Episode 144. Dermatology with Dr Alvin Chong (Part 2)
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these.
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these.
Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone.
Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression.
A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology.
In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care.
It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education.
Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne.
Please welcome Alvin to the Podcast.
References:
Dr Alvin Chong
http://spotdiagnosis.org.au/
https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis
Episode 143. Dermatology with Dr Alvin Chong (Part 1)
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these.
Clinical problems related to the integument are very common and contribute up to 15% of all general practitioner presentations. Humans are predisposed to a multitude of skin diseases ranging from acne and atopic dermatitis to psoriasis, autoimmune diseases such as SLE, vasculitis, skin cancers, viral exanthems, drug eruptions and external manifestations of internal disease - which in the gastroenterology world have erythema nodosum and pyoderma gangrenosum as interesting examples of these.
Given our love affair with the sun it’s not surprising to learn that skin cancer will affect 2 in 3 Australians in their lifetime. About 2000 Australians die each year from melanoma and non-melanoma skin cancer - 800 more than the number of people dying from car accidents annually in Australia bringing into perspective the impact of this disease alone.
Inflammatory skin diseases such as acne and eczema are also very common. They are a cause of serious morbidity, both physical as well as psychological – a child with severe eczema has a burden of disease that is worse than a child with diabetes. Have you ever had itchy skin? This is one of the most distressing symptoms one may experience.The mental health issues of patients with skin disease can be severe. A recent meta-analysis of patients with alopecia areata for example found that up to 17% of those patients required professional help for symptoms of anxiety and depression.
A skin problem is very visible and yet, in the hierarchy of “medical student teaching” – dermatology is treated almost as an optional extra. In recent years advances in skin management have been significant especially following the discovery of TNF inhibitors such as Adalimumab used in dermatology for moderate to severe psoriasis as well as in both rheumatology and gastroenterology.
In this podcast I was curious to learn more about dermatological management, the new horizons of treatment, possible role for AI in assisting diagnosis as well as to be reminded of key tips that would be useful in primary care.
It was a real honour to discover Melbourne dermatologist Dr Alvin Chong, founder of an internationally acclaimed podcast called Spot Diagnosis that has been ground-breaking in bringing the specialty of dermatology to general practice and medical students. Alvin has established himself as a key educator in this field and has received accolades from the RACGP recognising his achievements and contribution to education.
Alvin has public appointments as Visiting Dermatologist and Director of Dermatological Education at St Vincent’s Hospital Melbourne and Head of Transplant Dermatology Clinic at Skin Health Institute. He is Adjunct Associate Professor at the University of Melbourne.
Please welcome Alvin to the Podcast.
References:
Dr Alvin Chong
http://spotdiagnosis.org.au/
https://www.skinhealthinstitute.org.au/page/370/spotdiagnosis
Episode 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 14. The Misdiagnosis of ADHD with Assoc Professor Soumya Basu
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic condition including difficulty maintaining attention, hyperactivity, and impulsiveness. ADHD often begins in childhood and can persist into adulthood and reflects an ongoing pattern of behaviour that results in poor concentration and control of impulses and interferes with functioning and or development. It may contribute to low self-esteem, troubled relationships and difficulty at school or work.
ADHD is one of the most common neurodevelopmental disorders of childhood, it is estimated that one in 20 children in Australia have ADHD and diagnosis in adults is on the rise where it is estimated that fewer than 20% of adults with ADHD are currently diagnosed or treated by a psychiatrist.
I was curious in this podcast to explore ADHD in more detail and was hoping to gain insights into its neurobiology and the long-term consequences for patients with ADHD especially if not diagnosed. I was also keen to explore the concept of “late birthdate effect” where a younger child in a school year group may be diagnosed with ADHD and medicated at a higher rate than older classmates possibly as a misdiagnosis reflecting the relative immaturity of the student rather than a true developmental condition.
A new companion guide recently published in Australia is referred to as The Australian Evidence Based Clinical Practice Guideline for Attention Deficit Disorder and is designed to help parents and others understand ADHD and the different ways of managing it. It makes 113 recommendations about recognising, diagnosing, and treating the condition. Whilst generally well received these Clinical Practice Guidelines have drawn criticism from some child psychiatrists for recommending amphetamine medications for children as young as five years diagnosed with ADHD based on their impulsive, active, or inattentive behaviour. Some specialists have criticised this decision for relying on ‘low quality ‘evidence, so this warrants discussion also. I was also hoping to learn more about cognitive training and non-pharmacologic techniques that may be of value such as neurofeedback.
It was a great pleasure to welcome back to Everyday Medicine Associate Professor Soumya Basu who has a special interest in developmental disabilities including ADHD and 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 and provides expertise both at the St John of God Langmore Centre in Berwick and in Warragul Gippsland. Please enjoy this conversation with Soumya.
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
CHADDhttps://chadd.org › overviewAbout ADHD - Symptoms, Causes and Treatment
Coghill DR, Banaschewski T, Soutullo C, Cottingham MG, Zuddas A (November 2017). "Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder".
Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. (October 2018). "Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan". European
Attention deficit hyperactivity disorder". International Classification of Diseases 11th Revision. February 2022 [2019].
Institute for Health Metrics and Evaluation (17 October 2020). "Global Burden of Disease Study 2019: Attention-deficit/hyperactivity disorder—Level 3 cause" The Lancet. 396(10258).