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.
Episode 78. New Agents in Rheumatology with Dr Andrew Teichtahl
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
The past two decades have witnessed dramatic changes in the approach to managing rheumatologic conditions, born of a wider understanding of cellular biology, immunology, and the pathophysiology of inflammation we have consequently seen an explosion in the development and availability of both Biologic medications and small molecules for medical applications.
Some of these products are designed to interfere with cytokine function or production and include:
· TNF inhibitors
· TNF receptor fusion proteins
· IL6 inhibitors
· IL-17 inhibitors
· IL-12/23 inhibitors
· T-cell modulators
· B cell modulators
In addition, the development of small molecules as Janus kinase inhibitors has opened up new channels for inflammatory modulation.
It was a great privilege to welcome rheumatologist Dr Andrew Teichtahl to this podcast to help us understand how to apply this new age of science to the practice of rheumatology. Andrew is a senior staff specialist at the Alfred Hospital and the National Health and Medical Research Council Fellow at the Baker International Diabetes Institute. He is a chief investigator on two clinical trials funded by the National Health and Medical Research Council (NHMRC) and has authored over 75 publications in internationally peer reviewed journals. In his former life he was also a physiotherapist (a degree he attained with honours) and is passionate in his practice of rheumatology with expertise across rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.
References:
Dr Andrew Teichtahl: www.arthritiscentre.com.au
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911251/ New era of treatment with biologics in rheumatology – is it time to shift paradigms in treatment with biologics? Anna Felis-Giemza
www.nature.com/articles/nrrheum.2009.197, Are new agents needed to treat RA ?
https://arthritis-research.biomedcentral.com/articles/10.1186/1478-6354-13-S1-S5 Advances in rheumatology: new targeted therapeutics
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 77. The Microbiome with Dr Mark Morrison
Trillions of microbes are living in and on us, a thriving ecosystem of bacteria, viruses, archaea and fungi. Collectively these microbes form the human microbiome and this microbiome appears to play a key role in many aspects of health, crowding out harmful microbial invaders, breaking down fibrous food into digestible compounds and producing some essential vitamins such as B12 and vitamin K. New research is exploring the relationship between the gut microbiome and immunogenicity, autoimmune inflammatory diseases, neoplasia and brain development and is searching ways to correct dysbiosis.
Trillions of microbes are living in and on us, a thriving ecosystem of bacteria, viruses, archaea and fungi. Collectively these microbes form the human microbiome and this microbiome appears to play a key role in many aspects of health, crowding out harmful microbial invaders, breaking down fibrous food into digestible compounds and producing some essential vitamins such as B12 and vitamin K. New research is exploring the relationship between the gut microbiome and immunogenicity, autoimmune inflammatory diseases, neoplasia and brain development and is searching ways to correct dysbiosis.
In this episode with Professor Mark Morrison, Chair of Microbiology and Metagenomics at the University of Queensland Diamantina Institute we explore the human microbiome and how his work is expanding our understanding of this interesting clinical area of research and its possible medical applications.
Useful references include:
- Professor Mark Morrison - The University of Queensland Diamantina Institute
- WGO Handbook on Gut Microbiome – A global perspective - www.worldgastroenterology.org
- Gut microbiome – An Overview – www.sciencedirect.com
- Human Gut Microbiome : Hopes Threats and Promises – https://gut.bmj.com
- The Gut Microbiome in Health and in Disease – www.ncbi.nlm.nih.gov
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 76. Breast Cancer with Dr Corinne Ooi
Breast cancer affects 1 in 7 women and remains the most diagnosed cancer in Australia with 57 new cases diagnosed each day, 1000 new cases per year and tragically 2000 deaths annually. Men are not excluded, for every 100 breast cancers one is diagnosed in a male. Genetic links for breast cancer such as the BRCA 1 and 2 genes receive significant attention but account for only 5% of total cases,75% of patients have no family history and additionally 75% of breast cancers are diagnosed in patients 50 years or older. Multiple risk factors including family history, young age of menarche and older age of menopause are frequently cited but less well known is the association with obesity which is responsible for up to 8% of all breast cancers. It is estimated that 1: in 4 cases of all breast cancer may be prevented with attention to known modifiable risk factors. Breastfeeding and earlier age of pregnancy are both protective factors.
Breast cancer affects 1 in 7 women and remains the most diagnosed cancer in Australia with 57 new cases diagnosed each day, 1000 new cases per year and tragically 2000 deaths annually. Men are not excluded, for every 100 breast cancers one is diagnosed in a male. Genetic links for breast cancer such as the BRCA 1 and 2 genes receive significant attention but account for only 5% of total cases,75% of patients have no family history and additionally 75% of breast cancers are diagnosed in patients 50 years or older. Multiple risk factors including family history, young age of menarche and older age of menopause are frequently cited but less well known is the association with obesity which is responsible for up to 8% of all breast cancers. It is estimated that 1: in 4 cases of all breast cancer may be prevented with attention to known modifiable risk factors. Breastfeeding and earlier age of pregnancy are both protective factors.
In this episode we are joined by breast cancer surgeon Corinne Ooi who reviews risk factors linked to breast cancer and discusses management strategies when a breast lump is detected. This is a fascinating conversation with a truly passionate surgeon.
Useful references include:
- Dr Corinne Ooi – Southern Breast Oncology - sboncology.com.au
- Breastcancerriskfactors.gov.au - www.canceraustralia.gov.au
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 75. Urinary Incontinence in Women with Dr Natharnia Young
Dr Natharnia Young is a leading urogynaecologist servicing South Eastern Melbourne’s suburbs and joins this conversation to discuss urinary incontinence in women, a condition associated with significant personal and social stigmatisation and affecting up to 1:2 women over the age of 70.
Dr Natharnia Young is a leading urogynaecologist servicing South Eastern Melbourne’s suburbs and joins this conversation to discuss urinary incontinence in women, a condition associated with significant personal and social stigmatisation and affecting up to 1:2 women over the age of 70.
Rates of presentation by woman seeking management for stress incontinence and urge incontinence are low, perhaps on account of feelings of embarrassment and shame however there are many effective management strategies that Natharnia discusses in this very informative podcast episode. Please enjoy the conversation.
Useful references include:
Dr Natharnia Young – Australian Pelvic Floor Institute. enquiries@afpsinstitute.com Urinary Incontinence – symptoms and causes – Mayo Clinic – www.mayoclinic.org Urinary Incontinence – Office on women’s health – www.womenshealth.gov Urinary Incontinence in Women – www.ncbi.nlm.nih.gov
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.
#urinaryincontinence #urogynaecologist #EverydayMedicine
Episode 74. Sports Medicine and Supplements with Dr Peter Brukner
Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre and is one of Australia’s most respected and best-known specialist sports physicians with a wide breadth of knowledge of the subject. He has extensive experience, having enjoyed a stellar career with elite sports teams and Olympians over multiple decades in his professional capacity.
Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre and is one of Australia’s most respected and best-known specialist sports physicians with a wide breadth of knowledge of the subject. He has extensive experience, having enjoyed a stellar career with elite sports teams and Olympians over multiple decades in his professional capacity.
In this episode we discuss, several questions related to commonly used supplements taken by amateur and high-level athletes as well as delving into the darker realm of banned substances including anabolic steroids such as DHEA, testosterone and growth hormone. This is a tremendous conversation with master raconteur and communicator. Please enjoy the episode.
Useful references include:
- www.lowcarbdownunder.com.au
- peterbrukner.com
- youtube Professor Tim Noakes – “Medical aspects of the low carbohydrate lifestyle”
- ods.od.nih.gov – National Institutes of Health, Dietary Supplements for Exercise and Athletic Performance (the fact sheet for health professionals)
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 73. Sports Medicine and Low Carbohydrate Diet with Dr Peter Brukner
Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre at Latrobe University and is one of Australia’s most respected and best known specialist sports physicians. He has a deep breadth of knowledge and experience and was a founding partner at the Olympic Sports Medicine Centre in Melbourne as well as a sports physician to the Collingwood and Melbourne AFL clubs, Liverpool Football Club and has served as team doctor to the Australian cricket team, Socceroos and several Olympic teams. He has authored multiple best-selling books on sports medicine and more recently has become interested in the important relationship between lifestyle and health and after determining that he was pre-diabetic he embarked on a low carbohydrate ketogenic style diet. He has subsequently become a strong advocate of the low carbohydrate diet both in managing a healthy BMI and avoiding development of the metabolic syndrome and all its consequent health effects and authored the very popular and best-selling book A Fat Lot of Good. He energetically has also established the not for profit campaign Sugar By Half. He joins us today to discuss his experience and journey to a low carbohydrate diet and how such an approach may be highly beneficial to athletes of both amateur and elite persuasions. Please enjoy this podcast.
Dr Peter Brukner OAM is Professor of Sports Medicine at the Latrobe Sport and Exercise Medicine Research Centre at Latrobe University and is one of Australia’s most respected and best known specialist sports physicians. He has a deep breadth of knowledge and experience and was a founding partner at the Olympic Sports Medicine Centre in Melbourne as well as a sports physician to the Collingwood and Melbourne AFL clubs, Liverpool Football Club and has served as team doctor to the Australian cricket team, Socceroos and several Olympic teams. He has authored multiple best-selling books on sports medicine and more recently has become interested in the important relationship between lifestyle and health and after determining that he was pre-diabetic he embarked on a low carbohydrate ketogenic style diet. He has subsequently become a strong advocate of the low carbohydrate diet both in managing a healthy BMI and avoiding development of the metabolic syndrome and all its consequent health effects and authored the very popular and best-selling book A Fat Lot of Good. He energetically has also established the not for profit campaign Sugar By Half. He joins us today to discuss his experience and journey to a low carbohydrate diet and how such an approach may be highly beneficial to athletes of both amateur and elite persuasions. Please enjoy this podcast.
Useful references include:
- www.lowcarbdownunder.com.au
- peterbrukner.com
- youtube Professor Tim Noakes – “Medical aspects of the low carbohydrate lifestyle”
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 9. New Vaccines with Professor Dale Godfrey
The Peter Doherty Institute was the first Australian laboratory to establish a Covid 19 PCR test and diagnose the first SARS- Cov 2 infection on Australian shores, its research scientist is heavily involved in developing novel diagnostic tools applied across many areas of medical science and the institute plays a key leadership role in advising state and federal government on best medical practice. It’s no great surprise therefore that we have learned of their ground-breaking development of a new subunit Covid 19 vaccine utilising the receptor binding domain at the tip of the virus’s spike proteins. This is the region responsible for virus attachment and infection and for eliciting over 90% of neutralising antibodies following SARS Cov-2 infection. Parallel with the subunit vaccine development, another Melbourne group – the Monash Institute of Pharmaceutical Sciences has developed a similar vaccine but using mRNA technology copying the virus’s genetic sequence that codes for the receptor binding domain.
The Peter Doherty Institute was the first Australian laboratory to establish a Covid 19 PCR test and diagnose the first SARS- Cov 2 infection on Australian shores, its research scientist is heavily involved in developing novel diagnostic tools applied across many areas of medical science and the institute plays a key leadership role in advising state and federal government on best medical practice. It’s no great surprise therefore that we have learned of their ground-breaking development of a new subunit Covid 19 vaccine utilising the receptor binding domain at the tip of the virus’s spike proteins. This is the region responsible for virus attachment and infection and for eliciting over 90% of neutralising antibodies following SARS Cov-2 infection. Parallel with the subunit vaccine development, another Melbourne group – the Monash Institute of Pharmaceutical Sciences has developed a similar vaccine but using mRNA technology copying the virus’s genetic sequence that codes for the receptor binding domain.
These vaccines enter the pantheon of other existing mRNA/viral vector/and subunit protein vaccines already available offering protection against Covid 19 but are different as they focus the immune response to the tip of the spike protein – the important receptor binding domain.
Both new Melbourne developed vaccines are entering phase 1 trials and results will be eagerly awaited.
Professor Dale Godfrey is a senior principal research fellow and immunology theme leader at the Doherty Institute and has played a major role in RBD subunit protein vaccine development.
Please join this conversation where Dale discusses the new vaccine development, their efficacy, and the phase 1 clinical trials evaluating the vaccines further.
References:
Professor Dale Godfrey: godfrey@unimelb.edu.au
doherty.edu.au
Phone: 83449325 for further trial information or at virgo-studies@unimelb.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 72. Breaking Bad News and Admitting Error with Dr Bill Shearer and Dr Alan Saunder
Delivering hard news to a patient or their relatives and admitting error can be one of the most difficult duties encountered by a doctor. Significant effort is now spent in teaching young training doctors techniques and strategies to avoid miscommunication and uncertainty in undertaking this complicated task whilst also remaining emotionally engaged and empathetic to their situation.
Delivering hard news to a patient or their relatives and admitting error can be one of the most difficult duties encountered by a doctor. Significant effort is now spent in teaching young training doctors techniques and strategies to avoid miscommunication and uncertainty in undertaking this complicated task whilst also remaining emotionally engaged and empathetic to their situation.
Rabow and McPhee have written eloquently on the subject of breaking difficult or bad news and have devised a mnemonic using the letters ABCDE as an excellent guide to this subject.
Accepting responsibility and apologising genuinely to a patient and their relatives for an error incurred during care requires courage and honesty and both Rabow and McPhee as well as the Harvard School of Public Health have written informatively on this subject.
In this episode we are joined by Dr Alan Saunder, Program Director of Surgery at Monash Health and both vascular and transplant surgeon with Dr Bill Shearer Consultant Anaesthetist and Executive Director of Quality Safety and Transformation at the Northern Hospital. We discuss these very important subjects with the honesty and wisdom of many years of advanced clinical practice. I believe you will find this conversation both helpful and engaging.
Useful references include:
- www.ncbi.nlm.nih.gov - Beyond Breaking Bad News: How to help patient who suffer
- www.aafp.org - Breaking Bad News – American Family Physician, G. VandeKieft.2001
- Harvard School of Public Health – www.hsph.harvard.edu
- Mistakes Were Made (But Not by Me) by Carol Tavris and Elliot Aronson, (Chapter 8)
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 71. Chronic Pain with Dr Stephen Nutter
Chronic pain affects about 1 in 5 people in Australia and is a common reason for patients to see their doctor and to seek treatment. As patients seek ever increasingly strong pharmacological therapies they may become increasingly depressed, fatigued and dislocated from society.
Chronic pain affects about 1 in 5 people in Australia and is a common reason for patients to see their doctor and to seek treatment. As patients seek ever increasingly strong pharmacological therapies they may become increasingly depressed, fatigued and dislocated from society.
In this episode we have a very interesting conversation with Dr Stephen Nutter, we follow Stephen’s journey from anaesthetist to pain management consultant at Metro Pain Clinic and discuss his approach to –
· Non-pharmacological
· Pharmacological
· Interventional approaches to chronic pain management
Stephen provides us with his personal approach to some common clinical pain syndromes, which we explore as a great introduction to this topic. I am delighted to share the conversation with you.
Useful references include –
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.
Episode 70. Familial Cancer Screen with Dr Lucy Gately - Part 2
Genetic testing for cancer is important for a small number of families at increased risk due to the inheritance of genetic mutations. Most commonly this involves the inheritance of breast cancer genes such as the BRCA 1 and 2 or colorectal cancer genes such as the Lynch syndrome genes. Although these only represent a small percentage of total cancers reported there is significant public interest in these syndromes.
Genetic testing for cancer is important for a small number of families at increased risk due to the inheritance of genetic mutations. Most commonly this involves the inheritance of breast cancer genes such as the BRCA 1 and 2 or colorectal cancer genes such as the Lynch syndrome genes. Although these only represent a small percentage of total cancers reported there is significant public interest in these syndromes.
We have a further discussion with Dr Lucy Gately from the Cabrini Family Cancer Clinic in this episode in regard to the BRCA 1 and 2 genes on chromosome 17 inherited by 1:400 women and men, and the Lynch syndrome genes which are accounted for by five mutations inherited by about 1:280 people. The Lynch syndrome is believed to affect about 80,000 Australians of whom perhaps only 5% know they have inherited this mutation. Whilst the BRCA 1 and 2 genes are associated with both breast and ovarian cancer in women, BRCA 2 inheritance may also imply an increased incidence of prostate cancer and breast cancer in men. Lynch mutations have been associated with up to 12 different forms of cancer although colorectal cancer and endometrial cancer are most highly represented by these mutations.
It is a great pleasure to discuss this fascinating subject in more detail with Dr Lucy Gately whose expertise on this complex subject is generously shared.
Useful references include:
- www.cabrinicancerclinic - BRCA gene mutations
- Genetic Testing Fact Sheet – www.cancer.gov
- Genetics: Breast Cancer Risk Factors – breastcancer.org
- BRCA 1 and BRCA 2 associated hereditary breast and ovarian cancer – www.ncbi.nlm.nih.gov
- Lynch syndrome – www.cancer.net
- What is Lynch syndrome – Lynch syndrome Australia – lynchsyndrome.org.au
- Understanding genetic tests for Lynch syndrome – Centre for genetics – www.genetics.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 69. Familial Cancer Screening with Dr Lucy Gately and Lynne McKay - Part 1
In the context of family cancer screening, genetic testing looks for specific inherited changes or variants in a person’s genes which may predispose them to an increased risk of developing a neoplasm. Harmful variants in some genes are known to be associated with an increased risk of developing specific cancers such as mutations to the BRCA 1 and 2 genes associated with breast and ovarian cancer and the Lynch genes associated with colorectal and endometrial cancer.
In the context of family cancer screening, genetic testing looks for specific inherited changes or variants in a person’s genes which may predispose them to an increased risk of developing a neoplasm. Harmful variants in some genes are known to be associated with an increased risk of developing specific cancers such as mutations to the BRCA 1 and 2 genes associated with breast and ovarian cancer and the Lynch genes associated with colorectal and endometrial cancer.
Alterations in tumour suppressor genes (loss of function) and proto-oncogenes (gains of function) are fundamental to our understanding of the science associated with family cancer syndromes and can be tested in the setting of family cancer screening clinics. The subsequent very important genetic counselling for patients and relatives who may have inherited such mutations involves discussing the risk of inherited cancer, individual risk screening and cancer risk reduction strategies.
In this episode, we are joined by Dr Lucy Gately and Lynne McKay from the Cabrini Family Cancer Clinic who have been instrumental in delivering one of Australia’s premier family cancer screening services and genetic counselling services to our community. Please welcome them to this conversation.
Useful references include:
- Family Cancer Clinic for Risk Assessment Advice and Testing – www.cabrini.com.au
- Family Cancer Centres – www.cancer.vic.org.au
- Genetic Testing for Cancer Risk – www.cancer.net
- Family Cancer Syndromes – American Cancer Society – www.cancer.org
- Cancer Genes – pubmed.ncbi.nlm.nih.gov
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 68. The Ketogenic Diet with Dr Rod Tayler
The ketogenic diet has recently become popular as an effective dietary approach to weight loss. The diet restricts carbohydrates to just 5-10% of total calories and relies on caloric intake from fats (55-60%) and proteins (30-35%) forcing metabolism to shift from gluconeogenesis to ketogenesis with the production of acetoacetate, beta-hydroxybutyrate and acetone – ketone bodies – as the usable energy source. People adopting this diet report a significant reduction in hunger, increase in energy, clarity of thought and reduction in chronic inflammatory conditions. Some are concerned the diet is difficult to maintain long term and may be risky in patients that are diabetic and in those with chronic kidney disease.
The ketogenic diet has recently become popular as an effective dietary approach to weight loss. The diet restricts carbohydrates to just 5-10% of total calories and relies on caloric intake from fats (55-60%) and proteins (30-35%) forcing metabolism to shift from gluconeogenesis to ketogenesis with the production of acetoacetate, beta-hydroxybutyrate and acetone – ketone bodies – as the usable energy source. People adopting this diet report a significant reduction in hunger, increase in energy, clarity of thought and reduction in chronic inflammatory conditions. Some are concerned the diet is difficult to maintain long term and may be risky in patients that are diabetic and in those with chronic kidney disease.
In this podcast episode, we delve deep into the roots of the ketogenic diet and its benefits with Dr Rodney Taylor an expert educator and host of the increasingly popular and very well supported Low Carb Down Under science education program. Rod has been instrumental in bringing some of the world’s experts on metabolism and dietetics to conferences he hosts in Australia and his youtube channel Low Carb Down Under has over 325,000 subscribers. I was very privileged to catch up with Rod in this interview and welcome you to the conversation.
Useful references include:
- Dr Rod Tayler – lowcarbdownunder.com.au
- A Ketogenic Diet for Beginners: The #1 Keto Guide – www.dietdoctor.com
- Should you try the keto diet? Harvard Health – www.health.harvard.edu
- Ketogenic Diet – StatPearls – www.ncbi.nlm.nih.gov
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 67. Back Pain with Dr Max Kupershmidt
Before proceeding, we apologise for the audio quality in this week's episode. Unfortunately, we experienced some technical difficulties and we will endeavour to resolve these problems in future episodes of Everyday Medicine.
Before proceeding, we apologise for the audio quality in this week's episode. Unfortunately, we experienced some technical difficulties and we will endeavour to resolve these problems in future episodes of Everyday Medicine.
It is estimated that up to 80% of the population will experience back pain sometime in their lives with presentations from adolescent age to the elderly. Back pain is the third most common reason for visits to a medical practitioner and in many instances treatment strategies have already been sought elsewhere from chiropractors, physiotherapist myotherapists, personal trainers and osteopaths.
Radiological interrogation is often required to assist formulation of an appropriate treatment strategy and in this episode we discuss a radiological perspective of this problem with radiologist Dr Max Kupershmidt who has specialised in procedural radiology and musculoskeletal imaging.
Max completed radiology training at the Alfred Hospital in 2006 and worked there as an interventional radiology fellow before undertaking an Abdominal Imaging Fellowship in Toronto in 2008 . Max has been engaged in private radiology for the last 11 years and was a founding executive and treasurer of ARGANZ as well as running and organising many successful conferences and seminars. In this podcast we also discuss with Max the issue of radiation exposure in radiology noting that the average person may receive the equivalent of 3 mSv of radiation per year and that a plain chest x-ray delivers an equivalent of 7 days of background radiation and standard mammography about 7 weeks of equivalent background radiation. CT exposure with a modern scanner delivers approximately 2.6 years radiation, PET scans about 8 years equivalent exposure and MRI none. It is estimated that the additive lifetime risk from a CT scan from fatal and nonfatal malignancy is about 1 in 1100 (equivalent to the risk of drowning). As medical practitioners we all need to be aware of the exposure risk when ordering investigations particularly in our younger patients where the lifetime risk is very real. Please join this conversation with Max.
References:
Dr Max Kupershmidt: LinkedIn
www.cancer.org Understanding Radiation Risk from Imaging Tests
www.radiologyinfo.org Radiation Dose in Xray and CT Exams
www.racgp.org.au Radiation Safety
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 66. Diabetic Foot with Dr Ming Yii
Diabetic foot is the name given to the condition commonly experienced by people with diabetic peripheral neuropathy and results in an insensitive and often deformed foot. Found in both type I and type II diabetic patients (of which there are 1.8 million living in Australia-one new diagnosis is made every 5 minutes), even minor trauma in the diabetic foot may lead to the development of an ulcer. The combination of impaired vascular supply from micro and macro vascular disease and neuropathy presents real challenges for healing. Consequently, diabetic foot ulcer is a major event in 85% of subsequent amputations and is the cause of 20% of hospital admissions related to diabetes. Ten to 15% of diabetic foot ulcers fail to heal and of these, 25% lead to an amputation. In one study up to 50% of diabetic patients undergoing amputation were dead within 2 years. Failure to be seen and managed by medical attendants more than 6 weeks after developing an ulcer in a diabetic foot vastly increases the amputation risk however just one year after appropriate vascular surgical management, between 70 and 90% of limbs will be saved from amputation. Furthermore, one year after vascular intervention up to 60% of diabetic foot ulcers are healed, highlighting the importance of vascular surgical expertise early in the management of the diabetic foot.
Diabetic foot is the name given to the condition commonly experienced by people with diabetic peripheral neuropathy and results in an insensitive and often deformed foot. Found in both type I and type II diabetic patients (of which there are 1.8 million living in Australia-one new diagnosis is made every 5 minutes), even minor trauma in the diabetic foot may lead to the development of an ulcer. The combination of impaired vascular supply from micro and macro vascular disease and neuropathy presents real challenges for healing. Consequently, diabetic foot ulcer is a major event in 85% of subsequent amputations and is the cause of 20% of hospital admissions related to diabetes. Ten to 15% of diabetic foot ulcers fail to heal and of these, 25% lead to an amputation. In one study up to 50% of diabetic patients undergoing amputation were dead within 2 years. Failure to be seen and managed by medical attendants more than 6 weeks after developing an ulcer in a diabetic foot vastly increases the amputation risk however just one year after appropriate vascular surgical management, between 70 and 90% of limbs will be saved from amputation. Furthermore, one year after vascular intervention up to 60% of diabetic foot ulcers are healed, highlighting the importance of vascular surgical expertise early in the management of the diabetic foot.
In this episode we are joined by expert vascular surgeon Mr Ming Yii who is the director of vascular and transplant surgery at Monash Health and adjunct Senior lecturer with Monash University. Ming is part of the Monash transplant team in kidney and pancreas transplantation and brings a wealth of knowledge and experience as well as an effusive personality to accompany his skills. In this episode he discusses his approach to this major problem and the multidisciplinary strategy for management that is needed.
Useful references include:
mingyiivascular.com.au
www.bmj.com Diabetic foot. SC Mishra 2017
www1.racgp.org.au.diabetic foot ulcer
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 65. Renal Impairment with Dr Tony Amin
It is common in clinical practice to identify patients with impaired renal function as determined by diminished glomerular filtration rate and elevated creatinine. The decision to undertake thorough work-up and investigation of such patients or to observe and monitor, removing any potential offending nephrotoxic agent, is a clinical problem we address in this podcast with expert nephrologist Dr Tony Amin, who considers:
It is common in clinical practice to identify patients with impaired renal function as determined by diminished glomerular filtration rate and elevated creatinine. The decision to undertake thorough work-up and investigation of such patients or to observe and monitor, removing any potential offending nephrotoxic agent, is a clinical problem we address in this podcast with expert nephrologist Dr Tony Amin, who considers:
· Acute kidney injury
· Chronic kidney injury
· Appropriate management and work up
· Intravenous contrast nephrotoxicity
This is a complex subject with multiple considerations which Tony outlines with great clarity.
Useful references include:
- Dr Tony Amin – www.healthshare.com.au
- Okusa MD et al. Reading between the Guidelines – The KDIGO practice guideline on acute kidney injury in the individual patient. Kidney Int. 2014 January; 85(1):39-48
- Farrington K et al. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher: a summary document from the European Renal Best Transplant Group. Nephrology Dial Transplant. 2017 Jan 1:32(1):916
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 64. Hypo and Hypernatraemia with Dr Tony Amin
Sodium is a major extracellular cation. Normal sodium concentrations range between 135 and 145 mmol/L. Alterations in sodium concentration, particularly hyponatraemia is the most common electrolyte disorder doctor’s encounter in clinical practice. Up to 20% of people admitted to hospital have hyponatraemia and it is estimated that 1.7% of population also have hyponatraemia.
Sodium is a major extracellular cation. Normal sodium concentrations range between 135 and 145 mmol/L. Alterations in sodium concentration, particularly hyponatraemia is the most common electrolyte disorder doctor’s encounter in clinical practice. Up to 20% of people admitted to hospital have hyponatraemia and it is estimated that 1.7% of population also have hyponatraemia.
It was enlightening to review this subject with Dr Tony Amin, nephrologist and public educator who discusses:
· The importance of assessment of serum and urine osmolality in conjunction with serum sodium and urinary sodium
· Assessment of patient’s volume status (hyper/hypovolemic)
· A variety of different clinical examples in respect to this subject
Please join me in this very engaging conversation with Tony whose expertise is evident from our discussions.
Useful references include:
- Dr Tony Amin – www.healthshare.com.au
- UpToDate
- HenryDa.In the clinic: Hypernatremia. Annals of Internal Medicine.2a15 August 4; 163(3);ITC1-19
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 63. Dementia with Dr Helene Roberts
The consequences of dementia with short term memory loss, visuospatial dysfunction, executive dysfunction, apathy, word-finding difficulty and apraxia is devastating both to the patient and family. It is estimated that 1% of Australians aged 65 years have dementia and that almost half of our population over 85 years have dementia to varying degrees. Alzheimer’s (60% of cases), vascular dementia (15% of cases), Lewy body and frontotemporal (each 5% of cases) and other forms of dementia secondary to alcohol, trauma and neurodegenerative disorders reflect the main forms of dementia seen in our society
The consequences of dementia with short term memory loss, visuospatial dysfunction, executive dysfunction, apathy, word-finding difficulty and apraxia is devastating both to the patient and family. It is estimated that 1% of Australians aged 65 years have dementia and that almost half of our population over 85 years have dementia to varying degrees. Alzheimer’s (60% of cases), vascular dementia (15% of cases), Lewy body and frontotemporal (each 5% of cases) and other forms of dementia secondary to alcohol, trauma and neurodegenerative disorders reflect the main forms of dementia seen in our society.
In this podcast we engage expert neurologist and cognitive specialist Dr Helene Roberts to discuss:
· Forms of dementia
· Appropriate investigation
· Management strategies
Helene guides us gently through this difficult and devastating clinical problem. Please join me in conversation with her.
Useful references include:
- Dr Helene Roberts – www.healthshare.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 62. Falls in the Elderly with Dr Kim Tew
Each year in Australia, over 125,000 of our more elderly population are admitted to hospital consequent to a fall. About a third of people over the age of 65 years fall each year and this figure rises exponentially with age. In up to 10% of falls, serious injuries such as fractures (a third of which are hip), soft tissue injuries and direct brain injuries arise. Falls and injuries from falls have serious implications and consequences.
Each year in Australia, over 125,000 of our more elderly population are admitted to hospital consequent to a fall. About a third of people over the age of 65 years fall each year and this figure rises exponentially with age. In up to 10% of falls, serious injuries such as fractures (a third of which are hip), soft tissue injuries and direct brain injuries arise. Falls and injuries from falls have serious implications and consequences.
In this podcast episode we are joined by geriatrician Dr Kim Tew who discusses:
· The complex relationship between balance, ambulation, cognitive function, neuromuscular function and cardiovascular function
· Appropriate management of an elderly patient following a fall
· The importance of early referral to a falls clinic or geriatrician with a view to careful work up, the deprescribing of medication, engagement of physiotherapy and occupational therapy.
Please join me in this interesting episode with Kim.
Useful references include:
- www.monash.edu – Fall-related injury profile for Victorians aged 65 – Monash University
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 61. Infertility with Dr Peter Yong
Couples are said to be infertile if pregnancy does not result after a year of carefully timed sexual activity without the use of contraceptives and is estimated to affect up to one in six Australian couples. It is also estimated that male partners contribute approximately 40% to cases of infertility, the same percentage as women. In a third of couples, a combination of male and female factors both need consideration. Today, women in Australia are 31 years of age before their first child is born compared to a generation ago where women on average were 24 years of age, this change in timing of first pregnancy and lifestyle may also be contributing to the difficulty some couples have starting their families.
Couples are said to be infertile if pregnancy does not result after a year of carefully timed sexual activity without the use of contraceptives and is estimated to affect up to one in six Australian couples. It is also estimated that male partners contribute approximately 40% to cases of infertility, the same percentage as women. In a third of couples, a combination of male and female factors both need consideration. Today, women in Australia are 31 years of age before their first child is born compared to a generation ago where women on average were 24 years of age, this change in timing of first pregnancy and lifestyle may also be contributing to the difficulty some couples have starting their families.
In this conversation, we are joined by Dr Peter Yong, a specialist obstetrician and gynaecologist who works with Monash IVF and has a special interest in infertility and assisted conception. Peter trained in the United Kingdom and was awarded the gold medal in the membership examination at the Royal College of Obstetricians and Gynaecologists as well as being the recipient of the RCOG Young Obstetrician and Gynaecologist award. He also won a travel award to visit the Leuven Institute of Fertility and Embryology in Belgium. It was a privilege to have him on a conversation today to discuss:
· Incidence of infertility amongst couples
· Factors to consider
· Appropriate examination and workup
· Subsequent management strategies
Please join me in this very interesting conversation with Dr Yong.
Useful references include:
- emedicine.medscape.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.