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Doctor's Consultation
by Dr. Iain Corness
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Me? Depressed? Not me!
I’m not sure, but I
think there was once a pop song with the line “Big boys don’t cry” in it
somewhere, but that is not important. What is important is that if you
came from a western society, you were probably raised with that dictum.
You probably even picked up your crying toddler son after a tumble and
said, “There, there. Big boys don’t cry. You’re OK.” Correct?
We are all guilty
of promoting this stereotype. The big strong man who protects the weak
and vulnerable woman. Countless movies all follow this theme from “Gone
with the Wind” through to “Mission Impossible III”, so it must be true.
Unfortunately for all those big strong super-protective men out there,
the stereotype is not necessarily true and rigid following of it can be
quite contrary to good mental health.
“Men are far more
reluctant to talk about their emotional vulnerabilities than women,”
says Dr Nicole Highet, a psychologist. “This stigma may be due to the
perception that emotional problems and depression are women’s problems.”
“Men tend to be
action-oriented, so they mistrust feelings and tend to regard emotions
as a sign of weakness,” says Dr Michael Dudley, a psychiatrist and
chairman of Suicide Prevention Australia. “For men, mental illness is
seen as a moral failing, so they bury pain and don’t talk to people
about it. But depression is an illness, not a weakness.”
Depression is an
illness that can strike at any time, even to those normally associated
with dogged masculine determination. Famous amongst these was Sir
Winston Churchill, who guided the UK through the tribulations of WWII,
and who called his depression “the black dog”.
What has to be
understood is that just “feeling down” on its own is not a symptom of
mental illness. We all feel down from time to time, generally when
something has happened to precipitate it, even the death of a family
pet. “We all feel sad from time to time, but depression is an ongoing
sadness that lasts for two weeks or more, with a complete loss of
pleasure in things that were once enjoyed. Some men live with their
condition for months, or even years, and become acclimatized to their
low mood or negativity,” says Dr Highet. “But depression isn’t merely a
passing blue mood or something that someone can ‘snap out of’ without
help. Depression dramatically alters an individual’s body, mood and
thoughts,” she says.
Since men have been
raised not to have public displays of depression, many adopt strategies
to cover the problem, with the common ways being to become workaholics,
risk taking to produce ‘highs’, alcohol and illegal drugs.
“Men often try to
manage their own symptoms,” says Dr Highet. “While this may provide
temporary relief, it only compounds the illness as they are not
addressing the underlying condition. There is also some debate as to
whether the (drug) abuse masks the symptoms or actually causes the
depression. Whichever way, getting help is essential.”
The incidence in
the community is frightening. In Australia, which has a well-developed
reporting system, it is believed that clinical depression is Australia’s
fastest growing illness. The National Survey of Mental Health and
Wellbeing found that one in four women and one in six men suffered from
depression. In 20 years it is predicted that depression will be second
only to heart disease as Australia’s biggest health problem.
The enormity of the
problem has remained hidden, but consider this: Depressed men are four
times as likely as depressed women to commit suicide. Of the over 2,000
suicides in Australia each year, 80 percent are male. There are more men
committing suicide each year than dying on the roads, and almost 50
percent of suicides are males aged 25 to 44.
While the causes of
depression are multiple, and men try to mask their problem, the sad part
is that depression can be treated. Modern pharmaceutical medication is
not ‘mind altering’ but restores the chemical balance in the brain to
allow ‘normal’ thought processes to return.
However, it needs
the men to admit that they might, just might, have a problem!
We have too many
expats with hidden problems. Come and talk with one of our
psychiatrists. They can help.
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Exercise for Health. Does that include sexercise?
Probably the commonest
advice a doctor gives is to lose weight and get some exercise. Does that
ring a bell in your memory? Was that part of the advice after your annual
physical check-up?
Unfortunately, there
seems to be very little real understanding of what exercise should consist
of, how often, what type, how long, and what about sex? For example, I was
reading an article on exercise the other day and it said authoritatively
that one should wear comfortable clothing and socks with the correct size of
non-slippery, shock-absorbing shoes. If this includes sexercise, there are
some strange shoe fetishes out there that I haven’t heard of yet!
However, getting a
little serious, exercise will be good for you, provided that you pick a form
of exercise that is not harmful for you! Now I know that looks as if I have
put my money on both horses in the race, but take that sentence at its face
value. Enough research has been done to show that regular exercise is
beneficial for everybody, in both the physical and psychological aspects,
but, and it is a big ‘but’, all forms of exercise have relative bodily
risks, and this has to be taken into account before you buy a pair of
expensive jogging shoes and tackle a 10 km trot in the middle of the day.
True stories – a medical colleague in Australia took up playing squash when
he turned 50 and dropped dead on the court of a heart attack, and another
acquaintance of mine turned 40, decided he wasn’t fit, bought a bicycle to
ride to work each day and was run over by a bus.
The same article that
advised non-slippery shoes, did have some wise words however. These included
choosing appropriate exercise according to your ability. Never exceed your
limit. Remember that it is not the harder the better. If you have acute
medical problems (such as fever, or pain), stop exercising. If you have
chronic medical conditions (such as hypertension, diabetes, ischemic heart
disease and arthritis), seek advice from your doctor or physiotherapist
beforehand. All of these I agree with. If you are happy to take your body to
your medical advisor when it is sick, take it back to your doctor for advice
on how to tone it up as well.
The other words of
wisdom suggested that for prolonged exercise such as hiking, continually
drink water to supplement the loss of body fluid due to sweating. Do not
wait until you are thirsty. Take appropriate breaks during exercise. Do not
over-exert yourself. Forget about “powering through the pain barrier”. Leave
that for Olympic cyclists.
As well as the form of
exercise, there is the frequency. At least three times per week, 20-30
minutes (or more) is necessary each time, to derive the maximum benefit. And
always remember, if there is dizziness, fainting, shortness of breath, chest
pain, vomiting, nausea or severe pain during exercise, stop exercising
immediately and seek medical advice as soon as possible.
Now I did mention at
the start of this week’s article, the word “sexercise”, and some of you have
been impatiently reading, while nervously fiddling with your expensive
packet of Viagras, Kanagras, Sidegras, Cialis and other lead-in-your-pencil
medications (I draw the line at tiger willy). OK, what about sex? The
advisability of this form of exercise when you have some chronic complaint
(such as hypertension, diabetes, ischemic heart disease, etc.), should be
part of the advice you get from your doctor beforehand. The danger of over
the counter willy stiffeners is that you don’t get advice with them. The
answer is that if you are contemplating ‘performance’ drugs, make sure you
are fit enough to take them! It is not the medication that is the problem,
it is the cardiac exercise that you are not used to that is the problem!
Keep reminding yourself
that in the African jungle you don’t see the old lions chasing the pray.
They leave that to the young lions, so just go easy.
Finally, the learned
article did say “Exercise with friends. Company provides enjoyment, mutual
encouragement and support.” That goes for sexercise too!
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The end is nigh
I read an erudite
article the other day, showing that anti-biotic resistance will breed
“superbugs” which will kill off the inhabitants of this planet in the
next 50 years. Wow! That is worrying. Or is it?
You see, I would
have given more credence to the warning if I hadn’t read the same
predictions 20 years earlier.
Now I am not
denying that the bacteria are changing – they are. But by the same
token, so are we!
When we look at
the efficacy of bacteria, history will show us that 75 years ago,
penicillin was a “wonder drug” initially, until the bugs started to eat
it for lunch. So we developed ampicillin, followed by amoxicillin then
augmentin, and then augmentin plus clavulanic acid. What’s next?
Supermox? (Note to Big Pharma: I thought of the name first!)
The research into
antibiotics went further than the penicillin line and now we have
Cephalosporins, Chloramphenicols, Macrolides, Beta-Lactams, Quinolones,
Tetracyclines and more, with even newer antibiotics being tested right
now.
The reason the
ever-expanding list of antibiotics has come through was the successive
lines began to show that the bacteria were becoming less sensitive to
the antibiotics used.
Perhaps some
information on how we judge antibiotic sensitivity is in order. This is
generally done by taking a swab of infectious (bacterial) material and
smearing it over a container with agar (like a jelly). Next to the
tested swab contents are small amounts of several different antibiotics
and after a couple of days the laboratory technician examines the agar
plate and can see which antibiotic best stopped the growth of the
bacteria. That then is the antibiotic of choice for the infection.
That method of
choosing the best antibiotic for that particular infection unfortunately
belongs to the ideal world. The ideal world we don’t live in! Does the
doctor say, “I’ll send this off to the lab and I’ll get you back in a
couple of days and I’ll write you a prescription.” Yes, and the delay in
initiating treatment? Are you then prepared for the additional costs of
culture and sensitivity?
So in our less
than perfect world, does the doctor have a clinical “guess” and give you
an antibiotic that “should” work to take while you are waiting for the
lab results which you will pay for? Or does the doctor guess, and tell
you to come back if you don’t improve and at that point, the lab
investigation begins? Ah, the clinical dilemma.
Of course there is
the third option, which goes some of the way to the emergence of the
superbugs – self medication. In many SE Asian countries, “prescription”
medication is available OTC (over the counter) and that includes
antibiotics. Is there any way of your choosing the correct antibiotic?
Simple answer, no.
The report
released about the superbugs has made suggestions on ways to combat this
growing threat. It suggests we need to improve hygiene and prevent the
spread of infection.
“Improving hygiene
and sanitation was essential in the 19th century to counter infectious
diseases,” the report said.
“Two centuries
later, this is still true and is also crucial to reducing the rise in
drug resistance - the less people get infected, the less they need to
use medicines such as antibiotics, and the less drug resistance arises.”
For all countries,
the focus will be on the health care systems and limiting the spread of
superbugs in hospitals. Proper hand-washing is key, while it sounds
simple, it could be a huge step forward in combating the rise of the
superbug.
The report also
says there are circumstances where antibiotics are required in
agriculture and aquaculture - to maintain animal welfare and food
security; however, much of their global use is not for treating sick
animals, but rather to prevent infections or simply to promote growth.
In the US alone
more than 70 percent of antibiotics that are important for humans, are
sold for use in animals.
Countries should
also look at promoting the development and use of alternatives to
antibiotics, like vaccines.
“Vaccines can
prevent infections and therefore lower the demand for therapeutic
treatments, reducing use of antimicrobials and so slowing the rise of
drug resistance,” the report said.
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A time bomb in your belly
We hear about IED’s
(improvised explosive devices) every day in the Middle East conflicts, plus
some closer to home, unfortunately. And even more unfortunately some of us
have something similar in our bellies, and that is an AAA which stands for
Abdominal Aortic Aneurysm.
As I have often
pointed out, we doctors love acronyms. I am sure that the education bodies
decreed that the medical course should contain three years of acronyms, as
well as another three years of clinical practice.
So what is an
abdominal aortic aneurysm (AAA)? First off, what is the aorta? The aorta is
the main artery of the body, directly connected to the heart and taking the
vast majority of the blood from that important central pump to the abdominal
organs and the legs. This artery is around 2 cm in diameter.
However, a situation
can occur, whereby the artery begins to bulge and can grow to four or five
times the normal diameter. It is this swelling that is called an ‘aneurysm’.
Being of the Abdominal Aorta, then explains the AAA description. An aorta is
considered ‘aneurysmal’ when it grows more than 50 percent over its normal
size. By the way, aneurysms may occur in any blood vessel in the body, but
the most common place is in the abdomen below the renal arteries (the blood
vessels that provide the blood to your kidneys). Interestingly, aneurysms
are four times more common in men than women and occur most often after
55-60 years of age. Elderly males have yet another aspect to monitor, as
well as their prostates!
The danger of the AAA
comes from the fact that this can burst, like an over-inflated balloon, and
the patient experiences a catastrophic internal hemorrhage. This is
generally fatal. Aneurysm rupture affects approximately 15,000 people per
year making it the 13th leading cause of death in the US. The incidence of
aortic aneurysm increases every decade as the population ages. Fortunately,
early detection and diagnosis is increasingly possible as more sophisticated
medical screening methods become available.
So why does this
aneurysm occur? Aneurysms are caused by a weakening or damage in the wall of
a blood vessel. There are many conditions known to contribute to the
weakening of the artery wall including atherosclerosis (hardening of the
arteries), cigarette smoking, high blood pressure and inflammation or
infection.
Atherosclerosis
(hardening of the arteries) is the most common cause of abdominal aortic
aneurysms. This occurs when substances such as cholesterol, minerals, and
blood cells build up in the walls of the artery, and thus damaging it. The
muscular wall of the aorta weakens and with the pressure inside the artery,
it begins to bulge. High blood pressure may speed up the weakening, but it
is not the cause. Aneurysms also tend to run in families, so there is the
thought that genetics may play a role in who gets an aneurysm. (When in
doubt, blame your parents – for everything!)
There is a strong link
between cigarette smoking and the occurrence of aneurysms. Smokers die four
times more often from ruptured aneurysms than nonsmokers. Aneurysms in
smokers also expand and weaken faster than those in nonsmokers, making this
the one hundred and twenty thousandth good reason to give up cigarettes.
Unfortunately, until
an AAA bursts, there are generally no symptoms to let you know you have one
of these ‘time bombs’ sitting in your belly. The discovery is then usually
during an annual physical, where it can be palpated by the doctor, but by
far more accurate is an ultrasound, which can give exact dimensions, and
thus progressive indication of how rapidly the swelling is growing.
The answer to this is
an operation to replace the swollen, weakened artery, with a suitable piece
of highly expensive ‘garden hose’ of correct length and diameter. This is a
major operation, but once you have had an AAA detected, there is no other
way around the problem. There is also some work being done on encasing the
aorta to contain the swelling, but this is not the usual method of
‘defusing’ an AAA.
You should be lining
up for an ultrasound check every 12 months, after you reach 40 years of age.
When was your last one?
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