Explore every episode of the podcast Everyday Medicine with Dr Luke
| Title | Pub. Date | Duration | |
|---|---|---|---|
| Podcast 184. Memory with Dr Natalie Grima | 16 Dec 2025 | 00:33:57 | |
Memory is the cognitive process of acquiring, storing and retrieving information. It's the mind's ability to encode, store and recall experiences and knowledge, allowing for learning, adaptation, and the formation of personal identity. There are different types of memory, including short-term memory, where information is held briefly and long-term memory, where information is held for extended periods. There is sensory memory where information relating to senses such as sight, sound and smell are retained, explicit memory recalling memories or facts and events and implicit memory that influences our behaviour without conscious awareness; for example, like riding a bike or driving your car. Memory storage involves multiple brain regions, but the hippocampus is crucial for forming new memories, especially long-term memories and acts as a gateway for encoding and consolidating memories. The cerebral cortex and prefrontal cortex also participate in memory storage and retrieval. Without memory, our enjoyment of life’s wonderful pleasures and diversity is severely compromised. Unfortunately, memory loss is also a key feature of dementia and is often cited as an early clinical marker of cognitive decline in a patient who is starting to have difficulty coping with the complexity of life, their medication schedule, shopping lists and daily tasks. I was curious to understand how we may improve and maintain our own memories whilst also providing advice in terms of exercises that may benefit our patients coping with early cognitive decline. The history of memory recall starts in Greece with Simonides of Ceos in ~500 BC. Simonides is credited with developing the ‘method of loci’ or ‘room method ‘of memory recall after an earthquake collapsed the roof at a banquet he had just attended, killing all inside. Relying on his visual memory, he was able to accurately identify the corpses by precisely recalling their seating arrangements as he had noticed them while he was reciting poetry to the guests. This method, now popularised by many teaching memory techniques, highlights the value of linking things we need to remember together to enhance their recall. It is also interesting that memory for music and songs is often retained until late in cognitive decline. In an attempt to explore the ideas behind the complex subject of memory in more detail, it was an honour to have Dr Natalie Grima accept an invitation for the podcast. Natalie is a clinical neuropsychologist based in Melbourne and the founder of Neuro Psychological Counselling Australia. She is a senior clinical neuropsychologist at Monash Health and has published widely, completing her doctorate at Monash University and undertaking advanced clinical training at Harvard Medical School. Natalie has a special interest in the diagnosis of dementia, psychiatric conditions and cognitive rehabilitation following acquired brain injuries. She also has an expert knowledge on the subject of memory. Please welcome her to the podcast. References: Dr Natalie Grima: www.neuropychconsulting.com.au Simonides of Ceos-Wikipedia | |||
| Episode 183. Obesity Redefined with Dr Melissa Beitner | 20 Nov 2025 | 00:39:34 | |
Obesity has reached crisis levels in Australia, with 67% of Australians classified as being overweight or obese (2022 data). BMI measurements have been used in epidemiological studies to define overweight individuals with a measurement of 25 kilograms per metre squared and obese individuals with a BMI measurement of more than 30 kilograms per metre squared. It is now recognised, however, that BMI-based measures of obesity may both underestimate or overestimate adiposity and provide inadequate information about health at the individual level and subsequently undermine medically sound approaches to healthcare and policy. A recent Commission of 58 experts in this field reported a consensus in The Lancet defining obesity as "a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue and with causes that are multifactorial and still incompletely understood". They subsequently teased out the diagnosis of obesity to include preclinical and clinical definitions, where: Pre-clinical obesity is defined by excess fat accumulation as measured by direct means with DEXA or indirect anthropometric measurements such as waist to height, waist circumference or waist to hip ratio measurement. This group of patients have no clinical disease or end-organ damage or symptoms as yet, but an increased risk of developing clinical obesity and conditions such as type 2 diabetes, cardiovascular disease and some neoplasms. The treatment focus in this group includes counselling and the introduction of measures to prevent progression to the next subgroup, which is clinical obesity. Clinical Obesity is defined as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications. The main focus of management for this cohort is to improve end-organ dysfunction as a priority rather than to focus on weight loss alone. Treatment options include lifestyle modification through diet and counselling, and rely on established pharmacology such as GLP-1 receptor agonists, which are likely to be used as a long-term treatment strategy. For a select number of patients, however, these medications can induce nausea, vomiting, diarrhoea, constipation and reflux. In more serious cases gastro paresis and pancreatitis are described. Non-responsiveness and high cost may be a limiting factor amongst some patients. Consequently, surgery remains the cornerstone for safely and effectively managing obesity and includes both gastric sleeve and bypass operations. To discuss this new definition of obesity and approach to thinking about obesity, as well as to review surgical options, I was curious to open a discussion with Dr Melissa Beitner. Melissa is a fellow of The Royal Australasian College of Surgeons; she is American Board of Surgery certified, a fellow of the American Society of Metabolic and Bariatric Surgery and is a diplomat of the American Board of Obesity Medicine. Melissa is incredibly well credentialed, having undertaken bariatric surgery fellowships at Mount Sinai Hospital in New York, Royal Brisbane and Women's Hospital and St. George Hospital, Sydney. She has special areas of interest in bariatric surgery and obesity medicine, and is also highly skilled in hiatus hernia and anti-reflux surgery, cholecystectomy and general surgical removal of lumps and bumps. Please welcome Meissa to the podcast. References: Dr Beitner, Weight Loss Solutions: www.360surgery.com.au Definition and Diagnostic Criteria of Clinical Obesity, F Rubino et al. The Lancet Diabetes and Endocrinology Commission. Vol 13, Issue 3, P221-262, March 2025 | |||
| Episode 182. Molecular Pathology with Dr Pranav Dorwal | 28 Oct 2025 | 00:45:09 | |
Molecular pathology combines molecular analysis with traditional morphology and immunohistochemistry to understand disease at its most fundamental level. The field continues to evolve as new discoveries enter clinical practice. Through molecular pathology, our knowledge of genetic mutations and targeted therapies has expanded. It is now rare for a tumour report to omit genetic findings. This discipline, while distant from daily clinical work, underpins treatment algorithms and prognostic models. The ten hallmarks of cancer include: genome instability and mutation, resistance to cell death, sustained proliferative signalling, evasion of growth suppressors, replicative immortality, angiogenesis, invasion and metastasis, altered metabolism, tumour-promoting inflammation, and immune evasion. Normal DNA contains proto-oncogenes that promote growth and tumour suppressor genes that restrain it. When balanced, they regulate healthy proliferation. Mutations in either disturb this balance, driving uncontrolled growth. Germline mutations are inherited and present in every cell, while somatic mutations are acquired, often influenced by smoking, ultraviolet exposure, or diet. When proto-oncogenes mutate, they become oncogenes. The RAS and BRAF oncogenes are key in molecular pathology. RAS controls upstream signalling that triggers cell growth, differentiation, and survival. Mutated RAS genes cause constant activation, leading to excessive signalling. The three RAS genes, HRAS, KRAS, and NRAS, are found in 20 to 25 percent of all human tumours and in 90 percent of pancreatic cancers. The BRAF gene, on chromosome 7, regulates downstream signalling and cell growth. BRAF mutations occur in about 10 percent of colorectal cancers, up to 50 percent of papillary thyroid cancers, and 27 to 67 percent of melanomas. Other oncogenes include MYC, EGFR, and HER2. HER2 amplification is seen in some breast and ovarian cancers. These findings are vital as targeted treatments, such as JAK inhibitors and monoclonal antibodies, act on these pathways. A single mutation can activate an oncogene. Tumour suppressor genes perform repair functions including correcting DNA mismatches, regulating the cell cycle, and promoting apoptosis. As telomeres shorten with age, mismatch repair errors increase. Mutated genes lose this ability, causing abnormal protein synthesis. Reports often describe mismatch repair proficient (no mutation) or mismatch repair deficient (mutation present), particularly in colon cancer. Key tumour suppressor genes include BRCA1, BRCA2, and the Lynch syndrome genes MLH1, MSH2, MSH6, and PMS2. When mutated, they increase the risk of breast, ovarian, prostate, colon, uterine, and pancreatic cancers. While often inherited, mutations can also arise spontaneously or through epigenetic silencing. Each gene has two copies; both must be affected before suppression is lost. This two-hit hypothesis, proposed by Knudson in 1971, explains tumour development with ageing. Methylation, sometimes noted in reports, refers to chemical modification of CpG (cytosine-phosphate-guanine) sites within a gene, often influenced by epigenetic factors. Abnormal methylation disrupts DNA repair, leading to failed tumour suppression. This is a brief overview of a complex and evolving field. Joining me is Dr Pranav Dorwal, Molecular and Anatomical Pathologist at Monash Health, also working in Diagnostic Genomics. Dr Dorwal is an examiner for molecular pathology, researcher, and author of over 60 publications. He has held positions at MD Anderson Cancer Center (Houston, USA) and Memorial Sloan Kettering Cancer Center (New York, USA), completed a fellowship at ANU Canberra, and received the Chancellor’s Gold Medal for Clinical Pathology. Please welcome Dr Pranav Dorwal to the podcast. References: Dr Pranav Dorwal – www.monashhealth.org | www.genomicdiagnostics.com.au | |||
| Episode 181. Ovarian Cancer with Professor Thomas Jobling | 06 Oct 2025 | 00:28:45 | |
Each year in Australia, there are about 1,800 new diagnoses of ovarian cancer and over 1,000 deaths, making ovarian cancer the fifth most common cause of death from cancer in women. The lifetime risk is about 1.6%, increasing to 5% if a first-degree relative is affected, and 45% and 25% respectively if the BRCA1 or BRCA2 mutation is present. The median age of diagnosis is 63 years, with two-thirds of patients diagnosed at 55 years or older. Histologically, tumour cells may arise from the outer epithelial lining cells of the ovary (60%), the germ cells (30%), or sex cord stromal cells (8%). Epithelial tumours of the high-grade serous type are now thought to spread to the ovarian surface after arising from secretory cells at the fimbria of the fallopian tubes, acquiring a TP53 mutation there before metastasising to the ovary as clinically evident ovarian cancer. Serous carcinomas represent the vast majority of primary malignant ovarian tumours (75%–80%) and are composed of columnar cells with cilia. These tumours are subdivided into high-grade and low-grade serous carcinomas, which has particular relevance for BRCA-associated ovarian tumours. As with many internal diseases, clinical presentation may be late, with vague pelvic discomfort giving way to pain and bloating, followed by more systemic symptoms as the disease advances. The tumour marker CA 125 may only be elevated 50% of the time in early disease, rising to 80% in advanced cancer; however, false positives may occur with benign ovarian disease, leiomyomas, and endometriosis. As with tumour markers used in the follow-up of other cancers, its utility in screening and early diagnosis is limited. The disease is advanced in 75% of cases at the time of diagnosis. Five-year survival is about 41% when local spread is detected, reducing to 30% or less with distant metastases, compared to 89% survival or above with early detection when the disease is localised. Given the importance of this condition, I was curious to consult Professor Thomas Jobling once more on current practices of surveillance, approaches to detection and management, and how to manage risk in first-degree relatives. How should we approach an ovarian cyst found incidentally during abdominal imaging? What symptoms should we, as clinicians, be mindful of in triggering our suspicion to investigate further? I know you will find this conversation with Professor Thomas Jobling interesting. Tom is a gynaecological oncologist, ex-AFL footballer, and medical researcher with a highly respected reputation in Melbourne and internationally. He has extensive experience with minimally invasive surgery, including robotic surgery, for gynaecologic cancer. His main research area is ovarian cancer, for which he received an Order of Australia Medal in 2017, and he is currently Head of Gynaecological Health and VMO at Peter MacCallum Hospital. Please welcome Professor Jobling to the podcast. References:
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| Episode 180. Hyperbaric Oxygen Therapy with Dr Neil Banham | 15 Sep 2025 | 00:33:29 | |
On a recent vacation to Exmouth on Western Australia’s far North coast, home to the amazing Ningaloo National Park, I had the pleasure of meeting Anaesthetist and outdoor adventurer Dr Neil Banham. I discovered that when Neil wasn’t kiteboarding, his daytime job was Director of Hyperbaric Medicine at Fiona Stanley Hospital in Perth. Our conversation exposed my deep ignorance of the potential use of HBOT beyond the management of air and gas embolism and piqued my interest in the various conditions that ay assis Hyperbaric Oxygen Treatment (HBOT) exposes an individual to near 100% oxygen inside a treatment chamber at pressures higher than sea level. For clinical purposes, the pressure must equal or exceed 1.4 atmospheres absolute (ATA). Most HBOT in Australasia is performed at 2 ATA. HBOT was first used in the early 20th century and by the US Navy in the 1940s to treat decompression sickness (“the bends”). In the 1960s it was used for carbon monoxide poisoning, and its use has since expanded. There are currently 15 approved indications accepted by the Undersea and Hyperbaric Medical Society. These fall under urgent and non-urgent conditions, and the Medicare Benefits Schedule includes specific item numbers for many of them. Urgent conditions include: air embolism, central retinal artery occlusion, carbon monoxide poisoning, clostridial myonecrosis (gas gangrene), compromised surgical grafts and flaps, crush injuries and compartment syndromes, acute arterial insufficiency, decompression sickness, intracranial abscess, necrotizing soft tissue infections, exceptional blood loss anaemia, specific acute thermal burns, and idiopathic sudden sensorineural hearing loss. Non-urgent conditions include delayed radiation injuries (soft tissue or osteoradionecrosis). HBOT for radiation cystitis has proven effective in over 80% of cases in published literature. A typical course is 30 sessions (2.5 hours per day, five days a week for six weeks) – a significant commitment. HBOT is also indicated for radiation proctitis, chronic refractory osteomyelitis, and some problematic wounds such as grade 3–4 diabetic foot ulcers. There is growing interest in its application in inflammatory bowel disease, including ulcerative colitis and Crohn’s disease. A recent systematic review and meta-analysis of 118 patients treated with HBOT for perianal fistulizing Crohn’s demonstrated clinical response and remission rates of 75% and 55% respectively, warranting further consideration. Several studies also show improvements using HBOT as adjunctive therapy for hospitalised ulcerative colitis flares, and its role here will be watched with interest. Contraindications include untreated pneumothorax, uncontrolled hypertension, congestive cardiac failure with ejection fraction below 35%, claustrophobia, congenital spherocytosis, uncontrolled diabetes, chronic sinus conditions, and advanced emphysema (“blue bloater”). Other factors include avoiding disulfiram, which blocks superoxide dismutase, and doxorubicin. As in every field of medicine, delving into specialty subjects highlights deep knowledge and expertise. With curiosity at a high, I was privileged to hold this conversation with Neil about practical issues of HBOT, how it works, and its value across many indications. There is much to learn and reflect on in relation to the clinical problems we face. Please welcome Neil to the podcast. References: | |||
| Episode 179. Oncology in General Practice with Dr Michael Fernando | 01 Sep 2025 | 00:45:10 | |
Cancer is one of the biggest health challenges worldwide. In 2021, about 15% of all deaths were cancer-related. In Australia, there are approximately 624 cases of cancer per 100,000 people, an incidence which has increased by about 7 % over 20 years, with an estimated 43 % of people being diagnosed by the age of 85 years. On a positive note, improved oncological medicine and care have reduced mortality by about 25 % which is very reassuring. The top ten cancers diagnosed in Australia, starting with the most common, are Prostate Cancer, followed by Breast Cancer, Melanoma, Colorectal Cancer, Lung Cancer, Non-Hodgkin Lymphoma, Kidney Cancer, Pancreatic Cancer, Thyroid Cancer and Uterine Cancer. From this group, deaths are more common with Lung Cancer, followed by Colorectal cancer and then Pancreatic and Breast cancer. Often, a primary practitioner will make the diagnosis or suspect changes in his/her patient that lead to a diagnosis being established. Whilst most treatment regimens are initiated by Oncologists, radiotherapists or Surgeons, the primary practitioner is very frequently saddled with managing many of the day-to-day issues arising from therapy and the emotional trauma associated with cancer treatment. I was interested to explore oncology in general practice more with my colleague, Oncologist Dr Michael Fernando, who generously joins us today on the podcast. Michael is beginning his journey in medicine and brings a huge amount of compassion, maturity and enthusiasm with him. He also jointly runs a podcast called Oncology for the Inquisitive Mind, which has been very well received, and I strongly recommend it to you. Please welcome Michael to the conversation. References. Dr Michael Fernando. Epping Specialist Group. www.eppingspecialistgroup.com Oncology for the Inquisitive Mind: podcasts.apple.com | |||
| Episode 178. Uterine and Cervical Cancer with Professor Thomas Jobling | 18 Aug 2025 | 00:33:43 | |
Uterine cancer is the fifth most common cancer in females and the most common cancer of the female genital tract in Australia, with about 3,300 cases annually and 660 deaths. The major prevalence is in women between 50 and 70 years, and the quoted major risk factors include: early onset menarche and late menopause, obesity, nulliparity, unopposed oestrogen treatments, polycystic ovaries with prolonged anovulation, extended use of tamoxifen for breast cancer treatment and Lynch syndrome, which confers a 30 % lifetime incidence. Presenting with abnormal PV bleeding or prolonged post-menopausal bleeding, other presentations may include dyspareunia, pelvic pressure, weight loss, anaemia and in later stages, possibly pelvic pain. Whilst a PAP smear will frequently be negative, pelvic imaging revealing a suspicious endometrium and subsequently hysteroscopy and biopsy guide the diagnosis. Patients with more than 50 % myometrial invasion have a six-to-seven-fold higher prevalence of pelvic lymph node metastases and advanced surgical stage compared with women with less than 50 % invasion. With current management the five-year survival has improved over the past 40 years to 83 %. In contrast to endometrial cancer, which has seen an increasing incidence since 1982 of about 0.9 % per year, Cervical cancer prevalence has reduced from 14 per 100,000 in 1982 to 7 per 100,000 in 2017, influenced by the introduction of the HPV vaccine Gardesil in 2007. Gardesil 9 is the HPV vaccine used in Australia’s National HPV Vaccination Program, providing 100 % protection against HPV strains 6,11,16,18,31,33,45,52 and 58, which are known to cause genital warts and cervical and other HPV -related cancers. Types 16 and 18 cause most of the HPV -associated cancers. This vaccine is recommended for all children aged 12 to 13 years and is free for all Australians aged 12 to 25 years. The vaccine is estimated to prevent up to 90% of cervical cancers and 96% of anal cancers. I was fortunate in this podcast to have a conversation with Professor Thomas Jobling regarding the risks and management of endometrial and cervical cancer. Tom is a gynaecological oncologist, ex-AFL footballer and medical researcher with a very respected reputation in Melbourne and internationally. He has extensive experience with minimally invasive surgery, including robotic surgery, for gynaecologic cancer. His main research area is ovarian cancer for which he received an Order of Australia Medal in 2017, and he is currently Head of Gynaecological Health and VMO at Peter MacCallum Hospital. Please welcome Professor Jobling to the podcast. References : Professor Tom Jobling: reception_tjobling@bigpond.com.au Endometrial Cancer Treatment-NCI Endometrial Cancer-Cancer Australia | |||
| Episode 177. Sleep Hygiene with Josh Leota | 05 Aug 2025 | 00:46:28 | |
The pace of modern life may not give many of us the time to stop, rest and recover with a good night’s sleep, yet sleep is as important for good health as diet and exercise. Regular healthy sleep improves brain performance, mood and health. Poor sleep hygiene is associated with increased risk of heart disease, stroke, obesity, impaired immune and cognitive function. Sleep consists of two distinct states as shown by EEG: REM sleep (rapid eye movement sleep), where dreaming occurs, and non-REM sleep, which is divided into 4 stages. Sleep is cyclical, with four or five REM periods during the night, accounting for about 1/4 of total sleep. Initial REM periods are shorter than later ones. During REM sleep, information is believed to be cemented into memory. Stage 4 sleep is the deepest, during which blood pressure, heart rate and breathing slow, muscles relax, and both growth and repair processes are believed to occur. Stage 4 usually occurs in the first several hours of sleep. Variations in sleep may be due to shift work, travel or individual patterns. Creativity and responsiveness to unfamiliar situations are impaired by sleep loss. Alcohol, smoking and stimulants such as caffeine, cold remedies and cocaine can reduce sleep time. Benzodiazepines tend to increase total sleep time with variable effects on non-REM sleep. Antidepressants tend to decrease REM sleep, with rebound on withdrawal in the form of nightmares. For most adults, 7–9 hours of uninterrupted sleep is recommended — a little less for older adults and more (8–11 hours) for teenagers, with even more needed for infants and toddlers. Sleep dysfunction is common and includes short sleep (less than 6 hours for under 65s, or 5 hours for older adults), long sleep (longer than recommended), poor sleep quality (frequent waking, difficulty falling asleep), and disorders such as sleep apnoea, restless leg syndrome and insomnia. Doctor-diagnosed sleep disorders affect about 1 in 5 adults, and 48% of adult Australians report at least two sleep-related problems. Up to 19% report not getting enough sleep. Shift workers (around 16% of the Australian workforce) are at higher risk, with 1 in 3 experiencing sleep disorders, including falling asleep at work and having a 60% higher risk of accidents compared to non-shift workers. An Australian survey of 1,050 adults revealed that sleeping pills were being used by 37%, 14% were using melatonin, and the majority were taking a range of hypnotics, including benzodiazepines and non-benzodiazepine products (e.g. Zopiclone from the cyclopyrrolone group or orexin receptor antagonists). I wondered if this high level of prescribing indicates that our general approach to advising patients on sleep should change in favour of promoting more natural ways of achieving sleep hygiene. To satisfy my curiosity and gain insights into healthy sleep patterns and how to achieve this naturally, we are joined by senior research scientist Josh Leota from Monash University’s School of Psychological Sciences. Josh is actively involved in sleep research, especially regarding the effects of sleep on athletic performance, and is currently studying a cohort of elite female athletes competing locally and after travelling through time zones interstate. I was very pleased to welcome Josh to share smart insights into understanding sleep cycles, how poor sleep may impact health, and advice on achieving sleep without pharmacological assistance. References: Josh Leota, Research Fellow. School of Psychological Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, Vic 3168 Sleep problems as a risk factor for chronic conditions: www.aihw.gov.au | |||
| Episode 176. Death from the Feet Up with Mr Allan Abbott | 14 Jul 2025 | 00:40:33 | |
Falls in the elderly are associated with significant morbidity and, after a serious fall, indeed predict the transition within a year of 10-15% of seniors to long-term care facilities. Additionally, the one-year and three-year mortality for seniors is 16.4 % and 40.5% following a report of more than one fall in the past 3 months (about double the average). When a hip fracture complicates the fall, the all-cause mortality is three times higher than for the average population and as high as 27% in one year in some studies. Many factors are at play in the deterioration of senior patients experiencing falls and mobility decline. Faltering stability may arise from inadvertent overmedicating with hypotensive agents and beta-blockers, or the consequences of previous cerebrovascular accidents, Parkinson's disease and myopathies. Excluding these more overt and obvious conditions, one of the greatest determinants of falls is toe strength. Toe strength affects stability, which is a problem in an estimated 1:4 people over the age of 65 years. The problem of falls relating to toe strength, foot proprioception and distal muscular control piqued my interest and led to a curiosity to explore this issue further with expert physiotherapist Allan Abbott. Allan is known for pushing the boundaries of knowledge and learning, and for providing a fresh perspective on many functional issues affecting us that one may not have considered previously in any detail. In an earlier podcast, Allan helped us explore breathing techniques designed to enhance physiologic function, and I would commend these episodes, including 139,140, as well as 153 and 154, to you. The concept of dying from the feet up warrants careful examination and thorough understanding. Hopefully, after listening to this podcast, you will believe, as I do, that we could all benefit from the ideas Allan explores. I was keen to learn more about the major factors contributing to foot problems, the exercises we should be considering and recommending as well as performing regularly ourselves to improve toe strength, balance and dexterity. The role of footwear and how one may select “good” foot support in terms of orthotics is also of significant importance and interest. If you are interested in improving foot function and limiting morbidity both for your patients and yourself, please join me with Allan as he navigates this fascinating topic. References: Mr Allan Abbott - Physiotherapists http://www.healthinnovations.net.com/ The prognosis of falls in elderly people living at home: Donald et al. Age and Ageing. Vol 28. March 1999. Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study Panuka et al.BMC Muskuloskeletal Disorders. May 20, 2011 Older adults and balance problems. Sep 2022. www.nia.nih.gov | |||
| Episode 174. Volume Exercise and the Heart with Dr Maria Brosnan | 16 Jun 2025 | 00:31:00 | |
The Greek messenger Pheidippides famously ran 42 kilometres from Marathon to Athens delivering news of victory in battle before dropping dead, still a young man. Pheidippides was undoubtedly fit and an accomplished runner as he had been a Greek herald messenger his entire life. Was his untimely death due to excessive exercising or unforeseen preexisting cardiac risk factors? This stand-out story mirrors the sad death last year of champion athlete and Queensland iron man Dean Mercer, aged 47 years, from an acute cardiac event after an early morning swim session. Was his death a consequence of his extraordinary training schedule or preexisting cardiac disease? The famous Australian Carney sisters were both forced to retire from world triathlon competition and their elite standing with life-threatening cardiac disease, similar to world champion triathlete Greg Welch. Notable athletes such as American marathon runner Ryan Shay succumbed from a fatal cardiac event at 28 years during Olympic Marathon trials and athlete authors Christopher McDougall known for his book ‘Born to Run’ died alone on a trail run in New Mexico aged 58 years similar to Jim Fixx who wrote ‘The Complete Book of Running’ and died in 1984 at the age of 52 from an acute cardiac event. These notable cases raise questions about the insidious impact of elite endurance sport and volume exercise and raise concerns about cardiac rhythm disturbances and coronary arterial plaque rupture, as well as chronic inflammation in a condition some refer to as “Athletes’ Heart”. As compelling as this diagnosis may seem, the proposed condition “Athletes’ Heart”, however, is not widely accepted and indeed, quoting Andre La Gerche, who is an expert sports cardiologist at the Baker Heart and Diabetes Institute, there is no proven link between endurance sport and sudden death. To the contrary, Athletes live longer. Endurance athletes and gold medallists live the longest; however, endurance athletes are about 2-5 % more likely than the general population to develop heart problems, including rhythm disorders such as Atrial Fibrillation”. Dr La Gerche urges us to remember the importance of separating public health from individual risk and reminds us that exercise in all forms reduces the risk of cardiovascular disease and diabetes and extends life. Any individual can have a heart attack; there are 20,000 deaths from heart disease per year in Australia -one every 10 minutes. Common things happen commonly, and about 1 per 100,000 people die of heart attacks during marathons; no conclusion can be drawn as a preexisting condition in such cases was likely. The question remains whether moderate exercise should be the goal with caution for those entering elite high-volume endurance training regimes. As noted, studies are progressing, but to answer some of these questions, I was joined by cardiologist Dr Maria Brosnan. Maria is an elite athlete herself, having competed widely, and has a strong interest in arrhythmias as well as cardiac physiology in elite athletes. She works at St Vincent's Heart Centre and The Baker Institute as well as the National Centre for Sport Cardiology. She serves as a consultant for Tennis Australia, The AFL draft, Rowing Australia and several professional cycling teams. Please welcome her to the podcast. References: D Maria Brosnan: St Vincent’s Heart Centre, www.stvheart.com and nationalsportscardiology.com Competitive Sports and the Heart: Benefit or Risk ?. https://pmc.ncbi.nih.gov Athletes and Heart Disease: Why Does It Happen? www.mountelizabeth.com | |||
| Episode 173. Artificial Intelligence and Medicine with Anders Sorman-Nilsson | 03 Jun 2025 | 00:45:00 | |
Artificial intelligence is a wide-ranging branch of computer science concerned with building smart machines capable of performing tasks that typically require human intelligence. It is widely accepted that artificial intelligence computer systems will be used extensively in Medical Sciences. Common applications are likely to include illness diagnosis, end-to-end drug discovery and development, improving communication between physicians and patients, transcribing medical documents, including history note taking and writing prescriptions. It is probable that as technology advances, doctors and allied health professionals will be replaced in certain roles by artificial intelligence computers. Artificial intelligence is not new and has been an important enabler within the technology industry, built into our handheld phone computer devices, enabling new business innovation, including web search content recommendations, product recommendations, targeted advertising and autonomously driven vehicles. Humans reap the benefits of artificial intelligence systems every day. In medical practice, there are many advantages offered from embracing artificial intelligence, with the expectation that diagnostic accuracy and patient care will be the beneficiaries, whilst providing an excellent second opinion or co-collaborator with the physician, increasing medical efficiency and confidence in applying treatment strategies. I was curious to learn more about the likely trends this technology might bring to health management and was fortunate to meet Anders Sorman- Nilsson at a recent medical conference where he provided our audience with a thought-provoking, entertaining and informative lecture on the future, including the possible integration of AI in medicine. As a global futurist and innovative strategist, Anders gave us a wonderful glimpse into a new world. Anders has degrees in both law and political science as well as an EMBA, has keynoted at TED X in the United States and Australia and shared the stage with Hillary Clinton. He was nominated to the World Economic Forum's young global leaders in 2015 and has authored 3 books, including Seamless, Thinque Funky and Digilogue, as well as contributing to After Shock, edited by John Schroeter. Noting how meticulously researched and energetic his lecture was at our conference, I could strongly recommend Anders to anyone seeking an excellent keynote speaker who will provoke searching questions and prompt some deep thinking, possibly inspiring a new and creative approach to how you conduct business and prepare for the future. In this podcast, I was keen to explore the possible place of artificial intelligence in medicine, including how it could impact diagnostic assistance, drug discovery, provide virtual health assistance, enhance personalised medicine, as well as improve robot-assisted surgery. Other areas of interest extend to its place in influencing medical education and training, clinical trial optimisation, natural language processing for health records and how it may assist in both the sequencing of genomes and coping strategies for those requiring mental health support. It was a great privilege to speak to Anders today. Please welcome him to the podcast. References: Anders Sorman-Nilsson found at: anderssorman-nilsson.com Artificial Intelligence: How is it Changing Medical Science and Its Future? Basu et al. https://www.ncbi.nlm.nih.gov | |||
| Episode 172. Oral Medicine with Dr Asef Anwar | 22 May 2025 | 00:33:38 | |
Good oral health is fundamental to overall health and well-being, and a person's quality of life is compromised without it. By Oral health, we are referring to the condition of a person's teeth and gums, as well as the health of the muscles and bones in their mouth. Tooth decay, gum disease and tooth loss affect many Australian children and adults and contribute 4.5% of all the burden that non-fatal diseases place on the community. Most oral health conditions are largely preventable, and it is estimated by the World Health Organization that oral diseases affect close to 3.5 billion people worldwide, with three out of four people affected living in middle-income countries. Many factors contribute to poor oral health, including consumption of sugar, tobacco and alcohol as well as a lack of good oral hygiene and regular dental checkups. Additionally, a lack of fluoridation in some water supplies and a lack of access and availability to dental care impact adversely. There are also recognised links between poor oral health and chronic diseases, including cardiovascular disease, cerebrovascular disease, diabetes, oral cancers, pulmonary conditions and adverse pregnancy outcomes. Socially disadvantaged and indigenous Australians are more likely than others to experience untreated dental and oral disease, which negatively impacts their health outcomes. This important subject is certainly worthy of further discussion, and it was a pleasure to meet Dr Asef Anwar, a registered Dental Surgeon with a passion for oral medicine. He is a graduate of the University of Sydney Dental School and has degrees as a Bachelor of Medical Science as well as being a Doctor of Dental Medicine. He has worked across private practices in both New South Wales and Victoria and has special interests in complex Full Mouth Rehabilitation, Dental Implants, Oral Surgery and Cosmetic Dentistry. He is committed to continuing education and research and is extending his knowledge and studies as the Oral Medicine Registrar at the University of Melbourne. It was a real pleasure to conduct a conversation with him today on the subject of Oral Medicine, exploring its interface with the practice of general medicine. I was curious to learn more about the relationship between oral mucosal and dermatological conditions, oral manifestations of systemic conditions, orofacial pain management and oral cancers. Another area of interest I was keen to explore related to the treatment of obstructive sleep apnea with mandibular advancement and dental splints, as well as broaching the subject of dental implants. With these points in mind, please welcome Dr Asef Anwar to the podcast. References : Dr Asef Anwar, MBedSci, DMD, FRACDS, FICOI. https://www.drasef.com.au Australian Institute of Health and Welfare. aihw.gov.au Australian Dental Association. https://ada.org.au | |||
| Episode 171. Questions in Cardiology with Dr James Sapontis (Part 2) | 06 May 2025 | 00:25:11 | |
Cardiovascular disease is a major cause of mortality in Australia, responsible for around one in four (24%) of all deaths. On average, around 120 people in Australia die from CVD each day - equivalent to one person every 12 minutes. 40% more men die from CVD compared to women. With these statistics in mind, it is perhaps as well that the field of cardiology appears to be galloping toward the future with exciting treatments to manage this substantial burden of disease. We are witnesses to the development of incredible percutaneous interventions, including coronary stenting, valve replacements and repairs, watchman devices, radio frequency ablations as well as enhanced diagnostic tools and pharmacologic choices. At times, I have found the pace of change difficult to stay current with and was interested in putting some questions forth to my colleague, Dr James Sapontis to clarify my understanding and build my knowledge base. I was curious about the protocols around dual platelet therapy and their combination with DOACS, a combination I have observed leading to increased occult and overt gastrointestinal bleeding and the escalating use of iron infusions to correct deficiency states and Capsule studies to determine oozing sites. I was also interested in the indication for the use of mitraclips, the place of B-type Natriuretic peptide test in the elucidation of heart failure, as well as many more developments that have solidified their place in the clinical world of cardiology. Please join me with the ever-patient and erudite cardiologist James Sapontis as we explore these points in more detail. References: Dr James's Sapontis : www.jamessapontis.com Cardiac Society of Australia and New Zealand. Guidelines for the management of antiplatelet therapy in patients with coronary stents undergoing non-cardiac surgery. Royal Australian College of General Practitioners (RACGP) https://www.racgp.org.au › afp CSANZ https://www.csanz.edu.au | |||
| Episode 170. New Treatment Modalities for Cardiogenic Shock with Dr James Sapontis (Part 1) | 21 Apr 2025 | 00:20:33 | |
One in five people will develop heart failure in their lifetime. Half will have preserved ejection fraction- HFpEF, which is becoming increasingly prevalent, the other half have heart failure with reduced ejection fraction- so-called HFrEF. Separate to these two entities an extreme form of heart failure is cardiogenic shock. This most commonly occurs after acute myocardial infarction (AMI) and complicates AMI’s in 5-10% of cases. Cardiogenic shock is a clinical syndrome characterised by decreased cardiac output resulting in end-organ hypoperfusion and tissue ischemia. Patients presenting with ST-elevation myocardial infarction (STEMI) are 2-fold more likely to present with cardiogenic shock than those presenting with a non-STEMI. Cardiogenic shock carries a poor prognosis and is the leading cause of death in patients with acute myocardial infarction. About 80% of patients with cardiogenic shock die despite optimal treatment, usually from complications including dysrhythmias, cardiac arrest, renal failure, ventricular aneurysm, stroke and thromboembolism. Treatment modalities include medical resuscitation and pharmacologic management, primary percutaneous coronary intervention, urgent coronary artery bypass grafting and artificial circulatory support, drawing upon intra-aortic balloon pumps and extracorporeal membrane oxygenation (ECMO). Additionally, there are non-intra-aortic balloon pump percutaneous mechanical devices as well as cardiac transplantation to consider. These treatments have reduced in hospital mortality yet, cardiogenic shock patients who survive to reach hospital discharge still have a higher rate of mortality post-discharge than uncomplicated AMI patients. Some exciting new developments are afoot however with the recent introduction into clinical practice in Australia of the micro axial pump device. I was curious to learn more about this subject and new approach to management and was privileged to have this conversation on the subject with expert cardiologist Dr James Sapontis. James has been involved with some of the steering committees related to cardiogenic shock management and works actively as an interventionalist at many sites in Melbourne including St John of God Berwick and Victorian Heart Hospital. Please welcome James to the podcast. References: Dr James's Sapontis : www.jamessapontis.com | |||
| Episode 169. Being Vision Impaired with Mr Murray Stewart (Part 2) | 08 Apr 2025 | 00:24:17 | |
Vision Australia estimates there are 453,000 people in our country who are blind or have low vision. This number is predicted to grow to over 560,000 people by 2030. Low vision refers to the ability to see at only 6 meters what a normal vision could see at 60 meters. It also refers to a restricted peripheral vision narrower than 20 degrees in diameter. Such people need to use devices, technology and adaptive strategies to keep doing the things they enjoy. Conditions such as age-related macular degeneration, albinism, cataracts and glaucoma, are often responsible for low vision. For those of us with relatively normal vision, it is easy to forget, ignore and misunderstand the challenges blind and vision-impaired people face daily. Apart from the obvious day-to-day challenges, blind and vision-impaired patients receiving medication have to cope with the difficulty of not seeing their prescription medication clearly, not recognising a pigmenting skin spot that may be melanoma or scaly lesion that could be neoplastic and have the significant emotional burden of isolation thrust upon them. I was curious to understand some of these challenges by holding a conversation with the brilliant Mr. Murray Stewart. Murray is blind but has found his way to becoming a community leader, a podcaster, philanthropist, Myo therapist, athletics trainer for some of our future star athletes and managing director of Blind magic Communication. Murray Stewart hails from Australia’s’ red centre and is a true inspiration to all who meet him, please welcome him to the Podcast.
References: Murray Stewart: Bridgeovermurray@bigpond.com www.healthline.com | |||
| Episode 168. How to exercise well with Murray Stewart (Part 1) | 24 Mar 2025 | 00:42:20 | |
Helping our patients attain good health holistically consists of diagnosing and treating their organic diseases, assisting them in achieving a healthy mental and emotional state as well as providing education on the fundamentals of a balanced diet, sleep hygiene, supportive relationships and exercise. With over 65% of Australians recognised as being either obese or overweight, promoting and detailing a practical exercise plan should be one of our key health objectives for patients coupled with healthy eating. Often a busy schedule, poor health and both a lack of confidence and motivation can make exercise challenging for our patients. Generally, the biggest barrier to establishing the important habit of exercise is a mental one. Whatever our patients’ age or level of fitness there are many steps we may lead patients along to make exercise less intimidating and painful and more fun and instinctive. We have to help our patients’ overcome excuses couched in terms such as ‘I hate exercising’, ‘I'm too busy’,’ I'm too tired’, ‘I'm too old’ or ‘I'm too fat’, ‘my health isn't good enough’, or ‘exercise is too painful and difficult and I'm just not athletic’. Whilst going for a walk at any pace is better than sitting on the couch, the current recommendation for most adults is to exercise for at least 150 minutes at moderate activity per week and this may be achieved in many ways such as exercising for 30 minutes five times a week. Thinking about intensity of exercise, low intensity activity is where one can easily talk in full sentences or sing during exercise, at moderate intensity one can speak in full sentences but not sing. At vigorous intensity exercise one is too breathless to even speak in full sentences. It's important to recommend that patients start small with realistic chunks of time dedicated to exercise before slowly building momentum and a healthy habit. Personal trainers, exercise physiologists and exercise apps may all provide specialist assistance as well as further motivation whilst injecting fun and confidence into a routine. Group exercises can also be inspiring and hold individuals accountable to a routine exercise program. It is important to remember that whilst health gains from exercise provides excellent positive feedback to patients, as clinicians encouraging words and interval health checks including measurement of fitness parameters such as pulse and blood pressure as well as lipid profile can be immeasurably helpful in building a patient’s esteem. In this podcast we hold a conversation with a brilliant man, a podcaster, philanthropist, Myo therapist, athletics trainer for some of our future star athletes who is also blind and managing director of Blind magic Communication. Murray Stewart hails from Australia’s’ deep heart and discusses in this podcast his approach to exercise and how he’s managed to motivate many of our young Australians of whom a significant number are indigenous on the athletics track of our own Alice Springs located in the deep red centre of Australia. Please welcome him to the Podcast. References: Murray Stewart: Bridgeovermurray@bigpond.com www.healthline.com | |||
| Episode 167. Low-Calorie Meal Replacement with Glennis Winnett | 11 Mar 2025 | 00:21:12 | |
Obesity has become a major public health concern, with an estimated 34% of Australians classified as obese—defined as having a body mass index (BMI) of 30 kg/m² or more due to excess body fat. It is now the second leading risk factor for chronic disease in Australia, increasing the likelihood of developing type 2 diabetes, metabolic syndrome (including cirrhotic liver disease), osteoarthritis, and several types of cancer, as well as contributing to higher all-cause mortality. While the pathophysiology of obesity is not yet fully understood, the primary goal of obesity management is to prevent and address obesity-related complications while improving overall quality of life. Standard treatment objectives include setting a weight loss target of approximately 10% for individuals with a BMI of 30–40 kg/m² and 15% for those with a BMI over 40 kg/m². This is initially achieved through dietary, exercise, and behavioural modifications before considering pharmacotherapy or bariatric surgery. Dietary approaches that focus on calorie restriction are the most common first-line strategies for obesity management. These approaches emphasise consuming a wide variety of predominantly unprocessed foods while limiting high-calorie, nutrient-poor options such as sugar-dense foods, refined carbohydrates, and alcohol. Various low-carbohydrate, high-protein diets—such as the Atkins, Keto, and South Beach diets—have gained popularity over the years. However, studies have shown that low-calorie meal replacement diets are more effective for weight loss compared to conventional low-energy, food-based diets. Calorie-restricted diets can be categorised based on daily calorie intake:
Meal replacements serve as a behavioural strategy that promotes weight loss by reducing food choices while controlling intake. These products are typically high in protein, low in carbohydrates, and fortified with essential vitamins and minerals. They can be used to replace all daily meals or just one to two meals per day. While many meal replacement products are available on the market, many do not meet the recommended daily protein intake. In this episode, we speak with Glennis Winnett from the nutrition company Formulite, which has developed a range of high-protein meal replacement products, including shakes, bars, recovery protein, and soup. Formulite offers Australia's only VLED programme that meets protein requirements with a three-product-per-day plan, supporting obese patients on their weight loss journey. During our conversation, Glennis shares her motivation for developing the impressive Formulite product line and discusses how these meal replacements can be incorporated into effective dietary strategies for weight loss. Please welcome Glennis to the episode! References:
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| Episode 166. Regenerative medicine with Dr Jeffrey Gross | 11 Feb 2025 | 00:34:39 | |
The field of regenerative medicine is receiving significant interest with the objective of restoring damaged tissues to health using biological products, as well as influencing age-related decay. The use of pluripotent stem cells has been studied for some years now with the hope of nurturing their undifferentiated state into specific cell types reflecting the target tissues requiring repair. Another approach has been to harness the biological properties of exosomes. Exosomes are nano-sized biovesicles released by all nucleated cells into surrounding body fluids upon fusion of tiny intracellular multivesicular bodies and the plasma membrane. These small vesicles, measuring between 40 and 160 nanometers, were first identified in the late 1980s and initially were proposed as cellular waste resulting from cell damage or by-products of cell homeostasis with little or no effect on neighboring cells. This initial simple interpretation of their function has now been supplanted by new insights into their physiological roles. Exosomes carry a complex cargo of proteins, lipids, and nucleic acids and are now recognized as functional vesicles capable of delivering very important cargoes of information to target cells they encounter. This chemical messaging may ultimately reprogram the recipient cells remotely from their release and represent a novel mode of intercellular communication as well as playing a major role in many cellular processes such as immune response, signal transduction, and antigen presentation. It is likely that the cargo of exosomes may differ significantly depending upon the function of the originating cell type and its current physiological state, including states of transformation, differentiation, stimulation, or stress. A current line of study aims to determine whether active exosome cargo may offer prognostic information on a range of diseases such as chronic inflammation, cardiovascular and renal disease, neurodegenerative diseases, lipid metabolic disease, and tumors. Additionally, as exosomes are not immunogenic, they are being examined for their potential to actively deliver biological therapeutics across different biological barriers to target cells, including across the blood-brain barrier. References: Dr. Jeffrey Gross:www.ReCELLebrate.com Stem Cells and Regenerative Medicine: From Molecular Biology to Clinical Applications. Academic Press. 2021. Exosomes in Cell-to-Cell Communication and Regenerative Medicine. Theranostics. 2020.www.ncbi.nlm.nih.gov The Role of Exosomes in Regenerative Medicine and Tissue Engineering. Frontiers in Bioengineering. 2019.www.frontiersin.org | |||
| Episode 165. Modern Approaches to Bariatric Surgery – Dr. Jason Winnett | 22 Jan 2025 | 00:33:11 | |
In this episode, we delve into the critical issue of obesity and the transformative potential of bariatric surgery with Dr. Jason Winnett, a leading expert in weight loss treatments and Director of the Winnett Specialist Group in Melbourne. With obesity affecting 67% of Australians and posing severe health risks such as type 2 diabetes, heart disease, and cancer, Dr. Winnett explores how modern surgical techniques are offering hope to those struggling to achieve sustainable weight loss through traditional methods.
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| Episode 164. Vascular Fistulas - The Door to Haemodialysis with Dr Ming Yii | 20 Jan 2025 | 00:28:24 | |
As a background to this podcast in 2021 there were 15 200 Australians with kidney failure receiving dialysis, a doubling of the number receiving dialysis from 2000 with a male-to-female ratio of approximately 2 to 1. 82% of these patients were receiving chronic haemodialysis all of whom required an arterio venous vascular shunt for access. A small proportion (18%) were being managed by peritoneal dialysis and in that year, there were 857 functioning kidney transplants. Of the haemodialysis patients 25% were being dialysed in hospital, 65 % in satellite centres and 9 % at home. Indigenous Australians representing 2.5 % of the population comprised 9% of patients commencing renal replacement therapy highlighting a very significant health burden for first nations people. The main indications for patients receiving dialysis included having severe renal failure with a GFR less than 15ml/min/1.75m2 accompanied by complications such as metabolic acidosis, hyperkalaemia, pericarditis, encephalopathy, intractable volume overload, anorexia with weight loss and lethargy, peripheral neuropathy, intractable gastrointestinal symptoms or having an e GFR of 5-9 ml/min or less despite being asymptomatic. Vascular access for haemodialysis is accomplished by the creation of an arteriovenous fistula or use of a prosthetic graft with catheters providing temporary access only. As normal veins are not strong enough to cope with the high pump pressures and the rapid blood flow from a dialysis machine a native fistula joining vein to artery, normally in the forearm is created. As the fistula matures over 6 to 8 weeks the vein adapts and thickens leading to a stable fistula ready for use. Both immediate, early and late complications are described including infection, aneurysm, thrombosis and staphylococcal infection. Despite expert surgery up to 30% of fistulas are unusable. The Kidney Disease Outcome Quality Initiative (KDOGI) describes the Rule of 6 for fistulas comprising being: Ready for use 6 weeks or more after being formed, having a blood flow through the fistula of 600 ml/ min, a diameter of 6 mm accessible for 6 cm and at 6 mm depth. To learn more about arteriovenous fistulas as well as the Do’s and Don’ts of fistula care in primary practice we welcome back Dr Ming Yii. Ming is a well-recognised expert in vascular surgery and is the director of vascular and transplant surgery at Monash Health and adjunct Senior lecturer with Monash University. Ming is also part of the Monash transplant team in kidney and pancreas transplantation and brings a wealth of knowledge and experience as well as an effusive personality to accompany his skills. In this episode he discusses his approach to fistula formation and for their ongoing management and care. References: Dr Ming Yii. mingyiivascular.com.au or admin@yiivascular surgery.com.au Webster AC et al. Chronic Kidney Disease. Lancet .2017Mar 25;389 (10075):1238-52. National Kidney Foundation: kidney.org | |||
| Episode 163. Snake Bite Envenomation in Australia with Dr Tim Jackson | 06 Jan 2025 | 01:01:52 | |
Show Notes: Snake Bite Envenomation in Australia with Dr Tim Jackson Australia is home to many of the world’s most dangerous snake species so familiarity with snake bite management and understanding the clinical effects of snake bite is vital for Australian doctors, especially those with a rural practice. Each year in Australia there are about 1000 recorded snake bites but fortunately only 2-3 deaths, most of these relate to bites from the brown snake. This contrasts with a vastly higher number of reported deaths from snake bite in India and Africa contributing to a recorded 100 000 deaths from envenomation globally. Australian snakes, also known as elapids, deliver a venom through their bite which predominantly exerts systemic effects. There are five major venom types for Australian snakes. Minor to moderate local effects may also be experienced depending on the snake genera. Snake venom is a complex mixture of many components including peptides, enzymes, phospholipases, proteases, and others. The venoms may have a potent pro coagulant effect leading to venom induced consumptive coagulopathy which may ultimately lead to defective coagulation through consumption of clotting factors. D- Dimer levels will be high in such instances. A primary anticoagulant effect may occur without significant D-Dimer production but significant bleeding. Other effects include neurotoxicity where toxins have either pre or post synaptic targets. Early signs of developing paralysis such as ptosis need to be watched for closely in the hope of avoiding a neurotoxic flaccid paralysis that may require ventilation. Myotoxicity predominantly affects skeletal muscle and may lead to profound rhabdomyolysis with renal injury and intravascular haemolysis as associated sequelae. Clinical diagnosis of envenomation may be based on a definite history of observed snake bite however more cryptic presentations where definite snake bite has not been observed may result in baffling systemic effects with minimal local evidence of a bite. It’s important to be aware of envenomation as a potential diagnosis in such cases. Detecting coagulopathy is the most urgent investigation to consider after an Australian snake bite. A complete coagulation panel including D-Dimer assessment is essential, electrolyte, renal function and creatinine phosphokinase levels should also be checked. For a well patient these tests should be ordered at presentation, after removal of the first aid pressure bandage and then again at 6 and 12 hours post bite, assuming preceding tests have been normal. Evidence of envenomation requires stabilisation of the patient and administration of antivenom. Australia is the only country with commercially available snake venom detection kits that may assist in the identification of venom that has been inoculated and provide a very helpful guide to the appropriate antivenom to administer. A polyvalent vaccine is also available for administration although larger in volume and associated with more side effects than the ‘monovalent ‘antivenoms correctly chosen from the kits mentioned above. Doses are the same for adults, children and the pregnant. Expert assistance from a toxicologist and intensivist should be sought early if troubling signs and symptoms of envenomation are observed. In this episode we have a conversation with Dr Tim Jackson who is co-head of the Australian Venom Research Unit at Melbourne University and an evolutionary biologist. Tim brings a huge and enthusiastic wealth of knowledge to this discussion, and it was a real honour to invite him as an expert guest. Please welcome Tim to the podcast. References: Dr Tim Jackson - AVRU - Australian Venom Research Unit - Melbourne University White, J.A Clinician’s Guide to Australian Venomous Bites and Stings, BioCSL, Melbourne 2013. Preventing and managing snake bites. (PDF). Qld Govt. May 2018 | |||
| Episode 162. Medical Outreach Programs with Sister Jodie Manssen | 16 Dec 2024 | 00:30:30 | |
Episode 162 Show Notes. Medical Outreach Programs with Sister Jodie Manssen In this episode, we sit down with the inspiring Sister Jodie Manssen, an expert ICU and emergency nurse, adventurer, and philanthropist, whose journey exemplifies compassion and dedication. In 2023, Jodie self-funded and volunteered with TrekMedic, a Melbourne-based nonprofit comprised of volunteer doctors, nurses, and allied health professionals. This organization provides basic healthcare, education, and emergency aid to underprivileged communities around the world. Jodie spent over two months of her time and expertise participating in TrekMedic’s annual trip to Nepal, sacrificing the financial security of her regular job to make an incredible impact. Highlights from the Nepal Trip (Sept–Oct 2023):
Jodie’s current work involves supporting First Nations communities in Alice Springs while preparing for her next adventure, attending to ski, snowboard, and mountain trauma in New Zealand’s winter season. References:
About the Podcast:Join us for this compelling conversation with Jodie, where we dive into her life-changing experiences in Nepal, her dedication to helping underserved communities, and her adventurous spirit. You won’t want to miss this incredible story of resilience, compassion, and purpose. | |||
| Episode 161. The Health Practitioner’s Journey with Michael Kenihan | 09 Dec 2024 | 00:36:23 | |
Michael Kenihan is nothing short of a legend in the Australian allied health community. Over four decades, he has made remarkable contributions as a sports physiotherapist, business manager, sports administrator, entrepreneur, coach, and thought leader in health and sports medicine. A fellow of Sports Medicine Australia, Michael has led Australia’s largest allied health network, Life Care, navigating major acquisitions, divestitures, and even an IPO. His entrepreneurial ventures include founding the Melbourne Stem Cell Centre and the innovative technology application R-U-Ontrak. Michael's positive energy, vitality, and deep expertise are reflected in his brilliant new book, The Health Practitioners Journey. This essential guide offers a four-stage career plan designed for health practitioners - from recent graduates to seasoned professionals - providing practical strategies for achieving both clinical excellence and financial success. The book lays out a clear roadmap: building and owning a patient list, leveraging that equity, and eventually preparing for a commercial sale. More than a manual, The Health Practitioners Journey is a companion for all health practitioners, including doctors, physiotherapists, and allied healthcare workers. It emphasises harvesting knowledge, recognising personal potential, and attaining a fulfilling career. Packed with insights, actionable tips, and strategies, it’s a must-read for anyone at any stage of their healthcare career, from starting private practice to navigating the complexities of mature career management. It was an absolute privilege to be introduced to Michael and to interview him for our podcast. Please join me in welcoming Michael Kenihan to the conversation! | |||
| Episode 160. Motor Neuron Disease (MND) with Associate Professor Ernie Butler (Part 2) | 18 Nov 2024 | 00:32:55 | |
Motor neuron disease (MND) is a rare group of neurodegenerative disorders causing motor nerves in the brain and spine to lose function over time. It affects approximately 2,000 Australians (1 in 11,000), with two new diagnoses daily and a 1:300 lifetime risk. MND is more common in males (60%) than females (40%), particularly those aged 75–84. While 10% of cases have a hereditary cause, the genetic fault is identifiable in only 60% of these cases. Types of MND 1. Amyotrophic Lateral Sclerosis (ALS): The most common form, affecting both upper and lower motor neurons, leads to muscle weakness in the arms, legs, mouth, and respiratory system. ALS patients typically live 3–5 years post-diagnosis, but supportive care can extend survival. Prominent figures such as Stephen Hawking and Lou Gehrig had ALS. In Australia, Neale Daniher's 2013 diagnosis raised significant awareness. ALS is sometimes associated with frontotemporal dementia (10–15% of cases). 2. Primary Lateral Sclerosis (PLS): A rare, non-fatal form that progresses slowly, affecting brain neurons. 3. Progressive Bulbar Palsy (PBP): Involves the brainstem, causing speech, swallowing, and choking difficulties. Often co-occurs with ALS. 4. Progressive Muscular Atrophy: Affects lower motor neurons, leading to gradual muscle wasting in the arms, legs, and mouth. 5. Spinal Muscular Atrophy (SMA): An inherited condition caused by a genetic change (SMA1), mainly affecting children. 6. Kennedy’s Disease: An inherited disorder affecting males, causing muscle weakness, twitching, and other symptoms such as gynecomastia and azoospermia. Causes and Risk Factors While 10% of MND cases are hereditary, the rest arise randomly. The exact causes remain unclear, but factors such as genetics, toxins, viruses, and environmental influences are believed to contribute. Symptoms and Diagnosis Early symptoms, such as muscle twitching, weakness, and slurred speech, may mimic other conditions like multiple sclerosis. Diagnosis is challenging due to the lack of specific biomarkers, though imaging like MRI or CT can help rule out other conditions. Treatment and Management While MND has no cure, various treatments can slow its progression and help manage symptoms. Medications like Riluzole, which reduces glutamate release, can extend short-term survival in ALS, while Edaravone slows disease progression in milder cases. Baclofen helps alleviate muscle stiffness, and Botox provides temporary relief from muscle spasticity. Supportive therapies, including physical therapy, speech therapy, and NSAIDs, can reduce discomfort from cramps, spasms, and mild pain, improving the patient’s quality of life. Guest Expert In this episode, we welcome back Associate Professor Ernie Butler, a consultant neurologist and founding member of Frankston Neurology Group. He specialises in managing multiple sclerosis, myasthenia gravis, and Parkinson’s disease. Prof. Butler holds leadership roles at Peninsula Health, Monash Health, and the Monash MS clinic. He previously joined us on episodes covering multiple sclerosis, myasthenia gravis, and Guillain-Barre syndrome. Join us as we explore MND in-depth with Associate Professor Butler, gaining insights from his extensive expertise in neurology. | |||
| Episode 159. Parkinson's Disease with Associate Professor Ernie Butler (part 1) | 05 Nov 2024 | 00:49:04 | |
Exploring Parkinson's Disease with Associate Professor Ernie Butler In this episode, we dive into Parkinson’s Disease (PD), a progressive neurodegenerative disorder that primarily impacts dopamine-producing neurons in the substantia nigra, leading to motor and non-motor symptoms. Our guest, Associate Professor Ernie Butler, consultant neurologist and founder of Frankston Neurology Group, provides expert insights into PD's complexities. Pathophysiology of Parkinson’s Disease Global Impact Core Symptoms of Parkinson’s Disease
Parkinson’s Plus Syndromes
Risk Factors
Diagnosis and Treatment Treatment Options
References Frankston Neurologyhttps://www.frankstonneurology.com.au › ...Our Neurologists Parkinson's Foundationhttps://www.parkinson.org › what-is...What is Parkinson's? | |||
| Episode 158. Forest Ecology, Bush Fires and Health with Professor David Lindenmayer | 21 Oct 2024 | 00:35:03 | |
It’s difficult to walk through an old-growth natural forest anywhere in the world and not feel awe and a connection to the majesty of our beautifully stunning Earth, however, when these amazing ecosystems burn as forest fires the consequence has devastating outcomes for affected communities. In recent times in Australia the Ash Wednesday fires of 1983 claimed 75 lives, The Black Saturday Fires of 2009 claimed 173 lives, 3500 buildings, and 2000 houses and the Black Summer fires of 2019/2020 claimed 26 lives and 2500 houses. The health consequences in terms of mental health, acute pulmonary disease and socioeconomic effects from these disasters is difficult to comprehend and the loss of life devastating. The normal response to fire prevention has been to recommend controlled burns and to thin forests through commercial logging. Is this scientifically correct? We talk with Professor David Lindenmayer from the Fenner School of Environment at ANU in this episode to explore this idea further. David is a leading world expert on forest ecology and resource management, conservation science and biodiversity conservation. He has published over 900 peer reviewed scientific papers and written 48 books with his latest book The Forest Wars addressing myths concerning forest management and ecology to be released in the next few weeks. He is frequently consulted by government and has lectured widely on this subject. His scientific work has pointed to the reduced flammability of mature forests, wet or dry, compared to younger forests subject to recent logging or controlled burn offs. Forest disturbance has been found to stimulate flammability; an effect referred to as disturbance-stimulated flammability. Both crown fire -where burn occurs up to 7 times the height of flames, and house loss were more likely in the 2009 tragic Victorian fires if the area within 1 km of houses had been burnt off within the past 5 years. His work highlights the value of reviewing the science on the subject at hand, to be curious and question the evidence and rationale underpinning decision making and to muster the courage and commitment to educate the world despite the resistance and ignorance that exists to hear and understand the truth. As Bill Mollison said, “If we lose the forests, we lose our only teachers”. It was a great privilege to have this conversation with David who I believe is at the vanguard of ecological change and thinking both in Australia and on the world stage. I look forward to reading his new book The Forest Wars and hope you will also. Please welcome David to the podcast References: Professor David Lindenmayer, Professor of Ecology and Conservation Biology at the Australian National University’s Fenner School of Environment and Society Identifying and managing disturbance-stimulated flammability in woody ecosystems. David Lindenmayer and Phil Zylstra, Biological Reviews (2023) The Forest Wars, David Lindenmayer, Allen & Unwin 2024 | |||
| Episode 157. Globus and Cough with Dr Andrew Martin (part 3) | 08 Oct 2024 | 00:23:15 | |
Globus, a persistent or intermittent sensation of a lump or foreign body in the throat, is a well-defined clinical symptom. Though it is non-painful, it can be long-lasting, difficult to treat, and prone to recurrence. Interestingly, this sensation often improves with eating and typically does not accompany dysphagia (difficulty swallowing) or odynophagia (painful swallowing). Globus is a common condition, accounting for about 4% of new referrals to ear, nose, and throat (ENT) clinics, and is reported by up to 46% of apparently healthy individuals, with peak incidence in middle age. The condition affects men and women equally, though women are more likely to seek medical care for it. The origins of globus pharyngeus trace back to Hippocrates, who noted it around 2,500 years ago. In 1707, Purcell provided the first accurate description, attributing it to pressure on the thyroid cartilage from the contraction of the neck's strap muscles. Historically, the condition was labeled as "globus hystericus" due to its frequent association with menopause or psychological factors. However, in 1968, Malcomson introduced the more accurate term "globus pharyngeus" after discovering that most patients with globus did not have a hysterical personality. The exact cause of globus remains unknown, but it appears to be multifactorial. While data are limited, recent studies suggest that factors such as gastroesophageal reflux disease (GERD), abnormalities of the upper esophageal sphincter (UES), psychological and psychiatric disorders, and stress may contribute to the sensation of globus. The variety of potential causes has made it challenging to establish standard investigation and treatment strategies, requiring an open mind when considering possible causes. Dr. Andrew Martin, a practicing ENT surgeon based in the southeastern suburbs of Melbourne and Northern Tasmania, sheds light on this condition. He completed his MBBS at The University of Queensland in 2008, following a Bachelor of Pharmacy Sciences with Honours from Monash University in 2003. In 2021, he earned his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand and completed an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022. Dr. Martin has special interests in nasal obstruction, obstructive sleep apnea, ear and balance issues, chronic sinus disease, mid-facial pain, pediatric ENT, as well as swallowing, voice, and throat disorders. Beyond his professional achievements, Andrew is a dedicated family man with two young daughters and enjoys hunting and fishing in his free time. It was a privilege to have this insightful conversation with him about globus symptoms. Please welcome Dr. Andrew Martin to the podcast. References: "Globus pharyngeus: A review of its etiology, diagnosis and treatment." World Journal of Gastroenterology. 2012 May 28; 18(20): 2462–2471. Published online 2012 May 28. doi: 10.3748/wjg.v18.i20.2462 | |||
| Episode 156. Mid Facial Pain with Dr Andrew Martin (part 2) | 23 Sep 2024 | 00:20:20 | |
Approximately 1 in 10 adults will experience pain or discomfort in the mid-facial region, with a higher prevalence among females and young adults. Understandably, many patients attribute this pain to sinus issues, given the proximity of the sinuses to the face. However, nasal endoscopy and CT scans have shown that chronic sinus infections are not as common a cause of facial pain as one might think. Sinusitis typically causes significant pain only when accompanied by thick nasal drainage, loss of smell, or nasal obstruction. In these cases, nasal endoscopy usually reveals some drainage or inflammation. Facial pain related to sinusitis is generally alleviated, at least partially, by a course of antibiotics. When sinusitis is ruled out, other potential causes of mid-facial pain should be considered, including:
Dr. Andrew Martin is a practicing ENT surgeon based in Melbourne's southeastern suburbs and Northern Tasmania. He earned his MBBS from The University of Queensland in 2008, following a Bachelor of Pharmacy Sciences with honours from Monash University in 2003. In 2021, he completed his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand, followed by an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022. Dr. Martin has a special interest in various conditions, including nasal obstruction, obstructive sleep apnoea, ear and balance problems, chronic sinus disease and mid-facial pain, paediatric ENT, and disorders related to swallowing, voice, and the throat. Beyond his medical practice, he is a dedicated family man with two young daughters and enjoys hunting and fishing. It was a privilege to have Dr. Martin join us for this conversation, where we explored the complexities of mid-facial pain in greater detail. Please join me in welcoming Dr. Andrew Martin to the podcast. References:
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| Episode 155. Allergic Rhinitis and Sinusitis with Dr Andrew Martin (part 1) | 16 Sep 2024 | 00:34:46 | |
Rhinitis, Sinusitis, and Rhinosinusitis are common conditions frequently seen in primary care. Studies indicate that 1.4 out of every 100 general practice encounters involve acute or chronic sinusitis, and over 2 million Australians are estimated to suffer from chronic rhinosinusitis. In some studies, this condition has shown a greater impact on social functioning than chronic heart failure, angina, or back pain. Anatomy and Pathophysiology: The paranasal sinuses—frontal, maxillary, ethmoid, and sphenoid—are lined with ciliated epithelium and goblet cells, forming a mucociliary blanket that traps and moves harmful particles to the nasopharynx. The maxillary sinus, the largest air-filled sinus in the body, has a draining ostium only 2.4 mm in diameter, making it particularly prone to blockage during infection or inflammation. Treatment for sinusitis focuses on restoring mucociliary clearance and drainage while addressing underlying inflammation. Acute Rhinosinusitis: The spectrum of acute rhinosinusitis (ARS) includes the common cold, post-viral ARS, and acute bacterial rhinosinusitis. Though less than 2% of viral upper respiratory infections progress to bacterial infections, antibiotics are prescribed in over 85% of sinusitis cases. Symptoms of ARS include nasal obstruction, discharge, changes in smell, facial pain or pressure, and cough. Facial pain may worsen when bending forward and can radiate to the teeth. Diagnosis requires the sudden onset of two or more symptoms, with at least one being nasal blockage, congestion, obstruction, or discharge, accompanied by facial pain or pressure and/or a reduction in smell. Nasal examination should assess for discharge (clear or purulent), polyposis, swelling, and erythema. Chronic Rhinosinusitis (CRS): CRS presents in two forms, distinguished by the presence or absence of nasal polyps. It is defined by the persistence of symptoms for more than 12 weeks, including nasal congestion, discharge, facial pain or pressure, and reduced smell. Viral and bacterial infections are the most common causes, with Streptococcus, Pneumococcus, Haemophilus, and Moraxella being the usual bacterial suspects. Other factors such as allergies, structural abnormalities, ciliary dysfunction, immunodeficiencies, and fungal infections should also be considered. Allergic Rhinitis: Allergic rhinitis, commonly known as hay fever, affects around 18% of Australians. Despite its name, allergic rhinitis is not caused by hay and does not result in fever. It typically presents with sneezing, itching, rhinorrhoea, nasal congestion, and lacrimation, triggered by allergen exposure. These allergens can often be identified through patient history, but RAST serology may be required when clear precipitants are not evident. To deepen our understanding of these conditions, we welcome Dr. Andrew Martin, a practicing ENT surgeon in Melbourne's Southeastern suburbs and Northern Tasmania. Dr. Martin completed his MBBS at The University of Queensland in 2008 after earning a Bachelor of Pharmacy Sciences with Honours from Monash University in 2003. He completed his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand in 2021, followed by an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022. Dr. Martin’s specialties include nasal obstruction, obstructive sleep apnoea, ear and balance disorders, chronic sinus disease, mid-facial pain, paediatric ENT, and disorders affecting swallowing, voice, and throat. Outside of his medical practice, he is a devoted family man with two young daughters and enjoys hunting and fishing. It was a privilege to have this conversation with him as we explored rhinitis and rhinosinusitis in more detail. Please join me in welcoming Dr. Andrew Martin to the podcast. References: | |||
| Episode 154. Functional Breathing with Dr Allan Abbott (Part 2) | 02 Sep 2024 | 00:27:30 | |
In an earlier episode titled Breathing we had the privilege to explore heathy breathing patterns and the Bohr effect which governs oxygen delivery to tissues with physiotherapist and breathing expert Allan Abbott, if you haven’t had an opportunity to listen to that podcast, I recommend it as an introduction to the subject we are covering today. Allan has been exploring breathing techniques to enhance exercise performance and improved health for many years and has created a dynamic company called Health Innovations that can be found at healthinnovations.net.au in order to bring this important knowledge into public forum. Although most of us pay little attention to breathing technique in our busy world, many cultures and alternative health practises such as YOGA and Ayurveda have focused on this for centuries and the recent excellent book Breath by James Nestor explores the importance of breathing technique in detail including the influence on facial structure and disease brought about by mouth breathing and poor execution of this seemingly automatic task. Allan takes us further in this podcast episode in which we explore functional breathing, breathing during exercise and how we can utilise breathing techniques to replicate high altitude training at sea level to improve performance and stamina in ways you may not have considered possible. Allan was generous enough to give up a good deal of his spare time taking me on a deep dive through these breath training techniques one on one. We focused first on nasal breathing light, slow and deep utilising the diaphragm rather than purely chest muscles and aiming for a 4 second nasal inhalation followed by a slow nasal exhalation over 6 seconds. This develops the habit of six breaths per minute. We then worked on the breath oxygen level test - the so-called BOLT with the objective of building CO2 tolerance to reduce the ‘gassing out’ feeling that can occur when one trains at a moderate exercise intensity. Subsequently Allan took me to ‘altitude’ with some strong breath holds during exercise simulating the reduced partial pressure of oxygen experienced as we venture 2000 metres above sea level and more, slowly resetting central CO2 chemoreceptors, increasing our haematocrit, erythropoietin and 2-3 DPG levels as well as enhancing myoglobin production, mitochondrial density, and cardiac output. Allan is meticulous about this training and on establishing correct technique noting this would not be appropriate for those with advanced lung disease. I really enjoyed learning from him and have implemented these exercises into my daily routine. I hope this conversation will pique your interest as it did mine as we share the art of functional breathing. Please welcome Allan to the conversation. References: Allan Abbott at: healthinnovations.net.au (+61) 0419379371 Buteyko.com Acute Effects of Repeated Cycling Sprints in Hypoxia Induced by Voluntary Hypoventilation. Woorens/ European Journal of Applied Physiology. September 2017 Repeated Sprint Training in Hypoxia Rugby. Woorens . European Journal of Sport Science. 2018. Intermittent Hypoxia Training. Sohagatay et al. Journal of Human Kinetics Vol32/2012 197-210 Hypercapnic Hypoxic Training. Bakovic et al. Journal of Applied Physiology 2003, Vol 95 No 4 1460-1466 Breathing Pattern Disorders and Functional Movement. Bradley et Al. International Journal of Physiotherapy Feb 2014,9(1),28-39 James Nestor- Breath - The New Science of a Lost Art. Riverhead Books, 2020 | |||
| Episode 153. Functional Breathing with Dr Allan Abbott (Part 1) | 26 Aug 2024 | 00:33:43 | |
In an earlier episode titled 'Breathing' we had the privilege to explore heathy breathing patterns and the Bohr effect which governs oxygen delivery to tissues with physiotherapist and breathing expert Allan Abbott, if you haven’t had an opportunity to listen to that podcast, I recommend it as an introduction to the subject we are covering today. Allan has been exploring breathing techniques to enhance exercise performance and improved health for many years and has created a dynamic company called Health Innovations that can be found at healthinnovations.net.au in order to bring this important knowledge into public forum. Although most of us pay little attention to breathing technique in our busy world, many cultures and alternative health practises such as YOGA and Ayurveda have focused on this for centuries and the recent excellent book Breath by James Nestor explores the importance of breathing technique in detail including the influence on facial structure and disease brought about by mouth breathing and poor execution of this seemingly automatic task. Allan takes us further in this podcast episode in which we explore functional breathing, breathing during exercise and how we can utilise breathing techniques to replicate high altitude training at sea level to improve performance and stamina in ways you may not have considered possible. Allan was generous enough to give up a good deal of his spare time taking me on a deep dive through these breath training techniques one on one. We focused first on nasal breathing light, slow and deep utilising the diaphragm rather than purely chest muscles and aiming for a 4 second nasal inhalation followed by a slow nasal exhalation over 6 seconds. This develops the habit of six breaths per minute. We then worked on the breath oxygen level test - the so-called BOLT with the objective of building CO2 tolerance to reduce the ‘gassing out’ feeling that can occur when one trains at a moderate exercise intensity. Subsequently Allan took me to ‘altitude’ with some strong breath holds during exercise simulating the reduced partial pressure of oxygen experienced as we venture 2000 metres above sea level and more, slowly resetting central CO2 chemoreceptors, increasing our haematocrit, erythropoietin and 2-3 DPG levels as well as enhancing myoglobin production, mitochondrial density, and cardiac output. Allan is meticulous about this training and on establishing correct technique noting this would not be appropriate for those with advanced lung disease. I really enjoyed learning from him and have implemented these exercises into my daily routine. I hope this conversation will pique your interest as it did mine as we share the art of functional breathing. Please welcome Allan to the conversation. References: Allan Abbott at: healthinnovations.net.au (+61) 0419379371 Buteyko.com Acute Effects of Repeated Cycling Sprints in Hypoxia Induced by Voluntary Hypoventilation. Woorens/ European Journal of Applied Physiology. September 2017 Repeated Sprint Training in Hypoxia Rugby. Woorens . European Journal of Sport Science. 2018. Intermittent Hypoxia Training. Sohagatay et al. Journal of Human Kinetics Vol32/2012 197-210 Hypercapnic Hypoxic Training. Bakovic et al. Journal of Applied Physiology 2003, Vol 95 No 4 1460-1466 Breathing Pattern Disorders and Functional Movement. Bradley et Al. International Journal of Physiotherapy Feb 2014,9(1),28-39 James Nestor- Breath - The New Science of a Lost Art. Riverhead Books, 2020 | |||
| Episode 152. Amyloid Diseases with Dr Simon Gibbs | 12 Aug 2024 | 00:41:49 | |
Amyloidosis is a group of diseases in which abnormal proteins known as amyloid fibrils build up in various tissues including the kidney, heart, liver, skin, and nervous system resulting in a variety of clinical sequelae including organ dysfunction and death. There are over 23 unrelated proteins known to form amyloid fibrils, many of which are aggregates of misfolded proteins that are neither biodegradable nor can be recycled by our bodies. Abnormal Immunoglobulin light chains known as AL (amyloid light chain), transport protein transthyretin (ATTR) which normally transports retinol and thyroxine, and amyloid A (AA) are some of the better recognised examples of amyloid proteins. It is important to note however that hereditary, dialysis associated, localised and ocular forms also exist, and Beta protein precursor is implicated in Alzheimer syndrome as are other amyloid fibrils in different dementia diagnoses. The quoted incidence of amyloid disease is 12 per million and it is estimated that over 20 000 cases of amyloid are undiagnosed and untreated in Australia alone. It is noteworthy that 13-17% of patients with heart failure and degenerative aortic stenosis have amyloidosis and that up to 50 % of patients with amyloid see five doctors before a diagnosis is made. Up until recently only a four-year life expectancy was anticipated, fortunately pharmacological breakthroughs are expanding this horizon. Although the term amyloid was originally coined by German botanist Mathias Schleiden to describe the normal amylaceous of plants, it was Rudolf Virchow in 1854 who adopted the term to describe abnormal extracellular material seen in the liver during autopsy. As we will explore in this podcast we now think of amyloid disease in terms of primary systemic amyloid (AL) where a clone of abnormal plasma cells secretes excess immunoglobulin light chains that misfold and aggregate as non-biodegradable non-recyclable amyloid fibrils. Such a clone is also observed in about 5 % of myeloma diagnoses and about 12% of MGUS (monoclonal gammopathy of uncertain significance). Additionally, age associated amyloid transport transthyretin protein ATTR is an acute phase reactant produced predominantly in the liver in response to multiple cytokines which may become amyloid in form with senescence depositing in the heart and kidneys where diastolic dysfunction and renal impairment develop. In this podcast I was curious to explore how we can improve our surveillance for this condition and to raise our awareness. I was also keen to understand how to confirm the diagnosis and to explore treatment options. To explore this interesting area further please welcome to the podcast Dr Simon Gibbs from Precision Haematology who is a clinical haematologist and amyloidosis specialist, and a Senior adjunct lecturer at Monash University. After attaining his medical degrees from the University of Melbourne he moved to Cambridge in the United Kingdom to gain further experience in autologous and allogeneic bone marrow transplantation as treatment for myeloma and leukaemia and completed a four-year fellowship at the National Amyloidosis Centre at University College London, focusing on novel therapies for AL amyloidosis. Upon returning to Australia, he was appointed the Myeloma Lead at Eastern Health and established the Victorian and Tasmanian Amyloidosis Service (VTAS). He is the Chair of the Australian Amyloidosis Network (www.amyloidosis.net.au), and a member of the Haematology Society of Australian and New Zealand (HSANZ). He serves on both the Educational Subcommittee for the International Society of Amyloidosis, and the Medical and Scientific Advisory Committee (MSAG) for Myeloma Australia and is the author of over 40 publications in international medical literature. References : Dr Simon Gibbs: https://precisionhaematology.com.au/doctor/dr-simon-gibbs/ Australian Amyloidosis Network: https://aan.org.au/ | |||
| Episode 151. Faecal Microbial Transplant for IBD | 30 Jul 2024 | 00:27:04 | |
The use of faecal microbiota transplantation (FMT) to treat severe C. Difficile enterocolitis was visited in episode 14 of Everyday Medicine with Dr Darcy Holt as our guest. If you haven’t had an opportunity to listen to that conversation, please do and hopefully it will pique your interest. In this episode we invite a guest involved in active research at Melbourne’s St Vincent’s Hospital to discuss FMT in IBD broadly then more specifically as it applies to her current research project evaluating its efficacy in Crohn’s disease. FMT is defined as the infusion of faeces from healthy donors into the gastrointestinal tract of recipients to treat disease associated with gut dysbiosis. Noting that the precise aetiology of IBD is unknown, a multifactorial pathogenesis is proposed influenced by genetic susceptibility, host mucosal immune responses and the environment including diet, the gut microbiome and smoking history. Particularly with both ulcerative colitis and Crohn’s disease a deficiency in Faecal bacterium prausnitzii recognised for its potential anti- inflammatory properties has raised interest in the FMT space. To date FMT has been investigated in patients with inflammatory bowel disease (IBD) both in non- randomised and subsequently randomised controlled trials showing promising results although with significant differences in FMT protocols and procedures. The adoption of FMT for the treatment of IBD is compromised by recruitment of donors, preparation of faecal material, determination of the optimal route of administration and lack of established regulatory framework. Establishing an optimal framework is essential for the future management of IBD should the merits of this therapy stand up to scrutiny. The first international Rome consensus conference on gut microbiota and faecal microbiota transplantation in inflammatory bowel disease, published in Gut.bmj this year has attempted to set this framework and is a very helpful publication. In this episode we introduce Dr Sasha Fehily who is actively engaged in the MIRO study looking at FMT in Crohn’s IBD. The MIRO Study is a randomised, double-blind placebo-controlled trial where all recruited patients receive active standard IBD treatment and those on placebo who don't respond are administered active FMT therapy. This is an excellent study with greatly anticipated results, and I was curious to learn more about the research directly from Sasha. Please welcome her to the podcast. References : Dr Sasha Fehily - St Vincent’s Hospital Melbourne Guideline: The first international Rome consensus conference on gut microbiota and faecal microbiota transplantation in inflammatory bowel disease. Lopetuso et al. https://gut.bmj.com/content/72/9/1642 | |||
| Episode 150. Common Problems in Ophthalmology with Dr Rogan Fraser | 15 Jul 2024 | 00:40:15 | |
Primitive single-celled organisms had patches of photoreceptor proteins to detect light. The first eyes, developed over 550 million years ago, are now the second most complex organ after the brain, with over two million working parts and more than a million nerve fibres connecting each eye to the brain via the optic nerves. Unfortunately, many Australians suffer from chronic eye conditions, with over 13 million affected. Chronic eye disorders impact up to 93% of people aged 65 and over, with a higher prevalence in females. These conditions include refractory disorders like hyperopia, myopia, presbyopia, and astigmatism, as well as colour blindness (affecting about 550,000 Australians), cataracts, macular degeneration, diabetic retinopathy, strabismus, amblyopia, venous occlusions, and retinal detachment. Noteworthy conditions include: - Age-related macular degeneration (AMD): The most common cause of irreversible vision loss in Australia, affecting 1 in 7 people over 50. AMD impairs tasks requiring central vision like reading and driving. - Cataracts: Lens opacities impacting vision and the leading cause of visual impairment. Cataract surgery is the most common elective procedure in Australian public hospitals. - Glaucoma: The world's leading cause of blindness, affecting about 300,000 Australians. It is often asymptomatic early on and significantly increases in prevalence after 50. In this episode, Dr Rogan Fraser, completing his fellowship in ophthalmology, discusses common eye problems. Topics include managing red eye, ophthalmic complications from shingles, giant cell arteritis, and semaglutide (Ozempic), as well as glaucoma, retinal vein occlusion, and macular degeneration. Welcome Dr Rogan Fraser to the podcast for a focused tour of key ophthalmology topics. References: LinkedIn - https://www.linkedin.com/in/rogan-fraser-7a9855b8/ National Eye Institute https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases https://www.aao.org/eye-health/news/can-ozempic-affect-eye-health-here-s-what-ophthalm | |||
| Episode 149. Allergy and Food Sensitivity with Dr Colin Little | 01 Jul 2024 | 01:08:14 | |
An estimated 20% of Australians have an allergic disease, with Melbourne as a hotspot where one in three people experience hay fever and thunderstorm asthma. Allergies can affect the skin, sinuses, airways, gastrointestinal tract, or other organs. Allergies are immune reactions to foreign antigens, causing tissue inflammation and organ dysfunction. Symptoms depend on prior immune response, antigen exposure, and genetic factors. Atopic individuals have a genetic predisposition to conditions like allergic rhinitis, atopic dermatitis, allergic asthma, and IgE-mediated food allergies. Reactions can be immediate (within 60 minutes) or delayed (hours, days, or weeks). In 1963, Gell and Coombs classified hypersensitivity reactions into four types based on the immune response.
In this podcast, we explore the prevalence of allergies, their signs and symptoms, and common diagnostic tests. We also discuss non-allergic sensitivities like reactions to nitrates, sulphites, and food additives. Dr Colin Little, a Melbourne-based immunologist and allergist with over 40 years of experience, provides insights on treating common and rare allergic conditions. References:
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| Episode 148 - Barrett’s Oesophagus, Endoscopic Mucosal Resection and Radiofrequency Ablation with Professor Finlay Macrae | 17 Jun 2024 | 00:44:27 | |
Barrett’s oesophagus is a common condition, named after the Australian born thoracic surgeon Norman Barrett who practised in England and laid the foundation descriptions of this condition but incorrectly concluded the abnormal columnar tissue lining was embryonic in origin due to the presence of a congenitally shortened oesophagus leading to a tubular portion of stomach being trapped in the chest. We now recognise that between 5-10 % of patients with chronic reflux disease develop columnar metaplasia as a response to repeated oesophageal acid exposure. Long segment disease extends for more than 3 cm, short segment less than 3 cm and metaplasia at the OG junction (less than 1 cm in length) is not considered to be pathological. Its presence informs us that our patient has GORD and alerts to the possibility of dysplastic change and malignant transformation. Although the latter is relatively unlikely in any individual the risk is real. Estimates quote 0.33 to 0.5 % risk per year, that is 1: 200 per year which is 30-125 times the average population risk. Malignant risk increases with longer lengths of Barrett’s, Caucasian males and smokers but is probably not influenced by alcohol history. In the absence of invasive malignancy, nodular areas are removed by a mucosal stripping technique described as endoscopic mucosal resection (EMR) and remaining lengths of Barrett’s mucosa may be removed using radio frequency ablation (RFA). This ablative technique involves the use of radiofrequency energy delivered with balloon-based catheters that heats the oesophageal mucosa and destroys non dysplastic and dysplastic tissue. Randomised control trials have demonstrated superiority over sham ablation in limiting dysplasia and metaplasia at one year. The technique is associated with a lower stricture rate and decreased post procedure morbidity than other techniques sometimes utilised in this situation such as photodynamic therapy or cryotherapy. I was keen to have a conversation with Professor Finlay Macrae on this important subject exploring the topic of Barrett’s in more length as well as the techniques of EMR and RFA. Professor Macrae is a gastroenterology mentor, head of colorectal medicine and genetics at the Royal Melbourne Hospital and has public and private practices focusing on the management of Barrett’s oesophagus, inflammatory bowel disease and familial bowel cancer. He trained both in Melbourne and at St Marks Hospital in London. In 2016 he was awarded the Order of Australia for his work in genetics and genomics. Professor Macrae has been delivering advanced therapeutic solutions for patients with complex Barrett’s disease for over 30 years and was therefore, an obvious choice of expert guest to discuss this topic today, it was a great privilege to have this conversation with him. References: Professorfinlaymacrae.com Spechler S.et al. Barrett’s Esophagus. N ENG J Med 2014; 371:836-45 Whiteman et al. Journal of Gastroenterology and Hepatology 30 (2015) 804-820 Cancer Council Australia Barrett’s Oesophagus Guidelines Working Party. Clinical Practice Guidelines for the Diagnosis and Management of Barrett’s Oesophagus and Early Oesophageal Adenocarcinoma. Feb 12.2015 | |||
| Episode 147. Biologics and Dermatology with Associate Professor Peter Foley | 03 Jun 2024 | 00:44:27 | |
The advent of complex therapies including biologics and small molecules has provided a new paradigm for the treatment of many immune mediated inflammatory conditions notably in rheumatology, gastroenterology (Inflammatory Bowel Disease) and also in dermatology. New dimensions of treatment can now be applied from this amazing therapeutic armamentarium at our disposal. In this podcast we will turn our attention to how this relates to management strategies in dermatology. The term ‘biologic’ refers to agents synthesised from the products of living organisms and includes monoclonal antibodies raised against cytokines including Tumour Necrosis Factor (TNF) or some of the interleukins. Contrasting these small molecules are laboratory produced and directed to inhibit the so-called JAK- STAT messaging system which was discovered to link the external world of cells with the transcription of proteins from the genetic code held within DNA. These complex molecules as a group inhibit cytokines, and thus modulate immune mediated inflammation. As they are specific in terms of their immune system action their safety profile is generally considered to be more favourable than that of traditional systemic immuno-suppressive drugs. In this conversation we talk with Associate Professor Peter Foley to expand our understanding of the place of these complex molecules in dermatologic management. In particular we will focus on psoriasis which affects 2-4 % of the world’s population with a higher prevalence in northern countries. Plaque psoriasis is the most common type encountered with its prominent feature being sharply demarcated erythrosquamous plaques. Hyperproliferation and abnormal differentiation of keratinocytes is the hallmark of psoriasis which may also manifest with arthritis in up to 30% of patients and be preceded by nail changes characterised by small but definite pits in 50-80 % of cases. Associate Professor Peter Foley graduated from Monash University in 1987 after completing a BMedSc thesis which was the first National Skin Cancer Survey. He later obtained a fellowship in dermatology in 1997 and completed an MD exploring the effects of Vitamin D on the skin. He is actively involved in research and has been principal investigator for numerous clinical trials which include more than 70 on subjects such as psoriasis, eczema, seborrheic dermatitis, rosacea and many more. He has an appointment as an Associate professor in the Department of Medicine -Dermatology at The University of Medicine and is director of research and immediate Past-President of the Skin and Cancer Foundation. He is Australia’s only councillor on the International Psoriasis Council and sits on the Board of the Photomedicine Society. Clearly, he is well credentialed to discuss current approaches to using Biologics and Small molecules in dermatologic practice and we welcome him to the podcast. References: Assoc Professor peter Foley: Foley Dermatology and associates. www.foleydermatology.com.au Biologics in Dermatology: An Integrated Review, Seghal et al. ncbi.nlm. nih.gov The Australian College of Dermatologists, Biologic Treatments Used in Dermatology www.dermoll.edu.au | |||
| Episode 146. Into the Brain and Beyond with Neurosurgeon Rondhir Jithoo | 20 May 2024 | 00:44:17 | |
Neurosurgeon Rondhir Jithoo has led an extraordinary life, growing up in South Africa with a medical father and deeply thinking anthropologist mother. He obtained his medical degree from the Nelson Mandela School of Medicine at the University of Natal and trained in neurosurgery at South Africa’s Wentworth Hospital where he received the Registrars Prize from the South African Society of Neurosurgeons and obtained his neurosurgery fellowship in 2000. After relocating to Australia, he was awarded the Australasian Fellowship in Neurosurgery in 2004 and worked at Royal Melbourne Hospital where he developed an interest in spinal trauma, anterior spinal surgery and cranial surgery. This interest in cranial surgery took him to Frances’ famous neurosurgical epicentre in Montpellier to further his study and skills in the art of awake craniotomy. At Montpellier Rondhir was able to develop skills reflecting the modern connectionist approach to neurosurgery which has revolutionised treatment of brain tumours. The traditional concept proposed by Paul Broca, and still taught, is that the brain is organised into different areas controlling specific functions. This localisation theory has now been disproven, and work with contributions from Montpellier has shown that the brain is organised in dynamic interactive networks capable of constantly readapting. This connectionist approach explains why some patients can lead a perfectly normal life despite having a large tumour affecting an area of the brain previously considered crucial for brain function. The brain is able to compensate for lesions and its incredible plasticity allows it to reorganise itself to continue functioning normally. In awake craniotomy, providing lesions have not caused disability, tumours may be safely removed in real time using cortical mapping. By keeping the patient awake to verbal commands the impact of surgical resection can be carefully assessed and damage minimised. After returning to Australia with this skill Rondhir served with the Australian armed forces in Iraq, assessing and providing acute neurosurgical assistance for battlefield traumas and is now intrinsically involved in contributing his skill and expertise to establishing and independent neurosurgical service in Darwin where he travels at repeat intervals throughout the year. He is a head and clinic consultant of Neurosurgery at Alfred Health in Melbourne and is a member of the Victorian Audit of Surgical Mortality Committee as well as a postgraduate examiner for the Royal Australasian College of Surgeons. I found Ron to be deeply philosophical and spiritual in his approach to the art of medicine and I’m sure you will enjoy this conversation with him. References : Mr Rondhir Jithoo: www.healthshare.com.au www.alfredhealth.org.au | |||
| Episode 145. Medical Workforce - The Future with Mr Murray Bruce | 14 May 2024 | 00:27:44 | |
The health and welfare workforces deliver diverse services through many private and public organisations. Combined these services employ more than 1 million people of which there were more than 642 000 health practitioners working in their registered professions in Australia in 2020. This included 105 300 medical practitioners, 350,000 nurses and midwives, 21,500 dental practitioners and 166,000 allied health professionals. In this podcast we will consider more generally the positions of nursing and medical practitioners and a possible future landscape. In the five years to 2021 only the equivalent of 4200 full-time General Practitioners were added to the workforce and on average both male and female GP’s have been trending towards fewer hours per worker. The AMA’s Plan to Modernize Medicare campaign reported: 1. Australia faces a shortage of more than 10,600 GP’s by 2031-32 and the supply of GP’s falling behind growing community demand. 2. The demand for doctors’ services increased by 58% in the decade to 2019. 3. That the most cost-effective method with the best outcomes for patients is GP led primary care. GP’s provide twice the number of episodes of care as hospitals per year for one sixth the expense. Away from doctors the nursing and midwifery sector represent the largest workforce in the healthcare system accounting for 55% of total workforce however in a recent McKinsey survey one fifth of Australia’s registered nurses said they intended to leave the current role in the next year. Even before the pandemic a shrinking supply of nursing-school graduates and a decline in nurses migrating from other countries to Australia brought about nursing shortages. These short-term demands are superimposed on longer-term demands caused by Australia’s population growth and aging demographic. The McKinsey 2021 Future of Work in Nursing Survey found that in addition to the figure above 41% of nurses surveyed said they were planning to move countries or leave direct-care roles entirely, leading to a calculated deficit of between 20,000 and 40,000 unfilled nursing positions. Similar results have been documented in the United Kingdom, France, Japan, USA, Singapore and Brazil. In this podcast I was keen to pursue the workforce conditions and future strategies to manage them with Mr Murray Bruce, a young and energetic Lawyer with a welcomingly fresh set of ideas who is Director of Latrobe Community Health Service. Murray has extensive board and governance experience with expertise in strategic planning, risk management, commissioning, change management and policy development. Please welcome Murray to the Podcast. REFERENCES: Mr Murray Bruce.Board Directors -Gippsland Primary Health Network.gphn.org.au McKinsey and Company, Should I stay or should I go? Australia’s nurse retention dilemma, Sep 23rd, 2022 AMA report projects “staggering” GP shortage, Nov 25,2022 Health Workforce, Updated July 7, 2022 aihw.gov.au RACGP-Health of the Nation, 2022 racgp.org.au | |||
| Episode 144. Dermatology with Dr Alvin Chong (Part 2) | 07 May 2024 | 00:26:27 | |
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these. Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone. Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression. A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology. In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care. It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education. Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne. Please welcome Alvin to the Podcast. References: Dr Alvin Chong http://spotdiagnosis.org.au/ https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis | |||
| Episode 143. Dermatology with Dr Alvin Chong (Part 1) | 30 Apr 2024 | 00:24:39 | |
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these. Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone. Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression. A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology. In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care. It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education. Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne. Please welcome Alvin to the Podcast.
References: Dr Alvin Chong https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis | |||
| Episode 142. Common problems in Psychiatry with Dr Usman Riaz (part 2) | 23 Apr 2024 | 00:32:31 | |
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour. Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men. Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances. Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased. Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment. I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode. Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation. REFERENCES: Dr Usman Riaz-www.sjog.org.au World Health Organization-Mental Disorders. Who.int Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov | |||
| Episode 141. Common problems in Psychiatry with Dr Usman Riaz (part 1) | 16 Apr 2024 | 00:33:11 | |
From the RACGP Health of the Nation report; depression, anxiety, and sleep disturbances are amongst the most commonly seen presentations of mental disorders in general practice. About 1 in 8 people in the world live with a mental disorder which often involves significant disturbances in thinking, emotional regulation, or behaviour. Globally it is estimated that 5% of adults suffer from depression, affecting women a little more than men. Anxiety disorders affect a similar number of people, characterised by excessive fear, and worry and related behavioural disturbances. Bipolar disease is characterised by periods of depressive episodes alternating with periods where manic symptoms prevail. Affecting less than 1 % of the population, suicide risk is increased. Addiction disorders embrace a long list of destructive habits. Post traumatic stress disorder (PTSD), schizophrenia, disruptive behaviour, and dissocial disorders as well as neurodevelopmental disorders are amongst the many conditions presenting clinically and often requiring psychiatric assessment. I was also interested to discover more about the adverse effects of social media on teenage and young adults’ mental health and in this podcast, and was curious to explore some of the mental health conditions presenting commonly in primary practice and to understand the place of therapies available. It was a privilege to interview psychiatrist Dr Usman Riaz for this episode. Dr Muhammad Usman Riaz is a fellow of The Royal Australian and New Zealand College of Psychiatrists and has sub-specialised in addiction psychiatry. He Holds a Master of Public Health with a major in Occupational Health and Safety from Monash University and Master of Psychiatry from the University of Melbourne. He is Director of Medical Service at The Langmore Centre in Berwick operated by St John of God Hospital. Please welcome Usman to the conversation. REFERENCES: Dr Usman Riaz-www.sjog.org.au World Health Organization-Mental Disorders. Who.int Selective Serotonin Reuptake Inhibitors-Stat Pearls www.ncbi.nlm.nih.gov | |||
| Episode 140. Breathing for Performance - the power of Nasal Breath with Mr Allan Abbott (Part 2) | 09 Apr 2024 | 00:29:26 | |
Over the past decade there has been an emergence of literature pointing to potential clinical benefits for a range of disease states through the adoption of slow breathing techniques. The popularity worldwide of the Wim Hof method adopted from eastern techniques has done much to pique interest.
Notably the belief and practice of controlling one’s breath to both restore and enhance health is not new however and has been practised for thousands of years amongst Eastern cultures. Pranayama or Yogic breathing as well as Kundalini are well-known ancient practices of controlled breathing and exists in various forms often in conjunction with meditation.
A system of breathing developed in the 1900s by the Ukranian doctor Konstantin Buteyko claimed to successfully treat patients diagnosed with respiratory and circulatory disease possibly through reducing ventilatory dead space, increased tidal volume and by inducing favourable effects on the autonomic nervous system. Practised slow nasal breathing has been shown to extract 20 % more oxygen from each breath enhancing athletic performance.
Slow and controlled breathing through the nose with a respiration rate of between 6 and 10 per minute appears to be optimal for enhancing the Bohr effect. Getting there requires practice and adoption of nasal breathing techniques. The latter also delivers more Nitrous oxide, an important vasodilator which in relation to this subject is produced by the paranasal sinuses. Nasal breathing also filters and humidifies the air we breathe.
In this podcast I was interested to explore this fascinating subject with breathing expert, physiotherapist and snow skier Mr Allan Abbott. Allan has broadened his expertise with qualifications in physical education, ergonomics and acupuncture. He runs numerous seminars on breathing for performance including Athletes Master Classes incorporating high altitude training through his company Health Innovations Australia and has established the “Breathe Light Breathe Right” as well as the ‘Sleep Well be Well” programs.
Allan subscribes to a notion that breathing, sleep, diet, exercise and mindfulness are the major components to optimal health. Please welcome Allan to the podcast.
References: Mr Allan Abbott.oxygenadvantage.com and www.healthinnovations .net.au
Breath- The New Science of a Lost Art. Penguin Books. July 20,2021.James Nestor
The Physiological effects of slow breathing in the health human. Russo et al. www.ncbi.nlm.nih.gov
How Breath-Control Can Change Your Life : A systematic review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro et al.2018. www.frontiersin.org. | |||
| Episode 139. Breathing for Performance - the power of Nasal Breath with Mr Allan Abbott (Part 1) | 01 Apr 2024 | 00:35:38 | |
Over the past decade there has been an emergence of literature pointing to potential clinical benefits for a range of disease states through the adoption of slow breathing techniques. The popularity worldwide of the Wim Hof method adopted from eastern techniques has done much to pique interest. Notably the belief and practice of controlling one’s breath to both restore and enhance health is not new however and has been practised for thousands of years amongst Eastern cultures. Pranayama or Yogic breathing as well as Kundalini are well-known ancient practices of controlled breathing and exists in various forms often in conjunction with meditation. A system of breathing developed in the 1900s by the Ukranian doctor Konstantin Buteyko claimed to successfully treat patients diagnosed with respiratory and circulatory disease possibly through reducing ventilatory dead space, increased tidal volume and by inducing favourable effects on the autonomic nervous system. Practised slow nasal breathing has been shown to extract 20 % more oxygen from each breath enhancing athletic performance. Slow and controlled breathing through the nose with a respiration rate of between 6 and 10 per minute appears to be optimal for enhancing the Bohr effect. Getting there requires practice and adoption of nasal breathing techniques. The latter also delivers more Nitrous oxide, an important vasodilator which in relation to this subject is produced by the paranasal sinuses. Nasal breathing also filters and humidifies the air we breathe. In this podcast I was interested to explore this fascinating subject with breathing expert, physiotherapist and snow skier Mr Allan Abbott. Allan has broadened his expertise with qualifications in physical education, ergonomics and acupuncture. He runs numerous seminars on breathing for performance including Athletes Master Classes incorporating high altitude training through his company Health Innovations Australia and has established the “Breathe Light Breathe Right” as well as the ‘Sleep Well be Well” programs. Allan subscribes to a notion that breathing, sleep, diet, exercise and mindfulness are the major components to optimal health. Please welcome Allan to the podcast. References: Mr Allan Abbott.oxygenadvantage.com and www.healthinnovations .net.au Breath- The New Science of a Lost Art. Penguin Books. July 20,2021.James Nestor The Physiological effects of slow breathing in the health human. Russo et al. www.ncbi.nlm.nih.gov How Breath-Control Can Change Your Life : A systematic review on Psycho-Physiological Correlates of Slow Breathing. Zaccaro et al.2018. www.frontiersin.org. | |||
| Special Episode 17. Medicine in Colonial Australia with Professor Chris Reynolds (Part 2) | 25 Mar 2024 | 00:21:21 | |
The first fleet comprised of 11 ships and 1420 people arrived in Australia’s Botany Bay under the command of Captain Arthur Phillip in January 1788 after an 8-month journey from Portsmouth. On the voyage there were 48 deaths and 28 births but no recorded serious illnesses such as smallpox or tuberculosis. The colonists subsequently resettled in port Phillip Bay and quickly had to learn to adapt to an environment that was as foreign to them as it must have been for the local indigenous population of aboriginals who made first contact with these white skinned strangely dressed travellers. Many of the settlers first crops failed and stock brought with them aboard either died, absconded, or were eaten necessitating an early call for help to replenish dwindling supplies. This initial lack of nutrition jeopardised the viability and success of the newly forming colony. Second and third fleets arrived in 1790 and 1791. The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further. Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years. My curiosity for colonial medicine extended to enquire about the nutritional health concerns encountered by early colonists, how water was purified, and how adequate balanced meals could be provided in a new foreign land. I was also fascinated to learn of the smallpox epidemic of 1789 which was devastating to our indigenous first AUSTRALIANS. Further diseases such as tuberculosis, measles, influenza, and STD’s all earn mention. Alcoholism was a very significant problem amongst colonists as it remains in some quarters today but to a much lesser extent with our rigorous regulations around brewing and distribution. We discuss the medical problems encountered on our goldfields during the madness of the goldrush days in the 1850’s where dysentery was rife and food hygiene extremely poor. Indeed, William Howitt writing from the goldfields at that time where up to 1000 sheep were being slaughtered each day… “They are in their millions all over the country, they cover your horses, your load and yourselves, at your meals in a moment, myriads come swooping down, cover the dish and the meat on your plates till they are one black moving mass……”. It’s easy to imagine how disease spread quickly in that environment. Leaving gold fever aside, first nations people had survived in Australian conditions for thousands of years coping with illnesses and climatic hardship so what if anything have, we learned in a medical sense from the indigenous people? Chris Reynolds completed his PhD and Masters degrees at Americas Claremont Graduate University and has held appointments as Senior Professional Staff with both the United States Senate and House of Representatives. He has held several executive roles with NSW government including Executive Director of the World Trade Centre, Sydney. He has worked as a schoolteacher, University professor and political strategist and has applied his breadth of knowledge and experience to writing What a capital Idea-Australia 1770-1901. Please welcome Professor Chris Reynolds to the podcast.
References: What a Capital Idea- Australia 1770-1901. Christpher Reynolds. Reynold Learning. www.Reynoldlearning.com Medicine in Colonial Australia,1788-1900, MJA,7 July 2014 Illness in Colonial Australia. Smith FB, Melbourne: Australian Scholarly Publishing, 2011 | |||
| Special Episode 17. Medicine in Colonial Australia with Professor Chris Reynolds (Part 1) | 18 Mar 2024 | 00:29:22 | |
The first fleet comprised of 11 ships and 1420 people arrived in Australia’s Botany Bay under the command of Captain Arthur Phillip in January 1788 after an 8-month journey from Portsmouth. On the voyage there were 48 deaths and 28 births but no recorded serious illnesses such as smallpox or tuberculosis. The colonists subsequently resettled in port Phillip Bay and quickly had to learn to adapt to an environment that was as foreign to them as it must have been for the local indigenous population of aboriginals who made first contact with these white skinned strangely dressed travellers. Many of the settlers first crops failed and stock brought with them aboard either died, absconded, or were eaten necessitating an early call for help to replenish dwindling supplies. This initial lack of nutrition jeopardised the viability and success of the newly forming colony. Second and third fleets arrived in 1790 and 1791. The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further. Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years. My curiosity for colonial medicine extended to enquire about the nutritional health concerns encountered by early colonists, how water was purified, and how adequate balanced meals could be provided in a new foreign land. I was also fascinated to learn of the smallpox epidemic of 1789 which was devastating to our indigenous first AUSTRALIANS. Further diseases such as tuberculosis, measles, influenza, and STD’s all earn mention. Alcoholism was a very significant problem amongst colonists as it remains in some quarters today but to a much lesser extent with our rigorous regulations around brewing and distribution. We discuss the medical problems encountered on our goldfields during the madness of the goldrush days in the 1850’s where dysentery was rife and food hygiene extremely poor. Indeed, William Howitt writing from the goldfields at that time where up to 1000 sheep were being slaughtered each day… “They are in their millions all over the country, they cover your horses, your load and yourselves, at your meals in a moment, myriads come swooping down, cover the dish and the meat on your plates till they are one black moving mass……”. It’s easy to imagine how disease spread quickly in that environment. Leaving gold fever aside, first nations people had survived in Australian conditions for thousands of years coping with illnesses and climatic hardship so what if anything have, we learned in a medical sense from the indigenous people? Chris Reynolds completed his PhD and Masters degrees at Americas Claremont Graduate University and has held appointments as Senior Professional Staff with both the United States Senate and House of Representatives. He has held several executive roles with NSW government including Executive Director of the World Trade Centre, Sydney. He has worked as a schoolteacher, University professor and political strategist and has applied his breadth of knowledge and experience to writing What a capital Idea-Australia 1770-1901. Please welcome Professor Chris Reynolds to the podcast.
References: What a Capital Idea- Australia 1770-1901. Christpher Reynolds. Reynold Learning. www.Reynoldlearning.com Medicine in Colonial Australia,1788-1900, MJA,7 July 2014 Illness in Colonial Australia. Smith FB, Melbourne: Australian Scholarly Publishing, 2011 | |||
| Episode 138. Emotional Intelligence with Shawn Price | 05 Mar 2024 | 00:41:48 | |
Emotional intelligence (EI) also known as EQ, is the ability to perceive, understand and manage emotions in positive ways to communicate effectively, empathise with others, overcome challenges and defuse conflict as well as to relieve stress. Emotional intelligence helps build stronger relationships, achieve personal career goals, and interact more positively at work. It gives us an ability to join intelligence, empathy, and emotions to enhance thought and understanding of interpersonal dynamics, guiding our thinking and behaviour. For as in Shakespeare’s Hamlet - 'there is nothing either good nor bad but thinking makes it so'. The term EI first appeared in writing in 1964 and was popularised by Daniel Goleman in his book titled Emotional Intelligence published in 1995 in which he applied the concept especially to business defining the term as an array of skills and characteristics that drive leadership and performance. EI is commonly defined by four domains or attributes including: 1. Self-Awareness-Understanding what you are feeling and why and appreciating your strengths and weaknesses. 2. Self-Management- The ability to control impulsive feelings and behaviours, adapt to changing circumstances and manage emotions in healthy ways. This is also referred to as self-regulation and points to a positive outlook and achievement. 3. Social awareness -Including the concept of empathy which helps us understand the emotions, needs and concerns of others. Developing social awareness allows us to recognise the power dynamics in a group or organisation. 4. Relationship management-Which encompasses conflict management, coaching and mentorship and encourages the development of teamwork through inspirational leadership. There are several excellent books on the subject of emotional intelligence including: Achieving Emotional Literacy by Claude Steiner, 'How Emotions are Made' by Lisa Feldman Barrett, Emotional Agility by Susan David and Daniel Goleman’s Emotional Intelligence. I was curious to explore this topic in more detail and was privileged recently to meet Shawn Price who is an expert in this field. Shawn initially trained as a mathematician but was drawn to the study of psychology and especially emotional intelligence recognising its important application to both business, families, and individuals. Shawn now manages his company Positive Intelligence from where he coaches and consults privately as well as being engaged by industry and large organisations to run workshops and lecture programs on this important subject. Please welcome Shawn to the podcast. References: Shawn Price: Positive Intelligence. www.positiveintelligence.com.au Emotional Intelligence, Daniel Goleman. ISBN:9780553804911 Emotional Intelligence; www.helpguide.org/ Segal, Robinson and Shubin Emotional Intelligence has 12 Elements. Which do you need to work on? Harvard Business Review. Feb 06,2017. Goleman and Boyatzis | |||
| Episode 137. Haemochromatosis with Professor Darrell Crawford | 19 Feb 2024 | 00:42:06 | |
We are dedicating this podcast to the memory of Professor Lawrie Powell, both a gentleman, mentor and giant in the field of hepatology and whose very significant contributions to our understanding of hemochromatosis laid down a firm foundation of knowledge and insight for everyone practicing internal medicine. It is upon his shoulders that much further research in the field of hemochromatosis and hepatology generally has prospered. Haemochromatosis is the most common autosomal recessive disorder in Caucasians with an incidence of about 1 :260 and carriage of about 1: 10. Untreated the excess iron storage from hemochromatosis may lead to cirrhosis and hepatocellular carcinoma, diabetes, cardiomyopathy, hypogonadism, arthritis, bronzing of the skin and render some susceptibility to siderophilic bacteria including some vibrio and Yersinia species. The consequences of iron overload are exacerbated by preexisting condition such as NASH and alcohol associated liver disease. A key breakthrough in the understanding of hemochromatosis came with the discovery of a negative regulatory protein coded for by the HAMP gene on chromosome 19 called Hepcidin. Hepcidin serves as a counterregulatory protein. As iron absorption and stores increase Hepcidin levels in healthy individuals also increase leading to decreased iron absorption and restoration of normal iron levels. Hepcidin appears to work by internalization and degradation of Ferroportin thereby inhibiting iron absorption across the basolateral membrane of enterocytes as serum iron levels climb. A transferrin receptor on the surface of hepatocytes relays information concerning serum iron concentration as part of this elaborate feedback mechanism. Mutations of the so-called High Iron -or Hemostatic Iron Regulator -HFE gene on the short arm of chromosome 6 modulate the expression of Hepcidin, effectively blocking the elaborate feedback mechanism that senses serum iron and leading to inappropriately lowered levels of Hepcidin production as iron levels climb. This defect underlies the problem of excess iron absorption in Hemochromatosis with the consequent adverse physiologic effects mentioned above. The gene mutation responsible for Hemochromatosis is thought to have arisen some 6000 years ago within Viking or Celtic communities possibly protecting against iron deficiency states when resources were scarce. Treatment by regular phlebotomy remains the preferred method of management and screening for HCC in cases of established cirrhosis is mandatory. I was honored to further this conversation about hemochromatosis with Professor Darrell Crawford, one of my mentors from Queensland in a previous life. Darrell has both the reputation for being an excellent hepatologist as well as having significant international standing in the field of liver disease and has published widely. He has held leadership positions within the national and international professional societies relevant to his discipline including GESA and the University of Queensland including as the Acting Deputy Executive Dean and Head, School of Medicine where he has played a key role in reshaping the medical program and medical faculty at the University of Queensland. Please welcome Darrell to the podcast. Treatment by regular phlebotomy remains the preferred method of management and screening for HCC in cases of established cirrhosis is mandatory. References: Professor Darrell Crawford-medicine.uq.edu.au, Queensland Gastroenterology Greenberger’s Current Diagnosis and Treatment, 4th Ed, Friedman et al, McGraw Hill Lange Principles of Medical Biochemistry, 3Rd Ed, Meisenberg and Simmons, Elsevier Saunders | |||
| Episode 136. Coronary Calcium Score with Dr Alistair Fyfe | 05 Feb 2024 | 00:57:10 | |
The corner stone of cardiovascular disease prevention is the identification of high-risk asymptomatic individuals. In this regard coronary artery calcium is a highly specific marker of atherosclerosis and can be quantified using non contrast CT scanning which provides an accurate measure of atherosclerotic burden. Coronary artery disease is the single leading cause of disease morbidity and mortality in Australia and is responsible for approximately one in 10 deaths furthermore half the individuals with coronary artery disease will present with a myocardial infarction or death. The compelling reason for undertaking coronary artery calcium scoring is to identify asymptomatic at-risk individuals who are likely to benefit from early detection, risk factor intervention and treatment of coronary artery disease. In Australia risk assessment is recommended using the National Vascular Disease Prevention Alliance tool based on the Framingham Risk Equation. This risk stratification is drawn upon to guide the decision for calcium scoring which according to the Cardiac Society of Australia and New Zealand is recommended for asymptomatic intermediate risk patients or where there may be other strong evidence supporting its ability to improve cardiovascular risk assessment. High risk individuals may be better assessed by means of stress testing. The calcium score is determined by non-contrast CT scanning and is complete within about ten minutes delivering just a little over 1 mSv of radiation equivalent to the annual background radiation we are exposed to. Using the Agatston method the volume and density of calcium is calculated and computed as a score. Again drawing upon The Cardiac society of Australia and New Zealand calcium scores may be interpreted as follows: A measurement of 0 is very low risk of coronary disease, a score of 1-100 is low risk, a measure of 101-400 is considered moderate risk and a patient lying within the 75th percentile of this group is at moderately high risk. Measurement over 400 denotes a high risk. Multiple studies including the Multiethnic Study of Atherosclerosis (MESA) have confirmed the long-term prognostic value of CT calcium scores with over ten years of prospective follow up. The value of calcium scoring lies in its ability to improve the accuracy of risk prediction. It helps to identify individuals who may benefit from more aggressive primary prevention measures; including the use of low dose aspirin that may otherwise not be recommended for primary prevention, as well as aggressive lipid management with statin therapies. Given the importance of detecting asymptomatic coronary heart disease I was interested in pursuing the conversation further with one of the US expert cardiologists Dr Alistair Fyfe who has been practicing cardiology for over 38 years after graduation from the University of Tasmania. Alistair has worked in Canada as well as the United States and is in Dallas, Texas where he has affiliations with Medical City Dallas and White The Heart Hospital Baylor Plano and is Medical Director of Blue Cross and Blue Shield of Illinois, Montana, New Mexico Oklahoma, and Texas not bad for a home-grown lad. He is currently busy writing a contributing chapter to a soon to be published book titled: "The Implementation of Personalised Precision Medicine”, which, if I know Alistair will be excellent and a must read. Given his expertise I was curious to learn a little more about its application and how a measured coronary calcium score should influence our approach to patient management. I know you will find this conversation with Alistair very interesting. Please welcome him to the podcast. References: Dr Alistair Fyfe - on google and LinkedIn Coronary artery calcium in primary prevention Chuah.www1.racgp.org.au When not to use calcium scoring www.ausdoc.com.au Polonsky et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. | |||