Fall/Winter 2019 • Vol. 12 No. 2
In Atlantic Canada
ON A ROLL
Becoming her own advocate for accessibility
Your oral health
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Fall/Winter 2019 • Vol. 12 No. 2
In Atlantic Canada
ON A ROLL
Contents
Becoming her own advocate for accessibility
Your oral health
Dental exams, fresh breath, oral health & nursing homes
Features
New joint: new life 12 15 A tough call for some
Hip replacement surgery takes a team effort
Donna D’Amour
Should you get the new (expensive) shingles vaccine?
Departments
12
5 Ask the professionals 7 Ask the professionals 9 The wellness column Patient’s story 18 21 A steak-out 23 Your oral health
Walking—the wonder drug
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Bigstock/Dragon Images
Meningitis and children
9
15
Vegan versus omnivorous diets
On a roll
The truth about protein
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Living Healthy In Atlantic Canada Volume 12 Number 2 Date of Issue: October 2019 Living Healthy in Atlantic Canada is a publishing partnership between the four dental associations of the Atlantic Provinces and Saltscapes Publishing Ltd. Editorial Board
Dr. Margot Hiltz MSc, DDS Representative for the Newfoundland & Labrador Dental Association Penney Miller Communications Manager, Nova Scotia Dental Association Dr. Brian D. Barrett DDS, FACD, FICD, FPFA, FADI Executive Director, Dental Association of PEI
Saltscapes Co-Publishers Jim & Linda Gourlay • gourlays@saltscapes.com Advocate Group Publisher Fred Fiander • ffiander@saltscapes.com Editor-In-Chief Jim Gourlay • jgourlay@saltscapes.com Associate Editor Jodi DeLong • jdelong@saltscapes.com VP Sales and Marketing Linda Gourlay • lgourlay@saltscapes.com Sales Director Patty Baxter • pbaxter@saltscapes.com Account Executives Susan Giffin • sgiffin@saltscapes.com Pam Hancock • phancock@saltscapes.com Kathy Greene • kgreene@saltscapes.com Connie Cogan • ccogan@saltscapes.com
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Beth Arsenault, BSc, BA, Communications Specialist NBDS
Living Healthy in Atlantic Canada is founded upon the premise that the most effective health care is illness avoidance. Our mandate is to help inform the general public within Atlantic Canada as to how they might take steps to promote their own good health and that of their families…How they might improve the quality and extend the length of their lives, and those of their loved ones. Living Healthy in Atlantic Canada is published by Metro Guide Publishing Limited in collaboration with the following strategic partners who provide support, medical expertise and mentoring with respect to editorial content:
Sales Support Assistant Jennifer Williams • jwilliams@saltscapes.com Production & Creative Director Shawn Dalton • sdalton@saltscapes.com
Production Coordinator Paige Sawler • psawler@metroguide.ca Production and Design Assistant Nicole McNeil • nmcneil@metroguide.ca
Dental Association of Prince Edward Island
Senior Designer Graham Whiteman • gwhiteman@saltscapes.com Designer Roxanna Boers • rboers@saltscapes.com
New Brunswick Dental Society
Designer Jocelyn Spence • jspence@metroguide.ca Talk to us Send your letters to the address below, or email jgourlay@saltscapes.com. Include your name, the name of your town or city and telephone number. Letters that appear in the magazine may be edited for length and clarity.
Newfoundland & Labrador Dental Association
Living Healthy in Atlantic Canada is published twice a year by: Saltscapes Publishing Limited 2882 Gottingen Street, Halifax, NS B3K 3E2 Tel: (902) 464-7258, Sales Toll Free: 1-877-311-5877
Nova Scotia Dental Association
Contents copyright No portion of this publication may be reprinted without the consent of the publisher. Living Healthy in Atlantic Canada can assume no responsibility for unsolicited manuscripts, photographs or other materials and cannot return same unless accompanied by S.A.S.E. Publisher cannot warranty claims made in advertisements. Printed by: Advocate Printing & Publishing, Pictou, NS
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Living Healthy In Atlantic Canada •
Fall/Winter 2019
Ask the professionals
Walking—the wonder drug Why the 10,000-steps fad is both bogus and beneficial By Darcy Rhyno
Glenn Clark
Since retiring to Nova Scotia, Melda keeps active daily by collecting and bagging roadside litter. She counts coffee cups, and has a Facebook page where you can guess the number of cups in a photo and possibly win a prize. See the page “Oceans Matter” on Facebook.
Two years ago, at the age of 59, Melda Roache Clark described herself as morbidly obese. At more than double a healthy Body Mass Index for her five-foot two-inch frame, she was in heart attack territory and suffering the physical effects of obesity. “Every step is a struggle,” says Roache Clark. “Your feet hurt all the time. Climbing up hills or stairs, you’re huffing and puffing. If you have grandkids, you can’t keep up with them. There are a lot of things you just wouldn’t bother participating in.” As she grew older, she gained weight because of a job that kept her seated all day, a sedentary lifestyle at home, a poor diet and “a long history of major clinical depression. It’s been very hard to be active because it took every bit of energy just to put one foot ahead of the other.” Taking the first step One day, in the summer of 2017, Roache Clark simply took a walk. “The sun was shining or the universe was aligned just right. Anyway, I seemed to have a little bit of extra energy,” is how
she puts it. She left her house where she was living in Ontario and walked along the highway a couple hundred metres. “I wondered if I was going to stay alive long enough to get back home,” she says. But she made it back home, and a few hours later took a second walk. The next day, her shins and ankles ached. The soles of her feet felt like they were on fire. It was the first time she’d walked any distance for 13 years. But, in spite of the pain, she took another walk. On the third day, she drove into town and walked around. Her last stop was at a shoe store where she bought better footwear. Each day, she walked a little further, but each day, she suffered more pain in her feet and legs. While Roache Clark knew she was pushing it, she fought through the pain and continued walking and reaching for her new goal. She bought herself a Fitbit and began keeping a record. “I find numbers very motivating. Committing to 1,000 seemed very doable. I started it in August and by September I got to 10,000 steps.” Fall/Winter 2019 •
The 10,000 steps phenomenon Roache Clark is part of a worldwide fitness craze focused on reaching 10,000 steps daily. Devotees are on the streets, glancing at their electronic pedometers. They’re on the treadmill at the gym, working toward their daily goal. They’re on social media, posting another consecutive day of reaching that magical milestone. Bloggers, public service organizations and health gurus around the world have made it part of their activities and promotions. Roache Clark herself wrote about her experience in a couple of posts on her blog. The fad began more than half a century ago on the other side of the world. In 1964, Tokyo hosted the Olympics. At the time, walking clubs were popular in Japan. A company called Yamasa created the world’s first wearable pedometer and a clever promotional campaign to cash in on the big event. They named the device the manpo-kei, which translates as the 10,000step meter and marketed it with the slogan, “Let’s walk 10,000 steps a day.” The fad of counting 10,000 steps took off because of a catchy idea, an impressive, round number and a fancy piece of new technology. A wonder drug According to Korede Akindoju, “There really isn’t a lot of research that 10,000 is a magical number.” Akindoju is the
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wellness facilitator and physiotherapist with the community health team for Bedford, Sackville and Halifax. She says that while no minimum daily step count has been identified to stay healthy, “Some studies mention 7,500, others 8,000. I’ve seen some as low as 5,000.” Still, Akindoju understands the attraction of 10,000. “The number is really simple to spit out, so people have just run with it.” Different numbers are appropriate for different people, she says. The goal should vary according to circumstances, including—as Roache Clark learned—how new people are to this kind of exercise. “We know that some determined individuals with chronic conditions may only get 3,000-5,000 steps per day, but they’re making that effort to be active, and that’s important.” For the average person, she adds, “If you’re completing 5,000 steps, it’s certainly better than zero, and you’ll see the benefits.” Regardless of the step count, walking does indeed have significant health benefits. According to a Harvard Medical School study,
“Walking can have a bigger impact on disease risk and various health conditions than just about any other remedy that’s readily available to you.” Harvard quotes Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, who claims that walking is “the closest thing we have to a wonder drug.” The authors of the study write, “Walking for 2.5 hours a week—that’s just 21 minutes a day—can cut your risk of heart disease by 30 per cent.” The authors cite other studies that have found walking to be “as effective as drugs for decreasing depression.” Physical activity and goal setting Canadian guidelines on physical activity are offered in measurements of time rather than steps. The Heart and Stroke Foundation recommends 150 minutes of physical activity per week for adults. Each period of activity needs to be at least 10 minutes. Kids need more, at least an hour each day. On its website, Doctors Nova Scotia reports that only 15 per cent of adults and nine per cent of children in Nova Scotia are meeting those guidelines.
Still, the number 10,000 remains important to many people. It has clearly worked its magic on Roache Clark. Because she’s a blogger, she could make her progress public, which was a way to further commit to her larger goal of a healthier lifestyle that included improvements in her diet. She’s lost 100lbs. and says, “The abundance of energy is the most beneficial part and being able to keep up with my grandkids.” Walking does have limitations and downsides. Akindoju is concerned that a strict walking regime could prevent people from taking on rigorous exercise that’s so important for heart health. She says, “The beauty is, you can accomplish Canadian physical activity guidelines doing a number of activities. At the end of the day, we should be focused on moving more, rather than on a number.” As for Melda Roache Clark, she retired to Nova Scotia and pushed herself to 20,000 steps per day by adding a strong motivational element—collecting and bagging litter from the roadside.
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Living Healthy In Atlantic Canada •
Fall/Winter 2019
Ask the professionals
Meningitis and children Vaccination is critical
Bigstock/ TOFUMAX
By Jodi DeLong
Babies and toddlers cannot tell us how they are feeling, and sometimes there’s more going on than we as parents might think. Occasionally, a group of symptoms including sudden high fever, lethargy, stiff neck and headache, light sensitivity and other signs may suggest a form of meningitis. While not as common as they once were, infections of meningitis can be serious, with longterm damaging effects such as brain damage, deafness, learning challenges and seizures. Yet what we hear and read about meningitis can be very confusing. Happily, there are medical professionals who are expert in deconstructing the info out there for parents. What is meningitis? Meningitis is an inflammation of the protective membranes, the meninges, that cover the brain and spinal cord. Infection by various bacteria, viruses, and more rarely, fungus, will trigger swelling of the meninges, but other, more rare
greatly decreased and is now very uncommon in vaccinated children.” Before the vaccines were developed, bacterial meningitis was a cause of death (about 10 per cent of cases) and neurologic deficit (example, hearing Left: If you are concerned loss) in patients. that your child is unwell, There are also different types of you should consult a viral meningitis. Dr. Langley says health care professional for assessment. that some are very serious (example Herpes meningitis) and some are less Below: This guide serious and get better on their own is available on the over time. Due to vaccines against Meningitis Research bacterial meningitis, viral meningitis Foundation website. is now more common in children causes of the inflammation than bacterial meningitis. can include reactions to Dr. Langley also certain drugs, injuries to explains that some the head or spine, and pathogens are more likely types of cancer. to cause illness at certain Dr. Joanne Langley times of life. “For example, is an infectious disease people less than two years of specialist and deputy age and older than 65 years director of the are more likely to get serious Your guide Canadian Centre for pneumococcal (Streptococcus Vaccinology at the pneumoniae) meningitis or IWK in Halifax. She blood infections. People of any explains that the two main age can get viral meningitis.” types of meningitis are bacterial and Occasionally, a newborn contracts viral pathogens. the disease when it is exposed to “Bacterial meningitis is a serious bacteria that may cause meningitis as and life-threatening infection,” she it exits through the birth canal. states. A number of different species Meningococcal disease is not of bacteria can cause meningitis, exactly the same thing as meningitis; although “since the introduction it is specifically caused by the Neisseria of routine immunization programs bacteria, and can result either in against Streptococcus pneumoniae, meningitis or septicemia, a serious Neisseria meningitidis and Haemophilus infection in the bloodstream. The influenzae type B, the incidence Centres for Disease Control indicates of bacterial meningitis has it can be spread by close contact Recove
ring fro m menin childhood ba gitis an ct d septi erial caemia
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Calnen
Dr. Joanne Langley is an infectious disease specialist and deputy director of the Canadian Centre for Vaccinology at the IWK in Halifax.
with the saliva of others (coughing, sneezing or kissing) but is not normally as contagious as other forms. Many signs are the same as in meningitis, but if bacteria has spread into the bloodstream, symptoms such as cold chills, aches and pains in muscles and joints, and diarrhea may be present. If a dark purple rash develops, treatment is urgent. There are very effective antibiotics to treat the disease, and dedicated vaccines against the bacteria.
Prompt diagnosis Normally, the pathogens that cause bacterial meningitis are spread from one person to another by a number of means—from food that has been contaminated, from other infected people coughing or sneezing in close proximity, or from carriers—who carry the bacteria in their bodies but do not get sick. Occasional outbreaks take place on university campuses, where large groups of people live and attend classes and other activities together. Children who are not vaccinated or who have weak immune systems due to such conditions as immune deficiency, a recent transplant, or cancer treatments are more susceptible to meningitis than are healthy children. Symptoms of bacterial meningitis generally appear three days to a week after exposure, although this is not easy to track timewise
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Living Healthy In Atlantic Canada •
Fall/Winter 2019
if there’s no knowledge of a prior exposure. Children with meningitis may be confused, bothered by light, be lethargic, have a headache, nausea and/or vomiting, or exhibit a stiff, sore neck and fever. If you are concerned that your child is unwell, you should take your child to a health care professional. Viral meningitis is the more common form of meninges inflammation, and people often recover without treatment. A number of common viruses can occasionally cause meningitis, including mumps, measles and influenza viruses. It’s still very important to see a health professional because the form needs to be diagnosed. Infants less than a month old and those with weakened immune systems are more apt to have illness from viral meningitis. A health professional will take a history of the illness, do a physical examination, take blood tests, and do a lumbar puncture—removing some fluid from the area surrounding the spinal cord. Treatment and prevention Once diagnosis is confirmed, treatment can commence. “Depending on the cause of the meningitis, antibiotics or antiviral medications may be used,” Dr. Langley says. She adds that there are very few treatments for viral meningitis, and, of course, antibiotics do not work on viral diseases. The most important way to prevent bacterial meningitis is to make sure your child receives all recommended vaccines. Dr. Langley says, “the vaccines routinely provided to children prevent more than 20 types of meningitis.” Before the MMR (measles, mumps and rubella) vaccine was developed, those diseases could lead to viral meningitis, so vaccinations have greatly reduced cases of meningitis. Prevention is half the battle with many diseases: staying healthy with adequate sleep, exercise, good nutrition and excellent hygiene, especially around other people who are sick will, help prevent many infectious diseases.
The wellness column
Vegan versus omnivore diets It’s not quite that simple
Dr. Caldwell Esselstyn, author of Prevent and Reverse Heart Disease.
“I liked eating meat,” says John Van Gurp, a 58-year-old retiree from Halifax. “In fact, I used to have meat days. Every once in a while on a Friday, I’d come home from the store with the ribs and the beef and just barbecue meat with the flames and the smoke. I loved it.” That was before 2015 when Van Gurp experienced what he describes as a real shock. He knew his cholesterol was high. His doctor even tried him on cholesterol medication, but Van Gurp says he couldn’t tolerate it. Still, he didn’t think of himself at risk of illness. “With walking and bicycling, I always pictured myself as being pretty healthy.” Then his doctor diagnosed him with arterial blockages. “It was right out of the blue,” says Van Gurp. Heart surgery followed. He walked away with a couple of stents and a whole new mission in life. “It really upset me. I realized I had to do something,” says Van Gurp. The something he did was to take charge of his own health. “I am not somebody who does things in bits and pieces. I consider something like this a challenge.” The vegan mission Recent events—the success of Beyond Meat and other plant-based meat substitutes, as well as the August release of the United Nation’s Special Report on Climate Change and Land that suggests the world needs to move away from meat to help address climate change—have renewed interest in vegetarian and vegan diets. So, when
Bigstock/Dragon Images
By Darcy Rhyno
Just because you don’t eat meat, doesn’t mean your diet has to be boring.
Van Gurp starting researching, it wasn’t difficult to find resources. “The first book I read was called Fall/Winter 2019 •
Prevent and Reverse Heart Disease by Dr. Caldwell Esselstyn. In that book, the whole thrust is to go with a 100 per cent plant-based diet, and no oil either. It’s all based on an antiinflammatory diet.” Van Gurp became a vegan. No more Friday meat barbecues. It’s no big deal, he says. “You just learn different cooking techniques. The beauty of it is that it’s so easy to find interesting recipes.” He considers all the changes he’s made completely positive. “My diet has become far more varied and probably far more nutritionally rich. My palate has changed to enjoy spicy foods like curries. I put chili paste in many things and lots of fresh herbs from our garden.”
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When asked specifically what foods are prominent in his vegan diet, Van Gurp says, “We eat a lot of vegetables. We eat a lot of legumes, chickpeas, lentils and various types of beans, whether they’re roasted in a pasta or cold in a salad or turned into a paste that’s the basis of a burger.” Vegan vs omnivore It’s not just the health gurus Van Gurp follows that support his belief that a vegan diet leads to better health. According to the Doctors Nova Scotia website, “Beyond the political choice of going vegan—consuming no animal products at all—there are many known health benefits for cutting out meat in favour of a plant-based diet, including a natural increase in fibre and vitamins, a lower body mass and a decreased risk of heart disease and diabetes.” When asked if a vegan diet is healthier than an omnivorous diet, Angela Dufour says, “Not necessarily. It really depends on the types of foods you’re choosing.” Dufour is the lead performance dietitian with Team Canada and the Canadian Olympic Committee. “A longitudinal study linked consumption of red meats to premature death,” she says. “It suggested that every additional serving of unprocessed red meat increased risks by 13 per cent and every additional serving of processed red meat increased risks by 20 per cent. This caused a big uproar in the media, demonizing red meats.” “It’s important to note that the findings aren’t duplicated everywhere,” Dufour continues. “Other studies found no link between moderate red meat consumption of less than three ounces a day and premature death, or no link between unprocessed red meats and cardiovascular disease or diabetes.” Cutting dairy products from the diet is not necessarily a healthier choice “There’s no reason to avoid dairy,” says Dufour, “but if you are worried about saturated fat intake, the healthy components of dairy—16 vitamins and minerals—can also be achieved from a balanced vegetarian or vegan diet, with careful planning.”
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Fall/Winter 2019
Not all healthy Dufour says “many popular junk foods could theoretically be classified as vegan. Don’t be fooled by the word vegan on a food item. Vegan does not necessarily equal healthy. A lot of vegan products marketed as healthy options may have added sugars and salts.” The presence of such additives is one of the criticisms of the new plant-based burgers that are appearing at more and more restaurants. “There are some nutrients of concern due to an avoidance of dairy and meat,” says Dufour. “Iron needs of vegetarians can be up to 1.8 times greater than those of non-vegetarians. Iron deficiency is especially important in teenagers, during pregnancy and for female endurance athletes.” Iron from plants is harder to absorb than that from animal sources. Doctors Nova Scotia recommends combining iron-rich leafy greens with foods rich in vitamin C to help the body absorb the iron. Try a stir-fry with Swiss chard and bell peppers or a strawberry smoothie made with a handful of spinach. “The bottom line,” says Dufour, “is that evidence is lacking in being able to credibly suggest one way of eating over the other. Whether you eat animal products or not, making healthy choices still plays a big part in leading a healthy lifestyle.” “A lot of people call vegetarianism a diet and veganism a lifestyle. That’s because vegans are mindful of their consumption of any animal-derived products. People may become more mindful about their food choices and portions, start to increase physical activity, and be conscious of how their mental health affects eating patterns.” John Van Gurp is feeling great these days about his switch to a vegan lifestyle. When he’s out at non-vegan restaurants, there’s almost always a vegan option on the menu. When invited to dinner with family and friends, he says they’re always accommodating, often preparing a vegan meal just for him. “The last time I went to my cardiologist, he said I don’t need to be followed.”
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When he was 35 Derek Stewart was diagnosed with rheumatoid arthritis.
New joint: new life Hip replacement surgery takes a team effort By Donna D’Amour
“We see people in their 40s upwards to 80s and 90s having their hips replaced. Some people have early onset arthritis”
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As we
age we often hear friends or family complaining of a bad hip, making it difficult to get up from a chair, in or out of a car, or to manage stairs comfortably. Some parts of our bodies, particularly joints such as our knees and hips, can wear out while we still have a lot of years left in us. Fortunately, doctors are able to replace these parts to allow us to carry on doing things we want to do. But they can’t do it alone. Each surgery takes a team effort with the patient being an active participant. Recent hip replacement patient Pat Paul, age 87, says she was monitored by her orthopedic surgeon every six months for five years. “I had a real pain in my left foot. The doctor checked things out and told me the problem was that I had one leg shorter than the other. He also indicated to me that my left hip was at a Level 4 and my right hip was at a Level 2. He recommended that I get the left hip replaced,” she says.
Treatment starts with an assessment. Alissa Decker, program manager of the Orthopedic Assessment Clinic attached to the Veterans Memorial Building in Halifax, says, “You would come in and meet with a nurse case manager and a physiotherapist who would do an assessment to see how you are managing your life. How much pain you are having; how it is impacting
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Fall/Winter 2019
your daily activities and your quality of life. They would look at your X-rays to discover your arthritis level. It can range from 1 to 4, with 1 being mild and 4 being severe.” “What the person’s expectations are, often determines the need for surgery,” says Deidre Curiston, physiotherapist, Pre-habilitation Clinic. “We see people who have jobs such as carpenters. They still have to be able
Bigstock/edwardolive Donna D’Amour
X-ray scan image of hip joints with orthopedic hip joint replacement implant head and screws in human skeleton in blue gray tones.
to work in a more physical job. Their work life may be impacted by their arthritis. They might be ready to have a hip replacement to allow them to be active and to function longer. Whereas somebody who is not active, might be just puttering around the house, might be able to manage their pain and in terms of their activity level, they might not be that impacted.” Decker says you could have a person with Level 4 arthritis who can cope without surgery and a person with Level 2 arthritis who needs surgery to keep doing what they usually do. Each patient is different. “We see people in their 40s upwards to 80s and 90s having their hips replaced. Some people have early onset arthritis. People in their 40s with level 4 arthritis still have a long work life left, are still very active and the pain can greatly impact their activity,” says Decker. “We try to hold people off since that new hip has a shelf life. Generally it lasts a range of
Bigstock/nd3000
Try seated activities such as using an exercise bike or an elliptical machine, where your whole body weight is not going through your leg.
10 to 15 to 20 years; each individual is different. If they have surgery at a younger age, at some point, they would have to have the original replacement hip, replaced.” The assessment clinic and wellness model offers arthritis patients a number of options, before considering surgery. “We want people to be as active as possible, do the appropriate exercises, manage their weight, try different bracings, take medications to manage pain, as well as modifying activities,” Decker says. “Surgery is the last resort.” “My cardiologist also had to be consulted. I had had open heart surgery to repair a leaking valve a few years before. After giving me both an echocardiogram and an electrocardiogram, he gave his approval.” Most people have a hip replaced because of osteoarthritis. Deidre Curiston says. “Arthritis runs in families, but there are other factors Fall/Winter 2019 •
as well: the way we use our joints; previous injury, which can cause the hip to deteriorate more quickly; extra body weight, which is also a risk factor for developing osteoarthritis.” She says people think of the deterioration of cartilage, but the entire joint deteriorates: the bone underneath the joint, the muscles surrounding the joint, the lining of the joint, as well as the cartilage. Cartilage acts like a shock absorber between the hip joint, when it is broken down or missing, the bone on bone movement causes pain. Factors affecting the need for surgery include, X-ray results, a person’s lifestyle, their function, how well they get up and down from a chair, how their walking is affected, how bad their pain is. Staff want to make sure patients are aware of the many possible options for treatment before surgery is considered. “Education and activity is the first line of intervention,” says Curiston. “It should be the first thing that we try, and a lot of people get better from their arthritis just from that.” She says education about pain management, weight management and an appropriate exercise routine really helps. “The wrong type of exercise can aggravate the joint. We tell people to do activities that put less weight or less stress on the joint: water activity, where your body weight is supported by water; seated activities such as using an exercise bike or an elliptical machine, where your whole body weight is not going through your leg. Tai Chi and walking are also recommended.” She asks people to do 150 minutes each week of such exercise. She says physiotherapists can work on getting the joints moving better, having the biomechanics working better. “You do the activity and strengthen the muscles around the joint to protect the joint.” Once the decision is made to go ahead with hip replacement surgery there is a wealth of education available to make the experience as pleasant as possible. Preparation is key.
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Donna D’Amour
“Discharge planning needs to start the moment you decide to go this route because you are going to need to be prepared,” says Michelle Biso, Orthopedic Assessment Clinic Prehabilitation RN case manager. Biso provides two types of programs. “We have a pre-habilitation program for people who are on the surgical wait list. The team includes myself as a nurse, Deidre the physiotherapist, an occupational therapist, a nutritionist, as well as resources through a social worker. We support the patient. We do an assessment and they take an eightweek class of education and exercise with us. Two days a week they have an hour of exercise each class and one hour of education.” Biso says that if those with osteoarthritis don’t get out often, they may not be able to do the things they used to. Some people may have depression from not getting out. The environment in the class helps people relax. It’s a learning situation but also a social gathering. Peers learn from each other as well as from the instructors. Some participants may have already had surgery and can share their experience. The second program is a presurgical class at the Orthopedic Assessment Clinic in Halifax as well as one in Dartmouth General and Cobequid. “We talk about what to expect before, during, and after surgery. It optimizes their outcomes.” In keeping with the team approach, patients are asked to bring a “coach” along to the session. This can be a friend or family member who will see them through recovery. Patient Pat Paul was very impressed with the day-long pre-surgery series of interviews ending with the pre-surgical class. She met with the pharmacist to review her medications and explain any changes pre- and post-surgery; a nurse who took her vital signs, and reviewed her medical history; an anesthesiologist where Pat requested a spinal anesthetic, which she was told was given in most hip replacement surgeries. Pat also asked that she not be given hydromorphone and was assured there were alternative pain medications
Part of the team working with patients with hip and knee problems: Deidre Curiston, physiotherapist, Pre-habilitation Clinic, Alissa Decker, program manager, Orthopedic Assessment Clinic, and Michelle Biso, case manager RN, Pre-habilitation Clinic.
available. After tests including EKG, blood, urine and X-rays, she went to the pre-surgical education class. In one segment, they actually passed around the titanium joint that would replace the natural joint. “The ball and socket are replaced in a total hip replacement, which is what we see most often,” says Biso. “The ball part is the top of the femoral head and the stem goes inside the femur (thigh bone); the socket goes into the part of the pelvis called the acetabulum. Joints can be made of different materials; titanium is commonly used. They can be a combination of metal or ceramic or metal and plastic. The rough exterior of the new joint encourages new bone tissue to adhere to it.” Most patients are released from hospital the day after surgery, but some might stay longer if medical issues arise. “They have to be able to get up and down from a chair and walk a distance that is reasonable for their home situation. If they have stairs at home, they need to be able to get up and down the stairs with minimal assistance or supervision, so we know they are going to be safe at home,” says Curiston.
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Pat Paul says she was fine when she got home because she had someone staying with her. “I’m pretty agile so I often do things others would not do. I was making meals, doing my daily exercises.” “Hip replacements are very successful procedures,” says Curiston. She says most people have had so much pain prior to surgery, they are happy the pain is gone. They can move the joint much better, they can tolerate putting weight through the joint, they can walk further. Their level of activity is greatly improved. Most people are happy with the outcome. In 2018, there were 1,625 hip replacement surgeries in Nova Scotia. “Our goal is to increase that number and there has been a lot of funding to provide four new surgeons across the province, a new anesthesia and new operating room times,” says Decker. Wait times have gone down considerably as a result. Some people have surgery after six to eight months, some prefer a particular surgeon who may have a longer wait time. “The goal is to meet the sixmonth wait time set by the Canadian Institute for Health Improvement.”
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A tough call for some Should you get the new (expensive) shingles vaccine? Pat Chute.
By Darcy Rhyno
Her
father-in-law is 93. “He fell ill about two years ago, and he ended up with shingles,” says Pat Chute. “I remember seeing it down his hips and the backs of his legs. It was red blisters, it was weeping. It looked awful. She and her husband David operate the Cooper’s Inn in Shelburne, Nova Scotia. Her father-in-law’s case is just one of many on her mind these days. “We were hearing more and more stories of people having shingles and how painful it was,” says Chute. The gory details of these stories and her fatherin-law’s illness scared her. “I’ve heard of people getting it on their forehead and their scalp. People would talk about the pain that went on for months.” The stories drove the Chutes to act. “Hearing all that, I wanted to take measures,” says Pat. “When they announced this new and improved vaccine, I said I’m going for it.” Both she and David headed to the local pharmacy, TLC Pharmasave in Shelburne, to ask about the new vaccine. When they spoke to TLC pharmacist and owner, Colleen MacInnis, the Chutes discovered that
the new Shingrix vaccine would cost them more than $300 each. The price surprised them, but the Chutes knew they were at risk for shingles. Both are past 50 and had contracted chickenpox as children. Pat’s was a mild case, but at the age of nine, complications from David’s case resulted in encephalitis or swelling of the brain. He was hospitalized. The Chutes had no hesitation at paying the fees to protect themselves Fall/Winter 2019 •
against what they knew could be a serious illness. First came the chicken pox The microscopic beast that causes shingles is a virus, Varicella zoster, the very same that causes the familiar childhood illness we all know as chickenpox. Shingles (the scientific name is Herpes zoster (HZ)) occurs when the dormant chickenpox virus that’s sleeping in the infected person’s nerve ganglia becomes reactivated. That’s why anyone who’s had chickenpox should consider themselves at risk for shingles, especially later in life. According to Health Canada, “Age is the most important risk factor for development of HZ. More than twothirds of the cases occur in individuals over 50 years of age.” The older the patient, the more severe the symptoms can be. “Up to 10 per cent of persons
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Pharmacist Colleen MacInnis and her family.
Courtesy of Colleen MacInnis
over 65 years of age will be admitted to hospital with an episode of HZ.” Age isn’t the only risk factor, however. According to Colleen MacInnis, “Either you’re stressed out or your immune system takes a hit or you’ve been sick. Some people get it after an accident. Fishermen will get it from leaning over the side of the boat. The nerve itself becomes irritated, or the immune system that affects the nerve becomes worn out, and the chickenpox virus that’s been hanging out there for years shows itself as shingles.” The bottom line is, according to MacInnis, “Anyone over the age of 50 who has either had chickenpox or been immunized against it has the ability to develop shingles.” Because the virus sleeps in the nervous system, when it awakens as shingles, it causes pain and unilateral vesicular eruptions (that translates as rash and watery blisters) in an area of skin with nerves from a single spinal root. This single root is also why shingles often erupts in a swath or stripe around the torso or elsewhere on the body. Because the pain is nervebased, it can become so severe as to be considered debilitating and can last more than three months after the blisters and rash first appear. Infection rates are high—up to 30 per cent of the population. While death from shingles is very rare (only about 20 per year in Canada) complications from the disease can be severe. The most common is Postherpetic neuralgia (PHN). Health Canada says PHN is “characterized by prolonged and often debilitating neurogenic pain that lasts for more than 90 days from the onset of rash. Because treatment options for PHN are of limited effectiveness, PHN often has major adverse impacts on quality of life.” They estimate about 130,000 new cases occur each year in Canada with 17,000 new cases of PHN. In older patients and those with compromised autoimmune systems and chronic conditions like diabetes, shingles can lead to complications like
pneumonia, bacterial infection and nerve palsies. There is a misconception that shingles is contagious. “You can’t catch shingles from someone else who has shingles,” MacInnis explains. “But if you’ve never had chickenpox or you’ve never been vaccinated against chickenpox and don’t have an immunity to it, you could catch chickenpox from someone with shingles. The first appearance of the virus has to be chickenpox.” Because children are now vaccinated against chickenpox, MacInnis says the spread of the virus is more a concern for those with children or grandchildren too young to be vaccinated. To prevent the spread of the virus, she says, “We recommend people cover shingles because it’s the actual blisters and the fluid inside that has the virus.” The new vaccine When Pat Chute talks about a new and improved shingles vaccine, she’s referring to Shingrix. It comes in two doses, an initial injection and then a booster between two and six months later. It’s only been around a few years, but healthcare professionals like Colleen MacInnis are strongly recommending it over Zostavax, the previous vaccine. “Shingrix is about 90 per cent effective,” says MacInnis, adding that no vaccine is 100 per cent effective. “I believe Zostavax was between 40 and 46 per cent. And Shingrix is certainly longer
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lasting, guaranteed for four years. In comparison, Zostavax immune rates were dropping after the first year. By year four, Zostavax is virtually not effective.” In fact, says MacInnis, Shingrix is so new, it could be effective well beyond four years. “We’re following the ongoing data,” she says. Even those who have had the Zostavax vaccine in the past should consider the new Shingrix vaccine now because of the short lived protection offered by Zostavax. Because Zostavax is still on the market, MacInnis recommends asking specifically for Shingrix. Still, cautions MacInnis, those numbers don’t apply evenly to all members of the public. “Younger patients tend to have a better immune response to the vaccine,” she says. “If you get it at 50, unless you are immunocompromised, your immune system is more robust. If you get it at 90, you’re probably not going to get a 90 per cent effectiveness rate.” The downsides: side effects and expense “I had side effects,” says Pat Chute, “which I wasn’t counting on. This was one painful shot in the arm. Holy smokes, it stung. I could hardly lift my arm for a day and a half. About two inches around the injection site became very red, angry, itchy, burning and sore.” Chute lost a couple night’s sleep and was about to return to the pharmacy when the symptoms subsided. “I never did ask anyone about it, but people said it
was probably a very small case of chickenpox on my arm.” Her husband had no reaction at all. Pat Chute’s reaction was not unusual, and she did not have chickenpox. “There are side effects,” says MacInnis. “Most people have a bit of a headache, some malaise or general flu like symptoms. Some people have itching or redness at the injection site, but that only lasts two or three days.” “It’s similar for all vaccinations,” says MacInnis. “I like to say that if you feel like you’re fighting something off, you kind of are. That’s how you feel when your immune system is being activated—under the weather.” While Pat and David Chute were willing and able to pay the fee for the vaccine, Pat says, “I think the cost is very prohibitive. I know a lot of people who say they can’t do it because of the price.” MacInnis agrees. Even though the vaccine is tax free, she says,
“It is prohibitive for some people. Hopefully at some point, the drug plans and government will realize that it’s more cost effective to immunize people up front than it is to spend the money to help prevent the complications of shingles.” MacInnis has some money-saving suggestions. Not all pharmacies charge the same for the vaccine, so it’s worth shopping around. Some drug plans cover the shingles vaccine. MacInnis recommends getting the drug identification number from a pharmacy and calling the drug plan company to ask if it’s covered. She also says that pharmacists can do everything a patient needs for the vaccine from assessment services through to providing the required injections. However, each step has charges associated with it. But some, says MacInnis, are coming to her pharmacy with a prescription from their doctor. “There’s a bit of a cost savings,” says MacInnis.
Her most inventive tip is to put the vaccine on your wish list. “Some people are buying it as a gift for their elderly parents or loved ones,” she says. “We’ve had that at Christmas time.” Should you get the new shingles vaccine? If you’re older than 50 and have had chickenpox or been vaccinated against it, you are susceptible to getting shingles. This new vaccine is much more effective and longer lasting than the previous, but the older the person, the less effective the vaccine will be. Symptoms can be severe and even debilitating, but shingles is rarely fatal. The cost is definitely prohibitive for some. In the end, taking all these factors into consideration means that the decision to get the shingle vaccine is a personal call. As for Pat Chute, she says it’s given her peace of mind. “I feel relieved. I’m counting on its effectiveness.”
Thanks to medical research, Carol’s back on the road to health. Enthusiastic traveler, Carol Peterson is happy to support DMRF’s 2019 Molly Appeal. Carol’s trip to Surgical Oncologist, Dr. Carman Giacomantonio for immune therapy halted dangerous squamous cell carcinoma, and has Carol back making travel plans.
100% of gifts to DMRF’s Fall Molly Appeal will help fund sophisticated mass spectrometry equipment – allowing Dr. ‘G’ and his team to better develop individualized cancer immunotherapies. For ways to give, and more of Carol’s story, please go to mollyappeal.ca. Please make your cheque or money order payable to:
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Dalhousie Medical Research Foundation m I prefer to use my: mVISA mMC mAMEX
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m I do not wish to have my name appear in the DMRF annual report or have my gift publicly acknowledged in any donor recognition program.
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5743 UNIVERSITY AVENUE SUITE # 98 • PO BOX 15000 HALIFAX, NOVA SCOTIA B3H 4R2
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Patient’s story
On a roll A young paraplegic becomes her own advocate for accessibility
Casey Perrin was not about to let a set of stairs get in her way. Not after surviving an accident that paralyzed her and a meningitis infection that resulted in a brain injury. On a Sunday afternoon in June 2011, a few weeks before her 19th birthday, Casey and a group of friends were travelling on fourwheelers on a gravel road near Oxford, Nova Scotia, when something went horribly wrong. The ATV Casey was a passenger on struck the wheel of another ATV and she was thrown off, landing in the ditch and breaking a vertebra in the middle of her back. Twelve days after the accident and following two operations to put rods and screws along her spine, she contracted bacterial meningitis when a doctor apparently neglected to suture an incision after he removed a drain from her spine. Antibiotics, and the 24-hour vigilance of her mother, a registered nurse, pulled Casey through the six-week coma but the infection left her with impairments in her right arm. “When I came out of the coma, I didn’t remember how to talk,” she says. “And my hand stayed like this” (she curls her hand and wrist against her chest). “It’s not my dominant hand anymore because I don’t have the same sensation in both hands now.” She can make a fist with her right hand, but she can’t curl her fingers around a pen. 18
Bruce Murray/VisionFire
by Sara Jewell Photography by Bruce Murray/VisionFire
Casey Perrin. “All I wanted was to get to my class on time and probably use the bathroom first.”
By 2012, she was doing rehab in Halifax as an outpatient, so Casey and her mother, who drove her everywhere, moved in with Carol’s sister in Dartmouth. “Aunt Karen went to MSVU. We were talking about what I was going to do, and Mom wanted me to try going to university. My aunt said, ‘Case, you can do it.’” In the fall of 2013, Casey enrolled in one class, but it wasn’t until her second year that she came up against the reality of accessibility. Taking more classes in Seton Academic Centre, she discovered there was only one accessible bathroom in the entire building, and none on the fifth floor. “That made me mad,” Casey said. “They made a big deal about gender inclusive bathrooms, but they didn’t care if there was an accessible stall.”
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There was also a problem getting between buildings. “The doors from the Link were very heavy. How was anyone with a disability in a wheelchair supposed to get into the library?” She emailed then-president Dr. Ramona Lumpkin about the problem and “the next week, an automatic door was installed.” Casey was shocked this was the first time the president had heard about the issue. When the university’s newest building, McCain Centre, opened in 2015 it was touted as being “100 per cent accessible.” Casey soon discovered no automatic door buttons on the outside of the bathroom doors while under the sinks, a piece of wood covering the pipes meant Casey’s knees hit that wood and she couldn’t fit to wash her hands.
Courtesy of Casey Perrin
Communications Nova Scotia
“Anybody who is disabled doesn’t like code,” Casey says of the building code and the expression “it’s up to code.” “To be truly accessible, you have to go beyond code.” When she had classes in separate buildings 15 minutes apart, and no accessible bathroom to use, she went to Accessibility Services and requested her class to be moved into the newer building. She suggested that her human rights were violated. “The woman at AS said, ‘What records do you have of that?’ and I was like, you’ve got to be kidding me. I know a person’s rights are being violated when they can’t do something; how did she not know that? Apparently, the woman spoke to a lawyer who confirmed my rights were being violated,” says Casey, “and I received an email telling me my classroom was changed. All I wanted was to get to my class on time and probably use the bathroom first. They made such a big deal about it.” The executive director of accessibility for the government of Nova Scotia, Gerry Post, has used a wheelchair for six years and admits he, too, was surprised by society’s resistance to providing accommodations for disabilities. “A lot of people just don’t understand the challenges and the barriers that we face. I certainly didn’t seven years ago,” Post says. He says it’s easier to build awareness with people than it is with institutions. “With institutions, generally it’s about cost. Institutions have no problem saying all the right things but when it comes to allocating resources to make it happen, there’s a competition for those resources. The disabled community is gaining some ground now because there’s legislation in place dealing with accessibility.” Post says Casey is right when it comes to the code, which deals only with buildings.
Bruce Murray/VisionFire
Casey says, “To be truly accessible, you have to go beyond code.”
Left: Gerry Post. Above Casey and her idol Rick Hansen at her graduation.
“The code doesn’t deal with exterior spaces: sidewalks, crosswalks, parks, beaches. With this legislation that we have now in Nova Scotia, there’s a commitment to develop six modern standards. We’re focusing on two of them right now: the built environment, which is what Casey is talking about, and education.” There is a reminder that accessibility is about more than physical mobility. “If you’re blind, it’s a whole different challenge, and if you’re deaf, that’s another challenge,” says Post. Fall/Winter 2019 •
“Some people have multiple disabilities which become a real challenge as they compound each other.” Casey’s recovery from a traumatic accident and brain injury wasn’t merely about learning to use a wheelchair. It was about learning to create a new life for herself that upheld her independence and dignity. “When I was at rehab, they had a sports fair where they showed different sports you could do if you’re disabled,” Casey says. “That is so empowering for me.” She became a para-athlete in 2013
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and began competing in 2015, attending the Canada Games in 2017 where she won a bronze medal in shot put. So when it came to graduating from university with an arts degree and a certificate in non-profit leadership (a goal that had not been on her mind when she was 18 years old), Casey was not about to let the stairs to the stage get in her way, especially once she was chosen as valedictorian for her class. In order to graduate with her classmates and give her speech to a crowd that included her idol, Rick Hansen, who was receiving an honourary degree, Casey needed to wheel herself on to the stage. Having had a class in the Seton Centre auditorium, however, Casey knew that wasn’t possible. “It upset me because my professor had to push me up the ramp. I felt embarrassed,” she recalls. “Put me in a space where I can do things for myself. If it was a level classroom, no problem. When my professor had to do something for me, I felt helpless. He was nice about it. He probably felt good that he was helping me, but I felt terrible.” Nearly one in three Nova Scotians has a disability According to a 2017 Stats Canada survey, 30.4 per cent of Nova Scotians have at least one form of disability. The Canadian national average is 22.3 per cent. “The reason for that is we’re the oldest population, says Gerry Post, the executive director of accessibility for the government of Nova Scotia. “Forty-seven per cent of those older than 65 have at least one form of a disability in Nova Scotia. Those are big numbers.” Post says a disability doesn’t affect just one person; it affects everyone around them and “decision makers are starting to recognize that because when it comes to politics, it’s a numbers game. So we’re getting traction in part because of that but also there’s more awareness. But there’s a long way to go,” he adds. Stats Canada tracks the following disabilities: pain-related, flexibility, mobility, seeing, hearing, mental healthrelated, learning, dexterity, memory and developmental.
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Bruce Murray/VisionFire
Casey became a para-athlete in 2013, and won a bronze medal in shot put at the 2017 Canada Games.
At the start of her final year, Casey emailed the new president, Dr. Mary Bluechardt, and stated her purpose very clearly: “I want to graduate like everybody else.” Picture a modern movie theatre: there are stairs on either side of the seats, and all the seats look down on the stage. This is the same layout as the MSVU auditorium used for graduation, as well as for classes. Until the spring of 2019, graduates entered the auditorium from the fifth floor and walked down the stairs. Anyone in a wheelchair would enter from the fourth floor—by themselves. For Casey’s graduation, everyone entered from the fourth floor and walked up the stairs. The stage was levelled so no ramp was needed at all. According to Casey, the project manager for the reconfiguring of the stage has a daughter who uses a wheelchair. “He said, ‘I need to do this for her.’ He knew exactly what I was dealing with.”
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Independently and with dignity, Casey wheeled herself onto the stage to give her valedictory speech. Gerry Post was a guest at that MSVU graduation ceremony and witnessed Casey’s achievement. “It was an incredible day for her, and she deserved it for her advocacy,” he says adding that there’s been a change at that university because of those raising awareness about accessibility issues. “They’re doing some good things now at the Mount, and in fact, at most universities. There’s a commitment now from all the university presidents to prepare accessibility plans for their campuses.” Now 27, Casey believes her disability hasn’t limited her all, and she shared that in her speech on May 17. “My advice to you is be your own advocate and don’t let anyone stop you,” she told her classmates. “Fight for your dreams, believe in yourself and stand up—or in my case sit down—for what is right.”
Nutrition
A steak-out The truth about protein
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By Maureen Tilley, PDt
Protein has a long history of being in the nutrition spotlight from the latest protein supplement to bulk up muscle or improve athletic performance to the newest version of the high protein, low carb weight loss diet. We see these claims everywhere and if it’s not you who has tried it, you certainly know someone who has. Is there any truth to these protein claims? Are they safe and do the results last? Let’s set the record straight and look at the science, while also gaining a better understanding of its role, how much we need depending on age, health status, goals and how to get maximum benefit from the protein we eat. It’s common knowledge that protein is essential in muscle building and maintenance but that’s just one of its many roles. It’s also needed for building bones, skin, hair, and nails, as well as, hormone regulation and helps fight infection. The Recommended Daily Allowance (RDA) is 0.8g per kg body weight. Canada’s food guide recommends 10-35 per cent of our calories come from protein, (45-65 per cent carbohydrates, 20-35 per cent fat) approximately 50g/day for the average person on a 2,000-calorie diet. The protein package Well-known sources of protein include
meats, poultry and seafood, while often overlooked is dairy products and plant-based options such as legumes (beans, lentils), nut and seeds, soy products and quinoa. (Look up Health Canada’s “Nutrient Value of Some Common Foods” for protein in foods). It’s important to look beyond the protein content and consider what else that food has to offer. Legumes are low in fat and high in fibre while, fatty cuts of fresh and processed meats are high in saturated fats (linked to plaque buildup in arteries) and high in nitrates (may be linked to cancers). Protein powder and supplements are an easy and convenient option, but usually lack nutrients like iron and B12 you obtain from food sources. Key message is that all foods fit; but aim to get the majority of your protein from unprocessed, low saturated/transfats and sodium sources. Can you get too much? Protein is not stored in the body so should be eaten daily. On the other hand, if we eat more than our body needs, the leftovers are used as energy or stored as fat. Excessive protein intake has been argued to cause kidney damage and decrease bone density but many of these findings were found in rodent studies. Research performed on humans has deemed short-term high protein diets to be safe in healthy adults. Fall/Winter 2019 •
Many experts feel confident that a short-term protein intake 2.0g/ kg body weight is safe. Keep in mind; more research is needed to determine if long-term high protein consumption is safe. Even short-term high protein intake can be harmful for individuals with certain health conditions such as kidney disease or kidney stones. Always speak to a healthcare profession prior to increasing your protein. Aside from protein content itself; certain risks can accompany a high-protein diet. Often when eating a lot of one type of foods, it limits others increasing the risk of nutrient deficiencies—fibre, vitamins and minerals. Protein choice matters and many animal and processed products can increase cardiovascular and cancer risk while plant-based options can lower it. Protein distribution Most Canadians get a large amount of protein at dinner, moderate at lunch, while breakfast is lacking. Research has shown that spacing of protein may be equally, if not more important than total daily intake. It’s thought the body utilizes small portions more efficiently than large doses at once. We know the importance of eating breakfast and adding protein in the morning further
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enhances the benefits, helping increase fullness at meals and throughout the day, decrease cravings for high sugar and fat foods and help reducing blood sugars. It can be challenging to get enough at breakfast, as most traditional (healthier) breakfast proteins tend to be lower in protein (6g per large egg, 4g per 100g yogurt). Add a protein boost to hot cereals with egg white, seeds/nuts, Greek yogurt, peanut butter, or cooked red lentils (you won’t even taste them!). Make an omelet and add leftover chicken or black beans. Replace milk with Greek yogurt in cereal, add it to a smoothie, on top of pancakes or a yogurt parfait. Toast can be topped with cottage cheese, ricotta or fish (sardines, tuna, salmon) and sliced avocado and tomato. You don’t have to stick with traditional fares either; try a sandwich or leftovers.
intake (1.2-2.0g/kg) is recommended for individuals with certain chronic and acute illnesses/injuries. There may even be benefit in increasing protein recommendations in 30-40s when muscle decline begins. More research is needed, but it’s safe for healthy seniors to aim for the higher protein intake. Animal vs plant Dietitians of Canada state vegetarian and vegan eating patterns are healthy and nutritionally adequate ways of eating; it may just require a littler more organization. It can also be nutritionally balanced for those with higher protein needs such as athletes. Studies have shown that plant-based protein provide equal exercise capacity as omnivorebased eating. Most animal products are higher in protein per serving compared to plant-based proteins but we can still get enough if adding at meals and snacks. Protein is made up of various strands of amino acids that are needed to form complete proteins. Animal sources (as well as soy and quinoa) contain complete proteins, while most plant-based proteins are incomplete; amino acids need to come from other foods like whole grain bread and baked beans. We used to believe plant based proteins had to be paired with particular foods at each meal, but we now know that as long as a variety of foods are eaten throughout the day, then complete proteins can be formed. Research shows individuals who eat more
Aging population and muscle mass We start to gradually lose muscle mass in our 30s and more progressively declines in our 50s with a 30-50 per cent loss by our 80s. Loss of muscle leads to loss of strength and mobility and increased risk of fractures and illness. Muscle depletion can be slowed by exercise and nutrition. Despite Health Canada’s RDA recommendations for all adults, research from the International PROT-AGE Study Group and European Society for Clinical Nutrition and Metabolism (ESPEN) found a daily protein intake of 1-1.2g/ kg provided better muscle preservation in adults older than 65 years. Higher
plant-based foods have decreased risk of heart disease, diabetes, certain cancers and hypertension. It’s also better for the environment as production of plant-based products uses far less resources than the raising of most livestock. Fad diets Many popular diets such as Atkins and paleo focus on high protein and low carbohydrate intake. Studies have found that high protein can lead to weight loss but the actual mechanism is not well understood. There are several hypotheses including: protein is more filling, leading to decreased caloric intake; it suppresses our hunger hormone ghrelin; and protein increases the metabolism. Perhaps it’s simply the fact that cutting out food groups and/or watching what you’re eating automatically leads to a decrease in calories. Most weight loss diets, whether low carb, counting points, high fat, or high protein, lead to weight loss. The most challenging part is trying to maintain it over the long term and most people regain the weight they’ve lost. So what’s the solution? The best approach is an individual approach. Learn to feed your body based on what it needs (mind and body) and not dictated by diets or the scale. It’s not glamorous and requires adjusting weight loss expectations but it frees you from a lifetime of diet cycling and more likely to lead to better mental and overall health.
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HealthCare
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Your Oral Health
Fall/Winter 2019 •
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AD FP
GOOD ORAL HEALTH IS A TEAM EFFORT Your dentist sees you twice a year to examine the health of your mouth, teeth and gums. That means it’s up to you to brush and floss the other 363 days of the year, to keep your mouth healthy and happy. It doesn’t take much time to do it, just brush for two minutes twice per day and floss before bedtime. A little effort yields a big reward. Be a team player and care for your teeth! It will make visiting the dentist much easier.
The dental exam is critical to your ongoing oral health—and only your dentist can perform this By Donalee Moulton
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The dental exam: an overview The exam
consists, in part, of the dentist looking inside your mouth. In the past, you may not have ever realized an exam was taking place. Perhaps you thought the dentist was checking the work the hygienist had just completed.
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Some dental offices offer panoramic dental xrays.
• Damaged, missing, or decayed teeth • Early signs of cavities • Condition of your gums, such as periodontal pockets, inflammation, or other signs of gum disease (which can lead to tooth loss and bone loss) • To see how previous dental work such as root canals, fillings, and crowns are holding up • Early signs of mouth or throat cancer, such as white lesions or blocked salivary glands • Other suspicious growths or cysts • Position of your teeth (e.g., spacing, bite) • Signs that you clench or grind your teeth (a treatable problem that can cause headache or sore jaw and can, if serious, lead to hearing loss and tooth loss) • Signs of bleeding or inflammation on your tongue and on the roof or floor of your mouth • The overall health and function of your temporomandibular joint (which joins the jaw to skull), checking for signs of disorders that can cause pain or tenderness • The general condition of the bones in your face, jaw, and around your mouth The dental exam can catch problems early—before you see or feel them— when they are much easier and less expensive to treat. As well as the visual inspection of your mouth, the exam includes: • A complete medical history so the dentist will know about any health conditions that may affect the success of dental treatments or procedures and that may be associated with oral health problems. Sometimes it will also include: • An examination of your neck area, with the dentist feeling the glands and lymph nodes for possible signs of inflammation that could indicate general health problems • Dental X-rays, if necessary. These can show such problems as cavities under existing fillings, hairline fractures, impacted wisdom teeth, decay under your gum line, and bone loss caused by gum disease. 26
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Not so. Instead, the dentist is looking in your mouth for things that can affect your oral, and your overall, health. Many of these are things you can’t see on your own but a dentist is trained to detect. Here is some of what your dentist is looking for during a dental exam:
Your dentist may explain what’s happening during the exam and give you a summary of the findings. If not, be sure to ask. As patient, you are a full partner in you oral health care. Checklist: Tell your dentist The more your dentist knows about your overall health, the more effective they can be in addressing your oral health care needs. Be sure to let your dentist know: 1. Any new medical conditions you’ve been diagnosed with since your last visit, such as diabetes or AIDS, even if they don’t seem pertinent. Your dentist needs to know to properly manage your treatment and prevention program 2. Any new medications you’re taking (side effects can often include dry mouth and overgrown gums) 3. If you’re pregnant 4. If you have any allergies
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5. Any changes you’ve noticed in your teeth, such as changes in colour, looseness, or position 6. Any changes you’ve noticed in your gums, such as bleeding when you brush or floss, or changes in appearance 7. Any increased sensitivity to heat, cold, or sweets 8. Whether your floss catches on rough edges, causing it to shred 9. Any colour changes in the skin on the inside of your mouth 10. If you smoke or chew tobacco (which increases the likelihood of oral cancer) 11. If your neck or jaw muscles are tight, or you’re aware of clenching or grinding your teeth 12. If you’re nervous about going to the dentist. New ways of doing things have made modern dentistry more comfortable for patients and talking to your dentist may reassure you and help you feel more relaxed.
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A breath of freshness Halitosis is not just about being sociable By Donalee Moulton
When
your breath is bad, your mouth is trying to tell you something. It’s important to listen—and to take steps to address the problem. “Bad breath can indicate the presence of gum disease, cavities, oral infections, or stones that can build up in the tonsils,” notes Dr. Matthew Moore, a dentist in Fredericton, NB. If your dentist has ruled out oral health causes and you brush and floss every day, he adds, your bad breath could be the result of another health problem, such as a sinus condition, gastric reflux, diabetes, liver or kidney disease. “In this case, you should see your healthcare provider.” Bad breath is also a social issue. “[It] can be embarrassing and, in some cases, may even cause anxiety,” says Dr. Moore. “It is estimated that 25 per cent of the population are affected by bad breath.” Fall/Winter 2019 •
Living Healthy In Atlantic Canada
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It’s especially important to brush your tongue.
The most common cause of bad breath, also called halitosis, is poor oral hygiene. Our mouth is home to hundreds of types of bacteria. When we eat, these bacteria feed on the food left in our mouth and produce sulfur compounds as waste product. “These sulfur compounds are what cause bad breath,” says Dr. Moore. “The longer you wait after you eat to remove these bacteria, the more likely you will have bad breath.” Another common cause of bad breath is dry mouth, which can be caused by medications, salivary gland problems, certain health conditions such as respiratory tract infections, or simply by breathing through the mouth. Saliva is important because it helps to clean the mouth, says Dr. Moore. “If you don’t have enough saliva, then your mouth isn’t being cleaned as much as it should be.” 28
The foods we eat can also contribute. Among those foods most commonly associated with bad breath are garlic, onions, spicy dishes, and coffee. “What you eat affects the air you exhale,” explains Dr. Moore. “After you digest these foods, they enter your bloodstream, are carried to your lungs and affect your breath.” As well, smoking and tobacco use can also cause bad breath, and they also increase the risk for gum disease. Fortunately, the problem can be addressed. To reduce the likelihood of bad breath, you should clean your mouth after eating by brushing, flossing, and rinsing. Brushing and flossing are both important to removing the bacteria that cause bad breath. Brushing alone only cleans about 60 per cent of the surfaces of the teeth; flossing will
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take care of the hard-to-reach areas between the teeth, notes Dr. Moore. It’s especially important to brush your tongue, he adds, especially the back of the tongue where odorproducing bacteria tend to hide out and accumulate. “If you stick out your tongue, you may see a white or brown coating at the back. This is what you want to regularly remove, and a tongue scraper can be very helpful for this.” Staying hydrated is also important to keep your mouth moist. Sipping water regularly helps with this. There are also other steps you can take to help reduce bad breath. These include using an alcohol-free mouthwash every day. Chewing sugar-free gum and eating sugarfree candies can help to mask odors as well. Avoid chewing gum or sucking candies that contain sugar, cautions Dr. Moore. “Having these high-sugar items in the mouth consistently provides a sugar bath of sorts for the teeth, which greatly increases your chances of having cavities. “It is also a bad idea to continuously sip sugared drinks to mask bad breath for the same reason,” he adds. “If your goal is to keep the mouth hydrated, sip water only.”
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Oral health and ? ? nursing ? ? homes—a quiz
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oral health needs to be part of our daily routine at all stages of our life: toddler, teenager, adult, senior. For residents in nursing homes, however, oral health can be a significant issue.
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By Donalee Moulton
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Living Healthy In Atlantic Canada
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73 per cent of
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those living in long-term care never visit a dental professional or see one only for emergencies
TRUE OR FALSE Q: 13 per cent of people age 45 to 64 never visit a dental professional or see one only for emergencies. This figure is slightly higher for those living in long-term care. A: False. The figure is actually much higher. According to research conducted by Debora Matthews at Dalhousie University, 73 per cent of those living in long-term care never visit a dental professional or see one only for emergencies.
Denture stomatitis, small red lesions usually found under the top denture, is one reason dentures should be removed every night.
FILL IN THE BLANK Q: Approximately 19 per cent of Nova Scotians age 45 and over living in the community have untreated tooth decay compared with what per cent of long-term care residents. A: 35 per cent.
Q: Dentures should be removed at night. A: True. A condition called denture stomatitis, small red lesions usually found under the top denture, is one reason dentures should be removed every night. Q: Oral conditions have widespread effects on both the physical and mental health of nursing home residents.
Q: Can you name two reasons why there are higher risk factors associated with individuals in longterm care? A: There are often issues, such as dementia or decreased mobility, that make it difficult for residents to have optimal oral health care. It may also be difficult for residents to get to the dentist. Q: Dentures are made of what?
A: True. A study led by Matthias Hoben at the University of Alberta noted that social impacts, such as low self-esteem associated with bad breath or missing and decayed teeth, are prevalent in older adults with poor oral hygiene. The study also pointed out that, “Preventable suffering as a result of oral/dental pain can be seen in 3.4-8 per cent of nursing home residents.” 30
A: Acrylic. According to Brushing Up on Mouth Care, an oral health resource for those caring for older adults, acrylic is a porous material that can be easily scratched and damaged. The material also does not have any germ-fighting properties and bacteria can grow on the surface of the denture and cause odor, sores and irritations.
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An oral health toolkit Brushing Up on Mouth Care, produced by a project led by the Faculty of Dentistry at Dalhousie University, recommends creating an oral health care toolkit for each individual being cared for. (This could also be done at home.) The core components are a metal basket that is easily carried and a plastic cup with the person’s name written on in. Supplies that can be put inside the cup and the basket include: • • • • • • • •
toothbrush toothpaste mouthwash floss floss handle denture brush denture cleaner facecloth
Good oral health is linked to your overall health. The health of your mouth is critically important. Your mouth is the starting point for almost everything that goes into your body. It eats, it drinks, it breathes, it talks, it tastes and it coughs. The health of your mouth is linked to the health of your entire body. Dentists often find clues / indicators to other diseases in the mouth and encourage you to see your doctor... So get in the habit of brushing twice per day and flossing before bedtime. You only see your dentist twice a year so it’s up to you to keep your mouth clean.
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