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 135. Headaches with Dr Michael Eller
In my conversation with expert headache and movement disorder specialist Dr. Michael Eller from Richmond Neurology, I was keen to delve deeper into the realm of chronic primary headaches—specifically, migraine and cluster types. The evolving understanding of the pathophysiology of these headaches and the developing treatment approaches, focusing on inhibiting the neurotransmitter called Calcitonin gene-related peptide, is fascinating. This peptide is inhibited by the 5-HT1D and 1B receptor agonist effect of the triptans, as well as by a new family of CGRP-targeting drugs and monoclonal antibodies developed for the preventive treatment of migraine.
Headache is an extremely common symptom, and collectively, headache disorders rank among the most prevalent nervous system disorders. Approximately 95% of the general population have experienced a headache at some point in their lives, with a one-year prevalence rate of about one in every two adults. Headache accounts for up to 1 in 10 general practitioner consultations, remains a frequent reason for neurology referrals, and in Europe, constitutes up to 4% of emergency department visits, with migraine being the most common type.
The World Health Organization includes headache among the top ten causes of disability. While the impact on the economy and an individual’s quality of life may be challenging to quantify, in the case of migraine, up to 75% of patients report functional disability during an attack, and about 50% require the assistance of family and friends. Headaches do not discriminate; they affect people of all ages, races, and socioeconomic statuses, but they are more common in women.
Headaches are generally categorized as acute or chronic. Acute headaches may be new and severe, potentially indicating critical intracranial pathology like an aneurysm or meningitis. Chronic headaches are typically classified into primary types such as migraine, cluster, and tension-type, or secondary, which could reflect intracranial pathology or result from conditions like cervical spondylosis, dental and ocular disorders, sinusitis, hypertension, depression, TMJ dysfunction, temporal arteritis, medication side effects, and others.
When consulting with patients, inquiring about the onset of the headache, its frequency and type, duration, recent changes in characteristics, intensity, location, pain quality, associated symptoms like nausea and vomiting, factors that worsen or alleviate it, as well as the presence of neurological symptoms such as visual and sensory changes or alterations in speech, can all aid in establishing a diagnosis.
Migraine often demonstrates a complex polygenic pattern of inheritance, and in the case of familial hemiplegic migraine, it exhibits an autosomal dominant pattern of inheritance.
In my conversation with expert headache and movement disorder specialist Dr. Michael Eller from Richmond Neurology, I was keen to delve deeper into the realm of chronic primary headaches—specifically, migraine and cluster types. The evolving understanding of the pathophysiology of these headaches and the developing treatment approaches, focusing on inhibiting the neurotransmitter called Calcitonin gene-related peptide, is fascinating. This peptide is inhibited by the 5-HT1D and 1B receptor agonist effect of the triptans, as well as by a new family of CGRP-targeting drugs and monoclonal antibodies developed for the preventive treatment of migraine.
Michael completed his medical degree at the University of Sydney in 2003 following a Bachelor of Science and Arts. He has interests in archaeology, neuroscience, infectious disease, and indigenous health. Additionally, he has volunteered as an aid worker in remote locations, including PNG, and underwent training from 2012 to 2014 at The University of California, San Francisco, under Professor Peter Goadsby. I believe you will find this conversation quite engaging. Please welcome Michael to the podcast.
References:
Dr. Michael Eller: Richmond Neurology - richmondneurology.com.au
Headache disorders: differentiating and managing the common subtypes, Ahmed - ncbi.nlm.nih.gov
Current Medical Diagnosis and Treatment.2019: Papadakis, McPhee et al, McGraw Hill Education, Lange
Episode 134. Health Impacts on Climate Change with Professor Richard
The World Health Organisation estimates that between 2030 and 2050, climate change is anticipated to result in approximately 250,000 additional deaths annually. These fatalities may arise from issues such as malnutrition, and heat stress, as well as diseases like malaria and infectious diarrhea. The impact of a planet warming at a recorded rate of 0.08 degrees centigrade per decade since 1880, accelerating to 0.18 degrees centigrade since 1981, poses threats to human lives and health across multiple dimensions. It's important to note that this statement does not delve into the detrimental potential such warming has on other species. Factors crucial to human survival—such as clean air, safe drinking water, a nutritious food supply, and secure shelter—are all imperilled in a world grappling with climate change. In this podcast, my intention was not to focus on the specific science of global warming and subsequent climate change, but rather on the associated health consequences.
The World Health Organisation estimates that between 2030 and 2050, climate change is anticipated to result in approximately 250,000 additional deaths annually. These fatalities may arise from issues such as malnutrition, and heat stress, as well as diseases like malaria and infectious diarrhoea. The impact of a planet warming at a recorded rate of 0.08 degrees centigrade per decade since 1880, accelerating to 0.18 degrees centigrade since 1981, poses threats to human lives and health across multiple dimensions. It's important to note that this statement does not delve into the detrimental potential such warming has on other species. Factors crucial to human survival—such as clean air, safe drinking water, a nutritious food supply, and secure shelter—are all imperilled in a world grappling with climate change. In this podcast, my intention was not to focus on the specific science of global warming and subsequent climate change, but rather on the associated health consequences.
Despite the numerous pledges made by countries in various climate forums, global emissions in 2022 are projected to reach an unprecedented peak. However, there is a positive note to highlight—Australia managed to reduce its emissions by 1.9% in 2021. The historical responsibility for emissions lies significantly with the United States, followed by China, Russia, and Brazil.
Undoubtedly intertwined with atmospheric emissions and consequent climate change is the world's population, which is growing at an alarming rate. Thomas Malthus, in his Essay on 'the principle of population' in the 1800s, once predicted its unsustainability. Today, with a population exceeding 8 billion, the United Nations forecasts a peak population of about 10.4 billion by the 2080s, noting that the "peak baby" phase has already been reached, leading to a measurable slowdown in population growth. Time will undoubtedly affirm the accuracy of these figures in history. It's crucial to mention that an expanding population, particularly a growing wealthier middle class in many countries worldwide, is likely to result in increased greenhouse gas emissions, heightened resource consumption, and will test humanity's capacity to solve ecological problems arising from the collective global burden we carry.
My curiosity to delve deeper into this subject led me to invite Professor Richard Eckard to join the podcast and further enrich the discussion. Richard, a Professor of Sustainable Agriculture at The University of Melbourne and Director of The Primary Industries Climate Challenges Centre is a globally recognised authority on sustainable agricultural production. His focus includes carbon-neutral agriculture and agricultural adaptation to climate change. Richard's significant contributions encompass developing the initial greenhouse gas accounting tools for agriculture. Moreover, his research forms the scientific foundation for six carbon offset methods currently employed in Australia. Serving as a science advisor to various governments and international organisations such as the Australian, New Zealand, and UK governments, the International Livestock Research Institute, the Food and Agriculture Organisation of the United Nations, and the European Union, Richard provides invaluable counsel on climate change adaptation and mitigation in agriculture. Additionally, he represents Australia in the Global Research Alliance on Agricultural Greenhouse Gases.
Please welcome Richard to the podcast.
References:
• Professor Richard Eckard: rjeckard@unimelb.edu.au
• www.who.int/health-topics/climate-change
• "The Weather Makers" by Tim Flannery, Text Publishing
• National Geographic (multiple references)
Episode 133. Ehlers-Danlos and Hypermobility Syndromes with Associate Professor Chris O'Callaghan
Hypermobile joints were noted by Hippocrates as long ago as 400 BCE and are common, occurring in about 10-25 % of the population. In a minority of patients’ pain and injury results suggest that the clinical findings may reflect a condition referred to as hypermobility spectrum disorder, a polygenic connective tissue syndrome affecting between 1:500 to 1:600 people. This syndrome involves extreme joint flexibility often associated with joint pains, tends to run in families and is more common amongst females. Hypermobility spectrum disorder has been redefined separately from the more stringent diagnostic criteria required for the diagnosis of more extreme hypermobility syndromes such as Ehlers-Danlos syndrome, Marfans disease, Loeys-Dietz or Osteogenesis imperfecta syndromes.
Hypermobile joints were noted by Hippocrates as long ago as 400 BCE and are common, occurring in about 10-25 % of the population. In a minority of patients’ pain and injury results suggest that the clinical findings may reflect a condition referred to as hypermobility spectrum disorder, a polygenic connective tissue syndrome affecting between 1:500 to 1:600 people. This syndrome involves extreme joint flexibility often associated with joint pains, tends to run in families and is more common amongst females. Hypermobility spectrum disorder has been redefined separately from the more stringent diagnostic criteria required for the diagnosis of more extreme hypermobility syndromes such as Ehlers-Danlos syndrome, Marfans disease, Loeys-Dietz or Osteogenesis imperfecta syndromes.
In relation to the above-mentioned syndromes in 1901 a Danish doctor, Dr Lauritz-Edvard Ehlers presented a case of hypermobility, and a similar case was subsequently presented by French physician Dr Henri-Alexandre Danlos in 1908. The name Ehlers-Danlos syndrome (EDS) wasn’t proposed until many years later in 1936 by Englishman Dr Parkes-Weber. We now recognize 13 types of Ehlers-Danlos syndrome with hypermobile EDS as the most common and myopathic EDS, Spondylodysplastic classical EDS and brittle cornea syndrome as just some of the others. About 1: 3500 to 1: 5000 people have EDS. Both dominant and recessive inheritance patterns are noted. Frequent joint and ligament injuries including sprains and dislocations may occur and joint stiffness, clumsiness, fatigue dizziness and associated bowel and bladder complaints are often cited.
Another well-known hypermobility disorder Marfans syndrome is rare affecting about 1 in 5000 and in three-quarters of cases, inheritance is autosomal dominant with the defective fibrillin gene resulting in tall individuals with slender limbs, fingers and toes, cardiac defects including aortic dissections, aortic root aneurysms and valvular incompetence, lens dislocations as well as the high arched palate, crowded teeth and abnormal sternum development (pectus excavatum or pectus carinatum ). A quarter of cases experience a new gene mutation with no family pedigree identified.
These hypermobility conditions have common abnormalities in collagen structure and function. Whilst genetic studies are available in some cases of hypermobility (but not hypermobility spectrum disorder), the criteria for diagnosis referred to as The Beighton criteria are essentially clinical and includes a Beighton score reflecting joint extensibility and mobility combined with arthralgia over 3 months, dislocations and subluxations, soft tissue lesions such as epicondylitis, tenosynovitis and bursitis, Marfanoid habitus and abnormal skin with striae, hyperextensibility, thin skin and papyraceous scarring.
No cure is currently known for these syndromes which are managed symptomatically. Fortunately, societies such as the Ehlers-Danlos Society and physicians such as Assoc Professor Chris O’Callaghan from Melbourne’s Austin Health are the most helpful resources and I welcome you to the interview with Chris to expand our understanding of this subject today.
References:
Assoc Professor Chris O’Callaghan: www.austin.org.au
The Ehlers Danlos Society: www.ehlers-danlos.com
Ehlers-Danlos syndromes: www.nhs.uk
Episode 132. Acid Base Balance with Associate Professor Adrian Regli (Part 2)
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
As a background, Bronsted and Lowrys definitions of acids and bases are as follows: A base is a substance that accepts a proton (a hydrogen ion) an acid is a compound that dissociates in water to release a proton. A strong acid is one that readily dissociates in water to release a proton (eg HCL), and a weak acid does not readily dissociate in water (uric acid). pH is the negative logarithm of the hydrogen ion concentration to the base 10. Thus, the negative logarithm of 0.0000001 which may be expressed as 10 to the power of -7 is 7.
The reason blood and cellular pH are so important is that their stability is essential to the integrity of enzymes, metabolic processes, and cell membrane potential. Homeostasis holds our blood pH tightly between 7.35 and 7.45 with an intracellular pH of 6.8.
Where does the acid come from?
Acid production results from the production of CO2 by metabolism of glucose, fatty acids, and amino acids. CO2 combines with water and is converted to carbonic acid -H2CO3 by carbonic anhydrase and then dissociates to H+ and HCO3-. That enzyme carbonic anhydrase pops up everywhere.
Acid production also results from anaerobic glucose metabolism whereby glucose is converted to H+ and lactate in ketogenesis as well as from the catabolism of the amino acids: methionine and cysteine.
Which organs play a major role in the maintenance of pH?
Both the lungs and kidneys play critical roles in acid-base balance. We exhale CO2 from the lungs effectively blowing off acid but may also retain CO 2 by underventilation.
The kidneys have the potential to excrete or absorb bicarbonate and to excrete or reabsorb protons (hydrogen ions) influencing and compensating for pH disturbance through an intricate juggling of these two. The excretion of protons is by combination with ammonia from the metabolism of muscle glutamine or in combination with monohydrogen phosphate. These ingenious biological systems may be influenced by multiple disease processes and respiratory forms of acidosis and alkalosis as well as metabolic processes leading to acidosis and alkalosis are well recognised.
Whilst arterial blood gas assessment is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Venous blood gas (VBG) is a more accessible alternative to ABG sampling and correlates well with arterial sampling in pH measurement (slightly lower in venous sample) and HCO3 - (1.41 mmol/l higher in venous) with pCO2 approximately 5.6 mmHg higher in venous blood. These differences may be exaggerated however in circulatory failure.
In this podcast with ICU physician Associate Professor Adrian Regli, we will explore the subject further, delve into some of the typical metabolic and respiratory disturbances we are likely to encounter as clinicians and also review some handy rules of thumb to draw upon in practical acid-base interpretation. Currently, Adrian works as an ICU consultant at Fiona Stanley Hospital Perth. Please welcome Adrian to the Podcast.
References
Assoc Professor Adrian Regli - via Google
Oh’s Intensive Care Manual, Bersten et al 6 th ED, Butterworth
Medical Biochemistry at a Glance, Salway,3rd ED, Wiley-Blackwell
Acid-Base Disorders in the Critically Ill Patient, Achanti et al CJASN, Sept 2022
Episode 131. Acid Base Balance with Associate Professor Adrian Regli (Part 1)
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
Acid-Base theory is often considered a difficult subject. As long ago as 1962, Creese et al wrote in the Lancet … “There is a bewildering variety of pseudoscientific jargon in medical writing on this subject “My suspicion is that some degree of confusion and thus avoidance of the subject continues to this day. Hopefully, this podcast conversation will resonate with some of our listeners and smooth out any misunderstandings should they exist.
As a background, Bronsted and Lowrys definitions of acids and bases are as follows: A base is a substance that accepts a proton (a hydrogen ion) an acid is a compound that dissociates in water to release a proton. A strong acid is one that readily dissociates in water to release a proton (eg HCL), and a weak acid does not readily dissociate in water (uric acid). pH is the negative logarithm of the hydrogen ion concentration to the base 10. Thus, the negative logarithm of 0.0000001 which may be expressed as 10 to the power of -7 is 7.
The reason blood and cellular pH are so important is that their stability is essential to the integrity of enzymes, metabolic processes, and cell membrane potential. Homeostasis holds our blood pH tightly between 7.35 and 7.45 with an intracellular pH of 6.8.
Where does the acid come from?
Acid production results from the production of CO2 by metabolism of glucose, fatty acids, and amino acids. CO2 combines with water and is converted to carbonic acid -H2CO3 by carbonic anhydrase and then dissociates to H+ and HCO3-. That enzyme carbonic anhydrase pops up everywhere.
Acid production also results from anaerobic glucose metabolism whereby glucose is converted to H+ and lactate in ketogenesis as well as from the catabolism of the amino acids: methionine and cysteine.
Which organs play a major role in the maintenance of pH?
Both the lungs and kidneys play critical roles in acid-base balance. We exhale CO2 from the lungs effectively blowing off acid but may also retain CO 2 by underventilation.
The kidneys have the potential to excrete or absorb bicarbonate and to excrete or reabsorb protons (hydrogen ions) influencing and compensating for pH disturbance through an intricate juggling of these two. The excretion of protons is by combination with ammonia from the metabolism of muscle glutamine or in combination with monohydrogen phosphate. These ingenious biological systems may be influenced by multiple disease processes and respiratory forms of acidosis and alkalosis as well as metabolic processes leading to acidosis and alkalosis are well recognised.
Whilst arterial blood gas assessment is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Venous blood gas (VBG) is a more accessible alternative to ABG sampling and correlates well with arterial sampling in pH measurement (slightly lower in venous sample) and HCO3 - (1.41 mmol/l higher in venous) with pCO2 approximately 5.6 mmHg higher in venous blood. These differences may be exaggerated however in circulatory failure.
In this podcast with ICU physician Associate Professor Adrian Regli, we will explore the subject further, delve into some of the typical metabolic and respiratory disturbances we are likely to encounter as clinicians and also review some handy rules of thumb to draw upon in practical acid-base interpretation. Currently, Adrian works as an ICU consultant at Fiona Stanley Hospital Perth. Please welcome Adrian to the Podcast.
References
Assoc Professor Adrian Regli - via Google
Oh’s Intensive Care Manual, Bersten et al 6 th ED, Butterworth
Medical Biochemistry at a Glance, Salway,3rd ED, Wiley-Blackwell
Acid-Base Disorders in the Critically Ill Patient, Achanti et al CJASN, Sept 2022
Special Episode 15. Rheumatic Fever with Dr Alex Tai
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Acute Rheumatic fever (ARF) is a multisystem disease caused by an immunological response to Group A streptococcal infection leading to Rheumatic heart disease (RHD) and is responsible for 250,000 deaths per year worldwide, predominantly in young people. It is estimated that 15 million people across the globe have evidence of Rheumatic heart disease. In Australia, the estimated incidence is reflective of ethnicity with 65 per 100 000 infections among Aboriginal and Torres Strait Islander people compared with 3 per 100 000 for other Australians. Consequently, 92% of the ARF reported is among Aboriginal and Torres Strait Islander people, mostly affecting children aged 5-14 years with rates of ARF and Rheumatic heart disease highest across northern and central Australia.
Recent research has found that Aboriginal and or Torres Strait Islander people are ten times more likely and Pacific Islander people 82 times more likely to have an episode of ARF than other ethnicities.
Although more than 9000 people are on RHD registers across Australia currently very little is known about the epidemiology of ARF and RHD in southern regions of Australia despite an estimated 57% of the Aboriginal and Torres Strait Islander population living in these regions. Importantly on 31st July this year, acute rheumatic fever and rheumatic heart disease became routine notifiable conditions in Victoria with only Tasmania and the ACT left to enact this important policy.
A new case of ARF is recognised to be 10 times more common in an individual with a past episode of ARF than an individual from the same community without prior ARF underscoring how important disease notification is for secondary prevention. Presently 80 % of people diagnosed with ARF have no prior diagnosis registered.
It was a real honour to welcome back expert infectious diseases specialist Alex Tai who has been passionate about education and bringing forth new issues of an infectious nature for our understanding. It gives me great pleasure to welcome Alex back to Everyday Medicine to discuss this important topic further.
References:
Dr Alex Tai - Gippsland Region Public Health Unit - Monash University. - Baw Baw Physicianshttps://www.bawbawphysicians.com.au › ...Dr Alex Tai - Infectious Diseases Physician
Dr Alex Tai - LinkedIn
Notification of Rheumatic Heart Disease and Acute Rhematic Fever. https://www.health.vic.gov.au/health-advisories/notification-of-rheumatic-heart-disease-and-acute-rhematic-fever
National Treatment Guidelines - www.rhdaustralia.org.au/arf-rhd-guidelines
Episode 99. Radiation Oncology with Dr Marcus Foo (Part 2)
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Photon therapy is interesting in allowing delivery of energy to internal malignancies with relative tolerance at the level of the skin.
Radiation dose is measured as energy per unit mass -where 1 J/kg is 1 Gray.
In this podcast I was joined by Dr Marcus Foo who is a radiation oncologist with Genesis Care. Marcus graduated from the University of Melbourne in 2000 and trained in radiation oncology at the Peter MacCallum Cancer Centre before undertaking a clinical and research fellowship at the BC Cancer Agency in Vancouver, Canada focusing on gastrointestinal, breast and genitourinary oncology. He has strong interest in stereotactic radiation therapy and image-guided radiation therapy. I was keen to discuss with Marcus the principles of radiation oncology in more depth and understand much of the terminology used such as ‘fractionated radiotherapy’, ‘external beam’, ‘brachytherapy’, ‘stereotactic’ and ‘palliative therapy'. This conversation is covered across two very interesting episodes. I hope you enjoy the interview and I am pleased you have joined us.
References:
Dr Marcus Foo: www.genesiscare.com
Introduction to Radiation Oncology: www.astro.org
Introduction to Radiation Oncology : Apicelli, Parikh and Zoberi, Haematology and Oncology Subspecialty Consult, 4th Ed,Wolters Kluwer
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 98. Radiation Oncology with Dr Marcus Foo (Part 1)
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation oncology occupies a very important place in cancer therapy as an essential member of the multidisciplinary approach to cancer treatment . Of the near 146 000 Australians diagnosed with cancer each year is estimated that about half would benefit from radiation therapy as part of their overall cancer treatment.
Radiation therapy is a highly cost-effective cancer therapy contributing only about 10% of each healthcare dollar spent on treating cancer overall yet vital in about 40% or cancers that are cured. The technology employs ionising radiation that causes the ejection of an orbital electron which is the molecular event leading to damage and eventually cell death. The radiation used may be either electromagnetic in nature using photons or gamma rays or particulate- directing a stream of electrons, protons or other atomic particles to the target and causing DNA damage to both normal tissue and tumour cells. Cells are most susceptible in the G1 and G2 phases which represent growth and preparation for mitosis as well as the mitosis phase referred to as the M phase. Additionally, hypoxic cells are thought to be less susceptible to radiation than well-oxygenated cells as free radicals formed by ionising radiation are more easily repaired in the absence of oxygen.
Photon therapy is interesting in allowing the delivery of energy to internal malignancies with relative tolerance at the level of the skin.
Radiation dose is measured as energy per unit mass -where 1 J/kg is 1 Gray.
In this podcast, I was joined by Dr Marcus Foo who is a radiation oncologist with Genesis Care. Marcus graduated from the University of Melbourne in 2000 and trained in radiation oncology at the Peter MacCallum Cancer Centre before undertaking a clinical and research fellowship at the BC Cancer Agency in Vancouver, Canada focusing on gastrointestinal, breast and genitourinary oncology. He has a strong interest in stereotactic radiation therapy and image-guided radiation therapy. I was keen to discuss with Marcus the principles of radiation oncology in more depth and understand much of the terminology used such as ‘fractionated radiotherapy’, ‘external beam’, ‘brachytherapy’, ‘stereotactic’ and ‘palliative therapy'. This conversation is covered across two very interesting episodes. I hope you enjoy the interview and I am pleased you have joined us.
References:
Dr Marcus Foo :www.genesiscare.com
Introduction to Radiation Oncology: www.astro.org
Introduction to Radiation Oncology : Apicelli, Parikh and Zoberi, Haematology and Oncology Subspecialty Consult, 4th Ed,Wolters Kluwer
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 97. Hippocrasy with Dr Rachelle Buchbinder
In the September 25-26 edition of the weekend Australian magazine, I was drawn to a very interesting feature article reviewing the book Hippocrasy co-written by Professor Rachelle Buchbinder who is a rheumatologist as well as director of the Monash Cabrini Department of musculoskeletal health and clinical epidemiology at Cabrini Hospital and Professor of clinical epidemiology at Monash University with Ian Harris who is an orthopaedic surgeon at Liverpool St George and Sutherland hospitals and Professor of Orthopaedic surgery at the University of New South Wales Sydney and Honorary Professor at University of Sydney. The article was confronting in that it raised concerns that many of the medical procedures and treatments we are engaged with as clinicians may not help patients and that over diagnosis and the “medicalisation of normal” may be leading to a medical system failure.
In the September 25-26 edition of the weekend Australian magazine, I was drawn to a very interesting feature article reviewing the book Hippocrasy co-written by Professor Rachelle Buchbinder who is a rheumatologist as well as director of the Monash Cabrini Department of musculoskeletal health and clinical epidemiology at Cabrini Hospital and Professor of clinical epidemiology at Monash University with Ian Harris who is an orthopaedic surgeon at Liverpool St George and Sutherland hospitals and Professor of Orthopaedic surgery at the University of New South Wales Sydney and Honorary Professor at University of Sydney. The article was confronting in that it raised concerns that many of the medical procedures and treatments we are engaged with as clinicians may not help patients and that over diagnosis and the “medicalisation of normal” may be leading to a medical system failure.
The question the authors ask us to consider is whether doing a specific medical procedure or intervention is better for the patient than not doing it and they set the context of this question by drawing from a wide review of studies within the framework and reflecting of the Hippocratic oath. I subsequently purchased and read Hippocrasy which was as illuminating as it was confronting and would strongly recommend this book as essential reading for all doctors both graduated and training and hope it becomes a staple for medical students everywhere. Hippocrasy asks us to question the true value of specific medical practice, to choose wisely and to recognise cognitive dissonance and confirmation bias noting that up to a third of medical care may be of no value and that up to 10% of treatments and interventions may be harmful with medical error the third leading cause of death in the United States. We should all strive to practice evidence-based medicine when possible and there are many organisations such as the United Kingdom National Institute for Health and Care Excellence, Cochrane Collaboration and the United States Preventative Services Task force to guide us.
In this podcast with Rachelle Buchbinder, we discuss Hippocrasy in more detail including how the problem of the medicalisation of normal has arisen and what needs to change. Please join me on this interesting conversation.
References :
Prof Rachelle Buchbinder:www.malvernrheumatology.com
Hippocrasy: Buchbinder and Harris, NewSouth Publishing, 2021
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 96. Regenerative Medicine with Dr Kiryu Yap
The field of regenerative medicine is likely to significantly change how we practice medicine in the future with some amazing capabilities -harnessing the power of stem cells to restore form and function of damaged tissue. The potential of regenerative medicine has already being recognised in the areas of immunotherapy and bone marrow transplantation however the future is likely to see many further shining examples of its promise ,application and capability. Consider the possibility of injecting cardiac stem cells into the surrounding viable ventricular myocardium adjacent to an acute myocardial infarction providing functioning myocardial cells to restore cardiac output or indeed replacing a damaged organ such as a cirrhotic liver allowing restored hepatic synthetic function.
The field of regenerative medicine is likely to significantly change how we practice medicine in the future with some amazing capabilities -harnessing the power of stem cells to restore form and function of damaged tissue. The potential of regenerative medicine has already being recognised in the areas of immunotherapy and bone marrow transplantation however the future is likely to see many further shining examples of its promise ,application and capability. Consider the possibility of injecting cardiac stem cells into the surrounding viable ventricular myocardium adjacent to an acute myocardial infarction providing functioning myocardial cells to restore cardiac output or indeed replacing a damaged organ such as a cirrhotic liver allowing restored hepatic synthetic function.
A group of scientists at St Vincent's Institute of Medical Research in Melbourne with co lead researcher Kiryu Yap are attempting to do just that. Following a breakthrough over 4 years ago their team has the aim of growing entire lobes of the liver by taking patients’ blood and carefully reprogramming cells to become stem cells .This technology became available after the amazing techniques described by Sir John Gurdon and Shinya Yamanaka who discovered that mature cells can be reprogrammed to become pluripotent leading to their 2012 Nobel Prize in Physiology and Medicine.
It is known that about 7000 Australians die each year from chronic liver disease and that 260 livers are transplanted each year between Australia and New Zealand so if this bold project is successful, it will provide significant value to patients suffering with advanced and deteriorating liver disease. After genetically reprogramming cells to become pluripotent stem cells the application of very specific nutrients exerts the appropriate epigenetic effect to induce tiny liver cells. The plan is to implant these into the groin of patients where the small liver buds will be supported by the patient's blood vessels before the liver lobe is eventually harvested and transplanted to replace the diseased organ. Please join this fascinating discussion with Kiryu.
References:
Dr Kiryu Yap-School of Biomedical Sciences-University of Melbourne
www.svi.edu.au- Vacular biology-St Vincents Institiue of Medical Research-Dr Kiryu Yap
www.nobelprize.org- The 2012 Nobel Prize in Physiology or Medicine
https:/transplant.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 95. Remote and Rural Medicine with Dr Etienne Cawood
The Doctors, nurses, paramedics and hospital staff working at remote locations must be capable of dealing with a wide range of medical, surgical, obstetric, paediatric and psychiatric conditions that may present as emergencies. Where support help such as tertiary transfer may be hours or days away it takes a special team to come together to manage such difficulties. It was a great pleasure to interview Etienne Cawood who has spent the majority of his medical career working in rural and remote locations throughout the length and breadth of Australia and we him great debt gratitude for his services.
About 7 million Australians, around 28% of our population, live in rural and remote areas encompassing many diverse locations and communities that in some instances have poor access to the medical services we may take for granted in metropolitan centres. Higher rates of hospitalisations, deaths and injury are reported from remote and rural areas and statistics show that remote and very remote areas experience a greater burden of disease and injury compared to major city populations (about 1.4 times). The practice of medicine in such communities requires a higher level of medical literacy.
On average, people living in remote and very remote areas are younger than those in major cities and 18% of people living in remote and 47% in very remote areas are indigenous (aboriginal or Torres Strait Islander people) compared to 1.7% in major cities. Health risk factors such as smoking overweight and obesity, diet, high blood pressure, alcohol consumption and physical activity are just some of the factors influencing health outcomes.
The Doctors, nurses, paramedics and hospital staff working at remote locations must be capable of dealing with a wide range of medical, surgical, obstetric, paediatric and psychiatric conditions that may present as emergencies. Where support help such as tertiary transfer may be hours or days away it takes a special team to come together to manage such difficulties. It was a great pleasure to interview Etienne Cawood who has spent the majority of his medical career working in rural and remote locations throughout the length and breadth of Australia and we him great debt gratitude for his services.
References:
Etienne Cawood :ejcawood@gmail.com
Rural and remote health. aihw.gov.au
Australian College of rural and remote medicine. mycollege.acrrm.org.au
www.jcu.edu.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 94. Being an intern during COVID with Dr Nick Shearer
The journey from the VCE student to University and medical studies is highly competitive and never easy and for those undertaking a postgraduate degree in medicine, the graduate medical school admissions test-GAMSAT-designed to assess the capacity to undertake high-level intellectual studies in the medical and health professional programmes provides yet a further hurdle. Dr Nick Shearer completed his postgraduate medical studies at Deakin University before choosing and being accepted as an intern at the Northern Hospital Epping. In his dream of becoming a doctor he was immediately thrust into the incredible difficulty of not only managing the brutal responsibilities of internship but even more the harsh reality of coping with the COVID-19 pandemic at the very interface between disease and treatment in a hospital tasked with frontline COVID-19 responsibilities. Donning personal protective equipment for the entire year and honing his communication skills with often frustrated and frightened patients and their relatives Nick has become a shining example of how good our medical personnel and profession can function and be in a time of deep crisis.For his insights please welcome Dr Nick Shearer to the conversation.
The journey from the VCE student to University and medical studies is highly competitive and never easy and for those undertaking a postgraduate degree in medicine, the graduate medical school admissions test-GAMSAT-designed to assess the capacity to undertake high-level intellectual studies in the medical and health professional programmes provides yet a further hurdle. Dr Nick Shearer completed his postgraduate medical studies at Deakin University before choosing and being accepted as an intern at the Northern Hospital Epping. In his dream of becoming a doctor he was immediately thrust into the incredible difficulty of not only managing the brutal responsibilities of internship but even more the harsh reality of coping with the COVID-19 pandemic at the very interface between disease and treatment in a hospital tasked with frontline COVID-19 responsibilities. Donning personal protective equipment for the entire year and honing his communication skills with often frustrated and frightened patients and their relatives Nick has become a shining example of how good our medical personnel and profession can function and be in a time of deep crisis.
For his insights please welcome Dr Nick Shearer to the conversation.
References :
gamsat.acer.org
www.deakin.edu.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 93. Haemotology with Dr Thomas Lew (Part 3)
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias. Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress, there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interest in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.uptodate.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 92. Haemotology with Dr Thomas Lew (Part 2)
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias . Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interests in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.uptodate.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 91. Haemotology with Dr Thomas Lew (Part 1)
In this three-part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Observed abnormalities in the full blood count are not uncommon, they may be transient and mild, often involving one cell lineage and most likely benign, or progressive involving more than one cell lineage and pointing us toward a condition requiring further investigation, possible referral and treatment.
In foetal life, haemopoiesis occurs in the yolk sac and later in the liver and spleen. After birth normal haemopoiesis is restricted to the bone marrow. Infants have haemopoietic marrow in all bones but in adults, haemopoietic marrow is found in the central skeleton and proximal ends of long bones. Expansion of haemopoiesis down the long bones may occur in bone marrow malignancy such as with leukaemia or when there is increased demand such as with chronic haemolytic anaemias . Both the liver and spleen can resume extra medullary haematopoiesis when there is marrow replacement such as in myelofibrosis or when there is excessive demand for example in severe haemolytic anaemia such as thalassaemia major. Incredibly the bone marrow produces more than 1 million red cells per second in addition to similar numbers of white cells and platelets .Common primitive stem cells in the marrow have the capacity to self replicate and give rise to increasingly specialised and committed progenitor cells. Myeloid progenitors differentiate into platelets, red blood cells, eosinophils neutrophils, basophils, macrophages, mast cells and dendritic cells. Lymphoid precursors differentiate into T cells (CD4 helper and CD8 suppressor) B cells (plasma cells and memory cells) and natural killer cells.
In conditions of disease or physiologic stress there may be a reduced number of cells in the full blood count assessment suggesting decreased production or loss (e.g. bleeding), sequestration (spleen, lymph nodes), or peripheral destruction. Elevated counts suggest an excess production which may be reactive (physiologic stress) or reflective of a primary abnormality of the bone marrow or other haemopoietic organs.
In this three part series we will explore common haematological abnormalities including anaemia, polycythaemia, the basis for neutropenia, neutrophilia, lymphopenia and lymphocytosis as well as thrombocytopenia and thrombocytosis.
Please join these interesting conversations with Dr Thomas Lew - haematology advanced trainee at the Peter MacCallum Cancer Centre with special interests in novel therapies for haematological disorders.
References:
Dr Thomas Lew: petermac.org
www.uptodate.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 90. Venous Thromboembolism with Dr Sanjeev Chunilal
Venous thrombosis affects more than 30,000 Australians each year and is responsible for over 5000 deaths per annum, this is more than the number of Australians who die from motor vehicle accidents annually. VTE is the third leading cause of death amongst hospitalised patients and patients admitted to hospital are at least 100 times more likely of developing a clot compared to being active in the community-a risk that may be assessed by the modified Wells criteria.
Venous thrombosis affects more than 30,000 Australians each year and is responsible for over 5000 deaths per annum, this is more than the number of Australians who die from motor vehicle accidents annually. VTE is the third leading cause of death amongst hospitalised patients and patients admitted to hospital are at least 100 times more likely of developing a clot compared to being active in the community-a risk that may be assessed by the modified Wells criteria.
Tellingly 60% of all venous thromboembolisms occur within 90 days of hospitalisation and importantly it is predicted that up to 70% are preventable.
It is also estimated that about 50% of patients with an untreated proximal deep vein thrombosis will develop a symptomatic pulmonary embolus within 3 months …half of these cases are asymptomatic, however, in 25% of cases sudden death is the first symptom.
Whilst 10% of clots form either in the upper limbs or mesenteric system, the vast majority of clots-90%- occur in the lower limbs. Although pulmonary emboli may include fat, amniotic fluid, may be septic or be formed from contaminants such as talc we will restrict discussions in this podcast to blood clots and focus on lower limb clots.
This is potentially a huge subject with multiple factors leading to abnormal clotting, excessive clotting, and subsequent potentially fatal thromboembolism. The more one considers coagulation in both the normal and pathophysiologic states the more fascinating the subject becomes. No wonder then that Associate Professor Sanjeev Chunilal from Monash Health has developed a deep interest and expertise in this subject. Sanjeev completed a clinical and research fellowship in venous thromboembolism at McMaster University Ontario Canada, has published widely and is a member of the International Society of Thrombosis and Haemostasis as well as the Australasian Society of Thrombosis and Haemostasis, please welcome Sanjeev to the podcast.
References:
Associate professor Sanjeev Chunilal: jessiemcpherson.org, monashpathology.org
www.ncbi.nlm.nih.gov: Deep venous Thrombosis: pathogenesis, diagnosis, and medical management,2017
Khan Academy-khanacademy.org
Australian Family Physician VOL 39, No 7 July 2010
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 89. Myasthenia Gravis and Gulian Barre Syndrome with Professor Ernest Butler
The Guillain Barre syndrome is an acute inflammatory demyelinating polyradiculopathy and although relatively rare (0.4-2 per 100,000) it is still the most common cause of acute flaccid neuromuscular paralysis worldwide. It famously affected Joseph Heller author of Catch-22 and more recently AFL football Legend Alexander Clarkson. It is an immune-mediated disorder that affects the peripheral nervous system and is another example of molecular mimicry, occurring 1 to 6 weeks after a respiratory infection, Campylobacter enterocolitis, and rarely after trauma or surgery. In 1 in a million cases, GB may develop after the influenza vaccine.
Myasthenia gravis is an autoimmune disorder most commonly observed in women under the age of 40 years and in men over the age of 60 years where antibodies form against the nicotinic acetylcholine receptor at the neuromuscular junction (85% of cases), muscle-specific tyrosine kinase (MuSK 7-10%) or low-density lipoprotein receptor-related protein 4 (LRP 4-5%)-the MuSK 7 and LRP4 are both important to the health of the neuromuscular junction. MG results in muscle fatigue especially of the eyes, facial muscles and bulbar muscles.
To discuss these two interesting conditions we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has major clinical expertise in the management of both acute and chronic neurological conditions, please join me in this conversation with Ernie.
The Guillain Barre syndrome is an acute inflammatory demyelinating polyradiculopathy and although relatively rare (0.4-2 per 100,000) it is still the most common cause of acute flaccid neuromuscular paralysis worldwide. It famously affected Joseph Heller author of Catch-22 and more recently AFL football Legend Alexander Clarkson. It is an immune-mediated disorder that affects the peripheral nervous system and is another example of molecular mimicry, occurring 1 to 6 weeks after a respiratory infection, Campylobacter enterocolitis, and rarely after trauma or surgery. In 1 in a million cases, GB may develop after the influenza vaccine.
Myasthenia gravis is an autoimmune disorder most commonly observed in women under the age of 40 years and in men over the age of 60 years where antibodies form against the nicotinic acetylcholine receptor at the neuromuscular junction (85% of cases), muscle-specific tyrosine kinase (MuSK 7-10%) or low-density lipoprotein receptor-related protein 4 (LRP 4-5%)-the MuSK 7 and LRP4 are both important to the health of the neuromuscular junction. MG results in muscle fatigue especially of the eyes, facial muscles and bulbar muscles.
To discuss these two interesting conditions we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has major clinical expertise in the management of both acute and chronic neurological conditions, please join me in this conversation with Ernie.
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 88. Multiple Sclerosis with Ernest Butler
Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).
Multiple sclerosis is an autoimmune neurodegenerative disease of the brain and spinal cord resulting in CNS demyelination affecting 2.8 million people worldwide and 23,000 Australians. There are about 1000 new cases diagnosed in Australia each year and the accumulation of disability can be devastating with an estimated 50 to 80% of patients ceasing full-time work within 10 years. The condition is 3 times more common in women and is most often seen between the ages of 20 and 40 years. The damage in multiple sclerosis is caused by a type IV hypersensitivity reaction and may reflect molecular mimicry with activated T cells crossing the blood-brain barrier and attacking CNS myelin which is produced by oligodendrocytes (myelin in the peripheral nervous system is made by Schwann cells).
Environmental and genetic factors play a role in the aetiology with a higher incidence of multiple sclerosis identified in patients living north of 40 degrees (north of Beijing and including much of Europe Russia the northern parts of the United States and Canada) or South of 40 degrees (Tasmania) raising speculation about the role of ultraviolet light and vitamin D. MS is 15 times more likely when a 1st-degree relative is affected and concordance with monozygotic twins is about 25%. Obesity, smoking, high intake of dietary saturated fats and Epstein-Barr virus have also been implicated.
Despite the distressing nature of this neurodegenerative condition many treatments are evolving to manage both acute episodes (steroids, plasmapheresis) and to prevent further damage (from Interferon beta and Glatiramer acetate to Ocrelizumab, Natalizumab and Stem cell therapy amongst others).
To guide us through this complex subject we are joined by associate Professor Ernie Butler who is the founder of Frankston neurology group and has a major clinical expertise in the management of multiple sclerosis amongst many other acute and chronic neurological conditions, please join me in this conversation with Ernie.
References:
Assoc professor Ernie Butler: Frankston neurology.com.au
www.ninds.nih.gov , Multiple sclerosis : Hope Through Research
www.sciencedirect.com , Multiple Sclerosis-an overview
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 87. Neuroendocrine tumours with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers (Part 2)
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neuroendocrine tumours represent neoplasms of the diffuse neuroendocrine system (DNES) which is our body’s largest endocrine organ comprised of the fascinating amine precursor uptake and decarboxylase (APUD) cell series first described in the 1960s by British scientist A.G.E Pearse. These cells can produce numerous peptides and bioactive amines. Influenced by both the endocrine and nervous systems as well as by the chemistry in their local environment, neuroendocrine cells play a vital role in intracellular signalling and ensure the integrated functioning of many organs and systems within the human body working in both paracrine and endocrine fashion. The signalling molecules produced by the diffuse neuroendocrine system represent a universal chemical language, a vital contributor to the regulation of homeostasis. Cells of the DNES are found throughout the body and are present in almost every organ with well-known examples in the lining of the Gi tract, the lungs, pancreas, thymus, thyroid, brain, adrenal glands etc…
Neoplastic transformation results in the development of neuroendocrine tumours (NET’S) most commonly in the small bowel (~60%) followed by the lungs (~27%) and pancreas.
Whilst considered rare more than 5000 diagnoses per year occur in Australia which is more than the combined number of annually reported pancreatic and gastric malignancies. Unfortunately, up to 60% of cases are advanced at the time of diagnosis with metastases and is not uncommon for patients to be misdiagnosed with irritable bowel syndrome. Neuroendocrine tumours may be functional or non-functional (the majority), they may be poorly or well-differentiated, low-grade or high-grade.
NET's have somatostatin receptors (there are 5 known receptors) on the cell surface and up to 80% of NET's express somatostatin receptor 2 which octreotide has a strong attraction for. The gallium dotatate scan exploits this fact by detecting the presence of the somatostatin 2 receptor.
Neuroendocrine cells also contain vesicles stacked with chromogranin which has been utilised as a relatively sensitive and specific marker for NET although elevated levels of this marker may be seen with proton pump inhibitors, renal impairment and atrophic gastritis. 24-hour measurement of urinary 5 hydroxy indole 3 acetic acids (5-HIAA), the degradation product of serotonin, is a useful laboratory marker for NETs producing serotonin.
I was particularly interested to explore this extensive subject further with Professor Rodney Hicks, Dr Michael Lee and Megan Rogers from the Peter MacCallum Cancer Centre all experts in managing neuroendocrine tumours and I was keen to discuss peptide receptor radionucleotide therapy (PRRT) which Professor Hicks whose expertise with this therapy is world renown. Please welcome them to this two-part podcast.
REFERENCES:
petermac.org
neuroendocrine.org.au
www.ncbi.nih.gov (Australian experience of peptide receptor radionuclide therapy in lung neuroendocrine tumours,2020)
www.sciencedirect.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.