Episode 53. Drug Harm Reduction with Gyu Lee
In this podcast we have a conversation with Gyu Lee who works with Victoria Alcohol and Drug Counselling Service as a harm reduction practitioner managing patients in the community who have developed addictions to both alcohol and drugs. Management techniques include close engagement with referred clients and an approach based on:
In this podcast we have a conversation with Gyu Lee who works with Victoria Alcohol and Drug Counselling Service as a harm reduction practitioner managing patients in the community who have developed addictions to both alcohol and drugs. Management techniques include close engagement with referred clients and an approach based on:
· Behavioural modification
· Pharmaceutical intervention
· Job rehabilitation
Whilst there has been a reduction in methamphetamine use in Australia from 2001 to 2019 use of cocaine and methylenedioxymethamphetamine (MDMA – ecstasy) have both increased. These drugs combined with alcohol addiction pose major social problems for our community. Please join me as we discuss these complex and confronting issues with Gyu Lee.
Useful references include:
- Drug and Alcohol Clinical Advisory Service (DACAS) Ph: 1800 812 804
- PHARMACOTHERAPY NETWORK (EAST & SOUTH EAST REGION) for GPs http://a4pn.org.au/ email A4PN@semphn.org.au or call 03 8514 6600
- Medication Support and Recovery Service https://msrs.org.au/resources/gp-resources/
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 52. Globus with Mr Adnan Safdar
Globus pharyngeus in an intermittent or persistent non-painful sensation of a lump or foreign body in the throat. First described 2,500 years ago by Hippocrates who thought the condition was secondary to pressure on the thyroid cartilage from contractions of the strap muscles of the neck, we now know that globus is a relatively common condition representing up to 4% of ENT referrals and may be seen in just less than half of healthy individuals at some point in time. Gastro-oesophageal reflux disease and hypertonicity of the upper oesophageal sphincter are very important contributors to the sensation.
xGlobus pharyngeus in an intermittent or persistent non-painful sensation of a lump or foreign body in the throat. First described 2,500 years ago by Hippocrates who thought the condition was secondary to pressure on the thyroid cartilage from contractions of the strap muscles of the neck, we now know that globus is a relatively common condition representing up to 4% of ENT referrals and may be seen in just less than half of healthy individuals at some point in time. Gastro-oesophageal reflux disease and hypertonicity of the upper oesophageal sphincter are very important contributors to the sensation.
In this episode we are joined today by experienced ENT surgeon Mr Adnan Safdar, Head of the ENT unit at Monash Health, who discusses:
· Globus as a presenting symptom
· Aetiologies
· Management strategies.
I hope you can join me on this podcast where Adnan provides a logical and practical approach to managing globus in clinical practice.
Useful references include:
- berwickent.com
- bjgp.org
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 51. Facial Pain with Mr Adnan Safdar
Facial pain is a common presenting complaint in primary practice, in many cases the aetiology can be ascertained from a detailed history and examination, however the source of pain may also be obscure including referred pain from the oral cavity as well as neurological, vascular and psychogenic disorders
Facial pain is a common presenting complaint in primary practice, in many cases the aetiology can be ascertained from a detailed history and examination, however the source of pain may also be obscure including referred pain from the oral cavity as well as neurological, vascular and psychogenic disorders.
We are joined today by experienced ENT surgeon Mr Adnan Safdar, Head of the ENT Unit at Monash Health, to discuss a logical approach to facial pain management.
Adnan covers:
· Common aetiologies
· Involvement of the sinuses
· Practical management and tips
Please join me in this interesting discussion with Adnan.
Useful references include:
- berwickent.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 50. Otalgia with Mr Adnan Safdar
Ear pain or otalgia as a diagnostic problem presents commonly to primary health physicians. Otalgia may be primary, arising from the external auditory canal (otitis externa) or the middle ear (otitis media) or secondary. As the sensory innervation of the ear is richly supplied by branches of the trigeminal, facial, glossopharyngeal, vagal nerve as well as upper cervical nerves it is not surprising that many secondary causes of earache including TMJ dysfunction, dental infections and neoplasias may also be responsible for otalgia.
Ear pain or otalgia as a diagnostic problem presents commonly to primary health physicians. Otalgia may be primary, arising from the external auditory canal (otitis externa) or the middle ear (otitis media) or secondary. As the sensory innervation of the ear is richly supplied by branches of the trigeminal, facial, glossopharyngeal, vagal nerve as well as upper cervical nerves it is not surprising that many secondary causes of earache including TMJ dysfunction, dental infections and neoplasias may also be responsible for otalgia.
We are joined today by experienced ENT surgeon and head of ENT unit at Monash Health, Mr Adnan Safdar, who discusses:
· Primary otalgia
· Secondary otalgia
· Management strategies
This is a very interesting discussion with Adnan and I invite you to the episode.
Useful references include:
- berwickent.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 49. IBS with Dr Catherine Sorrell
Irritable bowel syndrome is an idiopathic clinical entity characterised by chronic (more than six months) abdominal pain that occurs in association with altered bowel habits. In 2016 the Rome IV Consensus report adjusted the diagnosis to include symptoms occurring at least once a week from a previous definition of three times a month and include the notation of abdominal pain rather than discomfort related to defaecation. In practical terms, irritable bowel syndrome is in part a diagnosis of exclusion, however, in younger patients without alarm symptoms a simple stool test for calprotectin rather than extensive endoscopic work up may be all that is required. A negative calprotectin favouring conservative and symptomatic management, a positive finding requiring further workup.
Irritable bowel syndrome is an idiopathic clinical entity characterised by chronic (more than six months) abdominal pain that occurs in association with altered bowel habits. In 2016 the Rome IV Consensus report adjusted the diagnosis to include symptoms occurring at least once a week from a previous definition of three times a month and include the notation of abdominal pain rather than discomfort related to defaecation. In practical terms, irritable bowel syndrome is in part a diagnosis of exclusion, however, in younger patients without alarm symptoms a simple stool test for calprotectin rather than extensive endoscopic work up may be all that is required. A negative calprotectin favouring conservative and symptomatic management, a positive finding requiring further workup.
To discuss IBS in more detail we are joined by experienced gastroenterologist Dr Catherine Sorrell who discusses:
· Prevalence and diagnosis of IBS
· Approach to younger patients with IBS
· Approach to older patients with IBS-like symptoms
In this conversation, Catherine fields several questions in regard to extensive workup versus assessment of symptoms by calprotectin alone and the importance of applying a low FODMAP diet and lifestyle changes to symptom control. Please join me in this interesting conversation.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 48. Eosinophilic Oesophagitis with Dr Darcy Holt
Now recognised as one of the most common conditions underlying food impaction events, eosinophilic oesophagitis (EOE) has an estimated prevalence of 0.4% among both children and adults. EOE is a chronic inflammatory disorder characterised by oesophageal dysfunction and eosinophil predominant inflammation. Relatively recently described we may speculate as to whether this is a truly new disease or a more recently recognised one.
Now recognised as one of the most common conditions underlying food impaction events, eosinophilic oesophagitis (EOE) has an estimated prevalence of 0.4% among both children and adults. EOE is a chronic inflammatory disorder characterised by oesophageal dysfunction and eosinophil predominant inflammation. Relatively recently described we may speculate as to whether this is a truly new disease or a more recently recognised one.
To discuss EOE in more detail we are joined by experienced gastroenterologist Dr Darcy Holt. In this conversation Darcy includes:
· Description of EOE (endoscopic and histologic findings)
· Common presentation
· Appropriate management strategies
Please join this very interesting discussion with Darcy on this relatively newly understood but very important oesophageal condition.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Special Episode 6. Mental Health in a time of Covid (and the polyvagal ladder) with Brenda Sutherland
Mental health has become a major casualty of the Covid pandemic that has swept across the globe and been responsible for rolling lockdowns throughout Australia restricting personal freedoms, social contact and the ability to prosper financially. No one is exempt from this unprecedented event and the anxiety, depression and anguish wrought is having a major effect on the health and wellbeing of our communities.
Mental health has become a major casualty of the Covid pandemic that has swept across the globe and been responsible for rolling lockdowns throughout Australia restricting personal freedoms, social contact and the ability to prosper financially. No one is exempt from this unprecedented event and the anxiety, depression and anguish wrought is having a major effect on the health and wellbeing of our communities.
To discuss the indicators that a patient or friend may be experiencing evolving or established mental health difficulties and learning methods for shifting patients holistically out of collapse we have a conversation with psychologist Brenda Sutherland founder and director of The Awakening Group. Brenda teaches us about the polyvagal ladder and how to use an understanding of this insight to instructively and empathically assist our most vulnerable patients.
Brenda's extensive knowledge of the human mental state in distress and happiness and her work with Bessel van de Kolk, Stan Tatkin and Byron Katie have placed her in an outstanding position to guide us on this subject.
Please enjoy the conversation.
References:
The Awakening Group.com.au
https://awakening.com.au/lms/2021/08/24/ventral-vibes-project/
Mental health services in Australia, COVID-19 impact on mental health
Weekend Australian - Aug 28-29 pages 1&6
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 47. Helicobacter Pylori with Dr Darcy Holt
Helicobacter pylori is a gram-negative curved bacillus that may colonise the gastric and proximal duodenal mucosa. Its significance was first described by Barry Marshall and Robin Warren in 1982 both of whom were awarded the Nobel prize in 2005 after the Nobel community described the discovery as the most impacting in medical sciences. Most medical practitioners are aware of the pathophysiological consequences of Helicobacter which is responsible for gastritis, gastric and duodenal ulcer disease, and may be associated with gastric adenocarcinoma as well as mucosa associated lymphoid tissue hyperplasia (MALT lymphoma). Its eradication has largely hinged on standard triple therapy including a PPI combined with amoxicillin and clarithromycin taken together for 1 week in Australia; unfortunately this regimen has a 10-15% failure rate.
Helicobacter pylori is a gram-negative curved bacillus that may colonise the gastric and proximal duodenal mucosa. Its significance was first described by Barry Marshall and Robin Warren in 1982 both of whom were awarded the Nobel prize in 2005 after the Nobel community described the discovery as the most impacting in medical sciences. Most medical practitioners are aware of the pathophysiological consequences of Helicobacter which is responsible for gastritis, gastric and duodenal ulcer disease, and may be associated with gastric adenocarcinoma as well as mucosa associated lymphoid tissue hyperplasia (MALT lymphoma). Its eradication has largely hinged on standard triple therapy including a PPI combined with amoxicillin and clarithromycin taken together for 1 week in Australia; unfortunately this regimen has a 10-15% failure rate.
In this episode we are joined today by Dr Darcy Holt, an experienced gastroenterologist to discuss second line treatments that may be considered when first line triple therapy fails.
Darcy covers:
· Current Australian antibiotic guidelines
· Alternate quadruple therapies that are effective in eradication although not subsidised by the PBS at this time
There is a large body of information we cover in this interesting episode, please join me and Darcy.
Maastricht V/Florence Consensus Report recommends:
o Bismuth quadruple therapy for 10-14 days including bismuth subcitrate 120mg qid, tetracycline 500mg qid, metronidazole 400mg tds and PPI bd
o Fluoroquinolone (levofloxacin) 500mg daily, Amoxicillin 1g bd plus PPI standard dose bd (can be converted to quadruple by adding Bismuth 120mg qid or 240mg bd for 10-14 days
o PPI 40mg bd, Bismuth 120mg qid, Tetracycline 500mg qid, Levofloxacin 500mg daily for 10 days (98% effective)
o PPI standard dose qid plus Amoxicillin 750mg bd 14 days – 89% effective
Useful references include:
- www.mja.com.au (MJA 2016:204, 376-380)
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Special Episode 5. Psilocybin assisted psychotherapy with Dr Margaret Ross
The burden of mental health to Western society ranks amongst the leading causes of overall clinical presentations and the impact of anxiety, depression, addiction, substance abuse and PTSD can be devastating both to individuals and society. Recognition that psychedelic therapies may offer a profound benefit in the treatment of these conditions has rekindled a renaissance in their use, in particular of psilocybin from Psilocybe cubensis or “magic” mushrooms. The Australian Psilocybin Assisted Psychotherapy study at St Vincent’s focusing on end of life anxiety and depression is providing fascinating insights into the place and future use of these compounds.
The burden of mental health to Western society ranks amongst the leading causes of overall clinical presentations and the impact of anxiety, depression, addiction, substance abuse and PTSD can be devastating both to individuals and society. Recognition that psychedelic therapies may offer a profound benefit in the treatment of these conditions has rekindled a renaissance in their use, in particular of psilocybin from Psilocybe cubensis or “magic” mushrooms. The Australian Psilocybin Assisted Psychotherapy study at St Vincent’s focusing on end of life anxiety and depression is providing fascinating insights into the place and future use of these compounds.
In this conversation, we are joined by the energetic and dynamic Dr Margaret Ross, a clinical psychologist with an interest in palliative care and cancer care, whose efforts in stimulating interest in the use of psychedelics was rewarded by the funding of the above study at St Vincent’s Hospital. Rather than proving addictive or damaging to mental health psychedelics have been shown to protect against it. Dr Margaret Ross expands their potential use in this fascinating conversation. Please join me on this podcast.
Useful references include:
- Dr Margaret Ross – www.svha.org.au
- ABC podcast: All In The Mind, Psychedelics Addiction and Mental Health with Sana Qadar, 2nd February 2019
- How To Change Your Mind: What The New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence - Michael Pollan, Penguin 2018
- How ecstasy and psilocybin are shaking up psychiatry – www.nature.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 46. Obstructive Sleep Apnea with Dr Michael Ho
Obstructive sleep apnoea is common, it is estimated that 49% of men aged 40-69 have obstructive sleep apnoea rising to 62% above the age of 70. Up to 1 in 10 have undiagnosed obstructive sleep apnoea which may present with snoring, daytime somnolence, depression and significant hypoxemia during sleep with associated cardiac arrhythmias.
Obstructive sleep apnoea is common, it is estimated that 49% of men aged 40-69 have obstructive sleep apnoea rising to 62% above the age of 70. Up to 1 in 10 have undiagnosed obstructive sleep apnoea which may present with snoring, daytime somnolence, depression and significant hypoxemia during sleep with associated cardiac arrhythmias.
To discuss this subject in more detail we are joined by experienced respiratory physician Dr Michael Ho in a conversation including:
· Definition of obstructive sleep apnoea
· Associated conditions and sequela
· Polysomnography
· Appropriate management
Please join me in this interesting podcast episode.
Useful references include:
- Dandenong Respiratory Group
- www.ncbi.nlm.nih.gov
- www.aci.health.nsw.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 45. Asthma with Dr Michael Ho
Australia has one of the highest rates of asthma in the world affecting about 11% of the population and in 2017/18 was responsible for 38,792 hospital admissions and 389 deaths, many of which may have been preventable. Asthma occurs when there is reversible expiratory constriction of the airways, especially the bronchioles and smaller bronchi, in response to various stimuli associated with a chronic inflammatory process. Today we are joined by Dr Michael Ho, an experienced respiratory physician who discusses:
Australia has one of the highest rates of asthma in the world affecting about 11% of the population and in 2017/18 was responsible for 38,792 hospital admissions and 389 deaths, many of which may have been preventable. Asthma occurs when there is reversible expiratory constriction of the airways, especially the bronchioles and smaller bronchi, in response to various stimuli associated with a chronic inflammatory process. Today we are joined by Dr Michael Ho, an experienced respiratory physician who discusses:
· Aetiology of asthma
· Non-drug approaches to management
· Pharmacological approaches to treatment
· Thunderstorm asthma
Please join me with this very interesting conversation with Michael covering many aspects of this common condition.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 44. Thyroid Nodules with Mr Cyril Tsan
Thyroid nodules are common, in some ultrasound series at least 30% of adults are found to have nodules and 4-7% of adults will have a palpable nodule. Whilst the overall risk of malignancy within a nodule is less than 5%, this is dependent on thyroid imaging reporting and data system (TI-RADS) which reflects features such as size of the nodule, presence of microcalcification, cyst complexity, whether the cyst is taller than wider and the presence of intranodular vascular images.
Thyroid nodules are common, in some ultrasound series at least 30% of adults are found to have nodules and 4-7% of adults will have a palpable nodule. Whilst the overall risk of malignancy within a nodule is less than 5%, this is dependent on thyroid imaging reporting and data system (TI-RADS) which reflects features such as size of the nodule, presence of microcalcification, cyst complexity, whether the cyst is taller than wider and the presence of intranodular vascular images.
We are joined by expert thyroid and breast surgeon Mr Cyril Tsan in this episode, who provides clarity in discussing a logical approach to the work up of thyroid nodules covering in particular:
· Epidemiology
· Risk factors
· When to refer the ultrasound
· The TI-RADS system
· When to refer for surgery
This was a tremendous discussion and I welcome you to the episode.
Useful references include:
- www.cleelandspecialists.com.au
- webmd.com
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Special Episode 4. Covid-19: My Indian Experience with Dr Shashikanth Manikappa
In this episode, we share an intimate conversation with Dr Shashi Manikappa who has spent the past 18 months in India’s heartland volunteering medical care to those affected by the Covid pandemic. Whilst over 400 million Indians have received at least one dose of vaccine to date, on the ground in India treatment protocols embracing the use of Ivermectin in combination with other drugs have gained significant popularity and anecdotal support as an effective treatment. Shashi discusses the value of these protocols as used in India and the medical experience and perspective gathered during his time there. It is acknowledged that the protocols discussed in this episode have not been endorsed for use in Australia.
In this episode, we share an intimate conversation with Dr Shashi Manikappa who has spent the past 18 months in India’s heartland volunteering medical care to those affected by the Covid pandemic. Whilst over 400 million Indians have received at least one dose of vaccine to date, on the ground in India treatment protocols embracing the use of Ivermectin in combination with other drugs have gained significant popularity and anecdotal support as an effective treatment. Shashi discusses the value of these protocols as used in India and the medical experience and perspective gathered during his time there. It is acknowledged that the protocols discussed in this episode have not been endorsed for use in Australia.
Dr Shashikanth Manikappa, MBBS,MD, DNB, FANZCA, FCA, PG Dip Echo
Specialist Anaesthetist I Cardiac Anaesthesia and Perioperative Medicine, Melbourne Australia
Adj. Professor, ESIC Medical College & Hospital, Hyderabad, India
Adj. Professor, Raja Rajeswari Medical College & Hospital, Bangalore, India
Honorary Clinical Senior Lecturer, The University of Melbourne, Melbourne, Australia
Adjunct Senior Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 43. Radiofrequency Ablation with Dr Matthew Swale
Radiofrequency ablation (RFA) has revolutionised treatment for tachyarrhythmias and has become first line treatment for some tachycardias. Some arrhythmias are relatively common, atrial fibrillation for example affects up to 9% of our population over the age of 80 years and provides a very significant risk for thromboembolic stroke, haemorrhagic stroke as well as impairment of quality of life whilst also contributing to heart failure.
Radiofrequency ablation (RFA) has revolutionised treatment for tachyarrhythmias and has become first line treatment for some tachycardias. Some arrhythmias are relatively common, atrial fibrillation for example affects up to 9% of our population over the age of 80 years and provides a very significant risk for thromboembolic stroke, haemorrhagic stroke as well as impairment of quality of life whilst also contributing to heart failure.
Since the pioneering work in 1998 of Michel Haissaguerre, RFA has become widely accepted therapy and we are fortunate to have a discussion today with expert electrophysiologist and cardiologist Matthew Swale regarding:
· RFA
· Suitable candidates
· Risks
This was an excellent discussion with Matthew, and I am very pleased to invite you to the episode.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 42. Atrial Fibrillation and DOAC's with Dr Matthew Swale
Atrial fibrillation is the most commonly experienced arrhythmia increasing in prevalence with age. It is estimated that 3 in 1000 under the age of 65 years have atrial fibrillation rising to 9% of people reaching the age of 80 years. The rate of stroke in untreated atrial fibrillation ranges from 5% per year with minimally associated risk factors up to 15-20% per year with associated risk factors such as hypertension, diabetes mellitus, heart failure and a history of vascular disease. The mortality of atrial fibrillation related to stroke is high and estimated at 25% in 12 months.
Atrial fibrillation is the most commonly experienced arrhythmia increasing in prevalence with age. It is estimated that 3 in 1000 under the age of 65 years have atrial fibrillation rising to 9% of people reaching the age of 80 years. The rate of stroke in untreated atrial fibrillation ranges from 5% per year with minimally associated risk factors up to 15-20% per year with associated risk factors such as hypertension, diabetes mellitus, heart failure and a history of vascular disease. The mortality of atrial fibrillation related to stroke is high and estimated at 25% in 12 months.
Not only is it very important to recognise atrial fibrillation it is also important to understand how to provide adequate anticoagulation. Whilst warfarin has been available since the 1950’s as a vitamin K inhibitor limiting the hepatic synthesis of factor II, VII, IX and X as well as protein C and S, since 2008 factor Xa inhibitors and direct thrombin inhibitors referred to as direct oral active anticoagulants or DOACs have become available, avoiding the food and drug interactions that are commonly seen with warfarin and the need for regular drug monitoring.
We are joined in this episode by experienced electrophysiologist and cardiologist Dr Matthew Swale to discuss:
· Atrial fibrillation and its risks
· Anticoagulation with DOACs
· Anticoagulation post stenting
This is a great conversation with Matthew and I am very pleased to invite you to the episode.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Special Episode 3. COVID-19 Vaccines with Professor Tony Cunningham
As the Covid pandemic continues to spread around the world with over 187 million recorded infections and 4 million deaths, countries including Australia have embarked upon vaccination programs including the use of mRNA (Pfizer and Moderna), viral vector (Astra Zeneca), and subunit protein vaccines (Novovax).
As the Covid pandemic continues to spread around the world with over 187 million recorded infections and 4 million deaths, countries including Australia have embarked upon vaccination programs including the use of mRNA (Pfizer and Moderna), viral vector (Astra Zeneca), and subunit protein vaccines (Novovax).
In Australia currently, less than 10% of our population have been fully vaccinated leaving our population exposed and subject to repeat widespread population lockdowns and contact tracing via local health departments.
Hesitancy to receive vaccination in part relates to perceived side-effects from vaccines as much as from difficulties relating to supply delivery.
In this episode, we are joined by Professor Tony Cunningham, Infectious disease physician and co-director of the Centre for virus research at WIMR who generously discusses vaccine side-effects including vaccine-induced thrombosis with thrombocytopenia syndrome (VITT), myocarditis and pericarditis as well as anaphylaxis. In this conversation, we delve into some very interesting aspects of vaccination and speculate on how the future may look for us all.
Please welcome Professor Tony Cunningham.
References include :
Australian Government Department of Health - joint statement from ATAGI and THANZ on thrombosis with thrombocytopenia syndrome and the use of COVID-19 vaccine Astrazeneca (23rd May 21 ) The ATAGI statement on revised recommendations on the use of COVID-19 vaccine Astrazeneca (17 June 2021) Professor Tony Cunningham, www.westmead institute .org.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 41. Secondary Prevention of Cardiovascular Disease with Dr John Counsell (Part 2)
Heart disease affects one in six Australians with an AMI occurring every 10 minutes and accounts for one in four of all deaths, so primary and secondary prevention are very important considerations in relation to any patient presenting with heart disease or at risk of heart disease. Risk factors including family history, lipid abnormalities, diabetes mellitus, hypertension, smoking or those with elevated BMI all need consideration. Whilst there have been significant controversies regarding lipids management and the use of statins, the evidence for their use, particularly in secondary prevention of heart disease is clear.
Heart disease affects one in six Australians with an AMI occurring every 10 minutes and accounts for one in four of all deaths, so primary and secondary prevention are very important considerations in relation to any patient presenting with heart disease or at risk of heart disease. Risk factors including family history, lipid abnormalities, diabetes mellitus, hypertension, smoking or those with elevated BMI all need consideration. Whilst there have been significant controversies regarding lipids management and the use of statins, the evidence for their use, particularly in secondary prevention of heart disease is clear.
To discuss this interesting subject in detail we are joined by the very experienced cardiologist and local mentor Dr John Counsell who covers:
· Primary prevention in cardiovascular disease [Part 1]
· Secondary prevention in cardiovascular disease [Part 2]
· Use of statins and ACE inhibitors
Please join me in this very interesting conversation with John Counsell.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
![Episode 41. Primary Prevention of Cardiovascular Disease with Dr John Counsell [Part 1]](https://images.squarespace-cdn.com/content/v1/6246708462f6e814e578b7a3/1653455742358-BI3NZ2T49PTYKWSG4CCH/Dr%2BLuke%2BCrantock%2BEveryday%2BMedicine%2Bwith%2BDr%2BJohn%2BCounsell.jpeg)
Episode 41. Primary Prevention of Cardiovascular Disease with Dr John Counsell [Part 1]
Heart disease affects one in six Australians with an AMI occurring every 10 minutes and accounts for one in four of all deaths, so primary and secondary prevention are very important considerations in relation to any patient presenting with heart disease or at risk of heart disease. Risk factors including family history, lipid abnormalities, diabetes mellitus, hypertension, smoking or those with elevated BMI all need consideration. Whilst there have been significant controversies regarding lipids management and the use of statins, the evidence for their use, particularly in secondary prevention of heart disease is clear.
Heart disease affects one in six Australians with an AMI occurring every 10 minutes and accounts for one in four of all deaths, so primary and secondary prevention are very important considerations in relation to any patient presenting with heart disease or at risk of heart disease. Risk factors including family history, lipid abnormalities, diabetes mellitus, hypertension, smoking or those with elevated BMI all need consideration. Whilst there have been significant controversies regarding lipids management and the use of statins, the evidence for their use, particularly in secondary prevention of heart disease is clear.
To discuss this interesting subject in detail we are joined by the very experienced cardiologist and local mentor Dr John Counsell who covers:
· Primary prevention in cardiovascular disease [Part 1]
· Secondary prevention in cardiovascular disease [Part 2]
· Use of statins and ACE inhibitors
Please join me in this very interesting conversation with John Counsell.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Luke has been offering interventional endoscopy for over 22 years. He is passionate about patient care and managing digestive health. He is highly regarded for technical ability and his compassionate approach to patients.
Episode 40. Mole mapping and skin cancer surveillance with Dr Archie Xu
Non-melanotic skin cancers and melanoma are the most common cancers affecting humans. At least two in three Australians will be diagnosed with skin cancer before the age of 70 years and the risk is higher for men than women. Whilst basal cell carcinomas and squamous cell carcinomas are more common they are not as lethal as melanomas which are referred to as Australia’s “national cancer”. Indeed in 2020 it is estimated that 16,200 will be diagnosed with melanoma, that is one new case every half hour and a death every five hours.
Non-melanotic skin cancers and melanoma are the most common cancers affecting humans. At least two in three Australians will be diagnosed with skin cancer before the age of 70 years and the risk is higher for men than women. Whilst basal cell carcinomas and squamous cell carcinomas are more common they are not as lethal as melanomas which are referred to as Australia’s “national cancer”. Indeed in 2020 it is estimated that 16,200 will be diagnosed with melanoma, that is one new case every half hour and a death every five hours.
Skin clinics have emerged embracing mole mapping to assist in the diagnosis and management of melanotic skin cancers as well as non-melanotic skin cancers and we are grateful to have a conversation today with Dr Archie Xu who has been running a suburban skin cancer clinic for many years. He joins us to discuss:
· Mole mapping
· Dermoscopy
· Melanoma and non-melanotic skin cancer
I am most grateful to have had this discussion with Archie on a very important subject particularly relevant to our sun-drenched outdoor lifestyle. Please join me with Archie.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 39. Muscle Joints Aches and Pains with Dr Minz Cheah
Based on the Australian Bureau of Statistics National Health Survey data about one in three people over the age of 18 living in Australia have hypertension or were taking blood pressure lowering medications. A staggering number requiring therapy for a condition which impacts on cerebrovascular disease, coronary artery disease, chronic kidney disease, heart failure and mortality.
Based on the Australian Bureau of Statistics National Health Survey data about one in three people over the age of 18 living in Australia have hypertension or were taking blood pressure lowering medications. A staggering number requiring therapy for a condition which impacts on cerebrovascular disease, coronary artery disease, chronic kidney disease, heart failure and mortality.
The National Heart Foundation guidelines are available for careful perusal, but to walk us through an intelligent approach to management of systemic hypertension we are joined by expert general physician Dr Minz Cheah who will discuss:
· Blood pressure targets
· Primary prevention
· Choice of hypotensive agent
This was an interesting conversation with Minz on a very important subject and I am happy to bring the episode to you.
Useful references include:
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.