When the volume control for pain gets turned up

4

By Dr Irwin Lim, Rheumatologist

She reached into her handbag and brought out the token of her appreciation.

Mug

It was very unexpected. And I’m been very touched by it.

She has been a “difficult” patient with lots of pain in various areas. Sometimes, there was an explanation such as a rotator cuff tear. Sometimes, her rheumatoid arthritis appeared active, but at other times, the degree of symptoms seemed out of keeping with what I could find on assessing her.

In recent months, I had found myself apologising for not helping her very much. I had tweaked her medication, started then stopped then replaced various drugs.

The preceding consultation, I had a discussion with her about the possibility that her pain was “centralised”. I explained that over time, in patients who suffer chronic disease, the body can become more sensitive to various stimuli and chronic pain seems to snowball.

It’s a situation where the volume control for pain gets turned up.

This seems to occur more often when there are other unpleasant events in one’s life, including but not limited to social and financial stress, anxiety and depression, increasing medical diagnoses, weight gain, poor sleep, poor fitness, etc.

This is not an easy discussion to have but she listened.

I then asked her to visit this website: https://fibroguide.med.umich.edu.

I learnt of this website at a recent meeting and it is now my go-to site for patients with fibromyalgia.

She went home, and worked through the website with her supportive family. Something clicked. She recognised many of the situations described.

She learned that the road forward was hard and involved a lot of self-help and family support. It’s not easy by any means but I think she felt relief.

She could understand. She could see that no doctor would be able to solve the problems with a magic pill.

And, unexpectedly, she thanked me for this.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
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Michael Slater & his Secret Spondylitis

6

By Dr Irwin Lim, Rheumatologist

Michael Slater was a dashing international cricketer during the 1990s, an opening batsman we rushed to watch. He is now a TV presenter. He is high profile, charismatic and public.

This may sound mean but it’s good when high profile celebrities get a disease they are willing to talk about.

It gets the message on air. It can improve the awareness of disease. It may lead to increased interest, improved research funding or other support and actually improve the lives of other sufferers.

Michael Slater has ankylosing spondylitis. Click the link to watch the TV piece on this from the national broadcaster, Nine.

Yours truly had a small part.

We need more media coverage of the rheumatic diseases. Our profile is poor and our patients suffer due to this.

A Current Affair: Michael Slater

A Current Affair: Michael Slater

 
Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
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Shoulder cortisone injection: a video showing what’s involved

0

By Dr Irwin Lim, Rheumatologist

It’s common to hear patients worried about having a cortisone injection to their shoulder. Often this is due to something well-meaning friends have said.

Most shoulder injections done by rheumatologists are done “blind”.

When I say “blind”, I mean they are done without the aid of any radiologic machine guiding the injection. I often perform cortisone injections this way. I’m not sure that there is clear evidence to suggest that radiology guidance is always better.

In the last few years however, I’ve started to use the ultrasound machine to help guide my injections for a particular type of shoulder injection.

I find it more satisfying for a subacromial injection. This is a type of injection where we direct the tip of the needle into the subacromial bursa under that ledge of bone at the point of your shoulder, the acromion.

The following video shows a subacromial injection performed in my rooms with Lisa, our ultrasonographer, helping guide the injection.

I recorded this to try and reassure some of you who may be very worried as to what a shoulder injection entails. I hope you’ll agree it looks rather simple and comfortable.

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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BJC Health’s Amazing Race

0

By Dr Irwin Lim, Rheumatologist

BJC Amazing Race2

On Saturday, 37 of our gang (clinic staff & loved ones) gathered at our Chatswood rooms to take part in our annual BJC Health Amazing Race.

Over 4 hours, we attempted to decipher clues and complete challenges, racing around Sydney to beat the other teams to the next destination.

We’re a pretty competitive bunch. So racing means actually running (or walking very, very fast) to get to each successive destination.

The challenges involved:

  • scavenging through a shop finding a noisy Japanese kid’s toy
  • taking photos of 30 strangers being hugged by your teammates
  • convincing a salon to allow a teammate to wash and style another teammate’s hair for $10
  • finding the location where the Wolverine could be found next to Nicole Kidman
  • scoffing an Adriano Zumbo macaron
  • finding some obscure cafe with a White Rabbit & A Global Clock
  • constructing a Nanoblock figure

I loved my team – Sarah, Shiv and Anne . They were really keen and pumped and we came 2nd out of the 10 teams.

It was a fun way to spend the afternoon. Lot of laughs were shared and we have stories to tell.

Check out our Facebook page for more pictures - www.facebook.com/BJCHealth.ConnectedCare

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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2nd Opinion Musings

4

By Dr Irwin Lim, Rheumatologist

I saw 2 new patients presenting for a 2nd opinion today.

They’ve seen rheumatologists I know. And while this situation was slightly uncomfortable when I first started out in practice more than a decade ago, that’s no longer the case.

The 2nd opinion is a powerful tool.

Sometimes, patient and doctor just don’t gel. It makes sense for the patient to then find someone else that they can work with in a more productive fashion. The doctor’s personality and practice style isn’t likely to change dramatically.

Sometimes, a fresh set of eyes are needed. A review of what has been done, sans the comfort and baggage of a long therapeutic relationship, may lead to an approach not previously considered.

All rheumatologists have strong practice points and weaker ones. We can’t be all knowing and we have our specific interests. I learned early on to admit this to myself and to the patient. If I don’t know and can’t help, there is likely to be someone else who can.

Occasionally, the patient just needs to hear a number of opinions to help them come to terms with the problem, and to help reinforce the advice they were given by rheumatologist no.1.

I get an increasing number of patients coming for these 2nd (or 3rd or more) opinions. I’m also sure that a number of my patients have moved on and are probably seeing another rheumatologist. The latter isn’t a pleasing thought of course but it is understandable.

What are your experiences with the 2nd opinion?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here.
Arthritis requires an integrated approach. We call this, Connected Care. Contact us.
This blog focuses on arthritis, healthcare in general, and Connected Care. Please subscribe to keep in touch:
 
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