Ehlers-Danlos Syndrome and Prolotherapy


May 22, 2019 Uncategorized

Ashlee

Ehlers-Danlos Syndrome and Prolotherapy

A case history by Dr Philip Dupre.

EDS is a genetic disorder that causes weak connective tissues and therefore affects joints, skin and sometimes blood vessels. Joints become unstable, skin becomes lax and blood vessels fragile. It affects about 1 in 5,000 of the population to a varying degree. It also affects animals.

Generally, surgical treatment for these unstable joints is ineffective because surgery does not correct the underlying tissue fragility.

About 3 years ago, I was approached by the mother of Ashlee, a 15 year-old girl affected by this condition and having a problem with dislocating patellae. She was keen to know if prolotherapy might help her daughter. Prolotherapy involves the injection of an irritant solution usually glucose, into areas of chronic pain in order to cause an inflammatory response. This initiates a healing process in the damaged soft tissue, and ligaments are strengthened. It is most commonly used for spinal pain with generally good results.

I had not heard of prolotherapy being used in Ashlee's situation but, in theory, injecting a sclerosant (concentrated 50% glucose mixed with an equal volume of local anaesthetic) into the medial joint capsule of her knee might tighten and strengthen the tissues and therefore stabilise her knee. She and her mother were keen to give it a try.

Her right patella had been dislocating about every other day for the past 6 months, so she was forced to wear a knee splint. Her left knee was doing the same. Initially, I infiltrated 2mls of the glucose mixture into the medial capsule of her right knee. Two weeks later she stated that her knee felt more stable, so 3mls were injected at this session. At 5 weeks' follow-up, after two injection treatments, she was able to discard her knee brace, and at 8 weeks she had stopped dislocating completely.

Meanwhile, as her left knee had the same problem it was also injected.

Two years after the initial treatment, both patellae had started to sublux but responded well to more injections.

In summary, her right knee stabilised after 4 treatments over 7 weeks but required two further inections 2 years later. Her left knee was stable 2 weeks after only one inection, but again required a booster 2 years later. It is now 6 months since her last treatment and Ashlee reports that both knees are feeling good.

About 18 months after her first knee treatment, she reported that her left wrist had been dislocating and this was demonstrable at the radiocarpal joint. In view of the reported success of treating lax cruciate knee ligaments with intra-articular glucose, I injected 2mls of glucose mixture into her left wrist joint. Two months later she stated that her wrist was about 60% improved. On this occasion I infiltrated 1ml of mixture into the dorsal capsule of her wrist joint. She was seen 6 months later and stated that her wrist had been good for 5 months following the last injection but was starting to sublax again. 2mls of mixture were again injected into her left wrist joint. Currently, 8 months after the last treatment, she is happy with the result, her wrist is stable with only occasional twinges of pain.

In retrospect I would in future only inject the dorsal capsule and if intra-articular injection was required only use 1ml of glucose mixture.

During all this time, Ashlee's left shoulder had been dislocating anteriorly. This was painful and distressing. The problem was how to stabilise a global joint laxity. The original operations for anterior shoulder dislocation involved suspending the humeral head from the acromion by tendon graft or transfer and, bearing in mind this principle, I infiltrated Ashlee's postero-superior shoulder capsule with 2ml of glucose mixture. She has required four further injection treatments over a 13 month period and currently she says her shoulder is not dislocating at all, whereas, in the past it had been happening up to thirty times a day which was painful and very inconvenient.

In addition to all the above, she reported instability in her left ankle, both inversion and eversion. This responded well to a single injection into her medial and lateral ligaments.

In summary, this is only one case, the story of an 18 year old girl with Type 3 Ehlers-Danlos Syndrome, who has gained significant improvement from a simple and inexpensive treatment over the past 2-and-a-half years. She is currently attending university and states that at the time (March 2018) none of her joints feel unstable, and she of course is very pleased with the results. She is unable to explain why her problems have generally been unilateral. She is right handed.

It is possible that prolotherapy may have a place in treating people with normal connective tissue who had joint instability, especially of the patella, but this will require further research.

 

Bibliography|
Reeves, K. D. and Hassanein, K, Randomised Prospective Double-Blind Placebo-Controlled Stud of Dextrose Prolotherapy for Knee Osteoarthritis With or Without ACL Laxity. Alternative Therapies, 2000 Mar, Vol 6. No. 2, pp. 68-79

 

 



March 29, 2019 Uncategorized

Our Mum and Bub Hub will be open on Monday 1st April

Our Midwives work closely with doctors who share our philosophy of the importance of midwifery care.

Pregnancy – Antenatal care

The Mum and bub hub offer a unique, collaborative, continuity of care model of pregnancy and post birth care for Mother and baby.

Known as the shared care model of antenatal care, this includes both your Doctor and our onsite Midwifery team.

Antenatal / pregnancy care includes:

  • Personalised, collaborative care with G.P. & Midwife
  • Appointments Medicare bulk billed
  • Pregnancy testing
  • Referrals for ultrasounds & blood test all performed within the Hub.
  • Regular routine pregnancy appointments with our midwives.
  • Pregnancy Immunisations; Pertussis, tetanus and Flu vaccine.
  • Guidance and support
  • Preparing for breastfeeding
  • Referral to other health professionals as required
  • Referrals/ collaboration with your birthing hospital, Caboolture hospital, Redcliffe hospital and The Sunshine Coast University hospital.

Postnatal Care

The care you receive after the birth of your baby is as important to us as your antenatal / Pregnancy care.

To support this transition, we can continue to bulk bill all your appointments with the midwives, including breastfeeding consultations up until 6 weeks of age.

Postnatal care includes:

  • 7 day check up for both mother and baby
  • Contraceptives
  • Weight checks
  • Feeding support
  • Immunisations
  • Referrals to other health professionals as required

 

Breastfeeding / Lactation support

The mum and bub hub, has its very own lactation dedicated rooms with consultants and midwives, providing bulk billed appointments up until 6 weeks of age.

Lactation services are for:

  • Support
  • Sore/ cracked nipples
  • Attachment concerns
  • Milk supply
  • Mastitis
  • Baby weight concerns for the breastfed baby.
  • Unsettled, reflux, colicky babies.
  • Expressing concerns.


January 30, 2019 Uncategorized

Dr Matthew Allen is a physician at Health Hub Doctors Morayfield who specialises in urgent care, skin and cosmetic medicine.

Each week, we aim to bring you news, updates and information about what is happening here at Health Hub Doctors Morayfield.

This week, Dr Allen talks about the rise of low iron treatments as people are eating less meat in their diets.

 

At Health Hub Doctors Morayfield, we are seeing increasing numbers of patients for iron infusions as many find that oral iron supplements fail to help.

As the amount of red meat Aussies eat declines, treatments including iron infusions and hospitalisations for iron deficiency anaemia are on the rise. For hospital-level anaemia, there's often another underlying condition, but a lack of iron-rich foods such as red meat, seafood or leafy greens is one of the biggest risks of low iron. Data from the most recent OECD and Food and Agriculture Organisation of the United Nations Agricultural Outlook shows in the 10 years to 2017, the average Australian annual red meat consumption dropped 22 kilograms. Lamb and mutton consumption have also dropped by 15.3 kilograms.

An increase in vegetarianism - whether due to soaring meat prices or environmental concerns - could also be at work. Iron in animal products, such as red meat, is generally absorbed easier than plant-based iron, with two to three servings of red meat a week the recommended amount. Vegetarians can be healthy though with a well thought out diet.

Anaemia is more common in women of child-bearing age but changing lifestyles could also be contributing to an increase in anaemia. Some cultures, particularly South Asian women - a fast-growing population in Australia -  are prone to low iron, possible due to the difference in cultural diets.

Symptoms of low iron are subtle at first, so people often take too long to get checked by a health professional. Commonly, people believe low iron is a symptom that is a part of life where people think "I'll sleep in a bit more, maybe have nap or some time to myself and I won’t feel so tired." Yet, it only gets worse over time and reaching for the coffee won’t help as caffeine inhibits the absorption of iron.

Typically with low iron patients will find that they will be out of breath quickly and will become tired quickly. Patients with low iron are essentially starving their body of oxygen.

If in doubt we encourage our patients to see their family doctor. To book an appointment at Health Hub Doctors Morayfield, please call reception on 5322 4900 or visit the Book Online tab at the top of the page.

 


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