Sunday, 7 September 2014


Part of taking a full history from a patient is learning what medications they are on. I think it is also important to know what vitamins/supplements patients are taking. There are some interesting ‘cure all’ remedies out there (many of which are completely ridiculous). Are there any vitamins/minerals that should be taken? Definitely, for certain populations anyway…

I don’t commonly dissuade patients from taking vitamins or supplements, but I will take a stand if I think they are wasting their life savings, or causing them harm. Most of us in developed countries will get the required vitamins and minerals from eating a healthy diet (and so a multivitamin is really unnecessary). So what do I commonly recommend?

Vitamin D – This is the only vitamin I consistently recommend to all patients. Most, if not all of us, will be deficient in Canada (because of the lack of sunlight exposure during the winter months). Vitamin D is important for bone health, and may also be good for our mood, cancer prevention and cardiovascular health (although studies are ongoing). How much? 1000-2000 IU/day. (The guidelines actually recommend 600-800 IU/day, but it seems the trend among family doctors is to ‘prescribe’ slightly higher doses).

Folic Acid – Women who are PLANNING on getting pregnant should take folic acid.  This helps to prevent neural tube defects (NTDs) like spina bifida. Since these defects occur within the first month of pregnancy, it is recommended to start taking folic acid (or a prenatal vitamin) at least 3 months prior to conception. How much? 400-800 mcg/day for women who have not previously had a child with a NTD. I often recommend taking a prenatal vitamin like Materna that has folic acid and other vitamins that pregnant ladies may need.

Calcium – In postmenopausal women, especially those with osteoporosis, 1200 mg (total diet plus supplement) of calcium is recommended.  In premenopausal women and men 1000 mg is recommended. Calcium is also important for bone health. Often if you are eating a balanced diet with dairy and green leafy vegetables you are meeting the quota without needing supplementation. Here is a link with calcium content of some common foods: 

Some people may need to take other vitamins/minerals depending on their situation. For example, a lot of young woman require iron. Or those with dietary restrictions, celiac disease, crohn's disease etc may require a number of different supplements. In those situations it is important to talk to your doctor.  Just be careful of different 'elixirs' that are marketed for exuberant amounts that are really not necessary. And remember vitamins, minerals and supplements are not all harmless, so let your doctor know what you are taking! I will do another post discussing remedies used for disease and disease prevention that seem to be popular, and if there is any evidence that they work (ie - glucosamine for arthritis).

Vitamins galore! (market in Barcelona)
Next up: As winter approaches (I am living in Yellowknife at the moment and we actually had snow last night), what can you do to prepare? We want to get this blog back up and running so we are going to try at least twice weekly posts!

Tuesday, 19 August 2014

Amyotrophic Lateral Sclerosis Ice Bucket Challenge - say what?

The other day, I was involved in a discussion about the "ALS Ice Bucket Challenge". I'm sure this has been a common topic of discussion amongst people lately, given how viral the campaign for raising awareness has been. It kind of caught me off guard though, when the person I was speaking with said, "I get that this campaign raises awareness for ALS, but how many people doing the challenge even know what ALS is? I know I don't even know what the acronym stands for". 

As a medical student/resident, you develop your own vocabulary. I often find myself telling a story to my friends and they look at me like I'm speaking a foreign language. It's easy to forget that common knowledge to someone in medicine is not the same as common knowledge in other professions. So, for anyone who doesn't know what the disease entails or what the acronym stands for - I have put together a mini lesson:

ALS: Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's disease after the famous Yankee baseball player who had the disease

What is it?
- Neurodegenerative disease involving both upper and lower motor neurons (see below for signs)
- Progressive and incurable

Who does it affect?
- 1 to 3 people per 100,000
- Genetic or familial in only 10 percent of cases
- No ethnicity predominantly
- Men more than women before age 65-70, then affects each sex equally
- Most commonly occurs in 7th and 8th decades

What are the features?
- Upper motor neuron signs: slowness, hyperactive reflexes, spasticity
- Lower motor neuron signs: weakness, muscle atrophy/pain, visible muscle twitching (fasiculations)

How does it usually present?
- asymmetric limb weakness, difficulty with swallowing and speech are the most common

Why is it fatal?
- ALS eventually leads to neuromuscular respiratory failure or inability to swallow

The ALS Ice Bucket Challenge:

By now, you have to have been living under a rock to not have heard of this campaign. How it started though, seems to be less publicized. Initially having nothing to do with ALS, the "ALS Ice Bucket Challenge" as we know it was started when a golfer named Chris Kennedy was nominated for the Ice Bucket Challenge. The original challenge involved the ice and the bucket, but allowed you to make donations to a charity of your choice. Since he had a relative affected by the condition, he chose the ALS Association. He posted the first video on July 16th, 2014 and the campaign caught on like wild fire. Within a month, Martha Stuart, Oprah, Lebron James and Mark Zuckerberg had all posted their videos. But is this just a social media trend?

Many articles lately have scrutinized the campaign. Opinions about the challenge have been voiced by associates at TIME magazine, Forbes, among many other notable magazines and newspapers. The most popular concern amongst critics seems to be regarding those people who participate in the challenge, but don't donate to the charity. However, as of today, the ALS Association has received 22.9 million dollars since July 29th, compared to only $1.9 million during the same period last year ( 

So, while I am not a huge fan of social media fads, I believe the proof is in the pudding - it's likely about time I accept my nominations and keep this icy ball rolling.

Oh, and don't forget to donate :)

Cheers to getting chilled!

Best picture I've seen - Ryan van Asten completes the ALS Ice Bucket Challenge with his friend, Kyle, who has ALS.