Browsing by Author "Derman, E W"

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    Factors predicting walking intolerance in patients with peripheral arterial disease and intermittent claudication
    (2008) Parr, B; Noakes, T D; Derman, E W
    Objective. To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). Design. The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. Setting. Patients were recruited from the Department of Vascular Surgery, Groote Schuur Hospital, Cape Town. Subjects. Thirty-one patients diagnosed with PAD were included in the study. Outcome measures. During a GTT, peak oxygen consumption (VO2peak), peak minute ventilation (VEpeak), peak heart rate and peak venous lactate concentrations were measured and compared with those from a comparison group. Anklebrachial index (ABI) was measured at rest and after exercise. During the GTT, maximum walking distance (MWD) and pain-free walking distance (PFWD) were measured to determine walking tolerance. Results. Peak venous lactate concentrations did not correlate significantly with either PFWD (r=–0.08; p=0.3) or MWD (r=–0.03; p=0.4). Resting ABI did not correlate with either MWD (r=0.09; p=0.64) or PFWD (r=–0.19; p=0.29). Subjects terminated exercise at significantly (p<0.05) lower levels of cardiorespiratory effort and venous lactate concentrations than did a sedentary but otherwise healthy comparison group: peak heart rate 156±11 v. 114±22 beats per minute (BPM); p=0.001; and peak venous lactate concentration 9.7±2.7 mmol/l v. 3.28±1.39 mmol/l; p=0.001. Conclusion. Perceived discomfort in these patients is not caused by elevated blood lactate concentrations, a low ABI or limiting cardiorespiratory effort but by other factors not measured in this study.
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    Healthy lifestyle interventions in general practice Part 10: Lifestyle and arthritic conditions - Osteoarthritis
    (South African Academy of Family Physicians, 2010) Schwellnus, M P; Patel, D N; Nossel, C; Dreyer, M; Whitesman, S; Derman, E W
    Chronic musculoskeletal disease is one of the most common causes of disability worldwide with considerable economic impact in health care. Osteoarthritis (OA) is the most common chronic musculoskeletal disease affecting a large proportion of the population with an increasing predicted prevalence in the next two decades. Regular physical exercise, nutritional intervention, psychological support and other lifestyle interventions are very important components of the nonpharmacological management of patients with OA. The main rationale to include regular exercise as part of a lifestyle intervention programme for OA is to improve muscle strength and proprioception, and to promote the other general health benefits of participating in regular physical activity. Nutritional intervention should focus on weight reduction while basic nutrients that are required for healthy joints should be provided. Glucosamine and chondroitin supplemention is commonly used and may reduce pain, improve function and reduce or arrest disease progression. Psychological intervention has a particular role in assisting with pain management.
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    Healthy lifestyle interventions in general practice Part 13: Lifestyle and osteoporosis
    (South African Academy of Family Physicians, 2011) Schwellnus, M P; Patel, D N; Nossel, C; Dreyer, M; Whitesman, S; Micklesfield, L; Derman, E W
    Osteoporosis is defined as a systemic skeletal disease that is characterised by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. Therefore, the diagnosis of osteoporosis is based on measurement of bone mineral density (BMD) using central (axial) dual energy X-ray absorptiometry (DXA), and clinical evidence of a fragility fracture (history or radiological evidence). Osteoporosis is a major public health problem, affecting about 30% of postmenopausal women of Caucasian origin, and 70% of those aged 80 years. The risk factors for osteoporosis include lifestyle factors, genetic/ethnic factors, specific diseases causing secondary osteoporosis, ageing factors, qualitative factors, and drugs that are toxic to bone. In addition, there are specific additional risk factors for falls that need to be considered. It is well established that lifestyle factors, including physical activity, nutritional intervention, psychosocial intervention, smoking cessation and other lifestyle factor interventions are key elements in the prevention and management of osteoporosis. Guidelines for these lifestyle interventions in the prevention and management of osteoporosis are reviewed.
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    Healthy lifestyle interventions in general practice Part 4: Lifestyle and diabetes mellitus
    (South African Academy of Family Physicians, 2009) Schwellnus, M P; Patel, D N; Nossel, C; Dreyer, M; Whitesman, S; Derman, E W
    Diabetes mellitus, in particular Type 2 diabetes, can be classified as a chronic disease of lifestyle. A lifestyle intervention programme is therefore an essential component of the primary and secondary prevention (management) of diabetes mellitus. The main indication for referral to a lifestyle intervention programme is any patient with either pre-diabetes or established diabetes mellitus. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are nutritional intervention, exercise training (minimum of 150 minutes at moderate intensity per week), psychosocial support and education. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2–3 months to assess progress and to re-set goals. Longer-term (5–6 months) intervention programmes are associated with better long-term outcomes.
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    Healthy lifestyle interventions in general practice. Part 2: Lifestyle and cardiovascular disease
    (South African Academy of Family Physicians, 2008) Derman, E W; Whitesman, S; Dreyer, M; Patel, D N; Nossel, C J; Schwellnus, M P
    This article forms the second part of the series on the role of lifestyle modification in general practice with specific reference to chronic cardiovascular disease. Whilst the major risk factors which constitute an unhealthy lifestyle were discussed in part 1 of this series, the focus of part 2 will give specific practical guidelines which the general practitioner may incorporate into their practice when counselling patients with chronic cardiovascular disease.
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    Healthy lifestyle interventions in general practice: Part 14: Lifestyle and obesity
    (South African Academy of Family Physicians, 2011) Derman, E W; Whitesman, S; Dreyer, M; Patel, D N; Nossel, C J; Lambert, E V; Schwellnus, M P
    Obesity is defined as an excessive amount of body fat or adiposity. It can be measured using the body mass index (BMI), and according to established criteria for adult men and women, overweight is defined as a BMI between 25-30 kg/m2, and obesity as a BMI > 30 kg/m2. Obesity is clinically associated with many serious co-morbidities, and is widely recognised as one of the leading health threats in most countries around the world. Weight loss is recommended for patients with a BMI > 25 kg/m2. The goals of weight loss therapy are to reduce obesity-related co-morbidities and decrease the risk of future obesity-related medical complications. The management of obesity is multifactorial, and involves the use of combined lifestyle interventions, including regular physical activity and dietary and psychosocial intervention. Practical clinical advice regarding interventions in these important areas is provided in this article.
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    Healthy lifestyle interventions in general practice: Part 15: Lifestyle and lower back pain
    (South African Academy of Family Physicians, 2011) Schwellnus, M P; Patel, D N; Nossel, C; Whitesman, S; Derman, E W
    Lower back pain (LBP) is one of the most common medical problems in the adult population. LBP can be defined as pain, muscle tension or stiffness that is localised below the costal margin (inferior rib cage) and above the inferior gluteal folds and that can present either with or without leg pain (sciatica), and it can be classified as “specific” or “non-specific”. LBP has a high lifetime prevalence and is associated with a substantial direct and indirect cost to the individual and society. In this review, the focus is on the identification of lifestyle risk factors and interventions that are associated with mainly non-specific chronic LBP. In addition to pharmacotherapy, the best treatment approach is exercise therapy (including physical reconditioning), psychosocial and behavioural intervention and therapeutic education. Other lifestyle changes include nutritional intervention and smoking cessation.
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    Healthy lifestyle interventions in general practice: Part16: Lifestyle and fibromyalgia
    (South African Academy of Family Physicians, 2011) Derman, E W; Whitesman, S; Dreyer, M; Patel, D N; Nossel, C; Schwellnus, M P
    Fibromyalgia is a chronic disorder, characterised by chronic widespread musculoskeletal pain, and the presence of multiple tender points as well as a host of associated symptomatology. Optimal management of patients with fibromyalgia requires a multidisciplinary approach, with a combination of pharmacological and non-pharmacological interventions that are tailored to the patient's pain, dysfunction and associated features, including depression, sleep disorder and fatigue. Non-pharmacological lifestyle-based interventions to treat this disorder include exercise therapy, dietary modification, and psychosocial interventions. This review outlines these three forms of lifestyle intervention in patients with fibromyalgia.
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    Medical care of the South African Olympic team: The Sydney 2000 experience
    (2003) Derman, E W
    Objective. This descriptive study was undertaken to report the medical care and injuries sustained by the athletes and officials of the South African Team at the 2000 Olympic Games and to provide data for planning future events. Setting. Retrospective review of medical records at the ί South African medical facility, 2000 Olympic Games, Sydney, Australia. Methods. Total number of consultations and diagnoses, were ascertained from medical logs and patient files which were completed daily by the members of the medical team. Acute and chronic soft tissue (muscle strain, ligament sprain, tendon injury, contusion or laceration) and bony injuries were analysed in terms of nature of injury, grading of severity and anatomical region injured. Main outcome measures. Number of consultations due to medical complaints or injuries amongst athletes and officials. Results. A total of 348 medical consultations were logged during the time in Australia. Seventy-nine per cent of consultations were with athletes and the remainder (21%) > with officials. Despite a comprehensive allergy screening and management programme, the most common medical complaints were respiratory (16%), ENT (18%), and neurological (16%) in nature whilst acute injury and chronic injury accounted for 17% and 14% of consultations: respectively. The most common acute and chronic injuries were soft tissue injuries. The most common acute injury regions were the foot and ankle (20%), hand and wrist ! (20%) and knee (14%). Eighty per cent of acute injuries were grade I, 14% grade II and 6% grade III. The most common chronic injury regions were foot and ankle (31%), shoulder (16%), knee (16%) and lumbar spine (13%). Conclusions. The nature of consultations suggest that it should be a prerequisite for doctors accompanying sports teams to multi-coded events to have a broad sports medicine knowledge of both medical and injury management of athletes. Furthermore, a sound knowledge of the management of soft tissue injury particularly in the hand and wrist, and foot and ankle regions is an important prerequisite. These data should be useful for planning medical services for future multi-coded events.
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    Persistent pain following ankle sprain: Bilateral accessory soleus muscles
    (2009) Neethling-du Toit, M; Derman, E W; de Villiers, R
    Persistent pain following ankle sprain remains a difficult diagnostic and management dilemma. We report a 22 year old rugby player who presented with a persistent painful left ankle following a minor ankle sprain. After examination and imaging investigations, a symptomatic accessory soleus muscle was diagnosed on the left ankle, and an asymptomatic accessory soleus muscle on the right.