IF THE ARTERIES around the heart become blocked by e.g. cholesterol deposits then blood flow to the heart muscle via the heart arteries ("coronary arteries") may be severely reduced, that part of the heart may die  or stop working effectively  because of  the lack of blood and a heart attack may follow. Before a heart attack occurs other heart symptoms such as chest pain especially on mild exertion may alert doctors to a potential cardiac problem.

To investigate the condition of the coronary arteries Cardiac Catheterisation is often used: A catheter which is a just a thin hollow flexible tube is inserted into an artery in the groin or arm. Under x-ray visualization the tip of the catheter is guided up to the heart. An x-ray movie of the heart and blood vessels is obtained as dye is injected through the catheter ("Angiogram").

The dye allows the coronary arteries to be visualized and any blockages to blood flow in the coronary arteries can be easily seen. Results from cardiac catheterization help determine whether treatment with bypass surgery or non-surgical treatment may be effective.

With non-surgical treatment ("Angioplasty") a catheter with an inflatable balloon at its tip is guided to the blockage in a coronary artery and the  balloon is inflated. This presses the blockage against the wall of the artery and improves blood flow. A small expandable, rigid wire  mesh tube called a stent can be inserted into that compressed area to hold the artery open. Blockage of the artery again is less likely to occur after angioplasty followed by stenting than after angioplasty alone. Heart symptoms usually improve immediately after angioplasty .You can go home next day and back to work a few days later.

STENTING can be very effective especially as it avoids  very major cardiac surgery. Stent insertion  is not without potential complications so be well informed before going ahead with the procedure.

Remember if you do have chest pain get it investigated. It may not necessarily be cardiac pain but be sure.

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                              Swine Flu in Perspective
RESEARCH IN AUSTRALIA about the real significance of Swine Flu found the clinical course of Swine Flu was largely indistinguishable from Seasonal Flu.  No difference in clinical signs between Swine Flu and Seasonal Flu was noted which  made clinical diagnosis difficult. Swine Flu diagnosis needs expensive laboratory testing.

Swine Flu virus was more common than Seasonal Flu among younger patients. Pregnant women were expected to be at increased risk during the Swine Flu outbreak but researchers did not find this to be so.

Generally treatment response did not differ significantly between the two infections with an average time to initial recovery of only 2 - 3 days. Our experience was  patients felt terrible during the first 2 -3 days but then recovered quickly. There is debate whether Tami flu had any real benefit.

Interestingly the problem  was simply that there was a higher  incidence of Swine Flu  than Seasonal Flu last year.  Increased  virulence of the new Swine Flu virus was not the problem as you might have expected.

A Swine Flu vaccine is now available for all age groups.

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                              Gents - Check for lumps - Testicular Cancer
TESTICULAR CANCER accounts for about 1% of all cancers in men. It most commonly occurs in men between 20 - 40 years. The cause of testicular cancer is unknown but there are risk factors:
   •   Undescended testicles as an infant    •   Family history of testicular cancer
   •   Previous cancer in the other testis    •   History of infertility

Become familiar with the usual level of lumpiness of your  testicles and seek advice if you notice a change.
Watch for: 
   •    a hard lump or swelling in either testicle
   •    pain in the testicle or scrotum
   •    change in the size or shape of the testicle
   •    feeling of heaviness in the scrotum
   •    enlargement  or tenderness of male breasts.

These symptoms are generally caused by other conditions e.g. benign testicular lumps are common but if they do occur then seek advice. An ultrasound of the testicles, a Chest X-Ray and blood tests will be necessary.  If cancer is suspected the testicle will be removed. Radiotherapy or chemotherapy may  follow surgery.  Infertility can be a side-effect of radiotherapy and chemotherapy but semen can be collected and frozen before treatment  for later IVF use.

The outcome for most men with testicular cancer is good if detected early.

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                              Please pass  the Salt
THERE IS a well known link between high salt intake and high bloodpressure and also a suspected link between the high salt intake of Japanese and stomach cancer in Japan. The obvious suggestion is reduce your salt intake. Do it slowly: No added  salt in cooking and no salt on the table. You will get used to no- added salt and you will actually experience food tastes other than salt. You will consume more salt than you need from processed foods.

Because of the salt - health connection Australian food processors were asked to reduce the salt in their products. One company reformulated 12 of its breakfast cereals. The result was 235 tonnes of salt were removed annually from the Australian food supply.    Easy.

Sadly the cardboard taste of most cereals was not improved.

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               Is there any hope for humanity ?
EVERY FRIDAY hospital staff found the patient occupying Bed No 5 in an intensive care unit lying dead with no apparent medical cause.

Initially coincidence was assumed but Friday deaths continued.
   Very puzzling.
Finally, a nurse noticed the regular Friday cleaner entered  the ward, unplugged  the life-support system beside Bed No 5, plugged in her floor polisher, cleaned  the ward, and once again plugged  in the patient's life support, leaving no trace of the cause of the patient's death.          True story !

If you have any suggestions or topics you would like discussed, please contact me:
Dr Richard Tomlins
rjtmedical@gmail.com

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Reviewed on    16  October   2017