Episode 128. Chronic Leukaemia with Jake Shortt

Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.  

As disease progression occurs, suppression of normal blood cell production leads to anemia and cytopenia with a host of attendant symptoms and clinical consequences.  

There are 14 new diagnoses of Leukaemia per day in Australia accounting for about 5200 diagnoses yearly and making up about 3.2 % of all new cancer diagnoses per year. Leukaemia is responsible for over 2100 deaths annually.  Men are slightly more likely to be affected in a 60: 40 split with women. By the age of 85 years, one has a 1: 50 chance of this diagnosis. With current treatment approaches overall 5-year survival sits at about 64 % but this figure is influenced by the subtype of Leukaemia diagnosed with aggressive forms of Leukaemia such as AML carrying a much worse prognosis than a diagnosis such as CLL which may run an indolent course for many years. 

Dividing adult Leukaemia into acute and chronic classification is most helpful and this podcast will approach the topic similarly over two episodes. 

The acute Leukaemias encompass acute myeloid leukemia (30 % of adult Leukaemia), acute lymphoblastic Leukaemia and Leukaemia's of ambiguous origin. 

The chronic Leukaemias include Chronic Myeloid Leukaemia (CML) and Chronic lymphocytic leukemia (CLL) 

This is another vast subject, and it was a real honour to invite Professor Jake Shortt to the podcast. Jake is the Head of Haematology Research at the School of Clinical Sciences and clinical lead at Monash Haematology for Myeloid Leukaemia, myelodysplasia and T-cell lymphoma. He is the Principal Investigator on a range of clinical trials for T-cell lymphoma and myeloid malignancies, conducted through the Monash Haematology clinical trials unit and the recipient of a Medical Research Future Fund Career Development Fellowship. His work in the School of Clinical Sciences is focused on strategies incorporating epigenetic drugs with immunotherapy in haematological cancers, particularly Lymphoma and Multiple Myeloma. Jake heads the Blood Cancer Therapeutics laboratory within the Monash Health Translation Precinct and somehow also finds the time to be Chair of the Laboratory Sciences Working Party of the Australasian Leukaemia and Lymphoma Group (ALLG) and Deputy Chair of their Scientific Advisory Committee.  

Please welcome Professor Jake Shortt to the podcast. 

References :  

Haematology and Oncology Subspecialty Consult, 4th Ed, Cashen and Van Tine, Wolters Kluwer, Ch 31 

⁠www.leukaemia⁠.org.au 

www.cancer.org.au 

www.monashhealth.org/services/haematology/jake-shortt/

Episode 125. The Art of Pilates with Samantha Wood

Pilates is a form of low-impact exercise that aims to strengthen muscles while improving postural alignment and flexibility. It can be practised with or without equipment and the movements reinforce slow precise actions and breath control. The exercises strengthen and stabilise the core which is the body's foundation allowing one to move efficiently while improving posture flexibility and mobility.

This method of exercise is based on the rehabilitation work of Joseph Pilates, born in Dusseldorf in 1883. Joseph Pilates believed that injuries were caused by imbalances in the body and by habitual patterns of imperfect movement and hypothesised that an overcompensation or overdevelopment of another area occurred when a person had a weakness or misaligned area in order to achieve the functional movements desired.

He felt it was critical to correct the misalignment and to re-educate the body to prevent recurrence. His studio in New York allowed him to develop over 600 exercises over his career and he invented various pieces of apparatus to assist with the execution of these in particular his so-called reformer and cadillac with pulleys and springs allowing his method initially called Contrology to be practised with precision and exact repetition.

Joseph Pilates died in 1967 before his method now called Pilates became well known and widely accepted. Today, decades later his approach has gained significant popularity with over 3000 studios in Australia and some 380,000 Australians practising Pilates either regularly or occasionally. His method has been widely adopted by physiotherapists in Australia, North America and Europe with increasing popularity is a testament to its amazing benefits.

Recently I had the pleasure of being introduced to Samantha Wood whilst she was blitzing it at a surfing location in Fiji with her tall athletic partner Jeff. They were both limber, flexible and in the moment and she was immediately recognised as the author of Pilates for Rehabilitation which has become a bible of Pilates based exercises and a comprehensive guide for therapists offering rehabilitation from orthopaedic injuries.

Samantha began her career as a physiotherapist and after a serendipitous meeting with Pilates guru Rael Isacowitz she developed a passion for Pilates and is now world renown in her field lecturing internationally, conducting workshops and convening body and mind retreats as well as running a busy Pilates and PT clinic at The Cypress Center in Pacific Palisades Los Angeles California.

I was very grateful that she was available for this interview to discuss Pilates further, as I believe we should all be familiar with the method and recognise the outstanding benefits it offers our patients.

Please welcome Samantha to the podcast.

References:

Samantha Wood-Cypress Center-Pacific Palisades, Los Angeles. www.samanthawoodphysio.com

Pilates for Rehabilitation -Samantha Wood. Human Kinetics

www.HumanKinetics.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 124. Lipids and Atherosclerotic Cardiovascular Disease with Dr Brett Forge (Part 3/3)

Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques.

Atheroma develops when cholesterol esters and triglycerides enter the vascular intima inducing local inflammation. Macrophages recruited to the inflammation engulf the cholesterol esters by phagocytosis. Stuffed with cholesterol these cells are referred to as foam cells. The inflammatory cascade is accentuated and recruits more inflammatory cells some of whom perish over time and calcium deposition and fibrosis develops within a forming plaque. Plaque enlargement may distort vascular anatomy expanding into the vessel lumen impeding blood flow and inducing ischaemia however not all plaques impact in this way and even large developing plaques may form in a way that does not disrupt blood flow. Instability in a growing plaque however may lead to rupture and the initiation of an acute thrombotic event. Whilst hyperlipidemia underscores atheroma pathogenesis this complex and life-threatening process is also adversely influenced by cigarette smoking, hypertension, genetics, and poor glycaemic control.

Having a clear understanding of lipid physiology allows us to appreciate both atheroma formation and how cardiovascular risk may be modified. One of the key points is that as lipids are water insoluble and they must be transported in specialized vesicles. These are called lipoproteins when produced by the liver for entry into the circulation and micelles for entry into the biliary system and subsequently the gastrointestinal tract. Chylomicrons are the specialized vesicles produced by gut enterocytes to transport lipids from the digestive tract via lymphatics ultimately into the circulation.

Current Australian guidelines for lipid management recommend:

Total Cholesterol < 4 mmol/l if high risk, < 5 .5 mmol/l for general population

LDL < 1.8 mmol/l for high risk, < 2.0mmol/l general population

Triglycerides < 2 mmol/l

HDL > 1.0 mmol/l

Lowering LDL cholesterol by 1mmol/l reduces the incidence of major vascular events (non-fatal myocardial infarction, coronary death, coronary revascularization, or stroke) by about one fifth. With 11 fewer vascular events per 1000 treated over 5 years. Similarly, triglyceride reduction per 1 mmol/l is associated with about half this cardiovascular risk reduction.

Interventions that are utilized to modify the cardiac risk associated with lipids include:

Dietary manipulation

Pharmacologic modification of lipid synthesis or absorption

Multiple epidemiological studies have demonstrated a greater incidence of coronary artery disease linked to non-HDL cholesterol and elevated serum triglycerides as well as a protective benefit from high HDL levels which includes when triglycerides and LDL levels are high and a lowering of CVD risk even when optimal triglyceride and non HDL cholesterol levels are achieved.

Given the critical importance of cardiovascular risk modification it was a pleasure to invite cardiologist Dr Brett Forge to the following two episodes of this podcast to expand on this fascinating subject.

References:

Basic and Clinical Pharmacology 14th ed -Bertram G. Katzung, LANGE Books, Ch 35.

Principles of Medical Biochemistry, Eisenberg & Simmons,3Rd Ed, Elsevier Saunders, Ch 23

Ganong’s Review of Medical Physiology, Barrett et al,25 th Ed, LANGE Books, Ch 26

Dietary Fat and Risk of Cardiovascular Disease: Recent Controversies and Advances, Annual Review of Nutrition, Vol. 37:423-446, Wang & Hu

Dietary Cholesterol and the Lack of Evidence in Cardiovascular Disease, Nutrients 2018Jun;10(6):780 Ghada A. Soliman

To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au. Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne, Australia, and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.