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Travel Advice from Dr. Zach

BT Montreal | posted Wednesday, Feb 8th, 2017

Plan ahead

  • Make sure you have medical insurance
  • Hopefully you won’t need it but if you don’t have it you’ll probably need it
  • Affordable, shop around
  • Make a timely Pre travel appointment with your doctor (less than 50% of ppl do)
  • You could need vaccinations – routine or otherwise – may need 4-6 weeks for this
  • Vaccines are individualized and depend on where you’re going.  Available:  yellow fever, meningococcal, typhoid, hep A, hep B, rabies, cholera, japanese encephalitis
  • Routine vaccinations — influenza, tetanus, diphtheria, pertussis, mmr, polio, varicella


Consider safety while away

  • Hand hygiene
  • Sun protection for eyes and skin — sunglasses, sunblock, sun shirts, hats, mosquito protection
  • Driving — intl license, be careful
  • STI’s – bring protection


Top things think of if you’re travelling to Mexico, Caribbean, or southern US this spring break:

  1. a) Traveller’s Diarrhea
  • Most common illness in travelers
  • Develops within 10 days of return
  • Variety of bacterial (etec most common), viral, parasitic (tend to persist longer) organisms
  • Prevention is key — eat only throoughly cooked hot foods, fruits you peel, pasteurized dairy.  Bottled drinks without ice, use straw
  • Freezing does not kill the diarrhea-causing organisms.  Alcohol does not sterilize them.  Fruit salads, lettuce, chicken salads unwise
  • Water purification — boiling for 3 min then cooling to room temp.  Adding 2 drops of 5% bleach to a quart of water will kill most bacteria in 30 min.  Adding 5 drops of tincture of iodine to a quart of water will kill bacteria within 30 min.compact water filters can be used
  • Chemoprophylaxis not recommended
  1. b) Chikungunya, Zika viruses – mosquito avoidance
  • Avoid feeding time (malaria Japanese encephalitis, west Nile virus between dusk and dawn; for dengue, chikungunya, zika, yellow fever during daytime)
  • Wear clothing that covers skin
  • Insect repellant.  DEET (there are others that work)  don’t saturate the skin.  Not under clothing.  Avoid eyes mouth genitals, wounds
  • Treat fabrics with insecticides’
  • Screens, tents
  1. c) Malaria (DR, Haiti) – chemoprophylaxis, mosquito bite avoidance
  • Depending on what else you do — diving barotrauma, STIs


2.     Staying well en route and coming home:

Air travel

  1. risk of VTE (blood clots) on flights of 4+ hours. Consider asa, compression stockings.  Get up and walk.
  2. Decreased paO2 in planes – may cause fatigue, “foggy brain”, headache.  Most ppl are fine but if sig heart lung dz, anemia, talk to your doctor
  3. It’s dry up there — drink
  4. Air pressure changes can cause ear pain in people with resp tract infections with blocked eustachian tubes — chew, yawn, suck sweets, valsalva, decongestant/antihistamine
  5. Jet lag — Curtail coffee, stay hydrated, Avoid or limit alcohol inflight, Try to sleep on the plane, Use sleeping pills wisely, Get outside, light, Adjust your clock, exercise
  6. Sharing germs — wash your hands!


Dr. Zach’s Guide to Postpartum Depression

BT Montreal | posted Monday, Jan 16th, 2017

By Dr. Zach Levine, ER physician, MUHC



A postpartum (PP) mood disorder begins within one-year of delivery with most occurring within four to eight weeks and lasts two weeks.

Distinguished by baby blues (BB) which is sadness interspersed with happiness, onset usually two-to-three days with a peak of seven-to-10 days.  Subsides within two weeks.

Baby blues affect 75 to 80% of new mothers, while 10-20% of new mothers are affected by postpartum depression.

Note — other postpartum mental health problems may be associated — anxiety disorders (PP Panic disorder, PP OCD), PP psychosis

Symptoms of PPD

  • Sadness
  • Crying
  • Insomnia
  • Appetite change
  • Difficulty concentrating
  • Feelings of worthlessness
  • Racing & obsessive thoughts
  • Anger
  • Fear
  • Guilt



  • Biological –  sudden drop in hormones (estrogen progesterone neurotransmitters) at delivery
  • Genetic – predisposition to mood disorders
  • Psychological – coping mechanisms, myths (below)


Freedom, identity, control, slim figure, feeling of unattractiveness. Usually comes down to a combination of factors.

  • Social – lack of support systems
  • Infant-related – even healthy infants require regular feedings around the clock and care, along with regular household needs. Unhealthy infants cause extra stress, as well as premature, those with colic.


The problem with myths is they don’t help – not meeting them can lead to guilt and shame. The fairytale image can be problematic: A happy mother, intuitive mothering, unremitting love, perfect baby, fathers being equally involved, being the perfect mother.


Risk Factors for PPD

  • First time mother
  • ambivalence about the pregnancy
  • History of mood disorder
  • Lack of social support
  • Lack of stable relationship with partner or parents
  • Unrealistic expectations about parenthood
  • Previous PPD


  • Therapy — individual or couple of group
  • Support groups
  • Practical help (every visitor brings food or does a load of laundry)
  • Medications

It is common and it is treatable and you are not alone.

Athena’s 2017 must-reads

BT Montreal | posted Thursday, Jan 12th, 2017

Athena the Book Explorer offers a selection of children’s books in English and French that she recommends to look at in 2017:

Book Series

  • ‘Magnus Chase and the Gods of Asgard’ by Rick Riordan
  • ‘The Trials of Appollo’ by Rick Riordan
  • ‘Diary of a Wimpy Kid: Double Down’
  • ‘Mother-Daughter Book Club’ series by Heather Vogel Frederick


  • ‘The Boy Who Dared’ by Susan Campbell Bartolleti
  • ‘Pax’ by Sarah Pennypacker
  • ‘Raymie Nightingale’ by Kate di Camilo
  • ‘Lily and Dunkin’ by Donna  Gephart
  • Escape from Mr. Lemoncello’s Library by Chris Grabenstein
  • (The sequel) Mr. Lemoncello’s Library Olympics by Chris Grabenstein

Graphic Novels

  • ‘Ghosts’ by Raina Telgemeier
  • ‘El Deafo’ by Cece Bell

French Suggestions

  • ‘Juliette’ series by Quebec author Rose Line Brasset
  • ‘Le comedien de Moliere’ by Annie Jay

Dr. Zach’s Guide to Winter Health

BT Montreal | posted Tuesday, Dec 6th, 2016

By Dr. Zach Levine, ER physician, MUHC

Colds and Flu Season

Why are viruses more prevelant in the winter? Beacause we spend more time indoors sharing air and viruses prefer dry air.

Colds are caused by one of several virus’; Symptoms are a runny nose, cough, congestion, low grade fever, sore throat – not caused by being cold.

Flu is caused by the influenza virus.  Every year 10-25% of Canadians get flu and 500-1500 die from it.

Virus shedding begins day before symptoms appear and lasts five-to-seven days.  Most ineffective on the second and third days after infection. Correlated with fever.

Virus lives longer with low humidity and lack of sunlight.  15 minutes on tissues, five minutes on skin, and one-to-two days on plastic or metal. Mucus protects (it remains up to 17 days on banknotes!)

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

Remember you can infect others, even if you take meds and feel better; see a doctor if sob, chest pain, drowsy, neck stiff, fever in infant less than three months, not urinating.

You can always get the shot! Flu shot (shot is dead virus, nasal is live weakened, only for ages 2-49) is available for everyone six months and older.  It takes two weeks to gain immunity.  If you have a chicken egg allergy you can get it, unless unless it is severe – if worried, 1/10th the dose and observe 30 min before giving the rest. Some people get soreness, or mild flu-like symptoms. Caregivers should get it.

Heart attacks – They increase in winter with 5-30% increase in heart related deaths in winter, up to 50% more MI’s in winter.

Cold causes vasoconstriction so increased bp.  Also blood clots easier in cold.

Caused by cold, shoveling, emotional stress, weight gain, little exercise, more salt, binge drinking and AF. Know the symptoms!

Recommend Vitamin D supplementation, and calcium for:

Bones and teeth

Immune system

DM control

CV health

Prevent cancer


SAD – Seasonal Affective Disorder is caused by a decrease in sunlight

Light therapy (10000 lux, little UV as possible as it is damaging to skin and eyes), 20-30 minutes soon after waking, eyes open but not looking directly; meds & therapy also an option.


Frostbite – An injury to the body caused by freezing.  It most commonly affects areas that are extremities and that are uncovered, such as the nose, ears, cheeks, fingers, and toes, especially in those with reduced blood circulation.  If recognized early, frostbite can be mild, but if left untreated it can lead to severe damage or loss of the frostbitten body part.

Signs of frostbite include a white or gray skin colour, numbness, and firmness or waxiness of the skin.  It is wise to warm or cover any area that begins to feel painful or turn red in the cold because once frostbite sets in the area may be numb and more damage may result without you feeling it.

Frostbite can be associated with hypothermia, another serious condition that is caused by the cold.  If you think you might have frostbite, seek medical care.  Until you can see a health care professional, the following tips might help: get warm, do not walk on frostbitten toes, put the frostbitten part into warm water or warm the area with body heat.  Be careful not to burn the affected area which may well be numb.

As always, prevention is better than treatment.  Dress properly


Hypothermia: Abnormally low body temperature – 35ºC or less.  Very cold temperatures or less cold temperatures if not well dressed or wet.  Very old and very young especially susceptible.

Warning signs of hypothermia include shivering, exhaustion, confusion, problems with coordination, memory loss, and slurred speech.  In infants you might note very low energy and bright red, cold skin.

Get warm, get help if bad. Move to a warm place, remove wet clothing and warm the person (such as in a warm blanket).  Warm beverages can help the person to warm up as well. Dress warm, wear layers. Be careful about falls.

Shovel, salt, stay active for muscles & balance, slow down, shoes with traction, bring a phone & have a plan.

Dr. Zach’s Guide to Staying Healthy in your 70s & 80s

BT Montreal | posted Monday, Nov 21st, 2016

Dr Zachary Levine, ER Physician, MUHC

In a nutshell the key to maintaining mental and physical health is continuing to be active, mentally (to ward off dementia) and physically (to prevent physical illness).

Life expectancy in Quebec: For men it’s 79, women 82

Growing older is not always easy – medical issues, friends and loved ones pass away. As – or more important – than quantity of life is Quality of Life.

How to stay healthy and live longer:


  • Have a doctor
  • Socialize, it’s important

Important for quality of life:

  • Doing things you enjoy
  • Social network and the risk of loneliness
  • Living space adjustment (mitigate risk of falls), life line or equivalent

Sleep Hygiene

  • Avoid napping
  • Avoid stimulants close to bedtime
  • Exercise (maybe not just before bed)
  • Don’t eat before bed
  • Get natural light during the daytime
  • Have a regular bedtime routine
  • Use bed for sleep
  • Keep the room dark


From AARP – 44 percent of women 68 through 80 report being very satisfied with their sex lives, compared with just 30 percent of women 55 to 68 years old.

About 50% of 70 years olds are sexually active — and this number is rising -risk of STIs


Know the signs and symptoms of stroke and heart attack.  Have a plan in case of emergency.

Continue screenings on:

  • Blood pressure
  • Cholesterol
  • Diabetes
  • Osteoporosis
  • Vision
  • Hearing
  • Cancer (bowel, breast until 74, cervical until 69)

Top causes of death 75-84:

  • heart disease (32.4%),
  • cancer (23.3%),
  • cerebrovascular diseases including stroke (8.2%),
  • chronic lower respiratory diseases (7.0%),
  • diabetes (3.1%),
  • influenza and pneumonia (2.7%),
  • Alzheimer’s (2.3%), — a big fear for many — activity (mental and physical), socializing
  • accidents (1.8%),


Remember – Stay active and engaged in your 70s, 80s, and beyond!

Dr. Zach’s Men’s Health Guide

BT Montreal | posted Wednesday, Nov 16th, 2016

By Dr. Zachary Levine, ER physician, MUHC

Men often don’t always take good care of themselves. Men go to the doctor only when necessary, or if they’re near death.

Men die younger -on average – than women.

The focus of International Men’s Day is on men’s and boy’s health, improving gender relations, promoting gender equality, and highlighting positive male role models.

The 2016 theme male suicide prevention.  Suicide rate among men is significantly higher (4:1) than women (3-4:1) (less attempts, more deadly). It is higher for native Canadians, while Quebec has highest rate of provinces, excluding territories.

Unintentional injuries is the No.1 killer of men before age 45.  It is high for ages 15 to 34 high, especially 20 to 24 (This does not include homicides.) In terms of number of years of life lost there is nothing close

General advice: Wear a helmet, don’t drink and drive and wear your seatbelt.


Reasons men actually will go to the doctor:

  • Erectile dysfunction
  • Hair loss
  • Forced by feamle friend — maybe one reason why married men live longer, less burnout

Why men don’t go to doctor:

  • Don’t think about it
  • Busy
  • Don’t want to know
  • No reason to go

Keep an eye on:

  • Be aware of testicular cancer (most cases ages 20-54)
  • Colorectal cancer screening as of 50
  • Hypertension
  • Lipids
  • Diabetes

Top killers of men: (depends on age):

  • Heart Disease
  • Unintentional Injuries
  • Chronic Obstructive Pulmonary Disease (LungDiseases)
  • Influenza and Pneumonia

Most common cancers in men:

  • Prostate
  • Lung
  • CRC
  • Bladder
  • Stomach

Dr. Zach’s Guide to Staying Healthy in your Sixties

BT Montreal | posted Monday, Nov 7th, 2016

By Dr. Zachary Levine, ER physician at MUHC                                                                  


Age really is changing — 60-year-olds are really like 40-year-olds used to be, 80 is the new 60.

The key to maintaining mental and physical health is continuing to be active, mentally (to ward off dementia) and physically (to prevent physical illness).


Need to have a doctor:

-check-in for screenings

-oversee medical issues and medications

-if something comes up



-Know your pharmacist

-Need a list of meds and medical issues



Heart disease



Respiratory Disorders


Flu, Pneumonia

Prevent these by a
voiding carcinogens, especially smoking; be physically active: help control blood pressure, cholesterol, glucose and weight.


Specific cancers in men:


-Discuss screening with md (psa not recommended by ctfph)





Specific cancers in women:





-Cervical – HPV Screening with pap test every 3 years until 69.  If 3 negative in a row can stop.  If not, continue every 3 years until 3 negative pap tests.

Smoking is associated with these cancers:  blood bladder cervix colon rectum esophagus kidney larynx liver lungs mouth throat pancreas stomach



Dr. Zach’s Guide to Staying healthy in your 40s and 50s

BT Montreal | posted Tuesday, Oct 25th, 2016

The body is changing… So do the best with what you can control it through diet, exercise, moderate alcohol, no smoking.

Issues for both women and men in this age group:

Weight gain — slowed metabolism, replace muscle with fat

Diet (plenty of fruits and vegetables, lean protein, healthy fats (omega 3s), whole grains,

fiber) and exercise

Stress and burnout — job, kids, parents to take care of.  Take time for self, vacation (see SD)

Cancer No. 1 killer in this age group


For Men:

Testis melanoma bowel brain nhl

Prostate/urinary issues, erectile dysfunction


For Women:

Breast melanoma cervix ovary brain; as of 50 breast then lung in women and prostate then lung in men

Cardiovascular disease catching up and becomes #1 in the 50s

There may be issues with skin, digestive system, vision, hearing

Menopause — bone loss, hot flashes, mood swings/depression, vaginal dryness, sexual dysfunction, Urinary incontinence


Check-ups — talk to your doctor about how often

Screening — testing for things before they are symptomatic:


Blood pressure at appropriate visits

Check height and weight at appropriate visits

Lipids (cholesterol) every 1-3 years in men 40+, in women 50+, and in people who are postmenopausal, diabetic, smokers, overweight, high blood pressure, men with erectile dysfunction, chronic kidney disease, atherosclerosis,

Screen for diabetes every 3yrs as of 40 years old

Optometric testing — no evidence based guidelines, consider every 1-2 yrs

Oral (dental) 1-2x/yr

Cancer screening:  do you have a family history? That changes things.


If of average risk:

For breast cancer — starting at 50, mammogram every 2-3 years

Colorectal cancer screen — starting at 50, fecal occult blood test every year (or flexible sigmoidoscopy every 5 years or colonoscopy)

Cervical Cancer — pap test every 3years (between 25-69 years)

Prostate cancer — PSA is not necessarily recommended as a screening test — talk to your doctor


Baseline EKG

Vaccines – Flu, Tetanus every 10 years


Stay active! Exercise for all — weight bearing and strengthening for bones, more muscle, and cardiovascular for weight loss and cardiovascular health


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