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Living Healthy Fall 2013 Vol. 6 No. 2 In Atlantic Canada Prevent hearing loss in young people LISTEN UP On Guard Digestive disorders More than just a pain in the belly Mouth guards can prevent years of pain My Williston After QEII brain surgeons gave back k his freedom Tim and his wife Nanc i cy made gifts in their wills to help futu ure patients get theirs back too. ns too I don t want anyone to have to go through what I went through. h The QEII Foundation raises funds to advance healthcare te echnology education and medical research that changes lives for patients at the QEII Health Sciences Centre. To learn more about how you can make a difference for QEII patients call 902 473 7932 or visit Cover photograph by Perry Jackson Contents Features 21 24 39 44 24 Mental health first aid Course teaches how to respond in a mental health crisis Fever Don t panic Despite popular belief in most cases there is no medical reason to treat a fever with over-the-counter medications A healthy trilogy for teeth The right amount of calcium a three-pronged affair First tooth first year first visit The benefits of taking your baby to the dentist 17 Join us online There s more Living Healthy in Atlantic Canada on the web--just go to and click on the Living Healthy box. You ll find stories about health wellness and living the good life in Atlantic Canada. See you there 5 Health Happenings 10 Ask the professionals 13 Ask the professionals 17 The wellness column 44 29 A patient s story 32 Nutrition 35 Your oral health Fall 2013 Departments 20 25 Protect your kids hearing--before the damage is done How to deal with digestive disorders Getting the goods on gluten Kayla Joudrey s miraculous recovery from a car accident Vitamin D--the sunshine vitamin Did you know oral health can point to overall health Living Healthy In Atlantic Canada 1 Living Healthy In Atlantic Canada Volume 6 Number 2 Date of Issue September 2013 Living Healthy in Atlantic Canada is a publishing partnership between the QEII Foundation IWK Health Centre Nova Scotia Department of Health and Wellness the four dental associations of the Atlantic Provinces and Saltscapes Publishing Ltd. Editorial Board Dr. Patrick McGrath OC PhD FRSC FCAHS Integrated Vice President Research and Innovation Capital District Health Authority and IWK Health Centre Dr. David Anderson MD FRCPC Head Chief Department of Medicine Capital Health & Dalhousie University Paula Bond Vice-President People-Centred Care Capital Health Anne Cogdon Executive Director of Primary Health IWK Health Centre Maggie Marwah Director Marketing & Communications Capital Health Kaylee Hake Acting Director Communications QEII Foundation Kathryn London-Penny Executive Director Public Relations IWK Health Centre Lia A. Daborn Executive Director New Brunswick Dental Society Dr. Margot Hiltz MSc DDS Newfoundland & Labrador Dental Association Eliot Coles Communications Manager Nova Scotia Dental Association Dr. Brian D. Barrett DDS FACD FPFA FADI Exetutive Director Dental Association of PEI Living Healthy in Atlantic Canada is founded upon the premise that the most effective health care is illness avoidance. Our mandate is to help inform the general public within Atlantic Canada as to how they might take steps to promote their own good health and that of their families... How they might improve the quality and extend the length of their lives and those of their loved ones. Living Healthy in Atlantic Canada is published by Saltscapes Publishing Limited in collaboration with the following strategic partners who provide support medical expertise and mentoring with respect to editorial content Saltscapes Publishing Limited Co-Publishers Jim & Linda Gourlay Associate Publisher Shawn Dalton Senior Designer Graham Whiteman Designer Thom Knowles Vice President of Sales Kerri Slaunwhite kslaunwhite Advertising Account Executives Susan Giffin sgiffin Pam Hancock phancock Advertising Traffic Coordinator Lisa Byrne lbyrne Accounting and Office Administration Manager Glenn Day gday Administration Valerie Blackmore Donna Archibald Talk to us Send your letters to the address below or email jgourlay Include your name the name of your town or city and telephone number. Letters that appear in the magazine may be edited for length and clarity. Living Healthy in Atlantic Canada is published twice a year by Saltscapes Publishing Limited 30 Damascus Road Suite 209 Bedford NS B4A 0C1 Tel (902) 464-7258 Sales Toll Free 1-877-311-5877 Contents copyright No portion of this publication may be reprinted without the consent of the publisher. Living Healthy in Atlantic Canada can assume no responsibility for unsolicited manuscripts photographs or other materials and cannot return same unless accompanied by S.A.S.E. Publisher cannot warranty claims made in advertisements. Printed by Advocate Printing & Publishing Pictou NS QEII Health Sciences Centre Foundation IWK Health Centre Nova Scotia Department of Health and Wellness Dental Association of Prince Edward Island New Brunswick Dental Society Newfoundland & Labrador Dental Association Nova Scotia Dental Association 2 Living Healthy In Atlantic Canada Fall 2013 2 0 1 4 I believe you have two choices. Do something or do nothing. I am doing something for those who can t. Fellow Bust-a-Mover Register for Bust a Move today i y and support the Breast Health Centre. e a a Learn more at M . March 22 2014 Health Happenings Research into aggressive prostate cancer treatment receives funding Dalhousie University pathologist Dr. Dellaire is part of a Canada-wide team working on a five-year 5-million project to find new ways to diagnose and treat aggressive prostate cancer. Dr. Dellaire an associate professor and director of research at Dalhousie s pathology department will receive the funding in September to assist with his work on tumour resistance to radiation and chemotherapy. Dellaire is also keen to find biomarkers that will demonstrate from the outset whether a patient has an aggressive form of prostate cancer. It s important to know which cancers are aggressive as the side-effects of treatment can be worse than the cancer symptoms especially with prostate cancer said Dellaire whose work is funded by Prostate Cancer Canada and the Movember Foundation. Dr. Dellaire is keen to understand the importance of promyelocytic leukemia (PML) a tumour-suppressor protein found in cells. He has been working on the PML protein since 2002 and has found that in many forms of cancer including prostate there is a complete loss of PML protein in aggressive disease. He and his team are trying to learn which cellular pathways are involved in PML loss. These pathways are composed of many individual proteins that work together within a cell and lead to changes in cell function. Dellaire believes that loss of PML indicates that a particular prostate cancer is aggressive and has defective pathways controlling cell division and cell death. Dr. Dellaire is also working with Dr. John Thoms another member of the Prostate Cancer Canada team and a radiation oncologist at Memorial University in Newfoundland on developing a centralized biobank of samples of prostate tumours and clinical records that will be available for researchers to access. They wish to identify other gene mutations that may alter cell pathways common to certain groups of patients. Identifying similarities would allow doctors to predict a patient s need for and response to treatment. Dr. Dellaire an associate professor and director of research at Dalhousie s pathology department. also has other positive effects such as reducing depression aiding with weight loss and lessening chemical sensitivities said Dr. Mary Lynch the director of research at the pain unit and the primary investigator on the study. Fibromyalgia is a common pain problem that can have a significant impact on quality of life and ability to function. There are treatments that can help and the earlier these are introduced the better the outcome. The unit s staff has long used alternative treatments in pain management acupuncture has been used since 1974 and Dr. Lynch is herself a practitioner. Qigong is an alternative treatment that has been recently introduced. Qigong is similar to tai chi but somewhat easier to learn. Both have their roots in traditional Chinese medicine and involve slow repetitive movements. Fibromyalgia is common in the Atlantic region Dr. Lynch said. Dr. Mary Lynch Director of Research at the Pain Management Unit QEII Health Sciences Centre. Qigong proven to relieve pain Research conducted with the help of local fibromyalgia sufferers has allowed staff at Capital Health s Pain Management Unit to demonstrate the pain-relieving effects of the Chinese exercise method qigong. The main thing we found was that qigong helps people with pain and sleep problems. It Fall 2013 Living Healthy In Atlantic Canada 5 Health Happenings A chronic disease fibromyalgia s symptoms may include muscle pain fatigue headaches sleep and abdominal problems anxiety depression and difficulties with concentration and memory. Dr. Lynch said that soon the researchers will undertake similar work with the help of people suffering from osteoarthritis of the knee another common health problem. Capital Health warns of Halifax syphilis outbreak Staff at Capital Health are behind a frank advertising campaign and website that highlight the current syphilis outbreak among men in Halifax and point out that although the disease is easy to acquire it is also easy to cure. The first batch of print adverts from Public Health workers appeared in pubs and restaurants in June. Adverts also went on websites and smartphone applications used to arrange sexual encounters. The second batch of ads will run in the fall to target students returning to university. The bacteria that causes syphilis can be acquired through oral sex and the messaging uses explicit language in order to get this message across said Carmen MacKenzie a senior communications adviser with Capital Health. Community partners encouraged us to use common everyday language used by the target audience said MacKenzie adding that the adverts have not been placed anywhere children may see them. She said the campaign focus is on testing and treatment. The ads highlight a new microsite Capital Health has developed called thehardfacts. ca. Created in both PC and mobile versions the microsite explains how syphilis is spread what it looks like (sufferers may have a red body rash or a single painless genital ulcer) and how to get tested and treated. The website allows organizers to pilot Capital Health s first ever online downloadable blood requisition form. The printed form can be filled out and taken to any of Capital Health s blood collection sites without the need to speak to a health care provider. Syphilis has been treated with penicillin since the 1940s and has been largely eradicated. Many family physicians have never seen a case making the online requisition especially useful MacKenzie said. Since 2008 167 men and two women aged 18 to 72 have been infected in Halifax alone. 6 Susan Kilbride Roper holds Stigma-the Elephant in the Room a symbol of the Mood Disorders Society of Canada s anti-stigma campaign. You display the little blue elephant to signify it is a safe place to talk about mental health issues a stigma-free zone. Losing the stigma of mental illness Today Susan Kilbride Roper works as a recovery consultant and co-owner with her husband of Empowerment Connection in Dartmouth--but her early years were more difficult. Twenty years ago she was diagnosed with bipolar disorder and an alcohol addiction now referred to as a concurrent disorder. Today she is a passionate advocate for people living with mental health issues. She teaches mental health first aid sits on Capital Health committees co-ordinates Defeat Depression Halifax and co-chairs the Mental Health Coalition of Nova Scotia with Joan Jessome head of the Nova Scotia Government and General Employees Union. Getting the diagnosis was what she calls the first day of the rest of my life. She learned her addiction to alcohol was her way of coping with bipolar mood swings. It was only when she beat her alcohol addiction that the mood swings became obvious and could be treated. Now mental health and addictions including alcohol substance and gambling are combined in Capital Health s program she says. Kilbride Roper sees the stigma associated with mental illness as similar to the stigma associated with cancer and AIDS in years past. The key (to removing the stigma) is education of self of others of the system she says. The stigma can be societal systemic (as in the workplace) or self stigma. She says Self stigma causes the most harm. Seventy per cent of people working and living with depression are not getting the help they need often because of the stigma. They don t want others to know. Mental illness can also affect the entire body often worsening existing health problems. Mental illness results in a loss of 51 billion each year for the Canadian economy. Even more disturbing is the human cost. Living Healthy In Atlantic Canada Fall 2013 Donna D Amour We have a responsibility to other human beings to reduce suffering in their lives says Kilbride Roper. Some upcoming enlightening events Oct. 6-12 is Mental Illness Awareness Week. Sunday Oct. 6 from 10 a.m. to 3 30 p.m. at the Halifax Forum a forum hosted by the Mental Health Coalition of Nova Scotia Putting together the pieces of mental health. Thursday Oct. 10 at Alderney Gate in Dartmouth NS Mental Health Community Festival of Hope. Donna D Amour r IWK launches new and improved website The IWK has launched a new website that offers more than 1 000 resources and 1 500 pages of content to help connect Maritime families with the health information they need. We took an approach that was focused on the end user. We have leveraged directories included an enhanced search function and expanded mental health and addictions content just to name a few of the site s improvements said Kathryn London-Penny executive director of public relations at the IWK. The site is designed to work across all platforms from desktops to smart phones and incorporates social media sharing to allow visitors to share content with ease. Another new feature is an events calendar that visitors can use to view and submit health-related community events. The IWK worked with Halifax-based web design company Norex to create the new site. LondonPenny said the process from the first steps of design development to migrating existing content and adding new content took more than a year. As it is a living communications tool the site will continue to be updated and thus never be complete. We are quite excited about the opportunities to build on this new foundation to become even better at sharing health information with those visiting our site London-Penny said. The site feedback form is crucial for this as visitors can use this form to submit ideas and tell us about any issues they find. The new site can be found at www.iwk. Breast Health Centre update Nova Scotians seeking specialized care for breast health are one step closer to receiving it all under one roof. This past summer diagnostic breast imaging services were moved to the Breast Health Centre located at the IWK Health Centre from the Dickson Building of the QEII Health Sciences Centre Capital Health. Made possible by construction of a breast imaging unit the move brings together breast health services previously available at the two hospitals. With the addition of breast imaging we are closer to our vision of creating an integrated world-class Breast Health Centre with co-ordinated care and resources to support patients and families says Michelle LeDrew director of the IWK Women s and Newborn Health Program. The next phase will include working with partners to enhance access to reconstructive surgery and creating an interdisciplinary team that will incorporate genetics and oncology at the Breast Health Centre. A number of years in development the Breast Health Centre aims to make many aspects of breast health simpler and more comforting for patients who need specialized care in this area. Future plans include creating more holistic care options such as psycho-social supports physical activity sexuality and spiritual care. The centre also hopes to provide access to services such as specialized clothing makeup and prosthesis support. The Breast Health Centre is a partnership between the IWK Health Centre and Capital Health made possible by the support of the QEII Foundation and the IWK Foundation. The new unit of the Breast Health Centre is on the sixth floor of the IWK s Women s Building. Visit www. for more details. Fall 2013 Living Healthy In Atlantic Canada 7 Advertisement Thrive In Action Thrive A plan for a healthier Nova Scotia is about changing the places where we live learn work commute and play to be healthier by ensuring there are policies and programs that support our health. About 75 per cent of the factors that determine our health lie beyond the health care system and some factors are not within everyone s control. Through Thrive the province is working with partners to help all Nova Scotians have the same opportunity to be healthy by supporting a healthy start equipping people with skills and knowledge for health creating more opportunities to eat well and be active and by planning and building healthier communities. Many of the plan s 34 actions cut across government departments and communities to address complex interwoven issues such as active transportation and food policies. Grants for healthy food policies in public places are leading to new food choices. The province and partners are funding more school gardens so more students are learning about growing food. Babies get their best start through breastfeeding so funding is helping groups and organizations promote workplace and peer breastfeeding support or Baby Friendly Initiatives. Provincial funding is helping Why do we need a plan for a healthier Nova Scotia Good nutrition and physical activity can help reduce the risk of chronic disease. Yet the world around us doesn t make healthy living easy. Heavily marketed convenience foods and limited time skill and money often make it difficult to eat a nutritious diet. With schools workplaces and stores far from where we live we drive where we once walked or biked. Children have less freedom to play because of real and perceived safety concerns. We sit most of the day -working at desks commuting and using technology during our leisure instead of physical activities. In addition to education we need policies to change the environments where we spend time to be healthier. That s what Thrive is about. Top Food Skills Camp at Common Roots Urban Farm. Above Dirt Divas. Cole Harbour High School s breakfast program communities create spaces where people can be physically active. For instance Hubbards is building a new skateboard park Bible Hill Recreation Park is adding a splash pad and St. Mary s in Guysborough County is improving its multi-use trail. The Municipal Physical Activity Leadership Program recognizes that every community is different and hires people to create unique physical activity plans tailored to local needs and integrating active transportation. A big success this year has been expanding the program to the Mi kmaw communities of Annapolis Valley Glooscap Eskasoni Membertou and Paqtnkek with more coming on board soon. New after-school activities are making it easier for junior-high youth especially girls in rural and remote areas to stay active during the years of greatest decline in physical activity. An example is Afterschool Adventures in Mountain Biking and Videography Dirt Divas organized by the recreation departments in Canning New Minas Wolfville and Trips For Kids (Annapolis Valley Mountain Bike Association). Thrive funding made the program more accessible 17 girls learned about cycling video production photo journalism outdoor adventure and a healthy lifestyle. A partnership with the Nova Scotia Branch of the Lifesaving Society of Canada is providing Swim to Survive training for children. On the food front Nourish Nova Scotia is a new charitable organization that will help school boards run breakfast and nutrition programs and create healthier food environments. The organization will receive yearly provincial funding and also be able to garner public private and corporate funds. Nova Scotia Moves grants supported by the Department of Energy are providing Nova Scotians with sustainable transportation choices. From new bike racks in Mahone Bay to trails connecting rural communities to the Town of Pictou projects are promoting healthy living through active transportation and also protecting and preserving the environment. Children youth and families will be able to use major sport and recreation facilities for free unstructured physical activity soon through a new program that will help address costs and other barriers to using pools arenas multipurpose recreation centres civic centres and community centres. Partnership and commitment are fundamental to changing places where we spend time to be healthier. Four of the province s largest employers recognize that. Through a public declaration called Thrive Halifax Capital Health Halifax Regional Municipality Maritime Forces Atlantic and the province have committed to making workplaces healthier for their employees. The hope is the concept will spread to other communities. A healthier population won t happen overnight. Yet there is a lot going on through the Thrive plan and partnerships. Together we are making Nova Scotia a healthier place. Success Stories Many people and communities have been working to change our lives to be healthier. See their stories at https Together we can Thrive Ask the professionals Now hear this Protect your kids hearing--before the damage is done by Carol Moreira Like most new parents Dr. Gillian Bonang is concerned with protecting her child s health. But perhaps unlike most parents (although she serves as an excellent example) the Dartmouthbased audiologist takes steps to safeguard her baby s hearing from noiseinduced damage. She may have more reason than some parents to be cautious her spouse is a part-time musician who often performs in noisy environments. People almost laugh at me when I take my infant into a noisy pub with giant ear muffs over her ears but I think it s better to be safe than sorry says Dr. Bonang as she bounces Dylan her lively 21-month-old daughter on her knee. It s easy for moms and dads to overlook the importance of hearing protection--perhaps because some noise-induced damage only reveals itself when people reach their 40s or 50s. But now potential hearing loss in young people is being taken more seriously. Just about everything the iPod generation is exposed to makes noise and we lead such noisy lives that every bit of exposure is potentially problematic says Dr. Bonang who just completed her clinical doctorate in audiology from the University of Florida while working at a Dartmouth NS hearing clinic. A sensitive sense Human ears are vulnerable because the ability to hear depends on the health of many thousands of microscopic hairs which grow on the surface of the cochlea a spiral shaped chamber in the inner ear. At the cochlea the tiny hairs convert sound vibrations into nerve 10 Early identification and intervention with hearing and speech-language disorders are directly linked to success with vocabulary speech-language development school readiness and achievement. signals which are then transmitted along the auditory nerve and interpreted by the brain. Noise causes hearing loss through direct mechanical damage to the hair cells and through secondary metabolic damage which involves the release of free radicals that may cause the hair cells to die. Loud events like concerts air shows and car races can result in sudden temporary or permanent hearing loss but lesser sounds can also threaten hearing. The loss is often signified by tinnitus or ringing ears. People don t understand that it s not just the level of sound Dr. Bonang says. Hearing loss can be caused by an extremely loud brief noise or by a very moderate level of noise that persists. If a moderate sound is heard for long enough it wears out the little hair cells on the cochlea to the point where they can t recover and they die. Continuous noise levels above 85 decibels can be damaging. Rock music at a concert is typically at a level of 110120 decibels. Turned up to their fullest headphones or earbuds from mobile music devices can emit sounds at levels up to 105 decibels into young ears. Fall 2013 We all suffer some hearing loss as we age. Famously the Mosquito antiloitering device an electronic unit sometimes used to dissuade young people from loitering emits an annoying high-pitched sound usually audible only to those aged 25 and younger. Some people are more susceptible to hearing loss than others but most of us don t know how susceptible we are until the damage has been done. Parental control Parents and caregivers need to be aware of noisy threats at each stage of a child s life. In early childhood the sharp sounds created by those colourful toys kids love can be risky. Some innocent-looking baby toys emit more than 100 decibels of noise (see Noisy Toys page 12). Ideally sounds emitted by toys should not exceed 80 decibels. Canadian standards stipulate that no toy can exceed 100 decibels. This is higher than other national standards and higher than the level recommended by the World Health Organization. Even if a toy does not seem excessively noisy parents should be vigilant as a toy held close to the head can still cause hearing damage. Living Healthy In Atlantic Canada There are a few basic types of hearing protection including inserted ear plugs which fully block the ear canal and ear protection muffs with soft ear cushions and a hard outer shell. Luckily foam earplugs offer a less visible solution as do the high fidelity protective earplugs (also known as musicians earplugs) sold in music stores. These earplugs contain a filter that allows speech to pass through but diminishes background and excessive noise. Dr. Bonang s husband Jeff who plays guitar and harmonica uses musicians plugs. She says the plugs filters have different degrees of attenuation (reduction in noise level) usually offering attenuation of between nine Dr. Bonang suggests that parents take noise-obsessed teens for hearing assessments. The sessions can teach teens about those precious little hair cells and make them realize how vulnerable their hearing is. A cautionary tale Drums are a popular instrument among musical kids who often vie for the coveted role of drummer when they begin band classes. Halifax performer and music teacher Rob Francis suffered hearing loss in his left ear as a result of ignoring his own parents warnings about noise. Now 42 Francis makes sure to teach his students and their parents about hearing protection. Some toys can be really loud especially if the toy is held at the opening to the ear canal Dr. Bonang says. Adults should also supervise children when they use anything with a headset or microphone. If the volume of the toy can be lowered lower it. With an iPod if there is an option to cap the level of sound--do that. Listening to loud music can affect hearing depending upon how loud and how long the exposure. Every time a sound level increases by three decibels listening for half as long will produce the same amount of hearing loss. A person listening to music on headphones should be able to hear people talking while the music is playing. Similarly if you are not wearing the headphones but can hear what your child is listening to the music is too loud. Dr. Bonang says parents need to talk to older children about the importance of protecting their hearing. Kids should be made aware of the dangers posed by noise generated by big events like concerts. They should also realize that even things like cutting the lawn and solitary drumming can be risky. Of course few teens are prepared to wear ear protection to any kind of social event. Perry Jackson Perry Jackson Rob Francis suffered hearing loss in his left ear as a result of ignoring his own parents warnings about noise. and 25 decibels. Every plug has a noise reduction rating but parents should realize that the plugs often don t provide the advertised attenuation simply because the ratings are based on optimal conditions and ideal fit. It s important to ensure that youngsters use earplugs correctly to be effective there should be an air seal between the ear plug and the skin. The foam plug should be compressed and the ear pulled up and back to straighten the ear canal then the plug should be placed inside and allowed to expand. Fall 2013 Drumming doesn t have to be deafening loudness depends on how fiercely the drums are hit and the softness or hardness of the skins that cover them but Francis aims to make kids aware of the dangers. I tell them it s no different to using a jackhammer without protection he says. I tell them about my hearing loss. It s a bit of a scare tactic. Their eyes get big--they don t want that to happen to them. The musician who plays with a band started drumming at age nine 11 Living Healthy In Atlantic Canada Noisy Toys Each year the Sight & Hearing Association (a year nonprofit organization dedicated to identifying preventable loss of vision and hearing in children) tests a variety of toys for potentially dangerous noise levels. Any sound above 85 decibels can cause hearing loss over time. Twelve of the 20 toys tested in 2012 threaten loss of hearing in less than 15 minutes. Here are some of the top offenders evaluated with the toy next to the child s ear. You can view the full list at sites files pdf Noisy_Toys_2012.pdf 111 dB Disney Pixar Toy Story Talking Figure Buzz Lightyear 109.2 dB Nickleodeon Teenage Mutant Ninja Turtles Leonardo s Electronic Sword 108.2 dB Dora the Explorer Dora s Desert Friends 108 dB Barbie Little Learner Laptop 107.3 dB Playskool 123 Sesame Street Let s Rock Grover Microphone (Source Sight and Hearing Association) d drummer always placed his snare drum t his left and turned his head slightly to to t right. Now he says everything the s sounds muffled. Today when he s performing Francis w wears in-ear monitors. The monitors w which have limiters connect to the s soundboard and allow him to control the v volume. At 500 the monitors are not c cheap but Francis says that for young d drumming students the regular foam earplugs or earmuffs like those worn for yard work offer sufficient protection. Improvements in testing The importance of good hearing to child development is increasingly being recognized. Newborn hearing screening is becoming more common as pediatricians realize parents may not always be able to spot early hearing difficulties in their child. According to the Nova Scotia Hearing and Speech Centres early identification and intervention with hearing and speech-language disorders are directly linked to success with vocabulary speech-language development school readiness and achievement. To assess a baby s hearing pediatricians measure the sounds created by the hairs on the cochlea in response to sound using what is known as the otoacoustic emissions test. The test measures an acoustic response that is produced by the cochlea which in essence bounces back out of the ear in response to a sound stimulus. Gillian Bonang says it s good news that health professionals are recognizing the importance of testing and protecting children s hearing. Statistics support her concern according to experts quoted by the Children s Hearing Institute the number of Americans aged three and older with a hearing disorder has more than doubled since 1971. But Francis says the parents he meets still have a long way to go in terms of educating themselves to prevent hearing loss in their kids--particularly those kids who are drummers. Not even 10 per cent of parents ask me about protecting their child s hearing from noise he says but I tell the kids If you re going to blast it out keep your ears protected. I should have taken better care. after being inspired by The Ventures tune Wipeout. His dad Gordon an accomplished amateur musician encouraged his son to protect his ears with his own bulky earmuffs which he wore for his work in construction. But young Rob only wore the earmuffs when his dad was around. I didn t listen he says. I felt that I couldn t hear what I was playing with them on and I was a little rebellious. He went without ear protection when jamming with high school friends too. Then in his 20s he noticed a persistent ringing in his left ear which he still suffers. An audiologist confirmed he had become deaf to high-pitched sounds in that ear. The damage was doubtless caused by the fact the right-handed 12 Otoacoustic emissions are sounds that are produced by the cochlea. When sound stimulates the cochlea the outer hair cells vibrate and this can be measured in the ear canal. Diagnostic testing tools provide objective information about hearing and middle ear status with only one test. The procedure is also beneficial in assessing children that cannot be tested by conventional means. Living Healthy In Atlantic Canada Fall 2013 MAICO Diagnostics Ask the professionals Tummy troubles John Sherlock The digestive system is prone to a wide range of afflictions--and many of them are more than just a pain in the belly Dr. Tony Otley a pediatric gastroenterologist at the IWK Health Centre in Halifax by Suzanne Robicheau Atlantic Canadians don t talk much about their digestive systems we rarely mention our bowels. Yet colon cancer is the second most likely cancer to kill us. The eastern provinces have the world s highest incidence of inflammatory bowel disease (IBD) an umbrella term for two chronic illnesses that involve the intestines--Crohn s disease and ulcerative colitis. Nova Scotia in particular has the dubious honour of having the highest rate of inflammatory bowel disease in the world says Dr. Tony Otley a pediatric gastroenterologist at the IWK Health Centre in Halifax. There s likely some environmental factor that combines with our genetic make-up he says but we don t really know why it s happening and we don t understand why there has been such a rapid increase in the last few decades. A specialist in inflammatory bowel disease Dr. Otley has spent almost two decades studying IBD and treats more than 300 children and adolescents in New Brunswick Prince Edward Island and Nova Scotia. Most GI problems are dealt with by family doctors and pediatricians he says. I see the cases they can t resolve so it tends to be the more extreme end of the spectrum. Early detection is key One of the struggles he says is early detection and diagnosis of digestive disorders especially in children and youth who comprise about 25 per cent of new cases of IBD. Picking it up early doesn t help with a cure for Crohn s says Dr. Otley. There is no cure it s a lifetime diagnosis. However treatment will put the disease in remission which is especially important for children because Crohn s disease can affect growth permanently. Detection and diagnosis of digestive disorders in adults can sometimes take years. Allan Stuart who lives just outside Halifax got lucky when a routine blood test revealed low levels of iron in his blood referrals to a hematologist and a gastroenterologist confirmed a diagnosis of celiac disease. The whole process took only about 10 months says Stuart. From what I understand the wait is usually much longer. Stuart is now vice president of the Nova Scotia chapter of the Canadian Celiac Association which plays a role in educating and supporting children and adults who have celiac disease and in promoting celiac awareness and education among health care professionals and the food service Fall 2013 industry. After 10 years his own symptoms are under control thanks to a wife who is a dietician and a strict gluten-free diet. The diet is sometimes a nuisance he admits but the doctor told me it would reduce my chances of colon cancer by 25 per cent. When I think of it in those terms there s really no choice. Digestive disorders According to the Canadian Digestive Health Foundation more than 20 million Canadians suffer from digestive disorders ranging from heartburn and lactose intolerance to gastroesophageal reflux disease (GERD) and cancers of the digestive tract. While many of these conditions present common symptoms such as bloating and diarrhea they differ greatly in severity and treatment. 13 Living Healthy In Atlantic Canada The Digestive System Allan Stuart is vice president of the Nova Scotia chapter of the Canadian Celiac Association Gastroenteritis is an inflammation of the lining of the intestines caused by a virus bacteria or parasites. Symptoms include fever stomach cramps bloating diarrhea and vomiting. Often when people refer to having a stomach flu they are suffering gastroenteritis--not a type of flu at all. Gastroesophageal reflux (GER) occurs when stomach contents reflux or back up into the esophagus during or after a meal. It occurs in people of all ages and is normal for infants however it does sometimes lead to GERD (see below) and require treatment. For more information about GER and kids go to Gastroesophageal reflux disease (GERD) is diagnosed when acid reflux is persistent it can affect people of all ages. Treatment to prevent permanent damage to the esophagus ranges from over-the-counter medications to exercise changes in diet prescription medications and surgery. Heartburn is a feeling of pain in the chest or throat it occurs when digestive juices and acid from the stomach back up into the esophagus toward the throat creating a burning sensation and over time damaging the lining of the esophagus. If you experience heartburn more than twice a week you may have GERD. Here s a rundown of many common digestive ailments Celiac disease is a permanent autoimmune condition that affects the small intestine. It is diagnosed after a blood test and a positive biopsy of the small bowel. Gluten a protein found in wheat rye barley and triticale acts as a trigger to the immune system which in turn causes damage to the small bowel. Symptoms can include cramping diarrhea or constipation and abdominal pain but often people have no symptoms at all. Instead they are found to have iron-deficiency anemia which may lead to a diagnosis. The number of celiac cases seen in the gastrointestinal clinic represents the tip of the iceberg with many more remaining undiagnosed says Cynthia King-Moore a pediatric dietitian at the IWK Health Centre in Halifax. According to the Canadian Celiac Association about one per cent 14 of Canadians are diagnosed with celiac disease. The only treatment for celiac disease is a strict gluten-free diet for life. Diverticular disease consists of two conditions diverticulosis and diverticulitis. Diverticulosis occurs when sac-like protrusions called diverticula form in the colon. Diverticulitis occurs if the pouches become inflamed. The likelihood of getting diverticular disease increases roughly every 10 years after age 40. About half of people between the ages of 60 and 80 have it and almost everyone over 80 has it. Dyspepsia is the pain belching nausea bloating and discomfort--also known as indigestion--that sometimes accompanies snacks and meals. Often associated with gastroesophageal reflux disease (GERD) dyspepsia is treated with changes to lifestyle and diet as well as acid-suppressing drugs both over-thecounter and prescription. Fall 2013 Living Healthy In Atlantic Canada After 10 years his own symptoms are under control thanks to a wife who is a dietician and a strict gluten-free diet. The diet is sometimes a nuisance he admits but the doctor told me it would reduce my chances of colon cancer by 25 per cent. The mission is remission A web-based self-care program from the IWK Health Centre in Halifax called the Mission is Remission helps children cope with Inflammatory Bowel Disease (IBD) by teaching them to regulate their own diets reduce stress and manage medications. A recent update of the program includes a social networking component that will allow users to establish a community and get peer support. The program was developed by Dr. Tony Otley a pediatric gastroenterologist at the IWK and vice president of research at the IWK and Capital Health Dr. Patrick McGrath. Perry Jackson Inflammatory bowel disease (IBD) is comprised of separate disorders that cause inflammation and ulceration of the small and large intestines Crohn s disease is an inflammation of the digestive system tract that often affects the lower part of the small intestine called the ileum. Symptoms include abdominal pain diarrhea joint pain skin problems and weight loss. Treatment usually involves drug therapy but there is no single treatment that works for everyone. Ulcerative colitis is a chronic condition that unlike Crohn s attacks only the innermost lining of the large intestine (colon) and rectum. A chronic disease it is often characterized by false urges to have a bowel movement. Other common symptoms include decreased appetite weight loss severe diarrhea abdominal pain nausea and anemia. There is no cure but some treatments can dramatically reduce the symptoms and even bring about a long-term remission. Irritable bowel syndrome (IBS) is a condition of the gastrointestinal tract which affects five million Canadians. Symptoms include bloating abdominal pain irregular bowel movements nausea and heartburn. Treatment includes over-the-counter medications exercise and changes to diet. Obesity enhances the severity of IBS symptoms. Lactose intolerance is experienced by roughly seven million Canadians. It is the inability to absorb the lactose (sugar) in milk products. When present in the colon lactose causes bloating diarrhea abdominal cramps and flatulence. Treatment options include either excluding lactose from the diet or dietary supplements to help with the digestion of lactose. Pancreatitis is an inflammation of the pancreas gland which affects more than one million Canadians. One third suffer from chronic pancreatitis a long-term rmanent condition often leading to permanent irds damage to the gland. Two thirds experience pancreatitis in its acute form. Both acute and chronic pancreatitis cause pain usually in the upper abdomen spreading to the middle of the back and is frequently accompanied by nausea and vomiting. Peptic ulcer is an umbrella term for gastric ulcer (a defect in the lining of the r stomach) and duodenal ulcer (a defect the upper part of the small intestine in an area called the duodenum). More than a million Canadians suffer from peptic ulcers. The most common cause is infection of the stomach by bacteria called Helicobacter pylori (H.pylori). Symptoms include nausea and abdominal pain. Treatment involves a combination of medications to kill the H. pylori bacteria (if present) and to reduce acid levels in the stomach. Fall 2013 Canadian Digestive Health Foundation Online information help and publications are available from the Canadian Digestive Health Foundation at Living Healthy In Atlantic Canada 15 THE 1 CHOICE FOR RETIREMENT LIVING IN ATLANTIC CANADA. Our modern campuses offer an active and social atmosphere with many special events and a long list of amenities. For those who may require some extra help y q p Parkland offers a continuum of service options in a supportive environment. It s about living your best life. For a personalized tour contact a Lifestyle Consultant today. Halifax Dartmouth Truro Sydney Riverview Quispamsis Fredericton S H A N N E X C E L E B R AT I N G 2 5 Y E A R S Spaghetti Squash & Chicken Au Gratin 6-8 cups 2 tsp 2 cloves 1 cup 1 lb 3 cups 1 2 tsp 2 cups 1 2 cup 1 2 cup 2 Tbsp spaghetti squash cooked separated into strands olive oil garlic minced onion(s) diced boneless skinless chicken breast(s) diced low-sodium mushroom & garlic pasta sauce black pepper freshly ground mozzarella cheese part skim 16.5% MF shredded feta cheese crumbled basil fresh sliced rosemary fresh minced 1.5-2 L 10 mL 2 cloves 250 mL 450 g 750 mL 2.5 mL 500 mL 125 mL 125 mL 30 mL 7. Spread half of spaghetti squash strands on the bottom of the baking dish. Top with half of the chicken & sauce followed by half the grated cheese and herbs. Repeat layers. 8. Bake uncovered for 30 minutes or until sauce is bubbling and cheese is lightly browned. Notes For a healthy dish choose a ready-made sauce that is lower in fat and sodium. Recipe for Success 85 Nova Scotia chicken farmers 82 000 tonnes of feed 47 million kilograms of chicken grown annually 68 million in revenue at the farm gate Nova Scotians who trust fresh local Nova Scotian chicken Supply Management Supply management is a uniquely Canadian approach to agricultural production that benefits farmers processors and consumers. Farmers get a fair return for their products and processors get a reliable supply of product. Consumers are provided with a consistent choice of excellent and high-quality products at reasonable prices. Retailers determine the price paid at your local grocery store not the farmers. Canadians have said they want Canadian-produced food and support Canadian farmers. Supply management operates without government subsidies. Serves 8 Cook time 1 hour Preparation time 15 min 1. Preheat the oven to 350 F (180 C). Spray a 12 x 12 inch (30 x 30 cm) baking dish with non-stick vegetable spray. 2. Prepare the spaghetti squash by splitting in half lengthwise removing seeds and discarding. Use a fork to pierce the outer skin in several places. Place squash cut side down on a baking dish and pour in cup (125 mL) water. Bake for 45 minutes or until tender when pierced with a fork and you can pull the flesh away into spaghetti-like strands. Alternately follow the tips above and microwave on HIGH power for 15 minutes. Check for tenderness after 8 minutes. Turn and continue to microwave for 7 minutes or until tender. 3. Prepare the sauce while the squash is cooking. Heat oil over medium-high heat in a skillet. Saut minced garlic and diced onion until softened about 4 minutes. 4. Cut chicken into inch (1.25 cm) cubes. Add to pan and saut further until cooked through. 5. Stir in pasta sauce and freshly ground black pepper. Cover and bring to a boil reduce heat to low and simmer for 15 minutes. 6. Mix shredded mozzarella and feta cheese. Slice the basil leaves and mince the rosemary. Mix with the two cheeses. Chicken a good choice Chickens are grain fed primarily a blend of corn wheat and soybean. Chicken production in Canada prohibits the use of hormones or steroids. Chickens raised for meat in Nova Scotia roam freely in large environmentally-controlled barns. 902-681-7400 16 Living Healthy In Atlantic Canada Fall 2013 The wellness column Getting the goods on gluten Identifying the three main problems related to gluten by Suzanne Robicheau After a few decades of demonizing fatty foods diet-conscious North Americans have identified gluten as the new enemy blaming it for everything from skin rashes and acid reflux to autoimmune disorders. As the grocery aisles fill with gluten-free products and flat-tummied celebrities lobby to ban the bagel Atlantic Canadians are struggling to separate the wheat from the chaff. It s important to understand the impact of gluten on health and to reach a consensus about the way we describe the clinical conditions related to it says pediatric gastroenterologist Dr. Mohsin Rashid an associate professor in pediatrics and medical education at Dalhousie University in Halifax NS. Terms like celiac disease gluten sensitivity and gluten intolerance are often used interchangeably when in fact they are very different. Three main problems related to gluten According to Dr. Rashid there are three main types of problems arising from people s reactions to gluten a protein found in wheat rye and barley. The first is an allergy to wheat which often has symptoms such as skin rashes and difficulties with bowel function. This is similar to a severe allergic reaction to other foods like peanuts says Dr. Rashid. The second and most well studied problem he says is celiac disease a permanent autoimmune condition in which the body s immune system turns against itself and attacks the bowels. While there is no cure for this disease a gluten-free diet is the magic bullet for avoiding symptoms such as bloating cramping diarrhea flatulence and abdominal pain. Celiac disease is a genetic problem explains Dr. Rashid who is the medical advisor to the Nova Scotia Chapter of the Canadian Celiac Association and a volunteer on the Medical Advisory Board at the national level. Not everyone with the genetic marker will develop it he says but many of the children I see have family members who have the disease. According to the Canadian Digestive Health Foundation more than 330 000 Canadians are presently diagnosed with celiac disease. But that number is just the tip of the iceberg says Cynthia King-Moore a pediatric dietician at the IWK Health Centre. The number would be much higher but some people with symptoms haven t had a blood test to confirm a diagnosis and aren t receiving medical attention. Gluten sensitivity is the third disorder related to gluten consumption. A better name for this would be non-celiac Fall 2013 gluten sensitivity says Dr. Rashid in order to distinguish it from celiac disease which is also characterized by a sensitivity to gluten. After consuming gluten people with non-celiac gluten sensitivity report symptoms including headaches bowel dysfunction exhaustion and tingling of fingers and toes. We don t know much about this condition yet says Dr. Rashid. There are no antibodies in the blood and no genetic markers so diagnoses are made by excluding other possibilities such as celiac disease. It s not even clear if this condition is permanent. Celiac disease and gluten sensitivity on the rise What is clear is the increasing prevalence of both celiac disease and non-celiac gluten sensitivity. I ve seen a dramatic increase in the number of people interested in avoiding gluten or reducing it from their diets says dietician Brenda MacDonald the manager of food services for the IWK Health Centre. For the first time we are offering a low gluten diet in the cafeteria. We even have a gluten-free toaster to avoid the danger of cross contamination by crumbs that contain gluten. In addition to the growing number of people who have celiac disease and 17 Living Healthy In Atlantic Canada Dr. Rashid associate professor in pediatrics and medical education Dalhousie University. non-celiac gluten sensitivity there s also an almost fad-like preoccupation with gluten by people who have no medical reason to eliminate it from their diets. These are people who believe that wheat barley and rye are not healthy choices says Cynthia King-Moore. They have a preference for avoiding gluten but that s very different from having celiac disease. People who have celiac disease have to be gluten-free. They have no choice. More gluten-free choices Whether a health need or a health preference gluten-free foods now fuel a billion dollar production industry with General Mills alone boasting more than 300 gluten-free food products. There is so much more choice now than there was just a few years ago says MacDonald. the IWK we deal with a At Lunenburg County company that makes wonderful gluten-free products such as cookies and muffins. They sell like gluten-free hotcakes. Despite the increased production of gluten-free products by major food brands a recent study in Halifax showed they still cost two to three times more than similar products that contain gluten. The problem says MacDonald is that in order to produce gluten-free items a plant can t also produce goods that contain gluten. The price of that restriction is passed on to the consumer. 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When going gluten-free avoid products high in sodium choose products high in fibre and nutrients sprinkle ground flaxseed on glutenfree cereals to add fibre off-set low fibre gluten-free foods by eating lots of lentils legumes fruits and vegetables limit the consumption of high-calorie gluten-free treats don t forget that natural foods such as fruits and vegetables have always been free of gluten preferable and healthier because it excludes eating junk food and dining at fast food restaurants says Dr. Rashid. Other s medical practitioners like Wisconsin cardiologist and author William Davis see even greater benefits in a gluten-free diet. In his bestseller In August 2012 Health Canada mandated the inclusion of all grains containing gluten at a level greater than 10 ppm on labels for food products sold in Canada. Local chapters of the Canadian Celiac Association are located throughout Atlantic Canada. For contact information refer to the website http index.php about-the-cca local-chapters NB The Canada Revenue Agency considers the incremental cost of gluten-free (GF) products an eligible medical expense for those who suffer from celiac disease. For information http tx ndvdls tpcs ncm-tx rtrn cmpltng ddctns lns300-350 330 clc-eng.html Nova Scotia s Schoolhouse Gluten-Free Gourmet has a 100 per cent dedicated glutenfree production kitchen in Martins Point Lunenburg County where small batch goodies are hand made using fresh local ingredients. http www.schoolhouseglutenfreegourmet. com 3 miscellaneous11.htm Jax Wilkinson Talk about personalized customer service Charlene from Johnson Insurance Service Representative Great insurance advice. Tailored to you. Call today. Dedicated service representative Earn AIR MILES reward miles 24 7 live customer support Easy claims handling Call or visit us today. 1-800-563-0677 Home & Auto Insurance Home and auto insurance is available through Johnson Inc. a licensed insurance intermediary. Policies are primarily underwritten by Unifund Assurance Company (Unifund). Unifund and Johnson Inc. share common ownership. Eligibility requirements limitations and exclusions may apply. AIR MILES reward miles awarded on regular home and auto insurance policies underwritten by Unifund. At the time the premium is paid one AIR MILES reward mile is awarded for each 20 in premium. AIR MILES reward miles not available in SK MB or QC. TMTrademarks of AIR MILES International Trading B.V. Used under license by LoyaltyOne Inc. and Johnson Inc. (for Unifund). MVM.08.2013 Fall 2013 Living Healthy In Atlantic Canada 19 travel by sea. save time. drive less. Then let the story begin. There s something romantic about taking the ferry. The sense of anticipation that you re about to embark on a great adventure...a true Maritime experience. the sea is filled with timeless memories. we re here to help make new ones. CARIBOU NS WOOD ISLANDS PEI SAINT JOHN NB DIGBY NS Saint John NB Halifax NS Bangor ME Digby NS Wood Islands PEI Caribou NS Portland ME call 1-877-882-8685 or find your ferry tale at Mental health first aid Learning to recognise and respond in a mental health crisis by Donna D Amour One in Algee a stuffed koala bear is the mascot of the Mental Health First Aid Program. five people in Canada lives with a mental illness according to the Mental Health Commission of Canada. That s 6.7 million people one million of these are children aged nine to 19. We all know someone in our circle of family and friends who has had a mental illness we may have been treated for a mental illness ourselves or tried to cope with symptoms without treatment. If mental health issues are so common why is there still a stigma a cringe or a squirm at the mention of mental health It s a combination of a lack of information and the presence of misinformation about the root causes of mental illness says Monique Yazbek co-ordinator Mental Health and Wellness Primary Health at the IWK Health Centre in Halifax--and a mental health first aid instructor. Yazbek says people generally don t understand mental health issues and are influenced by media or TV portrayals of mentally ill people. Mental illnesses vary greatly. In younger people we hear about anxiety disorders depression substance abuse eating disorders as well as psychotic illnesses like schizophrenia which is rarer says Yazbek. The common link in all these illnesses is that the illness affects how the brain functions. MHFA Fall 2013 Living Healthy In Atlantic Canada 21 Monique Yazbek co-ordinator Mental Health and Wellness Primary Health at the IWK Health Centre in Halifax NS. There are two different mental health first aid courses one designed for adults who work with youth the one Yazbek teaches and one designed for adults who work with adults. Donna D Amour In its role as a catalyst the MHCC has created ed partnerships to focus on key projects and issues and nd to make recommendations on how best to improve the he systems that are directly related to mental health care. re. See more at http ca We tend t h it t when it comes t d to hesitate h to helping someone with a mental illness. We may sense there is something wrong but we don t know what to do or fear we may do something to make matters worse. So we do nothing. When someone needs help that s not how we want you to respond says Yazbek. Training prepares you to act Mental health first aid teaches people the skills needed to help when a person is experiencing a mental health crisis. It teaches how to recognize the signs and symptoms how to provide initial help and how to guide the person to the community mental health resources and professional help. Much like physical first aid courses it prepares the person first on the scene to act. Physical first aiders may stop bleeding call 911 ensure the person s safety perform CPR or just talk calmly to the person till summoned help arrives. Mental health first aiders recognize the crisis situation and act as they have learned to calm the person and direct them to available help. In training role playing prepares mental health first aiders for a range of situations. 22 The first thing you do in a mental health crisis is to speak calmly and listen to the person. Get them to sit down and take a few breaths. We all function a little better when we are calm says Yazbek. It also helps in times of crisis to know that you are not alone that someone is looking out for you when you may not be in the state of mind to think clearly. There are two different mental health first aid courses one designed for adults who work with youth the one Yazbek teaches and one designed for adults who work with adults. Anyone can take the courses. Yazbek s taught grandmothers teachers pharmacists pastors interested citizens students people who know people in their family who have mental health issues and want to know how to help and people who struggle with mental health issues and want to learn how to help themselves. Early identification crucial for youth The course aimed at youth is crucial in identifying issues and dealing with them early. Most of the mental illnesses that we deal with tend to start in the early teens to early 20s things like anxiety Fall 2013 depression and substance abuse. Early identification increases the chances of successful treatment Yazbek says. Patterns and behaviours learned over 30 years may be difficult to change. However when you have a young person you can teach them the skills they need to cope effectively with mental health issues. There are things you can do to change how the brain functions. So it is really important to catch them early. Yazbek says to approach a person who seems more down who is isolating themselves from other people not hanging out with family as much. Tell them you have noticed a change and you are concerned. She says you may get told to get lost or the more colourful equivalent but in her experience the young person will often be relieved to talk about how they feel. The armour drops she says. The course will not teach you to be a therapist any more than the physical first aid course will teach you to be a doctor but it will help you to understand mental illness and make you aware of the resources in your community. The family doctor is often the first person you should see with a Living Healthy In Atlantic Canada mental h l h concern. He or she can l health direct you to the appropriate treatment which could be counselling by a mental health clinician. There are also organizations in the community such as the Self-Help Connection and the Canadian Mental Health Association that provide information. Mental health first aid began in Australia and has been offered in Canada since 2007. The course for adults working with youth is 14 hours in duration with instruction delivered during four afternoons in three and a half hour blocks each week through the Dartmouth and Chebucto Community Health Teams s. Topics cover substancerelated disorders mood disorders deliberate self injury anxiety disorders eating disorders psychotic disorders and mental health resources in the community. The course for adults working with adults is 12 hours long. Interestingly demand is high with classes filling quickly. Yazbek says Once you understand what mental health issues are you are less likely to look at people with mental health issues any differently than you would look at a person with any other illness. Mental Health Commission of Canada Fall bulbs bring spring flowers. Molly Moore believed today s Science is tomorrow s cure. She was right. Medical research gives us hope for the future. Our researchers are making groundbreaking strides with your help we see a brighter tomorrow for us all. Dalhousie Medical Research Foundation 1-A1 Sir Charles Tupper Medical Building 5850 College St. P.O. Box 15 000 Halifax NS B3H 4R2 For ways to give please go to molly appeal .ca Fall 2013 Living Healthy In Atlantic Canada 23 Emergency Department IWK Health Centre Dr. Shannon MacPhee in the Emergency Department with Julia Locke. Dr. MacPhee is chief of emergency medicine at the IWK Health Centre in Halifax NS. Fever Don t panic High fever in children is usually not cause for immediate concern by Suzanne Robicheau When to get help The Canadian Paediatric Society recommends contacting a health care provider for Babies younger than six months who have a fever Older children who have a fever that lasts for more than 72 hours Children of any age who are suffering from heat stroke Children with special medical circumstances such as heart conditions Children of any age who refuse to eat and drink and who exhibit signs of excessive irritability lethargy sleepiness unresponsiveness Children with worrisome symptoms such as difficulty breathing chest pains wheezing and coughing skin rashes and inflammation It turns Home treatment for fevers that don t require a visit to the doctor Keep hydrated comfortable and warm removing excess clothing and bedding to reduce body temperature Refrain from cool baths and alcohol rubs For adults over-the-counter medications can provide relief for symptoms. Choose medications such as acetaminophen or ibuprofen and follow directions for use. For children medications such as Tylenol Tempra Panadol are suitable for relief from symptoms related to fever. Ibuprofen (Advil and Motrin) should only be given to children who are drinking reasonably well and never to babies under six months without consulting a physician. As an additional caution never give acetaminophen and ibuprofen at the same time and never give acetylsalicylic acid (aspirin) to children or teenagers who have a fever. (Source Canadian Paediatric Society) out that Peggy Lee was right to sing the praises of fever. Although much maligned as a serious danger to children and adults and erroneously feared as a disease in itself fever is actually a sign the body is mounting an attack to prevent illness. Fever is a normal response says Dr. Shannon MacPhee chief of emergency medicine at the IWK Health Centre in Halifax NS. From a physiological point when our immune systems crank up the heat it s usually a sign that the body is fighting an infection caused either by bacteria or viruses. So why the panic when body temperatures rise--especially in children There are a lot of fears about fever says Dr. MacPhee and many myths about the danger it poses. Chalk it up to fever phobia a term coined in 1984 by Colorado pediatrician Dr. Barton Schmitt to describe the popular misconceptions around fever. In what later was described as a myth-busting article Dr. Schmitt urged doctors to do a better job of allaying unrealistic fears about elevated temperatures stressing the importance of educating parents about fever explaining that temperatures vary throughout the day often rising slightly at night and that fevers are rarely harmful below 41.7 C (107 F). Schmitt encouraged parents to be guided more by the condition of the child than by the degree of the fever and endorsed establishing parental guidelines for when a fever merits involving a physician. There have been many medical advances since 1984 and ample assurances that elevated temperatures do not necessarily require medical attention yet fever remains one of the most common reasons for seeking pediatric care in part because parents don t want to take any chances and in part because this generation of children is exposed to an increased number of bugs at daycare facilities. 24 Living Healthy In Atlantic Canada Fall 2013 We call it daycareitis says Dr. MacPhee. Today the average pre-school child will have 10 viral infections a year. Some infections will be milder than others. Winter is the time when they occur most frequently. Dr. MacPhee tackles the myth that children must be treated whenever one of these almost monthly infections results in a fever. People have come to believe that they should treat a fever she says. We live in a society with ready access to over-the-counter medications (OTCs) and we feel compelled to use them ourselves and to give them to our children. However the truth is that in most cases there is no medical reason to treat a fever with OTCs. What we are really doing is treating symptoms such as aches and pains. Instead of heading for the medicine cabinet when a child has a fever Dr. MacPhee encourages parents to monitor their children for changes in activity level and worrisome symptoms. Most fevers don t last very long she explains and the degree of the fever is not as important as how the child looks. I have three children under the age of 10. When they have a fever I don t treat them as long as they re up and playing. A child s behaviour and appearance tell more about illness than the reading on a thermometer. In assessing the condition of a child with a fever Dr. MacPhee suggests monitoring for symptoms like changes in behaviour extreme irritability redness and swelling problems with urination severe headache stiff neck unusual skin rash sensitivity to bright light confusion refusal to eat and drink persistent diarrhea and or vomiting. The duration of the fever is another way to help assess its severity she explains. If a fever lasts for more than 48 hours it s best to get medical attention. A large part of Dr. MacPhee s role as an emergency medicine specialist is educating parents particularly in regard to fever. Immunizations have made fevers less dangerous than they once were she says and there s a decrease in childhood diseases such as chicken pox bacterial meningitis and ear infections but parents want to be sure they don t miss something that could have helped their children. So when is a fever high enough to warrant medical attention The answer is different for different people Fall 2013 Taking a temperature There are four ways to take a temperature rectally orally (under the tongue) with a tympanic reading (in the ear) and by using the axillary method (under the armpit). The Canadian Task Force on Preventive Health recommends rectal readings as the most accurate for children up to the age of five. Oral readings are recommended for older children who are able to retain a thermometer under their tongues long enough to get an accurate reading. Because mercury presents an environmental hazard the Canadian Paediatric Society recommends user-friendly digital thermometers instead of old-style mercury models. Normal range of temperatures according to method Rectal 36.6 C to 38 C (97.9 F to 100.4 F) Mouth 35.5 C to 37.5 C (95.9 F to 99.5 F) Armpit 34.7 C to 37.3 C (94.5 F to 99.1 F) Ear 35.8 C to 38 C (96.4 F to 100.4 F) (Source Canadian Paediatric Society) and age groups says Dr. MacPhee. For newborns and anyone with a compromised immune system (including people receiving chemotherapy) a temperature higher than 38 C (100.4 F) is a sign that attention is needed. For the rest of us the number to watch for is 38.5 C (101.3F). 25 Living Healthy In Atlantic Canada Children s Building Link Building Children s Emergency Entrance Dr. Richard B. Goldbloom Pavilion Women s Building General Entrances CH Children s Entrance W Women s Entrance Please do not wear scented products when visiting medical facilities. 26 Living Healthy In Atlantic Canada Fall 2013 Emergency Entrance IWK Health Centre Fall 2013 Living Healthy In Atlantic Canada 27 PROFESSIONAL DIRECTORY For more information on advertising in our Professional Directory please contact Kerri Slaunwhite 902 464 7258 ext. 232 email kslaunwhite Post Cardiac Rehab Fitness & Education Program Heart For Life A division of Maritime Laundry & Textile Products Ltd. At ScrubsRus we strive to provide the best selection of scrubs and nursing uniforms at affordable prices. Whether you are a Veterinarian Dentist Nurse Doctor or Child Care professional ScrubsRus has the right uniform to fit your needs. Our brands include Alegria Antidote Baby Phat Bauerfeind Cherokee Dansko Dickies Healing Hands Jockey Med Couture KOI and many more. Monday Friday (9 5) Saturday (9 1) 500 Hillsborough Road Riverview NB 1 (506) 387-7674 OR 1 (800) 354-7674 scrubsrus This program is designed for anyone who has either had or are at risk of having heart disease heart attack heart surgery or angina. Fitness Leaders and Nurses. For details sandra.jamieson 420-5556 The Homburg Centre for Health & Wellness 920 Tower Road Halifax NS 902.420.5555 28 Living Healthy In Atlantic Canada Fall 2013 A patient s story Recovery amazes physicians Patient credits her determination to get better and her refusal to feel sorry for herself by Eleanor Beaton Kayla Joudrey of Cornwall NS is still recovering from a vehicle accident that crushed her skull and had her in a coma. Perry Jackson Spring was in the air and 23-year-old Kayla Joudrey was eager to get the yard cleaned up. She was a worker--always had been--and she spent the afternoon raking up last year s dead plants now brown and water-logged from layers of melted snow. Her boyfriend Cory worked with her heaping the debris on to the back of his old pick up. It was after supper when they finally heaved the long discarded Christmas tree onto the bed of the truck dark but not pitch black. The days were definitely getting longer. Kayla fastened her seatbelt and stared out the window as Cory pulled out on to the road. She was tired but in a good way. It felt so good to get things done. Maybe when they got home she d fix them a snack and they could watch a mov... Where am I Kayla wakes up. She is no longer in the truck. What happened She is confused. She s lying in a strange room. Everything feels heavy--her head her arms her legs her chest. Her vision is blurry but she can just make out the white sheets on the bed and sitting in chairs beside her two fuzzy but familiarlooking figures Mom and Dad. She wants to ask them if they know what has happened to her but she can t speak. So she blinks her eyes at them and hopes they understand she s trying to say hello. She is so tired. Her eyelids are so heavy. There s a dull ache in her head. Maybe she ll just go back to sleep. Urgent message from home Arabelle Joudrey is having a blast in Mexico. A nurse at the QEII Health Sciences Centre in Halifax she works in a large busy unit. She loves her job but she s been looking forward to her holiday for weeks. She s on the computer checking up on how things are doing back at home when she reads a message on Facebook that sickens her. Call home. Now Someone has posted a story about a horrific single car accident. Next to Fall 2013 the story is the picture of a young woman. It s her niece Kayla. Arabelle s cell phone doesn t work in Mexico so she rushes to the front desk and asks if they ll sell her a phone card. With shaking hands she calls her sister Kayla s mother. There s no answer. They must be at the hospital she thinks. She calls the Intensive Care Unit at the QEII and explains she s a nurse at the hospital. She thinks her niece has had a terrible accident she says can someone please tell her what s going on The nurse she speaks to is sympathetic and apologetic but because of rules concerning patient confidentiality he can t share any information with her. Hours pass. Eventually Arabelle is able to reach a family member who gives her an update. Kayla was in a car accident. Her skull was crushed. She s in a medically induced coma. Arabelle tries to arrange an earlier flight home but none will get her back to Nova Scotia sooner than her original departure. With nothing to do but wait she spends her days at the 29 Living Healthy In Atlantic Canada Health professionals predicted it would be up to a year before she would be able to walk unaided--she proved them wrong. beach looking out at the ocean her fists digging into the sand. I felt incredibly helpless she remembers. She arrives back in Halifax several days after Kayla s accident. She drives directly from the airport to the hospital. She s worked as a nurse for years but what she sees when she walks into Kayla s hospital room stuns her. Her niece is lying on the hospital bed surrounded by monitors. Her head is swathed in bandages and she has a breathing tube. Her parents are at her bedside their faces weary and pained. Arabelle wants to cry. Kayla is their only child. The accident The accident happened two minutes after Kayla and her boyfriend left their Caledonia NS house. A passing driver found the crashed vehicle and called 911. Cory had serious injuries with multiple broken bones. The right side of Kayla s skull was completely crushed. She was unconscious when she was discovered and paramedics had her airlifted from Kejimkujik National Park to the QEII in Halifax where doctors performed emergency surgery to remove the crushed skull bones. For the next week she would remain in a medicallyinduced coma which would allow her to heal faster because it prevented both pain and movement. When her family arrived Kayla had 49 staples in the side of her head and a broken jaw. Her brain was so badly bruised and damaged the doctors told her family they had little hope she would survive and that if she did somehow live she was likely to be suffer severe brain damage. It was so difficult to hear that says Arabelle who spent as much time as possible in Kayla s room for those first few weeks. I knew they had to prepare us for the worst but it was just so devastating to hear. When she wasn t at her niece s side she kept herself busy 30 Living Healthy In Atlantic Canada Fall 2013 Perry Jackson Kayla has few clear memories from her first two weeks at the QEII. When she finally emerged from the haze of her coma she was told she d been in a bad accident and that she was lucky to be alive. by answering questions about Kayla s condition to close family and friends on Facebook and calling everyone she could think of to ask for their prayers. We needed a miracle. And then about a week after the accident when the family thought their situation couldn t get any worse it did. Kayla s temperature shot up. Hospital staff did everything they could to bring her fever down but nothing worked. The mercury kept rising. In a last ditch effort to save her life the health team called in an infectious disease specialist who adjusted her medications. Her parents cried at her bedside all day convinced they were losing their beloved girl. A turning point I paced the floors for hours remembers Arabelle. And then something miraculous happened. Roughly 24 hours after the infectious disease specialist adjusted her antibiotics Kayla s fever finally broke. It was a turning point in her ordeal Arabelle says. She hasn t looked back. Kayla has few clear memories from her first two weeks at the QEII. When she finally emerged from the haze of her coma she was told she d been in a bad accident and that she was lucky to be alive. She has no memory of the accident the last thing she remembers is cleaning up the garden with her boyfriend. Her parents talked to her the whole time and while Kayla couldn t talk back--could only blink at them--it felt good to hear their voices. She spent two weeks in the ICU before moving to an intermediate care level unit on another floor where she would remain for the next two months. Each day she made small improvements her breathing and feeding tubes were removed and slowly she progressed from swallowing soup to soft foods. She started in daily therapy where she re-learned how to talk and eat and practised using her left hand over which she d lost control. On June 7 she had reconstructive surgery to get a synthetic skull a procedure that left her with 52 staples. A few weeks later when the staples were taken out she barely felt the pain and took no painkillers other than a couple of Tylenol the day after her surgery. After more than two months in the hospital Kayla went back home to Cornwall. For a few weeks she returned to Halifax for therapy twice a week but soon cut her sessions down to once per week. Her recovery has been nothing short of miraculous Arabelle says. With injuries as severe as the trauma Kayla sustained health professionals predicted (once it was clear she would live) that it would be at least six months before she d be ready to leave the hospital and up to a year before she d be walking without the help of a cane or walker. Kayla has proved them wrong. She walks unaided has no cognitive deficiencies and can speak and eat normally. She is still working to regain complete use of her left hand and waiting for her hair to grow out from the buzz cut she had post-skull surgery. I have my tough days when I want my hand to do something it just won t do. But mostly I focus on being grateful that I m alive. She tries to stay positive and determined. I enjoy every day because you never know what will happen. The key to her speedy recovery she says is her determination to get better and her refusal to feel sorry for herself or to make a big deal out of what happened to her. She sets small milestones for herself and when she achieves one goal she moves on to the next. Her next goal is to return to her job as the manager of a small deli in Bridgewater. Her doctors say it could be up to a year before she gets back to work. But Kayla s pretty sure she can do better than that. Fall 2013 Living Healthy In Atlantic Canada 31 Nutrition Shining a little light on vitamin D Chances are your body is not getting enough and you could pay a very high price for that by Maureen Tilley PDt. Vitamin D is also known as the sunshine vitamin as the body produces it naturally when the skin is directly exposed to the sun. It s well known for its role in pairing up with calcium and phosphorus to build and maintain healthy bones and teeth. It also plays an important role in muscle and nerve function reducing inflammation cell production and immune function. In recent years vitamin D has gained more and more attention for its potential role in the prevention of various conditions and diseases such as cancer cardiovascular disease multiple sclerosis type 1 and 2 diabetes and hypertension. How much do we need Health Canada recommends children and adults (1-70 years) and pregnant and lactating women obtain a daily dose of 600 international units per day infants (0-12 months) 400 IU and seniors (over 70 years) 800IU per day. These recommendations are based on the requirement to promote the development and maintenance of healthy teeth and bones. Recommendations for disease prevention remain inconclusive. Where do you find it Only a limited number of foods naturally contain vitamin D. Certain fish (salmon mackerel swordfish tuna) are the richest sources while lower amounts are found in egg yolks and beef liver-- 32 but it s far too difficult to meet the daily recommendation through diet alone. In the 1930s rickets (a disease impairing bone formation) affected 80 to 90 per cent of children. This significantly decreased when the government made it mandatory to fortify common foods such as milk with vitamin D. Today the majority of dietary vitamin D is obtained from fortified foods milk being the primary source. Other foods include fortified milk alternatives such as soy and rice milk margarine fortified juices and some breakfast cereals. Canada s food guide recommends two servings (500ml) of milk or fortified milk beverage a day. According to Statistics Canada 75 per cent of Canadians who consume one or more servings of milk a day had adequate vitamin D levels compared to 60 per cent of non-milk drinkers. Read the label--foods and beverages containing at least 15 per cent daily value per serving would be considered a good source. The sun The amount of vitamin D we obtain from the sun can be limited by many factors. Throughout the colder months there are fewer UV rays and less skin is exposed As we age our body becomes less efficient in converting sunshine to vitamin D Clouds and heavy smog block UV rays by 50-60 per cent The time of day UV rays peak between 11a.m. 3 p.m. Fall 2013 iStockPhoto Christou Darker skin tones naturally have higher protection from the sun s rays The recommended intake for vitamin D is based on the assumption of low sun exposure. There is no evidence determining safe levels for UV ray exposure for vitamin D production. Some experts advise against unprotected sun exposure and recommend all vitamin D come from diet or supplement. Others including the Canadian Cancer Society stress the importance of limiting sun exposure to no more than a couple of minutes a day. Research shows five to10 minutes a day to the face arms legs or back without sunscreen is enough to meet needs. How much are we getting A 2009 Statistics Canada report found that 68 per cent of all Canadians were getting adequate vitamin D while 32 per cent were below the recommendation. During the colder months a 15 per cent decrease was observed in those meeting their needs. Children (89 per cent) and seniors (75 per cent) came out on top while only 59 per cent of individuals between 20-38 years of age Living Healthy In Atlantic Canada Creamy Dill Salmon Time prepping 12 minutes cooking 6 to 8 minutes Most cream sauces are made with high-fat cream using light cream cheese and yogourt provides a delicious creamy flavoured sauce without all the added fat and sodium. This sauce is also delicious with trout. 1 1 4 4 2 1 1 8 1 1 cup (60 mL) low-fat plain cream cheese cup (60 mL) low-fat plain yogourt tsp (10 mL) lemon juice (about half a lemon) tbsp (15 mL) chopped fresh dill or 1 tsp (5 mL) dried dill tsp (0.5 mL) mustard powder pinch of red pepper powder lb (450 g) wild salmon fillets In a small bowl combine cream cheese yogourt lemon juice dill mustard powder and red pepper powder. Lay salmon fillets in a lightly greased pan. Top with cream sauce. Place in oven on broil for 6 to 8 minutes until salmon is cooked through and flakes easily. Makes 6 servings. Nutrition info per fillet (100 g) calories 181 fat 12 g saturated fat 3 g cholesterol 47 mg sodium 99 mg carbohydrate 2 g fibre 0 g sugars 1 g protein 17 g had sufficient blood levels. Among the individuals with adequate D levels 34 per cent were on a supplement. Then there s teeth We often think of calcium as the building block to strong bones forgetting its vital role in dental development as well. Tooth development begins in the fetus and continues into early 20s. Throughout pregnancy if the mother is not meeting her calcium needs her body will leach from her bones to ensure the fetus is properly nourished. In fact research has shown adequate calcium intake during pregnancy may reduce tooth decay in childhood. As teeth development continues infants children and teens should be meeting their daily calcium needs. When these needs are not met it can result in weak teeth development that s prone to decay and loss throughout life. Children between 1 to 8 years of age require 2 to 3 servings of milk and alternatives per day those 9 to 18 years of age require 3-4 servings. What s a serving 1 cup cow s milk 1 cup (250 mL) fortified soy beverage or almond milk 1 oz (50g) cheese block (example cheddar mozzarella Swiss feta) 1 oz (50 g) cheese goat cup (125 mL) pudding custard (made with milk) cup (175mL) yogourt (plain and flavoured) 200 mL yogourt drinks Infants younger than one year should stick to breast milk or infant formula not cow s milk. Children between one to two years require whole milk due to higher fat needs for brain development and growth. After two years choose low fat milk and alternatives. All milk contains the same amount of calcium regardless of fat content. To supplement or to not supplement The need for vitamin D supplementations is a controversial topic. According to Health Canada recommendations all infants who are breast fed should take 400IU until one year. Formula fed infants do not require a supplement because the formula is already fortified. All adults 50 years Fall 2013 and older should take 400IU of vitamin D daily to meet their increased needs. Children and adults who consume two cups (500ml) milk or fortified milk alternative a day do not require a supplement. Consideration should be made for individuals who do not drink milk or milk alternatives and or with low blood levels. Those with impaired absorption should also be assessed--they include darker skin tones conditions such as celiac disease Crohn s disease lower bone density and individuals who are obese. In contrast the Institute of Medicine states the current government recommendations are very conservative and don t provide enough consideration to the most recent findings. Osteoporosis Canada recommends all Canadians take a daily vitamin D supplement because it s impossible to obtain adequate levels from diet alone. Recommendations include adults (19-50 years) 400-1 000IU per day and those over 50 years and younger adults at high risk (low bone density) supplement with 800-2 000IU per day. All sources state supplements are safe up to 1 000IU per day. 33 Living Healthy In Atlantic Canada Vitamin D content in foods Food Milk Fortified rice or soy beverage Fortified orange juice Fortified margarine Egg yolk Herring cooked Trout cooked Mackerel cooked Salmon Atlantic cooked Salmon chum canned Salmon pink canned Salmon sockeye canned Sardines Atlantic canned Sardines Pacific canned Tuna canned light or white Tuna yellowfin (albacore ahi) cooked Tuna skipjack cooked Serving 1 cup 1 cup 1 2 cup 2 tsp 1 75 g 75 g 75 g 75 g 75 g 75 g 75 g 75 g 75 g 75 g 75 g 75 g Vitamin D (IU) 103 88 53 51 25 162 210 81 246 168 435 585 70 360 44 105 381 T. Daniel Lawen B.Sc. D.D.S. G.P.R Christo Migas B.Sc. D.D.S. Sara Hunter B.Sc. D.D.S. Halifax Professional Centre 5991 Spring Garden Road Suite 275 Too much of a good thing Too much vitamin D can have adverse effects. The upper tolerable limit for infants is 1 000-1 500IU for infants children (less than 9 years) 2 5003 000IU and children (9 years and up) adults and pregnant and lactating women 4 000IU. Toxicity is rare but has been observed in individuals taking a mega dose of 50 000IU over an extended period. It cannot occur from excessive sun exposure or diet. Symptoms include nausea vomiting weakness loss of appetite to more severe kidney damage. Most importantly never take a dose beyond the upper tolerable limit without medical supervision. Talk to your doctor pharmacist and other health care professional prior to taking any supplements. Request to have your vitamin D levels tested to determine if a supplement is needed. Beyond bones and teeth Cancer prevention several studies have revealed a potential link between increased cancer (breast colon and prostate) risk and low vitamin D. Colon cancer in particular has shown the strongest evidence. While some of the findings look very promising at this point it cannot be concluded that taking a vitamin D supplement will decrease the risk of cancer. Cardiovascular disease several studies have shown that low vitamin D levels Fall 2013 902.424.1888 Invisalign Dental Implants & General Dentistry may be a contributor to increased heart disease risk. In fact one study showed men with low vitamin D were twice as likely to have heart disease than those with normal vitamin D. It is thought that vitamin D improves cardiovascular health by decreasing calcium deposits in the arteries and or decrease blood pressure. More research is needed.. Diabetes There may be a potential link between vitamin D and the prevention of diabetes (type I & II). One study revealed that women taking 2 000IU per day were 80 per cent less likely to develop diabetes. Conclusive evidence is still needed. Multiple sclerosis There s a higher prevalence of MS in populations living north of the equator compared to the sunnier southern areas leading to questions as to whether vitamin D plays a role. One study revealed 62 per cent decreased risk of MS in those with adequate vitamin D levels. Another study showed that low vitamin D levels may be associated with the severity of MS symptoms. Again more research is needed. Whether you obtain vitamin D through diet sensible sun exposure and or supplement it s important to ensure you re meeting the vitamin D recommendations for healthy bones and teeth. The potential benefit of vitamin D in disease prevention requires more research and so far the future looks bright. 34 Living Healthy In Atlantic Canada Your oral health Did you know The link between good oral health and your overall health is strong Diabetes reduces the body s resistance to infection putting the gums at risk. Gum disease appears to be more frequent and severe among people who have diabetes. Conversely research shows that people with gum disease have a harder time controlling blood sugar levels. Endocarditis is an infection of the inner lining of your heart (endocardium). It typically occurs when bacteria or other germs from another part of your body such as your mouth spread through your bloodstream and attach to damaged areas in your heart. Pneumonias particularly in older or debilitated people can be caused by inhaling plaque. Periodontitis (gum diseases) has been linked to premature birth and low birth weight. Some research suggests that heart disease (clogged arteries and stroke) might be linked to the inflammation and infections that oral bacteria can cause. Osteoporosis which causes bones to become weak and brittle might be linked with periodontal bone loss and tooth loss. Oral problems such as painful mucosal lesions are common in people who have HIV AIDS. 35 Oral hygiene is not just about having a nice smile--not even close. Research is increasingly showing a considerable linkage between what s happening in your mouth and your general health. A growing body of statistics indicates that poor oral health increases your chances of suffering from a number of serious diseases Dr. Rob MacGregor of Kentville NS past president of the Canadian Dental Association says in addition to the connection between oral and heart health recent research shows that people with oral bacteria and periodontal (gum) disease seem more prone to respiratory illness and having babies with low birth weights. And it has long been known that uncontrolled diabetes can lead to aggressive periodontal disease and vice versa. Dental decay is the most chronic prevalent disease in the world. Approximately five times as many children suffer from dental decay than asthma and about seven times more than hay fever. But dental decay and periodontal disease are largely preventable while oral cancer risk can be reduced. The culprit Bacteria Your mouth is brimming with bacteria. The body s natural defenses and daily brushing and flossing will generally keep them under control. However without proper oral hygiene bacteria can reach levels that might lead to oral infections such as tooth decay and gum disease. Tooth loss before age 35 might be a risk factor for Alzheimer s disease. The very early (curative) stages of oral cancer are most likely to be detected by your dentist. Fall 2013 Living Healthy In Atlantic Canada Take the smart-mouth quiz 1. How often should you brush your teeth a) once a week or when you start to see a greenish tinge b) after every meal or at least once a day c) twice a day d) whenever things feel fuzzy Answer b) After every meal is best and always before bed. 2. How soon after eating should you brush a) right away. If possible eat your meals in the bathroom so you re already near the sink. b) within a few minutes c) about an hour later d) it doesn t make any difference Answer c) About an hour later. Surprisingly it s best not to brush right away Your mouth is at its most acidic at mealtimes (because of sugars and other substances mixing with bacteria). If you brush right then you ll spread that acid around and may damage your tooth enamel. An hour later things will be calmer in your mouth. Phew -- time to brush safely. 3. Ideally how long should you to brush a) 20 seconds b) two to three minutes c) one minute to brush your teeth and one minute to brush your tongue d) long enough to sing O Canada quickly in your head Answer b) If you re rushed and don t have two to three minutes to brush a minute will do the trick once you have flossed says Dr. John Steeves a dentist in Fredericton. If you can get a sustained 60 seconds of brushing that should give you adequate time to reach all accessible surfaces. As well it gives you 60 seconds exposure to the fluoride in the toothpaste. Dr. Steeves recommends using a timer. It is a great motivator for kids and adults he notes. 4. Flossing is only for grown-ups. True or False Answer False. As in no such luck. Once your teeth are close enough together (as early as age three) you need to floss once a day. Without flossing more than a third of your tooth surface doesn t get cleaned. 5. How should healthy gums look a) shiny and swollen b) pale and waxy c) bright red from bleeding d) none of the above Answer d) none of the above Healthy gums don t bleed when you brush or floss they look dull instead of shiny and are pink (perhaps a dark pink nearly red if your skin is dark). Healthy gums are important. They hold your teeth in 6. What is calculus a) a high school math class many kids fear b) what your body needs for healthy bones c) another word for what happens when plaque (a sticky substance) hardens into tartar on your teeth or under your gumline d) something guitar players get on their fingertips Answer c). Another term for what happens when plaque hardens into tartar. Tartar harbours more bacteria than plaque and is worse for your teeth and gums. Brushing flossing eating well and visiting your dentist -- all these things can help. 7. Why is toffee an especially bad snack a) because it s sticky b) it has more sugar than other candy c) it can leave dark stains on your teeth d) all of the above Fall 2013 Answer a) Because it s sticky. As in it sticks around in your teeth and causes trouble. No sweets even fruit gummies are good choices for snacks. Instead go for nuts and seeds peanut butter cheese plain yogurt or popcorn. 8. A dessert with your evening meal is better than the same dessert as an after-school snack. True or False Answer True because of how sugar does its damage. The explanation is sort of graphic but we ll spit it out (pun intended ). The sugars you eat mix with bacteria in your mouth to make an acid that can cause cavities. During meals your mouth makes more saliva and this helps in two ways it rinses food particles away and dilutes the cavity-causing acid. 9. How often do you need a new toothbrush a) every month b) anytime your dog has been chewing on it c) every two to three months d) at least once before you graduate from high school Answer c) Every two to three months or when the bristles are starting to fray. Old toothbrushes don t do their job well and can harbour bacteria that can lead to cavities. Also don t share your toothbrush with anyone (of any species). Don t even let its bristles touch another toothbrush s bristles And what type of toothbrush should you use Soft is best says Dr. Steeves. It s the motion of the bristles and using the proper technique combined with the cleaning action of the toothpaste that cleans the tooth surface. Dr. Steeves is also a big fan of electric brushes. These brushes don t always come in soft so I stress the need to be gentle when using them with patients he notes. 37 Living Healthy In Atlantic Canada A trilogy for healthy teeth Getting the calcium your body needs is a three-pronged affair by Donalee Moulton Feast on this A healthy diet should include nutritious sources of calcium Vitamin D and phosphorus. Dig in to these foods to get your fill of these important nutrients. Calcium Yogurt milk cheese eggnog Dark leafy vegetables Fish including salmon Grains Vitamin D Trout mackerel salmon tuna egg yolk milk Phosphorus Eggs beef chicken turkey halibut bread nuts Whole grains dried fruit garlic Healthy teeth and gums require a healthy mix of calcium Vitamin D and phosphorus. Together these nutrients help young teeth grow strong and help prevent adult teeth and gums from deteriorating as we get older. Here s how Calcium which is a mineral is the main component in our teeth--accounting for up to 70 per cent of each tooth. Calcium forms part of the dentin the hard bony tissue beneath the enamel as well as part of the hard outer layer of enamel itself. In fact teeth are the densest structures in our body. Fall 2013 Living Healthy In Atlantic Canada 39 Dr. Mary McNally an associate professor in the Faculty of Dentistry and Medicine at Dalhousie University and research associate Atlantic Health Promotion Research Centre. Infants children and Marilyn Klein Dalhousie University youth need calcium to ensure their teeth develop fully and well early in life Infants children and youth need calcium to ensure their teeth develop fully and well early in life says Dr. Mary McNally an associate professor in the Faculty of Dentistry at Dalhousie University. In addition without enough calcium kids may develop more cavities because their teeth are more susceptible to decay. Calcium is also important for life-long health. We naturally lose bone mass as we age. It s extra important for older adults to meet their requirements for these nutrients says Dr. McNally who recommends Eating Well with Canada s Food Guide as a helpful source of dietary information about calcium vitamin D and phosphorus. Even though adult teeth are no longer developing they still need to be protected against decay. That s what calcium can help to do. It also helps strengthen the jaw. Unfortunately as we get older the level of calcium in our body declines. A little boost is often needed. The good news about calcium is that it is widely and deliciously available. Dairy products such as milk and cheese are excellent sources. If calcium is not a big part of your diet or you are lactose intolerant calcium can be easily taken as a supplement. You ll find it available in a wide variety of formats including pill form and as a chewable supplement. The tricky thing about calcium however is that it needs a little help to be absorbed into the body. That s where Vitamin D and phosphorus play an important role. Vitamin D helps us absorb calcium Produced in our skin Vitamin D requires ultraviolet light from the sun. This can be difficult to come by in seasonal northern climates like we have in Atlantic Canada. Also because too much sun exposure presents a risk for skin cancer many are opting to avoid lengthy exposure. Fortunately Vitamin D is available as a supplement that can even be added to food. On its own Vitamin D does little for our teeth and bones. Combined with calcium however it does wonders. The vitamin acts as a catalyst so that our bones can more easily absorb calcium. calc Research also indicates that R Vitamin D may play an important Vit role in controlling gum disease. rol It appears to do this in two ways. First in tandem with w calcium Vitamin D helps teeth c grow and become stronger. g Second it helps to reduce S and soothe the inflammation caused by gum disease or gingivitis. As well Vitamin D helps keep teeth strong. If children in particular don t get enough of the sunshine vitamin their teeth can become susceptible to cavities and becom gum disease. Courtesy of Health Canada 40 Living Healthy In Atlantic Canada Fall 2013 Do-the-Lion-Pose-in-Yoga Smile Assured Full Service Laboratory for all your Prosthetic needs. Serving our community for over 35 years Join us to help the Parker St. Food and Furniture Bank. We will provide bins and signs for your office to collect donations. Yoga for example has a number of poses you can do easily and conveniently to give your mouth and jaw some exercise. Balance phosphorus and calcium In many ways phosphorus serves a similar--and important--purpose to Vitamin D. It works with calcium to build strong teeth and bones such as your jaw. Without enough phosphorus the calcium in your body will be wasted. Too little phosphorus also means your teeth are at greater risk of chipping and breaking. Too often however the problem is not a lack of phosphorus in the body but an overabundance. Phosphorus is the most plentiful mineral in our body and roughly 85 per cent of it is found in our teeth and bones. While diseases such as diabetes and celiac disease as well as some medications including diuretics can affect the level of phosphorus in our body most people usually get plenty of this mineral from such foods as milk and grains. It is not uncommon for our characteristic Canadian diet rich in protein and bubbling with carbonated drinks to have as much as 20 times more phosphorus than calcium. When this happens the body takes calcium from elsewhere such our bones. The more phosphorus you consume the more calcium is required. It s a balancing act necessary to ensure healthy teeth and bones. A work-out for your mouth Just as you exercise to keep bones and body healthy your mouth requires a work out. Exercising your jaw bone and the attached muscles helps to build new bone and keep existing bone strong. Yoga for example has a number of poses you can do easily and conveniently to give your mouth and jaw some exercise. Here s one to try The Lion 1. Sit in a comfortable position with your back arched slightly and your hands spread open on your legs. 2. Inhale deeply then force air from your lungs. 3. Open your mouth and eyes as wide as possible. 4. Stick your tongue out of your mouth as far as it will go. Try reaching for your chin. 5. Count to 10 as you slowly bring your tongue back into your mouth. 6. Relax and repeat. Fall 2013 Treats from the 1st Annual Halloween Treat Buy-Back. Pro-Dent Laboratory Ltd. 2441 Agricola St. Halifax Nova Scotia toll-free (800) 565-1204 office (902) 422-8531 fax (902) 420-9425 images Living Healthy In Atlantic Canada 41 Fear of the dentist A little prep work goes a long way to making it a positive experience With care trips to the dentist don t have to be overwelming for little ones. The first step is to find out why your child is anxious. In some cases it s because something hurt or startled them during a previous examination or treatment sometimes it s because they ve heard stories about other people s fear of the dentist or their painful experiences with an infected tooth or sore gums because of failure to visit a dentist. There is also the fear of the unknown. Children may be nervous if they have no knowledge of what is about to happen. Many children are also afraid of certain noises that may happen during a dental visit says Dr. Jason Noel a dentist in Bay Roberts NL and president of the Newfoundland and Labrador Dental Association. Show tell and do Your dentist can help alleviate these fears by using what is commonly called the show tell and do technique . The dentist for example will show the child an instrument explain what will be done with it and then use the instrument. In many cases the dentist will alert the child about the sound an instrument will make and let the child hear the noise before the drill or other tool is used. Do your prep work In advance of the visit it s a good idea to prepare your child generally for a trip to 42 Kids need to understand that every time they visit the dentist they re doing good things for their mouth and their overall health. the dentist. Ask if there are any questions and give simply and straightforward answers. In the absence of questions explain why your child is going to the dentist and why it s important to have healthy gums and teeth. Let the dentist answer more complex or detailed questions Dr. Noel recommends. Dentists are trained to describe things to children in a non-threatening way and in easy-tounderstand language. What you don t want to do as an adult is inadvertently add to a child s discomfort and uncertainty. Sometimes the language used can create a ripple of fear. Words like hurt and painful for example set up an expectation the visit will not be pleasant. So do statements like Be a brave girl no matter how cheery the tone. Then there is the one dreaded word that can make the heartiest little souls (and even big ones) quiver-- needle. Adults may want to leave the opportunity for discussion for the dentist Fall 2013 and the child. However if your son or daughter asks about needles answer honestly. Let them know that dentists sometimes use needles to make little boys and girls more comfortable during their visit. You can let them know their cheek might tingle a little and they want just might have a really cool drool for a few hours afterwards. For younger kids who are going to the dentist for the first time or who have not been in some time there are plenty of books available for them to read. There is an entire series of Berenstein Bears books but be forewarned they do discuss getting teeth filled and pulled. Other titles to tempt little ones to learn more about their oral health and the dentist include Dora Goes to the Dentist featuring Dora the Explorer. Sticker activity books that focus on visiting the dentist are also available. Bring activity books On the day of the visit bring activity books for your child to read or toys to play with while waiting for the dentist or hygienist and try to relax yourself. Kids Living Healthy In Atlantic Canada are amazing barometers. They register the tone around them and quickly catch h on that there is something making mom m or dad nervous. Another cause of fear often crops up when it s time to go the dentist s chair leaving mom or dad behind. If it helps a parent can accompany their child to the treatment room. Stand back and let the dentist answer questions explain what is s happening and establish a relationship with the child. Children who are frightened can act out in a number of ways everything from crying uncontrollably to throwing a temper tantrum. It s important to have a quiet calm child for the examination. Children and even adults that are fearful are less co-operative and can tend to be jumpy. It can interfere with the ability to examine and treat these patients notes Dr. Noel. Offering children a reward for going to the dentist is not effective. It reinforces the impression that going to the dentist is something out of the ordinary and kids deserve to be paid for accommodating the request. On the other hand one successful approach Bring activity books for your child to read or toys to play with while waiting for the dentist or hygienist. to helping kids feel good about the visit h is to give them a certificate when the examination is over. Parents can prepare this in advance (the CDA s website offers a certificate that can be printed out http en oral_health smile_certificate default.asp) and the dentist can present it when their little patient is leaving. Make it part of the routine Familiarity often breeds comfort. The more routine a visit to the dentist b becomes as part of a child s routine f h ld health care the less likely they are to be afraid when an appointment draws near. If on the other hand they only go to the dentist when there is a problem--a toothache or cavity that needs to be filled--they will come to associate the dentist with things that are unpleasant. Ultimately kids need to understand that every time they visit the dentist they re doing good things for their mouth and their overall health. It s enough to make a parent smile. NATURE S ANTIOXIDANT SUPERFRUIT 100% Pure Wild Blueberry Juice FOR RECIPES Fall 2013 Living Healthy In Atlantic Canada 43 First tooth first year first visit The benefits of introducing your infant to the dental environment by age one or by the arrival of their first tooth whichever comes first. The visit will help achieve a number of important things. First it will enable the dentist to examine your child to see if there are any problems. It will also give you a chance to ask questions about a wide range of oral health-related issues-- everything from the use of sippy cups to thumb sucking. That first visit is also a great time to introduce your child to the importance of oral health care and to help them become comfortable with visiting the dentist s office. Catch oral health problems early The dentist will examine your child and may take x-rays to get a look below the surface. A history will also be taken so the dentist gets the broadest sense of what may be happening in your child s mouth--and more. Dr. Smith points out that some oral health conditions may be an indication of another medical problem. Basically anything that you identify and fix can have an impact on long-term health he says. Some children for instance have a condition known as enamel hypoplasia or chalk teeth which occurs when the tooth s enamel doesn t form completely. This may be a sign the child is not getting necessary nutrients in their diet or that another illness has been or is at play. Children with significant tooth decay also tend to be in the lowest 10 per cent of the growth curve and they often can t eat or sleep well. Identifying that child will have an obvious impact (on their health) notes Dr. Smith. He points out that many of the Tooth cavities not colds are the most common childhood disease. The incidence of early childhood cavities appears to be on the rise with recent research indicating that children are getting more cavities at an earlier age. One study found that more than 25 per cent of children in North America have had at least one cavity by age four. Cavities or tooth decay are caused by a bacterial infection linked to acid produced by food that sits on our teeth and between our teeth. Adults are quite familiar with cavities and the fillings that fix them. But children even young children are not immune from having tooth decay. In fact says Dr. 44 Geoff Smith a pediatric dentist in St. John s NL roughly three per cent of all children will develop a cavity in early childhood. That is one of the main reasons why both the Canadian Dental Association and the American Dental Association recommend children visit the dentist Fall 2013 Living Healthy In Atlantic Canada The dentist will examine your child and may take x-rays to get a look below the surface. cavities in young children come from prolonged use of the bottle or sippy cup. There is a condition commonly called baby bottle tooth decay that occurs when infants and toddlers suck on a bottle of milk or juice over long periods. A domino effect happens sugars in the beverages feed the bacteria that in turn produce acids that then attack the tooth s enamel. That s when cavities are formed. The recommendation is that the baby bottle be discontinued by 12 months says Dr. Smith. The result is a healthier baby he notes. Removing the bottle or sippy cup from the equation will improve nutrition. Cavities in young children are also linked to frequent ear infections a result of the high sugar content of most antibiotics. If your child is prone to such infections you may want to take the little one to the dentist before age one. Certainly discuss the infections with the dentist during your initial visit. Talk with your dentist The opportunity for discussion is one of the main benefits of taking your child to the dentist by their first birthday. Dr. Smith for example makes it a point to talk about fluoride toothpaste and fluoride supplementation diet the health of the mouth s soft tissues and problems arising from thumb sucking or pacifier use. Other common topics include How to best care for your child s mouth now and as they grow How to prevent accidents that could damage the face and teeth Teething and other growth signposts It s helpful to identify your questions before the visit to make sure nothing gets omitted or overlooked when you re with the dentist. The Canadian Dental Association notes that during the first visit you can also find out if the cleaning you do at home is working. The first visit is also a milestone visit. This is an age where you normally don t expect to find a large number of problems and is a good time to begin the process of introducing the child to the dental environment says Dr. Smith. Many children are quite comfortable with that first visit. It s novel and they have a loved one with them. In fact many experts recommend two adults accompany the child. That way while mom or dad is speaking with the dentist the little one is engaged and content. Likewise bringing a favourite toy is a good idea. That way when the dentist says Open wide even the youngest patients will feel at ease. Well positioned For your child s first visit the dentist may opt to use a technique called a knee-to-knee exam that lets both of you get a look inside the mouth. This technique is done with you and the dentist sitting facing one another. Your child sits on your lap looking at you. Then you lay the child down with their head in the dentist s lap. This way the dentist can now look directly into the child s mouth and you can also see inside as the dentist points things out. This position also allows the little one to see the face of a parent or other loved one as the dentist conducts the examination. Dr. Smith points out that some oral health conditions may be an indication of another medical problem. Basically anything that you identify and fix can have an impact on long-term health Richard Smith Fall 2013 Living Healthy In Atlantic Canada 45 On guard An ounce of prevention can prevent a ton of pain In almost all sport or physical activity there is risk. In many cases the mouth jaw or teeth are affected. Mouth guards can reduce both the likelihood and the severity of injury. Depending on the type and extent of the injury a single blow to the mouth can result in months or even years of treatment--and no shortage of pain and discomfort. In almost all sport or physical activity there is risk. In many cases the mouth jaw or teeth are affected. Mouth guards can reduce both the likelihood and the severity of injury. Here s why. properly fitted mouth A guard will help protect not only your teeth but your lips tongue cheeks and jaw joint. The mouth guard cushions the impact and has even shown to reduce the severity of concussions says Dr. Todd Rix a dentist in Charlottetown whose office has been making mouth guards for the Charlottetown Islanders hockey team for six years. 46 teeth and the soft tissue in and around your mouth. More than just a mouth guard Not surprisingly mouth guards help prevent chipped or broken teeth and protect lips and gums. They may do much more however. Health Canada notes that some studies have found mouth guards may also help prevent concussion bleeding from ruptured blood vessels in the brain and neck injuries although the evidence is not definitive. Still almost a decade ago the Canadian Academy of Sport Medicine took the official position that mouth guards should be worn while playing Studies have shown that athletes are up to 60 times more likely to suffer harm to their teeth when not wearing a mouth guard he adds. According to Health Canada when you are hit in the mouth or jaw a mouth guard acts as a buffer that redistributes the force of the blow so the impact is absorbed more evenly. It also provides a barrier between the Fall 2013 Living Healthy In Atlantic Canada Dr. Todd Rix a dentist in Charlottetown says Studies have shown that athletes are up to 60 times more likely to suffer harm to their teeth when not wearing a mouth guard. 1. soccer for the definite dental protection they provide and the possible role in concussion prevention. Three types of mouth guards Wear the correct mouth guard for you 1. Stock tray mouth guards can be purchased from most sports stores. They are pre-made and come in a variety of sizes. All you have to do is open the package and put the guard in your mouth. 2. Boil-and-bite mouth guards which can be purchased at your local pharmacy become pliable when heated. Once softened you pop the guard in and it forms to the shape of your mouth and fits more closely over your teeth than a stock guard. 3. Finally there are custom made guards that your dentist can prepare. These are molded specifically for your teeth and your mouth. Many experts recommend those. Younger athletes those from about age six to 13 require custom mouth guards to be changed more frequently as they have a mix of adult and baby teeth and their mouths are changing. This means that their mouth guards will probably need to be made new each year and sometimes sooner says Dr. Rix. You can always have the dentist check to see if your mouth guard still fits or is worn out. Most mouth guards are worn over the upper teeth only. However for people with braces and other dental devices a guard for the bottom teeth may also be helpful. There is also no lack of variety. They come in different colours and combinations so can match your team s colours says Dr. Rix. If you re playing a sport or engaged in an activity that requires a helmet or headgear mouth straps can be added so your guard hangs lose when not in use and can be instantly popped in your mouth when required for play. 2. 3. Keep it clean You will need to ensure the mouth guard is clean. This isn t difficult before and after each use rinse the guard under cold water. You can also clean mouth guards easily with toothpaste and your toothbrush. Stay away from the automatic dishwasher though. Many patients have tried to clean them in their dishwashers only to find a big ball of plastic says Dr. Rix. He also recommends that mouth guards be stored in a perforated container to prevent distortion. High temperatures can also distort them and cause them not to fit Dr. Rix notes. Fit is critical. It s what affords you the ultimate protection you want when you re on the ice on the field or anywhere else your activity could cause an injury or an accident. Fall 2013 Not just for contact sports Mouth guards aren t just for pro athletes and extreme sports enthusiasts. Most team sports and some individual activities carry a risk of injury that mouth guards can help prevent. Most people think of contact sports like hockey or football but any sport where there is a potential for a fall or to be hit by something even individual sports like gymnastics or skateboarding will benefit from a mouth guard says Dr. Todd Rix. A sports mouthguard is also recommended for non-contact sports because mouth injuries can also occur unexpectedly in what may be considered fairly low-risk activities such as A blow to the face etc A jaw and teeth injury caused by severe clenching of teeth in weight lifting An inadvertent contact in basketball 47 Living Healthy In Atlantic Canada Avoiding bad breath One of the most common questions asked of dentists Looking to dampen a romantic moment an intimate conversation or special kiss with the grandkids Look no further than your breath. It s among the top questions asked of dentists. Halitosis (bad breath) is a common and sometimes persistent condition that can be freshened in the short term and avoided longer term. In most cases the causes are simple and straightforward but bad breath can also be an indication something is seriously wrong. instances where salvia flow has been reduced. Smoking. This will come as no surprise but tobacco isn t breath friendly. It dries the mouth and irritates some tissue. Unclean dentures. Just like teeth dentures require regular and thorough cleaning. When they re not fresh your breath won t be either. Infection. A throat sinus or lung infection can cause bad breath. Medical conditions. Some liver and kidney diseases cause bad breath. It can also be a warning sign of oral cancer and lesions in the mouth. Persistent bad breath should be discussed with your dentist. The treatment For most bad breath there is good news. It can be treated easily. Daily brushing and flossing are necessary to remove food particles and the bacteria that like to call your mouth home. Good brushing includes your tongue. Tongue scrapers are recommended by many dental professionals and can be purchased at your local pharmacy. Fall 2013 The culprits Food. What you put in your mouth will affect your breath in two ways. First there are some foods that cause an unpleasant odour when you exhale--garlic and onions being the classic examples. As well food that stays in your mouth because you haven t brushed or flossed in a while will collect bacteria which also creates breath odour. Interestingly eating too infrequently may also cause bad breath as dieters often discover. Oral bacteria. Bad breath that persists may be an indication you have a problem with plaque which causes gum disease. A cavity can also cause bad breath. Have your dentist take a look to see if there is a problem. Dry mouth. When there is too little saliva in your mouth food particles stick around and bad breath can result. Many medications cause dry mouth and some medical conditions that promote breathing through the mouth can do the same. You re also likely to get a whiff of halitosis in the morning before you brush your teeth or if a long time passes between meals. Both are 48 A mouthwash with antibacterial properties and no alcohol is also helpful to combat bad breath on short notice. For people with dry mouth there are special saliva supplement rinses. According to the New Brunswick Dental Society you can do more than freshen bad breath you can help to avoid it the first place. Here s how Drink plenty of water to flush away bacteria and keep your mouth from getting too dry Use sugarless gum or candies to moisten your mouth and freshen your breath Use mouthwash before bedtime to kill bacteria Bad breath is unpleasant but it is not uncommon. The dental society reports as many as 75 per cent of Canadians fret about their breath at least once a day. If it s on your worry list talk with your dentist about the cause and what you can do to freshen your mouth. 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