Dear Bellinger Shire, 28 September 2021.
You know the old game of “guess what is missing here?” A most excoriating intellectual challenge –: not to see what is present wrongly, but to fill a hole that doesn’t actually exist. It used to be one of the favourite “teaching by terror” methods of professors of medicine in older medical schools. An associated technique that is equally frustrating is “guess what is on my mind” which left quailing and quivering medical students in a lather of sweat and humiliation. At least that’s how I remember it. Never got those stains out!
This weekend I felt there was something missing. It’s late September, the birds are going nuts, yet it was traditionally one of my least favoured parts of the year…. Because of hay fever and allergies! (and end of year exams but fortunately I am past that).
Oh joy to be missing the sneezing, coughing, puffy face, headaches, and red eyes – for the moment – and it is because the State had for the weekend a cool and hovering moisture. Indeed in Gleniffer with the window up in the car one could have been forgiven for thinking curls of smoke were rising from the forest into a heavy choked grey brow blanketing the mountains. But it was cool and wet.
Yes, itchy eyes and tense nose heralded the allergy season start a week ago, but have faded again. For now.
For all of us who live with allergies it is time to get your treatment plans underway. The flowers will spring back with a vengeance and the privet is having an orgy. This seems like de ja vu – I was writing to alert this issue same time last year. Then it seemed important because we didn’t know whom to treat for Covid. Now it may even be more important as governments plan to relax restrictions and EVERYONE (almost) is going to be on alert for any sneezes and coughs coming up our way.
Of course apart from the whole new category of social pariah as a yet to be excluded suspect Covid19 Case, there is also the very real issue as mentioned last year that people with allergic disease – such as allergy induced asthma – do much worse with a Covid19 infection UNLESS they have their condition under good control. Successfully well-controlled asthmatics actually come out better than average.
I actually take allergic diseases such as hayfever and rashes very seriously -knowing the huge impact they have on lives, but unfortunately they are often relegated by society as an almost amusing nuisance.
I run a Spring webinar for junior doctors this week who also have a lot to learn on allergy, so it seemed like a good topic to lead off with for everyone. Please now is a great time to check in with your primary carer, physician, GP, naturopath, to optimise your management of allergic diseases.
Next month, during the “Surge”, Businesses will NOT want you sneezing or coughing in their premises regardless of your excuse.
On a sombre side, your local network of Hospitals (and Emergency departments) are preparing with weekly link ups for the arrival of the unwelcome visitor. With positive sewerage testing in Grafton and Ballina, cases in Kempsey, and 3 cases arriving in Coffs this week (according to State health) we are bracing for the inevitable. There is no evidence of local transmission in Coffs yet, or the Bellinger Shire.
When we start getting cases, please be ready that access to the local hospitals will change, with protected zones set up in the emergency departments and normal ED presentations rerouted through other doors. The priority will be to identify people with Covid19 who can go home, isolate but be kept in touch Vs those who need oxygen and more intensive treatment. We don’t have a lot of bays or staff. Not a great month to get drunk and break a bottle on your head!
AND AMBULANCES ARE FOR EMERGENCIES.
The more infectious Delta strain experience from Sydney now indicates that once one person in an unvaccinated household gets Covid 19 then everyone gets it. That means households will be isolating “in toto”, not by dividing rooms or work-arounds. We all need to be setting our expectations along those lines, including those who want to maintain a belief that this is not a dangerous disease.
On the good news side, the vaccination rates are incredible throughout the state. It is with a huge sigh of relief to see the far flung mobs of Bourke, Menindee and Bogan recording 90% of their eligible population had 1 dose and approaching 80% for the second, (and they are not dropping like flies from microchip radiation or bizarre diseases).
Locally Urunga, Nambucca Heads, Hyland Park are the top of the pops with over 80% first up, and approaching 60% second dose. It feels like Grand Final Season.
It is Grand Final Season!
A Journals curio: The medical Journal of Australia last week ran research on Drug Induced Liver injury presentations to a major Sydney Hospital over the last decade. Now the numbers weren’t big because they didn’t report on the major drug injury in the population – ie that caused by alcohol. That is a chronic injury. The report was about acute liver injuries that might be life threatening.
Terminology check: Lay folk often misunderstand the terms chronic and acute – they do not reflect severity, nor how cute the patient looks, but describe how long a condition is. Roughly “Acute” means new onset, now, peaking, for the short term. A broken bone, Influenza, new Covid19 infections are all acute. “Chronic” roughly means a prolonged illness. Post viral syndrome, smokers lung disease (called “Chronic Obstructive Pulmonary disease” or COPD), arthritis are all chronic, though they can also have “acute” surges or exacerbations.
So acute drug induced liver injuries: the most common was from good old paracetamol (Panadol, Tylenol, Panadol Osteo) and deserved a category of it’s own. Yes, it is freely available and cheap. It is a great medicine to relieve mild to moderate pain – both chronic and acute. But it is one of the drugs that has a tightly defined safety window. Incredibly safe to a point, but take too much and suddenly the liver’s ability to clean it out is overwhelmed and it causes devastating liver injury. Aspirin is also a bit like that. Horrible overdoses to treat in the emergency department and far too common, as people underestimate the lethality of what they do with a common pill in a fit of distress.
The next category is liver insults from antibiotics (28% of the non paracetamol cases). Some may say –“ ah! See antibiotics are unnatural and bad for you”. Then, to my horror, Herbal medicines and supplements come in closely at 22%. Also sadly the herbal medicine poisonings were more likely to cause long-term damage than paracetamol, and more often in non-European ethnic groups.
Now, humans have used herbal medicines for thousands of years, with striking concordance between unconnected tribes, successfully in the appropriate cultural context. Herbs have also been the kick off for many current modern medicines. But they have also many random variations of strength, quality, and application. Too often people blindly follow a Mantra that “natural must be safe”. Well sadly Mother Nature does not give a tinkers cuss what you believe. She dishes out harsh lessons. Socrates died of a natural herbal poison (Hemlock). I don’t mind herbal therapies – in their place, in the right dose and respected as powerful drugs.
This is partly why we have an independent, unassailable Therapeutic Goods Administration (TGA) – to test the claims of big Pharma, little Pharma, and herbal Pharma alike. Imperfect and slow, but better than the alternative.
In the same Journal edition was an Australian trial of salivary testing for Covid19 – esp in kids- Vs our current nose and throat swabbing, Vs both together. Unfortunately the saliva testing – although it is more comfortable- did not stack up well for sensitivity. It was useful as an accessory, but how much are we willing to spend on additional tests unless they are spectacularly better?
WHO last week: 231.5 Million confirmed cases, 4.7M deaths, 5.98 Billion vaccine doses given. Plenty still to go.
The third pandemic is rising again. It had a surge last year about this time as we lead up to Christmas. That is the pandemic of SCAMS. Please, please be very careful opening messages on your phone or computer. They are clever at teasing you to track a surprise parcel or prize. They are going harder at it than the bowerbirds in the garden.
The ACCC recommends checking their scam advice site and also to take your phone or device into a service hub to ensure your protection is up to date, to ensure Trojan horses and malware are cleaned out. Especially if you do payments and banking by your phone. I’m getting at least 3 a day, and my number is not public! How are your older non-digital native relatives faring? They may need help to get clean before we get any closer to Christmas.
For those who have chosen to not get vaccinated at this stage, for whatever reason, you may want to have discussions with your friends who are like minded, but who have been this week insulting and abusing nurses, harassing shopkeepers and service attendants just trying to do their job as instructed, and trying to pick fights about mask wearing. They are giving your political/philosophical position a very bad name.
As always above are some individual perspectives from the waiting room while anticipating the arrival of the visitor. Please check any detail with your own GP, Hanky in hand, and get up dated with your allergy or asthma treatment, and make sure your general health checks are to date. They may be busy next month.
Dr Trevor Cheney