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What is a fecal transplant?

BT Montreal | posted Tuesday, Jul 30th, 2019

By Dr. Zach Levine

An increasingly common and potentially life threatening infectious disease involving the bowel is C. Difficile (also known as C. Diff) colitis.  Colitis means an inflammation of the colon, or bowel. C. Diff is a bacteria that can sometimes take over the bowel flora, causing severe inflammation.  Taking antibiotics for other reasons can eradicate many of the bacteria which normally live in the bowel (of which there are thousands) and maintain a healthy equilibrium.  Without these many healthy bacteria C. Diff can take over. C. Diff colitis is normally treated with one of two powerful antibiotics, but sometimes that doesn’t work. A highly effective treatment for C. Diff colitis is fecal transplant.

Fecal transplant is the process of inserting a healthy person’s stool into another person’s colon in order to restore the healthy balance of bacteria in the colon.  It is performed most commonly by inserting a colonoscope into the colon which releases the healthy stool into the length of the colon. It can also be achieved by insertion of a nasoduodenal tube, a tube from the nose into the duodenum, through which the healthy stool can be delivered.  There is now evidence that the healthy stool can be given orally in capsules as well. The effectiveness of fecal transplant in C. Diff colitis appears to be 80-90%. There is also evidence that fecal transplant may be effective in treating ulcerative colitis. And we are learning that certain healthy people have particularly therapeutic stool.  These people are called “super donors,” and in the future they may well be the source of most stool transplants, to maximize the chance of effectiveness.

For many years doctors thought that stress was the cause of stomach ulcers.  Now we recognize that ulcers are commonly caused by a bacteria, Helicobacter Pylori.  There is more and more evidence that an imbalance of pathogens like bacteria can lead to disease, and that chronic inflammation can lead to disease as well, such as coronary artery disease, cancer, alzheimer’s, and diabetes.  (this bit on inflammation could be a separate article)

There is emerging evidence that healthy bowel flora is important to health outside the bowel as well.  There is some evidence that fecal transplant can be used to treat type 2 diabetes, and studies are underway to see whether it can help treat Alzheimer’s disease, multiple sclerosis, allergies, asthma, and cancer.

Fecal transplant is generally well tolerated.  However, like any treatment, there are potential side effects.  Specifically, the side effects of stool transplantation include abdominal discomfort, cramping, bloating, diarrhea or constipation, and, rarely, transmission of diseases that cannot be tested for by screening.  So, like with any treatment, the potential benefits have to be weighed against the potential risks.

At this time we know that fecal transplantation is a very effective treatment for C. Difficile colitis, a very serious infection and inflammation of the bowel.  There is evidence that it can help treat ulcerative colitis as well. And there is promise that it may be a treatment for other diseases such as Alzheimer’s disease, multiple sclerosis, and asthma.  Stay tuned, and if you’re curious, talk to your doctor.


Busting Medical Myths with Dr. Zach

BT Montreal | posted Wednesday, Apr 24th, 2019

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.

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.


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.


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.


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.


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.

more info: www.drzach.ca 

Dr. Zach’s 7 tips for living a longer & healthier life

BT Montreal | posted Tuesday, Feb 19th, 2019


1. Don’t smoke, If you do smoke, quit.  Smoking is known to cause numerous cancers, heart disease, lung disease, and stroke.  If you smoke, the best thing you can do to improve your health is to quit. This is much easier said than done but where there is a will there is a way and there is nothing more important for (or than) your health.

Longtime smokers can expect to lose about 10 years of life expectancy.  However, those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.  https://well.blogs.nytimes.com/2013/01/23/putting-a-number-to-smokings-toll/

2. Eat well and, if you have diabetes, control your sugars.  Everyone should choose lower glycemic index foods (brown rice, bread, pasta) over high glycemic index foods (white rice, bread, pasta) as well as choosing fats that are unsaturated (olive oil, salmon, almonds) over those with saturated fat (cheese, butter, cream).  Also, avoid trans fats (in fast foods, donuts). These recommendations are especially important to people with diabetes, who need to watch their diet and control their blood glucose.


3. Control your weight.  Obesity is a risk factor for many illnesses including type 2 diabetes, heart attack, stroke, and early death.  Weight control can be achieved by diet and exercise. Don’t buy things you will eat for emotional reasons or out of boredom (or if you do, moderate it).  Ask for help in setting a reasonable goal and taking small steps that make success more likely. Tell friends and family about your goal. Make your kitchen off-limits after dinner.  Trimming 5% to 10% of your starting weight is a realistic goal with excellent health benefits, including reducing blood pressure and cholesterol levels and lowering the risk for diabetes.  Work with your doctor, or a nutritionist, or a trainer — you don’t have to do it alone, and it’s easier to be motivated with others involved.

People with severe obesity have decreased life expectancy ranging from 6 to 14 years shorter than those of healthy weight — https://www.nih.gov/news-events/news-releases/nih-study-finds-extreme-obesity-may-shorten-life-expectancy-14-years


4. Stay active, physically and mentally.  People who are more physically active have better diabetes control, blood pressure, cholesterol, and weight.  And they live longer and healthier lives. Not everyone can run marathons, but whatever physical exertion you can do is infinitely better than none at all, and the more the better.

Staying mentally and socially active is as important as physical activity.  It has been shown to improve mental health and delay the onset and progression of dementia.


5. Drink alcohol only in moderation.  Moderate alcohol use for healthy adults means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.  If you don’t drink, don’t take it up for possible health benefits. If there are any they are small and probably only from having a single glass of red wine a day. Heavy drinking causes liver disease, heart disease, stomach disease, and increases your risk of certain cancers.  And it decreases one’s life expectancy by about 5 years — https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext.


6. Build a strong social network.  This has been shows to be protective to both your mental and physical health.

A healthy social life can be as beneficial to your health as not smoking.  And a study showed that those with poor social connections had on average 50% higher odds of death in the study’s follow-up period (an average of 7.5 years) than people with more robust social ties.



7. Have a doctor and go for screening when recommended.  Catch potential problems while they are easily treatable/curable and have someone to support you in improving your health.

Screening saves lives — for cancers, blood pressure, and many other conditions.


Controlling your blood pressure can add  5 years to your life expectancy — https://www.medscape.com/viewarticle/787720.

Patients who see the same doctor regularly have a lower risk of death than others — https://bmjopen.bmj.com/content/8/6/e021161

These are 7 ways to live longer, healthier lives.  There is no magic here; all take a bit of effort, and all are worth it.


For more info: www.drzach.ca 

Find yourself a fitness buddy! by Kathleen Trotter

BT Montreal | posted Tuesday, Feb 19th, 2019

Need Some Motivation? Get a “Fitness Buddy”

We all fall off our fitness horse from time to time. As I constantly remind myself (my inner critic can be nasty), we are only human. Undulations are an inherent part of life, and thus an inherent part of the process of “finding your fit”!

Now, that is not me giving you (or myself) the “okay” to purposely fall or to say, “I am unmotivated so who cares. I will just be lazy.”

NO! When you fall off your fitness horse, you have to course correctly as quickly as possible — get back on the horse ASAP and climb on a more informed rider. Ask yourself, “Why did I fall?” and “What would make me more motivated?”

My suggestion? Try getting a fitness buddy! Many of us fall in large part because we get bored of our routine and we don’t set up systems to keep us accountable.

A workout buddy solves both problems. Training with a friend can infuse some fun into your workout and create accountability!


The buddy system in detail

Partner training exists on a continuum.

The most “hands off” is to simply meet that person at the gym or a fitness class so you have accountability. Think of this as “independent” partner training. Get on side-by-side cardio machines to chat, do a group class, or put your headphones in to do your own strength or cardio workouts. This is ideal for those who want the accountability of having to meet someone but have no interest in interactive strength exercises or having medicine balls thrown at their faces.

The next level would be “gamifying” or “coachifying” your workouts. No throwing equipment at each other required — as with actual “partner exercises” — but you do work out together and, most important, actively motivate each other as you sweat. This is ideal for anyone who wants to gamify their workouts or who thrives on pushing or being pushed by a partner, coach, or trainer.

Try it on side-by-side cardio machines. First agree on a set workout and motivate and coach each other throughout. For example, do 10 sets of one minute hard and one minute recovery. “Coach” your friend to push as hard as they can. Maybe set a friendly competition based on effort.

Or take turns being the “coach.” Try partner fartlek training. Going for a run? Partners take turns identifying a landmark — a stop sign, for example — and sprint toward it. The coach dictates the pace; the second partner attempts to keep up. Recover and then spot the next landmark.


The most intertwined level — what I consider the most “fun” — are “partner exercises.” For these you actually use your partner to do strength and core. Partner exercises are ideal for those who want to improve coordination and reaction skills, or those who enjoy the team-like feel of training interactively.

Here are a few partner strength exercises to try.

  • Tapping push-ups: Start facing each other in push-up position. Do one push-up. On the way up, high-five each other. Repeat, alternating hands. Keep your hips stable as your hands connect.
  • Partner-resist side planks: Start in a side plank, facing each other, on your left forearm and feet. Place your right hands palm-to-palm. Each partner gently tries to push the other over as you both hold for 20 seconds or more. Switch sides. Brace your core to stay stable.
  • Standing single-leg medicine ball toss: Stand on one leg, facing your partner, and throw the medicine ball back and forth.
  • Plank medicine-ball roll: Start in plank position with your feet wide. Face away from each other, feet touching. Partner A rolls the medicine ball under both partners so that Partner B has to stop it. Partner B then rolls the ball back to Partner A. Keep your hips still. Roll the ball back and forth for 20 to 60 seconds.
  • V-sit partner toss: Sit on your bum facing each other with your feet on the ground and knees bent. Lean back slightly with chest out and core engaged. Toss a medicine ball back and forth. For an added challenge, lift one or both legs.

You can also gain numerous training partners by joining a running or triathlon training group.


The caveat!

I am not arguing that everyone should have a fitness buddy — you might not NEED a buddy to be successful. If you don’t like training with people or working out is your “alone time,” then great — be you! DO YOU. The trick to “finding your fit” is literately finding the method of being active that fits your life realities, genetics, goals, and personality.

Believe me, I often relish simply putting in my headphones and running “buddy-less.”

If you don’t want to train with someone but like the idea of some accountability, try an “accountability buddy.” E-mail or call your “buddy” regularly to discuss anything health related; establish weekly exercise plans, fitness goals, or meal plans, and identify possible road blocks and solutions.


Last, never use your partner “falling” off of their health horse as an excuse to fall off yours.

Establish clear goals with your partner so that you’re motivated to stay on track even when your buddy is not around. Commit to attending a set class regardless of whether your partner goes, sign up for a race so you always have a reason to do your training run, or set weight-loss or strength goals. When your schedules don’t match, train separately and report back.


Main take-away

No matter how reliable your partner is, your health is still ultimately your health.

Don’t transfer responsibility for your well-being to a buddy; don’t justify skipping a workout because your buddy can’t make it or duck out early because your partner does.

But if you’re struggling with motivation, try having some fun with a fitness buddy. Use your partner when it’s helpful. Use yourself — dig deep — when he or she is not.


Chest pain: should you go to the ER? A blog post by Dr. Zach

BT Montreal | posted Wednesday, Jan 23rd, 2019

Every year millions of people visit the hospital because of chest pain.  While many of these people will have benign problems, a significant number will have significant and potentially life-threatening ones.  With heart disease as the biggest killer of adult men and women in north America, chest pain is a symptom that can’t be ignored.  The question is how to know the difference between benign and serious chest pain, and whether it is ever safe to stay home with chest pain.


The causes of chest pain are many, and relate to the organs in the chest (and abdomen, and brain).  These include:

-Skin causes, such as shingles, which causes pain followed by a rash

-Musculoskeletal causes (muscles, tendons, bones), such as muscle strain, costochondritis (inflammation of cartilage), or a pinched nerve

-Cardiac (heart) causes, such as a heart attack or an inflammation of the heart muscle (myocarditis) or its sac (pericarditis)

-Vascular (blood vessel) causes, such as an aortic dissection (tearing of the big artery which carries blood from the heart to the rest of the body)

-Pulmonary (lung) causes, such as a pulmonary embolus (blood clot in the lungs), pneumonia, pneumothorax (air between the outside of the lung and the chest wall), pleurisy (pain or inflammation of the lining of the lung), or cancer

-Gastrointestinal, such as reflux/heartburn, spasm of the esophagus, gallstones, pancreas pain, stomach ulcer

-Psychological, such as a panic attack, which can cause symptoms very similar to a heart attack


The doctor has to consider all of these and more as possibilities in a patient who presents with chest pain.  In order to determine which is the most likely, we find out the exact nature of the pain, associated factors, and risk factors one has.  For example, “typical” heart attack chest pain is described as squeezing in nature behind the sternum (breast bone), worse with physical exertion, and association with shortness of breath, nausea, lightheadedness and sweating.


Risk factors for heart attack include smoking, family history, high blood pressure, high cholesterol, and diabetes.  So if a 65 year old man who smokes and is diabetic comes in with squeezing chest pain we naturally need to check out his heart.

Risk factors help guide us toward other diagnoses as well.  Risk factors for aortic dissection include high blood pressure, increased age, male gender, and some connective tissue disorders.


Risk factors for heartburn or acid reflux include smoking, alcohol consumption, caffeine consumption, pregnancy, and diabetes.


Risk factors for blood clots in the lungs include immobility, long-distance travel, and pregnancy.


Risk factors for pneumothorax include being tall and thin, asthma, and some connective tissue disorders.


Risk factors for stomach problems such as gastritis (inflammation of the stomach) include regular consumption of antiinflammatory medications and of alcohol.


Things that promote acid reflux include large meals, fatty foods, alcohol, particularly red wine, black pepper, garlic, raw onions, spicy foods, chocolate, citrus fruits, coffee and caffeinated drinks, including tea and soda, peppermint, and tomatoes.


Once the doctor has spoken with you he or she will examine you, looking for any telltale signs of the cause of your chest pain.  An EKG (heart tracing) will be done.  And further testing will be done, such as blood tests, a chest x-ray, or an ultrasound or scan.


It is worth noting that heart attack-related chest pain is frequently atypical, especially in diabetics, who may not feel pain but may feel shortness of breath, and in women, who may feel more of a hot or burning sensation in their chest or may feel the discomfort in their backs.  Some believe erroneously that heart disease effects women less than men, but it is a leading cause of death in women.  This belief can be deadly as women may delay going to the doctor, thinking it is not a heart attack.


Which brings us to the original question — when is it safe to stay home with chest pain?  The answer is that no one can ever tell you it is safe to stay home with persistent chest pain.  Certainly there are more worrisome types of chest pain and people who are at greater risk of serious causes of chest pain.  But without speaking with you and examining you no medical professional can guarantee that your chest pain is benign.  So if you have persistent chest pain, or shortness of breath, get to an ER.  But don’t drive yourself.  The best way to get there if someone is having dangerous chest pain is by ambulance, where paramedics can potentially begin life-saving treatment en-route to hospital.  It’s like the cardiologists say, “time is (heart) muscle.”  If you go to the hospital and are fine all you have lost is some time, if you don’t go and are having a heart attack, you could lose your life.

Alcohol consumption by Dr. Zach, ER physician

BT Montreal | posted Tuesday, Jan 8th, 2019

What is one drink?

A 341-ml (12 oz) beer or cooler with 5 per cent alcohol

A 142-ml (5oz) glass of wine (12% alcohol)

A 43-ml (1.5oz) glass of liquor (rye, gin, rum, vodka) – 40% alcohol


Recommended maximum alcohol intake:

10 drinks a week for women, with no more than 2 drinks a day most days

15 drinks a week for men, with no more than 3 drinks a day most days

Plan non-drinking days every week to avoid developing a habit.

Special occasions:

Reduce your risk of injury and harm by drinking no more than 3 drinks (for women)

or 4 drinks (for men) on any single occasion.

Plan to drink in a safe environment.


-Canada low risk drinking guidelines from canadian centre on substance abuse and addiction


Harms associated with alcohol:

When you drink alcohol, you may be putting your health and safety at risk. Your risk of harm increases with each drink that you have. And your risk of harm increases with how often you drink at amounts above the low-risk drinking guidelines, even if you do this only now and then.

Drinking alcohol may:

  • Harm your liver, pancreas, nervous system, heart, and brain.
  • Cause high blood pressure, depression, stomach problems, or sexual problems.
  • Contribute to the development of some cancers, such as cancers of the mouth, throat, esophagus, liver, colon, and breast.
  • Cause memory loss and affect your ability to think, learn, and reason.
  • Cause harm to your developing baby (fetus) if you drink during pregnancy.
  • Lead to problems at work, school, or home.
  • Increase the risk of car crashes and violent behaviour.
  • Cause you to develop an alcohol use problem.

Drinking more alcohol increases such dangers as alcoholism, high blood pressure, obesity, stroke, breast cancer, suicide and accidents.

Also, it’s not possible to predict in which people alcoholism will become a problem.

Drinking too much alcohol can raise the levels of some fats in the blood (triglycerides).

It can also lead to high blood pressure, heart failure and an increased calorie intake. (Consuming too many calories can lead to obesity and a higher risk of developing diabetes, heart attack and stroke.)

Excessive drinking and binge drinking can lead to stroke. Other serious problems include fetal alcohol syndrome, cardiomyopathy, cardiac arrhythmia and sudden cardiac death.


People who drink excessive amounts of alcohol — more than seven drinks per week for women or people older than 65 and more than 14 drinks per week for men younger than 65 — are at higher risk of death and many medical conditions.   Excessive alcohol use is the third-leading cause of preventable death in the United States, according to the U.S. National Institute on Alcohol Abuse and Alcoholism. People who drink unhealthy amounts of alcohol are more likely to have high blood pressure, heart disease, liver disease, nerve damage, infections including pneumonia and even certain cancers like breast cancer.  Drinking excessive amounts of alcohol is also associated with a number of psychiatric conditions, including depression, higher rates of suicide, anxiety, post-traumatic stress disorder, eating disorders, insomnia and other substance abuse disorders.


The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens when men consume 5 or more drinks or women consume 4 or more drinks in about 2 hours.4 Most people who binge drink are not alcohol dependent.


Binge drinking is associated with many health problems,8–10 including the following:

  • Unintentional injuries such as car crashes, falls, burns, and alcohol poisoning.
  • Violence including homicide, suicide, intimate partner violence, and sexual assault.
  • Sexually transmitted diseases.
  • Unintended pregnancy and poor pregnancy outcomes, including miscarriage and stillbirth.
  • Fetal alcohol spectrum disorders.
  • Sudden infant death syndrome.
  • Chronic diseases such as high blood pressure, stroke, heart disease, and liver disease.
  • Cancer of the breast, mouth, throat, esophagus, liver, and colon.
  • Memory and learning problems.
  • Alcohol dependence.

Havcing said all that, most alcoholic liver disease develops in peopl ewho drink daily as opposed to binging one of 2 nights a week.


Health benefits of drinking alcohol?

Some research suggests that having 1 drink a day may help lower the risk of heart disease and diabetes in middle-aged adults. But these possible health benefits decline with each additional drink that you have. Research also shows that any amount of alcohol can increase your risk of other health problems, such as some cancers.

If you don’t drink now, don’t start drinking to lower your risk of these health problems. There are many other ways you can lower your risk, such as eating a healthy diet, exercising, staying at a healthy weight, and not smoking. Talk to your doctor about your health and the benefits and risks of drinking alcohol.


What about red wine and heart disease?

Over the past several decades, many studies have been published in science journals about how drinking alcohol may be associated with reduced mortality due to heart disease in some populations.

Some researchers have suggested that the benefit may be due to wine, especially red wine. Others are examining the potential benefits of components in red wine such as flavonoids and other antioxidants in reducing heart disease risk. Some of these components may be found in other foods such as grapes or red grape juice. The linkage reported in many of these studies may be due to other lifestyle factors rather than alcohol. Such factors may include increased physical activity, and a diet high in fruits and vegetables and lower in saturated fats No direct comparison trials have been done to determine the specific effect of wine or other alcohol on the risk of developing heart disease or stroke.

Are there potential benefits of drinking wine or other alcoholic beverages?

Research is being done to find out what the apparent benefits of drinking wine or alcohol in some populations may be due to, including the role of antioxidants, an increase in HDL (“good”) cholesterol or anti-clotting properties. Clinical trials of other antioxidants such as vitamin E have not shown any cardio-protective effect. Also, even if they were protective, antioxidants can be obtained from many fruits and vegetables, including red grape juice.

The best-known effect of alcohol is a small increase in HDL cholesterol. However, regular physical activity is another effective way to raise HDL cholesterol, and niacin can be prescribed to raise it to a greater degree. Alcohol or some substances such as resveratrol found in alcoholic beverages may prevent platelets in the blood from sticking together. That may reduce clot formation and reduce the risk of heart attack or stroke. (Aspirin may help reduce blood clotting in a similar way.) How alcohol or wine affects cardiovascular risk merits further research, but right now the American Heart Association does not recommend drinking wine or any other form of alcohol to gain these potential benefits.

The AHA does recommend that to reduce your risk you should talk to your doctor about lowering your cholesterol and lowering high blood pressure, controlling your weight, getting enough physical activity and following a healthy diet.

There is no scientific proof that drinking wine or any other alcoholic beverage can replace these conventional measures.


Drinking a glass of wine is good for the heart in the sense that the main mechanism by which alcohol protects the heart is increasing good cholesterol.  The grape skin provides flavonoids and other antioxidant substances that protect the heart and vessels from the damaging effects of free oxygen radicals produced by our body.  This is particularly true for diabetics because they have been shown to have a high production of free oxygen radicals. But we don’t have any evidence specifically related to diabetes patients.

A glass of wine can also help individuals relax.  The strongest evidence is in favor of wine, but some evidence recently showed beer and other types of alcohol may provide the same benefits related to increasing good cholesterol (HDL).

In general, alcohol does not seem to have an adverse effect, unless an excessive amount is used — and it increases calories, among other things.  For example, excessive amounts of alcoholic consumption could be harmful by increasing the risk of high blood pressure, for which diabetic patients are already at high risk.


What problems does alcohol bring to the ER?

Violence, motor vehicle accidents, other injuries, heart problems, liver disease including liver failure requiring transplant.


How do I know if I have a problem?

CAGE questionnaire:

Have you ever felt you should Cut down on your drinking?

  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt bad or Guilty about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?


Item responses on the CAGE are scored 0 or 1, with a higher score an indication of alcohol problems. A total score of 2 or greater is considered clinically significant.

Other questions to detect a potential problem:

  • Had times when you ended up drinking more, or longer, than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Spent a lot of time drinking? Or being sick or getting over other after effects?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there


Dry January is a public health campaign urging people to abstain from alcohol for the month of January, particularly practised in the United Kingdom.

The campaign, as a formal entity, appears to be relatively recent, being described as having “sprung up in recent years” even in 2014.[1] However, the Finnish government had launched a campaign called “Sober January” in 1942 as part of its war effort.[2] The term “Dry January” was registered as a trademark by the charity Alcohol Concern in mid-2014;[3] the first ever Dry January campaign by Alcohol Concern occurred in January 2013.[4] In the leadup to the January 2015 campaign, for the first time Alcohol Concern partnered with Public Health England.[5]

In January 2014 according to Alcohol Concern, which initiated the campaign,[when?] over 17,000 Britons stopped drinking for that month.[6] While there is controversy as to the efficacy and benefits of the practice, a 2014 survey by the University of Sussex found that six months following January 2014, out of 900 surveyed participants in the custom, 72% had “kept harmful drinking episodes down” and 4% were still not drinking.[7]

Thirty-one days of sobriety might even help you cut back long-term: A 2016 study published in Health Psychology found that six months after the end of Dry January, people who had participated in the movement (even those who didn’t abstain for the entire month) reported having fewer drinks per day, drinking fewer days a week, and getting drunk less often.


Benefits of cutting out alcohol:

Weight loss

Deeper sleep

Immune system not suppressed

Better skin

The University of Sussex reported that 2015 Dry January participants in the United Kingdom also had several other benefits: 82 percent felt a sense of achievement, 79 percent saved money, 62 percent had better sleep, 62 percent had more energy and 49 percent lost weight.

Staying dry for January may also help jump-start people to give up alcohol for longer.

Although most people who participate in Dry January return to drinking, up to 8 percent stay dry six months later, according to Public Health England and the British Medical Journal.

And those who go back to drinking drink less. A 2015 study conducted in the United Kingdom and published in the journal Health Psychology found that people who participated in Dry January drank less often, had fewer drinks when they did drink and were drunk less often six months after Dry January was completed.

Dry January participants were also better able to refuse alcoholic drinks. These benefits were even seen in people who did not complete the whole month of Dry January


Should I have a Dry January?  

There is no harm in doing it (if you are dependent on alcohol then you should not stop all of a sudden; best to do it under guidance from a physician).  If you think you may have a problem, or it’s effecting your life in a negative way, then go for it. It may help you.

Safer drinking tips:


Set limits for yourself and stick to them.

Drink slowly.

Have no more than 2 drinks in any 3 hours.

For every drink of alcohol, have one non-alcoholic drink.

Eat before and while you are drinking.

Always consider your age, body weight and health problems that might suggest lower limits.

While drinking may provide health benefits for certain groups of people,

do not start to drink or increase your drinking for health benefits.

Kathleen-Approved “Systems” for Surviving the Holidays

BT Montreal | posted Tuesday, Dec 18th, 2018

Set up systems NOW that will save you from your FUTURE holiday-season self.

The holidays are a minefield for our health — we know this!

Instead of thinking “this year will be different” — without outlining the plan to make it different — only to wake up January 1st feeling unfit and energetically low, work to set up systems NOW to save you from your future less-disciplined self.

Create your strategy NOW!  Decide — in advance — which of my tips you will use!

For example, if you know that you make bad choices when you get overly hungry, never go to an event hungry. Always have food (like almonds) on you; grab a few before walking into a work event. That way you will not “have to” grab a cookie out of hunger.

Basically, ditch willpower. Change THE SYSTEM!!!!




Make it simple — the power of 3

Making healthy food choices can feel all-too confusing, and when overwhelmed it is easy to say “screw it” and fall completely off the wagon

The “simple” (but not always easy) system I follow is the “rule of 3.” I save my cognitive energy by telling myself that every meal has to have a protein, a vegetable or fruit high in vitamins and minerals (green leafy vegetables or berries), and a healthy fat. Once I eat those three things I don’t have room for any of the less-healthy stuff!


It is not just about what you eat — it is about what you DRINK!

Commit to being aware of your liquids this season. Many of us are aware of food, but fairly airy-fairy about liquids. Liquids count — they contain calories and, more important, impact our blood sugar, which effects our hormones and fat production.

Stay hydrated, watch your caffeine (and what you add to your coffee), avoid sugary liquids filled with empty calories, AND always be aware of how much alcohol you are drinking.

Before every work event, party, etc. decide in advance how much alcohol you will consume and what your plan is. Tell a friend or write it down if you need accountability. Decide … will you have a glass of water between each alcoholic drink? Or will you combine fizzy water with wine to make one glass of wine stretch into 3 drinks? Or will you sip a vodka-soda so you stay away from the carbs in beer? Or will you go wild and crazy an have weeks where you skip drinking altogether?

Carry a water bottle. Set an alarm at work to remind yourself to drink water. Too often we misunderstand dehydration as hunger. Make yourself have a set amount of water before you get your morning coffee.


Ask yourself, “How can I make this meal a little bit better??”

You don’t have to make each meal perfect, you just have to make it slightly better than originally planned.

Decide that no matter what — no matter where you are — you will attempt to make each meal even slightly better.

So, if you were going to have four servings of pasta, have three servings and some green vegetables. If you were going to have three eggs, bacon, and white bread, have two eggs, bacon, and one piece of seed-filled bread. “Eating well” exists on a continuum. Instead of labeling foods as “bad” and “good,” shoot to trend positive. Work to get to the next stage of your eating continuum.



Make your “base” healthy

Sure, indulge on your grandmother’s famous maple mashed sweet potatoes, but don’t make “indulging” your norm. When you are not at parties or events, commit to making your “base” meals as healthy as possible. If you are going to something in the evening, have a really healthy breakfast and lunch and go to the gym. Then mindfully consume only foods you enjoy at the event.

“Holiday heath perfection” is not a productive goal — it is not possible and thus simply sets you up for failure. What is possible is consistency of healthy habits during your daily life — optimizing your “base” nutrition. It is not the occasional deviations from the plan that matter — what matters are the choices you make on a daily basis, how intensely you deviate from your norms when you do deviate, AND how quickly you course correct. Deviations are not the end, they are part of the process.


Commit to the “love it” rule

Commit to only indulging with foods you LOVE. Don’t mindlessly eat. Go ahead and mindfully enjoy a small portion of something you love. I call this my “love it” rule. Love your mom’s apple pie? Have a small piece. Don’t mindlessly eat chips full of preservatives in front of the TV. Always be aware enough to know what you are eating so you can say no to things you don’t LOVE and then enjoy moderate portions of what you do LOVE.


BE AWARE — “awareness brings choice.” Commit to NO mindless eating

Always take a pause before you eat anything so that you know you are not simply mindlessly stuffing your face.

Sit when you eat.

Don’t mindlessly pick off of someone else’s plate.

DON’T eat as you cook — chew gum if that helps you not nosh.

Put your fork down between bites.

Consider journaling or tracking your food.  Most of us underestimate our unhealthy choices and overestimate our healthy choices.


Portions. Portions. Portions

Portions count! This season commit to being mindful of portions. Sure, have a slice of apple pie but have ONE not three.

Counting exact portions can be overwhelming and tedious, but you need a rough awareness of the amount of any one food you are eating. One cookie is not the same as five. Half a cup of pasta is not the same as four cups.

Think of a portion of healthy fat as the size of your thumb, protein as your palm, veggies as your fist, and carbs as your cupped hand.


Read menus in advance

Before your go to a restaurant, look online and decide in advance what you will eat. Chicken and vegetables? A big salad? Then when you arrive don’t even look at the menu, just order what you had previously decided on. Also, consider telling the waiter to only bring half and to have the other half packed up for tomorrow’s healthy lunch.


Always offer to bring something healthy

When I go to a party I always offer to bring a dish I want to eat — a big salad or steamed greens, etc. That way I know there will always be at least one healthy option.


Final thoughts

When you fall of your health horse—– you will; you are human — try not to let yourself “spiral” — one cookie or one drink is not the same as five cookies or five drinks. Ask yourself, “Did I enjoy the treat and have a moderate amount?” If the answer is yes, great. We all need a few treats. If the answer is no, work to understand why the fall happened — were you too hungry? dehydrated? feeling sad? — AND get right back on your health plan!


Enjoy the holidays and be merry. Don’t deprive yourself. Just be smart.

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

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