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Ross Walker
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Prevention is better than cure

Thursday, July 20, 2017

By Ross Walker

A recent report, co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education, is titled “Preventive health: how much does Australia spend and is it enough”?

It is estimated that $27 billion annually is spent in Australia treating chronic disease, which accounts for around a third of our annual health budget. But, Australia currently spends around $2 billion a year on prevention, ranking us 16th out of 31 OECD countries for per capita expenditure. This accounts for around 1.3% of Australian healthcare expenditure.

It is estimated that around 50% of Australians suffer some form of chronic disease, being responsible for 83% of all premature deaths in Australia and around 66% of the total burden of disease.

In my opinion, there are many reasons why much lip service is given to preventative health, but little action follows as seen in the report. Firstly, to examine the medical profession’s role in all of this, there is little emphasis placed on preventive health during the training of student doctors. The vast majority of their critical time is spent in hospitals dealing with very sick people with established diseases. There is little emphasis in medical courses on preventative measures, the variety of lifestyle factors and integrative techniques combining the evidence based aspects of pharmaceutical therapy, medical procedures and operative therapy, along with the proven aspects of complementary medicine.

Modern medicine is currently being practised by having the ambulance parked at the bottom of the cliff waiting for people to fall off and instead of fixing the rails at the top of the cliff, i.e. prevention. What we do in medicine is build faster ambulances. I make the analogy that this is like the financial world waiting for people to go bankrupt and then they give them financial advice.

Practising doctors are overloaded and time poor. Doctors are certainly not rewarded for spending time with patients discussing the vital aspects of prevention. When a person with clear lifestyle issues such as obesity, cigarette smoking or the excessive use of alcohol, to name three key areas, is given a pill for cholesterol-lowering or blood pressure (and told in one sentence to lose weight, give up smoking and cut back their alcohol intake), the perception is the pills will do the job and they can continue the variety of forms of self-abuse.

Until the remuneration system is rearranged for doctors, rewarding the profession for spending time with patients and not for churning them through as quickly as possible, nothing will change in this area.

At a government level, more is needed in the “carrot and stick” department, again legislating to reduce the costs of healthy, fresh foods, and to increase the cost for processed packaged foods, takeaway foods, the introduction of a sugar tax and continued heavy regulation of alcohol and cigarettes.

Also, more needs to be done to encourage people to exercise, move more and spend less time sitting at work and at home. These initiatives do need to come at a government level.

I also believe life insurance and health insurance companies should be rewarding clients for healthy behaviour with financial incentives based on a variety of health parameters.

Another issue, which is not really considered, is that of convenience. Around 10 years ago, I wrote a book titled “Diets Don’t Work”. One of the chapters in that book was, “Convenience is killing us”. One of the great paradoxes of life is that what seems good and fun at the time, and is easily accessible, is typically bad for you, which I believe is clear and obvious in our modern world.

Most importantly, however, is personal responsibility. With our modern, overloaded, time poor world, each individual needs to examine their day-to-day activity and behaviour. Basically, in life we have three choices - protection, life maintenance and urges. The protection aspect is obvious in that if you are in any sort of danger, you need to bring in steps to protect yourself from that danger. But, for most of the day, most of us living in the modern world are not at any acute risk from violence or abuse and thus we’re left with life maintenance or following our urges.

Life maintenance involves focusing on the five keys of good health:

  1. Quitting all addictions
  2. 7-8 hours of good quality sleep
  3. Eating less and eating more naturally
  4. 3-5 hours of testing exercise per week
  5. Happiness, peace and contentment

Following our urges is clearly the opposite of these five keys. Not suppressing urges can then lead to addictions. Whether this is ongoing cigarette smoking, consuming too much alcohol or using illegal drugs to the increasing pervasive urge of dependency on electronics. Rather than cultivating a good quality sleep habit, there is the urge to check messages and emails in the middle of the night. There is the urge to spend too much time sitting in front of the television, rather than exercising. There is the urge to overeat, or even munch on unnecessary food, while you are watching television.

With our urge-focused society, it is no wonder we’re seeing rampaging ‘diabesity’ and ongoing addictions.

Rather than laying the blame on poor government spending, inadequate medical emphasis on prevention, or even shifting all of this back onto the individual, I believe we require a global societal approach to shift from the current disease based medical model to a prevention focus at each level of society.

The first aspect here is to start the discussion, and thank goodness for reports such as the one explored in this article and others, such as the Obesity Initiative from the Royal Australasian College of Physicians. Hopefully, with the increasing emphasis on preventive health, we will start to see a reduction in the carnage from chronic illnesses.

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Contraceptive Microchip

Thursday, July 20, 2017

by Ross Walker


In my opinion, all major crises on this planet are linked to one key issue – whether you consider pollution, terrorism, conflicts between nations and communities, unemployment, government’s inability to offer and maintain basic services such as health, education, transport and all other infrastructure – in my view, it all comes down to the central fact that there are far too many people on the planet.
 
Dan Brown’s latest novel, “Inferno”, addresses this issue and, of course, it is a novel, but I believe we need to start the important discussion regarding overpopulation.  Some commentators and experts in the area believe that if we are to sustain the necessary resources to maintain life on this planet indefinitely, we need to keep the human population at four billion or below.  When I checked recently, the current population was 7,247,780,000 people and rising rapidly. 

Clearly, the growing world population is at a crisis level and some World bodies such as the United Nations, needs to debate this issue, or in my opinion, the human species will probably be extinct within the next one hundred to two hundred years, if that.
 
Thus, I was delighted to hear Bill Gates has partnered with the Massachusetts Institute of Technology in Boston to develop a contraceptive microchip which lasts for sixteen years.  This small microchip can be inserted beneath the skin in the buttocks, abdomen or upper arm and can be switched off remotely if the woman wishes to conceive.  It should be available for general use in 2018 and the Gates Foundation is trying to establish worldwide services in vaccination, contraception and improving the nutrition and accommodation for many people in the third world. 

As I have stated, if we do not start looking at the major issue of overpopulation, I do not have great hope for the long term future of the human species.  As Albert Einstein once said “we cannot solve our current problems with the same thinking we used to create them”. 

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Weight loss - is it all about calories?

Thursday, July 13, 2017

There is no doubt that to lose weight you have to take in less calories than you burn off every day. But, this is not as simple as eating less food and doing more exercise. New evidence is now emerging that it is not just what you eat but also when you eat.

Firstly, let us consider “Calories in”. “Calories in” is everything that goes in your mouth apart from water consumed in an inert container. All “calories in” have the potential of contributing to weight gain although, to take the example of an apple, the number of specific calories in an apple is actually less than the amount needed to metabolise the combination of nutrients found in the apple itself. Therefore, consuming an apple gives you a negative calorie balance which is therefore a help in losing weight. When you consider macronutrients, 1g of fat contributes nine calories, 1g of carbohydrates and protein each contribute four calories. But, a significant carbohydrate load leads to more insulin release, which tends to lay down more fat than the equivalent amount of fat and protein.

Fluid also has to be entered into the equation. If you consume water in an inert container such as a glass or a stainless-steel bottle, then this is not contributing to your calorie intake. Many people these days, however, consume water in a plastic bottle which leeches a vast array of, at times, quite damaging chemicals into the water which can significantly affect metabolism and contribute to weight gain.

Most people, however, also consume other forms of fluid such as tea, coffee, alcohol, juices, milk and the ubiquitous soft drinks, whether sugar sweetened or artificial. Alcohol, for example, contributes seven cal per gram and when you add in the sugar added to the alcoholic beverage, there is a significant caloric intake with each standard alcoholic drink consumed. For example, I saw a patient a few months ago who had significant abdominal obesity. His wife supported his comments that he did not eat much but he went on to tell me that he consumed a bottle of wine on a daily basis which in itself gives him close to 1000 cal per day before he puts anything else in his mouth.

To focus on soft drinks, the amount of sugar in the sugar sweetened beverages is anywhere between 8-12 teaspoons per can and recent work has demonstrated that the artificially sweetened drinks contribute to an equivalent amount of weight gain despite the fact that the artificial sweeteners allegedly carry no calories.

Then we must look at calories out or in other words the energy we burn on a daily basis. There are 3 components here which include exercise, movement and metabolism. Unfortunately, the system is more geared to sin than it is penance. If you go for a brisk half an hour walk, you burn 300 cal. If you have a small piece of chocolate cake you are taking in 300 cal.

Another big issue is that of prolonged sitting. It is now estimated that the average person living in modern society sits for 11 h/day and this is associated with a whole host of health issues from musculoskeletal problems, cardiovascular disease, high blood pressure and even cancer and, of course, the increasing weight gain we see across the board in our society. Last comes the thorny and often misunderstood concept of metabolism. Metabolism is basically the day-to-day functioning of each cell in our body contributing to existence. To maintain normal balance requires a very finely tuned system involving energy production by a component of the cell - the mitochondria, along with thousands of various proteins which have a variety of functions within the body. The complex process of metabolism consumes a significant amount of energy on a daily basis and in fact over a 24-hour period the average person burns around 1500-1600 cal daily before any exercise or movement.

But, the human being is not like a car. With the car, you put the fuel in and you can use the petrol when you need it. With our bodies, if you do not burn the fuel within a few hours of ingestion, it gets laid down as fat.

Now, to discuss the best studied diet, the Mediterranean diet. It is far too simplistic to look at the food that is ingested. In fact, it is the Mediterranean lifestyle that contributes significantly to their good health. They have a large breakfast of fresh fruits and whole grains and burn off any extra carbs in the hot Mediterranean sun in the morning. They have their biggest meal at lunchtime which typically involves pasta and a couple of glasses of wine (typically red wine). The carbs and alcohol make them sleepy and they have an afternoon sleep typically lasting around one hour and then burn off any extra carbs in the hot Mediterranean sun in the afternoon. In the evening, they have a small meal and go to sleep.

In Western society, we have a small breakfast and small lunch and typically snack throughout the day and have a huge evening meal and sit down for a few hours and watch television and then go to sleep. As we are not burning off any of the fuel taken in from our evening meal, it gets laid down as fat. Another major issue is the increasing sleep problems experienced by many people in modern society. 30% of adults experience some form of insomnia along with the very common sleep apnoea. As the body works on a 24 hour cycle, our so-called circadian rhythms are significantly affected by poor sleep as are many of the normal hormonal secretions throughout the day and can certainly affect our metabolism in a deleterious fashion.

Over the past decade, there have been increasing comments about the timing of eating. It appears that one of the bad habits of the modern world is to delay eating until late in the evening, which appears to have a profound effect on metabolism. Prolonged delayed eating can lead to weight gain, increasing insulin and cholesterol levels and negatively affect fat metabolism and the hormonal markers implicated in heart disease, diabetes and many other health issues.

Professor Namni Goel, a professor of psychology in the division of sleep and chronobiology at the University of Pennsylvania has performed a very elegant study on nine healthy weight adults subjecting them to two different conditions over an eight week period. The first involved daytime eating of three meals and two snacks between 8AM to 7PM with a two-week washout in between. This was followed by delayed eating including the same amount of meals and snacks and identical calories, but staggered to between 12 midday to 11PM. Sleep was kept constant throughout the study.

A variety of measurements were performed including weight, the respiratory quotient, which looks at indirect measurement of metabolism, along with a number of hormonal markers. The study clearly showed that delayed eating led to a gain in weight, metabolising fewer fats and more carbohydrates, increasing levels of insulin, glucose, cholesterol and triglycerides.

The well-known hormone, Ghrelin, stimulates appetite and this peaked earlier in daytime eating along with Leptin which induces the feeling of satisfaction when you eat, peaked later. Therefore, eating earlier keeps you satisfied for longer and prevents excessive eating in the evening.

Therefore, weight gain and weight loss is not a simple question of how much we eat and how much we move but clearly also involves the very complex concept of metabolism. This is not a fixed parameter for each individual but can significantly be affected by many factors including age, genetics, the amount of food consumed, the type of food and now, when we eat as well.

As the father of medicine, Hippocrates, has been often quoted as saying, "Let food be thy medicine and medicine be thy food". Although this is a very important comment, it is clearly not that simple.

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Is low dose alcohol safe?

Thursday, July 06, 2017

by Ross Walker

For many years, the battle between the proponents of temperance and the alcohol industry has raged on. Both sides have used medical evidence to support its case. There are not too many people on either side who would suggest that heavy drinking has any benefits apart from filling the coffers of the people who sell alcohol.

Heavy drinking, defined as the regular consumption of four or more standard drinks on a daily basis or intermittent binging, which is five or more drinks during one particular drinking session, is definitely associated with a vast majority of health issues. These typically involve the liver, the brain, the heart and a significant increased cancer risk for a variety of cancers. The World Health Organisation has suggested that 5% of the global burden of disease and injury was directly related to alcohol.  

But, the age-old three questions are

1) Is all alcohol harmful?

2) Is there a safe dose?

3) Is any particular type of alcoholic beverage beneficial to the health?

I have recently written my view on the low-dose alcohol and breast cancer association and since that article, two studies have emerged expressing concern in regard to low or moderate consumption of alcohol. The third study relates to indiscretions of youth and later health issues.  

The first study, in my view, does answer the question about the safety of alcohol during pregnancy. The study performed in Australia and Belgium examines 415 children born as part of the AQUA study - (Asking questions about alcohol in pregnancy study). The study reviewed the alcohol consumption of 1600 women. As a sub-study, the offspring of some of these women were examined at one year old and related the findings to the maternal alcohol consumption during pregnancy. The children underwent 3D imaging of the face to detect any variations in facial features based on the mother’s alcohol consumption.

Low-dose alcohol consumption was defined as less than 20 g on any one occasion and less than 70 g per week. Moderate dose was defined as 21 to 49 g per occasion and less than 70 g per week and high dose was defined as more than 50 g on any occasion. 15 g is a schooner of beer, 150 mL of wine and a standard 30 mL nip of spirits. When compared to women who did not consume any alcohol during pregnancy, there were definite variations in the nose, lips and eyes of children born to mothers who consumed alcohol.

The second study was 30-year data from the Whitehall II study which followed British civil servants. This particular sub-study looked at 550 healthy men and women with an average age of 43. Consuming more than 30 units per week of alcohol, which is the equivalent of around 10 pints of strong beer or 10 large glasses of wine, was definitely associated with damage to part of the brain known as the hippocampus, which is intricately associated with memory. But, consuming 14 to 21 units per week was also associated with the degree of hippocampal atrophy and problems in the white matter of the brain and also language fluency.

The final study, performed in Sweden, was a 27-year study looking at the drinking habits of young men and women and followed their risk for disease as they age. The study began at age 16 and found that binge drinking in younger age, only in women was associated with increased risk for higher blood sugar levels after age 40. This was independent of weight, blood pressure or cigarette smoking. There was not the same association with males. High blood sugar was only associated with weight and BP.

Although studies such as these cannot be extrapolated completely to every individual, they do raise concerns about society’s increasing exposure to alcohol. I have always been a strong supporter of the consumption of low-dose alcohol, which I would define as somewhere between 1-3 glasses most days of the week, but only when combined with a healthy diet, such as the Mediterranean diet, and the daily consumption of a high-quality multivitamin.

Also, not considered in any of the studies, is the reason why people consume alcohol in the first place. Many people consume alcohol for social reasons or to enhance the flavour of food, in the case of wine. But, a number of people also consume alcohol for more pervasive reasons such as stress management, loneliness or to relieve feelings of anxiety and depression. Could it also be that the people in the studies who are not alcoholics and therefore not consuming alcohol to excess had higher stress levels thus contributing to disease? Regardless, the studies do highlight the importance of not only choosing your poison wisely, but also choosing the dose of your poison. Although it is often said, all things in moderation, it is also very important to look at the setting of the moderation i.e., the other factors in your life which may be leading to this particular behaviour. 

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Aspirin for all?

Thursday, June 29, 2017

By Ross Walker

One of the most common questions I am asked, especially in people over the age of 50 is, ‘Should I be taking aspirin every day as a preventative?’ Although aspirin has been available for many years and has a very strong evidence base, as with all pharmaceuticals, there are some concerns around its widespread use.

Many studies over the years have shown around a 25% reduction in cardiovascular disease, including heart attack and stroke. Over the past decade, there have been a number of studies suggesting a reduction in the risk and recurrence of many common cancers.

Recent studies have suggested around a 20% reduction in breast cancer and breast cancer metastasising. In some studies, there have been suggestions of up to a 50% reduction in colon cancer. One study has suggested a reduction in chronic liver disease with the regular use of aspirin. It is not known whether this is specific for aspirin, or whether this pertains to all antiplatelet agents such as the commonly used clopidogrel.

So, with all of this very positive information in support of the regular use of low-dose aspirin as a preventative, should not all of us over the age of 50 be taking this? Well, unfortunately, it is not that simple. I would estimate that around 10% of the population are prone to easy bruising and bleeding and this certainly becomes more prominent as we age. Many of my patients on chronic aspirin, or clopidogrel therapy, have the tell-tale subcutaneous blotches of this treatment. Mind you, I do have a number of patients who are not on this therapy and still have these subcutaneous blotches caused by fragile capillaries beneath the skin, as we age.

Probably somewhere between 5-10% of people who take any form of aspirin, including the enteric-coated low-dose aspirin, may still suffer reflux and other forms of heartburn as a consequence of this therapy. This is not the case with clopidogrel. Aspirin is also associated with chronic inflammation in the stomach, and people who take regular aspirin do have higher rates of gastrointestinal bleeding, intracranial bleeding and, of course, increased bleeding if there is any trauma involved.

A recent study from the Oxford vascular group followed just under 3200 patients for around 10 years. These patients all had some vascular event, such as a transient ischaemic attack, ischaemic stroke or heart attack and were treated with mainly aspirin after the event. For patients under the age of 65, the rates of significant bleeding requiring admission to hospital was 1.5% but these rates increased significantly with patients over age 75, increasing to 3.5%. In patients over 85, the rates were 5%. It was a significant concern that in the patients who did suffer a major bleed, whether it be gastrointestinal or intracranial, the rates of disability and death thereafter increased 10 times higher than those who had not suffered a similar fate.

It may well be that those people who suffered the aforementioned haemorrhages had more fragile capillaries and thus were more prone to bleeding. This, in itself, may be a marker for a poor prognosis and the bleeding was yet just another manifestation of a more fragile population. But, it does raise the question as to who should, and who should not, be taking low dose aspirin. Although I do not believe there are any clear-cut answers, it would be my suggestion that if you have already had a proven vascular event, have a high coronary calcium score or known significant carotid atherosclerosis, then aspirin or clopidogrel should be part of your long-term preventative management. If you have a strong family history particularly of breast or colon cancer, then low-dose aspirin would probably be of benefit as well.

But, if you have a prior history of any form of significant bleeding, bruise easily, or have a strong family history of bleeding, then it is probably better to avoid aspirin or clopidogrel as a preventative. If you have a history of prior peptic ulceration, reflux or any significant upper gastrointestinal symptoms you should certainly have a strong conversation with your treating doctors.

Thus, should aspirin be a key aspect of preventative strategies for all people? Certainly not.

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Can you die of a broken heart?

Thursday, June 22, 2017

By Ross Walker

Although there are many romantic notions about people dying from a broken heart, the evidence is actually quite striking that this is a strong possibility, with specific medical conditions arising in this situation.

Less likely to follow healthy lifestyle principles

Firstly, and most obviously, a person with a broken heart is less likely to follow important lifestyle principles, which are commonly associated with reduced risk for cardiovascular disease.

These include:

1. Quitting all addictions;

2. Getting good-quality sleep;

3. Eating less and eating more naturally;

4. Doing three to five of exercise per week; and

5. Cultivating peace and happiness.

What the studies say

Secondly, there are a number of studies linking the acute release of hormones such as adrenaline and cortisone – typically seen during times of stress – and the generation of an acute coronary syndrome, such as heart attack, unstable angina and even sudden cardiac death.

Acute stressful situations, such as a broken heart, may be associated with the rupture of fatty plaques, and thus, a subsequent heart attack.

There are also a number of studies linking chronic anxiety, depression and loneliness with acute coronary syndromes.

There have also been a number of studies showing much higher rates of death in the three years after a person suffered significant bereavement following the passing of their lifelong partner.

Finally, there is the well-known Takotsubo syndrome, which is severe constriction of the coronary circulation during times of stress. This has been specifically called the broken-heart syndrome.

If an angiogram is performed at the time of presentation with chest pain and shortness of breath, there are no blockages but the circulation is in constriction and resolves once the stress has settled.

How can a broken heart affect your mental health?

People suffering from a broken heart do have much higher rates of depression and anxiety. Depression is felt to be due to a reduction in brain serotonin levels, the so-called ‘happy hormone’, which controls our mood.

If a situation such as a broken heart arises, there is a strong possibility that serotonin levels are affected and depression may occur. Closely linked to a feeling of depression is that of anxiety, probably through the same mechanism.

How a broken heart affects your happy hormones

Apart from the direct effect on serotonin, there are other happy hormones that may be affected as well. Oxytocin is the love hormone, vital for bonding between couples and also parents with their children. If these bonds are broken for any reason, this may have a direct effect on oxytocin levels.

Dopamine is the “pleasure chemical” released from the nucleus accumbens in the brain. When you have a broken heart, it is certainly hard to experience pleasure and therefore the normal secretion of dopamine will be affected.

How a broken heart affects your social life

Because of the profound effects of a broken heart on all aspects of life, many people in this situation prefer to avoid social situations. Although superficial interactions are of no value in this situation, staying close to other important, supportive people may ease the suffering somewhat.

Being held and comforted by important members of your family and close friends is an important part of healing the horrible wounds experienced when your heart is breaking.

However, superficial interactions with people who make ridiculous comments like “time heals all wounds, you’ll meet someone else again soon” or the worst comment, “there are plenty of fish in the sea” are completely unhelpful and, in fact, make the situation worse.

Sudden weight changes

The major way a broken heart may affect your weight is through the combination of reduced attention to maintaining a healthy lifestyle and hormonal abnormalities that arise in this situation, which I referred to above.

Sudden changes of weight in any situation always puts a strain on the body’s normal processes. The body is always trying to achieve homeostasis, which is basically metabolic balance. Any strain on the body changes this balance and can precipitate acute health issues.

Tips for coping with a broken heart

1) Strangely, the most important tip I can give in this situation is to feel and accept the pain. You are supposed to feel bad when your heart is broken and often, by not trying to fight this emotion, the dreadful feelings will ease somewhat.

2) Stay close to the people who genuinely care about you, rather than those who dish out ridiculous platitudes (some of which I mentioned above). People who will hold you, care for you and let you cry on their shoulder.

3) Sleep is important and difficult to achieve under these circumstances. It doesn’t hurt you or your body to take, for a short period of time, gentle pharmaceutical sedatives before bed. There are also a variety of more natural anti-anxiety treatments, e.g. Withania and Kava, which also may be of some benefit.

4) If you have any specific medical symptoms such as chest pain, palpitations or shortness of breath, you still should seek medical attention because a broken heart can lead to more serious health issues.

5) Finally, if your symptoms and feelings persist well beyond a few weeks, it is important to have a strong relationship with a trusted medical practitioner who can help you through this period.

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3 common myths about Fibromyalgia

Thursday, June 15, 2017

By Ross Walker

What is Fibromyalgia?

Fibromyalgia is a disorder of the muscles and joints characterised by widespread sensitivity to pain and marked tenderness in these areas.

It appears that somewhere between 2 to 4% of the population suffer fibromyalgia, of which 90% are women.

Common myths about Fibromyalgia

There are three common myths about this diagnosis.

Myth One: Fibromyalgia is not real and purely psychological

The most common myth is that this condition is not real and is purely psychological. One of the real problems here is that there are no diagnostic tests to confirm the condition.

I have often said that “science is only as good as its testing equipment”. When a doctor does not have a test to confirm a condition, then there is often the suspicion that the condition is purely in the person’s head.

There is no doubt that sufferers of Fibromyalgia have often multiple trigger points throughout the body, which are, at times, excruciatingly painful to touch.

Myth Two: The condition only affects older women

Although this is probably the case in around 80 to 90% of people with Fibromyalgia, it still can commonly affect men and women at any age.

Myth Three: The pain is minimal 

The reality is that this condition can be incredibly debilitating in a number of cases.

As stated, apart from the symptomatology and the finding of trigger points, there are no tests to confirm the diagnosis.

There are, however, a number of associations and precipitants that may give you a clue to the diagnosis:

1) Acute life trauma: significant physical accidents or emotional trauma such as the death of a loved one and relationship issues, may precipitate the condition;

2) Recurrent injuries can cause tearing, twisting and bending of the muscles and joints and thus precipitate Fibromyalgia;

3) There are some suggestion that there are genes involved as it does appear to run in families;

4) One of the major theories is that Fibromyalgia is a problem of the way the central nervous system processes pain messages from the body; and

5) There are number of associations with this condition including post viral syndrome, chronic fatigue syndrome, Lyme disease, any sleep disturbance, arthritis, adrenal and thyroid abnormalities, depression, headaches and migraines, painful periods and irritable bowel syndrome.

Stress

A flare up of Fibromyalgia typically occurs when a person is under significant stress. This may be excessive physical stress, emotional stress, mental stress or even pharmacologic stress - legal or illegal. Poor diets, hormonal changes, changes in sleep and temperature or weather have all been precipitants.

Before a diagnosis of Fibromyalgia is made, it is important to exclude other illnesses such as any inflammatory condition of the muscles. It is also important that your doctor does a screen for inflammatory and other arthritic conditions.

Other associations of Fibromyalgia

Some other interesting associations of Fibromyalgia are as follows:

  • Excessive sweating: 32%
  • Burning sensation of the skin or mucous membranes: 3.4%
  • Unusual skin sensations: 1.7%
  • Skin lesions from repetitive scratching, itchy lumps on the arms and legs or thickened skin areas that itch: around 2%
  • Itching with no identified cause: 3.3%
  • Inflammation of the skin that is not itchy: 9%

Criteria

The American College of Rheumatology have given specific criteria to make the diagnosis of Fibromyalgia:

1) Pain and other symptoms that have lasted for a least three months with painful areas in at least 7/19 body areas;  

2) No other health issues to explain the pain and other symptoms; and

3) Associated symptoms such as fatigue, waking up unrefreshed, memory or other problems with cognition and any other general physical problems.

Treatments

As with many conditions, one of the keys to managing Fibromyalgia is maintaining a healthy lifestyle.

This is where the “Five Walkerisms for Good Health” are very important.

1) Quit all addictions.

2) Good quality sleep. Cultivating healthy sleep habits is vital in managing Fibromyalgia, along with having adequate rest and relaxation during the day.

3) High-quality nutrition is also important in this situation.

The Cleveland Clinic has recommended an anti-inflammatory diet, which may be of some help. Interestingly, this is basically a healthy diet which is good for anyone and includes a high intake of fruit and vegetables, whole grains, limiting excess dairy and reducing red meat intake.

It appears that low Vitamin D levels may also be associated with Fibromyalgia and having foods such as eggs, fish and whole grains fortified with Vitamin D maybe of some benefit.

4) Exercise. Although exercise may be difficult with a chronic pain situation, it is important to have moderate exercise every week if you’re a sufferer of Fibromyalgia. This includes aerobic, along with strength and resistance, training.

5) Stress management. Cultivating happiness, having a meditation habit and many other factors in relieving stress will certainly help relieve the symptoms of Fibromyalgia. Acupuncture, massage, yoga and Tai Chi are all very useful and important aspects of management.

Physiokey and Painmaster should also be considered for this condition.

A variety of painkillers are used for this disorder, including common drugs such as paracetamol, Ibuprofen and Naprosyn. Some patients need to be on the stronger Pregabalin or Gabapentin. A variety of antidepressants also have pain modulating effects and may be useful in this situation.

There is also some hope that medical cannabis may be an effective treatment for Fibromyalgia, although no good studies have been performed as yet.

Fibromyalgia is not a psychological disorder and can be very debilitating in many cases. It should be taken seriously by the medical profession and the friends and relatives of the person who is affected by this disorder. Although there is no magic bullet for this condition, as I have stated, a combination of lifestyle, physical and mechanical therapies are very effective in giving relief.

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Statin use in older people

Thursday, June 08, 2017

By Ross Walker

Over the past decade, there have been increasing concerns raised by some people in the medical field (and in the public) about the increasing prescriptions written for statin drugs (e.g. Crestor, Lipitor, Zocor and Pravachol and numerous generics). There have also been concerns about the potential over-reporting of side-effects by the public, but equally the under-reporting of side-effects, in the numerous clinical trials of these drugs.

Most people practising medicine would support the use of statins for people who have existing heart disease. However, the real question is, does it benefit people purely because their cholesterol is elevated, without evidence of vascular problems?

The study

A recent study published in the JAMA-Internal Medicine journal has raised concerns about the use of statins for people without heart disease over the age of 65.

Statins are the major group of drugs used to block the production of cholesterol in the liver, and have been shown in a number of trials in people with existing heart disease, to reduce further cardiac events.

There is, however, no data to support the use of statins for people over the age of 75.

Despite this, the use of statins in people 79 years or older has increased threefold from the 1990s until recently. This has increased from 9% to 34% over the last decade.

The researchers’ analysed data from a long-standing trial called ALLHAT-LLT, otherwise known as the “Antihypertensive and lipid-lowering treatments to prevent heart attack trial-lipid lowering trial”.

This was a placebo, controlled trial of just under 2,900 people without heart disease, where half were given Pravachol 40 mg daily, and the other half, usual care.

Pravachol is the weakest of the four commonly prescribed statins. In people over 65 and up to age 74, there were more deaths in the statin group than the usual care group (141 versus 113). This was also the case in people older than 75 (92 deaths versus 65 deaths respectively).

The rates of overall cardiovascular events were slightly lower in the statin group versus the usual care group (76 versus 89) and for those 75 or older (31 versus 39).

The conclusion of the trial was that there were no benefits using statins for primary prevention in people over the age of 65. An editorial by the editor of Harvard Health publications suggested that the musculoskeletal abnormalities and potential memory problems from statin use in older people could further compromise a person’s ability to function in daily life.

The conclusion of the trial was: “the combination of these multiple risks and the ALLHAT-LLT data showing that statin therapy in older adults may be associated with an increased mortality rate should be considered before prescribing or continuing statins for patients in this age category.”

For many years, a minority of doctors, including my colleague and friend Dr Aseem Malhotra, and I have been warning about the excessive use of statins by the medical profession.

A few years back, Dr Maryanne Demasi was vilified by the medical profession following a segment on the ABC’s Catalyst program, when she dared to suggest that statin drugs were being overprescribed. Since her public vilification, the arguments put forward by Dr Demasi have been substantiated by a number of trials, including the one mentioned above, and it’s now time that the medical profession re-evaluated the excessive prescription of these medications. 

For many years, I have only prescribed statins to people who have existing cardiovascular disease such as prior heart attack, stent or coronary bypass surgery, or if they have a significant load of atherosclerosis, as seen by a coronary calcium score or on carotid ultrasound.

It is time that the conservative elements of medicine admit they were wrong and only prescribe statin drugs for people with appropriate indications. The first line of the Hippocratic Oath states, “First, do no harm.”

The excessive prescription of statins is certainly an extremely good example of where the medical profession can cause more harm than good.

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Doctors warned about using the word pain

Thursday, June 01, 2017

By Ross Walker

The latest piece of nonsense from the namby-pamby, politically correct, left-wing nut jobs is the suggestion that medical professionals should no longer use the word pain! Also, just as bad are those other dreadful terms: sting, hurt, itch and worry.

To quote the doctor who made these suggestions: “The evidence shows that describing things in negative terms increases anxiety and pain and negativity interpretations of perceptions”.

Really? Is the medical profession now left with the word perception to try put a positive spin on the person’s symptoms? Well, I hope I’m allowed to use the word "symptom".

Just imagine the conversation with the patient. ”Yes, Mr Jones, it appears you’re having chest perceptions. Without feeling at all uncomfortable, can you describe, only in glowing, positive terms, those perceptions?”  

When we were children, our parents often quoted that hackneyed aphorism: “sticks and stones may break my bones but words will never hurt me!” Well, it appears that if you believe this wacko from Adelaide (and I’m not criticising Adelaide), words may now hurt you.

Ever since the Tower of Babel, we’ve had this thing called language which is a major form of communication. As is the nature of our imperfect world, sometimes negative things happen. These negative occurrences may be very tragic, but it’s called reality. Symptoms are hardly ever positive.

The 'politically correct' have already tried to neutralise children’s sport by suggesting there should be no winners or losers. Heaven forbid that children learn they can’t always win! Now, they’re trying to make a doctor’s job even harder by trying to suggest we sanitise language by putting useful, common forms of communication which assist greatly in making diagnoses, purely on the off chance that these words may make the patient feel anxious or upset.

I would have thought that having the symptoms in the first place was enough justification for the person being anxious and upset - that’s why they’re seeing the doctor. This is not a battle between a conservative organisation such as the medical profession and certain elements suggesting we think differently about how we practise. This is doctors wanting to maintain their own, established set of norms such as the major tool of taking a careful history of the patient’s symptoms.

Let’s face it, this is a call to common sense. It’s now time that all people talking common sense point out to the vast majority of normal people that we won’t tolerate this type of politically correct nonsense any more.

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Euthanasia and compassionate medicine

Thursday, May 25, 2017

By Ross Walker

Recently it was announced that the New South Wales Parliament would debate the right for an adult over 25 (who is also a resident of New South Wales - clearly to prevent NSW becoming the Euthanasia capital of Australia), to legally end their own life with, of course, with the assistance of a qualified medical practitioner. 

There are strict criteria around this:

(i) The person has been medically assessed independently by their own medical practitioner, and, by a specialist in the terminal illness in question, with the expectation that the person would die from their condition at some stage during the following 12 months.

(ii) The patient must be independently assessed by either a psychologist or psychiatrist.

(iii) The patient retains the right to rescind the request at any time with also a 24-hour cooling off period.

(iv) Close relatives also have the right to appeal the decision in the Supreme Court.

Although I am a great supporter of ending a person’s suffering, personally I would like to see what I call “compassionate medicine” practised on a much wider scale.

I am referring to compassionate medicine as a sensible and compassionate way of allowing a person who fits the above criteria to end their life quickly and without suffering, apart from deciding a due date and time for the demise, which is what happens in the case of euthanasia.

There is a wonderful drug that is legally available through a medical practitioner known as morphine. Morphine, given in progressively increasing doses to a person with a terminal illness, places them in a peaceful oblivion and also works as a respiratory depressant. Often, a secondary infection intervenes, hastening death.

I still think euthanasia should be an option for people who fit the above criteria, for whom compassionate medicine has proven to be ineffective. But, I still believe compassionate medicine is the best initial approach.

But, here is where I am about to become controversial and discuss the “elephant in the room”. Most people, for some strange reason, appear uncomfortable to discuss this aspect of humans in the later stages of their existence. There are many more people languishing in nursing homes, not living, but purely existing and waiting for death. As a doctor, I wholeheartedly believe in prolonging everyone’s life, but not their death.

When a person develops an illness where there is clearly no quality of life, with no real possibility of recovery, in my opinion, they are no longer living but have entered their death phase.

I am referring to people with Alzheimer’s disease where they no longer recognise their loved ones; a stroke where a person is bedbound, or some other defined illness where a person’s quality of life is no longer present. This can be easily recognised by what I crudely refer to as the “bum wiping rule”. If there is no prospect of you being able to wipe your own backside again, what on earth is the medical profession, nurses or the nursing home trying to achieve? Why are we continuing chronic therapy such as blood thinners, cholesterol lowering, or BP treatment? More importantly, why do we administer antibiotics when these people develop the inevitable infection?

In my view, we should stop all chronic treatments, avoid antibiotic use, and only administer pain relief and sedation, allowing the person to pass away quickly without tubes in veins and orifices and urgent trips to the hospital in ambulances.

This is compassionate medicine which stops the needless suffering of very ill people and their relatives watching them waste away over months to (at times) years, not to mention the incredible, senseless waste of money and medical resources on people with no chance of recovery.

At present, with our current approach, all we are doing is prolonging the agony for dying, vulnerable people who deserve to die rapidly and with some dignity.

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