Episode 142. Common problems in Psychiatry with Dr Usman Riaz (part 2)
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.
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)
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.
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)
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.
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)
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.
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)
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.
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)
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.
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
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'.
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
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
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.
Special Episode 16. Interventional Radiology with Dr Yen Chieng
Interventional radiology is an innovative and rapidly growing medical profession that enables radiologists to blend clinical interaction, procedural work, and imaging. It stands as an exciting domain within modern medicine, offering precise, targeted treatments for complex diseases and conditions throughout the body. Interventional radiologists seamlessly integrate various specialty interests, including gastroenterology, vascular surgery, neurosurgery, oncology, pain management, gynecology, and more. Moreover, they've pioneered treatment techniques using state-of-the-art technology like MRI, CT scans, fluoroscopy, ultrasound, and plain X-rays.
Their scope of practice encompasses a broad range of procedures such as biliary intervention, cholecystostomy, chemo and radioembolization of tumors, Radiofrequency ablation, Cryoablation and microwave ablation, balloon angioplasty, vascular stenting, aneurysm repair, embolization (e.g., of the uterine artery, fibroids, and pulmonary arteriovenous malformations), catheter-directed thrombolysis, placement of IVC filters, dialysis-related interventions, central venous catheter placement, percutaneous nephrostomy placement, ureteral stent placement, coeliac axis nerve blocks, spinal blocks, and more.
Interventional radiology is poised to play an increasingly significant role in the future of modern medicine. It offers cost-effective, minimally invasive treatments with shorter procedural and recovery times, sometimes yielding better patient-focused outcomes compared to many surgical alternatives.
In this podcast, my goal was to expand my knowledge about the remarkable world of IR. I am delighted to welcome interventional radiologist Dr. Yen Chieng to join us, covering many of the areas mentioned above. Yen has skillfully navigated challenging clinical scenarios, bailing many of us out more than once with his incredible yet measured skills and enthusiasm. Please welcome Yen to the podcast."
References:
Dr. Yen Chieng: i-med.com.au
Royal Australian and New Zealand College of Radiologists: www.ranzcr.com
Interventional Radiology Society of Australasia: www.irsa.com.au
Inside radiology: www.insideradiology.com.au
Episode 123. Lipids and Atherosclerotic Cardiovascular Disease (Part 2/3)
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish over time and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.
Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.
Current Australian guidelines for lipid management recommend:
Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population
LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population
Triglycerides < 2 mmol/l
HDL > 1.0 mmol/l
Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per 1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.
Interventions that are utilized to modify the cardiac risk associated with lipids include:
Dietary manipulation
Pharmacologic modification of lipid synthesis or absorption
Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.
Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.
References:
Basic and Clinical Pharmacology 14th ed -Bertram G. Katzung, LANGE Books, Ch 35.
Principles of Medical Biochemistry, Eisenberg & Simmons,3Rd Ed, Elsevier Saunders, Ch 23
Ganong’s Review of Medical Physiology, Barrett et al,25 th Ed, LANGE Books, Ch 26
Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol. 37:423-446, Wang & Hu
Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease, Nutrients 2018Jun;10(6):780 Ghada A. Soliman
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 122. Lipids and Atherosclerotic Cardiovascular Disease (Background Information) Part 1/3
Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.
Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish over time and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.
Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.
Current Australian guidelines for lipid management recommend:
Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population
LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population
Triglycerides < 2 mmol/l
HDL > 1.0 mmol/l
Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per 1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.
Interventions that are utilized to modify the cardiac risk associated with lipids include:
Dietary manipulation
Pharmacologic modification of lipid synthesis or absorption
Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.
Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.
References:
Basic and Clinical Pharmacology 14th ed -Bertram G. Katzung, LANGE Books, Ch 35.
Principles of Medical Biochemistry, Eisenberg & Simmons,3Rd Ed, Elsevier Saunders, Ch 23
Ganong’s Review of Medical Physiology, Barrett et al,25 th Ed, LANGE Books, Ch 26
Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol. 37:423-446, Wang & Hu
Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease, Nutrients 2018Jun;10(6):780 Ghada A. Soliman
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 121. POTS with Dr Chris O’Callaghan
Postural orthostatic tachycardia syndrome-POTS is not rare, yet it is hard to find any references to the syndrome in medical textbooks. It is a form of dysautonomia that by some estimates may impact as many as one in 100, more commonly demonstrated in women between the ages of 13 and 50 years; men also may be affected. Classically defined as a form of orthostatic intolerance characterised by excessive tachycardia upon standing, POTS usually presents with symptoms that are much more complex than a simple increase in heart rate.
It is common for POTS patients to experience fatigue, headache, light-headedness heart palpitations excessive intolerance, nausea, diminished concentration, tremulousness, syncope, coldness or pain in the extremities as well as chest pain and shortness of breath. Patients may develop a reddish-purple colour in the legs upon standing, possibly caused by blood pooling or poor circulation. Colour changes subside upon returning to a reclined position. POTS is often diagnosed by a tilt table test, however the bedside measurement of heart rate and blood pressure taken in the supine and standing position at 2.5 and 10 minute intervals will help to clarify the diagnosis. A heart rate increase of 30 beats per minute or over 120 beats per minute within the first 10 minutes of standing is highly suggestive.
The term POTS was coined in 1993 by a team of researchers from the Mayo Clinic but it is not a new illness and terms such as Mitral valveprolapse, Da Costas syndrome, Soldiers heart, Chronic orthostaticintolerance and Neurocirculatory asthenia point to the single condition. POTS is not caused by anxiety, rather a malfunction of the patients autonomic nervous system and doctors such as Chris O’Callaghan from the Austin hospital have been at the vanguard of this diagnosis and management and thankfully for Australian clinicians, guiding us on appropriate management strategies. Such treatments may include increased fluid intake to 2-3 litres per day, increasing salt consumption to between 3000 milligrams and 10,000 milligrams per day, the wearing of compression stockings, raising the head of the bed and using a variety of medication such as Fludrocortisone, Beta blockers, Midodrine, Clonidine, Benzodiazepine and others.
Associate Professor Chris O’Callaghan is a physician and clinical pharmacologist working at The Austin Hospital Melbourne and is the principal at The Melbourne Cardiovascular and Autonomic Clinic, he has a special interest in cardiovascular medicine, Ehlers Danlossyndrome and POTS. It is a great privilege to welcome him to the podcast.
References:
Assoc Professor Chris O’Callaghan
Postural Tachycardia Syndrome. Blair P. Grubb, Circulation. 2008; 117:2814-2817.
National Institute of Health, Neurological Institute of Neurological Disorders and Stroke, Postural Tachycardia Syndrome Information Page.
The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.
Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161 (2011) 46-48.
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 120. Simulation in Healthcare with Dr Nancy Sadka
Simulation based medical education uses simulation aides to replicate clinical scenarios with the aim of enhancing patient safety by improving medical care and competence and reducing medical errors. Although relatively new to medicine, simulation has been used for a long time in other professions, such aviation. Increasingly, medical simulation is being recognized as a very important training method for doctors, nurses and allied health staff, allowing skill acquisition through deliberate practice. In simulation, a trainee may make mistakes in a controlled, no risk environment and learn from them without the fear of harming patients. This deliberate practice is aimed at taking medical staff from the “see one, do one, teach one” paradigm of apprenticeship style learning to the “see one, practice many, do one" simulation training model.
Simulation also builds group skills, cultivates team culture, and allows systems and processes to be practiced, reviewed and improved, enhancing medical competence. One of the main drivers for simulation-based learning and training relates to global study reports showing that up to 10% of patients admitted to hospitals suffer some kind of harm or injury through medical errors. A landmark report released in 1999 by the Institute of Medicine estimated that medical errors were responsible at that time for up to 98,000 deaths in the USA per year. These figures remind us that “to err is human”.
I was curious to take this conversation on medical simulation further and was honored to invite Dr Nancy Sadka, Emergency physician, ED clinical lead in education and research, and head of simulation training at The Northern Hospital in Epping, as a guest to this podcast. Please welcome Dr Nancy Sadka.
References:
Dr Nancy Sadka, www.nh.org.au
The future vision of simulation in healthcare, Gaba: ncbi.nlm.nih.gov
Simulation-based medical teaching and learning, AH Al-Elq :ncbi.nlm.nih.gov
Training and simulation for patients safety, R Aggarwal: qualitysafety.bmj.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 13. Autism with Associate Professor Soumya Basu
The concept of autism continues to evolve with our current approach to diagnosis and management differing significantly from 1908 when the word first appeared to describe a subset of patients with schizophrenia who were withdrawn and self-absorbed. Child psychiatrist Leo Kanner was credited with the first correct description in 1943, reporting eleven highly intelligent children who displayed “a powerful desire for aloneness” and “an obsessive insistence on persistent sameness”. He named this “early infantile autism”.
A year later in 1944, Hans Asperger described a “milder” form of autism now known as Asperger’s Syndrome where the boys he described were highly intelligent but had trouble with social interactions and specific obsessive interests. A major setback came in 1967 with psychologist Bruno Bettelheim’s theory of “refrigerator mothers” implying parental responsibility and causality through a lack of shared love. This psychoanalytic approach to explaining autism caused major damage to the mental health of parents struggling to provide their children love and care and was extremely cruel in its ignorance. Similarly, the forged research that lead to the subsequently retracted 1998 Lancet article, authored by the deregistered Andrew Wakefield, significantly damaged community understanding of this condition whilst creating unwarranted fear and panic regarding measles, mumps, rubella vaccine and the use of thimerosal (a mercury-based preservative now withdrawn from all vaccines to allay public fears). By 1977, twin studies helped us to understand that autism is caused by genetics and biological differences in brain development.
In this podcast, I was curious to learn more about autism, its diagnosis, and approaches to management. It was a great privilege to have a conversation with child and adolescent psychiatrist Associate Professor Soumya Basu who has a special interest in developmental disabilities including autism spectrum disorder. Soumya is a fellow of the Royal Australian and New Zealand College of Psychiatrists and is a senior lecturer at the Department of Psychological Medicine, Monash University with other keen interests in youth mental health and developmental trauma. Please welcome Soumya to the Podcast.
References:
Associate Professor Soumya Basu: Victorian Centre for Mental Health www.vcmh.com.au, warragulspecialistcentre.com.au, St John of God Langmore Centre: www.sjog.org.au
Autism Spectrum Disorder - National Institutes of Health: www.nimh.nih.gov
Episode 119. Coeliac Disease with Associate Professor Jason Tye-Din (Part 2)
First described by Samuel Gee in England in 1887 and Christian Herter in the United States, until the mid-twentieth century the disease of malnutrition and growth retardation now called Coeliac disease was known as Gee-Herter disease and managed with the so-called banana diet. We now know a great deal more about Coeliac disease which is recognised as an immune-mediated disorder characterised by chronic inflammation of the proximal small bowel which heals with gluten withdrawal from the diet and returns when gluten is reintroduced.
I was very interested to invite Assoc Prof Jason Tye-Din to Everyday Medicine to discuss this fascinating subject in more depth. Jason is an active clinician practicing gastroenterology but is also laboratory head in the division of immunology at Melbourne’s Walter and Eliza Hall. He is actively involved in researching the inflammatory response to gluten in human participants and in characterising CD4+T cell antibody responses to gluten whilst aiming to improve clinical pathways to promote timely and cost-effective diagnosis, monitoring and management of coeliac disease.
Please check last week's episode 1 before joining me with Jason Tye-Din for this concluding episode.
References:
Assoc Professor Jason Tye-Din: www.wehi.edu.au
Coeliac Society of Australia: www.coeliac.org.au
Gastroenterology Society if Australia : www.gesa.org.au
The Dietitians Association of Australia: www.data.asn.au
Gastronet: www.gastro.net.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 118. Coeliac Disease with Associate Professor Jason Tye Din (Part 1)
First described by Samuel Gee in England in 1887 and Christian Gerter in the United States, the disease of malnutrition and growth retardation now called Coeliac disease was known as Gee-Herter disease. Until the mid-twentieth century, the disease was managed with the so-called banana diet. We now know a great deal more about Coeliac disease, which is recognised as an immune-mediated disorder characterised by chronic inflammation of the proximal small bowel. The inflammation heals with gluten withdrawal from the diet and returns when gluten is reintroduced.
Coeliac disease exhibits significant geographical variation, with the highest incidence in Western Europe and less common occurrences in Asia and sub-Saharan Africa. Once considered rare, with prevalence estimates from the 1950s between 1 in 4,000 to 1 in 5,000, the true prevalence in Western countries, including Australia, is now recognised to be about 1 in 70.
There is a female predominance, and serological testing has demonstrated that silent coeliac disease (no or minimal symptoms with positive serology and small bowel biopsy) is about 7 times more common than a symptomatic disease. Monozygotic twins have a 70% concordance rate. First-degree relatives of individuals with coeliac disease have a prevalence of villous atrophy on small bowel biopsy ranging from 4% to 12%, and there is an increased risk associated with Type I Diabetes and Dermatitis Herpetiformis. Other associated diseases include thyroid disease, Down's syndrome, PBC, and IgA deficiency. The condition should be considered in cases of unexplained female infertility, osteoporosis, and iron deficiency.
Gluten encompasses the storage of proteins from cultivated grasses, including wheat, barley, and rye. After digestion, a wide variety of native peptide derivatives emerge, including the ethanol-soluble component of gluten referred to as gliadins. Gliadin peptides are highly immunogenic, and in genetically predisposed individuals, an immune response within the mucosal lining of the small intestine results in the characteristic injury observed, including mucosal inflammation with increased lymphocytes, crypt hyperplasia, and villous atrophy. Coeliac patients almost universally possess HLA-DQ2 or DQ-8 haplotypes, compared to 20-30% of the general population.
Clinical presentations of coeliac disease may vary from no symptoms to IBS-like presentations and more classic symptoms such as diarrhea, bloating, and weight loss. Osteoporosis presenting at an early age may be the first indication of the disease, as well as unexplained iron deficiency. Less commonly, neurological and psychiatric conditions may be associated, including ataxia, neuropathy, and epilepsy.
Serological studies, including antibodies to deamidated gliadin, tissue transglutaminase, and endomysium, have sensitivity and specificity above 95%. However, their performance may be influenced by IgA deficiency (occurring in 3-5% of coeliac patients) and must be followed by a diagnostic small intestinal biopsy taken proximal and distal to the ampulla of Vater.
HLA ‘gene’ screening for DQ-2 and DQ-8 has applications where there is doubt about the diagnosis. A negative result essentially excludes the diagnosis. However, there is no merit in using this test as a screening tool for coeliac disease, as these HLA antigens are present in 20-30% of the normal population. Thus, out of 100 people of Caucasian ethnicity tested for HLA, 20-30 would show a positive result, yet only one or fewer would have gluten enteropathy.
Treatment of coeliac disease requires lifelong adherence to a gluten-free diet. In Australia, gluten-free labelled products, by law, must contain less than 0.003% gluten. Triticale, Couscous, Spelt, Semolina, and Burghul or cracked wheat are all to be avoided. Rice, corn, buckwheat, tapioca, polenta, and dhal are all permitted for consumption by coeliacs. Beer and whiskey derived from malt, sadly, are not recommended, despite the lack of clear evidence of them inducing mucosal damage. Formal dietetic review and the use of support groups are strongly advised in patient management.
Untreated or inadequately treated coeliac disease is associated with a 20-fold increase in the risk of solid malignancies, including oropharyngeal, oesophageal, and intestinal cancers. Additionally, there is a quoted 80-fold increase in the risk of lymphoma.
I am very interested in inviting Assoc. Prof. Jason Tye-Din to Everyday Medicine to discuss this fascinating subject in more depth. Jason is an active clinician practicing gastroenterology, but he is also a laboratory head in the division of immunology at Melbourne's Walter and Eliza Hall. He is actively involved in researching the inflammatory response to gluten in human participants and characterizing CD4+T cell antibody responses to gluten. His aim is to improve clinical pathways to promote timely and cost-effective diagnosis, monitoring, and management of coeliac disease.
Please join me with Jason Tye-Din over the next two episodes.
References:
Assoc Professor Jason Tye-Din: www.wehi.edu.au
Coeliac Society of Australia: www.coeliac.org.au
Gastroenterology Society of Australia: www.gesa.org.au
The Dietitians Association of Australia: www.data.asn.au
Gastronet: www.gastro.net.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 117. Work-Life Balance With Dr Ian Martin
While the boundaries between work and home are clear for many professions, in medicine, this boundary has traditionally not been so well defined. Medical work is notorious for invading personal life, made worse by advances in technology that have allowed a constant connection to clinical practice, especially through telephones. This facilitates work responsibilities that frequently encroach upon home time, recreation, and the sensitivities of one's personal life. Maintaining a work-life balance is no simple task. It is very easy to become absorbed in one's medical work, lose sight of personal space and values, and feel overwhelmed by the weight of responsibility in caring for sick patients and worrying about tests ordered and the clinical progress of those under your care. Undoubtedly, our compulsive personality traits reinforce this behaviour.
The consequences of a poor work-life balance include fatigue, poor health, a negative impact on one's mental well-being, and lost time with friends and loved ones, including missing important family events and milestones.
Balancing work and life requires effort, planning, and trade-offs. Some important conversations we must engage in when striving for work-life balance include learning to:
Say No
Make choices about time and money
Avoid cynicism
In exploring these ideas, I had the privilege of meeting Dr. Ian Martin at the amazing Fiji island surf resort of Namotu. Ian is not only the consummate gentleman and an incredible athlete proficient in all water sports, but he also embodies a charming sense of peace and Zen. During our conversation, I soon realised that he had mastered the art of work-life balance. For those who know Ian, his professional career as a bariatric and upper gastrointestinal surgeon based in Brisbane is exemplary. He has received the Surgeon of Excellence award for his work in surgery and is one of the leading contributors to the National Bariatric Surgery Registry. He has served as a reviewer for the ANZ Journal of Surgeons and has been a respected mentor to many trainees. Recently, he transitioned from full-time work to a more balanced schedule, during which time he has mastered the art of paragliding and expertly flown from Slovenia to Italy and Austria before returning in a casual round trip of over 120 km.
It was a real privilege to ask Ian to share his wisdom and tips for achieving a more balanced life while working in medicine with us today. Please welcome Dr. Ian Martin to the podcast.
References:
Dr Ian Martin: brisbaneweightlosssurgery.com.au
Finding Balance in a Medical Life, by Lee Lipsenthal, 2007 (www.findingbalanceproductions.com)
Balancing Your Life at Work and Home: www.ncbi.nlm.nih.com.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 116. Integrative Medicine and Vively with Dr Michelle Woolhouse
Integrative medicine refers to the blending of conventional Western scientific medicine with evidence-based natural and complementary medicines and therapies, with an emphasis on lifestyle interventions aimed at delivering holistic, patient-centred care. The objective of integrative medicine is to enable patients to achieve optimal clinical outcomes, and this approach aims to treat the physical, emotional, mental, and spiritual needs of the patient. Examples of complementary treatments blended into this holistic management may be drawn from Chinese traditional medicine, Western herbal medicine, Tai Chi, yoga, mind-body meditation, and Qigong, for example.
I was curious to learn more about integrative medicine and was excited recently to hear about the wellness app developed by Vively. It is hoped to transform the way our patients approach their health holistically. Vively is passionately and successfully supporting and promoting holistic care through a model that blends lifestyle medicine, personalised care, and conventional medicine.
It was a great honour to catch up with and interview their medical director, Dr. Michelle Woolhouse, to discuss her approach to medical care and the health benefits Vively hopes to bring to our community. Michelle has an in-depth understanding of the underlying causes of diseases and the healing principles of the body from an energetic, biochemical, and structural level, as well as from a psychological, spiritual, and emotional level. She obtained her medical degree from Monash University in 1996 and is a fellow of the Royal Australian College of General Practitioners (RACGP), the Australasian College of Nutritional and Environmental Medicine (ACNEM), and the Australasian Society of Lifestyle Medicine (ASLM). She holds postgraduate qualifications in hypnotherapy, acupuncture, and a postgraduate diploma in mind-body medicine. She is also the author of "The Wonder Within: A Heart-Led Playbook for the Anxious, Stressed, and Burnt-Out," which is available via her website (refer to the references below). She also hosts the FX Medicine podcast.
With that introduction, please welcome Michelle to the podcast.
References:
Vively.com.au
Dr Michelle Woolhouse: www.theholisticgp.com.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.
Special Episode 12. Virtual ED with Dr Loren Sher
Most doctors in Australia are now very familiar with the use of telehealth and, in some cases, video health, as they have both been widely used during the Covid-19 pandemic. Northern Health, with its flagship Northern Hospital located in Melbourne's Epping, in conjunction with La Trobe University, has been incredibly innovative in extending the concept of the virtual consultation and establishing Australia's first virtual emergency department, which commenced on October 1, 2020.
Commenced during the Covid-19 pandemic, the virtual emergency department has already treated more than 28,000 patients, with up to 71% avoiding hospital presentation after receiving advice and instructions via video conference. This exciting new way of triaging patients and delivering care in real-time has profound implications for the ambulance service and translates to fewer trips, less transport, and more ambulances available to attend the next triple zero emergency or next lights and sirens emergency. While transport by ambulance to the hospital may extend up to eight or nine hours, it takes only 40-60 minutes for the average case attended by ambulance services to go through the virtual ED, highlighting the obvious advantage of this service.
In this conversation, I was interested in learning how consultations and advice regarding real-time home monitoring were provided and about the decision-making behind the instructions for patients to stay at home for treatment in conjunction with patients' primary health care providers, versus prompt transfer to the hospital for more specific urgent medical care. I was also curious to learn how the department is staffed and how it has partnered with the ambulance and home nursing services to dramatically improve the delivery of emergency medical care at home and aged care facilities and favourably reduce the need for patient transfer.
I was also hoping to gain a sense of the likely future of the service as developed by the Northern and its utility across Australia generally. I suspect we are rapidly approaching a tipping point for the provision of emergency services through the establishment of virtual emergency departments, and the possibility of bringing augmented reality into this equation makes for an exciting horizon.
It was a great pleasure to invite Dr. Loren Sher to this podcast. Loren is the head of paediatric emergency at The Northern Hospital and is also the clinical director of the Victorian Virtual emergency department. She is committed to outstanding paediatric care in the community as well as education at the University, hospital, and external level. As you shall see from our conversation, she brings energy, enthusiasm, and incredible optimism, which I am certain has helped her define success in her every endeavour.
Please welcome Dr. Loren Sher.
References:
nh.org.au
Victorian Virtual Emergency Department - Northern Health
Dr Loren Sher: au.linkedin.com, wildhealth.net.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.