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    vaccine.jpg
    Lisa Bywaters
    13/May/2020
    Health InformationMSK articles

    A vaccine for COVID-19

    Just the shot in the arm we need?

    It’s seems crazy when you think about it, COVID-19 has had such a life changing effect on us, but unless you’re a healthcare worker, you probably don’t even know someone who’s had it. Yay for the success of our pandemic plan, but it also means most of us are still susceptible to it.

    But we can’t stay in iso forever. Apart from all of the obvious reasons, we’ve run out of jigsaws, eaten all of the banana bread and we’re over video chatting to our friends about doing nothing.

    It appears that the only way we can get back to our normal lives is if there’s an effective vaccine against COVID-19. So far the info we’re hearing from scientists developing vaccines these vaccines is encouraging. We’re even hearing that one may be available as early as September this year! But what are vaccines, how do they work and what are the chances we’ll have a vaccine for this virus any time soon?

    Your immune system

    To understand how vaccines work, it’s important to understand a little about your immune system. It’s designed to protect you against harmful diseases and infections caused by foreign bodies (also called pathogens) such as viruses, bacterium and other microbes. When your body detects the presence of a pathogen, your immune system mounts an attack to try to defeat it.

    Side note: For those of you who have an autoimmune condition like rheumatoid arthritis, lupus or ankylosing spondylitis, your immune system has gone a little bonkers and has attacked your own body instead of a potentially harmful pathogen. This really sucks. But we can help. Contact our Help Line on 1800 263 265 weekdays.

    Vaccines

    Vaccines work by introducing your immune system to a virus or bacteria. This allows it to learn how to protect you from the pathogen before you meet it out in the world. A vaccine is a weakened or inactivated version of the pathogen. It causes your body to create antibodies – these are the soldiers in the battle against the foreign invader. They have one target and one target only…the specific virus or bacteria that you were vaccinated against. If it ever encounters it, it latches on and destroys or disables it.

    Well that’s the immune system and vaccines in the smallest of nutshells. Watch this short video How do vaccines work? for more info.

    Now it’s time to look at COVID-19 and the efforts to create a vaccine against it. You may be wondering why a vaccine rather than a treatment? That’s a good question, and there’s a LOT of work going into finding effective treatments for COVID. But to treat someone, they already need to be infected. And because this virus is highly infectious, that person can go on to infect many others. So it’s preferable that we prevent this and any subsequent spread of disease is prevented altogether.

    We know a lot about COVID-19

    Even though there are still so many unknowns, we do know a lot about this virus. If you compare it to other new viruses or disease outbreaks, we’re so much further ahead, which is really good news. We knew the genetic makeup of this virus within a couple of months of the outbreak. Researchers used this info to develop tests for diagnosing COVID and to start working on potential vaccines and treatments. So we’ve come a long way in a very short time.

    Types of vaccines

    Just as there are different types of pathogens, there are different types of vaccines. The type of vaccine developed will depend on characteristics of the pathogen and how it affects people

    Types of vaccines include:

    • A weakened, live version of the virus. We use this type of vaccine to prevent diseases such as measles, mumps, chicken pox and rubella. Note: people who have suppressed immune systems can’t use live vaccines.
    • An inactivated vaccine (e.g. flu vaccination). Chemicals are used to destroy the virus before being injected however it’s not as effective as a live vaccine, which is why we have regular boosters.
    • Vaccines that target specific parts of the virus, rather than the whole thing. This is used for diseases such as shingles, whooping cough and tetanus.

    Creating a vaccine

    A great article by The Conversation (31 March) outlined the steps involved in creating a vaccine for COVID-19:

    1. Basic understanding of the virus.
    2. Scientists decide which approach to use from the list above – i.e a live vaccine, an inactivated vaccine etc.
    3. Initial safety testing is carried out in animals to help us understand how it may affect people.
    4. Clinical trials being using people. There are three phases:
      • Phase I – testing on a small number of people, to see how safe it is, and if it has any side effects,
      • Phase II – testing on several hundred people to test for efficacy – or see if it works how it’s meant to work
      • Phase III – testing on several thousand people for efficacy and safety.
        If the vaccine can show it’s safe and provides effective protection against the virus, it will then go on to the next stage.
    5. Regulatory approvals.
    6. Production. This will involve a lot of work to create the quantities of vaccine we need to vaccinate large populations, and to ensure the vaccines are produced safely and with great attention to quality control.

    For more information read: Coronavirus vaccine: here are the steps it will need to go through during development.

    And….after all that we need to actually vaccinate people on a global scale! – which will take a great deal of planning and coordination.

    So when will we have a vaccine?

    The short answer is we don’t know. Most scientists say between 12-18 months. There are some who are more optimistic and say by the end of the year. With over 100 vaccines being researched around the globe, it may well be sooner rather than later. However we need to be mindful that we can’t rush this at the expense of safety.

    So until a vaccine does appear we need to get comfortable with our new normal. We need to continue with our physical distancing, maintain high levels of hygiene, stay active, eat well, managing our mental health and follow the restrictions that are in place where we live. This will eventually pass, but it will take time.

    More to explore

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    tired.jpg
    Lisa Bywaters
    07/May/2020
    Health InformationMSK articles

    Why am I so tired?

    Hands up if you’re feeling tired at the moment? Or if you’re too weary to raise your hand, just a brief nod will do it. It seems like we’re a nation of tired people at the moment (?).

    Why is this? We’re not going out like we used to, to the movies, restaurants, family gatherings, to see friends, sports events, or take the kids to all of their extra-curricular activities. We should be swimming in time and feeling relaxed and rested, right?

    Ah, no.

    We’re stressed

    Stop me if you’ve heard this before but we’re going through unprecedented times. This pandemic is causing massive disruptions to our lives, our families, our work and our routines. This constant uncertainty causes us to feel stressed. All the time.

    When we’re stressed our bodies release adrenaline. It’s so we can react to a crisis, the old ’fight or flight’ response. But when the stress is constant, as many of us are feeling at the moment, this has an effect on our health – including making us feel physically and mentally tired.

    There are lots of things you can do to manage stress. By understanding what’s causing your stress, you can start to manage it. This may include things like developing a new routine (and sticking to it), exercising, talking with your family about how you’re feeling, finding ways to relax, making sure you’re eating a healthy diet and drinking enough water, getting a good night’s sleep and avoiding excessive use of alcohol and other drugs.

    We’re staying indoors more

    Because of restrictions we’re staying inside our homes more. So we’re not getting exposed to as much sunlight as we normally would. A lack of sunlight causes the brain to produce more of the hormone melatonin, which makes us sleepy.

    To deal with this, schedule time every day to go outside for a walk or stroll in your yard, open your blinds or curtains as soon as you get up and expose yourself to as much sunlight as you can. It’ll help you feel more awake and improve your mood. Just think how much better you feel after being stuck indoors when you get out into the sun. It makes you feel so much more energetic and alive! So this one’s a no brainer. We just have to make time to do it.

    We’re sleeping less (or more) than usual

    Let’s face it, since this all started our usual everyday routines have been shot to pieces. Work, home life, family, socialising, shopping – it’s all so different at the moment. When you add stress to the mix, our sleep is often affected.

    You may find you’re sleeping less than usual because you’re working long hours to catch up on work after spending the day home schooling the kids, or you’re watching more TV and spending more hours online, or stress is causing you to feel more pain and you’re having issues sleeping through the night.

    Or you may be sleeping more – trying to rid yourself of this constant feeling of tiredness, or because you’re bored, or because it’s cold outside and you’re feeling cosy and warm indoors, or because you’re feeling sad. Not enough sleep, too much sleep and poor quality sleep will all increase how tired you feel.

    That’s why it’s important that you stick to a sleep schedule – even on the weekends. Get out of bed in the morning and go to bed at night, at the same time every day. Your body needs this regularity for your internal clock to function properly, and to help you fall asleep and wake up more easily and feeling more refreshed.

    And if you’re regularly finding it difficult to sleep or get out of bed because you’re feeling really sad or down, it’s a really good idea to talk with someone about this, whether it’s family, a close friend or your doctor. Please don’t ignore this.

    We’re exercising less

    Many of us are finding we’re exercising less because we don’t have access to our warm water exercise classes, tai chi, gyms and exercise groups. Not getting enough exercise can make you feel sluggish and tired. If this continues for some time, we start to get out of shape and feel less inclined to exercise. So it’s really important to make exercise – whether it’s online videos and apps, walking, dusting off your old exercise DVDs, or dancing around the living room – an essential part of your everyday routine. And get the family involved. Everyone needs to be exercising and staying active for our physical and mental wellbeing. If you’re home alone, use a video app to call a friend and exercise together. You’ll find you’ll feel more energised and happier when you’re exercising regularly.

    We live with chronic conditions

    Apart from all of above affecting how tired we’re feeling, we live with chronic musculoskeletal conditions and other health issues. These often cause us to feel fatigued. Many of our medications and living with chronic pain can also make us feel excessively tired. When you add a pandemic on top of that, the unique issues you’re facing – how the virus may affect you, worry about being more at risk, how to safely access your healthcare team, navigating telehealth – it can heighten you’re feelings of fatigue.

    Many of the things we’ve looked at – such as establishing a routine, getting adequate sleep, eating well, exercising and staying connected with your family, friends and work colleagues will help you with some of these issues.

    You can also get help from your GP and from the nurses on our Help Line. Contact a peer support group or go online and connect with others dealing with similar things. Even just talking with others who know exactly how you’re feeling can help you feel less isolated.

    We may need to talk with our doctor

    Finally if you’re concerned that your tiredness is due to more than just the reasons listed above, it might be worth talking with your doctor about it. Your tiredness may be caused by other things like vitamin deficiency (for example iron and vitamin D), side effects of your medications, feeling sad, anxious or depressed or it may indicate another health issue. So make an appointment to discuss it with your doctor – either in person or via a telehealth consultation.

    Contact our free national Help Line

    If you have questions about things like COVID-19, your musculoskeletal condition, treatment options, telehealth, managing your pain or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Photo by Tracey Hocking on Unsplash

    CONTINUE READING
    medications.jpg
    Lisa Bywaters
    25/Mar/2020
    Health InformationMSK articles

    Medications – it’s time to take a chill pill

    Does anyone else feel like things are going slightly pear shaped at the moment? The COVID-19 pandemic has really thrown us for a spectacular loop.

    It’s understandable that a lot of us are feeling anxious, worried and scared – it’s a pandemic for goodness sake, it’s normal for us to be feeling this way. However some people are taking it to the extreme and stockpiling loo paper, food, soap and now medications.

    While it’s important to ensure you have your prescription/s filled, and that you have enough of the usual over-the-counter medications you would normally have headaches, sore throats etc, there’s no need for us to lose our minds and go overboard.

    Stockpiling – it’s just not necessary

    Panic buying has led to certain medications – both prescription and over-the-counter – having limits placed on them to ensure that we don’t run out. Common medications such as paracetamol, asthma puffers, insulin and EpiPens are now restricted

    The Therapeutic Goods Administration (TGA), which is responsible for regulating the import, supply and manufacture of therapeutic goods in Australia, have stated that “as of 6 March 2020, the TGA has not received any notifications of medicine shortages in Australia that are a direct result of COVID-19. Therefore, while it may be appropriate for individuals to ensure that they have at least two weeks supply of prescription medicines in the unlikely event they are quarantined, any stockpiling of medicines is unnecessary.”

    So please everyone, breathe. Make sure you have what you need, but don’t take more than that. There’s just no need for it. Let’s all take a deep breath and remember we’re all in this together.

    The problem with hydroxychloroquine (Plaquenil)

    Unfortunately, there’s one medication we know has become difficult to access in Australia. Hydroxychloroquine (Plaquenil) is used by people with rheumatoid arthritis, lupus, juvenile idiopathic arthritis and other autoimmune diseases. There’s been a rush to access this prescription-only medication after US President Trump mentioned that it was a “game changer” in the treatment of COVID-19.

    Sadly, there have been reports from overseas that people taking these medications, to treat/prevent COVID-19, have become seriously ill. One man has died.

    Thankfully on 24 March, the TGA announced that they were placing new restrictions where “only certain types of specialists will be able to prescribe hydroxychloroquine to new patients”. This is great news as it will help to ensure hydroxychloroquine is available for people with musculoskeletal conditions who need it to keep their symptoms under control.

    And then there was ibuprofen

    Common brands include Nurofen, Advil, Celebrex, Naprosyn and Voltaren.

    There’s been quite a bit of confusion about the anti-inflammatory medication ibuprofen, which is used by many people with musculoskeletal conditions.

    Initially the World Health Organization (WHO), stated that ibuprofen could make some symptoms of COVID-19 worse. This was based on a study published in The Lancet. But that’s been debunked

    The WHO had to do a backflip stating that “based on currently available information, WHO does not recommend against the use of ibuprofen…we are consulting with physicians treating [COVID-19 patients] and are not aware of reports of any negative effects, beyond the usual ones that limit its use in certain populations”.

    In Australia the TGA has stated that “there is currently no published peer-reviewed scientific evidence to support a direct link between use of ibuprofen and more severe infection with COVID-19. We will continue to monitor this issue”.

    So at this stage, if you’re currently taking ibuprofen, or another NSAID, as prescribed by your doctor, don’t stop taking it without discussing with your doctor.

    What if you can’t get out to get your medications?

    If you’re self-isolating, sick or just can’t get out to get your medications, there are options for you.

    • Call your family, friends, neighbours. If they’re able to get to the pharmacy for you, that’s great. Remember to keep your distance – practise physical distancing (for example, arrange to leave your prescription, list, money etc in a certain place so they can pick it up without having direct contact with you). Wash your hands thoroughly before you handle the items you are leaving to be picked up, and after you handle the items that have been delivered.
    • Many pharmacies offer home delivery – so be sure to give them a call too.
    • As part of the National Health Plan, telehealth can now be bulk-billed and Electronic Prescribing is being fast-tracked. There are options immediately available to support telehealth services so you can get medicine sent directly to you at home.

    Please stay calm

    I know this is easier said than done, but pharmacies are an essential service, and remain open after many other (non-essential) businesses were required to close on 23 March 2020. So you can still access your local pharmacist – in person, over the phone, via a family member/friend or through other technology – and get the information, medication and support you need.

    And while there is a lot of confusion in our community about so many things at the moment, the government, at all levels, is trying to keep us safe and healthy, but these are extraordinary times. So we need to remain calm, work together and stay kind. We will get through this.

    More to explore

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    cortisone-foot.jpg
    Lisa Bywaters
    22/Jan/2020
    Health InformationMSK articles

    You want to stick a needle in my sore foot?

    Written by Steve Edwards, MSc(Oxon), MSc(Edinb), BSc(Pod)

    “A cortisone injection? You want to stick a needle in my sore foot?”

    Your health care clinician has suggested you have a cortisone injection into your foot. As with any medical procedure, both of you are best advised to discuss the benefits and risks before proceeding. It helps to know what cortisone is, what it does, and why it’s been offered to you.

    Cortisone is an anti-inflammatory medication that’s often used to treat musculoskeletal conditions. It’s a synthetic version of cortisol, a hormone that naturally occurs in your body. Injected into the affected area, cortisone can lower inflammation and pain, remove fluid, and thin scar tissue or adhesions. So if your clinician diagnoses a musculoskeletal condition affecting your foot or ankle – such as arthritis, bursitis, neuroma, or tendinitis – a cortisone injection is commonly raised as an effective treatment option.

    Cortisone injections also contain a local anaesthetic. For certain conditions an injection can be painful, so the anaesthetic may be injected separately before the cortisone to block this pain.

    The clinician may or may not use ultrasound technology to guide the injection. For pain relief in the foot or ankle, research finds no statistically-significant difference between procedures conducted with or without ultrasound. Interestingly, trials on cadavers injected with dyed cortisone show how it rapidly spreads from the injection-point to adjacent tissue, indicating that pinpoint accuracy is not key to effectiveness.

    There are several types of cortisone. In most cases the clinician will administer a long-duration cortisone, taking effect within 1-3 weeks, with benefits lasting between 1-9 months, depending on the condition and its severity. There’s a clinical consensus that no more than 3 injections should be administered to the same body-part within a 12-month period, though there’s no research literature to clearly support this belief.

    After the injection, you can quickly return to most activities. The clinician may recommend you avoid strenuous physical exertion such as gym workouts or running for a few days, so the cortisone isn’t displaced from the target tissue.

    As for risk-factors, there’s been research into whether the injection may risk tearing tendons in the target area. There’s no recorded case of this in human trials, though it has occurred in trials on dogs and horses. There were cases of more general tissue damage recorded in early trials on American gridiron players, but various factors could have produced this result – the needle used, the amount of fluid injected, and the subjects receiving multiple injections within a short period.

    No medical procedure has a 100-percent success rate, but a single cortisone injection administered by a trained clinician is both safe and effective in providing medium-term pain relief. Side effects are minimal, and the benefit to your musculoskeletal condition is potentially vast. And for some foot-specific conditions – such as a neuroma (pinched nerve), or plantar fasciitis (heel pain due to scar tissue) – a cortisone injection can often be a cure.

    Our guest blogger

    Steven Edwards is a trainee foot and ankle surgeon with the Australasian College of Podiatric Surgeons. He also teaches pharmacology and foot surgery to undergraduate podiatry students at La Trobe University.

    CONTINUE READING
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    Lisa Bywaters
    27/May/2018
    Health InformationMSK articles

    Pain A-Z

    A book by people like you

    Chronic pain is a common and complex problem that affects 1 in 5 Australians.

    It’s exhausting, a bit tricky and hard to know where to start.

    Fortunately, with our book Managing your pain: An A-Z guide you can start anywhere!

    Medications, sleep, laughter, fatigue, breathing. Think of it as a ‘choose your own adventure’ to getting on top of your pain.

    The book emphasises practical strategies tried and tested by people like you – consumers living with musculoskeletal conditions. There are also a bunch of quotes and useful insights to keep it real.

    You might also like…

    We also have a helpful kids pain book called The worst pain in the world. It’s beautifully illustrated and loaded with practical advice for children living with pain (not just those with arthritis). It also gives kids who don’t live with pain an understanding of what their friends or family are going through.

    CONTINUE READING

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