Weekend warriors watch out! If you are male, getting on a bit, have a sedentary job but like occasional sport, you are a prime candidate for a debilitating and highly irritating injury. Without warning you could do in the largest and most vulnerable tendon in your body -your Achilles. It is estimated that one in 20 men past the age of 40 will either strain or tear this tendon at some time.

The Achilles stretches from the middle of the calf to the heel, and as sections of it are poorly supplied with blood, it is easily injured. While younger men who exercise daily may overuse their Achilles, making it inflamed and tender, older men who exercise intermittently tend to do far more damage. With a sudden movement, rapid acceleration, a jump or a twist, they can rupture the tendon. Bolting from the base line to take a net shot could see them off the tennis court for a year with a torn Achilles. Some men actually hear a snap or a pop as it tears and experience acute pain. They say it is like being hit hard from behind. Although the pain decreases rapidly, walking on the injured leg is usually not possible.

Men over 40 should be fit for their sport rather than using their sport to get fit. With care, the Achilles can be prepared for exertion. The current wisdom is that exercise should be preceded by stretching and a warm-up. Most importantly it should end with another stretch, followed by a cool-down. Training should be increased gradually, and at the very first sign of discomfort, activity should be stopped and help sought.

The Achilles degenerates with age, but most men don’t notice. A large recent study of ruptures showed that in all cases there had been degeneration.

Middle-aged men should also read the fine print before they take a course of antibiotics. One class of these drugs can actually cause tendon damage, particularly to the Achilles. Fluoroquinolone is an antibiotic usually kept in reserve and used only when the more common antibiotics fail to work. This drug has a direct effect on the collagen in tendons and can weaken them within 6 hours of the first tablet being taken. Well over 200 cases of fluoroquinolone-induced tendonitis have been reported in the world literature.

This drug is also used to treat prostatitis, an often-intractable inflammation of the prostate that can drive men demented. Those who take fluoroquinolone for their prostate should take care to protect their Achilles and not exercise unwisely while on the course of antibiotics.

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It is well known that long-term alcohol abuse can affect higher-order functioning of the brain. It can impair memory and the ability to plan ahead. Usually, this catches up with men in their 50s and 60s.

One of the first symptoms is a dissociation between what they say and what they do. Affected men can recite rules but have trouble acting on them. It’s not deliberate: they just can’t. They know what is required, but they don’t put it into practice and they can’t see that they are not doing so.

One senior executive with a history of heavy drinking recently bowed to pressure from colleagues and consulted a neuropsychologist. He had excellent social skills, had obviously been very bright in the past and could hold a wonderful conversation. But although he was perfectly charming, he had a very poor memory. The doctor would tell him something, and when he raised it a few minutes later, it was as if the executive had never heard the information before.

CPs often do not pick up such impairments during standard check-ups. They do many basic tests but are not equipped to assess higher-order brain function. Men like this executive often sail through routine check-ups because their social skills disguise their symptoms.

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While the pharmaceutical industry powers ahead developing newer and increasingly complicated medications, a natural substance is experiencing a dramatic increase in popularity. The substance is pure oxygen, delivered into the body in such a way that it takes on the therapeutic qualities of a drug.

The air we breathe is usually only 20 per cent oxygen, and even if we were to breathe 100 per cent oxygen from a cylinder, as is fashionable in the oxygen cafes of Europe, we would still not get the therapeutic effects.

These effects are achieved by combining pure oxygen with pressure in a hyperbaric chamber – a chamber traditionally used to treat divers with the bends. In such a chamber, pressure can be increased to 2.4 atmospheres, which is the equivalent of being 14 metres under water. At such a pressure, it is possible for us to breathe 240 per cent oxygen.

This form of therapy is known as hyperbaric oxygenation therapy, or HBO. It is now accepted that such a rich flood of oxygen can help a myriad of bodily ailments. There are some conditions it has been proved conclusively to help, some for which there Ls anecdotal evidence that it may be effective, and some it may help.

In Australia people are now going into hyperbaric chambers for treatment of problem wounds, diabetic ulcers, osteomyelitis

(bone infection), radiation tissue damage, acutely blocked blood supply, gangrene, sudden deafness, sudden tinnitus (ringing in the ears), problems with blood supply to the eye and diving-related illnesses.

Such is the level of acceptance of the effectiveness of hyperbaric treatment that when it is provided in major hospitals it is rebatable on Medicare.

In some parts of the world, HBO is also used as a routine adjunct to cosmetic and plastic surgery. Advocates believe it can augment the healing process in patients having facelifts and laser facial peels.

Research is also suggesting that it can be helpful with certain sports injuries such as acute muscle injury and chronic tendon injury, although this has not yet been proved.

In Russia, there are labour wards that can instantly be turned into hyperbaric chambers. Usually the ward doors remain open, but if the baby goes into distress and appears to be deprived of oxygen, the doors are sealed and pressure is turned on.

During the past 5 years there has been a tremendous increase in interest in HBO in the USA, Europe, China and Japan. Australia has been a bit slower to follow the trend, but interest is picking up.

In Australia, there is a range of chambers. Some hospital chambers have more than one roomNind can accommodate wheelchairs and trolleys. Several small chambers exist in medical and paramedical practices around the country.

Hyperbaric medicine has come a long way since the late twenties, when it was so much in vogue in the USA that a hyperbaric hotel was built in Cleveland, Ohio. This steel-ball hotel, which could reach three atmospheres of pressure, had 72 rooms, a grand piano and luxury amenities. But pressure was all it provided, and in the absence of the oxygen, pressure is not therapeutic. The hotel was dismantled for scrap in World War II.

HBO has had several such false starts. In the seventies, for example, it was touted as a panacea that could ensure longevity and even cure impotence. This type of quackery set it back years. Today the status of HBO varies and in places such as the UK there are still very few hospital-based chambers.

One of the most notable achievements of HBO is that it can prevent amputations. People scheduled for amputations have tried it as a last resort and found their limbs saved. HBO accelerates healing. It works by reducing swelling, assisting the formation of granulation tissue (the healing tissue that fills a wound before the skin grows over it) and helping tiny blood vessels to grow into the damaged area. It also stimulates the growth of collagen – the connective tissue that strengthens the wound.

This therapy only works if the oxygen is inhaled. Over the years people have tried different delivery methods, such as blowing it onto wounds, but it has not been effective because the oxygen has to be dissolved in the blood. While HBO is not painful, its downside, apart from minor complications and some patients feeling claustrophobic, is that it is time-consuming. To heal a chronic wound a patient may have to spend 2 hours a day in the chamber for 5 or 6 days a week for up to 6 weeks.

But then, patients get to know each other and sit and read, watch television, play cards or chat. One very grateful 50-year-old man walked away from his stay in the chamber having avoided an amputation. He was a diabetic and had problems with circulation in his feet. Part of his foot had become gangrenous and he was on the list for an amputation below the knee.

With meticulous wound care and 5 weeks of HBO he was able to go home with his foot in a special shoe. He didn’t mind that it had taken so long! This sort of case is not uncommon.

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The older you get, the more spotty you become. As the years pass, expanses of skin that were once clear can become covered in a range of blemishes, dots, spots, moles and freckles. It’s hard to keep track of them all because it seems that new spots can emerge overnight. While most of the spots are harmless, there is always a risk that a melanoma is lurking among them.

Melanoma is one of the commonest cancers in Australia. On average, Australians have one chance in 25 of developing a melanoma before the age of 75. Although people know that early detection is crucial in preventing death from melanoma, most would find it difficult to distinguish a melanoma from moles and other spots.

Even doctors sometimes fail to recognise melanomas on their own faces. There are cases of doctors who have spent months carefully shaving around the melanoma on their cheeks without being aware of what it was they were seeing in the mirror. By the time they realised, their melanomas had become quite thick and advanced.

Older men are at higher risk. Although men over 50 constitute only 14 per cent of the population, they account for more than 50 per cent of deaths from melanoma. Every day, on average at least one older Australian man dies from melanoma. Often the figure is two men a day.

Part of the problem is that in men, melanoma usually develops on the back, shoulders or scalp, where the men can’t see it, let alone identify it.

Another complication is that men often have a nodular form of melanoma, which is more difficult to recognise than the usual form.

Apart from moles, as people age they often develop four other kinds of spots, the most common of which are solar keratoses. These are flaky spots caused when the skin over-repairs sun damage.

Seborrheic keratoses arise from oil glands in the skin and form dark, raised patches that resemble cowpats and look as if they can be flicked off.

Liver spots (lentigo) are the true ageing spots and are just large dark freckles.

There are small red spots too, known as cherry angiomas, which are malformations of little blood vessels. The only danger with these different spots is that a genuine melanoma might be mistaken for one of them.

Men at high risk should have their skin checked regularly. You are at high risk if you have a family or personal history of melanoma, have more than 100 ordinary moles on your body or have more than 50 irregularly shaped and coloured atypical moles.

A fair complexion, a tendency to burn rather than tan, the presence of freckles, light eye colour, light or red hair colour and a history of nonmelanoma skin cancer are also risk factors.

Following are descriptions of some characteristics that may help you identify a melanoma.

Compared to other spots, a melanoma often stands out like an ‘ugly duckling’. It can arise from clear skin or from an existing mole. Hair can grow from it early in its development. This hair-falls out when the melanoma gets deep enough to destroy the hair follicles. Usually, the change in a melanoma is minor and takes place over 2 to 6 months. It can itch, rarely bleeds and doesn’t hurt. Irregularity of colour is significant: a variety of colours in one lesion is a key feature of melanoma.

Doctors use the following ABCD+E system as a guide to detecting melanomas:

A stands for asymmetry.

B stands for the border, which is usually irregular.

C stands for colour, which is usually variegated.

D stands for diameter, which is usually greater than 6 mm when the melanoma is first diagnosed.

E stands for evaluation against surrounding moles – the melanoma should stand out.

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The search for a harder, stronger, more enduring erection has led numerous men directly into impotence. These men abused potency drugs without realising that they could end up with the opposite result – erections that were softer, weaker and didn’t endure.

Before Viagra was approved for use, the ‘leisure’ use of penile injections was alarming. Soon after injections became readily available, hospital casualty units began seeing cases of highly embarrassed men in pain who could find no way to make their erections go down.

If a man is perfectly potent, there is no point in his taking Viagra: it will not make him more of a man. Viagra works on biochemistry, and if biochemistry is in order, there is nothing for this drug to do: swallowing it is a waste of effort and money. Penile injections are different: if abused, they can do some serious damage.

Because Self-Injection Therapy (SIT) is, by definition, self-administered, it is easily overused. There are always a few clowns who think that if 1 ml is good, 2 ml will be much better. They go ahead and self-inject and then don’t know how to handle the consequences.

There have been reports of men who have obtained SIT illicitly and used it not because they were impotent but because They wanted to improve their sexual prowess. Wild expectations drove them to use bigger doses in the hope of getting bigger erections.

They ended up with extremely painful priapism. Such men typically don’t respond to warnings, don’t seek treatment and cause themselves permanent damage. While they may have been perfectly potent before they used the injections, they could become genuinely impotent alter abusing them.

Priapism can be profoundly painful. Often it is big-league pain that can only be relieved with narcotics.

Treated early, priapism is easily cured. However, it becomes problematic if men delay getting help. To let down an erection resulting from prolonged and untreated priapism, doctors have to stick a large needle into the shaft of the penis and draw out blood. They then have to re-inject the shaft with drugs. This can be dramatic.

If a man’s erection lasts for 4 hours, he should see a doctor. After 6 hours, he needs urgent attention. If an erection persists for more than 12 hours, there is a risk of permanent cell damage. The damage can be so extensive that injections may not work in the future and it may not be possible to implant a prosthesis. If treatment for priapism is delayed by more than 36 hours, the man will never regain normal erectile function.

In one well-known case, a 51-year-old man went to a hospital casualty unit 38 hours after injecting himself. His erection just would not go down. After two operations to achieve detumescence, he learnt he had permanently lost his erectile capability. There was so much internal scarring that nothing could be clone; even a prosthesis was out of the question. He had been in considerable pain, but embarrassment and the hope that his problem would resolve itself spontaneously had kept him from seeking help earlier.

The tragedy is that some men who end up with this damage never actually needed the injections in the first place. Men most at risk of priapism are those who have psychological impotence -men whose emotions inhibit their erections but whose physical erectile mechanism is normal. They have a good blood supply to the penis and so are supersensitive to the injections, which work by increasing blood flow. Physically they are fine, and their sexual difficulties could be treated in less invasive ways.

Although such men need counselling, they are often given injections at potency clinics because it’s quick and seems easier than talking about the issue for hours.

Men with premature ejaculation who are a bit anxious and perhaps not sure about their sexuality also go to these clinics and report erectile problems. Again, the short cut is to give them injections.

Men with neurogenic impotence – impotence resulting from spinal injuries or conditions such as multiple sclerosis – are also supersensitive to SIT because their blood supply is normal. While in their case injections are useful to ‘kick-start’ their erections, such men need very small doses.

Because SIT works by enabling blood flow to the penis to increase, it is useful for men whose arteries have narrowed or become blocked as a result of age or a disease such as diabetes. Once the blood flows in, the penis becomes engorged, and the veins kink and trap the blood to maintain engorgement. The erection does not disappear automatically alter climax. It lasts as long as the drug – usually from 20 minutes to an hour.

All men should be aware that if too much drug is administered, or the drug is used twice in a day or is used contrary to doctors’ instructions, priapism may result. When injection therapy is used judiciously, however, priapism is unusual.

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Penicillin and other medicines have revolutionized the treatment of this serious disease. However, this does not mean it is no longer a killer. But it is tremendously reassuring to know that syphilis can be readily and completely cured.

In the main, syphilis is transmitted through sexual contact. In extremely rare instances, it has been contracted by drinking from a glass previously used by a syphilitic person. It is not caught from contact with toilet seats.

Any sore on or near the sex organs should be examined and tested by a physician immediately. If it is not syphilis, a great deal of needless worry will be avoided. If it is syphilis, treatment can be started at once with assurance of a prompt cure.

If undiscovered and untreated, syphilis may continue for many years before there is obvious harm to the body. Late syphilis may cause blindness or severe disease of the bones and joints, the skin, or the internal organs, since the unchecked spirochetes can invade every cell of the body. The forms of syphilis most often resulting in death are those that damage the nervous system and the heart.

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Always consult a doctor if an adolescent suffers from severe acne. The doctor may want to refer the young person to a dermatologist or to the skin-diseases department of the nearest hospital. Frequent boils may be a sign of diabetes. Do not forget that this disease, which you may have associated only with adults, frequently strikes young people.

Freckles can be a source of worry to adolescents. Let me remind you that there is no way you can remove them safely at home. However, they can be prevented from getting worse by reducing exposure to the sun or by using protective ointments or lotions.

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Your life, unlike your grandmother’s, is not going to be very different now that you are pregnant. Your appearance need not be unattractive, your activities will not be much restricted.

What can you do during pregnancy?

Many doctors feel that it is safe to participate in sports such as golf, riding, tennis, and dancing, as long as you do not become overtired. Some doctors think that it is wise to engage in only mild forms of exercise during the early stages of pregnancy, when the danger of a miscarriage is greatest.

There is no reason why a pregnant woman cannot drive a car or even take motor trips as long as her figure does not become too cumbersome. However, if you go on a long trip, stop the car at least every hour and a half and get out and move around for a few minutes. And, of course, obey the cardinal rule, ‘Do not overtire yourself.’ This holds true for all forms of travel. If you have a tendency to seasickness, or if the weather is apt to be uncertain, do not take a trip by boat or aircraft.

Always consult your doctor before undertaking anything new, or when you are in doubt.

Clothing

Fortunately, the modern woman can dress becomingly in clothes that conceal her condition during the early stages of her pregnancy and keep her from looking ungainly later on. The only prohibition about clothing is that it should not be too tight or uncomfortable in any way. Wear comfortable, safe shoes. High heels will not support you properly during the last months of pregnancy.

Personal hygiene

There are no prohibitions about washing or bathing the entire body, including the genitals. Tub baths are sometimes forbidden in the last months of pregnancy because of the danger of infection. Shower or sponge baths are always safe. Never take a douche during pregnancy unless your doctor recommends it.

Alcohol and tobacco

Most doctors permit expectant mothers to drink alcoholic beverages in moderation. Until recently, they adopted the same attitude towards smoking, but with the new information on smoking, some physicians now advise their pregnant patients to stop altogether.

Sexual relations

Aside from the danger of miscarriage during the days of the month when your first three menstrual periods would occur if you were not pregnant, sexual intercourse is safe during the first seven to eight months of pregnancy. Again, moderation is essential. However, intercourse is not safe during the last six weeks. This is because bacteria are forced into the mouth of the womb during the sexual act. If labour should begin early, there is a real danger that these bacteria will cause an acute infection.

Emotional reactions

Especially during the early, months of pregnancy, you may be unusually sensitive and irritable, so that you become upset and cry if your husband seems to speak crossly to you. The demands and fretfulness of your other children may seem almost too much to bear. Try to take this in your stride. Our bodies and emotions are influenced

by special chemicals called hormones. During pregnancy, the body has more of certain hormones than it had before, and less of others. This imbalance may cause exaggerated emotional reactions. Remind yourself that they are only temporary. If you are concerned about this, consult your doctor.

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There are over 120 species of snakes throughout Australia, and more than half of them are poisonous. However, only about 16 snakes are venomous enough to kill an adult. Among the more deadly species are the copperhead, the tiger snake, the taipan—considered one of the world’s most dangerous snakes—the death adder, the red-bellied black snake, the various brown snakes, the mulga and the Clarence River snake.

Each of these snakes has two poison fangs and up to 13 small teeth on each side of its upper jaw, depending on the species. When a snake bites, the venom is squeezed from a gland and flows down a groove in each fang (with the exception of the death adder, which is hollow-fanged) and is deposited within the two-puncture wound. There are usually two rows of indentations from the smaller teeth as well.

Snakes usually bite people on the legs or arms, and a tourniquet should be applied to the upper part of the limb between the wound and the heart. Wash the bitten area thoroughly and suck the wound vigorously to remove any venom from the wound and the superficial tissues. Do not give him alcohol. Reassure the patient, keeping him warm and quiet. Get the victim to a doctor so that he can be injected with antivenene.

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The nose, with its bones, cartilage, nerves, and mucous membranes, which contain glands secreting a watery fluid, is the organ of smell; and, more important, it is the means by which we take air into our bodies. We can—and some people do—get along by breathing through the mouth. While this is not dangerous, it is by no means satisfactory. The nose is a far better ventilator. It filters out dust, provides moisture, and acts as an air conditioner by warming the air we take in.

Infections of the nose

The most common disease of the nose—in fact, the most common disease in the world—is the common cold.

Ozena is a severe form of chronic infection of the nose, which is characterized by an unpleasant odour. A persistent, foul-smelling discharge in children is usually caused by some foreign object, such as a bead or pencil eraser, that has become lodged deep in the nasal passage. Always have a doctor take care of removing such an object.

Should an unsightly nose be changed by plastic surgery? This is a problem you should talk over with your doctor.

Cleaning the nose

Your nose needs little regular care. Do not use nose drops, sprays, or ‘sniffers’ unless your doctor tells you to. They cure nothing and can cause irritation or injury.

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