Just For Canadian Doctors Winter 2019 by Just For Canadian Doctors

winter 2019

life + leisure

DOCTORS

east to

newfoundland

south to

Argentina

Din e on th e e d g e a t Fog o

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inside: Continuing medical Education Calendar where will you meet? b u e n o s a i r e s / c i n c i n n at i / m รก l ag a / taos

/ s e yc h el l es >>

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DOCTORS life + leisure

contents

winter 2019

Publisher Linh T. Huynh

Editor Barb Sligl

Art Direction BSS Creative Contributing Editor Janet Gyenes

Editorial Assistant Adam Flint Contributors Ann Britton Campbell Michael DeFreitas Janet Gyenes Lisa Kadane Dr. Chris Pengilly Manfred Purtzki Dr. Kellen Silverthorn Barb Sligl Roberta Staley Cover photo Fogo Island Inn

13 24

Senior Account Executive Monique Nguyen

Account Executive Wing-Yee Kwong Production Manager Ninh 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

clockwise, from top left: Janet Gyenes; barb sligl (2)

Just For Canadian Doctors is published four times a year by Jamieson-Quinn Holdings Ltd. dba In Print Publications and distributed to Canadian doctors. 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. In Print Publications 200 – 896 Cambie Street Vancouver, BC V6B 2P6 Canada www.justforcanadiandoctors.com Printed in Canada.

FEATURES

13 Deep south in Argentina on horseback 24 Far east in Canada to Newfoundland’s outer edge COLUMNS

DEPARTMENTS

9 photo prescription

5 Winter mix 17 CME calendar 29 sudoku

The wow of Yellowstone

11 pay it forward A flying physician for MSF

12 motoring

A fe a s for th et se n se s

You say you want a revolution… but is it green?

16 the thirsty doctor Brown spirits are being embraced by Canadian distillers

28 the wealthy doctor

Incorporate and retire early

30 doctor on a soapbox

Be stem-cell savvy

cover photo The dining room at the now-worldfamous Fogo Island Inn, which has spurred a kind of renaissance in northeast Newfoundland (page 24).

Winter 2019 Just For Canadian doctors

from the editor

Cast a spell

gauchos leaves our writer enchanted (page 13). Knife-wielding, parrilla-cooking, bushwhacking gauchos lead the way on an adventure under what’s known as “a little bit of the hidden sky.” Sign me up. Argentina’s spell continues on the streets of Buenos Aires, where another the kind of vibrancy and colour is found enchanted in murals and public art (page 17). Or, under a starry sky on salt flats thousands of kilometres to the north, there’s a desert oasis in Death Valley (page 5). After the excitement of all that travel, there’s the comfort of home…and giving back. Share good fortune with thoughtful gifts (page 7)…and then travel again, which may be the greatest gift to give yourself.

isle

Any ideas, comments or questions? Reach us at feedback@InPrintPublications.com.

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barb sligl

ometimes you travel to a place and don’t want to leave. And if you do have to leave, you know you want to go back. You will be back. This is Newfoundland, which, as soon as I left the first time, I planned to return to. I’d travelled to the west coast of the province before (if you haven’t been to Gros Morne National Park or L’Anse aux Meadows, here’s a push), and this time I went northeast, to experience Fogo Island (page 24). This island off an island has made the world stage with numerous tourism, architecture and best-hotel awards since the Fogo Island Inn opened five years ago. And the joy and pride in showing off their now-famous home is palpable among Fogo-islanders. Similarly, far south in the wilds of Argentina, a horseback adventure with

On Fogo Island in Newfoundland, you’ll meet charming community hosts and see how new architecture reinterprets the old (page 24).

what/when/where > winter

big love in death valley

mix

desert tripping

into the desert

ann britton campbell

here will come a moment on your getaway in Death Valley National Park—while hiking between walls of polished marble or standing on a blinding-white salt flat or floating in a spring-fed pool under ink-black skies awash with stars—when you’ll realize you’re falling in love. Because despite its morbid name, arid landscapes, and well-deserved rep for extreme heat, as park ranger Jess Kavanagh points out, “Death Valley slowly creeps into everyone’s heart.” To kindle that romance, pay attention to three things: the best time to visit (November through April, when temperatures are more moderate), how long to visit (at least one night but, really, make it two or three), and where to stay. >>

White salt flats at Badwater Basin, the lowest point in North America at 85.5 metres below sea level Winter 2019 Just For Canadian doctors

mix

in deep

winter

go + see

desert love story

Falling hard is easy in Death Valley, which woos with some grand gestures

otherworldly

luxurious Inn at Death Valley has completed its multi-million dollar renovation. Opened in 1927, this California Mission-styled retreat offers elegant rooms and brand-new casitas, broad terraces shaded by date palm trees, a fancy restaurant and bar, and a to-die-for swimming pool complete with deck-side stone fireplaces, cabanas, and a spa. The Inn is part of the Oasis at Death Valley, the park’s main tourist complex located near the must-see sights and beside the excellent Furnace Creek Visitor Center. Offerings at the Oasis include the family- and budget-friendly Ranch at Death Valley hotel, restaurants, horse stables and the world’s lowest-elevation golf course (which means, dear golfer, you’re guaranteed the lowest round of your life). A classic Death Valley day begins with a drive south along Badwater Road toward the lowest point in North America—85.5 metres below sea level—at Badwater Basin. Once there, walk out on the shimmering salt flats, then turn and search high on the cliffs for a white sign indicating sea level. Returning north, detour along the dipping, curving and colourful 14.5-km Artist’s Drive. Stop at popular Golden Canyon and take a hike through its otherworldly landscapes. Finish your day at Zabriskie Point where the late-day sun super-soaks the surrounding golden badlands. Other tempting sights—Mesquite Flat sand dunes, Father Crowley Vista Point where fighter jets sometimes streak through the canyon below, the 183-metre-deep Ubehebe Crater, and Mosaic Canyon with its polished marble walls—are widely spread [detour] out over this 1.3-million-hectare Make a side trip to see park so plan accordingly. the “rolling stones” at Be sure to include Dante’s Racetrack Playa, a remote View in that plan. As you stand spot in Death Valley at its extraordinary vantage National Park point— over 1500 metres above the valley, with views that encompass the entirety of this strange and wonderful park—you might find your heart racing. It may be due to the high elevation. Or it might be love. — Ann Britton Campbell

Room with a view at Ashford Castle

Zabriskie Point, with Panamint Range in distance

The Inn at Death Valley at sunset

Mosaic Canyon

Overlooking cloud-dappled Badwater Basin

Mesquite Flat sand dunes

if you go For more on Death Valley National Park: nps.com/deva. Stay at the Inn at Death Valley: oasisatdeathvalley.com. And start in Sin City before cleansing in the desert…the closest airport is Las Vegas McCarran International, 195 km away.

Just For Canadian doctors Winter 2019

fa r Go n d . . . a i n l b e l ow and

clockwise from top: ann britton campbell; national park service; Courtesy of Xanterra Travel Collection; national park service; Courtesy of Xanterra Travel Collection

>> That last decision is easy now that the

thoughtful treats

winter

mix

gifts that give Presents that give pleasure AND pay it forward… A Slice of Home

S 2

! inspire others

Share your experience on social media using the hashtag #HomeForDinner

dinner date

photos, top and right: Ronald McDonald House BC & Yukon

haring a meal with others might seem like a simple act. But for families who need to travel so their children can acquire life-saving medical treatment, it’s a heartfelt gesture. One that brings the comforts of your home to others and gives back to the community. Home for Dinner, an innovative program that supports families of Ronald McDonald House® BC & Yukon, is a community fundraising initiative. Locals can host a meal at their home or a restaurant, extending the precious moments of spending time together gathered around a to families who are sure to be newfound friends. Getting involved is easy. Many families give table who host a Home for Dinner meal invite friends and neighbours (ask them to make a donation + get instead of bringing a bottle of wine!) to share this opportunity to slow down our busy lives and take time to cherish those around us. (Volunteers can also sign up to cook a meal for families staying at any Ronald McDonald House.) “There is such comfort in sharing a meal with loved ones at the end of the day,” says Richard Pass, CEO of Ronald McDonald House BC & Yukon. “Families staying at the House are focused on ensuring their children receive crucial medical treatment, and often do not have the resources to engage in this powerful tradition.” A 73-bedroom house on the property of BC Children’s Hospital in Vancouver owned and run by the Children’s Family House Society of BC provides accommodation and resources for up to 2,000 families each year. Here, kids undergoing medical treatment get to be kids, play with Lego, do arts and crafts, or explore the magic room. Nationwide, Ronald McDonald Canada’s Fun Matters program takes play to a new level transforming events you organize (games, baking, photography; whatever your kids enjoy!) using a convenient online app into a “FUNdraiser.” Donations pledged help families stay at one of the 15 Ronald McDonald Houses across Canada while their child is getting treatment at a hospital nearby. For more information, go to: rmhbc.ca/homefor-dinner or rmhccanada.ca. — Janet Gyenes

1 one grid A candle that really lights things up: each one sold buys a solar-light for someone without electricity in the developing world. onegridcandle.com 2 Yoobi For every Yoobi school supply purchased at Indigo, one is donated to a classroom in Canada (in partnership with the Indigo Love of Reading Foundation; indigo.ca). yoobi.com 3 FEED One bag equals school meals for one child for one year. That’s some excellent math. feedprojects.com 4 raising the roof A toque that not only keeps your head warm—it helps raise a roof over the heads of the homeless. raisingtheroof.org 5 Awe This jewelry line donates 20% of every sale to the affiliated charity of your choice, from cancer research to mental health. aweinspired.com — Barb Sligl Winter 2019 Just For Canadian doctors

Merle L. Diamond, M.D., Course Director

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.

Yellowstone wow

destination photography

The National Park of yellowstone offers wild beauty from rutting elk to steaming geysers

Dramatic peaks, lakes, wildlife, geysers…all in America’s number-one National Park

natural drama

michael defreitas

he eastern sky was just starting to brighten as I set up my tripod on the frosty ground, making sure I avoided breathing on my camera and lens in the cold morning air. Old Faithful Geyser is the park’s most photographed attraction, so trying to photograph it differently is always a challenge. My hope was to backlight the steamy icon with a beautiful September morning sun. A low fence prevents visitors and rambunctious photographers from getting too close to the geyser so I had to use my 70–200mm telephoto zoom. Late September is a great time to visit Yellowstone. Most tourists have left, the trees are starting to show colour and the animals are getting ready for the winter. I snapped a few frames as the eastern sky brightened, but they looked pretty average, so I decided to wait for the sun to peak above the hill behind the geyser. I selected 1/400 of a second shutter speed and dialed in +1 of exposure compensation. Exposing for the sun renders everything else underexposed, so you have to manually dial in a bit of overexposure to help light the foreground aspects. A couple of small forest fires were still burning in the park and provided enough particulate in the sky to render the morning sun a bright orange. As I started shooting, the wind changed direction and the steam was no longer backlit. I quickly shifted position and fired off a few frames before the swirling wind made me shift position again. Luckily, I managed to get the shots I wanted before the sun got too high to properly backlight the steam. Pumped with my success at Old Faithful I quickly loaded my equipment into the car and moved on to a small lake on Yellowstone’s border with nearby Grand Teton National Park. I had scouted the lake the day before and wanted to get back there before the wind picked up and rippled the lake’s surface too much for a nice reflection image of the surrounding peaks. Great reflection shots need a low sun that lights the front of the subject. If the sun is too high it produces too much glare off the water for a good reflection. The photo gods were with me that morning. The angle of the sun was perfect,

Scale and perspective is always a concern when shooting geysers or basins. Sometimes the answer is to zoom in (left). Without a person or animal in the frame to add scale, most images will lack impact. While shooting the Norris Geyser Basin I waited for some people to cross the boardwalk to add scale and included a few trees in the foreground to provide more depth to the image (top). A medium telephoto lens in the 60–80mm range works best.

if you go

For more info on Yellowstone National Park: nps.gov/yell

Winter 2019 Just For Canadian doctors

there was little or no wind and the sky was clear of the smoky haze from the fires. With my 24–70mm medium telephoto lens set at 60mm, I snapped a series of pics at 1/160 second and f10.

Just as I started to pack up, a flock of Canada geese touched down on the lake nearby. I pleaded with the photo gods to make the geese swim across the lake’s mirror-like surface between the mountains and me. The geese were not cooperating,

so after 20 minutes, with the sun getting high and the wind picking up, I again began to pack up. With my tripod on my shoulder, I walked to the car, glancing back to make sure I wasn’t missing anything. Almost at the car I took one last look. Just then the geese changed direction to swim to where I was setup. I dashed back to my spot hoping the gods weren’t just teasing me. Conditions were not perfect, but I managed to get off a few shots while thanking the photo gods. The second-most photographed subject in the park is Lower Yellowstone Falls. Since the falls are located in a deep, narrow gorge, the trick is to shoot them between 11am and 1pm to avoid shadows crossing the falls. Another option is to beg those photo gods for a high-overcast day. The diffused light reduces shadows while providing enough sunlight to add sparkle to the white cascade. There are three overlooks along the south-side gorge road so pick the

Just For Canadian doctors Winter 2019

one that offers the best framing given the available light. On my overcast day I elected to shoot from the middle overlook and use a 70–200mm lens set at 170mm. I used a tripod and 1/250 second shutter speed. Early fall is a great time to photograph wildlife; most animals are focused on fattening up for winter and less finicky and easier to approach. Bull elk are the exception. Armed with deadly antlers, fall is rutting season, so be carefu. During the rut, elk are highly territorial and see you as a threat. It’s best to shoot bulls from the safety of a car (also allows you to get a bit closer). Lenses in the 200–400mm range work best for shooting wildlife at a safe distance. If you’re handholding the camera remember to select a shutter speed of at least 1/500 second. Yellowstone covers about a million hectares, so don’t try to cover everything. Remember that even if animals seem indifferent, their mood can instantly change. Every year dozens of visitors are mauled or gored. And please heed the fencing around the geysers. The white, salt-crusted ground may look solid, but it’s not. Lastly, don’t hesitate to beg the photo gods for help!

michael defreitas

photo prescription [continued]

pay i t f o r w a r d

r o b e r ta s ta l e y

Roberta Staley is a Vancouver-based magazine writer, editor and documentary filmmaker.

High flyer

A flying physician for MSF encounters an onslaught of medical afflictions

courtesy of Dr. Patrick Laflèche

outh Sudan, the world’s youngest nation, is in the grip of a brutal civil war that has plunged the country into a humanitarian crisis, with seven million people in dire need of aid, a growing famine and millions of displaced persons, many existing in limbo in refugee camps or tenuously trapped between warring factions. For more than four months, starting last February, Dr. Patrick Laflèche worked in South Sudan’s Unity State as a physician with Médecins Sans Frontières (MSF), or Doctors Without Borders. With the protracted war decimating the country’s infrastructure and road system, the country’s sick and injured, as well as mothers-to-be, have been unable to access emergency care. So, medical help went to them. Laflèche became a flying physician for MSF, embarking on excursions with medical teams of nurses, logisticians and pilots into isolated areas via helicopter or a single-engine turboprop Cessna Caravan. It was an odyssey that demanded ingenuity while challenging every skill that Laflèche had developed during his time as a general practitioner in Inuvik, Northwest Territories, undertaking emergency, clinical and obstetrical care for a population of about 10,000. Once Laflèche’s small plane or helicopter arrived at a community, medical care was typically delivered in makeshift tent shelters, allowing him to administer care with some degree of privacy and cleanliness. “Anything that required surgery or prolonged stay or intravenous medications had to be flown out to an MSF hospital,” Laflèche says. Laflèche recalls the myriad afflictions he encountered while in Unity State, which was divided into three separate states by South Sudan’s President Salva Kiir Mayardit a few years ago. “The variety of things was staggering,” says Laflèche. One patient, he recalls, had been shot through the neck yet, somehow, was still standing, the bullet having missed his major vessels while rupturing his oesophagus. “We got him on a plane and the surgeon did a fantastic job putting a feeding tube down. The wound then healed itself.” The repercussions of violence and the collapse of civil society were everywhere.

Laflèche treated delivery complications such Not all his patient relationships were as obstructed labour, including protracted so abbreviated. Laflèche also worked in labours where the fetus had died. He saw an MSF hospital where he oversaw the wounds from spears, gunshot wounds, old care of a boy of about 12 who inexplicably injuries that refused to heal due to infection developed a lesion on his chest. He also had and maiming from sexual violence. There weak legs and difficulty producing urine. were complications from tuberculosis and After X-raying the youngster, the diagnosis malaria, as well as sick, malnourished and of bony tuberculosis was made, allowing dehydrated children with diarrhea. Laflèche to tailor the appropriate treatment Laflèche and his fellow MSF colleagues also suffered from arduous working conditions, which included long hours, crowded sleeping quarters and dehydration from temperatures that soared to 45˚C. Many experienced bouts of gastrointestinal illness and some contracted malaria. Worse, says Laflèche, were the psychological Dr. Patrick effects. “Witnessing the Laflèche with South trauma of patients and Sudanese colleague hearing what they and clinical officer went through I found Joseph Gatdet Yar, who difficult. I also found it successfully helped difficult dealing with treat a boy with death, specifically the tuberculosis death of children.” When he wasn’t flying into isolated areas of Unity State, Laflèche was part of a vaccination campaign to inoculate children against diseases like rubella and measles. Due to the chaos of war, most South Sudanese youngsters had missed their childhood vaccinations, so MSF organized campaigns for thousands of kids. The physicians also vaccinated against polio and that, after a few weeks, saw the boy gain gave the children the anti-parasitic medicaabout 10 kilograms and regain leg strength tion, albendazole, to de-worm them. Not all and bladder function. “He’ll be left with the children were stoic; some fled, terrified, some disability but I’m hopeful we were at the sight of the light-skinned foreigners, able to make a difference for that young boy requiring a foot chase to catch them to and his mother.” administer the vaccines. Laflèche is planning to return to work Another difficulty, says Laflèche, was with MSF in 2019. “It seems natural to me to the transience of the care he gave: he only go to parts of the world where I can make a saw his patients for a short period of time bigger difference and provide the best care when flying into their community. “I don’t I can,” he says. The fact that the patients are know what happened to those people, if my on the other side of the world is immaterial. intervention made a difference, if they were “I conceive of humanity as one big whole, able to keep getting the care they needed. with people having the same fundamental It gives you a sense of helplessness not beneeds, desires, troubles, but in different ing able to have control over the outcomes degrees. Our common humanity transcends of your patient.” all barriers of culture or language.” Winter 2019 Just For Canadian doctors

motoring

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

You say you want a revolution

ortland, Oregon, hosts the top “green car” event for journalists each year. And the latest 2018 Drive Revolution has take-away points that will depend on one’s perspective—from doomsday to piein-the-sky. For the pessimist, it’s now 20 years since the first Prius hybrid, 12 years since the Volt plug-in hybrid concept was announced, and six years since the Tesla Model S full-electric sedan debut. Yet the market penetration for green vehicles hasn’t really budged from negligible—still just 1% battery electrics and 3–5% hybrids.

Unless you’re a green optimist. But even then it takes some twisted thinking, because what we really need to start a true revolution is quick-time doubling in the cost of gasoline. War or civil unrest in oil-producing regions could make that happen, although neither Venezuela’s implosion nor Iran’s blacklisting has. Russia could do something so heinous that their oil production is shut out of the world’s oil market, but China is unlikely to abide by those sentiments. Or maybe OPEC comes together again over something The Donald says or does. Yet

So, you say you want a revolution…? In fact, geopolitical events are now working against electrification of the fleet. Technologic advancements in oil exploration have pushed “peak oil” into our children’s lifetimes. Trump is keen to roll back vehicle gas mileage requirements and foster cheap energy. When faced with new carbon taxes many Canadians aren’t as sold on action to combat global warming as they once were. And both the US and Canada appear to be past “peak subsidy” on government grants for electric or hybrid car buyers. The market share of these greener vehicles seems set to stay in the doldrums for the foreseeable future. To pessimists, the “Revolution” is taking a smoke break.

even moving the US embassy in Israel to Jerusalem was met with something of a collective yawn. And BIG tax hikes on gasoline just don’t seem politically survivable in this era of populist advances. Looking past the short term with a more slow-and-steady approach, there is cause for mild optimism. Mainstream American/European/Asian manufacturers are making cautious hybrid and electrification forays into new market segments. The 2018 Green Vehicle was awarded to the Chrysler Pacifica Hybrid minivan. Crossovers are seeing more hybrid and full-electric offerings in family-friendly sizes. The new (Dodge) RAM full-size pickup has a mild-hybrid option—critical given

Just For Canadian doctors Winter 2019

the trend of buyers shunning cars in favour of light trucks. A significant sudden breakthrough in battery technology is always possible. China has over 100 companies pursuing electric-car tech. This field has been identified as one of China’s targets for world leadership in its Made in China 2025 Policy. Given that state’s ability to allocate resources and enforce societal change, I wouldn’t bet against the Middle Kingdom—especially in the all-important entry-level products. Europe is also at play. The continent’s love affair with the diesel engine is ending in divorce court over falsified emission claims. European manufacturers need something to shift the public’s attention to happier places. Electrification is their ticket. Tesla will have serious competition from the Europeans over the next few years in the premium electric market. EU cities are major players in this transition, as many are enacting bans on all internal combustion engines from their streets within decades. The unfailing optimists will be heartened by the progress in carbon sequestration. A Canadian outfit is proposing to mine C02 from the air to produce fossil fuel…without the dinosaurs and long wait that the natural stuff required. Try googling “carbon engineering” and read its coverage in Motor Trend or The New Yorker. Progressive building codes around the globe now require car-charger friendly wiring in new-home construction. California even requires all new-home construction to have solar energy capture systems. Hopefully such forward-thinking practices will migrate to your city. My own take is one of disappointment in our elected national and provincial leaders for their lack of decisive and effective policies. Instead, I look to Norway for inspiration. I also have faith that cities will be progressively dictating the agendas. And I still belong to “Fanboys R Us” when it comes to the ingenuity of the worldwide automotive engineering community. Our household will certainly be looking to plugin hybrids for our next family hauler…says this fanboy.

istock

The many shades of green at Drive Revolution

travel the world

the gaucho way

The ultimate Argentina road tripâ&#x20AC;Ś no car required story

+ photography by Janet Gyenes November/December 2018 Just For Canadian dentists

travel the world

he sound of the white stallion’s horseshoes clanging against the river rocks rings out into the canyon like a distress signal as he rears up on his hind legs, muscles rippling. Tati, his rider, pulls on the reins. But the young horse continues to kick and struggle, churning the water into a fury. The scene playing out before me is both folkloric battle of man against beast and modern-day display of a gaucho with true grit. In the 17th century the gauchos in this region fought for independence against the Spanish and won. And with a few more manoeuvres, Tati triumphs too, coaxing the horse through the narrow channel toward a waterfall. My hands tremble as I gently tug on my horse’s reins. “It’s OK, Picaflor,” I whisper and stroke her chestnut mane. Before I nudge her forward, I look back at my fellow riders, Tati’s teenaged daughter and my friend Melissa, whose face clearly says, “What have you gotten us into?” Our original travel plans had taken a detour. We had sketched out the ultimate Argentina road trip: driving high-altitude roads snaking through the foothills of the Andes in the northern province of Salta, bordering Bolivia, Paraguay and Chile. We’d traverse lonely landscapes inhabited by little more than skittish vicuñas and cartoonish cardon cactuses, with their century-old arms outstretched like a gang of giants gesturing in the oxygen-deprived air. But when my guidebook advised only to rent a car if you’re skilled at fixing the inevitable mechanical issues, we charted a different course—by horse—to spend a couple of days riding with gauchos, the archetypes of Argentina. Sayta Estancia sprawls alongside a dusty road in Chicoana, a traditional agricultural village backdropped by a spine of mountain ridges. Located 35 km from Salta city, the province’s colonial capital, Chicoana’s name comes from the Quechuan language and translates to “A little bit of the hidden sky.” Enrique, a silvery-haired fellow with a mischievous glint in his eyes, welcomes us. For more than two decades he has owned and operated this ranch, which is surrounded by trees bearing avocados, limes and oranges. “They’re all organic,” says Andreas, a horseman who’d lived in Los Angeles for two decades before returning to the gaucho way of life in Argentina. “Lunch first, then riding,” he announces after showing us to the casita where we spend our first night. Then we join him, Enrique and Sergio, another horseman, in a screened room at a long table laid with round wooden plates and bottles of organic red wine made by Benedictine monks. Enrique regales us with jokes in Spanish and scraps of English as we pile our plates with a salad of blood-red

Just For Canadian doctors Winter 2019

tomatoes and onions; earthy lentils and white beans; hunks of crusty bread; and the classic Argentinian chimichurri sauce. White shirt sleeves rolled up to his elbows, Mario, the asador, deposits chubby handmade sausages and slabs of tender beef onto our plates, then continues to offer us new cuts of meat as we eat. And so it goes. Rounds of meat, refills of red wine and conversation flowing. All is deliciously satisfying. The asado isn’t just a traditional Argentinian barbecue where meat is cooked on a parrilla, or grill, over wood coals. It’s soul and sustenance. A celebration of culture, community and reverence for the land that’s hardwired into the country’s collective DNA. Eventually we saddle up for a late-afternoon ride, soon crossing a shallow riverbed. I spot a dead horse. Not a skeleton, but a freshly spent carcass in repose, bathed in long shadows from the low autumn sun. I naively wonder out loud why the poor animal hasn’t been buried. Andreas explains matter-of-factly that it would be one big hole to dig. “Tomorrow,” he says, as if to change the subject, “Tati will take you into the mountains camping.” Nevertheless, the image of the motionless horse burns hot in my mind, like the mournful beauty of a still life painting. A man without a horse was a man without legs. In his memoir, Far Away and Long Ago, naturalist William Henry Hudson mythologizes this credo from the gauchos he grew up around in Argentina. Tati is the embodiment of that conviction. He’s dressed in traditional gaucho garb: loose trousers—bombachas—stuffed into leather boots, a scarf, beret and a knife called a facón tucked into his woven fabric belt. After a breakfast that includes biscuits slathered with dolce de leche, I watch the men outfit our horses. Six others arrive for our ride to the mountains; after lunch they’ll return to the estancia. Our group hits the road and the horses settle into a steady pace, passing fields of corn, chia, quinoa and leggy yellowand-black sunflowers saluting the azure sky. We ride a path skirting whitewashed brick buildings. There’s no activity here today, but Sergio says these structures are used for drying tobacco leaves. Almost three hours later, we arrive at our camping spot. Cows graze next to a stream framed by prickly pear cactuses. Chickens, sheep and a billy goat are corralled in pens. Showy roosters raise a raucous. Under a corrugated metal roof is a primitive cocina composed of stone blocks supporting a parrilla crowded with a gaucho’s feast of beef and whole chickens garnished with lemon halves. An old man with skin the colour of burnt caramel and hands like clubs stirs papas boiling in a cast-iron pot. “Dónde está el baño?” I ask Andreas, already suspecting his answer. “En naturaleza!” he says with a deep belly laugh, gesturing

travel the world Sergio in the tack room at Sayta Estancia, a ranch in the agricultural village of Chicoana previous page Tati leads the way. In the 17th century, gauchos battled the Spanish near here this page, top row from left Enrique, the owner of Sayta Estancia, next to the parrilla; Tati, dressed in traditional gaucho gear middle row from left Organic mandarin orange; lunch, gaucho-style (with tablecloth!) bottom row from left Traversing the mountainside; saddles, bridles and blankets ready for riding

opposite page

at the surrounding woods. “Anywhere you want.” Wild animals? “Pumas,” he replies. “Watch out for the pumas.” Still stuffed from lunch, we haul ourselves back onto our horses. They climb up the mountain trail, clambering for footholds. Tree limbs claw at me like wild animals, leaving tiny trails of blood on my hands and forearms. I duck down in my saddle to avoid getting a branch in the eye and bang my knee on a tree trunk instead. My battle scars feel well-earned when we reach the mountain’s 600-metre summit and Chicoana’s hidden sky appears. We dismount and stare in awe at the pleated green mountains and views of Salta in the distance before riding back to the camp. Tati and his daughter pitch our tents and place the padding and blankets from beneath our horses’ saddles inside as cushioning. Blackness cloaks the camp. Tati cooks our dinner in the dark, expertly making locro, a thick and delicious stew that’s ready hours later. One knife. One pot. One fire. Above us, a blanket of a billion stars flickering in the night. After eating, Tati pulls out his smartphone and shows us video after video of his friends—fellow gauchos— performing loco rodeo-style stunts on horseback and being tossed like rag dolls. It’s like a guts and glory bedtime story. We sleep like the dead. The roosters rouse us at dawn, cajoling us to get up for one last ride. Today Tati takes us on a different route up the mountain. After a few minutes of riding he wordlessly slows to a stop. The untamed forest has reclaimed the trail. In true gaucho form, Tati pulls out a machete and dispatches an army of branches. We forge ahead until it’s time to fight the forest again. It’s slow-going but that’s life here. No path? Make one. Hungry? Build a fire and cook. It’s the gaucho way. Not just a state of mind, but being at one with the land, no car required.

if you go

To ride with gauchos at Sayta Estancia check out saltacabalgatas.com.ar/ eng and for more about exploring Argentina go to welcomeargentina.com.

the thirsty doctor lisa kadane Lisa Kadane is a newspaper and magazine writer who likes to travel and partake in the destination’s preferred tipple, whether it’s rum, wine, a margarita or whisky sour. She’s been sharing her thoughts on spirits and cocktails since 2010.

Whisky business

Canadian distillers are getting into this popular brown spirit

[whisky] cocktail*

Maple BRBN Sour

2 oz Okanagan Spirits BRBN 1 oz fresh lemon juice 3/4 oz real maple syrup 1/2 egg white 1 mL chocolate bitters

1 BRBN Okanagan Spirits Craft Distillery, Okanagan Valley, BC Bourbon can only be called bourbon if it’s produced in the United States, which is why Okanagan Spirits cleverly calls its version, BRBN. And while Kentucky distillers typically blend their corn-weighted mash bill with wheat, the Vernon-based distillery makes up the difference with malted barley. The result is a smooth and slightly sweet spirit, with a full-bodied nuttiness from the barley, along with caramel notes and a touch of wood from being aged in barrel for three years. “It was a challenge to see if we could do a bourbon-style whisky that was terroirspecific,” says Okanagan Spirits CEO Tyler Dyck, noting the corn and barley are grown locally in the Okanagan. The distillery also wanted to round out its whisky portfolio, and with the sweeter profile, BRBN is more approachable than their rye or single malt. “It’s a gateway whisky,” says Dyck. BRBN still holds its own in a snifter, but it’s best shaken into a seasonal cocktail such as the Maple BRBN Sour (see recipe). okanaganspirits.com 2 The White Rye

Combine ingredients in a Boston shaker with ice, shake vigorously, and then fine strain into a cocktail glass and garnish with fresh-grated cinnamon.

*Courtesy of Duell Donaldson, Okanagan Spirits Craft Distillery

Just For Canadian doctors Winter 2019

Dillon’s Small Batch Distillers, Beamsville, ON Mezcal, tequila and rum all come in white, un-aged versions, so why not whisky? Purists argue that putting forward a spirit that hasn’t touched wood is the best way to showcase the true flavours of the grain and its terroir. This is definitely the case with Dillon’s The White Rye. Made from 100% rye grown in Brant County, ON, this spirit tempts with a subtle spiciness that’s underpinned by an almost cereal, sweet grassy taste. Like other un-aged spirits, this unadulterated rye is not meant to be consumed solo, says

Whitney Rorison from Dillon’s tasting room. Rather, mix it in cocktails. Use The White Rye as a tequila substitute in a Paloma, or try it in place of vodka in a Moscow Mule. dillons.ca 3 Northern Harvest Rye Crown royal, Gimli, MB This lovely nightcap, made with 90% rye grain, got the world’s attention when whisky aficionado Jim Murray named it World Whisky of the Year for 2016. After three more trips around the sun, Northern Harvest Rye is still smooth and complex, with spicy hits of cloves and cinnamon tied into the oak but not in an overpowering way. In fact, it’s almost un-rye-like in its sweetness. “It’s approachable,” concurs master blender Joanna Scandella. “It’s smooth and complex, with an overall character that is lighter in flavour than other types of whiskies.” Northern Harvest Rye’s universal appeal and good price point make it a go-to for filling whisky decanters for the holidays. Or, stir it into a cold-weather cocktail such as an Old Fashioned. crownroyal.com 4 Single Malt Whisky Eau Claire Distillery, Turner Valley, AB Eau Claire Distillery’s inaugural batch of Single Malt Whisky sold out quickly when it was released last year, and it wasn’t just due to the hype of being Alberta’s first whisky made in the style of Scotland’s finest. The amber fluid, aged three years, was smooth and complex, with fruity notes and a hint of spice that could be sipped deliciously neat or over ice. It drank like a much older single malt. Alberta’s extreme temperature fluctuations work to contract and expand the fluid in-barrel, enabling it to pull more flavours from the ex-bourbon, ex-sherry and new European casks, explains Eau Claire master distiller Caitlin Quinn. Plus, it’s made with the world’s best barley (fact: Alberta grain is shipped to Scotland to make single malt). Whisky connoisseurs can expect the same quality when the second batch of Single Malt Whisky is released midNovember. eauclairedistillery.ca

cocktail photo: courtesy Okanagan Spirits Craft Distillery

hile it’s true I didn’t learn to love scotch until a trip to Scotland opened my taste buds to the smoky wonders of peated whisky, it’s also a fact that my whisky journey began years earlier, with cocktails. A Manhattan here and a whisky sour there, eased me in to a world of darker spirits that warmed me up during Canada’s long winter. Now, I indulge in and appreciate the expanding range of our country’s national spirit—Canadian distillers are making single malts that rival those from Scotland, and bourbon-style spirits that taste as good as Kentucky’s best. At the same time, they’re still leading in the category Canada is known for: rye. Here’s the low-down on a few go-to Canadian whiskies, in time for seasonal gifting or holiday party uplifting. Cheers!

buenos aires / cincinnati / málaga / taos / seychelles … | c a l e n d a r

cMe

A n intern ation a l guide to continuing medical Education

winte r 2019 + beyond

Mural in La Boca barrio memorializing Argentina’s “disappeared”

buenos aires

Botero’s Naked Male Torso The 18-ton Floralis Genérica opens and closes daily

Cementerio de la Recoleta, where famous Argentinians like Eva Perón are buried

On the menu in the colourful ’hood of La Boca

Iconic buenos

aires is bueno indeed

(CME events in Buenos Aires are highlighted in blue.)

janet gyenes

very city has its icons. Places, people and landmarks that reveal its history and culture. The heartbeat of Buenos Aires’ porteños (“people of the port” as locals are called) thumps in its tango halls, parrillas and fútbol clubs—a trifecta of romance, indulgence and rivalry. With 48 neighbourhoods or barrios, this metropolis of three million people is alive and electrifying. But I also want to peer into its past. So I head to the upscale Recoleta barrio and visit the historic Cementerio de la Recoleta. This somnolent city of the dead is home to Argentina’s military heroes and politicians, including Eva “Evita” Perón. It’s surprisingly serene strolling the lanes crowded with 6,000 statues, sarcophagi and crypts. Palms offer shade from the fierce sun. Flowers find footholds in the stone. Cats play hideand-seek under the wings of angels. The sheer scale of some of the city’s sights, however, almost overwhelm. Like the 71.5-metre Obelisco de Buenos Aires erected in 1936. I get a peek of its point on a blistering bus ride down 16-lane Avenida 9 de Julio (the widest on the planet) whose name honours Argentina’s

Independence Day in 1816. At Parque Thays I watch people smirk and smile at Fernando Botero’s Naked Male Torso, a bronze behemoth. But I’m more mesmerized by the work of Argentinian architect Eduardo Catalano in nearby Plaza de las Naciones Unidas. Floralis Genérica is a 23-metre, 18-ton aluminum and stainless-steel flower. Its six outsize petals open daily at 8am, representing “hope reborn” according to Catalano. They close at sunset like a gargantuan Venus flytrap swallowing the sky. During a graffiti tour of the working-class barrios La Boca and Barracas I see a woman’s kerchief stencilled on a wall. It’s not just a cute piece of artwork, explains Sorcha O’Higgins from Graffitimundo. The words above it—La Boca no olvida a sus desaparecidos—pack a punch: The Boca does not forget its disappeared. We pass a jumble of corrugated-metal buildings painted in primary colours, pausing at a mural of fists, faces, names, dates and the words Ni olvido ni perdon. Do not forget or forgive. It’s another reference to Argentina’s Dirty War. From 1976–1983 as many as 30,000 people suspected of opposing the military regime were executed or thrown

off planes in “death flights” over the [more] Rio Plata. In 1977, 14 mothers of these Check out “disappeared,” wearing kerchiefs with turismo.buenosaires.gob.ar/en their children’s names embroidered on the back, silently marched in front of the presidential palace on the Plaza de Mayo. That promise has endured. Families of the missing still march there every Thursday at 3:30pm. Kerchiefs and fists aren’t the only symbols on the streets. In recent years “graphic design [collectives] Dome and Fase decided to create happy characters… as a positive visual antidote,” says O’Higgins. Many murals, products of a recent city-funded graffiti fest, are lively and self-referential. Like a multi-storey man painted by an artist who works in a parilla, says O’Higgins. His shirt is unbuttoned to his naval. Gold medallions are splayed across his chest. And his massive hands are curled, not into fists, but around a knife and fork. They’re slicing another symbolic staple: chorizo sausage. It’s a welcome jolt of optimism in this supercharged South American city. — Janet Gyenes

Winter 2019 Just For Canadian doctors

cMe

calendar

Cardiology

Anesthesia

Alternative Medicine

Aesthetic Medicine

cme when where

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/

topic

sponsor

contact

website

Jan 18-21 2019

Orlando Florida

2019 Orlando Dermatology Aesthetic & Clinical Conference (ODAC)

Creighton University Health Sciences

info@ orlandoderm. org

orlandoderm. org

Feb 02 2019

Portland Oregon

Cosmetic Sclerotherapy Of The Legs Live CME With Hands-On Component

PracticalCME

877-263-1234

practicalcme. com

Feb 09-11 2019

Amsterdam Netherlands

Level 1 Certificate Course In Aesthetic Medicine

American Academy of Aesthetic Medicine

65-93374708

europe aesthetic medicine.com

Apr 18 2019

Bethesda Maryland

Dissecting Spinal Pain Circuits For The Development Of Novel Viral Gene Therapies

Pittsburgh Center for Pain Research University of Pittsburgh School of Medicine

888-644-6226

nccih.nih.gov

Aug 28-29 2019

Rome Italy

9th International Conference On Alternative & Traditional Medicine

Pulsus Events

traditional medicine@ pulsusevents. org

traditionalalternativemedicine.cmesociety.com

Oct 12-16 2019

San Diego California

2019 Academy Of Integrative Health & Medicine Annual Conference

Academy of Integrative Health & Medicine (AIHM)

858-240-9033

aihm.org

Jan 13-18 2019

Vail Colorado

The 9th Annual Winter Symposium In Intensive Care, Anaesthesia And Emergency Medicine

info@ colloquium. com.au

colloquium. com.au

Feb 02-09 2019

Aspen Colorado

new CE to be placed Aspen Anesthesia Seminar

Colloquium

Holiday Seminars

877-859-0550

holiday seminars.com

Feb 17-20 2019

San Diego California

The Society Of Critical Care Medicine 48th Critical Care Congress

Society Of Critical Care Medicine (SCCM)

847-827-6888

sccm.org

May 09-12 2019

Chicago Illinois

Topics In Anesthesia + ACLS/PALS

Northwest Anaesthesia Seminars

800-222-6927

nwas.com

Jan 06-20 2019

Chile & Argentina Cruise

Update On Cardiology, Palliative Care And Primary Care CME Cruise

Sea Courses

800-268-3273

seacourses. com

Jan 15 2019

Cincinnati Ohio

BPD Symposium 2019: Advances In Diagnosis & Management

Cincinnati Children’s Hospital Medical Center

877-881-8479

cincinnati childrens.org

Mar 02-04 2019

Málaga Spain

Acute Cardiovascular Care 2019

European Society of Cardiology

33-4-92-9476-00

escardio.org

May 09-11 2019

Indianapolis Indiana

Weinstein 2019 Cardiovascular Development And Regeneration Conference

Indiana University School of Medicine

888-615-8013

iu.cloud-cme. com

Oct 12-26 2019

Japan, Korea & China Cruise

Essential Topics In Cardiology And Pulmonology: 2019 Update

Continuing Education, Inc./University at Sea

866-456-9464 See Ad Page 31

continuingedu cation.net

Dictation

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Diabetes

Dermatology

cme when where

contact

website

Houston Texas

Melanoma: From Biology To Target

American Association for Cancer Research (AACR)

215-440-9300

aacr.org

May 09-11 2019

Nashville Tennessee

Music City SCALE - 14th Annual Symposium For Cosmetic & Medical Dermatolgy

Tennessee Society for Laser Medicine and Surgery

781-793-0088

tnlasersociety. com

Jun 27-30 2019

Calgary Alberta

CDA 94th Annual Conference

Canadian Dermatology 800-267-3376 Association

dermatology. ca

Oct 03-06 2019

Budenheim Germany

16th International Workshop On Langerhans Cells

Conventus Congressmanagement & Marketing GmbH

9-3641-3116-314

lc2019.de

Feb 23 2019

Scottsdale Arizona

Diabetes Is Primary - Arizona

American Diabetes Association

602-861-4731

professional. diabetes.org

Oct 30Nov 02 2019

Boston Massachusetts

ISPAD 2019 - 45th Annual Conference

International Society for Pediatric and Adolescent Diabetes

49-0-3024603-210

ispad.org

Reston Virginia

Emergency Radiology

American College of Radiology

800-373-2204

acr.org

Feb 16-23 2019

Barbados

Emergency Medicine Review ACT V

877-377-2211

cmetravel.com

Feb 21-24 2019

Phoenix Arizona

Emergency Medicine & Acute Care 2019: A Critical Appraisal

The Center for Medical Education

800-458-4779

courses.ccme. org

Mar 27 2019

Houston Texas

Advanced Emergency Medicine/Next Level Point Of Care Ultrasound

Advanced Health Education Centre

800-239-1361

aheconline. com

Jun 11-22 2019

Northern & Western Europe Cruise

Topics In Critical Care And Pulmonary Medicine: 2019 Update

Continuing Education, Inc./University at Sea

866-456-9464 See Ad Page 31

continuingedu cation.net

Feb 28Mar 03 2019

Vilnius Lithuania

The 6th International Conference On Prehypertension, Hypertension, Metabolic Disorders And Cardiovascular Disease (PreHT 2019)

Paragon Group

41-22-5330 948

prehyper tension.org

Apr 07-09 2019

Los Angeles California

American Association Of Endocrine Surgeons (AAES) 40th Annual Meeting

American Association of Endocrine Surgeons (AAES)

859-402-9810

endocrine surgery.org

Apr 28May 01 2019

Glasgow Scotland

26th European Congress On Obesity (ECO 2019)

European Congress On Obesity

90-212-38146-00

eco2019.org

11-13 2019

Emergency Medicine

cme

sponsor

Jan 15-18 2019

Jan

Endocrinology

calendar

topic

new CE to CME Travel be placed

Contact 416-586-4800 ext 2489 or email cmeobgyn@mtsinai.on.ca to register or for more information. Evidence-based education that will change your Monday

www.obgyn.utoronto.ca/cpd

Quality Improvement & Patient Safety in Obstetrics & Gynaecology

St. Michael’s Hospital’s Women’s Health Symposium

FRIDAY | JANUARY 11, 2019

FRIDAY | FEBRUARY 1, 2019

Paediatric Adolescent Gynaecology Review Day

Mature Women’s Health Care

FRIDAY | JANUARY 25, 2019

FRIDAY | APRIL 12, 2019

Winter 2019 Just For Canadian doctors

cMe

calendar

Hematology

Geriatrics

General & Family Medicine

Gastroenterology

cme when where

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/

topic

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contact

website

American Society of Clinical Oncology

571-483-1300

gicasym.org

Jan 17-19 2019

San Francisco California

Gastrointestinal Cancers Symposium

Feb 14-16 2019

Fort Lauderdale Florida

30th Anniversary Jagelman/40th Annual Turnbull International Colorectal Disease Symposium

Cleveland Clinic

See website

clevelandclin icmeded.com/ live/courses/ ddi-colorectal

May 18-21 2019

San Diego California

Digestive Disease Week (DDW 2019)

Digestive Disease Week

301-272-0022

ddw.org

Feb 09-10 2019

Delray Beach Florida

Fifth Annual Atlantic Otolaryngology-Head And Neck Surgery Update

Johns Hopkins University

410-955-2959

hopkinscme. cloud-cme. com

May 17-27 2019

Croatia & Montenegro

The Balkans 2019 Medical Conference

Unconventional Conventions

61280114711

uncon-conv. com

Jul 14-21 2019

Alaskan Cruise

Current Medical Issues & Updates/ 7-Night Cruise Roundtrip Seattle On Star Princess

Professional Education Society

877-737-7005 See Ad Page 21

pestravel.com

Oct 22-29 2019

Yachting the Rivieras: Rome to Barcelona

Exploring Medicine & The Mediterranean Healthcare Model / 7-Night Cruise On Windstar Wind Surf

877-737-7005 See Ad Page 21

pestravel.com

Oct 30Nov 02 2019

Vancouver British Columbia

Family Medicine Forum 2019

The College of Family Physicians of Canada

800-387-6197

fmf.cfpc.ca

Mar 07-14 2020

Yachting the Seychelles Islands

Hot Topics In Medical & Public Health/ 7-Night All-Inclusive Cruise On All-Suite Yacht, Crystal Esprit

Professional Education Society

877-737-7005

pestravel.com

Feb 06-09 2019

Vancouver British Columbia

UBC Care Of The Elderly Intensive Review Course

University of British Columbia

604-675-3777

ubccpd.ca

May 02-04 2019

Halifax Nova Scotia

The Canadian Geriatrics Society Annual General Meeting

Canadian Geriatrics Society

905-415-3917

thecanadian geriatric ssociety.wild apricot.org

Feb 25-27 2019

Paris France

TAT 2019 - International Congress On Targeted Anticancer Therapies

European Society for Medical Oncology

41-091-9731990

esmo.org

Mar 21-23 2019

New York New York

HemOnc Today New York

Healio

800-257-8290

healio.com

ASCO Annual Meeting

American Society of Clinical Oncology

703-449-6418

am.asco.org

May 31Chicago Jun 04 Illinois 2019

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Just For Canadian doctors Winter 2019

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/

calendar

cme

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Jan 12 2019

Saint Louis Missouri

Hematology & ASH Abstract Review 2019

Washington University School of Medicine in St. Louis

800-325-9862

cme.wustl.edu

Feb 25-26 2019

London England

Global NASH Congress

Global Engage

44-0-1865849841

globalengage.com

Expiry Jan 19 2019

Online

Adult Pneumococcal Vaccination: Do You Know The New Recommendations?

mdBriefCase

416-488-5500

goo.gl/ M8Fe5A

Feb 11-24 2019

Australia and New Zealand Cruise

Infectious Diseases: 2019 Update

Continuing Education, Inc./University at Sea

866-456-9464

continuingedu cation.net

Mar 27-29 2019

Hamilton Ontario

11th McMaster University Review Course In Internal Medicine

McMaster University Department of Medicine

905-525-9140

mcmaster internal medicine.ca

May 16-18 2019

Aspen Colorado

Trending Topics In Internal Medicine 2019

Mayo Foundation for Education and Research

866-629-6362

gimeducation. mayo.edu

Mar 18-20 2019

Whistler British Columbia

Medical CBT Tools: Ten-Minute Techniques For Real Doctors

CBT Canada

877-466-8228

cbt.ca

May 10-11 2019

Richmond British Columbia

Collaborative Mental Health Care Conference

905-667-4861

shared-care.ca

Feb 15-18 2019

Carlsbad California

The 32nd Annual Practicing Physician’s Approach To The Difficult Headache Patient

Diamond Headache Clinic

312-867-9104 See Ad Page 8

dhc-fdn.org

Jul 25-28 2019

Lake Buena Vista Florida

Headache Update (Registration Opens March 15, 2019)

Diamond Headache Clinic

312-867-9104 See Ad Page 8

dhc-fdn.org

Jan 11 2019

Toronto Ontario

Quality Improvement & Patient Safety In Obstetrics & Gynaecology

University of Toronto

416-586-4800 ext 2489 See Ad Page 19

obgyn. utoronto.ca/ cpd

Jan 20Feb 01 2019

Rio to Buenos Aires Cruise

Updates In Medicine & Women’s Health / Brazil, Uruguay & Argentina On Regent Explorer

Professional Education Society

877-737-7005

pestravel.com

Jan 25 2019

Toronto Ontario

Paediatric Adolescent Gynaecology Review Day

University of Toronto

416-586-4800 ext 2489 See Ad Page 19

obgyn. utoronto.ca/ cpd

Feb 01 2019

Toronto Ontario

St. Michael’s Hospital Women’s Health Symposium

University of Toronto

416-586-4800 ext 2489

obgyn. utoronto.ca/ cpd

Feb 13 2019

Vancouver British Columbia

5th International Autonomic Symposium: Women’s Health After SCI

ICORD

604-675-8856 See Ad Page 22

icord.org

PROFE

Alaska & Inside Passage on Princess

Rome to Barcelona on Windstar

Circle Iceland Cruise on Ponant

Yachting the Seychelles on Crystal

info@PEStravel.com

1980

Since CR

Medical/Dental Healthcare Needs in Iceland July 29 – August 5, 2019

Family and Preventive Medicine/Challenges in Alaska July 14 – 21, 2019

CIETY

Visit our website for more exciting trips! • New Zealand & Australia • Panama Canal & the Tropics • Taiwan, Philippines, Borneo & Indonesia

Medical Advances in Japan/Updates in Primary Care April 6 – 16, 2019

Grand Japan Cruise on Windstar

L EDUCATIO NA N IO

Professional Education Society — CME/CE Cruise & Travel Seminars

new Hamilton CE toFamily Health Team be placed

Obstetrics & Gynecology

Neurology

Mental Health

Internal Medicine

Infectious & Chronic Diseases

Hepatology

cme when where

SE & RAVEL T

Medical Updates in Preventative Care October 22 – 29, 2019

Hot Topics in Medical & Public Health Issues March 7 – 14, 2020

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Winter 2019 Just For Canadian doctors

a divisio

cMe

calendar

Wilderness and Travel Medicine

Radiology

Primary Care

Pediatrics

Pain Management

Orthopaedics

Oncology

cme when where

MORE CME Full-access CME calendar and destinations at justforcanadiandoctors.com/cme/

topic

sponsor

contact

website

Jan 18-19 2019

Heidelberg Germany

International Meeting On Precision Oncology And Personalized Medicine For Head And Neck Cancer

University Hospital Heidelberg and the German Cancer Research Center

49-3641-3116-326

headandneckcancer.de

Mar 20-23 2019

Vienna Austria

St.Gallen International Breast Cancer Conference: Primary Therapy Of Early Breast Cancer - Evidence, Controversies, Consensus

St.Gallen Oncology Conferences

41-71-2430032

oncoconfer ences.ch

Jun 19-22 2019

Montréal Québec

Canadian Orthopaedic Association Annual Meeting And International Combined Orthopaedic Research Societies (ICORS)

Canadian Orthopaedic Association

514 874-9003

2019icors.org

Oct 03-05 2019

Dubai United Arab Emirates

Dubai 2019: AAOS Regional Meeting

American Academy of Orthopaedic Surgeons

847-823-7186

aaos.org

Feb 11-13 2019

Cleveland Ohio

Controlled Substance Prescribing: Pain, Anxiety, Insomnia

Case Western Reserve University

216-368-2000

case.edu

Aug 06-15 2019

Blue Danube River Cruise Conference

Topics In Family Medicine, Palliative Care, And Pain Management

Continuing Education, Inc./University at Sea

866-456-9464

continuingedu cation.net

Mar 14-15 2019

Zagreb Croatia

European Autism Congress

800-985-2178

autism.con ferenceseries. com

Apr 07-10 2019

Buenos Aires Argentina

new CE to beENTplaced World Congress Of Pediatric

Conference Series Argentine Association of Pediatric ENT and Speech Therapy

info@ wcpediatricent. com.ar

wcpediatricent. com.ar

Feb 04-08 2019

Naples Florida

7th Annual Essentials In Primary Care Winter Conference

Continuing Education Company

800-327-4502

cmemeeting. org

Apr 06-16 2019

Japan Cruise

Medical Advances In Japan And Updates In Primary Care / 10-Night Cruise On Windstar Star Legend

Professional Education Society

877-737-7005

pestravel.com

Dec 17-21

New York New York

NYU’s 37th Annual Head To Toe Imaging Conference

New York University Department of Radiology

212-263-3936

med.nyu.edu

Jan 13-16 2019

Big Sky Montana

43rd Annual UW Big Sky Radiology Conference In Memory Of Virgil And Sharon Graves

University of Wisconsin-Madison

See website

ce.icep.wisc. edu

Mar 21-23 2019

Taos Ski Valley New Mexico

2019 Mountain Emergency Medicine Conference

University of New Mexico

505-277-0111

hsc.unm.edu

May 24 2019

Nanaimo British Columbia

Rural Locum Forum

Rural Coordination Centre of BC

conference@ rccbc.ca

rccbc.ca

For feedback, requests or to have your course featured please email cme@inprintpublications.com or submit your course via www.justforcanadiandoctors.com

INTERNATIONAL AUTONOMIC SYMPOSIUM

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Just For Canadian doctors Winter 2019

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travel at home

far & away

There is another world on Fogo Island in Newfoundland story + photography by Barb Sligl

hey say one of the four corners of the flat earth is found on Fogo Island. And standing at the northeast edge of Newfoundland, where Brimstone Head looms above me and juts into the North Atlantic, I almost believe it. A hiking trail to the top of the rocky outcrop ends at a viewing platform with a world map indicating this corner (the others are Papua New Guinea, the Bermuda Triangle and Hydra, Greece). Okay then. But wait. This is not some regressive, anti-scientific throwback to ignorant times. Rather, it’s a different way of looking at things. Newfoundlanders have a slightly skewed view—in a good way. As Atlas Obscura describes, this particular flat-earth ideology “instigates critical thinking and disrupts expectations and rigid judgment.” There’s a Museum of the Flat Earth here that delves into this, but I’m happy to teeter outside on the fringe of far-and-away Fogo. Indeed, with the wind rushing into every pore and around each hair, my mind was pried open as soon as I disembarked the ferry. One Newfoundlander I met says, “We often say here that the wind is sharp. It’ll cut you.” Wide open, I think. And every hike and conversation pries my mind open a little more. As does a stay at the Fogo Island Inn, which put this fourth corner of the world on the map (so to speak). The inn, which opened five years ago and has since appeared on just about every list of top hotels and resorts and architectural wonders, is the brainchild of Zita Cobb, a Fogo-islander who left, made money and came back. I hear that a lot on Fogo. One artisan, who paints while his wife quilts, tells me that the “best part of a trip is coming back.” Winston Osmond lives in Shoal Bay and says, “When this all started…I thought poor ol’ Zita Cobb had lost her mind. Why would people come out here to this god-forsaken rock?” Now he sells his art to visitors from all over the globe (or flat earth) and says of Cobb: “Quite the visionary.”

From Osmond’s gallery, just across Shoal Bay, a twisty edifice pokes out of the otherwise level shoreline. It’s aptly named the Tower Studio, designed by the same architect behind the award-winning Fogo Island Inn, Todd Saunders—another Newfoundlander who left and came back to be a part of Cobb’s vision. A narrow twoplank boardwalk winds across a boggy bit of land to reach this artist studio, one of four on various spots of Fogo. I crane my neck to take it in, looking up, down and around at the surrounding spread. Saunders intended the structure to counterbalance all that horizontalness. The effect is astounding, as is the quiet. If only I could decamp here, be still on this patch of flat earth within this tower. But the Squish Studio (see page 25) is my favourite of the four artists’ studios that Saunders built for the Shorefast Foundation (the community-owned non-profit that’s also the custodian of Fogo Island Inn). Reached via a short climb from the tiny town of Tilting (a National Historic Site), Squish slowly emerges beyond a stony hill, where it sits at the water’s edge and morphs with each turn and step I take toward it. All these elements—the artist studios and residencies (international and highly sought-after), the so-called community hosts who give guided tours, hikes and experiences on the island, and the inn itself—are connected to the Shorefast Foundation that Cobb co-founded and which continues to channel tourism dollars back into the community. Shorefast has even developed something called an “Economic Nutrition Label,” much like the label you see on food items, documenting what percentage of cost goes where. At the Fogo Island Shop (run by Shorefast), every piece, from quilt to dining table, has one of these labels—even a night’s stay at the inn is broken down into labour, operations, marketing, and so on. And inside the shop you can watch local craftspeople at work, making the furniture that decorates the inn. I marvel at the simplicity of the Puppy Table, a three-legged side table-cum-stool made out of a single wood board that’s cut

Just For Canadian doctors Winter 2019

Community host, Allan Dwyer, at a “boil-up” (also, as Dwyer demonstrates, known as a “mug-up”)

Fogo Island Inn’s material palette and design is a reinterpretation of the maritime vernacular of fishing sheds or “stages,” including the white circles that serve as beacons after dark top The circle motif appears throughout the inn, like in the light fixtures above the bar

travel at home

The boardwalk to Tower Studio left Fogo Island Inn, early morning above Fogo Head trail, near Brimstone Head

if you go

Every room at Fogo Island Inn has a unique, hand-stitched quilt and local designs like the Puppy Table

Squish Studio, set on the rocky shores near the town of Tilting

Discover one of the seven seasons at Fogo Island Inn (next up: winter and pack-ice): fogoislandinn.ca. Find out more about the Shorefast Foundation and its initiatives: shorefast.org. Explore the rest of Newfoundland: newfoundland labrador.com.

travel at home

Another view of the Tower Studio and how it brings a vertical twist to the otherwise horizontal shoreline below left Mushroom toast (locally foraged) at Fogo Island Inn

A great auk sculpture looks toward iceland from Joe Batt’s Point above right Room key (cast from a piece of beachcombed driftwood) and collection of the inn’s furniture (atop a Donna Wilson Pouffe, the design of which is inspired by wooden shingles on a house in Joe Batt’s Arm)

Just For Canadian dentists November/December 2018

and reassembled using every part of the original piece. Once made out of necessity, it’s a vernacular design that’s become a signature and coveted décor item. This “loyal piece of furniture that follows you around the room,” as it’s described in the shop, has followed people home as far as New Delhi. The shop itself is another reboot, a re-purposed century-old building that’s had multiple lives, from Society of United Fishermen Hall to cinema/arcade, and has become yet one more form of communal space. The shopkeeper tells me, “The rule of thumb for this building, and the restoration, is if it’s old, let it be old.” Or just let it be. It’s kind of the default frame of mind on Fogo, I find. When I meet a community host, Allan Dwyer, for a “boil-up” (the local term for an outdoor gathering around a fire during which water is boiled for tea), he nonchalantly serves me the most unassuming yet delicious bakeapple jam. Also known as cloudberries, he picked them himself in “the barrens” and his wife preserved them. The tea is strong and dark, the jam is tart and Dwyer’s smile is easygoing and long-lasting. I could have sat there all afternoon on the side of Turpin’s Trail (named for the last white person who was killed by the Beothuk and had his head tossed onto nearby Sandy Cove Beach). For a remote island of little more than 2,000 people, there’s many a boil-up, shed party (just ask, you’ll be invited) or gathering of some kind. And it goes on year round. There are seven seasons, as the inn promotes: “trap berth” season (when markers are dropped for cod trap fishing berths), spring (icebergs and whales), summer (wildflowers and rowing punt boats), berry season (when you’ll find Dwyer in “the barrens”), late fall (bonfires and caribou watching) and pack-ice season… Whatever time of year, the wind will be there to clear your head and pry it open. Another hike takes me from the town of Joe Batt’s Arm (there’s another story…) to Joe Batt’s Point, where a sculpture of a great auk stands facing Iceland. I wrap my arm around the long-extinct creature that once used these rocky shores for its breeding grounds. As I gaze upon the white-capped waves, rolling and breaking, over and over, it does seem as if the water might drop off at the horizon. I think back to the notion of the Flat Earth Society of Canada and how here, watching the waves crash against the rocky shore, I’m at the very edge of it all. This place really feels like the beginning and end of the world. But on Fogo—and everywhere in Newfoundland—life is anything but twodimensional.

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DEPARTMENT OF PAEDIATRICS St. Thomas Elgin General Hospital (STEGH) is a fully accredited 157-bed facility providing comprehensive 24 hour coverage in Internal Medicine, Surgery, Obstetrics, Paediatrics, Anaesthesia, Emergency, Mental Health, and Family Medicine. Our Community Consultant Paediatricians support our local secondary level hospital and cover a six-bed Paediatric ward, four bed level 2a NICU and newborns - approximately 700/year – as well as support Labour & Delivery and Emergency when on call. Call is one in five, one week at a time. In the community, Paediatricians do a combination of consultant and primary Paediatrics. Candidates must hold an MD or equivalent and be eligible for licensure in the Province of Ontario with certification in Paediatrics from the Royal College of Physicians and Surgeons of Canada, or equivalent. The applicant will have a willingness to work in a dynamic team-based environment. Potential candidates would have the opportunity to help further continue the development of the Paediatric Program at STEGH, collaborate with primary care, and participate in education and capacity building with partners. STEGH participates in the Southwestern Ontario Medical Education Network, and provides educational opportunities for medical students and residents, as an affiliate of Western University. St. Thomas and Elgin County offers a plethora of activities and experiences. Learn more: elgintourist.com Interested candidates: Submit letter of intent and curriculum vitae to the address below. Thank you for your interest. Only applicants selected for an interview will be contacted. Attention: Kimberly Boughner, Medical Affairs Specialist St. Thomas Elgin General Hospital 189 Elm Street St. Thomas, ON N5R 5C4 Bus: 519-631-2030 x.2104 / Fax: 519-637-3212 www.stegh.on.ca

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Kirkland and District Hospital and Kirkland and District Family Health Team: Opportunity for a lucrative, satisfying practice. Overhead in a modern Family Health Team is only $2,000/month all-inclusive. Eligibility for HealthForce Ontario Northern and Rural Retention Initiative of approximately $111,600 over 4 years. Remuneration may include blended capitation for family practice, alternate payment plan in the ER, stipend and FFS for hospitalist medicine. Assistance with re-location expenses provided. Locum and emerg hospitalist rotations available throughout the year!

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WE LOOK FORWARD TO MEETING YOU! Winter 2019 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, CPA,CA, is a principal in the Vancouver office of Purtzki Johansen & Associates. He can be reached at: Manfred@purtzki.com or 604-669-7558.

Defer and reap

he most significant benefit you can reap from incorporating your practice is the opportunity to defer taxes. And the opportunity is still significant enough to add seven years to your retirement life. Income in the corporation is taxed at 12% (BC tax rate), which means $82 out of every $100 of practice income is retained in the corporation. The funds can be used to invest or to repay debt. The low corporate tax rate of 12% is made possible because of the Small Business Deduction (SBD). The SBD with an annual limit of $500,000 applies to the income from your

practice. Any practice income in excess of the SBD is taxed at 27%. The annual limit of $500,000 must be allocated among professionals who work together in a revenue-sharing arrangement with other professionals, either in a partnership or as shareholders in a corporation. Many radiologists, for instance, work in a partnership and therefore only have one $500,000 SBD to be divided among them. On the other hand, incorporated doctors who work in cost-sharing arrangements are each entitled the full $500,000 deduction. Investments such as a stock portfolio Be the or rental property should be made of your tax in the corporation, dollars…and especially when you have to borrow money retirement for it. This is because loan principal is not deductible, so it’s cheaper to repay the loan with after-tax corporate dollars. To repay a $100,000 loan, for instance, the corporation only needs $113,600 of pre-tax cash flow. To pay off a personal debt of $100,000, you need $192,300 (assuming a top personal tax rate of 48%) or $78,700 more income. In the absence of the corporation,

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Just For Canadian doctors Winter 2019

you basically need almost 70% more of precious cash flow to pay off debt. The tax deferral benefit will also have a huge impact on your retirement savings. Suppose you are a 35-year-old doctor earning $250,000 before tax in British Columbia. You need $125,000 of after-tax income for personal and living expenses. And you invest your remaining income in a stock portfolio with an annual growth rate of 12% for 30 years. If you’re not incorporated, your after-tax savings will grow to $2.5 million in 30 years by the time you are 65. If you do use your corporation, your corporate savings will grow to $5.8 million by age 65. And if you draw all the funds from your corporation when you retire, you’ll pay income taxes of $1.9 million, leaving you with $3.9 million. By incorporating, you can generate $1.4 million more in retirement savings than an unincorporated doctor. If you’re not incorporated, you would have to work another seven years to age 72 to make up the shortfall. With personal tax rates creeping up to 50% of your income, you’ll never be able to save enough money to retire without sacrificing your standard of living. But by incorporating your practice, the money you save on taxes can maintain your lifestyle in retirement, as well as provide cash for investments and education for your kids—or whatever you want to spend your hard-earned money on.

istock

How the Corporate Tax deferral can help you retire seven years earlier

diversion

sudoku

Solve puzzle #2 for a chance to win a $50 Amazon gift card! Each sudoku puzzle has a unique solution that can be reached logically without guessing. Fill in the grid so that every row, column and 3x3 square contains the digits 1 through 9. GOOD LUCK!

sudoku 2 harder solution in next issue

sudoku 1 easier solution on page 30

$50 Amazon Gift Card winner: Dr. Sheila Scott from Calgary, AB

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

Puzzle by websudoku.com

1 6

3 9 6 8

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

Puzzle by websudoku.com

Internal Medicine Opportunity

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Sudoku Contest entry form (solve + send in sudoku!)

Yes, I would like to receive the CME newsletter & updates by e-mail.

NB: Information collected will not be shared with any third party.

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E-mail: _________________________________________________________ Tel: ____________________________ Fax: ____________________________ sudoku Contest Rules:

1. Entry form must be accompanied with solved puzzle. Only correctly solved puzzles entered into random draw. 2. Send puzzle + entry form to Just For Canadian Doctors, 200 â&#x20AC;&#x201C; 896 Cambie St., Vancouver, BC, V6B 2P6 or fax 604681-0456. Entries must be received by February 22, 2019. 3. Prize: $50 Amazon Gift Card. 4. Contest can be changed and/or cancelled without prior notice. 5. All entries become property of In Print Publications. 6. Employees of In Print Publications and its affliates are not eligible to participate. 7. In Print Publications is not responsible for lost or stolen prizes.

Winter 2019 Just For Canadian doctors

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.

Stem cells

Be aware of this [not so] new

The growing industry of stem-cell therapy warrants a deeper dive

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Just For Canadian doctors Winter 2019

placement and assimilation of the transplanted tissue requires much further investigation. There is also a risk of oncogenesis. This is especially so in the case of pluripotent cells. These have the potential to form teratomas— tumours involving all three germ layers. Furthermore, there’s difficulty in enabling and ensuring the differentiation of stem cells into the desired tissue cells. Stem-cell therapy research has come a long way since the 1990s; it’s already a “mainline” treatment for a few conditions, namely haematological disorders including aplastic anaemia and haematological malignancies, bone grafting, skin grafting and some forms of corneal regeneration. Physicians should be cautious before endorsing any preclinical therapies at this stage. Many of these clinical trials are of dubious quality and value. Patients, no doubt, will criticize physicians for being too conservative—but I can remember laetrile therapy, the so-called wonder breastcancer treatment, and chelation therapy (which still will not go away) and liberation therapy for MS. A safe and very useful resource for this must-know subject is the International Society for Stem Cell Research, which publishes an online PDF, Patient Handbook on Stem Cell Therapies. There is also, closer to home, Stem Cell in Canada. I will post links to these on my webpage drpeng.ca.

therapy

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

Puzzle by websudoku.com

solution from Fall 2018 contest

classifieds 30

cell division, with one daughter cell being a further stem cell, and the other a designated somatic tissue cell. The optimum source of stem cells is from the human blastocyst that forms seven to 10 days post fertilization. These cells are defined as being pluripotent, which means they can differentiate into cells of any of the embryonic germ layers. These are referred to as embryonic stem [ES] cells. Cells harvested at about 10 to 14 days post-fertilization are known as multipotent, which means that they can differentiate, but only into cells of one germ layer. The harvesting of stem cells from a blastocyst (leftovers from fertility clinics) usually results in its demise. This has caused significant ethical problems because of the destruction of a potential human life form—and this has delayed research due to differing worldwide political pressures. For example, the USA has withdrawn federal funding from stem-cell research for several years. This logjam was relieved in 2006 when incredible ingenuity led to genetic manipulation of adult cells resulting in a few cells reverting to stem-cell behaviour. These are referred to as induced pluripotent stem (iPS) cells. They function very much like embryonic stem cells…but not exactly. Nevertheless it has eased a lot of the ethical delays in research. The use of stem cells carries significant, but not insurmountable, problems. The first is tissue integration, where the ultimate

solution from page 29

y wife recently has noticed full-page, highly visible advertisements every day in the newspaper. These are invitations to seminars that inform the public using stem cells for the treatment of a variety of musculoskeletal pains, as well as peripheral neuropathy. She asked me what I knew about this form of therapy; I realized I knew very little. So I began to do some research using, of course, the internet, and was soon wading through advertisements for innumerable clinics worldwide offering stem-cell therapy for a wide variety of conditions. Thank goodness for “UpToDate“ to get a comprehensive, advertisementfree-information jumping-off point. The first thing I noticed is that stemcell research is to family practice as rocket science is to putting gas in my car and checking the oil level. Nevertheless, some knowledge of stem-cell research and therapy will be necessary for physicians to be able to intelligently field questions from patients who have been seduced by highly motivated expert marketers. It’s theorized that stem cells are dormant in most body tissues, waiting until called upon to repair injury or illness. Stem cells have two unique properties. One is that they can reproduce indefinitely, unlike regular somatic cells that demonstrate senescence eventually. Stem cells can undergo mitosis and develop into further stem cells or differentiate into specific somatic cells. Rather amazing is the fact that they can also undergo asymmetrical

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

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