Health Check Magazine Special Winter Edition: Modern Medicine 2024

hea th magazine

Modern Medicine

MEDICINAL CANNABIS AND ITS POTENTIAL TO IMPROVE QUALITY OF LIFE

AUSTRALIAN HEALTHCARE INNOVATIONS THAT HAVE CHANGED LIVES FOR THE BETTER THE MYSTERY OF THE PLACEBO EFFECT

SUPPLEMENTS: EFFECTIVE AND SAFE TO USE?

Welcome to an enlightening edition where we explore the marvels of modern medicine. As we navigate the intricate landscape of health and wellness, we're reminded of the privilege we hold in Australia, including access to cuttingedge medical advancements that shape our lives for the better. Turn to page 8 to read about six Australian healthcare innovations that have changed lives for the better, all around the world. On page 23, we delve into the realm of medicinal

and its potential to alleviate symptoms

and improve quality of life. We explore the mysteries of the placebo effect and its profound implications on healthcare outcomes (page 14) and equip you with evidence-based knowledge on supplement usage, ensuring you make informed choices to support your wellbeing (page 16). And as we confront the challenges of chronic illness, we provide some strategies for effective management (page 27). Here's to embracing the wonders of modern medicine and the gift of good health.

Ask

a Pharmacist

HOW DO OUR DISPENSARIES WORK?

OUR PHARMACISTS DO MUCH MORE THAN FILLING PRESCRIPTIONS, BUT IT’S ALWAYS WITH TWO KEY GOALS IN MIND: DELIVERING HEALTHCARE TO OUR COMMUNITIES, AND IMPROVING PEOPLE’S QUALITY OF LIFE.

by Aurelia Captari

Blooms The Chemist has more than 2,000 team members working across more than 118 stores across Australia – with each one supporting a unique community.

A typical day for one of our Pharmacists can vary enormously. A key part of their day is filling prescriptions, advising patients about their medications, and talking to customers about over-the-counter products, too. But we might also be looking after patients in a residential aged-care facility; providing immunisations ; delivering health checks (such as cholesterol screening and sleep apnoea testing); and managing the retail aspects of the store.

Pharmacists usually prepare for the day ahead by checking stock levels, organising patient profiles and prescriptions from previous days, processing claims, and preparing the consulting room.

“The average Pharmacist knows more about medications and how they affect your body than the average doctor.” – Open Universities Australia1

Managing medications

When we receive a prescription, we may need to check the patient’s medication history (either because we have it on file, or by talking to them or their prescriber). This helps us to ensure the right dose for them, and the best way of taking the medicine – for example, as a tablet or liquid. We can also check that a new medicine won’t interfere with their existing medication.

We manage and maintain all kinds of equipment for ordering, storing, preparing, labelling, and packing liquid medicines, ointments, powders, tablets, and more.

Key to the Pharmacist’s role can be checking whether patients understand their medication and how to use it, especially if they’re vulnerable in some way – for example, if they’re elderly, ill, living alone, or forgetful. We try to make sure they know how and when to take their medicine. We want them to know about any possible side effects, and which ones mean they should stop taking their medication immediately. We like to check whether their medication is actually doing for them what it’s supposed to. We may also advise prescribers, such as doctors and nurse prescribers, on whether certain drugs can be taken together, and whether individual patients shouldn’t take a particular drug. This might be because of any side effects or allergies, and any underlying health conditions.

Beyond prescription medicine

Talking to our customers regularly, and understanding how their needs change over time, is what truly makes us community pharmacies. So besides dispensing medication, we also support customers by providing a wide range of additional products and advice on how they can support better health. This includes:

• Over-the-counter medication – for common ailments and minor injuries (where no prescription is needed)

• Test kits and equipment – such as thermometers, blood pressure monitor cuffs, glucose strips, ovulation tests, and sleep apnoea tests

• Therapeutic aids – like nebulisers and air purifiers

• Mobility aids – such as walking sticks and shower stools

• Supports and protectors – such as compression hose, slings, splints, neck collars, cushions, and air boots

• Vitamins and supplements – helping you feel, sleep, and move better

• Medication aids – such as tablet organisers and pill crushers.

Change is a constant

There’s a national focus on more patient-centred care, with more privacy for consultations and improved accessibility and inclusivity (such wheelchair-friendly layouts and multilingual signage).

Roles have changed, too. For example, pharmacy technicians have moved from assisting Pharmacists to taking responsibility for mixing and packing medications, educating patients about their prescriptions, processing insurance claims, and much more. They are integral members of our pharmacy teams, helping to ensure safe medication management and complete patient care.

Pharmacies must constantly update their practices as regulations continue to change, and react to new drugs emerging onto the market. This means continually staying abreast of what’s going on.

For example, in 2023 The Australian Government introduced 60-day prescriptions, so Australians can now access twice the amount of their Pharmaceutical Benefits Scheme medicines on a single prescription. As a result, it may now be up to a year before patients need a new prescription.2 This means pharmacies may see their customers less often, so we're encouraging customers with high pharmacy needs to continue popping in for advice or medication reviews as needed. Our community pharmacies care for generation after generation of the same families, and often get to know their customers well. The support we offer extends far beyond filling prescriptions.

Careers in pharmacy

Pharmacy is a rewarding job with a career for life. Work settings can also include hospitals, GP clinics, aged-care facilities, research environments, the defence force, and more. And Pharmacists are in demand: the number of job vacancies is expected to grow by 9% by 2026.1

To become a Pharmacist typically means at least four years studying pharmacy at university, or up to three years completing a graduate entry program (if you already have a different degree). There’s a year-long intern training program, and an exam to enable you to be registered as a Pharmacist.

While each of our Pharmacists are as unique as the communities they serve, they all have a passion for helping people achieve their best possible health outcomes.

Did you know… 3

• There are over 36,000 Pharmacists in Australia

• About two thirds of them are women

• More than half are aged under 40

• Community pharmacies are the most frequently visited health destination

• There are over 5,900 community pharmacies in Australia

• 2,127 of them are open after hours, including weekends

• On average, each Aussie visits a community pharmacy 18 times a year

• Community pharmacies dispense over 225 million prescriptions a year

• Pharmacists are one of the most trusted professions, along with nurses and doctors.

1What's life as a pharmacist like?: https://www.open.edu.au/advice/insights/whats-lifeas-a-pharmacist-like 2Cheaper medicines: https://www.health.gov.au/cheaper-medicines 3Pharmacy facts: https://www.findapharmacy.com.au/pharmacy-facts

Pharmacist focus

Melanise Moses BLOOMS THE CHEMIST BAKEWELL NT

How long have you been a Pharmacist with the Blooms The Chemist network?

I've been a Pharmacist for 13 years, and I've been part of the Blooms The Chemist network for almost my entire career.

What made you want to be a Pharmacist?

I love the mix of health and business. I was inspired when I was younger by a local Pharmacist in my hometown, called Tony. I did a placement (an unpaid internship) at his store when I was 16 and I loved the trust and rapport he built with customers and seeing how his knowledge helped them.

What is the most important thing you've learned as a Pharmacist?

Attention to detail. It’s the little things that people remember whether they’re coming in for the first or the hundredth time.

How do you relax or spend your free time?

I like spending time with my friends whether it’s outdoors, visiting restaurants or bars, or just having a coffee. And, I love spending time with my dogs.

What's the best thing about your community?

I love the diversity of the community I work in, as well as the beauty of the nature around us.

How does your pharmacy give back to your local community?

Our pharmacy gives back through charities such as Make-A-Wish Australia and the Gidget Foundation. My pharmacies are involved in local charities and organisations they partner with, such as Care Flight, Seniors groups, and Parkinson's Foundation. We’ve attended Career days for schools and local health exhibitions, and

hope to get even more involved in community initiatives this year!

We also provide free medication packing and delivery, which are valuable and much-appreciated services to the community.

How do you best support your team and customers?

The first step is connecting with people to build rapport and a relationship no matter who they are. Then it comes down to listening and being there to help. But also throwing in some fun and laughs!

What are five things you couldn't live without?

My friends, family, dogs, hair straightener, and dry shampoo.

Do you have a quote you live by?

“Life is happening for me and not to me.”

What’s your best health tip?

There isn't a condition I could think of that isn't helped by good hydration, diet, sleep and exercise - these are often the best medicines.

If you could give a shout out to one of your regular customers, who would it be and why?

A big shout out to Kelvin - he is truly the kindest person I have met. He is always so grateful and positive for even the littlest of things. Every time he visits, we all want to be the one serving him - he makes everyone feel so happy and appreciated.

What are you excited about for the future of your store?

I’m excited to expand our home delivery and packing services to reach a wider part of the community. I also love seeing the growth of my team as we train and learn together.

Six Australian healthcare innovations

AUSTRALIA IS OFTEN AT THE FOREFRONT OF EXCITING NEW ADVANCES IN HEALTHCARE AND THE LIFE SCIENCES. HERE ARE SIX OF OUR MOST EXTRAORDINARY RECENT INNOVATIONS.

In 2022, Australia was rated fifth overall in the annual World Index of Health Innovation.1 We have world-class universities, businesses, and research facilities that excel globally in fields such as oncology, neurology, medical devices, tropical diseases, diabetes, and cardiovascular disease.2 Here are some recent advancements we can be particularly proud of:

1. The cervical cancer vaccine

“Australia is on track to be the first country to eliminate cervical cancer.”

– University of Melbourne

The vaccine Gardasil was developed by two researchers at the University of Queensland, who had been studying the human papillomavirus (HPV), the cause of almost all cervical cancers. Cervical cancer affects the cervix, the opening to the uterus. It mostly affects

younger women, which is one reason why historically it has not always been spotted in time to prevent either radical treatments (including those which affect fertility) or even death.

It’s the fourth most common cancer affecting women, and was the thirteenth most commonly detected female cancer in Australia in 2022.3 That year, 222 people died of the disease here4 – and that’s 222 too many.

In 2007, we were one of the first countries to introduce a national HPV vaccination program. By 2038, Australian cervical cancer rates are expected to drop so low that it will no longer be considered a public health problem.5 This extraordinary achievement will save the lives of many, especially younger people. In Scotland, it was announced in 2024 that zero cervical cancer cases had been detected in women who have had the HPV vaccine since 2008.6

Screening has also reduced cervical cancer rates but regardless of the vaccine, it’s still vital to get tested. The old pap smear has been replaced by the HPV or cervical screening test, but the newer one is every five years, instead of every two.

2. A miracle malaria vaccine

In 2022, 249 million people around the world contracted malaria – a staggering 3% of the population in just one year. 608,000 of them died;7 it’s the third-leading cause of death in children aged under five.8 However, many more cases are likely to have gone unreported. Since 2015, 12 countries have been free of malaria, including Sri Lanka, the Maldives and China.7 However, it’s still an unpleasant, recurrent disease which is also life-threatening, especially for babies and children, the elderly, and pregnant women. Malaria is most common in tropical countries, where access to healthcare can be difficult. In 2021, the first desperately needed anti-malaria vaccine, Mosquirix, was endorsed by the World Health Organization for use in 12 African countries. It has since cut hospitalisations among children by around a third,9 and reduced deaths in toddlers by 13%.10

However, Mosquirix only offers partial protection from the worst effects of malaria, which is why it’s so exciting that an Australian research team at Griffith University, in South East Queensland, is developing what looks to be a considerably more effective new vaccine. It can also be delivered as a powder, to be reconstituted just before injection, making it cheaper and easier to transport and store.11 Phase 1 clinical trials were due to begin early in 2024.

3. Mini-organs for testing

The Children’s Medical Research Institute (CMRI), in Sydney, is looking for new ways to test and treat devastating diseases of the eye, brain, ear, kidney and heart. It should accelerate the development of treatments for millions of children with uncurable genetic and other disorders.12

CMRI is able to culture miniature 3D versions of a child’s organs. These mini-organs are called organoids. This is done using stem cells taken non-invasively from the child’s blood or skin – and the beauty of it is, each mini-organ is unique to that child, containing the same DNA. Almost any organ can be recreated, allowing doctors and researchers to understand how diseases progress and test treatments on the miniorgans to see what happens. This means the child itself doesn’t have to be the guinea pig for potentially risky experimental treatments (which can be traumatising when they’re already sick) and for their loved ones.

4. Seeing through sound

Two universities in Sydney have worked with members of the blind community to develop spectacles which help blind people to ‘see’ by understanding what’s going on around them.

The glasses are fitted with miniature sensors which gather data about the space around the wearer. They receive this data via sound messages, which help the user to visualise the environment around them – and their own location within it. The loudness of the signals tells the wearer how close they are to each object.

This ‘sensory augmentation’ technology helps people to navigate much more independently, to feel more confident, and to take greater enjoyment from the world around them. The plan is for the technology to eventually be able to read other people’s facial expressions – so a blind parent could hear their child smile for the first time.13

5. Targeting cancers

Two Australian companies are collaborating to adopt a revolutionary new technology which is being used to treat resistant blood cancers, such as acute lymphoblastic leukaemia in children. Now, it will be used to treat ‘solid’ tumours for the first time – such as breast or lung cancers. 90% of all cancers are solid.14

CAR-T therapy (which stands for chimeric antigen receptor T cell) is a way of engineering a patient’s own immune cells to attack their cancer. It’s highly specific to each patient and their own cancer, and it should be a one-time treatment with the potential for a cure.

The therapy enables the immune system to identify and attack cancer cells which haven’t managed to be treated with standard treatments such as radiation and chemotherapy.

6. Expanding treatment access

One of the biggest health changes coming from Australia isn’t related to a new medicine, but how they’re being delivered. States and territories across the country are beginning to implement more accessible healthcare, making health solutions easier than ever to access. While not a world-first, these changes will pave the way for the future of healthcare in our country.

The Eastern Australian states have increased the responsibilities of community Pharmacists as part of new health programs. Access to contraception has been increased; in NSW and QLD, those who are eligible (i.e. who are already taking oral contraceptives and are between 18-35 years of age) are able to resupply straight from their Pharmacist without visiting their GP. Victoria and ACT are also trialling expanded contraception access.

Urinary tract infection (UTI) treatments are also widely available as part of pharmacy trials. NSW, QLD, VIC, and WA have all introduced programs to allow Pharmacists to provide treatment for UTIs, allowing patients to avoid having to wait to book an appointment with a doctor.

The remaining states and territories in Australia are also exploring the implementation of similar programs.

Each state is bringing a slightly different approach, with Victorians having the greatest access to contraception, Western Australians only recently being able to access UTI treatment straight from the chemist, and Queenslanders possibly benefitting from 17 conditions that can be treated by just your Pharmacist.

1Australia: https://freopp.org/australia-5-in-the-2022-world-index-of-healthcareinnovation-c0dbc32668

2Health and life sciences: https://www.globalaustralia.gov.au/industries/health-andlife-sciences

3Cervical cancer statistics: https://accf.org.au/news-media/

4We can eliminate cervical cancer: https://pursuit.unimelb.edu.au/articles/we-caneliminate-cervical-cancer

5The projected timeframe until cervical cancer elimination in Australia: https://www. thelancet.com/journals/lanpub/article/PIIS2468-2667(18)30183-X/fulltext

6No cervical cancer cases detected in vaccinated women following HPV immunisation: https://publichealthscotland.scot/news/2024/january/no-cervicalcancer-cases-detected-in-vaccinated-women-following-hpv-immunisation

7Malaria: https://www.who.int/news-room/fact-sheets/detail/malaria

8The world’s first routine vaccine programme against malaria: https://ausvacs.com.au/ the-worlds-first-routine-vaccine-programme-against-malaria

9First malaria vaccine hits 1 million dose milestone: https://www.npr.org/sections/ goatsandsoda/2022/05/13/1098536246/first-malaria-vaccine-hits-1-million-dosemilestone-although-it-has-its-shortcom

10First malaria vaccine slashes early childhood mortality: https://www.science.org/ content/article/first-malaria-vaccine-slashes-early-childhood-deaths

11Developing a malaria vaccine for the world’s most vulnerable: https://www.griffith. edu.au/advancement/giving/why-giving-matters/developing-a-malaria-vaccine

12Tiny models promise large returns: https://www.medicalresearch.nsw.gov.au/tinymodels-promise-large-returns

13Bionic glasses ‘seeing’ through sound: https://www.uts.edu.au/research-andteaching/research/explore/impact/bionic-glasses-seeing-through-sound

14Next-generation i-body enabled CAR-T cancer therapeutics: https://adalta.com. au/adalta-carina-biotech-develop-next-generation-body-enabled-car-t-cancertherapeutics

Telehealth: a gamechanger

TELEHEALTH IS WHEN YOU HAVE A CONSULTATION WITH A HEALTHCARE PROVIDER BY PHONE OR VIDEO CALL. MANY PATIENTS HAVE WELCOMED THE WAY IT CARRIED ON AFTER THE PANDEMIC –BUT IT’S NOT FOR EVERYONE, OR FOR EVERY SITUATION.

Virtual appointments and healthcare have been available in some countries for around 20 years now. However, the COVID pandemic thrust us into a situation where direct contact between doctors and patients needed to be limited. So many practitioners, from GPs to physiotherapists to hospital specialists, moved face-to-face appointments over to phone and video appointments – known as telehealth.

When the patient benefits were seen, providers continued to deliver telehealth as a permanent solution for a proportion of consultations, even after COVID-19. Telehealth can also relieve the pressure on hospitals, clinics, elderly care and ambulance services.

Some of us have welcomed telehealth, thanks to the convenience of no travel, no childcare, less time off work, and more.

How it works

Various telehealth services are available from both public and private healthcare providers. Private appointments may be available sooner and some are available 24/7.

Your healthcare provider may simply call you over the phone or by video call. Like traditional appointments, it will be for a set time and date.

For video calls, you may need to follow a link sent to you by mail, email or SMS. You’ll need a device with internet access and either a webcam or an in-built camera (such as on a phone or laptop). You shouldn’t need to download any special software. You may need to wait on the call until the healthcare professional is ready.

Making healthcare fairer

More than one in four Australians live in rural and remote areas, including a high proportion of our Australian Aboriginal and Torres Strait Islander peoples. Those living remotely, compared to those who live in our cities, tend to have poorer ‘health outcomes such as delayed diagnoses or the inability to access certain treatments.1

What about relationships?

Understandably, many people worry that talking to a medical professional by phone or video call might make communication more difficult, and make it harder to see the same person more than once.

In fact, a 2022 global study2 found that, despite their expectations, patients felt just as heard and understood when using telehealth, and that it actually had a positive effect on their patient-doctor relationship.

While some consultations will always need to be in person, and some process improvements are still needed, telehealth is here to stay. There are too many benefits for us to go back to the preCOVID-19 situation, and it’s especially useful in our remote areas. And while virtual calls aren’t right for every situation, they can be a helpful first step in assessing what needs to happen next.

1Telehealth in remote Australia: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC10074370

2General practitioners’ perceptions of using virtual primary care during the COVID-19 pandemic: https://journals.plos.org/digitalhealth/article?id=10.1371/ journal.pdig.0000029

Medical miracles… by accident

ALEXANDER FLEMING DISCOVERED THE FIRST ANTIBIOTIC, AND, LIKE A SURPRISING NUMBER OF MEDICAL ADVANCES, FINDING PENICILLIN HAPPENED PURELY BY CHANCE. HERE’S THE STORY OF PENICILLIN AND THREE OTHER ‘HAPPY ACCIDENTS’ IN THE HEALTHCARE FIELD.

In the last 200 years, largely thanks to the Industrial Revolution, we’ve seen major advances in healthcare come about.

But those advances weren’t all planned. Often, they were the result of unexpected observations. The discoveries of many conditions, tests and treatments have been accidental, including anaesthetics, insulin, chlorpromazine (an antipsychotic drug), quinine for treating malaria, Viagra, and many more.

MEDICINE

Penicillin

Today, less than 100 years after the discovery of penicillin, we can’t imagine a world without antibiotics. Previously, common infections could kill you: even a paper cut could land you in hospital with sepsis, your doctors powerless to help. And yet the first antibiotic was found by accident.

In 1928, Scottish bacteriology professor Alexander Fleming was sorting out some lab dishes containing cultures of the bacterium Staphylococcus aureus. It’s a common microbe that many of us carry in our lungs, gut and/or skin. However, in the right conditions, it can cause deadly disease.

Fleming noticed that a patch of mould had grown on part of one dish. The area around it was completely clear of bacteria, as if something leaking from the mould was stopping the microbes from growing. He identified the mould as Penicillium notatum, a fungus similar to what turns bread mouldy. Fleming and other researchers isolated, stabilised and purified ‘penicillin’ for medical use. Other antibiotics were later developed, and the rest is history.

Penicillin is said to be one of the world’s greatest all-time discoveries, and to have saved over 500 million lives.1 In 1945, Fleming and two colleagues were awarded a Nobel Prize.

TESTS

X-rays

German physicist Wilhelm Conrad Ríntgen is the person to thank for x-rays. Spotting and setting broken bones would be much more difficult without x-rays, and much of our diagnostic testing – for cancer, pneumonia and dental problems, for example – would be impossible.

In 1895, Ríntgen was studying cathode rays (luminous streams of electrons) inside a glass tube which had been blacked out. In his darkened laboratory, he was surprised to see a glow appearing on a fluorescent screen several feet away from the tube. Rays of light were passing right through the thick blackout material, even though it was still intact.

Ríntgen found that this new ray could penetrate solids and even record the image of a human skeleton on a photographic negative. In 1901, he won a Nobel Prize for his accidental discovery, and x-rays were rapidly adopted by doctors around the world.

PROTECTION

Vaccines

We're fortunate to be routinely vaccinated against a range of diseases including chickenpox, diphtheria, flu, hepatitis b, whooping cough and many more.2 But without Edward Jenner and his clever observation over 300 years ago, none of it might have been possible. Smallpox was a disfiguring and deadly virus. By the late 1700s in France, for example, 60% of the population caught it, and many died as babies.3 Survivors were left terribly scarred and even blind.

In 1796, a British trainee doctor called Edward Jenner happened to notice that people who worked with cattle, and who developed cowpox (a related but much milder disease), didn’t seem to catch smallpox. Remembering what he’d previously observed, Jenner later collected cowpox scabs from a dairymaid and used them to vaccinate a young boy. After a few months, in what now seems like a breathtakingly bold step, he ‘infected’ the same boy with material from a smallpox patient. The boy never developed smallpox, and was assumed to be immune. Thanks to Jenner, smallpox has now been eradicated from the earth.

DEVICES

The pacemaker

An American engineer, Wilson Greatbatch, inadvertently invented the pacemaker in 1956. Pacemakers are used to normalise heart rate and rhythm, and can help the chambers of the heart to beat in time. Greatbatch was attempting to build a machine for recording heartbeats when he accidentally put in the wrong kind of resistor. It began to emit regular electrical pulses, and he realised that they replicated the electrical activity of a normal heartbeat.

In 1960 he patented a pacemaker that could be implanted into the heart. Over the years, these and more modern derivatives have saved countless lives (reducing death rates by up to 22%4) and improved the quality of life for many more.

1Our history: https://www.path.ox.ac.uk/centenary/our-history

2Routine vaccines for children: https://www.health.gov.au/topics/immunisation/ when-to-get-vaccinated/immunisation-for-infants-and-children

3Lettres Philosophiques (Voltaire): https://sourcebooks.fordham.edu mod/1778volt aire-lettres.asp

44 things you should know about your pacemaker: https://apprhs.org/4-things-youshould-know-about-your-pacemaker

What is the ‘placebo effect’?

THE PLACEBO EFFECT IS WHEN SOMEONE EXPERIENCES A POSITIVE CHANGE IN THEIR CONDITION AFTER RECEIVING A TREATMENT THAT HAS NO THERAPEUTIC EFFECT, SIMPLY BECAUSE THEY BELIEVE THE TREATMENT WILL WORK. IT REMAINS FAIRLY MYSTERIOUS, BUT THERE IS POTENTIAL FOR HARNESSING IT TO PROVIDE THE DELIBERATE RELIEF OF SYMPTOMS.

Placebos are often used in medical research as a comparison point to determine the true effectiveness of a treatment by measuring how much it outperforms the placebo.

Typically, one half of a patient group would be given the test treatment, and the other half would get the placebo – making them the ‘control group’. The people who get the placebo are very unlikely to be told that they’re getting a dummy treatment.

The idea is that at the end of the trial, the people who got the placebo won’t show any benefit, while the people who took the real treatment will hopefully show an improvement. This would enable the researchers to make the fairest possible assessment of the effect of the real drug. But it doesn’t always work out that way.

The placebo effect

Sometimes, even the people who get the placebo treatment will experience a benefit. According to BetterHealth, about one third of those who take placebos will see an improvement in symptoms such as pain.1

This isn't ideal for researchers, because it can make it look like the real treatment isn’t particularly effective, since the difference between the two groups is smaller than expected. But that isn’t the case – the placebo effect just needs to be taken into account.

Placebo effects are part of most treatment effects these days. From your healthcare providers’ positive delivery of information, to the size and colour of different medicines, it’s in both the patient’s and provider’s interest to maximise the placebo effect.

Does it cure you?

The placebo effect can alter your symptoms but it won’t cure you of the underlying cause. If you have asthma, for example, then a placebo may help you breathe better, and thus feel better, but it won’t heal your asthma.

Placebos have been shown to be most effective for conditions like pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea.

Why does it happen?

We don’t yet know enough about what’s behind the placebo effect. It seems complicated, involving releases of feel-good chemicals like endorphins and dopamine, along with increased activity in the parts of the brain linked to moods and emotions.

What we do know is that our brains have remarkable power over our bodies. For example, our nervous system, which sends messages throughout our body, is highly reliant on our brains. This means that while we can share a similar stimulus, the amount of pain or pleasure we experience can differ substantially. Some of the ways our brain does this are still unknown to researchers- but for a placebo effect, it all adds up to your brain telling your body to feel better.2

Significant others

The placebo effect appears to depend on the involvement of at least one other person. For example, if a Doctor or researcher gives you a placebo pill, you may experience the placebo effect – but giving yourself the same pill, without anyone else being involved, is unlikely to make any difference.

One study calls this ‘the interpersonal component of healing’, and another stresses ‘the ritual of treatment.1,2 It’s fascinating to consider the importance of human relationships and trust in supporting healing; when we receive care from others, we feel better.

Not all in the mind

Measurable physical changes can and do occur when people take placebos, so it’s not just a psychological effect. People given placebos have shown a drop in blood pressure and heart rate, and even blood test results have changed.

Known placebos

The placebo effect doesn’t even depend on the patients being unaware that their treatment is fake. Usually, studies are ‘blind’, which means that neither those receiving the real treatment, nor the ones getting the placebo, know which group they’re in.

However, in one study, a drug clearly labelled ‘placebo’ was still 50% as effective as the real drug. This happened even though the recipients knew full well that they weren’t getting the treatment!2 The inverse is also true; in one study, patients who received pain relief medicine but weren’t told about it, reported being in greater pain than those who had been told they were receiving pain relief.2

The implications

More research is needed into how the placebo effect works. The implications could be significant: can we harness it in some way to deliberately treat people and help them feel better, instead of it being an unintended consequence of something that was never intended to work? If nothing else, it offers a possible explanation as to why traditional, new-age and faith-based healing methods can genuinely provide relief.

‘Nocebo’

Sometimes, people taking the placebo can feel worse rather than better. This is called the ‘nocebo effect’. It’s less common, but can happen for a range of reasons, including being warned in advance that the treatment might have side effects. The placebo patients don’t know they’re getting the dummy treatment, so they get the same warning, and somehow experience those effects. Studied ‘nocebo’ side effects include nausea, pain, and headaches.

1The placebo effect: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ placebo-effect

2Six surprising things about placebos everyone should know: https://theconversation.com/ six-surprising-things-about-placebos-everyone-should-know-220829

3The power of the placebo effect: https://www.health.harvard.edu/mental-health/thepower-of-the-placebo-effect

4The placebo effect: https://www.health.harvard.edu/blog/the-placebo-effect-amazing-andreal-201511028544

The world of supplements

MANY OF US ARE TAKING SUPPLEMENTS, OR WONDERING IF WE SHOULD. HOW CAN WE BE SURE THEY’RE EFFECTIVE OR EVEN SAFE TO USE?

Almost three-quarters of us buy complementary medicines, with vitamins being the most popular.1

Since supplements are mostly things that we choose for ourselves, rather than necessarily having them prescribed, it can be hard to know whether something is right for us. Because although some supplements are essential for some people, it’s important to take them responsibly and as directed. Some supplements will do you a lot of good; some are unproven; and some won’t harm you, but won’t help you either.

In every case, it’s best to talk to a healthcare professional before you start – even when it seems as simple as a vitamin. Ensure you check with your GP or your local Blooms The Chemist Pharmacist.

Vitamins and minerals

A healthy diet should deliver all the vitamins and minerals you need, but some people may need a top-up of certain ones. For example, those who are pregnant or breastfeeding; people with osteopenia or osteoporosis (weak bones); those who smoke, take drugs, or drink too much alcohol; elderly people; crash dieters; vegetarians and vegans; people who have heavy periods, and those with food allergies.

However, there are risks which differ according to your circumstances. Too much of a vitamin supplement could alter a medical test result, for example, or prevent your existing medicine from working. Specific risks include:

• Too much vitamin B6 can cause nerve damage2

• Vitamin A supplements can increase the risk of lung cancer in smokers2

• Supplements of vitamins A, C and E can cause serious harm to an unborn baby

• Supplements containing high doses of vitamin E can cause early death.2

Australia’s Therapeutic Goods Administration (TGA) regulates all vitamins sold here: always check the label for an AUST R or AUST L number. Take extra care if you order online from overseas.

Stress and mood relief

There is evidence that vitamin B supplements can relieve stress and anxiety, but do note the warnings above.3 Similarly, omega-3 fish oils, St John’s wort and zinc can help to lift your mood. Always check first; for example, St John’s wort shouldn’t be taken if you’re pregnant or breastfeeding, and it can interfere with cancer drugs such as tamoxifen.

Sleep relief

If you’re struggling to get enough sleep, there is evidence for the helpfulness of taking natural melatonin, saffron, and vitamin D.4 Magnesium has also been shown to aid sleep and is increasingly being used – but too much can cause side effects or interfere with medication, so check the doses carefully.

Skincare

There’s growing proof of the effectiveness of a wide range of supplements aimed at improving the appearance of the skin. Check out our ‘A-Z of contemporary skincare’ on page 36 of this edition of Health Check magazine.

Sports performance

It's understandable that athletes at every level may want to improve their performance. You should be safe with caffeine (in moderation), creatine and glycerol.4 If you compete, you need to know which substances are banned. The Australian Sports Commission website has helpful information

on supplements from Group A (strongly evidenced and permitted) to Group D (banned).6 Never be tempted by anabolic steroids: they’re illegal without a prescription, and have some severe side effects.

Muscle recovery

Creatine may also be useful in helping muscles recover after exercise, particularly if taken with a protein drink.5 Glutamine may be beneficial, as can whey powder – but watch out for added sugars in whey powder (which can be in large amounts) and avoid it if you’re lactose intolerant.

Weight management

Some effective weight-loss drugs are available in Australia, but they are only available by prescription. The world of weight-loss supplements is something else altogether and should be approached with caution. According to researchers, the various teas6 and tablets don’t work. They can be dangerous for vulnerable young people who don’t know the risks to their physical and psychological health; they can lead to unhealthy weight gain in adulthood and increase the risk of eating disorders.7

Unregulated supplements

According to the TGA, unregulated supplements can contain little or no active ingredient, or dangerous ingredients. They may have been badly made, and may not do what they claim. It’s becoming an increasing problem as disreputable companies try to cash in on this booming market.

In December 2023, the TGA seized almost 500 sports supplements from one store in Sydney because they contained potentially dangerous substances.8 In 2024, they issued a safety alert after herbal supplements bought online were found to contain Viagra: this should only be available on prescription, has a range of side effects, and can interfere with other medications.9

Get expert advice

Always talk to your GP or a Pharmacist before taking any supplement, no matter how simple and ‘everyday’ it might seem. Your own circumstances and existing medication will dictate what’s safe for you. An expert may even be able to recommend something better than what you were considering.

1Healthy outlook: Australia’s vitamin and supplements market: https://my.nzte.govt.nz/ article/healthy-outlook-australias-vitamin-and-supplements-market

2Vitamin and mineral supplements: https://www.betterhealth.vic.gov.au/health/healthy living/vitamin-and-minerals

3The therapeutic impact of plant-based and nutritional supplements: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC10049309

4Supplements: https://www.ais.gov.au/nutrition/supplements

5Creatine supplements: https://theconversation.com/creatine-supplements-what-theresearch-says-about-how-they-can-help-you-get-in-shape-197260

6Slimming tea: https://www.medicalnewstoday.com/articles/319402

7Weight-loss products should not be sold to under-18s: https://www.theguardian.com/ society/2024/jan/11/weight-loss-products-should-not-be-sold-to-under-18s-expertswarn-global-study

8TGA seizes hundreds of potentially dangerous sport supplements: https://www. tga.gov.au/news/media-releases/tga-seizes-hundreds-potentially-dangerous-sportsupplements-sydney-retail-store

9TGA issues safety alerts: https://www.theguardian.com/australia-news/2024/jan/30/ tga-safety-alerts-supplements-viagra-contain-seized

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Depression and antidepressants

ONE IN SEVEN AUSTRALIANS TAKE ANTIDEPRESSANTS, WHICH IS ONE OF THE HIGHEST RATES IN THE WORLD.1 THAT’S WHY IT’S SO IMPORTANT FOR US TO UNDERSTAND THE CONDITION, ALONG WITH ITS TREATMENTS AND WHAT WE CAN DO TO HELP OURSELVES.

A million Australians suffer from clinical depression every year.2

According to Beyond Blue, “While we all feel sad, moody or low from time to time, some people experience these feelings intensely, for long periods of time and sometimes without any apparent reason. Depression is more than just a low mood – it’s a serious condition that has an impact on both physical and mental health.”3

There are different kinds of depression, and perhaps the bestknown types are clinical depression, postnatal depression, bipolar disorder, and seasonal affective disorder (SAD).

Thankfully, people now find it easier to seek help. Nevertheless, many still don’t – or don’t get the help they ask for. More than half of those who had depression in one year in Australia did not receive any professional help.3

Always ask for help if you think you have depression: the sooner you do, the sooner you can start to get your life back on track.

But it’s important to know that depression can come back, even if you’ve been treated successfully in the past.

Who might get depression?

Some people develop depression because of what’s happened to them. It can be a sudden incident, such as a bereavement or a redundancy. However, it’s more likely to be one or more longerterm concerns like unemployment, a difficult relationship, a major health condition, feeling isolated, or stress.4

Depression can also run in families. Some people may be more at risk because of their personality: perhaps they are naturally given to worrying, or struggle to deal with criticism, are perfectionists, or have low self-esteem.3 The abuse of drugs and alcohol can lead to depression, too; over 500,000 Australians will experience depression and a substance misuse at the same time.5

Symptoms

The symptoms of depression vary widely, but can often include feelings of hopelessness, failure, sadness, guilt, frustration, and irritation. These can be accompanied by a lack of energy, difficulty sleeping, brain fog, withdrawing from people, and giving up on activities you used to enjoy. In severe depression, there may even be a sense that ‘people would be better off without me’.

Treatment

Standard practice is for people to be offered psychological therapy first, particularly where the depression is mild or moderate.2 An antidepressant might be prescribed at the same time, or later if the psychological therapy hasn’t been effective enough. The following psychological therapies can be helpful:

• Cognitive behaviour therapy (CBT) – designed to overlay any unhelpful thoughts and behaviours you may have with new, more positive ones.

• Behaviour therapy – instead of changing the way you think, this focusses on increasing activities which make you feel better and decreasing those which make you feel worse (like withdrawing socially).

• Interpersonal therapy – this works on your relationship skills and any problems in how you interact with others.

Other medical treatments could be offered, depending on the type of depression or its severity. For example, people who have seasonal affective disorder (SAD) may benefit from the daily use of a lightbox. At the more extreme end, those who have very severe depression, and who haven’t responded to other treatments, may be offered electroconvulsive or ‘electroshock’ therapy (ECT).6

Prescribing antidepressants

Prescribers will consider many things when deciding which antidepressant to give you. It’s especially important to get this right for teenagers, the elderly, and those who are pregnant or breastfeeding.

The Doctor will assess a drug’s possible side-effects, which can be different for different people. They’ll also consider how any existing medication could alter the effectiveness of the antidepressant, along with how toxic an overdose might be – whether accidental or not.

Any antidepressant should be tried for at least three weeks. If there’s no improvement, or not enough, then the dose may be increased – or a different type of antidepressant may be prescribed. Side effects

Many people experience side effects with antidepressants, but they usually wear off over time. You might not notice any, or they might be unpleasant (at least initially). Yours might differ from someone else taking the same drug. It’s worth persevering, because depression is something which needs to be treated.

It’s important to talk to your doctor about possible side effects when a drug is prescribed for you, and to read the information leaflet which comes with it so that you know what to expect. If the side effects don’t wear off, talk to your GP or Pharmacist about other types of antidepressants.

Self-help for depression

If you’ve been diagnosed with depression, it’s very likely that you’ll need psychological therapy, and possibly antidepressants, because self-help alone won’t be enough. However, self-help methods can be enormously helpful when used alongside your medical support. For example, lifestyle changes can really help to improve your longer-term mood: getting more exercise, eating better, cutting down on alcohol, and getting out of an unhealthy relationship, for example.

If it all gets too much

Sometimes depression can be severe, and people can think about ending their own lives. If that’s you, or someone you care about, and you are in crisis, you can call:

• the Suicide Call Back Service on 1300 659 467

• Lifeline on 13 11 14

• 000 at any time.

Types of antidepressant

• Selective serotonin reuptake inhibitors (SSRIs) – these are the most commonly prescribed antidepressants in Australia, and are usually a doctor's first choice. The side effects are usually quite tolerable. Examples: sertraline, citalopram, escitalopram, paroxetine, fluoxetine, fluvoxamine.

• Serotonin and noradrenalin reuptake inhibitors (SNRIs) – these have fewer side effects than SSRIs, and are usually prescribed for severe depression. They are safer in case of an overdose. Examples: venlafaxine, desvenlafaxine, duloxetine.

• Reversible inhibitors of monoamine oxidase (RIMAs) – these are better for people with anxiety or sleeping difficulties than for severe depression. They have few side effects. Example: moclobemide.

• Tricyclic antidepressants (TCAs) – these older drugs are effective, and are often used to treat OCD, but have more harmful side effects than the newer SSRIs, including low blood pressure. Examples: nortriptyline, clomipramine, dothiepin.

• Noradrenaline-serotonin specific antidepressants (NaSSAs) – these are fairly new, and are especially useful for problems with anxiety or sleeping. They can cause weight gain. Example: mirtazapine.

• Noradrenalin reuptake inhibitors (NARIs) – these cause less drowsiness than some antidepressants, but are more likely to cause sleep difficulties, increased sweating, sexual problems, difficulty urinating, and faster heart rate. Example: reboxetine.

• Monoamine oxidase inhibitors (MAOIs) – these are used for serious depression. They require a special diet because of the risk of sudden blood pressure spikes and other troublesome side effects. They are prescribed only under exceptional circumstances. Example: tranylcypromine.

Other drugs, which are not strictly antidepressants, can also be used to treat certain types of depression. For example, antimanic agents such as lithium can be used to treat bipolar disorder.

1Why are so many Australians taking antidepressants?: https://theconversation.com/ why-are-so-many-australians-taking-antidepressants-221857

2Antidepressant prescribing patterns in Australia: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC9301763

3A guide to what works for depression: https://www.beyondblue.org.au/docs/defaultsource/resources/bl0556-what-works-for-depression-booklet_acc.pdf

4Depression explained: https://www.betterhealth.vic.gov.au/health/ conditionsandtreatments/depression

5Causes of depression: https://www.beyondblue.org.au/mental-health/depression/ causes-of-depression

6Treatments for depression: https://www.beyondblue.org.au/mental-health/ depression/treatments-for-depression

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Cannabis in healthcare

MEDICINAL CANNABIS, ONCE A CONTENTIOUS TOPIC, HAS BECOME MUCH MORE WIDELY ACCEPTED IN AUSTRALIA OVER RECENT YEARS. LET’S TAKE A LOOK AT WHAT IT MAY BE ABLE TO DO, AND HOW IT CAN BE OBTAINED.

Medicinal cannabis is derived from cannabis plants, a flowering plant from the hemp family. Its active ingredients are called cannabinoids, of which there are over 100.1 Most medicinal cannabis contains one or both of two common cannabinoids: tetrahydrocannabinol (THC) and cannabidiol (CBD).

Research is ongoing to discover more about its use in Australia and worldwide.2 That’s because there is, so far, limited evidence for its long-term benefits and its potential harms.

THC and CBD may offer different benefits. These can be used to treat various conditions which may not have responded to more traditional treatments, or can be used alongside them. They may be able to help for things such as epilepsy (seizures), multiple sclerosis, chronic pain, symptoms associated with cancer (such as nausea and loss of appetite), anxiety, and insomnia, and can possibly assist in palliative care.

Obtaining medicinal cannabis

In Australia, medicinal cannabis can only be prescribed by a registered medical practitioner. The Doctor will assess a patient before prescribing it, to see if the treatment will be appropriate for their condition and individual circumstances.

The Doctor must consider the patient's own medical history, their family health history, current medications, and any problems with drug dependence and substance abuse.3

The Therapeutic Goods Administration (TGA), which is part of the Australian Government’s Department of Health, is responsible for regulating all prescription medicines. It is important to note that the TGA has only evaluated two medicinal cannabis products for safety, quality and efficacy, even though hundreds of unregistered products are also available through the special access scheme. This scheme allows certain medical practitioners to supply unapproved products to patients on a case-by-case basis.1

How to take it

Medicinal cannabis should be thought of as a class of medication, rather than a single product. Many variants are available in Australia, differing in chemical constituents, strength, formulation, and quality.4 It can come in different forms, including:

• Capsules

• Chewables

• Creams

• Crystals

• Flower

• Lozenges

• Oil (most common)

• Mouth/throat (oromucosal) sprays

• Tinctures

Side effects

The potential side effects of medicinal cannabis vary, depending on the cannabinoid ingredients. Generally these may include difficulty concentrating (brain fog), dizziness, drowsiness, gastrointestinal upset, nausea, problems with balance, problems with thinking and memory, and changes in mood and appetite.

THC can also affect your ability to drive. Not enough is yet known about which doses are safe and which are not, so driving is not advised when taking medicinal cannabis. It may also affect the ability to operate machinery, so seeking medical advice is recommended.

Funding medicinal cannabis

In Australia, most medicines prescribed by your Doctor are subsidised by the Commonwealth Government under the Pharmaceutical Benefits Scheme (PBS). However, no medicinal cannabis products are currently subsidised. As these products are not subsidised by the PBS, you would have to pay for them yourself.2 The cost varies, depending on the type of product and the dose recommended by your Doctor.

1Medicinal cannabis: https://www.healthdirect.gov.au/medicinal-cannabis 2Medicinal cannabis: https://www.betterhealth.vic.gov.au/health/ conditionsandtreatments/medicinal-cannabis

3Guidance for the use of medicinal cannabis in Australia: https://www.tga.gov.au/ resources/resource/guidance/guidance-use-medicinal-cannabis-australia-patientinformation

4What medicinal cannabis products are available?: https://www.sydney.edu.au/ lambert/how-to-get-medicinal-cannabis/what-products-are-available.html

ALWAYS READ THE LABEL AND FOLLOW THE DIRECTIONS FOR USE.

Hormones in medicine

THE BODY’S ENDOCRINE SYSTEM INVOLVES A WIDE RANGE OF GLANDS AND HORMONES WHICH REGULATE ALL SORTS OF PROCESSES IN OUR BODIES. SOMETIMES, WE NEED HELP IF WE PRODUCE TOO LITTLE OR TOO MUCH OF A HORMONE, BUT A VARIETY OF HORMONE TREATMENTS CAN ALSO HELP US DEAL WITH OTHER CONDITIONS, TOO.

The word ‘hormone’ can trigger knee-jerk memories for some of us. How often have we as teenagers, or as menstruating or menopausal women, been dismissed by others as being driven by our ‘hormones’?

Of course, it’s true that hormones can affect our mood and behaviour – and some hormones are designed to do exactly that. But the world of hormones is far more complex, and medically far more useful, than that rather narrow-minded view.

There are hormones that manage all kinds of processes in our bodies, and they extend far beyond the ones responsible for mood swings.

What are hormones?

Hormones are chemicals which are manufactured in our body and then released into our bloodstream, from where they are transported to the tissues and organs that need them. Those tissues and organs contain special receptors which means they respond only to the hormones they need. It’s a bit like a chemical messaging system within the body.

There are over 50 human hormones, and they’re produced in very tiny amounts because that’s all we need.1 Together, these chemicals control or regulate many of our biological processes. That includes the way we digest and use food, how we think and feel, how we grow, when we sleep, and how we reproduce.

The glands

Certain glands around the body are responsible for making and releasing (‘secreting’) hormones. Together, these glands and the hormones they produce are called the endocrine system. Specialists in this system are called endocrinologists.

You may already have heard of some of the best-known glands, like the pancreas and the thyroid, as well as reproductive glands such as the testes and ovaries. There are others too, like the pituitary gland, the thymus, the hypothalamus, the pineal gland, and the adrenal glands, among others.

When things go wrong

If your body produces too much of a hormone, or too little, then problems arise. Abnormalities are usually detected by doing tests of the blood, urine, or saliva.

You might take a medicine to top up the hormone levels you need. But there are also other medications to manage the effects of hormone over-production. For example, tamoxifen is an anti-oestrogen breast cancer drug. It prevents oestrogen from attaching to breast cancer cells, and prevents the cells from feeding on oestrogen and then growing.

Thank heavens for hormones

Our hormones perform amazing tasks in our bodies, and there’s much to be thankful for. But we’re also extremely lucky to be able to benefit from decades of research and development in treating hormone disorders. Without the medications that have resulted, many people would lead much more difficult lives and their lifespans would be severely limited.

Insulin

Insulin is a hormone which lowers our blood sugar by letting it move from the bloodstream into muscles, fat, and other cells, when it can either be stored or used immediately for energy.

Someone with type 1 diabetes, and some people with Type 2 diabetes, must take insulin every day. This is because their pancreas simply doesn’t produce enough insulin to control their blood sugar, which can lead to very serious and even deadly complications.

According to Diabetes Australia: “Until the discovery of insulin in 1921, diabetes was considered a death sentence. One hundred years on it is still giving life to millions of people who otherwise would never have had the chance.”2

Thyroid treatment

The thyroid gland is at the front of the neck, and it produces several hormones which regulate our growth and development.

If you have an under-active thyroid gland, this is called hypothyroidism and you’d be prescribed the hormone thyroxine. But if you have an overactive thyroid, you might be prescribed propranolol, which is a beta-blocker.

Both of these thyroid conditions have unpleasant symptoms, and can in some cases be life-threatening, so treatment is essential.

1Overview of the endocrine system: https://www.epa.gov/endocrine-disruption/ overview-endocrine-system

2Impact of insulin: https://www.diabetesaustralia.com.au/100-years-of-insulin

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Chronic illness

MANY PEOPLE LIVE WITH SYMPTOMS FOR MONTHS, YEARS, OR FOREVER. WHAT CAN CAUSE THESE CONDITIONS, AND WHY ISN’T MODERN MEDICINE ALWAYS ABLE TO FIND A SOLUTION?

If you have a condition that’s been going on for at least six months, it’s described as ‘chronic’. Some people get a diagnosis and treatment, and their conditions may be resolved. Others spend years trying to find out what’s wrong but never get an explanation.

The most common chronic conditions are well-known, such as cancer, HIV/AIDS, or mental illness.

Sometimes, they can arise from a separate illness, like long COVID after COVID-19. Some develop after surgery, such as lymphoedema (swelling due to damage to the lymphatic system), while other people are born with a condition.

Such conditions can be frustrating, upsetting, and worrying, especially if there’s no clear diagnosis. The endless need to cope with the symptoms can be demoralising, and even lead to depression.

Chronic pain

One in five Australians live with chronic pain; it affects more women than men, and over two thirds of them are of working age.1 In chronic pain, the nerves that carry pain signals to the brain are often unusually sensitive. Symptoms can range from persistent aches to very severe pain. There may be no obvious cause, or it could be due to things like osteoarthritis, a slipped disc, injuries, or cancer.

The key thing about chronic pain is the effect it has on your life. It can stop you working or even walking. And for some people, it will never be cured.

MUPS

GPs aren’t pathologists or medical researchers. Sometimes they don’t know what’s going on. This can be understandable; after all, ‘GP’ stands for general practitioner, not specialist. The important thing is that your GP refers you on to see one or more experts.

Sometimes, even specialists sometimes can't find the answers, and may describe your condition as ‘medically unexplained physical symptoms’, or MUPS. The absence of a diagnosis doesn’t mean doctors think it’s all in your head. There’s a lot we don’t know about how the human body and brain work.

MUPS affect one in 10 people, most commonly in women, although some symptoms barely bother the patient.2 They could be almost anything, but commonly include pain; stomach and bowel problems; heart palpitations; exhaustion and brain fog; dizziness; breathing difficulties, muscle problems; and neurological symptoms like tingling, itching and numbness.

Emerging conditions

The world of pathology, or the study of diseases, never stands still. Some diseases go away forever: smallpox and rinderpest have been eradicated, while others almost have been – like polio and elephantiasis. On the other hand, pathologists are kept busy with new diseases, like COVID-19.

It’s hardly surprising that medical professionals may be stumped when trying to deal with conditions they’ve never come across before, or where even the experts don’t yet know much. And that may mean having to live with a chronic and unexplained condition.

Five ways to manage

If you have a chronic condition, it may be useful to:

• Learn about your condition – understanding what’s going on can help you feel more in control, and can help you make more informed decisions. Just remember that not everything you read on the internet is true!

• Track your condition – keep a journal of what’s going on, either on a daily basis or when anything changes. This can help you feel more in control, and provides evidence for medical professionals.

• Improve your wellbeing – avoid stress, get the best sleep you can, eat healthily, manage your weight, stop smoking, drink less alcohol, and exercise if you can (providing it’s recommended). And don’t withdraw from social contact.

• Explore the available help – you may be able to get support from a social worker, dietitian, occupational therapist, physiotherapist, or psychologist, for example. For many chronic conditions, there are charities or self-help groups where you can find peer support and resources.

1Painaustralia: https://www.painaustralia.org.au

2Medically unexplained physical symptoms: https://www.informedhealth.org/ medically-unexplained-physical-symptoms.html

The power of community

THROUGH THOUSANDS OF YEARS OF DEVELOPMENT, WE KNOW THAT HUMANS ARE INTENDED TO BE CONNECTED TO ONE ANOTHER THROUGH COMMUNITY. A SENSE OF COMMUNITY, OR LACK OF IT, CAN HAVE A MAJOR EFFECT ON THE WAY WE ALL LIVE AND THE WAY WE CARE FOR ONE ANOTHER.

Communities come together to care for their members all around the world, in ways that work – yet which differ from what we might call conventional modern medicine.

Communities may do this because they’re holding onto traditional practices, as we’ll see with the Sámi peoples. This is often the case in geographically distant areas: after all, half of the world’s population lives in remote and rural areas.1

Alternatively, communities may step in because of a lack of public provision, as with the ‘loneliness grannies’ in Zimbabwe. It might be because there are better ways to do things, as demonstrated by the dementia village in the Netherlands. Or it might be because communities understand themselves better than anyone else can, as with HIV/AIDS patients in London and Ethiopia.

Humanity often shines brightest in adversity, and it’s amazing to see how communities step up to take care of themselves.

ZIMBABWE

Happiness grannies

In many developing countries, access to support for physical health can be challenging enough. Access to care for mental health can be virtually impossible, especially if you can’t pay.

Dixon Chibanda, a psychiatrist in Zimbabwe, hit on the idea of training grandmothers to talk to people on park benches. The grannies learn to use proven talk therapy as an easy-to-access alternative to mental health care. Dixon began in 2006 with a vision and just 14 grannies: in 2022, the program was supporting over 80,000 individuals. The benches are a safe space where people can explore their depression and anxiety, but with a sense of belonging and inclusion. Then, after their face-to-face support ends, clients can join a peerled support group– again, it’s the community that does the work. Members can relate to each other because they’re from the same community. They’ve all sat on friendship benches, and all been empowered to tackle their problems.2

Back in 2006, Dixon must never have guessed that his idea would spread to several other countries, including the USA, or that it would be recognised by the World Health Organisation as a best practice in community-based mental health.

THE SÁMI

Mystical ‘medicine’

The Sámi are indigenous people living a remote and scattered life in the far north of Sweden, Finland, Norway, and part of Russia. In the depths of Winter, they can expect no more than three hours of twilight to break up the darkness. Their lifestyle has led to a reliance on traditions, and turning to one another for health and wellbeing support.

For the Sámi, illness is collectively ‘owned’ by a large social circle, a sort of extended family whereas in Western conventional medicine, healthcare is left to the medical professionals. Sámi people tend to see a Doctor to get a diagnosis, but then a traditional healer to get well. Their healing focusses mostly on prayer and the laying-on of hands, either face-to-face or remotely, but there can also be blowing, cupping, movement, and drumming. According to one study, “The Sámi deal with sickness holistically – including life’s events, relations with nature, social circles and spirits.”3

Astonishingly, the Sámi tend to live just as long as non-Sámi people in those countries,4 although there are some differences in the types of diseases they get – likely due to genetics, the environment, physical activity, and diet.

While turning away from modern medicine isn’t advised, this traditional approach seems to be effective. This may be because of the placebo effect, the sense of closeness that community can bring, or something we don’t yet understand at all.

THE NETHERLANDS

Dementia village

One of the biggest challenges in the modern world, now that we all tend to live longer, is how to care for large numbers of elderly people in a way that gives them dignity but is also affordable. For the growing numbers with dementia, there’s the additional need for care, safety, and security.

There’s a city block just outside of Amsterdam, in the Netherlands, which is about the size of four footy fields. There’s only one gate in and out, but there are no fences: the perimeter is simply the backs of rows of buildings, all the way around. Within those walls lies a minivillage called Hogewey – a carefully managed community for people living with dementia.

Instead of uniforms, staff wear casual clothes and simply mingle throughout the village like neighbourhood friends. They keep a watchful eye and step in to ‘help’ whenever necessary. They’re supported by an extensive network of CCTV cameras.

Instead of wards and corridors, there are 23 homes decorated in dated styles designed to make residents feel at home in a time they can remember. There’s a town square, a theatre, gardens, and a post office.

The result of this community-led approach is that residents need less medication, eat better, live longer, and seem happier than their contemporaries in standard elderly-care facilities.5 There seems to be something powerful in enabling people to benefit from a sense of community.

LONDON Peer support

Back in the 1980s, when the HIV/AIDS crisis first emerged, the attached stigma meant that finding care and support – let alone any understanding of identity and lifestyle – was very difficult. Ignorance and fear among the public meant that it was rare to find anyone who would mix with patients, let alone touch them.

Inevitably, people in the affected communities had to turn to one another. They understood the issues and the isolation, and they genuinely cared about one another. As Garry Brough, a British man living with HIV in London, pointed out: “A shared experience has huge benefits in creating empathy and a sense of connection and community, allowing us to feel that we are all human and the same... It moves people from potential isolation into a space of community.”6

His campaign group got funding to run groups and information sessions in a safe space, and he himself became the UK’s first paid HIV Patient Representative in the National Health Service. He met with every newly diagnosed patient at their first clinic appointment, helping to ease their anxiety and enabling them to ask questions of someone who was also going through it – not ‘just’ a healthcare worker.

It’s an approach that works globally; in Ethiopia, community members, many of whom are people living with HIV, are trained to educate others about HIV prevention, treatment, and reducing stigma. The result has been more people coming forward for HIV testing, as well as improved treatment outcomes.7

1Rural and remote care: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5734598

1Friendship Bench: https://www.friendshipbenchzimbabwe.org

1Sámi traditional medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8330704

1Somatic health in the Indigenous Sami population: https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC6610513

1The Dutch village where everyone has dementia: https://www.theatlantic.com/ health/archive/2014/11/the-dutch-village-where-everyone-has-dementia/382195

1When HIV communities lead: https://www.transformationpartners.nhs.uk/when-hivcommunities-lead-the-role-of-peer-support-in-redefining-hiv-care

1CDC division of global HIV & TB country profile: https://www.cdc.gov/globalhivtb/ where-we-work/Ethiopia.pdf

How to perform CPR

Knowing how to perform CPR can be the difference between life and death. It provides support in the time before an ambulance arrives, and is taught in community programs, such as schools, lifesaving clubs, and sports clubs.

This article was originally published by the Victor Chang Cardiac Research Institute. Visit victorchang.edu.au/cpr for more information.

ALWAYS CALL TRIPLE ZERO (000) FOR EMERGENCY ASSISTANCE IN AUSTRALIA. THIS INFORMATION IS NOT A SUBSTITUTE FOR PROPER CPR TRAINING BY AN ACCREDITED ORGANISATION.

What is CPR?

CPR stands for cardiopulmonary resuscitation. CPR is a lifesaving technique that can be used in emergency situations. CPR is performed when someone has stopped breathing, or their heartbeat has stopped. It involves hard and fast chest compressions, and it can be performed by both untrained and trained bystanders.

Why is CPR important?

CPR can save lives. In an emergency situation, for example a heart attack or near drowning, CPR can keep blood circulating through the body, delivering vital oxygen to the brain and other organs.

If you are unsure or afraid to perform CPR, remember that it’s always better to try than to do nothing at all. There is typically enough oxygen still in the blood to keep the brain and organs supported for a short time, but it isn’t circulating unless CPR is performed. Without CPR, it only takes a few minutes before brain injury can occur due to a lack of oxygen.

If you are untrained, immediately call Triple Zero (000) and the Operator will provide step-by-step CPR instructions until help arrives.

What does DRSABCD stand for?

The acronym DRS ABCD (or Doctor’s ABCD) is commonly used to help you remember what to do during a medical emergency.

• Check for Danger: Ensure the area is safe for yourself, others and the patient before proceeding

• Check for Response: Squeeze shoulders of the patient. Ask loudly; “Are you alright? What’s your name?”

If there is no response;

• Send for Help: Call Triple Zero (000) for an ambulance. Ask a bystander for help to bring an AED.

• Check their Airway: Open the patient’s mouth. Check if airway is clear by tilting head and lifting chin. If visible foreign item is present, place patient on their side and remove foreign items with fingers

• Check for normal Breathing: Look, listen and feel. If the patient’s breathing is not normal, start CPR

• Start CPR: Push hard and fast. 30 chest compressions followed by 2 rescue breaths (if able).

• Defibrillation: Attach AED (automated external defibrillator) as soon as available. Follow voice prompts. Anything containing metal should be removed from the area, including underwire bras.

When is CPR needed?

CPR is needed when a person is;

• Unconscious

• Breathing abnormally (e.g. gasping for air or grunting)

• Not breathing

CPR is most effective when it’s commenced as soon as possible.

Painkiller do’s and don’t’s

IT’S ALL TOO EASY TO REACH FOR THE PAINKILLERS, BUT DO WE REALLY UNDERSTAND WHAT THEY ARE AND HOW TO USE THEM? AND HOW WELL DO WE EVEN UNDERSTAND PAIN?

Pain is the body’s way of telling us that something is wrong: that tissue damage is happening, and we need to react to stop further injury. For example, think of touching a hot surface or a cactus; you’ll quickly pull your hand away. Nerves called nociceptors detect tissue damage and send information about it to your brain via the spinal cord. Then, the brain tells your arm muscles to pull your hand away from danger.

Of course, there may also be lingering pain, long after the injury has happened. There are also many types of pain we can’t withdraw from, like a migraine or arthritis. That’s when we may need painkillers to help.

We all respond to pain differently, which is why it can be hard for a healthcare professional to gauge how much pain you’re in. Some of the most painful conditions known to humankind include cluster headaches, shingles, kidney stones, trigeminal neuralgia, fibromyalgia, gout, and endometriosis.

Sometimes pain is chronic, lasting continually or intermittently for years. For example, one in 13 people around the world experience lower back pain.1 Around 13% of Australians live with chronic pain,2 and almost one in 10 of us live with osteoarthritis alone– that’s a very painful condition affecting the joints.3

For some people, living with pain can affect their ability to function in society. It can prevent them from working, sleeping, socialising, or even being able to prepare food for themselves.

The body’s own painkillers

The body makes a range of its own painkillers as part of the fightor-flight response, which is our way of reacting to danger. As one example, the brain releases hormones called endorphins whenever we experience stress or pain. These block the nerve cells that receive pain signals, reducing the effects so we can deal with our situation.

The body also releases protein-like peptides called enkephalins, which are potent painkillers. They reduce the sensation triggered by pain signals and manage the release of stress hormones.

The hormone adrenaline plays a role in pain relief, especially in sudden and unexpected situations such as a car accident. Although not a painkiller in itself, adrenaline tells the body to release endorphins. This is why a person’s pain, and indeed their injuries, can be masked in the immediate aftermath of an accident. The true extent of the pain is felt later, as the effect of the endorphins wears off.

Pain-relief drugs

Many of us automatically reach for painkillers to help us deal with pain, whether on prescription from a Doctor or simply bought over the counter in a pharmacy. Several types of drugs can relieve pain:

• Paracetamol: Which relieves pain but can also reduce fever

• Non-steroidal anti-inflammatory drugs: The NSAIDS include ibuprofen, diclofenac, naproxen and aspirin. Besides relieving pain, they can reduce inflammation and fever.

• Opioids: These can occur naturally or be made in a lab, and vary hugely in strength. The natural opioids, morphine and codeine, are derived from the poppy, while synthetic opioids include tramadol, pethidine, hydromorphone and methadone. Some synthetics are dangerously powerful, like fentanyl. All opioids must be treated with care as they can have significant side effects, including a high risk of addiction.

• Antidepressants: Some antidepressants have also been found to relieve neuropathic pain (which affects the nerves). One example is amitriptyline, which works on chemicals in the nerves, noradrenaline and serotonin, to reduce pain signals to the brain.

• Anticonvulsants: Similarly, pregabalin was originally developed to treat epilepsy but has also been found to block pain messages. Sometimes, different types of drugs can be blended together. For example, co-codamol is a mix of paracetamol and codeine. However, since codeine can be so addictive, drugs containing codeine have not been available without a prescription in Australia since 2018.4

There are other drugs that people take to help relieve pain, but which may not in themselves be painkillers. For example, people with migraines may use triptans, which trigger the release of serotonin, a chemical made by nerve cells. Serotonin then reduces inflammation and constricts the blood vessels. So by stopping the headache in this way, the pain is also stopped.

Non-drug pain relief

If you prefer to avoid painkillers, or you need extra help on top of what you’re already taking, you could consider:

• Boosting your natural endorphins: These are released during eating, exercise, and sex, so those activities can also provide a degree of pain relief, or at the very least a degree of enjoyment and distraction.

• Applying heat or cold: Check out what works for what, but cold water can ease burns and heat can ease joint and muscle pain, and period cramps.

• Physical treatment: Things like physiotherapy, hydrotherapy, acupuncture, yoga and massage can provide relief. A TENS machine (transcutaneous electrical nerve stimulation) can relieve some pain, including chronic pain and period pain. None of these treatments are suitable for every type and cause of pain, so check carefully first with a healthcare professional.

• Psychological therapy: Meditation, relaxation, psychotherapy (especially cognitive behavioural therapy) and even hypnosis could help you to manage your pain.

• Distraction techniques: Sometimes, finding a way to stop focussing on your pain for a while can help. Trying a craft activity, seeing a friend, or spending time playing with a pet, for example.

DOs

• Do read the leaflet: There may be reasons why you shouldn’t take a particular drug (for example, ibuprofen can make asthma worse), or warnings about side effects.

• Do look for hidden drugs: It’s easy to forget that cold and flu relief products, available over the counter, may contain paracetamol, ibuprofen or aspirin. Gels and creams may contain drugs you’re already taking orally. Take care not to take the same drugs separately at the same time.

• Do talk to your doctor: If the pain relief you’ve been taking at the correct dose isn’t working, or if you’ve been taking it for more than a week.

• Do seek help for major side effects: Watch out for things like rashes or swelling, black bowel movements, blood in your vomit, severe stomach pain or headache, difficulty urinating, or changes in vision or hearing.

• Do remember the risks of opioids: Find out if your painkiller contains an opioid, and take it strictly as directed. Addiction to opioids can happen all too easily, and can ruin lives.

DONTs

• Don’t exceed the stated dose: (unless advised by a healthcare professional) – And don’t forget that applying a painkiller to your skin via a cream, as well as by mouth, can exceed the safe dose.

• Don’t take on an empty stomach: Take ibuprofen and aspirin with food (although you can take paracetamol on an empty stomach)

• Don’t take them too often or for too long: (unless advised by a healthcare professional) – This can result in problems like liver or kidney damage, heart problems, ear problems which can lead to deafness, stomach ulcers, and bloodclotting problems which can result in excessive bleeding.

• Don’t assume children can have lower doses of adult painkillers: Seek advice as to what’s safe for children.

• Don’t leave painkillers within reach of children: They can look like sweets, and could be fatal or cause irreparable lasting damage to organs.

GET SUPPORT

Chronic Pain Australia – chronicpainaustralia.org.au

Provides information, connections and support.

Pain Australia – painaustralia.org.au

Works to improve the lives of those living with pain.

Reach For The Facts – reachforthefacts.com.au

Explores and supports opioid addiction.

1WHO releases lower back pain guideline: https://www1.racgp.org.au/newsgp/clinical/ who-releases-lower-back-pain-guideline

2PainAustralia: https://www.painaustralia.org.au/static/uploads/files/opioidreport-2022.pdf

3Chronic musculoskeletal conditions: https://www.aihw.gov.au/reports/chronicmusculoskeletal-conditions/musculoskeletal-conditions/contents/arthritis

4Codeine-containing medicines: https://www.tga.gov.au/sites/default/files/consumerfact-sheet-codeine-containing-medicines-harms-changes-patient-access.pdf

from the makers of

Traditionally used in Western Herbal Medicine to relieve muscle and mild joint pain.

PLANT POWERED ACTIVES

Combines the power of Arnica and Rosemary.

ALWAYS

EVERYDAY

PAIN RELIEF

Can be rubbed anytime*, any place, night or day. *max 4 times daily

TARGETED PAIN RELIEF

Targets the muscle pain right where it hurts.

Pain Relief Cream with arnica and rosemary oil

Skincare spotlight: exploring

the ingredients we're adding to our routine

FROM VITAMIN A TO ZINC, HERE’S OUR ROUND-UP OF THE LATEST SKINCARE SUPPLEMENTS AND INGREDIENTS, AND WHAT YOU NEED TO KNOW.

Our skin is incredible. It’s the biggest organ in the body, accounting for 15% of our body weight.1 Among its many roles, the skin protects our insides from the outside, manages our body temperature, makes vitamin D (which you need for healthy bones, teeth and muscles), and heals itself in the most extraordinary way. And, our course, it’s where we experience the sense of touch.

The key to good skin

When our skin is in good condition, it’s more able to protect us. Chapped, scaly, rashy, spotty and broken skin can be painful – and

makes us more susceptible to infection. The best skin comes from a combination of two things: genetics – which is basically just luck – and a healthy lifestyle. A well-rounded diet, plenty of exercise and sleep, avoiding smoking, and moderation when it comes to alcohol and sunshine, are how to get the best possible skin in the most natural way.

If you’re tempted to try any fortified skincare products, one moneysaving tip is to look for single products containing more than one of these ingredients, such as a moisturiser containing retinol, hyaluronic acid, and ceramides.

Ceramides

Ceramides are fats which occur naturally in the skin, forming a third or more of its outer layer. They act as the cement between skin cells, helping to create that all-important barrier. Their fatty properties help to lock moisture in, which is why people with eczema are often found to be low in ceramides.

Our ceramide levels decrease with age, making our skin drier and less supple. Ceramides can also be lost at any age through abrasive scrubbing, exfoliation, hot showers, and very cold or dry weather.2

A range of products contain ceramides, including moisturisers, toners, and serums, and the effects can usually be seen pretty quickly. They’re also safe to use, and don’t tend to clash with other skincare ingredients. In fact, a product containing ceramides can make other supplements more effective – retinol, for example.

Collagen

Collagen is the most abundant protein in the body, and it’s one of the most important parts of the skin – although it also plays a big role in muscles, tendons, and ligaments. Collagen is helpful to make fine lines and wrinkles less obvious. You can apply collagen to your skin via a moisturiser or serum.

You shouldn’t take collagen if you’re allergic to fish, shellfish or eggs. And since collagen is sourced from cows and pigs, it won’t be appropriate if you’re vegetarian or vegan, or if you follow a kosher or halal diet. However, you can source collagen naturally from your diet: go for fish, chicken, eggs, avocadoes, soy products, and cashew nuts.

Fish oils

Fish oils contain a type of fatty acids called omegas – the bestknown are omega 3, 6 and 9. All of them are good for the skin, but omega-3 in particular will help to keep moisture in, protect you from UV light, strengthen the barrier effect, and promote skin healing.3 It may even reduce acne.

Your body can’t make the omega oils; you must get them from your diet or supplements. Choose oily fish such as tuna, salmon, mackerel, and trout. Avoid anything labelled as ‘fish oil’ if you have an allergy to fish or shellfish. Vegetarians and vegans should find alternative dietary sources for their omega oils, such as flax and chia seeds, kale, broccoli, spinach, and seaweed.

Glycolic acid

Glycolic acid is made from sugar cane. It’s a chemical exfoliant, so it sloughs off dead skin cells to reveal younger, brighter skin. Because of its small molecular structure, glycolic acid also gets under your skin – literally, penetrating the deeper layers to stimulate your tissues to produce more collagen.

Since concentrated glycolic acid is what’s used in chemical peels, it’s important to treat it with respect, even in milder formulations. No one should use a product with a concentration of over 10% glycolic acid without the guidance of a dermatologist.

Hyaluronic acid

Hyaluronic acid is found in the skin, eyes, and joints, having a cushioning and lubricating effect. In higher concentrations, it is believed to also support the healing of wounds and scar tissue.

Hyaluronic acid creates a plump and hydrated look which decreases the appearance of lines and wrinkles. This is hardly surprising as it can bind with up to 1,000 times its weight in water, holding water molecules onto the surface of your skin to keep it well-hydrated.4 It can also help with eczema and facial redness.

Hyaluronic acid is usually added to products like moisturisers. Look for ingredients like hydrolysed hyaluronic acid, sodium acetylated hyaluronate, or sodium hyaluronate. If you want to source it through your diet, choose soy-based foods, bone marrow, citrus fruits, and dark leafy greens.

Niacin (vitamin B3)

Vitamin B3 helps to open up the blood vessels, increasing the oxygen supply to the skin – which can mean clearer, brighterlooking skin. It can protect you against UV rays, and pollution, and can treat acne.

You will often find niacin, or niacinamides, in cleansers and toners — but sensitive skins may experience redness, stinging or itching. However, you can get extra vitamin B3 through your diet: boost your intake of yeast extract spreads (like Vegemite), peanut butter, wholegrain rice, wholewheat bread and cereals, chicken, and offal.

You shouldn’t take vitamin B3 supplements if you have a history of kidney or liver disease, or stomach ulcers. If you have diabetes or gallbladder disease, talk to your GP first. Don’t take vitamin B3 for at least two weeks before surgery.

Retinol (vitamin A)

Vitamin A helps to reduce inflammation, and also replaces dead skin with new cells.

It’s easiest to think of retinol as vitamin A, which immediately suggests you can take it as a supplement, and it also occurs naturally in foods. Go for eggs, oily fish, fortified low-fat spreads, liver, and dairy products like cheese, milk and yoghurt. Red capsicums, tomatoes and sweet potatoes are sources, too.

However, it should be taken with care. It can irritate your skin and make it more sensitive to sunlight, so use sunscreen, and stay out of direct sun. Avoid retinol products if you have sunburn, broken skin, or other skin irritations. Large amounts of vitamin A can harm an unborn baby, so avoid it if you’re pregnant or trying to conceive. Too much vitamin A can weaken your bones, which may be especially problematic for those at risk of osteoporosis (brittle bones).

Retinoids

Not to be confused with retinol, retinoids are made at higher concentrations of vitamin A and are usually only available on prescription, for example, from a dermatologist.

Historically used just to treat acne, retinoids are now recognised as being able to fade pigmentation spots, increase the production of collagen, and improve skin colour by stimulating the production of new blood vessels.

It can take time for the difference to be seen – even up to a year, so you’d need to persevere. All the warnings about retinol will apply all the more to these stronger formulations, and side effects can even include peeling skin, headaches and nosebleeds.

1Understanding the structure and function of the skin: https://pubmed.ncbi.nlm.nih. gov/13677123

2Ceramides 101: https://www.everydayhealth.com/healthy-skin/ceramides/guide/ 3Is fish oil good for the skin?: https://www.medicalnewstoday.com/articles/fish-oil-forskin

4Why science says hyaluronic acid is the holy grail to wrinkle-free, youthful hydration: https://www.healthline.com/health/beauty-skin-care/hyaluronic-acid

Meet Our Team

Get to know the team at Blooms The Chemist Forestville, NSW.

Kim

One health tip I can give is to check your sleep health! Certain health conditions, such as diabetes or high blood pressure, can put you at risk of sleep apnoea – which can have a significant impact on other aspects of your health.

Olivia

The best part about Forestville is a nice community feel, a friendly environment where staff help and support each other.

Halina

I love working with the public, especially the elderly. Getting to help people in my role puts a smile on my face!

Leesa

Forestville is a great location, close to schools and transport. Everyone knows each other in the community, lots of families have lived here for generations and know the history and new families moving in as it’s a great area for families. I love it when customers come in and they know each other and have a catch up in the store.

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