“ use  it  or lose it  “  is  a useful adage  to remember  for  osteoarthritis  especially of weight  bearing  joints.

Weight  reduction of   5% in  20  weeks  is a  worthwhile  goal to aspire  to with  real benefits remembering that for every 1 kgm  weight loss  there is a 4kgm reduction in pressure  on the major  weight  bearing  joints of the leg  like the knee.

Regular Exercise   reduces  pain and maintains or  improves  joint function. Balance training  reduces   the  likelihood  of falls  and  enhances  joint movement.

Active  aerobic  exercise  should be  done  for   30 mins / day – most  days at a level that  makes you breathe  hard  but  still able to speak about 7 words at  a time. Walking  is  very easy  especially if done as part of  a lunch break  or  part  of the daily commuting walking to transport  or the car park. 3 x  10 min burst of  intense  exercise have also  been found to be  of similar benefit

Strengthening exercises should be done at least  3 x /week involving  core strength exercise , quadriceps hamstrings  hip abductors and calf muscles. Therabands  or light weights are  useful. Exercises to consider – standing leg  side  raises; sit to stand from chair ( no hands); calf raises  ( tip toes );  one  or  two step up and down – facing stairs  , side steps –  face  left and face right, have support  rail   or bannister next to the step for safety. Straight leg  raises and  knee  straightening when seated.

Flexibility exercises at  least  3 x/week for  at least the knee  and hip as well as the  back involving  stretches  and  rotations for  15-30 seconds  repeated  3-4 times  at least  3 x/week.  Quadriceps ,  hamstrings , hip flexors and abductor stretches

Water  based  exercise 2  x  /week for  30 mins  is a valuable  addition because  of  constant resistance, the  soothing  effect on  joints, the  improvement  Water aerobic  or  exercise  classes are a useful  adjunct. Consider  walking in  above  waist  height  water  , swimming ,  bicycling    action , star   jumps  and  lunges  also the  use  of   resistance   equipment  like  noodles  paddles   and  kickboards.

Ask  your  doctor , physiotherapist  or   trainer  for advice.

Lifestyle  modification   is the  mainstay of  treatment of type 2 Diabetes Mellitus and generally achieves around   5% weight loss and  should be maintained  for at least 2 years preferably 3 years to be considered sustained and permanent. It  is  best  if this weight loss is  apparent in a  reduction in waist  circumference  – less than 94 cm for  men and 80 cm for women  or  waist / hip ratio that is sustained. These  measurements reflect  the  fat load on central blood vessels.

Three  forms of bariatric    weight  reduction surgery are available in Australia.

Laparascopic   gastric  band, gastric sleeve  and   gastric bypass.

Strengthening exercises should be done at least  3 x /week involving  core strength exercise , quadriceps, hamstrings  hip abductors and calf muscles. Therabands  or light weights are  useful. Exercises to consider – standing leg  side  raises; sit to stand from chair ; calf raises; step up and down , side steps both directions; straight leg  raises lying /seated and  knee  straightening when seated.

Falls risk can be  reduced by doing flexibility balance exercises at  least  3 x/week for  at least the knee  and hip as well as the  back involving  stretches  and  rotations for  15-30 seconds  repeated  3-4 times  at least  3 x/week.  Quadriceps ,  hamstrings , hip flexors and abductor stretches

Water  based  exercise 2  x  /week for  30 mins  is a valuable  addition because  of  constant resistance, the  soothing  effect on  joints, the  improvement  Water aerobic  or  exercise  classes are a useful  adjunct. Consider  walking in  above  waist  height  water  , swimming ,  bicycling    action , star   jumps  and  lunges.

Ask  your  doctor , physiotherapist  or   trainer  for advice.

Previous  pap smear testing which was based  on looking  for  abnormal cervical cells derived  by  smear  test taken intravaginally has been replaced with routine  HPV ( human papilloma virus ) screening  combined with  liquid  based screening  of  cervical cells derived by intravaginal brush sampling where  indicated.

Routine  testing  is recommended from age  25-74 at  5  yearly intervals if there is  no indication  for more  frequent  testing  such as  a previous abnormality or  recall.

The  screening  is now  based  on testing for the presence  of high risk  HPV viral types which has been researched to be  a more sensitive test. If the  virus is detected cytology screening  is then done  on the cells  from the cervix that  have  been obtained at the same time from   the same sample-   looking for  abnormal cells.

Results are  in  3  categories

Low  risk  – HPV test is  negative   repeat  in 5 years

Intermediate risk -HPV test is positive repeat  test  in  12 months

High Risk – HPV  test is  +ve for  high risk  oncogene HPV types and/or                    cytology is abnormal suggesting  the presence  of  high grade cervical changes – follow up cytology by a gynaecologist  is recommended

Testing can now be  more focused  by  requesting the  cervical  screening  test  .

In the  format of

Cervical screening  Routine

Cervical screening – co test symptomatic

Cervical screening – follow up of previous abnormality

Cervical screening – co test Test  of cure  (  after  previous treatment)

Cervical screening – previous AIS ( previous carcinoma in situ )

Cytology only

A 2017  UK  study showed that  with high levels of continuity of care  resulted in 12.49% fewer  hospital admissions and in Holland  low levels of continuity of care was associated with increased  mortality. Traditionally high levels of continuity of care have  usually been with  a particular GP but similar  benefits at  lesser level  seem to be associated with the same group of practitioners in the same practice possibly due to shared long term  records.

More  common in  patients  older then  60 yo presenting with nausea  malaise , headache  confusion   gait  disturbance progressing to seizure and  eterioration of  conscious  state.

May  be associated  with  vomiting  , diarrhea kidney  disease  ,   diuretic   use/ abuse pituitary disease , medication  side effect   Inappropriate  fluid intake.

Treatment  initially is by  fluid restriction and  salt  supplementation after  review  of  medication.