Be proactive to help stop the spread of antibiotic resistance

Dr. Lynora Saxinger

November 2011

Many Canadians are alarmed when they find out that they or a loved one have been in contact with a hospital “superbug,” like MRSA (methicillin-resistant Staphylococcus aureus) or Clostridium difficile. Questions about the danger, preventing the spread and what to do once you leave the hospital are common.  

Once someone has been in contact with a carrier, they are put in isolation and tested. Testing positive does not mean they are, or will get sick from that bug; they may be one of the 25 per cent of people who carry the Staph bacteria on their skin or in their nose, and they happen to carry a strain that is resistant to some common antibiotics. 

Carrying this resistant strain does mean you might get an infection, but most people do not. Staph infections commonly involve the skin, operative incision sites and wounds. Knowing you carry it is useful, because if you get symptoms of infection, you are more likely to be put on the right kinds of antibiotics quickly.

Carriers usually remain in isolation in hospital to prevent spread of the germ. Once home, ordinary cleanliness is recommended—frequent hand-washing, keeping wounds covered and avoiding sharing towels. 

Carriers are not usually a risk to their loved ones with casual contact. However, a newer strain of MRSA called community associated MRSA is a little more likely to cause skin infections. If someone has had boils or “spider-bite” skin infections from MRSA, close contacts should be swabbed for MRSA if they get similar skin infections. 

Doctors may attempt to reduce or eliminate the bacteria from the nose and skin by “decolonization” with skin antiseptics and antibiotics.

Clostridium difficile colitis, or “C. diff” is a type of diarrhea usually caused by the overgrowth of a diarrhea-causing bacteria.

This is usually because of an imbalance caused when taking antibiotics reduces the good bacteria in the gut. People may carry C. diff spores for a long time, and spores can be spread by surfaces in bathrooms and hospitals. 

Some people get better when they stop taking the antibiotic and their good bacteria help rebalance their colon’s function, but many need an antibiotic treatment. Diarrhea has a tendency to recur, so anyone who has had C. diff should get tested quickly if it comes back.

Isolation precautions are meant to reduce the spread of resistant organisms in the hospital environment.

Often, this means wearing gowns over street clothes, gloves and sometimes masks. Gloves are not a substitute for hand-washing. Hand-washing (or using alcohol-based hand rubs) by health-care workers, patients and visitors is the most important way to reduce spread of resistant organisms. 

People often feel bad, or “dirty” when in isolation, but there should be no need for that; the precautions are a fact of life in modern hospital care.

Lynora Saxinger BSc, MD, FRCPC, CTropMed, is chair of the Antimicrobial Stewardship and Resistance Committee, Association of Medical Microbiology and Infectious Disease (AMMI) Canada, and associate professor, Divison of Infectious Diseases, Departments of Medicine and Medical Microbiology and Immunology, University of Alberta Hospital.

Bacteria that are resistant to common antibiotics are on the rise worldwide because of improper use of antibiotics, and some of these bacteria thrive and spread in hospital environments. Up to 50 per cent of antibiotics used in hospitals are given unnecessarily.

To avoid the rise of nearly untreatable infections, we need to make sure we take antibiotics only when needed and as prescribed. Doctors sometimes feel that patients will be disappointed if they don’t receive an antibiotic, even when symptoms are probably from a viral infection.

Patients can help by mentioning to their doctor that that if their ill- ness is probably viral, they’d appreciate advice on non-antibiotic management and information on when they should come in for reassessment for antibiotics.

Patients can ask to talk to their physician or infection control practitioners for more information.

November 14 to 20 is Antibiotic Awareness Week and several Canadian health-related organizations are working to promote the prudent use of antibiotics. For information on what you can do to help stop the spread of antibiotic resistance, visit antibioticawareness.ca

Alzheimer’s: more hope, resources

Kristine Berey

October 2011

As people live longer, we know that the chance of acquiring Alzheimer’s disease increases. But over time, progress has been made and patients and families have more support and tools at their disposal to help them, say experts who have been working in the field for more than a quarter of a century.

“Now we talk about people at risk,” says Dr. Serge Gauthier, director of the Alzheimer’s Disease Research Unit of the McGill Centre for Studies in Aging. “We’re looking at earlier and more accurate diagnosis, symptomatic treatment medications and in the future, prevention strategies for people at higher risk and the public at large.”

These include social networking, keeping your brain and your mind busy, regular physical and mental exercise, healthy eating, and small amounts of red wine. “It’s been long known that if you prevent strokes, you will delay Alzheimer’s.” However, Alzheimer’s involves a blend of factors that vary in individuals and Gauthier warns we will not get a “magic” pill anytime soon. “It’s not realistic that one pill will cure Alzheimer’s in everyone.”

However, there are four medications, administered earlier and combined as needed as the disease progresses, that can significantly slow the course of the illness, Gauthier says.

Though improved brain imaging techniques allow researchers to detect the neurological changes indicating Alzheimer’s, Gauthier says that it is possible to manifest these changes without physical symptoms.

“Over age 90, many people at autopsy have all these physical changes but no symptoms. Clinically, one out of four people over 85 will have symptoms. We are equally interested in the three without symptoms. At McGill we have a new centre for prevention for people who are concerned. They can join a program of physical and mental exercise, cognitive training and diet.”

Marva Whyte, director of support services at the Alzheimer Groupe agrees that huge strides have been made in the field. “The whole language around Alzheimer’s has changed,” Whyte says.

“We used to talk about victims, but not so much about the person behind the disease. The disease used to define the person. Now we look at the person and how the disease has affected them and what kinds of programs and activities will be of most benefit.”

The care provided is now individualized, Whyte says, with the person’s strengths, which are still present though the disease has progressed, being used as a springboard for managing the condition.

The Internet has been a boon for families who are touched by Alzheimer’s, Whyte says. While they may need help sorting through the avalanche of online info, they know there is something to be done. There are support services for the caregivers as well.

“The outlook is better and the families do not feel so alone.”

CSSS Cavendish provides increased access to medical care

Kristine Berey

April, 2011

The lack of access to regular medical care is an urgent concern for many Montrealers, especially as they age or suffer from chronic illnesses.

According to the Canadian Institute for Health Information, in 2006 more than 2 million, or 25 per cent, of Quebecers lacked a family doctor, compared with 14 per cent in the rest of Canada. In Montreal, 32.4 per cent of the population had no primary care physician, compared with only 9.4 per cent in Toronto. But for residents of N.D.G., Montreal West, Côte St. Luc, Hampstead and Snowdon, there should be some improvement, as the CSSS Cavendish has moved its medical clinic and test centre to the ground floor of the Cavendish Mall.

Executive director Francine Dupuis says the expansion of the clinic, which had been on the fourth floor, is a dream come true.

“We wanted this a long time ago,” Dupuis said. “Having a clinic on the bottom floor means visibility. People didn’t see the clinic, and some didn’t even know it existed. Lots of people go to the mall all the time but don’t know what services we have in the tower. We will be seen, and for seniors it will be easier not to have to take the elevator. Parking is free, it’s just at the doorstep.”

The clinic will have professionals in complementary fields able to offer co-ordinated services, Dupuis says. “The clinic has access to beautiful state-of-the-art equipment and features a team of multi-disciplinary professionals physically able to closely work with one another. We will have a larger test centre, and depending where the doctor wants samples to be sent, we will send to the lab and the lab will send the results to the doctor. We have an agreement with Mount Sinai, we can send our X-rays over there and if it’s an emergency request we will have the results within one hour.”

The clinic has connections with Maimonides and the Jewish General and St. Mary’s hospitals. As well, a chronic- care clinic that will follow patients with diabetes and chronic pulmonary disease is planned. All services, including medical tests, are free.

Dupuis emphasizes the importance of general practitioners. “Our philosophy is that you have to have a family doctor who knows you and sees you when you need to be seen. It’s much more difficult to be a family doctor than a specialist—you have to diagnose, follow patients, be knowledgeable about all diseases. You’re a social worker, a psychologist. People think specialists are much better than generalists, which is not the case.”

There are eight doctors at the clinic working part time, taking new patients when there is an opening. New callers are placed on a waiting list. “One hidden advantage of the clinic is that we want to attract more doctors,” Dupuis says. “We know there are many doctors in the community who work far away and we believe they will be attracted to work closer to where they live when they see the clinic. We’re counting on doctors who are closer to retirement and would like to decrease the number of days and administrative responsibilities they have.”

According to the journal Canadian Family Physician, patients with family doctors have higher survival rates, need to be hospitalized less often, are prescribed less medication and are less expensive to treat in the doctor’s office than in the emergency room, which costs five to 10 times more.

“We want people to receive services outside the hospital,” Dupuis says. “A hospital should be the end of the line, it’s a very costly service, there are too many people crowded in a room spreading infection and very often the patient doesn’t need that technical level. Many services can be very well provided in a physician’s office.”

For more information or to make an appointment, call 514-484-7878.

Lifestyle choices can be risky business

Marlene Eisner

November, 2010

Gabriel Shears had a heart attack when he was 55 years old. Thirty-one years later, the spry 86-year old, who is also a colon cancer survivor, is still attending the cardiac reconditioning program at the YM-YWHA.

“I used to be a smoker,” says Shears, who comes to the YM-YWHA four days a week to exercise under the supervision of the program staff.

“I quit a week before my heart attack!”

Gabriel Shears with Len Ockendahl of the YM-YWHA cardiac reconditioning program Photo:YM-YWHA

Starting to exercise after a sedentary lifestyle was not easy, Shears says, but being in a group motivated him.

“When I was told I had to jog, I felt sorry for myself. I hadn’t exercised since I was 18. Now, if I miss a day or two here, I feel guilty.”

Shears says the program also helped him recover faster from his cancer. The therapeutic exercise program is designed for adults at risk of developing illnesses such as heart disease, diabetes, high blood pressure and cancer, or who are undergoing treatment for these and other chronic conditions.

“Our program combines exercise with specific lifestyle recommendations, and how to integrate them into your daily life,” explains Josée Baillargeon, one of its directors, who is also a nurse. “Our staff include a nurse, a registered dietician and highly qualified personal trainers to provide safe, graduated, and individualized therapeutic exercises.”

A gym that makes house calls

Janie de Jeu

November, 2010

Jerry Spinak has arthritis – information that might surprise you when you hear what he does for a living. He attributes his mobility to a lifelong practice of an ancient Chinese art.

Spinak has been teaching tai chi for 35 years. He gained his apprenticeship with a Chinese master of the Yang style, the most practiced form of tai chi in the world.

It was through teaching tai chi at the YMCA in the ’80s that he discovered a passion for working with seniors. “I love it,” he says. “I teach at nursing homes, residences, and privately. I enjoy it so much that I show up early. And I get hugs! I get to tell jokes! We have such a good time. When I leave those classes, I feel so good.”

For the past four years, Spinak has been working on a form of tai chi he developed especially for seniors. “With the proliferation of research in the past 25 years I have learned a lot about balance and fall prevention,” he says.

It is a style that incorporates the choreographed, fluid motions of the traditional elements of tai chi. The only difference is that it is done in a sitting position and involves movements from the torso up that can be practiced by seniors with limited mobility. “These movements can be done by anyone, whether they walk, use a cane, or are in a wheelchair,” he says.

Spinak does encourage his students who feel centred and balanced enough to stand to do so, but he remains cautious. “I’m very concerned about safety and proper stance in repetitive movements for my students,” he says.

Spinak also teaches an ancient Chinese technique called Qigong, a breathing exercise that is proven to retrigger a part of the brain that regulates the heartbeat. “It’s as good as any medication on the market right now to reduce blood pressure – And studies have shown the combination of the two give even better results.

“In Australia one the first studies on tai chi was done for its benefits for people 70 and older. (The study) found that 47.5 per cent of those who did tai chi had fewer falls,” he says. “This has been tested time and time again by different universities and the results keep coming up the same. The statistic itself is amazing.”

Regain your youthful vitality with tai chi, one move at a time

Janie de Jeu

November, 2010

Joanne Wright and Terry Diachun have experience and passion when it comes to helping seniors. They both worked at the Lakeshore General Hospital in geriatrics, she as a recreational therapist and he as an orderly. They are also personal trainers and fitness enthusiasts, which is what spawned Age in Motion, a mobile gym for adults 55+.

“Most gyms are not catered to seniors. The machinery is intimidating to them, especially for those in between leaving the hospital and physiotherapy,” Wright says. “Transportation also poses a problem for them, as most of my clients have limited mobility or no longer have a driver’s license.”

Wright and Diachun are certified by the YMCA and Canadian Fitness Professionals, where they earned certificates as older adult fitness specialists. “You can’t just be a trainer,” Wright says. “For some of these people, we are the only touchstone they have. We don’t just walk in and out.”

Their specialties include working with specific problems such as Parkinson’s, arthritis and loss of mobility due to a stroke. “People just want to keep active and stay functional,” Wright says. “Privacy, autonomy, and mobility are important to everyone. You don’t know that until you’ve lost it.”

Wright and Diachun bring equipment for sessions in a large duffle bag – items such as weights, resistance bands and grip balls. The sessions are head-to-toe conditioning workouts or special needs training for improving bone density or mobility in a certain area of the body. “We work around pain,” she says, “not through it. These are completely individualized programs.”

The 50-minute sessions are two or three times a week. They include stretching, and endurance walking depending on the client’s level of mobility. “What we find is that our clients are a lot more capable than they ever thought they could be. If they’re really dedicated to change, we can make it happen.

“We’re all going to age. It’s up to us to decide how we’re going to do it.”

Regain your youthful vitality with tai chi, one move at a time

Janie de Jeu

November, 2010

Joanne Wright and Terry Diachun have experience and passion when it comes to helping seniors. They both worked at the Lakeshore General Hospital in geriatrics, she as a recreational therapist and he as an orderly. They are also personal trainers and fitness enthusiasts, which is what spawned Age in Motion, a mobile gym for adults 55+.

“Most gyms are not catered to seniors. The machinery is intimidating to them, especially for those in between leaving the hospital and physiotherapy,” Wright says. “Transportation also poses a problem for them, as most of my clients have limited mobility or no longer have a driver’s license.”

Wright and Diachun are certified by the YMCA and Canadian Fitness Professionals, where they earned certificates as older adult fitness specialists. “You can’t just be a trainer,” Wright says. “For some of these people, we are the only touchstone they have. We don’t just walk in and out.”

Their specialties include working with specific problems such as Parkinson’s, arthritis and loss of mobility due to a stroke. “People just want to keep active and stay functional,” Wright says. “Privacy, autonomy, and mobility are important to everyone. You don’t know that until you’ve lost it.”

Wright and Diachun bring equipment for sessions in a large duffle bag – items such as weights, resistance bands and grip balls. The sessions are head-to-toe conditioning workouts or special needs training for improving bone density or mobility in a certain area of the body. “We work around pain,” she says, “not through it. These are completely individualized programs.”

The 50-minute sessions are two or three times a week. They include stretching, and endurance walking depending on the client’s level of mobility. “What we find is that our clients are a lot more capable than they ever thought they could be. If they’re really dedicated to change, we can make it happen.

“We’re all going to age. It’s up to us to decide how we’re going to do it.”

With space-age technology, the ears have it

Giovanni Barbieri, audioprosthetist

April, 2010

The art of decision-making is becoming more and more difficult as space-age technology advances at a rapid pace.

With the vast amount of high digital technology developed, the purchase or renewal of a hearing aid can be a difficult decision to make. However, we can analyze the options so the chore won’t be as dramatic as it may seem. Firstly, one has to consider the type and amount of hearing loss. Once this is established, we must consider the discrimination factor: The intelligibility or understanding of words, the amount or percentage that the individual understands in any given sentence. A person may hear but not necessarily comprehend everything that is being said. Another very important consideration is whether it will be one hearing aid or two.

Provided that all the conditions are met and you are a candidate to wear hearing aids, a binaural fitting (using two aids) is always the best decision, because we should hear with both ears. This will give you more balanced hearing and a stereo effect, but also a more natural way of hearing, as Mother Nature had intended it to be.

A well-fitting hearing aid can help you communicate more freely with your loved ones. Photo: Mohammed Osman, Wikimedia Commons

Anyone who meets the government’s criteria, regardless of age, is eligible for a subsidized hearing aid, which is replaced once every six years, or earlier if its use has expired.

The price range for digital hearing aids range from $1,000 to very sophisticated instruments that can cost $3,600.

It is highly recommended that you first see an ear, nose and throat doctor to make sure there is no obstruction in the ear, such as earwax or an accumulation of debris or infection.

The physician will also verify whether a surgical intervention might remedy the problem. If the diagnosis is positive, your doctor will make a recommendation to have an audiometric examination performed by an audiologist, who will then make the appropriate recommendation as to the hearing instrument that would be best suited to you. An audioprosthetist will do the fitting.

There are many models available, such as C.i.C. (inside the canal), ITE (in the ear), open fit (tiny instrument that sits discretely behind the ear with a filament-type tubing that goes directly into the canal), full shell (fits completely inside the cavity of the ear) and, for the more severe losses, there is the BTE (behind the ear).

No matter which hearing aid is purchased, you and your audioprosthetist will have to make certain during the course of more than one appointment that the fitting of the acquired instrument is as comfortable as possible. The follow-up is an important step, assuring that everything is working properly.

The maintenance of your hearing aid is the best way to ensure that you get the maximum results.

Visiting your audioprosthetist every six months will ensure your well-being and the functionality of your hearing aid, which in turn will give you a better quality of life in communicating with your loved ones.

Keeping Zen might ease your pain, study shows

Melani Litwack

March, 2010

A Université de Montréal study has shown that Zen meditation has a surprising effect on the part of the brain that regulates pain and emotions, Agence France-Presse reports.

Researchers have discovered Zen practitioners show significant reinforcement in a central area of the brain known as the anterior cingulate.

“Through training, Zen meditators appear to thicken certain areas of their cortex and this appears to underlie their lower sensitivity to pain,” said lead author Joshua Grant.

Further pain reduction seemed to come from controlled breathing, with the practitioners averaging three breaths less per minute than their non-Zen counterparts.

The study was published in Emotion, a special issued by the American Psychological Association journal.

“Slower breathing certainly coincided with reduced pain and may influence pain by keeping the body in a relaxed state,” Grant said in the earlier study, which showed an impressive 18-per-cent increase in tolerance for the Zen-ites.

Cut the fat

A recent U.S. study shows that post-menopausal women with high-fat diets are 44 per cent more likely to have a stroke.

“It’s a tremendous increase that is potentially avoidable,” said Dr. Emil Matarese of St. Mary Medical Centre in Langhorne, Penn. “What’s bad for the heart is bad for the brain.”

The largest study of its kind, it involved 87,230 participants between the ages of 50 to 79 and looked at all types of fat.

Medication use, smoking and exercise were also considered.

Trans fat intake was another culprit, raising stroke risk by 30 per cent. This fat, found in such items as margarine, baked goods and fried foods, calls for extra vigilance when reading labels. Healthy fats can be found in fish, certain oils and nuts.

Hot flash news flash – the time for shame has past

Hayley Juhl

March, 2010

Your significant other has just taken a little blue pill and is looking at you the way he hasn’t since before your children were born. But if you’re one of the more than 50 per cent of post-menopausal women who suffer from vaginal atrophy, the butterflies in your belly might not be excitement.

If you’re in that awkward spot, you might feel like it’s too late. But it’s not, and ignoring the problem won’t make it go away. Symptoms of vaginal dryness don’t disappear on their own and, untreated, they will probably get worse.

Symptoms range from the seemingly benign – itching or mild burning – to such severe headaches as incontinence, frequent urinary tract infections and painful intercourse.

“It’s like sandpaper, rubbing over and over,” said one woman, cringing. A woman might also experience light bleeding after sex, a clear, watery discharge or urgency with urination.

“Women need to understand that vaginal atrophy is not a disease,” Shawna Johnston of the ob-gyn and urology department at Queen’s University in Kingston says on the website TheBigOw.ca. “It’s a natural state.”

As women enter menopause, their estrogen levels drop, which can lead to moodiness, night sweats, hot flashes and vaginal dryness.

"Though arousal increases blood flow and can help restore your natural fluids, you might need to take it slow in the bedroom and that’s okay".

Here’s the difference, according to Michèle Moreau, a general practitioner who specializes in menopause: Women speak about their hot flashes, but no one talks about this. With the lack of estrogen, women lose the wrinkles in the vagina. The tissue becomes rigid and thin and bleeds more easily. Even if a woman isn’t sexually active, she might notice some discomfort.

Moreau suggests some doctors might not be fully educated on the issue of vaginal atrophy or perhaps, during the course of a hurried examination, women forget to ask the question. They might not be comfortable bringing it up or it’s possible that the doctor, faced daily with life-threatening illnesses, might underestimate the impact this painful condition can have on a woman’s wellbeing.

Menopause is considered to start 12 months after the end of a woman’s last period, around age 51. The Mayo Clinic notes that in addition to physical changes, women can have feelings of loss as their fertile days are clearly behind them. But one’s life, sexual and otherwise, is far from over.

Estrogen is vital for the normal reproductive development of girls and it regulates the menstrual cycle. It also helps protect women against heart disease, Moreau notes. There are many treatments available for the proactive woman, but they must buck up their courage to talk to a doctor. The first step is over-the-counter, water-based lubricants.

“And there is always saliva,” Moreau says. “Remember that it’s completely free and always readily available.”

This is a restoration project, Moreau says. There are various levels of hormone-replacement therapies. Women, under the care of their doctors, can try topical creams, suppositories, patches or a ring that is inserted into the vagina and will release hormones for up to three months. Adding a hormone cocktail concerns women who have read conflicting studies on the effectiveness and safety of estrogen treatments. These treatments must be prescribed, so the conversation with your doctor should address all your worries.

“There are options that are helpful, that are easy” and mess-free Moreau emphasizes.

Moreau puts some of the responsibility not on the woman’s doctor, but on her partner’s doctor.

“When they prescribe for erectile dysfunction, they should make sure the woman has a vagina that is supple enough to support it,” she says.

Don’t just talk to your doctor – talk to your partner. Though arousal increases blood flow and can help restore your natural fluids, you might need to take it slow in the bedroom and that’s okay. It’s a marathon, not an Olympic-calibre sprint.

Dr. Michèle Moreau will hold a three-hour conference May 27 at Notre Dame Hospital, 1560 Sherbrooke St. E., from 7pm to 10pm. The conference in French, but many of the slides presented will be in English. Call to register: 514-890-8000, ext 25416.

Hot flash news flash – the time for shame has past

Hayley Juhl

March, 2010

Your significant other has just taken a little blue pill and is looking at you the way he hasn’t since before your children were born. But if you’re one of the more than 50 per cent of post-menopausal women who suffer from vaginal atrophy, the butterflies in your belly might not be excitement.

If you’re in that awkward spot, you might feel like it’s too late. But it’s not, and ignoring the problem won’t make it go away. Symptoms of vaginal dryness don’t disappear on their own and, untreated, they will probably get worse.

Symptoms range from the seemingly benign – itching or mild burning – to such severe headaches as incontinence, frequent urinary tract infections and painful intercourse.

“It’s like sandpaper, rubbing over and over,” said one woman, cringing. A woman might also experience light bleeding after sex, a clear, watery discharge or urgency with urination.

“Women need to understand that vaginal atrophy is not a disease,” Shawna Johnston of the ob-gyn and urology department at Queen’s University in Kingston says on the website TheBigOw.ca. “It’s a natural state.”

As women enter menopause, their estrogen levels drop, which can lead to moodiness, night sweats, hot flashes and vaginal dryness.

"Though arousal increases blood flow and can help restore your natural fluids, you might need to take it slow in the bedroom and that’s okay".

Here’s the difference, according to Michèle Moreau, a general practitioner who specializes in menopause: Women speak about their hot flashes, but no one talks about this. With the lack of estrogen, women lose the wrinkles in the vagina. The tissue becomes rigid and thin and bleeds more easily. Even if a woman isn’t sexually active, she might notice some discomfort.

Moreau suggests some doctors might not be fully educated on the issue of vaginal atrophy or perhaps, during the course of a hurried examination, women forget to ask the question. They might not be comfortable bringing it up or it’s possible that the doctor, faced daily with life-threatening illnesses, might underestimate the impact this painful condition can have on a woman’s wellbeing.

Menopause is considered to start 12 months after the end of a woman’s last period, around age 51. The Mayo Clinic notes that in addition to physical changes, women can have feelings of loss as their fertile days are clearly behind them. But one’s life, sexual and otherwise, is far from over.

Estrogen is vital for the normal reproductive development of girls and it regulates the menstrual cycle. It also helps protect women against heart disease, Moreau notes. There are many treatments available for the proactive woman, but they must buck up their courage to talk to a doctor. The first step is over-the-counter, water-based lubricants.

“And there is always saliva,” Moreau says. “Remember that it’s completely free and always readily available.”

This is a restoration project, Moreau says. There are various levels of hormone-replacement therapies. Women, under the care of their doctors, can try topical creams, suppositories, patches or a ring that is inserted into the vagina and will release hormones for up to three months. Adding a hormone cocktail concerns women who have read conflicting studies on the effectiveness and safety of estrogen treatments. These treatments must be prescribed, so the conversation with your doctor should address all your worries.

“There are options that are helpful, that are easy” and mess-free Moreau emphasizes.

Moreau puts some of the responsibility not on the woman’s doctor, but on her partner’s doctor.

“When they prescribe for erectile dysfunction, they should make sure the woman has a vagina that is supple enough to support it,” she says.

Don’t just talk to your doctor – talk to your partner. Though arousal increases blood flow and can help restore your natural fluids, you might need to take it slow in the bedroom and that’s okay. It’s a marathon, not an Olympic-calibre sprint.

Dr. Michèle Moreau will hold a three-hour conference May 27 at Notre Dame Hospital, 1560 Sherbrooke St. E., from 7pm to 10pm. The conference in French, but many of the slides presented will be in English. Call to register: 514-890-8000, ext 25416.

An advanced doctor at an advanced age

David Schmidt

When Dr. John Schmidt began his medical practice, there were 48 states in the Union, Ike was president, and Southern drinking fountains were still labeled “White” and “Coloured.” There was no vaccine for measles, mumps or rubella, and the world of medicine was still adjusting to Jonas Salk’s polio vaccine.

Today, at 80, Dr. Schmidt administers the H1N1 vaccine and examines MRIs delivered to him electronically. Much has changed in the 50 years of his medical career, but Dr. Schmidt still has the patience and bedside manner of a man who made house calls at local farms.

Growing up in rural Illinois, Schmidt’s inspiration for becoming a physician was the doctor in his own small town. “Dr. Roberts was the only doctor I knew,” Schmidt recalls. “He was the idol of everybody—very highly thought of.”

When he was only 12, John’s mother died of a brain aneurism and when he was 22, his father was burned alive after the basement furnace erupted. John went to live with his eldest sister, Dixie, who was like a second mom to him. Dixie went on to study nursing at the University of Chicago. Seeing her work and hearing her stories only gave his medical enthusiasm a shot in the arm.

John studied human biology at the University of Illinois. He graduated in 1951 and married Barbara Crawford as soon as he was accepted to medical school at the University of Chicago. After graduation, John and Barb moved to San Bernardino, where his sister Dixie was a nursing supervisor at San Bernardino County Hospital. There, John got a plum internship, where he could experience a full range of medical training.

“In one year at a smaller hospital you may not be able to work in orthopedics or get to deliver a baby,” he explains. “My whole idea was to have a well-rounded internship.”

After his one-year internship, rather than having his studies interrupted by the Korean War draft, John enlisted in the navy. Stationed in San Diego, he practiced orthopedics at the Naval Hospital and eventually spent six months at sea on a destroyer.

After the war, John and Barb prayed for an opportunity to return to California. John received a call from an old friend from his pre-med days when they waited tables together at a girls’ dormitory. The friend had settled in Fullerton, Calif. as a pediatrician. A colleague asked if he knew any doctors interested in practicing in nearby Yorba Linda. He called John. “I hopped a plane,” John says, laughing, “came out here and decided, out of the blue, that this was the place we needed to go.” At the time, Yorba Linda had only one doctor who had been practicing 50 years and was ready to retire. In 1959, John and Barb set out for Yorba Linda.

“I was the only doctor in the area,” he says. We didn’t have freeways and the nearest hospitals were in Fullerton. I used to make rounds starting at about 5:30 a.m. to get all four hospitals there attended to.” For a year, he didn’t take a single day off and built his practice by being available when doctors typically weren’t—making house calls at any hour, any day.

John continually adapted to huge technological leaps in response, diagnosis, and treatment. “As time went on, transportation became more available, house calls became less needed, and there was a greater dependence on technology—blood studies, X-rays, EKGs, and so on. Technology became the cornerstone of our profession, and, really, it still is.”

Eventually, because of the growth of the community, it was essential for Dr. Schmidt to take on partners and form a medical group. “As I observed other doctor groups in the area, ones that had one doctor as the boss usually failed. So my philosophy was to make my new partners equal with me—I didn’t get any more salary than they did, and they had equal voice when making decisions. And that philosophy made my career very successful compared with running the show.”

Looking back, John finds much contentment while also looking forward; he has no intentions of retiring. He still drives daily to his Yorba Linda clinic. He still sets broken arms, stitches up split chins, and hits knees with a rubber hammer. And he still treats every patient like a neighbour. “As long as it keeps working up here,” he says, tapping his noggin, “I’ll keep working.”

Staying connected with those we’ve lost

Dr. Michael Eleff

December, 2009

When we lose a loved one, the pain of loss is accompanied by a feeling of disconnection: “I will never see him again. I won’t be able to talk to him, tell him about my day, share news with him.”

However, it is not only possible but healthy and normal to maintain a sense of connection with those we love, even after the loved one has died. Close bonds, especially those forged and enriched over many years of shared experiences, are altered by death, but not necessarily severed. I’m not talking about ghosts, spirits or any specific religious beliefs, but rather about the reality that loving human relationships are enduring and continuous.

Recently, I had the opportunity to talk to a friend whose sister had died after a long illness. She was grieving this loss and commented that the most painful part was that she could no longer pick up the phone and talk to her sister. I commented that, although this was true, she could certainly write letters to her sister and maintain her connection that way. (I happened to know that this woman enjoys writing and is accustomed to sharing events, thoughts and feelings through writing.) She was initially stunned by the suggestion: many people would regard writing letters to a deceased person as “crazy.” She quickly warmed to the idea and has found both comfort and value in “staying connected” this way. It may well be that being encouraged to do this by a friend who happens to be a psychiatrist made it easier to see this as perfectly reasonable behaviour: if the psychiatrist doesn’t think it’s a sign of mental illness to remain in touch with my sister this way, I guess it is ok.

Not everyone is a writer, but everyone can maintain these important bonds. Certainly, death changes our relationships with our lost loved ones, profoundly and, at least within our usual understanding of day-to-day life in this world, permanently. However, we don’t stop loving a person just because he or she has died. Similarly, we don’t stop feeling connected with our loved ones. We can respect both the need to stay connected and the reality of enduring bonds, altered but not severed by death.

Michael Eleff is Associate Professor of Psychiatry at the University of Manitoba.

H1N1: Hopefully, this too shall pass

Kristine Berey

Since the flu-de-jour has monopolized headlines, the smallest cough or sneeze can elicit dirty looks in a bus or supermarket. As passengers or shoppers sidle over to a hopefully less infectious spot, their “bubble” invariably reads: “I hope it’s not H1N1!”.

The perception that H1N1 is to be feared has created what one pediatrician has called “H1N1 psychosis,” as worried people swamp emergency clinics and vaccination sites.

The fact that the virus has been declared a pandemic by the World Health Organization is, in itself, not a reason to panic, says Eric Toner, senior associate with the Center for Biosecurity of the University of Pittsburgh Medical Center.

Quoted in Bioworld Today, Toner says, “ ‘Pandemic’ means a global outbreak of an infectious disease … But the word ‘pandemic’ doesn’t relate to severity of the illness. So we have a pandemic of a virus that causes mild illness, apparently much like we did in the last influenza pandemic.” Dr. Toner predicts that H1N1 will replace the seasonal flu we know starting next year.

Experts say that in most people this virus will resolve on its own, what makes the H1N1 strain somewhat sinister is that it sickens healthy younger people and there is no sure way of identifying yet who is more susceptible to severe illness. If complications develop, they are severe, especially in people with underlying medical conditions. Healthy people born before 1957 are less at risk.

Although the symptoms of a cold, the seasonal and swine flu (H1N1) are similar, here’s how to tell them apart: A sore throat, runny nose and a cough indicate a cold. The same symptoms with fever and fatigue so overwhelming that bed rest is required likely indicate the flu. H1N1 differs from the seasonal flu in that sometimes there is no fever, but vomiting and diarrhea may be present.

If the illness worsens it’s important to seek medical help, as the H1N1 virus tends to attack the cells deep in the lungs, causing rare but serious complications requiring hospitalization in about 1 out of 1,000 cases. According to the Public Health Agency of Canada, warning signs are: fever over 39.5C, rapid breathing or shortness of breath, chest pain, bloody sputum, dizziness or confusion, persistent vomiting, bluish or grey skin colour, and low blood pressure.

“We know that this is now the dominant influenza virus transmitted around the world,” said Dr. Timothy Brewer, director of global health programs for the McGill Medical School and senior advisor for the International Society for Infectious Diseases. “The good news is that since this virus has been recognized, in April, it has been stable, not become more deadly. Most people have mild disease and do well. A very small percentage of people get very sick and it’s even a smaller percentage who die.”

Since Canada’s unprecedented mass vaccination campaign started, people have flooded flu clinics and stood in line for hours waiting to be immunized. However, some are concerned about possible side effects of the vaccines. A recent Associated Press-GfK poll found that 38 per cent of U.S. parents said they were unlikely to allow their children to be immunized. The adjuvanted Canadian vaccine, manufactured by Glaxo Smith Kline, contains squalene and thimerosol, two substances anti-vaccine activists are worried about.

In the NFB documentary film Silence on Vaccine, Lina B. Moreco focuses on families who believe their children have suffered adverse reactions to vaccinations. “I did three years of research and met people who suffered from side effects,” Moreco said. “When I finished the film, the NFB hired a lawyer from outside and from the film board and someone to check the archives I used to make sure I didn’t play with the information.”

Vaccine fears may originate in a 1976 swine flu vaccination campaign when there was an increase of Guillain-Barré syndrome, a neuro-immune disorder. Experts still debate whether it was coincidental or causal that during the campaign 500 fell ill and 25 died in the U.S.

Since then, Dr. Brewer says, studies done on the seasonal vaccine have shown no increase in Guillain-Barré. As well, there are unprecedented tracking systems in the US and Canada to monitor possible adverse reactions. “We’ll have to look and follow after people start using H1N1 vaccines. It’s the only way we’re going to know for sure.”

To date, the vaccine has been tested in more than 40,000 people globally. NDP health critic Judy Wasylycia-Leis says the vaccine seems to be effective and safe. “We continue monitoring, but based on everything I’ve seen and heard, the risks from serious illness are greater than problems you might get from the vaccine.”

Taking the heat: not a good idea

The long-awaited rays of summer sun may be too much of a good thing for small children and dogs left in parked cars.

Babies and toddlers are especially vulnerable to high temperatures, which, in a car, rise very quickly, says Dr. Catherine McLaren. The researcher’s 2005 study demonstrated that even on a sunny 72-degree day, temperatures inside a car could reach 117 degrees Fahrenheit in one hour. “Vehicles heat up rapidly with the majority of temperature rise occurring within the first 15-30 minutes,” McLaren says. Leaving the windows open 1.5 inches doesn’t make much difference. “If people knew the danger of leaving their children in the car, they probably wouldn’t do it.”

Heat stroke is also a danger for dogs left in cars, writes Joy Butler on the website suite101.com

“Contrary to what most people believe, dogs overheat more quickly than humans do. Heat inside a parked car can build, in just a few short minutes to as much as 40 degrees above the outside temperature. Never, ever, leave a dog in a parked car or without water in the sun.”

Incontinence: nothing to sneeze at

Kristine Berey

It doesn’t kill you, but it can make your life hell. Incontinence affects 55 per cent of women over 60 and can have devastating emotional, social and physical consequences, such as falling, isolation and depression.

“One study shows it will take an average of 7 years for a woman to talk to a health professional about her incontinence,” says Chantal Dumoulin, researcher at the Institut Universitaire de Gériatrie de Montréal.

Dumoulin and her team are trying to refine and target treatments more accurately.

“If we learn to better identify those who will benefit most from pelvic floor exercises, then it will be easier to get funding from the government to treat these women,” Dumoulin said. Right now, 70 per cent of women do improve with exercise, but in the other 30 per cent, the cause may be neurological, requiring a different approach.

“My primary training is in physiotherapy,” Dumoulin explains. “I look at the patient in terms of general function. We found that incontinent women will stay home more, have less strength in their legs and are at a greater risk for falling.” Dumoulin is inviting women, both continent and incontinent, to form exercise classes that may treat or prevent this insidious problem.

“We evaluate the pelvic floor muscle and leg strength, provide training and follow up two to five years later to see if their risk of falling has diminished.”

Classes are formed as soon as there are enough participants.

To join a class call 514-340-3540 ext. 4129

Province takes on Alzheimer’s challenge

Kristine Berey

June 2009

In a show of solidarity to the 120,000 individuals and their families across Quebec struggling with Alzheimer’s Disease, 500 walkers converged at the Quay of the Old Port for the third Rona Memory Walk organized by the Alzheimer Society of Montreal on May 31. Across the province, 20 other Alzheimer Societies organized walks as well, with the goal of raising $2,000,000 to improve the Society’s programs and services. “We make up a large family of solidarity,” said Montreal mayor Gérald Tremblay. “There is a strong message of hope; ever y step is important.” Alzheimer Montreal raised over $83,000.

The supporters of the 5km walk heard some good news as Yves Bolduc, minister of health and social services, said that Quebec will create an action plan regarding the management of Alzheimer’s Disease and other chronic illnesses. Bolduc made public a report drafted by a team of experts, led by Dr. Howard Bergman, an internationally renowned researcher in aging, titled Relever le défi de la maladie d’Alzheimer et des maladies apparentées. The recommendations in the comprehensive report, which pinpoints challenges and defines objectives, will play an integral part in the strategic plan that the health ministry will elaborate over the next six years, Bolduc said.

500 walkers joined the memory walk at the Old Port Photos: Kristine Berey

Hope came also from Marguerite Blais, the minister responsible for seniors and families, who said that the province recognizes the crucial role caregivers play in managing the illness and that funds would be available to help them. “Of a budget of $200 million over 10 years, at least 75 per cent will be devoted to people who work with patients suffering from Alzheimer’s or a related illness. The ultimate goal is to sustain, accompany, relieve and inform people who care for their loved ones in circumstances that are often very difficult.” Alzheimer’s Disease, a neuro-degenerative illness, has no known cure and no reliable method of early diagnosis. Although medications can now slow its progress, there is no treatment that can alter its course. With the aging of the population, the number of people affected is rising astronomically. “One out of five baby-boomers can expect to suffer from Alzheimer’s,” Dr. Bergman says.

While this year 100,000 Quebecers have the disease, in 20 years 160,000 will be affected. In the United States, the advanced stage of the disease is diagnosed in a patient every 70 seconds. In 2000, costs related to the illness across Canada reached $5.5 billion.

Yet, internationally, research into Alzheimer’s and related dementias remains chronically underfunded. According to Bergman’s report the funds allocated to Alzheimer’s by the Canadian Institutes of Health Research represent 3 per cent of their budget. In 2007-08, $26 million was allocated to Alzheimer’s research while $170 million was earmarked for cancer research. The impact of this disease on the health care system is underestimated, Bergman says.

Gilles Duceppe walks alongside Helen Fotopoulos and Marguerite Blais

For example, Alzheimer’s patients with another chronic illness will stay in the hospital twice as long as a person the same age and with the same illness but without Alzheimer’s. Research is also important, Dr. Bergman said, because it is conceivable that not far in the future a medication may be developed that may alter the course of the disease, in which case early diagnosis would be imperative. Recently Dr. Hemant Paudel of McGill University and the Lady Davis Research Institute at the Jewish General Hospital took one step closer to that goal. Paudel discovered that the action of a single phosphate on a particular protein in the brain is the culprit responsible for the tangles that wreak havoc in the brains of Alzheimer’s patients. “The possibility of early diagnosis now exists,” Dr. Paudel says. “The enzyme which puts this phosphate on [the protein] can be targeted by drugs, so therapies can be developed. This discovery gives us, for the first time, a clear direction towards the early diagnosis and treatment of Alzheimer’s.”

Dr. Bergman’s report is available in French at www.msss.gouv.qc.ca

For information or to donate to the Alzheimer Society of Montreal, call 514-369-0800.

Docs talk memory loss, holiday kidproofing

McGill University Health Centre presents a model Patient Room of the Future and public health lectures at Westmount Square in November.

Monday, November 10 at 2 pm Dr Gary Inglis, MUHC Geriatric Medicine Site Director, presents Where did I put my keys?

Taking a look at memory loss and cognitive disorders, Dr Inglis reviews warning signs, prevention and treatment. “What is the evidence out there that helps us prevent memory loss?” he asks. “We know that stroke and Alzheimer's share risk factors: hypertension, diabetes, high cholesterol, and sedentary lifestyle,” each soaring in our aging population. “There’s a lot of research out there for treatment,” and his ongoing work in clinical trials for new therapies to prevent amyloid deposition, though “still experimental,” will be up for discussion.

Thursday, November 13 at 2 pm Dr Carlo Galli, MUHC Pediatric Trauma Program Coordinator, speaks on How to keep kids safe when the temperature drops.

“We’ll explain a bit about pediatric trauma and treating and preventing injuries in kids, basing it more on winter activities coming up,” says Galli. “When grandkids are coming, it’s important to child-proof the home,” with medication, electrical sockets, candles, and tree decorations meriting special attention, he notes. Toy buying guidelines, proper car seat setup, and winter playground precautions will be reviewed, and more tips on holiday safety will be available to take home.

Location: 1 Westmount Square, Mezzanine level (metro Atwater).

Info: 514-934-1934 x 71552

Housebound seniors can stay active

Craig Cormack

Icy roads make walking treacherous for seniors during the winter months. Many of you find yourselves housebound and lacking the outdoor activity you get easily in better weather. But staying in shape at home is possible by doing a few targeted exercises. Pump up your health with a little determination and a small investment in time and equipment.

Strength, stamina, balance and flexibility are the cornerstones of any health program. As you age you may lose strength, balance and some flexibility in the extremities and joints. You may find yourself easily winded because you don’t get enough cardio training.

Strength exercises usually consist of resistance training using weights, floor exercises and swimming or water aerobics. Basic leg lifts using leg weights (which can be purchased at Canadian Tire) are good training for the quadriceps. Dumbbells can also be used to strengthen your arms (biceps). Exercise elastics (used in Pilates) are useful for resistance training.

To improve stamina a treadmill excellent choice, however a more economical alternative is to purchase a rebounder which is a small trampoline. According to NASA rebounding is 68% more efficient than jogging. There are many benefits to bouncing up and down which include: fighting fatigue, relieving neck, back and head pain, improving blood circulation and oxygen flow and promoting weight loss.

To work on improving your balance try the following exercise.

Stand perpendicular to a kitchen chair with its back facing you. Hold on to the back of the chair with your right hand for support.

Make sure your feet are side by side and a shoulder-width distance apart. Advance your left foot ahead by two feet.

Transfer your weight by pushing your right heel down into the floor and shifting your weight over to your left leg (make sure you bend your left knee). Do not lift your right heel during the transfer.

Push down on your big left toe back through your left heel and transfer the weight back to your right foot. Repeat this weight transfer movement a number of times.

Repeat weight shifting on the other leg.

To boost upper body flexibility, try this exercise. Start with your feet together. Interlace your fingers together and stretch upward by pushing your palms up to the ceiling. Do this for 3 times and then relax.

Always warm up before you start an activity and if you feel pain or you are out of breath, take a rest. Don’t over do it and don’t forget to cool down after you exercise.

If you are experiencing any health problems such as: arthritis, heart or circulatory disease, kidney disease, lung disease or osteoporosis, or have not exercised in over a year, consult your physician before starting an exercise program. Once you have been cleared for exercise keep in mind some basics: drink a lot of water, wear comfortable clothes and proper footwear.

A few good exercises are all you need to stay in shape. Look into making them part of your daily routine.