Health Across The Ages

Cardiovascular Risk: Triaging the Worried Well vs. At Risk – Dr. Ata Doost

Tue, 15 Sep 2026 13:55:00 +1000

Cardiovascular Risk: Triaging the Worried Well vs. At Risk – Dr. Ata Doost

Speaker: Dr. Ata Doost (Interventional & Structural Cardiologist Macquarie University Health. Biography click here).
Overview: Provides a structured primary care consultation framework to triage low-risk "worried well" individuals against asymptomatic, high-risk patients.
Key Takeaways:
Absolute Risk Calculation: Recommends using the 5-year absolute cardiovascular risk calculator for patients aged 45–79 (starting at age 35 for patients with diabetes, or age 30 for First Nations individuals).
Coronary Artery Calcium (CAC) Scoring: Emphasizes that CAC scoring should be reserved as a risk modifier in intermediate-risk, asymptomatic patients, avoiding its use in low-risk, established disease, or symptomatic cases.
Aspirin Primary Prevention Warning: Cautions against routine primary prevention with aspirin because bleeding risks typically outweigh minor vascular benefits.
Hypertension & Murmur Guidelines: Targets blood pressure below 130/80 mmHg generally (125/75 mmHg for established cardiorenal disease). Mandates early echocardiography for any new diastolic murmur or symptomatic systolic murmur

Inflammatory bowel diseases Dr Brandon Baraty

Tue, 15 Sep 2026 13:00:00 +1000

Inflammatory Bowel Diseases – Dr. Brandon Baraty

Speaker: Dr. Brandon Baraty (Gastroenterologist Macquarie University Health. Biography click here).
Overview: Outlines the growing prevalence of Inflammatory Bowel Disease (IBD) in Australia (~145,000 middle-aged individuals) and advocates for GP-specialist shared care.
Key Takeaways:
IBD vs. IBS: Emphasizes that IBD is a structural, organic inflammatory disease distinct from IBS, though functional crossover can occur.
Middle-Age Colitis Subtypes: Highlights conditions common in mid-life, including microscopic colitis (collagenous/lymphocytic), segmental colitis associated with diverticular disease (SCAD), and immune checkpoint inhibitor colitis.
Non-Invasive Diagnostic Tools: Recommends using fecal calprotectin testing and transabdominal intestinal ultrasound (IUS) in primary care for initial screening, monitoring, and triaging flares.
Early Intervention Window: Stresses that starting targeted therapy within the first 1–2 years of disease achieves 80–90% remission rates, compared to only 30–40% if delayed.

Weight Management: Endocrinologist’s Perspective – Dr. Judy Chen

Tue, 15 Sep 2026 02:15:00 +1000

Weight Management: Endocrinologist’s Perspective – Dr. Judy Chen

Speaker: Dr. Judy Chen (Endocrinologist Macquarie University Health. Biography click here).
Overview: Outlines endocrinological guidelines for managing obesity as a chronic disease focused on cardiorenal and hepatic health outcomes.
Key Takeaways:
Moving Beyond BMI: Recommends evaluating excess adiposity using waist circumference, waist-to-hip ratio, and DEXA scans rather than relying solely on BMI.
Cardiorenal & Hepatic Trial Evidence: Summarizes major trial evidence showing semaglutide reduces major adverse cardiovascular events (MACE) by 20% (SELECT trial) and kidney disease progression by 24% (FLOW trial), alongside MASH resolution in ESSENCE trials.
Prescribing Pitfalls & Side Effect Management: Advises starting at low doses and titrating slowly to manage GI effects. Highlights the need to de-escalate antihypertensive medications as patients lose weight to avoid hypotension.
Emerging Pipeline Therapies: Outlines upcoming triple agonists (GLP-1/GIP/glucagon) targeting liver fat and oral non-peptide GLP-1 receptor agonists (orforglipron).

Panel Discussion Dr Ata Doost, Dr Judy Chen, Dr Brandon Baraty

Tue, 15 Sep 2026 02:00:00 +1000

Panellists: Dr. Ata Doost, Dr. Judy Chen, Dr. Brandon Baraty.
Overview: Multidisciplinary discussion on managing metabolic syndrome, fatty liver, lipid targets, and drug safety.
Key Takeaways:
Calcium Score Interpretation: Dr. Doost clarifies that CAC scores should be evaluated by age/gender percentiles; a percentile at or above 75% mandates primary prevention treatment regardless of the absolute score.
Metformin Synergies: Dr. Chen highlights Metformin as a safe, synergistic adjunct with GLP-1/GIP therapies for weight management, up to 2g daily.
Lp(a) Screening Recommendations: Dr. Doost highlights that Lipoprotein(a) should be checked once in a patient's lifetime for cardiovascular risk assessment.
JAK Inhibitor Safety in IBD: Dr. Baraty and Dr. Doost review JAK inhibitors, noting rapid onset and safety as a steroid bridge, but requiring pre-screening for shingles vaccination, lipid monitoring, and blood pressure control.

Young-onset dementia Prof. James Burrell

Tue, 15 Sep 2026 01:45:00 +1000

Young-Onset Dementia – Prof. James Burrell

Speaker: Prof. James Burrell (Cognitive Neurologist Macquarie University Health. Biography click here)).
Overview: Explores young-onset dementia (<65 years), which affects 132 per 100,000 individuals in Australia (a prevalence comparable to multiple sclerosis).
Key Takeaways:
Atypical Non-Memory Phenotypes: Emphasizes that young-onset dementia frequently presents with atypical non-memory features, such as logopenic progressive aphasia (language variant), posterior cortical atrophy (visual variant), or frontotemporal dementia.
Diagnostic Delay & Workup Challenges: Highlights frequent diagnostic delays due to overlap with depression or burnout, urging careful review of brain MRI scans for focal anterior temporal or frontotemporal atrophy.
Anti-Amyloid Therapies & Biomarkers: Discusses disease-modifying anti-amyloid therapies (Lecanemab, Donanemab) that slow clinical decline by 20–35% when initiated during early mild cognitive impairment.
Social & Systemic Impact: Stresses the unique social burden on younger patients, including ongoing employment, young families, and navigating NDIS support.

Early Parkinsons disease AProf. Florin Gandor

Tue, 15 Sep 2026 01:30:00 +1000

Early Parkinson’s Disease – AProf. Florin Gandor

Speaker: Associate Professor Florin Gandor (Neurologist Macquarie University Health. Biography click here).
Overview: Details the early motor and non-motor clinical features of Parkinson's disease alongside evidence-based therapy initiation.
Key Takeaways:
Cardinal Motor Features: Highlights bradykinesia—specifically the progressive reduction or decrement of movement amplitude over time—as the core motor feature.
Early Non-Motor Clues: Identifies prodromal non-motor red flags that often precede motor diagnosis by years, including REM sleep behavior disorder (dream enactment), hyposmia, constipation, and unexplained shoulder pain.
Levodopa Misconception Refuted: Reassures clinicians that Levodopa can be started early to improve patient quality of life; motor fluctuations are driven by underlying disease progression rather than duration of Levodopa therapy.
Dopamine Agonist Precautions: Warns against impulse control disorders (hypersexuality, compulsive spending, gambling) and sudden daytime sleepiness from dopamine agonists, emphasizing slow tapering to avoid severe withdrawal syndromes.

Neuromuscular Disorders Dr Will Fokkink

Tue, 15 Sep 2026 01:15:00 +1000

Neuromuscular Disorders – Dr. Will Fokkink

Speaker: Dr. Will Fokkink (Neurologist Macquarie University Health. Biography click here).
Overview: Provides a practical clinical guide to evaluating neuromuscular disorders from the motor neuron down to the muscle fiber.
Key Takeaways:
Myasthenia Gravis Recognition: Discusses fatigable weakness, ocular ptosis, and bulbar symptoms; outlines simple bedside tests like the ice-pack test and sustained upward gaze to demonstrate fatigue.
Myopathies & Toxic Mimics: Reviews inflammatory myopathies (dermatomyositis) and cautions against toxic mimics such as statin-induced necrotizing myopathy, excess vitamin B6 toxicity, and steroid myopathies.
Neuropathy Triaging: Differentiates common length-dependent polyneuropathies from rapidly progressive, non-length-dependent neuropathies (e.g., Guillain-Barré syndrome, CIDP), which require urgent specialist attention.
Motor Neuron Disease Red Flags: Advises prompt referral for muscle fasciculations combined with progressive weakness and orthopnea, highlighting available PBS-listed treatments and early supportive care.

Panel Discussion 2 Prof. James Burrell, AProf. Florin Gandor, Dr Will Fokkink

Tue, 15 Sep 2026 01:00:00 +1000

Panel Discussion 2 – Prof. James Burrell, AProf. Florin Gandor, Dr. Will Fokkink

Panellists: Prof. James Burrell, AProf. Florin Gandor, Dr. Will Fokkink.
Overview: Specialist panel addressing primary care queries on neurodegenerative disease management, diagnostic testing cautions, and novel therapies.
Key Takeaways:
Caution with p-Tau 217 Biomarkers: Prof. Burrell warns against routine ordering of blood biomarkers like p-Tau 217 in primary care without a high pre-test probability, due to the risk of false positives in perimenopausal or low-risk patients.
Anti-Amyloid Therapy Costs: Notes that a full 18-month course of anti-amyloid monoclonal antibodies (e.g., Donanemab, Lecanemab) costs approximately $100,000 for medication alone, reinforcing the need for careful patient selection.
Polysomnography for REM Sleep Disorder: AProf. Gandor confirms that formal hospital-based polysomnography is required to objectively diagnose REM sleep behavior disorder linked to alpha-synucleinopathies.
Meralgia Paresthetica Management: Dr. Fokkink discusses refractory nerve pain, advising dynamic ultrasound or MR neurography before considering invasive surgical options.

Breast cancer risk factors Dr Negin Sedaghat

Tue, 15 Sep 2026 00:45:00 +1000

Breast Cancer Risk Factors – Dr. Negin Sedaghat

Speaker: Dr. Negin Sedaghat (Breast & Endocrine Surgeon Macquarie University Health. Biography click here).
Overview: Explores individualized breast cancer risk assessment beyond general population averages, distinguishing between absolute risk (e.g., 1 in 7 lifetime risk in New South Wales) and relative risk.
Key Takeaways:
Validated Risk Calculators: Recommends tools like iPrevent (validated for Australian cohorts, incorporating broad family history and lifestyle) and IBIS / Tyrer-Cuzick (international cohort, focusing on menopausal hormone therapy and density) to stratify patients into average, moderate, or high-risk categories.
Family History Criteria: Clarifies that a single relative with breast cancer does not automatically place a patient in a high-risk category; high risk generally requires three or more close blood relatives or specific high-risk features like diagnosis before age 40 or male breast cancer.
Menopausal Hormone Therapy (MHT): Highlights that estrogen-only MHT in women post-hysterectomy carries minimal to no increased breast cancer risk, whereas combined MHT carries a slight increased risk (~3 additional cases per 1,000 women over 5 years) that varies by progesterone type (e.g., micronized progesterone).
Dynamic Risk Profile: Reminds clinicians that risk changes across a woman's lifespan as modifiable lifestyle factors evolve, requiring review every 3 to 5 years.

Breast density and imaging Dr Robert George

Tue, 15 Sep 2026 00:30:00 +1000

Breast Density and Imaging – Dr. Robert George

Speaker: Dr. Robert George (Breast & General Surgeon Macquarie University Health. Biography click here).
Overview: Addresses the tissue composition of the breast and the clinical implications of high breast density.
Key Takeaways:
BI-RADS Classification: Explains the BI-RADS scale from category A (almost entirely fatty) to category D (extremely dense), noting that density cannot be determined by physical touch alone.
The Dual Challenge: Highlights that dense breast tissue acts as an independent risk factor (~3x relative risk) while creating a masking effect that conceals tumors on standard 2D mammograms.
Tailored Screening Modalities: Recommends adjunctive screening for dense breasts (Category C/D), including concurrent ultrasound, 3D tomosynthesis, contrast-enhanced mammography (CEM), or MRI.
Oncoplastic Surgery: Demonstrates how parenchymal density influences oncoplastic techniques to remold local tissue and preserve aesthetics following tumor excision

Lymphoedema Lipoedema (ALERT) Ms Robbie Blackwell

Tue, 15 Sep 2026 00:15:00 +1000

Lymphoedema / Lipoedema (ALERT Program) – Ms. Robbie Blackwell

Speaker: Ms. Robbie Blackwell (Occupational Therapist & Lymphoedema Specialist Macquarie University Health. Biography click here).
Overview: Reviews contemporary lymphatic physiology and clinical management protocols for lymphedema, chronic edema, and lipoedema within Macquarie University's ALERT program.
Key Takeaways:
Revised Fluid Homeostasis: Explains that the lymphatic system is the primary route for returning interstitial fluid and proteins, updating classic Starling capillary filtration concepts.
Lymphedema vs. Chronic Edema: Differentiates low-output lymphatic failure (lymphedema) from high-output capillary overload (chronic edema), noting that unmanaged chronic edema leads to secondary lymphatic damage.
ICG Lymphography Gold Standard: Highlights ICG lymphography imaging as the diagnostic standard, where "dermal backflow" confirms structural lymphatic damage.
Lipoedema Diagnostic Criteria: Defines lipoedema as a painful, symmetrical fat distribution disorder in women (sparing hands and feet), triggered by hormonal shifts (puberty, pregnancy, menopause), managed with compression, movement, and conservative or surgical (Brorson liposuction) approaches.

Panel Discussion 3 Dr Negin Sedaghat, Dr Robert George, Ms Robbie Blackwell

Tue, 15 Sep 2026 00:00:00 +1000

Panel Discussion 3 – Dr. Negin Sedaghat, Dr. Robert George, Ms. Robbie Blackwell

Panellists: Dr. Negin Sedaghat, Dr. Robert George, Ms. Robbie Blackwell.
Overview: Expert discussion on breast cancer risk factors, extended genetic panels, imaging combinations, and lymphedema service funding.
Key Takeaways:
Night Shift Work Mechanism: Dr. Sedaghat clarifies that night shift work increases breast cancer risk through circadian disruption and suppressed melatonin (an anti-estrogenic hormone) rather than psychological stress, though supplemental melatonin has no proven protective benefit.
Expanded Genetic Screening Panels: Dr. Sedaghat and Dr. George note that genetic testing indications have broadened for patients under 60 with high-risk features, reminding clinicians to request extended panels beyond BRCA1/2.
Adjunctive Ultrasound in Dense Breasts: Dr. George reiterates that mammograms and ultrasounds should be performed concurrently rather than in isolation for BI-RADS C/D density to avoid missing microcalcifications or masked masses.
Lymphedema Care Funding: Ms. Blackwell explains that GP Chronic Disease Management plans cover therapist consultations, and home sequential compression pumps (SIPC) offer cost-effective daily therapy.