July-August 2005 Volume 5, Issue 2
Upcoming Education Events
S.T.A.B.L.E. (Stabilization of Sick New-borns: PostResuscitation, PreTransport and Care After Return Transport) September 30, 2005 Regina, Saskatchewan For more information, please contact the Regina CPL Office at (306) 766-4016. Essentials of Electrocardiography September 30 and October 1, 2005 Saskatoon Inn, Saskatoon, Saskatchewan An intensive course on ECG Interpretation for family physicians.This course, preparatory for physicians planning to write the College of Physicians and Surgeons of Saskatchewan’s ECG Examination, provides an in-depth review of common ECG abnormalities. Dr. James D. McMeekin, Clinical Professor of Medicine, Division of Cardiology, University of Calgary, is the Guest Faculty. For more information, call Saskatoon CPL at (306) 966-7787.
Relieving the Burden of Chronic Pain
“The Idea is to send them back to work”
Regina Qu’Appelle Health Region Neurosurgeon Dr. Krishna Kumar, works with benign chronic pain sufferers who have not responded to traditional medical treatments. The techniques, developed by Dr. Kumar and his colleagues, place Regina in the forefront of chronic pain management strategy. Chronic pain is estimated to affect one in six people in North America. When pain, which Dr. Kumar calls, “nature’s warning system” becomes chronic and doesn’t go away, the results are borne by patient, family and society as a whole. “Chronic pain is an entity and it can devastate your life,” he says. “If a patient can’t work, an economic burden is created. If they lose a job, they may lose a house and often depression follows.” Statistics show that Canadians with chronic pain are twice as likely to develop depression as those without chronic pain. “These patients graduate from simpler medicine to narcotics and, subsequently, to alcohol to dull the pain,” says Dr. Kumar. Chronic pain results from myriad conditions. Failed disk surgery, Multiple Sclerosis, pancreatitis, shingles, complex regional pain and phantom limb pain are a few of the causes. When conventional pain therapies and simple techniques such as physiotherapy, chiropractic treatments, biofeedback and yoga aren’t working to relieve the pain, says Dr. Kumar, “Something else has to intervene and that’s where my work comes into play.” Low voltage electrical stimulation of the nervous system to dampen the feeling of pain is one technique used by Dr. Kumar to treat chronic pain patients. “Activating the army of neural pathways that suppress pain,” is his description of the treatment. “If you can activate production of your own endorphins, then the pain will be suppressed.” In deep-brain stimulation, an implant delivers low voltage electric stimulation to a predetermined area of the brain to diminish the feeling of pain. Other techniques include spinal cord stimulation to treat the neuropathic pain that is described as burning or lancinating. The spinal cord stimulator consists of a battery, extension cable and a wire lead with an electrode-stimulating tip. The battery is implanted in the abdominal wall; the extension cable connects to the lead, which is placed on the spinal cord. The impulses stimulate the pain-inhibiting fibers in the dorsal horn and dampen the sensation of pain. Intrathecal drug therapy is another method used. A fully implantable pump, individually programmed, delivers morphine or other pain medication directly into the spinal fluid. Making pain manageable and allowing patients to enjoy a better quality of life, returning to the work force, is the ultimate goal for Dr. Kumar and his colleagues. In mid-July, a television documentary, “Living with Pain” was released by Access Communications, the cable television cooperative serving communities across Saskatchewan. “Living with Pain” is a joint venture between Dr. Kumar and Access Communications, with assistance from the Regina Qu’Appelle Health Region and its employees. “We believe there is an important need for this documentary to show to others who suffer from pain that there are ways to help alleviate their suffering,” Dr. Kumar says. “The earlier the treatment is started, the better the results. We have engaged in ground-breaking research in Regina and we felt the need to let the rest of them know how it has helped improve the lives of people who suffer from chronic pain.”
Hospital-Acquired Infections
Staying Ahead of the Game
Hospital-acquired infections cost the Canadian health care system millions of dollars each year. Infections mean a longer hospitalization for patients, and increased use of nursing resources. The result: extra demands on health care dollars and longer wait times for patients scheduled for hospital admission. Clostridium difficile (C. difficile) and Methicillin-resistant Staphylococcus aureus (MRSA) are of particular concern to health care providers. While Alberta and Quebec hospitals have experienced significant bacterial outbreaks in the past year, the Regina Qu’Appelle Health Region has no serious outbreaks so far. “MRSA is prevalent in the hospital and the community in general. The problem is seen throughout Canada. They can pose particular concern in hospitals because many of our patients have weakened immune systems,” says Dr. Elizabeth Thomas, Medical Microbiologist with the Regina Qu’Appelle Health Region. “MRSA is dealt with by early detection and by isolating the patient who is infected or colonized with the organism.” Another worrisome bacterium for hospital staff and patients is C-difficile. Persistent C-difficile spores are present in feces and human waste. Effects on patients can be severe, causing diarrhea, discomfort and compromising an already vulnerable patient. Opportunity abounds for infection to spread in hospitals and long-term care facilities. Direct transmission can occur between caregiver and patient through activities like giving a patient a bath or turning a patient in bed. Indirect transmission occurs by handling contaminated equipment or touching body surfaces. Droplets from coughing and sneezing circulate bacteria through the air.
“Infection spread through food or vectors (flies, mosquitoes or mice) is a more rare occurrence,” says Dr. Thomas. There is an aggressive program to track infections within the hospital setting. Hospitals in the Regina Qu’Appelle Health Region follow Health Canada and the U.S. Centres for Disease Control guidelines for maintaining hygiene standards. While recognizing the importance of family support to patients in hospital, visitors also need to follow guidelines. They should be encouraged to use the gel dispensers and co-operate with any instruction from hospital staff while visiting a patient. “Antibiotic-resistant bacteria are a challenge to treat, but we are succeeding in controlling the spread of these bacteria in our hospitals. If everyone, including the public, practices good hygiene and follows the required infection control practices, we can avoid the outbreaks experienced by other hospitals,” says Dr. Thomas.
Sexually Transmitted Disease On the Rise
Rates for sexually transmitted diseases (STDs) are on the rise. In 1999, there were 598 reported cases of chlamydia in the former Regina, Pipestone, Touchwood, and East Qu’Appelle Health regions, combined. By 2003, the number of reported new cases was 1,027. The rates of gonorrhea and HIV are also on the rise. “Safe sex fatigue,” is how Kathy Lloyd, RQHR’s Supervisor for Communicable Diseases/Sexual Health explains why safe sex messages are not having the impact they once had. “Messages promoting safer sex have been around for so long that many people are not paying close attention to them anymore. They feel: ‘It can’t happen to me.’ ” In the case of chlamydia, Lloyd believes another reason rates are rising is that some people are having three to four sexual partners in a six-month period, whereas, five years previously, they had two sexual partners in the same time period. Lloyd recommends that sexually active people be tested for STDs. Statistics indicate that young people are more likely to contract diseases such as chlamydia. The age group with the highest chlamydia for the Regina Qu'Appelle Health Region include: a 12-bed brief detoxification centre; new prevention staff and resources; additional youth outpatient and outreach services with cross-trained addictions and mental health workers; and support for a drug treatment court. This investment will amount to approximately $800,000 in capital construction and $900,000 annual operational expenditures. Full copies of the Premier's Project Hope: Saskatchewan's Action Plan for Substance Abuse and Graham Addley's report Healthy Choices in a Healthy Community are available online at www.publications.gov.sk.ca. rate is 20 to 24 year olds, with 15 to 19 and 24 to 29 year olds making up the next largest groups. In the case of chlamydia, 80% of women and 50% of men have no symptoms and they continue to spread the infection unwittingly. “People are shocked when they discover they have a STD,” says Lloyd. Some people aren’t aware that STDs need special testing. “They think that this test is done regularly as part of their blood work or a PAP test.” She urges doctors to ask what’s going on in the patient’s sexual life, especially if they aren’t in a long-term committed relationship, and ask them to be tested.
New Alcohol and Drug Services for Regina Qu'Appelle
On August 4, the Premier announced Project Hope, a new three-year plan to prevent and treat substance abuse. The government is committing $10 million of new annual funding for the plan, based on 15 recommendations contained in the report, Healthy Choices in a Healthy Community, by Legislative Secretary on Substance Abuse Prevention and Treatment, Graham Addley. The plan includes new programs and services across the province. Highlights
News Reel
Announcements
The RQHR welcomes the following new physicians to the Region: Dr. A. Bhatt, Department of Family Practice; Dr. E. Cameron, Department of Family Practice; Dr. E. Kooiman, Department of Family Practice; Dr. J. McCahill, Department of Psychiatry; Dr. M. Yacoub, Department of Psychiatry; Dr. A. Beggs, Department of Surgery, Section of Orthopedics; Dr. T. Chikukwa, Department of Surgery, Section of Otolaryngology