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.