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Apple Watch Series 4 review: ‘Guardian on your wrist’ packs a punch

Winston Sih | posted Wednesday, Sep 19th, 2018

At Apple’s annual Sep. event in Cupertino, Calif., the tech giant announced a new Apple Watch that brings hardware and software improvements that doubles down on its commitment to health. With Series 1 only launched three years ago, in just under a week with my review unit of Series 4, you can tell that this is what Series 1 should have been all along.

From a hardware standpoint, Apple Watch Series 4 packs a punch in still a small form factor. It retains its iconic design with some minor updates, featuring 40 and 44mm size options, enabling an over 30 per cent larger display through rounded corners.

watchOS 5 takes advantage of this through enhanced complications on the watch faces, apps have more real estate, and button inputs are easier. This is the first thing you’ll notice when you power it up. While I’m traditionally a silver kind of a guy, I’m a huge fan of the new gold finish, too, aligning with the new iPhone XS offering.

Your bands are still good!

You’ll be relieved to know the bands you’ve spent so much money on are still compatible with Series 4—phew! This was a worry from some tech analysts—that this is a way to force consumers to purchase new bands to be compatible with the new model.

As far as other improvements to the body of Apple Watch itself, a new Digital Crown now has built in haptic feedback. When you scroll through different menu options, subtle vibrations will help guide you through the user interface—a very nice detail.

If you listen to music or interact with Siri on Apple Watch, the speaker is 50 per cent louder—enough to fill a small room with ample feedback. The microphone has been moved to the opposite side of the device to facilitate clearer phone calls.

The ‘guardian on your wrist’

Health is where you see the most improvement, and Apple is very proud of that. Series 3 brought a high heart rhythm alert that became quite popular in notifying users of irregular patterns. Now, Series 4 will do the same with low heart rhythms. 

At launch in the United States, Apple Watch will come with a first-of-its-kind over-the-counter electrocardiogram—or ECG—application, through a new heart sensor built into the back and Digital Crown. This will allow a new way to record information for medical professionals to analyze. However, no word on when this will come to Canada.

Last on the health developments, something that can be great for our aging population (and even clumsy people like me): fall detection. It utilizes the internal gyroscope and accelerometer to detect irregular movements like falls.

In these instances, users will receive a notification to decide whether they want to notify emergency services, and if there’s no response within 60 seconds, Emergency SOS will be activated automatically.  Apple likened these new features as the ‘guardian on your wrist.’

Added cellular support in Canada

New this year is expanded cellular support for Apple Watch in Canada. Rogers has joined the other major wireless carriers to carry the device, meaning active runners can leave their iPhones at home and still be connected to music, podcasts, and loved ones wirelessly.

eSIM technology shares data from your phone plan, while connecting Apple Watch independently to the cellular network. This, combined with the faster dual-core S4 processor and W3 wireless chip brings the future onto your wrist.

How much will this cost, and do I need all this power on my wrist?

Apple Watch Series 4 will start at $519 CAD, with the cellular model starting at $649 CAD. Series 3 will also be available for those who are happy with last year’s model—it is still a great watch. Cellular is good for you if you like to run and be mobile without a phone, however for many (including myself), the standard model suffices. I’m happy to see all three major Canadian carriers—including Rogers—on board with support.

Apple Watch Series 4 is really designed for iPhone users. So if you’re an Android user, you’ll have to look elsewhere.  If you use iPhone and are in the market for a new smart watch, this is a great upgrade. This is the first Apple Watch where I felt it could keep up with my fast fingers.

Rogers Communications is the parent company of Citytv and this website.

7 Days of Fat-Blasting Workouts by Kathleen Trotter

BT Montreal | posted Tuesday, Sep 18th, 2018

 

Intervals are convenient — you can do them anywhere and on any piece of equipment or without equipment — AND they are effective. With intervals, you alternate between bouts of high- and low-intensity training. This places a high metabolic demand on the body, burns lots of calories in a short amount of time, produces a high EPOC (post-workout calorie burn), increases mitochondria growth (mitochondria help to burn fat), and helps to improve one’s fitness level. Plus, they are a fantastic workout regardless of your fitness level; you adapt the interval intensity to fit your current capacity. The intensity of your interval is dependent on your individual fitness level. For some, the “high” interval will be walking quickly. For others, it might be jogging.

Exercise will improve your mood, energy, and overall health, and change your body shape, BUT no amount of fat-blasting workouts will help you shed those extra pounds if you are eating poorly. Be aware of your nutritional choices. Consider journaling — we often overestimate our health choices and underestimate our unhealthy choices.

Always do a proper warm-up and cool-down. The warm-up should be a minimum of 5 minutes; it should promote blood flow and prime your body for motion. Typically, it entails a lower-intensity version of the workout that is to come. For example, jog to warm-up for running or do a low-impact version of high knees before an intense interval of high-impact high knees. The cool-down is 5 or more minutes of stretching, foam rolling, and light cardio that cools the body down.

All exercises can — and should — be progressed or regressed depending on your fitness level. For example, cardio options can be made low or high impact (eg, stepping your feet back into a burpee vs jumping your feet back) and strength exercises can be progressed by adding weight and/or an unstable surface such as a Bosu.

Always listen to your body. Stop if you feel faint, sick, negative pain, etc.

Progress gradually. This week of workouts is an end goal. If you have never worked out before, don’t jump right in. Maybe do 2 of the more intense workouts and on the other days go for a walk. Slowly work your way up. Progress your intensity, choice of exercise, duration, and frequency.

 

Monday Tabata intervals: Cardio based

Tabata is a method of interval training. One cycle of Tabata takes 4 minutes. The 4 minutes is made up of 8 sets of 20 seconds of intense work followed by 10 seconds of complete rest. After 1, 4-minute Tabata set, rest for 1 minute and move on to your next exercise. Literally any exercise can be made into an interval. Both cardio and intense strength exercises can be made into Tabata. For today’s workout, focus on cardio exercises — we will do strength tomorrow! Think mountain climbers, high knees, bum kicks, burpees, or skipping.

Sample Workout

Warm up for 5 minutes by running on the spot or dancing around your living room. Then pick a cardio exercise (such as burpees or jumping jacks). Do the exercise hard for 20 seconds. Rest for 10 seconds. Repeat for 4 minutes. That is 1 Tabata. Do 4 to 6 Tabatas. Cool down.

 

TuesdayAMRAPs

AMRAP stands for “as many rounds as possible.” AMRAP is an example of time-based training. With AMRAP, you aim to fit in as many cycles of a circuit as possible within a set timeframe. The faster you get through the reps of each exercise, the more times you will complete the entire circuit in the given timeframe.

For this workout include strength and cardio exercises — push-ups, squats, and jumping jacks, for example. Beginners should do 2 to 3 sets of a 6-minute round. Intermediate exercisers should aim for 3 sets of 8 minutes. If you’re advanced, 3 sets of 10 minutes. Always warm up and cool down.

Sample Workout

Within your given timeframe (6, 8, or 10 minutes) do as many rounds as you can of 10 push-ups, 10 lunges on each leg, 12 bent-over rows, and 10 jumping jacks. Record how many rounds you get through. Gradually work to increase the number of rounds you can complete in 10 minutes.

 

Wednesday: Extra sleep and recovery day

Both sleep and recovery are KEY for weight and fat loss!!

 

Thursday: Strength and cardio-based minute intervals

With minutes you don’t count reps. You do each exercise as many times as you can within that minute. Pick 4 strength exercises and 2 core exercises. After you warm up, do 1 minute of each exercise, followed by 2 minutes of core and 1 to 3 minutes of intense cardio. Aim to fit in as many good reps as possible for each strength exercise within the 1-minute timeframe. Rest for 1 minute. Beginners repeat the cycle twice. Intermediate exercisers repeat 3 times. Advanced exercisers do 4 sets.

Sample Workout

After you warm up do 1 minute of a “push” exercise such as push-ups, 1 minute of a leg exercise such as squats or lunges, 1 minute of a “pull” exercise such as pull-ups, band reverse flyes, or bent over rows, and finally 1 minute of another leg exercise such as squat pulses, squats jumps, step-ups, or bridges. Then do 2 minutes of core — think planks, V holds, side planks, etc. Finish with 3 minutes of intense cardio such as running, skipping, jumping jacks, stairs, or rowing.

 

Friday: De-stress with yoga and/or pilates!

Stress is the arch nemesis of fat loss — especially abdominal fat. Plus, working your core with Pilates or yoga will help you stand taller. The taller you stand, the better your midsection looks!!

 

Saturday: Cardio-based pyramid intervals

Pick a cardio activity — ie, anything that gets your heart rate up. Any cardio machine, running or walking outside, swimming, dancing, aerobics, etc will all work. Warm-up for 5 minutes with a moderate version of your chosen activity. Then do the following pyramid: 1 minute hard, 1 minute easy, 2 minutes hard, 2 minutes moderate, 3 minutes hard, 3 minutes moderate, 4 minutes hard, 4 minutes moderate, 5 minutes hard, 1 minute easy, and finally 5 minutes hard. Cool down for 5 to 10 minutes.

 

Sunday: Meal prep!

Want to lose weight? EAT BETTER! Instead of exercising on Sunday use the time to rest your body and prep your food for the week!!

 

More info:

What is Tabata?  https://www.flamanfitness.com/blog/stay-fit-this-summer-with-my-do-anywhere-time-efficient-yet-effective-workouts 

What is the Minute Workout? https://www.huffingtonpost.ca/kathleen-trotter/the-minute-workout_b_8296398.html

What is AMRAP?  https://www.huffingtonpost.ca/kathleen-trotter/amrap-training_b_8974816.html

What is Interval Training? (https://www.flamanfitness.com/blog/make-interval-training-your-new-best-friend).

Recovery protocols: https://www.participaction.com/en-ca/blog/lifestyle-culture/4-ways-to-recover-reduce-soreness-and-avoid-injury 

Importance of sleep and how to set up a sleep routine: https://www.theglobeandmail.com/life/health-and-fitness/health/turns-out-sleeping-can-help-you-shed-those-extra-pounds-health/article31415104/

Review: iPhone XS features under-the-hood refinements, but it won’t come cheap

Winston Sih | posted Tuesday, Sep 18th, 2018

Like clockwork, Apple unveiled the latest iteration of their flagship smartphone, iPhone, on Sep. 12 in front of a packed audience at Steve Jobs Theater in Cupertino, Calif. Unlike previous years, however, the tech giant came out with not one, not two, but three smartphones—iPhone XS, iPhone XS Max, and iPhone XR. Tech enthusiasts applauded as CEO Tim Cook and team revealed the tech; but, is it worth the investment?

This review will focus on iPhone XS and iPhone XS Max—the devices Citytv had a chance to review ahead of the Sep. 21 launch in Canada, alongside Apple Watch Series 4. iPhone XR will go on sale later this year.

Hardware

On the exterior, iPhone X and iPhone XS are almost identical. The immersive screen remains at 5.8-inch, no home button, the same top notch you either love or hate, and IP68 water resistance up to two metres for 30 minutes—which Apple is quite proud of boasting through promotional videos. They also come in a new gold finish (in addition to space grey and silver), which I’m quite a fan of. Storage will be available in 64GB, 256GB, and 512GB configurations.

In all three models, you’ll notice Apple has done away with the iconic home button, foreshadowing a slow death of the physical switch. As with iPhone X, there is a slight learning curve, but from personal experience, you get used to the shift in habit.

As for the larger iPhone, it seems the company has nixed the ‘Plus’ naming convention, opting for ‘Max.’ iPhone XS Max comes with a 6.5-inch screen—and it’s gigantic. Both XS and XS Max are great for media consumption, but XS Max is immersive but large for pockets—think watching YouTube videos with the new wide stereo speakers. Or my latest obsession—Ignite TV PVR downloads on the airplane.

Do you need the larger screen? No.  Is it nice to have? Yes.  Can it be a pain to carry in your pocket? Certainly, but having the option is great.

Bionic chip for bionic speeds

When migrating my data from my iPhone X, I could notice speed and power from the get-go. This iPhone houses an A12 Bionic and Neural Engine—what Apple calls ’the smartest and most powerful chip in a smartphone.’ The power is best noticed in resource-intensive applications like video editing, augmented reality, and gaming.

Coupled with iOS 12, it’ll unlock new consumer-friendly functionality, like Memoji and every selfie-taker’s new favourite feature: Smart HDR. Using the two 12-megapixel wide and telephoto lenses, Smart HDR means you can, using a slider, control F-stop or depth-of-field appearance in Portrait mode photos. This puts the power of pro photography in a consumer-grade smartphone—perfect for the ‘gram.

Battery life

In comparison to iPhone X, Apple claims iPhone XS will get you 30 minutes longer than iPhone X. iPhone XS Max will beat iPhone X by 90 minutes, according to Phil Schiller.

In real-life, I got a 12-hour day of consistent use out of iPhone XS Max.

Dual SIM support

New to any iPhone is support for two SIM cards through eSIM technology. It’s reliant on carrier adoption—however, it’s the same technology used for cellular connectivity in Apple Watch Series 4—now on all major carriers in Canada.  Traditional SIM cards will still work, but there is only one slot. The variant to be sold in China which will have two SIM trays.

This means that eventually consumers can still have two phone numbers (say, one for personal use and one for work) and receive calls and texts on one iPhone.

Pricing

In terms of pricing, iPhone XS won’t come cheap. At $1,379 CAD for iPhone XS and $1,519 CAD for the iPhone XS Max variant, these phones aren’t cheap. Carriers will subsidize—for example, Rogers is launching an Ultra tier, where for $10 a month, customers can get up to $250 off the upfront cost of ‘iconic’ devices on a term.

Additionally, later this year, Apple is launching iPhone XR, the third device announced at the Cupertino event. It features a ‘Liquid Retina’ LCD display, 12-megapixel camera, and a wide-array of colours, reminiscent of the iPhone 5C. iPhone XR rings in at just over $1,000.

Bottom line

So why would you want this device? You’re likely using an older iPhone—perhaps a 7—and it’s time for an upgrade. As a former iPhone 7 Plus user, iPhone XS Max is a nice option—albeit the hefty price tag.

If you’re an iPhone X user, there’s plenty to love about it still. iPhone XS brings a lot of new under the hood, but might not be worth $1,379.

Lastly, there’s a lot to be intrigued about iPhone XR, from the colour options to battery life. For the average consumer, it may be worth considering it when it comes out later this year. Let the games begin.

Rogers Communications is the parent company of Citytv and this website.

World Suicide Prevention Day, by Dr. Zach, ER Physician

BT Montreal | posted Monday, Sep 10th, 2018

by Dr. Zach, MUHC (more info: www.drzach.ca)

WHO: Close to 800 000 people die due to suicide every year, which is one person every 40 seconds. Many more attempt suicide. Suicide occurs throughout the lifespan and is the second leading cause of death among 15-29 year olds globally (after unintentional trauma such as car accidents).

Quebec still has the highest suicide rate of any province in Canada, and men and Indigenous people are afflicted disproportionately.  Over 1,000 people die by suicide per year, at an average of just under 100 per month. Indeed,

Men make up around 80 per cent of suicide victims in Quebec. French-Canadian men living in small towns and rural areas have particularly high-rates of suicide.  Risk factors include being unemployed or underemployed, and divorced.

Suicide rates very high in native communities.  Risk  factors including poverty, unemployment and hopelessness, and the long-term impact of assimilationist policy and the residential school system. Many Indigenous people were taught to be ashamed of their culture, and others were sexually or physically abused at residential schools. Such abuse is a strong predictor of suicide and alcohol use.

Quebec has the highest suicide rate of any province in Canada, about 15 per 100,000 (the territories have higher rates, esp Nunavut).

Women make suicide attempts more often than man, and are hospitalized more frequently for them, but men have a higher rate of committing suicide (often they use more violent methods).

The main risk factors for suicide are:

  • A prior suicide attempt
  • Mental health disorders
  • Substance abuse disorder
  • Family history of a mental health or substance abuse disorder
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Being in prison or jail
  • Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
  • Medical illness
  • Being between the ages of 15 and 24 years or over age 60

The behaviors listed below may be signs that someone is thinking about suicide:

  • Talking about wanting to die or wanting to kill themselves
  • Talking about feeling empty, hopeless, or having no reason to live
  • Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
  • Talking about great guilt or shame
  • Talking about feeling trapped or feeling that there are no solutions
  • Feeling unbearable pain, both physical or emotional
  • Talking about being a burden to others
  • Using alcohol or drugs more often
  • Acting anxious or agitated
  • Withdrawing from family and friends
  • Changing eating and/or sleeping habits
  • Showing rage or talking about seeking revenge
  • Taking risks that could lead to death, such as reckless driving
  • Talking or thinking about death often
  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • Giving away important possessions
  • Saying goodbye to friends and family
  • Putting affairs in order, making a will

Protective factors:

  • Strong connections to family and community support
  • Skills in problem solving, conflict resolution, and non-violent handling of disputes
  • Personal, social, cultural and religious beliefs that discourage suicide and support self preservation
  • Restricted access to means of suicide — gun control
  • Seeking help and easy access to quality care for mental and physical illness

What can we (individuals) do to help prevent suicide:

  • Remove the stigma from mental illness
  • Learn and recognize the signs of warning signs for suicidality
  • Reach out and connect — engage the person, explore their situation
  • Know resources available (there is a list of QC resources here — https://amiquebec.org/suicide/)

 What people who interact with the public need to do:

  • People who interact with the public need to know how to recognize risk factors and address them:  primary healthcare providers, mental healthcare providers, emergency healthcare providers, teachers and school staff, community leaders, police officers and other first responders, social workers, spiritual and religious leaders, traditional healers

What government can do:

  • We need to restrict access to means of self-harm/suicide
  • Government needs to support crisis centres and workers and community programs — mental disorders need to be identified and treated

Suicide rates in Quebec have declined by almost 50 per cent since the year 2000. This may be directly linked to the publication in 1998 of Help for Life: the Quebec Strategy for Preventing Suicide. This strategy was written by the Ministry of Health and Social Services.

References:

https://montrealgazette.com/opinion/opinion-more-can-be-done-to-reduce-suicide-rates-in-quebec

http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

https://iasp.info/wspd2018/

Patient satisfaction doesn’t mean you’re getting good care, by Dr. Zach Levine, Er Physician, MUHC

BT Montreal | posted Wednesday, Aug 29th, 2018

by Dr. Zach (www.drzach.ca)

Are you satisfied with your doctor and medical care?  It might not be good for your health

In 2004 RateMDs.com was established.  It is a website that allows patients to rate their doctors.  Similar sites exist for rating dentists, psychologists, hospitals, and teachers.  It is an example of how the internet allows people to share information, and opinions.  Whereas in the past one might tell a friend about their experience with a doctor, this allows people to share their experience with anyone interested.  The concern for doctors is that those people who are satisfied may write nothing, whereas those with an axe to grind may be more motivated to share their negative reviews.  But when studied the majority of ratings are positive.

There are a couple of issues with such ratings sites, such as that there is no way to know who is actually writing the reviews and that some have a business model that allow paying customers to have some effect on their rating.  But that is not the point of this article. The point is that we all have opinions about other people, including our doctors, and now people have a way to share those opinions. The question is — do patient ratings of doctors and healthcare correlate to better doctors and better care?  The answer, from a few studies, seems to be no.

A study published in JAMA Internal Medicine in 2012 looked at almost 52,000 adults between 2000 and 2007, their satisfaction, healthcare usage, and mortality.   It found that “higher patient satisfaction was associated with greater inpatient hospital use, higher overall health care and prescription drug expenditures, and increased mortality.”  Yes, those who were more satisfied with their care had higher rates of death.

Some points made by the study authors:

Research has shown (see references, below) a tenuous link between patient satisfaction and health care quality and outcomes.

Patients tend to be more satisfied when they get more testing and treatment, aka “discretionary testing and treatment” (when they think they need it), and doctors are more likely to do this testing or treatment when their pay is linked to patient satisfaction.  But more testing may lead to harm. Other studies have shown that more intense healthcare (more testing and treatment) is associated with increased patient satisfaction but with increased mortality and no improvement in the quality of care.

Several other studies (see below) have found that patient satisfaction is not well correlated to better outcomes.  So what does this mean? It means that what people think they need may not be what’s best for them. However, there is good evidence that a doctor taking the time to communicate properly with a patient, including why in their medical opinion a certain test or treatment is not warranted, results in better patient satisfaction.

We are all human and we have a right to our opinion about other people.  Doctors have a responsibility to do what’s in the best interest of the patient, though it is not always exactly what the patient initially thinks they need.  A good doctor is someone who knows their stuff and will do what is best for the patient, regardless of pay, or pressure. A doctor who communicates well will explain why she or he feels that a certain test or treatment is needed, or not.  But doctors are human, and often feel rushed, and sometimes get frustrated or stressed, and they can feel pressure.

It is not easy to find a doctor in many places in Canada.  And most doctors in Canada are excellent. But doctors are human and our system is stretched.  It is important to be an advocate for yourself or your loved ones’ health care. You need to understand what is happening with your health in order to do everything you can to optimize it.  It is also important to work with your doctor to choose the best investigations and treatments for your specific case. You and your doctor should work together to make the doctor-patient relationship work, and communication is key.  Find a good doctor and ask questions of them. It is worth your time.

Ideas for helping the doctor-patient relationship and improving satisfaction:

  1. Think about visit before, be realistic about what will be covered
  2. Choose top issues
  3. Bring a list of you important past medical issues
  4. Bring a list of your medications
  5. Read about it
  6. Be an active participant in your care
  7. Be open and honest
  8. Everyone deserves good care
  9. Keep in mind that you have a common goal with your doctor — to maintain or improve health

 

References:

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1892143

https://www.nejm.org/doi/full/10.1056/nejmp1211775

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159721/

 

Schneider EC, Zaslavsky AM, Landon BE, Lied TR, Sheingold S, Cleary PD. National quality monitoring of Medicare health plans: the relationship between enrollees’ reports and the quality of clinical care.  Med Care. 2001;39(12):1313-1325

Rao JK, Weinberger M, Kroenke K. Visit-specific expectations and patient-centered outcomes: a literature review.  Arch Fam Med. 2000;9(10):1148-1155

Sequist TD, Schneider EC, Anastario M,  et al. Quality monitoring of physicians: linking patients’ experiences of care to clinical quality and outcomes.  J Gen Intern Med. 2008;23(11):1784-1790

Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending, part 2: health outcomes and satisfaction with care.  Ann Intern Med. 2003;138(4):288-298

Back to school tips from Dr. Zach, E.R. Physician, MUHC

BT Montreal | posted Wednesday, Aug 15th, 2018

 

by: Dr. Zach

Back to school is a busy and stressful time for both kids and parents.  It takes some time to get back into the school rhythm. Start preparing yourself and your kids for school early, so you are ready for day one.

Top 5 Back to School Health Tips:

  1. Get your kids’ sleep back in order
  2. Get your kids’ diet in order
  3. Backpack wisdom
  4. Phones and digital devices/screens
  5. Anxiety

 

Extra – checkups/vaccines, transportation safety

 

Get sleep schedules back on track.  Good sleep is essential for growth and optimal school performance, as well as mood and energy level.  In summer sleep schedules may shift and be less regular. Get ready for school by getting back in the habit of going to sleep at a decent hour and waking up early enough to get to school (if they’re sleeping until 11am they won’t fall asleep at 9pm).  Kids between the ages of 3 and 5 should get 10 to 13 hours of sleep a night; ages 6 to 13 need 9 to 11 hours of sleep; and teens 14 and older should get 8 to 10 hours of sleep a night. Avoid caffeine and stimulation at bedtime.

 

Pay attention to diet.  Start the day right with a healthy breakfast.  Model healthy eating. Don’t use food as a reward.  Limit added sugars. Have fruit, not juice. Healthy snack.  Balanced diet. Brown>white (for pasta, bread, rice). This will help maintain energy level and avoid post-sugary-binge crash.

Encourage breakfast, fruit, fibre, vegetables, protein.

Healthy eating in childhood sets good habits that kids will carry with them for life, hopefully protecting them from illnesses such as heart disease, stroke, and some cancers.

 

Get backpacks that fit well and make sure they aren’t carrying too much weight.  Kids carry more and more books as they get older, often more than they should.  International guidelines says children should carry no more than 10-15% of their bodyweight. Girls are often smaller than boys, but carry the same weight of books and homework. Recent research showed that 31% of boys carried overly heavy bags, compared to nearly 42% of girls.  The further one walks, and the less well-fitting the bag, the more pain it can cause. So get a well-fitting bag, wide, with padded shoulder straps and a padded back, use both shoulder straps, and limit the weight of the bag, but keep on walking because it’s healthy. Consider a rolling bag if there is no option but to carry a heavy load, if allowed by your school.  Back, neck, shoulder pain. Those who experience it in childhood are more likely to experience it as an adult. See more backpack recommendations below.

 

Phones and digital devices — if your kids have them there need to be limits on how much and what they use them for.  There are rising rates of loneliness, anxiety, and depression in youth.  Cell phones and screens aren’t clearly causing this, but they aren’t helping either (see article below).

Need to talk to your kids about using their phones responsibly.

 

Some use is ok, and there is peer pressure to play games with their friends, but remember it is not really being with other people.  And if they’re on their phones they are not outside running around, or really interacting, or reading, or creating.

Talk to them about safety from online content and from other people online.  Consider a program to limit their use and limit which sites they can access.

 

See cell phone rules, below.

 

Talk to your kids about what you worry about and what they are worried about.  For example, bullying, strangers, what to do in case of emergency.  Open the door for them to talk to you.

Kids can sense parental anxiety and it can make them more anxious.

 

Back to school Anxiety and Worries:  having friends, fitting in, clothes, teacher, schoolwork, bullying.

This may manifest as physical symptoms (abdominal pain, headache)

It’s crucial that they attend so as not to enforce avoidance and not to make things worse.  Most feel better once things begin. At school they learn not only schoolwork but also social skills, a chance to learn and master new skills, for success and mastery, to make friends.

Strategies to help – tired and hungry kids deal with stress less well.  Good sleep and eating routines, healthy snacks.

Encourage them to talk.  It is normal to be anxious — everyone is.

Work together on problem solving strategies

Talk about what they’re looking forward to

Involve the teacher if necessary

Kids should have some extracurricular activities including physical activity, which helps combat anxiety and depression.  This will also teach them life lessons about balance.

 

Take advantage of the time to get regular check-ups with the doctor, dentist, and optometrist.  And get vaccines updated.  Most of us are lucky enough to never have witnessed the devastating effects of the illnesses that we now prevent with vaccines.  Examples include polio, measles, mumps, and rubella. Vaccines are covered at your local CLSC.

Also, teach them good hygiene — wash hands and/or use hand sanitizer after using the restroom, after touching shared surfaces, avoid bringing dirty hands to eyes, nose, or mouth.

 

Other things to think about:

Lice

Review transportation safety — street crossing, car/bus/bike/walking safety

Homework – regular routine

Physical activity is important

 

Other than a reasonable weight, other things to consider when choosing and using a backpack:

 

  • Lightweight material, such as nylon instead of leather;
  • Padded double straps, to distribute the weight evenly across the shoulders (avoid one-strap, cross-body packs);
  • A belt that connects the two straps, or a waist belt, to transfer the load more evenly throughout the back and pelvic region.

If your child has a growth spurt, reassess the bag to make sure it still fits and is not too short or small. For some kids, especially older ones who have to lug heavy books, a rolling backpack may be more appropriate.

Using a Backpack Properly

Choosing the best backpack will go only so far in preventing injury and pain; kids also need to use it correctly:

  • Keep the load as light as you can. When possible, using two sets of books—one to keep at home and the other at school—may help allay some weight issues.
  • Always use both shoulder straps. They should be tightened symmetrically; not one loose and the other taut.
  • Position the pack properly. Make sure the straps fit the shoulders and chest snugly so that the bag can hug the back and not sag too low.

Some straps may loosen over time. When you first fit them, indicate with a permanent marker where the straps should be and then check them every couple of weeks to see if they need to be readjusted.

 

Cell phone rules from ahaparenting.com

  1. Remember that everything you send can become public. Never write a message or forward a photo or text, that you wouldn’t want forwarded to everyone in your school, plus your principal and your parents.
  2. Always ask before you forward a text or photo.  Be respectful. How would you feel if someone forwarded an unflattering photo of you?
  3. Always ask before you take a photo or video.  And even once someone has given you permission to take a photo, ask before you post it.
  4. If someone asks you to send a sexy photo… …remember that even with Snapchat (which “evaporates” the photo), the picture can be copied and forwarded to others. Anyone could see it — every kid in the school, your teachers, your parents. It happens all the time to great kids. Just don’t send it. And talk to your parents about it.
  5. If you receive a sexy photo…. immediately delete it from your phone, tell your parents, and block the number so you can’t receive more. Possession or distribution of sexual pictures of people who are under-age is illegal. If the person who sent it to you asks why, just say “It’s illegal. Let’s talk instead.”
  6. Never post your cell phone number…on Facebook, or broadcast it beyond your friends (because it leaves you open to stalking.)
  7. Never broadcast your location…except in a direct text to specific friends (because it leaves you open to stalking.) Don’t use location apps that post your location.
  8. Never respond to numbers you don’t recognize.
  9. If you receive an unsolicited text, that’s spam. Don’t click on it. Instead, tell your parents so they can report the problem and have the caller blocked.
  10. Don’t download apps without your parents’ permission.
  11. Don’t spend your baby-sitting money all in one place.  You don’t need more ringtones. Get unlimited texts so you don’t have to worry about budgeting.
  12. Don’t wear your cell phone on your body…and don’t use it if you can use a landline. Cell phones are always looking for a signal, and that means they’re sending out waves that you don’t want going through your body. Cancer? Maybe. We don’t know enough yet. So why not just be cautious?
  13. Leave your phone at a charging station in the living room overnight…so your phone is not in your room at night. It’s too tempting to respond to, and sleeping near it is bad for your brain.
  14. No cell phones at the dining room table.
  15. No cell phones out of your backpack while you’re in class.   And of course turn the sound off.
  16. Have a life.  Don’t feel obligated to respond to texts right away and don’t text until homework is done, during dinner, or after 9pm.
  17. L8R – Later! If you’re driving, turn off your cell phone…and put it in a bag where you can’t reach it in the back seat. (Make sure you have directions before you start out.) Cars kill people.
  18. Nothing replaces face to face talk.  If a “friend” sends you a mean message, take a deep breath and turn off your phone.Talk to them the next day, Face to Face, about it. Never say anything via text that you wouldn’t say Face to Face.
  19. Monitor your phone usage to prevent addiction.

Our brains get a little rush of dopamine every time we interact with our phones, so every text you send or receive, every post or update, feels good. Why is that a problem? Because it can distract us from other things that are important but maybe not so immediately rewarding, like connecting with our families, doing our homework, and just thinking about life. Research shows that people who use social media more often become more unhappy, because it causes them to constantly compare their lives to others, and to worry about whether they are being left out of things their friend group is experiencing.  To prevent addiction, make sure you block out time every day — like while you have dinner and do homework — when your phone is off. Also limit the number of times you check social media accounts. If you feel like that’s too hard, talk to your parents about it and ask for their help. There are programs that prevent your phone from being used at times you designate.

Depression does seem to be increasing in youth but no clear evidence that smart phones are fueling this trend.  They probably aren’t helping though.  http://fortune.com/2018/04/06/teens-youths-mental-health-smartphones-addicted/

Head over to www.drzach.ca for more info!

Hack your way into a healthy September, by Kathleen Trotter

BT Montreal | posted Monday, Aug 13th, 2018

It is possible to stay on your health horse while transitioning back to “real life” after summer — all you need are a few “back to real life” health hacks. Yes, transitioning back to school or work is often stressful, busy, and overwhelming, BUT the changeover does not have to undercut your health and fitness goals!

“Health hacks” are innovative ways to fit exercise into a busy schedule AND motivate yourself to actually do the exercise! (It is one thing to know how to fit motion in — it is another thing to actually do it. You know what they say, “if knowledge were enough we would all be billionaires with rocking bodies.”)

Hacks are always a useful, but they are especially useful in times of stress and transition. Getting yourself and your family back into the swing of “real life” qualifies as both stressful and a “time of transition.”

Remember, the more stressed you are, the MORE important the workout! Yes, finding the time is challenging, BUT finding the time is also critical. You will be a healthier, happier, and more productive version of you if you stay active!!

Instead of ditching your workouts in times of stress, use a few hacks!

 

Kathleen-approved “back to real life” hacks!!

 

Turn “back to school” chores into a workout

For example, do fartlek intervals as you walk the malls for school supplies. To do fartlek intervals simply pick random intervals — like the shopper 3 stores ahead of you — and speed walk towards them! Other options: always take the stairs, park far away from your destination (parking lot X vs A), stand on one leg as you wait at the cashier, do a few biceps curls or shoulder presses with books and other supplies in lines, or do 10 squats before you get into your car.

 

Make exercise a game with your kids and family

The options for this hack are endless. A few examples include setting up a family challenge (eg, track who can fit in the most steps the week leading up to “back to school”), racing your kids to the end of the block, challenging your family to a push-up or squat competition in front of the TV, or practising your kids’ sport with them.

 

Stop associating working out with the gym

Your workout doesn’t have to be in a gym to be worthwhile. Thinking it does simply gives you another excuse to be inactive. If the gym is not convenient, find an alternative. We all have enough reasons to skip a workout; don’t make convenience one of them.

For example, set up a home gym. Buy a few inexpensive pieces of fitness equipment — a band, the Pilates circle, the Glider, the TRX, and maybe some rotating discs. Train at home. Just commit to something realistic — anything — and do it!

 

Reward yourself (and/or reward your family)

Set goals and non-food-related rewards: a hot bubble bath, a new workout outfit, or a movie with friends. Don’t let yourself have the reward if you don’t reach your goal.

Get your family involved. Have everyone establish an exercise goal and a non-food-related reward. Prizes could be “the winner gets to pick the movie for movie night” or “the winner gets to pick the music on the next family car trip.” Get everyone to establish a goal and track their progress!

 

Find someone who inspires you … and learn from their experiences!

This could be someone from your real life or someone on social media. For example, talk to the mom or dad you know who seems to be able to stay fit and in control of their life. Ask how they do it.

Or start a Facebook chat.

Or try sending a message to someone on social media you admire. Ask them how they manage and/or overcame obstacles. Then extrapolate and apply their experiences to your own life.

 

Exercise at work

Walk as you take conference calls, invest in a treadmill desk, always take the stairs, do 10 squats before you sit in any chair, bike or walk to work, or go wild and crazy and dance around your office.

Another option is to bring a few pieces of equipment to work — such as a SITFIT and a band — and do exercises at your desk.

 

Couple exercise with something you enjoy

Watch TV or listen to a podcast, an audio book, or music as you work out. Better yet, have a program you are only allowed to listen to or watch when exercising.

 

Have an internal hashtag or a pep talk ready to go

We all have moments of low motivation. I love exercise and I still sometimes want to bail on a workout, but I don’t. When I don’t want to train, I use self-talk to convince myself to move.

I say, “Kathleen, you always feel better when you move. Your health quest is something you are doing for YOU. Moving is not a punishment; it is a privilege. If you don’t want to do your entire workout, fine, but you have to do something. Something is always better than nothing. Just start.”

Or I repeat simple internal hashtags. My current favourites are #IamWorthyOfSelfCare, #TheWorseYourMoodTheMoreImportantTheWorkout and #PerfectionIsTheOppositeOfDONE.

 

Get a fitness buddy

Friends make everything more fun. Plus, you are less likely to skip a workout (even if you are REALLY busy) if you are meeting someone. Meet your buddy and do fun fitness classes, go for a walk, do fun partner strength exercises at the gym, or simply meet and do cardio on side-by-side machines.

 

Create unique strategies for success

Working out in the morning? Sleep in your exercise clothes. Have an unpredictable schedule? Always have a gym bag packed and ready to go. One of my clients gets up and puts her sports bra overtop of her night clothes and then hops on her treadmill. She knows that if she stops to change she will skip her workout. Adopt the mindset that motion is a “non-negotiable.” Then, create a unique plan that works for you.

 

Create friendly competition

Figure out what drives you. If you care about saving money, pay yourself every time you train. When you reach a pre-established amount, splurge on something you normally wouldn’t buy. If competing with others is more your jam, sign up for ClassPass or a virtual activity tracker; compete with friends on how many classes you attend or how many steps you take.

 

Create visual reminders of your success

Have a calendar on the fridge and place a sticker on it every time you exercise or create a spreadsheet or graph and record your workouts.

 

Two last things to keep in mind

First, pick hacks that serve your personality. For example, if you hate being social, don’t try to make fitness a social activity. Maybe listen to music while you run instead of while you sit and eat potato chips.

Second, always have a growth mindset; recognize what has and has not worked for you. Capitalize on what has worked. If buying fitness clothes motivates you, then do that. Learn from what has not worked. If you aim to work out in the morning, but consistently snooze the alarm, figure out why you are tired (do you need to go to bed earlier?) or decide to work out at an alternative time. When you fall off of your fitness horse — it will happen; you are human — get back on a more informed rider!

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

vs

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:

https://www.nejm.org/doi/full/10.1056/NEJM199606133342406

https://www.reuters.com/article/us-health-cpr-expectations/cpr-survival-rates-are-lower-than-most-people-think-idUSKCN1G72SW

https://pmj.bmj.com/content/postgradmedj/early/…/postgradmedj-2017-135122.full.pdf

https://www.resuscitationjournal.com/article/S0300-9572(15)00373-1/abstract

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797279/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945517/

More info: www.drzach.ca

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