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Spring/Summer 2013
ArthritisToday
Living with
Ankylosing
Spondylitis
What Is Gout?
Choosing a Safe
and Effective
Exercise Program
CHECK OUT OUR
EXERCISES CLASSES
FOR 2014
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Contents
FEATURED
IN THIS
ISSUE
7
Living with
Ankylosing
Spondylitis
13
A Medicinal
Perspective
on Gout
22
Choosing a Safe
and Effective
Exercise Program
4. From the Desk of the Executive Director
5. Latest News
7. Feature Story:
Living with Ankylosing Spondylitis
10. Feature Story
What is Gout?
12. A Medicinal Perspective on Gout
13. Past Events
16. AO Youth
17. Volunteers
19. How to Book Online – Step by Step
20. Health & Lifestyle
Choosing a Safe and Effective Exercise Program
How can Changing my Diet Help with Gout?
Alana’s Recipe
25. Spotlight on Work
26. Upcoming Events
28. Exercise Classes – Term 1, 2014
29. AJ Smith Society
30. Country Rheumatology
31. Support Groups
From the desk of the
Executive Director
Welcome to our Spring/Summer
edition of Arthritis Today.
In this edition, we take a look at the
particularly painful condition of
Gout which is increasing in
incidence, especially as the
population ages. Associate
Professor Helen Keen has written
an article that provides important
information about the condition and
how to effectively self-manage it.
Our feature article focuses on the
story of Thomas Davies, a young
man who lives with the condition,
Ankylosing Spondylitis. We learn of
Thomas’ endeavour to manage his
condition and overcome obstacles
in order to live a productive life.
Thomas’ story is very important, as
it creates awareness and highlights
the fact that arthritis can and does
affect people of any age. Thomas is
now raising funds for Arthritis &
Osteoporosis WA in appreciation of
the assistance he received from us.
I encourage you to read his story
and support his quest by visiting his
Also in this edition, we show you
step-by-step instructions on how
you can book online for one of
our many events or exercise
classes. Our secure website
means you can safely pay online
by using your credit card. It’s
quick and easy to register - just
visit our website www.arthritiswa.
org.au and click on Calendar &
Bookings to see what we have on
offer.
Applications for the Chair in
Rheumatology and Musculoskeletal
Medicine have now closed and
interviews will be taking place in
November. We are excited to see
our vision coming closer to fruition
and we will keep you posted as soon
as the position is successfully filled.
As we near the end of another year,
I would like to thank all those who
have kindly supported us, without
Arthritis & Osteoporosis WA
Board
Arthritis Today is published by
Arthritis & Osteoporosis WA.
President: Dr J. Edelman MBBS FRACP
Vice President: Dr I.D. Froyland PhD(Crim),
MA(Psych), Dip Ed
Hon Treasurer: Ms Silvia Caratti B Com FCA
MBA
Members: Prof. R. Prince BSc MB ChB Birm.;
MD Melb, FRACP, MRCP(UK); Dr B. Langlands
MBBS FRACP; Dr Margaret Mazur MD FRACP;
Mr Brad Gordon SA (Fin.), Fdn DFP, MAICD;
Ms Debbie Borshoff BA (UWA), Dip Ed
Address:
17 Lemnos Street,
Shenton Park, WA 6008
Postal Address:
P0 Box 34,
Wembley, WA 6913
Tel: (08) 9388 2199
Fax: (08) 9388 4488
Toll Free: 1800 011 041
(Country Callers only)
Website: www.arthritiswa.org.au
Email: [email protected]
President:
Dr J Edelman MBBS FRACP
Executive Director:
Mr R Forlano CPA BCOM AICD
Magazine Editor & Advertising:
Lily Lomma: [email protected]
Front Cover Photography:
4
Everyday Hero webpage https://
give.everydayhero.com/au/
thomas-davies-racing.
Abigail Harman Photography
www.abigailharman.com
Production
Arthritis Today is published by Arthritis &
Osteoporosis WA. This magazine is designed
by Shape Design. This magazine is printed by a
“Level 2 Green Stamp” environmental accredited
printer, using petroleum free vegetable based
inks and 33% green electricity generated from
solar panels. The paper is sourced from FCC
accredited sustainable and well managed forests
and is 100% recyclable.”
your valuable generosity, we could
not provide the vital services or plan
for future initiatives for the much
needed people of Western
Australia.
I wish you all a safe and enjoyable
festive season and may 2014 be
exciting and prosperous for all.
Ric Forlano
Executive Director
Copyright: Articles appearing in this
publication may be reproduced subject to written
agreement from Arthritis WA. Arthritis WA
retains editorial control over its content.
Mission Statement
The objective of Arthritis & Osteoporosis WA
is to reduce the incidence and disabling effects
of arthritis, osteoporosis and related conditions
in the people of Western Australia through
programs in Care, Education and Research.
Advertising Policy Statement
Products and services advertised in Arthritis
Today are not necessarily recommended by
Arthritis & Osteoporosis WA. Some readers may
assume that anything that is advertised in these
pages has been cleared, vetted or in some way
approved by the charity. This is not so. Arthritis
& Osteoporosis WA is not equipped to test and
approve products and services that are available
to the general public. Please exercise your own
judgment about whether the item or service
advertised is likely to help you personally and,
where appropriate, obtain professional advice
from your doctor or specialist before purchasing.
Australian scientists have
conducted a study that
reveals a potential new
target for developing drugs
for anti-inflammatory
conditions, such as
rheumatoid arthritis.
A team led by Dr James Murphy,
Associate Professor John Silke,
Dr Joanne Hildebrand, Dr Peter
Czabotar, Professor Warren
Alexander and colleagues from the
Walter and Eliza Hall Institute in
Victoria, have been able to reveal
the structure of a protein that is
essential for triggering a form of
programmed cell death. Known as
MLKL, the protein is involved in
the signalling pathways that trigger
a recently-discovered cell death
pathway called necroptosis.
Arthritis Research UK
spokesperson, Professor Anisur
Rahman explained “Necroptosis is
a normal biological pathway which
results in programmed cell death.
When activated appropriately,
this process can be important in
allowing damaged or infected
cells to be removed from the body.
However, under some conditions
the necroptosis pathway is
activated inappropriately, causing
inflammation and potentially
contributing to the development
of inflammatory diseases such as
rheumatoid arthritis.”
Arthritis Research UK, Published 6th September
2013, http://www.arthritisresearchuk.org/news/
general-news/2013/september/cell-death-proteincould-be-rheumatoid-arthritis-treatment-target.
aspx#sthash.fGPjC94I.dpuf
Findings from the Australian
researchers published in the
journal ‘Immunity,’ have provided
the first full-length, threedimensional structural images of
MLKL at an atomic level, revealing
that the protein needs to be
switched on before it can activate
necroptosis. As such, it
is hoped that new therapies
could be developed that can
block the action of the protein,
thus providing a new means of
treating a wide range of chronic
inflammatory diseases.
Professor Silke said the team is
now trying to determine the on
and off states of MLKL and how it
could be modified to treat disease,
with specific drug-like molecules
being developed to test in disease
models. In addition to rheumatoid
arthritis, this treatment approach
could be used as a means of
addressing inflammatory bowel
syndrome, Crohn’s disease and
psoriasis.
Professor Rahman added:
“This study sheds new light
on the process of necroptosis
by suggesting a key role for
the protein MLKL. A thorough
understanding of the causes
of inflammation (including
necroptosis), is important to
allow the development of new
and effective treatments for
inflammatory arthritis. Further
work is now required to investigate
the role of MLKL.”
Latest News
Cell Death Protein ‘Could
Be Rheumatoid Arthritis
Treatment Target’
Chair in
Rheumatology &
Musculoskeletal
Medicine
Applications for the Chair in
Rheumatology and Musculoskeletal
Medicine have now closed and
interviews will be taking place in
November. The position received much
interest from around the world and the
standard of applicants who applied was
very high.
The successful candidate will make
a significant contribution to the
development of the disciplines of
rheumatology and musculoskeletal
medicine (including both bone and
joint disorders) in the University of
WA, the North Metropolitan Area
Health Service at Sir Charles Gairdner
Hospital and in the wider community,
by close involvement with the
objectives of Arthritis and Osteoporosis
WA. The newly appointed Professor
will begin the position in 2014.
Arthritis Today | SPRING/SUMMER 2013
5
Fremantle International
Portrait Prize
The gala exhibition was officially opened
on 24th August at the historical Moores
building in Fremantle, after another
successful year of entries received from
around the world. The Mayor of Fremantle,
Brad Pettitt, addressed the guests and
spoke of the City of Fremantle being proud
to be associated with this international
competition. The event was also attended
by Arthritis & Osteoporosis WA’s Executive
Director, Ric Forlano and Vice President,
Dr Irene Froyland, who thanked the
sponsors, committee members, volunteers
and the competition entrants, for making
this successful event possible.
Over 1,700 entries were received from
nearly 30 countries around the world,
making this competition amongst
the largest, and most worldwide,
photographic competition in Australia.
Of these 1,700 entries, 82 finalists were
chosen and the three judges were given
the tremendous task of choosing the final
seven images.
The winning image titled, ‘Rain Boy,’ was
taken by Goran Jovic, who comes from
Croatia. The judges said of his entry,
“They were struck by the sheer technical
perfection of the image. Combined by
the classical natural light and the boy’s
hauntingly expressive eyes, they rated it
a simple, classical, perfect portrait.”
Again, we would like to thank the
sponsors, FiPP organising committee,
volunteers and entrants who have
supported this initiative and helped raise
over $25,000 in funds. Not only does
this help us to continue to provide our
valuable services to the community, but
it is also helping to expand our profile
through the expressive medium of
photography.
We look forward to the continuing
success of this competition and to the
awareness it brings to our Foundation.
We invite you to view the amazing
portraits by visiting the Fremantle
International Portrait Prize website at
www.fremantleportraitprize.org.au
Left: 1st prize, Rain Boy by Goran
Jovic (Splitsko-Dalmatinska,
Croatia)
Top Right: 2nd Prize, Dog’s Best
Friend by Charmaine Heyer
(Mooroobool, Queensland)
Bottom Right: 3rd Prize, Lady with
Pipe by John Coxon (Kotara South,
New South Wales)
By Lily Lomma
T
homas Davies is a young
man who stands tall at
over 6 feet and his slim
physique shows no sign of the
painful endeavour he has endured
over the last few years. Now 21
years of age, Thomas humbly talks
about his arduous journey since
being diagnosed with Ankylosing
Spondylitis and how he is
combining his passion for Formula
500 racing by fundraising for
Arthritis & Osteoporosis WA.
In 2011, Thomas was diagnosed
with Ankylosing Spondylitis (AS),
which is one of the many forms
of arthritis and mainly affects the
spine which causes inflammation,
pain and stiffness. Thomas clearly
remembers when at 14 years
of age, he experienced pain in
his right hip and wasn’t able to
kick the soccer ball. He visited
a physiotherapist for treatment
and soon everything seemed to be
going well. “I wasn’t playing much
sport and was feeling okay until I
was in Year 11. Then, during the
Christmas break, I was offered
a welding and metal fabrication
apprenticeship.”
Thomas began working for a
company that built agricultural
machines and was enjoying
working with his hands and
learning to build the machinery
from start to finish. His
enthusiasm and hard work soon
paid off when he was awarded
‘Apprentice of the Year’ in 2010,
but not long after, he started
experiencing back pain. Initially,
he thought it might be due to the
awkward positions he maintained
while working on the machinery
but as time progressed, his
back pain was increasing and
he couldn’t stand up straight or
even put on his socks. “It was
frustrating and sometimes even
sitting in a chair was just too
painful. It was starting to affect my
apprenticeship, as I was taking a
lot of time off work. The CT scan
and blood tests I had showed that
everything was normal and that it
was probably just a back injury.”
But that wasn’t the case.
Frustrated and still in debilitating
pain, Thomas travelled from
Narrogin to Perth to see a back
specialist. The specialist ordered
an MRI for further investigation,
and it was then, that Ankylosing
Spondylitis was diagnosed. He was
then referred to a Rheumatologist
who prescribed anti-inflammatory
medication as part of a 3 month
trial basis. Stretching exercises
and cardio work saw slight
improvement, but after the 3
month trial ended, he was still not
any better. He was then given AntiTumour Necrosis Factor (TNF)
injections, which is a chemical
produced by the body’s cells and
is given to patients to help reduce
inflammation of the joints. With
this new treatment, he was now
able to increase his non-strenuous
exercises to 5 days per week.
He returned to work hopeful
but after 5 weeks he was still
experiencing pain and finding
it difficult to continue with the
physicality required for the job.
“It was the hardest decision I
have ever had to make (to quit
my apprenticeship) as I still had
one year left.” Unfortunately,
Thomas was forced into giving up
his future career as a result of his
condition, and yet despite this, he
still managed to finish his studies
at TAFE and received a Certificate 3
in Engineering.
Feature Story
Living with
Ankylosing Spondylitis
Ankylosing Spondylitis was
starting to affect all aspects of
his life - including his love of
racing. He was first introduced
to Dirt Karts by his father at age
6 and his natural talent became
evident as he began winning many
championship races. He then
turned his attention to Speedway
racing and at 16 years of age, his
father purchased a Formula 500
for him. In 2009, Thomas was
named ‘Rookie of the Year’ and has
since gone on to win 4 consecutive
championships at his home track.
His Rheumatologist advised him
to reconsider his involvement in
racing but this was not an option
Thomas at the Dowerin Field Day.
Arthritis Today | SPRING/SUMMER 2013
7
for Thomas, as he would often compete
even when he was in pain.
With the help of his father, Thomas
found a job as a petroleum fitter
which proved to be less taxing on him
physically. His employer was very
accommodating and understanding
of his condition and so incorporated
variety into his work to ensure he was
not always sedentary.
He began to see improvement in his
condition and with his new medication
working well to ease his pain, he was
beginning to see the possibility of a
much better life. He began making
other changes like limiting alcohol
intake, changing his diet and exercising
regularly. He was now incorporating
running, free weights and mixed
martial arts into his exercise regime,
which was something he thought was
not at all possible not so long ago.
“It was a difficult time and it became
frustrating trying to get people to
understand my condition. That’s why I
want to raise the awareness that young
people can get arthritis too.”
“There was an abundance of
information available on how to
live with AS, initially through
my Rheumatologist, but a lot of
information I gathered was provided by
Arthritis & Osteoporosis WA.”
“This was in the form of booklets such
as ’10 Steps to Living with Arthritis,’
‘Taking Control of Ankylosing
Spondylitis,’ and a DVD on stretching
exercises. The information gave me
plenty of things to try in order to cope
better with AS, and all of the changes
I made now make my daily life less
painful and more enjoyable.”
8
Thomas also tried reaching out to
connect with people of his own age who
were also facing the same challenges.
He joined the AS Facebook page which
proved to be a great forum for people to
talk about their daily struggles. “I found
that a lot of people I connected with
didn’t know that help was available. I
would like to see more support groups
available, especially for younger people,
as you can feel very alone.” Thomas
remembers feeling petrified about what
life had installed for him and being
able to talk with others who have AS
would have been helpful.
Without a doubt, the drive and
determination that saw Thomas
successful on the race track helped him
to persevere with managing his AS.
Season 2011/12 proved to be his most
successful, competing against the best
in Australia, he took home a fourth
local track championship, a consecutive
Perth TQ Car Club championship,
he finished 5th in the Oval Express
series, 5th in the Western Australian
title and qualified out of position 12
for the Australian title A main before
succumbing to mechanical failure. In
2012, Thomas was one of only 8 elite
drivers under the age of 24 in Australia,
chosen to participate in Speedway
Australia’s Rising Star Program.
Thomas would like to see more positive
stories about people managing their
arthritis well and wants to help quash
the myth that arthritis is a disease
of the elderly. During the racing
season, Thomas will be fundraising
for Arthritis & Osteoporosis WA,
aiming to raise awareness and will
also be displaying free information
booklets and materials provided by the
Foundation at the race events. “The
“
I would like to
see more support
groups available,
especially for
younger people,
as you can feel
very alone.
“
It was a difficult time
and it became frustrating
trying to get people to
understand my condition.
That’s why I want to
raise the awareness that
young people can get
arthritis too.
work Arthritis & Osteoporosis WA is
doing is very important to me and I
am asking everyone to support them
by donating whatever you can – no
donation is too small.”
Thomas hopes that through his
fundraising efforts he can help other
people with AS work through their
condition and receive the support
Above:Thomas Davies with
Executive Director, Ric Forlano
(Photo by Abigail Harman
Photography)
that he enjoyed. It is not hard to be
impressed by this young man, whose
tenacity has certainly helped him
endure a very difficult time in his
life. His favourite quote by James
Michener, (which can be found on his
webpage) gives much insight into the
measure of the man he is destined to
become. It reads, “The master in the
art of living makes little distinction
between his work and his play, his
labour and his leisure, his mind
and his body, his education and his
recreation, his love and his religion.
He hardly knows which is which; he
simply pursues his vision of excellence
in whatever he does, leaving others to
decide whether he is working or playing.
To him he is always doing both.”
Ankylosing Spondylitis Education
& Self-Management Program
This program aims to educate individuals about their disease and provide
up-to-date information on the best ways to manage their condition. The course
length is 6 x 2.5 hour sessions over 6 weeks and is run by health professional.
You can help support Thomas
by donating via his Everyday
Hero fundraising page at
https://give.everydayhero.
com/au/thomas-davies-racing
For more information, please call Arthritis & Osteoporosis WA on
(08) 9388 2199 or visit our website at www.arthritiswa.org.au to view our
Calendar & Bookings page.
To learn more about Thomas
you can visit his website at
www.thomasdavies.com.au
Arthritis Today | SPRING/SUMMER 2013
9
Spotlight on Arthritis
What is Gout?
Associate Professor Dr Helen Keen
MBBS FRACP PhD
Dr Helen Keen, Associate
Professor (Rheumatology)
consultants at Royal Perth
Hospital, privately in Subiaco,
and undertakes teaching and
research at UWA.
Gout is the most
common form of
arthritis in men.
It is a disease
associated with
significant disability
and illness
Gout is a form of arthritis
that occurs when uric acid
levels in the blood rise above
that which can remain
soluble, and the uric acid
crystallises. These crystals
are deposited in soft tissues
and joints causing gout.
Gout is the most common form of
arthritis in men, but is rare in premenopausal women. The incidence
of gout is increasing, particularly as
the population ages. It is a disease
associated with significant disability
and illness, and can affect more
than just the joints.
Gout is best diagnosed by having
a doctor take fluid from a joint,
and demonstrating the crystals in
the fluid. Sometimes this is not
possible, and a rheumatologist or
other doctor may be reasonably
comfortable in making the
diagnosis of gout based on the
symptoms. Sometimes the level of
uric acid in the blood, and x-rays
or a CT scan may assist in the
diagnosis.
Gout usually affects people
by causing arthritis, which is
inflammation of the joints.
Inflammation is associated with
pain, swelling, heat and redness.
The arthritis in gout usually affects
peripheral small joints, and indeed
the most typical presentation
is an acutely inflamed big toe
(sometimes termed podagra). But
really any joint can be involved,
and it is common for gout to
involve other joints of the feet, the
ankles, knees, hands and wrists.
Occasionally gout can affect joints
of the spine, and sometimes gout
can affect several joints at one time.
Acute gout usually comes on very
suddenly, often overnight, with
some people reporting tingling
being the first symptom, followed
by increasing pain which reaches
a peak within about 12 hours. The
acute attacks of gout usually settle
over some days to weeks, but can
settle more quickly with treatment.
Free Information
Booklets
These booklets provide valuable information
about prevention and how to better manage your
condition, so you can lead an active and healthy life.
If you would like to receive any of these free
booklets, please call us on
(08) 9388 2199 or visit our website
www.arthritiswa.org.au
10
*Booklets can only be posted within Australia
Acute attacks may be precipitated by
many factors in people prone to gout.
These include an excess of protein or
alcohol in the diet, dehydration, and
changes in medications, such as blood
pressure medications.
If the high uric acid levels in the blood
are not treated, then gout may become
chronic, with ongoing pain, and the
deposition of the crystals in soft tissue,
including skin. These deposits are called
tophi, and often appear to be chalky
lumps, often on the fingers or ears.
Tophi can disappear with long term
treatment.
Untreated gout can result in irreversible
damage to the joint, and untreated high
levels of uric acid are associated with
cardiovascular and kidney disease.
Preventative measures
There are good therapies for gout,
however international guidelines state
that the management of gout should
not rely solely on medications. It is
important for people with gout to
be educated so they can understand
their disease, and what factors may
precipitate an acute flare. People with
gout should undertake regular physical
activity, and try to maintain a healthy
body weight in order to reduce the
risks. Dietary changes, decreasing
the intake of meat, shellfish, fruit
juices and other sugary drinks, alcohol
(especially beer) as well as increasing
the intake of water and dairy products
may assist in preventing attacks of gout.
Additionally, people with gout should
be screened for cardiovascular risk
factors, such as high blood pressure,
high cholesterol, and counselled about
the risks of smoking.
The levels of uric acid in the blood can
be lowered to prevent the development
of acute attacks with drugs. The
commonly used drugs include
allopurinol and probenicid.
If an acute attack occurs, then the
inflammation can be treated in the
short term to resolve the attack with
drugs such as non-steroidal antiinflammatories, colchicine, and
sometimes steroids.
New drug therapies for gout have
been developed; but these drugs are
expensive, and can cause side effects,
so they are usually reserved for people
Screening
There are good
therapies for gout,
however international
guidelines state that the
management of gout
should not rely solely
on medications.
Healthy diet
low in protein
and sugar
Understanding
whose gout cannot be controlled in
the usual way. These drugs include
synthetic uricase enzymes that prevent
the production of uric acid.
Maintaining a healthy body weight,
regular exercise, a healthy diet low in
protein and sugar, and increasing fluid
and dietary dairy intake may aid the
self-management of gout.
Additionally, understanding your
disease combined with taking your long
term medication correctly, may mean
you can better control your disease. You
Rheumatologist will be able to assist
you with education regarding lifestyle
and medications, and assist you in
developing a self-management plan to
reduce the impact of gout in your life.
Regular
Exercise
Maintaining
healthy body
weight
Medication
Arthritis Today | SPRING/SUMMER 2013
11
Feature Story
A Medicinal Perspective on Gout
Michael Garlepp BPharm, BSc (Hons), PhD, MPS
Executive Officer - Pharmaceutical Society of Western Australia Inc.
Gout is a particularly painful
inflammatory condition which is
precipitated by the formation of
crystals of uric acid in the joints
and the ensuing inflammation
in response to that deposition.
It is caused when the uric acid
concentration in the blood rises
to a point beyond its solubility
and crystals are deposited. This
condition may be short term and
once the individual has recovered
it may not recur for some time.
Alternatively, it can be a chronic
condition with continuous pain
and disablement and continued
high levels of serum uric acid.
Gout can be precipitated by overindulgence in a range of purine
rich foods including brain, liver,
fish roe and a range of others,
but many patients get an attack of
gout due to or an over production
of uric acid from endogenous
precursors by an overactive
enzyme. Increased uric acid
concentrations are also associated
with certain drugs such as thiazide
diuretics. An attack of gout can be
precipitated by dehydration which
can cause an increase in blood
uric acid. Gout mainly affects men
12
after puberty, and women are not
affected until after menopause but
at a lesser frequency.
The approaches to therapy of gout
are to reduce the inflammatory
response and the associated
pain, and then to prevent the
overproduction of uric acid. When
one suffers from an isolated,
one-off episode of gout, one
option is to take a non-steroidal
anti-inflammatory drug, (such
as indomethacin or naproxen)
because these are relatively short
acting and the dose is more easily
regulated to the severity of the
symptoms. If one cannot take these
drugs, then one may use colchicine
orally in 500 micrograms doses
every 6 to 8 hours (up to a
maximum of 6 mg over 4 days) or
a dose of prednisolone 15 to 20 mg
daily for 3 to 5 days. This may be
all that is necessary and an attack
may not occur again or may be
several months away.
When the hyperuricaemia is more
persistent and attacks of gout
become more frequent, it is usually
advisable to start on allopurinol.
This is a drug which inhibits the
enzyme which forms uric acid
and so brings about a lowering of
the plasma urate concentration.
It should not be started during an
acute attack of gout, but when the
symptoms are sufficiently subdued
by the therapies above. Allopurinol
may be commenced at 50 mg
orally daily and slowly increased
to the target dose, which is usually
100 to 300 mg per day. The final
dose that is used is dependent on
the patient’s renal function and
plasma urate levels.
Having a high uric acid level is
detrimental to health in many
ways. The kidney in particular
may potentially be damaged
by deposition of uric acid,
but the formation of tophi,
or accumulations of uric acid
in joints or around the ear,
(although generally not painful),
can be destructive and cause
malformations. It is essential
that once started on allopurinol,
one continues with the therapy
uninterrupted to ensure that
the concentration of uric acid is
maintained at safe levels.
Events
Bones & Joints Website Launch
In partnership with Telethon,
Arthritis & Osteoporosis WA
officially launched the online
Bones and Joints school
initiative on 25th July. The
online school was created in
conjunction with the Australian
School Curriculum and aims to
educate children on maintaining
healthy bones and joints.
The launch was attended by
the Minister for Education;
Steve Mummery, General Manager,
Channel 7 Telethon Trust
Aboriginal Affairs and Electoral
Affairs; the Hon. Peter Collier,
MLC and General Manager of
the Channel 7 Telethon Trust,
Mr Steve Mummery.
The online school is a virtual
and interactive information
portal for kids, parents and
teachers, with modules within
the website focusing on; healthy
eating, exercise, teeth, the
skeleton and growth. One of
the modules is also dedicated
to highlighting the condition
of Juvenile Idiopathic Arthritis,
which is an umbrella term used
for children affected with arthritis
under the age of 16 years.
The website is due to go
live soon.
www.bonesandjoints.com.au
Hon. Peter Collier MLC, Minister for
Education, Aboriginal Affairs and
Electoral Affairs
Trina Glover, Developer of the Bones
& Joints School Program
Arthritis Today | SPRING/SUMMER 2013
13
MAKING
SENSE
OF
PAIN
a workshop for Health Professionals
Prepared by John Quintner, Melanie
Galbraith & Jane Muirhead.
9-10th August, 2013.
In a first for Western Australia,
Arthritis and Osteoporosis WA
presented ‘Making Sense of Pain’
– a workshop promoting a truly
inter-disciplinary approach to health
professional engagement with people
in pain.
Prior to attending the workshop, the
registrants were invited to complete
an online questionnaire designed to
encourage them to reflect upon their
own beliefs and attitudes towards
people in chronic pain.
At the commencement of the
workshop, the registrants were given
a case-study based on an actual
patient with chronic pain. They were
required to answer several questions
around their management of that
patient. This process was repeated at
the conclusion of the 2-day workshop.
The comparison demonstrated that
the majority (78%) of the participants
had changed their practice towards
evidence-based care.
Day one comprised a series of talks
under the heading ‘Learning the Skills.’
They included:
•
Approaches to Clinical
Engagement – Old and New by
John Quintner (Pain Physician)
•
Psychological Output of the
Dedicated to the memory of Bob
Elvey [1942-2013], a world-renowned
pioneering Western Australian
physiotherapist.
Venue: Wyllie Arthritis Centre
Person in Stress by Vance Locke
(Psychologist) and
•
•
Multifactorial Assessment of the
Person in Pain,
Above: Participants at the workshop
Letting Go of the Struggle and
Engaging in Life, Strategies for
Improving Function by Mary
Roberts (Psychologist) and Melanie
Galbraith (Physiotherapist).
Below: Vance Locke (Psychologist),
Mary Roberts (Psychologist) and Melanie
Galbraith (Physiotherapist) at the
‘Making Sense of Pain’ workshop.
On Day two, attendees were shown
how to put these skills into practice,
whilst at the same time being aware of
the possibility of them inadvertently
stigmatizing their patients.
Vance Locke and John Quintner
introduced Health Professionals
to the important topics of Stigma,
Stereotyping, and Empathy, particularly
in relation to patients with chronic pain.
Jane Muirhead, Occupational
Therapist, explained the concept of
“Entering the third space”: a radical
paradigm shift in patient/practitioner
interaction. The third space represents
a relational interaction where
practitioner and patient work together
dynamically and in partnership to
explore solutions that will help the
person in pain move forward in their
life. It involves a willingness on
the part of the health professional
to put aside pre-conceived ideas of
“treatment” and “cure” to enable them
to explore “what really works” for that
individual here and now, even if that
does not always correspond with what
the practitioner believes is “right” for
the patient.
In the last half of the day, Health
Professionals were given the opportunity
to hear from, and engage with, each of
our three Pain Champions – Vanessa
Watson, Eva Miller and Jamie Martin.
Their powerful stories and how they are
working with the challenges of living
with ongoing pain provided us with
first-person perspectives of the long and
difficult journeys they are undertaking
to get their lives back on track. Their
struggles associated with the health
system and the prejudices towards
persistent pain conditions that they have
encountered, clearly illustrated to course
participants, the issues many longterm pain sufferers encounter in their
attempts to regain their health
and wellbeing.
NATIONAL PAIN WEEK IN WA
PAIN SUCKS
In a first for Western Australia, a
small group of volunteers under the
Chairmanship of Jane Muirhead
organized three events during National
Pain Week (July 22nd – 26th). We call
ourselves Pi Squared (Pain Information
Initiative).
Arthritis and Osteoporosis WA
(AOWA) underwrote the project, which
enabled us to print leaflets and posters,
which we distributed at suitable venues
around Perth.
Another innovation was the purchase
of small lollipops to which we attached
a sticker with our theme (“Pain Sucks”)
and a ribbon directing people to the
Face Book page of Pi Squared.
PROGRAMME OF EVENTS:
Gentle Yoga for Pain: Rachael
West (Yoga Instructor)
Mindfulness for Pain: Jane
Muirhead (Occupational
Therapist)
New Frontiers in Pain Research:
Beliefs about back pain and what that
means for you.
Associate-Professor Benedict Wand, School of
Physiotherapy, University of Notre Dame.
For many years, managing back
pain has focused on the back - how
it looks (on x-ray) and how it moves.
This approach has been largely
unsuccessful and may actually
contribute to the problem. A more
recent focus has been towards the
pain experience of the individual and
the variety of factors that impact the
emergence of the pain experience.
This brief talk will look at how recent
information from the neurosciences
might help us reformulate
management of chronic back pain.
The importance of cold sensitivity in
osteoarthritis.
Professor Tony Wright, School of Physiotherapy,
Curtin University
Our research showed that osteoarthritis sufferers tend to have higher
cold sensitivity than the general
population. Of that group, those
who are particularly sensitive to cold
have more pain, more problems with
function, are slower to complete
physical tasks and have more general
pain sensitivity than people with
osteoarthritis who do not have high
cold sensitivity. They also respond less
well to standard drugs like NSAIDs.
If we can identify those who are
susceptible to increased pain severity
from an early stage in their osteoarthritis, we may be able to intervene
with treatments that modify their
pain sensitivity. The impact: they can
better manage their pain.
What is causing my back pain?
Martin Rabey, School of Physiotherapy, Curtin
University
Despite low back pain being a very
common complaint, research suggests
that improvements gained following
treatment are often moderate at best.
We know that findings on x-rays
and scans do not correlate well with
the pain and disability suffered by
people with back pain. Our research
is examining the multiple dimensions
that all interact in people with low
back pain to make their pain persist.
We are beginning to determine
different profiles of people with back
pain that better explain what “drives”
their condition. Longer-term, this may
allow treatments to be better targeted
towards individuals profiles to achieve
greater improvement.
PainHealth: an integrated web-based
platform.
Associate-Professor Helen Slater, School of
Physiotherapy, Curtin University
Helen presented a new, interactive
web platform developed for people
with musculoskeletal pain, the first
in Australia. Using a partnership
approach and based on extensive
research, the Department of Health
WA, Curtin University, University
of WA and Fremantle Hospital have
developed this resource to offer
consumers practical, scientificallybased, readily accessible resources
including self check questionnaires,
consumer stories about managing
pain and practical management
modules. Helen gave the audience an
update on the success of this project
and the research that informed the
design of this practical tool.
Arthritis Today | SPRING/SUMMER 2013
15
Arthritis and Osteoporosis
Youth
Camp Freedom
Camp Freedom is a fun-filled,
5 day activity camp, specifically
designed for children aged
between 7-17 years who have
Juvenile Arthritis, related
rheumatologic or other
musculoskeletal conditions.
Camp Freedom provides barrierfree outdoor experiences, which
promote personal growth and
foster independence. Campers
are encouraged to try new
experiences in order to gain selfconfidence, learn cooperation and
communication, and increase
personal independence and selfmanagement in a safe and fun
environment. Campers get to
participate in numerous activities
throughout the week. Previous
camps have included rock
climbing, fishing, snorkelling,
arts and crafts, canoeing, archery,
disco, sports, games and
much more!
Children are supervised
by medical staff as well as
Arthritis & Osteoporosis WA
volunteers, who remain onsite
for the duration of the camp.
All supervisors and health
professionals attending the camp
have ‘Working with Children’
checks.
The camp is held once a year
between September and October.
For more information, please
contact Arthritis & Osteoporosis
WA on (08) 9388 2199 or email
[email protected]
Studies show that
arthritis affects about
1 in 1000
children
Children with Arthritis
Contrary to the commonly held belief,
arthritis is not a disease of the elderly it can happen at any age. Studies show
that arthritis affects about one child
in every thousand and there are more
than 100 different types of arthritis.
Those that occur in children under
the age of 16 are classified as Juvenile
Idiopathic Arthritis (JIA).
Any or all of these symptoms may
occur and symptoms usually fluctuate
between periods of mild to severe,
which can cause much discomfort
and limits children in participating
in many types of activities. Children
usually describe the pain of arthritis
as hurting, stinging, warm and
uncomfortable.
JIA is an autoimmune disease where
the immune system starts attacking
the body’s healthy tissue, targeting
the lining of the joints which leads to
inflammation and joint damage. The
common joint related symptoms for
all types of JIA include:
In general, there are five main types of
JIA, with each type having their own
set of symptoms. The main types are:
•
Pain
•
Swelling
•
Tenderness
•
Stiffness
•
Redness and warmth around the
join area
16
1. Systemic Onset
2. Oligoarthritis
3. Polyarticular
4. Enthesitis related arthritis
5. Psoriatic Arthritis
While there is no single test to
diagnose JIA, the doctor will examine
the patient, ask questions and perform
tests to rule out other types of illnesses
that can cause joint pain. Although
medicine plays a major part in the
management of JIA, physiotherapy
and occupational therapy will also
form an important part of treatment.
Unfortunately, the cause of arthritis
in children is unknown, yet research
suggests that for some types of JIA,
genetics may be involved. However,
these conditions are not regarded as
hereditary. At this stage there is no
known cure for Juvenile Arthritis,
so good medical care is vital for
managing this condition. For most
children with JIA, the effects of their
illness can be reduced to the point
where they can go on to live a healthy,
adult life.
If you would like to receive free
information booklets about Juvenile
Arthritis, please contact us on (08)
9388 2199 or visit our website at
www.arthritiswa.org.au
Volunteers
Volunteer Spotlight
Julie Holdaway
Originally from Portsmouth in
England, Julie came to Perth in 1968
as a teacher of the deaf.
“Later on I worked as a Receptionist
with the Nedlands Council, trained as a
Reflexologist and also taught English to
migrants. Overtime I realized the need to
take my health more seriously, tests and
diagnosis gave little help in managing
symptoms. However sharing knowledge
and taking part in classes at the Arthritis
Foundation provided the best answer. I
have benefited from Hydrotherapy since
2000, and have done classes in Pilates
and Tai Chi as well.
JIA Parent
Get-Together
Arthritis & Osteoporosis WA has
just started up a social group for
parents of children with juvenile
arthritis and bone disease.
Come along to a new social group
for parents to share experiences,
gain greater understanding and
receive regular advice from health
professionals.
For more information, please
contact us on (08) 9388 2199 or
email [email protected]
Alternatively, you can visit our
website, www.arthritiswa.org.
au and view our Calendar &
Bookings page to register for our
next JIA Parent Get-Together.
In 2009 when volunteers were
requested at the Foundation I was
happy to offer. Over time I have helped
with mail-outs and organised the
brochures. I now work two mornings
a week to help the Foundation to stay
in touch with its essential group of
supporters. When mail is returned my
job is to contact the person by phone to
check on correct contact details or other
reasons why their mail may have been
returned. It well may be my voice on
the phone or your answering machine,
so please do phone back”.
We are very fortunate to have such a
great bunch of volunteers like Julie
helping us with various tasks at the
Foundation. Like all of our volunteers,
Julie’s role is a vital one and one that is
greatly appreciated. Trish Broderick,
Manager Relationships who supervises
Julie says: “It is so essential that the
contact details of our supports are kept
up to date and that they know they are
appreciated. We can then continue to
offer support and services to children
and adults who have arthritis.”
TELEPHONE ADVISORY LINE
Call one of our trained, friendly
telephone advisors at Arthritis &
Osteoporosis WA on 9388 2199 or
1800 011 041 (country callers).
They will assist you with your
questions about arthritis or
osteoporosis and send out any
relevant information to you, free of
charge. Service available Mon - Fri
either am or pm between 10am - 4pm.
Arthritis Today | SPRING/SUMMER 2013
17
Support Services
Tell us
What You Would Like
Survey
In the last edition of Arthritis Today
we included a survey asking you to
tick what services you would like
in your area. Thank you to all those
who completed the survey - the
information is now being processed.
However, we would like to hear from
those of you who have not told us
what you would like, particularly
if you live in the outer metro and
country WA. You can do this by
completing the survey online on our
website or facebook page or if you
prefer, we can mail out the survey.
Just call our Telephone Advisory Line
on (08) 9388 2199.
https://www.surveymonkey.com/s/
arthritiswatelluswhatyouwouldlike
Second Hand Bookshop
Our second hand bookshop is stocked
with a variety of ‘great reads’ which can
be purchased at very low cost. Located
in the Foyer Entrance of the Wyllie
Arthritis Centre, you can browse the
shelves for novels on crime, thriller, or
perhaps a cook book is more your style?
Social Lines
Do you have arthritis which sometimes
limits your social interactions?
or even have a grumble - they are here
to listen to you!
Why not join our Social Lines Program
and speak with a volunteer from
Arthritis & Osteoporosis WA. Our
volunteers will telephone you on a
regular basis at a time suitable for you.
You can talk about a hobby, your family
If you are interested in being part of
the Social Lines Program or know of
someone who might be interested,
please call us on (08) 9388 2199 or
email [email protected]
18
We are always in need of book
donations, so if you would like to
donate any pre-loved books that are in
good condition, please bring them into
the Centre.
How to Book Online
Step by Step
You can register and pay for
our events online by using your
credit card. It’s safe, quick and
easy. Here’s how………
Go to our website
www.arthritiswa.org.au
Click on Calendar &
Bookings.
1
2
Select your event.
Scroll down to the end
of the page.
Click Register Now!
Add your contact details then click
Book Event. Review your booking
details.
If your details are correct, then
click submit
If your details are incorrect, then
click go back.
3
4
Click submit to pay by credit card.
Enter your credit card details then
click submit.
You will then receive confirmation
of your payment.
Arthritis Today | SPRING/SUMMER 2013
19
Health & Lifestyle
Choosing a Safe & Effective
Exercise Program
It is widely know that exercise is
beneficial for those with arthritis and
osteoporosis. According to the
American College of Rheumatology
“Physically active individuals are
healthier, happier and live longer than
those who are inactive and unfit. This is
especially true for people with arthritis”.
However for those with arthritis and
osteoporosis, finding the right kind of
exercise is very important.
While there are some general exercise
guidelines for arthritis and for
osteoporosis, it is important to visit
your GP or qualified health professional
who can advise which types of exercise
will be suitable and safe for you, and
which exercises should be avoided.
Maintaining an ongoing relationship
with your health professional is
advisable for those engaging in an
exercise program.
The next step is to find a program
which you enjoy. Enjoyment is the key
to engaging successfully in a long term
exercise program. Many people enjoy
the social element of exercising with a
friend or in groups, and some people
find engaging in different types of
exercise programs helps to keep them
interested. It is advisable to engage in
small amounts of exercise regularly and
to make exercise part of your routine.
Meeting a friend or attending group
exercise classes at set times can be
helpful in establishing a routine.
Physically active individuals are
healthier
happier &
live longer
than those who are inactive
and unfit. This is especially
true for people with arthritis.
20
There are 3 main types of
exercises:
1. Mobility exercises – range
of movement and stretching
exercises help to maintain or
improve flexibility in affected
joints and surrounding muscles.
2. Strengthening exercises –
protect and support the joints
by strengthening muscles around
the joints.
3. Cardiovascular fitness – aerobic
or fitness exercises to improve
heart, lung and muscle function
as well as controlling weight
and improving mood and sleep
patterns.
The American College of
Rheumatology recognises Body
Awareness as a fourth type of exercise
which includes activities to “improve
posture, balance, joint position sense
(proprioception), coordination and
relaxation”.
Many types of exercise programs
cover more than one of the above
types of exercise while some
programs will help with mobility,
strength, cardiovascular fitness
and body awareness. Some popular
exercises programs run by Arthritis &
Osteoporosis WA (AOWA) include the
following:
Warm water exercise classes:
Exercising in water is beneficial for
arthritis as it decreases the stress on
joints, muscle spasms, tension and
pain due to the buoyancy and warm
temperatures (33-34 degrees Celsius).
AOWA has regular pay as you go
classes and open pool sessions.
Tai Chi:
Dr Lam’s Tai Chi for Arthritis
program has been scientifically proven
to be beneficial for arthritis. The
program increases muscle strength,
improves flexibility and balance,
improves cardiovascular fitness as
well as reducing pain and stiffness
and promoting relaxation. Tai Chi has
also been shown to be beneficial for
Osteoporosis as it is a safe form of
exercise which reduces falls and risk of
fracture and can assist in maintaining
bone density. AOWA currently has
Tai Chi for Arthritis classes in Shenton
Park, Swanbourne and Wanneroo and
will be commencing specific Tai Chi for
Osteoporosis classes in 2014.
life, combining physical exercises
and breathing to build body strength
and generate mental calm. Poses can be
Nordic Pole Walking:
An exercise program designed to
enhance bone strength and improve
balance. Each class involves a warm
up, weight bearing exercises, resistance
exercises and stretches. The resistance
exercises include the use of free hand
weights, leg weights, resistance bands
and body weight. There are also
exercises for balance and posture and
mat work is optional for those who are
comfortable exercising on the floor.
An easy form of fitness which involves
walking with lightweight poles which
help to propel you along and provide
extra support by taking some of the load
off your lower back, hips and knees.
Nordic Pole Walking gives a total body
workout. Participants should be able to
walk at least 500m unaided to enrol in a
beginner’s course. Courses and ongoing
classes are currently held in Kings Park.
AOWA hopes to be offering classes
south of the river in 2014, keep an eye
on our website for details.
Gentle & Restorative Yoga:
In these classes the focus is on
gaining easier movement patterns
with an emphasis on freeing up the
breath and relaxing muscles and tight
joints. Classes use modified poses
using breathing techniques, deep
relaxation and meditation to reduce
pain. Restorative yoga classes are all
about relaxing the nervous system
and recharging our batteries. Soft
restful positions supported by bolsters,
blankets and props are maintained for
5-7 minutes during each session. It
is a great class for people who suffer
fatigue, pain or are generally depleted.
Participants must be able to get down
onto the floor for both Gentle and
Restorative Yoga classes. Classes are
currently run in Shenton Park.
modified for individuals so they can be
performed effectively and safely and all
poses can be done seated on a chair if more
comfortable, however it is desirable for
participants to be able to get down onto the
floor to perform a number of movements
throughout the class.
Osteoporosis Exercise:
Please refer to our website
www.arthritiswa.org.au or
contact AOWA on 9388 2199
to find out more.
References:
http://www.osteoporosis.org.au/about/aboutosteoporosis/excercise/
http://www.arthritisresearchuk.org/arthritisinformation/arthritis-and-daily-life/exercise-andarthritis/what-sort-of-exercise-is-important.aspx
http://www.arthritisresearchuk.org/arthritisinformation/arthritis-and-daily-life/exercise-andarthritis.aspx
http://www.betterhealth.vic.gov.au/bhcv2/
bhcarticles.nsf/pages/Arthritis_and_exercise
http://www.rheumatology.org/Practice/Clinical/
Patients/Diseases_And_Conditions/Exercise_
and_Arthritis/
http://www.mayoclinic.com/health/osteoporosis/
HQ00643/NSECTIONGROUP=2
Pilates for Arthritis:
Pilates teaches participants awareness
of their bodies leading to boosted
strength, stability and mobility in daily
Arthritis Today | SPRING/SUMMER 2013
21
Arthritis Self –Management and Education Programs
Arthritis & Osteoporosis WA run
education and self-management courses
for people who want to learn more about
their condition and how to better take
care of themselves. We recommend
them to anyone who wants to learn more
about taking control of their health.
The education part of the courses is
focused on providing facts and the latest
findings on specific conditions. The selfmanagement part of the courses is where
we help you to focus, set goals, make
decisions and learn to take responsibility
for your health. Our courses cover a
variety of topics including, nutrition
and healthy eating, activity and exercise,
pain and fatigue management and
some courses provide an overview of
medications and blood tests.
“My husband and I found
the course and facilitators
straightforward and easy to
understand. The facilitators
approach was excellent
considering the different
backgrounds and health
histories of the people
attending. The exercises
that we were recommended
were simple and effective.
We’ve found this course
was interesting, useful and
enjoyable and we have been
22
We run education and self-management
programs for the following conditions:
Ankylosing Spondylitis, Inflammatory
Arthritis (Rheumatoid, Psoriatic or
Seronegative), Osteoarthritis of the
Knee, and Challenge Your Arthritis
which is a general arthritis course.
People who have previously attended
our courses have enjoyed them
thoroughly and what they have learned
has made a difference to their day to day
management of arthritis.
If you are interested in joining one of
our courses call us on 9388 2199 or
email us at [email protected]
You can also look up our courses on
our website at
www.arthritiswa.org.au/events
telling all our friends about it.
Not only that but we also found
the course affordable.
My husband who came as the
main participant only paid $30
and I joined him for support and
only paid $5 for a 6 week course
with handouts. All in all we
found it a valuable course and
we are happy to recommend it
to others.”
Margaret Hounslow –Osteoarthritis
of the Knee Program participant.
How can changing my
help with gout?
diet
Foods that contain a lot of purines
may play a part in the build-up of
uric acid but there are a number
of other factors involved.
If you’re prone to attacks of gout
the most useful changes you can
make are:
•
•
•
Lose weight (if you’re
overweight) as this can
reduce high uric acid levels in
the body but it must be done
gradually. Extreme weight
loss or fasting can actually
raise uric acid levels because
it speeds up the breakdown of
cells in the body.
Drink less alcohol,
as excessive alcohol
consumption is often
associated with gout. If you
suffer from gout you should
aim to keep your alcohol
intake to around 1–2 units
a day. Avoid wines with
sediment (such as mature
red wines) and any cloudy
ales or ciders.
Drink plenty of water to
help to ‘flush out’ excess
uric acid and prevent it from
crystallising in the joints.
You should drink at least 1
litre (about 2 pints) of nonalcoholic fluids per day, or up
to 3.5 litres (about 6 pints) if
you have kidney stones.
Sugar-sweetened soft drinks and
fructose-rich fruits and juices may
be associated with an increased
risk of gout. Diet soft drinks don’t
appear to increase the risk.
Cutting down on purine-rich
foods may not have as great an
impact on gout as the measures
described above, but it can still
be helpful. Aim to reduce the
amount of protein you get from
meat – for example, by eating one
less portion of meat or fish per
day. This can be replaced by other
sources of protein, such as beans,
eggs, pulses or low-fat dairy
products.
Uric acid levels aren’t affected
by acidic fruits and there’s some
evidence that higher vitamin C
intake can help to reduce the
risk of gout attacks. So you can
include fruits like oranges and
grapefruit in your diet. There’s
some evidence to suggest that
cherries may be helpful, and that
drinking a glass of skimmed milk
every day can help to prevent
attacks of gout.
Reference: http://www.
arthritisresearchuk.org/arthritisinformation/arthritis-and-dailylife/diet-and-arthritis/how-canchanging-my-diet-help-with-gout.
aspx#sthash.2jlPqDfn.dpuf
Challenging
Arthritis Course
Rural and
Remote Areas
This program has been specifically
designed for people living in
remote or rural areas who cannot
attend our self-management
programs held in metro areas.
The program will provide you
with an opportunity to gain
information and acquire skills that
will help you self-manage your
arthritis and make positive changes
to your lifestyle.
Registration Closes:
17th December 2013
Cost: $40.00 (includes
workbook, handbook and CD)
For more information
please contact:
Kirsty Inglis
(08) 9388 4409
[email protected]
Arthritis Today | SPRING/SUMMER 2013
23
Alana’s Caramel Slice Recipe
Ingredients
Method
Base
Step 1
1 cup plain flour, sifted
• 1/2 cup brown sugar
• 1/2 cup desiccated
coconut
• 125g butter, melted
Preheat oven to 180°C. Line a 3cm
deep, 28 x 18cm (base) baking tin
preferably rectangle. (Baking Paper is
easier to use rather than spraying the
tin or greasing the tin)
Filling
Combine all base ingredients in a bowl.
Mix well. Press into prepared baking
tin. Bake for 15 to 20 minutes, or until
light golden. Remove from oven. Let
the base cool.
•
400g can sweetened
condensed milk
• 2 tablespoons golden
syrup
• 60g butter, melted
•
Topping
•
125g cooking chocolate
(Chocolate melts are
best to use)
Step 2
Step 3
Make the filing Combine all ingredients
in a saucepan over medium heat.
Continuously stir for 5-10 minutes or
until golden. Pour over cooked base.
Bake for 12 minutes or until firm. Cool
completely. Refrigerate for 3 to 4 hours,
or until set.
Step 4
To make the topping, place a heat proof
bowl over a saucepan of simmering
water (Make sure that the bowl isn’t
touching the water) Stir until melted.
Pour over caramel. Refrigerate to set.
Cut into squares to serve.
*It is much easier to cut the caramel
slice into squares before the chocolate
has fully set on the caramel.
24
Spotlight
on Work
Peter
Ramshaw
I
work in the electorate office of
a senior member of the WA
Government. Being a desk job
it is quite sedentary and weight
has often been a problem over the
years. I was very fit as a young man
but for various reasons have not
been sufficiently so for many years.
Before this I was (respectively) a press
photographer and journalist (20 years),
private secretary, computer systems
engineer, newspaper managing editor,
sub-editor, and speech writer.
When I first suffered from gout I
thought I’d twisted an ankle or foot.
Soon, however, the pain was too great
and the swelling lasted too long for that
to be the case. I visited my Doctor and
to my shock I was diagnosed with gout.
"
I believed, like many do, that it was a
disease of massive overindulgence and
risky high living.
On the occasions I have had bouts,
it has had a severe effect. When one
can hardly move a foot, one isn’t
much good at walking to work or, in
fact doing anything. In fact, without
treatment, the pain is so all-consuming
that the sufferer cannot think of
anything else but the pain and possible
ways to relieve it.
I try not to consume some of the things
I think contribute to gout and I try to
drink lots of water and other liquids
during the day. These days I am more
sensitive to the onset of a possible
bout and there is usually a prolonged
period of days of feeling unwell for no
particular reason, and one comes to
recognise this is subtly different from
other illness or weariness.
In my spare time I design paperback
books and dust jackets, and edit and
assess manuscripts for emerging
writers. I used to play a lot of sport,
particularly swimming, squash and
cricket. However, an improperlydiagnosed Achilles injury failed to
repair properly, largely curtailing
the sporting activity. I write fiction
(having completed 2 novels) and help
other writers where I can. I’m also a
committee member of the Fremantle
International Portrait Prize, which runs
portrait photography competitions to
help raise funds for AOWA.
without treatment, the pain is so all-consuming
that the sufferer cannot think of anything else
but the pain and possible ways to relieve it.
"
Arthritis Today | SPRING/SUMMER 2013
25
Upcoming Events
Osteoporosis Exercise
Classes (Term 4)
Osteoporosis Exercise
Classes (Term 4)
Tai Chi for Arthritis
(Term 4) Beginners Class
wed 16 oct - 11 dec
thurs 17 oct - 12 dec
Mon 21 oct - 9 dec
These physiotherapist run exercise
classes are designed specifically for
people who have been diagnosed
with osteoporosis or who have
experienced a first “low trauma”
fracture. Sessions are 1 hour per
week for 9 weeks.
These physiotherapist run exercise
classes are designed specifically for
people who have been diagnosed
with osteoporosis or who have
experienced a first “low trauma”
fracture. Sessions are 1 hour per
week for 9 weeks.
When: 8:30am
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: $90
Check for availability.
When: 9:00am
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: $90
The movements of the Tai Chi
for Arthritis program have been
specifically designed to be safe for
people with arthritis. The slow
movements prevent injury, but
build muscle strength and calm
the mind. Sessions are 1 hour per
week for 8 weeks.
Nordic Pole Walking
(Term 4) Beginners
Course
thurs 17 oct - 14 nov
Nordic Walking is a fun and easy
form of fitness using light weight
poles that allows a total body
workout without the feeling of
greater exertion. Great exercise
for anyone, including people
with arthritis or osteoporosis.
Participants should be able to
walk at least 500 metres unaided.
Sessions are 1 hour per week for
5 weeks.
When: 11am
Where: Meet at Zamia Cafe car
park, Synergy Parkland, May St,
Kings Park
Cost:$75
Restorative Yoga
(Term 4)
fri 18 oct - 29 nov
In this restorative yoga class
participants will hold soft restful
positions on the floor, with the
support of bolsters, blankets and
props, for up to 5-7 minutes.
Restorative yoga connects the body
and the mind through the medium
of the breath. Sessions are 1 hour
per week for 7 weeks. Participants
will need to bring their own yoga
mat.
When: 1:30pm
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: $70
Tai Chi for Arthritis
(Term 4) TCA2
Mon 21 oct - 9 dec
Bookings essential.
To register for events
call 9388 2199
or go online at
arthritiswa.org.au/events
The movements of the Tai Chi
for Arthritis program have been
specifically designed to be safe for
people with arthritis. The slow
movements prevent injury, but
build muscle strength and calm
the mind. Sessions are 1 hour per
week for 8 weeks.
When: 11:00am
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: $80
When: 12.45am
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: $80
Tai Chi for Arthritis
(Term 4) Ongoing
Mon 21 oct - 9 dec
The movements of the Tai Chi
for Arthritis program have been
specifically designed to be safe for
people with arthritis. The slow
movements prevent injury, but
build muscle strength and calm
the mind. Sessions are 1 hour per
week for 8 weeks.
When: 11:00am
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: $80
Challenge Your Arthritis
Self-Management
Course
wed 23 oct - 27 nov
A self-management course to help
people cope with the pain and day
to day problems caused by arthritis
and fibromyalgia, delivered by
specially trained people who
understand. Sessions are 2 hours
per week for 6 weeks. Bookings
Essential.
When: 10am - 12pm
Where: Bibra Lake
Cost: $30 single, $35 participant
plus partner
Inflammatory Arthritis
Education & SelfManagement Course
Thurs 24 oct - 28 nov
This 6 week program is specifically for
people with diagnosed rheumatoid,
psoriatic or seronegative rheumatoid
arthritis. It offers a holistic approach
providing disease specific education
and self-management techniques and
is run by health professionals. Sessions
are 2.5 hours per week for 6 weeks.
If you are unsure whether you
have rheumatoid arthritis (RA) or
an inflammatory arthritis (IA), i.e.
psoriatic, or seronegative arthritis,
please contact the program coordinator
on 08 9388 2199 before enrolling in
this program.
When: 6-8:30pm
Where: Shenton Park
Cost: $30 single, $35 participant
plus partner
Nordic Pole Walking
(Term 4) Ongoing
thurs 24 oct - 12 dec
Nordic Pole walking enthusiasts get
together for Nordic walking followed
by coffee at the nearby cafe. Anyone
who has done the Nordic Pole walking
instruction course is welcome. Sessions
are 1 hour per week for 8 weeks.
When: 9:30am
Where: Meet at Zamia Cafe car park,
May St, Kings Park
Cost: Nordic Pole group walks - w/out
pole hire $40.00 ea
8 Nordic Pole group walks - w/out pole
hire $60.00 ea
4 Nordic Pole group walks - PLUS pole
hire $50.00 ea
8 Nordic Pole group walks - PLUS pole
hire $70.00 ea
Pilates for Arthritis (Term 4)
JIA Parent Get-Together
thurs 24 oct - 12 dec
tues 29 OCT
Pilates combines physical exercises
with breathing regulation to build
body strength and generate mental
calm. Pilates classes at Arthritis
and Osteoporosis WA are run by a
qualified and experienced instructors.
Participants will need to bring a mat
(all other equipment will be provided).
Sessions are 1 hour per week for 8
weeks.
Arthritis & Osteoporosis WA has just
started up a social group for parents
of children with juvenile arthritis and
bone disease. Come along to a new
social group for parents and share
experiences, gain greater understanding
and receive regular advice from health
professionals. Guest speaker TBC. Tea
and coffee provided.
When: 12pm
Where: Shenton Park Community
Centre, cnr Onslow Rd and Herbert St
Cost: $80
Gentle Yoga Classes
(Term 4)
thurs 24 OCT - 12 dec
In this gentle yoga class participants
will move through a series of
movements to help improve joint
health, flexibility and balance.
Movements can be performed seated or
on a mat on the floor and participants
will need to be able to get onto the
ground. Sessions are 1 hour per week
for 8 weeks. Please bring your own
yoga mat.
When: 9:30am
Where: Shenton Park Community
Centre cnr Onslow Rd & Herbert St,
Shenton Park
Cost: $80
When: 7:30pm-9:00pm
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: Free
Tai Chi (Term 4) 73 Form
Advanced
wed 30 oct - 27 nov
Tai chi 73 Sun Style (Advanced level)
is for people who are confident and
competent at Tai Chi and looking for a
further challenge. Sessions are 1 hour
per week for 5 weeks.
When: 10:30am
Where: Main Hall, Church of the
Resurrection, 105 Shenton Rd
Swanbourne
Cost: $50
Tai Chi for Arthritis
(Term 4) Beginners Class
wed 6 nov - 18 dec
thurs 7 nov - 19 dec
Dr Paul Lam’s Tai Chi for Arthritis is
an enjoyable exercise program which is
easy to learn and safe for people with
arthritis. The slow movements help to
build muscle strength, improve balance
and flexibility and calm the mind.
Sessions are 1 hour per week
for 7 weeks.
When: 10:00am
Where: Leapfrogs Cafe (in the
marquee) 25 Drovers Place, Wanneroo
Cost: $70
Arthritis Today | SPRING/SUMMER 2013
27
Scleroderma Support
Group Talk
Thurs 14 Nov
“Scleroderma and the role of the
Scleroderma nurse”. Guest Speaker
Helen Marsden, Clinical Nurse
Rheumatology, Royal Perth Hospital
When: 10:30am - 11:30am
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: Entry by donation
Joint Replacement Talk
JIA Parent Get-Together
fri 22 nov
tues 26 nov
“Is a New Model for Post Joint
Replacement Care Safe & Effective?”
Arthritis & Osteoporosis WA has just
started up a social group for parents
of children with juvenile arthritis and
bone disease. Come along to a new
social group for parents and share
experiences, gain greater understanding
and receive regular advice from health
professionals. Guest speaker TBC.
Tea and coffee provided.
Julie Headford from the Department of
Orthopaedics at Fremantle Hospital will
discuss the randomised controlled trial
which was designed and implemented
to investigate a new follow-up model for
patients undergoing elective primary
total hip/knee joint replacement within
Fremantle Hospital Health Services
compared to current follow-up practices.
When: 11am - 12pm
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: Entry by donation
When: 7:30pm-9:00pm
Where: Wyllie Arthritis Centre, 17
Lemnos Street, Shenton Park
Cost: Free
For more information please call
(08) 9388 2199 or email
[email protected]
Term 1, 2014 TIMETABLE FOR EXERCISES CLASSES
DAY
TIME
CLASS
MON
9.30am - 10.30am
Tai Chi for Arthritis TCA2. 8wks @ AOWA. 10 Feb – 7 April
11.00am - 12.00pm
Tai Chi for Arthritis Ongoings. 8wks @ AOWA. 10 Feb - 7 April
12.45pm - 1.45pm
Tai Chi – Beginners. 8wks @ AOWA. 10 Feb - 7 April
TUES
4.30pm - 5.30pm
Gentle Yoga. 9wks @ AOWA. 11 Feb - 1 April
WED
8.30am - 9.30am
Osteoporosis Exercise. 9 wks @ AOWA. 12 Feb – 9 April
3.30PM, 4.45PM,
6PM
Pilates for Arthritis. 7wks. 5 Feb - 19 March. Como Primary
7.30am - 8.30am
Nordic Pole Walking. Ongoing Group. City Beach.
9.30am - 10.30am
Nordic Pole Walking. Beginners Course. 5 weeks @ Kings Park 3 April – 1 May
9.30am - 10.30am
Gentle Yoga. 9wks@ Shenton Park Community Centre. 13 Feb – 10 April
10.45am - 11.45am
Pilates for Arthritis.9 wks@ Shenton Park Community Centre. 13 Feb – 10 April
12.00pm - 1.00pm
Pilates for Arthritis.9 wks@ Shenton Park Community Centre. 13 Feb – 10 April
THURS
28
We two old friends met by accident
as we’d done most of our lives. And
just like old friends, we remarked
on the weather, chastised our
politicians, gave thanks for our
continued mobility and realised we
worried, much as would twins.
We two old friends, aged three score
years plus a few were travelling OK
but we were both in the window,
so to speak. We knew because we’d
both lost a close friend or three in
recent months and the writing was
on our respective walls.
‘What plans have you made?’ I asked
of my friend. He told me of his
insurance policy covering funeral
matters and how he’d written a
detailed plan for his wife to follow
in those critical days when the loss
weighs so heavily. ‘And what plans
have you made?’ he asked of me.
To which I replied… “I’m hoping my
wife will surprise me!...”
It’s an old joke and we both laughed
which lightened the air of morbidity
that had developed but there was
nonetheless, a dark cloud hanging
over us both. In death there is
much that surprises and not just
to the victim.
If there is an illness from which
there is no recovery, then plans can
be prepared but if death is sudden,
surprise is total, and devastating to
those left to cope.
discover credit cards blocked, bank
accounts frozen and you’re out of
money. Once again, the saying…
‘leave a Will or leave a mess!’ has
been well proven, to your cost.
If you can’t or won’t decide how
to share your estate, others must
do it for you. If there is no Will,
an Executor will be appointed who
will share your estate with the
immediate family according to rules
that are quite specific. If there is
no partner, spouse or children, the
Executor will look for next nearest
relatives who might see their share
of the estate as like winning Lotto.
AJ Smith Society
Surprise me
The message of this article is
therefore two fold…
First, write a Will if you don’t have
one and update it regularly. Second,
a Will is an instruction about the
sharing of your estate, give some
thought to the idea of leaving a
bequest to the Arthritis Foundation
Inc WA. Such gifts we largely apply
to help advance research efforts that
we hope will one day develop a cure
for these insidious, pain inducing,
mobility limiting bone and joint
diseases.
There is no time to lose, do it today.
For further information, contact Ric
Forlano on (08) 9388 2199.
The information above is not legal advice. We urge
everyone to write a Will, to update it regularly and to
seek legal and financial advice in its preparation.
It can be a surprise to find there is
no Will, turning to panic when you
29
✂
Simply make a donation to help offset our printing costs,
and we’ll deliver your own copy, three times per year.
We pride ourselves in delivering services for the many
thousands who daily, struggle with the trauma and
limitations imposed on them by musculoskeletal diseases.
Services include access to our specialist bookshop,
courses on arthritis and osteoporosis and use of our
exercise and hydrotherapy facilities.
Education is just one aspect of our work as is our ongoing
funding of vital research. If you can assist us by making
a donation, we will be most grateful. Whether it’s to find
a cure or to simply make living with arthritis or osteoporosis
a little easier, we know we will do better if we had your
support too.
All donors receive receive a years subscription to
“Arthritis Today”, our magazine filled with up-to-date
information about arthritis and osteoporosis, as well as
news on our regular presentations and events.
Thank you sincerely,
Ric Forlano
Executive Director
To help offset some of the costs Arthritis & Osteoporosis WA
incurs and to receive a years subscription to Arthritis Today,
here is my contribution of:
$20
$30
Cash
$40
$50 or $
Cheque
OR, please charge my gift to my credit card:
Visa
Mastercard
Exp. Date:
/
Amex
Name on card:
Country Rheumatology
Want Arthritis Today
delivered to your door?
Rural Rheumatology Clinics
Established since 1974, the Rural Clinic Program
aims to provide early diagnosis and specialist
treatment to patients of Regional WA.
A doctor’s referral is needed when making
an appointment. Please call Arthritis and
Osteoporosis WA for further information
regarding each clinic area.
Toll free 1800 011 041
OCT 13- FEB 14
ALBANY
MANJIMUP
Oct, Nov, Dec, Jan, Feb
Clinic held every mth.
Nov
Clinic held every 4 mths
BRIDGETOWN
Nov
Clinic held every 4 mths
Oct/Nov, Feb
Clinic held every 3 mths.
CARNARVON
NORTHAM
Feb
Clinic held every 6 mths
Nov, Jan
Clinic held bi-monthly
ESPERANCE
PORT HEDLAND
Nov
Clinic held 2-3 times/yr
GERALDTON
Oct
Clinic held every 6 mths.
BUNBURY &
DUNSBOROUGH
Oct, Nov, Dec, Jan
Clinic held approximately
Private Clinics - contact
every mth.
Specialist Rooms in
Perth for clinic dates.
KALGOORLIE
Signature
Nov, Dec, Jan, Feb
Clinic held every mth.
Mr/Mrs/Ms/Miss:
KARRATHA
Address:
NARROGIN
Oct
Clinic held every 6 mths.
Phone:
Dates for clinics in 2014 are to be confirmed.
Email:
PLEASE SEND TO: PO Box 34, Wembley, WA 6913
30
Arthritis & Osteoporosis
WA has a number of
support groups which are
led by a trained volunteer
leader. If you would like the
opportunity to:
•
Talk freely about your
experiences and feelings
in a safe non-judgmental
environment;
•
Share helpful hints
and practical tips;
•
Receive and give
encouragement and
support to others;
•
Socialise and make
new friends.
Why not come along to one
of our groups?
Register online at
www.arthritiswa.org.au/
events
For more information about
attending a support group,
please call Arthritis &
Osteoporosis WA on
(08) 9388 2199 or email
[email protected]
Talks are sometimes held
during support group
meetings. For details of talk
topics and dates, please see
page 26.
17 Lemnos Street, Shenton Park
Inflammatory Arthritis
Support Group
Meets 1st Tuesday of the month (2nd
Tues in Nov)
10:30am–12noon.
Dates: 1 Oct, 12 Nov, 3 Dec , 4 Feb
No meeting Jan 2014.
Scleroderma Support Group | NEW
A newly formed group for people
with Scleroderma and related
conditions.
Meets monthly on the 2nd Thursday,
10:30am–12noon.
Dates: 10 Oct, 14 Nov, 12 Dec, 13 Feb.
No meeting Jan 2014.
Joint Replacement Group
For people (mostly with OA) who are
considering or have undergone a
Joint Replacement. Meets quarterly
on a Friday, 11am–12:30pm. Dates:
22 Nov, 28 Feb.
JIA Parents Group
A social group for parents of
children with juvenile arthritis and
bone disease. Meets on the last
Tuesday of the month, 7:30–9pm.
Dates: 29 Oct, 26 Nov. No meeting
Dec or Jan.
Support Groups
Groups held at the Wyllie Arthritis Centre
Suburban & Regional Groups / Branches
Evening Inflammatory Arthritis
Social Group for those of
working age
Meets 3rd and 4th Wednesday of the
month for coffee/drinks from
7-9pm.
3rd Wed (North) Mille Café,
Inglewood. Dates: 16 Oct, 20 Nov, 15
Jan, 19 Feb. No meeting Dec 2013.
4th Wed (South) C15 Espresso Café,
Applecross. Dates: 23 Oct, 27 Nov,
22 Jan, 26 Feb. No meeting in Dec.
Albany Arthritis Support Group
Meets 4th Wednesday of the month,
1pm–1:45pm, Resource Centre
Lotteries House, 211 North Road,
Albany.
Dates: 23 Oct, 27 Nov, 26 Feb
No meeting Dec 2013 or Jan 2014.
Mandurah Scleroderma
Support Group
Meets quarterly on a Tuesday,
10am-12pm, Eastlake Church,
99 Lakes Rd, Mandurah.
Dates: 19 Nov 2013, 18 Feb 2014
Ankylosing Spondylitis
Exercise Group
Meets every Monday evening for a
hydrotherapy and gym exercise
program at Royal Perth Hospital in
Shenton Park.
Bassendean Arthritis Group
Meets every Tuesday, 1:30-2:30pm
for gentle exercise. Bassendean
Community Centre (Main Hall),
48 Old Perth Road.
(Note: Group in recess from the
11 Dec 2013. Recommences on the
4 Feb 2014.)
Arthritis Today | SPRING/SUMMER 2013
31