Do Cortisone Shots Posses Potential Dangers?

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Cortisone shots have been used for decades.  In years past, it was thought that there was no real harm or risk involved in having a steroid injection.  There have always been side effects such as dizziness, headaches, trouble sleeping, mood swings, or weight gain but no long term effects identified.  According to a new report, cortisone injections may have more serious side effects than previously reported such as damage to the joints as well as other serious dangers.  

Steroid injections have effectively been used in treating conditions such as back pain, bursitis, gout, osteoarthritis, lupus and tendonitis.  Osteoarthritis (OA) alone affects nearly 5 million Canadians (1 in 6). When medications, physiotherapy and lifestyle no longer work, doctors will often try a cortisone injection to treat the pain.  Although this does not cure the problem, it can be a temporary fix to mitigate pain and swelling to avoid more extreme measures such as surgery.  It can also give you the opportunity to rehabilitate the affected area by reducing the swelling to allow for easier ability to strengthen the joint and surrounding muscles.  

Potential Dangers

Although cortisone has many benefits, there have been more recent concerns identified with regards to knee and hip osteoarthritis.  Some of those include: Rapidly progressive osteoarthritis, subchondral insufficiency ie. a type of stress fracture, osteonecrosis – when bone tissue dies, or causing a delay in surgery.  The study recently done could not provide an exact explanation why these things occur, however, it was thought that the anesthetic that is combined with the injection could be toxic to the cartilage.  More studies would be needed to understand the full effects.

The list of side effects from cortisone shots can be long and exhaustive, however, the advantages can be significant.  It is important to discuss all of the pros and cons with your doctor prior to having one, especially if they are required multiple times or if a surgery may be in the near future.  

December 2019 Newsletter

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How Does Canada Perform On Universal Health Care Compared to Other Countries?

If you listen to some of the presidential candidates south of the border, you would hear that Canada has the greatest health care system in the world, a system to model.  But is that just an opinion or is it based on fact?  Recent data suggests something far worse than what the debaters might have you believe.

A recent study completed by the Fraser Institute compared universal health care systems to determine how well Canada’s system really ranks.  The overall conclusion was that although Canada is the most expensive system in the OECD (Organization for Economic Cooperation and Development) and the performance is modest to poor.  Below are the 5 areas in which the data was measured:

Expenditure on Health Care

Of the majority of high income OECD countries that utilize universal health care systems, Canada spends much more. After an age adjustment, it ranks 2nd highest for expenditure as a percentage of GDP and 10th highest for health care expenditure per capita.

Availability of Resources

Canada has substantially fewer human and capital resources than many like jurisdictions that spend comparable amounts of money on their health care.  Canada has significantly fewer physicians (26th out of 28 countries), acute care beds (27th out of 28 countries) and psychiatric beds (25th out of 28 countries) per capita when you compare them to the average OECD countries.  Nurses rank close to average at 15th out of 28 countries.  On medical technologies such as MRI & CT Scan, Canada again ranks very low.  For MRI it is ranked 22nd out of 26 countries, CT Scan 22nd out of 27 countries and PET Scan 17th out of 22. Canada has fewer other medical technologies than the average high income OECD county.  One area we rank high is on Gamma Cameras 2nd out of 21 countries.

Use of Resources

After age adjustment, Canada ranks 9th (out of 26th) for doctor consultations,  14th (out of 25th) for MRI examinations, 12th (out of 25) for CT Scans and last at 28th (out of 28) for hospital discharge rates.  Other areas examined were for cataract surgeries, coronary angioplasties, coronary bypass grafts, appendectomies, cholecystectomies, hernias, hip replacements and knee replacements.  Canada’s performance is mixed.  We performed well or at higher rates than the average OECD country on about half of the indicators examined but lower rates on the rest.

Access to Resources

Access to resources can be measured by the timeliness of care, ie. waiting lists.  Canada tied last place (out of 10) for percentage of patients making a same day appointment when sick, 4 (out of 10) for after hours care, 10th (out of 10) for waiting 2 months or more for a specialist appointment, and 10th (out of 10) for waiting more than 4 months for elective surgery.  These findings place them at the bottom or near the bottom on 4 out of 5 indicators.  

Quality and Clinical Performance

Canada performs 17th (out of 24) for primary care, 4th (out of 21) for acute care, 12th (out of 16) for mental health, 6th (out of 16) for cancer, and 19th (out of 19) for patient safety.  Measures of longevity was also compared.  Canada ranks 14th (out of 28) for life expectancy at birth.  

Canada is the most expensive universal health care system that participates in the OCED.  The overall performance for availability and access to resources is below the average country.  Performance for resources and quality and clinical performance is mixed.  This presents a huge imbalance in the value of health care Canadians receive when you look at how high the spending is. The spending is financed by taxes all Canadians pay. In other words, what we pay for taxes we do not get back in return for good health care – we wait, wait and wait….

 

 

Medical Travel Success – Plan and Ask Questions!

There are numerous reasons to travel outside one’s local area to receive medical treatment.  A procedure may not be available where you live, the wait for it is too long, or the price is too high. With the world becoming so well connected and easy to communicate, all one has to do is to look up a reputable hospital and hop on the plane or drive. Sounds simple right? But traveling for medical reasons is far more complicated and involved than regular travel. If you have determined that you are going to take your health matters in your hands and take a pro-active approach, this article will give you a couple of points to be aware of.

DO: Communicate and be transparent with your local family physician or specialist

First and foremost, we cannot emphasize the importance of communicating with your family doctor and/or specialist.  It matters tremendously at all stages of your medical journey, but especially before and after. Before the travel, give your doctor an opportunity to voice all of his/her concerns with your plans.  It will help you mitigate the risks associated with receiving medical care abroad. Remember, only your doctor will have the medical facts and necessary expertise to raise such concerns. You can ask for a second (or third) opinion, or do your own research, but it all starts with you and your doctor.

When you come back from your procedure, your doctor will not be surprised and unprepared to learn about your journey and if necessary, provide or advise post op care. In many, if not all surgeries, the recovery time and post op care are so important.  The success of the procedure largely depends on it and therefore, you have to have the medical support you need when you come back home.  Talk to your family doctor 4-6 weeks or earlier before you go!

DO:  Go to a hospital that is able to provide their HAI (Healthcare Associated Infection) rates and prevention mechanisms

Many internet articles and government health authority bodies warn medical travelers about accreditations and standards for out of the country hospitals and doctors, and rightfully so. Not only do you need to make sure that your hospital and doctor are properly accredited and certified, you need to make sure the hospital has an ongoing prevention plan for preventing Healthcare Associated Infections (HAI). 

Are you aware that there are multi-drug resistant bacterias in hospitals and other health care facilities around the world?  For example, there was a rapidly growing Mycobacterium outbreak among medical tourists in the Dominican Republic: 21 cases identified in 6 states, 13 of them or 62% underwent surgery. Significant time and resources were spent for recovery, including therapeutic surgical intervention, hospitalization and 3+months of antibiotic treatment.  In Jan of 2019, the American CDC placed warnings about being treated at certain hospitals in Mexico due to antibiotic resistant infections.

Outbreaks among medical tourists are inherently difficult to detect due to patients returning to broad geographical areas, non-notifiable conditions and the fact that communications between countries can impact detection of outbreaks.

The US and Canadian healthcare authorities make an effort to publish results, however, other countries’ healthcare systems may differ.  Ask your provider for a discussion of HAI rates and what is being done to prevent them.

DO: Have a plan B

Have you thought about the fact that there is a chance that your doctor may advise a different treatment plan? There are cases of “change of treatment plans”. For example, a hip replacement client may be given a less invasive, less costly alternative that would keep the quality of life for a few years before she has to have surgery.  While it doesn’t mean you cannot have your surgery, it does mean that there may be more health related decisions made on location and you have to be open and ready to discuss those. To prepare yourself, don’t be afraid to ask questions.  Work with your doctor on the plan B before you leave.  The more planning you do the less stressful your medical journey will be.

DO NOT: Make your provider selection off of price alone

While this may be the obvious one,  but we are always alarmed at the low amounts people are quoted.  Figuring out price differences may prove to be daunting.  You have to go through each quote to see why they differ and if the difference is going to affect the quality of your treatment and stay.  Ensure that all quotes are detailed and figure out what different hospitals consider extra to the quote to get a better picture of your final bill. Also, look for hidden costs and always know how the Medical Facilitator gets paid. It should not be hidden in your hospital costs.  Always remember, you get what you pay for!

In addition, be prepared for complications and what the cost may be. It is best that you talk to a medical complication insurance agent about this as this may end up being very costly. In addition, your insurance agent will be able to spot hospitals that had bad cases and will not be able to insure you at that particular facility.  That’s an additional risk management step you absolutely must take.

If you have any questions or concerns or would like to discuss any of the medical travel issues further, please reach out to us.  We are here to listen and give you the best answer today! Health Vantis specializes in making your medical travel more enjoyable by giving you our most personal support and care along the way, start to finish!

 

5 Tips For The Next 2 Weekend Holidays And Eating

This time of year is full of cheer and over indulgence.  We all love to have a good time but here are some tips to help get you through the next few weeks when you are at a party!

1. Chose fresh fruits, dark chocolate, sweet potatoes, beans, vegetables or whole grains.  All of these are natural appetite suppressants.

2. Pick foods that you don’t eat often during the year. It will give you a chance to try the special food without filling up on the typical fare

3. Overindulging in alcoholic beverages is common during this time of the year. Have a glass of water before and in between your adult beverage. Not drinking 3 hours before you go to bed can also be of benefit in affecting your sleep cycle.

4. Watch for the ‘sigh’ which is your body’s natural way of letting you know you are full.   When you ‘sigh’, you are actually making room in your stomach.  Pay attention to this to avoid overeating and know that is your body’s queue that it’s time to stop.

5. Have a strategy before you go to a party.  Set limits and know what you plan on doing.  Easier said than done, isn’t it?  If you at least think about it before you go, you may have a chance at actually following it!

Have a wonderful holiday season!

Risk of Infection After Surgery

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Risk of infection after surgery can be devastating and require further surgery or prolonged treatment.  Severe problems such as sepsis, organ failure and even death can occur if not treated quickly and properly.  While surgeons take thorough precautions prior to the surgery starting, our skin and environment contain millions of bacteria that can still cause an infection.  

There are many risk factors that can make you more susceptible to a post-operative infection:

– BMI > 40

– Smoking

– Poor Nutrition

– Diabetes

– Prior Surgery on the affected area

– Recent cortisone injection in to the joint within 3 month period

– Suppressed immune systems

– Open wounds or sores

– Steroids

Some of these risk factors can be changed or modified to reduce the chances of an infection occurring.  Ways to decrease some of these risks are:

– Smoking cessation

– Weight loss 

– Improved nutrition.  

– Skin preparation by bathing with a topical antiseptic beginning 3 days leading up to the surgery 

– Keeping the incision site clean and covered 

– No submerging the incision under water for the first 3 weeks or until your doctor has said it is ok

– Watch for signs of infection from the incision

– If prescribed antibiotics, be sure to take them as directed until they are gone

Most infections will start within 30 days of surgery.  Identifying the start of one and having it treated promptly could keep it from getting in the blood stream.  Bacterial infections can often be prevented with caution and care.  Reducing controlled risk factors prior to your surgery and following your doctors instructions will help keep chances of one starting to a minimum.

Patient’s Experience and How A Second Opinion Was Valuable

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What Exactly Is Happening?

Susan started experiencing continued abdominal pain.  She sought local treatment and was diagnosed with irritate bowel syndrome (IBS).  They put her on a gluten-free, dairy-free and starch carb-free diet. Her pain did not improve, it actually got worse. All the while, her GI doctor was still diagnosing her with IBS. 

A couple of years later, she arrived at the ER in severe pain. Susan was told she had sigmoid volvulus and emergency surgery was performed the next morning. She did well for 6 months until one evening, the excruciating pain returned. Another trip to the ER was made and another obstruction was found. She was put on a Nasogastric (NG) tube and off work for 1 week.  2 weeks later she was in pain and made a trip back to the ER where they put her on a NG tube again. 

Finally, the head of the GI department at the hospital told her that they would need to remove her colon. Removing your colon is no simple surgery.  It comes with high risks for complications, not to mention life long changes that might require a permanent colostomy bag.

Yet, the next day she was released from the hospital. No explanation was given as to why she was told she needed surgery the day before to her release to go home. 

Decision to Get A Second Opinion

After her discharge, Susan decided it was time to get a second opinion. She was referred to a facility in Boston that offers excellent care and is patient centered. After the first visit the GI doctor and Colorectal Surgeon suspected she might have an outlet obstruction. They recommended she see the pelvic floor clinic at another medical hospital nearby. The hospital did a diagnostic study, defogram, that is not done locally in Halifax. Based on the results of this study, a true diagnosis was finally given  – Idiopathic GI Dysmotility. 

The proposed treatment for this is physiotherapy for the pelvic floor, biofeedback and massage for the colon. Surgery for this condition is the absolute last option. 

Susan returned home, began this treatment and as of today, is doing well. She takes no medication and most importantly, she has her colon.

Susan’s Words

‘The difference between the local doctors and the facility I visited in Boston is that the doctors in Boston worked as a team. They reviewed her records prior to her appointment so that both of their time was put to good use. Doctors locally do not communicate as a team and they want you in and out ASAP. I was a very compliant patient and this was my frustration. How can I do everything they are saying and more and be no further ahead. It didn’t make sense to me. As far as a real diagnosis here (in Halifax) they really never came up with one. It may be “scar tissue” was all they could come up with.’

Consider a Second Opinion

Health Vantis works with several reputable facilities that can provide second opinions to you.  If you have something undiagnosed, recently diagnosed or are scheduled for a serious surgery, consider getting another opinion.  It may prevent something unnecessary or even just give you the peace of mind that what has been recommended is appropriate.  We are happy to help make the arrangements!