Patients with colorectal cancer often have their diagnosis, treatment, and care discussed at a regular multidisciplinary team meeting. This includes: gastroenterologists, surgeons, oncology, radiation oncology, pathologists, home care nurses, oncology nurses, genetic councillors, care coordinators plus others. This is the third episode of a three part series on colorectal cancer. This episode focuses on management. Many thanks to Dr Tristan Rutland who helped organise this series. This is the story of colorectal cancer (part 3). Our special guests: Dr Stephanie Lim: medical oncologist who works at GenesisCare and Macarthur Cancer Therapy Centre Dr Meredith Johnston: radiation oncologist who works at Liverpool hospital Dr Emilia Ip: medical oncologist and cancer geneticist at Liverpool hospital This Medical Life podcast is available on all podcasting services and Spotify.

The lifetime risk for colorectal cancer is 1 in 23 men and 1 in 25 women. Detecting and diagnosing cancer is a critical step in managing a patient’s health as well as the multidisciplinary team where their care is discussed. This is the second episode of a three part series on colorectal cancer. This episode focuses on diagnosis. Many thanks to Dr Tristan Rutland who helped organise this series. This is the story of colorectal cancer (part 2). Our special guests: Dr Milan Bassan: gastroenterologist and Director of Endoscopy at Liverpool Hospital and returning guest Dr Scott Mackenzie: surgeon and senior lecturer at the Liverpool Hospital and returning guest Dr Tristan Rutland: lecturer, award winning anatomical pathologist for teaching and regular guest This Medical Life podcast is available on all podcasting services and Spotify.

Colorectal cancer accounts for ~10% of all new cancer diagnoses. Fortunately, over the last three decades, the 5 year patient survival has increased from 56% to 71%. As with most cancers, the key to good outcomes is early detection. This is the first episode of a three part series on colorectal cancer. This episode focuses on screening. Many thanks to Dr Tristan Rutland who helped organise this series. This is the story of colorectal cancer (part 1). Our special guests are: Professor Ken Sikaris: chemical pathologists, Director of Chemical Pathology at Dorevitch Pathology and regular guest Dr Milan Bassan: gastroenterologist and Director of Endoscopy at Liverpool Hospital and returning guest Dr Tristan Rutland: lecturer, award winning anatomical pathologist for teaching and regular guest This Medical Life podcast is available on all podcasting services and Spotify.

Troponin is a protein found in heart muscle that was a game changer when it came to diagnosing heart attacks and myocardial injury in the late 1990s. Three decades later, it is an invaluable test with widespread use throughout medicine. Troponin assays are venturing into their 5th generation with high-sensitivity and Point-Of-Care (POC) devices. However, there are important exceptions, caveats and pitfalls for doctors to know. This is the story of troponin. Our special guest: Our special guest is Dr Christina Trambas who is a chemical pathologist, Medical Director at St Vincent’s Pathology and chair of the Royal College of Pathologists of Australiasia (RCPA) Troponin Working Party. This Medical Life podcast is available on all podcasting services and Spotify.

Our eagle-eyed This Medical Life podcast listeners will wonder why we have called this episode 100 … is that right? Well, it kinda is. If you add up both This Pathological Life and This Medical Life podcasts episodes, it’s well over 100 episodes. This is a small milestone for this ‘Trav and Steve’ dynamic duo who have never resolved the question: which one is Robin? In honour of this achievement, we reflect upon the life and death of an amazing poet and author Oscar Wilde. We dive back into the 1850s to 1900s when modern medicine was at its infancy and the ‘love that dare not speak its name’ was a crime. This is the story of Oscar Wilde Our appreciation goes out to our listeners who we hope will enjoy this flight of fancy episode and reflect on where we have come from, where we are, and where we are heading. Our special guest: We have no special guests this episode, other than some choice quotes from the man of the hour, Oscar Wilde. This Medical Life podcast is available on all podcasting services and Spotify.

Throughout history, humanity has been captivated by heroes overcoming immense challenges—from ancient legends to modern Marvel icons. In this episode, Dr Travis Brown and Steve Davis are honoured to have Janine Watson, a Paralympian athlete who reached out to us after our episodes on Chronic Traumatic Encephalopathy (CTE) (Episode 53 and Episode 54) opened her eyes to the unrecognised trauma her brain and body have endured. This is the story of Janine Watson’s journey from MS diagnosis to history making Paralympian. And how listening to a particular episode of This Medical Life changed her future. Our special guest: Paralympian, Janine Watson. This Medical Life podcast is available on all podcasting services and Spotify.

In this episode, Steve Davis and Dr. Travis Brown reflect on the journey through Series 5 of This Medical Life. From discussing the impact of episodes on medical professionals to revisiting significant stories and breakthroughs, this episode provides a retrospective on the memorable moments and invaluable lessons learned. Whether it's the exploration of vitamin B6's role in patient care or the unexpected feedback from a Paralympian, this recap offers you a chance to catch up on episodes you might have missed and gain deeper insights into the world of medicine. Our special guest: We do include an excerpt of Dr Adam Cifu from the podcast, Econtalk, What's Happening Inside Your Doctor's Head And Heart. This Medical Life podcast is available on all podcasting services and Spotify.

Thyroid lumps have always been with us. Often referred to as goitres (interpreted from Latin to mean neck swelling), numerous ancient medical sources mention these and how to manage them. However, it has only been with modern medicine and investigations that we can distinguish between benign and malignant lesions. In this episode, we examine the investigations, diagnosis, management and prognosis of thyroid lumps. This is the story of Thyroid lumps (Part 2) Part 1 focuses on cytology and surgery for thyroid. Part 2 focuses on anatomical pathology and molecular/genetics. Our special guests: Professor Yuri Nikiforov is the Director of the Division of Molecular Anatomic Pathology at the University of Pittsburgh School of Medicine. Co-developer of the test we discuss in this episode, ThyroSeq. Dr Tiffany Symes is a histopathologist and deputy director of Anatomical Pathology at Melbourne Pathology. She is also featured in part one. Dr Rachael Chambers is a histopathologist at Sullivan Nicolaides Pathology, Brisbane. This Medical Life podcast is available on all podcasting services and Spotify.

Thyroid lumps have always been with us. Often referred to as goitres (interpreted from Latin to mean neck swelling), numerous ancient medical sources mention these and how to manage them. However, it has only been with modern medicine and investigations that we can distinguish between benign and malignant lesions. In this episode, we examine the investigations, diagnosis, management and prognosis of thyroid lumps. This is part one of the story of Thyroid lumps. Our special guest: Dr Tiffany Symes is a histopathologist and deputy director of Anatomical Pathology at Melbourne Pathology. Associate Professor James Lee is a leading endocrine surgeon in Australia, co-editor of the Endocrine Surgery section of the ANZ Journal of Surgery and deputy co-chair of the Endocrine Surgery Section of the Royal Australasian College of Surgeons. This Medical Life podcast is available on all podcasting services and Spotify.

A common myth about epilepsy is that women who suffer from this condition should avoid getting pregnant. This is simply not true. It can be safely managed for both the mother-to-be and future child. Epilepsy is not a contraindication for pregnancy. Certainly there are additional precautions and steps that should be taken when a woman who has epilepsy is considering starting a family and it requires a multidisciplinary approach. This is the story of pregnancy and epilepsy. Our special guests include: Daisy Beyer who lives in Melbourne with her husband and son expecting their second child in August of this year. Daisy is a registered psychiatric nurse and lives with generalised epilepsy. Dr Amber Moore is an obstetrician and gynaecologist working in Melbourne, Federal Councillor for the Royal Australian & New Zealand College of Obstetricians & Gynaecologists, and deputy chair of the Continuing Professional Education Committee. Professor Mark Cook is a consultant neurologist, Director of Neurology and Chair of Medicine at St Vincent’s Hospital in Melbourne. He was awarded an Officer in the Order of Australia for distinguished service to neurological medicine and treatment research for epilepsy. Anna Heldorf lives in Melbourne with her partner and is a public servant. Anna was diagnosed with juvenile myoclonic epilepsy and had her first baby in April this year. Our gratitude goes to Dr Amber Moore for her assistance in helping get this episode together. This Medical Life podcast is available on all podcasting services and Spotify

Tonsillectomies are one of the most common operations both today and historically, however, it has always been mired in controversy. In ancient times, this was touted as being either life-saving or completely unnecessary and continued to be a polarising topic into the twentieth century. An evidence based approach has helped to provide guidelines such as the Paradise criteria. However, there is always nuance and particular patient circumstances that play a role in deciding if surgical management is appropriate. We talk to one of Australia’s foremost experts to help us navigate this topic. This is the story of Tonsillectomies. Our special guest: Dr Eric Levi is a triple-Fellowship trained Specialist Otolaryngologist (Ear Nose & Throat), Head & Neck Surgeon based in Melbourne, Australia. He has completed Fellowships in Head & Neck Surgery, Facial Plastic & Reconstructive Surgery and Paediatric Otolaryngology.

Over two-thirds of the world’s population lose the ability to metabolise during their lifetime (the majority during childhood). We know today that lactose intolerance, or lactase persistence, has a strong genetic predisposition. Almost 100% of Asians, 70% of African-Americans, East Indians, US Hispanics and approximately 50% of Spanish and French have very low levels of lactase in adulthood (what we would call lactose intolerant). Alternatively, the majority of Caucasians can tolerate lactose into adulthood. Testing for lactose intolerance/lactase persistence can be done either via chemical or genetic testing. Each has their advantages and disadvantages but is important for any doctor or patient to know about. This is the story of Lactose intolerance. Our special guests: Dr Michael Page is a Chemical Pathologist and Chief Executive Officer at Clinipath in Western Australia. Dr Melanie Galea is a Genetic Pathology specialist and Director of genetics at Douglass Hanly Moir Pathology in Sydney.

Pelvic pain is a difficult and challenging medical condition for both patients and doctors. It can be debilitating for women that can begin as a teenager or a young adult and progress for years impacting every facet of their lives. Similiarly, pelvic pain can be challenging for symptom to assess and manage for doctors as there are a multitude of causes that range from simple and straight forward to complex and chronic diseases such as endometriosis. In this episode we discuss pelvic pain and endometriosis with two guests who are leaders in diagnosis, treatment and management. Travis also references a previous episode that touched on this issue: The Tragedy Of The Wandering Womb. Also, Associate Professor Susan Evans, promised to share a link to this paper (click to download): An Embodied Predictive Processing Theory of Pain Experience (NEI Ensemble Paper). This is the story of pelvic pain and endometriosis Our special guests: Dr Alecia Macrow who is a General Practitioner, owner of Thrive Family Practice, and one of 22 clinics around Australia that received government funding to assist patients with pelvic pain and endometriosis. Associate Professor Susan Evans who is a Gynaecologist, Surgeon and Pain management physician in Adelaide. Associate Professor Evans is Executive Chair of the Pelvic Pain Foundation of Australia and CEO of Alyra Biotech which is a biopharmaceutical company developing intrauterine products for pain relief. This Medical Life podcast is available on all podcasting services and Spotify.

Vitamin B6 is a common additive in supplements, energy drinks and breakfast cereals. In rare circumstances though, it can reach levels toxic levels and cause neurological symptoms the mimic neurodegenerative disease. This year newsGP reported a case where a GP took magnesium supplements for muscle cramps and over the course of a few years resulted in vitamin B6 toxicity that caused peripheral neuropathy and difficulty walking. Fortunately, vitamin B6 toxicity is rare but it is an important condition for doctors to be aware of particularly in the setting of patients presenting with peripheral neuropathy. This is the story of vitamin B6. Our special guest: Our special guest is Dr David Kanowski who is a senior chemical pathologist at Sullivan Nicolaides Pathology. This Medical Life podcast is available on all podcasting services and Spotify.

Scleroderma is a disease characterised by the hardening and tightening of the skin and connective tissues. The first medical description can be traced back to the 1750s. Our understanding has evolved over the centuries but the pathogenesis remains largely unknown. The disease as several forms including diffuse and localised. Symptoms include skin discoloration and tightness to more severe complications like organ dysfunction. Fortunately we have several different treatment options available for patients that can assist them in managing this disease. This is the story of Scleroderma. Our special guest: Our special guest is Dr. Daman Langguth, a renowned clinical and laboratory immunologist with deep expertise in autoimmune diseases. Dr. Langguth discusses the importance of recognising scleroderma’s symptoms, the critical nature of early diagnosis, and the latest advancements in treatment. This Medical Life podcast is available on all podcasting services and Spotify. Help support us at https://www.patreon.com/ThisMedicalLife

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 microbiologist 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.

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

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

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

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

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

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.

And that’s another year done. A huge thank you to all of our guest speakers who have been generous with their time and expertise. We would also like to thank our listeners and hope you enjoyed the episodes. This episode is a mini reflection on this year’s episodes, a link to one of Steve’s favourite podcasts, some TML clips, and an embarrassing memory lapse on my behalf…thanks for keeping that part in Steve & Tim.  Random acts of Medicine on EconTalk podcast: https://www.econtalk.org/anupam-bapu-jena-on-random-acts-of-medicine/ This Medical Life podcast is available on all podcasting services and Spotify.

During the mid-twentieth century, menopause was touted as a severe disease that destroyed women’s femininity and was a burden to their husbands. Thankfully, today we recognise menopause as a natural part of ageing and conversations about it are happening more and more. In this episode, we have four special guests: Niki Bezzant: award-winning writer, author, journalist and media personality from New Zealand who has written the book ‘This Changes Everything: the Honest Guide to Menopause and Perimenopause’.  Dr Carmel Reynolds: General practitioner and SA/NT board member on the Australian Menopause Society Dr Angelique Swart: Obstetrician & Gynaecologist with an interest in post-menopausal bleeding Dr Ashley Winter: Urologist and Sexual health specialist Australasian Menopause Society This Medical Life podcast is available on all podcasting services and on Spotify

In July 2020 in the midst of a global pandemic, we released our first episode called ‘What is pathology?’ with This Pathological Life podcast. We hoped to create something that would entertain and education the audiencem and shed light on to some of the amazing stories and characters in medicine. In creating these podcasts, I am always thankful and appreciative to our guests who willingly give their time and expertise. If there is anyone who has excited our audience, been an inspiring teacher and a fantastic storyteller, it is Professor Graeme Suthers. He has been involved in the following episodes over the last four years: This Medical Life podcast: Ep 40 Carrier screening Ep 30 BRCA (Part 1) Ep 21 Marfan syndrome Ep 15 Lynch syndrome Ep 10 Familial Hypercholesterolaemia This Pathological Life podcast: Ep 45 Pharmacogenetics Ep 44 PKU and Cystic Fibrosis Ep 33 Fragile X Ep 13 Trisomy / Chromosomal abnormalities On the 30th of June 2023, Professor Graeme Suthers retired and we wanted to take some time to thank him, but also ask him some questions and reflect on his career. This is the story of Professor Graeme Suthers. This Medical Life podcast is available on all podcasting services and Spotify.

On the 1st of November 2023, the Australian Government will release new guidelines for screening prostate cancer with the Prostate Specific Antigen (PSA) blood test. These guidelines are based upon the Clinical Practice Guidelines (CPG) published in 2016 with new items to be included in the Medicare schedule. These items are based upon the Prostate Cancer Foundation and the Cancer Council of Australia guidelines that have been endorsed by the NHMRC, RACGP, and USANZ. We speak to Professor Ken Sikaris who has been at the forefront of these new recommendations. Our special guest is Professor Ken Sikaris who is a chemical pathologist and Director of Chemical Pathology at Melbourne Pathology. This Medical Life podcast is available on all podcasting services and Spotify.

We continue the second episode of this two part series on breast screening and mammograms focusing on the future. In this episode, we talk about the importance of breast density as a new risk factor, personalised breast cancer risk assessment (iPrevent developed by Peter MacCallum Cancer Centre https://www.petermac.org/iprevent), and discuss a personal account with Dr Sandy Minck. Special guests: Associate Professor Michelle Reintals is the Director of BreastScreen South Australia and an Australian trained radiologist with extensive and international experience in breast screening and mammography. Professor Kelly-Anne Phillips is a medical oncologist who cares for breast cancer patients and is a researcher at Peter MacCallum Cancer Centre that is internationally recognised in breast cancer genetics and treatment. Doctor Sandy Minck is a fellow of the Royal Australian College of General Practitioners and an advocate for breast density awareness and personalised risk assessments. She has personal experience in this area as both a doctor and a patient. This Medical Life podcast is freely available on all podcasting services and Spotify.

A critical tool in the fight against breast cancer is population screening. Early detection, surgical intervention +/- further treatment has dramatically reduced advanced disease and mortality rates but it still remains the most common cancer worldwide. In this episode, we focus on the history of breast cancer, the development of mammograms and early detection with our understanding of the underlying pathology. Our special guests include: Associate Professor Michelle Reintals is the Director of BreastScreen South Australia and an Australian trained radiologist with extensive and international experience in breast screening and mammography. Associate Professor Wendy Raymond is a histopathologist who has specialised in breast pathology and cytology. A/Professor Raymond is a past president of the Australian Society of Breast Disease and co-edited the IAC Yokohama system for reporting breast FNA biopsies. This is the first part of a two-part series on breast screening, focusing on the present. The second part (coming soon) will focus on the future.

Our understanding of the world today is constantly changing. What was once considered truths and facts can, in hindsight, be seen as misguided or wrong. It may be challenging to accept but becomes evident over time that the things we learn today may become irrelevant or superseded in the future and this is particularly relevant to medicine. Scientometrics is the quantitative study of science and the rate at which change occurs. Today, we discuss this topic with scientist and author Sam Arbesman, to ask the following question: what is the rate of change of facts in the field of medicine? Our special guest is Sam Arbesman who is a scientist and author of Overcomplicated: Technology at the Limits of Comprehension and The Half-Life of Facts.

Vitamin D has been a controversial topic in recent times with the debate continuing over appropriate testing, adequate levels, and the evidence for treatment. We discussed the appropriateness of testing and chemical pathology component with Professor Ken Sikaris (Episode 25), but what does the research tell us about diseases associated with Vitamin D and the utility of replacement? We discuss this with Professor Scott Byrne from The University of Sydney. Our special guest is Professor Scott Byrne from the Westmead Institute for Medical Research. Professor Byrne is also Co-director of the Centre for Immunology and Allergy Research and Head of the Cellular Photo-immunology Group in the School of Medical Sciences at Sydney University. This is the second chapter in the story of Vitamin D.

Professor Peter Doherty trained as a veterinarian before venturing into immunology research. Professor Doherty travelled extensively throughout his career and has undertaken numerous research posts around the world. The achievement that he is most noted for is he was able to demonstrate how the body distinguished between virus-infected cells from non-infected cells and was awarded the Nobel Prize for Physiology or Medicine in 1996. However, there is far more that he has achieved throughout his career. Professor Doherty has been a strong advocate for science communication to the general public at large. He has written numerous books, commented extensively on environmental sustainability and climate change, as well as an active participant and medical voice to the public during the recent Covid-19 pandemic. Our special guest is Professor Peter Doherty, Nobel Prize winner in Physiology or Medicine 1996, Author, Science commentator, and Professor at the faculty of medicine at the University of Melbourne. This is the story of Professor Peter Doherty.

The double helix structure of DNA was the discovery of the century. However, the story about the discovery is mired in controversy as one of the major contributors, Rosalind Franklin, was conspicuously absent from acknowledgements and died (and subsequently not named) before the Nobel Prize was awarded. In 1968, James Watson wrote the book ‘The Double Helix: A Personal Account of the Discovery of the Structure of DNA’ and reads more like a fictional detective novel than an autobiographical account with the portrayal of Franklin as a forceful, gruff and confrontational. Recently, an article in Nature shows an unpublished news article from 1953 (at the time of the discovery) that Franklin’s contribution was crucial to uncovering the structure of DNA. Today, we talk to one of the authors of the article in Nature, Nathaniel Comfort, who is Professor of the History of Medicine at John Hopkins University. Link to the article: https://www.nature.com/articles/d41586-023-01313-5 Our special guest is Professor Nathaniel Comfort from the John Hopkins University. His interest lies in the histories of genetics, eugenics, genomics and biomedicine. He has authored two books (The Tangled Field and The Science of Human Perfection), written for Nature, The Atlantic, The Nature as well as appeared on PBS, National Public Radio and the BBC. This is the story of the DNA double helix.

Essentially every culture, modern or ancient, understood that health and faeces are inherently linked. The Ancient Chinese practiced ‘copromancy’ which was the assessment of health based upon the shape, size and texture of faeces. Today we have the Bristol Stool Chart that helps us to classify faeces/poo into seven different groups. As disconcerting as it may be, the state of our poo can tell us a lot about our own health and this is only going to increase as our knowledge about our faecal microbiome expands. The faecal microbiome is the composition of all the microorganisms within our faeces. We are learning that the composition not only affects our health but can also be contributory to diseases we experience. In some circumstances, this has also become a treatment with faecal transplantation to manage treatment resistant clostridium-difficile colitis. This is the story of the faecal microbiome. Our special guests: Dr Piers Mitchell, who is a hospital specialist consultant in the NHS and co-editor of the International Journal of Osteoarchaeology. Dr Mitchell has trained in paleopathology, osteoarchaeology, parasitology, medical history, and orthopaedic surgery. Dr Vincent Ho, who is a Gastroenterologist practicing in NSW, is an Associate Professor at Western Sydney University and head of a research laboratory.

In 1891, Guido Werdnig documented two cases of brothers who had global progressive muscular weakness. In 1935, Dr Dorothy Anderson conducted an autopsy on a young child who had died from malnutrition due to suspected coeliac disease despite being on the upon treatment. In 1943, in inherited form of intellectual disability in boys was described by Martin and Bell. The diseases are Spinal Muscular Atrophy, Cystic Fibrosis, and Fragile X syndrome respectively. The learning curve for genetics in the last 100 years has been a steep one. Recessive genes circulate in the general community and for the most part, they are hidden and play no part in day-to-day life. Some may even have had a survival advantage in pre-modern times. However, if two parents each carry matching recessive genes, there is an increased chance that their children can have a severe or even life-threatening illness. Carrier screening provides a test for parents to assess this risk, however, it also requires an understanding of the testing paths, risks and cost from requesting doctors. This is the story of carrier screening Our special guest is Professor Graeme Suthers who is the Director of Sonic Genetics Australia. Additional information: Link to further information about reproductive carrier screening: https://www.sonicgenetics.com.au/patient/test-information/rcs/ Link to carrier screening online patient course: https://www.sonicgenetics.com.au/patient/test-information/rcs/carrier-screening-online-patient-course/

Seasonal influenza causes significant morbidity and mortality every year but can often fall into the underestimated category. Between 10-30% of the general population are infected each year with influenza that leads to an increase in hospital and intensive care unit admissions, the onus for prevention and early intervention has never been more important. Our special guest is Associate Professor Paul Griffin from the School of Medicine at the University of Queensland and is an Infectious Disease Specialist at Mater Health. This is the story of influenza.

In 1998, a 6 page report published in the Lancet that would later be described as one of history’s great science frauds. The article was titled “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive development disorder in children” but the news headlines ran with a much shorter version: the MMR vaccine causes autism. The article was written by Andrew Wakefield, a British gastroenterologist turned researcher, who had taken it upon himself to deceive the medical community and general population at large. Fortunately, investigative journalist Brian Deer uncovered the truth behind this ‘study’ through hard work, significant obstacles and persistence. Although Wakefield’s claims have been thoroughly discredited, we still feel the impact of this fraud to this day and he has become an icon of the anti-vax movement. Our special guest is Brian Deer who is an award winning investigative journalist and bestselling author for The Doctor that Fooled the World, published in 2020. This is the story of the MMR vaccine fraud.

In 1834, Robert Graves gave a lecture series on the ‘Newly observed affection of the thyroid gland in females’. He presented three women who had violent palpitations, enlarged thyroids, and an apparent enlargement of the eyeballs (later it would be called ‘exophthalmos’). In 1912, Hakaru Hashimoto reported a new disease in a German journal after examining microscopically the thyroid tissue from four middle-aged women. He noted the lymphocytic infiltration and likened it to other conditions containing lymphocytes (ie. Sjögren syndrome) and named it ‘Strum lymphomatosa’. It would not be until the 1950s that the underlying mechanism of these diseases would be known: autoimmunity. The former, now known as Graves’ disease, and the latter Hashimoto disease are the most common causes of hyperthyroidism and hypothyroidism respectively. Our special guest is Dr Daman Langguth who is an immunology and Head of the Immunology Department at Sullivan Nicolaides Pathology. This is the story of autoimmune thyroiditis.

Since recorded history, heartburn has been a common complaint and the descriptions from ancient physicians are virtually indistinguishable from today’s accounts. However, one thing we do know that they did not is a small subset of patients whose long standing heartburn could predispose them to a precancerous condition known as Barrett oesophagitis. Barrett oesophagitis is caused by chronic gastro-oesophageal reflux disease with a number of known risk factors for developing this. These patients require regular monitoring +/- intervention as they have an increased rate of developing oesophageal adenocarcinoma. For this episode we have called in some specialists to help us out. Our guests include: Dr Tristan Rutland – Anatomical Pathologists who specialises in Gastrointestinal Pathology Dr Milan Bassan – Gastroenterologist who is Head of the endoscopic department at Liverpool Hospital This is the story of Barrett Oesophagitis.

Professor Ian Frazer pioneered the development of the first Human Papilloma Virus (HPV) vaccine which has seen a reduction of HPV infections in young women between 70-86% and the incidence of cervical cancer rates drop by 90%. Few doctors/scientists have had such a profound impact on the health of so many people. Today we talk to Professor Ian Frazer about his career, the events leading up to the HPV vaccine development, and the future of this life-saving medicine. Some of Professor Ian Frazer awards include: Australian of the Year (2006) Prime Ministers Prize for Science (2008) The Balzan Prize (2008) Fellow of the Royal Society of London (2012) Companion of the Order of Australia on the Queen’s Birthday Honours list (2013) Immunology research department named the Frazer Institute at the University of Queensland This is the Story of Professor Ian Frazer and the development of the cervical cancer vaccine.

In 1964, a young woman was murdered as she walked to her apartment in Queens, New York. Her screams were left unanswered. No one came to her help. Within the space of thirty minutes, the assailant would return two more times to stab her again and again. The woman died. The number of witnesses to this crime who did not help was: 38. Two psychologists posed a question: how could this happen in such a heavily populated city? Two other landmark studies occur around this time including the Milgram experiment and the Stanford prison experiment. Two experiments that range from insightful to controversial. However, all of these have captured the attention of psychologists and students, and helped us to learn more about ourselves. If nothing else, the latter certainly taught how one should not conduct a psychology study. These are some of the stories of psychology from the 60s.

In 1912, Merck Pharmaceuticals was searching for a blood clotting agent to compete with a competitor in the market. One of the agents, a chemical by-product (and not even named) was produced and patented without any significant testing. This was a drug that we would come to know as MDMA or Ecstasy. In the 1960s, this drug found it’s way into use by a Chilean psychiatrist for psychotherapy, Dr Claudio Naranjo. He found that it helped patients to open up, it intensified emotions, gave access to suppressed memories, and provided insights. In the 1970s and 1980s, the recreational use of MDMA became prevalent but also became a focus in the war on drugs with both political and scientific powers advocating strongly against its use. Today, the experimental studies confirm that MDMA is very useful in a controlled medical setting for the use of patients suffering from Post-Traumatic Stress Disorder (PTSD). Our special guest is Dr Stephen Bright who is a clinically-trained psychologist, senior lecturer at Edith Cowan University, researcher into psychedelic science and co-founder of Psychedelic Research in Science & Medicine (PRISM), an Australian non-profit research association that supports formal research into psychedelics such as primarily MDMA. There is additional information for GPs about MDMA posted. This is the story of Ecstasy.

The medicinal properties of aspirin (acetylsalicylic acid) have been well-documented for hundreds of years. It seems even our ancient ancestors thousands of years ago had some insight into its healing properties even if the usage was misguided. We are still learning about aspirin and the best ways to use it. Our special guest is Professor Simon Dimmitt, a Physician in General and Cardiovascular Medicine. He has released a website providing evidence-based prescribing for Doctors. This is the story of Aspirin.

This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings.  Merza, E.Y., Pearson, S.J., Mallows, A.J. and Malliaras, P., 2023. The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study. Physical Therapy in Sport. Mallows, A., Jackson, J., Littlewood, C. and Debenham, J., 2020. The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study). Musculoskeletal Care, 18(2), pp.169-176.

We have known for a while that type of exercise intervention (e.g. intensity, frequency, etc) does not seem to influence self-reported outcomes such as pain. Maybe all the benefits from exercise are explained by non-specific effects, or maybe exercise has benefits that do not depend on the type of exercise. In this episode, I discuss 3 studies that look into (at least partly) other benefits that we may see at the level of the muscle and tendon from higher-load exercise interventions.  References: Radovanović, G., Kunz, J., Bohm, S., Arampatzis, A. and Legerlotz, K., 2021. Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function. Journal of Sports Sciences, 39(24), pp.2786-2795. Radovanović, G., Bohm, S., Peper, K.K., Arampatzis, A. and Legerlotz, K., 2022. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Medicine-Open, 8(1), pp.1-19. Radovanović, G., Bohm, S., Arampatzis, A. and Legerlotz, K., 2023. In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial. Journal of Clinical Medicine, 12(3),

A continuation of Episode 30. In this episode, we discuss the continued management of patients with Breast Cancer and the BRCA pathological variant. Our special guests: Associate Professor Nick Murray who is a Medical Oncologist and Director of the Medical Oncology Unit at the Royal Adelaide Hospital Cancer Services Dr Eryn Dow – Medical Oncologist and Clinical Cancer Geneticist It is important to note that while Breast Cancer is the most common cancer in women, the discussion of BRCA and familial breast cancer accounts for ~10% of cases. This is a complex disease that we are learning about every day and with the remainder of Breast Cancers accounting for 90%, it is a topic we will be revisiting in the future. This is the continued story of BRCA.

This week, I had an engaging conversation with Anthony Nasser, an up-and-coming researcher on tendinopathy who recently completed his PhD on proximal hamstring tendinopathy. Our discussion covered the reasons for the lack of research attention towards this condition, the current state of evidence, and insights from his doctoral studies. You can find the full conversation here. Here are Anthony's related publications: Nasser, A.M., Pizzari, T., Grimaldi, A., Vicenzino, B., Rio, E. and Semciw, A.I., 2021. Proximal hamstring tendinopathy; expert physiotherapists’ perspectives on diagnosis, management and prevention. Physical Therapy in Sport, 48, pp.67-75. Nasser, A.M., Vicenzino, B., Grimaldi, A., Anderson, J. and Semciw, A.I., 2021. Proximal hamstring tendinopathy: a systematic review of interventions. International journal of sports physical therapy, 16(2), p.288. Nasser, A., Semciw, A., Grimaldi, A., Rio, E., Pizzari, T. and Vicenzino, B., 2022. Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol. Physical Therapy Reviews, 27(4), pp.313-319.

Palpation can be useful for the diagnosis and assessment of tendinopathy, but there are limits. This is because non-painful tendons can be tender, and tenderness in painful tendons seems to be very slow to get better.  Link to Evidence for Improvement in Local but not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Tendinopathy: A Systematic Review Link to  Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

In 1866, a French physician by the name of Pierre Paul Broca recognised a terrifying disease running through the women of his wife’s family: breast cancer. He wrote that they could be well and have perfect health before this ‘germ’ of an illness would go off like an ‘explosion’ and could kill within 1 to 2 years. Broca studied his family for the next 30 years where he noted that 15 close relatives including his wife’s mother, his wife, and his daughter were all affected. It would not be until the late 20th century that our knowledge and scientific techniques would lead us to understand this phenomenon. Professor Mary-Claire King in the late 1980s helped to identify the genetics of the BReast CAncer gene and continued research identified another. Today we know these as the BRCA1 and BRCA2 genes. Unfortunately, women who have these BRCA gene mutations have an increased risk of breast and ovarian cancer (plus some others). The nature of this disease spans multiple specialities and, as such, we have some special guests for this episode to help us understand this disease, the treatment, and the management of this illness. This is the story of BRCA (Part 1). Our special guests for Part 1: Professor Graeme Suthers – National Director of Genetics for Sonic Pathology Australia Doctor Melissa Bochner – Breast and Endocrine Surgeon and member of BreastSurgANZ and current chair of the Breast Cancer Quality Audit

Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups. 

This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice. Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study