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Join Australia's leading comic speechmaker, Homer Papantonio, and renowned cardiologist, Dr. Ross Walker, for a podcast that blends humor and health in a way you’ve never heard before. "The Seriously Funny Wellbeing Podcast" delivers top-notch insights on wellness and well-being with a satirical twist. Get ready to laugh, learn, and live better—it's not for the faint-hearted!
Welcome people to the seriously funny wellbeing podcast number 18. I'm your host, Homer Papantonio. With me, we have the wonderful Dr. Walker, fresh from his recent colonoscopy. So bottoms up Ross. It all went well, hear.
Ross Walker (03:02.734)
Hmm.
It all went very well. And I think it's really important that we talk about this because it was my fifth colonoscopy. Why have I had so many? Because my beautiful dad died of bowel cancer when he was 73. And for the first time, I had three small polyps in the column, which were removed. I'm waiting for the pathology to come through next week. But it's so important if you have a family history to have regular colonoscopies every five years. If you've got high grade.
abnormalities on the polyps to have them more often than that. And I also believe Homer that all people deserve at least one colonoscopy in their life over the age of 50. Some people I know should have one a week without the anesthetic of course. But still it's really an important thing to have and it's all finished and now everything's back to normal.
Homer (03:47.148)
you
Homer (03:55.963)
So I hear that, as you know, a colonoscopy is nothing to fear. It's just a little crappy for a few days after. True.
Ross Walker (04:03.298)
Hmm. no, no, I'm 24 hours later. I feel totally normal.
Homer (04:08.75)
There are squillions of colonoscopy one-liners. I've got a colonoscopy due later this year, but unlike you, I'm nervous about my colonoscopy, but at least soon I'll be able to put this all behind me. My doctor wouldn't let me see the video of my colonoscopy. What is the asshole hiding?
Ross Walker (04:22.357)
yeah.
Ross Walker (04:29.56)
Yep. That's right. And then it's my joke. What's what's the definition of a colonoscope? A long black tube that joins two assholes?
Homer (04:31.512)
I'm to cut.
Homer (04:38.01)
My colonoscopy wasn't the worst medical procedure I've had but it was up there.
Ross Walker (04:44.014)
That's good. You're getting a bit of...
Homer (04:45.666)
My doctor said that my colonoscopy results look like crap. I wouldn't have the guts to be a proctologist. And that's interesting. There is a profession, a proctologist, that is a profession, is it? No. Yeah.
Ross Walker (04:55.01)
No
Ross Walker (05:00.974)
There is, there's not really the gastroenterologists and some of them specialize in the lower colon, in the upper colon. So my colonoscopy was done by a general surgeon. That's all he does is colonoscopies and does general surgery on the colon. So basically I went to him because I've got a bit of diverticular disease, which is extremely common.
Homer (05:18.297)
Mm-hmm.
Ross Walker (05:29.006)
And as part of the diverticular follow-up, I had a colonoscopy with him five years ago and then yesterday. Anyhow, it's all good. And as I said out there, please, over the age of 50, do the national, I think it's now 45 to 75, do the national bowel cancer screening test every two years, which just, you collect a little bit of feces, check it for blood, send it in, and they'll do the test for you. And then,
Homer (05:35.94)
Yeah, yeah, OK.
Ross Walker (05:56.64)
If they find anything, go off and have a colonoscopy or if you're like me, family history, have a regular colonoscopy. If you don't have a family history, at least have one just to make sure that you don't have any polyps in your bowel. Simple thing to do.
Homer (06:08.602)
If they do find polyps, like I've had one, a few polyps removed, I have colonoscopy every six years, I think seven years, whatever, every five years. If those polyps aren't burnt off or whatever, eradicated, they go on to become most likely something sinister.
Ross Walker (06:16.074)
No, it should be fine.
Ross Walker (06:28.108)
No, they may go on to become colorectal cancer. So having a colonoscopy is not just diagnostic, it's also therapeutic because you're reading the body of the pre-cancerous lesions, which are polyps. And there are different types of polyps. So there's a thing called adenomatous polyps, which are much more likely to go into cancer. So I look forward to finding out my pathology results next Wednesday to see whether they would just benign what we call sessile polyps, which is nothing to worry about.
Homer (06:32.975)
Okay.
Homer (06:37.754)
Yeah.
Ross Walker (06:57.196)
or whether they were early adenomas pulps with no early malignant change, which means I'll have another colonoscope in five years.
Homer (07:05.284)
So can those polyps go away by themselves? They can't.
Ross Walker (07:07.95)
Yeah, they can. Yeah, they can. But because people don't have very, very frequent colonoscopies, you don't really know. But I'm sure you could form a little lesion that breaks away and that's it and it doesn't become a problem. But some of them can grow depending on the size of the stalk. So polyps are just a little lump attached to the colon. And they might break away from that attachment. And then you just pass them out through the feces. But
Homer (07:22.819)
Yeah.
Homer (07:29.198)
Yeah.
Ross Walker (07:35.822)
If they stay on that stalk and then become malignant over time, that's when they can turn into a cancer. Bowel cancer is 100 % preventable if you pick it up early. But if you wait for it, like my dear dad did many, many years ago, then you end up with the misery of someone dying of terminal bowel cancer. It's just horrible.
Homer (07:45.39)
Yes.
Homer (07:55.813)
So when do you stop the olinoscopy? Yeah.
Ross Walker (07:58.638)
Yeah, look, if you've made it to about 75 and there's nothing going under the collar, if you've still got significant polyps, well, you might keep having them whilst ever you're well enough to have them. But my brother, for example, who's five years older than me, he's now stopped having colonoscopes because he just doesn't have anything in his bowel.
Homer (08:09.465)
Yep, okay.
Homer (08:18.464)
Okay, so let's get on to medical news. Upcoming
Ross Walker (08:22.216)
Before we do, just want to tell you something. Did you hear that Mick Jagger and Keith Richards went to a friend's place for dinner and he was cooking a turkey, but he undercooked the turkey and all the people at the dinner got very sick. So this man almost killed two stones with the one bird.
Homer (08:39.93)
I think you're cashing the same check in there Ross. think that was wasn't that on healthy living a while back? No, might have been. Yeah, yeah, yeah. Okay. Okay, that's good. And and do you know that there's no copyright on a joke? You can't you can't say like, Wally, you breached my copyright there. You can't say that joke.
Ross Walker (08:49.203)
yeah, well, I mean, not everyone listens to both. I can use the same joke twice as long as you don't have the same audience.
Ross Walker (08:59.02)
No, sure they did.
Ross Walker (09:05.454)
Yeah, and just before we get onto the topics, I just want to tell you, and I use this one on healthy living as well. My wife and I went shopping the other day and she said to me, I was one of the laziest people she'd ever met in her life. I was so shocked. I almost fell out of the shopping trolley.
Homer (09:22.774)
Ha
That's a good one. so medical news, upcoming flu season. Yes.
Ross Walker (09:31.948)
Yeah, this is actually quite a concern because every year, you're probably well aware of this, influenza hits the Northern Hemisphere first during their winter. Then it picks up its frequent flyer point. Somebody who's got influenza in the US flies over to Australia or wherever in the Southern Hemisphere. And when we get into the colder months, then influenza starts to rise. Now, this is the concern because
Homer (09:44.559)
Yep.
Homer (09:51.289)
Yeah, yeah.
Ross Walker (09:59.928)
the flu season that's hitting the US at the moment is the worst season they've had for 15 years. So I'll just read out some of the figures from the US. There have been 24 million influenza cases so far this year out of the population of 330 million. And when you say 24 million cases, they're the reported cases. So not every case gets reported. So I'm saying there have been many more cases of influenza.
310,000 hospitalizations for influenza and 13,000 deaths, including 57 children from influenza. So look, it's recommended, Homer, in this country, in the US, that everybody over the age of six months has a yearly flu vaccine. And you know how many people do that? 45%. So we're talking about 55 % of people
Homer (10:41.146)
Mm.
Homer (10:52.74)
Yeah, Okay.
Ross Walker (10:58.814)
missing out on a treatment that can prevent them from getting very ill from influenza. Now, again, it's a bit like the COVID vaccines. The COVID vaccines didn't stop you getting COVID. What they stopped you doing was getting the severe versions of COVID that killed people or put them on ventilators. And it's exactly the same thing with the flu vaccine. It's really, really interesting that I also said on my show a few weeks back, there was a study to show that people who have their regular vaccinations, whether it be
Homer (11:15.822)
Okay.
Ross Walker (11:28.302)
flu vaccines or whether it be the shingles vaccines when you get to a certain age or even just the standard vaccines we had as kids. People who get those regular vaccines have around a 30 % reduction in progression to Alzheimer's disease as one example. And also a big study at the University of New South Wales a few years back showed that people have a yearly flu vaccine have a 40 % reduction in heart attack. So why is this? It's because we're suppressing inflammation.
by being vaccinated. So I just thought it was really, really interesting topic.
Homer (11:58.587)
Yeah, So respectfully, I disagree a little bit to you, with you on the whole vaccinate, because I would just... I would look at that 13,000. Now, if we analyse the 13,000 deaths there, you said quite 57 % were children.
Ross Walker (12:06.818)
Yes, thank you, Dr. Patentonio. That's good. Yeah. I really respect your opinion.
Ross Walker (12:18.882)
Hmm?
Ross Walker (12:22.414)
No, no, no, I didn't. said 57 children out of 13,000, not 57%.
Homer (12:25.76)
Okay, out of that, yeah, yeah. So if out of that 13,000, the average age of death was, just say, in their 80s, would that still warrant all the young people to get vaccinated? Yeah.
Ross Walker (12:35.372)
Hmm?
Ross Walker (12:40.974)
I think so. Yeah. Because, look, I'll tell you from a personal viewpoint, I'll tell you two stories. Okay. I'll tell you my own story and I'll tell you another story. I, my immune system loves influenza. So if I don't have a yearly flu vaccine, I will get influenza every time it comes around. So it's just something about the immune system. My own immune system really soaks up at the influenza virus. Whereas I've got a friend who's 92 years old.
Homer (13:08.259)
Yeah.
Ross Walker (13:11.458)
He's never had influenza in his life and he's never had a flu vaccine in his life. so, and this is the same for all medical therapies. I think this is a really vital point that everyone takes on board. When you give anyone a treatment, it doesn't mean they all benefit from the treatment. It means that you're hitting some people and you see we're headed towards the era of personalized medicine. We're not there yet where
Homer (13:13.976)
Hahaha.
Yeah.
Homer (13:28.963)
Yeah, yeah.
Ross Walker (13:39.214)
it'll be seeing what we do now as being a bit barbaric. So for example, I had the colonoscopy yesterday, but we'll get to the point where we're able to test people's genetic makeup to see whether they're going to get bowel cancer. And we'll only do the targeted testing on the people who have the gene for the definite gene for bowel cancer and leave everyone else alone. In the same way, we will be able to at some stage in the next 10 to 20 years,
map people's genomes and their epigenomes and say, okay, you're much more predisposed to COVID or to influenza or RSV. So therefore you're the ones that need the vaccine, but you, you're going to react badly to the vaccine. So with the COVID vaccine, for example, the RNA vaccines, 0.2 % of the population had a serious adverse reaction. Now that's a few.
Homer (14:32.474)
But are you stuck between two philosophies there? Like if I said to you that vitamin C, garlic, zinc, vitamin D are really good at preventing cancer, and I'll pursue that tact instead of getting the vaccine. If they could prove it.
Ross Walker (14:50.912)
I think that's really foolish. think it's foolish because why don't you do both? You see, that's the thing. It's not either or, it's both. And let me also say, and this is why I've got a real problem with people who are anti-vaxxers. The last century, the greatest medical innovation was vaccination. There is no doubt about that. And anyone who disputes that is a moron.
Homer (14:55.853)
Okay.
Homer (15:09.888)
Mm. I'm not, yeah, yeah.
Yeah.
Ross Walker (15:15.766)
It's proven that vaccination prevented so many nasty childhood illnesses, polio, smallpox, and it also got us out of the pandemic. But no one, no one, Homer, is suggesting it's harmless. That's the point here. I make that, let's just talk about measles for a second, because I think it's a really important discussion. If you put measles through a group of kids,
Homer (15:26.968)
Yep.
Homer (15:33.23)
Yep.
Ross Walker (15:44.462)
One in a thousand will get a thing called subacute sclerosing pan encephalitis, which is a dreadful neurologic condition, leaves them intellectually impaired for the rest of their life. If you vaccinate a group of kids, one in 10,000 will get the same condition. So therefore, the measles vaccine is 10 times safer than measles, but it's still not 100 % safe. And this is where
Homer (15:49.764)
Yep.
Ross Walker (16:14.51)
I have a real problem with people that don't really follow modern medicine. Because modern medicine is like a high-performance motor car. It gets you from A to B very quickly, but there is still the small potential of crashing and killing yourself. So you need safety belts, you need safety mechanisms in the car, you need very rigid road rules. Whereas a bicycle, I know you occasionally get on a bike, a bicycle gets you from A to B much slower. That's like vitamin supplements.
Homer (16:29.945)
Mm.
Ross Walker (16:43.288)
but you only have to wear a helmet and keep away from lunatic car drivers and also don't breathe in the fumes from the cars. But what I'm saying is there two different things. One has a much stronger and more acute effect. The other one there, and I say all the time, vitamin supplements keep healthy people healthier and they make the drugs and everything else work better if you are sicker. So yes, of course, the people who will get
Homer (16:56.184)
Yep.
Ross Walker (17:11.34)
very sick from influenza are young, they're very young and they're very old and most of us don't get as much of it. But when, as a doctor of 45 years experience as opposed to an armchair critic, I have seen people in their 20s, 30s and 40s dying from influenza, dying from the common cold, dying from COVID. And when you see these things, you say, we want to offer them the best medical therapy we have.
Homer (17:30.456)
Yeah.
Ross Walker (17:40.514)
But as the only true integrative cardiologist in this country, I still believe there is a place, only 10%, but a place for supplementation. But I still believe that 80 % of anyone's management is how they look after themselves.
Homer (17:50.36)
Yeah.
Homer (17:54.905)
Yep, beautiful. Okay, medical news, nasal spray for major depression. Immediately I thought of the word opium or when I read this, nasal spray for major depression. So someone's feeling not that crash, they just whack a few drops up their nose. Suck it.
Ross Walker (18:18.702)
Many, many, many people working in the financial industry in Sydney do that, but it's a different sort of drop. Yeah, no, no, look, what we're talking about here is a thing called esketamine, which is a bit like ketamine. So the molecules been tweaked a bit. It's what we call an NMDA receptor antagonist. And this esketamine is used for this major depressive disorder. Now, let me just put this in perspective.
Homer (18:23.546)
Yeah.
Homer (18:32.281)
Yep.
Homer (18:40.697)
Yeah, yeah.
Ross Walker (18:48.566)
Major depressive disorder is the commonest mental health issue around the world. And here's where depression gets the wrong messages in the public. somebody goes to the doctor, they can't stand their partner, their kids are on drugs, they hate their job. I'm depressed, doctor. No, no, no, you're suffering grief. That is a reaction to your situation. That is not true depression. True depression
Homer (18:54.65)
Mm.
Homer (19:15.245)
Yeah.
Ross Walker (19:17.068)
is a disorder of brain chemicals. You can have the allegedly happiest life on the planet and be depressed because you have this major depressive disorder, which is characterized by losing your interest in things. So someone like you, who's an expert cyclist, would say, I just don't feel like cycling anymore. That's a major symptom of major depression. You feel tired throughout the day. And typically, you wake up at 2 in the morning staring at the ceiling for an hour for no good reason.
They're the three cardinal symptoms of major depressive disorder. The two really bad ones are a feeling or a sense of hopelessness about life and the other one being suicidal thoughts or suicidal ideations. So that's major depressive disorder. And here's the problem that 30 % of people who get that particular syndrome, not the grief, so antidepressants do nothing to the grief.
change your relationship with your partner, they don't get your kids off the drugs and they don't make you like your job. major, antidepressants treat about 30 % of people with major depressive disorder. One course they feel better. But still many people need two courses and even then they don't feel better. So refractory major depressive disorder, they use this nasal spray. It works within minutes and it's quite effective. So I'm saying this could be
Homer (20:29.658)
Yep.
Homer (20:41.027)
Mm.
Ross Walker (20:44.568)
the future of the treatment of depression to use it? No, well, it's local and just goes straight into the brain. So there's not a huge amount of side effects with it. So it seems like it, but it's not available yet. So for anyone who's suffering major depression disorder, it's just been approved by the FDA in the US. Our TGA is much slower because I think they're a bit more careful with what they do. And so I just think it's something to think about that will be delivering a lot of treatments, including vaccinations intranasally.
Homer (20:46.67)
Side effects?
Homer (20:53.261)
Okay.
Homer (20:57.177)
Yeah.
Ross Walker (21:14.168)
there's been talk about intranasal insulin as one example, rather than injecting yourself. So a lot of interesting things are happening in this space.
Homer (21:21.73)
And there was an interesting study a few years ago looking at the relationship with vigorous exercise to mood by bipolar disorders and whatever. And they found that when you exercise at a really intensive level, it actually neutralized anxiety and improved mood more than...
even antidepressants with... Yeah, have you seen that? That's interesting, isn't it?
Ross Walker (21:51.136)
About the same as antidepressants. Yeah, I've seen the studies. look, that's what I say to everybody. We all should have a three to five hour a week exercise habit because just by doing three to five hours a week of exercise, you reduce your risk by 30%, heart disease, cancer, Alzheimer's, diabetes, 50 % reduction in depression and osteoporosis, drop your blood pressure and you sleep better. Exercise is the second best drug on the planet after happiness.
Homer (21:59.247)
Yeah.
Homer (22:03.065)
Yeah.
Homer (22:14.446)
Yeah.
Homer (22:20.73)
Yeah, it's interesting. I don't know what this one is. Controversies. When you hear the word sexsomnia, you think you're staying up. It's up. Everything's up. You're thinking about sex having intercourse. What is it?
Ross Walker (22:41.102)
No, that's not what it is, my friend. Let me tell you, the definition, I have to read this, the definition of sexsomnia is a type of parasomnia, so it's a disorder that occurs when you're asleep, which leads to individuals engaging in sexual behaviors whilst asleep. So, oh, wasn't me, I was asleep at the time. So in fact, it's been used, I just thought this is more the weird file than anything else, it's been used as a defense.
in cases of
Homer (23:12.74)
But isn't that a conventional nocturnal emission? I mean, when you have a nocturnal emission, I love that word, nocturnal, when you have that, you're not really conscious that you're doing it. It's normally in a dream. A nocturnal emission is normally, yeah, a wet dream, yeah, isn't it?
Ross Walker (23:17.954)
Mmm.
Ross Walker (23:28.471)
I don't think I...
I get you wet dream, see. Yeah, but we're taking these people are taking it to the next level. They're actually having sex with their partner or with someone and they're allegedly saying they don't remember it and they're asleep. And now it's actually been added to DSM five, which is the diagnostic and statistical manual of mental disorders. A long side wait for this sleepwalking and night terrors.
I'd probably prefer the sexsomnia, but anyhow, and sexsomnia is allegedly triggered by stress and alcohol, and they actually have medical treatments for sexsomnia. I don't want be treated there. It's like the woman went to the doctor and said, doctor, every time I sneeze, I have an orgasm. What do you use for it? Pepper. So anyhow, it's said that there are now...
Homer (24:19.994)
That's really weird. That's in that area that it's not what you are anymore, it's what you identify as. Isn't it? it? It is in that area. mean, anyway.
Ross Walker (24:26.734)
Yeah, let's not get into that. don't want to get into that. There's been 116 cases documented as of 2020 of sex omnia. So I just thought it was a weird thing to bring up. I think it's a bit funny. look, and if there's anyone out there who genuinely suffers this condition, I'm not demeaning what you're suffering. But look, we're just having a bit of fun. And as the greatest comedian ever on the planet, my view, Ricky Gervais once said,
you find it offensive, I find it funny, that's why I'm happier than you. if you do suffer it, I'm sorry for you, it's dreadful, but I just think users are the defense in legal cases a bit much. Okay, next.
Homer (25:01.434)
Yeah.
Homer (25:05.501)
Yeah, yeah.
Homer (25:11.574)
Okay, so Ross, the subject of, and we're going to graduate to another subject, technically the subject of this week's podcast is what is health, aging and what is functional ability. So we agree that every person in every country in the world should have the opportunity to live a long and healthy life. Yet the environments in which we live can favour health or be harmful to it. And quite interesting,
much to my wife's pleasure or displeasure, I've always picked where we live to where I can cycle, the environment for cycling, for safe cycling. there
The environments are highly influential on our behaviour, our exposure to health risks, for example, air pollution or even violence, even our access to quality health and social care and the opportunities that ageing brings. Healthy ageing is about creating the environment and opportunities that enable people to be and do what they value throughout their lives. Everyone, everybody can experience healthy ageing, being free of disease or infirmity.
And then the other thing is functional abilities, having the capabilities that enable all people to be and do what they have reason to value. This includes a person's ability to meet their basic needs, learn, grow and make decisions, be mobile, build and maintain relationships and contribute to society. Functional ability very quickly consists of the intrinsic capacity of the individual relevant environmental characteristics.
and the interaction between them. So that's a really interesting area. I've always liked the definition of fitness as having enough energy to do what you need to do in one day. And there's a functional aspect of that where like, it's almost like how you spend your time, your free time, you know?
Homer (27:21.274)
happy functionality is where you're functional and you're fulfilled because you're doing something you like to do that's also good for you. And then when you brought in your subject, I thought that's interesting because through the process of them being functional, they may elevate their heart.
to certain middle-aged athletes exercising too heavily and the atrial fibrillation side of it.
Ross Walker (27:59.756)
Yeah, yeah. And look, I think this all sort of goes together. If people practice my five keys of being healthy, no addictions, good sleep, good eating and less of it, three to five hours every week of exercise and happiness. And happiness is the hardest thing for people to attain. But as I think I've mentioned before on the podcast, there's a little known university in America called Harvard, which we've been doing for the last 80 years, the grant study and the grant study shows clearly.
Homer (28:13.145)
Yeah.
Ross Walker (28:28.098)
the one key to health and happiness is to have someone else in your life who loves and cares for you, who you love and care for. Now tragically, at least one in six adults in Australia, the proportion's probably even higher, complain of or admit to being either lonely or feeling socially isolated, which is where you have little contact with other people. And that's dramatically associated with all forms of
disease, cardiovascular disease, cancer, Alzheimer's, et cetera. So when you talk about being functional and being happy and doing all those things, they all meld in together. And also, if you do have strong relationships with other people, if you do feel socially connected, you will be more inclined. So for example, in your case, you don't cycle by yourself. You've got a group of mates you cycle with.
Homer (29:06.414)
Yeah, yeah.
Ross Walker (29:25.258)
and you have a cycling community and being in that community bonds you with other people and makes you happier. But the one key to health and happiness from this grant study was to have someone else in your life who loves and cares for you, who you love and care for. So it's so important to really nurture your social relationships, especially with the people who are around you.
Homer (29:25.304)
Yeah, occasionally.
Homer (29:50.267)
What about spiritual connections? People that, I mean, because being a Christian, God loves you, you've got to erase theoretically a relationship with God. Even in a meditative state or whether you believe in a Buddhist or whatever, is that relationship also as important as having someone or can it be?
Ross Walker (29:52.888)
Yeah, but that's...
Ross Walker (30:15.106)
Look, I don't think it's either or. Again, it's the same thing. There are many people who have no religious beliefs, not even any spiritual beliefs. So what's the difference? I religious belief is when you hook your name to, you just said you're a Christian. So you hook your name to one religious belief. That's fine. But there are other people who have no religious beliefs. They don't believe in specific religions, but they still believe there's a higher force, higher being, whatever you want to call it. But I think having that sort of
Homer (30:17.934)
Yeah.
Ross Walker (30:44.692)
life connection in it, whether it's religion or just spirituality or just having even having a life purpose that's been shown also to be vitally important.
Homer (30:52.91)
Yeah. So what let's get on to the atrial fibrillation in middle aged athletes. And let me get as a preface to that, say that.
Ross Walker (31:01.175)
Okay.
Homer (31:07.386)
As I've mentioned before, are almost an epidemic, and you probably see it more than what I do, of middle-aged athletes, triathletes, because the thing with, like I've done like 100 triathlons over the years, and they really do, something about triathletes is that they push the envelope, not just in one discipline, but in three, swimming, cycling, and running.
And it's not a normal, the Olympic distance used to be 1.5, 40 and 10. Now it's, you know, the ultra distance, the Hawaii ones where you're 4K swim, 180 on the bike and a 42K run at the end of it, right? And we're going to a stage now where... You've cracked that joke.
Ross Walker (31:53.39)
Look, can I just butt in? These people should all know there's a perfectly good bus and ferry service. Why anyone would do this to their body? Look, as a cardiologist, I think it's madness. And I'll start this with a story.
Homer (32:09.912)
Okay, but before you get on to that, you've got to look at it in maybe a balanced objective way if you can. But they are addicted to it. It's like a drug and they are addicted to that.
Ross Walker (32:17.742)
I think balance and objective, those extremes, it stuffs your body around.
Ross Walker (32:27.446)
It's a better addiction than heroin or cocaine, but it still has its consequences. Every addiction has its consequences. Now, let me just start this conversation with a story. I had a man as a patient who was in his 40s. He was a semi-professional triathlete. But after he'd done a number of triathlons, every time he'd go into the triathlon, he'd start competing, he'd go into atrial fibrillation. So I said to him, the best thing he could do for his heart was to
Homer (32:32.313)
Yeah, yeah, yeah.
But...
Homer (32:38.756)
Okay.
Ross Walker (32:57.198)
buy a jacket with coach written on the bottom, on the back. And he did went straight through the keeper. didn't get what I was talking about. look, let me just make a point here. Atrial fibrillation is the commonest serious heart rhythm disorder. 1 % of people up to the age of 50 have had a clinical episode of atrial fibrillation, 5 % 60, 10 % 70, 20 % 80. If we all live to 150 and thank God we don't, we'd all be in atrial fibrillation.
probably need pacemakers as well which has got nothing to do with atrial fibrillation, it's not part of the management. So the problem is they did a study of veteran soccer players over the age of 50, much higher rates of atrial fibrillation compared with the rest of the population. Any high-performance athlete, whether they be triathletes, cyclists, swimmers, have higher rates of atrial fibrillation. Now the question is why? It's because when you exercise, you do what we call remodel the heart.
The heart's physiology changes, the electrical system which runs through the heart, so the electrical system through the atria at the top, the ventricles at the bottom, changes. So I've seen so many people who were high-performance athletes in their younger years now end up with all the electrical problems in their older years, including especially atrial fibrillation.
So it's what the Buddhists call, you mentioned Buddhism before, but it's what the Buddhists call the middle path. And you see, the dose of exercise that is good for you is three to five hours per week of moderate exercise, two-thirds cardio, a third resistance training. If you do more than that, it may do you no harm. But the problem is the studies are showing beyond a doubt that heavier exercises
have much more atrial fibrillation, as we mentioned, much more coronary calcification. And not everybody gets it, but they get it more than people who don't do it. So as you pick up on something you said, it's an addiction. Now, it's a better addiction than alcoholism or cigarettes or illegal drugs, but it's still an addiction. So I say to people, if you want to exercise for good health,
Homer (35:04.547)
Yeah, yeah.
Positive addiction.
Ross Walker (35:15.746)
do three to five hours a week. If you want to exercise for other reasons beyond that, you're doing it for your own stuff. But it's not to be healthy. You don't get any more health above the three to five hours a week.
Homer (35:21.378)
Yeah, but.
Respectfully, I agree with everything you've said, Dr. Walker, but there's also a mental, emotional, even a spiritual component to activities that many people regard as important as the physical outcome they have. Yeah.
Ross Walker (35:35.747)
I think,
Ross Walker (35:43.406)
Well, look, as I said, there's the community that goes with it. There's the endorphins that are released when you exercise. Look, I'm a regular exerciser, but I would not do more than about five hours of exercise a week. I do the dose.
Homer (35:52.942)
Yeah.
Homer (35:56.507)
What about, so on the bike, you've got the luxury, you can actually spin and it's all, I'll be lucky. So my basic training regimen in a week is I have two or three, two intense sessions of about an hour where I've got a heart rate between 170 and 190, which sets everything off for my age, right?
And then I do an ETH ride three or four days for one or two hours and I've got a heart rate of maybe 80 to 90. That sort of regimen, also with weight training, would that predispose me to this sort of ailment? It will.
Ross Walker (36:38.998)
Absolutely, absolutely. it doesn't mean, see this is the problem with the public who are not scientific. It's all about them. We're not talking about it's all about them. Many people will get away with the exercise you do and it's not going to have an effect on your body. I think it does have an effect in some way in almost everybody and it mightn't be heart disease. It could be a predisposition to cancer or what else. And look,
Homer (36:44.493)
Okay.
Homer (36:50.074)
Yeah.
Homer (37:06.906)
Yeah.
Ross Walker (37:07.982)
As a stupid old fart that played soccer and squash till I was 52, I've had to my knee replaced. I have constant problems with my neck and my lower back from all of the excessive exercise I've done throughout my life. Now, and I love exercise. I will do a half an hour today on my bike. I've already done my weights and stretching this morning. But I do that. That's enough for me. My body can't take any more. And as I say, the only joint you blow over the age of 50 is your hip or your knee.
Homer (37:14.522)
Mm-hmm.
Homer (37:27.95)
Yeah.
Ross Walker (37:37.548)
So you've got to be a bit sensible about this. Now let's move back to atrial fibrillation. So what is it? So the heart goes boom, boom, boom, boom, boom, boom. That's called sinus rhythm. The sinus node up the top of the heart and the right atrium sends an electrical impulse through the two. Instead of doing that with sinus rhythm, in fibrillation, the top chambers just quiver. That's the fibrillation. So you're not flushing blood through the top chambers into the bottom chambers.
Homer (38:00.239)
Yeah. Yep.
Ross Walker (38:05.42)
So little clots form because it's stagnant. And so those little clots can flick up to your skull and cause a stroke. So atrial fibrillation is the cause of a third of strokes. even if you're not fibrillating at the time, can still have a clot that's sitting there, it just flicks off up in your brain. So the two major consequences of atrial fibrillation, stroke number one. Number two is heart failure. So the heart pump just becomes impaired by the chaotic rhythms that are going through it all the time.
Homer (38:08.024)
Yep.
Ross Walker (38:35.138)
so the heart stops working as well. can we just, Ziggy, just stop the, don't stop the recording. I've just got to tell my cleaners to stop cleaning outside the room because it's making a noise. Just give me two seconds.
Homer (38:47.288)
Okay. Okay, yep.
Homer (39:08.634)
Yep, 38 minutes.
Ross Walker (39:10.818)
Sorry, if we can restart that, sorry about that, but he's making noise there, he's gone now. Okay.
Homer (39:12.92)
Yeah. So we're talking about atrial fibrillation and holding strokes, heart attack, Yep. Yeah, heart failure.
Ross Walker (39:17.994)
Yeah, yeah. Yeah. And causing heart failure and not heart attacks. It causes, there's no link between atrium. So this is something that does my head in. Someone goes off into a doctor, they're in atrial fibrillation. And so, and they might've had a little stroke flicked off from their, from their atrium into their brain. And so the doctor puts them on a statin. Why? Because you've had a stroke. No, but it's a stroke caused by a clot going into my brain. It's got nothing to do with my cholesterol. Orbiturus stroke. See, it's just,
Homer (39:39.482)
Mm.
Homer (39:45.658)
Okay, yeah. Because the GP would assume quite wrongly that the ailment was, the stroke was caused by a blockage. So it's an electrical problem, it's not a plumbing problem.
Ross Walker (39:47.936)
illogical arguments.
Ross Walker (40:04.494)
It's an electrical problem of then the atrium has static flow, clots form and flick up to your skull. It has nothing to do with your cholesterol. So you don't need a cholesterol lowering pill because of atrial fibrillation and a stroke. You need a cholesterol lowering pill if you've got muck in your arteries and it's been shown high level muck in your arteries, so a calcium score above 100, or you've had a heart attack, stent or a bypass.
Or you've got a whole lot of atherosclerosis in the carotid arteries going up to the brain. That's another reason to go into cholesterol-lowering pills. But let's move off to that and talk about the management, the causes and the management of atrial fibrillation. So what causes atrial fibrillation? Well, getting older. You see, we're only designed, as I've said a hundred times on this podcast, to wander around a jungle for 30, 40 years with a spear and then die. But when you hit 50 and the hormones go south,
Everything wears out in the body. The electrics wear out in the body. And as the electrics wear out, you have more chance of getting atrial fibrillation. So that's the first thing. So age is a major thing. age is the major cause. But throw high blood pressure on top of that. Throw thyroid problems. And then any stressor. So the five stresses can precipitate an episode of fibrillation. Emotional stress, mental stress.
Excessive physical stress, which is what we're talking about now. And pharmacologic stress. I had a fellow in his 30s who thought it was a good idea to have three double shot cappuccinos in an hour, send his heart into overdrive atrial fibrillation and the heart went into failure because of that. So we had to restore everything back to normal and he was fine after that. But have a snort of cocaine or have a joint or have a night on the grog. There's a thing called the holiday heart syndrome.
So when people go on holidays, they tend to drink more alcohol than when they're at home. And often people end up in the accident emergency department in the middle of the night in atrial fibrillation because they've had a night on the grog. So any pharmacologic stress, legal or illegal, can put you into atrial fibrillation. And then finally, in this COVID pandemic, or any, we've been talking about influenza today, any infection can inflame the electrics in the heart, send you into atrial fibrillation. That's atrial fibrillation.
Ross Walker (42:24.43)
And if you've got a thyroid problem, it makes it worse as well. But the management of atrial fibrillation depends on the atrial fibrillation. So some people have one episode of atrial fibrillation lasting for half an hour every three or four years. So what? I treat those people with what I call the pill in the pocket. So I give them a script for a particular drug. I've checked their heart out, made sure it's OK. They go into fibrillation. Six months later, they swallow the pill.
Homer (42:42.244)
Mm-hmm.
Ross Walker (42:53.592)
they're back in sinus rhythm. That's all they need to do. They shouldn't be on aspirin. Aspirin doesn't do a damn thing to fibrillation, stopping the clots forming. But that's all you do for those people. But then there are people who have what we call paroxysmal atrial fibrillation, where they might get it for a half an hour, an hour or two every week or so. They're the ones that are predisposed to getting the clots. So they need either what we call ablation.
where you're going through the vein and the groin up to the heart. It's a three hour general anesthetic, it's a big deal. And I think over the age of 65, I would reserve prolonged general anesthesia for really life threatening conditions. or something like me, I need my knee replaced, that's an hour general anesthetic, but this can be a three hour general anesthetic. So if you're a 78 year old with paroxysmiatrial fibrillation.
You don't want to put your brain under a three hour general anesthetic because of the risk of dementia. So what you do is you go into chronic pharmaceutical therapy, which includes a very strong blood thinner and anticoagulant, not aspirin, not warfarin. We've got other drugs now. We don't have to use warfarin anymore. And also you go into antiarrhythmics to keep you in a good rhythm. So that's the way to manage atrial fibrillation. Now for very, very old people where nothing seems to be working,
you can sever the connection between the top chambers and the bottom chambers of the heart, them back in, putting them into a chronic atrial fibrillation, but it's not affecting the bottom chambers of the heart, and whack a pacemaker in. But the pacemaker doesn't control atrial fibrillation, it just controls the heart rhythm in that situation. So there's your overview of atrial fibrillation. It's easy to manage. I would see three or four cases every day in my practice.
But let me make the final point about atrial fibrillation, which should be made for every condition. There's been some work by one of my colleagues, Prash Sanders in Adelaide on lifestyle changes. And the reason we're now seeing this pandemic of atrial fibrillation is because we have a pandemic of diabetics. So if people can lose five, 10, 15, 20, 30 kilos,
Homer (44:59.481)
Yeah.
Ross Walker (45:10.018)
they take the fat out of the electrics in their heart and they markedly improve the management of their atrial fibrillation. So we need to look at that side of it as well.
Homer (45:18.104)
That's interesting, especially given that most endurance athletes have got minimal body fat.
Ross Walker (45:24.908)
Now, that's, but you see, again, you're doing what the public do. You're just bringing it back to yourself. Of course, fatter people will get atrial fibrillation, as will high-performance athletes, which in their case has got nothing to do with their body fat. So the worst things you can do, it's much worse for your body to be overweight, obese, diabetic than it is to be an athlete. I'm just saying that the people who are the healthiest people, not the fittest, but the healthiest people,
Homer (45:39.331)
Okay.
Homer (45:44.534)
Yeah, okay. Yeah, yeah.
Ross Walker (45:53.11)
are people who follow the middle path, do their exercise, but only three to five hours a week. And they can still be happy and still have the connections without having to do the excessive exercise. And it is excessive.
Homer (46:04.356)
Do you think we're ever going to get to the stage where maybe exercise physiologists or esteemed cardiologists like yourselves would say, this is what the research shows, you can do that type of exercise and maybe miles and miles of it, but it has to be anaerobic or it has to be basically aerobic. You need to have...
Will there be any supplementation or any...
Ross Walker (46:37.774)
There may be, but we will get to the point where we can say, map someone's genes and their epigenes and say, you're someone where the exercise isn't going to cause atrial fibrillation or isn't going to harm you. You're fine to do that, but you're not. look, who knows what's going to happen in say 30, 40 years. We might have a cure-all for everything. Who knows? But at the moment, can deal with
Homer (46:51.798)
Okay.
Homer (47:02.522)
What's the association with atrial fibrillation and longevity?
Ross Walker (47:10.478)
there's a strong link between the more atrial fibrillation you have, the more dementia you have, the higher death rates. Atrial fibrillation is bad news and it needs to be managed and the earlier you manage it, the better. But I've got a bucket of people who are following all of my advice in atrial fibrillation all the time and they'll still have a normal lifespan.
Homer (47:16.375)
Okay.
Homer (47:34.074)
So with the dementia, have that got a lot to do with the oxygen deprivation to the brain?
Ross Walker (47:38.21)
No, no, no, it's to do with microclots going up to your brain and destroying the brain from the atrium.
Homer (47:45.252)
Really interesting area, isn't it? And there are exercise physiologists out there that are trying to work out why this is happening in middle-aged athletes.
Ross Walker (47:56.788)
It's damn obvious. We were only designed for the short sharp runs to get away from the beast or to follow the beast to kill it. We weren't designed to be doing this ridiculous long term exercise. You're designed to move all day. The people with the greatest longevity on the planet we've spoken about, the Blue Zones, they've never heard of damn gyms or cycling. They just move up and down all the time. They move all day. They don't exercise. They just move, move and more move.
Homer (48:08.909)
Yeah, yeah.
Homer (48:22.742)
Okay. I should have brought you a recent study of Tour de France cyclists showed that they lived longer than the general population and they
Ross Walker (48:34.562)
Yeah, look, there's a guy in Australia who's the sports cardiologist, Dr. Andre Lagush, and he knows a thousand times more about this than I do. And I've interviewed him on my radio show and Andre published a paper to show that people who have run the sub four minute mile, starting with Sir Roger Bannister and beyond that have greater longevity than people who can't do that. So.
Homer (48:41.806)
Mm.
Ross Walker (48:59.736)
There's something about certain people who can do certain things that gives them enormous longevity. But again, I think there is a subselected or preselection bias in that because they're able to do that level of activity, it probably gives them some other protection. But it doesn't mean that all people who want to become a middle-aged cyclist or a middle-aged athlete are going to come out of it well. That's the point I'm making. Some people will do it without any issues at all.
maybe the people who can cycle to the level of the Tour de France, which is not everybody, have some other protective mechanisms in their body. don't take, you see what you're doing is you're taking data from a preselected group and extrapolating it to everyone else. That's nonsense, that's not science.
Homer (49:38.308)
So.
Homer (49:46.959)
Yeah. So duration versus intensity. it? OK. Is the intensity worth? OK. So the duration is probably, in your terms, worse than the intensity? Is it the other way around?
Ross Walker (49:52.75)
Well, the duration is three to five hours of moderate exercise. It's a very simple mercy chamber. What's the kiss principle? Keep it simple stupid.
Ross Walker (50:08.322)
No, no, no, no, no, no, no. think, no, I think it's the whole package. It's what is good for, I'm not saying what's bad for you. I'm saying what's good for you. Three to five hours of moderate exertion per week.
Homer (50:15.714)
Okay, okay.
Homer (50:19.928)
Yeah, very interesting. We did have, I can't find the other questions, but we did have, we've got one question. Bev, can you, from Bev, asking, Ross, can you tell me what the name of the multivitamin with glycosam on salts that you mentioned? You can't, you're not allowed to mention. Okay, so I, okay. Yep.
Ross Walker (50:40.45)
Yeah, no, I'm not allowed for them. can send an email in and I will answer that. I'll answer it on the email because I can't publicly say on a public forum podcast, a particular product, I will be hammered by the TGA. But if someone Googles glucose amine salt of five prime methyl tetrahydrofolate, I'll say that again.
the glucosamine salt of five prime methyl tetrahydrofolate, they'll find exactly what I'm talking about.
Homer (51:14.584)
Yeah, it's wonderful. And we've got Valerie asking, my husband suffers from UTIs. I thought it was essentially a female ailment.
Ross Walker (51:29.794)
Yep, yep. And it is typically in some people, but always there are other things that can happen here. So if he's getting recurrent UTIs, there's possibly something wrong with his prostate. He might have a chronic infection in his prostate. That's one thing.
Homer (51:35.034)
Yep.
Homer (51:50.062)
bladder infection, a bladder.
Ross Walker (51:52.342)
No, the UTI is a bladder infection. It's the same thing. But the prostate may be infected feeding bugs into the bladder. That's one thing. Very rarely you can get a connection between the bowel and the bladder. It's called a fistula. And that's feeding bugs in there as well. It's unusual, but not rare for a male to get UTIs. And Valerie's correct. It's much more common in women than it is in men. And the reason's very simple.
Homer (51:55.862)
Okay, yeah, yeah.
Ross Walker (52:21.142)
A woman's urethra is tiny, whereas a male, depending on the length of your penis, is much longer. So takes a lot longer for the bugs to grow up into the bladder to set up a urinary tract infection. But it still happens.
Homer (52:30.53)
Okay, this is folklore. This is folklore, because I've gone through this myself. I've had a bladder infection and a lot of people, and they say that cyclists are notorious not only for bladder infections and UTIs, but also for prostate problems.
Ross Walker (52:45.966)
Yeah, yeah, because you're sitting on the seat, your prostate's sitting right on the seat. So for example, if you're a cyclist, don't have a PSA the day after a long cycle. You've got to cheat for your PSA. You're going to have the PSA test done a couple of days after the last cycle or the last piece of sexual activity, but empty your prostate regularly with sexual activity is much better for your prostate. So yes, cyclists do get more prostate issues.
I've not heard the urinary tract infection side of it. I'm not really sure why there'd be any link there. But as I said, we don't get it as males as much as females because our urethra is longer.
Homer (53:23.3)
What about lack of hydrogen around the shimmy? Would that cause the UTI? That may cause it. Okay, so that could be it.
Ross Walker (53:25.588)
that's yes. Yeah, yeah. Lack of high lack of hygiene can certainly do it. Yep. And often if men are uncircumcised, they have more UTIs than men who are circumcised. So there's a lot of different issues which we should not get into on this podcast.
Homer (53:42.554)
That's great. Okay, I think that's about all we've got this week. Ross, thanks for being here. And we'll see everyone next week or the week after. Bye.
Ross Walker (53:46.407)
I think that's enough. That's a pleasure.