1. Skip to navigation
  2. Skip to content
  3. Skip to sidebar

Blogs

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

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

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

image 2

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’

image 2

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.

image 3

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

image 4

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