Just For Canadian Doctors Fall 2015 by Just For Canadian Doctors

fall 2015

DOCTORS life + leisure

big sky in

jasper

train tour in

europe

+ fighting HIV-AIDS in Africa + ADDED-VALUE dealerships + growing a bigger nest egg

win

+ a sip (or two) on the CIDER trail

$50 Visa Gift Card page 37

Publications Mail Agreement #41073506

inside: Continuing medical Education Calendar where will you meet? b e r l i n

toronto

chicago

lima

izmir

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EVER WORKED IN THE UK - BRITISH OR NOT?

IF YOU ONLY DID HOUSEMAN YEARS THERE, YOU COULD QUALIFY FOR A BRITISH STATE PENSION.

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Testimonial from a Doctor: Our own applications to receive the benefits owed to us by the British Government were met with excuses and blank negativity. We resigned ourselves to the impossibility of the UK pensions ever being honoured. This was before Tom Hewetson volunteered to negotiate with the UK on our behalf. After several months of meticulous information and documentation gathering, diligence, persistence, skilful diplomacy, and sheer hard work always with cheerful optimism and humour, Tom achieved what had seemed impossible to us and would have been impossible without his exceptional services. Thank you Tom!

For more doctor testimonials, contact us today!

Just for C

DOCTORS life + leisure

contents

fall 2015

Publisher Linh T. Huynh

Editor Barb Sligl

Art Direction BSS Creative

Contributing Editor Janet Gyenes

Editorial Assistant Adam Flint

Contributors Cover photo

Diana Ballon Crai S. Bower Michael DeFreitas Dr. Holly Fong Tim Johnson Dr. Chris Pengilly Manfred Purtzki Dr. Kelly Silverthorn Roberta Staley Barb Sligl

17 30

Senior Account Executive Monique Nguyen Account Executives Lily Yu Wing-Yee Kwong

Production Manager Ninh Hoang

Circulation Fulfillment Shereen Hoang

CE Development Adam Flint

Sales, Classifieds and Advertising In Print Circulation Office 200 – 896 Cambie Street Vancouver, BC V6B 2P6 Canada Phone: 604-681-1811 Fax: 604-681-0456 Email: info@AdvertisingInPrint.com

FEATURES

17 Take the train Riding the rails in central Europe 30 Big sky country Sky watching in Jasper, Alberta COLUMNS

DEPARTMENTS

8 photo prescription

5 fall mix 21 CE calendar 37 sudoku 38 small talk

Going under the surface

clockwise from top left: barb sligl; jeff bartlett; barb sligl

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.

11 pay it forward Fighting HIV-AIDS in Africa

12 the wealthy doctor

14 motoring A new kind of dealership

15 the thirsty doctor

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

with Dr. Norah Rogers

Grow a bigger nest egg

Season’s harvest…in cider

16 the hungry doctor

Bring on the kale

www.justforcanadiandoctors.com

28 soapbox

Printed in Canada.

want to reach us? check out our website!

Rethinking benzodiazepines cover photo

Looking up at the Messe Basel New Hall by architects Herzog & de Meuron, part of Congress Center Basel and home of Art Basel—just one stop on a whirlwind train tour of the Upper Rhine Valley (page 17).

Fall 2015 Just For Canadian doctors

from the editor

fall rush

nother summer has come and gone, and with it that twinge of nostalgia that autumn seems to bring, thinking of back to school, or back to reality. But fall is also one of the prettiest times of the year, when leaves turn brilliant shades of vermillion and ochre. This transition period, when intense all-day heat fades to morning and evening chills, is a feast for the senses: the soft caress of breezes that shake leaves from tree limbs, the fragrant musk of fallen leaves, the crackle and crunch of those leaves underfoot, the taste of the year’s harvest (think pumpkin pie), the visual overload of a landscape that looks as if it’s on fire… All those sensations are dialed up even more in the Rockies. Jasper National Park is quiet yet beckoning—there are fewer crowds than in summer and yet the landscape puts on a last hurrah before every-

Just For Canadian doctors Fall 2015

Wir lieben Berlin… and the rest of Europe, where liebe or “love” is easy to find—especially when touring farther southwest into the Upper Rhine Valley by train with a Eurail pass. Story on page 17.

thing is blanketed with snow in winter. And in the fall, you can still do it all—hike, bike, golf and even swim—and have the park, and its massive canopy of stars (the second largest Dark Sky Preserve in Canada) to yourself (page 30). You can also have Europe to yourself at this time of year. Once the masses dissipate after the summer holidays, the tourist meccas of France, Germany and Switzerland await with more breathing room and a more authentic vibe. Even more so if you travel by train. Think back to your backpacking days, but with today’s comprehensive first-class Eurail pass. It’s oh-so civilized and may be the easiest—and prettiest—way to explore the Upper Rhine Valley (page 17). And when embarking on your train tour

of central Europe, the place to start from is Berlin. The legendary city hasn’t yet overdone its cool factor, still drawing those creative types and iconoclasts since the Wall came down over 25 years ago now. If you haven’t been yet, go while it’s still the “it” city in Europe (page 21). Other adventures await, from a road trip up the Pacific Coast Highway (page 5) to sampling cider in the Pacific Northwest (page 15), because, come autumn, cooler weather definitely doesn’t mean staying home. Here’s to the fall rush. Happy travels! Any ideas, comments or questions? Reach us at feedback@InPrintPublications.com.

what/when/where > fall

california

mix

road trip!

dreaming

visit california / Chris Leschinsky

highway with a view One of the most iconic spots on the Pacific Coast Highway in California is the engineering feat of the 80-metre-high, single-span Bixby Bridge.

The drive of a lifetime on the Pacific Coast Highway

riving a long length of hardtop—a road stretching through some of the most scenic coastline in the world—I turn up the radio, feeling the essence of Bob Seger’s “Against the Wind” as I descend through a stiff sea breeze toward the water. I’m on US Highway 101, headed for California Highway 1—two roads that, together, form the heart of the famed Pacific Coast Highway. >>

Fall 2015 Just For Canadian doctors

fall

california

dreaming

on the road

he Pacific Coast Highway—or “PCH,” as it’s often called—is known around the world for its surf-skirting curves and breathtaking bridges. Last year, California Highway 1 celebrated the 80th anniversary of its completion, a massive feat of engineering. Motoring northwest from Los Angeles, I spend an evening in the pretty seaside city of Santa Barbara, touring and sampling the flavours of Old California on a Taste Santa Barbara Food Tour. We check out the city’s compact and bustling Public Market, eat chips and View to Picton salsa at Cielito, and sip some of the finest Pinot Noir in the country Bay from at the tasting room for Cebada, a local vineyard. But the PCH calls, Claramount so I head for the California 1, which narrows to just two-lanes after Inn. skirting the broad Pacific beaches at Morro Bay. Just north of the town of San Simeon, I stop to see the area’s resident colony of elephant seals. Lining the crescent-shaped beach at Piedras Blancas, these beasts lay in the sun and wade into road Point the shallow water in pairs, baring their stubby teeth while playtrip fighting. A docent with the Central Coast Friends of the Elephant Seal explains that these are juvenile males making a test run for a journey later in life, when they’ll return to this rookery for mating season. “They’re learning to defend the castle,” she says. I continue north, hugging the coastline on the undulating highway as Bob Seger sings about twisting, turning roads on “Roll Me Away.” I stop for a glass of wine at Nepenthe in Big Sur, a restaurant that clings to the edge of a cliff. I see a waterfall plunge to the beach at Pfeiffer Big Sur State Park, and marvel at Bixby Bridge, an oft-photographed single-span arch that carries drivers more than 80 metres high across a seaside chasm. I roll into Monterey feeling giddy, browsing along Cannery Row (a spot made famous in the John Steinbeck novel of the same name) and taking in ocean wonders at the town’s aquarium. And then onwards, to San Francisco, where, to the tunes of Bob Seger, I make it to the end of the road. — Tim Johnson if you go This road trip can take 9 hours or a week, but three days and nights allows for tourist stops and exploring—and some leisurely Seger-listening. Here’s where to stay along the way.

Los Angeles Le Parc Suites Hotel, in West Hollywood; leparcsuites.com Santa Barbara Hotel Santa Barbara; hotelsantabarbara.com Monterey Portola Hotel; portolahotel.com San Francisco The Fairmont San Francisco; fairmont.com/san-francisco

coastal drive

rural retreat

into the

country N

orah Rogers and I meet in the parlour room of the Waring House, a country inn on the edge of Picton in Prince Edward County. She arrives slightly out of breath, coming straight from her private practice as a family doctor in town. But Rogers is no stranger to multi-tasking. As co-owner, with her veterinary husband Chris Rogers, not only of The Waring House, but the nearby Claramount Inn and Picton Harbour Inn, they operate many businesses, along with both having full-time practices. This soft-spoken woman, her hair pulled back neatly in a bun, speaks confidently about what inspired her to combine careers in business and medicine (see page 38 for more on the doctor’s life and travels). Chris and I are really interested in business and love get- music“Both and I love antiques and interior decorating…A medical away practice can be very confining—very time-consuming, [making it] difficult to expand your interests.” As well as her work having variety, she also contributes to the community by employing as many as 170 to 230 employees at one time: having a respectable job gives people a sense of well-being, it nurtures their self-esteem, Norah says. Norah and Chris first moved to the County in 1981, and then bought The Waring House in 1995. Once a fine dining restaurant, they added four rooms upstairs in the Main House, “had guests in the first summer, and then no one from Labour Day to Christmas,” she says. Now it’s open all-year round, has 49 rooms, a pub with live music, a conference centre, a cooking school, a fine dining restaurant and many antique furnishings—much of them from an antique store she also owns. Norah stands up to give me a quick tour of the many well-loved antiques in the room—a Bartlett print of the Picton Bay, a china plate from the 1850s, and portraits of Prince Albert and Queen Victoria in frames from the 1860s. Her love of antiques, she explains, is about a love of history, about learning the origin of things, and going about the long process of restoring them, imbuing them not just with a function, but a new life. In 2001, the couple bought the Claramount Inn, a stunning colonial revival mansion from 1906. They then devoted the next three years to renovating it, using the original architectural plans for the building they found at the archives at Queen’s University as their blueprint. Since then, they’ve added the first spa in Canada based on the Kneipp model, a German philosophy that incorporates water, movement, botanicals, nutrition and therapies that promote mental well-being. The spa has an infrared sauna, a heated pool and outdoor Jacuzzi and quirky services like the “wet socks” treatment, which involves layering wet and dry socks as a way to stimulate metabolism. And the future? Although 65, Rogers doesn’t seem in any rush to retire. She says she wants to further restore the spa at the Claramount and do dietary work with people who are morbidly obese, and help people recuperate after cosmetic surgery. Some kind of psychotherapy work might also be another career direction. When I ask for her email address at the end of the interview, Norah sheepishly tells me that she doesn’t have one. But for that she can be forgiven. Her energies have been devoted to other more worthwhile projects. — Diana Ballon if you go Enjoy the heyday of autumn in Prince Edward County at:

the waring house waringhouse.com claramount inn claramountinn.com

Just For Canadian doctors Fall 2015

bottom: visit california; top: claramount inn and spa

mix

maverick style

fall

free

mix

spirit Embrace the unconventional, wherever you wander Written + produced by Janet Gyenes

art incubator To the uninitiated, Nevada’s Black Rock art Desert is merely a dried-up lake—devoid of life. But for a short stretch in late summer, a new existence springs up from the sand. “Burners” congregate here for the annual Burning Man fest and create their vision of art, often on a massive scale. HK Guy, a Britain-based Canadian writer and photographer has documented the event in his book, Art of Burning Man (TASCHEN, 2015), chronicling more than 16 years of selfexpression in its pages. From $50, indigo.ca

the un-routine

switch it up!

pick

bend these babies!

diy eyewear We get it: unisex eyewear isn’t exactly earthshattering. But the Hong Kong-based Baendit brand, gear created by Alex Schueli, offers a refreshing take, with its DIY designs that let you create your own sunnies from more than 100 possible colour combos. Going from urban to outback? Change out the lenses, nose pieces and stems to go from sultry to sporty. And there’s another twist: the lightweight shades are made with a plastic titanium frame that’s bendable so you can wear your glasses snug or loose depending on your adventure of the day. $130, baendit.com

inspirational style You never know when inspiration will strike, gear Jullianna Smith learned, after she discovered her late mother’s spiritual and whimsical sketches. The artwork spurred Smith to embark on a personal journey, which culminated in the creation of her activewear company, NoMiNoU—a playful take on her mother’s name, Naomi, and the words “know me, know you.” Smith’s body-conscious tanks and pants are fashioned from eco-friendly PET fabric (from recycled post-consumer drinking bottles) and feature her mother’s work, along with inspirational quotes from famous women. Starting at $75, nomidesigns.ca

Just For Canadian doctors

eco apparel

Lunges in London? work- Barre in Boston? out Spinning in Vancouver? Change up your routine at home and on the road with ClassPass, which lets you work out at gyms and studios in 30 cities worldwide for a flat monthly fee. The program recently launched in Vancouver, expanding its Canadian reach from Toronto to the West Coast. Members get unlimited monthly classes, with a maximum of three visits per studio, per month. Banishing boredom and staying mentally and physically fit doesn’t get easier than this. From $79/month, classpass.com

editor’s

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 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.

take the plunge

Proximity and patience can help capture stunning underwater photos

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

Just For Canadian doctors Fall 2015

Underwater photography is an exercise in patience, especially with macro subjects (right).

michael defreitas

When down below, shoot from below, whether a fellow diver (left) or manta ray (right).

under

go down

ifteen metres above, the sun sparkled at the surface like a giant disco ball. Streams of sunbeams pierced the underwater pristine blue water, illuminating French wonderland Cay Shallows reef in the Turks and Caicos Photograph marine life Islands. I was trying to photograph an from beneath…except uncooperative three-centimetre-long when looking down reveals spotted shrimp, but each time I had the the exquisite shape of a floral-like coral that dwarfs illusive crustacean in focus, it darted a diver (sometimes rules in and out of the tentacles of a giant are meant to be Caribbean sea anemone. Underwater broken). photography takes patience, but shooting macro subjects seems to test my limits. I managed to get off about six shots when my dive buddy nearly tugged my right arm off. Turning his way, I saw him frantically gesturing and pointing upwards. About five metres overhead, a giant manta ray was performing a ballet of loops and rolls, its enormous wings propelling it effortlessly through the water. My heart was pounding as I raised my camera. Then it hit me. I was set up for macro, not wide-angle, shooting. All I could do was watch the magnificent creature until it disappeared into the blue abyss, then go back to my pesky shrimp. The next day, I setup my camera rig for wide-angle shots, and managed to get a few great manta shots. Underwater photography is growing in popularity thanks in part to the proliferation of waterproof equipment, as well as the vast numbers of those who dive and/or snorkel. Today, dozens of manufacturers offer waterproof point-and-shoots and housings for most DSLRs, making it easier and less expensive to capture the underwater world. Of course, it’s not without its challenges. Water is almost 800 times denser than air, so light—especially warmer reddish tones— doesn’t travel far beneath the surface, rendering most images bluish and dull. Getting close is a priority. The number one rule for underwater photography: if you think you’re close enough you’re probably not—get closer. Whether snorkelling or diving, you’ll get the best results when your subject is within a metre of your camera. (My fidgety shrimp was shot from about 30 centimetres away.) One trick I use when I think I’m close enough is to extend my arms towards the subject. This gets the

“WITH MD, I DON’T HAVE TO WORRY ABOUT REMEMBERING TO PLAN FOR MY FINANCIAL FUTURE.” “I believe that MD not only really understands my role as a doctor, but also as a mother and someone with unique challenges. MD’s support and financial advice has helped me make sense of the path I’m on and see exactly where it is I want to go—and how to get there. I stay with MD because I really feel they put physicians first.” – Dr. Sarah Lesperance, Public Health and Preventative Medicine Resident

EVERY PHYSICIAN HAS A STORY. HEAR MORE FROM YOUR PEERS: MD.CMA.CA/MYSTORY

FOUR TIMES MORE PHYSICIANS TRUST MD.1

Fifty-three per cent of Canadian Medical Association members trusted MD Financial Management as their primary financial services firm, four times more than the next closest individual competitor at twelve per cent. Survey respondents (MD clients and non-MD clients) were also asked to identify their primary financial institution (MD or Other), and rate their level of trust associated with that institution. MD received the highest trust rating compared with all other firms rated. Source: MD Financial Management Loyalty Survey, June 2014.

MD Financial Management provides financial products and services, the MD Family of Funds and investment counselling services through the MD Group of Companies. For a detailed list of these companies, visit md.cma.ca. Incorporation guidance limited to asset allocation and integrating corporate entities into financial plans and wealth strategies. Professional legal, tax and accounting advice regarding incorporation should be obtained in respect to an individual’s specific circumstances. Banking products and services are offered by National Bank of Canada through a relationship with MD Management Limited.

> Always shoot with the sun behind you and near the middle of the day. Light penetrates water deeper at midday.

> Try not to shoot down on your subject. Shooting subjects level or from slightly below yields a better composition.

> With any wildlife photo, make sure the subject’s eye is in focus.

> Resist using digital zoom. Use a

wide-angle lens or setting, and move in closer.

> Practice your underwater skills with

your waterproof housing/bag/camera at the local pool first. Use a small toy as your subject.

gear up Start off with a waterproof housing or bag for your point-and-shoot or DLSR camera. Ikelite makes clear, rigid, polycarbonate cases for a variety of cameras (from $200). Ewa Marine offers clear, rugged, flexible plastic waterproof bags to fit most cameras (from $80). Both types allow you to adjust controls and use your built-in flash while underwater.

camera closer, but not your body (handy when shooting moray eels). It’s also less intimidating for you and your subject. One of the easiest ways to add colour back into your underwater pics is to use a flash. Today, most waterproof point-andshoots and DSLRs have built-in flashes. Set your camera to aperture-priority mode, and the aperture to f8. Set your ISO to 200 or 300, and your flash to auto or TTL mode. These settings should deliver fairly good results. But because of water’s density, the effective range of most built-in flashes is only about one metre. Shooting in RAW file format gives you some flexibility—you can use image-processing software, such as Adobe Elements, Photoshop or Lightroom to adjust colours and brightness back at home. Another trick to add warmth to your images is to set your white balance to “cloudy.” This fools the camera sensor into thinking the scene is too blue, so it adds some red. Or attach a reddish colour correction filter (by Ikelite) to the front of your lens, and shoot with your default “sun” white balance setting. It’s never been easier to get into underwater photography—take the plunge and go down under on your next vacation.

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

Puzzle by websudoku.com

solution from page 37

PRO TIPS when going down under

solution from Summer 2015 contest

photo prescription [continued]

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

Puzzle by websudoku.com

too blue

michael defreitas

Shooting anything below 10 metres gives images a blue cast. Add “warmth” with an orange filter or set your white balance to “cloudy” to warm up the image.

Just For Canadian doctors Fall 2015

pay i t f o r w a r d

r o b e r ta s ta l e y

Roberta Staley is an award-winning magazine writer and the editor of the Canadian Chemical News, published by the Chemical Institute of Canada. She is also a magazine writing instructor at Douglas College and a graduate student at Simon Fraser University.

an ongoing battle

How Dr. Allan Ronald of Winnipeg spurred the fight against still-prevalent HIV-AIDS in Africa

Jonah O’Neil

tephen Lewis is arguably Canada’s most famous diplomat, in large part because of his passionate advocacy on behalf of the millions afflicted with HIV-AIDS throughout the world—especially Africa. Lewis was first alerted to the scourge while he was Canada’s Ambassador to the United Nations. The warning came in 1986 in the form of a letter from Dr. Allan Ronald at the University of Manitoba. Ronald’s twopage letter spoke of an unfolding tragedy, one where HIV-AIDS would “devastate Africa—yet the world wasn’t paying attention.” Lewis wrote back to say thank you, “he was pleased that I had raised the alarm,” recalls Ronald, 77, Distinguished Professor Emeritus at U of M, an Officer of the Order of Canada and a Fellow of the Royal Society of Canada. Ronald was in Nairobi, Kenya when HIV-AIDS struck in the early 1980s. The son of Manitoba farmers, Ronald was in the East Africa nation setting up the University of Manitoba/University of Nairobi World Health Organization Research and Training Program in Sexually Transmitted Diseases. Ronald, who was then the Director of Clinical Microbiology and Head of the Section of Infectious Diseases at U of M as well as Winnipeg’s Health Sciences Centre since 1968, had been invited to Nairobi to help with a devastating outbreak of chancroid. A few years earlier, Ronald and his team in Winnipeg had ended an outbreak of this bacterial infection, which causes genital ulcers, among sex workers and their clients. When chancroid swept the adult population in Nairobi, Ronald was asked by Kenyan microbiologist Dr. Herbert Nsanze to lend his expertise to the problem. Upon Ronald’s arrival, “there were literally hundreds of men lining up each day at the sexually transmitted disease clinic in downtown Nairobi.” Ronald was still in Nairobi in 1983 when a pathology colleague alerted him to an unusual post-mortem case. A young woman had died of pneumocystis carinii, a fungus known to attack those with HIV. The diagnosis was AIDS, which at the time was referred to as “the American disease,

because it had been first identified in 1981 in 2000, allowing him to focus on fighting in the United States,” Ronald says. AIDS in Africa. He assisted in developing HIV soon swept through the patients in the Infectious Diseases Institute at Makerere the Nairobi treatment program. In 1980, says University in Uganda, which has trained Ronald, none of the Nairobi patients were more than 10,000 Africans in HIV prevention HIV-positive. By 1986, 50% were infected. and care since 2002. The ensuing years saw Ronald fight the Millions of people have died in Africa battle against HIV-AIDS on two fronts. On since 1982 and more than one million adults the clinical side, teams at the research and and children continue to die each year. training program cared for patients with (Worldwide, an estimated 75 million people a myriad of opportunistic diseases such have been infected with HIV and about 40 as tuberculosis, cryptococcal meningitis, million have died since the virus emerged.) Kaposi’s sarcoma and pneumonia. Ronald says that access to antiretroviral Ronald also helped ensure drugs, male circumcision, behavioural that Kenyans were able change and condom use has led to obtain additional to a decrease in the number of Dr. Allan Ronald clinical and research of Winnipeg rang the training in Canada alarm on HIV-AIDS, and the United stating that it would States. The other “devastate Africa—yet fight was trying to the world wasn’t convince government paying attention.” bodies like the Canadian International Development Agency (CIDA) and the World Health Organization (WHO) to dedicate resources, drugs and human resources to the pandemic. CIDA “never really jumped on side,” says Ronald. “We were recognized internationally as among the best research centres in the world for combining HIV cases by 20–40% in many countries. science and development in a way that However, he worries about increasingly risky has become a model for global health. But sexual behaviour among adolescent girls. too often, bureaucrats trivialized what was According to UNAIDS, in some regions this being done in Nairobi,” says Ronald, adding age group is contracting HIV at a rate of that the training centre is the longest 4–5% a year. running HIV-AIDS research initiative in the Ronald is optimistic that vaccines, new developing world. drugs and methods that allow women to American funding agencies were more protect themselves will thwart HIV in the dependable collaborators, Ronald says. In future. He is somewhat jaded though; long 1995, former US President Jimmy Carter experience treating the disease, Western and Bill Gates Sr., father of the billionaire Microsoft founder, visited the Nairobi apathy towards Africa and the lack of human program. Impressed, the program was given resources bodes ill for “short-term fixes,” $1 million from the Gates Foundation, which says Ronald. “There will still be continuing provided consistent funding thereafter. epidemics of HIV 20 years after I’m gone— Ronald retired from teaching at U of M but I hope I’m wrong.” Fall 2015 Just For Canadian doctors

t h e w e a lt h y d o c t o r m a n f r e d p u r t z k i Manfred Purtzki is the principal of Purtzki & Associates Chartered Accountants. You can reach him at manfred@purtzki.com.

nesting time

Growing a bigger retirement nest egg

ll of us should be saving money for a rainy day—tucking away extra cash for unforeseen emergency expenditures or growing the proverbial nest egg. That term, “nest egg,” comes from a farmers’ custom of placing eggs—real or fake—in hens’ nests to encourage more egg laying. Similarly, putting aside more money yields more savings, but here’s how to be strategic in growing a bigger, more golden, retirement nest egg.

Retain any surplus funds in the company to maximize tax deferral benefits. Keeping $100,000 in the corporation instead of paying it out to you as dividends will give you a tax saving of about $30,000. There are two reasons for skipping RRSP contributions. Firstly, the tax refund of

Leveraging

During the recent Presidential Republican debate, Donald Trump was asked how he made his fortune. Mr. Trump answered “Leverage!” For him it meant borrowing against the inherited capital to make high-risk investments. Leveraging provides you with access to a greater pool of capital and the opportunity to generate larger investment returns. To illustrate, suppose you wish to use $500,000 of savings to buy a $500,000 condo in Toronto or Vancouver, promising an annual return of 8% or a $40,000 profit. If you use the $500,000 and borrow an additional $500,000 at 3% to purchase two condos for $1 million, you are generating a return of $80,000. After deducting the interest cost of $15,000, your net return will increase from $40,000 to $65,000, which is equivalent to a 13% return, instead of 8%, on your capital of $500,000. Keep in mind that leveraging is a two-edged sword. While you can drastically boost the return on your capital, you also increase the investment risk at the same time. Thus, it is imperative to proceed with caution. One big incentive to leveraging funds is that the interest on the money borrowed for investments is tax-deductible.

Avoid “bad debts”

A “bad debt” is a loan for depreciable assets like boats and fancy cars, or assets that are costly to maintain and not likely to increase much in value, such as a recreational property. How you manage All of us your debts will should be determine whether you are going to be mon ey for a rich or simply middle-class. rainy day If you are still struggling with debt repayments in your late 50s, you will likely only have accumulated wealth in your RRSP and principal residence.

saving Be strategic in growing a bigger, more golden, retirement nest egg

Keep incorporation savings and skip the RRSP

Only draw funds from the corporation to pay for personal and living expenses.

monthly collections from your practice account and deposit it to your investment account. If you feel that you can handle the monthly payments to this latter account, you can always increase them. Follow the advice in “The Richest Man in Babylon” book by putting aside 10% of your gross earnings each month and never skip a payment. If you are short one month because of holidays, for example, continue to make the payment from a line of credit.

Just For Canadian doctors Fall 2015

the RRSP contribution is negligible, because the funds taken from the company to make the contribution is taxed as dividend, largely offsetting the benefit of the RRSP deduction. Secondly, with interest rates being so low as they are now, most RRSP portfolios today produce capital gains mainly through equities. Capital gains are fully taxable in RRSP, while only one-half of those outside the RRSP are subject to tax.

Set up an automatic savings plan

Setting up an automatic monthly savings plan is a great way to plump up your savings. Start withdrawing 5% of your

If you want to have more, spend less!

Medical school gave you the skills to make money, but many doctors did not learn how to spend it. Rich people buy assets, while poor people buy liabilities. Regrettably, many doctors do not know the difference between the two. Do you? An asset is an investment that generates income, but items such as boats, sports cars and motorbikes—tempting as they may be—are liabilities requiring cash to maintain. Hence, don’t waste your precious discretionary dollars on depreciable items.

21st Annual

Primary Care in Paradise Medical Specialties from the Primary Care Perspective

April 4–7, 2016 Hyatt Regency Maui • Lahaina – Maui, Hawaii Featuring an interactive dermoscopy workshop!

Scripps Conference Services & CME • www.scripps.org/paradise

motoring

D r . k e l ly s i l v e r t h o r n Dr. Kelly Silverthorn is Just For Canadian Doctors’ automotive writer. He tries to keep one convertible and/or one track-day car in the family fleet.

dealers choice

Dealerships are doing more… and even becoming the “thoughtful” one:

How dealer groups are upping the ante for their clientele

hat do you get from the car dealerships you frequent? At a minimum they should provide competitive sales pricing and attentive mechanical servicing. But they can also provide much, much more. Today’s top dealerships are outdoing each other with innovative incentives. I stumbled upon a dealer group that exceeds my wildest expectations of “added value” with insightful strategies that alter the regional car enthusiast dynamic— and arguably the national dynamic as well. It’s just one example (see sidebar for other dealerships across the country) of what your dealer or dealer group could—or should— be doing for you. Some background. As a business model, a stand-alone single dealership structure is rapidly disappearing. The economies of scale in back-office operations of banking, accounting, legal, payroll, human resources, media and advertising are driving the “dealer group” model, in which one ownership structure/entity controls between five to 50 dealerships. The largest such groups are even publicly traded on stock exchanges. The best of these enterprising dealer groups harness these economies of scale and apply in a whole new direction: to deliver unexpected added value to their customers. And these added values then attract more clients, and/or inspire existing clients to become bigger clients. Consider the 10-dealership strong Vancouver Island group that I recently discovered. It primarily sells European brands (German Auto Import Network, which I’ll refer to as the “Group”) and is betting the proverbial farm on the premise that an underserved Canadian market desires an intensely immersive automotive lifestyle. To

[hot list]

serve those clients, the Group’s key asset is a private racetrack estate. Seriously. Not so much for organized racing, rather the track allows members to practise and improve driving skills while exploring the outer reaches of their car’s performance envelope. And this private haven of horsepower is designed by the best-known designer of top-drawer racetracks, Tilke GMBH (involved in all of the new Formula One tracks around the globe over the last 15 years). Situated between Victoria and Nanaimo, the Vancouver Island Motorsport Resort will function something like an exclusive private golf club. And the climate-enabled 12 months per year of track availability should help deliver the 60% of members expected from beyond Vancouver Island. The Group also recognizes that satisfying its members and their guests will require more than just track time. So a number of co-host partners have signed on, including a golf-course syndicate, tennis clubs and the like. A luxury lodge/spa perched above the Pacific between the track and Victoria (the legendary Aerie) will be the designated accommodation outpost. Part of the resort’s attraction will be social. I can’t wait to meet the other enthusiasts who elect to spend their leisure time on this Tilke road-course rollercoaster. Any track time is great, but sharing it with like-minded enthusiasts is even better. Followed by a fine meal and great view, of course. The Group’s other two value-added plays may not be as dramatic as a Tilke track and resort (hard to top), yet still show the Group’s conviction that its client base is seeking a more engaged ownership experience of their premium automobiles. Some more background. The 24 Hours of

“We are well past vendor-client and on our way to ‘relationship.’”

LeMans is the most important race of the year to automobile manufacturers. Past multiple-year Le Mans winners include Porsche, Audi, Ferrari, Jaguar, Ford, Mercedes and, during the interwar-war years, Bentley and Alfa Romeo. The same third weekend in June as the 24 Hours of Le Mans, multiple Group dealerships have VRX race simulators in-store. Teams of dealership staff and clients race against other dealership teams over the same 24 hours, over the same Le Mans track, in the same cars as the real racers, hammer and tongs, in the northwest of France. Bragging rights are established that’ll last 52 weeks. And thousands of dollars are raised for local charity. And then the Group is also involved in the Vancouver Island Motor Gathering. This annual August event features judged static displays of older cars, rather than the new cars the Group sells—a recognition that the well-rounded auto enthusiast seeks and loves both. The goal is to elevate car appreciation in general with professional judging and prize money. The efforts may not eclipse world-standard Pebble Beach Concours d’Elegance any time soon, but a top Canadian and/or Pacific Northwest show ranking is within the realm of possibility. Thanks to my Group, I now have three value-added features I wasn’t expecting: a year-round Tilke track, an annual Le Mans simulation team experience and an annual car show à la Concours of substantive stature. Seems my dealership is spookily in tune with added-value features that engage me—in fact, I think we are well past vendorclient and on our way to “relationship.”

Dealerships double down The German Auto Import Network (GAIN) on Vancouver Island isn’t the only dealer group with value-added incentives for its clientele. Here’s what some other dealer groups are doing, whether for customers or community.

Club OpenRoad offers comp tickets and a cocktail reception to the Vancouver International Auto Show, as well as perks like Grouse Mountain ski passes and an annual Club OpenRoad Driving Event.

Just For Canadian doctors Fall 2015

Dilawri Group is the official National Support Vehicle Partner of the Ride to Conquer Cancer across Canada, and offers special promotions/ donations to applicable member/participant’s fundraising efforts.

The Zanchin Automotive Group in Toronto rewards students with the Joe Zanchin Academic Excellence Scholarship, and has installed a wind turbine at one of its dealerships to showcase energy efficiency and forward thinking.

The Trillium Automobile Dealers Association’s EV (Electric Vehicle) Challenge is an annual race of studentdesigned electric cars. How does your dealership group stack up in comparison?

the thirsty doctor janet gyenes 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

craft cider comeback European-style apples are getting pressed into service

here’s a hard cider explosion going on—literally. During late summer, news media outlets across North America reported on bursting bottles of Angry Orchard cider, which the Ohio-based company recalled. The blow-up was caused by re-fermentation in the bottle, which causes carbonation levels to increase. And when that extra pressure builds up, something’s gotta give! The news put hard cider in the spotlight, which can’t hurt, since the fermented apple juice doesn’t get much appreciation outside of Europe. And that’s surprising, considering it was the first boozy beverage produced and consumed in North America, according to the Ontario Craft Cider Association. Back then, everyone knew how to make it—and did. But cider faced stiff competition from an influx of German immigrants who preferred making beer. And during Prohibition, cider trees were cut down. But now craft cider is finally making a comeback. In Canada, the industry is expected to increase to $263 million annually in 2016, up from $90 million in 2006. What took so long? Maybe mass-market overly sweet or too-tart ciders have coloured our understanding of how traditional cider should taste. Or maybe it’s because of the craft movement that’s seen breweries and distilleries cropping up across the country. In the Pacific Northwest, there’s a profusion of small-batch producers on both sides of the border growing their own apples and making artisanal ciders. During a recent trip to Port Townsend, a Victorian village on Washington’s Olympic Peninsula, I visited Alpenfire Cider, home of Washington’s firstever organic cider apple orchard and the first

organic cider processor in the state’s history. Alpenfire is owned by Nancy and Steve “Bear” Bishop, an affable couple who got serious about cider-making after wrapping up other careers in the early 2000s. “We started with Red Delicious [apples] because that’s all we were growing in Western Washington,” says Bear. But now he knows better. In 2003, Bear and Nancy travelled to England, France and Spain to learn about European cider-making. Nancy focused on production; Bear spent his time studying the fruit. Planting a proper cider apple orchard wasn’t in the initial plans, but after their education abroad, Nancy and Bear knew it was an essential step. Why? Cider apples are classified based on their tannin and acid content, ranging from bittersweet and bittersharp to sharp and sweet. It’s these characteristics that set European-style cider apart from many North American varieties. Standard apples tend to produce one-dimensional ciders, says Nancy. Fortuitously, Washington State University’s Mount Vernon research centre had a 20-year-old block of European varieties of cider fruit it had planned to discard. These were used to propagate the espaliered trees in the Alpenfire orchard. Nancy points out some of the 14 varieties of apples—half bittersweets, half bittersharps—that go into the seven ciders Alpenfire produces. There’s Foxwhelp, which “get huge,” compared to other cider apples, and Muscadet de Dieppe, which grows in clusters. Both are blended into Flame, a French-style cider made in the méthode champenoise. They also get mixed with others to make Pirate’s Plank Bone Dry, a “scrumpy-style” cider. Scrumpy, a British term, refers to rough-and-ready farmhouse cider.

Once apples are harvested, typically in late autumn, they’re washed twice, pressed and left to sit and “sweat” for four to six weeks, which concentrates sugars and softens apples. “The cider fruit has all the tannins in it so it preserves the fruit. They don’t break down like a grocery store apple,” says Nancy. Like wine, cider vintages vary from year to year depending on how much acid is in the fruit, and blending the varieties brings balance. Alpenfire’s ciders are unfiltered and aged in neutral oak barrels for a couple of months, then bottle conditioned. That means a bit of sugar is added to the cider before bottling, which works with the yeast to produce natural bubbles—no carbonation required. The Dungeness Orchard blend, however, is an example of yet another way Alpenfire is challenging the cider status quo. It’s made from a blend of more than 200 varieties grown by an apple pioneer in neighbouring Sequim. And unlike its effervescent counterparts, Dungeness Orchard is flat—no bubbles—something unexpected in a cider, says Nancy. It’s reminiscent of white wine and representative of the complexity of cider that’s taken for granted in North America. Another unintended benefit of such a cider? It won’t explode.

the

cider rules

drink up! Sample Pacific Northwest cider at these two autumn events NW Ciderfest | October 10, 2015 Pioneer Courthouse Square, Portland, Oregon

BC Cider Week | October 17–25, 2015 Various locations in BC

More than 30 cider producers will be on hand at this event that will feature food trucks and live music. Fundraising efforts on behalf of NW Ciderfest are in support the Muscular Dystrophy Association’s Summer Camp. nwciderfest.org

The first annual BC Cider Week welcomes members of the NorthWest Cider Association to join BC cider producers in a week-long event throughout the province. It kicks off with an opening festival. bcciderweek.com

From left Dungeness still cider; Pirate’s Plank “Scrumpy” cider; Flame cider, made in the méthode champenoise

Fall 2015 Just For Canadian doctors

t h e h u n g r y d o c t o r d r . h o l ly f o n g Dr. Holly Fong is a practising speech-language pathologist with three young children who’s always trying, adapting and creating dishes.

harvest greens Yes, kale is still the “it” ingredient

Linguine with baby kale and italian fennel sausage (serves 4–5)

Linguine with baby kale and italian fennel sausage 1 package of linguine (375g) 500g package of mild Italian sausage with fennel 1 large box of prewashed baby kale (454g), roughly cut into strips 2 cloves of garlic, peeled, end trimmed and sliced 2 tablespoons extra virgin olive oil ¼ cup freshly grated Parmesan cheese 2 tablespoons finely chopped fresh chives 3 tablespoons salt Salt and fresh ground pepper to taste

Bring about 7–8litres of water to a boil in a large pasta pot. Cut the sausage on the diagonal into oneinch slices. In a large soup pot or Dutch oven, heat the olive oil over medium-high heat. When the oil is shimmering, swirl to coat the pan before adding the sausages to brown, until no pink remains, approximately 10minutes. Add the garlic and cook until soft for about 4minutes. Add the sliced kale, stirring to combine. Reduce heat to medium and cover for 4–5minutes. Remove lid and set aside. Once the pasta water is boiling add the 3tablespoons of salt. Drop the linguine into the water and cook for a minute less than the package instructions. Just before the pasta is done, ladle ½cup of the cooking water into the pan containing the kale. Reserve another ½cup and set aside. Drain the pasta in a colander and immediately add to the sausage kale mixture. Toss over medium heat for about 30seconds until the pasta is nicely coated. If the pasta seems dry, add a little more of the reserved pasta water. Add some freshly ground pepper to taste. Mix in the chives and cheese. Pour into a warmed serving bowl and serve immediately. If desired, garnish with more cheese. Enjoy.

Just For Canadian doctors Fall 2015

Keep summer y family loves pasta in any shape and way. going as long as you And I love making homemade pasta sauces, can with the Tohu 2013 but I’d rather not spend a lot of time preparing single-vineyard Marlborough them. Sure, pesto is easy, but it’s also almost too simple, Sauvignon Blanc. Hints of pasand I feel compelled to make an elaborate salad or side sion fruit and lemongrass and dish to accompany it. My ultimate goal is a one-dish, grassy herbaceous notes are a one-pot meal that’s tasty and low maintenance. For sunny balance to the strong this, I try to combine a strongly flavoured protein such as flavours of fennel bacon or Italian fennel sausage with a slightly bitter kale or sausage and kale. arugula. And if I use baby kale or arugula that’s pre-washed, all I need to do is roughly cut up these greens before adding to the mix. Then I grate some fresh Parmesan before serving and I’ve satisfied my family’s pasta cravings with a dish that’s not only tasty but healthy as well. And, since we’re still in the last bit of Indian-summer warmth, my wine pick for accompanying this pasta is a dry white with some acidity and minerality that counterbalances the fattiness of the meat—like the Tohu 2013 single-vineyard Marlborough Sauvignon Blanc. This wine has hints of passion fruit and lemongrass along with grassy herbaceous notes that pair well with the fennel in the sausage. The wine’s bright acid and strong minerality are well-balanced, creating a long, dry finish. Perfect for a last warm-weather hurrah and dinner on the deck.

Kale has been hailed as a superfood for a while now, with good reason— one cup has more vitamin C than an orange, and it has more calcium per 100 grams than milk. It’s so full of good stuff, it has its own book by Dr. Drew Ramsey, Fifty Shades of Kale. And kale now has a celebratory day too. So, this October 1st, on National Kale Day, be sure to put kale on your menu.

travel the world

Vineyard in the Pfalz winemaking region; The Museum of Printed Textiles in Mulhouse; Harvest season at the market in Freiburg; Twilight in La Petite France in Strasbourg. clockwise from top left

3 countries, 1 week

When riding the rails in central Europe, there’s a train (and an app) that’ll take you almost anywhere…including this autumnal (and crowd-free) tour through the Upper Rhine Valley of Germany, France and Switzerland—all on one Eurail pass story + photography by barb sligl

Fall 2015 Just For Canadian doctors

travel the world here’s a rhythmic thrum of the train as it glides over the tracks. Da-dum, da-dum. It’s hypnotic. Conducive to gazing out the window as landscape rolls by. This is how more of travel should be: slower, attune to its surroundings, immersive, quieter. Even the clang, clang of the train on tracks seems softer, more civilized in Europe. And yet, the vast rail network here actually makes train travel fast and easy. So much so that you can cover

three countries in a week, tracing the Rhine River through vineyards in the Palatinate to half-timbered houses in Alsace, back to the Black Forest and into Switzerland. It’s a train trek through a fairytale.

Germany

Start in Berlin, the “it” capital (see page 21), at the gleaming Hauptbahnhof or main train station. The Deutsche Bahn or DB (German Rail system) is as efficient as you’d expect and after a few hours of that smooth da-dum, da-dum, you’re in the vineyards of the Upper Rhine Valley in the Southern Palatinate region. My first stop is Landau, a town that feels off the beaten path, even though it’s just an hour from Frankfurt and on a wine route that was established in 1935 in the largest Rieslinggrowing region in the world. Winemakers have tilled the soil here for generations and I get a crash-course in Germany winemaking at Weingut (Winery) Dr. Wehrheim from youngand-strapping, fourthgeneration winemaker Franz Wehrheim, who’s worked here in the Pfalz since he was a teenager. But there’s more than wine (and Riesling!) here: medieval castles, fortresses, churches and festivals. I spend the night in centuryold Villa Delange, a former winery that’s now a meticulously restored Gästehaus, and where I’m greeted with regional sparkling and Flammkuchen (think gourmet pizza with crème fraîche, lardons, caramelized onions). I could stay a week, but the train calls… From Landau, I take the DB to another relatively unknown town (despite having hosted Thomas Jefferson in its heyday), Karlsruhe. “Young” by European standards (founded in 1715) it’s being branded as a “media city,” following its origins as a centre of progress built around a stunning residential palace modelled after Versailles. The dream project of a tortured-genius royal (literally—the elaborate fan-shaped city plans came to Karl III William as a vision), this was the home of many forward-thinkers, including Carl Benz (as in Mercedes-Benz) and Baron Drais von Sauerbronn, inventor of the

Palatinate

Freiburg

Strasbourg

Baden Baden

if you go

GO BIG, GO FAR The Eurail Global Pass gives you access to 28 countries. SHORT ON TIME? The “5 in 10 Days” Global Pass gives you five travel days anywhere within a 10-day span. Or the Eurail Select Pass is valid in four bordering countries by rail or ferry. BONUS Children ages four to 11 ride free with a family member or friend with an Adult Eurail Pass. APP IT Download the Eurail app when on wifi and then use off-line to plan travel, track trains (in real time via smartphones with GPS—no cell reception necessary) and follow your progress en route. Wow. eurailgroup.org/eurail-vendors

Just For Canadian doctors Fall 2015

“Draisine” (the forerunner of the bicycle). After wandering this model-like city for a few hours, I get back on the train for Baden Baden, the town that’s so nice, Bill Clinton famously said it had to be named twice. A spa mecca (bad means “bath”) that’s drawn wellness seekers for 2,000 years, it’s still a hotspot, especially for Russians who revere it through their literature (Baden Baden is named more often than any other city except Paris in classic tomes by Tolstoy et al). There’s even a Fabergé museum here with four of the remaining legendary eggs. And for those not into soaking, there’s gambling (at Marlene Dietrich’s favourite casino, no less). I stay for lunch, a leisurely walk among the fall leaves of the Black Forest and people watching at Café König, before catching another train (they’re constant!)…now to France.

France

Strasbourg is another ancient city (it began as a Roman camp more than 2,000 years ago) on the banks of the Ill river just west of the Rhine that’s switched from German to French rule many times. Now the European Union’s capital (alongside Brussels), it’s a UNESCO World Heritage Site and the heart of the Alsace region. I stay and stroll in La Petite France, amongst canals and half-timbered houses, as if in a diorama, before making my way to the city’s centrepiece, the 1,000-year-old Romanesque-turnedGothic cathedral. After craning my neck to gaze upon the cathedral’s towering façade, I tuck into a winstub, a kind of casual, homey wine bar with a mash-up of Germanic and French cuisine. Here, Flammkuchen is now a tarte flambée, Bibeleskäs is sautéed potatoes smothered in fromage blanc, and Choucroute is a mound of saucisse with sauerkraut. And then there’s pâté de foie gras; Strasbourg is the famed delicacy’s birthplace. Despite an exhaustive wine list (from Reisling and Gewürztraminer to Sylvaner and Muscat— and even Klevener, a white that’s grown in only one village in Alsace), I chase my beer with Quetsche, a strong-yet-smooth Alsatian digestif made from plums. After eating my fill (and then some), I walk to the Gare Central, another modern glass dome, to take the train south to Mulhouse, a city that’s gone mostly unnoticed despite (or perhaps because of) its industrial heritage in textile-making. The Museum of Printed Textiles here began in 1830 as a library of patterns going back centuries (from fabric created for Japanese kimonos to haute couture for Empress Eugénie), a historical record that modern-day designers use for inspiration (like Ikea). After oohing and aahing exquisite fabrics, I balance all that softness with fast cars at what’s been called the most beautiful car

travel the world

Strasbourg Cathedral. A giant Calder sculpture on the grounds of Fondation Beyeler in Basel. above The New Hall of the Congress Center Basel, designed by Herzog & de Meuron, one of many Pritzker Prize winners for architecture whoâ&#x20AC;&#x2122;ve created buildings in the city.

Karlsruhe Palace.

Hauptbahnhof in Berlin. opposite page, clockwise from top left Winemaker Franz Wehrheim; Freiburg guide, BĂ¤rbel Ambs, wearing a Bollenhut; lounging in Baden Baden, in the Black Forest; locals in Strasbourg.

UpperDiscover Rhine Valtheley... VILLA DELANGE villa-delange.com WEINGUT DR. WEHRHEIM weingutwehrheim.de KARLSRUHE karlsruhetourismus.de/en BADEN BADEN baden-baden.com STRASBOURG otstrasbourg.fr/en MULHOUSE tourisme-mulhouse.com FREIBURG freiburg.de BASEL basel.com

Automobil Museum in Mulhouse.

Vineyards in the Palatinate.

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museum in the world—a 430-car collection of two brothers who made their fortune in the textile industry (bien sûr!). I learn a few things (like the fact that Bugatti is French) and marvel at the oldest French car, a jalopylike Jacquot from 1878, before speeding off again on the French version of the DB, SNCF.

Switzerland

CANADA • • • • • • • • • • •

travel the world

Just For Canadian doctors Fall 2015

I make my way to Switzerland via one more stop in Germany, back across the Rhine. Freiburg is another oh-so-cute town with more history than I can take in over a lunch stop (founded in 1120, it’s also switched allegiances between France and Germany many times)—but I try. I take a tour with guide Bärbel Ambs, who dons local traditional dress, including the delightful pom-pom bonnet, Bollenhut. There’s yet another Gothic cathedral that’s so impressive its architect was blinded after finishing the plans to prevent him repeating the design. I browse stalls burgeoning with autumn’s harvest, building up an appetite for spätzle (dumpling-like noodles) and a huge piece of black forest cake (I’m back in the Black Forest again, after all—Karlsruhe at one end, Basel on the other) that tides me over for my final leg on the train. As the train pulls into the Swiss Railway station (SBB) in Basel, I note the stylish locals and think of the city’s claim to fame. Art. Known as the cultural city of Switzerland and a lively university town, it’s also home to Art Basel, the now-iconic art fair that has satellite shows in Miami and Hong Kong. This is the home of the oldest art collection in the world at the Kunstmuseum, founded in 1661. And there are more than 40 other museums here. With an afternoon to spare, I take a tram to Fondation Beyeler, just outside the city centre, to gape at big-name modern artwork inside (Gustave Courbet’s “L’Origine du monde,” for one) and the architecture of Renzo Piano (one of 12 Pritzker Prize winners who’ve designed buildings in Basel) outside. But more than art, this city that dates from 100 BC has a youthful feel. The sort of energy that’s made “Rhine swimming” a hot sport—people even commute by swimming downstream with their clothes in dry bags. The city is set on both sides of the Rhine, but I’m not keen to take a dip in October, so I walk instead. I meander past quirky boutiques and galleries, chocolateries and brasseries, masses of bikes (with their own parking spots) and reach Münster, one of the city’s hills that was settled by Celts in 100 BC and is the site of, yes, another grand cathedral. I continue to the Pfalz viewing terrace overlooking the Old Town and beyond to the border triangle of France, Germany and Switzerland. It’s as if I’ve come full circle, to the beat of that rhythmic da-dum, da-dum, from one Pfalz to another.

berlin / toronto / chicago / lima / izmir …

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cMe

A n intern ation a l guide to continuing medical Education

BERLIN

fall 2015 + beyond

Graffiti artist in Mauer Park.

Berliner, Haim Hoffmann, sports seriously cool Kaiser-style whiskers. Stolpersteins.

Curry wurst, a local favourite, and fries (with mayo, of course). Footprint of the former Mauer or Berlin Wall.

Amidst the 2,711 concrete slabs or stelae of the Holocaust Memorial.

The Kiss, one of the most famous murals on the remaining stretch of the Wall in what’s now called the East Side Gallery.

berlin is old + new, historic + avant-garde, nuanced + over-the-top, nostalgic +

iconoclastic, all of which make it Europe’s “it” city (CME events in Berlin + just beyond are highlighted in blue.)

b. Sligl

erlin is achingly cool. Aching because of its fraught past, a city that went from being the world’s second largest before WWII to a stagnant shell, literally and figuratively divided during the Cold War. And cool because after many dormant years it’s become a creative hotspot—with graffiti, galleries, cafés, beer gardens—that welcomes everyone, whether hipsters in skinny jeans on fixie bikes or old men sporting socks and sandals (Birks, of course), or, even better, dapper gentleman with elaborate Kaiserstyle whiskers. I see both en route from the airport, riding through a surreal cityscape that seems laden with layer upon layer of history. Here a converted brick warehouse riddled with pockmarks from machine-gun fire, there the glittering glass dome of the Hauptbahnhof, the new main train station. The city is still revitalizing, growing anew, recovering its former glory. And former East Berlin feels like the beating heart of all this. I stay in a new, modern boutique hotel that’s steps from an old, bustling market and the aboveground train and trams. The trams are a telltale sign of

the east side (along with the iconic and beloved ampelmann pedestrian signal) because the west invested in an underground system while the city was split. Walking the streets, I try to look down as much as up. Below are the Stolpersteines or “stumbling stones” that commemorate the Jews of Berlin who were deported and died in concentration camps. Only 10% of the 55,000 who were killed are represented, another sad layer to a city where Jewish life was once intertwined with all Berliners—there was never a Jewish ghetto here. Looking up I see a row house that’s been partially destroyed, its exposed side left raw with the names of families that once lived there. Everywhere are such rents in the fabric of this city: the bullet holes, the Stolpersteine, the remnants of the Wall. I walk among the maze of the Holocaust Memorial, getting lost in my steps and thoughts. Nearby is the Brandenburg Gate, which for years was in no-man’s land behind the Wall, but now teems with tourists taking selfies. On the other side of the river, itself once part of the east-west border, is the longest still-standing portion of the Wall, the East Side Gallery, reborn as

an artist’s mecca with canvas after canvas. It’s as if everything has been reimagined with an upbeat spin. Another section of no-man’s land or the “death zone,” as it was known, is now Mauer Park (Wall Park), filled with joggers, dogwalkers, cyclists, picnicking families, buskers, curry-wurst vendors, pop-up beer gardens and young men using the once-divisive Wall as a blank slate for vibrant graffiti. I sit and watch, mesmerized by the life that’s taken over in this oncedesolate space. I take a bike tour with two young Berliners, who were only kids when the Wall came down, yet share stories of how their families were affected. The Wall has been gone for 25 years, after being up for 28, and its power is still felt. But it’s superseded by joy. At an old dance hall, still in its original building dating from 1895, I sip a local Schultheiss pilsner and watch ballroom dance lessons in which old and young twirl together. Just like the past and present that swirl simultaneously through the streets. — B. Sligl For more on Berlin, go to visitberlin.de/en.

Fall 2015 Just For Canadian doctors

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Fall 2015 issue

604 - 681 - 0456 Ethical Dilemmas, Pediatric Concerns, Depth of

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Just For Canadian doctors Fall 2015

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

beleaguered benzodiazepines Are benzodiazepines unnecessarily vilified?

seeing with monotonous regularity. Much can, I think, be attributed to information overload and hyperbole via the media. Many vulnerable people do not need to be reminded of climatic catastrophes due to global warming, the plunging price of oil and the sinking Canadian dollar every hour, and even every half hour, on the radio. Worse still, nonstop visual media with unnecessarily graphic depictions. There is nothing that the average listener can do about these situations; this leads to an overwhelming sense of helplessness and thence to chronic, distressing and often disabling anxiety. There are several treatment options for GAD that are not necessarily mutually exclusive. Cognitive (behavioural) therapy is one. Trials prove that it is effective. In fact,

n my new semiretired status I have more time for reading. One recurring subject is benzodiazepines—mostly their overuse, their dangers and their general undesirability. I am going to defend this beleaguered group of medications. I am sure that this will be controversial and I hope to get some feedback (drpeng.ca). I believe that some of the bad press for benzodiazepines comes from the inappropriate use of the stronger of this group’s use as a regular hypnotic. (I have a handout concerning mostly nonpharmaceutical treatment of insomnia that I have used with success for many years and can be freely plagiarised from my webpage.) In my practice the major use of benzodiazepines is for general anxiety disorder. This is a condition that I am

in the UK the National Health Service is training several hundred therapists. The cost/benefits have yet to be proven. In my experience, it is effective, relatively easy to do and very rewarding to undertake. The problem is that it takes time, and needs to be “topped up” from time to time. For the appropriate patient there are a couple of good self-help CBT resources at moodgym. anu.edu.au and/or livinglifetothefull.com. My blog also has a link to a very useful list of other self-help literature and resources. Pharmacotherapy is effective but at a cost both in dollars and side effects. SSRI antidepressants can control the symptoms of generalized anxiety disorder. The problem is that they are not entirely safe, carry a heavy burden of side effects and usually require a high dose. Venlafaxine, for example, is reported continued on page 28

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as having a serious drug interaction with some beta blockers as a life-threatening increase in the QTc interval. There is also a listed serious serotonin drug interaction with trazodone, as well as the readily available over-the-counter dextromethorphan. The side effects of this group of medications are extensive and include headaches, diaphoresis, insomnia and anorgasmia. It can significantly reduce libido; many of my female patients tell me that they experience a distressing general emotional flattening. They never feel very…anything. Finally there is an unpleasant discontinuation syndrome. Unlike narcotics, this is not life-threatening but it is an unpleasant flulike dizziness. Atypical antipsychotics are occasionally recommended; I think this is a case of a sledgehammer to crack a nut. Side effects of these medications can be serious even in Is it time small doses. to RETHINK Buspirone stands alone in its pharmaceutical group for the cost the treatment of anxiety. It benef i of will be effective occasionally. a too-often Like other medications that affect serotonin it does require misused cautious prescribing. drug? The only other choice for general anxiety disorder is the benzodiazepines. Unlike the antidepressants they begin to work immediately. They have fewer cardiac and serotonin drug interactions, but will potentiate other sedating medications and alcohol. They have little by way of side effects other than sedation, but a major problem is that dependency can develop very quickly. It could be argued that the dependency is a factor of the efficacy—rapid relief of the painful sensation of anxiety. Sudden stopping of the medication can cause prolonged withdrawal symptoms, or is it an exaggerated rebounding of the suppressed anxiety? Either way it is a serious consideration and dose related. Benzodiazepines too act on the GABA receptors, and therefore have much in common with alcohol, including the potential for misuse. It is my experience that very small doses of benzodiazepines (for example alprazolam 0.25 mg ½ b.i.d.) will prove effective in treating free-floating anxiety, especially if combined with small relatively frequent “doses” of cognitive therapy and lifestyle counseling—limiting caffeine, nicotine, alcohol and news broadcasts, while encouraging an aerobic exercise program. So for GAD I have some reluctance prescribing SSRI medications with their pervasive side effects, potential lifethreatening drug interactions and no better efficacy, as against low dose benzodiazepines, even though this latter requires more ongoing physician input, and rigorous monitoring of the dosage especially as the patient ages. Finally, the cost of 30 of the generic brands: alprazolam 0.25 mg is $16.87; venlafaxine 75 mg is $32.85; cipralex 10 mg is $71.60. Case closed? continued from page 27

Just For Canadian doctors Fall 2015

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Richmond, BC — Family Physician Recruitment January 2017 Our colleague will be leaving her busy practice which is a part of our group family practice in the south-east of Richmond BC (juncture of Richmond, Ladner and Tsawwassen), with easy highway access. We require a family physician who must be comfortable with good primary care, women’s health and EMR skills. Fast paced, friendly environment, supportive staff, 3–5 working days, competitive split. Seeking a long term associate to take over a built up longitudinal care practice with some walk in component. www.mydoctor.ca/ drsinghal CPSBC Provisional Licensure Applicants from IMGs also encouraged to apply. For information please contact office number: (604)-448-9595 or email: msinghalmd@gmail.com Richmond, BC — Cosmetic/Aesthetic Dermatology Wishing Lasers We are interested in sublease of Dermatology Lasers as demand for such services grow. Our practice is located in the south-east of Richmond BC (juncture of Richmond, Ladner and Tsawwassen) with easy highway access. We are seeking to sublease with potential to buy or lease takeover of Dermatology Lasers for Cosmetic/ Aesthetic Dermatology. We recognize there are quite a few physicians who have leased or purchased lasers which are being underutilized and would wish a symbiotic agreement in using the Lasers for private patients. www.mydoctor.ca/drsinghal For enquiries please contact office number: (604)-448-9595 or email: msinghalmd@gmail.com Fall 2015 Just For Canadian doctors

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asper National Park in autumn reminds me of college during school break, when campus, suddenly empty and accessible, is shared by only a fortunate few. Of course, in Jasper, the rare woodland caribou, black bears and 51 other mammals don’t follow the academic calendar, but their increased visibility suggests that they too are pleased with the extra room. But better wildlife viewing is just one of myriad reasons to visit the Rockies in fall. The Athabasca River Loop traces Jasper’s main tributary for almost 23 km, occasionally

Just For Canadian doctors Fall 2015

dipping into forest, but mostly gliding beside the glacially fed artery that bears a teal colour I’d expect to see in a Bahamian dive hole. I borrow a mountain bike from Jasper Park Lodge to see where the trail will take me, tucking my map and cares away, not concerned with pedaling exactitude. Jasper’s mountain bike network grows annually, documented in the ever-expanding Jasper National Park Mountain Biking Guide. The Jasper Park Cycling Association regularly upkeeps trails and tracks. The Wildland Trails feed the advanced rider, but today I’m in the valley, turning upon the Maligne Canyon ride, a trail that can bloat with hikers during peak season yet contains nary a pedestrian

in early October. And the sun remains warm enough to justify a dive into the waiting pools. Not every fall day reflects summer here, autumn being the most fickle of seasons in the alpine. A thousand metres above sea level, a swim-worthy afternoon may be chased by afternoon clouds that build with symphonic crescendo, furious kettle drums portending a cacophony of rain, even hail, followed by a dusting (or more!) of snow the next morning. This concerto of weather embellishes Jasper’s wildness. Given that, it’s essential to be prepared with all-weather gear (think bathing suit and raincoat), even if a crisp, sunny climate dominates the barom-

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country star gazing, wildlife viewing, and even cliff jumping by crai S. bower

The celestial showcase over Jasper, as seen from Old Fort Point.

eter in autumn. I turn off River Trail onto Lac Beauvert Trail where I pedal alongside my late-afternoon destination, the Jasper Park Lodge Golf Club, a Stanley Thompson design that ranks among the premier resort courses in Canada. Narrow fairways crowded by stout conifers—and a number-one handicap on the 427-year eighth hole—more than compensate for the relatively short 6,663-yard layout. Yellowed aspen leaves settle across landing areas. A young bull elk and his harem occupy the 11th greenside bunker and fringe, leading the marshal to advise we forfeit our balls and play through. Like many bogeygolf amateurs, I’m a great 12-hole golfer, but

my concentration (and putts!) start to lag at around the three-hour mark. Unfortunately, the Jasper Lodge course hardly forgives wayward thoughts (or shots!), as Lac Beauvert comes into play from the 14th to 16th holes. The same high altitude that boosts my drive with a few yards also dictates this sylvan 18 must close after the first October weekend. Ignoring my scorecard (as per usual), I stand in the building breeze at the home hole green and survey Thompson’s masterstroke, just as the golden light breaks from the tree shadows to play hide-and-seek upon the fairway. The waning sun finally concedes to Excelsior Mountain, suggesting I add a fleece

layer and slip onto the Emerald Lounge terrace with a Scottish Style Heavy Ale from Calgary’s Big Rock Brewery in hand. National park lodges are a treasure and I consider Jasper Park Lodge, JPL in local parlance, to be the apotheosis of the species, not just in Canada, but all of North America. Most park resorts feature broad picture windows and easily accessed trails amid a general understanding that, even in a five-diamond property, nature remains the premier amenity. JPL goes further, placing a series of floating decks along the Lac Beauvert shoreline, an ideal perch to share a bottle of Okanagan wine over whispered conversation as sun

Fall 2015 Just For Canadian doctors

travel at home and moon step quietly across Mount Edith Cavell. Much later, elk imitate the human inhabitants, bedding down among the scattered cabins, their breath hovering like the last remaining fireflies in the night air. JPL also stands clear from its peers with dining options. I save my red-meat moments for Alberta, and the Moose Nook’s five-course Chef’s Table menu doesn’t disappoint, especially the DISCOVER autumn six-ounce bison tenderloin. More in the Rockies at Jasper National Park; pc.gc. surprising are the other fine ca/eng/pn-np/ab/jasper/index.aspx. CYCLE the expansive trail network via the Jasper Park Cycling dining options, ORSO Trattoria Association; Jasperparkcycling.com. STAY at one of and especially Oka Sushi. Like North America’s cherished national park lodges, the its brethren, the Banff Springs, Fairmont Jasper Park Lodge; fairmont.com/jasper. JPL knocks this Seattle-based PLAY a round of golf at Fairmont Jasper Park Lodge west coaster out with the Golf Club; fairmont.com/jasper/golf. WATCH the stars quality of Oka’s sashimi and during the Jasper Dark Sky Festival; jasperdarksky. sushi. travel. Find the best VIEW at Brewster Glacier But there is life beyond JPL. Skywalk; brewster.ca. MORE Travel Alberta Tourism; travelalberta.ca AND Jasper And I never come to Jasper and Tourism; jasper.travel. not spend plenty of downtime in the village itself. Recently renovated, Syrahs of Jasper offers a great wine list and game-oriented menu, including Alberta elk tenderloin and a BC sturgeon filet. The Olive Bistro & Lounge focuses on Mediterranean tapas, keeps its late dinner menu going all year, and often brings in outstanding western musicians on weekends. Standing outside on an autumn night confirms another, lesser known, Jasper landmark, the second largest Dark Sky Preserve in the world. Founded in 1999 by Ontario’s Torrance Barrens to raise awareness about growing light pollution in otherwise pristine environments, the International Dark Sky Association joined the Royal Astronomical Society of Canada to designate Jasper’s status High jump into mountain in 2011. waters or “dusting off” Set over October weekends, Jasper’s Dark after a mountain bike ride through Maligne Canyon. Sky Festival celebrates the celestial showcase glowing above the park’s 11,000 km2. The event features keynotes by astral celebs like the “singing astronaut,” Colonel Chris Hadfield, a Symphony Under the Stars and, my favourite, a two-day night sky photography workshop. Naturally, there are plenty of hosted star, aurora borealis and glacier-bymoonlight gazing opportunities. Most evening sky-watching gatherings are held on the year-old Brewster Glacier Skywalk, a stunning perspective at any time of the day—or night. Jasper shines all year, every day glimmering with seasonal discoveries. But then autumn delivers four species of ungulates on the move and bear cubs tumbling a little farther from their watchful mothers. Whether tracking wildlife, launching a stellar drive into thin air, star gazing, biking and hiking through more than 650 kilometres of trail, or jumping into the waters of Maligne Canyon, the sky really is the limit in Jasper.

A star trails photograph of Jasper’s Dark Sky Preserve. Daytime astrophotography at the Jasper Dark Sky Festival.

JPL has paddleboats, SUPs, kayaks and canoes throughout fall on Lac Beauvert. Jasper National Park is a wildlife-viewing mecca. Here, where cubs roam, sows, like this roadside mom, are sure to follow.

Just For Canadian doctors Fall 2015

from top: bluepeak travel photography; jeff bartlett; crai s. bower (3)

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3. Burn More Calories This shouldn’t come as a surprise: you’ll burn more calories with an active work style than a sedentary one. Even if you exercise regularly, sitting for eight or more hours a day can negatively affect your health. Multiple studies have found that some health benefits of regular exercise are cancelled out by prolonged periods of sitting and inactivity.

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5. Look & Feel Good Standing will strengthen the large skeletal muscles in the legs, back and trunk required for upright movement, resulting in you appearing taller and more confident. But it doesn’t stop there: A CDC* study on sit/stand workstations reported that standing increased overall feelings of health and happiness, decreased stress and more.

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2. Reduce Pain If you work in an office, you are probably more than familiar with the ubiquity of back and neck pain complaints. Extended sitting causes a vicious cycle of pain, weakening postural muscles causing residual strain elsewhere in the body. Standing, or active sitting, can break the cycle of inactivity by introducing movement.

4. Be Heart Smart Studies continually show that extended sitting-time throughout your day can significantly increase risk of cardiovascular events, including strokes. Try limiting your inactive time at work, choosing to stand when you need to be alert and focused, and active sitting (which allows your pelvis, hips and legs to move) when you need a break.

1. Wake Up! Sitting slows down the central nervous system because it is a naturally “relaxed” state. The body is left dormant, forcing the brain to work overtime. Standing up increases blood flow, putting the body into a functional state. Do this while working and your mind and body can operate together.

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* Reducing Occupational Sitting Time and Improving Worker Health: The Take-a-Stand Project. CDC, 2011

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Fall 2015 Just For Canadian doctors

norah rogers seems to do it all—from transforming grand heritage buildings into charming inns in pretty-asa-picture Prince Edward County (see page 6) to dealing with the daily grind of running a medical practice. And yet she doesn’t have an email address. This Renaissance woman in the 21st century would rather enjoy a fine meal and watch Pride and Prejudice than peruse social media. How refreshing. My name: I am professionally Dr. Norah Connell; my married name is Norah Rogers I live, practise in: Picton, Prince Edward County, ON My training: Queen’s University, CFPC Why I was drawn to medicine: My father’s and mother’s free thinking crossed boundaries still present even when I was a teenager. They had faith in my potential and somehow knew medicine was the

in hospital was a newborn and my oldest was 100! My last trip: A wine tour in Ireland with “Billy’s Best Bottles” (William Munnelly and Kato Wake—great hosts!). It was outstanding: interesting, fun and different. Most exotic place I’ve been: Venice on the Orient Express. I’ll never forget stepping off the train and gazing at the Grand Canal. Victoria Falls was pretty amazing too!

farm when I was a child. My dad’s turkey and all of mother’s wonderful Christmas dishes, including plum pudding to die for. Memorable restaurant: There are too many to name. One that stands out is the hotel/restaurant La Chèvre d’Or in the village of Eze in Provence with its stunning views of the French Riviera and 40 cheeses on the trolley. Of course, two others are Amelia’s at The Waring House Inn

Barbados. Can’t believe I’ve never been to: Galapagos Islands Dream vacation: A cruise around the world If I could travel to any time, I’d: Probably stay where I am if I was smart. Too many provisos in other eras (who you were, what sex you were, what your health was like, where you lived, what war was around the corner, who was head of state, what your religion was, etc., etc., etc.)

Favourite city: Quebec City

a singer or instrumentalist

Favourite film: Pride and Prejudice with Kiera Knightley, Matthew Macfadyen, Donald Sutherland—amazing direction, acting, cinematography, musical score, amazing period

A big challenge I’ve faced: Fitting everything in, making it work—”it” being my practice, my marriage (with an amazingly supportive husband), our businesses, our community involvements, our families, our downtime getting older and having less energy

Favourite band/ orchestra: The Beatles, St. Martinin-the-Field My first job: Dressing turkey and gardening for my dad. My first job in medicine was an ER physician in Kingston Gadget or gear I could not do without: My tool box; my stethoscope

The village of Eze, home of La Chèvre d’Or and the site of a most memorable meal.

I’d describe my home as: Lived in and loved Last purchase: Fresh corn on the cob for The Waring House (today) Last splurge: Dinner at a two-star Michelin restaurant in Dublin

The doctor’s off-call project: The Claramount Inn.

Dr. Norah Connell (Rogers) in the parlour of the country inn she restored, The Waring House.

career for me even before I did. I love my profession and I’m so glad I chose family medicine in a rural community. I always remember one day when my youngest patient

My guilty pleasure: Time completely off

Best souvenir: Pressed flower I picked from the abandoned home of my forbearers in Ireland Best meal: Christmas dinner at our family

Just For Canadian doctors Fall 2015

and Clara’s at the Claramount Inn and Spa in Picton! “Wow” hotel: Hard to choose! Hôtel Welcome in Villefranche-surMer, Provence, or The Colony Club,

I’d want this if stranded on a desert island: My husband My jet lag cure: Take the morning flight to London and arrive on time for a late dinner and go to bed.

My secret to relaxing and relieving tension: Music, a holiday with my husband and family, reading

I always travel with: My husband

I talent I wish I had: A significant musical ability as

One thing I’d change about myself: Sometimes I am a procrastinator. I am often late because I try to fit too many things in The word that best describes me: Late? I’d rather say “caring” My motto: By the inch, life’s a cinch A cause close to my heart: The fight against wind turbines and the preservation of rural self determination (and that definitely does not mean I am not for green energy). Also the education and equality of women in the world. The future of the world depends on it. If I wasn’t a doctor, I’d be: Retired!! My husband and I have really enjoyed the challenges and demands for creativity that our businesses have presented. If I weren’t a physician, I’d be full-time in hospitality and retail

photo of Norah Rogers: diana BAllon; bottom photo: claramount inn and spa; top photo: La Chèvre d’Or

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