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iPhone X kicks off a new generation at a hefty cost

Winston Sih | posted Tuesday, Oct 31st, 2017

Pros

  • All-new design is slick and seamless
  • Face ID doesn’t just work—it works well
  • TrueDepth camera makes way for interactive augmented reality

Cons

  • It’s expensive
  • No Home button means you have to learn a whole new set of gestures
  • You better put a case on it—or else

When Apple first announced the 10th-anniversary iPhone at their September event in Cupertino, Calif., analysts questioned the decision to stagger the launch of two premium smartphones—and whether a stray from their traditional annual launch strategy would do them more harm than good.

Many enthusiasts decided to wait and see how iPhone X stacked up to its recently-launched sibling. While lineups for iPhone 8 were shorter than previous releases, carriers are reporting record-breaking preorder demand for iPhone X. But is a smartphone really worth a whopping $1,300? We were among the first to put iPhone X through its paces.

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Redesigned from the inside out

The first thing you notice when picking up iPhone X is the gorgeous design. Everything has been reimagined. From the edge-to-edge 5.8-inch Super Retina OLED display, to the glass front and back that Apple touts as the ‘most durable ever in a smartphone,’ the stunning curvature of the edges makes this design an engineering feat and resembles a piece of artwork.

 

image2iPhone X remains water- and dust-resistant, featuring speakers 35 per cent louder, and is compatible with Qi-enabled wireless chargers. The device will turn heads and start conversations—though you’re best to throw a case on it, especially if you’re prone to dropping things. You know who you are.

No more Home button

First the headphone jack, now the home button. They finally did it. iPhone X is the first iPhone to do away with the one button that does virtually everything. Instead, users will need to learn a new series of gestures in iOS 11—like swipe up to go to your home screen; double press on the side button to activate Apple Pay; and hold the side and volume button to power off.

There was a learning curve for the first while. You’ll be reaching for the Home button annoyed it’s no longer there, and then cycle through the gestures. You get used to it—and is the price you pay for an all-screen display.

If you’re the type who likes using your smartphone with one hand, the new gestures may complicate things.  There are more swipes from the top, bottom, and sides. Unless you have long thumbs, you may need two hands to perform certain actions.

 

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Facial recognition is the new fingerprint scan

For those who have become accustomed to the fingerprint authentication (known as Touch ID), iPhone X introduces a new facial recognition technology. I was blown away by how quick it learns your face and how effortless it is to use.

Face ID uses a new, front-facing TrueDepth camera that maps over 30,000 invisible dots to your face. It is stored securely on your device and is accurate to 1 in 1,000,000 that a random person can unlock your device. It also adapts to changes in appearance like facial hair growth, and cosmetic makeup.

It is used to do everything from unlock your device, authenticate into apps, and pay for purchases through Apple Pay. And none of the information is uploaded to the cloud, similar to Touch ID.

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Cameras and AR

Camera enthusiasts will see a step-up in quality through not one, but two 12-megapixel rear cameras with dual optical image stabilization. This includes an updated Quad-LED True Tone flash that lights images more evenly and gives you more vibrant and accurate colours.

 

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The popular portrait mode that was once for the rear cameras on iPhone 7 Plus and iPhone 8 Plus is now coming to iPhone X’s front-facing camera—something that will delight selfie takers and up their social media game.

The same TrueDepth camera that maps your face for security also unlocks a whole new world through augmented reality technology. Apple continues to double down on AR as a future way of interacting with the real world, and apps including Snapchat and IKEA are making use of ARKit. New Animojis in iMessage enable users to have 10-second clips of emojis mimicking your expressions and facial movements captured. A lot of fun to use and without a doubt going to be popular with the tweens—that is, if they can afford one.

Is it worth it?

And for the age-old question… The phone is expensive. Over $1,000 expensive. iPhone X will run you $1,319 and $1,529 for the 64GB and 256GB variants, respectively. So is it worth throwing down a month’s mortgage payment on a smartphone that is made of all-glass? It depends on which features are important to you.

iPhone X is without a doubt one of the slickest devices I’ve seen in a long time. The build quality is unlike many other smartphones on the market today. The iPhone changed the smartphone industry and paved way for a lucrative app market. It is the combination of well-built hardware, easy-to-use software, and the potential of apps to personalize the mobile computing experience that put iPhone on the map a decade ago. And the tech giant is hoping to do that all over again.

As preorder sales have proven already, enthusiasts who want to be part of that experience will line up overnight or wait upwards of six weeks to get hold of a device. But for many others, iPhone 8—even iPhone 7—will suffice, especially if the Home button is still of great value. Though, iPhone 8 will still make a dent in your wallet at just under $1,000, off contract.

Apple hopes that choice and category redefinition will help boost sales, after the wait-and-see approach of iPhone 8 resulted in shorter lineups at retail stores.

Rogers Communications is the parent company of this website.

Shortness of Breath, by Dr. Zach Levine

BT Montreal | posted Tuesday, Oct 24th, 2017

Shortness of breath (aka dyspnea) is the feeling of not being able to get enough air.  It is very uncomfortable and quite common.  It results from the brain sensing that the tissues are not getting enough oxygen, or CO2 is too high.

 

Shortness of breath is one of the most common reasons people go to the ER (along with chest pain, injuries, abdominal pain, back pain, headache, and infections).  Almost everyone experiences it at some point in their life.

 

Dyspnea is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations[2] or light exertion.

 

In 85% of cases it is due to lung disease, heart disease, or psychological causes, specifically asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or psychogenic causes,[2][3] such as panic disorder and anxiety.[4] Treatment typically depends on the underlying cause.[5]

 

Causes range from the benign to the life-threatening:

 

Lung and airway causes: pneumonia

Cancer

Asthma

COPD

Pneumothorax (punctured lung)

Airway blockage from mass or infection

 

Being physically deconditioned (in bad shape) and exerting yourself

 

Cardiac (heart) problems:

Heart failure causing fluid backup into the lungs

Inflammation or swelling on the pericardium (the lining around the heart)

Inflammation of the heart muscle

 

Circulatory problems heart and lungs):

Pulmonary embolus (blood clot in the lungs)

 

 

Blood problems:

Anemia (low oxygen delivery to tissues due to low levels of hemoglobin in

blood)

 

Hormone problems:

Hypothyroidism

Adrenal Gland insufficiency

 

Nerve problems:

Amyotrophic Lateral sclerosis (Lou Gherig’s Disease)

Guillane Barre Syndrome

Myasthenia Gravis

 

Psychiatric Problems:

Panic Attack

Generalized Anxiety Disorder

 

With so many causes for shortness of breath, what is one to do when one feels short of breath?  The safest thing to do is, of course, to see a doctor.  In a very brief period of time the doctor can rule out almost all of the causes and narrow it down to a handful of possibilities.

 

When discussing your case with you, the doctor will ask you how long the symptom has been present, what makes it better or worse, and what other symptoms you are suffering from.  In addition the doctor will find out about your medical history, medications, and recent illnesses.  The doctor will certainly ask whether you smoke, the major cause of COPD (chronic lung disease) and lung cancer, and whether you have been exposed to things that are potentially harmful to the lungs, such as asbestos.

 

Then the doctor will examine you.  First he or she will check your vital signs — your heart rate, blood pressure, oxygenation, and temperature.  Then they will listen to your heart and lungs and possibly examine other parts of you, if needed.

 

Finally, testing may be necessary.  Tests may include x-ray or CT scan of the lungs, pulmonary function tests to see how well you are able to inhale and exhale, and blood tests, and possibly more specialized testing.

 

Once all of this is done the doctor can give you a clear diagnosis and treatment plan.  Once you have this you no longer dealing with the fear of the unknown.

Online Medical Searches By Dr Zach Levine, ER physician MUHC

BT Montreal | posted Tuesday, Oct 10th, 2017

Online Medical Searches

By Dr Zach Levine, ER physician MUHC

People search the web about health

In a pew study over one year:

59% of people looked up health info

35% used the internet to try and diagnose their ailment

When people look up their symptoms they get the correct diagnosis 34% of the time

Medical questions:

— Most common online general health questions

·         Is bronchitis contagious?

·         Is pneumonia contagious?

·         How much water should I drink?

·         How many calories should I eat?

·         What is lupus?

·         How far along am I?

·         When do you ovulate?

·         What is gluten?

·         How long does the flu last?

·         Men search about urinary and erectile issues

·         Questions about non-western medicine

— Most common online symptom questions (mayo precedings/13)

Flu

Gallbladder infection

Measles

Listeria

Sinus Infection

Gastritis

Anxiety Attack

H. Pylori infection

Heat Stroke

Lactose intolerance

— Most commonly searched diseases

Diabetes

Depression

Anxiety

Hemorrhoid

Yeast infection

Lupus

Shingles

Psoriasis

Schizophrenia

Lyme disease

Vs.

Why people actually present to to the doctor

1. Skin disorders, including cysts, acne and dermatitis.

2. Joint disorders, including osteoarthritis.

3. Back problems.

4. Cholesterol problems.

5. Upper respiratory conditions.

6. Anxiety, bipolar disorder and depression.

7. Chronic neurologic disorders.

8. High blood pressure.

9. Headaches and migraines.

10. Diabetes.

And

What actually kills people (biggest killers in Canada)

Cancer

Heart disease

Stroke

Chronic lung disease

Trauma

Diabetes

Alzheimer’s disease

Influenza and pneumonia

Suicide

Kidney disease

Analysis:

1. Why the differences between what people Google and what they ask their doctor?

Embarrassment, forget, don’t have doctor, and they try to get a diagnosis online.  Also, they ask what’s on their mind at the time.  More likely to look up calories, water intake online.

2. Why the difference between what people as their doctor and what the doctor addresses?

Doctors focus on the big killers, ie cardiovascular disease, cancer risk factors and screening.  Patients focus on what’s ailing them and what worries them

3. Men vs women internet health – women search more, more well-informed, search for their families.  Women are often the reason men finally come to get things checed out

4. Increasing mental health concerns — unclear if incidence is going up but people are more aware of it, and look it up online

5. Mind body health relationship, integrative health — people understand that the mind and body are intimately connected, and that mental health is important to physical health.  And people like non-medicinal and natural treatments (but make sure there’s evidence)

6. The main point — you are not alone.  Millions have already searched that.  You can and should talk to your doctor about it.

—————————————————————————————————————————————————————————————————————————————————

_Details below_______________________________________________________________________________

Not much relationship between the top killers and what people search.

People search what they really want to know and what scares but may be embarrassed or afraid to ask.  People aren’t that scared of the top killers but they want to feel better (mental health), they look how to treat themselves (hemorrhoids, yeast infections).  And some things may have subtle symptoms — eg/Lyme disease.

Categories of questions (gomerblog):

1.    Too embarrassed to ask doctor — gonorrhea from toilet seat, anal sex

2.    Worries — is this cancer?

3.    Google second opinion – weight loss without exercise or diet, avoiding flu without the shot, lyme disease

Increasing searches about mental health issues point to both increasing awareness and maybe incidence (conflicting studies).  There is still stigma so people should talk about it, and doctors should ask about it.

Doctors and patients agendas often aren’t the same — docs may focus on the cardiovascular killers while patients are worried about their health now.

Lupus is a chronic inflammatory disease that occurs when your body’s immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different body systems — including your joints, skin, kidneys, blood cells, brain, heart and lungs.

(incidence about 1/1000 people, more in women and people of colour)

Lyme disease – spread by tick bite

Stage 1 – circular rash (approximately 50% get it), flulike illness

Stage 2 – headaches, joint pains,

Stage 3 – problems with memory mood sleep, fatigue, arthritis

Increasing in QC — 32 cases in 2011, about 200 this year (esp in eastern townships and monteregie, southwest of montreal – not many deer on the island of Montreal

Gender differences men v women internet health searches.  2015 study by Bidmon or Terlutter

RESULTS:

Women were more engaged in using the Internet for health-related information searching. Women used the Internet for health-related information searches to a higher degree for social motives and enjoyment and they judged the usability of the Internet medium and of the information gained by health information searches higher than men did. Women had a more positive attitude toward Web 2.0 than men did, but perceived themselves as less digitally competent. Women had a higher health and nutrition awareness and a greater reluctance to make use of medical support, as well as a higher personal disposition of being well-informed as a patient. Men may be more open toward the virtual patient-physician relationship.

CONCLUSIONS:

Women have a stronger social motive for and experience greater enjoyment in health-related information searches, explained by social role interpretations, suggesting these needs should be met when offering health-related information on the Internet. This may be interesting for governmental bodies as well as for the insurance and the pharmaceutical industries. Furthermore, women may be more easily convinced by health awareness campaigns and are, therefore, the primary target group for them. Men are more open to engaging in a virtual relationship with the GP; therefore, they could be the primary target group for additional online services offered by GPs. There were several areas for GPs to reinforce the virtual patient-physician relationship: the fixing of personal appointments, referral to other doctors, writing prescriptions, and discussions of normal test results and doctor’s notes/certificates of health.

Mind and body are intimately intertwined

Integrative medicine (UCI new $200B grant) – uses both western and complementary tx

Complementary – in addition to western

Alternative – instead of western

complementary/alternative tx — natural products, yoga, chiropractic and osteopathic manipulation, meditation, and massage therapy, acupuncture, hypnotherapy, homeopathy, naturopathy

Concussion and CTE by Dr. Zach

BT Montreal | posted Wednesday, Sep 27th, 2017

By Dr Zach Levine, ER physician MUHC

 

Background – Aaron Hernandez found to have grade 3 (of 4) CTE at the age of 27

Numerous other players have had CTE (bob probert hockey, junior seau football)

 

Sports with head contact — hockey, soccer, football, basketball (can have collisions), cycling (falls)

Sports are good for fun, relaxation, health, fitness, sense of achievement

 

ER visits for concussions have increased 60% over the past 10 years

 

 

What is CTE?

(used to be called demetia pugilistica or punch drunk syndrome, discovered in boxers)

Chornic traumatic encephalopathy.

Symptoms — memory loss, confusion, aggression, suicidality.

  • Difficulty thinking (cognitive impairment)
  • Impulsive behavior.
  • Depression or apathy.
  • Short-term memory loss.
  • Difficulty planning and carrying out tasks (executive function)
  • Emotional instability.
  • Substance abuse.
  • Suicidal thoughts or behavior.

So mood changes, thinking problems, memory loss

 

Diagnosed only on autopsy.  Buildup of tau protein in brain.

Caused by recurrent hits to head, symptomatic and not

Onset in the 40’s (much earlier than dementia, which has similar symptoms)

 

What is concussion?

Blow to the head that causes symptoms.  Not need to have LOC.

Concussion symptoms:

blurred/double vision

Headache

Fatigue

Sleep probs

Confusion

Memory problems

Difficulty concentrating

Somatic (h/a), cognitive, and emotional symptoms

 

Get off the field.  Evaluation with SCAT5.

Rest 24-48 hours.  Then gradual activity, mental then physical, below symptom threshold

 

What is the relationship between CTE and Concussion?  Recurrent hits to the head cause CTE.  Not necessarily concusions.  Also not all people with multiple head hits or concussions will get CTE

 

The earlier one starts to get head injuries, the worse the outcome

 

Kids concussions and QC contact sport:

 

Kids concussions — big head thin skull, weak neck muscles, poor technique (use forehead where skull is thickest) all contribute.  Also less myelinated (and protected) nerve cells.

 

Girls get concussed as much if not more than boys (but less play football)

 

Takes longer to heal with subsequent concussions

 

NFL players have significantly higher risk of Alzheimer’s, ALS

 

Contact in sports in QC:

In QC hockey hitting starts at bantam (age 13-15) double letters

 

Football always has contact

 

The U.S. Soccer Federation has banned heading the ball in youth soccer for players under 10 years of age after a class action lawsuit revolving around concussions.

The federation also restricted heading the ball for players aged 11–13; they are allowed to head in practice sessions, but not in games.

The Canadian Paediatric Society has warned against heading in youth games

 

Helmets:  Helmets are good at preventing skull fractures, which is what they were made to do.

 

Risk factors for concussion:

 

Learning disabilities

Attention disorder

Migraine headache

 

What do you recommend for kids who play sports?

 

Consider having kids with risk factors not play contact sports

General Recommendations:

(Dr. Robert Cantu, sports med expert)

No contact sports until 14

No heading in soccer until 14

No head first sliding in bball

 

Need to teach proper body checking, heading technique in soccer, tackling in football

 

Individualize decision on contact sports — which sport, has child had prev concussions

 

Credit to Dr. Scott Delaney, top Quebec sport-related brain injury expert

Apple TV refresh brings 4K, City to streaming platform

Winston Sih | posted Thursday, Sep 21st, 2017

Screen Shot 2017-09-19 at 4.36.28 PM

Amidst the iPhone announcements in Apple’s annual September event in Cupertino, Calif., brings a few other surprises including an update to Apple TV—finally embracing 4K technology in the living room. But is the market finally ready, or is it a little too late?

4K HDR

IMG_0110

Physically, the device is the same in size. But it does pack a punch with new technology to bring your TV viewing experience to life. Leveraging the A10X Fusion chip—the previous-model chip in iPhone 7—the tech giant hopes that will provide the needed computing power to stream 4K-resolution content. Quadruple the pixels of high definition, quadruple the crispness, and you notice it from the get-go when you power the unit on. Caveat is, of course, that you need a 4K television—something many households don’t currently have.

If you are an owner one a 4K television set, the colours and depths of the pictures are stunning. Colours are more vibrant, blacks are deeper, and whites are brighter. This is all thanks to the high-definition range that adapts to your television set, finds the optimal performance, and scales the content up or down to fit your display environment. Apple TV 4K follows two leading formats on the market, Dolby Vision and HDR10, and the engineering shines through when streaming content.

From the previous-generation model, Apple says its 4K older sibling is two-times faster, and graphics performance is up to four times faster, though unless you’re streaming 12 things at once, you won’t notice a massive difference. However for 4K content, it will benefit from the spec bump.

Surfacing the TV content you want

Through the new tvOS update, Canadians now get access to the Apple TV app—one of a seven countries this is rolling out to outside of the United States.

Screen Shot 2017-09-19 at 4.36.17 PM

Canadian broadcasters, including City and FX, have joined onto this new platform to unify on-demand offerings in one easy-to-find location for binge-watchers. Users can subscribe and sign into their favourite services, and titles are synced and streamed across Apple TV, iPhone, and iPad. HD movies from iTunes are upgraded to 4K HDR at no additional cost.

Screen Shot 2017-09-19 at 4.35.23 PM

There’s an app for that

Thousands of apps are being added on an on-going basis, allowing users to do everything from play games, control your smart home devices, to edit your family photos from iCloud. Selection isn’t as robust as the likes of App Store on iOS devices, and the remote experience simplifies what you can (and can’t) do on Apple TV.

Siri is integrated into the physical remote itself, and for those looking to type on a traditional keyboard, you can do so via the Remote app on your iOS device.

Final thoughts

For those looking to invest in a streaming player, Apple TV is a good choice. It won’t replace your cable subscription or PVR, but it’ll give you plenty of options to compliment your viewing experience—especially if you’re into streaming. The computing power will make using interactive apps a breeze, and while the selection of programs isn’t as robust as it could be, developers will take advantage as more users adopt.

The 4K HDR 32GB variant ($229) is a great option only if you have the display to go with it, otherwise the fourth-generation non-4K model ($199) will suffice—the price difference only being about $30.

iPhone 8: A taste of iPhone X with less sticker shock

Winston Sih | posted Tuesday, Sep 19th, 2017

featured

When Apple announced three new smartphones at its new Cupertino, Calif. headquarters, Apple Park, I instantly got dozens of texts with the same question: Winston, which one is right for me?

The answer is—these devices are targeted at different people. iPhone 8 packs a lot of punch that makes it a significant upgrade from its iPhone 7 sibling, but it also jams in a lot of familiar that will leave enthusiasts waiting to compare with the 10th-anniversary iPhone X when it goes for sale in November.

Design

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At first glance, users will notice a vary familiar design. Yes, the headphone jack is still gone, but the tech giant’s classic Home Button remains, with TouchID functionality for fingerprint access and Apple Pay. Turn the phone around and you’ll find a new, all-glass back—admittedly making me very nervous at first—but makes way the much-welcomed wireless charging on iPhone.

Apple says iPhone 8 features the most durable glass in a smartphone—a 50 per cent deeper strengthening later—and aerospace-grade 7000 Series aluminum on the exterior for reinforcement. Despite my initial worries, our review unit has proven to be that, quite durable, though I’d still recommend using a case in the day-to-day. They remain water-resistant—not waterproof. So don’t go diving with iPhone 8.

The new devices are still available in two sizes—iPhone 8 and iPhone 8 Plus—with 4.7- and 5.5-inch Retina HD screens, respectively, in three finishes—grey, silver, and gold.

Bionic performance

Replacing its A10 chip predecessor, Apple introduces A11 Bionic to its latest roster of smartphones—‘the most powerful and smartest chip ever in a smartphone.’  And that’s a big claim to make. Pushing the six-core CPU and three-core GPU to max simultaneously was difficult in my day-to-day use cases, making it easy for developers to integrate apps to take advantage of augmented reality.

The power in the new devices also makes way for TrueTone—the same technology in the latest iPad—that adaptively adjusts the hue of your screen to your environment realtime, minimizing eye strain. Users will notice louder audio through new stereo speakers, though minimal improvement from iPhone 7.

Similar with new sensors, ‘Portrait Lighting’

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I struggled when thinking about how a smartphone camera could see improvements. It basically does everything I need it to do today—Instagram, Facebook Live, the odd Boomerang, make funny faces on Snapchat. Oh, right, and the awe-worthy, photographer-of-the-year Portrait Mode pics that made anyone the star of a party.

The camera remains at 12 megapixels for both devices, but new sensors make room for better video stabilization, improved colour filter, calibrated cameras alongside the gyroscope for those augmented reality apps.

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On iPhone 8 Plus, a new feature called ‘Portrait Lighting’ is introduced, taking advantage of the dual cameras. You get the bokeh depth-of-field effect while the software gives users the options to digitally manipulate lighting to enhance facial contour, mimic studio conditions, and crop out the background. When it works well, it works well, but on testing, conditions need to be just right or it becomes a little finicky. Definitely a beta feature until it is refined.

Say goodbye to cord city

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Apple has introduced new charging technology in all three devices that follows the same Qi standard in many third-party accessories today. Paired with iPhone’s glass back, this allows users can ditch the Lightning cable and recharge by simply placing their device on a Qi-compatible mat, including Apple’s AirPower mat, not out until later this year.

But surprise, their charging mat will only work with the new iPhones, Apple Watch Series 3, and a new AirPods case. Older devices will not work.

Accessory makers like Mophie are making wireless mats, and expect many more restaurants and cafes to take advantage of wireless charging as more smartphone manufacturers are taking the lead on integrating it into their phones.

iOS 11

Through the latest operating system, iOS 11, brings many refinements to the user experience to new and existing devices, including Apple Pay in iMessages, Do Not Disturb mode when driving, a new Siri voice assistant, and central file storage. A large improvement for existing iPhone owners who don’t want to make the upgrade.

Pricing

iPhone 8 will be available in 64GB and 256GB capacities for $929 and $1,139 off-contract, respectively. iPhone 8 Plus will be available in the same capacities for $1,059 and $1,269 off-contract.

So, I make the upgrade?

iPhone 8 brings a lot of improvements to Apple’s flagship smartphone—the A11 Bionic processor, refinements in the 12-megapixel camera sensor, wireless charging, as well as iOS 11. But it also brings a lot of similar through its familiar design. If you have an iPhone 6s or iPhone 7, you’ll see minor improvements, but unless you’re going to be taking advantage of augmented reality or eager for wireless charging, the free upgrade to iOS 11 will suffice.

iPhone 8 and iPhone 8 Plus is a good upgrade if you are an older-model iPhone user due for an upgrade. You’re looking to take better family photos, want to stay productive on a larger screen, and can’t let go of that Home Button—not yet anyway. You get a lot of the power from iPhone X with a little less of the sticker shock.

As for those still curious about iPhone X, the all-new device breaks tradition and will be the shiny new toy many are waiting out for—marketed as Apple’s flagship premium offering. It rings in at a whopping $1,300 to start, and features an edge-to-edge OLED display, no home button, and FaceID facial recognition technology, to be available Nov. 3 in Canada.  No doubt many will be waiting to compare the devices side-by-side before making their decision.

A killer high: Opioid crisis By Dr. Zach Levine, ER physician, MUHC

BT Montreal | posted Wednesday, Sep 13th, 2017

Opioids used to refer to synthetic opiates but now refers to all natural, synthetic, and semi-synthetic opiates.
The different opioids:
Codeine, Morphine
Heroin, Oxycodone, Hydromorphone
Fentanyl, Demerol (meperidine), Methadone
People take opioids for the high — they induce euphoria and relaxation. But they are addictive and dangerous.
Signs of Opioid intoxication:
Depressed mental status
Decreased respiratory rate
Decreased bowel sounds
Miotic (constricted) pupils
Heart rate may slow and blood pressure may drop
Temperature may drop
Naloxone aka Narcan is life-saving. It starts them breathing again.
Fentanyl and fentanyl analogs — Fentanyl and fentanyl analogs are increasingly entering the drug supply as counterfeit tablets or substituted for heroin. These analogs include drugs such as alfentanil, remifentanil, and sufentanil, as well as drugs that are not approved for use in humans, such as carfentanil, furanylfentanyl, and others. Fentanyl is 50 to 100 times more potent than morphine and 40 times more potent than heroin and some analogs are even stronger.
When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenges. Non-pharmaceutical fentanyl is sold in the following forms: as a powder; spiked on blotter paper; mixed with or substituted for heroin; or as tablets that mimic other, less potent opioids.8 People can swallow, snort, or inject fentanyl, or they can put blotter paper in their mouths so that fentanyl is absorbed through the mucous membrane.
From QC: Le fentanyl est un narcotique 40 fois plus puissant que l’héroïne et 50
-100 fois plus puissant que la morphine. Cet opioïde est associé à des risques élevés de surdoses et de décès. Il peut être vendu sous forme de poudre ou de comprimé, en tant qu’héroïne, cocaïne ou oxycodone ou être inclus dans leurs compositions. Il produit des signes et symptômes qui sont semblables aux surdoses par autres opioïdes.
HARM REDUCTION AND TAKE-HOME NALOXONE — Bystander-administered naloxone by the intramuscular and intranasal routes can be used successfully to resuscitate opioid overdose patients. Providing opioid users, family members, and friends with naloxone, accompanied by teaching them how to recognize opioid toxicity, may reduce overdose mortality.
For more information about Fentanyl, how to limit harm, and how to get naloxone (20-30 minute training required) — http://www.dsp.santemontreal.qc.ca/surdosesOpioids used to refer to synthetic opiates but now refers to all natural, synthetic, and semi-synthetic opiates.
The different opioids:
Codeine, Morphine
Heroin, Oxycodone, Hydromorphone
Fentanyl, Demerol (meperidine), Methadone
People take opioids for the high — they induce euphoria and relaxation. But they are addictive and dangerous.
Signs of Opioid intoxication:
Depressed mental status
Decreased respiratory rate
Decreased bowel sounds
Miotic (constricted) pupils
Heart rate may slow and blood pressure may drop
Temperature may drop
Naloxone aka Narcan is life-saving. It starts them breathing again.
Fentanyl and fentanyl analogs — Fentanyl and fentanyl analogs are increasingly entering the drug supply as counterfeit tablets or substituted for heroin. These analogs include drugs such as alfentanil, remifentanil, and sufentanil, as well as drugs that are not approved for use in humans, such as carfentanil, furanylfentanyl, and others. Fentanyl is 50 to 100 times more potent than morphine and 40 times more potent than heroin and some analogs are even stronger.
When prescribed by a physician, fentanyl is often administered via injection, transdermal patch, or in lozenges. Non-pharmaceutical fentanyl is sold in the following forms: as a powder; spiked on blotter paper; mixed with or substituted for heroin; or as tablets that mimic other, less potent opioids.8 People can swallow, snort, or inject fentanyl, or they can put blotter paper in their mouths so that fentanyl is absorbed through the mucous membrane.
From QC: Le fentanyl est un narcotique 40 fois plus puissant que l’héroïne et 50
-100 fois plus puissant que la morphine. Cet opioïde est associé à des risques élevés de surdoses et de décès. Il peut être vendu sous forme de poudre ou de comprimé, en tant qu’héroïne, cocaïne ou oxycodone ou être inclus dans leurs compositions. Il produit des signes et symptômes qui sont semblables aux surdoses par autres opioïdes.
HARM REDUCTION AND TAKE-HOME NALOXONE — Bystander-administered naloxone by the intramuscular and intranasal routes can be used successfully to resuscitate opioid overdose patients. Providing opioid users, family members, and friends with naloxone, accompanied by teaching them how to recognize opioid toxicity, may reduce overdose mortality.
For more information about Fentanyl, how to limit harm, and how to get naloxone (20-30 minute training required) — http://www.dsp.santemontreal.qc.ca/surdoses

Dr. Zach’s tips for Navigating the ER

BT Montreal | posted Wednesday, Aug 16th, 2017

The ER is often a very busy and crowded place.  It is the first stop for whatever ails you, and whatever ails anyone else.  The beauty of the ER, but also what makes it so crazy, is that all are welcome and people are prioritized on the basis only of how severe or life-threatening their medical issue.  The problem is that some very uncomfortable problems can wait a long time if they are bumped by life-threatening ones.  And Canadians visit the ER on average more often, and wait longer, than people in other commonwealth countries.  Reference https://www.cihi.ca/en/commonwealth-fund-survey-2016.

 

It is a good idea to find out what off-hours coverage your doctor’s office has.  Many offices share an on-call system whereby off-hour and holidays are covered by a doctor.  This could save you many hours in the ER for something that does not need ER care.

 

Given these facts it is important to understand how the ER works, in order not to spend any more time there than you have to.  Here are some tips and explanations:

 

  • Life-threatening problems are seen first, which means that even painful problems can wait.  Triage nurses evaluate you, determine how life threatening a problem is, and assign a triage code.  However, most ER’s do have policies in place whereby they can treat pain early.  It is important to let the staff know if something changes or gets worse because triage codes can and do change.  ER’s don’t want people collapsing in the waiting room
  • Come with an advocate if you can (or have one meet you).  Often you are not in great shape to advocate for yourself in an emergency situation, and if you need something or feel worse your advocate can advocate for you.  This person can also keep track of who you saw and what was said and done.  An ill person often can’t keep track of these things.
  • Carry a list of your regular medications, allergies, significant illnesses, and doctors with you.  This will allow the ER doctor to get make the most informed assessment possible.  Also, it will save them (and you) time searching for this information
  • If you are severely ill, call an ambulance.  There are several reasons for this: if you’re very sick it is not safe to drive.  The paramedics can begin life-saving treatment en route to the hospital.  The ambulance can usually get there faster than you can.  And the ambulance will know the best place to take you — in many large cities certain centres are deemed the stroke centre, or the heart centre.  You want to go to the right one first.  Of note, coming by ambulance will not get you seen faster if your problem does not warrant it
  • Keep in mind that you may not get a final diagnosis, especially for a chronic problem, in the ER.  ER doctors are specialized in resuscitating acutely ill people and ruling out life threatening conditions.  Once they have ruled out dangerous causes they may let you go home with follow-up for further testing
  • Make sure to ask any questions you have before you leave, to understand what the diagnosis is, the treatment, and where to follow-up.  And know the reasons why you should return to the ER

 

A visit to the ER is often stressful and can be frustrating.  Knowing how things work and following the tips above can help mitigate some of the stress and frustration.  Communication is key — if you have a question or concern then ask or say something.  The ER staff are people who will do their best to help you.  The more they know the better for everyone.

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