About Dr. Jenson Mak
Dr. Jenson Mak PhD(USyd)MBBS FRACP FACP FAFRM(RACP) BMedSci JP works as a Consultant Physician, Geriatrician, and Rehabilitation Physician in and near the Sydney metropolitan and Central Coast regions. He has been elected to Fellowship and will be traveling to Washington D.C. for Convocation into the American College of Physicians in May 2016. He has more than two decades of experience in the medical field. Dr. Mak’s published work has covered vitamin D, osteoarthritis, osteoporosis, stroke, hip fracture, hip and knee disorders, and holistic medicine. His expertise also details best practice guidelines for general practitioners, specialists, and other healthcare providers who serve patients battling conditions like osteoarthritis and hip fracture.
A strong believer in the power of preventative medicine, Dr. Mak emphasizes the complementary relationship between traditional and holistic approaches to healthcare and wellbeing. Traditional medical science assumes only two states of being – “sick” or “healthy.” However, it is important to recognize that even when you are not actively in the throes of illness, you may still be far from well. Holistic medicine extends beyond this overly simple binary and identifies a gray area in between dubbed “un-health.” Areas of un-health can rapidly deteriorate into unpleasant conditions.
In contrast, vitality encompasses a well-rounded approach to nurturing both a strong body and a sharp mind. Dr. Mak’s professional and academic expertise encompasses a wide enough spectrum to empower him to guide patients towards achieving that goal. Whereas many healthcare professionals overemphasize a symptom-centric approach, Dr. Mak considers the big picture. His passion is finding the root of the problem, and resolving it in a way that can create lasting change. Through fostering real relationships with his patients and their caregivers, he uniquely understands the value of thinking outside the box. Complementary practices like acupuncture, musical therapy, massage therapy, or psychotherapy can better equip many people to achieve a more vital and healthy lifestyle.
On the other hand, it is important to appreciate the value that traditional Western medicine and research does offer. Alternative medical practitioners have the unsavory tendency to overpromise and a relative deficiency in properly conducted clinical trials. However, when you marry the best that both worlds offer, patients win.
Providing helpful, useful information is one of the best aspects of working as a healthcare professional. Dr. Mak most loves proving to clients that just because a conventional doctor might suggest recovery or improvement is impossible, that does not make it true. Life happens outside of books. Working in a capacity that enables him to rehabilitate and care for some of Australia’s most valuable and inspiring community members is a true privilege. As one of the only medical care providers with his unique cluster of skills, Dr. Mak is proud to be in a position to make a big difference in healthy ageing.
Inpatient Consultation Services
Outpatient Consultation Services
Chatswood NSW 2067
Tel: +61 2 9411 3366
Fax: +61 2 9415 4383
Sydney NSW 2000
Tel: +61 2 9282 9725
Fax: +61 2 9252 9721
Campsie NSW 2194
Tel: +61 2 9787 9388
Fax: +61 2 9789 1488
Gosford Private Hospital
North Gosford NSW 2250
Tel: +61 2 4323 8105
Fax: +61 2 4323 8184
GET IN TOUCH:
Preventative medicine ('How to live longer and happier')
Hip/Pelvic fracture rehabilitation
Neurological rehabilitation (e.g. stroke, post neurosurgery)
Conservative management of Spinal Pain (back & neck)
Musculoskeletal rehabilitation for conditions not requiring surgery, such as sprains, strains, minor/moderate injury.
Cardiac and Respiratory Rehabilitation
Rehabilitation of the Older Person, after physical deterioration (deconditioning) due to any medical or surgical illness
Injury rehabilitation, such as work injuries, or other accidents
Orthopaedic rehabilitation (e.g. after joint replacement surgery for knees, hips, shoulders, and fractures, joint fusion surgery, and common spinal surgeries
Psychogeriatrics including dementia, depression and anxiety disorders
Osteoporosis and other fractures
Chronic Pain Syndromes
Dr. Mak's Published Work
- Clinical Book Chapter
- Clinical Guideline
- Cochrane Review (1st)
- Cochrane Review (2nd)
- Cochrane Review (3rd)
An Evidence-Based Review of Acupuncture in Osteoporosis and Fracture-Related Pain
After 40 years of extensive studies, compelling evidence has been obtained to support acupuncture as a useful tool for treating a spectrum of diseases. In fact, more than 40 disorders have been endorsed by the World Health Organization (WHO) as conditions that can benefit from acupuncture treatment (Han, 2011). A study on 202 subjects attending an Australian university osteoporosis clinic found that almost one-fifth of those using a complementary medicine modality used acupuncture (Table 1: Mak 2010). This chapter begins by looking at the history of documented acupuncture use in osteoporosis. It then utilises an evidence-based approach in appraising relevant clinical trials over the past 10 years of the benefits of acupuncture use in osteoporosis (improvements in bone-mineral density, falls and fracture rates), as well as the efficacy in the treatment of acute fracturerelated pain. Finally, it discusses the pathophysiological basis of the efficacy of acupuncture in these conditions. ‘Within the next 5-10 years, clinicians could be routinely recommending acupuncture as a first-line treatment for fracture-related pain. The use of acupuncture in this circumstance bypasses the common problem of systemic side-effects from oral and topical analgesic agents’.
Read more here.
Evidence-based Guidelines for the Management of Hip Fractures in Older Persons: An Update
We identified 128 new studies, of which 81 met our inclusion criteria. Twenty-seven studies were excluded for one of the following reasons: they were not RCTs (11 studies), they were not specific for hip fractures (5), they were primary prevention studies (6), and they were published in a language other than English or did not meet our other inclusion criteria (5). Twenty studies were not re-reviewed, as they were included in Cochrane Collaboration reviews at the time of searching.
Sixteen Cochrane Collaboration reviews and 65 additional relevant articles published from October 2001 to June 2008 were identified. No new RCTs or meta-analyses were found relating to the following interventions: preoperative traction, prevention of pressure sores, oxygen therapy, pressure-gradient stockings, surgical wound drains, postoperative blood transfusion, surgical swabs and urinary catheterisation.
Four new issues in hip fracture management — surgical wound closure, reducing postoperative delirium, osteoporosis treatment and hip protectors — were included in our review, because they are pertinent management issues that have not been included in previous reviews or because studies addressing these issues are now available.
Read more here.
Vitamin D and Vitamin D Analogues for Preventing Fractures in Post-Menopausal Women and Older Men
Hip fractures and several other types of fractures are very common in post-menopausal women and older men due to age-related weakening of their bones (osteoporosis).
Fractures due to osteoporosis often occur in the hip, wrist or spine and can lead to considerable disability or even death. Those who survive often have reduced mobility and may require greater social and nursing care.
Vitamin D is necessary for building strong bone. Older people often have low vitamin D levels because of lack of exposure to sunlight and low consumption of vitamin D in their diet. Therefore, it has been suggested that taking additional vitamin D in the form of supplements may help to reduce the risk of fractures of the hip and other bones.
To investigate the effects of vitamin D or vitamin D-related supplements, taken with or without calcium supplements, for preventing fractures in post-menopausal women and older men.
The review authors searched the medical literature up to December 2012, and identified 53 relevant medical trials, with a total of 91,791 people taking part. The trials reported fracture outcomes in postmenopausal women or men aged over 65 years from community, hospital and nursing-home settings. These trials compared vitamin D or related supplements with – or without – calcium supplements, against fake supplements (placebo), no supplement or calcium supplements alone.
The review found reliable evidence that taking vitamin D only, in the forms tested in the trials, is unlikely to prevent fractures. However, reliable evidence showed that vitamin D taken with additional calcium supplements slightly reduces the likelihood of hip fractures and other types of fracture. The review found that there was no increased risk of death from taking vitamin D and calcium.
Although the risk of harmful effects (such as gastrointestinal (stomach) symptoms and kidney disease) from taking vitamin D and calcium is small, some people, particularly with kidney stones, kidney disease, high blood calcium levels, gastrointestinal disease or who are at risk of heart disease should seek medical advice before taking these supplements.
Read more here.
Multidisciplinary Rehabilitation for Older People with Hip Fractures
Hip fracture is a serious injury in older people and can contribute to their death or loss of independence. Normally surgery is performed and followed by care in a ward under the supervision of orthopaedic staff. Additional rehabilitation within the hospital is sometimes provided by a geriatrician and other health professionals. Sometimes, the emphasis is on early discharge from hospital with multidisciplinary rehabilitation provided to the patient at home. There is enormous variety in these rehabilitation programmes.
This review included 13 trials, which involved a total of 2498 older, usually female, patients who had undergone surgery for hip fracture. Generally the trials appeared well conducted, although some were at risk of bias that could affect the reliability of their results. For example, despite randomisation, in five trials there were some important differences in patient characteristics, such as age, at the start of the trial that could have influenced trial findings. The trial interventions were very varied but all compared multidisciplinary rehabilitation with usual care. In 11 trials, care was provided either totally or mainly in an inpatient or hospital setting. While there was a tendency for a better outcome after multidisciplinary rehabilitation, the results were not statistically significant and thus cannot be considered conclusive. However, the overall evidence indicates that multidisciplinary rehabilitation is not harmful. Additionally, there was some inconclusive evidence that multidisciplinary rehabilitation did not add to the burden of carers. In one trial that compared home-based multidisciplinary rehabilitation with usual inpatient care, carers reported significantly lower burden in the long term after multidisciplinary rehabilitation. Participants in the home-based rehabilitation group of this trial had shorter hospital stays, but longer periods of rehabilitation. One other trial found no significant effect from doubling the number of weekly contacts at the patient’s home by a multidisciplinary rehabilitation team.
Overall, the results of this review suggest that multidisciplinary rehabilitation may help more older people recover after a hip fracture. However, the results are not conclusive and more research is needed.
Read more here.
Interventions for Improving Mobility after Hip Fracture Surgery in Adults
The aim of care after surgery for hip fracture is to get people safely back on their feet and walking again. Initially, people may be asked to rest in bed and restrict weight bearing. Then various strategies to improve mobility, including gait retraining and exercise programmes, are used during hospital stay and often after discharge from hospital.
This review includes evidence from 19 trials involving 1589 participants, generally aged over 65 years. Many of the trials had weak methods, including inadequate follow-up. There was no pooling of data because no two trials were sufficiently alike.
Twelve trials evaluated interventions started soon after hip fracture surgery. Single trials found improved mobility from, respectively, a two-week weight-bearing programme, a quadriceps muscle strengthening exercise programme and electrical stimulation aimed at alleviating pain. Single trials found no significant improvement in mobility from, respectively, a treadmill gait retraining programme, 12 weeks of resistance training, and 16 weeks of weight-bearing exercise. One trial testing ambulation started within 48 hours of surgery found contradictory results. One historic trial found no significant difference in unfavourable outcomes for weight bearing started at two versus 12 weeks. Of two trials evaluating more intensive physiotherapy regimens, one found no difference in recovery, the other reported a higher level of drop-out in the more intensive group. Two trials tested electrical stimulation of the quadriceps: one found no benefit and poor tolerance of the intervention; the other found improved mobility and good tolerance.
Seven trials evaluated interventions started after hospital discharge. Started soon after discharge, two trials found improved outcome after 12 weeks of intensive physical training and a home-based physical therapy programme respectively. Begun after completion of standard physical therapy, one trial found improved outcome after six months of intensive physical training, one trial found increased activity levels from a one year exercise programme, and one trial found no significant effects of home-based resistance or aerobic training. One trial found improved outcome after home-based exercises started around 22 weeks from injury. One trial found home-based weight-bearing exercises starting at seven months produced no significant improvement in mobility.
In summary, the review found there was not enough evidence to determine which are the best strategies, started in hospital or after discharge from hospital, for helping people walk and continue walking after hip fracture surgery.
Read more here.