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Dizziness by Dr. Zach

BT Montreal | posted Wednesday, Jul 26th, 2017

Dizziness is a common problem and a common reason why people go to the emergency department.  It can range from mildly annoying to totally incapacitating and dangerous.  Dizziness is actually a term which encompasses two different entities, each of which has a different cause and treatment:  Presyncope, or light headedness, is the feeling that one is about to faint.  The cause of this is usually cardiovascular, meaning that not enough blood is getting to the brain.  Vertigo, on the other hand, is the feeling of movement or spinning when one is actually stationary.  It is often associated with nausea and vomiting.



  1. Vertigo — illusion of movement due to imbalance in the vestibular apparatus

Can be either peripheral (from the inner ear, much more common) or central (from brain)

-Peripheral (inner ear cause) is more severe than central, often accompanied by nausea and vomiting.  May have ear symptoms such as pain or ringing or decreased hearing

Treatment depends on cause (BPV – calcium crystals in endolymph in semicircular canal.  Tx with Epley manoeuvre).

-Central is usually milder, no hearing loss, may be associated with other neuro symptoms (double vision, difficulty speaking, weakness, incoordination)


Peripheral causes
Benign paroxysmal positional vertigo
Vestibular neuritis
Herpes zoster oticus (Ramsay Hunt syndrome)
Meniere disease
Acoustic neuroma
Aminoglycoside toxicity
Otitis media
Central causes
Vestibular migraine
Brainstem ischemia
Cerebellar infarction and hemorrhage
Chiari malformation
Multiple sclerosis


Treatment is directed at the cause, or the symptom

As you age your threshold to become dizzy and your tolerance of dizziness decreases


  1. Presyncope/lightheadedness results from not getting enough blood supply to the brain

Feeling of nearly fainting often with lightheadedness, a feeling of warmth, diaphoresis, nausea, and visual blurring occasionally proceeding to blindness. An observation of pallor by onlookers

Frequently when one gets up quickly — orthostatic hypotension

Being dehydrated, hot day predispose

Or can be caused by a reaction to pain, anxiety – vasovagal

Need to make sure heart, brain, sugar are ok

Also hyperventilation can cause it


Treatment depends on cause.  Often people need to be hydrated.

Some tx for orthostatic hypotension include avoiding heat, get up slowly, avoid big meals and alcohol, exercise, elastic stockings, increased water and salt, occasionally medications

Kasie Savage’s Cottage Gifts

BT Montreal | posted Thursday, Jul 20th, 2017

If you’ve been invited to spend a weekend getaway at a cottage, thank your host by creating a personalized gift basket. Not only will it impress more than a case of beer, but the special touches that come with creating themed gift baskets will definitely put your name on the top of “best guest list” – so you will end up getting that coveted invite back!  Here are three themes basket ideas you can’t go wrong with.

1.      Cottage Décor Enthusiast:

a.      Vintage crate: not only to hold your gifts, but a vintage Canadiana crates makes a beautiful piece to hold throws in the living room.

b.      Outdoor wine glasses: buy a pair of matching outdoor wine glasses to share a glass of rose upon arrival.  

c.       Cottage Life Artwork:  look for modern rustic décor that can fit in any cottage space.

2.      Cottage Foodie:

a.       Canadian Maple Syrup and Canadian Coffee:  surprise your host by making pancakes and coffee in the morning.  

b.      Gourmet chocolate/cashew Popcorn:  bring gourmet treats for those late night games or chick flicks.

c.       Sunflower oil: this summer fresh oil has real herbs and cinnamon inside. It’s delicious to cook with and looks luxurious.

3.      Cottage Essentials:

a.      Craft Kit and Canadiana Colouring Book: ditch social media and get crafty. a fun and classic pastime for all ages!

b.      Water bottle: a great way to suggest a cottage hike with your host.

c.       Natural toothpaste: your host will thank you by keeping it green with environmentally friendly toiletry supplies.

Is Sugar the new Fat?

BT Montreal | posted Tuesday, Jul 11th, 2017

Blog post by: Dr. Zach

For years the conventional wisdom was that we should cut down on fat and cholesterol in order to lose weight and decrease our risk of heart attack and stroke. But people in the western world did not get slimmer and healthier, and cardiovascular disease is the number one killer of both men and women. So what went wrong? Part of the problem, it seems, is that in cutting fat people increased their consumption of sugar. Glucose is a simple sugar that is an essential energy source for humans. But not all sugar is created equal, and too much of any sugar is bad for you.

In March, 2015 the World Health Organization presented the following new guideline: “In both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake. A further reduction to below 5% of total energy intake would provide additional health benefits.” Free sugar refers to sugar that is added to food, as opposed to the natural sugar that exists in fruits and vegetables, which are not as unhealthy. The WHO says that limiting your sugar intake will decrease your risk of obesity, which is associated with heart attack, stroke, and certain cancers, and dental cavities.

The amount of calories that are recommended per day depend on one’s age and gender (here is a guide — http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/1_1_1-eng.php). An average adult male should take in about 2500 calories per day, and an average woman about 2000 calories. 10% of 2000 is 200 calories, which is about 50g of sugar. An single can of soda contains about 39g of free sugar, approaching the 100% recommendation for an entire day.

While most people realize that there is free sugar in soft drinks, candies, cakes, and cookies, many don’t realize that there is added sugar in such foods as bread, pizza, salad dressing, yoghurt, and ketchup. Also, even though the sugar in fruit is ok, that in fruit juice or punch is not because it in ingested without the benefit of the other components of fruit, especially the fibre. Fibre slows down the absorption of sugar and thereby decreases the unhealthy spikes in our blood glucose levels. There is extra concern about a type of added sugar called high fructose corn syrup, which is found in many cakes and pastries, because it may cause extra weight gain and be associated with fatty liver.

Packaged foods have information about how much sugar is in them, information which we can use to make wise choices. Legislators are considering making companies display the amount of added sugar in products. In general, “real” foods, like fruits and vegetables, are the best sources of sugar. The less added sugar you eat the more you’ll appreciate the taste of natural foods, and the better your chances of living a longer, healthier life.