How often have you worked when sick?
​If you ask me, too often. 

As a doctor, I have often turned up at work when sick. Turning up at work sick is not good at all. When I think back on it, I should not have gone, but it's always hard at the time.

I am a cancer surgeon. I often see patients who have been diagnosed with cancer.

Often I hear this from my patients:
"I am going to beat this cancer."
"Can I beat this cancer doc?"
"I am going to continue fighting this until I die."

I love wearing scrubs and whole operating theatre attire.  I also love having a fancy reusable operating theatre cap.  I prefer using it to the ones that hospitals provide.  Hospitals usually provide single-use ones, so they do not need to wash them.  And the claim was that they are more sterile and less likely to lead to infections.  But I do not like those.  

Sunscreen or Sunblock

It's one of the first lessons I learnt after coming to New Zealand.  The first summer I burnt sooo badly on my trip to Northland enjoying the beaches that I had to change my ways.

The name 'Cancer' invokes so many emotions in every patient who hears this word.  Anything that they hear after that is in a fog of this emotion. Even us, doctors have the same reaction if we are faced with this diagnosis.  The best description that I could find about this is in the book "When Breath Becomes Air" by Paul Kalanithi.

There are two examples where we have either changed the name or should be possibly thinking about the change.

​I have always thought that eating raw food is better for us, and this study by Kevin D Hall et al proves this.  Their study concludes that an average person eating ultra-processed food puts on almost 1kg in 2 weeks while eating unprocessed food leads to the same weight loss in the 2 weeks.  And this is huge. So how did they do this?

Early in April France has banned several types of breast implants that are linked to Anaplastic  Large Cell Lymphoma.  The implants that were banned are macro-textured and polyurethane implants.

I have written previously a blog about the link of certain implants to Anaplastic Large Cell Lymphoma (click on this link to read previous blog post).

As doctors, we are rarely taught this. We learn about body composition, metabolism, physiology, anatomy etc. But how much, when and why is sometimes more of the mystery. Or maybe I have forgotten all this.

Luc van Loon is a professor of exercise physiology and nutrition in the Netherlands and he has done amazing research in this field.  Most of the data written in this blog is from his research.

There is going to be a significant impact on climate change on healthcare.  And healthcare has a substantial effect on the production of gas emissions.

I have recently been listening to the podcast Explore the Space with Dr Shapiro. He invited Dr Nick Watts from Lancet Countdown on his show to discuss climate change.  And I was so surprised to learn how much healthcare impacts on climate change and in what way does climate change impact on healthcare.

Exercise is good for us, but developing a habit of daily exercising is extremely hard for most, if not all the people. Regular exercise is associated with lower mortality rates, lower rates of cancer and lower rates of cardiovascular illnesses. How can we exercise more?

I have struggled with developing this habit, and at times, I am still struggling with it. I have recently read a great book called Atomic Habits by James Clear.

Patients most commonly come to see me in the clinic for a reassurance that they do not need treatment, especially surgery, for the condition that they have. Sometimes they attend their appointment with me because they need an operation, like for the treatment of cancers. Sometimes they come because of the fear of unknown.

Exercise is not only helping prevent breast cancer but also lowers your blood pressure.

Moderate exercise has been shown to decrease the risk of breast cancer by up to 20%. And this is huge. We are talking about risk that drops from 11% down to 9% or less. And we are talking about doing 30 min of exercise 5 days per week.

The answer is yes, but the increase in risk is dependent on the amount of alcohol that you drink per week on average. But the devil is in the details.

This picture explains it best. The more you drink, the higher the risk is.

The three most important things in choosing your medical consultant/specialist are:

1. Recommendation from your General Practitioner (GP) for that specialist

2. Knowing if the specialist has had training in the area/condition you wish to see them about

3. Whether this specialist is the right fit for you

I am often asked in the breast cancer clinic by my patients: "Should I have genetic testing for Breast Cancer? or What is the risk of breast cancer for my daughters?"

My usual answer was that breast cancer is common, around 1 in 9 women will develop breast cancer during her lifetime. Let's talk about your family history. Do you have any family history of breast cancer?

This is a question I get often asked by my patients, and my reply is usually: it depends. This depends on: is it possible to have laparoscopic (keyhole) repair or not and whether you prefer to have one over another.

There are several reasons why a surgeon may not be able to perform laparoscopic inguinal hernia repair:

The researchers have concluded that: "In this large, multinational, prospective cohort study involving participants from 21 countries in 5 continents, we found inverse associations between total dairy consumption and mortality or major cardiovascular disease events. The risk of stroke was markedly lower with higher consumption of dairy.

Whole fat dairy has been vilified for years or decades. It has been thought to be associated with hypercholesterolaemia (high cholesterol levels) as well as high levels of other fat in the blood. We have been programmed by heart foundation to drink low-fat milk, almost no fat milk etc. for years. I have recently moved back to drinking regular fat milk and eating dairy products that are the least amount processed as possible. I drink blue (full-fat milk), butter (not margarine), homemade yoghurt (no added sugar), all various cheeses (apart from processed spreadable ones).

Thyroid nodules are very common, up to 67% of people have them. We assess them with the use of thyroid ultrasound. There are ultrasound criteria called TI-RADS that guide us thyroid surgeons and physicians which nodules should or should not be biopsied. And we act based on the results of the biopsy.

Melbourne International Joint Breast Congress

I enjoyed seeing and catching up with friends. As an educational conference, it has been a good conference, and I have learnt or solidified my knowledge. And we in Wellington are doing well. Our medical oncologist and breast surgeons are up to date with their medical knowledge, and we inform and treat our patients with up to date information