harvard nametag

I do write, I really do write. The prolonged silence on my blog has more to do with the my not uploading my writing than a lack of words written. I tend to only write during flights, and over the last few years I have flown, and flown. Whenever I get back to Sydney, there is often so much to do that the upload phase seems to pass away. This flight will be to a whole new continent, Welcome to South America. I am off to Brazil to complete a journey that I started in August last year when  SOSORT offered its members a chance to apply for a part scholarship to undertake a course in clinical research. I remember submitting my application during a particularly difficult time in my life and not telling anyone about it; partly not expecting to be successful.  Thank you SOSORT for graciously accepting my application and thank you Harvard for giving me the opportunity to participate in an educational process that has forever changed the way I consider medicine, clinical practice, clinical research, academia, industry and this thing we call…. Healing.

PPCR is a real time and online lecture, discussion forum, assignment and exam based course designed for healthcare workers hoping to become versed and skilled in the Principles and Practice of Clinical Research (PPCR).  The final project of my currently ongoing PhD was always going to be a clinical research project and I was hoping to concurrently  use the course to help develop the protocol. I didn’t realise that the course was going to override everything else in my life, including much of my available PhD time. But, it has provided me with a framework to become a much better clinician, researcher and healer.

In all this time, I have still been seeing my curves, teenage kids, young kids, adults and aged. I have seen kids go for surgery and have seen kids go for bracing. I have seen and felt the despair of braces not holding curves and relief of braces that have taken control of the curve for the moment. I have made late night calls to radiologists to confirm that spinal images on the x-rays I am seeing are actually as severe as they appear and not some wild radiographic artefact from poor positioning or patient movement. I have referred patients for surgery and stressed with concerned parents when a proposed 6 hour operation becomes 10 hours due to dysplastic vertabrae. I have seen experimental rods implanted and have even had some correspondence with the spine surgeons that have been so distant and silent, in the past.

Well, its now 4.5 days later and the course is over.  There were 200+ young (at least younger than me) mostly medical doctors and mostly specialists. We had a geriatrician, pulmonologist, neurologist, cardiologist, plastic surgeon as well as clinical pharmacists and industry and government regulatory agency specialists in my syndicate.  Oh my goodness, the intelligence, the intensity, the robust and fun debate in a beautiful setting.  I am often amazed at how lucky we are to live in Sydney, but truthfully, I don’t get much time to enjoy the environment. Our PPCR course was held in a resort in the Brazilian state of Bahia. It was really beautiful and I managed to fit in a daily swim in the pool and a longer open water swim in the bay. The bay is home to a protected turtle population, whose members,  I could occasionally see from the beach, but never able to locate them in the very murky, but pleasantly warm water.

PPCR resort

The  PPCR course officially ends in mid November but luckily, most of us received our graduation certificates at the end of the 5 day immersion course. The final session was a conference type session where each team presented a clinical trial protocol that we had been working on for the last few months. Our team  project was presented by Dr Marlon Aliberti, a Brazilian Gerontologist who much to the surprise of many of our highly specialised team members proposed a clinical trial to evaluate the efficacy of a herb called Boswelllia in the management of hand osteoarthritis in an elderly population.  We argued to the wider PPCR group that there is some preliminary evidence that Boswelia is effective in reducing pain, inflammation and increasing quality of life and that a more robust trial should be considered for hand osteoarthritis.

PPCR slide

 

Dr Stefano Negrini of ISICO in Milan, often comments that there has never been a trial comparing conservative management of scoliosis with surgery. I used to think that I understood what this meant but now I really understand. Unfortunately I don’t think there will ever be a trial like this. In order to do this trial we would need to randomly assign a matching group of scoliotic kids into conservative vs surgical treatment and then follow up for a very long time.  30,40,50,60 years. Dr Manuel Rigo from Barcelona often remarks that surgical treatment today might be associated with significant complications later on in life, and that we don’t know if these complications later on in life would be worse if the scoliosis was left untreated.

This is a painfully challenging question to have to face, consider and decide.   For me too!

+ posts

Larry is a highly skilled physiotherapist who specialises in treating back and neck pain, postural issues and scoliosis. He is certified in Schroth and SEAS methods and through the Egoscue University. Larry has a background in elite gymnastics and springboard diving and also has many years experience in endurance running and triathlons. His specialist knowledge and techniques have seen him appointed as a gymnastics coach and physiotherapist at both the Olympics Games and Special Olympics.

His passion and driving philosophy is about achieving the best outcomes for his patients utilising an amalgam of the latest techniques and theories while recognising there may sometimes be a need for invasive procedures. Where deemed appropriate Larry will then refer to a specialist. To further his holistic understanding and approach, Larry is currently undertaking a Ph.D. in Spinal Deformity and regularly attends and speaks at international conferences and courses and clinics.

Fun fact: Larry is learning how to surf - so be careful next time you go to the beach! Qualifications: B.Sc (Physiotherapy); M.Sc. (Exercise Physiology); Advanced Certificates in Schroth (BSPTS) and Egoscue (PAS) and SEAS Larry is Level II certified (advanced) in the conservative treatment of Scoliosis based on the Schroth method. The training was conducted by Dr Manuel Rigo of the Barcelona School at Scoliosis Rehab Inc in Wisconsin. He has completed his SEAS scoliosis treatment training at ISICO in Milan. Larry has also spent time working with Dr Rigo in the Barcelona clinic. Larry also has advanced certificates in shoulder treatment, posture alignment therapy and acupuncture.