In January we left for Guadalajara, Mexico, to join an international group of prolotherapists for a week-long mission. Dr David de la Mora arranges this "brigada" annually, to help many Mexicans obtain treatment who otherwise would not be able to afford it. The group treated more than 1000 patients, had fun, experienced daily education times, exchanged experiences and techniques, and we feel blessed to have been included. This is one of the HHPF's (Hackett Hemwall Patterson Foundation) organised medical missions, led by the very capable Mary Doherty. This year in Mexico we had 5 Canadian physicians, many Americans, and also doctors from Mexico, Puerto Rico, Turkey and Italy volunteering! Here is the Canadian team goofing around, and also a photo of all the doctors volunteering.
Knee arthritis and Prolotherapy
Striving to obtain the best medical evidence for a treatment is a good goal to have. We are pleased to report one more study (well, really it is a review of several good studies, and in this case it is the highest level of medical research, even more exacting than randomized and blinded trials) showing that prolotherapy is an effective treatment for knee osteoarthritis. This is good news to those suffering this type of knee pain. Not everyone is helped, as some arthritis is too far-advanced, but many people have a great response to prolotherapy as a treatment for arthritis.
Here are the doctors, nurses and volunteers who headed down to inject prolotherapy in Honduras this year. It was my third opportunity to work in Honduras, where we helped many hurting people at clinics in 3 small towns there. It is such a privilege to do this, teaching, learning and helping. My lecture there this year was on wrist prolotherapy - we take it in turns to present topics. The Hackett Hemwall Patterson Foundation is such an excellent teaching organization based in Wisconsin, where we meet up with good friends that we have made from different countries. In addition the foundation also sends down an Ear, Nose and Throat team as well as a Varicose Vein and Ulcer team. What a difference they make!
The CAOM holds annual conferences in Regenerative Medicine and this year we met in Vancouver. It is always stimulating to listen to excellent speakers in the field, meet old colleagues and new, and exchange information that makes all of us better practitioners. This year we heard an excellent talk on nutrition and its importance by Dr Aileen Burford-Mason - this will have its own blog entry. In addition we had workshops on prolotherapy, platelet-rich plasma and ultrasound-guided techniques. Erik Ouellette, well-respected prolotherapist from Ontario gave a great lecture on injecting the shoulder, and followed up by doing just that. Physicians presented new research studies, some so new they haven't been published quite yet, and our North Vancouver colleague Dr Helene Bertrand discussed her positive shoulder prolotherapy study which has been accepted for publication. Kelowna physician Dr Francois Louw piqued our interest with favourable early trends in his TMJ (jaw) pain study. We came away tired but grateful to belong to such a good organization.
An interesting study was published recently. Having a knee arthroscopy (a surgical procedure with a "telescope" looking into the knee, and cleaning out any part that is rough or loose) does not improve pain. Many, many people suffer from knee arthritis and so this is helpful in deciding on a course of action. Having a knee replacement may be the eventual answer, but in the mean time regenerative injections (perineural injecting of dextrose, or prolotherapy, or PRP) can be a big help in reducing symptoms, and may even prevent the "kneed" to do surgery at all.
This changed my practice
The University of BC regularly sends out articles by physicians who have found some aspect of medicine has changed the way they practice. I have been meaning to send them my views on the subject and here they are! Thank you to the many patients over the years who have taught me so much about the treatment of pain.
This is cool
This gadget from CoolSense is an ingenious device. Kept in the freezer, then placed on the skin for a few seconds it reduces skin sensation by cooling the skin, enabling us to inject the skin without pain. It basically replaces the need to use local anaesthetic injections prior to prolotherapy and it works remarkably well. After use we clean the head with cavicide which thoroughly disinfects the unit.
Does it work?
Most physicians like to see evidence of any medical therapy before they embrace or promote it. This is the world of research, which is often not clear cut but at least gives us guidance about what works and what doesn't. Recently we met up with a colleague in BC who is studying the effect of prolotherapy for TMJ or temporomandibular joint syndrome, aka painful jaw. The study is on-going and won't be published for at least a year, but the results thus far are very promising. Most of the patients who were in the non-prolotherapy arm of the study opted to have prolotherapy after their involvement in the study was complete, as they hadn't benefited from the "blinded saline" injection to the same extent as the "blinded dextrose" group. This shows that the proliferative effect of concentrated dextrose into damaged joints is effective, leading to healing and of course less pain - our goal! We have updated the research section of the website, and for your interest and information you can look at these studies near the top of the Links page. Some of the researchers are Jack Taunton, well-known Vancouver sports injury clinic physician, Dean Reeves, "father" of prolotherapy research collation, and David Rabago (and the late Jeff Patterson) of the University of Wisconsin, home of the Hackett Hemwall Patterson Foundation whose teaching of prolotherapy is first class. We have met several of the researchers in the world of prolotherapy and they are enthusiastic about this simple, elegant and effective treatment.
In March 2015, David and I travelled to Honduras, to the village of Tela, to spend 2 weeks at a medical mission for people with chronic pain. We gave prolotherapy injections to many needy and willing recipients. The people of Honduras are so gracious: first the support team to run these clinics is second to none, and the patients who have so little (and line up for long hours and often travel many miles to come) are so grateful for anything we can do to help relieve their pain. We treated many people with arthritis, injuries, and poorly healing conditions and also benefited ourselves by being surrounded by other fantastic volunteering physicians, including a first rate teaching team. We are all better injectors as a result of these experiences. We salute the Hackett Hemwall Foundation who has been running humanitarian relief work in Honduras (prolotherapy, vein clinics and an ear, nose and throat team) for many, many years. We had the privilege of working under Dr Carl Osborn from Oregon, who celebrated his 20th year of this volunteer work. He is an excellent teacher! (see photo below - Carl is in the brown scrub top below). OK, so we had a bit of time to relax too...
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.