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‘Preventing Aging’—What Strategies can Physicians Advise?

Teaser: 

Dr. Marina Abdel Malak, MD, CCFP, BSc.N,

is a Family Physician in Mississauga, Ontario. She has served on several committees and groups, including The Primary Care Network and Collaborative Mental Health Network. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health. Dr. Abdel Malak is highly involved in quality improvement initiatives, and her research interests include strategies to support physician wellness, patient self-management, and optimizing physician education.

CLINICAL TOOLS

Abstract: The Canadian population continues to age, and therefore, promoting healthy aging is essential. Physicians play an important role in counselling patients on how they can optimize their health. Despite the range of societal myths and fads, the 4 pillars of health are the strategies that have been shown by evidence to promote healthy aging. In the clinical setting, it is critical for physicians to advise patients on these 4 pillars: a balanced diet, a range of physical activities, maintaining relationships, and utilizing the brain’s cognitive capacities all promote physical, mental, social, and emotional wellness. Although aging itself is unavoidable, these lifestyle behaviours can support patients in experiencing aging as a positive, fulfilling, and meaningful part of their lives.
Key Words: Health promotion, aging, nutrition, exercise, cognition, social engagement.
1) Although aging is unavoidable, patients can engage in lifestyle habits and behaviours that promote healthy aging and improve quality of life
2) Optimal nutritional intake and physical activity positively impact mental, emotional, and physical health throughout the lifespan
3) Engaging in social relationships, as well as cognitive stimulation, improves the self-esteem life-satisfaction of elderly patients
1) The four pillars of health that promote healthy aging throughout the lifespan are nutritional intake, physical activity, cognitive stimulation, and social engagement. Physicians need to counsel patients on strategies that address these four pillars
2) Chronic under and over-nutrition are both harmful to health. Physicians should therefore provide advice to patients on how to eat a balanced diet that provides essential vitamins, minerals, and macronutrients
3) Cognitive stimulation can involve activities such as word searches, memory games, playing a musical instrument, mazes, and more. Evidence supports that these activities promote neuroplasticity and can prevent the development of dementia
4) Attending groups and workshops provides social engagement opportunities for elderly patients, which allows them to contribute to the community, develop social skills, and maintain a sense of human connectedness
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Related Terms: Caregiving, health promotion, aging, nutrition, exercise, cognition, social engagement
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Surgical Management of Spondyloarthropathies in the Age of Disease Altering Drugs

Teaser: 

1Mosaab Alsuwaihel, MD, 2Sean Christie, MD,

1PGY4 Dalhousie Neurosurgery Program, Dalhousie University, Halifax, NS. 2Professor, Department of Surgery (Neurosurgery), Faculty of Medicine, Vice-Chair and Director of Research , Division of Neurosurgery, Dalhousie University.

CLINICAL TOOLS

Abstract: Inflammatory spondyloarthropathies produce synovitis of the spinal joints in rheumatoid arthritis (RA), or enthesitis in ankylosing spondylitis (AS). In RA, progressive disease leads to synovial destruction, ligamentous laxity, pannus formation and deformity. In AS progressive enthesitis results in ascending ossification, kyphotic deformity and rigidity which increase the risk of fracture. Although pain is the common presentation, spinal cord compression can produce neurological deficits. Although the need for surgery has decreased with the advent of new disease altering drugs, there remains a number of indications when surgical consultation remains important.
Key Words: Spondyloarthropathy and spondyloarthritis, Synovium and synovitis, Enthesis and enthesitis, Pannus.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
1. Inflammatory arthritis from multiple etiologies may affect the spine with different patterns and pathophysiology.
2. Rheumatoid arthritis is a disease of synovial inflammation and in advanced disease leads to synovitis within the atlanto-dental articulation and the facet joints of the spine.
3. If left untreated atlantoaxial subluxation, cranial settling and pannus formation may lead to spinal cord and lower medullary compression.
4. Seronegative arthropathies leads to an enthesitis of the spine, usually starting in the sacroiliac spine and ascending with progressive ossification.
5. As a consequence of pathological alteration of the spine biomechanics, trauma in the setting of ankylosing spondylitis leads to different fracture patterns with a high chance of instability even after minimal trauma.
1. Early and adequate treatment of rheumatoid arthritis can prevent advanced atlanto-axial disease, deformity and neurological injury.
2. Even minimal trauma to the spine in a patient with ankylosing spondylitis has a high risk of instability and neurological injury; detailed imaging is always warranted.
3. With the advent of modern disease modifying agents for the treatment of spondyloarthropathies, the requisite for surgery has decreased but there remain important indications.
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Related Terms: Back Health, Spondyloarthropathy and spondyloarthritis, Synovium and synovitis, Enthesis and enthesitis, Pannus
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Athletes and their Hearts: What the Primary Care Physician Should Recognize

Teaser: 

Dr. Marina Abdel Malak

is a Family Medicine Resident at the University of Toronto. She graduated and completed her Bachelor of Science in Nursing and went on to study Medicine. She has a passion for medical education, patient empowerment, and increasing awareness about the relationship between mental, emotional, and physical health.

CLINICAL TOOLS

Abstract: Physicians will undoubtedly follow athletic patients in their practice, and must therefore be aware of the cardiac adaptations that occur in these patients. Athletic heart syndrome (AHS) is a term used to describe the physiologic adaptation (leading to cardiac hypertrophy and/or dilation) that the heart undergoes in response to intense physical activity. Although these are adaptive responses, physicians need to ensure that these changes are not due to pathological causes such as hypertrophic cardiomyopathy, other genetic or congenital disorders, etc. To do so, physicians must take a through history from the athlete (including family history), conduct a physical exam, and order investigations (such as ECGs, an echocardiograph, etc.) as appropriate. If a pathologic cause is not identified and AHS is noted to be the sole cause of these changes, the athlete should still be counselled on how to safely participate in physical activity.
Key Words: Athletes, cardiovascular care, sports medicine, primary care, screening.
Athletic heart syndrome (AHS) is a physiologic adaptation hypertrophy and/or dilation of the heart that allows for increased stroke volume, decreased heart rate, and increased blood flow and oxygen delivery
The hypertrophy and/or dilation that occurs in AHS can mimic serious illnesses that must be ruled out
To differentiate between AHS and pathological causes of AHS, the physician should take a history and conduct a physical exam. Echocardiography and an ECG are also important
A family history of sudden cardiac death (SCD) is a 'red flag' that must be investigated further
Inquire and investigate for symptoms such as syncope, shortness of breath, connective tissue changes, lab abnormalities, etc. It is important to keep the differential diagnosis broad to ensure a serious cardiovascular condition isn't missed
An echocardiogram should be ordered to assess cardiac function and look for structural changes in the heart
When other causes have been ruled out, AHS may be diagnosed. Although this is not inherently dangerous in itself, all athletes engaging in strenuous activity require counselling and advice around warming up, pacing activity, etc.
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Related Terms: Cardio-Cerebrovascular, athletes, cardiovascular care, sports medicine, primary care, screening
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