2011 February | BJC Health Connected Care

Blogging from Langkawi 3

By Errol Lim, Physiotherapist

This post is probably best described through this picture and the accompanying video. Connected Care also means having a work-life balance. If this can be achieved, optimal outcomes are sure to come.

It would be great to know how some of you out there achieve work-life balance. Do tell, all of us deserve to know your secret.

Errol Lim is a physiotherapist and a director of BJC Health.

BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy.

Posted on: 02-28-2011
Posted in: Connected Care, Our journey to better health

Finally, some good press! Bisphosphonates & Death 0

Image: renjith krishnan / FreeDigitalPhotos.net

It’s easy to put something down, easy to criticise and find flaws. The last few years have been a little rough for osteoporosis treatment with the media magnifying rare side effects.

While its definitely important to know about possible adverse effects from a treatment, this should always be balanced with an understanding of the benefits of the treatment.

Bisphosphonates are a class of medications used to treat osteoporosis. Common brands include Fosamax, Actonel and Aclasta. These medications are on the whole easy to use and effective in reducing worsening osteoporosis and the risk of recurrent fractures, with all the negative outcomes fractures bring (see previous post).

Bisphosphonates were linked to a painful, but rare condition called osteonecrosis of the jaw. The media circus around this led to a marked drop in the use of these drugs. The public were shown the very worst examples on TV. Dentists started to refuse to treat patients as this condition typically occurs after invasive dentistry (for eg, tooth extraction rather than a clean & scale). Patients would come in terribly afraid of this complication to the point it was not possible to reason with them. A balanced view of risk and benefit is needed, and I invite you to read the position statement from the Australian & New Zealand Bone Mineral Society.

More recently, there are reports that a very small percentage of patients on long-term therapy (more than 5 years) develop atypical fractures of the femur, the long bone in the thigh; and with the oral bisphosphonates, there may also be a small increase in the risk of oesophageal cancer.

I must stress that the risks are very low. Osteoporosis experts all agree that the benefits of bisphosphonate therapy still outweigh the risks, because these medications are clearly associated with a reduced risk for osteoporotic fractures.

It’s time for some good press.

There is accumulating evidence that osteoporosis treatment reduces the risk of death. Aclasta, a potent intravenous bisphosphonate, was associated with a 28% reduction in death after hip fractures. That’s a worthwhile positive benefit.

Most recently, analysis by the team from the Garvan Institute, using data from the Dubbo Osteoporosis Epidemiology Study (reference) demonstrated a significant and larger reduction in death in older women with or without fractures who were on these medications. This reduction in death is only partially explained by a reduction in the number of fractures, and may be due to beneficial effects of the drug on the immune system.

These findings are extremely important. The study authors wrote in their conclusion: “The apathy that currently surrounds osteoporosis treatment, whereby even in those with fractures, less than 20% of women and less than 10% of men are treated, should no longer be tolerated.”

It’s routine to be warned about possible and rare side effects, and understandable to be wary. Do you however balance this by considering the potential benefits of a medication equally carefully?

Dr Irwin Lim is a rheumatologist and a director of BJC Health.

This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy.

Posted on: 02-27-2011
Posted in: Medications, Osteoporosis

Educating the Educators 2

Image: luigi diamanti / FreeDigitalPhotos.net

By Irwin Lim, Rheumatologist

Awareness. If you’re not aware of something, you won’t think of it. If you don’t think of it, you can’t use it, you can’t teach it, you won’t work with it.

Our clinic was involved in 2 activities last week designed to increase awareness of rheumatic disease.

GP seminar: Degenerative Joint Disease: Slowing Down Progression through Connected Care

On Wednesday night, we ran this seminar for general practitioners (GPs) working on the north shore of Sydney.

Hardly a “sexy” title. Usually GPs turn up to talks about the latest expensive anti-cholesterol drug or some new anti-blood pressure medication. This time, the focus was clearly on non-drug treatment. Errol Lim taught the biomechanics of the knee while Rachael Butterworth explained the importance of core stability in helping treat and prevent progression of back pain. Monica Kubizniak talked about buying plates with markings to help portion control, about how she works hard at realistic measures in helping real-life people make better food choices. Ray Jongs showed how he creates splints to help the symptoms of arthritis at the base of the thumb.

It was a practical night and hopefully the 28 dedicated GPs who attended after a long day’s work were made more aware.

AS You See It Physiotherapy Seminar

On Sunday, over 200 physiotherapists gave up their rest day to attend a 6-hour seminar at the Kerry Packer Education Centre, at Royal Prince Alfred Hospital.

The topic: Ankylosing Spondylitis & other inflammatory rheumatic diseases such as Rheumatoid Arthritis.

Our aim: Make frontline musculoskeletal clinicians aware of these common diseases. We talked about how patients actually present, their signs, their symptoms. We explained the poor natural history of these conditions and the need for early diagnosis and appropriate treatment. We described recent advances in therapy.

The physio attendees were hungry for this knowledge and there was clearly a need for education of this type.

I wrapped-up the seminar with these words:

“I hope those of you who felt that you don’t see these diseases have changed your mind. On Monday, I’m almost sure you’ll look at that chronic back pain patient a little differently. You’ll probably be suspicious when you see that patient with the 5th episode of achilles tendinopathy. You may even notice that scaly rash on the elbow, or that puffy knuckle. If so, my rheumatology colleagues with the help of our various friends & colleagues have done a good job.”

Awareness. Remember when you became aware of something for the 1^st time?

Dr Irwin Lim is a rheumatologist and a director of BJC Health. BJC Health provides coordinated, comprehensive, and colocated multidisciplinary care to achieve effective solutions for patients. We call this model of care, Connected Care. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.

This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy. Read More.

Posted on: 02-21-2011
Posted in: Connected Care, Physiotherapy, The Medical Profession

Ankylosing Spondylitis: “Wonder Drugs” do exist! 2

By Irwin Lim, Rheumatologist

It’s (almost) true. Yes, doctors do tend to prescribe medications, and all medications have potential side effects. However, this is one example of medication which is truly life changing. In this case, the benefits can far outweigh the risks.

Ankylosing Spondylitis (AS) is a chronic disease characterised by inflammatory low back pain and stiffness. Over time, this spinal inflammation leads to progressive spinal restriction, with pain, deformity and loss of the ability to perform the daily activities that we take for granted.

The whole spine can be involved. The disease can also target other areas, including arthritis at the joints of the upper and lower limb (commonly at the hips or knees). It can cause inflammation of the eye (uveitis), and inflammation at the region where tendons insert into bone (enthesitis). The lungs, heart and gastrointestinal tract can also be affected.

For many years, treatment was limited to exercise and anti-inflammatory medication (NSAIDs & Cox-2 inhibitors). These remain very useful. However, a significant number of patients have persistent, debilitating symptoms.

Tumour necrosis factor-alpha (TNF) is a potent chemical (cytokine) produced by the immune system. TNF seems to be a key player in causing the manifestations of Ankylosing Spondylitis. Drugs which block the action of TNF have essentially revolutionized the management of AS.

And yet, many patients and doctors remain unaware of these new biologic agents as highly effective treatments for rheumatic disease. This is a shame as in AS in particular, they are life-changing.

In Australia, the TNF inhibitors available for use in Ankylosing Spondylitis include Infliximab, Etanercept, Adalimumab and Golimumab. Infliximab is given by intravenous infusion while the other 3 are self-administered injections.

These are powerful drugs, with their own set of problems. The cost is prohibitive, currently more than A$20,000 a year. They have a range of potential side effects, some nasty, such as severe infections.

And yet, in most cases, the benefit greatly outweighs the risk.

Patients respond quickly, sometimes within a week. The improvement is usually marked, and most importantly, patients report a vast improvement in quality of life.

Often, to a degree they didn’t think possible after years of suffering. Ask an AS sufferer who responds to these drugs, and the person will very likely agree that “wonder drugs” do exist.

If you suffer from Ankylosing Spondylitis, please go and find out more. Use the internet. See a rheumatologist. Things have changed a lot.

This blog focuses on musculoskeletal disease, healthcare in general, and our Connected Care philosophy. Read More.

Stop Press: For Physiotherapists only. Attend the BJC Health Professional Development Seminar on February 20, 2011. Register to attend and link or join the professional page on Facebook. Our Hootcourse will also be online soon. Details on Facebook.