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From eye exams to blood tests and surgery: how doctors use light to diagnose disease

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/matthew-griffith-1539353">Matthew Griffith</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>You’re not feeling well. You’ve had a pounding headache all week, dizzy spells and have vomited up your past few meals.</p> <p>You visit your GP to get some answers and sit while they shine a light in your eyes, order a blood test and request some medical imaging.</p> <p>Everything your GP just did relies on light. These are just some of the optical technologies that have had an enormous impact in how we diagnose disease.</p> <h2>1. On-the-spot tests</h2> <p>Point-of-care diagnostics allow doctors to test patients on the spot and get answers in minutes, rather than sending samples to a lab for analysis.</p> <p>The “flashlight” your GP uses to view the inside of your eye (known as an <a href="https://medlineplus.gov/ency/article/003881.htm">ophthalmoscope</a>) is a great example. This allows doctors to detect abnormal blood flow in the eye, deformations of the cornea (the outermost clear layer of the eye), or swollen optical discs (a round section at the back of the eye where the nerve link to the brain begins). Swollen discs are a sign of elevated pressure inside your head (or in the worst case, a brain tumour) that could be <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/headache/increased-intracranial-pressure-icp-headache">causing your headaches</a>.</p> <p>The invention of <a href="https://openmedscience.com/lighting-the-way-in-healthcare-the-transformative-role-of-lasers-in-medicine/">lasers and LEDs</a> has enabled many other miniaturised technologies to be provided at the bedside or clinic rather than in the lab.</p> <p><a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">Pulse oximetry</a> is a famous example, where a clip attached to your finger reports how well your blood is oxygenated. It does this by <a href="https://www.howequipmentworks.com/pulse_oximeter/">measuring</a> the different responses of oxygenated and de-oxygenated blood to different colours of light.</p> <p>Pulse oximetry is used at hospitals (and <a href="https://theconversation.com/whats-a-pulse-oximeter-should-i-buy-one-to-monitor-covid-at-home-174457">sometimes at home</a>) to monitor your respiratory and heart health. In hospitals, it is also a valuable tool for detecting <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60107-X/fulltext">heart defects in babies</a>.</p> <h2>2. Looking at molecules</h2> <p>Now, back to that blood test. Analysing a small amount of your blood can diagnose <a href="https://theconversation.com/blood-tests-and-diagnosing-illness-what-can-blood-tell-us-about-whats-happening-in-our-body-80327">many different diseases</a>.</p> <p>A machine called an automated “full blood count analyser” tests for general markers of your health. This machine directs focused beams of light through blood samples held in small glass tubes. It counts the number of blood cells, determines their specific type, and reports the level of haemoglobin (the protein in red blood cells that distributes oxygen around your body). In minutes, this machine can provide a <a href="https://www.nuffieldhealth.com/article/inside-the-pathology-lab-what-happens-to-my-blood">snapshot</a> of your overall health.</p> <p>For more specific disease markers, blood serum is separated from the heavier cells by spinning in a rotating instrument called a centrifuge. The serum is then exposed to special chemical stains and enzyme assays that change colour depending on whether specific molecules, which may be the sign of a disease, are present.</p> <p>These colour changes can’t be detected with the naked eye. However, a light beam from an instrument called a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476943/#R88">spectrometer</a> can detect tiny amounts of these substances in the blood and determine if the biomarkers for diseases are present, and at what levels.</p> <h2>3. Medical imaging</h2> <p>Let’s re-visit those medical images your GP ordered. The development of fibre-optic technology, made famous for transforming high-speed digital communications (such as the NBN), allows light to get inside the body. The result? High-resolution optical imaging.</p> <p>A common example is an <a href="https://www.medicalnewstoday.com/articles/153737#risks-and-side-effects">endoscope</a>, where fibres with a tiny camera on the end are inserted into the body’s natural openings (such as your mouth or anus) to examine your gut or respiratory tracts.</p> <p>Surgeons can insert the same technology through tiny cuts to view the inside of the body on a video screen during <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9553337/">laparoscopic surgery</a> (also known as keyhole surgery) to diagnose and treat disease.</p> <h2>How about the future?</h2> <p>Progress in nanotechnology and a better understanding of the interactions of light with our tissues are leading to new light-based tools to help diagnose disease. These include:</p> <ul> <li> <p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/advs.201903441">nanomaterials</a> (materials on an extremely small scale, many thousands of times smaller than the width of a human hair). These are being used in next-generation sensors and new diagnostic tests</p> </li> <li> <p><a href="https://www.nature.com/articles/s41587-019-0045-y">wearable optical biosensors</a> the size of your fingernail can be included in devices such as watches, contact lenses or finger wraps. These devices allow non-invasive measurements of sweat, tears and saliva, in real time</p> </li> <li> <p>AI tools to analyse how blood serum scatters infrared light. This has allowed researchers to build a <a href="https://www.advancedsciencenews.com/powerful-diagnostic-approach-uses-light-to-detect-virtually-all-forms-of-cancer/">comprehensive database</a> of scatter patterns to detect <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/aisy.202300006">any cancer</a></p> </li> <li> <p>a type of non-invasive imaging called <a href="https://www.ncbi.nlm.nih.gov/books/NBK554044/">optical coherence tomography</a> for more detailed imaging of the eye, heart and skin</p> </li> <li> <p>fibre optic technology to deliver a tiny microscope into the body on the <a href="https://www.uwa.edu.au/projects/microscope-in-a-needle">tip of a needle</a>.</p> </li> </ul> <p>So the next time you’re at the GP and they perform (or order) some tests, chances are that at least one of those tests depend on light to help diagnose disease.<!-- Below is The Conversation's page counter tag. 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More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/matthew-griffith-1539353"><em>Matthew Griffith</em></a><em>, Associate Professor and ARC Future Fellow and Director, UniSA Microscopy and Microanalysis Facilities, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/from-eye-exams-to-blood-tests-and-surgery-how-doctors-use-light-to-diagnose-disease-231379">original article</a>.</em></p> </div>

Body

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John Farnham tells all about gruelling surgery and recovery

<p>John Farnham has candidly shared the details of his mammoth surgery to remove a cancerous tumour from his jaw, and the subsequent recovery process. </p> <p>Revealing all in his new memoir <em>The Voice Inside</em>, the Aussie music legend spoke about his recent health challenges after he was diagnosed with oral cancer in August 2022 which saw him undergo a marathon 12-hour surgery to the tumour. </p> <p>The procedure involved the reconstruction of part of his jaw and required intensive care and an extended recovery period, as surgeons removed all his bottom teeth and scraped his jaw bone.</p> <p>Farnham’s recounting of the experience in his memoir, marking the first time the music legend has talked publicly about the surgery and his recovery.</p> <p>“I was told later that someone from the medical team called Jillian [Billman, Farnham’s wife] a couple of times while I was in ­theatre – apparently I was very close to dying,” he said.</p> <p>He went on to write about the lengthy journey of finding his voice again, writing, “My facial disfigurement from the surgery means I can’t open my mouth wide enough for a strip of spaghetti, let alone to sing a top C."</p> <p>"At this stage I can’t get the movement to make the sounds I want to make, and that’s where the vibrations and my voice come from,” he wrote.</p> <p>“It’s still a very disconcerting thing. And trying hurts [...] I can barely open my mouth but I still wail in the shower.”</p> <p>Farnham's memoir comes after his long-time friend Gaynor Wheatley told <em>Today</em> that he has not ruled out the possibility of ever <a href="https://oversixty.com.au/health/caring/longtime-friend-opens-up-on-john-farnham-s-potential-return-to-singing" target="_blank" rel="noopener">performing</a> again. </p> <p>"As soon as I saw him in the studio doing the audiobook and as soon as he got behind the microphone, the twinkle was in the eye," she told the show on Wednesday. </p> <p>"That's when I thought, you know, we're still in with a shot and he can still sing, his voice box is still great, there's just a few more things to do with the mouth recovery, but we all know he's as strong as a boxer so if he wants to do something, he'll do it.</p> <p>"If I say to him, 'You won't sing, you can't sing, what a shame', then he'll go, 'Yes I can, I'll prove you wrong'."</p> <p><em>Image credits: Getty Images / Facebook</em></p>

Caring

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John Farnham's voice heard for the first time since throat surgery

<p>John Farnham's voice has been heard for the first time since undergoing extensive surgery on his throat and jaw to treat his cancer in August 2022. </p> <p>The Aussie music legend is lending his voice to narrate the audio version of his new <a href="https://oversixty.com.au/health/caring/finally-felt-like-the-right-time-john-farnham-s-huge-announcement" target="_blank" rel="noopener">memoir</a> titled <em>The Voice Inside</em>, which is to be released on October 30th. </p> <p><em>The Morning Show</em>'s entertainment reporter Peter Ford broke the news that Farnham's voice would be heard for the first time in over two years, while playing an exclusive clip from the audio book. </p> <p>Ford said Farnham co-wrote the book with Poppy Stockwell, who directed his recent Logie-winning documentary <em>The Voice Inside</em>, saying the documentary was “brilliantly done,” and “obviously John feels safe and a great connection with her”.</p> <p>“So they’ve written it together now," Ford said. </p> <p>“We got the news that John was going to do the audio version of the book, and also his wife Jill will actually be writing two chapters.”</p> <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-permalink="https://www.instagram.com/reel/DA17RsMNCTK/?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/DA17RsMNCTK/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by The Morning Show On 7 (@morningshowon7)</a></p> </div> </blockquote> <p>Ford expressed his excitement over the clip, saying, “This is for the first time now in many years.”</p> <p>“We haven’t heard John. We haven’t seen John. We know what he’s been going through. So this is great for that reason."</p> <p>“He’s older and there has been some impact on his voice because of the surgery. But, you know, the delivery, the tone, the cheekiness, it’s all there. It’s instantly John Farnham.”</p> <p>“I‘m just thrilled to hear his voice and to think he’s doing something, and what a rollercoaster that would have been for him,” Ford says.</p> <p>“It’s one thing to sit down with Poppy and tell her the stories and share the memories, but to actually get behind a microphone and deliver it."</p> <p>“John, as we know, is a performer who always gives 120 per cent. He would have really been challenged, I think, in delivering some of those sadder stories of recent times.”</p> <p><em>Image credits: Getty Images / Facebook</em></p>

Caring

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Jimmy Barnes shares positive update after surgery

<p>Jimmy Barnes has shared a heartwarming update on his health following his emergency hip surgery in August. </p> <p>While on the New Zealand leg of his tour in early August, the 68-year-old rockstar was taken to <a href="https://oversixty.com.au/health/caring/bad-news-jimmy-barnes-reveals-shocking-health-update" target="_blank" rel="noopener">hospital</a> after complaining of "unbearable pain", telling his fans, "The doctors have recommended a remedial medical procedure ASAP followed by some physio to address the issue."</p> <p>Now back at home with his family, Barnes shared that he is on the road to recovery with an update on his healing journey. </p> <p>Barnes said he has had his PICC line, a thin tube inserted through a vein in your arm to deliver medications and treatments directly to the larger veins near your heart, finally removed, meaning he can gain back some normalcy.</p> <p>Barnes said was living with a PICC line in his arm for the past six weeks to continue his treatment as an out patient.</p> <p>“It’s meant that I could leave hospital and continue most of my recovery at home,” he said on Instagram on Friday.</p> <p>“It’s been restricting and liberating at the same time."</p> <p>“This part of my recovery is now over and with the help of (doctors), nurses, physiotherapists, family, friends, you guys and my Jane, everything is on track.”</p> <p>Posing in front of a calendar with Cold Chisel dates, Barnes said rehearsing with the band again this week has “topped things off”.</p> <p>“I can even get back behind the wheel,” he said. “Aah! FREEDOM.”</p> <p><em>Image credits: Instagram</em></p>

Caring

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Jimmy Barnes shares heartwarming health update

<p>Jimmy Barnes has shared a series of heartwarming updates following his emergency hip surgery earlier this month. </p> <p>While on the New Zealand leg of his tour in early August, the 68-year-old rockstar was taken to <a href="https://oversixty.com.au/health/caring/bad-news-jimmy-barnes-reveals-shocking-health-update" target="_blank" rel="noopener">hospital</a> after complaining of "unbearable pain", telling his fans, "The doctors have recommended a remedial medical procedure ASAP followed by some physio to address the issue."</p> <p>Now back at home with his family, Barnes has posted a series of messages to Instagram describing how thrilled he was to be out of hospital.</p> <p>“I can’t tell how great it feels to be back in my own bed, back to our home and the beautiful garden. Of course, being very spoilt,” he said on Monday.</p> <p>Barnes has also now commenced a high-protein diet and continued with his physio, which he said was “getting tougher”.</p> <p>“If I’m to be on a high-protein recovery diet, I’ve come to the right place,” he said of his wife Jane Barnes’ expert cooking skills.</p> <p>“I’m being loaded up with protein and iron to rebuild muscles that I never had,” he explained in an Instagram caption.</p> <p>He also shared a sweet photo with his grandchildren who have been keeping his spirits high during his recovery, writing alongside the photo, "Rosie and Dylan here to cheer me on at the end of the day. The physio is getting tougher and the protein shakes are growing on me. I sure am a lucky guy."</p> <p>When sharing the news of his surgery with his fans, he said, “Providing all goes to plan, I’m expected to make a full recovery in six weeks.”</p> <p><em>Image credits: Instagram </em></p>

Caring

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Do you have knee pain from osteoarthritis? You might not need surgery. Here’s what to try instead

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/belinda-lawford-1294188">Belinda Lawford</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>Most people with knee osteoarthritis can control their pain and improve their mobility without surgery, according to <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">updated treatment guidelines</a> from the Australian Commission on Safety and Quality in Health Care.</p> <p>So what is knee osteoarthritis and what are the best ways to manage it?</p> <h2>More than 2 million Australians have osteoarthritis</h2> <p>Osteoarthritis is the most common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. It <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">costs the economy</a> A$4.3 billion each year.</p> <p>Osteoarthritis commonly <a href="https://pubmed.ncbi.nlm.nih.gov/33560326/">affects</a> the knees, but can also affect the hips, spine, hands and feet. It impacts the whole joint including bone, cartilage, ligaments and muscles.</p> <p>Most people with osteoarthritis have persistent pain and find it difficult to perform simple daily tasks, such as walking and climbing stairs.</p> <h2>Is it caused by ‘wear and tear’?</h2> <p>Knee osteoarthritis is most likely to affect older people, those who are overweight or obese, and those with previous knee injuries. But contrary to popular belief, knee osteoarthritis is <a href="https://pubmed.ncbi.nlm.nih.gov/31192807/">not caused by</a> “wear and tear”.</p> <p><a href="https://pubmed.ncbi.nlm.nih.gov/21281726/">Research shows</a> the degree of structural wear and tear visible in the knee joint on an X-ray does not correlate with the level of pain or disability a person experiences. Some people have a low degree of structural wear and tear and very bad symptoms, while others have a high degree of structural wear and tear and minimal symptoms. So X-rays are <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">not required</a> to diagnose knee osteoarthritis or guide treatment decisions.</p> <p>Telling people they have wear and tear can make them worried about their condition and afraid of damaging their joint. It can also encourage them to try invasive and potentially unnecessary treatments such as surgery. We have <a href="https://pubmed.ncbi.nlm.nih.gov/37795555/">shown this</a> in people with osteoarthritis, and other common pain conditions such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9545091/">back</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/33789444/">shoulder</a> pain.</p> <p>This has led to a global call for a <a href="https://pubmed.ncbi.nlm.nih.gov/38354847/">change in the way</a> we think and communicate about osteoarthritis.</p> <h2>What’s the best way to manage osteoarthritis?</h2> <p>Non-surgical treatments work well for most people with osteoarthritis, regardless of their age or the severity of their symptoms. These <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">include</a> education and self-management, exercise and physical activity, weight management and nutrition, and certain pain medicines.</p> <p>Education is important to dispel misconceptions about knee osteoarthritis. This includes information about what osteoarthritis is, how it is diagnosed, its prognosis, and the most effective ways to self-manage symptoms.</p> <p>Health professionals who use positive and reassuring language <a href="https://pubmed.ncbi.nlm.nih.gov/35750241/">can improve</a> people’s knowledge and beliefs about osteoarthritis and its management.</p> <p>Many people believe that exercise and physical activity will cause further damage to their joint. But it’s safe and can reduce pain and disability. Exercise has fewer side effects than commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/36593092/">paracetamol and anti-inflammatories</a> and can <a href="https://pubmed.ncbi.nlm.nih.gov/26488691/">prevent or delay</a> the need for joint replacement surgery in the future.</p> <p>Many types of exercise <a href="https://pubmed.ncbi.nlm.nih.gov/30830561/">are effective</a> for knee osteoarthritis, such as strength training, aerobic exercises like walking or cycling, Yoga and Tai chi. So you can do whatever type of exercise best suits you.</p> <p>Increasing general physical activity is also important, such as taking more steps throughout the day and reducing sedentary time.</p> <p>Weight management is important for those who are overweight or obese. Weight loss <a href="https://pubmed.ncbi.nlm.nih.gov/34843383/">can reduce knee pain and disability</a>, particularly when combined with exercise. Losing as little as 5–10% of your body weight <a href="https://pubmed.ncbi.nlm.nih.gov/36474793/">can be beneficial</a>.</p> <p>Pain medicines should not replace treatments such as exercise and weight management but can be used alongside these treatments to help manage pain. <a href="https://pubmed.ncbi.nlm.nih.gov/33786837/">Recommended medicines</a> include paracetamol and non-steroidal anti-inflammatory drugs.</p> <p>Opioids are <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">not recommended</a>. The risk of harm outweighs any potential benefits.</p> <h2>What about surgery?</h2> <p>People with knee osteoarthritis commonly undergo two types of surgery: knee arthroscopy and knee replacement.</p> <p>Knee arthroscopy is a type of keyhole surgery used to remove or repair damaged pieces of bone or cartilage that are thought to cause pain.</p> <p>However, high-quality research <a href="https://pubmed.ncbi.nlm.nih.gov/24369076/">has shown</a> arthroscopy is not effective. Arthroscopy should therefore not be used in the management of knee osteoarthritis.</p> <p>Joint replacement involves replacing the joint surfaces with artificial parts. In 2021–22, <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">53,500 Australians</a> had a knee replacement for their osteoarthritis.</p> <p>Joint replacement is often seen as being inevitable and “necessary”. But most people can effectively manage their symptoms through exercise, physical activity and weight management.</p> <p>The new guidelines (known as “care standard”) recommend joint replacement surgery only be considered for those with severe symptoms who have already tried non-surgical treatments.</p> <h2>I have knee osteoarthritis. What should I do?</h2> <p>The <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> links to free evidence-based resources to support people with osteoarthritis. These include:</p> <ul> <li>education, such as a <a href="https://www.england.nhs.uk/wp-content/uploads/2023/07/making-a-decision-about-knee-osteoarthritis-v1.pdf.pdf">decision aid</a> and <a href="http://www.futurelearn.com/courses/taking-control-hip-and-knee-osteoarthritis">four-week online course</a></li> <li>self-directed <a href="https://healthsciences.unimelb.edu.au/departments/physiotherapy/chesm/patient-resources/my-knee-exercise">online exercise</a> and <a href="https://myjointyoga.com.au/">yoga</a> programs</li> <li><a href="https://www.gethealthynsw.com.au/program/standard-coaching/">weight management support</a></li> <li>pain management strategies, such as <a href="https://www.myjointpain.org.au/">MyJointPain</a> and <a href="http://www.paintrainer.org/">painTRAINER</a>.</li> </ul> <p>If you have osteoarthritis, you can use the <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard">care standard</a> to inform discussions with your health-care provider, and to make informed decisions about your care.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/236779/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/belinda-lawford-1294188"><em>Belinda Lawford</em></a><em>, Postdoctoral research fellow in physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/joshua-zadro-504754">Joshua Zadro</a>, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/rana-hinman-1536232">Rana Hinman</a>, Professor in Physiotherapy, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">original article</a>.</em></p> </div>

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Australia’s IV fluids shortage will likely last all year. Here’s what that means for surgeries

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/stuart-marshall-1115779">Stuart Marshall</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722"><em>The University of Melbourne</em></a></em></p> <p>The current <a href="https://www.tga.gov.au/about-IV-fluids-shortages">shortage of sterile intravenous (IV) fluids</a> is a serious ongoing concern for doctors across Australia. During surgery, these sterile fluids are essential to administer drugs and hydrate patients intravenously (via the veins).</p> <p>But supplies of two of the most common solutions are critically low.</p> <p>The Australian government has recently moved to <a href="https://www.theguardian.com/australia-news/article/2024/aug/16/australia-iv-fluid-shortage-government-distribution">coordinate supplies</a> of IV fluids to increase manufacturing and ensure distribution. Despite this, supplies are not expected to return to normal levels <a href="https://www.health.gov.au/sites/default/files/2024-08/joint-statement-on-iv-fluids-health-ministers-meeting-16-august-2024.pdf">until the end of the year</a>.</p> <p>So, what will this mean for surgery in Australia? And are there any alternatives?</p> <h2>Why do we need IV fluids for surgery?</h2> <p>IV fluids are used before, during and after surgery to maintain blood volume and the body’s normal functions. They also combat dehydration, which can happen in a number of ways.</p> <p>Before surgery, patients may become dehydrated from illnesses that cause vomiting or diarrhoea. They are also asked to stop eating and drinking for several hours before surgery. This is to minimise the risk of stomach contents being regurgitated and inhaled into the lungs – a <a href="https://my.clevelandclinic.org/health/diseases/21954-aspiration-pneumonia">complication that can cause injury or death</a>. But it can also make them more dehydrated.</p> <p>During surgery, the body continues to lose fluid through normal processes such as sweating and making urine. But some aspects of surgery also exacerbate dehydration, for example, through blood loss or when internal organs are exposed and lose more fluid through evaporation.</p> <p>After the operation, IV fluids may be required for some days. Many patients may still be unable to eat and drink until the function of the gut returns to normal.</p> <p>Multiple research studies, including <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1801601">a trial </a>of 3,000 patients who underwent major abdominal surgery, have demonstrated the importance of adequate fluid therapy throughout all stages of surgery to avoid kidney damage.</p> <p>Apart from hydration, these sterile fluids – prepared under strict conditions so they contain no bacteria or viruses – are used in surgery for other reasons.</p> <p>Anaesthetists commonly use fluid infusions to slowly deliver medications into the bloodstream. There is some evidence this method of maintaining anaesthesia, compared to inhalation, can improve patients’ experience of “waking up” after the procedure, <a href="https://medcast.com.au/blog/total-intravenous-anaesthesia-tiva">such as being clearer headed and having less nausea and vomiting</a>.</p> <p>Surgeons also use sterile fluids to flush out wounds and surgical sites to prevent infection.</p> <h2>Are there workarounds?</h2> <p>Fluid given intravenously needs to closely resemble the salts in the blood to prevent additional problems. The safest and cheapest options are:</p> <ul> <li>isotonic saline, a solution of water with 0.9% table salt</li> <li>Hartmann’s solution (compound sodium lactate), which combines a range of salts such as potassium and calcium.</li> </ul> <p>Both are <a href="https://www.tga.gov.au/about-IV-fluids-shortages">in short supply</a>.</p> <p>One way to work around the shortage is to minimise how much IV fluid is used during the procedure. This can be achieved by ensuring those admitted to surgery are as well hydrated as possible.</p> <p>Many people presenting for minor surgery can safely drink water up until an hour or so before their operation. A recent initiative termed “<a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15855">sip ‘til send</a>” has shown it is safe for patients to drink small amounts of fluid until the operating theatre team “sends” for them from the waiting room or hospital ward.</p> <p>However, this may not be appropriate for those at higher risk of inhaling stomach contents, or patients who take medications including <a href="https://www.journal.acorn.org.au/cgi/viewcontent.cgi?article=1291&amp;context=jpn">Ozempic</a>, which delay the stomach emptying. Patients should follow their anaesthetist’s advice about how to prepare for surgery and when to stop eating and drinking.</p> <p>Large research trials have also helped establish protocols called “<a href="https://www.bjanaesthesia.org/article/S0007-0912(17)53976-8/fulltext">enhanced recovery after surgery</a>”. They show that using special hydrating, carbohydrate-rich drinks before surgery can improve patients’ comfort and speed up healing.</p> <p>These protocols are common in <a href="https://aci.health.nsw.gov.au/__data/assets/pdf_file/0003/736617/ERAS-Key-principles-for-colorectal-surgery.pdf">major bowel surgery</a> in Australia but not used universally. Widespread adoption of these processes may reduce the amount of IV fluids needed during and after large operations, and help patients return to normal eating and drinking earlier. Medications reducing nausea and vomiting are now also routinely administered after surgery to help with this.</p> <h2>What will the shortage mean for surgeries?</h2> <p>The Australian and New Zealand College of Anaesthetists <a href="https://www.anzca.edu.au/news/guidance-on-sparing-of-intravenous-fluid-use">has advised anaesthetists</a> to reduce the consumption of fluid during operations where there might be limited or minimal benefit. This means that the fluid will only be used for people who need it, without a change to the quality and safety of anaesthetic care for any patient.</p> <p>Even with these actions, there is still a chance that some planned surgeries may <a href="https://www.abc.net.au/news/2024-08-15/iv-fluid-shortage-elective-urgery-delays/104225280">need to be postponed</a> in the coming months.</p> <p>If needed, these cancelled operations will likely be ones requiring large volumes of fluid and ones that would not cause unacceptable risks if delayed. Similar to cancellations during the height of the COVID pandemic, emergency operations and surgery for cancers are unlikely to be affected.</p> <p>Monitoring of the supplies and ongoing honest and open dialogue between senior health managers and clinicians will be crucial in minimising the disruption to surgical services.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/237009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/stuart-marshall-1115779">Stuart Marshall</a>, Associate Professor, Department of Critical Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/australias-iv-fluids-shortage-will-likely-last-all-year-heres-what-that-means-for-surgeries-237009">original article</a>.</em></p> </div>

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"Bad news": Jimmy Barnes reveals shocking health update

<p>Jimmy Barnes has been taken to hospital after complaining of "unbearable pain" while on the New Zealand leg of his tour. </p> <p>The Aussie rock legend took to Instagram to tell his fans that he would be out of action for six weeks after experiencing pain in his hip that requires surgical intervention. </p> <p>"I’ve got some bad news unfortunately," he started the post. "I had a twinge in my hip when I was leaving Dunedin on Thursday morning and by late last night the pain was unbearable so I went off to hospital."</p> <p>"The doctors have recommended a remedial medical procedure ASAP followed by some physio to address the issue. These doctors don’t muck around! Providing all goes to plan, I’m expected to make a full recovery in six weeks."</p> <p>The 68-year-old then clarified that because of the upcoming surgery, his August and September shows on his <em>Hell of a Time</em> tour would be impacted. </p> <p>"Ticket holders will be contacted with further info in the coming days once we have new plans in place," he said.</p> <p>"As you know, I hate to let anyone down, but I’m also never going to compromise the quality of my gigs. I apologise for the inconvenience this will cause everyone – I HATE moving shows! - but thank you for understanding."</p> <p>Just hours after his post, Jimmy's wife Jane took to his social media accounts to tell his fans that he was out the ICU and "recovering well" while he awaits the procedure. </p> <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-permalink="https://www.instagram.com/p/C-PaHMCT78j/?utm_source=ig_embed&amp;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/p/C-PaHMCT78j/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Jimmy Barnes (@jimmybarnesofficial)</a></p> </div> </blockquote> <p>"Jimmy is out of ICU and recovering well. I brought in some healing chicken soup and chocolate chip cookies for afternoon tea, a bit of home always helps hospital days," she said. </p> <p>"Our kids always around watching over us. Full of Love."</p> <p>The health shock comes just months after he underwent open heart surgery for a life-threatening infection, while also following on from a hip replacement surgery Barnes underwent in 2022 after experiencing more pain while performing.</p> <p><em>Image credits: Instagram </em></p>

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Pauline Hanson's surprising act of kindness for struggling family

<p>Pauline Hanson has revealed a surprising act of kindness for a struggling Queensland family, who have been battling the private healthcare system. </p> <p>Nine year old Kadee Byrnes, from Yeppoon, about 740km north of Brisbane, has been on the public hospital waiting list for seven years waiting for the adenoid surgery she desperately needs.</p> <p>The surgery is a procedure to remove the adenoids, small tissue lumps in the nasal cavity, to address her chronic tonsillitis.</p> <p>While on the waitlist, Kadee had to repeat the fourth grade after missing so much school due to reoccurring infections. </p> <p>After hearing of Kadee's plight, the One Nation senator said she was "disgusted" the young girl had to wait so long for surgery and promised to cover the cost of her private treatment.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">Queensland Senator Pauline Hanson has promised to cover the surgery costs for a nine year old Yeppoon girl, who has been on the public hospital waiting list for more than seven years. <a href="https://t.co/WbYeQT6ZHu">https://t.co/WbYeQT6ZHu</a> <a href="https://twitter.com/cpenny_6?ref_src=twsrc%5Etfw">@CPenny_6</a> <a href="https://twitter.com/hashtag/7NEWS?src=hash&ref_src=twsrc%5Etfw">#7NEWS</a> <a href="https://t.co/AdToZNR6Ii">pic.twitter.com/AdToZNR6Ii</a></p> <p>— 7NEWS Central Queensland (@7NewsCQ) <a href="https://twitter.com/7NewsCQ/status/1817847532908912803?ref_src=twsrc%5Etfw">July 29, 2024</a></p></blockquote> <p>"I'm grateful for the opportunity to help 9-year-old Kadee by covering the cost of her private treatment," Ms Hanson said on Tuesday.</p> <p>"It is unacceptable that young Kadee was told she would have to repeat Grade 4 due to missing so many school days because of tonsillitis."</p> <p>"Situations like this are sadly all too common and highlight the severe consequences of the Labor government's lack of investment in our public hospitals, especially outside South East Queensland."</p> <p>Senator Hanson broke the happy news to Kadee's mother, Kahlia, at a speaking event in Roslyn Bay.</p> <p>"Straight away, I said we're going to get this operation done. Kahlia you don't know, I'm paying for it, all right, I'm going to pay for it," Senator Hanson said. </p> <p>Kahlia said she was grateful for Senator Hanson's generosity and to see her daughter finally have a normal life. </p> <p>"I am very that it's going to end this way," Kahlia said. "She is finally going to have a surgery and she is finally going to be able to live a life as a normal nine year old."</p> <p><em>Image credits: 7News </em></p> <p class="mol-para-with-font" style="font-size: 16px; margin: 0px 0px 16px; padding: 0px; min-height: 0px; letter-spacing: -0.16px; font-family: Inter, sans-serif;"> </p> <p> </p>

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Dr Charlie Teo's surprising next move after Aussie surgery restrictions

<p>One year after being slapped with restrictions that effectively stopped him from operating in Australia, Dr Charlie Teo is restarting his career overseas. </p> <p>The neurosurgeon was investigated by Australia’s Health Care Complaints Commission, who last year placed restrictions on the surgeon after they discovered he had been operating on tumours that had been deemed "inoperable". </p> <p>Now, one of China’s most respected neurosurgeons has thanked Australia for imposing such restrictions because it has allowed her country to benefit from the controversial surgeon’s ability to remove high-risk brain tumours.</p> <p>Dr Teo has been operating regularly in China including on high profile VIPs, and at least eight other countries around the world, according to reports from the <em>Sunday Telegraph</em>. </p> <p>An investigation has found Dr Teo has operated on 150 patients, with many of them being from Australia, in China, Spain, Germany, India, Switzerland, Brazil, Peru, South Africa, and Nepal since the restrictions effectively stopped him from operating in Australia.</p> <p>In an interview from Beijing, Professor Ling Feng, Deputy Director of the China International Neuroscience Institute, said she is “not worried” about the restrictions imposed on Dr Teo a year ago for unsatisfactory conduct.</p> <p>“I took a careful look into what happened over there. I don’t think it should be imputed to Charlie’s neglect of care and passion for the patients,” Professor Ling told the <em>Sunday Telegraph</em>.</p> <p>“It is just a different view of the indications for surgery. Similar cases occur across the world. Instead, I ‘thank’ Australia for the restrictions on Charlie, which gave me the opportunity to work with him.”</p> <p>In the past year, patients have travelled from Australia, Romania, Britain, Saudi Arabia, France, Indonesia, and Singapore to have Dr Teo operate.</p> <p>Of those surgeries Dr Teo’s logbook documents one death, one “poor” outcome, three “fair outcomes”, 20 “good outcomes” and 145 cases have been documented as “excellent”.</p> <p>Dr Teo says his results are better than ever and he feels terrible for patients in his own country that he can’t help, but hopes that he may one day be able to return to Australian operating rooms to help patients. </p> <p>“All it would take is one sensible and brave person in one hospital somewhere in Australia to change the status quo,” Dr Teo said.</p> <p>“Just one person to sit back and go ‘okay he might be an a**hole, he might be into money, he might be a bit of a cowboy, he might be all the things the media have said he might be, but the fact is that patients, Australian patients, some need him and he does operations that other people don’t do and most of those outcomes are good so what about we just drop the politics and allow him to operate in Australia?"</p> <p>“That’s all it would take … some common sense for the greater good, not for his sake but for the sake of patients.”</p> <p><em>Image credits: Instagram </em></p>

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Sam Armytage in hospital for major surgery

<p>Former <em>Sunrise </em>host Samantha Armytage has undergone major hip replacement surgery following a severe case of osteoarthritis. The 47-year-old TV personality shared her journey on Instagram on Tuesday, posting photos from St Vincent's Private Hospital in Sydney.</p> <p>Armytage revealed in a detailed caption that she had been struggling with osteoarthritis after tearing the cartilage in her right hip. This condition, a degenerative joint disease, causes the tissues in the joint to break down over time and is more prevalent among older individuals.</p> <p>Reflecting on her experience, the host of <em>The Farmer Wants a Wife</em> explained that the hip replacement was necessary to address the bone-on-bone friction and the severe osteoarthritis. Despite the challenges, she reassured her followers that her recovery is progressing well.</p> <p>"Hip, hip hooray. New hip, new me, no worries," she wrote. "A few weeks ago, I had a total hip replacement. After a very active, outdoorsy childhood (& a skiing accident 30 years ago), I'd torn all the cartilage out of my right hip. It was bone-on-bone & then became full of severe osteoarthritis. I'm so proud of how strong my body is & how well I've healed. I'm now truly bionic...& my nearest & dearest are pleased to not have to watch me limp around in pain anymore."</p> <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/p/C85u8pqPlGS/?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/p/C85u8pqPlGS/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Samantha Armytage (@sam_armytage)</a></p> </div> </blockquote> <p>Armytage extended her gratitude to the medical staff and her loved ones, adding a touch of humour by sharing a photo of herself with a bit of Endone, a pain relief medication. She also praised her surgeon, Dr Michael Solomon, highlighting that hip replacements are common in Australia, with approximately 54,000 performed each year.</p> <p>Her post quickly garnered support from friends and fans alike. Presenter Kylie Gillies suggested a celebratory purchase, writing, "I think this deserves a new pair of Jimmy Choos …just to kick up those old heels and new hip! Glad to hear it’s gone well x" Meanwhile, singer Ricki-Lee Coulter expressed her encouragement, saying, "You’ll be dancing in no time. Sending you love xxx"</p> <p>Fans also chimed in with well wishes and supportive messages. One commented, "Good luck with the recovery and welcome to the Hip New Hip Gals Club," while another noted, "Oh a bit young for that Sam. Good luck on your recovery."</p> <p>Recovery from hip replacement surgery can be a lengthy process, often requiring dedicated physiotherapy. However, with her positive outlook and the support of her community, Samantha Armytage is well on her way to a full recovery.</p> <p><em>Images: Instagram</em></p>

Caring

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I’ve been given opioids after surgery to take at home. What do I need to know?

<div class="theconversation-article-body"> <p><em><a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a></em></p> <p>Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.</p> <p>These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.</p> <p>However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.</p> <h2>Which types of opioids are most common?</h2> <p>The <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">most commonly prescribed</a> opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).</p> <p>In fact, <a href="https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.16063">about half</a> of new oxycodone prescriptions in Australia occur after a recent hospital visit.</p> <p><a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">Most commonly</a>, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.</p> <p>Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.</p> <p>Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.</p> <p>Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.</p> <p>Controlling your pain after surgery is <a href="https://www.nps.org.au/assets/4811a27845042173-00a4ff09097b-postoperative-pain-management_36-202.pdf">important</a>. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.</p> <p>Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.</p> <h2>But there are also risks</h2> <p>As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.</p> <p>Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.</p> <p>But up to <a href="https://pubmed.ncbi.nlm.nih.gov/35545810/">one in ten</a> Australians still take them up to four months after surgery. <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/msc.1837">One study</a> found people didn’t know how to safely stop taking opioids.</p> <p>Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.</p> <p>Dependency and side effects are also more common with <a href="https://www.anzca.edu.au/getattachment/535097e6-9f50-4d09-bd7f-ffa8faf02cdd/Prescribing-slow-release-opioids-4-april-2018#:%7E:text=%E2%80%9CSlow%2Drelease%20opioids%20are%20not,its%20Faculty%20of%20Pain%20Medicine.">slow-release opioids</a> than immediate-release opioids. This is because people are usually on slow-release opioids for longer.</p> <p>Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed <a href="https://journals.sagepub.com/doi/full/10.1177/0310057X231163890">more than twice</a> the amount they needed.</p> <p>This results in unused opioids at home, which <a href="https://www.anzca.edu.au/getattachment/558316c5-ea93-457c-b51f-d57556b0ffa7/PS41-Guideline-on-acute-pain-management">can be dangerous</a> to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.</p> <h2>How to mimimise the risks</h2> <p>Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).</p> <p>These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.</p> <p>Other techniques to manage pain include physiotherapy, exercise, <a href="https://theconversation.com/hot-pack-or-cold-pack-which-one-to-reach-for-when-youre-injured-or-in-pain-161086">heat packs or ice packs</a>. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.</p> <p>However, if you do need opioids, there are some ways to make sure you use them <a href="https://www.safetyandquality.gov.au/sites/default/files/2022-04/opioid-analgesic-stewardship-in-acute-pain-clinical-care-standard.pdf">safely and effectively</a>:</p> <ul> <li> <p>ask for <a href="https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.16085">immediate-release</a> rather than slow-release opioids to lower your risk of side effects</p> </li> <li> <p>do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing</p> </li> <li> <p>as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen</p> </li> <li> <p>before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.</p> </li> </ul> <h2>If you’re concerned about side effects</h2> <p>If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:</p> <ul> <li> <p><a href="https://theconversation.com/health-check-what-causes-constipation-114290">constipation</a> – your pharmacist will be able to give you lifestyle advice and recommend laxatives</p> </li> <li> <p>drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor</p> </li> <li> <p>weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.</p> </li> </ul> <h2>If you’re having trouble stopping opioids</h2> <p>Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.</p> <p>You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.</p> <h2>How about leftover opioids?</h2> <p>After you have finished using opioids, take any leftovers to your local pharmacy to <a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">dispose of them safely</a>, free of charge.</p> <p>Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.</p> <hr /> <p><em>For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has <a href="https://www.choosingwisely.org.au/resources/consumers-and-carers/patient-guide-to-managing-pain-and-opioid-medicines">free online information</a> about managing pain and opioid medicines.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/228615/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/katelyn-jauregui-1527878">Katelyn Jauregui</a>, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/asad-patanwala-1529611">Asad Patanwala</a>, Professor, Sydney School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/jonathan-penm-404921">Jonathan Penm</a>, Senior lecturer, School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/shania-liu-1433659">Shania Liu</a>, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, <a href="https://theconversation.com/institutions/university-of-alberta-1232">University of Alberta</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/ive-been-given-opioids-after-surgery-to-take-at-home-what-do-i-need-to-know-228615">original article</a>.</em></p> </div>

Body

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John Farnham steps out at son's wedding for first time since jaw surgery

<p>Beloved Aussie rock legend John Farnham exuded pride and joy as he stepped out in style at his son Robert's wedding on the weekend. After enduring extensive surgery due to oral cancer, Farnham, now cancer-free, appeared in high spirits at the intimate wedding of his oldest son and his new wife, Melissa.</p> <p>The 74-year-old icon looked remarkably well and largely unchanged since his challenging surgery in August 2022. In the heartwarming photos shared on Instagram, John posed alongside his son, both beaming with happiness. John looked dapper in a black suit with a bronze tie and matching pocket square, while Rob opted for a stylish white tux with black accents.</p> <p>The joyous occasion was beautifully captured in a series of family photos, including John's wife, Jill, and other close family members. Fans flooded the comments with heartfelt messages, celebrating the happy family and John's remarkable recovery. "Such a beautiful father and son pic," one fan wrote, while another added, "Congratulations to you both. It's so nice to see your Dad, he looks fantastic! Love to you all."</p> <p>The bride, Melissa, looked stunning in an off-the-shoulder ivory gown, posing for romantic photos with her new husband against the lush backdrop of their wedding venue. Rob's touching caption on Instagram encapsulated the joy of the day: "Shared the happiest moment with my favourite person in the universe and she said I do. Melissa, my life is forever better that you’re apart of it. You looked radiant, beautiful and elegant. I can’t wait to see what the future has in store for us and I’m truly honoured to have you by my side as my wife for life❤️."</p> <p>The couple had announced their engagement in November 2022, with Rob expressing his excitement about their future together: "My best friend and love of my life said yes to marrying me. I can't wait to spend the rest of my life with you."</p> <p>John Farnham's presence at the wedding was particularly special, as it marked a year since his successful battle against cancer. In August 2023, Farnham revealed he was cancer-free, a triumph after numerous surgeries and a challenging recovery process. In a heartfelt statement, he shared his gratitude: "It's been a year since my first surgery and to be honest, I've lost count as to how many other procedures there have been since then. But, I'm home now and I'm a very grateful and happy man. I'm sitting here in my living room lapping up the attention from my beautiful wife, Jill, my boys Rob and James, and my mini Schnauzer, Edmund."</p> <p>Throughout his recovery, John's family provided updates on his progress. His son Robert shared that his father was "doing fantastic" after a 12-hour surgery for throat cancer and was even dancing a little and walking his dog regularly. "He's really, really happy. He's doing really good, he's super positive," Robert said in an interview.</p> <p>While it is unlikely that John will perform again after his extensive surgery, the love and joy he shared at his son's wedding are a beautiful reminder of life's precious moments.</p> <p><em>Images: Instagram</em></p>

Relationships

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Beloved Home and Away star shares major health update

<p><em>Home and Away</em> star Georgie Parker has shocked her online followers by revealing she has undergone a major surgery. </p> <p>The actress, who plays Roo Stewart in the Channel Seven soap, is currently recovering from her second hip replacement and this week posted a series of pictures taken from her hospital bed after the operation.</p> <p>Now three weeks into her recovery, the 59-year-old is undergoing extensive rehabilitation.</p> <p>“I’ve been busy. Finishing a play and then straight into another theatre (get it) for a new hip,” she said on Instagram.</p> <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-permalink="https://www.instagram.com/p/C7rI2iApE3K/?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/p/C7rI2iApE3K/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by georgieparker (@georgieparker)</a></p> </div> </blockquote> <p>“My second in six years, and thank god I had the same brilliant surgeon and his team."</p> <p>“I hate the drugs but love the rehab. I’m three weeks post op, recovery is going well and I’ve had the most brilliant support from my family, my workplace and my incredible friends.”</p> <p>She ended her post saying, “Practising patience now while I heal ... so I can get back to work baby.”</p> <p>Parker's famous friends took to the comments to wish her the best during her recovery, including fellow actor Hugh Sheridan who said, “Hip hip hooray!! We’ll be bending and stretching on play school together again in no time.”</p> <p>“Wishing you the speediest of recoveries Georgie!” actor Kat Stewart said.</p> <p>Parker previously spoke out about living with scoliosis, something she has suffered from since a child when she dreamed of becoming a dancer. </p> <p>“Every scoliosis is different, it’s like a fingerprint — but mine is all in the torso, I’ve lost about three inches (7.6cm) in height,” she told <a href="https://www.bodyandsoul.com.au/health/celebrity-profiles/how-the-home-and-away-stars-stay-healthy-all-year-round/news-story/a4072ec268f7e26cbc4926faf4e7fede" target="_blank" rel="noopener" data-link-type="article-inline"><em>Body + Soul</em> in 2020. </a></p> <p>“It impacts me on a daily basis and I just have to stay fit to keep my back as functional as possible.”</p> <p><em>Image credits: Instagram </em></p>

Caring

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Major TV star's 7-year-old undergoes third open heart surgery

<p>Jimmy Kimmel's seven-year-old son has undergone his third, and hopefully final open heart surgery after being born with congenital heart disease. </p> <p>In 2017, Jimmy <a href="https://www.youtube.com/watch?v=MmWWoMcGmo0" target="_blank" rel="noopener">revealed</a> that Billy was only three days old when had to undergo his first open heart surgery, after doctors found “a hole in the wall of the left and right side of his heart” that was preventing enough oxygen from reaching his blood. </p> <p>Billy was only seven months old when he had to undergo his second open heart surgery, and over the weekend he had to undergo his third major surgery at the Children's Hospital Los Angeles. </p> <p>A few days later, the TV host took to Instagram to share an update following his son's successful surgery. </p> <p>"We went into this experience with a lot of optimism and nearly as much fear and came out with a new valve inside a happy, healthy kid," Kimmel wrote, alongside a picture of his youngest son smiling in a hospital bed. </p> <p>He then thanked all the surgeons, doctors and other medical staff who "came through for us with immeasurable kindness and expertise." </p> <p>"Walking around this hospital, meeting parents at their most vulnerable, children in pain and the miracle workers who do everything in their considerable power to save them is a humbling experience," Kimmel continued.</p> <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-permalink="https://www.instagram.com/p/C7fE-p4S7YN/?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/p/C7fE-p4S7YN/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Jimmy Kimmel (@jimmykimmel)</a></p> </div> </blockquote> <p>He then highlighted the hospital's dedication to providing help to families "regardless of their ability to pay". </p> <p>Jimmy then extended his thanks to his family and friends and the "loving strangers who took time to pray for and send positive energy to our baby".</p> <p>He gave a special shout out to his wife Molly – for "being stronger than is reasonable for any Mum to be". The pair also share daughter Jane, nine. </p> <p>The late night TV host then praised his son for being "the toughest (and funniest) 7 year-old we know."</p> <p>"There are so many parents and children who aren't fortunate enough to go home after five days," he added and encouraged his followers to send their thoughts and prayers to these families. </p> <p><em>Image: Instagram/ X</em></p> <p> </p>

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

<p><em><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></em></p> <p>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.</p> <p>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.</p> <p><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.</p> <p>The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?</p> <h2>Opioids and invasive procedures</h2> <p>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.</p> <p><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.</p> <h2>Addressing the contributors to pain</h2> <p>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:</p> <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> <p>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.</p> <p>The interventions have minimal side effects and are cost-effective.</p> <p>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.</p> <p>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.</p> <h2>Why isn’t everyone with chronic pain getting this care?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <h2>So what can we do about it?</h2> <p>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.</p> <p>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.</p> <p>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.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/christine-lin-346821"><em>Christine Lin</em></a><em>, 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></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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>.</em></p>

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Princess Kate's post-surgery pic ignites even wilder conspiracy theories

<p>In a recent revelation that has the internet buzzing, Kensington Palace released a brand new photo of the Princess of Wales alongside her adorable brood, but it seems like the royal family might be playing with more than just thrones and crowns.</p> <p>The picture, meant to express gratitude to the public for their support during Catherine's recovery from abdominal surgery, quickly became a subject of speculation, leaving royal enthusiasts scratching their heads and raising eyebrows faster than you can say "corgi".</p> <p>The image, which features Catherine sitting and embracing her children – Prince Louis, Prince George and Princess Charlotte – in the scenic backdrop of Windsor, seems like a wholesome Mother's Day tribute at first glance. However, upon closer inspection, the cracks in this picture-perfect façade begin to show.</p> <p>Social media erupted with theories faster than a racehorse at Ascot. Some eagle-eyed observers speculated that the photo might have been the handiwork of artificial intelligence, citing suspiciously green grass and leaves in the dead of winter, a rarity even in England where the weather is as unpredictable as a teenage royal's romantic interests.</p> <p>"AI is that you?" asked one astute commentator on Instagram, voicing the suspicions of many.</p> <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/p/C4U_IqTNaqU/?utm_source=ig_embed&amp;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/p/C4U_IqTNaqU/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by The Prince and Princess of Wales (@princeandprincessofwales)</a></p> </div> </blockquote> <p>"Ummmmm, this photo looks doctored…" wrote another astute reader. "Catherine’s right hand around Louis is entirely blurry but the left hand around Charlotte, at the same distance to the camera, is not, and either is Louis’ jumper around the hand blurry. Also Charlotte’s dress, which is clothing her torso behind her arm, impedes on the sleeve at the wrist… the cardigan sleeve shows the dress in front of it, when it should only be behind. And Louis’ middle finger must be awfully long to be entirely wrapped around the next finger without being able to see the finger nail… it’s also blurry. I’m a keen photographer, and those are not true elements of a photo as taken."</p> <p>But wait, there's more! The absence of Catherine's wedding ring did not escape the notice of keen observers, prompting questions about the state of her marriage. "WHERE'S YOUR RING??!" demanded one fan, while another pondered, "no ring, tree in full bloom in winter, jeans after major abdominal surgery, face shape completely different from car photo."</p> <p>And if that wasn't enough to fuel the royal gossip mill, Prince Louis's peculiar finger-crossing gesture sent conspiracy theorists into overdrive. Is he sending secret messages? Or is it just further evidence that we're all living in a simulation run by an eccentric royal fan with a knack for Photoshop?</p> <p><span style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;">Additionally, a subtle misalignment in Princess Charlotte's hand compared to her jumper sleeve raised clear suspicions of digital manipulation. As the speculation grew louder, four of the world's largest photo agencies – The Associated Press, AFP, Getty Images and Reuters – issued a "mandatory kill notice", on the image, effectively retracting it from circulation.</span></p> <p>The reasons cited varied slightly among the agencies, with mentions of "editorial issues" and inconsistencies in the photograph's details. The decision to retract the photo wasn't taken lightly; it's a standard protocol for picture agencies to withdraw images that have been significantly altered.</p> <p>The reaction on social media was swift, with royal watchers and media personalities dissecting the image for clues. Chris Ship, ITV News's royal editor, shared close-up sections of the photo, highlighting apparent discrepancies in Charlotte's sleeve, Prince Louis's jumper, and the background behind him. His commentary underscored the seriousness of the situation, questioning Kensington Palace – the source of the photo – about the authenticity of the image.</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">I’ve never been much of a conspiracy theorist but if <a href="https://twitter.com/AP?ref_src=twsrc%5Etfw">@AP</a> <a href="https://twitter.com/AFP?ref_src=twsrc%5Etfw">@AFP</a> <a href="https://twitter.com/Reuters?ref_src=twsrc%5Etfw">@Reuters</a> &amp; other picture agencies are concerned enough to remove it and ask clients to delete it, there are serious questions for Kensington Palace - which was the source of the photo.<br />These appears to be the issues 👇 <a href="https://t.co/ifcSB9mUzu">https://t.co/ifcSB9mUzu</a> <a href="https://t.co/bH5gN9fJtJ">pic.twitter.com/bH5gN9fJtJ</a></p> <p>— Chris Ship (@chrisshipitv) <a href="https://twitter.com/chrisshipitv/status/1766947758529822803?ref_src=twsrc%5Etfw">March 10, 2024</a></p></blockquote> <p>Amidst the fervent speculation, Kensington Palace remained silent, neither confirming nor denying the allegations of photo manipulation. The lack of clarity has only fuelled the fire, leading to further conjecture about the intentions behind the controversial image.</p> <p>In a world where every pixel is scrutinised and every detail dissected, the royal family's attempt at a heartwarming family photo has turned into a comedic saga worthy of a Shakespearean farce.</p> <p>As the internet continues to buzz with speculation, one thing is for certain: when it comes to the royals, truth is often stranger than fiction. Or in this case, more digitally manipulated than reality TV.</p> <p><em>Image: Instagram</em></p>

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Kate Middleton spotted for the first time since surgery

<p>Kate Middleton has been seen for the first time in over six weeks, as she continues to recover from a "planned abdominal surgery". </p> <p>The Princess of Wales was last seen by the public attending mass on Christmas Day before being admitted to hospital in early January for the procedure. </p> <p>Despite Kensington Palace sharing that the princess wouldn't be returning to royal duties until after Easter, <a href="https://oversixty.com.au/health/caring/kate-middleton-s-disappearance-sparks-bizarre-conspiracy-theories" target="_blank" rel="noopener">rumours</a> began to swirl online over her whereabouts. </p> <p>Now, the 42-year-old royal has been <a href="https://www.news.com.au/entertainment/celebrity-life/royals/kate-middleton-finally-spotted-after-disappearing-for-more-than-two-months/news-story/d1ca1f9c54e1526ba2ba69a605af7811" target="_blank" rel="noopener">photographed</a> in a car alongside her mother Carole in Windsor. </p> <p>As rumours continued to run rampant online about Kate's wellbeing following her surgery, Kensington Palace was forced to <a href="https://oversixty.com.au/health/caring/palace-responds-to-bizarre-conspiracy-theories-about-kate-s-whereabouts" target="_blank" rel="noopener">interfere</a> and debunk the wild accusations. </p> <p>After "Where is Kate Middleton?" was trending worldwide on social media, due to her not being in the public eye for an unprecedented amount of time, the Palace reiterated their original statement following Kate's surgery, saying she was simply at home recovering.</p> <p><span style="font-size: 16px; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; background-color: #ffffff;">“We were very clear from the outset that the Princess of Wales was out until after Easter and Kensington Palace would only be providing updates when something was significant,” the statement read. </span></p> <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">"That guidance stands."</p> <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">The Palace also added that Kate is well on the road to recovery as she is "doing well", and with all things going to plan with her health, she can be expected to be seen in public after Easter, as they originally made clear. </p> <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';"><em>Image credits: Getty Images </em></p> <p> </p> <p> </p>

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