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Monthly Archive for: ‘28 February 2012’

Home / 2012 / February

How would you design an Arthritis Clinic? 15

By Dr Irwin Lim, Rheumatologist

The layout above is a preliminary sketch to expand one of our clinics. If we could get more space, someday.

Our clinics have all evolved over time, and as we’ve grown, we often need more room. Room to fit more people. Room to fit more services.

It’s definitely not ideal growing in this way, as space is always at a premium and you end up compromising on the layout with effects on the general workflow of a busy clinic.

With this in mind, we have set ourselves on a 5 year planning phase for an Arthritis “Super”-Centre, an integrated hub to deliver the type of Connected Care, patients suffering from rheumatic disease deserve.

To truly be connected, the design of the clinic has to make sense & it has to encourage great workflow for both staff and patients.

The elements which I think need to be incorporated include:

  • At least 6 Consulting rooms, to be used by doctors, a nurse or two, a rheumatology educator, allied health professionals
  • 1 minor procedure room
  • 1 room for musculoskeletal ultrasound
  • 1 room to house a Bone Densitometer
  • An infusion room
  • A pathology collection area
  • 6 treatment bays for physiotherapists
  • 2 treatment rooms for remedial massage therapists
  • Office space for the physiotherapists/exercise physiologists
  • A compact central gym area including space for small group exercise classes
  • An area next to the gym for biomechanical testing/assessment
  • Showers & Toilets
  • 2-3 offices, to be used by administrative workers, the practice manager & the managing director
  • A large staffroom which can also function as a small (20 seat) lecture theatre/staff meeting space
  • The staffroom needs to incorporate a functional kitchen which can be utilised for group healthy cooking demonstrations
  • A reception area with space for 5 front-line reception staff
  • Seating space for patients
  • An area built for patient self-education utilising smart pads or computers
  • An area to display & demonstrate useful products & devices which are used in managing arthritis
I’m hoping you can help us with some design tips/ideas.
Are there any features you have seen in other clinics we should incorporate?
For those patients reading, how do you think clinics could be designed to make things easier for you?
Dr Irwin Lim is a rheumatologist and a director of BJC Health.
Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
 
Posted on: 02-28-2012
Posted in: Connected Care

The Running Performance Screen 0

By Errol Lim, Physiotherapist

Over the past year, we have developed a very strong relationship with Kaz Muddell , principal of Mind Body Motion Fitness Solutions (MBMFS). She is not just your regular personal trainer. Kaz is more of a fitness and personal health coach who has a knack of motivating her clients and achieving their desired goals. Apart from fitness coaching involving personal and group sessions, the MBMFS team have had their own running club for some time now and this year, they asked us to be involved.

Rachael Butterworth, our senior physiotherapist, spoke last weekend at an injury prevention seminar for MBMFS running club members. Thanks to Kaz, we have had a resounding response to the introduction of our Running Performance Screen.

It may be a cliché, but “prevention is better than cure”. The aim of the screen is to identify risk of injury.

Our exercise physiologists carry out the performance screen (worksheet shown below) which typically incorporates a body composition scan. Once we know where one’s deficits are, we can then start to prescribe appropriate management in the form of physiotherapy, massage therapy and/or exercise prescription specific to the client’s goal.

Focused therapists and motivated clients working on the appropriate areas will reduce risk of injury.

There is nothing worse than getting close to your peak exercise volumes and getting injured. Worse still, is getting injured while thinking you have done the appropriate rehabilitation and having that injury rear its ugly head again the following season.

The worksheet shown below may look a little confusing if you are not a health practitioner but hopefully you can appreciate the detail.

We have placed much collaborative thought amongst our physiotherapists and exercise physiologists in developing it. It incorporates Functional Movement System screening as well as fundamental functional tests specific to runners.

Let me know what you think. The screen is dynamic and we will be making improvements to it as new research is presented.

Do the hard yards early. Get screened, identify risk, seek help and reduce risk of injury. Running should hopefully be more enjoyable.

 

 

Errol Lim is a physiotherapist and the managing director of BJC Health.
Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
 

 

Posted on: 02-19-2012
Posted in: Sports Injury

We’ve created an Ankylosing Spondylitis Interactive iBook! 0

By Dr Irwin Lim, Rheumatologist

A few weekends ago, I decided to try my hand at creating an interactive ibook after Apple announced iBooks 2 & iBook Author.

It wasn’t too hard actually & 12 hours of so later, I had a pretty good looking booklet on Ankylosing Spondylitis pieced together from various media I found on my computer. I then submitted this to iTunes & 3 weeks later, it’s on 32 iTunes stores around the world.

For all of you with an idevice (you need to have updated to iBooks 2),  please check it out (the link or just search under my name or “spondylitis” on iTunes).

I know it’s on a subject not necessarily relevant to you, but just do it so you can tell me how cool this is!

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

Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
Posted on: 02-16-2012
Posted in: Ankylosing Spondylitis, Arthritis: inflammatory

Spondylitis, a diagnosis so very delayed 0

By Dr Irwin Lim, Rheumatologist

It’s an unfortunate truth that the diagnosis of spondyloarthritis & ankylosing spondylitis is terribly delayed, usually for many years.

Part of this is the fact that the symptoms and signs a patient presents with can be non-specific, and it can be hard to distinguish inflammatory spinal pain from mechanical spinal pain.

Part of this is the fact that treating health professionals have poor knowledge & awareness of this condition (read if you don’t know what to look for, how are you going to treat it).

I can understand why patients who suffer from these diseases can be terribly frustrated.

Delayed diagnosis = Poor treatment options = Wasted Opportunity/Time/Resources = Suffering

I thought I’d share some Australian statistics. Dr Lionel Schachna’s group from Melbourne, Australia presented this work at the 2011 Chicago ACR meeting.

A self-administered questionnaire was completed by 127 of 219 patients attending an Ankylosing Spondylitis referral centre, patients who were treated with a tumor necrosis factor (TNF) inhibitor.

The mean age when these patients started to have symptoms was 23.9. The mean delay to diagnosis was unfortunately 10 years.

Patients played a part in this delay. Over one-third did not consult a health care professional for more than 12 months after the start of symptoms, with 71% assuming that the symptoms would just go away.

The diagnosis of Ankylosing Spondylitis was established by a rheumatologist in 68%, a family physician in 18%, and an orthopaedic surgeon in 5.5%.

Working in a multidisciplinary arthritis centre like BJC Health, I was very interested to learn that prior to diagnosis, 68% consulted a physiotherapist and 16% consulted 3 or more physiotherapists!

44% went to see a chiropractor and 9% saw 3 or more chiropractors. 27% chose to see an osteopath with 3% seeing 3 or more osteopaths.

The diagnosis of spondyloarthritis was, sadly, suspected by an allied health professional in only 2 of these patients (1.7%)!

I’m sure our BJC Health physiotherapists would do better given their specific training. These sort of statistics really suggest that our efforts to better educate physiotherapists about rheumatic conditions need to continue.

On a more positive note, establishing the diagnosis led to emotional relief for 69%, a positive shift in how symptoms were perceived by 76%, and a more optimistic outlook was reported by 66%.

What’s your experience with a delay in diagnosis?

Dr Irwin Lim is a rheumatologist and a director of BJC Health.
Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
 
Posted on: 02-13-2012
Posted in: Ankylosing Spondylitis, Arthritis: inflammatory

Bali Belly 0

By Errol Lim, Physiotherapist

I didn’t realize my last blog (sportsman’s hernia) was going to be the start of a series of blogs about the same subject matter but my recent trip to Bali gave me another unique patient experience.

36 hours into our trip, my wife and I had our first and hopefully last experience of Bali belly. The best thing I can say about this is that our two kids made it through unscathed, if you discount having two “not so” functional and irritable parents for the rest of the trip.

Food poisoning or gastroenteritis from a bacterial infection or even a viral one can be extremely debilitating.

It can hit with such vengeance. My wife had just enjoyed a leisurely swim but then suddenly felt ill and had to lay in bed. Unfortunately, that is where she stayed for the next 48 hours if you don’t count the half hourly trips to the bathroom. Hours later, I had finished dinner and the “bug” came for me as well. Violent vomiting and consistent diarrheoa were the least of our worries. The fever, stabbing stomach pain and aching legs were the persistent reminder we were not well at all.

With both mother and father literally out of action and not able to stomach anything, and with knowing the importance of hydration, doctors were called into action early. We were hit with a cocktail of drugs on top of what I already had in my travel kit. Anti-nausea, anti-diarrhoeal, anti-spasmodic medications as well as antibiotics in tablet and injectable form were used. I explained to the doctors that our main problem was dehydration and that both my wife and I needed to be rehydrated intravenously as everything we ingested was not being absorbed as it was going right through. Personal experience in the past had taught me this lesson. The doctors did not have appropriate facilities in-house and they wanted to treat us conservatively with medication. We agreed to call them if we did not make any significant recovery.

A day later, I insisted we were taken to hospital. I knew if we were hydrated, our bodies would function a whole lot better thus allowing us to drink and eat more normally. The medication would then also be absorbed more readily giving the expected outcomes.

We needed special help. This help came in the form of a bag of saline hanging from the drip stand. It was like infusing liquid gold straight into our veins. In our states, saline had the same effect as spinach would have had on Popeye. The immediate effect of being rehydrated was amazing. 45 minutes and one litre of salt water later saw my wife transformed from a person who required assistance to walk to a lady who strolled in casually into my cubicle asking me how I was.

We were by no means fully recovered but having the ability to stand upright and pick yourself off the bed was a wonderful feeling.

What about the kids you ask? We were very fortunate to have chosen wonderful accommodation in Nusa Dua where their service was second to none in terms of our care and that of our children especially when we had to go to hospital.

I hope you never experience what we went through but do tell if you have had a similar story.

Errol Lim is a physiotherapist and the managing director of BJC Health.
Arthritis requires an integrated approach. We call this, Connected Care.  Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.
 
Posted on: 02-8-2012
Posted in: Our journey to better health
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