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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!
Homer Papantonio (00:04.176)
Hello and welcome everybody to the Seriously Funny Wellbeing Show with yours truly home of Papantonio and with me is someone who doesn't need an introduction but I'll give him one anyway, Dr Ross Walker. How are you Ross? This... That's great. This week's podcast is on the draining, enticing subject of fatigue. So thought we'd kick off this podcast with some humour related to fatigue. So here goes. Ross, why did the keyboard get exer...
Ross Walker (00:18.176)
I'm fine, thank you, lovely to be here.
Homer Papantonio (00:33.996)
exhausted after work because it had two shifts. Let me laugh, yep that's beauty. And Ross I had to quit working at the gym because I got too exhausted wrecking all the weights so I put in my two week notice.
Ross Walker (00:36.205)
No idea.
Ross Walker (00:39.895)
Rod.
Ross Walker (00:52.732)
Yep, Yeah, I think two weeks is probably a good summary of that joke.
Homer Papantonio (00:54.286)
So... Ross, you, like me and many of our listeners, would be old enough to remember Batman and Robin. Do you just remember them? Yes, yes, yes. These super heroes, Batman and Robin, go out for a few drinks and they're exhausted after a long week of non-stop crime fighting and decide to chill out...
Ross Walker (01:08.853)
I do, I do.
Homer Papantonio (01:21.494)
for a few hours at the local watering hole. Robin knows his friend has been working way too hard and for long hours, so he thinks what the heck he can get drunk and relaxed. He decides to remain watchful and orders non-alcoholic beer, while Batman orders a bottle of scotch all for himself. The booze takes the edge off and Batman opens up about his dead parents, the millions he lost on
on bitcoin, his romantic relationship flatters, he's almost crying, a couple of hours later Batman finishes the bottle and is totally inebriated, or shit-faced I think is the medical term. And Robin pays the bill and they exit the park and head off to where they park the Batmobile. Batman can barely walk, he realises he can't drive so he hands the
Batmobile keys to Robin. You're driving tonight kiddo. Robin's jaw drops. He can't believe his luck. After all these years he's finally driving this machine. And boy is he going to test its limits. He puts Batman in the passenger seat, lowers it up and buckles him up. He turns on the engine, grabs a stick shift, shifts into first, slams down the gas pedal. He quickly shifts into second, third gear. goes from
0-60 in 2.5 seconds, he's driving through Gotham streets like a maniac, he takes a hard turn and downstairs to control the steer, he enters the freeway, he's quickly upshifting, going down the whole lot, he parks the Batmobile, opens the door to exit, puts a... but a hand stops him. Kiss me Robin. What Batman? Kiss me Robin.
Batman what the heck you know I'm not gay? Robin shut up and give me a kiss. Batman I don't know what gave you that idea but I'm not into you. come on Robin you've always known that the Batmobile is an automatic.
Ross Walker (03:38.694)
I don't know. I think we... I'll just say, just say it was tragic really. He died and no one knew, just because no one knew his blood type. And I've got to say to you, I'll never forget his inspirational last words. Be positive.
Homer Papantonio (03:41.855)
The lever, okay. that's why I said we might Yeah, yeah, so Ross let's get down
Homer Papantonio (04:05.19)
That's a good one. Okay, medical news is on experimental cancer vaccines.
Ross Walker (04:09.176)
Let's go.
Ross Walker (04:15.618)
Yeah, yeah. And this is a big deal. You see, and I don't want to bring in the arguments from the anti-vaxxers, you know, these vaccines are dreadful things, et cetera, et But this is using the same technology as the RNA vaccines for COVID. Now, let me explain to you why there was an issue with the RNA vaccines for COVID, because basically the mRNA vaccine is a direct copy of the DNA of the spike protein.
and then it's injected into people. Now, the spike protein of COVID initially was very pro-inflammatory. So therefore, people who were given the RNA vaccines, Pfizer or Moderna for COVID, some of them did have an inflammatory reaction to the vaccine. But what people have to realise is with the initial to quote, the Donald, the China virus,
The initial Wuhan strain was very lethal, 3 % mortality rate, probably 30 % of people had significant reaction to the initial COVID virus, not vaccine, had long COVID as a consequence. So when you then took an RNA copy of that spike protein, the way the COVID virus got into cells, it was very pro-inflammatory, which is why some people did develop myocarditis and pericarditis.
and what they're calling the vaccine injuries. But they've used the RNA technology, getting RNA copies of different cancers. So basically what they've done is taken your own cancer and developed a vaccine against that, which allows your immune system to recognise that cancer so much better. Because one of the things cancers do, a lot of people don't realise this, they trick the immune system, they almost have an invisible shield around themselves.
Homer Papantonio (06:07.29)
Yeah, yeah.
Ross Walker (06:09.996)
In fact, the invisible man married the invisible woman. I actually don't know what they saw in each other. the kids, their kids weren't much to look at either. But that aside, that aside. the cancers trick the immune system by having this invisible shield. And so what these vaccines are doing are breaking down that invisible shield and making the cancers more visible to the immune system. So they're using that sort of technology. So this study was done in about 19 people who had
Homer Papantonio (06:15.942)
You
you
Ross Walker (06:39.924)
very advanced end stage cancers where they had nothing else left. So basically they were dying. And when they looked at about half these people who were given the vaccine, so this is people who were definitely going to die, half of them still months later had no further tumour growth and no new tumours. So this is very, very promising early stuff and I think pretty exciting for the near future.
Homer Papantonio (07:07.302)
So what's the preferred option for cancer, having a vaccine or a cure?
Ross Walker (07:13.88)
Well, I don't think there is such a thing as a cure. mean, for example, the best option for cancer is to detect it early. And in fact, we're now getting to the point where the technology is there. It just needs to be validated and accepted by the medical profession where you have a blood test that picks up early tumor markers of cancer. So what we call circulating tumor antibodies. So every cancer has its own DNA footprint. And so these
these blood tests can pick up that early DNA footprint so that if you've got a cancer brewing somewhere and it takes one cancer cell nine years to become a two centimeter tumor. So when it's in its early stages where it might be a really tiny tumor that you can't even see on scans, you might be able to detect it in the bloodstream. Once you can do that, you can see, that's the marker of a lung cancer or the marker of a breast cancer or the marker of a kidney cancer and hone in on that organ.
to try and find out where the cancers are and then remove the thing early. So that's the only way to cure cancer is to detect it early and get rid of it with either surgery or targeted therapies at that cancer. but once you got to this point where you've got end stage cancer that's spread all through your body, there's not much left. So now we're getting to the point where there may be something in the relatively near future that could potentially either arrest or possibly even as you said,
Homer Papantonio (08:32.463)
Yeah.
Ross Walker (08:41.496)
Cure cancer.
Homer Papantonio (08:42.48)
So the vaccine is the preferred option.
Ross Walker (08:45.304)
Well, it may be, it may be, but there are other, there's immunotherapies, there's a whole lot of new therapies coming through. So I think like anything in medicine, there is not one treatment. There's integrative treatments that work to get rid of that particular problem.
Homer Papantonio (08:59.952)
Okay, so future of medicine Ross wearable lump patches.
Ross Walker (09:02.796)
Yeah. Yeah, this is interesting because it brings up the whole concept of monitoring people. And we speak a lot about being able to monitor your heart with the Apple watch or the other smart watches that can do ECGs and all that sort of stuff. And everybody knows about having home blood pressure monitoring. We now have the continuous glucose monitor that you can actually put onto your skin, leave it there for two weeks, put your phone up to it, and it gives you a blood sugar level. So all of these things are happening, but people don't talk a lot.
about monitoring lung function. And the problem is when you've got asthma or chronic lung disease, that many people with these conditions will work their life around it. So they'll avoid activities where they get very short of breath. And often their lung function is not being monitored and managed properly. So this particular study looked at 52 people who are part of an asthma outpatients clinic. And they put this little patch on their lungs and got them to breathe.
for about 30 seconds deeply and I found that it could work as well as an automated stethoscope to see whether there was any wheeze because a lot of these people would just sound okay when they're talking and they'll be able to do normal mild activity but they really are struggling with their lung function so it'd be very good to be able to have a wearable that tells people what's happening in their lungs. At the moment if someone is a chronic asthmatic or has chronic lung disease from their prior
cigarette smoking habit because hopefully no one these days is smoking or vaping which is just as bad. But what they can do is have a peak flow meter where they blow into this this little tube that tells them how good their lung function is at the moment. But this is probably even easier just to wear this patch breathe in and look at your phone and say I'm wheezing today I need more therapy I need to really hone my asthma management plan or possibly need to get back to my specials and have my lungs sorted out.
Homer Papantonio (11:01.456)
Yeah, yeah. And you can't have healthy lungs and smoke at the same time, can you?
Ross Walker (11:05.706)
no, can I say to you, for anyone listening to this, any asthmatic who smokes has a 100 % chance of developing emphysema. 100%. So look, I think everyone should stop smoking. Personally, come the revolution, I'm running the show, it'll be banned.
Homer Papantonio (11:17.435)
Wow.
Homer Papantonio (11:23.59)
But it's financially debilitating. My wife was at Coles the other day and this lady in front of her had a carton of cigarettes. How much do think the carton of cigarettes was? $502.
Ross Walker (11:33.666)
Yeah.
Ross Walker (11:41.333)
But look, can I say smokers are doing their bit for the community. Let me tell you why. The government gets around five billion dollars from the tax. Now, hang on, hang on. Let me finish. It's five billion dollars from the tax excise from cigarettes, but pays out ten billion dollars in the diseases created by cigarettes. So they're down five billion dollars. But here's where they save their money. Smokers are very community minded people because they die.
Homer Papantonio (11:51.013)
Yeah, yeah.
Ross Walker (12:07.086)
10 or 15 years earlier than the rest of us so the government doesn't have to pay out the pension monies. That's where the government's saving its money. Be cynical.
Homer Papantonio (12:15.142)
There you go. Body of evidence, the key biomarkers for heart disease from a small establishment in the US known as Harvard University, as you say, as well as the Lancet.
Ross Walker (12:29.346)
Yep. Yep. Yeah, this is interesting stuff. There's a institution in America, as you say, called Harvard, which is one of the great learning institutions in the world. And for the last 30 years, they've been doing the women's health study. And they've been measuring a whole lot of different health parameters in women. And there's something that doctors have only recently shown any interest in.
It's called lipoprotein little a. So lipoprotein lowercase a in brackets. as I said, doctors have only been measuring it for two or three years. Be cynical. Why? Because the pharmaceutical industry is now developing five different drugs that lower lipoprotein little a. Now let me tell you something, Hamer. 20 % of the population have an elevated lipoprotein little a. And if they do, they're at a 70 % higher risk for vascular disease over their lifetime.
I've been measuring lipoprotein in my patients for 30 years and I've been managing it for 30 years. But there haven't been any strict strong pharmaceutical drugs to lower it. But I've been using a combination of vitamin C, vitamin E and lysine and an old style cholesterol lowering drug called nicotinic acid that reduces LP to delay by about 30%. That's the topic for another time. But this particular study showed that if the women in this study had a high
lipoprotein delay, a high LDL cholesterol, and a high H highly sensitive C reactive protein, which is an inflammatory marker, they had marked increased risk for vascular disease. So basically saying we should be doing these biomarkers in all in all people, including of course, women and men, because they're strong risk for heart disease. So for example, we've spoken a fair bit on this podcast about the importance of coronary calcium scoring.
The worst coronary calcium score I have is in a 68 year old man in the fitness industry like you, doesn't have an ounce of body fat, absolute rabbit exerciser, and this man has a normal cholesterol, blood pressure, never smoked, not diabetic, and no family history of heart disease. So he none of the five major risk factors for heart disease, I don't believe they are, but none of the five standard risk factors for heart disease.
Ross Walker (14:57.112)
but he has an elevated lipoprotein delay. Now, anything over 400 is a serious calcium score. His coronary calcium score is the world champion as far as I'm concerned. 8,500 coronary calcium score at the age of 68. He had bypass surgery 10 years ago, sent me an email a few years ago with a picture of him and his mates winning their latest basketball grand final.
Homer Papantonio (15:19.984)
So you wouldn't give him another calcium score test.
Ross Walker (15:22.363)
It's a waste of time. Once you get over 400, it's a waste of time having another calcium school.
Homer Papantonio (15:25.614)
Okay, but the Honourable Member knows that's more a rarity than for someone in the fitness industry to have. And who looks after himself? To have it at that level?
Ross Walker (15:34.316)
No, it's not in the slightest. is nonsense. No, no, That level is the world champion of coronary calcification. But interestingly, people who are high level exercises, not people who do the Walker suggested dose, which is three to five hours a week, people who go beyond seven hours a week have much higher rates of coronary calcification than people who moderate exercises. Yeah.
Homer Papantonio (15:41.26)
Yeah, yeah, yeah, yeah.
Homer Papantonio (15:49.604)
Mm-hmm.
Homer Papantonio (15:57.988)
Yeah, and that's a subject for another podcast too, especially the events, arterial fibrillation, atrial fibrillation. yeah. That's happening more and more to masters, athletes and all that, yeah.
Ross Walker (16:08.014)
Atrial fibral, atrial atrial fibral. So anyhow, the point I want to make from this study from New England Journal of Medicine and from the Lancet is the importance of lipoprotein in a delay, the importance of having HSCRP, the inflammatory markers, and the lesser importance, I believe, of LDL cholesterol, because LDL cholesterol is not the problem. It's whether it's small or large, which I think was our first podcast we spoke about that.
Homer Papantonio (16:35.77)
Yep. And again, controversy we're getting back to, anti-vaxxers and the dark tetrad.
Ross Walker (16:43.422)
The dark tetrad, yes, this is an interesting one. This was the study, this is more people who believe in conspiracy theories. And so there are people who genuinely believe that JFK was killed by the CIA and that Princess Diana was killed by the royal family, the moon landing was a fabrication. And a lot of these people believe that the governments have brought in COVID and they've tried to control us all.
Homer Papantonio (16:45.842)
Okay.
Homer Papantonio (16:52.614)
Hmm.
Homer Papantonio (17:03.984)
Yeah.
Ross Walker (17:12.31)
and people are going to have these 5G network injected into their arm. And it's obviously complete nonsense. But they did a study on people who, they filled in these surveys, and the people who scored high on believing in conspiracy theories also scored high on the dark tetrad. So what is the dark tetrad? So I'm not suggesting that if you believe in conspiracy theories, you definitely have any of these. They're just saying there was higher scores of these.
So number one is Machiavellianism, is basically being cunning. So these people who are cunning movers and shakers who will just play people off against each other. It's number one, shifty, shifty. Number two, they scored high on the psychopathic scale. So really quite interesting that they were manipulative and they were...
Homer Papantonio (17:54.79)
Shifty, shifty, yeah.
Ross Walker (18:09.1)
that they had no real concern for other people. Number three, going with that, scored high on the narcissistic scale. And number four, they scored high on the sadistic scale. So like to see other people suffering. So it's interesting. I'll just put the question to everyone listening. If you know anyone who genuinely believes in a lot of these ridiculous conspiracy theories, ask yourself, do they also have any of the dark tetrad?
Homer Papantonio (18:37.798)
Thank you.
Ross Walker (18:37.826)
So it's just an interesting question. Now I'm not saying if you don't believe in conspiracy theories, you couldn't score high in the dark tetra, rather, I'm just saying it's just there's more of a tendency to have those features.
Homer Papantonio (18:47.792)
But you could understand a large segment of the population being a little bit cynical about the relationship with vaccinations and the pharma industry and everything. And I think we've got to delineate between anti-vaxxers and anti-experimental potentially harmful vaccinations. See, I'm not an anti-vaxxer, I believe it, but I want to know that what's going into the body won't, yeah.
Ross Walker (19:08.526)
Nah, better pick the ones that have to reel.
Ross Walker (19:16.555)
We were confronted with a situation with the China virus that in 2020, were dying quite commonly. were on ventilators, people were getting severe long COVID as a consequence of the initial strain of COVID. The governments in the pharmaceutical world and the medical profession had to come up with an urgent solution.
Homer Papantonio (19:20.634)
Yeah.
Homer Papantonio (19:28.229)
Yeah.
Ross Walker (19:43.927)
It's not and the point is with the marked improvement in technologies over the years, they borrowed from stuff that was already being developed. wasn't as if this RNA technology was new or the AstraZeneca viral vector technology was new or the protein based technology with Novavax was new. It just hadn't been used widespread in populations. So they were given the job. The pharmaceutical industry was given the job by governments, by the medical profession to
to fast track all of these things. And of course, no one could suggest they were harmless, but they were less harmful than COVID. And that's the point I'm making.
Homer Papantonio (20:20.048)
Yeah, yeah, yeah. Okay, okay. Okay, I agree 100%. Okay, so Ross.
Ross Walker (20:25.726)
Homer, the books just fell on my head. I only have my shelf to blame.
Homer Papantonio (20:30.95)
No it didn't because look, circumstantial evidence if you turn around your shelf is intact behind you. So are you telling fibs? Okay.
Ross Walker (20:40.374)
It is. I was only joking. Yeah, but yeah, I was telling fibs about that. Look, I just saw this man slumped over a lawnmower crying his eyes out. And I said, mate, are you all right? says, yeah, I'm just going through a rough patch.
Homer Papantonio (20:54.083)
Hahaha
And that's a great segue into this week's pot-hast topic of fatigue. What causes it and what should be done? So a quick intro. The definition of fatigue is extreme tiredness. Severe fatigue makes it difficult for you to get up in the morning and make it through your day. Many conditions and lifestyle factors can cause fatigue. You may be able to relieve it by changing your habits. If an underlying condition causes it, a health care provider
can usually help you manage it. So everyone feels tired from time to time, but fatigue means...
feeling severely overtired. Extreme fatigue makes it hard to get up in the morning, go to work, do your usual activities and make it through your day. Fatigue feels like you have an overwhelming urge to sleep, but you may not feel refreshed after you rest or sleep. So fatigue, you know, Ross, often occurs with other symptoms such as depression, trouble concentrating or focusing, very low energy motivation, nervousness, anxiety.
irritability, muscle pain, weakness. Other symptoms include tired eyes, tired legs, whole body tiredness, stiff shoulders, boredom and impatience. So Ross, like you're impatient with me but you're just genetically impatient with me. So Ross over to you.
Ross Walker (22:20.536)
Hmm, you make me tired just listening to this.
Ross Walker (22:27.694)
I'm just genetically impatient. I just want to get to the damn point. So yeah, over to me. Let me say firstly that we all get tired, as you say. Everyone gets tired and there are times where you just think, I just need to go and have a lie down and that's fine. And often people come to me and say, doctor, I'm tired all the time. What sort of tonic can I take to overcome my tiredness? And that is the worst question. The question is always, what is the cause of your tiredness?
Find out the cause, treat the cause, then the tiredness will go away. So there are five categories of fatigue I want to talk about, then finish up with a discussion of chronic fatigue syndrome, what that is. But let's firstly go through the five categories of fatigue. Probably the commonest cause of fatigue is you're working too hard, you're playing too hard, you're not sleeping well enough. And we've all had that, where we just had a long day.
At the end of day, we've had all of our energy drained and we're tired. And that really, you just need to manage that better.
Homer Papantonio (23:31.216)
So is it question of managing energy there?
Ross Walker (23:34.242)
Yeah, yeah, yeah. And I think we're given about eight hours of active energy, eight hours of relaxation energy, and we need eight hours of sleep on average. mean, it doesn't have to be exactly eight hours. And I have people come and say to me, Doc, I haven't had a holiday for 10 years. And I go, well, you're an idiot. People that aren't managing their time well, people that don't take time off, just time off during the day, time off on the weekends, time off during the year.
and people who work themselves in the ground, it's a recipe for disaster. number one, certain stressors in the body can bring out fatigue. That's number one. Number two, you've already mentioned it. There is a medical condition, not a psychological condition, called endogenous depression. Now, endogenous depression is not to do with your life. It's to do with your brain chemicals. Now, certain aspects of living can be
reduce your brain chemicals. So bereavement, divorce, or moving to another area, they're three major life stresses and they may change your brain chemicals. But for example, in my area in cardiology, people who go through coronary bypass grafting, 40 % of people get some degree of endogenous depression where their serotonin levels in the brain drop.
after the bypass. I've had people come and see me say, doc, what did you put me through this thing for? My life's worse. And I go, ha ha, they've got the endogenous depression. That's where antidepressants work because it lifts back up their brain chemicals. Whereas if you go to the doctor and you say, doctor, I can't stand my partner, my kids are on drugs and I hate my job and I'm depressed. No, no, no, that's grief. Antidepressants. No.
Homer Papantonio (25:19.532)
But isn't it the chicken or the egg here? Aren't they depressed because they're not managing their energy? Normally low energy you feel, you know, down. High energy? Okay.
Ross Walker (25:29.678)
I know, with greatest respect, that's far too simplistic. It's a complex, this whole thing's a complex interaction of your brain chemicals, how you're managing your life. And often when your brain chemicals are down, you don't manage your life so well. So the three cardinal symptoms of endogenous depression are number one, fatigue, number two, you've lost your interest in things. So things that you used to look forward to, you think, who cares?
And number three, and this is another cardinal symptom, you wake at about two o'clock in the morning staring at the ceiling for an hour. You may not be depressed or not be worried about anything, but you stare at the and you just can't get back to sleep. So early morning wakening with inability to get back to sleep is another feature of endogenous depression. You don't need to have the full hand, but they're the typical symptoms. Now that's mild endogenous depression. Once you get down to psychotic depression,
That's where you have a total sense of hopelessness in your life and also possibly suicidal ideation. So when you hear the horrible, horrible stories where people come home with a shotgun, kill their family and turn it on themselves, that's not because their life's gone bad. It's because their brain chemicals have just hit dirt. And they just think, look, life is so bad for me. It must be bad for the people I love. I'll put them out of their misery. Then I'll put me out of my misery.
That's why that happens. It's a horrible, horrible situation. And please, if anyone is listening to this, please seek medical help as soon as you start to these symptoms. Because that's where things like antidepressants do work. And there's now all of this new work on psilocybin, which is the active ingredient of magic mushrooms. There's a thing called direct cranial stimulation, which a little pat over the skull sends electromagnetic.
waves into the brain and that can help as well. And that's when you hear about that stuff that ECT, which was commonly used many years ago, it's still used, but where they shock the brain under an anesthetic and that can also give people relief from severe psychotic endogenous depression. So that's number two. Number three is probably as common as number one, maybe even more common as a cause of fatigue, which is sleep apnea. So sleep apnea
Ross Walker (27:54.976)
in my view, occurs in all males and all postmenopausal females. And it can occur at any age in any person anyhow. And what sleep apnea is, where typically there's two types. There's obstructive sleep apnea where the airway closes off at night. And then there's central sleep apnea where the brainstem at the back of the brain isn't working properly. And so what happens is these people
They start off awake and they drift into a deep sleep. When they get into a deep sleep, especially with obstructive sleep apnea, the airway closes over. So the body's got a choice. Stay in deep sleep with a closed airway, which means no oxygen, that's called death, or go to a lighter phase of sleep. And so you never get proper deep sleep. Now what rejuvenates us the next day is bursts of deep sleep throughout the night. So we have five cycles of sleep and we need that
that deep sleep going for 10, 15, 20 minutes within each of those cycles.
Homer Papantonio (28:56.74)
Heavy snorers normally sleep apnea sufferers? Yeah.
Ross Walker (28:59.198)
yeah, they're typically more commonly sleep apneas, but you might be a light snorer or a non snorer and have more central sleep apnea. So the key question I ask my patients about this is when you wake up in the morning after what you perceive to be a reasonable night's sleep, do you feel refreshed or unrefreshed? And if the answer is unrefreshed, you typically have bad sleep apnea. Other symptoms of sleep apnea is
During the day, you'll sit down to watch your favorite TV show or to just have a bit of a rest and boom, within five seconds, you're asleep. The micro sleeps, which is so dangerous when people are driving. So if anyone gets really tired when they're driving, please pull over and have a rest because you could kill other people as well as yourself. they're the sore throat, waking with a sore throat. Often, again, in my specialty in cardiology, it's people who wake.
in the middle of the night with their heart jumping out of their chest, the wake up shorter breath, that's often sleep apnea. Because in sleep apnea, it's like someone's got their hands around your throat. So that's sleep apnea. Category number four is what I call the pauses. So whether it's menopause, which is obviously when women get ovarian failure, or andropause, when we get testicular failure, our testosterone levels drop. And basically,
All the symptoms of menopause are the same as the symptoms of andropause except for we don't lose our periods because we never had them in the first place. But we get grumpy, psychological changes, we get night sweats and women get exactly the same things of course. A lot of other things go with that. So marked fatigue occurs in your 50s around the time of those hormonal changes which your body often adjusts to. And there are many people in medicine, I'm one of them, who do believe in
in hormone replacement therapy for men and women. I prefer more the bioidentical hormones than the standard pharmaceutical therapies. But again, I'm not an expert in the area. And it's best if anyone's listening to this and says, that could be me, be guided by the experts. Go and see an expert, an opinion. But always get a few opinions if you're not happy with the first one you get. OK, number five, and this is vital, is a medical condition.
Ross Walker (31:17.696)
So you may have an underactive thyroid or an overactive thyroid. Thyroid is a great mimicker of many conditions. You could be iron deficient or iron excess. So there's a condition called haemochromatosis where you absorb too much iron into the body. And one of the symptoms that is marked fatigue. Any autoimmune disease like rheumatoid arthritis, lupus, when you have an exacerbation, that can make you incredibly tired. Some problem in the full blood count, you might have some.
some early changes in the full blood count to indicate a bone marrow disorder, fatigue is a major symptom there, kidney failure, liver problems, heart... Interestingly, almost everyone who is headed towards a heart attack in the few days beforehand gets marked fatigue. So you can see why I'm saying to you, I don't want people to just go off and get a tonic across the counter at their local pharmacy. Go and get your fatigue sorted out, especially if it's...
Homer Papantonio (32:07.846)
you
Ross Walker (32:15.67)
if it seems out of the ordinary. If you had a big night or you've worked 12 hour days for a few days and you're feeling tired, that's normal. But if you're out of the ordinary tiredness, please go and see your doctor and get it sorted out to make sure what category you're in.
Homer Papantonio (32:31.622)
So that's really intriguing. What is it as a precursor to a heart attack that's happening to maybe your blood profile that's causing fatigue? Is it decreased oxygen levels or?
Ross Walker (32:42.342)
easy, No, no, no, it's got nothing to do with oxygen levels. It's to do with when you rupture a plaque. So what happens in a heart attack? Imagine a donut like that with the blood going through the middle, the fat sitting there in the wall. When you have a heart attack, it doesn't block the artery. It goes and cracks open like that. And then a big clot forms. So when you rupture the plaque, you're releasing chemicals into the system that just exacerbate fatigue. So those chemicals are there.
Homer Papantonio (32:55.216)
Yeah.
Ross Walker (33:11.606)
attracting what we call platelets to form that clot. But the chemicals go systemically around and just completely wash you out. And that process of the plaque rupturing can occur over a few days or it can occur over 10 minutes, where somebody just suddenly has some symptoms. But I've got to say, a study done on 25 squash players who dropped dead playing squash, 24 out of 25 in the week before their death had told a doctor or a relative that they had chest pain.
So you always get a warning for your heart attack, but one of the warnings may be marked fatigue. I was playing soccer 16 years ago when my knee finally collapsed, but a month before the knee finally caved in, 20 minutes into the game, the opposition left fullback dropstead in front of me. Now, because he was a fullback, I resuscitated him. was a forward, I would let him die. Those primitivists don't deserve to exist.
Homer Papantonio (34:04.635)
Ha
You
Ross Walker (34:08.556)
So I kept this guy alive for 15 minutes until the ambulance got there and we hit him with a pack of wacker, got him back into a good rhythm, got him to Sydney's Royal North Shore Hospital and within two hours had his chest split open, had bypass surgery. He's still, 16 years later, still one of my faithful patients and doing very well. But I said to him, did you get any warning before this? And he said to me, the only thing I was completely washed out. So he shouldn't have hit blank sock, bet.
Probably lucky he did because he dropped it in front of somebody and knew what to do.
Homer Papantonio (34:40.368)
So things like aspirin or fish oil, omega 3s, when you're feeling like that, would that maybe avoid a heart? No? Well, yeah. Yeah. Yeah, yeah.
Ross Walker (34:49.582)
No, no, no, no, no. Look, it's OK to take an aspirin. Fish oil is not strong enough in that situation. Fish oils are preventative that you take over a long period of time. But aspirin, might help minimise the severity of the heart attack. There's no studies have done about a 25 % reduction in cardiovascular disease in people who at high risk for heart disease who take an aspirin. But other studies, three major studies that have been out in the last 10 years, showed that for people over the age of 70,
There's no value taking an aspirin as a preventative. There's just across the board. But I still use aspirin for people who are at very high risk for heart disease, or they've got a high calcium score. And there's some work to show that people who take a baby aspirin every day have lower rates of bowel cancer. Anyhow, that's another topic. So that's number five in the category. Now, the final thing we need to talk about is chronic fatigue syndrome.
Homer Papantonio (35:22.992)
Yeah, yeah.
Ross Walker (35:48.46)
So what is chronic fatigue syndrome? Chronic fatigue syndrome is defined as fatigue that is present with no good cause for more than three months. And typically, about 10, and this is the Walker theory, so not absolutely validated by scientists yet, but I still think it's a good theory. 10 % of people are born with slightly dodgy mitochondria. Now what are the mitochondria? They're the fuel packs in our cells that drive the cell.
So it doesn't matter what sort of car you drive, Homer, if there's no energy in the car, it doesn't move. And it's the same thing with our cells. If our mitochondria don't work well, then the cell doesn't work well. So people who were born with defective mitochondria, they're the people that really weren't attracted to sport, don't like exercise, always the ones at school, came last in the cross country, those sort of people. So this is theory, okay? But it's...
Homer Papantonio (36:16.251)
Yep.
Homer Papantonio (36:39.878)
This is just your theory, isn't it? Yeah, about moderate. But how can how can you, the medical fraternity come up with a syndrome when they don't know what the cause of it is?
Ross Walker (36:51.534)
no, no, no, but we have analyzed the mitochondrial function in people and it's on a bell-shaped curve. So someone like Usain Bolt, it just has these finely tuned mitochondria that just drives his muscles that work better than other people. And other people who down the other end of the bell-shaped curve, their mitochondria just don't work well as the next guy. And so they chug along in life okay and then in their 20s get Epstein-Barr virus or cytomegalovirus or some other sort of virus and it just...
pulverizes what's left of their mitochondrial function, they just can't get out of bed. So, and I have a regime or regimen that I use for people with mitochondrial dysfunction. See, here's the interesting thing. If you're insulin resistant, you've got abdominal obesity, et cetera, one of the best things for you is fasting, time restricted eating, et cetera, et cetera. The worst thing for someone with mitochondrial dysfunction is to fast because they're just not getting any fuel into those mitochondria.
So I say to them, have high quality complex carbohydrates three or four times a day, low doses, because you don't want to get fat, but three or four times a day. So constantly have fuel going to the system throughout the day to feed the mitochondria. Really important thing to do. So you don't fast. You have regular good quality meals throughout the day. And things like ubiquinol, 150 milligrams daily.
Homer Papantonio (38:16.07)
Yes.
Ross Walker (38:17.694)
and magnesium orotate aspartate, a combination of that twice a day feeds into the mitochondria, gives you healthier mitochondria. So there's a lot of a lot of work being done in the mitochondrial space at the moment to help those people. And I believe long COVID, chronic fatigue syndrome, fibromyalgia is all part of the same spectrum causing this mitochondrial dysfunction that needs to be improved with what I've said. But I wouldn't want anyone listening to this to go
straight to the ubiquinol and the magnesium orotate and say that's my solution because no you've got to get it all sorted out.
Homer Papantonio (38:53.527)
It's a real conundrum isn't it, that whole fatigue and I'm looking at it from an exercise physiology perspective. Like people that say that I haven't got enough, I'm too tired to exercise. The reality is you need to expend energy to create it. Energy.
Ross Walker (39:12.326)
You do and you need, but people in that situation, they are too tired to exercise. So they've got to ease into an exercise program. It's slowly built up. And let me say to you, one of the best things for this entire syndrome, if you have chronic fatigue or long COVID or whatever, is cold water swimming. So if the temperature is below 20 degrees, it markedly improves your immune system, your mitochondrial function. So there's my hints for fatigue. There we go.
Homer Papantonio (39:19.962)
Yes.
Homer Papantonio (39:30.554)
Yes.
Homer Papantonio (39:37.818)
Yes.
What about infrared saunas?
Ross Walker (39:43.628)
Yeah, that's not so good if you've... Yeah, that's a good thing to do as well.
Homer Papantonio (39:45.796)
like alternating ice baths, that's what they're doing now.
Yeah, okay. We've got questions from our listeners. We've got Jerry from Orange. And he's got drunk or drugged then concussion. So this is...
I have two friends of a similar age who experienced the same accidents with vastly different outcomes. Both men had consumed far too much alcohol, were drunk, and whilst walking up the stairs at their home, stumbled up the stairs and hit their heads into the edge of the step. Both had immediate treatment for bleeding to the head by their partner and or neighbour.
One was taken to casualty and survived, albeit with serious complications from the subsequent head trauma. The other refused to go to hospital, was thankful to the neighbour for cleaning him up and chose to sleep off his condition. That person was found deceased, unfortunately, by his son on Father's Day. My question is for someone who is more drugged than drunk.
is the same danger. These men were in their 60s, old enough to know better. Is there an age group that is more prone to death from head trauma or should all accidents involving head trauma be taken to hospital?
Ross Walker (41:10.818)
I think they should, especially if there's any loss of consciousness there, because you may remember that the wonderful actor Liam Neeson, his wife Natasha Richardson was on the ski slopes, fell over, hit her head, had a bit of a headache, but just kept skiing and died about, I think it was seven or eight hours later, because she'd ruptured her middle menangial artery, which is a really serious...
problem that needs urgent neurosurgical assessment and therapy. So I think any time you have a significant head injury, that especially if it's associated with loss of consciousness, I think it's important to go to a hospital. I mean, if the worst thing you have is a brain scan, so what? But you don't want to miss something like that. And that's probably what happened to the second case that you mentioned. And this is the problem with consuming too much alcohol. If you've consumed alcohol to the point where you're to fall over and crack your skull, then
then there's a real issue there. So it's a serious issue and it does need to have medical assessment. And I don't want to be flippant about this, but I knew this fellow who lived five minutes away from the hotel, so it'd take him five minutes to get to the hotel and 35 minutes to get back home. The difference was staggering.
Homer Papantonio (42:29.158)
Okay, that was a bit like Black Huma almost there Ross. Okay, we've got Matilda from Ballarat. I recently underwent an angiogram on advice from my doctor because I felt exhausted after walking up a steep hill.
Ross Walker (42:46.039)
Yep.
Homer Papantonio (42:46.822)
I stopped once or twice to regain my breath. I'm not overweight, a non-smoker and eat a very healthy diet. My father died from a heart attack at the age of 62. I found the procedure to be very uncomfortable. They couldn't insert the apparatus into my wrist after multiple attempts and then gained access through my groin. Sounds painful. It was thankfully all clear. Is there another alternative procedure that provides the same?
information.
Ross Walker (43:17.678)
Yeah, the answer is a definite yes. I mean what the way I as a cardiologist how I would have looked after Matilda's case I wouldn't have sent her straight for an angiogram. I think that's outrageous. I would have first done a stress echocardiogram on her if the stress echocardiogram was completely normal and I would have checked her for other things like an iron deficiency a thyroid problem full blood count etc etc all the things I was talking about before as far as the fatigue went and then if
That was all normal. I just would have seen what happened with it. I wouldn't go straight to an angiogram. If the results of the stress echo were equivocal. So she had a few symptoms.
there's some minor changes on the stress echo, I would have gone to an intravenous angiogram, called a CTCA, on a CT scan, rather than go through the groin or the wrist. That's an invasive procedure, and it's one I do if I've got very strong evidence. So I'll give you an example. I saw a woman the other day who was 73, and she had
two episodes of quite severe right-sided chest pain, which is not the typical place you get cardiac pain. I did a stress echo on her and there were some moderate changes on the stress echo. And I thought, there's a potential she could have some significant blockages here. So I'm sending her for an angiogram based on the stress echo. Because I said, look, we could do a CTCA, but if you've got a blockage in your artery, because it looks like you do, then they've got to do another angiogram.
So that's two lots of dye. And you can have a reaction to the dye. can damage your kidneys. You have two lots. It makes it even worse. So I'm going straight to an angiogram in her case. But if Matilda says that all she had was the symptoms and straight to an angiogram, I think that's wrong.
Homer Papantonio (45:07.887)
Larry from Glen Iris, I play golf with a group of guys that are older than me. They all complain of sore joints and tweaks in their backs but I don't notice too many of them warm up or warm down with stretching prior to or after the game. Is there an age...
when this is not important anymore. I mean, basically, is it important to stretch? When I did my phys ed course, even back then they said there wasn't really any compelling evidence to say that stretching avoids injuries. Yeah.
Ross Walker (45:38.168)
Now, but also the question I'd put to Larry, ask these gentlemen, are they taking statins to lower their cholesterol? Because every man and his dog is on a statin, which gives you the aches and pains in the joints and in your muscles. So it could be that they're taking statins. And interestingly, I've got a mate who I've known for years and years and years.
Homer Papantonio (45:50.318)
okay.
Ross Walker (45:59.092)
His cholesterol has always been high and his GP's always wanted to throw a statin at him. But I've measured his current calcium score over the years and it's always been zero. He's in his 70s now and his calcium score has gone up to about eight. So certainly doesn't need a statin. And he said to me, know, Ross, I'm the only guy at the golf club that can still whack a ball 250, 300 meters. The rest of them are all on statins. They're all like this because I've got no muscles left. So and I'm not saying statins does that to everyone. But all I'm saying is in Larry's mate's case,
Homer Papantonio (46:21.062)
Yes.
Ross Walker (46:27.264)
Again, find out the cause for why the joints are sore. And I don't think it's just that they're not stretching.
Homer Papantonio (46:34.566)
See, I really admire you. I don't want a piss in your pocket, and I can't. But you are what I think all doctors should be, a lifestyle practitioner instead of pharmaceutical dispensers. know. Yeah.
Ross Walker (46:38.786)
Now you can urinate in my pocket as much as you like.
Ross Walker (46:49.358)
Yeah, well, look, I talk about the 80-10-10 rule all the time. 80 % is how you look after yourself. Four times more powerful than anything a damn doctor can suggest. 10 % is the appropriate use of medical therapies, pharmaceutical treatments, procedures, et cetera. 10 % is the appropriate use of evidence-based supplements. But really, it's the lifestyle that's key.
Homer Papantonio (46:58.789)
Yeah.
Homer Papantonio (47:03.493)
Yeah.
Homer Papantonio (47:09.904)
Yeah, we've got two more quick questions. Donna from Sorrento. Is there a simple blood test to see what sort of arthritis I have? I'm a 63 year old fit, exercise, do weight three times a week regularly, but my bones and joints are becoming sore.
Ross Walker (47:27.458)
Yeah. Yeah.
Well, it's not just arthritis, it might also be osteoporosis. So I think in Donna's case, she needs a DEXA scan to measure how much osteoporosis she has. And then just the general blood screen. There are simple blood tests. We just do a normal full blood count. A thing called ESR and HSCRP are inflammatory markers. And there's all of these tests for the autoimmune arthritities, rheumatoid factor, SLE tests. it's anti-nuclear antibodies. You're going to have a worker.
Homer Papantonio (47:31.878)
Mm.
Ross Walker (47:58.44)
up for a whole lot of the less common causes of inflammatory arthritis but the interesting thing is does someone have an inflammatory arthritis caused by one of these autoimmune disease or is it just more osteoarthritis causing their aches and pains and the simple blood test will do that very simply and if people are getting still ongoing problems and their GPs aren't helping them a referral to a rheumatologist to have it sorted out properly is probably the best way as a one-off thing to do.
Homer Papantonio (48:26.042)
Okay and last one is Samantha from Brisbane. Walker, can you explain a bit about vertigo? I developed a bad case in 2011 and I've been to vertigo clinics to help me out but I've never been the same in my head space. One doctor said it was virus related, another said it was when the crystals move in your ear. I take ginger tablets for the nausea symptoms, they've helped a bit. What do you think caused it and how?
can I prevent an episode coming on.
Ross Walker (48:58.828)
Well, a very good question and different answer to probably what Samantha wants to hear. But not all people have vertigo. They think they do, but they don't. There are three types of dizziness. I saw a woman the other day who said, Dr. I've had vertigo. She described to me, said, that's not vertigo. So vertigo is when you're looking at me and I'm going... So if people don't have that rhythmic movement when you're looking at them, it's not vertigo.
If it is vertigo, the doctors are right. It's due typically post-viral due to problems. The post-viral syndrome affects the crystals in the inner ear. And so therefore, you get a sense of rotatory movement of the environment. If that's vertigo, then you can be given a set of exercises for your neck that does help to some extent. But then it's just a matter of symptomatic treatment with ginger may help.
to some extent. During an acute episode, good old-fashioned Valium helps, not because it calms down your anxiety, just works on the inner ear. As does Finurgan, which is an over-the-counter antihistamine, 25 milligrams half at night, that helps as well. But then the other two types of dizziness, number two, what we call presyncope. Now, presyncope is when you stand up quickly and you think, gee, I could collapse here.
People say, I've had a vertigo. I've said, no, you haven't. You've had presyncope, where the blood's not getting up to the engine room, and you feel a little bit lightheaded, like you could go down. And that's typically due to some sort of cardiac problem, where you're just not pumping blood up to the head. And then the final one, probably the commonest cause of dizziness that people wrongly label as vertigo, is a thing called disequilibrium, where you're feeling wonky.
So it's a bit like you had a bit too much to drink or whatever, and you feel, I'm a bit unsteady on my feet, not the environment's unsteady. And that's typically due to a neck problem. And I don't know anyone over the age of 60. Now here is a bit of detailed medical term, I don't know anyone at the age of 60 who doesn't have a crappy neck or a crappy back. We all do. It just comes from going well beyond our use by date, which is 40.
Ross Walker (51:12.204)
So you get your crappy neck and you've got these blood vessels that up the back of the neck and they get affected by the blood flow going up there. And so it can affect just the way you monitor things when you're walking and so you feel wonky. So it's a neck, it's an eye, it's a joint problem, joint position.
Homer Papantonio (51:28.031)
So you're not into osteopaths or chiropractic cracking necks?
Ross Walker (51:31.762)
I look, no, no, no, that's all right. I think osteopaths are very good. I personally have a thing about chiropractic manipulation. I've had a manipulation my lower spine without actually, I thought it was an osteopath. I was told this guy was an osteopath and he was a chiropractor. I found it quite uncomfortable. I prefer osteopathic.
mobilization rather than manipulation. But look, there'll be chiropractors that say, that guy doesn't know what he's talking about. Chiropractic manipulation is terrific. And there'll be many people who've been helped by chiropractors. again, I don't want to get into that discussion because I respect what all health professionals do. I'm just saying I don't like any manipulation of the neck, but chiropractors don't do that these days anyhow. I've seen people have strokes after neck manipulation. So you mobilize the neck, not manipulate.
Homer Papantonio (52:18.886)
Mmm.
Homer Papantonio (52:22.916)
Okay, I think that's about our episode for this week. So we could sign off here. See you next week listeners, thanks for listening. If you want more information on what we do, go to seriouslyfunnywellbeing.com and you'll get everything there. Bye from me.
Ross Walker (52:27.374)
Yep.
Ross Walker (52:41.678)
Bye.