Dr
Feelgood Saturday 4th January 2003
DISEASE(s)
OF THE WEEK
Last
week we discussed heart attack and angina in the context of angioplasty
treatment. When we took calls it reminded me of the fear that people associate
with chest pain as a symptom. Of course people consider they might be having a
heart attack when they get chest pain but just to be confusing…..it can
present as neck or arm symptoms as well. AND THEN AGAIN chest pain may be due to
a variety of causes. Of course the other side of the coin is that people may try
diagnosing themselves and mistake pain of heart origin for indigestion.,
So
I thought this week it would be appropriate to revisit the notion of chest pain
in the context of other causes – in particular those of gastrointestinal
origin . This leads to discussion on Acid Reflux (oesophageal reflux) , Hiatus
Hernia, Gastritis and even Ulcer.
Some
weeks ago we talked to Prof Barry Marshall our home grown West Australian
Medical Celebrity who together with his colleague Dr Robin Warren convinced the
medical world they were wrong about the causes of stomach ulcer ( see archives :
November 24 2002). They revolutionised the treatment of ulcer by proving that
many were caused by a bacterium called Helicobacter Pylori. H Pylori isn’t the
whole story.
Digestion
is a complex procedure that begins as soon as food enters our mouth. Today I
want to concentrate of the bit about midway down your body – where the oesophagus (gullet)
meets the stomach at the diaphragm. As the oesophagus passes though a
“doorway” formed by the 2 “wings” of the diaphragm. (to get an idea of
how this “doorway is formed - spread the fingers of both hand as wide as you
can – put your fingers of your left hand over those of your right forming a 90
degree angle – the space formed between your thumbs represents where the
oesophagus would pass if your hands and fingers represented the diaphragm.)
At this point the stomach
starts. The significant thing is that at this point the lining changes and the
upper part of the stomach contains acid producing cells. The diaphragm
“doorway” acts as a sort of valve to keep the acid in the stomach and
prevent it refluxing up the oesophagus where it could potentially burn the
delicate tissue (reflux oesophagitis) - when this happens it causes pain behind
the sternum ( breast bone) which may travel up to the throat or give an acidy
taste in the mouth.
This
can happen now and again, say after a big meal especially if air fills the
stomach and a big burp causes pressure to force some stomach contents back up,
or when the abdomen is full of something else - Anyone who has been in the late
stages of pregnancy will know what I mean !
If this happens frequently then the lining of the oesophagus may become
inflamed and even cause ulcers to form ( ulcerative reflux oesophagitis)
If
the diaphragm “doorway” is permanently a bit big or loose then part of the
stomach may slide or pop up above the diaphragm into the chest cavity. This is a
hiatus hernia and this can cause on going problems with inflammation of the
oesophagus .
Treatment
of this condition has come a long way in the last 20 years. Identification of
the particular cells in the stomach that produce the acid has lead to
development of medications that can block the cause of the problem. These drugs
have been marvellous and I recall while a young doctor I worked briefly in a
gastroenterology unit at Prince Henry’s Hospital ( which is now a swish
apartment block :((( in St Kilda Rd, Melbourne ) where they were trailing these
then new and exciting drugs. Together with lifestyle changes li
ke
weight loss and posture they are
now the main stay of treatment for reflux and together with antibiotics are used
to treat peptic Ulcers due to H Pylori Professor
Mel Korman was one of the senior doctors at Prince Henry’s at the time
involved in the unravelling the complexities of reflux and acid. He is now the
Director of Gastroenterology Unit
at Monash Medical Centre and he will join us today to talk about
Until
Barry Marshall’s revelation about H Pylori happened it was thought that
over-production of Acid by these cells was the most likely cause of Peptic
(including duodenal) ulcer as well. Over production of acid can be a cause but
it is not a common one.
Some
cases of refractory reflux may require surgery.
Click HERE
to read Prof John Murtagh’s description of HIATUS HERNIA at the NW Div General
Pracitice site
Click HERE
to visit the Department of Medicine at Monash Medical Centre
Click HERE
to read my article on Peptic Ulcer
SUPPORT
GROUP OF THE WEEK
Last
week a lady called Pat from Brisbane East called us seeking help to identify an
amphibian in her back yard. But Herpetology isn’t my long suit (initially I
thought it might be until I realised that it isn’t the study of herpes viruses
but the study of amphibians and reptiles ) . However Jenny Holdway the Secretary
of the Queensland Frog Society was listening at the time and called in to
assist.
Jenny felt, to Pat’s horror,
that the large brown knobbly friend in her garden was a cane toad (Bufus
Marinus).But she was quick to point out that although the Bufus would win no
beauty prize it deserved humane
treatment.Jenny suggested donning a plastic bag as gloves, picking Bufus up and
taking him to the local park –definitely more acceptable to the QFS than
Susie’s suggestion of a 7 iron – but Pat balked. We parted with the notion
that her 13 year old grandson would be the ideal bufus broker.
The Bufus Marinus is a brownish
mottled leathery heavily set frog which can grow up to 20 cm in diameter !! 3400
young Cane Toads were introduced to Australia in 1835 from South America in an
attempt to eradicate the grey back beetle which was devastating the Queensland
Sugar industry at the time . Unfortunately the beetle doesn’t live close to
the ground and Cane Toads don’t feed high – consequently they had little
effect on the grey back beetle problem.
But the Cane Toads have thrived
and are now considered by many as one of Australia’s most widespread feral
pests. They can live for up to 16 years and breed more like rabbits each one
depositing up to 35,000 eggs in a slimey mass to plant debris ! They have toxin
stored in their parotid glands to spit and kill (perceived) enemies mall
animals. They feed on all sorts of things including small mammals.
The
Cane Toad has spread way beyond the cane fields and is migrating at a rate of
In
1989, Brisbane City Council started a cane toad eradication program. They
suggested people put the toads in their freezer as the most humane form of
killing. Cane Toads become dormant as a reaction to the cold and will eventually
die in their sleep. I received many emails from people after the show with this
recommendation. Thanks :)
Now
you might think this is an exclusively Queensland issue – think again – The
Cane Toad is on the move and now
found in Coastal NT and Central Northern NSW. According James Cook University
research the natural rate of spread of B. marinus is now 30-50 km/year in
the Northern Territory and about 5 km/year in northern New South Wales.
However after considering
all this and as I believe in equal opportunity and am not speciest I
thought this week we would highlight the Queensland Frog Society as our Support
Group of the Week. Especially because Bufo isn’t the only frog in the pond !
In preparation I have opened a whole new world for myself – the world
of frogs.
On
the frog Society web page I found something which I found particularly useful
– They point out that Pacific Blue-eye frog , Pseudomugil signifer, which
is native to the Brisbane region eat
mosquito larva. They suggest considering keeping 3 or 4 in a small pond and feed
them once a week with fish food.
Also
there is research looking at frog migration and habits calling for you to fill
in a form if you see a dead or sick frog – click HERE
for more info and HERE
to see the form
Click
HERE
to hear some Froggy Songs
Click HERE to hear some Froggy Christmas Carols
Click
HERE
to visit the Qld Gov Environment site Naturally Queensland - info on Bufo
Marinus
Click
HERE to visit a great
site with lots of frog pics
Click
HERE to
Visit the Queensland Herpetological Society
Click
HERE to
visit the James Cook University Cane Toad Research Lab
LOVE
YOUR WORK
AMBULANCE
PARAMEDIC
I have enormous respect for people working in the Emergency Services. Our Police, Fire and Ambulance people work under enormous pressure in conditions that are very difficult. They are dedicated and they care. Their jobs don’t have prospects to earn money like people in the corporate or business world. But the jobs still attract enthusiastic young people.
In particular over 20 years in clinical medicine my experience has taught me how lucky we are to have our highly skilled Ambulance Paramedics in this country. I get quite riled when I hear people sometimes refer to them as “ambulance drivers”. Our paramedics are highly trained experts in pre-hospital emergency care emergency.
Training
differs a bit around the country but they are all skilled and equipped to
recognise serious life threatening disorders and institute first aid treatment
-especially cardiopulmonary resuscitation. There are also Paramedics who have
training and are skilled to institute certain
medication or treatment for certain
conditions that need immediate action like heroin overdose or cardiac rhythm
problems.
Today
we will meet Paul Holman, Group Manager, Emergency Operations – Metropolitan
Ambulance Service in Victoria. He
has been a paramedic for over 20 years. (you may have seen his face on TV from
the program Emergency 000 on Channel 7 ) . Paul will tell us all about being a
Paramedic.
Ambulance
Service Victoria consists of MAS and RAV ( Rural Ambulance Service ) and is
widely recognised for its extremely high standard of Paramedic training and
skill levels. 29 years ago MICA (
mobile intensive care ambulance) Paramedics began in Victoria . These highly
trained professionals are experts in management of certain cardiac emergencies
and other serious life threatening condition that require immediate medical
treatment on scene. I can honestly say that as a GP, that my respect for these
people is such I would be comfortable to stand aside and take direction from a
MICA paramedic in one of these situations.
In Victoria a further step has been added to Paramedic training –
Advanced Life Support.
Click
HERE to read more
about AMBULANCE PARAMEDIC TRAINING in VICTORIA – go to careers section
In
all states Ambulance Paramedics are highly skilled emergency medical
professionals. I get saddened when I read media reports that put Ambulance
services in an adverse light -
especially when I consider that they might be motivated by political ideas
because - I believe that no matter
what ever political issues may be involved, the level of trust and respect we should and can have for our
Paramedics should not be affected.
Click HERE to visit the Ambulance Service in your state in Australia- click on the map
AUSTRALIAN WOMEN’S WEEKLY HEALTH SURVEY
Deborah
Thomas, editor of Australian Women’s Weekly will join us to tell us about the
Women's Health & Wellbeing Survey they are running
Click
HERE to visit the Australian Women’s
Weekly Website
HEALTHY HOLIDAYS
LILIANFELS
BLUE MOUNTAINS
Wouldn’t
you like to escape the stress of 21 century city life and
take a step us back to a time when the gentile folk took in the country
health giving air of the Blue Mountains.
Lilianfels
is one such place. Built in 1902 this beautiful hotel still maintains its
magnificent tranquillity but with modern luxury conveniences. Lilianfels is
listed with the prestigious small luxury hotels of the world
Megan
Staal from Lilianfels will tell us all about this stress free escape.
Lilianfels
Blue Mountains
Lilianfels Avenue
Katoomba, New South Wales 2780
Australia
Tel: +61 2 4780 1200
Fax: +61 2 4780 1364
Click HERE
to visit Lilianfels via small luxury hotels site
Click
HERE to visit the Lilianfels
RETURNING GOODS - YOUR RIGHTS
AUSTRALIAN
CONSUMERS ASSOCIATION
So the Christmas gift your agonised over isn’t their size? The one you received form your favourite aunt is exactly the same as the one she gave you last year ? The wheels fell off the toy car you bought your nephew before he got it out of the box. OK so it’s a week or so after Christmas now and you want to return the goods. BUT what are your rights ? What do you have to do ……?
Also ………….how’s your credit card looking ? melted ? To afraid to open the next statement ?
Catherine
Wolthuizen from the Australian Consumers
Association will join us to discuss turning goods and managing credit card blow
out . The Australian Consumers Association produce Choice MAgazine
Click HERE to read online CHOICE magazine – the journal of the Australian Consumers Association
PROCEDURE OF THE WEEK
AGED CARE ASSESSMENTS
Gernatology,
the study of health issues and aging is a blossoming medial speciality . In
Australia programs are being developed constantly to help people stay
independent and in their own homes as long as possible . Part of these programs
are AGED CARE ASSESSMENTS.
The assessments are run at a
local level and involve multidisciplinary teams who are skilled in assessing the
needs of older people will organise to visit a person in their home and make
recommendations based on the persons health status, mental state as well as family and community support system . The aim is to maximise
support to keep the person independent as long as possible.
Unfortunately I suspect some
older people are afraid to access these services for fear that they may
behijacked and whisked off into some care
facility . I think these fears need to be dispelled so I have invited
Dr Michael Murray an Geriatrician or expert
in Aged Care and health to tell us
Click HERE to Visit Aged Care Australia
Click HERE to read Federal Government brochure on Aged Care Assessments