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Ross Walker
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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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Are hospitals always the safest place to be?

Thursday, May 18, 2017

By Ross Walker

Recently, Professor Sir Liam Donaldson, an international patient safety expert, has suggested that medical errors account for 1 in 10 hospital admissions. A 2016 study published in the British Medical Journal also suggested that 250,000 deaths per year in the United States were related to medical error, making it the third leading cause of death, not to mention disability, after cardiovascular disease and cancer.

This was recently reported in an article in the Sydney Morning Herald, which also quoted Professor Jeffrey Braithwaite from Macquarie University’s Australian Institute of Health Innovation, who had an interesting spin on the data when he suggested, “it was astonishing that 90% of people receive good care, given the complexities of the health system”.

The article quoted Professor Sir Liam Donaldson, who defined medical errors as avoidable infections, errors involving prescribed medicine such as wrong dosing, not using the treatment for the suggested indications, giving the wrong medicine to the wrong patient, accidents in hospitals (such as elderly people falling over, patients falling out of bed, etc.), and even the much quoted  —  performing the wrong operation on the wrong patient  — which is  often the origin of the good news/bad news jokes, which would be funny if it wasn’t so serious.

Medical therapy causing harm (whether it be medical or surgical therapy) even has a medical term - Iatrogenesis. This is defined as “inadvertent and preventable induction of disease or complications by the medical treatment or procedures of a physician or surgeon."

Despite the enormous cost of health care, in many instances, there does not appear to be a profound benefit. The United States, which is renowned as the most expensive medical system in the world, has life expectancy amongst the lowest in developed countries, poor infant mortality rates, and expensive and unrestrained technology.

Across the developed world, we’re now seeing a major move towards ''super specialisation'', where the patient as a whole person is not considered, with spiralling costs for new drugs that often have not shown any clinical benefit over existing and proven treatments. A good case in point here is the very expensive PCSK9 inhibitors which pulverise LDL cholesterol to extremely low levels. Recent three-year data has shown a reasonable reduction in cardiovascular mortality and mortality but not particularly profound when compared with current proven therapy with much more long-term data. The PCSK9 inhibitors cost around $10,000 per year and require either a fortnightly or monthly injection and have only been trialled in very high risk patients.

Modern medicine is now very big business. It is making doctors, pharmaceutical companies, device companies and healthcare providers billions of dollars. But are we really benefiting the consumer?

While we continue the “ambulance at the bottom of the cliff” approach to health care, and continue to only give lip service to “fixing the fence at the top of the cliff”, nothing is going to change. There is no incentive for doctors to practice preventative, holistic care to the whole patient and thus prevent this enormous carnage from Western healthcare.

The longest living people on our planet live in communities typically isolated from the modern world, with very common similar life habits. They eat a significant amount of fruit and vegetables, they don’t smoke, have a strong sense of family and community, exercise regularly and have a life purpose. Their longevity has nothing to do with Western Healthcare.

But, don’t blame it all on doctors and the associated people working in the medical industry. Modern lifestyles have seen rampaging “Diabesity”, cardiovascular disease and cancer. Most people are stressed out of their brains, often depressed, anxious and sleep poorly. The medical industry is purely trying to combat these problems with the only tools they have been trained to use  —  the prescription pad and the scalpel. With the evidence I have presented, I certainly believe we need a total re-think about the services provided, possibly starting with the old Chinese approach of only paying doctors if their patients are healthy. Wouldn’t that be a strange thing to do!

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The death of general practice

Thursday, May 11, 2017

By Ross Walker

An article in the Sydney Morning Herald on 1 May 2017 has raised significant concerns around the fate of general practice in Australia.

A new report from the University of Melbourne has seen a reduction in job satisfaction, problems with work/life balance and an increase in corporate ownership of medical practices.

These factors, combined with a significant reduction in income because of bulk billing, the number of people in Australia on some form of welfare, very long hours worked, the pressure to push patients through quickly, and not to mention the constant threat of litigation, has seen doctors leaving general practice in droves and many younger doctors opting for speciality training, where the rewards are greater and the work is often more interesting.

It is a bizarre notion in our society where the public will pay tradesmen a significant fee (and I’m not saying tradesmen aren’t skilled and do not do a good job), which is typically much more than a general practitioner receives who has had years of training with ongoing demands for continuing medical education and I would suggest, a much more stressful, demanding job.

If the general practitioner dares not to bulk bill and actually charge what I would suggest they are worth or heaven forbid, the Government suggests a seven dollar co-payment, there is this ridiculous outcry from the public and the usual nonsense from the socialist left.

I’m a specialist and I’m not complaining about my lot but I’m defending my pathetically remunerated, very dedicated, hard-working colleagues in general practice.

We have already witnessed over the last few decades the death of the general physician, leaving most patients with multiple, complex medical issues and having at times up to five specialists managing their (so-called) health, but better stated, diseases. But, if we lose high-quality general practitioners because of all of the above issues, I can promise you the health of our nation will drastically suffer.

Until general practitioners are adequately rewarded for providing high-quality care, which includes better pay for longer consultations, more focus on preventative health strategies and more autonomy in the management of their own practice by cutting the ridiculous bureaucratic red tape, we will continue to see the current exodus from what was once (and still is in certain practices) a vital service.

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Non-alcoholic fatty liver disease

Thursday, May 04, 2017

By Ross Walker

Non-alcoholic fatty liver disease is defined as the presence of fat in the liver when no other obvious cause is present, such as alcohol abuse or any other potential liver toxin. With the increasing problems of diabetes and obesity in modern society, the incidence of non-alcoholic fatty liver disease is rising and, without appropriate management, may lead to cirrhosis of the liver.

Non-alcoholic fatty liver disease is divided into early non-alcoholic fatty liver and then the more significant non-alcoholic steatohepatitis. Non-alcoholic fatty liver disease is now the most common liver disorder in Western industrialised countries. There is a strong association with insulin resistance and the subsequent metabolic syndrome, which is the varying combination of tendency to diabetes, hypertension, specific cholesterol abnormalities manifested by high triglyceride and low HDL, and, most importantly, abdominal obesity. Another common association here is that of gout.

A recent disturbing report has suggested that fatty liver occurs in around 15% of children and 40% of people over the age of 60. Although it is much more common in people who are overweight or obese, fatty liver can still occur in people with normal body weight. In most cases, there are no symptoms of fatty liver disease, although with the more significant non-alcoholic steatohepatitis, affected people may experience fatigue, malaise and abdominal pain below the right side of the ribs where the liver is located. Although, occasionally a doctor may be able to feel an enlarged liver, fatty liver is more typically detected on blood tests, otherwise known as liver function tests or on the various scans available, such as ultrasound. If any liver abnormalities are detected, it is important to exclude other conditions such as alcohol abuse, infectious hepatitis, autoimmune disease and less common genetic abnormalities, such as haemochromatosis.

Fatty liver is more severe in older people, those with diabetes, those who are obese, and surprisingly, those who don’t drink coffee. Although fatty liver is not typically a life threatening disease, occasionally people still require liver transplantation because of this condition. Interestingly, the common cause of death in people with fatty liver is cardiovascular disease because the insulin resistant gene and subsequent metabolic syndrome account for now around 70% of atherosclerotic cardiovascular diseases i.e. heart attack, stroke, etc.

Management

Clearly, the best management of fatty liver disease is weight loss. Reducing the waist circumference to below 95cm for a male and 80cm for a female also reduces the amount of fat in the liver. A variety of therapies have been trialled for fatty liver with minimal success for most treatments. There have been some promising data using vitamin E 400 I.U. daily.

A number of diabetic drugs such as metformin and pioglitazone have been trialled with no real benefits, along with some newer diabetic drugs such as liraglutide. Liraglutide did demonstrate a weak benefit. Statin drugs have been trialled for this condition with no real benefits. Omega three fatty acids have also been trialled, with a slight trend towards improvement in liver function.

The most promising results to date have been with bergamot polyphenolic fraction. There have been significant improvements in liver function and reduction in fatty infiltration as seen on ultrasound when people were being treated with BPF 47% polyphenolic fraction. The most recent trial, which was placebo-controlled, involved 188 people with proven fatty liver, and after 16 weeks of therapy, all patients on BPF showed a significant improvement in liver function. The only product on the market that has this concentration of bergamot polyphenolic fraction is BergaMet pro plus. I have been saying for a number of years that all people over the age of 50 should take BergaMet pro plus twice a day purely as prevention against cardiovascular disease, diabetes and obesity, but these most recent studies show yet another benefit from what I believe to be the best natural product on the market. With the recent death of George Michael and his subsequent autopsy study that revealed death from cardiovascular disease and fatty liver, it is now emerging that yet another condition of the modern trends to overeating and under exercising is fatty liver. As the solution is so simple i.e. eating less, eating more naturally, moving more and taking a daily, very beneficial supplement (BergaMet pro plus), you must ask yourself the question, why aren’t more people doing so?

Disclosure: Dr Ross Walker has an association with BergaMet. 

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When pills become part of the long-term problem

Thursday, April 27, 2017

By Ross Walker

There are three main choices in life: protection, life maintenance, or following your urges.

Firstly, and most importantly, is protection. If you are in danger, concerning yourself with good lifestyle principles would do you no good if you don’t take acute steps to extricate yourself from the immediate dilemma.

But most of the time, an immediate threat to our acute survival isn't occurring, so we are left with the last two choices. From moment to moment, we can either follow principles that maintain good health, or follow our urges. 

The five keys to ultimate health are:

  1. Quit all addictions
  2. Cultivate good quality sleep
  3. Eat less and eat more naturally
  4. 3 to 5 hours every week of testing exercise
  5. Cultivate peace, happiness and contentment

Following your urges can be as common and obvious as reaching for that second helping, having that extra unnecessary glass of wine, or even being too lazy or too tired to exercise. But, can I make the important point, that I have never seen a situation where a person benefits from the excessive practice of following their urges.

There are many reasons we all do so, but the reality is that, in the end, following our urges can ultimately lead to bad habits and often addictions. Modern humans have made the quick fix an art form. One of the paradoxes of life is that the quick fix is typically very bad for you in the long run.

Nothing could be closer to the mark than the recent evidence emerging from both Australia and the UK around increasing carnage from prescription painkillers and sedatives. It now appears that in both countries there are more deaths from overdoses (both accidental and intentional) from prescription painkillers and sedatives than from illegal narcotics.

A recent disturbing report from the UK has suggested 1 in 11 people are taking antidepressants, 50% of whom are taking these drugs for more than two years and strangely one third for no good medical reason at all. The report goes on to state that a quarter of a million people are taking sedatives such as Valium for more than six months, when the recommended limit is one month. Taking Valium or related drugs for more than six weeks is associated with a 50% chance of addiction.

With the medicalisation of modern society, there is the strong urge created to reach for a pill to solve a problem. As a doctor, I believe the short-term use of medications when an acute physical or emotional crisis occurs is certainly justifiable, but now it appears we have purely shifted the crisis to a potential serious, and at times lethal, long-term problem.

As a community, we need to explore much better ways to handle these events rather than seeing long-term medications as the central aspect of management. There are no doubt times where people suffer significant, endogenous depression and in certain cases medications are effective. Benzodiazepines, such as Valium, Serepax and Xanax are very effective at relieving acute anxiety but should not be prescribed for the long haul.

There are now emerging very effective non-drug methods for the management of depression, excellent management programs for anxiety (including online approaches), not to mention the highly effective long-term pain management strategies such as Physiokey, Painmaster, the Cefaly device for migraine, transcranial neuro-stimulation, not to mention the entire range of natural therapies.

The urge to swallow a pill for an acute problem may be the right approach in many situations but, in almost all cases, is not the answer for chronic issues. In this case the pill, all too often becomes part of the long-term problem. The healthiest people on the planet are those who spend most of their time in life maintenance, with minimal time devoted to following their urges. The urge to swallow a pill for any minor ailment has now created a major issue for which modern society needs to find better answers.

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Strokecheck: does it cause more harm than good?

Thursday, April 20, 2017

By Ross Walker

Concerns have been raised about a new service known as Strokecheck, which is offered in certain pharmacies in Australia. These pharmacies host general practitioner consultations, where the person is questioned about the risk factors for stroke and if they are significant. A free ultrasound of the carotid arteries is offered. Strokecheck appears to be significantly promoted on social media and has also combined with a gym, a university and a large company to promote the service.

But, this has raised significant concerns within the medical profession. The president of the Australia and New Zealand Society of Vascular Surgeons, Dr Bernard Bourke said, “I am concerned the group is disease-mongering and masquerading as a charity to make money out of Medicare. It’s a rip off”, he said. “They’re putting the fear of God into people”.

Dr Bourke went on to say that “there was absolutely no evidence that people without symptoms of stroke should be getting screened for the stroke risk and having ultrasounds. This decision should be made by consultation with their regular general practitioners”.

Dr Bourke quoted a recent review by the US Preventive Services Task Force, which concluded that general screening in the population using ultrasounds of the carotid arteries for stroke risk caused more harm than good.

So, what is the reality here? Firstly, it is my strong opinion that any ultrasounds should be performed by highly trained technicians and reported by specialists in the area who are reading these all of the time. The results of carotid ultrasounds can often be over-interpreted leading the patients to believe they have more issues than is really the case.

Also, an important point left out of the debate in an article published in the Sydney Morning Herald on March 25 is that carotid atherosclerosis is only one cause of stroke, and a normal carotid scan does not mean you are risk-free. Secondly, many people over the age of 60 will have a degree of carotid atherosclerosis which will never cause any issues.

Let me make the point that the two major risk factors for stroke are hypertension and atrial fibrillation. The presence of significant hypertension - which is typically long-standing, poorly controlled high blood pressure or atrial fibrillation - will immediately alert a doctor that the sufferer has a higher risk for stroke, requiring further investigation and management.

These two major factors aside, there are five categories of stroke that need to be considered as the underlying factors which need investigation and management.

1)  Carotid atherosclerosis - this is a major cause of stroke and the reason the carotid scanning is being offered. In my opinion, however, it is being offered in the wrong setting by the wrong people.

2) Lacunar infarction - this is typically a different type of stroke, with a very dramatic presentation. But, in many cases, there’s a complete recovery, or the person is left with minimal disability. The real cause here is a bout of poorly control blood pressure. The management is, of course, better control of the blood pressure.

3) Cerebral embolism - although there are many causes of cerebral embolism, the major factor is atrial fibrillation. Atrial fibrillation is where the top chambers of the hearts develop a chaotic rhythm, where these chambers quiver without effective contraction. Because there is then sluggish flow within these chambers, small clots can form which may then break away and travel up to the brain - potentially causing a stroke.

4) Paradoxical embolism - the commonest cause of this condition is a Patent Foramen Ovale. In utero, this communication between the right and left atrium in the heart is open because we derive our blood supply and oxygen from the umbilical vessels. When we take our first breath, the pressure on the left side of heart increases, typically closing the flap. But in around 30% of cases, a small communication is left. If a clot forms on the venous side of our circulation (with situations such as prolonged immobilisation), it may break away and travel up towards the lungs. If it is going through the right atrium at the wrong time, and for some reason the pressure increases on the right side of the heart such as is seen with straining, coughing or sneezing, the small clot can be forced across this flap and again can travel up to the brain where it may cause a stroke.

 5) The final relatively common cause of stroke is a disorder of blood clotting. Any condition that makes the blood thicker may precipitate the formation of a clot, and thus, a subsequent stroke, if this occurs in the cerebral circulation. There are eight relatively common genetic causes of excessive blood thickness, the commonest cause being a condition known as Factor Five Leiden. But there are also acquired causes that typically occur as one ages. This is especially so over the age 50, and is commonly associated with medical therapy such as hormone replacement therapy, chronic inflammatory conditions, and even cancer. 

There are a number of other rarer causes of stroke which are outside the scope of this article, but clearly having a screen in a pharmacy is not, by any means, an adequate assessment. And in some cases, it may cause excessive worrying about something that is purely a normal aspect of ageing (such as minor carotid atherosclerosis) and in other cases, may falsely reassure someone that they do not have a risk of stroke and therefore, they may not seek proper medical attention.  

As always, these matters should be managed by a competent physician.

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