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Dr. Zach’s Guide to Dr. Google

BT Montreal | posted Monday, Mar 27th, 2017

Dr. Google — Using the Internet to improve your health


Unlimited information available at the click of a button.

People are getting informed about their health.

One in every 20 Google searches is health related

Pew research ctr:  80% of ppl have looked up health info online


Internet has info about conditions, health maintenance advice, and even programs that will try to diagnose you.


Self-diagnosis? Regarding online symptom checkers – Harvard study reviewed 23 symptom checker sites and found that they are not good at triaging or diagnosing — they err on the side of caution (can’t say it’s nothing if it’s something) and they only got the right diagnosis 34% of the time.  23 websites, 45 vignettes half common.

BMJ 2015;351:h3480 doi: 10.1136/bmj.h3480

Conclusions Symptom checkers had deficits in both triage and diagnosis. Triage advice from symptom checkers is generally risk averse, encouraging users to seek care for conditions where self care is reasonable.


So be careful about symptom checkers.  At best they can give you a list of possibilities.


Knowledge is power.  Good to be a partner in your healthcare — better to be active than a passive recipient.  The doctor has a limited time to explain. More info empowers patients — doctor as guide




Is the information real or “fake news”?  Who is writing it?  Who is paying for it?  What is their motive?

—-Be careful of miracle cures that cost money


Another problem is that we tend to search out things that we agree with or want to believe and dismiss the rest


So where do we go for valid information:

–Governmental (eg/ health Canada, Canadian public health agency), sites that end in.edu, .org

–Mayo, harvard



In some countries they’ve curated bona fide health info to pop up with searches eg/ Australia

What about online forums?  They are good for support, community (you are not alone) but careful to make sure they relate to you.

Dr. Zach’s Guide to Kidney Stones

BT Montreal | posted Tuesday, Mar 14th, 2017

I am a 50 year old man who experienced my first kidney stone last week.  The pain was excruciating.  The doctor sent me home with some pills and a follow-up but I want to know — will the stone pass on its own and will this permanently damage my kidneys?

Kidney stones are very common, with a lifetime prevalence of 12% in men and 7% in women.  The risk is higher if you have relatives with kidney stones.  They are known to cause very severe pain which often requires a visit to the ER to control.

In general, kidney stones are not considered to be a common cause of kidney failure.  The risk of kidney stones causing kidney failure is higher in people with diabetes, only one kidney, pre-existing kidney disease, and polycystic kidneys.

Most kidney stones (85%) pass on their own.  The chance of passing depends on the size (less than 6 mm have a better chance of passing), shape, and orientation of the stone.  In the ER the doctor gives medication to control the pain and checks to make sure that the kidneys are functioning well and that there is no infection.  If the stone cannot pass on its own then a urologist will determine the best way to help it do so.  Methods include lithotripsy (using electromagnetic shock waves to break it down), ureteroscopy (using a scope to remove it), or percutaneously (through the skin).

What is important if you have kidney stones is to have follow-up with a doctor after the acute episode, for two reasons: first, the doctor can determine what kind of stone you have and recommend ways to decrease your risk of recurrence.  In general it is wise to drink a lot of fluid and, for calcium (the most common type) stones have a low protein and low salt diet.  In addition, the doctor can check your risk factors for kidney disease and control them early.  This will protect your kidney function for the future.

Travel Advice from Dr. Zach

BT Montreal | posted Wednesday, Feb 8th, 2017

Plan ahead

  • Make sure you have medical insurance
  • Hopefully you won’t need it but if you don’t have it you’ll probably need it
  • Affordable, shop around
  • Make a timely Pre travel appointment with your doctor (less than 50% of ppl do)
  • You could need vaccinations – routine or otherwise – may need 4-6 weeks for this
  • Vaccines are individualized and depend on where you’re going.  Available:  yellow fever, meningococcal, typhoid, hep A, hep B, rabies, cholera, japanese encephalitis
  • Routine vaccinations — influenza, tetanus, diphtheria, pertussis, mmr, polio, varicella


Consider safety while away

  • Hand hygiene
  • Sun protection for eyes and skin — sunglasses, sunblock, sun shirts, hats, mosquito protection
  • Driving — intl license, be careful
  • STI’s – bring protection


Top things think of if you’re travelling to Mexico, Caribbean, or southern US this spring break:

  1. a) Traveller’s Diarrhea
  • Most common illness in travelers
  • Develops within 10 days of return
  • Variety of bacterial (etec most common), viral, parasitic (tend to persist longer) organisms
  • Prevention is key — eat only throoughly cooked hot foods, fruits you peel, pasteurized dairy.  Bottled drinks without ice, use straw
  • Freezing does not kill the diarrhea-causing organisms.  Alcohol does not sterilize them.  Fruit salads, lettuce, chicken salads unwise
  • Water purification — boiling for 3 min then cooling to room temp.  Adding 2 drops of 5% bleach to a quart of water will kill most bacteria in 30 min.  Adding 5 drops of tincture of iodine to a quart of water will kill bacteria within 30 min.compact water filters can be used
  • Chemoprophylaxis not recommended
  1. b) Chikungunya, Zika viruses – mosquito avoidance
  • Avoid feeding time (malaria Japanese encephalitis, west Nile virus between dusk and dawn; for dengue, chikungunya, zika, yellow fever during daytime)
  • Wear clothing that covers skin
  • Insect repellant.  DEET (there are others that work)  don’t saturate the skin.  Not under clothing.  Avoid eyes mouth genitals, wounds
  • Treat fabrics with insecticides’
  • Screens, tents
  1. c) Malaria (DR, Haiti) – chemoprophylaxis, mosquito bite avoidance
  • Depending on what else you do — diving barotrauma, STIs


2.     Staying well en route and coming home:

Air travel

  1. risk of VTE (blood clots) on flights of 4+ hours. Consider asa, compression stockings.  Get up and walk.
  2. Decreased paO2 in planes – may cause fatigue, “foggy brain”, headache.  Most ppl are fine but if sig heart lung dz, anemia, talk to your doctor
  3. It’s dry up there — drink
  4. Air pressure changes can cause ear pain in people with resp tract infections with blocked eustachian tubes — chew, yawn, suck sweets, valsalva, decongestant/antihistamine
  5. Jet lag — Curtail coffee, stay hydrated, Avoid or limit alcohol inflight, Try to sleep on the plane, Use sleeping pills wisely, Get outside, light, Adjust your clock, exercise
  6. Sharing germs — wash your hands!


Dr. Zach’s Guide to Postpartum Depression

BT Montreal | posted Monday, Jan 16th, 2017

By Dr. Zach Levine, ER physician, MUHC



A postpartum (PP) mood disorder begins within one-year of delivery with most occurring within four to eight weeks and lasts two weeks.

Distinguished by baby blues (BB) which is sadness interspersed with happiness, onset usually two-to-three days with a peak of seven-to-10 days.  Subsides within two weeks.

Baby blues affect 75 to 80% of new mothers, while 10-20% of new mothers are affected by postpartum depression.

Note — other postpartum mental health problems may be associated — anxiety disorders (PP Panic disorder, PP OCD), PP psychosis

Symptoms of PPD

  • Sadness
  • Crying
  • Insomnia
  • Appetite change
  • Difficulty concentrating
  • Feelings of worthlessness
  • Racing & obsessive thoughts
  • Anger
  • Fear
  • Guilt



  • Biological –  sudden drop in hormones (estrogen progesterone neurotransmitters) at delivery
  • Genetic – predisposition to mood disorders
  • Psychological – coping mechanisms, myths (below)


Freedom, identity, control, slim figure, feeling of unattractiveness. Usually comes down to a combination of factors.

  • Social – lack of support systems
  • Infant-related – even healthy infants require regular feedings around the clock and care, along with regular household needs. Unhealthy infants cause extra stress, as well as premature, those with colic.


The problem with myths is they don’t help – not meeting them can lead to guilt and shame. The fairytale image can be problematic: A happy mother, intuitive mothering, unremitting love, perfect baby, fathers being equally involved, being the perfect mother.


Risk Factors for PPD

  • First time mother
  • ambivalence about the pregnancy
  • History of mood disorder
  • Lack of social support
  • Lack of stable relationship with partner or parents
  • Unrealistic expectations about parenthood
  • Previous PPD


  • Therapy — individual or couple of group
  • Support groups
  • Practical help (every visitor brings food or does a load of laundry)
  • Medications

It is common and it is treatable and you are not alone.

Athena’s 2017 must-reads

BT Montreal | posted Thursday, Jan 12th, 2017

Athena the Book Explorer offers a selection of children’s books in English and French that she recommends to look at in 2017:

Book Series

  • ‘Magnus Chase and the Gods of Asgard’ by Rick Riordan
  • ‘The Trials of Appollo’ by Rick Riordan
  • ‘Diary of a Wimpy Kid: Double Down’
  • ‘Mother-Daughter Book Club’ series by Heather Vogel Frederick


  • ‘The Boy Who Dared’ by Susan Campbell Bartolleti
  • ‘Pax’ by Sarah Pennypacker
  • ‘Raymie Nightingale’ by Kate di Camilo
  • ‘Lily and Dunkin’ by Donna  Gephart
  • Escape from Mr. Lemoncello’s Library by Chris Grabenstein
  • (The sequel) Mr. Lemoncello’s Library Olympics by Chris Grabenstein

Graphic Novels

  • ‘Ghosts’ by Raina Telgemeier
  • ‘El Deafo’ by Cece Bell

French Suggestions

  • ‘Juliette’ series by Quebec author Rose Line Brasset
  • ‘Le comedien de Moliere’ by Annie Jay

Dr. Zach’s Guide to Winter Health

BT Montreal | posted Tuesday, Dec 6th, 2016

By Dr. Zach Levine, ER physician, MUHC

Colds and Flu Season

Why are viruses more prevelant in the winter? Beacause we spend more time indoors sharing air and viruses prefer dry air.

Colds are caused by one of several virus’; Symptoms are a runny nose, cough, congestion, low grade fever, sore throat – not caused by being cold.

Flu is caused by the influenza virus.  Every year 10-25% of Canadians get flu and 500-1500 die from it.

Virus shedding begins day before symptoms appear and lasts five-to-seven days.  Most ineffective on the second and third days after infection. Correlated with fever.

Virus lives longer with low humidity and lack of sunlight.  15 minutes on tissues, five minutes on skin, and one-to-two days on plastic or metal. Mucus protects (it remains up to 17 days on banknotes!)

Symptoms can include fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue.

Remember you can infect others, even if you take meds and feel better; see a doctor if sob, chest pain, drowsy, neck stiff, fever in infant less than three months, not urinating.

You can always get the shot! Flu shot (shot is dead virus, nasal is live weakened, only for ages 2-49) is available for everyone six months and older.  It takes two weeks to gain immunity.  If you have a chicken egg allergy you can get it, unless unless it is severe – if worried, 1/10th the dose and observe 30 min before giving the rest. Some people get soreness, or mild flu-like symptoms. Caregivers should get it.

Heart attacks – They increase in winter with 5-30% increase in heart related deaths in winter, up to 50% more MI’s in winter.

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

Caused by cold, shoveling, emotional stress, weight gain, little exercise, more salt, binge drinking and AF. Know the symptoms!

Recommend Vitamin D supplementation, and calcium for:

Bones and teeth

Immune system

DM control

CV health

Prevent cancer


SAD – Seasonal Affective Disorder is caused by a decrease in sunlight

Light therapy (10000 lux, little UV as possible as it is damaging to skin and eyes), 20-30 minutes soon after waking, eyes open but not looking directly; meds & therapy also an option.


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.

Frostbite can be associated with hypothermia, another serious condition that is caused by the cold.  If you think you might have frostbite, seek medical care.  Until you can see a health care professional, the following tips might help: 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


Hypothermia: Abnormally low body temperature – 35ºC 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, problems with coordination, memory loss, and slurred speech.  In infants you might note very low energy and bright red, cold skin.

Get warm, get help if bad. Move to a 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. Be careful about falls.

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

Dr. Zach’s Guide to Staying Healthy in your 70s & 80s

BT Montreal | posted Monday, Nov 21st, 2016

Dr Zachary Levine, ER Physician, MUHC

In a nutshell the key to maintaining mental and physical health is continuing to be active, mentally (to ward off dementia) and physically (to prevent physical illness).

Life expectancy in Quebec: For men it’s 79, women 82

Growing older is not always easy – medical issues, friends and loved ones pass away. As – or more important – than quantity of life is Quality of Life.

How to stay healthy and live longer:


  • Have a doctor
  • Socialize, it’s important

Important for quality of life:

  • Doing things you enjoy
  • Social network and the risk of loneliness
  • Living space adjustment (mitigate risk of falls), life line or equivalent

Sleep Hygiene

  • Avoid napping
  • Avoid stimulants close to bedtime
  • Exercise (maybe not just before bed)
  • Don’t eat before bed
  • Get natural light during the daytime
  • Have a regular bedtime routine
  • Use bed for sleep
  • Keep the room dark


From AARP – 44 percent of women 68 through 80 report being very satisfied with their sex lives, compared with just 30 percent of women 55 to 68 years old.

About 50% of 70 years olds are sexually active — and this number is rising -risk of STIs


Know the signs and symptoms of stroke and heart attack.  Have a plan in case of emergency.

Continue screenings on:

  • Blood pressure
  • Cholesterol
  • Diabetes
  • Osteoporosis
  • Vision
  • Hearing
  • Cancer (bowel, breast until 74, cervical until 69)

Top causes of death 75-84:

  • heart disease (32.4%),
  • cancer (23.3%),
  • cerebrovascular diseases including stroke (8.2%),
  • chronic lower respiratory diseases (7.0%),
  • diabetes (3.1%),
  • influenza and pneumonia (2.7%),
  • Alzheimer’s (2.3%), — a big fear for many — activity (mental and physical), socializing
  • accidents (1.8%),


Remember – Stay active and engaged in your 70s, 80s, and beyond!

Dr. Zach’s Men’s Health Guide

BT Montreal | posted Wednesday, Nov 16th, 2016

By Dr. Zachary Levine, ER physician, MUHC

Men often don’t always take good care of themselves. Men go to the doctor only when necessary, or if they’re near death.

Men die younger -on average – than women.

The focus of International Men’s Day is on men’s and boy’s health, improving gender relations, promoting gender equality, and highlighting positive male role models.

The 2016 theme male suicide prevention.  Suicide rate among men is significantly higher (4:1) than women (3-4:1) (less attempts, more deadly). It is higher for native Canadians, while Quebec has highest rate of provinces, excluding territories.

Unintentional injuries is the No.1 killer of men before age 45.  It is high for ages 15 to 34 high, especially 20 to 24 (This does not include homicides.) In terms of number of years of life lost there is nothing close

General advice: Wear a helmet, don’t drink and drive and wear your seatbelt.


Reasons men actually will go to the doctor:

  • Erectile dysfunction
  • Hair loss
  • Forced by feamle friend — maybe one reason why married men live longer, less burnout

Why men don’t go to doctor:

  • Don’t think about it
  • Busy
  • Don’t want to know
  • No reason to go

Keep an eye on:

  • Be aware of testicular cancer (most cases ages 20-54)
  • Colorectal cancer screening as of 50
  • Hypertension
  • Lipids
  • Diabetes

Top killers of men: (depends on age):

  • Heart Disease
  • Unintentional Injuries
  • Chronic Obstructive Pulmonary Disease (LungDiseases)
  • Influenza and Pneumonia

Most common cancers in men:

  • Prostate
  • Lung
  • CRC
  • Bladder
  • Stomach
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