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Champlain Lung Health Intake and Referral

The Champlain Lung Health – Intake and Referral program is your access point to community lung health education and support in Champlain if you are living with COPD.

For healthcare providers, this program offers one referral form that allows your adult clients living with COPD access to effective community lung health services in Champlain.

The lung health programs provide an evidence-based approach that improves the health and quality of life of people living with COPD.

http://champlainlunghealth.ca/

“Since joining your program my breathing and general overall health has been greatly improved …Your program is a hidden gem and should have more exposure so others may experience what I have been given”

– Lung Health Program Participant

“When I started 4 years ago, I was barely able to walk due to my shortness of breath; today I am able to walk for over a half an hour. I love this program for what is has helped me accomplish.”

– Lung Health Program Participant

The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness

Jerrold Petrofsky, Lee Berk, Gurinder Bains, Iman Akef Khowailed, Haneul Lee, Michael Laymon

Clinical Journal of Sport Medicine, Volume 27, No. 4, July 2017

Delayed-onset muscle soreness (DOMS) is a relatively common phenomenon experienced by people who are new to exercise, or essentially anyone who exceeds their normal workout intensity. DOMS can range from mild irritation to severe pain that can form a significant barrier inhibiting performance, or exercise participation altogether. Furthermore, previous research has shown that DOMS is greater in intensity and duration in older individuals and individuals with diabetes, which is a particularly important patient population within family medicine. This cross-sectional repeated measure design study was performed to assess the impact on DOMS of heat applied for 8 hours immediately or 24 hours after exercise.

60 subjects aged 20-40 who were physically inactive for 6 weeks and had BMI’s less than 40 were divided randomly into 3 groups (control, ThermaCare heat wraps applied immediately after exercise, and ThermaCare heat wraps applied 24 hours after exercise). To provoke DOMS, the subjects completed squats in 3, 5-minute bouts with 3 minutes of rest in-between each bout.  Visual analog pain scales, blood myoglobin, muscle strength, range of motion, and stiffness of the quads were the main outcome measures of the study.

The results revealed a significant reduction in soreness in the group that had the heap wraps applied immediately after exercise (P<0.01). This was corroborated by blood myoglobin, algometer and muscle stiffness data. In addition, there was some benefit to applying the heat 24 hours after exercise when compared to control.

In summary, low-level continuous heat wraps left for 8 hours after heavy exercise can reduce the effects of DOMS (assessed by both subjective and objective measures). Although cold therapy is commonly used after heavy exercise to reduce soreness, heat seems to have the added benefit of increasing flexibility of tissue and tissue blood flow. The authors note that for the purposes of reducing joint swelling, it is still probably better to use cold therapy.

 

Sean Mindra MD, CCFP

PGY3 – Sport and Exercise Medicine, University of Ottawa

Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine

The Noisy Knee

Song, S. J., Park, C. H., Liang, H., & Kim, S. J. (2018). Noise around the Knee. Clinics in orthopedic surgery, 10(1), 1-8.

A common MSK question patients ask is “is it normal that my knee makes this sound?” While this review focuses on the knee, the approach can be generalized to any shoulder. Noise in the knee is common, and often patients are worried the noise is pathological.

Noise around the knee can be separated into physiologic and pathologic causes. This is defined by whether the sound is associated with pain, swelling, and abnormal range of motion. There are also many different types of sounds which are more likely to describe one cause than another. Crepitus is a vague descriptor used to represent a sound during a joint’s range of movement. Popping is a sudden explosive and well perceived sound, usually associated with injury such as meniscal, cruciate, or collateral ligament tears. Clunking is a loud singular noise due to release against resistance, often suggestive of something that was subluxed and now relocated. Clicking is a tiny, singular noise that occurs during one cycle of knee extension and flexion, this can be associated with various causes. Grinding and grating are used to describe continuous scratching sounds and are more associated with degenerative OA and patellofemoral pain syndrome.

Physiologic Sounds:

Not associated with any history of trauma, swelling, or pain.

Tend to be sporadic in nature

No aggravation of sounds and combined symptoms

Causes include:

  • build up or bursting of tiny bubbles in the synovial fluid
  • snapping of ligaments
  • catching of the synovium or physiological plica
  • hypermobile or discoid meniscus.

One way to distinguish between these causes is whether the joint sound occurs repeated during range of motion. If it happens repeatedly, it is usually due to anatomic structures rubbing against each other, such as ligaments/tendons or plica over a bony prominence. One common is the bicep femoris tendon at the lateral aspect of the knee. If the crack has a refractory period, it is likely due to air build up in the joint, and subsequent changes in joint pressure during range of motion cause cavity formation which creates a popping sound.

Management of physiologic noise involves reassurance and stretching and strengthening of affected musculotendinous structures.

Pathologic Sounds:

Can have history of trauma or injury

Tend to be higher pitch/frequency

observed consistently, has gradual aggravation

Causes:

  • Degenerative changes
    • Structural cause such as bony spurs and cysts, meniscal tears…etc
  • Pathologic plica
    • If a plica gets irritated, it can cause synovitis and pain
  • Patellofemoral instability
    • Due to hypermobility of patella or subluxation of patella
  • Post-surgical
  • Pathologic snapping knee syndrome
    • Any extra or intra-articular structure that causes painful sounds, which can include ganglion cysts, lipoma, synovial nodules, fabella, osteochondromas, osteophytes

Management of these pathologic noises depends on the underlying cause.

Overall, noise around the knee is a common phenomenon, with one study suggesting 38.1% of women and 17.1% of men over 40. With this approach, careful evaluation of the noise can help prevent unnecessary diagnostic interventions and provide appropriate guidance for healthy patients experiencing physiologic noise.

 

Jim Niu MD, CCFP

Sport and Exercise Medicine Fellow, University of Ottawa

Advisor Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport Med

Chronic Exertional Compartment Syndrome – An Introduction

We have all heard of compartment syndrome. This is a medical emergency where increased pressures within a compartment can lead to rapid ischemia, muscle damage, and even potential amputation after a trauma or injury.

How many of us have heard of chronic exertional compartment syndrome (CECS)?

CECS is a cause of chronic exertional leg pain. Most often seen in young runners and elite athletes, it is a relatively unknown and underdiagnosed condition. Its incidence and pathophysiology are not well understood. One theory suggests a noncompliant fascia that cannot accommodate the expansion of muscle volume during exercise, causing increased intracompartmental pressures.

Suspect CECS with athletes who present with chronic anterior/lateral leg pain that worsens with prolonged use and resolves shortly upon cessation of activity. Most cases will occur in the anterior or lateral compartments. Classically, these athletes will be able to tell you that a specific time, distance, or intensity will bring on the symptoms, characterized as burning, aching, cramping, or pressure. It usually resolves fairly shortly if they stop the activity unless they continue to push through the symptoms for longer durations. It is fairly common to be bilateral. They may have some numbness/tingling in the dermatomal distribution of the nerve that runs through the compartment and weakness of those muscle groups.

Physical exam is often normal at rest. Some people will have visible painless fascial herniations. On physical exam immediately after exercise, there may be pain on palpation of the muscles involved, pain with passive stretching of the muscles, and the compartments may be quite firm. No imaging is necessary but will commonly be done to rule out other diagnoses such as a stress fracture. The diagnosis of CECS can be made clinically but given its non-specific nature, it can be confirmed using immediate post-exercise intracompartmental pressure testing. If confirmed, a surgeon may be consulted for an ELECTIVE fasciotomy.

The differential diagnosis includes medial tibial stress syndrome (shin splints), stress fractures, fascial defects, nerve entrapment syndromes, popliteal artery entrapment syndrome, and vascular or neurogenic claudication.

It is important to note that shin splints present with pain on the medial border of the tibia. Shin splints are NEVER lateral! A high level of suspicion is required for the diagnosis of ant/lat CECS as all imaging will be reported as normal.

While uncomfortable, there is no evidence to suggest that the pain from CECS indicates any muscle damage or has long-lasting implications. Modified activity is a reasonable treatment option. People may choose to avoid continuous running and opt to bike, swim, skate or play shorter shifts. Hopefully, this brief introduction sheds some light on the subject.

Jim Niu MD, CCFP

Sport and Exercise Medicine Fellow, University of Ottawa

Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport Med

Cancer Update 2018

The Champlain Regional Primary Care Cancer Program presents: CANCER UPDATE 2018

Friday, December 7, 2018, from 08:00-16:30
Ottawa Conference and Event Centre
200 Coventry Road, Ottawa, ON K1K 4S3 Cost: $125.00 (Until December 6, 2018)
$150.00 (After December 6, 2018)

Register online NOW!
www.cancerprimarycare.eventbrite.ca
For more information contact cancerprimarycare@toh.ca or 613-798-5555 x 15811

View details and agenda – print and share! Cancer Update 2018 – details and agenda

Meet regional experts & learn more about :

  • Cardiovascular Health and Cardiotoxicity
  • Pancreatic Cancer
  • Preserving Fertility After Cancer
  • Indigenous Health and Cancer  Genetics and Cancer
  • New Prostate Guidelines and Treatment
  • Advanced Care Planning
  • Pain Management
  • Population Health
  • Cancer Related Risk Factors
  • and more!

First-Aid Treatment for Friction Blisters: “Walking Into the Right Direction?”

Lando Janssen, Nenltje A.E. Allard, Dominique S.M. ten Haaf, Cees P.P. van Romburgh, Thijs M.H. Eijsvogels, Maria T.E. Hopman. Clinical Journal of Sports Medicine, Vol 28, No. 1, January 2018.

Trauma-induced separation within the epidermis, or friction blisters, are frequently encountered by patients choosing to be physically active to improve their overall health and well-being. Although most blisters are benign entities, complications including antalgic gait patterns, exercise-related or overuse injuries, cellulitis or sepsis can result. Thus, from the primary care physician’s perspective, the goal of treatment remains to reduce pain, facilitate healing and prevent both infection and recurrence.

However, much of the advice provided to patients regarding this topic is not evidence-based. To date, very limited research has been conducted to examine different treatment regimens for friction blisters. Furthermore, each study on this topic is limited to studying a homogenous population (elite athletes, military personnel). The purpose of this study was to compare the efficacy of fixation dressing versus adhesive tape in the first-aid treatment of friction blisters. These 2 methods were evaluated based on 1) Time of treatment application, 2) effectiveness, 3) material satisfaction in a large group of participants of the Nijmegen Four Days Marches (4DM). In addition, this study included a 1 month follow-up period to evaluate blister healing and complications when comparing treatments with different blister-covering materials.

The major findings of this prospective observational cohort study were:

  • Time of treatment application was significantly lower in the wide area fixation dressing group (41.5min, SD = 21.6min) compared to the adhesive tape group (43.4min; SD = 25.5min; P = 0.02).
  • A significantly higher drop-out rate in the 4DM was observed in the fixation dressing group as compared with the adhesive tape group (11.7% vs. 4.0%, respectively, P = 0.048)
  • There was no difference in pain intensity scores, infection rates, and the need for additional medical treatments. However, there was delayed blister healing in fixation dressing group (51.9% vs. 35.3%; P = 0.02) and a trend towards decreased satisfaction (P = 0.054) when compared to the adhesive tape group.

The authors conclude that despite a small, but significant reduction in the time of treatment application with wide area fixation dressings, these dressings resulted in delayed blister healing, a trend towards lower satisfaction, and a higher drop-out rate of in the 4DM. For these reasons, they do not recommend the use of wide-area fixation dressings in routine first-aid treatment for friction blisters and rather support the use of adhesive tape for this purpose.

Sean Mindra, MD, CCFP                                                                                                                  PGY3 – Sport and Exercise Medicine, University of Ottawa                                                      Advisor: Dr. Taryn Taylor BKin, MSc, MD, CCFP (SEM), Dip Sport & Exercise Medicine

 

Mental Health Resources for Primary Care Practitioners

A new resource to help family physicians support individuals with mental health and substance use problems

From the Mental Health Commission of Canada and the College of Family Physicians of Canada 

MONTREAL, Oct. 23, 2018 /CNW/ – Today, the Mental Health Commission of Canada (MHCC) and the College of Family Physicians of Canada (CFPC) launched the Best Advice guide: Recovery-Oriented Mental Health and Addiction Care in the Patient’s Medical Home at the Canadian Mental Health Association’s 3rd annual Mental Health for All (MH4A) Conference.

Family physicians deliver almost two-thirds of mental health services in Canada, yet some describe mental health and addiction as an area in which they would like further development. At the same time, people living with mental health or substance use problems often report that their needs are not being met. The new Best Advice guide represents a small step toward bridging that gap.

Developed in consultation with family physicians, mental health experts and people with lived experience, the guide offers a compendium of practical and easy-to-implement strategies and recommendations. It includes simple yet powerful tips for health care providers on how to open the door to important conversations on mental health and addiction issues — from using non-stigmatizing language and displaying signage in support of mental wellness to incorporating at least one question per visit that elicits a response about emotional health.

Family physicians are invited to learn more about the recovery-oriented approach — a concept in which the caregiver supports and engages the individual as an active participant in their own treatment and recovery. All primary care providers should find this guide useful in their daily practice. Similarly, people with lived experience are encouraged to share the guide with their physician to promote dialogue on how to break down barriers to receiving quality mental health care.

For more details please refer to the Best Advice guide: Quick Reference fact sheet.

Quick Facts

  • In 2012, 1.6 million people reported an unmet need for mental health care, and 7.5 million people in Canada were living with a mental health issue.
  • It is estimated that about one in five Canadian youths are affected by a mental illness at any given time and, by age 40, half of all Canadians will have experienced a mental health issue.
  • Almost 40 per cent of parents say they wouldn’t tell anyone, including their family doctor if their child was experiencing a mental health problem.
  • Patients who receive recovery-oriented, comprehensive mental health and addiction care in primary care settings experience greater satisfaction and better health outcomes.
  • The Patient’s Medical Home is the CFPC’s vision for the future of family practice in Canada. In this vision, every family practice offers care that is centred on individual patients’ needs, within their community, throughout every stage of life, and integrated with other health services.

About the College of Family Physicians of Canada 

The College of Family Physicians of Canada (CFPC) is the professional organization that represents more than 37,000 members across the country. The College establishes the standards for and accredits postgraduate family medicine training in Canada’s 17 medical schools. It reviews and certifies continuing professional development programs and materials that enable family physicians to meet certification and licensing requirements. The CFPC provides high-quality services, supports family medicine teaching and research, and advocates on behalf of family physicians and the specialty of family medicine.

About the Mental Health Commission of Canada 

The Mental Health Commission of Canada (MHCC) is a catalyst for improving the mental health system and changing the attitudes and behaviours of Canadians around mental health issues. Through its unique mandate from Health Canada, the MHCC brings together leaders and organizations from across the country to accelerate these changes. Each of its initiatives and projects is led by experts who bring a variety of perspectives and experience to the table. The MHCC’s staff, Board, Advisory Council and Network of Ambassadors all share the same goal — creating a better system for all Canadians.

Stay Connected

Follow MHCC on Facebook

Follow MHCC on Twitter

Follow MHCC on LinkedIn

Follow MHCC on Instagram

Subscribe to MHCC on YouTube

www.mentalhealthcommission.ca

www.cfpc.ca

For further information: Samuel Breau, Manager, Communications & Stakeholder Relations, Public Affairs,

Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis

Enke, Oliver, et al. “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ 190.26 (2018): E786-E793.

Back pain is a common issue seen in the family medicine practice that can result in significant morbidity. There are many therapies and pharmacological options available for the treatment of back pain, but high-quality studies showing efficacy are lacking for many of these options. In 2012, a BMJ review showed treatment benefit of gabapentin for low back radicular pain based on one study, and a few although not all guidelines subsequently suggested a trial of anticonvulsants for patients with acute neuropathic pain. This has resulted in a significant increase in the use of anticonvulsants in the family practice setting for low back pain. This review examines the use of anticonvulsants (topiramate, gabapentin or pregabalin) to treat low back pain with or without radicular pain. 9 studies were examined for a total of 859 participants. Of note, however, this study was not able to perform any significant subgroup analysis, such as acute vs chronic low back pain.

  1. Low back pain with or without radiating leg pain
    1. Gabapentin
      1. No effect for pain in short term. High-quality evidence.
      2. No effect for pain in the intermediate term, low-quality evidence
    2. Topiramate
      1. Small clinically significant improvement pain in short-term, moderate evidence
      2. No effect on disability in short-term
    3. Lumbar radicular pain
      1. Gabapentin or pregabalin
        1. No effect on pain in intermediate term, high quality evidence
        2. No effect on disability in short, intermediate, and long term, moderate evidence
      2. Topiramate
        1. No effect on pain or disability in short term. Low quality evidence
      3. Adverse events
        1. Higher in anticonvulsants compared to placebo, high quality evidence
        2. Most common side effects: drowsiness, somnolence, dizziness, nausea

In summary, this review suggests that anticonvulsants do not appear to improve patients’ pain or disability with regards to back pain, with or without radicular pain. While there are many nuances, the key to treating back pain without red flags remains centred on patient education, exercise therapy, and getting a multidisciplinary treatment program involved whenever possible.

Jim Niu PGY3 Sport and Exercise Medicine Fellow

Advisor: Dr. Taryn Taylor, BKin, MSc, MD, CCFP (SEM), Dip Sport Med

BounceBack Endorsement from Dr. Max Buxton

My name is Max Buxton, and I am a family physician in the Ottawa Valley. Like many other primary care providers, I have at times felt overwhelmed by patients seeking help for depression and anxiety. The problem is not uniquely rural, but the lack of services available to rural patients provides an additional barrier to addressing the problem.

A relatively new service that I have found very helpful, and that my patients have come to appreciate is BounceBack.

BounceBack provides cognitive behaviour therapy through an online program, with the help of a coach who contacts your patient directly via phone or email, and guides them through a series of CBT exercises.

The program is funded by the Ontario Ministry of Health and requires a referral from a registered nurse practitioner or family physician.

Feedback from my patients to date has been universally positive, and it has given me something to offer people who may have no access to a psychiatrist, no coverage for psychologic services, and limited ability to travel.

The referral process is simple. Forms can be downloaded from bouncebackontario.ca, along with a brief screening questionnaire for the patient to complete. The referral can be faxed, emailed or submitted directly through some EMR’s. BounceBack has helped my patients with anxiety and mild to moderate depression. Maybe it can help your patients too.

See related article: https://primarycaredigest.org/2018/09/18/new-mental-health-resources-available-to-everyone-who-needs-them/

Interprofessional Spinal Assessment & Education Clinic (ISAEC) rolling out across Champlain

By  Dr. Aly Abdulla,

BSC, MD, LMCC, CCFPC, DipSportMed CASEM, FCFCP, CTH (ISTM), CCPE, Masters Cert Phys Leader

Medical Director The Kingsway Health Centre

FHO Lead Manotick Rideau River South BAPH

Assistant Professor The University of Ottawa Faculty of Medicine

Clinical Instructor The University of Ottawa Faculty of Nursing

Ottawa West LHIN Subregional Clinical Lead

I am a family doctor in Manotick in a 20 doctor Family Health Organization (FHO). I am also a sports medicine doctor so I receive many referrals for various musculoskeletal issues. The most common referral is for chronic low back pain (LBP). These patients don’t seem to get better with conventional therapy or after so many weeks. There is a consideration for an MRI and a neurosurgeon consult but the wait list is too long so they decide to send the patient to me. Many doctors (and patients) find this challenging.

But there is another option:

The ISAECS Interprofessional Spine Assessment and Education Program is a great resource in our community to manage these cases. In addition, they provide a robust educational program online (for patients and doctors) at your convenience to improve outcomes. Here are some highlights:

  • Is your pain back or leg dominant?
  • Is the pain constant or intermittent?
  • What position makes it worse/better (flexion or extension)?
  • What have you tried and failed?
  • How disabled are you?
  • The use of red flags (NIFTI guide for critical pathology),
  • yellow flags or STarT Back (for risk of chronicity) and
  • the Opioid Risk Tool (to prevent addiction).

The biggest benefit is the patient self-management and the CORE back tool home exercises.

The ISAEC program provides optimisation of conservative management including exercise prescription, education and advice, support and appropriate referral if needed.

SEE: 1. http://www.isaec.org/educational-resources.html

SEE: 2. https://www.drugabuse.gov/sites/default/files/files/OpioidRiskTool.pdf

SEE: 3. https://www.thewellhealth.ca/wp-content/uploads/2016/04/CEP_CoreBackTool_2016-1.pdf