Head clash: Footballers and administrators have been warned of the dangers of concussions. Picture: Michael Dodge Source: Herald Sun

MEDICAL experts have said Australian football codes must investigate the long-term impact of head injuries and concussions.

Concerns are intensifying over the potential for concussions to cause long-term harm after autopsies on brains of American National Football League players showed evidence of chronic traumatic encephalopathy (CTE), two Australian researchers say.

CTE is a degenerative brain disease with similar symptoms to early onset dementia.

Players of Australia’s three major football codes regularly sustain concussions, raising concerns about possible brain damage, cognitive impairment and mental health problems, the researchers say in an article published on the Medical Journal of Australia (MJA) website today.

The University of Tasmania’s Frederic Gilbert and the University of Queensland’s Bradley Partridge say there is an urgent need to investigate the cumulative effects of head traumas over long periods by tracking athletes’ playing history and recording head injuries.

They say the research would require the co-operation of all three codes – Australian rules, rugby league and rugby union – and the findings could prove controversial.

"This research may raise uncomfortable questions about how head injuries are managed but it is crucial for the football codes to facilitate such research to ensure the safety and future welfare of their players," the article said.

Reducing the risk of concussive impacts was even more important in amateur leagues to protect vulnerable young players, Dr Gilbert and Dr Partridge said.

In an editorial in the MJA, director of neurosurgery at Royal Melbourne Hospital, Andrew Kaye, said athletes, referees, administrators, parents and coaches all had a responsibility to learn about when it was safe to play again after injury.

Prof Kaye, a board director of AFL club Hawthorn, said the AFL and NRL had developed their own concussion guidelines in line with the Zurich consensus statement, considered world’s best practice.

However, he said there was a danger that links between CTE and the playing history of American footballers and ice hockey players had been overstated.

Media interest had centred on a handful of reported cases, some of which involved a family history of dementia and illicit drug use, he said.

"Critically, the detection of pathological change in the brains of former athletes does not necessarily support a causal relationship with their sporting careers or history of head impacts," he said.

All three medical experts said the use of protective headgear was problematic in sport as athletes altered their playing behaviour, with some American footballers using their helmets as "weapons". 

But as it affects younger women, the issue of pregnancy can be a matter of particular concern.

As the menopause usually occurs at around the age of fifty, specialists use the term early menopause or rather “premature ovarian dysfunction” when it occurs before the age of 40.

When menopause occurs, periods cease. Sometimes it engenders menstrual cycle problems, including hot flushes, mood swings, vaginal dryness, etc.

And according to medical experts, women should consult with their doctors as soon as they start experiencing some of the symptoms.

While early menopause can be brought on by treatment for certain types of cancer, chromosome anomalies can also be to blame, as can auto-immune diseases.

Smoking too has been shown to be a risk factor. however, it is often the case that the precise cause of early menopause remains unknown.

To improve the patient’s quality of life, but also to avoid the risks associated with the menopause, and osteoporosis in particular, appropriate treatment may be offered.

So speak to your doctor.

19-year-old Jessica Butler is given a dose of the Gardasil vaccine.  Picture: Fiona Hamilton Source: Herald Sun

a QUARTER of young girls are forsaking a life-saving cervical cancer vaccine because of ignorance.

Two studies suggested a lack of knowledge was to blame for many girls aged 12-13 not taking up the vaccine, Cancer Council spokeswoman Kate Broun said.

The Gardasil jab, which protects against two strains of the human papillomavirus, the cause of 70 per cent of cervical cancers, is provided free to schoolgirls under a federal government program.

Of almost 3000 year 10 and 12 students interviewed in one study, only a third had heard of the virus, while more than half did not know it was sexually transmitted, and almost two-thirds were not aware it caused cervical cancer. Those numbers would likely be even lower in schoolgirls aged 12-13, Ms Broun said.

The second study found parents knew little about the vaccine, with many unsure whether their daughter should have it.

Some parents did not trust medical experts who favoured the vaccine and were concerned it "condoned" early sexual activity, despite evidence to the contrary.

Infection was common, and typically had no symptoms, but it could have very serious consequences – which was why the vaccine was so important, Ms Broun said.

"These research findings suggest that knowledge about HPV and this vaccine … is really quite low among teenage girls and their parents," she said.

With a better understanding of the serious consequences of HPV infection and vaccination, parents would be far more likely to give consent for it, she said.

The Gardasil vaccine was a major leap forward, and, if all eligible girls were vaccinated, 70 per cent of cervical cancers would be eradicated.

The state health department released its first draft of medical-marijuana rules late Thursday, providing a glimpse at how the program may work in Arizona.

The rules spell out who may qualify for medical marijuana, establish operating criteria for dispensaries and provide strict guidelines for doctors who may recommend marijuana.

Read the draft rules Send your opinion on rules to the state

The release kicks off a three-week public-comment period, but the Arizona Department of Health Services will have final say on how to implement a medical-marijuana program in the state.

In November, voters passed Proposition 203, which will allow qualifying patients with certain debilitating medical conditions to receive up to 2?1/2 ounces of marijuana every two weeks from dispensaries or cultivate up to 12 marijuana plants if they live 25 miles or farther from a dispensary.

The state health department must finish drafting the rules by April 13. The agency will then review applications from people who want to use medical marijuana or operate a dispensary. The program should be fully functioning by summer 2011, when dispensaries have had time to grow the plants.

ADHS Director Will Humble said the department had two goals: Make the rules strict enough to prohibit people who don’t have serious medical conditions from abusing the system without impeding patients’ access to marijuana, and ensure that medical experts are deeply involved in the process of patients obtaining and using marijuana.

“I’m taking this seriously that this is the medical-marijuana act, not the recreational-marijuana act,” Humble said.

The rules cover everything from the definition of “current photograph” for identification cards to the number of hand-washing sinks a dispensary must have.

ADHS officials spent the past four weeks writing the 47-page draft, which is available on the department’s website.

Staffers researched other states’ medical-marijuana rules and reviewed rules for other state programs.

But because the medical-marijuana program is unlike any other existing program, officials used their creativity and their personal experience of crafting other state protocol, said Tom Salow, acting manager of administrative counsel and rules at ADHS.

Doctor involvement

According to Prop. 203, qualified patients or their designated caregivers could get a doctor’s recommendation to receive medical marijuana.

Doctors must certify in writing that their patient likely will benefit from using marijuana as a medicine to treat his or her debilitating disease. these conditions include cancer, HIV/AIDS, hepatitis C and multiple sclerosis.

Marijuana is not a federally-approved medicine. But department officials drafted rules so that doctors would oversee the program and be held accountable for patients’ access to marijuana, Humble said.

Here are some key proposals related to physician involvement in the program:

-?Requires a medical director.

ADHS wants all dispensaries to hire a medical director who will be on-call or on-site at the facility.

Medical directors would make sure patients or their caregivers document changes in their symptoms and track their marijuana usage. They also would ensure dispensaries provide educational materials, such as how to administer marijuana safely, signs of substance abuse or dependency, and possible side effects.

Medical directors would not be allowed to write medical-marijuana recommendations for patients.

-?Defines physician-patient relationship.

The department wants to require doctors to have an ongoing physician-patient relationship before they recommend marijuana.

That means the patient would need to have seen the doctor for at least one year and had at least four visits for the debilitating condition, or the doctor assumes primary responsibility for managing the patient’s debilitating condition and for providing routine care.

-?Specifies “severe and chronic pain.”

Medical-marijuana opponents have expressed concern that Prop. 203 lists “severe and chronic pain” as a symptom that would qualify a patient to receive medical-marijuana recommendations.

The department’s proposal specifies the patient must have severe and chronic pain as a result of a chronic or debilitating disease or its treatment.

-?Holds physicians accountable.

Physicians will be the “gatekeepers” of Arizona’s medical-marijuana program, Humble said. The department wants physicians to thoroughly assess the risks and benefits of their patient’s marijuana use and make sure only patients who truly need marijuana for medical use have access to it.

The department’s proposal does not require doctors to provide proof, such as MRIs and X-rays to prove chronic pain, in addition to their medical-marijuana recommendations. this means the rules “put the onus on the physician to practice ethical procedures,” said Laura Nelson, ADHS chief medical officer.

Regulating system

Even before Election Day, entrepreneurs looking to cash in on the state’s medical-marijuana industry had been preparing to open non-profit dispensaries.

Prop. 203 caps the number of dispensaries in the state: only one dispensary is allowed for every 10 pharmacies.

The department’s rules do not specify how it will review and approve dispensary applications, but officials expect to decide on a process by the time they begin accepting applications.

The rules are designed to provide oversight on dispensaries. Requirements include:

-?The department will require an electronic security system that consists of panic buttons and video surveillance that ADHS can access and monitor at any time.

-?Dispensary applicants must provide a slew of documents and records, including security policies; floor plans drawn to scale locating each hand-washing sink, panic button and video camera; a business plan that details the dispensary’s ongoing viability; and even whether a dispensary board member has any unpaid court-ordered child support.

-?A dispensary must grow at least 70 percent of the marijuana it provides patients. It may not acquire from or sell to other dispensaries more than 30 percent of its marijuana.

-?Dispensaries also must follow specific guidelines for inventory control. a dispensary agent must document at the beginning and end of each day how much marijuana the dispensary acquires, harvests, sells, disposes of and disburses. Among other requirements, the agent must specify the date and method of disposal, date and amount of harvested pot, and the estimated amount of marijuana infused in edible products.

Looking forward

The public-comment period ends Jan. 7. The department will release a new draft of the rules Jan. 31 and hold public meetings mid-February.

Prop. 203 requires the department to develop an electronic data and verification system to keep track of patient and dispensary information. Law-enforcement and dispensary agents must be able to access this system at any time.

The department will focus on developing this system starting next week.

Salow said he hopes a wide variety of people submit their opinions, especially those who opposed Prop. 203. he said department officials will read and review every comment.

Humble said he is open to changing any part of the initial draft, as long as the suggestion fits under the department’s goals for the program.

“We’re not going to change our goal, period, no matter what anyone comments. Our overall goal is to make this a medical-marijuana law. so whatever comments that we get in have to fit within that framework,” Humble said.

By Elizabeth Wasserman 

When there's an illness in the family, the first place Andrea Rosenthal turns to for advice is the Internet. It's not that the mother of two trusts all online web sites for diagnoses. But if her son has swollen glands in his throat or her daughter has a rash, Rosenthal says looking up the symptoms on a site such as WebMD can help her diagnose the best step to take to care for her kids.

“I like to use the Internet to figure out whether or not to take them to the doctor,” Rosenthal says. “Or to figure out what type of doctor to see.”

There's no doubt: It's easy to search the web for medical advice these days. A recent survey by the Pew Internet & American Life Project found 79% of Internet users have researched at least one health topic online, from diseases or medical treatments to medications. in addition to health reference sites, the Internet provides an opportunity to connect with others suffering from similar maladies — or their families. there are autism support groups. there are discussion groups for sufferers with colitis and Crohn's disease. Cancer survivors have also formed online communities.

But medical experts warn that some of the information you find online might hurt more than help. with the click of a mouse, you might end up with a misdiagnosis or order dangerous medications. “It's definitely not a substitute for your medical doctor's advice,” says Dr. Michael Smith, medical editor at WebMD. Dr. Smith adds that the Internet can be a valuable tool for helping you to “fully understand medical information and make more informed health choices for you and your family.”

Anyone can put up an “Rx” web site, so here's how to separate quality medical advice from potential quacks:

Rx Tip #1: Verify the site's sponsor

 find out who's behind a so-called medical site before you take the advice to heart. Is a medication being recommended by a research institution, the company that manufacturers the drug, or a blogger whose only qualification may be that he was born in a hospital? These days, a large number of medical web sites that seem like editorial or unbiased advice sites are actually produced by pharmaceutical companies. To steer clear of pure marketing sites, check out the online guide by the 200-year-old non-profit, the Medical Libraries Association: User's Guide to Finding and Evaluating Health Information on the Web. the MLA's first piece of advice is to check whether the site has an advisory board or consultants. the MLA also advises that web addresses can also provide clues about sponsorship. A government agency's site should end in “.gov,” a university's site should end in “.edu,” a health professional organization should be identified by “.org.” On the other hand, a “.com” site can be trickier — it might be run by a company that wants to sell you something. To probe deeper, review the copyright information on the site or terms of service to find out who's really behind the site.

Rx Tip #2: Check credentials

Medical advances are made daily, so avoid taking advice from a site that's stale. “You don't want to be reading information that was published on a health site five years ago and hasn't been reviewed since,” Smith says. Another red flag is when a site presents more opinion than fact and doesn't label its content as such. Many bloggers opine about medical topics, and you may agree or disagree with their views, but don't necessarily decide that you have lung cancer just because a site says your cough is a sure sign of the disease. the MLA suggests that creditable online medical information should disclose its source — professional studies, abstracts, or links to other web pages. Beware also of sites that volunteer to give you an over-the-Internet diagnosis for a serious ailment. no web site is a replacement for meeting with your physician if your condition requires medication or immediate attention, Smith says.

Rx Tip #3: use trusted sources

 one of the safest places to get online medical information online is from an organization or agency that you already know and trust. the National Cancer Institute provides information about cancers, treatments, clinical trials, and other literature. the Centers for Disease Control and Prevention offers information about maladies from Avian Influenza to Zoster (aka Chicken Pox). the American Academy of Family Physicians provides advice on how to choose a doctor and has a run-down on over-the-counter medications, what they are and how they work.

Several research hospitals and clinics also post resourceful information online, such as the prestigious Mayo Clinic. the Journal of the American Medical Association web site features articles on everything from opiate analgesia in abdominal pain to respiratory effects of a smoking ban in public places. several commercial sites also have earned reputations for providing credible information. WebMD, which has all content reviewed by certified physicians and specialists, has a handy symptom checker, where you can click on a part of the body to see what possible ailments could be causing your pain. HealthCentral features medically-reviewed content from doctors, researchers and patients on combating everything from cold sores to gangrene. And of course, well-known physicians who appear on TV and have written best-selling books, such as Dr. Weil or Dr. Oz, who have their own web sites as well.

When in doubt, if the tips from the web don't work or you can find the support or information you need, it's always best to see your doctor. But in some cases, some trusty web research could mean you can save yourself a co-pay and time, says Rosenthal: “I don't need to see a doctor if it's something I can handle at home.”

Elizabeth Wasserman is a freelance writer and editor based in Fairfax, Va. she writes for a variety of publications including Congressional Quarterly, Inc magazine, and she edits the online publication CIO Strategy Center.

Copyright (c) 2010 Studio one Networks. All rights reserved.

Posted: Tuesday 14 December 2010 06:58am

The Women’s Health Initiative study in the early 1990s had a tsunami effect through the world in raised concerns about the risks of Hormone Replacement Therapy (HRT), which had the effect of many women suffering unnecessarily through peri menopause and post menopause. One arm of the study demonstrated an increased risk of breast cancer from progestin, which the synthetic form of progesterone. Since then, there has increasing interest in and use of hormones which are identical to our own. Improved technology has created other biologically identical hormones for both men and women. these are the questions I am most often asked:

A significant number of medical experts and the ageing public realize that optimising hormone levels is necessary to preserve the aging body and the mind to physiological levels.

What are Bioidentical Hormones?

Bioidentical Hormones (prescribed as Bioidentical Hormone Replacement, BIHR) are identical in chemical structure to the hormones in our body. about 20 years ago, women were applying yam creams. some women would notice the benefits and some did not. this was due to variable absorption and more importantly, not all women could not convert the yam cream to the hormones that was needed by their body. it was assumed that the yam would be absorbed as progesterone and in the body it was converted to oestrogens.

Nowadays, the basic source is converted to the hormones outside the body and consequently when the hormone is absorbed either as a cream, troche or a capsule, the correct dose, ratios and more importantly, the deficient hormone is prescribed.

Bioidentical hormones are  sourced from soy bean or wild yam, called diosgenin. the diosgenin is purified and modified to a chemical structure that is identical to our own hormones. the process also includes bringing the hormone to pharmaceutical grade and is micronised for improved absorption.

Unfortunately there is confusion between the term progesterone (what is in our body) and progestin (the synthetic form). these two names are used to mean the same when they are not.

Why would my doctor prescribe BIHR?

Our body’s chemistry is designed to connect with our own hormones, and not a hormone which has a structure that is foreign to the receptors and breakdown pathways. Therefore products that that do not have an exact fit are broken down less efficiently by the liver’s detoxification pathway.

Many factors affect this pathway. To name a few: fatty liver, external toxins, poor nutrients and our genetic profile. consequently is will be easier for our liver to breakdown hormone that easily fit into our receptors rather than a non-identical hormone.

Synthetic hormones also have additives that are foreign to our chemistry and stay in our body for longer periods of time, and may be responsible for side effects.

What hormones typically need to be replaced (in women) and at what age?

In my practice, young women up to the age of the peri menopause, present with premenstrual symptoms. In this age group, progesterone has been very helpful to control the fluid accumulation, the mood symptoms, the carbohydrate cravings and the central weight gain.

The peri menopause age group is more challenging as there can be oestrogen deficient symptoms as well as premenstrual symptoms. consequently oestrogen as well as progesterone may be needed. In addition the levels can fluctuate from month to month.

The menopause age group needs oestrogen and progesterone, even after a hysterectomy, as progesterone has benefits of its own. Additionally, testosterone may be prescribed.

DHEA is often prescribed for adrenal fatigue, a very common complication of modern society.it should be emphasised that the above is only prescribed in the presence of relevant signs, complaints and most importantly, deficient levels. it is also important that the hormones are in balance, as in our body, all the hormones work synchronously like a symphony orchestra.

What causes these hormones to decline?The pre- peri menopause age, often has low progesterone to oestrogen ratio, often called oestrogen dominance. this dominance is caused by the presence of synthetic hormones in our environment, called xenoestrogens; common sources are plastics, petroleum products, pesticides like DDT, synthetic hormones, fatty liver from causes mentioned above and overweight.

The most cause for deficiency is ageing; as our hormone glands age, they become less productive.

How do I know if I need BIHR?

Both, men and women have a choice of non BIHR and BIRH. Most people see a doctor if there are symptoms which they suspect is related to their hormones. In females the symptoms are:

* PMS, which includes mood and behaviour changes, fluid retention, breast tenderness, weight gain, headaches or migraines, increase menstrual flow and pain.

* Peri-menopause symptoms are as for PMS but may occur throughout the monthly cycle; feeling hot, sweats and loss of libido

* Menopause symptoms are night sweats, hot flushes, dry vagina, loss of libido, vaginal infections, urinary incontinence, depression, anxiety, irritability, muscle aches and pains, insomnia, facial hair growth, lower back pain, flatulence, indigestion, osteoporosis, hair loss, frequent urination, sore breast, snoring, palpitations, varicose veins, dizzy spells, panic attacks, skin feeling crawly, migraine headaches and memory lapses.

In males, there are symptoms related to the equivalent of menopause, called Andropause, which include loss of libido, erectile dysfunction, fatigue, inability to cope with stress, muscle weakness, weight gain, depression and loss of self esteem.

What benefits should I see if I am on BIHR?The benefits are an improvement to the above symptoms. the pre menstrual female will notice an improvement in most of her PMS symptoms. the peri menopausal woman will note an improvement of her moods, improvement in her PMS and better temperature tolerance. the post menopausal female will notice control of her hot flushes and night sweats, less aches and pains and less vaginal symptoms.

The male will notice an improvement in self esteem and libido.

How long do I need to stay on treatment?The Australian Menopause Society, states that for women between 50 to 59, the benefits of HRT outweigh the risk. however some women prefer to stay on treatment for many years as they have made the decision that the benefits outweigh the risks. the male can stay on the treatment for life.

The Anti-Ageing Colleges would recommend that BIRT is necessary for healthy ageing. Ultimately the decision is a personal one, but only if there is proper monitoring of hormone levels and possible side effects.

What is the difference between BIHR and HRT?The main difference is the BIRT are identical to our own hormones and the conventional HRT is mostly not identical to our hormones. Experts feel that the BIHR has less side effects. this is well demonstrated between the Bioidentical Progesterone and that non Bioidentical Progestins.

The progestin cause the unwanted side effects of weight gain,  headaches and fluid retention to name a few. the progesterone causes weight loss, acts as a natural antidepressant, increases metabolic rate helps sleep and acts as a diuretic.

How is BIHR applied?

Cream, pills. Most of the world experts recommend a cream for oestrogen; this method avoids swallowing the hormone which then goes through the liver to be changed to a bad oestrogen. Swallowing the oestrogen can cause weight gain, increases triglycerides, increase depression, elevate liver enzymes and increase sex hormone binding protein and consequently reduce available testosterone.

Troches theoretically should be absorbed by the oral mucosa. however there is risk that some of the oestrogen will be swallowed. Therefore it is best to use a troche  last thing at night so when there is no talking or swallowing.

Progesterone and DHEA can be swallowed as a capsule. like oestrogen, testosterone should be taken as a cream or troche.

Are there any side effects?Like all things medical and non medical there is a potential for side effects. We now know that our genes can affect the chemical pathways in the liver and the cellular and mitochondria response. the genes can change under the influence of the environment, diet and lifestyle. Therefore the risk can change with time.

Breast cancer and prostate cancer can occur even without taking hormone replacement. the risk increases with the wrong family history, smoking, obesity.

However there is encouraging news for BIHR. In a study of 80,377 women by Fournier in 2009, there was no increase in breast cancer in women taking oestrogen and progesterone compared to a 69 per cent increase in women taking oestrogen and progestin. Campagnoli stated in 2005 that synthetic progestins increase breast cancer risks.

In 2009, Holtorf wrote in Journal of Postgraduate medicine, “until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT”.

The Australian Menopause Society states in its website that there is no evidence for BIHT. it has a fact sheet on this treatment which interested parties should read for alternative view.

Blood clots and strokes can occur but is increased in individuals who smoke, have a sedentary lifestyle or have a family history. less serious side effects can occur but should be detected by elevated hormone levels.

What are the risks of BIHR?

The risks of BIHR are the same as HRT but there is encouraging evidence that with proper use and monitoring, the risks are small.

Apart from the possible risk mentioned above, there are local side effects if the cream is not applied correctly or the troches used incorrectly.

Creams should be rotated between the arms and only applied to non fatty region and where the skin is thin.  Increased hair growth can occur if testosterone is applied to the daily to the same limb.

Excess progesterone can cause sweet cravings and weight gain and laxity of ligaments causing back ache and urinary incontinence, smooth muscles can relax to cause bloating, fullness and constipation.

Excess oestrogen can cause weight gain, sore breast, fluid retention, headaches, migraine, increase uterine bleeding and increase risk of breast cancer.

Excess testosterone may cause hirsutism, acne, greasy skin, aggressiveness, fatigue, depression and hair loss.

Excess DHEA can cause greasy skin and acne in a female (females are very sensitive to DHEA), fatigue, weight gain, facial hair, restless sleep, sugar cravings and insomnia.

The above is not a complete list of side effects, but are the most common. the individual should consult their own doctor for a comprehensive list.

Can any doctor prescribe BIHR?

All doctors can prescribe BIHR. it is my personal experience that my knowledge of BIHR was significantly improved by completing the Australasian Academy of Anti-Ageing Medicine (A5M) Fellowship. the course looked at all aspects of BIhr. it concentrated in detail, on appropriate testing and application of various preparations. it also prepared attendees for the various patient symptoms and management of side effects.

It is recommended that individuals consult practitioners experienced in BIHR or have completed the A5M Fellowship.

To find an anti-ageing doctor, visit a5m.net or call 03 9813 0439.

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