A very common symptom of sarcoidosis is dry eye and dry mouth. Dry mouth is called xerostomia (Greek meaning “dry” and “mouth” and is due to granulomas damaging the salivary glands. As an aside, there is a syndrome in sarcoidosis called Heerfordt’s syndrome which consists of parotid gland enlargement, fever and uveitis which is inflammation of the eye. The parotid glands are those which you see enlarged in mumps and which makes you look like a chipmunk.

We take saliva for granted when we have it.  There is a joke about lung transplants in the same vein.

Question: What’s the worst thing about a lung transplant?

Answer: Coughing up someone else’s sputum.

Imagine if we had salivary gland transplants. We won’t go there.  Thus, producing sputum, saliva and gastric juices is a wonderful thing.

WHAT ELSE CAUSES IT?

Another condition which affects salivary glands is Sjogren’s syndrome which is an autoimmune condition a bit like lupus (SLE). There are many other causes but sometimes no cause can be found. It just happens. Radiotherapy is a common cause but the reference below does not mention sarcoidosis.

HOW DO WE TREAT IT?

1. Treating the sarcoidosis early before it causes irreversible damage to the salivary glands is the best thing to do.
2. Sugar-free gum can help stimulate salivary flow without which we end up with holes in our teeth, gum disease and even losing teeth to decay. SalivaSure *(lozenge containing xylitol) is a salivary stimulant. Omni Theragum and Theramints *(contains xylitol) and Dentiva *(slow dissolving soft lozenge) (American Dental Association, 2006) (all ameircan brands – Wrigley’s extra is a sugar free gum)
3. There are saliva replacements as well but these are really lubricants and need to be administered regularly. Oral-Lube, Biotene Oral-Balance (mouthwash, sprays, toothpaste, gel, gum), GC Drymouth Gel and Tooth Mosse, Oral 7 (mouthwash, toothpaste,gel), Oasis* (moisturizing mouthwash), Salivart Synthetic Saliva Omni Theraspray * (contains xylitol).
4. Pilocarpine is a drug which can stimulate salivary flow but has too many side-effects to be universally useful (see the reference below).
5. Xerostomia can be a very distressing problem.  See your dentist regularly and you would qualify for subsidy from the Federal Government now for a medical condition requiring regular dental care.
6. Early recognition is important. If you think your mouth is dry all the time, tell your doctor and get help early.
7. Avoid other causes. Finally, some drugs can cause dry mouth eg the tricyclic antidepressants so always check that this is not a cause. Keeping yourself well hydrated is important and observed good dental hygiene eg brush and floss after meals and use mouth rinses and  ToothMousse.

It is important that patients try a variety of products (gels, toothpastes, mouthwashes etc) as individuals respond differently to each treatment.

Acknowledgements:

I wish to thank Dr Yoram Chaiter on the BMJ website doc2doc for his input into this subject and for the listing of some of the medications he uses.  I go under the name, Odysseus on this site.

References:

http://www.australianprescriber.com/magazine/29/4/97/8/

Broadcast date: Monday 9 May 2011 ABC 612AM

Go to http://www.abc.net.au/local/stories/2011/05/09/3211407.htm?site=conversations to listen to the interview.

Dr Roger Allen is a sleep and thoracic physician at Brisbane’s Wesley Hospital.

He sees people who are suffering from lack of sleep for all sorts of reasons, and also patients with asbestos-related diseases, including mesothelioma.

Many of his patients are war veterans and soldiers. Roger feels a certain connection with those men and women because he’s served in East Timor as an army medical officer.

Ballina Boy: a Child’s Odyssey through the 1950s.Published Xlibris.

The book opens in 1951 with the untimely death of my grandmother from a hypertensive stroke as there was no effective treatment then for “blood pressure”.  The year I was born (1951) saw the biggest poliomyelitis epidemic in our history and my mother who was called in to help caught polio.  The Salk vaccine was yet a dream and as result kids in steel callipers and iron lungs were common.  The following year she was nearly killed when a tractor accident when a disc plough ran over her. The only antibiotics were penicillin and sulpha and many people died of tetanus.  Despite the staff shortages, nurses were forbidden to work once they married.

As a second year intern my father worked at Willoburn, near Toowoomba, a hospital for the insane and psychotically depressed where s hock treatment and rest were the only treatments with the first anti-psychotic, Largactil appearing in 1955.  In 1949 that John Cade in Melbourne first described lithium for bipolar disorder.

In the year I was born, a seminal observation was made by some TB doctors at Staten Island, New York, that depressed TB patients on Isoniazid became happier due to a fortuitous property of the drug; MAO-inhibition and which spawned the first antidepressants in the fifties.

One day when swimming with my father, I nearly drowned only to be resuscitated by a life-saver using the Sylvester-Broche method as CPR was not invented. Sometimes my father would take me on ward rounds at the Ballina Hospital and remember him developing his x-rays in the eerie orange of the dark room, the smell of hypo and solvents, and the wet ghostly film hanging from stainless steel pegs to dry.

When he considered moving to Ballina he was daunted by the dazzling array of surgical procedures done by his predecessor in the days when the GP did midwifery, abdominal surgery, managed most fractures, and “tonsils and adenoids” were a right of passage of nearly every kid in town and he also did anaesthetics with ether and a Schimmelbusch mask.  His surgery was like a chemistry lab; test-tubes for boiling urine for protein, testing for sugar with tablets that changed colour, a haemoglobinometer with coloured glass inserts, a tube for ESR’s, a microscope and slides for micro-urines, plaster of Paris and plaster shears, bottles for pathology specimens, stomach pumps, kidney trays, ear syringes and so it went on.  His syringes were stainless steel and glass, wrapped in huckaback. He resharpened his needles and kept catgut in butter dishes of blue Zephrin (benzylconium chloride). His steriliser was a cantilevered boiler. He did not have a fancy ECG machine as heart attacks were then diagnosed clinically and by a rise in WCC and ESR which he did himself.

Pregnancy was diagnosed with urine on toads and pre-eclampsia by boiling urine with a metho burner and a test tube to which acetic acid was added. Asthma attacks were treated by subcutaneous adrenaline “a minim a minute”. Most measurements were in Imperial with drugs in grains eg of phenobarb and ounces of Ipecac and instead of “mls” he spoke in “cc’s”. Drug company reps were well regarded as they brought with them medical advances and news from the big smoke. He did night surgery on week nights after dinner, had no after hours locum service and had no appointment system. At night my mother made swabs of cottonwool and thin layers of gauze which went in the steriliser and then stored in large jars with steel lids. Mum patched rubber surgical gloves, covered them inside and out with talc and sterilised them for reuse.  AIDS was unheard of. Our lounge room was a “spill over” bay from the attached surgery and thus my medical apprenticeship started in pre-school.

As there was no Medicare, he was often paid in kind; a mud crab, a quart of cream which Mum churned into butter, some freshly caught fish or some prawns.  The doctor-patient bond was close, the doctor greatly valued as he was the bastion beyond which was death. Every child ran the gauntlet of viral exanthems, febrile convulsions were common and just called “convulsions”. Rheumatic fever laid up many a child in bed for months only to result in an early death from a stenosed valve and nearly everyone knew someone who had died from TB.  Childhood had more freedom, people and life were tougher. We had less material stuff but more simple riches and were arguably happier. For a happy adventure through childhood please read Ballina Boy (www.ballinaboy.com). Its darker moments are illuminated by black humour and there are numerous illustrations and photographs.

However, this was still my story; my Dreaming with this Olympian Zeus presiding over the lowlands of my childhood with his wife, Hera, incarnate as my mother, Lucy of the Hearth, who held together, house, surgery and Mt Olympus despite the thunderbolts of adversity. It is not easy to unearth the visions and influences  of childhood which for me started at my grandmother’s  funeral  when I was in utero and concluded on my ninth birthday on the equator, somewhere in the Indian Ocean scored  by the foaming wake of the SS Arcadia and my father‘s dreams. Childhood is covered by an overburden of adult perceptions set like dried lava and disguised by the vegetation of conformity.  The magma of childhood is still unset with its wobbly questioning and a refreshing venting of expressions of awe, be it at the feigned spikes of a wily caterpillar or the pictographic sunset of sheep-clouds. To complicate matters, the growth rings of childhood reveal increasing sophistication; an ontological rerun of the ascent of man.  As the child grows, the horizon becomes more distant.

The backdrop of my childhood was the surgery of a country general practice dominated by my father, Lucius who was “different” from any other man I knew partially due to his first class honours in Classics and years teaching at two grammar schools before he entered medicine in 1944. He had won the Lilley Medal as Dux at the Brisbane Grammar School in 1937. His father, Kennedy Allen, in turn was a man of letters, a polymath and Classicist, who had won the gold medal at the King’s Inn in Dublin having been Dux at Rockhampton Grammar like his younger brother. He was a courtly man, a respected Brisbane barrister, later judge and was made an Honorary Doctor of Law by the University of Queensland. My father too was a gifted linguist, a master not only of Ancient Greek, Latin, French, Philosophy and Metaphysics but later of Spanish and Italian.

His intellect cast a long shadow over me as well as his herculean stamina, his at times exasperating dedication to patients and his curiosity about all things intellectual but not extended to things mechanical like lawn mowers. He was an intellectual filter-feeder siphoning up ideas and facts but also giving out like Mentor in Homer’s Odyssey as I discovered then he later taught me Senior French as an extra subject at BGS and taught his brother Junior Algebra and in retirement French at the University of the Third Age. However, he was intensely private with even my mother excluded from his “Dales of Arcady” and never once did I see him shed his crusty carapace softened by the hormones of prose or verse. It was about this complex man I wrote; the doctor who kept his MBBS degree rolled up in his bottom drawer with his self-doubts, and who always had a book of Greek or Latin on his desk in case a patient didn’t come. His enemy was time and death was a realm where it was too dark to read. Among his legacy were years of dedicated medical practice. His name plate at the garden cemetery just reads, “Dr Lucius Allen, Doctor and Scholar.”

This book is about my childhood on the once bustling Richmond River, about medicine but also about him. Its genesis has many facets one of which shows that the common saying, “Just a GP” can be so trite. I hope you enjoy reading it as much as I did telling this story.

www.ballinaboy.com

The Latin version is also charming and it is great to see how skillfully the translator adapts Latin to modern words eg toaster, car, milk bottles. Indeed this is the most wonderful part of the book. I have ordered the Latin version of Chamber of Secrets and have a book of 1000 modern Latin words eg for aeroplane, dishwasher etc as per the Vatican Latin masters.

May I commend those of you schooled in these ancient and dark arts to buy the Latin version, and with the English one by your side, delve into the wonder and sheer hedonism of languages other than your own. I realise I may be speaking to a select few as natural selection is choosy with regards H. sapiens nerdiensis.

I am also trying to obtain the Modern Greek version but so far to no avail as I live in a far flung outpost of the Federation of Muggles, called Terra Australis. If anyone can help I’d appreciate it.

For me, language is a great ocean waiting to be charted. At first we dance along its sandy shores and pick up sea shells washed up by its rolling surf. Then we venture out in our fragile barks to explore the coast and see the horizon from a new perspective. This ocean is alluring like the Sirens’ beckoning us; to touch her shores and sound her shoals until we feel confident to leave behind that familiar world to discover new islands, new reefs until we find ourselves in the land of the lotus eaters, far from home, forgetting our native tongue for just a moment, where we become the stranger, the ξένος, welcomed by the hospitality of a strange idiom and tongue, food and folklore until our thoughts enter this new paradigm and we dream its dreams.

When this happens we are changed forever, like Odysseus, that man so wary and wise. We are transformed as our eyes are opened. We can never go back again. We have seen a new world which is different from our own like those creatures on that beautiful planet in Avatar and we see in 3D like we do when we become doctors. O how medicine wearies us and makes us her slave.

“Sing, O Muse, of the man so wary and wise, who in far lands

Wander’d whenas he had wasted the sacred town of the Trojans.

Many a people he saw and beheld their cities and customs,

Many a woe he endured in his heart as he tossed on the ocean,

Striving to win him his life and to bring home safely his comrades.”

Odyssey, Book 1 by H.B. Cotterill MXM11 (I like this as he translated Greek iambic hexameter into English iambic hexameter although he has his detractors.)

We strive to do the same in medicine but instead of our comrades pulling oars and setting sails, they are our patients. The ocean of language to me is the ocean of paradigms of the human condition which is no different now than in Minoan times. To explore this gives to me the greatest pleasure, akin to sailing boat on the ocean.

“There be three things which are too wonderful for me, yea, four which I know not;

The way of an eagle in the air; the way of the serpent on a rock; the way of a ship in the midst of the sea; and the way of a man with a maid.”   Proverbs 30:18-19

This afternoon, we closed our office and cancelled any outstanding appointments as our building was quietly evacuated because of the threatening flood waters. As I drove out of the doctors’ car park, I was confronted with streets flooded with water and after a tentative attempt to drive through it I turned around and hoping that the car would not stall; I drove along the footpath which was higher and returned to the car park.

I then drove it to the highest level and went back and told my wife who was finishing consulting. No one had realised how bad things had become and we still had some patients in the waiting rooms. We sent all our staff home in the hope they would be able to get home in time before nightfall.  The water had risen so quickly and the main road outside was in the process of being closed as it runs parallel to the Brisbane River.

I am not one to become frightened easily as I have been in war zones as a soldier but today I had a genuine concern for our safety and thought of our children at home and my daughter who lives in a river-side suburb which can flood.

On the way home near the hospital, road were closed with the flashing blue lights of police cars blocking off roads that were lakes.

After a few detours we managed to get onto the main road home which was still clear although water was lapping the verge and we knew that the high tide was not yet here. We drove along a main road along the river a few miles downstream from the hospital and noticed the surging river with logs and debris rushing past.

When we got to our suburb which is on high ground we went to a supermarket where there were long queues of people lining up with trolleys full of provisions. My wife and I headed straight for the tins of Italian tomatoes and pasta and as well as baker’s flour and packets of yeast while most were buying “normal” stuff. We had a giggle as we know how to survive on the basics.

So far nine have drowned including 4 children and over 70 people are missing in SE Queensland. Even brick houses have been washed away. This is proving to be a bigger flood than the big one in 1974 and rivalling the “big wet” in the 1890′s.

This is an unprecedented natural disaster. Regardless of who you are and where you live in Queensland, it is touching everyone.

There will be some very high tides in the next few days and people are expecting the worst. The central business district has been closed and even our hospital has cancelled all elective work. I don’t know how many nurses and doctors will get to work.

Many doctors’ surgeries have gone under. And this is just the beginning. The area underwater is bigger than France.

Wednesday 12.01.11

I awoke this Wednesday morning to an eerie silence. The arterial road not far from us was deserted. It was like Good Friday and for some, their Golgotha has come. I then heard the distinctive sound of a Black Hawk overhead. Its rotors sound different from the “chocka-chocka” of Iroquois which I used to go in on Army Exercises. The RAAF are sending in C130′s (Hercules) and but the Army was unable to get to flood victims in the Lockyer Valley west of Brisbane as even their high wheeled trucks were not up to it. It was over to the helicopters.

We are thankfully still dry and we have our daughter and partner staying with us as they moved out of their flat which may be by now underwater. As university students all they managed to save were their laptops and a few clothes, so this is touching all of us. We thought of the contents of their fridge as there will be no power. Fortunately they had only a few slices of ham in it. Meat a week old can devastate a fridge. It has happened to us before. You never get the smell out.

I have been through cyclones before but flooding gives a different feel with the water rising silently and spreading as an insidious force like something in a science-fiction movie.

The next few days will be critical as the “modelling” of the hydrologists predict that the waters will be at their highest.

Another helicopter passes overhead. The media now talk of helicopter “assets” as our leaders now speak the double-talk of “jargonese” and “economic collateral damage” as if we can reduce human misery to a profit and loss statement as reporters ask the PM whether this will affect the government’s projected return to “surplus” by 2013. We have descended into the banality of reporters and politicians; a flood of media verbosity, and constant prattle while the world goes on.

After the “Big One” in 1974 they built the Wivenhoe dam in the foothills to the north-west of Brisbane to mitigate against the risk of flooding. However, since then people have forgotten and a new generation has grown up; Generation “What Flood?”. Houses have been built in lower-lying areas as people felt sure that the “100 year flood”, the event which insurance companies and city councils allow for, would not occur on their watch. There was money to be made in real estate in this primaeval flood plain of the Brisbane River we call greater Brisbane.

After the recent seven year drought when the dams were nearly empty, they are now brimming over but ironically we are still on water restrictions (no sprinklers!). Over the past few days Wivenhoe Dam has been taking in the equivalent in volume of twice that of Sydney Harbour. To avert disaster (a breached dam), the water authorities have released water “in a controlled way” into the Brisbane River but in such a way as not to coincide with the high tide as the river is tidal all the way up to Ipswich about fifty miles upstream; more ice bergs to the sinking Titanic.

There is an air of unreality at our place a bit like being in the bunker at the Reichstag in Berlin in 1945 while a battle rages outside. We watch the television and see our mayor giving us the low down on stuff like how many thousand streets are underwater and how many thousand businesses are…. Then we cross over a reporter with lip gloss poking a black microphone in some hagged bloke’s face, asking him how he felt when he was inside his house with his wife and kids as it was ripped off its stumps and became a boat rushing for half a mile before a 20 foot wall of water and the floor boards lifting with the pressure as they are not designed as a hull….more questions…”and what were you thinking at the time…was it scary….” and so it goes on, such is the genre of reporters’ rhetorical questions before we cross over for the latest update from the MET (Bureau of Meteorology) which is a form of modern astrology based on portents from meteors, Star’s of Bethlehem. They gave us no warning when I went to work yesterday morning that by lunchtime my hospital was on Orange Alert and that our medical suites would need evacuation but I suppose none of the fiscal Magi picked the signs of the impending implosion from the GFC in the sky above Wall Street.

Another helicopter flies over…a Squirrel.

0910 hrs.

We drive into New Farm, an inner city suburb to see if my daughter’s flat is under water. Her partner comes with me as she is at work.

We find a street cordoned off and police cars and blue and white tape across the road. I count five policemen doing squat all as far as I can see apart from chatting with the locals about “the water”. Surely they could do it with maybe one or two cops?

We do a detour and find that her flat is dry still. Then we gathered up armfuls of clothes and the accoutrements of domesticity into the back of my 4×4. We empty the fridge of things which could stink if the power dies. I unplug plugs and raise things off the floor to a new high water level realising that if it goes “pear-shaped” that book cases and tables will float and spill their contents. It is a sort of moral statement; the triumph of optimism, human spirit and chance above chaos, “shit happening” and the whim of the River Spirit.

The sun has come out temporarily bringing a sense of surrealism to the city. I see people leaving shops with white plastic bags laden with essentials. A post-man is delivering the mail on his scooter and when we get home the garbage has been collected. “Normalcy” at last or the quiet of the “Phony War”. The next few days will tell.

A patient rings me on my mobile. He has an appointment today and has flown down 1000 miles from Townsville to see me. He is staying across the road from the hospital. I give him some advice and tell him to sit it out for a few days…

The State Premier, Anna Bligh, we call Captain Bligh is on ABC TV again surrounded by expressionless “heavies”; the State Emergency Service Minister, the Police Commissioner in light blue shirt and dark blue epaulettes, the mayor and then we cross to the PM, Julia Gillard. Both women look drawn as they respond to the moronic questions of reporters wanting air time and asking the usual questions of which no one knows the answers…God knows…

The flies have been bad presumably because of rotting debris and the sodden earth like the Plagues of Egypt. I suppose a few million sheep and cattle would be a factor and no doubt when the water has subsided there will be some grizzly findings in flood-ravaged cars.

Entomologists in the local paper explain the plague of spiders and insects washed from their burrows while snakes and other animals fight for their lives too. A farmer describes a small dry plot of land on his property where animals have found a sanctuary where wild dingoes coexist with kangaroos, wallabies and sheep in an unscripted truce until the flood waters subside; the lion with the lamb.

Yachts and pontoons have been wrenched from their moorings and swept down the river like dead leaves in a storm water drain. On the Hamilton Reach near my home I see the fin of a yacht and can’t make out whether it is the hull or a rudder. As it is stationery I assume that the boat is still at anchor although submerged. Debris accumulating around anchor chains acts as the final straw until the boat breaks loose or goes under from perforate hulls from collisions with logs, errant pontoons or shipping containers.

And so we wait. I made bread last night and we have plenty of provisions. I filled up three jerry cans with water as we have been warned that if the power goes, so does the water. I ring my mother and tell her to fill her bath and laundry tubs. She acquiesces and tells me she doubts it will get to this. However, we just don’t know. I see how fragile modern society it with its reliance on power, water, and food supply from third parties. We don’t have a well and would not survive on our current vegetable garden. It has been too wet. Armageddon is really only a few meals away for most. And that is why we have compost bin and cake bake bread and live on basics but even this, in the long run, is not enough. Perhaps such catastrophes are salient lessons for us all.

1400 hrs.

One of my two secretaries sent me a text this afternoon saying that they had to evacuate their house which has water lapping the gutters of her roof. She had broken her arm last week which gives being in a POP cast new dimension. If only she had two good arms. She got only a few things out.

In a street in Ipswich, some neighbours saw a bull shark swimming in their flooded street.

In Brisbane, in the last few days 190,000 sand bags have been used and 80,000 since last night.

1600 hrs.

A long floating river walk pontoon in the inner city is posing a serious safety risk as it is threatening to rise up over the pylons and come loose. The mayor is ordering its scuttling lest it wreck boats and other structures downstream. They would weigh hundreds of tons.

A ferry is holding on with only one mooring line as men work to secure it as the river rises inexorably over the next 36 hours.

The radio is on 24/7 as we get updates. In many areas the power has been turned off. The bus services are being ceased and the main inner city free way I came home on yesterday is now cut. The inner city business area is now a ghost town as many places go under and most of the bridges have been closed. About 250, 000 people are without power including 60,000 in the inner city. Last time this happened a lot of people were electrocuted when they returned to their homes.

Electricity substations have been turned off as rising water would cause explosions.

Raw sewerage is now getting into the flood water as sewerage plants go under and sewers are flooded. Our garbage has not been collected as I had thought. We are told to sandbag our toilets and drains e.g. in showers to prevent sewerage coming back up. People are being assisted in halls and churches all over the city. It is to be one all mighty sleep over.

Society in crisis. We have a Volunteer Help Line which is being overwhelmed with offers of assistance.

More helicopters pass over. God bless the ADF.

1800 hrs.

I saw our former PM, The Hon Kevin Rudd walking through flooded streets carrying bags on his head belonging to people in his electorate whose streets were going under. He had been doing this since late last night. This was no media stunt. He even got the TV interviewer to pitch in and give a hand.

I went down to the river this evening at 1800 hrs to see what was happening. Indeed I had gone to return some library books and was amazed that the librarians were still there, 100 yards from the river and had sandbagged the library and put plastic over all the air vents in the wall on the building. They seemed calm and resolute. I checked in my audio books and asked for an extension on two.

Across the road was a bistro full of people eating and drinking while in all the shops next door and down the street there were sandbags against their walls and door. It was surreal like the last day in Pompeii.

I walked down to the river where there is usually a busy arterial road which parallels its banks. It was silent and the police had cordoned off the road to traffic. Sight seers were walking to see the river which was an awesome sight of swirling brown with trees passing, then a pontoon, and then a large blue tarpaulin covering what was probably a boat. Its sullen power was frightening.

A riverside seafood restaurant was closed, its margins lined with sandbags. There was almost a carnival atmosphere for a Wednesday but people only spoke with hushed voices and no one was laughing.

When I first got there I noticed than the tide was rushing in along the shallower water along the stone embankment but the current was rushing downstream in the deeper water. It was a mix of vectors with both tide and current deciding the fate of men and women in its path.

This surpasses the devastation of Hurricane Katrina in New Orleans but the support services are doing us proud. We are doing well.

Thursday 13 Jan 11

0800 hrs

We awoke this morning to sunny sky notwithstanding gathering rain clouds. The river had peaked on the high tide at 0400 at about 4.5 metres which is the height above sea level. There was a slight sigh of relief as it was not quite as high as expected, for each metre means a few thousand more houses, more businesses and more disruption. It is a hydrologist’s statistic with “flow on” implications.

We still don’t know whether my daughter’s place went under as we can’t get to it. However, the riverside suburb of New Farm was one of the worst hit. We expect the worst. She is going to London with her partner in two weeks. At least we got out their winter clothes and shoes and they are safe.

I watched the morning television to see that a hundred metres of the city walk pontoon had been wrenched from its mooring and was floating down the river. There are all sorts of things heading down stream. Someone’s pontoon with chairs still standing on it, as if time has frozen a once tranquil vista of life by the river.

The port has been closed until they can survey the river and those with boats have been told to keep avoid the water as there are so many navigation hazards. I was going in a sailing race from the southern end of the bay at Southport to Brisbane next weekend but I fear that sailing into the night may be foolish with so much debris around. As there are about 100 boats in the race, it will be interesting to see if common sense prevails for this year’s “Surf to City”.

A riverside beer garden on a barge which was once a large vehicular ferry has come adrift. Bridges have been threatened as debris hits their cut waters and most have been closed.

Over 120,000 houses are without power which was cut off on purpose for safety reasons. The reservoirs in the hills of Brisbane, although full need power to pump more water to them. There are a few days worth of water in them we have been told to conserve water until the crisis has passed as there will be a massive need for water when the clean-up starts. Our bath is still full of water for drinking just in case.

The Wesley Hospital where I work is surrounded by water as it is on a hill less than 100 yards from the river. The only access is by a pedestrian bridge from the station next door. I wonder how staff can get there to work as we lucky ones who are dry are marooned on our suburban islands of hilly suburbs while just down the road muddy waters lurk. Brisbane has about seventy hills a bit like Rome only more. Luckily, as I only returned from vacation on Monday, I have only one patient in hospital and he is also under an oncologist who is seeing him. I would be a drama queen to try to see him.

I turn the pages of our paper, The Courier Mail to see the faces of men, women and children who have perished. I read their tragic stories. A four year old boy washed away during a rescue, his parents surviving.

There are still a lot missing and unaccounted for. 13 dead so far, about 50 more somewhere. There is a photo of a woman waist deep in the flood waters carrying a tray of fruit cake serving people in a conga line of workers passing things salvaged from shops and houses in Rosalie, a suburb near the Wesley.

There were some nice things said about Kevin Rudd and his genuine and tireless efforts in his electorate. He is now our Foreign Minister and it is good to see people leading from the front, up to their waist in water and talking about the need for everyone to pitch in, for bipartisanship in government, and the need for coordinated plans for recovery and reconstruction. This will cost tens of billions not to mention the human cost.

Now we can only sit and wait. The flood waters will remain high all day today. There is still an air of unreality for those who are “unaffected”. Somehow, it almost feels unfair not to have suffered more; “flood guilt” or is it “survivor guilt”? I can now understand how those in war feel when they see others go down when they remain untouched.

The land lines are not responding so we don’t try the phone. Even the mobile net yesterday was overloaded so we only text and have been told to use phones only sparingly. The Internet went down too last night just after I posted to doc2doc. Sort of dramatic in a way to be deprived of these things we take for granted.

There are many tales of neighbours and strangers working tirelessly to help one another. That is what is so wonderful about humanity when push comes to shove. I feel proud to be a Queenslander for as in our rugby match, The State of Origin Series against NSW, the maroon jersey means we fight until the final whistle.

There is a photo of a railway bridge in the Lockyer Valley at Grantham where 30 cars are piled up against it, revealed by the falling flood waters. The ABC interviewer ironically is Paul Lockyer. They suspect that many will have bodies in them. At this place, one young woman managed to get onto the bonnet of her car as it was swept headlong towards the bridge. A man seeing this waded out into the torrent to help. She jumped off just before the car was sucked under and landed in his arms. Many, he said laconically, were not so lucky.

There is an air of cohesion in the place; neither panic nor despair. I have not heard anyone grumble and all over town there are refuges set up by the Red Cross, Salvation Army and social agencies, each to house a thousand people give or take a few. People were warned not to forget their medications when they evacuate especially diabetics. There are scenes of young people in these places playing Monopoly or cards while the displaced elderly eat with plastic knives and forks while other people sleep on a sea of mattresses across the varnished floor of a sports centre; sleep a brief reprieve from what the flood has taken from them.

I see on the MET forecast this morning the rain fall totals. I have a cottage in the hills north of Brisbane at Maleny. This month, in the last 12 days they have had 792mm rain. No wonder our rivers are swollen. The rain is now falling heavily in South Australia and NW Victoria and Northern New South Wales. This is an area as large as Europe.

My daughter has gone to work again this morning at the local Clayfield Market, a fruit and vegetable market which is one of the few places in town with any fresh produce. She unwittingly has become an Essential Service according to the Mayor. As a doctor, I am not needed.

When I went to pick her up last night after work, many of the shelves were bare. A semi-trailer-load of fresh produce has been consigned from Sydney, 1000 km south but as many of the rivers in Northern NSW are flooded, we don’t know if it will get through. So far, it appears it can’t get through.

Our markets at the suburb of Rocklea are now a lake and our CBD (Central Business District) deserted. Most of the inner city freeways are cut too. Ironically, the new Clem7 Tunnel under the river is still open. The M1 freeway which goes past the iconic Breakfast Creek Hotel is underwater and the hotel has been inundated as in the last flood. (There is a drawing of this lovely French Renaissance style hotel in my book).

My son, who is 14, is excited as there has been another sighting of a bull shark in a suburban street. These are aggressive sharks which attack and attack. He has an encyclopaedic fascination with sharks and I never argue with him on this topic. It seems funny to think these brutes are swimming where a few days ago the postman did his run.

ABC TV last night interviewed the manager of a well-known Brisbane hotel near the river, just near our botanical gardens. They had sensibly instituted a flood plan as they had been through it in ’74. We are not called the River City for nothing.

He was composed and showed the swimming pool which was full of pool furniture and desk chairs lest the torrent sweep them away and become a hazard to others. In the lobby was the long expanse of new carpet still untouched and the wood panelling and the concierge’s desk and half way up the wall, a graphic line showing where the water came up to in 1974.

…the calm before the storm.

You may be becoming bored with this account of the flood. In a way, I am too. We want to get back to work, but my hospital is an island. I am not used to sitting around on weekdays while the world is in standstill mode but for many it has crumbled before their eyes like prized sandcastles washed away by the surge of a rising tide.

Friday 14 Jan 11

0730 hrs

Although it is sunny today, I still can’t get to the Wesley Hospital as the main roads are cut. The river is going down slowly and houses are emerging but I can’t move.

An email from my one of my secretaries forwarded from the other who has lost her house, tells me she has been able to go back in to assess the damage. The ceilings have caved in and all the walls are buckled. It will all have to be stripped out.

As the flood waters rose, her husband let all his homing pigeons go and locked the cage door lest they return and drown. Some neighbours took care of their chooks and chocolate Labradors which she breeds.

Where do you start when you return? Electricians have to certify that the house is safe after the power has been restored to the area. She will live in a caravan in the backyard while her house is fixed. It will be a long stay. The police arrested a few looters in her street but by and large this sort of behaviour is an aberration. There will always be “low lives” in any society; parasites on the back of the noble elephant.

Yesterday, 150 metres of concrete and steel pontoon riverside walk way broke loose and headed down stream threatening the Gateway Bridge which is a huge bridge about 100 metres above the river not far from the port. Seeing this, two private tug boat skippers in their mid sixties, got in their 40 year old tug boat, Mavis, and with considerable courage and skill, shepherded the massive structure under the bridge by making it float parallel to the pylons and then deposited on at Nudgee Beach just to the north of the mouth. This was not done at the instigation of the authorities but by the demands of insight and common sense. There was also a marina just below the bridge full of yachts and boats. If it had hit this, there would have been chaos. These men have done something heroic but they were quite surprised at the fuss being made of their actions.

Another email yesterday; the QCYC Marina on Cabbage Tree Creek has so much debris that a working bee has been organised for tomorrow. We are asked to bring chain saws, wheel barrows, axes etc. It is a job for sailor boys.

Another walkway pontoon was scuttled yesterday with explosive charges as it also was a threat if it broke loose.

We met with friends last night and ate out at a cheap Thai Restaurant which was opened for business as it was not affected by the floods. All our friends there shared a feeling of agitation during this time. I listened to ABC radio most of the time as the drama unfolded. Both my wife and I could not settle as there is so much misery going on about us. You start to resonate with the sorrow. We feel we would like to help but until the flood passes, it is not yet time. Perhaps it is why I am writing this post to you all. Please forgive me.

This reminds me of what it must have been like on the Eastern Front in WW2 as the distance is large. To the north 400 miles away on the coast, Rockhampton is underwater, and between us and them, Bundaberg and Gympie and to the west of the Great Divide, a few hundred miles west (I still like miles), the town of Goondiwindi has been evacuated along with the hospital as the townsfolk wait at the evacuation point at the show grounds while the McIntyre River creeps ever upwards on the levy which is 11 metres high. The water is now only a hand span width below the top of the levy as we wait by our radios to hear. These towns may seem remote to you, but I know GP’s in these areas and patients who come down to see me and I think of the man I see who is on a wheat and sheep property outside Goondiwindi and whether he and his wife are all right. Last time I saw him he recounted carry sheep in his car to higher ground.

The water in the rivers west of the Great Divide all head south-west eventually to the Darling which later joins the Murray to empty at Lake Alexandrina and then into the Southern Ocean near the South Australian border. So vast are the distances that it will take 6-8 weeks for the Queensland flood waters to reach the sea.

We still don’t know if my daughter’s flat has survived. We are waiting to hear if the roads are open.

I had an email from the Maritime Museum yesterday that the replica Dutch caravel, the Duyfken (Dove) moored there was still intact and floating and the WW2 corvette, HMAS Diamantina which was in dry dock was now floating. One man had stayed up all night adjusting mooring lines as the ship rose. The old lighthouse ship alas had sunk and the steam tug, Forceful was OK.

As I am self-employed, the impact of this flood will affect us as well even though we escaped unscathed. The aftermath of flood will be considerable social dislocation, financial ruin for many, physical and mental illness.

Soon the restless mass media, like industrious honey bees, will go off in search of the next newsworthy disaster, leaving unwritten and untelevised, the small print of devastation in the lives of men and women. There will be wrangles with insurance companies, the problems of insolvency, unpaid bills, how and where to get tradesmen, quotes and building material, the problems of cars which have been flood damaged and whatever became of my carrier pigeons?

Sure, the governance of this disaster has been commendable and the social agencies are coming in to help with financial support and the ADF has been mobilised to help clean up and look for missing people and so it goes on…

I think of two patients with lung cancer I had diagnosed just before Christmas and whom I was going to start on treatment this week. Even cancer has to wait….

For those of you who have read this post, I thank you. I wrote to tell you, not so much of my tale, but of how a natural disaster affects a community. This is not Haiti or Pakistan but in a way it is. It is like a war when the only war you see is how it affects you or for a soldier, at the level of a section of seven or ten men and not on the grand scale of an Army Group of a million men as in Russia in WW2. Only a historian or government supremo can see it in this scale.

My wife who is a psychiatrists will no doubt see patients downstream from this event as will I; depressed and anxious patients, those who have witnessed grizzly scenes of decaying bodies or a limp body of a dead child or lost loved ones who are never found along with all their worldly possessions or how their pets were carried away. Only yesterday a man in Brisbane was sucked down a storm water drain when he went to help his elderly father.

The country people are tough here but their support services less than that of “city-slickers”. As most farmers were reeling from the effect of seven years of drought, I fear that for some, this flood will be the end. Some will blow their brains out but most will be OK.

However, on an optimistic note, human resilience and the life force is something to be wondered at and life will for most, will soon resume some level of normality. Those who have experience the 2011 flood, this January will remain both dark and wide among the annual tree rings of their lives.

Sunday, 16th January

I read in the paper of the dead and missing. There have been five cases of melioidosis since the flood; mostly from Rockhampton 400 miles north as this organism lives in the soil and is a common cause of pneumonia in the tropics. I once wrote an article about this in a French journal. There have been Flavi virus infections which the paper says includes Kunjin virus (apparently a local version of West Nile Fever) and other forms of encephalitis. Murray Valley encephalitis was the first encephalitis where a virus was isolated. I am sure that arboviruses will flourish with the stagnant water everywhere, ideal for mosquitoes and insects. Our Foreign Minister, Kevin Rudd had to go to hospital with an infected cut. Bacteria do not discriminate between the legs of politicians or plebeians. He has valvular heart disease which may be another consideration.

I read in the paper (Courier Mail) of a system called the Walker Circulation which brings easterly air currents from South America and hence warm moist air. The whole world’s weather is governed by a phenomenon called Rossby Waves which are both atmospheric eg in the jet stream and deep oceanic currents due to the spinning of the earth, shear stresses and the Coriolis effect. We are in reality all clinging onto a giant wobbling spinning top and live in side a gigantic cosmic kitchen blender. It is not surprising therefore to see that Brazil and Australia are connected and even Africa through the same flow-on effect in the Indian Ocean viz. Sri Lanka. The weather is also affected by sunspot activity and solar wind and more. Do you know that the annual background radiation from solar gamma rays is equivalent to 100 chest radiographs (2 mSv/annum and one radiograph is 0.02 mSv). Why the La Niña dances so methodically with El Niño I think is still in the realm of the semi-unknown. I’ll leave it to the boffins.

Whatever the reason, it shows the fragility of human existence and how homes with “riverside frontages” or “ocean views” are somewhat limited in long-term vision. Since human habitation of Australia, Brisbane’s Moreton Bay has been a dry paddock several times and the same with the North Sea. The perspective of modern men and real estate agents as well as global warming pundits tend to be a little meiopic.

I hope to bore you no more about floods and the state of the world. The world resumes on Monday.

Monday, 17th Jan.

50,000 volunteers worked all weekend in Brisbane where so far 30,000 tons of debris and flood damaged material has been moved.

The Premier tells us that 500,000 square km of Queensland is flooded.

A former disaster worker arranges the shipment of 1500 gum boots by QANTAS and Toll Freight free of charge from New Zealand. We have run out of gum boots.

20,000 homes are still without power.

I resume work this morning not knowing how many patients will turn up. The roads are in a bad way and one main road is a concern as it could fall into the river as in the last flood.

Yesterday I went on a bike ride with my son along the muddy river where we found a 30 foot yacht by the bank, unsecured, wedged into some errant pontoons and debris. I called the Water Police as it needed to be taken to a safe mooring. Another yacht at a mooring looked a sorry sight.. as if it had sailed around the world without a stop. Mine sweepers are surveying the bay and river still.

Another body has been found; 18 so far which is small compared with Brazil. There are about as many still missing. An infirm old lady was found dead in her house as she was unable to get out in time.

We see the plight of Brazil… they are doing it tough. All the same stuff but there’s is more to do with terrible mudslides which have wiped out whole villages and with disastrous loss of life.

There is more flooding in Victoria another world away to the south. It is their worst flooding ever. Says something about global warming??

The two cyclones off the coast seem to be less of a threat now as they are well out to sea.

Life resumes.

Tuesday, 18^th Jan 11.

In my book, Ballina Boy, I describe such flooding which occurred in Australia between 1954-6. One night we had 13 inches of rain. These things are cyclical (La Niña) and I feel that the global warming zealots sometimes overlook cyclical events and also long-term events of geological time scales.

Senator Bob Brown, our Greens Senator has just blamed our coal industry for this disaster which is a bit like blaming the iron ore producers which made the Titanic for its sinking. It is not so simple and his message went over like a lead balloon. This does no credit to their cause and he even suggested that the coal industry pay for the some of the damage.

I have been asked to talk on ABC Radio today on the dangers of asbestos in the flood clean-up. This is a tricky one.

The city and state is bouncing back quickly. Our markets which were under 3 metres of water last week are now operational. The amount of rubbish being taken away in big trucks is staggering.

We learn today that during the flood, the Brisbane River was taking away an excess 9,500 cubic metres/second but it would have been 13,000 without the dams. The Wivenhoe Dam was taking it its whole capacity daily at the height of the flooding and it had to be released to prevent catastrophe. Last year we were on water restrictions.

Yesterday we had our hottest day for a year (33 degrees C) which is very unusual for Brisbane. It has been an unusually cool 12 months which may be linked with your cold winter?

Life in the 1950’s Ballina captured in newly released memoir

Release date: 1st of December 2010

• Paperback ISBN: 978.1.4535.98.53.5
• Hardback ISBN: 978.1.4535.9854.2
• eBook ISBN: 97831.4535.9531.2

The book will be available at www.Xlibris.com, www.amazon.com and www.ballinaboy.com

Ballina Boy Relives Memories of His Hometown and Favourite Doctor

Life in the 1950’s Ballina captured in newly released memoir

Release date to be advised

Brisbane, QLD, Australia – Taking readers back to half a century ago, author Roger KA Allen relives his unforgettable childhood and pays tribute to the most dominant person in his life. In Ballina Boy: A child’s odyssey through the 1950s, his newly released book published through Xlibris, he divulges relevant moments of his childhood spent in his hometown and while savouring the rewards of being his father’s son.

Ballina Boy captures the author’s childhood in Ballina in the 1950s. Through vivid narration, Allen reminisces his adventure on the bustling Richmond River, his fascination for his father’s medical practice, and the years that offered a way of life that he loved and that exists no longer. This colourful memoir gives a glimpse of the demanding life of a country doctor, who in this case was extraordinary because of his classical background. Like his father, the author became a doctor and thus, he provides in this journal some medical insights as the story unfolds. Along the way, readers will see why one man believes that Ballina, in the fifties, was the perfect setting for an idyllic childhood, though overall they were tough times and not necessarily better than now; just different.

“I wrote this story for many reasons: as a historical record; to preserve my family history; but most of all to share with others today what childhood was like in Australia in the fifties,” discloses the author.

Wrapped with humour and nostalgia, Ballina Boy: A child’s odyssey through the 1950s endearingly reminds people of what childhood was like half a century ago. As well, it provides insights into the current society using the yardstick of the more rigid social structure of the fifties and shows how medicine was practised and how both medicine and nursing have changed – not always for the better.

About the Author

The son of a country doctor and classicist, Roger Allen inherited his father’s love of medicine and languages. After graduating from the University of Queensland, Allen specialised in chest diseases and sleep medicine in Melbourne and became a recognised authority on Sarcoidosis (www.sarcoidosis.com.au).  He is currently in private practice at the Wesley Medical Centre, Brisbane, and he also teaches medical students. Allen’s interests include family, sailing, military history, medical research, and writing. Interested parties may visit www.ballinaboy.com for more information on the book.

BALLINA BOY * by Roger KA Allen

A child’s odyssey through the 1950s

• Paperback ISBN: 978.1.4535.98.53.5
• Hardback ISBN: 978.1.4535.9854.2
• eBook ISBN: 97831.4535.9531.2

The book will be available at www.Xlibris.com, www.amazon.com and www.ballinaboy.com

THE 13^TH WORLD CONGRESS ON PAIN, MONTREAL, CANADA, 29^th August-2^nd September, 2010.

THANKS

I wish to thank the Queensland Asbestos Related Disease Support Society Inc. and the Vojakovic Fellowship under the auspices of the Slater and Gordon Asbestos Research Fund for their generous financial support in assisting me to attend this international conference in Montreal. I am also grateful for their generous research grant by Slater and Gordon to the Asbestos Research Group of the Wesley Research Institute which made this study possible and to Mr Greg Hafner, WRI, for his invaluable assistance with our poster. I wish to add that the hundreds of hours of work I did for this project was done pro bono and for those of us in private medical practice, the cost of taking time away from work is considerable as our running costs continue undiminished. I appreciated being able to use the Business Class lounge particularly when my flight was delayed in Vancouver for six hours due to engine trouble and to be able to sleep lying down when I boarded the plane home at 4am Montreal time.

On my return yesterday, I was saddened to read of the death of Mr. Christopher John Smith in your newsletter as I gave expert evidence in his landmark case in Melbourne a few years ago.  Whenever I came across him in the wards at the Wesley, Chris was always smiling and exuded a sense of stoical optimism.

THE IASP

As one who has only recently been admitted as a member of the International Association for the Study of Pain (IASP), this was the first time I had attended one of their meetings which was huge by Australian standards, with several thousand delegates from all over the world.  I have found that meetings which are a little outside my direct line of work i.e. thoracic and sleep medicine, are more rewarding as these areas have both novelty and present different clinical approaches. It is like the plumber attending an electricians’ conference. Although both work on the same house, each tradesman sees the house from a different perspective. Novelty also invokes more reflection and induces a fresh approach to what may be often seen as mundane and repetitive. I have found that this time away from a busy medical practice also allowed time for a revitalisation, new ideas and renewed energy for research.

RESEARCH

With regards research in general, there is a tendency by the lay public to give it a somewhat mystical aura worthy of great hushed respect. To me it is purely a matter of curiosity; of asking a question about something unknown and applying energy and reason to find an answer or a better way of doing something. As I flew home on a non-stop flight from Vancouver to Sydney across the vastness of the Pacific Ocean, I thought of Sir Charles Kingsford-Smith who was, to my way of thinking, a pioneer of aviation research although by convention we tend to call this “exploration”. It was in 1927 that my father as a young boy saw Smithy land at Eagle Farm. We now take such a trip for granted as we do with advances of medical research with its forgotten heroes of its discoveries. Who can name the discoverers of the link between asbestos and mesothelioma, or who thought of the idea of MRI or the CT scan let alone mundane drugs such as Panadol (paracetamol) and Normison (temazepam)? We know far more about the heroes and anti-heroes of sport and politics.

CHEST PAIN IN ASBESTOS DISEASES

For some time now I have been looking at the question of chest pain which I and others believe is caused by benign asbestos diseases i.e. pleural plaques, pleural thickening, folded atelectasis and asbestosis. At this meeting, I was privileged to present the results of our findings on this subject and was the only paper out of 2,000 on this.  The poster was entitled, Chest pain in 282 patients with benign asbestos disease, with my co-authors Professor Tess Cramond and Ms Deborah Lennon of the Wesley Research Institute, neither of whom were able to attend.  This was well received by those who discussed the findings with me and with not one dissenting voice. Indeed, many who had no experience with this condition thought it surprising that not everyone suffered from pain. During my poster session I met several Canadians who were very apologetic about Quebec’s still mining white asbestos in the hundreds of thousands of tons a year. Most of it was being exported to India where it is used in the building industry. The unvetted forces of capitalism seem too strong to lead to its prohibition and even the Canadian medical and thoracic societies seem either powerless to stop it or are defensive of this practice. I once sent a letter to the Canadian Thoracic Society about this and had no reply.

In the study we took a random sample of the initial presenting data of patients I had seen over the previous ten years and divided them into those referred for medicolegal assessments and those referred by their general practitioners with the two groups roughly equally divided. We later excluded those with mesothelioma.  The results showed that these were mainly blue collar workers aged in their mid 60’s, many of whom were ex-smokers. They were not a very healthy group as a whole as they suffered from a wide range of medical conditions including cardiovascular disease, diabetes and sleep apnoea.  Care had been taken to exclude angina as the cause of chest pain and I had no input into the way the patients were chosen or into the data collection.  The medicolegal patients had as a rule more severe disease and we fold a strong correlation between those with folded atelectasis and chest pain. Pleural thickening was also strongly associated with chest pain. It is not surprising that an infolding of the pleura (folded atelectasis) would lead to chest pain. However, there was no increase in chest pain in the litigants compared with the GP group which indeed had more pain. A possible explanation is that the GP group had presented for investigation because they had symptoms e.g. chest pain.

This is the only clinical paper of this kind so far in the literature and is in close agreement with the findings of a study published in 2000 base on a questionnaire sent out to over 1,200 people who had been associated with the Wittenoom mine site. They found over 40% had chest pain but there was no clinical examination of the patient or any clinical information such as CT information which was available in our study. However, where there is smoke there is fire and I feel our study adds one more piece of evidence to the jigsaw puzzle and will help validate the pain suffered by so many people.

I have submitted the full paper which has much more detail to an international pain journal and wait to see if it is accepted. If not I will not be deterred. I suspect that defendants’ lawyers will try to “sink” or discredit this paper and no doubt scrutinise what I am writing now but regardless, for the past ten years, on a daily basis, I have seen patients with this chest pain and the rate remained constant over this period.  It came as a surprise that patients had put up with the pain for so long; an average of 4.8 years and as long as 20 years and in most case no doctor had been able to give an explanation.  There had been no closure on the pain which tends to make pain even more difficult to bear. If doctors are ignorant of the condition, there is a tendency not to ask the patient about it, or worse still dismiss it as either imaginary or due to something else e.g. a hiatus hernia of back problems. But as Abraham Lincoln once said, “You can’t fool all the people all of the time” and such it is in my opinion with this type of chest pain.  If this is a real entity, as we think it is, further studies conducted with good will and an open mind, will confirm our findings and that of the West Australian study. This in turn will eventually lead to more cost-effective treatment, more empathy and better outcomes. We are currently working on a paper showing treatment algorithms for doctors. We may even develop better ways of diagnosing it as at present it is a diagnosis made only after thorough exclusion of other causes of chest pain.

THE CONFERENCE

The meeting started on a Sunday with a refresher session which went from 8am until 8pm on pain from A to Z and was accompanied by a 450 page book which covered the subject matter. It was a long day. The following four days were packed with concurrent lectures and each day there were over 450 posters, a large number of which were to do with the assessment of pain, psychology and some on how ways to image pain. Persistent pain leads to permanent changes in the cerebral cortex (the outside layer of the brain we call the grey matter). Studies there showed elegant ways of mapping the brain by use of MRI and PET scanning (positron emission tomography). However, out of all the posters, ours was the only one on asbestos diseases and the only other ones on chest pain were on chest pain after surgery.

NEWER WAYS OF TREATING PAIN

Other things I gained from the meeting were newer ways to treat pain including the use of patches on the skin applying capsaicin which is the irritating substance found in chillies which makes it taste hot. These patches had an effect lasting weeks and reminded me of my father’s accounts of mustard plasters on the chest for pleurisy when he was a child. How we return to old remedies. The other method was the use of local anaesthetic patches which was used for chest pain. These methods reduced the need for strong analgesics such as opioids (narcotic related drugs like morphine, oxycodone and codeine.

SIDE-EFFECTS OF OPOIDS

With regards the use of opioids in high doses long-term, there was an interesting session on how these can lead to significant side-effects such as feminisation in men. They have a wide range of actions on the nervous system including in the brain and thus affect the hormonal system in the pituitary gland and hypothalamus.  In the days of the opium trade in the nineteenth century, the British had observed in the Far East as they called it, men who smoked opium became lethargic, infertile and took on feminine characteristics. The British thought it was a good form of birth control for the oriental masses.  However, I have been told that the Norspan (buprenorphine) patches which are used widely for asbestos-related chest pain does not appear to cause this. Perhaps the dose is not high enough.

PAIN PERCEPTION

The perception of pain is quite variable and is gender-specific (women feel pain more) and has a genetic basis. There are even some rare genetic disorders where the affected person is incapable of feeling pain at all.  Trance like states as one sees in India can reduce the feeling of pain as the central nervous system has inhibitory pain system which damps down our perception of pain. This may explain how soldiers in battle have felt no pain when losing an arm but later complained about an injection.  Interesting studies in mice are casting new light on the complex range of genes responsible for the perception of pain. The more they look, the more complicated it becomes.  Things which also reduce or mollify pain include a compassionate touch, empathy and even music (depending on the sufferer’s taste).

Pain is felt more in people who are depressed and anxious and in those who tend to catastrophise i.e. see things as worse than they really are. With the same pain stimulus e.g. a pin prick, not everyone feels the same amount of pain and some won’t feel much at all.  In remember in the movie, Lawrence of Arabia, he could slowly put out burning match with his thumb and index finger without wincing. The treatment of the patient’s depressed mental state goes some way to alleviating pain. However, from my own experience of over twenty or so years in this area, the stress of a medicolegal setting with its adversarial paradigm is hardly a conducive environment for the treatment of pain. The natural history of asbestos diseases, by and large is one of insidious progression with the pain often worsening which in itself is a depressing thought for someone with pain.  At the risk of stating the obvious, pain like love, cannot be seen and is thus easy to discount. It is impossible to prove someone is in pain unless we do fancy tests of brain imaging or secret video surveillance and even then a scream can be feigned.  This presents a difficult legal problem; the just compensation of pain. Similarly, depression cannot be seen either; only the physical effects. Pain has strong psychological component as we see in what we experience sometimes as the unbearable pain of loss, homesickness and bereavement and this in itself can make the perception of co-existing somatic (bodily) pain all the more intolerable.

CANADA AND OUR COMMON HERITAGE

As I had not been to Canada before, I found the experience rewarding and the Canadians very easy to get on with as they think more like us than people from those below the 47^th (this parallel separates Canada from the United States). The Canada was first opened up to the Europeans by the Frenchman, Jacques Cartier in 1534. Quebec is the largest province in Canada and is bigger than Spain, France and Norway put together and French is spoken by 90% of Quebecois (the people of Quebec).  Where ever I went, I was frequently complimented on my French which they said was unusual in Australians. As this is a francophone province, I never first addressed anyone in English out of respect.

Montreal which has 3.5 million people was founded in 1641 after the hill there they called Mont Royal and initially was a Roman Catholic mission in the midst of the Iroquois people who fought the French for many years. The city is strategically located on large island in the middle of the St. Lawrence River which is one of the largest bodies of fresh water in the world being 35 km wide at its mouth. Quebec City which is 250 km down stream was chosen because this is where the river is at its narrowest, and was first founded in 1608 by the Frenchman, Samuel de Champlain. However, during the Seven Years War, it was captured by the British in 1759 under General Wolfe whose troops stormed the heights of Quebec City and also from the rear by the plateau behind called the Plains of Abraham. James Cook was Wolfe’s navigator and later charted the St Lawrence so well he was asked to chart the east coast of New Holland. The French general opposing Wolfe was Montcalm whose third-in-command was the famous scientist, Bougainville, the only Frenchman at the time to be admitted to the Royal Society. Although both generals were killed in the battle, Cook and Bougainville were destined to leave their indelible mark by exploring the South Seas. Canada changed forever but their French heritage remains an integral part of their culture.  When I visited the picturesque port of Victoria on Vancouver Island there was a statue there to Captain James Cook who had charted their west coast on his third and fatal voyage in the HMS Resolution and Discovery (1776-80). Cook was killed in Hawaii on St Valentine’s Day, 1779 having charted the coast of Alaska, the Bering Sea and the east Russian Coast. His midshipman was George Vancouver who later returned for more exploration.

AUTOCHTONES AND ASBESTOS

The indigenous peoples we call the Red Indians, were called by the French, autochtones, (Greek autos self, and chthon meaning Earth) which comes from the Greek myth about infants who were born spontaneously from the Earth without the procreation of human parents. Like our own autochtones, for thousands of years, these people lived in harmony with Earth whom they regarded as their mother. They did not see themselves as the dominant species but amongst all the other animals. In 1854, the famous Red Indian, Chief Seattle, said, “The Earth does not belong to humans. It is we who belong to the Earth.” In Genesis, God tells man to have dominion over the Earth, but this invokes the need to be a wise and caring husbandman, not a tyrant.

Lamentably, modern man has lost this vital notion and has exploited Earth to his detriment; the degradation of once pristine land, the loss of fish stocks, the ongoing extinction of species with even the loss of bees in the USA and now, global warming – all symptoms of this philosophical imbalance with Nature. It may yet destroy us. Like spoilt children we have an insatiable quest for the emptiness of “stuff” as well perpetual economic growth which is untenable in a finite and delicately balanced system. Each day we read in the newspapers and see on television, the effects of deep sea drilling of oil and gas, the effect on aquifers of the extraction of gas by burning coal underground, the degradation of the land by mining with its noxious by-products of heavy metals and cyanide and our modern practice of converting vast tracts of complex habitats to a monoculture dominated by large seed and chemical companies. Although we cannot see it, the glacier is moving and melting at that. The goose is laying golden eggs, but at what cost; this modern utilitarian attitude to the Earth.  Man’s short-sighted use of asbestos despite repeated medical warnings is just one small example of the malaise we have inflicted on ourselves and even the now it is being exported by several countries to innocent people who know nothing of its perils. It is with this perspective and with my greater appreciation of the complexity of this thing we call pain that I thank you for your generous support.

REFERENCE

1. Allen RKA, Cramond T, Lennon D. Chest pain in 282 patients with benign asbestos disease. Abstract. Proceedings of the 13^th World Congress on Pain, IASP, Montreal. PW036.