Do you know how healthy you are?

The Benefits of getting a Personal Health Risk Assessment
Don’t we all want to know how we’re doing from a health point of view and if we’re on the right track? That was a question posed centuries ago by the learned Hippocrates-the father of modern medicine who focused on diet and exercise to forecast the health of his patients. Fast forward a few centuries later and we now have a more formal process, called the Personal Health Risk Assessment.The process refined over the years is a four-part questionnaire used to evaluate the health risks and quality of life of patients.The questions are based on lifestyle including what level and form of exercise is practiced, demographics such as age, sex, personal and family medical history, and physiological data such as your weight, height, blood pressure and cholesterol.
Another important part of the process is your level of willingness to charge your behaviour to improve your health. A personal health risk assessment can have enormous benefits, whether the assessment is for an person or used as part of an employee health and wellness program.
It provides a snapshot of your current health. Enables individuals to monitor their health status overtime. And having concrete information helps prepare you for a change in your lifestyle. The information is there, before you, and makes it clear in black and white what needs to change.
If your company is engaged in a health prevention program, it can help determine on an aggregate basis how healthy and productive the company work population is AND what health related programs they might include such as lunch and learns, flu shot clinics, reviewing the company cafeteria menu to ensure healthy food choices are available, and introducing a health management program.
Hippocrates –the father of modern medicine at one point was imprisoned for 20 years for believing and arguing that disease was not a punishment inflicted by the gods, but rather the product of environmental factors, diet, and living habits.
The same holds true today.  You can make changes to your health.
A Personal health risk assessment is one of those ways.

The more information you have —both the good and the challenges—the better able you are to make informed decisions about what you can do keep or improve your well-being.

Disclaimer: The material contained in this blog is for informational and educational purposes. Great efforts are made to ensure the quality of the content. However, it is strongly recommended that the treatment/management of any medical conditions mentioned here, should not be used by an individual/visitor of this blog, on their own, without consulting competent persons such as your doctor, or health care provider. As always we encourage your comments on this blog or any others and hope you will join discussions.

 

Pharmacogenomics: Determining the most effective drug for your genetic makeup.

Genetic Testing & Drugs
Each person is unique and so is his or her response to certain medications.  Since the mapping of the Human Genome Project was completed in 2003, a new area of study and research has opened up called, Pharmacogenomics, the technology that analyses how genetic makeup affects an individual’s response to drugs—will a drug be helpful for a specific treatment or will it be toxic? Will it help or hinder? Will you be at increased risk for certain side affects or will genetic testing help to avoid a serious adverse drug reaction.

Such approaches promise the advent of personalized medicine in which drugs and drug combinations are optimized for each individual’s unique genetic makeup.

There are two areas  pharmacogenomics is being applied.  One is in the area of cancer treatment and the other is using genetic testing to determine response to certain medications.

In the area of cancer treatment, oncologists may order certain tests that will look at the genetic features of a tumor to assess how the cancer will respond to certain types of treatment and what form of therapy would be best for a particular patient.  This is the only area today that may be covered by health insurance in Ontario.

The other use for genetic testing is in the area determining the effectiveness of certain drugs for treatments related to heart disease such Plavix or Warfarin.
We have learned that the uniqueness of our genetic makeup means that not all drugs work in the same way for all individuals or it may be hard to get the dose right.   It is not yet common practice in Canada or covered under OHIP, but genetic testing in this area can be carried out privately if your doctor determines it is warranted.  Ideally, Medisys genetic counselor, Katherine Hodson, suggests the test be carried out before a drug such as Warfarin or Plavix is prescribed to avoid adverse reactions and ensure the right dosage.

Genetic testing may also be used to determine whether certain pain relievers such as codeine will work well for a given patient.  An individual suffering from chronic pain may not respond to codeine as genetically, that person may metabolize the drug too quickly.  In this case, the patient would need a different medication and of course, given concerns about narcotics and drug seeking, how reassuring it is to have a clear medical answer about different or higher dosing requirements.

We are on the cusp of understanding more about genetics, medications, reactions, both good and bad, and that will make prescribing drugs much more personalized, with predictable and better outcomes.

Disclaimer
The material contained in this blog is for informational and educational purposes. Great efforts have been made to maintain the quality of the content.  However, it is strongly recommended that the treatment/management of any medical conditions mentioned here, should not be used by an individual/visitor of this blog, on their own, without consulting competent persons such as your doctor, or health care provider.   As always we encourage your comments on this blog or any others and hope you will join discussions.

Probiotics –Healthy or Hype?

There’s a growing body of research that shows bacteria in our gut is related to many health problems, from common diarrhea and obesity to urinary infections and stress.

There is also growing evidence that taking some probiotics- live microorganisms that have health benefits is not a fad and has real health benefits.  Several years ago, the prestigious Journal of the American Medical Association, confirmed that probotics prevent diarrhea caused by antibiotics by restoring the balance of friendly bacteria in the intestinal tract. This is significant as many as 30 percent of people using antibiotics experience diarrhea as a result of medication.

Just taking a look in the diary case, at your local supermarket will attest to the fact that probiotics are used in many foods today, such as yogurt, baby formula and even chewing gum!  But not all yogurts for instance are considered probiotic foods. All yogurt in Canada for instance contain live bacteria—Lactobacillus bulgaricus and Streptococcus thermophilus —that typically offer up to 300,000 live bacteria per serving, which most experts say is too low. Look for a yogurt that has 10 billion per serving.

Probiotic supplements in capsule form are also available using specific bacterial strains to combat various conditions –from IBS-irritable bowel syndrome and IBD-inflammatory bowel disease to traveler’s diarrhea and constipation.

There are hundreds of supplements on the shelves today but most have not undergone the necessary research to prove it.   The first step is to look for products backed by scientific research.

A recent study of brand name probiotic supplements available in Canada with clinical evidence to support specific uses was published in the Canadian Journal of Gastroenterology www.ncbi.nlm.nih.gov/pmc/articles/PMC2659138/ .  There is also an excellent chart at the end of the article related to probiotics and the clinical data to support specific uses.  It’s is a good starting point to determine which probiotics are right for you and which have scientifically proven health benefits. Another good reference site, www.scienceofprobiotics.ca is also very helpful.

You will also need to choose a probiotic that contains specific strains known to be beneficial for a particular condition.  So read the labels. For instance, for yeast infections choose a probiotic that has specific strains shown to be beneficial for this condition.  In this case, the strains are Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14.If you don’t have a specific ailment but want to improve the overall health of your gut, choose a probiotic that has several kinds of bacteria.    But again, do your research.
Probiotics are not for everyone, so it is best to speak to your doctor before taking a supplement.

Understanding cholestrol-the good, the bad, and the guidelines

Heart disease is the number one cause of death in Canada, which makes prevention of heart disease so important. Some risk factors for heart disease unfortunately cannot be changed, including your genes, gender and ethnicity. There are many other factors, however, that you can control. These are called modifiable risk factors, and include high blood pressure, obesity, smoking, diet, exercise levels, and high cholesterol. But what level of cholesterol is considered to be high, and how does your doctor determine whether or not cholesterol-lowering medication is right for you?

You may have heard of “good” cholesterol and “bad” cholesterol. Good cholesterol is called HDL and bad cholesterol is LDL. LDL cholesterol is used as the primary target when deciding whether your cholesterol is at target or not. Target cholesterol levels differ according to risk category; if you are a low-risk individual, we accept higher LDL levels than we do for high-risk individuals. So the first step that your doctor takes when assessing your cholesterol profile is determination of your risk category. This is done by calculating what’s called a Framingham Risk Score, which takes into account your age, gender, total and HDL cholesterol levels, smoking status, blood pressure, family history, and whether or not you have diabetes.

A Framingham Risk Score of less than 10% is considered low-risk, and for these individuals an LDL level of less than 5.0 is considered acceptable. Individuals with a risk score of less than 5% can have their cholesterol rechecked in 3-5 years, while those with a risk score of 5-9% should have their cholesterol levels repeated yearly. Framingham Risk Scores between 10 and 19% fall into the moderate-risk category. The target LDL level for moderate-risk individuals is <3.5. Levels greater than 3.5 should be treated with cholesterol-lowering medication. However, cholesterol-lowering medication will also be recommended if your LDL is less than 3.5, but a different marker called non-HDL is elevated. Finally, Framingham Risk Scores of 20% or greater are considered high-risk. Treatment with cholesterol-lowering medications will be considered for all high-risk patients, regardless of LDL cholesterol levels.

Your doctor will discuss the specifics of cholesterol-lowering medication with you if it is indicated based on these guidelines. For some individuals, lifestyle modification can be tried before medication in order to help lower cholesterol levels. For others, however, medication may be required at the outset depending on risk level and degree of elevation of cholesterol levels. Whether you require cholesterol-lowering medication or not, everyone should try to implement the Canadian Cardiovascular Society’s recommendations for a heart-healthy lifestyle:

1.    Diet with reduced saturated fats and refined sugars
2.   
Weight reduction and maintenance
3.   Exercise: 150 mins/week of moderate activity (i.e. brisk walking, biking, swimming, etc.
4.   Quit Smoking
5.   Limit alcohol to no more than 1-2 drinks/dayTo learn more about dietary fats from the Heart & Stroke Foundation, click here: http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.3581947/k.D7AE/Healthy_Living__Dietary_fats_oils_and__cholesterol.htm

 

 

Personalized Medicine –When should you consider genetic testing?

Since the Human Genome project made it possible to map the entire DNA of a human in the 1990’s, it has become a powerful information tool. Learning an individual’s personal genetic make up can lead to improved diagnosis of certain illnesses. We also can advise you, if you are at higher risk because of a disease or condition that runs in your family.  It can help physicians like me make more informed decisions when prescribing medicines.  It is truly miraculous and a continually emerging and exciting field.
Breast cancer, heart disease, type II diabetes, prostate cancer are just a few of the diseases and conditions that can be tested.
However, before you begin the process, I would suggest you discuss your concerns with a qualified genetic counselor.  And that counselor should be certified by the Canadian Association of Genetic Counselors. (
www.cagc-accg.ca)
Sometimes, the first and only step you may need to take, is knowing your family history for a medical condition to be flagged with your counselor.
 For instance, the vast majority of breast cancer cases occur by chance and are not as the result of genetic factors.  Genetic counseling can be incredibly reassuring. Although rare, inherited changes in the BRCA1 and BRCA2 genes, which was the case for actress Angelina Jolie, are linked to a high lifetime risk of breast, ovarian and other specific cancers.  In that case, preventative measures were taken.  And that too is reassuring.
Once you and your counselor decide genetic testing is right for you, all that is needed is a saliva sample to begin the process.
In a future blog, I will discuss genetic testing and medication responses. We are learning how genetic testing can help in prescribing the best medication to treat a condition or disease. And we can tailor medication to specifically treat an individual…. for we all know, it is NOT one size fits all.

 

Flu Season is here!!!

      Ontario has already documented a few cases of flu and the vaccine is HERE

      Influenza vaccines authorized for use in Canada are safe and associated with minimal side effects and can be administered to anyone over 6months of age. *We know that between 10% and 20% of all Canadians will get the flu this winter.  And for some of us it can be severe, life threatening and perhaps even life ending. About 4000 Canadians die every year of flu and related complications. Generally the very young and the very old are most at risk, but we know pregnant women, children under 5, those with asthma, COPD, heart disease and diabetes are also at significant risk compared to the general population.  And even if you personally are not a high risk individual, chances are you will spread this easily to others in your family or community who are at greater risk.  You need to protect yourself and others!
Does the flu shot eliminate every case of flu? NO.  But if you have been immunized, but still get the flu, chances are it will be much less severe than if you were unprotected.  So you are less likely to need the emergency room and in- hospital treatment.  And that’s what it’s all about.  We can’t avoid every case of influenza, but we can decrease our chance of a serious episode!

       I can’t emphasize enough how important it is to get a flu shot.  I have taken mine, immunized my family, my staff and my coworkers!  Have you had yours?

      Aside from having flu shot,  here are everyday preventative measure to protect you from colds and flu

Top ways to fight the flu*
Wash your hands with soap and water
Avoid touching your eyes, nose and mouth as germs spread this way
Sneeze into your arm or sleeve
After or blowing your nose with a tissue, throw away the tissue and wash your hands.
Stay home and avoid crowds if you feel sick

*Health Canada, Flu Watch

Life-saving vaccine school program gets boost from Toronto Board of Health.

Each year the diagnosis and treatment of HPV-related infections (Human Papillomaviruses (HPV)) cost the Canadian health care system more than $300 million.  HPV are the cause of almost all cervical cancers, are a leading cause of other genital cancers, anal cancers, and warts, and contribute to cancers of the head and neck.  Three out of every four Canadians will have at least one HPV infection in their lifetime. Not every infection leads to cancer, but medicine still is unclear as to why some people clear this virus, while others have persistent virus that then does become more aggressive.

In 2007, the National Advisory Committee on Immunization (NACI) recommended the use of the HPV vaccine for females between nine and 26 years of age to prevent cervical cancer, as well as other infections such as genital warts.  That year, the Ontario Ministry of Health and Long-Term Care (MOHLTC) made the HPV vaccine publicly available, free of charge, to all grade 8 girls (13-14 years of age).  In September 2012 the MOHLTC also funded a “catch-up” program to vaccinate females born between 1993 and 1998 that had not received all three HPV shots while in grade 8.

In January 2012, NACI added a recommendation for all males aged nine to 26 to receive HPV vaccine to prevent anal and genital cancers and genital warts.  It also recommended HPV vaccine for all males who have sex with males since they have a disproportionately higher burden of HPV infections.  Vaccinating males with HPV vaccine will also reduce the spread of HPV infection to females.  

To date, the Ontario’s MOHLTC has not acted on this recommendation, and the HPV publicly funded vaccination program remains available only to females in grades 8-12.  In other provinces, PEI and Alberta, the program is being funded for boys as well.  Ontario needs to step up to the plate.

 

As a family physician and member of the Federation of Medical Women of Canada I cannot stress enough how crucial it is to expand this program to include boys!!!   This is a contagious infection that has serious potential to spread and we have the tools to stop it!  This is what we mean by primary prevention, stopping infection and disease, before it starts.

 

Currently, I am meeting with all 3 parties at Queen’s Park to discuss these issues and to encourage equitable access for all young Ontarians.  It is only fair.