Huntington's chorea is an autosomal dominant disease that affects patients in their middle to old age with a progressive dementia and writhing movements of their face and limbs. Since 1993, it has been possible to estimate the risk in children of affected patients. However, there is no cure and many individuals at risk have preferred not to know their status and carry on their lives in ignorance, if not bliss. Suicide rates in patients diagnosed as being positive can be up to 9%. Patients testing negative may experience “survival guilt”.

Testing for antenatal chromosomal abnormalities have also become increasingly available in recent years. Once again there are no trivial therapeutic options with termination of pregnancy an unacceptable choice for many people.

In the early 1980s there was no therapy for HIV and performing diagostic tests posed similar ethical challenges for doctor and patient alike.

In medicine we are taught that if the result will not change the therapy, the test should not be performed. However, as we see in end of life care, a better understanding of the disease process and a more accurate prognosis may allow patients to cope with their disease.

RDAA President, Dr Ewen McPhee

Responding to a report in the Australian (9 Aug) that the Federal Health Department seeks the removal of 41 health roles, including GPs, from the skilled occupations list for visas, the Rural Doctors Association of Australia (RDAA) says such calls should be part of Australia's future medical workforce considerations.

It also wants an ‘urgently required’ National Rural Generalist Framework to get more Australian-trained doctors to the rural and remote communities that need them.

iron infusion

Iron deficiency is a common problem in general practice. Traditionally it has been treated with oral tablets, intramuscular injections or intravenous administration. Each of these modalities have their own problems.

While tablets are first line therapy, they take several months to work and are associated with significant gastro-intestinal side effects. Intramuscular injections are painful and may lead to staining of the skin. Previous intravenous formats of iron have been associated with serious side effects during administration, most notably anaphylaxis.

Rapid replenishment of blood and iron stores is needed for pre-operative patients where blood loss during or prior to surgery can be expected. Bowel surgery, gynaecological operations and major joint replacements are those where haemoglobin and iron replacement needs pre-operative optimisation.

The Federal MP for Page, Kevin Hogan (Centre), with his wife Karen, and Paul Murphy, manager of The Winsome & Lismore Soup Kitchen, at Homelessness Connect day.

I would like to congratulate our North Coast Primary Health Network, which has been selected as one of four lead sites across Australia to implement the new $192 million suicide prevention program. This is exactly what I have been advocating to reduce suicide in our community.

Any suicide is tragic and unfortunately we have far too many in our community. Under this new programme, the North Coast PHN will receive millions of dollars in additional resources to develop localised methods to help prevent suicides.

Suzy (not her real name) went to a leading Northern Rivers high school but at 15 was lured away to Sydney by an older man who introduced her to the drug scene. During the next five years in “a different place and a different world” she got into speed, alcohol and marijuana, and eventually came into contact with the police, and the hospital system.

Back home, she felt estranged from family, and rebelled again, seeking out the local drug scene, and ending up involved with a biker club:

“I felt like I fitted in. I gained some protection and felt secure. I was being supplied drugs, so my addiction soared… there were a lot of females in my situation… it just ruined their lives really. I was hitting the drugs and alcohol really hard and notched up a few criminal records of my own.”

Suzy now finds her past haunting her - when she applies for jobs her record often “bites me on the backside.”

On the positive side, “I feel the only work I can do now is in the Drug and Alcohol field and I’ve studied to support that. I think they are the only people who are going to value my experience, so I’ll keep following that path.”