DR FEELGOOD SATURDAY JANUARY 11TH 2003

PROSTATE CANCER

Prostate Cancer affects 1 in 10 men. Every year, around 10,000 Australian men are diagnosed and more than 2,500 die of the disease, making prostate cancer the second largest cause of male cancer deaths, after lung cancer. It is with noting that Cervix cancer affects 1 in 90 women and we routinely recommend pap smears in all women over about 24 years of age.

Breast Cancer affects 1 in12 women and we routinely recommend mammograms in all women over 50

……..So why is there an ongoing controversy about whether we should or shouldn't be screening for prostate cancer ?

Mr Michael Chamberlain, Urologist and Past President Australian Urological Society and Max Gardiner, Honorary Deputy Chairman of the Prostate Cancer Foundation of Australia, will help us understand this condition and the controversy around diagnosis and treatment.

The prostate gland is about the size of a walnut and only found in men. Its function is to produce fluid which will carry sperm on its journey to the outside world !

The prostate sits under the bladder wrapping round the beginnings of the urethra. The seminal vesicles and tubes from the testes empty through the prostate into the urethra . During ejaculation the prostate secretes fluid, which inturn carries the sperm on their way down the urethra.

As a natural part of aging from round the age of 40or 50 a man's prostate gland naturally begins to enlarge. This is not a risk factor for, or related to cancer.

The gland continues to enlarge as he ages and at some stage, in some people, the enlargement of the gland may cause some local mechanical problems. That is - as it enlarges it may squeeze the urethra causing stream problems on urination - like difficulty starting or dribbling at the end as well as reduced power of stream. Also it may push up on the bladder reducing its capacity to hold urine - hence the symptom of wanting to "go" frequently. Again - this IS NOT cancer nor necessarily even a precursor for it.

Cancer is an abnormal area of cell growth, and as far as I understand it is unrelated to the natural enlargement process. It may cause NO symptoms AT ALL in the early stages. Infact it may not cause any symptoms until after it has spread beyond the prostate gland an into other parts of the body, such as bone.

Men with a family history may be more at risk of developing this condition however it is said that if all men were to live long enough they would all eventually develop a form of prostate cancer, which may not be the cause of their demise. However there are some aggressive forms, which are obviously best treated early.

The key is to find the cancer early. There has been great debate about screening - especially in the light of the success of women's health programs involving screening for breast and cervix cancer.

We do have a blood test that can be used for screening for prostate problems - called a PSA ( prostate specific antigen ). This chemical is released by the prostate into the blood stream when the gland is not functioning properly ….. it is NOT a diagnostic test for cancer but it is only an indicator that the gland has a problem and cancer should be ruled out especially in the absence of any other cause for the level of PSA to be elevated especially persistent elevation.

Doctors can also offer men a digital rectal examination - a doctor's gloved finger inserted into the rectum and can usually palpate the prostate a few centimetres from the anus opening .A skilled doctor may be able to detect an abnormal lump.

Ok,so how come it isn't routine that all men have these tests? Excellent question!!!

In my experience I have found that when people are given a diagnosis of cancer they generally respond with the statement - "well doctor - lets get rid of it ". The problem with prostate cancer is that the some of treatment options can have side effects, which may be devastating - incontinence, impotence and bowel disorders. So we need to be sure that the treatment is needed to avoid the treatment being worse than the disease.

But should that deter anyone from finding out if they have the condition? Wouldn't it be best to know your options ?

Once a positive result is found on the PSA and /or digital rectal examination an ultrasound guided biopsy can be performed by a specialist and the abnormal areas examined under a microscope where a diagnosis can be made. After this an appropriate set of treatment options can be offered.

I don't really understand it but there is constant debate about the "value" of prostate screening - the important question to ponder here is ….. value to whom? - The individual man himself ?… The Government ?….. Please remember when you hear statistics quoted or authorities basing recommendations on population statistics these may have little relevance to an individual whose health is impacted upon by many variables like family history and lifestyle - you individual risk may be very different from that of the whole population

Also remember that when governments or public health authorities make recommendations or allocate money they must consider the health of community as a whole. Economics will impact on their decisions of what tests and procedures they recommend when they are picking up the tab. In this country while our public health system is one of the best in the world you can,as an individual, always opt to pay privately for a test or procedure - So I believe it is important to assess your own risks when considering what tests or treatments are on offer.

I believe that an individual is better armed to face life and make decisions if they know what they are up against and what their options are ?

Some groups advise that we shouldn't do mass screening because it may scare people and cause a lot of unnecessary expensive testing and possibly lead to treatments with undesirable sideeffects……………

Others argue that this is a paternalistic approach treating men as if they have no right or intellect. They argue that men deserve the knowledge and should be given all the OPTIONs inorder to decide for themselves. Indeed one option in the treatment of prostate cancer IS watchful waiting - regular testing and close surveillance ready to intervene if things escalate.

I believe that the emphasis IS on OPTIONS ! I live and practice by the notion that knowledge is power and ignorance breeds fear.

However I believe that any screening program HAS to be in conjunction with a concerted effort in education

click HERE for the Prostate Cancer Foundation of Australia support page

Click HERE for the collaborative site which includes medical information as well  

Click HERE to visit the Urological Society of Australia 

Red Blood Cell Shape and Anaemia 

focus on Spherocytosis

Red Blood cells are the body's freight service for oxygen delivery. They are shaped rather like a bagel or doughnut with an incomplete hole !

In the lungs Oxygen is attached to a pigmented protein carriage with in the red cells called haemoglobin This coupling causes the iron containing pigment part of the carriage (haem) to change colour giving the cell its characteristic red look . Rather like an occupied taxi might signal it is full with a change in its roof light ( hmm I can never remember which way those signs are ).

When the red blood cell reaches its destination the haemoglobin uncouples the oxygen, releasing it for use. The cell then travels back via the veins to pick up its next oxygen load from the lungs. The red blood cells continue these delivery rounds day in day out.

The life span of a red blood cell is about 100 -120 days. Each time they circulate round the body they they pass through the spleen and undergo surveillance. This spongy organ sits just in the left upper abdomen tucked up the back under the ribs. It is part of the lymphatic system and is a highly specialised garbage disposal unit, full of hungry scavenger (white) cells eager to consume aging cells ( especially juicy red blood cells!) .

As the red cells pass through the spleen they are put through a squeeze test. Basically to pass the test they must be able to change their shape and squeeze through a network of fine tubes and ducts and pop out the other end intact. As a red cell gets older it is thought to lose the ability to squeeze through so easily and so aging red cells are constantly being removed, and then replaced as they pass their use by date.

Someone who has problems in the shape of their red blood cells may mean that the efficiency of the spleens surveillance system can work against the person. As the abnormally shaped red blood cell passes through the spleen it is mistaken for an old one and it is removed. If a large number of red cells are affected then the body would have to work very hard to keep up with the removal rate. Consequently the person may use more iron stores and could become anaemia.

Hereditary Spherocytosis is one such condition. It is an inherited problem affecting the structure of the red blood cell wall and results in these  cells being round or spherical in shape. it is inherited in an autosomal dominant pattern meaning that you only need to inherit one affected gene from one parent to develop the condition. But because your affected parent probably only has one of a pair of genes affected you have a 50 /50 chance of getting a non affected gene from them too ! The condition can be variable with affected people having varying numbers of red cells affected. Treatment therefore also varies - some people need little intervention, others may require transfusions from time to time and still others may find they are advised to consider having their spleen removed.

Splenectomy - or surgical removal of the spleen can help by slowing of the premature removal of the round red cells and therefore reducing the continual demand on iron stores to make replacement cells. The cells are still spherical but they last longer !

It occurs in approximately 1 in every 5000 people of North European ancestry.

During the week I received an email from Liz who asked me to get more information about the role of removal of the spleen in people with hereditary Spherocytosis . She told me she has the condition and has had her spleen removed and now she is going through the decision process with some of her children who have inherited it.

Dr Helen Savoia is a physician who specialises in haematology and she often  works with families with a history of  - she counsels them on the risks involved if they are carriers of the affected genes and advises them on treatment options  - she will join us to explain more about the conditions and the role of Splenectomy in more serious forms of the disease

lick HERE for a UK site with fact sheets about hereditary and rare anaemias

Click HERE for an American Site with info on Hereditary Spherocytosis

4X4 WEEKEND WARRIORS

Michael Coldham, president of  Four Wheel Drive Victoria joins us again to talk about getting away into the outback with your 4x4 !

click HERE to visit the Four Wheel Drive Victoria

FIT FEET!

PODIATRY

Podiatrist Rick Osler will be back again today to talk about the bane of summer - cracked heels and ingrown toenails !

Rick's sports shoe shop - Active Feet -  is more than just a place to buy running shoes - he assesses your personal footwear needs based on  your sports requirements and running style.

click HERE to visit the Australian  Podiatry Council web page 

SEXISM AND LAWN BOWLS ???????

White hats white shirts white shoes and skirts and black balls ……According to media reports this week there have been huge upheavals in womens lawn bowls when MEN have started winning WOMENS competition! Infact one club's women's champion is A MAN …does he have to wear the starched white dress too ? ….

However this is not such a land mark ruling -in 2001 a landmark decision was made in the equal opportunity commission after a woman fought for the right to play in the men's competition

Lawn bowls is no longer the strict domain of the over 60's its popularity amoungst young people is growing rapidly - Mark Rendell, CEO, Bowls Australia (lawn bowling) will join us today to tell us all about it

click HERE to visit Bowls Australia

HEALTHY HOLIDAYS

MONKEY MIA RESORT

Monkey Mia resort is situated on the world heritage coast line at Shark Bay in Western Australia.The resort itself overlooks the magnificent Dolphin bay .

Dean Massie the Resort Manager will join us today He says that they work hard at Monkey Mia resort so visitors can relax and enjoy the huge variety of mammal and bird life, native flora and fauna, such as the Dugong. Over 10,000 of these sea dwelling mammals live in the protection of the Shark Bay Marine Nature Reserve. They are often seen near the Resort . It is Dugongs that are believed to be what longsuffering sailors mistook for mermaids. People travel from all over the world to get a close up experience with the many dolphins living in their natural habitat at Monkey Mia

Click HERE to visit Monkey Mia

AESTHETIC SURGERY and COSMETIC TREATMENTS

WHAT IS REALISTIC AND WHAT IS FANTASY?

Have you noticed that it seems like in all the magazines there are before and after photos of people with wobbly or dimply bits, blemishes or blotches that miraculously disappear after some new wonder treatment. How much of this is true ? How can you tell ? What can you expect? What are the risks ? How do you know who to trust? ( and can you really get rid of cellulite …..for that matter ….what IS cellulite …….. we weren't taught about it in anatomy class ….. ! )

Mr Howard Webster, plastic surgeon and member of the Association of Plastic Surgeons will join us in the studio to give us some tips on what is reasonable to expect from cosmetic or aesthetic surgery or treatment

Click HERE to visit the Australian Society of Plastic Surgeons for more information about plastic surgery

I LIKE AEROPLANE JELLY…

AEROPLANE JELLY FOR MEEEEEeeeeee!

Its as Aussie as Vegemite and its jingle is as well known - Aeroplane jelly has been around FOREVER - well actually 75 years and they have just run a national competition to find new voices for the jingle. Well be talking to Nick Pucar, Marketing Manager Aeroplane Jelly who'll tell us who the winners are and also we'll be looking for your best Aussies Jelly recipes

ps - Our Speech Pathologist has deferred to next week - she needs to read up a bit more on my case ( not really - but she will join us next week )