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Family fundraising for mother’s Russian MS treatment

Diagnosed more than 17 years ago, Ms Moore’s condition has deteriorated to a point where her speech, vision and mobility are severely affected.


Her family are pinning their hopes on a controversial treatment called haematopoietic stem cell transplant treatment (HSCT) – where bone marrow is injected with a patient’s own stem cells to “reboot” the immune system.

Clinical trials at a British hospital have shown promising results in patients with the most common form of the disease – called relapsing and remitting MS.

However, the results are preliminary, and the effectiveness of the treatment on people with the progressive form of the disease, which Ms Moore has, remains unclear.

The National Health and Medical Research Council has previously warned against what it calls “stem cell tourism” in a warning on its website about the risks of unproven treatments.

However, the Moore family says they have exhausted all other options.

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Ms Moore is slated to begin the treatment at Russia’s A.A. Maximov centre in April, and her daughter Rebecca said the family is ready to “try absolutely anything”.

“If you live with mum day-to-day, you would to see to the extent that she’s affected,” she said.

“The main things [affected] is her speech… she has the words in her brain but can’t physically get them out.

“It’s extremely difficult. I was six years old when she was diagnosed so I’ve never really known it to be any different.

“It’s really hard watching your mum go through that… you would obviously do absolutely anything to take it all away.”

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About 20 patients received bone marrow transplants using their own stem cells in a clinical trial at Britain’s Royal Hallamshire Hospital.

Some patients who were paralysed have been able to walk again.

Professor Basil Sharrack, from the hospital, told the BBC Panorama program: “To have a treatment which can potentially reverse disability is really a major achievement”.

Professor of stem cell sciences at the University of Melbourne, Dr Martin Pera, said the treatment uses chemotherapy, which is more aggressive than other treatments available.

“There are clinics offering this treatment outside of a trial setting, at considerable cost and obviously patients who are suffering will look for answers,” he said.

“But really until we have carefully conducted trials that look in a very careful way at the outcomes of this treatment will we know whether its any good.

“This is not like taking an asprin or a valium. These are toxic drugs with a number of side-effects. Certainly its not a treatment you would undergo unless you had very strong indications that it would actually do some good.”

The Moore family are fundraising to pay for Mary’s treatment.


Nose spray relieves childbirth pain: study

Women may soon be able to use a nasal spray for pain relief during childbirth following successful trials by an Australian midwifery researcher.


The nasal spray analgesic drug, fentanyl, was shown to be just as effective in relieving labour pain and have fewer side effects than pethidine injections, which are commonly used.

Fentanyl nasal spray is commonly used for pain relief in children and in patients being transferred by ambulance.

As a result of the Flinders University and the University of Adelaide study involving 156 women, fentanyl is expected to be offered as an alternative medication in South Australian maternity hospitals this year.

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“Women can self-administer a controlled dose using the nasal spray, under a midwife’s supervision, which helps them feel more in control of their pain management and avoids the need for additional intervention and painful injections,” said lead researcher Dr Julie Fleet.

Fentanyl resulted in less nausea and sedation, shorter labour, fewer babies admitted to the nursery, fewer breastfeeding difficulties and greater satisfaction, she said.

“Fentanyl administered by the nasal spray doesn’t completely eliminate pain – as it can when administered as an epidural, which blocks all sensation – so it is suited to women who still want to be able to feel something,” Dr Fleet said.

“It’s also good for women who might not be able to have an epidural due to conditions such as pre-eclampsia.”

Pethidine and fentanyl are opioids, which cross from the mother to the baby.

But when pethidine is processed by the body it’s converted into another active drug and remains in the baby’s body for three or more days, potentially causing breathing trouble, drowsiness and irritability.

“Because fentanyl is not converted in the same way and is out of the system within two to seven hours, it has less chance of producing negative effects on the baby.”

Dr Fleet is now examining whether the nasal spray will also reduce the need for epidurals.


Govt will seek mandate before tax change

The Turnbull government has yet to decide whether it will pursue a hike in the GST but any change will be put to voters at the next election, a senior Liberal insists.


Finance Minister Mathias Cormann says the government is focused on making the tax system more growth-friendly in order to steer the economy away from resource driven growth.

The government had not made a decision about changes to the tax system or the GST but would get a mandate from voters at this year’s federal election, Senator Cormann told ABC radio on Thursday.

South Australian Premier Jay Weatherill appeared to take a swipe at Opposition Leader Bill Shorten’s opposition to changing the GST.

There was a “massive and undeniable revenue problem” threatening school and hospital services, as well as the federal budget.

“Both major parties at a national level must front up to the fact that we need to find additional revenue,” Mr Weatherill told The Australian.

Labor backbencher Nick Champion told Sky News he was “stunned” any Labor premier would support a change to the GST.

Assistant Minister to the Prime Minister Alan Tudge said Mr Weatherill showed “what a small person” Mr Shorten was.

Mr Shorten said he didn’t blame state politicians, who were facing a “fiscal cliff” because of the federal government’s cuts to schools and hospitals.

“I understand that they’ve effectively been taken hostage by the massive cuts that the Abbott-Turnbull governments are imposing on schools and hospitals,” he told reporters in Darwin.

A 15 per cent GST would not only mean higher living costs but would kill consumer confidence and force small businesses to lay off workers.

“It’s a rotten idea and it should be put in the dust bin of history and that’s where Labor is going to put it.”


Should women exercise during and after pregnancy?

Nigel Stepto, Victoria University and Cheryce Harrison, Monash University

Michelle Bridges was this week branded “irresponsible” and accused of providing a “poor message” to new mums following an Instagram post of her workout one month after giving birth.


The workout boasts 56 minutes of exercise – 32 minutes of jogging and 24 minutes of walking in intervals. Prefaced with the self-recognition of an experienced trainer, it was therefore advised that women “dial down” the duration to “15-20 minutes of total work”.

Young women of reproductive age are a high-risk group for sedentary behaviour. They also face increased barriers to physical activity including family and work commitments. So it’s commendable to advocate for women to be physically active after giving birth.

However, exercise prescription in a public forum is not individualised or tailored to medical, physiological and musculoskeletal variations that exist during pregnancy and after giving birth.

While it’s important women are encouraged to be physically active during this time, it’s important to consider the type, frequency, intensity and duration of physical activity. This should always be done in conjunction with a health-care professional based on your individual fitness, health and your pregnancy.

Fairfax media reported new mums are generally advised against running for three months after birth. However, this doesn’t seem to be backed up by evidence, at least for a normal uncomplicated pregnancy. This recommendation is more appropriate where surgical interventions have been needed or musculoskeletal injury occurred during pregnancy and/or child birth.

related readingExercise during pregnancy

In the absence of specific national recommendations for pregnancy and after giving birth, otherwise healthy women are advised to follow national physical activity recommendations for Australian adults. This includes accumulating 150-300 minutes of moderate physical activity each week.

Any activities or exercise undertaken at this time should be at a pace that is comfortable for you, not cause you to overbalance or place extreme forces or pressure on any of your joints.

Usual exercise routines will require higher-than-normal efforts to complete. As such, these should be altered to a lighter intensity based on how you feel. Be aware that your body will be changing shape and physiology as it adapts to your pregnancy.

For women used to running, we would recommend progressing to moderate to light jogging or brisk walking. Weight lifters could perhaps consider modifying their exercise programs to incorporate aerobic-style activities of light to moderate intensity with less weight-bearing exercise. Specialised yoga and pilates classes for pregnancy are also widely available.

The aim is to maintain or improve fitness to cope with pregnancy, not train for competition. The most important thing is that you are aware of warning signs that indicate you should stop exercising. These include vaginal bleeding, regular painful contractions, amniotic fluid leakage, breathlessness before exertion, dizziness, chest pain, muscle weakness affecting balance and calf pain or swelling.

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These recommendations do not apply to pregnant women who have heart or lung disease, incompetent cervix (weak cervical tissue leading to premature birth), are pregnant with twins or triplets with risk of premature labour, persistent second- or third-trimester bleeding, placenta previa (where the placenta is in the wrong place) after 26 weeks gestation and pre-eclampsia, where exercise and physical activity should be avoided unless under strict medical supervision.

With a safe upper level of exercise intensity during pregnancy yet to be established, an activity that can be easily quantified to monitor the intensity and exertion is recommended, specifically sticking to moderate levels of exertion.

We recommend gauging exercise intensity using a rating of perceived exertion scales. Women might aim to reach exertion levels of 13-14 on a scale of 6 to 20, where 7 is very very light, 11 is fairly light, 13 is somewhat hard, 15 is hard and 19 very very hard. Examples of safe exercise activities to start or maintain during pregnancy include:

• walking

• swimming

• aqua-aerobics

• stationary cycling

• low-impact aerobics

• modified Yoga

• modified Pilates

• running and jogging (after consultation with health-care team)

• modified strength training.

There is little evidence to suggest regular moderate intensity exercise throughout pregnancy is detrimental to the baby’s development or birth weight, or that it increases the risk of preterm birth, or raises maternal body temperature sufficiently to impose risk.

In normal pregnancies, and when physical activity is at recommended levels, there is general agreement the benefits of exercise far outweigh any risks. Contact or high-risk sports should obviously be restricted.

Despite the recommendations and minimal risk, pregnancy is usually associated with decreased levels of activity. Concerns about safety and potential adverse effects on the developing baby, as well as changing body shape, tiredness and time constraints are the most common barriers for women during pregnancy.

Exercising during pregnancy, however, has many benefits. These include decreased likelihood of gaining weight, gestational diabetes, hypertensive disorders such as pre-eclampsia, and of needing medical interventions during birth, including caesarean sections.

Exercising after giving birth

Latest guidelines suggest physical activity can be resumed gradually after giving birth as soon as is medically safe, depending on the mode of delivery, and in the absence of other health issues.

Depending on each woman’s personal circumstances, even after an uncomplicated vaginal delivery, there will be a need for rest and recovery. This physically demanding experience is associated with significant hormonal changes required to return the uterus to its pre-pregnant state while switching on milk production to sustain the newborn baby.

Return to exercise should be gradual and in conjunction with a health-care professional. Within hours or days of the delivery, this may mean starting to walk in short bouts (three to five minutes) a few times a day, gradually building up to longer and harder sessions of 20-30 minutes.

Alongside a resumption in exercise, women should regularly practise pelvic floor exercises. Returning to pre-pregnancy exercise regimens or sporting activities should be a gradual process of reconditioning yourself in small increments over weeks and months depending on your personal circumstances.

In the absence of complications, resumption of moderate activity has not been associated with any adverse effects. No negative impact has been found on breast milk composition and volume, provided adequate food and fluid intake is maintained, or on infant development.

On the plus side, exercise has been shown to help prevent weight gain in the period after giving birth, and may promote modest weight loss (around 1.5 kg). It has also been found to reduce the severity of postnatal depression by 50-60% – irrespective of the exercise intensity (light/moderate/vigorous), and especially when undertaken in group environments.

Women wishing to start or maintain exercise routines during and after pregnancy are recommended to seek advice from their health-care team including an obstetrician, gynaecologist, midwife, general practitioner, or accredited exercise physiologist.

Nigel Stepto is an Accredited Exercise Physiologist affiliated with Exercise and Sport Science Australia, He also has received funding from NHMRC.

Cheryce Harrison is a National Heart Foundation Research Fellow (100168).


Brazil birth defects cases rising

The cases of babies born with unusually small heads continue to rise in Brazil where researchers say they have found new evidence linking the increase to the Zika virus spreading through the Americas.


The Ministry of Health said the number of suspected cases of microcephaly, a neurological disorder in which infants are born with smaller craniums and brains, increased to 3893 by January 16 from 3530 cases 10 days earlier.

The number of reported deaths of deformed babies rose to 49, ministry officials said at a news conference.

So far, health authorities have only confirmed six cases of microcephaly where the infant was infected with the mosquito-borne Zika virus.

The surge of cases since the new virus was first detected last year in Brazil led the ministry to link it to the fetal deformations and warn pregnant women to use insect repellent to avoid mosquito bites.

On Tuesday, Brazilian researchers took another step towards proving Zika causes microcephaly. The Fiocruz biomedical centre in Curitiba announced it had found Zika in the placenta of a woman who had a miscarriage, proving the virus can reach the fetus. Until now, researchers had only found Zika in the amniotic fluid of two pregnant women.

“This is a significant advance, but we still cannot scientifically state that Zika is the cause of microcephaly,” said Jean Peron, an immunology expert who is experimenting on pregnant mice at the University of Sao Paulo’s Institute of Biomedical Sciences.

The Zika virus is transmitted by the Aedes aegypti mosquito, which is also known to carry the dengue, yellow fever and Chikungunya viruses.

Health experts are unsure why the virus detected in Africa in 1947, but unknown in the Americas until last year, is spreading so rapidly in Brazil and neighbouring countries.

The US Centres for Disease Control and Prevention issued a travel advisory last week warning pregnant women to avoid 14 countries and territories in the Caribbean and Latin America affected by the virus.

Last week, US health authorities confirmed the birth of a baby with microcephaly in Hawaii to a mother who had been infected with the Zika virus while visiting Brazil last year.