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Just for C

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DOCTORS life + leisure

fall 2013

contents

fall 2013

Editor Barb Sligl

Art Direction BSS Creative

Contributing Editor Janet Gyenes

Editorial Assistant Adam Flint

Contributors Cover photo

Michael DeFreitas Dr. Holly Fong Dr. Chris Pengilly Manfred Purtzki Dr. Kelly Silverthorn Roberta Staley B. Sligl

Senior Account Executive Monique Nguyen Account Executives Wing-Yee Kwong Lily Yu Sales, Classifieds and Advertising In Print Circulation Office 200 – 896 Cambie St. Vancouver, BC V6B 2P6 Canada Phone: 604-681-1811 Fax: 604-681-0456 Email: info@AdvertisingInPrint.com Associate Publisher Linh T. Huynh

Production Manager Ninh Hoang

Circulation Fulfillment Shereen Hoang

CME Development Adam Flint

Founding Publisher Denise Heaton

Just For Canadian Doctors is published 4 times a year by Jamieson-Quinn Holdings Ltd. dba In Print Publications and distributed to Canadian physicians. Publication of advertisements and any opinions expressed do not constitute endorsement or assumption of liability for any claims made. The contents of this magazine are protected by copyright. None of the contents of the magazine may be reproduced without the written permission of In Print Publications.

clockwise from top left: B. Sligl (3)

In Print Publications 200 – 896 Cambie Street Vancouver, BC V6B 2P6 Canada

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FEATURES

11 riding the rails From BC to Alberta by train 16 ready for Rio This iconic city is everything one imagines

COLUMNS

DEPARTMENTS

8 photo prescription

5 fall mix

Take it slow

10 pay it forward Dr. Susie Tector’s work with Médecins sans Frontières

14 motoring 50 years strong: Porsche 911 and Corvette

25 the hungry doctor Take your sandwich to the next level

www.justforcanadiandoctors.com

26 the thirsty doctor miss an issue? check out our website!

19 CME calendar 31 employment opportunities 37 sudoku 38 small talk with Dr. Eric Jablonski

15 doctor on a soapbox Work efficiently and make more

Printed in Canada.

—and so much more

Essential bar tools

cover photo

Oh, Rio, Rio! It’s summer in the southern hemisphere, when the boisterous beaches of Brazil’s starlet, Rio, are abuzz with carioca spirit. Yet you’ll still find quiet moments…like this serene scene of sea spray and twilight settling over Ipanema Beach. Story on page 16.

FALL 2013 Just For Canadian Doctors

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from the editor

autumn adventure 10th Annual Conference November 15-16, 2013 Hyatt Regency Hotel • Toronto, ON www.caam.ca • info@caam.ca • 604.988.0450

Join us for our 10th Annual Conference. Don’t miss out on our new format of Expert Panels, Open Sessions & Live Demonstrations. Learn more about our Certification/Training Program and the launch of the “Aesthetic Complication Tele-Health” program.

Invited Speakers Keynote Speaker Dr. Mitchel Goldman, San Diego Dr. Stephen Bellemare, CMPA, Ottawa Dr. Yves Hébert, Montréal Dr. Mark Lupin, Victoria Dr. Jack Kolenda, Oakville Dr. Channy Muhn, Burlington Dr. Jaggi Rao, Edmonton Dr. Romy Saibil, Toronto Dr. Zaki Taher, Edmonton Dr. Renier van Aardt, Halifax

Sponsors & Exhibitors to date ~ Audessa Health Care Products ~ Clarion Medical Technologies ~ Cutera ~ Cynosure ~ Medicis Aesthetics Canada ~ Northern Optotronics Inc. ~ Sciton ~ SkinCeuticals ~ SkinHealth Canada ~ Stogryn Sales Ltd. ~ Venus Concept ~ Vivier Pharma Inc. ~ Zeltiq

Your Face in Aesthetic Medicine for 10 Years www.caam.ca

Just For Canadian Doctors FALL 2013  

stairway to heaven?

It certainly feels that way, 2,281m high on this boardwalk that hugs Sulphur Mountain in Banff National Park. Those with vertigo be warned…the 360-degree views of the surrounding Rockies (six mountain ranges!) and valleys are goosebump-inducing. It’s the type of vantage point usually only hardcore experienced alpinists get. And, yes, hardy souls can trek up (a worthy workout of 11km and 700m in elevation gain), but the easy route is to take the gondola (and enjoy yet another viewpoint of Bow Valley). Topside, it’s a short ramble along a rather luxe boardwalk to the summit of Sanson Peak. Here, you’ll find the Cosmic Ray Station (a UNESCO World Heritage Site) and Sanson’s Peak Meteorological Station. Go in the fall for pops of gold amidst the uncut swathe of evergreens— and more peaks than you’re likely to get in a single view anywhere else. Better yet, make it the culmination of a train ride across BC that brings you right into Banff and the threshold of these mountains (see page 11). —B. Sligl

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hen September rolls by again, it often feels like the start of a new year, especially for those with school-age children, as our food columnist, Dr. Fong shares (page 25). Whether we have kids or not, we all remember our student days when fall signalled the unwanted end of lazy summer days and the start of school days in the classroom instead of outside. These memories always seem to give September a tinge of nostalgia and sense of a new beginning. The glorious colours of deciduous trees, the earthy scent of fallen leaves, the crisp chill in the air…It’s why riding the rails aboard the Rocky Mountaineer is like stepping back in time, both because of the historic nature of the journey itself (its tracks completed in 1885) and the nostalgic essence of the fall season (page 11). If autumn (and the onslaught of colder weather!) isn’t your thing, well, the southern hemisphere is now gearing up for its spring and summer. It’s the time to go to Brazil. Beat the global crowds making their way to this legendary city for the 2014 FIFA World Cup. Oh, and the 2016 Summer Olympics… Rio deserves the hype. Besides its stunning natural beauty—set amidst peaks and beaches—it’s making a profound effort to clean up its act before taking to the world stage. Visiting a revived favela is a lesson in gratitude and inspiration. And be prepared for overt friendliness—cariocas can’t help but share their happiness (page 16). In a completely different part of the world, literally and figuratively, we follow Dr. Susie Tector to war-torn Syria, where she worked with Médecins sans Frontières. One of MSF’s goals is témoignage, or ‘witnessing,’ tells Dr. Tector. “If I couldn’t provide medical care, I could at least be a witness to the horrible conditions these people are living in.” As such, her missions are often trying, but Dr. Tector feels strongly about bringing attention to this plight (page 10). Do you know a physician making a difference, at home and abroad? Let us know if you have a story to share, and tell us what you’re up to. We want to know where in the world you’re travelling, photographing, volunteering, working…stay in touch through justforcanadiandoctors. com. Happy autumn! feedback@InPrintPublications.com

trek with a view

Banff National Park, pc.gc.ca/pn-np/ab/banff/index.aspx; Banff, banfflakelouise.com; Banff Gondola, explorerockies.com/banff-gondola

Walk this “stairway to heaven,” then stay just below on the lower slopes of Sulphur Mountain at the Fairmont Banff Springs…see page 6.

FALL 2013 Just For Canadian Doctors     

mix

B. SLIGL

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what/when/where > fall style | food | shows | festivals | places | getaways | gear…

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appetite app

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editor’s

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[taste] Petite Pleasures Purists may think that messing with real maple syrup is sacrilege, but the diminutive infusions by NOBLE are straight from gourmet heaven. The handcrafted syrups (sourced from Quebec and New Hampshire) are anointed with ingredients such as organic, fair-trade Egyptian chamomile blossoms and Tahitian vanilla beans, then aged in bourbon barrels. And since the bottles are so petite, they’re perfectly portable. Stash a couple of these 60ml beauties in your carry-on luggage and elevate those room service pancakes to decadent new heights. $26.95, 6/60 ml bottles; $28.95/450 ml bottle, mikuni.myshopify.com

fall

5 hot Perfect the art of escape mustlist picks with excursion-friendly items sure to make your trip more tasty and trouble free

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[gear] Taskmaster When high-tech function and low-tech smarts culminate in a simply genius invention, an engineer is likely behind the scenes. That’s the scenario that led to the creation of TaskOne, a super-slim and lightweight iPhone case outfitted with 22tools made of hardened steel. Strip wires or slice through steak? Tighten screws or crack open a bottle of beer? TaskOne has got you covered. And smart thinking: the 2.5cm knife blade is travel-friendly and removable so you can check it in your bag or leave it at home. $99.99, thetasklab.com

2[dine] chef’s table

castle in the rockies Set on the stay slopes of Sulphur Mountain, its towers and turrets rising up over the treetops, the Fairmont Banff Springs has long been the icon of the mountain-surrounded town in Canada’s must-visit Banff National Park (a UNESCO World Heritage Site). The “Castle in the Rockies” is a relic of the railway’s heydey, when grand hotels modelled on French chateaux were luxurious respites en route to the wild west. And that hasn’t changed—this is still the gold-standard stay for guests disembarking the Rocky Mountaineer train (see page 11). Here, it’s the best of both worlds: old-world glam (along with all the expected modern amenities and one very swish spa) on the doorstep of pristine wilderness (see page 5). —B. S. fairmont.com/banff-springs Just For Canadian Doctors FALL 2013

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5 [explore] City Alternatives While there’s always “an app for that,” we love the tactile nature of a book for exploring a locale, especially Lomography’s quartet of alternative city guides. Covering London, Berlin, Hong Kong and Vienna, each book is composed of hundreds of analogue travel shots captured by “Lomographers,” using the film cameras to reveal hidden spots and unusual treasures, accompanied by tips for exploring the city. Have a hankering for American diner grub in London? Head to Fatboy’s Diner in the Docklands. Want to revel in the ‘80s? Sing a few lines of “Rock Me Amadeus,” in homage to Austrian singer Falco at his Berlin grave site. $9.90 ea., lomography.ca

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[chill] sound ideas The array of in-ear headphones on the market can be confounding. Look no further than Scandinavian-design collective Urbanears, which mindfully marries sound performance with ergonomics. Medis is compactly constructed with an unmatchable EarClick solution (and four interchangeable ear pads in various sizes) that helps relieve pressure from the earpiece to maximize comfort while reducing outside noise. After all, neither Miles Davis nor Mumford and Sons need be interrupted. Add to that a microphone and remote to pick up calls or skip back to your fave song over and over… $59.99, bestbuy.ca

far left: b. Sligl

Through the looking glass at the Fairmont Banff Springs.

Can’t get a reservation at Chef Thomas Keller’s vaunted restaurant, the French Laundry? No time to stop in at Susur Lee’s eponymous Toronto watering hole en route to Paris? You can’t always squeeze in to your favourite chef’s restaurants, but you can find out what dining spots they recommend—and what dishes they’ve enjoyed—thanks to the new app, Chefs Feed. Follow more than 750 of the world’s best chefs in major cities from Austin to Vancouver and test out their top spots. You never know which celeb chef might be sitting at a table nearby. free, iTunes.com

indulge + escape

high-end, mountain high

written + produced by Janet Gyenes

FALL 2013 Just For Canadian Doctors

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p h o t o p r e s c r i p t i o n m i c h a e l d e f r e i ta s

photo prescription [continued]

Michael DeFreitas is an award-winning photographer who’s been published in a wide variety of travel publications. With his initials, MD, he’s been nicknamed “doc,” making his photography prescriptions apropos.

Sometimes slow and steady wins the photography race

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Learn how to take it slow, really slow… Pops of orange cheese and red hats draw the eye as a still spot amidst the blur of movement surrounding on-the-go cheese carriers. Had this scene been “frozen,” the sense of urgency of the bustling market would have been lost amidst a distracting background. Here, blur is a good thing, accentuating the action. This effect is achieved with panning, as with the whitewater-rafting shot, which captures an eye-of-the-tornado feeling.

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Just For Canadian Doctors FALL 2013

Send your photos and questions to our photography guru at feedback@ inprintpublications.com and your shot may be featured in a future issue!

vercast skies and a big crowd greet me as I ready my cameras at Holland’s world-famous Alkmaar cheese market. Rows of bright orange and yellow Edam and Gouda cheese rounds stretch across the cobblestone square. At the centre of the square, pairs of cheese carriers with bright red hats load Gouda rounds onto wooden sleds fitted with shoulder straps. After loading the rounds, the carriers pull the straps over their shoulders, hoist the sled and dash off to the weigh scales amid a sea of popping flashes. Most of the spectators probably shoot on “auto” so the camera’s computer automatically fires the flash to compensate for low light. In this case, the resulting images probably won’t convey motion well because flash tends to “freeze” action. In order to create an actual action shot you need to switch from auto mode to shutter priority. With my flash turned off, I use a combination of slower shutter speeds (between 1/10th and 1/30th seconds) and panning (following) to accentuate the cheese carriers in action. The slower shutter speed conveys action by recording the carriers’ pumping legs and arms as blurs while panning helps streak/blur the distracting background and keep their heads and red hats in fairly sharp focus. Using a slow shutter speed is one of the best ways to simulate action. Of course, “freeze” action shots taken at very fast shutter speeds like 1/550 to 1/1000 seconds (especially in sports) or with a flash are also effective techniques. Freezing a powwow dancer at the peak of a jump or a whitewater raft exploding through a wave will certainly produce great action shots, but motion blurring/streaking is a simple technique that adds drama. At the 2011 Taos Pueblo Powwow in New Mexico, I shot a young aboriginal male’s “grouse” dance at various shutter speeds (between 1/500th and 1/15th seconds). Although all the photos look good, the one shot at 1/30th seconds is my favourite. I used the same technique to capture whitewater rafters on the Gallatin River in southwest Montana near Yellowstone National Park. Again, the slower version portrays more drama.

PRO TIPS on shooting slow

> For shots of running water, always use a tripod and shoot between 1/15th and 1 sec. If you shoot too slow you risk “washing out” (overexposing) the water and losing detail, so vary your speeds accordingly.

> When panning, keep your feet apart, tuck your elbows into your body and keep the camera firmly against your face. Follow the subject by twisting/rotating at the hips (not at the shoulders).

> When capturing an object moving across the frame, use your left eye for the viewfinder when the subject is approaching from the right (and vice versa). By tracking the subject out of the corner of one eye and framing with the other, you can shoot as the subject enters the frame.

> When shooting fast moving subjects (with either method) set your

camera’s motor drive to continuous and shoot a burst of three or four images. This will improve your chances of getting at least one or two keepers.

> When shooting slow without a tripod, don’t stab or jerk down on the

shutter release button. It will produce distracting vertical blurs. Grip your camera tightly, take a deep breath, exhale and smoothly press the shutter release button (and hold it down) until after the shot is recorded.

gear up A tripod consists of legs and a head, the swivel part that

the camera connects to. You can use a variety of heads with any tripod. Although heads with three or more adjustment handles/knobs work great for some types of photography, I highly recommend a simple ball head for travel. Mini tripods ($20 – $40 by Joby, Sunpack, Giottos, Vanguard) work well with lighter point-and-shoots and compact DSLRs. Heavier DSLRs (especially those fitted with telephoto lens) require sturdier aluminum or carbon-fibre tripods and heads ($200 – $500 by Manfrotto, Induro, Gitzo).

YOU WANT A SECOND OPINION.

Where do you go from here? As a medical professional, you’re busy caring for your patients and may not always know how to diagnose your business challenges. For a second opinion on matters relating to incorporation and effectively structuring your business to managing your tax and retirement planning, MNP delivers solutions that enhance the health of your practice at every stage. Contact Calvin Carpenter, CA, Vice President of Professional Services at 1.800.661.7778 or calvin.carpenter@mnp.ca

michael defreitas

slow it down

Other ideal opportunities for slow shutter speeds include waterfalls and streams in Hawaii, Vespa scooters in Rome, chuckwagon races in BC or tuk-tuks in Bangkok. To accentuate motion for any moving subject you can use two slow-speed techniques: panning/following the subject as it moves or holding the camera steady while allowing the subject to move across/within the frame. If you want to keep your moving subject in fairly sharp focus while blurring an unattractive or busy background, try the panning method. I used this method for the Alkmaar cheese carriers and the Montana whitewater rafting shot. I used the other method on a recent Hawaii trip to photograph mountain bikers on a back road. I wanted to emphasize people enjoying the Big Island’s outdoors (action) while preserving the beautiful landscape (panning would have blurred the background). The 1/15th second shutter speed recorded the background scenery as sharp while blurring the cyclists. I made sure to snap the shot as the cyclists entered the frame. Camera shake becomes a major problem at slower speeds and it can ruin a shot with unwanted blur, so use a tripod whenever possible. I use a versatile Manfrotto ball head on my tripod, but pan and tilt heads also work great. Lightly tightening the ball head produces enough friction to keep your camera fairly steady while still allowing you to pan and tilt. It takes a while to master slow shutter speed photography so practise these techniques before your next trip and you’ll bring home some cool shots­—and score bragging rights on Facebook with your friends.

FALL 2013 Just For Canadian Doctors

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pay i t f o r w a r d

travel at home

r o b e r ta s ta l e y

Roberta Staley is an award-winning magazine editor and writer with experience reporting from the developing world and conflict and post-conflict zones. Staley specializes in medical and science reporting and is a magazine instructor at Douglas College and Simon Fraser University.

frontline medicine

An Ottawa physician provides medical care and témoignage in war-torn Syria

currence,” says Tector, an emergency room doctor at Montfort Hospital in Ottawa. Tector was in Syria earlier this year to set up a maternal-child health care facility for Médecins sans Frontières (MSF). The region where the new MSF hospital was located, in northwest Syria, would service a population of about 400,000, scattered among 40 agrarian villages. Since the civil conflict began two years ago, the country’s medical system had largely been destroyed. The March 15, 2011 uprising, sparked by opposition to President Bashar al-Assad’s oppressive regime, had seen 57% of hospitals damaged and 36% rendered defunct. About 2.5 million people have been displaced, according to the United Nations.

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This network of villages had been selected as the location for MSF’s fourth Syrian hospital because locals claimed it was relatively free of shelling from government forces, Tector says. In villagers’ minds, Tector soon realized, the area was ‘secure’ because most of the mortar shells fell harmlessly in nearby fields and only a few of the buildings were hit and casualties few. Tector and two other MSF members: a logistician from France and project coordinator from Pakistan, had arrived on the heels of a reconnaissance team that had selected a sturdy, three-storey, concrete building for the maternal-child health care hospital. “More people were supposed to come later: a midwife, a surgical team, and administration team and we were going to hire local nurses and doctors.” Tector estimated it would take a week to renovate and set up the hospital, then medical supplies could be shipped in. But that first night was a sleepless one for Tector, as the Dr. Susie quiet of the chilly Tector treats a February night amyoung patient plified the noise of in Darfur, exploding mortars Africa. outside the village. The second night, the shelling continued. This time, an exhausted Tector slept through it. “You get used to it quite quickly. When it’s further away it becomes background noise.” But a thought haunted her: were government troops—entrenched 10 kilometres away—aware of MSF’s presence and had increased shelling to drive them out? It was a risk that Tector and her team decided they couldn’t take. They would evacuate. “It’s a terrible, terrible feeling,” says the 41-year-old. “To look at someone and say, ‘This isn’t safe enough for us, but I know you’re living here and raising your children and your two-yearold child is in front of me and they all have

Just For Canadian Doctors FALL 2013

to stay here.’” To Tector’s surprise, the Syrian villagers, instead of being bitter about her exodus, expressed gratitude for the brief stay. The six-week mission to Syria, from February to March of this year, was, Tector admits, the most frustrating of all her MSF postings, which have included the Congo, Pakistan, Chad and Darfur. In Darfur, for example, the villages were safe from insurgents and medical care could be administered in safety. This wasn’t the case in northern Syria. Yet the need was just as great here as in Africa’s conflict zones, Tector says. Syrian women had no pre-natal care and were birthing their babies at home. Children hadn’t been vaccinated in two years. “Women were dying and babies were dying,” says Tector, who grew up in a large family in the Eastern Townships of Quebec to a physician father and physiotherapist mother. Those suffering diabetes and cancer also weren’t receiving therapy. The Roman ruins that Tector had thought so beautiful upon her arrival—the tombs and manmade caves that had been dug by traders more than a thousand years ago—were being used as protection from overhead missiles. But the cold and damp caused lung and skin infections among the children, which were also going untreated. With heavy hearts, Tector and her team left the village, hoping to return soon. She was briefly stationed at another MSF hospital in Syria close to the border of Turkey, where there was a displaced persons camp. Due to the contaminated water, MSF healthcare workers were treating diseases like hepatitis A and typhoid, as well as measles and scabies, says Tector. Despite being unable to create a functioning hospital, Tector at least upheld one key mandate. “One of MSF’s goals, besides medical care, is témoignage, or ‘witnessing.’ If I couldn’t provide medical care, I could at least be a witness to the horrible conditions these people are living in. “Canada should be doing more to help the people affected,” she adds.

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passage to the west Gliding under city bridges, through valleys and canyons, past still lakes and jagged peaks, a train ride across BC into Alberta is the original scenic tour. courtesy Dr. Tector

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otoring through northern Syria’s red-brown rolling hills, with their ancient Roman ruins and tombs and geometric patterns of olive trees, Dr. Susie Tector thought what a wonderful place this would be for a holiday. Then, the mortar shells began dropping—100 metres, 200 metres away from the car—a skyward burst of dust and percussive boom marking the collision with earth. “Drive faster,” Tector told her driver, who didn’t appear “fazed at all. I think for him it was an everyday oc-

story + photography by barb sligl

A passenger snaps scenery somewhere near the Continental Divide, en route from BC to Alberta. FALL 2013 Just For Canadian Doctors

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+

travel at home

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ear on the right, bear on the right!” Blankets fly off laps, people tumble out of seats, necks crane to catch a glimpse. The scenery whizzes by, gold streaks of end-of-summer grass, rolling greens of coniferous-clad hills, shades of grey rock and, um, a “grizzly cow.” False alarm. Jonny, the train manager and de facto concierge, laughs. “If more than three people see it, it’s a bear.” He tells still-searching passengers riding the rails through BC that a bear is everyone’s most-wanted thing to see. Forget sky-high peaks and glacier-silt-hued waters, it seems a patch of fur is the Holy Grail. This trip, alas, there’s no grizzly sighting. No matter, there’s plenty to gape at on the historic “First Passage to the West,” Rocky Mountaineer’s modern-day version of a journey that’s been happening on these tracks since 1885, when the last spike of this railway was laid. Nowadays the passage is a leisurely two-day ride and excuse to sample gourmet fare and simply sit and stare. We start at the western terminus of this epic railway, backing out of the industrial landscape of East Vancouver, past graffiti and warehouses. It’s a slow meander through

if you go

ride the rails Rocky Mountaineer’s “First Passage to the West” route runs April to October. Start or finish with a stay in Banff (see pages 5 + 6). rockymountaineer.com

peded views and the lower dining level is about haute cuisine. Executive Chef Frédéric Couton, who’s trained at Michelin-star restaurants in Paris and Geneva, transforms the ingredients (from 120,000 eggs per season to 200 Albertabeef shortribs per day in the Gold Leaf cars) into the locally sourced menu. In the convivial atmosphere of the dining room, where global accents (Aussies, Kiwis, Americans, French, Germans…) mingle over Canadian fare, one couple feels the need to call Jonny over to extol the flavours of the tomato-and-wildmushroom soup. It is worthy of exclamation. As is the wild BC salmon. Noshing on salmon and hearing about its epic journey up the same Fraser Canyon (of course, our route is decidedly effortless) seems almost sacrilegious as I spot flicks of silver on the river’s surface far below. These fish make their arduous journey over thousands of kilometres, through seemingly impossible-tobreach obstacles (like roiling Hell’s Gate, the narrowest part of the canyon) to spawning grounds—all simply to reproduce. The train slows to “Kodak speed,” some five km/hour. “Oh là! C’est trop beau,” and plenty of oohs and aahs are overheard as we hug the canyon’s walls. Cameras snap inces-

After a sunset amble along the quiet waterfront and a locally brewed pilsner at The Noble Pig Brewhouse, it’s an early wake-up call to catch sunrise over Peter and Paul before breakfast back aboard the train. We skirt glassy Shuswap Lake in the morning light, passing BC’s lake country and Adams River, where the world’s highest concentration of salmon brings out scores of fishing boats even earlier than us. Soon we’re passing the legendary last spike of the transnational railway, Craigellachie. The plaque states “A nebulous dream was a reality: an iron ribbon crossed Canada from sea to sea.” We’re on that same track more than 125 years later. Fittingly, “Day 2 is when the magic happens,” say our hosts. We pass Eagle River and, as if making an entrance, a bald eagle soars over a buffet of spawning Kokanee salmon. Every few minutes there’s another eagle. The water is tinged red from the salmon. “That was worth the trip alone,” says one woman of the mid-September salmon spectacle. And, yes, there’s a bear. Finally. It’s not a grizzly, but a black bear bounding into the forest. Everyone makes a mental check. Hereafter, the checks come fast and furious: going under Rogers Pass in Connaught Tunnel, winding through the engineering feat of the Spiral Tunnels, crossing the Continental Divide. At this point, the crew serves liqueur, and most of us put down the cameras, sit back and simply sip and gaze. Autumn has arrived in the mountains, with aspens turning a glossy yellow, breaking up the evergreen spread with pops of gold. We’re now in the big-time mountains of Banff National Park in Alberta. The Rockies elicit an “Oh là là” from my French seatmate. The 3,543-metre behemoth of Mount Temple dominates the skyline and, as we continue along the Bow River Valley, the iconic swathe of ice suspended over Lake Louise, Victoria Glacier, almost seems within grasp. We reach Banff as the late sun touches the tips of the surrounding mountain peaks. It’s golden hour here. Jonny leaves us with an excerpt of a poem, The Station: “So, stop pacing the aisles and counting the miles. Instead, climb more mountains, eat more ice cream, go barefoot more often, swim more rivers, watch more sunsets, laugh more and cry less. Life must be lived as we go along. The station will come soon enough.” And it does—too soon.

travel at home Old-school-cool patterns in a Fairmont Banff Springs suite, where the glamour of the heyday of railway travel is still strong and the rooms all come with a view (see page 6).

The arid beauty of BC’s Fraser Canyon.

Fine dining in the Gold Leaf car.

Welcome crew in Kamloops, BC.

The Rockies elicit an “Oh là là”… urban Vancouver that feels like its own reconnaissance. We cross the Fraser River under the broad span of the Port Mann Bridge and inch through Thornton Yard, one of the largest railyards in North America. As the train picks up speed outside the Lower Mainland, it chugs through the Fraser Valley, where farmland competes with Greater Vancouver’s spread east. The steep sides of the Cascade and Coast Mountains contrast ruler-straight lines of crops ready for harvest. Cows, barns, tractors and snow-capped Mount Baker (all 3,319 metres of it) roll by. In Mission, Jonny tells us about Canada’s first train robbery in 1904, when bandits first used the term “hands up!” And our hands do go up shortly thereafter, bringing fork to mouth… We savour the produce of the valley we just glided through (berries, corn, chicken) as we head north into the Fraser Canyon. The three-course menu is paired with award-winning BC wines: Nk’Mip Cellars Qwam Qwmt Chardonnay, See Ya Later Ranch Pinot 3, Sumac Ridge’s Black Sage Vineyard Merlot, to name a few. This is the doubledecker Gold Leaf Service car, after all, where the glass-dome upper level is about unim-

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santly as we spot the first golden leaves of fall. By the time the multi-course lunch is over, we’re almost out of the canyon. There’s a blast of arid heat in the open-air vestibule (and congregation point for camera aficionados on board) and the landscape is desert-like. We’ve gone from the moist greens of the coast and farmland to burnished coppers of arid desert dotted with hoodoos, sage shrubs and giant osprey nests. Jonny tells us that BC is the most ecologically diverse province in Canada, and it’s easy to see those striations in landscape through the glass dome of this train. Post-lunch, people are nodding off, pleasantly sated and looking rather dreamy. It’s the mid-afternoon lull, Rocky Mountaineer style. The average speed is an easygoing 40 – 50 km per hour, making riding the rails with an afternoon cocktail rather hypnotic. The rhythmic clang, combined with the gentle sway, is almost like the beating heart of the train. After a while, it seems in sync with my own. We turn east and follow the blue-green Thompson River to Kamloops, our stop for the night that’s “no Paris or London,” as one passenger comments, but does boast Mounts Peter and Paul, giant, camel-like twin hills.

Just For Canadian Doctors FALL 2013

The Rocky Mountaineer snakes through the Rockies.

Wild BC salmon in the Gold Leaf dining car.

Rail bridge in Kamloops, BC, the overnight stop on the First Passage to the West train tour with Rocky Mountaineer.

Just off the tracks: silt-blue rivers, greenblanketed hillsides, jagged peaks.

story

Gold Leaf car tradition: Caesar Sligl + photography by aBarb cocktail as the train crosses into Alberta. FALL 2013 Just For Canadian Doctors

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motoring

d o c t o r o n a s o a p b o x D r . c h r i s p e n g i l ly

D r . k e l ly s i l v e r t h o r n

Dr. Chris Pengilly is Just For Canadian Doctors’ current affairs columnist. Please send your comments to him via his website at drpeng.ca.

Dr. Kelly Silverthorn is a radiologist and Just For Canadian Doctors’ automotive writer.

50 years of evolution

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What would yesteryear’s engineers think of the latest Porsche 911 and Corvette?

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here are two ways for a physician to increase his/her take-home income—work harder and longer hours or work more efficiently. The formula is to maximize the time for the physician to perform billable work, and to minimize the costs in achieving this.

his year saw both an all-new Porsche 911 and all-new Corvette. Coincidentally (or not), 2013 is exactly 50 years since the original 1963 Porsche 911 and Corvette Stingray debuts. A lot has changed since then. I tried to imagine what those early 1960s engineering teams would think of the new models if teleported Star Trek-style 50 years forward to the 2013 Geneva and Detroit Auto Shows respectively. Our “away teams” would re-materialize at the back of the 2013 show crowds as the drums rolled and the curtains were raised. What gestalt would emerge from our tele-

ported engineers’ first look at the new models? Once they assimilated the 50 years longer, wider and more in the making…the menacing ethos, I do 2013 Porsche 911 Carrera 4S Coupe and original Porsche 911 2.0 Coupe.

hot!

think they’d recognize these distant progeny as the offspring of their original creations. Remember, they’d be unaware of the look of the five intervening generations of Corvette (or 911). Proportions, logos and scripts have shown some consistency through these generations—and for the Porsche at least— headlights and taillights too. I’m surmising the original engineers would have little appreciation of the aerodynamic advances now contained in the body shape and undertray…both of the 1960s models suffered increasing lift with increasing speeds. The modern cars generate desired

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downforce at speed. They also have far lower coefficients of drag. The new cars need these aero advancements to safely reach their top speeds of 290kph and more. Some of the braver teleported engineers would have white-knuckled the earliest 1963 versions of these models to reach their claimed top speeds of just more than 210kph. The show cars would be rotating on an elevated carousel with standing, murmuring crowds all around, and camera flashes popping. The teleported teams would notice how

tires and wheels have changed. Their early products employed 15-inch diameter wheels vs 18-inch plus today. Standard issue wheel widths were five to seven inches then; today, 8.5 inches, front, 11 inches, rear. Tire sidewalls were 75% of tire width then, just 30 – 40% now. The load and speed rating for modern tires are also much higher. I’m confident our early engineers would peer between the wheel “spokes” to see the original Corvette’s 11-inch diameter drum brakes had evolved into ~13-inch disc brakes (ditto the 2013 911 disc diameters). The acronym ABS (anti-skid braking system) would be Latin to our time travellers, as would be the alphabet soup of all the other electronic control systems aboard. And improved braking performance has progressed to a distance of just 100 feet at 60 miles per hour. Being engineers, I’d like to think the timetravellers would next migrate to the show’s floor models and “pop the hood.” Past the bolt-ons, they’d see the familiar. Porsche still runs a rear-engined, horizontally opposed six-cylinder, overhead cam engine—though now water-cooled and four-valves per cylinder. The Corvette engine would be even more unadulterated, still running a front-engined, pushrod two-valve-per-cylinder V-8—

Just For Canadian Doctors FALL 2013

though the Stingray’s transmission is now one with the rear-mounted transaxle. Would both away teams be surprised today’s cars run on gasoline, albeit now unleaded? If so, at least they’d be impressed by how much more efficiently the fuel is consumed. The original Porsche derived 130hp from its 2.0-litre displacement versus the 350hp from 3.4 litres it gets now. The Corvette improved its base V8 from 250hp from a 5.2-litre displacement to the current 455 hp from 6.2 litres. Yet, fuel mileage and non-CO2 emissions are now light years ahead.

Our teams would be sure to sit in the floor models. Those with three pedals and stick-shift would be familiar to them, though their early 4- and 5-speed transmissions are now both 7 speeds. The teams would have little idea of the numerous airbags surrounding them, or all the crash-worthy engineering and testing now done. The sound and navigation systems would, quite simply, blow their minds…so would the numerous nanny-state warning and hectoring stickers. Hopefully our away teams would find a way to huddle with some of the current engineers. “Ja, the Porsche is still a steel unibody, but different,” and “Yah, the Corvette body is still fibre-based, but different.” The usual laments about corporate politics, office perks and assigned parking stalls probably haven’t changed much in five decades. But pushing past the work stresses and technojargon into their shared passion for these cars, I’m sure the early pioneers would come away confident the current generation carries the flame competently. Few car companies last 50 years. Fewer still are the car models that last 50 years. Still, would our early teams be disappointed that, after more than 50 years of intervening engineering excellence, they’re seeing mostly evolutionary changes rather than revolutionary? True, many advancements would be invisible to their eyes. Would today’s auto engineers think similarly about evolution/revolution if teleported to 2063? But free food is free food, and tired sore feet need a rest. I’m banking on Scotty locking onto the away teams from pre-set coordinates to the show’s hospitality areas.

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> Be accurate in submitting billing and challenge refused billings > Work in a group of 3 or more physicians > Change to an electronic medical record or, if already a user, optimize this > Use voice recognition technology > Charge for uninsured services It may seem obvious but the physician will not be paid for what he/she does not bill. Such errors are easy to make. Sometimes there is a second fee with an office visit that can be overlooked. A particular area of risk is work completed outside the office, where the support staff has no real awareness of what work is being done. Immediately upon returning to the office a note of the work should be made and given to the staff. As the fee schedules have developed over the years they have become more complex, and refused payments are not uncommon. I am surprised by the number of physicians who never see their submissions or remittance statements from the paying authorities. It can be quite an eye opener; it is important that these are analyzed and, when appropriate, refusals vigorously challenged. By reviewing these the physician can learn which services are not being paid and could be billed alternatively or avoided. Working in a single-handed practice makes poor economic sense. The cost of overheads such as photocopiers, fax machines and janitorial services will be divided among the number of members in the group. Staff can be employed more efficiently—a group of four physicians will likely employ four medical office assistants. Each one could have an area of increased responsibility, for example, one concentrates on the billing, one oversees supplies for the office, one has nursing

expertise and the fourth manages the medical record. Another significant saving is that with three or four medical office assistants it is not usually necessary to pay extra staff for holiday relief. Changing to an electronic medical record saves support staff a great deal of repetitive unproductive labour, such as pulling and refiling charts, and the labourintensive chore of filing paper results and letters as well as organizing the chart. In fact, the savings are such that four family physicians may need to employ just three medical office assistants. A good EMR will offer several other advantages. Add-on features improve patient safety while saving money. Most will record all medications as they are prescribed and simultaneously check for potential drug interactions. Timeconsuming and irritating tasks like infant growth charting are automatically graphed. A good EMR should have an easily accessible template to rapidly generate excellent referral or consultations letters and even lengthy medical reports. Handwriting or labouriously typing (unless the physician can type at 70 or 80 words per minute) is time-consuming and tends to lead to too brief recording of medical information. A transcriptionist will demand at least $30 an hour, but save the physician sufficient time to see two or three more patients in a day, which would more than cover the cost. Voice recognition has now reached the point of being very usable and another economy. This requires a powerful computer with a quad processor and about 2GB of RAM. A dedicated medical program is essential, not only for the vocabulary but also the syntax. It is tempting to think that the regular program can be trained to learn the “few medical terms I use” but this is not the case. It will likely lead to frustration and abandonment of what could have been a major money saver in a physician’s practice. The program will cost the physician about $1,600 and two hours dedicated to learning for optimal use of the program. At $30+ an hour for a typist, the program will pay for itself within a few months.

Medicare covers many medical expenses but not all by any means. Patients are becoming aware of this and are surprisingly willing to pay for many of these uninsured services. Many accept the idea of an optional annual user fee, which will give coverage for brief ‘doctor notes,’ repeat prescriptions over the telephone and minor cosmetic procedures such as cryotherapy. These and several other ideas are dealt with in detail in my eBook, The Successful and Audit-Proof Medical Office. After some 30 years in medical practice and peer assessments I have learned a great deal about running a medical practice. This book is the culmination of that learning—my ‘soapbox’—and something I’m happy to now pass on (see page 31).

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FALL 1/6 2013 Just For Canadian Doctors Vertical : 2.25”w x 4.875” h May2013

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travel the world here’s something about Rio. This iconic city has all the things you might expect: out-of-this-world scenery, gorgeous beaches and locals, tasty caipirinhas (Brazil’s classic cachaça cocktail), football frenzy, flip-flops (that is, Havaianas, made right here) on every foot…plenty of buzz. There’s a chaotic thrum to Rio. The vibe is both laid-back and ready to party. It’s the carioca spirit. Rio locals are dubbed carioca, and they fit the stereotype of beach-loving, surf-riding, sun-bathing, party-going… This is the home of bossa nova, the inspiration for “The Girl from Ipanema,” the vibe that begot the Copacabana. Think Carmen Miranda. It’s about being simpático or carismático. The cariocas of Rio are proud to be friendly, fun and free-spirited. To be a “very carioca guy,” explains my rather charming guide (carioca himself), is to be “not so serious, cool,” like one of Brazil’s most famous actors, Rodrigo Santoro. “He would go in Havaianas to the shopping mall.” That simpático nature bodes well for Rio’s upcoming spotlight on the world stage: first, the FIFA World Cup in the summer of 2014, then the Olympics in 2016. Rio needs no preparation in hosting a party—after all, it puts on Carnaval every year—yet, with the entire globe focused on the city soon, Rio is pulling out all the stops. Some major cleaning up is going on, from educating its vast populace (over six million) on recycling and sustainability to the pacification of its favelas, the Portuguese term for the shanty towns that creep up Rio’s hillsides. Dona Marta favela is home to over 6,000 people in Rio’s Botafogo neighbourhood. Residents and guides Veronica and Salete take me on a tour that’s part of a government initiative to redefine the favela—from drug- and gang-riddled vacuum of lawlessness to thriving community in its own right. This Rio Top Tour is an insider look at Rio’s model favela. It’s the first favela to open to the public and cooperate with police. In 2008, a few short years ago, a special-ops mission cleaned up the neighbourhood held hostage by gangs. Now there’s a water treatment facility and U.P.P. (Unidade de Polícia Pacificadora) or Police Pacification Unit on site. It’s the first favela to have electricity (legally, that is), water on tap and internet—a dramatic turnaround from once being considered one of the most dangerous favelas in Rio. But there’s no dwelling on the past here. It’s about the future, not the past. Dogs are yapping, kids screeching and chasing each other, teens playing soccer (on a pitch with

16

astro turf!). This favela is full of life. There’s even a funicular (it’s one of Rio’s steepest favelas), but we walk the zig-zag of narrow corridors amidst the jumble of cracker-jackstacked homes. It’s like making one’s way through a maze. We pass a group of young men playing truco (a lively card game), an old man sweeping his threshold, a woman sitting on her stoop. A man sells candy from his tiny stall perched at the top of crooked stairs. Another man hawks fresh-baked sonho or “dream,” a donut oozing with a caramel cream filling. We come upon one courtyard where people are setting up for some forró, a Brazilian music and dance style with a partner “for everyone,” says one local. Another stand sells brigadeiros, a beloved sweet treat made from condensed milk (Brazilians have a sweet tooth) that’s inspired a common saying, “We have a brigadeiro sky today,” meaning clear, blue skies. That picture-perfect sky might best be seen from across the city atop another of Rio’s seemingly endless peaks, where it’s been said “God comes down every morning and has his breakfast on Sugar Loaf.” Looking back at Sugar Loaf with a beatific expression—and Dona Marta as well—is Rio’s main hallmark, Christ the Redeemer, himself visible from just about anywhere in the city. The outstretched arms (a 28-metre span) of the stylized, stark-white Christ figure (38 metres tall) atop Corcovado mountain seem to welcome visitors and embrace locals at the same time, whether those lounging on hip-and-highfashion Copacabana or trekking up the steep steps of Dona Marta’s upper reaches. A funicular takes us to the seemingly unreachable peak, followed by stairs or an escalator up the side of the mountain (really!) to the base of the statue. Gathered around the stylized folds of Christ the Redeemer’s robe are the masses. This is what everyone who comes to Rio wants to check off the list. And it’s worth it, if only for the view of Rio spread out far below. The mishmash of favelas and pockets of highrises are tucked between those characteristic peaks, up hillsides, skirting lagoons and bays. Ribbons of beach, far-off surf, and the vast Atlantic play peek-a-boo with shifting clouds and mist. It feels, rather appropriately, as if I’m standing atop the clouds, getting a glimpse of earth from a heavenly perch. Guide João says, “We call it the curve of oh,” as in “Oh, ohhh…” The exclamation is uttered repeatedly around me. It’s one of those places that, despite all its hype and oft-seen and over-referenced imagery, doesn’t disappoint. João can’t count how many times he’s been up here. “Everyday is different,” he says. The view fluctuates between flitting clouds, mercurial sea, incessantly spreading favelas

Just For Canadian Doctors FALL 2013

The always happening Rio de Janeiro is now gearing up for the

World Cup + Olympics

Rio on therise story

+ photography Barb Sligl

Local boys hit Ipanema Beach at sunset. above, clockwise from top left

Christ the Redeemer overlooks all of Rio; Speedo-clad carioca strolling the tiled sidewalk of Ipanema; the view from Sugar Loaf; Coconut-water break, Rio style. opposite page, from top Kids in Dona Marta favela; carioca guide, João; Dona Marta residents and Rio Top Tour guides, Veronica and Salete.

FALL 2013 Just For Canadian Doctors

17


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saskatoon / st. thomas / geneva / lorne / napa … | c a l e n d a r

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A n in ter n ation a l guide to c ontinuing Medica l Education

fall 2013 + beyond

Saskatoon

4

3

2

5

1

Saskatoon is surprisingly happening—from tasty microbrews and farm-to-fork fare to a university scene and light machine that’s out of this world. (CME events in Saskatoon are highlighted in blue.)

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+

B. Sligl

Drowning in paperwork?

and the cranes and construction that are the harbingers of the World Cup and Olympics. To one side is Estádio do Maracanã, the football stadium built in 1950 that was once the world’s biggest, hosting some 200,000 spectators in its stands during that year’s World Cup between Brazil and Mexico. It’s since been modernized and revamped for safety as an all-seater with a capacity of 80,000 and will be the main venue for the upcoming World Cup. It’s also the base of the Flamengo and Fluminense teams, two of Rio’s four home teams. As I’m told repeatedly, you haven’t experienced futebol until you’ve attended a game here with carioca fans… After an acerola juice from one of the juice stalls found on every corner (offering fruit like açaí and graviola that seem exotic but are everyday fare here), João demonstrates capoiera and Brazilian jiu-jitsu while we wait for the funicular. He flips backward off a bench, lands in a crouch before twirling in a flurry of arms and legs. The national sport (and way of life), which João describes as “human chess,” is performed on street corners, squares and in gymnasiums throughout Brazil. Besides soccer, the meld of dance and martial arts is one of Brazil’s best-known exports. That, and bossa nova’s rhythms. And, as if on cue, our descent on the funicular includes a bossa nova serenade by local musicians, hawking their trade of tunes. After seeing the curvaceous shape of Rio from above, we want to explore her bombshell curves up close…by bike. Rio, like most cosmopolitan cities these days, has rentalbike kiosks scattered throughout its touristfriendly “south zone,” Zona Sul. The “BikeRio” orange bicycles are available at 60 stations (with 600 bikes) in Rio’s happening neighborhoods, from Copacabana and Ipanema to Lagoa and Botafogo—and there are an astounding 250km of official cycle paths. We weave along a small portion of that, around the lagoa or lagoon (stopping at the Flamengo football team’s store for souvenirs) and by Ipanema Beach, past surf shops and kiosks with heaps of coconuts. Post-ride, we sip from one of those freshly cracked-open coconuts, Rio-style, as locals gather in the fading light for impromptu samba dancing. A Speedo-clad carioca walks by in Havaianas on the Portuguese-tile-patterned sidewalk. This is Rio. Another local, standing if you go at a crowded rock it in rio corner café, drink Now’s the time to discover in hand, says, Rio de Janeiro’s carioca “Congratulations!” spirit—summer’s starting What for, we ask. and the pre-World-CupHis matter-of-fact and-Olympics party prep is underway. rioguiaoficial. answer: “You are com.br/en/home here!” Indeed.

he Ninkasi Imperial Pilsner goes down very nicely. So does the Black Cat German Schwarzbier, Loki Double (Imperial) IPA and Bête Noire Dry Oatmeal Stout. Yes, there’s a lot of great brew to choose from in Saskatoon, especially from Paddock Wood Brewing Co. at the Woods Alehouse [thewoodsalehouse.com] 1 . At Saskatoon Brewery, there’s the Berry Dark Ale. If you prefer crisp cider, Living Sky Winery [livingskywinery.com], just outside the city, is garnering plenty of attention for its Bunny Hugger Sask-cherry cider (“bunny hug” is a Saskatchewan term for a hoodie)—so much so that a band touring through the area bought up the last of the current stock. Owners and farmers Vance Lester and Sue Echlin won the Outstanding Young Farmer of Canada last year (Vance now sports the eye-catching belt buckle-cum-trophy 2 ). All these local growers and brewers are part of a burgeoning group of bright, young folk revitalizing this prairie town. In downtown Saskatoon, there’s the Woods Alehouse with locavore fare as well as beer, and a tiny joint with a double identity: “Poached” in the mornings for breakfasts that, you guessed it, boasts perfectly poached eggs, and “Flint” by night [flintsaloon.com], with

hand-crafted cocktails like the Berry Saskatoon martini , made with house-infused gin 3 . Across the South Saskatchewan river 4 , white-hot restaurant Weczeria [weczeria.ca] is leading the food movement on the hipster stretch of Broadway (sample dish: Chef Daniel Walker’s Wild Boar Cheek). The street showcases local fare from cupcakes (home-baked goods are part of the Eastern European roots of Saskatoon) and cheese at the Bulk Cheese Warehouse (locals’ go-to gourmet grocery store) to the must-try “prairie blend” coffee at Broadway Roastery [broadwayroastery.com]. Walk northeast along the river and you’ll get to the University of Saskatchewan, founded in 1907 [usask.ca]. Renowned for its medical, dental and veterinary schools, U. of S. has kept this prairie city on the cutting edge. The Canadian Light Source, Canada’s national synchrotron research facility [lightsource.ca], is located here (it’s like real-life sci-fi: the synchrotron is a giant electron beam). A short walk away is the award-winning high-tech research/ science park, Innovation Place [innovationplace.com]. Back on the other side of the South Saskatchewan river the creative set gets arty again at the Mendel Art Gallery

[mendel.ca]. Check out the “Shaping Saskatchewan: the art scene 1936-1964” exhibit on until September. And opening in 2015 will be the province’s largest art gallery, the Remai Art Gallery of Saskatchewan [remai.ca], alongside Persephone Theatre at the River Landing [riverlanding.ca]. Also on this side of the river is the downtown core, where the Delta Bessborough hotel has been an imposing structure since 1935 [deltahotels.com/Hotels/DeltaBessborough] 5 . The grand dame claims “All the festivals, one castle,” referring to Saskatoon’s moniker of Festival City (summertime there’s a new fest going on every week, from the Jazz Fest to Shakespeare on the Saskatchewan). Coming up is September’s Word on the Street and, in the new year, the PotashCorp WinterShines fest and Blues Festival. Whatever time of year, post-fest, embrace all that Saskatoon spirit downtown in The James—a boutique style hotel on the river’s edge where you can sip an oldschool Sazerac and channel this city’s newfound spirit. [thejameshotel.ca]. —B. Sligl For more info on Saskatoon, go to tourismsaskatoon.com; and Saskatchewan in general, sasktourism.com.

FALL 2013 Just For Canadian Doctors

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MCE Conferences

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mceconferences.com

Dec 28Jan 04 2014

Caribbean Cruise

Rheumatology & Dermatology

Sea Courses Cruises

888-647-7327 See Ad Page 20

seacourses. com

Nov 13

Hamilton Ontario

2013 Evidence-Based Management Of The Diabetes Epidemic

McMaster University

905-525-9140

mcmaster.ca

Dec 07-11

Lorne Australia

13th International Congress Of The Immunology of Diabetes Society

011-61-3-59832400

ids2013.com.au

Feb 22Mar 04 2014

Caribbean Cruise

Cardiovascular 2014 Focus On Diabetes

CMEatSEA

888-523-3732 See Ad Page 23

cmeatsea.org

Oct 18-19

Saskatoon Saskatchewan

2013 Saskatchewan Emergency Medicine Annual Conference

University of Saskatchewan

306-966-7787

usask.ca

Jan 25-26 2014

San Antonio Texas

Hospitalist And Emergency Procedures CME Course

Hospital Procedures Consultants

805-339-0225

hospitalprocedures.org

Feb 11-15 2014

New York New York

20th Annual Scientific Assembly Of American Academy Of Emergency Medicine (AAEM)

American Academy of Emergency Medicine

800-884-2236

aaem.org

Oct 05-06

Monterey California

New Concepts & Emerging Therapies In Metabolic UC Davis Health System Disorders & Vascular Disease

916-734-5390

ucdmc.ucdavis. edu

Oct 16-20

San Juan Puerto Rico

83rd Annual Meeting Of The American Thyroid Association (ATA)

American Thyroid Association

703-998-8890

thyroid.org

Mar 13-15 2014

Munich Germany

2014 Power Of Programming: International Conference On Developmental Origins Of Adiposity & Long-Term Health

Project EarlyNutrition Secretariat

earlynutrition@med. lmu.de

munich2014. project-earlynutrition.eu

Dec 06

Warrenville Ohio

12th Annual Liver Update

Cleveland Clinic for Continuing Education

216-448-0770

clevelandclinicmeded.com

Dec 16-17

Amsterdam Netherlands

Amsterdam Live Endoscopy 2013

European Postgraduate Gastro-surgical School

011-31-20-5663926

amsterdamendoscopy.com

Feb 06-09 2014

Scottsdale Arizona

2014 North American Society For Pediatric, Gastroenterology, Hepatology & Nutrition (NASPGHAN) 3rd Year Fellows Conference

NASPGHAN

215-233-0808

naspghan.org

new CME list fromASNAdam Events

For the past 20 years, our Primary Care Conferences have been designed to educate primary care physicians, with a focus on practical and useful information for clinical practice. Choose from three upcoming 2014 conferences. 9th Annual Primary Care Update Westin Maui Resort & Spa Ka’anapali Beach, Lahaina, Maui March 3-7

Primary Care Essentials Wailea Beach Marriott Resort Wailea, Maui March 10-14

17th Annual Primary Care Update Marco Island Resort & Spa, Marco Island, Florida March 24-28 March 31-April 4 April 7-11

Continuing Medical Education Institute 952.948.1685 • www.CMEIconference.org FALL 2013 Just For Canadian Doctors

21


when

where

Oct 04-06

Halifax Nova Scotia

topic

sponsor

contact

website

Pathophysiology Of Obstructive Sleep Apnea Syndrome & Diagnosis Of Obstrctive Sleep Apnea Syndrome, Explain Polysomnography, Home Study - Plus More

Canadian Sleep Society

rdexter@ planaheadevents-halifax. com

canadiansleepsociety.ca

usask.ca

6th Conference Of The Canadian Sleep Society

cme

calendar

cme

when

where

topic

sponsor

contact

website

Nov 06-07

Coral Gables Florida

Second Annual Miami Neuro Symposium

Baptist Health South Florida

786-596-2398

baptisthealth. net

Feb 02-16 2014

Australia and New Zealand Cruise

Neurology And Pain Management

Continuing Education, Inc./University at Sea

800-422-0711

continuingeducation.net

Feb 19-22 2014

San Juan Puerto Rico

65th Southern Neurosurgical Society (SNS) Annual Meeting

Southern Neurosurgical Society

630-681-1040

southernneurosurgery.org

Nov 02

St. Petersburg Florida

Nutritional Medicine

Scripps Conference Services

858-652-5400

scrippshealth. org

Apr 26-30 2014

San Diego California

78th American Society For Nutrition (ASN) Scientific Sessions & Annual Meeting

American Society For Nutrition

301-634-7050

nutrition.org

Oct 06-16

Barcelona to Athens Cruise

Family Medicine: Women’s Health

Continuing Education, Inc./University at Sea

800-422-0711

continuingeducation.net

Jan 19Feb 02 2014

South American Cruise

Pain Management & Women’s Health Update 2014

CMEatSEA

888-523-3732

cmeatsea.org

Frank Moya Continuing Education

954-763-8003

currentreviews. com

Saskatoon Saskatchewan

Practical Management Of Common Medical Problems

University of Saskatchewan

306-966-7787

Jan 04-22 2014

Antarctica, South Georgia & Falklands

Current Medical Issues Cruise

Professional Education Society

877-737-7005

pestravel.com

Jan 09-11 2014

Whistler British Columbia

Medical CBT for Depression: Ten-Minute Techniques for Real Doctors

CBT Canada

877-466-8228

cbt.ca

Feb 18Mar 05 2014

Vietnam and Cambodia River Cruise

Healthcare Delivery

Professional Education Society

877-737-7005 See Ad Page 40

pestravel.com

Mar 24-26 2014

Maui Hawaii

Medical CBT For Depression: Ten-Minute Techniques For Real Doctors

CBT Canada

877-466-8228 See Ad Page 18

cbt.ca

Mar 24-28 2014

Marco Island Florida

17th Annual Primary Care Update - Session 1 Mar 24-28, Mar 31-Apr 04 Or Apr 07-11

Continuing Medical Education Institute

952-948-1685

cmeiconference.org

Mar 14-16 2014

Lake Buena Vista Florida

40th Annual Virginia Apgar Seminar

Jun 29Jul 07 2014

Galapagos Cruise

Current Medical Issues

Professional Education Society

877-737-7005 See Ad Page 40

pestravel.com

Various Dates

Victoria British Columbia

Education Series For End Of Life Care: Multiple Topics

Victoria Hospice Society

250-370-8715 See Ad Page 24

victoriahospice. org

Nov 06-07

Barcelona Spain

ESH International Conference On Haematological Disorders In The Elderly

European School of Haematology

011-33-1-57276739

esh.org

Oct 24-26

New York New York

Lymphoma & Myeloma 2013: An International Congress On Hematologic Malignancies

Imedex

770-751-7332

medex.com

May 14-17 2014

Chicago Illinois

27th Annual American Society Of Pediatric Hematology Oncology Meeting: ASPHO 2014

American Society of Pediatric Hematology/ Oncology

Victoria Hospice Society

250-370-8715

aspho.org

Victoria British Columbia

Palliative Care: Medical Intensive Course

847-375-4716

Nov 18-22

victoriahospice. org

Oct 17

Saskatoon Saskatchewan

Canadian Association Of Emergency Physicians (CAEP) Toxicology Roadshow

Ongoing

caep.ca

Capacity Building Internship For HIV/AIDS Orphanage (Volunteer Opportunity)

778-300-2466

613-523-3343

Multiple Cities Colombia

The Humanity Exchange

CAEP

thehumanityexchange.org

Sep 10-20 2014

Ireland Cruise

Updates In Disease Prevention & Public Healthcare Delivery - Explore The Emerald Isle

Professional Education Society

Noosa Australia

2013 Paediatric Acute Care Conference

Advanced Paediatric Life Support, Australia

011-61-40-4938656

apls.org.au

877-737-7005

Oct 25-27 Oct 21-25

Maui Hawaii

3rd Annual Primary Care Fall Conference

Continuing Education Company

800-327-4502

cmemeeting.org

Nov 08-15 2014

Tahiti Cruise

Updates In Disease Prevention & Public Healthcare Delivery

Professional Education Society

877-737-7005

pestravel.com

Oct 31Nov 02

Destin Florida

2013 Annual Scientific Assembly Of Southern Medical Association (SMA)

Southern Medical Association

Lahaina Hawaii

9th Annual Primary Care Update - Fall Conference

Continuing Medical Education Institute

952-948-1685 See Ad Page 21

cmeiconference.org

800-423-4992

sma.org

Mar 03-07 2014

Mar 08-15 2014

Eastern Caribbean Cruise

Potpourri Of Recent Advances In Internal Medicine Update 2014

Wailea Hawaii

Primary Care Essentials

Continuing Medical Education Institute

952-948-1685 See Ad Page 21

CMEatSEA

888-523-3732 See Ad Page 23

Mar 10-14 2014

cmeiconference.org

Nov 08

Toronto Ontario

2013 Canadian Medical Protective Association (CMPA) Symposium Toronto

Canadian Medical Protective Association

Medical CBT Tools: Ten-Minute Techniques For Real Doctors

877-466-8228 See Ad Page 18

cbt.ca

cmpa-acpm.ca

Caribbean Cruise (Disney Fantasy)

CBT Canada

800-267-6522

Dec 07-14

Dec 12-19

New York New York

USA Pacific Medical & Legal Conference

Conferences 21

011-61-7-32543331

conferences21. com

Feb 17-19 2014

Waikiki Hawaii

Medical CBT Tools: Ten-Minute Techniques For Real Doctors

CBT Canada

877-466-8228

cbt.ca

Obstetrics & Gynecology Oncology & Palliative Care Pediatrics

pestravel.com Primary Care

new CME list from Adam

Nutrition

Nov 15-16

cmeatsea.org Psychiatry/ Psychology

Legal and Ethics

Internal Medicine

Infectious and Chronic Diseases

Hematology

General & Family Medicine

cme

Neurology

c m e calendar

new CME list from Adam

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*Air Included from select North American Gateways. All funds in USD. **Free Beverage Package for Two applies to two guests per stateroom and includes beers up to $5 per serving; spirits, cocktails, and wine up to $8 per serving, all soda selections, fresh squeezed and bottled juices, premium coffees, and teas and non-premium bottled water. Server gratuities are included (amount based on gratuity guidelines), cruise must be booked by Oct. 06, 2013. Offer applies to ocean view and higher staterooms CMEatSEA reserves the right to make changes, correct errors or omissions. BPCPA #28364.

22

Just For Canadian Doctors FALL 2013

FALL 2013 Just For Canadian Doctors

23


c m e calendar

Urology

Technology

Surgery

Rural Medicine

Rheumatology

Respirology

Radiology

cme

the hungry doctor Dr. fong

when

where

topic

Oct 28-31

Sonoma California

2013 Update On Advanced Imaging In The California Wine Country

Nov 17-20

Miami Florida

Dec 01-06

sponsor

contact

website

UC Davis Health System

916-734-5390

ucdmc.ucdavis. edu

Thirteenth Annual Emergency Radiology Symposium

Baptist Health South Florida

786-596-2398

baptisthealth. net

Chicago Illinois

99th Scientific Assembly & Annual Meeting of Radiological Society of North America (RSNA)

Radiological Society of North America 2013

800-650-7018

rsna.org

Oct 24-26

Calgary Alberta

2013 Alberta Sleep Forum

The Lung Association

780-488-6819

ab.lung.ca

May 10-26 2014

China and Tibet Cruise

Endocrinology & Respirology

Sea Courses Cruises

888-647-7327

seacourses. com

Oct 21-23

San Diego California

Forensic Psychiatry Review Course

American Academy of Psychiatry and the Law

800-331-1389

aapl.org

Nov 21-24

Brussels Belgium

2nd World Congress On Controversies, Debates & Consensus In Bone, Muscle & Joint Diseases

GL events/CongressMed

011-97-273706-6954

congressmed. com

Apr 26May 03 2014

Galapagos Cruise

Gastroenterology & Rheumatology

Sea Courses Cruises

888-647-7327

seacourses. com

Oct 06-13

Tucson Arizona

Wilderness Medicine Expedition: Backpacking In The Galiuro Wilderness

Wilderness Medicine Institute

866-831-9001

nols.edu

Nov 13-15

Prince George British Columbia

12th Conference Of The Canadian Rural Health Research Society (CRHRS): Stories Of Rural Health through Knowledge, Research & Collaborative Action

Canadian Rural Health Research Society

306-966-7888

crhrs-scrsr. usask.ca

Nov 01

Maidstone England

Laparoscopic Complex Hernia Surgical Techniques Symposium

International Minimal Access Centre

011-44-162222-3058

imacs.org.uk

Nov 15-17

Napa California

Advances In Cleft Lip And Palate

UC Davis Health System

916-734-5390

ucdmc.ucdavis. edu

Oct 10

Toronto Ontario

Medical Record Keeping

University of Toronto

888-512-8173

utoronto.ca

Oct 21-25

Boston Massachusetts

Become A Permanent Digital Citizen: Technology For Lifelong Learning & Health

Harvard Medical School

617-384-8600

hms.harvard. edu

Nov 21-24

San Diego California

Conference On Practice Improvement

American Academy of Family Physicians

800-274-2237

aafp.org

Dec 05

London England

Bladder Reconstruction - Live Surgery

Royal College of Surgeons of England

011-44-207869-6300

rcseng.ac.uk

Dec 14

New York New York

Advanced Robotic Upper Urinary Tract Surgery: Teamwork Approach

NYU Langone Medical Center

212-263-5295

cme.med.nyu. edu

Feb 09-16 2014

Caribbean Cruise

Men’s Health & Urology

Sea Courses Cruises

888-647-7327 See Ad Page 20

seacourses. com

For feedback, requests or to have your1 course featured VicHospiceJFCDadQuarterBanner08-13 copy.pdf 07/08/13 1:45 PMplease email cme@inprintpublications.com or submit your course via www.justforcanadiandoctors.com

Dr. Holly Fong is a practising speech-language pathologist with three young children who’s always trying, adapting and creating dishes.

This school year, serve up this “out of the box” lunch

F

This Peking-duck sandwich calls for a Château de Bord 2010 Laudun Villages La Croix de Frégère that can stand up to the sweetness of hoisin.

Halve avocado. Pit, peel and cut thin slices lengthwise. Drizzle with lemon juice. Set aside. Remove skin from the duck breasts (delicious on its own if you scrape off the adhering layer of fat with the back of a knife) and any fat on the meat. Remove meat from the breast bone by slicing down close to the bone. Lay a breast, cut side down on a cutting board. Using a sharp

24

Just For Canadian Doctors FALL 2013

Do you want a relaxing venue?

fusion sandwich or those of us with school-age children, September seems like the start of a new year. It’s the return to bag lunches and sandwiches. My eldest used to like leftovers for lunch, but last year she succumbed to peer pressure and asked for sandwiches. However, she wasn’t too keen when given plain deli-meat-and-lettuce sandwiches. If you think about it, a sandwich is nothing more than filling between slices of bread. Why does it have to be deli meat? If you’re too rushed to grill or roast something yourself, there are supermarket takeaways like rotisserie birds. And if you go to a Chinese roast-meat shop or grocery with a hot-food counter, you’ll find BBQ pork, soya chicken or roast duck. My eldest’s favourite is the Peking-duck

sandwich. Roast duck from Chinese shops has the same flavour as Peking duck in a restaurant, only without the crispy skin. Pick up a whole roast duck and ask for it to be split in half lengthwise or quarters (otherwise it’ll be chopped into bite-sized pieces not suited for sandwiches). At home, use the breasts for sandwiches and reserve the thighs and legs for another meal (they’re great with vegetables and noodles). Give the sandwich some crunch with sliced radishes or daikon “noodles” (using a Japanese Benriner or mandoline slicer). Add hoisin-flavoured mayonnaise, tomato, avocado, greens and pecan-and-dried-fruit bread to make a delicious “out of the box” fusion sandwich. Make your own hoisin mayonnaise (recipe upon request; email info@inprintpublications. com), or simply add hoisin sauce to mayo. The traditional wine pairing with duck is an old-world Pinot Noir, but a Côte du Rhône with mostly Grenache rather than Syrah also works well. I paired this Peking-duck sandwich with the Chateâu de Bord 2010 Laudun Villages La Croix de Frégère, which has a deep, dark fruit-forward nose with tastes of cherry and raspberry, soft tannins and a long peppery finish. The wine wasn’t overwhelmed by the sweetness of the hoisin sauce, and brought out the anise and chili flavours in the sandwich.

Peking Duck Sandwich (serves 6)

knife, make thin cuts parallel to the board (approximately ¼-inch thick). Toast bread and thinly spread with hoisin mayonnaise. Sprinkle on sliced green onions. Reserve some mayonnaise to spread on the duck, if desired. Divide the duck, avocado, tomato and radish or daikon amongst 6 toast slices. Add a handful of baby kale. Cover with the remaining bread. Secure each sandwich with 2 toothpicks, if desired and halve to serve. Enjoy with some sliced raw peppers and carrots.

Do you need Ultrasound Training?

2 roasted duck breasts 1 large ripe tomato, cored and sliced crosswise into 6 rounds 1 large firm but ripe avocado 1 tablespoon lemon juice 4 radishes washed, stem ends removed and thinly sliced (or optional 1 small daikon radish, peeled and turned into thin strands) 2 stems green onions, rinsed, ends trimmed and thinly sliced on a diagonal box of baby kale or arugula, rinsed and dried 12 slices of pecan-anddried-fruit bread (figand-anise or cranberry pistachio also work well) hoisin mayonnaise

Since 1985, Gulfcoast Ultrasound Institute, Inc. located in beautiful St. Pete Beach, Florida, has been a respected leader in Continuing Medical Education (CME) dedicated to the diagnostic ultrasound profession.

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the thirsty doctor janet gyenes Special Advertising Feature

Janet Gyenes is a magazine writer and editor who likes to dally in spirits, especially when discovering something like corenwyn jenever (a gin-like Dutch spirit)—straight or in cocktails like the “bramble.” Have a boozy idea or question? Send it to feedback@inprintpublications.com

essential bar tools

Outfit your home bar with tools of the bartender trade

T

here’s something of an art to making a cocktail well at home, whether a Hemingway-inspired Death in the Afternoon or a Sazerac that’s reminiscent of a night spent in New Orleans. Of course, the all-important first step is to have quality ingredients at the ready (liquor, juices, sodas and garnishes), but making drinks quickly, consistently and with minimal fumbling through cupboards and drawers, requires a few tools of the bartender trade. the tools Crack open a copy of The PDT Cocktail Book, the (Part 2: the booze; celebrated bartender guide stocking penned by resident mixoloyour bar) gist Jim Meehan, and 30 bar tools—from absinthe spoons to swizzle sticks—are listed within its pages in medical precision. There are tools for measuring, muddling and misting and tools for stirring, shaking and straining, each accompanied by an artful illustration. It’s one part Gray’s Anatomy and one part Cabinet of Natural Curiosities. Thorough? Yes. Overwhelming? A little. I turned to Halifax-based bartender, Jenner Cormier, who was recently named Diageo World-Class Canada Bartender of the Year, to pare the pro-tools list down to a handful of home bar essentials. Cormier’s top two tools are the Boston shaker and mixing glass. The Boston shaker is essentially two parts—a shaking tin and a mixing glass. (A pint glass will work for the latter). “If you have this tool,” says Cormier, “you are able to not only shake cocktails using both components, but you are also able to stir cocktails using just the mixing glass.” Sure, a Boston shaker looks and operates like the utilitarian “everyman” shaker, compared to handsome sleek three-part cobbler shakers, which come with a cap (often used as a measure) and built-in strainer. There’s a downside to all that style, though. The parts can be tough to wrest apart and the small strainer makes for a slow pour. When to shake? As general rule, shake cocktails that include juice, eggs or cream. Ice is a key player here, not just for chilling ingredients but for diluting the mix, so skip the monster cubes for this step. Fill the metal por-

Part 1:

26

tion of the shaker halfway with ice and shake vigorously for at least eight to 10 seconds to get ingredients amply chilled and diluted. Stirring is preferred when a cocktail is composed only of spirits, such as a classic Manhattan. Again, ice is essential (your stirring glass should already be chilled). Add the ingredients to the glass and let your mind wander for 10 seconds or so while stirring with a long-handled bar spoon. Have two to three spoons on hand, suggests Cormier. “There are dozens of beautifully designed and extremely handy bar spoons on the market right now. These can be used for stirring cocktails and also as a measurement tool.” Some spoons come with trident tips, ideal for fishing cocktail onions and cherries from jars; others feature flat bottoms that can double as muddlers for mashing mint. What’s shaken or stirred must be strained into a glass before being garnished (if appropriate). Cormier recommends the tried-andtrue hawthorne strainer, which is “crucial for straining shaken cocktails; [it does] a really good job straining out debris and/or ice shards, keeping your drink smooth and clean.” A julep strainer, which looks like a big metal spoon shot with holes, is the go-to for stirred drinks. When it comes to measuring, forget about free pouring, unless you can eye an ounce with laser-like precision. And put down that shot glass: use a jigger. A greattasting beverage is about balance after all. A jigger is often made of stainless steel and looks a little two funnels stuck together, with a different measure on each side.. Again, Cormier suggests having a few different volumes (measured in ounces) on hand. There’s no reason why you can’t raid your kitchen for paring and chef’s knives. The former will help you cut garnishes (think classic lime wedge or orange twist), while the latter will let you cut citrus safely and efficiently for juicing, says Cormier. The same goes for juicers, whether a low-tech hand press or an electric one. Don’t have either? Consider how much citrus you’re going through and purchase accordingly. You’ve got the home bar essentials handy—what next? Cormier extols the virtues of PDT as a great cocktail-oriented book

Just For Canadian Doctors FALL 2013

Strategically Speaking

jenner cormier’s tools + tips Splurge or steal? > Buy quality tools, but it’s not necessary to spend a small fortune.

Value-added Solutions for Your Practice

Next-level bar tools > Oak barrels: fun for aging cocktails, bitters or certain for beginners. But if you’re lready beyond ingredients. Available from a few different cocktail suppliers online. Secret weapon > Books. Cookbooks and cocktail books (old or new) can be very helpful for discovering new flavour combinations. 6 1

2

5

4

3

7

8

[1] PRESS > Chef’n citrus juicer. $19.99, amazon.ca [2] measure > Cocktail measure in 18/10 stainless steel. $50, Alessi; alessi.com [3] shake + stir > 18/10 stainless steel Boston shaker with glass tumbler. $173, Alessi; alessi.com [4] strain > Brass/horn hawthorne strainer. $20, Williams-Sonoma [5] Slice > Eight-inch forged chef’s knife and three-inch forged paring knife. $110 and $80, Victorinox Swiss Army; 1-800-665-4095 [6] DISCOVER > The Drunken Botanist: The Plants that Create the World’s Best Drinks. $24.95, amazon.ca [7] LEARN > The PDT Cocktail Book: The Complete Bartender’s Guide from the Celebrated Speakeasy. $29.95, chapters.indigo.ca [8] stir > Brown bone stirrer spoon. $10, Williams-Sonoma; williams-sonoma.ca

basics, he recommends Amy Stewart’s The Drunken Botanist, which focuses on individual ingredients. Above all, avoid making up your mind that there is only one way to make a cocktail, says Cormier. “Depending on where you are in the world ... everyone will make drinks differently. I believe that that is where the beauty is; you create your cocktail around your needs. You can never learn too much.”

Financial strategies Determines Success Payroll Services Simplified


Developing Financial Strategies for your Professional Practice

Paying Yourself and Your Staff

DON MURDOCH

SAM VASSA

D

M

uring our careers, each of us wants to achieve a series of financial goals that will propel our personal and professional lives forward. Milestones such as retiring student loans, putting a down payment on a home, starting a family, accumulating wealth for retirement and assisting elderly relatives are examples of goals that are unique to each of us—along with the priority we place on these goals at different stages of our career. For most professionals, the primary vehicle used to achieve our unique financial goals is income from a professional practice. There, the strategies we implement and the investment decisions we make regarding our accumulated wealth determines the rate at which we successfully achieve our financial goals.

ost Canadian doctors are considered to be in private practice. This essentially means you are an entrepreneur – running your own business. It also means you should ensure you are paying yourself (and any employees) accurately and in accordance with the employment standards of your province.

“Payroll can be easy, convenient and accessible from any device.”

“...the investment decisions we make regarding our accumulated wealth determines the rate at which we successfully achieve our financial goals.”

Prevent Temporary or Permanent Derailment You may not always realize it, but your investment decisions have significant influence over the achievement of your financial goals. To ensure you don’t unknowingly jeopardize your future, it’s important to build and access an integrated team of advisors that includes an: Accountant, Banker, Investment / Insurance Advisor and Lawyer. The right team will keep you on track by helping you structure your practice and investments, protect your accumulated wealth and preserve income. By clearly communicating your financial goals and decisions with your team of advisors, they will help you prepare comprehensive financial strategies that aid in protecting your wealth as your practice grows and evolves. You will know you have the right team if your advisors know you and your

ing now. Security and privacy have also evolved to keep pace to ensure that these systems are, in fact, safer than the old desktop you might have been using. Fees for paying your staff have also come down to realistic levels – in fact, some cloud-based payroll services offer their tools for free. Knowing which ones

financial goals well enough to bring you strategy changes before you even realize they are required. Schedule Annual Checkups Annual checkups with your advisory team will ensure that as your financial goals change, you have the most comprehensive strategies in place to support their fulfillment. Factors such as the accumulation of wealth, new risks you need to insure, Federal and Provincial Budget announcements and tax legislation changes all have an impact on your strategies and overall success. Ensure you Review your Tax Strategies Regularly Since every taxpayer has a “not so silent” partner known as Canada Revenue Agency (CRA) having tax strategies in place that are updated regularly is

imperative. How soon and the number of financial goals you reach is inevitably linked to the tax you pay and when you pay it to the CRA. Implementation is Key Even with the most comprehensive financial strategies and brilliant advisory team behind you— Failure To Implement (FTI) the processes and systems needed to achieve your goals at an individuallevel is a serious threat to your success. In order to achieve your goals and enjoy the results of your success, you need to be committed to developing and implementing strategies that will support you and your goals. If you do, you’ll not only have a healthy practice but a very profitable one too. Don Murdoch, CA Contact Don at 1-877-766-9735 or by email at don.murdoch@mnp.ca. www.mnp.ca Don Murdoch is a partner with MNP LLP. He provides accounting and business consulting services to doctors and other professionals to help them enhance the profitability of their practices and achieve personal financial well-being for themselves and their families.

Not long ago, payroll was considered a dark art requiring magical calculators and inside knowledge to get it done. In fact, industries popped up supporting the notion that paying your staff was “difficult” and they spread fear, uncertainty and doubt regarding penalties from tax authorities like the Canada Revenue Agency. Nothing can be farther from today’s reality – payroll can by easy, convenient and accessible from any device. Just like online banking, payroll in Canada has evolved to use the latest cloud technologies making it simple to get you and your staff paid. Online electronic payments have eliminated the need for paper cheques while employees enjoy convenient 24/7 access to their pay history without worrying about printed stubs and reports. The hallmark of any modern medical practice is automation and simplification. Just as your patient records become electronic, so should your business operations. The convenience and safety of electronic records helps streamline your operations giving you more time to focus on running your business. If you haven’t reconsidered how your staff get paid, you’ll be surprised at the changes in the last year. Modern cloudbased accounting and payroll have revolutionized how Canadian businesses operate. Gone are the days of the “dark arts” – financial information about your business and staff is available immediately on the mobile device you are carry-

are right for you requires just a bit of research but the time spent will ensure that your staff are happy with easy-touse tools, accurate pay and convenient online access to their pay history. Here are some tips on how to find the right payroll service for you: • Employees should have easy online access to their full pay history, all payslips and important year-end tax documents like T4 and RL-1 (Québec) forms. • Eliminate cheques which not only cost you more to issue, but can become a tracking and reconciliation nightmare for your bookkeeping. Safer and more secure electronic payments are preferred by your employees — choose direct deposit and save. • Keep detailed records – most provinces require you to retain employee pay records to facilitate tax and other social service benefits. Use an online service that maintains these electronic records for you in a secure location safe from theft, fire and other threats. • Consider employee benefits and incentives as a way to retain and attract staff. While direct compensation is a key factor for employees, most put a high value on benefits and rewards as part of their overall pay. Look for a payroll service that accurately calculates and tracks the tax burden for these programs.

• Ensure your payroll service can integrate with your bookkeeping and accounting system. Cloud based accounting services like Kashoo, Xero and FreshBooks are convenient and rival the capabilities of old desktop software. Make them and integrated cloud payroll part of your modern practice. By adopting these tips you’ll ensure that paying yourself and your medical staff is compliant with local regulations, and importantly, convenient to do. Sam Vassa heads PaymentEvolution – Canada’s largest and most loved cloud payroll and payments service. Sam founded the company with a team of technology and subject matter specialists and devised an award-winning solution that empowers organizations and their accountants to manage their own payroll process. Find out more http://PaymentEvolution.com/Doctors Previously, Sam led business development for the capital markets industry at Microsoft Corporation. His team worked with leading Microsoft partners to build compelling solutions for the financial services industry. Sam was responsible for alliance relationships with Microsoft’s largest global partners, as well as sales and marketing execution with the community. He has worked with Microsoft’s US and Canadian subsidiaries and is known for his passion for forming strong partnerships. Sam was a channel manager at Digital Equipment Canada and served with the Canadian Department of Foreign Affairs and International Trade at their foreign missions worldwide. He is a board member of Telecompute – a leading software development firm pioneering the use of portable database technology for vertical markets. Sam is active in the emerging business market as an advisor and mentor to firms seeking management and technology expertise. Sam is a graduate of McMaster University where he studied biochemistry. Contact Sam at (647) 776-7600 or directly at sam@paymentevolution.com.


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Interested in working in Northern Newfoundland and Labrador? Then you may be the type of physician that Labrador-Grenfell Health is seeking to join our multi-disciplinary health care team which provides integrated health care and emphasizes health promotion and disease prevention.

Interested in working in Northern Newfoundland and Labrador? Then you may be the type of physician that Labrador-Grenfell Health is seeking to join our multi-disciplinary health care team which provides integrated health care and emphasizes health promotion and disease prevention.

We are currently recruiting for Medical Internists, General Surgeons, Pediatricians, Obstetrician/Gynecologists, Anesthetists and Family Physicians.

We are currently recruiting for Medical Internists, General Surgeons, Pediatricians, Obstetrician/Gynecologists, Anesthetists and Family Physicians.

Candidates must be eligible for full or provisional licensure by the College of Physicians and Surgeons of Newfoundland and Labrador. For a preliminary review of your CV for licensure, please submit using the format provided by the College at www.cpsnl.ca. Physicians are eligible for a non-pensionable retention incentive which is paid after one year of service and increases as the period of service continues up to three years. Additional remuneration is also available for coverage of extra call. We offer an accredited CME program and an allowance for Continuing Medical Educational activities. We also assist with relocation costs and immigration.

Candidates must be eligible for full or provisional licensure by the College of Physicians and Surgeons of Newfoundland and Labrador. For a preliminary review of your CV for licensure, please submit using the format provided by the College at www.cpsnl.ca. Physicians are eligible for a non-pensionable retention incentive which is paid after one year of service and increases as the period of service continues up to three years. Additional remuneration is also available for coverage of extra call. We offer an accredited CME program and an allowance for Continuing Medical Educational activities. We also assist with relocation costs and immigration.

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Dr. Kweku Dankwa, Associate VP, Medical Services Angie Elliott, Manager, Medical Services Labrador-Grenfell Regional Health Authority 178-200 West Street • St. Anthony, NL • Canada • A0K 4S0 T: 709-454-0127 • F: 709-454-2052 • www.lghealth.ca Email: kweku.dankwa@lghealth.ca or angela.elliott@lghealth.ca

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Discontinuation Symptoms Patients currently taking PRISTIQ should NOT be discontinued abruptly, due to risk of discontinuation symptoms (see WARNINGS AND PRECAUTIONS, Discontinuation Symptoms). At the time that a medical decision is made to discontinue an SSRI or other newer antidepressant drug, a gradual reduction in the dose, rather than an abrupt cessation, is recommended. (See DOSAGE AND ADmINISTRATION.) General Concomitant Use of PRISTIQ with venlafaxine

Prescribing Summary

Since desvenlafaxine is the major active metabolite of venlafaxine, concomitant use of PRISTIQ with products containing venlafaxine is not recommended since the combination of the two will lead to additive desvenlafaxine exposure. bone fracture Risk

Patient Selection Criteria Therapeutic Category: Antidepressant Action: Serotonin and Norepinephrine Reuptake Inhibitor (SNRI) Indications and Clinical Use Adults: PRISTIQ (desvenlafaxine succinate extended-release tablets) is indicated for: the symptomatic relief of major depressive disorder. The short-term efficacy of PRISTIQ has been demonstrated in placebo-controlled trials of up to 8 weeks. Pediatrics (<18 years of age): PRISTIQ is not indicated for use in children under the age of 18. Safety and efficacy in the pediatric population have not been established (see WARNINGS AND PRECAUTIONS, POTENTIAl ASSOCIATION WITh bEhAvIOURAl AND EmOTIONAl ChANGES, INClUDING SElf-hARm). CONTRAINDICATIONS • PRISTIQ must not be used concomitantly in patients taking monoamine oxidase inhibitors (MAOIs), including linezolid, an antibiotic, methylene blue, a dye used in certain surgeries, or in patients who have taken MAOIs within the preceding 14 days due to the risk of serious, sometimes fatal, drug interactions with selective serotonin reuptake inhibitor (SSRI) or serotonin norepinephrine reuptake inhibitor (SNRI) treatment or with other serotonergic drugs. These interactions have been associated with symptoms that include tremor, myoclonus, diaphoresis, nausea, vomiting, flushing, dizziness, hyperthermia with features resembling neuroleptic malignant syndrome, seizures, rigidity, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma. Based on the half-life of desvenlafaxine succinate, at least 7 days should be allowed after stopping desvenlafaxine succinate and before starting an MAOI • Hypersensitivity to desvenlafaxine succinate extended-release, venlafaxine hydrochloride or to any excipients in the desvenlafaxine formulation. For a complete listing, see the DOSAGE fORmS, COmPOSITION AND PACKAGING section of the Product Monograph Special Populations Pregnant Women: the safety of desvenlafaxine in human pregnancy has not been established. The extent of exposure to PRISTIQ in pregnancy during clinical trials was very limited. There are no adequate and well-controlled studies in pregnant women. Therefore, desvenlafaxine should be used during pregnancy only if the potential benefits justify the potential risks. If desvenlafaxine succinate is used until or shortly before birth, discontinuation effects in the newborn should be considered. Post-marketing reports indicate that some neonates exposed to SNRIs, SSRIs, or other newer antidepressants late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Such complications can arise immediately upon delivery. Reported clinical findings have included respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, hypotonia, hypertonia, hyperreflexia, tremor, jitteriness, irritability, and constant crying. These features are consistent with either a direct toxic effect of SNRIs, SSRIs and other newer antidepressants, or, possibly a drug discontinuation syndrome. It should be noted that, in some cases, the clinical picture is consistent with serotonin syndrome (see DRUG INTERACTIONS). When treating a pregnant woman with PRISTIQ during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. Patients should be advised to notify their physician if they become pregnant or intend to become pregnant during therapy. Labour and Delivery: the effect of desvenlafaxine on labour and delivery in humans is unknown. PRISTIQ should be used during labour and delivery only if the potential benefits justify the potential risks. Nursing Women: desvenlafaxine (O-desmethylvenlafaxine, a metabolite of desvenlafaxine) is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from PRISTIQ, a decision should be made whether or not to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. Only administer PRISTIQ to breastfeeding women if the expected benefits outweigh any possible risk. Pediatric: safety and effectiveness in patients less than 18 years of age have not been established. Geriatrics ( ≥65 years of age): of the 3,292 patients in clinical trials with PRISTIQ, 5% were 65 years of age or older. No overall differences in safety or efficacy were detected between these subjects and younger subjects; however in the short-term placebo-controlled trials, there was a higher incidence of systolic orthostatic hypotension in patients ≥65 years of age compared to all adults treated with desvenlafaxine. For elderly patients, possible reduced renal clearance of desvenlafaxine should be considered when determining dose (see Dosing Considerations, Geriatrics and ACTION AND ClINICAl PhARmACOlOGY, Geriatrics). Greater sensitivity of some older individuals cannot be ruled out.

Safety Information WARNINGS AND PRECAUTIONS POTENTIAl ASSOCIATION WITh bEhAvIOURAl AND EmOTIONAl ChANGES, INClUDING SElf-hARm. Pediatrics: Placebo-Controlled Clinical Trial Data Recent analyses of placebo-controlled clinical trial safety databases from Selective Serotonin Reuptake Inhibitors (SSRIs) and other newer antidepressants suggest that use of these drugs in patients under the age of 18 may be associated with behavioural and emotional changes, including an increased risk of suicidal ideation and behaviour over that of placebo. The small denominators in the clinical trial database, as well as the variability in placebo rates, preclude reliable conclusions on the relative safety profiles among the drugs in the class. Adults and Pediatrics: Additional Data There are clinical trial and post-marketing reports with SSRIs and other newer antidepressants, in both pediatrics and adults, of severe agitation-type adverse events coupled with self-harm or harm to others. The agitation-type events include: akathisia, agitation, disinhibition, emotional lability, hostility, aggression, depersonalization. In some cases, the events occurred within several weeks of starting treatment. Rigorous clinical monitoring for suicidal ideation or other indicators of potential for suicidal behaviour is advised in patients of all ages especially when initiating therapy or during any change in dose or dosage regimen. This includes monitoring for agitation-type emotional and behavioural changes. An fDA meta-analysis of placebo-controlled clinical trials of antidepressant drugs in adult patients ages 18 to 24 years with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo.

Epidemiological studies show an increased risk of bone fractures following exposure to some antidepressants, including SSRIs/SNRIs. The risks appear to be greater at the initial stages of treatment, but significant increased risks were also observed at later stages of treatment. The possibility of fracture should be considered in the care of patients treated with PRISTIQ. Elderly patients and patients with important risk factors for bone fractures should be advised of possible adverse events which increase the risk of falls, such as dizziness and orthostatic hypotension, especially at the early stages of treatment but also soon after withdrawal. Preliminary data from observational studies show association of SSRIs/SNRIs and low bone mineral density in older men and women. Until further information becomes available, a possible effect on bone mineral density with long-term treatment with SSRIs/SNRIs, including PRISTIQ, cannot be excluded, and may be a potential concern for patients with osteoporosis or major risk factors for bone fractures. Gastrointestinal Potential for Gastrointestinal Obstruction: because the PRISTIQ tablet does not appreciably change in shape in the gastrointestinal tract, PRISTIQ should not be administered to patients with pre-existing gastrointestinal narrowing (pathologic or iatrogenic, such as small bowel inflammatory disease, “short gut” syndrome due to adhesions or decreased transit time, past history of peritonitis, cystic fibrosis, chronic intestinal pseudo-obstruction, or Meckel’s diverticulum). There have been rare reports of obstructive symptoms in patients with known strictures in association with the ingestion of other drugs in nondeformable controlled-release formulations, and very rare reports of obstructive symptoms associated with the use of nondeformable controlled-release formulations in patients without known gastrointestinal stricture. Due to the controlledrelease design, PRISTIQ tablets should only be used in patients who are able to swallow the tablets whole. (See DOSAGE AND ADmINISTRATION, Recommended Dose and Dosage Adjustment.) Neurologic Seizures: cases of seizures have been reported in trials with PRISTIQ. Desvenlafaxine succinate should be prescribed with caution in patients with a seizure disorder. Desvenlafaxine has not been systematically evaluated in patients with a seizure disorder. Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-Like Reactions: as with other serotonergic agents, serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions, a potentially life-threatening condition, have been reported with SNRIs and SSRIs alone, including PRISTIQ treatment, particularly with concomitant use of other agents that may affect the serotonergic neurotransmitter systems (such as triptans, serotonin reuptake inhibitors, sibutramine, MAOIs [including linezolid, an antibiotic, and methylene blue], St. John’s Wort [Hypericum perforatum] and/or lithium) and with drugs that impair metabolism of serotonin or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, and hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/ or gastrointestinal symptoms (e.g., nausea, vomiting, and diarrhea). Serotonin syndrome, in its most severe form, can resemble NMS, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. If concomitant treatment with desvenlafaxine and other agents that may affect the serotonergic and/or dopaminergic neurotransmitter system (such as another SSRI/SNRI) or a 5-hydroxytryptamine receptor agonist (triptan) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases. The concomitant use of desvenlafaxine with serotonin precursors (such as tryptophan supplements) is not recommended (see DRUG INTERACTIONS, Serotonin Syndrome). Treatment with PRISTIQ and any concomitant serotonergic or antidopaminergic agents, including antipsychotics, should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated. Ophthalmologic Narrow Angle Glaucoma: as with other SSRIs/SNRIs, PRISTIQ can cause mydriasis and should be used with caution in patients with raised intraocular pressure or those with narrow angle glaucoma. Psychiatric Mania/Hypomania: mania/hypomania may occur in a small proportion of patients with mood disorders who have received medication to treat depression, including desvenlafaxine succinate. During phase 2 and phase 3 studies, mania was reported for approximately 0.1% of patients treated with PRISTIQ. Activation of mania/hypomania has also been reported in a small proportion of patients with major affective disorder who were treated with other marketed antidepressants. As with all antidepressants, PRISTIQ should be used cautiously in patients with a history or family history of mania or hypomania. monitoring and laboratory Tests Serum Lipids: increases in cholesterol (total and LDL) and triglycerides were observed in some patients treated with desvenlafaxine succinate in placebo-controlled pre-marketing clinical trials, particularly with higher doses. Measurement of serum lipid levels should be considered during treatment. Heart Rate and Blood Pressure: increases in heart rate and blood pressure were observed in some patients in clinical trials, particularly with higher doses. Measurement of blood pressure is recommended prior to initiating treatment and regularly during treatment with desvenlafaxine succinate (see ADvERSE REACTIONS, vital Sign Changes). Self-Harm: rigorous clinical monitoring for suicidal ideation or other indicators of potential for suicidal behaviour is advised in patients of all ages. Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behaviour, worsening of depression, and suicidal ideation, especially when initiating therapy or during any change in dose or dosage regimen. (See WARNINGS AND PRECAUTIONS, POTENTIAl ASSOCIATION WITh bEhAvIOURAl AND EmOTIONAl ChANGES, INClUDING SElf-hARm.) ADvERSE REACTIONS The safety of PRISTIQ in major depressive disorder was evaluated in 3,292 patients exposed to at least one dose of PRISTIQ. The most commonly observed adverse reactions (incidence of 5% or greater for the PRISTIQ-pooled 50- to 400-mg doses, and incidence higher than placebo) in PRISTIQ-treated MDD MDD patients in short-term placebo controlled trials were: nausea, headache, dry mouth, hyperhydrosis, dizziness, insomnia, constipation, decreased appetite, somnolence, fatigue, tremor, and vomiting, and, in men, erectile dysfunction and ejaculation delayed.

Adverse Events Reported as Reasons for Discontinuation of Treatment in mDD Clinical Trials In the 8-week placebo-controlled, pre-marketing trials for MDD, 12% of the 1,834 patients who received PRISTIQ (50-400 mg/day) discontinued treatment due to an adverse experience, compared with 3% of the 1,116 placebo-treated patients in those trials. At the recommended dose of 50 mg, the discontinuation rate due to an adverse experience for PRISTIQ (4.1%) was similar to the rate for placebo (3.8%) and only 1% of patients discontinued due to nausea. The most common adverse reactions leading to discontinuation (i.e., leading to discontinuation in at least 2% and incidence higher than placebo) of the PRISTIQtreated patients in short-term trials of up to 8 weeks were: nausea (4%); dizziness, headache and vomiting (2% each). If you suspect you have a serious or unexpected reaction to this drug, you may notify Health Canada by telephone at 1-866-234-2345 or Pfizer Canada at 1-800-463-6001. DRUG-DRUG INTERACTIONS Monoamine Oxidase Inhibitors: desvenlafaxine succinate is contraindicated in patients taking MAOIs. Desvenlafaxine succinate must not be used in combination with a monoamine oxidase inhibitor (MAOI), or within at least 14 days of discontinuing treatment with an MAOI. Based on the half-life of desvenlafaxine succinate, at least 7 days should be allowed after stopping desvenlafaxine succinate before starting an MAOI (see CONTRAINDICATIONS). Serotonin Syndrome: as with other serotonergic agents, serotonin syndrome, a potentially life-threatening condition, may occur with desvenlafaxine treatment, particularly with concomitant use of other agents that may affect the serotonergic neurotransmitter system (including triptans, SSRIs, other SNRIs, lithium, sibutramine, fentanyl and its analogues, dextromethorphan, tramadol, tapentadol, meperidine, methadone and pentazocine or St. John’s Wort [Hypericum perforatum]), with drugs which impair metabolism of serotonin (such as MAOIs, including linezolid [an antibiotic which is a reversible non-selective MAOI], and methylene blue; see CONTRAINDICATIONS), or with serotonin precursors (such as tryptophan supplements). Serotonin syndrome symptoms may include mental status changes, autonomic instability, neuromuscular aberrations and/or gastrointestinal symptoms (see WARNINGS AND PRECAUTIONS). If concomitant treatment of desvenlafaxine with an SSRI, an SNRI or a 5-hydroxytryptamine receptor agonist (triptan) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases. The concomitant use of desvenlafaxine with serotonin precursors (such as tryptophan supplements) is not recommended. Central Nervous System (CNS) Active Agents The risk of using desvenlafaxine succinate in combination with other CNS-active drugs has not been systematically evaluated. Consequently, caution is advised when desvenlafaxine succinate is taken in combination with other CNS-active drugs. Drugs Affecting Platelet function (e.g., NSAIDs, ASA, and other anticoagulants) Serotonin release by platelets plays an important role in hemostasis. Epidemiological studies of the case-control and cohort design that have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding have also shown that concurrent use of use of an NSAID, ASA or other anticoagulants may potentiate this risk of bleeding. Altered anticoagulant effects, including increased bleeding, have been reported when SSRIs or SNRIs are coadministered with warfarin. Patients receiving warfarin therapy should be carefully monitored when PRISTIQ is initiated or discontinued (see WARNINGS AND PRECAUTIONS, hematologic, Abnormal bleeding).

Administration General PRISTIQ is not indicated for use in children under 18 years of age (see WARNINGS AND PRECAUTIONS, Potential Association with behavioural and Emotional Changes, Including Self-harm). Recommended Dose and Dosage Adjustment Initial Treatment: the recommended dose of PRISTIQ (desvenlafaxine succinate extended-release tablets) is 50 mg once daily, with or without food. In clinical studies, no additional benefit was demonstrated at doses greater than 50 mg/day. In clinical studies, doses of 50-400 mg/day were shown to be effective, although no additional benefit was demonstrated at doses greater than 50 mg/day, and adverse events and discontinuations were more frequent at higher doses. If the physician, based on clinical judgment, decides a dose increase above 50 mg/day is warranted for an individual patient the maximum dose should not exceed 100 mg/day. Patients should be periodically reassessed to determine the need for continued treatment. It is recommended that PRISTIQ be taken at approximately the same time each day. PRISTIQ tablets must be swallowed whole with liquids, and must not be chewed, divided or crushed. The medication is contained within a non-absorbable shell designed to release the drug at a controlled rate. The tablet shell, along with insoluble core components, is eliminated from the body; patients should not be concerned if they occasionally notice something that looks like a tablet in their stool. Due to the controlled-release design, PRISTIQ tablets should only be used in patients who are able to swallow the tablets whole. Missed Dose: a patient missing a dose should take it as soon as they remember to. If it is almost time for the next dose, the missed dose should be skipped. The patient should be cautioned against taking two doses concomitantly to “make up” for the missed dose. Discontinuing PRISTIQ: symptoms associated with discontinuation of PRISTIQ, other SNRIs and SSRIs have been reported (see WARNINGS AND PRECAUTIONS, Discontinuation Symptoms and ADvERSE REACTIONS, Discontinuation Symptoms). Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate. As the lowest dosage strength of PRISTIQ is 50 mg, it is recommended that dose reduction from 50 mg/day should proceed to 50 mg every other day before discontinuation. Switching Patients from Other Antidepressants to PRISTIQ Discontinuation symptoms have been reported when switching patients from other antidepressants, including venlafaxine, to PRISTIQ. Tapering of the initial antidepressant may be necessary to minimize discontinuation symptoms (see CONTRAINDICATIONS). Switching Patients to or from a monoamine Oxidase Inhibitor At least 14 days should elapse between discontinuation of an MAOI and the initiation of therapy with desvenlafaxine succinate. In addition, based on the half-life of desvenlafaxine succinate, at least 7 days should be allowed after stopping desvenlafaxine succinate before starting an MAOI. Dosing Considerations Patients with severe renal impairment and end-stage renal disease: the recommended dose in patients with severe renal impairment (24-hr CrCl <30 mL/min) or end-stage renal disease (ESRD) is 50 mg every other day. Because of individual variability in clearance in these patients, individualization of dosage may be desirable. Supplemental doses should not be given to patients after dialysis (see ACTION AND ClINICAl PhARmACOlOGY, Renal Insufficiency).

Use in patients with hepatic impairment: no dosage adjustment is necessary for patients with hepatic impairment (see ACTION AND ClINICAl PhARmACOlOGY, hepatic Insufficiency). Geriatrics (≥65 years of age): no dosage adjustment is required solely on the basis of age; however, possible reduced clearance of PRISTIQ should be considered when determining dose (see ACTION AND ClINICAl PhARmACOlOGY, Geriatrics). Discontinuation of Therapy: a gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. Discontinuation regimens should take into account the individual circumstances of the patient, such as duration of treatment and dose at discontinuation (see WARNINGS AND PRECAUTIONS and ADvERSE REACTIONS). SUPPlEmENTAl PRODUCT INfORmATION Adverse Reactions in mDD Clinical Trials PRISTIQ was evaluated for safety in 3,292 patients diagnosed with major depressive disorder who participated in multiple-dose pre-marketing trials, representing 1,289 patient-years of exposure. Among these 3,292 PRISTIQ-treated patients, 1,834 patients participated in 8-week, placebo-controlled trials at doses ranging from 50 to 400 mg/day. Of the total 3,292 subjects exposed to at least 1 dose of PRISTIQ, 1,070 were exposed to PRISTIQ for greater than 6 months and 274 were exposed for 1 year. Adverse Reactions Occurring at an Incidence of ≥2% and Twice the Rate of Placebo Among PRISTIQ-Treated Patients in Short-Term Placebo-Controlled Trials Table 1 lists alphabetically by body system, the common adverse reactions that occurred in ≥2% of PRISTIQ-treated MDD patients and twice the rate of placebo at any dose in the pooled 8-week, placebo-controlled, fixed-dose clinical trials. Reported adverse events were classified using a standard MedDRA-based Dictionary terminology. Table 1: Common Adverse Reactions (≥2% in any fixed-Dose Group and Twice the Rate of Placebo): in Pooled mDD 8-Week Placebo-Controlled Studies System Organ Class Preferred Term Cardiac disorders Blood pressure Gastrointestinal disorders Nausea Dry mouth Constipation Vomiting General disorders and administration site conditions Fatigue Chills Feeling jittery

PRISTIQ Placebo (n=636)

50 mg (n=317)

100 mg (n=424)

200 mg (n=307)

400 mg (n=317)

1

1

1

2

2

10 9 4 3

22 11 9 3

26 17 9 4

36 21 10 6

41 25 14 9

4 1 1

7 1 1

7 <1 2

10 3 3

11 4 3

2

5

8

10

10

5 4 2 <1

13 4 2 <1

10 9 3 1

15 12 9 2

16 12 9 1

6 2 1 1 0

9 3 <1 2 <1

12 5 1 3 2

14 4 2 2 2

15 4 2 4 6

0

<1

1

2

2

<1

1

1

4

3

4

10

11

18

21

1 <1 1 1 1

3 2 2 2 1

4 2 1 1 1

4 6 5 1 1

4 6 3 2 2

<1

1

1

2

2

metabolism and nutrition disorders Decreased appetite Nervous system disorders Dizziness Somnolence Tremor Disturbance in attention Psychiatric disorders Insomnia Anxiety Nervousness Abnormal dreams Anorgasmia Renal and urinary disorders Urinary hesitation Respiratory, thoracic and mediastinal disorders Yawning Skin and subcutaneous tissue disorders Hyperhidrosis Special senses Vision blurred Mydriasis Vertigo Tinnitus Dysgeusia Special senses Hot flush MDD=major depressive disorder.

Sexual function Adverse Reactions Table 2 shows the incidence of sexual function adverse reactions that occurred in ≥2% PRISTIQ-treated MDD patients in any fixed-dose group (8-week, placebo-controlled, fixed and flexible-dose, pre-marketing clinical trials). Table 2: Sexual function Adverse Reactions (≥2% in men or Women in any PRISTIQ Group) During the On-Therapy Period PRISTIQ mEN ONlY

Placebo (n=239)

50 mg (n=108)

100 mg (n=157)

200 mg (n=131)

400 mg (n=154)

0 1 0 <1 1 0 0 0

0 4 0 1 3 0 1 1

3 5 1 5 6 1 0 0

5 6 2 7 8 2 2 0

8 3 3 6 11 5 2 2

WOmEN ONlY

Placebo (n=397)

50 mg (n=209)

100 mg (n=267)

200 mg (n=176)

400 mg (n=163)

Anorgasmia

0

1

1

0

3

Anorgasmia Libido decreased Orgasm abnormal Ejaculation delayed Erectile dysfunction Ejaculation disorder Ejaculation failure Sexual dysfunction

PRISTIQ


The following list is a list of MedDRA preferred terms that reflect adverse events that have been determined to be adverse drug reactions throughout the dose range studied (50 to 400 mg) during any pre-marketing MDD trials. Adverse reactions are categorized by system organ class and listed in order of decreasing frequency using the following definitions: Very common: ≥10% of patients Common: ≥1% and <10% of patients Uncommon: ≥0.1% and <1% of patients Rare: ≥0.01% and <0.1% of patients Very rare: <0.01% of patients

ECG Changes: electrocardiograms were obtained from 1,492 PRISTIQ-treated patients with major depressive disorder and 984 placebo-treated patients in clinical trials lasting up to 8 weeks. No clinically relevant differences were observed between PRISTIQ-treated and placebo-treated patients for QT, QTc, PR, and QRS intervals. In a thorough QTc study with prospectively determined criteria, desvenlafaxine did not cause QT prolongation. No difference was observed between placebo and desvenlafaxine treatments for the QRS interval (see ACTION AND ClINICAl PhARmACOlOGY). A thorough QTc study was designed to assess the potential effect of 200 and 600 mg of PRISTIQ on QT interval prolongation. Table 3: Estimated and 90% Confidence Interval for QTc Changes from Time-matched baseline Relative to Placebo at hour 8 after Dose with Different heart Rate Corrections a Population QT Correction (ms)

PRISTIQ 600 mg b

-2.43 (-4.90, 0.04)

0.98 (-1.42, 3.38)

Moxifloxacin 400 mg (Active control)

10.80 (8.44, 13.16)

10.92 (8.62, 13.22)

Supine systolic bp (mm Hg) Supine diastolic bp (mm Hg)

-1.4 -0.6

1.2 0.7

2.0 0.8

2.5 1.8

2.1 2.3

-0.3 0.0

1.3 -0.4

1.3 -0.6

0.9 -0.9

4.1 -1.1

PRISTIQ Placebo Sustained hypertension

0.5

50 mg 1.3

100 mg 0.7

200 mg 1.1

400 mg 2.3

Adverse Reactions Identified During Post-Approval Use The following adverse reactions have been identified during post-approval use of PRISTIQ. Because post-approval reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency. Ear and labyrinth disorders – vertigo Skin and subcutaneous tissue disorders – Stevens-Johnson Syndrome, toxic epidermal necrolysis, erythema multiforme Adverse Events Identified During Post-Approval Use The following adverse events have been identified during post-approval use of PRISTIQ. Because post-approval events are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

DRUG-DRUG INTERACTIONS Potential for other drugs to affect desvenlafaxine succinate (see also ACTION AND ClINICAl PhARmACOlOGY) Inhibitors of CYP3A4: CYP3A4 is a minor pathway for the metabolism of PRISTIQ. In a clinical study, ketoconazole (200 mg BID) increased the area under the concentration vs. time curve AUC of PRISTIQ (400 mg single dose) by about 43% and Cmax by about 8%. Concomitant use of PRISTIQ with potent inhibitors of CYP3A4 may result in higher concentrations of PRISTIQ.

Drugs metabolized by CYP3A4: in vitro, desvenlafaxine does not inhibit or induce the CYP3A4 isozyme. In a clinical study, PRISTIQ (400 mg daily) was co-administered with a single 4 mg dose of midazolam (a CYP3A4 substrate). The AUC and Cmax of midazolam decreased by approximately 31% and 16%, respectively. In a second study, desvenlafaxine 50 mg daily was co-administered with a single 4 mg dose of midazolam. The AUC and Cmax of midazolam decreased by approximately 29% and 14%, respectively. Concomitant use of desvenlafaxine with a drug metabolized by CYP3A4 may result in lower exposure to that drug. Drugs metabolized by a combination of both CYP2D6 and CYP3A4: clinical studies with aripiprazole and tamoxifen suggest that desvenlafaxine at twice the recommended dose (100 mg daily) does not have a clinically relevant effect on drugs metabolized by a combination of both CYP2D6 and CYP3A4 enzymes. Desvenlafaxine succinate was studied at a dose of 100 mg daily in conjunction with a single 5 mg dose of aripiprazole, a CYP2D6 and CYP3A4 substrate metabolized to the active metabolite dehydroaripiprazole.

P-glycoprotein transporter In vitro, desvenlafaxine is not a substrate or an inhibitor for the P-glycoprotein transporter. The pharmacokinetics of desvenlafaxine are unlikely to be affected by drugs that inhibit the P-glycoprotein transporter and desvenlafaxine is not likely to affect the pharmacokinetics of drugs that are substrates of the P-glycoprotein transporter.

Drug-laboratory Interactions False positive urine immunoassay screening tests for phencyclidine (PCP) and amphetamine have been reported in patients taking PRISTIQ. This is due to lack of specificity of the screening tests. False positive test results may be expected for several days following discontinuation of PRISTIQ therapy. Confirmatory tests, such as gas chromatography/mass spectrometry, will distinguish PRISTIQ from PCP and amphetamine.

PRISTIQ 400 mg

50–400 mga

Total Cholesterol Increase ≥1.29 mmol/L and absolute value ≥6.75 mmol/L

Drug-herb Interactions St. John’s Wort: in common with SSRI's, pharmacodynamic interactions between PRISTIQ and the herbal remedy St. John’s Wort may occur and may result in an increase in undesirable effects (see DRUG INTERACTIONS, Serotonin Syndrome).

Drug-lifestyle Interactions Ethanol: as with all CNS-active drugs, patients should be advised to avoid alcohol consumption while taking desvenlafaxine succinate. for complete prescribing information please refer to the Product monograph.

2

3

4

4

10

5

Reference: PRISTIQ Product Monograph, Pfizer Canada Inc., March 18, 2013.

lDl Cholesterol Increase ≥1.29 mmol/L and absolute value ≥4.91 mmol/L

<1

1

0

1

2

1

3

2

1

4

6

3

Triglycerides ≥3.7 mmol/L

a. Includes data from all short-term, placebo-controlled studies including fixed-dose and flexible-dose studies. Proteinuria In placebo-controlled studies 6.4% of subjects treated with PRISTIQ had treatment-emergent proteinuria. Proteinuria was usually of trace amounts, and was not associated with increases in BUN or creatinine or adverse events. The mechanism of the enhanced protein excretion is not clear but may be related to noradrenergic stimulation. vital Sign Changes Tables 5 and 6 summarize the changes that were observed in placebo-controlled, short-term, pre-marketing trials with PRISTIQ in patients with MDD.

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Drugs metabolized by CYP2D6: clinical studies have shown that desvenlafaxine does not have a clinically relevant effect on CYP2D6 metabolism at the dose of 100 mg daily. When desvenlafaxine succinate was administered at a dose of 100 mg daily in conjunction with a single 50 mg dose of desipramine, a CYP2D6 substrate, the AUC of desipramine increased approximately 17%. When 400 mg of desvenlafaxine was administered (8 times the recommended 50 mg dose), the AUC of desipramine increased approximately 90%. Concomitant use of desvenlafaxine with a drug metabolized by CYP2D6 may result in higher concentrations of that drug.

The percentage of subjects who exceeded a predetermined threshold for values of outliers is represented in Table 4.

200 mg

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Potential for desvenlafaxine to affect other drugs (see also ACTION AND ClINICAl PhARmACOlOGY)

Drug-food Interactions Food does not alter the bioavailability of desvenlafaxine.

100 mg

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Inhibitors of other CYP enzymes: based on in vitro data, drugs that inhibit CYP isozymes 1A1, 1A2, 2A6, 2D6, 2C8, 2C9, 2C19, and 2E1 are not expected to have significant impact on the pharmacokinetic profile of desvenlafaxine.

Abnormal hematologic and Clinical Chemistry findings Serum Lipids Elevations in fasting serum total cholesterol, LDL cholesterol, and triglycerides occurred in the controlled trials. Some of these abnormalities were considered potentially clinically significant (see WARNINGS AND PRECAUTIONS, Serum Cholesterol Elevation and monitoring and laboratory Tests, Serum lipids).

50 mg

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Gastrointestinal – gastrointestinal bleeding Psychiatric – hallucinations Immunologic – photosensitivity reactions

Drugs metabolized by CYP1A2, 2A6, 2C8, 2C9 and 2C19: in vitro, desvenlafaxine does not inhibit CYP1A2, 2A6, 2C8, 2C9, and 2C19 isozymes and would not be expected to affect the pharmacokinetics of drugs that are metabolized by these CYP isozymes.

Table 4: Proportion (%) of Subjects With lipid Abnormalities of Potential Clinical Significance for All Short-Term, Placebo-Controlled Clinical Trials

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Table 6: Incidence (%) of Patients with Sustained hypertension for All Short-Term fixed-Dose Clinical Trials

A single 40 mg dose of tamoxifen, which is metabolized to active metabolites 4-hydroxy-tamoxifen and endoxifen by CYP2D6 and CYP3A4, was also studied in conjunction with desvenlafaxine succinate (100 mg daily).

a. Mean (90% confidence intervals). b. The PRISTIQ doses of 200 and 600 mg were 2 and 6 times the maximum recommended dose, respectively.

Placeboa

sudoku

Table 6 provides the incidence of patients meeting criteria for sustained hypertension (defined as treatment-emergent supine diastolic blood pressure ≥90 mm Hg and ≥10 mm Hg above baseline for 3 consecutive visits).

sudoku 1 easier solution at right

Orthostatic Hypotension: Of the 3,292 patients in clinical trials with PRISTIQ, 5% were 65 years of age or older. No overall differences in safety or efficacy were detected between these subjects and younger subjects; however, in the short-term placebo-controlled trials, there was a higher incidence of orthostatic hypotension in patients ≥65 years of age compared to patients <65 years of age treated with desvenlafaxine. Greater sensitivity of some older individuals cannot be ruled out. For elderly patients, possible reduced renal clearance of desvenlafaxine should be considered when determining dose (see DOSAGE AND ADmINISTRATION, Dosing Considerations, Geriatrics and ACTION AND ClINICAl PhARmACOlOGY, Geriatrics).

3.18 (0.87, 5.50)

400 mg

PRISTIQ ® Wyeth LLC, owner/ Pfizer Canada Inc., Licensee © 2013 Pfizer Canada Inc. Kirkland, Quebec H9J 2M5 D000046438

5 9 7 8 6 5 1 2 3 7 4 7 4 9 1 2 5 7 3 1 8 6 7 5 1 2 5 2 3 4 6 9 6 8

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sudoku 2 harder solution in next issue

Discontinuation Symptoms: adverse drug reactions reported in association with abrupt discontinuation, dose reduction or tapering of treatment in MDD clinical trials at a rate of ≥5% include: dizziness, nausea, headache, irritability, diarrhea, anxiety, abnormal dreams, fatigue, and hyperhidrosis. In general, discontinuation events occurred more frequently with longer duration of therapy (see DOSAGE AND ADmINISTRATION and WARNINGS AND PRECAUTIONS).

1.5 (-0.88, 3.88)

200 mg

At the final on-therapy assessment in the 6-month, double-blind, placebo-controlled phase of a long-term trial in patients who had responded to PRISTIQ during the initial 12-week, open-label phase, there was no statistical difference in mean weight change between PRISTIQ- and placebo-treated patients.

Ischemic cardiac adverse events: in clinical trials, there were uncommon reports of ischemic cardiac adverse events, including myocardial ischemia, myocardial infarction, and coronary occlusion requiring revascularization; these patients had multiple underlying cardiac risk factors. More patients experienced these events during desvenlafaxine treatment as compared to placebo (see WARNINGS AND PRECAUTIONS/Cardiovascular/ Cerebrovascular).

PRISTIQ 200 mg b

100 mg

blood Pressure

Supine pulse (bpm) Weight (kg)

Ear and labyrinth disorders: Common: tinnitus. Eye disorders: Common: mydriasis, vision blurred. Gastrointestinal disorders: Very common: nausea, dry mouth, constipation; Common: vomiting, diarrhea. General disorders and administration site conditions: Very common: fatigue; Common: asthenia, chills, feeling jittery, irritability; Uncommon: drug withdrawal syndrome. Immune system disorders: Uncommon: hypersensitivity. Investigations: Common: weight decreased, weight increased, blood pressure increased; Uncommon: blood cholesterol increased, blood prolactin increased, blood triglycerides increased, liver function test abnormal. metabolism and nutrition disorders: Very common: decreased appetite, Rare: hyponatremia. musculoskeletal, connective tissue, and bone disorders: Common: musculoskeletal stiffness. Nervous system disorders: Very common: headache, dizziness; Common: somnolence, tremor, disturbance in attention, paraesthesia, dysgeusia; Uncommon: syncope; Rare: convulsion, dystonia. Psychiatric disorders: Very common: insomnia; Common: orgasm abnormal, anorgasmia, anxiety, nervousness, libido decreased, abnormal dreams; Uncommon: depersonalization, hypomania, bruxism. Renal and urinary disorders: Common: urinary hesitation; Rare: proteinuria. Reproductive system and breast disorders: Common: erectile dysfunction,* ejaculation delayed,* ejaculation disorder,* ejaculation failure*; Uncommon: sexual dysfunction. Respiratory, thoracic, and mediastinal disorders: Common: yawning; Uncommon: epistaxis. Skin and subcutaneous tissue disorders: Very common: hyperhidrosis; Common: rash; Uncommon: alopecia; Rare: angioedema. vascular disorders: Common: hot flush; Uncommon: orthostatic hypotension, peripheral coldness. * Frequency is calculated based on men only.

fridericia’s QT Correction (ms)

50 mg

Pulse rate

Cardiac disorders: Common: palpitations, tachycardia.

Treatment

PRISTIQ Placebo

6 3 7 3 1 5 6

9 7

9 2 6 9 1

7 4 5 6 3 1

1 8

6 1 5 7 2 4 9

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positions / locums

positions / locums

positions / locums

LOCUM POSITION GP: Anaesthesia/ Emergency/Family Practice Locum wanted in Sechelt-Sunshine CoastBritish Columbia. 7 1/2 month locum July 01, 2014 - Feb 15, 2015 working in a 7 doc group practice. Emergency shifts approx 3 per month. Anaesthetic days 1 in 5 working with a General Surgeon, Gynaecologist and visiting Urologist. Call shifts to be determined. 65/35 split supplemented with MOCAP. Possible use of 2 year old, 5 bedroom house in newer neighbourhood. Contact: karen_morgenstern@telus.net or (250)-486-1910

etc. in a busy group Medical Practice in Richmond BC’s Premier Strip Mall. www.mydoctor.ca/drsinghal We have excellent experienced physician support staff plus our own Information Technology Support staff with a custom EMR for efficiency of practice/ workflow, etc. For Information please phone (604)-4489595 Email: msinghalmd@gmail.com

available on site. We have pleasant and efficient staff. The potential for income is excellent with very attractive split. Please contact our office at (306)-546-2005 or e-mail us at princeofwalesclinic@gmail.com

NANAIMO, BC: Edgewood, located in beautiful Nanaimo, is an internationally renowned accredited and licensed facility seeking a general practitioner locum from December 23, 2013 – January 3, 2014. This is a unique offer providing an opportunity to work with a multidisciplinary team in a residential addiction treatment setting. Flexible hours with no on-call requirements. A competitive remuneration as well as accommodation is included in this locum position. Contact: Dr. Gary Richardson. Email: gary@edgewood. ca or telephone: (800)-683-0111 POSITION AVAILABLE: Family practice clinic conveniently located in Southport area SW Calgary looking for 2-3 full or part-time family physicians. New clinic with a computer system, EMR, and electronic labs. Pharmacy on-site. Competitive split. High patient traffic. Flexible hours. On-call optional and no hospital shifts required. Please contact Dan at (403)-208-5830 or email dbw1689@yahoo.ca RICHMOND, BC: Office space available four days a week for Consultant / Specialist / Podiatrist

LONG TERM ASSOCIATE FAMILY PHYSICIAN POSITION: We would welcome a transitioning Richmond Family Physician who wants to move their practice in anticipation of scaling back or wishing to end their current lease with a seamless transition. We would also welcome a physician who wishes to have less administrative headaches with their current practice. We are a Richmond BC collegial group medical practice with EMR and Chronic Disease Nurse as well as excellent support staff. We also have our own Computer Experts with our custom EMR. We anticipate professional satisfaction with excellent earnings. The successful transitioning physician would continue to have their chronic disease patients as the MRP while working in a collegial group. We may also consider new grads. Full support. 7030 split. www.mydoctor.ca/drsinghal Please phone: (604)-448-9595 Email: msinghalmd@gmail.com REGINA, SK: Prince of Wales Medical Clinic invites family physicians to join busy practice located in East Regina, close to major shopping centers and first class housing. Full-time, part-time or locum basis positions are available. Regular and walk-in patients are accepted. Fully networked EMR, internet accessible system is used to manage patient records. Each office and exam room is equipped with a computer and a printer. ECG and lab facilities are

REGINA, SK: Family Physicians are invited to join busy Quance East Medical Clinic, located in East Regina, close to major shopping centers and first class housing. Full-time, part-time or locum basis positions are available. Regular and walk-in patients are accepted. Each office and exam room is equipped with a computer and a printer networked with our EMR system. Remote access from home to the EMR is available. ECG and lab facilities are available on site. Our staff is pleasant and efficient. Very attractive split arrangement. Please contact clinic manager at (306)-522-2278 or email us at quanceclinic@yahoo.ca for more information.

solution from puzzle at left

A total of 3,292 subjects were exposed to at least 1 dose of PRISTIQ ranging from 50 to 400 mg/day in MDD clinical trials. Long-term safety was evaluated in 1,070 subjects in MDD who were exposed to desvenlafaxine succinate for at least 6 months (180 days) and 274 subjects in MDD who were exposed for 1 year (356 days).

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Table 5: mean Changes, vital Signs, at final On-Therapy for All Short-Term, fixed-Dose Controlled Trials

sudoku 1 easier solution 3 2 8 5 9 7 6 1 4 6 5 1 4 2 3 7 9 8 4 9 7 1 8 6 5 3 2 1 6 5 8 4 9 3 2 7 9 7 4 3 1 2 8 5 6 8 3 2 6 7 5 9 4 1 7 1 6 9 3 4 2 8 5 2 8 3 7 5 1 4 6 9 5 4 9 2 6 8 1 7 3

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solution from SUMMER 2013 contest

ADvERSE DRUG REACTIONS — All mDD ClINICAl TRIAlS

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________________________________________________________________________ E-mail: ________________________________________________________________ Tel: ______________________________ Fax: _________________________________ Sudoku Puzzle Contest Rules: 1. Entry form must be accompanied by solved puzzle. Only correctly solved puzzles entered into random draw. 2. Send puzzle and entry form to Just For Canadian Doctors, 200 – 896 Cambie Street, Vancouver, BC, V6B 2P6 or by fax to 604-681-0456. Entries must be received no later than November 27, 2013. 3. Prize: 3-month unlimited membership to Bikram Yoga Vancouver (valued at $420) or a $50 Visa gift card. Odds of winning dependent upon number of entries. Winner contacted by telephone and announced in Winter 2013 issue. 4. Contest can be changed and/or cancelled without prior notice. 5. All entries become property of In Print Publications. Employees of In Print Publications and its affiliates are not eligible to participate. FALL 2013 Just For Canadian Doctors

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Rural BC, . e b o t e c la p the

Dr. Eric Jablonski comes from a family of musicians (his father, Dr. Ted Jablonski is also a GP and singer-songwriter under the name “dr j”; see the last issue of Just for Canadian Doctors). But while the father makes folk/blues music, the son is all about punk rock. Playing drums for punk band Knucklehead in front of a sold-out crowd is a definite high. Off stage (and off call), the younger Dr. Jablonski is happiest being around music; he’d be lost without his iPod. And his secret to relieving stress? Playing the drums, of course. My name: Eric Jablonski I live and practise in: Live in Calgary, work in Calgary and Black Diamond My degrees / training: BSC Med, MD CCFP University of Calgary Why I was drawn to medicine and my specialty: Wanted to pursue a career with lifelong learning and very much enjoy working with people. Also I loooove paperwork… My last trip: European adventure April 2013­—Sweden/ Spain/Denmark

The most exotic place I’ve travelled to: India—my senses have never been so overwhelmed The best souvenir I’ve brought back from a trip: Recipe for curry doubles­—street food in Tobago A favourite place that I keep returning to: Kelowna, BC­—sun/ water/relaxation My ultimate dream vacation: Mediterranean beach vacation If I could travel to any time, I’d go…: Aboard a Viking ship to explore new lands My favourite book: The Sun Also Rises by Ernest Hemingway My favourite film: The Rocky Horror Picture

Show (family fave!) Must-see TV: Arrested Development (family dysfunction at it’s finest) My favourite CD/album or song: London Calling, The Clash My first job: File Clerk at a family medicine clinic—I should have realized that these heavy volumes were full of future paperwork… The gadget or gear I could not do without: My iPod—80GB, full to the brim My favourite room: Living room—comfortable couch, record collection nearby and space for friends/family My car: Subaru Legacy 2000 (hand me down…falling apart) My last purchase: New tires for my bicycle Last splurge: Recent trip to Sweden—that place is not a cheap destination… Most-frequented

Dr. Eric Jablonski, store: I really hate striking a pose with his shopping. Grocery girlfriend Jen in the photo store? booth at a friend’s wedding; with his Knucklehead My closet has bandmates (in the middle, too many: Socks, sans beard); his band’s I don’t know how latest album; and in this happened but Sweden, during his they can no longer last trip and splurge. all fit in the drawer,

time for a sock purge My fridge is always stocked with: Apples My medicine cabinet is always stocked with: Metamucil! I’m a strong believer in the stuff Guilty pleasure: Microbrewery beers— specifically stouts/ porters My favourite exercise/ sport: Biking or squash My favourite sport to watch: Hockey (GO FLAMES)

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Just For Canadian Doctors FALL 2013

Celebrity crush: Zooey Deschanel—singer and actress I’d want this item with me if stranded on a desert island: My iPod—not at all practical but necessary My secret to relaxing: Playing the drums is a great stress reliever A talent I wish I had: I really want to learn the guitar My scariest moment: Seeing my first patient die My fondest memory: Summer trips with my family to Kelowna

Me e t w i t h o ur t e a m

My biggest challenge: Trying to limit my endeavors in order to prioritize quality over quantity One thing I’d change about myself: My difficulty with accepting criticism

th , T he N o r Smit he rs

The word that best describes me: Fun-loving I’m inspired by: Creative individuals My biggest ego boost: Playing drums in a punk-rock band to a sold-out crowd

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My biggest ego blow: Reading scathing music reviews about music that I have been a part of creating

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I’m happiest when: I have music around—playing it, listening to it or watching it live

emy of Family American Acad P) Physicians (AAF mbly Scientific Asse Booth 1336 8 September 26-2 ornia, USA if al C San Diego, e Forum Family Medicin Booth 719 November 7-9 , Canada Vancouver, BC

My greatest fear: Being alone My motto: Knowledge is Power, Arm Yourself A cause that’s close to my heart: Calgary Urban Project Society—dedicated to helping individuals and families in Calgary overcome poverty On my must-do list: Learn how to surf If I wasn’t a doctor I’d be: Trying to make it in the music business…likely busking outside the Just for Canadian Doctors office building

photos courtesy Dr. eric Jablonski

s m a l l ta l k

doctors share their picks, pans, pleasures + fears

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