Dr Feelgood Saturday 15th February 2003

MOUTH ULCERS AND OTHER PAINS IN THE FACE !

 I often talk about secret dentist business and how little training we doctors often receive in matters of the mouth !

I often have people ask me about mouth ulcers and I have to say they seem mysterious entities – while it seems there may be several causes there are also those mouth ulcers which have no explanation – at least that I know.

Oral and facial pain can be due to a range of causes and can be debilitating. I feel undereducated about Oral things so I thought it might be time to find out some of the secret dentist business.

 To do so I have invited Dr Jonathan Tversky to join us. Jonathan is Dental Specialist in Oral Medicine and Oral Pathology' and he works in private practice as well as with the Skin and Cancer Foundation.

 PROSTATE CANCER SCREENING

LEGITIMATE CONTROVERSY...... OR COP OUT ?

What would you prefer to be – informed and in control or head in the sand and fingers crossed?

 Prof Alan Coates is the CEO of Cancer Council of Australia . He is a medical oncologist  by training his work on quality of life cancer patients is widely recognised.  Professor Coates is an expert statistician and mathematician and monitors all the research programmes of the Melanoma and Skin Cancer Research Institute.

In the last week he has been quoted in the Financial review and other papers as saying he would not undergo prostate screening .

I believe that no one should have any test without understanding the implications the results may hold,but I also think that statements like Professor Coates has made, in this particular instance, may be taken by many men to be justification for avoiding learning about the pros and cons of investigating for this common disease.

Epidemiology is the study of health and populations. Health statisticians work with populations and numbers not individuals. Their findings are important for communities and planning and  especially useful if you are a decision maker in the area of health economics. Their findings can be confusing for individuals and need to be carefully considered when making decisions for yourself. They come up with stats like 1 in 10 men get prostate cancer …. So what does that mean for an individual? Well, it gives you an idea of what your odds are of getting the condition. However you can sit 10 men in a room and none may get it or all may get it …. And its fine to know the odds but they mean little if you happen to be the ONE in TEN ! So they refine their stats and give risk factors – things that increase or decrease your likelihood of getting a particular disease.

So case in point – prostate cancer– if 1 in 10 men will get it ..and around 10,000 new cases are diagnosed each year with 2500 men dying from it each year  wouldn’t it seem logical to bring in some sort of mass screening regime – like that for Breast Cancer  ( 1 in 11 women ) with mammograms or Cervical Cancer ( one in 90 women ) with  pap smears?  The government spends millions of dollars on awareness campaigns for women – teaching them about the conditions, alerting them to risk factors and encouraging them to participate in the screening programs.

 So why is there any controversy about Prostate Cancer screening? Why isn’t there a massive government funded (or even privately sponsored) campaign   to inform men of their risks and encouraging them to have a regular digital rectal exam (that’s finger not mpeg!) and a blood test (Prostatic Specific Antigen – PSA).

 The issues  

  1. Men don’t like going to doctors – they seem to be content with the ostrich approach – if it doesn’t hurt it must be ok ……….so anyone who can give them just cause not to go for a check up will be embraced as the new Messiah !
  1. We believe that if all men lived long enough they would probably develop prostate cancer in some form and many would die of something else unrelated.
  1. There are obviously different degrees of aggressiveness amongst prostate cancers – some attack and spread quickly and others grumble on with not much effect.

So what’s the problem? Why don’t we do a mass screening program of all men and make the diagnoses and treat everyone?  

  1. One problem is the treatment – it can have devastating side effects – radical prostatectomy can result in impotence and/or incontinence … Radiotherapy can result in chronic bowel inflammation. …. Imagine having these side effects if in fact your prostate cancer was never going to cause problems and you would have otherwise died at 112 from a heart attack !
  1. Another problem is MONEY – if we screen everyone then we will make lots of tentative diagnoses – these people will all need further investigations – ultrasound guided transrectal( through the rectum)  biopsies of their prostate……not cheap ……. For Government or individual  ( especially if that cancer wasn’t aggressive ) ….and then there is the other treatment – brachytherapy ……now THAT’s Expensive !  Who will pick up the tab if we screen everyone – say over 50 ?
  1. The screening tests we have aren’t 100% ( show me one that is !?! )- infact thats why they are "screening tests" AND NOT "diagnostic tests".  Screening tests are done on patients with NO symptoms. A high PSA indicates something wrong with the prostate – not necessarily cancer – a digital rectal exam on its own may not detect a deep seated small cancer – they are a better together than alone. Maybe we need to work on a better screening test ( where are you Professor Papanicolau ?)
  1. Some ( like Prof Coates ) say that mass screening will turn healthy men into cancer victims ………..ahem ……are you men or children ? ….. I always thought that Kylie Minogue was right that it was better the devil  you know …..
  1. Experts cant agree on what the statistics really say ……but then if you torture statistics long enough they will tell you anything you want them to …….. could there be another agenda for the anti-screeners.

 What should a man do ?  

  1. Get your head out of the sand and face your health issues – Confront the demons and take control – talk to your doctor about risks and benefits and how they apply to YOU not the whole population – for example do you have a father or brother with prostate cancer ?
  1. Prostate cancer may have no symptoms until its spread beyond the gland so if you bury your head in the sand  and wait til you have back pain from the metastatic spread – well … to put it politely - it won’t be so easy to treat.  Every cancer message we get is EARLY DETECTION IS BEST – so WHY is the CANCER COUNCIL OF AUSTRALIA ( through its CEO) dissenting on THIS Particular cancer ? Check out NSW Cancer Council’s View  (CLICK HERE)
  1. Consider screening – Medicare do fund prostate cancer screening under certain circumstances
  1. If given a positive result – consider ALL your options – watchful waiting is one – here you will have repeat tests and  remain under surveillance incse it takes an aggressive turn
  1. Get funding for research to find out the truth and invent better screening tests and treatments

 I cant believe that men would accept the sort of political rhetoric they are being fed on this issue – millions and millions of dollars of Medicare money –  your tax money – is being spent on screening for women’s cancer – don’t you deserve the same privilege ?

 What should a woman do ?

 How about organizing an appointment for him to see the GP on the back of your pap smear appointment ……

LINKS

click HERE to visit the Prostate Foundation of Australia

click HERE to read the Cochrane Collaboration's findings on Prostate disease and management ( note there is no comprehensive review done yet )

click HERE to see the NSW Cancer Council response to their National Body's CEO's Announcement

click HERE to visit the Cancer Council of Australia

click HERE to read a statement made by Prof Coates about cancer treatment and the need for evidence

 THE REACH FOUNDATION

Reach Foundation, Heinz and Looney Tunes have got together to put on a fun day for kids and at the same time raise money for and awareness of the need for kids to feel good bout themselves.

800 lucky young people aged between 8 and 12  from across the country have been  lucky enough to have won the opportunity to be part of a family fun day which is the first of its kind in Australia. Many more are Livinia Nixon on the track with Kids Bugs and Tweety expected to flock to Olympic Park in Melbourne tomorrow ( Sunday 16th February) to see the fun and games.

All gate proceeds from the day go to the Reach Foundation. Reach was established in 1994 and is a non-profit organization which runs programs designed to help young people see through the negativity of their environment and ignite a passion for life.

Reach Rookys aims to build resilience and self-esteem in children, and provide them with creative, artistic, playful and inspirational experiences.  Through the integration of a variety of mediums including visual arts, music drama, dance, games and sports, young people are encouraged to become critical thinkers who are more socially aware.

JimStynes is the  Co-Founder of: THE REACH FOUNDATION Member , a former AFL footballer and Brownlow Medallist and author of "Whatever it takes". He'll be telling us a little of what to expect at the event !

 click HERE for further information on the Looney Tunes Games

click HERE for more information on the Reach Foundation

  

AROMATHERAPY AND NATURAL SKIN CARE

 Robyn Minski our regular Aromatherapist joins us to talk  aromatherapy and natural skin care.

Click HERE to visit Robyn's International Academy of Aromatherapy

 

PROCEDURE OF THE WEEK

COLONOSCOPY

Last week we talked about the Federal Government bowel cancer screening initiative using a simple test looking  hidden blood in bowel actions. While many things can cause bleeding in the ano rectal area - one devastating cause is Bowel Cancer which affects 1 in 25 Australians.

The definitive test to diagnose bowel disorders including cancer is currently a colonoscopy. This is a procedure involving a light anaesthetic ( yes you shouldn't remember a thing) and a fibre optic tube inserted into the rectum via the anus. The doctor passes the tube up the bowel observing the wall on the way - any suspicious areas or lumps are biopsied. Polyps may be "nipped" off during the procedure - removal of these potentially pre cancerous lesions may prevent cancer! people at risk are offered lifetime surveillance

 Prof Adrian Polglase is a colorectal surgeon and colonoscopist. He will join us to explain the procedure.

click HERE to read further information about colonoscopy on Prof Polglase's site

click HERE to visit the GUT FOUNDATION - they have a booklet on bowel cancer

  

ASSISTED REPRODUCTION TECHNOLOGY

Recently someone asked me a question, which struck a cord. She wanted to know more about fertility drugs, how they worked and were they safe. The question was not for herself, but about her daughter. Her daughter was taking the ovulation stimulation drug – Clomid. The person asking the question didn’t quite see why …..and she didn’t want to ask her daughter as she want to be misconstrued as  judgmental or interfering.

 These days people seem to want everything NOW ! And if we cant have it NOW, then at least we want to schedule it in at a convenient time.

Reproduction seems to be no exception. Australia has always been at the leading edge of fertility technology. It has been a miracle for those people unable to conceive by themselves. But are people wanting to use this science as an ergonomic tool ? And is that reasonable?

 Are there people who want to take fertility drugs in order to get pregnant quicker to fit in with a schedule or take away the anxiety of waiting for nature…..

 I often see women who are concerned that time is running out for their biological clock . They’ve been busy with life and career or finally met the right partner and suddenly they find getting pregnant isn’t necessarily as easy as falling off a log …… SO when is the right time to seek advice or assistance to achieve a pregnancy.

 Prof Gab Kovacs is the medical director of Monash IVF, one of the worlds leading IVF groups. He will join us to explain the processes, risks and benefits of assisted reproduction.   

 Click HERE to visit Monash IVF

DOCTORS STANDING UP FOR PEACE

Doctors aren’t known for their political activism ( ok maybe some are) but collectively we are more often accused of being a rather difficult lot to get motivated to take a stance on issues – even issues that affect us or our profession. Most people agree that this is not that doctors don’t care – infact usually the reason they don’t do it is they care too much – We often work in isolation looking after our brood of patients and we spend all our working hours fighting for them and their rights. So it’s traditionally hard to corral doctors after hours to stand up and be counted on wider political issues .

 Sure like any other profession there are always individuals and groups of people bleating about conditions and pay …and they get to have their say like any other union. Often their claims are reasonable and sometimes it falls on deaf ears ….. but sometimes there are issues that can’t be ignored.

If you can get a large group doctors riled up enough to form an association to fight a community issue then you can be sure their arguments will be well thought out and worth considering. Moreover when you read the names on the list of members and see credible quiet people you listen even closer.

 Dr Tillman Ruff is just this sort of Doctor .I have known Tillman for over 20 years. He is a quiet doctor, the sort of softly spoken physician who is ergonomic with words. He is a well respected infectious diseases specialist and he is also on the committee of the Medical Association for Prevention of War in Australia. When I saw his name I wanted to listen.

 I think I speak for many, and certainly hearing David Williamson’s Batman Oration on Australia Day made me feel comfortable to be open about it, I don’t understand the actual reasons why there is an imminent war being waged on Iraq. Yes I understand that terrorism exists…… but I thought that those threats were coming from Osama Bin Laden and his followers….Yes I understand that we have been told that Iraq has been unwilling to fully cooperate with UN weapons inspectors …and Yes I understand that they finally found a missile ………I have no problem with the notion of fighting to protect our home and our children ….but I would like to be sure that we need to and that  fighting IS the only way……. I have a university education ….I don’t usually have a problem with understanding logical debate or even scientific concepts – It worries me, that I cant understand the reasons we are possibly going  for war …… May be I have overestimated myself …….Maybe I have missed something …… May be it so secret that telling the community might blow the game ? Is there anyone who can explain it to me in simple terms that justify the huge potential loss of life and enormous, possibly irrevocable, pain that would occur with a war on Iraq ….. email me if you can …please.

 click HERE to visit Doctors against War Australia

DREAM ALCHEMY

 

By popular demand Jane Theresa Anderson, author of  'Dream Alchemy' joins us again to talk about what your dreams could mean.

Click HERE to visit Theresa Jane's dream interpretation site