This Medical Life - SoundSage

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Bone sarcomas are rare, accounting for 0.2% of all cancer diagnoses, with around 200 cases diagnosed in Australia each year. The three main types differ by age and site: osteosarcoma (around 30 to 35% of cases, often in the arms, legs and pelvis, with peaks in adolescence and again in the seventies and eighties), chondrosarcoma (around 30% of cases, typically in adults over 40), and Ewing sarcoma (around 15% of cases, most common in children).

Professor Fiona Maclean, an anatomical pathologist, describes bone sarcoma diagnosis as a pattern-recognition challenge made harder by rarity, noting that tumour type and stage are the two most useful pieces of information for a GP reading a pathology report.

A/Professor Richard Boyle, an orthopaedic oncological surgeon, outlines the red flags, including unexplained deep bone pain and night pain, and the diagnostic pathway from X-ray through biopsy to multidisciplinary review.

This is the story of Bone Sarcoma Part 1.

Useful links:

Australia and New Zealand Sarcoma Association: https://sarcoma.org.au/

Find a sarcoma specialist: https://sarcoma.org.au/pages/about-sarcoma/find-a-sarcoma-specialist

Sarcoma guidelines: https://sarcoma.org.au/pages/sarcoma-guidelines

Seeking a second opinion: https://sarcoma.org.au/pages/about-sarcoma/seeking-second-opinion

Useful patient information: https://sarcoma.org.au/pages/about-sarcoma/patient-and-carer-sarcoma-information

Our Special Guests:

A/Professor Richard Boyle who is a Sydney-based orthopaedic oncological surgeon and head of the NSW Sarcoma unit.

Professor Fiona Maclean who is an anatomical pathologist and professor from Macquarie University.

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The treatment of soft tissue sarcomas is a highly specialised area. The first effective chemotherapy agent against sarcomas was only identified in the 1960s and benefits of adjuvant radiotherapy treatment began in the 1970s. We continue to learn as new agents become available and tailor treatments to each patient.

This is the story of Soft Tissue Sarcoma (Part 2). Here is the link to Part 1.

Useful links:

Australia and New Zealand Sarcoma Association: https://sarcoma.org.au/

Find a sarcoma specialist: https://sarcoma.org.au/pages/about-sarcoma/find-a-sarcoma-specialist

Sarcoma guidelines: https://sarcoma.org.au/pages/sarcoma-guidelines

Seeking a second opinion: https://sarcoma.org.au/pages/about-sarcoma/seeking-second-opinion

Useful patient information: https://sarcoma.org.au/pages/about-sarcoma/patient-and-carer-sarcoma-information

Article from the RCPA about reviewing soft tissue tumours and obtaining second opinions: https://pubmed.ncbi.nlm.nih.gov/41390329/

Our Special Guests:

Professor Peter Grimison who is a medical oncologist at Chris O’Brien Lifehouse and clinical professor at University of Sydney

Associate Professor Stephen Thompson is a radiation oncologist at Prince of Wales hospital and conjoint associate professor at the University of New South Wales

This is the story of Soft Tissue Sarcoma (Part 2). Here is the link to Part 1.

Useful links:

Australia and New Zealand Sarcoma Association: https://sarcoma.org.au/

Find a sarcoma specialist: https://sarcoma.org.au/pages/about-sarcoma/find-a-sarcoma-specialist

Sarcoma guidelines: https://sarcoma.org.au/pages/sarcoma-guidelines

Seeking a second opinion: https://sarcoma.org.au/pages/about-sarcoma/seeking-second-opinion

Useful patient information: https://sarcoma.org.au/pages/about-sarcoma/patient-and-carer-sarcoma-information

Article from the RCPA about reviewing soft tissue tumours and obtaining second opinions: https://pubmed.ncbi.nlm.nih.gov/41390329/

Our Special Guests:

Professor Peter Grimison who is a medical oncologist at Chris O’Brien Lifehouse and clinical professor at University of Sydney

Associate Professor Stephen Thompson is a radiation oncologist at Prince of Wales hospital and conjoint associate professor at the University of New South Wales

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Soft tissue sarcomas are tumours that arise from connective tissue, fat, muscle, and blood vessels. They are distinct from epithelial malignancies (carcinomas) in both morphology and behaviour. Unfortunately, due to their rare occurrence, these tumours can be mistaken clinically and pathologically which affects patients management and prognosis.

As part of sarcoma awareness month, we are doing a series on soft tissue sarcomas as well as bone sarcoma in conjunction with the Australian & New Zealand Sarcoma Association to raise awareness and help provide education about these diagnoses.

This is the story of soft tissue sarcoma (part 1).

Useful links:

Australia and New Zealand Sarcoma Association: https://sarcoma.org.au/

Find a sarcoma specialist: https://sarcoma.org.au/pages/about-sarcoma/find-a-sarcoma-specialist

Sarcoma guidelines: https://sarcoma.org.au/pages/sarcoma-guidelines

Seeking a second opinion: https://sarcoma.org.au/pages/about-sarcoma/seeking-second-opinion

Useful patient information: https://sarcoma.org.au/pages/about-sarcoma/patient-and-carer-sarcoma-information

Article from the RCPA about reviewing soft tissue tumours and obtaining second opinions: https://pubmed.ncbi.nlm.nih.gov/41390329/

Our Special Guests:

Associate Professor Richard Boyle who is an orthopaedic oncologist and surgeon who specialises in the bone and soft tissue sarcoma.

Professor Fiona Maclean is an anatomical pathologist who specialises in soft tissue pathology and clinical professor at Macquarie University.

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Ethics, codes of conduct, and challenging decisions are universal constants in medicine. Difficult situations and trying to do the right thing are not always obvious particularly when these decisions involve lots of emotions, family members, and have life and death implications. Ethics, and ethics committees, can help to provide a clear and consensus path for clinicians, patients, and family members. We discuss the role ethics and ethics committees have in modern medicine with our special guest.

This is the story of clinical ethics.

Useful links:

Free critical thinking course through UQ school of philosophy

Clinical Ethics Society of Australasia – Great organisation focusing on clinical ethics, with affordable membership and lots of access to resources. They run an excellent ‘ethics intensive’ and yearly symposium as well as other masterclasses throughout the year.

Australasian Association of Bioethics and Health Law – Major organisation for ethics and health law. Excellent conference each year.

Links to Dr Melanie Jansen’s poetry

Instragram: @drmelaniejansen_poetry

Dr Melanie Jansen’s debut poetry collection, All That Could Be Lost, is available online from 5 Islands Press and at independent bookstores.

Our Special Guest:

Dr Melanie Jansen who is a clinical ethicist and paediatric intensive care consultant

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Lipoprotein (a) (Lp(a)) was discovered in 1963 by a Norwegian geneticist by the name of Kåre Berg who studied particles that carried cholesterol in the blood. He found some patients had an additional protein on the low-density lipoprotein. Studies found that patients with elevated Lp(a) had increased risks of cardiovascular disease. However, the levels were not affected by diet, environmental factors, or medications. The result is that this test was largely ignored for the last few decades.

Recent dyslipidaemia guidelines released by the United States and Europe have returned a focus back on to Lp(a). They recommend that patients should have Lp(a) tested once throughout their life to assess their cardiovascular disease risk. The result can help identify which patients are at a higher risk of cardiovascular morbidity and mortality and who will benefit from lifestyle modification and early intervention.

This resource is referenced during the discussion: https://www.lpaclinicalguidance.com/

This is the story of lipoprotein (a).

Our Special Guests:

Dr Michael Page is a chemical pathologist at Clinipath in Perth, senior lecturer at the UWA Medical School, and immediate past President of the AMA (WA).

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Skin has always told stories. For thousands of years, those whose skin behaved differently — scaling, thickening, inflaming — were feared, isolated, and misunderstood. Psoriasis was long lumped together with leprosy, its sufferers cast out rather than cared for.

It would take centuries before medicine began to separate these conditions, and longer still before we understood what was really happening beneath the surface. Psoriasis is not an infection, not a curse, not a failure of hygiene. It is the immune system turning on itself, a complex, chronic inflammatory disease that affects not just skin but joints, confidence, and quality of life. It touches roughly 2-3% of the population, and for many it is a lifelong companion.

Today we have a clinical dermatologist and a dermatopathologist to help us understand what psoriasis looks like to the clinician, what it reveals under the microscope, and how our understanding of its immunological roots has transformed the way we treat it.

This is the story of psoriasis.

Our Special Guests:

Associate Professor Laura Scardamaglia, a Consultant Dermatologist, a Fellow of the Australasian College of Dermatology, and Clinical Associate Professor at the University of Melbourne.

Dr Grace Liu is an Anatomical Pathologist with Histopath in Sydney, Australia.

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The Artful Dodger is a television series on Disney+ that is a historical medical drama set in 1850s Australia with Jack Dawkins, the Artful Dodger from the world of Oliver Twist. Jack is a former pick pocket now surgeon who is reacquainted with old partner in crime, Fagin, who is keen for Jack to resume old habits.

The Artful Dodger takes pride in being one of the most historically accurate depictions of nineteenth century medicine and surgery. The hospital, surgical tools, and treatments are accurate portrayals of what we knew back then. We organised a discussion with its creator to take a deep dive into this entertaining show that both myself and Steve thoroughly enjoyed.

This is the story of The Artful Dodger

Our Special Guest:

James McNamara who is the creator, showrunner, head writer, and executive producer of The Artful Dodger available on Disney+.

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The complex symptomatology of hormonal diseases only started to be recognised in the 19th century as we learned about anatomy and physiology. When Doctor Robert Graves began piecing the hyperthyroid puzzle together when he saw patients with similar symptoms such as anxiousness, nervousness, aggitation, bulging eyes, and rapid/irregular heart rate. He realised this was a previously unknown condition to the medical field.

It would not be until the mid-20th century before we had a full understanding of the thyroid and thyroid diseases. Today, we have tests to diagnose and medications to manage. Graves’ disease accounts for 70-80% of all cases of hyperthyroidism.

This is the story of Graves’ Disease.

Our Guests:

Dr Liam Mulcahy who is studying physicians training with a strong interest in neurology. He was written a book called Beyond the White Coat: The Faces Behind Medical Eponyms.

Professor Duncan Topliss who is a senior endocrinologist at Alfred Hospital in Melbourne and Professor of Medicine in the Department of Medicine, Monash University.

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It has been well established in studies and articles that cholesterol lowering medications have significant heart morbidity and mortality benefits. However, high dosage trials did not show additional survival benefits but had increasing side-effects for patients. Therefore, the maximum dose for statins is not necessarily the best dose for patients.

This is the story of statin dosing.

Guest:

Professor Simon Dimmitt is a Consultant Physician working in General and Cardiovascular Medicine. He is Clinical Professor of Medicine at the University of Western Australia and Adjunct Professor, School of Medicine & Public Health at the University of Newcastle. His website contains Dose Tables and reviews for a modest subscription: Correct Dosing.

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Crucifixion was a form of punishment, humiliation, and execution. Adopted by the Ancient Romans, crucifixion was used on the State’s worst criminals on lower classes and slaves. As common as it was though, we know very little about how people died on the cross. In this episode, we take a closer look at crucifixion through a medical lens.

This image is not historically accurate. It was crafted within the guidelines of Gemini as a stereotypical rendering of crucifixion but our episode gets into the, sadly more brutal, truth.

This is the story of crucifixion.

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Recreational use of steroids and testosterone to enhance image and performance is on the rise. Over the last 70 years, testosterone and testosterone-like substances have been used extensively to enhance performance particularly in elite sports. Nowadays, the use is more widespread and occurs in the general community with far more drugs available to people via the internet. Unfortunately, the evidence users base their drug regimes on range from anecdotal and scant to wrong and dangerous. We discuss the use of testosterone (and other substances) to learn more, identify how we can look after patients who use anabolic steroids, and what risk factors we need to consider.

This is the story of anabolic steroids.

You can listen to Part One of this series here.

Our special guests:

Dr Tim Piatkowski is a senior research fellow at the University of Queensland on image and performance enhancing drugs.

Dr Mair Underwood is a senior lecturer in the School of Social Sciences at the University of Queensland and is an anthropologist of the body.

Professor Ken Sikaris is a chemical pathologist and Director of chemical pathology at Dorevitch pathology.

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Hypogonadism is a medical condition where the body does not produce enough testosterone. This can be primary (testicular failure) or secondary (pituitary or other condition). There are a number of conditions that doctors need to be aware of that can cause hypogonadism.

This is the story of hypogonadism.

Image ref: https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/hypogonadotropic-hypogonadism

Our special guests:

Professor Duncan Topliss is a senior endocrinologist and Professor of Medicine at Monash University.

Professor Ken Sikaris is a chemical pathologist and Director of chemical pathology at Dorevitch pathology.

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While testicular cancer is rare, it is the most common cancer in young men aged between 15 and 39 years. Like with every cancer, early detection is the key. Self-examination is important along with seeking medical attention if there are any concerns. Fortunately, overall survival is around 95%.

This is the story of testicular cancer.

Our special guests:

Dr Nari Ahmadi who is a Urologist and coordinator of the Urological Oncology Cancer research at Chris O’Brien Lifehouse.

Professor Peter Grimison who is a Medical Oncologist at the Chris O’Brien Lifehouse, VMO at the Royal Prince Alfred Hospital, and Clinical Professor at the University of Sydney.

Professor Fiona Maclean who an Anatomical Pathologist, Clinical Professor at Macquarie University, and previous President of the Australasian Division of the International Academy of Pathology (IAP).

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And we’re back – for another year – with more stories, more expert guests, more topics to discuss. Episodes released fortnightly.

And we’ve also released an ebook with audio narrated by the masterful voice of Steve Davis for a general audience sharing some of the amazing stories of medicine.

Chapter J provided in this episode.

Our special guest:

In this episode, our special guest is the audiobook itself: Diseased: The A to Z of illnesses, medicine, and important people through history.

Link to kindle version: Diseased: The A to Z of illnesses, medicine, and important people through history

Link to audiobook: Coming soon.

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Charles Dicken’s first novel has an adolescent boy named Joe who was overweight and always sleepy. He could fall asleep at any time, even during meals. The novel is known as the Pickwick Papers. Decades later, doctors began to recognise patients with the same symptoms. They called it Pickwickian syndrome.

Obstructive sleep apnoea is a common condition in the general community. Risk factors include being overweight, male, and over the age of 50. The difficulty for patients is they may not be aware they suffer from this condition unless a partner tells them they stop breathing during sleep. Fortunately, we have a number of treatment options available for patients who suffer from sleep apnoea.

This is the story of sleep apnoea.

Our special guests:

Dr Saul Gilbert is the managing director of a sleep clinic called The Oasis in Adelaide with 25 years research and clinical experience in sleep psychophysiology.

Dr Anuk Kruavit is a respiratory, sleep and general medicine physician with an interest in obstructive sleep apnoea and complex respiratory sleep disorders.

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Willem J Kolff was an intern when he saw a 22 year old man die of kidney failure. He realised that the patient’s life could have been saved if his blood could have been detoxified. Willem set to work and developed the first ever dialysis machine (initially the ‘rotating drum kidney’).

While dialysis is a lifesaving treatment, it is one that we hope to avoid for patients. In this episode, we discuss two topics that are the largest contributors to chronic kidney disease: Diabetes, and Hypertension.

This is the story of Chronic Kidney Disease (Part 2).

Our special guest:

Dr Richard Phoon who is the Senior Medical Advisor at Westmead Hospital and has worked full-time as a Nephrologist at Westmead and Blacktown Hospitals since 2007.

Useful links:

CKD Management in Primary Care handbook (KHA) Link: https://kidney.org.au/health-professionals/ckd-management-handbook

Kidney Health 4 Life: Kidney Health 4 Life – Better kidney health, for life

Health professional webinar here: Kidney Health 4 Life Healthcare Professional Webinar – YouTube

For health professionals looking for printed posters and brochures for their clinic or unit: Kidney Health 4 Life Print Materials

Or contact the Kidney Health Australia Helpline on 1800 454 363

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One in 10 Australians over the age of 18 years are living with signs of Chronic Kidney Disease (CKD) with the number of patients needing treatment for kidney failure has doubled in the last 20 years. Early detection and intervention can slow the progression of CKD by up to 15 years or longer.

Our understanding of kidney disease can be traced back to Dr Richard Bright, one of the founding fathers of nephrology. He noted that heating a patient’s urine with kidney disease could form a precipitate – nowadays we’d call this albuminuria (albumin in the urine) and it is a marker of kidney damage.

Today, there are a range of conditions that can reduce kidney function, cause kidney damage, and can cause significant morbidity and early mortality in patients. By screening patients, we can reduce the progression of CKD and significantly affect the health of patients in the long term.

This is the story of Chronic Kidney Disease (Part 1).

Our special guests:

Maddie Williams who is a Registered Nurse with Kidney Health Australia who was diagnosed with kidney disease at the age of 17 requiring haemodialysis, peritoneal dialysis, and received a renal transplant.

Dr Richard Phoon who is the Senior Medical Advisor at Westmead Hospital and has worked full-time as a Nephrologist at Westmead and Blacktown Hospitals since 2007.

Useful links:

CKD Management in Primary Care handbook (KHA) Link: https://kidney.org.au/health-professionals/ckd-management-handbook

Kidney Health 4 Life: Kidney Health 4 Life – Better kidney health, for life

Health professional webinar here: Kidney Health 4 Life Healthcare Professional Webinar – YouTube

For health professionals looking for printed posters and brochures for their clinic or unit: Kidney Health 4 Life Print Materials

Or contact the Kidney Health Australia Helpline on 1800 454 363

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This Medical Life podcast is available on all podcasting services and Spotify. Help support us on our donation page.

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The statistics of Intimate Partner Violence (IPV) and Domestic Violence prevalence are staggering. 1 in 6 adult women and 1 in 16 adult men have experience physical or sexual abuse at the hands of their partner. Approximately 2.5 million Australians (13%) experienced abuse during their childhood. However, IPV is a topic that is rarely discussed. As healthcare professionals, we need to change this.

A recent study by our guests on this episode, Timelines of psychological, physical and sexual intimate partner violence among a nationally representative sample of Australian women, studied the timeline of psychological, physical, and sexual intimate partner violence. They highlighted that early warning signs of an abusive partner include isolation, controlling behaviour, and intense jealously. We discuss these important findings and other take home messages of this study and how we can apply it to everyday practice.

This is the story about intimate partner violence.

Our special guests:

Dr Elizabeth McLindon is a Research Fellow in the Department of General Practice and works in the Sexual Abuse and Family Violence (SAFE) program. Elizabeth is the Deputy Director of the Centre for Family Violence Prevention at the Royal Women’s Hospital in Melbourne.

Professor Kelsey Hegarty is an academic general practitioner who holds the joint Chair in Family Violence Prevention at the University of Melbourne and the Royal Women’s Hospital. She also leads the Safer Families Centre.

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Oral cancer was a fatal disease even into the twentieth century. Patients required extensive surgery and often had a painful recovery or went into palliative care but the result was the same. Modern medicine has thankfully provided much to our understanding, the treatment and management of patients with oral cancer.

In recent times, patients have been able to be stratified into two general but distinct categories: the first are older with a strong history of heavy smoking and/or alcohol use; the second are younger and have a history of multiple sexual partners. The distinction is important as the treatment and management are different between the two groups with the second group having a much better prognosis.

This is the story of oral cancer.

Our special guests:

Dr Rebecca Morrow is an anatomical pathologist and deputy head of department at the Royal Adelaide Hospital with SA Pathology.

Dr Rowan Valentine is a paediatric and adult Ear, Nose and Throat Surgeon.

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The first medical description of pernicious anaemia is from 1821. It is written by Dr James Combe and describes a previously well 47 year old corn-merchant who presented with pallor, weakness, and neurological symptoms. It would take over a hundred years before we would know how to treat this condition, and another decade after that to understand why the treatment worked.

Vitamin B12 is an essential component of our diet and only found in animal products. Deficiency in vitamin B12 can present with fatigue, anaemia (macrocytic), and neurological symptoms. The most at risk from a dietary perspective are vegetarians, vegans, and the elderly. Patients may also have an autoimmune condition (pernicious anaemia) that interferes with gastric parietal cells and intrinsic factor; the way our body can absorb vitamin B12 from our diet.

This is the story of vitamin B12.

Our special guest:

Our special guest is Professor Ken Sikaris who is a chemical pathologist and Director of Chemical Pathology at Dorevitch Pathology.

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One of the most difficult cancers to detect early has been lung cancer. Patients often present with advanced disease that and can often be fatal.

In April 2025, a new National Lung Cancer Screening program has been rolled out in Australia to detect asymptomatic patients with a significant smoking history (30 Pack-Year). Suitable patients are eligible for a free low-dose CT (computer tomography) scan on their lungs to identify any potential lesions suspicious for cancer.

This is the story of lung cancer screening.

Our special guests:

A/Professor Nicole Rankin is Head of the Evaluation and Implementation Science Unit in Melbourne School of Population and Global Health (University of Melbourne) and led the team that developed the Australian National Lung Cancer Screening Program Guidelines.

Dr Julie Teague is an Anatomical Pathologist with an interest in thoracic and gastrointestinal pathology.

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In 1966, the Chief of Urology asked the Chief of Pathology at the Minneapolis VA Hospital to develop a system to communicate the results of prostate cancer to researchers. The Chief of Pathology was Donald Gleason and he developed a system that would revolutionise our understanding of prostate cancer. Today, every prostate cancer worldwide is classified using the Gleason score, named after Donald Gleason.

Prostate cancer is one of the most common cancers worldwide and accounts for 15% of all male cancers. Its incidence of prostate cancer is estimated to double by 2040.

This is the story of prostate cancer.

Our special guests:

Professor Fiona Maclean is a Clinical Professor, Anatomical Pathologist, author, past President of the Australasian Division of the International Academy of Pathology (IAP), and advisor in Pathology Artificial Intelligence.

Dr Joanna Olphert is a urologist and robotic surgeon involved in genitourinary reconstructive surgery, robotic uro-oncology, and open complex peritoneal surgery.

Dr Carole Harris is a medical oncologist, senior lecturer, and senior research fellow.

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Over the last 100 years, numerous types of implants (i.e. ivory, glass, wool) and injections (i.e. epoxy resin, beeswax, paraffin) have been used in an attempt for breast augmentation but the results were poor. In 1962, the first operation using silicone implants was performed and it revolutionised breast surgery. Breast augmentation surgery (cosmetic and reconstructive) is one of the most common cosmetic surgeries in Australia, United States, and the United Kingdom.

As one of the most common cosmetic surgeries, it is important for doctors and patients to know about the risks and myths of this procedure. In this episode, we discuss breast augmentation surgery and our discussion includes common complications, risks, and breast implantation illness.

This is the story of breast augmentation

Our special guest:

Our special guest is plastic surgeon Dr Andrew Campbell-Lloyd from ACL Plastic surgery in Adelaide.

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The interplay between genetics and medications is important but complex. Pharmacogenomic testing provides doctors with information about how individual patients may respond to certain medications (ie. fast and slow metabolisers).

The RCPA recently released guidelines for doctors about requesting patient pharmacogenomic testing before prescribing some medications. These guidelines have identified 35 medications into three pharmacogenomics testing categories: recommend, consider, and no consensus. We discuss this testing with our guest today.

This is the story of pharmacogenomics.

RCPA guidelines: https://www.rcpa.edu.au/Library/Practising-Pathology/Pharmacogenomic-Indications-in-Australia

Our special guest:

Our special guest is Professor Luke Hessen who is the manager of the Genetics Department at Douglass Hanly Moir and co-Chair of the RCPA Pharmaogenetic Advisory Group.

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In 1924, a surgeon and a pathologist had a conversation about some patients with multiple bowel polyps. The pathologist, Dr Cuthbert Dukes, and the surgeon, Mr JP Lockhart-Mummery, noted that patients had a family history of bowel cancer and could have hundreds of colonic polyps. They, with the help of HRJ Bussey, set up the Polyposis Registry.

The registry collected information about these patients and the families from 1918 to 1954. They found that patients developed polyps in childhood, the risk of affected children was 50%, and cancer took 15 years to develop from first diagnosis. This was clearly a familial disease.

Today, we know this a Familial Adenomatous Polyposis or FAP. The genetic basis for this condition was identified in the 1980s and 1990s. Professor Sir Walter Bodmer led a team to map the location of the Adenomatous Polyposis Coli (APC) gene involved.

This is the story of Familial Adenomatous Polyposis (FAP)

Our special guests:

Professor Sir Walter Bodmer is a professor of the Cancer and Genetics laboratory and Department of Oncology at Oxford University. Areas of research include: HLA, population genetics, Human Genome Project, and mapped the APC gene. He was knighted in 1986.

Dr Tristan Rutland is an Anatomical Pathologists, recipient of the Konrad Muller RCPA Outstanding Teaching Award (2020), and recipient of the Resident Advocate Award from the College of American Pathologists.

Dr Emelia Ip is a trained medical oncologist, staff specialist in cancer genetics, and co-chair of EviQ Adult Cancer Genetics Reference Committee.

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We have come a long way in our understanding of epilepsy and seizures.

Historically, epilepsy was associated with possession and demonic forces.

Modern medicine has helped us to understand that epilepsy is an electrical disorder of the brain that can affect an area or the entire brain itself.

Unfortunately, a lot of stigma and misinformation remains about epilepsy and it is an important condition to be aware of.

This is the story of epilepsy.

Our special guest:

Professor Mark Cook who is the Director of Neurology and Chair of Medicine at St Vincent’s Hospital in Melbourne. He was awarded the Order of Australia in 2023.

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It is evident from paintings that Leonardo da Vinci and Michelangelo suffered some form of underlying hand pathologies. These have been the focus of discussions and journal articles amongst many academics. Our understanding of different disease processes involving the hand have come a long way. There are a lot of options for patients both medical and surgical that we discuss in this episode.

This is the story of hand pathology

Our special guest:

Dr Paul van Minnen is a plastic and reconstructive surgeon who runs his own private practice in Adelaide called ‘Grip surgery’.

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Hyponatraemia, the most common electrolyte disturbance in clinical medicine, is often subtle but can be serious.

In this episode, we trace the surprising history of fluid replacement back to the 1832 cholera riots in Liverpool, where experimental saline saved lives amidst chaos and mistrust.

We then bring the conversation into modern practice, exploring diagnostic steps, common causes, and when GPs should refer patients to hospital.

This is the story of Hyponatraemia.

Our special guest is:

Dr Michael Page, Chemical Pathologist and CEO of Clinipath.

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In 1958, Dr Denis Burkitt was working in Uganda when he saw multiple children with large and aggressive jaw tumours. He had never seen anything like this before and he investigated further. Over the next few years, he discovered that these tumours had a geographical distribution across equatorial Africa and also was related to rainfall.

This led to the discovery of an aggressive form of lymphoma that we now know as Burkitt lymphoma as well as the Epstein-Barr virus (EBV). It is a remarkable story of intellectual curiosity, scientific discovery, and commitment.

Éanna Mac Cana was diagnosed with Burkitt lymphoma in 2017. This diagnosis led him to the story of Dr Denis Burkitt and how we first learned about this disease. He has created a documentary using never-before-seen archival footage of Dr Denis Burkitt and his discovery, and included his own journey with this disease.

This is the story of Burkitt lymphoma.

Our special guests include:

Éanna Mac Cana who is a documentary filmmaker from Belfast in Ireland.

Professor Jonathan Bond from the University College Dublin and works in paediatric molecular haemato-oncology.

This Medical Life podcast is available on all podcasting services and Spotify.

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Osteoporosis is a disease that takes years and even decades to develop. Up to 40% of post-menopausal women are affected who have a lifetime risk of fracture of ~40%. Men aged 60 have a 25% lifetime risk of an osteoporotic fracture. Evidence also shows that patients health significantly deteriorates following a significant fracture.

The best treatment for osteoporosis is prevention. We discuss this disease, lifestyle, diagnosis, and management with a panel of experts at COMBATT: Comprehensive Osteoporosis Management workshop, at the Adelaide Convention Centre in February 2025.

This is the story of osteoporosis.

Our special guests:

Our special guests are:

Dr Alecia Macrow: General Practitioner

Dr Nick Kasmeredis: Endocrinologist

Dr Steve Soukoulis: Periodontist

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Recent genetics studies have shown that ancient Humans and Neanderthals coexisted around 50,000 years ago for approximately 7,000 years. There is evidence of these different human species mixing and having offspring. Around 2-4% of modern humans can be traced back to Neanderthals.

This is the story of Humans and Neanderthals.

Our special guests:

Our special guest is Associate Professor Bastien Llamas who is affiliated with the Australian Centre for Ancient DNA.

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And we’re back for 2025. We thought we’d ease into this season with some medical stories. From the Manhattan project and the demon core to the inspirational stories of Dr Elizabeth Blackwell, Dr Elizabeth Garrett Anderson, and Dr Emma Constance Stone. We are reaching back into the medical archives.

Our special guests:

Dr Travis Brown, himself!

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Patients with colorectal cancer often have their diagnosis, treatment, and care discussed at a regular multidisciplinary team meeting. This includes: gastroenterologists, surgeons, oncology, radiation oncology, pathologists, home care nurses, oncology nurses, genetic councillors, care coordinators plus others.

This is the third episode of a three part series on colorectal cancer.

This episode focuses on management.

Many thanks to Dr Tristan Rutland who helped organise this series.

This is the story of colorectal cancer (part 3).

Our special guests:

Dr Stephanie Lim: medical oncologist who works at GenesisCare and Macarthur Cancer Therapy Centre

Dr Meredith Johnston: radiation oncologist who works at Liverpool hospital

Dr Emilia Ip: medical oncologist and cancer geneticist at Liverpool hospital

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The lifetime risk for colorectal cancer is 1 in 23 men and 1 in 25 women. Detecting and diagnosing cancer is a critical step in managing a patient’s health as well as the multidisciplinary team where their care is discussed.

This is the second episode of a three part series on colorectal cancer.

This episode focuses on diagnosis.

Many thanks to Dr Tristan Rutland who helped organise this series.

This is the story of colorectal cancer (part 2).

Our special guests:

Dr Milan Bassan: gastroenterologist and Director of Endoscopy at Liverpool Hospital and returning guest

Dr Scott Mackenzie: surgeon and senior lecturer at the Liverpool Hospital and returning guest

Dr Tristan Rutland: lecturer, award winning anatomical pathologist for teaching and regular guest

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Colorectal cancer accounts for ~10% of all new cancer diagnoses. Fortunately, over the last three decades, the 5 year patient survival has increased from 56% to 71%. As with most cancers, the key to good outcomes is early detection. This is the first episode of a three part series on colorectal cancer. This episode focuses on screening.

Many thanks to Dr Tristan Rutland who helped organise this series.

This is the story of colorectal cancer (part 1).

Our special guests are:

Professor Ken Sikaris: chemical pathologists, Director of Chemical Pathology at Dorevitch Pathology and regular guest

Dr Milan Bassan: gastroenterologist and Director of Endoscopy at Liverpool Hospital and returning guest

Dr Tristan Rutland: lecturer, award winning anatomical pathologist for teaching and regular guest

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Troponin is a protein found in heart muscle that was a game changer when it came to diagnosing heart attacks and myocardial injury in the late 1990s. Three decades later, it is an invaluable test with widespread use throughout medicine.

Troponin assays are venturing into their 5th generation with high-sensitivity and Point-Of-Care (POC) devices. However, there are important exceptions, caveats and pitfalls for doctors to know.

This is the story of troponin.

Our special guest:

Our special guest is Dr Christina Trambas who is a chemical pathologist, Medical Director at St Vincent’s Pathology and chair of the Royal College of Pathologists of Australiasia (RCPA) Troponin Working Party.

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Our eagle-eyed This Medical Life podcast listeners will wonder why we have called this episode 100 … is that right?

Well, it kinda is.

If you add up both This Pathological Life and This Medical Life podcasts episodes, it’s well over 100 episodes.

This is a small milestone for this ‘Trav and Steve’ dynamic duo who have never resolved the question: which one is Robin?

In honour of this achievement, we reflect upon the life and death of an amazing poet and author Oscar Wilde. We dive back into the 1850s to 1900s when modern medicine was at its infancy and the ‘love that dare not speak its name’ was a crime.

This is the story of Oscar Wilde

Our appreciation goes out to our listeners who we hope will enjoy this flight of fancy episode and reflect on where we have come from, where we are, and where we are heading.

Our special guest:

We have no special guests this episode, other than some choice quotes from the man of the hour, Oscar Wilde.

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Throughout history, humanity has been captivated by heroes overcoming immense challenges—from ancient legends to modern Marvel icons.

In this episode, Dr Travis Brown and Steve Davis are honoured to have Janine Watson, a Paralympian athlete who reached out to us after our episodes on Chronic Traumatic Encephalopathy (CTE) (Episode 53 and Episode 54) opened her eyes to the unrecognised trauma her brain and body have endured.

This is the story of Janine Watson’s journey from MS diagnosis to history making Paralympian. And how listening to a particular episode of This Medical Life changed her future.

Our special guest:

Paralympian, Janine Watson.

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In this episode, Steve Davis and Dr. Travis Brown reflect on the journey through Series 5 of This Medical Life.

From discussing the impact of episodes on medical professionals to revisiting significant stories and breakthroughs, this episode provides a retrospective on the memorable moments and invaluable lessons learned.

Whether it's the exploration of vitamin B6's role in patient care or the unexpected feedback from a Paralympian, this recap offers you a chance to catch up on episodes you might have missed and gain deeper insights into the world of medicine.

Our special guest:

We do include an excerpt of Dr Adam Cifu from the podcast, Econtalk, What's Happening Inside Your Doctor's Head And Heart.

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Thyroid lumps have always been with us. Often referred to as goitres (interpreted from Latin to mean neck swelling), numerous ancient medical sources mention these and how to manage them.

However, it has only been with modern medicine and investigations that we can distinguish between benign and malignant lesions. In this episode, we examine the investigations, diagnosis, management and prognosis of thyroid lumps.

This is the story of Thyroid lumps (Part 2)

Part 1 focuses on cytology and surgery for thyroid.
Part 2 focuses on anatomical pathology and molecular/genetics.

Our special guests:

Professor Yuri Nikiforov is the Director of the Division of Molecular Anatomic Pathology at the University of Pittsburgh School of Medicine. Co-developer of the test we discuss in this episode, ThyroSeq.

Dr Tiffany Symes is a histopathologist and deputy director of Anatomical Pathology at Melbourne Pathology. She is also featured in part one.

Dr Rachael Chambers is a histopathologist at Sullivan Nicolaides Pathology, Brisbane.

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Thyroid lumps have always been with us. Often referred to as goitres (interpreted from Latin to mean neck swelling), numerous ancient medical sources mention these and how to manage them.

This is part one of the story of Thyroid lumps.

Our special guest:

Dr Tiffany Symes is a histopathologist and deputy director of Anatomical Pathology at Melbourne Pathology.

Associate Professor James Lee is a leading endocrine surgeon in Australia, co-editor of the Endocrine Surgery section of the ANZ Journal of Surgery and deputy co-chair of the Endocrine Surgery Section of the Royal Australasian College of Surgeons.

This Medical Life podcast is available on all podcasting services and Spotify.

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A common myth about epilepsy is that women who suffer from this condition should avoid getting pregnant. This is simply not true. It can be safely managed for both the mother-to-be and future child. Epilepsy is not a contraindication for pregnancy.

Certainly there are additional precautions and steps that should be taken when a woman who has epilepsy is considering starting a family and it requires a multidisciplinary approach.

This is the story of pregnancy and epilepsy.

Our special guests include:

Daisy Beyer who lives in Melbourne with her husband and son expecting their second child in August of this year. Daisy is a registered psychiatric nurse and lives with generalised epilepsy.

Dr Amber Moore is an obstetrician and gynaecologist working in Melbourne, Federal Councillor for the Royal Australian & New Zealand College of Obstetricians & Gynaecologists, and deputy chair of the Continuing Professional Education Committee.

Professor Mark Cook is a consultant neurologist, Director of Neurology and Chair of Medicine at St Vincent’s Hospital in Melbourne. He was awarded an Officer in the Order of Australia for distinguished service to neurological medicine and treatment research for epilepsy.

Anna Heldorf lives in Melbourne with her partner and is a public servant. Anna was diagnosed with juvenile myoclonic epilepsy and had her first baby in April this year.

Our gratitude goes to Dr Amber Moore for her assistance in helping get this episode together.

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Tonsillectomies are one of the most common operations both today and historically, however, it has always been mired in controversy. In ancient times, this was touted as being either life-saving or completely unnecessary and continued to be a polarising topic into the twentieth century.

An evidence based approach has helped to provide guidelines such as the Paradise criteria. However, there is always nuance and particular patient circumstances that play a role in deciding if surgical management is appropriate. We talk to one of Australia’s foremost experts to help us navigate this topic.

This is the story of Tonsillectomies.

Our special guest:

Dr Eric Levi is a triple-Fellowship trained Specialist Otolaryngologist (Ear Nose & Throat), Head & Neck Surgeon based in Melbourne, Australia. He has completed Fellowships in Head & Neck Surgery, Facial Plastic & Reconstructive Surgery and Paediatric Otolaryngology.

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Over two-thirds of the world’s population lose the ability to metabolise during their lifetime (the majority during childhood). We know today that lactose intolerance, or lactase persistence, has a strong genetic predisposition. Almost 100% of Asians, 70% of African-Americans, East Indians, US Hispanics and approximately 50% of Spanish and French have very low levels of lactase in adulthood (what we would call lactose intolerant). Alternatively, the majority of Caucasians can tolerate lactose into adulthood.

Testing for lactose intolerance/lactase persistence can be done either via chemical or genetic testing. Each has their advantages and disadvantages but is important for any doctor or patient to know about.

This is the story of Lactose intolerance.

Our special guests:

Dr Michael Page is a Chemical Pathologist and Chief Executive Officer at Clinipath in Western Australia.

Dr Melanie Galea is a Genetic Pathology specialist and Director of genetics at Douglass Hanly Moir Pathology in Sydney.

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Pelvic pain is a difficult and challenging medical condition for both patients and doctors. It can be debilitating for women that can begin as a teenager or a young adult and progress for years impacting every facet of their lives.

Similiarly, pelvic pain can be challenging for symptom to assess and manage for doctors as there are a multitude of causes that range from simple and straight forward to complex and chronic diseases such as endometriosis.

In this episode we discuss pelvic pain and endometriosis with two guests who are leaders in diagnosis, treatment and management.

Travis also references a previous episode that touched on this issue: The Tragedy Of The Wandering Womb.

Also, Associate Professor Susan Evans, promised to share a link to this paper (click to download): An Embodied Predictive Processing Theory of Pain Experience (NEI Ensemble Paper).

This is the story of pelvic pain and endometriosis

Our special guests:

Dr Alecia Macrow who is a General Practitioner, owner of Thrive Family Practice, and one of 22 clinics around Australia that received government funding to assist patients with pelvic pain and endometriosis.

Associate Professor Susan Evans who is a Gynaecologist, Surgeon and Pain management physician in Adelaide. Associate Professor Evans is Executive Chair of the Pelvic Pain Foundation of Australia and CEO of Alyra Biotech which is a biopharmaceutical company developing intrauterine products for pain relief.

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Vitamin B6 is a common additive in supplements, energy drinks and breakfast cereals. In rare circumstances though, it can reach levels toxic levels and cause neurological symptoms the mimic neurodegenerative disease.

This year newsGP reported a case where a GP took magnesium supplements for muscle cramps and over the course of a few years resulted in vitamin B6 toxicity that caused peripheral neuropathy and difficulty walking.

Fortunately, vitamin B6 toxicity is rare but it is an important condition for doctors to be aware of particularly in the setting of patients presenting with peripheral neuropathy.

This is the story of vitamin B6.

Our special guest:

Our special guest is Dr David Kanowski who is a senior chemical pathologist at Sullivan Nicolaides Pathology.

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Scleroderma is a disease characterised by the hardening and tightening of the skin and connective tissues. The first medical description can be traced back to the 1750s.

Our understanding has evolved over the centuries but the pathogenesis remains largely unknown. The disease as several forms including diffuse and localised. Symptoms include skin discoloration and tightness to more severe complications like organ dysfunction.

Fortunately we have several different treatment options available for patients that can assist them in managing this disease.

This is the story of Scleroderma.

Our special guest:

Our special guest is Dr. Daman Langguth, a renowned clinical and laboratory immunologist with deep expertise in autoimmune diseases. Dr. Langguth discusses the importance of recognising scleroderma’s symptoms, the critical nature of early diagnosis, and the latest advancements in treatment.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In 1901, the state of Montana organised for scientists and doctors to investigate a mysterious illness from the Bitterroot Valley called ‘Black measles’ and ‘Black typhus’. People of all ages were affected but predominantly those who worked in the brush and were exposed to tick bites. The investigators called it ‘tick fever’ and this particular strain had a mortality rate over eighty percent.

Today this disease is known as Rocky Mountain spotted fever. In Australia, it is sometimes called ‘spotted fever’ or ‘Queensland tick typhus’. It is caused by an obligate intracellular bacterial micro-organism (needs a cell to survive). This organism is very difficult to culture and can be even more difficult to diagnose but surprisingly easy to treat. Rickettsial disease is an under-recognised infection and important in the differential diagnosis of any patients presenting with fevers, headaches and rash.

This is the story of Rickettsia

Our special guest:

Our special guest is Professor Stephen Graves who is a medical microbiology and founder of the Australian Rickettsial Reference Laboratory (ARRL). He specialises is infectious diseases transmitted by ectoparasites such as ticks, lice, fleas and mites.

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Our understanding of infectious disease and pathology stems from the 19th century with Robert Koch pioneering research. Dr Koch help to shaped modern microbiology and medicine when he identified the causative agents for anthrax and tuberculosis. Since that time, the number of infectious microorganisms that we know of that cause illness and diseases has increased exponentially. Thanks to modern day techniques, laboratories can test for these agents directly or indirectly and get an answer often within hours.

As such, microbiology is on the verge of a new era. Instead of the principle of one test: one micro-organism, we are moving into the realm where one test can detect hundreds of potential pathogens and antimicrobial resistance genes in a single stool sample. The new test is called Metapanel. This includes 175 gene targets using metagenomics (shotgun gene sequencing) and is able to detect bacteria, viruses, helminths, protozoa, fungi, microsporidia. This information is collated and reported by a pathologist and advice given as to what is the implications of the result. The test is ideally suited for patients with chronic diarrhoea, inflammatory bowel disease and/or inflammatory bowel syndrome.

This is the story of advanced faeces testing and Metapanel

** Please note: General Practitioners in Australia, will be able to claim CPD points after listening to this episode. Full details and registration, coming shortly.

Our special guest:

Dr Michael Wehrhahn is the Director of Molecular Biology and Infectious serology at Douglass Hanly Moir Pathology. Michael has a Master in Public Health, is an Infectious Disease Specialist as well as a Microbiologist and Adjunct Senior Lecturer at the University of Notre Dame.

Dr Wehrhahn is actively involved in research on clinical and laboratory aspects of a range of microorganisms and is a reviewer for a number of journals. Michael has been involved in researching and validating the new Metapanel available through Sonic in conjunction with Microba.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In episode 56 of This Medical Life, Dr Travis Brown and Steve Davis delve into the critical topic of iron studies, with a special focus on iron deficiency, under the expert guidance of returning guest, Professor Ken Sikaris.

Iron deficiency’s prevalence is influenced by factors such as age, sex, and ethnicity, noting that women, especially those of childbearing age and pregnant women, are at higher risk. Prof Sikaris addresses the challenges and misconceptions surrounding iron studies, particularly the reliability of various tests like serum iron, transferrin saturation, and ferritin. While ferritin is the most reliable marker for total body iron stores, it can be influenced by factors like inflammation.

Through this episode, we provide This Medical Life provides a comprehensive exploration of iron deficiency, combining historical context, clinical insights, and practical advice, all aimed at improving understanding and management of this prevalent health issue.

Our special guest:

Professor Ken Sikaris is a chemical pathologists and Director of Chemical Pathology at Melbourne Pathology. Professor Sikaris is a NATA-accredited laboratory assessor, Founding Fellow of the RCPA Faculty of Science and a principle examiner in Pathology Informatics. He is a Fellow of the Department of Pathology at the University of Melbourne.

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In this episode we delve into the nuanced world of the Pomegranate Health podcast with our guest, Mic Cavazzini. Pomegranate Health, a creation of the Royal Australasian College of Physicians, serves as a platform to explore the multifaceted culture of medicine. It weaves through the clinical intricacies of medicine with episodes that span from the deeply technical aspects of healthcare to broader discussions on skills essential for effective practice and systemic issues within global health.

This episode embarks on a journey through the confused history of opium use, offering a rare focus on historical narratives as a foundation for modern medical discussions. Join us as Mic Cavazzini shares insights from his diverse background in science and journalism, illustrating how the past informs current medical practices and the human factors that influence care. Through this conversation, we aim to shine a light on the complexities of medicine's culture, underscoring the importance of history, philosophy, and the human experience in shaping healthcare today.

Our special guests:

Mic Cavazzini - is a journalist and audio geek passionate about engaging people with ethics, health and the natural world. He produces the Pomegranate Health which is a podcast with the Royal Australasian College of Physicians and won an Australian Podcast Award in 2018. Mic has a background in neuroscience and is associated with the University of Sydney. He has worked as a research scientist at Oxford and ANU where he investigated how brain cells process information and learning. He has also written for The Medical Republic, Australian Doctor, and The Canberra Times.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In Chronic Traumatic Encephalopathy (CTE) Part 1, we learned that CTE is a neurodegenerative disease caused by repetitive cumulative brain injury. Patients suffer from debilitating mental health symptoms and may even have suicidal thoughts or actions. Unfortunately, there is no treatment for this disease and it can only be official diagnosed at autopsy (after death). The only successful strategy to combat this illness is prevention.

Unfortunately, this is an ongoing challenge as there is a lot we don’t know about CTE but some features are clear. The largest risk factor for CTE is the duration of time participating in contact sport. In order to prevent CTE, the aim is to reduce life time exposure to repeated head impacts (either direct or indirect ie. significant acceleration and deceleration injuries). We also delve into grass-roots education aimed at informing school-aged children about concussion and brain health.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

** Please note: General Practitioners in Australia, will be able to claim 2.25 CPD points after listening to this episode and part 1. Full details and registration on our GP CPD Points page.

Our special guests:

Amanda Green – wife to National Rugby League legend player and coach Paul Green who played 162 first-grade games and represented Australia. At the end of 2022, Paul was found unresponsive in his home. Paul’s brain was donated to the Australian Sporting Brain Bank for examination where he was diagnosed with CTE. Paul was 49 years old.

Associate Professor Michael Buckland – Head of the Neuropathology department at Royal Prince Alfred Hospital, founder and director of the Australian Sports Brain Bank (ASBB), co-director of the Multiple Sclerosis Australian Brain Bank, and Head of the Molecular Neuropathology Program at the Brain & Mind Centre.

Doctor Stephanie Adams – Honorary Fellow in Sports & Brain Health at the University of Edinburgh. She is founder and director of ConcussEd which is an education program for school-aged children to learn about brain health. She is a retired rugby and equestrian athlete.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In 2005, Dr Bennet Omalu would publish a report in the United States on the autopsy brain findings of a former professional footballer from the NFL. His conclusion was the former athlete suffered from Chronic Traumatic Encephalopathy (CTE); a disease caused by repeated brain injuries most likely due to sport. The response was swift and severe claiming that the findings were incorrect, the conclusions erroneous, and a retraction of this report was demanded.

Surprisingly, this was not the first time medical literature has noted the link between sport, repeated head injuries and brain damage. The first publication was written in 1928 by Dr Harrison Martland who was the Chief Medical Examiner of Essex County in New Jersey. Harrison performed hundreds of autopsies on people with head injuries including boxers. He noted twenty-three examples of boxers with permanent brain damage that he called ‘punch drunk’. Other researchers found this was not limited to boxing but other contact sports such as football. Later, this condition became known as ‘Dementia pugilistica’.

This disease has surged into the spotlight in the last decade due to a number of high-profile athletes who have been diagnosed with CTE. Unfortunately, both professional and amateur athletes are at risk. This condition also greatly impacts the family and friends of those who suffer from it. However, a great deal of misinformation also exists about the risks and causes of this disease. These two episodes (of which this is part 1) are designed to explain what we know, what we don’t, and what can be done about this debilitating condition.

This is the story of CTE, part 1.

** Please note: General Practitioners in Australia, will be able to claim 2.25 CPD points after listening to this episode and part 2. Full details and registration on our GP CPD Points page.

Our special guests:

Renee Tuck – sister of Shane Tuck who was a professional footballer in the Australian Football League (AFL) playing 173 games and a brief career as a boxer. Later in Shane’s career, he suffered from mental health issues and in July 2020 took his own life. Shane was diagnosed with a severe form of CTE. He was only 38 years old.

Associate Professor Linda Iles – Head of the Forensic Pathology Services at the Victorian Institute of Forensic Medicine (VIFM). VIFM is in partnership with the ASBB to send brain specimens for further examination/analysis for suspected CTE or other neurodegenerative diseases.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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We begin this year with one of the most important topics for General Practitioners in 2024: what are the Continuous Professional Development requirements for doctors and how have they changed?

Our special guest is Rachel White who is the Managing Director for the Australian Medical CPD Standards (AMcpdS) who has over twenty years supporting high quality medical education. We discuss the yearly requirements for doctors, component breakdown and what has changed.

This is the story of CPD for 2024.

And here is a summary of CPD requirements, supplied by Rachel.

We are also thrilled to announce that 6 of our genetics episodes from our catalogue (‘genetics module’) have been approved for official CPD hours for General Practitioners. These episodes are:

Episode 10: Familial hypercholesterolaemia (FH)
Episode 15: Lynch syndrome
Episode 21: Marfan syndrome
Episode 30 & Episode 31: BrCa (Breast Cancer genes)
Episode 40: Carrier screening

Register with us on our website (https://thismedicallife.com.au/) and we will send you a certificate to lodge with your CPD home to claim 5.75 hours when you have listened to them.

We have also registered with https://www.patreon.com/ThisMedicalLife where you can subscribe for free to get a short update when new episodes are published, or make a one-off or regular contribution to help fund this work, which is being created without any outside funding support.

With your support, we hope to accredit more of our episodes in the future. Thank you to all of our listeners.

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And that’s another year done. A huge thank you to all of our guest speakers who have been generous with their time and expertise. We would also like to thank our listeners and hope you enjoyed the episodes.

This episode is a mini reflection on this year’s episodes, a link to one of Steve’s favourite podcasts, some TML clips, and an embarrassing memory lapse on my behalf…thanks for keeping that part in Steve & Tim.

Random acts of Medicine on EconTalk podcast: https://www.econtalk.org/anupam-bapu-jena-on-random-acts-of-medicine/

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During the mid-twentieth century, menopause was touted as a severe disease that destroyed women’s femininity and was a burden to their husbands. Thankfully, today we recognise menopause as a natural part of ageing and conversations about it are happening more and more.

In this episode, we have four special guests:

Niki Bezzant: award-winning writer, author, journalist and media personality from New Zealand who has written the book ‘This Changes Everything: the Honest Guide to Menopause and Perimenopause’.
Dr Carmel Reynolds: General practitioner and SA/NT board member on the Australian Menopause Society
Dr Angelique Swart: Obstetrician & Gynaecologist with an interest in post-menopausal bleeding
Dr Ashley Winter: Urologist and Sexual health specialist

Australasian Menopause Society

This Medical Life podcast is available on all podcasting services and on Spotify

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In July 2020 in the midst of a global pandemic, we released our first episode called ‘What is pathology?’ with This Pathological Life podcast. We hoped to create something that would entertain and education the audiencem and shed light on to some of the amazing stories and characters in medicine.

In creating these podcasts, I am always thankful and appreciative to our guests who willingly give their time and expertise. If there is anyone who has excited our audience, been an inspiring teacher and a fantastic storyteller, it is Professor Graeme Suthers. He has been involved in the following episodes over the last four years:

This Medical Life podcast:

Ep 40 Carrier screening
Ep 30 BRCA (Part 1)
Ep 21 Marfan syndrome
Ep 15 Lynch syndrome
Ep 10 Familial Hypercholesterolaemia

This Pathological Life podcast:

Ep 45 Pharmacogenetics
Ep 44 PKU and Cystic Fibrosis
Ep 33 Fragile X
Ep 13 Trisomy / Chromosomal abnormalities

On the 30th of June 2023, Professor Graeme Suthers retired and we wanted to take some time to thank him, but also ask him some questions and reflect on his career.

This is the story of Professor Graeme Suthers.

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On the 1st of November 2023, the Australian Government will release new guidelines for screening prostate cancer with the Prostate Specific Antigen (PSA) blood test. These guidelines are based upon the Clinical Practice Guidelines (CPG) published in 2016 with new items to be included in the Medicare schedule. These items are based upon the Prostate Cancer Foundation and the Cancer Council of Australia guidelines that have been endorsed by the NHMRC, RACGP, and USANZ. We speak to Professor Ken Sikaris who has been at the forefront of these new recommendations.

Our special guest is Professor Ken Sikaris who is a chemical pathologist and Director of Chemical Pathology at Melbourne Pathology.

This Medical Life podcast is available on all podcasting services and Spotify.

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We continue the second episode of this two part series on breast screening and mammograms focusing on the future.

In this episode, we talk about the importance of breast density as a new risk factor, personalised breast cancer risk assessment (iPrevent developed by Peter MacCallum Cancer Centre https://www.petermac.org/iprevent), and discuss a personal account with Dr Sandy Minck.

Special guests:

Associate Professor Michelle Reintals is the Director of BreastScreen South Australia and an Australian trained radiologist with extensive and international experience in breast screening and mammography.
Professor Kelly-Anne Phillips is a medical oncologist who cares for breast cancer patients and is a researcher at Peter MacCallum Cancer Centre that is internationally recognised in breast cancer genetics and treatment.
Doctor Sandy Minck is a fellow of the Royal Australian College of General Practitioners and an advocate for breast density awareness and personalised risk assessments. She has personal experience in this area as both a doctor and a patient.

This Medical Life podcast is freely available on all podcasting services and Spotify.

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A critical tool in the fight against breast cancer is population screening. Early detection, surgical intervention +/- further treatment has dramatically reduced advanced disease and mortality rates but it still remains the most common cancer worldwide.

In this episode, we focus on the history of breast cancer, the development of mammograms and early detection with our understanding of the underlying pathology. Our special guests include:

Associate Professor Michelle Reintals is the Director of BreastScreen South Australia and an Australian trained radiologist with extensive and international experience in breast screening and mammography.

Associate Professor Wendy Raymond is a histopathologist who has specialised in breast pathology and cytology. A/Professor Raymond is a past president of the Australian Society of Breast Disease and co-edited the IAC Yokohama system for reporting breast FNA biopsies.

This is the first part of a two-part series on breast screening, focusing on the present. The second part (coming soon) will focus on the future.

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Our understanding of the world today is constantly changing. What was once considered truths and facts can, in hindsight, be seen as misguided or wrong. It may be challenging to accept but becomes evident over time that the things we learn today may become irrelevant or superseded in the future and this is particularly relevant to medicine.

Scientometrics is the quantitative study of science and the rate at which change occurs. Today, we discuss this topic with scientist and author Sam Arbesman, to ask the following question: what is the rate of change of facts in the field of medicine?

Our special guest is Sam Arbesman who is a scientist and author of Overcomplicated: Technology at the Limits of Comprehension and The Half-Life of Facts.

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Vitamin D has been a controversial topic in recent times with the debate continuing over appropriate testing, adequate levels, and the evidence for treatment. We discussed the appropriateness of testing and chemical pathology component with Professor Ken Sikaris (Episode 25), but what does the research tell us about diseases associated with Vitamin D and the utility of replacement? We discuss this with Professor Scott Byrne from Westmead Institute.

Our special guest is Professor Scott Byrne from the Immunology department at the school of Medical Sciences at Westmead Institute for Medical Research. Professor Byrne is also Co-director of the Centre for Immunology and Allergy Research and Head of the Cellular Photo-immunology Group.

This is the second chapter in the story of Vitamin D.

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Professor Peter Doherty trained as a veterinarian before venturing into immunology research. Professor Doherty travelled extensively throughout his career and has undertaken numerous research posts around the world. The achievement that he is most noted for is he was able to demonstrate how the body distinguished between virus-infected cells from non-infected cells and was awarded the Nobel Prize for Physiology or Medicine in 1996. However, there is far more that he has achieved throughout his career.

Professor Doherty has been a strong advocate for science communication to the general public at large. He has written numerous books, commented extensively on environmental sustainability and climate change, as well as an active participant and medical voice to the public during the recent Covid-19 pandemic.

Our special guest is Professor Peter Doherty, Nobel Prize winner in Physiology or Medicine 1996, Author, Science commentator, and Professor at the faculty of medicine at the University of Melbourne.

This is the story of Professor Peter Doherty.

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The double helix structure of DNA was the discovery of the century. However, the story about the discovery is mired in controversy as one of the major contributors, Rosalind Franklin, was conspicuously absent from acknowledgements and died (and subsequently not named) before the Nobel Prize was awarded.

In 1968, James Watson wrote the book ‘The Double Helix: A Personal Account of the Discovery of the Structure of DNA’ and reads more like a fictional detective novel than an autobiographical account with the portrayal of Franklin as a forceful, gruff and confrontational. Recently, an article in Nature shows an unpublished news article from 1953 (at the time of the discovery) that Franklin’s contribution was crucial to uncovering the structure of DNA.

Today, we talk to one of the authors of the article in Nature, Nathaniel Comfort, who is Professor of the History of Medicine at John Hopkins University. Link to the article: https://www.nature.com/articles/d41586-023-01313-5

Our special guest is Professor Nathaniel Comfort from the John Hopkins University. His interest lies in the histories of genetics, eugenics, genomics and biomedicine. He has authored two books (The Tangled Field and The Science of Human Perfection), written for Nature, The Atlantic, The Nature as well as appeared on PBS, National Public Radio and the BBC.

This is the story of the DNA double helix.

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Essentially every culture, modern or ancient, understood that health and faeces are inherently linked. The Ancient Chinese practiced ‘copromancy’ which was the assessment of health based upon the shape, size and texture of faeces. Today we have the Bristol Stool Chart that helps us to classify faeces/poo into seven different groups. As disconcerting as it may be, the state of our poo can tell us a lot about our own health and this is only going to increase as our knowledge about our faecal microbiome expands.

The faecal microbiome is the composition of all the microorganisms within our faeces. We are learning that the composition not only affects our health but can also be contributory to diseases we experience. In some circumstances, this has also become a treatment with faecal transplantation to manage treatment resistant clostridium-difficile colitis.

This is the story of the faecal microbiome.

Our special guests:

Dr Piers Mitchell, who is a hospital specialist consultant in the NHS and co-editor of the International Journal of Osteoarchaeology. Dr Mitchell has trained in paleopathology, osteoarchaeology, parasitology, medical history, and orthopaedic surgery.
Dr Vincent Ho, who is a Gastroenterologist practicing in NSW, is an Associate Professor at Western Sydney University and head of a research laboratory.

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In 1891, Guido Werdnig documented two cases of brothers who had global progressive muscular weakness. In 1935, Dr Dorothy Anderson conducted an autopsy on a young child who had died from malnutrition due to suspected coeliac disease despite being on the upon treatment. In 1943, in inherited form of intellectual disability in boys was described by Martin and Bell. The diseases are Spinal Muscular Atrophy, Cystic Fibrosis, and Fragile X syndrome respectively. The learning curve for genetics in the last 100 years has been a steep one.

Recessive genes circulate in the general community and for the most part, they are hidden and play no part in day-to-day life. Some may even have had a survival advantage in pre-modern times. However, if two parents each carry matching recessive genes, there is an increased chance that their children can have a severe or even life-threatening illness. Carrier screening provides a test for parents to assess this risk, however, it also requires an understanding of the testing paths, risks and cost from requesting doctors.

This is the story of carrier screening

Our special guest is Professor Graeme Suthers who is the Director of Sonic Genetics Australia.

Additional information:

Link to further information about reproductive carrier screening: https://www.sonicgenetics.com.au/patient/test-information/rcs/

Link to carrier screening online patient course: https://www.sonicgenetics.com.au/patient/test-information/rcs/carrier-screening-online-patient-course/

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Seasonal influenza causes significant morbidity and mortality every year but can often fall into the underestimated category. Between 10-30% of the general population are infected each year with influenza that leads to an increase in hospital and intensive care unit admissions, the onus for prevention and early intervention has never been more important.

Our special guest is Associate Professor Paul Griffin from the School of Medicine at the University of Queensland and is an Infectious Disease Specialist at Mater Health.

This is the story of influenza.

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In 1998, a 6 page report published in the Lancet that would later be described as one of history’s great science frauds. The article was titled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive development disorder in children” but the news headlines ran with a much shorter version: the MMR vaccine causes autism.

The article was written by Andrew Wakefield, a British gastroenterologist turned researcher, who had taken it upon himself to deceive the medical community and general population at large. Fortunately, investigative journalist Brian Deer uncovered the truth behind this ‘study’ through hard work, significant obstacles and persistence.

Although Wakefield’s claims have been thoroughly discredited, we still feel the impact of this fraud to this day and he has become an icon of the anti-vax movement.

Our special guest is Brian Deer who is an award winning investigative journalist and bestselling author for The Doctor that Fooled the World, published in 2020.

This is the story of the MMR vaccine fraud.

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In 1834, Robert Graves gave a lecture series on the ‘Newly observed affection of the thyroid gland in females’. He presented three women who had violent palpitations, enlarged thyroids, and an apparent enlargement of the eyeballs (later it would be called ‘exophthalmos’).

In 1912, Hakaru Hashimoto reported a new disease in a German journal after examining microscopically the thyroid tissue from four middle-aged women. He noted the lymphocytic infiltration and likened it to other conditions containing lymphocytes (ie. Sjögren syndrome) and named it ‘Strum lymphomatosa’.

It would not be until the 1950s that the underlying mechanism of these diseases would be known: autoimmunity. The former, now known as Graves’ disease, and the latter Hashimoto disease are the most common causes of hyperthyroidism and hypothyroidism respectively.

Our special guest is Dr Daman Langguth who is an immunology and Head of the Immunology Department at Sullivan Nicolaides Pathology.

This is the story of autoimmune thyroiditis.

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Since recorded history, heartburn has been a common complaint and the descriptions from ancient physicians are virtually indistinguishable from today’s accounts. However, one thing we do know that they did not is a small subset of patients whose long standing heartburn could predispose them to a precancerous condition known as Barrett oesophagitis.

Barrett oesophagitis is caused by chronic gastro-oesophageal reflux disease with a number of known risk factors for developing this. These patients require regular monitoring +/- intervention as they have an increased rate of developing oesophageal adenocarcinoma. For this episode we have called in some specialists to help us out.

Our guests include:

Dr Tristan Rutland – Anatomical Pathologists who specialises in Gastrointestinal Pathology
Dr Milan Bassan – Gastroenterologist who is Head of the endoscopic department at Liverpool Hospital

This is the story of Barrett Oesophagitis.

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Professor Ian Frazer pioneered the development of the first Human Papilloma Virus (HPV) vaccine which has seen a reduction of HPV infections in young women between 70-86% and the incidence of cervical cancer rates drop by 90%. Few doctors/scientists have had such a profound impact on the health of so many people. Today we talk to Professor Ian Frazer about his career, the events leading up to the HPV vaccine development, and the future of this life-saving medicine.

Some of Professor Ian Frazer awards include:

Australian of the Year (2006)
Prime Ministers Prize for Science (2008)
The Balzan Prize (2008)
Fellow of the Royal Society of London (2012)
Companion of the Order of Australia on the Queen’s Birthday Honours list (2013)
Immunology research department named the Frazer Institute at the University of Queensland

This is the Story of Professor Ian Frazer and the development of the cervical cancer vaccine.

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In 1964, a young woman was murdered as she walked to her apartment in Queens, New York. Her screams were left unanswered. No one came to her help. Within the space of thirty minutes, the assailant would return two more times to stab her again and again. The woman died. The number of witnesses to this crime who did not help was: 38. Two psychologists posed a question: how could this happen in such a heavily populated city?

Two other landmark studies occur around this time including the Milgram experiment and the Stanford prison experiment. Two experiments that range from insightful to controversial. However, all of these have captured the attention of psychologists and students, and helped us to learn more about ourselves. If nothing else, the latter certainly taught how one should not conduct a psychology study.

These are some of the stories of psychology from the 60s.

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In 1912, Merck Pharmaceuticals was searching for a blood clotting agent to compete with a competitor in the market. One of the agents, a chemical by-product (and not even named) was produced and patented without any significant testing. This was a drug that we would come to know as MDMA or Ecstasy.

In the 1960s, this drug found it’s way into use by a Chilean psychiatrist for psychotherapy, Dr Claudio Naranjo. He found that it helped patients to open up, it intensified emotions, gave access to suppressed memories, and provided insights.

In the 1970s and 1980s, the recreational use of MDMA became prevalent but also became a focus in the war on drugs with both political and scientific powers advocating strongly against its use. Today, the experimental studies confirm that MDMA is very useful in a controlled medical setting for the use of patients suffering from Post-Traumatic Stress Disorder (PTSD).

Our special guest is Dr Stephen Bright who is a clinically-trained psychologist, senior lecturer at Edith Cowan University, researcher into psychedelic science and co-founder of Psychedelic Research in Science & Medicine (PRISM), an Australian non-profit research association that supports formal research into psychedelics such as primarily MDMA.

There is additional information for GPs about MDMA posted.

This is the story of Ecstasy.

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The medicinal properties of aspirin (acetylsalicylic acid) have been well-documented for hundreds of years. It seems even our ancient ancestors thousands of years ago had some insight into its healing properties even if the usage was misguided. We are still learning about aspirin and the best ways to use it.

Our special guest is Professor Simon Dimmitt, a Physician in General and Cardiovascular Medicine. He has released a website providing evidence-based prescribing for Doctors.

This is the story of Aspirin.

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A continuation of Episode 30. In this episode, we discuss the continued management of patients with Breast Cancer and the BRCA pathological variant.

Our special guests:

Associate Professor Nick Murray who is a Medical Oncologist and Director of the Medical Oncology Unit at the Royal Adelaide Hospital Cancer Services

Dr Eryn Dow – Medical Oncologist and Clinical Cancer Geneticist

It is important to note that while Breast Cancer is the most common cancer in women, the discussion of BRCA and familial breast cancer accounts for ~10% of cases. This is a complex disease that we are learning about every day and with the remainder of Breast Cancers accounting for 90%, it is a topic we will be revisiting in the future.

This is the continued story of BRCA.

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In 1866, a French physician by the name of Pierre Paul Broca recognised a terrifying disease running through the women of his wife’s family: breast cancer. He wrote that they could be well and have perfect health before this ‘germ’ of an illness would go off like an ‘explosion’ and could kill within 1 to 2 years. Broca studied his family for the next 30 years where he noted that 15 close relatives including his wife’s mother, his wife, and his daughter were all affected.

It would not be until the late 20th century that our knowledge and scientific techniques would lead us to understand this phenomenon. Professor Mary-Claire King in the late 1980s helped to identify the genetics of the BReast CAncer gene and continued research identified another. Today we know these as the BRCA1 and BRCA2 genes.

Unfortunately, women who have these BRCA gene mutations have an increased risk of breast and ovarian cancer (plus some others). The nature of this disease spans multiple specialities and, as such, we have some special guests for this episode to help us understand this disease, the treatment, and the management of this illness.

This is the story of BRCA (Part 1).

Our special guests for Part 1:

Professor Graeme Suthers – National Director of Genetics for Sonic Pathology Australia

Doctor Melissa Bochner – Breast and Endocrine Surgeon and member of BreastSurgANZ and current chair of the Breast Cancer Quality Audit

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In the 16th century, a curse was foretold about the Scottish MacCrimmon clan that they would cease to be the official (bag) pipers of the chiefs of the Clan MacLeod and would be forced to leave the Isle of Skye forever. The curse came true. The fingers of the men from the MacCrimmons clan became twisted and gnarled resembling a claw and they were unable to play the pipes.

Throughout history, this disease has been known by many names: ‘MacCrimmons curse’, ‘Celtic Hand’ or the ‘Vikings disease’. While this is clearly a debilitating condition and many cultures believed it to be a curse, others associated it with divinity.

In the 19th century, French surgeon Guillaume Dupuytren presented his now famous lecture at the Hotel Dieu where he showed 30-40 patients with what he called ‘rétraction permanente’ that that he had seen over 20 years and demonstrated successful surgery to manage it. Today we know this disease as Dupuytren contracture.

Our special guests on this episode are:

Dr Paul van Minnen who is a plastic and reconstructive surgeon specialising in hand surgery and runs his own private practice ‘Grip surgery’ in Adelaide; and
Dr Sarah Shepard who is an Anatomical Pathologist at Clinpath Pathology who has specialised in bone and soft tissue pathology.

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While I amputated one man’s thigh, there lay at one time thirteen, all beseeching to be taken next… It was a strange thing to feel my clothes stiff with blood, and my arms powerless with the exertion of using the knife.” – Charles Bell, Surgeon at the Battle of Waterloo, 1815.

Hippocrates said that ‘war is the only proper school for surgeons’ and, throughout history, we have become experts at battlefield medicine. From swords and spears to ballistic missiles and machine guns, the destructive power of our weapons has increased exponentially, but so has our ability to manage injuries and save lives that extend beyond the battlefield.

Our special guest is Dr Dan Pronk who is a qualified General Practitioner, completed Australian SAS selection and worked with Special Forces in the Army where he served five years including four tours of Afghanistan and awarded a Commendation for Distinguished Services. He is the author of ‘Average 70kg D**khead’, ‘The Combat Doctor’, and ‘The Resilience Shield.

This is the story of war and medicine.

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This Medical Life is a podcast for GPs, specialists, allied health professionals, and medical students but in this episode we share content related to the Australian Podcast Awards and talkback radio.

Dr Travis Brown and Steve Davis are taking a short break so this episode is a little different. You might consider it an audio snack.

It features two pieces of content.

The first is the 15-minute submission created for the 2022 Australian Podcast Awards. The criteria state we could select snippets from up to five episodes, published in the previous 12 months, and compile them into one track of less than 15 minutes duration.

If you have a colleague new to This Medical Life, the first half of this episode would be a good primer of the style and content we strive to produce. There is a video version of the submission at the bottom of the show notes page.

The second part of this episode is of similar length, containing one of Dr Travis Brown’s regular interviews on Adelaide talkback station, FIVEaa.

Host, Richard Pascoe, has Travis share some of the novel history and insights about diseases we cover on This Medical Life.

What makes these interviews different is the fact that they’re for a popular audience, not our specialist, medical audience.

We hope you enjoy hearing this act of outreach.

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Intestinal problems are as ancient as human’s themselves. However, the first case was only documented in the 18th century by a great Italian anatomist Giovanni Battista Morgagni, of a 20 year old man who had died with fever, abdominal pain, and bloody diarrhoea. The autopsy findings by Morgagni are consistent with what we know today as Inflammatory Bowel Disease.

As time continued, so did our knowledge of these diseases. Today, Crohn’s disease and Ulcerative colitis are as important as they are complex, and patients require complex multidisciplinary management and follow-up. That is why, for this episode, we have assembled an array of specialists to help GPs and patients in their journey.

Our special guests include:

Dr Vincent Ho
- Gastroenterologist, Senior lecturer at Western Sydney University (aka: the Gut Doctor – gutdr.com)
Dr Scott Mackenzie
- Colorectal surgeon at Liverpool Hospital, Senior lecturer in surgery at Liverpool Hospital
Dr Tristan D Rutland
- Pathologist, Senior lecturer at Western Sydney University

This is the story of IBD.

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The sun has always been special to us. Most cultures, particularly in ancient times, worshipped it as a God to be feared. In modern society, we recognise both the potential life-affirming and life-dangers that the sun poses.

In this episode, we focus on the beneficial side the sun provides to us via Vitamin D. We discuss the pros and cons of testing, treating, and managing Vitamin D in patients, and of particular concern is identifying those who are at a high risk of deficiency.

Our special guest is Professor Ken Sikaris who is a chemical pathologist and Director of chemical pathology at Melbourne Pathology.

This is the Story of Vitamin D.

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In the 19th century, a French doctor recognised a subset of patients with joint disease that didn’t fit the traditional diagnoses of gout or osteoarthritis. These patients were predominately female with affected hands and fingers, joint stiffness, and often had a low socioeconomic background (gout was traditionally associated with high socioeconomic status).

Later, an English Physician noted an important distinction that these patients did not have elevated uric acid such as those with gout. This must be a different disease; he was right. It would be his son who took on this family interest and ultimately gave this disease the name we know it as today: Rheumatoid Arthritis.

Our special guest for this episode is Dr Daman Langguth, an immunologist, Head of the Immunology Department at Sullivan Nicolaides Pathology and a member of the Australian Rheumatology Association.

This is the story of Rheumatoid Arthritis.

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The first ever recorded blood pressure was done by Stephen Hales in 1733 with a glass tube inserted into the artery of a horse. It would be well over a century for us to develop a non-invasive technique to measure blood pressure and another century to understand its significance.

Today, hypertension is one of the most common conditions facing General Practitioners. However, in the pursuit of lower blood pressure, can we be causing unnecessary harm by overprescribing and/or increasing doses with little to no benefit? Is this a case where less is more (or preferable)?

Our special guest is Professor Simon Dimmit who is a consultant physician in General and Cardiovascular Medicine. He is a Clinical Professor of Medicine at the University of Western Australia and an Adjunct Professor at the School of Medicine and Public Health at the University of Newcastle.

This is the story of Hypertension.

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Streptococcus pyogenes is a critical micro-organism for every doctor to know about.

It is a gram positive coccus that grows in chains and has the potential to cause significant morbidity and even mortality. It has taken us centuries to learn the significance of this infection and is a testament to modern day medicine that its complications are rare.

This is the story of Streptococcus Pyogenes.

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Marfan syndrome is a disease of connective tissue. Patients who have this condition often have a tall stature, long slender arms, legs and fingers but it is the connective tissue in and around organs that is the greatest risk.

This is a genetic disease that was first recognised at the end of the 19th century and the gene responsible identified in the last few decades. Unfortunately, with the propensity for tall people, it may not be surprising that this condition has been unrecognised in some athletes with occasional tragic outcomes.

Our special guest on this episode is Professor Graeme Suthers from Sonic Genetics Australia.

This is the story of Marfan syndrome.

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There are three known transmissible cancers in the mammalian world. Surprisingly, two of the three are found in Tasmanian Devils. They are called the Devil Facial Tumour Disease (DFTD) and one Devil can pass this tumour to another Devil via direct contact.

These DFTD’s have had a devastating impact on the Devils population and even threatened their survival. Over the last few decades, researchers have investigated these tumours and are learning how to tackle this problem.

Our special guests for this episode include Dr Andrew Flies and Dr Ruth Pye from the Menzies Institute of Medical Research at the University of Tasmania.

This is the story of transmissible cancer.

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Ancient Egyptians called it podagra (foot-trap), Hippocrates the unwalkable disease, and the 17th and 18th century it became known as the Disease of Kings. Gout has long been associated with rich foods and an affluent lifestyle. Yet, its significance in the modern era cannot be overstated.

Commonly thought of a joint disease, the systemic impact are becoming increasingly apparent. Join us as we discuss the significance of gout for patients and the importance of diet, treatment and management.

Our special guests include:

Professor Richard Johnson is a physician in internal medicine, renal, and infectious diseases. Professor Johnson is involved in research and published over 260 journal articles, ‘The Fat Switch’ in 2012, and ‘Nature wants us to be fat’ in 2022. He also is popular on youtube: https://www.youtube.com/watch?v=gAjC_BWMElk

Professor Ken Sikaris is a chemical pathologist and the Director of Chemical Pathology at Melbourne Pathology. Professor Sikaris is a NATA assessor, Founding Fellow of the RCPA Faculty of Science and principle examiner in Pathology Informatics. He is also an advocate of the low carb diet on YouTube (with over half a million views) and was Professor Blood in the Australian documentary ‘That Sugar Film’.

This is the story of gout.

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Marijuana has a complex history. It seems every society has grappled with balancing the positive and negative effects. Historical records indicate that Ancient Chinese farmers were the first to grow this plant but also were the first to reject it as a socially acceptable drug.

In the middle ages, Pope Innocent VIII took this fight to the extreme associating it with witchcraft and sorcery labelling marijuana an existential threat. Those who cultivated it were imprisoned, exiled or executed. Alternatively, in the 1790s, the British saw it as a great source of tax revenue out of India.

Today we recognised there is a number of benefits of medicinal cannabis. Our special guest is Professor Jennifer Martin who is a clinical pharmacologist and physician with vast experience and research in this field.

Australian registered medical practitioners who would like to access to medicinal cannabis products for the treatment of appropriate patients may apply through the following links:

Accessing medicinal cannabis for a patient: https://www.tga.gov.au/accessing-medicinal-cannabis-patient
Special Access Scheme: https://www.tga.gov.au/form/special-access-scheme
Authorised Prescriber Scheme: https://www.tga.gov.au/form/authorised-prescribers

This is the story of medicinal cannabis.

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In 1770, in the small German town of Bonn, a child was born that would impact the world on a par with great emperors and conquerors. Yet, it was not with a sword or bloodshed but with imagination and composition. This man was Ludwig van Beethoven and his influence is possibly even more important today than when he was alive.

Ludwig was one of seven children but only three of them survived beyond infancy. Ludwig’s musical gifts were apparent at a very young age but he had an abusive and alcoholic father who demanded performances at any time he desired (often back from the pub with his similarly inebriated friends). At the age of 16, Ludwig’s mother died of tuberculosis. At the age of 21, his father died.

Beethoven’s life was beset with poor health including gastrointestinal problems and headaches. He was not fond of doctors but he loved his wine, his women and his music. Unfortunately, in his late twenties, Ludwig experienced progressive hearing loss which eventually led to complete deafness in his late 40’s and 50’s.

At the age of 56 years, on the 26 March 1827, Beethoven died. His final words ‘Pity, pity, too late’.

This is the story of Ludwig van Beethoven’s death.

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In the 1930s, outbreaks of a mysterious febrile illness occurred with abattoir workers in Queensland in Australia. Physicians investigated these patients but no cause was able to be identified. To complicate matters, there wasn’t any consistency between those who got sick, the area where they worked in the abattoir nor the animals with which they worked with. Hence, the name has come to us as ‘Q’ (meaning ‘Query’) fever.

It would take significant investigative skills and an outbreak in the United States to confirm the diagnosis. Today, the causative agent is called Coxiella burnetti.

This is the story of Q fever.

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Pauline Gross was a seamstress in 1895 who had seen family members die at an early age from cancer. At the time, one of her clients was a pathologist by the name of Dr Aldred Scott Warthin and confided in him her fear that that this would be her fate too. The two combined to record the most comprehensive family history ever created. Dr Warthin called them ‘Family G’.

In the 1960s, Dr Henry T Lynch who revived the search for the members of Family G. Through family gatherings and meetings, he managed to track down over 650 family members, of which, 95 had a history of cancer. He noted that they had an Autosomal Dominant disorder that increased their incidence of uterine and gastrointestinal cancers. Dr Lynch called it a ‘Cancer Family Syndrome’. Today, it is known as Lynch syndrome.

Our special guests include:

Ami McKay: an award winning novelist who has written ‘Daughter of Family G/Before my time: a memoir of love & fate’. Ami has also produced the radio documentary ‘Daughter of Family G’ available at amimckay.com
Dr Tristan Rutland: Anatomical pathologists at Liverpool hospital and based at Western Sydney University with a PhD in colorectcal cancer. Dr Rutland was the recipient of the Konrad Muller RCPA Outstanding Teaching Award
Professor Graeme Suthers: National Director of Genetics for Sonic Pathology Australia who trained in clinical and laboratory genetics in Sydney, Adelaide, and Oxford.

This is the story of Lynch syndrome.

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In 1951, Australian anthropologists reported on a unique neurodegenerative disease from Papua New Guinea. The natives called it ‘Kuru’ which meant to tremble or to be afraid and it certainly struck fear into those who saw it.

Through amazing investigative work and serendipity, a veterinary pathologist in the United States saw the histology of a Kuru from the brain and noted it looked a lot like ‘Scrapie’ (a neurodegenerative disease in sheep) and the link was made.

It would not be until 1980s that the causative agent for these diseases was identified: Prion’s.

And then in the 1990s, cows in the United Kingdom began showing symptoms…

This is the story of Prion disease

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In 1924, a previously well 20 year old woman presented to hospital with a headache and general fatigue. Her condition rapidly deteriorated and she died in 6 days. Over 6000 cases occurred within 1924. The search was on to find the cause. Fortunately, in 1935, a breakthrough occurred.

We know the virus today as the Japanese Encephalitis Virus. The vast majority of people who become infected with JEV are either oblivious (asymptomatic) or only have mild non-specific viral symptoms (ie. fever). However, those who are very unwell and require hospitalisation have significant risks of morbidity and mortality.

In 2022, cases of JEV have been identified in Queensland, New South Wales, Victoria and South Australia. This is the first time cases have been recorded this far south. We know that JEV is endemic in at least 24 countries around Asia. Is Australia going to become the 25th?

This is the story of Japanese Encephalitis Virus.

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In 1951, two Haematology fellows, Dr William Harrington and Dr James Hollingsworth, agreed upon an experiment. They would ask the next patient with Idiopathic Thrombocytopenia Purpura (ITP) to donate 500ml of blood. Then, whoever was a blood-type match would get the transfusion and see if they got the disease. The results were immediate and dramatic.

Surprisingly, the fact that platelets are the foundation of coagulation and derived from megakaryocytes have only been known for just over a century. Our understanding during this time has been exponential but the key to ITP remains in its name: idiopathic. Yes, we actually don't know the cause of this disease. Fortunately, there is a lot about ITP that we do know.

Our special guest is Dr Nicholas Myles who is a General Haematologist and Senior lecturer at the University of Adelaide.

This is the story of ITP.

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In 1347, the European world encountered one of history’s greatest tragedies: the great plague. Today, it is known by many names: the black death, the black plague, or the great mortality. Whatever name we give it though, one thing is clear: those who lived through this time genuinely believed this disease would eradicate of humanity

The true toll of this plague is unknown. Tens of millions of people were killed and those that weren’t, were scarred in every way imaginable. This disease would ravage European cities and countries for 7 years before it finally relented. Amazingly, it would only be 9 years before another plague epidemic appeared. They called this one the ‘Children’s plague’.

Join us with this episode to study the disease that is responsible for millions of deaths in history and still exists with us today.

This is the story of the black plague and Yersinia pestis.

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Familial Hypercholesterolaemia (FH) is an under-recognised genetic condition that causes elevated cholesterol in patients and affects approximately 1/250 people in Australia. Approximately 100,000 Australians have FH but only ~5% are diagnosed. This needs to change.

FH causes early cardiovascular disease and can be a significant cause of morbidity and mortality in those affect. How do I know? Because a few years ago my brother with no significant co-morbidities and a healthy lifestyle had a life-threatening acute myocardial infarct (heart-attack) at the age of 43.

Our special guests for this episode include:

Dr Gavin Brown (brother of the co-host)
A/Professor Damon Bell (Chemical pathologist for Clinipath, PhD in FH, A/Prof at the School of Medicine at the University of Western Australia)
Professor Graeme Suthers (Director of Sonic Genetics Australia)

This is our story of Familial Hypercholesterolaemia.

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Scattered throughout history are epidemics of catarrhal or campaign jaundice (the latter was experienced during military campaigns). The pivotal moment was during World War II where troops became sick with jaundice due to a contaminated Yellow Fever vaccine and sporadic jaundice outbreaks in different countries. While the symptoms appeared similar (ie jaundice), one did not confer immunity to the other and further investigation was needed.

This discovery of Hepatitis A and B lead to the discovery of Non-hepatitis A and Non-hepatitis B: other illnesses that caused jaundice and liver damage. This lead to the identification of Hepatitis C, D, and E. Although they have similar names, these are 5 separate virus and require different tests for identification.

This is the story of hepatitis.

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King Henry VIII was both a literal and a historical giant but his reputation of brutality and malevolence has few equals. He took power at the start of the English renaissance and was responsible for the English reformation. He had inroads into public health and regulated medical practitioners but also oversaw the enactment of vicious traitorous laws where could be jailed or executed for actions (including speaking out) against the crown.

Henry was touted as being a tall and striking young man who was gifted in athletic sports. However, his health deteriorated during his mid-30s apparently as a result of a significant accident in a jousting event. At the age of 55, he died. Legend had it that after his death, he was so large that his coffin exploded. Is this true?

This is the story of King Henry VIII historical autopsy

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How we teach those who come after us is as important as the knowledge we learn for ourselves. Medicine throughout the ages has been an apprenticeship style model, but over the last few hundred years this has changed to tertiary education. However, is this the right model?

Our special guest is Dr Tristan Rutland who is an Anatomical Pathologist at Liverpool hospital and teaches at Western Sydney University. He was the recipient of the Konrad Muller RCPA award for Outstanding Teaching in 2020. He is also very active on Twitter (@TristanRutland7) posting #Tweetorials and Pathology Education.

This is a story of Medical Education.

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At the end of the 14th century, a young woman is skating on a frozen canal and suddenly falls injuring herself. Her name is Lidwina. Over the next 30 years her body deteriorated due to a disease we know today as Multiple Sclerosis. Lidwina faced this illness admirably and was canonized in the late 19th century for her fortitude and faith.

The breakthrough for MS is attributed to Jean-Martin Charcot. Known as the Father of Neurology, he called this condition ‘sclerose en plaque disseminee’ and even watched as his servant ‘Luc’ developed symptoms. He confirmed as her disease when he performed her autopsy and found sclerotic plaques on her spinal cord and brain.

Our special guest is Dr James Leyden from Leyden Neurology who has been practicing in Adelaide for 12 years. Links to the MS Society of Australia have been provided in the show notes.

This is the story of Multiple Sclerosis.

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Ancient Egyptians hold a special place in history. Their civilization, religions, gods, conquests, traditions and rituals are some of the most well documented and fascinating. Throughout the centuries, we have been able to piece together the health and medicine of our ancient ancestors and the mummification process plays a significant part in this.

Which brings us to story the of Ramesses III and the Judicial papyrus of Turin. This tells a story of the Harem conspiracy to assassinate Ramesses III and ‘overturn the royal bark’. Through modern imaging techniques, the body of Ramesses III has given up its secrets about this conspiracy and the punishment of those responsible.

This is the story of Egyptian mummification and the trial of a millennia.

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If there is one constant throughout all of medical history, it is the value of urine. Our ancient ancestors believed they predict a patient’s recovery (or not) upon examination of their urine to the middle ages where they used a scale of colour, thickness, and sediment.

Urine was also used in a range of non-medical and even commercial uses that boggles the modern mind. This episode examines the history of urine, its uses, and its modern-day medical uses. The range of testing we have available for urine is staggering and it raises the question: is urine liquid gold?

This is the story of urine.

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SLE is a chronic relapsing autoimmune disease. ‘Lupus’ is latin for wolf and glimpses of it can be seen throughout history. However, it is often obscured by the complexity of the disease and the conglomeration of other conditions.

Over time, our understanding of SLE has dramatically improved but it still remains a complex condition to diagnose and a significant challenge to interpret pathology results. Anti-nuclear antibodies (ANA) are commonly ordered but are commonly misunderstood.

Our special guest is Dr Daman Langguth who is a clinical immunologist and Head of the Immunology Department at Sullivan Nicolaides Pathology. We discuss diagnosing, testing, and management of patients with Systemic Lupus Erythematosus.

This is the story of SLE.

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The emergence of syphilis in 15th century Europe caused widespread panic and finger-pointing as to the cause and origin of this disease. Unfortunately, the treatment at the time was as dangerous as it was ineffectual.

Many historical figures have been associated with syphilis; some will have certainly had it but others will be to cast aspersions against one’s character. This is because it is a disease of rare distinction that sits at the historical nexus of a sex, disease, moral depravity, and mental illness.

It would take centuries before the cause of syphilis (Treponema pallidum) would be known. However, despite all of our knowledge and available treatment of syphilis, we see the prevalence of this on the rise.

This is the story of syphilis.

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Modern day surgery is synonymous with anaesthetic. Yet, it has only been that way since the mid-1800s. Prior to this, people either resided to their fate without surgery or faced the knife with little to nothing to numb any pain.

The story about the discovery of anaesthetic is both hopeful and tragic. Ether, the first widespread anaesthetic used, was a blessing to the world but a curse to those who discovered its use. However, it would revolutionise the care of patients and open the door to disciplines of surgery previously unimaginable.

This is the moment surgery changed forever. This is the story about the discovery of anaesthetic.

Welcome to This Medical Life.

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