WIN the
PAIN
GAME
Health Home, Sweet Home
Coaching to prevent chronic disease
Eating Well
How to balance your diet
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Health Home, Sweet Home
Coaching to prevent chronic disease
cover story
5
WINNING THE PAIN GAME
Team brings hope 6
10
Eating Well
How to balance your diet
8
New resource helps Calgarians find a doctor
9
Healthy eating
10
Face of a doctor
Recipe: Soy ginger salmon
On a mission to make lives better: Dr. Robert Burn
Cover photo: Patient Jen walks with her boyfriend and dogs.
VOLUME 6 • NO. 2 • 2014
12
Programs and clinics
www.boehringer-ingelheim.com Calgary Foothills Primary Care Network would like to thank Boehringer Ingelheim (Canada) Ltd. for their assistance in printing this medical communication publication.
Medical director’s message
Primary Care Networks in Alberta are built to improve the access and delivery of primary health care in their communities. Calgary Foothills Primary Care Network is working with your doctor to provide you with quality primary health care in north Calgary and Cochrane. For example, our after-hours Access 365 Clinic is there for your urgent after-hours needs and our behavioural health consultants are there to provide you with short-term mental health support, such as coping with loss. Our team of health care professionals is committed to making sure you are connected to the care that you need. Enjoy this issue of Connecting Care, which highlights our ongoing commitment to excellence in patient care.
Editor
Paula Beauchamp Cover Photograph
Neil Zeller Photography Publisher
Jim Thornton
Sincerely,
Dr. Linda M. Slocombe Medical Director Calgary Foothills Primary Care Network
Calgary Foothills Primary Care Network
500, 1716 - 16th Avenue NW Calgary, AB T2M 0L7 P 403.284.FPCN (3726) F 403.284.9518 communications@cfpcn.ca cfpcn.ca
Published for CFPCN by
Paragon Publishing Inc.
Calgary, Alberta P 403.287.9818 ads@paragonpublish.com paragonpublish.com
Background Calgary Foothills Primary Care Network is a group of doctors who provide primary care services to patients living in north Calgary and Cochrane. Created in 2006, the PCN aims, through the leadership of family doctors, to provide enhanced access to integrated and comprehensive primary care, while engaging health teams in collaboration with the broader health care system.
What is primary care? Primary care involves the activities provided in the community that address the everyday health needs of individuals and their families through health promotion and the prevention, diagnosis and treatment of illness and injury. Connecting Care is a PCN publication aimed at educating patients of member doctors about health issues and programs available to them and their families.
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Connecting Care Magazine is made available free of charge to the 350,000+ north Calgary and Cochrane patients of 392 PCN member physicians at more than 80 clinics in 54 communities. The e-magazine version is available at cfpn.ca and by free subscription at connectingcare@paragonpublish.com All rights reserved ©2014. Printed in Canada. Member of the Canadian Federation of Independent Business. Placeholder for white FSC logo. Publisher is to insert.
Photo: Paula Beauchamp
FUTURE FOCUSED: Patient Rob Ward believes he will live a healthier, longer life thanks to his health team.
HEALTH HOME, SWEET HOME Coaching to prevent chronic disease BY PAULA BEAUCHAMP TO say Robert Ward is happy with the care he receives at his
Robert’s body was no longer processing food as effectively as it did
health home — his doctor’s office in Capitol Hill — would be an
when he was 18. Built-in physical activity patterns were lost when he
understatement. In fact, the retired exhibition designer is thrilled with
retired. “I no longer had that big cardio workout from pedaling uphill
the changes he sees in the health system.
to get home.” Robert says his health team helped set him on a road to
“Identifying problems earlier and encouraging people to play a role in looking after their own health is so helpful,” he says. “When
mindful recovery. Some 99.6 per cent of family physicians who are members of
everything is going in the direction of self-checkouts and self-help, it is
the Calgary Foothills Primary Care Network have at least one health
wonderful to have a human being there to actually help you.”
team member in their clinic. The teams work to improve the delivery
The health team at Robert’s doctor’s clinic includes a behavioural
of health care by increasing patient access to quality information
health consultant, health management nurse and clinical pharmacist.
and care, improving patient outcomes. Team members may include
Working together with doctors at the clinic, they regularly see patients
health management nurses, clinical pharmacists, behavioural health
who need extra information and support.
consultants, registered dietitians, diabetes educators and respiratory
Referral in-house In late 2013, Robert’s doctor, Cassandra Millar, referred him to two members of the team after routine blood tests revealed he had
educators.
Aha moments Clinical pharmacist Noorani Ramji says patients often don’t know
high sugar levels and high cholesterol. With the help of a health
what to expect because this is a new model of care. “Patients feel
management nurse and clinical pharmacist, Robert overhauled his
reassured that we are all working together with their doctor,” she says.
lifestyle habits, particularly around eating and exercise.
“They feel empowered and so much more aware of what is happening
Together they set goals for change, aiming to prevent Robert’s issues from developing into a chronic condition. Temptations such as apple fritters, pastries and chocolate bars were identified, as well as a need for more regular exercise.
with their health because of the resources devoted to them. Sometimes there is an aha moment or an epiphany.” Robert now travels with a fold-up bike and exercises on a bouncer that he keeps in his studio. He consciously chooses the food he eats
Portion sizes and food quality were discussed — and the impact
and feels positive about the future. “The bottom line is, maybe I’ll just
changes could have on his body. “It’s like an athlete having their own
end up living longer and have more Saturday night jam sessions with
team of coaches,” Robert, 63, says. “I can do this for myself for a few
my buddies and continue to travel and go places with my wife,” he
months, but then I start to fall off the wagon. Being accountable to
says. “I certainly feel better.”
someone else helps.” Robert, an avid guitar player, believes the knowledge he has gained from in-depth conversations with his health team will dramatically
To find out more about your health team, please talk to your family doctor.
improve his future. Although he was physically active as a youngster, cfpcn.ca
3
WINNING AGAINST PAIN TEAM BRINGS HOPE
A NEW LIFE: Jen puts her best foot forward. 4
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Photo: Neil Zeller Photography
WATCHING Jen walk down the street, you’d never know she is bracing against the pain with each step. The 31-yearold says that is part of the problem. “I look good on the outside. It would be easy for someone to think I am faking it,” she says. “On the inside I can be crying with pain.
Jen was 18 when she first experienced pain from endometriosis. In
On this journey to better manage her chronic pain, the team helped
years gone by, there have been times when the dark clouds of pain
Jen deal with her mental health issues that were making her pain worse.
hanging over Jen left her feeling down. By 26, the pain was having
Jen now understands that a difficult childhood prevented her from
such an impact on her life that she was ultimately forced to quit the job
developing some of the life skills she needed. “I couldn't communicate
she loved. “Pain wears on you day after day in a way you could never
before, even express that I was angry or discuss things,” she says. “The
understand if you haven’t experienced it,” she says.
mental health team talked to me and I learned so much — steps on
In 2011, Jen’s family doctor Dennis Hayes began working with her at
how to get angry, how to communicate. You don't know you are
his clinic and those feelings started to lift. He later referred Jennifer to
missing these steps until someone points them out. I learned I don't
the Calgary Foothills Primary Care Network’s Extended Team. “I honestly
have to put a smile on my face all of the time and it’s okay to cry
can’t tell you what a difference they have made to my life,” Jen says.
sometimes.”
The Extended Team offers care to patients who suffer from complex, long-term (chronic) conditions including chronic pain, irritable bowel syndrome and mental health issues, such as depression and anxiety. “Just having someone I can call or turn to when I’m down and think I’ll never get out of the pain — and at the end of the line there’s someone so warm and open and willing to listen,” she says. “I owe them so much more than I can say.” While many patients are referred to the Extended Team for assessment or treatment of a single condition, added complexity and other issues can be uncovered. The health team, which includes a range of health professionals such as health management nurses, pharmacists and doctors, takes a holistic approach to each patient’s needs.
Reducing pain Jen's first step towards recovery was a class on understanding pain
“Just having someone I can call or turn to when I’m down and think I’ll never get out of the pain — and at the end of the line there’s someone so warm and open and willing to listen.”
— learning how the brain and the nervous system work together to produce our emotional and physical experience of pain. She joined pacing classes, which taught her to intersperse the activities she needs to do each day with periods of rest that help reduce pain flare-ups. Jen also learned about breathing, meditation and yoga and how distracting herself can help reduce the pain. Over time clinical pharmacist Joe Kwan helped Jen, who was taking
A team approach Jen says she feels more whole as a person thanks to the help of Dr. Bergman, behavioural health consultant Deborah McDougall, shared mental health consultant Jean Leong and the rest of the team. Jen is
pharmaceutical drugs to cope with the pain, to slowly reduce her
also more ready to accept help, such as efforts to bring specialists to the
dosage. At the same time, they worked to minimize the effects of
Extended Team's Crowfoot clinic, where Jen felt more comfortable.
withdrawal, such as cold sweats and mood swings. “The challenge is to
Jen's partner is also surprised how extensively the team has included
help patients develop other coping tools so they can rely on those tools
him in every step in her care. “I've been to a lot of the appointments.
to deal with the pain when the narcotics are removed,” Joe says. “It
I'm always invited,” he says. “They explain what is happening for Jen,
can involve working to improve mental health and providing supports in
and that's good, because I really didn't know how bad it was. I don't
their social environment that increase the ability to function.”
pressure her to go out and do something if she says she isn't feeling
Medication can reduce pain by up to 10 per cent. But opioids are no longer recommended in the treatment of chronic pain that is not
well, because I understand now.” The couple has grown closer through shared understanding. “Just the
caused by cancer. Research now shows it is best to get support, get
fact that she is up and doing stuff is enough for me,” he says. “Before
active, get a recovery plan and get started.
Jen was taking the pain killers just to get through the day, but she'd be
Extended Team medical lead Dr. June Bergman says patients can develop a different world view because of something that happened as they first experienced chronic pain — often as a result of adverse
knocked out and couldn't go anywhere because she was sleeping all the time. I find she laughs more like she used to.” While Jen still feels moderate pain throughout the day and occasional
events in early life. “We try to help patients shift that world view that
bouts of intense pain, she feels better able to manage and is happier.
is no longer working for them,” she says. “We help them explore new
She is looking forward to further treatments, to feeling even better in
ways of being. Once we have that shift and that buy-in, we can try
the future and getting back to the work she loves. “I know there is
something totally different.”
hope now and I am looking forward with hope,” she says. “That's a good place to be.” cfpcn.ca
5
Eating Well
How to balance your diet By Paula Beauchamp
A dietitian’s step-by-step guide to eating well
dinner plates are 10 to 12 inches in diameter, but it is easier to achieve
IT might be your favourite pair of jeans that suddenly feels tight or
a healthy balanced plate if you replace them with 8 to 9 inch plates.
a gnawing awareness your energy levels are low. For each of us, the
Remember those small plates that come with your dinner set? Those
realization that our eating habits are spiraling out of control can come in
may be closer to the size you need. “A larger plate is a visual cue to fill it
a myriad of ways.
up and then portion sizes and calorie intake rise,” Andrea says.
Calgary Foothills Primary Care Network registered
The best way to ensure a good balance is to fill half of
dietitian Andrea Kroeker says these are perfect
your plate with vegetables of at least two kinds at
moments to take stock and review the basics of
both lunch and dinner. Fill a quarter of your
healthy eating. But first, a word of warning.
plate with whole grains (potato, whole
“It is important to take things slowly and
wheat bread, brown rice) and the
make small changes that gradually move you in the right direction,” Andrea says. “Small behaviour change, rather than a diet or radical action, helps you sustain a healthy weight longer term.”
Get started with regular meals Eating at least three well-spaced meals a day is essential before you can start worrying about portion
remaining quarter with meat or meat
"A larger plate is a visual cue to fill it up and then portion sizes and calorie intake rise"
sizes or anything else. “It is ideal to
Once you are eating regular meals, it is time to take a good hard look at your plate. Actually, take out your tape measure. Average 6
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— they give you a big boost of fibre, antioxidants, vitamins and minerals, while keeping your calorie intake down. Andrea recommends you round lunch and dinner off with a piece of fruit and milk or a milk alternative,
vegetables and fruit, grain products, meat and
your portions and prevent overeating at your next
A healthy, balanced lunch and dinner plate
broccoli yields only 31 calories
aim is to eat three to four food groups —
“Regular meals help you control the size of
low blood sugars bring.
are low in calories — 1 cup of
fruit for a snack in-between meals. The
snacks in between if needed,” Andrea says.
hours apart also helps you avoid dips in energy and the sluggish feeling
or lentils). Because vegetables
such as yogurt. Or save the milk and
eat three meals a day with one to two
meal,” she says. Spacing meals a maximum of four to six
alternatives (lean meat, chicken
alternatives and milk and alternatives — at each meal. Eating too much meat, meat alternatives and grain products and eating too few vegetables are the most common meal-time mistakes that lead to unwanted weight gain, Andrea says. The Handy Portion guide below illustrates an easy way to estimate healthy portion sizes. “People most often struggle to accept the smaller portion sizes and the need to add way more fruit and vegetables,” Andrea says. “But if you
HANDY PORTION GUIDE: Canadian Diabetes Association You can use your hands to estimate appropriate portions. When planning a meal, use the following portion sizes as a guide:
ADD MORE VEGETABLES: Calgary Foothills Primary Care Network registered dietitian Kari Derbyshire discusses the keys to a healthy, balanced plate with patient John-David Malta.
are eating a 9-ounce steak each night, don’t suddenly switch it for a 3-ounce steak. Aim to reduce the portion size gradually.”
A healthy breakfast and snacks What does a healthy, balanced breakfast look like? A bowl of high fibre, low sugar cereal with low-fat milk and fruit or two pieces of whole grain toast with peanut butter and a banana are great examples. Ideas for breakfast include a quarter of a plate of grain products, vegetables or fruit. For protein, add milk or milk alternatives, yogurt, eggs, nut butters or a serving of meat and alternatives. For snacks, Andrea’s favourites include a cheese string with an apple or yogurt and berries.
Take it slowly
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Try to eat slowly. Take 20 minutes to eat each meal so you have time to realize your stomach is full. Eat protein and whole grains at each meal to help your stomach feel full for longer. “People are often surprised they don’t feel hungry when they eat healthy, nutritious food, when the portion sizes are smaller and they are eating more frequently,” Andrea says. To learn more about healthy eating, register
Our trained tobacco reduction pharmacists can help you quit or reduce the number of cigarettes you smoke. We work with you to develop a plan that works! Get started today. No appointment necessary.
for a free Ask a Dietitian group appointment by calling 403-284-3726 ext 206. You can ask personal nutrition questions and book a one-onone follow-up appointment with a dietitian.
calgarycoop.com/pharmacy cfpcn.ca
7
Photo: Neil Zeller Photography
“It’s hard to find a family doctor in this city, so I was thankful for the website. It was easy to find and registering didn’t take long.”
LINKED-IN: Patient Linda Sayers is enjoying continuity of care with her new doctor, Branden Reid.
registration form as Linda did, would-be
NEW RESOURCE HELPS
CALGARIANS FIND A FAMILY DOCTOR
By Kelly Parks
patients can also take a more active role in their search for a physician. One of the new features, a map, lists all Calgary and area physicians who are members of a Primary Care Network. It highlights those who are accepting new patients and provides contact information. While Linda was happy to wait two months to be linked with Dr. Reid, the new resource gives people the option of finding a physician more quickly.
WHEN Linda Sayers began her search
Those who register online can expect to “Dr. Reid is very thorough and on top of
wait as little as a few weeks, or as long as
for a family doctor, her son’s pediatrician
things. He helped my family out a lot in a
recommended she register on the Find a
a few months, to hear back from a Primary
short amount of time.”
Care Network with an available physician’s
Doctor website.
Dr. Reid, who moved from Edmonton to
“I’ve never really had a family doctor,” says Linda. “I’ve just gone to walk-in clinics.” “It’s hard to find a family doctor in this city, so I was thankful for the website. It was easy to find and registering didn’t take long.” The Find a Doctor registry is an online service that connects residents of Calgary and surrounding areas to a family doctor who is accepting new patients.
Calgary this year, says his roster of patients is
details. Last year, 4,370 patients found a doctor at
already close to full thanks in large part to the
Calgary Foothills PCN, one of seven PCNs in
website after 9 months.
the area, through the website.
“Many of my patients didn’t have a family
Dr Linda Slocombe, medical director with
doctor before and they are very appreciative,”
the Calgary Foothills Primary Care Network,
he says.
urges people who do not have a family doctor
“The site works very well and I am very thankful.”
to register. Research shows having a family doctor
The Find a Doctor website was first
and seeing him or her regularly keeps you
launched by the Calgary Foothills Primary
online, Linda was contacted by the Calgary
healthier as you age, helps you live longer
Care Network in 2009 to help people living in
Foothills Primary Care Network and connected
and can aid in catching illnesses before they
north Calgary and Cochrane find a physician.
become serious.
Two months after completing the form
with Dr. Branden Reid at the Foothills Primary Care Centre. “I was happy. I didn’t expect it to be that quick,” she said.
In 2011, it expanded to include people and physicians throughout Calgary and
If you need a family doctor, please go to
surrounding areas and before this past holiday
www.calgaryareadocs.com
season, new features were added. While people can still use the online
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Healthy Eating
Great news: good food can be easy to prepare. The key is finding healthy ways to creatively add flavour to the food you eat — so you don’t get tired of eating the same foods over and over again.
Andrea Kroeker, a registered dietitian with the Calgary Foothills Primary Care Network, talks about flavour
Garlic and onion are staples for adding flavour to food in many cultures, without adding salt or fat. Others you can try: 1 Dry spices (curry, cumin, turmeric, oregano) 2 Fresh spices (ginger) 3 Fresh herbs (cilantro, Italian parsley, basil, dill) 4 Juices (lemon juice, lime, orange juice) 5 Chili flakes 6 Pepper Add dry spices such as curry to soups and fresh herbs to salads or other dishes.
ADD FLAVOUR WITHOUT FAT
Heart healthy oils, such as canola and olive, are great choices for cooking. Try adding other flavourful oils such as the sesame oil used in this soy ginger salmon recipe. The ginger and green onions used here give the fish a wonderful south Asian flavor. Enjoy!
SOY GINGER SALMON
Recipe by Kari Derbyshire and Andrea Kroeker Calgary Foothills PCN registered dietitians
Ingredients
Directions
2 lbs salmon fillets
Whisk together all marinade ingredients and pour it into a large freezer bag. Add salmon fillets. Allow to sit for 30 minutes.
Marinade: 2 tbsp olive oil 1 tbsp sesame oil 1 tbsp soy sauce 3 tbsp balsamic vinegar 1 tbsp brown sugar 2 cloves garlic crushed 1.5 tbsp grated ginger Dash of pepper
Preheat oven to 400 F. Arrange salmon fillets in a large baking dish, skin side down, and pour over marinade. Bake time depends on salmon fillet thickness — about 10 minutes per inch or until the salmon flakes with a fork. Remove from oven and garnish with green onion. Serve with brown rice and sautéed or steamed vegetables for a complete, balanced meal.
Tip: Try this recipe on the barbeque in the summer as well!
cfpcn.ca
9
Why did you become a family doctor? At school I loved biological science. It was the thing I was good at. I
What is the most challenging part of being a family doctor?
was fascinated by spiders, dissecting worms. When I was introduced
It is trying to help people whose anxieties present as physical
to Darwin’s Theory of Evolution by Natural Selection I was bowled
symptoms. It is often difficult to reassure them that they don’t have a
over by the beauty of it. It led me to decide that medical science was
physical disease. It can be a challenge to help these patients redirect
the thing I wanted to do. My dad was an ophthalmic surgeon, so I
their energies towards dealing with their anxieties.
chose to specialize in surgery at first. But after 10 years, I was aware I was missing out on the human side of people’s illnesses. I decided to retrain. I spent three years training to become a family doctor, while at the same time earning a living as a surgeon. Not many people
What do you do to unwind? Gardening. In the summer, my wife (also a family doctor) and I grow
choose that path!
strawberries, raspberries, tomatoes and flowers and try to turn our garden into a little oasis. In the winter, it is renovating the basement.
What do you enjoy most about being a family doctor?
It is relaxing because I’m using my hands, but I don’t use power
I like being able to fix people. When you have a patient who is
music. Outside my family, sailing is my passion. During summer
worried about something, it is satisfying to figure out what is wrong
holidays (over the past 19 years), I’ve sailed my boat down to Mexico
and to make it better, so they can go away with that worry lifted. It
and across to Tahiti.
tools. All the nasty injuries we see (related to handy work) are from amateurs using power tools. I also read a lot and listen to classical
is ideal if you can fix a person’s medical problem and make a good connection as well.
What is the fun part of the job?
What are you looking forward to in your retirement? My daughter is having a baby and I’m looking forward to being
It’s the babies. I love babies. Seeing a healthy baby and watching that
a grandfather. We also plan to enjoy winters in Mexico. We have
person grow up is a delight. We’ve had lots of babies born in our
a small house in a fishing village there where we grow papayas,
practice in recent years, mostly at Riley Park.
mangoes and bananas. Dr. Imrana Muhammad has taken over the care of Dr. Burn’s patients.
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Face of a Doctor
Photo: Neil Zeller Photography
ON A MISSION TO MAKE LIVES BETTER
Dr. Robert Burns FROM surgical wards in England to famine-ravaged Ethiopia in the 1970s and a rural doctor’s practice in Hinton, Alberta, Dr. Robert Burns has enjoyed a varied life as a family doctor. For more than 19 years, he was a family doctor to patients at The Doctors Office in Nose Hill, Ranchlands. He retired in late 2014.
SANCTUARY: Dr. Burn loves gardening — it’s his favourite place to relax. cfpcn.ca
11
Calgary Foothills PCN
Programs & Clinics Clinics and Services After Hours Clinic
Extended Team
The Access 365 Clinic runs year-round. It offers after-hours appointments for non-emergency medical care. Access the clinic by calling Health Link Alberta at 403-943-5465.
The Extended Team provides care for patients with complex, chronic diseases who are referred by member physicians. Areas of experience include chronic pain, mental health, gastrointestinal and medical musculoskeletal conditions. Help is also available for older adults.
Riley Park Maternity Clinic Care is available to low-risk pregnant women who do not have a family doctor or by referral from a family doctor. Patients must plan to deliver at Foothills Medical Centre.
Programs Patients of Calgary Foothills PCN member doctors can register for the following free programs by calling 587-774-9736.
Ask A Dietitian
TrymGym
Meet with a registered dietitian in a small group to learn nutrition basics such as Canada’s Food Guide, how to read labels and more.
This eight-week program offered by University of Calgary teaches participants to lose weight safely and keep unwanted pounds off for good. Bi-weekly classes include exercise, nutrition education and behaviour change strategies. Calgary Foothills PCN patients receive a $200 discount; call 403-220-4374.
Craving Change Most people know what they should eat, but struggle to control what they actually do eat. This series of four classes covers the relationship between food-related thoughts, emotions and behaviours, and offers empowering strategies to support change.
Happiness Basics This series of seven classes is for adults who want to learn how to be happier. Participants learn and practice simple, positive and empowering skills. Not suitable for anyone with severe depression, anxiety, suicidal thoughts or in crisis.
Walking Programs Join a peer-lead walking group weekday mornings in North Hill Mall or at Confederation Park in the summer. For Cochrane walking groups located at Mitford Park, call 403-851-2534.
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WINTER 2014
Tobacco Cessation This four-week group program is for patients who smoke and are considering quitting. Ask your doctor for a referral.
Find A Doctor website Need a family doctor? Register at www.calgaryareadocs.com or call Health Link Alberta at 403-943-5465.
The protection your family needs, the peace of mind you deserve.
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