Weekly Report from the Bellingen Covid-19 Clinic: Dr Trevor Cheney

Dr Trevor Cheney gives his weekly report from the Bellingen Shire Covid-19 Clinic

Dear Bellinger Shire

1 June 2021

 

Today’s Bumbling Broadside is brought to you by the letter B.

 

On Sunday morning I was sitting at a café in that rather unique sprawl of style and excess called the Gold Coast, after a quick trip up for a family issue.  This café actually is on a corner only 2 streets from were I grew up at Broadbeach, and used to be our local corner store, or more realistically, lolly and milkshake shop.  Now of course the real estate is nuts and the clientele were the Buffed, the Bold and the Beautiful.  I was trying not to stare at the heavily tattooed couple at the next table – she had a large one of the Buddha on one arm and a picture of herself, but with mermaid fins, on one leg??  Not sure how these somewhat opposite symbols of value juxtapose.  I fear there is internal philosophical turmoil.

Anyway the better thing to look at was the unusually lower market but tricked up Suzuki, sandwiched between the very new Mercedes Benz and the BMW.  Not a normal Bellinger shire sight.  The intriguing thing about that image was the Brake discs.

Now you may wonder what sort of quiet madness makes Brake discs interesting.

It was the ubiquity. Every car has to have them and use them every day.  A cheap brand can’t operate without reliable discs.  They have to perform every time.  They have to be expertly engineered and they inherit a long evolution of engineering design, testing, experimentation, sometimes mistakes with catastrophic consequences.  Like most advances in science.  There have been some not so good brake discs/pads/drums.  I grew up in an era when most of the pads were made of asbestos, until after some decades people started wondering what happened to all the asbestos that was worn off the pads, and the answer was that we inhaled it, and then it seemed like not such a good idea, and the materials were reconsidered.

Actually, I think some poor mechanics copped mesothelioma (an untreatable slow cancer of the lung lining set off by tiny asbestos fibres) and that made people wake up.

Anyway the striking realisation was that they are exquisitely engineered, and yet are really quite simple – the essential concept has not changed for some thousand or more years since people started pimping chariots.  Once you start going fast you have to be able to stop. And the simplest way is to put friction on the wheel.   Many of us have scars from scientifically testing the validity of the hypothesis as kids, and Billy carts, and shopping trolleys and … you know how that goes.

However they are a perfectly vital component that humbly remains really hidden.  Except, now with spoked wheels being the “must have” design on every new car, the discs and pads are very visible.  It was the (usually hidden) anatomy on view concept that I found intriguing.

And so that leads onto another train of thought – Bowels. And crap, poo, dunneydoo, faeces, Sh*t, turd, log, thunder drug, motion, action, stool, poop, dung, scat, droppings, dootz, doodoo, manure, scheitzen, bathroom.

We have so many ways of not talking about a hidden, essential and exquisitely engineered piece of functional anatomy that probably most us prefer not to have anything to do with .  And yet it is absolutely vital!  Of course there are some folk who are sickeningly obsessed with the coloured product of an anus.  We call them new parents.  But really it is a big deal that we should be able to be aware of.  Because as the old saying goes – “ you don’t s*it, you die”.

It is something we all have to do.  My dear old royalist mum, who met Elizabeth R when Dad was awarded a DFM, would say “even the Queen has to sit on the toilet everyday”.  Having to poo is probably a greater leveller than a Bolshevik revolution.

But the humble bowel can be battered and bruised.  It can get many ailments and needs some loving care.  It works really well if it is allowed to work -regularly and relatively often – a bit like your car.  Oh how we neglect and poison it.

And it also harbours what could be called the biggest organ – the collection of little bacteria, fungus and viruses that are actually helpful.  There is more DNA in your gut/bowel than in the rest of you, and it’s all alien! Fortunately it is mostly friendly.

Bowel  (Colo-rectal) cancer is Australia’s third most common cancer. The risks first were noticed by European surgeons working in Africa.  I recall lecturers in surgery changing their own habits after realising that, before late 20thcentury, bowel cancer was almost unknown in Africa.  The key differences in diet risk are fibre. Good levels of fibre – that’s stuff in your food that your gut doesn’t digest – becomes like a broom that sweeps through your gut.  Some fibrous material is digested by friendly germs, and produces essential vitamins.

But there are also some equivocal characters in your gut. One of the theories of cancer development has been that of stasis, ie a slow moving bowel allows certain bacteria to ferment the contents too far, producing  some toxic substances which over time mess up the normal  fast and busy replication of the cells lining your gut.  Like copying data between your computers – the faster and more often you copy then you are more likely to get corrupted data, esp if there is interference in transmission.

While we can’t say exactly what caused someone’s bowel cancer, there are very predictive risk factors.  Of course family history is a significant predictor that you can’t change.

But your’e gonna hate this :– once again drinking and smoking increases Bowel cancer risk.  More than 2 standard drinks a day, and any smoking – they are simply poisons.

Being markedly overweight is a serious predictor and deserves yet another really good go.  Sadly, eating heavily processed meats is a big risk increaser.

Daily activity (sounds like a broken record) actually reduces bowel cancer risk.  High calcium intake – (dairy foods, eggs or leafy green leaves) reduces the risk, while also helping get you a daily evacuation – or better : twice a day.

Indeed I am really happy to go and pass a motion twice a day.  This is a good sign for a human.  Do you know you even get a built in reward – with certain chemicals being released in your brain when you release that pent up pressure.

On the flip side old moulding faeces in your gut is not good for your brain.

Like any good function, bowels can have a daily rhythm.  You can train your bowel to some extent.  There is a thing called a gastrocolic reflex.  Essentially food in mouth sends a nerve message to the other end of the column to say  “clear out residue – incoming!”.  So if your kids have trouble getting a regular bowel motion, then actually sitting on the toilet within half an hour after a meal is a big help.  It is not just to get you out of the dish washing.  It works especially after Breakfast.  Grandpa – who was in the trenches in WW1 – used to say that if they hadn’t attacked by breakfast then they weren’t about to, so it was always the best to time to train for the latrine.

 Battles have been lost by what happens in bowels.  Empires have fallen.  Infections of the bowel – cholera and typhoid fever  -were instrumental in the casualty rates in the big wars of the 19thcentury, even at Gallipoli, in World War 1.   Bacteria that spread in contact with dirty food or water cause these 2.

The recognition of cholera spreading in water supplies is attributed to an English obstetrician John Snow, who followed a deadly outbreak of cholera in 1854 in Soho – London.  He eventually figured out that the people getting sick all took water from a particular well.  When he convinced the Burgers to take the handle off the pump at the well, the outbreak waned.  This simple event is heralded as a beginning of epidemiology – that previously hidden profession that is on our news every day now.

Sewerage, clean water, peace are the key factors in stopping these classical diseases.  We have no idea how lucky we are, and how potent good council sewerage management is, in preventing deadly infectious diseases, because again the anatomy of that process is so hidden.

Sadly at times of conflict the infrastructure falls apart and cholera, typhoid, and even polio (which is also transmitted though the gut before going on to paralyse  spinal nerves)  are all having a great old time in Syria.

Back to bowel cancer:  why ? Because it happens to be the start of Bowel cancer awareness month  -from the Bowel Cancer Australia charity. And because the tragedy about the hidden anatomy of bowel cancer, is that it is not hard to prevent, or to diagnose early, or to hopefully cure if picked up early.  Yet over 5000 Australians die of it every year.

More potently, Bowel cancer is one of the big secondary insults of the pandemic, as people slowed or stopped turning up for screening. Our epidemiologists warn that we have fewer diagnoses than we should over the last year – not because miraculously bowel cancer disappeared – but because of interrupted screening or testing.

While talking about bowels is a favourite form of fun for little kids and stand up comedians, it’s not fun to live through.  I have been scarred by caring for patients who up to the end refused timely screening or early treatment, ultimately  leaving orphaned kids.  Yes it happens to younger adults.

I was travelling through Adelaide years ago.  While visiting my favourite aunt and uncle, they asked for advice on their daughter – my cousin.  She had abdominal pain and altered bowel motions for more than 6 months and initially had little or no investigations. Unfortunately when we examined her, found the big lump, sent her for an ultrasound, it was way too late.

So please – for Bowel Cancer week, month or whatever – if you have any symptoms of blood in the motion, pain, unintended change in bowel habit, stringy mucousy motion, a feeling like you can’t empty your bowel fully (called “Tenesmus” – sounds a bit like a Mediterranean town),  it is neither painful nor difficult to check with your GP.

Oh, and we have not had any reports of Covid 19 or cholera or typhoid Fragments in the local sewerage –despite events expanding from the south.   (There’s your link).

 

Remember this is just one researched, though not referenced, unsponsored perspective on a Bundle of issues .  Please check any detail with your own GP who will be keen to Beat the crap out of Bowel cancer, when given the chance, early.

 

Dr Trevor Cheney

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