6 degrees of geographical separation 

All American medical conferences have routinely between 5 to 10000 registrants, in other words they are big! This “breakthrough” event was small , I would hazard a guess at about 1500 neurologists. On every table at which I sat, the conversation would immediately or within minutes, rapidly open with a passing query as to from whence one came. “Oh I am in Philadelphia, County Clinton, east side”. The other responded that he had recently moved down south from Alaska to New Mexico, County Cibola, west side. 

Now the USA covers an area of 9 million square kilometres and has a population of 435 million. It is a remarkable fact that into which each and every conversation I eavesdropped, not one of the attendees did not immediately give the nonchalant impression that each, to within a bald eagles pin feather, knew precisely where the other lived as they forked food to mouth. 

“Oh yah” each says in a way that reminds me of laconic Brainerd police chief Marge Gunderson in that memorable Cohn brothers movie Fargo. Turns out that each had either been born in the others current town or attended the local kindergarten or went there over more than 25 years to spend every Thanksgiving with their Ma and Pa or did a year of their training at the city hospital in 1995.

This compares to my response if I attend an Epilepsy Congress in Adelaide ( local) and a colleague shares his present address as Clovelly Park in the southern city of Onkaparinga. 

Upon my return will install a similar billboard at the intersection of Grand Junction Road and Main North Road 

Brain Screening can help you think clearly

Bulk billing with Dignity

Norton Synapse Institute

Mere Mortals – Dr Oliver Sacks.

As i sit in the oppressive heat that is summer in Turkey, I learn of the death of Dr Oliver Sacks from disseminated melanoma aged 82. A brilliant communicator who also happened to be an unconventional neurologist.He was a very handsome man, a bikie and champion weightlifter. He described himself as celibate but in his last book, “On the Move” he is open about his homosexuality and the joy of meeting a partner in his mid 70’s. Although I never had the privilege of meeting him, readers will surely undertand it when I say that as a neurologist and openly gay man, I have lost a fellow traveller along the yellow brick road.

Less than 12 months ago, the world also lost Robin Williams, the actor and comedian who portrayed Oliver Sacks in the film “Awakenings”. This was based on the book of the same name by Oliver Sacks in which he described the miraculous response to Levodopa of patients who had survived the great influenza pandemic of 1918 (The Spanish Flu) and subsequently developed severe features of Parkinsons Disease.
There are several remarkable coincidences between these two gifted men. Sacks experimented with LSD and other recreational drugs in the 1950s, describing the consequences in one of his first books “Hallucinations”. Robin Williams took his own life and at autopsy had features of Lewy Body dementia, a progressive neurological degenerative disease presenting in a Parkinsons like manner and with unsettlimg hallucinations.

A Book is Born

I belong to the “slide night” generation, having been subjected to these events in childhood, the consequence of having a father who enjoy photography. Not surprisingly I followed in his footsteps. My first trip overseas at the end of my fifth year in medicine was to Nepal. In Singapore I purchased a relatively expensive SLR Pentax camera. Over the next 15 to 20 years I accumulated a cupboard of Kodachrome slides. In the three months that I worked at a mission hospital in Kathmandu I wrote a diary in fact it was the beginning of a travel blog before travel blogs were invented! Those of you who have been intermittently reading this web-based travel blog realise that I enjoy creating and I think have a modicum of talent, in such writing. So it was a few weeks ago that I purchased an expensive Epson professional photocopier which had the ability to copy and archive Kodachrome slides. I have now dictated the typewritten diary which I turned into a bound book at the end of my university course and now plan to “publish” it in a more modern and user-friendly version To whet your appetite I post below two or three of the slides which I took and have modified in terms of size to incorporate them into my pending publication. My stay in Kathmandu was divided into working in the hospital and finally for the last month I trekked to Everest base camp and then returned, to enjoy after a month without washing, a beautiful warm shower. The pictures explain it all.

I am listening to a young Nepalese man complain of chest pain. Many were convinced they had TB and not without reason!

I am listening to a young Nepalese man complain of chest pain. Many were convinced they had TB and not without reason!

The summit from the Based Camp at Kalapatar.

Everest : The summit from the Based Camp at Kalapatar.

Some say this is more majestic than Everest.

Amadablam Some say this is more majestic than Everest.

First cycle is a hot shower with soap and srub

First cycle is a hot shower with soap and srub


Then a rinse cycle in COLD water, enough to make everything shrink.

Idle conference  jottings

Some unrelated jottings during a couple if boring conference sessions.

I had a sense of unease and frustration from day one at the conference. As english is my first and only language, I can’t morally complain about a failure to comprehend when the presenter has a thick Russian accent at a conference in Hungary. Secondly I am bombarded by the very worst convoluted unfathomable PowerPoint slides. Finally at least two sessions discussed new and novel ways to deliver medication to the patient using inventions that have been engineered in a small start up company in which, if one reads the small print of the financial disclosure, the presenter has an interest. 

Many of the papers described using various types of electrical or magnetic stimulation of specific superficial cranial nerves. 

Unashamedly, enrolled patient numbers in these trials were often less than a few dozen!  All one can categorically state is that based on statistically questionable studies of  a few migraneurs, these medical technology companies will make many millions of dollars.

Migraine is often crippling with protracted vomiting. So a minute pump with silastic tubing could deliver the abortive drug into the rectum. How this might work is conjectural but it would certainly take the focus away from the head. Imagine what a creative advertising company could come up with

” yes we know, migraine is a bummer…”

“Migraine – get your head round this…”

” Migraine – does not have to be a pain in the butt.. Or does it?”

” Migraine – we have the answer to your annus horribilus”

” We guarantee to get to the bottom of your migraine”.
Another technology company displayed a leather upholstered reclining chair with a circular magnet which sat on and around the skull. Picture an expensive old fashioned hair salon perm chair but more like a Jason recliner. Elderly patients who were mildly forgetful, sat in this contraption and whilst a high powered magnetic field swirled around their skull, at the same time they were submitted to mind games on a computer screen. Doing this every day for a few months apparently improved  their mental ability which was maintained for at least 12 months.

Surfing my news feeds threw up this bit of fascinating trivia: the results of a 2011 census found only 2,418 self-identified Scientologists in England and Wales. (In contrast, 176,632 respondents identified as Jedi Knights.)

Back to the conference! Hans Lassman a member of the faculty presenting on MS looked for all the world like Victor Borge and on beginning his presentation , had his voice and accent! 

day 1 was held in the Hungarian Academy of Science


Alessandra-Acqui Terme-Albe

These first two days have turned out to be rather relentless in terms of cycling. Both were of a distance no more than 60km. A gentle Sunday perambulation for those that own a light weight carbon or even better, titanium framed contraption. We ride that most Sundays! One could be at the Cafe latte after tackling Norton Summit, 2 hours from a standing start! Snigger you may, but it took us on average 5hrs 30min day one and more than 6 and a half hours on the second. Not for want of trying. Day 1 we climbed up and down dale for 700m whilst on day 2 it was 1000m. A few panoramic shots will do more than words to demonstrate the endless rolling hills of vineyards, apple, plum and stone fruit orchards as well as acres and acres of hazelnut trees! Often we cycled along a saddle with picturesque valley on either side then more mountains!

The guide books supplied have in the main been excellent and becoming lost or mildly disorientated has occurred only a few times.

Acqui Terme is a hot springs town and the piazza has an ornate marble tower our of which the sulphurous greenish water gushes at a constant 75degrees centigrade.

The town of Alba is the capital of the truffle and the wonderful black variety is on display in glass cabinets on the street in front of the store with the price of a truffle I estimate at about 1 euro a gram or in other words 1000 euro a Kg!

At Alba after the exhaustion of our ride and with a well deserved air of achievement and smugness, we ate out at a nice restaurant and sampled the local food and wine, naturally with truffles and pasta in at least one dish.





Banter at the Bar – Pass the Lipitor.

A universal and mandatory topic amongst self funded travelling retirees is one’s health or rather lack of it, together with an almost pharmacopeia like forensic analysis of side effects of one’s medication. This is pure theatre, or rather more accurately a complex TV soap opera combining elements of “What”s my Line” with “Big Brother”.

On the Bay of Islands cruise, we are all seated around a large table on the upper deck before dinner. It begins with an innocent female, remarking that she experienced angina last year and had an angiogram. She is now taking Aspirin and Lipitor. There is a polite silence. A slightly more overweight and breathless woman then chips in that she had a “massive heart attack” 2 years ago and had 2 stents. She was on something Continue reading

Thoughts on Health Farms.

We call them “farms” in Australia, but over here they are called “Wellness Centers”! The Appesbach is one such place. But the raison d’être for them all, whether Austrian or Australian is exactly the same!

Their pitch is identical! Glossy brochures detail all sorts of treatments involving alternating steam, heat and cold plunges, massages with exotic oils and the strategic placing of some unusual looking black porous stones, in a line up and down the spine, that have the appearance of fossilized dinosaur dung.

All brochures depict smooth skinned, coyly naked women, aged somewhere between spent youth and late thirties. They are invariably lying supine on a bed with white linen and white orchids. A hint of buttock with seductive sweat drop or two and a subtle mattress pressing of one bosom.

There is never ever depiction of men. I ask you, what is wrong with a masculine hint of buttock and a pressing of phallus?

At this establishment they have things down to a fine art! Sauna, massage, aromatherapy, infra-red radiation boxes, all finished off with “high tea”! It’s reverse psychology! You have worked, sweated and pumped so hard, you deserve a baked cheese cake and a slice of Black Forest cake!

I are in tonight and ignored my self consciousness! Here are the three courses!


Roasted carrot-ginger foam soup with fried scallops!


The saddle of wild boar, stuffed with dried fruits, truffled spinach, potato strudel and black beer sauce!


Soufflé of white chocolate and limes with coconut-rum sauce and poppy seed honey ice-cream

Thoughts from Stroke Conference Day 1 Brazil

Questions from the floor, invariably bring out the occasional “nutter”.

Such performances at the microphone usually are a variation on two types. The first, with which I can cope if not empathize, is a request for a comment on an anecdotal case, provoked by a preceding brilliant discourse and objective lecture on a specific subject. The lecture may have been on “Current evidence based guidelines for anti coagulation in atrial fibrillation”.

The unique scenario presented from the floor goes something like this: a patient, from Eucador, a man aged 48, who for the last 12 years has, after 3 bottles of beer at night, followed by vigorous sexual intercourse, taken his prescribed Warfarin tablets and 20 minutes later develops severe palpitations….. Would Professor Bickersdorf care to comment?

The other is more of a dissertation. Following an eloquent, lucid lecture on “Current Theories of the Mechanism of Headache after a TIA”, a member of the audience approaches the microphone and explains that over the last 25 years he has gathered a cohort of 121 women who have had a TIA involving the carotid artery and has found in 29, calcification of the nipple. What is even more fascinating, the speaker theatrically emphasizes, is that it is only ONE nipple that is so afflicted and invariably it is the nipple contralateral to the diseased artery!

Having brought the auditorium to a stunned silence, including the guest lecturer, the man who has the floor, finishes his own presentation with an impassioned plea that ALL women who present with a TIA should have mandatory palpation of both breasts. It would, he exhorts with a flourish, be negligent for the audience to do otherwise. It has been, he states with a degree of pride, a routine part of his physical examination since he made this initial discovery more than 15 years ago.

Day 2 awaits me!


Stockholm conference

Medical matters

This blog will chat about the first two days of the conference and finish with a description of a fascinating session I attended combining music and neurology. Those of you who have no interest in either medicine or music can skip this blog.

The medical sessions have been interesting and of variable standard. From first class to “dodgy”. Rather perennial topics, familiar to my professional colleagues, were presented including choice of drugs in epilepsy, the dilemma of inflammation of the brain in multiple sclerosis, numerous sessions on dementia and finally movement disorders including Parkinsons Disease. There was much discussion on issues with respect to treatment for the broad range of neurodegenerative diseases. When to start, what to use, side effects.

There is a persistent curiosity in the unusual psychological manifestations of Parkinson’s Disease such as pathological gambling, hyper-sexuality and “punding”. As I don’t exhibit ANY of these unique characteristics, I am reassured that I don’t have early PD. This information together with my intact sense of smell, continues to reassure me that I am rather boringly normal after all.

In case you are too frightened to ask, “punding” is an almost addictive desire to collect things. So if you have a display cabinet at home containing teaspoons, thimbles, tea towels, old glass butter dishes, old money boxes, china dolls or even pre-worn AFL shorts, then seek immediate help from a neurologist, if you find one actually working and not overseas.

If by chance you collect both dolls and used AFL player football shorts, I would be very happy to assess you myself upon my return from overseas. I will squeeze you in to my busy working day.

I was flabbergasted when a Scandinavian specialist argued that ALL patients referred for possible dementia should have an MRI scan and or other complex and expensive scans, and if normal, then follow up with serial scans! The economic burden would be on par with the Greek annual budget.

Drug companies and Sponsors kiosks were similar to those in Australia. Interactive touch screens and iPads abounded! There was little objective scientific information easily obtained from the sophisticated marketing indeed naked commercialism of each booth.

I was amazed to see that many of the Sponsors booths which offered free coffee (barista style) displayed a laminated “warning” to those north American physicians that accepting such a trivial beverage, would require mandatory disclosure! How and why this disclosure should be done, was not specified.

The Afternoon drug company sponsored satellite meetings fairly blatantly pushed their newest wonder drug! Whilst I am critical of many aspects of medical practice in America, they are scrupulous about disclosure and at meetings such as this, held in the USA, all speakers will commence their presentation with a statement of disclosure.

I have babbled on far too long so the music session must become an encore to today’s blog!

$10 = 68 kroner !

Or to be more depressing

1 Kroner is about 15 cents ( on a good day!)

So how can I demonstrate that Sweden is bloody expensive? Easy ….
3 day bike hire (nothing flash- city tourer with flat handlebars)

590 kroner! ($85)