A Gold Coast Private cardiologist has made a potentially life saving breakthrough in stroke prevention.
Associate Professor Ross Sharpe and sonographer, Assistant Professor Dan Traves, are the first in Australia to use contrast Trans Cranial Doppler Ultrasound (cTCD) to test if a patient has a Patent Foramen Ovale (PFO). A PFO forms when a connection in the heart that exists in-utero does not close shortly after birth, leaving a flap between the upper chambers of the heart. When the flap fails to close it can result in small clots bypassing the lungs. The clots enter the brain and block the artery, causing a stroke.
“The incidence of PFO is much more prevalent in the younger population than first thought, affecting up to a third of people aged up to 12 years,” said Dr Sharpe.
“If left undetected in a stroke victim, a PFO can lead to further strokes.
“The PFO is also linked to migraines with aura, exertional fatigue and breathlessness, divers decompression illness and altitude sickness, amongst other things.
“Recent studies have revealed that it may be responsible for a lot of diseases that could even shorten our life expectancy.”
Invasive Vs Non-Invasive Stroke Prevention
The accepted gold standard test for PFO detection is a trans-oesophageal echo (TOE). This is where a probe is passed down the throat into the oesophagus to take ultrasound images of the heart. This must be performed under anaesthetic in hospital. Dr Sharpe said this invasive procedure missed up to a 15 per cent of PFO’s – of which 25 per cent were large – while the non-invasive cTCD was 100 per cent accurate in detecting a potential abnormal connection in the heart.
“cTCD is a better, cheaper, safer and quicker test to detect a PFO than the current standard procedure,” said Dr Sharpe.
“A cTCD can be performed in the consulting rooms in less than 15 minutes and involves injecting a saline solution into the blood stream to see if it reaches the brain.
“If it appears in the brain, this would suggest the patient has a PFO.”
Dr Sharpe is not only leading the charge in PFO diagnosis. He is also the Chairman of the PFO Research Foundation. Dr Sharpe has been working on new methods for closure once it has been discovered. He believes closing a PFO can drastically improve, or even save, thousands of lives.
“The non-surgical treatment of PFO complications such as stroke typically involves a life-time of blood thinning medications like Warfarin, but in my experience, closing it is the most effective course of action,” said Dr Sharpe.
“Three highly-regarded studies have recently shown that the hole should be closed and is superior to medication in preventing further brain attacks.
“One study has shown 11 strokes in the medical treatment arm, and none in those treated with a patch – a method used to close a PFO.
“Another study found there was a 400 per cent increased risk of stroke if the patient didn’t have their PFO closed with a patch.”
A Simple, Fast Procedure for Stroke Prevention
Dr Sharpe has developed and altered the techniques to allow for minimally-invasive PFO closure to be done in 20 minutes. This procedure also allows same-day discharge. The method involves local anaesthetic, twilight sedation and locating the hole rapidly with a specially shaped catheter that then allows the patch to be delivered through a 2mm cut in the groin vein with positioning under X-Ray. Dr Sharpe said there were still some in the medical community who didn’t support the procedure. However, the evidence was clearly in favour of closure.
“Unfortunately there is still a long-held belief in the medical community that closing the PFO has few benefits, however the evidence in the literature is now overwhelmingy in favour of closing the hole,” he said.
First Hand Success
Dr Sharpe said studies aside, he had seen the success first-hand.
“My team is now at the point that we are expanding the closure indications to those with severe disabling migraine with aura and who have failed to benefit from usual treatment,” he said.
“Our results have been presented at a major international conference in Europe and we have attracted significant funding for more research. Those studies are about to begin.
“We have seen many patients who have been unable to work or have any kind of meaningful social life due to their severe migraine and following closure they have resumed a normal life.
“Eight years ago there was a young lady who lost her job, her marriage and her baby went into care as she wasn’t able to function due to her headache.
“She travelled the world spending thousands of dollars looking for help before being sent to us where we closed her huge PFO, which had never been picked up.
“The headache disappeared, she started a successful business, and had her child returned to her full-time care.
“I believe we have only scratched the surface of the PFO story and there is potentially many more negative impacts it may be having on the human condition.
“For example we are also investigating the impact of these holes on higher brain functions. Our hypothesis is that the unfiltered blood products may influence the brain neuronal health and even general genomic expression.
“My team will be looking for those factors using advanced analysis of the blood collected at the time of closure.”
Gold Coast Private Hospital
For more information contact: Dr Ross Sharpe, Coastal Hearts and Vascular, Ground Floor, Suite 9, Gold Coast Private Hospital. P: 1300 9 12345, F: 07 5532 9890. Visit the website for the Gold Coast Private Hospital here.
Bunions are a common problem for many seniors with more than five million Australian’s suffering from the painful foot condition. The good news is, this issue can be easily fixed with minimally invasive bunion surgery.
73-year-old Sue Strong discovered that her bunion issues can be an easy fix with little to no pain. At one point, the Helensvale resident’s bunion became so painful she could no longer wear shoes. That was when she decided something had to be done.
“Any time my bone touched or rubbed something the pain was excruciating and I just couldn’t bare it any longer,” said Sue.
“I told my GP I wanted to go to Gold Coast Private Hospital and she put me onto Dr Platt as she’d heard very good things about him.
“When I walked in I was delighted with his approach and manner. I actually really enjoyed my appointment.
“I had already researched minimally invasive bunion surgery and he confirmed I was a good candidate for it.
“The surgery itself was so quick – my appointment was at 12.30pm and I was home just after 5pm the same day.
“I couldn’t believe it, but I had not one ounce of pain from my surgery. Obviously coming home that first night I’d have had pain control from the anaesthetic, and I was prescribed Panamax but I only took it for the first day and really just as a precaution. It’s been amazing.”
New Technology Improving Bunion Surgery
Sue had been referred to Gold Coast Private orthopaedic foot and ankle specialist Dr Simon Platt. Dr Platt an expert in minimally invasive surgical techniques that help reduce pain in the post-operative phase. Dr Platt said Sue’s bunion was the result of a deformity, making her a great candidate for minimally invasive surgery.
“In the past, bunion surgery has garnered a reputation for being extremely painful with a long and difficult recovery – but with today’s techniques, this is rarely the case,” said Dr Platt.
“My patients who have minimally invasive bunion surgery are usually surprised about the appearance of their foot – which has just a couple of small incisions that heal quickly and leave virtually no scars.
“What we do to the bone is the same whether you have open surgery or minimally invasive surgery, so it’s important to remember that the bone takes just as long to heal regardless of which method is used.
“What we’ve seen is that patients who have minimally invasive, also known as ‘keyhole’ surgery, experience less swelling, discomfort and pain due to the fact that less soft tissue is disrupted.
“This also results in a faster recovery initially, but the long-term recovery is the same.”
Be Free of the Pain
For Sue, the procedure has been life changing.
“I’m only a few weeks post-surgery so I’ve still got to wait for the bone to fully recover but I am pain-free and I can’t wait to wear shoes again,’ she said.
“The recovery has been easy because the wounds are so small – like scratches really. I do my own bandages and my husband couldn’t believe it when we first took them off and he saw virtually nothing on my foot.”
Sue hopes her story will encourage others who are suffering from bunions to seek the right treatment. She also hopes that people will not be put-off by the idea of surgery.
“Anyone with a bunion knows how excruciating it is,” said Sue.
“For me, surgery has eliminated that pain. I hope anyone in my situation can get the same relief.”
Dr Simon Platt said non-surgical treatments such as bunion braces and silicon spacers could provide short-term relief. He said while surgery should always be the last option, it provided more reliable long-term corrections.
“Most people I see have tried conservative treatment methods but the pain has become too great to bare. They want to know their options,” he said.
“Generally, most people who have a bunion caused be deformity can have minimally invasive surgery, but I thoroughly investigate every patient and decide the best treatment method based on their individual circumstances.”
Minimally invasive bunion surgery is performed in Gold Coast Private Hospital’s Day Surgery Centre. Patients are discharged the same day. Dr Platt said patients with two bunions could have them operated on simultaneously, further reducing recovery times.
“Patients can expect to be able to walk and mobilise immediately after surgery in a post-operative shoe, which is worn for an average of six weeks,” he said.
“After this time, people can wean back into normal shoes and activities including running.”
For more information contact Dr Platt or visit your GP for a referral. Dr Simon Platt, Gold Coast Specialist Suites, Gold Coast Private Hospital, 14 Hill Street, Southport, Qld, 4215. T: (07) 5530 0770. Check out the website for the Gold Coast Private Hospital here.
Education and early fall intervention is key to preventing falls amongst the over-65 community, according to Gold Coast Private’s head of rehabilitation, who says they are still admitting an alarming number of patients with fall-related injuries.
Look For The Signs
Dr Michael Johnson is urging local GPs to look out for early signs of frailty in their patients – a warning sign for falls – and to refer them to rehabilitation beforea fall occurs.
“GPs need to have a look at their patients when they come in with respect to a risk of falls as well as frailty, talk to them and establish if there are any issues,” he said.
“From there, they should send a referral through to us so that we can intervene and reduce their fall risk.
“With falls of this age group, prevention is crucial – otherwise, they end up having a fall and while the injuries could be minor like bruising and abrasions, they can also be more serious, like a hip fracture.
“At this age, the complications of surgery can be significant and often lead to more issues, so it’s best to be avoided altogether.”
Fall Intervention: Anxiety Affecting Fall Rates
Dr Johnson said anxiety and loss of confidence were also major contributors to falls in the elderly.
“It’s a vicious cycle,” he said.
“We see older patients who become increasingly anxious and concerned about the possibility of a fall, so they pull back on their level of activity to ‘avoid’ falling.
“However, by reducing their activity, they end up becoming an even bigger falls risk, and that’s usually when an accident happens.
“It becomes a downward spiral so it’s vital that we’re able to intervene early to stop these issues in their tracks.”
Dr Johnson said Gold Coast Private’s 52-bed rehabilitation unit was pro-active in their prevention efforts. He said the unit ran a weekly education program with a team of doctors and allied health professionals for inpatients. There are also people in the community who take part in the hospital’s ‘day therapy’ groups.
“The program covers a range of topics and is run by a multi disciplinary team, including physiotherapists, occupational therapists, nutritionists and speech pathologists – just to name a few,” he said.
Dr Johnson said generally speaking, the number of elderly people in the community who suffer from frailty is grossly underestimated.
“I would really encourage GPs to look at issues of frailty in their patients and if they have concerns, talk to us” he said.
“It is much easier to treat early, than further down the track.”
Fall Intervention: Case study
Pat Miller always thought rehabilitation came after a serious injury. At least she did until she was seriously injured.
“You tend to think of going to rehab after a fall but I now realise it would have benefitted me before my accident,” the 82-year-old said.
“Rehabilitation at my age is equally about strengthening your body and educating yourself before a fall. I’ve learned so much at Gold Coast Private during the past couple of months and only wish I had done this sooner.”
Pat, who lives with husband Max at Paradise Point, has been working with Dr Michael Johnson and his Gold Coast Private rehabilitation services team after suffering a serious fall at home. She has been visiting Gold Coast Private two days a week where she is learning what she wished she knew earlier.
“My confidence has improved greatly,” she said.
“I’ve learned so much I had never thought of – even simple things like how to turn around safely.
“I now know rehabilitation isn’t just about overcoming injuries. It’s about helping you with day-to-day living.”
Gold Coast Private Hospital
For more information contact:
Gold Coast Private Hospital, Rehabilitation Care Centre, Level 2, 14 Hill Street, Southport QLD 4215, P: 07 5530 0125.
The director of Gold Coast Private Emergency Care Centre (ECC) is encouraging the community not to neglect their own health. Especially during concerning times such as the COVID-19 pandemic.
Less People in the Emergency Care Departments
Emergency medicine specialist Dr Anthony Padowitz works across the public and private sectors. Dr Padowitz said there has been a big drop in emergency department presentations across the board. He wants to remind people of the dangers of ‘putting your health on hold’. Dr Padowitz wants to reassure people that it is safe to visit a hospital.
“In recent months, we have observed a drop-off in the number of people presenting at our emergency departments for treatment, a trend also noted among GPs and allied health professionals,” Dr Padowitz said.
“Based on feedback from those patients who do present, we think that the trend is driven by two factors – people are concerned about catching COVID-19, or do not want to be a burden on the system during the pandemic.
“It may come as a surprise, but not seeking treatment until the last minute actually puts a strain on the system – if we can treat something earlier, it is better for everybody.
“We want to reassure the community that it is safe, and advisable, to visit a hospital, should you be experiencing a medical emergency.
“We have plenty of protocols in place to ensure people are kept safe and away from those presenting with respiratory symptoms.”
Always Seek Medical Advice and Emergency Care
Dr Padowitz said Queenslanders had done an outstanding job maintaining social distancing and dramatically reducing the spread of COVID-19. However, warned it was still vital that people sought medical advice and treatment should a health concern arise. He said ignoring or postponing medical attention for what may be a critical undiagnosed health issue was dangerous.
“All too often we see individuals present at our emergency department with a complaint that, had it been ignored, might have led to serious longer-term repercussions,” said Dr Padowitz.
“At the height of the pandemic, presentations to Gold Coast Private’s ECC were down 30 per cent.
“Even now, we are still treating about 15 per cent fewer people than before the pandemic – a trend that is being experienced across both public and private sectors and one that is dangerous for public health.
“Fortunately, the number of patients presenting with chest pain remains normal, and we are seeing an understandable drop in injuries due to restrictions on sport and outdoor activities.
“The worrying trend is the drop in patients presenting with things like abdominal pain and chronic illness. This is especially evident in diabetic patients and we have seen some cases where the patient is very ill by the time they arrive at hospital.”
Protecting People During COVID-19
Gold Coast Private acting general manager David Seton said the hospital had taken a number of steps to protect patients, staff, doctors and visitors during the COVID-19 pandemic.
“We are conducting patient screening and temperature checks on everyone who presents at our hospital,” he said.
“We’ve also implemented strict social distancing protocols in line with health authority advice.
“We urge anyone who may be putting off seeking medical advice or treatment, please contact your appropriate health professional, and if it’s an immediate concern, Gold Coast Private Emergency Department is open, safe, and here for your care.”