“Pain can vary. For a patient with a knee replacement, pain may be slight after surgery but more intense as they start physiotherapy,” says Dr. Bheeshma Ravi, an orthopaedic surgeon at Sunnybrook’s Holland Bone and Joint Program. “We know medications are helpful if [patients] need them, but risky to have in the home if they don’t.” 

To support patients, teams are piloting RECOVERED (Reclaiming ExCess Opioids for VERifiEd Disposal), a program offering a secure way to dispose of medication they don’t need.  

Hip and knee joint replacement patients at the Holland Centre are asked to bring in all medications to their six-week follow-up with their doctors. At this appointment, the doctor reviews pain management and medication needs with the patient. If pain medications are no longer needed, the patient can return the unused portion. Any returned opioids are locked away and removed only by authorized personnel for verified disposal. 

“RECOVERED works in tandem with other pain management supports, including education for patients while in hospital and 24-hour on-call assistance,” says Andrew Kennedy, project co-lead and manager of the Pre-operative Clinic at the Holland Centre. 

While the program is primarily about helping manage post-surgery pain, it offers additional benefits to patients, adds Dr. Ravi, project co-lead. “We hope by participating in RECOVERED, they may [also] feel empowered in helping to reduce harm.” 

The post New program offers safer disposal of unused pain medication appeared first on Your Health Matters.

He offers these general tips to help you:

Talk with your care team

If you are in the hospital or starting rehabilitation, you can learn more about assistive devices and options by talking with your physician, physiotherapist and or your occupational therapist.

See your family doctor

If you are in the community, Giovanni recommends making an appointment with your family doctor to discuss next steps. They can refer you to a specialist or prosthetist. Giovanni recommends getting a physician’s referral because it is required when applying for funding coverage.

Check your private health insurance plan

If you also have health insurance with a private company, it’s important to find out what your plan may cover, Giovanni advises. “Always submit your quote [the potential cost of the medical device] to your insurance provider for a pre-determination first,” says Giovanni. “You may be asked to pay upfront, unlike your dental plan, but your plan may be able to waive this requirement depending on your situation.”

Bring all documents to your specialist appointment

“Patients referred to us at SCIL bring in all information in addition to their OHIP card and possible private health insurance coverage,” says Giovanni.

If you are receiving social assistance, he recommends that you also bring to your specialist, your most recent proof of social assistance to confirm that coverage. “That way, they have the complete picture. They are able to prepare the appropriate funding options based on your financial situation,” he says.

Learn about other potential partial funding sources

Charities are also a possible resource for additional funding assistance. They generously help specific patient populations and depending on your medical condition and assistive device need, you may be eligible for additional funding support.

The post Are you coping with limb loss and have questions about how to access a prosthesis? appeared first on Your Health Matters.

Lupus primarily affects women of childbearing age. For hopeful moms-to-be with this condition, planning your pregnancy is one of the most important things you can do for yourself and your baby.

Lupus or Systemic Lupus Erythematosus (SLE) occurs when your own immune system attacks healthy parts of the body and causes inflammation and damage to tissues and organs such as the joints, kidneys, lungs, skin and heart.

“When women in their twenties and thirties are first diagnosed with lupus, it’s an important discussion to have with them – to work out plans they may have for pregnancy and whether they may have a timeline,” says Dr. Sharron Sandhu, a rheumatologist in the Holland Bone and Joint Program, who provides pre-pregnancy counseling to these patients.

Here are some questions you can discuss with your rheumatologist:

Why is it important to plan my pregnancy?

“We know that outcomes for mother and baby are best when conception coincides with good disease activity,” Dr. Sandhu says.

She describes good disease activity as having minimal symptoms, with blood test results that suggest the condition is well controlled and there is no inflammation or minimal disease activity in organs like the kidneys or lungs.

What might my plan for pregnancy involve?

“Every patient is different. If there are only mild symptoms and the disease is well controlled, it should be safe for a patient to proceed with pregnancy plans,” says Dr. Sandhu.

If disease has been moderately active, especially if there is kidney involvement, Dr. Sandhu says it is best to gain more control of the disease and to maintain that for six months or more before a patient proceeds.

“If kidney disease is severe or their lupus is very active, pregnancy would not be recommended due to the strong likelihood of adverse effects on both the mother and the baby,” she says.

How have things changed for those of us who want to try for kids?

“Young women with lupus who have goals to start a family should not feel discouraged. We’ve come a long way in rheumatology practice. We now understand more about the disease – how to treat and control it – and that has helped to improve outcomes in pregnancy,” adds Dr. Sandhu.

A study published in the Journal of Rheumatology shows that rates of early pregnancy loss for patients with lupus is significantly reduced by half at 17 to 20 per cent or 1 in 5 women, compared to rates 40 years ago. Though women with lupus in pregnancy have a higher likelihood of preterm births, data from the study also shows a trend toward a decrease in rates for these patients over the last 20 years. These reductions in rates are due to better screening and disease management and improvements in monitoring in pregnancy.

What does better screening and disease management mean?

“Better screening and management relate, in part, to greater understanding of antibodies associated with autoimmune conditions.

Generally, the body’s immune system forms antibodies to fight infections or cells it recognizes to be separate or external. With lupus, an autoimmune condition, the immune system no longer differentiates and begins to attack itself.

For diagnostic tests, your rheumatologist would have conducted an autoimmune panel including blood work to test for different antibodies,” says Dr. Sandhu.

“About 25 to 50 per cent of lupus patients carry either the anti-Ro antibody or both anti-Ro and anti-La. Early on, it is best for these women to be on Hydroxychloroquine, a disease-modifying anti-rheumatic drug. That’s because in two to five per cent of pregnant patients who carry these antibodies, there is a risk of the antibody crossing the placenta and affecting the fetal heart.

For this small number of patients, the risk is highest at the 18 to 24 weeks gestation period. The encouraging news is that if these patients remain on Hydroxychloroquine throughout their pregnancy, the risk of developing the condition is significantly reduced: by 65 per cent. As soon as a patient who carries these antibodies is pregnant, she is referred for fetal echocardiography monitoring. This monitors for a condition called congenital heart block and is done weekly from 16 to 26 weeks, and every two weeks after.

It is also important to screen for an antibody called the anti-phospholipid antibody. We know that women in the general population have a risk of early pregnancy loss and that women with lupus have a higher-than-average risk.

If the anti-phospholipid antibody is present, there is increased risk of later loss in pregnancy for women with lupus, and it’s important to understand and manage these risks ahead of time, possibly adding other medications such as aspirin. If there is a history of blood coagulation issues and later loss in pregnancy, a rheumatologist may recommend a patient be on a combination of aspirin and heparin in pregnancy,” she says. 

What medications should I be on, and when?

“Each medication is decided upon between you and your rheumatologist and based on your individual condition and how each medication relates to your pregnancy.

Pre-pregnancy counseling should also involve your rheumatologist conducting with you, a maternal risk and fetal risk assessment, and a medication review.

Keeping in mind that it is best to for a woman with lupus to try to get pregnant when the disease is most inactive:

• medications such as Hydroxychloroquine are safe and it is recommended that patients remain on this before conception and through pregnancy. This medication helps reduce the risk of flares and of placental transfer of maternal antibodies. Azothiaprine is an immuno-suppressant that is also relatively safe to use in pregnancy.
• medications such as Methotrexate are not safe to take if a patient is trying to get pregnant.
• medications like non-steroidal anti-inflammatory drugs, such as Ibuprofen, should be used judiciously, in the first and second trimester. These should be avoided in the third trimester of pregnancy and should be discontinued after 32 weeks,” says Dr. Sandhu.

What else can I do to help myself, and my baby?

“Fatigue is common in pregnancy in the general population. With lupus, we know that 50 to 80 per cent of patients experience fatigue. Fatigue alone is not an indication of increased disease activity. “You’re also going to have some weight gain, but it’s best to avoid excessive weight gain. Eat healthy and do a bit of activity to give yourself a boost. Get help as much as you can,” says Dr. Sandhu. “Pace yourself and prioritize your activities. If you’ve got a list of 10 things to do, look at the top two to five things you must do today…and park the rest.”

The post Hopeful moms-to-be with lupus: don’t be discouraged appeared first on Your Health Matters.

“The Saturday afternoon I became an unwitting participant in a crash,” says Andrew Lawlor, 51, of Unionville, Ontario. “I remember I kissed my wife as I dropped her off at the spa. Apparently then, I got back into my jeep, drove home and headed out on my motorcycle.”

Andrew says ‘apparently’ because he doesn’t remember much else about that day in July 2018.

He was admitted to Sunnybrook. “The teams in trauma and in critical care did surgeries to treat the many fractures in my arms and pelvis, and later did procedures to repair serious nerve injuries in my right shoulder,” he says. His left leg was badly mangled in the crash, and he had to undergo a transfemoral [above-knee] amputation.

After three months in the intensive care unit and critical care, the writer and father of two boys gained more support from team members — including physiatrist Dr. Amanda Mayo and prosthetist David Smith — during his rehabilitation stay at St. John’s Rehab.

He is continuing therapy there on a weekly basis. Physiotherapist Vera Fung (above) is teaching him how to walk, and she is helping with conditioning, strengthening and flexibility. This will help prepare him for the positions and posture he will eventually need to walk with a lower-extremity prosthesis.

Occupational therapist John Cho (below) generally helps patients with upper body exercises and functional-related range of motion for lifting, reaching overhead, carrying, pushing and pulling. He is working with Andrew on improved range of motion in his right shoulder and arm, flexibility in the wrist and dexterity in the fingers.

Below, Andrew talks about his healing journey and living with limb loss:

What has helped you cope in your journey so far?

It’s Day 264 since the crash. Keeping track of the days helps me stay focused. I’ve had a lot of help. I awoke on August 19 and my wife, Lesley had already put up things in my room and she knows I’m goal oriented. She thought: ‘let’s put a list on the wall and let’s work towards those goals.’ Lesley really helped shape the plan with me, together with my care team.

Healing is a community exercise, whether your community is one, or three, or a whole town. We live in a tight-knit community in Unionville. On the Tuesday morning after the crash, Lesley found a homemade casserole on our front porch with an unsigned note that simply read: Because I had to do something. To this day, we don’t know who did this kind gesture, but we are forever grateful. There was a groundswell of support in our community led by amazing friends. People started an online campaign to send us well wishes and encouragement.

Support came from individuals, sports leagues and businesses in Unionville. A local grocer helped the boys stay healthy throughout the crisis, and a group of friends pitched in to buy us snow plowing for the winter.

Sometimes ‘what can I do to help?’ or ‘let me know if I can help’ can turn into action — that if there is something I can do to help, I can think to do it — and that’s what many of our friends and the community did for us.

What do you have a greater appreciation for?

My family has always been important to me, and yet, I have gained an even deeper appreciation for them.

All the things you might take for granted as an unencumbered, fully capable person — the seemingly easy things — you now don’t take for granted. I can’t drive, so simply getting milk at the corner store becomes a plan. Yes, it puts a dent in your freedoms, but you learn to adapt.

I have also found that my focus has been much better. I’m me. I’m a dad. I’m a husband, son, friend, boss, worker — I am all of these. When those things have the possibility of being stripped away, it brings your focus to a pretty fine point. Right now, I have one job to do, and that’s to get better. And I’m fortunate because I know not everyone has that opportunity to focus on that one job.

I’ve also learned perspective. When I first got to St. John’s Rehab, both my arms were in casts. It took five members of the team to move me out of a bed. They brought me in to therapy one day, and this young man says to me: Don’t worry. They’ll take good care of you. Here is this young man with third degree burns helping me by saying that everything’s going to be okay.

I have great respect for this young man who showed and shared such courage.

I have also learned self-advocacy — to be involved, to be engaged in my health care and in how the rehab teams support my continued healing.

Even now, I try to come early to therapy, so I can talk to others living with limb loss — to connect with them about what they’re doing, how they are doing, and getting in contact with guys ahead of me to ask, ‘how do you do it?, ‘what works for you?’

What would you want the community at large to understand about living with limb loss?

I am the first amputee I’ve ever met… and I don’t know how I would react. Everyone generally has good intentions. It’s in our nature to want to help, and to want to be supportive.

We are all our own unique experience — as is the case too, for people living with limb loss or limb difference. I’ve developed my own ‘icebreaker’ mechanism. When I meet someone for the first time, I try to make eye contact and to speak early, offering a connective comment. That approach often helps diffuse any tensions or misperceptions that may be forming.

For me, I am now part of the community of individuals living with limb loss. If I met another individual, I’d want to share and exchange stories and experiences. But only if the individual was open to it.

It’s back to that idea of giving back. I’d like to do what I can to help others, going through their own journey. One of the messages Lesley put on my wall from day one still resonates with me — it’s a quote from the author Max Lucado:

The key is this: Meet today’s problems with today’s strength. Don’t start tackling tomorrow’s problems until tomorrow. You do not have tomorrow’s strength yet. You simply have enough for today.

The post Months after a motorcycle crash, Andrew reflects on his healing journey and living with limb loss appeared first on Your Health Matters.

Studies show that having arthritis, especially rheumatoid arthritis, doubles your risk of developing a heart condition, says Dr. Jessica Widdifield, a scientist in the Holland Bone and Joint Research Program at Sunnybrook Research Institute. She leads population-based studies to improve the evaluation, care and outcomes for patients with musculoskeletal conditions.

Cardiovascular disease is also the leading cause of death in patients with rheumatoid arthritis. Researchers believe the increased risk may be due to rheumatoid arthritis as an autoimmune condition where there is ongoing inflammation. The immune system attacks the body’s own tissues and affects the synovium or lining of the joints. This causes swelling which leads to damaged bones and joints.

Inflammation in rheumatoid arthritis can then also lead to damage in other areas of the body. It contributes to hypertension (high pressure of blood against artery walls) a well-established risk factor for developing heart disease resulting in overall reduced elasticity in blood vessels and increased stiffness, specifically in arteries.

Most individuals with arthritis are unaware that they are at an increased risk of developing cardiovascular disease in relation to their condition. If you didn’t know of these connections you are not alone, adds Dr. Widdifield who is also an assistant professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation. Her research team has also identified that patients are not often adequately screened for cardiovascular risk factors by their physicians. “So it’s very important that patients take a proactive role in their health,” she adds.

If you have rheumatoid arthritis or have been newly diagnosed, what can you do to be proactive about heart disease risk? Rheumatologist Dr. Shirley Lake, also a member of Sunnybrook’s Holland Bone and Joint Program, offers information that may be helpful in your discussions with your doctor:

How much exercise should I be getting?

“The Canadian Physical Activity Guidelines for adults recommends getting at least 150 minutes of moderate to vigorous-intensity aerobic physical activity weekly, in bouts of 10 minutes or more. However, if there are other existing medical conditions or if there is difficulty with weight bearing, talk to your doctor or a health care provider such as a physiotherapist who can help you tailor a plan that works. It is also beneficial to add muscle and bone strengthening activity using major muscle groups at least two days a week.”

What is a moderate weight for me to aim for?

“Some people aim for an average body-mass index of 18.5-25 kg /m2. But there are exceptions based on the amount of muscle someone may have, so it is best to use this average only as a general guideline.”

What can I do to quit smoking?

“Just asking about options is the first step. There are so many resources to help people quit – from books, helplines, counsellors, and medications. Talk to your health care provider and check out smokershelpline.ca”

How do I manage inflammation? Are their dietary or other things I can do?

“The not-so-good news is that diets don’t cure arthritis. The good news is that switching some foods may help you manage your arthritis better. By maintaining a healthy weight, there’s less strain on your joints and this gives you more energy. A good rule is to try to minimize calories and maximize nutrients like whole grains, fruits and vegetables, lean proteins and lower-fat dairy products. For certain arthritis conditions like gout, eating less red meat, shellfish and alcohol help prevent attacks. More vegetables and low fat dairy are beneficial. In general, talk to a dietitian about what would be beneficial.

Am I at risk for diabetes? If yes, what can I do reduce my risk?

“The prevalence of insulin resistance and type 2 diabetes is increased in patients with rheumatoid arthritis. The increased insulin resistance in rheumatoid arthritis is related to systemic inflammation. Some of the drugs used to treat arthritis, such as steroids, can increase your risk of diabetes. Early introduction of effective disease-modifying anti-rheumatic drugs such as methotrexate, hydroxychloroquine, and TNF alpha antagonists control inflammation, which may decrease insulin resistance. Other things you can do to reduce your risk of diabetes is be active, keep a healthy weight, and make healthy food choices.”

Might my medications for rheumatoid arthritis, work, or not, for helping reduce risk for a heart condition?

“Certain medications such as methotrexate that treat rheumatoid arthritis have been shown to reduce risk of heart disease^**. Other medications such as NSAIDs (non-steroidal anti-inflammatory drugs), especially in the long term, can increase your risk of certain heart diseases. Certain biologics have been associated with worsening heart conditions such as heart failure. However, if these medications decrease pain and improve quality of life so that an individual can now function and exercise, they may improve their overall health. Every medication needs to be decided upon based on each person’s individual cardiac risk factors and the benefits and risk of the medication, and in consultation with your doctor.”

**A study led by Dr. Widdifield recently published in the Journal of Rheumatology evaluated the associations between use of methotrexate and risk of cardiovascular events in a cohort of 23,994 patients diagnosed with rheumatoid arthritis after age 65. The study observed a 20 percent decrease in cardiovascular events associated with these patients’ recent continuous use of methotrexate.

The post Heart disease and arthritis: what you need to know appeared first on Your Health Matters.

To understand what this means for patients, we spoke with Dr. Bheeshma Ravi, the study’s lead investigator, adjunct scientist at ICES, and an orthopaedic surgeon with the Holland Bone and Joint Program at Sunnybrook.

Why is this study important?

Hip fractures are one of the most common reasons for surgery in older adults. These patients are more likely to have existing medical conditions, have lower physiological reserve, and therefore are more vulnerable to delirium after surgery. If we can gain a fuller understanding of what adds to risk, this will help reduce these experiences for patients, avoid longer hospital stays, and contribute to better outcomes.

What are the main takeaways from the study?

We found that increasing risk for delirium after hip fracture surgery among older adults is strongly associated with longer duration of hip fracture surgery, particularly in patients who undergo a general anaesthetic.

This is a large study looking at surgery activity over an eight-year period. We examined data related to almost 70,000 individuals ages 65 years or older from the general population who had hip repair surgery in 80 hospitals in Ontario, Canada.

How might this study help patients?

The duration of this type of surgery is related to many factors and considerations including the complexity of the injury and the procedure is often unfortunately an urgent one. It may be helpful for patients and or their loved ones to speak with the surgeon if there are known prior episodes of delirium after surgery, and to explore with the anaesthologist the potential use of regional anaesthesia, such as a spinal anaesthetic.

How might this study add to improvements in hip fracture care?

Due to the aging population, hip fractures are one of the most common reasons for urgent surgery, and all practitioners want to continue to provide quality of care. Our hope is that these study findings contribute to the growing body of literature on the effects of general anaesthesia in older patients, and support the notion that these surgeries should ideally be managed expeditiously, by experienced surgeons and anaesthiologists.

This study also builds on previous research about the importance of timely access to hip fracture surgery, supported by the Marvin Tile Chair in Orthopaedic Surgery.

Join the conversation

Join JAMA Network for a live discussion about this research on Twitter or Facebook. Hosts Drs. Seth Trueger and Michael Berkwits will talk about this study on Monday February 25 at 3 p.m. ET.

Read more from our bone and joint experts:

• When is hip surgery necessary?
• Tips for maintaining good bone health

The post Behind the research: hip fracture surgery & delirium risk appeared first on Your Health Matters.

Add the fact that interest in food changes as we age, meal times are especially challenging when your appetite ‘goes out the window’, says Wendy Lopez, a registered dietitian at St. John’s Rehab who is doing research on a meal assistance program that engages specially trained volunteers to assist patients with meal-time tasks while supporting them through socialization.

Interest in food indeed relates to how we socialize around it. Our appetites are also influenced by what we can taste and smell. Medications can sometimes affect those senses. Older adults may also have chewing or swallowing challenges and need to avoid certain foods that do not mix with medications.

If your appetite is not great, you can get full if you drink fluids first. Try drinking your fluids after your meals.

You can get nutrition details and food suggestions here and try this calculator to help figure out your daily dietary intake.

Small but mighty

But what’s the harm in eating less? Wendy says older adults are at higher risk of muscle loss and falls so it is important to get a variety of foods and to include a source of protein with every meal.

If you’re not eating a lot, Wendy suggests to eat small, frequent meals. Choose nutrient-dense foods higher in protein such as chicken, fish, eggs, Greek yogurt, tofu, peanut butter, beans and nuts. Choose foods that are moist and easy to chew. Add herbs and spices for flavour instead of salt. For individuals on a tighter food budget, she suggests using high protein skim milk powder to enrich soups, oatmeal, muffins and puddings.

Make the most out of meal times

Cooking for yourself may seem daunting. Why not prepare meals at a time when you are on less medications or experiencing less side effects? Cooking larger batches can be helpful. Meals can be frozen for a later time. Little things like putting on music, adding flowers or using a placemat can create a pleasant environment which may help you eat better, adds Melissa Sobie, also a registered dietitian at St. John’s Rehab.

Skip the social tea and toast

Make the most of your social get-togethers. If you’re meeting a friend or family member for brunch, skip the tea and toast. Dive into an omelette. Add cheese for more protein and calcium!

How you can help an older loved one

If you have an older adult in your life, here are some ways you can help with meals:

• Offer to do their food shopping or encourage them to come along.
• Add an extra portion when cooking for your family. Bring the meal by, visit, stay a while.
• Invite them to dinner once or twice a week.

The post Where did my appetite go? Tips for older adults appeared first on Your Health Matters.

Dr. Amanda Mayo is a physiatrist who specializes in amputee care at St. John’s Rehab. Todd Domingo is an active amputee and a certified peer visitor who offers support to other amputees. Both share insights to help you along your journey.

A life-changing event

Says Dr. Mayo, “It is important to recognize limb loss is a life-changing event. Limb loss affects how you move and many aspects of your life. It is common to go through a period of grieving after loss of a limb, and you may have a period of developing a new self image. Having a good support network of friends, family, and/or healthcare providers can help with these transitions.”

Says Todd, “When it comes to body image, keep reminding yourself that value is about who you are and what you can do – and less about physical appearance. Though it takes a lot emotionally the goal is to try to get to a point where you can say, let me make something better of this. People will always stare: it is human nature. Use it as a positive teachable moment.”

Last year Todd had to have a left below knee amputation. “Losing a limb is similar to losing loved one – believe it or not,” he says. “Everyone experiences the process of dealing with limb loss differently.”

Recovery takes time

Dr. Mayo: It is a long process to recover from amputation. Be patient with yourself. It takes time to regain your strength, emotional recovery and for the residual limb to heal.

Patients have to wait at least 4-6 weeks after amputation before being measured for their first prosthetic device by a prosthetist.

Be open to new experiences

Todd: Over time it is then good to get to know the things you can do and to remain open to new experiences. I found it helped to accept that my prosthesis was not replacing my limb. It’s a ‘tool’ to help me do things.

Don’t be discouraged

Todd:  During fittings and adjustments, try to stay positive and get to know the differences between pain, soreness, discomfort and pressure. Acknowledge and address the discomfort and find a way to trust that your device will support you.

Seek support about the financial aspects of a potential device

Dr. Mayo: Patients also often face financial stressors at this time. Talking with members of your medical team – the social worker, the physiotherapist, the occupational therapist – can help you learn more about potential device options and how to navigate assistive devices funding.

Todd: Find out what your options are, and aim for a device that can help match the activities you want to do.

Become adaptive and active

Todd: Learn what being adaptive means. Ask yourself, how am I going to do this? in a strategic way to safely do it.  For example, instead of asking, how am I going to get in my car with my leg prosthesis on since it is low to the ground? Start by thinking how you can physically get into your car. Whether that is by holding on to the car as you sit down and swinging your legs over, it is all about taking that first step. You’ll soon figure out that adapting simply means doing things in a different way, but still getting to the end goal. 

Todd: Be active and involved. Be aware of the community of amputees around you. Advocate for yourself and have good, regular exchanges with your medical team.

The post Going forward after limb loss appeared first on Your Health Matters.

New technique improves quality of life for burn patients in rehab

Thanks to a form of therapy typically used in orthopaedic rehabilitation, burn survivor Jerry Louvis, 46, now talks about regaining his strength. “I am much closer to where I was and what I was able to do.”

In spring 2016, Jerry was treated at the Ross Tilley Burn Centre at Sunnybrook for severe burns to most of his body from a chemical fire, receiving care as an inpatient at Sunnybrook’s St. John’s Rehab. By the summer, he was back at home but continuing to go to St. John’s Rehab for therapy appointments.

The goals of burn therapy include improving patients’ range of motion and function, minimizing contracture and supporting their social reintegration. Jerry had regained some muscle strength but felt that his movements were “wooden” and clumsy. An accomplished scientist with a very precise mind, he longed to be able to do things with more accuracy and finesse.

A year and a half later, he had surgery for heterotopic ossification – a condition that sometimes affects patients after severe burns or orthopaedic trauma – when bone grows in muscle or tendons, which can be painful and can significantly restrict movement.

During rehabilitation, Jerry received both standard manual therapy and a new approach called myofascial release technique. Standard manual procedures are helpful and effective and have been used for decades in burn rehabilitation. They involve scar massage, joint exercises, stretching, the use of pressure garments and silicone-based gels to treat scars, as well as splints to help control how a burn heals.

“More people are fortunately surviving larger burns, and there is greater need to help them improve their ability to move and carry out activities every day, [which] helps enhance their quality of life,” says Lisa Giardino, a physiotherapist in outpatient rehabilitation services at St. John’s Rehab.

Myofascial release techniques are a type of manual therapy used with orthopaedic patients – those recovering from conditions of the bones and joints. Lisa is now researching these techniques for the first time in patients with burn injury. Having worked with burn patients for 15 years, Lisa felt there was more that could be done to improve her patients’ outcomes.

It made sense to her that the same techniques used in orthopaedic recovery could be used to overcome the scarring caused by burn injuries. She set out to prove her hypothesis.

Scars can affect many aspects of the body, including muscles and fascial systems. Fascia, the layer of connective tissue under the skin that forms a network surrounding other kinds of tissues, including muscles, bones, blood vessels and organs, connects those tissues like woven fabric. Healthy fascia is relaxed and can glide easily over underlying tissues. Injuries to the body, such as burns, can restrict mobility of the fascia, causing tension and pain.

“Scars are like icebergs – what you see is only part of the story. The bigger part is how the scar has been laid down, underneath. You have to feel it to know,” says Lisa.

Myofascial release techniques involve loosening the fascia within the scar tissue, using massage. This technique frees up the scar from the underlying tissues, so those tissues can glide over each other more freely, making it more comfortable for the patient and restoring function.

“Considering the significant impact of burn injury on tissue integrity, using myofascial techniques to improve scar outcomes could be an innovative approach to burn care in patients with closed wounds,” Lisa points out. “Myofascial release techniques are a good enhancement to standard approaches. They’re another tool in a clinician’s toolbox.”

Patients often report that the techniques are gentle and comfortable. Some find it so restful they fall asleep. This new approach gave Jerry more range of motion that has since stayed with him. “I was a skeptic at first, but then I really noticed the difference. There I was, trying to move muscle that had been stuck for a year,” he recalls.

Over the next six to 12 months, Lisa will continue to measure changes in patients in terms of their range of motion, function, scar characteristics and quality of life to benchmark the use of myofascial release techniques in therapy. “Burn rehab is a team effort,” notes Lisa, who is collaborating with her colleagues and encouraging them to learn more about the technique.

“My ability to move has become a lot more refined since this type of therapy. I can now write, type and do repairs around the house,” says Jerry. “For me it’s about getting to the subtleties of range of motion – not just getting up in the morning, but instead, sitting up in bed with the confidence of knowing I can move with measure and precision.”

Below: range-of-motion outcomes for a 39-year-old patient with 11 per cent total body- surface-area burns who had myofascial release therapy for 30-minute sessions twice a week for 8 weeks.

The post Orthopaedic rehab technique is improving quality of life for burn patients appeared first on Your Health Matters.

“Finding good health information online can be tricky,” says Patricia Dickson, an advanced practice occupational therapist with the Holland Bone and Joint Program. “When it comes to researching treatments, there’s often no magic pill or shiny object. Avoid websites that promise amazing results for little effort. And for good reason.” Patricia sees patients at the Holland Centre, who have been diagnosed with osteoarthritis, and says it’s not about finding the cutting-edge experimental treatment, but going for the evidence-based, reliable treatments, that will improve your condition both in the short and long term.

No matter the health topic you’re researching, the better quality of information you get from credible articles and published studies, the more informed you’ll be when you talk to your health care team, says Patricia, and Ekaterina Petkova, a librarian at the Holland Centre Library in Sunnybrook’s Library Services.

And if you’re not still sure about the credibility of information you find, ask for advice from a librarian at your local library.

[toggle title=”Click here to view a plain-text version of the infographic”]

Reliable?

Website credible? Visit government or large non-profit health agency websites. Look for well-researched, best practice treatment information.

Expert?

Author named? Credentials? Relevant to the health topic you’re researching? Are they linked to an academic institution?

Source?

Where is the information from? Our health care system is different from the United States. Try looking at Canadian sites first.

Everywhere?

The same article on many sites doesn’t make it reliable. It may be paid for or sponsored, and may not be objective.

Accurate?

Are there typos in the article? Does it reference a list of credible and published articles?

Reviewed?

Article or study been reviewed by a relevant specialist or group of specialists? Published in a peer-reviewed journal?

Current?

Timely information? When was the study done? How is the website updated? Do articles have dates?

How?

When looking at studies, how many patients participated in the study? How was the study done?

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