Breast Cancer Prevention

By Dr. Yvette Lu.

What can you do to prevent breast cancer?

In this video, I discuss mammograms, who needs them, and behavioural changes you can make to reduce your risk of breast cancer. Check it out!

 

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Are you taking too much Tylenol? Tips on how to use acetaminophen (Tylenol) and other over-the-counter medications safely.

By Dr. Yvette Lu.

Recently Health Canada issued new guidelines for manufacturers of medications containing acetaminophen, a common medication used for pain relief and the control of fevers. Acetaminophen (Tylenol) is a leading cause of liver failure in Canada. Liver failure, in serious cases, can require a liver transplant or even lead to death.

Check out my five minute chat on Roundhouse Radio on acetaminophen and the use of other over-the-counter pain medications, or read my detailed notes below.

Make sure you’re taking Tylenol and these other pain medications correctly.

Roundhouse Radio: Dr Yvette Lu on acetaminophen use

 

***

Q&A on acetaminophen use:

1. Is Acetominphen is still safe to use?

  • Acetaminophen (Tylenol) is a widely used drug for pain control and relief of fevers
  • It is safe if used properly

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2. What are the new labelling guidelines for?

  • Health Canada has recommended new labelling guidelines because acetaminophen is the most common cause of liver injury in Canada
  • Liver injury occurs when a person takes too much acetaminophen
  • This causes toxic byproducts to be produced, which damages cells
  • People can inadvertently ingest too much acetaminophen when they don’t follow the dosing guidelines on the bottle (Eg. take too many or take them too frequently) or when they are taking multiple medications that have acetaminophen and don’t realize it
  • Acetaminophen is found in over 700 over the counter products including combination cough and cold medications and night time medications

3. How much acetaminophen is safe?

  • Adults should follow the directions on the bottle, maximum 1000mg per dose, every 4-6 hours, no more than 4000mg per day
  • Children should be dosed by age and weight
  • People at higher risk include people with liver disease, people who drink 3 or more alcoholic drinks per day, people who take acetaminophen long term (3200mg per day maximum for long term use, 2400mg per day maximum for people with liver injury)

4. What are the signs and symptoms of acetaminophen overdose?

  • Aceteminophen is the most common cause of liver injury in Canada
  • Overdose symptoms can range from vomiting, to abdominal pain, to jaundice, to liver failure and death
  • Symptoms may not start for 24-72 hours so if you’ve taken too much acetaminophen, you should go to the hospital even if you don’t feel any symptoms yet

5. What can I do to stay safe?

  • All drugs have risks and benefits and should be taken with caution
  • Be aware of how many pills you can take with each dose and how often
  • Be careful about how many pills you take, write down how much medication you’ve taken and what time you’ve taken them
  • Read labels and avoid using multiple products with acetaminophen at once
  • If you use multiple medications, check with pharmacist or doctor first so you know what the safe limit is for the number of pills you can take per dose and per day
  • Don’t take acetaminophen long term without medical supervision
  • If you are high risk for liver injury, talk to your doctor before taking acetaminophen
  • If you need acetaminophen for more than a week, see your doctor because the underlying problem needs to be diagnosed and treated

 

Additional links:

Health Canada website: acetaminophen

Visiting Vancouver’s Public Pianos

There are two amazing programs this summer in Vancouver that put pianos on the streets for anyone to play.

I visited some of them today.

Check out my adventure!

 

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Sun Safety Myths: What’s true and what’s not.

By Dr. Yvette Lu.

Summer is FINALLY here, and it’s time to discuss Sun Safety. I review some common beliefs about sunscreen and sun safety in my 4 minute video and more extensively in my blog below.

Please enjoy the video and the lovely freeze frame that accompanies it as the video preview!

 

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Below, I will go over sunscreen and sun safety myths in more detail.

 

MYTH: The higher the SPF the better

There are two types of Ultraviolet (UV) radiation that we worry about, UVA and UVB. SPF refers to the ability of sunscreen to protect against UVB rays. UVA rays age your skin causing wrinkles and age spots, and can pass through glass. UVB rays cause sunburns (B for burn!) and are blocked by window glass. Both UVA and UVB cause skin cancer.

Sunscreens are products that reflect or absorb radiation so that it can’t damage our skin. SPF (Sun Protection Factor) refers to the ability of the product to protect against UVB rays. The numbers aren’t logical (the relationship is not linear), i.e. SPF 30 is not double the protection of SPF 15. SPF 15 protects against 93% of the UVB radiation that hits your skin, SPF 30 protects against 97% of the UVB radiation, and SPF 50 blocks out 98% of the UVB radiation. If you use products with SPF >50 you will get a negligible increase in protection from UVB radiation. Buy a sunscreen that is at least SPF 30, but don’t bother spending extra money on SPF greater than 50, because you won’t get much additional benefit.

SPF

Source: https://www.beyondcoastal.com/page/sun-protection

It’s also important to make sure that your sunscreen protects against both UVA and UVB radiation. Look on the bottle to make sure it says “broad spectrum” protection against UVA and UVB.

This is a striking photo from the New England Journal of Medicine of a man with extensive UVA damage to the left side of his face from sun exposure while driving a truck for 28 years. You can see how the left side of his face is thickened and filled with wrinkles from photodamage.

UVA Sun Damage
UVA Sun Damage

Source: http://www.nejm.org/doi/full/10.1056/NEJMicm1104059

 

MYTH: You don’t need that much sunscreen to be protected.

The Shotglass Rule for Sunscreen.
The Shotglass Rule for Sunscreen. (Image Source: http://biohormonesinc.com/anti-aging/get-the-facts-on-sunscreen-use-anti-aging/)

The amount of sunscreen researchers use when they study the product is 2mg of sunscreen for each square centimeter of exposed skin. Think about that for a second… that’s a lot of sunscreen! Most people apply only 25-50% of the recommended amount of sunscreen. A good rule of thumb is the shotglass rule. The amount of sunscreen that fills a shotglass (one ounce, or 30mL) is how much you need to cover exposed areas of the body for an adult. Since most bottles of sunscreen are 90-150mL, they should be used up after 3-5 applications of sunscreen. If you put on less sunscreen, you will still get some protection, but you won’t get the full SPF protection that is labeled on the bottle. Sunscreens should last for at least three years – however, if you are using it properly, you shouldn’t have to worry about the expiry date because you will have consumed your bottle before then.

 

MYTH: I don’t need sunscreen on cloudy days.

UV rays are present on cloudy days and winter days, and up to 80% of UV rays can still penetrate the skin when it’s cloudy. A better indication of whether or not you need sun protection is to look at the UV index on your local weather report. The UV index looks at how much radiation we are receiving from the sun. A UV index greater than 3 indicates a moderate risk of harm from sun exposure. If the UV index is 3 or greater, put on sunscreen and stay out of the sun during the peak times of 11am to 4pm, when the UV rays are the strongest. Plan your outdoor activities before 11am and after 4pm if possible.

 

MYTH: If I put on sunscreen, I can safely sit in the sunshine.

Sunscreen is meant to provide protection during periods of sun exposure. It shouldn’t be used as a way to increase the amount of time you can spend in the sun. Even if you put on sunscreen, you should still wear a hat, stay in the shade, wear protective clothing, and take breaks from the sun. Apply sunscreen early, about 20-30 minutes before sun exposure to allow the product to form a protective film on your skin. Reapply every couple of hours or after swimming and sweating – even if it’s labelled water resistant!

There are two ways that sunscreens work – via physical block or chemical block. Physical block sunscreens work by reflecting or blocking UV rays. Chemical sunscreens work by absorbing UV rays so that they can’t damage your cells.

Sunscreen mechanisms of action
Sunscreen mechanisms of action. (Image source: http://www.acne.org/spf-sunscreen.html)

Don’t forget your ears, nose and neck when applying sunscreen. A lip product with sunscreen and sunglasses to protect your eyes are also important. Sun exposure can cause cataracts in the eyes.

Do not use sunscreen and insect repellent combination products. Sunscreen is meant to be used amply and reapplied every few hours. Insect repellent is meant to be used sparingly.

Babies can use sunscreen after the age of 6 months. Do a test patch on the baby’s inner arm first to check for reactions. All babies should be kept out of direct sunlight.

 

MYTH: Spray on sunscreens are the same as regular sunscreens.

There are two main concerns with spray on sunscreens: accidentally breathing in the products and adequate protection. When we spray sunscreen, the particles are aerosolized and we can breathe them in. We do not have enough data on whether or not these particles are safe, especially in children. It is possible that they could trigger asthma attacks or allergic reactions. Some organizations recommend avoiding spray on sunscreen in children (unless no other product is available) due to the lack of safety data.

The other concern about spray on sunscreens is that it is difficult to tell if you’ve put on enough, possibly resulting in less protection compared to the cream form. How you spray on the sunscreen and environmental factors like the wind can also affect how much sunscreen gets on your skin. If you decide to use spray on sunscreen, avoid inhaling it as much as possible. Don’t spray it in enclosed areas, and be aware around open flames (BBQs, candles) because some sprays are flammable. It is best to spray the product onto your hands and then rub it onto your skin, particularly when applying to your face. This reduces inhalation and provides better coverage. Apply lots, because it’s harder to assess coverage with sprays.

 

MYTH: Some sun is good for me.

The biggest risk factor for developing skin cancer is exposure to UV radiation.

There is no safe way to tan. Every time you tan, you damage your skin.

It is easy to get Vitamin D in your diet, and ambient sunlight will also provide you with Vitamin D.

We know that UV radiation from the sun causes skin cancer. It is a known carcinogen. Protect yourself!

 

Here is an informative slideshow on the different ways that UV radiation from the sun can damage skin:

http://www.webmd.boots.com/melanoma-skin-cancer/ss/slideshow-sun-damaged-skin

 

Here are some other good websites:

BC Cancer’s Sun Safety website: suntips.ca

Healthlink BC: Protecting Your Skin From the Sun

Canadian Dermatology Association http://www.dermatology.ca/

You are at risk of hearing loss. How to prevent it.

By Dr. Yvette Lu.

May is speech and hearing awareness month, making it the perfect time to discuss how to prevent hearing loss! When I started researching this topic, I was surprised to find that 47% of adults aged 60-79 have hearing loss. Even more interesting is that out of the people who have hearing loss, 70% of adults and 83% of children are unaware of their condition.

For a quick overview of how to prevent hearing loss, check out my recent chat on Breakfast Television. For more detailed information and some fun charts, keep reading!

 

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Who is at risk of hearing loss?

Hearing loss is a problem that we often experience, for example during an airplane flight, after going to a loud concert, or maybe during an ear infection. Usually, these are temporary problems. More concerning is permanent hearing loss.

Age-related hearing loss is the most common cause of permanent hearing loss. We will all get age-related hearing loss eventually if we live long enough. We can’t do much about that… But we can prevent another common form of hearing loss, noise-induced hearing loss. Exposure to excessive noise can also permanently damage hearing.

Permanent hearing loss is an important health concern that is often unrecognized and untreated. It can have many emotional and social consequences including social isolation, mood disorders, safety issues, mobility limitations, reduced income and employment opportunities, and poor quality of life. In children, it can affect academic performance, language development, and learning. A hearing test is one of the first things I order when a child comes into my office with delayed language development.

 

How to prevent hearing loss?

The best way to prevent hearing loss is to protect yourself from loud noises. Repeated exposure to excessive noise for long periods of time can cause permanent hearing damage. A single exposure to an intense sound (like a gun shot) can also cause permanent hearing loss. Loud noises can also worsen age-related hearing loss. Until recently, noise-induced hearing loss was usually caused by excessive noise in the workplace. Now with stricter regulations, recreational and everyday activities are more frequently the cause of hearing loss, especially in young people. Loud mp3 players, concerts, nightclubs, and garden tools are a few of the culprits.

As a general rule, if you have to shout to make yourself heard to someone two meters away, then the ambient noise is too loud. If you have ringing in your ear or dull hearing after exposure to noise, then that noise has been too loud. The key number is 85dB, which is the volume of a lawn mower or loud traffic. Continued exposure to noise above the level of 85dB can cause hearing loss.

Here’s a chart that looks at how long you can be exposed to a noise level before you risk damaging your hearing.

For every 3 dBAs over 85dBA, the exposure time before possible damage can occur is cut in half.

Decibel Exposure Time Guidelines

Source: Dangerous Decibels

Dangerous decibels is a great website with information about hearing loss prevention, particularly in children.

And here’s a chart from WSJ which gives you an idea of what those decibel levels mean in everyday life:

howloudistooloud

Source: Wall Street Journal: Behind the Music: IPods and Hearing Loss

To assess your daily risk, you have to consider all the noise you’re exposed to on a given day – you may have two activities that separately don’t put you at increased risk, but because they both happen on the same day, then your exposure would cross the risk threshold for that day.

Tips for prevention:

  • Don’t have your TV, radio, or music on too loud, particularly if there are young children in the house, as their ears are more sensitive. If you need to raise your voice to be heard above the TV, turn it down.
  • If you can’t hear external sounds when you have your headphones on, or if the person next to you can hear the music, it’s too loud.
  • 60:60 rule – listen to your music at 60% of the maximum volume for no more than 60 minutes per day. Take breaks from your headphones to give your ears a rest. Also be careful in the car, because you are listening to music in a confined space.
  • Use headphones that block out outside noise, rather than turning up the volume.
  • Use ear protection equipment when you work in noisy environments – eg a pub, nightclub, garage workshop or building site, or when using noisy equipment – eg. power tools, yard equipment, riding a motorcycle/snowmobile, using firearms.
  • People worry about not being able to hear properly with ear protection on, but just as sunglasses help vision in bright light, hearing protectors can enhance speech understanding in noisy places.
  • For people with damaged hearing, hearing protection may reduce the ability to understand normal conversation, but protection must be worn to prevent further damage.
  • Use ear protection at loud concerts and other events that have high noise levels like motor races. You can get specially designed musician earplugs if you frequently go to concerts, and sound quality is important to you. At these events, stand away from the speakers and use the chill-out zones, which give you a break from the loudest areas.
  • Give yourself recovery time. You need at least 16-48 hours of rest for your ears away from loud noises after spending 2 hours in 100 dB sound, eg. in a nightclub. Reducing recovery time increases risk of permanent hearing loss.
  • Particularly in children, vaccinations are important to prevent illnesses that can cause permanent hearing loss (eg. measles, chicken pox, mumps, rubella).

 

When to get your hearing tested?

See your doctor if you have any signs and symptoms of hearing loss, for example:

  • asking people to repeat things or speak louder
  • having difficulty understanding or following conversations
  • having to concentrate to understand what people say
  • a feeling that your ear is plugged
  • listening to the TV or radio at a higher volume than in the past
  • ringing, roaring or buzzing in the ear (tinnitus)
  • a feeling that you or your surroundings are spinning (vertigo)
  • ear pain, itching, irritation of the ear, or fluid leaking from the ear

Your doctor will start by looking for reversible and medical causes of hearing loss.

For permanent hearing loss, hearing amplification (eg. getting a hearing aid) can help improve communication and quality of life. Hearing amplification won’t restore hearing completely. It usually improves hearing by only one half of the loss, which is all the more reason to do what you can to prevent hearing loss before it occurs!

I hope this post inspires you to protect your hearing! Please share and comment below.

 

What you need to know before you travel

by Dr. Yvette Lu.

With Spring Break and Easter Holidays this weekend, and summer holidays coming up, a lot of people are making travel plans. What are the health considerations that we need to think about before travelling? Check out my Breakfast Television chat and my tips below!

 

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In my blog below, I will look at

  • what needs to be done before travel
  • what goes in a travel health kit
  • what precautions to take while travelling abroad
  • what to think about when travelling with children

 

What needs to be done before travel?

Here are some basic things to do and think about before you travel. Start thinking about these things early! I have so many people who come into my office a few days before their trip asking about whether or not they need vaccinations. Some of the vaccinations and medications that are required for travel require several weeks lead time before they start taking effect. I tell my patients, book an appointment in the office as soon as you book your plane tickets to discuss your vaccinations!

More “Before You Go” tips:

  • consult a health care provider or travel clinic, preferably at least six weeks before travel to review vaccinations
  • make sure your basic vaccinations up to date – eg. tetanus/diphtheria (every 10 years), measles, mumps, rubella, pertussis, varicella (chicken pox), polio.
  • For certain places, additional vaccinations may be recommended – eg. yellow fever, typhoid, traveller’s diarrhea, hepatitis A.
  • When travelling to warmer areas, you may need protection against malaria (it involves taking antimalarial medication).
  • Check the Health Canada and CDC websites for any travel alerts to the areas you will be visiting.
  • Consider registering your trip with the Registration of Canadians Abroad Service – a free service that allows the Government of Canada to notify you in case of an emergency abroad or a personal emergency at home. It also allows the traveller to receive information before or during a natural disaster or civil unrest. Americans have a similar service called the Smart Traveler Enrollment Program. Many people don’t know about these programs, so spread the word.
  • Buy travel insurance – highly recommended! Health care costs can add up VERY quickly in a foreign country. We are lucky here in Canada, because we have good health insurance, but that is not the case in other countries.
  • Prepare a travel health kit (see next section).

 

What should be in a travel health kit?

It’s important to carry a basic travel health kit with you. First aid supplies and medications may not be easily available in other countries or may be different from those available here. A good travel health kit contains supplies to prevent illness, handle minor injuries and illnesses, and manage pre-existing medical conditions.

Here’s what to put in your travel medical kit:

  • Basic first aid items: eg. bandages, adhesive tape, hand sanitizer, antiseptic wound cleanser, blister pads or moleskin, disposable gloves, gauze, safety pins and scissors, tensor bandage, thermometer, tweezers for removing ticks/splinters, oral rehydration salts.
  • Basic medications: allergy medication, antidiarrheal medication, medication for motion sickness, 1% hydrocortisone cream for minor skin irritation (bug bites, poison ivy), antibacterial and antifungal ointments, cold and flu medications (decongestants, cough suppressants, throat lozenges), pain and fever medication, stomach and intestinal medication.
  • Prescription medication: bring more than enough medication to last your entire trip, at least an extra week. Carry a list or prescription of your medications from your health care provider. If you use needles or syringes, carry a medical certificate from your health care provider explaining that they are for medical use. Bring extra medications. Pack all medications in your carry-on baggage in their original, labelled containers to facilitate airport security and customs screening. Prescription medication is usually exempted from the liquid restrictions but must be presented to the screening officer separately from your carry-on baggage. More information about travelling with medications and with medical devices can be found on the Health Canada Website.
  • Destination specific medication: antimalarial pills, medication for altitude sickness.
  • Be aware that some over-the-counter medications, dietary supplements and herbal and homeopathic products are illegal for import and use in other countries or may require a prescription.
  • Other useful items: moisturizer, eye drops, ear plugs, extra glasses/contacts, sunscreen, water purification tablets or filter.
  • Emergency Contact card – with name and number of emergency contact, health care provider, address and phone number of accommodation at destination. You can also include information about hospitals/clinics at destination, number for your country’s embassy/consulate.
  • Proof of insurance coverage and emergency contact number for travel insurance.
  • Immunization record and proof of immunization — especially if going to a country that requires specific vaccinations (eg. yellow fever).

 

Precautions to take while travelling abroad

When travelling abroad, you don’t want illness and a hospital visit to ruin your trip. Here are some simple precautions that you can take to ensure that you stay healthy while away from home.

  • Prevent insect bites – many travel related diseases are spread by diseased insects like mosquitoes, ticks, fleas, flies. Be aware of insects at your destination that cause disease, make sure you have the appropriate preventive vaccines/medications, and take protective measures to avoid bites.
  • Eat and drink safely – the most common illnesses among travellers are generally from eating food or drinking beverages that are contaminated by bacteria, parasites, or viruses. Precautions include washing hands, only eating food that is well-cooked and served hot, avoiding raw/undercooked food, peeling or cooking fruits/vegetables, avoiding food from street vendors, drinking water only if it has been boiled/disinfected or if it is in a commercially sealed bottle, brushing your teeth using purified or bottled water, avoiding unpasturized dairy products/fruit juices. I know… it seems like sort of a drag since doing some of these things are part of getting a “local” travel experience… but when you think about the consequences (i.e. getting sick with traveller’s diarrhea or worse), it’s worth taking the precautions. Make decisions based on your location of travel and the local health and safety standards.
  • Be careful when swimming and bathing – water (pools, lakes, ocean, hot tubs etc.) may look clean but could be contaminated or inadequately treated. There are also water-based parasites that live in certain countries. Be aware of water safety when doing water based activities (eg. motorized water vehicles, safety of equipment).

 

Travelling with children

Travelling with children can present certain challenges. Here are some tips to make your trip run more smoothly!

  • In children, there is a higher risk for most vaccine-preventable diseases when travelling abroad and these diseases tend to be more severe in children than in adults. Make sure all immunizations are up to date! Some immunizations can be given early or on an accelerated schedule if necessary. Talk to your doctor for more details.
  • Ear pain due to changes in pressure during airplane travel (especially during take off and landing) is more common in children than in adults. To lessen the pain, infants can bottle or breast feed. Older children can chew gum, swallow or yawn.
  • Children can be more sensitive to jet lag and motion sickness. Avoid reading in moving vehicles. Sleeping or focusing on the horizon can also help with motion sickness. An anti-nauseant medication may also be helpful. Make sure you follow the age-appropriate dosing instructions.
  • Travellers’ diarrhea in children can be concerning because they become dehydrated more quickly than adults. Make sure children stay hydrated and consider using an oral rehydration solution.
  • Unfamiliar environments and a change in routine may cause stress for children. For older children, familiarize them in advance with the food, customs, and language of the destination and involve them in developing the travel itinerary. For younger children, a favourite toy or special snacks may help them adjust to a new environment.
  • Traffic laws differ around the world. Even if the use of safety devices like car seats, seat belts, and bike helmets is not required in the destination country, caregivers should follow the practices recommended in Canada as closely as possible. Remember to bring your age-appropriate car or booster seats from home as availability abroad may be limited.

 

Want more information? Check out these links:

http://travel.gc.ca/

http://www.cdc.gov/travel

 

How To Set Health Goals That Work

By Dr. Yvette Lu.

25% of people give up on their New Year’s Resolutions after one week.
36% give up after one month.
By six months, only 46% of people are still working on their New Year’s Resolutions.
Clearly, we have a problem!

The leading causes of death in Canada are heart disease, stroke, and cancer, particularly lung cancer. You can prevent and reduce your risk for these diseases by making lifestyle changes. It’s easy to say you’re going to change, but how to set a goal that will actually work to help you achieve lasting change?

Check out our chat on how to set goals that work. Let’s troubleshoot those New Year’s Resolutions!

 

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Two additional troubleshooting points that we didn’t have a chance to cover in the video:

  • Make sure your goal is something you actually want to do.
    • If you’re having trouble with your health goals, it may be because you’re not ready to make change. It’s very hard to make change if you’re not ready and motivated. Perhaps you’ve only set the goal because somebody else is pressuring you! Go back and look at your goal, and ask yourself, what would I like to change about my life. You are more likely to be successful at your resolution if you truly want to achieve it and are motivated internally.
  • Get help.
    • If you find that you’re still not able to achieve your goal, then you want to go and talk to your doctor and get help. A lot of habits like smoking and overeating are self reinforcing. Our brain gets a chemical reward when we do those activities, so it makes it hard to quit. For example, when we overeat or eat sugary foods, our bodies release endorphins, chemicals which make us feel happy. Your doctor can help with behavioural strategies, and in some cases medications. There are some medications that are available to help reduce cravings, especially for smokers. Some people may also have an underlying disease like depression or anxiety that may be causing them to smoke, overeat, or drink too much alcohol. It’s important to treat the underlying illness, as those habits will be very tough to break without treating the underlying problem that’s causing those behaviours.

 

Troubleshooting summary for setting health goals:

  1. Set specific goals.
  2. Make sure your goal is achievable.
  3. Don’t exhaust your willpower by working on too many goals at once.
  4. Make sure your goal is internally motivated.
  5. Get help!

 

Now, go out there and set yourself some goals! Good luck!

Facts you need to know about HIV

By Dr. Yvette Lu.

Today is World AIDS Day.

36.9 million people have HIV worldwide.

About 75,000 people had HIV in Canada at the end of 2014.

About 21% of HIV positive people in Canada are unaware that they have HIV. That’s about 16,200 people in Canada who DO NOT KNOW that they have HIV.

It is estimated that 7 Canadians are infected with HIV every day.

HIV is a virus that attacks the immune system. Without treatment, HIV wears down the immune system to the point where it can no longer fight infections and cancer. When this happens, we say that a person has AIDS. Not everyone who has HIV will develop AIDS.

With the treatment we have today, HIV is a chronic illness and with early and regular treatment, people with HIV may not develop AIDS and can expect to live into their early 70s.

The key to living a healthy life with HIV is early diagnosis and early treatment, so get tested! It’s better to know. Then you can get treatment.

More details on HIV testing in our 4 minute video. Check it out!

 

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More information on HIV Prevention:

  • Most of HIV in Canada is spread through unprotected sexual contact
  • You can NOT get HIV from casual contact like shaking hands, hugging, or sharing dishes/drinking glasses
  • Some ways to reduce your risk of exposure to HIV:
    • Choose less risky sexual behaviours
    • Use protection consistently and correctly (condoms)
    • Reduce exposure by having fewer sexual partners
    • Get tested regularly for sexually transmitted infections including HIV
    • Ask your partner to get tested before sexual contact
  • If you have ongoing high risk of exposure to HIV, there are medications that you can take to lower transmission rates. This is called pre-exposure prophylaxis. The medications help keep the virus from taking hold in the body, but must be taken regularly to work. (Note: This is not currently funded in British Columbia, but may be funded by private medical insurance.)
  • If you think you have been exposed to HIV, there are medications that can help prevent your body from becoming infected with the virus. This is called post-exposure prophylaxis. You need to see the doctor as soon as possible after the exposure (within 3 days), and take the medications daily for a month for the medications to work properly and reduce your chance of getting HIV.

 

More information at:

AIDS.gov: U.S. Government HIV/AIDS information.

CATIE: Canadian Information about AIDS and Hepatitis C

Smart Sex Resource: a website by the BC Centre for Disease Control

BC Centre for Excellence for HIV/AIDS

 

 
How Can I Prevent HIV Transmission?

 
 

Facts about HIV in Canada

 

 

Preventive Health: Here are the tests you need to do to keep you and your family healthy.

by Dr. Yvette Lu.

 

Last week on Breakfast Television, I reviewed some of the tests that we need to do as we get older.

Here’s the video (5 min):

 

Since we had limited time on the show, here are more details about what we talked about, plus additional information on items that we didn’t have a chance to chat about during the Breakfast Television segment. Preventive health is very important. It’s probably clear to everyone why! If you catch a disease early, you have a better chance of getting it under control and preventing it from causing significant problems in your body. Here are some of the basic tests we use and discussions we have for health prevention. Some people may need additional tests that I haven’t mentioned here (for example, based on their family history), or they may need tests more frequently that what I’ve written below. This list serves only as general guideline, a gentle reminder, and a starting point for talking to your physician. Care should always be individualized to each person.

 

Kids

  • Immunizations (http://www.immunizebc.ca/vaccine-schedules).
  • Dental care.
  • Vision checks, especially in early childhood, then every 18-24 months, or more frequently if needed.
  • Hearing check, especially in early childhood.
  • Regular growth checks for height and weight gain.
  • Talk to your kids about bullying, school, friends, and their mood, particularly stress, sadness and anxiety. An estimated 1.2 million Canadian children and youth are affected by mental illness, but less than 20 per cent will receive appropriate treatment. If you detect mental illness early, you can address it and possibly prevent it from becoming a lifetime problem.
  • Consider checking Iron, especially if diet is unhealthy.
  • Consider checking Vitamin D levels, especially if you live in places that are far from the equator (eg. Canada).
  • Monitor screen time – no more than 1-2 hours per day for children aged 3-18, and none for children under the age of 2. Excessive screen time can lead to attention problems, obesity, school difficulties, sleep disorders, eating disorders, and risky behaviours. In children under the age of 2, the brain is developing rapidly and it’s best for them to interact with people, not screens.
  • Ensure your child gets regular physical activity.

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Teens

  • Immunizations (http://www.immunizebc.ca/vaccine-schedules).
  • Regular growth checks.
  • Dental care.
  • Vision checks, every 18-24 months or more frequently if needed.
  • Communication: Stay involved in their lives. Find out what their friends are doing, what pressures they’re facing. Talk to your teens about alcohol, smoking, sex, and drugs. Be a supportive presence. Have family dinners.
  • Be aware of potential mood disorders, especially anxiety, depression, and ADHD (Attention-deficit/hyperactivity disorder). 1 out of 7 children and youth in BC are affected by mental illness (about 14%) and 50-70% of mental illness will present before the age of 18. The earlier we detect these conditions, the better the chance we have of treating them successfully.
  • Monitor screen time (as described above, aim for less than 2 hours per day) and physical activity levels.

 

Adults of all ages:

 

Women in their 20s onwards:

 

Adults in their 40s onward:

  • Most guidelines recommend diabetes screening between the ages of 40-45, or sooner if high risk. This is a blood test, and it should be repeated every 3-5 years or sooner if high risk. If sugars are in the prediabetes range, then they should be checked every year. Canadian guidelines recommend testing based on a risk calculator instead of age.

 

Women in their 40s onward:

  • Breast cancer screening: Between the ages of 40-50, mammograms are optional, and can be done up to every two years. After age 50, mammograms are recommended every 2 years until age 75. For those older than 75 years old, mammograms can be done every 2-3 years depending on health status. Mammograms are recommended yearly starting at age 40 for people with a first degree relative (mother, sister, daughter) with breast cancer. Should you start getting mammograms at age 40? For more insight, watch my 4 minute Breakfast Television chat on mammograms: “The Mammogram Controversy“.

 

Adults in their 50s onward:

  • Colon cancer screening – A stool test to check for blood every 1-2 years or a colonoscopy every 5-10 years depending on your risk level, until age 75. In British Columbia, MSP covers stool screening every 2 years for people at average risk, and a colonoscopy every 5 years for people at higher risk (one first degree relative diagnosed at younger than 60 years old, 2 first degree relatives diagnosed at any age, or a history of adenomas).
  • Heart Disease: Talk to your doctor about screening for heart disease to see if you’re at increased risk. Prevalence of heart disease increases after age 45 for men, and after age 55 for women. This involves checking your blood pressure, cholesterol, and talking to you about your risk factors. If you have symptoms and signs of heart disease, your doctor may order additional tests.

 

Men in their 50s onward:

 

Adults in their 60s onward:

  • Pneumococcal vaccine is recommended after age 65 (prevents pneumonia caused by pneumococcal bacteria). People with certain chronic diseases can get this vaccine earlier.
  • Shingles vaccine is recommended after age 60. You can get it starting at age 50, but it is most effective in people age 60-69, partly because the disease is more common in that age group. Shingles is a painful blistering rash caused by a reactivation of the chicken pox virus. It can cause post-herpetic neuralgia, a condition in which people get chronic nerve pain long after the rash has disappeared. The vaccine reduces the risk of getting shingles by 50%, and reduces the risk of post-herpetic neuralgia by 67%. Protection lasts at least 6 years and the vaccine costs approximately $200.
  • Abdominal Aortic Aneurysm screening:  An abdominal aortic aneurysm is an enlargement of a section of the aorta, the major blood vessel that supplies blood to the body. The aorta is normally about the thickness of a garden hose. It runs from your heart through the center of your chest and abdomen. Since the aorta is the body’s main supplier of blood, a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Screening is recommended in males aged 65-75, especially smokers or previous smokers, or people with a positive family history of Abdominal Aortic Aneurysm. Canadian guidelines recommend screening men aged 65-75 regardless of smoking status. For women, the screening decision is based on risk factors (history of smoking, cerebrovascular disease, and family history).
  • Osteoporosis screening: Osteoporosis is a bone disease which causes bones to become weak and brittle, leading to an increased risk of fractures after age 65. Screening should start at age 65 with a Bone Mineral Density exam, or sooner if you are at increased risk according to risk calculators.

 

Adults in their 70s onward:

 

Adults in their 80s onward:

  • Watch for memory loss.
  • Social issues:  living situation, coping at home, social support, social isolation.
  • Mental illness can be common in the elderly and often presents with physical symptoms like fatigue instead of depressed mood.

 

Websites:

http://www.screeningbc.ca

http://canadiantaskforce.ca/

http://www.uspreventiveservicestaskforce.org/

http://www.aafp.org/patient-care/clinical-recommendations/cps.html

http://healthlinkbc.ca

 

 

The NHL has the Mumps. What are Mumps anyway?

by Dr. Yvette Lu.

Mumps.

We’ve all heard of mumps, but most of us don’t really know what they are. They sound like things that creep out from under your bed, or maybe something green and globby that grows on food you’ve left too long in the fridge.

Most of us were also blissfully unaware that we could get the mumps…

That all changed when our Hockey Canada poster boy Sidney Crosby’s test came back positive for the disease last week.

I talked about the mumps with Breakfast Television’s Jody Vance this week. While we covered the main points, we didn’t have time to get into the details of who needs to be vaccinated and why. So let’s do that now.


First, here’s the video: (it’s about 3.5 minutes long)



What are mumps?

Mumps is a contagious disease caused by the mumps virus. Like I said in the video, for most people it starts off like other viruses: fever, headache, muscle aches, tiredness, loss of appetite. Then, within about 48 hours, 95% of people who get those initial symptoms will get parotitis — swelling of the parotid gland in their face — and the swelling can last up to 10 days.

You may have seen some photos online… like this one:

Sidney Crosby
Source: http://www.cbc.ca/sports/hockey/nhl/sidney-crosby-diagnosed-with-mumps-1.2872807


Why do we care about the mumps?
(other than not wanting a swollen face)

Most people with mumps do recover fully, but some people can have serious complications, and that’s why we recommend that everyone follow the vaccination guidelines for mumps.

Complications include:

  • Viral meningitis (inflammation of the lining of the brain and spinal cord) and encephalitis (inflammation of the brain), especially in young children.
  • Transient or permanent hearing loss in 0.5-5/100,000 cases.
  • Orchitis in 20-30% of post-pubertal (i.e. adult) males. Orchitis is inflammation of testicles and results in severe testicular pain and swelling. Long term complications of orchitis can include testicular atrophy (shrinkage) in up to 30-50%, and impaired fertility in approximately 13% of men.
  • Mastitis (inflammation of the breast) in up to 31%, and oophoritis (inflammation of the ovaries) in 5-7% of post-pubertal (adult) women.
  • Sterility in both males and females if both testicles or ovaries are affected (rare).
  • Increased risk of miscarriage for women in early pregnancy.
  • Injury to organ systems, eg. thyroid, heart, kidney, joints, pancreas (rare).

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How is Mumps spread?

Mumps is very contagious. The incubation period (the time from when you contact the virus to when you start showing symptoms) is an average of 16-18 days, and you can be contagious before you start showing symptoms! 15-20% of people have mumps and never show symptoms but can still pass the disease to others!

Remember Ebola? R0 looks at how easily a disease is spread from one person to another. One person with Ebola will spread the disease to, on average, two people. One person with mumps will spread it to an average of ten people in a susceptible population!

Source: http://www.npr.org/blogs/health/2014/10/02/352983774/no-seriously-how-contagious-is-ebola


Of course, Ebola is a lot more deadly than mumps, but as we saw above, mumps can still cause serious complications.

A few months ago, there were a lot of questions about whether or not Ebola is spread by airborne transmission. Ebola is not airborne. Mumps, however, is airborne, and can spread through the air on respiratory droplets that can float and infect someone some distance away if they breathe in the particles. Mumps can also be spread by direct contact with secretions from the mouth and nose (kissing, sharing drinks) and by touching objects contaminated with the virus, and then touching your mouth or nose.

So…

  • Wash your hands
  • Don’t touch your face, mouth, or nose with unwashed hands
  • Don’t share food and drinks, particularly not with someone who is sick
  • Don’t kiss anyone who is sick!
  • Clean surfaces frequently, especially if someone in the vicinity is sick
  • Get vaccinated!



Who needs the mumps vaccine?

Most people born in Canada before 1970 were exposed to mumps as a child and have natural immunity to the disease. Most people born after 1970 have had at least one dose of the vaccine. (Note: The US guidelines use a cutoff date of 1956 instead of 1970.)

Check your immunization records to make sure you’ve had at least one dose of the vaccine if you’re born after 1970!!

On your vaccine record, it may appear as “MMR” or “MMRV”. It might also appear as “Mumpsvax”, “Priorix”, “Priorix-Tetra”, or “MMR II”. If you’re not sure, bring it in to your doctor and ask them.

The mumps vaccine is good but it is not 100% effective. It’s about 62-91% effective if you get one dose, and about 76-95% effective if you get two doses. As a result, people at high risk of getting the mumps need TWO doses of the mumps vaccine.

High risk groups include:

  • Children
  • People in secondary and post-secondary educational institutions
  • Military personnel
  • Travellers to outside North America
  • Health Care Workers

If you fall in one of those groups, make sure you’ve had TWO doses of the mumps vaccine.

The mumps vaccine is combined with the measles and rubella vaccines in the MMR immunization. You can also get the mumps vaccine in MMRV – a 4 in 1 vaccine which gives you protection against MMR and Varicella (chicken pox). The mumps vaccine is no longer available on its own. Don’t get the vaccine if you’re pregnant. If you’re immunocompromised, talk to your doctor before getting the vaccine.

Note: All people born after 1970 need two doses of the measles vaccine, so while you’re checking your immunization record for mumps, check it for two doses of measles vaccine as well! All people born in British Columbia after 1996 should have had two doses of MMR if they received their routine childhood immunizations.

Is the MMR Vaccine safe?

A quick note about the MMR vaccine. It DOES NOT cause autism. Multiple studies have shown NO CORRELATION between MMR and autism. If you look on the internet, you will find people claiming that it does, and they are basing their beliefs on a study that has been retracted from the medical literature and shown to be false. The author falsified data and did not follow ethical scientific procedures, and has had his medical license taken away. More on MMR vaccine safety here: http://www.cdc.gov/vaccinesafety/vaccines/mmr/mmr.html

The key to remember is that vaccines are MUCH SAFER than the diseases they prevent. Do you remember all those complications that I listed at the beginning of this post? The reason why we recommend the mumps vaccine is to prevent all those bad things from happening. Those are all real risks, and the chance of them happening is much higher than the chance of getting a major adverse effect from the vaccine.

And the mumps vaccine works. Mumps cases have decreased by more than 99% since the approval of the vaccine in Canada in 1969, from 34,000 cases per year to less than 400 cases per year in the 1990s, to 28 cases in 2003. Since then, there have been a few outbreaks (usually in non-immunized religious communities or on college campuses), but overall, the numbers have remained low. However, since the vaccine is not 100% effective, it’s important for as many people as possible to get immunized so that we can build up herd immunity.

What is herd immunity?

Imagine herd animals huddling in a ring around their young to protect them. They form a barrier so that their young are safe from enemies. In the same way, when most people are immunized, they can fight off the virus and are less likely to spread it. The disease tries to attack them but can’t because these immunized people already have antibodies. The antibodies are like soldiers that fight off the virus and protect the body. In this way, the immunized people create herd immunity, a barrier to prevent disease from spreading to the most vulnerable in our population.

What happens after I get vaccinated?

After you get the vaccine, most people will have antibodies in their blood by 5 weeks after immunization. Most people will be protected with these antibodies, but since the vaccine is not 100% effective, not everyone will be immune. However, even if you catch mumps after vaccination, being vaccinated will help you get rid of the virus faster from your body and will reduce your risk of getting those nasty complications. Neither catching the “wild” mumps virus naturally nor getting the vaccine will guarantee lifetime immunity. However, most people who have caught the disease or who have had two doses of the vaccine will be protected long-term.

What do I do if I think I have mumps?

Treatment for the mumps is supportive. Rest, drink your fluids, and take acetaminophen (Tylenol) or ibuprofen (Advil) if needed. Since it’s a virus, antibiotics will not work. Antibiotics work only on bacteria, not on viruses. If you’re worried you have mumps and are going to see your doctor, call your doctor first to warn them. They will likely have you visit at the end of the day or put you in a separate waiting area so that you do not accidentally infect others. Mumps is so contagious that the government keeps close track of cases to prevent and control outbreaks.

Stay home when you’re sick, so you don’t infect others. You are contagious from a few days before you show symptoms to 5 to 9 days after you start feeling sick. Wash your hands and cough into the crook of your elbow. In particular, stay away from babies, pregnant women, and people who are immunocompromised. These people may not have immunity to the mumps, and/or are at higher risk of complications from the mumps.

Remember! Make sure you’re vaccinated!! Go check… now! And tell your family and friends to check their immunization records as well. Share this and other vaccination information with them. We need to build our herd immunity so that we can all stay safe from preventable diseases.




More information:

US Center for Disease Control: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt09-mumps.html
BC Center for Disease Control:
The basics: http://www.bccdc.ca/dis-cond/a-z/_m/Mumps/default.htm
Technical document: http://www.bccdc.ca/NR/rdonlyres/8D7495ED-B903-4B6D-B168-9364660D2001/0/MumpsSeptember2014.pdf
BC vaccination schedules: http://immunizebc.ca/vaccine-schedules
Health Canada: http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-mump-orei-eng.php