Leukemias are malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leucocytes. This is thought to occur after somatically acquired genetic mutations lead to dysregulation and clonal expansion of progenitor cells. Whilst most leukemias involve white blood cells, occasionally other cells are the primary leukemia cells such as red blood cells or platelets.   As disease progression occurs, suppression of normal...

Attention Deficit Hyperactivity Disorder (ADHD) is a chronic condition including difficulty maintaining attention, hyperactivity, and impulsiveness. ADHD often begins in childhood and can persist into adulthood and reflects an ongoing pattern of behaviour that results in poor concentration and control of impulses and interferes with functioning and or development. It may contribute to low self-esteem, troubled relationships and difficulty at school or work.  ADHD is one of the most...

Pilates is a form of low-impact exercise that aims to strengthen muscles while improving postural alignment and flexibility. It can be practised with or without equipment and the movements reinforce slow precise actions and breath control. The exercises strengthen and stabilise the core which is the body's foundation allowing one to move efficiently while improving posture flexibility and mobility. This method of exercise is based on the rehabilitation work of Joseph Pilates, born in...

Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques. Atheroma develops when...

Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilizing preexisting atheromatous plaques. Atheroma develops when...

Lipids are essential for cell function and healthy metabolism however clinical analysis of a patient’s lipid profile also addresses one of the fundamental drivers of atherosclerotic cardiovascular disease responsible for 25 % of all deaths in Australia. Modification of abnormal serum lipid levels by lifestyle and pharmacologic intervention aims to achieve a healthy coronary circulation reducing new atheroma formation and stabilising preexisting atheromatous plaques. Atheroma develops when...

Postural orthostatic tachycardia syndrome-POTS is not rare, yet it is hard to find any references to the syndrome in medical textbooks. It is a form of dysautonomia that by some estimates may impact as many as one in 100, more commonly demonstrated in women between the ages of 13 and 50 years; men also may be affected. Classically defined as a form of orthostatic intolerance characterised by excessive tachycardia upon standing, POTS usually presents with symptoms that are much more complex...

Simulation based medical education uses simulation aides to replicate clinical scenarios with the aim of enhancing patient safety by improving medical care and competence and reducing medical errors. Although relatively new to medicine, simulation has been used for a long time in other professions, such aviation. Increasingly, medical simulation is being recognized as a very important training method for doctors, nurses and allied health staff, allowing skill acquisition through deliberate...

The concept of autism continues to evolve with our current approach to diagnosis and management differing significantly from 1908 when the word first appeared to describe a subset of patients with schizophrenia who were withdrawn and self-absorbed. Child psychiatrist Leo Kanner was credited with the first correct description in 1943, reporting eleven highly intelligent children who displayed “a powerful desire for aloneness” and “an obsessive insistence on persistent sameness”. He named this...

First described by Samuel Gee in England in 1887 and Christian Herter in the United States, until the mid-twentieth century the disease of malnutrition and growth retardation now called Coeliac disease was known as Gee-Herter disease and managed with the so-called banana diet. We now know a great deal more about Coeliac disease which is recognised as an immune-mediated disorder characterised by chronic inflammation of the proximal small bowel which heals with gluten withdrawal from the diet...

First described by Samuel Gee in England in 1887 and Christian Herter in the United States, the disease of malnutrition and growth retardation now called Coeliac disease was known as Gee-Herter disease. It is now recognised as an immune-mediated disorder characterised by chronic inflammation of the proximal small bowel, which heals with gluten withdrawal from the diet and returns upon gluten reintroduction. Coeliac disease exhibits geographical variation, with the highest incidence in...

While the boundaries between work and home are clear for many professions, in medicine, this boundary has traditionally not been so well defined. Medical work is notorious for invading personal life, made worse by advances in technology that have allowed a constant connection to clinical practice, especially through telephones. This facilitates work responsibilities that frequently encroach upon home time, recreation, and the sensitivities of one's personal life. Maintaining a work-life...

Integrative medicine refers to the blending of conventional Western scientific medicine with evidence-based natural and complementary medicines and therapies, with an emphasis on lifestyle interventions aimed at delivering holistic, patient-centred care. The objective of integrative medicine is to enable patients to achieve optimal clinical outcomes, and this approach aims to treat the physical, emotional, mental, and spiritual needs of the patient. Examples of complementary treatments...

Most doctors in Australia are now very familiar with the use of telehealth and, in some cases, video health, as they have both been widely used during the Covid-19 pandemic. Northern Health, with its flagship Northern Hospital located in Melbourne's Epping, in conjunction with La Trobe University, has been incredibly innovative in extending the concept of the virtual consultation and establishing Australia's first virtual emergency department, which commenced on October 1, 2020. Commenced...

Disclaimer: Please note that the audio quality in this podcast episode may not meet our usual high standards. We apologise for any inconvenience or frustration this may cause. Despite the subpar audio quality, we believe the information and insights shared in this episode are valuable and worth sharing with our audience. We have made every effort to enhance the audio quality during the editing process, but some imperfections may still be present. We appreciate your understanding and...

Renal stones are common, at least 10% of our population will develop stones in their lifetime. One of the consequences of ureteric colic, which is the formation of stones, is reported in 3 out of every 1000 Australians per year, with a male predominance and a curious increasing incidence. Stones form when urine becomes supersaturated by minerals. Most stones contain calcium but there are many other constituents including oxalate, phosphate, uric acid, cystine and ammonia.     The Australian...

Haematuria is a common presenting problem in primary care, with some estimates stating that blood in the urine may be found in between 2-30% of the adult population. Haematuria may be macroscopic or microscopic which is defined as more than 3RBC/HPF and arising from glomerular or non-glomerular origin. Although only 40% of patients with macroscopic haematuria and 14.5% with microscopic haematuria are referred on to urologists for further investigation, the presence of blood in the urine...

Recently, whilst holidaying in Daylesford, I came across a copy of David Gillespie’s book - Sweet Poison. It was lying on the library’s coffee table. Its subtitle: “Why sugar makes us fat” promised to answer a question I was particularly interested in. I picked up the book and began reading, after completing the first chapter I was unable to rest Sweet Poison down. I have now read it a couple of times, an undertaking I would strongly recommend to primary practitioners, medical students, and...

In an earlier episode, we reviewed the principles of radiation therapy from a general perspective. This field of medicine unifies the management of cancer, by harnessing the therapeutic benefits of radiation, utilising ionising radiation. A specific form of this treatment is stereotactic radiotherapy, which administers radiotherapy from different angles around the body, with the focus of ionisation meeting at the targeted tumour to be treated. This allows the focussed delivery of high-dose...

Urinary tract infections are one of the top twenty reasons patients present, for primary care. According to Kidney Health Australia, 1 in 2 women and 1 in 20 men will develop a urinary tract infection in their lifetime. Approximately 4 in 10 women who develop a UTI will have at least one more infection in the next 6 months. Furthermore, 4% of patients in residential care develop recurrent UTIs, which is defined as 3 infections in a 12-month period or 2 or more in a 6-month period (including...

A patient approaching a doctor expects medical treatment with all the knowledge and skill that the doctor possesses, to bring relief to his or her medical problem. The relationship takes the shape of a contract. Equally, a doctor owes certain duties to his patient and a breach of any of these duties gives a cause of action for negligence against the doctor. As doctors, we have a duty to obtain prior informed consent from the patient, before carrying out diagnostic tests and therapeutic...

The term Multiple Myeloma was introduced in 1873 by von Rustizky when at autopsy he found 8 separate tumours of the bone marrow in a patient, described as soft in consistency and reddish in colour and thence called “Multiple Myeloma”. Today over 2400 Australians are diagnosed annually with Multiple Myeloma. It is slightly more common in men, with an average age of onset at 70 years. Myeloma accounts for 10% of all haematologic malignancies and about 2% of all cancers diagnosed. The five-year...

Non-alcoholic fatty liver disease has emerged as one of the more important clinical problems being faced by primary care clinicians and hepatologists and is estimated to affect 20-30% of our population. Closely linked to metabolic syndrome, insulin resistance and diabetes, an increasing prevalence of this condition mirrors the rising average BMI of western societies. Decompensated cirrhosis requiring intensive medical management or transplantation and or hepatocellular carcinoma development...

Functional hands and fingers are taken for granted until they are damaged by disease or injury. The hand is an incredibly complex structure tasked with fine motor skills as well as the power of grip. Its incredible sensory connections communicate to us the beauty of touch, and the importance of temperature and texture and serve as a vital link in our relationship with the world. The hand is stabilised by a complex set of carpal bones comprising the wrist and invested with amazing...

Musculoskeletal disorders are a common cause of long-term disability and are estimated to make up about 15% of the workload of general practitioners. Joint pain specifically is also extremely common, especially as one ages. In one national survey, one-third of adults reported having joint pain within the past 30 days. Knee pain was the most common complaint followed by shoulder and hip pain. Epidemiological studies suggest that there is a large reservoir of patients with significant...