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Many of you are familiar with “annual exams”. In the past, patients and their family doctor would meet once yearly to review their health status and perform a checklist of physical exams and diagnostic tests.

The physician would start by looking into patient’s ears and throat and work her way down to palpating the pulses in the feet. Almost everyone would have a yearly urine test and complete bloodwork regardless of their age, gender, or lifestyle.

Numerous studies have shown that people who have a yearly check-up don’t tend to be healthier or live any longer than those who do not. As a result, many provinces such as New Brunswick, Nova Scotia and Newfoundland have stopped paying doctors to perform yearly physicals outright. In 2012, Ontario government also scrapped annual exams in favour of Periodic Health Assessment (PHA).

As the name implies, PHA is done periodically and not necessarily every 12 months. Rather than everyone getting the same batch of tests, doctors are supposed to focus on the specific needs of individual patients – taking into account their age, gender and medical history.

In my practice, I have made an effort to make sure that doing routine screening is as convenient as possible for my patients. I obtain yearly height, weight, and blood pressures on my patients regardless of reason of visit. I typically spend a few minutes at the end of each visit reviewing which periodic health maneuvers are overdue and promptly order them. Furthermore, my staff contact patients for many other overdue tests such as colonoscopies, pap tests, and bone densities. All this so that you do not feel the need to collect your various medical complaints for 12 months; simply come in as medical issues arise.

In short, you do not need to book an ‘annual’. Come in anytime through out the year with any issue or concern and during the visit I will always strive to make sure you are caught up with evidence based routine screening tests. In the upcoming blogs I will go over the evidence for specific screening tests such diabetes/cholesterol checks, mammograms, and colonoscopies to name a few.

Keep it Healthy!
Dr. Matin

Fatigue is an extremely common complaint amongst Canadians. 20%-30% report suffering from chronic fatigue. In this blog I will present the most common causes:

– Sleep Quantity
– Sleep Quality
– Mental Health
– Deconditioning
– Medication Side Effect
– Organic Disease

The first two possible causes were the focus of previous blogs. In short, if you have non restful sleep due to either sleep debt or a sleep disorder, you will naturally be fatigued throughout the day.

Mental health conditions such anxiety and depression cause profound fatigue. Apart from mental fatigue, most patients suffering from mental health conditions also suffer from poor sleep. Typically, patients toss in bed all night suffering from intrusive negative thoughts or worries.

Deconditioning is a leading cause of fatigue. Unfortunately, due to our predominantly indoor and sedentary lifestyles, most of us do not achieve anywhere near recommended daily activity levels. Exercising regularly, losing weight, and getting outdoors improves your energy levels by activating your metabolic and neuroendocrine systems.

Fatigue is also a commonly listed side effects of many medications. If you are suffering from fatigue and are on multiple medications, it is worth reviewing your medications at your next appointment to see if alternative options are available.

Finally, there are some organic causes of fatigue such as under functioning thyroid gland, anemia, or a number of chronic illnesses (i.e. rheumatological, cardiac, and respiratory diseases). A clinical assessment including diagnostic tests can rule out many of these causes. It is worth mentioning that organic diseases are far less common than the other aforementioned causes.

This is not an exhaustive list and obviously blogs are no replacement of a proper clinical assessment. My hope, however, was to give many of you suffering from fatigue a framework to approach it and seek medical advice if needed. As noted above, most cases of fatigue can be addressed by yourself through proper sleep hygiene and lifestyle changes.

As always, keep it healthy!
Dr. Matin

Unfortunately, there is now a second case of confirmed measles in Ottawa. This is an impromptu blog aimed at answering many of the questions I have received over the past few days. It will serve as a resource for you and your family in understanding this illness and whether you require further vaccination.

1- When was Measles vaccine introduced in Canada?
Universal vaccination started in 1975. The vaccine was introduced in 1963 but the uptake was not high.

2- One dose vs. two dose vaccination?
Between 1975-1996, patients were only given one dose of the vaccine. One dose of the vaccine provides 95% effectiveness where as a second ‘booster’ dose provides 99% effectiveness. Since 1996 children in Ontario (and most other provinces) have been given two doses of the measles vaccine.

3- Why don’t babies (less than 1 year) get the vaccine?
Unfortunately, the vaccine is not effective when given before 12 months of age. Thankfully, an infant has antibodies from her mother for the first several months of life. Between 6-12 months of age, babies are at risk of getting Measles but thanks to very high immunization rates they are protected by herd immunity.

4- What is Herd Immunity?
When sufficient number of people in a community are vaccinated against an illness, the virus will not have the opportunity to spread. For measles, 94% of a community needs to be vaccinated in order to be protected by herd immunity.

5- Vaccination rate in Ottawa?
In Ottawa vaccination rates are 94.5%! However, provincial average is 91% and there are pockets in the province where vaccination rates are concerningly low

6- I was born before 1970, do I need an MMR vaccine booster?
No. You were likely exposed to measles. Measles is so highly contagious and at the time so rampant in Canada that you have presumed immunity

7- I was born between 1970-1995, do I need an MMR vaccine booster?
Likely yes as you only received one dose of the vaccine and Measles was largely eradicated in Canada during this period. Unfortunately, at our clinic we only have sufficient dosage to immunize infants. Please contact Public Health Ottawa for directions in regards to adult catch up immunizations.

8- I am not sure if I got a dose of the measles vaccine, do you have my vaccine records?
No. I only have records of vaccinations that I have provided to you and your children. Look to see if you kept your own records (yellow card) or contact your previous family physician if still in practice. You can also contact Ottawa Public Health to see whether they might have your records.

9- I never got the vaccine (born after 1970). Should I get it now?
Yes! You will not only be protecting yourself but you will also be protecting the risk of spread to vulnerable unimmunized infants and those with weakened immune systems.

To learn more about measles visit the Ottawa Public Health website:
http://www.ottawapublichealth.ca/en/public-health-topics/measles-red-measles.aspx

Just like baking requires following a recipe, falling asleep requires you to follow a few important steps. These steps are collectively called sleep hygiene and by following them you can dramatically improve your sleep.

1- Create a dark sleeping environment. Make sure all lights are off and invest in proper window draping.

2- Keep your room cool. For optimal sleep keep your room around 18 degrees Celsius (adjust to your comfort).

3- Establish a regular bedtime and stick to it. Aim to be in bed 15 minutes prior to your sleep time so that you can relax.

4- Establish a relaxation routine. A regular routine helps the body recognize that it is bedtime. For example, you can read a book or do a short mindfulness meditation.
Avoid watching TV or looking at your phone. Disengage your mind!

5- Do not eat late at night as it can cause painful heartburn that disrupts sleep.

6- Avoid stimulants such as caffeine and nicotine close to bedtime.

7- Avoid depressants such as alcohol and cannabis close to bedtime. These drugs typically cause drowsiness but severely disrupt your sleep architecture causing you to have a restless sleep.

8- Exercise daily. Aerobic exercise during the day can drastically improve nighttime sleep quality.

9- Limit naps to less than 30 minutes. Excessive napping during the day causes poor nighttime sleep.

10- Never toss and turn in bed! If you are tired but wide awake, get out of your bed. Go to another dark and cool room and read for a bit. Only return to bed when you begin to doze off.

At Greenbelt FHT we offer a monthly workshop on insomnia that is highly rated by our clients. If you wish to participate, write me a portal message and I will facilitate the referral.

Keep it Healthy!
Dr. Matin

In the last blog I focused on insufficient sleep quantity. In this blog I will focus on disorders that effect sleep quality. There are many sleep disorders such as Restless Legs Syndrome, Narcolepsy, and Parasomnias. However, no other sleep disorder is as prevalent (and serious) as Obstructive Sleep Apnea (OSA).

Sleep Apnea occurs when a person’s breathing is interrupted during sleep resulting in the body not getting enough oxygen. 15% of men and 5% women suffer from this disease and the prevalence is on the rise. There are many risk factors but being overweight is by far the most significant.

Complications of sleep apnea include those of sleep deprivation such as cognitive impairment, depression, anxiety, and chronic fatigue. However, what makes OSA deadly is the fact that it increases your risk for hypertension, diabetes, heart disease, and strokes.

You should suspect OSA if you have excessive daytime sleepiness or unrefreshing sleep. Your bed partner’s reporting of snoring, gasping, snorting, or interruption in breathing are also important signs.

If you are questioning whether you suffer from OSA, you can complete a validated questionnaire online:
http://www.stopbang.ca/osa/screening.php

If you are at intermediate or high risk, you should be evaluated for sleep apnea.

In summary, if you suffer from excessive daytime sleepiness, book an appointment so that we can rule out sleep disorders such as OSA.

Keep it healthy!
Dr. Matin

Sleep as two dimensions: Duration (quantity) and depth (quality). The focus of this blog will be on sleep duration and sleep deprivation’s very real effects on physical health. In a future post, I will also discuss sleep disorders such as sleep apnea that effect sleep depth and other medical conditions that cause excessive daytime fatigue.

Chronic sleep deprivation is such a pervasive problem that I have decided to blog about this before more topical conditions such as cancer, mental health, and obesity. On average, an adult requires 8 hours of sleep per night. Younger adults and teenagers require closer to 10 hours per night! There is, of course, some variability from one person to another. However, the vast majority of my patients are not getting anywhere close to the amount of sleep they require in order to feel rested and avoid long term health concerns.

Short term effects of sleep deprivation include cognitive impairment such as poor concentration, memory impairment, poor academic and work performance. Lack of sleep also effects mood and judgement by worsening depression and anxiety states.

Chronic sleep deprivation has even more profound negative effects on your physical health. It leads to increased risk of heart attacks and strokes. There is also good evidence demonstrating increased risk of obesity, hypertension, and high cholesterol in those who are chronically sleep deprived.

In short, if you want do something good for your health, sleep! It is cheaper than your multivitamins and is far more impactful on your overall health.

Keep it healthy!
Dr. Matin

I am going to start the series with a review of a very basic but important distinction. Namely the difference between screening tests and diagnostic tests.

A screening test is one that is ordered in the absence of any symptoms. For example, ordering a cholesterol level in the absence of any chest pain or prior heart disease.
A diagnostic test is one that is ordered to diagnose a patient’s presenting symptoms. For example, a patient presents with fever and a cough for which an x-ray is ordered to diagnose pneumonia.

There are very FEW evidence-based indications for screening tests but diagnostic tests are ALWAYS required to determine the cause of a patient’s symptoms. Often the diagnostic test is simply a history and physical undertaken by the physician. On occasions, it will require blood work, imaging tests, or even invasive procedures.
Many patients request ‘routine’ bloodwork and are disappointed when they find out that there is no screening bloodwork indicated based on their age or risk factors. However, often they are actually requesting ‘routine’ bloodwork because they are suffering from an underlying symptom or concern such as persistent fatigue. This would require a diagnostic work up; not a routine screening test. Each medical presentation has its own focused diagnostic approach. It is important to present your concerns and symptoms so that best care can be provided to you.

In summary, always come see me for any symptoms that cause you concern or alarm and come prepared to provide the list of your symptoms, their severity, and their onset. As to what screening (routine) tests you might be due for, stay tuned for the upcoming blogs!

Keep it Healthy!
Dr. Matin