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Dr RICHARD's Desk - 2006

Dr Richard Tomlins

The Cost of Medical Treatment
Some research claims up to one quarter of the entire government health budget is spent on hospital care during the last 18 months of lifeMuch of this care is given in the absence of any real prospects of extending overall survival or quality of lifeTerminal care

The number of patients who need to be treated to save one life or prevent one serious event can be in the order of hundreds of thousands with sophisticated procedures such as some cardiac surgery, breast cancer screening and surgery for localised  prostate  cancer.

A claimed consequence of these enormous costs is between 20% - 45% of eligible people miss out on effective treatments for common and serious conditions such as cardiac problems and stroke.

The implication is a serious one. Rationing of medical treatment is on the way as no government can afford the cost of meeting patients’ over expectations of the value of modern technological medicine. An ageing population is very threatening to health services.

The real questions are how will  health care rationing be done and  who will be responsible for that rationing.


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Diet and Cancer
Unfortunately there is no evidence that dietary supplements or dietary modification alters the clinical course of cancer or pre-cancer.
drugs
The National Cancer Institute examined various diets and supplements including vitamins, anti-oxidants, retinol and garlic and their effect on various cancers. The conclusion was no benefit was seen. The study noted the large personal expenditure on supplements by some patients.

A healthy diet alone, or in combination with dietary supplements, weight loss or exercise has no effect on all–cause mortality. Equally research showed no evidence of harm. A healthy diet is still strongly encouraged as many cancer patients live for many years and could die or be affected by other diet related illnesses.

Unfortunately this is another example of something like dietary supplements, vitamins, anti oxidants etc sounding as though it should be helpful treatment but it simply is not.


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Drugs and Professional Cycling
You will have seen reports of alleged drug use in Tour de France cyclists. Unfortunately cycling is one of the sports with the worst drug use record
Cyclist
One top cyclist said it was not possible to make the top 50 ranking without drug use. Some claim up to 90% performance drug usage in professional cyclists

One champion cyclist spoke of injecting himself 12 to 13 times per day and  taking a blood test to measure a certain blood parameter which indicates illegal drug use up to four times per day. He also took Growth hormone, Folic Acid, Iron, blood transfusions & aspirin to prevent clotting caused by the drugs and on some days injected cortisone and male hormones as well as a drug co-factor.

In one year recently four professional cyclists died from heart attacks. The youngest was 23 the oldest 35.
CyclistAbout 100 cyclists have died prematurely over the last 20 years.
  Amphetamine fuelled riders have fallen dead from their bikes in mid-race.

The use of performance enhancing drugs is now very sophisticated and often well ahead of drug testing methods. The rewards are so high many cyclists are tempted. It is generally considered the problem is so large and profitable that control or elimination of drug use in cycling is unlikely.

Genetic performance enhancement has yet to become widespread . . . and is thought to be almost undetectable !


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Exercise is good . . . but don't turn off the TV !!man watching TV
Australians value their health but many are not prepared to do anything to improve it

A recent survey of 1,000 people showed an impressive 86% believed health was more important than a high IQ or wealth.

Sadly 74% would not turn off the TV or computer to become healthier and nearly 50% would not trade chocolate or dessert for good health.

About 60% had no idea of their blood pressure or cholesterol levels


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I think . . therefore I am . . .(or something like that)Friedrich Nietzsche
This world famous Philosopher died in August 1900.
Who was he ? ? ?. . .and what did he die from ? ? ?

At age 24 he became a Professor of Philosophy in Basle which was a remarkable achievement. He later served in the Franco-Prussian war where it appears he contracted the disease which caused his disastrous medical problems and ultimately his death.

He returned to Basle University but in 1878 his health became worse and by 1889 he had a breakdown. He collapsed in a street in Turin, was half blind, in almost unrelenting pain and wrote crazy notes to his friends.

He spent the last 11 years in total mental darkness and was looked after first in an asylum and then under the care of his mother.

Imagine what ideas Friedrich Nietzsche might have produced had he not suffered from Tertiary Syphilitic Disease . . . or . . .where some of his ideas produced because of the mental effects of Syphilis ?


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Is anyone reading your promotional material ? ? ?
The Australian Bureau of Statistics found almost half of the 15 -74 year group had " poor " or " very poor " literacy skills. These people had difficulties with many of life’s daily literacy demands. 

A further 35% of those surveyed did not have a high level of literacy but were able to cope day to day.

Health literacy is defined as the ability to read, understand and act on health information. Clearly much Health Education material is simply not being understood and so is ineffective. Many patients are simply unable to understand treatment or the reason for tests and are unable to understand medication directions.

Almost certainly the same applies to company promotional material and other written company material such as instructions for use of a product. IT information and the design of many of the forms we have to fill out are significant culprits.

It also gives cause to wonder at the effectiveness of  the Australian Education system


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Management of Adreno Cortical Insufficiency during Surgery. . .Wott ? ?
50 years ago an article with this topic appeared in a learned medical journal. A sharp JFKeyed reader somehow put two and two together and was able to make a very significant revelation.
One of the three patients discussed was 37 years old and treated his Addison's Disease with daily oral cortisone as well as injections of cortisone every three months.

He suffered from severe back pain with subsequent bone fusions and a metal plate inserted. This back problem was a football injury aggravated by World War II service. He had a well known stooped posture.

--> Not surprisingly he also suffered from chronic lethargy and weakness typical of Addison's Disease. These symptoms were of considerable public and political concern in JFK & Jackie1960 and almost certainly affected his ability to work to his full potential.   At least publicly, his political career was not characterised by these symptoms.

He had a " Moon Face " from the cortisone. For pain relief he famously used a rocking chair, took hot baths and wore a very stiff corset.

It has been reasonable speculated that this corset held President John F Kennedy upright long enough for Lee Harvey Oswald's third shot to strike President Kennedy with fatal consequences


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Holidays and Long Haul Flights and DVTBoeing 247
It's that time of the year again when families head off to distant fields for the school vacations.

Long flights are often involved with the associated stress, sleep deprivation, irritation and challenges of airports, marveling at the speed and discomfort of modern planes and the frustrations of keeping young children confined for hours at a time.

It is also that time when the risks of Blood Clots (Deep Venous Thrombosis - DVT) forming usually in the legs of long distance travelers….sometimes called "Economy Class Syndrome"….concern holiday makers. The risk of DVT continues for about 2 weeks after the flight. Remember a DVT can form during any form of travel eg car, bus ,train where you are sitting in a cramped position for some time.

DVTs most commonly occur in hospital patients, post surgery.

A DVT can affect anyone but risk Factors include:
Hooters air hostess      * Age over 40 years
     * Pregnancy
     * People with or who have had cancer
     * Anyone taking Oestrogen e.g. the contraceptive pill
     * Smokers
     * Obese people
     * Dehydration
     * Recovering from recent surgery
     * Having an immobilised limb e.g. a leg in plaster

A DVT is potentially a very serious problem, so take the following precautions when traveling to prevent DVT:
girl with computer          * Exercise as much as possible
   * Walk around the cabin
    * Drink plenty of water
    * Avoid excess coffee and alcohol
    * Elasticised stockings may help
    * Taking Aspirin pre flight might help a little

    The overall risk of DVT ?  Not really known but perhaps 1:50,000 travellers or about one death per two million flights. Even lower risk with the above precautions.


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Flying and Radiation Exposure
A seven hour flight will expose a passenger to about the same radiation as a standard ChernobylChest X-Ray (0.04 units).

Each year people living near Chernobyl Nuclear Reactor receive about 250 times the Chest X-Ray dose. . . with a consequent risk of developing cancer of about one in 1700.

An abdominal CT scan is equal to the radiation dose of about 400 Chest X-Rays

The message is clear: Avoid unnecessary X-Rays.

Radiation is not a potential danger from Ultrasound which uses sound waves and not X-Rays


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Melatonin –the arguments continue !
Melatonin is a hormone produced by the Pineal Gland which is a very small gland situated deep in the brain and very inaccessible. Melatonin has an effect on the body clock with hormone production being affected by daylight and darkness.

Melatonin has been available for some years over the counter. Melatonin

Efforts to have such a potentially dangerous drug restricted to a prescription-only status as with other hormones were unsuccessful as opponents to restriction successfully argued Melatonin was a " natural substance "

Melatonin has been widely promoted and used as the solution to jet lag and to promote sleep. Other bizarre uses include being used as a " perpetual youth drug ".

A recent meta-analysis of published research, as opposed to hearsay and commercial promotion found Melatonin in reality did little to promote sleep or assist with sleep restriction as happens in jet lag. Most claimed effects can be attributed to placebo. In people with a sleep disorder from medical causes Melatonin did increase the time asleep by about 10 minutes in eight hours sleep.

Melatonin has been poorly researched to date for all sorts of technical reasons. As well the quality of commercially available products is often very suspect and the recommended dosage varies widely between commercial products and between stores selling the product. Be aware " natural " Melatonin may contain a virus

Hormones are very potent body chemicals often with multiple target body organs eg the hormones oestrogen and thyroxine affect a wide range of physiological functions.

Would I take a hormone such as Melatonin with largely unknown effects on the body for such a simple, self limiting problem as sleep deprivation ?     No way !!


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MEN should take more interest in their Health
Men: Visit their doctor less often than women. Take fewer medicines than women. Use the Health System less often than women. Have shorter life spans than women.

Many of the diseases that shorten men's lives are the so called " Lifestyle Illnesses "resulting at least in part from the way they behave. Smoking, excessive alcohol, lack of exercise, obesity, illicit drug use and stress at work are all examples of a lifestyle that put men's health at risk.Man drinking orange juice

Women have access to effective breast cancer and cervical cancer screening, but men have little in the way of effective cancer screening programs

For men regular Blood Pressure, Weight and Cholesterol checks are important.  Do not ignore the other symptoms such as an alteration in usual bowel habit, blood in bowel motions and trouble passing urine. These symptoms may indicate bowel or prostate cancer so check them out.

Men are prone to emotional illness as well as women, but men from a western culture may be less willing to acknowledge a problem. Anxiety and Depression are usually easily managed.

It is easy to put sleep disturbance, poor appetite, inability to concentrate and general irritability down to a busy job but there may be more to it than that.

If you have any doubts about any of your symptoms, it would be useful and probably reassuring, to have a chat with your doctor


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Nicotine Dependence
While talking about good health, use this Quiz to check your nicotine dependence:
    1. How many cigarettes do you smoke per day? (More than 20/day indicates nicotine dependence).pregnant woman smoking

    2. Do you have your first cigarette within 30minutes of waking ?

    3. Do you smoke when you are so sick you have to stay in bed?

For those answering yes then you have a problem (you already knew anyway!).
Nicotine patches to help quit smoking are not usually suggested for a >10 cigarettes/day habit. Nicotine patches are more useful in >20/day habits
      Check www.quit.org.au for more information


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Nicotine is safe . . . . . .what did you say ? ?
      * Nicotine does not cause cancer
      * Nicotine does not cause respiratory disease
      * Nicotine is not directly responsible for tobacco & related diseases.

      * It is the other components of tobacco which cause all of the problems

Nicotine only induces and maintains tobacco addiction

That means Nicotine Replacement Therapy e.g. as Nicotine Patches used to stop smoking, is safe and does not cause the health problems associated with tobacco

Nicotine patch
Nicotine in these patches slowly reduces the nicotine addiction while the psychological addiction or ritual of reaching for a cigarette, lighting the cigarette, repetitive hand to mouth etc is overcome. Psychological dependence is a very difficult habit to eradicate

Just how addictive is smoking girl smoking
Recent U.K. research showed smoking just one cigarette at age 11 doubles the risk of taking up the habit   e.g. after three years of non-smoking those who had smoked just one cigarette at age 11 years, were twice as likely to be smoking by age 14 years than those who had never smoked.

Rat Pack smoking
   Anything else ? ? ? ?  
 Lots more about smoking !! . . . . . . .
  Try this:   Men who smoke more than a packet of cigarettes per day have a 40% greater chance of being impotent than non smokers


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      Hangover                                                             Dr Richard 2007Next
Reviewed    10  December   2017