Doctors' Notes

91�Թ� expert on how to avoid heat stroke when the temperature climbs

Christopher.Sorensen — Tue, 03 Jul 2018 16:41:05 +0000

91�Թ� expert on how to avoid heat stroke when the temperature climbs

Christopher.Sorensen Tue, 07/03/2018 - 12:41

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Children play in the water at Lakefront Promenade Park Splash Pad in Mississauga, Ont. (Andrew Francis Wallace/Toronto Star via Getty Images)

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City & Culture

Doctors' Notes

Faculty of Kinesiology & Physical Education

Faculty of Medicine

With soaring temperatures and muggy conditions expected to linger in southern Ontario for the remainder of the week, residents should be on the lookout for signs of heat stroke and take precautions to keep themselves safe, a 91�Թ� medical expert says.

“In my work as a sports medicine doctor, I would most commonly see heat illness in endurance sports, like marathons, and intensive outdoor training sessions, like in football,” says Dr. Mark Leung in this week’s edition of Doctor’s Notes, the Toronto Star’s weekly column written by 91�Թ� medical experts.

“But, you don’t have to be a serious athlete to experience these conditions.”

Leung writes that heat stroke is a potentially serious condition that can lead to damage to internal organs, including the brain. However, if the signs are recognized and treated early – through rapid cooling and by calling 911 – most people will survive the heat attack.

He further writes that there are two different types of heat stroke: classic heat stroke, which is related to being in an excessively hot environment and tends to affect the very young and very old; and exertional heat stroke, which tends to affect young, healthy adults who exercise in hot, humid environments. The former tends to have non specific symptoms such as dizziness, nausea, and headache that present over days, while the onset of the latter can be much quicker, causing a person to collapse.

Leung suggests the following precautions to stay safe when the mercury climbs:

• Limit exertion during peak heat. Try to schedule it during the cooler times of day like first thing in the morning or later in the evening. If peak heat exertion is unavoidable, try to reduce your intensity accordingly.

• Dress for the weather. If you can, choose breathable, lightweight fabrics that will help you keep your cool.

Read the full Doctors' Notes column in the Toronto Star

91�Թ� expert on the importance of getting shingles vaccine if you're 50 and older

noreen.rasbach — Tue, 30 Jan 2018 16:19:59 +0000

91�Թ� expert on the importance of getting shingles vaccine if you're 50 and older

noreen.rasbach Tue, 01/30/2018 - 11:19

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(photo by Media for Medical/UIG via Getty Images)

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Ontario and some other provinces pay for people between the age of 65 and 70 to get the shingles vaccine, but everyone over the age of 50 should consider getting the vaccine even if means paying for it yourself, a University of Toronto medical expert says.

“I think it’s worth considering paying out of pocket for early protection from this painful rash and its potential long-term complications,” writes Dr. Marla Shapiro in this week's edition of Doctors' Notes, the Toronto Star's weekly column created by 91�Թ� medical experts.

Read previous Doctors' Notes columns from 91�Թ� medical experts

Shingles occur when the chickenpox virus, which can remain latent for decades, is reactivated – usually when people are over the age of 50, writes Shapiro, an associate professor in 91�Թ�'s Faculty of Medicine and a family physician. Shingles are a rash, often on the chest or neck, that is made up of painful red blisters. The rash usually breaks out along the distribution of a nerve root called a dermatome, on one side of the body, writes Shapiro.

About 13 per cent of people with shingles develop a chronic pain syndrome called postherpetic neuralgia, with significant pain that can be difficult to control. The pain is often described as burning or stabbing pain, sometimes with an altered sensation response to stimuli. "For example, lukewarm water might feel like it’s scalding hot or a cool breeze could feel agonizing," Shapiro writes.

Getting a vaccine helps. Not only does the vaccine reduce the incidence of illness, but for those who do develop shingles, having had the vaccine can make it less likely thay you will develop postherpetic neuralgia, Shapiro writes.

This month, a new, adjuvanted vaccine called Shingrix became available. Shapiro writes that in studies, all people who got the vaccine, regardless of their ages, received the same level of protection – 90 per cent and greater.

“I believe immunization is one of the most important strategies we offer patients in primary care," wirtes Shapiro. "If you get vaccinated, we can’t always guarantee you won’t get shingles, but if you do, we know it will be milder and your risk of developing postherpetic neuralgia will be lower.”

Read the full Doctors' Note column in the Toronto Star

When caring for relatives with dementia, develop a good relationship: 91�Թ� expert

ullahnor — Tue, 23 Jan 2018 17:56:49 +0000

When caring for relatives with dementia, develop a good relationship: 91�Թ� expert

ullahnor Tue, 01/23/2018 - 12:56

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Dr. Michael Gordon talks about caring for loved ones who develop dementia (photo by Adam Berry/Getty Images)

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With more Canadian families becoming caregivers for people living with dementia, it's important to establish positive relationships with loved ones who will be receiving the care, says Dr. Michael Gordon, a professor of medicine at the 91�Թ� and a geriatric specialist at Baycrest Health Sciences.

Over the next 15 years the number of Canadians living with dementia will almost double, Gordon writes in this week's edition of Doctors' Notes, the Toronto Star's weekly column created by 91�Թ� Medical experts. He writes that having the perfect relationship should not be a prerequisite for being a caregiver, but he found with his late parents, his positive relationship with them, as well as his sister’s, helped them navigate difficult next steps.

Read previous Doctors' Notes columns from 91�Թ� medical experts

As people with dementia experience a progressive decline in their ability to remember, understand, communicate and complete day-to-day tasks, being overprotective can be a common source of conflict, he writes.

“Though dementia hampers a person’s capacities, their independence still matters a great deal," Gordon writes. “Caregivers can overstep boundaries when they take over ordering at a restaurant, criticize clothing choices and arrange activities the person being cared for doesn’t enjoy.”

Read the full Doctors' Notes column in the Toronto Star

There’s no one solution for treating depression in seniors: 91�Թ� expert

noreen.rasbach — Tue, 19 Dec 2017 16:42:23 +0000

There’s no one solution for treating depression in seniors: 91�Թ� expert

noreen.rasbach Tue, 12/19/2017 - 11:42

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Almost one in 10 seniors suffers from clinical depression, a rate that doubles in long-term care homes (photo by BSIP/UIG via Getty Images)

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Depression is prevalent in older people and is often a greater challenge to treat, says Dr. Alastair Flint, a professor in the 91�Թ�’s Faculty of Medicine.

Almost one in 10 seniors suffers from clinical depression, a rate that doubles in long-term care homes, Flint writes in this week's edition of Doctors' Notes, the Toronto Star's weekly column created by 91�Թ� medical experts.

Read previous Doctors' Notes columns from 91�Թ� medical experts

“And a growing body of research suggests if you suffer from depression, you’re at a higher risk of developing memory loss or dementia,” writes Flint, who is also a geriatric psychiatrist at the University Health Network and a senior scientist in the Toronto General Hospital Research Institute.

But treating depression in older people can be tough: They often find it hard to tolerate medications, and side-effects can be severe, he writes. Seniors often take a lot of medications that can interact badly, and older people often are more forgetful, skipping some medications or taking them improperly.

Flint writes that he and his colleagues have launched a five-year study named OPTIMUM to study two strategies commonly used for treating older adults with difficult-to-treat depression – switching to a new medication, or continuing with the first medication and adding a second one.

Flint’s team is working with scientists in Canada and the U.S., with the hopes of recruiting 1,500 seniors with treatment-resistant depression.

“Right now, we don’t really have any evidence to show which is the best approach to help older adults, so my colleagues and I want to fix that,” Flint writes.

Read the full Doctors' Notes column in the Toronto Star

91�Թ� expert on knowing the signs of a stroke – and acting quickly

rasbachn — Mon, 11 Dec 2017 18:10:44 +0000

91�Թ� expert on knowing the signs of a stroke – and acting quickly

rasbachn Mon, 12/11/2017 - 13:10

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The sooner you get help, the better your outcomes will be, writes 91�Թ�'s Dr. Gurpreet Jaswal (photo by BSIP/UIG via Getty Images)

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It is crucial to know the signs of a stroke and get help right away when symptoms suddenly strike, says 91�Թ�’s Dr. Gurpreet Jaswal.

That means calling 911 immediately.

The sooner you get help, the better your outcomes will be, Jaswal writes in this week's edition of Doctors' Notes, the Toronto Star's weekly column created by 91�Թ� medical experts.

“As a general internal medicine physician, I see how the passage of time can affect patient outcomes after a stroke," Jaswal writes. "More often than we’d like, my colleagues and I see people who have waited to get help, or gone to an urgent care or walk-in clinic before coming in to the hospital. They might not have realized they were having a stroke or how serious their symptoms were. The problem is, this delays our ability to help tremendously.”

Read the full Doctors' Notes column

How trauma affects the brain: 91�Թ� expert

rasbachn — Tue, 05 Dec 2017 05:00:00 +0000

How trauma affects the brain: 91�Թ� expert

rasbachn Tue, 12/05/2017 - 00:00

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Trauma has a huge effect on the brain, but the brain responds well to treatment, writes 91�Թ�'s Dr. Dana Ross (photo by Penn State via Flickr)

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We’re living through an important moment where people who have been through traumatic experiences feel more comfortable coming forward with their stories, says Dr. Dana Ross.

A lecturer in the 91�Թ�'s department of psychiatry in the Faculty of Medicine, Ross says trauma can have a profound impact on every area of person’s life. And “it is important for people to be familiar with the different ways that trauma can cause distress,” because studies have shown that traumatic experiences such as physical and sexual abuse are common, she says.

“We still have a lot to learn about the effects of trauma but we do know that a number of changes occur in the brain and body that can make it difficult for people to live the life they would like to lead,” Ross writes in this week's edition of Doctors' Notes, the Toronto Star's weekly column created by 91�Թ� medical experts.

Read the full column in the Toronto Star

New research findings on breast cancer could dismantle the one-size-fits-all approach for prevention and screening: 91�Թ� expert

rasbachn — Tue, 07 Nov 2017 19:47:15 +0000

New research findings on breast cancer could dismantle the one-size-fits-all approach for prevention and screening: 91�Թ� expert

rasbachn Tue, 11/07/2017 - 14:47

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The 72 new genes, which were discovered after scientists studied blood samples of 275,000 women, aren’t as risky as BRCA, but they are more common. (photo by Pearl Pirie via Flickr)

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Faculty of Arts & Science

The news that 72 new genes associated with breast cancer were identified by scientists around the world, including five teams from the 91�Թ�, is considered a major step forward in how we understand the disease.

Gary Bader, a professor at 91�Թ�’s Donnelly Centre for Cellular and Biomolecular Research and the departments of molecular genetics and computer science, says there are important short- and long-term implications of the findings.

The long-term hope, Dr. Bader writes in this week’s edition of Doctors’ Notes, the Toronto Star’s weekly column created by 91�Թ� medical experts, is that “the more we know about the biology of breast cancer, the faster we will be able to stop it from starting and spreading.”

The discoveries, he adds, could ultimately help develop drugs that prevent breast cancer altogether.

In the meantime, he writes, the findings provide an important step forward in the development of “precision medicine,” instead of the one-size-fits-all approach doctors currently use.

The discoveries can help predict who is most at risk for breast cancer, he writes. Right now, women with a family history of certain cancers can get the BRCA genetic test to see if they’re at high risk of developing breast and ovarian cancer. But, he writes, the BRCA mutations “are very rare – the vast majority of women who develop breast cancer are not BRCA-positive.”

The 72 new genes, which were discovered after scientists studied blood samples of 275,000 women, aren’t as risky as BRCA, Bader writes, but are more common.

"Some of these mutations may only raise your chance of getting breast cancer by a few percentage points – not 80 per cent as in the BRCA mutations – but you may carry enough of them to add up to a high risk. Alternatively, you may have one that is more sensitive to environmental risk factors such as smoking and obesity."

Read the full Doctors' Notes column in the Toronto Star

De-escalation of agitated people is a trained skill and a team effort: 91�Թ� expert

rasbachn — Tue, 24 Oct 2017 17:20:00 +0000

De-escalation of agitated people is a trained skill and a team effort: 91�Թ� expert

rasbachn Tue, 10/24/2017 - 13:20

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When someone’s behaving in an aggressive or threatening way during a mental health or emotional crisis, “they’re probably scared," writes Dr. Brittany Poynter (photo by Robert Gauthier/Los Angeles Times via Getty Images)

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Our Community

Doctors' Notes

Faculty of Medicine

It’s normal to want to run the other way when you come across somebody who is agitated, aggressive and yelling. But Dr. Brittany Poynter, an assistant professor in the department of psychiatry at the 91�Թ�’s Faculty of Medicine, says there are strategies to deal with an agitated person.

Poynter, an emergency department psychiatrist at the Centre for Addiction and Mental Health (CAMH), says de-escalation is a skill that requires training and experience. It takes a team of people working together to make sure everyone is safe, she writes in this week’s edition of Doctors’ Notes, the Toronto Star’s weekly column created by medical experts from the 91�Թ�.

“I don’t recommend anyone try it alone.”

When someone’s behaving in an aggressive or threatening way during a mental health or emotional crisis, “they’re probably scared," she writes. "Their actions are driven by fear, rather than a desire to harm anyone.”

She also advises family members who face an escalating situation with a loved one experiencing psychosis to call 911 sooner rather than later.

Read the full Doctors’ Notes column

Getting tested for BRCA genetic mutation saves lives: 91�Թ� expert

rasbachn — Tue, 10 Oct 2017 14:35:36 +0000

Getting tested for BRCA genetic mutation saves lives: 91�Թ� expert

rasbachn Tue, 10/10/2017 - 10:35

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Angelina Jolie in New York last month: The actress made headlines when she announced that she had a double mastectomy as a preventative measure (photo by Gotham/Getty Images)

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Our Community

Dalla Lana School of Public Health

Doctors' Notes

Faculty of Medicine

We all remember when the actress Angelina Jolie announced she had a double mastectomy, a preventative measure after learning she had the BRCA-1 genetic mutation (she later had her ovaries removed as well). Jolie got herself tested after her mother died of ovarian cancer.

Taking preventative measures could very well have saved Jolie’s life, says Dr. Mohammad R. Akbari, an assistant professor at 91�Թ�’s Dalla Lana School of Public Health and the Institute of Medical Sciences in 91�Թ�’s Faculty of Medicine.

Anyone with a family member who has been diagnosed with four major cancers – breast, ovarian, prostate or pancreatic – should consider getting a simple saliva test to determine if you have the genetic mutations BRCA-1 or BRCA-2, writes Akbari in this week’s edition of Doctors’ Notes, the Toronto Star’s weekly column created by medical experts from the 91�Թ�.

Akbari, who is also a scientist at the Women’s College Research Institute, cites the dangers of being BRCA positive – a lifetime risk of developing breast cancer of 80 per cent; 40 per cent for ovarian cancer, 35 to 40 per cent for prostate cancer, and about 7 per cent for pancreatic cancer.

There is an advantage to knowing you have the mutation, he writes: With all four cancers, there are preventative measures you can take, and knowing you’re at risk can help you catch it as early as possible. A BRCA diagnosis also helps to customize cancer treatments.

Women’s College Hospital has developed The Screen Project, where participants pay US$165 to receive a simple saliva collection kit by mail. If you are found to have the BRCA mutation, a genetic counsellor will meet with you to discuss next steps.

“As a genetic researcher, I know how scary it can be to undergo this kind of testing. Many people don’t want to live their lives in fear; if they’re at higher risk of cancer, they’d rather not know,” Akbari writes. “But if there’s breast, ovarian, prostate or pancreatic cancer in your family, you likely already live with the fear of getting these diseases.”

Read this week's Doctors' Notes in the Toronto Star

91�Թ� expert on how to help women with postpartum depression

rasbachn — Mon, 02 Oct 2017 20:57:46 +0000

91�Թ� expert on how to help women with postpartum depression

rasbachn Mon, 10/02/2017 - 16:57

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Research shows that interventions such as peer support and home visits from public health nurses can help women even before PPD symptoms develop (photo by Philip Dean via Flickr)

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Our Community

Faculty of Medicine

Doctors' Notes

Most new mothers experience baby blues – a few weeks of emotional upheaval that may include being irritable or crying easily. But some mothers have postpartum depression (PPD), with symptoms that are significantly more severe and prolonged.

Women with PPD may feel sad, anxious, irritable, unmotivated or overwhelmed, says Dr. Simone Vigod, an associate professor in University of Toronto’s department of psychiatry in the Faculty of Medicine, and a staff psychiatrist at Women’s College Hospital. These woman usually experience some symptoms within three months of giving birth, but Vigod says: "As a psychiatrist, I see the first year postpartum as a high-risk period."

Help is available, Vigod writes in the current edition of Doctors' Notes, a weekly column in the Toronto Star written by members of 91�Թ�'s Faculty of Medicine. Research shows that interventions such as peer support and home visits from public health nurses can help women even before PPD symptoms develop, she writes. And for women with PPD, “effective treatments include talk therapy, and in more serious cases, medication.”

Vigod writes about her involvement in an international study called PACT for the Cure that will help scientists learn why some women develop PPD while others don’t. Participants download an app and answer questions as to whether they have experienced PPD. If they have, they are asked to provide a DNA sample to help in research to find genetic determinants.

Vigod is also involved in developing online health groups and virtual psychotherapy, to help women who live in more remote areas or those who struggle to get to appointments.

Doctors' Notes

91�Թ� expert on how to avoid heat stroke when the temperature climbs

Read the full Doctors' Notes column in the Toronto Star

91�Թ� expert on the importance of getting shingles vaccine if you're 50 and older

Read previous Doctors' Notes columns from 91�Թ� medical experts

Read the full Doctors' Note column in the Toronto Star

When caring for relatives with dementia, develop a good relationship: 91�Թ� expert

Read previous Doctors' Notes columns from 91�Թ� medical experts

Read the full Doctors' Notes column in the Toronto Star

There’s no one solution for treating depression in seniors: 91�Թ� expert

Read previous Doctors' Notes columns from 91�Թ� medical experts

Read the full Doctors' Notes column in the Toronto Star

91�Թ� expert on knowing the signs of a stroke – and acting quickly

Read more Toronto Star Doctors' Notes columns by 91�Թ� experts

Read the full Doctors' Notes column

How trauma affects the brain: 91�Թ� expert

Read more Toronto Star Doctors' Notes by 91�Թ� experts

Read the full column in the Toronto Star

New research findings on breast cancer could dismantle the one-size-fits-all approach for prevention and screening: 91�Թ� expert

Read the full Doctors' Notes column in the Toronto Star

De-escalation of agitated people is a trained skill and a team effort: 91�Թ� expert

Read the full Doctors’ Notes column

Getting tested for BRCA genetic mutation saves lives: 91�Թ� expert

Read this week's Doctors' Notes in the Toronto Star

91�Թ� expert on how to help women with postpartum depression

Read the entire Doctors' Notes column in the Toronto Star