WHERE CAN YOU FIND GOOD HEALTH INFORMATION?
The internet is full of information. Some of it is good, much of it is misleading or inaccurate.
On this page I provide guidance on some conditions and issues, but there is no way I can cover everything.
So there are sites that I can recommend that have detailed information about conditions, medications and so on.
The Canadian Family Physican site has information about some common conditions.
For children's health I recommend the Canadian Pediatric Society website.
WebMD is a site that has a lots of information about medical conditions and medications. A word of warning: it has ads and parts of it are sponsored by drug companies, and I'm always skeptical about any medical information that is sponsored by a drug company.
The Wellness Letter is a newsletter put out by the University of California that has excellent information about nutrition, healthy living and so on. It has a very good section that give information on alternative medications (herbs, supplements and so on).
Antibiotics
Antibiotics are incredibly effective medications for fighting bacterial infections.
However, they are often over-prescribed for conditions that do not require them. This has led to many bacteria developing resistance to antibiotics, and the development of “super-strains” of bacteria that are very difficult to treat.
I take a cautious approach to prescribing antibiotics. Some conditions clearly require antibiotics. Other conditions are often treated with antibiotics even though they probably don’t need them. Bronchitis is one condition like this. Studies show that whether a case of Bronchitis is treated with antibiotics or not, the outcome is the same. The same is true for most cases of Sinusitis. In children, most cases of Middle Ear Infections resolve on their own, without any antibiotics.
My role is to know which cases do and which don’t require antibiotics, and then to prescribe them appropriately.
Back Pain
This is one of the most common problems I see.
Most people will have low back pain at some point in their lives.
Dr. Hamilton Hall is a back specialist who has written some good books for how to deal with back pain.
A good website that explains back pain and has exercises is: www.back.com
Most people will have low back pain at some point in their lives.
Dr. Hamilton Hall is a back specialist who has written some good books for how to deal with back pain.
A good website that explains back pain and has exercises is: www.back.com
Cholesterol
Everyone asks about their cholesterol. Everyone wants to have it tested
It is true that high blood cholesterol levels do go hand in hand with heart disease, and people with higher cholesterol levels are at higher risk of heart attacks. But cholesterol is only one factor in this. Age, blood pressure, salt intake, family history, smoking, exercise, depression, and ethnic background also have an impact on whether a person is at risk for heart disease
In my opinion the importance of cholesterol is only one small factor in a person’s health, and certainly testing for it and medication treatment for high cholesterol are overemphasized. Having said that, I will recommend testing for some people, and I think that diet and exercise are very important for a person’s health, especially if their cholesterol is high. Only sometimes will I prescribe medications.
Here is a good web page about lowering cholesterol with diet.
Your risk for heart disease can be calculated, using some of these factors, by going to: Heart Attack Risk Calculator
It is true that high blood cholesterol levels do go hand in hand with heart disease, and people with higher cholesterol levels are at higher risk of heart attacks. But cholesterol is only one factor in this. Age, blood pressure, salt intake, family history, smoking, exercise, depression, and ethnic background also have an impact on whether a person is at risk for heart disease
In my opinion the importance of cholesterol is only one small factor in a person’s health, and certainly testing for it and medication treatment for high cholesterol are overemphasized. Having said that, I will recommend testing for some people, and I think that diet and exercise are very important for a person’s health, especially if their cholesterol is high. Only sometimes will I prescribe medications.
Here is a good web page about lowering cholesterol with diet.
Your risk for heart disease can be calculated, using some of these factors, by going to: Heart Attack Risk Calculator
Who needs Cholesterol lowering medications?
There is a lot of controversy about who should be taking cholesterol lowering medications (statins).
Just because your cholesterol is high, it doesn't necessarily mean that you should be taking a statin.
It is clear that people who have had heart attacks, and so have “established cardiovascular disease”, benefit from taking statins. In these people, taking a statin will reduce the risk of further heart attacks.
However, it is less clear about how effective statins are for people who have never had a heart attack and so don’t have “established cardiovascular disease”. Some research shows that they benefit. Some research shows that they don’t, and that even though the medications are effective at lowering cholesterol, the medications don’t prevent heart attacks. In general, if a person is at high risk of heart disease, they are more likely to benefit from taking a statin.
(It is important to remember that Statin medications are big business, and pharmaceutical companies have a huge stake in seeing research that shows that more people should be using their products. I believe that this has biased the research on cholesterol. )
I fall in the group that is careful about treating with statins. These medications can have side effects, and some of the long-term effects are not known yet. And once you start taking the medication you are on it forever – if you stop it your cholesterol level will go back to what it was before.
Generally I don’t recommend Cholesterol-lowering medications for my patients unless they are known to have cardiovascular disease, or they are at particularly high risk of developing heart disease.
Just because your cholesterol is high, it doesn't necessarily mean that you should be taking a statin.
It is clear that people who have had heart attacks, and so have “established cardiovascular disease”, benefit from taking statins. In these people, taking a statin will reduce the risk of further heart attacks.
However, it is less clear about how effective statins are for people who have never had a heart attack and so don’t have “established cardiovascular disease”. Some research shows that they benefit. Some research shows that they don’t, and that even though the medications are effective at lowering cholesterol, the medications don’t prevent heart attacks. In general, if a person is at high risk of heart disease, they are more likely to benefit from taking a statin.
(It is important to remember that Statin medications are big business, and pharmaceutical companies have a huge stake in seeing research that shows that more people should be using their products. I believe that this has biased the research on cholesterol. )
I fall in the group that is careful about treating with statins. These medications can have side effects, and some of the long-term effects are not known yet. And once you start taking the medication you are on it forever – if you stop it your cholesterol level will go back to what it was before.
Generally I don’t recommend Cholesterol-lowering medications for my patients unless they are known to have cardiovascular disease, or they are at particularly high risk of developing heart disease.
Flu Vaccine
The influenza vaccine is available in late October of each year.
The Ontario government suggests that everyone get the vaccine. Here is a link to their website.
I recommend the vaccine to patients who have serious chronic medical conditions, or chronic lung conditions such as asthma. Healthy adults may get the vaccine, and it does seem to be effective in preventing the flu, but it is not 100 % effective, especially in years that it does not match well with the strain of flu going around. Your chance of getting the flu if you are not vaccinated is about 3 in 100. If you are vaccinated it is 1 in 100. ( This also means that we have to vaccinate 100 people to prevent 2 cases of flu).
A summary of the research is here.
The Ontario government suggests that everyone get the vaccine. Here is a link to their website.
I recommend the vaccine to patients who have serious chronic medical conditions, or chronic lung conditions such as asthma. Healthy adults may get the vaccine, and it does seem to be effective in preventing the flu, but it is not 100 % effective, especially in years that it does not match well with the strain of flu going around. Your chance of getting the flu if you are not vaccinated is about 3 in 100. If you are vaccinated it is 1 in 100. ( This also means that we have to vaccinate 100 people to prevent 2 cases of flu).
A summary of the research is here.
Insomnia
This is a common and frustrating problem. I often see patients with insomnia that leaves them feeling tired and worn out.
I avoid prescribing sleeping pills for chronic insomnia, because they almost always cause dependence: the body gets used to having a sleeping medication at night, and then it gets difficult to do without them. In the worst case, they can be quite addictive.
Having said that, if somebody is going through a very difficult period and is having trouble sleeping, it may be OK to take a sleeping pill for a short time ( a few days to a couple of weeks).
The first thing to do for insomnia is to follow good sleep habits, which most of us don’t do very well. This websitehas a good section on sleep habits, ( also called “sleep hygiene”). There are good self-help books that give a more in-depth approach to insomnia. A book that I recommend is: Quiet Your Mind And Get to Sleep by Coleen Carney. When I treat patients for insomnia this is the approach I use.
If those basic things don’t help, you may want to come in to speak to me. For some sleep problems ( sleep apnea, for example) you may need a referral to a sleep clinic for an evaluation.
I avoid prescribing sleeping pills for chronic insomnia, because they almost always cause dependence: the body gets used to having a sleeping medication at night, and then it gets difficult to do without them. In the worst case, they can be quite addictive.
Having said that, if somebody is going through a very difficult period and is having trouble sleeping, it may be OK to take a sleeping pill for a short time ( a few days to a couple of weeks).
The first thing to do for insomnia is to follow good sleep habits, which most of us don’t do very well. This websitehas a good section on sleep habits, ( also called “sleep hygiene”). There are good self-help books that give a more in-depth approach to insomnia. A book that I recommend is: Quiet Your Mind And Get to Sleep by Coleen Carney. When I treat patients for insomnia this is the approach I use.
If those basic things don’t help, you may want to come in to speak to me. For some sleep problems ( sleep apnea, for example) you may need a referral to a sleep clinic for an evaluation.
Plantar Fasciitis
Here is a website that describes plantar fasciitis and its treatment.
Stretching is most important.
If you are going to get shoe inserts, the ones you can buy off the shelf should be just as good as custom orthotics.
Stretching is most important.
If you are going to get shoe inserts, the ones you can buy off the shelf should be just as good as custom orthotics.
Regular Check-ups
How often should you have a check-up? People frequently ask me this. There is no standard answer, as it varies from patient to patient according to age, risk factors and underlying medical conditions. So, for example, a patient with Diabetes should be seen every 3 months.
Infants need monthly check-ups at first. People with a family history of high blood pressure should have that checked annually.
My general guidelines are this:
People over the age of 65 should have an annual check-up.
Healthy people under 65 should have a check-up once every few years.
People over 50 should have a colon cancer screening test every two years, and should check their blood pressure annually.
Women need pap smears every three years once they've been sexually active, starting at age 21 until age 70.
There are several parts to a check-up. First I ask detailed questions about health risk factors ( family history, lifestyle risks such as smoking or lack or exercise, etc.). Then I do a physical exam ( which varies according to age, risk factors and so on), and then I order any necessary tests. The blood tests that are done also vary from person to person. Typically they are to check for things like Diabetes or Anemia. There are some specific cancer screening tests ( for Colon cancer, Breast cancer and Prostate cancer), which I might or might not recommend.
Travelers' health
If you are traveling to a country outside the developed world, there are certain health precautions I recommend. Information about travel can be found at the Center For Disease Control Website This website has up to date information about travel health, and provides advice about travel to specific countries. This is the site I check when I need to find detailed information about travel health.
I can provide the basic vaccines covered for all by the public health department ( Tetanus, for example).
I can also give you a prescription for Hepatitis A vaccine, typhoid vaccine or medications for prevention of malaria.
For certain vaccines ( yellow fever, for example), you need to go to a travel health clinic.
I can provide the basic vaccines covered for all by the public health department ( Tetanus, for example).
I can also give you a prescription for Hepatitis A vaccine, typhoid vaccine or medications for prevention of malaria.
For certain vaccines ( yellow fever, for example), you need to go to a travel health clinic.
Screening for Prostate cancer
Should you be screened for Prostate Cancer?
Men over the age of 50 are at risk of getting prostate cancer. One way of checking for cancer is to do a blood test, the PSA (Prostate Specific Antigen) test. If your PSA level is high, it might mean that you have prostate cancer.
There has been controversy about whether this test should be done or not.
The problem is that it is not a very accurate test, and so can lead to results that are incorrect. It might detect a cancer that would be life-threatening if left untreated. But there is a good chance that it might detect a type of prostate cancer that is growing so slowly that it would never bother you in your lifetime. However, once the cancer is detected you are "living with cancer", and because it is difficult to tell whether a cancer in the prostate will advance rapidly or grow very slowly, it is likely that treatment (e.g. surgery) will be recommended. Surgery can cure a cancer, but it leaves most men with urinary incontinence and impotence. The statistics are that 1410 men will need to be screened to save one person from dying of prostate cancer. Out of those 1410 about 50 will have been diagnosed and treated for prostate cancer unnecessarily.
This is the Ministry of Health's web page that describes PSA testing. It provides a good analysis of the pros and cons of the test.
Two recent studies from the New England Journal of Medicine about Prostate cancer screening are here: http://content.nejm.org/cgi/content/full/NEJMoa0810696 and http://content.nejm.org/cgi/content/full/NEJMoa0810084
Most recently the US Preventive Health Services advised against the test.
I don't recommend the test unless there is a very strong family history of prostate cancer or you have symptoms that might be from prostate cancer.
Men over the age of 50 are at risk of getting prostate cancer. One way of checking for cancer is to do a blood test, the PSA (Prostate Specific Antigen) test. If your PSA level is high, it might mean that you have prostate cancer.
There has been controversy about whether this test should be done or not.
The problem is that it is not a very accurate test, and so can lead to results that are incorrect. It might detect a cancer that would be life-threatening if left untreated. But there is a good chance that it might detect a type of prostate cancer that is growing so slowly that it would never bother you in your lifetime. However, once the cancer is detected you are "living with cancer", and because it is difficult to tell whether a cancer in the prostate will advance rapidly or grow very slowly, it is likely that treatment (e.g. surgery) will be recommended. Surgery can cure a cancer, but it leaves most men with urinary incontinence and impotence. The statistics are that 1410 men will need to be screened to save one person from dying of prostate cancer. Out of those 1410 about 50 will have been diagnosed and treated for prostate cancer unnecessarily.
This is the Ministry of Health's web page that describes PSA testing. It provides a good analysis of the pros and cons of the test.
Two recent studies from the New England Journal of Medicine about Prostate cancer screening are here: http://content.nejm.org/cgi/content/full/NEJMoa0810696 and http://content.nejm.org/cgi/content/full/NEJMoa0810084
Most recently the US Preventive Health Services advised against the test.
I don't recommend the test unless there is a very strong family history of prostate cancer or you have symptoms that might be from prostate cancer.
Vaccines
Early childhood vaccines are very important in keeping children healthy.
They are safe and incredibly effective, and I recommend them strongly far all children, as per the recommended vaccine schedule.
There is good information on childhood vaccines at the Canadian Pediatric Society website:
They are safe and incredibly effective, and I recommend them strongly far all children, as per the recommended vaccine schedule.
There is good information on childhood vaccines at the Canadian Pediatric Society website:
