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What to do about a DNR Tattoo by Dr. Zach, MUHC

BT Montreal | posted Wednesday, Jul 18th, 2018

When a person’s heart stops or they stop breathing, emergency medical personnel are trained to intervene and try to save their life.  That is the default unless there is a reason not to, such as a medical mandate/living will/advance directive. Doctors cannot decide unilaterally that resuscitating someone is futile, nor can they decide that the person’s ultimate quality of life will be so poor that it’s “not worth it.”  That is very difficult to predict, and each person has a different opinion on what an acceptable quality of life it.


The consequences of deciding whether or not to resuscitate someone can be massive.  A person who may have lived may die. Or a person who would have died may live, but with severe impairment.  A doctor can potentially be held liable for resuscitating someone who did not wish to be, especially if that person lives many years requiring intensive and expensive care.


Most of us have seen fictional resuscitations on TV.  They are exciting and often the life is saved. Unfortunately reality is less rosy.   Several studies have looked at the results of CPR on TV. One such study showed that on TV 75% of people are alive immediately after CPR, and 67% survive long term.  In real life the success of CPR after cardiac arrest in hospital (survival after out of hospital cardiac arrest is significantly lower) is 40% right after CPR, but only 10-20% make survive to be discharged.  And resuscitations are quite violent; ribs are cracked, tubes are put in airways and veins and chests. Which is all fine if the expected outcome is good, but again often it isn’t.


It is interesting to note that healthcare professionals who have experienced many resuscitations are more likely to decline it.  Studies have shown that at least 80% (up to 90%) of doctors would choose not to have CPR performed on them.  Over the years a number of colleagues have joked to me about getting a Do Not Resuscitate tattoo on their chest because they know that it is often impossible to ascertain one’s wishes vis a vis resuscitation at the moment when it’s needed.  It turns out, however, that this has actually happened.


A letter in the November 30, 2017 issue of the New England Journal of Medicine discussed the case of a 70 year old male who presented to the ER very ill.  He had the words Do Not Resuscitate tattooed on his upper chest. He had no identification on him and no family with him. Despite their best efforts his condition and his worsened.  The doctors had to decide whether to pursue aggressive treatments (breathing by machine, intravenous lines in large veins with medications to bring up the blood pressure, potential eventual CPR).  Initially they did, since he could not speak and it was possible that he no longer wanted no resuscitative efforts (there has been a case reported where a person with DNR tattoo changed his mind and was pleased to be resuscitated).  Furthermore, letting him die was an irreversible course of action, and they were not completely sure of his wishes.


However, the clinical ethicists who reviewed the case decided that the man’s wishes, expressed on the tattoo, should be honoured, and he not be resuscitated.  Eventually they were able to find that he did have an official DNR order.

One of the many issues this case highlights is that DNR is much more complicated that just a yes or no answer.  There are a number of different treatments that can or cannot be withheld, such chest compressions, defibrillation (delivering electricity across the chest to change the heart rhythm, intubation (breathing tube and breathing machine), and assorted intravenous lines and medications.  Sometimes (when the patient has had an actual cardiac arrest) there is no time to find out the person’s wishes, unless they are readily available. Many provinces and states have registries to make the information more accessible, but not all. And many of us have just not thought about it.


It is something to think about and discuss with your doctor.


What do you think?  Have you discussed it with your doctor?


Addendum — a few other thoughts:

He could have changed his mind

Not resuscitating is forever

The doctor:

Could be sued for resuscitating, especially if the patient had a bad outcome

Could be sued for not resuscitating if he was not competent to decide and the family wanted him to be resuscitatedh


Most people have not discussed resuscitation plans with their doctor

80-90% of doctors say they would not have resuscitation


On TV:  70% survive cpr and 50% surviving to hospital discharge


In reality: 35% survive cpr and 11% survive to hospital discharge


DNR isn’t just yes or no — intubation, chest compression, central line, hemodialysis, feeding tubes, defibrillation (shocks)


Some people would want resuscitation if the condition is reversible, but it is often not 100%


Advance directives are things that outline your wishes if you can’t:

  1. A living will says what you want if you can’t say

  2. Power of attorney/substitute decision maker is someone who can make decisions on your behalf if you are unable to.  If you don’t have one there is a hierarchy (spouse, blood relative…)

 but right now doctors don’t have a way to access this information unless there is someone with the patient
Some references:







More info: www.drzach.ca

Why you feel tired all the time, by Dr. Zach Levine

BT Montreal | posted Wednesday, Jun 6th, 2018

There are many reasons for tiredness, including a lack of sleep, poor diet, a sedentary lifestyle, stress, and medical conditions.

According to the Centers for Disease Control and Prevention (CDC), around 15.3 percent of women and 10.1 percent of men regularly feel very tired or exhausted in the United States.

Tiredness can cause an array of problems. For example, around 1 in 25 adult drivers report falling asleep at the wheel each month.

(In the new study, AAA found sleep-deprived drivers are almost twice as likely to be involved in an accident when they get five to six hours of sleep, more than four times as likely with four to five hours and nearly 12 times more likely to crash with less than four hours of sleep.

“Driving with having only earned four to five hours of sleep in a 24-hour period can be just as impairing as driving legally drunk,” Jack Nelson (AAA director of traffic safety) said.)

About 72,000 crashes and 44,000 injuries each year are a result of drowsy driving, and that’s not to mention the estimated 6,000 fatal crashes caused by drowsy drivers.

Everyone feels tired at some point in their lives — whether it’s due to a late night out, staying up to watch your favorite TV show, or putting in some extra hours at work.

Often, you can put your finger on the reason you’re not feeling your best, but what about those times when you can’t pinpoint the cause of your tiredness? What makes you feel tired then?

Medical News Today have researched the possible explanations for why you could be feeling so drained and the steps that you can take to feel re-energized.

1. Lack of sleep

A lack of sleep may seem an obvious reason for feeling tired, yet 1 in 3 U.S. adults are consistently not getting enough of it.

Tiredness increases the risk of accidents, obesity, high blood pressure, depression, and heart disease.

People aged between 18 and 60 years need 7 or more hours of sleep every day to promote optimal health, according to The American Academy of Sleep Medicine and the Sleep Research Society.

Getting under the recommended hours of sleep each night is not only associated with fatigue, impaired performance, and a greater risk of accidents, but it also has adverse health outcomes.

These include obesity, high blood pressure, depression, heart disease, stroke, and an increased risk of death.

If you struggle to fit in 7 hours of sleep, here are some tips to help you achieve a full dose of much-needed slumber:

  • Maintain a consistent sleep routine. Try to go to bed at the same time every night and get up at the same time each morning — even on the weekends.
  • Avoid naps. We need a certain amount of sleep within a 24-hour period and no more than that. Napping reduces the amount of sleep that we require the following night, which might lead to difficulty getting to sleep and fragmented sleep.
  • Limit time awake in bed to 5–10 minutes. If you find that you are lying awake in bed worrying or with your mind racing, get out of bed and sit in the dark until you are feeling sleepy, then go back to bed.
  • Ensure that your bedroom is quiet, dark, and a comfortable temperature. Any light that enters your room could disturb your sleep. Ensure that your room is dark and that light emitted from digital devices is out of sight. Cooler room temperatures are considered better to promote sleep than warmer temperatures.
  • Limit caffeinated drinks. Try not to consume caffeinated beverages after noon. The stimulating effects of caffeine can last for many hours after intake and cause issues with initiating sleep.
  • Avoid tobacco and alcohol before bed. Smoking cigarettes and drinking alcohol before going to bed may cause fragmented sleep.

If you practice all the sleeping habits listed above and still wake up tired, it might be a good idea to contact your healthcare provider and discuss whether you have a sleep-related medical problem such as insomnia, obstructive sleep apnea, or restless legs syndrome.

2. Poor diet

The easiest way to banish tiredness is to make adjustments to your diet. Eating a healthful and balanced diet can make the world of difference to how you feel.

Eating a healthful and balanced diet can help to combat fatigue.

To improve your health and get all the nutrients you need — as well as eliminate fatigue — it is vital to choose a healthful mix of food from the five food groups, which are: fruits, vegetables, grains, protein, and dairy.

You can switch up your eating style today by implementing some of these small changes:

  • Eat the right amount of calories for your sex, age, weight, and activity level. Eating either too much or too little can make you feel sluggish.
  • Fill half of your plate with fruits and vegetables. Be sure to focus on eating whole fruits and a selection of vegetables.
  • Ensure whole grains make up half the grains you consume. Examples of whole grains include brown rice, oatmeal, whole cornmeal, bulgur, and whole-wheat flour.
  • Shift to low-fat and fat-free dairy to help limit your calories from saturated fats.
  • Vary your protein routine. Try to choose lean poultry and meat, limit processed meats, choose unsalted nuts and seeds, and select some omega-3-rich seafood.
  • Cut down on sugar. Sugar can give you a quick rush of energy, but it wears off fast and might make you feel more tired. Avoid foods and drinks that have lots of added sugar.
  • Never skip breakfast. Regularly skipping breakfast can lead to you missing out on key nutrients and the energy that you need to kick-start your day.
  • Eat at regular intervals. Sustain your energy levels by eating three meals per day and limiting unhealthful snacks.
  • Drink enough water. Drinking water can help to prevent dehydration, which results in fatigue, unclear thinking, mood changes, overheating, and constipation.

3. Sedentary lifestyle

When tiredness sets in, sitting on the couch and relaxing could seem to be the only answer. But getting up and moving may be the best thing you can do to re-energize and eradicate fatigue.

Exercising can help to increase energy and reduce tiredness.

Research by the University of Georgia (UGA) in Athens discovered that compared with sitting quietly, one single bout of moderate-intensity exercise lasting for at least 20 minutes helped to boost energy.

An earlier study by UGA also found that when sedentary individuals completed an exercise program regularly, their fatigue improved compared with those who did not.

The U.S. Department of Health and Human Services Physical Activity Guidelines for Americans suggest that all adults need 2 hours and 30 minutes of moderate-intensity exercise per week and muscle-strengthening activities that work all the major muscle groups on 2 or more days per week.

This may seem to be a lot of time spent exercising, but you can spread out your activity across the week and, in total, it is just the amount of time that you might otherwise spend watching a movie.

If you have not exercised for a while, start slowly. Begin with a brisk 10-minute walk each day and build up to walking fast for 30 minutes on 5 days per week.

Brisk walking, water aerobics, riding a bike, playing tennis, and even pushing a lawnmower can all count toward your time spent doing moderate-intensity exercise.

4. Excessive stress

Many situations can cause stress. Work, financial problems, relationship issues, major life events, and upheavals such as moving house, unemployment, and bereavement — the list of potential stressors is never-ending.

Excessive stress can lead to physical and emotional exhaustion.

A little stress can be healthy and may actually make us more alert and able to perform better in tasks such as interviews, but stress is only a positive thing if it is short-lived.

Excessive, prolonged stress can cause physical and emotional exhaustion and lead to illness.

Stress makes your body generate more of the “fight-or-flight” chemicals that are designed to prepare your body for an emergency.

In situations such as an office environment where you can’t run away or fight, the chemicals that your body has produced to protect you can’t be used up and, over time, can damage your health.

If the pressures that you face are making you feel overtired or giving you headaches, migraines, or tense muscles, don’t ignore these signals. Take some time out until you feel calmer, or try some of these tips.

  • Identify the source of stress. Until you can recognize what is causing you to create and maintain stress, you will be unable to control your stress levels.
  • Keep a stress journal to identify patterns and common themes.
  • Learn to say no. Never take on too much — be aware of your limits and stick to them.
  • Avoid those who stress you out. If there is someone in your life causing you a significant amount of stress, try to spend less time in their company.
  • Communicate your concerns. Learn to express your feelings and concerns instead of keeping them bottled up if something is bothering you.
  • View situations in a different way. Try to look at stressful situations in a more positive light. For example, if you’re stuck in a traffic jam, see it as an opportunity to have some alone time and listen to your favorite tunes.
  • Look at the bigger picture. Think about whether the stressful situation will matter in a month’s time. Is it worth getting upset about?
  • Accept the things you are unable to change. Some sources of stress, such as an illness or the death of a loved one, are unavoidable. Often, the best way to deal with stress is to try and accept things the way they are.
  • Learn to forgive. We are all human and often make mistakes. Let go of anger, resentments, and negative energy by forgiving friends, family, and colleagues and moving on.

Physical activity is a significant stress reliever and releases feel-good endorphins. If you are feeling stress build up, go for a walk, take your dog out, or even put on some music and dance around the room.

5. Medical conditions

If you have made lifestyle changes to do with your physical activity, diet, stress levels, and sleep but still feel tired all the time, there could be an underlying medical condition.

Many medical conditions, such as anemia, can make you feel tired.

Some of the most common conditions that report fatigue as a key symptom include:

If you are concerned that you have a medical condition that is causing you to feel tired, arrange an appointment with your healthcare provider to discuss your worries as soon as possible.

12 things you need to know from Apple’s WWDC keynote announcement

Winston Sih | posted Monday, Jun 4th, 2018

Apple held their annual Worldwide Developers’ Conference in San Jose, Calif. Monday, where a slew of software updates were announced. While there was no new hardware announced at their annual keynote address by CEO Tim Cook and team, developers were left with new features to sink their teeth into.  Here’s a brief recap:

iOS 12

Augmented Reality
The tech giant is doubling down on performance with the latest iteration of its mobile operating system for iPhone and iPad. On iOS 12, the next generation of its augmented reality tool set, ARKit 2, was introduced, alongside a new ‘Measure’ app that enables users to get measurements of real-world items—all without a ruler or tape measure.


Screen Time/Down Time

Screen Time will offer users a way to see how actively they use their device. Through a central dashboard, insights like device use time, time spent in specific apps, and regular reports sent out means users can see how much time they really spend on Instagram. This will be something that appeals to parents. Down Time will introduce the ability for device managers (like mom and dad) to limit access to specific apps, category of apps, or the entire device from certain periods of the day, or once a set threshold is reached. Sorry, kids!


Animojis become more personal
Remember those animoji characters announced back in September? They are emojis brought to life using AR technology on iPhone X. The next step brings—ready for it?—Memoji to your repertoire. Users will design their own animated version of themselves—almost like a Bitmoji—and using iPhone’s front-facing camera, you’ll see the character come to life, mimicking your facial expressions, including tongue movements.
Group FaceTime
The video chatting service brings multiple parties together in a group video chat—up to 32 people to be specific. Active speakers’ tiles are made larger and smaller, while quiet participants are shelved. Chats can then utilize the Memoji effects, as well as a whole host of stickers and filters.


watchOS 5

Automatic workout detection
In the new operating system for Apple Watch, for those who use it to work out, technology including the built-in heart rate sensor will automatically detect when you start a work out. It will alert you, and once accepted will retroactively record the fitness data.  This is powerful for people like me who forget to activate a new workout more often than not.
Yes, it’s back—and it’s cool again. But it’s the 21st-century watch version. Once you accept the connection with your desired family and friends, you can tap to record a short audio message, and it is transmitted to their device. A fun way to tell your kids, “Dinner’s ready!”


No more “Hey Siri”
With the improved Siri Apple Watch face, users can now raise to activate Siri, without saying the words “Hey Siri.”
tvOS 12
Dolby Atmos surround sound support
Apple announced they are rolling out improvements to sound quality on Apple TV 4K, with integration of Dolby Atmos surround sound. Users with an enabled sound bar or speaker system will see an improvement, with upgraded media like movies to be pushed through iTunes automatically.

macOS 10.14 Mojave

Your privacy, first
The tech giant announced their new operating system, macOS 10.14 Mojave. The California road trip continues. Apple was quick to highlight privacy is at the forefront of user data, from mail to messages. Surprisingly, on Safari, updates will shut down Facebook tracking and ad targeting, forcing users to opt-in before they can use share/like buttons—the traditional source of ad tracking.
Dark Mode
The audience ooh’d and ahh’d for this one. Dark Mode is coming to macOS 10.14 Mojave. It is an adaptive mode that can dim your user experience to make being productive easier on the eyes at night. This is similar to the ’Night mode’ experience on the Twitter app.
Clean up your desktop with organization tools
New organization tools will help keep the clutter off your desktop. You can finally reclaim your wallpaper! Using ’stacks,’ macOS will sort and group materials by type. Photos, documents, videos, etc. For those who have a method to their madness, there will be a way to customize this function accordingly.
Rebuild of Mac App Store
In an attempt to better integrate Mac applications with its successful App Store ecosystem, Apple has rebuilt their App Store from the ground up, breaking app discovery down by ‘Create,’ ‘Work,’ ‘Play,’ and ‘Develop.’

Top medical symptoms women shouldn’t ignore, by Dr. Zach Levine

BT Montreal | posted Tuesday, May 8th, 2018

Women’s Health

Conditions more common in women, and

Top Symptoms Women Should Not Ignore

By Dr. Zach Levine, ER physician, MUHC


The good news:

Women live longer — life expectancy 84 for women, 80 for men

Women are more likely to see the doctor and get symptoms checked out


More common in women:

Gynecological and pregnancy issues (obviously) Urinary tract infections

Urinary incontinence

Women are more likely to die from a heart attack

Depression and anxiety


STI effects (such as infertility) – more often asymptomatic in women

Stroke (extra risk factors — estrogen, being pregnant) Blood clots (extra risk factors — estrogen, being pregnant) Autoimmune disorders such as Lupus



Medical Symptoms Women Shouldn’t Ignore

Women are usually better than men at taking care of themselves and checking in with the doctor.  But some may neglect themselves when they are busy at work and at home. Remember you have to be well to take care of others, and paying attention to your symptoms may mean picking up an illness early, when it’s easy to treat or cure.


Symptoms Women Should Not Ignore

  1. Fatigue and Tiredness


Even with an overwhelming number of responsibilities to take care of, exhaustion and tiredness is something a woman just shouldn’t ignore.

If you get tired sometimes due to a busy schedule and feel energetic again after proper rest, then it is not a big deal.  Constant fatigue could also be a sign of a medical problem. There are several medical conditions linked to fatigue, including depression, liver failure, anemia, cancer, kidney failure, cardiovascular disease, thyroid disease, sleep apnea and diabetes.

A 2008 study published in the American Journal of Physiology – Regulatory, Integrative and

Comparative Physiology indicates that fatigue is more predominant in women than men. If you frequently feel fatigued, a visit to your doctor can help pinpoint the cause.


A constant feeling of tiredness could be a sign of a medical problem. Problems that can cause fatigue include:

  • depression
  • liver failure
  • anemia
  • cancer
  • chronic fatigue syndrome
  • kidney failure
  • cardiovascular disease
  • thyroid disease
  • sleep apnea
  • diabetes



  1. New Moles


Be it men or women, everyone has moles on their skin. On average, most people have at least

10 moles and they can appear anywhere on the body. Women in particular should keep a close eye on their moles, as changes in moles can be associated with melanoma.

Women should be aware of the ABCDE’s of melanoma, which is recommended by the Skin

Cancer Foundation and American Academy of Dermatology to help detect a problem.

It provides an easy way to remember what to look for when checking the moles on your body. Take note of moles that have:

A – an asymmetrical shape

B – uneven borders

C – changed in color

D – changed in diameter

E – evolved over time, increasing in size or bleeding.

You also should not disregard a new spot if you get one. These are all reasons to have a mole evaluated by a specialist.

Men get more skin cancer (except melanoma<40) because more time in sun, don’t protect themselves



  1. Breast Lumps


Any kind of redness, swelling or lump in one or both of your breasts may signal breast cancer. According to the American Cancer Society, the most common symptom of breast cancer is a new lump or mass.

While a painless, hard lump with irregular edges is more likely to be cancerous, even a tender, soft or rounded lump that is painful can be cancerous.

Along with lumps, swelling or discoloration (purple or red spots) may be signs of inflammatory breast cancer.

Apart from cancer, breast lumps and other problems can be due to hormonal changes in the body, a breast infection or fat necrosis (damaged tissue). Hence, any kind of lump, swelling or pain in the breast needs to be checked by a doctor.

Recommendation:  as of 50, get a mammogram every 2 to 3 years to detect signs of breast cancer early.



  1. Chest Pain or Discomfort


Any kind of chest pain or discomfort should never be taken lightly as it can indicate heart disease, one of the main causes of death in women.

Even though cardiovascular disease accounts for 43 percent of all female deaths in the United States, women still ignore chest pain or attribute it to heartburn or indigestion. This contributes to late diagnosis of heart disease.

Women are often diagnosed with coronary artery disease at a much older age than men. Prior to menopause, the female hormone estrogen helps maintain adequate levels of “good”

high-density lipoprotein (HDL) cholesterol, which is important for cardiovascular health.

But, after menopause, the ovaries stop making estrogen. Thus, women become more prone to heart disease after menopause, due to the lower estrogen level in the body.

Along with chest pain, if you experience weakness, hot flashes, shortness of breath, cold sweats and pain in the left arm or shoulder, immediately see a doctor.


  1. Unusual Shortness of Breath


Walking up flights of stairs or a steep hill leaves many people winded. However, being short of breath after only light activity could be an early sign of a serious lung or heart problem. It is important to discuss any new shortness of breath with a doctor. Shortness of breath is also called dyspnea.  One potential cause of dyspnea is coronary ischemia. Coronary ischemia is a lack of blood flow in the heart muscle. It is caused by a partial or complete arterial blockage. A complete arterial blockage may also cause a heart attack.

Get to an emergency room as soon as you can if you have dyspnea and begin to experience other symptoms, such as:

  • chest pain or discomfort
  • nausea
  • Lightheadedness

Other serious causes of shortness of breath, in addition to heart:  pulmonary emoblism (blood clot in lungs), pneumothorax (collapsed lung), asthma, anemia, pneumonia


  1. Vaginal Bleeding after Menopause


Vaginal bleeding of any kind after menopause is never normal. It may be harmless, but it can be an early indicator of cancer, including endometrial cancer and uterine sarcoma as well as cancer of the cervix or vagina.

Other prominent causes of postmenopausal vaginal bleeding include thinning of the tissue lining the uterus, uterine fibroids and polyps, infection of the uterine lining, pelvic trauma and endometrial hyperplasia.

The cause of your postmenopausal bleeding may be entirely harmless. However, don’t be embarrassed to bring it up to your doctor, as sometimes it can be very serious and need timely assessment.

In fact, any kind of changes in your monthly cycle, such as very heavy bleeding, bleeding that lasts longer than normal and bleeding that occurs after sex or between periods, should be reported to your doctor.



  1. Unexplained Weight Loss or Gain


The next time you get on the scale and notice a slight variation in your weight, do not panic. Your body weight can fluctuate anywhere from 2 to 4 pounds per day on average, and this is very normal.

However, when weight fluctuation is very noticeable and occurs without making any changes in your diet and daily routine, be alert. There may be something wrong.

Unexplained and sudden weight loss or weight gain of 10 pounds or more can be a sign of problems like cancer (most commonly linked to cancers of the pancreas, stomach, esophagus and lungs), celiac disease, diabetes, heart disease, thyroid disorder, depression, stress, digestive problems, nutritional deficiencies, and fluid retention.

Possible causes of unexplained weight loss include:


  • cancer
  • Celiac disease
  • diabetes
  • heart disease
  • thyroid disease


  1. New or severe headaches


It is true that women are more prone to headaches and migraines than men. The occasional headache after a stressful day is understandable, but sudden and persistent headaches can indicate certain health problems.

A severe headache is one of the signs of a stroke, according to the National Institute of Neurological Disorders and Stroke. In fact, a headache can also be an early warning sign of other serious health issues like high blood pressure.


  1. Abdominal pain

According to a 2007 report released by the Gynecologic Cancer Foundation, bloating, as well as pelvic or abdominal pain and difficulty eating are some early symptoms of ovarian cancer.

Gas and bloating can also signal inflammatory bowel syndrome, celiac disease, irritable bowel syndrome or diverticulitis, which needs to be diagnosed and treated timely to reduce the need for surgery.

At times, abdominal pain can even signal an appendicitis, a stomach ulcer or a gallbladder problem.


  1. Change in bowel habit, Black or bloody stools


Consult your doctor if you are experiencing severe or frequent abdominal discomfort or any persistent change in bowel habits, such as mild diarrhea lasting a week, constipation that lasts more than a couple of weeks, sudden urges to have a bowel movement, bloody diarrhea and black or tarry-colored stools.



  1. Leg Swelling


Pregnancy is a common factor related to fluid buildup and swelling in the legs.

However, there are many other underlying health conditions that can cause leg swelling, including peripheral edema, chronic kidney disease, cirrhosis, deep vein thrombosis, Achilles tendon rupture, knee bursitis, osteoarthritis, rheumatoid arthritis and a sprained ankle.

Swelling in one leg can also mean a blood clot, which is even more dangerous if left untreated. A blood clot can travel through your veins up to your lungs, cutting off your oxygen supply and ultimately leading to a heart attack.

If you experience leg swelling without any known reason, consult your physician. Along with swelling, redness or blistering on the legs needs to be checked by a doctor.



  1. Chest or Facial Hair


Facial hair growth isn’t just a cosmetic concern. Growth of hair on the chest or face is usually caused by elevated levels of androgens (male hormones). This may be a symptom of polycystic ovary syndrome (PCOS).

PCOS is the most common hormonal disorder among women of reproductive age. Other symptoms associated with PCOS include:

  • adult acne
  • obesity
  • irregular periods
  • high blood pressure



  1. Chronic Stomach Problems


Occasional stomach problems shouldn’t be a major cause of concern. However chronic stomach problems could be a sign of irritable bowel syndrome (IBS). Symptoms of IBS include:

  • abdominal pain and cramps
  • diarrhea
  • constipation

IBS is more common in women than men. It’s easy to ignore or dismiss the symptoms as an upset stomach or a bad meal. You should see a doctor if these symptoms recur regularly. IBS is treatable with changes in diet, lifestyle, and stress management. Medication may also help with symptoms.

Stomach symptoms can sometimes be a sign of other serious health problems. Talk to your doctor if you have recurrent problems with your digestive system.



  1. Heart Palpitations

Why it’s dangerous: Heart palpitations are often related to stress. But if they’re persistent, they may signal atrial fibrillation, an irregular heartbeat. Without treatment, atrial fibrillation raises your risk of a stroke, especially if you have these other heart disease risk factors:


What you should do: If you experience heart palpitations or any unusual heartbeat signals, see a doctor immediately. If you smoke, stop, and if you’re overweight, ask your doctor about a weight-loss plan

Dr. Zach’s Spring Health Check-Up

BT Montreal | posted Tuesday, Apr 24th, 2018


Sharpens your brain function, improves your sex life, as well as the other things you know (live longer, be happier, lose weight)


Find a way (friends, fun, part of regular activities)

  • Exercising improves brain performance. …
  • Working out sharpens your memory. …
  • Running burns calories! …
  • More muscle mass = burning more fat while resting.
  • The more muscle mass you have, the more fat your body burns while resting. …
  • A pound of muscle burns 3 times more calories than a pound of fat. …
  • You get sick less often.

Better skin, more self-confidence, better sleep

Better sex — Increased blood flow helps explain why exercise leads to better sexual function in men as well. … Men and women who exercise may be more likely to feel sexually desirable, which can lead to better sex. So can greater strength, flexibility, and stamina that result from exercise.



Your vitamin D levels rise. Sunlight hitting the skin begins a process that leads to the creation and activation of vitamin D. Studies suggest that this vitamin

Helps fight certain conditions, from osteoporosis and cancer (breast, colon, prostate, ovaries, esophagus, and lymphatic system) to depression, heart attacks, and diabetes, ms, rheumatoid arthritis

Limited sun exposure (don’t overdo it), supplemented with vitamin D pills if necessary, is a good regimen.

In addition to bone health, there is recent and mounting evidence that links low levels of the vitamin to an increased risk of type 1 diabetes, muscle and bone pain, and, perhaps more serious, cancers of the breast, colon, prostate, ovaries, esophagus, and lymphatic system.  If you want to lower your blood pressure, vitamin D may be just what the doctor ordered. If you’re trying to reduce your risk of diabetes, or lower your chances of heart attacks, rheumatoid arthritis, or multiple sclerosis, then vitamin D should be at the front of the line in your daily supplement regimen.

You’ll get more exercise. If you make getting outside a goal, that should mean less time in front of the television and computer and more time walking and doing other things that put the body in motion.

You’ll be happier. Light tends to elevate people’s mood, and there’s usually more light available outside than in. Physical activity has been shown to help people relax and cheer up, so if being outside replaces inactive pursuits with active ones, it might also mean more smiles.

Your concentration will improve. Children with ADHD seem to focus better after being outdoors. It might be a stretch to say that applies to adults, but if you have trouble concentrating, outdoor activity may help.

You may heal faster. In one study, people recovering from spinal surgery experienced less pain and stress and took fewer pain medications when they were exposed to natural light. An older study showed that the view out the window (trees vs. a brick wall) helped recovery in the hospital.



Helps you stay slim, keep your blood pressure down

Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke

Why Sleep Deprivation Causes Weight Gain. Losing out on sleep creates a vicious cycle in your body, making you more prone to various factors contributing to weight gain. “The more sleep-deprived you are, the higher your levels of the stress hormone cortisol, which increases your appetite,” says Breus



Take the opportunity to eat fresh and local fruits and vegetables

Berries are natural antioxidants, protecting cells from damage

Berries are the crown jewels of summer, the gems that inspire pies, parfaits, cobblers, ice cream treats, and whipped cream wonders. Best of all, berries deliver super-healthy antioxidants that help fight disease.

In fact, one landmark study shows that just one cup of berries provides all the disease-fighting antioxidants you need in a single day

Antioxidants protect the body from damage caused by harmful molecules called free radicals. Many experts believe this damage is a factor in the development of blood vessel disease (atherosclerosis), cancer, and other conditions.

You are exposed to free radicals:

  • Through by-products of normal processes that take place in your body (such as the burning of sugars for energy and the release of digestive enzymes to break down food).
  • When the body breaks down certain medicines.
  • Through pollutants.

Antioxidants include some vitamins (such as vitamins C and E), some minerals (such as selenium), and flavonoids, which are found in plants. The best sources of antioxidants are fruits and vegetables



Skin care

Why is skin care important?

The skin is the body’s largest organ

It holds body fluids in, preventing dehydration, and keeps harmful microbes out—without it, we would get infections.

Apply sunscreen (every morning, and reapply every two hours. If you get wet, apply every hour. Use makeup that has SPF protection? It may not be enough.  Spf 60 or higher (this refers to uvb, look for broad spectrum or uv protection factor)

UVA rays penetrate deep into the dermis, the skin’s thickest layer. Unprotected exposure can lead to premature skin aging and wrinkling (photoaging), and suppression of the immune system. UVB rays will usually burn the superficial layers of your skin. It plays a key role in the development of skin cancer.


Smoking is bad for you and bad for your skin, in case you hadn’t heard


Experts agree that smoking accelerates skin aging, so that smokers look 1.4 years older than nonsmokers, on average.

The nicotine in cigarette smoke can not only make your teeth (and the walls of your home) brown, but it’s also notorious for staining fingers and nails as well.

Scarring – Nicotine causes vasoconstriction, a narrowing of the blood vessels that can limit oxygen-rich blood flow to the tiny vessels in the face or other parts of the body.  This means your wounds will take longer to heal and you’ll have scars that are bigger and redder than you would in a nonsmoking parallel universe.

Cigarette smoke contains carbon monoxide, which displaces the oxygen in your skin, and nicotine, which reduces blood flow, leaving skin dry and discolored. Cigarette smoking also depletes many nutrients, including vitamin C, which helps protect and repair skin damage.

While genital warts are caused by sexually transmitted types of HPV, smoking is also a risk factor. Even taking the number of sex partners into account, women who smoke are nearly four times as likely to have genital warts as nonsmokers, according to one study.

More visceral fat, stretch marks, cataracts, skin cancer, thinner hair,

Celebrity Health Advice by Dr. Zach, ER Physician MUHC

BT Montreal | posted Tuesday, Mar 27th, 2018

For better or worse, celebrities get a lot of attention in our society. Their faces and names sell
product, and so their thoughts and opinions reach many people. And many people listen to
them, even if they don’t actually know what they’re talking about. This power can and is used
for good by a number of celebrities (see below). However, there are a fair number of examples
of celebrities giving inaccurate, bad, or even dangerous health advice. In those cases, hopefully
people won’t listen.
Gwyneth Paltrow 
Vaginal steam treatment: an energetic release – not just a steam douche – that balances female
hormone levels.” But douching is not necessary and it disturbs the natural flora of the female
reproductive system, increasing the risk of urinary tract infections and yeast overgrowth.
Post on Gwyneth Paltrow’s site by Dr. Habib Sadeghi suggests a link between breast cancer
risk and wearing a too-tight bra, a claim that has been discredited by major health organizations,
including the American Cancer Society.
In an interview, Paltrow disagreed with doctors who warn patients against tanning saying,
“We’re human beings and the sun is the sun – how can it be bad for you? I think we should all
get sun and fresh air. I don’t think anything that is natural can be bad for you.”
Unfortunately, while nature is great, it produces some very toxic, poisonous substances. The
sun damages the skin and increases the risk of skin cancer.
Jenny McCarthy, Jim Carrey
Jenny McCarthy is one of the most well-known proponents of the anti-vaccination movement, a
small but vocal faction who refuse to vaccinate their children due to fears that it will lead to
autism. Jenny McCarthy has long been a leading voice in the campaign against vaccines,
saying that the measles, mumps, rubella vaccine led to her son’s autism. She has also claimed
to have “repaired” his autism through vitamins. There’s no scientific basis to these claims, and
parents opting against vaccinations for their children lower herd immunity, which is dangerous to
everyone’s health, especially the young and elderly.
The belief stems from a 1998 study which was later found to be based on fraudulent data and
discredited by the medical community. Numerous large-scale studies over many years have
found no connection between vaccines and autism.
Few people remember polio, a devastating infection which is largely eradicated by a vaccine.
January Jones
In 2012, “Mad Men” star January Jones revealed that after giving birth to her son Xander Dane
Jones, she had her placenta dried and turned into capsules — which she ingested regularly and
credited with staving off postpartum depression. But experts and dietitians say there are no
health benefits to eating the placenta.
Mayim Bialik
“The Big Bang Theory”‘s Mayim Bialik , a neuroscientist as well as an actress, has also spoken
favorably about ingesting her own placenta after giving birth. In a 2012 blog post, she argued
that “human beings are the only mammals that have chosen to not routinely ingest their
placenta, which is consumed by every other mammal for its protein and iron-rich properties that
are critical in helping the mother’s body recuperate after giving birth. End of story.”
But despite celebrity backing, a 2015 study found no evidence to support claims of health
benefits from eating the placenta .
Ingesting the placenta after giving birth, a practice called placentophagy, is something almost all
nonhuman mammals partake in. Enthusiasts believe it may help prevent postpartum
depression , reduce post-delivery pain, increase energy levels and improve lactation.
But after reviewing the existing scientific literature on the subject, Dr. Crystal Clark, a
psychiatrist specializing in reproduction-related mood disorders at Northwestern University,
found that there is no data to support these claims. What’s more concerning, she says, is that
there are no studies examining the potential risks of eating the placenta, which filters out toxins
and pollutants during pregnancy to protect the developing fetus.
Tom Cruise
In 2006, Tom Cruise publicly criticized actress Brooke Shields for taking antidepressants to help
with her postpartum depression . While Shields later said the actor came over to her house to
apologize, Cruise’s rep told the Associated Press at that he had not changed his position on
While antidepressants are generally considered safe for most adults, the FDA lists a number of
side effects.
Cruise is a Scientologist, and the group opposes the use of antidepressants and other aspects
of mainstream psychiatric care.
Suzanne Somers
In her 2013 book “I’m Too Young for This!: The Natural Hormone Solution to Enjoy
Perimenopause,” Suzanne Somers touted the benefits of bioidentical hormones – otherwise
known as natural hormone therapy – as a safer alternative to ease symptoms of menopause that
have fewer long-term risks and side effects than other hormone treatments. But experts quickly
warned that while these hormones may be “natural” in origin, there’s no evidence that the
ingredients are safer, let alone superior to other therapies on the market.
Dr. Mehmet Oz
Dr. Mehmet Oz, host of “The Dr. Oz Show,” is proud of helping millions of viewers with their
health concerns. But he came under fire at a Congressional hearing in 2014 for promoting the
supposed fat-burning benefits of green coffee bean extract – a product accused by the Federal
Trade Commission of making fraudulent claims. The company behind the green coffee bean
study, meanwhile, had to pay $3.5 million dollars in a settlement.
Dr. Oz’s credibility was also hurt by a 2014 study finding that fewer than half of his on-air
recommendations – just 46 percent – were backed up by medical evidence.
Jessica Alba
To shed baby weight after giving birth, Jessica Alba said she wore a double corset to “retrain”
her waist. While women have been attempting to make their wastes tinier by wearing corsets for
centuries, the practice has been growing in popularity in the last year with celebs like Alba
touting its benefits.
But experts say the effects from waist trainers don’t last. “These women who are wearing these
corsets are fully grown adults so there’s no reason to suppose that by tying a tight corset around
is going to do any permanent change,” Dr. Mary Jane Minkin, clinical professor at Yale
University, told CBS News.
Alicia Silverstone
Another advocate of placenta eating and the anti-vaccination movement, actress Alicia
Silverstone also wrote a parenting book last year with some very questionable advice. In “The
Kind Mama: A Simple Guide to Supercharged Fertility, a Radiant Pregnancy, a Sweeter Birth,
and a Healthier, More Beautiful Beginning,” Silverstone suggests a plant-based diet can help
prevent miscarriages and stave off postpartum depression.
Alana Stewart
Actress Alana Stewart, the former wife of Rod Stewart, said in 2012 she’d used
human-growth-hormone therapy to keep her hair from turning gray. But the U.S. Federal Trade
Commission has cracked down on products making such unfounded claims, and the Mayo
Clinic lists carpal tunnel syndrome, swelling in the arms and legs, joint and muscle pain, and for
men, enlarged breast tissue, as possible side effects from the hormones.
Shailene Woodley
“Divergent” star Shailene Woodley says she eats clay to remove heavy metals from the body
and recommends other women do the same. She also suggests getting a little sun on your
vagina for some extra vitamin D.
Miley Cyrus
In 2012, after receiving criticism that she was too thin, Miley Cyrus took to Twitter to announce
that she has a gluten and lactose allergy. She went on to tweet that everyone should try to go
gluten-free for a week, saying “The change in your skin, phyisical (sic) and mental health is
amazing! U won’t go back!”
But doctors say that a gluten-free diet is only prescribed to people with celiac disease, a
condition that causes the immune system to react to gluten in the body, causing damage to the
lining of the intestines, along with uncomfortable gastrointestinal symptoms. For people without
the disease, foods that are gluten-free have no special health benefits, and some gluten-free
snacks may actually contain more fat.
Katy Perry
In 2013, Katy Perry revealed that she takes 26 vitamins and supplements a day and even
tweeted a photo of herself with all her capsules. But experts say routinely overloading on
vitamins can have the opposite of the intended effect, and may lead to symptoms including
nausea, diarrhea, stomach cramps, hair loss and fatigue.
A recent study also found that use of dietary supplements leads to more than 23,000
emergency room visits per year due to adverse reactions.
Mark Cuban
Mark Cuban, who has invested in four health care companies, tweeted (in tweets subsequently
deleted) that people should get their blood tested four times a year if they can. Health experts
pointed out the flaws in Cuban’s quarterly testing idea, saying that the more blood tests you
receive, the greater the possibility of false reports, misdiagnosis, and false positives, not to
mention the fact that many people simply can’t afford it.
Roger Moore
Former James Bond Roger Moore has declared that eating foie gras can lead to Alzheimer’s
disease, diabetes, and rheumatoid arthritis, calling the duck delicacy, “a tasty way of getting
terminally ill.” While the ethics of foie gras are certainly up for debate, scientists and doctors
say there is absolutely no proof that it can be claimed to cause such diseases.
Megan Fox
Megan Fox has claimed that swallowing vinegar will help you lose weight. “It just cleanses out
your system entirely. It will get rid of, for women who retain water weight from your menstrual
cycle and all that, it gets rid of it really fast,” the Transformers star said. Doctors counter that the
body is, in fact, “a well-oiled detoxing machine, which will not be improved by vinegar, whether it
be organic, apple cider, unfiltered, or your bog-standard malt vinegar.”
Good advice, education
Examples of celebrities using their platform for good:
Michael J. Fox ’s battle with Parkinson’s disease, and his subsequent advocacy for research into
the disorder, as a particularly noteworthy example.
Katie Couric , whose husband had colon cancer, had her own colonoscopy on TV.
The Marlboro Man, Wayne McLaren , became an anti-tobacco advocate after being diagnosed
with lung cancer.
Angelina Jolie , whose genetic makeup included a strong possibility of breast cancer, had a
preventive double mastectomy.
A celebrity can have a positive impact.

Effects of Marijuana by Dr. Zach, ER Physician MUHC

BT Montreal | posted Tuesday, Mar 13th, 2018

Cannabis (also called marijuana) is the most commonly used illegal psychoactive substance
worldwide. Its psychoactive properties are primarily due to one cannabinoid:
delta-9-tetrahydrocannabinol (THC); THC concentration is commonly used as a measure of
cannabis potency
Cannabis was used by an estimated 182 million people (range 128 to 234 million) worldwide in
2014, approximately 3.8 percent (range 2.7 to 4.9 percent) of the global population age 15 to 64
The potency of cannabis has increased significantly around the world in recent decades , which
may have contributed to increased rates of cannabis-related adverse effects. Cannabis use
disorder develops in approximately 10 percent of regular cannabis users, and may be
associated with cognitive impairment, poor school or work performance, and psychiatric
comorbidity such as mood disorders and psychosis.
Men use more, people 12-25 use more.

Acute effects: Cannabis intoxication in adolescents and adults also results in the following neuropsychiatric
Mood, perception, thought content – Ingestion typically leads to feeling “high,” marked by a
euphoric, pleasurable feeling and a decrease in anxiety, alertness, depression, and tension.
However, first-time cannabis users, as well as anxious or psychologically vulnerable individuals,
may experience anxiety, dysphoria, and panic. Increased sociability usually occurs during
intoxication, although dysphoric reactions may be accompanied by social withdrawal.
Inexperienced users who ingest cannabis products may not be aware that effects may not be
felt for up to three hours which may cause them to continue to consume high potency products
with an increased likelihood of dysphoria.
Perceptual changes include the sensation that colors are brighter and music is more vivid. Time
perception is distorted in that perceived time is faster than clock time. Spatial perception can
also be distorted, and high doses of potent cannabis products may cause hallucinations.
Mystical thinking, increased self-consciousness, and depersonalization may occur, as well as
transient grandiosity, paranoia, and other signs of psychosis.
Cognition, psychomotor performance – Cannabis use increases reaction time and impairs
attention, concentration, short term memory, and risk assessment. These effects are additive
when cannabis is used in conjunction with other central nervous system depressants. Acute
cannabis use also impairs motor coordination and interferes with the ability to complete complex
tasks that require divided attention.
Impairment of cognition, coordination, and judgment lasts much longer than the subjective mood
change of feeling “high.” Psychomotor impairment lasts for 12 to 24 hours. However, a
marijuana user may think that he or she is no longer impaired several hours after the acute
mood altering effects have resolved. As an example, a placebo controlled trial with licensed
pilots found that smoking marijuana impaired performance on a flight simulator for up to 24
hours, although only one of the nine subjects possessed self-awareness of this.
Acute psychomotor impairments interfere with the ability to operate other heavy machinery,
such as automobiles, trains, and motorcycles. A meta-analysis of nine studies found an
association between cannabis intoxication and an increased risk of a motor vehicle collision
involving serious injury or death. Drivers using cannabis are two to seven times more likely to be
responsible for accidents compared to drivers not using any drugs or alcohol. Furthermore, the
probability of causing an accident increases with plasma levels of delta-9-tetrahydrocannabinol.
Children — In children, acute marijuana intoxication typically occurs after exploratory ingestion
of marijuana intended for adult use. Less commonly, intentional exposure of children by
caretakers, including encouragement of cannabis inhalation to promote sleepiness and to
decrease activity, has been reported. Pediatric ingestions of marijuana products happen more
frequently in regions with decriminalization or legalization of cannabis use.
After limited exposures, children may display sleepiness, euphoria, irritability, and other
changes in behavior. Vital signs may show sympathomimetic effects (eg, tachycardia and
hypertension) or, in patients with depressed mental status, bradycardia. Nausea, vomiting,
conjunctival injection, nystagmus, ataxia, and, in verbal children, slurred speech may also be
present. Dilated pupils have frequently been reported, although miosis has also been described.
In large overdoses (eg, ingestion of edible products, concentrated oils, or hashish), coma with
apnea or depressed respirations can occur.

Although not typical of pediatric cannabis intoxication, seizures have also been reported. In one
instance, cocaine was also found on urine screening.
Adolescents and adults — The physiologic signs of cannabis intoxication in adolescents and
adults include:

●Tachycardia (fast heart rate)
●Increased blood pressure or, especially in the elderly, orthostatic hypotension
●Increased respiratory rate
●Conjunctival injection (red eye)
●Dry mouth
●Increased appetite
●Slurred speech

Acute side effects
Numbness, dizziness, low blood pressure, dysphoria (state of unease), anxiety, confusion,
vision changes, psychosis, speech disorder
Complications associated with inhalation use include:

●Acute exacerbations and poor symptom control in patients with asthma.
●Pneumomediastinum (air around the heart) and pneumothorax (air around/outside the lungs).
●Rarely, angina and myocardial infarction.

The risk for myocardial infarction among regular cannabis users has been found to be as high
as 4.8 times baseline.

  • Smoking
  • Alcohol
  • Opiates (gateway vs just ppl who take more drugs)
  • Stimulants
  • Mood disorders
  • Schizophrenia (increased risk if taken before 19)
  • Anxiety disorders, ocd, ptsd, adhd
  • Personality disorders (borderline, schizotypal, antisocial)

Urine drug screens are less helpful in adolescents and adults for the diagnosis of acute
intoxication. Although testing is usually positive several hours after acute exposure it can also
be positive well after symptoms have resolved. As an example, positive results for delta-9
tetrahydrocannabinol metabolites have been reported up to 10 days after weekly use and up to
25 days for after daily use
Medical uses:
Only evidence for efficacy in these conditions — Chemotherapy-induced nausea and vomiting,
neuropathic pain, palliative cancer pain, and MS or spinal cord injury-related spasticity.
In neuropathic pain, palliative cancer pain, CINV, and MS- or SCI-related spasticity, they should
only be considered for patients whose conditions are refractory to standard medical therapies.
When considered, there should be a discussion with patients regarding the limited benefits and
more common harms, and a preferential trial of pharmaceutical cannabinoid first (over medical
Plans for cannabis laws in Canada once legalized:
Controlled access
Should the Cannabis Act become law in July 2018, adults who are 18 years or older would be
able to legally:

  • possess up to 30 grams of legal dried cannabis or equivalent in non-dried form
  • share up to 30 grams of legal cannabis with other adults
  • purchase dried or fresh cannabis and cannabis oil from a provincially-licensed retailer
  • In those provinces that have not yet or choose not to put in place a regulated
    retail framework, individuals would be able to purchase cannabis online from a
    federally-licensed producer.
  • grow up to 4 cannabis plants per residence for personal use from licensed seed or
  • make cannabis products, such as food and drinks, at home provided that organic
    solvents are not used
  • The sale of cannabis edible products and concentrates would be authorized no later than 12
    months following the coming into force of the proposed legislation.

Strict Regulation
Laws re: driving high Canada:
Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired
driving, while drivers with both alcohol and THC in their system would be considered impaired if
they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5
nanograms of THC in their blood.
The government said the other two proposed offences would be similar to the offences for drunk
driving. Drivers with more than five nanograms of THC in their blood would be punished with a
mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120
days for a third offence.
Legalization results elsewhere:
The public health impact of decriminalization or legalization of recreational cannabis use

  • Both decriminalization and legalized recreational use have been associated with increased
    unintentional pediatric ingestions. As an example, after legalization of recreational marijuana
    use in Colorado, annual calls to the regional poison control center for pediatric marijuana
    exposure increased 34 percent on average to 6 cases per 100,000 population, which was
    almost twice the rate for the rest of the United States. Exposure to recreational marijuana
    accounted for about half of cases. Rates of hospital visits at a large regional children’s hospital
    system also increased significantly during the period of the study, although the total number of
    presenting patients (81) was small.
  • In regions with medical marijuana availability, diversion of drug from registered users may also
    encourage adolescent abuse.
  • In other countries where cannabis can be used legally, rates of usage vary. For example, in
    the Netherlands, the overall annual prevalence of cannabis usage is 23 percent among young
    adults compared with 5 percent annual usage reported by persons 12 to 64 years of age in
    Uruguay. Thus, the impact of decriminalization or legalization on the subsequent prevalence of
    cannabis usage is not easily predicted and varies depending upon the specifics of regulatory

In Washington and Colorado:

  • Rising rates of pot use by minors
  • Increasing arrest rates of minors, especially black and Hispanic children
  • Higher rates of traffic deaths from driving while high
  • More marijuana-related poisonings and hospitalizations
  • A persistent black market
  • The THC content, or potency, of marijuana, as detected in confiscated samples, has been steadily increasing from about 3% in the 1980s to 12% in 2012.

Negative effects:
Marijuana use has been associated with substantial adverse effects, some of which have been
determined with a high level of confidence. Marijuana, like other drugs of abuse, can result in
addiction. During intoxication, marijuana can
interfere with cognitive function (e.g., memory and perception of time) and motor function
(e.g.,coordination), and these effects can have detrimental consequences (e.g., motor-vehicle
accidents). Repeated marijuana use during adolescence may result in long-lasting changes in
brain function that can jeopardize educational, professional, and social achievements. However,
the effects of a drug (legal or illegal) on individual health are determined not only by its
pharmacologic properties but also by its availability and social acceptability. Alcohol and
tobacco are legal and account for the greatest burden of disease due to drugs.
Psychosocial functioning and health — Adolescent cannabis use is strongly associated with
lower educational attainment and increased use of other drugs, but not with school performance
or psychological health; even the strong associations are not clearly causal:
Not strong evidence that is is a cause of cancer, heart attack, stroke, arteritis, atrial fibrillation
Causes hyperemesis (vomiting) syndrome, tx with haldol or hot shower/bath (or fluids,
antiemetics (ondanzatron), benzos)
Cannabis use disorder: the continued use of cannabis despite clinically significant impairment,
ranging from mild to severe.
The main risk factors for cannabis abuse include frequent use at a young age; personal
maladjustment; emotional distress; poor parenting; school drop-out; affiliation with drug-using
peers; moving away from home at an early age; daily cigarette smoking; and ready access to
cannabis . The researchers conclude there is emerging evidence that positive experiences to
early cannabis use are a significant predictor of late dependence and that genetic predisposition
plays a role in the development of problematic use
The school experience strongly influences risk of cannabis use or vice versa. Among
adolescents enrolled in school, two- threefold greater prevalence of cannabis use during the
past month is seen among adolescents with (compared with without) the following

  • Failing grades
  • Nonparticipation in extracurricular activities
  • Dislike of school
  • Others in grade who use cannabis, alcohol, or cigarettes
    ie regular cannabis users in adolescence increases risk of poor school performance
  • Employment status – Those employed full-time or not in the labor force (eg, students, retired,
    disabled) have lower prevalence of cannabis use during the past month than do those working
    part-time (11.6 percent) or unemployed (7.5 and 4.8 versus 15 percent).
  • Income – Adults with income less than $20,000 USD annually have 2.5-times higher rates of
    cannabis use during the past year than adults with income of at least $70,000 USD annually
    (15.6 versus 5.9 percent)
  • Marital status – Unmarried adults are more likely to have used cannabis during the past year
    than are married adults or those widowed/separated (21.0 versus 5.5 versus 8.3 percent).
  • Legal status – Adults on parole, probation, or supervised release status are approximately
    three times more likely to have used cannabis in the past month than are individuals not in such
    legal status. Adolescents with violent or illegal behavior in the past year are at least twice as
    likely as those without such behavior.
  • Social network – Among adolescents, a positive relationship with parents and having parents,
    friends, or peers who disapprove of cannabis use are all associated with at least twofold lower
    prevalence of cannabis use over the past month.
  • Religion – Adolescents with frequent attendance at religious services or strong religious beliefs
    are two to three times less likely to have used cannabis over the past month than those without
    such protective factors.
  • Other substance use – Cigarette smokers and alcohol drinkers are each five to six times more
    likely than nonsmokers and nondrinkers to use cannabis.
  • Geography – Prevalence of cannabis use over the past month in the United States varies
    somewhat by geographic characteristics. Highest rates are found in New England (11.0 percent)
    and the West (10.3 percent) and in large (>1 million population) metropolitan areas (8.7
    percent). Lowest rates are found in the South Central region (5.9 percent) and in rural areas
    (4.5 percent).

But Cannabis use disorder constitutes a small proportion of the global burden of disease relative
to other substance use disorders. Of the approximately two million total disability adjusted
life-years lost to substance use disorders (not including tobacco), individual substance use
disorders were:

●Alcohol – 47 percent
●Opioids – 24.3 percent
●Amphetamines – 7.0 percent
●Cannabis – 5.5 percent
●Cocaine – 2.9 percent
●Other illicit drugs – 13.4 percent

Pros of legalization — regulation (know what exactly you’re getting), taxation
Large-scale cross-sectional epidemiological studies and smaller prospective longitudinal studies
have not found cannabis use to be significantly associated with serious or chronic medical
conditions or death from medical conditions.
Canadian medical college marijuana prescribing guidelines, authorized producers, more info:

Medical Myths By Dr. Zach Levine, ER physician, MUHC

BT Montreal | posted Wednesday, Feb 28th, 2018

Medical Myths

By Dr. Zach Levine, ER physician, MUHC


Medical myths are false beliefs about our health and healthcare that we pass on to each other with the best of intentions.  Indeed many doctors believe certain medical myths.  In this episode we’ll bust a few common ones.


1. Going out in the cold causes a cold

We have all experienced the common cold.  It is an infection caused by one of a number of viruses, most commonly rhinovirus.  Many studies have been done on this topic, and the result it clear – going out in the cold does not cause you to get a cold.  The myth may come from the name of the illness, or may come from the fact that more people tend to catch colds in the winter because the virus lives longer in cold environments and because people tend to spend more time indoors in closed environments where they share germs.  But you can go out in the cold without fear of the cold causing you to catch a cold.  Sleep deprivation has actually been shown to be associated with an increased risk of catching a cold, perhaps because your defences are down.  But the cause of a cold is always a virus, and if you’re not exposed to it you won’t catch it no matter how tired or cold you are.


2. Reading in dim light damages the eyes

This is a common myth but is a myth nonetheless.  Reading in dim light has not been shown to cause any permanent damage to the eyes.  Some people feel that their vision is a bit blurred or have a headache temporarily after reading in dim light because they have strained but again this is temporary, not permanent.  The same is true of watching TV too close to the screen – it causes no permanent damage to the eyes.  This goes for other screens as well.

Looking at a screen for long periods of time, similarly, can cause some strain or fatigue but not permanent eye damage.


3. Sleeping too little will kill you

Most people need an average of 7 to 9 hours of sleep per night.  Many people worry that they don’t get enough sleep and that it affects their health.  There is some evidence that sleeping too little puts extra strain on your cardiovascular system, but there has also been at least one study showing that people who sleep too much live less long.  So the jury is still out.  What is most important is to sleep enough so that you don’t feel tired and are able to function properly.  Tips for improving sleep include:

-avoiding alcohol and caffeine before bed

-regular exercise but not just before bed

-using the bed for sleep (and sex) but not spending hours reading or watching TV in bed

-the use of relaxation techniques are very useful for some people in getting to sleep

Sleep medications can be effective but should only be used occasionally.


4. Green sputum means you need antibiotics

The color of your sputum (aka snot, phlegm – the stuff that comes out of your nose and/or that you cough up when you are sick) does not indicate whether or not you need antibiotics.  Antibiotics are medications that treat bacterial illnesses, like strep throat and many pneumonias.  They are not useful in treating viral illnesses, like the common cold or the flu.  If you are ill and have colored sputum it is reasonable to visit the doctor.  By asking you questions and examining you, and doing other tests if necessary, your doctor can determine if you have a viral or a bacterial illness, and treat you with antibiotics if necessary.  If you have a viral illness like the common cold, your body’s immune system will eventually take care of healing you.  In the meantime certain medications may be useful in treating your symptoms so you don’t feel as rotten, but antibiotics will not help fight a viral illness – your natural defences will.


5. The flu vaccine will make you sick

The most common vaccine given to older adults is the flu vaccine.  It is formulated to prevent the flu, which is a serious infectious illness that kills thousands of people every year, especially the elderly, the very young, and people with chronic illness.  The vaccine is therefore recommended especially to the elderly, the very young, people with chronic illness, and people who work with these populations (like healthcare workers).  The vaccine is available by injection and by nasal spray (recommended for ages 2-49).  The injection is a dead virus which cannot cause the flu but may cause a bit of muscle ache and rarely a temporary unwell feeling.  The inhaled vaccine is a weakened virus which, even if it causes a mild illness, will cause one much less severe than the actual flu.  Remember that it is always better to prevent an illness than to treat it, and there is no cure for the flu.  So get the vaccine, and prevent it.  You most likely will not get sick, and if you do, you’ll be less sick than you would be if you caught the flu.

6. A made-in-Quebec myth:

Sitting on a cold toilet seat will give you a urinary tract infection

Urinary tract infections are caused by bacteria, usually bacteria that come from the gut.  Until later adulthood they are more common in women, because women have a shorter urethra (tube from outside into bladder) so the bacteria have less distance to climb from the outside into the bladder.  Ways to decrease the risk of catching them are wiping your bum from front to back, urinating after sexual intercourse, stay well hydrated, and urinate when you have to.

Sitting on a cold toilet seat is uncomfortable, but it has no effect on whether or not you catch a urinary tract infection.

There is so much health information available these days that it can be confusing.  Find sources and people you can trust and inform yourself about the facts before you make any decisions about your health.

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