So you think muesli and sushi are healthy?

A comparison of two isocaloric diets for a diabetic with blood sugar control as the endpoint. Some carbohydrates in menu 1 were replaced with fat of equal caloric value and insulin was optimised in each case.
The diet with a higher proportion of fat produced much better blood sugar control for Dave. How well will it work for you? The scientific way to test this is to perform an N-of-1 trial.
If you are keen, learn the technique yourself, because most doctors don't have a clue how to do it.

Pic from nz herald.

A conference of 21 EU scientists in Parma concluded there was insufficient evidence to conclude that drinking water eases dehydration.

Brexit has brought into prominence EU edicts that their loopy academics have forced onto the UK.
Banning diabetics with purely nocturnal hypoglycaemia from driving meant people lost their licences unnecessarily. The 1994 EU regulation that bananas be "free from abnormal curvature", and not sold in large hands was "daft"

But how could a conference of 21 EU scientists in Parma concluded there was insufficient evidence to conclude that drinking water eases dehydration?

It is the same lack of logic that enables doctors to conclude that low carb diets do not work. When academics with absolutely no common sense insist that a large randomised trial analyzed by intention to treat must be published before anything can be listed as a possible treatment, both water for dehydration, and low carb diets for diabetics are rejected.

And as many have said before, it also leads to the conclusion that there is no evidence that parachutes work. After all, it is only a series of anecdotal cases that supports their use.

 James Heckman won a Nobel prize for showing how wrong these academics are. Unfortunately most doctors are too under-educated to comprehend the implications of his work.

Doctors try to ban social media posts on alternative treatments.

After years reading thousands of web pages and social media threads from around the world, I am unable to find anyone my age with T1D and Addison's who is even close to being able to do all the activities I engage in on a regular basis. And that is coming from someone whose only sporting award at school was for chess.
I attribute this to my novel non-pharmacological methods, most of which have still not been revealed in any forum.
Yet Canberra doctors have described my methods as inappropriate without even knowing what they are.
They have refused to allow me to present them in any departmental meeting. Apparently they consider their current treatment methods to be perfect, despite  ample evidence to the contrary.
As the excepts from the letter below show, they also believe they have the power to prevent me from posting details of my success on social media and stating that the methods I use are not even close to current Australian guidelines.

Their use of legal thuggery against me is pure harassment. But it will not stop me skiing, running and bouldering this winter in a way which no one my age and with my diseases can match. A dozen bottles of expensive wine to the first person to prove me wrong.

Dramatic new figures on the number of insulin-dependent Australians

RMIT and Diabetes Australia think that more than a million Australians will die if insulin becomes unavailable. That is more than 4% of the population.
As the punchline to the two positives make a negative joke goes, Yeah, right!
Medical academics really are some of the most clueless people you will ever meet.

An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery

An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery was conducted for the purpose of quality assurance. This comprised all elective cases up until the end of 2014 in which I was the primary anaesthetist.

Outcomes of interest include the scope of operations for which anaesthesia was provided, the usage of and complications from trans-oesophageal echocardiography (TOE), and adverse outcomes, both major and minor.

Scope of surgery

Operation type	Freq.	Percent
Cabg	329	60.37
Avr +/- cabg	128	23.49
Mitral +/-cabg	36	6.61
Opcab	11	2.02
Other	12	2.20
Other valve	8	1.47
Redo cabg	9	1.65
Redo valve	12	2.20
Total	545	100.00

Other valve cases included tricusip and multiple valve surgery. Other non valve cases included ASD closure, atrial myxoma and lipoma, HOCM surgery, pericardiectomy on bypass, aortic root replacement and Bentall procedure. Arrhythmia ablation was performed concomitantly in 3 cases.

Not included in this review are emergency cases for cabg or dissection, cases such as pericardial window which did not use bypass, take-backs, or combined AAA/cabg surgery. The cases that are included are those which provide useful information for prospective patients about to undergo elective cardiac surgery.

Adverse outcomes

Death: Death within 24 hours of anaesthesia is a definition which fails to capture the majority of anaesthesia-related deaths, so was not used. Death within 30 days of surgery is a standard measure, but data for this is not available to me. Failure to leave ICU alive was the most inclusive definition for which I have reliable data. There were two cases – a patient who died in ICU 4 days post-operatively with an IABP that had been placed before surgery. A second patient also died in ICU more than 24 hours after surgery.

Other: There were no major airway, TOE, CVL or other problems complications.

Summary

An audit of 545 consecutive cases of anaesthesia for elective cardiac surgery was conducted for the purpose of quality assurance. This information can be used to inform prospective patients about the performance of this particular surgical unit. The audit is to be repeated once a total of 750 patients is reached.

Wikipedia knows more than most doctors about diabetes.

This was standard advice in the 1970s and earlier, but nowadays doctors seem intent on imposing their own ignorance on patients, with not so much as a case series showing long-term high level functioning with low fat eating.

The Canadian Diabetes Association love the Banting LowCarbHighFat diet so much they made it their phone number.

I'm sure they love Fred too.

More bullying and harassment by Canberra doctors

Last year I wrote "Someone with the appropriate knowledge has told me that almost every patient in The Canberra Hospital catchment with Type I diabetes and on steroid replacement is in quite poor health. I am not. 

Despite almost 20 years with T1DM, and 10 years on steroids, my arteries are in superb condition, and I would be very surprised if you have heard of anyone with both conditions in the Southern hemisphere who matches me in physical performance.

I did not get this way by subscribing to local medical dogma. Quite the opposite. In many aspects of treatment I act completely contrary to the recommendations of local researchers. If you think it is just a coincidence that I am also the only doctor at TCH who has managed to complete the M Biostat, think again."

When this was reported to AHPRA, they decided it constituted evidence that I was impaired and that they needed to "investigate (my) health" They claimed that this constituted an "Own Motion notification" and was justification for applying the full force of the coercive powers they have been given.

There is no one in the world my age and with my diseases reporting anywhere near the success I have had in living a full life. (not in English anyway)

How this constitutes impairment is beyond me.

Unfortunately, the Senate Inquiry into medical bullying has been postponed due to the Federal election. But sooner or later, those clueless Canberra doctors will get their comeuppance.

How do doctors treat a blood sugar of 13 mmol/l (234 mg/dl)? They give intravenous glucose!!!

Here is the local protocol for treatment of diabetics on insulin.

It dictates that a diabetic with a blood sugar of 13 (234) be given intravenous glucose, in the form of 4%dextrose/saline, usually at 120 ml/hr. That is 120 g of glucose per day for a standard hospital patient resting in bed.
Many type 1s lead very active lives on much less carbohydrate per day than this, yet when they are confined to bed, doctors obsession with high carbs give them much more. They then treat the resulting hyperglycaemia with massive doses of insulin. The recommended starting rate equates to almost 100 Units per day, a massively supra-physiological level.
Mammalian evolution has equipped injured animals to deal with immobilising injuries without exogenous glucose, yet doctors still feel the need to overdose patients on sugar, and insulin.

Even if this results in a near normal blood sugar, problems are not infrequent. Insulin is one of the medicines most commonly listed in adverse drug reports. Any interruption of the dextrose delivery means that the patient is receiving a large amount of insulin unopposed. A low-insulin/low-glucose protocol would see hypoglycaemia developing much more slowly, and much more likely to be detected before harm was done.
Dilutional errors in the preparation of infusions are also frequently reported. A high delivery rate magnifies the effect of these.
I could also go on and on about the water load, effects in head injured patients, infection risks, longer term effects and the larger variability of blood sugars with a high glucose load...

You will also note that the protocol contains 2 contradictory thresholds at which saline should be started.
Have I previously mentioned doctors poor numeracy skills?

Bizarre ACT Health Laws - more illegal maths

ABC radio did a story this morning on bizarre laws from around the country, so I thought I would chip in with another.
Protection of confidential data by altering just some of the numbers is a technique that is used and accepted around the world. See the example below. But is it accepted inCanberra?
The technique means that the recipient is unable to determine which values have been altered, and are unable to tell whether a specific datapoint is true or false. However, because most values are intact, the recipient can glean useful summary information such as the average of certain values.
But a little-known ACT law apparently makes it an offence to transmit false health data.
This would make it illegal to create a hypothetical teaching scenario where a patient did not want some of their private details revealed to students.
Even fictional data, which is declared as such, seems to be caught by the breadth of this law.

Stay tuned for an update on the legality in the ACT of this standard statistical method.

The reason for my success. Is it because I am "prescribed a range of steroids, including prednisolone .. to manage (my) Type 1 diabetes"?

Canberra's medical investigators may have stumbled on the reason why I have been so successful at managing Type 1 diabetes.
Certainly I am pleased with my results of late. Recently running 5km in 20 minutes and 20 seconds is faster than I have run since I was 19. That was 37 years ago. ( 76% for Parkrunners)
That equates to a VO2max of nearly 50, which is an excellent prognostic factor.
How have I improved this much?
Those Canberra doctors have suggested that I use a range of steroid, including prednisolone, hydrocortisone and fludrocortisone to manage my Type 1 diabetes.

No, this is not a mistake. Those doctors were given ample opportunity to amend or retract this statement, but chose to repeat it.

In any case, why would I self-prescribe medications that are essential for me to stay alive? It would only be necessary for me to do that if my own doctor had NOT prescribed them. In which case it is my doctor who should be investigated, not me.

And what was the evidence I self-prescribed? Allegedly it is in my blog. Huh? Read for yourself. My blog says no such thing, and I promise I have not deleted anything on this.

Clearly this is a vexatious action by Canberra doctors who are desperate to discredit anyone who claims success from LCHF, or any other alternative approach, to diabetes.

Alteration of insulin dose - does it constitute illegal self-prescription? Legal clarification at last.

Following threats made against me by AHPRA for allegedly self-prescribing drugs, I sought legal clarification on the issue of patients using doses of insulin and steroids other than those prescribed by their doctor from various State Health Departments and State diabetes organisations.

The only organisation to provide a detailed response to this question was the WA Department of Health, whose reply stated that not only was dose alteration acceptable for those drugs, but self-prescription of insulin and prednisolone was also perfectly legal.

Why then the threats against me by AHPRA? It couldn't possibly be retribution for the embarrassment my blog posts have caused to some of its committee members, could it?

(WA Health also noted that although self-prescription of insulin and standard Addison's drugs are legal, this does not apply to any Schedule 8 drugs, or to any Schedule 4 medicines classified as "specified drugs" under the Poisons Act)

Can you believe why Calvary Hospital is the second most expensive in Australia?

Can you believe why Calvary Hospital is the second most expensive hospital in Australia?
According to the Health Minister "Specialist services, such as open-heart surgery, some complex brain surgery, bone marrow transplantation, and some high-level care for babies offered in the ACT do not have the same economies of scale possible in larger jurisdictions."
Calvary does NOT do open-heart surgery, complex brain surgery, bone marrow transplants, or have a high-level neonatal ICU.
How can a politician get away with such a statement? Because voters let him. Canberra people get the politicians they deserve, and the health system, and the funding cuts in other areas to pay for ACT Health incompetence.


And if you think expensive health care means good service look at the KPIs of the clipboard army.

Of course, none of this will be any surprise if you have read my previous blog posts. And if you think all that money means state-of-the-art equipment look at what happened when a surgeon repeatedly complained that the operating theatre was too hot, and the manager kept saying it was fine. Eventually, the manager brought along their thermometer to show the surgeon they were wrong.

After procuring a polystyrene cup, water and ice from the tea room, the thermometer was found to read minus 4.6 degrees C in ice water. Theatre temperature was then adjusted to what it should have been. Battle won. War goes on.

For decades, doctors encouraged patients to consume trans-fat laden oils and margarine. Why?

Don't believe me? Look at the facts. From the late 1970s, doctors persuaded  many patients to give up the butter they had previously used on their sandwiches and for cooking, and instead use margarine and vegetable oils.

As the BMJ records, there was never any good evidence that butter was contributing to cardiovascular disease. In fact, even in 1980, it was widely known that the French were consuming large amount of butter and full fat cheese, with relatively low levels of arterial disease compared to other Western countries.
Note that while dairy food does contain trans fats, these fats are completely different in their health effects from the industrially produced trans fats from hydrogenation and other processing of vegetable oils. You can find a comprehensive review of this at
Adv. Nutr. 2: 332-354, 2011

Many people currently in their 60s were conned into giving up butter and instead spent the next few decades using vegetable oils, margarines and processed foods, many of which were high in industrial trans fats.
It is only very recently that trans fats have been largely eliminated from most Australians' diets, but the damage to coronary arteries from decades of medically sanctioned consumption of trans fats is extremely difficult to reverse.
Even as recently as 2012, the Medical Journal of Australia (Editorial MJA 196 (1) 18 June 2012 ) reported many common foods such as, breakfast bars, chips, popcorn, savoury and sweet biscuits, and pastries contained unacceptable levels of trans fats, often without labelling. This particularly applied to the cheaper brands.

Those health nutters who have always believed in consuming the same natural, minimally processed foods that their ancestors had eaten for centuries never fell for the margarine and hydrogenated vegetable oil  trap. They didn't need to read all the scientific literature to tell them that doctors didn't have a clue. We stayed with butter and olive oil, ghee and coconut cream. And we certainly didn't eat bars for breakfast.

Coles canola oil 4.6g Trans fat/100ml

How well do you understand food labels? Try this quick quiz

I have 2 brands of the same product. The ingredient list is the same for both.  Neither contains any artificial sweetener or alcohol. Both have been processed the same way and both are about 21% protein. Numbers are per 100g serve.

                     Energy   Carbs   Sugars   Fat      SaturatedFat   Fibre           Sodium

Brand A     1550kJ    11g        1g          21g        13g                28g               30mg

Brand B      1620kJ   39.5g    <1g        23g        14.5g             not stated      16mg


What is the difference? Why?

If you would vary your insulin depending on which brand you were using, ask yourself whether you really get it.

Added 29.4: if you understand the above, you should also understand why the food label on a related grocery item I bought at Woolies today showed ingredients adding to 120g/100g. (no, I was not adding the sugar and total carbs together, or counting both the saturated and total fat, etc)

How is your maths? Are your diabetes and steroid algorithms as good as mine?

Oops! Some of this standard 9X9 Sudoku is missing, but there is still enough information to determine the next move. Just add one correct number. If this is too easy and the answer is obvious from a brief look, then lots of harder problems can be found at https://diabeticathlete60.blogspot.com

 

I'm sick of hearing doctors say healthy eating is expensive

It is completely untrue to say that take-away and junk food are cheap calories, and that people eat them because healthy food is expensive. Do the maths.

Yes, activated organic jimbu salad from a trendy hipster cafe is beyond many families, but there are cheaper options.

Even if you buy coca-cola cans in bulk for the cheapest price around here, you are still paying $A10.00 per kilo for the carbohydrate content. The same supermarkets sell rice for a dollar per kilo, or about SA1.40 per kilo of carbohydrate. And take-away is hugely expensive as a source of protein.

These PNG highlanders lived on not much more than a dollar a day, had very little formal education and didn't speak English, but they knew how to eat healthy. No, they are not cannibals, but they do know how to set up an interesting photo for a gringo.
What little communal money they had was spent on 20 kg sacks of rice and the cheapest fish they could buy - usually boxes of tinned mackerel. They grew/gathered vegetables and occasionally caught small animals and birds in the forest. They never bought take-away or junk food. They couldn't afford it.

Attempts by health groups to supply fresh vegetables to people in remote parts of central Australia are completely misguided, expensive and wasteful when the produce wilts before reaching its destination. Tinned and dried vegetables are extremely nutritious. I know of no research which shows a convincing health benefit of fresh vegetables over an ample supply of preserved ones.

In fact, in his book Guns, Germs and Steel, Jared Diamond theorised that learning to manage without fresh produce contributed to the success of Western civilization. In fact it is really only since the end of WW2 that much of northern Europe has had year-round access to fresh salad vegetables.

Take-away and junk food are industries supported by ignorance, not lack of money.

Denmark's FAT TAX was a disaster. Doctors should apologise for the damage it caused.

As noted in previous posts, there was NO evidence from randomised trials that reduction in consumption of dairy fat would have beneficial health effects. Had researchers looked at successful type 1s, or other evidence, they would have concluded that exactly the opposite was true.

The tax was based on the ideology of innumerate doctors and medical academics, not science.

Whether the tax reduced fat consumption is difficult to know due to pre-tax stockpiling and cross-border purchases. It seems the tax was introduced with no intention of accurately measuring its effect adjusted for confounding variables.

Irrespective of its effect on consumption, there was NO measurable effect on heart disease.

What it did cause was
-a financial impost for the poor
-a disincentive to consume healthy dairy products
-substantial administrative costs
-hardship for danish dairy producers

Denmark's politicians voted to abolish the tax not much more than a year after it was introduced.

It is time for doctors to apologise for the damage they cause to honest citizens

ref: health.spectator.co.uk

NHMRC Dietary Guidelines on fat are not evidence based

Open Heart does not mince words.

"Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines.."

The British Medical Journal suggest clinicians be more questioning of dietary guidelines and less accepting of low fat, high carb advice.

pic tf

Full fat dairy food prevents diabetes

A huge volume of research supports the beneficial health effects of high dairy fat consumption.

Circulationaha.115.018410 In two prospective cohorts, higher plasma dairy fatty acid concentrations were associated with lower incident diabetes.

Br J Nutr,91 (4),635-42 ..Intake of milk fat is negatively associated with cardiovascular risk factors

Scand J Prim Health Care Non-obese men with low dairy fat intake were more likely to become fat in 12 years of follow up, independent of exercise, age, SES, alcohol, smoking, and fruit and vegetable intake.

Eur J Nutr 2013 High fat dairy consumption ..is inversely associated with obesity risk.

Don't just believe what the NHMRC tells you about full fat dairy. Read the original research yourself.

Added 9.5.16
The specific effect of  dairy foods in the diet of Type 1s has been raised in a forum. There is no useful data on this in the peer reviewed literature. There is, however, a fair amount of information posted on the use of dairy and sporting success in Type 1s on social media. Look it up.

Can you believe any Australian medical research?

An Inquiry into this research cleared the authors of any misconduct, and it hasn't been retracted, so it must be right.
Here are some of the reported comments on it.

Their "data was not quite right"
"They had claimed sales... were down by 10%, but..their own research actually shows a 29% increase"
"the highest levels of nutrition science in Australia... can publish whatever nonsense they want"
"acceptance of a fee from Coca-Cola " by one of the authors
NYU Professor "There's no Australian Paradox" "Sugar is.. bad for you"
Dr Rosemary Stanton "Ignore it"
"..the Australian Paradox paper was based on inaccurate data."

How bad does medical research in Australia have to be before it is retracted? Short of a researcher murdering a volunteer it is hard to know.

Can you believe what the Heart Foundation says about fat?

The Heart Foundation is reported as saying "..there is international scientific consensus that replacing saturated fat with ... polyunsaturated fat, reduces your risk of heart disease."

REALLY? Thousands of scientists and many large rigorous, randomized clinical trials say otherwise.

1. The Minnesota Coronary Experiment, a large (9,570 subjects) rigorous trial of replacement of saturated fat with vegetable oil rich in linoleic acid found no difference. A decrease in cholesterol, yes, but NO improvement in survival. (post hoc it was noted that a sub-group of the linoleic acid patients had the highest risk of death)

2. The Sydney Diet Heart Study found that "substituting dietary linoleic acid in place of saturated fats increased the rates of death from all causes, coronary heart disease and cardiovascular disease"

3. The Mediterranean diet trial (Lancet 1994 June 11) Patients randomized to lower linoleic acid consumption (compared to a prudent diet) had a much lower mortality post infarct. This trial is also evidence that not all of your fat intake should be in the form of satutated fat. A diet with lots of saturated fat, but little omega-3 is bad.

4. A review published in the British Journal of Nutrition in 2010 found a trend for omega-6 supplementation to increase cardiovascular disease risk.

Many other studies suggest poor health outcomes from diets relatively high in linoleic acid. (see future posts) Not to mention common sense. Rational people have been following the right diet for decades, not just since 1994.

Of course some research seems to support the use of linoleic acid. This is not surprising because many foods high in linoleic acid also contain omega-3s, and consuming them will likely provide a benefit to someone whose omega-3 intake was previously too low. Next time you look at a study which allegedly supports the use of omega-6s, check whether the benefit was attributable to omega-3s. Also look at the end-point. Was it death or major cardiovascular event, or was it merely a change in serum rhubarb.

The Heart Foundation seems not to understand that the laws of syllogism do not necessarily apply to statistical associations. If A correlates with B, and B correlates with C, it is illogical to conclude that A correlates with C. That linoleic acid lowers cholesterol in some subgroups, and high cholesterol often correlates with cardiac events, does not allow one to conclude that linoleic acid reduces cardiac events.

Take home message - not all polyunsaturated fats are the same. Learn the difference. I suggest we leave the terms saturated and polyunsaturated fats to the chemists. There are such large differences in the health effects of different polyunsaturates that it is illogical to lump them together for dietary purposes. Same with saturated fats.

Is this the stupidest safety warning you have ever seen?

No one else in the world was stupid enough to recommend Vioxx as part of a NOF protocol in late 2004, so it is not surprising that The Canberra Hospital is also a nominee in the category of stupidest safety warning ever. ( No, it wasn't an April Fools' joke )

I have lost count of how many times ACT Health buildings have been evacuated because of "fumes", only for the fire brigade to declare that there was no problem.

Our Prime Minister has suggested that States be allowed to raise their own taxes to fund Health. How about an inquiry into the monumental incompetence of Health bureaucrats instead? The ACT is consistently the most profligate with taxpayers' dollars in the provision of healthcare. No surprise there.

Illegal cost cutting at Canberra Public Hospital

Here are Schedule 4 drugs prescribed for a public hospital inpatient prescribed by someone who is not a doctor and allegedly had no legal right to chart these drugs.
Hospital administration allegedly claimed that the prescriber was being supervised from a distance by a doctor (That doctor had not seen the patient and had no knowledge of their medical details.)

Medical regulators refused to take any action against the doctor who allegedly claimed to be providing distant supervision with no knowledge of the patient. They also declined to take action against the prescriber, who allegedly was in effect impersonating a doctor.

Rumour has it that doctors turned a blind eye to this cost cutting in exchange for some fee-for service medical specialists being allowed to engage in a form of double dipping, which continues to this day. There is no doubt that there was a temporal relationship between the two activities.

Select Blog Index - Find posts on:

Anesthesia / pain   2015: 11 Nov, 20 Nov, 9 Dec
                               2016: 10 Jan, 16 Jan, 6 Feb, 14 Feb, 1 Mar, 18 Mar

Addison's    2015: 19 Sep, 29 Nov, 1 Dec, 7 Dec,
                    2016: 12 Jan, 13 Jan, 14 Jan, 1 Feb, 22 Feb, 1 Mar

Diet  2015: 9 Nov, 21 Dec
         2016: 22 Jan, 26 Jan, 28 Jan, 12 Feb

One Move Sudoku 2016: 15 Jan, 1 Feb, 11 Feb, 2 Mar, 15 Mar

Race results   2015: 16 Sep, 7 Oct, 2 Dec, 19 Dec,
                      2016: 12 Jan, 14 Jan, 1 Feb, 15 Mar, 20 Mar

Diabetes  2015: 20 Sep, 24 Sep, 18 Oct, 25 Oct, 2 Dec, 13 Dec, 17 Dec, 18 Dec
                2016: 11 Jan, 5 Feb

Australian health bureaucrats can't tell lung from stomach, think heart is on the right side of the body.

Diabetics and anatomists will also be appalled at the depiction of the pancreas.

MATHS ILLEGAL - Australia's numeracy cringe

I am accused of promoting alternative approaches to disease management via social media.

Of course I do. I promote the use of maths.

Specifically I promote the used of least-squares minimisation to solve the problem of cortisol homeostasis. (with appropriate conditions on variable values) Interestingly, this gives a similar result to what some creative and successful Addison's patients have worked out by trial and error and posted online. (In contrast, look at the posts from patients on the Addison's disease Australia facebook page, complaining about their poor health, but refusing to even consider alternative treatments.) 

But when I mention this in medical circles I get stupid responses such as it not being "evidence-based" or "peer-reviewed" or "unproven" The real reason is that most doctors are so under-educated in maths the only calculus they know is a Tintin character. I'm yet to hear of any doctors in Canberra who can solve my Sudokus.

AHPRA tell me I cannot promote unproven treatments via social media. Apparently using maths doesn't count as proof.

AHPRA is trying to kill me.

AHPRA have launched an investigation of me, alleging I take doses of medication other than those prescribed by my endocrinologist.
Of course I do. I would be dead otherwise.

It seems they are incapable of distinguishing between the footballers who used prescribed oxycodone recreationally and a patient with Addison's disease faced with a potentially fatal adrenal crisis.

My endocrinologist prescribed me 50 micrograms of Florinef a day. On occasions this was too much, and I took half that.
However, if I took that even triple that dose on a mega back country ski day, I would end up collapsed in the snow, far from medical help, dry retching uncontrollably, and unable to stand up without feeling like I was going to pass out. Or worse. I know this from my own experience.

I learned from bitter reality that prescribed doses of Florinef were either excessive, or grossly inadequate. No endocrinologist has experience with many patients who do the sort of things I do in my spare time. And the peer reviewed literature on the subject is grossly deficient. Look for yourself.

Now I have AHPRA telling me I cannot take any dose of drug of drug which has not been prescribed by my endocrinologist or GP, because it is illegal. It seems I am supposed to die from an adrenal crisis if the appropriate paperwork has not been done.

I'm wondering whether next week I should go for a long run taking only my prescribed dose and finish in Parliament House having to be carried out in an ambulance because my blood pressure is so low I can't stand up.

You saw in a previous post a bsl of 1.8; low BP might be my next project.

Half marathon 21.1km in 1:34:57

Yesterday I ran my first half marathon. Despite being very average at school sport, I placed 2nd in the over 55s (would have been 3rd if Simon had not been sick) My time was 1:34:57
How many Type 1s can do that?
How many Addison's patients?
Another victory for maths over medical dogma.

Doctors clueless about post op pain control

My friend was completely unimpressed to receive this prescription for pain relief on discharge less than 24 hours after a hernia repair.
Is there anywhere in the world apart from Canberra where this is considered acceptable practice?
Panadeine forte one tablet each morning
Endone 5 mg every 4 hours if required

The patient was completely pain free after a simple procedure under local anaesthesia, yet is prescribed 30mg of endone to take home. Have any doctors there heard of the hillbilly heroin problem?

As for the paracetamol and codeine doses...

Is it technically illegal for diabetics to vary their insulin doses?

I was contacted yesterday by a representative of AHPRA who informed me that I was being investigated for self-prescribing.

The evidence he cited came from my blog which shows that in varying circumstances, I alter the doses of drugs used to manage my diabetes and Addison’s disease.

He said it was the opinion of the entire AHPRA Board in Canberra that this constituted self-prescribing and was illegal.

Medical advice to a patient with Addison’s that they should not stress-dose is negligent in the extreme.

Are approaches like DAFNE, and stress-dosing of steroids in Addison’s illegal unless specifically prescribed, or are AHPRA incompetent in their interpretation of existing legislation?

Are my doctors negligent if they have not provided written advice on whether I should alter my drug doses in varying circumstances?




ps. Readers may wish to speculate on whether it is a coincidence that I received this phone call just weeks after making a submission to the current Senate Inquiry into harassment of doctors by AHPRA

Some doctors say I use the wrong drugs, in the wrong way, but look at my results!

National Orienteering League competition in Melbourne. While the Opens battled for world ranking points, I competed in the M50s, placing equal 4th.

Those doctors who say I use the wrong drugs, in the wrong doses, by the wrong method will no doubt continue to make pathetic excuses for the poor performance of their own patients, and will continue to use the same ridiculous glucose control algorithms.
If you don't learn enough maths, you can't even quantify how disadvantaged you are by your ignorance.

How many patients died because doctors ignored drug company recommendations?

  

Vioxx was always a drug considered unsafe in patients in patients with renal failure, or at high risk of developing it. In 2002 the FDA implemented labelling changes to reflect the findings of the VIGOR study. The labelling changes included information about the increase in risk of cardiovascular events, including heart attack. The nature of these risks was such that they were most likely to manifest in patients already at high risk of CVS events, such as the elderly, or those with a recent neck of femur fracture (NOF).

Yet years later, a tertiary trauma hospital was still recommending routine prescription of Vioxx to a NOF patients either with or at high risk of both renal failure and cardiovascular events.

Patient often fall and break their hip because they have had a small cardiac or cerebral event, and even if their kidneys are normal before they fall, their age, dehydration, surgery and anaesthesia, blood transfusions, muscle necrosis and other factors mean they are at considerable risk of developing it. 

Look at a page from the protocol which was approved by the hospital executive, and to be followed by intern and resident doctors. Vioxx was to be prescribed regardless. 

Yet history records that doctors were extremely successful at diverting the blame for patient deaths onto the drug company, despite the fact that its product guidelines advised against the use in patients like these.

ps. note also the endone dosage recommendations. Not at all appropriate for this patient group.

Is there any other teaching hospital in the world that was stupid enough to make vioxx part of a treatment protocol for anyone, let alone high risk patients in Sept 2004? Only Canberra?

Osteoporosis prevention

Government guidelines for osteoporosis prevention state that in addition to traditional weight-bearing exercise, patients should also engage in "exercise that involves pulling forces acting on entheses (tendon insertions) of long bones, even in the very elderly. Weight bearing and resistive exercises are better for bone strength than .. exercises such as swimming and cycling."
"It should also be noted that the benefits are only maintained as long as the patients take exercise."
Note that these recommendations apply to the upper as well as the lower limbs.
I'm only 55 so I have no excuse, but very few Addison's patients seem to do much in the way of physical therapy, presumably because their doctors fail to stress its importance.

One rule of social media is that if something is not reported at all on social media it either doesn't happen or is very rare. I have read literally hundreds of posts from many forums and other sources about where Addison's patients have discussed doses and dose reduction to avoid steroid side effects, yet I can't recall a single post (apart from my own) where any arm exercise to prevent osteoporosis has been discussed.

Patients frequently report on social media that their doctor has pushed steroid dose reduction,with its consequent loss of energy and life enjoyment. Patients do report that their doctors give them drugs when their bones do get brittle.
Patients don't report that their doctor has made them aware of the recommended clinical guidelines shown above.

Medical body suggests patient with Addison's disease should NOT be taking steroids. Yes, some doctors really are that stupid.

The other day I received a phone call from AHPRA threatening me with various dire consequences if I did not forward evidence that I had been prescribed steroids. The clear implication was that I should not be taking them.
AHPRA knows full well that I have Addison's disease. I have documentary evidence of that, and I reminded them again during that phone call.
But they were insistent. They did not believe that I had a valid reason for taking steroids and requested evidence that my endocrinologist had prescribed them for me.
WTF?
Addison's and other forms of adrenal insufficiency are not that rare, yet there is an appalling level of ignorance about it among senior doctors.

Social media defeats unscientific doctors on medical cannabis.

Many doctors have spent years opposing the introduction of therapeutic cannabis into any area of medicine, whether for treatment of pain, anorexia or epilepsy.
So opposed are they, that many refuse to even support research into the potential uses. That way they can continue to say there is no good evidence to support its use.

Fortunately, politicians are sensible enough to be skeptical of self-professed medical experts.
They listened to social media instead.

"The rise of medical marijuana...is an example of what can be achieved through the sharing of personal stories on the Internet and social media.." reports Medscape Medical News.

They quote Daniel Friedman, MD, NYU School of Medicine, co-author of a recent review in The New England Journal of Medicine, as saying " It is a very interesting mix of science, politics and social media which has moved medical marijuana to the forefront of treatment...."

 " It was used medicinally in ancient China and by Victorian neurologists for seizures, but it has never been properly scientifically studied. That is now happening."

" This has come about because individuals have shared anecdotal experiences about its effectiveness in children with severe intractable epilepsy on the Internet.."

Whether cannabis products are ultimately found to be effective in any one particular area is irrelevant here. It is completely unscientific of doctors to white-ant support for research which will determine its ultimate place in the therapeutic armamentarium.


pics

The internet knows way more than your doctor. Here's proof.

There is an extremely limited amount of information available to endocrinologists in the peer-reviewed literature on rare diseases such as Type 2 polyglandular autoimmune syndrome. Mostly your doctor will base their recommendations on what they know about diabetes and Addison's separately, ignoring the interaction between the two conditions. They often fail to take into account the fact that fluctuating glucocorticoid levels typical of standard Addison's treatment play havoc with blood glucose control.

What does your endo know?

Here is the typical spiel from a large textbook on internal medicine, complete : ".hydrocortisone dosage usually should not be >30mg/day: otherwise, insulin requirements are increased. It is often difficult to completely control hyperglycemia in this syndrome."
Not very reassuring is it. No comment on different drug regimens or the clinical outcome of each.

If your doctor is extremely conscientious, they may search the ncbi database of medical literature for specific articles on the combined conditions. Here is how little they will find.

1. Type 1 diabetes and polyglandular autoimmune syndrome. A review. Lots on diagnosis and theory. Nothing on treatments and outcomes.

2. case report. Pt given cortisone acetate tds. No outcome described.

3. No treatment or outcome described, but interestingly, of the 24% of Addison's only patients who did not take HC as their only glucocorticoid, the commonest treatment was a combination of pred and HC.

4. Single case report. Outcome not reported.

5. , 6, 8, 9, 10, 12, 13 Lab research. No clinical info

7. Single case report. went on HC. Able to work again, re-gained drivers licence. thats it.

11. four patients diagnosed. No treatment of outcomes described.

14. Immunologic endocrine disorders . Clinical , No treatment of outcomes described.

15 No relevance

16. Not diabetes related, but interesting in that is describes as useful a low GI, high fat dietary approach to a complication of Addison's!

17-27. Lab data

28. A second paper on hypoglycemia in Addison's disease. Due to fluctuating HC levels!!! Admits "unphysiological dosing with orally available glucocorticoids. Recommended "Shifting the last hydrocortisone dose to the late evening.." CGM used.

 All others up to 40. No useful treatment or outcome data.

That's the top 40 papers, and more than a thousand pages of pdf on my computer. Pitifully deficient in useful clinical information, isn't it. If you have a polyglandular syndrome you would like to see at least a moderate number of patients tried on different treatments and outcomes recorded. Sorry to disappoint you, but your doctors' scientific resources are not even close to that.

Yes, an extremely obsessive doctor with lots of free time will be able to dig up a few extra cases, but even with those, the total sum of the peer-reviewed literature contains less useful information for me than my own experience with various combinations of treatment.

Soon, lets look at the wealth of information on the internet from actual patients (apart from myself) who have tried lots of different approaches, for long periods of time, and described their outcomes.

tbc

Melbourne research concludes paleo diet causes 15kg weight gain in 2 months for the average 100kg person.

I don't think I need to comment on this.
I won't be holding my breath waiting for the results to be replicated in humans.

Bureaucratic doctors fiddle while Rome burns

AHPRA and related medical regulators have been in the news recently. After what was presumably a substantial lobbying effort, they have been granted new powers to deal with health bloggers. You know, the ones who forced doctors to begrudgingly admit that low carb diets work for diabetes, and cannabis products work for some with intractable epilepsy. Embarrassing isn't it?

Yet over the same time period they seem to have been doing nothing about the appalling number of neonatal deaths at Bacchus Marsh.

Bacchus Marsh - the name invokes contrary images. No doubt AHPRA and friends are celebrating their newfound power Bacchanalian style, while would be parents are in a marsh of despair.

Word nerds will also note Crookwell, NSW as an oxymoron. They may also point to the tautological Wombeyan Caves located nearby.

Back to serious and some comments from the Victorian Health Minister.

According to the ABC she said the regulator had not done its job and must focus more on patients' interests.
It quotes her as saying
"..there was series of cascading failures."
"There was a failure at the regulator level.. to pick up some of the early warning signs."

Looking back over my last dozen posts, you can see how many organisations think that there is a problem with doctors hiding bad outcomes, or researchers hiding findings they don't like by selective presentation of data. The BMJ, the ICMJE, The Singapore Statement authors, Retractionwatch. the list goes on.

People wonder how the anti vaccination lobby has so much support, given the weakness of their arguments. I am not a supporter of the AVN in any way, but it is not surprising really.
How can doctors who say vaccines are safe be believed when doctors and medical researchers are continually being found to be very selective with the truth.

As the saying goes, a half truth is a lie.


Bacchus pics tf

Added 1.3.16: Scepticism of doctors' recommendations, whether diet or vaccination related, is just one example of the low level of public trust in administrators, the subject of an article in today's Canberra Times.
NAA Director-General  David Fricker has recently spoken at the National Press Club on suppression of information. "There seems to be an accepted position that the general public must always resort to freedom of information legislation to obtain the information it needs.."
He also referenced former Department of PM&C Peter Shergold's recent review of government failing, which found there was a need to further improve access to information.

DAFNE? Not for this diabetes legend!

There aren't many people in the world who have lived with Type 1 diabetes for 70 years. Winsome Johnston is one. What she does is no secret. She is happy to tell people that she rejects normal eating with its accompanying excessive insulin doses. Here are her words:
".. do all the right things and not eat the wrong things."
"..it's sometimes hard if you go to parties..But I think if you always tell the person whose having a party that there are certain things you can't eat, then it makes it a lot easier."

She rejects eating what her healthy friends eat.
Doctors may tell you that other approaches are possible, but they can't point to even a single person who has used a DAFNE type strategy for 70 years and done well.

winsome pic here

related post on Bob Krause

To those readers who call my stories on Winsome and Bob selective information presentation, please forward me details of any or all similar Type 1s who have done as well by eating a population average amount and type of carbs as part of a low fat diet, and I will gladly include them here.
I have been unable to find any myself in my online sampling.

Theft of confidential patient information from The Canberra Hospital?

Will doctors stop at nothing to try and discredit my interpretation of research data? You may have heard rumours that I was involved in the inappropriate accessing of confidential patient records from The Canberra Hospital.  Do not believe them.

If you are thinking that these rumours may have an element of truth, consider the following.
Who first stated that they suspected me, and what was their evidence?
Given that I was not involved, WHO DID steal the data?
I have heard from too many people that I am suspected, yet years down the track, no formal charges have been made.
WHY HAVE PATIENTS NOT BEEN NOTIFIED? Many patients' medical records were allegedly involved, yet none of those patients have been notified by the Hospital afaik.

Hospitals and health clinics should be required to notify patients if their personal medical records have been the subject of a privacy breach. And this is one piece of legislation that should be made retrospective.

Someone knows who accessed these patients' records. The Hospital computer logs every occasion on which records are accessed electronically, and the account from which they are accessed is recorded, as is the time and date. What really went on?

Note: The Privacy Commissioner will not investigate based on third party reports. There will not be any enquiry until a patient finds out and is sufficiently concerned and motivated to lodge a formal notification with the OAIC. This practice should also change.

CSIRO belatedly joins the low carb team, but still thinks dietary cholesterol causes heart disease

Last weeks news: Low Carb Zen has half a million likes on facebook.

This weeks news: CSIRO has a "NEW" diet!! It's LOW CARB !!!

But it seems CSIRO still haven't read the Framingham study, which found absolutely no connection between dietary cholesterol and serum cholesterol. Maybe that will be in their next promo. And maybe one day they will look at the evidence behind the new US recommendations on saturated fat.

Cardiologist calls dietary guidelines a "guess" based on "inadequate" evidence

These were the words used by Dr Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic about the new US dietary guidelines. Lets look at the fiasco that is nutrition science research.
The recent UN review of meat consumption looked at 800 studies (probably costing tens of millions of dollars in all), with their only conclusion on fresh meat being to eat a bit less. Really? Researchers have milked grants, salaries and funding to come to the same conclusion as my mother did 40 years ago as she watched the neighbours get fatter and have heart attacks.
After decades of advice from dietitians to limit egg consumption, we now have the NHS saying there is "no recommended limit" Limits on fat intake have also been relaxed, for the reasons that thousands of health bloggers have been pointing out for years.
Dietitians' advice changes more than the weather. Bran and wheat germ on your cereal were once heavily promoted. Thankfully no longer.

Decades of research has done little but line researchers pockets. Dr Nissen laments " Diet is essential to health.. we are really left with no solid advice for most people"

He calls on Governments to conduct well controlled studies that address the right questions. Medical researchers are failing to answer the questions that are important to patients. As a diabetic I want information on long term effects and important outcomes like quality of life, mobility, good eyesight and absence of fatigue, not the short term effect of some drug on serum rhubarb.

Before you donate money to medical research, consider the vast amount of futile research which never had any chance of producing Nissen's "solid" evidence, but merely muddied the waters. Choose your beneficiaries wisely.



NHS pic
Nissen pic

Yet MORE evidence of doctors being careless with the truth

Selective presentation of data by doctors is in the news again today with the Fertility Society of Australia concerned that some IVF clinics are presenting misleading figures on their success rates.
It is not only medical research that is allegedly compromised by lies, damned lies and statistics. Audit / Quality Assurance activities are also being questioned.
It is not hard to do. If you filter data by enough variables/subgroups you can find numbers to support any conclusion you want. And you don't even have to fabricate data. Why fabricate data when you can get exactly the same result by generating lots of data and then presenting selectively?
I have never heard of any medical researcher in Australia being busted for failing to tell the whole story. Yet the end result is no different from data fabrication.

Can you trust doctors to tell you the whole story?
It really is time for an enquiry into medical ethics. I suggest the ICMJE choose the people to run it.

(ivf pic to go here)

The walls are closing in on incompetent and irresponsible researchers

No longer will irresponsible researchers who selectively present data be protected by their friends in high places under new proposals by the International Committee of Medical Journal Editors. (ICMJE)
The BMJ has deplored the failure of regulators to take any action on selective data presentation, and is appalled by the use of defamation laws to inhibit valid scientific discussion of research findings.
I have previously referred to the comments of Sessler and Retractionwatch that data "massaging" is a widespread and serious problem in medical research, much more serious than actual data fabrication.

In brief, the ICMJE is proposing to not only make de-identified raw data available within 6 months of publication, but also require that authors include a plan for data sharing as a component of clinical trial registration.

Journal editors plan to withhold publication of those researchers who might otherwise resort to bureaucratic obfuscation and legal thuggery to avoid public scrutiny of their work.

It can't happen soon enough.

Don't believe that data massaging is a problem in health research relevant to T1 diabetes? Look at how the abysmal research of Keys has pervaded decades of medical "thinking" in Australia. How many articles have quoted him, or quoted articles that have quoted him (and so on) to support the low cholesterol diet? More on that later.


Additional thought. Question really. Are these researchers deliberately setting out to mislead, or are they just too under-educated to realise the scientific implications of selective data presentation?
Answer: It matters not. The research needs to be withdrawn and the researcher re-educated either way. Ask any lawyer. The requirement to prove intent is exceedingly difficult to meet, and will result in no finding in many cases.

(ICMJE pic to go here.)