Life's Booming
Frequently asked questions with Dr Sam Hay, Dr Simon Grof & Dr Mohammad Jomaa
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Episode notes
Embarrassed about asking your doctor something? We’re doing it for you. Our experts are going to answer some of those concerns you might have that are a bit quirky, less dinner chat, more private google search type questions. Our expert doctors are getting the stigma out of the way and getting you on your way to a healthier life.
About the episode – brought to you by Australian Seniors.
Join James Valentine as he explores the incredible stories of Aussie characters, from the adventurous to the love-struck. Across 30 inspirational episodes, Life’s Booming explores life, health, love, travel, and everything in-between
Our bodies surprise us in ways we never thought possible as we age, so in series five of the Life’s Booming podcast – Is This Normal? – we’re settling in for honest chats with famous guests and noted experts about the ways our bodies behave as they age, discussing the issues and awkward questions you may be too embarrassed to ask yourself.
This episode, we hear from Sydney GP Dr Sam Hay. Also known as Dr Kiis, Sam is director of the Your Doctors network, health expert for Kidspot, and was host of Embarrassing Bodies Down Under and Amazing Medical Stories.
You'll also hear from geriatrician Dr Simon Grof, who has been a consultant geriatrician at Victoria’s Eastern Health since 2014, and is Chief Medical Officer at Jewish Care Victoria, who talks through some questions of ageing in later life.
And Dr Mohammad Jomaa is a Sport and Exercise Physician, who has a special interest in sports-related injuries and their management, and shares his advice on mobility and healthy exercise for over 50s, to maintain longevity.
If you have any thoughts or questions and want to share your story to Life’s Booming, send us a voice note - [email protected].
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For more information visit seniors.com.au/podcast.
Produced by Medium Rare Content Agency, in conjunction with Ampel Sonic Experience Agency
Transcript:
James Valentine: Hello and welcome to Life's Booming, series five of this most excellent and award winning podcast. I'm James Valentine and in this series we're going to ask the question, is this normal? I mean, as we age, stuff happens to us. Our bodies change, things fall off, we get crook, stuff doesn't work as well as it used to.
There's nothing we can do about it, we're getting older, we're ageing. But which bits are normal? Which bits do we have no control over? Which bits can we do something about? That's the kind of questions that we're going to be asking in this series, Is This Normal? of Life's Booming. Now, of course, if you enjoy this series, leave us a review. Tell all your families and friends about it.
And we want to hear from you as well. You can contribute to this. If you've got questions about things in particular that you want to know, perhaps there's some particular wear and tear happening to you, let us know. We'd love to see if we can answer that question in the series.
We're going to look at things like menopause, gut health, mental health, lots of other burning questions. So think about those areas and if there's something in there that's specific to you that you'd like us to cover, let us know.
On this episode of Life's Booming, we're tackling your frequently asked questions. Embarrassed about asking your doctor something? Today, we're going to do it for you. Our experts are going to answer some of those concerns you might have that are a bit quirky, a little bit less, “I can talk to my friends about this or at a dinner party”.
It's more, I've got to get on Google and search this up on my own. Whether their patients voice them or not, together with our doctors, we're getting the stigma out of the way and we're getting you on your way to a healthier life. Some of you have sent in voice notes to ask us questions. Terrific, thank you so much.
If you want to ask a question, you can visit the website or the link in the show notes and share a voice question. We're going to be chatting to Sydney GP, who's known as Dr Kiis, from army veteran to hit morning radio and director of the Your Doctors network: this is Dr Sam Hay. And you'll also hear from geriatrician Dr Simon Grof as well, and we'll talk about some questions of ageing in later life with him.
But first up, let's meet Sam. Sam, nice to meet you.
Sam Hay: Yeah, you too. How are you?
James Valentine: Yeah, very, very well. I suppose I'm thinking that the relationship with the GP changes as you age. You know, and unfortunately perhaps you start to get to know them really quite well. You see them a lot.
Sam Hay: Absolutely, I think for younger people, they don't fully understand what the worth of a good GP is to them. And then as people drift through their middle years, they certainly start to have more of a relationship.
James Valentine: So let's say post 50, what are the kind of things you'd recommend that we, that I should be coming to see the doctor, once a year, once every couple of years?
Sam Hay: I think there are some people out there who truly are looking after their health very, very well. They have no problems. They're very lean. They exercise a lot. They eat a great diet. They don't smoke. And they have literally nothing going on. And then they come and get a check-up and we literally find nothing.
So those people, sure, they probably can go a couple of years between visits to the doctor. But in general, over the age of 50, I like to see patients every single year for a check-up because we want to pick up very early the major risk factors for the big things that are going to cause problems down the track, and those big ones are heart attacks, strokes and diabetes.
James Valentine: And what do you pick up? What are you looking for?
Sam Hay: Well, we want to do a general check-up. And in that we're looking at blood pressure, weight, waist, from an examination perspective. Then we want to check the history, how are they going, how much exercise are they doing, what's their smoking, what's their general diet like, what are their stress levels, so where does mental health potentially fit into that.
Pretty much all the time we'll do a set of blood tests, and once again, doing a general screen, but trying to pick up the big risk factors that come in, cholesterol, diabetes, a couple of other simple things. And then the major cancers that we need to be screening for. So your major community ones are going to be bowel cancer, cervical cancer, breast cancer, having a conversation with the doctor about prostate cancer screening.
But then the last bit overall is we're going to look at somebody's family history. So what have they got in the family that might be putting them at more risk and does it influence all of those things? And do I have to do any other tests?
James Valentine: We've also, you know, again, I'd say if you're 50 and over, you've grown up with the notion you only see the doctor when you're sick.
Sam Hay: Correct. And so it's people understanding that check-up is important. Even if the last three check-ups have been completely normal and fine, what we're trying to do is we're trying to pick up your cholesterol or your diabetes or your blood pressure or something else before it falls off a cliff.
James Valentine: Yeah. This would make such a difference to you, wouldn't it, Simon, if we were all doing this in our 50s and 60s?
Simon Grof: Oh, absolutely. And I must reinforce that having a good GP is just the number one thing, I think. And we see that in hospitals all the time where some of our older people have not seen a GP for 40, 50 years; there's no-one regular, and just to have that touch point to call the GP who has that relationship and to get some of that background story is just so, so, so crucial. So, couldn't agree more.
James Valentine: Let's look at a few frequently asked questions. Do you see many 85-year-olds still smoking, Simon? Does anyone turn up? They're out for a sneaky… [inhales].
Simon Grof: People do smoke. Strangely enough, I had a virtual consultation the other day and I logged on. An 89-year-old lady, once again widowed, and she had the whole time during the hour-long consultation, and she kept on apologising saying, “I'm sorry it's a habit I can't give up.”
James Valentine: And what are you seeing in smoking habits, because we are into a generation that have largely given up, you know, at 50 or 60 or so.
Sam Hay: I've definitely seen a drop-off in cigarette smoking and an increase in vaping and a complete misunderstanding about the risks of vaping.
James Valentine: And what's being misunderstood?
Sam Hay: What I find fascinating is, what was it, 50 or 60 years ago, the government was endorsing cigarettes across the world. And then they realised, hang on a minute, these cause disease. And so that, all the governments had a massive flip.
And the community struggles to understand why the government won't endorse these things. Because we don't know the risks. And one of the biggest risks are that we don't really know what these chemicals do when they're vaporised and you inhale them.
The second thing is, the majority of vapes that people are using come from underneath the counter, which means they're being produced in factories where you just don't know the chemicals that are in there. So yes, some of the vapes you can get from pharmacies, etc., are going to be more reliable and therefore, for want of a better word, safer, but it's all these other ones that we don't know about.
And we are seeing injuries, there are people going to hospital, there are people dying, it's in the media. So it fascinates me that people are still seeking it out.
James Valentine: Yeah. I genuinely believe that anything positive that's being said about vaping is tobacco industry propaganda. But people do say, well, at least it's a way to get off smoking cigarettes.
Sam Hay: So this, I think, is the challenging thing because there does seem to be a place for vaping in a harm minimisation program for people who are smoking. So for getting people off the smokes because in vape products that you can get through pharmacies, we have much more reliability about what's in them.
We do understand that they seem to be much safer than smoking. So using them in a quit smoking regime, it's generally accepted that they are valuable and useful. For non smokers to take up vaping, still not recommended whatsoever.
James Valentine: Vision. Is this something that you see a lot of that you have to deal with? People start to get cataracts. They start to have eye conditions that they didn't experience before?
Simon Grof: Yeah, we do. And as we get older, there are a lot of age related visual disturbances and vision is so crucial.
A story that I can think of, I had a patient of mine who just kept on falling and would present to hospital, would get to the emergency department. There wouldn't be any broken bones, they'd check out the sensation and his power in his body and then send back home. And by the third or fourth time, someone said, let's just give this person a little bit more time in hospital.
So it ends up being on my ward and my very astute junior register actually had a look in his eyes. No-one had actually got an ophthalmoscope before and had macular degeneration and off to get some treatments and was, you know, not having any further falls. So I think we sometimes don't think about it.
We want to find sometimes the more complex things in medicine, but sometimes it's just taking a step back, being thorough, as what geriatricians and what GPs do, and just making sure you're asking the right questions.
James Valentine: At some point, do you look at people and go, well, this can't be ageing. At another point, a few years down the track, you go, well, this is ageing.
Sam Hay: And it's not as simple as that because I think people are maintaining their general health and their fitness for longer. And I think this whole concept of when do you suddenly become old and when do you suddenly start becoming affected by all these old age diseases? It certainly is shifting.
I don't tend to look at patients as an age, and therefore this is an age related thing. I tell you, I go, you've got arthritis, you've got a heart problem, you've got a kidney problem, whatever it might be. And just keep it as simple as that.
James Valentine: Yeah, yeah. And I suppose, is there a bit of a trap for the geriatrician as well, Simon? It may not be ageing, it might be something else.
Simon Grof: Yeah, that's absolutely correct. And when in the hospital setting, when my junior doctors are describing and telling me about everyone new that's being admitted to the ward, the age for me is somewhat irrelevant. It's more about their social history, what they're able to do on a day to day basis, where they live, what they can get up to. And it's usually the family that are the worriers still managing their tablets.
As we do age, we do have more comorbidities and their ailments, such as some heart problems, some problems with the breathing, problems with the bladders and bowels. And when you were younger, that didn't seem to bother people too much, but with the accumulation of these, it can be quite difficult to manage as we get older, and I suppose there's a very small threshold.
Whereas, if you were to get a urinary tract infection, that is an infection in the bladder, that can sometimes contribute to problems with peeing, urine to be retained in the body, or it can cause you to go a bit more frequently as we get older. Potentially, a small thing like that can actually have a wide range of issues and complications, and sometimes something like a urinary tract infection, can actually go on and lead to a sudden memory and thinking problems.
And we see that quite commonly, whereas people and older people present to the hospital setting with a urinary tract infection with other things that might be seen as minimal, and they've got a condition that's called a delirium, which is really a sudden change in their memory and thinking with their orientation, with their ability to focus. And that could be quite stressful for both them and for family members, because these things can come on quite suddenly.
James Valentine: Over the last few years, we've learned so much about vaccines. You know, it's been such a constant topic of conversation. And it's made, vaccines became age-related, didn't they? Through, during COVID-19, there were various vaccines. Well, you better go and have your boost if you're over 65, and we're going to make that available to you.
Well, now you can get your retrovirals if you're over that age, and you know, you better get in and get those. Take me through vaccines for sort of 60-plus. What are you seeing? What can people get?
Sam Hay: I think the general population doesn't fully understand the burden that influenza has. It is a big risk to kids under five and to the elderly bubble of people.
There's no magic age group, but we've kind of delineated it at about the age of 65. It's really any adult with any chronic health condition is going to be at high risk from influenza. I am a major advocate for getting your annual flu shot. We need it every year because protection starts to drop off quickly and it's a virus that changes, mutates, so therefore we've got to try and keep up with that, with our updated shots.
As we age we get a higher risk of lung conditions and lung infections, you know, pneumonia. And so there's one or two vaccines out there against pneumonia, which are incredibly effective at reducing the number of people that are going to end up in hospital with Simon.
James Valentine: COVID? What's the current thinking on COVID-19?
Sam Hay: So people should be up-to-date with their boosters. And this is a conversation to have with your doctor. It really is, to determine what your risk is. So I think people could be up to about their sixth shot if they sort of kept on getting them. But if we go back to the guidelines, they're really saying we only need, from the guideline perspective, three to four shots, definitely. And people could have access to those extra ones. So that's as of the beginning of 2024.
I look at it somewhere in the middle, in that if people have a cluster of medical issues that are going to increase their risk, then they should consider those regular vaccines. If they're looking after people who are at risk, perhaps more boosters. If you're going travelling or into high risk environments, then you may want to consider it.
James Valentine: And what do you see in aged care and among your patients? Are they keen to still get vaccines or they go, ah!
Simon Grof: COVID in residential aged care now is still a huge issue and I'm trying to promote vaccines to the older people and their families as well, but you have a lot of people who never took it up to start off with.
So you're not going to convince them now, but the people in the middle, the target audience take up these boosters, which are better. Because they do attract and they target against the newer type of variants of COVID. It's more to stop the seriousness of the actual infection and then stopping them presenting to hospitals.
So I think in a residential aged care environment, we're still pushing it, which is at odds with what's happening in the community.
James Valentine: At what age am I too young to go and see the geriatrician?
Simon Grof: That's a really good question and that's a question we get asked quite commonly. Essentially a geriatrician is a doctor with specialist training and caring for the health of older people.
The term is, I suppose, geriatric medicine. And geriatricians like myself diagnose and treat age-related medical conditions. And the age usually is above 65. But you know what? Really, is it above 65? Most of the people on my ward, or I see in residential aged care, are 85 and above. So, is 85 the new 65? I don't know.
James Valentine: Oh, let's not put it that way around. That seems wrong! But there must be many a condition that would have been better off if we were starting to deal with it in our 60s.
Simon Grof: Absolutely. Similar to the heart where, you know, they say middle age is when you really need to up your game and, you know, continue the consistency with the exercise, continue the consistency with eating well, not smoking, alcohol, all the things we hear about.
It's similar for the body, similar for the brain, similar for everything into old age as well. So the sooner we can start and the sooner we can look after things, the better it is. And you know, we might be living to 150 soon, who knows.
James Valentine: All right, let's talk about mobility and exercise and bring in sports physician, Dr Mohammad Jomaa, UK educated and now in Sydney, where he's practising as a sports physician. Thanks so much.
Mohammad Jomaa: Thanks, James. It's been a real pleasure to jump on and speak to you today.
James Valentine: So what's your general advice for exercise for over 50s?
Mohammad Jomaa: Exercising safely is paramount. It usually is injuries and complications, which stops people from exercising at all in the first place.
So we need to use exercise as a means to reduce the risk of our injuries, as opposed to increase the risk of injury through exercise. Doing nothing is bad for us, but we also know that doing too much is bad for us. And so where's the sweet spot? Finding that is all about figuring out where your current function is and very cautiously and gradually increasing from there, giving you enough time to recover and get stronger so that you can keep building and building.
James Valentine: So do you have a recommended exercise regime for perhaps, you know, 50-plus?
Mohammad Jomaa: Everyone has a different starting point. Everyone has a different goal. And so exercise prescription is always very nuanced. It's very tailored. It's a science as well as an art. So any good exercise program needs to have cardiovascular exercise, strength training, and stability training. And I'll talk a little bit about each one of those.
Cardiovascular exercise, which is our aerobic exercise, is the mainstay and no matter what our age is, it's very trainable. The bad news is that if we don't maintain it, it will typically decline by about 10 to 15 percent per decade. So about one or one-and-a-half percent per year.
And that can really add up and it can affect the way that we live and the things that we can do as we get older as well. Absolutely everyone should be doing about 30 minutes every single day of what we call zone two exercise. The Australian guidelines call it moderate exercise. Essentially, it's a bit hard work, but if you were pressed, with some discomfort, you could talk in full sentences.
And that's the best way to measure that you're in that zone two range. This is essentially our general maintenance, it helps with chronic diseases, and there's lots of evidence that shows that it supports in the management of metabolic diseases like diabetes, cardiovascular disease, reduces our risks of stroke.
It actually improves and reduces the risk of cognitive decline and Alzheimer's disease as well. Strength training is really essential to do maybe two or three times per week. Usually we encourage compound resistance, which means hard work, heavy loads lifted or moved around. And this has to be done safely, and so it's always important to have this tailored for you.
One of the most common exercises that I prescribe for patients over 50 is that I get them starting to push and pull a sled; we'll find a gym with a sled track. Typically we'll start with around a quarter of the patient's body weight on the sled, and we'll just have them two or three times a week pushing and pulling that sled for 20 minutes.
And it can be really hard work but it also is a very comprehensive exercise as well. And it's really safe. You can imagine if you're trying to pick up something really heavy or carry something really heavy on your back, there's a higher risk of injuring yourself than if you're trying to push something over and you just can't, or pull it over and you just can't. So there's some safety there to that as well.
And then, yeah, finally something that's so important, especially as we get older, is stability exercise. So, stability exercises, the best way to get involved with those are to just join a local tai chi or yoga or pilates or any other mat-based mobility exercise program local to you.
With patients who aren't inclined to do that, I talk them through specific balance exercises they can do, standing on one leg, standing on a pillow to make it a little bit harder, and we introduce some movement and instability with that as well. The reason stability is so, so important, and mobility, which is a factor of that as well, is that it's essentially our insurance as we get older. Really major cause of patients coming into hospital and it can be a life-changing event. So it's something to really, really be avoided. And so stability exercises are really important as an insurance against that.
James Valentine: So what about heart health? What's good exercise there?
Mohammad Jomaa: One thing that we're quite well aware of, and this is a great thing for the heart, maybe not so much for our muscles and bones, the heart is always trainable.
We can improve our cardiac output, we can improve our VO2 max, which the heart contributes to quite a lot. And that's our ability to consume oxygen and our level of maximal output. When it comes to just general age and ageing, then the main issue with the heart is the development of atherosclerosis, which is the name of the gradual hardening of the arteries in our whole body, but importantly the ones that lead to our heart as well.
If you're the sort of person who develops heaviness and tightness in the chest with physical exertion, with exercise, then that's something that definitely needs to be checked out as well. And that's something that your sports doctor will ask you about. Exercise is so incredibly good for us that it's better than any medical intervention really that we can do. There's a lot of evidence that shows that exercise and our underlying fitness are the primary definers of how long we live and how we live towards the end of our days as well.
And so you absolutely have to make it a part of your life as best as you can. Seek help from a sports physician or an exercise physiologist to get you going.
Even the smallest amount of exercise for someone who doesn't have an exercise baseline will have huge benefit as well. So if you're someone who's just completely sedentary, there's lots of studies that show anywhere between an hour to 90 minutes of just walking per week, which is, you know, 15 minutes a day, can massively improve your health factors and improve the quality of your life in the medium to long term.
So get exercising and stay healthy.
James Valentine: That's very good. I'm thinking, you know, 50-plus, have an excellent 50th birthday. Have a great time. For your 51st birthday, go get a check-up. and start doing an annual check-up after that. Then you're well ahead of the curve, right?
Sam Hay: Yes, but can we bring it forward to the 50th birthday?
James Valentine: You want it on the 50th?
Sam Hay: Yeah, don't wait till the 51st!
James Valentine: Let me have the party, you know, then after that I'll go, you know.
Sam Hay: Wait a couple of weeks if you have to, then come in.
James Valentine: Okay, straight after that. All right, but through your 50s start, start the check-ups. And then with geriatrics, Don't be frightened of it.
Simon Grof: We're nice people. We like a conversation. We'll spend time with you, or unfortunately sometimes your GPs can't, and we'll have a plan and we'll work that plan out together. You know, you're not going to be put in a home just because you see one of us. I promise you that.
Sam Hay: I've started to explain why I refer people off to specialists in a different manner nowadays.Because some people feel that they're going to see a geriatrician or a knee doctor to get a diagnosis of dementia or to get a knee replacement. Whereas what we're going for is we're going for an opinion. We're going for an assessment. We're going for what do they feel is the problem and what are the potential management or follow-up options?
The patient then decides what they want to do. That's where we need to think of using our specialist more and be freer in just going and getting their opinion and then look at what the management might be down the track.
And that's where I use geriatricians for that advice and education and that baseline.
James Valentine: Well thanks to all our experts today, to Sam, to Simon and Mohammad for getting us into the frequently asked and sometimes, you know, a little bit uncomfortable questions. Let us know if any of our doctors today gave you the golden solution to your health's concern.
Or did you find out something you didn't even know that you needed to know? We'd love to hear from you. You've been listening to Season 5 of Life's Booming: Is This normal? Brought to you by Australian Seniors.
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