May 19, 2018 - May 25, 2018
Growing old – the end game
Many seniors will
tell you just how dreadful old age really is. However, even if you
don’t like getting older, with all the attendant aches and pains, it
still beats the alternative!
There are also
people like my father who was only afraid of one thing – growing old.
So he didn’t. He died aged 56 of a massive heart attack, and missed the
enjoyment of watching children and grandchildren grow up, and holiday
travel, because for pensioners, every day is a holiday.
Fact Number 1: we
are all getting older. Not wiser nor necessarily richer, just older.
Just keep your seat reserved in God’s waiting room and you’ll be right.
OK, so we are all
living longer, what can we do to get our arthritic hands on the elixir
of youth? If you believe the popular press, the answer to aging is
multivitamins. Peddling mega-vitamins is a megabuck industry, credited
with improving your health, your love life and fixing everything from
falling hair to falling stock markets.
The question is,
should you take daily doses of antioxidants such as beta carotene,
vitamin A and C or selenium to protect yourself against cancer, heart
disease or tinea? There is some scientific suggestion that people who
have a high level of antioxidants in their diet may have a lower risk of
heart disease and certain cancers. That is why the nutritionists say we
should eat at least five portions of fruit and vegetables a day.
However, other studies also seem to suggest that taking those same
antioxidants in pill form may not have the same effect and may even be
harmful. Who do you believe?
Cancer Research UK
says, “These products don’t seem to give the same benefits as vitamins
that naturally occur in our food.”
The British Heart
Foundation agrees, “Research does not support the claim that taking
extra antioxidants in the form of supplements will benefit the heart.”
chief dietitian at St George’s Hospital in London says, “The whole idea
that you must meet some vitamin and mineral target every day of your
life is a marketing myth. You can eat lots of fruit and veg one day and
not much the next but over a week you will still get the right amount of
nutrients. There is very little scientific evidence that there is any
benefit whatsoever in taking a daily multivitamin – even in old people.
You cannot exist on a poor diet then shore yourself up with a
multivitamin. The idea that taking high quantities of vitamins will
give you a health boost – like putting premium petrol in your car – is
Dr Toni Steer,
nutritionist with the British Medical Research Council’s Human Nutrition
Research in Cambridge, states supplements cannot compete with real food
because when we eat fruits and vegetables the vitamins and nutrients
interact with other chemicals to produce positive effects on the body.
“If these same vitamins are pulled out and isolated in pill form, there
is no guarantee at all that they will have the same effect.” This is
the old in vivo and in vitro argument.
Another nail in the
multivitamin pill coffin came from the US journal of the National Cancer
Institute which found that men with prostate cancer who took more than
seven multivitamins a week were 30 percent more likely to get an
advanced and fatal form of the disease.
Medical Association found that people who took antioxidant vitamin
tablets (particularly vitamins A and E, and beta-carotene) were more
likely to die earlier than those who did not. Oops! That isn’t
something you will read on the back of the multivitamin bottle.
Let’s look at the
old Vitamin C to ward off the common cold, as proposed many years ago by
Linus Pauling. Common claim: one gram doses will ward off or even cure
the common cold. Reality check: the human body can absorb only 500
milligrams of vitamin C and will excrete the excess. Vitamin C reduces
the average length of a common cold from five days to four and a half –
if you are lucky.
The answer in
staying young is to stay active, keep the mind exercised and do things
you enjoy. Just do it!
May 12, 2018 - May 18, 2018
Feeling a little ‘liverish’ today?
Have you ever stopped
to consider that the most important organs you have are all singletons,
while with the less important ones you have a back-up duplicate? You have
two lungs and you can get by on one, kidneys ditto, eyes ditto, hands ditto.
But you only have one brain, one heart, one bladder, one uterus (ladies),
one Willy (men) and one liver.
Yes, one liver, one of
the more important organs you possess. Without it you will die, whereas you
can get by without a kidney, or a lung or an eye, for example. Yes, I’d rate
my liver above my kidney any day.
So what does this liver
do? Think of your liver as a filtering and de-toxifying device. Chemicals
are taken up by the liver, to be broken down into non-toxic chemicals, all
to protect your total system. Clever organ your liver.
The most well-known
liver toxin is our old friend Ethanol, more usually referred to as grog or
booze. That alcohol affects the liver is well known, with the end result
being called Cirrhosis, a kind of fibrous hardening of the liver which then
becomes unable to carry out its job correctly. Toxins build up. You feel
unwell and it’s all downhill from there.
But the list does not
end there either. Some proprietary or prescription drugs can produce an
inflammation of the liver tissues too. Or worse, produce a breakdown of the
liver tissue itself. Amongst these is the headache medication paracetamol
(the ubiquitous headache tablets, for example), but before you throw them
out of your bathroom cabinet, it requires some heavy and very frequent
dosage of paracetamol to do this. Remember Paracelsus: “Dosage alone
items that may produce liver problems include Methyldopa, several
penicillins, Simvastatin (the cholesterol lowering drug), Diclofenac (a
non-steroidal anti-inflammatory) and Ketoconazole (anti-fungal).
So we all know that
prescription drugs (even though you can get most of them over the counter in
Thailand) can be dangerous, that’s why they have a PI (patient information)
leaflet inside the box, but what about “Health” food preparations? The
purveyors of these all cite the fact that the ingredients are “natural” so
everyone assumes that this means “safe”. Not quite so fast, I’m afraid.
Lead, for example, is a naturally occurring compound, and not much good for
young kidneys. However, since we are talking about liver problems, hands up
all those of you who have heard of Echinacea? Supposedly fixes everything
from falling hair to fallen arches - but is it “safe”? Well, Echinacea,
along with Kombucha Tea are two of the commonest compounds showing a
well-documented history of being toxic to the liver. So if you’re sipping
Kombucha tea because you’ve drunk too much alcohol, I would suggest that you
stop right now!
Others for sale in the
Health Food shops with known toxic effects on the liver include Evening
primrose oil, Valerian, Chaparral, Japanese Daisaiko-to (for dyspepsia),
Chinese Jin-bu-huan and several forms of herbal teas such as those from
Heliotroprium, Senecio crotalaria and Symphytum. Makes you think that the
‘Health’ shops that sell them may be incorrectly named, doesn’t it!
But while the column
this week seems to be spreading doom, gloom and disaster, it’s not quite
that bad. There are tests we can do to see if the liver is in trouble. Liver
enzymes can be measured in the blood and a Fibroscan will show if the liver
is getting fibrous, on its way to Cirrhosis.
The other good news is
the fact that the liver is a very powerful organ and is capable of
regenerating itself quite quickly, so in most cases of toxicity following
ingestion of chemical compounds, by stopping taking them, the liver recovers
and the patient feels well again.
So remember that if you
are taking anything regularly and you feel unwell, it may be the liver - but
tell your doctor everything you have been taking! And no thanks, I’ll give
the herbal tea a miss today.
May 5, 2018 - May 11, 2018
True tales from the examination couch
I have been a doctor for more years
than the length of time some of the readers here have propped up a long
wooden bar with a nubile hovering near their wallets. Yes, I’ve seen
quite a few changes in the art of medicine in my time, and it is an art
keeping patients happy while the treatment seems to be so slow in some
Remember the five inch floppy? Not
the computer one, but the one we didn’t talk about 30 years ago, so
secret that we didn’t even refer to it by name, but used the acronym ED.
That stood for (I can say it in these enlightened days) Erectile
Dysfunction. Roughly explained as the inability of the penis (another
word not often spoken in polite company, which I usually refer to as
Willy the Wonder Wand), to get erect to carry out its number one
function in a man’s life.
ED caused marriages to fold as men
with the affliction looked for a lady with the key to making the member
remember its function. And then along came Alprostadil, and this was
long before the blue diamonds.
As a GP working on the frontline of
medicine you were brought up to speed on the latest developments by the
detailers, and a rather breathless chappie came to see me to tell me
about Alprostadil, the wonder drug that could put the lead back in any
One would imagine that the cheers
would be heard everywhere at the bar with its attendant nubile, but
there was one drawback. Alprostadil only worked by injection. And that
injection was directly into the penis. Definitely cringe material.
As a medical student we were
supposed to be able to get blood samples from our classmate’s thumbs.
That of course was someone else’s thumb, but which of my fellow
undergraduates would I trust with mine? Simple answer – none of them, so
I spent 30 fruitless minutes chasing my thumb around the room. And that
was for a thumb prick. Imagine the problems with a different prick.
What the treating GP had to do was
get over the innate reluctance of patients exposing one’s member, and
then teach the patient how to inject the Alprostadil. To make this even
more of a hit and miss, the dosage was not accurately known and we were
told that the first injection should be done in the surgery and then
send the patient off having guessed the dose, probably somewhere in the
middle of the dosage range. In addition, the patient was to telephone
the GP in the morning to report back so we could get some idea of dose
My first patient in need was an
Aussie welder, blue Jacky Howe singlet and all. These are the salt of
the earth characters, with the blue singlet very much an Australian
icon, originally worn by shearers and now adopted by the blue collar
workers. “Can’t do me homework Doc,” he said, getting straight to the
point as Aussies do. After examination and history taking, he was
certainly suffering from ED. So following explanation and an embarrassed
demonstration by both doctor and patient, he hared off to see if he
would get a pass for his homework that evening, and with the promise to
ring me in the morning.
First call was my welder, “How did
you go?” said I. The reply was straight to the point, “Best root I’ve
had in years!” (Forgive the Aussie vernacular, but that’s how Australian
Delighted I congratulated him, but
he went on a little further. “I think we should cut the dose down a
“They could have picked me up by
the legs this morning and ploughed the front yard with me!”
I admit I was unable to stifle my
laughter, but my patient didn’t worry. “When’s me next injection, Doc?”
With the advent of Viagra
(Sildenafil, AKA the blue diamonds) the need for Alprostadil waned, but
is still used today for those ED sufferers for whom Sildenafil is not
getting them a pass on their homework.
April 28, 2018 - May 4, 2018
Check-ups. Worthwhile? Or a waste of time?
Check-ups are inherently involved in
that important feature called the Quality of Life. Longevity alone, with no
Quality, just isn’t worth having. Being stuck in a wheelchair as a double
amputee for the last 20 years of your life because you did not know you had
diabetes is not the Quality I would want.
Check-ups are designed to find
deviations from normal health patterns at an early stage. Early enough to
reverse the trend, before damage has occurred. This includes high Blood
Pressure (BP), a significant factor in poor future health if unchecked now.
Unfortunately, elevated BP generally gives no warning symptoms.
Now blood sugar. It requires sky-high
sugar levels before you begin to feel that something might be wrong. By then
the sugar levels have affected vision, the vascular system and many other
systems, all of which can decrease your future Quality of Life.
Cardiac conditions are very easily
found during a routine check-up. Blood tests and an ECG (EKG) can show just
how well the heart is functioning. The inability to walk more than 30 meters
certainly takes the fun out of shopping!
Other silent killers can be discovered
in your lipid profile, with Cholesterol and its fractions HDL and LDL being
intimately connected with your heart’s health. Detecting abnormalities now
can mean that you can get through the deadly 50-60 year age bracket with
clean coronary arteries and a clean bill of health.
There are so many conditions that can
affect your enjoyment of the future, but can be discovered early. Renal
(kidney) function and liver function can be monitored through an annual
check-up, as can prostate size (indicated by the PSA blood test) or breast
tumors (by mammogram).
My hospital has check-up packages, but
unfortunately asking “What package should I have,” is like asking “How long
is a piece of string?” However, there are some general guidelines depending
on your age and your personal and family medical histories.
If you are a non-smoker, under 30 years
old, play sport every weekend, train regularly during the week, have never
visited a doctor other than childhood immunizations and have grandparents
alive and well, then a very simple general check-up is all that is needed.
You are not at high risk, but it is good to have a baseline to compare
against as you get older! If everything is normal, then a repeat check every
two years will be fine.
If you are under 40 years of age, but
have given up the regular training and weekend sport, you are in a somewhat
different situation. Your ‘risk’ category is higher and now is the time to
look at your cardiovascular system in particular. Lipid (blood fats) profile
and a check on your red and white cells and a blood sugar reading will cover
most major future problem areas. If both grandparents are still around, and
your check-ups have been normal, then continue your biennial check-ups, but
if the grandparents have popped their clogs, then step up the frequency to
By the time you are in the 40-50 age
bracket, now is the time you should be looking at exercise stress tests and
vascular screening. Now is also the time to apply yourself to correct any
lifestyle factors which are going against your general health. By the way,
if you are female then you should throw a Pap Smear into the annual equation
But it gets worse! When you pass the
magic 50 number, you are considered to be ‘at risk’. If you have become
overweight, smoke cigarettes and get no exercise, then you have a much
greater risk. If you are a male, then you should add in your prostate
screen, the PSA blood test.
By the time you pass 60, then it is
prudent to check everything from head to toe. Really! If you are having any
doubts about your health, then it might be worth the indulgence.
If you have been having some symptoms
of ill health, or have a poor family history, then discus these with your
doctor before deciding which check-up package and add-ons you should have.
The important factor is to get into the habit of regular check-ups. Your
family will thank you.