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ImageIt has been a pet peeve of mine for a number of years of the terrible emergency care mostly due to my personal experience of a cancer patient and observing the long waits. This prompted me to sponsor a symposium on emergency care based on process design with the people who are the best with Terri Zborowski and team at  Ellerbe Becket AECOM and Dr Todd Warden, a leading ER specialist from the US who amazing with his expertise brings the wait time down to 9 min.

What was there not to be impressed? We had eight Ontario hospitals participate and some who could not attend attend due to timing conflicts received a package. The bittersweet irony was that Ontario Long Term Care called and stated great idea but because it is free we just “don’t know what to do”. Despite the setback I continued to contact physicians across Canada and sent the info package.

Well, something must have worked because my wait time in the Toronto General Hospital or better known as TGH was only 30 mins and I was sent directly to a room. The waiting room was even clean and I noted it was divided into two sections of triage those registered and those waiting to be registered.

I was pleased with the prompt care, diagnosis and treatment. The staff did not appear hurried although one nurse thought I was a renal transplant without checking my ID band and the ER physician, Dr Salmon who was professional was running out the door when I tried to ask a question. This is one reason why I like to pay directly for care at the Mayo because then there is more of a customer patient service. This caused some problems when the pharmacist had to call back the doctor to clarify a medication as it was contraindicated as an allergy on my alert. I hate clogging up the system.

I had to chuckle when I heard a nurse in the next room telling the patient  to order pan medication because she is paying for it anyway through OHIP- it is free. So don’t hold back.

I was impressed when I left the ER well under 8 hours with my prescription in hand to see a room off to one side with big words, “Rapid Assessment” and that helped eased the clogging with triage. I am sure this was part of our input from the symposium as our diagrams clearly indicate this process, although I never knew until I was again, the patient who is the real test.

Many women who were on Tamoxifen were only on it for the suggested 5 years and then it was time to celebrate the 5 tear survival marker. But the truth is that women are living longer after diagnosis but that there are higher risks for relapse. A study released in June 2013 looks at women staying on Tamoxifen for 10 years rather than the 5 years, as there is better protection for recurrence and dying from the disease.

The study looked at 7000 women and it showed that those who took the Tamoxifen for 10 years had 25 % less recurrences and 23% fewer died. Not numbers to to be ignored.

The concern is that Tamoxifen is not metabolized by everyone is still a concern and is a $60 blood test to see what type of metabolizer you are, but is not offered in Canada. This is where Canadian women need to be vocal as the recommended time to take Tamoxifen increases as consumers we need to be armed with knowledge to make better decisions.

Tamoxifen needs to be metabolized before it can be fully effective to treat breast cancer.  An enzyme in your body called CYP2D6 is important to convert the Tamoxifen to Endoxifen, which then can block estrogen. There are four levels of metabolizers: ultra rapid metabolizer, normal metabolizer, intermediate metabolizer and poor metabolizer. The poor metabolizer notes that your body is unlikely to convert Tamoxifen to the useable form and that a different cancer treatment should be reviewed with your physician.

The CYP2D6 blood test is one factor in determining treatment.

Obtaining the CYP2D6 blood test is not available in Canada despite the fact that Tamoxifen is the most prescribed form of treatment for pre-menopausal breast cancer. At the Mayo Clinic Clinic, USA this blood test costs approximately $60. In certain circumstances patients in Canada maybe able to be tested, but at a cost of approximately $500 with blood work sent over the border. This would have to be arranged by your oncologist. While Tamoxifen is the most widely prescribed cancer medication in the world generating revenues of US $265 million in 1992 and in 1995, worldwide sales reached $400 million there is no information or access to a blood test that is essential for its effectiveness. It is unclear why this blood test is not standard procedure for women prescribed Tamoxifen or even mentioned on their literature.

Sign petition

https://www.change.org/en-CA/petitions/canadian-government-to-cover-cyp2d6-blood-test-for-women-on-tamoxifen-for-breast-cancer-mandatory-cyp2d6-blood-test-for-women-on-tamoxifen-to-prevent-further-recurrences

tamoxifen

One thing that amazes me is that the face of cancer is getting younger.
No longer is the patient an elderly senior but youth.

I asked myself someone who faces a terminal illness at the beginning of their life must feel fear and how do they cope. They are not at the end of their life after having a career and raising a family but at the beginning.

I had the honour of meeting such a young man in his early twenties quite by accident, as I took some time browsing at Italian custom furniture. Life just happens unexpectedly, when we connect with someone.

I wanted to share his story to help others his age but also to put a younger face on cancer.

As well knowledge is power and prostate cancer is not just an older person’s cancer.
Here is Justin’s story

* What is your diagnosis age?

Formative Stages of Prostate Cancer; Age 20.

*Is it unusual for someone your age to be diagnosed with this illness?

Yes

*Was there any family history?

Yes, My Grandfather battled it for 10 years and it was a leading contributor to his passing.

*How did your family react to the diagnosis?

Family and friends were really frightened by it, My grandfather had passed away only 2 years earlier, this diagnosis was too familiar.

*Were your peers open to discussing your diagnosis given this is uncommon in your age group.

I stayed pretty quiet about the whole diagnosis, close friends knew, and they were very sensitive to it, maybe too sensitive. They looked at me differently as if I had a ticking time bomb over my head.

*Did your outlook on life change?

Absolutely; I wanted to enjoy every moment to its fullest, not so much in a fear of sickness/death, but for the enjoyment of life. I chose to believe that this would not conquer me, and that was the outlook I maintained throughout my whole treatment.

*What was the best thing you did for yourself?

Keep my life normal – I always maintained a full schedule and stayed connected with work, friends and family. When I was weaker, I caught up on years of missed TV, Movies and reading; I thoroughly enjoyed this!

*What was the best thing someone else did for you?

I asked my best friend to never treat me any different (which can be a tall order to ask someone who cares about you!) If something was wrong, I would tell them. This helped me to maintain my own psyche.

*Did you find the medical information given to you helpful in explaining what was happening?

Yes and No; For the most part I had to investigate meanings and diagnoses further than the information I was provided; But my doctors also helped me to understand what I was going through by responding to emails and calls as needed.

*Who do you feel in the medical profession ie hospital, clerk, doctor, nurse,…. gave you the most support?

It was the Nurses who were most accessible and often worked with me through treatments, Doctors were also fairly supportive.

*Do you feel your treatment was timely with no delays?

It took about 14 months to really confirm the presence of Cancerous cells, treatment happened about 6 months after; it lasted for another 6.

*What advice would you give someone your own age?

Don’t Fear anything. Life happens to everyone, be thankful for what you have and keep living the way you did before  diagnosis. A positive outlook will keep you sane for the roller coaster that is cancer treatment.

 

I am always surprised how easy it is for people to make decisions for their pets when they are too ill and need to be euthanized.

When it comes to health decisions for family members there are so many barriers including emotional ones. I find that even healthcare professionals cannot agree on the use of morphine for end stages of cancer. The main reason for addiction and to work around the reasoning does not make sense especially when the patient is termiinally ill and experiencing pain.

Somehow, there appears to be difficulty in making that responsible decision, yes the patient will die but given the morphine he/she will have an easier transition. This includes the family who are caught in the middle having to support their loved one and witnessing the suffering, feeling helpless and being forced to be put in advocacy situation.

It has been twenty years since my father passed away from cancer who in his last days was in severe pain and every dose of morphine had to be begged from the treating physician who was concerned about addiction for my father who only had days to live.

In a recent article on BBC World News the reader is informed patients in the USA and the UK are given morphine if needed but in Third countries availability is a problem. We are introduced to Joyce dying in a Uganda hospital in agony due to pain and a lack of available morphine.

The poignant part of Joyce and other patients who are dying in needless pain is that this issue needs to be addressed as a priority regardless of where one lives that patients have the right to die in dignity and painfree. Unfortunately, those who can be spokespersons pass on and the family members traumatized by the events rarely have the energy to address this. So, it is up to responsible individuals who need to address this issue now in the hopes there will be guidelines in place if they should ever require  such humane care.

Hospices are a vital link to dying at home or home setting with all the available resources at hand. Many are associated with local hospitals and are able to provide services and special attention to services than on an ordinary ward. They have specialists and may assist getting through the red tape for pain management. Hospice is a vital option to those who require support both in services and to the family.

The OHIP Appeal Board is the news more frequently as a result of cases involving prior approval for out of country medical services denied by the ministry. The main issue as Canadians we are brought up to believe that we have universal healthcare and that we will be taken care of by our government.

Unfortunately, with an aging population, decreased medical resources and long waiting lists some Canadians have looked elsewhere for healthcare including India for cardiac care and Thailand for hip replacements. We are not talking about third world care but first world care and medical care with affordable prices and no wait times making this an attractive proposition.

What is in the news today are the most tragic of stories of individuals being caught in having to leave the country for care due to a lack of experts in Canada necessity a leave such as my March 24, 2012, “Ordinary People Do Get Cancer “:
“Lisa, 34 years of age is one such person living in the Ottawa area who was living a full life when she was diagnosed with neurofibromatosis. During a routine check up in her late teens she was informed was told she had neurofibromatosis but that it was benign and if they grew she would have them removed.

Fast forward to about two years ago when Lisa was experiencing difficulty eating as the tumours had grown so large, she was unable to swallow. After seeing specialists in Canada and the USA, she was informed there was nothing that could be done. In 2009 there was clinical trials at the Mayo Clinic and she was accepted with OHIP coverage, as there was no other treatment available in Canada. Then she was informed by OHIP they would not accept it as it was termed “experimental”. The cost was $50,000 and as an average citizen there was no extra cash. Lisa is a public servant working at the Canada Border Services Agency. Family, friends and community have supported Lisa with donations on her website and it is at the $33,455.81 mark. “

Recently, Erika Crawford’s family have spent over $90,000 to have surgery for Ehlers-Danlos syndrome to stabilize her neck and if not done any fall or sudden movement could have taken or life or made her a quadriplegic. 17 years old with her whole life ahead of her and to be faced with waiting to die or as in this case her family and her community supporting her to recovery. The specialist was in Maryland, USA and this is classified as out-of-country care. The final bill from Maryland is over $90,000 and was denied by OHIP. The appeal hearing is booked for January 2013 but maybe pushed to February 2013.
There are other individuals in the news such as Brooklyn Mills, Oakville and Charlie Smith, Kingston who have been denied. With the surgery Erika has a new lease on life.
Read Susan Gamble’s article in The Brantford Expositor.
What Canadians should ask is why the OHIP Appeal Board exists as it appears it serves no purpose other than to pay representatives that they are giving a “fair hearing to Canadians”. While in actuality the members are bound by strict rules and legislative law. The board is not even allowed to make recommendations back to the government, so when you think if you do not get monetary compensation, that this will allow justice for other Canadians, it does not. This hearing is one sided. This appeal process should be overhauled or abolished as it costs taxpayers money and brings false hope to those who are seeking a fair hearing and loss of valuable time to their lives of two years at least. The sad part it is not the money in the end, but that as Canadians we are given a voice in a democratic society.

What happens to other Canadians who do not have family or a community -give them a voice in the next election. Shout loud and hard.
STOP OHIP APPEAL HEARINGS & SAVE TAX DOLLARS & LIVES

 

Tea is the old, new kid on the block being touted as the new wonder antioxidant.
After water, tea is the second most consumed beverage in the world.
Tea is derived from the tea leaves of the Camiellia sinensis plant and different teas derive from the way it is processed. Herbal teas are not infact tea but made from infusions of fruit or herbs.

Tea has been drunk for taste and ritual. Ony recently have we been given the facts of the health benefits of this centuries old drink.

Tea’s origins are in China and were brought to England as part of Catherine of Braganza dowry to Charles II where it became all the rage at Royal Court. It was a drink for the rich. Tea was kept under lock and key. The Chinese controlled the supply and not wanting the origins of the tea to be known it was dyed blue green colour with arsenic. Throughout history ea has a presence in every culture as part of a daily routine i.e. tea break and for social gatherings such as afternoon tea.

Recently tea has come back into favour due to the discovery of health benefits of flavinoids: green and black tea may protect against cancer including a lower risk for cancer metasis and recurrence,as well as cardiovascular disease. As well, tea’s antixiodants benefit the skin keeping you looking younger.

White tea which is two leaves and a bud and silvery in colour and green teas have the reputation as teas as the highest antioxidants. These teas are best prepared with water just below the boiling point 65-85 degrees C. Since oxygen reacts with phenolic molecules to turn them brown and reduce potency as antioxidants. Therefore bring the water to full boil then cool to desired temperature to ensure the best antioxidant qualities.

A lesser known fact is that tea prevents tooth decay and fights bad breath with catechins kill bacteria, and the calcium and magnesium in tea helps with teeth maintenance.

Green tea is touted as reducing the risk of coronary artery disease with flavonoids reducing cholesterol and build up of plaque on artey walls.

Black tea is known for weight loss as catechins block fat mainly abdominal fat. It also protects the brain against developing Alzheimer’s disease.

Tea drunk without milk has the most benefits as milk proteins adhere to the catechins and interfering with the benefits. So clear tea with no milk or lemon is preferred.

Research on prostate cancer shows it benefits in a British study published by the Tea Council.

Research in Sweden 2005 in a 15 year study with 60,000 women  notes drinking 1-2 cups of tea a day can reduce your chance of developing ovarian cancer by 46 %.

As with anything that is good for you, drink in moderation 2-3 cups daily. Limit cutoff before 4 pm as if sensitive to caffeine this may impact on sleep patterns.
Although tea is picked as an alternative to coffee as it has less caffeine.

Raise a cup of tea to good health.

healthspeaker:

Everyone pays taxes for universal healthcare. Canadians need to realize this does not exist not just for refugees but every Canadian. Make your vote count.

Originally posted on Metro News:

REGINA – Saskatchewan Premier Brad Wall is criticizing a federal decision to deny chemotherapy to a refugee as “unbelievable” and un-Canadian.

Wall says he doesn’t understand the rationale behind the move.

“It’s unbelievable that some of the decisions that have been taken federally are having this impact on people who are clearly the most vulnerable, refugees who are obviously fleeing something quite terrible — that’s why they’re refugees,” Wall said Thursday.

“On the face of it, you just consider the case of this particular gentleman or others who, for example, as it was pointed out … might need prenatal care, this is just common sense. You just do this.

“This is the kind of country we are. You cover it.”

The man arrived in Saskatoon several months ago after fleeing a Middle Eastern country where he was persecuted for being Christian. Soon after arriving, he started having abdominal pain and…

View original 417 more words

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