Tuesday, 15 April 2014

When baby brain ain't your thang...contraceptives in a nutshell

After broaching this topic with patients many times, I have learned that the most appropriate line to open with is probably,  "There are way more options out there than you may think!"

SO, you may be wondering,  "What do I need to know in order to choose the right contraceptive for me?"

The options differ in the many categories: efficacy, cost, duration of action, convenience, side effects/benefits, reversibility and ability to protect against sexually transmitted infections.

You need to choose what is best for YOU.

Let's look at the options individually (in order of most efficacious to least)...

Intrauterine devices (ex. Copper T) or systems (ex. Mirena):
- less than 1% failure rate in first year with typical use
- copper IUDs can last up to 10 years; Levonorgestrel releasing (progestin) IUS's last up to 5 years
- copper IUDs can cause heavier periods, while Levonorgestrel releasing IUS's usually result in lighter periods (occasionally heavier at first), which are more irregular (usually less frequent)
- insertion and removal must be done by a physician
- risks include infection (for 20 days post insertion), uterine perforation and expulsion

Depot provera (injection)
- 6% failure rate in the first year with typical use
- lasts for 12 weeks
- hormone type is progestin
- results in lighter, more irregular periods
- injection must be administered by a clinician
- may cause mood swings or weight gain

Contraceptive pill/patch/ring
- 9% failure rate in the first year with typical use
- the pill requires daily use, the patch is weekly and the ring is monthly
- hormone types are ESTROGEN and progestin
- periods are typically lighter and more predictable (withdrawal bleeds when used regularly)
- contraindicated in women over 35 who smoke, those who are sensitive to estrogen-related side effects, as well as in patients with numerous medical conditions** (see link below for full list)
- may slightly increase risk of blood clots and hepatic adenomas
- may decrease acne and hirsutism, as well as hot flushes during peri menopause

Diaphragms
- 12% failure rate in the first year with typical use
- must be inserted prior to intercourse every time (and used with spermicide)
- access is via prescription
- may increase the risk of urinary tract infections

Male condom
- 18% failure rate in the first year with typical use
- single use
- may be purchased over the counter
- occasionally can break
- best protection against STI's!!!

Well, there you have it! Lots of options and a lot of information to take in. And unfortunately, if none of these options appeal to you, I will suggest what my Catholic school taught me: "Abstinence is the best policy" ;)

References:
UpToDate
**http://www.medscape.com/viewarticle/421497_7





Sunday, 10 November 2013

"No One Said it Would Be Easy"

I'm sitting upon a rooftop patio in Manhattan Beach, soaking in the sun and wondering why I can't spend every Sunday morning doing this. I spent most of last night explaining to my long distance boyfriend's friends why I only ever visit him for 48 hours. I just committed to working New Years Eve, and it was either that or Christmas Day. I had to use a stat day in July just to make it to my friends' wedding rehearsal dinner on time. I haven't once been able to visit my sister in the Carribean because I can't get enough days off to make it worth while.

I think it's safe to say that sometimes being a resident can make you feel like you want to complain. But as my attending likes to say: "No one said it would be easy".

So, when I'm sitting here wondering why I chose this lifestyle for myself, it's a good time to reflect on all the great experiences I've had in medicine.

Take me back to this weekend: I attended a family medicine conference in Vancouver (FMF), where Carolyn introduced me to some of her new resident friends from Calgary. We all got along swimmingly. Given that we all are going through the same residency, and at the same point in our training, I think we just understood each other. These are friends I will now see every year at this conference and I look forward to many conversations with them.

Take me back to med school - where I met some of the best friends anyone could ask for.

Take me back to the day I got into medicine - receiving the email while vacationing in South Carolina with my parents, and crying to my mom because all my dreams had come true.

Take me back to the patient who thanked me for just listening to him talk about growing old; the young patients who tell their mom they want to grow up and be just like me; the patients who I've bonded with during the final days of their life, or the patients who have kept so many emotions bottled up and are so relieved when I ask the right question.

These are just some of the reasons I chose to go into medicine. And in one and a half more years, when residency has flown by, I can practice wherever I want. And the way I see it, sitting on this rooftop before spending a day with patients, will be more rewarding for me than just sitting on this rooftop.

Although, I wouldn't mind doing the latter either. 


Good Ol' Manhattan Beach.


- Lindsey

Tuesday, 8 October 2013

The Good, The Bad or The Common? Help your doctor help you


I have found during my training as a doctor that medicine is just as much an art as it is a science. Few things are absolute or 100%. New studies come out daily, which change the way we practice. Different countries, even provinces may follow different guidelines. It is not that one is necessarily wrong, or the other is right… it is just different.

When patients go to the doctor, say for a headache, doctors are trained to formulate a differential diagnosis. Most of the time we cannot guarantee 100% what is going on. Investigations may need to be done, and follow up appointments made. Treatments may be attempted, stopped and then reassessed many times. When formulating a list of possible diagnoses, most physicians include things that are common and things that are life threatening (even though it may be unlikely). Next time you go to the doctor with an issue, say abdominal pain, here is a little mnemonic to help the visit go smoothly. Being less vague about a complaint will help the doctor arrive at a diagnosis, which in turn will get you the appropriate treatment faster. There are a lot of different ones to use, but this one is relatively easy to remember - OPQRST.
Say you are going to your doctor for abdominal pain:

O – onset
             -When did the pain start? What were you doing? Was it sudden/gradual onset?
P-provocation and palliation 
            -Does anything make it better or worse?
Q- quality
           -What does it feel like (sharp, dull, constant, intermittent). Any other symptoms?
R – region and radiation
           -Where is the pain? Localized or everywhere? Does it radiate anywhere?
S- severity
           -How bad is the pain? Some doctors use a scale - 0 (not bad) to 10(worst pain of your   life). 
T – timing
            - How long has the pain been going on? Has it changed? Have you ever had this pain before?

Hope this helps with your next visit to the doctor! 
Diagnosing a classmate in the early days of training :)
-Carolyn



Wednesday, 2 October 2013

Yoga for Depression and Anxiety!

I apologize for not posting in a while, but I have a flurry of ideas that should keep the blog going for the next couple weeks.

Last week, our Integrative Medicine course director held a journal club where we discussed this article:

Saeed SA, Antonacci DJ, and Bloch RM. Exercise, Yoga and Meditation for Depressive and Anxiety Disorders. Am Fam Physician 2010; 81:8.

To summarize the article, yoga has shown to benefit individuals with depression at a therapeutic level comparable to that of cognitive behavioral therapy (CBT) and some medications (the mainstays of treatment). It has also demonstrated benefit in individuals with anxiety, however there is far less data available on this subject.

I've never really been one for yoga, but after reading this article it really made me consider giving it another shot...not to mention how relaxed I felt after we participated in an hour of yoga followed by a guided meditation. Residency is definitely a busy time and yoga seems to have the ability to help with "de-stressing".

While I wouldn't recommend quitting any current treatment regimens for depression or anxiety without talking to your doctor, if you suffer from either of these, consider adding yoga as an adjunct.

Namaste, right?

Paddle board yoga can be fun too :)


- Lindsey



Monday, 16 September 2013

Peanut Butter Protein Balls: A Quick Healthy Snack

Looking for a healthy alternative snack on the go? One of my most favourite low carb snacks is “Protein balls”. Essentially, I describe them as the healthy version of cookie dough… and we all know everyone is “down with the dough”. They’re simple and quick to make and real kick is- they don't even need to be baked! They’re full of protein, healthy, and can give you that afternoon boost you need. 

Prep Time: 15 mins
Cook Time: 1 hour

Ingredients:

1 cup chocolate whey protein powder
1 ½ cups of crunchy natural peanut butter
½  cup rolled oats
2 tbs flax seeds
2 packets splenda
½  cup of chopped up mixed nuts
1 tbs ground coffee


Put all the ingredients in a mixing bowl and mix as needed. The constancy should be somewhat like cookie dough; depending on the type of protein you use, you may need to adjust the amount of protein or peanut butter.  Roll the protein in to balls (about 2 tbs worth per ball). This makes about 16 balls. You can sprinkle the balls with cinnamon and or flaked coconut for an added delight. For best results, I like let them firm up in the fridge for about an hour.



Enjoy!! 

-Carling

Tuesday, 10 September 2013

Keep Your Sleep Clean as a Whistle - Tips on Sleep Hygiene for the Insomniac

More and more patients are coming into the office looking for a quick fix for their "insomnia".

Inability to sleep can be due to many reasons, but medications are not always the only solution or the best solution. 

Here are some lifestyle modifications to try at home when you're having difficulty catching some z's:

1) Only go to bed when you are tired. Don't force it! If 20 minutes has passed and you still aren't sleeping, get out of bed and go to another room.
2) Keep a regular sleep schedule. I.e. if you have to be up at 5am on the weekdays, staying out till all hours of the night on the weekends isn't going to help you.
3) Once you feel rested, get up! Don't sleep your life away. 
4) Quit the bad stuff: don't smoke, drink, or have coffee before bed. Actually, don't even have a coffee after lunch. Also, quit taking naps!
5) Do the good stuff: exercise 20 minutes a day, 4-5 times per week, eat healthy and don't go to bed famished
6) Deal with your worries before bed. Rumination can keep you up all night. 
7) All in all, think of your bed as a sacred space that can only be used for sleep and sex. Don't read, watch tv, look at your phone or do anything else in your extra special sleep zone. 
8) See your doctor if you still can't sleep. 

Sweet dreams everyone!


Lindsey


References: 

Stephanski EJ, Wyatt JK. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003; 7(3):215. 
Bootzin RR, Perlis ML. Nonpharmacologic Treatments of insomnia. J Clin Psychiatry. 1992 Jun;53 Suppl:37. 

Friday, 6 September 2013

Hey Doc…Get a Job!! Tips on how to find employment in Medicine - by Guest Blogger and #1 Dad, Dr. Peter MacDonald -


In my role as an orthopedic university section chair I frequently get asked for career counseling from fellows, residents, medical students and even pre medical students.
I can remember the same angst that too many medical grads are facing, particularly in our field where there is a recent employment crisis. The most common question from an R4 to R5 resident is “Hey Pete, what can I do to best position myself to someday take your job?”  Having so many people covet your job is flattering but most don’t realize that the road is long and hard with no easy short cuts and at the end of it, my job isn’t as peachy as it looks.  Being a busy surgeon and wearing many hats is onerous and doesn’t leave much free time. Nevertheless, I feel very lucky to have the chosen profession that I am in and look forward to the daily challenges that it brings.

Sooo …here are the tips that I might offer to young budding doctors….

1)   It’s really important that you like your work, so considering employment opportunities is important but you have to do this job for 35 years so make sure your number one priority is to choose something you like!
2)   Identify early on what your life plan is and stick with it. Ambiguity doesn’t help the cause
3)   Been a keener, work hard, try to impress your mentors, but don’t become a pest or be annoying
4)   Demonstrate that you are a team player and a good person with balance in your life including a solid family life and interests outside of medicine.  Be someone that you would want to work with.
5)   Research, publications and awards are important and will enhance your CV to the point where you will be a more attractive hire.
6)   Aspire to train in different places. Medicine is global and the perspective you get from a fellowship elsewhere will help strengthen your training and form lifelong connections outside of your home town.
7)   Shoot for the stars, aspire to work with the very best and their attributes will rub off on you!

If you follow all these tips then it will be more than likely that your dream job will come looking for you, instead of you looking for it.   

Happy job hunting!!!

- Dr. Peter MacDonald 


Pete and his daughters (both authors of Doctor Confidentials) at their white coat ceremonies.





Wednesday, 4 September 2013

Odd study fun.

So- I'm in my second year here, and it's my last term on the island before we get to go to the "real world" for clinical's. The importance of this term is essentially to gear us up for studying for the USMLE. It's one of the most important exams in our medical careers.  That being said, we spend a lot of time going crazy in the library (no, we're not always on the beach). The point of this post is to share the odd thing that my friends and I do to add some fun into our daily lives. We essentially have a group where we post study selfie's. Now, study selfies... one may think thats pretty lame and weird, but I think it's actually hilarious. What I'm trying to say here is- having some odd fun in your day really makes a difference when you're stressed out.  

The rules for our group rules are as follows: 
"- You must post at least one selfie a week to remain a member of this group - the whole point is to keep us updated, as close to daily as possible, with how happy or miserable you are.
- Duck faces/head tilts and all other cliche selfie poses are encouraged
- The more tears the better - we all want to laugh at your sorrow - it will help us get through the day"


Happy hump day people, laugh on!

-Carling 





Sunday, 1 September 2013

GLUTEN-FREE: a fad diet or a solution to an intolerance?

Patients, friends, acquaintances...lately, it seems everyone is telling me that they are "gluten intolerant".

Now, I don't want to sound distrusting, but I'm sure a lot of these people are making self-diagnoses.
And despite what some people may think, gluten-intolerance is not synonymous with "carb-free diet".

So let me take this opportunity to teach y'all a little bit about gluten.

There is a spectrum "gluten issues". These range from gluten sensitivity to wheat allergy to Celiac disease.

Last year, the New England Journal of Medicine published a study by Fasano and Catassi which highlighted the differences between these three. Here is a chart from their article titled "Celiac Disease" titled that I find very helpful:


















The manifestations of the gastrointestinal symptoms of any of these three include the following:

- diarrhea
- bulky, floating stools
- weight loss
- anemia - related to Vitamin B12 or iron deficiency
- osteopenia - related to calcium and Vitamin D deficiency

Not all people present in the same way and there are non-gastrointestinal signs and symptoms of this disease (such as anxiety and depression), but they are much more rare.

Testing by your doctor will include a blood test which looks for an antibody called anti-tissue transglutaminase (IgA). If this test is negative, but there are unexplainable symptoms such as those present in Celiac disease, the patient should undergo duodenal (small intestine) biopsy. Testing should not be done while the individual is gluten-free. In fact, if negative test results are obtained, some people recommend re-testing once the patient has eaten a gluten-rich diet for a few weeks.

So people, if you have these symptoms, tell your doctor. Have some tests done. See a dietician. Don't diagnose and treat yourself or all us docs will be out of a job...and you may be over-diagnosing yourself, or even worse, you may be missing something more ominous than just a mere intolerance.

That's all for Sunday.











Monday, 26 August 2013

Live from Olympic Camp - "Concussions" with Mike Richards

As I mentioned in my first post, I hope to pursue an extra year in sports medicine following my family medicine residency. Concussions are a particular area of interest for me, especially given that they are so common these days and we don't learn much about them during medical school. Athletes in hockey, football, boxing all have the unfortunate experience of concussions. Mike Richards of the LA Kings is no stranger to that. Here's what he has to say all the way from Calgary Olympic Camp:

Me: When was your first concussion?
Mike: I was 18

Me: How many concussions have you had?
Mike: Three officially on the book. I had one that wasn't considered a concussion, but I still missed games with some symptoms.

Me: Describe the immediate feeling of a concussion. What are the symptoms you experience in the days following?
Mike: Usually nothing right away, then after a min or two I've gotten blurred vision out of 1 or both eyes. One of the times I forgot a part of the play and tried to describe it, but missed a part.

Me: Did your subsequent concussions feel the same, better or worse?
Mike: They all felt about the same in terms of symptoms. My last one wasn't as severe a my 2 prior, but I still had the same symptoms.

Me: How do they evaluate you for concussions during a game? After the game?
Mike: Right when you get a head injury, you have to go to what is called the "quiet room". They run you through several memory tests and tests on how you feel. Then the doctor usually makes the call as to whether you can play. If it is questionable as to whether you should go back or not, you and the doctor decide what is best. If you go back and play, you re-evaluate the symptoms after the game.

Me: How do they evaluate you in order to decide that you are ready to play again?
Mike: You have to go through exercise with no symptoms and then you have to do a baseline test to see if you are back to the same results in the test you've done at a prior time.

Me: What's your advice to people struggling to get back to play following a concussion?
Mike: There's really nothing you can do to improve a concussion other than rest. It just takes time.

~ Exit Mike ~

But what exactly is a concussion?
A concussion is also termed a mild traumatic brain injury - basically, it results from a force that causes a brain "contusion" (aka bruise) as well as axonal (nerve component) damage.

The most common symptoms are confusion and amnesia. Occasionally, people experience loss of consciousness, but more often they have altered levels of consciousness.

The most recent tool used to assess concussions is the SCAT3. A link to this form is available here:
http://www.cattonline.com/scat

Patients should NOT return to play on the same day as their injury, nor should they return until they are symptom free. A return to play followed by a second concussion too soon can lead to life-threatening brain swelling.

Patients whose symptoms persist should eventually undergo head CT.

Overall, concussions are serious and shouldn't be taken lightly. Athletes, don't push it too hard!

Hope you learned a bit about concussions and thanks to Mike for the interview! Share your stories with us here...



Mike Richards - enjoying the ocean view in "Calgary".

Sunday, 25 August 2013

You are what you eat


It is one thing to say ‘start eating healthy’ to a patient, and a totally different thing whether the patient understands what that means. I have heard some interesting "healthy eating" strategies. For example, having peanut butter and banana smoothies for breakfast, lunch and dinner (not healthy or likely to result in weight loss). I have heard even more excuses as to why a patient is not eating healthy. For example being on the road or not knowing how to cook.

As a family doctor I think it is important to take the time to counsel patients on healthy eating.  Some physicians get their patients to make food diaries – and then make frequent follow ups to debrief and see how they are doing. Since a bad diet increases an individuals chance of acquiring chronic diseases – ie high blood pressure and diabetes (just to name a few) – there is definitely merit in encouraging good eating habits. 

Here are some general healthy eating tips that I may discuss with patients:

-BMI (body mass index) is a good place to start to determine what your goal weight may be. Calculate your BMI here. Normal is between 18.5 to 24.9.
-Take it slow. You do not want to lose 10 pounds in your first week – that is just not healthy. The optimal rate of weight loss is 1-2 lbs/week
-Fad diets do not work to KEEP the weight off. You need the right balance of nutrients –Canada’s Food Guide is a good place to start. Print it out and put it on your fridge.
-PORTION CONTROL. PORTION CONTROL. PORTION CONTROL. After finishing a plate of food instead of going straight back for seconds have a glass of water (or red wine). It may take a second for your brain to remind you that you are actually full.
-Minimize sugary food and drinks (and alcohol).
-Remember keeping weight off is a lifestyle change that takes perseverance.

Trip to the Calgary Farmer's Market today - some delicious fresh blueberries...
and as a treat Vanilla Bean and Salted Caramel Ice Cream (made by marcus)
YUMMY :)!

Friday, 23 August 2013

Stress: You vs Yourself

Okayyyy so for today’s post I’m going to write about stress/anxiety...

I consider myself a pretty outgoing, confident person who really tries not to let stress or anxiety get to me too much. However, I do have to say that medical school has been a whole different “ball game” so to speak. Being away from my family in an atmosphere where everyone is “buggin’ out” in Grenadian terms (aka uber stressed) can start to get to really anyone.  As for anxiety, I can admit that I’ve definitely experienced that put-on-the-spot jittery feeling, with a racing heart, a red face, complete with the voice cracks of a teenage boy... the feeling that makes you really just want to crawl in a hole and hide. My point is: everyone gets stressed and everyone gets anxiety on different levels (even when you think you're invincible).

I definitely started to let stress get the best of me a few months ago and I want everyone to know that it's very possible to turn things around. I had never experienced any anxiety in my life, so I didn’t really know what was going on when it started. When people used to say that they were having the worst anxiety and that they needed to sit down or something, I’d pretty much shrug it off and say “you’re fine, there’s nothing wrong with you”.  However, karma nipped me in the butt when I too started to experience my own anxiety. My anxiety got so bad that it was to the point where I’d sit at my desk and my heart would just start racing. Then I’d feel a sense of vertigo and just wanted to get out of the library as fast as I could. I tried to blame it on too much coffee, or poor eating habits, or not enough sleep etc. I even at one point thought I had a cardiomyopathy ha (as most med students know, the more info we learn, the more things we try to diagnose ourselves with outrageous things). I started to feel anxious even when I had stopped drinking caffeine. I’ve never been claustrophobic at all, and even simply getting in the back seat of a car started to make me anxious. I felt like I was losing complete control, thinking of any reason under the sun for what could be causing these feelings.  Finally, I came to terms with the fact I, the person who could drink 4 cups of coffee and a red bull a day and feel perfectly fine, had a problem with anxiety.

The next step was now what? Basically, I learned that anxiety is very common in students living away from family, in a setting such as medical school with overwhelming stress, and it even has some genetic factors; my sister Lindsey and I always joke about how our faces turn red when we’re caught off guard, or how our voices both crack if we’re put on the spot and we literally are like-geeze this is soo embarrassing. But anyways, in short, fixing anxiety has to do with the way you think and approach situations. Here are some tips that I think are very useful:

1. Imagine yourself in a situation that makes you anxious over and over until the thought of the situation doesn't bother you anymore 

2. Get rid of black and white thinking and mix in some grey. ie. “oh crap, I’m in a situation that makes me anxious, now I’m going to get anxious, I can feel my heart racing ahh”. That would be the black. The white would be not feeling anxious at all, possibly by avoiding the situation in general. Now go for grey thinking- this situation will probably make me anxious, but it’s likely that I’ll live through it and it won’t be that bad.  

3. Make goals to conquer your fears! 

4. Eliminate avoidance. Avoidance just perpetuates anxiety. 

5. Learn to breathe! Try to breath from your diaphragm and through your nose at a slower rate to help calm yourself down.


Thats all for now!
#happyfriday #nostress

-Carling