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Winter health tips by Dr. Zach, ER Physician

BT Montreal | posted Thursday, Nov 22nd, 2018

Colds and Flu: Why viruses more in winter — more time indoors sharing air, viruses prefer dryer air

Cold: caused by a virus, one of several

Runny nose, cough, congestion, low grade fever, sore throat

Not caused by being cold (maybe predispose via cold vasoconstricted dry mucus membranes)


Flu: caused by influenza virus

Symptoms include fever, headache, muscle aches, extreme fatigue, sore throat, runny
nose, cough and nasal congestion. Occasionally, stomach symptoms such as nausea,
vomiting, diarrhea and abdominal pain are present.

What are complications associated with flu?
Complications caused by influenza include pneumonia and dehydration, and
worsening of chronic medical conditions such as chronic lung or heart diseases. Children
may develop sinus problems or ear infections.

How is influenza spread?
Influenza is spread from person to person by direct contact with airborne particles or large
droplets from the respiratory tract of the infected person when coughing, sneezing, or
talking. Transmission can also occur through articles recently contaminated by secretions
from the nose and throat of the infected person. Handwashing and avoiding or limiting
contact with an infected person may reduce the risk of infection.

How soon do symptoms appear?
Symptoms of influenza usually appear 1-4 days after exposure.

Virus shedding (contagiousness) 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!)

Get the shot!  Safe for pregnant and breastfeeding women

Influenza can occur throughout the year, but seasonally peaks from December to March.

See doc if short of breath, 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+)

Kids can take it but not necessary unless have health problems

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 2-59):  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.




From the QC government website:

In QC this year the flu vaccine is recommended and offered free of charge to people who are at higher risk of complications:

  • Children from 6 months to 17 years old who have certain chronic diseases (flushot not given before 6 months)
  • Pregnant women, in the 2nd and 3rd trimesters of their pregnancy
  • Adults who have certain chronic diseases (including pregnant women regardless the stage of pregnancy)
  • People aged 75 and over.

To reduce the risk of contamination, the flu vaccine is also offered free of charge to:

  • Family members who live in the same household of a child under 6 months of age or a person at higher risk of being hospitalized and to their caregivers
  • Health care workers

Flu vaccination is also free of charge to:

  • Healthy children from 6 to 23 months old
  • Healthy people from 60 to 74 years old (and 75 and over)

Chronic Diseases Recognized Under the Program

The flu vaccine is offered free of charge to people who have any of the chronic diseases listed below because their disease makes them more susceptible to complications from the flu.

  • Chronic cardiac or pulmonary disorders severe enough to require regular medical attention or hospital care, including the following:
    • Bronchopulmonary dysplasia
    • Cystic fibrosis
    • Chronic obstructive pulmonary disease (COPD)
    • Emphysema
    • Asthma
  • Chronic conditions such as:
    • Diabetes or other chronic metabolic disorders
    • Liver problems, including cirrhosis
    • Kidney problems
    • Blood disorders, including hemoglobinopathy
    • Cancer
    • Immunodeficiencies, including HIV infection
    • Immunosuppression caused by radiotherapy, chemotherapy and anti-rejection drugs
  • Medical conditions that may affect the ability to expel respiratory secretions and the ability to swallow, including the following:
    • Cognitive disorder
    • Spinal cord injury
    • Convulsive disorder
    • Neuromuscular disorders
    • Morbid obesity

If you are not eligible for the free vaccine, you can still get vaccinated. Since the fee may vary, contact the vaccination clinic of your choice (CLSC, medical clinic or pharmacy) to find out how much it will cost.

Where to get the flu vaccine in QC:   https://www.quebec.ca/en/health/advice-and-prevention/vaccination/flu-vaccination-program/procedure/


Heart attacks: increase in winter

5-30% increase in heart related deaths in winter, up to 50% more MI’s in winter

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


From the cold, shoveling

Emotional stress, weight gain, little exercise, more salt

Binge drinking is associated with atrial fibrillation, a common cardiac arrhythmia

Know the symptoms


Recommend Vitamin D (800iu/d) supplementation especially in winter, and calcium (1000mg, 1200 if >50yo)


-Bones and teeth

-Immune system

-Diabetes control

-Cardiovascular health

-Help prevent cancer — There is evidence that vitamin D may reduce the risk of some types of cancer, particularly colorectal and breast cancers.


Read more: http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/make-healthy-choices/eat-well/should-i-take-a-vitamin-d-supplement/?region=on#ixzz5X1bvapy

SAD: seasonal affective disorder — decrease in sunlight

Major depressive disorder with seasonal pattern; usually worse in winter.  SAD’s prevalence in the U.S. ranges from 1.4% in Florida to 9.9% in Alaska.[

Light therapy, medications, therapy

Light therapy (10000 lux, little uv as possible (damaging to skin and eyes), 20-30min

soon after waking, eyes open but not looking directly)

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.

Tips: 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, cover your skin in the cold.



Dress like it’s cold out, not like you’re going from a heated house to a heated car to a heated work.

Abnormally low body temperature — 35C 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, incoordination, memory loss, and slurred speech.  In infants you might note very low energy and bright red, cold skin.

Patients with mild hypothermia demonstrate tachypnea, tachycardia, initial hyperventilation, ataxia, dysarthria, impaired judgment, shivering, and so-called “cold diuresis.”

  • Moderate hypothermia is characterized by proportionate reductions in pulse rate and cardiac output, hypoventilation, central nervous system depression, hyporeflexia, decreased renal blood flow, and loss of shivering. Paradoxical undressing may be observed. Atrial fibrillation, junctional bradycardia, and other arrhythmias can occur.
  • Severe hypothermia can lead to pulmonary edema, oliguria, areflexia, coma, hypotension, bradycardia, ventricular arrhythmias (including ventricular fibrillation), and asystole

Get warm, get help if bad. To 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

Careful about falls

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

Dr. Zach on Sexually Transmitted Infections (STIs)

BT Montreal | posted Wednesday, Nov 7th, 2018

STI’s (sexually transmitted infections) formerly known as STD’s (sexually transmitted diseases)

more info: www.drzach.ca

Rates of sexually transmitted infections are continuing to rise across Canada

In general, all the sexually transmitted infections have been increasing in the last 20 years.

Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year in the United States, the Centers for Disease Control and Prevention announced August 28/18 at the National STD Prevention Conference in Washington.

Last year, nearly 2.3 million US cases of these sexually transmitted diseases were diagnosed, according to preliminary data.

That’s the highest number ever reported nationwide, breaking the record set in 2016 by more than 200,000 cases, according to the CDC.

The growth of dating apps is one suspected culprit.  It’s easier to find sex and easier to find anonymous sex than it was before.

More people appear to be having condomless sex, including those in the gay community, who once were at the vanguard of safe-sex campaigns in response to the HIV-AIDS epidemic.

But with HIV treatment being really so effective now that it’s essentially a chronic disease, the concern around contracting HIV has really decreased a lot and that potentially is diving the reduction in condom use.

The majority of cases are diagnosed in the under-30 age group and many of them are diagnosed at university or college sexual health clinics but there has been increasing prevalence in older adults (https://www.aarp.org/health/conditions-treatments/info-2017/std-exposure-rises-older-adults-fd.html)

With young girls and many boys in Canada being vaccinated against human papillomavirus — a major cause of cervical cancer — and changes to guidelines advising that lower-risk women be tested less often for that malignancy than previously recommended, there is likely less screening for gonorrhea and chlamydia. Such STI testing was often performed at the same time as a Pap smear.

Nationally, statistics confirm bacterial STIs are on an upward trajectory in jurisdictions across the country.

In 2015, the latest year for which national figures are available, there were almost 116,500 cases of chlamydia, the most commonly reported STI in Canada, with females accounting for two-thirds of infections, says the Public Health Agency of Canada (PHAC). Between 2010 and 2015, chlamydia rates increased by almost 17 per cent.

Gonorrhea is the second most commonly reported STI in the country. About 19,845 cases were recorded in 2015, a jump of more than 65 per cent from 2010. Males had higher rates than females, with the highest number of cases among those aged 15 to 29, PHAC says.

From 2010 to 2015, the rate of infectious syphilis in Canada increased by almost 86 per cent. In 2015, a total of 3,321 cases were reported, with nearly 94 per cent occurring among males; those aged 20 to 39 had the highest rates and men who have sex with men were among those at most risk.

While the three STIs can be successfully cured with antibiotics, untreated chlamydia and gonorrhea can lead to pelvic inflammatory disease in females, affecting fertility. Untreated, syphilis can cause damage to the brain, nerves, eyes, cardiovascular system, bones and joints. In extreme cases, it can be fatal.

There is a rare strain of gonorrhea that is resistant to standard antibiotics.  There was one case in Quebec last year.

Condom use is among the best ways to protect against infection.


Information about condoms: https://www.canada.ca/en/public-health/services/sexual-health/safer-condom-use.html

Information about gonorrhea:


Information about chlamydia:


Information about syphilis:


Information on Lymphogranuloma venereum:


Information about genital herpes:


Information about human papillomavirus:


Information about HIV-AIDS:


Hepatitis B virus (HBV) is a virus that causes inflammation of the liver. Most people do not think of hepatitis as a sexually transmitted infection; however, one of the more common modes of the spread of viral hepatitis B is through intimate sexual contact.

Hepatitis B (HBV) is 50 to 100 times easier to transmit sexually than HIV ( the virus that causes AIDS). HBV has been found in vaginal secretions, saliva, and semen. Oral sex and especially anal sex, whether it occurs in a heterosexual or homosexual context, are possible ways of transmitting the virus.

Hepatitis B is a sexually transmitted disease, but it is spread in other ways, too. This is a hardy virus that can exist on almost any surface for up to one month. You can get infected through contact with an infected person’s blood or body fluids.

Hepatitis C (HCV) is spread through contact with an infected person’s blood — which may be present because of genital sores or cuts or menstruation.HCV has been detected with greater-than-average frequency among people who have a history of sexual promiscuity — which can be defined as a history of a sexually transmitted disease, sex with a prostitute, more than five sexual partners per year, or a combination of these. A person who is in a long-term monogamous relationship with an HCV-infected person rarely contracts this virus. Only approximately 2% of sexual partners of HCV-infected people also test positive for HCV.

In Quebec HPV vaccine is offered to grade 4 students free of charge, both girls and boys.  2 doses (need 3 doses after age 18)