November was Osteoporosis Month in Canada, which is designed to bring awareness about a disease that is characterized by bone loss and a subsequent weakening of the skeleton. Often called “the silent thief,” there are no symptoms of osteoporosis until one experiences a fracture as a result of the loss of bone.
If you are hit by a truck and fracture a bone, that is traumatic, but not unexpected. But if you fall from your adult height or from a few steps, such as falling off the curb or missing the last step in a staircase, and fracture a bone, that is a fragility fracture and it’s a sign of osteoporosis. What it means is that your bones were not strong enough and therefore broke.
Eighty percent of fractures in women over 50 are fragility fractures. That is scary, because the likelihood of a fracture leading to another fracture is high, particularly in the first year or two after the initial fracture. Those who have experienced such a fracture should talk to their doctors about bone health.
What are the components of bone health? Vitamin D intake is essential. Osteoporosis Canada (OC) generally recommends 1,000-2,000 international units a day for women over the age of 50. Calcium is also important, as it is a building block of bone. Generally aim for 1,200 mg per day.
Ideally, people should get their calcium from milk, cheese, yogurt and other dairy products. While other foods have some calcium, the amounts are not high. On the OC website, there is a calcium tracker. You can input your diet and find out how much calcium you had on a given day. If you’re not getting enough, increase your intake of calcium-rich foods or start taking a supplement. But more is not better, as higher amounts of calcium are associated with other risks.
Bone health also depends on exercise. Weight-bearing exercise is ideal, as it strengthens the muscles around joints and bones, improves balance and decreases the risk of falls.
Bone mass is measured using a bone mineral density test (BMD), a scan that’s done at various facilities. By age 65, both men and women should have a BMD.
If your BMD is acceptable, that is great and you have good bone quantity. A lower score means that bone quantity is too low and must be acknowledged. The goal is to do a risk assessment – looking at bone health, the issues faced by a given patient and the risk of fractures – and then make a decision on whether to treat the patient using medication. We have a number of choices of medications in Canada, so patients should discuss with their doctors about which treatment option is best for them.
When it comes to osteoporosis, aggressive prevention, preventing the next fracture, is perhaps the most important thing. Indeed, a hip fracture can be deadly. About 23 percent of women and 37 percent of men will die from complications in the year after a hip fracture. And about 40 percent of patients will not be able to live independently but will need care in a facility. Another 40 percent will not walk properly for the rest of their lives.
So when we talk about healthy aging, independence, and empowerment, let’s remember the huge importance of osteoporosis, not just in November, but all year long.
As Canada’s weather plummets from pleasant autumn chill to the sharp bite of winter, employee moods – and productivity – can drop right along with it.
31 Oct 2019
As Canada’s weather plummets from pleasant autumn chill to the sharp bite of winter, employee moods – and productivity – can drop right along with it.
“So when the weather turns cold and the days grow shorter and darker, it’s easy for energy in the office to decline,” says Dr. Vivien Brown, Vice President of medical affairs at Medisys. “But the end of the year is also a critical period for employees to pull together and turn out their best work.”
Brown says fun office activities – perhaps a cold-weather theme like a hot chocolate day or winter retreat – can help keep a team’s enthusiasm up. Another idea to help boost morale and maintain productivity is to offer remote work arrangements. “Allowing employees to work from home can eliminate that frigid walk or icy drive and let employees know you want them to feel comfortable,” she says.
“This shows you understand how winter days can affect mood and psyche.”
Stock Healthy foods
Another simple idea to give employees a boost is stocking healthy food like Vitamin D enriched yogurts, vegetables and fruit in the office fridge to combat reduced sunlight and the pressures that come at the end of the year.
Kim Tabac, Chief People Officer at League Inc., says the company
notices a higher rate of use of its health and wellness products during
the winter months and suggests employers provide their employees with
resources, “such as subscriptions to meditation and mindfulness apps
like Headspace and Inkblot, and encouraging proper nutrition, sleep and
Ecotherapy May Help
“But while it may be easy – or at least easier – to talk about mental health in personal, social and family lives, it continues to be more difficult to discuss openly in the workplace,” Tabac adds. Brown also suggests creating good working conditions by using ecotherapy techniques. Ecotherapy has been proven to boost mood and energy “because humans are part of nature,” Brown explains.
Ecotherapy elements that contribute to creating a healthy work environment include some fairly simple things like decorating the office with live plants, which provide fresh oxygen and a bright green colour that research shows help humans in many ways, including by improving alpha brainwaves; making use of full-spectrum lightbulbs that mimic natural sunlight which has been proven to lift moods and encourage the production of minerals and vitamins such as Vitamin D which combats depression and increases energy levels; and encouraging employees to get outdoors on breaks and connect to the natural world. Brown also notes that animals as low-maintenance as fish can reduce stress – watching them swim relaxes the brain and gives people a lift.
Tabac says one of the services League offers to its clients is the
Mental Health Concierge, “where employees can live chat with a real
health professional when and where they’re facing a health issue — any
time they need.”
This ease of access is key when it comes to mental health, she says, as when an employee is having an anxiety attack or is in the midst of depression, it’s difficult to figure out who or what to turn to for help.
“Oftentimes, you don’t even know where to start,” Tabac says. “According to a recent survey League conducted with Harvard Business Review, 58% of respondents reported that their employees are unaware of the company-provided health benefits to which they are entitled. This shouldn’t be the case broadly, and especially for something as important as mental health.”
Tabac recommends employers make mental health part of the full-benefits onboarding process, with introductions to specific resources and direction on how to access them.
Find Ways to address Mental Health
“While seasonality can play a role in mental health, it’s crucial
that employers continue to find ways to address mental health in the
workplace year-round,” she says, adding that despite the fact the
Substance Abuse and Mental Health Services Administration reports 1 in 5
adults in the United States experience mental illness each year, only
43% of them received treatment in 2018.
Tabac notes managers “play a significant role in safeguarding the mental health of their teams.”
“It’s critical that they receive education and substantial training,” Tabac says so that they are able to engage in supportive conversations with their team members and to understand when they should escalate to a mental health professional.
She also suggests managers be prepared to lead by example and “share
their own personal experiences with mental health rather than how
someone else’s mental health affected them.”
“As an employer or manager, one of your top priorities is caring for your employees,” Brown says. “Empowering your staff to understand and recognize depression is an invaluable way to support that mission.”
Find ways to communicate
There are a few strategies employers can implement, including creating a simple brochure about workplace depression and handing it out to each staff member or bringing in a speaker or consultant to teach employees to identify the signs of depression and how to seek treatment.
“When your employees understand that their feelings are identifiable,
it reduces uncertainty and may prompt someone experiencing symptoms to
seek professional help.”
Brown also suggests that if employers notice a certain employee seems to have “checked out” at the office, they need to realize depression may be to blame. She says one approach is to have a talk with the employee – “remembering that you are not a psychologist but an employer.” A simple script such as, “Hey, you look a little down. Let’s talk. I’m here for you. Can I help you get counseling?” can be effective.
Small compassionate gestures – which employers can ramp up during the
winter months – can “go a long way toward helping someone deal with
“While the winter months are an important time for discussion and action, mental health is not a one-time fix or something we can ignore the rest of the year,” says Tabac. “We must bring the conversation about it to the forefront in the workplace and provide wellness programs that support people on their mental health journeys year-round. By bringing mental health out of the shadows, investing in the right resources and encouraging leaders to share their personal experiences and struggles, we can create a psychologically safe and healthy environment that improves the overall employee experience.”
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
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
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.
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
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.
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.
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
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
@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.”
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
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.”
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.”
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.
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:
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.TIPIt’s only natural that we experience varying forms of stress and even trauma. However, a healthy brain with neuroplasticity will better weather these storms.
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!)
TIP It’s hard to follow any diet 100 percent, but research shows that even moderate adherence, most of the time, pays off.
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.
TIP Learning and socializing are exercise for your brain.
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.
TIPI 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!
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.
TIPMeditation 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
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.