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Movement as Medicine in Osteoarthritis

Teaser: 

Dr. Zahra Bardai MD CCFP (COE) MHSc FCFP,

Community Family Physician, Lecturer, University of Toronto, Assistant Clinical Professor (Adjunct), Department of Family Medicine, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: Osteoarthritis is a prevalent health condition that affects millions of people worldwide. Increasingly, there has been a growing body of international recommendations emphasizing non-pharmacologic interventions using physical activity to modify joint mechanics. Discussion will focus on pathophysiology of joint mechanics as it relates to physical activity as well as the use of specific clinical strategies that can be incorporated into physical activity counseling in osteoarthritis management.
Key Words: Osteoarthritis, Physical Activity, Exercise Vital Sign, Exercise Prescription.
Osteoarthritis is a leading source of nonfatal health burden
Non-pharmacologic treatments of osteoarthritis focus on modifiable factors in joint mechanics
Osteoarthritis is a structural and functional failure of joints
Movement and physical activity have protective effects on osteoarthritic joints
The Exercise Vital Sign should become incorporated into assessments for preventative health and chronic disease including osteoarthritis.
The Exercise Prescription tool can help clinicians formally prescribe exercise as a treatment for their patients.
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JCCC 2017 Issue 3

Table of Contents

Back Education: Does it Work for Patients?

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,

Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

CLINICAL TOOLS

Abstract: Back education or “Back Schools” are used both as a method of prevention and, in conjunction with traditional rehabilitation and exercise programs, as a component in treatment of recurrent or persistent low back pain. It is challenging to evaluate the effectiveness of this educational effort. Models have varied from brochures, booklets and simple office conversations to formal scheduled classes. Content has ranged from purely mechanical instruction to complex cognitive behavioural therapy. Essential to success is the ability to integrate the instructions into activities of daily living. The composition of those lessons remains the subject of continuing debate.
Key Words: Back School, education, body mechanics, prevention, pain management.

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Back education programs do not reduce the frequency or severity of future back pain attacks.
The educational message should be consistent, frequent and stress self-management.
Group education is useful but the message must be tailored to the individual.
Information must be integrated into the patient's daily routine.
Back education should be part of rehabilitation and is probably most effective during the sub-acute phase of recovery when the pain is still present but not so distracting that it prevents learning.
Comprehensive back school includes spinal anatomy, instruction in proper body mechanics, individualized pain control techniques plus the recognition and treatment of pain disorder through cognitive behavioural therapy when required.
The back program should follow the precepts of adult education with frequent interaction, problem solving, practical applications and a focus on participation.
A successful back school educates the patient about the benign nature of back pain and provides the tools to transfer knowledge about back hygiene into practice in the patient's life.
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A Few Degrees of Separation

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I have often talked about how important stories are when it comes to medical care. We must, of course, use the best available medical knowledge to benefit our patients, but I believe it is also important to find the humanistic aspects of care and build on them, in order to foster human relationships.The importance of learning the patient’s personal story is key to achieving this goal.

Instead of asking a new patient, “How are you?” I recommend asking, “Who are you?”—meaning, “What is your story?” Recently, before meeting a new patient, I tried to see if his name would tell me anything about who he is. Having spent many years travelling, I can often relate to people if I get a clue as to their background or nationality—which, for people with European backgrounds, is reasonably easy for me at this point in my career.

I looked at his name and could not be sure of his origins, but I thought it might be close to Greek, or at least Mediterranean. To my surprise, his wife, who appeared initially to be more outspoken, said, “we are Egyptian.” With my knowledge of Egypt, I felt comfortable enough to ask, “Are you Coptic or Jewish? The name does not appear Muslim.” The patient seemed surprised that I actually knew about the various ethnic groups in Egypt. I told him that I had lived in Israel for a number of years, so knowing about Egypt was important for many reasons.

Their eyes lit up and he said, “We are Egyptian Jews.” After I inquired further, they said that they left the country just as Gamal Abdel Nasser came to power in the 1950s and began expelling most of the country’s remaining Jewish population.

“There are only few remaining Jews in Cairo, with members of one family being responsible for maintaining the main synagogue. We knew the family, the name of which is Haroun, and the elder sister died recently so the younger one is the primary caretaker of the synagogue, along with a half a dozen or so other Jewish women—there are no Jewish men left in Cairo,” he said.

When I mentioned that some of my friends and colleagues are Coptic, he said that they were very close to the Coptic community, both being minorities and beleaguered communities in a predominately Muslim country, but had managed well for centuries, prior to the explosion of pan-Arabic nationalism.

When I retold this fascinating story to one of my Coptic medical colleagues, she said she would mention the story to her parents, without naming my patient, but but would inquire about the Haroun family.

The next morning, I received a text saying that her mother knew the Haroun family and went to school with the remaining sister. As it turns out, Magda Haroun is still involved in keeping the local synagogue active (an interview with her, titled Closing the door: the last Jews of Cairo, can be found on YouTube).

When I mentioned the follow-up to the story to one of my Coptic friends, he mentioned that he too knew the family and told me that there are in fact eight remaining Jewish women in Cairo and that Magda Haroun is the community leader.

The story reminded me that there are often only a few degrees of separation between us, and that a little searching can bring out wonderful stories (elders are often the repository of such stories). We must find these stories whenever we can, as they are our collective human legacy.

This article was originally published online at http://www.cjnews.com/

Five Dermatologic Diagnoses at Your Fingertips

Teaser: 

Rebeca Pinca, MD,1 Joseph M. Lam, MD, FRCPC,2

1Department of Dermatology & Skin Science, University of British Columbia, BC.
2Clinical Assistant Professor, Department of Pediatrics and Dermatology, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: Dermatology is a visual specialty, yet palpation can also play an important diagnostic role. We present five dermatologic diagnoses that can be made at point of care by palpation or physical manoeuvres, potentially reducing unnecessary investigations, such as biopsies.
Key Words: Dermatofibromas, pilomatricomas, mastocytomas, spider angiomas, terra firma-forme dermatitis.
Dermatofibromas and pilomatricomas are benign papulonodular lesions that can be differentiated by the dimple sign, and the teeter-totter sign or tent sign, respectively.
Solitary mastocytomas can be diagnosed by Darier sign, whereby rubbing of the lesion causes a wheal and pruritus.
Spider angiomas can be diagnosed by diascopy, which involves the application of gentle downward pressure with a glass slide on the skin, resulting in blanching of the telangiectasia.
Terra firma-forme dermatitis is a benign discoloration that can be diagnosed, and treated, by gentle rubbing with isopropyl alcohol.
These dermatologic physical examination manoeuvres are quick, cost-effective, point-of-care diagnostic tools.
If in doubt, do not hesitate to biopsy lesions that appear suspicious.
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JCCC 2017 Issue 2

Table of Contents