The GP Show

Today I am joined by A/Professor David Colquhoun, Cardiologist, Lipidologist, President of the QLD Heart Foundation, Co-President of the Clinical and Preventative Council of the Cardiac Society of Australia and New Zealand, and Senior Lecturer at the University of Queensland School of Medicine.  He has dedicated his life to reducing cardiovascular disease, and pleasingly with a strong focus on improving lifestyle factors. Part 1 - Cholesterol and CVD risk, Lipid "hypothesis" - is it still a hypothesis? Cholesterol physiology, Measuring sub-fractions and receptor ratios - is there a point? Reducing cholesterol LDL and CVD risk with medication statins, ezetemide and lifestyle, Measuring fasting vs non fasting cholesterol, Cholesterol relevance in age - is it a risk or protective factor? Do statins reduce risk regardless of cholesterol? Part 2 - CVD risk assessment and treatment, Risk assessment and importance of using overall risk instead of single factors, Calcium score scan use, Risk calculation in those >75 years, Risk assessment and treatment options including mediterranean diet, exercise, mental health, social isolation, even owning dogs versus cats! Fibrates and triglycerides, Statins and side effects = what's the evidence?   Further reading: https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf  CVD risk, low LDL and artherosclerosis regression https://www.mja.com.au/system/files/issues/ham00039.pdf Fasting vs non-fasting cholesterol testing - https://www.rcpa.edu.au/getattachment/0961c6d1-ec80-4500-8dc0-de516500e05b/Lipid-and-lipoprotein-testing.aspx Mediterranean Diet and CVD - https://www.ncbi.nlm.nih.gov/pubmed/26528631 https://academic.oup.com/eurheartj/article/37/39/2999/2414995 http://www.bmj.com/content/337/bmj.a1344 Calcium Score Scans - http://www.csanz.edu.au/wp-content/uploads/2016/11/CAC_Position-Statement_Exec-Summary_ratified-4-August-2016.pdf Evidence and resources for part 2 will be placed in part 2 show notes   Cheers all  

Today I am joined by exercise physiologist Tim Douge to discuss what role EPs play in disease management and prevention and how GPs and allied health can work more closely to benefit patients.  

Had some good laughs with GP, former Headspace worker and all round top bloke Dr Chris Ganora.  I was way too ambitious with the list of areas I wanted to cover as youth mental health is wide ranging and deep in content.  So this is really more a "concept" overview and we shall have to revisit this area - many many times!   We cover building trust and getting a good history as that forms the crucial basis to any therapy and relationship.  We discuss the HEADS acronym (or CHEEADSSS now, not quite the same ring to it), rapport building and general tips and thoughts from our experiences.  Plus - Never forget risk assessment! Some good resources: Headspace centres and website Black Dog institute Centre for Clinical Interventions - http://www.cci.health.wa.gov.au/ Online psychotherapy programs like Moodgym and This Way Up Enjoy friends!

Non-invasive prenatal testing is becoming more common and cost effective.  It detects more than 99% of fetuses with Trisomy 21, and more than 95% of fetuses with Trisomy 18, Trisomy 13 or abnormalities of sex chromosomes. These are much better detection rates than we observe with conventional first trimester screening for these trisomies (85% for trisomy 21, 50% for trisomy 18, and 50% for trisomy 13)   Further reading: https://www.racgp.org.au/afp/2014/july/noninvasive-prenatal-testing/

Welcome to the first of a new segment I am trying out every now and then.  I review the theory and science behind controversial topics and rate it - confirmed, busted or plausible. I have had a lot of requests to cover medicinal cannabis, so here it is.  There is some really interesting science here, but it is still early days.  In this episode we cover: What is medicinal cannabis? How does it work?   What conditions can it be used in and what is the level of evidence? What are the side effects? What forms does it come in? What is the cost to the patient? How do you apply for it? What don’t we know about it?   If you don't agree with me for what ever reason - don't be a hater!  Just let me know - peacefully!   References The National Academies of Sciences, Engineering, Medicine, The Health effects of Cannabis and Cannabinoids, 2017  QLD Health, Clinical guidelines; for the use of medicinal products in QLD, 2017, https://www.health.qld.gov.au/__data/assets/pdf_file/0023/634163/med-cannabis-clinical-guide.pdf Sachs et al, Safety and Toxicology of cannabinoids, 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604177/ Whiting et al, Cannabinoids for Medical Use: a systematic review and meta-analysis, 2015, JAMA, https://www.ncbi.nlm.nih.gov/pubmed/26103030 Borgelt et al, The pharmacological and clinical effects of medical cannabis, 2013, https://www.ncbi.nlm.nih.gov/pubmed/23386598 Grotenhermen et al, The therapeutic potential of cannabis and cannabinoids, 2012, https://www.ncbi.nlm.nih.gov/pubmed/23008748

I really enjoyed this online conversation with Professor Felice Jacka from the Deakin University School of Medicine and Food and Mood Centre about how food effects our mental health and what clinicians and patients can do about it.  We reviewed the SMILES trial, a randomised control trial showing healthy food choices like the Mediterranean diet can produce remission in people with major depression disorder, which foods are good and bad for our mental health and the suspected mechanisms of action. And a lot more!

After making a fool of myself in the first 30 seconds, Dr Tony and I have a good yarn about prostate cancer history, examination, investigations and treatments with the last 10 minutes covering the evidence for PSA testing for screening.  For more on PSA screening guidelines and types of PSA testing, DRE in screening and lifestyle medicine interventions in early prostate cancer - check out my earlier podcast on this topic. NB For DRE in this talk the take home point is - not necessarily for screening, but if the PSA is elevated then DRE is a part of your work up and helpful before referring.   Enjoy all

I caught up with my old friend and GP registrar Dr Nadim Cody in Central QLD and we talked about his experiences with Medicins San Frontieres (Doctors Without Borders) in PNG and various regions of Sudan.  Informative, touching, hopefully helpful are three ways to describe the talk.  Humble, wise and an inspiration are three words I would use to describe Nadim.   I apologise for some mic bumping noises, more at the beginning then they are pretty sporadic.  Enjoy

On December 1 2017 the cervical screening program changes from the current pap smears to HPV testing with a change in frequency and follow up.  Join gynaecologist Dr Kelvin Larwood and I having a casual yarn over the new guidelines.  

A/Prof Bittoun gave one of the most useful workshops I have ever done at the recent Australasian Society of Lifestyle Medicine conference on smoking cessation. I had to interview her to share some of the principles with you.  With 15% of Australians still smoking and 21% in disadvantaged areas - this is still a major disease determinant - but were the people who have already quit the low hanging fruit?  Why is it so hard for the rest to stop? Today we cover some incredibly important and interesting content: 1. Renee shares some of her history in dealing with "Big Tobacco" 2. Smoking history 3. Nicotine physiology - positive and negative effects of nicotine, withdrawal effects, fast vs slow metabolisers, bell curve of blood nicotine levels, effect on liver metabolism, blood glucose and medication 4. Nicotine replacement therapy - when to use, how to use, how to increase, how long to use and how to reduce 5. Champix (varenicline) use - the EAGLES trial and use with NRT 6. Brief mentions of behaviour change (we ran out of time!) Further reading: http://aascp.org.au/health-professionals/resources/guidelines/