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Thoracic Medicine

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Sleep Medicine

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The Wall Street Journal reported recently on the topic of sleep deprivation as to which cities around the World are the most and least sleep deprived. Brisbane leads the way with the earliest bed time and earliest wake up time.

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According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours.

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As we get older there is a strong relationship between reduced amount and quality of sleep. Recent research has found specific cluster of neurons that have linked insomnia and more sleep fragmentation. The reduction of these neurons can be from normal aging but has also been seen in Alzheimers disease.

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A bedtime routine might sound like something that's only necessary for the grade-school set, but following a nightly schedule can greatly improve the sleep of adults, too. Sleep experts recommend establishing a bedtime routine, both to calm and relax you as you get ready to sleep and so you aren't inadvertently giving yourself jet lag.

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Researchers at NYU Langone Medical Center and elsewhere, using a mouse model, have recorded the activity of individual nerve cells in a small part of the brain that works as a "switchboard," directing signals coming from the outside world or internal memories. Because human brain disorders such as schizophrenia, autism and post-traumatic stress disorder typically show disturbances in that switchboard, the investigators say the work suggests new strategies in understanding and treating them.

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The death rate from asthma in Australia has fallen by almost 70 per cent since the 1980s, according to a new report released by the Australian Institute of Health and Welfare

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Sarcoidosis

WHAT IS Sarcoidosis?

Sarcoidosis causes small inflammatory masses or nodules (known as granulomas) to form mainly in the lungs and chest lymph glands but can affect the eyes, liver, heart and brain as well. Granulomas are groups of immune cells, which are normally part of the body’s defence system.  These granulomas might alter the structure or function of the organs involved.  Often there are no symptoms, however some people may have a cough or chest discomfort, tiredness, breathlessness, dry mouth, sore eyes and skin rashes.  Some patients develop tender, red lumps on their shins or ankles called erythema nodosum.

Sarcoidosis and the lungs

The lungs are affected in about 9 out of every 10 sarcoidosis patients – however still not all will show symptoms.  It is thought that Sarcoidosis of the lungs starts with inflammation of the alveoli – the tiny gas exchanging units of the lungs.   Alveolitis either clears up naturally or leads to granuloma formation.  Eventually fibrosis can form causing the lung to stiffen – making breathing even more difficult.   About 20-30% of people with Sarcoidosis will develop some kind of permanent lung damage.

 WHAT causes SARCOIDOSIS?

The cause of Sarcoidosis is not yet known – despite extensive world-wide research.   Occasionally Sarcoidosis runs in families and most commonly affects people between the ages of 20-40, however much younger and older people have been known to have the disease.  How Sarcoidosis spreads from one part of the body to another is also currently being studied.  Sarcoidosis can appear suddenly and/or severely and subside after a short amount of time.  Sometimes symptoms can come on slowly and subtly and last or recur over a long time span.

how is SARCOIDOSIS diagnosed?

Sarcoidosis is usually diagnosed through biopsy of the affected organ; however it can sometimes be diagnosed by x-rays, blood tests and a detailed patient history.  The following are the main tools your doctor will use to diagnose you:

  • Chest x-ray – look for cloudiness (pulmonary infiltrates) or swollen lymph glands
  • CT scan – provides an even more detailed look at the lungs and lymph glands than an x-ray
  • Breathing test – measures how well your lungs are functioning
  • Bronchoscopy – involves passing a tube down the airways to provide a better look at what is happening inside your lungs.   The doctor can also take a small biopsy to check for granulomas and rule out other infection.

how is sarcoidosis treated?

Most cases of Sarcoidosis get better over 1-3 years, and may not need any treatment at all.  The granulomas can go away by themselves. Most people with Sarcoidosis can lead a normal, active life.

Treatment, when needed generally falls under 2 categories – maintenance of good health and drug treatment.  Maintenance of good health involves:
  • Getting regular check-ups with your doctor
  • Eating a well-balanced diet
  • Getting 6-8 hours of sleep per night
  • Exercising regularly and maintaining your weight
  • Quitting smoking
  • Avoiding dust, gases and harsh chemicals that can irritate your airways
  • Occasionally people with Sarcoidosis will have high blood or urine levels of calcium – if your doctor has told you this relates to you, it may help to avoid excess calcium in your diet and avoid excessive sunlight (i.e. daily sunbathing). 

Drug treatments are used to relieve symptoms, reduce the inflammation of affected tissues, reduce the impact of granuloma development and possibly prevent the development of lung fibrosis and other irreversible organ damage.  Drug treatments include prednisolone and corticosteriods – both of which have side effects if used for an extended period of time, however often the benefits outweigh the risks. 

Other drug combination treatments may be available, speak to your doctor to find out what treatment is right for you. Unfortunately there are no treatments able to reverse the fibrotic damage Sarcoidosis may cause on the lungs.

 

 

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