Ballarat OSM back in Madagascar

Julie (second from the right) in Madagascar

Julie (BOSM Practice Nurse) has recently returned from another aid trip to Madagascar.

As a member of Australian Doctors for Africa (ADFA), Julie joined forces with Richard McMullin (Ballarat Urologist), Michael Shaw (Ballarat Anaesthetist), Berni Toscolaro (Paediatric Surgeon, Royal Children’s Hospital, Melbourne) and Wendy Williams (Logisitic Coordinator, Ballarat).

The focus of this trip was Prostate Surgery & Paediatric Hernia Repair.

Julie (Centre) with the surgeons in Madagascar

As a team they were able to treat approximately 90 patients in outpatient clinics and perform 50 surgical procedures.

 

ausdocafrica.org

 

Durolane is now our preferred Hyaluronic injection

Ballarat OSM is now using Durolane instead of Synvisc injections

Hyaluronic injections are an established treatment of early arthritis.

Joints have a natural lubricating fluid – synovial fluid that contains “hyaluronic acid, (HA)”.  Viscosupplementation involves injecting the knee with a commercial version of HA.  In joints that are very swollen, the existing fluid fluid is removed (often 50-80 mls), before injecting the HA.  Not only is the existing fluid tight and uncomfortable, it contains inflammatory mediators “cytokines” that need to be removed.

HA (Hyaluronic Acid) is either made completely synthetically (Durolane) or using chicken related products (Synvisc).  Both work equally, indeed McGrath’s paper in a randomised controlled trial demonstrating Durolane reduces analgesic use up to nine months after the injection.  A disadvantage of the Synvisc is the potential to allergy.

The HA is not funded by the PBS or Medicare, so costs the patients approx $475 in addition to appointment fees. The $475 cannot be claimed from Medicare or any private health insurance policy.  The knee joint can be injected at BallaratOSM – you just need an appointment with one of the doctors/surgeons who does the injections.  The hip joint can also be injected, but under CT control with one of a radiology colleagues.

 

References:

McGrath et al.  A Comparison of Intra-Articular Hyaluronic Acid Competitors in the treatment of Mild to Moderate Knee Osteoarthritis. J Arthritis 2013, 2(1)

Agerup et al, Non-Animal Stabilised Hyaluronic Acid – a new formulation for the treatment of osteoarthritis.  Biodrugs 2004 19(1): 23-30

Applying Rapid Recovery principles to injury

Pelvic acetabular fractures may not be obvious candidates for rapid recovery surgery – but this is how it went!

Some months ago – one of our founding surgeons at Ballarat OSM had the misfortune of a bicycle crash – sustaining an acetabular fracture. The is the pelvic side of the hip joint, the fracture was comminuted, but effectively undisplaced. Surgery was not required fortunately, but the injury is severe none the less. There were three goals of care: rapid recovery, a lack of long term sequele, and a biking event in the Italian Alps, in only 3 months!

Mr Shaun English and Mr David Mitchell on their recent cycling trip

 

Rapid recovery concepts are to understand what is biologically possible, then having the right rehabilitation plan, and medication plan to allow. Rapid recovery includes the concept of cognitive function – so our approach minimised the use of Narcotics. Anti-inflammatories are key – Mobic 7.5mg twice daily does not affect bone healing, Paracetamol is a useful background. If Narcotics are to be used – slow acting is essential – and the Norspan (buprenorphone) patches again do the trick. 5ug/hour is equivalent to 0.5mg morphine/hr, or four Endone tablets in a day. The problem with Endone though is highs and lows of dosage, and disrupted sleep. Patient independence and having the ability to take something extra is again a key concept – Tramal 50mg-100mg as necessary achieves top up analgesia, and through its serotonergic effects – other psychological improvements in the recovery from injury. We are cognisant of other corollaries of injury – constipation, peptic ucleration have historically been a problem – we address these too.

So – what did it look like for our intrepid orthopaedic surgeon? Four weeks off work, on crutches. Then back onto the bike trainer – just spinning to start with. At six weeks – ramp up the amount of weight placed through the broken pelvis – partial weight bearing. At eight weeks – on the road bike (although needed to be carried to the coffee shop), at ten weeks discard the crutches. At twelve weeks – riding in Italy. At 13 weeks – competed in the Coppi Fausto Gran Fondo – 120km, 2500m of climbing.

 

Dr Greg harris and Dr Anthony Hipsley out and about

Dr. Anthony Hipsley and Dr. Greg Harris at the Motocross

 

Ballarat OSM’s sports medicine team have been very busy in action outside the clinic of late!

Drs Greg Harris and Anthony Hispley ventured to Maffra for the first round of the Australian Motocross series (MX Nationals)

Braving some wild weather, there was some excellent racing on a fast and technical track.

The Motorcycling Australia Racesafe Medical Team had a good day at work, with no major injuries.

 

Dr. Harris then had an opportunity to run a Sports Trainers education night at Saxon House. As the official Sports Medicine Providers for the AFL Goldfields, it was very exciting to run such an event.

Over 50 participants attended, from the Ballarat, Riddell, Maryborough/ Castlemaine and Central Highlands Leagues, learning more about assessment and management of concussion head injuries.

This was the first of what will become regular events, with another one or two sessions already planned for this season.

 

Amongst all of this, the Sports Medicine team still have time to consult! Appointments are available on Mondays, Tuesday, Thursdays and every Friday fortnight.

Bookings can be made online or give us a call. 

 

Dr. Tanusha Cardoso is back!

Tanusha at the Commonwealth Games

Dr. Tanusha Cardoso has been busy of late!

Due to commitments with various sporting teams around the country Tanusha has been away from the Sports Medicine clinic here at Ballarat OSM but is now back consulting every Thursday.

One of her commitments was being part of the 2018 AFLW season, working as the Collingwood Football club’s AFLW team doctor. She says she has embraced the opportunity to work with women’s football in it’s formative years.
“Watching the girls train so hard, despite full time jobs and their constant gratitude inspired me to work even harder to support them. I will always cherish the friendships that I’ve established with this amazing group of players and staff”.
Tanusha has also taken some time off to volunteer at the recent commonwealth games on the Gold Coast in April and was the field of play doctor at the beach volleyball.
“Watching international live sport in one of the coolest places on the coast with some really close games created an electric atmosphere and an amazing work place. It also enhanced my understanding and appreciation for the Sport. I do hope to continue volunteering for the commonwealth games in the future – it’s a truly rewarding and enjoyable experience.”
It took every bit of three sets and every reserve of talent Australia could draw on, but Chris McHugh and Damien Schumann became the first ever Commonwealth Games beach volleyball gold medallists, while the women lost out to the Canadian team.
The Collingwood girls also didn’t get the wins they would have liked, but they did have a first-class medical team looking after them.
We welcome back Tanusha from her travels ready for the rest of the year at Ballarat OSM. She will be consulting every Thursday at 107 Webster Street.

Hip arthritis & incontinence symptoms

A number of seperate research papers have described a change in bladder control in women following hip replacement. It seems that bladder function can improve or deteriorate following hip replacement, and it might depend partly on the surgical approach used (Baba et al).

Continue reading

One of BOSM’s own playing tennis with a Prince

Prince Edward shaking hands with Mr Luke Spencer’s son Ash before a game of Real Tennis

 

Ballarat OSM’s chairman Mr Luke Spencer was proud on Sunday April 8th as his son Ash was given the opportunity to play Real Tennis with Prince Edward.  Ballarat broke an 18-year royal drought with Prince Edward’s jam-packed visit to the city.

The had a busy morning at Federation University before travelling to the Ballarat Tennis Club to play Real Tennis, formally known as Royal Tennis, against juniors including one of our own, Mr Luke Spencer’s son Ash, as part of his mission to play on every one of the 48 Real Tennis courts in the world.

 

Prince Edward preparing for a game of Real Tennis with some Junior Players. (Far right – Mr Luke Spencer’s son Ash)

The Prince’s evening in Ballarat was spent at a civic reception at Ballarat Town Hall, where he presented the Duke of Edinburgh awards, before a Real Tennis Challenge fundraising dinner at Craig’s Royal Hotel.

 

You can read the full story from The Courier here.

Welcome, Dr. Anthony Hipsley!

Our new Sport and Exercise Medicine Registrar

Dr. Anthony Hipsley, Sport and Exercise Medicine Registrar

Anthony is a registrar accredited by the Australasian College of Sport and Exercise Physicians. Originally from Sydney, Anthony moved to Melbourne in 2010 where he subsequently gained his Doctorate of Medicine from the University of Melbourne. He is excited by his move to Ballarat in 2018, where he feels he can become an integral contributor of the Sport and Exercise Medicine expertise provided by the team at BallaratOSM.

Having previously worked with australian rules football, surfing, rugby league, athletics, swimming and motorsports, Anthony enjoys all facets of Sport and Exercise Medicine. He enjoyed working with a Perth based ‘golden oldies’ AFL side in 2017, true to his belief that there is an inner athlete in everyone whether 15 years old or 70! He is currently the Team Doctor for the Sandringham Zebras VFL, a Match Day Doctor for the Melbourne Rebels Rugby Union and the touring doctor for the Ireland Rugby League Team.

Anthony is excited to join the team at Ballarat OSM and looks forward to helping the Ballarat community remain healthy and active!

Partnership with AFL Goldfields

We are very excited to announce our new partnership with AFL Goldfields for 2018.  We look forward to the year ahead and working with the AFL Goldfields team of trainers and of course their players across their Football and Netball clubs.

Here is the official media release announcing the partnership:

AFL Goldfields is pleased to announce a new partnership with Ballarat OSM for the 2018 season following the announcement in 2017 that a new Sports Medicine Team and Acute Injury Clinic will open in Ballarat.

Sports Physician, Doctor Greg Harris anticipated the partnership and needs of players by developing a new service unique in Ballarat. “We are overjoyed to work with AFL Goldfields to provide this service to the region’s athletes who compete in Leagues locally.”

 

“Early assessment and treatment of injuries greatly improves how well they recover”, says Dr Harris. “From my time working with elite athletes, I’ve seen players get up for matches by treating an injury properly from day one.”

 

In recognition that most sports injuries happen on the weekend, the clinic is open on Monday afternoons. Patients can easily book an appointment online. They receive an initial 20-minute consultation with a sports physician and then a further 20 minutes with a physiotherapist.

 

“Ballarat is blessed with many highly skilled physiotherapists and our new clinic is a collaboration with three of these groups. The three-way conversation between physio, doctor and patient means that patients not only get a thorough diagnosis, but also a treatment plan aimed at an active recovery as soon as possible.”

 

“Treating the injury promptly and effectively is the best way to get back to normal activities as soon as possible.”

 

AFL Goldfields Commercial & Regional Operations Manager Aaron Nunn said, “We’re thrilled to be partnering with Ballarat OSM to promote what will be a wonderful service to all Community Football & Netball players across the AFL Goldfields Region. The setup of the new Acute Injury Clinic at 107 Webster Street, Ballarat will be key to treating injured players as early as possible and provide ongoing assistance through the recovery phase.”

 

Find out more about the Acute Injury Clinic at http://bos.inkserver.com.au/acute-clinic/

 

Members of any club registered with any Community Football & Netball League in the AFL Goldfields Region will be able to book appointments online through the Ballarat OSM website or via a special link accessible via www.aflgoldfields.com.au under the TRAINERS tab.

Pre Season Tips From Dr. Greg Harris

Footy and netball season is almost here again, and while most of the pre-season work is done, here are a few tips to turn the pre-season slog into a successful start to matches.

 

Build into it

While it would be ideal to have had three months of regular, steady fitness work before the season, sometimes that just doesn’t happen. If that sounds like you, just about the worst thing to do is to try to ‘catch up’ on the training you have missed. Going from not much exercise to high volume or high intensity training is the most common cause of injuries such as stress fractures, tendon problems and joint pain. Studies from the Australian Institute of Sport (AIS) show that big changes in workload also lead to an increased risk of illness. While it might not seem like the ‘team thing’, you’re probably better off starting the season underdone, and building your fitness over the season. Just in time for finals!

 

Warm up and cool down

It’s also important to build into each training session to prevent injuries like muscle strains. A steady warm-up gets everything moving and starts to ‘prime’ the neuromuscular system for the movements required for sport. A good example of warm-up drills is the FootyFirst program (www.aflcommunityclub.com.au/index.php?id=906), or the Netball Australia KNEE program (www.knee.netball.com.au), both of which have been shown to decrease the rate of lower limb and knee injuries when done consistently.

 

Keep hydrated and fuelled

It’s not quite winter yet, so remember to drink enough water in these warm autumn afternoons. Being a few percent dehydrated also increases your risk of injury and decreases your performance. Refuelling after training is one of the key ways to ensure a good recovery: some good, low-fat carbohydrates (e.g. a sandwich or muffin, or some sports drink) in the first 30 minutes after hard exercise gets some energy into you to help your body repair and recover. KFC and a coke is NOT a good recovery fuel!

 

Don’t ignore the niggles

If you have a twinge that isn’t going away with a bit of rest and ice, get it looked at by a trainer, physio or doctor. Many injuries start as something just a bit annoying, and some simple treatment can fix it, but if ignored can worsen to be something that makes you miss months of sport. It might not need a scan or some treatment…but it might.

 

Have fun!

Don’t forget that sport is meant to be fun! Sure, try your best on the track or on the court, but no-one enjoys playing against, or with, someone with white-line fever. And if you feel like you’re not enjoying your sport like you should, or you’re feeling sad, or anxious, or worried, or angry… talk to someone. If you think a team-mate is not coping, don’t be afraid to ask, “Are You OK”.