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Terminally ill 23-year-old's final request

Liam Bulman was working a shift at The Illawarra Hotel in Wollongong last month when he asked to leave early, as he felt unwell. The following week he found himself in "crippling pain" and was rushed to hospital by his friend. After days of intensive testing, the 23-year-old was diagnosed with stage-four High Grade Neuroendocrine Carcinoma — a "rare" cancer that had spread. Now, his family and friends are doing everything they can to raise funds so he can have a "chance to make memories" through ticking off items on his bucket list in this "scary, sad and unknown" time. "He's smart and kind. He's been raised to work hard and contribute to people's lives, and our community. He's incredible," Liam's colleagues from The Illawarra Hotel wrote on the<a href="https://www.gofundme.com/f/youre-friendly-local-bartender-bulmans-bucket-list" target="_blank" rel="noopener"> GoFundMe</a> page. So far they have raised over $28,000 of their $50,000 goal, with most of the money raised going towards his medical costs, medical trial attendance and palliative care, and any remaining money will help fund his bucket list. His bucket list includes activities like attending the F1 in Melbourne, going for a joyride in a helicopter, learning to surf and taking a family photo session. Liam's mum, Emily Bulman, revealed his cancer is "incurable" and he has since started a bout of chemotherapy in hope it will "buy him more time" as the cancer has spread to his lymph nodes and lower digestive tract. "This will assist us to aim for longevity, quality of life, a chance to make memories, and receive the care and comfort that suits Liam best," she said on the fundraising page. "Anything we can raise to help take the burden off Liam, we would be incredibly grateful for." Images: GoFundMe/Facebook

Caring

How long does back pain last? And how can learning about pain increase the chance of recovery?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Back pain is common. One in thirteen people have it right now and worldwide a staggering 619 million people will <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">have it this year</a>. Chronic pain, of which back pain is the most common, is the world’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/">most disabling</a> health problem. Its economic impact <a href="https://www.ncbi.nlm.nih.gov/books/NBK92510/">dwarfs other health conditions</a>. If you get back pain, how long will it take to go away? We scoured the scientific literature to <a href="https://www.cmaj.ca/content/cmaj/196/2/E29.full.pdf">find out</a>. We found data on almost 20,000 people, from 95 different studies and split them into three groups: <ul> <li>acute – those with back pain that started less than six weeks ago</li> <li>subacute – where it started between six and 12 weeks ago</li> <li>chronic – where it started between three months and one year ago.</li> </ul> We found 70%–95% of people with acute back pain were likely to recover within six months. This dropped to 40%–70% for subacute back pain and to 12%–16% for chronic back pain. Clinical guidelines point to graded return to activity and pain education under the guidance of a health professional as the best ways to promote recovery. Yet these effective interventions are underfunded and hard to access. <h2>More pain doesn’t mean a more serious injury</h2> Most acute back pain episodes are <a href="https://www.racgp.org.au/getattachment/75af0cfd-6182-4328-ad23-04ad8618920f/attachment.aspx">not caused</a> by serious injury or disease. There are rare exceptions, which is why it’s wise to see your doctor or physio, who can check for signs and symptoms that warrant further investigation. But unless you have been in a significant accident or sustained a large blow, you are unlikely to have caused much damage to your spine. Even very minor back injuries can be brutally painful. This is, in part, because of how we are made. If you think of your spinal cord as a very precious asset (which it is), worthy of great protection (which it is), a bit like the crown jewels, then what would be the best way to keep it safe? Lots of protection and a highly sensitive alarm system. The spinal cord is protected by strong bones, thick ligaments, powerful muscles and a highly effective alarm system (your nervous system). This alarm system can trigger pain that is so unpleasant that you cannot possibly think of, let alone do, anything other than seek care or avoid movement. The messy truth is that when pain persists, the pain system becomes more sensitive, so a widening array of things contribute to pain. This pain system hypersensitivity is a result of neuroplasticity – your nervous system is becoming better at making pain. <h2>Reduce your chance of lasting pain</h2> Whether or not your pain resolves is not determined by the extent of injury to your back. We don’t know all the factors involved, but we do know there are things that you can do to reduce chronic back pain: <ul> <li> understand how pain really works. This will involve intentionally learning about modern pain science and care. It will be difficult but rewarding. It will help you work out what you can do to change your pain </li> <li> reduce your pain system sensitivity. With guidance, patience and persistence, you can learn how to gradually retrain your pain system back towards normal. </li> </ul> <h2>How to reduce your pain sensitivity and learn about pain</h2> Learning about “how pain works” provides the most sustainable <a href="https://www.bmj.com/content/376/bmj-2021-067718">improvements in chronic back pain</a>. Programs that combine pain education with graded brain and body exercises (gradual increases in movement) can reduce pain system sensitivity and help you return to the life you want. These programs have been in development for years, but high-quality clinical trials <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">are now emerging</a> and it’s good news: they show most people with chronic back pain improve and many completely recover. But most clinicians aren’t equipped to deliver these effective programs – <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">good pain education</a> is not taught in most medical and health training degrees. Many patients still receive ineffective and often risky and expensive treatments, or keep seeking temporary pain relief, hoping for a cure. When health professionals don’t have adequate pain education training, they can deliver bad pain education, which leaves patients feeling like they’ve just <a href="https://www.jpain.org/article/S1526-5900(23)00618-1/fulltext">been told it’s all in their head</a>. Community-driven not-for-profit organisations such as <a href="https://www.painrevolution.org/">Pain Revolution</a> are training health professionals to be good pain educators and raising awareness among the general public about the modern science of pain and the best treatments. Pain Revolution has partnered with dozens of health services and community agencies to train more than <a href="https://www.painrevolution.org/find-a-lpe">80 local pain educators</a> and supported them to bring greater understanding and improved care to their colleagues and community. But a broader system-wide approach, with government, industry and philanthropic support, is needed to expand these programs and fund good pain education. To solve the massive problem of chronic back pain, effective interventions need to be part of standard care, not as a last resort after years of increasing pain, suffering and disability.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222513/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sarah-wallwork-1361569">Sarah Wallwork</a>, Post-doctoral Researcher, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> and <a href="https://theconversation.com/profiles/lorimer-moseley-1552">Lorimer Moseley</a>, Professor of Clinical Neurosciences and Foundation Chair in Physiotherapy, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-does-back-pain-last-and-how-can-learning-about-pain-increase-the-chance-of-recovery-222513">original article</a>. </div>

Body

I feel sick. How do I know if I have the flu, COVID, RSV or something else?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> You wake with a sore throat and realise you are sick. Is this going to be a two-day or a two-week illness? Should you go to a doctor or just go to bed? Most respiratory illnesses have very similar symptoms at the start: sore throat, congested or runny nose, headache, fatigue and fever. This may progress to a dry cough. Best case scenario is that you have “<a href="https://lungfoundation.com.au/wp-content/uploads/2018/09/Factsheet-Common-Cold-Mar2016.pdf">a cold</a>” (which can be any one of hundreds of viruses, most commonly rhinovirus), which is short-lived and self-limiting. But some respiratory illnesses can be much more serious. Here is a brief guide to some important bugs to know about that are circulating this winter, and how to work out which one you have. <h2>Respiratory syncytial virus (RSV)</h2> For most people an RSV infection will feel like “a cold” – annoying, but only lasting a few days. However, for babies, older adults and people with immune issues, it can lead to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a> or pneumonia, and even become life-threatening. RSV isn’t seasonal, which means you are just as likely to get it in summer as in winter. However, it is highly contagious so we noticed it <a href="https://pubmed.ncbi.nlm.nih.gov/32986804">disappearing almost completely</a> during COVID lockdowns. There is now a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">rapid-antigen test (RAT) for RSV</a> which also checks for influenza and COVID, and is the best way of finding out if RSV is what is causing symptoms. Recently, a preventative immune therapy has become available for high risk babies (<a href="https://www.schn.health.nsw.gov.au/respiratory-syncytial-virus-rsv-monoclonal-antibody-factsheet">nirsevimab</a>) and there are also <a href="https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked">vaccines for higher risk adults</a>. Nirsevimab is also available to all babies for free in <a href="https://www.health.wa.gov.au/Articles/N_R/Respiratory-syncytial-virus-RSV-immunisation">Western Australia</a> and <a href="https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/immunisation/paediatric-rsv-prevention-program">Queensland</a>. But there are no specific treatments. Adults who get it simply have to ride it out (using whatever you need to <a href="https://www.mayoclinic.org/diseases-conditions/common-cold/diagnosis-treatment/drc-20351611">manage symptoms</a>). Babies and higher risk patients need to present to an emergency department if they test positive for RSV and are also looking or feeling very unwell (this might mean rapid shallow breathing, fevers not coming down with paracetamol or ibuprofen, a baby not feeding, mottled-looking skin, or going blue around the mouth). If a patient has developed a bronchiolitis or pneumonia, they may need to be hospitalised. <h2>Influenza</h2> Once you have had the “true flu” (influenza), you will find it frustrating when people call their sniffly cold-like symptoms a “flu”. Influenza infections generally start with a sore throat and headache which quickly turns into high fevers, generalised aches and excessive fatigue. You feel like you have been hit by a truck and may struggle to get out of bed. This can last a week or more, even in people who are generally fit and healthy. Influenza is a major public health issue internationally, with 3–5 million cases of severe illness and <a href="https://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)">290,000 to 650,000 respiratory deaths annually</a>. People who are at <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/influenza-flu">greater risk of complications</a> from influenza include pregnant women, children under five, adults aged 65 and over, First Nations peoples, and people with chronic or immunosuppressive medical conditions. For this reason, annual vaccination is <a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">recommended and funded</a> for vulnerable people. Vaccination is also readily available for <a href="https://www.health.gov.au/topics/immunisation/immunisation-contacts">all Australians who want it</a>, through pharmacies as well as medical clinics, usually at a cost of less than A$30. In <a href="https://www.vaccinate.initiatives.qld.gov.au/what-to-vaccinate-against/influenza#:%7E:text=The%20flu%20vaccine%20is%20free,.qld.gov.au">some states</a>, it’s free for all residents. Influenza is seasonal, with definite peaks in the winter months. This is why vaccines are offered from early autumn. If you think you may have influenza, there are now home-testing RATs: all current influenza RATs are in combination with COVID RATs, as the symptoms overlap. Treatment for most people is to manage symptoms and try to avoid spreading it around. Doctors can also <a href="https://theconversation.com/i-think-i-have-the-flu-should-i-ask-my-gp-for-antivirals-210457">prescribe antivirals</a> to vulnerable patients; these work best if started within 48 hours of symptoms. <h2>COVID</h2> It has been less than five years since COVID-19, caused by SARS-CoV-2, started to spread around the world in pandemic proportions. Although COVID is no longer a <a href="https://www.health.gov.au/news/ahppc-statement-end-of-covid-19-emergency-response">public health emergency</a>, it still causes <a href="https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-may-2024">more deaths than influenza and RSV combined</a>. Unlike RSV and influenza, only those <a href="https://www.health.gov.au/topics/covid-19/protect-yourself-and-others/high-risk-groups">aged over 70</a> are in a high-risk age group for COVID. Other <a href="https://www.cdc.gov/covid/risk-factors/?CDC_AAref_Val=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">factors besides age</a> may put you at higher risk of becoming very unwell when infected by this virus. This includes having other respiratory diseases (such as asthma or chronic obstructive pulmonary disease, also known as COPD), diabetes, cancer, kidney disease, obesity or heart disease. Unlike most respiratory viruses, SARS-CoV-2 tends to set off inflammation beyond the respiratory system. This can involve a range of other organs including the heart, kidneys and blood vessels. Although most people are back to their usual work or study after a week or two, a significant proportion go on to experience extended symptoms such as fatigue, breathlessness, brain fog and mood changes. When these last <a href="https://aci.health.nsw.gov.au/statewide-programs/critical-intelligence-unit/post-acute-sequelae">more than 12 weeks</a>, without any other explanation for symptoms, it’s called <a href="https://www.healthdirect.gov.au/covid-19/post-covid-symptoms-long-covid">long COVID</a>. COVID vaccines can prevent serious illness and have been <a href="https://pubmed.ncbi.nlm.nih.gov/38282394/">monitored</a> for several years now for their safety and effectiveness. Current vaccination recommendations are <a href="https://www.health.gov.au/resources/publications/atagi-statement-on-the-administration-of-covid-19-vaccines-in-2024?language=en">based on age and immune status</a>. It’s worth discussing them with your doctor if you are unsure whether you would benefit or not. <a href="https://www.health.gov.au/topics/covid-19/oral-treatments">Antivirals</a> can treat COVID in higher-risk people who contract it, whether vaccinated or not. Specific advice about what to do if you test positive on a RAT will vary according to your current state guidelines and workplace, however the <a href="https://www.health.gov.au/topics/covid-19/testing-positive">general principles</a> are always: avoid spreading the virus to others, and give yourself time to rest and recover. <hr /> <iframe id="ConNR" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/ConNR/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> <hr /> <h2>What if it’s not one of those?</h2> So you’ve done your combined RSV/flu/COVID RAT and the result is negative. But you still have symptoms. What else could it be? More than 200 different viruses can cause cold and flu symptoms, including rhinovirus (mentioned above), adenovirus and sometimes even <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2130424/">undefined pathogens</a>. If an illness progresses to a cough which will not go away, and/or you start coughing up sputum, this could be a bacterial infection, such as pertussis (whooping cough), streptococcus pneumoniae, haemophilus influenzae or moraxella catarrhalis. So it’s worth <a href="https://www.racgp.org.au/getattachment/0a637812-c8f0-45a2-af9c-fa215b64f8e4/attachment.aspx">getting assessed by a GP</a> who may do a chest Xray and/or <a href="https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/M/MCS-sputum">test your sputum</a>, particularly if they suspect pneumonia. You also may also start out with what is clearly a viral infection but then get a secondary bacterial infection later. So if you are getting more unwell over time, it’s worth getting tested, in case antibiotics will help. However, taking antibiotics for a purely viral illness will not only be useless, it can contribute to harmful <a href="https://www.nps.org.au/consumers/antibiotic-resistance-the-facts">antibiotic resistance</a> and give you unwanted side effects.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234266/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">original article</a>. </div>

Body

Do you have a mental illness? Why some people answer ‘yes’, even if they haven’t been diagnosed

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/jesse-tse-1429151">Jesse Tse</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/nick-haslam-10182">Nick Haslam</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Mental illnesses such as depression and anxiety disorders have become more prevalent, especially among <a href="https://www.aihw.gov.au/mental-health/overview/prevalence-and-impact-of-mental-illness#changeovertime">young people</a>. Demand for treatment is surging and prescriptions of some <a href="https://pubmed.ncbi.nlm.nih.gov/35176912/">psychiatric medications</a> have climbed. These upswinging prevalence trends are paralleled by rising public attention to mental illness. Mental health messages saturate traditional and social media. Organisations and governments are developing awareness, prevention and treatment initiatives with growing urgency. The mounting cultural focus on mental health has obvious benefits. It increases awareness, reduces stigma and promotes help-seeking. However, it may also have costs. Critics worry <a href="https://www.bacp.co.uk/bacp-journals/therapy-today/2023/april-2023/the-big-issue/">social media</a> sites are incubating mental illness and that ordinary unhappiness is being pathologised by the overuse of diagnostic concepts and “<a href="https://www.bustle.com/wellness/is-therapy-speak-making-us-selfish">therapy speak</a>”. British psychologist <a href="https://www.psych.ox.ac.uk/team/lucy-foulkes">Lucy Foulkes</a> argues the trends for rising attention and prevalence are linked. Her “<a href="https://www.sciencedirect.com/science/article/pii/S0732118X2300003X">prevalence inflation hypothesis</a>” proposes that increasing awareness of mental illness may lead some people to diagnose themselves inaccurately when they are experiencing relatively mild or transient problems. Foulkes’ hypothesis implies that some people develop overly broad concepts of mental illness. Our research supports this view. In a new study, <a href="https://www.sciencedirect.com/science/article/pii/S2666560324000318?via%3Dihub">we show</a> that concepts of mental illness have broadened in recent years – a phenomenon we call “<a href="https://www.tandfonline.com/doi/full/10.1080/1047840X.2016.1082418">concept creep</a>” – and that <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-023-05152-6">people differ</a> in the breadth of their concepts of mental illness. <h2>Why do people self-diagnose mental illnesses?</h2> In our new <a href="https://doi.org/10.1016/j.ssmmh.2024.100326">study</a>, we examined whether people with broad concepts of mental illness are, in fact, more likely to self-diagnose. We defined self-diagnosis as a person’s belief they have an illness, whether or not they have received the diagnosis from a professional. We assessed people as having a “broad concept of mental illness” if they judged a wide variety of experiences and behaviours to be disorders, including relatively mild conditions. We asked a nationally representative sample of 474 American adults if they believed they had a mental disorder and if they had received a diagnosis from a health professional. We also asked about other possible contributing factors and demographics. Mental illness was common in our sample: 42% reported they had a current self-diagnosed condition, a majority of whom had received it from a health professional. Unsurprisingly, the strongest predictor of reporting a diagnosis was experiencing relatively severe distress. The second most important factor after distress was having a broad concept of mental illness. When their levels of distress were the same, people with broad concepts were substantially more likely to report a current diagnosis. The graph below illustrates this effect. It divides the sample by levels of distress and shows the proportion of people at each level who report a current diagnosis. People with broad concepts of mental illness (the highest quarter of the sample) are represented by the dark blue line. People with narrow concepts of mental illness (the lowest quarter of the sample) are represented by the light blue line. People with broad concepts were much more likely to report having a mental illness, especially when their distress was relatively high. People with greater mental health literacy and less stigmatising attitudes were also more likely to report a diagnosis. Two interesting further findings emerged from our study. People who self-diagnosed but had not received a professional diagnosis tended to have broader illness concepts than those who had. In addition, younger and politically progressive people were more likely to report a diagnosis, consistent with some <a href="https://www.sciencedirect.com/science/article/pii/S2666560321000438">previous research</a>, and held broader concepts of mental illness. Their tendency to hold these more expansive concepts partially explained their higher rates of diagnosis. <h2>Why does it matter?</h2> Our findings support the idea that expansive concepts of mental illness promote self-diagnosis and may thereby increase the apparent prevalence of mental ill health. People who have a lower threshold for defining distress as a disorder are more likely to identify themselves as having a mental illness. Our findings do not directly show that people with broad concepts over-diagnose or those with narrow concepts under-diagnose. Nor do they prove that having broad concepts causes self-diagnosis or results in actual increases in mental illness. Nevertheless, the findings raise important concerns. First, they suggest that rising mental health awareness may <a href="https://www.newscientist.com/article/mg25934573-900-why-being-more-open-about-mental-health-could-be-making-us-feel-worse/">come at a cost</a>. In addition to boosting mental health literacy it may increase the likelihood of people incorrectly identifying their problems as pathologies. Inappropriate self-diagnosis can have adverse effects. Diagnostic labels may become identity-defining and self-limiting, as people come to believe their problems are enduring, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032724002489?via%3Dihub">hard-to-control</a> aspects of who they are. Second, unwarranted self-diagnosis may lead people experiencing relatively mild levels of distress to seek help that is unnecessary, inappropriate and ineffective. Recent <a href="https://pubmed.ncbi.nlm.nih.gov/37844607/">Australian research</a> found people with relatively mild distress who received psychotherapy worsened more often than they improved. Third, these effects may be particularly problematic for young people. They are most liable to hold broad concepts of mental illness, in part due to <a href="https://www.sciencedirect.com/science/article/pii/S0010440X22000682?via%3Dihub">social media</a> <a href="https://www.tandfonline.com/doi/full/10.1080/10810730.2023.2235563">consumption</a>, and they experience mental ill health at relatively high and rising rates. Whether expansive concepts of illness play a role in the youth mental health crisis remains to be seen. Ongoing cultural shifts are fostering increasingly expansive definitions of mental illness. These shifts are likely to have mixed blessings. By normalising mental illness they may help to remove its stigma. However, by pathologising some forms of everyday distress, they may have an unintended downside. As we wrestle with the mental health crisis, it is crucial we find ways to increase awareness of mental ill health without inadvertently inflating it.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/231687/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jesse-tse-1429151">Jesse Tse</a>, PhD Candidate at Melbourne School of Psychological Sciences, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> and <a href="https://theconversation.com/profiles/nick-haslam-10182">Nick Haslam</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/do-you-have-a-mental-illness-why-some-people-answer-yes-even-if-they-havent-been-diagnosed-231687">original article</a>. </div>

Mind

"I am the Bicycle Bandit": Terminally-ill ex-cop confesses to 20-year-old mystery

In a startling twist to a 20-year-old mystery, 73-year-old Kym Allen Parsons, a terminally-ill former police officer and firefighter, has admitted to being the notorious "Bicycle Bandit" who terrorised South Australian banks and residents for a decade. Parsons' confession came just days after receiving approval for voluntary assisted dying (VAD) and being provided with a VAD kit by SA Health. Parsons, who has stage 4 cancer and who had previously denied the charges, changed his plea to guilty during a Supreme Court session on Monday, ending years of speculation and investigation. His sudden admission of guilt follows a plea bargain brokered by the Office of the Director of Public Prosecutions and his counsel after the VAD approval was granted. In a tearful apology read to the court, Parsons expressed deep remorse for his actions, acknowledging that his behaviour was both irrational and without excuse. "I have no excuse for my behaviour," he told the court. "My reasoning was illogical and irrational over that time, and over the past 10 years I have tried to rehabilitate, seek help and forgiveness and demonstrate my shame in distressing actions. "I was fearful of confessing my past and destroying their [my wife and family's] love and trust in the person they knew. "I do not expect your forgiveness, and I humbly ask you accept my sincerest apology and deepest remorse." Despite Parsons' request for bail ahead of his sentencing, Justice Sandi McDonald deemed his crimes too severe for continued freedom and ordered his immediate custody. His access to the VAD kit while in custody remains uncertain. The courtroom was filled with Parsons' victims and their supporters, many of whom had worked at the banks he robbed. Some were victimised multiple times. One victim described the lasting impact of being robbed at gunpoint, detailing the immense trauma and the development of an auto-immune disease likely induced by stress. Other victims recounted struggles with PTSD, anxiety, depression, and ongoing trust issues. Parsons had been scheduled for trial in February on charges of armed robbery, attempted armed robbery, and firearms offences, with prosecutors alleging he stole over $250,000 from 11 banks between 2004 and 2014. DNA evidence was cited as a link to the crimes. His guilty plea and impending death are expected to ignite a legal battle over his $2.4 million estate, involving prosecutors, his heirs, and his victims. Previously, Parsons had been granted home detention due to his terminal stage 4 cancer diagnosis, after significant weight loss while in custody. His defence lawyer, James Marcus, stated that Parsons pleaded guilty to provide closure to the victims and their families. Parsons' sentencing is scheduled for June 28, marking the conclusion of a complex and emotional case that has gripped the state for years. Images: ABC News / SA Police

Legal

Longer appointments are just the start of tackling the gender pain gap. Here are 4 more things we can do

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/marilla-l-druitt-1533572">Marilla L. Druitt</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Ahead of the federal budget, health minister Mark Butler <a href="https://www.abc.net.au/news/2024-05-10/endometriosis-australia-welcomes-govt-funding-for-endometriosis/103830392">last week announced</a> an investment of A$49.1 million to help women with endometriosis and complex gynaecological conditions such as chronic pelvic pain and polycystic ovary syndrome (PCOS). From July 1 2025 <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/historic-medicare-changes-for-women-battling-endometriosis">two new items</a> will be added to the Medicare Benefits Schedule providing extended consultation times and higher rebates for specialist gynaecological care. The Medicare changes <a href="https://www1.racgp.org.au/newsgp/clinical/longer-consults-for-endometriosis-sufferers-on-the">will subsidise</a> $168.60 for a minimum of 45 minutes during a longer initial gynaecologist consultation, compared to the standard rate of $95.60. For follow-up consultations, Medicare will cover $84.35 for a minimum of 45 minutes, compared to the standard rate of $48.05. Currently, there’s <a href="https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=104&qt=item&criteria=104">no specified time</a> for these initial or subsequent consultations. But while reductions to out-of-pocket medical expenses and extended specialist consultation times are welcome news, they’re only a first step in closing the gender pain gap. <h2>Chronic pain affects more women</h2> Globally, research has shown chronic pain (generally defined as pain that persists for <a href="https://www.healthdirect.gov.au/chronic-pain">more than three months</a>) disproportionately affects <a href="https://academic.oup.com/bja/article/111/1/52/331232?login=false">women</a>. Multiple biological and psychosocial processes likely contribute to this disparity, often called the gender pain gap. For example, chronic pain is frequently associated with conditions influenced by <a href="https://www.sciencedirect.com/science/article/abs/pii/S0304395914003868">hormones</a>, among other factors, such as endometriosis and <a href="https://theconversation.com/adenomyosis-causes-pain-heavy-periods-and-infertility-but-youve-probably-never-heard-of-it-104412">adenomyosis</a>. Chronic pelvic pain in women, regardless of the cause, can be debilitating and <a href="https://www.nature.com/articles/s41598-020-73389-2">negatively affect</a> every facet of life from social activities, to work and finances, to mental health and relationships. The gender pain gap is both rooted in and compounded by gender bias in medical research, treatment and social norms. The science that informs medicine – including the prevention, diagnosis, and treatment of disease – has traditionally focused on men, thereby <a href="https://www.theguardian.com/lifeandstyle/2015/apr/30/fda-clinical-trials-gender-gap-epa-nih-institute-of-medicine-cardiovascular-disease">failing to consider</a> the crucial impact of sex (biological) and gender (social) factors. When medical research adopts a “male as default” approach, this limits our understanding of pain conditions that predominantly affect women or how certain conditions affect men and women <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10921746/">differently</a>. It also means intersex, trans and gender-diverse people are <a href="https://www.deakin.edu.au/about-deakin/news-and-media-releases/articles/world-class-centre-tackles-sex-and-gender-inequities-in-health-and-medicine">commonly excluded</a> from medical research and health care. Minimisation or dismissal of pain along with the <a href="https://www.hindawi.com/journals/ecam/2016/3467067/">normalisation of menstrual pain</a> as just “part of being a woman” contribute to significant delays and misdiagnosis of women’s gynaecological and other health issues. Feeling dismissed, along with perceptions of stigma, can make women less likely <a href="https://link.springer.com/article/10.1186/s12905-024-03063-6">to seek help</a> in the future. <h2>Inadequate medical care</h2> Unfortunately, even when women with endometriosis do seek care, many <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.15494?saml_referrer">aren’t satisfied</a>. This is understandable when medical advice includes being told to become pregnant to treat their <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02794-2">endometriosis</a>, despite <a href="https://academic.oup.com/humupd/article/24/3/290/4859612?login=false">no evidence</a> pregnancy reduces symptoms. Pregnancy should be an autonomous choice, not a treatment option. It’s unsurprising people look for information from other, often <a href="https://www.mdpi.com/2227-9032/12/1/121">uncredentialed</a>, sources. While online platforms including patient-led groups have provided women with new avenues of support, these forums should complement, rather than replace, <a href="https://journals.sagepub.com/doi/full/10.1177/1460458215602939">information from a doctor</a>. Longer Medicare-subsidised appointments are an important acknowledgement of women and their individual health needs. At present, many women feel their consultations with a gynaecologist are <a href="https://www1.racgp.org.au/newsgp/clinical/longer-consults-for-endometriosis-sufferers-on-the">rushed</a>. These conversations, which often include coming to terms with a diagnosis and management plan, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496869/">take time</a>. <h2>A path toward less pain</h2> While extended consultation time and reduced out-of-pocket costs are a step in the right direction, they are only one part of a complex pain puzzle. If women are not listened to, their symptoms not recognised, and effective treatment options not adequately discussed and provided, longer gynaecological consultations may not help patients. So what else do we need to do? 1. Physician knowledge Doctors’ knowledge of women’s pain requires development through both practitioner <a href="https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-022-00815-4/tables/2">education and guidelines</a>. This knowledge should also include dedicated efforts toward understanding the <a href="https://www.newyorker.com/magazine/2018/07/02/the-neuroscience-of-pain">neuroscience of pain</a>. Diagnostic processes should be tailored to consider gender-specific symptoms and responses to <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00137-8/fulltext">pain</a>. 2. Research and collaboration Medical decisions should be based on the best and most inclusive evidence. Understanding the complexities of pain in women is essential for managing their pain. Collaboration between health-care experts from different disciplines can facilitate comprehensive and holistic pain research and management strategies. 3. Further care and service improvements Women’s health requires multidisciplinary treatment and care which extends beyond their GP or specialist. For example, conditions like endometriosis often see people presenting to emergency departments in <a href="https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia/contents/treatment-management/ed-presentations">acute pain</a>, so practitioners in these settings need to have the right knowledge and be able to provide support. Meanwhile, pelvic ultrasounds, especially the kind that have the potential to visualise endometriosis, take longer to perform and require a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0015028223020757/">specialist sonographer</a>. Current rebates do not reflect the time and expertise needed for these imaging procedures. 4. Adjusting the parameters of ‘women’s pain’ Conditions like PCOS and endometriosis don’t just affect women – they also impact people who are gender-diverse. Improving how people in this group are treated is just as salient as addressing how we treat women. Similarly, the gynaecological health-care needs of culturally and linguistically diverse and Aboriginal and Torres Strait islander women may be even <a href="https://www.mdpi.com/1660-4601/20/13/6321">less likely to be met</a> than those of women in the general population. <h2>Challenging gender norms</h2> Research suggests one of the keys to reducing the gender pain gap is challenging deeply embedded <a href="https://pubmed.ncbi.nlm.nih.gov/29682130/">gendered norms</a> in clinical practice and research. We are hearing women’s suffering. Let’s make sure we are also listening and responding in ways that close the gender pain gap.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/229802/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michelle-oshea-457947">Michelle O'Shea</a>, Senior Lecturer, School of Business, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a>; <a href="https://theconversation.com/profiles/hannah-adler-1533549">Hannah Adler</a>, PhD candidate, health communication and health sociology, <a href="https://theconversation.com/institutions/griffith-university-828">Griffith University</a>; <a href="https://theconversation.com/profiles/marilla-l-druitt-1533572">Marilla L. Druitt</a>, Affiliate Senior Lecturer, Faculty of Health, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a>, and <a href="https://theconversation.com/profiles/mike-armour-391382">Mike Armour</a>, Associate Professor at NICM Health Research Institute, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/longer-appointments-are-just-the-start-of-tackling-the-gender-pain-gap-here-are-4-more-things-we-can-do-229802">original article</a>. </div>

Body

3 common travel illnesses (and how to avoid them)

Nobody wants to fall sick when they’re on holidays but it happens and is actually quite common. Not every travel illness is foreseeable, but the most prevalent ones usually can be managed if you’re prepared and know what to look out for. Here are three of the most common illnesses travellers experience and what you can do to avoid them. Traveller’s diarrhoea It may be an unpleasant topic of conversation, but as diarrhoeais the most common travel sickness, it’s important to be prepared. It is estimated diarrhoeais experienced by almost half of travellers at some point on their holiday, but mainly by those visiting developing countries. It’s contracted by eating or drinking contaminated food and water and in severe cases can last for days. How to avoid it: Stick to bottled or purified water, freshly cooked meals and fruits and vegetables you can peel yourself. Talk to your doctor for antibiotics you can take in case you are struck with traveller’s diarrhoea. Motion sickness Whether it’s by boat, plane, or car, many travellers experience motion sickness. This occurs when your eyes see motion but your body doesn’t register it, leading to a conflict of the senses. It often results in nausea, vomiting, headaches, and sweating. How to avoid it: If flying, try to sit near the wings of plane. If cruising, get an outside cabin in the middle of ship, and if in a car, sit up front. Don’t play with your devices, as looking at a small screens often exacerbates the problem; instead try to look far to the horizon. Have a light meal before travelling and avoid spicy, greasy or rich foods. You can talk to your doctor about over-the-counter medication that can help motion sickness as well. Bug bites There are all sorts of infectious diseases like malaria, dengue, chikungunya and yellow fever you can pick up from bug bites, especially in developing nations. While you should always talk to your doctor about the types of vaccines you need to take for your travel destination, it is always advisable to protect against insect bites. How to avoid it: Apply insect repellent, wear long sleeves and pants where possible and try to avoid outside activity around dust and dawn when mosquitos are active. If sleeping outdoors, it is advisable to use curtain nettings. Image credits: Getty Images

Travel Tips

Families including someone with mental illness can experience deep despair. They need support

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/amanda-cole-1484502">Amanda Cole</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> In the aftermath of the <a href="https://theconversation.com/bondi-attacker-had-mental-health-issues-but-most-people-with-mental-illness-arent-violent-227868">tragic Bondi knife attack</a>, Joel Cauchi’s parents have <a href="https://www.theguardian.com/australia-news/video/2024/apr/15/bondi-junction-stabbings-joel-cauchis-father-extremely-sorry-for-victims-video">spoken</a> about their son’s long history of mental illness, having been diagnosed with schizophrenia at age 17. They said they were “devastated and horrified” by their son’s actions. “To you he’s a monster,” said his father. “But to me he was a very sick boy.” Globally, one out of every eight people <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders">report a mental illness</a>. In Australia, <a href="https://www.aihw.gov.au/reports/mental-health-services/mental-health">one in five people experience a mental illness</a> in their lifetime. Mental illness and distress affects not only the person living with the condition, but <a href="https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity">family members and communities</a>. As the prevalence of mental health problems grows, the flow-on effect to family members, including caregivers, and the impact on families as a unit, is also rising. While every family is different, the words of the Cauchis draw attention to how families can experience distress, stress, fear, powerlessness, and still love, despite the challenges and trauma. How can they help a loved one? And who can they turn to for support? <h2>The role of caregivers</h2> Informal caregivers help others <a href="https://www.aihw.gov.au/reports/australias-welfare/informal-carers">within the context of an existing relationship</a>, such as a family member. The care they provide goes beyond the usual expectations or demands of such relationships. Around <a href="https://www.aihw.gov.au/reports/australias-welfare/informal-carers">2.7 million Australians</a> provide informal care. For almost a third of these the person’s primary medical diagnosis is psychological or psychiatric. It has <a href="https://journals.sagepub.com/doi/10.1177/1074840708323598">long been acknowledged</a> that those supporting a family member with ongoing mental illness need support themselves. In the 1980s, interest grew in caregiving dynamics within families of people grappling with mental health issues. Subsequent research recognised <a href="http://www.aihw.gov.au/chronic-diseases/">chronic health conditions</a> not only affect the quality of life and wellbeing of the people experiencing them, but also impose burdens that reverberate within relationships, caregiving roles, and family dynamics over time. Past studies have shown families of those diagnosed with chronic mental illness are increasingly forced to <a href="https://pubmed.ncbi.nlm.nih.gov/24943714/">manage their own depression</a>, experience elevated levels of <a href="https://pubmed.ncbi.nlm.nih.gov/23692348/">emotional stress</a>, negative states of mind and <a href="https://pubmed.ncbi.nlm.nih.gov/21165597/">decreased overall mental health</a>. Conditions such as depression, anxiety disorders, bipolar disorder, and schizophrenia can severely impact daily functioning, relationships, and <a href="https://pubmed.ncbi.nlm.nih.gov/36875411/">overall quality of life</a>. Living with mental illness is often accompanied by a myriad of challenges. From stigma and discrimination to difficulty accessing adequate health care and support services. Patients and their families navigate a complex and often isolating journey. <h2>The family is a system</h2> The concept of <a href="http://apps.who.int/iris/bitstream/10665/40336/1/16937_eng.pdf">family health</a> acknowledges the physical and psychological wellbeing of a person is significantly affected by the family. Amid these challenges, <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1330720/full">family support</a> emerges as a beacon of hope. Research consistently demonstrates strong familial relationships and support systems play a pivotal role in mitigating the adverse effects of mental illness. Families provide emotional support, practical assistance, and a sense of belonging that are vital for people struggling with mental illness. My recent <a href="https://www.collegianjournal.com/article/S1322-7696(24)00004-0/fulltext">research</a> highlights the profound impact of mental illness on family dynamics, emphasising the resilience and endurance shown by participants. Families struggling with mental illness often experience heightened emotional fluctuations, with extreme highs and lows. The enduring nature of family caregiving entails both stress and adaptation over an extended period. Stress associated with caregiving and the demands on personal resources and coping mechanisms builds and builds. Yet families I’ve <a href="https://www.collegianjournal.com/article/S1322-7696(24)00004-0/fulltext">interviewed</a> find ways to live “a good life”. They prepare for the peaks and troughs, and show endurance and persistence. They make space for mental illness in their daily lives, describing how it spurs adaptation, acceptance and inner strength within the family unit. When treating a person with mental illness, health practitioners need to consider the entire family’s needs and engage with family members. By fostering open and early dialogue and providing comprehensive support, health-care professionals can empower families to navigate the complexities of mental illness while fostering resilience and hope for the future. Family members <a href="https://www.collegianjournal.com/article/S1322-7696(24)00004-0/fulltext">express stories</a> of an inner struggle, isolation and exhaustion. <h2>Shifting the focus</h2> There is a pressing need for a shift in research priorities, from illness-centered perspectives to a <a href="https://shop.elsevier.com/books/child-youth-and-family-health-strengthening-communities/barnes/978-0-7295-4155-8">strengths-based focus</a> when considering families “managing” mental illness. There is transformative potential in harnessing strengths to respond to challenges posed by mental illnesses, while also <a href="https://www.collegianjournal.com/article/S1322-7696(24)00004-0/fulltext">supporting family members</a>. For people facing mental health challenges, having <a href="https://www.sane.org/information-and-resources/facts-and-guides/families-friends-carers">loved ones who listen without judgement</a> and offer empathy can alleviate feelings of despair. Beyond emotional support, families often serve as crucial caregivers, assisting with <a href="https://www.blackdoginstitute.org.au/emergency-help/helping-someone-else/">daily tasks, medication management and navigating the health-care system</a>. As the Cauchi family so painfully articulated, providing support for a family member with mental illness is intensely challenging. Research <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804270/">shows</a> caregiver burnout, financial strain and strained relationships are common. Health-care professionals should prioritise support for family members at an early stage. In Australia, there are various support options available for families living with mental illness. <a href="https://www.carergateway.gov.au/?utm_source=google&utm_medium=paid-search&utm_campaign=10626744435&utm_adgroup=102994881737&utm_term=carer%20gateway%20wa&gad_source=1&gclid=EAIaIQobChMIt8T6pJzIhQMVjAyDAx2KiQl1EAAYASAAEgLj-fD_BwE">Carer Gateway</a> provides information, support and access to services. <a href="https://www.headspace.com/?utm_source=google&utm_medium=search&utm_campaign=HS_Headspace_Brand-Exact_Search_AU-INT_Google_NA&utm_content=&utm_term=headspace&gad_source=1&gclid=EAIaIQobChMI4uKKvpzIhQMVFheDAx1bZgk8EAAYASAAEgLy6vD_BwE">Headspace</a> offers mental health services and supports to young people and their families. Beyond these national services, GPs, nurses, nurse practitioners and local community health centres are key to early conversations. Mental health clinics and hospitals often target family involvement in treatment plans. While Australia has made strides in recognising the importance of family support, challenges persist. Access to services can vary based on geographic location and demand, leaving some families under-served or facing long wait times. And the level of funding and resources allocated to family-oriented mental health support often does not align with the demand or complexity of need. In the realm of mental illness, family support serves as a lifeline for people navigating the complexities of their conditions. <hr /> If this article has raised issues for you, or if you’re concerned about someone you know, call <a href="https://www.lifeline.org.au/">Lifeline</a> on 13 11 14.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228007/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/amanda-cole-1484502">Amanda Cole</a>, Lead, Mental Health, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/families-including-someone-with-mental-illness-can-experience-deep-despair-they-need-support-228007">original article</a>. </div>

Caring

Surgery won’t fix my chronic back pain, so what will?

<a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> This week’s ABC Four Corners episode <a href="https://www.abc.net.au/news/2024-04-08/pain-factory/103683180">Pain Factory</a> highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain. The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain. <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">One in five</a> Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated <a href="https://www.aihw.gov.au/getmedia/10434b6f-2147-46ab-b654-a90f05592d35/aihw-phe-267.pdf.aspx">A$139 billion a year</a>, including $12 billion in direct health-care costs. The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work? <h2>Opioids and invasive procedures</h2> Treatments offered to people with chronic pain include strong pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/30561481/">opioids</a> and invasive procedures such as <a href="https://pubmed.ncbi.nlm.nih.gov/36878313/">spinal cord stimulators</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14120">spinal fusion surgery</a>. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06900-8">Spinal fusion surgery</a> and <a href="https://privatehealthcareaustralia.org.au/consumers-urged-to-be-cautious-about-spinal-cord-stimulators-for-pain/#:%7E:text=Australian%20health%20insurance%20data%20shows,of%20the%20procedure%20is%20%2458%2C377.">spinal cord stimulators</a> are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual. <h2>Addressing the contributors to pain</h2> Recommendations from the latest <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/low-back-pain-clinical-care-standard">Australian</a> and <a href="https://www.who.int/publications/i/item/9789240081789">World Health Organization</a> clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as: <ul> <li>education</li> <li>advice</li> <li>structured exercise programs</li> <li>physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.</li> </ul> Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain. The interventions have minimal side effects and are cost-effective. In the <a href="https://jamanetwork.com/journals/jama/fullarticle/2794765">RESOLVE</a> trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move. In the <a href="https://pubmed.ncbi.nlm.nih.gov/37146623/">RESTORE</a> trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it. <h2>Why isn’t everyone with chronic pain getting this care?</h2> While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session <a href="https://www.sira.nsw.gov.au/__data/assets/pdf_file/0005/1122674/Physiotherapy-chiropractic-and-osteopathy-fees-practice-requirements-effective-1-February-2023.pdf">can cost</a> $90–$150. In contrast, <a href="https://www.servicesaustralia.gov.au/chronic-disease-individual-allied-health-services-medicare-items">Medicare</a> provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions. Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs. Access to trained clinicians is another barrier. This problem is particularly evident in <a href="https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf">regional and rural Australia</a>, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited. Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/data-file-57-opioid-medicines-dispensing-2016-17-third-atlas-healthcare-variation-2018">rate of opioid use</a>, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas. <h2>So what can we do about it?</h2> We need to reform Australia’s health system, private and <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/taskforce-final-report-pain-management-mbs-items-final-report-on-the-review-of-pain-management-mbs-items.docx">public</a>, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments. Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian <a href="https://pubmed.ncbi.nlm.nih.gov/38461844/">trial</a>, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain. Advocacy and <a href="https://pubmed.ncbi.nlm.nih.gov/37918470/">improving the public’s understanding</a> of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227450/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/christopher-maher-826241">Christopher Maher</a>, Professor, Sydney School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/fiona-blyth-448021">Fiona Blyth</a>, Professor, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/james-mcauley-1526139">James Mcauley</a>, Professor of Psychology, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/surgery-wont-fix-my-chronic-back-pain-so-what-will-227450">original article</a>.

Body

Why do I keep getting urinary tract infections? And why are chronic UTIs so hard to treat?

<a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Dealing with chronic urinary tract infections (UTIs) means facing more than the occasional discomfort. It’s like being on a never ending battlefield against an unseen adversary, making simple daily activities a trial. UTIs happen when bacteria sneak into the urinary system, causing pain and frequent trips to the bathroom. Chronic UTIs take this to the next level, coming back repeatedly or never fully going away despite treatment. <a href="https://www.ncbi.nlm.nih.gov/books/NBK557479/">Chronic UTIs</a> are typically diagnosed when a person experiences two or more infections within six months or three or more within a year. They can happen to anyone, but some are more prone due to their <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults">body’s makeup or habits</a>. Women are more likely to get UTIs than men, due to their shorter urethra and hormonal changes during menopause that can decrease the protective lining of the urinary tract. Sexually active people are also at greater risk, as bacteria can be transferred around the area. Up to <a href="https://www.urologyhealth.org/urology-a-z/u/urinary-tract-infections-in-adults#Related%20Resources">60% of women</a> will have at least one UTI in their lifetime. While effective treatments exist, <a href="https://www.health.harvard.edu/bladder-and-bowel/when-urinary-tract-infections-keep-coming-back#:%7E:text=Your%20urine%20might%20be%20cloudy,they%20take%20on%20your%20life.">about 25%</a> of women face recurrent infections within six months. Around <a href="https://sciendo.com/article/10.33073/pjm-2019-048?tab=article">20–30%</a> of UTIs don’t respond to standard antibiotic. The challenge of chronic UTIs lies in bacteria’s ability to shield themselves against treatments. <h2>Why are chronic UTIs so hard to treat?</h2> Once thought of as straightforward infections cured by antibiotics, we now know chronic UTIs are complex. The cunning nature of the bacteria responsible for the condition allows them to hide in bladder walls, out of antibiotics’ reach. The bacteria form biofilms, a kind of protective barrier that makes them nearly impervious to standard antibiotic treatments. This ability to evade treatment has led to a troubling <a href="https://theconversation.com/rising-antibiotic-resistance-in-utis-could-cost-australia-1-6-billion-a-year-by-2030-heres-how-to-curb-it-149543">increase in antibiotic resistance</a>, a global health concern that renders some of the conventional treatments ineffective. Antibiotics need to be advanced to keep up with evolving bacteria, in a similar way to the flu vaccine, which is updated annually to combat the latest strains of the flu virus. If we used the same flu vaccine year after year, its effectiveness would wane, just as overused antibiotics lose their power against bacteria that have adapted. But fighting bacteria that resist antibiotics is much tougher than updating the flu vaccine. Bacteria change in ways that are harder to predict, making it more challenging to create new, effective antibiotics. It’s like a never-ending game where the bacteria are always one step ahead. Treating chronic UTIs still relies heavily on antibiotics, but doctors are getting crafty, changing up medications or prescribing low doses over a longer time to outwit the bacteria. Doctors are also placing a greater emphasis on thorough diagnostics to accurately identify chronic UTIs from the outset. By asking detailed questions about the duration and frequency of symptoms, health-care providers can better distinguish between isolated UTI episodes and chronic conditions. The approach to initial treatment can significantly influence the likelihood of a UTI becoming chronic. Early, targeted therapy, based on the specific bacteria causing the infection and its antibiotic sensitivity, may reduce the risk of recurrence. For post-menopausal women, <a href="https://link.springer.com/article/10.1007/s00192-020-04397-z">estrogen therapy</a> has shown promise in reducing the risk of recurrent UTIs. After menopause, the decrease in estrogen levels can lead to changes in the urinary tract that makes it more susceptible to infections. This treatment restores the balance of the vaginal and urinary tract environments, making it less likely for UTIs to occur. Lifestyle changes, such as <a href="https://journals.lww.com/co-nephrolhypertens/FullText/2013/05001/Impact_of_fluid_intake_in_the_prevention_of.1.aspx">drinking more water</a> and practising good hygiene like washing hands with soap after going to the toilet and the recommended front-to-back wiping for women, also play a big role. Some swear by cranberry juice or supplements, though researchers are still figuring out <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001322.pub2/full">how effective these remedies truly are</a>. <h2>What treatments might we see in the future?</h2> Scientists are currently working on new treatments for chronic UTIs. One promising avenue is the development of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10052183/pdf/pathogens-12-00359.pdf">vaccines</a> aimed at preventing UTIs altogether, much like flu shots prepare our immune system to fend off the flu. Another new method being looked at is called <a href="https://link.springer.com/article/10.1007/s12223-019-00750-y">phage therapy</a>. It uses special viruses called bacteriophages that go after and kill only the bad bacteria causing UTIs, while leaving the good bacteria in our body alone. This way, it doesn’t make the bacteria resistant to treatment, which is a big plus. Researchers are also exploring the potential of <a href="https://www.mdpi.com/2079-6382/12/1/167">probiotics</a>. Probiotics introduce beneficial bacteria into the urinary tract to out-compete harmful pathogens. These good bacteria work by occupying space and resources in the urinary tract, making it harder for harmful pathogens to establish themselves. Probiotics can also produce substances that inhibit the growth of harmful bacteria and enhance the body’s immune response. Chronic UTIs represent a stubborn challenge, but with a mix of current treatments and promising research, we’re getting closer to a day when chronic UTIs are a thing of the past.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223008/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/iris-lim-1204657">Iris Lim</a>, Assistant Professor, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-keep-getting-urinary-tract-infections-and-why-are-chronic-utis-so-hard-to-treat-223008">original article</a>.

Body

"I'm lowkey dying": Brave young woman with terminal illness shares her final wish

Samantha Bulloch was given three years to live after she was diagnosed with gut-wrenching stage four bowel cancer at the young age of 28. A year later, Bulloch has shared a heartfelt plea on social media in hopes of meeting her idol- pop star Taylor Swift. The Swiftie has scored a ticket to Taylor's final show in Sydney on the 26th of February, but she’s calling on “anyone to hook a sister up” so she can meet-and-greet the singer backstage. “I’m low key dying and honestly this would just make my year,” she said in a video shared to TikTok. “I’m going out on a limb here so I’m just shooting my shot and we’re going to see what happens. “If anyone has any connections... I would love you forever.” Bulloch has been a fan of the megastar since she was 15 years old. “Taylor means so much to me, and I’d love the opportunity to tell her just how much of an impact she’s made on my life,” she told 7Life. “I’ve loved her since I was 15, and her music has seen me through so many chapters in my life — including this one. “I love that her music transcends all kinds of walks of life, and so many of us connect with it so personally, despite the differences in our situations. “She has a real talent for making you feel less alone.I recently got a new tattoo of the lyric, ‘For the hope of it all’, from her song called August. “I adopted that lyric during my experience with cancer. I’m choosing to live for the hope of it all.” As she faces terminal cancer, Bulloch said that she is determined to live the rest of her life to the fullest. "I’m hoping and praying for many more years than what I’ve been given. But if not, I intend to try and maximise these few I’ve got left to the best of my ability," she said. “Thankfully I’ve always been quite a positive and hopeful person, and that hasn’t left me during this experience.” Bulloch was diagnosed with terminal cancer in 2023, after experiencing low iron levels, fatigue and blood in her stool. She is currently on a chemotherapy regime and an immunotherapy drug and added that she also hopes to tick off many of her bucket list destinations this year, including visiting UK, Paris, New York and Tasmania. “My doctor has said I can, providing the treatment I’m on now works," the hopeful 29-year-old said. “Thankfully treatment has been working so hopefully in a few months I’ll be able to do that." Images: Samantha Bulloch

Caring

"One step forward, two steps back": Joh Griggs reveals debilitating health battle

Johanna Griggs has revealed how she overcame a debilitating health struggle that threatened to derail her career as a teenager. The former swimming champion won her first medal at the Commonwealth Games in 1990 at 16 years of age, but just one year later, her world changed forever. In a new interview with Prevention magazine, the Better Homes & Gardens host admitted that being diagnosed with chronic fatigue syndrome at the young age of 17 was a blow, but one she ultimately felt “thankful” for. “You learn more about yourself during a tough period than you do during a great one,” she said. “One of the most important things that it taught me was to be able to be by myself and to be comfortable in my own skin.” With her swimming career on pause, Joh shared that the next few years were “one step forward, two steps back”. As a teenager, she learned the power of positive self-belief while learning what was best for her body as she worked her way back to physical and emotional strength. “It’s asking yourself, ‘Can you put your head on the pillow and know in your heart of hearts you’ve done everything within your power that day to get better?’,” she said of that time in her life. “But also, not beating yourself up on it, just working out what was working (and) what wasn’t working.” Over the next two and a half years, Johanna was on a highly restricted diet to combat her health issues, one that was “wheat-free, yeast-free, egg-free, malt-free, sugar-free, dairy-free, herb-free, spice-free, caffeine-free”. Eventually she was able to return to the pool, although she faced further setbacks, including a bout of pleurisy that landed her in hospital. By 1993, she was back at the top of her game, taking out the win for the 50m backstroke at the Australian Swimming Championships. Riding this high, Johanna decided her swimming career was over. “For me, it was a massive milestone to get to say I could be the best, but I also knew when I hit that (pool) wall, I did not want to keep living like that,” she said. “I told my mum I was retiring that night and remember her voice going up a couple of octaves higher than normal.” Image credits: Getty Images / Instagram

Body

Woman heartlessly steals terminally-ill man's pokies win after he collapsed

Thomas Purtill, 80, had “decided to go up and throw a few dollars in the pokies" at his local pub in Caboolture, Brisbane. To his surprise, the pensioner won $300. As the terminally-ill pensioner was about to collect his winnings, he collapsed during a medical episode and dropped his ticket. “I remember landing on the floor,” Purtill, who only has six months to live, told 7News. “I think I fell over before I got the ticket into the machine (to cash it in).” CCTV footage from the pub showed the alleged thief looking concerned as she rushed to call pub staff. When she returned, Purtill can be seen pointing to something by the machine, and this was when she noticed the ticket he had dropped. The woman then moved over to the machine and allegedly pocketed the pensioner's winnings. While Purtill received medical attention, the alleged thief escaped and used another machine to withdraw the cash. Now, the CCTV footage has been released to help police identify the mystery woman, as they urge anyone with information to come forward. The pensioner spend two days in hospital after the incident on November 27, and has since been diagnosed with terminal cancer. “I don’t want to die,” he said. “But I’m going to.” He was told he has between three to six months to live, and has since returned for treatment. When Purtill was asked what he thought of the alleged thief's actions he said: “I can’t really say on TV. It wouldn’t be allowed.” “If you’re that desperate … If someone came up to me and said, ‘You’ve had a win, can I have $10 to buy a loaf of bread, a bottle of milk for the kids?’, I would have given it to them.” He then went on to call her "weak", and urged anyone who might know her to “give her up”. Staff members have offered to reimburse Purtill for his stolen winnings. Images: 7News

Legal

Bec Judd's son taken to hospital with mystery illness

Bec Judd's seven-year-old son, Tom, has been hospitalised due to an undisclosed medical condition, as the concerned mother shared on her Instagram account. In the recent post, the 40-year-old WAG posted a heartwarming picture of Tom comfortably lying in a hospital bed. In the photo, Tom flashed a smile at the camera, clutching his teddy bear and savouring an ice cream treat. However, Bec did not reveal the specific reason for Tom's hospitalisation in her social media update. With a hopeful tone, Bec wrote, "Onwards and upwards, Tom," and expressed gratitude to Nurse Becky Bell for her care and support during this challenging time. Bec Judd, a mother of four, shares her children with her ex-AFL star husband, Chris Judd. Alongside her recent family concerns, Bec has also been actively involved in charitable endeavours. She disclosed her plans to contribute 25,000 meals to Food Bank Victoria, an organisation dedicated to addressing food insecurity. Bec's involvement extends beyond her vocal support, as she is using her design skills to create a unique spatula for fundraising purposes. The entirety of the proceeds from the spatula sales will be donated to Food Bank. In Bec's own words, each spatula sold translates into an impressive "25 meals on the table", with the ambitious goal of providing "250,000 extra meals by Christmas". She encouraged her substantial following to support the cause by considering the spatula as a unique Christmas gift option. Not only will buyers acquire an original Bec Judd creation, but they will also make a significant contribution to their community. This charitable campaign features other notable personalities, including New Zealand culinary expert Ben Shewry, radio and TV presenter Chrissie Swan, and Australian pastry chef Kirsten Tibballs. In addition to her philanthropic efforts, Bec Judd has been making appearances on the celebrity edition of The Amazing Race, where she teams up with her sister, Kate Twigley. During a recent interview on KIIS FM's Jase and Lauren show, Bec recounted some of the show's more challenging moments, including an encounter with elephant dung. "It was interesting; they really threw us into these challenges that were quite foul, like shovelling poo, and I was like, where are the gloves?" Bec shared. "You know, I worked at The Alfred Hospital; I have four kids, I've got a puppy. I'm used to vomit and poo and secretions, but we always had gloves and masks, so it was okay. But this is bare hands, and I was not happy about it." In a recent trailer for the Ten reality show, Bec also revealed her germophobic tendencies, adding a layer of intrigue to her adventures on The Amazing Race. Images: Instagram

Caring

Terminally ill teacher convicted of child abuse granted end-of-life permit

A convicted child abuser from Adelaide, who was imprisoned for his acts of paedophilia against students during his tenure as a music teacher, has been authorised to pursue assisted dying, according to an exclusive report by <a href="https://www.9news.com.au/national/exclusive-adelaide-news-jailed-paedophile-teacher-malcolm-day-given-end-of-life-permit-voluntary-assisted-dying/cab7e95c-f3b1-4dbd-ae0d-cc8dbfee22c0" target="_blank" rel="noopener">9News</a>. Malcolm Day, aged 81, has emerged as the first incarcerated individual in Australia to receive approval for voluntary assisted dying following a terminal illness diagnosis, reportedly linked to cancer. Having received a 20-year prison sentence last June, Day's remaining term spans 17 years. Navigating the 11-step process required for accessing voluntary assisted dying in South Australia, Day's application is reported to be in its concluding stages, potentially reaching completion within the next few days. Dr Philip Nitschke, the director of the pro-euthanasia organisation Exit International, acknowledged that an incarcerated individual availing themselves of this scheme was an inevitable eventuality. "By the sounds of it, he satisfies all the conditions of the South Australian assisted dying legislation," Dr Nitschke told 9News. "So there should be no impediment… he should be given the option that any other person would have if they were terminally ill." During the 1980s, Day, while serving as a music teacher in South Australia, inflicted profound and lasting harm upon two of his students. After grooming and exploiting his victims, he vehemently refuted all allegations when investigated by educational authorities. When Day was sentenced, his legal representative, Stephen Ey, acknowledged the real possibility of his client passing away behind bars, saying at the time that it was "a real prospect... given his age." According to the latest data from SA Health, since the initiation of voluntary assisted dying in January of this year, 39 terminally ill residents of South Australia have opted to peacefully conclude their lives after being granted the necessary permits. Image: Nine News

Legal

Bruce Springsteen cancels shows after being "taken ill"

Bruce Springsteen's upcoming performances have been unexpectedly put on hold due to his falling ill, leading to the postponement of his scheduled shows. A sudden announcement, posted on the singer's official X account, has informed fans that the show dates will be rescheduled. "Due to Bruce Springsteen having been taken ill, his concerts with The E Street Band at Citizens Bank Park in Philadelphia on August 16 and 18 have been postponed. We are working on rescheduling the dates so please hold on to your tickets as they will be valid for the rescheduled shows." This announcement emerged mere hours before the debut show, just as eager fans were anticipating a memorable experience with Springsteen and his band. <blockquote class="twitter-tweet"> Due to Bruce Springsteen having been taken ill, his concerts with The E Street Band at Citizens Bank Park in Philadelphia on August 16 and 18 have been postponed. We are working on rescheduling the dates so please hold on to your tickets as they will be valid for the rescheduled… — Bruce Springsteen (@springsteen) <a href="https://twitter.com/springsteen/status/1691872953414115424?ref_src=twsrc%5Etfw">August 16, 2023</a></blockquote> This occurrence isn't the first instance where the music icon had to modify a show at the 11th hour due to health issues. Earlier this year, Springsteen communicated the postponement of his March 9 event at the Nationwide Arena in Ohio, attributing it to "illness." No explicit details about his health condition were disclosed in that instance either, but fans were encouraged to retain their original tickets for the rescheduled shows. Following the Ohio cancellation, two more postponements were subsequently declared. The performance originally slated for March 12 at the Mohegan Sun Arena in Connecticut has been rescheduled to September, while the March 14 show at the MVP Arena in Albany, upstate New York, was similarly postponed. Both changes were tied to unspecified health concerns. During this period, Steven Van Zandt, a member of the E Street Band, assuaged fans' concerns. He reassured them via Twitter, stating: "No need to be anxious or afraid. Nothing serious. Just a temporary situation. We will all be back in full force very soon." The band embarked on their tour in February, commencing in Tampa and traversing the United States before crossing the Atlantic to Europe in April. Returning to the United States in August, Springsteen and his crew intended to entertain audiences for several more months before culminating the extensive tour on December 10 in San Francisco. With a career spanning over 50 years, the seasoned singer-songwriter shows no signs of slowing down anytime soon.

Caring

Sandra Bullock mourns the passing of her longtime partner after private illness

Hollywood star Sandra Bullock's beloved partner, Bryan Randall, has passed away at the age of 57, with the heart-wrenching news confirmed by his grieving family in a statement shared on Monday. “It is with great sadness that we share that on Aug. 5, Bryan Randall passed away peacefully after a three-year battle with ALS,” the statement read. “Bryan chose early to keep his journey with ALS private and those of us who cared for him did our best to honour his request. We are immensely grateful to the tireless doctors who navigated the landscape of this illness with us and to the astounding nurses who became our roommates, often sacrificing their own families to be with ours. At this time we ask for privacy to grieve and to come to terms with the impossibility of saying goodbye to Bryan.” The statement was signed with a poignant, "His Loving Family". Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s Disease, is a merciless neurological affliction that ravages motor neurons that command delicate voluntary muscle movement. Regrettably, there is currently no remedy for the condition. Bullock, aged 59, crossed paths with model-turned-photographer Randall when he was summoned to capture her son Louis’ birthday celebration in the early days of 2015. Their connection was immediate and profound. The mother-of-two, and an actress who has fiercely guarded her privacy over the years, chose to unveil fragments of her relationship's intimacy during a candid appearance on Red Table Talk in 2021. “I found the love of my life. We share two beautiful children — three children, [Randall’s] older daughter. It’s the best thing ever,” Bullock said at the time. “I don’t wanna say do it like I do it, but I don’t need a paper to be a devoted partner and devoted mother … I don’t need to be told to be ever present in the hardest of times. I don’t need to be told to weather a storm with a good man.” She added that Randall was also a superb “example” to her two children: “He’s the example that I would want my children to have... I have a partner who’s very Christian and there are two different ways of looking at things. I don’t always agree with him, and he doesn’t always agree with me. But he is an example even when I don’t agree with him... I’m stubborn but sometimes I need to sit back and listen and go, ‘You’re saying it differently but we mean exactly the same thing.’ “It’s hard to co-parent because I just want to do it myself.” "He was so happy, but he was scared. I'm a bulldozer. My life was already on the track, and here's this beautiful human being who doesn't want anything to do with my life but the right human being to be there." Images: Getty

Caring

King Wally Lewis' devastating diagnosis

Rugby league legend Wally Lewis, known as "The King" for his tough football persona, has made a heartbreaking revelation about his health. In an exclusive interview with 60 Minutes, the 63-year-old Queenslander disclosed that he has been diagnosed with probable chronic traumatic encephalopathy, or CTE. Despite his physical fitness, Lewis is experiencing the distressing effects of this progressive and fatal condition, which can be caused by repeated blows to the head. CTE leads to memory loss, behavioural issues, and a decline in basic cognitive skills. Fans who still follow Lewis' work as a beloved media personality and sports commentator were shocked by this news. “For a lot of the sport guys, I think a lot of us take on this belief that we’ve got to prove how tough we are. How rugged," Lewis said on the program. "And if we put our hands up and seek sympathy, then we're going to be seen as the real cowards of the game. But we’ve got to take it on and admit that the problems are there.” Throughout his illustrious rugby league career spanning three decades, Lewis captained Australia and inspired Queensland, winning a record eight man of the match awards in his State of Origin career. He later transitioned to a successful career in sports commentary. However, in 2006, Lewis suffered an epileptic seizure during a live broadcast, leading to brain surgery in 2007 to control the seizures. The evidence of Lewis' brain deterioration is evident in his scans compared to those of a healthy brain. Leading neurologist Dr. Rowena Mobbs, who has observed an increasing number of former players suffering from CTE, believes Lewis' symptoms align with the condition. "It's devastating," Mobbs said on the program. "It's hard to see these players go through it. The last thing I want to do is diagnose them with dementia." While definitive diagnosis can only occur through a brain autopsy after death, Mobbs is 90% certain about Lewis' condition based on her expertise. Although some former players are contemplating legal action and compensation claims against the NRL and AFL, Lewis has decided against such measures. He remains grateful for the game he loved and the opportunity to have played it. “I loved the game that I played," he said. "I felt privileged to have played it, and to have been given that chance. When you go out there and you’re wearing the representative jerseys, particularly the one for Australia, you feel ten feet tall and bulletproof. Well, you might think you are. But you’re not.” Lewis plans to leave a legacy beyond the football field by donating his brain for research to create awareness of CTE. He emphasises that his intention is not to seek sympathy but rather support for those affected by the disease. In response to Lewis' revelation, Dementia Australia offers support, information, education, and counselling for those dealing with similar challenges. The NRL has taken steps to address head injuries and concussions, implementing comprehensive head-injury policies and procedures in alignment with world's best practices. The league actively invests in the Retired Professional Rugby League Players Brain Health Study to assess and monitor the health of retired players. Wally Lewis' bravery in sharing his story aims to shed light on the impact of CTE on athletes and underscores the importance of advancing research and support for those facing similar health struggles. Images: 60 Minutes.

Mind

Olympian dies at just 37 years of age

It’s a sad day in the world of winter sports and the Alpine Ski World Cup. Italian skier and silver medalist, Elena Fanchini has died at 37 from a tumour. "At the end of a serious illness, Elena Fanchini passed away in her home in Solato (near Brescia)," the Italian Winter Sports Federation said in a short statement. Fanchini died on the same day that fellow Italian skier Marta Bassio won the super-G world championships in Meribel, France; and just two days after Federica Brignone, a former teammate, won gold in combined. Another fellow skier, Sofia Goggia, the favourite for Saturday’s downhill, dedicated her win in Cortina d’Ampezzo last month to Fanchini. American champion skier, Mikaela Shiffrin took to Twitter to share her grief over Fanchini’s death. "This was a day filled with emotions. There is so much I'd like to share... but what weighs the heaviest is the loss of @ElenaFanchini,” she said in her tweet. Fanchini won a silver medal in the 2005 world championships and two World Cup races in her career - both in downhill. Fanchini last skied competitively in December 2017. She was cleared to return to training almost a year late but her condition had worsened. She had to miss the 2018 Pyeongchang Olympics because of her condition. Fanchini's younger sisters Nadia and Sabrina were also World Cup racers. Image credit: Getty

Caring

90-year-old-with chronic leukaemia skydives for charity

A thrill-seeking 90-year-old has celebrated her birthday - in what some would call an unconventional manner for her age - by skydiving, and raising £5,000 for a homeless charity in the process. Shirley Robinson, from Long Clawson in Leicestershire, jumped out of a plane at 14,000ft for the fundraiser at Skydive Langar in Nottinghamshire. Shirley, who was diagnosed with chronic leukaemia in 2022, raised funds for Crisis, a charity that provides help and support for homeless people. She told BBC News, “It's just wonderful how generous people have been. It's lovely.” Footage of her dive saw Shirley styled in a bright blue jumpsuit as she was cheered on by family and friends before getting on the plane. She smiled and waved at the camera as she was strapped to her skydiving instructor. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/reel/CsZGxykN0PN/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/CsZGxykN0PN/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Skydive Langar (@skydivelangar)</a> </div> </blockquote> After Shirley’s adrenaline packed skydive, she landed safely in a field and can be heard in the video exclaiming, “That was wonderful.” When asked about her favourite part of the experience, she responded, “That was lovely, going through the clouds.” She confessed afterwards that the free fall was a “bit breathtaking” but she “loved it” before thanking her instructor for looking after her. Shirley returned to a hero’s welcome with her beaming friends and family congratulating her. A spokesperson for the charity said, “We want to say an enormous thank you to Shirley for the incredible amount of money she has raised. “Shirley's donation will provide vital support for people experiencing or at risk of homelessness. We're so grateful.” Image credit: Instagram

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