if you are experiencing symptoms of low blood pressure, consult your doctor. Picture: Supplied. Source: Supplied

THE risks of high blood pressure are well known. But low blood pressure can be problematic, too. Here?s what to do.

We all know having high blood pressure puts you at risk of a heart attack and stroke, but what if your blood pressure is too low? a growing number of people are seeking treatment for hypotension (low blood pressure), says cardiologist Dr Gautam Vaddadi from the Baker IDI Heart and Diabetes Research Institute in Melbourne. “People assume low blood pressure is good because they won’t have a heart attack,” he says. “But if your blood pressure is too low you can be prone to recurrent fainting, which is disabling.” low blood pressure doesn’t always cause problems, but symptoms can include: + Dizziness+ Blurred vision + Feeling shaky+ Nausea+ Fatigue+ Fainting

>> why it happensSome people have a natural tendency to low blood pressure, but even if you know you have it, symptoms such as dizziness or fainting should be investigated. It can also be a sign of something more serious. “call an ambulance if someone passes out and it’s the first time it’s happened,” Dr Vaddadi says. Some people look as though they are having a seizure and can lose control of their bladder or bowels when they faint. there could be underlying factors including heart disease, brain disease (stroke, epilepsy) or other metabolic or blood disorders.Some drugs, particularly those for high blood pressure, can cause blood pressure to become too low. Diuretics, which increase the amount of urine your kidneys excrete, can cause blood pressure to drop, as can some antibiotics. a Canadian study found people on blood-pressure medication and certain antibiotics were up to six times more likely to be hospitalised for low blood pressure.

>> Diet’s roleIf you drink a lot of caffeine and not enough water, you risk dehydration, which can cause your blood pressure to drop. And if you drink a lot of alcohol and don’t eat enough, your blood pressure can drop so low you pass out, Dr Vaddadi says. “It’s not what you expect to hear from a cardiologist, but sometimes a bit of salt can make dizzy spells go away,” he says. Smaller meals can also help. “when you eat a big meal, blood is diverted to the gut to help digestion, so some people with low blood pressure can pass out.”

>> How to avoid fainting“when someone faints, people often feel they should prop them up or support them,” Dr Vaddadi says. “however, lying down gets blood to the brain more quickly. sometimes you can prevent a fainting spell by crossing your legs in a standing position and clenching your buttocks and thighs for 10 to 15 seconds.” this squeezes the blood vessels in the legs and allows more blood to reach the brain.

“I was worried I’d faint at the altar”Laura Greaves, 30, has had low blood pressure for most of her life. “the first time I fainted I was about 12, but it didn’t occur to me it might be blood pressure-related. For about 10 years, from the age of 15 or so, I’d faint a handful of times a year. I passed out in some pretty strange places! I was eventually diagnosed with low blood pressure.“I rarely feel the actual fall and I don’t seem to lose consciousness - as soon as I’m on the ground I come good. “the fainting always starts the same way: the edges of my vision go dark and everything goes black pretty quickly. if I’m talking to someone, their voice will recede into the distance. “I’ve fainted in several queues. Standing still for an extended period is a trigger, especially if it’s hot or stuffy. “I was so worried I’d faint at the altar during my wedding that my now-husband and I worked out a signalling system in case I suddenly felt I was going to pass out. Luckily, the ceremony was uneventful. “I avoid long queues or other circumstances where I have to stand up for a long time. I don’t skip meals and I try to stay hydrated. Earlier this year I nearly fainted while driving, which was a bit scary, but I managed to pull over and it quickly passed.”

DOG bites are on the rise but should we crack down on specific breeds or target careless owners?

IN the early 1800s the dog breeders of Britain faced a dilemma. Parliament had banned the old blood sports of bull and bear baiting to end the cruelty of letting dogs rip into trapped animals. yet watching dogs fight – each other, or rats in a pit – was still immensely popular.

So breeders developed another fighting dog, one that was tough, determined, well-muscled but designed to be submissive to humans in case its handlers had to step in. it became known as the pit bull terrier.

Fast forward to 2011 and the submissive qualities seem to have been forgotten. Today, "pit bull" is shorthand for an aggressive, dangerous dog. In a horrific attack in August, four- year-old Ayen Chol was mauled to death in her

Melbourne home by a pit bull cross, and this week a man was charged over the attack.

Ayen’s death provoked outrage and prompted the Victorian government to immediately strengthen laws which will require unregistered pit bulls to be destroyed. There were even calls to ban the breed entirely. here, the Weatherill Government is also considering tougher laws – but has yet to reveal its plans.

A solution may not be so easy to find. Is the problem the breed of dog, or the way the owners treat them? around the world, countries have different approaches. Italy and Holland in recent times have lifted bans on restricted breeds because the laws have been ineffective. instead, they are concentrating on punishing owners who mistreat animals.

In Australia, despite steps taken to control so-called dangerous dogs, the number of dog bite injuries is on the rise, and most attacks are by family pets. In the wrong hands and the wrong circumstances any dog can be a weapon.

AT the Hahndorf Animal Shelter kennel manager Robyn Page sees first-hand what humans can do to dogs. She has taken in dogs that have been badly beaten, starved, encouraged to be aggressive and dogs that have just been abandoned. Dogs such as Alexis and Shyloh. both are around 12 months old although it’s hard to be precise because they were dumped and left to fend for themselves. both are lucky. they ended up at the Page’s shelter, a kind of nirvana for discarded, neglected and abused dogs who need a second chance in life. If they had ended up in a council pound they would be dead by now.

The shelter rehoused a record 245 animals last year. Dogs can be big, boisterous and expensive to keep and Page says some people simply choose to abandon their pets when they lose that puppy cuteness. "People love the cute," she says. "but they don’t love it when they become like teenagers and act all gangly and disobedient."

But there may be something else happening as well.Alexis and Shyloh are part of a trend. As many as 40 per cent of the dogs at the shelter are, like them, staffy crosses – a mix of staffordshire bull terrier and something else. Alexis has some mastiff thrown in. No one is sure about Shyloh. the numbers are not unique to this particular shelter. the RSPCA reports staffies and kelpies are the two breeds most often dumped by uncaring owners.

One theory as to why so many dogs end up on the streets is that staffies are being lumped in with perceived dangerous dogs such as the demonised American pit bull terrier. the staffy shares certain breeding characteristics and history with the pit bull and there is a physical resemblance to the untrained eye.

Like all dogs, Page says, staffies can be the product of their environment. If they are mistreated and abused the dogs will likely have "baggage". the key is love and respect. "the problem with some of the dogs that come here is they have not been socialised," Page says. "If you lock them up in the backyard, don’t take them for walks, they don’t see much of the world."

Both Shyloh and Alexis turned up at the shelter in July. when they arrived they displayed many of the symptoms of the unloved dog. they were aggressive, suspicious and jumpy. they didn’t like one another, they would fight. Three months later it seems a

personality transplant has taken place. At first glance, there is no doubt that there is something scary about these dogs. they are powerful, with muscular shoulders, triangular heads and strong jaws. If they wanted to, they could inflict severe damage.

And yet Alexis and Shyloh today carry all the threat of an angry goldfish. they play with each other, come and sniff and seek affection, and generally gambol about. Page hopes they will find good homes soon.

The reputation of dogs like these is also undermined by the human company they keep. Dogs such as pit bulls and staffies are popular breeds among gangs like the bikies. the pit bull in particular has acquired a reputation as a menace to society.

ONE staffy terrier owner, who wanted to remain anonymous, says attitudes to her dog hardened considerably after the Victorian tragedy. "Since the attack people have been abusing me on the street, picking up their dogs and children, muttering horrible things about me and my dog under their breath and crossing to the other side of the road," she says.

"Usually people have a giggle at her when we are walking as she is such a sook she lies on her back in submission to even small fluffy dogs. but now the owners of these small fluffy dogs think she is going to attack and kill their dogs."

Sue Swalling, a fierce advocate for her staffies, lives in Callington. She has owned the breed since 1966 after seeing one in the pet shop at Harrods department store in London. She has let her children play with them and now lets the grand kids do the same.

It’s a true and enduring love. "In all the years I have had one, I have not had a dog in any way be aggressive to me," she says. "I have not had one with a mean bone in its body."

The State Government is considering whether it needs to follow Victoria’s example and change the law on dangerous dogs. Environment Minister Paul Caica has received advice from the Dog and Cat Management Board but would offer no comment on the government’s likely position. the issue of uniform national laws for dangerous dogs is also on the agenda for a meeting of the state and federal attorneys-general later this month in Launceston.

There are currently five restricted breeds of dog in South Australia. this means severe limitations are placed on them. they must be desexed, microchipped and must wear a muzzle and be restrained in public. the dogs cannot be bought, sold, or given away. There is a $2500 fine for any breach.

The restricted breeds are the American pit bull terrier, the Brazilian fighting dog fila brasileiro, the Argentine dogo, Japanese tosa and the perro de presa canario, another fighting dog. According to official records the only restricted breed currently in South Australia is the pit bull, of which there are 103 registered. several years ago an Argentine dogo was found in the Riverland but it had been imported from new Zealand and the owner believed it was something else.

All dogs, regardless of their breed, can be dangerous to some extent. the SA Dog and Cat Management Board says there were 535 recorded dog attacks in the 2000-01 year. By 2009-10 that had almost doubled to 994 out of a registered dog population of around 295,000. That was a slight dip on the previous year’s figure of 1058 attacks. What isn’t collated in SA is the breed of dog involved.

The board also tracks the number of hospitalisations. In the 2009-10 year 220 people visited hospital because of dog bite injuries. around a quarter of them were to children under 10, which suggests the family pet, rather than wandering dogs, were responsible. There has not been a fatal dog attack in South Australia since 1987 when four bull terriers killed a 17-month old boy.

A NSW government report published in may pinpointed staffordshire bull terriers and german shepherds as the dogs most likely to be responsible. However, these are two of the most popular breeds in NSW and if the attacks are viewed as a proportion of the overall dog population they fall to 9th and 12th.

Looked at that way, the dogs most likely to attack are pit bulls. According to the NSW statistics, 1 in 76 pit bulls will attack. other popular breeds in the top five are the mastiff, the American staffordshire terrier and the bull mastiff.

But the value of these numbers has been questioned. Ben Luxton, executive officer of the SA Dog and Cat Management Board, says his body does not collect these figures because identifying dog breeds, especially when relying on a person who has being attacked, is unreliable. "If there is a lot of emotion involved you don’t necessarily have a positive identification of the dog," Luxton says. "Do I question the stats coming out of new South Wales? yes, I do."

The identification of American pit bull terriers is highly complicated. Luxton says pit bulls are not recognised as a breed, they are a type. this means it is left in the hands of dog inspectors who judge temperament, muscle formation, physical appearance and jaw power to decide if a dog is a pit bull. it is then up to the dog’s owner to prove that it is not a restricted dog.

The question of what is and what is not a pit bull is causing a great deal of angst in Victoria since the laws were changed after the death of Ayen Chol. Council officers can now seize and destroy any dog they believe to be an unregistered pit bull or cross.

Vets are now being asked by owners to verify that their dogs are not pit bulls and the president of the Victorian division of the Australian Veterinary Association Susan Maastricht says many in the profession are worried about issues of legal liability when it comes to identifying dangerous dogs.

"We are all a bit twitchy about this at the moment," she says. the biggest concern is what happens if a vet declares a dog is not a restricted breed but subsequently attacks someone and is found to be a pit bull. DNA tests are unreliable because no genetic profile of the pit bull has been built because the dog is a product of so many different breeds. In the case of cross breeds the problem becomes even more murky. "At information sessions for vets we have all been saying, ‘Oh my God, what are we going to do about this?’," she says.

The usefulness of breed specific laws is now being questioned in the United Kingdom and the United States. the Netherlands recently repealed its legislation after 15 years as did Italy. Holland has moved to enforce stricter laws on leashing dogs and increased education for dog owners. It’s an approach that judges dogs by their behaviour rather than their breed.

Simon Hallsworth, Chair in Social Research in the Department of Applied Social Science at London Metropolitan University, recently published a paper theatrically called Then they came for the dogs, which blames knee-jerk policy making by the government, and media hysteria, for demonising pit bulls.

"Since the late 1980s, when the pit bull first came to public attention, this canine has found itself the object of an official campaign that has as its stated aim the wholesale destruction of the pit bull as a breed," Hallsworth says. "Not to put too fine a point on it, (it’s)

Britain’s very own attempt at a canine genocide."

The UK passed the dangerous Dogs Act in 1991 after a spate of dog attacks by rottweilers and pit bulls. According to Hallsworth, within five years of the Act being passed 1000 pit bulls had been killed. but in the 20 years since the act was brought in, dog bites in Britain have risen. Of nine fatalities caused by dogs in the UK since 2005 two have been attributed to pit bull types. "In all of these cases the dogs had been neglected or abused by their owners, allowed inappropriate, unsupervised access to small children, or left in the control of incompetent adults," he says. "the dog is often the victim of inhumane treatment; yet, the dog is always blamed and killed."

In Australia, Linda Watson, an academic at Monash University in Melbourne, says there have been 33 dog-bite-related deaths in this country since 1979 and only one of those was ascribed to a pit bull-type until the death of Ayen Chol.

Martin McKenna is one of Australia’s best-known commentators on dog behaviour. an Irishman who grew up with a pack of stray dogs, he now lives here and writes best-selling books on canine behaviour. "We sometimes go too far with the kinds of dogs we breed," he says. "American pit bull terriers in my opinion are a dangerous dog because they try to actively work you out, dominate and then take over," he says.

But it’s not just pit bulls that concern McKenna. most dog owners don’t understand the body language of their pet, he says. We are the two top predators yet we can’t communicate, he says. "this is where a lot of the aggression comes from."

Should laws target dogs or owners? best letter wins theatre tickets. Email .com.au

Comments

22 comments

Sadly as a woman with endometriosis which has spread to the pelvis and bowel with adhesions there is no way I would be able to differentiate the symptoms of ovarian cancer from my current disease

– February 25, 2011, 1:40PM

Another symptom is constipation. my best friend complained of this for almost a year. Eventually she went to the doctor for a checkup and found after some investigation that she had cervical cancer. it was a less aggressive type of cancer that triggered the release of an enzyme that caused constipation.That was really her only symptom.

AP | Sydney – February 25, 2011, 1:47PM

Actually, the 5-year survival rate for people diagnosed with breast cancer is over 90%… which makes the ovarian statistics all the more concerning

Shane | Melbourne – February 25, 2011, 2:07PM

I have all of these symptoms. but I also have coealic disease and poly-cystic ovarian syndrome. And between these two the bloating, fatigue, pain and changes in bowel habits are well and truly covered.

Kate – February 25, 2011, 3:41PM

I also have had endometriosis with adhesions and I found that acupuncture virtually cured it, leaving me pain free and happy again. Western medicine seems to have no cure, but acupuncture has worked for other people I know with endo too, I can not recommend it highly enough.

Sadly, I do not know of a better treatment or diagnosis for ovarian cancer

Nicky | Melbourne – February 25, 2011, 3:46PM

My mother died of ovarian cancer last November.

All I can say is that if you are unsure, keep going back to your doctor and demand more scans and check ups. She persisted, and after some months doctors found a football-sized tumor in her abdomen! this was removed and she underwent preventative chemotherapy. it came back again about four months after her treatment and this saw a fast decline.

My thoughts are with those who have this sad, agressive disease, or those who are in the scary place where they feel they have symptoms but are unsure of their origin. Sadly, ovarian cancer does not get a lot of publicity. even though it isn’t as common as breast cancer, it surely has a much higher mortality rate.

The more we talk about this disease, the better.

Timberrr | Melbourne – February 25, 2011, 4:41PM

What I also find worrying is that there is no way a woman can go to a doctor and have a routine test, be it an ultra sound or something else to check on the health of her ovaries.Why isnt anyone discussing this?I had, sadly unsuccessful, IVF attempts where I was internally ultra sounded every month or so on the ovaries to check the growth of follicles. Couldn’t the same thing be done for all women on a regular basis to check for lumps etc?can anyone answer this for me please?

Internet armchair traveller | Melbourne – February 25, 2011, 8:35PM

Useful information for the most part. Not sure what the relevance of Patrick Dempsey is. What a very peculiar photograph!

ruth | Melbourne – February 25, 2011, 9:22PM

i read recently where drs are angered at people checking things on the net..so i do feel guilty saying ‘i read this & it sounds like me..’ with my dr replying im sure lots of people have a few painful spots in their bodies !?? my small pain has been dismissed by the dr & large gyno hospital here but to me its becoming more prominent as a lump ..whats next ..i think of the money i will make sueing these people if it is discovered i actually do have something..how much longer with all the knowledge of the net available to us are we to be treated like naughty children by drs !??

anne | perth – February 26, 2011, 3:49AM

During our reproductive years and beyond, we are advised to have biennial pap smears to detect cervical cancer. After age 50, we are invited to have mammograms and continue our pap smears. also, bowel scan kits will be sent to you at age 50. perhaps it would make good sense that when we go to the doctor for our pap smears from age 40 onwards, we ask our doctors to screen us for ovarian cancer as well. As previous correspondents have pointed out, the vagueness of symptoms matches many other conditions we can suffer from. Peace of mind is a wonderful thing.

Robyn | Central Highlands – February 26, 2011, 10:46AM

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Posted December 18, 2010 12:15:00

New testing has found the first New South Wales cases of a super bug that has killed thousands of patients in European and North American hospitals.

New South Wales Health says 21 patients tested positive to a virulent strain of Clostridium difficile, not detected in Australia until earlier this year in Melbourne.

Some of the symptoms include mild to severe diarrhoea, fever and stomach pains.

Professor Lyn Gilbert, chair of the New South Wales expert advisory group on health care associated infections, says New South Wales Health are now testing regularly for the bug.

“Some cases have been identified almost by chance in northern Sydney that have occurred over the last couple of years in several different hospitals in northern Sydney,” she said.

“None of them as far as we can tell have particularly severe disease, contrary to what happened in the northern hemisphere where it often was more severe than usual.”

Australian researchers undertook a five year study to investigate the extent and duration of one of the most common side-effects of prostate cancer treatment: impotence.

Transcript

This transcript was typed from a recording of the program. The ABC cannot guarantee its complete accuracy because of the possibility of mishearing and occasional difficulty in identifying speakers.

Norman Swan: good morning and welcome. Today on the Health Report a radical way of operating on your liver, what you and me as health consumers, not to mention doctors and nurses, might learn from the recent Qantas A380 emergency in Singapore and…

The results of a five-year follow-up of 2,000 Australian men who have been treated for prostate cancer to see what complications endure and how they’ve survived. and as you’ll hear, the findings are a bit troubling.

The person who coordinates this study is Dr David Smith, who presented the results at a cancer conference in Melbourne last week.

David Smith: most men are diagnosed with localised prostate cancer, that’s an early type of prostate cancer, so in our cohort we had 88% were diagnosed with localised prostate cancer, potentially curable and 63% of our men were diagnosed with no symptoms.

Norman Swan: They were diagnosed having had a PSA test?

David Smith: This is very much a group of men who represent men diagnosed as a result of PSA, yes.

Norman Swan: a year or so ago you published the three-year follow-up and now what you did this week at the Clinical Oncology Society of Australia meeting in Melbourne was actually look at the five-year follow-up of these men. So just take us through how they are going in terms of what many men are concerned about, with complications such as impotence and incontinence.

David Smith: what I presented this week was the men with localised prostate cancer and in general they are going pretty well. When you look at their overall quality of life they don’t differ in many respects from the control group that we studied, so that’s a normal group of men from the general population who don’t have prostate cancer. But in certain areas there are risks that are being attributable to the type of treatment they had. and the biggest risk that men who have prostate cancer treatment face is in sexual function. and the group that we looked at overall about 70% to 75% of men were impotent five years after the treatment for prostate cancer.

Norman Swan: Now there are degrees of erectile dysfunction; what are we talking about here?

David Smith: The single measure that we’ve used was whether men were able to achieve an erection sufficient for sexual intercourse.

Norman Swan: Without a drug?

David Smith: That includes with drugs.

Norman Swan: Right, so you could take a Viagra like drug?

David Smith: That’s correct. if you’ve had a drug or any other aid, a penile implant, or a vacuum erection device and you could get an erection, we include you as being potent.

Norman Swan: Now that’s probably higher than many urologists think it is?

David Smith: That is higher than most urologists think it is. we took our three-year results to a group of urologists and before we presented the results we said what do you think the impotence rates are? and they recorded levels quite a bit lower than our results, our population whole results.

Norman Swan: did it vary by surgeon or you didn’t analyse by surgeon?

David Smith: we haven’t analysed by surgeon, I think there are some good studies overseas that show that surgeon experience and volume are important but we haven’t analysed by surgeon.

Norman Swan: Does it vary by surgical procedures? So some surgeons do it with a robot, or say they try and spare the nerves around the prostate which might help erection to occur. When you had a nerve-sparing operation did that seem to make a difference, or what the surgeon claimed was a nerve sparing operation?

David Smith: The robots were not in great use at the time of our study. But the second part of that question is whether nerve sparing intent was offered compared with non-nerve sparing intent with radical prostatectomy. we found that nerve-sparing intent did improve sexual outcome but not greatly and men who had nerve-sparing intent were often the most disappointed when it didn’t work.

Norman Swan: So how does this marry with the fact that when you look at the psychological profile they didn’t vary from controls when they were having quite significant sexual dysfunction: three out of four of them?

David Smith: The measures we used to look at overall psychological wellbeing aren’t specific enough to pick out the fine details that affect a man’s sexual life.

Norman Swan: Men are offered more than just surgery if they’ve got prostate cancer. They could be offered radio therapy, two forms of radio therapy — one is where you get the machine aimed at your prostate gland and the other is where they put radioactive seeds inside the prostate: so-called brachytherapy, which is claimed to have a lower rate of sexual dysfunction although it causes other problems as well, such as irritation in the bowel and the bladder. what did you find there?

David Smith: we looked at external beam radio therapy and we looked at whether men had androgen deprivation therapy as well and we also looked at high dose rate and low dose rate of brachytherapy. by five years the men on low dose rate brachytherapy had almost returned to a normal control group sexual functioning. So low dose rate brachytherapy in our group certainly showed the best sexual outcomes at five years.

Norman Swan: and of course the one issue with low dose rate brachytherapy is that it’s yet to be shown to perform as well as surgery in terms of survival and recurrence.

David Smith: That’s right.

Norman Swan: Incontinence?

David Smith: Incontinence is a lower level of risk in the group that we looked at but in radical prostatectomy there were about 12% of men who had persistent incontinence.

Norman Swan: and the predictors of erectile function after surgery, are they the same as people have said that if you were strongly potent before, you stand to be in the one in four who are going to have it afterwards?

David Smith: Men who are younger certainly had much better potency than the older men in our group. Men with good baseline sexual function had better sexual function at five years. Men with less co-morbidities, so other diseases that might affect sexual function…

Norman Swan: Like heart disease or diabetes?

David Smith: Absolutely, but also some interesting socio-economic issues, so men from regional and rural parts of Australia had worse sexual function and men with lower incomes had worse sexual function.

Norman Swan: how do you explain that?

David Smith: I think it’s an issue about access to large centres, perhaps private health insurance as well.

Norman Swan: So you’re suggesting less experienced urologists are operating on them?

David Smith: That could be the case.

Norman Swan: The other issue with rural people from data from the Cancer Institute of NSW is that they get diagnosed later. did rural men in your sample have less localised cancer?

David Smith: yes, there was a small but significant difference in the stage of presentation in our group.

Norman Swan: So what are the immediate implications of your findings? Presumably informed consent needs to change a little bit.

David Smith: we think that better communication is needed in the consultation about when men are deciding the type of treatment for prostate cancer. The group of men when asked stated that they would have liked to have a bit more time to consider the type of treatment that they had and they would have liked to have had more information about the likely consequences. So we think that’s the initial priority.

Norman Swan: and to be fair to Australian urologists, or at least the ones who specialise in this kind of surgery, they are found to say to people ‘look, you’ve got time, this is not necessarily something you’ve got to decide tomorrow’.

David Smith: Absolutely. and I think there’s a growing feeling now that active surveillance which is a wait and see approach and not hopping straight in and treating prostate cancer radically is a very good alternative for men with the right type of disease which gives them time to think about the best way to treat it in the long term.

Norman Swan: Given this was done in NSW you think the results are applicable elsewhere in Australia, much less internationally?

David Smith: there are subtle differences between the states in the way in which treatment is offered. some differences that we’ve seen in terms of survival may be partly a result of…

Norman Swan: oh spit it out, what are you actually trying to say David?

David Smith: Look we know that in some of the smaller states, there are only a few urologists and they treat prostate cancer differently from some other areas. So there are lots of regional differences.

Norman Swan: what you’re trying to say here is that in smaller states the skill level might not be up to scratch?

David Smith: oh no, not at all, I think…

Norman Swan: So there’s a smaller number of urologists doing all the work therefore they are getting quite good at it?

David Smith: That could well be the case and the problem is there is no other data like this in Australia, let alone in the world, this is one of the few studies that has got a large group of men with prostate cancer from the whole population not just from one centre of excellence and also has a control group to compare them with across all the treatment types.

Norman Swan: So this data are not a reason for not having the operation it’s just have the information at hand when you make the decision?

David Smith: Absolutely, talk to your doctor about the best options for you and if you’re not happy with what you’re being offered by the first doctor you go and see ask for a referral.

Norman Swan: Dr David Smith is a research fellow at the Cancer Council of NSW and you’re listening to the Health Report with me Norman Swan here on ABC Radio National.

Smith DP et al. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. British Medical Journal 2009 Nov 27;339:b4817.doi:10.1136/bmj.b4817

A woman with a disability that requires her to have extra oxygen when she flies has argued her case in the Court of Appeal at Wellington today after a decade-long court battle against Air New Zealand for what she calls discrimination.

Valerie Joan Smith suffers from a congenital condition which, among other symptoms, means she has a limited lung capacity and can not fly without supplementary oxygen because of the lowered air pressure in the cabin.

in 1999, Ms Smith took an Air NZ flight to Melbourne and advised the company of her need for extra oxygen, for which she was charged $298, a cost she was not happy with.

she took the case to the Human Rights Commission in December 1999, arguing that it was only because of her disability that she was out of pocket.

The case was dismissed by the Human Rights Review Tribunal as it found the airline had reasonably accommodated her requirements – but subsequently the director of the Human Rights Proceedings appealed the tribunal’s findings.

Air NZ cross-appealed on the issue of discrimination and the case was taken to the High Court, which found there was no discrimination.

The High Court granted the director leave to appeal the decision to the Court of Appeal.

in the Court of Appeal today, Ms Smith’s lawyer Frances Joychild argued that there needed to be different treatment for people with disabilities in order to level the playing field.

“If all supplementary oxygen is to be paid for then it seems like everyone is the same but that’s not right. Only if you provide oxygen is everyone equal,” Ms Joychild said.

Lawyer Harry Waalkens, QC, appeared for Air NZ and said the issue was one of safety, not discrimination.

“The whole rational behind the policy is safety. Air NZ now has a policy that allows passengers to bring their own oxygen system on board whereas in 1998 the company did not,” mr Waalkens said.

he conceded that the passenger would have to pay for the system and may not have it on hand.

Ms Smith realised that there were safety issues with extra oxygen on board but her issue was who would pay for it. The cost was a burden to the disabled community, Ms Joychild said.

“Other passengers don’t pay for their oxygen and neither should she. The airline has to provide her with oxygen unless it was unreasonable to ask them to do that.”

Ms Joychild likened the situation to special allowances given to people with disabilities in other circumstances, such as guide dogs being allowed where pet dogs were not.

The Human Rights Commission (HRC) intervened in the case and argued that society should share the cost.

“The concept of recovering costs from the person is not the right way of thinking,” Andrew Butler, of the HRC, said.

“This society is for everyone and disability is not a problem that can be fixed. That’s the wrong mindset.”

Judgement has been reserved.