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Doctor's Consultation  by Dr. Iain Corness


Update June 25, 2016

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.

Update June 18, 2016

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!

Update June 11, 2016

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.

Update June 7, 2016

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?

HEADLINES [click on headline to view story]

Me? Depressed? Not me!

Exercise for Health. Does that include sexercise?

The end is nigh

A time bomb in your belly