More commonly prescribed medications that cause weight gain include oral diabetic medication, medications from the ‘beta blocker’ class and the injectable progesterone containing medication such as the contraceptive ‘Depoprovera®’. In my experience, weight gain with Depoprovera® is almost inevitable, as a consequence of progesterone’s role as an anabolic ie tissue building, hormone. The Product Information for Depoprovera® warns of weight gain of several kilograms. The class of medication known as beta blockers are no longer on the ‘preferred’ list for blood pressure control because of their tendency to slow body metabolism, decrease exercise capacity and therefore lead to an increase in weight. Atenolol (Tenormin®, Noten®) is a commonly prescribed beta blocker. Beta-blockers are named as they block the ‘beta’ receptor which is one of the ‘receptors’ for the Adrenaline. Cortisone containing medications such as prednisolone (Solone®) are well known for causing weight gain. If taking any of these medications on an ongoing basis a weight management plan should be in place.

*Please click here for the abstract.

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Most people know to avoid ‘saturated’ fats. ‘Saturated’ is a chemical term referring to the structure of the fat molecule and including fats which are solid at room temperature such as butter and other animal derived fats. In contrast, ‘unsaturated’ fats the ‘fats’ derived from vegetable and marine sources, although not all vegetable derived oils are ‘unsaturated’. These obviously less desirable vegetable oils include coconut or palm oil (in spite of recent promotion, so check the labels on the packaging!). Another trap, that is now less of a trap because of a change in manufacturing processes, are ‘trans fats’, which are a byproduct when vegetable oils are processed a certain way (the process is called ‘hydrogenation’). Nevertheless, if oils do not state or have a significant ‘trans fats’ component, it may be best to avoid them.

The ‘unsaturated’ oils, which as I said are the preferred oils, include ‘monounsatured’ and ‘polyunsatured’ oils, the latter of which include oils such as linseed (flaxseed), soybean, sunflower, safflower and canola oil and the margarines derived from these oils by processing. Monounsaturated oils include the olive oil which contains ‘oleic acid’. The polyunsatured oils include both the ‘omega 6s’ and the ‘omega 3s’.

So…what is better amongst the unsaturated oils? The omega 3’s, which I would put in the ‘very polyunsaturated’ category, are said to have the cardiovascular benefits and include those from oily fish plus the linseed (flaxseed) oils. Margarine made from canola or soybean also have an omega 3 content, and the amount should be specified on the packaging. Some studies however have not shown a proven cardiovascular benefit. There is ongoing research about the optimal proportions of omega 3 and omega 6 oils in the diet to optimise cardiovascular health, ie avoiding an excessive ratio 6’s over the 3’s. For references:
https://www.nrv.gov.au/nutrients/fats-total-fat-fatty-acids

The omega 3 oils are said to oxidise ie lose their beneficial properties, at normal cooking temperatures especially if not stored in a cool location away from sunlight, and cooking with a monounsatured oil ie extra virgin olive oil, which does not ‘smoke’ until 210 degrees, may be the preferable when selecting an oil for cooking. Linseed oil does contain omega 3s as discussed but must be refrigerated if stored for extended periods or else it becomes rancid.

For an excellent discussion of the omege 3’s, please refer to the National Heart Foundation’s website at:
http://heartfoundation.org.au/healthy-eating/food-and-nutrition/fats-and-cholesterol

*full access to Australian Doctor Magazine content is not available to the general public

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Two to three doses depending on the age, as an intramuscular injection are required over a defined period of time. Children under two years of age should have a dose of paracetamol to reduce the risk of fever. Information on use of the vaccine in individuals over 50 is incomplete, and a decision is best made in consultation with your doctor. The name of the vaccine is Bexsero®. Meningococcal Type B is often abbreviated to ‘MenB’

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I refer to psychologists at the Small St clinic in Hampton, to psychotherapists at Bayside Psychotherapy* in East Brighton and further afield.

A number of well designed online resources and even an App, including mindspot, moodGYM and ‘anxiety online’, are available. A comprehensive list was found here at the Beyond Blue website at the time this article was written. Completing the DASS test, which is a validated questionnaire developed by researchers at the University of New South Wales, will provide a very useful insight into the nature and severity of one’s condition. The easiest way to do this is online, such as at this UK based online DASS site.

*Some of the psychotherapists at Bayside Psychotherapy are not registered for Medicare rebates, but they are fully qualified health professionals. Psychotherapists differ from Psychologists in that they look more deeply into your formative history in order to link it with your present problems.

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Dermatitis can be treated with oral medication and creams, plus of course removal of the cause once identified. Liberal applications of good quality ‘over the counter’ moisturising creams and ointments can also be quite relieving.

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Further information:

• The phone number ie 9521 0352 has not changed.
• You can also contact me by email:
• All consultations continue to be Bulk Billed.
• Click this link here for an interactive map showing the new 4 Willis Lane, Hampton location (NB Willis Lane, not Willis St).

I look forward to seeing you at the new location!

Sincerely

Dr Michael Daly MB, BS GradDip(Integrative Medicine), GradCert(Evidence Based Practice)

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The term “influenza like illness” refers to an illness with similar symptoms to actual influenza but which may or may not be caused be the influenza virus. From a symptomatic viewpoint, without laboratory testing it is often difficult to distinguish between the two. The emphasis here however is on the effect of the influenza vaccine on healthy adults, who arguably are the predominant group in receipt of the influenza vaccine. Explaining these figures, the research indicates that 1 in 40 of healthy adults who are vaccinated will escape the symptoms of an ‘influenza like illness’. To use an example, consider two groups each of 80 people, both randomly sampled at the end of the flu season from the general population, and separated into those that have and those that have not, had the influenza vaccine. If at the end of the flu season 5 people had experienced an ‘influenza like illness’ in the unvaccinated group, one would expect 2 less cases of an ‘influenza like illness’ (ie 80 divided by 40) in the vaccinated group. Similarly, if there were 5 case of actual influenza in the unvaccinated group, one would expect 4 cases (approximately) in the vaccinated group. In closed groups, such as workplace situations, the protection rate could be much higher as we are not referring to randomly sampled situations.

Obviously, statistics alone should not be the sole reason in deciding whether to vaccinate or not. Certain groups of adults and children have been identified as being at increased risk, to the extent that the vaccine is provided free to GP clinics for those in such groups. The list is at available at the Dept. of Health, Victorian Government, viz:

• People who are 65 years of age and over
• Pregnant women at any time during their pregnancy
• Aboriginal and Torres Strait Islander people aged 15 years  and older
• Residents of nursing homes and other long-term care facilities
• Any person 6 months of age and older with a chronic condition predisposing to severe influenza illness that requires regular medical follow-up or hospitalisation, including children aged 6 months to 10 years undergoing long-term aspirin therapy, and people with:
  • cardiac disease
  • chronic respiratory conditions
  • immunocompromising conditions
  • renal disease
  • diabetes and other metabolic disorders
  • chronic neurological conditions
  • haematological disorders
  • Down syndrome and fall under one of the above categories
  • obesity (BMI greater than or equal to 30 kg/m²) and fall under one of the above categories
  • alcoholism requiring regular medical follow-up or hospitalisation in the preceding year and fall under one of the above categories.

Note that healthy children are not included in the above, although the benefit of influenza vaccine  seems greater for children, as reported in a separate Cochrane review, with one in eight being protected from ‘influenza like illness’ and one in twenty eight protected from actual influenza. However, the researchers found no evidence that immunisation decreased the rate of secondary cases (ie as spread to contacts), lower respiratory tract disease (such as influenza pneumonia), the need for prescribed medication, middle ear infection and impact of a socioeconomic nature.

However the research reports no benefit in children under six with the ‘inactivated’ vaccines in use in Australia and raises concerns about the lack of good research into flu vaccine safety. This is particularly relevant given the reporting of over 1700  reactions to influenza vaccine in 2010 over in Western Australia. This resulted in the authorities withdrawing approval for a particular brand of the vaccine to children under 5 years of age (the CSL based ‘Fluvax’ brand). This withdrawal remains in place as at 2014.  Refer to the TGA report Investigation into febrile reactions in young children for more information.

Another concern raised by the authors related to the sources of studies included in their review. Although not confirmed in their current review, reference was made to studies provided by the pharmaceutical industry for a previous review in 2007. The authors reported the industry studies seemed to have more favourable outcomes, and appeared in the more prestigious journals with more citations, than those provided by independent or Government sources, irrespective of their quality or size. Somewhat damningly, the authors concluded that “reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in the light of this finding”.

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So if you are really concerned about minimising the risk of bowel cancer, you can’t rely just on one normal FOBT result. A way around this is to repeat the FOBT on an annual or more frequent basis. Another option is the ‘CT colon’, which is a CT scan of the bowel costing about $300 from various Radiology Services (usually, no Medicare Rebate is available). CT colon will detect polyps above 2mm in size, but cannot determine if they are benign or otherwise. You’ll then need to have the colonoscopy. Its important to note that Colonoscopy itself is not without risk of complications, albeit low. Discuss these with your doctor.

One of the key questions relates to the optimal frequency of colonoscopy screening, if a pre-cancerous lump is found. I’ve seen patients  recalled after only 12 months for what I’ve understood to be simple benign polyps. As with anything, the answer to this lies in the research and guidelines. The National Health and Medical Research Council provides guidelines on this aspect of colon cancer screening. Refer page 10 of this document, as dated December 2011. Therein the guideline is for a five yearly follow up for ‘low risk’ polyps:
“follow-up of patients with one or two small (<10 mm) tubular adenomas, the first surveillance colonoscopy should be performed at five years …. Options for subsequent surveillance are ten-yearly colonoscopy, or FOBT at least every two years”

However, the guidelines do go on to state that timelines may need to be individualised. This means the follow up can be discussed with your gastro-enterologist.

There is a privately run colonoscopy clinic describing describing itself as a Program targeting Bowel Cancer, which some patients are confusing with the offical government ‘National Bowel Cancer Screening Program’. The difference of course is that the former is a privately run fee-based service using colonoscopy as a screening tool, whereas the latter is a government run mass screening Program relying on FOBT as its methodology. Offically, colonoscopy has not been accepted as a mass screening method for bowel cancer but of course it is the gold standard.

Finally, some mention should be made of the risk of bowel cancer. The risk of developing it, as stated in The National Health and Medical Research Council’s Guidelines for the Prevention, Early Detection and Management of Colorectal Cancer (2005) are:

• 1 in 100 at age 50, of developing it over the next 10 years
• 1 in 50 at age 60, of developing it over the next 10 years

I have tabulated more detailed statistics here, for download.

That meshes with informal advice received from a gastro-enterologist some years ago, where it was suggested to have a screening colonoscopy at age 50, then again at age 60. That should dramatically decrease the risk of succumbing to bowel cancer in your 50’s or 60’s. He advised that screening beyond that date is an individual decision, ie he didn’t advocate further colonoscopies purely for screening purposes after that date.

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The alert was sparked by the 35 confirmed cases of Measles in Victoria this year, with 18 of the cases in returned travellers from Philippines, Bali, Thailand, India, China, Vietnam and Sri Lanka. Apparently there is a large outbreak in Manila and much of the Philippines. Note that we are referring to ‘Measles’, AKA ‘English Measles’ as distinct from ‘German Measles’ (AKA ‘Rubella’ – ie the one that causes the birth defects). English Measles causes a rash and a flu like illness.

Children are routinely vaccinated against measles in Australia, via the ‘Measles Mumps Rubella’ vaccine. The childhood vaccination schedule has recently changed, with the second dose now being given at an earlier age than previously.

You can see from Google that Measles Alerts have been previously listed on the Chief Health Officer’s (CHO’s) Health Alerts page, but that particular Alert is not currently there. Here is the document we received today:
IEMML GP Urgent Notifications Measles 20140326

I think it was last Tuesday on ABC 24/7 that I noticed the CHO confirming that GP Measles vaccines stocks, as supplied by the State Government, could be used to immunise adults up to the age of 50. Well, at least some things are still free!

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