Episode 59 of "This Medical Life" podcast delves into the enigmatic world of scleroderma, a disease characterized by the hardening and tightening of the skin and connective tissues. Historically, the first medical description can be traced back to the 1750s when Dr. Carlo Curzio documented the case of a young woman plagued by severe skin tension and hardness. This condition, initially referred to as an extraordinary disease of the skin, has evolved in our understanding but remains a complex ailment that challenges modern medicine.

Scleroderma, known for its diverse manifestations, encompasses several subtypes such as localized scleroderma (morphea) and systemic sclerosis. Localized scleroderma primarily affects the skin, while systemic sclerosis has more widespread symptoms affecting internal organs. The disease can manifest in various forms, from skin discoloration and tightness to more severe complications like organ dysfunction. Historically, treatments ranged from warm milk and vapor baths to more dubious methods like bleeding and mercury administration. Today, the focus has shifted towards understanding the pathogenesis of scleroderma and managing its symptoms more effectively.

This is the story of Scleroderma.

Our special guest:

The podcast features an interview with Dr. Daman Langguth, a renowned clinical and laboratory immunologist with deep expertise in autoimmune diseases. Dr. Langguth discusses the importance of recognizing scleroderma's symptoms, the critical nature of early diagnosis, and the latest advancements in treatment. With scleroderma's potential to significantly impact quality of life, this episode not only sheds light on its historical background but also emphasizes the modern approaches to managing and understanding this multifaceted disease.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In 1901, the state of Montana organised for scientists and doctors to investigate a mysterious illness from the Bitterroot Valley called ‘Black measles’ and ‘Black typhus’. People of all ages were affected but predominantly those who worked in the brush and were exposed to tick bites. The investigators called it ‘tick fever’ and this particular strain had a mortality rate over eighty percent.

Today this disease is known as Rocky Mountain spotted fever. In Australia, it is sometimes called ‘spotted fever’ or ‘Queensland tick typhus’. It is caused by an obligate intracellular bacterial micro-organism (needs a cell to survive). This organism is very difficult to culture and can be even more difficult to diagnose but surprisingly easy to treat. Rickettsial disease is an under-recognised infection and important in the differential diagnosis of any patients presenting with fevers, headaches and rash.

This is the story of Rickettsia

Our special guest:

Our special guest is Professor Stephen Graves who is a medical microbiology and founder of the Australian Rickettsial Reference Laboratory (ARRL). He specialises is infectious diseases transmitted by ectoparasites such as ticks, lice, fleas and mites.

This Medical Life podcast is available on all podcasting services and Spotify.

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Our understanding of infectious disease and pathology stems from the 19th century with Robert Koch pioneering research. Dr Koch help to shaped modern microbiology and medicine when he identified the causative agents for anthrax and tuberculosis. Since that time, the number of infectious microorganisms that we know of that cause illness and diseases has increased exponentially. Thanks to modern day techniques, laboratories can test for these agents directly or indirectly and get an answer often within hours.

As such, microbiology is on the verge of a new era. Instead of the principle of one test: one micro-organism, we are moving into the realm where one test can detect hundreds of potential pathogens and antimicrobial resistance genes in a single stool sample. The new test is called Metapanel. This includes 175 gene targets using metagenomics (shotgun gene sequencing) and is able to detect bacteria, viruses, helminths, protozoa, fungi, microsporidia. This information is collated and reported by a pathologist and advice given as to what is the implications of the result. The test is ideally suited for patients with chronic diarrhoea, inflammatory bowel disease and/or inflammatory bowel syndrome.

This is the story of advanced faeces testing and Metapanel

** Please note: General Practitioners in Australia, will be able to claim CPD points after listening to this episode. Full details and registration, coming shortly.

Our special guest:

Dr Michael Wehrhahn is the Director of Molecular Biology and Infectious serology at Douglass Hanly Moir Pathology. Michael has a Master in Public Health, is an Infectious Disease Specialist as well as a Microbiologist and Adjunct Senior Lecturer at the University of Notre Dame.

Dr Wehrhahn is actively involved in research on clinical and laboratory aspects of a range of microorganisms and is a reviewer for a number of journals. Michael has been involved in researching and validating the new Metapanel available through Sonic in conjunction with Microba.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In episode 56 of This Medical Life, Dr Travis Brown and Steve Davis delve into the critical topic of iron studies, with a special focus on iron deficiency, under the expert guidance of returning guest, Professor Ken Sikaris.

Iron deficiency’s prevalence is influenced by factors such as age, sex, and ethnicity, noting that women, especially those of childbearing age and pregnant women, are at higher risk. Prof Sikaris addresses the challenges and misconceptions surrounding iron studies, particularly the reliability of various tests like serum iron, transferrin saturation, and ferritin. While ferritin is the most reliable marker for total body iron stores, it can be influenced by factors like inflammation.

Through this episode, we provide This Medical Life provides a comprehensive exploration of iron deficiency, combining historical context, clinical insights, and practical advice, all aimed at improving understanding and management of this prevalent health issue.

Our special guest:

Professor Ken Sikaris is a chemical pathologists and Director of Chemical Pathology at Melbourne Pathology. Professor Sikaris is a NATA-accredited laboratory assessor, Founding Fellow of the RCPA Faculty of Science and a principle examiner in Pathology Informatics. He is a Fellow of the Department of Pathology at the University of Melbourne.

This Medical Life podcast is available on all podcasting services and Spotify

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In this episode we delve into the nuanced world of the Pomegranate Health podcast with our guest, Mic Cavazzini. Pomegranate Health, a creation of the Royal Australasian College of Physicians, serves as a platform to explore the multifaceted culture of medicine. It weaves through the clinical intricacies of medicine with episodes that span from the deeply technical aspects of healthcare to broader discussions on skills essential for effective practice and systemic issues within global health.

This episode embarks on a journey through the confused history of opium use, offering a rare focus on historical narratives as a foundation for modern medical discussions. Join us as Mic Cavazzini shares insights from his diverse background in science and journalism, illustrating how the past informs current medical practices and the human factors that influence care. Through this conversation, we aim to shine a light on the complexities of medicine's culture, underscoring the importance of history, philosophy, and the human experience in shaping healthcare today.

Our special guests:

Mic Cavazzini - is a journalist and audio geek passionate about engaging people with ethics, health and the natural world. He produces the Pomegranate Health which is a podcast with the Royal Australasian College of Physicians and won an Australian Podcast Award in 2018. Mic has a background in neuroscience and is associated with the University of Sydney. He has worked as a research scientist at Oxford and ANU where he investigated how brain cells process information and learning. He has also written for The Medical Republic, Australian Doctor, and The Canberra Times.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In Chronic Traumatic Encephalopathy (CTE) Part 1, we learned that CTE is a neurodegenerative disease caused by repetitive cumulative brain injury. Patients suffer from debilitating mental health symptoms and may even have suicidal thoughts or actions. Unfortunately, there is no treatment for this disease and it can only be official diagnosed at autopsy (after death). The only successful strategy to combat this illness is prevention.

Unfortunately, this is an ongoing challenge as there is a lot we don’t know about CTE but some features are clear. The largest risk factor for CTE is the duration of time participating in contact sport. In order to prevent CTE, the aim is to reduce life time exposure to repeated head impacts (either direct or indirect ie. significant acceleration and deceleration injuries). We also delve into grass-roots education aimed at informing school-aged children about concussion and brain health.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

** Please note: General Practitioners in Australia, will be able to claim 2.25 CPD points after listening to this episode and part 1. Full details and registration on our GP CPD Points page.

Our special guests:

Amanda Green – wife to National Rugby League legend player and coach Paul Green who played 162 first-grade games and represented Australia. At the end of 2022, Paul was found unresponsive in his home. Paul’s brain was donated to the Australian Sporting Brain Bank for examination where he was diagnosed with CTE. Paul was 49 years old.

Associate Professor Michael Buckland – Head of the Neuropathology department at Royal Prince Alfred Hospital, founder and director of the Australian Sports Brain Bank (ASBB), co-director of the Multiple Sclerosis Australian Brain Bank, and Head of the Molecular Neuropathology Program at the Brain & Mind Centre.

Doctor Stephanie Adams – Honorary Fellow in Sports & Brain Health at the University of Edinburgh. She is founder and director of ConcussEd which is an education program for school-aged children to learn about brain health. She is a retired rugby and equestrian athlete.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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In 2005, Dr Bennet Omalu would publish a report in the United States on the autopsy brain findings of a former professional footballer from the NFL. His conclusion was the former athlete suffered from Chronic Traumatic Encephalopathy (CTE); a disease caused by repeated brain injuries most likely due to sport. The response was swift and severe claiming that the findings were incorrect, the conclusions erroneous, and a retraction of this report was demanded.

Surprisingly, this was not the first time medical literature has noted the link between sport, repeated head injuries and brain damage. The first publication was written in 1928 by Dr Harrison Martland who was the Chief Medical Examiner of Essex County in New Jersey. Harrison performed hundreds of autopsies on people with head injuries including boxers. He noted twenty-three examples of boxers with permanent brain damage that he called ‘punch drunk’. Other researchers found this was not limited to boxing but other contact sports such as football. Later, this condition became known as ‘Dementia pugilistica’.

This disease has surged into the spotlight in the last decade due to a number of high-profile athletes who have been diagnosed with CTE. Unfortunately, both professional and amateur athletes are at risk. This condition also greatly impacts the family and friends of those who suffer from it. However, a great deal of misinformation also exists about the risks and causes of this disease. These two episodes (of which this is part 1) are designed to explain what we know, what we don’t, and what can be done about this debilitating condition.

This is the story of CTE, part 1.

** Please note: General Practitioners in Australia, will be able to claim 2.25 CPD points after listening to this episode and part 2. Full details and registration on our GP CPD Points page.

Our special guests:

Renee Tuck – sister of Shane Tuck who was a professional footballer in the Australian Football League (AFL) playing 173 games and a brief career as a boxer. Later in Shane’s career, he suffered from mental health issues and in July 2020 took his own life. Shane was diagnosed with a severe form of CTE. He was only 38 years old.

Associate Professor Michael Buckland – Head of the Neuropathology department at Royal Prince Alfred Hospital, founder and director of the Australian Sports Brain Bank (ASBB), co-director of the Multiple Sclerosis Australian Brain Bank, and Head of the Molecular Neuropathology Program at the Brain & Mind Centre.

Associate Professor Linda Iles – Head of the Forensic Pathology Services at the Victorian Institute of Forensic Medicine (VIFM). VIFM is in partnership with the ASBB to send brain specimens for further examination/analysis for suspected CTE or other neurodegenerative diseases.

This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

See omnystudio.com/listener for privacy information.

We begin this year with one of the most important topics for General Practitioners in 2024: what are the Continuous Professional Development requirements for doctors and how have they changed?

Our special guest is Rachel White who is the Managing Director for the Australian Medical CPD Standards (AMcpdS) who has over twenty years supporting high quality medical education. We discuss the yearly requirements for doctors, component breakdown and what has changed.

This is the story of CPD for 2024.

And here is a summary of CPD requirements, supplied by Rachel.

We are also thrilled to announce that 6 of our genetics episodes from our catalogue (‘genetics module’) have been approved for official CPD hours for General Practitioners. These episodes are:

• Episode 10: Familial hypercholesterolaemia (FH)
• Episode 15: Lynch syndrome
• Episode 21: Marfan syndrome
• Episode 30 & Episode 31: BrCa (Breast Cancer genes)
• Episode 40: Carrier screening

Register with us on our website (https://thismedicallife.com.au/) and we will send you a certificate to lodge with your CPD home to claim 5.75 hours when you have listened to them.

We have also registered with https://www.patreon.com/ThisMedicalLife where you can subscribe for free to get a short update when new episodes are published, or make a one-off or regular contribution to help fund this work, which is being created without any outside funding support.

With your support, we hope to accredit more of our episodes in the future. Thank you to all of our listeners.

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