Living Healthy
Spring 2014 • Vol. 7 No. 1
In Atlantic Canada
Healthy
choices
Do you need to
take vitamins?
Brush up
Aging and dental care
Hear this!
PEI mom’s ear surgery a
medical milestone
Cover photograph
by Perry Jackson
Lawtons Drugs...Travel made simpler.
Living Healthy
Spring 2014 • Vol. 7 No. 1
Contents
In Atlantic Canada
HEALTHY
CHOICES
Do you need to
take vitamins?
We love to make your
medications simple
and convenient.
Brush up
Aging and dental care
Hear this!
PEI mom’s ear surgery a
medical milestone
Features
19 Hear, hear
We can package your prescriptions
and over-the-counter medications
by day and time of day so you know
exactly what to take and when.
Bilateral bone implant —a medical first for North
America—helps PEI mom
21 If a stroke is suspected
37 Fluoride and your teeth
Get help—early assessment and treatment is critical
Fill your prescriptions on the go!
Fluoride treatment recommended, especially for those
at higher risk of tooth decay
On the lookout for oral cancer
40
• On line at lawtons.ca
Dental exam about more than healthy teeth
• Scan with Lawtons App
19
• Ask for automatic refills, we will call or
text you when your prescription is ready
Departments
20Happenings
25
3 Health
Ask the professionals
11
• Phone your nearest
Lawtons Drugs
Don’t spoil your children’s
vacation by packing medicine
they don’t like the taste of!
Ask your Lawtons pharmacist
to add a flavour they will like better.
lawtons.ca
29
35
Excessive sun exposure is dangerous, but moderate sun exposure is healthy
14 Ask the professionals
Increased awareness of endometriosis means more
women are receiving treatment now than in past years
The wellness column
16
Community-based wellness programs reap big health
benefits
Join us online!
There’s more Living Healthy in Atlantic
Canada on the web—just go to
saltscapes.com, and click on the Living
Healthy box. You’ll find stories about
health, wellness and living the good life
in Atlantic Canada. See you there!
A patient’s story
29
Nutrition
33
35 Your oral health
Kimberley Csihas thought she had the flu—it was a stroke
The multivitamin debate
Spring 2014 •
Living Healthy In Atlantic Canada
1
Living Healthy In Atlantic Canada
Health Happenings
Volume 7 Number 1 Date of Issue: March 2014
Living Healthy in Atlantic Canada IWK Health Centre,
Nova Scotia Department of Health and Wellness, the
four dental associations of the Atlantic Provinces
and Saltscapes Publishing Ltd.
Saltscapes Publishing Limited
Co-Publishers Jim & Linda Gourlay
Associate Publisher Shawn Dalton
Senior Designer Graham Whiteman
Designer Thom Knowles
Vice President of Sales
Kerri Slaunwhite • [email protected]
Advertising Account Executives
Susan Giffin • [email protected]
Pam Hancock • [email protected]
Advertising Traffic Coordinator
Lisa Byrne • [email protected]
Accounting and Office Administration Manager
Glenn Day • [email protected]
Administration Valerie Blackmore • Lisa Sampson
Talk to us
Send your letters to the address below, or email jgourlay@
saltscapes.com. Include your name, the name of your town
or city and telephone number. Letters that appear in the
magazine may be edited for length and clarity.
Living Healthy in Atlantic Canada is published twice a
year by:
Saltscapes Publishing Limited
30 Damascus Road, Suite 209, Bedford, NS B4A 0C1
Tel: (902) 464-7258, Sales Toll Free: 1-877-311-5877
Contents copyright No portion of this publication may be
reprinted without the consent of the publisher. Living
Healthy in Atlantic Canada can assume no responsibility for
unsolicited manuscripts, photographs or other materials
and cannot return same unless accompanied by S.A.S.E.
Publisher cannot warranty claims made in advertisements.
Printed by: Advocate Printing & Publishing, Pictou, NS
Living Healthy in Atlantic Canada
is founded upon the premise that the most effective health
care is illness avoidance. Our mandate is to help inform the
general public within Atlantic Canada as to how they might
take steps to promote their own good health and that of their
families…
How they might improve the quality and extend the length
of their lives, and those of their loved ones.
Living Healthy in Atlantic Canada is published by Saltscapes
Publishing Limited in collaboration with the following
strategic partners who provide support, medical expertise
and mentoring with respect to editorial content:
QEII Health Sciences Centre Foundation
IWK Health Centre
Nova Scotia Department of Health and Wellness
Dental Association of Prince Edward Island
New Brunswick Dental Society
Newfoundland & Labrador Dental Association
Nova Scotia Dental Association
Acne treatment awareness growing
Acne has always been an issue for teens, but more
youngsters are aware of treatments that can shorten
its sometimes devastating impact on their lives, says
Dr. Peter J. Green, a program director in dermatology
at Dalhousie University.
“Awareness about acne and effective treatments
is probably higher and young people have
unprecedented access to information through social
media, TV, etcetera,” says Dr. Green, who also holds
clinics for youth at the IWK. “There is probably more
pressure on teens with all this exposure, and celebrity
endorsements, to maintain near perfect skin.
“Marketing acne treatments has certainly
aggressively targeted teens,” he continues.
“Fortunately, there are safe and very effective
therapies that are accessible, as acne is not just a
stage that will go away.”
According to the Canadian Dermatology
Association, the term acne is used to describe
blackheads, whiteheads, pimples and cysts. The
condition usually appears on the face and neck, but
it can also mark shoulders, back and arms. Acne is
often caused by hormonal surges at puberty. It affects
about 90 per cent of adolescents and 20 to 30 per
cent of adults age 20 to 40.
The condition ranges in severity. A Canadian
study published in the British Journal of Dermatology
found that even mild acne may induce feelings of low
self-esteem, depression and even suicidal thoughts.
Many cases can be treated with topical overthe-counter medications, but severe acne may need
prescription drugs. Prescription treatments include
topical formulations, such as antibiotics and retinoids
(vitamin A derivatives). Oral (or systemic) medication
can include antibiotics, retinoids, or hormonal
agents, such as the birth control pill.
Dr. Green says today’s teens are benefitting from
newer combination treatments that blend topical
agents for convenience. “For example, topical
vitamin A acids have previously been combined with
erythromycin, but are now compounded with low
dose benzoyl peroxide,” he says. “Topical dapsone is a
newer therapy for inflammatory acne as well.”
~Carol Moreira
markcarper/Bigstock.com
Dr. Patrick McGrath OC, PhD, FRSC, FCAHS
Integrated Vice-President, Research and Innovation,
Capital Health and IWK Health Centre
Dr. David Anderson MD, FRCPC
Head/Chief Department of Medicine, Capital Health and
Dalhousie University
Paula Bond
Vice-President, People-Centred Care, Capital Health
Maggie Marwah
Director, Marketing & Communications, Capital Health
Kaylee Hake
Acting Director, Communications, QEII Foundation
Kathryn London-Penny
Executive Director, Public Relations, IWK Health Centre
Lia A. Daborn
Executive Director, New Brunswick Dental Society
Dr. Margot Hiltz MSc, DDS
Newfoundland & Labrador Dental Association
Eliot Coles
Communications Manager, Nova Scotia Dental Association
Dr. Brian D. Barrett DDS, FACD, FPFA, FADI
Executive Director, Dental Association of PEI
monkeybusinessimages/Bigstock.com
Editorial Board
Nova Scotia’s books-for-babies program has been
translated into Chinese and Arabic.
The province-wide Read to Me! program offers
every baby born in Nova Scotia a bright yellow Read
to Me! bag containing free baby books, a nursery
rhyme CD, baby’s first library card and the Read to
Me! Family Reading Guide. The
guide is an important resource
that gives parents month-bymonth book sharing tips for
their baby’s first year.
“One’s language is a
key aspect of identity and
an important source of
cultural pride,” says
Read to Me! director,
Carol McDougall.
“By providing
book titles and
nursery rhymes
in a parent’s
primary
language we
hope to
Acne affects about 90 per cent
of adolescents and 20 to 30
per cent of adults age 20 to 40.
Below: Read to Me!
Read to Me! program launches new
Arabic and Chinese resource
Thanks to a grant from The Chronicle-Herald,
the Family Reading Guide that accompanies
2
Living Healthy In Atlantic Canada •
Spring 2014
Spring 2014 •
Living Healthy In Atlantic Canada
3
Health Happenings
Bust a Move celebrating its
fifth and final year.
encourage families to read, talk and sing to their baby
in their first language.”
Reading, talking and singing to babies has
powerful health and education benefits, McDougall
says. It enhances the bonding and attachment
between parent and child and nurtures an early love
of reading.
Read to Me! worked with members of the Arabic
and Chinese speaking communities to ensure the
books and rhymes in the guides were culturally
appropriate and served the needs of each of these
language communities, McDougall says.
Since 2002, when the program began, more
than 96,000 Read to Me! bags have been distributed.
The Read to Me! bag is available in English, French,
Chinese, Arabic and Mi’kmaq. Families can request
a Read to Me! bag in any of the available languages
when they are visited by a Read to Me! representative
in the hospital.
~Carol Moreira
Fifth and final year for Bust a Move
Run by the QEII and the IWK Foundation, the
Bust a Move for Breast Health has been a popular
and colourful fundraiser since 2010, when the
first of the six-hour dance marathons was held.
Now, with only $1.3 million left to raise until the
completion of the new Breast Health Centre at the
IWK, Bust a Move will celebrate its fifth and final
event March 22.
Bust a Move has been an important part of
the fundraising for the new centre, which saw the
addition of a breast-imaging unit at the IWK last
4
Living Healthy In Atlantic Canada •
Spring 2014
year. Breast health supporters
have now raised $3.9 million
for the centre which will offer
patients comprehensive care.
Patsy MacDonald knows
first hand the positive impact
the Breast Health Centre
will have on Nova Scotians.
Diagnosed with breast cancer
in April 2011, MacDonald
underwent several months
of treatments, including
a double mastectomy, and
was deemed cancer-free in
December 2011.
“I have become friends
with some very brave women
who I wouldn’t have met
if not for the common bond we all share—breast
cancer,” says MacDonald. “I think that’s what Bust
a Move is all about; surrounding yourself with a
positive community of people who are focused on a
common goal—better breast health in Nova Scotia.
This is a goal we are so close to reaching with the
new Breast Health Centre.”
Located at the IWK Health Centre, the new Breast
Health Centre will offer a holistic approach to breast
health. Patients will benefit from a collaborative
environment as physicians, nurses, specialists,
technologists and oncologists come together to offer
the best possible patient-focused care.
With Australia joining five other Canadian cities
in holding fundraising dance marathons, Bust a Move
has grown from a local dream to an international
phenomenon.
“The Breast Health Centre exists
because participants and donors
believed in the possibility and
joined the movement,” says Bill
Bean, president and CEO of the
QEII Foundation.
~Carol Moreira
New endowed chair
in transplantation
research
Atlantic Canadians will
benefit from advancements
Dr. Ian Alwayn
in organ transplantation as a result of the new QEII
Foundation Endowed Chair in Transplantation
Research. Dr. Ian Alwayn has been announced as the
inaugural chair.
Currently the surgical lead for the Multi-Organ
Transplant Program at the QEII and an associate
professor with Dalhousie University’s faculty
of medicine, Dr. Alwayn’s research focuses on
optimizing the health of donors and recipients,
while improving the quality of organs prior to
transplantation.
“I work with a team who are very dedicated to
making transplants possible, our focus is always on
improving the health of our patients,”
said Dr. Alwayn. “As the chair, my goal is
to bring researchers together, collaborate
with different programs and enhance the
transplant experience for patients.”
An endowed chair provides stable
long-term funding for the research
chair holder, allowing further medical
advancements to be made in a dedicated
area. It’s intended this research will
enhance care for future Atlantic
Canadian patients receiving organ
transplants at the QEII; patients like Ellie
O’Brien, who received her new kidney
from a family friend after 14 months on
the transplant list.
“I am a perfect example of the
progress transplantation research has
made to date,” says O’Brien. “It’s been
more than four years since my surgery
and I am completely healthy and happy.
In fact, my experience with the QEII
inspired me to study nursing at St. Francis Xavier
University.”
The Multi-Organ Transplant Program at the
QEII has performed approximately 3,500 organ
transplants for Atlantic Canadians since 1969. The
QEII is the only health centre in Atlantic Canada able
to perform transplants.
“This announcement will boost a service we’re
already extremely proud of,” says Chris Power,
president and CEO of Capital Health. “The MultiOrgan Transplant Program is a prime example of the
specialized service and high-calibre care available at
the QEII Health Sciences Centre that helps Atlantic
Canadians when they need it most.”
~Carol Moreira
Mobile Care Team attends to
patients overnight in New Waterford
Demand is growing for the services of a new Mobile
Care Team (MCT) serving the area around New
Waterford, Cape Breton as part of a greater emphasis
on collaborative care.
Designed to treat non-urgent health issues
overnight, the MCT has been in place since last
September; it includes a registered nurse and
an advanced care paramedic working together
to provide non-urgent healthcare, under the
supervision of an online doctor.
The service is free to users and referrals are made
by staff in emergency departments, as well as by
doctors and nurse practitioners. Also, if ambulance
staff attend a patient at home and determine their
health care needs are not urgent, the MCT may be
sent for follow up.
The MCT is part of the New Waterford
Collaborative Emergency Centre (CEC). The CEC
brings together a collaborative team of health
professionals to provide care tailored to the needs of
the community.
The plan is for New Waterford’s CEC to offer
residents several other benefits, including a more
consistent daytime emergency department schedule
and enhanced access to primary care through a
daytime CEC, family doctors and nurse practitioners.
Spring 2014 •
Mobile Care Team, meeting
non-urgent health needs.
Living Healthy In Atlantic Canada
5
Scott’s Nursery
2192 Route 102 Hwy,
Lincoln, NB
Ph: (506) 458-9208
Open Year Round
[email protected]
Tap the Tap initiative emphasizes
water over sugary drinks.
The New Waterford CEC is the eighth in
Nova Scotia. All were developed following the
recommendations of Dr. John Ross, whose 2010
report suggested ways to improve emergency medical
care in the province.
At present, the Mobile Care Team is on the road
Monday to Thursday, from 7pm until 7am. Greg
Boone, the director of public affairs for the New
Waterford district, says plans are in the works for the
Mobile Care Team to operate seven nights a week.
“With the Mobile Care Team, it’s reminiscent of
the old-fashioned house call,” he said.
“The team brings care to people where they live,
instead of the people having to come to us.”
~Carol Moreira
Tap the Tap
A new campaign called Tap the Tap: Water between
Meals is highlighting the importance of water as a
6
Living Healthy In Atlantic Canada •
Spring 2014
healthy drink for children. Drinking water instead
of sugary drinks can help prevent tooth decay, and
encourage healthier food choices.
“We see many families who want to make
healthy choices for their children, but they need
support and reliable information. Juice, fruit drinks
and other sugary beverages … are not healthy
choices. These can lead to picky eating, obesity and
tooth decay,” says Dr. Tara Chobotuk, IWK Health
Centre community pediatrician at the Spryfield
Community Wellness Centre.
The Tap the Tap initiative arose from discussions
between members of the Spryfield community and
Dr. Chobotuk. The program is run by IWK health
professionals, staff from the Dartmouth and Spryfield
Community Health Teams, Public Health Services,
community daycares, high schools and family
resource centres.
~Carol Moreira
Spring 2014 •
Living Healthy In Atlantic Canada
7
Advertisement
Active Transportation Coordinator
with Ecology Action Centre. “Inverness
has just started a walking school bus,
which is when two or more families
walk to school together in the mornings
as an alternative to driving.”
The school travel planning program
has been piloted in 18 schools since
2007, including Halifax Regional
Municipality, Bridgewater, Chester
District, Annapolis County and Cape
Breton Regional Municipality. By
helping create the safe environment
for walking and wheeling students,
the program promotes physical
activity among children and youth as
well as environmentally sustainable
transportation with reduced traffic
congestion and air pollution. Greater
mental alertness in school and better
emotional well being are other positive
outcomes.
Thrive!
In Action
A walking school bus can be part of a school travel plan to help children power their own way to school safely.
Everyone wants to be
healthy and, generally, we
know what we need to do
to be healthier. But the
world around us doesn’t
make it easy.
Our communities are built for cars.
Schools, workplaces and stores are
often far from where we live, so we
drive when we once walked or bicycled.
Children often have less freedom to
play because of real and perceived
safety concerns.
Through Thrive!, A plan for a healthier
Nova Scotia, the province is working
to help all Nova Scotians be healthy
by changing the places where we live,
learn, work, commute and play. With
its focus on healthy eating and physical
activity, one of Thrive!’s many objectives
is to increase active transportation
among Nova Scotians. By establishing
policies, governments, communities
and other organizations can create safe,
supportive environ-ments for people
to get around more without motorized
vehicles.
Safety is a key concern, especially with
children, that sometimes holds people
back from walking or biking. However
programs like Active & Safe Routes to
School help families and communities
create a school travel plan that ensures a
safe environment for children to power
their own way to and from school.
School travel planning is based on the
belief that any community can shift
towards more active lifestyles. It takes
communities through a step-by-step
process to identify and remove physical
barriers as well as change attitudes
that may otherwise prevent active
transportation.
“Bedford South Elementary School
will be painting a mural on their street
focused around different modes of
active transportation,” Barlow says.
“It will be a nice reminder to parents
and students to not rely so heavily on
motorized vehicles to get to school and
work every day.”
Active transportation is sometimes
more challenging in rural areas than in
urban settings. For example, there aren’t
sidewalks on many rural roads for
safe walking. Rae Gunn, Active Pictou
County Coordinator, suggests driving
Janet Barlow with the Ecology Action Centre helps communities to develop active
transportation plans that create safe environments for walking, biking and more.
to a common area and walking from
that point to the school is one way of
overcoming the challenges.
“In Scotsburn, we drove to the fire hall
and walked with 20 students to the
school,” says Rae. “It’s about making an
effort and teaching children good habits
and leading by example.”
The Ecology Action Centre also
developed the Active Transportation
(AT) 101 Guide to help people bring
active transportation to their broader
community. The guide provides tips on
forming a committee in order to assess
community needs, getting buy-in from
municipal council, securing funding for
plans, and many other useful steps.
“We have done 14 workshops since
the fall of 2012 visiting over 35
municipalities and talking to over 200
community members about creating
their own active transportation plan,”
Barlow says.
Antigonish is one community that
has benefitted from the AT 101 Guide
and workshop. Within a year of the
workshop, the town and the county
are working together on an active
transportation plan having received
funding from the Department of Health
and Wellness and the Department of
Energy’s Nova Scotia Moves Program.
This program supports sustainable
transportation, of which active
transportation is an important part.
Active transportation is just one
example of how Thrive! is bringing
many government departments
together to work to support
communities to change their physical
and social environment so that Nova
Scotia can become the easiest place in
Canada to grow up healthy.
“We’re working with schools clear
across the province,” says Janet Barlow,
Together,
we can
Thrive!
Establishing bike lanes is one way that communities can create a safer environment for
cycling, encouraging more people to peddle to their destinations instead of driving.
thrive.novascotia.ca
Ask the professionals
Chicken and Broccoli Divan over Nutty Rice
Developed for CFC by Nancy Guppy, RD, MHSc
This updated casserole demands a place on the dinner table. Its unique preparation of brown rice,
pecans, and sesame seeds is delicious paired with the traditional broccoli, cheese, and chicken flavours.
boneless, skinless chicken breast(s)
butter or margarine
lemon juice, fresh
whole wheat flour
1% milk
tarragon, dried
nutmeg
salt
black pepper, freshly ground
part-skim mozzarella cheese
broccoli
short grain brown rice
sesame seeds
pecans, chopped
paprika
Excessive sun exposure is dangerous,
Recipe for Success
450 g
30 mL
15 mL
45 mL
500 mL
5 mL
0.6 mL
1.25 mL
2.5 mL
250 mL
1L
250 mL
15 mL
60 mL
2.5 mL
•
•
•
•
•
Supply Management
Serves: 6
Cook time: 1 hour 15 min
1. Dice boneless skinless chicken breast into 1” squares. Melt margarine or butter in a large nonstick skillet over medium-high heat. Sautee chicken until golden brown. Remove chicken,
sprinkle with fresh squeezed lemon juice and set aside.
2. Whisk flour into pan juices; cook, stirring, for 2 minutes to brown flour. Gradually whisk in milk,
stirring constantly until smooth and thickened (i.e., coats the back of a spoon). Remove from
heat; stir in tarragon, nutmeg, salt, pepper and half the grated cheese.
3. Remove ends from fresh broccoli and cut spears. Quickly blanch in boiling unsalted water until
just tender crisp.
4. Prepare the short grain brown rice according to package directions in unsalted water. The pecans
and sesame seeds can be added at the beginning of cooking time.
5. Spray a 10 cup (2.5 L) oblong baking dish with vegetable oil cooking spray. Spread nutty rice
but moderate sun exposure is healthy
88 Nova Scotia chicken farmers
84,000 tonnes of feed
48 million kilograms of chicken grown annually
$75 million in revenue at the farm gate
Nova Scotians who trust fresh, local Nova Scotian chicken
• Supply management is a uniquely Canadian approach to agricultural production that
benefits farmers, processors and consumers.
• Farmers get a fair return for their products and processors get a reliable supply of
product.
• Consumers are provided with a consistent choice of excellent and high-quality products
at reasonable prices.
• Retailers determine the price paid at your local grocery store, not the farmers.
• Canadians have said they want Canadian-produced food and support Canadian farmers.
• Supply management operates without government subsidies.
Chicken, a good choice!
• Chickens are grain fed, primarily a blend of corn, wheat and soybean.
• Chicken production in Canada prohibits the use of hormones or steroids.
• Chickens raised for meat in Nova Scotia roam freely in large,
environmentally-controlled barns.
www.nschicken.com · 902-681-7400
The conventional wisdom passed down
through the generations from nonmedical sources (mainly mothers and
grandmothers) is impressively sound:
• “Cod liver oil is good for you” (and
now we know that’s because of
omega-3 fatty acids).
• “Fish is brain food” (and science has
proven that advice to have validity,
omega-3 again).
• “Carrots are good for your eyesight”
(and modern science verifies that beta
carotene in carrots does, in fact,
benefit the eyes).
How unsophisticated, poorly educated
people developed such knowledge is
quite another question.
Then we have the big one from
grandma—“moderation in all things…”
And as we increasingly assume
more control of our own health,
and increasingly educate ourselves
in that regard, we grow increasingly
frustrated with seemingly contradictory
information out there—one day
something is good for you; then another
study changes all that.
Exposure to the sun is perhaps the
best example of a case in point. We’ve
seen a huge volume of media coverage
of the sun exposure-skin cancer risk
scenario in recent years; the public has
responded by covering up—and we are
especially protective, of course, of our
children.
Excessive UV radiation means skin
damage. Skins cancers are the most
dangerous risk, of course, but premature
aging of the skin (and the skin is an
organ don’t forget), while cosmetic,
represents a significant risk as well.
But just a minute—along comes
10
Living Healthy In Atlantic Canada •
Spring 2014
nito/Bigstock.com
1 lb
2 Tbsp
1 Tbsp
3 Tbsp
2 cups
1 tsp
1/8 tsp
1/4 tsp
1/2 tsp
1 cup
4 cups
1 cup
1 Tbsp
1/4 cup
1/2 tsp
Hello sunshine
over bottom of dish and top with the broccoli spears, cooked chicken, sauce and the remaining
grated cheese. Sprinkle with paprika.
6. Bake uncovered in a preheated 350ºF (180ºC) oven for 45-60 minutes until bubbling and lightly
browned.
another parade of medical sources
warning that we need some sun
exposure to assure optimum health and
that our bodies are hard wired that way.
What to believe?
Moderation seems to be the best
advice at this point.
Like most medical questions, it’s
complex.
What time of day, for instance,
presents the most cancer risk?
Answer—we’re not sure.
The amount of UV light exposure
Spring 2014 •
depends on time of day, time of year,
elevation, and cloud cover. Weather
services nowadays offer UV forecasts on
a numerical scale.
But researchers are still struggling
with determining which type of
ultraviolet radiation (UVA or UVB)
actually poses a cancer hazard from
overexposure and ultraviolet radiation
actually changes throughout the day.
Ultraviolet B (UVB) is the exposure that
gives our bodies vitamin D—a vital
element almost impossible to get in
Living Healthy In Atlantic Canada
11
Natural sources of vitamin D
Yastremska/Bigstock.com
fed newborns are at higher risk of
vitamin D deficiency and of developing
rickets, and so we supplement their diets
with the vitamin these days.
The elderly
As we age, our capacity to manufacture
vitamin D wanes. Many older folks,
especially those living in nursing homes,
are vitamin D deficient out of lack of
sun exposure. Vitamin D deficiency is
a known risk in bone health, and the
elderly, of course, are most prone to bone
density problems.
Failure to protect the eyes from
UV rays can also encourage the
development of cataracts.
The rest of us
We assume the most potentially
dangerous time of day for exposure is
We also know that an early life sunburn
can increase susceptibility to skin cancer later in life.
Children
A Swedish epidemiologic study found
that having a sufficient source of
vitamin D in early life was associated
with a lower risk of developing type 1
diabetes later.
We also know that an early life
sunburn can increase susceptibility to
skin cancer later in life.
And some reports indicate that breast
12
holbox/Bigstock.com
sufficient amounts from food. Vitamin
D3 supplement pills, while valuable
during the winter months in northern
latitudes, are less efficiently processed by
the body than vitamin D from natural
sunlight. (Apart from the fact we tend
to spend less time outdoors in the cooler
months, peak ultraviolet radiation in
the summer can be 1,000 times higher
than in winter.)
So, what does responsible, moderate
sun exposure do for us?
Fear of excessive UV radiation and possible skin damage has us slathering on sunscreen—especially on children.
Living Healthy In Atlantic Canada •
Spring 2014
high noon when the sun is strongest,
but there are also variations in intensity
resulting from skin tone (fair-skinned
people are at highest risk while dark
complexions require about five to six
times more solar exposure than pale skin
for equivalent vitamin D absorption).
Geographic latitude is a factor
because the sun is most intense closest to
the equator (or places lying under a very
thin ozone layer, such as New Zealand),
the amount of exposed skin, and so on—
but the “moderation” factor still calls for
some exposure to the sun most days for a
brief period of about 20 minutes or so.
Why?
• Exposure to ultraviolet light, in
safe doses, is related to a healthy
immune system and can help prevent
autoimmune diseases and mitigate
against hypersensitivity and skin
disorders such as psoriasis. Ironically,
limited sun exposure is thought to
actually reduce melanoma risk by
assisting gene repair.
• Responsible sun exposure also appears
to promote a chemical reaction in
the skin, producing mood-improving
endorphins (perhaps partially
explaining why we tend to be moody
and depressed in mid-winter).
• Moderate, safe exposure of skin to
sun releases a compound (nitric oxide)
known to reduce blood pressure and
cut the risk of heart attack and stroke, a
University of Edinburgh study suggests.
(And in northern climates, heart
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• It also helps us manufacture
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which also goes to mood, quality of life
generally and vital health.
So: Sun worshipping without effective
protection or excessive use of tanning
salons, can be hazardous to your
health…
But a nice walk on a nice day is one of
the best things you can do for yourself.
Grandma was right. Moderation and
common sense are key.
The independence you want,
with the assistance you might need.
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Spring 2014 •
Living Healthy In Atlantic Canada
13
A very personal pain
Increased awareness of endometriosis means
more women are now receiving treatment
It’s a disease that does not have a high
public profile, but its incidence and
attendant social costs are considerable.
Public education and advocacy
literature related to endometriosis
sometimes depicts a woman with strands
of barbed wire wrapped around her
midsection. For those afflicted with this
gynaecological condition, the metaphor
is apt. It conveys not only the debilitating
physical pain that accompanies many
cases, but also the psychological effects
and the loss of freedom associated with
symptoms of the disease or resulting
fertility problems.
Endometriosis occurs when tissue
similar to the uterine lining (the
endometrium) forms in other parts of
the pelvic cavity, attached to organs
such as the ovaries, fallopian tubes,
uterus, bladder, or bowel, or on other
surfaces within the abdomen. Like the
endometrium, these abnormal tissues
are stimulated by hormonal changes
occurring with the menstrual cycle,
which can cause pain and internal
scarring as well as infertility. “My
special interest is endometriosis, so
I see it almost every day,” says Dr.
Gillian Graves, at the IWK Health
Centre’s department of obstetrics and
gynaecology.
“Every gynaecologist would see it
on a regular basis. Among the pelvic
pain population, probably 35 per cent
of them have endometriosis when you
further investigate it. In the infertility
population it’s about 18 per cent.”
The scoring system used by the
medical profession categorizes cases
of endometriosis as minimal, mild,
14
Kletr/Bigstock.com
by David Lindsay
moderate or severe, based on the
condition’s impact on fertility. But Dr.
Graves points out that these scores do
not necessarily correspond with pain
symptoms. Even severe endometriosis,
involving large cysts or significant
structural abnormalities, may go
unnoticed until discovered incidentally
when a woman has her regular pap
smear. On the other hand, a tiny spot
of endometriosis may cause extreme
discomfort, resulting in repeated trips to
emergency.
“It has variable presentations,” says
Dr. Graves. “As a cause of pelvic pain it
is a pretty big issue in young women,
and it can be crippling, and lead to loss
of school time, job opportunities.... It’s
cyclic pain, every month. Even with
treatment, it’s not always controlled. It
affects everything—their career, their
social life, in some cases their sexual
capacity because it hurts to have
intercourse, it hurts to have a bowel
movement.”
The investigation of possible
endometriosis may include an imaging
test, such as an ultrasound, as well
as physical examination. The gold
standard for diagnosis is laparoscopy, a
Living Healthy In Atlantic Canada •
Spring 2014
minimally invasive procedure involving
the insertion of a tube through a
small incision in the abdominal wall,
to examine the internal organs. If
endometriosis cysts or scar tissue are
identified, the surgeon may be able to
remove or destroy them on the spot.
But Dr. Graves notes that laparoscopy
is expensive, and it is not without
risk, so the Society of Obstetricians
and Gynaecologists of Canada has
recognized the value of treating some
© Blausen Medical
Ask the professionals
suspected cases of endometriosis in
the absence of a rock-solid diagnosis.
The first line of treatment is oral
contraceptives, along with non-steroidal
anti-inflammatory drugs such as Advil,
Aleve or Motrin.
“Usually it works, if you create a
situation where the patient doesn’t have
periods, using the pill continuously. It
causes a pseudo pregnancy-like state. It’s
very effective for women who have cyclic
pelvic pain.”
For some cases, injectable or
intrauterine hormonal contraceptives
may be prescribed. “We have lots of
different therapies,” says Dr. Graves, “but
unfortunately for some women they
need narcotics sometimes for the pain,
because it can be really disabling.”
Because many cases are never
confirmed by laparoscopy, it’s hard
to know exactly how common
endometriosis is. It’s also hard to know
whether the condition’s incidence is
changing, because increased awareness
has resulted in more women receiving
treatment. One thing we have learned is
that heredity plays a significant role.
“There’s a seven-fold increased risk
in your first-degree relatives if there’s
an indexed case in the family,” says Dr.
Graves. “If you have an aunt who’s
infertile and has known endometriosis
in this day and age, where laparoscopy
is available and everyone has health
insurance, it is far more likely that you’re
going to be doing more investigation
of the female relatives of that indexed
case. Whereas in 1952, if Auntie Sophie
had a chocolate cyst (a cyst caused by
endometriosis), it was treated by open
surgery, possibly by a general surgeon;
nobody would talk about it, and we
didn’t know anything about its genetics.
The growth of tissue, similar to the kind that lines a woman’s uterus, elsewhere in her body. That ‘elsewhere’ (highlighted as
dark red areas) is usually in the abdomen. This misplaced tissue responds to the menstrual cycle in the same way that the tissue
lining the uterus does: each month the tissue builds up, breaks down and sheds. Menstrual blood from the uterus flows out of
the body through the vagina; however, the blood and tissue from endometriosis has no way of leaving the body. This results in
inflammation and sometimes scarring (adhesions), both of which can cause the painful symptoms of endometriosis.
So we are looking for it more.
“Plus, women are in the workforce,
so it’s a different world right now,
compared to when people were told
that periods should be painful and it’s a
woman’s role to suffer, etcetera. ‘Have
a baby and it will go away.’ That used to
be common, because people didn’t have
treatment.”
Another factor that could play a role
is the high proportion of the population
carrying extra weight. “Over 40 per
cent of the young women of Nova Scotia
right now are greater than the expected
BMI,” points out Dr. Graves. “Those are
the future reproducing women. BMI has
a high link to endometriosis because fat
“There’s a seven-fold increased risk
in your first-degree relatives if there’s an indexed
case in the family,” says Dr. Graves
Dr. Gillian Graves
Spring 2014 •
tissue makes estrogen; estrogen drives
endo. So we may be seeing a change in
the epidemiology of the condition.”
Smoking, too, is thought to increase
the likelihood that a woman will
develop endometriosis, because it
suppresses the immune system. Even
if you are genetically predisposed to
the disease, maintaining overall good
health improves the odds of avoiding
it. Dr. Graves’ advice is to get a regular
pelvic exam, get plenty of exercise, and
generally take good care of your body.
“The trouble is,” she says, “healthy
people can still get sick.”
“General gynaecologists are
very comfortable dealing with
endometriosis—diagnosing it and
treating it. However, there are some
special cases that would be sent here
(the IWK) because we are the regional
tertiary care infertility service. Some
endometriosis cases have the potential
for infertility if you have severe
disease, and some of them are already
older and are worried about fertility
potential, and some of them have
really tremendous surgical problems
where the bowel needs resection, or the
bladder or kidney tubes—challenges
where you need a big team, and that
often gets referred here.”
Living Healthy In Atlantic Canada
15
The wellness column
A healthy approach
Hall says the risk paid off.
The two initial teams were able to show
impressive results, something difficult to do in a field
where outcomes are usually measured in decades.
Community-based health programs reap big rewards
by Megan Venner
16
risk factor for heart disease and diabetes,
and one particular program aimed at
the morbidly obese showed a 25 per
cent increase in participants’ ability
to maintain optimum adult activity
levels of 150 minutes a week. It’s been
enough to garner funding to expand
the program to two more sites, one in
Bedford and one in urban Halifax.
The province too is accepting the need
for this shift in focus. Chronic conditions
like cancer, heart disease and diabetes
are expected to account for 75 per cent
of deaths world-wide by 2020, and Nova
Scotia still has some of the highest rates
of those conditions in the county.
“There’s much more
acknowledgment that we really have
an illness care system and we need
to be moving upstream to decrease
the demand for that care,” says Nova
Scotia’s chief medical officer, Dr. Robert
Strang.
The province has responded with
Thrive!— a comprehensive strategy
aimed at creating healthy communities,
and supporting people as they make
healthy changes in their lives. The
government has already spent $5
million on Thrive! and more is expected.
Barbara Hall, a vice-president with
Capital Health and health promotion
advocate. Taking a million dollars out
of the budget to fund two community
health teams (Dartmouth and Spryfield)
was no easy feat, but Hall says the risk
Living Healthy In Atlantic Canada •
Spring 2014
paid off. The two initial teams were able
to show impressive results, something
difficult to do in a field where outcomes
are usually measured in decades.
Participants showed a 15 per cent
drop in metabolic syndrome, a major
style-photographs/Bigstock.com
Digital Storm/Bigstock.com
Bernadette Maillet didn’t seek out the
Nova Scotia health care system because
she was sick… she went looking because
she wasn’t feeling healthy. Two years ago
the Armdale resident was newly retired
and found herself sitting on the couch
watching TV. Her blood pressure and
cholesterol were on the rise and arthritis
was developing in her hand and knees. “I
wasn’t doing anything,” says Maillet.
Then Maillet found her local
community health team. A relatively
new program for Capital Health, the
teams are made up of health promotion
specialists like dieticians, occupational
therapists and social workers, whose
sole goal is to help Nova Scotians live
healthier lives.
Maillet took part in free exercise
and nutrition classes. She now walks
regularly with a group and has changed
her eating habits. “It’s improved my
health tremendously.” Maillet’s blood
pressure is under control, her arthritis
doesn’t bother her and her social life
has improved. “I’m not sitting around
waiting for my husband to come home
so I can complain about how bored I
was today.”
The changes Maillet is making
today will reap benefits well into the
future. Studies show that people who
participate in free, community-based
wellness activities, such as Maillet is
doing, are far less likely to need the
acute care system later.
Getting these programs up and
running, however, took some work.
Wait times, emergency room closures
and doctor shortages get the attention
and, therefore, the budget lines.
“It was a big leap of faith,” says
www.csep.ca/guidelines
The Canadian Physical Activity and
Sedentary Behaviour Guidelines handbook
is published by The Canadian Society for
Exercise Physiology (CSEP).
Studies show that people who participate in free, community-based wellness activities are far less likely to need the acute care system later.
Spring 2014 •
“We’re just at the beginning stages
of this,” says Strang. He’s hopeful it’s
the beginning of a fundamental shift
not only for health care but society as a
whole—such as community planning
to increase active transportation,
like walking and biking, and making
changes in how fast food, tobacco and
alcohol are marketed.
Changes in government policy or
launching media campaigns may not
seem like health care in the traditional
sense but studies show such initiatives
can create real change over time.
Smoking rates are a good example. The
battle against tobacco involved changes
in legislation and public education
programs, even social media has been
used in recent years. The results are
impressive, and measurable. In the last
15 years smoking rates in Nova Scotia
have dropped 15 percent.
All this is good news to Jackie Spiers,
manager of primary health at the IWK.
“We were getting bogged down with the
very expensive cost of chronic disease.”
Health promotion is an essential piece of
the system, Spiers adds, not only from a
financial standpoint but also for peoples’
quality of life.
On the front lines, change is about
helping someone learn how they might
Living Healthy In Atlantic Canada
17
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People know they have to get active,
Shelton says, but there are a lot of barriers both real and
perceived. “We don’t have to be athletes.”
avoid another stroke or helping a family
establish healthy eating habits. The
child who learns about healthy eating
at school takes that information home
to the dinner table. The father who
increases his own activity level will
help his kids develop the same habits.
Bernadette Maillet says her husband is
benefitting from the community health
team as well, despite never setting foot
in a class.
Step by step
Just one of the many health promotion programs
available to Nova Scotians is the Heart and Stroke
Foundation’s Walkabout initiative. It has one, very
simple goal in mind: To get Nova Scotians walking.
Eighty-five percent of Canadians are inactive and
the foundation aims to change that, one step at a
time. “We have to shift the way people are thinking,”
says Elaine Shelton, director of health promotion
with the Heart and Stroke Foundation in Halifax.
People know they have to get active, Shelton
Living Healthy In Atlantic Canada •
Spring 2014
“His eating habits have changed
tremendously. Lentils… he would never
eat them before but now I can add them
to things and he doesn’t even know they
are there.”
The couple is now walking together
on weekends and trying new activities.
“I’m trying to get him to go skating but
he won’t go for that one, yet,” Maillet
adds with a smile.
says, but there are a lot of barriers, both real and
perceived. “We don’t have to be athletes.”
Walkabout is about reminding people of the joy
of simply going for a walk. Through social media,
facilitating walking groups and work place training,
Nova Scotians are going the distance. More than
15,000 pedometers have been sold or loaned through
the program, and so far the website reports nearly
two billion steps taken by more than 11,000 people.
Healthy changes, step by step.
Hear, hear
New bone implant
surgery helps PEI mom
by Donna D’Amour
Shannon Micallef
is smiling. Free from wearing hearing aids for
the first time in almost 35 years, Shannon,
a Charlottetown mother of three, became the first person in North America to receive bilateral
Bonebridge hearing implants last fall.
Shannon was just 18 months old when her parents noticed her putting her ear to the
television screen to hear. She has worn hearing aids ever since.
“I have bone conductive hearing loss. The bones inside my ears are misshapen and don’t do
their job,” says Shannon. “Wearing traditional hearing aids, where you have the mold in and
behind your ear, for almost 35 years had taken a toll on the inside of my ear. I had lots of ear
infections and ruptured ear drums. Something had to change.”
When Shannon had these painful ear infections, she couldn’t wear her hearing aids; during
these episodes in younger years she couldn’t go to school and as an adult she was unable to go
to work.
Shannon was referred to ear surgeon Dr. David
P. Morris at the Queen Elizabeth II Health Sciences
Centre in Halifax, who began last March by trying
to work with her natural hearing. Years of wearing
two powerful hearing aids left the skin inside
Shannon’s ear macerated and itchy; her ear drum
was weakened and had a hole in it. Dr. Morris
wanted to patch up the ear drum so Shannon
could wear her hearing aids. “At the same time,
we explored the middle ear to see if we could do
Shannon Micallef at home with
her three children. “My kids think
I’m part robot now,” she says.
something with the little bones to get some sound
in there. I was very careful not to go too far or
damage the inner ear,” says Dr. Morris.
The ear drum repair went well, but Shannon’s
hearing didn’t improve. “The palpable
disappointment at that clinic visit was quite
something,” he says. “I felt sure we should be able
to do something else for her.”
Dr. Morris had been to a surgical course in
Berlin, Germany, in November 2012, to observe
Spring 2014 •
Living Healthy In Atlantic Canada
19
Donna D’Amour
If a
stroke is
suspected
the new Bonebridge transcutaneous
(under the skin) bone conduction
implant surgery. He wondered if
Shannon might make a good candidate.
The device had been approved by Health
Canada and 600 successful operations
had been done in Europe and elsewhere.
The Bonebridge device, developed by
MED-EL, based in Austria, is comprised
of an internal section and an exterior
processor, held in place by a magnet.
Dr. Morris says this surgery is more
of a bone and scalp surgery than an ear
operation. “We make an incision about
four centimetres long in the skin crease
behind the ear. It’s a simple dissection
down to the skull itself. We take a little
drill and drill a housing on the side of
the temporal bone. The device is actually
recessed into a well on the side of the
skull and is secured by two little screws,”
he says.
The incision is closed and the external
magnetic microphone and processor are
placed behind the ear to line up with the
internal component. “The microphone
transmits sound to the coil under the skin
which sends it to the disk, then to the
cylinder which vibrates through the little
screws in the temporal bone. The inner
ear is part of the temporal bone. You see
the little cochlea, the snail shape with little
hair cells for hearing, so it’s like putting
your ear to the table and me knocking on
the table. You will hear it extremely well. It
is direct bone conduction going all the way
20
through to the inner ear,” says Dr. Morris.
The device works with the hearing
ability of the inner ear, which is why it
was important during Shannon’s initial
ear drum surgery to protect the inner ear.
The implant keeps the skin intact
between the internal and external
sections, unlike traditional cochlear
implants, which involves both an internal
surgical device and an external piece—
attached by a screw that protrudes
through the skin and requires daily care
and cleaning by the patient, as well as
regular monitoring by the surgeon.
“The biggest difference for me is
letting my ear be my ear. Now I can
actually get air in there,” says Shannon.
Shannon hears more clearly now
Bonebridge facts
• Cost of one device, including internal and
external sections, is $10,000.
• Initial surgery and device is covered in NS; similar
arrangements have been negotiated with PEI and
NB. PEI covered Shannon’s costs.
• Replacement costs for external component (every
5 years) is the recipient’s responsibility.
MED-EL, producer of the Bonebridge implant, is
based in Innsbruk, Austria, but has 8 home-based
audiologists across Canada.
• The first Bonebridge implant was performed in
Austria in 2011.
• Unilateral Bonebridge implants have been done
in other provinces in Canada.
Living Healthy In Atlantic Canada •
Spring 2014
than she did with her hearing aids. She
can talk with a friend at a restaurant
and still hear the background music.
Dr. Morris is very pleased with
Shannon’s high frequency hearing
and ability to discriminate between
consonants—the type of hearing that
often diminishes as a person ages,
making conversations difficult. Shannon
keeps a daily journal of new sounds—
like car keys jingling as she drives, her
feet scuffing on the floor. “My kids think
I’m part robot now,” she says smiling.
Since last summer, Dr. Morris has
done seven implants for six patients in
Nova Scotia, New Brunswick and Prince
Edward Island, including Shannon’s
bilateral implants. He says the implants
are not for everyone. They are meant for
people who cannot wear regular hearing
aids. He and his colleague have been
doing between 30 to 40 traditional bone
anchored hearing device operations a
year for the past 10 years.
The internal section never needs
replacement; the external piece must be
replaced every five years.
Recipients have reported the device
is more comfortable, less visible and
requires fewer doctor follow-ups than
conventional implants, says Cathy
Creaser, a Halifax-based audiologist and
clinical specialist with MED-EL.
“There’s a lot of excitement about
being able to offer an intact skin bone
conduction solution.”
digitalista/Bigstock.com
Donna D’Amour
Left: Dr. David P. Morris, ear surgeon, Cathy Creaser, MED-EL clinical
specialist, and bilateral Bonebridge recipient Shannon Micallef.
Above: The Bonebridge active bone conductive implant in a model
temporal bone.
Call 911—minutes matter
by Darcy Rhyno
You’re
carrying the groceries in from the car, a bag in each hand. Suddenly, your
left arm goes numb. Your hand doesn’t work, and the grocery bag slips from
your fingers. A carton of eggs tumbles from the bag and a few of them smash on the ground.
Your spouse notices and comes to help, asking you what happened. When you answer that it’s
nothing, just a moment of weakness, your speech is slurred.
Do you pause and clean up the eggs, do you get yourself inside, with a little help, and sit down
while your spouse takes care of the groceries or do you call 911? The decision you make now
could change your life forever, perhaps even end it.
Weakness, numbness and difficulty with speech are among the most common signs of
stroke. Something has gone wrong with the blood flow in or to your brain. Vision, headache and
dizziness are the other common symptoms. If this is a stroke, you have about four and a half
hours to get medical attention for the best chance of recovery.
However, if you’re like most people, you’ll clean up
the eggs or rest, unaware that permanent damage is
being done to your brain. According to Dr. Gordon
Gubitz, assistant professor at Dalhousie University
and a stroke neurologist at Capital Health in Halifax,
only about 12 per cent of Nova Scotians, who suffer
from a stroke get medical attention within that fourand-a-half-hour window. As disconcerting as that
statistic is, it’s better than the national average of
about eight per cent.
More than 10,000 Canadians die each year from
a stroke and almost 300,000 live with the sometimes
devastating after-effects.
Short term treatment
Don’t hesitate when it comes to stroke says Dr.
Gubitz. “Call 911. That’s the most important
thing.” Every hour of delay in treating a stroke
is the equivalent of 3.6 years of normal aging.
Because the clock is ticking, it’s vital you get
professional help immediately.
First responders will make every effort to get
you to a stroke centre or at least to an emergency
department trained for early stroke assessment.
A blood test and CAT scan of the brain can tell
physicians if you’ve had a stroke and which
treatment will lead to best recovery.
Spring 2014 •
Living Healthy In Atlantic Canada
21
Courtesy of QEII Foundation
A patient learns how to negotiate
sidewalk curbs at the Nova Scotia
Rehabilitation Centre.
Nova Scotia has seven stroke centres, PEI one.
Newfoundland has three stroke units and stroke
patients are treated within designated care areas in
New Brunswick hospitals.
The average length of stay on Dr. Gubitz’s
stroke unit is a week to 10 days. Most patients are
discharged back into the community. Some might
require longer term, more complex rehabilitation
at the Nova Scotia Rehabilitation Centre in Halifax.
Some patients don’t recover and go into long
term care or back into the community with home
support. While 10 per cent recover completely,
about 15 per cent never leave hospital. Stroke is the
fourth leading cause of death in this country.
Stroke statistics
• Cancer, heart disease and stroke are the leading causes of death in Canada and
in the Atlantic Provinces.
• Over 10,000 Canadians die each year from a stroke and almost 300,000
Canadians live with its after-effects.
• About 1500 Nova Scotians experience a stroke each year.
• Cardiovascular diseases combined account for 32 per cent of all deaths in NS.
• Strokes accounts for 22 per cent of all cardiovascular disease deaths in NS, therefore, 7 per cent of all deaths in NS are due to stroke.
• In New Brunswick between 2004-2005, there were 1,103 discharges from hospitals for which the most responsible diagnosis was stroke.
• PEI stroke death rates are similar to the national average and have remained
steady over the years.
22
Living Healthy In Atlantic Canada •
Spring 2014
Dr. Gubitz advises against taking aspirin if a
stroke is suspected. That’s because if your stroke
is hemorrhagic (one of 20 per cent caused by
bleeding in the brain) rather than the 80 per cent
that are ischemic (caused by a blood clot) aspirin
can make the bleeding and your stroke worse.
“Our job,” says Dr. Gubitz, “is early, quick
assessment of patients who might benefit from
medication to dissolve a blood clot—‘clot-busting
drugs’ as they’re called. Tissue Plasminogen
Activator (t-PA) is the one we use. If we can get to
people early enough and restore the blood supply to
the brain, the damage isn’t always as severe. We’re
hopeful people will have a better outcome down the
road.” About 25 per cent recover with only minor
impairment.
Aside from early assessment and treatment, the
other important predictor of best recovery is getting
admitted to a hospital’s stroke unit. “We know
having an interdisciplinary stroke team is the best
way to achieve the best recovery,” says Dr. Gubitz.
Physicians, nurses, physiotherapists, occupational
therapists, nutritionists, speech pathologists and
even swallowing specialists assess stroke victims.
“It’s all about rehabilitation and therapy and
a consistent approach, even in the short term.
Therapy starts on day one.”
Long term recovery
Dr. Gubitz says long term recovery has three
components. “There’s the prevention bit. You want
to do your best to reduce vascular risk factors—
blood pressure, cholesterol, diabetes and smoking.
Understand which risk factors you have and if
they’re under control. The second is the physical
recovery—making sure you’re being seen by the
right therapist. The third factor is community
re-engagement and social recovery. Stroke can
be isolating. If you used to go bowling with your
friends, and you can’t go bowling any more, that
part of your life gets closed down.”
Prevention is first up because a stroke survivor
has a 20 per cent chance of having another stroke
• Each year, more women than men die from stroke.
• There are between 40,000 to 50,000 strokes in Canada each year.
• After age 55, the risk of stroke doubles every 10 years.
• Of every 100 people who have a stroke:
15 die (15 per cent)
10 recover completely (10 per cent)
25 recover with a minor impairment or disability (25 per cent)
40 are left with a moderate to severe impairment (40 per cent)
10 are so severely disabled they require long-term care (10 per cent)
• For every minute delay in treating a stroke, the average patient loses 1.9
million brain cells, 13.8 billion synapses and 12 km of axonal fibres (Saver, 2006).
• Each hour in which treatment does not occur, the brain loses as many neurons as
it does in almost 3.6 years of normal aging.
within two years. “We look at the underlying cause
of the stroke,” says Dr. Gubitz. The number one
cause is high blood pressure.” Drug therapy might
be required—blood thinners like aspirin, warfarin
and others, cholesterol medications—but a priority
for Dr. Gubitz is healthy eating. “Get the salt out of
your diet, cook smarter,” says Dr. Gubitz, “or it’s
going to reoccur.”
Physical, mental and emotional recovery is
improved when patients take up a more physically
active lifestyle. Dr. Gubitz suggests a patient consider,
“Is there a better way I can learn to bowl? Is there
something else I can do with my friends? Walking
is a simple activity most can do. It doesn’t cost any
money. It’s something you can do with friends.”
Dr. Gubitz would like to see everyone, not just
stroke survivors, walk 15 to 20 minutes a day.
“If everybody did that, most of us would be a lot
healthier.”
Functional recovery is the goal. Physio and
occupational therapy starts right away. “The
therapists are the building blocks of recovery,” Dr.
Gubitz explains. “Physical activity, aerobic activity,
muscle strengthening are hugely important. A
lot of the therapy involves repetitive exercise,
focused tasks to try and improve hand function, for
example.” The hand is an important part of daily
activity, so a good portion of the brain is dedicated
to its function.
“The sooner we engage people with
rehabilitation, the better their chances of being
more independent than they would have been.” In
rehab, survivors work on self-care skills like feeding,
dressing and bathing, as well as communication,
thinking and social skills.
In some cases, a Botox treatment might even
be useful. “For people who have weakness in an
arm or a leg, as time passes, the muscles tend to
tighten. They might become spastic. The spasticity
can sometimes interfere with function. You’d like to
move the hand and you could if it wasn’t so tight.
We use a bit of Botox here and there to loosen it up
to improve positioning and function. It sometimes
helps the pain as well because if the muscles are
Dr. Gordon Gubitz, assistant professor at
Dalhousie University and a stroke neurologist
at Capital Health in Halifax.
constantly tight, it can make the joints sore.”
To assist with community re-engagement,
patients and their families often turn to support
groups and organizations. In larger centres, stroke
recovery clubs offer chances to meet and engage
with other survivors. If there isn’t a club in your
area, Dr. Gubitz suggests starting one. “And check to
see whether or not there might be services in your
community you might not know about.” The Heart
and Stroke Foundation is the best place to start
when it comes to finding resources and making
connections. “A lot of it is to help demystify stroke.
Once they meet a few people who’ve had a shared
experience, they can problem solve together.”
Prevention is the best medicine
“Of course, you’d rather never have one,” says Dr.
Gubitz of stroke. So he suggests addressing those
four risk factors—blood pressure, cholesterol,
diabetes and smoking. Being physically active
and eating well are two easy and enjoyable places
to start. “Shop around the outside of the store if
you’re going to eat healthy. The processed foods
are all in three aisles in the middle.” Like stroke
survivors, we’d all be better off if we left the car
at home and walked to the store for the groceries.
Fewer eggs would get broken.
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Spring 2014 •
Living Healthy In Atlantic Canada
23
Lack of adequate hearing care in seniors’
homes an international reality
Hearing
loss has several causes, but the most
common is aging. Most of us will suffer
auditory dysfunction as we age.
Loss of hearing leads to loss of socializing opportunity and
“tuning out.” Lack of regular social engagement can exacerbate
the progression of various forms of dementia at worst, or, at best,
merely lower the quality life.
Modern technology has seen the development of some very
sophisticated (and correspondingly expensive) hearing devices—
but all require at least a minimum of regular maintenance, from
merely changing batteries, to cleaning, to periodic technical
maintenance and retesting.
24
Living Healthy In Atlantic Canada •
Spring 2014
Most elderly folks require assistance with
hearing aid maintenance. Family will normally
provide such assistance to parents living at home
and arrange hearing tests, etcetera—but what of
those living in extended care facilities?
Studies—one done here locally, another in the
U.S. and a third in the U.K.—all arrived at very
similar conclusions… elderly people living in longterm care homes are not getting their audiology
technology needs attended to, something that could
be easily remedied with minimal staff training.
In the Halifax study, for instance (undertaken,
incidentally, by two masters audiology students)
A World of Silence, a British study on hearing,
recommended the following:
•
•
•
•
•
•
•
•
•
•
•
To make sure that their staff receive training so that they understand and meet
residents’ communication needs.
To have clear procedures around assessment and recording of hearing loss and
to ensure that staff follow these procedures.
To ensure that staff know how to recognize hearing loss and what they can do if
they think that a resident has an undiagnosed hearing loss.
To consider and manage environmental factors, such as seating arrangements
and background noise, that affect residents’ ability to hear.
To ensure that staff are aware of communication tactics for people with hearing
loss, and that they use these.
To use induction loops and assistive technology to support residents where this
will enable them to hear better.
To ensure that staff understand how to use hearing aid controls, such as the
volume control and the ‘T’ switch.
To ensure that hearing aids are effectively maintained and batteries are replaced
as appropriate.
To minimize the number of lost hearing aids, and to ensure that lost hearing
aids are replaced as quickly as possible.
To consider how training can deliver an appreciation of what hearing loss
feels like.
To assess residents’ hearing when they enter their care home.
management of hearing loss a major priority.”
Both residents and staff said they had trouble
adjusting hearing aids. On the other hand,
that study found that caring staff, untrained in
hearing device maintenance, had devised means
and methods for effectively communicating with
hearing impaired people in their care.
“For example, we witnessed care home staff
making sure they were looking directly at residents
when they were speaking to them. High levels of
background noise, such as the TV or radio being on
constantly, can make things more difficult for people
with hearing loss. Many staff did demonstrate an
awareness of how this affected residents and, in
some cases, took steps to minimize this.”
feierabend/Bigstock.com
alexraths/Bigstock.com
Hard to hear
noticeable problems included receivers and tubing
plugged with earwax and dead batteries—“all
problems that nursing home staff members could
fix with relative ease.” In all, fully one third of
hearing aids examined were not functioning on
either a listening check, visual inspection or an
electro-acoustic evaluation.
“Previous research has shown that hearing
loss can result in communication barriers leading
to depression, decreased cognitive functioning,
impaired ability to perform daily activities, social
dysfunction, and decreased quality of life…
“The present findings indicate greater need
for audiological services on site in long-term care
facilities and for nursing staff training in hearing
aid maintenance.”
Although the situation does appear to be
improving. A 1988 study in Texas revealed 72 per
cent malfunctioning hearing aids in long-term
care facilities while a 2002 study in Michigan
found 45 per cent malfunctioning hearing devices.
Improvement in the reliability of the devices
themselves, though, is considered to be a factor.
The Halifax study noted: “This trend may be
attributed to improved hearing aid reliability and/or
more knowledgeable residents and staff members
regarding the trouble shooting of simple problems.”
In contrast, a recent study in the U.K. found 69
per cent malfunctioning devices in long-term care
homes.
The findings generally highlight the need for
regular hearing assessments in the retirement
community and nursing home population. They
also suggest the need for evaluation of institutionallevel policies regarding screening and hearing
aid management, as well as the need for further
information regarding potential barriers to effective
hearing aid use.
Among residents exhibiting hearing problems,
but who did not use a hearing aid, the major
problem was simple staff neglect. Staff, in some
cases, could not explain why residents did not have
a hearing aid, or not had hearing evaluations, and
staff members were not aware of hearing problems
in residents.
In one instance, almost half of the staff
members had not received any training in the use
or maintenance of hearing aid devices.
The U.K. study, entitled A World of Silence,
concluded:
“Our research confirmed what we already knew:
if care home residents’ hearing loss is managed
effectively, there is a real chance of improving their
quality of life. But, on the flip side, we also identified
a worrying trend—hearing loss not being diagnosed
and managed properly, flagging up an urgent need
for substantial improvements to be made. Managers
and staff in care homes must make the effective
Spring 2014 •
Living Healthy In Atlantic Canada
25
Children’s Building
Link Building
Children’s Emergency
Entrance
Dr. Richard
B. Goldbloom Pavilion
Women’s Building
General Entrances
CH Children’s Entrance
W Women’s Entrance
Please do not wear scented products when
visiting medical facilities.
Emergency
Entrance
IWK Health Centre
Professional
Directory
A patient’s story
Stroke fells young mother
For more information on advertising
Kimberley Csihas thought she had the flu—it wasn’t
in our Professional Directory
Story and photography by Donna D’Amour
please contact:
Kerri Slaunwhite
902 464 7258 ext. 232
On a warm August day last year,
Kimberley Csihas and her 18-month-old
son Jarvis were playing with sidewalk
chalk in the backyard. Suddenly
Kimberley felt like something hit her in
the back of the head. She dropped to the
ground, couldn’t walk, so she crawled
up the back steps calling to her husband
Andrew. He came running.
Once she got inside, she was throwing
up—a lot. They assumed she had the
flu, so she went to bed for a couple of
days. The vomiting continued, but on
the third day Kimberley was slurring
her words. Andrew rushed her to the
hospital.
“For a long time Andrew blamed
himself for not taking me to hospital
sooner, but we had no idea it was any
more than the flu … and even when we
went to hospital (because of the slurred
speech and her age) they thought I was
on drugs,” says Kimberley.
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No common risk factors
What the medical professionals didn’t
recognize at first was that this 32-yearold woman was having a stroke. People
that age are just not expected to have
strokes. What’s more, Kimberley had no
common risk factors—no family history
of heart problems; she didn’t smoke,
wasn’t on the birth-control pill and led
a very active life. She loved to swim, and
was an artist and a social worker.
“I was very healthy before I had the
stroke. I had actually lost quite a bit of
weight and I was exercising a lot,” she
says.
Kimberley Csihas at her home outside Halifax.
Kimberley and her husband Andrew moved to their
new home following her stroke.
28
Living Healthy In Atlantic Canada •
Spring 2014
Spring 2014 •
Living Healthy In Atlantic Canada
29
Since her stroke, Kimberley and Andrew have had to change their
household routines to accommodate what Kimberley can physically do.
One of her first goals was to be able to pick up her son Jarvis, and hold
him. She’s just mastered that one recently.
Fig. 1
The MRI showed that she had a blood
clot in her brain and required immediate
surgery.
“I woke up in hospital and I couldn’t
move and could barely communicate.
I realized I’d had a stroke, but no one
would give me a straight answer about
how long I was going to be there,” she
says. At first she couldn’t talk and would
point to letters to spell out questions and
answers. As the mother of a young child,
she desperately wanted to go home.
30
with her confidence, since she wanted
to return to swimming when she got
home.”
DeYoung also says the pool would
have given staff a better opportunity
to see how Kimberley’s abilities have
changed since the stroke, what she could
do and what she couldn’t.
“The therapy pool would also serve
people with spinal cord injuries, geriatric
patients, multiple-trauma patients who
may have weight-bearing restrictions.
The pool provides buoyancy, it takes the
pressure off joints, so it is good for people
with arthritis and joint pain,” says
DeYoung.
Living Healthy In Atlantic Canada •
Spring 2014
Time to go home
After three months, Kimberley went
home, a month earlier than the doctors
advised, but she couldn’t stand to be
away from her family any longer.
Those early days at home were rough.
She and Andrew are from Alberta and
Ontario respectively, so there was no
extended family here to help out. Her
sister travelled from Calgary to care for
Jarvis while Kimberley was in hospital,
freeing Andrew to spend his days at the
hospital. “Andrew was there from 7 a.m.
till 11 p.m. every day,” Kimberley says.
As a social worker who had just
completed her doula training, Kimberley
was used to being the person helping
others. She found it very difficult to
accept help from the nurses. The lack of
privacy also bothered her. As a stroke
victim, she was among mostly older
men. Andrew’s presence and daily care
were a huge help.
New daily routines
When she first came home, little Jarvis
was afraid to get too close to his mom,
worried he might hurt her. Kimberley
and Andrew had to make changes to
accommodate what she could physically
do. Kimberley relearned how to change
a diaper—physically demanding at
© Can Stock Photo Inc. / alila
“I wanted to go swimming”
The earliest words she remembers saying
were “water” and “swimming”. “That’s
because I wanted to go swimming so
bad,” she says.
Kimberley had loved swimming at
the Canada Games Centre in Halifax
before the stroke and now that she
was in hospital recovering, she wanted
to get back to it. While the Nova
Scotia Rehabilitation Centre staff
were a great help to her, the therapy
pool at the rehabilitation centre has
been closed since 2011 due to safety
and infrastructure risks. (The Queen
Elizabeth II Health Sciences Centre
Foundation currently has a fundraising
campaign to reopen the pool.)
Karla DeYoung, physiotherapist on
the Acquired Brain Injury Unit at the
rehabilitation centre says: “When I first
started working with Kimberley, she
didn’t have a lot of movement in her
leg and her balance was decreased. She
would have definitely benefited from
some strengthening work in the pool.
It would have been a nice transition for
her in terms of discharge planning to
re-integrate her into the community, to
practise swimming here in a controlled
environment. It would have helped
Fig. 2
Fig 1. About 80 per cent of strokes are ischemic, which means they are caused by the
interruption of blood flow to the brain due to a blood clot. The buildup of plaque (fatty
materials, calcium and scar tissue) contributes to most ischemic strokes by narrowing the
arteries that supply blood to the brain, interfering with or blocking the flow of blood.
Fig 2. About 20 per cent of strokes are hemorrhagic, which means they are caused by
uncontrolled bleeding in the brain. This bleeding interrupts normal blood flow in the brain
and by flooding the brain, kills brain cells. There are two main types of hemorrhagic stroke:
Subarachnoid hemorrhage is uncontrolled bleeding on the surface of the brain, in the area
between the brain and the skull. Intracerebral hemorrhage occurs when an artery deep
within the brain ruptures.
Spring 2014 •
Living Healthy In Atlantic Canada
31
Nutrition
she’s gained new insight into how difficult it
is for a disabled person to function day to day,
especially out in public.
first because she had lost the feeling
in one side of her body. (That feeling
is returning.) The bedtime routine
changed too. Instead of a bath before
bed—something Kimberley still can’t
do for Jarvis—Andrew bathes him
in the afternoon before he leaves for
work. Instead of rocking him to sleep,
Kimberley lies beside him until he drifts
off. One of her first goals was to be able
to pick Jarvis up and hold him. She’s
just mastered that one recently.
“Jarvis adjusted well to everything,”
Kimberley says, but she worries how
the situation they’re dealing with might
affect him later on. While she was in
hospital, Jarvis would say, “Mama” as
he and his father drove by the hospital,
or if he saw someone in a wheelchair.
Steady improvements
“The good news is that the stroke didn’t
affect my brain,” says Kimberley. Unlike
the female patient in the next bed who
lost her memory and the use of both
sides of her body, Kimberley’s memory
is intact. With daily physiotherapy
from staff at the rehabilitation centre,
she regained the use of her arm and
relearned how to walk. She still goes
to the centre regularly to work on
strengthening her arm (which now
has full movement) and on improving
her ability to walk. She has swelling
in her foot that requires her to take a
32
diuretic. She also developed a deep vein
thrombosis (DVT) in her unaffected leg,
from the period of inactivity. She takes
warfarin and has regular blood tests to
monitor this condition.
“Considering that I couldn’t move
at all or talk just after it happened, I’ve
come quite far.”
Her physiotherapist agrees.
“Kimberley is amazing. She has come
a long way and is a very motivated
person,” DeYoung says.
Kimberley says she’s gained new
insight into how difficult it is for a
disabled person to function day to day,
especially out in public. She’s had people
stare at her when she rode the scooter
cart at the grocery store, thinking she
was too young to use the scooter. She
says she can walk for a time but her
hips get sore and she has to rest, so she
rides the cart. She doesn’t go to public
pools because she believes people would
stare and make her feel uncomfortable.
She said she would go to the pool at the
rehabilitation centre, if it was available,
because the people there would also be
working towards recovery.
“We have to learn to be kinder to the
disabled,” she says. “While my injuries
will heal with time and hard work,
others will stay disabled for a lifetime.
And it’s all a struggle. It’s financially
hard, emotionally hard and physically
hard. It’s hard to relearn things.”
Living Healthy In Atlantic Canada •
Spring 2014
She worries about her husband as
well. “As a social worker, I know about
caregiver stress, so he has to be mindful
as he is taking care of us that he not
do everything. Sometimes he needs a
break.”
Her occupational therapist told her
not to think about going back to work
for at least 12 months, the worst case
scenario being two years. “He gave me
a big lecture about not thinking about
work so much; but I have been thinking
about what I am going to do when I go
back. I was told in hospital that social
work possibly could be a stress factor.”
(Kimberley was employed as a social
worker at a women’s shelter.)
“Right now my job is getting better
and being a mom to Jarvis and a wife to
Andrew.”
Kimberley Csihas is a soft-spoken,
caring, patient person, with wideranging interests and a great sense of
fun. Her home is warm and inviting.
Before her stroke, the couple lived in
a flat in downtown Halifax. Andrew
thought that wouldn’t be good for her
recovery, so he bought a house outside
the city, overlooking a lake. He felt
being surrounded by nature would
help. Kimberley agrees; the setting
helps her keep positive through the
long winter. She’s looking forward to
spring when she hopes to do a little
gardening.
The multivitamin debate
They have their value—but they’re no
substitute for a healthy diet
The question: to take a multivitamin or
not to take a multivitamin?
According to a recent academic
review that made international
headlines, supplements are a waste of
money in regards to chronic disease
prevention—but let’s not disregard
their benefit in preventing and treating
deficiencies .
A typical multivitamin contains
a balance of water-soluble vitamins,
including vitamins C, B12, B6, thiamine,
riboflavin, niacin, pantothenic acid,
biotin and folic acid; fat-soluble vitamins
A, K, D and E, and minerals such as
calcium, copper, iron, magnesium,
phosphorus, selenium and zinc—all
nutrients found in food.
Water-soluble vitamins are easily
absorbed and any excess is typically
excreted through the urine. Generally,
they need daily replenishment because
they are not stored in large amounts.
Fat-soluble vitamins are stored in the
body and not as readily excreted, they do
not need to be replenished as frequently.
They’re natural, why worry?
When obtained from food in their
natural form, it’s rare to ingest excessive
levels. But in pill form the levels tend to
be more concentrated, which can lead
to too much of a good thing. If this is
the case, you may be literally flushing
money down the drain—but even more
disconcerting is the potential risk of
adverse side effects and toxicity .
A standard multivitamin and mineral
supplement contains small levels of
micronutrients and typically poses little
risk for most, provided you stick to your
daily recommended dosage.
As for individual vitamins and
minerals, take extra caution with
vitamin D, calcium, vitamin A, niacin,
by Maureen Tilley, PDt.
Coprid/Bigstock.com
Kimberley says
iron, vitamin B6, fluoride and selenium,
as high doses can lead to toxicity and
also negatively impact the absorption
of other nutrients. Excessive vitamin
C, in doses higher than 3,000 mg, can
lead to gastrointestinal upset. Choose
supplements with a NPN or DIN number
as they are monitored by Health Canada
for safety and quality. Most importantly,
talk to your doctor, pharmacist or
dietitian before taking any supplements.
Who can benefit from supplements?
• It’s recommended breastfed babies
and adults beyond age 50 should take
400IU vitamin D supplement daily.
• Osteoporosis Canada recommends
all Canadian adults take a vitamin
D supplement, while Health Canada
recommends supplementation only
if your diet is inadequate or limited
direct skin sun exposure. All sources
Spring 2014 •
•
•
•
•
state that vitamin D supplements are
safe up to 1,000IU per day.
Individuals following calorierestricted diets may not be getting
adequate vitamins and minerals.
Pregnant women, or those who
might become pregnant or are
breast-feeding, should take 400ug
folic acid per day to decrease risk of
neural tube defects.
People who are sick, injured, or
recovering from surgery or who have
a long-term health problem such
as irritable bowel syndrome, food
allergies/intolerances, etc.
Vegans and some vegetarians may
require vitamin B12 and iron.
What about the rest of us?
If your diet is lacking, a multivitamin
and mineral supplement makes a
good choice to prevent any potential
Living Healthy In Atlantic Canada
33
deficiencies. If you’re eating a wellbalanced diet in accordance with
Canada’s Food Guide, however, you’re
likely getting all the nutrients you need.
Benefits beyond a pill
In an ideal world, we could pop a pill but
there’s no quick fix to good health and
far more benefit to eating healthily than
simply avoiding deficiencies. Firstly, a pill
does not provide all the essentials needed
for good health like carbohydrates,
protein, fat and fibre and other potential
disease fighting phytonutrients.
Research has shown that many vitamins
and minerals may play an important
34
Cashew Mango Chicken Stir-Fry
Time: prep 10 minutes, cooking 15 minutes
Mango and coconut milk, not the customary sodiumlaced soy sauce, provide the flavour punch in this
delicious stir-fry. You can use fresh vegetables rather
than frozen, but they will take a bit longer to prepare
and to cook. Serve over rice, whole wheat noodles or
couscous for a well-balanced meal with an abundance
of vegetables.
½
¾
½
½
1
2
2
2
1
1
6
cup (125 mL) light coconut milk
cup (175 mL) pineapple juice
tbsp (7 mL) minced fresh ginger
tbsp (7 mL) soy sauce
tbsp (15 mL) flour
tsp (10 mL) canola oil
skinless, boneless chicken breasts, fat
removed, sliced
cloves garlic, minced
onion, thinly sliced
green pepper, sliced
cups (1.5 L) fresh or frozen stir-fry vegetables
role in preventing and fighting disease—
but this benefit has only been seen from
the nutrients in food, not from a pill.
A diet rich in fruit and vegetables may
help prevent cardiovascular disease,
certain cancers and obesity. Research
has even gone as far to say that some
vitamin and mineral supplements may
increase the risk of certain chronic
diseases and decrease lifespan.
It’s not rocket science. Eating well
leads to health benefits, so why aren’t
more Canadians doing it? Well, it’s easier
said than done. There are numerous
and complex factors why we eat the
way we do, including availability
and environment, emotional coping,
economical, personal preferences, social
norms and the list goes on.
Changing habits can be difficult, here
are some tips to get you started:
Living Healthy In Atlantic Canada •
Spring 2014
3
1
tbsp cashews
ripe mango, peeled, pitted and chopped
pepper to taste
In a bowl, combine coconut milk, pineapple juice,
ginger and soy sauce; add flour, whisking well so flour
doesn’t clump.
In a large non-stick skillet, heat 1 tsp (5 mL) oil over
medium heat. Add chicken breast slices and sauté
until just cooked and no longer pink. Remove from
pan and set aside.
In the same skillet, heat the other 1 tsp (5 mL)
oil over medium heat. Add garlic and sauté until
fragrant, about 30 seconds. Add onion and green
pepper and sauté for 2-3 minutes. Add fresh or frozen
stir-fry vegetables; sauté until heated through.
Add sauce, chicken and cashews to skillet; sauté
for several minutes until sauce has thickened. Add
mango and cook for 2 minutes.
Add pepper to taste. Serve over cooked rice.
Makes: 6 servings
Source: Hold that Hidden Salt! by Maureen Tilley, PDt.
• Ask yourself where your diet is
lacking and what you’re eating in
abundance? What can you change?
• Don’t change all your eating habits
at once. Set small goals to help build
confidence as you go.
• You don’t have to avoid all the
foods you love. Think in terms of
re-balancing your food choices and
portion sizes. Add more vegetables to
your plate. Bring a salad three days a
week in place of that frozen dinner or
grab-and-go pizza.
For the healthful benefits of good
nutrition, there’s simply no way around
it—eat whole, real foods. You may still
need a daily or occasional multivitamin
and mineral supplement to fill the gaps
but hopefully you’re eating healthier.
Like many things in life, what you put
into it is what you get out of it.
monkeybusinessimages/Bigstock.com
Nutrition check on Canadians
Many Canadians’ eating habits
fall short of Canada’s Food Guide
recommendations. According to
Statistics Canada, overall micronutrient
inadequacies were highest among the
elderly but were seen in all age groups.
Canadians as a whole are meeting the
Estimated Average Requirement for
the majority of vitamins and minerals
but that still leaves 10 to 35 per cent of
adults (19 years and older) below the
EAR for folate, vitamin B6 and zinc.
Ninety per cent of 19- to 30-year-olds
are inadequate in vitamin B6 and folate .
The highest micronutrient inadequacy
among adults is in magnesium (34 per
cent), calcium (average 53.5 per cent
in males and 67.2 per cent in females),
vitamin A (35 per cent) and in the lead is
vitamin D (more than 90 per cent). These
vitamins and minerals play a vital role in
bone and teeth health, energy levels, eye
health, liver, kidney and heart function.
Foods rich in these nutrients include,
leafy greens and orange vegetables, nuts,
whole grains, soy products and dairy
products. Many nutrients work as a team
in the body, so if one is inadequate that
can impact the performance of others .
Our diet should consist of mostly
fruits and vegetables, providing a rich
low-calorie source of vitamins, minerals
and fibre. Not surprisingly, only 50 per
cent of adults are getting five or more
servings of fruits and vegetables day, yet
70 per cent of males and 50 per cent
of females in Canada are consuming
too many calories. The result? Excessive
food, but yet a malnourished population.
Your Oral Health
Spring 2014 •
Living Healthy In Atlantic Canada
35
TODAY.
BOOK AN EXAM TODAY.
03
FILE NAME
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TRIM
MAR 2011
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Canadian Dental Association
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PIC INFO
0.125"
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Fluoride and
your teeth
Fluoride treatment can fight
tooth decay—especially for
those at higher risk
redrawn, evenly spaced
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NB: The Canadian Dental Health Association logo to be replaced with your association’s logo
© Can Stock Photo Inc. / vectomart
he Canadian Dental Health Association logo to be replaced with your association’s logo
T CAN.
NOT EVERYBODY CAN SEE IT, BUT YOUR DENTIST CAN.
Children and cavities
Children at risk of tooth decay may benefit
from a fluoride treatment. Here are some
risk factors for children who may be at risk of
early childhood tooth decay, according to the
Canadian Dental Association.
The child:
• Lives in a community that does not have
fluoridated water.
• Has a visible defect, notch, cavity or white
chalky area on a baby tooth in the front of
the mouth.
• Regularly consumes sugar, even natural
sugars such as fruit juice, between meals,
perhaps in a sippy cup.
• Has special health care needs that make
it difficult for mom and dad to brush the
teeth
• Brushes less than once a day
• Was born prematurely with a very low birth
weight of less than 1500 grams (3 lbs)
APPROVED BY
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PROOFREAD
by Donalee Moulton
VERSION 1: BOOK AN EXAM
(all elements on master page)
Your dentist
will often recommend a
fluoride treatment. There are
two reasons for that recommendation—and both will help make
your teeth healthier.
First, notes Dr. Kelly Manning, a dentist in Saint John, NB,
fluoride strengthens and repairs teeth that have been weakened by
natural acids in the mouth. Second, it helps make teeth resistant
to decay.
Topical treatment
At the dentist’s office, a fluoride treatment may be applied to
the surface of your teeth in gel, foam or varnish form. “A high
concentration fluoride is applied for two minutes,” says Dr.
Manning. Spring 2014 •
Living Healthy In Atlantic Canada
37
The topical fluoride you receive at the
dentist differs from the action of fluoride
in water. At low concentrations, water
fluoridation strengthens developing
teeth in the jaw up to age 18, which
helps make teeth more resistant to
natural acids, and decreases acid
production caused by bacteria.
Some at higher risk
Anyone with a risk of tooth decay can
benefit from a fluoride treatment. At high
risk of tooth decay are people with poor
oral hygiene or decreased dexterity, such
as children, individuals with diseases
like Parkinson’s and multiple sclerosis
and those with dementia. People with
reduced salivary flow, individuals with
diabetes or those taking medications
that cause dry mouth, for example, are
also at higher risk. Finally, people with
acidic diets or disorders—including
pop drinkers and those with reflux
problems—may need fluoride to help
repair damaged teeth.
Children may also require fluoride,
which is a mineral found naturally in
soil, fresh water and salt water as well
as various foods such as grape juice,
spinach and carrots. Your dentist is able
to assess your child’s risk of developing
tooth decay and can advise you of an
appropriate level of fluoride protection.
“We take a very cautious approach.
Safety is always paramount in infants
dutchinny/Bigstock.com
At the dentist’s office a topical
fluoride treatment may be applied
to the surface of the teeth in gel,
foam or varnish form.
and toddlers,” says Dr. Ross Anderson,
chief of dentistry at the IWK Health
Centre in Halifax, NS. “In children
below three years of age, have a health
professional like your dentist do a risk
assessment.”
The assessment will determine if a
little one is at risk of developing cavities.
If a child is drinking juice out of a sippy
cup all day and drinking bottled water
instead of tap water, for example, they
may be at higher risk.
In some cases, a toothpaste with
fluoride will be recommended. The
toothpaste removes the bacteria or
plaque that forms on teeth and gums
every day and can cause tooth decay;
fluoride helps remineralize damaged
teeth and strengthens tooth enamel.
“We need different sources of fluoride
throughout our lives to build and keep
healthy teeth,” says Dr. Manning.
Brush up
The Canadian Dental Association
recommends adults and older children
use a fluoride toothpaste twice a day to
brush teeth. However, because young
children tend to swallow toothpaste
when brushing, which may increase
their exposure to fluoride, they need a
helping hand from mom or dad.
Spring 2014 •
Children under three years of age
should have their teeth brushed by an
adult. For kids at risk of developing
cavities, use only a small amount of
toothpaste —about the size of a grain
of rice, says Dr. Anderson, who is
also head of the division of paediatric
dentistry at Dalhousie University. If your
child is not at risk for cavities, you can
forego toothpaste altogether and use a
toothbrush moistened with tap water.
For children three to six years of
age, a small amount of fluoridated
toothpaste, about the size of pea, should
be used. While these older kids can do
most of the brushing on their own,
parents should still assist.
In some cases, the dentist will
recommend a fluoride treatment for a
child. “We tend to use a fluoride varnish
that is painted on quickly and children
don’t ingest it,” notes Dr. Anderson.
Some children will develop white
flecks throughout their teeth from
fluoride. “It is not a disease, and does not
result in tooth loss or pain,” explains Dr.
Manning. “It’s called fluorosis and is rare
in Canada.”
However, she notes, “white spots
on teeth can be other conditions so be
sure to check with a dentist for a proper
diagnosis.”
Living Healthy In Atlantic Canada
39
luckybusiness/Bigstock.com
Dr John Lovas, professor in the faculty of
dentistry at Dalhousie University in Halifax.
On the
lookout for
oral cancer
Dental exam about more than healthy teeth
by Donalee Moulton
40
Living Healthy In Atlantic Canada •
Spring 2014
Tips for a healthier mouth
Oral health care is an important part of your
overall health care. The Canadian Dental
Association recommends the following to
keep your mouth, teeth and jaw healthy, and
to help identify problems early:
• Brush your teeth and tongue at least twice
a day with a soft-bristle toothbrush and
fluoride toothpaste to remove plaque and
bacteria.
• Floss every day. If you don’t floss, you are
missing more than a third of your tooth
surface.
• Look for warning signs of oral cancer. The
three most common sites for oral cancer
are the sides and bottom of your tongue
and the floor of your mouth.
Your mouth
©2012 Terese Winslow LLC, U.S. Govt. has certain rights
reveals a lot about your oral health and
your overall health—and your dentist can
see what you can’t.
The dental exam, as the oral health check is called, helps dentists identify
and diagnose problems—including oral cancer—often before they become
more serious. It is critical to your ongoing health, and only your dentist can
perform this procedure.
“Dentists are highly trained to recognize abnormalities occurring within
the mouth and are the health care professionals who most frequently
perform oral and neck examinations,” says Dr. John Lovas, a professor in the
faculty of dentistry at Dalhousie University in Halifax, NS.
Here’s what your dentist is looking for:
• A sore on your lower lip that hasn’t
healed within 10 days.
• A white and/or red patch inside your
mouth.
• An unexplained lump on your lip,
inside your mouth, or on your neck.
• Soreness or bleeding of your lips,
mouth or neck.
• Unexplained sore or loose teeth.
• Abnormal healing after having a
tooth pulled.
“Patients should inform their dentist
if they’ve noticed any of the signs
or symptoms,” says Dr. Lovas. “Only
the patient knows if they’ve seen
something new in their mouths.”
Oral cancer starts in the cells of the
mouth. Normally these cells are quite
resistant to damage but repeated injury
or irritation may cause sores or painful
areas where cancer can start. While
the actual cause of oral cancer is not
known, important risk factors have
been identified. They include smoking,
heavy drinking, oral sex, prolonged
and repeated exposure of the lips to the
sun and poor diet.
Spring 2014 •
Oral cavity cancer starts in cells of the mouth. The oral cavity includes
the lips, cheeks, gums and teeth, the part of the tongue in the mouth
(oral tongue), hard palate (bony part of the roof of the mouth) and
floor of the mouth (under the tongue). A mucous membrane lines and
protects the inside of the mouth. The structures in the oral cavity play
an important role in speech, taste and chewing.
Read more: http://www.cancer.ca/en/cancer-information/cancer-type/
oral/overview/?region=ns#ixzz2t7Ykpso5
The Canadian Cancer Society
estimated that in 2013 more than
4,000 Canadians would be diagnosed
with oral cancer and approximately
1,150 would die from the disease,
which affects men almost twice as often
as it does women.
Early detection is important and
can have a marked effect on outcomes,
stresses Dr. Lovas. “It’s extremely
important to report new findings in a
timely manner rather than waiting for
a scheduled appointment that may be
months away.”
Living Healthy In Atlantic Canada
41
iStockPhoto/
hand to your shoulder. Wrap it around your index and
middle fingers, leaving about two inches between your
hands.
Flossing 101
It’s important to floss regularly—and to floss properly.
The Newfoundland and Labrador Dental Association
recommends taking these steps to a healthier mouth.
2. Slide the floss between your teeth and wrap it into
a “C” shape around the base of the tooth and gently
under the gum line. Wipe the tooth from base to tip
two or three times.
3. Be sure to floss both sides of every tooth. Don’t forget
the backs of your last molars. Go to a new section of the
floss as it wears out and picks up particles.
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S
uth along
1. Take a length of floss equal to the distance from your
Flossing is an
important—but often
overlooked—part of
daily oral health care
by Donalee Moulton
mangostock/Bigstock.com
Dr. Linda Blakey
42
Living Healthy In Atlantic Canada •
Spring 2014
4. Brush your teeth after you floss. It is a more effective
method of preventing tooth decay and gum disease.
A little
piece of string can go a long way to helping prevent gum disease. Flossing should be part of your
daily oral health care. For many Atlantic Canadians, however, it isn’t.
“Unfortunately, even though we tell our patients the importance of flossing, most people do not floss. The result
is that most people have some degree of gum disease, which can result in bad breath and even tooth loss,” says Dr.
Linda Blakey, a dentist in Mount Pearl, NL.
Flossing removes plaque and bacteria that your toothbrush
cannot reach. According to the New Brunswick Dental Society
(NBDS), if you don’t floss, you are missing more than one-third
of your tooth surface.
Dr. Blakey recommends flossing twice a day to remove
food debris and plaque between teeth. Plaque is an invisible
bacterial film that develops on your teeth every day, and
the main cause of gum disease. Within 24 to 36 hours,
plaque hardens into tartar, which can only be removed by
professional cleaning. When you floss, plaque never gets the
chance to harden into tartar.
“Clinical studies have shown that when used properly,
flossing can improve oral health,” Dr. Blakey notes.
Flossing can also help with your physical health, she adds.
“It also protects your heart, your joints and can even help
you lose weight.” (Researchers have discovered a possible link
between inflammation of the gums and weight gain.)
There are many types of floss. The most common is the
string variety. “This is probably the best type as we are able to
adapt this floss around the individual teeth,” says Dr. Blakey.
“With a bit of practice, you are able to reach to the back molar
teeth to ensure thorough cleaning.”
String floss comes in two main varieties: waxed and
unwaxed. Because the floss is nylon, it may sometimes tear or
shred, especially between teeth with tight contacts. There is
another option to help with this: PTFE or monofilament floss,
which slides easily between tight spaces but is more expensive
than nylon floss.
Dental tape is also available. It is like string floss except it
is flatter and wider. It is used in the same way as dental floss,
but some people find dental tape a little easier to work with
because it is less likely to get caught between the teeth.
You may also be familiar with what is commonly called floss
handles. These are small devices with approximately an inch
of floss attached at the end. They can fit between the teeth and
allow easier access for people with less dexterity in their hands.
“These would be good for children just learning how to floss,”
notes Dr. Blakey.
There is also the water flosser, a rechargeable device that
uses a steady stream of water to flush out debris between
teeth. This can be an effective device for children or people
with arthritis. “This is also a useful tool for those wearing
braces or who have fixed bridgework where it is more difficult
to manoeuvre your floss,” Dr. Blakey says.
Other products are also available to help you clean between
your teeth. These include wooden and plastic sticks that can
massage your gums, as well to stimulate blood flow, and proxibrushes, tiny brushes with short bristles, to get into tight
places between your teeth.
Regardless of your personal preference, all of these
methods will help remove plaque and debris, as long as you
use them properly and consistently.
If you haven’t flossed your teeth in a while (or at all), your
gums may bleed at first. Not to worry. Bleeding usually stops
after a few days. If bleeding does not stop, be sure to see your
dentist.
To make flossing less tedious, the NBDS recommends
flossing while you are doing something else, like watching TV
or listening to music. It’s an activity that doesn’t require your
full attention but it is important for optimal oral health.
Spring 2014 •
Living Healthy In Atlantic Canada
43
Watch your
mouth
prawny/Bigstock.com
Test your knowledge on
oral health care and aging
medications can reduce saliva flow—and
saliva helps protect our teeth by diluting the
cavity-causing acid and washing food particles
away. Also, receding gums expose the roots of
teeth, and roots decay more easily.
1. Receding gums can be minimized with
proper care. True or false?
True. Some seniors’ gums may recede as a
natural part of aging but some people’s gums
recede more than necessary. They may be
struggling with self-care because of arthritis
in their hands or other health issues (poor
self-care results in extra plaque, which pushes
the gum line back further). Or, they may have
been brushing too hard or too often for years.
4. An increase in risk for dental decay is
more greatly affected by the number of
times sugar is consumed in a day, compared
to the total amount of sugar. True or false?
True. Each time sugar is consumed, acid
is produced. Sucking on mints or candies
should be avoided because it leaves sugar in
the mouth for long periods of time. If a sweet
snack or tea with sugar is part of someone’s
daily diet it is better to be consumed at
mealtimes
2. Teeth naturally darken as we age. True
or false?
True. Dentin—the hard tissue that makes
up the core of each tooth—changes. It also
becomes more visible because the tooth
enamel that covers it gets thinner. This is a
natural process.
Teeth also darken for another reason: we
produce more plaque. Good self-care and
regular professional cleanings can help
minimize this.
3. The cause of tooth decay is the same for
everyone—young and old. True or false?
True. Decay happens for everyone when the
bacteria in plaque interacts with the sugar
in our diets. An acid is produced that can
cause cavities.
Seniors may be at greater risk to get cavities,
though. Some chronic health conditions or
44
5. If you have dentures, you no longer need
to see the dentist. True or false?
False. People with dentures still need regular
check-ups. The dentist needs to check the fit
and condition of your dentures, as well as
check for signs of gum disease and your overall
gum health.
6. Dentures should be replaced periodically
because they change shape over time. True
or false?
False. Dentures don’t change, but mouths do.
If dentures no longer fit well, the gums have
probably changed or the bone supporting the
dentures. Often, such changes are natural.
See your dentist so adjustments can be made.
7. The first symptom of gum disease is pain
when brushing. True or false?
False. Gum disease can sneak up on seniors
because it often progresses slowly, over years,
and with no pain. And it can do a lot of harm
if undetected.
Early signs include bleeding (when brushing,
flossing, or eating hard foods); red, swollen,
or tender gums; pus between teeth and
Living Healthy In Atlantic Canada •
Spring 2014
gums (when the gums are pressed); loose
or separating teeth; any change in the fit of
partial dentures; any change in bite; and bad
breath or a bad taste that won’t go away.
An important part of
your overall health
8. Your dentist needs to know about any
medications you are taking. True or false?
True. Medication side effects can include dry
mouth, overgrown gums and mouth ulcers.
Knowing about your prescriptions can save
your dentist from looking unnecessarily for
other causes.
By Donalee Moulton
9. As a senior, you should protect your teeth
and gums by using a soft-bristle toothbrush
and eating soft foods. True or false?
True and false. Choose a soft-bristle brush.
But crunchy fruits and vegetables are part of
a balanced diet. Talk to your dentist and your
doctor if you have pain or tenderness in your
mouth that makes you restrict your choice
of foods.
10. There are links between a healthy
mouth and other aspects of your health.
True or false?
True. Researchers have become aware of
many links in recent years—some of them of
special concern to seniors.
Gum disease, for example, has been linked
to heart disease, respiratory disorders
and stroke. Heart disease is a disease of
inflammation, and inflamed gums give
the body an extra load to handle. The
bacteria that cause pneumonia may begin
in the gums, and early signs of diabetes are
sometimes found in a dental exam. Also,
as noted earlier, a sore mouth can lead to a
restricted diet and to nutrition problems.
The links aren’t fully understood yet, but they
have been proven. Taking care of your oral
health is important in itself—and it’s also
key to taking care of the rest of you.
lidophotography/Bigstock.com
Your mouth isn’t separate from your
body; it’s part of it. This quiz contains
information that can help you maintain
good oral health—and overall health—
in your senior years.
Give your teeth a gentle to moderate brushing
one to three times a day, ideally about an
hour after every meal and always before bed.
And floss once a day. If you have problems
with dexterity, ask your dentist for advice.
Not just a
check-up
Some things your dentist is looking
for during a dental exam:
While most
people think the dental exam is the time
the dentist takes to physically examine
the teeth and inside the mouth, from the moment the dentist walks in the
clinic examining room he or she is looking for signs or symptoms of other
potentially serious health problems.
“The dentist will also be looking at your lips inside and out as well as
checking for any abnormal looking areas on your face and neck that could
indicate a problem including cancer,” says Dr. Brian Barrett, a dentist and
executive director of the Dental Association of Prince Edward Island in
Charlottetown.
In past visits, you may not have
even realized an exam was taking place.
Perhaps you thought the dentist was
simply checking the hygienist’s work.
Years of training and experience mean
your dentist can quickly detect anything
amiss—just as you can spot a tiny dent
on your car.
“I have known dentists standing in
line in a store who noticed a bump or
lesion on someone’s face or neck in front
of them and urged them to go have it
checked, and later they found out it was
early skin cancer,” says Dr. Barrett.
“The dental exam can catch
problems early—before you see or feel
them—when they are much easier and
less expensive to treat,” says Dr. Barrett.
As well as a visual and physical
inspection of your mouth, a dental exam
will also include a complete medical
history, so the dentist will know about
any health conditions that may affect
the success of dental treatments or
procedures. At future appointments
you may only be asked if there are any
changes since the last visit.
Sometimes the dentist will also
examine the glands and lymph nodes
for possible signs of inflammation that
could indicate general health problems.
Dental X-rays may also be required.
Your dentist will often explain what
is happening during the dental exam and
give you a summary of the findings. “If
you have any questions, be sure to ask,”
stresses Dr. Barrett. “As a patient, you are
a full partner in your oral health care.”
Spring 2014 •
• Damaged, missing or decayed teeth.
• Early signs of cavities.
• Condition of gums, such as periodontal pockets,
inflammation, or other signs of gum disease.
• Condition of previous dental treatments, such
as root canals, fillings, and crowns.
• Early signs of mouth or throat cancer, such as
white lesions or blocked salivary glands.
• Any suspicious growths or cysts.
• Position of your teeth (e.g., spacing, bite).
• Signs that you clench or grind your teeth (a
treatable problem that can lead to sore jaw
muscles and, if serious, other problems).
• Signs of bleeding or inflammation on your
tongue and on the roof or floor of your mouth
the overall health and function of your
temporomandibular joint (which joins the jaw
to skull).
• Early signs of diseases such as diabetes,
nutritional problems or bulimia.
Your dental examination is not
meant to be stressful and although
everyone wants to have a clean bill
of health, delaying can lead to more
problems.
“Preventive maintenance is always
cheaper than letting things go and
trying to fix it when it is really causing
you trouble. By then, it may even be too
late to do anything,” says Dr. Barrett.
Living Healthy In Atlantic Canada
45
Helping seniors with dementia
Individuals with dementia may need a helping
hand with brushing their teeth. Here are some
recommended steps from the Brushing Up on
Mouth Care dementia video to help long-term
care staff, family and friends:
•
•
•
•
•
Set a routine time and place for oral care.
Identify yourself and what you plan to do.
Maintain a calm and quiet atmosphere.
Provide oral care after a meal or when the
person is most content and co-operative.
Distract the person by singing or giving them
something to hold like a facecloth.
Top left: Dr. Mary McNally, associate professor in the faculty of dentistry at
Dalhousie University in Halifax.
Dr. Debora Matthews, chair of the department of dental clinical sciences
at Dalhousie University in Halifax.
Brushing up on Mouth Care resources are available online at ahprc.dal.ca/
projects/oral-care/
The need
Aletia/Bigstock.com
for good oral health care doesn’t diminish with age. Gum disease,
cavities and other dental problems can be painful realities for many
older Atlantic Canadians. The issues are often magnified for those who depend on others to assist
with care needs.
“We have to be attentive to daily oral health care. It sometimes gets lost amongst the busyness
of a health care or long term-care residence,” says Dr. Mary McNally, an associate professor in
the faculty of dentistry at Dalhousie University in Halifax.
Atlantic Canada
leading the way
on oral health
research for an
aging population
by Donalee Moulton
46
Brushing
up on seniors’
mouth care
Living Healthy In Atlantic Canada •
Spring 2014
Research led by Dr. Debora Matthews at
Dalhousie found significant differences between
middle-aged and older Nova Scotians living in the
community, compared with those living in longterm care. Among those differences:
• 13 per cent of people age 45 to 64 never
visit a dental professional or see one only for
emergencies, compared with 73 per cent of
those living in long-term care.
• Approximately 19 per cent of Nova Scotians
age 45 and older living in the community have
untreated tooth decay, compared with 35 per
cent of long-term care residents.
• Overall, 70 per cent of Nova Scotians living in
long-term care had untreated dental care needs.
The findings of the research are significant but not
unique to Nova Scotia, notes Dr. McNally. “We just
happen to be the canary in the coal mine since we
currently have the oldest population in Canada.”
The reasons for these differences are numerous.
First, there are two important realities shaping the
Canadian landscape and, in particular, the Atlantic
Canadian landscape: People are both living longer
and keeping more of their natural teeth as they age.
On the surface these are welcome trends, but they
are resulting in new patterns of oral disease and
significant challenges for oral health care.
Second, there are higher risk factors associated
with individuals in long-term care. “The ability
for residents to do their own hygiene, for example,
often decreases. Residents may have reduced
dexterity or be suffering from dementia,” says Dr.
McNally. “Care staff work hard to meet the needs of
residents, but now that most people entering longterm care no longer have dentures, daily mouth
care becomes very challenging.”
It may also be difficult for residents to get to the
dentist. Mobility often declines as we age and it
can be difficult for individuals in long-term care
to get out to the dentist, even with help. While a
few dentists do make visits to nursing homes, this
service is unusual because the needed equipment is
often in the dentist’s office.
The best scenario, of course, is prevention. This
starts with an emphasis on daily care. “The key is
to ensure that this gets well incorporated into daily
care routines,” says Dr. McNally. “Good oral health
Spring 2014 •
Living Healthy In Atlantic Canada
47
Michael
A recent study found that 70 per
cent of Nova Scotians living in
long-term care had untreated
dental care needs.
Keeping your mouth moist
Dry mouth, or xerostomia, affects 60 per cent of older adults.
It results from a decreased production of saliva as we get older.
Gums that bleed easily, ill-fitting dentures and frequent cavities,
may all be signs of xerostomia. Here’s what you can do to help
your mouth stay hydrated:
• Sip water or suck on ice cubes.
• Brush with fluoridated toothpaste.
• Use a mist humidifier at night.
• Floss regularly.
• Chew sugar-free gum or suck on sugar-free candy.
• Use a water-based lip balm.
is important for our overall physical health.”
“Everything needs to be in place, from policy to a
person brushing residents’ teeth,” adds Dr. McNally,
who was the principal investigator on the Brushing
Up on Mouth Care research project. Working out of
the Atlantic Health Promotion Research Centre,
this research project included three long-term care
facilities on Nova Scotia’s Eastern Shore, as well
as seniors’ representatives, facility administrators,
educators, physicians and decision-makers. The
team looked at the factors that influence daily
mouth care in long-term care and established a
formal process for integrating oral care into daily
routines.
As part of the research initiative, an oral care
manual for staff in long-term care settings has been
48
Living Healthy In Atlantic Canada •
Spring 2014
alexraths/Bigstock.com
Coady
developed to provide educational resources, videos
and hands-on tools that can be used throughout
Nova Scotia. All of these materials are available on
the Brushing Up on Mouth Care open access website
(ahprc.dal.ca/projects/oral-care/). The site may also
be helpful for seniors, caregivers and other health
professionals as well.
One recommendation the site offers to help
seniors in long-term care is the use of oral care
cards that outline the necessary steps for providing
daily care to someone with their natural teeth,
dentures, partials, or some combination of these.
The resident’s name goes on the front of the card
along with any special instructions, including the
time of day they prefer to have mouth care done.
On the back of the card, there is a place to record
the date the person’s toothbrush was last changed
and the date of their last visit to the dentist.
It’s also recommended that an oral health toolkit
be prepared for every resident. This can be as simple
as a small metal basket that contains a disposable
cup, toothpaste, a toothbrush, mouth rinse and
other oral care items.
“This is all part of daily oral health care,” says Dr.
McNally. “Having these tools and these reminders
front and centre helps ensure oral care isn’t
overlooked and that problems are prevented.”
A snowboarding accident at 16
years old left Michael paralyzed.
Six years later, Michael lives
independently and credits the
QEII’s Rehabilitation Centre and
its staff for helping him get there.
“ Taking that first step in the pool was an important milestone.
I realized that my goal,
to live independently, was attainable.”
- Michael Coady
Every year the QEII’s Nova Scotia Rehabilitation Centre cares for Nova Scotians, like
Michael, who face physical challenges resulting from injury, illness or aging. The goal is
to help them return to life in the most rewarding way possible.
Today, the Rehabilitation Centre needs your help to revitalize two key areas: the
Therapeutic Pool and the Assisted Living Training Apartment.
To learn more, visit us at QE2Foundation.ca or call 902 473 7932.
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