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Winter 2010

While you’re YOURS TO TAKE HOME

© iStockphoto.com/daniel rodriguez

Men’s health Organ donation – what it means and why it’s important

Alcohol – when one more drink is one too many

Nutrition – healthy winter warmers

Skiing – staying safe on the slopes


Foreword

Welcome to this Winter edition of While you’re waiting… the magazine that aims to educate and inform you about important health topics while you’re waiting to see your GP. Often, underlying areas of health and wellbeing are overlooked in favour of immediate health problems. For example, the adverse effects of being overweight, smoking and excessive alcohol intake are often ignored until the health problems that stem from these areas becomes a problem.

While you’re waiting… Publisher The Royal Australian College of General Practitioners Managing Editor Denese Warmington denese.warmington@racgp.org.au Editor Nicole Kouros nicole.kouros@racgp.org.au Features Writer Rael Martell Publication conditions The authors and editors are not responsible for the results of any actions taken on the basis of any information neither in this publication, nor for any error in or omission from this publication. The information contained in this publication has been compiled using information from other sources. Any person having concerns about the contents of this publication should refer to those sources for more specialist information and advice. The publisher is not engaged in giving medical or other advice or services. The publisher, authors and editors, expressly disclaim all and any liability and responsibility to any person, whether a reader of this publication or not, in respect of anything, and of the consequences of anything, done or omitted to be done by any such person in reliance, whether wholly or partially, upon the whole or any part of the content of this publication. Published by: The Royal Australian College of General Practitioners 1 Palmerston Crescent South Melbourne, Victoria 3205 Tel 03 8699 0414 Fax 03 8699 0400 ACN 000 223 807 ABN 34 000 223 807 ISSN 1836-6694 Printing Offset Alpine Printing, Lidcombe NSW © The Royal Australian College of General Practitioners 2010. All rights reserved. Requests for permission to reprint articles must be made to the Managing Editor.

While you’re waiting… is printed on PEFC certified paper, meaning that it originates from forests that are managed sustainably. PEFC is the Programme for the Endorsement of Forest Certification schemes. PEFC is an international certification programme promoting sustainable forest management which assures consumers that a forest product can be tracked from a certified, managed forest through all steps of processing and production in the supply chain by a Chain of Custody process.

GPs provide ongoing care to people over time, and play an essential role in health promotion and providing preventive counselling and advice. It is crucial that you give your GP the opportunity to discuss health related topics with you in order to help you get on the right track. An example of this is the way GPs can assist with helping patients to change patterns of excessive alcohol consumption. They can assist patients by discussing the consequences of drinking too much, talking about their options, and referring them to a counsellor or psychologist if necessary. Although GPs can provide advice and support when it comes to lifestyle health factors such as drinking, prevention begins with the individual. The role of your GP is to help you understand the ways in which you can change your lifestyle in order to combat ill health. We have gone one step further with this notion by developing the M5 HEALTH ONLINE tool, which is aimed at getting men to take an active role in focusing on their health and wellbeing. This tool is designed to engage men with a personalised experience that includes targeted health information and interactive risk assessments, coupled with professional ongoing support and advice. In practical terms, small changes in behaviour can make a world of difference. A 30 minute walk around your neighbourhood with your family or friends is a great way to exercise. Make simple changes to your diet such as cutting down on fatty foods and snacks and eating fruit, vegetables and grains instead. Another easy tip is to limit your take-away meals. Weight loss is a gradual process, one that is supported by healthy eating, a balanced diet and moderate exercise. In this edition of While you’re waiting… you will find stories about everyday health issues that give practical information you need to know about topics such as men’s health, alcohol intake, exercising when the weather gets colder and much more. I hope you enjoy this Winter edition of While you’re waiting… and remember to talk to your GP about any health related questions you might have. Dr Chris Mitchell President, The Royal Australian College of General Practitioners


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Men’s health – easy online... A new online health tool – M5 HEALTH ONLINE– is helping men to assess and address their health issues. This new service is confidential and easy to use. It is part of The Royal Australian College of General Practitioner’s M5 Project.

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The gift of life We all know that organ donation can save lives and give quality of life to those who are desperately ill. So why is Australia’s donor rate so low? We discuss organ donation; the myths and facts surrounding donation; and why it is important to let your loved ones know of your wishes regarding organ donation in the event of your death.

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Winning ways Read about a mother-to-daughter kidney donation and how the daughter went on to win a gold medal at the Australian Transplant Games.

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Drinking – are you at risk? Do you need to look at your drinking habits? We discuss safe drinking and where to go if you think you need help?

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Pulling teeth – ouch! Going to the dentist might scare you, but spare a thought for those in days gone by. We look at a very strange dental instrument.

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Staying safe on the piste Preparing your body for a skiing holiday can help you avoid unexpected injury. We give advice on staying safe on the slopes.

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What’s for dinner? Keep your family content with these wholesome, tasty winter recipes.

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Give your mouth a sporting chance Many people who play sport in Australia are lazy about wearing a mouth guard – we tell you why it’s important to wear one.

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Winter 2010

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Book reviews We present a range of both fiction and non-fiction book reviews.

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Men’s health – easy online... The new online men’s health tool, M5 HEALTH ONLINE, is giving men the opportunity to assess their health status and lifestyle risk factors, and if necessary to act to improve their health. The service is confidential and easy to use. It is part of The Royal Australian College of General Practitioner’s (RACGP) M5 Project, which in the latest phase of its development is urging employers to recognise that the workplace is an ideal location for men to learn about their health.

Here’s a brief autobiography from someone you have never met, but try not to quit reading. It could be relevant to you. I have a sedentary job – I’ve been a journalist for almost 20 years, but never of the adventurous or glamorous kind. I don’t risk my life reporting in war zones or spy on the rich and famous to furnish the front pages of the tabloids with news of their infidelities. Most of my working time is spent sitting at a desk in front of a computer – either in an office or at home writing.

However, I’m not a goody two-shoes either. I’m a smoker (three or four cigarettes most days – one after breakfast and a couple in the evening, and for me life without ripe, full fat camembert cheese oozing out of its rind would barely be worth living. While I swim a mile most days, I am no Eamon Sullivan. I swim breaststroke at a sedentary rate, prompting such comments from fellow swimmers as, “Mate, you swim like a nun.” 2

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I take tablets to keep my cholesterol and blood pressure levels down; I will have to do so for the rest of my life. My terrific GP, who makes sure I get regular check ups thinks it’s probably genetic, as both my parents have these conditions. I suspect I am also one of what I believe are sometimes called the ‘worried well’. I have led a relatively trauma free life, I don’t believe I have a stressful job or life outside work, but I can allow day-to-day banalities to prey unnecessarily on my mind. I would hazard a guess, although I should emphasise that I have no clinical background whatsoever and am no public health expert, that I am pretty average in my lifestyle – a mixture of good and bad. In short, I weigh 73 kg and am 1.71 m of ordinariness. Oh, one other thing I forgot to mention. My gender. I am a man. It’s a predicament I share with 49% of the world’s population. One of the consequences of ‘being a man’ is that there is a strong likelihood you don’t think a great deal about your health.

© iStockphoto.com/daniel rodriguez

I’m 45, I exercise most days, the scales tell me that while I’m not overweight I am hovering on the margins. I love my fruit, veg and fish and I don’t eat food like red meat, chocolate or junk food takeaway. I haven’t drunk alcohol for around 6 months after my partner and I decided on a period of abstinence at Christmas last year when it dawned on us that we couldn’t remember the last time we’d had a ‘drink free’ evening.

Also, I used to smoke a lot more – a packet and a half a day throughout my teens – and I used to exceed the two standard drinks per day recommendations. In fact, I don’t believe I have ever been to a pub in my life and drunk fewer than, say, four standard drinks. Going back to my university days I suspect I would have easily doubled that.

Put bluntly, men are pretty bad at looking after themselves and they need all the help they can get. This is why the Government recently launched the first National Male Health Policy and the RACGP launched the men’s M5 Project. Readers of While you're waiting... may remember reading about the M5 Project before (March 2009 edition) but there have been a few developments since then. Now the M5 Project is out not only to educate men about their health and lifestyle but to actively encourage them Winter 2010


What is body mass index?

to change their behaviour. Not having regular GP check ups, having a poor diet, drinking too much, not exercising enough and smoking are all risk factors that can be tackled. It may not sound easy but it is doable and men should not be inhibited about seeking help to help themselves. That is why the M5 Project has launched M5 HEALTH ONLINE: so that men can carry out a personalised health check followed by access to no nonsense, practical advice on where to go and what to do if lifestyle changes Winter 2010

Body mass index (BMI) is used as a guide to a healthy body weight. For adults, it is calculated using a formula of weight in kilograms divided by height in metres squared. For example, I weigh 73 kg and my height is 1.71 m. If I square my height I get a figure of 2.92. If I divide 73 by 2.92 I get a figure of 25. Opinions of the threshold figure for what constitutes being overweight, obese or underweight vary. I looked at a wide range of statistics from various reputable sources including the World Health Organization and the figures I found most commonly cited are these: • BMI above 25 for a diagnosis of being overweight • BMI above 30 suggests obesity • BMI below 18.5 indicates someone is underweight. If you measure your own BMI using this calculation it may well be accurate but it is important not to accept it as the gospel truth of your weight status. There are variables. Your muscularity, your age and the size of your frame can all affect your BMI reading. If you are worried about being either overweight or underweight it is important you discuss this with a health professional.

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are needed. It delivers a number of programs that address stress, exercise, weight loss and smoking cessation. The assessment stays online, meaning it doesn’t end up as waste paper and get thrown away with the exercise bike you were given last Christmas. While M5 HEALTH ONLINE is not currently available to the general public, the RACGP is very keen for employers to subscribe to the service, allowing their employees to get a picture of their health and lifestyle risk factors – the workplace is where the RACGP believes men’s health can really be turned around. “The good health of employees is in the interest of employers,” says Dr Robert McCartney, an occupational physician who advises on M5 and works for Prime Health, an organisation specialising in occupational health. “Healthy workplaces have lower rates of absenteeism and better records of health and safety.”

So what can you expect from M5 HEALTH ONLINE?

First off I clicked on the left hand bar: ‘How Healthy Are You?’ This took me to my personal details: date of birth, weight, height, measurements, occupation, marital status and the like.

© iStockphoto.com/mammamaart

I had a trial run and was very impressed with its simplicity – even for a technological dunce like me it was extremely user friendly.

 Did you know…? 

The Medicare Benefits Schedule Item 717 is a health check for men and women of 45–49 years of age and is available as a once only service for those who have one or more identifiable risk factors that can lead to chronic disease. It should help your GP detect and prevent chronic disease and decide upon health intervention strategies to help you. Speak to your GP about health checks.

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Winter 2010


Next I was asked about any medical conditions. It is only because I take medication that my blood pressure and cholesterol levels are fine so Dr McCartney suggested I acknowledge that I have high blood pressure and cholesterol because these need to be managed. I then filled in my family history – I included elevated cholesterol, high blood pressure, and coronary heart disease and allergies. I was then asked about my smoking status. It is worth pointing out here that tempted as I was to lie to the questionnaire I entered the 2–10 cigarettes per day category. There is, after all, no point in taking part in M5 HEALTH ONLINE unless you are honest with yourself – and the program. Therein lies another of its virtues: the service is completely confidential so no one else needs to know about aspects of your lifestyle that may carry a stigma, such as if you drink too much. On the lifestyle questions you are also asked whether you are planning to change at all and, if so, within what time frame. For example, I said I intended to quit smoking within 1 month which (keep your fingers crossed please) I do. Having said I was a non-drinker I filled in the exercise question and said I do 5 hours per week and that I had no intention of either increasing or decreasing my time spent exercising – I don’t aspire to becoming a panting gym junky and am realistic about my chances of ever having Brad Pitt’s body. When it came to diet I explained that I ate breakfast daily (you are not asked what you eat for breakfast but it is important to stress that M5 HEALTH ONLINE is an ongoing project and by the time you read this it may have evolved), have five or more serves of vegetables, two or more serves of fruit, more than eight glasses of water and that I rarely eat in restaurants or from takeaways. Now time to fill in my stress levels. I hazarded a guess that on a scale of 1–10, where 1 is ‘not stressed’ and 10 Winter 2010

Useful websites beyondblue The national depression initiative addresses issues associated with depression, anxiety and related substance misuse disorders in Australia www.beyondblue.org.au Andrology Australia The Australian Centre of Excellence in Male Reproductive Health www.andrologyaustralia.org National Heart Foundation of Australia Funds cardiovascular research and provides guidelines for health professionals, as well as informing the public and assisting people with cardiovascular disease www.heartfoundation.org.au Foundation 49 An organisation dedicated to improving the health status of men across each decade of life www.49.com.au Cancer Council Australia Advises on the prevention, detection and treatment of cancer, and advocates for rights of cancer patients www.cancer.org.au

is ‘extremely stressed’, I would hover variously around the 5 or 6 mark. I took the plunge and keyed in 6, figuring that I would fill in everything on a ‘worst case scenario’ basis. I answered that I slept fine (I sleep trouble free and find seven hours a night plenty) and explained that I had seen my GP in the past 12 months and had a blood pressure test reading of 130/72. All that was left was to answer were the questions about any interests I have in wellbeing – I listed mental health (I have a close friend who has bipolar disorder) and care of the elderly (I do some voluntary work with older people). It was then just a question of clicking on the submit button and holding my breath. The assessments that appear on the screen are accompanied either with a ‘smiley’ face or a ‘frowney face’. I got more smileys than frowneys but was warned about my smoking and stress levels. Also, my BMI is 25, which is fine but I need to keep an eye on it – above 25 is officially overweight. The magic of M5 HEALTH ONLINE

is that I then clicked on the ‘next’ button and was given a list of programs on stress management and quitting smoking. As far as the former goes, well, it’s my decision but I think I’m ok. As far as smoking goes, I’ll try and go it alone but if I find myself in trouble at least at the touch of a button I know where to go for help. If you are an employer and want a healthier workforce why not provide your staff with access to M5 HEALTH ONLINE? Email m5healthonline@ m5project.com.au

 Want to know more? 

For information on the RACGP’s M5 Project visit www.m5project.com.au For the Government’s National Male Health Policy visit www.health.gov.au/ malehealthpolicy

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The gift of life We often hear about the heroics of public servants such as firefighters and police officers who risk everything to save others. However, there are other, ordinary Australian lifesavers who allow their organs and/or tissue to be transplanted either during their life – live donors or after their death – deceased donors, giving seriously ill people the chance of a future. Last year in Australia there were at least 1300 people who could have potentially benefited from an organ transplant, but fewer than 250 of these people received an organ from a deceased donor. While Australia can pride itself on having one of the world’s highest transplant success rates, it is considerably behind comparable countries in numbers of donors. Less than 1% of people die in hospital each year in an intensive care unit under circumstances (brain dead and being kept alive on a ventilator) that

make them viable as deceased organ donors. For someone who dies after a diagnosis of cardiac death, only tissues (which do not generally require a constant blood supply as a prerequisite for successful transplant) can be donated for transplantation. To put this in context: in Australia, a person is 10 times more likely to need an organ or tissue transplant than to become a donor. The Department of Health and Ageing says that as a consequence of the

 Did you know…? 

• More than 30,000 Australians have received transplants in the past 60 years • For the past 10 years organ donation rates have fluctuated at around 200 donors per year • The first ever heart transplant took place in Cape Town, South Africa, in 1967 • The organisation, Transplant Australia offers the seedling of a specially bred rose called ‘Reflection’ to families of donors to grow in memory of their loved one and as an acknowledgment of the generosity of those who have died and donated.

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low number of donors in Australia, “substantial numbers of people die while waiting for suitable donated organs to become available.” Data from last year shows that in a list of 32 countries, Australia is number 22 in the rate of deceased donors per million of the population. Australia has 11.3 per million, compared with countries such as Spain, which tops the list at 34.4, and the United States which comes third with 21.9. The number of living donors per million of the population is 14.9 in Australia, putting it sixth in a table of 27 countries. The reasons for the low number of deceased donors are complex. The ‘tyranny of distance’ has a particular impact on the practicalities of organ transplant procedures in Australia, says Chris Thomas, CEO of Transplant Australia, the transplant advocacy, awareness and support organisation. To be classified as a potential deceased organ donor, a person must be clinically brain dead, with their body being sustained by a ventilator. Not everyone in such a vast country is likely to die in such circumstances, in close proximity to the necessary medical provision. Chris also says that until recently, with the establishment of the Australian Organ and Tissue Authority, each state and territory was doing things ‘slightly Winter 2010


Tissue donation • Organ transplants are the form of donation which seem to receive most publicity but tissue donation, which also usually occurs after brain death, has a vital role to play in giving people with serious or life threatening illnesses a second chance of survival and prolonged life • Tissue donation can include heart valves, bone tissue, skin tissue, corneas, bone marrow and blood • The majority of donor bone is obtained from living donors and is needed for reconstruction following trauma or cancer and as a consequence of failed joint replacement surgery

In Australia, a person is 10 times more likely to need an organ or tissue transplant than to become a donor

differently’ in coordinating transplant donation. The new authority has a specific remit to establish a nationally coordinated approach to organ and tissue donation and to improve consent rates for organ donation. In addition, people have misplaced ideas about organ donation which make them reluctant to register as donors (see ‘Organ donation: myths and facts’ in this story). Chris says one positive reason that there are fewer donors in Australia is that here we have a relatively low rate of injuries from road trauma accidents and weapons – injuries which can lead to a worst case scenario of someone being brain dead and kept on a ventilator. Winter 2010

While the reasons for Australia’s low donor rate may remain speculative, what is not in doubt is the dramatic impact organ donation can have, whether from a living donor (see our interview with live donor Amy and her daughter Tamaryn who received her mother’s kidney) or a deceased donor. “Put simply, organ donation saves lives,” Chris Thomas told While you’re waiting... Organs commonly transplanted include the heart, kidney/s, lung/s, liver and pancreas. There are many reasons why someone’s only hope for an extended lifespan or improved quality of life is a transplant. Someone could have been born with a bile duct that has failed to develop and need a new liver, or a congenital heart defect requiring a new heart, or they might develop a disease that causes organ failure. Even when a person is considered a suitable candidate on the grounds that they have a condition for which transplantation is considered a viable treatment, there are other criteria that must be met. A potential organ recipient must be willing to accept the risks presented by surgery and the medical treatment that will follow, and be physically and emotionally capable of handling the procedure and subsequent treatment.

• Skin tissue is vitally important in helping the healing of people who have sustained burn injuries • Eye tissue is used in corneal transplantation to replace the clear, dome shaped surface on the front of the eye and can preserve the eye, treat painful diseases or trauma, or improve visibility • Replacing heart valves can help people when their valves malfunction. For example, their valves may not have developed, the valve opening may be too narrow or unable to close completely. This can have serious implications, such as preventing the blood from pumping properly throughout the body • The most commonly transplanted tissue is blood. People who need blood transfusions include accident victims, patients undergoing surgery, organ and bone marrow transplant recipients and those undergoing treatment for leukaemia • Although only 1 in 30 people give blood, 1 in 3 of us will need the aid of a blood donation at some stage in our lives.

 Want to know more? 

For more information on donating blood or to find out your nearest blood donor centre visit the Australian Red Cross Blood Service at www.donateblood.com.au or call 13 14 95

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If you are considering becoming a donor it is vital to discuss this with your loved ones

When successful, it is hard to overstate the dramatic impact that an organ transplant can have on a recipient’s life and while donor rates may be low, Australia can take pride in its success rates – one of the highest in the world. “If I was going to have an organ transplant, Australia is where I would want it done,” says Chris Thomas. In Australia kidney transplant survival rates are around 90% in the first

year and more than 75% in 5 years. Patient survival rates for heart and liver transplantation are 90% in the first year and 85% after 5 years. Pancreas transplants have the highest survival rate of 94% in the first year and 87% at 5 years. Chris Thomas explains that if you are considering becoming a donor it is vital to discuss this with your loved ones. Some research suggests that as many as 78% of people carrying organ donor cards have not told their family or friends they have registered. Next of kin play a crucial role in allowing a transplant to go ahead. If your family members have no knowledge of your wish to become a donor they may decide against the transplant if it is not be something they are comfortable with. It is also important to think about the circumstances of your family should you die and wish to donate. This will be a painful and difficult time for your loved ones when they will be grieving and not predisposed to making tough decisions about a part, or parts, of

your body being removed. Discussing donation before your death is likely to make it easier for them. “It’s important that this isn’t the first occasion that your family are having a discussion about you donating,” explains Chris Thomas. Discussion is key and while if you register as a deceased donor you will never know of the consequences, the opportunity is open to make, quite literally, a life or death decision.

 Want to know more?  www.transplant.org.au

If you have discussed becoming a donor with your family and friends and have come to the decision that you want to become a card carrying donor you can do so by visiting the Australian Organ Donor Register at www.donorregister.gov.au or by calling 1800 777 203

Organ donation: myths and facts • Organ donation is not inconsistent with most religions, including Catholicism, Protestantism, Islam and most branches of Judaism. However, if you are uncertain about your faith’s position on donation you may want to discuss this with a member of your clergy • Health professionals are not permitted to facilitate the introduction or meeting of donor families and transplant recipients. Health professionals are bound by law to forbid the disclosure of identifying information • If you are treated in a medical emergency, the doctor in charge of your care will have nothing to do with your potential status as a donor • You cannot register your legal consent to donate an organ before the age of 18 but you can register your ‘intent’ if you are 16–17 years of age

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• If you donate an organ or tissues, professional expertise can ensure that your appearance after death be arranged in order for an open casket funeral to take place. For example, in the case of an eye donation, an artificial eye is inserted and the eyelids are shut, disguising signs of donation • There is no age limit on organ donation – people in their 70s and 80s have donated their organs. Medical criteria are what determine donor suitability • It is not enough to assume that if you have written in your will your desire to become a donor, or indicated this on your driver’s licence, that it will suffice. You must register your consent to become a donor on the Australian Organ Donor Register

• Brain death is not the same as a coma: a failure to recognise this distinction leads to the misconception that there is a danger that transplant will take place among people who are in a coma from which they may recover • Donating organs and/or tissues is a different issue from donating parts of the body for medical research. Separate and specific permission is required for donated organs/tissues to be used for research purposes. Donations will not be used for medical research unless explicit written permission is given by the next of kin or family. For more information visit www.health. gov.au and go to ‘Organ and tissue donation’ on the ‘Select a topic’ bar Source: www.transplant.org.au/Myths.html

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Winning ways Every 2 years transplant patients from around the world demonstrate their athletic skills while raising awareness of the importance of organ donation. At last year’s World Transplant Games on the Gold Coast, Victorian GP and live organ donor Dr Amy Rothfield witnessed the gold medal winning achievements of her 18 year old daughter Tamaryn, to whom she donated one of her kidneys.

Dr Amy Rothfield “Tamaryn was 13 years old when she received my kidney, which she needed as a consequence of focal segmental glomerulosclerosis (FSGS), a scar tissue that forms in parts of the kidney called glomeruli. “Initially she saw a paediatrician and then a kidney specialist who took a biopsy. When FSGS was diagnosed Tamaryn was put on medication. This was unsuccessful and doctors tried chemotherapy but within 18 months Tamaryn had lost all native kidney function. “She then went on to dialysis. Her diet was severely restricted and her fluid intake restrictions were such that it was unbearable for her. Her quality of life became very poor. “Eighteen months later she was considered healthy enough to receive my kidney. The effect was a dramatic improvement in her health. “The minor discomfort in donating my kidney was nothing compared to the joy of seeing my daughter just get better and better. “Tamaryn had always been a normal, healthy, active individual and after the transplant she took up cycling, badminton and swimming. She took part in the badminton tournament at the World Transplant Games in Thailand in 2007 and it was then that she was encouraged to take up cycling. Later she Winter 2010

Dr Amy Rothfield and daughter Tamaryn Stevens

won a gold medal in the 20 km cycle race at the Australian Transplant Games in Perth in 2008. “Then, last year at the World Transplant Games she won gold in the 15–17 years female category for the 20 km race. “The main aim of the games is to promote public awareness of organ donation. Australia has a poor record of organ donor registration and we need this to improve. It is impossible to overemphasise the new lease of life that an organ can give to a transplant patient.”

Tamaryn Stevens “I started getting ill when I was around 10 years old. The night before the transplant I was feeling very cold. When you are on dialysis you really can’t do very much. Immediately after the transplant I was so much better. I was able to do everything that anyone else can do. “Winning the 20 km cycle road race on the Gold Coast was great. I also got a medal in the backstroke swimming but in a way all that is secondary. It is the event itself and the occasion that makes it such an experience.

“Even when you are in situations when someone is passing you in a race they encourage you and say ‘well done, great job’. “It’s great taking part in a competition where you are part of a community that knows what you have been through and what it’s like to have had a transplant. “People taking part have had all sorts of transplants... like me some have received a kidney, others have had liver, heart transplants, bone marrow transplants... everything. “In the competition there is a great sense of togetherness. We eat together, sometimes we party together. It is not about winning. It is about meeting each other, going to the games. It’s about having fun.”

 Want to know more? 

The Department of Health and Ageing publishes a list of frequently asked questions on the subject of organ and tissue donation. Visit www.health. gov.au/internet/main/publishing.nsf/ Content/health-organ-faq.htm

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Drinking – are you at risk? Drinking alcohol in moderation can be a harmless pleasure – many of us enjoy a glass of wine with a meal or a beer after work with friends or colleagues. However, drinking to excess can result in serious problems for an individual’s physical and psychological health and can also be damaging to loved ones. Alcohol misuse constitutes a major public health problem in Australia. If you or a loved one has a drinking problem it is important to recognise the warning signs and seek help and advice.

Have colleagues at work commented on your frequent drinking, or friends expressed concern about you and your alcohol use? Do you find it hard to relax, or to cope with stress without alcohol? These are some of the warning signs that you may be drinking too much or ‘misusing alcohol’. Alcohol misuse is a serious problem in Australia. Its effects can range from a hangover that impinges on a person’s work or personal life, to fatal road accidents, violent assault and terminal medical conditions such as irreversible liver damage. In Australia, alcohol related harm has been estimated to lead to as many as 65,000 hospital admissions and 3000 deaths annually. One way of assessing whether or not you are drinking safely is to use the internationally accepted concept of a ‘standard drink’. This represents a

measure of alcohol and allows for ‘safe drinking’ to be assessed according to the number of standard drinks consumed. Australian guidelines, endorsed by the RACGP, suggest that both men and women consume no more than two standard drinks per day. For one standard drink, think a can or stubbie (375 mL) of a mid strength beer (3.5%). A can or stubbie of full strength beer (4.8%) contains 1.4 standard drinks, an average restaurant serving of red wine is about 1.6 standard drinks, and a nip (30 mL) of spirits such as whisky, gin or brandy equals one standard drink. A person’s gender, size, metabolism, and whether or not they have eaten can all have an effect on blood-alcohol concentration. There are many consequences for an individual’s health if alcohol is misused. Drinking a large amount on

 Did you know…? 

Evidence exists of drinking vessels for beer dating as far back as 10,000 BC and alcohol was ceremonially offered to the gods by the Ancient Egyptians. Warnings of the importance of drinking in moderation also go back thousands of years.

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you find it  Do hard to relax, or to cope with stress without alcohol?

a single occasion can be toxic, leading in a worst case scenario to seizures, respiratory failure and death. Long term alcohol misuse can lead to cirrhosis of the liver, which involves scarring of the vital organ. For people with cirrhosis, it is vital to quit drinking completely, rather than just moderating their alcohol consumption. It is important, however, to realise that alcohol misuse and alcoholism (in other words, an addiction to alcohol – see Daniel’s story) are treatable. People addressing their problem with drinking tend to go through several stages which include contemplating quitting drinking, or moderating drinking to safe levels, taking action, and maintaining sobriety or safe drinking. Some people who misuse alcohol may, in spite of all their best efforts, relapse but succeed after repeated attempts. If you are worried about yourself, or you think a loved one is misusing alcohol, a GP can be your first port of call. Winter 2010


Daniel’s story Daniel (not his real name) is a university lecturer in Western Australia and is 39 years of age. He misused alcohol for around 20 years. I began drinking when I was 18 and by my early 20s I had a fully fledged problem with alcohol. Outwardly, not much seemed a problem. I was a hard working student who got excellent grades and was in a loving relationship, but every evening without fail I was getting sloshed. Throughout my 20s I was averaging a bottle and a half of wine a night and often more, much more. My girlfriend and friends had commented on it and I was aware it was a problem but something I thought I could deal with later in life. It was only when I was around 33 that things got out of hand. I was knowingly driving over the limit, and my relationship broke down. I was an addict, drinking four bottles of wine a day. I couldn’t function without a drink and hid bottles around the house.

© iStockphoto.com/VMJones

Mark Harris is Professor of General Practice and the Executive Director of the Centre for Primary Health Care and Equity at the University of New South Wales. “People should feel able to talk to their GP in confidence. The GP may want to discuss the consequences of drinking too much, without making a moral judgment about the patient. “These consequences could be, for example, the effect of drinking too much on blood pressure. General practitioners are good at a problem solving approach and talking about the options. However, a person may feel self conscious talking to their GP and there are anonymous helplines that people can call. “It may also be that if someone is drinking very hazardously with a problem that is out of control, a GP can refer them to an alcohol counsellor or psychologist. “It is really important that people with a drinking problem know that there are effective treatments and things that can be done.”

Without a drink I would sweat and shake and be mentally all over the place – really disoriented. I used all sorts of excuses for my behaviour. For instance, I would reassure myself that I was never aggressive and could loosely be called a ‘cheerful drunk’ but I was embarrassing other people who cared about me. I only took action when someone very close to me said, “Daniel, unless you do something our friendship is over. I’m not going to watch you drink yourself to death.” I saw my GP who was very sympathetic. To cut a long story short when a biopsy was taken I discovered I had sustained liver damage but thankfully, not cirrhosis. I was referred to a liver specialist and a psychologist, and with enormous help from friends and health professionals I eventually quit completely. I realised that for me moderation was not an option. Giving up was a really hard experience and I went through appalling withdrawal symptoms. Now I am a different person. Recent tests show my liver is in recovery. I exercise regularly, I eat properly – I used to drink rather than eat. I look like a healthy person and a stranger probably wouldn’t guess my past. If it wasn’t for the help of health professionals and friends who never made me feel like a ‘loser’, I think, without a shadow of doubt, I would have been dead within a couple of years. I either would have died from organ failure or been in some kind of accident. I would encourage anyone with a problem to deal with it as early as possible – don’t leave it as late as I did. And, while there is a stigma surrounding alcohol misuse and alcoholism it is important to remember that you are not in a minority of one. Recovery can sometimes feel like a lonely road but it is one worth taking. I feel human again.

Where to go for help Turning Point Promotes the health and wellbeing of individuals and communities living with and affected by alcohol www.turningpoint.org.au. For 24 hour, 7 days a week counselling and information call 1800 888 236 Alcoholics Anonymous (AA) Australia A fellowship of people seeking to help themselves and others recover from alcoholism www.aa.org.au. Call the national office on 02 9599 8866 for information about local AA services

Winter 2010

Lifeline A support service for people in crisis with valuable links to alcohol support agencies www.lifeline.org.au. Call the 24 hour counselling line on 131 144 beyondblue Works to address issues associated with depression, anxiety and related substance misuse disorders in Australia www.beyondblue.org.au. Call beyondblue information line 1300 224 636

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Smarter Diabetes Management for a Digital Lifestyle


ADVERTORIAL

Service is a new healthcare capability

What do Patients say about MyGlucoHealth Wireless

being offered by Telstra throughout

Telstra User:

The Diabetes Management Online

Australia. The Diabetes Management Online Service uses the MyGlucoHealth Wireless meter in combination with a real-time online data collection network to upload and manage patient blood glucose readings using a mobile phone.

Test, Upload, Manage… Live The Diabetes Management Online Service connects with the MyGlucoHealth Portal at www.myglucohealth.com.au so patients can wirelessly upload and evaluate their daily readings while communicating those same results automatically to their clinician. This allows the clinicians to stay up-to-date on their patients and intercede if needed. The heart of the solution is the highly accurate MyGlucoHealth Wireless meter, the world’s first integrated Bluetooth®-enabled blood glucose meter. With rapid testing results available in 3 seconds, smallest blood sample size (0.3µL) and automatic coding of test strips, MyGlucoHealth is the most technically advanced diabetic patient care product on the market today.

Part of a Connected Care Community The Diabetes Management Online Service is more than just an advanced meter, with convenient operation and rapid results, it gives patients direct control over their care and enables clear lines of communication with their care providers. The MyGlucoHealth Portal is an extensive communication and data management web site that provides an easy-to-use interface for automatically collecting test results from the meter. Stored results are transmitted by mobile phone using Bluetooth to the secure Portal for posting. The direct upload process eliminates manual logging of results, improving accuracy, providing better access to critical data and removing the opportunity for inaccurate entries.

“This BSL (blood sugar level) system is simply excellent. I am testing myself much more often as the lancet prong is painless, and the device is simple and easy to use - but a little bulky. I enjoy transferring the information via the phone online, and the website is easy to navigate and very functional. Although I was only diagnosed with diabetes nearly a year ago, I have not managed to get a handle on the BSL’s until recently. It’s a constant learning process, working out what affects me and how badly. MyGlucoHealth has inspired me to be much more vigilant with my self-testing and in turn has enabled me to get a better handle on the disease. Everyone I have told about this system immediately grasps the benefit and ingenuity of this product.”

Teenage Patient: “There are so many simple things I love about this meter. I love only waiting 3 seconds for the result, especially when I’m exercising. I also love, love the strip release button and how little blood is needed on the strip. The lancing device is really cool, because it looks like a pen and I don’t have to pull anything back. I just have to click it.”

Parent Of Teenage Diabetic: “… even if she (the patient) were on a trip away from home and was having difficulty with control, as long as her mobile phone had coverage, she would be able to send the data to the web and call her normal doctor from across the country to make adjustments and help her manage her condition. This would keep her from having to go into a new doctor or an emergency room where they know nothing about her health history.”

Visually Impaired User: “The MyGlucoHealth meter requires such a small sample that I am able to test easily without multiple needle pokes. I am able to test and upload the results independently, without the aid of another person. My doctor is very impressed with the ability to look at my records from his office and make recommendations.”

Active Mother of Two: “Results in 3 seconds! I really like the strip release and ability to download and have all of my data so neatly recorded.”


ADVERTORIAL

Take Ownership of Your Disease On the Portal, readings are charted and interpreted in a number of ways to best analyze and evaluate blood glucose data so the patient can feel confident that they are effectively managing their day-today care. The Portal is designed to help patients take “ownership” of their disease, so they can make healthy lifestyle choices.

Reminders, Messages & Alerts – You’re Not Alone in Managing Your Health MyGlucoHealth allows patients to send themselves or their caregivers alerts and reminders about their changing condition. It can also remind them to test or take medication. Alerts and reminders automatically are sent by SMS text message or email. Each patient can create personalized high or low “threshold” settings for blood glucose. The Portal monitors results and sends an alert to the patient, their family, clinician or caregiver when the threshold is exceeded. In addition, patients can send related health information and secure messages directly to their physician and schedule appointments online using the Portal.

Diabetes - The Statistics In Australia the number of new cases of diabetes each year would fill the Melbourne Cricket Ground: approximately 275 people develop diabetes every day. • The average weight of Australian adults (aged 18-70) has increased by 0.5-1kg per year for the last 20 years. • It is currently estimated that 1.5 million Australians are living with diabetes. It is thought that half of these people are living with undiagnosed type 2 diabetes. • By 2031 it is estimated that 3.3 million Australians will have type 2 diabetes. • Nearly one in four Australians over the age of 25 years has either diabetes or prediabetes.

How to Subscribe to the Diabetes Management Online Service Telstra provides and supports MyGlucoHealth and the Diabetes Management Online Service across Australia to mobile phone subscribers. To use the service, each patient must have a supported compatible Telstra Next G mobile handset. These are listed on the MyGlucoHealth web site. The MyGlucoHealth Wireless meter and other consumables are available online at myglucostore.com.au and at premium retailers throughout Australia. Test strips are available from the National Diabetes Services Scheme (NDSS) for registered participants. The test strips are listed on the current NDSS order form under code 02. More information about MyGlucoHealth is available online at www.myglucohealth.com.au.

• The total number of Australians with diabetes and prediabetes is estimated at 3.2 million. • The cost of diabetes to the Australian community and the individuals affected is significant – government health budgets are impacted to the extent of an estimated $6 billion each year, while people living with diabetes are hit with greatly increased personal health costs. • There are over 950,000 people diagnosed with diabetes registered on the National Diabetes Services Scheme. * *Source: Diabetes Australia


What is that?

Pulling teeth – ouch! In a room rich with an antiseptic aroma, under the control of a drill-wielding figure in a white gown. What will happen once you’re in ‘the chair’? A visit to the dentist has become synonymous with dread... Of course this vision fits an unfair stereotype of the dentist’s surgery and the work of oral health professionals who fill a vital role in keeping Australians’ teeth, gums and mouths in good working order. However, this was not always the case. Consider the instrument pictured on this page. Known as a ‘toothkey’ and probably dated around 1820, it was used to grip onto and remove a tooth. Dr John North, a retired GP and curator of the RACGP’s archive of medical instruments, explains that during this period in history dentists as we know them, with their years of training and expertise, simply did not exist. He admits that even he is not entirely sure how such an instrument would have been used. What he does know is that it comes from an age when anaesthetics would have been nonexistent or, at best, primitive. “The procedure of removing the stump of a tooth using this instrument would have required providing the patient with a lot of whisky,” says Dr North.

Such is the unusual appearance of the toothkey, that Dr North originally speculated that it may have been used during a period such as the Crimean War (1853–1856) as a bullet remover. Alternatively, he says, upon inspecting the toothkey, it could feasibly have been used to reduce a dislocated finger. However, having established that it was used for removing teeth, Dr North points out that it would only have had the facility to do so if there was room within the mouth for the end of the instrument (the semicircular part of the instrument that you see pictured here) to surround the tooth. It is this that prompts Dr North to speculate that it would have been used to remove the isolated stump of a tooth, whether this was an incisor, a canine or any other kind of tooth. Once surrounded with the end of the instrument the handle would have been turned and the root or stump fixed. And then, rather like a corkscrew, a swift pull would have withdrawn the unwanted remnant of the tooth.

Toothkey dated around 1820

“Of course, I am speculating as to how this toothkey would have been used. Perhaps patients reading this magazine in the waiting room may want to use their own imagination as to how it worked!” says Dr North. Now, there’s a challenge. But if it is one you would rather not take up, we quite understand. Elizabeth Bennion’s fascinating book Antique Medical Instruments, published by Sotheby’s Publications 1979 and University of California Press 1980, was a useful source for this article.

 Did you know…? 

In the famous Western Gunfight at the OK Corrall, Kirk Douglas plays John Henry ‘Doc’ Holliday. It is no coincidence that the character was nicknamed Doc because in real life, Holliday first studied and successfully qualified as a dentist in Philadelphia before he became a professional gambler and famous gunslinger. Often considered the first and one of the greatest novels ever written, Don Quixote contains many knowledgeable references to dentistry and oral health and has led critics to speculate that the father of its Spanish author, Cervantes, was a 16th century dentist.

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Winter 2010


Staying safe on the piste

© iStockphoto.com/Shawn Gearhart

With the arrival of winter some of us may be heading for a well earned break to ski country to enjoy the outdoors and engage in some invigorating exercise. Most of us are aware of the hazards of skiing when it comes to falls and collisions, and the bruising, breakages and worse that can be a consequence of skiing. However, like all sports, a lack of preparation can lead to other ailments and injuries such as muscle soreness and cramp. Not only will adequate preparation help you to avoid injury but it will make your holiday all the more enjoyable. The health club group Fitness First warns that skiing can be an extremely taxing sport and take its toll on your body. Preparation is key and it is necessary to start getting your body ready for a skiing holiday with a training program beginning 6–8 weeks before you set off. • Improving your cardiovascular fitness boosts your endurance levels and allows you to ski for longer Winter 2010

• Lower body conditioning will prepare you for the specific type of dynamic movement that is involved in skiing • Balance is a key element of skiing and to ensure that this is up-to-scratch use swissballs or dura discs to improve your balance and stability • Use weights to build up your muscle strength if you want to ski for lengthy periods of time. You can’t expect your body to cope without a struggle if you don’t prepare and want to comfortably ski all morning and be back on the slopes after lunch • Interval cardiovascular training will mimic the on/off activity that skiing involves • Remember to rest while you are undertaking a training regimen – you need time to recover even during your preparation • Last, but not least, ski safely and have a great holiday!

 What is…?  borborygmus bor-buh-RIG-muhs noun: A rumbling noise caused by the movement of gas through the intestines idiopathic id-i-o-path-ic adj: Used to describe a disease or disorder that has no known cause megalopodia meg-al-o-po-de-ah noun: Abnormally large sized feet oögamy o-o-gam-e noun: The process of union of dissimilar male and female sex cells acritochromacy uh-KRIT-o-kro-muh-see noun: Colour blindness trichotillomania trik-o-til-o-ma-ne-ah adverb: Compulsive hair pulling myiasis mi-as-is noun: Infestation of the body by larvae of flies

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Nutrition

What’s for dinner?

Tomato and butter bean soup with toast Serves 4 PREPARATION TIME 15 minutes COOKING TIME 20 minutes

1 tablespoon extra virgin olive oil 1 red onion, peeled and finely chopped 2 cloves garlic, peeled and finely chopped 1⁄2 teaspoon chilli powder (optional) 2 x 400 g can reduced-salt chopped tomatoes 2 cups salt reduced chicken or vegetable stock 1 x 400 g can butter beans, drained and well rinsed 1⁄4 cup basil leaves 2 tablespoons parmesan shavings 1 teaspoon sugar freshly ground black pepper

Heat the oil in a large saucepan over a medium heat then add the onion and cook for 5 minutes or until soft. Add the garlic and chilli powder (if using) and cook for a further minute.

Toast 2 small multigrain rolls cut into 8 slices olive oil spray

Add the butter beans to the soup and cook for 3 minutes to heat through, then stir in the basil leaves and serve in bowls. Top with shaved parmesan and serve with the toast.

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Pour in the canned tomatoes and add the sugar and black pepper and cook for 5 minutes uncovered.

Nutrients per serve Energy

824 kJ

Energy

197 kcal

Total fat

7.2 g

Saturated fat

1.5 g

Monounsaturated fat

3.8 g

Polyunsaturated fat

1.1 g

Protein

8.4 g

Carbohydrate

24.4 g

Fibre

6.9 g

Sodium

728 mg

Cholesterol

3.1 mg

Add the chicken stock and bring the soup to the boil then reduce the heat and allow to simmer for 15 minutes uncovered. To make the toast heat a barbecue or grill pan until very hot. Lightly spray the bread slices with olive oil spray and place on the grill for 2–3 minutes on each side or until golden and grill marks are visable. Place the toast on a plate and cover with foil to keep warm.

These recipes from Real Food are printed with permission from the National Heart Foundation of Australia. For more information or resources, please contact the Heart Foundation’s Health Information Service at 1300 36 27 87 (local call cost) or health@heartfoundation.com.au. Healthy food need not be boring. Real Food, the inspirational cookbook from the Heart Foundation, has 55 stunning recipes from fresh ideas to family favourites and also provides practical heart health information.

Winter 2010


Tuscan apple cake Serves 12 PREPARATION TIME 15 minutes COOKING TIME 45 minutes 2 large eggs 1⁄4 cup caster sugar 200 g plain flour 2 teaspoons baking powder 2 teaspoons grated lemon zest 2⁄3 cup low fat milk Nutrients per serve Energy

698 kJ

Energy

167 kcal

Total fat

1.3 g

Saturated fat

0.4 g

Monounsaturated fat

0.5 g

Polyunsaturated fat

0.2 g

Protein

4.1 g

Carbohydrate

35.2 g

Fibre

3.0 g

Sodium

37.4 mg

Cholesterol

94 mg

800 g golden delicious apples, peeled, cored and thinly sliced 1⁄4 cup demerara sugar

Preheat the oven to 180°C (160°C fan). Lightly spray a nonstick, 22 cm springform tin with oil. Dust with a little flour, shaking out excess. Set aside. In a large bowl, whisk the eggs until pale, add the 1⁄4 cup of caster sugar and beat in well. Whisk in the flour, baking powder and lemon zest, then slowly whisk in the milk. Set aside for 15 minutes. Pour the batter into the prepared tin, then arrange the apples on top, pressing down so all the apples fit. Sprinkle the top with demerara sugar and bake for 45 minutes or until a testing skewer comes out clean. Cool in the tin on a wire rack for 5 minutes. Run a knife around the edge and release the spring. Place on a platter and serve warm or at room temperature. Dust with icing sugar.

Baked meatballs with mozzarella Serves 12 PREPARATION TIME 15 minutes COOKING TIME 45 minutes 2 slices Italian-type bread, crusts removed, soaked in low fat milk 500 g minced lean beef 1 large clove garlic, finely chopped 15 g freshly grated parmesan, plus 15 g extra, for the top 1 teaspoon grated lemon zest 1 tablespoon chopped fresh oregano leaves 2 large eggs 1 tablespoon extra virgin olive oil 400 g can reduced-salt diced roma tomatoes, with juice 2 cups fresh basil leaves, roughly torn 50 g shredded reduced fat mozzarella 500 g steamed savoy cabbage wedges, to serve 6 cups cooked risoni (rice shaped pasta), to serve freshly ground black pepper

Winter 2010

Nutrients per serve Energy

1800 kJ

Preheat the oven to 200°C (180°C fan) and spray an 8-cup ovenproof dish with olive oil spray.

Energy

431 kcal

Total fat

13.9 g

Squeeze the bread to remove milk and combine in a bowl with the mince, garlic, 15 g parmesan, lemon zest, oregano and eggs. Season with pepper, make a little patty and fry to check seasoning.

Saturated fat

4.9 g

Monounsaturated fat

6.1 g

Polyunsaturated fat

1.2 g

Protein

31.7 g

Carbohydrate

44.3 g

Fibre

7.1 g

Sodium

311 mg

Cholesterol

125 mg

Shape the mixture into balls and refrigerate to firm up, if time permits. Heat a heavy based frying pan or casserole over moderately high heat, add the oil and when hot but not smoking, add the balls. Cook until golden brown on all sides, shaking the pan frequently. Add the tomatoes and cook until the sauce slightly thickens. Stir in half the basil. Transfer the mixture to the prepared dish and cover with the mozzarella. Tuck in the basil here and there and scatter with the extra parmesan. Bake 20 minutes, or until the cheese is golden and the filling is bubbling. Serve with steamed savoy cabbage wedges.

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19


Give your mouth a sporting chance Every year people suffer a range of injuries to their teeth and jaws because they do not wear mouthguards when participating in sport. Research in Victoria shows that 2000 dental injuries were treated in the state’s emergency departments over 2 years with those under 25 years of age most at risk. Some of these included dental injuries from taking a knock to the head or face when playing sport.

Such injuries can leave a person with tooth loss or a damaged tooth which can lead to a lifetime of expensive dental care.

“Be smart on the sports field by wearing a custom fitted mouthguard. Investment in a properly fitted mouthguard, made to suit an individual’s mouth, is a smart choice when you look at the associated cost of repairing damaged teeth,” says Dr Hewson. He also emphasises that custom fitted mouthguards should be worn both in training and in competitive matches. For information and fact sheets on mouthguards and tooth protection visit www.mouthguardawareness.info

© iStockphoto.com/Kolbz

The Australian Dental Association (ADA) says that wearing a custom fitted mouthguard when playing contact sports can reduce the risk of injury to the mouth.

mouthguards should be mandatory in “any sport where the mouth or face could be injured.”

Research suggests that with the exception of hockey players, those taking part in sports in which a risk of injury to the mouth is likely, are bad at wearing mouthguards. President of the ADA, Dr Neil Hewson says that

Topping your morning cereal with raspberries or choosing kale over spinach as a vegetable side dish for lunch or your evening meal could have health benefits. We all know how important it is to have a diet rich in fruit in vegetables and it is easy to focus on widely available fresh products such as oranges, grapes, carrots, tomatoes and other healthy old staples. But while researchers emphasise the health benefits of including these staples in our diet, they point out that some other less widely consumed fruit and vegetables provide a more concentrated source of nutrients contained within plants – sometimes called ‘phytonutrients’. For example, sweet potatoes, fresh papaya, kale, raspberries and blueberries have more of certain nutrients than carrots, oranges, spinach, strawberries and grapes and there can be health benefits to eating a variety of phytonutrients.

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While you’re waiting…

Winter 2010

© iStockphoto.com/Lew Robertson

 Did you know…? 


Work And mentAl heAlth Mental health conditions affect one in five people in any given year. Almost half of the population experiences a mental health condition (including stress and depression) at some point during their lifetime. Some people fall out of paid work as a result.

Discuss these issues with your GP. Your GP may be able to help you discuss them with your employer.

Assistance available z

JobAccess is an information and advice service that offers practical workplace solutions for people with mental health conditions or disability and their employers. JobAccess includes a comprehensive website and a free telephone information service where you can access confidential, expert advice on all disability and mental health employment matters. Visit www. jobaccess.gov.au or phone 1800 464 800 and speak directly to a JobAccess Adviser.

z

The Work and your mental health brochure will give you some tips about planning your return to work including simple adjustments to the workplace or to your role. Ask your GP about the brochure or download a copy from www.jobaccess.gov.au

Paid work can be good for your mental health. It can provide you with a sense of purpose, routine, social contact and financial independence. Even people with mental health problems that are often attributed to work can benefit from an early return to work. The longer you are out of paid work the harder it is, and the less likely you are, to return to work. Long term sickness-related absence or unemployment is harmful for physical and mental health and wellbeing and can contribute to a sense of social isolation. Talk to your GP about the role work can make in your recovery. You may need to make a decision about your employment goals. There are a number of things to think about when you decide to find a job or return to work:

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Employment Assistance Fund provides people with mental health conditions and their employers with easier access to resources to assist with finding and maintaining employment. This can include workplace modifications.

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people with mental health conditions who have been placed in work but need additional support.

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Manage your stress early before it becomes overwhelming.

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Work and your mental health Sane australia

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Work and your mental health


WYW book reviews… The Hidden Journey – Melanoma up Close and Personal

Fighting Cancer with Knowledge & Hope A guide for patients, families & health care providers

Christine Lister Melbourne: Brolga Publishing, 2008, $24.99 This story is taken from Christine Lister’s personal journal, recounting a period of turmoil and upheaval when her husband Rex was diagnosed with melanoma. Over a period of a few years, Rex goes through many operations, gets better, and gets sick again. Their story is very personal and emotional, and it sometimes feels as if you are prying into the couple’s privacy. It is also informative and factual. Lister uses descriptive medical terms for melanoma and its symptoms so that the reader can understand what Rex’s illness means to his health and wellbeing. This is a sad tale that draws the reader into both Christine and Rex’s pain. Despite Listers’ attempt to be humorous and honest, at times the book is almost too sad and repetitive with the cycle of pain. Christine and Rex’s love for each other is strong – making the journey that much sadder. Christine struggles to stay brave and not drown in misery and fear. This book is informative and purposeful, it will certainly appeal to your emotions and takes more than few sittings to read – it is quite intense.

Rebekah Prendergast, Brisbane, Qld

Richard C Frank Melbourne: Black Inc, 2009 $29.95

Reading by Moonlight Brenda Walker Hamish Hamilton, 2010, $29.95 When Brenda Walker, Professor of English and Cultural Studies at the University of Western Australia, was diagnosed with breast cancer in her 40s she experienced ‘uncontrollable waves of dread’, and felt ‘demolished, stupid with grief and fear’. In Reading by Moonlight, she describes how crucial literature was during her illness. “Write, my books were telling me. Live,” she says. When preparing for surgery she chooses to take with her Samuel Beckett’s Malone Dies – the title of her novel is a reference to the character of Malone, who seeks comfort in the constancy of the moonlight as he slowly dies. For Walker, books provided such constancy. Dante, Tolstoy, Nabokov, Poe and Dickens take their place alongside Beckett as companions during her illness. However, this is far from a morbid book. Walker has a laconic sense of humour, and uses her reading and meditation upon her illness to point out human denial of death’s omnipotence. Walker’s account of her illness remains optimistic despite the honesty about her brutal experience with breast cancer. Ultimately, however, hers is a message of hope.

The term cancer engenders great fear, and when I learnt of my cancer it was totally unexpected and discovered by chance. Many books later I have found a book that simplifies the medicine and science related to cancer, allowing patients and families to make informed decisions about treatment and care. Reading this book, one comes to understand that no two cancers are exactly alike. The author’s goals include introducing an appreciation of what cancer is and how it grows, how oncologists determine treatment for each patient and what different treatment strategies may be, as well as how to visualise treatments at work in the body. He also writes about how to cope with a poor prognosis, facing fears of chemotherapy and the distinction between chemotherapy and newer targeted medicines. Some detailed explanation of the behaviour of cancer in the body, how different cancers are staged and how oncologists estimate curability is given earlier in the book. This book is written with a great amount of compassion and I would recommend it to patients, family, friends, and cancer support groups.

John Field, Adelaide, SA

Rael Martell, Melbourne, Vic 22

While you’re waiting…

Winter 2010


Towards Parenthood Preparing for the changes and challenges of a new baby Jeannette Milgrom, Jennifer Ericksen, Bronwyn Leigh, Yolanda Romeo, Elizabeth Loughlin, Rachael McCarthy, Bella Saunders Australia: ACER Press, 2009 $34.95 Being pregnant has definitely been one of the most exciting times of my life. Reading everything and anything about pregnancy, I have been overwhelmed by how much there is to learn, but I have found that only a few books deal with the emotional changes and issues you need to address when becoming a parent. Towards Parenthood is more than a book, it is a ‘workbook’. As well as many of the ‘hot’ topics for new parents: sleeping, feeding, settling and crying, it helps upcoming parents to think about many of the emotional and practical issues they are about to face.

It guides both mother and father through thinking about the changes, the feelings and the possible stresses. You are helped to identify the sort of parents you want to be and to look at how your own childhood influenced your attitudes. The book provided a great ‘at home’ counselling session, helping us talk about the way we both want to bring up our child and by doing this we also learnt things about each other that we probably would never have thought to talk about. I loved the chapter ‘Caring for yourself is caring for your baby’. There were techniques to help reduce tension and

to reassure new mums that it’s okay to feel worry and stress. Other chapters look at keeping balance in your life and how to maintain a healthy point of view. The book asks you to use a six step process of problem solving and the lists and tips reminding couples how to help each other were great. Towards Parenthood is the sort of book you can use as a reference tool. It’s a great way for parents to get closer emotionally.

Emily Jenkins, Viewbank, Vic

Baby on Board Understanding your baby’s needs Other chapters cover how evolution in the first twelve months Howard Chilton Australia: Finch Publishing, 2009 $29.95 Baby on Board is a great practical baby book for expecting parents. Its topics are medically technical, sensible, informative and in some instances inspirational. The topics cover what a baby needs and the experiences in the first 12 months of life, and what parents should know in dealing with these experiences. Examples include settling your baby, breastfeeding your baby, and common baby medical matters such as nappy rash and cradle cap. Part two, entitled ‘Interesting Information’ delivers just that.

Winter 2010

designed our babies and how babies subjugate parents – immunisation is another section of great interest. However, I would have preferred to see a more objective approach around this matter rather then just a straightforward Western medical approach, especially in today’s time where immunisation has become such a controversial topic. The book’s content is supported by its design, and the topics inspire wonder, hope and at times, good humour. The book is original in style, is distinctive and expressive, and the presentation is engaging throughout. Dr Howard Chilton has proven that even in today’s times, a book about babies can be written in a fresh new way which will maintain parents’

interest – and not only first time parents. This book is easy to follow and should appeal to many readers. I’ve become a fan.

Fay Samaras, Melbourne, Vic

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23


WYW news file Incontinence continues in first time mothers

New research suggests that men and women heading for foreign destinations may be prone to different types of diseases associated with travel.

A recent Spanish study found that among more than 1100 first time mothers almost 40% reported urinary incontinence or urine leakage while 10% experienced anal incontinence, which includes passing wind or stools during pregnancy.

Clinics from around the world, including Australia, contributed to Swiss-led research that looked at almost 60,000 patients and found that women travellers are more likely than men to contract diarrhoea, irritable bowel syndrome, upper respiratory and urinary tract infections, psychological stress, oral or dental conditions, or adverse reactions to medicine. However, they are less likely than men to get ‘febrile illnesses’ (fevers), malaria, sexually transmitted infections, viral hepatitis or noninfectious problems including cardiovascular disease, acute mountain sickness and frostbite. Women are better than men at obtaining advice before travelling, and researchers found that female travellers who become ill are less likely to be hospitalised than males. If you are reading this and are planning a trip abroad, remember to speak to your GP who can give you advice on health measures to take for travel.

Medicine doses now easier for non-English speakers If you have a friend or relative who would have difficulty reading this, the chances are they would also have problems reading instructions on prescribed medicines they receive. Webster-paks give instructions for daily doses of medications – ‘two tablets to be taken daily at breakfast’. Instructions are now available in 20 languages for patients with low English proficiency. If you, a friend or a relative wants a multilingual Webster-pak, your pharmacist should be able to provide one. If your pharmacist does not have access to the language you need they can call 1800 244 358 to get their hands on the appropriate multilingual Webster-pak. 24

While you’re waiting…

These women were also more likely to have symptoms of incontinence 7 weeks after giving birth than women who did not display symptoms during pregnancy. Overall, 16% of women in the study had urinary incontinence 7 weeks after giving birth and 7% had anal incontinence. However, the researchers emphasise that there are ways to reduce the risk of incontinence. These include avoiding disproportionate weight gain during pregnancy – in other words, gaining only the recommended number of ‘pregnancy pounds’. Pelvic floor exercises can also lower the risk of pregnancy related incontinence and may be something you wish to seek your GP’s advice on.

Suicidal people urged to seek help The charity beyondblue has used new figures on suicide rates from the Australian Bureau of Statistics to highlight the help available to people at risk. Suicide deaths have tended to be underreported in the past but a new means of analysing data by the ABS reveals that in 2007 there were 2054 deaths by suicide, an increase of 173 from earlier figures. In 2008 there were 2191 deaths by suicide, with three quarters of these accounted for by males. Leonie Young, CEO of beyondblue, says every depression related death is ‘one too many’. “Effective treatments are available and more services are now accessible across the community,” she says. She has called for an end to the stigma surrounding mental illness and to urge people who are depressed or suicidal to seek help, which is available ‘24/7 through national agencies’. If you are feeling depressed or suicidal you can discuss this with your GP. Also, for more information about depression

and anxiety, and related disorders as well as treatment advice and direction on where to seek help, visit www. beyondblue.org.au or call the charity’s information line on 1300 22 4636. The charity SANE Australia has produced a practical guide to help people who sometimes feel suicidal. Drawing on people’s personal experiences with suicide, the guide includes information on creating a ‘crisis plan’ so people can prepare what to do and who to contact if they feel they are a danger to themselves in the future. The SANE Guide to Staying Alive is available from the online bookshop at www.sane.org or by calling the SANE helpline on 1800 18 7263 (cost $15).

Parents underestimate children’s weight Apparently parents’ perceptions of their healthy children’s weight status have a high degree of accuracy, but this is not the case with parents of overweight or obese children, say Australian researchers. A study of more than 3040 children and adolescents of 5–17 years of age were recruited from the Healthy Kids Queensland Survey. Parents’ perception of their children’s weight status was obtained for the children under 12 years of age, and the adolescents self reported their own weight status. Using the body mass index (BMI) measure, just over 20% of parents underestimated their child’s weight status – only 1% overestimated. Adolescent boys were more prone than girls to underestimate their weight status – girls were more likely to overestimate their weight, says the study in the Journal of Paediatrics and Child Health. Parents of overweight children were more likely to underestimate their children’s weight status than parents of obese children, and less than 50% of parents identified their obese child as ‘too fat’. Winter 2010

© iStockphoto.com/Shawn Gearhart

Travel sickness in men and women


M5 HEALTH ONLINE M5 HEALTH ONLINE is a new online health and wellness program designed to encourage men to access relevant health information and interactive health risk assessments, supported by professional ongoing support and advice. This online tool not only educates men about their health, but also gives them the opportunity to alter their health behaviours in order to help improve their health status. M5 HEALTH ONLINE provides clear and concise information on wellness and lifestyle issues, as well as diseases and conditions. Interactive programs provide help and support if men want to lose weight, get fit, quit smoking, maintain a work-life balance, reduce their stress levels or improve resilience.

ABOUT THE M5 PROJECT

© iStockphoto.com/daniel rodriguez

The M5 Project is a men’s preventive health initiative, managed by The Royal Australian College of General Practitioners. The project aims to encourage men, with the help of those who share their lives, to take better care of their health and to see their GP if they have any health concerns. The M5 Project encourages men to take five key preventive steps to improve their health: 1 Share your family history with your GP 2 Know your healthy weight 3 Check your blood pressure 4 Stop smoking – it’s the only healthy option 5 Maintain a healthy mind and a healthy body.

Talk to your employer or human resources department to consider offering the M5 HEALTH ONLINE program to staff at your workplace. We can tailor a workplace health risk assessment and employee wellness program to suit the needs of your workplace, including onsite health checks. Visit M5project.com.au or call 03 8699 0447 to request a resource kit.


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