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Happy Summer! I hope after a particularly difficult winter everyone is getting out and enjoying the beautiful outdoors. This presents a great opportunity to have a quick review of Lyme disease and how to keep you and your family safe when out and about this summer.

What is Lyme Disease:

Lyme disease is a bacterial infection (Borrelia burgdorferi) that is transmitted to humans through the bite of an infected blacklegged (Deer) tick. With warming climate, the blacklegged ticks have rapidly moved into Ontario over the past two decades. Ottawa Valley is now considered an endemic region for blacklegged ticks and hence a high-risk exposure area for Lyme disease.

Prevention:

Avoiding tick bites is the best defence against Lyme disease. Avoid tall grass and stick to established hiking/walking paths as much as possible. Pant-tucking into socks, DEET based insect repellent, and permethrin treated clothing are some of the best ways to avoid tick bites. After outdoor activities, check yourself and your kids, and know where to look: behind the ears, collarbone, armpit, waistband, gluteal cleft, behind the knee, sock-band, even genitalia.

What to do if you discover an attached tick?

Simply remove with a tweezer by grabbing the tick as close to the skin as possible by pulling it straight out. Do not be alarmed if any mouthparts remain in the skin as this is quite common and poses no concerns.

If you are sure the tick was attached for less than 24 hours, then there is no concern for Lyme transmission and no further follow up is required.

If you believe the tick was attached for more than 24 hours, then you should contact the clinic to see if you might benefit from a dose of antibiotics to reduce your chances of acquiring Lyme Disease.

Enjoy the summer and keep it healthy!

Dr. Matin

Life can change in an instant.

Imagine: You have been in a serious car accident. You have lost the ability to speak for yourself or direct your care. You do not recognize your family or friends. Do you know who would make health and personal care decisions for you? Does that person know what your wishes are in such a situation?

None of us know what tomorrow will bring. We cannot always predict if, or when, we will need to rely on others to make health care decisions for us, or when we will be called on to make these decisions for a family member. Advance Care Plan (ACP) is the way to addressed this scenario.

ACP involves two steps:

• Confirming your substitute decision maker(s) (SDMs); AND
• Communicating your wishes, values and beliefs to help your SDM(s) make health care decisions for you when the need arises

Substitute Decision Makers (SDMs)

In Ontario there is an automatic hierarchy of possible SDMs. (Your spouse or partner followed by your children and your surviving siblings). If you are not satisfied with your automatic SDM, then you can choose and name a person, or more than one person, to act as your SDM. This can be done by completing a document called a Power of Attorney for Personal Care. You may also assign a Power of Attorney for Property which names the person who can make decisions about your financial affairs. You can download and complete a free Powers of Attorney legal document on the Government of Ontario website. Another option is to have a lawyer write your power of attorney. Consider seeing a lawyer if your personal or business affairs are more complicated.

Advance Care Directive (AKA living will)

Once you identify your SDM(s) – you need to communicate your wishes to them in case of incapacity. Do they know your fears, wishes, and beliefs? Do they know what you value the most about life? You might value a life where you can live independently and have the ability to socialize with your loved ones. Does your SDM know your wishes if you are confined to a hospital bed unable to communicate?

The link below is a simple document that you can complete to assign your SDM(s) and communicate your wishes. Once completed, you can forward a copy of it to me and I will keep it on your file as well.

https://d3n8a8pro7vhmx.cloudfront.net/dwdcanada/pages/3905/attachments/original/1606438476/DWDC__2020Form_Ontario.pdf?1606438476

I wish you and yours a Merry Christmas and Happy Holidays.

Stay safe and keep it healthy!

Dr. Matin

One of the most common questions that I get from patients is in regards to fevers and when you need to seek out medical care. Before answering that question, let’s review what is an actual fever.

Large scale studies have shown that average oral temperature in the population is 36.8 degrees Celsius (°C). This number was rounded up to give 37 °C as the ‘normal’ temperature. Similarly, fever was observed to be 37.8 °C and it was rounded up to give 38 °C.

Fever = 38 °C (100 °F)

The above is an average and there are slight variations in body temperature from one person to another. Body temperature also varies over the course of a day. It is lowest in the morning and rises by 0.5 °C by early evening. There are other variations based on ethnicity and ovulatory cycles but none have been shown to be clinically relevant.

Oral and rectal digital thermometers are the most accurate method of measuring body temperature. Oral thermometers should be used by all adults and older children who can properly cooperate. Infants and toddlers should use rectal thermometers. Tympanic (ear) and forehead thermometers are not reliable and should be avoided. Axillary (underarm) measurement with a digital thermometer is a less ideal option that can be used in children. If using axillary thermometer, a fever is 37.5 °C.

Is fever dangerous?

No. Fever is the body’s natural response to fighting an infection and does not in itself cause harm. However, fever can cause dehydration and does cause general malaise and this is the main reason why it is commonly treated with Tylenol or Advil. Also, fever is not the same as hyperthermia. Hyperthermia is the rise of body temperature due to external environment factors and can be dangerous. Last, the precise height of the fever is not as important as the duration in determining the seriousness of an infection. A fever of 41 °C x 2 days is less concerning than a fever of 38°C x 5 days.

What is a ‘low grade fever’?

It is a non-specific term that is not used by doctors. It is meant to communicate a temperature between 37 °C and 38 °C lasting greater than 24. It has no clinical value.

How to treat fever?

Both Ibuprofen (Advil) and Acetaminophen (Tylenol) can be used to treat fever. Ibuprofen is superior to Tylenol and should be used unless you have been told to avoid ‘NSAID’ medications. Combining Tylenol with Advil is slightly better than either by themselves but it has a confusing dosing regimen which leads to many medication errors. Ibuprofen dose is 400 mg four times daily. Children dose is 10mg/kg four times daily.

When to seek out medical care?

– Fever ≥ 5 days
– Fever in infants < 3 months old
– Fever in children that are unimmunized/partially immunized
– Fever + Personal history of immunocompromise
– Fever + Cough > 10 days
– Fever + Short of Breath/Difficulty breathing
– Fever + Decrease urine output (dehydration)
– Fever + Confusion and unresponsive
– Fever + Chest Pain
– Fever + Pain when urinating
– Fever + Severe abdominal pain
– Fever + Recent Travel history outside of Canada

The above is not meant to be an exhaustive list and you should always seek care if you are worried about a particular symptom. However, the vast majority of appointments in regards to fever that I see are due to simple viral illness that can be managed at home. Patients have runny nose, cough, and body aches along with a fever. The fever is easily lowered with Advil or Tylenol and patient is drinking and eating well.

How to care for fever at home?

Rest and drink plenty of fluids. Take Advil and Tylenol to lower your temperature. Only return to work and school once fever has completely resolved. That’s it! If you have a short course of fever (< 5days) and are drinking properly, there is nothing else that is required. Allow your body the time it needs to successfully fight the infection.

Keep it Healthy!

Dr. Matin

Here is a link of previous blog posts: https://www.greenbeltfht.com/?cat=23

Food labels are found on all packaged food and include a Nutrition Facts Table and an Ingredient List so that you can make informed choices. In this blog I will highlight the most important aspects of food labels and provide a quick approach on how to read them.

Nutrition Facts Table
1- Start by looking at the serving size. The serving size reflects the amount Canadians eat of that food product in one sitting. The serving size is consistent for easy comparison. For example, serving size for bread will always be 2 slices and for yogurt always 175 g.

2- Next look at the calories per the serving size. It is bold and in larger font so that it stands out. While the science of weight gain is complicated, calories are still the most important factor when making healthy decisions.

3- Look at the right-hand column showing ‘% Daily Value’. Percent (%) daily value is a very helpful and quick way to see if the food product has a little (5%) or a lot (15%) of a nutrient. The table shows all macronutrients (Carbohydrates, Fats, and Protein) and important micronutrients (Sodium, Calcium, Potassium and Iron).

4- Now look at ‘Sugars’ under Carbohydrates. After calories, the next most important line on the table is Sugars. You want to choose foods that contain less than 5% Daily Value of Sugars.

Ingredient List
Underneath the Facts Table will be a list of all ingredients in the packaged food product. Ingredients are listed in order of weight, beginning with the ingredient that weighs the most and ending with the ingredient that weighs the least. This list is helpful to get a complete picture of what you are consuming and helpful to those with certain food intolerances.

“Contains” section directly follows the ingredients list and details any of the Health Canada priority food allergens such as peanuts, gluten, and sulphites. “May Contain” section is a voluntary declaration in cases where the manufacturer can not guarantee cross contamination with one of the priority food allergens.

Hope this quick blog helps you feel comfortable looking at labels. In future posts I will do an depth review on the new Canada Food Guide and discuss the emerging science of obesity and weight management.

Wishing you happy holidays and a healthy 2020!
Dr. Matin

Q: Who Should get the vaccine?
A: Everyone over the age of 6 months.

But specifically, very high-risk patients:
• Children under 5 years old
• Adults older than 65
• Pregnant mothers
• Those suffering from respiratory illnesses (Asthma, Emphysema)
• Those suffering from heart disease
• Those who are Immunodeficient (Diabetes, Cancer, Kidney disorders, on certain medications)

Q: Who should NOT get the vaccine?
A: Those who have had previous life-threatening allergy to a flu vaccine. Children younger than 6 months of age.

Q: What is the risk of life-threatening allergic reaction to the Flu vaccine?
A: 1.3 patients per million vaccine doses.

Q: Are there any other severe side effects to the Flu shot?
A: No. Most people get redness, soreness, or swelling where the vaccine was given. Some, especially those who get the flu shot for the first time, have a headache, muscle aches, or tiredness.

Q: How does the flu vaccine work?
A: A dead strain of influenza virus is injected to trigger antibody production against the virus. The antibodies develop approximately 2 weeks after immunization.

Q: What’s in this year’s flu vaccine?
A: Influenza A strains (H1N1 and H3N2). Influenza B strains (Colorado and Phuket). This is knowns as the ‘quadrivalent’ vaccine. A high dose ‘trivalent’ vaccine is available for adults over 65 years of age that protects for all of the above strains minus the Phuket strain.

Q: When should you get vaccinated?
A: Now! Unfortunately, Ontario is grappling with distribution delays for the vaccine so you should expect longer than normal delays.

Q: Where can I get my vaccine?
A: Your local pharmacist (for patients 5 years and older). Ottawa Public Health Flu Clinics: https://cutt.ly/ieUb7tt. Our clinic will offer Flu Shot clinics for those over age 65 when we finally receive our shipment from Public Health. We will notify patients when vaccines arrive.

Q: Can I get sick from the vaccine?
A: No. The vaccine is made from a dead virus. Those patients who ‘got sick’ the last time they received the flu vaccine most likely suffered from many other respiratory viruses that the flu shot does not protect against.

Q: Why do I need to get vaccinated every year?
A: Influenza virus mutates (changes) rapidly. This ‘antigenic drift’ is the reason why each year microbiologists design a new vaccine which will protect against the predominant circulating strain of the Flu.

Q: How effective is the flu vaccine?
A: Depends on how well the vaccine strains match with circulating influenza virus. When there is good match between vaccine and circulating strain, the vaccine reduces your risk of getting the flu by 40%-60%. Conversely, when there is a poor match, the effectiveness is lower.

Q: What if there is a poor match between vaccine and circulating Influenza strain?
A: All is not lost. There are still some benefits as the vaccine protects against the other non dominant circulating strains and some individuals carry their immunity forward to future years as well.

Q: If the vaccine is at best 60% effective, why get it at all?
A: Imagine if you were told you only have a 60% chance of winning the lotto. Would you turn down the opportunity? The flu vaccine is a safe vaccine where you or your loved ones might be the beneficiary of the winning lotto ticket.

Here are some of the possible ‘winnings’:
• Reduces risk of getting hospitalized for Flu complications
• If you get hospitalized, it reduces your risk of getting admitted to ICU by 82%
• Reduces your risk of getting heart attacks!
• Reduces pregnant mothers being hospitalized due to influenza by 40% and it also protects the new born infant after birth
• Reduces children risk of dying from an influenza by 50%

Q: Where can I get the key facts and evidence on the Flu vaccine?
A: https://www.cdc.gov/flu/prevent/keyfacts.htm#benefits

Keep it healthy!
Dr. Matin

Link to previous blogs: https://www.greenbeltfht.com/?cat=23

Influenza (The Flu) is a severe and potentially deadly viral upper respiratory tract infection. Influenza A and B are the two main strains of this virus that cause seasonal outbreaks. Both strains are extremely contagious with Influenza A typically causing the majority of outbreaks.

Microbiologists further classify each strain into subtypes based on surface proteins. For example, Influenza A subtypes that have caused widespread human disease over the past century are: H1, H2, H3, N1, N2.

Last year marked the 100-year anniversary of the Spanish Flu (H1N1) Pandemic of 1918 which claimed 50 million lives world wide. The Asian Flu (H2N2) Pandemic of 1957 claimed 1.1 million lives while 1968 pandemic (H3N2) was similarly responsible for another million deaths. Most recent pandemic still fresh on many people’s minds was the H1N1 pandemic of 2009. It claimed the lives of half a million people and was particularly severe in children and young adults.

Antigenic Drift: Influenza virus is constantly mutating (changing) its surface protein thereby fooling the body’s natural defences (antibodies). This ‘antigenic drift’ is the reason why each year microbiologists and epidemiologists design a new vaccine which will protect against the predominant circulating strain of the Flu.

Twice a year, the World Health Organization (WHO) organizes a consultation with laboratory researchers from around the world to determine the composition of the vaccine. The production of the vaccine takes at least 6 months and on occasions by the time the vaccine comes off the production line, the virus has mutated making the vaccine less effective than initially anticipated.

As you can appreciate, Flu vaccine production is costly and represents the pinnacle of scientific achievement and cooperation. Unfortunately, majority of Ontarians do not appreciate just how fortunate we are to be the recipient of this potentially life saving vaccines since the price tag is ‘free’. A vaccine that saves the life a 5-year old child or prevents the spread of the flu to a loved one receiving chemo therapy is priceless. It is time we all appreciate this fact and do the least we can do by getting a simple ‘jab’ yearly.

In the next blog I will answer frequently raised questions about the flu vaccine and go over the logistics of getting your shot this year.

Until then, keep it healthy!
Dr. Matin

The common Cold and the Flu are viral upper respiratory infections. Since both are caused by viruses, neither can be treated with antibiotics. Rest and proper hydration are the mainstays of treatment. Tylenol and Advil can be taken to manage fever and body aches. Short course of nasal sprays can be used to help with problematic nasal congestion. Your pharmacist can help make sure the above medications are appropriate for you and your family based on your personal medical history.

When to See a Doctor
You do not need to see the doctor for routine symptoms of the Cold and Flu such as fever, cough, and nasal congestion.
However, you do need to seek medical attention if you have any of the following signs or symptoms:

• Dehydration (no urine for 8 hours)
• Breathing Difficulties (Labored or rapid breathing)
• Chest Pain (Particularly chest pain that worsens with deep breaths)
• Severe weakness or unsteadiness
• Seizures, confusion, or inability to stay awake
The above list is not exhaustive and you should always feel comfortable to seek help if there are symptoms that worry you. It is also important to note that certain patients suffering from immunosuppression or chronic lung diseases also require early medical assessment.

Fever
Fever is a temperature of 38 ℃ taken orally. It is a normal physiological response of the body to an infection. It is not a sign of infection severity or a risk for complications. It can be treated with Advil (Ibuprofen) or Tylenol (Acetaminophen). While fever itself is not a concern, certain fever presentations should lead to prompt medical assessment:

• Fever in newborns less than 12 weeks
• Fever that lasts more than 4 days
• Fever that initially improves but then returns
• Fever accompanying any of the concerning symptoms listed above

Hopefully this blog was educational. Ironically, every year many patients end up getting another viral illness while sitting in crowded waiting rooms for what are ultimately unnecessary clinic visits. I wish everyone good luck this cold and flu season. For those not so lucky: Tylenol, rest and plenty of fluids will do the trick!

Keep It Healthy,
Dr. Matin

Viral illness season is upon us again and today’s blog is the first of a multi-part series reviewing what you really need to know about these common illnesses.

The Cold and the Flu can have very similar symptoms. They both can cause fever, cough, and nasal congestion. However, the flu is a much more severe in intensity, lasts longer, and can lead to very serious complications.

Common Cold: By far the most frequent infectious disease in humans. The average adult gets two to three colds per year while the average child may get six to eight. There are many viruses that can cause the common cold but the most common is rhinovirus (30%-80%). Significant nasal and sinus congestion are the hallmark symptoms. Patients also typically suffer from mild fatigue, general aches, and a low-grade fever.

Influenza (The Flu): While more serious, the Flu is far less common than the cold. An average adult suffers from the Flu once a decade. Typically, there is profound fever (39-40 °C) along with severe muscle aches, and extreme fatigue. What makes Influenza dangerous is its potential to cause secondary complications such as lung infections (pneumonia), inflammation of the heart (myocarditis) and the brain (encephalitis) which are life-threating and can result in death. In Canada, there is on average 12,000 hospitalization and 3,500 deaths per year caused by the Flu.

Gastroenteritis: Is viral infection of the gastrointestinal tracts causing diarrhea, vomiting, and abdominal pain. I make a quick mention of this illness since it is colloquially known as the “stomach flu”. This unfortunately leads to great confusion amongst patients believing that they are suffering from an Influenza infection. While gastroenteritis is unpleasant, it is usually self limiting and does not cause any of the worrisome complications seen with Influenza.

In the next blog I will discuss how to manage your symptoms at home and when is it necessary to seek out medical advice.

Until then, Keep it Healthy!
Dr. Matin

Today I briefly touch on medical cannabis since many of you have been asking me about this new treatment over the past year.

Cannabis plant has a number of active compounds (Cannabinoids) that work on the Endocanabanoid System (ECS) of the body. ECS is a widespread neuromodulatory system that plays a major role in the functioning of our central nervous system and homeostasis. There are at least 8 known Cannabinoids but the two most well known and studied are THC and CBD.

Tetrahydrocannabinol (THC) – Is the substance which causes marijuana ‘High’ and hence the reason for its recreational use. It can cause euphoria but also anxiety/paranoia. It is a CNS depressant and as such can cause mental slowness, drowsiness, and impaired reaction time.

Cannabidiol (CBD) – Has almost no psychoactive effects when administered independently of THC. Very early clinical studies have shown anti-inflammatory, anti-anxiety, anti-nausea, and “pain-killing” effects. These CBD effects are the focus of emergent medical management of many chronic conditions. CBD (unlike THC) does not cause driving impairment and can safely be consumed during the day. It also seems to moderate some of the psychoactive effects of THC when taken in a balanced (1:1) formulation (For example less likely to cause paranoia/anxiety). This overall risk/benefit profile has led many doctors to now consider medical cannabis as a tool in managing many chronic pain conditions.

With the above primer out of the way, here are a few considerations that go into deciding if medical cannabis is appropriate treatment for a patient:

– It is never the first line medication. In other words, to be considered, a patient must first have tried other (better studied) medications.

– It is expensive! Unfortunately, as of the writing of this blog, no private or public formulary covers the cost of medical cannabis (small exception is Veterans Affairs). Typical cost for medical cannabis can range from $200-$300 per month.

– Patients with current, past, or family history of psychosis are not candidates for therapy.

– Pregnant and lactating mothers are advised against consumption as there are reported evidence of physiological effects on their fetus/newborn.

– It is not a sleeping medication but some clinicians provide a night time dose of balanced formulation to address patient sleep and pain at the same time.

– Currently, there are a number of Cannabis clinics with expertise in prescribing of medical cannabis. If considered an appropriate therapy, patients are referred to these clinics to obtain their first prescription.

– Medical Cannabis is obtained from online licensed producers (LPs) and are delivered to the patient’s home.

– Consumption is ideally done through ingestible oils (administered by a metered syringe) or inhalation via a vaporizer.

Hope this quick blog is helpful in answering your questions as to whether medical cannabis is appropriate for you. It is important to note that the science of cannabis consumption is still emerging. As mentioned, the cannabis plant has a number of other trace Cannabinoids as well as other compounds such as Flavonoids, and Terpenes. We do not know the full potential benefits and harms of these products.

As always, Keep it Healthy!
Dr. Matin

P.S. Here is a link of previous blog posts: https://www.greenbeltfht.com/?cat=23

P.S.S. This summer I read an amazing book by Dr. Matthew Walker “Why We Sleep”. It is a MUST read for any one who suffers from chronic fatigue and non refreshing sleep. Even if you are a sound sleeper, this amazing book gives you insight to an activity that you do on average 20-25 years of your life! https://tinyurl.com/y6fs46dt