Everyday Medicine with Dr Luke

Medical cybercrime refers to criminal activities involving cyber-attacks on healthcare systems, devices and data. These attacks can range from ransomware and data breaches to the exploitation of vulnerabilities in medical devices, posing serious threats to patient safety, data privacy and the stability of healthcare operations.According to the Office of the Australian Information Commissioner in 2023, the healthcare industry tops the list for cyber-attacks. Healthcare became the most reported non-government sector for cybercrime incidents in FY2023–24 with more attacks than financial services, education and other critical infrastructure industries, highlighting its vulnerability, further ransomware attacks targeting the Australian health sector are growing.Highlighting this point 41% of healthcare organisations in Australia experienced a cyber-attack in 2023. This marks a significant rise in the targeting of this critical sector with a 71% year on year increase in global cyber-attacks targeting healthcare organisations.32% of healthcare cyber incidents involved compromised accounts or credentials, others included malware infections (17%) and compromised network infrastructure (12%).Patients are also concerned, in one survey 82% of Australians indicated they were worried about unauthorised access to personal health records and consider health information security when choosing healthcare providers. 33% said they were “very to extremely worried” about the security of their health information.In December 2022, Medibank, the Australian health insurance giant, was the victim of a major data breach, affecting the personal details of 9.7 million customers. The attack was believed to be linked to a well-known ransomware group based in Russia, the REvil ransomware gang.Eastern Health an operator of 4 Melbourne hospitals subsequently fell victim to a cyberattack causing certain elective surgeries to be postponed at the time. Another notable incident targeted Melbourne Heart Group.Reinforcing these concerns tech giant Microsoft has also stated that the healthcare sector (and aligned industries) is one of the top targets for cyber criminals.Types of Medical Cybercrime include: Ransomware Attacks: These attacks encrypt a healthcare organisation's data, demanding a ransom for its release, potentially disrupting critical services and delaying patient care. Data Breaches: Cybercriminals may steal sensitive patient information, including medical records, financial data, and personal details, for various malicious purposes. Medical Device Exploitation: Vulnerabilities in connected medical devices, such as pacemakers or insulin pumps, can be exploited to compromise patient safety or disrupt treatment. Supply Chain Attacks: Cybercriminals may target the healthcare organisation's supply chain, compromising vendors or partners to gain access to the primary target. Phishing Attacks: These attacks involve tricking individuals into revealing sensitive information or installing malware, often through deceptive emails or websites. Social Engineering: Attackers use psychological manipulation to gain access to systems or information.Impact of medical cybercrime on patient safety, data privacy, financial losses, operational disruptions and erosion of trust cannot be overstated.To explore and discuss this topic in more detail we are joined on this podcast by both Dave Vosnakes and Stephanie Way from The Australian Government National Office of Cybersecurity who provide an expert overview of the growing problem. Please welcome them to the podcast.References:Office of the Australian Information CommissionerAct Now. Stay SecureAustralian Signals Directorate

It is now increasingly recognised that women’s health care needs at menopause have been both under-recognised and under-treated by medical practitioners, and that menopause management has not been emphasised adequately in graduate and post-graduate education. Considering that half the world’s population spend about a third of their lives after menopause, this unmet need must be recognised and addressed. I was curious to explore this subject in greater detail and welcome the opportunity to review some basic science and definitions. Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of the reproductive stage for females. It is often defined as having occurred when a woman has not had any menstrual bleeding for a year.Perimenopause is the natural stage in a woman’s life occurring before the final menstrual period, or menopause, when a woman's body transitions away from its reproductive years. Based on these criteria, perimenopause starts when there are persistent differences in cycle length of seven or more days between consecutive cycles and continues until 12 months after the last menstrual period. During this time, the ovaries gradually become less functional, leading to changes in menstrual cycles and potential infertility.Perimenopause is a time when risk factors for chronic disease need to be considered, including acceleration of bone loss, increase in cardiovascular risk arising from adverse changes in lipids and altered glucose metabolism. Cancer screening programs, including bowel, breast, and cervical cancer should also be discussed with patients at this time.Medical treatment of perimenopause and menopause is aimed at ameliorating symptoms and to prevent bone loss and is centred on the use of menopausal hormone therapy (MHT) with replacement of oestrogens either alone, in the case of previous hysterectomy, or combined with progesterone when the uterus is present.Many of the concerns about MHT raised by older studies are no longer considered barriers to its use in healthy women. The risks arise around discussions of breast cancer, uterine cancer and cardiovascular disease including thromboembolic events and strokes.For cardiovascular disease the evidence pertaining to MHT risk relates to timing and the use of oral rather than transdermal oestrogen. If oral or transdermal oestrogen therapy is initiated within 10 years or earlier since menopause or less than age 60 years, there may be a slightly reduced coronary heart disease risk.With this background I would like to introduce Dr Sugandha Kumar. Dr Kumar is an Obstetrician and Gynaecologist committed to providing comprehensive women’s health care in the south-eastern suburbs of Melbourne.Sugandha did her early specialist training at a prestigious medical institute in India (PGIMER, Chandigarh) and completed her advance training in Obstetrics and Gynaecology in Australia (Monash and Eastern Health). She holds specialist appointments at Box Hill Hospital and has a strong focus on improving outcomes for her patients by offering up-to-date and evidence-based treatment options. She provides obstetric and gynaecological and is expert in advanced laparoscopic surgery including laparoscopic hysterectomy and endometriosis surgery as well as having specialist interest in menopausal hormone therapy. Please welcome Sugandha to the podcast which we will present in two parts.References:Dr Sugandha Kumar : Create Fertility: www.createfertility.com.auhttps://www.thelancet.com/series/menopauseSwan Study : JAMA 2015;175:531–39

A pandemic is defined as a new disease or new strain of an existing disease spreading worldwide. An ‘outbreak’ refers to a localised epidemic – something that affects hundreds, sometimes thousands; an ‘epidemic’ refers to an illness or infection that is in excess of normal, and ‘pandemic’ is an epidemic that occurs over a very wide area, crosses international boundaries, and touches thousands or millions.The enormous health and financial impacts of epidemics and pandemics are made worse through human foibles like fear, denial, panic, complacency, hubris, and self-interest. Experts advise we can end epidemics by facing up to them and by applying concrete actions ensuring, building resilient health systems, fortifying 3 lines of defence against disease including prevention detection and response, and ensuring timely and accurate communication, investing in smart innovation and spending wisely to prevent disease before an epidemic strikes.Pandemics have far reaching effects as we have recently witnessed with Covid -19, and I was curious to reflect on the way we responded to this threat as a community from the psychological perspective. Humans have had to respond to many pandemics over the course of recoded history, notably the so-called black plagues or black death spread by rats carrying yersinia pestis infected fleas hidden within their pelt.A series of black death pandemics dramatically and profoundly affected European and Middle Eastern populations both in the 6–8th century plague of Justinian and 14th–19th century, killing up to half the local population (over 100 million people), but paradoxically bringing about cultural and economic renewal.Before this was a deadly smallpox pandemic called the Antonine Plague during the time of Marcus Aurelius around 160–180 AD, killing an estimated 25–30 % of the Roman population and no doubt far more through Eurasia (between and 5 and 20 million). In the 16 th century between 1545 and 1548, the so called Cocoliztli epidemic in Mexico and Central America, caused by an unidentified pathogen, reportedly killed 5–15 million.Fast forward to 1918 – Spanish Flu caused by influenza H1N1 with between 17–100 million dead, the HIV epidemic responsible for approximately 44 million deaths with fortunately treatments now available, and not forgetting bird flu and swine flu, our most recent pandemic experience with Covid 19 claiming 7–36 million lives.When I came across Dr Robert Kaplans excellent article in the May edition of the GUT REPUBLIC discussing pandemics and the often-flawed human response where fear, emotion and disinformation easily crowd perspective, I was keen to invite him to talk on this subject on Everyday Medicine.Rob is a forensic psychiatrist and clinical associate professor at Western Sydney University, as well as a keen historian and author with a sharp wit and eye for the arcane. His latest book is The King who Strangled his Psychiatrist and Other Dark Tales, but he also has a deep catalogue of publishing including the books Medical Murder: Disturbing tales Of Doctors Who Kill and The Exceptional Brain and How It Changed the World amongst others.He is a sort after speaker and key thinker in forensic psychiatry and serves on the Professional Advisory Panel Victim’s Services. Please welcome Rob to the Podcast.ReferencesDr Robert Kaplan: www. rkaplan.com.auThe End Of Epidemics. Dr Jonathan D Quick. Scribe Publications 2018The Little Book of History. www.dk.com Wikipedia

Molecular pathology combines molecular analysis with traditional morphology and immunohistochemistry to understand disease at its most fundamental level. The field continues to evolve as new discoveries enter clinical practice.Through molecular pathology, our knowledge of genetic mutations and targeted therapies has expanded. It is now rare for a tumour report to omit genetic findings. This discipline, while distant from daily clinical work, underpins treatment algorithms and prognostic models.The ten hallmarks of cancer include: genome instability and mutation, resistance to cell death, sustained proliferative signalling, evasion of growth suppressors, replicative immortality, angiogenesis, invasion and metastasis, altered metabolism, tumour-promoting inflammation, and immune evasion.Normal DNA contains proto-oncogenes that promote growth and tumour suppressor genes that restrain it. When balanced, they regulate healthy proliferation. Mutations in either disturb this balance, driving uncontrolled growth.Germline mutations are inherited and present in every cell, while somatic mutations are acquired, often influenced by smoking, ultraviolet exposure, or diet. When proto-oncogenes mutate, they become oncogenes.The RAS and BRAF oncogenes are key in molecular pathology. RAS controls upstream signalling that triggers cell growth, differentiation, and survival. Mutated RAS genes cause constant activation, leading to excessive signalling. The three RAS genes, HRAS, KRAS, and NRAS, are found in 20 to 25 percent of all human tumours and in 90 percent of pancreatic cancers. The BRAF gene, on chromosome 7, regulates downstream signalling and cell growth. BRAF mutations occur in about 10 percent of colorectal cancers, up to 50 percent of papillary thyroid cancers, and 27 to 67 percent of melanomas.Other oncogenes include MYC, EGFR, and HER2. HER2 amplification is seen in some breast and ovarian cancers. These findings are vital as targeted treatments, such as JAK inhibitors and monoclonal antibodies, act on these pathways. A single mutation can activate an oncogene.Tumour suppressor genes perform repair functions including correcting DNA mismatches, regulating the cell cycle, and promoting apoptosis. As telomeres shorten with age, mismatch repair errors increase. Mutated genes lose this ability, causing abnormal protein synthesis. Reports often describe mismatch repair proficient (no mutation) or mismatch repair deficient (mutation present), particularly in colon cancer.Key tumour suppressor genes include BRCA1, BRCA2, and the Lynch syndrome genes MLH1, MSH2, MSH6, and PMS2. When mutated, they increase the risk of breast, ovarian, prostate, colon, uterine, and pancreatic cancers. While often inherited, mutations can also arise spontaneously or through epigenetic silencing. Each gene has two copies; both must be affected before suppression is lost. This two-hit hypothesis, proposed by Knudson in 1971, explains tumour development with ageing.Methylation, sometimes noted in reports, refers to chemical modification of CpG (cytosine-phosphate-guanine) sites within a gene, often influenced by epigenetic factors. Abnormal methylation disrupts DNA repair, leading to failed tumour suppression.This is a brief overview of a complex and evolving field.Joining me is Dr Pranav Dorwal, Molecular and Anatomical Pathologist at Monash Health, also working in Diagnostic Genomics. Dr Dorwal is an examiner for molecular pathology, researcher, and author of over 60 publications. He has held positions at MD Anderson Cancer Center (Houston, USA) and Memorial Sloan Kettering Cancer Center (New York, USA), completed a fellowship at ANU Canberra, and received the Chancellor’s Gold Medal for Clinical Pathology.Please welcome Dr Pranav Dorwal to the podcast.References:Dr Pranav Dorwal – www.monashhealth.org | www.genomicdiagnostics.com.auOncology at a Glance, Graham Dark, Wiley-Blackwellwww.pmc.ncbi.nlm.nih.gov

Uterine cancer is the fifth most common cancer in females and the most common cancer of the female genital tract in Australia, with about 3,300 cases annually and 660 deaths. The major prevalence is in women between 50 and 70 years, and the quoted major risk factors include: early onset menarche and late menopause, obesity, nulliparity, unopposed oestrogen treatments, polycystic ovaries with prolonged anovulation, extended use of tamoxifen for breast cancer treatment and Lynch syndrome, which confers a 30 % lifetime incidence. Presenting with abnormal PV bleeding or prolonged post-menopausal bleeding, other presentations may include dyspareunia, pelvic pressure, weight loss, anaemia and in later stages, possibly pelvic pain. Whilst a PAP smear will frequently be negative, pelvic imaging revealing a suspicious endometrium and subsequently hysteroscopy and biopsy guide the diagnosis. Patients with more than 50 % myometrial invasion have a six-to-seven-fold higher prevalence of pelvic lymph node metastases and advanced surgical stage compared with women with less than 50 % invasion. With current management the five-year survival has improved over the past 40 years to 83 %. In contrast to endometrial cancer, which has seen an increasing incidence since 1982 of about 0.9 % per year, Cervical cancer prevalence has reduced from 14 per 100,000 in 1982 to 7 per 100,000 in 2017, influenced by the introduction of the HPV vaccine Gardesil in 2007. Gardesil 9 is the HPV vaccine used in Australia’s National HPV Vaccination Program, providing 100 % protection against HPV strains 6,11,16,18,31,33,45,52 and 58, which are known to cause genital warts and cervical and other HPV -related cancers. Types 16 and 18 cause most of the HPV -associated cancers. This vaccine is recommended for all children aged 12 to 13 years and is free for all Australians aged 12 to 25 years. The vaccine is estimated to prevent up to 90% of cervical cancers and 96% of anal cancers.I was fortunate in this podcast to have a conversation with Professor Thomas Jobling regarding the risks and management of endometrial and cervical cancer. Tom is a gynaecological oncologist, ex-AFL footballer and medical researcher with a very respected reputation in Melbourne and internationally. He has extensive experience with minimally invasive surgery, including robotic surgery, for gynaecologic cancer. His main research area is ovarian cancer for which he received an Order of Australia Medal in 2017, and he is currently Head of Gynaecological Health and VMO at Peter MacCallum Hospital.Please welcome Professor Jobling to the podcast.References :Professor Tom Jobling: reception_tjobling@bigpond.com.auEndometrial Cancer Treatment-NCI Endometrial Cancer-Cancer Australia

Obesity has become a major public health concern, with an estimated 34% of Australians classified as obese—defined as having a body mass index (BMI) of 30 kg/m² or more due to excess body fat. It is now the second leading risk factor for chronic disease in Australia, increasing the likelihood of developing type 2 diabetes, metabolic syndrome (including cirrhotic liver disease), osteoarthritis, and several types of cancer, as well as contributing to higher all-cause mortality.While the pathophysiology of obesity is not yet fully understood, the primary goal of obesity management is to prevent and address obesity-related complications while improving overall quality of life. Standard treatment objectives include setting a weight loss target of approximately 10% for individuals with a BMI of 30–40 kg/m² and 15% for those with a BMI over 40 kg/m². This is initially achieved through dietary, exercise, and behavioural modifications before considering pharmacotherapy or bariatric surgery.Dietary approaches that focus on calorie restriction are the most common first-line strategies for obesity management. These approaches emphasise consuming a wide variety of predominantly unprocessed foods while limiting high-calorie, nutrient-poor options such as sugar-dense foods, refined carbohydrates, and alcohol. Various low-carbohydrate, high-protein diets—such as the Atkins, Keto, and South Beach diets—have gained popularity over the years. However, studies have shown that low-calorie meal replacement diets are more effective for weight loss compared to conventional low-energy, food-based diets.Calorie-restricted diets can be categorised based on daily calorie intake:Low-energy diets (LEDs) allow for 1,000–1,500 calories per day.Very-low-energy diets (VLEDs) restrict intake to 600–800 calories per day, with carbohydrate consumption limited to less than 50 grams per day.Meal replacements serve as a behavioural strategy that promotes weight loss by reducing food choices while controlling intake. These products are typically high in protein, low in carbohydrates, and fortified with essential vitamins and minerals. They can be used to replace all daily meals or just one to two meals per day. While many meal replacement products are available on the market, many do not meet the recommended daily protein intake.In this episode, we speak with Glennis Winnett from the nutrition company Formulite, which has developed a range of high-protein meal replacement products, including shakes, bars, recovery protein, and soup. Formulite offers Australia's only VLED programme that meets protein requirements with a three-product-per-day plan, supporting obese patients on their weight loss journey.During our conversation, Glennis shares her motivation for developing the impressive Formulite product line and discusses how these meal replacements can be incorporated into effective dietary strategies for weight loss.Please welcome Glennis to the episode!References:www.formulite.com.auMin et al., The Effect of Meal Replacement on Weight Loss According to Calorie-Restriction Type and Proportion of Energy Intake: A Systematic Review of Randomised Controlled Trials. Journal of the Academy of Nutrition and Dietetics, 2021, Vol 121, Number 8.Obesity, WHO, 30 June 2020.

In this episode, we delve into the critical issue of obesity and the transformative potential of bariatric surgery with Dr. Jason Winnett, a leading expert in weight loss treatments and Director of the Winnett Specialist Group in Melbourne. With obesity affecting 67% of Australians and posing severe health risks such as type 2 diabetes, heart disease, and cancer, Dr. Winnett explores how modern surgical techniques are offering hope to those struggling to achieve sustainable weight loss through traditional methods.Dr. Winnett provides insights into the latest bariatric procedures, including gastric sleeve and mini-gastric bypass surgeries, highlighting their effectiveness in achieving long-term weight loss and managing chronic conditions. We also discuss pre-surgical pharmacological approaches, the role of multidisciplinary care, and the importance of managing potential nutritional deficiencies.This episode offers a comprehensive overview of the advancements in bariatric surgery and its critical role in combating obesity. Tune in to learn from Dr. Winnett's decades of expertise and discover how these treatments are transforming lives.Resources and References:* Winnett Specialist Group: winnettspecialistgroup.com.au* Australian Institute of Health and Welfare: Impact of Overweight and Obesity as a Risk Factor for Chronic Conditions, 2017* Australian Bariatric Surgery Registry, 2019* Swedish Obesity Study: J Internal Medicine, 2013* British Obesity and Metabolic Surgery Society Guidelines, 2020 Update* RACGP Guide to Bariatric Metabolic Surgery, 2017

Show Notes: Snake Bite Envenomation in Australia with Dr Tim Jackson Australia is home to many of the world’s most dangerous snake species so familiarity with snake bite management and understanding the clinical effects of snake bite is vital for Australian doctors, especially those with a rural practice. Each year in Australia there are about 1000 recorded snake bites but fortunately only 2-3 deaths, most of these relate to bites from the brown snake. This contrasts with a vastly higher number of reported deaths from snake bite in India and Africa contributing to a recorded 100 000 deaths from envenomation globally. Australian snakes, also known as elapids, deliver a venom through their bite which predominantly exerts systemic effects. There are five major venom types for Australian snakes. Minor to moderate local effects may also be experienced depending on the snake genera. Snake venom is a complex mixture of many components including peptides, enzymes, phospholipases, proteases, and others. The venoms may have a potent pro coagulant effect leading to venom induced consumptive coagulopathy which may ultimately lead to defective coagulation through consumption of clotting factors. D- Dimer levels will be high in such instances. A primary anticoagulant effect may occur without significant D-Dimer production but significant bleeding. Other effects include neurotoxicity where toxins have either pre or post synaptic targets. Early signs of developing paralysis such as ptosis need to be watched for closely in the hope of avoiding a neurotoxic flaccid paralysis that may require ventilation. Myotoxicity predominantly affects skeletal muscle and may lead to profound rhabdomyolysis with renal injury and intravascular haemolysis as associated sequelae. Clinical diagnosis of envenomation may be based on a definite history of observed snake bite however more cryptic presentations where definite snake bite has not been observed may result in baffling systemic effects with minimal local evidence of a bite. It’s important to be aware of envenomation as a potential diagnosis in such cases. Detecting coagulopathy is the most urgent investigation to consider after an Australian snake bite. A complete coagulation panel including D-Dimer assessment is essential, electrolyte, renal function and creatinine phosphokinase levels should also be checked. For a well patient these tests should be ordered at presentation, after removal of the first aid pressure bandage and then again at 6 and 12 hours post bite, assuming preceding tests have been normal. Evidence of envenomation requires stabilisation of the patient and administration of antivenom. Australia is the only country with commercially available snake venom detection kits that may assist in the identification of venom that has been inoculated and provide a very helpful guide to the appropriate antivenom to administer. A polyvalent vaccine is also available for administration although larger in volume and associated with more side effects than the ‘monovalent ‘antivenoms correctly chosen from the kits mentioned above. Doses are the same for adults, children and the pregnant. Expert assistance from a toxicologist and intensivist should be sought early if troubling signs and symptoms of envenomation are observed. In this episode we have a conversation with Dr Tim Jackson who is co-head of the Australian Venom Research Unit at Melbourne University and an evolutionary biologist. Tim brings a huge and enthusiastic wealth of knowledge to this discussion, and it was a real honour to invite him as an expert guest. Please welcome Tim to the podcast. References: Dr Tim Jackson - AVRU - Australian Venom Research Unit - Melbourne University White, J.A Clinician’s Guide to Australian Venomous Bites and Stings, BioCSL, Melbourne 2013. Preventing and managing snake bites. (PDF). Qld Govt. May 2018

Michael Kenihan is nothing short of a legend in the Australian allied health community. Over four decades, he has made remarkable contributions as a sports physiotherapist, business manager, sports administrator, entrepreneur, coach, and thought leader in health and sports medicine. A fellow of Sports Medicine Australia, Michael has led Australia’s largest allied health network, Life Care, navigating major acquisitions, divestitures, and even an IPO. His entrepreneurial ventures include founding the Melbourne Stem Cell Centre and the innovative technology application R-U-Ontrak. Michael's positive energy, vitality, and deep expertise are reflected in his brilliant new book, The Health Practitioners Journey. This essential guide offers a four-stage career plan designed for health practitioners - from recent graduates to seasoned professionals - providing practical strategies for achieving both clinical excellence and financial success. The book lays out a clear roadmap: building and owning a patient list, leveraging that equity, and eventually preparing for a commercial sale. More than a manual, The Health Practitioners Journey is a companion for all health practitioners, including doctors, physiotherapists, and allied healthcare workers. It emphasises harvesting knowledge, recognising personal potential, and attaining a fulfilling career. Packed with insights, actionable tips, and strategies, it’s a must-read for anyone at any stage of their healthcare career, from starting private practice to navigating the complexities of mature career management. It was an absolute privilege to be introduced to Michael and to interview him for our podcast. Please join me in welcoming Michael Kenihan to the conversation!

Exploring Parkinson's Disease with Associate Professor Ernie Butler In this episode, we dive into Parkinson’s Disease (PD), a progressive neurodegenerative disorder that primarily impacts dopamine-producing neurons in the substantia nigra, leading to motor and non-motor symptoms. Our guest, Associate Professor Ernie Butler, consultant neurologist and founder of Frankston Neurology Group, provides expert insights into PD's complexities. Pathophysiology of Parkinson’s DiseasePD affects dopaminergic neurons in the substantia nigra, leading to a significant drop in dopamine, a neurotransmitter essential for movement. Dopamine loss disrupts communication between the substantia nigra and corpus striatum, impairing motor functions. Additionally, the loss of norepinephrine-producing nerve endings can cause non-motor symptoms like fatigue and blood pressure irregularities. Lewy bodies, protein aggregates containing alpha-synuclein, are also present and may contribute to neuronal death. Global ImpactAs the second most common neurodegenerative disorder, PD affects millions worldwide, with over 200,000 cases in Australia. Around 38 new cases are diagnosed daily, and one in five diagnoses is made before age 50. Core Symptoms of Parkinson’s DiseasePD's four main motor symptoms are: Tremor - Typically a “pill-rolling” tremor noticeable at rest. Rigidity - Muscle stiffness, often evident when limbs are moved. Bradykinesia - Slowed movement, which reduces facial expression and complicates tasks. Postural Instability - Impaired balance, often resulting in a shuffling gait and episodes of “freezing.” Parkinson’s Plus SyndromesSeveral conditions mimic PD but include unique symptoms: Multiple System Atrophy (MSA): Involves autonomic symptoms like poor coordination. Lewy Body Dementia: Features motor symptoms and cognitive impairment with visual hallucinations. Progressive Supranuclear Palsy (PSP): Includes gait instability, eye movement issues, and mood changes. Corticobasal Degeneration (CBD): Causes rigidity, balance problems, and tau protein deposits. Risk FactorsPD risk factors include: Age: Most cases begin around age 70. Biological Sex: More common in men. Genetics: About 25% of patients have a family history, with mutations in genes like GBA and LRRK2. Environmental Exposure: Living in rural areas and exposure to pesticides may increase risk. Diagnosis and TreatmentPD is diagnosed through medical history and neurological exams, as CT and MRI scans often show no abnormalities in early stages. Treatment OptionsWhile PD has no cure, several treatments help manage symptoms: Medications: Dopamine precursors (levodopa and carbidopa) increase dopamine. COMT inhibitors (entacapone) extend the effect of levodopa. Anticholinergics reduce tremors, while amantadine treats dyskinesia. Surgical Intervention: Deep Brain Stimulation (DBS) involves implanting electrodes in the brain to improve motor symptoms in patients unresponsive to medication. With extensive experience in managing PD, MS, and myasthenia gravis, Associate Professor Ernie Butler is a senior neurology specialist at Frankston Neurology Group and Monash Health. He has been featured in prior episodes on Multiple Sclerosis and Myasthenia Gravis, providing valuable insights into complex neurological conditions. References Frankston Neurologyhttps://www.frankstonneurology.com.au › ...Our Neurologists Parkinson's Foundationhttps://www.parkinson.org › what-is...What is Parkinson's? National Institute of Neurological Disorders and Stroke (.gov)https://www.ninds.nih.gov › disordersParkinson's Disease | National Institute of Neurological Disorders ...

Globus, a persistent or intermittent sensation of a lump or foreign body in the throat, is a well-defined clinical symptom. Though it is non-painful, it can be long-lasting, difficult to treat, and prone to recurrence. Interestingly, this sensation often improves with eating and typically does not accompany dysphagia (difficulty swallowing) or odynophagia (painful swallowing). Globus is a common condition, accounting for about 4% of new referrals to ear, nose, and throat (ENT) clinics, and is reported by up to 46% of apparently healthy individuals, with peak incidence in middle age. The condition affects men and women equally, though women are more likely to seek medical care for it. The origins of globus pharyngeus trace back to Hippocrates, who noted it around 2,500 years ago. In 1707, Purcell provided the first accurate description, attributing it to pressure on the thyroid cartilage from the contraction of the neck's strap muscles. Historically, the condition was labeled as "globus hystericus" due to its frequent association with menopause or psychological factors. However, in 1968, Malcomson introduced the more accurate term "globus pharyngeus" after discovering that most patients with globus did not have a hysterical personality. The exact cause of globus remains unknown, but it appears to be multifactorial. While data are limited, recent studies suggest that factors such as gastroesophageal reflux disease (GERD), abnormalities of the upper esophageal sphincter (UES), psychological and psychiatric disorders, and stress may contribute to the sensation of globus. The variety of potential causes has made it challenging to establish standard investigation and treatment strategies, requiring an open mind when considering possible causes. Dr. Andrew Martin, a practicing ENT surgeon based in the southeastern suburbs of Melbourne and Northern Tasmania, sheds light on this condition. He completed his MBBS at The University of Queensland in 2008, following a Bachelor of Pharmacy Sciences with Honours from Monash University in 2003. In 2021, he earned his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand and completed an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022. Dr. Martin has special interests in nasal obstruction, obstructive sleep apnea, ear and balance issues, chronic sinus disease, mid-facial pain, pediatric ENT, as well as swallowing, voice, and throat disorders. Beyond his professional achievements, Andrew is a dedicated family man with two young daughters and enjoys hunting and fishing in his free time. It was a privilege to have this insightful conversation with him about globus symptoms. Please welcome Dr. Andrew Martin to the podcast. References: ⁠Dr Andrew Martin "Globus pharyngeus: A review of its etiology, diagnosis and treatment." World Journal of Gastroenterology. 2012 May 28; 18(20): 2462–2471. Published online 2012 May 28. doi: 10.3748/wjg.v18.i20.2462 https://www.uptodate.com/contents/globus-sensation

Rhinitis, Sinusitis, and Rhinosinusitis are common conditions frequently seen in primary care. Studies indicate that 1.4 out of every 100 general practice encounters involve acute or chronic sinusitis, and over 2 million Australians are estimated to suffer from chronic rhinosinusitis. In some studies, this condition has shown a greater impact on social functioning than chronic heart failure, angina, or back pain. Anatomy and Pathophysiology: The paranasal sinuses—frontal, maxillary, ethmoid, and sphenoid—are lined with ciliated epithelium and goblet cells, forming a mucociliary blanket that traps and moves harmful particles to the nasopharynx. The maxillary sinus, the largest air-filled sinus in the body, has a draining ostium only 2.4 mm in diameter, making it particularly prone to blockage during infection or inflammation. Treatment for sinusitis focuses on restoring mucociliary clearance and drainage while addressing underlying inflammation. Acute Rhinosinusitis: The spectrum of acute rhinosinusitis (ARS) includes the common cold, post-viral ARS, and acute bacterial rhinosinusitis. Though less than 2% of viral upper respiratory infections progress to bacterial infections, antibiotics are prescribed in over 85% of sinusitis cases. Symptoms of ARS include nasal obstruction, discharge, changes in smell, facial pain or pressure, and cough. Facial pain may worsen when bending forward and can radiate to the teeth. Diagnosis requires the sudden onset of two or more symptoms, with at least one being nasal blockage, congestion, obstruction, or discharge, accompanied by facial pain or pressure and/or a reduction in smell. Nasal examination should assess for discharge (clear or purulent), polyposis, swelling, and erythema. Chronic Rhinosinusitis (CRS): CRS presents in two forms, distinguished by the presence or absence of nasal polyps. It is defined by the persistence of symptoms for more than 12 weeks, including nasal congestion, discharge, facial pain or pressure, and reduced smell. Viral and bacterial infections are the most common causes, with Streptococcus, Pneumococcus, Haemophilus, and Moraxella being the usual bacterial suspects. Other factors such as allergies, structural abnormalities, ciliary dysfunction, immunodeficiencies, and fungal infections should also be considered. Allergic Rhinitis: Allergic rhinitis, commonly known as hay fever, affects around 18% of Australians. Despite its name, allergic rhinitis is not caused by hay and does not result in fever. It typically presents with sneezing, itching, rhinorrhoea, nasal congestion, and lacrimation, triggered by allergen exposure. These allergens can often be identified through patient history, but RAST serology may be required when clear precipitants are not evident. To deepen our understanding of these conditions, we welcome Dr. Andrew Martin, a practicing ENT surgeon in Melbourne's Southeastern suburbs and Northern Tasmania. Dr. Martin completed his MBBS at The University of Queensland in 2008 after earning a Bachelor of Pharmacy Sciences with Honours from Monash University in 2003. He completed his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand in 2021, followed by an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022. Dr. Martin’s specialties include nasal obstruction, obstructive sleep apnoea, ear and balance disorders, chronic sinus disease, mid-facial pain, paediatric ENT, and disorders affecting swallowing, voice, and throat. Outside of his medical practice, he is a devoted family man with two young daughters and enjoys hunting and fishing. It was a privilege to have this conversation with him as we explored rhinitis and rhinosinusitis in more detail. Please join me in welcoming Dr. Andrew Martin to the podcast. References: ⁠Dr Andrew Martin⁠ ⁠National Institutes of Health - Rhinitis and Sinusitis⁠ ⁠Journal of Allergy and Clinical Immunology - Rhinitis and Sinusitis⁠

In an earlier episode titled 'Breathing' we had the privilege to explore heathy breathing patterns and the Bohr effect which governs oxygen delivery to tissues with physiotherapist and breathing expert Allan Abbott, if you haven’t had an opportunity to listen to that podcast, I recommend it as an introduction to the subject we are covering today. Allan has been exploring breathing techniques to enhance exercise performance and improved health for many years and has created a dynamic company called Health Innovations that can be found at healthinnovations.net.au in order to bring this important knowledge into public forum. Although most of us pay little attention to breathing technique in our busy world, many cultures and alternative health practises such as YOGA and Ayurveda have focused on this for centuries and the recent excellent book Breath by James Nestor explores the importance of breathing technique in detail including the influence on facial structure and disease brought about by mouth breathing and poor execution of this seemingly automatic task. Allan takes us further in this podcast episode in which we explore functional breathing, breathing during exercise and how we can utilise breathing techniques to replicate high altitude training at sea level to improve performance and stamina in ways you may not have considered possible. Allan was generous enough to give up a good deal of his spare time taking me on a deep dive through these breath training techniques one on one. We focused first on nasal breathing light, slow and deep utilising the diaphragm rather than purely chest muscles and aiming for a 4 second nasal inhalation followed by a slow nasal exhalation over 6 seconds. This develops the habit of six breaths per minute. We then worked on the breath oxygen level test - the so-called BOLT with the objective of building CO2 tolerance to reduce the ‘gassing out’ feeling that can occur when one trains at a moderate exercise intensity. Subsequently Allan took me to ‘altitude’ with some strong breath holds during exercise simulating the reduced partial pressure of oxygen experienced as we venture 2000 metres above sea level and more, slowly resetting central CO2 chemoreceptors, increasing our haematocrit, erythropoietin and 2-3 DPG levels as well as enhancing myoglobin production, mitochondrial density, and cardiac output. Allan is meticulous about this training and on establishing correct technique noting this would not be appropriate for those with advanced lung disease. I really enjoyed learning from him and have implemented these exercises into my daily routine. I hope this conversation will pique your interest as it did mine as we share the art of functional breathing. Please welcome Allan to the conversation. References: Allan Abbott at: healthinnovations.net.au (+61) 0419379371 Buteyko.com Acute Effects of Repeated Cycling Sprints in Hypoxia Induced by Voluntary Hypoventilation. Woorens/ European Journal of Applied Physiology. September 2017 Repeated Sprint Training in Hypoxia Rugby. Woorens . European Journal of Sport Science. 2018. Intermittent Hypoxia Training. Sohagatay et al. Journal of Human Kinetics Vol32/2012 197-210 Hypercapnic Hypoxic Training. Bakovic et al. Journal of Applied Physiology 2003, Vol 95 No 4 1460-1466 Breathing Pattern Disorders and Functional Movement. Bradley et Al. International Journal of Physiotherapy Feb 2014,9(1),28-39 James Nestor- Breath - The New Science of a Lost Art. Riverhead Books, 2020