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    Teeth.jpg
    Lisa Bywaters
    13/Jul/2023
    Health InformationMSK articles

    The importance of good oral health

    Hate going to the dentist? You’re not alone. Many of us become anxious or worried about visiting the dentist.

    But for people with a musculoskeletal condition, taking care of their teeth and gums – including the dreaded visit to the dentist – can also be painful.

    We’ve got some tips to help make this a little easier.

    But first, why should we care about oral health?

    Looking after the health of your mouth, teeth, gums, and the structures that support them helps you keep your teeth healthy and intact for longer as you age. This is important because it makes you feel more confident and comfortable when speaking, smiling, eating, and laughing.

    Poor oral health is also linked to diabetes, heart disease, stroke and respiratory conditions. And in some studies, gum disease has been linked to rheumatoid arthritis.

    So oral health is important. Got it. 👍

    Musculoskeletal conditions and oral health.

    There are various reasons why people with musculoskeletal conditions may have difficulties with their oral health, such as:

    Pain. Pain can affect your ability to open your mouth for the time it takes to clean and floss your teeth or to keep your mouth open during a check-up. It can also affect your ability to hold and use a toothbrush or dental floss.

    Dry mouth. Whether it’s due to a health condition such as Sjogren’s syndrome or taking certain medicines, having a dry mouth reduces the amount of saliva in your mouth. And that’s a problem because saliva washes away food remnants, neutralises the acids in your mouth, helps prevents bad breath, tooth decay and gum disease, and protects your teeth’s enamel.

    Being immunosuppressed or having a weakened immune system due to your condition or medicines can increase your risk of infections, including oral thrush and mouth ulcers.

    Taking care of your oral health.

    Get brushing.

    While it sounds obvious, you need to clean your teeth, tongue and gums twice a day for at least two minutes for good oral health. But according to the Oral Health Tracker, only about half of us do this 😮.

    And yes – I did say brush your tongue. Gently brushing your tongue removes any bacteria, other microbes or bits of food lurking there.

    For more info, check out the Australian Dental Association’s brushing basics.

    Oh – and if you need some help knowing if you’ve brushed for two minutes, or to make it fun for the kids, check out Spotify and YouTube for music to brush your teeth by. There’re plenty of playlists and songs out there! 🎶🎵 Or get creative and make your own. 😉🎵🎶

    Choose your tools.

    Toothbrushes. I don’t know why, but I always thought using a hard toothbrush and giving my mouth a good old scrub was the way to clean teeth. Turns out, a softer brush is the best choice. And you shouldn’t use too much pressure when brushing; it’s bad for your teeth and gums and can aggravate your joint pain. Brushing too hard also wears down the bristles of your toothbrush faster.

    If the handle of your toothbrush is difficult to hold, you can make it thicker and easier to grip by adding some thick rubber or foam tubing to the handle. You can pick this up at the hardware store.

    An electric toothbrush is another option, especially if pain or dexterity affects your ability to brush. Electric toothbrushes also generally have a bigger handle that may be easier for some people to grip; however, they’re also a bit heavier than a standard toothbrush, so you’ll need to consider that.

    Whether you use a standard or electric toothbrush, you need to change the brush regularly. That’s generally every three months or sooner if you notice the bristles falling out or pointing in the wrong direction.

    Toothpaste. There are so many varieties of toothpaste available it can be hard to choose one! The good news is that a Choice article reports that ‘most toothpastes contain essentially the same ingredients’ and do the same thing – remove plaque and prevent tooth decay and cavities. So choose the toothpaste you like.

    But if you have a dry mouth or sensitive teeth and gums, talk with your dentist about the best toothpaste for you.

    Dental floss. Flossing is essential to teeth cleaning as it helps remove food particles and microbes from between your teeth. Not flossing increases your risk of developing tooth decay and gum disease. However, according to the Australian Dental Association, many of us forget to floss our teeth, with only one in four people saying they floss daily 😐.

    But using dental floss can be a challenge if you have sore hands. Talk to your dentist about other options, such as dental floss picks (not toothpicks), interdental brushes, water flossers and electric flossers.

    Mouthwash. Most people don’t need mouthwash, especially if you’re cleaning and flossing regularly and properly.

    Many types of mouthwash kill the bacteria in your mouth, both good and bad. They can also mask bad breath, which may indicate an infection or other problem. And they can be irritating if you have a sensitive mouth.

    But mouthwash may be helpful if you have a dry mouth, as certain types can help stimulate saliva.

    So what to do? Have a chat with your dentist about whether or not a mouthwash is appropriate for you.

    Check yourself out. 😁

    The best way to stay on top of any problems is to regularly check your teeth and gums for changes. That way, if you notice any bleeding, inflammation, signs of infection, or other issues, you can see your doctor or dentist and get on top of it quickly.

    See your dentist regularly.

    You should see your dentist every 6-12 months to ensure good oral health. Or sooner if you have toothache, damage to your teeth and gums, or pain or sensitivity when eating or drinking. When combined with regular brushing and flossing, seeing your dentist regularly will reduce your risk of needing more invasive and costly procedures in the future.

    If you have problems keeping your mouth open for long periods and/or lying in the chair while having a check-up, discuss this with your dentist. There are options to make this less painful, such as:

    • Using pain-relieving medicines or heat/cold packs before and after your visit.
    • Taking breaks. Have an agreed signal with your dentist – for example, raising your hand – if you need to move, close your mouth, or relax your jaw.
    • Distraction, for example, put on some headphones and listen to music, a podcast or a book.
    • Using your supports, for example, a cushion or blanket that helps you relax and get comfortable.
    • Visiting your dentist more frequently but for shorter visits, so you don’t have to spend so much time in one sitting. Though this can become costly, so talk with your dentist about your options.

    Your dentist may also suggest using a mouth prop. Mouth props are rubbery, flexible tools that dentists can place between your teeth to help reduce muscle fatigue caused by keeping your mouth open wide.

    Eat well.

    A healthy diet with a variety of nutritious foods and plenty of water is best for your oral health and general wellbeing. You should also limit your intake of foods high in sugar and snacks between meals.

    Quit smoking.

    Smoking and vaping increase your risk of gum disease.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

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    Lisa Bywaters
    13/Jul/2023
    Health InformationMSK articles

    Shining bright

    Every year on 29 June, people mark World Scleroderma Day. This year, many landmarks around Australia shone gold like sunflowers in June to support people living with scleroderma.

    What’s the connection between scleroderma and sunflowers? 🌻 🌻 🌻 And what exactly is scleroderma?

    According to Scleroderma Australia, just as sunflowers follow the sun for warmth, people with scleroderma find the warmer weather more comfortable. That’s why sunflowers have become a hopeful symbol representing scleroderma in many parts of the world, including Australia.

    “I want to be like a sunflower; so that even on the darkest days I will stand tall and find the sunlight.” – Unknown

    Scleroderma is a chronic (or long-term) condition that affects your connective tissue. The word scleroderma literally means ‘hard skin’; as you’ll see, it’s an apt name for this condition.

    Connective tissue is the cells and fibres that hold together the millions of cells of your body. It ‘connects’, or supports and holds together your joints, muscles, internal organs, skin and other body tissues. Types of connective tissue include bone, cartilage, fat, blood, and lymphatic tissue.

    The connective tissue of people with scleroderma has too much collagen, which causes it to become hard and tight.

    Anyone can develop scleroderma, but it’s more common between the ages of 30 and 60 and is more common in females.

    There’s no cure for scleroderma, but it can be managed effectively.

    We don’t know the cause.

    Scleroderma is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Your immune system is designed to identify foreign bodies (e.g. bacteria, viruses) and attack them to keep you healthy. But in the case of scleroderma, your immune system mistakenly targets healthy tissue. This triggers connective tissue cells, especially a cell type called fibroblasts, to make too much collagen and other proteins. This leads to the hardening and scarring of the skin and other tissues.

    We don’t know why this happens. Scientists believe a complex mix of genes and environmental factors may be involved.

    There are different types of scleroderma.

    There are two broad classifications of scleroderma based on the amount of skin and other organs affected.

    Localised scleroderma mainly affects the skin. It can affect both adults and children. There are two types of localised scleroderma, morphea and linear. Both have distinctive signs and symptoms. Localised scleroderma can sometimes restrict normal joint movement due to the hardening of the skin over the joint.

    Systemic scleroderma (or systemic sclerosis) affects internal organs like the heart, lungs, kidneys, and skin. Systemic means it affects several organs and tissues, or the entire body, rather than a single organ or body part. Sclerosis means abnormal hardening of body tissue.

    Systemic scleroderma can also be broken into sub-types depending on the symptoms. They are limited scleroderma and diffuse scleroderma.

    Symptoms vary.

    The symptoms of scleroderma vary from person to person and will depend on the type you have.

    Symptoms can include:

    • thickening and hardening of the skin
    • skin dryness and ulcers
    • sudden constriction of the blood vessels, resulting in pale, blue, or red fingers or toes (Raynaud’s phenomenon)
    • stiffness and pain in the muscles and/or joints.

    If some of your internal organs are involved, you may experience:

    • digestive issues, such as heartburn, bloating, constipation, stomach pain
    • lungs problems, such as shortness of breath
    • heart problems, such as chest pain
    • kidney problems may lead to high blood pressure.

    While these symptoms sound very scary, your doctor and specialist/s will monitor your condition and symptoms to prevent/treat complications.

    “Keep your face to the sunshine and you cannot see the shadow. It’s what sunflowers do.” – Helen Keller

    It can be difficult to diagnose.

    Scleroderma can be a difficult condition to diagnose. Symptoms vary significantly from one person to another and are similar to those of other conditions. They can also change or fluctuate. So, it may take some time to get a definitive diagnosis of scleroderma.

    No single test can diagnose scleroderma, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

    •  Your medical history.
    •  A physical examination.
    •  Blood and urine tests.

    There’s no cure, but there are effective treatments.

    While there’s currently no cure for scleroderma, medicines can help ease your symptoms. Your doctor will develop a treatment plan based on your symptoms. You’ll generally start on the lowest possible dosage and, if necessary, slowly increase the dose until your symptoms are under control. All medicines have side effects, so you should discuss these with your doctor.

    Medicines may include:

    • Topical corticosteroid (steroid) creams that you apply to your skin.
    • Anti-inflammatory medicines to help manage pain and control inflammation.
    • Corticosteroids taken as a tablet, injection, or into the vein (intravenous or IV) act quickly to control or reduce inflammation and may be used in the short term. They aren’t used for long periods as they’re associated with serious side effects.
    • Medicines that suppress your overactive immune system and control symptoms. These medicines may also be in the form of topical creams, tablets, injections, or IV infusions.

    As well as seeing your GP, you’ll likely see a skin specialist (dermatologist) and a specialist in joint and muscle conditions (rheumatologist). Other healthcare providers, like respiratory physicians and gastroenterologists, may be involved in your ongoing treatment.

    There are things you can do to manage your condition.

    Learn about scleroderma. Knowing as much as possible about your condition means that you can make informed decisions about your healthcare and actively manage it.

    Lifestyle changes. Avoid exposure to cold temperatures, dress warmly and don’t smoke. This will help you manage Raynaud’s phenomenon.

    Stay active with regular exercise. Exercise will reduce tightness and help keep your joints moving, especially those areas affected by scleroderma, such as the hands and wrists. Exercise will also strengthen your muscles and improve overall health. Talk with a physiotherapist or exercise physiologist about an exercise program tailored to your condition and symptoms.

    See a hand therapist. They’re qualified physiotherapists or occupational therapists with extensive knowledge and skill in understanding and treating problems with the fingers, wrists, elbows and shoulders. They can help you keep your hands and wrists flexible and moving well.

    Aids and equipment. Scleroderma can make some actions difficult, for example, using door handles or getting dressed. An occupational therapist can advise on aids and other gadgets that may help and provide additional solutions to make life easier.

    Eat well. Eating a balanced diet can help provide you with better energy levels, help to maintain your weight, and give you a greater sense of wellbeing.

    Get support from others. Research has shown that people with positive social support cope better with pain and chronic conditions. Family, friends, colleagues, and health professionals can help you manage. A peer support group may be another option. Contact Scleroderma Australia for details on support options in your state or territory.

    “Someone was sitting in front of a sunflower, watching the sunflower, a cup of sun, and so I tried it too.
    It was wonderful; I felt the whole universe in the sunflower. That was my experience. Sunflower meditation.
    A wonderful confidence appeared. You can see the whole universe in a flower.“ – Shunryu Suzuki

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
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    Lisa Bywaters
    21/Jun/2023
    Health InformationMSK articles

    A disease of the bone

    What do a 10th-century Viking/poet, the subject of a 16th-century painting, and an 18/19th-century composer have in common?

    Researchers at one time or another speculated they all had Paget’s disease of bone. That the physical features of Egil Skallagrímsson and the Ugly Duchess, and Beethoven’s deafness resulted from living with untreated Paget’s disease.

    Later research has thrown shade on these speculations. And in reality, we may never know if they did or didn’t have Paget’s disease. And remember, one’s a painting! But it’s an interesting bit of trivia to store away in the back of your brain. You never know when it might come in handy. 😉

    So what is Paget’s disease?

    Paget’s disease of bone is a chronic condition that causes abnormal enlargement and weakening of bones. Any part of the skeleton can be affected, but the most common sites include the skull, spine, pelvis, thigh bone, shin and upper arms. It can affect one bone or many bones.

    Paget’s disease tends to affect people over the age of 50. It affects slightly more men than women.

    Paget’s disease of bone is named after Sir James Paget, a 19th-century English surgeon and pathologist. Paget was quite the go-getter and was the first to describe many medical conditions, several of which bear his name. However, they shouldn’t be confused with Paget’s disease of bone.

    Bones and Paget’s disease

    To understand how Paget’s disease affects bones, it’s helpful to know how bones work.

    Although we often consider them dry and lifeless, bones are living tissue that are constantly changing throughout life. This is called ‘remodelling’.

    Bone cells called osteoblasts build new bone (formation), while other bone cells, osteoclasts, break down and remove old bone (resorption). This process is controlled by hormones such as calcitonin, parathyroid hormone, oestrogen (in women), testosterone (in men), and vitamin D.

    In a person with Paget’s disease, the osteoblasts become overactive, producing too much bone tissue. The abnormal growth results in the affected bones becoming deformed (e.g. bowed leg bone), enlarged and weak. The new bone also contains more blood vessels than normal bone.

    The reason for this accelerated bone growth is unknown. A combination of genetic and environmental factors (e.g. a virus) is suspected.

    Causes, symptoms and diagnosis

    As with most musculoskeletal conditions, we don’t know the cause of Paget’s disease. However, some factors increase your risk of developing it. They include:

    • Genetics. You’re more likely to develop it if you have a family history of Paget’s disease.
    • Ethnicity. It’s more common in people from England, Scotland, central Europe and Greece, and countries settled by European immigrants (e.g. Australia and New Zealand).
    • Age. Paget’s disease becomes more common with age, but it’s rare before age 55.

    Many people don’t realise they have Paget’s disease because they don’t have any symptoms or only mild symptoms. Symptoms vary but may include:

    • bone pain
    • enlarged or misshapen bones
    • warmth over affected bones due to increased blood supply to the bone
    • osteoarthritis.

    Paget’s disease is often discovered by accident when x-rays are taken for another reason or a bone is broken. Diagnosis can be confirmed with further x-rays, bone scans or a blood test that checks for an enzyme crucial to bone growth called alkaline phosphatase.

    Treatment

    There’s no cure for Paget’s disease; however, your symptoms can be effectively managed with medicines and self-care.

    Your doctor may refer you to a specialist, such as a rheumatologist or endocrinologist. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system, while endocrinologists specialise in diagnosing and treating problems of the endocrine system.

    Medicines.

    The types of medicines used for Paget’s disease include:

    Calcium and vitamin D may be recommended as both are essential for good bone health. You can get calcium through your diet and vitamin D through safe exposure to sunlight. If you’re concerned you’re not getting enough calcium and vitamin D, talk with your doctor about whether you need supplements.

    Stay active.

    Exercise helps maintain bone health and joint mobility and strengthens muscles. However, as bones are weaker and more susceptible to fracture, some exercises may not be suitable for people with Paget’s disease. It’s best to talk with a physiotherapist or exercise physiologist about the most appropriate exercise plan for you.

    Enjoy a healthy, well-balanced diet.

    This can help you maintain a healthy weight and reduce your risk of other health problems. Make sure you include calcium-rich foods.

    Learn new ways to manage pain.

    There are many ways to manage pain, and different strategies will work for different situations. Read our A-Z guide for managing pain for more information.

    Complications

    For most people, Paget’s disease progresses slowly and can be managed effectively. However, in some cases, complications can arise, including:

    • Osteoarthritis. In joints close to bones affected by Paget’s disease, the cushioning cartilage on the ends of the bones can break down, causing pain and stiffness.
    • Broken bones. The new bone growth is fragile and more susceptible to breaking than healthy bone.
    • Hearing loss may be caused by pressure on nerves in the ear.
    • Numbness or tingling in the spine caused by pinched nerves in the spinal cord.
    • Too much calcium in the blood. When several bones have active Paget’s disease, the increase in bone breakdown can lead to an elevated blood calcium level. This is rare, but it can cause symptoms such as fatigue, weakness, abdominal pain, constipation, and loss of appetite.
    • Very rarely, Paget’s disease can cause heart failure or bone cancer.
    • In severe cases, surgery may be required to relieve pinched nerves or bone fractures or to replace a joint severely affected by arthritis.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

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    Lisa Bywaters
    21/Jun/2023
    Health InformationMSK articles

    Exercising for bone health

    We all know regular exercise is essential for good health. It can improve the fitness of your heart and lungs, sleep quality, energy levels and mental wellbeing. And it can reduce your risk of developing conditions such as diabetes.

    Exercise is also vital for the health of your bones.

    Like muscle, bone is living tissue that responds to exercise by becoming stronger. People who exercise regularly have stronger bones and higher bone density than those who don’t. This reduces the risk of developing osteoporosis.

    Exercise also increases your balance, coordination and flexibility, which improves your ability to prevent trips and falls. DYK, falls are Australia’s largest contributor to injuries that require a stay in hospital and are a leading cause of injury deaths? More than half of the hospitalisations were due to broken bones (fractures).(1)

    Bones need exercise.

    To understand why exercise is important for bone health, it helps to know how bones work.

    Throughout your life, your bones are constantly changing. This is called ‘remodelling’. Bone cells called osteoblasts build new bone, while other bone cells (osteoclasts) break down and remove old bone. This process is controlled by hormones such as calcitonin, parathyroid hormone, oestrogen (in women), testosterone (in men), and vitamin D.

    From birth to about 25, you build more bone than you lose. Your bones are not only getting bigger as you grow, but they’re also developing their density. This determines how strong they are.

    From about 25 to 50, your bones break down and rebuild at about the same rate. They’re in a state of balance. This is when you’ve achieved your ‘peak bone mass’. Your bones are at their strongest.

    After about 50, you break down more bone than you rebuild. While this means everyone will experience some bone loss as they age, it doesn’t mean everyone will develop osteoporosis.

    Women commonly experience a period of rapid bone loss after menopause. This is due to a drop in oestrogen levels. It’s estimated that the average woman loses up to 10% of her bone mass in the first five years after menopause.(2)

    For good bone health, exercise is vital for everyone – from the very young to the very old.

    A combination of different exercises is best for bone health.

    Different exercises challenge and strengthen your bones and muscles in different ways, so you should include the following in your exercise plan:

    Weight-bearing exercises or activities where your body carries its own weight. These exercises put stress on your bones, making them stronger and denser. It also strengthens the muscles around your bones, providing support and reducing the risk of fractures. Weight-bearing exercises include brisk walking, climbing stairs, tennis, and netball.

    High-impact exercises such as jogging, running, jumping, and skipping rope. They’re also weight-bearing exercises, but they place greater stress on the bones of the spine and legs as your feet hit the ground. This can provide more bone-strengthening benefits; however, these exercises aren’t suitable for everyone.

    Resistance training, also known as strength training, uses resistance or weights to strengthen your muscles by working them harder than you do in everyday life. The strong muscle contractions required to move a heavy weight place stress on the bone where the muscle attaches. When bone feels this strain repeatedly, it responds by becoming stronger. Resistance training uses equipment like free weights (e.g. dumbbells), gym machines, elastic resistance bands or your body weight (e.g. push-ups, squats).

    Balance and flexibility exercises such as tai chi and yoga improve balance and mobility and can reduce your risk of falling. This is important for preventing fractures.

    Before beginning an exercise program, speak with your health professional. Not all types of exercise are suitable for everyone. This is especially important if you have other health conditions, including osteoporosis. A physiotherapist or exercise physiologist can assist you with a safe exercise program that targets your specific needs and reduces your risk of injury.

    Exercise must be regular and ongoing.

    You need to exercise regularly to have a significant benefit, so you should choose activities you enjoy. This will make it easier to exercise consistently.

    Australian physical activity and exercise guidelines recommend that all adults be active most days, preferably every day, for 30 minutes or more. This includes at least two sessions of strength training every week. However, when you’re just beginning, this can seem daunting.

    That’s why it’s good to know you don’t have to do all your exercise in one session. For example, a 30-minute brisk walk can be broken up across your day into shorter, more achievable sessions, such as three 10-minute or six 5-minute walks.

    You can do other things to make exercise a regular, ongoing activity.

    Exercise with a group or a partner. This can improve your motivation to exercise and provides an opportunity for socialising with others.

    Exercise SMART and set goals. A clear goal can motivate you to stay on track with your exercise program. But they must be realistic and specific to your abilities, needs, and health issuehttps://msk.org.au/goals/s. So, ensure your goal is SMART – Specific, Measurable, Achievable, Realistic and has a Timeframe.

    For example, a good SMART goal for resistance training for stronger bones and muscles could be: “I will perform resistance exercises, such as lifting weights or using resistance bands, for 30 minutes, twice a week, for the next three months.”

    This goal is Specific (focuses on resistance training), Measurable (30 minutes, twice a week), Achievable (realistic for most people), Relevant (aimed at improving bone and muscle strength), and has a Timeframe (three months).

    Constantly evaluate your goals, adjust them as needed and reward yourself for your successes.

    Add variety. Vary where you exercise and the type of exercise you do. Include recreational activities such as bushwalking or dancing. This will help keep your mind fresh and your motivation high. Find activities that are enjoyable to you so that you’ll be motivated to continue doing them.

    Exercise within your capabilities. Often, people drop out of exercise programs because they exercise at a level beyond their current capabilities. Ensuring your exercise program suits your current abilities will decrease your risk of injury and increase your enjoyment and motivation to continue your exercise program.

    Challenge yourself. Increase the intensity of your exercise as your fitness improves. It’ll make your exercise more interesting and also has greater health benefits.

    Stop if you have pain. Don’t continue exercising if you experience pain or severe discomfort. Talk with your fitness professional for advice to ensure you’re not doing an exercise incorrectly.

    Bone health doesn’t happen in a vacuum.

    As well as exercise, you need to also to eat a nutritious diet with calcium-rich foods, get sufficient sun exposure for vitamin D, take medicines or supplements as prescribed by your doctor, quit smoking, and moderate your use of alcohol, caffeine, and salt intake, as they can impact bone density.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Falls. Australian Institute of Health and Welfare.
    (2) Osteoporosis, Australasian Menopause Society

    CONTINUE READING
    Test-image-clock.jpg
    Lisa Bywaters
    21/Jun/2023
    Health InformationMSK articles

    16 ways you can maximise micro-moments

    It’s hard to believe we’re already halfway through 2023 😮.

    I don’t know about you, but after years of forced-slowness I’m finding life incredibly busy and fast! Catching up with friends and family, working in the office, weekend adventures, professional development, hobbies, looking after my health – it can be a bit overwhelming. And when I’m feeling overwhelmed, I feel more pain, fatigue and anxiety.

    Which is a problem 😕.

    But I know from experience that having someone tell me to just relax or breathe 😑 isn’t going to help at the time. Especially if I’m already feeling time-poor and stressed.
    What I have found works is taking advantage of micro-moments for self-care. Small pockets of time when I can look after myself.

    Using these small moments for ‘me time’ is much more achievable than trying to shoehorn 30 minutes of yoga into my crowded mornings or planning and cooking MasterChef-worthy dinners every night 👩🍳. Using these moments for small acts of self-care to do what I need has really helped. I’m finding improvements in my anxiety, sleep quality, and pain.

    But don’t just take my word for it. The World Health Organization (WHO) says the “sustained adoption of quality, evidence-based self-care interventions can reduce mortality and morbidities and improve health and wellbeing”. (1)

    You too can maximise these micro-moments and reap the benefits of regular self-care. They can be done anywhere, anytime, and won’t cost you a thing. Here are some of our ideas for embracing micro-moments.

    Get physical.

    We talk about exercise a lot, but it really is a great way to look after your physical, mental and emotional wellbeing. Small bursts of activity can be added to your existing exercise routine for fun and to mix things up 🏃🤸🚴. Or if you’re not exercising regularly, they can help ease you back into becoming more active.

    Exercise is so adaptable. You can do it on your own or with others. You can take two minutes to stretch and move at your desk or dance in your lounge for an entire song. You can take a short walk in your local park, mow your front lawn (unless it’s enormous – in which case, mow a section), clean out a cupboard, or do a five-minute cardio blast. Whether it’s structured or incidental exercise, it all adds up. And as they’re micro-moments, they aren’t large blocks of time. So you’re more likely to fit them into your day, less likely to become fatigued or strain yourself, and still reap some of the benefits of being active. And you may have a tidy cupboard or freshly mown lawn at the end! 😉

    Breathe.

    I know, I know. At the start of this article, I said that when someone tells me to breathe, it doesn’t work. But that’s usually regarding a ‘just breathe, Lisa’ when someone cuts me off in traffic 😣.

    Now I’m referring to focused and controlled breathing. It’s a simple and effective technique to relieve pain and stress that can be done anywhere and at any time. You can do it at home, at work, on a train, in a waiting room, or in your car in traffic 😉. It’s useful when you’re trying to sleep or waiting for your pain meds to kick in. We take breathing for granted and often forget how effectively it relieves stress and anxiety. So remember to breathe…

    “Breathing in, I calm body and mind. Breathing out, I smile.
    Dwelling in the present moment I know this is the only moment.”
    Thich Nhat Hanh

    Use your senses.

    I love this one 💜 and use it a lot. It’s where you use your five basic senses – touch, sight, hearing, smell and taste – to identify things in your current space that relate to those senses. You can find one thing per sense – for example, I can feel the warmth of my heat pack on my shoulder, I can see leaves falling outside my window, I can hear my cat running around the house like a lunatic🐈, I can taste my tea, and I can smell the orange oil in my candle.

    Or you can try the 5, 4, 3, 2, 1 method. For example, 5 things you can hear, 4 things you can see, 3 things you can feel, two things you can smell, and one thing you can taste. And mix up the senses and numbers of things you’re finding depending on your situation. For example, when eating lunch, switch it to 5 things you can taste, 4 things you can smell, etc. It’s a great way of focusing on what you’re doing at that time.

    Do a body scan.

    The body scan is a type of meditation where you mentally scan your body from head to toe, paying attention to how each part feels. It helps you relax, become more aware of your body, and brings a sense of calm to your mind. Check out our short body scan script to help you get started.

    Use your imagination.

    What works for me won’t necessarily work for you. Plus, you don’t want things to become stale and boring. So mix it up. Read a chapter of a book, make balloon animals, do some guided imagery, call a friend, plant a herb garden, knit, paint, sculpt, fly a kite, breathe deep of your first morning coffee… whatever makes you happy, relaxes you, brings you into the moment, and sharpens your attention. Do it.

    Focus on the moment and savour the experience.

    With such busy, active lives, we often miss some of the small joys and experiences. So slow down and focus. For example, when you’re eating an apple, savour the feeling of the first crunchy bite and the taste as the juices burst into your mouth. Or when you head outside for a walk, breathe in the cool, crisp smell of winter… what can you smell? When you’re catching up with a friend, really listen to what they’re saying and enjoy their company – remember it wasn’t so long ago that we couldn’t meet in person 😔. Focus on the moments and enjoy them.

    “What day is it?” “It’s today,” squeaked Piglet.
    “My favourite day,” said Pooh
    Piglet & Winnie the Pooh

    Drink water.

    When you’re busy, it’s easy to forget to hydrate. But it’s vital for our health and wellbeing. Water lubricates and cushions your joints, aids digestion, prevents constipation, keeps your temperature normal and helps maintain blood pressure. It carries nutrients and oxygen to your cells, flushes out toxins, and cushions the brain and spinal cord. It can also help prevent gout attacks, boost energy levels and fight fatigue. It’s practically magic! ✨ Make sure you grab your glass or water bottle and drink up throughout your day.

    Go to the toilet.

    I’m sure it’s not just me who gets caught up in work or another activity and thinks, “I’ll go to the loo as soon as I finish X, Y or Z”. But before you know it, you don’t just need to go, you really NEED to go 😶. And even though I’m pretty sure it’s a physical impossibility, I always have visions of Grandpa Simpson’s kidneys exploding from not going to the toilet. So please, just go to the toilet when your body tells you it’s time 😊.

    Reflect.

    When cleaning your teeth, think about your day. What are you looking forward to? What are two things you really want to achieve? What went well in your day? What two things are you thankful for? Take a small moment to reflect on your upcoming day or the day that’s been.

    “Learn from yesterday, live for today, look to tomorrow, rest this afternoon.”
    Charles M. Schulz

    Leave your phone at home.

    Relax!! I don’t mean all the time. (I had palpitations reading that too 😂😉)

    Our phones are so much a part of our lives that it‘s hard to imagine not having them with us. But every now and then, leave your phone at home when you go outside. You won’t be distracted by the constant ring, dings, alerts and chirps it makes. And you can focus on the world and people around you.

    Declutter.

    Feel like you’ve got clutter and mess invading all of your spaces? Spend five minutes tidying one area and putting things back in their place. Do this once daily, and you’ll soon feel calmer and more relaxed. Don’t like cleaning? Pop on some music and do what you can in the space of one or two songs. Then stop cleaning, go do something else and enjoy the calm.

    “Out of calmness comes clarity.”
    Trevor Carss

    Stretch.

    Another one of my faves. Stretching is great for loosening up tight, stiff muscles and joints that have been in one position for long periods. I love stretching my arms above my head or arching my back when I’ve been sitting at my desk for some time and feeling stiff… bliss. It doesn’t take long, and it feels so good 😊

    Versus Arthritis have some videos with various stretches for you to try. They’re a bit longer than a micro-moment but worth checking out. Watch them and find the ones that work for you. Or speak with a physio about stretches you can do daily to ease muscle tension and pain.

    Hug someone.

    Being able to touch or hug others reduces stress, anxiety, and depression and makes you feel good. And here’s a tip from me to you: don’t save your hugs for when you’re feeling down. Hug each other when you feel happy, excited, or just because it’s Wednesday 😍.

    “A hug a day keeps the demons at bay.”
    German Proverb

    Plan a meal or two for your upcoming week.

    Having an idea about what to cook during the week can be challenging and often stressful. But pre-planning a meal or two (or more if you’re able) can help immensely. Think about your week ahead – what are your time commitments and responsibilities? Do you have time to be creative and adventurous with your meal planning? Or do you need to keep it basic and simple? What do you have in the fridge, freezer and pantry? Once you’ve established all that, write down some meal ideas, pick up any extra ingredients you need, and you’re on your way!

    Give yourself time.

    Hands up if you’re often rushing from pillar to post, trying to get everything done in the shortest amount of time ✋✋✋. It can be hectic and exhausting.

    When you can, build some extra time into your work commute and school drop-off/pick-up to allow for the inevitable traffic issues, lost schoolbooks, and forgotten lunches, so you can arrive at your destination as calmly as possible. Do the same at work – avoid back-to-back meetings when you can so you can catch your breath, write down your thoughts, drink water, have a snack, review your notes etc. This will make you more productive and less stressed.

    Get changed.

    Is there anything more wonderful at the end of a long day than getting changed out of your work clothes and getting into something relaxing and comfy? Especially now that winter is here? Whether it’s your favourite trackies, or the most relaxing of all, your oldest, softest pyjamas 😊, when you’re at home and in the cosiest clothes, all feels calm and right in the world.

    Finally.

    As with any changes to your habits and behaviours, you need to start small. Pick one of these ideas, or one of your own, and start adding it to your day. Just a micro-moment here and there. Over time you can add others and/or more time to the ones you’re doing.

    Changing the way you do things takes time, patience and practice. But it’s worth persevering to reap the rewards of these small acts of self-care 💚.

    Oh, one last thing.

    It’s important to recognise that self-care can’t and won’t solve everything. Sometimes we need help – whether for an exercise program, mental health, housework, or whatever. This help may be from our family or friends, or it may be professional help. Don’t be afraid to ask for it.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Reference

    (1) Self-care interventions for health, WHO, 2022.

    CONTINUE READING
    walking-in-winter.jpg
    Lisa Bywaters
    18/May/2023
    Health InformationMSK articles

    Walking in a winter wonderland

    How to keep up (or start) walking for health and pleasure when it’s cold outdoors

    It’s not quite winter yet, but it sure feels like it!

    And if you’re like me and love to get outdoors and walk, it can be a little tough staying motivated when it’s cold, wet and wintery. But there are things you can do to boost your motivation, stay active and even come to relish the experience of walking in colder weather.

    But, I hear you ask, why would any sane person want to get off their warm, cosy couch, put aside the remote control and brave the elements??? Because exercise doesn’t take a break for the colder months 😐 and we need to engage in regular, consistent exercise year round.

    And while it can be challenging at times, we all know how much better we feel after we hit the pool, go for a walk, or take part in an exercise class. Being active every day helps us manage our pain, get better quality sleep, and improve our mood. It also helps us manage our other health conditions. And it gets us out of the house so we can connect with others – our friends, teammates, gym buddies, and other people walking their dogs in the park.

    Knowing all of that doesn’t make it easy though, so here are some strategies to help you get out there.

    Timing is everything

    Plan to go walk when your body has had a chance to loosen up. Do some stretches, or have a warm shower to relax your muscles and joints so you can walk more easily and with less pain. The Arthritis Foundation has some basic stretches you can use before you head out the door.

    Dress for the weather

    Your usual exercise gear may not cut it when it comes to walking in colder weather. You need to think layers. The clothes closest to your skin should draw moisture away from the skin (known as wicking) so your skin doesn’t stay damp. It should also dry quickly. Look on the labels for mention of wicking or polypropylene. Avoid cotton. When cotton clothes get wet, they stay wet, making you colder.

    Next, add an insulating layer of fleece or wool to keep you warm. And finally, add a layer that will resist wind and rain. The beauty of layers is that you can take them off and put them back on if/when needed.

    Choose bright colours so you’ll be seen through the fog and rain, even on the greyest days 👕👚🦺. And at the risk of losing my Melbournian status 😉, there’s something lovely about ditching the black clothes and wearing bright colours on a gloomy day.

    There’s no such thing as bad weather, just the wrong clothing, so get yourself a sexy raincoat and live a little.“ Billy Connolly

    Now accessorise!

    I’m not talking bling here, 💎💍 though; like adding colour, bling can definitely brighten your day 😊. But I’m referring to appropriate socks and footwear. It’s best to wear walking shoes that are waterproof or dry quickly. And they need good traction – it can get very slippery out there! If you’ve got old shoes from last winter, check the soles to ensure they’re still ok.

    It’s important to know that the walking shoes you wear in warmer months are unlikely to be suitable for walking in colder months. The tops of these shoes are generally a lightweight mesh that lets air in to keep your feet cool. Not what you need on a cold walk!

    You also need to protect your extremities (this is a must if you have Raynaud’s). Wear gloves or mittens, a hat that covers your ears, a scarf, sunglasses and sunscreen. Even in the colder months, your skin can be damaged by the sun’s rays.

    Oh, and depending on the length of the walk you’re planning, you might want to take a lightweight backpack or bag for your water bottle and to store any of the layers you remove.

    Get a walking buddy

    Having a buddy to walk with can be fun and boost your motivation on cold days. This could be your partner, kids, family, friend, neighbour, pet 🐕🐈, or a walking group.

    Or go on your own

    Sometimes you just need some time to yourself.

    Be aware of the walking surfaces

    Slips, trips and falls are enemies of anyone with a musculoskeletal condition. So we need to take care out there. Uneven surfaces, moss, wet leaves or mud on footpaths and trails, and slick tiles at the shopping centre can all be dangerous. So keep an eye on the surfaces. And check out this info from MyHealth.Alberta.ca for some tips to lower your risk of falling.

    Explore new areas

    Whenever you can, take the time to explore new walking paths, rail trails, parks, or neighbourhoods. It’s amazing what you discover when you go beyond your own backyard.

    Always check BOM 💣

    Visit the Bureau of Meteorology (BOM) or your weather channel of choice, and get the weather and rain forecast. This will help you dress appropriately and may also affect your timing. If you like walking in the rain, you may decide to head out regardless. But if you’re not a fan, the radar will give you an idea of when to go (just don’t forget your umbrella – just in case).

    Take your phone

    It’s handy for listening to music, podcasts, and audiobooks and taking pics of the things you discover on your walk. It’s also essential for safety. Unfortunately, accidents can happen to us all, so stay safe and take your phone in case you need help. Or so you can call someone to pick you up if the weather becomes nasty!! 🚗🚓🚕

    Add some mindfulness to your walk

    Much of the pleasure of walking outdoors comes from enjoying the beauty of the changing seasons. So on your next walk, focus on your surroundings and how you feel. Try using the 5, 4, 3, 2, 1 method. For example:

    • What are 5 things you can see – e.g. the stripes on your gloves, the different hues of autumn leaves, a dog chasing a ball, fluffy clouds, ducks enjoying rain puddles.
    • What are 4 things you can physically feel: e.g. your feet on the ground, your partner’s hand, the wind on your face, the way your stride lengthens as you get into your rhythm.
    • What are 3 things you can hear: e.g. leaves crunching under your feet, children laughing, thunder in the distance.
    • What are 2 things you can smell: e.g. cut grass, rain coming.
    • What is 1 thing you can taste: e.g. your coffee traveller. ☕

    Walk indoors

    If you’re not a fan of exercising in cold and wet weather or you’re worried about slippery wet surfaces, walk indoors. Do laps of your home, hire/buy a treadmill, or walk briskly in your local shopping centre, gym or community centre.

    Stay hydrated

    Even though you may not be sweating as much as you would be on a hot day, your body is still losing water through your sweat and breathing. Take a water bottle with you and drink when you need to.

    Set yourself a goal

    If you’re still finding it hard to get motivated, set yourself a goal. It may be the ability to walk a certain distance without being out of breath or taking part in an upcoming fun run/walk. Choose something that matters to you, then create a SMART goal – that is, it’s Specific, Measurable, Achievable, Realistic and has a Timeframe. Read more about goal setting.

    “Sunshine is delicious, rain is refreshing, wind braces us up, snow is exhilarating; there is really no such thing as bad weather, only different kinds of good weather.” John Ruskin

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    dodgy-knee.jpg
    Lisa Bywaters
    18/May/2023
    Health InformationMSK articles

    Got dodgy knees? Find out what helps.

    Do you have osteoarthritis in your knees? Does the pain sometimes interfere with your ability to be as quick or mobile as you’d like? If so, you’re not alone – it’s a big club!

    Osteoarthritis (OA) is the most common type of arthritis, affecting 1 in 11 Australians. It can develop in any joint but commonly occurs in weight-bearing joints like your knees. And because it’s so common and causes lots of pain and distress, we’re all looking for effective treatments to manage the pain and keep moving.

    The good news is there’s strong evidence about the most effective treatments for knee OA, those that aren’t effective, and those that don’t have enough evidence to support their use.

    And yet, a recent study has shown an increasing number of people with OA are investigating some less effective treatments such as stem cells, platelet-rich plasma, and Botulinum toxin.

    There are likely many reasons for this.

    We’ve become much more familiar with searching online for information during the pandemic.

    Information about the effectiveness (or not) of treatments isn’t always translated for consumers. And unfortunately, to access much of this information, you need access to journals and databases that are often behind a paywall.

    Another problem is that it’s easy for anyone to create a video, blog, or social media post about the latest and greatest treatment without using current evidence. Their reasons for doing so can be many – from sharing personal experiences in the hopes of helping others to purely commercial gain. This info is everywhere online, easily accessible and often looks legitimate.

    So you need to weigh any information carefully, be cautious and discuss your options with your doctor.

    Here’s a snapshot of what we know works (or doesn’t) for knee OA

    Staying active and exercising regularly

    You had to know this was coming 😉. Research has repeatedly shown that exercise is key in managing knee OA (and other musculoskeletal conditions). A tailored exercise program developed by a physiotherapist or exercise physiologist can help reduce knee pain and improve knee function. If pain prevents you from exercising, you may find that warm water exercise is a good starting point. Warm water pools offer the comfort of warmth and the buoyancy of the water to ease the load on your joints.

    Managing your weight

    Being overweight or obese is directly related to the risk of developing knee OA. It’s also likely to speed up how quickly your OA develops or progresses. Evidence shows a relationship between weight loss and relief of symptoms such as pain and stiffness. But weight loss can be a long process for many people. And it’s challenging, especially when pain affects your ability to be as active as you’d like. However, it’s good to know that any weight loss can reduce your pain and increase your ability to exercise. So making small, achievable changes to your eating and exercise habits can bring big results. If you’d like to lose weight to improve your symptoms, your doctor and/or dietitian can assist you in losing weight safely.

    Dealing with stress and your emotions

    It’s natural to feel stress, anxiety and frustration when living with chronic pain. However, if you’re always fearful or worried about it, it can worsen your pain. That’s because pain isn’t just a physical sensation – it also involves your perceptions, feelings and thoughts.

    The worse you think your pain will be, the worse it can feel. It can affect your sleep, and you become less active. These feelings, thoughts and behaviours can become a vicious cycle.

    Talking with a family member, close friend, or a health professional about how you’re feeling can get it out in the open so you can start dealing with these feelings and hopefully break this cycle.

    Strategies like breathing exercises, cognitive behavioural therapy (CBT), meditation, heat, and gentle activities like tai chi, walking, swimming, and cycling can also help you control your stress and anxiety.

    What about medicines?

    No medicine can affect the underlying disease process of OA. Still, combined with self-care and lifestyle changes, medicines may provide temporary pain relief and help you stay active.

    There are a variety of medicines used in the management of knee OA, and each comes with varying degrees of evidence to support their use. They may be taken by mouth as a tablet or capsule (orally), applied directly to the skin in the form of gels and rubs (topical), or injected into the joint (intra-articular). Discuss the benefits and risks with your doctor if you’re interested in the following medicines.

    Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. Nurofen, Celebrex, Voltaren). Depending on the dosage and other ingredients, NSAIDs are available over-the-counter or with a prescription. Oral NSAIDs are the preferred first-line drug treatment for OA and have been shown to reduce pain and symptoms in knee OA.

    It’s important to note that NSAIDs are designed to be taken at low doses for short periods. Always talk to your doctor before starting NSAIDs, as they can cause harmful side effects, especially in older people.

    Paracetamol (e.g. Panadol, Panamax). Research has shown that paracetamol provides only low-level pain relief and, in some cases, no pain relief compared to a placebo in knee OA. However, some people report that it helps reduce their pain so they can be more active. If you can’t take NSAIDs, they may also be an option. Before using paracetamol, talk with your GP to see if it’s appropriate.

    Some medicines aren’t effective

    Other medicines have been used for OA in the past that we now know aren’t effective and may have harmful side effects.

    Opioids. Opioids are powerful pain-relieving medicines. They’re effective at reducing acute pain (or the pain resulting from an injury or surgery), but evidence shows they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of knee OA.

    Capsaicin. Capsaicin is the active ingredient in chilli peppers – it makes them ‘hot’. Capsaicin in creams and lotions has been used to help reduce OA pain, and some people report beneficial effects. However, evidence for its effectiveness in knee OA is low, and it’s generally not recommended. It also has side effects when applied, such as a burning sensation, which can take several uses to wear off.

    Glucosamine and chondroitin. Studies have found no benefit from taking glucosamine and/or chondroitin for osteoarthritis.

    The pointy end of the stick – intra-articular injections

    Intra-articular injections are given directly into the knee joint. They include steroids, platelet-rich plasma, stem cells, hyaluronic acid and Botulinum toxin. Let’s look at them a bit more closely.

    Corticosteroid injections. If you have persistent knee pain and haven’t had relief from oral medicines or other treatments (e.g. exercise, weight loss), your doctor may suggest a corticosteroid (steroid) injection. However, the duration of pain relief can vary from a few days to a few weeks, and the number of injections you can have is limited due to potential harm. There’s also emerging evidence that long-term use of these injections may cause OA to worsen in the affected joint.

    Hyaluronic acid injections. The benefits of hyaluronic acid joint injections (also known as viscosupplementation or hyaluronan injections) are uncertain. Research findings have been inconsistent, and although some people find the treatment helpful, it can be expensive and isn’t generally recommended. The Australian Rheumatology Association states, “emerging evidence indicates that the effect of hyaluronic acid could be smaller than previously reported.”

    Platelet-rich plasma (PRP) injections. Platelets are small cell fragments in the blood that help form blood clots to slow or stop bleeding and help wounds heal. PRP is a concentrated version of a person’s platelets injected into the affected joint. An Australian clinical trial led by researchers at the University of Melbourne, University of Sydney and Monash University has found that PRP was no better than a placebo at reducing symptoms in people with knee OA.

    Stem cell injections. Despite being commercially available, there’s no evidence for using stem cell injections in treating knee OA. The International Society for Stem Cell Research and the Australian Rheumatology Association do not support using stem cell injections for osteoarthritis.

    Botulinum toxin injections. The American College of Rheumatology/Arthritis Foundation Guidelines states that the small number of trials that have looked at the use of botulinum toxin in knee and hip OA ”suggest a lack of efficacy”.(1)

    What about surgery?

    Surgery may be an option for some people with knee OA when all non-surgical treatment options have failed, and knee pain and reduced function impact their quality of life. In this case, your doctor may refer you to an orthopaedic surgeon to discuss your options.

    A total joint replacement of the knee is the most common type of surgery for knee OA. However, having an artificial knee means there will still be some limitations. An artificial knee won’t have the same sideways movement as a natural knee. It won’t bend fully, so getting down and up from kneeling is more likely to be challenging.

    Arthroscopy is a surgical technique that involves the insertion of small surgical instruments, including a camera, into the knee. This allows the surgeon to examine the inside of the joint and cut, shave and remove material from the inside of the knee joint. “The Australian Government and most orthopaedic surgeons recommend against using arthroscopy for osteoarthritis of the knee. Research shows that doing an arthroscopy for this condition isn’t effective. Arthroscopy should only be used for knee OA if other treatments fail, such as losing weight, exercising and taking pain relievers.” (2)

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Kolasinski, S.L., et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology (2020).
    (2) Arthroscopy, Healthdirect

    CONTINUE READING
    AS-blog.jpg
    Lisa Bywaters
    20/Apr/2023
    Health InformationMSK articles

    Walk like an Egyptian

    DYK for many years it was believed that ancient Egyptian pharaohs Amenhotep (Amenophis) II, Ramses II (“The Great”), and his son Merenptah all had ankylosing spondylitis (AS)? In 2002, scientists examined X-rays of their mummies and found what they believed were radiological signs of AS. Cool story. And, if you have AS, it’s a mic drop moment. 🎤 Boom!

    Unfortunately, this has now been debunked 😑 and the mummies show signs of a completely different condition. But let’s not let facts get in the way of a good story 😁. And let’s find out about AS.

    Ankylosing spondylitis is an inflammatory arthritis that causes inflammation in the spine and the joints that connect the lower spine to the pelvis (sacroiliac joints). This inflammation causes back pain, stiffness and reduced mobility in the spine.

    The good news is there are effective treatments for AS.

    What causes it?

    Ankylosing spondylitis is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Instead of identifying foreign bodies (e.g. bacteria, viruses) and attacking them to keep you healthy, your immune system mistakenly targets healthy tissue in and around your joints, causing inflammation and pain.

    We don’t know why this happens. Genes are thought to play a role. You’re more likely to get AS if your family has a history of it. Most people with AS have the gene called HLA-B27; however, this gene can also be found in people who don’t have AS.

    Since this gene doesn’t automatically lead to the development of AS, scientists believe a complex mix of genes and environmental factors may be involved.

    We used to think AS affected more men than women, but recent research suggests men and women are affected relatively equally. AS tends to develop in late teens and early adulthood.

    Symptoms

    The symptoms vary from person to person. The most common are:

    • Pain and stiffness in the back, buttocks or neck, often worse after waking or resting and relieved by exercise and movement.
    • Enthesitis, or inflammation and pain where tendons or ligaments connect to bone. Common areas for enthesitis are in the front of the chest where the ribs join the breast bone, the back of the heel (Achilles tendon) or underneath the foot.
    • Fatigue or extreme tiredness that doesn’t get better after sleep or rest.

    Other symptoms can include:

    In AS, due to chronic inflammation, new bone may grow around the joints in the spine. This can lead to permanent stiffness in the back and neck of some people with AS. In severe cases, the bones of the spine can fuse together; however, this can usually be prevented by starting appropriate treatment as early as possible.

    Symptoms may change from day to day. At times your symptoms (e.g. pain, fatigue, inflammation) can become more intense. This is a flare. Flares can be unpredictable and seem to come out of nowhere.

    Diagnosis

    If you have ongoing back pain and stiffness or other symptoms of AS, it’s essential that you see your GP. Getting a diagnosis as soon as possible ensures treatment starts quickly. This will give you the best possible outcomes.

    No single test can diagnose AS, so your doctor will use a combination of tests. They may include:

    • Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
    • A physical examination to assess joint tenderness, flexibility, and stiffness.
    • Genetic testing to look for the HLA-B27 gene.
    • Blood tests to check for inflammation.
    • Scans such as an X-ray and MRI (magnetic resonance imaging) to look for joint inflammation and damage.

    Your GP will refer you to a rheumatologist if they think you have AS. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

    Treatment

    Ankylosing spondylitis is treated using a range of different treatments, including medicines, regular exercise and self-care.

    Medicines

    The two main types of medicines used to treat AS and help manage its symptoms are NSAIDs and targeted therapies:

    Non-steroidal anti-inflammatory drugs (NSAIDs) are nearly always used as the first medicine to treat the pain, inflammation and stiffness of AS unless there’s a reason you can’t take them. Research shows that NSAIDs are very effective in managing symptoms of AS. Some people may need to take them regularly, while others will only take them as needed. This will depend on your symptoms and how you respond to the NSAID.

    Your rheumatologist will discuss how often you should take NSAIDs and their long-term benefits and risks. There are many different types and brands; some are over-the-counter, while others are only available on prescription.

    Targeted therapies are medicines that ‘target’ specific proteins in the immune system that produce inflammation. They include biological disease-modifying anti-rheumatic drugs (biologics), biosimilars and targeted synthetic disease-modifying anti-rheumatic drugs. These targeted treatments have dramatically improved the quality of life for people with AS who need more than NSAIDs to manage their condition.

    Your rheumatologist will talk with you about using these medicines if you need more than NSAIDs to manage your condition or if you can’t take NSAIDs.

    Exercise

    This is the most important thing you can do to help manage your AS. Exercise can improve symptoms, including stiffness, pain, fatigue, breathing capacity and posture. It helps increase your flexibility and range of movement, so it’s easier to do many everyday tasks.

    As soon as possible after receiving your diagnosis, you should ideally begin a personalised exercise program developed by a physio or exercise physiologist (EP) and aim to do some exercise every day. Being active is also essential for your overall health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

    Self-care

    As well as taking your medicines as prescribed and exercising regularly, there are other things you can do.

    Learn about your condition. Understanding AS allows you to make informed decisions about your healthcare and actively manage it.

    Manage your weight. Being overweight or obese increases inflammation throughout your body. This inflammation affects not only your joints but also blood vessels and insulin levels. This can increase your risk of chronic health conditions such as heart disease and diabetes. Losing weight is an important thing you can do to reduce your risk of these conditions and reduce your AS symptoms. Being overweight or obese also limits the effectiveness of some medicines used to treat AS. Losing weight can be challenging, so if you need to lose weight or advice on healthy eating, talk with your doctor or dietitian.

    Learn ways to manage your pain. Pain is the most common symptom of AS, so it’s crucial to learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.

    Work closely with your healthcare team. The best way to live well with AS is by working closely with the people in your healthcare team (e.g. GP, rheumatologist, physio). Keep them informed about how you’re doing and if you’ve experienced any changes in your symptoms or tried new medicines, complementary therapies, supplements or other treatments.

    Use aids and equipment. Supports such as long-handled shoehorns, reachers and canes can reduce joint strain and make life easier, especially if your condition has reduced your flexibility and mobility. An occupational therapist can advise you on aids, equipment and home modifications.

    Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about how to deal with this.

    Manage stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.

    Practise mindfulness. Regularly practising mindfulness meditation can improve your mood, relieve stress, improve sleep, improve mental health and reduce pain.

    Eat a healthy, balanced diet. While there’s no specific diet for AS, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other health problems, such as diabetes and heart disease.

    Quit smoking. Smoking cigarettes harms your general health, negatively affects your bone health, and increases inflammation.

    Seek support from others. You might find it helpful to contact the Ankylosing Spondylitis Australia or the Ankylosing Spondylitis Group of Victoria and speak to others who have AS and know what you’re going through.

    Complications

    Some people with AS develop an eye problem called iritis or uveitis, which causes a painful red eye with blurred vision and sensitivity to light.

    If you develop eye symptoms, you’ll need to quickly get your eye checked and treated by an ophthalmologist. Treatment is usually with prescription eye drops, which reduce the chance of permanent eye damage.

    Understanding this risk and knowing what signs to be alert for can reduce the risk of eye damage. Ask your GP or rheumatologist what you should do if you develop any eye symptoms.

    One last thing

    If you think ankylosing spondylitis sounds like a dinosaur, you’re not far wrong. There was a dinosaur called an ankylosaurus. So, what you’ve lost in ancient pharaohs, you’ve gained with a very impressive dinosaur 🐉 😉.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    parenting-blog.jpg
    Lisa Bywaters
    20/Apr/2023
    Health InformationMSK articles

    Planning to become a parent

    There comes a time in many people’s lives when the desire/hope/dream of becoming a parent takes hold. This is an exciting and anxious time for any person, but it can be made more challenging and stressful if you, or your partner, have a musculoskeletal condition.

    However, by working closely with your healthcare team and planning your pregnancy, you’ll be in the best position to have a safe pregnancy and a healthy baby.

    General planning

    Having a baby doesn’t happen in a vacuum. There are many considerations you need to take into account before becoming pregnant. The sooner you do this, the better.

    Pre-pregnancy health checks.

    Let’s put the musculoskeletal elephant in the room aside 🐘 🐘 for now. Potential parents should discuss many other things with their doctor to ensure they’re the healthiest they can be before conceiving. Some relate specifically to the person becoming pregnant, while others involve both parents-to-be. They may include:

    • Beginning folic and iodine supplements. Both are essential for your baby to grow and develop.
    • Other supplements may be necessary if you’re deficient or need help getting the essential vitamins and minerals through your diet. It’s important you discuss this with your doctor before taking any additional supplements.
    • Cervical screening.
    • Sexually transmissible infections (STI) screening.
    • Addressing lifestyle factors such as diet, exercise, smoking, alcohol and illicit drug use.
    • Having a dental check-up.
    • If you have a mental health condition, discuss how your pregnancy may affect your mental health and how you can manage this.
    • Ensuring your vaccinations are up-to-date.

    Consider the cost.

    The ugly truth is that having a baby is expensive – from medical and health bills to maternity and baby clothing, nappies, car seat, baby furniture, supplements, breast pumps, and formula 🍼👶. And there are many ongoing and future costs that you need to be ready for – food, healthcare, clothes, school costs, childcare, transport, shoes, and social and sporting activities 🛴🤸. Being prepared means that you can save and look at ways to budget for future costs. This Moneysmart article, ‘Having a baby: Budgeting for the costs of a baby’, has information, links and a budget planner to help you understand some of the costs you need to plan for.

    Which brings us to work.

    How long you and/or your partner choose to take for parental leave before and after the birth of your baby is an individual thing. Factors such as finances, your job/workplace, available leave etc., will impact this timing. Planning for this before you have a baby is a good idea.

    Baby furniture, equipment and other doo-dads.

    Preparing your home for a baby is important to ensure you and your baby are comfortable and safe. But there’s a big industry around baby bits and bobs. Raising Children Network has a very handy new baby checklist to help you prepare, including what’s essential and how to save money. Also, check out this ABC article, ‘Having a baby on a budget: What items can you buy second-hand?’ for more tips.

    Family planning and musculoskeletal conditions

    People with musculoskeletal conditions can and do have safe pregnancies and healthy babies. But the planning is even more critical.

    The first step is to gather your support team.

    Talk with your GP and rheumatologist about your plans. The best time to become pregnant is when your condition is well-managed and controlled. If your condition is active or flaring, it can harm you and your baby. By talking with your rheumatologist, you can develop a treatment plan to get your condition under control before you conceive.

    You’ll also see a midwife or obstetrician.

    A midwife is a health professional trained to provide support and care during your pregnancy, labour and birth. They’ll also provide you with support in the weeks after you have your baby. An obstetrician is a doctor trained to provide medical care during these times and has the skills to manage complex or high-risk pregnancies and births. Whether you see a midwife, obstetrician, GP, or a combination depends on where you plan to give birth and your health needs.

    You may see a physiotherapist and/or occupational therapist if needed. Physios use strategies such as exercise, massage, heat and cold, and education to help keep you moving and functioning as well as possible. An OT can help you learn better ways to do everyday activities and can provide information on aids and equipment to make tasks easier.

    Both can help you learn to manage your musculoskeletal condition and the changes your body is experiencing through pregnancy. They can also help you manage after birth.

    Other vital members of your support team will be your partner, family and/or friends 💜💚💛.

    Fertility

    Having a musculoskeletal condition generally doesn’t affect fertility. Some studies have shown that women with rheumatoid arthritis may take longer to conceive; however, it’s unclear if this is related to the condition, medicines, or other factors.

    Men with musculoskeletal conditions may find that some medicines affect their sperm count; however, this can often be reversed with a change of medicines.

    If you want to conceive, or you’re having problems conceiving, discuss this with your doctor.

    Medicines

    The use of medicines for most musculoskeletal conditions is a necessity. Active or flaring disease is harmful to both the mother and the baby, so continuing to take your medicines while trying to conceive and during pregnancy is vital.

    However, some medicines aren’t recommended during this time. They need to be replaced with safer or ‘pregnancy-compatible’ medicines. You may also need to stop taking some medicines for several months before trying to get pregnant.

    This will depend on the medicines you or your partner are taking. Your doctors will help you understand and plan for this to ensure the least pain and disruption, and ensure safer outcomes for all.

    The Australian Rheumatology Association has developed a resource, ‘Medications and pregnancy: Information for women and men with rheumatoid arthritis thinking about starting a family’, which goes through many medicines used for treating musculoskeletal conditions. This is a great guide to help you during your discussions with your healthcare team as you plan your pregnancy.

    It’s important to understand that some medicines can’t be stopped immediately. So although you may want to become pregnant quickly, to protect the health of the person taking these medicines, as well as future babies, it’s critical that you follow the advice of your healthcare team.

    You may also need to use contraception until it’s safe to conceive.

    Self-care

    The journey to parenthood is full of ups and downs. When you add a painful, chronic condition, it’s even more challenging. So taking time during the pregnancy planning stage to look after yourself is essential. That includes all the usual self-care strategies – exercising regularly, eating a healthy diet, getting good quality sleep, and looking after your mental health.

    Lupus

    Most women with lupus can have children. However, there’s an increased risk of complications. Again, that’s why planning your pregnancy for when your condition is well-managed and less active, and working closely with your healthcare team, is best for you and the baby. You’ll likely need blood tests before you conceive to check for the anti-Ro and antiphospholipid antibodies that may affect a baby. This would require more frequent fetal monitoring.

    Other ways to become a parent

    If you can’t become a parent biologically for whatever reason, there are other ways to become one. They include:

    While these options may not be what you’d initially dreamed or planned, they provide other choices for many people and may be worth exploring.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    Carers-blog.jpg
    Lisa Bywaters
    20/Apr/2023
    Health InformationMSK articles

    Caring for the carer

    NB: This article refers to unpaid or informal carers – people who provide care to those who need it within an existing relationship, such as a family member, a friend or a neighbour (1) – and not professional carers.

    DYK, there are almost 2.7 MILLION carers in Australia?(2) That’s about 1 in 10 Australians 😮.

    Carers are incredibly diverse. They come from all backgrounds, lifestyles, genders and ages.

    You’re a carer if you care for a family member or friend with a physical or mental health condition, disability, or is frail due to old age.(3) You may share the caring role with others or do it alone. And the time spent caring for someone could be from a few hours a week to caring for them 24/7. You may be a carer for a short period while someone is recovering from an illness, injury or surgery or for a more extended or indefinite period.

    Being a carer can be very fulfilling and bring you closer to the person you’re caring for. But at times, it can also be demanding and stressful. Here are some practical tips to help you look after yourself and the person you care for.

    R.E.S.P.E.C.T – Find out what it means to me

    It can be difficult for any of us to accept that we need help. That our body or health has let us down, and we can’t manage on our own as we once could. This loss of independence can make us feel vulnerable, afraid, or angry.

    When you become a carer for someone, it’s essential that you ask about their needs and how they want to be treated. This gives them control over their life and choices. It also maintains their dignity.

    Respect goes both ways. Just as you must respect the person you care for and their choices, preferences and boundaries, they need to respect yours.

    Discuss boundaries. Doing this from the outset with clear, open communication is essential. What are the needs of the person you’re caring for? What do they want your help with? And what don’t they want help with? What are you comfortable or able to do? Over time, you may need to revisit this as circumstances and needs change.

    Understand personal choices. It’s sometimes hard for carers to understand why the person they care for may not follow suggestions made to them by health professionals, such as taking medicines as prescribed, exercising, or quitting smoking. Try to encourage – but not push or nag – the person you care for. But if you’re concerned their behaviour is adversely affecting their health, discuss it with them. Is there something that’s putting them off? Do they need more information so they can make an informed choice? Are they worried, scared, or unsure about the pros and cons of a treatment? Having a respectful conversation about these feelings is important. And you may need input from the relevant health professional to move forward.

    Have fun together. Don’t let your relationship be consumed by the caring role. Have a cup of tea, discuss things you enjoy, go for a walk, visit parks/galleries/cafes, or share a hobby. Doing things together that don’t relate to health issues will give you both balance and quality of life. ☕

    Care for yourself

    You can’t pour from an empty cup – so take care of yourself first. Caring is rewarding but also tiring, stressful, and often lonely. You need to take care of your own physical and mental health so that (a) you don’t fall in a heap and (b) you can continue to be a carer. If you’re running on empty, you can’t give your best as a carer, daughter, husband, sister, friend, mum etc. Ensure you get enough quality sleep, eat well, exercise regularly, relax and take breaks, meet up with friends, and accept your feelings. I know, that’s a lot. 😴 Especially if you’re also working and have a family and other commitments. But you need to make your health a priority.

    Look after your mental health. As a carer, you may experience a range of emotions that can be difficult to deal with. Be aware of and acknowledge these feelings. If you need help, discuss your situation with your GP, a psychologist, or the Carer Gateway phone counselling or online carer forum.

    Get support. It’s hard for most people to ask for help, but you don’t have to do things alone. Whether it’s having someone to talk to about your stress or anxiety, help around the house, or respite care, options are available. Talk with your GP, contact Carer Gateway, or talk with a friend or family member. You might also consider joining a peer support group or seeing a mental health professional.

    Attending health appointments

    When caring for someone, you may need to attend some or all of their health appointments. Before attending any, you should discuss your role at these appointments with the person you’re caring for. For example, are they happy for you to discuss their health and ask questions, or would they prefer you provide silent support?

    It’s a good idea to write a list of questions you’d both like to ask before you go. And, if there’s a lot, consider booking a longer appointment so you have the time to get through them.
    Attending appointments also ensures you know of any changes to their health condition/s and treatments.

    Managing medicines

    Find out about the medicines the person you’re caring for is taking – the type, dose, and any possible side effects.

    It’s easy to forget to take medicines regularly, especially if there’s more than one and they’re taken at different times of the day. Talk to your pharmacist about using a pill dispenser if this is a problem. They contain individually sealed compartments to help make taking medicine easier. You can buy a pill dispenser and do it yourself, or your pharmacist can do it for you.

    You can also arrange with the pharmacist to do a Home Medicines Review. This review ensures the medicines are safe, effective, and taken correctly.

    Making things easier

    Access services. Many services are available to help make things easier for you and the person you’re caring for. The Commonwealth Home Support Program provides a variety of services, including delivered meals, respite care, domestic assistance, community transport and much more. Contact My Aged Care or your local council for more information.

    Carer Gateway also provides info about accessing services to make life easier in and around the home.

    Pace yourself. Caring can take a toll on you physically and mentally. So pace yourself, and don’t try to do everything at once. For example, stagger the cleaning over several days instead of cleaning the whole house at once. Or cook meals in larger batches to freeze the leftovers for those days when you don’t feel up to cooking, or you’ve run out of time. By pacing yourself, you’ll have more energy and feel less frazzled – which is good for you and the person you care for.

    Investigate aids, gadgets and home modifications. There’s a huge range of aids and equipment available to help you manage. They can help reduce stress on muscles and joints, save energy, prevent fatigue, and make life easier – with everything from personal safety, bathing, writing, dressing, bedding, mobility, seating, and lifting.

    Simple things like long-handled shoehorns can allow the person you care for to put on their own shoes. Items such as grab rails in the bathroom can make bathing easier and safer. To find out more, speak with an occupational therapist.

    Sharing the care

    Caring, while fulfilling, can sometimes be challenging work. It’s essential that there are others who can share the work to make it easier for the primary carer. This help could be in the form of cleaning, shopping, or being available for you to talk to. 🧡

    As a carer, you need to know your limits and boundaries. For example, if you can’t lift the person you care for, seek alternative devices or assistance to make things easier. Occupational therapists can assess the home and suggest modifications, aids and equipment.

    Carer payments

    You may be eligible to receive government benefits to help you provide care. There are different payments depending on your circumstances and those of the person you care for. Visit the Services Australia website for more info.

    Planning ahead

    It‘s essential to think about Powers of Attorney and Guardianship if the person you care for can no longer make their decisions known. Planning ahead ensures that their wishes are met and they can make necessary plans.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Australian Government. Australian Institute of Health and Welfare. Informal carers. 2021.
    (2) Australian Bureau of Statistics. 2018. Disability, ageing and carers, Australia: Summary of findings.
    (3) Australian Government. Department of Social Services. Supporting carers.

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