When George’s symptoms began, they were initially very mild. “After isolating myself for about a week, I started to feel worse. My muscles ached, I couldn’t concentrate on simple tasks, and I felt very winded after the slightest movement,” explains George.

Primarily dealing with the cognitive and physical symptoms associated with Long COVID, George worked virtually with clinicians at St. John’s Rehab to build his mental and physical strength. Through the St. John’s Rehab Outpatient Post-COVID Rehab Program, Sunnybrook patients who experience lingering or residual deficits from COVID-19 infection are enrolled in an active rehabilitation program to manage their recovery.

When patients who have been diagnosed with COVID-19 continue to experience symptoms, it becomes an issue of Long COVID. This is where a rehabilitation consult may be beneficial and can be conducted as early as 4 weeks after COVID-19 diagnosis.

“When we are presented with a patient that has continued symptoms, it’s important for us to work with them to figure out their rehab focus. It helps us organize their care plan and tap into additional supports, when needed,” explains Dr. Melody Nguyen, physiatrist in the division of physical medicine and rehabilitation. She adds, “It’s not just physiotherapy – we’re looking at the whole person.”

Current research emphasizes the importance of a personalized approach to rehab given the many areas of the body that can be impacted by the virus. Dr. Marina Wasilewski, a scientist at St. John’s Rehab recently published a scoping review evaluating the current research on rehabilitation for COVID-19. “We know a range of respiratory, physical, psychosocial, cognitive and cardiovascular complications can persist following COVID-19,” says Dr. Wasilewski. “Our review underscored the importance of individualized rehabilitation programs provided across the care continuum by an interdisciplinary team of professionals.

For George, the personalized goals he set for rehabilitation included activities that are often taken for granted such as remembering names, making his bed, and participating in light gardening. “They were simple activities that I wanted to be able to do again and my care team helped me along the way to build my endurance,” shares George. 

Regaining functional independence through occupational therapy

Sarah Rockman is an occupational therapist and was on George’s care team. “I was looking to help George regain his functional independence at home, in the community and at his place of work,” says Sarah.

Patients with Long COVID have been reported to experience symptoms like brain fog or mental fatigue. “When it comes to long-term recovery, we want to make sure everyone has the necessary education and resources to get back to their pre-COVID functional ability,” explains Sarah. She adds, “Rehabilitation can be vital for this patient group.”

This meant focusing George’s treatment on some of the cognitive aspects of Long COVID. “George expressed some cognitive challenges, especially at work. He noted that he was having difficulty focusing on tasks, forgetting people’s names, and was mentally and physically exhausted after just a few hours of work,” explains Sarah.

In occupational therapy, Sarah worked with George on the importance of pacing and working with external aids to assist with scheduling and monitoring his activities. Over time, George was able to learn effective memory and energy conservation strategies that could be easily incorporated in his day-to-day activities at home and at work.

“We slowly and gradually increased George’s mental and physical endurance to work in larger chunks of time and re-adjusted his goals as needed. With this plan in place, George was able to return to work and noted improvements in his cognitive abilities,” shares Sarah.

COVID rehabilitation and virtual care

The St. John’s Rehab Outpatient Post-COVID Rehab Program uses a hybrid model of in-person and virtual appointments. For some patients, having treatment sessions in-person meant they could access equipment that may not be available at home. For others, virtual treatments were more appropriate. Depending on the patient, this model of care is adjusted to better serve the rehabilitation goals of each patient.

All of George’s appointments were conducted virtually. “Based on George’s needs and goals, we were able to provide treatment successfully via Zoom. We were able to implement the treatment and strategies he needed at a distance,” explains Sarah. She adds, “Virtual care is appropriate for some patients, and is always dependent on their needs and goals. Some patients might need a more hands-on approach which we are able to provide at St. John’s Rehab.”

“My experience with the program was amazing,” shares George. In addition to working with Sarah on building his cognitive strength, he worked with physiotherapist, Jean Yee, to build his physical strength.

He explains, “I was progressing pretty well but had a few bad days here and there. Jean was able to help me adjust my treatment plan to something that was better suited for me.”  The skills that George learned with the experts at St. John’s Rehab benefitted him at the time of his treatment and still benefit him today.

George clears snow from the sidewalk at his home

George explains, “There’s not a lot of information about Long COVID right now, and at times, it felt like I was alone or that it was never ending. My care team was really supportive of my journey and if I stumbled or needed help, they were only an e-mail away.”

Rehabilitation experts can provide the patient with a connection to their community, especially during this significantly isolating time.

“There is a lot of anxiety attached to recovering from COVID-19. Seeing other people or going back to work can be some very real barriers for some patients and rehabilitation acknowledges those barriers,” explains Dr. Nguyen.

She stresses, “It’s so vital to recognize that if something doesn’t feel right, you can and should advocate for yourself. Get in touch with your family physician and see what kinds of resources or educational opportunities are available so you can get back to your usual day to day activities.”

The post Recovering from Long COVID: How rehab is helping patients like George regain independence appeared first on Your Health Matters.

Find simple ways to move

If you have hip or knee osteoarthritis, staying active can be a challenge.

But staying active can help you manage your pain. Consider incorporating the options below in your daily routine:

• Aim for 3,000 steps a day. If you are able, you can work your way up to 6,000 steps or more! Use hiking poles or a cane to ease any pain and improve your walking pattern.
• To put less of a load on your hips or knees, biking and water-based exercises are great options.
• Mind-body exercises like Tai Chi can help to improve strength, balance and your mood.

It’s important to remember that aiming for 30 minutes of moderate exercise per day is a great way to start. “This doesn’t have to be one 30-minute chunk — you can exercise in 10-minute intervals throughout the day too,” says Patricia.

You might also consider attending a GLA:D Canada Hip and Knee Arthritis Exercise Program after consulting with your family doctor or arthritis specialist.

Get the most out of your virtual care experience

“Some aspects of your care might be a little different, so you might need to prepare a little more,” highlights Patricia when speaking of virtual care. As we continue to navigate the changes brought on by COVID-19, virtual care is a great avenue to improve your access to care while staying in the comfort of your own home.

For the best virtual consultation experience, here are a few tips:

• Dress in loose, comfortable clothing so you can move around easily.
• If your appointment will occur over the phone, think about how to best describe what your joint looks like.
• In the case that your appointment will be over a video call, make sure you are in a space where you can move comfortably and show your joints.
• Try to log in early so you can check your internet connection!

Watch Patricia’s full presentation in the archived video of September’s lecture:

For more information and resources on osteoarthritis, check out some of the resources below:

• A guide for patients having hip or knee replacement
• The Arthritis Society
• Health Quality Ontario, Quality Standards “Care for Adults With Osteoarthritis of the Knee, Hip, or Hand” Patient Reference Guide

The post Living well with hip or knee arthritis: A Speaker Series summary appeared first on Your Health Matters.

“I didn’t know anything that I could do about it,” says 55-year-old Albert. When he brought it up to his family doctor, his doctor mentioned that a knee osteotomy was an option for individuals in his age bracket. By shifting weight off of the damaged side of the joint, an osteotomy can relieve pain and improve function.

While Albert was correctly identified as being a potential candidate for an osteotomy surgery, many primary care physicians are not familiar with this type of modern joint preservation procedure. “Great advancements have been made in the field of osteotomy surgery, but many healthcare professionals and patients alike are not aware of these options,” says Dr. Sebastian Tomescu, orthopaedic surgeon at Sunnybrook.

Albert did his research on the procedure and thought it would be a good idea to proceed, especially if it could relieve the pain in his legs at nighttime.

He underwent a knee osteotomy for his right leg first, and then about a year later, he had an osteotomy of his left knee as well.

Despite the onset of the COVID-19 pandemic, Albert continued to receive care but in a new, virtual format. He explains, “My care team was available virtually in case I had any questions, but my knees just naturally had gotten better over time.”

“Within three to four weeks, I wasn’t feeling pain in my hips and I wasn’t taking any anti-inflammatory medications,” says Albert, “My knees feel like they’re back to 100 per cent and life is starting to feel like it’s returning to normal!”

For patients with cases like Albert’s, the Schatzker Joint Preservation Initiative for Active Adults at Sunnybrook can make a significant difference. For a population with early to mid-stage arthritic diseases impacting their quality of life, this initiative aims to provide advanced surgical treatment options.

With newer bone and joint procedures targeting localized osteoarthritis, the progression of arthritis in different areas can be slowed down while preserving the native joint, which functions better than an artificial one when healthy.

Albert explains, “My whole family life has improved because I can participate in these recreational activities again with my loved ones.” Having this surgical procedure at Sunnybrook meant that Albert got the opportunity to kick a soccer ball around, ride his bike and go on long hikes with his wife and kids.

“Hopefully, I’ll be able to play recreational soccer again soon!” says Albert.

The Schatzker Joint Preservation Initiative for Active Adults is named after Sunnybrook’s Professor Emeritus, Dr. Joseph Schatzker. Known for his expertise in trauma, joint preservation and fracture management, Dr. Schatzker continues to consult on patients with a variety of orthopaedic issues.

The post New generation of treatments to preserve joint health your doctor may not know about appeared first on Your Health Matters.

This has been a tough year for everyone. The onset of the COVID-19 pandemic meant that milestone events would be missed, get-togethers with family and friends would move online, and the stresses of everyday life would be amplified by feelings of uncertainty. While adapting to a physically-distanced way of life is important to help stop the spread of COVID-19, the realities of pandemic life are also having a significant impact on mental health.

At the latest Speaker Series, expert panelists Dr. Peggy Richter, Dr. Mark Sinyor and Dr. Rosalie Steinberg covered topics relating to mental health in a COVID world, providing some excellent tips on how to cope and build resilience as we mark one year of the COVID-19 pandemic. It’s especially important to remember that there are resources available to help us take care of our mental health in these difficult times.

Simple strategies to build resilience

Dr. Richter introduced many tips that can help individuals to remain resilient including:

1. Staying connected with friends and family whether it is online or on the phone.
2. Being active and enjoying the outdoors safely, when you can.
3. Limiting your intake of COVID-19 news.
4. Taking up a relaxing practice like meditation or mindfulness.
5. Eating and sleeping well.

“Like everything else, times of great challenge can also represent opportunities. We may have opportunities as we come back from COVID, to do things better. There may be some good news out there with all the negative, and there are some simple steps that you can take to stay healthier,” says Dr. Richter.

Building an action plan

Dr. Sinyor highlighted the importance of building an action plan to manage distress. Having a plan can be a helpful way of preparing for and dealing with feelings of anxiety and stress.

Try using the strategies below to manage distressing moments:

1. Identify your triggers/stresses. Knowing what they are will help you recognize when it is time to start your action plan.
2. Distraction techniques like reading, sleeping, or going for a walk can help in passing through a stressful moment.
3. Emotional regulation strategies like breathing exercises, mindfulness techniques and progressive muscle relaxation can also help in managing your distress.
4. Reaching out to others can help with managing distress. In some cases, you may want to reach out to help distract yourself from the way you are feeling. Confiding in a trusted family member or friend that you aren’t feeling well can also help to diminish feelings of distress.
5. Speaking with a health-care professional can also help you to find comfort in working through your feelings of distress.
6. Identify a list of crisis resources like a crisis line or emergency department that can be contacted for help (see the Crisis Services Canada number below).

Using a coping card to write down your crisis action plan details can help outline what to do in moments of distress.

“Think of it like a fire drill.  You need to practice this over and over again, so you feel confident that you know what to do to manage a crisis,” says Dr. Sinyor.

Reflecting on positive experiences

It’s important to remember that the COVID-19 pandemic has provided the opportunity to reflect on positive experiences too. Dr. Steinberg emphasises the importance of writing your “Silver Linings Playbook” and recognizing the moments that have supported you in the past year.

To get started, you can:

1. Reflect on sources of purpose and meaning.
2. Identify things that hold value to you and/or to society.
3. Reflect on what inspires you .
4. Tap into your spiritual supports, if you choose to do so.

Dr. Steinberg describes, “It’s not all doom-and-gloom. Think about what the new positive aspects are in your life. The participation in reflecting on things that you are grateful for is physically healthy for your brain: it promotes wellness, it helps you become pro-social and engage with others, and it helps cope with stress.”

There are a number of a number of resources available on the Department of Psychiatry’s website with respect to coping and building resilience. You can find them here.

To learn more on the impact of COVID-19 on mental health, tips to build resilience and coping with crises, view the whole Speaker Series event here.

If you need help in an emergency, please call 9-1-1 or visit your local emergency department. If you’re feeling like you’re in a crisis or need somebody to talk to, please know that help is also available through community resources:  

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 pm – midnight Eastern Time)

The post Mental health in a COVID world: How to build resilience during a global pandemic appeared first on Your Health Matters.