Monthly Archives: April 2014

7 Things You Need To Know About Cancer

Apr 30

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16 April 2014, 8.38am AEST

7 Things You Need To Know About Cancer

In Lima, Peru this week, filming our latest NCDFREE short film on inequalities and progress in cancer care – a collaboration with the UICC (global cancer body) and GlobalRT (a group that aims to increase global access to radiotherapy).

Lima, Peru

A beautiful country and a nation of wonderful, creative and vibrant people – the film aims to highlight some of the successes and challenges of global cancer care in low and middle-income nations, as well as bring attention to the need for further investment in the prevention and treatment of this group of diseases.

The film will be released in the coming months, but in the meantime I wanted to share some key facts and myths around cancer with you. Debunk some pervasive, perennial misunderstandings on cancer globally…

1. Cancer is not a disease of affluence – but wealth can change the type and outcome

When people think of cancer, they usually think of rich people in rich nations. Actually, the reality is that 70% of all cancer cases worldwide occur in low and middle-income nations, posing an enormous public health and economic burden. Now of course, this is also where a majority of the world’s population lives, but the reality is still that millions of cases of cancer occur in healthcare systems least prepared to treat them (and some would argue find them) and in communities and families least able to cope with the health and financial consequences.

A misunderstanding that not only affects local but also global prioritisation and funding for these conditions in development budgets, philanthropic responses, aid and national health expenditures.

Lima, Peru

Whatsmore, as always, it’s not so simple. Because although the rates (age standardised, per 100,000 people) of cancer are still higher in the richest nations, the types of cancer are different and patients usually present later in poorer settings – with more advanced disease. For example worldwide, the leading cause of cancer deaths in women is breast cancer, but in many poorer nations it’s cancer of the cervix.

2. It is not about laziness

A classic myth when it comes to cancer and particularly bowel cancer, is that these are diseases of laziness. Actually, there are a myriad of causes – and many we still don’t know or understand. Things like diet, tobacco and alcohol; infections and chronic inflammation; but also environmental pollutants; and genetics.

3. Cancer is not always ‘non-communicable”

Although I talk a lot about NCDs – or non-communicable diseases – some cancers are actually caused by infections. In fact, about one-fifth of all cancers worldwide are caused this way – including cervical and liver cancers, which are paricularly common in poorer nations.

The good news, though, is that the two viruses that cause these cancers are largely preventable by vaccine – hepatitis B and human pappiloma virus.

4. Tobacco is the single biggest, preventable cause of cancer

Lima, Peru

Plain and simple, tobacco is bad.

Causing 22% of all cancer deaths worldwide, the good fight against tobacco, tobacco advertising and the big corporations that make this carcinogen continues.

5. We can prevent many cancers

Some good news, many cancers can be prevented.

30% of cancers are preventable through not using tobacco, having a healthy diet, being physically active, limiting alcohol use and being vaccinated for the most common cancer-causing infections.

These are largely the focuses of public health policies for cancer for which “prevention is better than cure” will always be a core mantra.

6. Early detection and treatment saves lives

Building on prevention, early detection and early access to treatment is of paramount, complementary importance – with treatments falling into three broad groups: surgery, chemotherapy and radiotherapy… Breast, cervical and colorectal cancers, for example, can often be cured if found and treated in the early stages of disease and are far less costly (in terms of health, economic and social costs) if identified quickly.

These challenges are magnified in a context of weaker health systems and limited funding, but it is important to remember that screening and early detection save money and lives – a driving argument for the continued work on ensuring universal prevention and care coverage.

7. Palliative care and pain relief must become universal

Although a large number of cancers are preventable or curable through appropriate policies, lifestyles, screening and treatments – many are not. For this reason, it is also crucial that every person has access to pain relief and palliative care when dying of cancer.

But in reality, many don’t.

This is one area where science has the answers – and it’s not about a lack of technology or understanding, just a lack of funding and global political will. This is a gap that must be closed.

From Lima

Lima, Peru

Signing off from Lima, I give you just a taste of the themes, challenges and ideas we will explore in the coming NCDFREE shortfilm. But for now, take a moment to reflect on the myths – and realities – of cancer globally. After all, it is only through knowledge that we will inspire collective action on cancer, a pressing global health challenge.

–

This article is based on the World Health Organization’s cancer fact sheet.

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Hot flushes, hormone therapy and alternative treatments – 30 years of experience from Sweden.

Apr 28

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Unfortunately, many women have suffered hot flushes unnecessarily, because of fear over the risks of HRT, especially breast cancer. The information has not got out to women that HRT is much safer if used properly, using more natural hormones, individually dosed and through the skin.
Climacteric. 2014 Apr 18. [Epub ahead of print]

Hot flushes, hormone therapy and alternative treatments – 30 years of experience from Sweden.

Lindh-Åstrand L, Hoffmann M, Hammar M, Spetz Holm AC.

Abstract

ABSTRACT Objectives The use of hormone therapy (HT) for hot flushes has changed dramatically over the past five decades. In this cross-sectional questionnaire study, the aim was to describe the use of HT and alternative treatments and to study the frequency of hot flushes. A further aim was to compare data from the present questionnaire with data from previous studies made in the same geographic area.

Method A questionnaire was sent to a random sample of 2,000 women aged 47-56 years living in Östergötland County, Sweden. The results were compared with findings from previous studies regarding use of HT, alternative treatment and hot flushes, and the number of HT prescriptions dispensed during the corresponding time using data derived from the Swedish Prescribed Drug Registry.

Results The response rate was 66%. Six percent used HT, in line with prevalence data from the Swedish Prescribed Drug Registry. Alternative treatments were used by 10%. About 70% of postmenopausal women reported flushes and almost one third of those with flushes stated that they would be positive to HT if therapy could be shown to be harmless, a view more often stated by women with severe complaints of hot flushes (67%).

Conclusion The use of HT and alternative treatments is low and many women suffer from flushes that could be treated. Women considered their knowledge of the climacteric period and treatment options as insufficient. Individualized information should be given and women with significant climacteric complaints, without contraindications, should be given the opportunity to try HT.

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Kinesiology- What is it?

Apr 27

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19 December 2012, 2.33pm AEST

Muscle testing (kinesiology): panacea or placebo?

Muscle testing, or kinesiology, has grown in popularity over the last 30 years. It’s a simple, non-invasive assessment tool used by many different kinds of health practitioners during examination or evaluation. It’s used to assess many different things – as broad as general health status and as refined…

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Muscle testing is used to gauge everything from general health status and specific supplement dosage. University of the Fraser Valley

Muscle testing, or kinesiology, has grown in popularity over the last 30 years. It’s a simple, non-invasive assessment tool used by many different kinds of health practitioners during examination or evaluation. It’s used to assess many different things – as broad as general health status and as refined as specific supplement dosage, and almost everything in between.

Different professionals use muscle testing in different ways, so there’s some confusion about the term itself, how the test is used and what the results mean. Because of this confusion, research evaluating the usefulness of muscle testing has been difficult to design and interpret.

A brief history

Muscle testing was first used in the early 20th century to measure muscle weakness in polio victims. Then, in 1949, Kendall and Kendall, two physiotherapists, described specific ways to test individual muscles for other neuromusculoskeletal conditions.

About 15 years later, a different use for muscle testing was developed by chiropractor George Goodheart. Goodheart’s technique is called applied kinesiology and it’s used by approximately 40% of American chiropractors.

It’s similar to the practice developed by Kendall and Kendall because specific muscles are tested. But Goodheart didn’t use muscle testing to evaluate muscular power alone, he was more interested in how well the nervous system controlled muscle function. So, while the different types of muscle tests looked very similar, the reason the tests were performed and the meaning of the results started to differ significantly.

A third form of muscle testing emerged following on from Goodheart’s work. I call this kinesiology-style muscle testing. This kind of muscle testing is estimated to be used in over 70 different techniques, and by over one million practitioners worldwide.

In kinesiology-style muscle testing, muscles are still tested but not as specifically as Kendall and Kendall did or as it’s done in applied kinesiology. Examples of techniques that use kMMT include, but are not limited to, PSYCH-K, total body modification (TBM), BodyTalk, neuro emotional technique (NET), and emotional release technique.

What does it mean?

The basic principle of kinesiology-style muscle testing is that when there’s some stress or abnormal nervous system input to a muscle, it “weakens”. During a muscle test, a practitioner applies a force to one muscle or group of muscles, with a particular intent in mind. The muscle is then labelled “weak” or “strong” based on its ability to resist this force.

What a “strong” test means compared to a “weak” test varies between techniques and applications. For example, kinesiology-style muscle testing is used to determine the state of organs and organ systems, to evaluate nutritional status and the need for supplementation, to detect imbalances in the meridians and chakras, to discover the presence of mental or emotional stress, and to identify chemical sensitivities and “allergies”.

Muscle testing and research

There are many different uses for kinesiology-style muscle testing in clinical practice, and many different ways that it could be studied, so it’s impossible to list them all here. And unfortunately, the amount of sound research on it is limited.

One study of kinesiology-style muscle testing found that a muscle stayed “strong” after a patient spoke true statements, and went “weak” after a patient spoke false statements. But it’s unclear from the study what biases may have been present to influence the outcome. While it’s generally accepted that all forms of muscle testing have some bias, little is known about how much actually exists.

Using applied kinesiology, another study found that experienced practitioners (five or more years’ experience) more accurately predicted muscle strength compared to inexperienced practitioners (less than five years’ experience), with accuracies of 98% and 64% respectively.

Other studies of kinesiology-style muscle testing, have found that practitioners were able to determine if a spoken statement was true significantly more accurately than guessing whether it was true (69% correct for muscle testing, 49% correct for guessing, p of less than 0.0001). These studies found accuracy had no connection with practitioner experience.

In still other studies, kinesiology-style muscle testing was found to accurately predict low back pain and simple phobias, and applied kinesiology was found to accurately predict food allergies.

But further studies found that applied kinesiology was not able to predict nutritional needs, nutritional intolerance, thyroid dysfunction, exposure to practitioner-defined noxious stimulus, and chiropractic subluxation detection and correction.

How safe is muscle testing?

There has been no muscle testing-caused harm reported in the literature to date, but no formal investigation of the risks of muscle testing has been published either. If harm were to be linked to muscle testing, it’s likely that it would be indirect. A serious medical condition might go undiagnosed or untreated while someone opts to see a muscle testing practitioner. This delay might put an ill person at undue risk.

It’s generally accepted that most practitioner-applied assessment tools are rarely 100% accurate or entirely bias-free. But given the simplicity of muscle testing and its good safety record, together with its reasonable accuracy rate, muscle testing may be a reasonable addition to medical evaluation.

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Life on Us: a close-up look at the bugs that call us home

Apr 24

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This appears to be a must watch for those of us interested in our bodies and our health. SBS on Sunday. Also available online after SUNDAY.
25 April 2014, 7.07am AEST

Life on Us: a close-up look at the bugs that call us home

Many microscopic bugs and bacteria live on our skin and within our various nooks and crannies. Almost anywhere on (or even within) the human body can be home to these enterprising bugs. Bugs affect us…

Parasites can infest any part of the body that has an opening to the outside world. SBS

Many microscopic bugs and bacteria live on our skin and within our various nooks and crannies. Almost anywhere on (or even within) the human body can be home to these enterprising bugs.

Bugs affect us in a variety of ways: some bad, such as infections, but many good. From the passing of helpful bacteria from mother to baby, to the defence of our skin and intestine from disease-causing bacteria, our resident bugs are with us throughout the course of our lives.

A new two-part SBS documentary Life on Us looks at the bugs that make our body their home, using new tools to visualise these microscopic creatures. The first one-hour episode airs on SBS One at 8:30pm on Sunday, April 27.

Belly button bugs

Two of the main stories in the first episode focus on belly button bacteria and on the many varieties of lice.

A person’s belly button contains hundreds of bacterial species. The belly button is rarely well-washed and is a cosy place for these bacteria to settle. The bacteria here are probably not critical to our existence, but their presence does provide a quick and easy way to sample the great variety of bacteria living on the rest of human body.

Scientists can take a simple swab and quickly build up a profile for the sort of bacteria to which you’ve been exposed. As they build up profiles from many people, it becomes possible to tell the difference between good and bad bacteria. Your belly button bacteria can then help predict which diseases you might get and, if you do get one, how easily you may fight it off.

The story of the human louse and its various specialities is also a good one – and is examined with stunning new electron microscopy videos. It is an evolutionary tale that explores how lice migrated across the body during our hairier past. It explains how they had to specialise to live in different environments as we became less hairy, as head lice can’t survive on any other part of the body.

Microscopic scabies mites live on the skin. SBS

The documentary links our loss of hair (to get rid of these parasites) with the lighter coloured skin of cooler climate people. It even looks at why we have some lice that came from our nearest simian neighbours – in this case, there must have been some close physical contact. Despite some aspersions cast on our early ancestors, this makes for a complex and interesting tale.

Unlikely roles

Many of the protective species of bacteria on the human body do their job by competing for living space with invading bacteria. Since the good bacteria were here first, they have an advantage and they are able to push the invading bacteria out.

These invaders might be bad bacteria like those responsible for food poisoning. Or it may be good bacteria such as those found in yogurt. In either case, the invaders are at a distinct disadvantage.

In the case of skin, those bacteria on the surface jealously guard their home and invading bacteria find it difficult to find nutrients and space to grow. Invading bacteria can also be attacked by existing bacteria using chemical warfare.

Unfortunately, as the documentary points out, once your skin is broken these invaders can get inside easily. Often this causes a local infection, but sometimes it causes problems throughout your body.

Bugs can also affect how we think. Among the fascinating tit-bits is the story of toxoplasmosis and risk-taking behaviour. Toxoplasmosis is an infection commonly picked up from cat poo that can cause serious harm to pregnant woman or other people with a weakened immune system.

In rats or mice, this infection is associated with behaviour that makes it more likely that they’ll be caught by a cat. In humans, it was associated with an increased likelihood of putting themselves in a risky situation.

Scientific rigour

The two-part series is a co-production between Australia and France, with the Aussie trailer heavy on monsters and dramatic music and the French version heavy on lingering shots of human bodies.

For the most part, this documentary delivers what is promised. It has beautiful (and sometimes gruesome) graphics showing what our bugs are up to. And there is a wide-range of interesting findings – some of which are sure to surprise even experts.

A hookworm makes its home in your gut. SBS

Where the first part of the series lets us down is its failure to deliver Australian science. Most of the science highlighted is being done overseas, while the commentary and human interest stories are of Australian origin. Fortunately, a sneak peek at the second part of the series promises a much stronger showing for Australian science.

Another shortcoming of this documentary is in the lack of depth and scientific rigour to which some of the facts are subjected. This can be forgiven in a documentary targeted at the general public. Nonetheless, it would have been nice to go into more detail and to give the pubic a sense of how well established some of the facts are.

I personally was interested in how gut bacteria colonise the vagina prior to birth. These bacteria form the basis for the infant’s own gut flora. However, this event was taken care of with a ten-second animation showing descending sparkles in the area of interest. When I looked further into the topic, it seemed clear that in some cases these colonising bacteria are not helpful – a point missed by the documentary.

I was also interested in the role of toxoplasmosis in human behaviour. However, the story of its tentative links with psychiatric disease was not discussed. The controversy and complexity around this topic could have provided more insight into the scientific method.

It’s important to appreciate that the scientific method produces advances that are not always grand leaps forward. Advances can come in fits and starts, with sometimes fierce debate in-between. The documentary is a good one, but as is often the case, there is more focus on the grand leaps, and less on the nitty-gritty of science.

Life on Us airs on SBS One at 8:30pm on Sunday, April 27.

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Bedtime aspirin may reduce risk of morning heart attack

Apr 23

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Bedtime aspirin may reduce risk of morning heart attack

Taking aspirin at bedtime instead of in the morning might reduce acute heart events, according a new study presented at the American Heart Association’s Scientific Sessions 2013.

Low-dose daily aspirin is recommended for people at high risk of heart disease and for reducing the risk of recurrent heart events. Aspirin thins the blood and makes it less likely to clot. The tendency for platelet activity to be higher peaks in the morning.

The Aspirin in Reduction of Tension II trial is the first study to explore the timing of aspirin intake among cardiovascular disease patients. In the randomized, open-label study, 290 patients took either 100 mg of aspirin upon waking or at bedtime during two 3-month periods. At the end of each period, blood pressure and platelet activity was measured.

Blood pressure was not reduced; however, bedtime aspirin platelet activity was reduced by 22 units (aspirin reaction units).

“Because higher platelet activity contributes to a higher risk of acute heart events , this simple intervention – switching aspirin intake from morning to bedtime – could be beneficial for the millions of patients with heart disease who take aspirin on a daily basis,” said Tobias Bonten, M.D., Ph.D student at the Leiden University Medical Center in the Netherlands.

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Creativity makes us happy

Apr 23

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How Creativity Can Make Us Happier

by Shana Lebowitz · about a month ago · Happiness
As a kid, whenever I’d hastily compose a picture of a cycloptic blob or attack an unoffending piece of paper with angry orange scrawl, I’d proudly shove the picture in my mother’s face, already knowing what she’d say.

“Ooh!” she’d gasp. “How… creative!”

There’s no concrete definition of creativity, but most experts agree it’s got something to do with the ability to come up with new ideas, new links between ideas, and novel solutions to problems (with or without destroying a pack of Crayolas). But here’s the kicker: Forget the image of the brooding artist alone in a basement studio. Research suggests creative people are actually happier than everyone else.

Creating Smiles — Why It Matters

Get CreativeNot a singer, writer, or dancer? No problem. Experts say absolutely anyone can be creative, though different people may have different talents. “It really has to do with open-mindedness,” says Dr. Carrie Barron, co-author of “The Creativity Cure,” who says creativity applies to everything from making a meal to generating a business plan.

But whether creativity means whipping up a spinach soufflé or tap-dancing for a Broadway audience, experts say there’s a strong connection between creative expression and overall wellbeing. Key components of the creative personality, like novelty-seeking and perseverance, are also good predictors of life satisfaction.And it works both ways: People also tend to be most creative when they’re in a good mood, possibly because they don’t fixate on individual pieces of information and are able to think more broadly[1]. And according to creativity researcher Dr. Shelley Carson, “Increases in positive mood broaden attention and allow us to see more possible solutions to creative problems.”

Some psychologists talk about “flow,” or getting so immersed in creative work that we don’t pay attention to anything else, like what time it is or how our body feels. These experts argue that getting into a state of flow can produce substantial happiness, the kind that lasts longer than the pleasure we get from eating a good cookie. But don’t expect picking up a paintbrush to instantly solve life’s problems.

Creation Nation? — The Answer/Debate

Because people in a flow state are so immersed in their work, they might not necessarily feel happy while they’re being creative. It’s only afterward, when looking back on the creative process, that they get that warm, fuzzy feeling.

There’s also a substantial amount of research on the link between creativity and mental health issues such as depression. Studies suggest creative people tend to be more vulnerable to psychiatric issues, particularly bipolar disorder[2][3]. Yet many psychologists say depression has nothing to do with the ability to be creative. Instead, creativity is associated with self-reflection, and that tendency to ruminate may be what’s causing the feelings of depression.

In fact, far from promoting creativity, depression may actually make it harder for people to be creative, and they may only start to be creative again once their mood improves. But creativity might be a remedy for the blues: Barron suggests doing something creative (like writing about a bad experience) can help people get over feelings of depression.

As always, if depression is a serious issue, consider seeing a therapist. But when life has just got us in a funk, it looks like staying holed up in the bedroom blasting Alanis Morissette won’t lead to any creative revelations. Instead, consider singing a new song, penning a poem, or trying to solve that damn Rubiks cube. Who knows what you might discover?

Special thanks to Dr. Carrie Barron, Dr. Shelley Carson, and Greatist Expert Dr. Paul J. Zak for their help with this article.

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Is Coconut Oil Healthy?

Apr 21

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Is Coconut Oil Healthy?

Published: 7/11/2013 By Dr Weil.

I am increasingly persuaded that consuming modest amounts of natural saturated fats such as virgin coconut oil is not hazardous, although some controversy still persists. However, using cosmetic products containing coconut oil is another story – there is widespread agreement that such products are safe and effective.

Although I prefer skin care products with natural anti-inflammatory activity, some components of coconut oil have been studied for their benefits to both skin and hair. The lauric acid found in coconut oil is available in a wide variety of skin and hair care products, including body and facial cleansers, soap and sunscreens. Clinical research supports the safety of these products in general, and the utility of coconut oil to help moisturize skin in particular. Try them!

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Poo Transplants

Apr 21

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6 December 2012, 6.39am AEST

Trading chemistry for ecology with poo transplants

Antibiotics joined our growing arsenal of weapons in the fight against disease over seventy years ago. Their target – the bacterial infections that putrefied our wounds, filled our lungs with pneumonia, and made our genitals less than appealing to our lovers. Bacteria were worthy opponents, and with…

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As simple as the procedure sounds, we don’t yet fully understand how faecal transplants work. Image from shutterstock.com

Antibiotics joined our growing arsenal of weapons in the fight against disease over seventy years ago. Their target – the bacterial infections that putrefied our wounds, filled our lungs with pneumonia, and made our genitals less than appealing to our lovers. Bacteria were worthy opponents, and with antibiotics, the war against infection seemed ours to win.

But gradually, two facts have become abundantly evident. The first is that not all bacteria are foe. There are billions of bacteria – many of them essential to our health – that call us home. We’re each colonised by trillions of microbes forming communities that occupy every imaginable niche in our body.

These microbial commensals – known collectively as our microbiome – have evolved with us over millennia, and a co-dependent relationship has resulted.

While we provide a cosy niche and abundant supply of food to the microbes living in our intestine or on our skin, they in turn help to release nutrients from otherwise indigestible dietary fibre, synthesise essential vitamins, or produce a moisturising film to keep our skin soft and supple.

The second fact is that antibiotics may be thwarting our best efforts to stave off infection by messing with the delicate ecosystems that our microbial companions form. By indiscriminately annihilating microbes with antibiotics, we are taking a carpet-bombing approach where an assassination is more what we’re after. Innocent bystanders, as well as some of our closest allies, inevitably end up as casualties.

Unsurprisingly, some wily species of bacteria have evolved to take advantage of an ecosystem that has been thrown out of balance. The diarrhoea-causing bacterium, Clostridium difficile, is one such organism that flourishes in the power vacuum that results after antibiotic treatment.

Clostridium difficile. AJC1

A small number of people naturally harbour C. difficile in their large intestine, but most become infected in hospitals or nursing homes, the typical breeding grounds for superbugs.

In recent years, a highly toxic strain of C. difficile has emerged in hospitals in North America. In 2010, it was estimated that half a million people in the US were infected with C. difficile, and up to 20,000 of those died from the infection. The C. difficile superbug is also on the move, with cases in Europe and Australia rising.

For an increasing number of people, even the strongest antibiotics are powerless against C. difficile. In these cases, exasperation has turned to ingenuity, with an increasing number of doctors abandoning chemical warfare in favour of an ecological approach to fighting C. difficile infection.

Introducing the poo transplant

The unsavoury, yet highly effective treatment that has been adopted as an alternative to antibiotics is the faecal microbiota transplant, aka the poo transplant. A poo transplant is exactly as it sounds – taking faeces from a healthy donor, and transferring it, usually via enema, to a willing recipient.

It’s a simple idea, really. By replacing a depleted, out-of-balance gut ecosystem with a robust and healthy one, balance is restored. C. difficile becomes out-competed by friendly bacteria and the diarrhoea ceases. Unlike blood infusions and tissue transplants, faecal transplants require no immunological typing (tests to determine donor-recipient compatibility) to prevent rejection.

Poo transplants are the ultimate in probiotics. Although consuming a tub of lactobacillus-laden yoghurt is easier to swallow than the idea of a faecal enema, the principals are essentially the same.

There has been a resurgence of the technique, faecal transplants are not new. A Denver surgeon, Dr Ben Eiseman, and his colleagues published the first report of the procedure in 1958. And once again, doctors are discovering what Eiseman did 50 years ago – that poo transplants work.

A recent review of all reported studies of faecal transplants to treat C. difficile infection found poo transplants to be effective in over 90% of cases. Recurrence of infection is rare and there has not been a single report of adverse side effects.

Antibiotics may be thwarting our best efforts to stave off infection by messing with the delicate ecosystem of the gut. sparktography

As simple as the procedure sounds, we don’t yet fully understand how faecal transplants work. This may be set to change, however, as global efforts to make sense of the staggering complexity of our microbiome ramp up. The Human Microbiome Project funded by the National Institutes of Health in the United States, and the European Commission-funded Metagenomics of the Human Intestinal Tract project, are beginning to define our most intimate microbial co-habitants.

As we grapple with the complexity of our microbial ecology, perhaps we will discover which specific microbes are responsible for reigning in C. difficile during a faecal transplant. It might be a single species, or perhaps it’s a combination of several.

By identifying the microbes responsible, the poo transplant could eventually be replaced with a probiotic pill containing only the necessary species required to right the system. The “yuck” factor would be removed.

Or perhaps there are particular foods and supplements that we could consume as prebiotics to favour the growth of healthy bacteria when superbugs take hold.

In the meantime, the simplest, and perhaps most obvious way of modifying our gut ecology when superbugs take hold may well be to transfer an ecosystem en masse, through the under-appreciated technique of the poo transplant.

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What is deep vein thrombosis?

Apr 15

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7 January 2013, 6.23am AEST
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Venous thromboembolism is the fifth leading cause of death in Australia. Image from shutterstock.com

Living in Australia, we’re used to flying long distances. So you’ve probably wondered about the risk of developing a deep vein thrombosis. Perhaps you’ve even considered buying some pressure stockings for that next long-haul flight?

So, what is deep vein thrombosis? And what does the evidence say about reducing our risk of developing it?

Deep vein thrombosis is the formation of a blood clot (called a thrombus) in the deep veins of the leg. The clot can be either located in the lower leg or in the thigh, or both. Rarely, a blood clot develops in other veins such as in the arm.

Eventually, the thrombus is in danger of dislocating from the vessels in the leg and going straight into the lung circulation (pulmonary embolism), thus blocking the blood supply of the lung and leading to shortness of breath.

Venous thromboembolism (VTE) – the term which encompasses both deep vein thrombosis and pulmonary embolism – affects around 52 in every 100,000 Australians and is the country’s fifth leading cause of death. So early detection and treatment is vital.

On the other end of the spectrum, blood clots can also form in the more superficial veins of the leg, just under the skin. This is called thrombophlebitis and is a much less serious condition.

Who is at risk?

There are three principal mechanisms that increase the likeliness of developing deep vein thrombosis:

  1. Reduced flow of blood (from being immobilised due to illness, leg injury, or long sitting during long-haul flights),
  2. Increased tendency of blood clotting (due to hereditary diseases such as Factor V Leiden disease)
  3. Injury of blood vessels (from accidents or surgery).

The risk of developing a deep vein thrombosis is increased in patients who have previously had deep vein thrombosis or a pulmonary embolism, and in those with a family history of blood clots.

Other risk factors include cancer (or cancer treatment), taking contraceptive pills containing oestrogen, hormone-replacement therapy, pregnancy and conditions that cause blood clotting, such as thrombophilia.

As some of these risk factors are modifiable, there is a chance to reduce your risk by losing excess weight, quitting smoking (as smoking affects blood clotting and circulation), and using contraception methods other than oestrogen-containing pills.

On long-haul flights, car rides or bus trips, exercise your lower calf muscles. Whenever possible, get up and walk around, or raise and lower the heels while keeping the toes on the floor while sitting.

Get up and walk around as much as possible on long-haul flights. Image from shutterstock.com

Symptoms

The first signs of deep vein thrombosis are swelling of the entire leg or, more often, one side of the calf. Sometimes there is a localised painful tenderness and reddening.

In case of the life-threatening complication of lung embolism, the symptoms are sudden shortness of breath with rapid pulse (heart rate), sweating and coughing up blood. If you have any of these symptoms, see your health practitioner immediately.

After a series of questions about the onset and characteristics of your symptoms and a thorough physical examination, further testing will confirm the diagnosis. The best way to diagnose a suspected deep vein thrombosis is an ultrasound examination of the leg. In case of a suspected pulmonary embolism, other special imaging diagnostics (computer tomography or scintigraphy) need to be applied.

Treatment options

The aims of the treatment are to stop the blood clot from getting bigger, from breaking loose – and drifting into the lung leading to pulmonary embolism – and to reduce the chances of deep vein thrombosis happening again.

Deep vein thrombosis is treated with blood thinners (anticoagulants), usually for a period of three to six months. These are mostly administered as injections in the first days, followed by tablets.

Compression stockings of the lower leg prevent the blood from pooling and subsequent clotting. The stockings should be worn for at least one year and after that, whenever immobilised, such as on long-haul flights.

The stockings also prevent one common complication that frequently occurs after deep vein thrombosis: post-thrombotic syndrome, which arises from the damage of the veins caused by the blood clot. The syndrome comprises swelling of the affected leg, pain and skin discolouration.

So, should you have an injection or wear compression stockings when you fly?

Long-haul flights (for more than four hours) increase the risk for developing deep vein thrombosis, like every other condition where your movement is restricted. Although few studies have been performed to address this question, the increase in risk seems small.

It’s important to assess the thrombosis risk on an individual basis. People at the highest risk of travel-related thrombosis who travel more than three hours should wear compression stockings. The stockings need to be individually adjusted to ensure they don’t restrict the blood flow and thereby cause, rather than prevent, thrombosis.

There’s no need to wear compression stockings unless you’re at an increased risk of deep vein thrombosis. Image from shutterstock.com

In general, a prophylactic injection of heparin is not recommended and wearing compression stockings on each flight has not been proven to be beneficial. This advice is, of course, different for people, who have had a previous venous thromboembolism or who have more than one risk factor for developing blood clots.

In any case, it’s important you try to reduce the modifiable risk factors for deep vein thrombosis, particularly when travelling long distances.

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Questions difficult to answer

Apr 15

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An interesting post from Professor Obermair.

Questions difficult to answer

Posted by on 7 April 2014 | 0 Comments

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In my gynaecological surgical practice, patients are encouraged to ask questions. I really enjoy working with well-informed patients. From our patient satisfaction surveys it appears that well-informed patients are happier and give us better marks.

Some questions patients tend to ask me are easy to answer: What exactly is it that you will remove? What are the risks of a surgical procedure? How many of these operations have you done in the last 12 months?

Some other questions are also commonly asked but are more difficult to answer. I hear from my colleagues that they seem to struggle most with exactly these same questions in their practice.

The most likely reason I struggle with some answers is because as a doctor and researcher I try to answer them scientifically correct. Unfortunately, sometimes there is no “correct” or exact answer.

I see patients with gynaecological malignancies but also with benign tumours, such as fibroids, ovarian cysts or endometriomas. The most common question I receive from affected patients is:

How did this growth develop and how long has it been there?

The truth is that no one knows: Take for example the Human Papilloma Virus (HPV), widely accepted to be a necessary but not sufficient cause of cervical cancer. While HPV is extremely common in sexually active women and men, most people who are infected by HPV can easily deal with the virus and clear it, but others cannot.  True, there are co-factors that increase the risk of developing a HPV-associated  tumour, such as smoking. However, a large number of women who I see and treat for abnormal PAP smears, cervical or vulval cancers do not smoke and also do not have any other obvious immunosuppressive risk factor, and we do not as yet know exactly why their body could not clear the virus.

Obesity is another complex example. With rising obesity rates, the incidence of endometrial cancer increases. In Australia, we have one of the highest rates of endometrial cancer worldwide. I attended a conference in the US last week that suggested bariatric surgery (surgery to decrease the size of the stomach) reduces the risk of endometrial cancer. It sounds logical, given that obesity is a risk factor for tumour development and bariatric surgery reverses reduces obesity. However, it is still unclear how exactly obesity of linked to endometrial cancer. Is it the hormones or is it inflammation? Once we know we will be able to better advise women on how to prevent getting endometrial cancer. Already now, many  obese women never develop endometrial cancer, and we need to learn from these women the secrets of staying healthy.

Sometimes patients endeavour to track the onset of a cancer back to a significant circumstance in life. The death of a loved one, personal stress, or grief. Good research suggests that life events are unlikely to bring on cancer. Lifestyle factors (what we eat and drinking, whether we smoke or not, and whether we take enough time to exercise and move our body) or genetic factors (BRCA, Lynch) are far more likely to cause cancer.

How long has the tumour been there and how fast does it grow?

This question is impossible to answer exactly, because as each tumour is unique in the exact cellular changes it has experienced. We can watch tumours grow in mice but those data are not applicable to humans. All we can say is that it is likely that it takes many years for a tumour to grow into a tiny detectable mass of a couple of millimetre cubic. Then, it may take another number of years for the tumour to grow to a size where we can actually diagnose it. Most tumours less than a centimetre in diameter escape any investigations. Until a malignant tumour is 5 or 10 centimetres in diameter, it probably has been developing for many years, which make it difficult and impossible to track it back to an isolated life event that could have brought it on.

Cancers develop as a result of a step-by-step, over considerable time, with many changes in the cells on a molecular level contributing. As for the exact time, this would differ depending on exactly what molecular changes the particular cells acquire, but usually cancers only become diagnosed when they have 10 billion to 100 billion cells, which would take years in time.

How long will my recovery from surgery take?

I find that the majority of patients who have laparoscopic surgery recover faster than patients who require a laparotomy. While the vast majority of patients bounce back very quickly, sometimes and for reasons that I am unable to explain, some patients recover very slowly. However, again it’s hard to predict recovery exactly. I also know patients who have a laparotomy for rather advanced surgery and are well enough to go home after only three days. Recovery is a steady process that goes fast for many women and slower for others. I find that women, who had surgery previously and recovered quickly, will again have a quick recovery. Women, who had made the experience that it takes them a while to  recover, will likely also need more time for full recovery at the next surgery and should give themselves that time.

Some patients have physically demanding work and for those patients I usually recommend a longer time off work. Generally, my impression is if women are under pressure either by themselves or work or family commitments to recover quickly, that can be a good thing if it causes positive stimulus. Sometimes however, too much pressure distresses patients and hinders them to get well. One of the presentations at last week’s international conference suggested that women who already have with low quality of life prior to surgery may have a longer recovery, indicating that these women may have exhausted their inner resources and need to recharge.

I find it impossible to predict a patient’s recovery. The old story of a 6-weeks recovery after hysterectomy is definitely out-dated and applies to hysterectomy trough an abdominal incision. Good evidence suggests that recovery from laparoscopic hysterectomy is much faster with a lower risk of complications. Laparotomy for hysterectomy should not be practiced any longer except in a few cases where there are contraindications. It exposes patients to unnecessary complications, pain and prolonged recovery.

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