Special Episode 17. Medicine in Colonial Australia with Professor Chris Reynolds (Part 2)
The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further.
Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years.
The first fleet comprised of 11 ships and 1420 people arrived in Australia’s Botany Bay under the command of Captain Arthur Phillip in January 1788 after an 8-month journey from Portsmouth. On the voyage there were 48 deaths and 28 births but no recorded serious illnesses such as smallpox or tuberculosis. The colonists subsequently resettled in port Phillip Bay and quickly had to learn to adapt to an environment that was as foreign to them as it must have been for the local indigenous population of aboriginals who made first contact with these white skinned strangely dressed travellers.
Many of the settlers first crops failed and stock brought with them aboard either died, absconded, or were eaten necessitating an early call for help to replenish dwindling supplies.
This initial lack of nutrition jeopardised the viability and success of the newly forming colony. Second and third fleets arrived in 1790 and 1791.
The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further.
Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years.
My curiosity for colonial medicine extended to enquire about the nutritional health concerns encountered by early colonists, how water was purified, and how adequate balanced meals could be provided in a new foreign land. I was also fascinated to learn of the smallpox epidemic of 1789 which was devastating to our indigenous first AUSTRALIANS.
Further diseases such as tuberculosis, measles, influenza, and STD’s all earn mention. Alcoholism was a very significant problem amongst colonists as it remains in some quarters today but to a much lesser extent with our rigorous regulations around brewing and distribution. We discuss the medical problems encountered on our goldfields during the madness of the goldrush days in the 1850’s where dysentery was rife and food hygiene extremely poor. Indeed, William Howitt writing from the goldfields at that time where up to 1000 sheep were being slaughtered each day… “They are in their millions all over the country, they cover your horses, your load and yourselves, at your meals in a moment, myriads come swooping down, cover the dish and the meat on your plates till they are one black moving mass……”. It’s easy to imagine how disease spread quickly in that environment.
Leaving gold fever aside, first nations people had survived in Australian conditions for thousands of years coping with illnesses and climatic hardship so what if anything have, we learned in a medical sense from the indigenous people?
Chris Reynolds completed his PhD and Masters degrees at Americas Claremont Graduate University and has held appointments as Senior Professional Staff with both the United States Senate and House of Representatives. He has held several executive roles with NSW government including Executive Director of the World Trade Centre, Sydney. He has worked as a schoolteacher, University professor and political strategist and has applied his breadth of knowledge and experience to writing What a capital Idea-Australia 1770-1901.
Please welcome Professor Chris Reynolds to the podcast.
References:
What a Capital Idea- Australia 1770-1901. Christpher Reynolds. Reynold Learning. www.Reynoldlearning.com
Medicine in Colonial Australia,1788-1900, MJA,7 July 2014
Illness in Colonial Australia. Smith FB, Melbourne: Australian Scholarly Publishing, 2011
Special Episode 17. Medicine in Colonial Australia with Professor Chris Reynolds (Part 1)
The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further.
Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years.
The first fleet comprised of 11 ships and 1420 people arrived in Australia’s Botany Bay under the command of Captain Arthur Phillip in January 1788 after an 8-month journey from Portsmouth. On the voyage there were 48 deaths and 28 births but no recorded serious illnesses such as smallpox or tuberculosis. The colonists subsequently resettled in port Phillip Bay and quickly had to learn to adapt to an environment that was as foreign to them as it must have been for the local indigenous population of aboriginals who made first contact with these white skinned strangely dressed travellers.
Many of the settlers first crops failed and stock brought with them aboard either died, absconded, or were eaten necessitating an early call for help to replenish dwindling supplies.
This initial lack of nutrition jeopardised the viability and success of the newly forming colony. Second and third fleets arrived in 1790 and 1791.
The illnesses and medical conditions that early colonial Australians faced has interested me for some time and after hearing a very interesting radio conversation with historian and constitutional lawyer Professor Chris Reynolds I was honoured to have him join our conversation exploring this subject further.
Chris has completed an excellent history of early colonised Australia called What a Capital Idea - Australia 1770-1901 available from Reynolds publishing (link in the show notes below). What a Capital Idea is essential reading for anyone interested in this period of Australian settlement, carefully researched, and written in colourful prose it affords an intimate familiarity with many famous characters, explorers, and events over those years.
My curiosity for colonial medicine extended to enquire about the nutritional health concerns encountered by early colonists, how water was purified, and how adequate balanced meals could be provided in a new foreign land. I was also fascinated to learn of the smallpox epidemic of 1789 which was devastating to our indigenous first AUSTRALIANS.
Further diseases such as tuberculosis, measles, influenza, and STD’s all earn mention. Alcoholism was a very significant problem amongst colonists as it remains in some quarters today but to a much lesser extent with our rigorous regulations around brewing and distribution. We discuss the medical problems encountered on our goldfields during the madness of the goldrush days in the 1850’s where dysentery was rife and food hygiene extremely poor. Indeed, William Howitt writing from the goldfields at that time where up to 1000 sheep were being slaughtered each day… “They are in their millions all over the country, they cover your horses, your load and yourselves, at your meals in a moment, myriads come swooping down, cover the dish and the meat on your plates till they are one black moving mass……”. It’s easy to imagine how disease spread quickly in that environment.
Leaving gold fever aside, first nations people had survived in Australian conditions for thousands of years coping with illnesses and climatic hardship so what if anything have, we learned in a medical sense from the indigenous people?
Chris Reynolds completed his PhD and Masters degrees at Americas Claremont Graduate University and has held appointments as Senior Professional Staff with both the United States Senate and House of Representatives. He has held several executive roles with NSW government including Executive Director of the World Trade Centre, Sydney. He has worked as a schoolteacher, University professor and political strategist and has applied his breadth of knowledge and experience to writing What a capital Idea-Australia 1770-1901.
Please welcome Professor Chris Reynolds to the podcast.
References:
What a Capital Idea- Australia 1770-1901. Christpher Reynolds. Reynold Learning. www.Reynoldlearning.com
Medicine in Colonial Australia,1788-1900, MJA,7 July 2014
Illness in Colonial Australia. Smith FB, Melbourne: Australian Scholarly Publishing, 2011
Episode 137. Haemochromatosis with Professor Darrell Crawford
We are dedicating this podcast to the memory of Professor Lawrie Powell, both a gentleman, mentor and giant in the field of hepatology and whose very significant contributions to our understanding of hemochromatosis laid down a firm foundation of knowledge and insight for everyone practicing internal medicine. It is upon his shoulders that much further research in the field of hemochromatosis and hepatology generally has prospered.
Haemochromatosis is the most common autosomal recessive disorder in Caucasians with an incidence of about 1 :260 and carriage of about 1: 10. Untreated the excess iron storage from hemochromatosis may lead to cirrhosis and hepatocellular carcinoma, diabetes, cardiomyopathy, hypogonadism, arthritis, bronzing of the skin and render some susceptibility to siderophilic bacteria including some vibrio and Yersinia species. The consequences of iron overload are exacerbated by preexisting condition such as NASH and alcohol associated liver disease.
A key breakthrough in the understanding of hemochromatosis came with the discovery of a negative regulatory protein coded for by the HAMP gene on chromosome 19 called Hepcidin. Hepcidin serves as a counterregulatory protein. As iron absorption and stores increase Hepcidin levels in healthy individuals also increase leading to decreased iron absorption and restoration of normal iron levels. Hepcidin appears to work by internalization and degradation of Ferroportin thereby inhibiting iron absorption across the basolateral membrane of enterocytes as serum iron levels climb.
A transferrin receptor on the surface of hepatocytes relays information concerning serum iron concentration as part of this elaborate feedback mechanism.
Mutations of the so-called High Iron -or Hemostatic Iron Regulator -HFE gene on the short arm of chromosome 6 modulate the expression of Hepcidin, effectively blocking the elaborate feedback mechanism that senses serum iron and leading to inappropriately lowered levels of Hepcidin production as iron levels climb. This defect underlies the problem of excess iron absorption in Hemochromatosis with the consequent adverse physiologic effects mentioned above.
The gene mutation responsible for Hemochromatosis is thought to have arisen some 6000 years ago within Viking or Celtic communities possibly protecting against iron deficiency states when resources were scarce.
Treatment by regular phlebotomy remains the preferred method of management and screening for HCC in cases of established cirrhosis is mandatory.
I was honored to further this conversation about hemochromatosis with Professor Darrell Crawford, one of my mentors from Queensland in a previous life. Darrell has both the reputation for being an excellent hepatologist as well as having significant international standing in the field of liver disease and has published widely. He has held leadership positions within the national and international professional societies relevant to his discipline including GESA and the University of Queensland including as the Acting Deputy Executive Dean and Head, School of Medicine where he has played a key role in reshaping the medical program and medical faculty at the University of Queensland. Please welcome Darrell to the podcast.
Treatment by regular phlebotomy remains the preferred method of management and screening for HCC in cases of established cirrhosis is mandatory.
References:
Professor Darrell Crawford-medicine.uq.edu.au,
Queensland Gastroenterology
Greenberger’s Current Diagnosis and Treatment, 4th Ed, Friedman et al, McGraw Hill Lange
Principles of Medical Biochemistry, 3Rd Ed, Meisenberg and Simmons, Elsevier Saunders
Episode 136. Coronary Calcium Score with Dr Alistair Fyfe
The corner stone of cardiovascular disease prevention is the identification of high-risk asymptomatic individuals. In this regard coronary artery calcium is a highly specific marker of atherosclerosis and can be quantified using non contrast CT scanning which provides an accurate measure of atherosclerotic burden. Coronary artery disease is the single leading cause of disease morbidity and mortality in Australia and is responsible for approximately one in 10 deaths furthermore half the individuals with coronary artery disease will present with a myocardial infarction or death.
The compelling reason for undertaking coronary artery calcium scoring is to identify asymptomatic at-risk individuals who are likely to benefit from early detection, risk factor intervention and treatment of coronary artery disease.
In Australia risk assessment is recommended using the National Vascular Disease Prevention Alliance tool based on the Framingham Risk Equation. This risk stratification is drawn upon to guide the decision for calcium scoring which according to the Cardiac Society of Australia and New Zealand is recommended for asymptomatic intermediate risk patients or where there may be other strong evidence supporting its ability to improve cardiovascular risk assessment. High risk individuals may be better assessed by means of stress testing.
The calcium score is determined by non-contrast CT scanning and is complete within about ten minutes delivering just a little over 1 mSv of radiation equivalent to the annual background radiation we are exposed to. Using the Agatston method the volume and density of calcium is calculated and computed as a score. Again drawing upon The Cardiac society of Australia and New Zealand calcium scores may be interpreted as follows: A measurement of 0 is very low risk of coronary disease, a score of 1-100 is low risk, a measure of 101-400 is considered moderate risk and a patient lying within the 75th percentile of this group is at moderately high risk. Measurement over 400 denotes a high risk.
Multiple studies including the Multiethnic Study of Atherosclerosis (MESA) have confirmed the long-term prognostic value of CT calcium scores with over ten years of prospective follow up.
The value of calcium scoring lies in its ability to improve the accuracy of risk prediction. It helps to identify individuals who may benefit from more aggressive primary prevention measures; including the use of low dose aspirin that may otherwise not be recommended for primary prevention, as well as aggressive lipid management with statin therapies.
Given the importance of detecting asymptomatic coronary heart disease I was interested in pursuing the conversation further with one of the US expert cardiologists Dr Alistair Fyfe who has been practicing cardiology for over 38 years after graduation from the University of Tasmania.
Alistair has worked in Canada as well as the United States and is in Dallas, Texas where he has affiliations with Medical City Dallas and White The Heart Hospital Baylor Plano and is Medical Director of Blue Cross and Blue Shield of Illinois, Montana, New Mexico Oklahoma, and Texas not bad for a home-grown lad.
He is currently busy writing a contributing chapter to a soon to be published book titled: "The Implementation of Personalised Precision Medicine”, which, if I know Alistair will be excellent and a must read.
Given his expertise I was curious to learn a little more about its application and how a measured coronary calcium score should influence our approach to patient management.
I know you will find this conversation with Alistair very interesting. Please welcome him to the podcast.
References:
Dr Alistair Fyfe - on google and LinkedIn Coronary artery calcium in primary prevention
Chuah.www1.racgp.org.au When not to use calcium scoring
www.ausdoc.com.au Polonsky et al.
Coronary artery calcium score and risk classification for coronary heart disease prediction.
Special Episode 16. Interventional Radiology with Dr Yen Chieng
Interventional radiology is an innovative and rapidly growing medical profession that enables radiologists to blend clinical interaction, procedural work, and imaging. It stands as an exciting domain within modern medicine, offering precise, targeted treatments for complex diseases and conditions throughout the body. Interventional radiologists seamlessly integrate various specialty interests, including gastroenterology, vascular surgery, neurosurgery, oncology, pain management, gynecology, and more. Moreover, they've pioneered treatment techniques using state-of-the-art technology like MRI, CT scans, fluoroscopy, ultrasound, and plain X-rays.
Their scope of practice encompasses a broad range of procedures such as biliary intervention, cholecystostomy, chemo and radioembolization of tumors, Radiofrequency ablation, Cryoablation and microwave ablation, balloon angioplasty, vascular stenting, aneurysm repair, embolization (e.g., of the uterine artery, fibroids, and pulmonary arteriovenous malformations), catheter-directed thrombolysis, placement of IVC filters, dialysis-related interventions, central venous catheter placement, percutaneous nephrostomy placement, ureteral stent placement, coeliac axis nerve blocks, spinal blocks, and more.
Interventional radiology is poised to play an increasingly significant role in the future of modern medicine. It offers cost-effective, minimally invasive treatments with shorter procedural and recovery times, sometimes yielding better patient-focused outcomes compared to many surgical alternatives.
In this podcast, my goal was to expand my knowledge about the remarkable world of IR. I am delighted to welcome interventional radiologist Dr. Yen Chieng to join us, covering many of the areas mentioned above. Yen has skillfully navigated challenging clinical scenarios, bailing many of us out more than once with his incredible yet measured skills and enthusiasm. Please welcome Yen to the podcast."
References:
Dr. Yen Chieng: i-med.com.au
Royal Australian and New Zealand College of Radiologists: www.ranzcr.com
Interventional Radiology Society of Australasia: www.irsa.com.au
Inside radiology: www.insideradiology.com.au
Episode 40. Mole mapping and skin cancer surveillance with Dr Archie Xu
Non-melanotic skin cancers and melanoma are the most common cancers affecting humans. At least two in three Australians will be diagnosed with skin cancer before the age of 70 years and the risk is higher for men than women. Whilst basal cell carcinomas and squamous cell carcinomas are more common they are not as lethal as melanomas which are referred to as Australia’s “national cancer”. Indeed in 2020 it is estimated that 16,200 will be diagnosed with melanoma, that is one new case every half hour and a death every five hours.
Non-melanotic skin cancers and melanoma are the most common cancers affecting humans. At least two in three Australians will be diagnosed with skin cancer before the age of 70 years and the risk is higher for men than women. Whilst basal cell carcinomas and squamous cell carcinomas are more common they are not as lethal as melanomas which are referred to as Australia’s “national cancer”. Indeed in 2020 it is estimated that 16,200 will be diagnosed with melanoma, that is one new case every half hour and a death every five hours.
Skin clinics have emerged embracing mole mapping to assist in the diagnosis and management of melanotic skin cancers as well as non-melanotic skin cancers and we are grateful to have a conversation today with Dr Archie Xu who has been running a suburban skin cancer clinic for many years. He joins us to discuss:
· Mole mapping
· Dermoscopy
· Melanoma and non-melanotic skin cancer
I am most grateful to have had this discussion with Archie on a very important subject particularly relevant to our sun-drenched outdoor lifestyle. Please join me with Archie.
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 37. Why We Get Fat And What We Can Do About It with Professor Joseph Proietto
The western world faces a very significant obesity epidemic. In Australia, two-thirds of our population or 12.5 million are either overweight or obese and as a consequence may experience many medical sequelae including development of the metabolic syndrome, type 2 diabetes, cardiovascular disease, cerebrovascular disease, osteoarthritis and depression, contributing significantly to our health burden. In the first part of this series, we were joined by Joseph Proietto, Professor Emeritus at the University of Melbourne, the Department of Medicine at Austin Health and an endocrinologist specialising in diabetes and obesity to discuss why we become obese. Professor Proietto joins us again to guide us through a strategy of how to treat and manage obesity and direct our patients toward a healthy body mass index (BMI).
The western world faces a very significant obesity epidemic. In Australia, two-thirds of our population or 12.5 million are either overweight or obese and as a consequence may experience many medical sequelae including development of the metabolic syndrome, type 2 diabetes, cardiovascular disease, cerebrovascular disease, osteoarthritis and depression, contributing significantly to our health burden. In the first part of this series, we were joined by Joseph Proietto, Professor Emeritus at the University of Melbourne, the Department of Medicine at Austin Health and an endocrinologist specialising in diabetes and obesity to discuss why we become obese. Professor Proietto joins us again to guide us through a strategy of how to treat and manage obesity and direct our patients toward a healthy body mass index (BMI).
In this episode Professor Proietto discusses:
· The concept of energy balance
· The influence of exercise
· Dietary approaches including - Very low energy diets that induce a ketogenic state
· Medication used to suppress appetite and assist patients to establish an optimal BMI
Professor Proietto was extremely informative in this conversation navigating steadily and logically through a management strategy that may be applied to our patients experiencing obesity in primary practice. Thank you for joining me in this conversation.
Useful references include:
- www.darebinweightlosssurgery.com.au
- vermontsouthmedicalcentre.com.au
- Body Weight Regulation – Essential Knowledge to Lose Weight and Keep It Off by Joseph Proietto. ISBN 9781514497005. Published 12 August 2016, Publisher Xlibris.
- 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 36. Why We Get Fat with Professor Joseph Proietto
Up to two thirds of Australians are either overweight or obese as defined by body mass index (overweight: BMI 25-29.9, obese: BMI >30) with subsequent significant medical consequences including cardiovascular disease, type 2 diabetes, cerebrovascular disease (metabolic syndrome), osteoarthritis and depression. Becoming overweight and obese involves complex interactions between neurohormonal systems of the gut, neurobiology of the brain (particularly the hypothalamus) and leptin production from adipose sites coupled with an environment where there is an abundance of high glycaemic energy dense foods. Science demonstrates that the overarching controls of obesity are genetic (70%) rather than environmental (30%). Adoption studies relating to monozygotic twins demonstrate this. In view of the metabolic consequences of obesity, understanding why we get fat is extremely important to medical practitioners.
Up to two thirds of Australians are either overweight or obese as defined by body mass index (overweight: BMI 25-29.9, obese: BMI >30) with subsequent significant medical consequences including cardiovascular disease, type 2 diabetes, cerebrovascular disease (metabolic syndrome), osteoarthritis and depression. Becoming overweight and obese involves complex interactions between neurohormonal systems of the gut, neurobiology of the brain (particularly the hypothalamus) and leptin production from adipose sites coupled with an environment where there is an abundance of high glycaemic energy dense foods. Science demonstrates that the overarching controls of obesity are genetic (70%) rather than environmental (30%). Adoption studies relating to monozygotic twins demonstrate this. In view of the metabolic consequences of obesity, understanding why we get fat is extremely important to medical practitioners.
We are privileged to have a conversation in this podcast with Joseph Proietto, Professor Emeritus at the University of Melbourne in the Department of Medicine at Austin Health and an Endocrinologist who specialises in diabetes and obesity. Professor Proietto established the first Obesity Clinic in Victoria at the Royal Melbourne Hospital and is the head of Weight Control Clinic at Austin Health. He was the inaugural Sir Edward Dunlop medical research foundation Professor of Medicine and head of the Metabolic Disorders Research Group in the Department of Medicine, Austin Health, Joseph is on the executive of World Obesity and Chair of the Clinical Care Committee.
In this conversation he discusses:
· Why we become fat
· The role of genetic and epigenetic factors
· Some of the important hormones controlling satiety and hunger
Please enjoy this very interesting and informative conversation with Professor Joe Proietto.
Useful references include:
- www.darebinweightlosssurgery.com.au
- vermontsouthmedicalcentre.com.au
- Body Weight Regulation – Essential Knowledge to Lose Weight and Keep It Off by Joseph Proietto. ISBN 9781514497005. Published 12 August 2016, Publisher Xlibris.
- 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 35. The spleen and postsplenectomy syndrome with Dr Mohammed Al Souffi
The spleen performs a large number of important functions including processing and removal of opsonized pathogens, cellular maintenance, immunoglobulin production and the removal of effete worn out red blood cell. When removed either through trauma or for therapeutic indications the risk of overwhelming post splenectomy infection (OPSI) increases significantly; up to 58 times the general population in the setting of trauma and up to 1,100 times increased risk when for thalassaemia.
The spleen performs a large number of important functions including processing and removal of opsonized pathogens, cellular maintenance, immunoglobulin production and the removal of effete worn out red blood cell. When removed either through trauma or for therapeutic indications the risk of overwhelming post splenectomy infection (OPSI) increases significantly; up to 58 times the general population in the setting of trauma and up to 1,100 times increased risk when for thalassaemia.
The risk of OPSI is particularly high in the first 2-5 years for capsulated bacteria such as Strep pneumonia, Haemophilus influenzae and Neisseria meningitidis. To discuss the functions of the spleen and post splenectomy syndrome in more detail we are joined by expert and very affable general physician Dr Mohammed Al-Souffi, formally trained in Iraq and the United Kingdom before “walking free” to Victoria, where we are very fortunate to welcome him as a colleague and member of the Royal Australian College of Physicians. Mohammed joins us to talk about:
· Functions of the spleen
· OPSI
· Appropriate vaccination post splenectomy
· Management of thrombocytosis
· Spleen registry
I am most grateful to have Mohammed as part of this podcast series. I do hope you can join me in this conversation.
Useful references include:
Spleen.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.