands of years amongst Eastern cultures. Pranayama or Yogic breathing as well as Kundalini are well-known ancient practices of controlled breathing and exists in various forms often in conjunction with meditation.
A system of breathing developed in the 1900s by the Ukranian doctor Konstantin Buteyko claimed to successfully treat patients diagnosed with respiratory and circulatory disease possibly through reducing ventilatory dead space, increased tidal volume and by inducing favourable effects on the autonomic nervous system. Practised slow nasal breathing has been shown to extract 20 % more oxygen from each breath enhancing athletic performance.
Slow and controlled breathing through the nose with a respiration rate of between 6 and 10 per minute appears to be optimal for enhancing the Bohr effect. Getting there requires practice and adoption of nasal breathing techniques. The latter also delivers more Nitrous oxide, an important vasodilator which in relation to this subject is produced by the paranasal sinuses. Nasal breathing also filters and humidifies the air we breathe.
In this podcast I was interested to explore this fascinating subject with breathing expert, physiotherapist and snow skier Mr Allan Abbott. Allan has broadened his expertise with qualifications in physical education, ergonomics and acupuncture. He runs numerous seminars on breathing for performance including Athletes Master Classes incorporating high altitude training through his company Health Innovations Australia and has established the “Breathe Light Breathe Right” as well as the ‘Sleep Well be Well” programs.
Allan subscribes to a notion that breathing, sleep, diet, exercise and mindfulness are the major components to optimal health. Please welcome Allan to the podcast.
References:
Mr Allan Abbott.oxygenadvantage.com and www.healthinnovations .net.au
Breath- The New Science of a Lost Art. Penguin Books. July 20,2021.James Nestor
The Physiological effects of slow breathing in the health human. Russo et al. www.ncbi.nlm.nih.gov
How Breath-Control Can Change Your Life : A systematic review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro et al.2018. www.frontiersin.org.
Over the past decade there has been an emergence of literature pointing to potential clinical benefits for a range of disease states through the adoption of slow breathing techniques. The popularity worldwide of the Wim Hof method adopted from eastern techniques has done much to pique interest.
Notably the belief and practice of controlling one’s breath to both restore and enhance health is not new however and has been practised for thousands of years amongst Eastern cultures. Pranayama or Yogic breathing as well as Kundalini are well-known ancient practices of controlled breathing and exists in various forms often in conjunction with meditation.
A system of breathing developed in the 1900s by the Ukranian doctor Konstantin Buteyko claimed to successfully treat patients diagnosed with respiratory and circulatory disease possibly through reducing ventilatory dead space, increased tidal volume and by inducing favourable effects on the autonomic nervous system. Practised slow nasal breathing has been shown to extract 20 % more oxygen from each breath enhancing athletic performance.
Slow and controlled breathing through the nose with a respiration rate of between 6 and 10 per minute appears to be optimal for enhancing the Bohr effect. Getting there requires practice and adoption of nasal breathing techniques. The latter also delivers more Nitrous oxide, an important vasodilator which in relation to this subject is produced by the paranasal sinuses. Nasal breathing also filters and humidifies the air we breathe.
In this podcast I was interested to explore this fascinating subject with breathing expert, physiotherapist and snow skier Mr Allan Abbott. Allan has broadened his expertise with qualifications in physical education, ergonomics and acupuncture. He runs numerous seminars on breathing for performance including Athletes Master Classes incorporating high altitude training through his company Health Innovations Australia and has established the “Breathe Light Breathe Right” as well as the ‘Sleep Well be Well” programs.
Allan subscribes to a notion that breathing, sleep, diet, exercise and mindfulness are the major components to optimal health. Please welcome Allan to the podcast.
References:
Mr Allan Abbott.oxygenadvantage.com and www.healthinnovations .net.au
Breath- The New Science of a Lost Art. Penguin Books. July 20,2021.James Nestor
The Physiological effects of slow breathing in the health human. Russo et al. www.ncbi.nlm.nih.gov
How Breath-Control Can Change Your Life : A systematic review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro et al.2018. www.frontiersin.org.
The first fleet comprised of 11 ships and 1420 people arrived in Australia’s Botany Bay under the command of Captain Arthur Phillip in January 1788 after an 8-month journey from Portsmouth. On the voyage there were 48 deaths and 28 births but no recorded serious illnesses such as smallpox or tuberculosis. The colonists subsequently resettled in port Phillip Bay and quickly had to learn to adapt to an environment that was as foreign to them as it must have been for the local indigenous population of aboriginals who made first contact with these white skinned strangely dressed travellers.
Many of the settlers first crops failed and stock brought with them aboard either died, absconded, or were eaten necessitating an early call for help to replenish dwindling supplies.
This initial lack of nutrition jeopardised the viability and success of the newly forming colony. Second and third fleets arrived in 1790 and 1791.
The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further.
Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years.
My curiosity for colonial medicine extended to enquire about the nutritional health concerns encountered by early colonists, how water was purified, and how adequate balanced meals could be provided in a new foreign land. I was also fascinated to learn of the smallpox epidemic of 1789 which was devastating to our indigenous first AUSTRALIANS.
Further diseases such as tuberculosis, measles, influenza, and STD’s all earn mention. Alcoholism was a very significant problem amongst colonists as it remains in some quarters today but to a much lesser extent with our rigorous regulations around brewing and distribution. We discuss the medical problems encountered on our goldfields during the madness of the goldrush days in the 1850’s where dysentery was rife and food hygiene extremely poor. Indeed, William Howitt writing from the goldfields at that time where up to 1000 sheep were being slaughtered each day… “They are in their millions all over the country, they cover your horses, your load and yourselves, at your meals in a moment, myriads come swooping down, cover the dish and the meat on your plates till they are one black moving mass……”. It’s easy to imagine how disease spread quickly in that environment.
Leaving gold fever aside, first nations people had survived in Australian conditions for thousands of years coping with illnesses and climatic hardship so what if anything have, we learned in a medical sense from the indigenous people?
Chris Reynolds completed his PhD and Masters degrees at Americas Claremont Graduate University and has held appointments as Senior Professional Staff with both the United States Senate and House of Representatives. He has held several executive roles with NSW government including Executive Director of the World Trade Centre, Sydney. He has worked as a schoolteacher, University professor and political strategist and has applied his breadth of knowledge and experience to writing What a capital Idea-Australia 1770-1901.
Please welcome Professor Chris Reynolds to the podcast.
References:
What a Capital Idea- Australia 1770-1901. Christpher Reynolds. Reynold Learning. www.Reynoldlearning.com
Medicine in Colonial Australia,1788-1900, MJA,7 July 2014
Illness in Colonial Australia. Smith FB, Melbourne: Australian Scholarly Publishing, 2011
The first fleet comprised of 11 ships and 1420 people arrived in Australia’s Botany Bay under the command of Captain Arthur Phillip in January 1788 after an 8-month journey from Portsmouth. On the voyage there were 48 deaths and 28 births but no recorded serious illnesses such as smallpox or tuberculosis. The colonists subsequently resettled in port Phillip Bay and quickly had to learn to adapt to an environment that was as foreign to them as it must have been for the local indigenous population of aboriginals who made first contact with these white skinned strangely dressed travellers.
Many of the settlers first crops failed and stock brought with them aboard either died, absconded, or were eaten necessitating an early call for help to replenish dwindling supplies.
This initial lack of nutrition jeopardised the viability and success of the newly forming colony. Second and third fleets arrived in 1790 and 1791.
The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further.
Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years.
My curiosity for colonial medicine extended to enquire about the nutritional health concerns encountered by early colonists, how water was purified, and how adequate balanced meals could be provided in a new foreign land. I was also fascinated to learn of the smallpox epidemic of 1789 which was devastating to our indigenous first AUSTRALIANS.
Further diseases such as tuberculosis, measles, influenza, and STD’s all earn mention. Alcoholism was a very significant problem amongst colonists as it remains in some quarters today but to a much lesser extent with our rigorous regulations around brewing and distribution. We discuss the medical problems encountered on our goldfields during the madness of the goldrush days in the 1850’s where dysentery was rife and food hygiene extremely poor. Indeed, William Howitt writing from the goldfields at that time where up to 1000 sheep were being slaughtered each day… “They are in their millions all over the country, they cover your horses, your load and yourselves, at your meals in a moment, myriads come swooping down, cover the dish and the meat on your plates till they are one black moving mass……”. It’s easy to imagine how disease spread quickly in that environment.
Leaving gold fever aside, first nations people had survived in Australian conditions for thousands of years coping with illnesses and climatic hardship so what if anything have, we learned in a medical sense from the indigenous people?
Chris Reynolds completed his PhD and Masters degrees at Americas Claremont Graduate University and has held appointments as Senior Professional Staff with both the United States Senate and House of Representatives. He has held several executive roles with NSW government including Executive Director of the World Trade Centre, Sydney. He has worked as a schoolteacher, University professor and political strategist and has applied his breadth of knowledge and experience to writing What a capital Idea-Australia 1770-1901.
Please welcome Professor Chris Reynolds to the podcast.
References:
What a Capital Idea- Australia 1770-1901. Christpher Reynolds. Reynold Learning. www.Reynoldlearning.com
Medicine in Colonial Australia,1788-1900, MJA,7 July 2014
Illness in Colonial Australia. Smith FB, Melbourne: Australian Scholarly Publishing, 2011
Emotional intelligence (EI) also known as EQ, is the ability to perceive, understand and manage emotions in positive ways to communicate effectively, empathise with others, overcome challenges and defuse conflict as well as to relieve stress. Emotional intelligence helps build stronger relationships, achieve personal career goals, and interact more positively at work. It gives us an ability to join intelligence, empathy, and emotions to enhance thought and understanding of interpersonal dynamics, guiding our thinking and behaviour. For as in Shakespeare’s Hamlet - 'there is nothing either good nor bad but thinking makes it so'.
The term EI first appeared in writing in 1964 and was popularised by Daniel Goleman in his book titled Emotional Intelligence published in 1995 in which he applied the concept especially to business defining the term as an array of skills and characteristics that drive leadership and performance. EI is commonly defined by four domains or attributes including:
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Self-Awareness-Understanding what you are feeling and why and appreciating your strengths and weaknesses.
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Self-Management- The ability to control impulsive feelings and behaviours, adapt to changing circumstances and manage emotions in healthy ways. This is also referred to as self-regulation and points to a positive outlook and achievement.
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Social awareness -Including the concept of empathy which helps us understand the emotions, needs and concerns of others. Developing social awareness allows us to recognise the power dynamics in a group or organisation.
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Relationship management-Which encompasses conflict management, coaching and mentorship and encourages the development of teamwork through inspirational leadership.
There are several excellent books on the subject of emotional intelligence including: Achieving Emotional Literacy by Claude Steiner,
'How Emotions are Made' by Lisa Feldman Barrett, Emotional Agility by Susan David and Daniel Goleman’s Emotional Intelligence.
I was curious to explore this topic in more detail and was privileged recently to meet Shawn Price who is an expert in this field.
Shawn initially trained as a mathematician but was drawn to the study of psychology and especially emotional intelligence recognising its important application to both business, families, and individuals.
Shawn now manages his company Positive Intelligence from where he coaches and consults privately as well as being engaged by industry and large organisations to run workshops and lecture programs on this important subject. Please welcome Shawn to the podcast.
References: Shawn Price: Positive Intelligence. www.positiveintelligence.com.au
Emotional Intelligence, Daniel Goleman.
ISBN:9780553804911 Emotional Intelligence;
www.helpguide.org/ Segal, Robinson and Shubin Emotional Intelligence has 12 Elements.
Which do you need to work on? Harvard Business Review. Feb 06,2017. Goleman and Boyatzis
We are dedicating this podcast to the memory of Professor Lawrie Powell, both a gentleman, mentor and giant in the field of hepatology and whose very significant contributions to our understanding of hemochromatosis laid down a firm foundation of knowledge and insight for everyone practicing internal medicine. It is upon his shoulders that much further research in the field of hemochromatosis and hepatology generally has prospered.
Haemochromatosis is the most common autosomal recessive disorder in Caucasians with an incidence of about 1 :260 and carriage of about 1: 10. Untreated the excess iron storage from hemochromatosis may lead to cirrhosis and hepatocellular carcinoma, diabetes, cardiomyopathy, hypogonadism, arthritis, bronzing of the skin and render some susceptibility to siderophilic bacteria including some vibrio and Yersinia species. The consequences of iron overload are exacerbated by preexisting condition such as NASH and alcohol associated liver disease.
A key breakthrough in the understanding of hemochromatosis came with the discovery of a negative regulatory protein coded for by the HAMP gene on chromosome 19 called Hepcidin. Hepcidin serves as a counterregulatory protein. As iron absorption and stores increase Hepcidin levels in healthy individuals also increase leading to decreased iron absorption and restoration of normal iron levels. Hepcidin appears to work by internalization and degradation of Ferroportin thereby inhibiting iron absorption across the basolateral membrane of enterocytes as serum iron levels climb.
A transferrin receptor on the surface of hepatocytes relays information concerning serum iron concentration as part of this elaborate feedback mechanism.
Mutations of the so-called High Iron -or Hemostatic Iron Regulator -HFE gene on the short arm of chromosome 6 modulate the expression of Hepcidin, effectively blocking the elaborate feedback mechanism that senses serum iron and leading to inappropriately lowered levels of Hepcidin production as iron levels climb. This defect underlies the problem of excess iron absorption in Hemochromatosis with the consequent adverse physiologic effects mentioned above.
The gene mutation responsible for Hemochromatosis is thought to have arisen some 6000 years ago within Viking or Celtic communities possibly protecting against iron deficiency states when resources were scarce.
Treatment by regular phlebotomy remains the preferred method of management and screening for HCC in cases of established cirrhosis is mandatory.
I was honored to further this conversation about hemochromatosis with Professor Darrell Crawford, one of my mentors from Queensland in a previous life. Darrell has both the reputation for being an excellent hepatologist as well as having significant international standing in the field of liver disease and has published widely. He has held leadership positions within the national and international professional societies relevant to his discipline including GESA and the University of Queensland including as the Acting Deputy Executive Dean and Head, School of Medicine where he has played a key role in reshaping the medical program and medical faculty at the University of Queensland. Please welcome Darrell to the podcast.
Treatment by regular phlebotomy remains the preferred method of management and screening for HCC in cases of established cirrhosis is mandatory.
References:
Professor Darrell Crawford-medicine.uq.edu.au,
Queensland Gastroenterology
Greenberger’s Current Diagnosis and Treatment, 4th Ed, Friedman et al, McGraw Hill Lange
Principles of Medical Biochemistry, 3Rd Ed, Meisenberg and Simmons, Elsevier Saunders
The corner stone of cardiovascular disease prevention is the identification of high-risk asymptomatic individuals. In this regard coronary artery calcium is a highly specific marker of atherosclerosis and can be quantified using non contrast CT scanning which provides an accurate measure of atherosclerotic burden. Coronary artery disease is the single leading cause of disease morbidity and mortality in Australia and is responsible for approximately one in 10 deaths furthermore half the individuals with coronary artery disease will present with a myocardial infarction or death.
The compelling reason for undertaking coronary artery calcium scoring is to identify asymptomatic at-risk individuals who are likely to benefit from early detection, risk factor intervention and treatment of coronary artery disease.
In Australia risk assessment is recommended using the National Vascular Disease Prevention Alliance tool based on the Framingham Risk Equation. This risk stratification is drawn upon to guide the decision for calcium scoring which according to the Cardiac Society of Australia and New Zealand is recommended for asymptomatic intermediate risk patients or where there may be other strong evidence supporting its ability to improve cardiovascular risk assessment. High risk individuals may be better assessed by means of stress testing.
The calcium score is determined by non-contrast CT scanning and is complete within about ten minutes delivering just a little over 1 mSv of radiation equivalent to the annual background radiation we are exposed to. Using the Agatston method the volume and density of calcium is calculated and computed as a score. Again drawing upon The Cardiac society of Australia and New Zealand calcium scores may be interpreted as follows: A measurement of 0 is very low risk of coronary disease, a score of 1-100 is low risk, a measure of 101-400 is considered moderate risk and a patient lying within the 75th percentile of this group is at moderately high risk. Measurement over 400 denotes a high risk.
Multiple studies including the Multiethnic Study of Atherosclerosis (MESA) have confirmed the long-term prognostic value of CT calcium scores with over ten years of prospective follow up.
The value of calcium scoring lies in its ability to improve the accuracy of risk prediction. It helps to identify individuals who may benefit from more aggressive primary prevention measures; including the use of low dose aspirin that may otherwise not be recommended for primary prevention, as well as aggressive lipid management with statin therapies.
Given the importance of detecting asymptomatic coronary heart disease I was interested in pursuing the conversation further with one of the US expert cardiologists Dr Alistair Fyfe who has been practicing cardiology for over 38 years after graduation from the University of Tasmania.
Alistair has worked in Canada as well as the United States and is in Dallas, Texas where he has affiliations with Medical City Dallas and White The Heart Hospital Baylor Plano and is Medical Director of Blue Cross and Blue Shield of Illinois, Montana, New Mexico Oklahoma, and Texas not bad for a home-grown lad.
He is currently busy writing a contributing chapter to a soon to be published book titled: "The Implementation of Personalised Precision Medicine”, which, if I know Alistair will be excellent and a must read.
Given his expertise I was curious to learn a little more about its application and how a measured coronary calcium score should influence our approach to patient management.
I know you will find this conversation with Alistair very interesting. Please welcome him to the podcast.
References:
Dr Alistair Fyfe - on google and LinkedIn Coronary artery calcium in primary prevention
Chuah.www1.racgp.org.au When not to use calcium scoring
www.ausdoc.com.au Polonsky et al.
Coronary artery calcium score and risk classification for coronary heart disease prediction.
Interventional radiology is an innovative and rapidly growing medical profession that enables radiologists to blend clinical interaction, procedural work, and imaging. It stands as an exciting domain within modern medicine, offering precise, targeted treatments for complex diseases and conditions throughout the body. Interventional radiologists seamlessly integrate various specialty interests, including gastroenterology, vascular surgery, neurosurgery, oncology, pain management, gynecology, and more. Moreover, they've pioneered treatment techniques using state-of-the-art technology like MRI, CT scans, fluoroscopy, ultrasound, and plain X-rays.
Their scope of practice encompasses a broad range of procedures such as biliary intervention, cholecystostomy, chemo and radioembolization of tumors, Radiofrequency ablation, Cryoablation and microwave ablation, balloon angioplasty, vascular stenting, aneurysm repair, embolization (e.g., of the uterine artery, fibroids, and pulmonary arteriovenous malformations), catheter-directed thrombolysis, placement of IVC filters, dialysis-related interventions, central venous catheter placement, percutaneous nephrostomy placement, ureteral stent placement, coeliac axis nerve blocks, spinal blocks, and more.
Interventional radiology is poised to play an increasingly significant role in the future of modern medicine. It offers cost-effective, minimally invasive treatments with shorter procedural and recovery times, sometimes yielding better patient-focused outcomes compared to many surgical alternatives.
In this podcast, my goal was to expand my knowledge about the remarkable world of IR. I am delighted to welcome interventional radiologist Dr. Yen Chieng to join us, covering many of the areas mentioned above. Yen has skillfully navigated challenging clinical scenarios, bailing many of us out more than once with his incredible yet measured skills and enthusiasm. Please welcome Yen to the podcast."
References:
Dr. Yen Chieng: i-med.com.au
Royal Australian and New Zealand College of Radiologists: www.ranzcr.com
Interventional Radiology Society of Australasia: www.irsa.com.au
Inside radiology: www.insideradiology.com.au
Headache is an extremely common symptom, and collectively, headache disorders rank among the most prevalent nervous system disorders. Approximately 95% of the general population have experienced a headache at some point in their lives, with a one-year prevalence rate of about one in every two adults. Headache accounts for up to 1 in 10 general practitioner consultations, remains a frequent reason for neurology referrals, and in Europe, constitutes up to 4% of emergency department visits, with migraine being the most common type.
The World Health Organization includes headache among the top ten causes of disability. While the impact on the economy and an individual’s quality of life may be challenging to quantify, in the case of migraine, up to 75% of patients report functional disability during an attack, and about 50% require the assistance of family and friends. Headaches do not discriminate; they affect people of all ages, races, and socioeconomic statuses, but they are more common in women.
Headaches are generally categorized as acute or chronic. Acute headaches may be new and severe, potentially indicating critical intracranial pathology like an aneurysm or meningitis. Chronic headaches are typically classified into primary types such as migraine, cluster, and tension-type, or secondary, which could reflect intracranial pathology or result from conditions like cervical spondylosis, dental and ocular disorders, sinusitis, hypertension, depression, TMJ dysfunction, temporal arteritis, medication side effects, and others.
When consulting with patients, inquiring about the onset of the headache, its frequency and type, duration, recent changes in characteristics, intensity, location, pain quality, associated symptoms like nausea and vomiting, factors that worsen or alleviate it, as well as the presence of neurological symptoms such as visual and sensory changes or alterations in speech, can all aid in establishing a diagnosis.
Migraine often demonstrates a complex polygenic pattern of inheritance, and in the case of familial hemiplegic migraine, it exhibits an autosomal dominant pattern of inheritance.
In my conversation with expert headache and movement disorder specialist Dr. Michael Eller from Richmond Neurology, I was keen to delve deeper into the realm of chronic primary headaches—specifically, migraine and cluster types. The evolving understanding of the pathophysiology of these headaches and the developing treatment approaches, focusing on inhibiting the neurotransmitter called Calcitonin gene-related peptide, is fascinating. This peptide is inhibited by the 5-HT1D and 1B receptor agonist effect of the triptans, as well as by a new family of CGRP-targeting drugs and monoclonal antibodies developed for the preventive treatment of migraine.
Michael completed his medical degree at the University of Sydney in 2003 following a Bachelor of Science and Arts. He has interests in archaeology, neuroscience, infectious disease, and indigenous health. Additionally, he has volunteered as an aid worker in remote locations, including PNG, and underwent training from 2012 to 2014 at The University of California, San Francisco, under Professor Peter Goadsby. I believe you will find this conversation quite engaging. Please welcome Michael to the podcast.
References:
Dr. Michael Eller: Richmond Neurology - richmondneurology.com.au
Headache disorders: differentiating and managing the common subtypes, Ahmed - ncbi.nlm.nih.gov
Current Medical Diagnosis and Treatment.2019: Papadakis, McPhee et al, McGraw Hill Education, Lange
The World Health Organisation estimates that between 2030 and 2050, climate change is anticipated to result in approximately 250,000 additional deaths annually. These fatalities may arise from issues such as malnutrition, and heat stress, as well as diseases like malaria and infectious diarrhoea. The impact of a planet warming at a recorded rate of 0.08 degrees centigrade per decade since 1880, accelerating to 0.18 degrees centigrade since 1981, poses threats to human lives and health across multiple dimensions. It's important to note that this statement does not delve into the detrimental potential such warming has on other species. Factors crucial to human survival—such as clean air, safe drinking water, a nutritious food supply, and secure shelter—are all imperilled in a world grappling with climate change. In this podcast, my intention was not to focus on the specific science of global warming and subsequent climate change, but rather on the associated health consequences.
Despite the numerous pledges made by countries in various climate forums, global emissions in 2022 are projected to reach an unprecedented peak. However, there is a positive note to highlight—Australia managed to reduce its emissions by 1.9% in 2021. The historical responsibility for emissions lies significantly with the United States, followed by China, Russia, and Brazil.
Undoubtedly intertwined with atmospheric emissions and consequent climate change is the world's population, which is growing at an alarming rate. Thomas Malthus, in his Essay on 'the principle of population' in the 1800s, once predicted its unsustainability. Today, with a population exceeding 8 billion, the United Nations forecasts a peak population of about 10.4 billion by the 2080s, noting that the "peak baby" phase has already been reached, leading to a measurable slowdown in population growth. Time will undoubtedly affirm the accuracy of these figures in history. It's crucial to mention that an expanding population, particularly a growing wealthier middle class in many countries worldwide, is likely to result in increased greenhouse gas emissions, heightened resource consumption, and will test humanity's capacity to solve ecological problems arising from the collective global burden we carry.
My curiosity to delve deeper into this subject led me to invite Professor Richard Eckard to join the podcast and further enrich the discussion. Richard, a Professor of Sustainable Agriculture at The University of Melbourne and Director of The Primary Industries Climate Challenges Centre is a globally recognised authority on sustainable agricultural production. His focus includes carbon-neutral agriculture and agricultural adaptation to climate change. Richard's significant contributions encompass developing the initial greenhouse gas accounting tools for agriculture. Moreover, his research forms the scientific foundation for six carbon offset methods currently employed in Australia. Serving as a science advisor to various governments and international organisations such as the Australian, New Zealand, and UK governments, the International Livestock Research Institute, the Food and Agriculture Organisation of the United Nations, and the European Union, Richard provides invaluable counsel on climate change adaptation and mitigation in agriculture. Additionally, he represents Australia in the Global Research Alliance on Agricultural Greenhouse Gases.
Please welcome Richard to the podcast.
References:
•Professor Richard Eckard: rjeckard@unimelb.edu.au
•www.who.int/health-topics/climate-change
•"The Weather Makers" by Tim Flannery, Text Publishing
•National Geographic (multiple references)
Hypermobile joints were noted by Hippocrates as long ago as 400 BCE and are common, occurring in about 10-25 % of the population. In a minority of patients’ pain and injury results suggest that the clinical findings may reflect a condition referred to as hypermobility spectrum disorder, a polygenic connective tissue syndrome affecting between 1:500 to 1:600 people. This syndrome involves extreme joint flexibility often associated with joint pains, tends to run in families and is more common amongst females. Hypermobility spectrum disorder has been redefined separately from the more stringent diagnostic criteria required for the diagnosis of more extreme hypermobility syndromes such as Ehlers-Danlos syndrome, Marfans disease, Loeys-Dietz or Osteogenesis imperfecta syndromes.
In relation to the above-mentioned syndromes in 1901 a Danish doctor, Dr Lauritz-Edvard Ehlers presented a case of hypermobility, and a similar case was subsequently presented by French physician Dr Henri-Alexandre Danlos in 1908. The name Ehlers-Danlos syndrome (EDS) wasn’t proposed until many years later in 1936 by Englishman Dr Parkes-Weber. We now recognize 13 types of Ehlers-Danlos syndrome with hypermobile EDS as the most common and myopathic EDS, Spondylodysplastic classical EDS and brittle cornea syndrome as just some of the others. About 1: 3500 to 1: 5000 people have EDS. Both dominant and recessive inheritance patterns are noted. Frequent joint and ligament injuries including sprains and dislocations may occur and joint stiffness, clumsiness, fatigue dizziness and associated bowel and bladder complaints are often cited.
Another well-known hypermobility disorder Marfans syndrome is rare affecting about 1 in 5000 and in three-quarters of cases, inheritance is autosomal dominant with the defective fibrillin gene resulting in tall individuals with slender limbs, fingers and toes, cardiac defects including aortic dissections, aortic root aneurysms and valvular incompetence, lens dislocations as well as the high arched palate, crowded teeth and abnormal sternum development (pectus excavatum or pectus carinatum ). A quarter of cases experience a new gene mutation with no family pedigree identified.
These hypermobility conditions have common abnormalities in collagen structure and function. Whilst genetic studies are available in some cases of hypermobility (but not hypermobility spectrum disorder), the criteria for diagnosis referred to as The Beighton criteria are essentially clinical and includes a Beighton score reflecting joint extensibility and mobility combined with arthralgia over 3 months, dislocations and subluxations, soft tissue lesions such as epicondylitis, tenosynovitis and bursitis, Marfanoid habitus and abnormal skin with striae, hyperextensibility, thin skin and papyraceous scarring.
No cure is currently known for these syndromes which are managed symptomatically. Fortunately, societies such as the Ehlers-Danlos Society and physicians such as Assoc Professor Chris O’Callaghan from Melbourne’s Austin Health are the most helpful resources and I welcome you to the interview with Chris to expand our understanding of this subject today.
References:
Assoc Professor Chris O’Callaghan: www.austin.org.au
The Ehlers Danlos Society: www.ehlers-danlos.com
Ehlers-Danlos syndromes: www.nhs.uk
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
As a background, Bronsted and Lowrys definitions of acids and bases are as follows: A base is a substance that accepts a proton (a hydrogen ion) an acid is a compound that dissociates in water to release a proton. A strong acid is one that readily dissociates in water to release a proton (eg HCL), and a weak acid does not readily dissociate in water (uric acid). pH is the negative logarithm of the hydrogen ion concentration to the base 10. Thus, the negative logarithm of 0.0000001 which may be expressed as 10 to the power of -7 is 7.
The reason blood and cellular pH are so important is that their stability is essential to the integrity of enzymes, metabolic processes, and cell membrane potential. Homeostasis holds our blood pH tightly between 7.35 and 7.45 with an intracellular pH of 6.8.
Where does the acid come from?
Acid production results from the production of CO2 by metabolism of glucose, fatty acids, and amino acids. CO2 combines with water and is converted to carbonic acid -H2CO3 by carbonic anhydrase and then dissociates to H+ and HCO3-. That enzyme carbonic anhydrase pops up everywhere.
Acid production also results from anaerobic glucose metabolism whereby glucose is converted to H+ and lactate in ketogenesis as well as from the catabolism of the amino acids: methionine and cysteine.
Which organs play a major role in the maintenance of pH?
Both the lungs and kidneys play critical roles in acid-base balance. We exhale CO2 from the lungs effectively blowing off acid but may also retain CO 2 by underventilation.
The kidneys have the potential to excrete or absorb bicarbonate and to excrete or reabsorb protons (hydrogen ions) influencing and compensating for pH disturbance through an intricate juggling of these two. The excretion of protons is by combination with ammonia from the metabolism of muscle glutamine or in combination with monohydrogen phosphate. These ingenious biological systems may be influenced by multiple disease processes and respiratory forms of acidosis and alkalosis as well as metabolic processes leading to acidosis and alkalosis are well recognised.
Whilst arterial blood gas assessment is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Venous blood gas (VBG) is a more accessible alternative to ABG sampling and correlates well with arterial sampling in pH measurement (slightly lower in venous sample) and HCO3 - (1.41 mmol/l higher in venous) with pCO2 approximately 5.6 mmHg higher in venous blood. These differences may be exaggerated however in circulatory failure.
In this podcast with ICU physician Associate Professor Adrian Regli, we will explore the subject further, delve into some of the typical metabolic and respiratory disturbances we are likely to encounter as clinicians and also review some handy rules of thumb to draw upon in practical acid-base interpretation. Currently, Adrian works as an ICU consultant at Fiona Stanley Hospital Perth. Please welcome Adrian to the Podcast.
References
Assoc Professor Adrian Regli - via Google
Oh’s Intensive Care Manual, Bersten et al 6 th ED, Butterworth
Medical Biochemistry at a Glance, Salway,3rd ED, Wiley-Blackwell
Acid-Base Disorders in the Critically Ill Patient, Achanti et al CJASN, Sept 2022
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
As a background, Bronsted and Lowrys definitions of acids and bases are as follows: A base is a substance that accepts a proton (a hydrogen ion) an acid is a compound that dissociates in water to release a proton. A strong acid is one that readily dissociates in water to release a proton (eg HCL), and a weak acid does not readily dissociate in water (uric acid). pH is the negative logarithm of the hydrogen ion concentration to the base 10. Thus, the negative logarithm of 0.0000001 which may be expressed as 10 to the power of -7 is 7.
The reason blood and cellular pH are so important is that their stability is essential to the integrity of enzymes, metabolic processes, and cell membrane potential. Homeostasis holds our blood pH tightly between 7.35 and 7.45 with an intracellular pH of 6.8.
Where does the acid come from?
Acid production results from the production of CO2 by metabolism of glucose, fatty acids, and amino acids. CO2 combines with water and is converted to carbonic acid -H2CO3 by carbonic anhydrase and then dissociates to H+ and HCO3-. That enzyme carbonic anhydrase pops up everywhere.
Acid production also results from anaerobic glucose metabolism whereby glucose is converted to H+ and lactate in ketogenesis as well as from the catabolism of the amino acids: methionine and cysteine.
Which organs play a major role in the maintenance of pH?
Both the lungs and kidneys play critical roles in acid-base balance. We exhale CO2 from the lungs effectively blowing off acid but may also retain CO 2 by underventilation.
The kidneys have the potential to excrete or absorb bicarbonate and to excrete or reabsorb protons (hydrogen ions) influencing and compensating for pH disturbance through an intricate juggling of these two. The excretion of protons is by combination with ammonia from the metabolism of muscle glutamine or in combination with monohydrogen phosphate. These ingenious biological systems may be influenced by multiple disease processes and respiratory forms of acidosis and alkalosis as well as metabolic processes leading to acidosis and alkalosis are well recognised.
Whilst arterial blood gas assessment is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Venous blood gas (VBG) is a more accessible alternative to ABG sampling and correlates well with arterial sampling in pH measurement (slightly lower in venous sample) and HCO3 - (1.41 mmol/l higher in venous) with pCO2 approximately 5.6 mmHg higher in venous blood. These differences may be exaggerated however in circulatory failure.
In this podcast with ICU physician Associate Professor Adrian Regli, we will explore the subject further, delve into some of the typical metabolic and respiratory disturbances we are likely to encounter as clinicians and also review some handy rules of thumb to draw upon in practical acid-base interpretation. Currently, Adrian works as an ICU consultant at Fiona Stanley Hospital Perth. Please welcome Adrian to the Podcast.
References
Assoc Professor Adrian Regli - via Google
Oh’s Intensive Care Manual, Bersten et al 6 th ED, Butterworth
Medical Biochemistry at a Glance, Salway,3rd ED, Wiley-Blackwell
Acid-Base Disorders in the Critically Ill Patient, Achanti et al CJASN, Sept 2022
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Recent research has found that Aboriginal and or Torres Strait Islander people are ten times more likely and Pacific Islander people 82 times more likely to have an episode of ARF than other ethnicities.
Although more than 9000 people are on RHD registers across Australia currently very little is known about the epidemiology of ARF and RHD in southern regions of Australia despite an estimated 57% of the Aboriginal and Torres Strait Islander population living in these regions. Importantly on 31st July this year, acute rheumatic fever and rheumatic heart disease became routine notifiable conditions in Victoria with only Tasmania and the ACT left to enact this important policy.
A new case of ARF is recognised to be 10 times more common in an individual with a past episode of ARF than an individual from the same community without prior ARF underscoring how important disease notification is for secondary prevention. Presently 80 % of people diagnosed with ARF have no prior diagnosis registered.
It was a real honour to welcome back expert infectious diseases specialist Alex Tai who has been passionate about education and bringing forth new issues of an infectious nature for our understanding. It gives me great pleasure to welcome Alex back to Everyday Medicine to discuss this important topic further.
References:
Dr Alex Tai - Gippsland Region Public Health Unit - Monash University. - Baw Baw Physicianshttps://www.bawbawphysicians.com.au › ...Dr Alex Tai - Infectious Diseases Physician
Dr Alex Tai - LinkedIn
Notification of Rheumatic Heart Disease and Acute Rhematic Fever. https://www.health.vic.gov.au/health-advisories/notification-of-rheumatic-heart-disease-and-acute-rhematic-fever
National Treatment Guidelines - www.rhdaustralia.org.au/arf-rhd-guidelines
Recently, I had the privilege of being introduced to Dr. David Stewart, Professor of Medicine at the University of Ottawa and a medical oncologist. He was kind enough to forward a copy of his excellent book, "A Short Primer on Why Cancer Still Sucks," in which he reviews various aspects of cancer medicine and raises important questions about the incidence of malignancies, treatment strategies, and the sometimes-flawed way healthcare systems and bureaucracies deliver outcomes. Ultimately, it is oncologists and primary care physicians who find themselves at the interface of providing real-time care to sick patients while navigating healthcare systems with many speed bumps.
Around the time David contacted me, an article was also published in The Australian (Sept 10-11, 2022), reviewing a book written by Emeritus Professor of Immunology at the University of Queensland, Robert Tindle, titled "Your Cash or Your Cancer." In this book, Tindle discusses the crushing cost of cancer treatment and the difficulties in procuring therapies, especially for the 25,000 or so uncommon cancers, which account for about a third of all cancer diagnoses in Australia. His concerns resonated with many of the points David raises in his book and highlight that David's concerns are international.
David's book offers a significant contribution not only for patients and families unfortunate enough to have had to deal with a cancer diagnosis but also for doctors and medical students embarking upon a career in primary practice. I give this well-researched and engaging 300-page book a strong recommendation. I have benefited greatly from reading it and especially enjoyed the chapter on screening and risk, as well as cancer biology.
In writing the book, David explains his three main objectives:
"The first objective was to give cancer patients, their families, other members of the public, healthcare trainees, and non-experts a better understanding of cancer. What causes it? Why is it so common? What are the limitations of screening? How does cancer cause symptoms? How do therapies work, and how do they cause side effects? Why might they fail?
The second very important objective in writing this book was to raise public awareness of 'systems' obstacles we face in the fight against cancer. We need allies in the struggle to make everything happen faster. To speed up the development and approval of effective new treatments, the funding for those therapies, the tests a patient must undergo to diagnose and characterise a cancer, and the initiation of a patient's therapy. There are too many impediments. It doesn't have to be this way. The rapid government response to COVID-19 demonstrates clearly what concerted action can achieve. When it comes to cancer, there are many reasons why things proceed at a much slower pace than with COVID, but there are no valid excuses.
The third objective was to give the family and friends of oncologists some insight into what drives many of us—why most oncologists love what they are doing and why our workdays can be so long."
With that said, please welcome David to the podcast.
References:
https://www.amazon.com/Short-Primer-Cancer-Still-Sucks/dp/0228871999
www.youtube.com; “Why Cancer still sucks" David J Stewart.MD, FRCPC
www.med.uottawa.ca Professor David Stewart
Recently a team from the Monash Department of Diabetes published in the Nature Journal ‘ Signal Transduction and Targeted Therapy ‘ how their research could lead to the regeneration of insulin in pancreatic stem cells. As their findings could potentially benefit the 130,000 Type I diabetics in Australia and 30 per cent of Type II diabetics who are insulin dependent it received significant media attention. Diabetes is the fastest-growing illness in Australia and about 500 million people have diabetes worldwide with the potential complications of cardiovascular disease, renal failure, cerebrovascular disease, neuropathy, retinopathy, and lower limb amputation.
Associate Professor Neale Cohen who is the director of diabetes clinical research at the Baker Heart and diabetes institute believes the research shows great potential. Currently, the research is being conducted by a carefully selected team lead by Professor Sam El-Osta and including Dr Ishant Khurana and Dr Al-Hasani and we will be discussing their work and objectives further with Ishant in this podcast.
The research has discovered how to reawaken stem-like cells in the diabetic pancreas. Using an inhibitor of the protein called EZH2 which induces histone H3 lysine 27 trimethylation that functions to silence the insulin gene, insulin expression may be reawakened. If successful, the research will not only lead to a method for avoiding islet cell transplantation but possibly the need for exogenous insulin therapy altogether which is very exciting.
I was curious to have this research explained in more detail and to discover how close the investigative team were to success using these groundbreaking epigenetic strategies.
Please join me in welcoming Dr Ishant Khurana to the podcast.
References:
Dr Ishant Khurana: https ://research.monash.edu
Twitter: https://twitter.com/IshantKhuranaAU
Nature journal, Signal Transduction and Targeted Therapy titled: Inhibition of pancreatic EZH2 restores progenitor insulin in T1D donor. DOI: 10.1038/s41392-022-01034-7
Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.
As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.
There are 14 new diagnoses of Leukaemia per day in Australia accounting for about 5200 diagnoses yearly and making up about 3.2 % of all new cancer diagnoses per year. Leukaemia is responsible for over 2100 deaths annually. Men are slightly more likely to be affected in a 60: 40 split with women. By the age of 85 years, one has a 1: 50 chance of this diagnosis. With current treatment approaches overall 5-year survival sits at about 64 % but this figure is influenced by the subtype of Leukaemia diagnosed with aggressive forms of Leukaemia such as AML carrying a much worse prognosis than a diagnosis such as CLL which may run an indolent course for many years.
Dividing adult Leukaemia into acute and chronic classification is most helpful and this podcast will approach the topic similarly over two episodes.
The acute Leukaemias encompass acute myeloid leukemia (30 % of adult Leukaemia), acute lymphoblastic Leukaemia and Leukaemia's of ambiguous origin.
The chronic Leukaemias include Chronic Myeloid Leukaemia (CML) and Chronic lymphocytic leukemia (CLL)
This is another vast subject, and it was a real honour to invite Professor Jake Shortt to the podcast. Jake is the Head of Haematology Research at the School of Clinical Sciences and clinical lead at Monash Haematology for Myeloid Leukaemia, myelodysplasia and T-cell lymphoma. He is the Principal Investigator on a range of clinical trials for T-cell lymphoma and myeloid malignancies, conducted through the Monash Haematology clinical trials unit and the recipient of a Medical Research Future Fund Career Development Fellowship. His work in the School of Clinical Sciences is focused on strategies incorporating epigenetic drugs with immunotherapy in haematological cancers, particularly Lymphoma and Multiple Myeloma. Jake heads the Blood Cancer Therapeutics laboratory within the Monash Health Translation Precinct and somehow also finds the time to be Chair of the Laboratory Sciences Working Party of the Australasian Leukaemia and Lymphoma Group (ALLG) and Deputy Chair of their Scientific Advisory Committee.
Please welcome Professor Jake Shortt to the podcast.
References :
Haematology and Oncology Subspecialty Consult, 4th Ed, Cashen and Van Tine, Wolters Kluwer, Ch 31
www.leukaemia.org.au
www.cancer.org.au
www.monashhealth.org/services/haematology/jake-shortt/
Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.
As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.
There are 14 new diagnoses of Leukaemia per day in Australia accounting for about 5200 diagnoses yearly and making up about 3.2 % of all new cancer diagnoses per year. Leukaemia is responsible for over 2100 deaths annually. Men are slightly more likely to be affected in a 60: 40 split with women. By the age of 85 years, one has a 1: 50 chance of this diagnosis. With current treatment approaches overall 5-year survival sits at about 64 % but this figure is influenced by the subtype of Leukaemia diagnosed with aggressive forms of Leukaemia such as AML carrying a much worse prognosis than a diagnosis such as CLL which may run an indolent course for many years.
Dividing adult Leukaemia into acute and chronic classification is most helpful and this podcast will approach the topic similarly over two episodes.
The acute Leukaemias encompass acute myeloid leukemia (30 % of adult Leukaemia), acute lymphoblastic Leukaemia and Leukaemia's of ambiguous origin.
The chronic Leukaemias include Chronic Myeloid Leukaemia (CML) and Chronic lymphocytic leukemia (CLL)
This is another vast subject, and it was a real honour to invite Professor Jake Shortt to the podcast. Jake is the Head of Haematology Research at the School of Clinical Sciences and clinical lead at Monash Haematology for Myeloid Leukaemia, myelodysplasia and T-cell lymphoma. He is the Principal Investigator on a range of clinical trials for T-cell lymphoma and myeloid malignancies, conducted through the Monash Haematology clinical trials unit and the recipient of a Medical Research Future Fund Career Development Fellowship. His work in the School of Clinical Sciences is focused on strategies incorporating epigenetic drugs with immunotherapy in haematological cancers, particularly Lymphoma and Multiple Myeloma. Jake heads the Blood Cancer Therapeutics laboratory within the Monash Health Translation Precinct and somehow also finds the time to be Chair of the Laboratory Sciences Working Party of the Australasian Leukaemia and Lymphoma Group (ALLG) and Deputy Chair of their Scientific Advisory Committee.
Please welcome Professor Jake Shortt to the podcast.
References :
Haematology and Oncology Subspecialty Consult, 4th Ed, Cashen and Van Tine, Wolters Kluwer, Ch 31
www.leukaemia.org.au
www.cancer.org.au
www.monashhealth.org/services/haematology/jake-shortt/
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic condition including difficulty maintaining attention, hyperactivity, and impulsiveness. ADHD often begins in childhood and can persist into adulthood and reflects an ongoing pattern of behaviour that results in poor concentration and control of impulses and interferes with functioning and or development. It may contribute to low self-esteem, troubled relationships and difficulty at school or work.
ADHD is one of the most common neurodevelopmental disorders of childhood, it is estimated that one in 20 children in Australia have ADHD and diagnosis in adults is on the rise where it is estimated that fewer than 20% of adults with ADHD are currently diagnosed or treated by a psychiatrist.
I was curious in this podcast to explore ADHD in more detail and was hoping to gain insights into its neurobiology and the long-term consequences for patients with ADHD especially if not diagnosed. I was also keen to explore the concept of “late birthdate effect” where a younger child in a school year group may be diagnosed with ADHD and medicated at a higher rate than older classmates possibly as a misdiagnosis reflecting the relative immaturity of the student rather than a true developmental condition.
A new companion guide recently published in Australia is referred to as The Australian Evidence Based Clinical Practice Guideline for Attention Deficit Disorder and is designed to help parents and others understand ADHD and the different ways of managing it. It makes 113 recommendations about recognising, diagnosing, and treating the condition. Whilst generally well received these Clinical Practice Guidelines have drawn criticism from some child psychiatrists for recommending amphetamine medications for children as young as five years diagnosed with ADHD based on their impulsive, active, or inattentive behaviour. Some specialists have criticised this decision for relying on ‘low quality ‘evidence, so this warrants discussion also. I was also hoping to learn more about cognitive training and non-pharmacologic techniques that may be of value such as neurofeedback.
It was a great pleasure to welcome back to Everyday Medicine Associate Professor Soumya Basu who has a special interest in developmental disabilities including ADHD and autism spectrum disorder. Soumya is a fellow of the Royal Australian and New Zealand College of Psychiatrists and is a senior lecturer at the Department of Psychological Medicine, Monash University with other keen interests in youth mental health and developmental trauma and provides expertise both at the St John of God Langmore Centre in Berwick and in Warragul Gippsland. Please enjoy this conversation with Soumya.
References:
Associate Professor Soumya Basu: Victorian Centre for mental Health www.vcmh.com.au,warragulspecialistcentre.com.au, St John of God Langmore Centre: www.sjog.org.au
Australian ADHD Professionals Associationhttps://adhdguideline.aadpa.com.auAustralian Evidence-Based Clinical Practice ADHD Guideline
CHADDhttps://chadd.org › overviewAbout ADHD - Symptoms, Causes and Treatment
Coghill DR, Banaschewski T, Soutullo C, Cottingham MG, Zuddas A (November 2017). "Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder".
Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. (October 2018). "Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan". European
Attention deficit hyperactivity disorder". International Classification of Diseases 11th Revision. February 2022 [2019].
Institute for Health Metrics and Evaluation (17 October 2020). "Global Burden of Disease Study 2019: Attention-deficit/hyperactivity disorder—Level 3 cause" The Lancet. 396(10258).
Pilates is a form of low-impact exercise that aims to strengthen muscles while improving postural alignment and flexibility. It can be practised with or without equipment and the movements reinforce slow precise actions and breath control. The exercises strengthen and stabilise the core which is the body's foundation allowing one to move efficiently while improving posture flexibility and mobility.
This method of exercise is based on the rehabilitation work of Joseph Pilates, born in Dusseldorf in 1883. Joseph Pilates believed that injuries were caused by imbalances in the body and by habitual patterns of imperfect movement and hypothesised that an overcompensation or overdevelopment of another area occurred when a person had a weakness or misaligned area in order to achieve the functional movements desired.
He felt it was critical to correct the misalignment and to re-educate the body to prevent recurrence. His studio in New York allowed him to develop over 600 exercises over his career and he invented various pieces of apparatus to assist with the execution of these in particular his so-called reformer and cadillac with pulleys and springs allowing his method initially called Contrology to be practised with precision and exact repetition.
Joseph Pilates died in 1967 before his method now called Pilates became well known and widely accepted. Today, decades later his approach has gained significant popularity with over 3000 studios in Australia and some 380,000 Australians practising Pilates either regularly or occasionally. His method has been widely adopted by physiotherapists in Australia, North America and Europe with increasing popularity is a testament to its amazing benefits.
Recently I had the pleasure of being introduced to Samantha Wood whilst she was blitzing it at a surfing location in Fiji with her tall athletic partner Jeff. They were both limber, flexible and in the moment and she was immediately recognised as the author of Pilates for Rehabilitation which has become a bible of Pilates based exercises and a comprehensive guide for therapists offering rehabilitation from orthopaedic injuries.
Samantha began her career as a physiotherapist and after a serendipitous meeting with Pilates guru Rael Isacowitz she developed a passion for Pilates and is now world renown in her field lecturing internationally, conducting workshops and convening body and mind retreats as well as running a busy Pilates and PT clinic at The Cypress Center in Pacific Palisades Los Angeles California.
I was very grateful that she was available for this interview to discuss Pilates further, as I believe we should all be familiar with the method and recognise the outstanding benefits it offers our patients.
Please welcome Samantha to the podcast.
References:
Samantha Wood-Cypress Center-Pacific Palisades, Los Angeles. www.samanthawoodphysio.com
Pilates for Rehabilitation -Samantha Wood. Human Kinetics
www.HumanKinetics.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish over time and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.
Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.
Current Australian guidelines for lipid management recommend:
Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population
LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population
Triglycerides < 2 mmol/l
HDL > 1.0 mmol/l
Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per 1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.
Interventions that are utilized to modify the cardiac risk associated with lipids include:
Dietary manipulation
Pharmacologic modification of lipid synthesis or absorption
Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.
Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.
References:
Basic and Clinical Pharmacology 14th ed -Bertram G. Katzung, LANGE Books, Ch 35.
Principles of Medical Biochemistry, Eisenberg & Simmons,3Rd Ed, Elsevier Saunders, Ch 23
Ganong’s Review of Medical Physiology, Barrett et al,25 th Ed, LANGE Books, Ch 26
Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol. 37:423-446, Wang & Hu
Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease, Nutrients 2018Jun;10(6):780 Ghada A. Soliman
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish overtime and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.
Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.
Current Australian guidelines for lipid management recommend:
Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population
LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population
Triglycerides < 2 mmol/l
HDL > 1.0 mmol/l
Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.
Interventions that are utilized to modify the cardiac risk associated with lipids include:
- Dietary manipulation
- Pharmacologic modification of lipid synthesis or absorption
Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.
Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.
References:
Basic and Clinical Pharmacology 14th ed - Bertram G. Katzung, LANGE Books, Ch35.
Principles of Medical Biochemistry, Eisenberg & Simmons, 3rd Ed, Elsevier Saunders, Ch 23
Ganong’s Review of Medical Physiology, Barrett et al, 25th Ed, LANGE Books, Ch26
Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol.37:423-446, Wang & Hu
Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease,Nutrients 2018 Jun; 10(6):780 Ghada A. Soliman
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish over time and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.
Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.
Current Australian guidelines for lipid management recommend:
Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population
LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population
Triglycerides < 2 mmol/l
HDL > 1.0 mmol/l
Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per 1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.
Interventions that are utilized to modify the cardiac risk associated with lipids include:
- Dietary manipulation
- Pharmacologic modification of lipid synthesis or absorption
Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.
Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.
References:
Basic and Clinical Pharmacology 14th ed -Bertram G. Katzung, LANGE Books, Ch 35.
Principles of Medical Biochemistry, Eisenberg & Simmons,3Rd Ed, Elsevier Saunders, Ch 23
Ganong’s Review of Medical Physiology, Barrett et al,25 th Ed, LANGE Books, Ch 26
Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol. 37:423-446, Wang & Hu
Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease, Nutrients 2018Jun;10(6):780 Ghada A. Soliman
Postural orthostatic tachycardia syndrome-POTS is not rare, yet it is hard to find any references to the syndrome in medical textbooks. It is a form of dysautonomia that by some estimates may impact as many as one in 100, more commonly demonstrated in women between the ages of 13 and 50 years; men also may be affected. Classically defined as a form of orthostatic intolerance characterised by excessive tachycardia upon standing, POTS usually presents with symptoms that are much more complex than a simple increase in heart rate.
It is common for POTS patients to experience fatigue, headache, light-headedness heart palpitations excessive intolerance, nausea, diminished concentration, tremulousness, syncope, coldness or pain in the extremities as well as chest pain and shortness of breath. Patients may develop a reddish-purple colour in the legs upon standing, possibly caused by blood pooling or poor circulation. Colour changes subside upon returning to a reclined position. POTS is often diagnosed by a tilt table test, however the bedside measurement of heart rate and blood pressure taken in the supine and standing position at 2.5 and 10 minute intervals will help to clarify the diagnosis. A heart rate increase of 30 beats per minute or over 120 beats per minute within the first 10 minutes of standing is highly suggestive.
The term POTS was coined in 1993 by a team of researchers from the Mayo Clinic but it is not a new illness and terms such as Mitral valveprolapse, Da Costas syndrome, Soldiers heart, Chronic orthostaticintolerance and Neurocirculatory asthenia point to the single condition. POTS is not caused by anxiety, rather a malfunction of the patients autonomic nervous system and doctors such as Chris O’Callaghan from the Austin hospital have been at the vanguard of this diagnosis and management and thankfully for Australian clinicians, guiding us on appropriate management strategies. Such treatments may include increased fluid intake to 2-3 litres per day, increasing salt consumption to between 3000 milligrams and 10,000 milligrams per day, the wearing of compression stockings, raising the head of the bed and using a variety of medication such as Fludrocortisone, Beta blockers, Midodrine, Clonidine, Benzodiazepine and others.
Associate Professor Chris O’Callaghan is a physician and clinical pharmacologist working at The Austin Hospital Melbourne and is the principal at The Melbourne Cardiovascular and Autonomic Clinic, he has a special interest in cardiovascular medicine, Ehlers Danlossyndrome and POTS. It is a great privilege to welcome him to the podcast.
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
References:
Assoc Professor Chris O’Callaghan
Postural Tachycardia Syndrome. Blair P. Grubb, Circulation. 2008; 117:2814-2817.
National Institute of Health, Neurological Institute of Neurological Disorders and Stroke, Postural Tachycardia Syndrome Information Page.
The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.
Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161 (2011) 46-48.
Simulation based medical education uses simulation aides to replicate clinical scenarios with the aim of enhancing patient safety by improving medical care and competence and reducing medical errors. Although relatively new to medicine, simulation has been used for a long time in other professions, such aviation. Increasingly, medical simulation is being recognized as a very important training method for doctors, nurses and allied health staff, allowing skill acquisition through deliberate practice. In simulation, a trainee may make mistakes in a controlled, no risk environment and learn from them without the fear of harming patients. This deliberate practice is aimed at taking medical staff from the “see one, do one, teach one” paradigm of apprenticeship style learning to the “see one, practice many, do one" simulation training model.
Simulation also builds group skills, cultivates team culture, and allows systems and processes to be practiced, reviewed and improved, enhancing medical competence. One of the main drivers for simulation-based learning and training relates to global study reports showing that up to 10% of patients admitted to hospitals suffer some kind of harm or injury through medical errors. A landmark report released in 1999 by the Institute of Medicine estimated that medical errors were responsible at that time for up to 98,000 deaths in the USA per year. These figures remind us that “to err is human”.
I was curious to take this conversation on medical simulation further and was honored to invite Dr Nancy Sadka, Emergency physician, ED clinical lead in education and research, and head of simulation training at The Northern Hospital in Epping, as a guest to this podcast. Please welcome Dr Nancy Sadka.
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
References:
Dr Nancy Sadka, www.nh.org.au
The future vision of simulation in healthcare, Gaba: ncbi.nlm.nih.gov
Simulation-based medical teaching and learning, AH Al-Elq :ncbi.nlm.nih.gov
Training and simulation for patients safety, R Aggarwal: qualitysafety.bmj.com
The concept of autism continues to evolve with our current approach to diagnosis and management differing significantly from 1908 when the word first appeared to describe a subset of patients with schizophrenia who were withdrawn and self-absorbed. Child psychiatrist Leo Kanner was credited with the first correct description in 1943, reporting eleven highly intelligent children who displayed “a powerful desire for aloneness” and “an obsessive insistence on persistent sameness”. He named this “early infantile autism”.
A year later in 1944, Hans Asperger described a “milder” form of autism now known as Asperger’s Syndrome where the boys he described were highly intelligent but had trouble with social interactions and specific obsessive interests. A major setback came in 1967 with psychologist Bruno Bettelheim’s theory of “refrigerator mothers” implying parental responsibility and causality through a lack of shared love. This psychoanalytic approach to explaining autism caused major damage to the mental health of parents struggling to provide their children love and care and was extremely cruel in its ignorance. Similarly, the forged research that lead to the subsequently retracted 1998 Lancet article, authored by the deregistered Andrew Wakefield, significantly damaged community understanding of this condition whilst creating unwarranted fear and panic regarding measles, mumps, rubella vaccine and the use of thimerosal (a mercury-based preservative now withdrawn from all vaccines to allay public fears). By 1977, twin studies helped us to understand that autism is caused by genetics and biological differences in brain development.
In this podcast, I was curious to learn more about autism, its diagnosis, and approaches to management. It was a great privilege to have a conversation with child and adolescent psychiatrist Associate Professor Soumya Basu who has a special interest in developmental disabilities including autism spectrum disorder. Soumya is a fellow of the Royal Australian and New Zealand College of Psychiatrists and is a senior lecturer at the Department of Psychological Medicine, Monash University with other keen interests in youth mental health and developmental trauma. Please welcome Soumya to the Podcast.
References:
Associate Professor Soumya Basu: Victorian Centre for Mental Health www.vcmh.com.au, warragulspecialistcentre.com.au, St John of God Langmore Centre: www.sjog.org.au
www.autismspectrum.org.au
www.autismawareness.com.au
Autism Spectrum Disorder -National Institutes of Health:www.nimh.nih.gov
First described by Samuel Gee in England in 1887 and Christian Herter in the United States, until the mid-twentieth century the disease of malnutrition and growth retardation now called Coeliac disease was known as Gee-Herter disease and managed with the so-called banana diet. We now know a great deal more about Coeliac disease which is recognised as an immune-mediated disorder characterised by chronic inflammation of the proximal small bowel which heals with gluten withdrawal from the diet and returns when gluten is reintroduced.
I was very interested to invite Assoc Prof Jason Tye- Din to Everyday Medicine to discuss this fascinating subject in more depth. Jason is an active clinician practicing gastroenterology but is also laboratory head in the division of immunology at Melbourne’s Walter and Eliza Hall. He is actively involved in researching the inflammatory response to gluten in human participants and in characterising CD4+T cell antibody responses to gluten whilst aiming to improve clinical pathways to promote timely and cost-effective diagnosis, monitoring and management of coeliac disease.
Please check last week's episode 1 before joining me with Jason Tye-Din for this concluding episode.
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
References :
Assoc Professor Jason Tye-Din: www.wehi.edu.au
Coeliac Society of Australia: www.coeliac.org.au
Gastroenterology Society if Australia: www.gesa.org.au
The Dietitians Association of Australia: www.data.asn.au
Gastronet: www.gastro.net.au
First described by Samuel Gee in England in 1887 and Christian Herter in the United States, the disease of malnutrition and growth retardation now called Coeliac disease was known as Gee-Herter disease. It is now recognised as an immune-mediated disorder characterised by chronic inflammation of the proximal small bowel, which heals with gluten withdrawal from the diet and returns upon gluten reintroduction.
Coeliac disease exhibits geographical variation, with the highest incidence in Western Europe and lower occurrences in Asia and sub-Saharan Africa. Once considered rare (prevalence of 1 in 4,000 to 1 in 5,000 in the 1950s), its true prevalence in Western countries, including Australia, is now estimated to be around 1 in 70.
Females are predominantly affected, and serological testing reveals that silent coeliac disease (positive serology and small bowel biopsy without or with minimal symptoms) is about 7 times more common than symptomatic disease. Monozygotic twins have a 70% concordance rate, and first-degree relatives of individuals with coeliac disease have a prevalence of villous atrophy ranging from 4% to 12%. Type I Diabetes and Dermatitis Herpetiformis increase the risk, as do thyroid disease, Down's syndrome, PBC, and IgA deficiency.
Gluten encompasses storage proteins from wheat, barley, and rye. Gliadins, the ethanol-soluble component of gluten, are highly immunogenic. In genetically predisposed individuals, an immune response in the mucosal lining of the small intestine leads to mucosal inflammation, increased lymphocytes, crypt hyperplasia, and villous atrophy.
Clinical presentations range from no symptoms to IBS-like or classic symptoms such as diarrhea, bloating, and weight loss. Osteoporosis at an early age or unexplained iron deficiency may indicate the disease. Neurological and psychiatric conditions like ataxia, neuropathy, and epilepsy can also be associated.
Serological studies for deamidated gliadin, tissue transglutaminase, and endomysium antibodies have sensitivity and specificity above 95%. However, performance may be influenced by IgA deficiency, occurring in 3-5% of coeliac patients, necessitating a diagnostic small intestinal biopsy proximal and distal to the ampulla of Vater.
HLA 'gene' screening for DQ-2 and DQ-8 may assist in diagnosing uncertain cases, as a negative result essentially rules out coeliac disease. However, using this test as a screening tool is not recommended, as 20-30% of the normal population carries these HLA antigens without having gluten enteropathy.
The lifelong treatment of coeliac disease requires strict adherence to a gluten-free diet. Avoidance of triticale, couscous, spelt, semolina, and cracked wheat is necessary, while rice, corn, buckwheat, tapioca, polenta, and dhal are permitted. Formal dietetic reviews and support groups are strongly advised for patient management.
Untreated or inadequately treated coeliac disease carries a 20-fold increased risk of solid malignancies, including oropharyngeal, oesophageal, and intestinal cancers, as well as an 80-fold increased risk of lymphoma.
I'm interested in inviting Assoc. Prof. Jason Tye-Din to Everyday Medicine. Jason is an active clinician practicing gastroenterology and a laboratory head in the division of immunology at Melbourne's Walter and Eliza Hall. His research focuses on the inflammatory response to gluten in humans and characterising CD4+T cell antibody responses. He aims to improve clinical pathways for timely and cost-effective diagnosis, monitoring, and management of coeliac disease.
Please join me with Jason Tye-Din over the next two episodes.
References:
Assoc Professor Jason Tye-Din: www.wehi.edu.au
Coeliac Society of Australia: www.coeliac.org.au
Gastroenterology Society of Australia: www.gesa.org.au
The Dietitians Association of Australia: www.data.asn.au
Gastronet: www.gastro.net.au
While the boundaries between work and home are clear for many professions, in medicine, this boundary has traditionally not been so well defined. Medical work is notorious for invading personal life, made worse by advances in technology that have allowed a constant connection to clinical practice, especially through telephones. This facilitates work responsibilities that frequently encroach upon home time, recreation, and the sensitivities of one's personal life. Maintaining a work-life balance is no simple task. It is very easy to become absorbed in one's medical work, lose sight of personal space and values, and feel overwhelmed by the weight of responsibility in caring for sick patients and worrying about tests ordered and the clinical progress of those under your care. Undoubtedly, our compulsive personality traits reinforce this behaviour.
The consequences of a poor work-life balance include fatigue, poor health, a negative impact on one's mental well-being, and lost time with friends and loved ones, including missing important family events and milestones.
Balancing work and life requires effort, planning, and trade-offs. Some important conversations we must engage in when striving for work-life balance include learning to:
- Say No
- Make choices about time and money
- Avoid cynicism
In exploring these ideas, I had the privilege of meeting Dr. Ian Martin at the amazing Fiji island surf resort of Namotu. Ian is not only the consummate gentleman and an incredible athlete proficient in all water sports, but he also embodies a charming sense of peace and Zen. During our conversation, I soon realised that he had mastered the art of work-life balance. For those who know Ian, his professional career as a bariatric and upper gastrointestinal surgeon based in Brisbane is exemplary. He has received the Surgeon of Excellence award for his work in surgery and is one of the leading contributors to the National Bariatric Surgery Registry. He has served as a reviewer for the ANZ Journal of Surgeons and has been a respected mentor to many trainees. Recently, he transitioned from full-time work to a more balanced schedule, during which time he has mastered the art of paragliding and expertly flown from Slovenia to Italy and Austria before returning in a casual round trip of over 120 km.
It was a real privilege to ask Ian to share his wisdom and tips for achieving a more balanced life while working in medicine with us today. Please welcome Dr. Ian Martin to the podcast.
References:
Dr Ian Martin: brisbaneweightlosssurgery.com.au
Finding Balance in a Medical Life, by Lee Lipsenthal, 2007 (www.findingbalanceproductions.com)
Balancing Your Life at Work and Home: www.ncbi.nlm.nih.com.au
Integrative medicine refers to the blending of conventional Western scientific medicine with evidence-based natural and complementary medicines and therapies, with an emphasis on lifestyle interventions aimed at delivering holistic, patient-centred care. The objective of integrative medicine is to enable patients to achieve optimal clinical outcomes, and this approach aims to treat the physical, emotional, mental, and spiritual needs of the patient. Examples of complementary treatments blended into this holistic management may be drawn from Chinese traditional medicine, Western herbal medicine, Tai Chi, yoga, mind-body meditation, and Qigong, for example.
I was curious to learn more about integrative medicine and was excited recently to hear about the wellness app developed by Vively. It is hoped to transform the way our patients approach their health holistically. Vively is passionately and successfully supporting and promoting holistic care through amodel that blends lifestyle medicine, personalised care, and conventional medicine.
It was a great honour to catch up with and interview their medical director, Dr. Michelle Woolhouse, to discuss her approach to medical care and the health benefits Vively hopes to bring to our community. Michelle has an in-depth understanding of the underlying causes of diseases and the healing principles of the body from an energetic, biochemical, and structural level, as well as from a psychological, spiritual, and emotional level. She obtained her medical degree from Monash University in 1996 and is a fellow of the Royal Australian College of General Practitioners (RACGP), the Australasian College of Nutritional and Environmental Medicine (ACNEM), and the Australasian Society of Lifestyle Medicine (ASLM). She holds postgraduate qualifications in hypnotherapy, acupuncture, and a postgraduate diploma in mind-body medicine. She is also the author of "The Wonder Within: A Heart-Led Playbook for the Anxious, Stressed, and Burnt-Out," which is available via her website (refer to the references below). She also hosts the FX Medicine podcast. With that introduction, please welcome Michelle to the podcast.
References:
Vively.com.au
Dr Michelle Woolhouse: www.theholisticgp.com.au
www.niim.com.au
www.racgp.org.au
Most doctors in Australia are now very familiar with the use of telehealth and, in some cases, video health, as they have both been widely used during the Covid-19 pandemic. Northern Health, with its flagship Northern Hospital located in Melbourne's Epping, in conjunction with La Trobe University, has been incredibly innovative in extending the concept of the virtual consultation and establishing Australia's first virtual emergency department, which commenced on October 1, 2020.
Commenced during the Covid-19 pandemic, the virtual emergency department has already treated more than 28,000 patients, with up to 71% avoiding hospital presentation after receiving advice and instructions via video conference. This exciting new way of triaging patients and delivering care in real-time has profound implications for the ambulance service and translates to fewer trips, less transport, and more ambulances available to attend the next triple zero emergency or next lights and sirens emergency. While transport by ambulance to the hospital may extend up to eight or nine hours, it takes only 40-60 minutes for the average case attended by ambulance services to go through the virtual ED, highlighting the obvious advantage of this service.
In this conversation, I was interested in learning how consultations and advice regarding real-time home monitoring were provided and about the decision-making behind the instructions for patients to stay at home for treatment in conjunction with patients' primary health care providers, versus prompt transfer to the hospital for more specific urgent medical care. I was also curious to learn how the department is staffed and how it has partnered with the ambulance and home nursing services to dramatically improve the delivery of emergency medical care at home and aged care facilities and favourably reduce the need for patient transfer.
I was also hoping to gain a sense of the likely future of the service as developed by the Northern and its utility across Australia generally. I suspect we are rapidly approaching a tipping point for the provision of emergency services through the establishment of virtual emergency departments, and the possibility of bringing augmented reality into this equation makes for an exciting horizon.
It was a great pleasure to invite Dr. Loren Sher to this podcast. Loren is the head of paediatric emergency at The Northern Hospital and is also the clinical director of the Victorian Virtual emergency department. She is committed to outstanding paediatric care in the community as well as education at the University, hospital, and external level. As you shall see from our conversation, she brings energy, enthusiasm, and incredible optimism, which I am certain has helped her define success in her every endeavour.
Please welcome Dr. Loren Sher.
References:
nh.org.au
Victorian Virtual Emergency Department - Northern Health
Dr Loren Sher: au.linkedin.com, wildhealth.net.au
Disclaimer:
Please note that the audio quality in this podcast episode may not meet our usual high standards. We apologise for any inconvenience or frustration this may cause. Despite the subpar audio quality, we believe the information and insights shared in this episode are valuable and worth sharing with our audience. We have made every effort to enhance the audio quality during the editing process, but some imperfections may still be present. We appreciate your understanding and patience as we work to improve our production quality going forward. Thank you for listening and we hope you find the content of this episode to be informative and engaging.
Neurosurgery is the surgical specialty managing structural diseases of the nervous system, including; the brain, spinal cord, and peripheral nervous system. In death, the ancient Egyptians knew their way into the central nervous system, with a process of excerebration. During the Roman Empire and subsequently the middle ages, surgeons performed neurosurgery on depressed skull fractures. As well as for the management of head injuries, skull fractures, spinal injuries, hydrocephalus subdural effusions, and headaches - although how successful we can only imagine.
The Incas practised a neurosurgical procedure known as trepanation, drilling a hole into the skull, well before European colonisation. However, now in the modern age, specialised branches of neurosurgery have developed to cater for an array of challenging conditions including:
- Vascular neurosurgery includes clipping of aneurysms and performing carotid endarterectomy (CEA)
- Stereotactic neurosurgery, functional neurosurgery-including deep brain stimulation and epilepsy surgery
- Oncological neurosurgery for the treatment of benign and malignant central and peripheral nervous system cancers
- Skull base surgery
- Spinal neurosurgery (which we will focus on in our conversation today)
- Peripheral nerve surgery, and
- Pediatric Neurosurgery
A quote I found from a neurosurgeon reads "...Neurosurgery seemed to present the most challenging and direct confrontation with meaning, identity, and death. Only the neurosurgeon dares to improve upon five billion years of evolution in a few hours. The human brain.”
That said, please welcome neurosurgeon David Oehme to the conversation to introduce us to his special interests in neurosurgery, including the management of complex spine conditions with minimally invasive and keyhole techniques, as well as the treatment of brain tumours. We look forward to David guiding us through this fascinating specialty.
References:
Dr David Oehme: www.doneurosurgery.com
www.nsa.org.au
www.aans.org - Minimally Invasive Spine Surgery
www.webmd.com - Back Surgery
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Renal stones are common, at least 10% of our population will develop stones in their lifetime. One of the consequences of ureteric colic, which is the formation of stones, is reported in 3 out of every 1000 Australians per year, with a male predominance and a curious increasing incidence. Stones form when urine becomes supersaturated by minerals. Most stones contain calcium but there are many other constituents including oxalate, phosphate, uric acid, cystine and ammonia.
The Australian stone belt, encompassing northern and central Australia, is well known for its increased presentations of urinary colic. No doubt dehydration is a significant factor explaining this heightened prevalence. Conditions such as gout, hyperparathyroidism and some malignancies may also underlie an increased stone prevalence in some patients. Additionally, anatomical abnormalities such as calyceal diverticula and an obstructed pelvi-ureteric junction may reflect underlying factors, leading to increased stone formation.
The classic presentation of renal colic coupled with haematuria is well described and I was interested in understanding the decisions behind urgent intervention or expectant management in stone disease. To discover how one may judge if a stone is likely to pass spontaneously and the value, if any, of using alpha-adrenergic receptor blockers. When is a nephrostomy favoured over ureteroscopy and stenting? How is shockwave lithotripsy used and what are the standard techniques for stone rupture and removal? I was also interested in reviewing the risk of future stone development, currently estimated at 10% per year - what advice should we give to a patient who has experienced calculus disease?
To explore this topic further it was a great privilege to invite Dr Paul Manohar to this conversation. Paul undertook training, both locally in Australia and internationally, with a focus on minimally invasive laparoscopic and robotic urological surgery and pain management. He also has a strong research interest and holds a position within the Monash University Prostate Cancer Laboratory.
Please welcome Paul to the podcast.
References:
Paul Manohar: paulmanoharurology.com.au
Diets higher in calcium and potassium may help prevent recurrent symptomatic kidney stones: newsnetwork.mayoclinic.org
Medical and Dietary Therapy for Kidney Stone Prevention-NCBI: www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Haematuria is a common presenting problem in primary care, with some estimates stating that blood in the urine may be found in between 2-30% of the adult population. Haematuria may be macroscopic or microscopic which is defined as more than 3RBC/HPF and arising from glomerular or non-glomerular origin. Although only 40% of patients with macroscopic haematuria and 14.5% with microscopic haematuria are referred on to urologists for further investigation, the presence of blood in the urine should never be ignored. Ultimately, up to 30% of cases will be shown to have a urological malignancy.
Urinary analysis, looking for infection and including an assessment of protein (questioning a glomerular pathology), and cytology is the standard initial workup. Noting that some patients presenting with altered urine colour they may suspect is blood could be reporting the excretory products of beetroot, blackberries, rhubarb, urobilinogen, or discolouration from drugs such as rifampicin, methyldopa or suphamethoxazole.
It’s important to consider the social history, medical background, gender, and age of patients presenting with haematuria in the clinical workup. Neoplasms of the bladder are more common in men (3x more common than in women), especially in male smokers. The incidence also increased significantly after pelvic radiation, with the use of cyclophosphamide, or after exposure to some pesticides, carbon-containing fuels, or trichloroethylene used in the dry-cleaning business. Each year 3,100 Australians are diagnosed with bladder cancer, which is in the top ten malignancies for men.
In this episode, I was interested to pursue the subject of haematuria further with Urologist Paul Manohar, who undertook training both locally in Australia and internationally. With a focus on minimally invasive laparoscopic and robotic urological surgery and pain management. He also has a strong research interest and holds a position within the Monash University Prostate Cancer Laboratory.
It’s a great pleasure to welcome Paul Manohar to the conversation and thank you for joining us.
References:
Paul Manohar: paulmanoharurology.com.au
Assessment and management of haematuria-RACGP: www1.racgp.org.au
Evaluation of Haematuria in a Large Public Health Care System-NCBI: www.ncni.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Recently, whilst holidaying in Daylesford, I came across a copy of David Gillespie’s book - Sweet Poison. It was lying on the library’s coffee table. Its subtitle: “Why sugar makes us fat” promised to answer a question I was particularly interested in.
I picked up the book and began reading, after completing the first chapter I was unable to rest Sweet Poison down. I have now read it a couple of times, an undertaking I would strongly recommend to primary practitioners, medical students, and anyone interested in the pathophysiology and history of obesity. This is a great book and has no claim to have been written by either a dietician or medical specialist. David Gillespie is a lawyer whose specialty skill set is in researching evidence. Perhaps the absence of a medical science background has led him to delve more deeply into the subject of obesity and metabolic syndrome. David questioned the influence of fat and sugar consumption on this growing pandemic, without medical bias and free from preformed assumptions, that may otherwise have distracted enquiry. I found his analysis of the compelling causal association between increased sugar consumption with the corollary of type 2 diabetes and heart disease to be highly insightful—particularly the fructose component of table sugar, and the catastrophic emergence of obesity and the metabolic syndrome.
Sweet poison was first published in 2008 and is probably more relevant now than when David first wrote it. The book contains a great deal of well-researched information and would be a good recommendation to patients eager to learn how a relatively simple dietary choice may turn around emerging health issues.
David has a significant opus of other books including on diet, seed oils, and managing relationships. In this podcast, however, we invite him to discuss his book Sweet Poison and its core subject in more detail. Please welcome David Gillespie to Everyday medicine.
References:
Sweet Poison; David Gillespie, Penguin Books 2008
www.sweetpoison.com.au
Metabolism and health Impacts of Dietary Sugars: Alam et al, Journal of Lipid and Atherosclerosis 2022 jan,11(1)20-38
Biochemistry, Fructose Metabolism StatPearls, Dholariya 2021
The Case Against Sugar; Gary Taubes, Portobello Books 2016
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In an earlier episode, we reviewed the principles of radiation therapy from a general perspective. This field of medicine unifies the management of cancer, by harnessing the therapeutic benefits of radiation, utilising ionising radiation. A specific form of this treatment is stereotactic radiotherapy, which administers radiotherapy from different angles around the body, with the focus of ionisation meeting at the targeted tumour to be treated. This allows the focussed delivery of high-dose radiation to the tumour, whilst nearby tissues receive a much lower and thus less damaging dose - lowering the risk of side effects.
As a corollary to this treatment, a fascinating observation has arisen whereby localised radiation therapy may elicit an away from target tumour response — this is called “the Abscopal Effect”. Observed over 70 years ago in 1953 by RH Mole, who coined the term abscopal from Ab “away” and scopal “Target”, after observing a clinical response to irradiation at distant sites that were not directly exposed to radiation treatment. An abscopal response is defined as at least a 30% reduction in the size of the tumour from baseline, in any measurable non-irradiated lesion.
In this episode, I was curious to learn more about this amazing event, which whilst still relatively rare, raises the perplexing question as to why the abscopal effect does not occur more frequently in patients receiving radiotherapy.
To expand this conversation please welcome back Dr Marcus Foo - radiation oncologist with Genesis Care, who thoughtfully guides us through this subject.
References:
Dr Marcus Foo: www.genesiscare.com
Mole RH. Whole body irradiation; radiobiology or medicine? Br J Radiol 1953;26:234-41.
Formenti SC, Demaria S. Systemic effects of local radiotherapy. Lancet Oncol 2009;10:718-26.
https://atm.amegroups.com › htmlRadiation therapy and the abscopal effect: a concept comes of age
https://www.ncbi.nlm.nih.gov › pmcAbscopal effect of stereotactic radiotherapy combined with anti ...
https://www.cancer.gov › def › stere...Definition of stereotactic radiation therapy - National Cancer Institute
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Urinary tract infections are one of the top twenty reasons patients present, for primary care. According to Kidney Health Australia, 1 in 2 women and 1 in 20 men will develop a urinary tract infection in their lifetime. Approximately 4 in 10 women who develop a UTI will have at least one more infection in the next 6 months. Furthermore, 4% of patients in residential care develop recurrent UTIs, which is defined as 3 infections in a 12-month period or 2 or more in a 6-month period (including cystitis and pyelonephritis).
UTI is the most common cause of septicaemia in the elderly, with a mortality approaching 50%. Although symptoms suggestive of urinary infection are generally well-known including dysuria, frequency, fever, haematuria, etc. Urinary infection should always be considered and searched for in a noncommunicative patient presenting with fever or sepsis. In this regard a point of care dipstick, if possible, followed by formal culture may be most instructive.
Whilst anti-microbial therapy is the mainstay of management… in this podcast, I was also keen to investigate the role of behavioural changes, hygiene, oestrogen, cream, Methenamine Hippurate, and other approaches to holistic care.
I was also curious to learn how our guest approaches the role of post coital antibiotic dosing (up to 2/3 of women are estimated to benefit from this approach) as well as longer term (3-6 month) low dose antibiotic therapy in managing recurrent UTI.
This was a fascinating conversation with a return guest Dr Tony Amin, a renal physician and educator. I’m very grateful to him for joining us once more.
Please welcome Tony to the podcast.
References:
Dr Tony Amin: www.healthshare.com.au
https://www1.racgp.org.au › April, Recurrent UTIs, and cystitis symptoms in women - RACGP
https://www.ncbi.nlm.nih.gov › pmcGuidelines for the diagnosis and management of recurrent urinary tract ...
www.ncbi.nlm.nih.govRecurrent Urinary Tract Infections Management in Women: A review
www.nature.comNonantibiotic prevention and management of recurrent urinary tract infection
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses, to bring relief to his or her medical problem. The relationship takes the shape of a contract. Equally, a doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. As doctors, we have a duty to obtain prior informed consent from the patient, before carrying out diagnostic tests and therapeutic management. We also need to clearly document our conversations, investigations, and procedures. Communication, consent, and documentation are the big three issues that tend to permeate most medical claims.
It is estimated that 140,000 cases of diagnostic error occur in Australia each year. Of those cases, 21,000 are of serious harm and result in 2,000 to 4,000 deaths. Multiple factors are considered responsible, and any one of these errors may lead to legal dispute. Additionally, communication disputes stemming from a difference in perception and understanding by a patient of what has been discussed and agreed to, are not uncommon. Misunderstandings of fact and or a perceived disregard for patient and families’ emotional concerns, may also lead to litigation. But be mitigated through careful documentation by the practitioner of the consultation undertaken.
Medicolegal entanglement is one of the most uncomfortable situations a doctor may face in his or her professional life. The emotional strain is often felt alone and can be devastating for one’s confidence, reputation, and perception by the community and the subsequent relationship with their peers. No doubt, many in the medical profession feel terribly exposed and subsequently defensive in their medical practice. Which draws another form of attention and possible rebuke from the medical regulators and Medicare.
In this conversation with expert, medical defence solicitor, Rocky Ruperto, I was curious to explore the top ten red flags that can save us from medical perdition, misery, and embarrassment. Rocky is the legal and Policy advisor for the Avant organisation. He advocates for changes to health-related legislation, regulation, and policy with the aim of making a positive difference to the practice of medicine and the Australian healthcare system. Rocky provides legal and educational support to doctors and practices to help reduce their medicolegal risk and improve patients’ safety and quality. Clearly, an excellent resource to converse with. This was an interview I really enjoyed…
Please join me with Rocky.
References:
Rocky Ruperto: rocky.ruperto@avant.org.au
Avant Mutual: www.avant.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au.
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The term Multiple Myeloma was introduced in 1873 by von Rustizky when at autopsy he found 8 separate tumours of the bone marrow in a patient, described as soft in consistency and reddish in colour and thence called “Multiple Myeloma”. Today over 2400 Australians are diagnosed annually with Multiple Myeloma. It is slightly more common in men, with an average age of onset at 70 years. Myeloma accounts for 10% of all haematologic malignancies and about 2% of all cancers diagnosed. The five-year survival is about 51% and with improving therapy options and life expectancy, primary practitioners are very likely to be involved in the shared care of myeloma patients. Each year just over 1000 patients die as a direct consequence of this condition.
An abnormal clone of immunoglobulin-producing plasma cells is responsible for the disease. A precursor called MGUS found in 4% of patients progresses to myeloma at a rate of about 1% per year. The presenting symptoms of Myeloma may be remembered by the mnemonic CRAB standing for: Hypercalcaemia, Renal impairment, Anaemia, and Bone pain or pathological fractures.
Myeloma is not hereditary but may be influenced by radiation exposure and some viruses such as HIV. In about 80% of cases, entire immunoglobulin is secreted by the abnormal plasma cells, in just under 20% light chains only are secreted. These paraproteins may be measured by electrophoresis in the blood or urine in the case of light chains, which may be filtered through nephrons. So-called Bence Jones proteins. Less than 2% of myeloma is nonsecreting. Radiology including plain X-ray and CT, bone marrow biopsy, and cytogenetics are also essential in patient work and we will discuss this with our guest in more detail shortly.
Treatment is complex including a host of therapies such as:
· Thalidomide and Lenalidomide dexamethasone - enhancing T cell and NK cell activity
· Cyclophosphamide and Melphalan - alkylating agents
· Bortezomib - a proteasome inhibitor which inhibits the so-called garbage disposal systems within cells
· Histone deacetylase inhibitors inducing cell cycle arrest
· Monoclonal antibodies
· Radiation of bone deposits
· Stem cell transplantation
· Palliation
We will discuss these therapies as well as risk stratification and prognosis with our guest Dr Jeremy Er, haematology fellow at Peter MacCallum clinic Melbourne. There he is undertaking a PHD on Multiple Myeloma, investigating growth factors influencing myeloma, and remains very passionate about expanding our therapeutic options and success in treating Myeloma.
Please welcome Jeremy Er.
References:
Dr Jeremy Er: petermac.org
Myeloma-Causes, Symptoms and Treatments - Cancer Council: www.cancer.org.au
Myeloma.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Non-alcoholic fatty liver disease has emerged as one of the more important clinical problems being faced by primary care clinicians and hepatologists and is estimated to affect 20-30% of our population. Closely linked to metabolic syndrome, insulin resistance and diabetes, an increasing prevalence of this condition mirrors the rising average BMI of western societies.
Decompensated cirrhosis requiring intensive medical management or transplantation and or hepatocellular carcinoma development are all possible sequelae. In one British study in 2008, 12% of patients waiting for transplantation had cirrhosis from NASH. About 11% of NASH patients ultimately are at high risk of death from liver-related illness.
Liver hardness may be evaluated using a Fibroscan which measures the velocity of an induced vibration wave (the ‘shear wave’) generated on the skin by a non-invasive probe and checks the time the vibration wave takes to travel to a particular depth inside the liver. Because fibrous tissue is harder than normal liver, the degree of hepatic fibrosis can be inferred from the liver hardness. As more fibrosis and scarring occur, the higher the liver stiffness reading will be. Taking about ten minutes the test is very useful in the assessment of patients with all forms of chronic liver disease not just fatty liver including chronic hepatitis C, chronic hepatitis B and chronic alcohol abuse. By providing an estimate of the existing degree of liver damage fibre scanning enables accurate non-invasive monitoring of disease progression or regression via serial measurements. This information is helpful in gauging prognosis and in helping determine further management strategies.
Results are expressed in kilopascals (kPa). Fibroscan results may range from 2.5 kPa to 75 kPa. Between 90 –95% of healthy people without liver disease will have a shear wave measurement of <7.0 kPa (median is 5.3 kPa). Validation studies, including comprehensive systematic reviews of studies that have used liver biopsy as the ‘gold standard’ for assessing liver scarring, have indicated the optimal cut-off for the detection of cirrhosis is around 14 kPa. A patient with chronic hepatitis C and a liver stiffness >14 kPa has approximately a 90% probability of having cirrhosis, while patients with liver stiffness >7 kPa have around an 85% probability of at least significant fibrosis.
Fibroscan measurements now play an important role in liver disease assessment and management, consequently the utility of the Fibroscan has become an essential part of the diagnostic tool kit widely relied upon by hepatologists.
I was keen to explore this topic in more detail with our guest Michael Braude who has just completed a PhD exploring liver disease and mental health and is currently involved in establishing a fully integrated metabolic fatty liver clinic at Monash Health bringing his own enthusiasm and intellect to this well-needed community service…
Please welcome Michael to the podcast
References:
Dr Michael Braude: www.gihealth.com.au,monashhealth.org
Nonalcoholic Fatty Liver Disease: www.niddk.nih.gov
Fibroscan and transient elastography: www.racgp.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Functional hands and fingers are taken for granted until they are damaged by disease or injury. The hand is an incredibly complex structure tasked with fine motor skills as well as the power of grip. Its incredible sensory connections communicate to us the beauty of touch, and the importance of temperature and texture and serve as a vital link in our relationship with the world.
The hand is stabilised by a complex set of carpal bones comprising the wrist and invested with amazing articulations, vessels and nerves. Similarly, the importance of the elbow cannot be underestimated, made up of three bones joined together as a hinge joint- fractures, dislocations and inflammation including of the lateral or medial epicondyles or tendons may have devastating functional consequences.
I was curious therefore to explore the branch of orthopaedics that so expertly deals with these clinical problems.
Jason Harvey is an internationally trained Melbourne Orthopaedic surgeon with a special interest in hand, wrist and elbow surgery. He has a fascinating back story to his career, training at the “House of God” -Beth Israel Hospital in Boston and at UCLA-California and on return to Australia, apart from establishing a busy private practice, he has worked in the role of Director of training in Orthopaedics -Monash Health, Dandenong and as the Deputy Director of Training of Orthopaedics for the Victoria - Tasmania training region. He is actively involved in advanced teaching courses in hand, wrist and elbow surgery and is renowned as the ‘go-to’ for our local AFL sports stars with hand, wrist and elbow injuries-an impressive accolade. It was a great privilege to have this conversation with Jason covering aspects of his training and specialty which I am sure you will enjoy.
References:
Jason Harvey-osv.com.au
www.racgp.org.au: Hands, fingers, thumbs-assessment and management
www.msdmanuals.com
The House of God - Samuel Shem, Random House
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Musculoskeletal disorders are a common cause of long-term disability and are estimated to make up about 15% of the workload of general practitioners. Joint pain specifically is also extremely common, especially as one ages. In one national survey, one-third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint followed by shoulder and hip pain.
Epidemiological studies suggest that there is a large reservoir of patients with significant musculoskeletal disorders who do not consult with health services at all, contributing to community malaise and common problems such as soft tissue pain, back pain and minor arthritides that may often go untreated in the community.
When such patients do present in primary practice the practitioner must remain alert to the possibility such presentations could also reflect an emerging more serious rheumatic or nonrheumatic condition.
The practice of rheumatologic medicine embraces a wide range of conditions making this field of medicine incredibly interesting. Apart from “wear and tear” -osteoarthritis which is the most common type of arthritis there are inflammatory autoimmune conditions to consider such as rheumatoid, ankylosis spondylitis and lupus for example, crystal arthropathies and then the very large group of strains, sprains, other injuries and fibromyalgia which can all be expected as clinical problems to be managed in primary practice.
Doctor Mirza Baig is a general physician with an interest in rheumatological diseases and has a busy medical practice extending across metropolitan and rural communities. It was a great privilege to have this conversation with Mirza across two episodes embracing a practical approach to inflammatory and noninflammatory joint disease and joint counselling as well as practical tips for the management of fibromyalgia. Please welcome Dr Mirza Baig.
References:
Dr Mirza Baig : www.sjog.org.au
fibromyalgiaausralia.org.au
www.rheumatology.org
www.ncbi.nlm.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Musculoskeletal disorders are a common cause of long-term disability and are estimated to make up about 15% of the workload of general practitioners. Joint pain specifically is also extremely common, especially as one ages. In one national survey, one third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint followed by shoulder and hip pain.
Epidemiological studies suggest that there is a large reservoir of patients with significant musculoskeletal disorders who do not consult with health services at all, contributing to community malaise and common problems such as soft tissue pain, back pain and minor arthritides that may often go untreated in the community.
When such patients do present in primary practice the practitioner must remain alert to the possibility such presentations could also reflect an emerging more serious rheumatic or nonrheumatic condition.
The practice of rheumatologic medicine embraces a wide range of conditions making this field of medicine incredibly interesting. Apart from “wear and tear” -osteoarthritis which is the most common type of arthritis there are inflammatory autoimmune conditions to consider such as rheumatoid, ankylosis spondylitis and lupus for example, crystal arthropathies and then the very large group of strains, sprains, other injuries and fibromyalgia which can all be expected as clinical problems to be managed in primary practice.
Doctor Mirza Baig is a general physician with an interest in rheumatological diseases and has a busy medical practice extending across metropolitan and rural communities. It was a great privilege to have this conversation with Mirza across two episodes embracing a practical approach to inflammatory and noninflammatory joint disease and joint counselling as well as practical tips for the management of fibromyalgia. Please welcome Dr Mirza Baig.
References:
Dr Mirza Baig : www.sjog.org.au
fibromyalgiaausralia.org.au
www.rheumatology.org
www.ncbi.nlm.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Colorectal cancer is one of the most common cancers diagnosed in Australia with about 15,500 cases reported last year accounting for 10% of all new cancer diagnoses. Death from colorectal cancer at about 5300 yearly ranks only second behind lung cancer and accounts for about 10% of all cancer deaths in Australia highlighting the importance of its early detection and treatment.
Recognising these critical statistics the National Bowel Cancer Screening Program (NBCSP) was conceived and commenced in 2006 and by 2019 all Australians aged between 50 and 74 years were invited to participate in biennial faecal occult blood test screening for human haemoglobin using an immunochemical methodology as a surrogate marker of more serious internal colonic disease.
Although the current participation in the NBCSP is only a little more than 40%, the program is estimated to reduce the mortality rate from colorectal cancer by 15 to 25% and save about 1300 lives per year (more than deaths from road accidents annually). It is extremely important as clinicians that we support and promote this excellent screening initiative.
In this podcast, I was curious to learn how we may increase the national participation rate of this screening program as well as to review the performance characteristics of the immunochemical FOBT. I was also interested to review who should have an FOBT and who should not.
It was a real privilege to have a conversation with Professor Finlay Macrae on this important subject who is the head of colorectal medicine and genetics at the Royal Melbourne Hospital. Professor Macrae has public and private practices focusing on inflammatory bowel disease and familial bowel cancer. He trained both in Melbourne and at St Marks Hospital in London and has undertaken a significant body of clinical research in colon cancer prevention and detection. In 2016 he was awarded the Order of Australia for his work in genetics and genomics.
Professor Macrae has been close to the administration of the National bowel cancer screening program and remains on its clinical advisory group, he was, therefore, an obvious choice of the expert guest to discuss FOBT in the Australian context and it was a great privilege to have this conversation with him.
References:
Professorfinlaymacrae.com
National Bowel Cancer Screening Program, Australian Government: www.health.gov.au
Bowel Cancer in Australia statistics,www.canceraustralia.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In the last 12 months, 121,000 Australians were diagnosed with diabetes, this statistic represents a 7% increase from the preceding year. There are now over 1.236 million Australians with type 2 diabetes and over 129,000 with type 1 diabetes and about 50,000 Australians have gestational diabetes each year -these staggering figures mean that 332 new diagnoses occur each day, about one new case every 5 minutes.
In respect to type 2 diabetes, the metabolic syndrome secondary to the obesity epidemic would appear to be a major contributor to new diagnoses. Australia ranks 6th highest amongst OECD countries (Organisation for Economic Cooperation and Development) in relation to its overweight and obese citizen with 67% characterised as overweight or obese (36% overweight, 31% obese).
In this podcast, I was curious to explore how our society might stem the increasing number of cases that are contributing to the major public health epidemic we are facing. Is a sugar tax warranted for example as has been introduced in the United Kingdom? Do we need more health campaigns explaining what a healthy lifestyle and eating plan should look like?
From the pharmacological perspective we are fortunate in having some relatively new and effective drugs added to our therapeutic armamentarium available to tackle type 2 diabetes and these have opened up some exciting new management possibilities with impressive outcomes.
In this conversation with Associate Professor Ekinci, I was keen to understand the place of all these new medications in treatment strategies and the target haemoglobin A1C clinicians should be aiming for.
I was also keen to discuss when insulin should be added to manage type 2 diabetes noting that 40 to 50% of Beta cell function is lost by the time of diagnosis and it is estimated that a further 4-5% of function is lost each subsequent year.
Another exciting line of conversation I had hoped to explore related to new initiatives in the management of type one diabetes in relation to continuous glucose monitoring which in the lead-up to the federal election both major political parties have made firm commitments to support.
Assoc Professor Elif Ekinci is the Sir Edward Dunlop Principal Research Fellow in Medicine at Austin Health and the Dame Kate Campbell Fellow at the University of Melbourne. Elif is a clinician-researcher and an academic endocrinologist who is working to translate research into improved outcomes for people with type one and type 2 diabetes. Her research is focused on the pathophysiology, prevention, detection and treatment of diabetes and its complications through mechanistic studies, observation studies and clinical trials. Elif has received multiple awards for her work in diabetes and is clearly on a stellar career trajectory. It was an incredible privilege to have this conversation with her. Please welcome Assoc Prof Elif Ekinci to the next two episodes.
References:
Assoc Professor Elif Ekinci-Endocrinology Melbourne-www.endocrinologymelb.com.au
Diabetes-Australian Institute of Health and Welfare: www.aihw.gov.au
www.uptodate.com
In the last 12 months, 121,000 Australians were diagnosed with diabetes, this statistic represents a 7% increase from the preceding year. There are now over 1.236 million Australians with type 2 diabetes and over 129,000 with type 1 diabetes and about 50,000 Australians have gestational diabetes each year -these staggering figures mean that 332 new diagnoses occur each day, about one new case every 5 minutes.
With respect to type 2 diabetes, the metabolic syndrome secondary to the obesity epidemic would appear to be a major contributor to new diagnoses. Australia ranks 6th highest amongst OECD countries (Organisation for Economic Cooperation and Development) in relation to its overweight and obese citizen with 67% characterised as overweight or obese (36% overweight, 31% obese).
In this podcast, I was curious to explore how our society might stem the increasing number of cases that are contributing to the major public health epidemic we are facing. Is a sugar tax warranted for example as has been introduced in the United Kingdom? Do we need more health campaigns explaining what a healthy lifestyle and eating plan should look like?
From the pharmacological perspective, we are fortunate in having some relatively new and effective drugs added to our therapeutic armamentarium available to tackle type 2 diabetes and these have opened up some exciting new management possibilities with impressive outcomes.
In this conversation with Associate Professor Ekinci, I was keen to understand the place of all these new medications in treatment strategies and the target haemoglobin A1C clinicians should be aiming for.
I was also keen to discuss when insulin should be added to manage type 2 diabetes noting that 40 to 50% of Beta cell function is lost by the time of diagnosis and it is estimated that a further 4-5% of function is lost each subsequent year.
Another exciting line of conversation I had hoped to explore related to new initiatives in the management of type one diabetes in relation to continuous glucose monitoring which in the lead-up to the federal election both major political parties have made firm commitments to support.
Assoc Professor Elif Ekinci is the Sir Edward Dunlop Principal Research Fellow in Medicine at Austin Health and the Dame Kate Campbell Fellow at the University of Melbourne. Elif is a clinician-researcher and an academic endocrinologist who is working to translate research into improved outcomes for people with type one and type 2 diabetes. Her research is focused on the pathophysiology, prevention, detection and treatment of diabetes and its complications through mechanistic studies, observation studies and clinical trials. Elif has received multiple awards for her work in diabetes and is clearly on a stellar career trajectory. It was an incredible privilege to have this conversation with her. Please welcome Assoc Prof Elif Ekinci to the next two episodes.
References:
Assoc Professor Elif Ekinci- Endocrinology Melbourne-www.endocrinologymelb.com.au
Diabetes-Australian Institute of Health and Welfare: www.aihw.gov.au
www.uptodate.com
The provision of healthcare to our indigenous population provides both a privilege and a challenge for administrators, doctors, nurses and allied healthcare workers. For most of us living far away in metropolitan centres, comfortably ignorant and sheltered from these very real challenges we can only begin to imagine the cultural sensitivities, demands and clinical problems at hand.
The central Australian aboriginal Congress (CAAC) was established in 1973 to find health care solutions and to provide support and advocacy for aboriginal people in the struggle for justice and equity. Congress is the largest and oldest aboriginal community-controlled health organisation in the Northern Territory providing culturally appropriate holistic primary care to aboriginal people living in Alice Springs and within a 100 km radius of Alice including 5 remote communities. Congress also has four clinics in Alice Springs itself and their many services are designed to meet the needs of Aboriginal and Torres Strait Islander people in central Australia.
Congress is a strong political advocate of closing the gap in both health and life outcomes amongst aboriginal people and a leader in improving health care outcomes for all aboriginal people.
I had the opportunity of reaching out to Dr Sam Heard who is the medical director of Congress and associate Professor at Flinders University whilst he was on holiday in the Mornington Peninsula. I wanted to find out more about Congress and the typical life of a doctor working in Alice Springs with Aboriginal health. It is a reflection of his generosity and character that he accepted this invitation whilst on vacation. Sam is not only incredibly well credentialled as a medical practitioner with many decades of experience and contribution to indigenous health in the provision of expert health care in the top end he has also been a major contributor to the electronic health record standards in Australia, Europe and the USA. His comprehensive knowledge of health sciences has gained him worldwide recognition and acclaim. Sam was awarded a medal of the order of Australia (OAM) in the 2019 Queen's birthday honours for his services to medicine. Beyond his work at Congress, he also finds time to play guitar in a band he started called cheeky docs which plays regularly at conferences and other venues and is a keen mountain bike rider.
Please enjoy this conversation with Sam
References:
Sam.heard@caac.org.au
caac.org.au
mycommunitydirectory.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Photon therapy is interesting in allowing delivery of energy to internal malignancies with relative tolerance at the level of the skin.
Radiation dose is measured as energy per unit mass -where 1 J/kg is 1 Gray.
In this podcast I was joined by Dr Marcus Foo who is a radiation oncologist with Genesis Care. Marcus graduated from the University of Melbourne in 2000 and trained in radiation oncology at the Peter MacCallum Cancer Centre before undertaking a clinical and research fellowship at the BC Cancer Agency in Vancouver, Canada focusing on gastrointestinal, breast and genitourinary oncology. He has strong interest in stereotactic radiation therapy and image-guided radiation therapy. I was keen to discuss with Marcus the principles of radiation oncology in more depth and understand much of the terminology used such as ‘fractionated radiotherapy’, ‘external beam’, ‘brachytherapy’, ‘stereotactic’ and ‘palliative therapy'. This conversation is covered across two very interesting episodes. I hope you enjoy the interview and I am pleased you have joined us.
References:
Dr Marcus Foo: www.genesiscare.com
Introduction to Radiation Oncology: www.astro.org
Introduction to Radiation Oncology : Apicelli, Parikh and Zoberi, Haematology and Oncology Subspecialty Consult, 4th Ed,Wolters Kluwer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Photon therapy is interesting in allowing delivery of energy to internal malignancies with relative tolerance at the level of the skin.
Radiation dose is measured as energy per unit mass -where 1 J/kg is 1 Gray.
In this podcast I was joined by Dr Marcus Foo who is a radiation oncologist with Genesis Care. Marcus graduated from the University of Melbourne in 2000 and trained in radiation oncology at the Peter MacCallum Cancer Centre before undertaking a clinical and research fellowship at the BC Cancer Agency in Vancouver, Canada focusing on gastrointestinal, breast and genitourinary oncology. He has strong interest in stereotactic radiation therapy and image-guided radiation therapy. I was keen to discuss with Marcus the principles of radiation oncology in more depth and understand much of the terminology used such as ‘fractionated radiotherapy’, ‘external beam’, ‘brachytherapy’, ‘stereotactic’ and ‘palliative therapy'. This conversation is covered across two very interesting episodes. I hope you enjoy the interview and I am pleased you have joined us.
References:
Dr Marcus Foo :www.genesiscare.com
Introduction to Radiation Oncology: www.astro.org
Introduction to Radiation Oncology : Apicelli, Parikh and Zoberi, Haematology and Oncology Subspecialty Consult, 4th Ed,Wolters Kluwer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In the September 25-26 edition of the weekend Australian magazine, I was drawn to a very interesting feature article reviewing the book Hippocrasy co-written by Professor Rachelle Buchbinder who is a rheumatologist as well as director of the Monash Cabrini Department of musculoskeletal health and clinical epidemiology at Cabrini Hospital and Professor of clinical epidemiology at Monash University with Ian Harris who is an orthopaedic surgeon at Liverpool St George and Sutherland hospitals and Professor of Orthopaedic surgery at the University of New South Wales Sydney and Honorary Professor at University of Sydney. The article was confronting in that it raised concerns that many of the medical procedures and treatments we are engaged with as clinicians may not help patients and that over diagnosis and the “medicalisation of normal” may be leading to a medical system failure.
The question the authors ask us to consider is whether doing a specific medical procedure or intervention is better for the patient than not doing it and they set the context of this question by drawing from a wide review of studies within the framework and reflecting of the Hippocratic oath. I subsequently purchased and read Hippocrasy which was as illuminating as it was confronting and would strongly recommend this book as essential reading for all doctors both graduated and training and hope it becomes a staple for medical students everywhere. Hippocrasy asks us to question the true value of specific medical practice, to choose wisely and to recognise cognitive dissonance and confirmation bias noting that up to a third of medical care may be of no value and that up to 10% of treatments and interventions may be harmful with medical error the third leading cause of death in the United States. We should all strive to practice evidence-based medicine when possible and there are many organisations such as the United Kingdom National Institute for Health and Care Excellence, Cochrane Collaboration and the United States Preventative Services Task force to guide us.
In this podcast with Rachelle Buchbinder, we discuss Hippocrasy in more detail including how the problem of the medicalisation of normal has arisen and what needs to change. Please join me on this interesting conversation.
References :
Prof Rachelle Buchbinder:www.malvernrheumatology.com
Hippocrasy: Buchbinder and Harris, NewSouth Publishing, 2021
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The field of regenerative medicine is likely to significantly change how we practice medicine in the future with some amazing capabilities -harnessing the power of stem cells to restore form and function of damaged tissue. The potential of regenerative medicine has already being recognised in the areas of immunotherapy and bone marrow transplantation however the future is likely to see many further shining examples of its promise ,application and capability. Consider the possibility of injecting cardiac stem cells into the surrounding viable ventricular myocardium adjacent to an acute myocardial infarction providing functioning myocardial cells to restore cardiac output or indeed replacing a damaged organ such as a cirrhotic liver allowing restored hepatic synthetic function.
A group of scientists at St Vincent's Institute of Medical Research in Melbourne with co lead researcher Kiryu Yap are attempting to do just that. Following a breakthrough over 4 years ago their team has the aim of growing entire lobes of the liver by taking patients’ blood and carefully reprogramming cells to become stem cells .This technology became available after the amazing techniques described by Sir John Gurdon and Shinya Yamanaka who discovered that mature cells can be reprogrammed to become pluripotent leading to their 2012 Nobel Prize in Physiology and Medicine.
It is known that about 7000 Australians die each year from chronic liver disease and that 260 livers are transplanted each year between Australia and New Zealand so if this bold project is successful, it will provide significant value to patients suffering with advanced and deteriorating liver disease. After genetically reprogramming cells to become pluripotent stem cells the application of very specific nutrients exerts the appropriate epigenetic effect to induce tiny liver cells. The plan is to implant these into the groin of patients where the small liver buds will be supported by the patient's blood vessels before the liver lobe is eventually harvested and transplanted to replace the diseased organ. Please join this fascinating discussion with Kiryu.
References:
Dr Kiryu Yap-School of Biomedical Sciences-University of Melbourne
www.svi.edu.au- Vacular biology-St Vincents Institiue of Medical Research-Dr Kiryu Yap
www.nobelprize.org- The 2012 Nobel Prize in Physiology or Medicine
www.anzdata.org.au
https:/transplant.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
About 7 million Australians, around 28% of our population, live in rural and remote areas encompassing many diverse locations and communities that in some instances have poor access to the medical services we may take for granted in metropolitan centres. Higher rates of hospitalisations, deaths and injury are reported from remote and rural areas and statistics show that remote and very remote areas experience a greater burden of disease and injury compared to major city populations (about 1.4 times). The practice of medicine in such communities requires a higher level of medical literacy.
On average, people living in remote and very remote areas are younger than those in major cities and 18% of people living in remote and 47% in very remote areas are indigenous (aboriginal or Torres Strait Islander people) compared to 1.7% in major cities. Health risk factors such as smoking overweight and obesity, diet, high blood pressure, alcohol consumption and physical activity are just some of the factors influencing health outcomes.
The Doctors, nurses, paramedics and hospital staff working at remote locations must be capable of dealing with a wide range of medical, surgical, obstetric, paediatric and psychiatric conditions that may present as emergencies. Where support help such as tertiary transfer may be hours or days away it takes a special team to come together to manage such difficulties. It was a great pleasure to interview Etienne Cawood who has spent the majority of his medical career working in rural and remote locations throughout the length and breadth of Australia and we him great debt gratitude for his services.
References:
Etienne Cawood :ejcawood@gmail.com
Rural and remote health. aihw.gov.au
Australian College of rural and remote medicine. mycollege.acrrm.org.au
www.jcu.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The journey from the VCE student to University and medical studies is highly competitive and never easy and for those undertaking a postgraduate degree in medicine, the graduate medical school admissions test-GAMSAT-designed to assess the capacity to undertake high-level intellectual studies in the medical and health professional programmes provides yet a further hurdle. Dr Nick Shearer completed his postgraduate medical studies at Deakin University before choosing and being accepted as an intern at the Northern Hospital Epping. In his dream of becoming a doctor he was immediately thrust into the incredible difficulty of not only managing the brutal responsibilities of internship but even more the harsh reality of coping with the COVID-19 pandemic at the very interface between disease and treatment in a hospital tasked with frontline COVID-19 responsibilities. Donning personal protective equipment for the entire year and honing his communication skills with often frustrated and frightened patients and their relatives Nick has become a shining example of how good our medical personnel and profession can function and be in a time of deep crisis.
For his insights please welcome Dr Nick Shearer to the conversation.
References :
gamsat.acer.org
www.nh.org.au
www.deakin.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias. Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress, there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interest in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.wileymedicaleducation.com
www.sciencedirect.com
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias . Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew -haematology advanced trainee at the Peter MacCallum Cancer Centre with special interests in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.wileymedicaleducation.com
www.sciencedirect.com
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias . Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interests in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.wileymedicaleducation.com
www.sciencedirect.com
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Venous thrombosis affects more than 30,000 Australians each year and is responsible for over 5000 deaths per annum, this is more than the number of Australians who die from motor vehicle accidents annually. VTE is the third leading cause of death amongst hospitalised patients and patients admitted to hospital are at least 100 times more likely of developing a clot compared to being active in the community-a risk that may be assessed by the modified Wells criteria.
Tellingly 60% of all venous thromboembolisms occur within 90 days of hospitalisation and importantly it is predicted that up to 70% are preventable.
It is also estimated that about 50% of patients with an untreated proximal deep vein thrombosis will develop a symptomatic pulmonary embolus within 3 months …half of these cases are asymptomatic, however, in 25% of cases sudden death is the first symptom.
Whilst 10% of clots form either in the upper limbs or mesenteric system, the vast majority of clots-90%- occur in the lower limbs. Although pulmonary emboli may include fat, amniotic fluid, may be septic or be formed from contaminants such as talc we will restrict discussions in this podcast to blood clots and focus on lower limb clots.
This is potentially a huge subject with multiple factors leading to abnormal clotting, excessive clotting, and subsequent potentially fatal thromboembolism. The more one considers coagulation in both the normal and pathophysiologic states the more fascinating the subject becomes. No wonder then that Associate Professor Sanjeev Chunilal from Monash Health has developed a deep interest and expertise in this subject. Sanjeev completed a clinical and research fellowship in venous thromboembolism at McMaster University Ontario Canada, has published widely and is a member of the International Society of Thrombosis and Haemostasis as well as the Australasian Society of Thrombosis and Haemostasis, please welcome Sanjeev to the podcast.
References:
Associate professor Sanjeev Chunilal: jessiemcpherson.org, monashpathology.org
www.ncbi.nlm.nih.gov: Deep venous Thrombosis: pathogenesis, diagnosis, and medical management,2017
Khan Academy-khanacademy.org
Australian Family Physician VOL 39, No 7 July 2010
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The Guillain Barre syndrome is an acute inflammatory demyelinating polyradiculopathy and although relatively rare (0.4-2 per 100,000) it is still the most common cause of acute flaccid neuromuscular paralysis worldwide. It famously affected Joseph Heller author of Catch-22 and more recently AFL football Legend Alexander Clarkson. It is an immune-mediated disorder that affects the peripheral nervous system and is another example of molecular mimicry, occurring 1 to 6 weeks after a respiratory infection, Campylobacter enterocolitis, and rarely after trauma or surgery. In 1 in a million cases, GB may develop after the influenza vaccine.
Myasthenia gravis is an autoimmune disorder most commonly observed in women under the age of 40 years and in men over the age of 60 years where antibodies form against the nicotinic acetylcholine receptor at the neuromuscular junction (85% of cases), muscle-specific tyrosine kinase (MuSK 7-10%) or low-density lipoprotein receptor-related protein 4 (LRP 4-5%)-the MuSK 7 and LRP4 are both important to the health of the neuromuscular junction. MG results in muscle fatigue especially of the eyes, facial muscles and bulbar muscles.
To discuss these two interesting conditions we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has major clinical expertise in the management of both acute and chronic neurological conditions, please join me in this conversation with Ernie.
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).
Environmental and genetic factors play a role in the aetiology with a higher incidence of multiple sclerosis identified in patients living north of 40 degrees (north of Beijing and including much of Europe Russia the northern parts of the United States and Canada) or South of 40 degrees (Tasmania) raising speculation about the role of ultraviolet light and vitamin D. MS is 15 times more likely when a 1st-degree relative is affected and concordance with monozygotic twins is about 25%. Obesity, smoking, high intake of dietary saturated fats and Epstein-Barr virus have also been implicated.
Despite the distressing nature of this neurodegenerative condition many treatments are evolving to manage both acute episodes (steroids, plasmapheresis) and to prevent further damage (from Interferon beta and Glatiramer acetate to Ocrelizumab, Natalizumab and Stem cell therapy amongst others).
To guide us through this complex subject we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has a major clinical expertise in the management of multiple sclerosis amongst many other acute and chronic neurological conditions, please join me in this conversation with Ernie.
References:
Assoc professor Ernie Butler: Frankston neurology.com.au
www.ms.org.au
www.ninds.nih.gov , Multiple sclerosis : Hope Through Research
www.sciencedirect.com , Multiple Sclerosis-an overview
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.
Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome. Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.
NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.
Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.
I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown. Please welcome them to this two-part podcast.
REFERENCES:
petermac.org
neuroendocrine.org.au
www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)
www.sciencedirect.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.
Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome.
Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.
NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.
Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.
I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown.
Please welcome them to this two-part podcast.
REFERENCES:
petermac.org
neuroendocrine.org.au
www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)
www.sciencedirect.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Pancreatic cancer is the eighth most common cancer reported in Australia. In 2021, it is estimated that there will be 4261 new cases and 3391 deaths. The incidence has increased from 10 per 100,000 in 1982 -to 12 per 100,000 today with the average age of onset between 60 and 65 years. At the time of diagnosis, approximately one-third of patients already have advanced disease with a limited 3 to 4-month survival prognosis, overall, 1-year survival for pancreatic cancer is only 16% and 5-year survival of 3% despite new approaches to management.
Risk factors include obesity, smoking (fivefold increase risk) and type 2 diabetes mellitus which after cigarette smoking and obesity is likely the third most modifiable risk factor for pancreatic cancer.
Other risks include family history (7%) and autosomal dominant syndromes such as Hereditary pancreatitis, Peutz-Jeghers syndrome, Hereditary breast and ovarian cancer syndrome (BRCA 2 and 1 genes), and Lynch syndrome and the Familial atypical multiple mole melanoma syndromes.
Additionally, there is probably a risk associated with ongoing heavy alcohol consumption and subsequent chronic pancreatic inflammation.
After imaging and subsequent diagnosis, staging determines locally respectable, borderline respectable, locally advanced unresectable or metastatic disease, and guides the choice of surgery, chemotherapy, radiotherapy and or palliation.
It was a privilege to be joined in this conversation by Dr Michael Lee from the Peter McCallum Cancer Centre, an oncologist specialising in clinical translational genomic research and advanced cancers with a special focus on metastatic pancreatic cancer. Michael trained in Australia and subsequently worked in Vancouver at the BC Cancer and Michael Smith's Science Centre before returning to Melbourne where he is undertaking a PhD with the aim of developing a new novel therapy for pancreatic cancer. Michael’s motto is to provide holistic oncology care with an honest conversation, supported by the latest research from the bench side to the bedside and tailoring it to his patient’s goals and wishes.
References:
www.petermac.org
canceraustralia.gov.au
www.cancer.org.au
www1.racgp.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
As case numbers and deaths continue to climb from Covid 19 infection and its many variants, two antiviral drugs have entered the market and are now available on the Australian PBS with specific prescription criteria to be met. So, what are they and what do they do?
Molnupiravir - Made by Merck in collaboration with Ridgeback Biotherapeutics was the 1st to be introduced to Australia as a trade named Lagevrio available from March 1st. This drug is a polymerase inhibitor administered as four tablets twice daily for a five-day course and works by stopping Covid 19’s genetic material from being replicated accurately. By inhibiting the virus’s own polymerase, it induces replication errors so that ultimately the virus is unable to survive with these. This is the so-called catastrophe method. A question for our guest relates to this drug’s safety…. for example: Could this drug also affect host enzymes?
Paxlovid - takes a different approach the drug consists of Nirmatrevir, and an existing drug called Ritonavir. These are protease inhibitors affecting the viral proteases which cut apart long strands of non-functional viral protein into smaller functional proteins. Nirmatrevir is the drug working on this whilst Ritonavir prevents other enzymes from destroying Nirmatrevir. Ritonavir may be found elsewhere and used in anti-HIV cocktails. Paxlovid is also taken BD for five days.
These drugs are most effective when given early and the PBS criteria states these drugs are for adults who have mild to moderate COVID-19 confirmed by a PCR or medically verified RAT and who can start treatment within 5 days of symptom onset if:
o they are 65 years of age or older, with two other risk factors for severe disease (as increasing age is a risk factor, patients who are 75 years of age or older only need to have one other risk factor); or
o they identify as Aboriginal or Torres Strait Islander origin and are 50 years of age or older with two other risk factors for severe disease, or
o they are moderate to severely immunocompromised.
We should draw attention to:
Evushield (Tixagevimab+ Cilgavimab) and Sotrovimab
We need a primer on who should receive these and will discuss this with our guest shortly.
And what about other drugs that have at times perhaps controversially been recommended around the globe such as?:
Chloroquine and Ivermectin
And then is there an early place for steroid prescription?
To expand our knowledge on this emerging and complex subject please welcome to the podcast Dr Alex Tai Infectious Diseases specialist with a special interest in public health, tropical medicine, multi drug microbial resistance and travel medicine.
For more information on this episode please visit: https://www.gihealth.com.au/everyday-medicine-podcast-blog/special-episode-11-anti-virals-for-covid-19-with-dr-alex-tai
References:
Dr Alex Tai-Infectious Diseases Physician-
www.bawbawphysicians.com.au
www.health.gov.au
What GPs need to know about the new Covid antivirals: www1.racgp.org.au
Antiviral treatments for Covid 19-NPS MedicineWise-www.nps.org.au
Liverpool COVID -19 Interactions : www.covid19-druginteractions.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:
References:
www.melbournehaematology.com.au
www.ncbi.nlm.nih.gov
www.cancer.org
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Lymphoma is a clonal neoplastic proliferation of lymphoid cells (B cells, T cells and NK cells) and is the sixth most common malignancy reported in this country which makes it the most common hematologic malignancy with over 5000 cases diagnosed each year in Australia putting lifetime risk at 1 in 50.
There are over 70 different types of lymphoma which are divided into 2 main groups: Hodgkin's lymphoma accounts for 10% of cases and non-Hodgkin's lymphoma accounts for 90% of cases.
Hodgkin's lymphoma named after Thomas Hodgkin (1832) is more common in men, and tends to occur at a younger age than non-Hodgkin's lymphoma with a bimodal age distribution but the average age at diagnosis of 39 years and involves lymph nodes frequently on just one side of the body usually above the diaphragm. The tumour cell is referred to as the Reed Sternberg cell which is a bi or multi-nucleated B cell comprising characteristically just 1% of the lymphoma mass. Just to make this nomenclature interesting there is classic Hodgkins which make up about 95 % of cases and of which nodular sclerosing comprises about 70 % and mixed cellularity 20-25 % and non-classic Hodgkins is characterised by nodular lymphocytic predominant pathology.
Non-Hodgkin's lymphoma can occur at any age and although the median age at diagnosis is 67 years it is one of the more common cancers among children, teens and young adults, none the less the risk of developing NHL increases throughout life and more than half the patients with NHL are 65 years or older at diagnosis. It is also more common amongst men and those with autoimmune diseases or a family history of hematologic malignancies. Presentations often involve the finding of involved lymph nodes on either side of the diaphragm. 85% of non-Hodgkin lymphomas are B cells in origin, and 15% are T cells. The most common the B cell non-Hodgkin lymphomas are diffuse large B cells -accounting for 37% of NHL cases, followed by follicular 29%, Malt 9% and Mantle cells 7%.
This is a complex and vast subject with a number of environmental factors and associated diseases influencing the fascinating pathogenesis of lymphoma which goes to the heart of B cell biology and our immune systems’ task of fighting for our lives against antigen invaders. There are a host of treatment options available with new emerging therapies at the cutting edge of medicine and it was a privilege to have a conversation with Professor Stephen OPAT -and to journey for a short time into his world of haematology. Stephen is the professor and director of clinical haematology at MMC and has a special interest in lymphoma, chronic leukaemia, cancer genomics and disorders of metabolism. I found Stevens’ conversation incredibly insightful and welcome you to this podcast:
References:
www.melbournehaematology.com.au
www.ncbi.nlm.nih.gov
www.cancer.org
www.uptodate.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In May this year, new cases of the rare infection - Monkey Pox - typically limited to Africa, began spreading within Europe and North America.
More than 780 cases have now been reported across 15 countries with Australia recently reporting 8 cases.
www1.racgp.org.au - Monkeypox exposure, a member of the same family of viruses as smallpox and typically is spread through close physical contact with skin lesions, body fluids, respiratory droplets, and conta minated materials such as bedding and is much less infectious than respiratory illnesses such as Covid 19. Transmission of Monkey pox virus by respiratory droplets would normally require prolonged face-to-face contact, so the apparent rapid spread of the virus may signal a shift in its behaviour and some scientists have questioned if the virus may have mutated to become more transmissible. Two strains have been identified.
The west African strain has a 1-3% mortality and is the strain currently spreading beyond Africa. The Central African strain is more deadly with a 10% mortality rate.
Infection is characterised by: Lymphadenopathy, muscle aches, fever, headache, and a pustular rash developing 1-3 days after the fever and typically starting on the face before spreading to other parts of the body.
It’s estimated that just 3% of close contacts of Monkeypox will become infected however asymptomatic spread is being postulated and another unusual feature of the current outbreak is the detection of cases through sexual health services and amongst same-sex men.
As smallpox was declared eradicated in 1980 the last mass vaccination against smallpox was in the 1970’s and it is speculated that declining herd levels of immunity against smallpox may be leading to the current propensity for transmission.
I thought it may also be interesting to expand the conversation with our guest beyond Monkeypox to discuss the recent spike in cases of Japanese encephalitis reported in Australia, noting that JEV is a mosquito-born presenting with fever, vomiting and headache and linked to piggeries as well as pig handling and abattoirs.
Please welcome Dr Alex Tai Infectious Diseases specialist with a special interest in public health, tropical medicine, multi-drug microbial resistance and travel medicine.
References:
Dr Alex Tai-Infectious Diseases Physician-www.bawbawphysicians.com.au
www1.racgp.org.au -Monkeypox exposure
Monkeypox-Fact sheets-NSW Health-www.health.nsw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Dr John Levin practices antiaging medicine and joins this podcast to discuss his practical approach to treatment. As John laments antiaging medicine is not taught in medical school yet he believes the science of anti-ageing holds the key to significantly reducing human suffering and improving health span. Whilst the average human life span continues to increase and modern medicine more efficiently tackles diseases, the science of anti-ageing looks at mechanisms leading to cell degeneration and decay and seeks ways to regenerate cell health and thereby delay the many diseases associated with ageing.
Many believe that regeneration clinics where therapies include removing senescent cells repairing damaged DNA and perhaps topping up a reservoir of stem cells will become a reality sooner than one might think. Until such time, however, the simple caveats of avoiding smoking and excess alcohol, adopting a healthy body mass index, controlling blood pressure and blood sugar levels, exercising, and paying attention to good nutrition, sleep and dental hygiene as well as receiving vaccination should be considered as best proven advice. John's approach dives deeper into the science and includes measurement of serum growth hormone with a physiological replacement only if required and he also uses a number of supplements included in the list below:
ANTI-AGING SUPPLEMENTS New York Academy of Science journal: work done by Cardiac Surgical Research Unit, Alfred Hospital, the Baker Heart Research Institute Melbourne and Department of Biochemistry and Molecular Biology Monash University showed that Co-Enzyme 010, Alpha Lipoic Acid and Magnesium Orotate helped protect the aging heart against stress. In addition, work performed by the Karolinska Institute in Sweden showed that adding Selenium to Co-Q10 improved heart function and slashed mortality risks by almost 5O%. POO (Pyrroloquinoline Quinone) not only protects mitochondria from oxidative stress -it promotes the spontaneous generation of new mitochondria within aging cells, a process known as 'mitochondrial biogenesis'.
Carnosine can provide benefits to cells and tissues throughout the body that would otherwise succumb to the pathological effects of aging. Over 2000 studies have shown the beneficial effects in preventing age-related diseases such as type 2 diabetes, cardiovascular disease, dementia and cancer. Pterostilbene has multiple benefits in the treatment and prevention of human disease due to its antioxidant, anti-inflammatory and anticarcinogenic properties. Dr Bruce Ames, a world-renowned biochemist at the University of California showed that Acetyl L-Carnitine and Alpha Lipoic Acid could provide protection against the pathological hallmarks of aging. L-Citrulline increases your L-arginine which is converted into nitric oxide which causes blood vessels to dilate and helps lower blood pressure. It helps the brain function by promoting greater circulation to the brain. It also helps the body get rid of ammonia in the form of urea.
Fisetin research by the Mayo Clinic shows it helps get rid of senescent cells (Cells that no longer divide). These cells accumulate with age and at sites of multiple chronic conditions such as diabetes, lungs in chronic pulmonary diseases, vascular diseases and joints in osteoarthritis. NMN (Nicotinamide Mononucleotide) Professor David Sinclair, professor of Genetics at Harvard University says that this molecule is the missing key to regenerating healthy cells through 'old' age allowing your youthful existence to be sustained for much longer. Metformin New research is suggesting that metformin may hold promise in treating or preventing a whole host of conditions. It may be cardioprotective, it may prevent cancer, be neuroprotective and reduce dementia and stroke risk. D-Ribose Is involved in the energy production in all cells of the body.
PCOS is the most common endocrinopathy of reproductive age women affecting about 1 in 10. Characteristically the condition presents with menstrual irregularity, excess androgens, and polycystic ovarian morphology. More common in women with a family history and type 2 diabetes the condition is associated with obesity, infertility, pregnancy complications and metabolic derangements as well as a number of psychological consequences.
In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well-being, and more informed patients. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.
References:
Dr Mei Cheah -create-health.com.au
www.jeanhailes.org.au
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Endometriosis is the presence of endometrial tissue outside the uterus or embedded within its muscular wall. This unusual condition is known to induce a chronic inflammatory reaction that may be associated with pelvic pain and infertility. In women of reproductive age the estimated prevalence is 7 to 10% and up to one third of women undergoing laparoscopy for pelvic pain are diagnosed with endometriosis. Endometrial deposits may be deeply infiltrating, found in the abdomen and pelvic region may be invading the ovary but also found in the lungs, pleura and on the diaphragm. Ectopic endometrial tissue within the uterine myometrium is referred to as adenomyosis and may be responsible for heavy menstrual bleeding, some estimates place adenomyosis with a prevalence of 20 to 28%.
Pathogenetic mechanisms including retrograde menstruation and coelomic metaplasia as well as the induction theory have been proposed. In this podcast we have a conversation with obstetrician and gynaecologist Dr Mei Cheah founder of Create Health a leading group of specialists in women's health creating visions for a healthy future, better well being and more informed patient's. Create Health aims to deliver exceptional care across obstetrics, gynaecology, reproductive endocrinology, minimally invasive surgery, fertility and IVF plus allied and complimentary health services. We look forward to exploring the practical aspects of this diagnosis further with you.
References:
Dr Mei Cheah -create-health.com.au
www.endometriosisaustralia.org
www.ncbi.nlm.nig.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode we explore investigations in rheumatology-what is helpful and what is not?
A clinician faced with a patient complaining of myalgias and generalised rheumatic aches may be tempted to order a host of immunological and inflammatory tests whilst also assessing multiple other differential diagnoses that need considering. There are a host of serological tests available each with different degrees of sensitivity and specificity for rheumatological conditions, furthermore it is important to understand the sensitivity (ability to rule out condition) and specificity (ability to rule condition in) is applied to such tests. Fortunately, we had the opportunity to have a conversation with Dr Andrew Teichtahl who provides excellent clarification on the subject.
Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
www.racp.edu.au Investigations: In Medicine-Rheumatology-RACP
www.ncbi.nlm.nih.gov : Common Laboratory Tests for Rheumatological Disorders, ED Gupta 2009
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
Some of these products are designed to interfere with cytokine function or production and include:
· TNF inhibitors
· TNF receptor fusion proteins
· IL6 inhibitors
· IL-17 inhibitors
· IL-12/23 inhibitors
· T-cell modulators
· B cell modulators
In addition, the development of small molecules as Janus kinase inhibitors has opened up new channels for inflammatory modulation.
It was a great privilege to welcome rheumatologist Dr Andrew Teichtahl to this podcast to help us understand how to apply this new age of science to the practice of rheumatology. Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911251/ New era of treatment with biologics in rheumatology – is it time to shift paradigms in treatment with biologics? Anna Felis-Giemza
www.nature.com/articles/nrrheum.2009.197, Are new agents needed to treat RA ?
https://arthritis-research.biomedcentral.com/articles/10.1186/1478-6354-13-S1-S5 Advances in rheumatology: new targeted therapeutics
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Trillions of microbes are living in and on us, a thriving ecosystem of bacteria, viruses, archaea and fungi. Collectively these microbes form the human microbiome and this microbiome appears to play a key role in many aspects of health, crowding out harmful microbial invaders, breaking down fibrous food into digestible compounds and producing some essential vitamins such as B12 and vitamin K. New research is exploring the relationship between the gut microbiome and immunogenicity, autoimmune inflammatory diseases, neoplasia and brain development and is searching ways to correct dysbiosis.
In this episode with Professor Mark Morrison, Chair of Microbiology and Metagenomics at the University of Queensland Diamantina Institute we explore the human microbiome and how his work is expanding our understanding of this interesting clinical area of research and its possible medical applications.
Useful references include:
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Professor Mark Morrison - The University of Queensland Diamantina Institute
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WGO Handbook on Gut Microbiome – A global perspective - www.worldgastroenterology.org
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Gut microbiome – An Overview – www.sciencedirect.com
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Human Gut Microbiome : Hopes Threats and Promises – https://gut.bmj.com
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The Gut Microbiome in Health and in Disease – www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Breast cancer affects 1 in 7 women and remains the most diagnosed cancer in Australia with 57 new cases diagnosed each day, 1000 new cases per year and tragically 2000 deaths annually. Men are not excluded, for every 100 breast cancers one is diagnosed in a male. Genetic links for breast cancer such as the BRCA 1 and 2 genes receive significant attention but account for only 5% of total cases,75% of patients have no family history and additionally 75% of breast cancers are diagnosed in patients 50 years or older. Multiple risk factors including family history, young age of menarche and older age of menopause are frequently cited but less well known is the association with obesity which is responsible for up to 8% of all breast cancers. It is estimated that 1: in 4 cases of all breast cancer may be prevented with attention to known modifiable risk factors. Breastfeeding and earlier age of pregnancy are both protective factors.
In this episode we are joined by breast cancer surgeon Corinne Ooi who reviews risk factors linked to breast cancer and discusses management strategies when a breast lump is detected. This is a fascinating conversation with a truly passionate surgeon.
Useful references include:
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Dr Corinne Ooi – Southern Breast Oncology - sboncology.com.au
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Breastcancerriskfactors.gov.au - www.canceraustralia.gov.au
www.aihw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Dr Natharnia Young is a leading urogynaecologist servicing South Eastern Melbourne’s suburbs and joins this conversation to discuss urinary incontinence in women, a condition associated with significant personal and social stigmatisation and affecting up to 1:2 women over the age of 70.
Rates of presentation by woman seeking management for stress incontinence and urge incontinence are low, perhaps on account of feelings of embarrassment and shame however there are many effective management strategies that Natharnia discusses in this very informative podcast episode. Please enjoy the conversation.
Useful references include:
- Dr Natharnia Young – Australian Pelvic Floor Institute. enquiries@afpsinstitute.com
- Urinary Incontinence – symptoms and causes – Mayo Clinic – www.mayoclinic.org
- Urinary Incontinence – Office on women’s health – www.womenshealth.gov
- Urinary Incontinence in Women – www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
urinaryincontinence #urogynaecologist #EverydayMedicine
Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre and is one of Australia’s most respected and best-known specialist sports physicians with a wide breadth of knowledge of the subject. He has extensive experience, having enjoyed a stellar career with elite sports teams and Olympians over multiple decades in his professional capacity.
In this episode we discuss, several questions related to commonly used supplements taken by amateur and high-level athletes as well as delving into the darker realm of banned substances including anabolic steroids such as DHEA, testosterone and growth hormone. This is a tremendous conversation with master raconteur and communicator. Please enjoy the episode.
Useful references include:
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www.lowcarbdownunder.com.au
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peterbrukner.com
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youtube Professor Tim Noakes – “Medical aspects of the low carbohydrate lifestyle”
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ods.od.nih.gov – National Institutes of Health, Dietary Supplements for Exercise and Athletic Performance (the fact sheet for health professionals)
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre at Latrobe University and is one of Australia’s most respected and best known specialist sports physicians. He has a deep breadth of knowledge and experience and was a founding partner at the Olympic Sports Medicine Centre in Melbourne as well as a sports physician to the Collingwood and Melbourne AFL clubs, Liverpool Football Club and has served as team doctor to the Australian cricket team, Socceroos and several Olympic teams. He has authored multiple best-selling books on sports medicine and more recently has become interested in the important relationship between lifestyle and health and after determining that he was pre-diabetic he embarked on a low carbohydrate ketogenic style diet. He has subsequently become a strong advocate of the low carbohydrate diet both in managing a healthy BMI and avoiding development of the metabolic syndrome and all its consequent health effects and authored the very popular and best-selling book A Fat Lot of Good. He energetically has also established the not for profit campaign Sugar By Half. He joins us today to discuss his experience and journey to a low carbohydrate diet and how such an approach may be highly beneficial to athletes of both amateur and elite persuasions. Please enjoy this podcast.
Useful references include:
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www.lowcarbdownunder.com.au
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peterbrukner.com
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youtube Professor Tim Noakes – “Medical aspects of the low carbohydrate lifestyle”
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The Peter Doherty Institute was the first Australian laboratory to establish a Covid 19 PCR test and diagnose the first SARS-Cov 2 infection on Australian shores, its research scientist is heavily involved in developing novel diagnostic tools applied across many areas of medical science and the institute plays a key leadership role in advising state and federal government on best medical practice. It’s no great surprise therefore that we have learned of their ground-breaking development of a new subunit Covid 19 vaccine utilising the receptor binding domain at the tip of the virus’s spike proteins. This is the region responsible for virus attachment and infection and for eliciting over 90% of neutralising antibodies following SARS Cov-2 infection. Parallel with the subunit vaccine development, another Melbourne group – the Monash Institute of Pharmaceutical Sciences has developed a similar vaccine but using mRNA technology copying the virus’s genetic sequence that codes for the receptor binding domain.
These vaccines enter the pantheon of other existing mRNA/viral vector/and subunit protein vaccines already available offering protection against Covid 19 but are different as they focus the immune response to the tip of the spike protein – the important receptor binding domain.
Both new Melbourne developed vaccines are entering phase 1 trials and results will be eagerly awaited.
Professor Dale Godfrey is a senior principal research fellow and immunology theme leader at the Doherty Institute and has played a major role in RBD subunit protein vaccine development.
Please join this conversation where Dale discusses the new vaccine development, their efficacy, and the phase 1 clinical trials evaluating the vaccines further.
References:
Professor Dale Godfrey: godfrey@unimelb.edu.au
doherty.edu.au
Phone: 83449325 for further trial information or at virgo-studies@unimelb.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Delivering hard news to a patient or their relatives and admitting error can be one of the most difficult duties encountered by a doctor. Significant effort is now spent in teaching young training doctors techniques and strategies to avoid miscommunication and uncertainty in undertaking this complicated task whilst also remaining emotionally engaged and empathetic to their situation.
Rabow and McPhee have written eloquently on the subject of breaking difficult or bad news and have devised a mnemonic using the letters ABCDE as an excellent guide to this subject.
Accepting responsibility and apologising genuinely to a patient and their relatives for an error incurred during care requires courage and honesty and both Rabow and McPhee as well as the Harvard School of Public Health have written informatively on this subject.
In this episode we are joined by Dr Alan Saunder, Program Director of Surgery at Monash Health and both vascular and transplant surgeon with Dr Bill Shearer Consultant Anaesthetist and Executive Director of Quality Safety and Transformation at the Northern Hospital. We discuss these very important subjects with the honesty and wisdom of many years of advanced clinical practice. I believe you will find this conversation both helpful and engaging.
Useful references include:
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www.ncbi.nlm.nih.gov - Beyond Breaking Bad News: How to help patient who suffer
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www.aafp.org - Breaking Bad News – American Family Physician, G. VandeKieft.2001
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Harvard School of Public Health – www.hsph.harvard.edu
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Mistakes Were Made (But Not by Me) by Carol Tavris and Elliot Aronson, (Chapter 8)
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Chronic pain affects about 1 in 5 people in Australia and is a common reason for patients to see their doctor and to seek treatment. As patients seek ever increasingly strong pharmacological therapies they may become increasingly depressed, fatigued and dislocated from society.
In this episode we have a very interesting conversation with Dr Stephen Nutter, we follow Stephen’s journey from anaesthetist to pain management consultant at Metro Pain Clinic and discuss his approach to:
· Non-pharmacological
· Pharmacological
· Interventional approaches to chronic pain management
Stephen provides us with his personal approach to some common clinical pain syndromes, which we explore as a great introduction to this topic. I am delighted to share the conversation with you.
Useful references include:
www.painaustralia.org.au
www.apsoc.org.au
www.racgp.org.au
www.metropain.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Genetic testing for cancer is important for a small number of families at increased risk due to the inheritance of genetic mutations. Most commonly this involves the inheritance of breast cancer genes such as the BRCA 1 and 2 or colorectal cancer genes such as the Lynch syndrome genes. Although these only represent a small percentage of total cancers reported there is significant public interest in these syndromes.
We have a further discussion with Dr Lucy Gately from the Cabrini Family Cancer Clinic in this episode in regard to the BRCA 1 and 2 genes on chromosome 17 inherited by 1:400 women and men, and the Lynch syndrome genes which are accounted for by five mutations inherited by about 1:280 people. The Lynch syndrome is believed to affect about 80,000 Australians of whom perhaps only 5% know they have inherited this mutation. Whilst the BRCA 1 and 2 genes are associated with both breast and ovarian cancer in women, BRCA 2 inheritance may also imply an increased incidence of prostate cancer and breast cancer in men. Lynch mutations have been associated with up to 12 different forms of cancer although colorectal cancer and endometrial cancer are most highly represented by these mutations.
It is a great pleasure to discuss this fascinating subject in more detail with Dr Lucy Gately whose expertise on this complex subject is generously shared.
Useful references include:
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www.cabrinicancerclinic - BRCA gene mutations
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Genetic Testing Fact Sheet – www.cancer.gov
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Genetics: Breast Cancer Risk Factors – breastcancer.org
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BRCA 1 and BRCA 2 associated hereditary breast and ovarian cancer – www.ncbi.nlm.nih.gov
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Lynch syndrome – www.cancer.net
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What is Lynch syndrome – Lynch syndrome Australia – lynchsyndrome.org.au
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Understanding genetic tests for Lynch syndrome – Centre for genetics – www.genetics.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In the context of family cancer screening, genetic testing looks for specific inherited changes or variants in a person’s genes which may predispose them to an increased risk of developing a neoplasm. Harmful variants in some genes are known to be associated with an increased risk of developing specific cancers such as mutations to the BRCA 1 and 2 genes associated with breast and ovarian cancer and the Lynch genes associated with colorectal and endometrial cancer.
Alterations in tumour suppressor genes (loss of function) and proto-oncogenes (gains of function) are fundamental to our understanding of the science associated with family cancer syndromes and can be tested in the setting of family cancer screening clinics. The subsequent very important genetic counselling for patients and relatives who may have inherited such mutations involves discussing the risk of inherited cancer, individual risk screening and cancer risk reduction strategies.
In this episode, we are joined by Dr Lucy Gately and Lynne McKay from the Cabrini Family Cancer Clinic who have been instrumental in delivering one of Australia’s premier family cancer screening services and genetic counselling services to our community. Please welcome them to this conversation.
Useful references include:
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Family Cancer Clinic for Risk Assessment Advice and Testing – www.cabrini.com.au
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Family Cancer Centres – www.cancer.vic.org.au
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Genetic Testing for Cancer Risk – www.cancer.net
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Family Cancer Syndromes – American Cancer Society – www.cancer.org
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Cancer Genes – pubmed.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The ketogenic diet has recently become popular as an effective dietary approach to weight loss. The diet restricts carbohydrates to just 5-10% of total calories and relies on caloric intake from fats (55-60%) and proteins (30-35%) forcing metabolism to shift from gluconeogenesis to ketogenesis with the production of acetoacetate, beta-hydroxybutyrate and acetone – ketone bodies – as the usable energy source. People adopting this diet report a significant reduction in hunger, increase in energy, clarity of thought and reduction in chronic inflammatory conditions. Some are concerned the diet is difficult to maintain long term and may be risky in patients that are diabetic and in those with chronic kidney disease.
In this podcast episode, we delve deep into the roots of the ketogenic diet and its benefits with Dr Rodney Taylor an expert educator and host of the increasingly popular and very well supported Low Carb Down Under science education program. Rod has been instrumental in bringing some of the world’s experts on metabolism and dietetics to conferences he hosts in Australia and his youtube channel Low Carb Down Under has over 325,000 subscribers. I was very privileged to catch up with Rod in this interview and welcome you to the conversation.
Useful references include:
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Dr Rod Tayler – lowcarbdownunder.com.au
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A Ketogenic Diet for Beginners: The #1 Keto Guide – www.dietdoctor.com
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Should you try the keto diet? Harvard Health – www.health.harvard.edu
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Ketogenic Diet – StatPearls – www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Before proceeding, we apologise for the audio quality in this week's episode. Unfortunately, we experienced some technical difficulties and we will endeavour to resolve these problems in future episodes of Everyday Medicine.
It is estimated that up to 80% of the population will experience back pain sometime in their lives with presentations from adolescent age to the elderly. Back pain is the third most common reason for visits to a medical practitioner and in many instances treatment strategies have already been sought elsewhere from chiropractors, physiotherapist myotherapists, personal trainers and osteopaths.
Radiological interrogation is often required to assist formulation of an appropriate treatment strategy and in this episode we discuss a radiological perspective of this problem with radiologist Dr Max Kupershmidt who has specialised in procedural radiology and musculoskeletal imaging.
Max completed radiology training at the Alfred Hospital in 2006 and worked there as an interventional radiology fellow before undertaking an Abdominal Imaging Fellowship in Toronto in 2008 . Max has been engaged in private radiology for the last 11 years and was a founding executive and treasurer of ARGANZ as well as running and organising many successful conferences and seminars. In this podcast we also discuss with Max the issue of radiation exposure in radiology noting that the average person may receive the equivalent of 3 mSv of radiation per year and that a plain chest x-ray delivers an equivalent of 7 days of background radiation and standard mammography about 7 weeks of equivalent background radiation. CT exposure with a modern scanner delivers approximately 2.6 years radiation, PET scans about 8 years equivalent exposure and MRI none. It is estimated that the additive lifetime risk from a CT scan from fatal and nonfatal malignancy is about 1 in 1100 (equivalent to the risk of drowning). As medical practitioners we all need to be aware of the exposure risk when ordering investigations particularly in our younger patients where the lifetime risk is very real. Please join this conversation with Max.
References:
Dr Max Kupershmidt: LinkedIn
www.cancer.org Understanding Radiation Risk from Imaging Tests
www.radiologyinfo.org Radiation Dose in Xray and CT Exams
www.racgp.org.au Radiation Safety
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Diabetic foot is the name given to the condition commonly experienced by people with diabetic peripheral neuropathy and results in an insensitive and often deformed foot. Found in both type I and type II diabetic patients (of which there are 1.8 million living in Australia-one new diagnosis is made every 5 minutes), even minor trauma in the diabetic foot may lead to the development of an ulcer. The combination of impaired vascular supply from micro and macro vascular disease and neuropathy presents real challenges for healing. Consequently, diabetic foot ulcer is a major event in 85% of subsequent amputations and is the cause of 20% of hospital admissions related to diabetes. Ten to 15% of diabetic foot ulcers fail to heal and of these, 25% lead to an amputation. In one study up to 50% of diabetic patients undergoing amputation were dead within 2 years. Failure to be seen and managed by medical attendants more than 6 weeks after developing an ulcer in a diabetic foot vastly increases the amputation risk however just one year after appropriate vascular surgical management, between 70 and 90% of limbs will be saved from amputation. Furthermore, one year after vascular intervention up to 60% of diabetic foot ulcers are healed, highlighting the importance of vascular surgical expertise early in the management of the diabetic foot.
In this episode we are joined by expert vascular surgeon Mr Ming Yii who is the director of vascular and transplant surgery at Monash Health and adjunct Senior lecturer with Monash University. Ming is part of the Monash transplant team in kidney and pancreas transplantation and brings a wealth of knowledge and experience as well as an effusive personality to accompany his skills. In this episode he discusses his approach to this major problem and the multidisciplinary strategy for management that is needed.
References:
mingyiivascular.com.au
www.webmd.com
www.bmj.com Diabetic foot. SC Mishra 2017
www1.racgp.org.au.diabetic foot ulcer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
It is common in clinical practice to identify patients with impaired renal function as determined by diminished glomerular filtration rate and elevated creatinine. The decision to undertake thorough work-up and investigation of such patients or to observe and monitor, removing any potential offending nephrotoxic agent, is a clinical problem we address in this podcast with expert nephrologist Dr Tony Amin, who considers:
· Acute kidney injury
· Chronic kidney injury
· Appropriate management and work up
· Intravenous contrast nephrotoxicity
This is a complex subject with multiple considerations which Tony outlines with great clarity.
Useful references include:
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Dr Tony Amin – www.healthshare.com.au
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Okusa MD et al. Reading between the Guidelines – The KDIGO practice guideline on acute kidney injury in the individual patient. Kidney Int. 2014 January; 85(1):39-48
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Farrington K et al. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher: a summary document from the European Renal Best Transplant Group. Nephrology Dial Transplant. 2017 Jan 1:32(1):916
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Sodium is a major extracellular cation. Normal sodium concentrations range between 135 and 145 mmol/L. Alterations in sodium concentration, particularly hyponatraemia is the most common electrolyte disorder doctor’s encounter in clinical practice. Up to 20% of people admitted to hospital have hyponatraemia and it is estimated that 1.7% of population also have hyponatraemia.
It was enlightening to review this subject with Dr Tony Amin, nephrologist and public educator who discusses:
· The importance of assessment of serum and urine osmolality in conjunction with serum sodium and urinary sodium
· Assessment of patient’s volume status (hyper/hypovolemic)
· A variety of different clinical examples in respect to this subject
Please join me in this very engaging conversation with Tony whose expertise is evident from our discussions.
Useful references include:
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Dr Tony Amin – www.healthshare.com.au
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UpToDate
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HenryDa.In the clinic: Hypernatremia. Annals of Internal Medicine.2a15 August 4; 163(3);ITC1-19
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The consequences of dementia with short term memory loss, visuospatial dysfunction, executive dysfunction, apathy, word-finding difficulty and apraxia is devastating both to the patient and family. It is estimated that 1% of Australians aged 65 years have dementia and that almost half of our population over 85 years have dementia to varying degrees. Alzheimer’s (60% of cases), vascular dementia (15% of cases), Lewy body and frontotemporal (each 5% of cases) and other forms of dementia secondary to alcohol, trauma and neurodegenerative disorders reflect the main forms of dementia seen in our society.
In this podcast we engage expert neurologist and cognitive specialist Dr Helene Roberts to discuss:
· Forms of dementia
· Appropriate investigation
· Management strategies
Helene guides us gently through this difficult and devastating clinical problem. Please join me in conversation with her.
Useful references include:
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www.dementia.org.au
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www.nia.nih.gov
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www.nhs.uk
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Dr Helene Roberts – www.healthshare.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Each year in Australia, over 125,000 of our more elderly population are admitted to hospital consequent to a fall. About a third of people over the age of 65 years fall each year and this figure rises exponentially with age. In up to 10% of falls, serious injuries such as fractures (a third of which are hip), soft tissue injuries and direct brain injuries arise. Falls and injuries from falls have serious implications and consequences.
In this podcast episode we are joined by geriatrician Dr Kim Tew who discusses:
· The complex relationship between balance, ambulation, cognitive function, neuromuscular function and cardiovascular function
· Appropriate management of an elderly patient following a fall
· The importance of early referral to a falls clinic or geriatrician with a view to careful work up, the deprescribing of medication, engagement of physiotherapy and occupational therapy.
Please join me in this interesting episode with Kim.
Useful references include:
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www.aihw.gov.au
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www.anzfallsprevention.org
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www.monash.edu – Fall-related injury profile for Victorians aged 65 – Monash University
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Couples are said to be infertile if pregnancy does not result after a year of carefully timed sexual activity without the use of contraceptives and is estimated to affect up to one in six Australian couples. It is also estimated that male partners contribute approximately 40% to cases of infertility, the same percentage as women. In a third of couples, a combination of male and female factors both need consideration. Today, women in Australia are 31 years of age before their first child is born compared to a generation ago where women on average were 24 years of age, this change in timing of first pregnancy and lifestyle may also be contributing to the difficulty some couples have starting their families.
In this conversation, we are joined by Dr Peter Yong, a specialist obstetrician and gynaecologist who works with Monash IVF and has a special interest in infertility and assisted conception. Peter trained in the United Kingdom and was awarded the gold medal in the membership examination at the Royal College of Obstetricians and Gynaecologists as well as being the recipient of the RCOG Young Obstetrician and Gynaecologist award. He also won a travel award to visit the Leuven Institute of Fertility and Embryology in Belgium. It was a privilege to have him on a conversation today to discuss:
· Incidence of infertility amongst couples
· Factors to consider
· Appropriate examination and workup
· Subsequent management strategies
Please join me in this very interesting conversation with Dr Yong.
Useful references include:
-
www.sjog.org.au
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monashivf.com
-
www.aafb.org
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www.ncbi.nlm.nih.gov
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www.nichd.nih.gov
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www.nhs.uk
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emedicine.medscape.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Altered uterine bleeding is estimated to affect 10-30% of women in midlife and constitutes about a third of outpatient gynaecological reviews. There are many aetiologies to consider including leiomyomas (fibroids), endometrial pathologies, polyps, malignancy, platelet dysfunction and coagulopathies.
In this conversation, we are joined by expert obstetrician and gynaecologist Dr Peter Yong who completed his undergraduate medical training in Singapore before undertaking postgraduate training in obstetrics and gynaecology in Scotland. He has a special interest in infertility and assisted conception and was awarded the gold medal in the membership examination at the Royal College of Obstetricians and Gynaecologists as well as being a recipient of the RCOG Young Obstetrician and Gynaecologist award. Peter also won a travel award to visit the Leuven Institute of Fertility and Embryology in Belgium. He works both in private practice and at Monash IVF and joins us in this discussion to consider:
· Causes of altered uterine bleeding
· Appropriate investigations and work-up
· Management strategies
Please join me in this very interesting conversation with Dr Yong.
Useful references include:
-
www.sjog.org.au
-
monashivf.com
-
www.aafb.org
-
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The detection of colorectal polyps is of critical importance in the prevention of colorectal cancer. Studies have demonstrated that colorectal cancer arises from colorectal polyps in more than 95% of cases. Fortunately most polyps do not become malignant (less than 1%) and it is known that less than 5% of all colonic adenomas harbour malignancy. The National Bowel Cancer Screening Program has been a government initiative to assist in the detection of early cancers and malignant polyps through the detection of occult haemoglobin in stool and some larger clinical trials have demonstrated the benefits of screening population this way. Once a malignant polyp is determined colonoscopically a fresh set of questions arises in regards to best management practice.
To discuss this topic of malignant polyps in more detail we are joined by expert colorectal surgeon Hanumant Chouhan, who covers:
· Detection of malignant polyps
· Surgical decisions to progress to resection vs relying on endoscopic removal
· Transanal total mesorectal excision (TaTME)
I am most grateful for his expert review of this subject. Please join me for this interesting conversation.
Useful references are:
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www.sjog.org.au
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www.ncbi.nlm.nih.gov
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www.surgery.wisc.edu
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Rectal bleeding is a very important clue to the possibility of serious internal colonic pathology. Whilst our approach to work up of patients with rectal bleeding is determined by the description of blood, the age of the patient and background history, it is extremely important not to overlook rectal bleeding as a possible early sign of a malignant polyp, premalignant polyp, colorectal malignancy or inflammatory bowel disease.
To discuss this subject in more depth we are joined by the very well-trained colorectal surgeon Hanumant Chouhan who discusses:
· Approach to rectal bleeding guided by patients’ age and family history
· Increased risk of colorectal malignancy in young patients
· Appropriate investigations and workup
Hanumant provides an excellent synopsis of this subject in conversation. Please join us on this episode.
Useful references are:
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www.sjog.org.au
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my.clevelandclinic.org
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www.mayoclinic.org
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www.asge.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Metabolic bone disease is common, it is estimated that about 4.75 million Australians have either osteopenia or osteoporosis. Osteoporosis affects up to 23% of women and 6% of men over the age of 50 with a markedly increased risk of minimal trauma fractures including hip fracture with increased morbidity and mortality. Osteoporosis is characterised by microscopic architectural deterioration of bone structure, loss of bone mass and a change in bone metabolism and can be confirmed by dual-energy x-ray absorptiometry (DEXA scan). Until recently 70-85% of patients presenting with a minimal trauma fracture have tended to be both under investigated for osteopenia and osteoporosis, nor appropriately managed to prevent a further fracture. Metabolic bone disease is a silent epidemic.
We are joined today by Dr Ie-Wen Sim who is an endocrinologist and andrologist with special interests including clinical andrology, reproductive endocrinology and metabolic bone disease. He is a graduate of the University of Melbourne with first class honours and the recipient of the NHMRC post graduate scholarship for osteoporosis research. In this conversation Ie-Wen covers:
· Incidence and aetiology of metabolic bone disease
· Comorbidities and risk factors including medications
· Diagnosis
· Medical interventions including use of anabolic and antiresorptive therapies
I hope you enjoy this fascinating conversation with Ie-Wen.
Useful references include:
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www.epworth.org.au
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www.osteoporosis.org.au
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www.aihw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Centrally mediated abdominal pain syndrome is a chronic recurrent condition that is not related to bowel function, diet or definite organic pathology such as inflammatory bowel disease, diverticulosis, vascular syndromes nor neoplasia.
It appears to be secondary to nerve sensitisation and may develop after significant emotional trauma or gastrointestinal infections.
The syndrome may be highly intrusive and distressing but can be managed by a multipronged approach drawing upon hypnosis, cognitive behavioural therapy and pharmacotherapy including antidepressants with deliberate avoidance of narcotics.
In this episode, we have a conversation with an amazing pain physician-Dr Olivia Ong who has experienced her own personal trauma which she relates with us yet courageously has reentered the workforce at a high functioning level in the field of pain management. She continues to make major contributions to the community and her peers whilst raising a family, preparing for a TED talk and writing her first book. To discuss her journey from trauma back to life in medicine and also to introduce her new book soon to be released called: The Heart Centredness of Medicine, please join this interesting conversation with Dr Olivia Ong.
References:
https://drolivialeeong.com/book-pre-sale/
https://www.sciencedirect.com
https://pubmed.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Covid vaccine induced Pericarditis-Myocarditis
Since the release of mRNA vaccines medical practitioners around the world have been receiving calls from patients complaining of chest discomfort typical of pericarditis some of these patients have also had associated ECG changes and cardiac enzyme elevation consistent with myocarditis. This phenomenon does not appear to be related to the non mRNA vaccines available.
As of the 14th of November Australian data shows there have been 329 reports of likely myocarditis from 23.4 million delivered mRNA vaccine doses, a further 592 suspected but not confirmed cases and 1370 episodes of pericarditis. Based on this the TGA reported data for Australia estimates the rate of myocarditis or pericarditis after the first dose for men across all ages to be 2.1 per 100,000 and for women after the first dose to be 0.9 per 100,000. Rates following the second dose are higher with estimates of 2.7 per 100 000 for men and 1.1 per 100 000 for women. By comparison rates associated with the Covid 19 virus are estimated at the much higher rate of 11 per 100 000.
It should be noted that background normal rates of pericarditis for males aged 18-34 is 37 per 100,000 and for females aged 18-34 years the rate is 16 per 100,000.
TGA statistics also show higher suspected rates of myocarditis and pericarditis for boys aged 12-17 especially after their second dose of Pfizer estimated at 8.5 cases per 100,000 which is more than 3 times the overall rate amongst all males (2.7 per 100,000).
Reliable data for the Moderna mRNA vaccine are not yet available in Australia however overseas data suggests higher rates of myocarditis and pericarditis for male recipient's under the age of 30 years compared with the Pfizer vaccine.
It was a real privilege to have this conversation with Dr James's Sapontis director of cardiology at St John of God Hospital Berwick who has been fielding calls from primary practitioners seeing such patients and attending emergency admissions.
References:
Dr James's Sapontis : www.jamessapontis.com
www.health.gov.au :Covid 19 vaccination-Guidance on myocarditis and pericarditis
www.cdc.gov :Myocarditis and pericarditisafter mRNA Covid 19 vaccination
www1.racgp.org.au :TGA updates post-COVID vaccine myocarditis ratesTo be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Polyps are discreet mass lesions that protrude into the intestinal lumen and represent a very important precancerous pathology to be identified and removed at colonoscopy. Up to 95% of adenocarcinomas arise from polyps, such cancers develop either after inactivation of the APC gene (for adenomas) or by KRAS mutation or BRAF oncogene activation with methylation of promoter regions for the serrated polyp pathway. As colorectal cancer is one of the most commonly diagnosed cancers in Australia, with up to 1 in 18 males and 1 in 25 females developing cancer in their lifetime, identification and removal of polyps as demonstrated by the National Polyp Study remains an important objective at colonoscopy.
In this podcast we are joined by expert gastroenterologist Dr Geetha Gopalsamy to discuss:
· Adenomatous polyps
· Mucosal serrated polyps
· Mucosal non-neoplastic polyps
· Submucosal polyps
Focusing on the significance of each in relation to their clinical significance as well as providing pointers to the conversations we should have as clinicians with our patients about consent for colonoscopy and what to do with anticoagulation therapies pre-procedure. Geetha guides us systematically through this interesting subject. I hope you can join us.
The useful references include:
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www.gihealth.com.au
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www.gesa.com.au
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www.gastrojournal.org
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The National Polyp Study Gastroenterology 1990
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pubmed.ncbi.nlm.nih.gov
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www.nham.org 23 February 2012
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Up to 23% or more of Australians have varicose veins which may include small spider telangiectasias to large cosmetically challenging varicosities. In this episode we talk with phlebologist Louis Loizou who runs a very successful vein solution clinic in the community where he manages patients with all presentations of varicose veins, large, small, spider veins – he is able to find a solution for all. Louis is a past vice president and honorary secretary of the Australian College of Phlebology.
Louis discusses how he manages patients at his busy outpatient clinic that has been providing services to patients in Melbourne for over 20 years using:
· Sclerotherapy
· Endovenous laser therapy
· Phlebectomy
· Application of glue
I enjoyed this conversation with Louis tremendously and hope you do too.
Useful references include:
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www.veinsolutionsmelbourne.com.au
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www.phlebology.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Newfound freedom from lockdown in both Victoria and New South Wales will undoubtedly lead to greater COVID-19 exposure. Whilst widespread vaccination uptake has been achieved a significant number of adults and our children remain unvaccinated and vulnerable to the Delta strain. What can we expect from the health perspective for those exposed?
What are the health departments rules governing exposure? Is there a plan for rapid antigen testing in our community and what about version 2.0 of the vaccines?
Join me with Professor Erwin Loh, Chief Medical Officer from St Vincent’s health who has a superb grasp of world health data and is an expert in translating research evidence into best practice.
References:
https://au.linkedin.com › erwinlohWeb resultsProfessor Erwin Loh - Group Chief Medical Officer - LinkedIn
https://www.health.gov.au › newsCoronavirus (COVID-19) case numbers and statistics - Australian ...
https://www.worldometers.info › aus...Australia COVID - Coronavirus Cases - Worldometer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this podcast we have a conversation with Gyu Lee who works with Victoria Alcohol and Drug Counselling Service as a harm reduction practitioner managing patients in the community who have developed addictions to both alcohol and drugs. Management techniques include close engagement with referred clients and an approach based on:
· Behavioural modification
· Pharmaceutical intervention
· Job rehabilitation
Whilst there has been a reduction in methamphetamine use in Australia from 2001 to 2019 use of cocaine and methylenedioxymethamphetamine (MDMA – ecstasy) have both increased. These drugs combined with alcohol addiction pose major social problems for our community. Please join me as we discuss these complex and confronting issues with Gyu Lee.
Useful references include:
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Drug and Alcohol Clinical Advisory Service (DACAS) Ph: 1800 812 804
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gyu.lee@windana.org.au
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PHARMACOTHERAPY NETWORK (EAST & SOUTH EAST REGION) for GPs http://a4pn.org.au/ email A4PN@semphn.org.au or call 03 8514 6600
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Medication Support and Recovery Service https://msrs.org.au/resources/gp-resources/
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Globus pharyngeus in an intermittent or persistent non-painful sensation of a lump or foreign body in the throat. First described 2,500 years ago by Hippocrates who thought the condition was secondary to pressure on the thyroid cartilage from contractions of the strap muscles of the neck, we now know that globus is a relatively common condition representing up to 4% of ENT referrals and may be seen in just less than half of healthy individuals at some point in time. Gastro-oesophageal reflux disease and hypertonicity of the upper oesophageal sphincter are very important contributors to the sensation.
In this episode we are joined today by experienced ENT surgeon Mr Adnan Safdar, Head of the ENT unit at Monash Health, who discusses:
· Globus as a presenting symptom
· Aetiologies
· Management strategies.
I hope you can join me on this podcast where Adnan provides a logical and practical approach to managing globus in clinical practice.
Useful references include:
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berwickent.com
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www.ncbi.nlm.nih.gov
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bjgp.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Facial pain is a common presenting complaint in primary practice, in many cases the aetiology can be ascertained from a detailed history and examination, however the source of pain may also be obscure including referred pain from the oral cavity as well as neurological, vascular and psychogenic disorders.
We are joined today by experienced ENT surgeon Mr Adnan Safdar, Head of the ENT Unit at Monash Health, to discuss a logical approach to facial pain management.
Adnan covers:
· Common aetiologies
· Involvement of the sinuses
· Practical management and tips
Please join me in this interesting discussion with Adnan.
Useful references include:
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berwickent.com
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www.racgp.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Ear pain or otalgia as a diagnostic problem presents commonly to primary health physicians. Otalgia may be primary, arising from the external auditory canal (otitis externa) or the middle ear (otitis media) or secondary. As the sensory innervation of the ear is richly supplied by branches of the trigeminal, facial, glossopharyngeal, vagal nerve as well as upper cervical nerves it is not surprising that many secondary causes of earache including TMJ dysfunction, dental infections and neoplasias may also be responsible for otalgia.
We are joined today by experienced ENT surgeon and head of ENT unit at Monash Health, Mr Adnan Safdar, who discusses:
· Primary otalgia
· Secondary otalgia
· Management strategies
This is a very interesting discussion with Adnan and I invite you to the episode.
Useful references include:
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berwickent.com
-
www.racgp.org.au
-
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Irritable bowel syndrome is an idiopathic clinical entity characterised by chronic (more than six months) abdominal pain that occurs in association with altered bowel habits. In 2016 the Rome IV Consensus report adjusted the diagnosis to include symptoms occurring at least once a week from a previous definition of three times a month and include the notation of abdominal pain rather than discomfort related to defaecation. In practical terms, irritable bowel syndrome is in part a diagnosis of exclusion, however, in younger patients without alarm symptoms a simple stool test for calprotectin rather than extensive endoscopic work up may be all that is required. A negative calprotectin favouring conservative and symptomatic management, a positive finding requiring further workup.
To discuss IBS in more detail we are joined by experienced gastroenterologist Dr Catherine Sorrell who discusses:
· Prevalence and diagnosis of IBS
· Approach to younger patients with IBS
· Approach to older patients with IBS-like symptoms
In this conversation, Catherine fields several questions in regard to extensive workup versus assessment of symptoms by calprotectin alone and the importance of applying a low FODMAP diet and lifestyle changes to symptom control. Please join me in this interesting conversation.
Useful references include:
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www.gihealth.com.au
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www.nbs.org.au
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www.gesa.org
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www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Now recognised as one of the most common conditions underlying food impaction events, eosinophilic oesophagitis (EOE) has an estimated prevalence of 0.4% among both children and adults. EOE is a chronic inflammatory disorder characterised by oesophageal dysfunction and eosinophil predominant inflammation. Relatively recently described we may speculate as to whether this is a truly new disease or a more recently recognised one.
To discuss EOE in more detail we are joined by experienced gastroenterologist Dr Darcy Holt. In this conversation Darcy includes:
· Description of EOE (endoscopic and histologic findings)
· Common presentation
· Appropriate management strategies
Please join this very interesting discussion with Darcy on this relatively newly understood but very important oesophageal condition.
Useful references include:
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www.gihealth.com.au
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www.racgp.org.au
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www.mayoclinic.org
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www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Mental health has become a major casualty of the Covid pandemic that has swept across the globe and been responsible for rolling lockdowns throughout Australia restricting personal freedoms, social contact and the ability to prosper financially. No one is exempt from this unprecedented event and the anxiety, depression and anguish wrought is having a major effect on the health and wellbeing of our communities.
To discuss the indicators that a patient or friend may be experiencing evolving or established mental health difficulties and learning methods for shifting patients holistically out of collapse we have a conversation with psychologist Brenda Sutherland founder and director of The Awakening Group. Brenda teaches us about the polyvagal ladder and how to use an understanding of this insight to instructively and empathically assist our most vulnerable patients.
Brenda's extensive knowledge of the human mental state in distress and happiness and her work with Bessel van de Kolk, Stan Tatkin and Byron Katie have placed her in an outstanding position to guide us on this subject.
Please enjoy the conversation.
References:
The Awakening Group.com.au
https://awakening.com.au/lms/2021/08/24/ventral-vibes-project/
Mental health services in Australia, COVID-19 impact on mental health
Weekend Australian - Aug 28-29 pages 1&6
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Helicobacter pylori is a gram-negative curved bacillus that may colonise the gastric and proximal duodenal mucosa. Its significance was first described by Barry Marshall and Robin Warren in 1982 both of whom were awarded the Nobel prize in 2005 after the Nobel community described the discovery as the most impacting in medical sciences. Most medical practitioners are aware of the pathophysiological consequences of Helicobacter which is responsible for gastritis, gastric and duodenal ulcer disease, and may be associated with gastric adenocarcinoma as well as mucosa associated lymphoid tissue hyperplasia (MALT lymphoma). Its eradication has largely hinged on standard triple therapy including a PPI combined with amoxicillin and clarithromycin taken together for 1 week in Australia; unfortunately this regimen has a 10-15% failure rate.
In this episode we are joined today by Dr Darcy Holt, an experienced gastroenterologist to discuss second line treatments that may be considered when first line triple therapy fails.
Darcy covers:
· Current Australian antibiotic guidelines
· Alternate quadruple therapies that are effective in eradication although not subsidised by the PBS at this time
There is a large body of information we cover in this interesting episode, please join me and Darcy.
Maastricht V/Florence Consensus Report recommends:
o Bismuth quadruple therapy for 10-14 days including bismuth subcitrate 120mg qid, tetracycline 500mg qid, metronidazole 400mg tds and PPI bd
o Fluoroquinolone (levofloxacin) 500mg daily, Amoxicillin 1g bd plus PPI standard dose bd (can be converted to quadruple by adding Bismuth 120mg qid or 240mg bd for 10-14 days
o PPI 40mg bd, Bismuth 120mg qid, Tetracycline 500mg qid, Levofloxacin 500mg daily for 10 days (98% effective)
o PPI standard dose qid plus Amoxicillin 750mg bd 14 days – 89% effective
Useful references include:
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www.gihealth.com.au
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www.ncbi.nlm.nih.gov
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www.mja.com.au (MJA 2016:204, 376-380)
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The burden of mental health to Western society ranks amongst the leading causes of overall clinical presentations and the impact of anxiety, depression, addiction, substance abuse and PTSD can be devastating both to individuals and society. Recognition that psychedelic therapies may offer a profound benefit in the treatment of these conditions has rekindled a renaissance in their use, in particular of psilocybin from Psilocybe cubensis or “magic” mushrooms. The Australian Psilocybin Assisted Psychotherapy study at St Vincent’s focusing on end of life anxiety and depression is providing fascinating insights into the place and future use of these compounds.
In this conversation, we are joined by the energetic and dynamic Dr Margaret Ross, a clinical psychologist with an interest in palliative care and cancer care, whose efforts in stimulating interest in the use of psychedelics was rewarded by the funding of the above study at St Vincent’s Hospital. Rather than proving addictive or damaging to mental health psychedelics have been shown to protect against it. Dr Margaret Ross expands their potential use in this fascinating conversation. Please join me on this podcast.
Useful references include:
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Dr Margaret Ross – www.svha.org.au
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ABC podcast: All In The Mind, Psychedelics Addiction and Mental Health with Sana Qadar, 2nd February 2019
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How To Change Your Mind: What The New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence - Michael Pollan, Penguin 2018
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How ecstasy and psilocybin are shaking up psychiatry – www.nature.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Obstructive sleep apnoea is common, it is estimated that 49% of men aged 40-69 have obstructive sleep apnoea rising to 62% above the age of 70. Up to 1 in 10 have undiagnosed obstructive sleep apnoea which may present with snoring, daytime somnolence, depression and significant hypoxemia during sleep with associated cardiac arrhythmias.
To discuss this subject in more detail we are joined by experienced respiratory physician Dr Michael Ho in a conversation including:
· Definition of obstructive sleep apnoea
· Associated conditions and sequela
· Polysomnography
· Appropriate management
Please join me in this interesting podcast episode.
Useful references include:
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Dandenong Respiratory Group
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www.ncbi.nlm.nih.gov
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www.aci.health.nsw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Australia has one of the highest rates of asthma in the world affecting about 11% of the population and in 2017/18 was responsible for 38,792 hospital admissions and 389 deaths, many of which may have been preventable. Asthma occurs when there is reversible expiratory constriction of the airways, especially the bronchioles and smaller bronchi, in response to various stimuli associated with a chronic inflammatory process. Today we are joined by Dr Michael Ho, an experienced respiratory physician who discusses:
· Aetiology of asthma
· Non-drug approaches to management
· Pharmacological approaches to treatment
· Thunderstorm asthma
Please join me with this very interesting conversation with Michael covering many aspects of this common condition.
Useful references include:
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Dandenong Respiratory Group
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www.nationalasthma.org.au
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www.one.racgp.org.au
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www.mps.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Thyroid nodules are common, in some ultrasound series at least 30% of adults are found to have nodules and 4-7% of adults will have a palpable nodule. Whilst the overall risk of malignancy within a nodule is less than 5%, this is dependent on thyroid imaging reporting and data system (TI-RADS) which reflects features such as size of the nodule, presence of microcalcification, cyst complexity, whether the cyst is taller than wider and the presence of intranodular vascular images.
We are joined by expert thyroid and breast surgeon Mr Cyril Tsan in this episode, who provides clarity in discussing a logical approach to the work up of thyroid nodules covering in particular:
· Epidemiology
· Risk factors
· When to refer the ultrasound
· The TI-RADS system
· When to refer for surgery
This was a tremendous discussion and I welcome you to the episode.
Useful references include:
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www.cleelandspecialists.com.au
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www.ncbi.nlm.nih.gov
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www.mj.com.au
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webmd.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode, we share an intimate conversation with Dr Shashi Manikappa who has spent the past 18 months in India’s heartland volunteering medical care to those affected by the Covid pandemic. Whilst over 400 million Indians have received at least one dose of vaccine to date, on the ground in India treatment protocols embracing the use of Ivermectin in combination with other drugs have gained significant popularity and anecdotal support as an effective treatment. Shashi discusses the value of these protocols as used in India and the medical experience and perspective gathered during his time there. It is acknowledged that the protocols discussed in this episode have not been endorsed for use in Australia.
Dr Shashikanth Manikappa, MBBS,MD, DNB, FANZCA, FCA, PG Dip Echo
Specialist Anaesthetist I Cardiac Anaesthesia and Perioperative Medicine, Melbourne Australia
Adj. Professor, ESIC Medical College & Hospital, Hyderabad, India
Adj. Professor, Raja Rajeswari Medical College & Hospital, Bangalore, India
Honorary Clinical Senior Lecturer, The University of Melbourne, Melbourne, Australia
Adjunct Senior Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Radiofrequency ablation (RFA) has revolutionised treatment for tachyarrhythmias and has become first line treatment for some tachycardias. Some arrhythmias are relatively common, atrial fibrillation for example affects up to 9% of our population over the age of 80 years and provides a very significant risk for thromboembolic stroke, haemorrhagic stroke as well as impairment of quality of life whilst also contributing to heart failure.
Since the pioneering work in 1998 of Michel Haissaguerre, RFA has become widely accepted therapy and we are fortunate to have a discussion today with expert electrophysiologist and cardiologist Matthew Swale regarding:
· RFA
· Suitable candidates
· Risks
This was an excellent discussion with Matthew, and I am very pleased to invite you to the episode.
Useful references include:
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www.genesiscare.com
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www.ncbi.nlm.nih.gov
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www.heart.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Atrial fibrillation is the most commonly experienced arrhythmia increasing in prevalence with age. It is estimated that 3 in 1000 under the age of 65 years have atrial fibrillation rising to 9% of people reaching the age of 80 years. The rate of stroke in untreated atrial fibrillation ranges from 5% per year with minimally associated risk factors up to 15-20% per year with associated risk factors such as hypertension, diabetes mellitus, heart failure and a history of vascular disease. The mortality of atrial fibrillation related to stroke is high and estimated at 25% in 12 months.
Not only is it very important to recognise atrial fibrillation it is also important to understand how to provide adequate anticoagulation. Whilst warfarin has been available since the 1950’s as a vitamin K inhibitor limiting the hepatic synthesis of factor II, VII, IX and X as well as protein C and S, since 2008 factor Xa inhibitors and direct thrombin inhibitors referred to as direct oral active anticoagulants or DOACs have become available, avoiding the food and drug interactions that are commonly seen with warfarin and the need for regular drug monitoring.
We are joined in this episode by experienced electrophysiologist and cardiologist Dr Matthew Swale to discuss:
· Atrial fibrillation and its risks
· Anticoagulation with DOACs
· Anticoagulation post stenting
This is a great conversation with Matthew and I am very pleased to invite you to the episode.
Useful references include:
-
www.genesiscare.com
-
www.ncbi.nlm.nih.gov
-
www.heart.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
As the Covid pandemic continues to spread around the world with over 187 million recorded infections and 4 million deaths, countries including Australia have embarked upon vaccination programs including the use of mRNA (Pfizer and Moderna), viral vector (Astra Zeneca), and subunit protein vaccines (Novovax).
In Australia currently, less than 10% of our population have been fully vaccinated leaving our population exposed and subject to repeat widespread population lockdowns and contact tracing via local health departments.
Hesitancy to receive vaccination in part relates to perceived side-effects from vaccines as much as from difficulties relating to supply delivery.
In this episode, we are joined by Professor Tony Cunningham, Infectious disease physician and co-director of the Centre for virus research at WIMR who generously discusses vaccine side-effects including vaccine-induced thrombosis with thrombocytopenia syndrome (VITT), myocarditis and pericarditis as well as anaphylaxis. In this conversation, we delve into some very interesting aspects of vaccination and speculate on how the future may look for us all.
Please welcome Professor Tony Cunningham.
References include :
- Australian Government Department of Health - joint statement from ATAGI and THANZ on thrombosis with thrombocytopenia syndrome and the use of COVID-19 vaccine Astrazeneca (23rd May 21 )
- The ATAGI statement on revised recommendations on the use of COVID-19 vaccine Astrazeneca (17 June 2021)
- Professor Tony Cunningham, www.westmead institute .org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Part 2.
Heart disease affects one in six Australians with an AMI occurring every 10 minutes and accounts for one in four of all deaths, so primary and secondary prevention are very important considerations in relation to any patient presenting with heart disease or at risk of heart disease. Risk factors including family history, lipid abnormalities, diabetes mellitus, hypertension, smoking or those with elevated BMI all need consideration. Whilst there have been significant controversies regarding lipids management and the use of statins, the evidence for their use, particularly in secondary prevention of heart disease is clear.
To discuss this interesting subject in detail we are joined by the very experienced cardiologist and local mentor Dr John Counsell who covers:
· Primary prevention in cardiovascular disease [Part 1]
· Secondary prevention in cardiovascular disease [Part 2]
· Use of statins and ACE inhibitors
Please join me in this very interesting conversation with John Counsell.
Useful references include:
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www.dandycardiology.com.au
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www.ncbi.nlm.nih.gov
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www.heart.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Heart disease affects one in six Australians with an AMI occurring every 10 minutes and accounts for one in four of all deaths, so primary and secondary prevention are very important considerations in relation to any patient presenting with heart disease or at risk of heart disease. Risk factors including family history, lipid abnormalities, diabetes mellitus, hypertension, smoking or those with elevated BMI all need consideration. Whilst there have been significant controversies regarding lipids management and the use of statins, the evidence for their use, particularly in secondary prevention of heart disease is clear.
To discuss this interesting subject in detail we are joined by the very experienced cardiologist and local mentor Dr John Counsell who covers:
· Primary prevention in cardiovascular disease [Part 1]
· Secondary prevention in cardiovascular disease [Part 2]
· Use of statins and ACE inhibitors
Please join me in this very interesting conversation with John Counsell.
Useful references include:
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www.dandycardiology.com.au
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www.ncbi.nlm.nih.gov
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www.heart.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Non-melanotic skin cancers and melanoma are the most common cancers affecting humans. At least two in three Australians will be diagnosed with skin cancer before the age of 70 years and the risk is higher for men than women. Whilst basal cell carcinomas and squamous cell carcinomas are more common they are not as lethal as melanomas which are referred to as Australia’s “national cancer”. Indeed in 2020 it is estimated that 16,200 will be diagnosed with melanoma, that is one new case every half hour and a death every five hours.
Skin clinics have emerged embracing mole mapping to assist in the diagnosis and management of melanotic skin cancers as well as non-melanotic skin cancers and we are grateful to have a conversation today with Dr Archie Xu who has been running a suburban skin cancer clinic for many years. He joins us to discuss:
· Mole mapping
· Dermoscopy
· Melanoma and non-melanotic skin cancer
I am most grateful to have had this discussion with Archie on a very important subject particularly relevant to our sun-drenched outdoor lifestyle. Please join me with Archie.
Useful references include:
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www.ozscc.com.au
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www.melanoma.org.au
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www.cancer.org.au
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www.cancercouncil.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Chronic joint and muscle pain affects many millions of patients with more than one in four adults affected by some form of arthritis. Arthritis is the most common chronic condition among long-term users of opioids with fibromyalgia, polymyalgia, osteoarthritis, reactive arthritis, psoriatic arthritis and other forms of connective tissue disease such as rheumatoid arthritis contributing in a very significant way to morbidity.
We are joined in this episode with experienced general physician Dr Minz Cheah to discuss his experience of joint aches and pains in private practice including:
· A personalised approach to fibromyalgia and arthritis
· Treatment choices available
This is a helpful practical conversation and I am very happy to bring this episode to you.
Useful references include:
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www.sjog.org.au
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www.ncbi.nlm.nih.gov
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www.who.int
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Based on the Australian Bureau of Statistics National Health Survey data about one in three people over the age of 18 living in Australia have hypertension or were taking blood pressure lowering medications. A staggering number requiring therapy for a condition which impacts on cerebrovascular disease, coronary artery disease, chronic kidney disease, heart failure and mortality.
The National Heart Foundation guidelines are available for careful perusal, but to walk us through an intelligent approach to management of systemic hypertension we are joined by expert general physician Dr Minz Cheah who will discuss:
· Blood pressure targets
· Primary prevention
· Choice of hypotensive agent
This was an interesting conversation with Minz on a very important subject and I am happy to bring the episode to you.
Useful references include:
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www.sjog.org.au
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www.healthdirect.gov.au
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www.cdc.gov
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www.heartfoundation.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Coronary artery disease caused by atherosclerosis is responsible for one heart attack every ten minutes in Australia. Not all plaques however are equally dangerous or vulnerable, and stable plaques may be asymptomatic and associated with low risk of coronary events contrasted with the unstable or ruptured plaque. To discuss this very interesting subject in more detail we are joined by Dr James Sapontis, experienced cardiologist and head of complex coronary intervention at Monash Heart who will consider:
· Concepts of atherosclerosis
· Pathologies of angina vs acute myocardial infarction
· How to recognise the vulnerable plaque
This is a discussion broadening our understanding of this very important pathophysiology. Please join me in this episode and conversation with James.
Useful references include:
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jamessapontis.com
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www.mayoclinic.org
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www.nhlbi.nih.gov
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www.heart.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The western world faces a very significant obesity epidemic. In Australia, two-thirds of our population or 12.5 million are either overweight or obese and as a consequence may experience many medical sequelae including development of the metabolic syndrome, type 2 diabetes, cardiovascular disease, cerebrovascular disease, osteoarthritis and depression, contributing significantly to our health burden. In the first part of this series, we were joined by Joseph Proietto, Professor Emeritus at the University of Melbourne, the Department of Medicine at Austin Health and an endocrinologist specialising in diabetes and obesity to discuss why we become obese. Professor Proietto joins us again to guide us through a strategy of how to treat and manage obesity and direct our patients toward a healthy body mass index (BMI).
In this episode Professor Proietto discusses:
· The concept of energy balance
· The influence of exercise
· Dietary approaches including - Very low energy diets that induce a ketogenic state
· Medication used to suppress appetite and assist patients to establish an optimal BMI
Professor Proietto was extremely informative in this conversation navigating steadily and logically through a management strategy that may be applied to our patients experiencing obesity in primary practice. Thank you for joining me in this conversation.
Useful references include:
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www.endocrine.net.au
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www.darebinweightlosssurgery.com.au
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vermontsouthmedicalcentre.com.au
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Body Weight Regulation – Essential Knowledge to Lose Weight and Keep It Off by Joseph Proietto. ISBN 9781514497005. Published 12 August 2016, Publisher Xlibris.
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www.aihw.gov.au
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pubmed.ncbi.nlm.nih.gov
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www.sciencedirect.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Up to two thirds of Australians are either overweight or obese as defined by body mass index (overweight: BMI 25-29.9, obese: BMI >30) with subsequent significant medical consequences including cardiovascular disease, type 2 diabetes, cerebrovascular disease (metabolic syndrome), osteoarthritis and depression. Becoming overweight and obese involves complex interactions between neurohormonal systems of the gut, neurobiology of the brain (particularly the hypothalamus) and leptin production from adipose sites coupled with an environment where there is an abundance of high glycaemic energy dense foods. Science demonstrates that the overarching controls of obesity are genetic (70%) rather than environmental (30%). Adoption studies relating to monozygotic twins demonstrate this. In view of the metabolic consequences of obesity, understanding why we get fat is extremely important to medical practitioners.
We are privileged to have a conversation in this podcast with Joseph Proietto, Professor Emeritus at the University of Melbourne in the Department of Medicine at Austin Health and an Endocrinologist who specialises in diabetes and obesity. Professor Proietto established the first Obesity Clinic in Victoria at the Royal Melbourne Hospital and is the head of Weight Control Clinic at Austin Health. He was the inaugural Sir Edward Dunlop medical research foundation Professor of Medicine and head of the Metabolic Disorders Research Group in the Department of Medicine, Austin Health, Joseph is on the executive of World Obesity and Chair of the Clinical Care Committee.
In this conversation he discusses:
· Why we become fat
· The role of genetic and epigenetic factors
· Some of the important hormones controlling satiety and hunger
Please enjoy this very interesting and informative conversation with Professor Joe Proietto.
Useful references include:
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www.endocrine.net.au
-
www.darebinweightlosssurgery.com.au
-
vermontsouthmedicalcentre.com.au
-
Body Weight Regulation – Essential Knowledge to Lose Weight and Keep It Off by Joseph Proietto. ISBN 9781514497005. Published 12 August 2016, Publisher Xlibris.
-
www.aihw.gov.au
-
pubmed.ncbi.nlm.nih.gov
-
www.sciencedirect.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The spleen performs a large number of important functions including processing and removal of opsonized pathogens, cellular maintenance, immunoglobulin production and the removal of effete worn out red blood cell. When removed either through trauma or for therapeutic indications the risk of overwhelming post splenectomy infection (OPSI) increases significantly; up to 58 times the general population in the setting of trauma and up to 1,100 times increased risk when for thalassaemia.
The risk of OPSI is particularly high in the first 2-5 years for capsulated bacteria such as Strep pneumonia, Haemophilus influenzae and Neisseria meningitidis. To discuss the functions of the spleen and post splenectomy syndrome in more detail we are joined by expert and very affable general physician Dr Mohammed Al-Souffi, formally trained in Iraq and the United Kingdom before “walking free” to Victoria, where we are very fortunate to welcome him as a colleague and member of the Royal Australian College of Physicians. Mohammed joins us to talk about:
· Functions of the spleen
· OPSI
· Appropriate vaccination post splenectomy
· Management of thrombocytosis
· Spleen registry
I am most grateful to have Mohammed as part of this podcast series. I do hope you can join me in this conversation.
Useful references include:
Spleen.org.au
www.racgp.org.au
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
There have been many new advances in the field of cardiology.
Since I was a trainee the incredible developments we now take for granted in this field have been exponential. Given the high incidence of heart disease in our community one in six Australians have heart disease) revascularisation and techniques to prevent thromboembolic events as well as methods to repair heart valves with a minimally invasive approach have all proven extremely valuable advances.
We are joined today by Dr James Sapontis, head of complex coronary intervention at Monash Heart and formerly trained through Mahi Missouri and Kings College London to discuss:
· Revascularisation by PCI and CABG
· TAVI (TAVR)
· LAAC – left atrial appendage closure techniques using the Amplatzer occluder or the Watchman technique
This is a fascinating discussion as James walks us through these developments clearly and concisely. I invite you to join this episode.
Useful references include:
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jamessapontis.com
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www.health.harvard.edu
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www.ncbi.nlm.nih.gov
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www.medtronic.com
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my.clevelandclinic.org
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www.hopkinsmedicine.org
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www.secondscount.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Lung cancer is a major problem facing Australian doctors representing 9% of all cancer diagnoses and with 12,200 new cases of lung cancer diagnosed each year it is the fifth most commonly diagnosed cancer, but the most common cause of cancer death in this country for both men and for women. The early presentation of lung cancer may be as subtle as a small coin lesion or nodule seen on chest imaging and there are a multitude of ways in which such nodules may be interrogated further. Whilst a wait and watch approach may be appropriate, further evaluation by VATS with a tissue diagnosis maybe required.
In this podcast episode we are joined by expert thoracic surgeon Mr Cliff Choong who discuss:
· Lung nodules and coin lesions
· Appropriate follow-up and review when a lung nodule or coin lesion is found on imaging
· Surgical approaches to diagnosis and management including VATS (video assisted thoracic surgery)
This is an excellent conversation with Cliff who generously guides us through a logical approach to management. Please join me.
Useful references include:
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www.sjog.org.au
-
www.nlm.nih.gov
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my.clevelandclinic.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Benign prostatic hyperplasia (BPH) is a common condition as men age and the most common benign tumour in men. Approximately half of all men between the age of 51 and 60 years have BPH and upto 90% of men over the age of 80 years have it. Prostate enlargement can be responsible for a variety of urinary symptoms including hesitancy with poor urinary flow, frequency, nocturia and incontinence. Where surgery was once a likely outcome for this condition many medical therapies have evolved to provide suitable alternatives including Alpha 1 adrenoceptor blockers resulting in smooth muscle relaxation in the prostate and bladder neck, 5-alpha reductase inhibitors which reduce prostate volume and growth by inhibiting the conversion of testosterone to dihydrotestosterone (DITT) and phosphodiesterase 5 inhibitors which may improve quality of life and voiding symptoms.
To discuss this subject in more detail we are joined by expert urological surgeon Mr Dennis King who covers:
· Diagnosis of BPH
· Medical approaches
· When to refer surgically
This was a great summary and overview of BPH. I do thank you for joining our episode.
Useful references include:
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urologyassociates.com.au
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www.mayoclinic.org
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www.healthdirect.government.au
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www.urologyhealth.org
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www.niddk.nih.gov
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www1.racgp.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this podcast episode, we have a conversation with physiotherapist Ryan Johnson of R3 Physiotherapy in London who is passionate about gait correction and has written a book called The Way to Walk.
I looked forward to this conversation as Ryan’s strategies address some very major public health problems in our community with 20-37% of 45-year-olds and older estimated to be experiencing foot pain alone, additionally, many hip, knee, back and neck complaints may be traced back to gait disorder at their foundation.
In applying these techniques within his busy physiotherapy practice in London, Ryan has had some very impressive results. The methods can be found in his book The Way to Walk which include very detailed but easy to follow descriptions and video examples.
Please enjoy this conversation with Ryan Johnson.
Useful references include:
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The Way to Walk by Ryan Johnson BSC (hons) (MCSP) through Amazon and r3physiotherapy.com
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https://www.r3physiotherapy.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Prostate cancer is the second most commonly diagnosed cancer among men and the second most common cause of death from cancer in men, yet many prostate cancers are not fatal and some autopsy series have demonstrated up to 50% or more silent prostate cancers in men over the age of 70 years. At 50 years of age some studies suggest a 40% chance of harbouring a latent cancer, 16% chance of developing an apparent and invasive cancer and 2.9% risk of death from prostate cancer. These facts raise several controversies regarding management and the approach to surgical treatment is also subject to debate.
To discuss this subject in more detail we are joined by expert urological surgeon Dr Dennis King who covers:
· Approaches to diagnosis of prostate cancer
· Separating indolent disease from lethal and aggressive disease
· Surgical approaches including robotic surgery
I enjoyed this conversation with Dennis immensely and am very pleased to invite you to the episode.
Useful references include:
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urologyassociates.com.au
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www.prostate.org.au
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www.cancer.org.au
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ghr.nlm.nih.gov
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www.mayoclinic.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Personalised medicine also known as precision medicine uses the knowledge of genetics to help predict disease development and to influence decisions about lifestyle choices and to tailor treatment to a particular individual’s tumour. The hope is that personalised medicine will allow more appropriate choices of targeted therapy and minimise side effects rather than choosing a “one size fits all” approach to prescription medication. Pharmacogenetics may now be used in some circumstances to minimise the likelihood for adverse reactions to a medicine and improve outcomes. To discuss this interesting subject as it applies to oncology, we are joined by Dr Sem Liew an oncologist who has already joined us to discuss immunotherapy in a previous episode. Sem will cover:
· An outline of personalised medicine
· Clinical applications
Please join me on this interesting podcast with Sem.
Useful references include:
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www.victorianoncologycare.com.au
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www.nhmrc.gov.au
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www.england.nhs.uk
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Cancer is responsible for over 40,000 deaths annually in Australia and has traditionally been managed by modalities including surgery, radiotherapy and chemotherapy. In 1992, Tasuku Honjo’s discovery of checkpoint proteins on tumour cells led to the birth of immunotherapy which has revolutionised the treatment of many cancers including bladder and kidney cancer, head and neck cancer, melanoma, non-small cell lung cancer and Hodgkin’s lymphoma. To broaden our appreciation of checkpoint inhibition chemotherapy in practice we are joined by expert oncologist Dr Sem Liew who discusses:
· Immunotherapy broadly
· Application
· Possible future developments
Please join me on this very interesting interview with Dr Sem Liew.
Useful references include:
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www.victorianoncologycare.com.au
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www.cancer.gov
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www.racgp.org .au
-
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this podcast episode we have a conversation with Mr Andrew Tang, Director of the Epworth Musculoskeletal Clinical Institute and an experienced orthopaedic surgeon operating at Epworth Richmond and St John of God Berwick since the early 1990’s. He has a particular interest in robotic knee surgery which allows improved accuracy with implant positioning and as the convenor of the Internal Orthopaedic Audit at Epworth Health he is in an excellent situation to review approaches to hip surgery, including the increasingly popular anterior approach. The ratio of knee to hip surgery currently being conducted in Australia is nearly 2:1 and it is estimated that by 2030 there will be up to 161,000 total knee replacements and 79,000 total hip replacements. Undoubtedly this figure will be contributed to by our aging population and relative obesity epidemic. Please join me in this excellent conversation with Andrew Tang as he reviews:
· Robotic knee surgery
· Surgical approaches to hip surgery
Useful references are:
www.epworth.org.au
pubmed.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
As clinicians we are often faced with the dilemma of working up cystic structures in the pancreas. These may have been discovered incidentally but may also be clinically relevant and contributing to symptoms. In this podcast episode we are joined by Mithra Sritharan a hepatopancreaticobiliary and general surgeon with a particular interest in liver and pancreatic disease, but whose management skills and high level of competence is evident from this interview. Today Mithra shares his knowledge in discussing:
· Pseudocysts
· Pancreatic cystic neoplasms including serous cystadenomas
· Mucinous cystic neoplasms
· Intraductal papillary mucinous neoplasms (branch duct, main duct and mixed type)
· Cystic tumours
· Non-neoplastic cysts
We cover a lot in this conversation including the Fukuoka guidelines and other investigative approaches we can draw upon to interrogate cystic structures further. Please welcome and enjoy the conversation with Mithra Sritharan.
Useful references include:
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www.sjog.org.au
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www.caseysurgicalgroup.com.au
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www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Our approach to space-occupying lesions (SOL’s) in the liver is dependent on a firm knowledge of the potential pathology, the choice of imaging modality and the understanding of any background clinical liver disease in the index patient. We are joined today by expert hepatopancreaticobiliary and general surgeon Mr Mithra Sritharan, who carefully guides us through a logical approach to liver SOL’s including:
· Cysts
· Haemangiomas
· Focal nodular hyperplasia
· Adenomas
· Malignancies
This is an excellent and clear discussion by Mithra and I am very pleased to invite you to the conversation.
Useful references include:
-
www.sjog.org.au
-
www.caseysurgicalgroup.com.au
-
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode, we talk with experienced general practitioner Dr Sally McDonald who has committed a large part of her time, energy and emotion providing palliative care for her local community. Palliative care is care focused on improving the quality of life for people and families with serious illnesses, directed at treating the symptoms of the patient, support for patient’s families and loved ones and aligning care with patient’s preferences, values and goals. Professor Ian Maddocks, a palliative care specialist, said “sometimes I think it’s better to step back and say you don’t need all that procedural stuff, what you need is good care now. You are going to die, let’s do it well.”
Along this theme Sally discusses:
· How she approaches palliative care from the perspective of the patient and family
· Treatment choices
· Services that can provide support
I am most grateful to Sally for her conversation with us. Please join this interesting episode.
Useful references include:
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lakesidesquaremedical.com.au
-
Palliative Care Victoria
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www.palcare.vic.asn.au
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www.betterhealth.vic.gov.au
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www.cancervic.org.au
-
www.aph.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Seizures may be defined as a transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge in the brain with epilepsy defined by any disorder characterised by recurrent (more than two) unprovoked seizures. It is estimated that 1-2% of the Australian population experience epileptic seizures in adult life and up to 4% of children experience epileptic seizures. With over 40 different types of epilepsy and epileptic syndromes the risks of death from this very important clinical problem is two to three times the average. It is estimated that 60-70% of patients with good epileptic care will be seizure free with treatment and this may lead to treatment withdrawal in up to 60% of adults after two to five years of successful therapy.
With this background we had a very interesting conversation with Dr Doug Crompton head of Neurology at Northern Hospital Melbourne in regard to:
· Definition of seizure and epilepsy
· Types of epilepsy
· Investigation and work up
· Management, including advice with respect to driving and daily activities
This was a very enjoyable conversation from a master in his field. Please join me with Doug.
Useful references include:
-
www.nh.org.au
-
www.epilepsy.org.au
-
www.webmd.com
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How to treat 2016 yearbook Epilepsy Part I & II, pp. 143-154
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Australia is in the dawn of its vaccination program against SARS-COV2, inoculations commenced this week among frontline health workers and aged care residents as well as our Prime Minister. By comparison, Israel’s vaccination rollout has been the fastest in the world, half the population has received one dose already and one third has received both inoculations.
In a sense, Israel has become a real-time global experiment watched by health authorities and governments across the locked down world as Israel opens itself up again to those vaccinated. Australia has much to learn from their experience. In this special episode we are joined by Professor Gabriel Barbash from Israel, Professor of Epidemiology and Preventive Medicine in the Sackler School of Medicine, Tel Aviv University and at the forefront of Israel’s inoculation program who discusses :
•Vaccine choices
•Vaccine safety and efficacy
•Mutant strains - their impact
•Special cases to consider - the immunosuppressed patient, those with previous allergies, Guillain Barre, •Pregnant and breastfeeding women
•Herd immunity
•Children and vaccination
This was a fascinating conversation and I was deeply honoured to have Professor Barbash join us with many key points covered. Please enjoy.
References
www.nejm.org/covid-vaccine/faq
www.weizmann.ac.il
www.health.gov.au
www.cdc.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
It is estimated that more than 56,000 strokes will be experienced by Australians this year (new and recurrent) and that half of Australians are living with the effects of a stroke which remains the third leading cause of death in Australia and kills more women than breast cancer and more men than prostate cancer. As more than 80% of strokes may be prevented and four in 10 stroke survivors have a recurrent stroke within a decade it is very important we understand the aetiology of strokes and how we may intervene effectively to reduce incidence and morbidity.
In this episode we have a conversation with Dr Doug Crompton head of neurology at Northern Hospital who discusses:
· Aetiology of CVA
· Diagnosis
· Importance of thrombolytic therapy
· Place for clot retrieval
· Primary and secondary prevention
This was a very interesting conversation with Doug, covering this fascinating topic and I am certain you will find the conversation extremely valuable.
Useful references include:
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strokefoundation.org.au
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www.stroke.org.uk
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www.mj.com.au
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pubmed.ncbi.nlm.nih.gov/Epidemiology: Advancing our understanding of disease
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pubmed.nbo.Ovbiagele.et.al.2011
-
www.nh.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
It is estimated that 130,000 Australians have been diagnosed with insulin dependent diabetes mellitus with about seven new cases per day. Approximately 60% of the diagnoses are in children and young adults under the age of 25 years. As IDDM is an autoimmune disease resulting in the destruction of insulin producing cells, glycaemic control is obtained through the administration of insulin. There have been several recent advances in continuous glucose monitoring and insulin delivery to review.
In this podcast episode we are joined by experienced endocrinologist Dr Chin Tan who will discuss:
· The importance of glycaemic control
· The choice of insulin
· Continuous glucose monitoring (CGM)
· Insulin pumps
I really enjoyed this conversation with Chin conducting it in his medical rooms and I was able to carefully inspect the latest gadgets that are available for IDDM patients. I am very pleased to bring this conversation to you.
Useful references include:
-
southeasternendocrine.com
-
www.ncbi.nlm.nih.gov
-
www.aihw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Endorectal ultrasonography combined with anorectal physiology allows the evaluation of the constituents of the wall of the anal canal and the scientific understanding of anorectal pathophysiology. It is very important to appreciate a patient’s anorectal dynamics before initiating an effective management strategy for what may be a wide variety of pelvic-anorectal disorders.
In this episode we are joined by expert colorectal surgeon Mr T C Nguyen as he discusses the application of endorectal ultrasound and anorectal physiology studies –
· The management of faecal incontinence
· Management of obstructed defecation (Anismus) and dyssynergia
These medical problems are more common than is recognised and often not openly discussed by patients. Please join this interesting and helpful conversation.
Useful references include –
www.secr.com.au
www.sciencedirect.com
pubmed.ncbi.nlm.nig.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Robotic assisted surgery allows doctors to perform complex procedures with more precision, flexibility and control than is possible with conventional techniques. Now used in many forms of surgery including cardiac, prostatic and orthopaedic, in this episode we are joined by the dynamic and highly skilled Mr T C Nguyen who discusses –
· The application of robotic surgery to colorectal pathology
· Appropriate patient selection
· Outcomes and advantages
TC shares his personal journey from a young boy fleeing war torn Vietnam making his home in Melbourne, to highly skilled and respected surgeon in this excellent conversation which I am delighted to share with you.
Useful references include –
www.secr.com.au
www.ncbi.nim.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Wednesday 19th June 2019 was a historic day for Victoria after parliament introduced voluntary assisted dying legislation to the community for patients facing imminent death as a result of incurable disease, with that ruling a patient’s decision to end his or her life voluntarily became a possibility.
The legislation is complicated and coupled with many safeguards. VAD has understandably been debated with great emotion and considerable controversy before and since the legislation was introduced.
In this episode we discuss the legislation with Dr Frank Hofmann who approaches the subject with extreme sensitivity, consideration and empathy including -
· Implementation of the legislation
· Safeguards, rules and checks involved
· The supports including palliative care that are available for patients choosing VAD
I think you will agree that Frank navigates the conversation with great professionalism. I am very pleased to share the episode with you.
Useful references include –
www.bettersafercare.vic.gov.au(Voluntary Assisted Dying Review Board)
www.vic.gov.au
www.racgp.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Medical cannabinoids are derived from the cannabis sativa plant. There are 144 known cannabinoids, THC is perhaps the best known for its psycho-active effects, however cannabidiol (CBD) is now being recognised for its many medical applications. To discuss the role of cannabidiol in medicine we are joined by Dr Sud Agarwal, anaesthetist and CEO of one of Australia’s most interesting and emerging biotechs called Cannvalate. In this episode Sud discusses the uses of CBD -
· as an anticonvulsant and neuroprotective agent
· as an anti-inflammatory and
· as an immunomodulator
Sud also takes us on his journey to becoming seriously involved in the biotech industry. Please enjoy this episode with the very colourful and energetic Dr Sud Agarwal.
Useful references include –
www.cannvalate.com.au
www.compassclinics.com.au
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In 2019 experienced anaesthetist Dr Tom Edgley was left to defend his two properties in the rural and bushy enclave of Tonimbuk from the disastrous fires claiming over 26 properties in the region. Not only did Tom survive protecting his properties from the fire, but he also lent a major hand to his neighbours and was involved in the emotional rehabilitation of his community. He cited his attendance at emergency courses including –
· EMST (Early Management of Severe Trauma)
· Wilderness Medicine Utah
Both important resources in laying the foundation for him to follow effective strategies in the emergency
Tom has been an active advocate for extending one’s medical knowledge beyond the clinical environment of hospitals and discusses his experience, these courses and his life philosophy.
Please enjoy the conversation in this episode with Dr Tom Edgley.
Useful references include –
wmutah.org
www.surgeons.org(EMST)
www.realresponse.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode we have a conversation about Type 2 diabetes, a condition that affects at least 1.2 million Australians (5% of Australians) and for which there are a complex number of pharmacologic treatment strategies available.
We are joined by experienced and very popular Endocrinologist Dr Chin Tan who discusses –
· Oral hypoglycaemic agents that are available to us in Australia
· How to combine these agents for effective glycaemic control
· The place of insulin in type 2 diabetes
Chin also discusses the broader metabolic syndrome and the key requirement for BMI control in type 2 diabetic patients.
This is a detailed conversation which I hope you will find very informative.
Useful references include –
www.southeastendocrine.com
www.diabetesaustralia.com.au
www.diabetesvic.org.au
www.aihw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
The transfer of stool from a healthy donor into the gastrointestinal tract of a recipient (FMT) at first consideration does not seem like a reasonable or scientific approach to the treatment of gastrointestinal diseases. Historically however, it has been used by communities for over 3,000 years, gaining credibility in 1958 after a paper by Eisemen in Denver who described treating pseudomembranous colitis this way. More recently double-blind randomised control trials have demonstrated the efficacy of FMT in the treatment of severe clostridium difficile enterocolitis. To discuss this subject in more detail we are joined in a conversation with Dr Darcy Holt, senior consultant at Monash Health, who also works at the Centre for GI Health, as he leads us through –
· The indications for FMT
· Therapeutic advantages
· Practical aspects of FMT
With his typical academic flare and clarity of dialogue, please enjoy this interesting conversation with Darcy.
Useful references include –
www.gihealth.com.au
www.nps.org.au
www.racp.edu.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
DARCY HOLT - BIOLOGICS AND SMALL MOLECULES FOR INFLAMMATORY BOWEL DISEASE
Biologic agents (produced in living organisms or containing components of living organisms) coupled with a variety of new small molecules (acting in novel ways to influence the human immune system) have dramatically improved medical management of inflammatory bowel disease. In this podcast episode, we are joined by Dr Darcy Holt, a senior gastroenterologist at Monash Health, with a special interest in inflammatory bowel disease and body composition to discuss -
· TNF inhibitors including the chimeric infliximab, fully humanised recombinant adalimumab, fully humanised monoclonal antibody golimumab
· Anti-integrins which regulate lymphocyte trafficking to the gut including the gut selective vedolizumab
· Interleukin inhibitors including ustekinumab which inhibits interleukin 12 and 23 as well as
· JAK inhibitors which decrease signalling by cytokines growth factor receptors including Tofacitinib
Darcy covers appropriate indications, screening for tuberculosis and viral hepatitides before therapy commencement, relative contraindications and the use of biosimilars. I found this a very interesting discussion on a group of therapies that have brought significant improvement to the quality of life of many patients with inflammatory bowel disease.
The useful references include:
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www.gihealth.com.au
-
www.gesa.com.au
-
www.crohnsandcolitis.com.au
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www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Inflammatory Bowel Disease (IBD) affects approximately 85,000 Australians and 5 million people worldwide and includes Crohn’s disease and ulcerative colitis. These conditions may have a major impact on patient’s quality of life. To discuss both ulcerative colitis and Crohn’s disease in more detail we are joined by Dr Catherine Sorrell, a very experienced and popular gastroenterologist who takes us on a fascinating journey including –
· Top down and bottom up approaches to pharmacological management
· Sharing her approach to selecting medical therapy for patients with IBD.
Catherine explains these clinical problems with great mastery. I am pleased to invite you to this conversation.
Usual references include:
www.gihealth.com.au
www.chrohnsandcolitis.com.au
www.acnc.gov.au
www.gesa.org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Australia has led the world in pain management, interventional techniques and pain research including in the management of severe and debilitating axial and musculoskeletal pain via spinal cord and DRG stimulation as well as in several evolving techniques for the management of visceral pain.
Recently potential breakthroughs have been emerging in the application of spinal cord stimulation to control symptoms related to IBS and gastroparesis. Dr Paul Verrills entered pain management as a consultant during the dawn of the speciality and has been at the vanguard of pain management both in Australia and worldwide. He established the Metro Pain Group in Clayton which has stood like a beacon and shining example of how to manage chronic pain syndromes and Paul has personally been involved in education and mentoring both in this state, in Australia and internationally. We are honoured to welcome him as our guest to this podcast where he discusses:
· Pain management techniques including spinal cord and DRG stimulation
· Why medications often fail (the elephant in the room)
· The emerging future of pain management as applied to a variety of clinical syndromes
It was a real pleasure to interview Paul and I welcome you to this conversation.
Useful references include:
-
www.metropain.com.au
-
Chronic Abdominal Pain. An Evidence-based Comprehensive Guide to Clinical Management, Leonardo Kapural
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode I have a conversation with Dr Puneet Mahindra on the subject of Barrett’s oesophagus. Puneet not only discusses the origins of this condition, named after Australian born thoracic surgeon Mr Norman Barrett, but also discusses –
· Its relationship to chronic reflux disease
· Adenocarcinoma risk
· Surveillance guidelines
· Appropriate medical management
Puneet makes the point that Barrett’s oesophagus is an important reason why we should all take gastro-oesophageal reflux disease seriously. This is an excellent introduction and overview to the subject; I hope you enjoy the conversation.
Refences include –
www.gesa.org.au
pubmed.ncbi.nlm.nih.gov
www.mayoclinic.org
ASGE guidelines
wiki.cancer.org.au
www.gihealth.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode I interview experienced gastroenterologist Dr Puneet Mahindra on the common clinical problem of gastro-oesophageal reflux disease. Puneet details –
· Risk factors
· Complications
· Approaches to management
He provides personal tips drawn from experience and the literature outlining an approach that should be helpful to everyone practicing clinical medicine.
Puneet also walks us through his journey to becoming a gastroenterologist, growing up in India, working and studying in the United Kingdom and then Australia. I hope you enjoy the conversation.
Useful references include –
www.gesa.org.au (Clinical update and Management guidelines)
www.gihealth.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
It is estimated that at least 300,000 Australians have chronic heart failure imposing a significant impact on the quality of life and mortality. In this podcast episode, we are joined by an experienced interventional cardiologist, Dr James Sapontis, as we explore heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). James carefully dissects and describes these two forms of heart failure by discussing –
· Diagnosis
· Risk factors
· Treatment approaches
This was a very interesting conversation that I am delighted to share with you.
Useful references include –
www.jamessapontis.com
www.ncbi.nlm.nih.gov
www.heartfoundation.org.au
www.mayoclinic.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
It is estimated that 1 in 4 Australian deaths relate to cardiovascular disease and that there are over 60,000 acute coronary events, including either angina or myocardial infarctions, recorded each year in Australia. In an attempt to reduce morbidity and mortality medical efforts have been directed to primary prevention and improving the selection of patients likely to require coronary intervention, such as cardiac stenting or revascularisation. To discuss the place of coronary CT angiography in the investigation and work up of a patient suspected to have coronary disease we are joined by the very impressive and knowledgeable interventional cardiologist, Dr James Sapontis as he explains –
· CCTA
· Explores the appropriate place of CCTA in the workup and management of coronary artery disease.
I found this conversation very interesting and I am very pleased to share the episode with you.
Useful references include –
Jamessapontis.com
www.uwhealth.org
www.ncbi.nlm.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode we have a very interesting conversation with one of Australia’s leading bariatric surgeons, Mr Raymond McHenry, on surgical approaches to weight loss, focussing particularly on the gastric sleeve and roux-en-y gastric bypass operations.
Ray discusses –
· patient selection
· psychological profiling
· choice of operation and outcomes and
· covers some of the early experiences with other bariatric approaches
This conversation provided a very insightful discussion from one of our surgical masters.
Useful references include -
www.lapsurgeryaustralia.com.au
www.niddk.nih.gov
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Covid 19 has brought forth upon the world a pandemic unrivalled since the Spanish flu (1918 – 1920) caused by H1N1 influenza A. Described by Australian Treasurer Josh Frydenberg as the “new and invisible enemy”, every doctor has had to avail themselves of knowledge regarding this highly contagious virus.
Today we are joined by expert infectious disease specialist Dr Babak Rad who will discuss:
· Our knowledge regarding the incubation period of Covid 19
· Virulence
· Quality of testing
· Asymptomatic spreaders
· The immunocompromised patients
· Medical therapies
· Vaccines
Much of our knowledge continues to be a work in progress, by the time this pandemic passes Covid 19 may be the best-known pathogen ever studied by humankind. Please join me in this interesting conservation with Dr Babak Rad.
Useful references include:
-
www.babak.rad.com
-
www.health.gov.au
-
www.o.int
-
www.cdc.gov
-
www.cidrap.umn.edu
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode I have a conversation with hepatologist and gastroenterologist Dr Ferry Rusli in a four-part series on liver disease where we explore chronic hepatitis C, its population reservoirs in Australia and approaches to treatment.
In particular, Ferry points out –
· The need to increase our effectiveness at treating hepatitis C in at risk populations (e.g. prison population)
· Discusses the impressive breakthrough with new antiviral therapies and their effectiveness in curing hepatitis C
· Surveillance for hepatocellular carcinoma
I really hope you find this conversation as interesting as I did.
Useful references include -
www.gesa.org.au
www.hep-druginteractions.org
www.hepatitisaustralia.com
www.gihealth.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode I talk with experienced gastroenterologist and hepatologist Dr Ferry Rusli on the subject of hepatitis B in a four-part series on liver disease. Ferry discusses -
· the prevalence of hepatitis B in the Asia Pacific region
· the long-term complications and consequences of hepatitis B
· treatment options including pharmacological therapies which are currently falling short of the national target for patients receiving treatment.
This conversation provides a great introduction to current approaches to hepatitis B management. I hope you enjoy the conversation.
Useful reference are -
www.gesa.org.au
www.hepatitisaustralia.com
www.gihealth.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode I am joined by Dr Ferry Rusli, an experienced gastroenterologist and hepatologist to discuss non-alcoholic fatty liver disease in a four-part series on hepatology.
Ferry discusses –
· the prevalence of non-alcoholic fatty liver disease (NAFLD) as it applies to the Australian population
· non-alcoholic steatohepatitis (NASH)
· cirrhosis, hepatocellular carcinoma and liver failure as sequela of unmanaged NASH
Ferry discusses the relevance of non-alcoholic fatty liver disease to the metabolic syndrome and some key management points, in particular focussing on controlling body mass index. There is much to learn from this conversation with Ferry, I hope you enjoy the conversation.
Useful references include -
www.gesa.org.au
www.health.queensland.gov.au
www.hepvic.org.au/fattyliverdisease
www.gihealth.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
In this episode I interview gastroenterologist and hepatologist Dr Ferry Rusli in the first of a four-part series on liver disease. Ferry discusses his approach to a patient presenting with abnormal liver function tests and navigates us through -
· Obstructive liver patterns
· Hepatitic patterns
Ferry will address in broad terms common aetiologies such as non-alcoholic fatty liver disease, chronic hepatitides, acute viral infections, biliary obstruction, malignancy and the possibility of drug side-effects. There are some great insights to be gained here. We also find out about Ferry’s journey into medicine growing up in Indonesia, completing schooling in Melbourne and being awarded the travel scholarship in hepatology from the Gastroenterological Society of Australia. I hope you enjoy the show.
Useful reference -
www.gihealth.com.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.