Is my vagina ugly?

I see a lot of vaginas (and penises for that matter); it’s part of my job and I’ve seen so many that any awkwardness or self consciousness that I may feel is now completely gone. However, for most people, whose work does not involve the examination of strangers’ genitalia on a daily basis, experience with what female genitals look like may be limited. It’s not really something people flash around. As such, how on earth are we supposed to know what’s normal, and more importantly what is healthy?

The most important thing to understand is that we are all beautifully unique and there is actually a huge diversity in how female genitals look. As long as the size or shape of your vulva or labias does not cause any discomfort then there is no reason to change anything.

 

If you have any concerns about how your genitals look or any lumps or bumps that you feel, talk to someone you trust or see your local doctor who does have a lot of experience looking at genitals. You can also visit the website labialibrary.org.au which has some excellent information on female genital anatomy and a huge range of pictures of different looking, healthy, “normal” genitals.

Female Genital Cosmetic Surgery

# The mystery surrounding female genitals is what health professionals believe is the driving factor behind a recent upsurge in female genital cosmetic surgery.

# Female genital cosmetic surgery usually involves a labiaplasty (trimming dangly bits) or vaginaplasty (quaintly called “vaginal rejuvenation” or more sickeningly “designer vagina” – basically to make your vagina tighter).

# Between 2001 and 2013 the number of women having cosmetic surgery on their vaginas has increased by 140%.

# The increase in genital cosmetic surgery has been attributed to the fact that we don’t see a lot of other people’s genitals throughout our lives, as well as little education or awareness about the wide spectrum of healthy anatomy, and social expectations of what is considered “normal” or “desirable”.

-Most people don’t know what healthy genitals look like.

– In the 21st century pornography is easily accessible on the Internet and increasingly watched by women; at the same time it is common for women to have hair removal whether via waxing or laser allowing full view of your vulva and labia. Sex education classes are focused on promoting safe sex (which is excellent) and may not cover what healthy genitals look like, the oozing syphilitic sores are much more exciting to look at.

– Images on the Internet or in magazines are often airbrushed to make women, and their genitals, more appealing.

# As such women, particularly young women, can see their genitals uncovered by pubic hair and often have nothing to compare it too apart from pornography. Understandably this can lead to confusion and distress that their genitals are “abnormal” or “ugly”.

-Sadly for some women their self-consciousness and concern can stem from comments made by someone else, perhaps a mother, friend, sexual partner or beauty therapist. Most people don’t know what healthy genitals look like or they might just be really mean – whatever the reason, it is inappropriate for them to pass judgment on your genitals. Sex is a vulnerable moment and never a good time to criticize someone’s physical appearance, let alone suggest that their vagina looks weird.

# We are all different and unique. The same applies to our genitals, there is a huge amount of diversity in the way our genitals look that is perfectly healthy. Our genitals come in all different shapes, sizes and colours and are very rarely symmetrical (nature isn’t fond of symmetry)

# There is no scientific evidence to support any benefits to genital cosmetic surgery, there is no evidence to support claims that labiaplasty leads to increased sexual satisfaction, and it does not improve hygiene or prevent thrush.

# There are risks to genital cosmetic surgery including bleeding, infection and scarring. Other risks include pain with sex and changes to sensation, which can affect arousal and enjoyment.  

# As a doctor, I would not recommend surgery without a medical reason where the benefits outweigh the risks of undergoing a surgical procedure.  

# As a woman, I would suggest that when it comes to our private parts, they are just that….PRIVATE. You choose who gets to see your genitals, and if their love, respect, admiration or attraction to you is diminished because your vulva doesn’t look like what they saw in a porno, then I would suggest that perhaps you are better off without their opinions.

Dr HT

Things I don’t like about being an adult #234 – Pap smears.

I hate having to be an adult. It’s not nearly as fun as I thought it would be and life is much easier when you can blame your parents for everything. Despite all the independence that comes with moving out of home and having an income, I don’t spend most of my time doing what I want to do, which includes watching Disney movies, re-reading the Harry Potter series, and eating entire packets of Tim Tams without a thought for the consequences. Instead, because I’m an adult, I spend most of my time wanting to take a nap, regretting making social plans and googling things like “who do I vote for”, “what are taxes” and “how to stick to a budget”. I’m also now responsible for my own health. So I get pap smears. Every two years. Not because I enjoy having a stranger insert a metal speculum inside me or having miniature broom rummage around my cervix, but because I am a responsible adult, and getting a pap smear is an important part of women’s health.

As of May 2017 there are changes being made to the National Cervical Screening Program, and although the procedure is the same (speculum, broom rummaging etc), it will reduce the number of times women have to have cervical screening tests done (Thank God for small blessings). These changes are based on the huge success of the HPV vaccine (aka Gardasil) and new evidence about the nature of HPV infection and the development of cervical cancer.
Currently women are encouraged to start having pap smears between 18-20 years old, or 2 years after first having sex (whichever is later); and continue to have pap smears every 2 years until they are 69. This translates to about 25 pap smears in a lifetime. The new changes to the National Cervical Screening Program will reduce the number of tests to only about 10 in a lifetime (insert collective gasp of delight here).

Also, just to confuse you more, the term pap smear will be replaced by “cervical screening test” (CST). This is a technical formality as doctors will no longer “smear” the sample on a slide but rather mix it around in some fluid before sending it off.
How do these changes affect me?

As of May 1st 2017:
# Cervical screening will be offered to women between the ages of 25 and 74 years (if you are sexually active).
# Screening tests will be done every 5 years.
# The new screening test will look for HPV infection rather than abnormal cervical cells – however obtaining the sample will still involve the insertion of a speculum and obtaining a sample from the cervix.
# Cervical screening is encouraged for both vaccinated and unvaccinated women as the HPV vaccine only protects against 70% of cervical cancers.
# Until May 2017 when these changes come into effect, continue to have routine pap smears every 2 years.
Follow the link below for more information on the new screening process and cervical screening in general:
http://www.cancerscreening.gov.au/…/Content/future-changes-…

Why do I have to get cervical screening anyway?
# The National Cervical Screening Program is a scheme to reduce the number of cases of cervical cancer. Cervical cancer is a slow growing cancer and it may not cause symptoms until late stages where the cancer can be quite aggressive and may have spread.
# By screening women who are at risk we can prevent cervical cancer. Cervical cancer is one of the cancers that we are most able to prevent.
# In 2012 226 women died from cervical cancer. In Australia, 80% of women who had cervical cancer had not been screened or not had regular screening tests.

What does HPV have to do with anything?
# HPV stands for human papillomavirus and is the cause of 99% of cervical cancers.
# HPV is a common infection which is transmitted by sexual activity. Most women will get HPV at some point during their lives. Men can also be infected with HPV.
HPV infection usually doesn’t cause any symptoms as such it can be passed on unknowingly to sexual partners.
# There are many types of HPV infections, most will clear up without causing any problems within 1-2 years.
# Some HPV infections may persist and can increase the risk of developing cervical cancer. However these changes are very slow, developing cervical cancer from HPV usually takes more than 10 years.
# There is currently no treatment for HPV infection.
# Condoms provide some, but not complete, protection against HPV. You may have a HPV infection even if you use condoms every single time you have sex.
# The Gardasil vaccine protects against 4 types of HPV infection, these types of HPV are the most high risk and are responsible for 70% of cervical cancers.
# The Gardasil vaccine is part of the school immunisation program and is administered to children between the ages of 10-15 years depending on the state or territory. This is because teenagers are having sexual intercourse at younger ages, with ¼ year 10 students and ½ of year 12 students having had vaginal intercourse.
-Parents must sign a consent form for their child to have the Gardasil vaccine. If you would like more information as a parent, for your child or as a patient the HPV vaccine website is very comprehensive.http://www.hpvvaccine.org.au

Dr HT

The Thyroid

“An overactive thyroid turns you into the energizer bunny on steroids…but thinner….and more hysterical…with diarrhoea. An under active thyroid turns you into Eeyore’s less fun big brother…..sad and chubby…..and also constipated.”

What’s a thyroid?

You may not have heard of thyroid disease, but the key to understanding it is the concept of balance. I use the example of food (my favourite thing) to demonstrate. Food is necessary for life but if you have too much food you feel sick and hate yourself; if you don’t have enough food you are hangry and your loved ones dive for cover. In the same way, the thyroid and the hormone it produces are necessary for life, but too much or too little will throw our whole system out of whack.

The thyroid gland sits in your neck just below the Adam’s apple and produces a hormone called thyroxine which regulates your metabolism. The thyroid is like Goldilocks; its job is to produce the right amount of thyroxine to keep your metabolism balanced, not too fast and not too slow, but just right. The thyroid receives messages from the pituitary gland which sits in your brain and collects information about how your body is doing and what your body needs. Between the two of them they regulate our breathing, heart rate, digestion, fertility, menstruation, our mood, our energy levels and basically our ability to function as a normal human person in everyday life.

Thyroid disease is more common in women; because obviously we don’t have enough to deal with. Thyroid disease has many causes but the result is either an overactive thyroid or a lazy thyroid. An overactive thyroid turns you into the energizer bunny on steroids…but thinner….and more hysterical…with diarrhoea. An under active thyroid turns you into Eeyore’s less fun big brother…..sad and chubby…..and also constipated. Often the most distressing symptom of thyroid disease is the psychological effects, depression and anxiety, too much or too little energy. People often do not feel like themselves and this can have a severe impact on their relationships, career and their happiness.

Thyroid disease is very common, causes significantly distressing symptoms and is treatable. Below I have made a list of the common symptoms of an overactive or underactive thyroid. If you have any concerns it is worthwhile seeing your doctor because if it is your thyroid, treatment is available so that you can get back to being the awesome human being that you are.

I have not gone into the causes of thyroid problems, because there are so many and by now you’ve probably stopped reading. The cause is important as it will help define treatment, which may vary from medication to surgery. If you would like more information the best person to speak to is your local doctor. If you must Google (and some of us can’t help it), I have included a link below that has some useful information, Wikipedia is not bad either.

https://www.thyroidfoundation.org.au/

 

Hyperthyroidism (Over active)
Weight loss
Heavy, frequent periods and infertility
Anxiety, nervousness, fatigue
Palpitations, feeling short of breath
Excessive sweating
Tremors
Diarrhoea

 

Hypothyroidsim (Under-active)
Weight gain
Heavy periods and infertility
Random bleeding between periods
Depression and fatigue
Poor memory, slow thinking
Muscle weakness
Feeling extra cold
Dry skin and hair loss
Constipation

 

Vaginal Infections

Ewwww, right?

We don’t often talk about vaginal infections but I wish we would because then maybe women wouldn’t feel so bad about them. Vaginal infections can cause significant discomfort and embarrassment, but they are also super common, easily treatable and are not necessarily related to sexual activity.

We all have a certain amount of yeast and good bacteria in our vaginas and they live happily in balance together at a very specific pH (aciditiy). Factors that disrupt that happy ecosystem by affecting the pH or the number of good bacteria present create an environment where infection can thrive. Conveniently, your vagina is self cleaning, so it is not necessary clean inside the vagina. If you must, there are vaginal washes that are matched to the pH of your vagina available from the pharmacy but you can just leave it be.

Below, I cover the two most common vaginal infections: Bacterial vaginosis and thrush.

Thrush

Thrush (or candida) is a yeast infection of the vagina caused by an overgrowth of the yeast that resides there. It is similar to teenagers throwing a rave party when their parents leave town. Thrush is extremely common, 3 out of 4 women will know the joys of thrush and be able to sympathise.

You are more likely to get thrush if you have recently been taking antibiotics, this is because the antibiotics can also kill the natural good bacteria in your vagina allowing the yeast to grow out of control. Thrush is also more common if you have diabetes or conditions that weaken the immune system. Tight clothing can also contribute as they trap moisture which facilitates the growth of infection. Cleaning inside your vagina with soaps or using baby wipes can change the acidity in your vagina and upset the balance of bacteria and yeast that live there.

Thrush symptoms include a sore and itchy vulva, thick whitish discharge (often described as cottage cheese, which has resulted in me never eating cottage cheese), a burning sensation when passing urine and a dry/sore vagina during sex.

Thrush is NOT sexually transmitted (you cannot give it to or get it from your partner) and is NOT a sign of poor hygiene; as such you do not need to avoid having sex.

Thrush is diagnosed by taking a swab from the vagina that is tested in a lab. Usually your GP will also use these swabs to run tests for bacterial vaginosis, Chlamydia and gonorrhoea as they can cause similar symptoms.

Treatment for thrush is simple and involves anti-fungal medication in the form of cream that you insert into your vagina. You do not need a script for this treatment, however, it is still advisable to see a doctor to make sure that your symptoms are due to thrush and not bacterial vaginosis, Chlamydia or gonorrhoea which have different treatments. Chronic thrush infections are uncommon but require different treatment.

Your GP will be able to discuss a treatment plan with you.

Bacterial Vaginosis

Bacterial vaginosis (fondly shortened to BV) is irritation of the vagina due to an overgrowth of the normal bacteria in your vagina. BV is extremely common, it is estimated that 30% of women have bacterial vaginosis at any one time. So think of you and two of your girl friends….one of you probably has BV.

BV symptoms include a sore and itchy vulva, greyish discharge that has a fishy smell (rotten fish smell, not delicious sushi fish smell), and a burning sensation when passing urine.

BV is NOT sexually transmitted this means you CANNOT give it to or get it from your partner; however your own risk of developing BV is related to sexual activity though exactly why is not understood. It is more likely in women who are sexually active, have sex with other women, have a new partner or have sex without a condom.

Cleaning inside your vagina with soaps or using baby wipes can also cause BV as it can change the acidity in your vagina and upset the balance of bacteria that live there.

BV is diagnosed by taking a swab from the vagina that is tested in a lab. Usually your GP will also use these swabs to run tests for thrush, Chlamydia and gonorrhoea as they can cause similar symptoms.

BV is effectively treated with antibiotics in the form of a tablet or cream. Usually treatment only takes a week, rarely infection will persist and treatment may be up to 6 months.

Dr HT

Introducing Dr Hilary Thomson (BSc, MD)

Dr Hilary Thomson is a medical doctor who grew up in Melbourne. She obtained a Bachelor of Science at the University of Melbourne, majoring in anatomy and physiology, before completing a Doctor of Medicine.

During her training Dr Thomson used professional development as an excuse to travel overseas, volunteering in clinical practice and health education projects in the Philippines and Cambodia, and completing an Endocrinology rotation at the Royal Infirmary Hospital in Edinburgh, Scotland.

Upon graduation Dr Thomson migrated north to warmer climates and now works at a regional hospital in the Northern Suburbs of Brisbane. She has undertaken a research project in collaboration with the social work team to improve local assistance for victims of domestic violence and is currently completing a Master of Public Health at James Cook University. Next year, Dr Thomson will enter the community to begin her General Practice training, at which point she hopes never to do night shift again.

Her varied experiences in medicine have cemented her commitment to primary health care, particularly in developing nations, and revealed an unexpected love of teaching. Working in a low socioeconomic area has highlighted the importance of providing patients with accurate medical information delivered in a relevant and comprehensible fashion.

Dr Thomson’s main interests include tropical and adventure medicine, health education and improving public health initiatives to better overall population health. When she grows up, Dr Thomson hopes to live on a tropical beach, eat fresh fish and mangoes everyday, and try to make a difference to the lives of people who have limited access to health care.

Paediatric Burns

 

Unfortunately, many of my clinic days are filled with little ones who have sustained nasty burns at home. Burns can cause significant pain and injury to your children and are largely preventable. Here are a few tips you need to know:

1. Please ensure that you do not leave hot drinks on the edges of benches and tables. Children often reach for these and burn their faces.

2. Please do not carry a hot drink while you are also carrying an infant.

3. Ensure if you have an old freestanding stove it is bolted to the wall so your little one cannot tip the stove if they stand on the oven door. Have a lock on the oven door.

4. If your baby can crawl be very careful about the grills of heaters and ovens, they love sticking their hands in dangerous places.

5. Opt for luke warm drinks around babies.

6. Be careful of irons and other hot appliances.

7. Be careful with the temperature of your child’s bathwater.

8. KNOW BASIC FIRST AID. If your child sustains a burn, remove any jewellery or clothing and hold the burned area under cool running water for 20 minutes.
After cooling the injured area for up to 20 minutes you may cover the area in a piece of clean non-adherent cling film and seek medical attention.

Dr SK

Why there can never be just one cure for cancer.

In my previous article, I discussed the difficulty in navigating medical information on social media and distinguishing fact from fiction. In particular, there tends to be a strong focus on cancer. Disturbingly, I have seen many posts claiming that chemotherapy is poison, that it does not work and that it should never be used. This is often accompanied by claims of a miracle fruit or herb that can cure any cancer.

Before I discuss the problems with such claims, I think it is important to discuss what cancer actually is (and isn’t). Cancer occurs when some of the body cells start to divide uncontrollably. In healthy cells, cell division is a tightly controlled process that is essential for normal body functions. In cancer, mutations to the DNA, and especially to genes that control the life cycle of a cell, result in uncontrolled cell division, such that a single cancer cell quickly multiplies into many cells. Cancers differ based on the body part they originate from. Lung cancer is very different to breast cancer, which is very different to blood cancers. This is why cancer is not a single disease – rather the word cancer refers to a broad group of cancers that are all very different to each other. This is why it is incorrect to talk about a single cure for cancer. Each cancer is so different from the next that they need their own specific targeted treatments and medications.

There are some treatments for cancer that are used as a general first line defence – such as chemotherapy. Chemotherapy works by killing rapidly dividing cells, such as cancers. Unfortunately, it also causes damage to other rapidly dividing cells in the body, causing strong side effects. Some people will use these side effects to argue against the use of chemotherapy completely. While there is no denying that chemotherapy can be difficult, for many cancers it remains the best treatment options and has an excellent success rate. Unfortunately, for other cancers it does not work as well. However, a specialist is the best person to determine whether chemotherapy will be the right treatment for a specific patient, not a random Facebook page.

So what about claims that chemotherapy should be abandoned in favour of nature therapies? There is evidence that some natural compounds from plant based sources can kill cancer cells in a petri dish. The truth is, killing cancer cells in a petri dish is very easy. Killing cancer inside a person is much more difficult, for many complex reasons, including accessibility to the tumour and intolerable drug doses. A petri dish is a very different environment to the human body, and until such compounds have been proven to work for specific cancers in actual humans, it is wrong and potentially life threatening to rely on such measures instead of conventional treatments recommended by your specialist.

Finally, prevention is better than cure. Cancer is not a result of modern lifestyles – there is evidence of cancers occurring thousands of years ago. However, many aspects of modern lifestyles contribute significantly to increased risk of some kinds of cancers. We know that smoking causes lung cancer, that excess sun exposure can lead to the development of skin cancers, and excess drinking can lead to liver cancer. Obesity and diabetes are also risk factors. You can help reduce your risk by a eating healthy diet rich in plant based foods, avoiding smoking and drinking, and being sun smart. Remember, while this might help reduce your risk of cancer, it cannot eliminate it.

This is because there are factors linked to cancer that are independent of lifestyle. Genetics is a major risk factor for some kinds of cancers. Perhaps most well known is that mutations in the gene BRCA1 can dramatically increase the risk of breast and ovarian cancers in women. In these cases, the risk of developing cancers runs in the family and extreme preventative measures, including mastectomy and hysterectomy can be required.

In summary, remember that cancer is not one disease. Be wary of claims that a single food or compound can cure all cancer types, and of treatments that aren’t tailored for a specific cancer diagnosis. If you do choose to use natural therapies along side your conventional medical treatment, always inform your doctor as certain natural therapies might be incompatible with other medications you might be prescribed.

Below are some interesting links for those interested in further reading:

What is cancer?

http://www.cancer.org.au/about-cancer/what-is-cancer/

What is chemotherapy?

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cancer-treatments-chemotherapy

Lifestyle and cancer.

https://canceraustralia.gov.au/healthy-living/lifestyle-risk-reduction

 

Dr HR

Fact or fiction: navigating health information on social media.

Social media is an integral part of the lives of most young (and young at heart) people. It is not longer just a platform to follow the lives of friends: websites such as Facebook are now used to follow organisations, bloggers and common interest groups. While a lot of good is shared on social media, it can be very difficult and confusing for someone from a non-medical background to differentiate between factual and reliable webpages, and those that are not evidence based.

A recent and very disturbing example is the case of blogger Belle Gibson. Gibson, who has since been outed as a pathological liar, faked a terminal brain cancer diagnosis for years. Her claim to fame is her extraordinary assertions that she cured herself by pursuing alternative therapies such as eating more fruit and vegetables and, bizarrely, using coffee enemas daily. Not only did she amass thousands of followers before the lie was exposed, she also gained a book deal and had her app promoted by Apple. Worse still, she collected an estimated $300,000 dollars for multiple charities from her followers, but she never passed on the money. She kept it for herself. Understandably, many of her followers were left devastated when the truth was revealed: their idol was a fraud, a liar looking for fame and riches at the expense of vulnerable individuals desperate for miracle cure for their own cancers.

However, the most horrifying aspect of this scandal is that cancer patients actually believed Gibson’s claims and rejected conventional treatments such as chemotherapy, in favour of diet, exercise and other unproven ‘therapies’. We may never know how many people died, or had their lives cut short, as a result of Gibson’s lies.

As a scientist, it seems obvious to me that Gibson’s claims are fraudulent. However, I only know this because I studied cancer at university, spent a year researching at a cancer hospital, and currently research the applicability of certain cancer drugs to other diseases. I also know that cancer research is amongst the most well funded by governments world wide: if curing cancer were as easy prescribing healthy eating and coffee enemas, they would not be wasting their money looking for cures.

If I didn’t have the background I do, perhaps I also would have been confused by the claims. Certainly, some of the confusion is understandable. Eating healthy can only be a good thing, right? There is scientific evidence to suggest that certain cancers can be prevented by leading a healthy life style, including eating more fruit and vegetables, exercising and avoiding smoking, alcohol and excess sun exposure. Unfortunately, prevention is not the same as cure. Once the cancer is established, lifestyle changes are no longer sufficient.

Given that it can be confusing to filter though the lies and misinformation, especially when so many of it is mixed in with real facts and scaremongering, my next few blog posts will be focused on empowering women with the basic facts required to critically evaluate health related information on their own.

In the mean time, here are some links on the topic that you might find useful:

“Panacea or placebo: doctors should only practise evidence-based medicine”

http://theconversation.com/panacea-or-placebo-doctors-should-only-practise-evidence-based-medicine-2212

“I know people will be shocked by Belle Gibson’s story, but I’m angry”

http://www.news.com.au/lifestyle/health/health-problems/i-know-people-will-be-shocked-by-belle-gibsons-story-but-im-angry/news-story/76687c4cfd7e621427a12c1d8a52a8dd

Eyes: Windows to the soul…. And your body!

Eye exams can determine much more than your visual acuity and prescription for glasses. Many systemic conditions can manifest in the eyes before other obvious signs and symptoms develop. Regular eye exams (every 2 years unless otherwise specified by your practitioner) are important for every age group.

During an eye exam, the back of the eye is examined in detail. By looking through the pupil to the back surface inside the eye at the retina, we can view retinal arteries and veins, the macula, which is responsible for a central vision, and also the optic nerve, which is a direct connection from the eye through to the brain. In fact, the eye is the only part of the body where we can have a direct view of living vasculature and brain tissue uninterrupted & noninvasively. In other words, the eye can literally act as a window to the rest of the body.

Abnormalities in retinal vasculature for example can often reveal associated systemic vascular conditions such as diabetes, systemic hypertension or carotid disease/stroke. Another example is optic nerve swelling or inflammation, which can suggest conditions as serious as intracranial hypertension or MS. As a follow up from one of our recent articles, today we will be focusing on one of the most common systemic conditions that can manifest in the eye, diabetes.

As mentioned in our previous article by Dr S.H, diabetes is one of the leading causes of blindness & vision impairment in developed countries. It is therefore particularly important for diabetic patients to have regular eye exams. Studies show that up to 50% of Australians with diabetes do not have regular eye tests.

Most Medical practitioners now work closely with Optometrists & Ophthalmologists part of diabetes care plans for diabetic patients. The National Health & Medical Research Council (NHMRC) recommends annual eye exams for patients with higher risk of developing diabetic retinopathy and at least every second year for those less at risk. Risk is often determined by the duration of diabetes, how well blood sugar levels are controlled and whether there are already signs of pre-existing diabetic retinopathy. Diabetic retinopathy is a sight threatening complication that can cause irreversible blindness if undetected & not treated in time.

So what is diabetic retinopathy? It is defined as the microvascular anomalies that develop in the retina secondary to blood sugar fluctuations. This leads to leakage of blood and fluid from the retinal blood vessels at the back of the eye. The more advanced form of the disease is proliferative diabetic retinopathy, where new blood vessels begin to grow in the retina. The problem with these new blood vessels is that unlike normal retinal vasculature, they are leaky! The chance of irreversible vision loss is therefore very high. The unfortunate fact is however, at the early stages of diabetic retinopathy, there are no obvious symptoms until the changes are severe (and often too late to treat).

Another less known ocular manifestation of diabetes is fluctuation in vision and spectacle refraction. Blood sugar fluctuations due to diabetes can cause temporary swelling of the lens that controls focusing inside the eye. Diabetic patients are also known to be 2-5 times more likely to develop cataracts and at a much earlier age group than the rest of the ageing population (Klein et al).

The Visual Impairment Project conducted in Victoria in 2000 showed that on average almost a third (29.1%) of Australians with diabetes have diabetic retinopathy. Furthermore, as reported by Cheung et al, more than 60% of type 2 & almost all type 1 diabetics of at least 20 years duration will have some sort of diabetic retinopathy. In other words, everyone with diabetes is at risk of developing diabetic retinopathy. The good news is that 98% of vision impairment due to diabetes can be prevented with early detection and treatment (Ting et al). This can be achieved by firstly working with your medical practitioners to adequately control blood sugar levels & also by having regular eye exams so that ocular complications are detected early.

References:
Photo: K. Viswanath. J. Comm. Eye Health 2003;16(46) 22

Klein BE, Klein R, Moss SE. Incidence of cataract surgery in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Am J Ophthalmol. 1995;119:295–300. [PubMed]

Resnikoff S et al. Global data on visual impairment in the year 2002. Bulletin of the World Health Organization, 2004, 82:844.

Ting D et al, Diabetic Retinopathy. Screening and Management by Australian GPs, Aust Fam Physic, 2011;Vol 40(4):233-8

McKay, R., C.A. McCarty, and H.R. Taylor, Diabetic retinopathy in Victoria, Australia: the Visual Impairment Project. Br J Ophthalmol, 2000. 84(8): p. 865-70.

Cheung N, Mitchell P, and Wong TY, Diabetic retinopathy. Lancet., 2010. 376: p. 124-136.

By: Dr YB

The not-so-sweet truth about diabetes.

As doctors in training, our learning is especially focused on the management of the most commonly seen medical conditions, the ones that you will be exposed to again and again in your medical practice. And when it comes to common conditions, you can’t get more common than diabetes. Diabetes is largely considered the epidemic of the 21st century, and one of the biggest challenges confronting Australia’s health system.  An extensive Australian study in 1999-2000, known as the AusDIAB, found that 7% of adults aged 25 and over have diabetes, and follow-up studies in 2011-2012 have shown that every year a further 0.7% of the adult population develops diabetes. This amounts to whopping 280 Australians developing diabetes every single day. And the most terrifying thing is that for every person diagnosed, there is another Australian who is living life with undiagnosed diabetes, and that a further 1 in 4 Australians are considered to have pre-diabetes.  It will come as no surprise then that 1 in 3 inpatients admitted in hospitals have diabetes, and it is highly likely that someone you know and love has the condition.

But what exactly is diabetes? Simply put, when someone has diabetes, it means that their body is unable to maintain healthy levels of glucose in the blood. Glucose is a form of sugar, which is the main source of energy for our bodies. It is found in a wide range of foods such as breads, cereals, fruit and starchy vegetables and sweets. When we are fit and healthy, a specialised gland in the body called the pancreas produces a hormone called insulin, which works to convert glucose from food into energy. In people with diabetes, insulin is either no longer produced (as is the case with Type 1 diabetes, an autoimmune condition where the insulin producing cells of the pancreas are attacked and destroyed) or the insulin is produced but the levels are either insufficient or the body develops resistance to it (as is the case with Type 2 diabetes, which is lifestyle induced). The result is that when people with diabetes eat glucose it can’t be converted into energy and instead the glucose stays in the blood resulting in high blood glucose levels which can be easily detected with a blood glucose monitor.

What exactly is the harm of having high levels of glucose in the blood, do I hear you say? When there are unhealthy levels of glucose in the blood, this can lead to many complications. We know diabetes is the leading cause of blindness in working age adults. It is one of the leading causes of kidney failure and dialysis. Diabetes increases the risk of heart attacks and stroke by up to 4 times and is a major cause of limb amputations. And the nerve damage caused by long standing diabetes can be especially devastating for men, resulting in erectile dysfunction and impotence. While this paints quite a gloomy picture, the good news is that for the 85% of diabetics who are classified as Type 2, these complications can be avoided through early diagnosis, lifestyle changes, ongoing support and monitoring. In subsequent posts we will talk a little bit more about Type 2 diabetes, including the risk factors, symptoms and best evidence based management.

Dr SH