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Dr. Zach’s Spring Health Check-Up

BT Montreal | posted Tuesday, Apr 24th, 2018

Exercise

Sharpens your brain function, improves your sex life, as well as the other things you know (live longer, be happier, lose weight)

 

Find a way (friends, fun, part of regular activities)

  • Exercising improves brain performance. …
  • Working out sharpens your memory. …
  • Running burns calories! …
  • More muscle mass = burning more fat while resting.
  • The more muscle mass you have, the more fat your body burns while resting. …
  • A pound of muscle burns 3 times more calories than a pound of fat. …
  • You get sick less often.

Better skin, more self-confidence, better sleep

Better sex — Increased blood flow helps explain why exercise leads to better sexual function in men as well. … Men and women who exercise may be more likely to feel sexually desirable, which can lead to better sex. So can greater strength, flexibility, and stamina that result from exercise.

 

Outdoors

Your vitamin D levels rise. Sunlight hitting the skin begins a process that leads to the creation and activation of vitamin D. Studies suggest that this vitamin

Helps fight certain conditions, from osteoporosis and cancer (breast, colon, prostate, ovaries, esophagus, and lymphatic system) to depression, heart attacks, and diabetes, ms, rheumatoid arthritis

Limited sun exposure (don’t overdo it), supplemented with vitamin D pills if necessary, is a good regimen.

In addition to bone health, there is recent and mounting evidence that links low levels of the vitamin to an increased risk of type 1 diabetes, muscle and bone pain, and, perhaps more serious, cancers of the breast, colon, prostate, ovaries, esophagus, and lymphatic system.  If you want to lower your blood pressure, vitamin D may be just what the doctor ordered. If you’re trying to reduce your risk of diabetes, or lower your chances of heart attacks, rheumatoid arthritis, or multiple sclerosis, then vitamin D should be at the front of the line in your daily supplement regimen.

You’ll get more exercise. If you make getting outside a goal, that should mean less time in front of the television and computer and more time walking and doing other things that put the body in motion.

You’ll be happier. Light tends to elevate people’s mood, and there’s usually more light available outside than in. Physical activity has been shown to help people relax and cheer up, so if being outside replaces inactive pursuits with active ones, it might also mean more smiles.

Your concentration will improve. Children with ADHD seem to focus better after being outdoors. It might be a stretch to say that applies to adults, but if you have trouble concentrating, outdoor activity may help.

You may heal faster. In one study, people recovering from spinal surgery experienced less pain and stress and took fewer pain medications when they were exposed to natural light. An older study showed that the view out the window (trees vs. a brick wall) helped recovery in the hospital.

 

Sleep

Helps you stay slim, keep your blood pressure down

Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke

Why Sleep Deprivation Causes Weight Gain. Losing out on sleep creates a vicious cycle in your body, making you more prone to various factors contributing to weight gain. “The more sleep-deprived you are, the higher your levels of the stress hormone cortisol, which increases your appetite,” says Breus

 

Food

Take the opportunity to eat fresh and local fruits and vegetables

Berries are natural antioxidants, protecting cells from damage

Berries are the crown jewels of summer, the gems that inspire pies, parfaits, cobblers, ice cream treats, and whipped cream wonders. Best of all, berries deliver super-healthy antioxidants that help fight disease.

In fact, one landmark study shows that just one cup of berries provides all the disease-fighting antioxidants you need in a single day

Antioxidants protect the body from damage caused by harmful molecules called free radicals. Many experts believe this damage is a factor in the development of blood vessel disease (atherosclerosis), cancer, and other conditions.

You are exposed to free radicals:

  • Through by-products of normal processes that take place in your body (such as the burning of sugars for energy and the release of digestive enzymes to break down food).
  • When the body breaks down certain medicines.
  • Through pollutants.

Antioxidants include some vitamins (such as vitamins C and E), some minerals (such as selenium), and flavonoids, which are found in plants. The best sources of antioxidants are fruits and vegetables

https://www.theatlantic.com/health/archive/2011/10/antioxidants-explained-why-these-compounds-are-so-important/247311/

 

Skin care

Why is skin care important?

The skin is the body’s largest organ

It holds body fluids in, preventing dehydration, and keeps harmful microbes out—without it, we would get infections.

Apply sunscreen (every morning, and reapply every two hours. If you get wet, apply every hour. Use makeup that has SPF protection? It may not be enough.  Spf 60 or higher (this refers to uvb, look for broad spectrum or uv protection factor)

UVA rays penetrate deep into the dermis, the skin’s thickest layer. Unprotected exposure can lead to premature skin aging and wrinkling (photoaging), and suppression of the immune system. UVB rays will usually burn the superficial layers of your skin. It plays a key role in the development of skin cancer.

 

Smoking is bad for you and bad for your skin, in case you hadn’t heard

 

Experts agree that smoking accelerates skin aging, so that smokers look 1.4 years older than nonsmokers, on average.

The nicotine in cigarette smoke can not only make your teeth (and the walls of your home) brown, but it’s also notorious for staining fingers and nails as well.

Scarring – Nicotine causes vasoconstriction, a narrowing of the blood vessels that can limit oxygen-rich blood flow to the tiny vessels in the face or other parts of the body.  This means your wounds will take longer to heal and you’ll have scars that are bigger and redder than you would in a nonsmoking parallel universe.

Cigarette smoke contains carbon monoxide, which displaces the oxygen in your skin, and nicotine, which reduces blood flow, leaving skin dry and discolored. Cigarette smoking also depletes many nutrients, including vitamin C, which helps protect and repair skin damage.

While genital warts are caused by sexually transmitted types of HPV, smoking is also a risk factor. Even taking the number of sex partners into account, women who smoke are nearly four times as likely to have genital warts as nonsmokers, according to one study.

More visceral fat, stretch marks, cataracts, skin cancer, thinner hair,

Celebrity Health Advice by Dr. Zach, ER Physician MUHC

BT Montreal | posted Tuesday, Mar 27th, 2018

For better or worse, celebrities get a lot of attention in our society. Their faces and names sell
product, and so their thoughts and opinions reach many people. And many people listen to
them, even if they don’t actually know what they’re talking about. This power can and is used
for good by a number of celebrities (see below). However, there are a fair number of examples
of celebrities giving inaccurate, bad, or even dangerous health advice. In those cases, hopefully
people won’t listen.
Gwyneth Paltrow 
Vaginal steam treatment: an energetic release – not just a steam douche – that balances female
hormone levels.” But douching is not necessary and it disturbs the natural flora of the female
reproductive system, increasing the risk of urinary tract infections and yeast overgrowth.
Post on Gwyneth Paltrow’s site by Dr. Habib Sadeghi suggests a link between breast cancer
risk and wearing a too-tight bra, a claim that has been discredited by major health organizations,
including the American Cancer Society.
In an interview, Paltrow disagreed with doctors who warn patients against tanning saying,
“We’re human beings and the sun is the sun – how can it be bad for you? I think we should all
get sun and fresh air. I don’t think anything that is natural can be bad for you.”
Unfortunately, while nature is great, it produces some very toxic, poisonous substances. The
sun damages the skin and increases the risk of skin cancer.
Jenny McCarthy, Jim Carrey
Jenny McCarthy is one of the most well-known proponents of the anti-vaccination movement, a
small but vocal faction who refuse to vaccinate their children due to fears that it will lead to
autism. Jenny McCarthy has long been a leading voice in the campaign against vaccines,
saying that the measles, mumps, rubella vaccine led to her son’s autism. She has also claimed
to have “repaired” his autism through vitamins. There’s no scientific basis to these claims, and
parents opting against vaccinations for their children lower herd immunity, which is dangerous to
everyone’s health, especially the young and elderly.
The belief stems from a 1998 study which was later found to be based on fraudulent data and
discredited by the medical community. Numerous large-scale studies over many years have
found no connection between vaccines and autism.
Few people remember polio, a devastating infection which is largely eradicated by a vaccine.
January Jones
In 2012, “Mad Men” star January Jones revealed that after giving birth to her son Xander Dane
Jones, she had her placenta dried and turned into capsules — which she ingested regularly and
credited with staving off postpartum depression. But experts and dietitians say there are no
health benefits to eating the placenta.
Mayim Bialik
“The Big Bang Theory”‘s Mayim Bialik , a neuroscientist as well as an actress, has also spoken
favorably about ingesting her own placenta after giving birth. In a 2012 blog post, she argued
that “human beings are the only mammals that have chosen to not routinely ingest their
placenta, which is consumed by every other mammal for its protein and iron-rich properties that
are critical in helping the mother’s body recuperate after giving birth. End of story.”
But despite celebrity backing, a 2015 study found no evidence to support claims of health
benefits from eating the placenta .
Ingesting the placenta after giving birth, a practice called placentophagy, is something almost all
nonhuman mammals partake in. Enthusiasts believe it may help prevent postpartum
depression , reduce post-delivery pain, increase energy levels and improve lactation.
But after reviewing the existing scientific literature on the subject, Dr. Crystal Clark, a
psychiatrist specializing in reproduction-related mood disorders at Northwestern University,
found that there is no data to support these claims. What’s more concerning, she says, is that
there are no studies examining the potential risks of eating the placenta, which filters out toxins
and pollutants during pregnancy to protect the developing fetus.
Tom Cruise
In 2006, Tom Cruise publicly criticized actress Brooke Shields for taking antidepressants to help
with her postpartum depression . While Shields later said the actor came over to her house to
apologize, Cruise’s rep told the Associated Press at that he had not changed his position on
antidepressants.
While antidepressants are generally considered safe for most adults, the FDA lists a number of
side effects.
Cruise is a Scientologist, and the group opposes the use of antidepressants and other aspects
of mainstream psychiatric care.
Suzanne Somers
In her 2013 book “I’m Too Young for This!: The Natural Hormone Solution to Enjoy
Perimenopause,” Suzanne Somers touted the benefits of bioidentical hormones – otherwise
known as natural hormone therapy – as a safer alternative to ease symptoms of menopause that
have fewer long-term risks and side effects than other hormone treatments. But experts quickly
warned that while these hormones may be “natural” in origin, there’s no evidence that the
ingredients are safer, let alone superior to other therapies on the market.
Dr. Mehmet Oz
Dr. Mehmet Oz, host of “The Dr. Oz Show,” is proud of helping millions of viewers with their
health concerns. But he came under fire at a Congressional hearing in 2014 for promoting the
supposed fat-burning benefits of green coffee bean extract – a product accused by the Federal
Trade Commission of making fraudulent claims. The company behind the green coffee bean
study, meanwhile, had to pay $3.5 million dollars in a settlement.
Dr. Oz’s credibility was also hurt by a 2014 study finding that fewer than half of his on-air
recommendations – just 46 percent – were backed up by medical evidence.
Jessica Alba
To shed baby weight after giving birth, Jessica Alba said she wore a double corset to “retrain”
her waist. While women have been attempting to make their wastes tinier by wearing corsets for
centuries, the practice has been growing in popularity in the last year with celebs like Alba
touting its benefits.
But experts say the effects from waist trainers don’t last. “These women who are wearing these
corsets are fully grown adults so there’s no reason to suppose that by tying a tight corset around
is going to do any permanent change,” Dr. Mary Jane Minkin, clinical professor at Yale
University, told CBS News.
Alicia Silverstone
Another advocate of placenta eating and the anti-vaccination movement, actress Alicia
Silverstone also wrote a parenting book last year with some very questionable advice. In “The
Kind Mama: A Simple Guide to Supercharged Fertility, a Radiant Pregnancy, a Sweeter Birth,
and a Healthier, More Beautiful Beginning,” Silverstone suggests a plant-based diet can help
prevent miscarriages and stave off postpartum depression.
Alana Stewart
Actress Alana Stewart, the former wife of Rod Stewart, said in 2012 she’d used
human-growth-hormone therapy to keep her hair from turning gray. But the U.S. Federal Trade
Commission has cracked down on products making such unfounded claims, and the Mayo
Clinic lists carpal tunnel syndrome, swelling in the arms and legs, joint and muscle pain, and for
men, enlarged breast tissue, as possible side effects from the hormones.
Shailene Woodley
“Divergent” star Shailene Woodley says she eats clay to remove heavy metals from the body
and recommends other women do the same. She also suggests getting a little sun on your
vagina for some extra vitamin D.
Miley Cyrus
In 2012, after receiving criticism that she was too thin, Miley Cyrus took to Twitter to announce
that she has a gluten and lactose allergy. She went on to tweet that everyone should try to go
gluten-free for a week, saying “The change in your skin, phyisical (sic) and mental health is
amazing! U won’t go back!”
But doctors say that a gluten-free diet is only prescribed to people with celiac disease, a
condition that causes the immune system to react to gluten in the body, causing damage to the
lining of the intestines, along with uncomfortable gastrointestinal symptoms. For people without
the disease, foods that are gluten-free have no special health benefits, and some gluten-free
snacks may actually contain more fat.
Katy Perry
In 2013, Katy Perry revealed that she takes 26 vitamins and supplements a day and even
tweeted a photo of herself with all her capsules. But experts say routinely overloading on
vitamins can have the opposite of the intended effect, and may lead to symptoms including
nausea, diarrhea, stomach cramps, hair loss and fatigue.
A recent study also found that use of dietary supplements leads to more than 23,000
emergency room visits per year due to adverse reactions.
Mark Cuban
Mark Cuban, who has invested in four health care companies, tweeted (in tweets subsequently
deleted) that people should get their blood tested four times a year if they can. Health experts
pointed out the flaws in Cuban’s quarterly testing idea, saying that the more blood tests you
receive, the greater the possibility of false reports, misdiagnosis, and false positives, not to
mention the fact that many people simply can’t afford it.
Roger Moore
Former James Bond Roger Moore has declared that eating foie gras can lead to Alzheimer’s
disease, diabetes, and rheumatoid arthritis, calling the duck delicacy, “a tasty way of getting
terminally ill.” While the ethics of foie gras are certainly up for debate, scientists and doctors
say there is absolutely no proof that it can be claimed to cause such diseases.
Megan Fox
Megan Fox has claimed that swallowing vinegar will help you lose weight. “It just cleanses out
your system entirely. It will get rid of, for women who retain water weight from your menstrual
cycle and all that, it gets rid of it really fast,” the Transformers star said. Doctors counter that the
body is, in fact, “a well-oiled detoxing machine, which will not be improved by vinegar, whether it
be organic, apple cider, unfiltered, or your bog-standard malt vinegar.”
Good advice, education
Examples of celebrities using their platform for good:
Michael J. Fox ’s battle with Parkinson’s disease, and his subsequent advocacy for research into
the disorder, as a particularly noteworthy example.
Katie Couric , whose husband had colon cancer, had her own colonoscopy on TV.
The Marlboro Man, Wayne McLaren , became an anti-tobacco advocate after being diagnosed
with lung cancer.
Angelina Jolie , whose genetic makeup included a strong possibility of breast cancer, had a
preventive double mastectomy.
A celebrity can have a positive impact.

Effects of Marijuana by Dr. Zach, ER Physician MUHC

BT Montreal | posted Tuesday, Mar 13th, 2018

Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance
worldwide. Its psychoactive properties are primarily due to one cannabinoid:
delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of
cannabis potency
Cannabis was used by an estimated 182 million people (range 128 to 234 million) worldwide in
2014, approximately 3.8 percent (range 2.7 to 4.9 percent) of the global population age 15 to 64
years.
The potency of cannabis has increased significantly around the world in recent decades , which
may have contributed to increased rates of cannabis-related adverse effects. Cannabis use
disorder develops in approximately 10 percent of regular cannabis users, and may be
associated with cognitive impairment, poor school or work performance, and psychiatric
comorbidity such as mood disorders and psychosis.
Men use more, people 12-25 use more.

Acute effects: Cannabis intoxication in adolescents and adults also results in the following neuropsychiatric
effects:
Mood, perception, thought content – Ingestion typically leads to feeling “high,” marked by a
euphoric, pleasurable feeling and a decrease in anxiety, alertness, depression, and tension.
However, first-time cannabis users, as well as anxious or psychologically vulnerable individuals,
may experience anxiety, dysphoria, and panic. Increased sociability usually occurs during
intoxication, although dysphoric reactions may be accompanied by social withdrawal.
Inexperienced users who ingest cannabis products may not be aware that effects may not be
felt for up to three hours which may cause them to continue to consume high potency products
with an increased likelihood of dysphoria.
Perceptual changes include the sensation that colors are brighter and music is more vivid. Time
perception is distorted in that perceived time is faster than clock time. Spatial perception can
also be distorted, and high doses of potent cannabis products may cause hallucinations.
Mystical thinking, increased self-consciousness, and depersonalization may occur, as well as
transient grandiosity, paranoia, and other signs of psychosis.
Cognition, psychomotor performance – Cannabis use increases reaction time and impairs
attention, concentration, short term memory, and risk assessment. These effects are additive
when cannabis is used in conjunction with other central nervous system depressants. Acute
cannabis use also impairs motor coordination and interferes with the ability to complete complex
tasks that require divided attention.
Impairment of cognition, coordination, and judgment lasts much longer than the subjective mood
change of feeling “high.” Psychomotor impairment lasts for 12 to 24 hours. However, a
marijuana user may think that he or she is no longer impaired several hours after the acute
mood altering effects have resolved. As an example, a placebo controlled trial with licensed
pilots found that smoking marijuana impaired performance on a flight simulator for up to 24
hours, although only one of the nine subjects possessed self-awareness of this.
Acute psychomotor impairments interfere with the ability to operate other heavy machinery,
such as automobiles, trains, and motorcycles. A meta-analysis of nine studies found an
association between cannabis intoxication and an increased risk of a motor vehicle collision
involving serious injury or death. Drivers using cannabis are two to seven times more likely to be
responsible for accidents compared to drivers not using any drugs or alcohol. Furthermore, the
probability of causing an accident increases with plasma levels of delta-9-tetrahydrocannabinol.
Children — In children, acute marijuana intoxication typically occurs after exploratory ingestion
of marijuana intended for adult use. Less commonly, intentional exposure of children by
caretakers, including encouragement of cannabis inhalation to promote sleepiness and to
decrease activity, has been reported. Pediatric ingestions of marijuana products happen more
frequently in regions with decriminalization or legalization of cannabis use.
After limited exposures, children may display sleepiness, euphoria, irritability, and other
changes in behavior. Vital signs may show sympathomimetic effects (eg, tachycardia and
hypertension) or, in patients with depressed mental status, bradycardia. Nausea, vomiting,
conjunctival injection, nystagmus, ataxia, and, in verbal children, slurred speech may also be
present. Dilated pupils have frequently been reported, although miosis has also been described.
In large overdoses (eg, ingestion of edible products, concentrated oils, or hashish), coma with
apnea or depressed respirations can occur.

Although not typical of pediatric cannabis intoxication, seizures have also been reported. In one
instance, cocaine was also found on urine screening.
Adolescents and adults — The physiologic signs of cannabis intoxication in adolescents and
adults include:

●Tachycardia (fast heart rate)
●Increased blood pressure or, especially in the elderly, orthostatic hypotension
●Increased respiratory rate
●Conjunctival injection (red eye)
●Dry mouth
●Increased appetite
●Nystagmus
●Ataxia
●Slurred speech

Acute side effects
Numbness, dizziness, low blood pressure, dysphoria (state of unease), anxiety, confusion,
vision changes, psychosis, speech disorder
Complications associated with inhalation use include:

●Acute exacerbations and poor symptom control in patients with asthma.
●Pneumomediastinum (air around the heart) and pneumothorax (air around/outside the lungs).
●Rarely, angina and myocardial infarction.

The risk for myocardial infarction among regular cannabis users has been found to be as high
as 4.8 times baseline.
Comorbidities:

  • Smoking
  • Alcohol
  • Opiates (gateway vs just ppl who take more drugs)
  • Stimulants
  • Mood disorders
  • Schizophrenia (increased risk if taken before 19)
  • Anxiety disorders, ocd, ptsd, adhd
  • Personality disorders (borderline, schizotypal, antisocial)

Testing:
Urine drug screens are less helpful in adolescents and adults for the diagnosis of acute
intoxication. Although testing is usually positive several hours after acute exposure it can also
be positive well after symptoms have resolved. As an example, positive results for delta-9
tetrahydrocannabinol metabolites have been reported up to 10 days after weekly use and up to
25 days for after daily use
Medical uses:
Only evidence for efficacy in these conditions — Chemotherapy-induced nausea and vomiting,
neuropathic pain, palliative cancer pain, and MS or spinal cord injury-related spasticity.
In neuropathic pain, palliative cancer pain, CINV, and MS- or SCI-related spasticity, they should
only be considered for patients whose conditions are refractory to standard medical therapies.
When considered, there should be a discussion with patients regarding the limited benefits and
more common harms, and a preferential trial of pharmaceutical cannabinoid first (over medical
marijuana).
Plans for cannabis laws in Canada once legalized:
https://www.canada.ca/en/services/health/campaigns/legalizing-strictly-regulating-cannabis-fact
s.html
Controlled access
Should the Cannabis Act become law in July 2018, adults who are 18 years or older would be
able to legally:

  • possess up to 30 grams of legal dried cannabis or equivalent in non-dried form
  • share up to 30 grams of legal cannabis with other adults
  • purchase dried or fresh cannabis and cannabis oil from a provincially-licensed retailer
  • In those provinces that have not yet or choose not to put in place a regulated
    retail framework, individuals would be able to purchase cannabis online from a
    federally-licensed producer.
  • grow up to 4 cannabis plants per residence for personal use from licensed seed or
    seedlings
  • make cannabis products, such as food and drinks, at home provided that organic
    solvents are not used
  • The sale of cannabis edible products and concentrates would be authorized no later than 12
    months following the coming into force of the proposed legislation.

Strict Regulation
Laws re: driving high Canada:
Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired
driving, while drivers with both alcohol and THC in their system would be considered impaired if
they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5
nanograms of THC in their blood.
The government said the other two proposed offences would be similar to the offences for drunk
driving. Drivers with more than five nanograms of THC in their blood would be punished with a
mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120
days for a third offence.
Legalization results elsewhere:
The public health impact of decriminalization or legalization of recreational cannabis use
include:

  • Both decriminalization and legalized recreational use have been associated with increased
    unintentional pediatric ingestions. As an example, after legalization of recreational marijuana
    use in Colorado, annual calls to the regional poison control center for pediatric marijuana
    exposure increased 34 percent on average to 6 cases per 100,000 population, which was
    almost twice the rate for the rest of the United States. Exposure to recreational marijuana
    accounted for about half of cases. Rates of hospital visits at a large regional children’s hospital
    system also increased significantly during the period of the study, although the total number of
    presenting patients (81) was small.
  • In regions with medical marijuana availability, diversion of drug from registered users may also
    encourage adolescent abuse.
  • In other countries where cannabis can be used legally, rates of usage vary. For example, in
    the Netherlands, the overall annual prevalence of cannabis usage is 23 percent among young
    adults compared with 5 percent annual usage reported by persons 12 to 64 years of age in
    Uruguay. Thus, the impact of decriminalization or legalization on the subsequent prevalence of
    cannabis usage is not easily predicted and varies depending upon the specifics of regulatory
    enactment.

In Washington and Colorado:

  • Rising rates of pot use by minors
  • Increasing arrest rates of minors, especially black and Hispanic children
  • Higher rates of traffic deaths from driving while high
  • More marijuana-related poisonings and hospitalizations
  • A persistent black market
  • The THC content, or potency, of marijuana, as detected in confiscated samples, has been steadily increasing from about 3% in the 1980s to 12% in 2012.

Negative effects:
Marijuana use has been associated with substantial adverse effects, some of which have been
determined with a high level of confidence. Marijuana, like other drugs of abuse, can result in
addiction. During intoxication, marijuana can
interfere with cognitive function (e.g., memory and perception of time) and motor function
(e.g.,coordination), and these effects can have detrimental consequences (e.g., motor-vehicle
accidents). Repeated marijuana use during adolescence may result in long-lasting changes in
brain function that can jeopardize educational, professional, and social achievements. However,
the effects of a drug (legal or illegal) on individual health are determined not only by its
pharmacologic properties but also by its availability and social acceptability. Alcohol and
tobacco are legal and account for the greatest burden of disease due to drugs.
Psychosocial functioning and health — Adolescent cannabis use is strongly associated with
lower educational attainment and increased use of other drugs, but not with school performance
or psychological health; even the strong associations are not clearly causal:
Not strong evidence that is is a cause of cancer, heart attack, stroke, arteritis, atrial fibrillation
Causes hyperemesis (vomiting) syndrome, tx with haldol or hot shower/bath (or fluids,
antiemetics (ondanzatron), benzos)
Cannabis use disorder: the continued use of cannabis despite clinically significant impairment,
ranging from mild to severe.
The main risk factors for cannabis abuse include frequent use at a young age; personal
maladjustment; emotional distress; poor parenting; school drop-out; affiliation with drug-using
peers; moving away from home at an early age; daily cigarette smoking; and ready access to
cannabis . The researchers conclude there is emerging evidence that positive experiences to
early cannabis use are a significant predictor of late dependence and that genetic predisposition
plays a role in the development of problematic use
The school experience strongly influences risk of cannabis use or vice versa. Among
adolescents enrolled in school, two- threefold greater prevalence of cannabis use during the
past month is seen among adolescents with (compared with without) the following
characteristics:

  • Failing grades
  • Nonparticipation in extracurricular activities
  • Dislike of school
  • Others in grade who use cannabis, alcohol, or cigarettes
    ie regular cannabis users in adolescence increases risk of poor school performance
  • Employment status – Those employed full-time or not in the labor force (eg, students, retired,
    disabled) have lower prevalence of cannabis use during the past month than do those working
    part-time (11.6 percent) or unemployed (7.5 and 4.8 versus 15 percent).
  • Income – Adults with income less than $20,000 USD annually have 2.5-times higher rates of
    cannabis use during the past year than adults with income of at least $70,000 USD annually
    (15.6 versus 5.9 percent)
  • Marital status – Unmarried adults are more likely to have used cannabis during the past year
    than are married adults or those widowed/separated (21.0 versus 5.5 versus 8.3 percent).
  • Legal status – Adults on parole, probation, or supervised release status are approximately
    three times more likely to have used cannabis in the past month than are individuals not in such
    legal status. Adolescents with violent or illegal behavior in the past year are at least twice as
    likely as those without such behavior.
  • Social network – Among adolescents, a positive relationship with parents and having parents,
    friends, or peers who disapprove of cannabis use are all associated with at least twofold lower
    prevalence of cannabis use over the past month.
  • Religion – Adolescents with frequent attendance at religious services or strong religious beliefs
    are two to three times less likely to have used cannabis over the past month than those without
    such protective factors.
  • Other substance use – Cigarette smokers and alcohol drinkers are each five to six times more
    likely than nonsmokers and nondrinkers to use cannabis.
  • Geography – Prevalence of cannabis use over the past month in the United States varies
    somewhat by geographic characteristics. Highest rates are found in New England (11.0 percent)
    and the West (10.3 percent) and in large (>1 million population) metropolitan areas (8.7
    percent). Lowest rates are found in the South Central region (5.9 percent) and in rural areas
    (4.5 percent).

But Cannabis use disorder constitutes a small proportion of the global burden of disease relative
to other substance use disorders. Of the approximately two million total disability adjusted
life-years lost to substance use disorders (not including tobacco), individual substance use
disorders were:

●Alcohol – 47 percent
●Opioids – 24.3 percent
●Amphetamines – 7.0 percent
●Cannabis – 5.5 percent
●Cocaine – 2.9 percent
●Other illicit drugs – 13.4 percent

Pros of legalization — regulation (know what exactly you’re getting), taxation
Large-scale cross-sectional epidemiological studies and smaller prospective longitudinal studies
have not found cannabis use to be significantly associated with serious or chronic medical
conditions or death from medical conditions.
Canadian medical college marijuana prescribing guidelines, authorized producers, more info:
http://www.cfp.ca/content/cfp/suppl/2018/02/13/64.2.111.DC1/Cannabinoid_Guidelines_Supplm
ent.pdf

Medical Myths By Dr. Zach Levine, ER physician, MUHC

BT Montreal | posted Wednesday, Feb 28th, 2018

Medical Myths

By Dr. Zach Levine, ER physician, MUHC

 

Medical myths are false beliefs about our health and healthcare that we pass on to each other with the best of intentions.  Indeed many doctors believe certain medical myths.  In this episode we’ll bust a few common ones.

 

1. Going out in the cold causes a cold

We have all experienced the common cold.  It is an infection caused by one of a number of viruses, most commonly rhinovirus.  Many studies have been done on this topic, and the result it clear – going out in the cold does not cause you to get a cold.  The myth may come from the name of the illness, or may come from the fact that more people tend to catch colds in the winter because the virus lives longer in cold environments and because people tend to spend more time indoors in closed environments where they share germs.  But you can go out in the cold without fear of the cold causing you to catch a cold.  Sleep deprivation has actually been shown to be associated with an increased risk of catching a cold, perhaps because your defences are down.  But the cause of a cold is always a virus, and if you’re not exposed to it you won’t catch it no matter how tired or cold you are.

 

2. Reading in dim light damages the eyes

This is a common myth but is a myth nonetheless.  Reading in dim light has not been shown to cause any permanent damage to the eyes.  Some people feel that their vision is a bit blurred or have a headache temporarily after reading in dim light because they have strained but again this is temporary, not permanent.  The same is true of watching TV too close to the screen – it causes no permanent damage to the eyes.  This goes for other screens as well.

Looking at a screen for long periods of time, similarly, can cause some strain or fatigue but not permanent eye damage.

 

3. Sleeping too little will kill you

Most people need an average of 7 to 9 hours of sleep per night.  Many people worry that they don’t get enough sleep and that it affects their health.  There is some evidence that sleeping too little puts extra strain on your cardiovascular system, but there has also been at least one study showing that people who sleep too much live less long.  So the jury is still out.  What is most important is to sleep enough so that you don’t feel tired and are able to function properly.  Tips for improving sleep include:

-avoiding alcohol and caffeine before bed

-regular exercise but not just before bed

-using the bed for sleep (and sex) but not spending hours reading or watching TV in bed

-the use of relaxation techniques are very useful for some people in getting to sleep

Sleep medications can be effective but should only be used occasionally.

 

4. Green sputum means you need antibiotics

The color of your sputum (aka snot, phlegm – the stuff that comes out of your nose and/or that you cough up when you are sick) does not indicate whether or not you need antibiotics.  Antibiotics are medications that treat bacterial illnesses, like strep throat and many pneumonias.  They are not useful in treating viral illnesses, like the common cold or the flu.  If you are ill and have colored sputum it is reasonable to visit the doctor.  By asking you questions and examining you, and doing other tests if necessary, your doctor can determine if you have a viral or a bacterial illness, and treat you with antibiotics if necessary.  If you have a viral illness like the common cold, your body’s immune system will eventually take care of healing you.  In the meantime certain medications may be useful in treating your symptoms so you don’t feel as rotten, but antibiotics will not help fight a viral illness – your natural defences will.

 

5. The flu vaccine will make you sick

The most common vaccine given to older adults is the flu vaccine.  It is formulated to prevent the flu, which is a serious infectious illness that kills thousands of people every year, especially the elderly, the very young, and people with chronic illness.  The vaccine is therefore recommended especially to the elderly, the very young, people with chronic illness, and people who work with these populations (like healthcare workers).  The vaccine is available by injection and by nasal spray (recommended for ages 2-49).  The injection is a dead virus which cannot cause the flu but may cause a bit of muscle ache and rarely a temporary unwell feeling.  The inhaled vaccine is a weakened virus which, even if it causes a mild illness, will cause one much less severe than the actual flu.  Remember that it is always better to prevent an illness than to treat it, and there is no cure for the flu.  So get the vaccine, and prevent it.  You most likely will not get sick, and if you do, you’ll be less sick than you would be if you caught the flu.

6. A made-in-Quebec myth:

Sitting on a cold toilet seat will give you a urinary tract infection

Urinary tract infections are caused by bacteria, usually bacteria that come from the gut.  Until later adulthood they are more common in women, because women have a shorter urethra (tube from outside into bladder) so the bacteria have less distance to climb from the outside into the bladder.  Ways to decrease the risk of catching them are wiping your bum from front to back, urinating after sexual intercourse, stay well hydrated, and urinate when you have to.

Sitting on a cold toilet seat is uncomfortable, but it has no effect on whether or not you catch a urinary tract infection.

There is so much health information available these days that it can be confusing.  Find sources and people you can trust and inform yourself about the facts before you make any decisions about your health.

Dangers of the flu, by Dr. Zach Levine

BT Montreal | posted Tuesday, Jan 16th, 2018

Flu —   caused by influenza virus

Virus shedding begins day before symptoms appear and lasts 5-7 days.  Most infective on 2nd and 3rd days after infection.  Correlated with fever.    (re shedding – shouldn’t go to work)

Every year 10-25% of canadians get flu and 500-1500 die from it

Virus lives longer with low humidity and lack of sunlight.  15 min on tissues, 5 min on skin, 1-2 days on plastic or metal.  Mucus protects (up to 17 days on banknotes!)

can include fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue

Get the shot!  Safe for pregnant and breastfeeding women

 

See doc if sob, chest pain, drowsy, neck stiff, fever in infant less than 3 months, not urinating

 

Tamiflu/oseltamivir.  Best if given within 48hrs.  Lessens symptoms and shortens illness 1-2 days.  Can be used as prophylaxis if exposed.

Give to ppl with chronic dz (lung dz, cancer, liver dz, kidney dz, dm, smokers, 65+)

 

Remember you can infect others, even if you take meds and feel better

Prevention with hand washing, cough into bend of elbow

 

Flu shot (shot is dead virus, nasal is live weakened, only for ages 2-49):  everyone 6 months and older can get.  takes 2 weeks to gain immunity.  Can get if chicken egg allergy unless severe — if worried, 1/10th the dose and observe 30 min before giving the rest.

Some people get soreness, or mild flulike sx.

Caregivers should get it.

A typical cough shoots out jets of air several feet long, along with around 3,000 droplets of saliva at speeds of up to 50mph.

Sneezes typically contain as many as 40,000 droplets, some which leave the body at more than 100mph.

In moist air, these particles may remain relatively large, and drop to the floor. But in dry air, they break up into smaller pieces – eventually becoming so small that they can stay aloft for hours.  Moistness itself also hurts the virus.

The mask’s effectiveness is also heavily dependent on how the illness is transmitted. For airborne viruses and bugs expelled from the body in large droplets, the mask may be your best bet. The trouble is, the flu and other ailments aren’t only spread in this manner. One study found that 65 percent of viruses spread among flu patients consisted of small particles. Unfortunately, the generic face mask is not airtight and cannot offer protection against these smaller particles. That means that if a sick person sitting next to you coughs, you can catch their ailment regardless of if you’re wearing a mask or not.

The CDC wrote in its H1N1 flu advisory that “facemasks help stop droplets from being spread by the person wearing them. They also keep splashes or sprays from reaching the mouth and nose of the person wearing them. They are not designed to protect against breathing in the very small particle aerosols that may contain viruses.”

Also, the CDC reminds us that the flu’s most effective avenue of transmission is not the air but via direct contact with an infected individual. For example, drinking from a glass that was shared with a sick person, or touching your mouth after touching a surface also touched by a sick individual is not only more likely to get you infected but is something the mask offers absolutely no protection against.

Alcohol during the Holidays

BT Montreal | posted Monday, Dec 18th, 2017

By Dr. Zach Levine, ER physician, MUHC

 

Overview:  Alcohol is addictive and in excess is bad, dangerous, addictive, but

it gives a buzz, is enjoyable, is a disinhibitor,

That’s why we can’t get rid of it, prohibition in the US failed

Same in the many places where it is officially banned — Northern QC native communities, certain middle eastern nations where it is underground

Russia France Greece 🇬🇧 Germany USA etc all have alcoholism

 

Maybe for another time — Alcohol vs Pot

 

Is alcohol good for your health?

It’s a mixed bag but it’s not worth starting to drink to help one’s health.  Drinking too much alcohol contributes to accidents and injuries and can lead to liver disease, high blood pressure, various cancers, and birth defects, among other health problems. However, moderate alcohol use may provide certain health benefits, particularly with regard to coronary heart disease. Understanding the possible risks and benefits of alcohol is essential to make an informed decision about alcohol use.

HOW MUCH IS ONE DRINK? — Alcoholic drinks come in multiple forms and contain differing amounts of pure alcohol (ethanol). In the United States, one portion of alcohol is defined as approximately 10 to 15 grams of ethanol, which can be found in:

  • One 12 ounce bottle or can of beer (roughly equivalent to the 330 mL cans of beers sold in some countries)
  • One 5 ounce serving of wine (about 150 mL)
  • One shot (1.5 ounces) of 80-proof distilled spirits (about 50 mL)

Moderate drinking is generally defined as 3 to 9 servings of alcohol per week, depending on age, sex, and other conditions. For example, the National Institute on Alcohol Abuse and Alcoholism defines ‘low-risk’ drinking as no more than three drinks on any single day and no more than seven drinks per week for women, and no more than four drinks on any single day and no more than 14 drinks per week for a man.

 

Binge drinking is defined as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 or above. This typically occurs when men consume 4 or more drinks or women consume 2.5 or more drinks in about a two-hour timeframe (varies a lot depending on size, tolerance)

It is most common in 18-34 year olds.  It is twice as common in men as in women.  Binge drinking is more common among people with household incomes of $75,000 or more than among people with lower incomes. However, people with lower incomes binge drink more often and consume more drinks when they do.

Binge drinking has been associated with unintentional harm and injuries from car accidents, falls, burns, and alcohol poisoning. Due to the altered state of mind, those who binge drink can fall victim to suicide, violence from their partner, and sexual assault.

Repeated binge drinking is associated with Chronic diseases such as high blood pressure, stroke, heart disease, and liver disease, cancer of the breast, mouth, throat, esophagus, liver, and colon, Memory and learning problems, and Alcohol dependence.

 

Legal limit: In Quebec and the rest of Canada, the maximum legal BAC for fully licensed drivers is 80 milligrams of alcohol in 100 millilitres of blood ( BAC/blood alcohol concentration of 0.08.  This is 17mmol/L in hospital units). Driving with BAC over 0.08 is a criminal offence.  This applies to everyone except drivers 21 or younger and professional drivers who are transporting other people (e.g. bus drivers, taxi drivers, etc.), in which case the limit is 0 mg (zero).

 

HEALTH CONDITIONS AND ALCOHOL — Multiple studies suggest that consuming alcohol can affect the risk of developing certain health conditions.

Cardiovascular disease — Cardiovascular disease, including disorders of the heart, blood vessels, and blood circulation, is the leading cause of death in North America. However, several studies suggest that moderate alcohol use, as compared to heavy drinking or abstaining, decreases the risk of coronary heart disease (CHD).

High blood pressure — People who consume more than two drinks per day have up to a twofold increase in the incidence of high blood pressure compared with nondrinkers. However, the effect of drinking less than two drinks per day on high blood pressure remains unclear.

Atrial fibrillation — Drinking several drinks at a single occasion, even among individuals who otherwise drink safely, can induce abnormal heart rhythms, including atrial fibrillation (aka “holiday heart”). There may be a slightly increased risk of atrial fibrillation (the most common chronic heart rhythm disturbance) among moderate drinkers, although it is still uncertain if this may result from occasional binges among otherwise moderate drinkers or occurs even within recommended limits of alcohol use.

Peripheral vascular disease — Peripheral vascular disease can cause pain in the calves with walking, also known as claudication. Moderate alcohol use reduces the risk of peripheral artery disease in healthy men.

Stroke — Alcohol consumption has been shown to affect the risk of stroke in contradictory ways, depending upon the amount of alcohol consumed and the type of stroke. A stroke occurs when brain tissue dies as a result of a sudden, severe disruption of blood flow and insufficient oxygen. Strokes may be due to a blockage (ischemic stroke) or rupture and leakage (hemorrhagic stroke) of one of the blood vessels supplying the brain.

Heavy alcohol use increases the risk of both ischemic and hemorrhagic stroke. Moderate alcohol use is associated with fewer ischemic strokes; the risk appears to be lowest in people who consume one drink or less per day. In contrast, the risk of hemorrhagic stroke appears to rise even with minimal alcohol use.

Breast cancer — There is consistent evidence that breast cancer risk is higher for women consuming moderate to high levels of alcohol (three or more drinks/day) compared with abstainers. Drinking as little as one to two drinks per day also appears to increase this risk

Taking folic acid (folate) may reduce the effect of alcohol consumption on breast cancer, suggesting that women who drink alcohol may benefit from a daily multivitamin fortified with folic acid.

Cancers of the head and neck and digestive tract — Alcohol use has been linked to several types of cancer of the head and neck and digestive (gastrointestinal) tract, even at low levels of consumption. People who drink and smoke have a greater risk than would be expected from either factor alone.

Cancer arising within liver cells (hepatocellular carcinoma) has been linked to alcohol use. This may be related to liver scarring (ie, cirrhosis) that occurs in people who consume excessive amounts of alcohol since cirrhosis is a major cause of hepatocellular carcinoma. Low levels of alcohol do not clearly cause cirrhosis.

However, even at low levels, drinking may increase the risk of hepatocellular cancer in people with inflammation of the liver (hepatitis) due to infection with certain viruses (ie, hepatitis C virus). People with chronic hepatitis should avoid alcohol.

Cirrhosis (scarring of the liver) — Low levels of alcohol do not clearly cause cirrhosis. Heavy drinking is generally required to cause cirrhosis in men in the absence of other factors.

Alcohol is the leading cause of chronic liver disease and failure in North America.

Gallstones — Moderate alcohol use has been shown to lower the risk of gallstones. However, heavy drinking may reverse this benefit.

Pancreatitis — Heavy drinking increases the risk of both sudden (acute) and long-term (chronic) inflammation of the pancreas (pancreatitis).

Osteoporosis — Heavy drinking increases the risk of hip fractures because it increases the risk of both osteoporosis and falls.

Pregnancy — There is a significant risk of birth defects related to use of alcohol use during pregnancy. Heavy drinking can cause fetal alcohol syndrome, which prevents normal growth, and may cause intellectual disability (mental retardation), malformations of the skull and face, and other findings (Fetal Alcohol Syndrome).

Moderate alcohol consumption may also be harmful, although this is a matter of some controversy. There is no known benefit of alcohol use during pregnancy. Thus, experts advise completely avoiding alcohol during pregnancy.

Perception of health and quality of life — Excessive and frequent alcohol use reduces quality of life for individuals, their families, and others around them, potentially leading to failure at work or school, interpersonal problems, and physically hazardous situations.

Accidents and trauma — Alcohol use increases the risks and severity of injury from motor vehicle accidents.

Exposure to alcohol is generally measured in blood alcohol concentration (BAC) rather than drinks per day or week. In most of the United States, the legal BAC limit for driving is 0.08 percent, which corresponds to about 4 drinks for a 200 pound man and 2.5 drinks for a 150 pound woman. However, the risk of having an accident while driving doubles at a BAC of only 0.05 percent, and driving ability is impaired with BACs as low as 0.02 percent.

Alcohol also increases the risk of injury from other sources. It has been shown to impair a pilot’s ability to fly and an operator’s ability to control a boat, bicycle, and snowmobile. In addition, occupational injuries, falls, drownings, burns, and hypothermia are more common in those who use alcohol, particularly in heavy drinkers.

Good resource — https://www.facs.org/~/media/files/quality%20programs/trauma/alcoholinjury.ashx

Violence — Alcohol is involved in more than one-quarter of all rapes, at least one-half of serious assaults, and one-half to two-thirds of all homicides.

Suicide — Alcohol abuse is associated with an increased risk of suicide. Although moderate drinking does not appear to raise suicide risk, episodes of heavy drinking cause disinhibition that can increase suicide risk.

IS ALCOHOL SAFE FOR ME? — The bottom line is that it is difficult to weigh the benefits and risks of alcohol. Nevertheless, several important conclusions can be drawn:

  • Beginning to drink alcohol may be inappropriate for people who have been lifelong abstainers. There is no evidence that lifelong abstainers who begin drinking in middle or older age will lower their risk of any disease.
  • The diseases that may be prevented by moderate drinking (eg, coronary heart disease and ischemic stroke) are most prevalent in older adults, men, and people with CHD risk factors (eg, hypertension, hypercholesterolemia, smoking, diabetes mellitus). For these groups, moderate alcohol use may reduce their risk of these conditions.
  • For young to middle-aged adults, particularly women, moderate alcohol use increases the risk of the most common causes of death, such as breast cancer and trauma. Men under age 45 years also may experience more harm than benefit from drinking. In these younger age groups, moderate alcohol use is unlikely to reduce the risk of dying.

Consuming less than one drink daily appears to be safe (that is, if not done before or while operating a car or heavy equipment), although even that level of drinking can be dangerous for some people (see next section).

Reasons to avoid alcohol — Alcohol use is not recommended for individuals who:

  • Are younger than the legal drinking age (18 in Quebec)
  • Are pregnant
  • Have a personal or strong family history of alcoholism
  • Have liver or pancreatic disease related to alcohol
  • Have precancerous conditions of the digestive tract
  • Operate potentially dangerous equipment or machinery (including cars, boats, planes, or construction equipment)

Wine versus other alcoholic beverages — Some research suggests that wine provides the strongest protection against cardiovascular disease, possibly due to naturally occurring compounds known as flavonoids. In France, for example, death from CHD is lower than would be expected from the high rate of smoking and saturated fats in the diet; this “French paradox” has been attributed to frequent red wine consumption.

However, other studies indicate that all alcoholic beverages offer cardioprotective benefits. Whether beverage type matters for specific diseases other than CHD remains uncertain, although most evidence suggests that it does not.

A safe dose of alcohol — As mentioned above, for some people, no amount of alcohol is considered safe.  However, for individuals without such conditions, the healthiest dose of alcohol appears to be in the range of 0.5 to 1 drink of alcohol daily.

Gender differences — Established recommendations for safe levels of drinking do not address an “ideal” level of alcohol consumption. However, they advise

  • No more than two drinks daily for men
  • No more than one drink daily for women

What is the best approach in my case? — The following guidelines may help in making an informed decision about alcohol use:

  • Consult a healthcare provider to determine the specific risks and benefits of alcohol use. Multiple factors must be considered in any such “risk-benefit analysis,” including age, sex, personal medical history, family history, diet, physical fitness, and certain lifestyle choices such as smoking, among others.
  • Women should not drink any alcohol during pregnancy; in addition, experts advise that women should stop drinking when trying to conceive.
  • Never consume alcohol before or while driving or operating any potentially dangerous equipment.

 

holiday heart syndrome was coined. It was defined as an acute cardiac rhythm and/or conduction disturbance, most commonly supraventricular tachyarrhythmia, associated with heavy ethanol consumption in a person without other clinical evidence of heart disease.

 

Blood alcohol concentration Clinical effects
20-50 mg/dL (4.4-11 mmol/L) Diminished fine motor coordination
50-100 mg/dL (11-22 mmol/L — 0.08 is 17mmol/L) Impaired judgement; impaired coordination
100-150 mg/dL (22-33 mmol/L) Difficulty with gait and balance
150-250 mg/dL (33-55 mmol/L) Lethargy; difficulty sitting upright without assistance
300 mg/dL (66 mmol/L) Coma in the non-habituated drinker
400 mg/dL (88 mmol/L) Respiratory depression

 

What is alcohol poisoning? — Alcohol poisoning is what happens if someone drinks far too much in a short amount of time. This is different from being drunk or having a little too much to drink. Alcohol poisoning is life-threatening. A person with alcohol poisoning could stop breathing or choke on his or her own vomit.

What are the symptoms of alcohol poisoning? — Some of the symptoms are the same as those for a person who is “just drunk.” For instance, people who have alcohol poisoning can seem confused or have trouble standing up. But some of the other symptoms of alcohol poisoning are more serious. Alcohol poisoning can slow or stop a person’s breathing. It can also cause seizures or an irregular heartbeat.

Call for an ambulance (in the US and Canada, dial 9-1-1) if the person:

  • Stops breathing or goes 10 seconds or more without breathing
  • Is breathing very slowly (fewer than 8 breaths in 1 minute)
  • Turns blue or very pale, and his or her skin feels cool to the touch
  • Has a seizure
  • Is passed out and cannot be woken up at all
  • Cannot stop vomiting
  • Looks very sick

What will the doctors at the hospital do? — If someone goes to the emergency room with alcohol poisoning, the doctors there can make sure that the person:

  • Keeps breathing. (If the person stops breathing, the doctors can put him or her on a breathing machine.)
  • Gets fluids through a tube in a vein (IV) if needed. (This can be important if the person has been vomiting a lot)
  • Is healthy except for the alcohol. People who have been drinking sometimes have other problems that are tough to spot, because they cannot tell you what they are feeling. For instance, people who have been drinking often fall down or otherwise hurt themselves. Doctors can use X-rays and other tools to spot possible injuries or other health problems.

Is there anything doctors can do to get the alcohol out of your system? — No. Alcohol is absorbed into the body very quickly. It does no good to empty the stomach. There is nothing that can soak up or cancel out the effects of the alcohol. The only thing that gets rid of alcohol in the body is time.

What can you do at home to help keep someone safe? — For people who have been drinking but do not seem to need emergency care, you can:

  • Keep checking their breathing and call for an ambulance (in the US and Canada, dial 9-1-1) if their breathing slows too much or stops
  • Lay them on their side, so that they do not choke on their own vomit if they throw up
  • Check them for bumps, bruises, bleeding, or any sign of injury
  • Make sure they stay warm (use blankets)

If someone you know drinks so much that you are afraid for his or her safety, that might be a sign of a drinking problem. When he or she recovers, it might be good to sit down and talk about what happened. Suggest speaking to a doctor, nurse, or mental health expert who can help diagnose and treat a drinking problem.

 

Stay safe:

Have a plan – designated driver, sober person, hydrate

Drink in Moderation

Eat food

If alcoholism in family history, be especially vigilant…

Good friends look after each other

Avoid dangerous situations, wild unsupervised parties

Avoid using “other” drugs

Alcohol is not an anti-depressant

Don’t drink and drive!  DUI’s are serious offenses, with very tough consequences

 

Alcohol vs marijuana — https://www.nytimes.com/2015/03/17/upshot/alcohol-or-marijuana-a-pediatrician-faces-the-question.html

Shingles: Symptoms, Causes, Treatments by Dr. Zach Levine

BT Montreal | posted Tuesday, Dec 5th, 2017

  1. What is shingles?

 

Shingles is a painful rash that is shaped like a band or a belt. Shingles can affect people of all ages, but it is most common in those older than 50. Another name for shingles is “herpes zoster.”

 

  1. What causes shingles?

 

Shingles is caused by the same virus that causes chickenpox. After someone has chickenpox, the virus sometimes hides out, “asleep” in the body. Years later, it can “wake up” and cause shingles. The first time a person is infected with that virus, he or she gets chickenpox, not shingles.

 

  1. Who gets shingles?

 

RISK OF SHINGLES — Up to 20 percent of people will develop shingles during their lifetime. The condition only occurs in people who have had chickenpox, although occasionally, chickenpox is mild enough that you may not be aware that you were infected in the past.

Age — Shingles can occur in individuals of all ages, but it is much more common in adults aged 50 years and older.

Immune status — Shingles can occur in healthy adults. However, some people are at a higher risk of developing shingles because of a weakened immune system. The immune system may be weakened by:

  • Certain cancers or other diseases that interfere with a normal immune response
  • Immune-suppressing medications used to treat certain conditions (eg, rheumatoid arthritis) or to prevent rejection after organ transplantation
  • Chemotherapy for cancer
  • Infection with the human immunodeficiency virus (HIV), the virus that causes AIDS

 

  1. Is shingles contagious?

 

Yes and no. It is not possible to “catch” shingles from someone who has the rash. But it is possible to “catch” the virus and then get sick with chickenpox. Shingles and chickenpox are caused by the same virus.

 

You probably will not catch the virus (or get chickenpox) if you:

  • Had chickenpox or shingles in the past
  • Had the chickenpox vaccine
  • Were born in north america before 1980 (most people born before 1980 have had chickenpox even if they don’t remember it)

 

  1. What are the symptoms of shingles?

 

At first, shingles causes weird sensations on your skin. You might feel itching, burning, pain, or tingling. Some people get a fever, feel sick, or get a headache. Within 1 to 2 days, a rash with blisters appears. Blisters most often appear in a band across the chest and back. They can show up on other parts of the body, too. The blisters cause pain that can be mild or severe.

Within 3 to 4 days, shingles blisters can become open sores or “ulcers”. These ulcers can get infected. Within 7 to 10 days, the rash should scab over. By then, most people are no longer contagious.

 

  1. Can shingles be serious?

Pain and seriousness get worse with increasing age.

Yes. Shingles can be serious, but that is rare. About 1 out of 10 people with shingles will get something called “postherpetic neuralgia,” or “PHN.” People with PHN keep feeling pain or discomfort even after their rash goes away. This pain can last for months or even years. It can be so bad that it makes it hard to sleep, causes weight loss, and leads to depression.

Shingles can also cause:

  • Skin infections
  • Eye problems (if the rash is near the eye)
  • Ear problems (if the rash is near the ear)
  • Dangerous infections in people who have other health problems

 

  1. Should I be treated?

 

Yes — for the virus and if needed for the pain

 

Treatment of shingles usually includes a combination of antiviral and pain-relieving medications. The affected areas should be kept clean and dry.

Antiviral medications — Antiviral medications stop the varicella zoster virus from multiplying, speed healing of skin lesions, and reduce the severity and duration of pain.

Antiviral treatment is recommended for EVERYONE with shingles, and is most effective when started within 72 hours after the shingles rash appears. After this time, antiviral medications may still be helpful if new blisters are appearing.

Three antiviral drugs are used to treat shingles: acyclovir (Zovirax®), famciclovir (Famvir®), and valacyclovir (Valtrex®). Acyclovir is the least expensive treatment but it must be taken more frequently than the other drugs.

 

Pain medications — The pain of shingles and postherpetic neuralgia can be severe, and prescription medications are frequently needed.

 

Treatment of postherpetic neuralgia — Treatment is available to reduce pain and maintain quality of life in people with postherpetic neuralgia. Treatment generally begins with a low-dose tricyclic antidepressant, and may also include narcotic medications and an anti-seizure medication.

Tricyclic antidepressants — Tricyclic antidepressants (TCAs) are commonly used to treat the pain of postherpetic neuralgia. The dose of TCAs is typically much lower than that used for treating depression. It is believed that these drugs reduce pain when used in low doses, but it is not clear how the drug works.

Anti-seizure medications — Medications that are traditionally used to prevent seizures, called anticonvulsants, can sometimes reduce the pain of postherpetic neuralgia. They may be used instead of or in addition to TCAs. Anticonvulsants commonly used for postherpetic neuralgia include gabapentin (Neurontin®) and pregabalin (Lyrica®).

Capsaicin — Capsaicin is a substance derived from chili peppers that can help to treat pain. Capsaicin cream (Zostrix®) may be recommended to treat postherpetic neuralgia. However, the side effects of the cream (including burning, stinging, and skin redness) are intolerable for up to one-third of patients.

Topical anesthetics — Lidocaine (Xylocaine) gel is a medicine that you can rub into your skin. A lidocaine patch (Lidoderm®) is also available, which you wear on your skin for 12 hours per day. It delivers a small amount of lidocaine to the most painful or itchy areas. However, the benefit of lidocaine is likely to be moderate at best.

Steroid injections — For people with postherpetic neuralgia who have severe pain despite using the above measures, an injection of steroids directly into the space around the spinal cord may be considered. Steroid injections are not used to treat facial pain.

In one study of patients with postherpetic neuralgia for at least one year, steroid injections led to good or excellent pain relief in about 90 percent of individuals [1].

 

  1. When can I return to work?  How long is it contagious? — contagious until all blisters are dry and crusted over

If you have shingles, you may wonder when it is safe to return to work. The answer depends upon where you work and where your blisters are located.

  • If the blisters are on your face, do not return to work until the area has crusted over, which generally takes seven to 10 days.
  • If the blisters are in an area that you can cover (eg, with a gauze bandage or clothing), you may return to work when you feel well.

 

  1. How can we prevent shingles?

Who can get the vaccine?

 

Vaccination — a vaccine is now available to reduce the chance of developing shingles. If you do develop shingles after receiving the vaccine, your infection may be less severe and you are less likely to develop postherpetic neuralgia

There are two vaccines that have been approved for adults over 50 years.

Drugs in everyday life By Dr. Zach Levine

BT Montreal | posted Wednesday, Nov 8th, 2017

Drug: a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.

Or

**A substance taken into the body by any form (orally, intravenously, transdermally, intramuscularly, intranasally…) that affects the way our body functions, the way we think, or the way we feel — ie medications, OTC, illegal drugs, drinks and foods

 

Terms:

Illicit: forbidden by law, rules, or custom

Narcotic:a drug or other substance affecting mood or behavior and sold for nonmedical purposes, especially an illegal one

Illegal and controlled “recreational” drugs in Canada:

Marijuana

Cocaine (stimulant from coca plant)

LSD (hallucinogen, altered sensorium)

Opiates – Heroin (semisynthetic), Fentanyl (synthetic)

Ecstasy (MDMA) – a stimulant

Ketamine – trance-like state, analgesia, sedation

Methamphetamine – stimulant

Magic mushrooms – change mood and perception, cause hallucinations

GHB – sedative, colourless and odourless

Rohypnol (nitrazepam)

 

Performance Enhancing Drugs:  (some legal, some not)

Anabolic steroids to build muscle

Stimulants to enhance performance and alertness

Also, amphetamine and methylphenidate increase power output at constant levels of perceived exertion and delay the onset of fatigue

Painkillers

Sedatives (to steady nerves and hands (eg/ for archery) for performance (beta blockers for performance anxiety)

Blood doping – to increase O2 carrying capacity of blood, for endurance sports

 

People use recreational (as opposed to performance enhancing) drugs for reasons including to change the way they feel, for pleasure, to self-medicate, and for social reasons.

 

Legal substances people use to affect how they feel or act:

 

Alcohol — legal at age 18 in QC, Alberta, Manitoba, 19 in the rest of the provinces.  It is the most abused substance in Canada

https://www.canada.ca/en/public-health/services/publications/chief-public-health-officer-reports-state-public-health-canada/2015-alcohol-consumption-canada.html

 

Psychoactive prescription medications

— ritalin, adderall — stimulants for treating ADHD

–Sleeping pills

–Depression (SSRI’s)

–Anti-anxiety medications

–For performance anxiety (beta blockers)

 

Legal, OTC stimulants:

Caffeine

Nicotine

Sugar

 

The point is not to suggest an equivalence between all drugs.  At some point most people use some substance to alter how they feel and some to enhance performance, even if at work or school.

 

Illicit drugs can be deadly, especially cocaine, fentanyl.  Part of what makes them deadly is the lack of oversight so they can be “laced.”

 

There are many important questions, such as whether it’s fair if only some people have access to performance enhancing substances, whether it would be safer if drugs were legalized and regulated.

 

But for a doctor the main concern is your health, so we need to know what you took (or think you took)

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