Men’s Health at every age Young Blokes The Middle Ages

Healthy
2012
men
The Alfred talks about men’s health
Men’s Health
at every age
Young Blokes
Health issues in your
20s & 30s
The Middle Ages
What to watch out for
in your 40s & 50s
Older Guys
Staying healthy in your
60s & beyond
Contents
Younger Years
Trauma...............................................................6
Drug and alcohol use........................................7
Sleep deprivation...............................................9
Skin cancer & Testicular cancer......................10
Sexual health................................................... 11
Stress and anxiety...........................................12
Sedentary lifestyle and nutrition......................13
Middle Years
Obesity.............................................................16
Type 2 diabetes...............................................17
High cholesterol...............................................19
Hypertension....................................................20
Sleep apnoea .................................................21
Parkinson’s disease ........................................22
Erectile dysfunction ........................................23
Ladder falls......................................................24
Prostate problems...........................................25
Lung cancer ....................................................26
Bowel cancer...................................................27
Later Years
Stroke...............................................................30
Prostate cancer................................................31
Respiratory illness ..........................................32
Depression ......................................................33
Chronic kidney disease...................................34
Failing eyesight................................................35
Osteoporosis....................................................36
Osteoarthritis ...................................................38
Dementia..........................................................39
All Ages
Coronary heart disease...................................41
2
*This publication should be read in conjunction with advice provided by your GP or specialist doctor.
Foreword
Confessions of an ordinary man…
just like you.
I’ve spent 20 years at The Alfred trying to
assist its unending cause and surrounded
by the medical expertise that has won it
high regard.
I’ve heard thousands of times the advice
for men – particularly those over 50 – to
undertake a simple test for bowel cancer.
Did I heed the message? No.
Did I rationalise my lack of action?
Yes…no symptoms, no bleeding, no lack
of energy, running every day, working well,
no irregularity.
Bad luck!
I’ve now had bowel surgery and I’m currently
undertaking a course of chemotherapy.
So obviously my strong recommendation
is that you have a check-up and that you
don’t put it off.
As we move through life’s journey there
are many pitfalls that can test our overall
health and wellbeing, but knowing how
to take control and make the right choices
offers the best chance for a fulfilling future.
What you commonly see in your twenties
and thirties is often very different to the
middle years and to what may be likely
to challenge you in later life.
Reading on is the first step in ensuring
we promote a population of healthy men.
Tony Charlton
Board Member, The Alfred Foundation
3
Younger
Years
You guys are in the best
possible position to live a
lifestyle that can save you
from serious health issues
down the track.
The good news is that your age
group does not commonly suffer
from diseases or illnesses. But
your lifestyle may change that.
Maybe you’re feeling stressed,
not exercising enough or not
eating a healthy diet. Perhaps
you’re having unsafe sex,
drinking too much alcohol or
taking drugs. These factors can
all put your life at risk – now
and in the future.
4
20–40
YEAR OLDS
• Trauma
• Alcohol and drug use
• Sleep deprivation
• Skin cancer and
Testicular cancer
• Sexual health
• Stress and anxiety
• Sedentary lifestyle
and nutrition
4
5
Younger Years
Trauma
Injury is the most common cause
of death before 40.
What you can do:
You’re in the prime of your life and you sometimes
feel invincible. It’s not surprising that many of you
take risks and end up in a hospital emergency
department.
• Choose a car with maximum safety
features, such as airbags
Log onto www.howsafeisyourcar.com.au
to find your car safety rating
Most commonly, young men end up in The Alfred’s
Emergency & Trauma Centre with serious – even
life-threatening – injuries from car or motorbike
crashes, sporting injuries, assaults or impulsive
stunts. So often, such injuries are preventable.
Injury is the most
common cause of
death before 40.
Car crashes are still the number one cause of
trauma we see at The Alfred and the vast majority
of people killed in car crashes are male.
Alcohol and trauma often go together. Too many
beers at the footy, a night of partying and an
argument with a stranger can lead to tragedy.
• Always buckle up – seatbelts save lives
• Don’t drink and drive – the legal alcohol limit
is .05 and zero for probationary drivers
• Don’t drive if affected by drugs. Your reflexes
and decision making can be fatally affected
• Observe the speed limit and drive according
to conditions. Speed is a major contributor to
road crashes
• Pull over and rest if you’re tired
• Distractions are deadly – don’t use your phone
while driving
• Always wear a helmet when riding a motorbike
or bicycle – head injuries in a crash can be fatal.
Protective gear is also a must on your motorbike
• Pedestrians should remain alert when crossing
roads – don’t listen to music while crossing
roads or train tracks
• Drive defensively or undertake defensive
driver training.
Car crashes are
still the number
one cause of
trauma we see at
The Alfred.
6
Drug and alcohol use
Alcohol is the most widely used
social drug in Australia. It makes
you feel relaxed because it’s actually
a depressant drug. Our liver breaks
down most alcohol we drink, but can
only do so at a certain rate. If you drink
faster than your liver can process the
alcohol, it stays in your blood and
you get drunk.
That alcohol in your blood stream affects your
nervous system, reducing muscle co-ordination,
memory, judgement and problem-solving abilities.
Alcohol also affects your body; over time excessive
alcohol use increases your risk of inflammation to
the stomach and liver.
Alcohol misuse can also contribute to accidents of
all types, as well as family breakdowns, depression,
violence and chronic anxiety. It can lead to a fatty
liver (which may affect liver function), obesity and
loss of sex drive.
Do you know it’s dangerous to mix alcohol with
stimulants such as energy drinks? It can make you
unsure exactly how much alcohol you have drunk,
and dehydration may be worse with the combined
effect of alcohol and caffeine.
Remember that a ‘standard drink’ is often less than
you realise. A 375ml stubby of full strength beer,
for instance, equals 1.4 standard drinks, while an
average restaurant 150ml glass of red wine equals
1.6 standard drinks.
Amphetamines
The use of amphetamines such as
methamphetamine, ice and ecstasy, has increased
in recent years. These drugs over-stimulate the
central nervous system and can lead to serious
physical and mental health problems.
Marijuana
In young men, we are seeing significant lung
damage amongst those who have been regular
users of marijuana for five years or more. This
damage is often missed on standard breathing
tests. These patients in their 20s and 30s come
into hospital 20 years earlier than cigarette smokers,
with an aggressive, different form of emphysema.
Symptoms include a productive (or ‘wet’) cough,
shortness of breath and weight loss.
What you can do:
• Drink responsibly – no more than two standard
drinks per day and have one or two alcohol free
days each week. The label on an alcohol drink
container tells you the number of standard drinks
in the container
• Do not drive or operate heavy machinery after
drinking or drug use
• Quit smoking.
7
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Younger Years
Sleep deprivation
If you are getting less than four hours
sleep a night, you are sleep deprived.
To perform at your best you actually
need eight to nine hours sleep, each
night. And yet when you are sleep
deprived, you have less ability to judge
your performance – you can’t tell just
how badly you are affected.
Ever since electricity was invented people have been
getting less than optimal sleep. Now with the social
media revolution, many are finding it even harder to
switch off.
It only takes a day or two of very little sleep for your
health to suffer.
Lack of sleep stops your brain from working properly –
your judgement is poor, you make mistakes, forget
things and your reflexes slow down. Driving when
sleep deprived is like driving when drunk. Going
without sleep for 24 hours is equivalent to a .08 blood
alcohol level.
It only takes a day or two
of very little sleep for
your health to suffer.
If you mix bad sleep habits with alcohol and drugs
you get a compounding effect. A blood alcohol
level of .03 plus sleep deprivation causes you to
behave as if you were drunk. To make matters
worse, the sleep you do get with alcohol and drugs
is poorer quality.
Lack of sleep also stops your body from functioning
well. When you are sleep deprived your body doesn’t
handle glucose efficiently, meaning a sleep-deprived
person can be predisposed to diabetes. A twenty five
year old who only gets four hours of sleep a night
clears glucose from their blood like an 80 year old.
Poor sleep is also linked to heart disease and a
reduced ability to fight off infection. Loud snoring with
fragmented sleep is now recognised as an important
cause of high blood pressure.
Depression, higher suicide rates and personality
changes are all linked to not enough, good
quality sleep.
The good news is that you can do a lot to improve
your sleep, like taking the TV out of the bedroom,
avoiding caffeine and nicotine in the evening and
having a cut off time for online gaming and social
media. Developing a regular sleep pattern and a
ritual at bedtime can help your mind and body get
into a good sleep rhythm.
Sleep deprivation is like an iceberg – you only see
the tip – the full danger is often not realised.
What you can do:
• Sleep in a quiet, cool, dark environment
• Attempt to sleep regular hours and sufficiently
long enough
• Exercise regularly but avoid strenuous activity
before bedtime
• Treat underlying conditions that might disturb
your sleep (such as asthma, arthritis, heartburn).
9
Younger Years
Skin cancer
You are unlikely to be in hospital with
skin cancers during your teens or 20s,
but this is often when the damage is
done. Sun exposure during childhood
and adolescence make an important
contribution to the development of
melanoma.
Skin cancer is the most common cancer in Australia
and more than half of Australians will develop some
form of skin cancer before the age of 70.
It is completely preventable, and treatable if caught
early. Signs include new spots and changes in
size, shape and colour of existing moles or freckles.
Red, raised lesions that last for more than a month
are suspicious.
What you can do:
• Check your skin for any new or changed lumps
or spots at the start of every season and
let your doctor know of any changes
• Be sunsmart: UV levels are highest between
10am and 3pm during summer
Some sun is good for your health (for vitamin D)
but too much UV can cause sunburn, skin and
eye damage and skin cancer
• Avoid solariums, which radiate with both UVA
and UVB radiation (five times as strong as the
midday summer sun) and are known to be
dangerous to the skin
• Be sunsmart during winter too, when snow
skiing or snowboarding, as UV radiation can
still be high.
Testicular cancer
The cancer most likely to affect young
men is testicular cancer. Most men
are surprised that it typically occurs in
the 25-45 age bracket. Fortunately, it
is relatively uncommon, with less than
200 cases reported in Victoria each
year. It generally has a good outcome,
with 95 per cent of men with this
cancer cured.
Cure rates are better with early diagnosis
and treatment, so tell your doctor about any
unusual growth or swelling in your testicles.
Doctors use an ultrasound to examine any
mass in the testes.
10
Two-thirds of cases are cured with surgery alone,
but treatment may also include chemotherapy or
maybe radiotherapy.
What you can do:
• Examine your testicles monthly – check for
any change in size or shape. Most lumps in the
testicles are not cancer but check with your
doctor to be sure.
Sexual health
You might be well informed about how
to avoid an unwanted pregnancy, but
remember that safe sex is about more
than family planning. Condom use is
falling, which mean the chances of
getting a sexual infection is rising.
Chlamydia is the most common bacterial sexually
transmitted infection in Australia, affecting both
women and men. There are often no symptoms of
chlamydia, although men may notice redness at
the opening of the penis, stinging or burning when
passing urine and a clear discharge from the penis.
If not treated, chlamydia may occasionally cause
pain and swelling in one or both testicles. As well
as possibly leading to infertility in women, chlamydia
can affect the fertility of men too. There are very
effective treatments available.
Until recently, HIV was uncommon in the
heterosexual community but we are seeing an
increase in this disease amongst men who travel
and have sex in countries where HIV is prevalent.
What you can do:
• Practice safe sex – using a condom is the best
way to prevent sexually transmitted infections
• If you are diagnosed with a sexually transmitted
infection, notify recent sexual partners so they
can be tested. Melbourne Sexual Health Centre
provides tips and advice on partner notification. Visit www.letthemknow.org.au for details
• Have respectful relationships where you are
open and honest with each other
• Ensure both partners are tested for infections
before stopping condom use in a new relationship.
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11
Younger Years
Stress and anxiety
Stress, anxiety and sleep deprivation
are common amongst men in their
20s and 30s. Men in this age group are
having increased work responsibilities
and may be becoming dads for the
first time. They may also be the sole
income earner in the household.
Stress affects the body’s ability to protect against
illness, as it directly impacts the immune system.
Symptoms of a weakening immune system include
headaches, cold sores, skin inflammation (such as
eczema) and feelings of anxiety, irritability or fatigue.
What you can do:
• Listen to your body – if you’re feeling
run down, rest and get plenty of sleep
• Exercise – the hormones produced from exercise
have a positive effect on mood due to increased
blood flow. There is an added benefit to your
physical health. Yoga, Tai Chi, relaxation exercises
and counselling may be useful in managing
stress and anxiety
• Sleep in a cool, quiet environment and avoid
alcohol, caffeine and nicotine and strenuous
exercise prior to bedtime
• See your GP regularly for check-ups and advice
on how to tackle stress before illness takes hold.
Stress affects the body’s ability
to protect against illness.
Cortisol, a hormone produced during stressful times,
temporarily suppresses the immune system, leaving
you vulnerable to contracting various bugs and
possibly worsening conditions such as asthma and
cardiovascular disease.
It’s common for men to avoid tackling stress head
on and instead ‘treat’ it with behaviours that only
make things worse – binge drinking or drugs.
Stress can lead to high blood pressure and anxiety
disorders (such as panic attacks or obsessive
behaviours and insomnia), heartburn
and premature cardiovascular disease. Stress
and anxiety can also lead to depression and
social withdrawal.
12
Sedentary lifestyle & nutrition
Current trends estimate that 65 per
cent of young Australians will be
overweight or obese by 2020.
Fewer active jobs combined with a trend to stop
playing competitive sport in the mid-20s mean many
men lapse into a sedentary lifestyle early in life. And
that means they don’t have healthy, active habits
when health issues arise in the middle years.
There is speculation that this may be the first
generation not to outlive their parents.
A poor diet can lead to obesity, which heightens your
risk for a whole host of diseases, including cancers,
diabetes and heart disease.
Yes, your metabolism may be strong at 20 and your
body might not show the effect of poor diet, but
this WILL change in time. The food and drink you
consume doesn’t just affect weight but also your
fitness, stamina and long-term health. If you wouldn’t
put poor quality petrol in your car why would you give
your one and only body a poor diet?
There is speculation
that this may be the first
generation not to outlive
their parents.
What you can do:
• Establish healthy eating habits now – eat two
serves of fruit and five serves of vegetables daily,
along with plenty of fibre
• Limit sugars, including soft drinks (as most contain
10-20 grams of sugar) and foods high in fat
• Have your cholesterol checked annually especially
if you have a family history of heart disease or high
cholesterol
• Drink plenty of water and limit your caffeine and
energy drink intake
Both can increase the heart rate as well as cause
side effects like insomnia, anxiety, headaches and
high blood pressure
• Introduce exercise into your weekly routine. Health professionals recommend at least 30
minutes of moderate-intensity physical activity on
most, preferably all, days.
13
Middle
Years
You may be shocked to think
of yourself as being middle-aged.
Isn’t 40 the new 30?
Realistically, if you look at life
expectancy for men, you’re
about halfway through your life.
But these can be your
best years.
You may notice that you start
to slow down a little and may
have your first experience with
ill health – or realise you can’t
take good health for granted
anymore.
14
14
40 –60
YEAR OLDS
• Obesity
• Type 2 diabetes
• High cholesterol
• Hypertension
• Sleep apnoea
• Parkinson’s disease
• Erectile dysfunction
• Ladder falls
• Prostate problems
• Lung cancer
• Bowel cancer
15
Middle Years
Obesity
Australia ranks high on worldwide
obesity rates. A man whose waist
measures more than 94cm or has
How is it diagnosed?
a Body Mass Index (BMI) over 30 is
To diagnose
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Tests may include endoscopy (a thin tube
inserted through the nose or mouth to
examine the affected area) or scans. You
would be referred to a doctor specialising
in these cancers.
Obesity comes with a host of health problems – it is
linked to cardiovascular disease, erectile dysfunction
and is the number one cause of type 2 diabetes.
What
I do?
Extracan
weight
also puts pressure on the lungs,
the ability
breathe,
particularlyin
when
• impairing
Quit smoking
andtoavoid
over-indulge
horizontal
asleep.
and respiratory
alcohol – or
both
are Snoring
risk factors
for head failure
are
in obese people.
andcommon
neck cancers.
• What
Avoid other
risk factors,
you can
do: including
prolonged sun exposure and certain
• MeasureyourBodyMassIndex(BMI).
industrial exposures, such as hard wood
While it doesn’t distinguish between fat mass
dust inhalation.
Latest figures
reveal that one
in four adults and
one in 12 children
are obese
A biopsy of tissue would usually be taken
and examined under a microscope in a
laboratory to confirm the diagnosis.
and lean mass, it can be a useful guide.
A healthy BMI is between 18.5 and 24.9,
overweight is between 25-29.9 and 30 and
above indicates obesity
• Improveyourdiet.Eatplentyoffibreand
a variety of fruits and vegetables, especially
brightly coloured vegetables which offer the
mostprotectivehealthbenefits
• Avoidfoodshighinfat,sugarandsaltand
processed meats. If you are overweight you
have an increased risk of diabetes, heart
disease, heartburn and cancers
• Exerciseforatleast30minutesfivedaysaweek
• Measureyourselftoassessyourriskofobesity.
Men should have a waist circumference no larger
than 94cm and a neck circumference (i.e. shirt
collar size) of 45cm or less.
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25
Type 2 diabetes
Diabetes is a chronic metabolic
disease marked by high levels of
glucose in the blood. It is caused
by inadequate levels of insulin or
insulin that doesn’t work effectively
in the body.
It is now occuring more
frequently in younger
and younger people.
As Australians continue to become more overweight
and live sedentary lives the incidence of type 2
diabetes is dramatically increasing. It is now occuring
more frequently in younger and younger people.
Often people don’t have any symptoms and remain
undiagnosed for a long time. Complications may be
prevented if diagnosis can occur earlier.
What you can do:
• Exerciseregularly–30minutesofmoderate
exercise on most, if not all, days
• Keepbloodpressureandcholesterollow
• Sticktoalowfatdietandwatchyourportions
While type 1 diabetes occurs in children or young
adults and always requires insulin treatment, type 2
diabetes is the most common form and sometimes
requires insulin treatment. Type 2 diabetes, occuring
mostly in people over 40, is linked to obesity and
is more common in men. If left untreated, diabetes
can affect a number of organs – resulting in heart
disease, stroke, renal failure, nerve damage,
amputations and blindness.
Paint like a Pro
• Don’tsmoke
• Measureyourwaisttoassessyourrisk.
Obesity can lead to type 2 diabetes – men
with a waist circumference of 94cm or more
are at risk
• BescreenedfordiabetesifyouareAboriginal,
Torres Straight Islander or Polynesian and
over 30, or if you have a family history or
are overweight.
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17
Middle Years
High cholesterol
Cholesterol is a fatty substance
found in your blood. For many men,
high blood cholesterol begins
in their 20s.
Risk increases with age and cholesterol naturally
rises as you get older. High cholesterol puts you
at risk of stroke and heart attacks.
Losing even 10 per cent
of your body weight can
help to decrease blood
pressure, cholesterol and
blood glucose levels.
A total cholesterol level of 5.5 or more is
considered high.
It is the build-up of fats, cholesterol and other
substances in the inner lining of the arteries of
the heart that leads to cardiovascular disease.
Blood vessel linings are usually smooth and
durable but if cholesterol levels are too high,
it can lead to artery-clogging plaque that can
bring on heart attacks, angina or stroke.
Men should know their cholesterol and eat
accordingly by the time they reach middle age.
Often high cholesterol runs in families and you
may need medication to keep it under control.
But you can make a difference with a good diet,
regular activity and maintaining a healthy weight.
Losing even 10 per cent of your body weight can
help to decrease blood pressure, cholesterol and
blood glucose levels.
What you can do:
• Ifyouareover50,haveyourcholesterolchecked.
If it is high, change your diet and check cholesterol
levels regularly
• Don’tsmoke
• Exerciseregularly–frequentexercisecanboost
the good cholesterol (HDL)
• Eatplentyoffruitandvegetablesandavoidfoods
high in saturated fats, processed foods and limit
foods high in carbohydrates – which in turn should
help you maintain a healthy weight
• Limitalcoholintake
• VisityourGPregularlytoensureallknown
risk factors for cardiovascular disease are well
controlled.
For many men, high blood cholesterol
begins in their 20s.
19
Middle Years
Hypertension
High blood pressure (or hypertension)
is one of the first warning signs of ill
health, as well as a major risk factor for
stroke and heart disease. Hypertension
is a common disorder and affects
about one in seven adults in Australia.
It becomes more common with age.
When you have high blood pressure, blood is
pumping with more force than normal. This is normal
when you are exercising but when your blood
pressure is high when you are at rest, it means the
heart is over-worked.
The extra pressure damages the arteries, leading
to premature blockage with heart attack, stroke or
poor blood supply to the legs.
Your blood pressure changes all the time,
depending on your circumstances. Optimal blood
pressure when at rest is 120/80 or lower.
Hypertension is a
common disorder and
affects about one in
seven adults in Australia.
What you can do:
• Don’t smoke – smoking causes an immediate
increase in blood pressure and heart rate after
just one cigarette
• Have an active lifestyle – exercise regularly and
keep your weight in a healthy range – men should
have a waist measurement of less than 94cm
• Aim for a stress-free life as stress has a direct,
harmful effect on blood pressure – practice
relaxation techniques
• Eat less salt and fat
• Have your blood pressure checked regularly, at
least annually if it’s high, as there are often no
symptoms for hypertension
• Drink alcohol in moderation - two standard drinks
per day for men and have at least two alcohol-free
days each week. Labels tell how many standard
drinks are within the bottle or can.
20
Sleep apnoea
Sleep apnoea can be a serious
condition, which most typically affects
men in their middle years. This sleep
disorder is quite common, affecting
about one in four men over 30. In
adults the disorder is three times more
common in men than women, though
often is undiagnosed.
It occurs when the walls of the throat come together
during sleep, blocking off the upper airway. Breathing
stops – from a few seconds and up to one minute
– until the brain registers a drop in oxygen levels
and then the sleeper snorts or gasps and drifts back
to sleep, often not even aware of the disturbance
to their breathing. This pattern can be repeated
hundreds of times each night.
This disruption to sleep can lead to excessive
tiredness during the day, poor concentration,
irritability and mood changes. It can also cause
reduced libido, impotence and a much higher risk
of having motor vehicle accidents. Those with
significant sleep apnoea have an increased risk of
high blood pressure, which in turn increases the risk
of heart attack and stroke.
Loud snoring can indicate sleep apnoea. The
impaired airflow creates extra noise and a drop in
the body’s oxygen stores. Research has shown
that sleep apnoea is linked with heart failure. See
your GP if you snore most nights, if it’s loud enough
to disturb people in other rooms, occurs in all
sleeping positions, is associated with periods of not
breathing, makes you excessively sleepy during the
day, and if you also have high blood pressure
or cardiovascular disease.
What you can do:
• Watch your weight. Obesity, especially extra
weight in the neck and torso, is one of the common
causes of sleep apnoea. Weight loss can reduce
the severity of snoring and sleep apnoea
• Reduce your alcohol intake – alcohol hampers the
brain’s reaction to sleep disordered breathing
• Don’t smoke (smoking increases the chances of
developing sleep apnoea)
• Avoid taking sleeping tablets and sedatives, which
tend to exacerbate sleep apnoea
• See your GP if you’re experiencing persistent
snoring and excessive daytime sleepiness.
Treatment may include mouthguards, nasal
ventilation or surgical correction of an upper
airway obstruction.
This sleep disorder is quite common,
affecting about one in four men over 30.
21
Middle Years
Parkinson’s disease
Some people think Parkinson’s disease
only affects older people, but most are
affected from around 50 to 60 years,
with one-fifth diagnosed between 30
and 50 years. About four people per
1000 have Parkinson’s and this
incidence increases to one in 100 for
those over 60 years.
It is a progressive, degenerative neurological
condition that affects the control of body movements.
Ithasnoknowncauseandisdifficulttodiagnose.
While symptoms vary greatly, they generally include
tremors (shaking), muscle stiffness, stooped posture
andashufflinggait.
Tremors usually start in one hand, spread to the
leg and then cross to the other side of the body
and are most noticeable when at rest or when
tired or stressed.
The disease progresses very slowly over decades.
What you can do:
• SeeyourGPifyouareexperiencingany
symptoms such as trembling
• KnowthatthesymptomsofParkinson’s
disease can be managed with medication,
physical therapies and even surgery
•Seeaspecialistregularlytomonitortreatments.
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where the
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22
Erectile dysfunction
You might feel embarrassed about it,
but it’s actually common for men to
have significant erectile problems as
they age. Mild erectile dysfunction is
experienced by four in every 10 men
after the age of 40 and complete loss
of erections are noted by about 15
percent of men over 60.
Many cases of persistent erectile dysfunction are
caused by a physical illness and can be an early
warning sign for diabetes or heart disease.
Many cases of
persistent erectile
dysfunction are caused
by a physical illness and
can be an early warning
sign for diabetes or
heart disease.
Surgical treatment of prostate cancer can lead
to erectile dysfunction and reduced libido, but
benign prostate enlargement doesn’t usually
affect erections.
Only 10 per cent of erectile dysfunction cases
are caused by psychological problems.
Problems such as obesity, diabetes, high cholesterol
and high blood pressure and depression, can also
lead to erectile dysfunction. A poor diet is also a
major contributor as are alcohol and a lack of sleep.
We’ve all seen the ads, so know there is a big
industry out there selling testosterone replacement,
but erectile dysfunction is not usually due to
testosteronedeficiency.
Testosterone measurements may be lower in
these men and may contribute to reduced libido.
But unfortunately taking extra testosterone
usually doesn’t help and can be risky.
Effective treatment for erectile dysfunction can be
obtained through your GP, although it may not suit all.
Depression, alcohol and a lack of sleep are other
contributing factors.
What you can do:
• SeeyourGPforacheckupforinvestigation
into any underlying medical causes – your doctor
may check your cholesterol, blood pressure and
test for diabetes
• Exerciseregularlyandeatahealthydiet
• Bewaryofthemany‘quickfix’treatments
advertised.
23
Middle Years
Ladder falls
D.I.Y. jobs at home can often end up
with men – commonly in the 40-60 age
group – coming into the Emergency
Department. While we see many
middle-aged men with injuries from
car accidents, cycling incidents and
from using various household tools,
the most serious injury comes from
men falling off ladders.
Falls account for about
one-third of all hospitalised
injury cases.
Falls account for about one-third of all hospitalised
injury cases and ladder falls have recently increased.
According to a recent Alfred study, eight per cent of
admissions relating to a ladder fall result in death
and 88.5 per cent of these admissions are from
ladder use at home.
What you can do:
• Avoid climbing a ladder if it’s not part of
your profession
• Avoid over-reaching, carrying excessive loads,
or shifting the ladder while on it. Do not climb
ladders while under the influence of drugs or
alcohol. Wear sensible clothing and footwear
and avoid wet and windy conditions
• Use ladders with wide angled rungs or
non-slip rubber footings, or special hand grip
railings
• Secure both ends of your ladder or have
somebody else brace the ladder
• Allow only one person on a ladder at once
• Ensure you always have at least both feet
and one hand on the ladder
• Never step beyond the second highest ladder
rung. The ladder should extend one metre
above the top support.
If you’re not trained how to use a ladder (for
example, as part of your job), it’s best to avoid using
them completely. Remember: our reflexes and
balance deteriorate as we age.
BEWARE
24
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Prostate problems
From the age of 50, it’s common
for men to have problems with their
prostate. The prostate is a small,
walnut-sized gland that contributes to
the process of making seminal fluid.
Symptoms of an enlarged prostate include having a
poor urine stream or a need to frequently pass urine.
Several medications can treat this condition. If an
operation is required, surgeons simply remove the
centre of the prostate.
Enlarged prostate
What you can do:
Having an enlarged prostate is a common
urological problem. When it is enlarged, the gland
squeezes the urethra, causing problems in urinating.
If untreated, it can lead to urinary infections, bladder
and kidney damage. It is not known why this
happens, but it seems to be a common part of
ageing for men.
• See a doctor if you have any urination problems,
regardless of your age. Once symptoms develop,
they remain persistent. Without medical attention,
the condition may worsen.
Prostatitis
Prostatitis is an inflammation of the
prostate gland, usually caused by a
bacterial infection. It can also occur
when the muscles of the pelvis or
bladder don’t work properly or when
there is a bladder blockage, causing
infection or inflammation.
It can be very painful and can affect men at any age.
It is thought that one in every six men experience
this disorder at some stage.
What you can do:
• See a urologist
• To ease the pain, take hot baths
• Avoid alcohol, spicy foods and caffeine
• Use a cushion when sitting for long
periods of time
• Have safe sex – unprotected sexual intercourse
can let bacteria into the urethra which can move
up to the prostate
• Pelvic floor muscle relaxation techniques may
be helpful for symptom relief.
25
Middle Years
Lung cancer
The more and longer you smoke,
the higher the risk of lung cancer.
The disease is commonly seen in 45
to 70 year olds and cigarette smoking
causes 90 per cent of lung cancers.
Symptoms of lung cancer include a cough that
won’t go away, a change in a chronic cough, blood
insputum(fluidcoughedupfromthelungs)and
breathlessness.
There have been major advancements in treatments
in recent years and improved survival rates with the
use of chemotherapy and targeted radiotherapy.
What you can do:
• Quitsmoking
• Ifyouareathighriskorhaveastrongfamily
history, have regular check-ups
• Eatahealthydiet.Adietrichinfruitand
vegetables may offer a protective effect against
lung and other cancers
• Keepfit!Exerciseislikesuperannuation
especially for heart disease and cancers. If
you are unlucky enough to either develop heart
disease or cancer, your cumulative exercise
history will improve your chance of survival.
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Bowel cancer
Your risk of colorectal cancer,
which includes bowel, colon and
rectum cancers, rapidly increases
after the age of 50. Over a lifetime,
one in 20 men in Australia will
develop bowel cancer.
What you can do:
Most bowel cancers develop from tiny growths
called polyps, although not all polyps become
cancerous. Cancer can narrow and block the
bowel and cause bleeding.
• Haveacolonoscopyeveryfiveyearsifyou
have a strong family history of bowel cancer
It is one of the most curable cancers, if detected
early.
Over a lifetime, one in
20 men in Australia will
develop bowel cancer.
The most common symptoms are blood in faeces,
very dark faeces (if blood has been sitting in the
bowel) or a change in the bowels, such as diarrhoea
or constipation, fatigue, weight loss and cramping.
• Haveafaecaloccultbloodtesteverytwo
years after you turn 50. You can buy this at the
chemist and do the test at home.
If you have a family history of bowel cancer,
historyofpolypsorinflammatoryboweldisease,
have this test annually
• Eatwell–apoordietandobesityincreasesthe
risk of cancer. Eat plenty of fruits, vegetables
andfibrewhilelimitingfatsandavoiding
processed meats
• Exerciseregularlytoreduceyourrisksof
developing bowel cancer.
The more exercise the better, but do at least
three 30 minute exercise sessions weekly
• Don’tsmokeordrinkexcessively–smoking
and alcohol are both cancer triggers
• Don’tavoidinvestigatingsymptoms–see
your doctor if you have blood in faeces, very
dark faeces or a change in the bowels such
as diarrhoea, constipation or cramping.
However, in its early stages, bowel cancer often
has no symptoms.
A poor diet and obesity
increases the risk of cancer.
27
Later
Years
These days, with people living
and working longer, being in
your 60s, 70s or even 80s is
no longer the ‘old’ it was once
thought. Many still lead active
lives at this age, despite a few
more wrinkles.
Our trend of living longer shows
that this generation did all the
right things in looking after
themselves, including walking
instead of driving everywhere.
Like anything else worth
having, you can never take your
eye off the ball when it comes
to good health.
28
28
60+
YEAR OLDS
• Stroke
• Prostate cancer
• Respiratory illness
• Depression
• Chronic kidney disease
• Failing eyesight
• Osteoporosis
• Osteoarthritis
• Dementia
29
Later Years
Stroke
Unfortunately, your risk of having a
stroke increases with age. In Australia,
there is about one stroke every 12
minutes, mainly in men over 60 years.
Stroke is a vascular disease that can lead to
severe, long-term disability. A stroke occurs when
a blood vessel to the brain is either blocked by a
clot or bursts, depriving the brain of blood and
oxygen.
Stroke can cause paralysis and can affect vision,
language, balance and thinking. Sometimes there
are no warning signs, as stroke can be a sudden
event.
In Australia, there is
about one stroke every
12 minutes, mainly in
men over 60 years.
What you can do:
Tohelppreventstroke:
• Manageyourbloodpressure–menover65years
with high blood pressure are most at risk, as are
those with heart disease and high cholesterol
The FAST test is an easy way to recognise and
remember the key signs of stroke, and what to do
when they occur.
• Don’tsmoke
It involves three simple questions – and a key action.
• Face–checktheface–hasthemouthdrooped?
• Arms–canbotharmsbelifted?
• Speech–isthespeechslurred?Dothey
understand you?
• Time–iscritical.Ifyouseeanyofthesesigns
call 000 immediately.
• Eatahealthydiet.
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Prostate cancer
Most men diagnosed with prostate
cancer are over 60 years old. However,
men are increasingly being diagnosed
in their 50s and even 40s.
About 4000 men are diagnosed with this disease in
Victoria each year. Two-thirds of these men will not
die from this cancer, as it will not progress enough
to cause harm within their lifetime. However, prostate
cancer can be lethal and presents a challenge to
doctors to find and treat those prostate cancers
that are deadly.
The prostate itself is a walnut sized gland that
sits below the bladder. It secretes fluid to nourish
ejaculated sperm. Most men with early prostate
cancer have no symptoms, but can sometimes need
to urinate often, or feel they have not completely
emptied their bladder.
What you can do:
• Keep your weight down and reduce your
intake of saturated fats
• Eat at least five serves of vegetables each day.
Antioxidants in vegetables may lower your risk
of prostate cancer, especially cooked tomatoes
and broccoli, as well as reducing the incidence
of colon cancer and heart disease
• Consider an annual prostate check. While
population screening is not recommended
for prostate cancer, men over 40 are advised
to discuss their prostate health with their GP
and consider testing
Men with a family history of the disease are
especially encouraged to be tested. Testing
includes a digital rectal exam and a blood test
for PSA (Prostate Specific Antigen).
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Later Years
Respiratory illness
Chronic Obstructive Pulmonary
Disease (COPD) is a serious,
progressive, disabling respiratory
disease attributed to long-term
smoking. It results in a destruction of
lung tissue and narrowing of the air
passages that obstruct oxygen intake,
leading to chronic shortness of breath.
You may know it as emphysema or
chronic bronchitis.
What you can do:
• Stop smoking – 95 per cent of patients with COPD
have this disease after years of smoking
• Exercise regularly – there are physical and
psychological benefits, plus pulmonary
rehabilitation works to reverse any muscle loss
• See your GP for an assessment of respiratory
function
• Get vaccinated - flu and pneumonia can worsen
the symptoms of COPD.
Each day, 1000 people are in hospital as a result
of COPD.
While a serious illness, it can be treated well with
medication, ventilation and rehabilitation.
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Depression
Everybody feels sad and anxious
sometimes. But if you can’t shake it
off, you might be depressed.
More than 1.3 million Australians are treated for
depression each year and that figure is growing,
as people live longer.
It’s important to remember that depression is a
real medical condition. It is a very common, serious
illness that at its most extreme can lead to suicide,
particularly in men aged between 65 and 75 years.
What you can do:
Nobody should feel embarrassed to have
depression.
It is characterised by a prolonged feeling of sadness,
irritability, anxiety and hopelessness. People with
depression may lose their appetite, suffer from
headaches and other pains, and not sleep well.
They might also overeat and put on weight, putting
themselves at risk of obesity, diabetes and heart
disease.
Depression can also cause cognitive changes
including slowed thinking, difficulties with memory
and learning new things, and negative thoughts
about yourself and the future.
Many men hide the fact they have depression, often
using drugs and alcohol unsuccessfully to control
feelings of despair.
Depression is the second most common illness
worldwide in terms of its social and economic impact.
• Talk to trusted friends and family
• Get enough sleep – a lack of sleep affects mood. Most people need at least eight hours of sleep
a night
• Get regular exercise
• Limit the use of alcohol and other drugs
• Complete beyondblue’s ‘depression checklist’
at www.beyondblue.org.au
• Obtain advice and information from organisations
such as beyondblue on 1300 224 636,
Lifeline on 131 114 or SANE on 1800 187 263
• Talk to your GP. You may need to see a counsellor
or a psychologist or may need a trial of
anti-depressants
• Depression that doesn’t improve with medicine
or talking therapies or both may need specialist
medical input from a psychiatrist. There are many
new treatments being developed for severe and
enduring forms of depression. Some of these are
being trialled at The Alfred, such as Transcranial
Magnetic Stimulation (TMS) which uses
electromagnetic pulses.
33
Later Years
Chronic kidney disease
It is estimated that one in three
Australians is at increased risk of
developing Chronic Kidney Disease
(CKD). You are at higher risk of CKD
if you have diabetes, high blood
pressure, smoke, are obese, have a
family history of kidney disease, are
over 60 years or if you are of Aboriginal
or Torres Strait Islander background.
CKD is a long-term health condition that, in many
cases, is potentially preventable. Diabetes and high
blood pressure are overwhelmingly the leading
contributors to kidney disease in Australia.
The main function of the kidneys is to remove waste
products and excess water from the blood. The
kidneys process about 200 litres of blood every day
and produce about two litres of urine. There are no
real warning signs for kidney disease and there is no
absolute cure. The finding of albumin (protein) in the
urine is an indicator of possible CKD and is also a
risk factor for cardiovascular disease.
Very importantly, CKD is associated with a very high
incidence of cardiovascular disease including heart
attacks and strokes.
34
Although measures can help slow progression of
CKD in those patients whose kidneys ultimately fail,
dialysis or transplantation are the only treatment
options. Loss of kidney function may also cause
other problems such as anaemia, high blood
pressure, acidosis (excessive acidity of body fluids)
and bone disease.
What you can do:
• If you have any of these risk factors –
hypertension, diabetes, family history of CKD
or are of an Aboriginal background – see your GP
and have a blood and urine test for CKD
• Don’t smoke
• Check your blood pressure regularly and keep
it under control. High blood pressure is the third
leading cause of kidney disease in Australia
• Exercise – do 30 minutes of exercise five days
a week
• Eat a healthy diet and maintain a healthy weight.
Obesity can lead to diabetes and kidney disease.
Men with a waist circumference of more than
94cm have an increased risk of developing chronic
disease
• Drink plenty of water
• Ensure your blood glucose is well controlled
if you have diabetes as diabetes is the leading
cause of kidney disease.
Failing eyesight
While vision may start failing in the
middle years, major problems with
eyesight tend to occur in the later
years, once people are over 60 years.
laucoma sees the optic nerve at the back of the
G
eye slowly destroyed due to increased pressure
inside the eye. Vision is lost from the periphery first. It is thought that more than 300,000 Australians have
glaucoma and half of them don’t know it, as there
are no noticeable symptoms until side vision starts
to disappear. If not treated early, glaucoma can
lead to blindness. Damage progresses slowly and
the person doesn’t realise they have a problem
until a large amount of nerve fibres are damaged.
Treatment can slow the process so early
detection is vital.
Macular degeneration, where sight is lost from
the centre of the eye, is the leading cause of
blindness in Australia. In its early phases, it leads
to trouble reading, driving and recognising faces.
It becomes more common as people age, with one
person in three over 80 having age-related macular
degeneration. It is linked to smoking, family history
and poor diet, but good treatments are available.
It is thought that more
than 300,000 Australians
have glaucoma and half
of them don’t know it.
What you can do:
• See an optometrist or ophthalmologist for an eye
test if you have a family history of glaucoma or are
over 50, as there are few early symptoms for this
condition
• Don’t ignore blurred or distorted vision – have your
eyes checked regularly
• Quit smoking – smoking triples your risk of eye
conditions such as glaucoma
• Eat a healthy diet, which includes fruit and leafy
green and yellow vegetables and fish, limited fats
and oils, and eat a handful of nuts weekly
• Look after your eyes in the sunlight. Wear dark
glasses or a hat in the sun and at the snow.
A cataract is when the lens of the eye becomes
cloudy. People experience blurred vision and glare
or light sensitivity. Cataracts are very common in
people aged over 70 years and are often part of
ageing. Damage from sustained sunlight can often
be the cause of cataracts, especially in those who
have spent years working outdoors without using
sunglasses. The condition is treated with surgery.
Surgeons replace the cloudy lens with a clear,
plastic lens.
35
Later Years
Osteoporosis
Musculoskeletal conditions,
which include osteoporosis and
osteoarthritis, are a national health
priority due to the huge burden
of disease (in terms of cost and
disability) these conditions involve.
Every five minutes somebody in Australia is admitted
to hospital with a fracture due to osteoporosis. While
osteoporosis tends to be thought of as a problem
affecting women, it’s actually very common for men
to have thin, brittle bones too.
One in three men over 60 years will fracture a bone
due to osteoporosis and men have high mortality
rates due to this condition, particularly following hip
fractures.
Often people do not realise they have osteoporosis
until they have a fracture – most commonly in the
hip, wrist or spine. After our 30s, bones slowly start to
One in three men
over 60 years will
fracture a bone due
to osteoporosis.
lose density or strength. Osteoporosis occurs when
bones lose minerals, such as calcium, more quickly
than the body can replace them. As a result, bones
become thinner and more fragile so even a minor
bump can cause a serious fracture. We all lose
calcium every day through our skin and nails, sweat
and urine.
36
If you have a fracture after a low level trauma, such
as a stumble, you should be concerned about your
bones. Bone density can be measured with a DXA
(Dual-energy X-ray Absorptiometry) scan.
Osteoporosis needs to be treated early.
Fractures can lead to stooping, muscle weakness,
deformity of the spine and chronic pain. The big risk
factors are: alcohol, which limits your absorption of
calcium, long-term smoking and vitamin D deficiency.
Concern about skin cancer has seen a shift to people
being anti-sun, even in winter. As a result, many
Australians are now deficient in vitamin D. Indoor
lifestyles have also led to poor vitamin D levels. To
ensure our bones are strengthened through sunlight,
we all need some sun on our skin.
What you can do:
• Quit smoking, limit alcohol and caffeine
• Exercise – walking is great for bone health
Exercise increases muscle strength, balance
and co-ordination helping to prevent falls
• Soak up some sun – but avoid sunburn by
staying out of the sun when the UV levels are
high, usually 10am-2pm
• Find out more about falls prevention. Simple
strategies can help you avoid falls, which are
the main reason people fracture their hips
• Concentrate on calcium. Up to 51 years, eat
at least two serves of calcium-rich foods (or
1000mg) a day and over 70 years, 1300 mg
of calcium is recommended. Milk, yoghurt
and most cheeses are high in calcium.
After our 30s,
bones slowly start to lose
density or strength.
37
Later Years
Osteoarthritis
The most common joint disorder,
osteoarthritis (OA) is due to loss of
cartilage over the years. The cartilage
in your joints cushions the bones but
when that cartilage breaks down and
wears away, the bones rub together
causing pain and stiffness.
OA mainly affects people over the age of 45, but
it can develop in younger people. By the age
of 70 almost everyone has some symptoms of
osteoarthritis. Current trends suggest that by 2050,
seven million Australians will suffer from some
form of arthritis. While it cannot be cured or the
progression slowed, symptoms can be controlled
with medication.
The hands and feet are most commonly affected
and symptoms are usually worse after resting or not
moving the joints for a while. Although you might
want to avoid high impact activities like jogging, the
generaladviceis:stayactive–exerciseincreases
yourflexibilityandbonestrengthandpromotes
general movement. However, don’t overuse a joint
that is painful.
Obesity is a major risk factor for osteoarthritis and
fat around the abdomen puts men at particular risk.
This is due to the load on the joints and metabolic
reasons. Maintaining a health weight reduces
your risk.
Other risk factors include joint wear and tear and joint
injury. If your job involves kneeling or squatting for
more than an hour a day, you’re at risk of developing
OA. Direct impact on the joint, such as with jogging,
also put you at increased risk. Joints are prone
to injury when you do sudden bouts of infrequent
exercise, so keep your muscles strong and joints
protected with regular exercise.
What you can do:
• Watchyourweight–decreaseextrabellyfat
• Stayactive–activitiessuchasswimmingand
Tai Chi are particularly good
• Protectyourjoints–avoidlongperiodsofkneeling
or squatting and irregular high impact exercise.
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Dementia
More than 250,000 Australians
currently live with dementia and that
figure is expected to soar to almost
one million by 2050 unless there is
a medical breakthrough.
One in four people over the age of 85 have
dementia; it is the third leading cause of death in
Australia after heart disease and stroke and is the
biggest cause of disability in Australians over
65 years.
Dementia refers to a group of illnesses that cause
a progressive decline in brain function and affects
thinking, behaviour and memory, disrupting everyday
tasks. Alzheimer’s Disease is the most common
cause of dementia and accounts for 50 to 70 per
cent of all cases. Most cases are not inherited.
The condition sees abnormal material building up
inside brain cells and ‘plaques’ developing outside
brain cells, disrupting messages within the brain.
These changes lead to the death of brain cells and
significantlyaffectmemory–firstshort-termmemory
and progressively, long-term memory. Other brain
functions are also affected as the disease worsens,
leadingtocompletedependenceandfinally
death from complications of the disease, such as
pneumonia.
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While people can have dementia in their 40s, it is
more likely to occur after 65.
Early signs include frequent memory loss, confusion,
personality change and apathy. Symptoms vary from
person to person, as does the progression of the
disease.
Dementia is the third
leading cause of death
in Australia after heart
disease and stroke.
The cause of dementia is not fully known. Numerous
research studies are looking for cause and effective
treatment.
What you can do:
• Seekearlydiagnosis–someconditionshave
similar symptoms to dementia, including hormone
disorders, depression, overmedication and
infections. A full assessment can be carried out
by Cognitive Dementia and Memory Service
(CDAMS) clinics
• Whilethereisnopreventionorcurefordementia,
there are some medications that reduce
symptoms, so ensure you see your doctor early
for diagnosis and for tips on how to manage the
condition
• Seekmoreinformation–Alzheimer’sAustralia
runs a National Dementia Helpline.
Call 1800 100 500.
39
All
Ages
40
Coronary heart disease
Heart disease does not distinguish
according to age and is the biggest
killer of Australians aged between 25
and 64 years, and leading cause of
hospitalisation for those over 65.
The build up of fats, cholesterol and other
substances in the heart’s arteries leads to
cardiovascular disease. Blood vessel linings
are usually smooth and durable but when scar
and cholesterol tissue are deposited, the walls
are weakened. This can cause cracks in the
lining, which attract blood clots.
If you are over 50, have
your cholesterol checked.
If blood supply to the heart is severely reduced
the patient may have a heart attack.
While it’s more common for men in their 50s and
older to develop heart disease, you should start
caring for your body early to ensure you are in the
best possible shape and to avoid risk factors such
as high blood pressure, high cholesterol, poor diet
or a life of inactivity.
You’re at high risk of cardiovascular disease if you
are over 35 years, smoke, are physically inactive,
have diabetes, depression or a family history of heart
disease. Warning signs include chest pains while
at rest or during exercise, breathlessness and a
general feeling of being unwell.
But sometimes there are no warnings at all.
Heart disease does
not distinguish
according to age.
What you can do:
• Visit your GP regularly to ensure any risk factors
are known and well controlled
• Have your blood pressure checked every two
years if it is normal. Have it checked at least every
year if it is borderline high. It needs to be checked
more regularly if you have high blood pressure
• If you are over 50, have your cholesterol checked.
Those with a family history of heart disease should
be checked in their 20s. A total cholesterol level
of 5.5 or more is considered high in those with a
family history of heart disease. If it is high, change
your diet and check cholesterol levels regularly
• Quit smoking
• Exercise regularly – 30 minutes of moderate
activity on most, if not all, days
• Weigh yourself regularly, eat plenty
of fruit and vegetables, avoid foods high
in saturated fats and limit your intake
of alcohol and salt
• Regularly eat fish and other sources of foods that
are high in Omega-3 fatty acids
• Relax – stress can cause a hardening of the
arteries, blocking blood vessels.
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Acknowledgements
This publication was produced with the help of Alfred hospital staff:
• Professor Peter Cameron, Director Research, Emergency & Trauma Centre
• Professor Flavia Cicuttini, Head Rheumatology
• Professor Tony Dart, Director, Cardiovascular Medicine
• Professor Christopher Fairley, Director Melbourne Sexual Health Centre
• Dr Judith Frayne, Senior Neurologist
• Professor Russell Gruen, Director National Trauma Research Institute
• Mr Jeremy Grummet, Urologist
• Associate Professor Anthony Hall, Head, Ophthalmology
• Dr Andrew Haydon, Medical Oncologist
• Dr John Kelly, Head, Victorian Melanoma Service, The Alfred
•Associate Professor Jeremy Millar, Director William Buckland
Radiotherapy Centre
• Professor Matthew Naughton, Head General Respiratory & Sleep
• Associate Professor Harvey Newnham, Director General Medicine
• Associate Professor Peter Royce, Director Urology
• Dr De Villiers Smit, Director Emergency & Trauma Centre
• Associate Professor Simon Stafrace, Director Alfred Psychiatry
• Professor Elsdon Storey, Director Neurology
• Professor Rowan Walker, Director Renal Medicine
• Associate Professor David Williams, Senior Neurologist
• Ms Heather Thomas, Public Affairs
Thanks also to CHE Proximity for assistance in the production of this publication.
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Sponsors
A special thanks to
Produced by Public Affairs & The Alfred Foundation
Phone: 03 9076 3222 Fax: 03 9076 2775
Email: [email protected] alfred.org.au
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