COVID Distrupted 2020
Written by Sean Cooney
If you caught our January internal newsletter I discussed how we adapted when severe COVID restrictions hit New South Wales. We knew there was going to be a continued need for good health care but we had to concern ourselves with the best way to deliver it. There was also a need to educate patients on how looking after their health was one thing that was in their control in a world that was seemingly changing by the day, sometimes by the hour (depending on the next press conference).
We connected with the mantra of Reconnecting to Purpose both for our patients and for our clinical and exercise teams
. Why did patients value their health and the time spent working on caring for their health? If they could connect with what their long-term goals were then it made more sense to keep working in that space and enjoy all the mental clarity that comes from being in a good state of health. Most who connected with this found that they had more time considering that commutes and the access to “bad health choice options” were removed. For our Healthfix team, reconnecting to why they became a health professional allowed us to focus on the actionable solutions that were in place to deliver effective health care – outdoor sessions, telehealth, better communication, more teamwork and integrating.
We’ve always had a strong focus on the person and not just the presentation as per our biopsychosocial approach teaching but this is so much more at the forefront of people’s minds now. The vernacular around coaches and mentors, thriving instead of surviving, looking after oneself holistically and making enough time down time is so much more of a prominent discussion. Patients are wanting meaningful engagement and to be on a path that works for them with a clinician who can be flexible and adaptable to their changing needs. I think our patients like to know that they have a team behind them for support but they want care that is simple and makes sense. I can see more of our patients ready to get to work on health care issues that have been around for a while and happy to chip away at getting a long-term, sustainable result.
Who knows? Do we go back to a fast-paced life and take our health for granted OR does that freeze in time that the global pandemic offered to reflect and check where our lives and our health was going lead to happier and healthier humans? With consideration to how some areas of health care strengthened whilst others were used less, perhaps due to being seen more as a discretional spend or ineffective, I can see good health care operators will continue to thrive within a more discerning crowd of patients. Ones who can embrace the holistic nature of good health and how it impacts mental, physical and emotional wellbeing as well as our work productivity and social relationships may be in a better position. But then again Nassim Nicholas Taleb
has won a lot of praise from teaching us not to be fooled by randomness and a “black swan robust” so effectively who really knows what the future holds but there’s a good chance that we can get through it! Either way we’re looking forward to helping even more people in 2021 than in 2020 with what we’ve learned and with collaborating with awesome GP’s.
Mel Juergens 5 quick questions
Written by Sean Cooney
Our dietitian Mel and I sat down to have a conversation about the early influx of GP and non GP referred patients that we tend to see in the months of January and February. Here’s some key take away points.
You say that a lot of people come into your consults after having visited their GP’s for blood work in the earlier months of the year, what do you think is behind this trend?
People seem to have that “New Year, new me” feeling. They’re wanting to start the new year fresh and kick start their health with an understanding of where they currently sit.
Why do they come to see a dietitian and what conditions are you seeing mostly?
Weight loss is a big one. Many have tried and failed at multiple diet fads or they’re after a long term solution and not a fad. They want to do it the right way.
For some they can feel it’s their last resort coming to see a diet professional. There’s a lot of confusing information out there online and they’re, well, confused. Others have regrettably tried the fad diets and failed to stick to it which has wound up resulting in weight gain as we now know research shows can often happen.
What else do you see at this time of year?
People with diabetes and cholesterol issues. Ultimately at this time of year there are just a lot of people wanting to focus on their health and they have the time to act as they haven’t got too busy at work just yet. They are in a better position to make time for their health.
How have dietetic patients presented post COIVD?
During COVID there seemed to be a lot of people just surviving, not necessarily thriving. Now there seems to be a different attitude. The people that I am seeing now are wanting to work on their health and get great, long term outcomes from learning good habit and diet behaviours.
What would one expect when seeing you?
What most might find surprising is that we only spend 10-15 minutes talking about what you’re eating. 40 minutes or more are spent on truly understanding the person and their dietary choices. We look to understand their upbringing around food, their family history and a lot about their work and life now. Once knowing their history and all the factors that will impact on their diet and food choices we begin to forge a plan around what is realistic for the person and where is the best place to start.
GP’s wanting to know more about how our dietetics department, with Mel and Ash, are helping with general and more speciality based diet clientele please get in contact. We are always happy to arrange a visit to our clinics, come and visit you or set up a time to get on the phone (as we know how busy you are!).
Medicare’s Chronic Disease Management
Written by Sean Cooney
With the chronic disease management
and team care arrangements offering such a wide scope of practice for a wide variety of people, no two patients are really the same. But, of course, there are some key similarities.
Patients who see multiple allied health professionals on one referral
When the five sessions are spread across 2-3 practitioners we find that the first practitioners’ initial assessment is really important. The GP referral is so valuable at providing the history of the presenting illness or ailment and the goal setting section is instrumental. Where the patient decides to start the allied health care approach, ie which practitioner they see first, normally dictates the approach that they want to take.
For example, seeing a physio before the AEP may mean that there could be a level of fear avoidance behaviours that are present due to the length or severity (or both) of the patient’s condition. Seeing the AEP before the physio may mean that they’re more keen to get started with exercise and wanting to top up on education around their previous injury or refresh their self management strategies.
Seeing the dietitian before an AEP or the physio may mean that they know that their food choices are impacting their ability or willingness to move. It can also mean that this is what they’ve identified as the best place to start forming better habits or routines around a healthy living – considering that we can eat 3-5 times per day whereas we might only exercise once.
5 sessions or more?
The premise of the CDM program being about setting goals and then setting a plan to achieve these goals means that we need to have an early conversation around how much they’re expecting to achieve in the 12 months that the sessions are valid. Some like to use their sessions and move straight onto the private healthfunds but for others they can only afford the 5 or only want the 5 sessions.
When the person is requesting to continue beyond the 5 sessions, these initial sessions serve really well to get a thorough assessment of where the patient’s condition is at, how they have been managing, educate them on updates to evidenced based practice that are applicable to their condition and then getting started with a meaningful intervention.
When the person is only wanting the 5 sessions from Medicare it is much more about educating on self management strategies and tools for reassessment from day 1. Patient’s can feel they didn’t get value out of the sessions if they’ve started on a plan of intervention that there wasn’t adequate follow up to reassess whether this was effective for them or not.
The value in a health spend
Working in CBD areas in North Sydney and Broadway, sometimes the reliance on a Medicare subsidy isn’t so great which can bring into question one’s value on the contribution. I think it stills gives the opportunity to set the person up for success and moving towards a happier and healthier existence. The premise of the management plan, to have the GP integrating with allied health professionals, mandating that we communicate, including the use of objective measures, health care plan and goal setting with time frames is no doubt the structure that is required to deliver long term outcomes and reduce the “burden of disease”. If this gives a person the first taste of this approach, it can surely do no harm.
Whichever is the patient preferred approach to their healthcare, the program is awesome and can be so effective. We’re truly lucky to live in Australia. As long as expectations are clearly communicated and smart planning is discussed from the initial appointment then we can truly chip away year on year, helping the patient adopt good management strategies to manage their chronic conditions.
What is a Foam Roller?
Foam rollers essential look like large noodles but they can quickly become your best friend. There are many types nowadays of all shapes and sizes. They get used to loosen up before a match or training session as well as serving as a great homework tool to do some physio or trainer prescribed home exercises around mobility and flexibility. When making your selection about which one to use I always recommend that you get one that is practical to fit in your home/ room / home gym (they can be quite large and bigger isn’t always better) and get one that feels comfortable and inviting to use – it shouldn’t be used as a tool of torture. You’ll see these commonly now in Pilates and physio studios as well as commercial gyms and sporting environment including institutes of sport.
What are Foam Rollers used for?
They work on releasing soft tissue, relieving muscle tightness and soreness and they can also be valuable in helping to break down soft tissue adhesions and scar tissue after injury. They can stimulate blood flow and are really valuable in promoting neural down regulation (this is often why they can be sore to first get on but then this soreness eases with a lasting effect of relief of the symptoms that made you get on the roller).
Effectively, any intervention that we put the body through be it a strong sports massage, Chiro or Osteo manipulation, hot / cold pack, dry needling, etc needs to be analysed and accepted by the body. Jumping on foam roller puts a lot of pressure to the area where the brain may be holding some tense muscles or trying to protect it with a pain response. So as you consciously lie on the foam roller, the brain can start to accept that you don’t want those muscles so tense or so much protection of the area and it relaxes; and then you can feel relaxed.
Things to be aware of:
– Make sure you understand and are confident with how you intend to use the foam roller. Our Physiotherapists, Exercise Physiologists and Personal Trainers can help a lot here.
– Don’t push through pain for too long. The whole point is to feel relief so if you’re still experiencing strong pain after say 1 minute, take it easy on yourself and ease up.
– Be aware of any “no pain no gain” or “go hard” on the foam roller commentary. Use your common sense and you’ll be fine. At the end of the day it’s a foam roller so it should never pose as a threat or tool of torture unless you’re trying to use it incorrectly or your body need a lighter intervention to start with.
A couple of common and popular Foam Roller exercises:
The ITB (great for runners, field sports players and gym goers)
Iliotibial band (ITB) is a band of fascia on the outside of your upper leg, when it is tight it can cause knee and hip pain.
– Lie side on with the affected side on the foam roller, rest your upper body through your forearm. With your unaffected leg, place over affected side and place the full surface of your foot on the ground. Start with the foam roller just above your knee and roll back and forth slowly for 30 seconds to just below your hip bone. For further pressure, place unaffected leg on top of affected side.
The Quadricep (similar to above demographic plus people who kick in their sport like martial arts, kick boxing, football and AFL):
Tight quadriceps can pull on your patella and cause some compressive pain at the front of your knee (most commonly).
– lie on your stomach with the roller placed under your thighs. Hold your body straight and rest your upper body through your forearms. Roll yourself back and forth slowly from just above your knee to just below your hip bone. For further pressure bend your knees.
If you like these exercises and want some more or you want to get some advice on which foam roller would be best for you please do not hesitate to get in contact with us
, we offer them in our clinics and the team are always happy to help!