Embrace Technology As a Health Care Option

Many look to Virtual Care

Health care is a hot topic of debate and it seems we are almost always talking about shortages. For instance, 20 percent of patients wait seven or more days to see their doctor, more than 40,000 Canadians visit the emergency room every year just to renew prescriptions and 68 percent of Canadians have skipped or avoided medical appointments due to barriers like long wait times. Family doctors are in short supply and 68 percent say they cannot accommodate urgent appointments. Our Canadian population is aging. With the advent of newer techniques and better options, we no longer are dying of heart attacks or various cancers, but we are living with these chronic diseases and the need for ongoing care.

So how do we accommodate the needs and demands on a health-care system that is struggling? Well, one innovative option is the use of virtual care. That means trading some in-person visits with physicians for on-screen consults. It means better access despite late nights and weekends. It means using technology to save time and money.

Let me give you some examples:

Say you are on blood pressure medication and you realize you don’t have enough for an upcoming trip. It would be easy to access medical care virtually and renew that prescription on time.

If you have controlled diabetes and do diagnostic tests every three months, you may be able to contact virtual care to find out there have been no changes to your medication regime.

Or perhaps you come home from work and discover your child has a rash. Instead of running to the ER, you could take a picture, contact your virtual health-care provider and answer a few questions. Maybe they’d tell you, “No, this looks local. Not infected. No need for medication at this time.” Whew.

Well, what about the loss of face-to-face time with your doctor? What do patients think? In 2018, Medisys Health Group (for whom I work part-time) commissioned the “Canadian Virtual Healthcare Study” to assess attitudes towards tech-enabled health services. The results:

1. Two-thirds of Canadians would use virtual care if it were provided in their employee benefit plan.

2. 71 per cent of Canadians are willing to trade some of their current benefits for virtual care.

3. 67 per cent of millennials want virtual care access.

4. 69 per cent of parents and caregivers want virtual care access.

5. 70 per cent of those dealing with chronic diseases want virtual care access.

In a separate survey done by Ipsos, a leading Canadian provider of public opinion research, 69 per cent of Canadians indicated they would use virtual health care in lieu of or to complement in-office visits.

The Canadian Medical Association released their report, “The Future of Connected Healthcare,” this past August, illustrating that “Canadians are ready for a more connected approach to health care.”

What about the loss of that “human touch”? Do we lose by adopting virtual care as an adjunct to our routine care? The Massachusetts General Hospital published a multi-year study looking at this question and determined that virtual consults can successfully replace office visits in many situations without compromising the quality of care and communication between patient and doctor. According to the study, “With a Telehealth visit, 95 per cent of the time spent by the patient is face to face with the doctor, compared to less than 20 per cent of a traditional visit, in which most of the time is spent travelling and waiting.”

So let’s consider virtual care as one more option in ongoing health care. In the United Kingdom, there is widespread use of such a system, as the government has supported telehealth as part of its public program. We need to be innovative in health care and health-care options as we age, as our population ages, as we successfully navigate through various diseases, stresses and life cycles. So let’s be open to innovation and technology. We want our smartphones to work for us! Now that is being smart.

Healthy Aging: The UN-Vaccinated Hordes

In the past year, there have been outbreaks of measles nationwide – a worrying trend for an entirely preventable disease that was once thought to have been virtually wiped out in North America.

Back in the 1960s, it seemed as though we had eliminated the disease, at least in the developed world, thanks to a fabulous vaccine, which is usually paired with mumps and rubella vaccines, called MMR. We vaccinated our children and we rarely, if ever, saw a case. This was a huge success, given that the disease can be deadly.

However, measles has come back – with a vengeance. There are two main reasons for this. First, although measles was rarely seen in North America, it was still prevalent in other countries. When a susceptible person visits one of those countries, or if unvaccinated people from abroad visit us, it is easy to bring the virus here. And measles is a very contagious virus.

Second, a significant number of people chose not to be vaccinated would never or are hesitant about receiving the vaccine. This has resulted in communities with high levels of unvaccinated people throughout the country. Now, public health officials are dealing with a growing number of cases, which presents increased risks for the entire population.

According to the U.S. Centers for Disease Control and Prevention, everyone should understand four things about measles:

1. It’s a potentially life-threatening and life-altering disease. Yes, it is a rash, it’s itchy and uncomfortable and causes fever in children. But about 25 per cent of people with measles end up in hospital. In one out of every 1,000 cases, it will cause brain swelling, which can lead to brain damage. And it kills one or two out of every 1,000 people who contract it, even in countries with advanced health-care systems, like ours.

2. It is a very contagious virus. It spreads in the air from coughing or sneezing. And it spreads early in the disease’s progression, before symptoms develop. The virus can linger in the air in a room for two hours after someone with the disease has left, and about 90 per cent of those who are not immune will become ill from breathing that air. It’s therefore easy to understand how even one case of measles can infect large numbers of people.

3. Even if there are few cases of measles in a community, every unprotected person is at risk, due to the frequency of international travel.

4. The best protection from this disease is vaccination. Those born before 1957 are very likely to have had the disease and are immune for life. Those born after 1957 have generally been offered immunization. However, we now know that we need two shots of MMR (or MMRV) to properly protect against the disease. Lots of people only received a single dose of MMR, and while a single dose does provide protection (it’s about 93 per cent effective), two doses increase that protection to over 97 per cent and is considered the requirement for children today.

Health-care workers, people serving in the military, as well as those who travel to at-risk areas should definitely get both shots. For others, many guidelines suggest that one is often enough. However, given the amount of international travel that takes place on a daily basis, the cosmopolitan nature of our communities, the lessons of how quickly viruses can spread, as we saw with SARS, and the death rate from this preventable disease, it would be wise to play it safe and get both doses.

I am immune, as I had the disease as a child. My children and grandchildren have been immunized, as I would never gamble on their health. But unfortunately, far too many people these days are willing to take that gamble – and are paying the price.

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.

Healthy Aging: What is the best advice when it comes to Aspirin?

In order to understand whether we should be using Aspirin to prevent a cardiac event, it is essential to understand the difference between primary and secondary prevention.

Primary prevention is for people who are healthy, not at risk of a given event and are choosing to do something to try to prevent an episode. In this case, the risk of the treatment must be very low, as the risk of having an event is low. People at low risk of having a heart attack, for example, have not had angina or an attack, though perhaps they have a family history that is concerning or have smoked when they were younger and less aware of the risks. Nonetheless, they have not had an event, so mitigating any risks is considering primary prevention.

Secondary prevention, on the other hand, is for people who have already had an event, or are at high risk of having one, and are choosing treatment to prevent another episode. Perhaps a patient has had a mild heart attack or a transient ischemic attack. Or maybe that person has angina or chest pains and is on prescription medication to lower his or her risk.

Aspirin affects the platelets in the blood, making them less sticky, thus decreasing the chance of having a blood clot. This may be very important in a small blood vessel, especially if it has already been narrowed by cholesterol plaque. But in making the blood less sticky, there is a risk of easy bleeding. That can cause blood vessels to leak or rupture, and diminish the body’s ability to form clots, in order to stop the bleeding.

So what is the best advice with respect to Aspirin? New guidelines from the American College of Cardiology were published last month. They’re based on a review of all the major studies and guidelines. The college focused on shared decisions between patient and physician, with a focus on implementing all the recommended strategies for good cardiac health, such as quitting smoking, exercising, etc. For today, let’s review the Aspirin issue.

Aspirin has been, and continues to be, widely recommended for secondary prevention. Here, the benefits – reducing the risk of another event in the cardiovascular system – outweigh the risks of taking the medication. However, recent studies do not support the use of Aspirin for routine primary prevention, due to a lack of net benefit.

Most importantly, we need to avoid this treatment for people who are already at risk of bleeding, such as those who have had ulcers, are on other drugs such as nonsteroidal anti-inflammatories, have kidney disease and so on. Also, everyone age 70 and above is considered at higher risk for bleeding, so again, Aspirin is not a good choice. It can, perhaps, be considered in selected cases with patients who are at higher than average risk of developing heart disease and are between the ages of 40 and 70 and are not at risk of increased bleeding.


The material contained in this blog is for informational and educational purposes. Considerable efforts have been made to maintain the quality of the content.  However, it is 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 discuss

Highlighting the role of vaccines in preventing HPV-related cancer

Alethea Spiridon  | March 22, 2019

@BenefitsCanada Employers Cancer Cares Summit 2019

Since human papillomavirus can have a significant impact on the health of the working-age population, it’s necessary to talk to patients and employees at to look at the health benefits of vaccines, said Dr. Vivien Brown.

Brown, a family physician and vice-president of medical affairs at Medisys Health Group, discussed the current issues and epidemiology of HPV-related cancer in Canada and the value of prevention in the adult population at Benefits Canada‘s Employers Cancer Care Summit in Toronto on Feb. 27.

“When we talk about vaccine in my world, what we’re talking about is preventing the disease, not treating the disease,” she said. “Most vaccines on the market prevent infection. When we’re talking about an HPV vaccine, we’re talking about preventing cancer — it’s a whole new paradigm, a whole new standard. And that’s why, as a family doctor, [I find it] exciting to be preventing one of these cancers.”

Read: How HPV is causing more than just cervical cancer

According to Brown, half the population will have cancer at some point in their lives, and the current vaccine for HPV can reduce the risk of cervical cancer by 90 per cent. “We reduced genital warts, and that causes a lot of visits and a lot of costs to the system. And when we’re looking at the number of cases . . . we see a sizeable number of cases every year in Canada. We still lose about one woman a day to cervical cancer.”

The cost burden of HPV isn’t just related to cancer, it’s the time and the cost of pap tests and other diagnostics, she added. “Think of the resources and the time involved with these cancers and the difficulty in screening a large population.”

About 75 to 80 per cent of the population will get HPV at some point in their lives, said Brown, noting it’s a virus that will clear on its own for most people, the same way a body would clear up a cold. However, she added about 20 per cent of people are unable to fight it off naturally, which leads to persistent HPV and then cancer.

“We know the vaccine works very well. But what do patients, employers and health-care workers care about? They care about whether it’s safe and it works. When you look at safety, no matter which agency looked, everybody’s acknowledging this is a very safe vaccine.”

Read: How to implement a health screening program

Worldwide, 16 million doses of the vaccine has been delivered, she said. “Women remain at risk for HPV throughout their lifetime. We also know that as you get older, the subtypes are slightly different in the different age groups. This vaccine is even more important in women who are slightly older.”

The vaccine is currently administered to boys and girls between the ages of nine and 26, but Brown said she believes it should be offered to everybody over the age of 26 if they’re at risk. “Your patient, clients and employees are less likely to have recurrent disease if [they’ve] been vaccinated. So we need to advocate and prevent the cancers, not just treat them.”

Read more coverage of the 2019 Benefits Canada Employers Cancer Care Summit.

Distinctive Women Interview

Who is Dr. Vivien Brown? That’s the first question asked by Ashley Robson from the Distinctive Women Organization. Here is a brief interview about me and my recent endeavors to educate women about the importance of healthy aging and important steps they can take towards that goal.

What can I do to boost my brain health? Here’s what you need to do…..


Brain health and healthy aging go hand in hand. We all want to live a long life, but with quality to our days, not merely quantity. This means taking action now to protect our brains so that as we age, we sustain the ability to remember, learn, engage, maintain a clear mind and enjoy life. Here’s how:

  1. Exercise As we get older, our brains shrink due to reduced blood supply. One of the best ways to stave off shrinkage is exercise, which boosts blood supply to the brain and can actually increase your brain volume. Exercise further increases brain-derived neurotropic factor (BDNF), which is critical for neural plasticity – a fancy way of saying our brain’s ability to adapt.TIP It’s only natural that we experience varying forms of stress and even trauma. However, a healthy brain with neuroplasticity will better weather these storms.
  2. The MIND diet A diet that is rich in vegetables, fruits, legumes and lean protein is good for our bodies and our brains: Studies show those who eat more vegetables experience less risk of cognitive decline than their peers who eat fewer vegetables. The Mediterranean–DASH Intervention for Neurodegenerative Delay (or MIND) diet is specifically designed to reduce the risk of dementia, while slowing the loss of brain function that can happen with age. In a nutshell, the MIND diet is a combination of the low-sodium Dietary Approaches to Stop Hypertension (DASH) diet and the Mediterranean diet – it even allows some wine on a daily basis. (Okay, I’m in!)
    It’s hard to follow any diet 100 percent, but research shows that even moderate adherence, most of the time, pays off.
  3. Be social Research shows that regular interactions and strong connections with friends and family not only lead to a longer, better quality of life, but also stimulate us in a way that protects the brain. Whether through work, sport, volunteer efforts or social engagements, the more you do, the more you will be able to do as you age. Loneliness is linked to heart disease, and we know that isolation can increase the risk of dementia.

    Learning and socializing are exercise for your brain. 
  4. Think fatty fish and omega-3 The fatty acids EPA and DHA are critical for normal brain function and development throughout all stages of life. In older adults, however, lower levels of DHA in the blood are associated with smaller brain size, which, as we now know, accelerates aging. Eat about 12 ounces (340 grams) per week – or three to four servings – of fish high in omega-3 fatty acids, including salmon, halibut, herring, mackerel, oysters, sardines, trout and fresh tuna.
    I tend to take omega-3 tablets at night, but if I’ve had fatty fish that day, I skip the dose. Otherwise, I take omega-3 along with my vitamin D and multivitamin. Good to go!
  5. Reduce stress While some stress can be a good thing – it helps the brain cope with life-threatening situations – too much is harmful. Long-term stress, for instance, can raise cortisol levels, leading to weight gain. Chronic, unrelenting stress is a major problem because it takes not only an emotional toll, but also a physical toll as it ages our telomeres, those caps on the ends of chromosomes that protect our cells.
    Meditation and other activities that reduce stress help increase the flow of oxygen-rich blood to your brain. 

Women experience depression, stroke and dementia twice as much as men, and an astounding 70 percent of new Alzheimer’s patients will be women. The Women’s Brain Health Initiative creates educational programs and funds research to combat brain-aging diseases that affect women. www.womensbrainhealth.org

First published in https://www.youareunltd.com/about-us/    Nov. 13, 2018




HPV Vaccine can eliminate cervical cancer as a public health issue

HPV Prevention Protect your children, yourself & your partner

October 1-7, 2018 marked the second annual HPV (Human Papilloma Virus) Prevention Week in Canada. As Chair of this educational week, initiated by the Federation of Medical Women of Canada, we focused on the need for both education and awareness of this common virus and how we can prevent the cancers associated with persistence. What does that mean practically? Well, 75-80% of adults in North America will be exposed to HPV at some point in their life. Most of us clear the virus, the way we clear a common cold. But persistence of the virus has now been linked to 6 different cancers in men and women. The most common one is cervical cancer where HPV now accounts for more than 99% of cancers. And oral cancers (think of the Michael Douglas story) are rapidly increasing in men.

The good news?

We have a fabulous vaccine, now offered to all boys and girls in the school system throughout Canada, in every province and territory. However, we do not have 100% uptake of the vaccine. Some of our young people may not be protected.

And what about older men and women? Our national guideline says there is no upper age limit for use of the vaccine. If you are likely going to be exposed, a new partner for example, you should talk to your doctor about immunization.

How do we know vaccination is really worth it? Australia is the leading country in the world with respect to this vaccine. When they announced vaccination in the school system more than 10 years ago, their uptake was very high. And they started immunizing boys as well in their school system soon after girls. The result: they just announced that by 2028, they will be the first country in the world to have eliminated cervical cancer as a public health issue, with less than 4 cases per 100,000. And by 2066, they project less than 1 case per 100,000.

Eliminating cancer by vaccination against the virus responsible.
That is what this is all about. That is why we held a week of education. That is why we want to be the second country in the world to eliminate cervical cancer. That is why you should protect your kids, protect yourself, protect your partner. That is why you should talk to your doctor!


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.

Healthy Aging: The NON-DIET SOLUTION

One of the areas that truly impacts aging is weight. Having a reasonable body mass index is a marker for predicting how well one will do in the next 10 years. And we know that summertime – a time of barbecues, drinking, sharing meals with friends and family and vacations – is an easy time to overindulge.

Dieting is defined as restricting oneself to small amounts of food, in order to lose weight. An estimated 45-million Americans spend $33 billion a year trying to lose those extra pounds. Yet, as many of us have experienced, the weight will almost inevitably come back and the whole cycle of food deprivation will begin again.

So the question is: if diets don’t always work, what does? The answer is to turn to a more balanced, realistic approach to losing weight and maintaining good health with nourishing foods, daily physical activity, positive thinking and smart lifestyle choices.

The not dieting trend was confirmed in a 2013 study produced by the NPD Group, an American research organization, which found that people were dieting less and that women were showing the biggest decline in dieting. According to the report, “In the past 10 years, the percentage of women on a diet has dropped by about 10 points. In 1992, 34 per cent of women told NPD they were on a diet; and in 2012, 23 per cent of women reported being on a diet.”

Contrast this with the fact that 57 per cent of adults said that they would like to lose 20 pounds and almost half said they need to change their diet to improve their health.

According to the NPD report:

• 55 per cent said eating healthy includes adding to, and taking out of, their diet;

• 25 per cent said “adding something to the diet” is healthy;

• 19 per cent said “taking something out” of the diet is healthy;

• 72 per cent said they eat reduced-fat foods;

• nearly 45 per cent eat foods with whole grains on a regular basis; and

• 24 per cent include organic foods and beverages in their diet.

Notice that there is no mention of restricting foods as a way to lose weight. So instead of dieting by depriving yourself of food, which usually is a joyless endeavour, try practicing the 80/20 rule: 80 per cent of the time, focus on eating clean, healthy foods; and 20 per cent of the time, you have the freedom to indulge as you please. This means that you don’t have to cut out all treats, you just have to be smart about it 80 per cent of the time.


Research into the impact of diet and brain health confirmed this proposal. Researchers looking at the effects of the MIND diet – which basically entails eating lots of fruits, vegetables, nuts, seeds, some low-fat proteins and either grapes or a glass of wine per day – confirmed that even if you follow this diet most of the time, but not all of the time, it has a significant impact on brain health.

And that makes good sense. None of us can be perfect all the time. But we can make the effort to eat healthy, live healthy and make healthy choices 80 per cent of the time. 


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.

Sex & Menopause Why Bother?

Menopause is a process, not an event. Menopause is not a disease, does not always need treatment, and does not get “cured.” Rather it is a time of transition, with lots of changes in a woman’s body, not unlike the changes we understand as normal during puberty. It begins with a decline in estrogen production that ultimately results in cessation of ovulation, but a woman’s last period is by no means the end of the process. There are many adjustments that continue over time

A very, very common experience of menopausal and post-menopausal women is a major change in their libido, which, like other symptoms of menopause, results from the lack of estrogen. Women often tell me they have less interest in sex, they don’t feel the same,  don’t function the same, and they may think, “It’s all over for me.”

I think it is very important when you look at something like the Masters and Johnson model of sexual function, which envisions a start, a peak, and a finish to sexual activity, that you realize that process may be true in younger women and it may be true in men, but it is not true in menopausal women. Interestingly, a Vancouver-based researcher named Rosemary Basson proposed a different reality, one that has become well accepted in the medical community. Based on her research, first published in 2001, she has created a schematic diagram illustrating sexual function in women as they age, and that diagram portrays sexual experience not as a line with a start and a finish but rather as a circle.

Her research shows that, with menopause, women often lose interest in initiating sexual activity; however, if they are intimate, if they are close with their partner and the partner begins sexual activity, they can derive pleasure from it. I think her model is much more accurate regarding how women function because I know that a lot of the women in my practice feel this way. But many women, because they have lost interest in initiating sexual activity, and because the idea of sex doesn’t have the same appeal, often say, “No way. Why bother?”

It’s Not Just You

When I talk to women in my practice about sexual issues they often respond with a huge sigh of relief. Women tend to think it’s a completely personal problem; they think it is just about them or about their partner or their relationship. So, it is extremely reassuring for them to learn about Basson’s research. They say things like, “Oh! You mean it’s not just me?” And they begin to see possibilities for maintaining and deepening their relationship, possibilities they thought no longer existed for them. And so I do encourage women to maintain intimacy, to maintain closeness, and to allow themselves to continue to be involved sexually with their partner, because generally once they start and once they get involved they can go through that circle and to derive pleasure from the activity itself and satisfaction from the ongoing intimacy.

One menopausal symptom that does not go away with time is the genitourinary syndrome of menopause. That term may sound off-putting, but it is more medically accurate—and perhaps less alarming—than the name that was previously used: vaginal atrophy. So, what is it? Because of lack of estrogen the vagina gets dryer and the back wall of the bladder loses its estrogen support. This results in vaginal symptoms like dryness, burning, and itching; it also causes bladder symptoms such as loss of control and results in an increased risk of bladder infections.

Don’t get me wrong: estrogen is not a panacea; it does not solve everything. Adding back estrogen does not necessarily replace lost interest or replace the physiological response so that it is the same as when you were 30. But adding back estrogen can lubricate and make you more comfortable, and for many women, it is discomfort that convinces them they are past the time when sex can be good, can be enjoyable for them.

In Chapter 5 of my book, A Woman’s Guide to Healthy Aging- 7 Proven Ways to Keep You Vibrant, Happy & Strong, I go into a great deal of detail about hormone treatments and various options.


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 healthcare provider.   As always we encourage your comments on this blog or any others and hope you will join discussions.