Archive | Health & Fitness

How to Protect Your Skin From the Sun This Summer

Posted on 26 June 2015 by admin


What have been the recent changes in sunscreen protection?

There are two major changes in Canadian sun protection taking effect this summer. They’re part of a new Health Canada legislation that passed late last year. These changes are going to start happening this summer and will apply to new products. However, you may still see some products in the store, like last year’s stock in example, that aren’t following these rules.

The first major change is the UVA circle, which is the new seal of protection. This is possibly the most important piece of news in sun protection.

UVB rays cause sun burns and represent 5 per cent of the harmful UV rays which come from the sun. Meanwhile, UVA rays cause skin cancer and aging, and represent 95 per cent of the harmful UV rays that come from the sun. SPF is only a measure of UVB protection and doesn’t imply anything about UVA at all.

Since SPF is only referring to protection from UVB rays causing sunburns, Health Canada wanted a way to let people know how well sunscreens on the market can protect from UVA rays.

What to look for: Sunscreens that meet health Canada’s minimum standard of UVA protection will be allowed to display a new logo on their packaging. It looks like the image below. Canadians need to look for the circle.

The second major change is the new limit on SPF.

While there’s a significant difference between SPF levels of SPF 30 and SPF 60, once you
go above SPF 60, there’s a minimal difference in the level of protection that you’re getting.

Reason for the change: Health Canada wants to stop the misconceptions that lead to under-use of sunscreens with excessively high SPF. For example a common misconception is the idea that “SPF 100 is 100 per cent protection from the sun.”

It’s not, in fact no sunscreen is truly 100 per cent protection but once you’re at SPF 50, you’re about as close as you’ll get. This misconception causes people to under-apply thinking they’re more protected than they are. Or perhaps worse, not bother to re-apply.

What to look for: From now on the new cap on SPF will be 50. If a sunscreen has a higher SPF value than that it will be labelled as SPF 50+. This should keep things safe and easy to understand for Canadians.

Who should be using sunscreen?

Everyone should be using sunscreen, but especially children as their skin is more fragile and susceptible to sun damage. More importantly, if you get a serious sun burn before the age of 16, your chances of suffering from skin cancer later in life (increases).

If you have been using self tanner are you safe from the sun?

If you want a your skin to have a golden, “sun-kissed” glow, self-tanners are a much safer way to achieve this look, rather than actually tanning in the sun. Just keep in mind that self-tanners often don’t contain much (if any) SPF or UVA protection. So if you’re going outside in the sun, you’ll still need a high protection sunscreen.

How to get the most out of your sunscreen protection?

Ensure that you’re applying 30 ml (which is the equivalent of the size of a golf ball) for your whole body when you’re out in the sun.

Ensure you apply your sunscreen 30 minutes before going outside. It takes about this long to bind to your skin. However, if you use a mineral sunscreen, it can be applied right before you go out under the sun and you won’t need to wait 30 minutes.

Sunscreen only lasts for two hours. Make sure you re-apply if you’re going to be out in the sun longer. Keep in mind that it takes 30 minutes for your sunscreen before it starts working, so that implies to re-apply every 1.5 hours to be safe.

Any other tips?

Even if you’re using waterproof sunscreen, make sure you re-apply after you towel off.

I will be using these tips to keep my skin safe and happy this summer. Your suggestions are always welcome, as I continue on my journey to enjoy life to the fullest. Let’s have the very best 2015!


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Monkey malaria in humans on the rise

Posted on 13 June 2015 by admin


Plasmodium knowlesi, previously thought to only affect macaques, caused 66 per cent of Malaysia’s malaria cases last yea

In the spring of 1965, a lone American set off for the jungles of Malaysia, sleeping by day and working by night. The official story is that “B.W.” was a surveyor with the U.S. army; it’s believed, however, that he was actually a CIA spy, dispatched to the Malaysian hilltops to eavesdrop on communists.

It remains unclear what B.W. accomplished in that jungle. But according to the medical literature, he definitely picked up something strange: a mean case of monkey malaria.

Two weeks after leaving Malaysia, B.W. landed in a Maryland hospital with a diagnosis of Plasmodium knowlesi, a form of malaria previously thought to only infect macaques.

He became the first person in recorded history to catchmonkey malaria in the wild, but he would not be the last. Today, five decades after B.W. came down with a fever, thousands of P. knowlesi cases have been reported across Southeast Asia, in every country but Laos. The vast majority have occurred in Malaysia, where the monkey parasite is now the leading cause of human malaria, and government officials recently announced that P. knowlesi caused 66 per cent of the country’s 3,923 malaria cases last year.

Once written off as a monkey problem, scientists now consider P. knowlesi to be the “fifth human malaria.” But even as the human toll ticks upward, the mystery around this strange disease lingers.

“It’s surprising how little we do know about P. knowlesi,” said Jonathan Cox, a medical geographer with the London School of Tropical Medicine and Hygiene, who is spearheading a project studying the disease’s emergence. “I don’t think it’s going to cause a pandemic or anything. But we don’t know enough about the risk factors to know exactly what we’re dealing with yet.”

Even the CIA agent’s case was considered a fluke, with investigations at the time concluding it was a freak occurrence.

“The 1965 case was probably considered a curiousity,” said Dr. Christopher Plowe, a malaria expert with the University of Maryland. “We had no clue P. knowlesi was significant to human health.”

But then came the husband-and-wife team of Balbir Singh and Janet Cox-Singh, both malaria researchers who moved to Malaysian Borneo, where they started a lab at the University of Malaysia Sarawak.

Prior to leaving, Singh asked a World Health Organization colleague if there was anything interesting about malaria in Malaysia that he should investigate. “He said, ‘Look out for P. malariae,” Singh recalled.

  1. malariaeis one of the rarer forms of human malaria. But as the country made greater strides in fighting malaria — reducing its annual caseload from 60,000 in 1995 to less than 4,000 last year — it became increasingly clear that there was something odd about Malaysia’sP. malariae cases.

For one, patients were getting really sick, sometimes even dying — unusual for P. malariae, which is thought to cause milder disease. So Singh travelled by boat up the Rajang river to visit a hospital in the remote region of Malaysia where cases were clustering, bringing a handful of patient blood samples back to his lab.

Using what was then-considered novel gene sequencing technology, Singh quickly realized why these cases were so weird. They weren’t P. malariae at all; they were P. knowlesi.

“Initially, we thought it was just one or two cases,” said Singh. “But what we found out was that virtually everything that’s been identified as P. malariae has been P. knowlesi.”

Singh has since identified more than 1,200 cases and he now believes that P. malariaeisn’t endemic to Malaysia at all. He explains that previous cases were probably misdiagnosed because the two malarias look so similar under the microscope.

For Singh, there are many important questions to answer still when it comes to P. knowlesi, including why, exactly, cases seem to be on the rise. His worst-case scenario is that P. knowlesi (still believed to be sporadically jumping from monkey to human) will evolve to start spreading human-to-human — a development that could pave the way for monkey malaria to spread beyond Southeast Asia and regions where macaques are prevalent.

Of the five human malarias, P. knowlesi is still a lower priority, accounting for a tiny proportion of the total human misery caused by this disease. But scientists know fully well that infectious diseases are always ready to send up new surprises.

“We can too often, as researchers, slip into a way of thinking that ‘Malaria is this’ or ‘Malaria is that,’” said David Conway, a malaria researcher at the London School of Hygiene and Tropical Medicine who also studies P. knowlesi. “But that can change — and it has changed.”

Why are cases of monkey malaria on the rise?

Here are four theories for what might be driving the uptick:

Better detection

Scientists suspect Plasmodium knowlesi has long been infecting people — only now we have the tools to detect it. Under the microscope, the parasite looks near-identical toPlasmodium malariae but thanks to a technology called PCR, scientists can now accurately diagnose monkey malaria. And as the old adage goes: “The more you look, the more you will find.”


Malaysia is undergoing massive deforestation, primarily due to an expansion of palm oil plantations. This means macaques (the natural “host” for the P. knowlesi parasite) are being driven from their habitats and spreading closer to human populations. Meanwhile, human population expansion is bringing people into jungles — and therefore closer to macaques and the mosquitoes that bite them.

Mosquito behaviour

The mosquitoes that transmit monkey malaria belong to the Anopheles leucosphyrusgroup, a forest-dwelling insect that likes to feed outdoors and bite at night. They prefer feeding on macaques but perhaps they’ve recently developed a taste for humans; another theory is that a new mosquito species has entered the mix. “Some mosquito vectors are quite open-minded,” said David Conway with the London School of Hygiene and Tropical Medicine. “Mosquito populations can shift.”

Parasite mutation

Scientists still have a lot to learn about the P. knowlesi parasite and a recent study revealed that humans were actually being infected by two subtypes of the parasite, each specific to a species of macaque. So what might happen if mosquitoes were simultaneously infected by both P. knowlesi subtypes? “Potentially you could get hybridization,” said Jonathan Cox with the London School of Hygiene and Tropical Medicine. “And that might change how pathogenic this parasite is.”

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Effective moves to deal with flabby arms

Posted on 08 February 2015 by admin

O you are one of those, one with the slender waist, yet are too embarrassed to get into a sleeveless outfit because you are embarrassed of your jiggly arms. It’s that upper arm flesh, which makes us think twice even when wearing short leaves. But you don’t have to live with those bat wings, sweat it out at the gym, or at home, and you are good to go.

But to get those wellsculpted arms, you need to work to reduce that flab from the back of your arms. For that, you need to include regular cardio workouts such as swimming, running, brisk walking, cycling in your workout regime, eat a healthy, balanced diet, give up processed, sugary food (cakes, biscuits, bread) for lean protein and good fats (chicken, lentils and dairy products), which will help your body build more muscle, and get at least six hours of sleep.

Aside of giving you a leaner silhouette, building muscle in your upper arms and shoulders helps you stand taller, so your posture improves. Arm strength is good for performances in activities from swimming to yoga.


Hold a weight in each hand and stand with your feet shoulder-width apart.

» The palms of your hands should be facing forwards.

» Bend your elbows, bringing your lower arms up towards your shoulders.

» Lower your arms slowly back and with control to the starting position.


Stand with your knees slightly bent, a free weight in each hand.» Keeping your back flat, bend forward at the hips, lift both arms to the sides until they are parallel to the floor, squeezing your shoulder blades as you lift and main taining a slight bend in your elbows.» Count to one, then slow down. Do 10 reps.


Sit tall in a chair or stand with feet shoulder width apart and knees slightly bent. Hold a weight in each hand and extend your arms straight out in front of you, chest height, slightly wider than your

» Bring your arms slightly forward, upward, and then backward, making 12 inch circles with your arms.

» Repeat the circle movement twelve times and then reverse the motion by going backward, upward, and the forward. Repeat that motion 10 times.


Lying on your back on a bench, extend your arms overhead with a free weight in each hand » Bend your el-

bows so your forearms are parallel to the floor. Slowly lengthen both arms at once, ex tending as high as you can. Count to one, then slow down. Do 10 reps.


Sit on a chair or bench. With your arms straightened, place your hands on the chair bench next to your butt.

» Extend your legs straight out in front of you. Now, lift your bottom off the bench. This is your starting posi tion.

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Heart and Stroke Foundation urges limits to sugar intake

Posted on 17 September 2014 by admin

The Heart and Stroke Foundation is calling on the federal government to set limits on the amount of sugar manufacturers can add to their products and on consumers to avoid sugar-sweetened beverages.

Mounting research has linked even moderate amounts of sugar consumption to heart disease, diabetes, stroke and other major health problems. The average Canadian consumes more than 13 per cent of their daily calories in the form of sugars added to food and beverages.

The new evidence is what prompted the Heart and Stroke Foundation to issue a series of recommendations, including a call for Canadians to reduce their total consumption of so-called “free” sugars to no more than 10 per cent of daily calories, with the ideal benchmark being 5 per cent of daily calories. Free sugars refers to all sugar added to food, as well as syrups, honey and fruit juices. Earlier this year, the World Health Organization issued the same recommendations.

The report is adding to the growing pressure on Ottawa to step up and do more.

After months of mounting calls to establish a national sugar-consumption guideline, the federal government in July proposed the creation of a 100-gram-a-day limit as a way to help people control how much sweet stuff they consume. Health experts criticized the limit for being far too high and failing to distinguish between sugars naturally found in fruit, milk and other healthy fare and sugars added to cereal, pop, yogurt and other products.

For instance, under the proposed limit, a person could drink two 355-millilitre cans of Coca-Cola every day and still be under the recommended sugar threshold. And the focus on total, rather than added, sugars may mislead consumers into thinking they should limit natural sources of sugar, such as whole fruit, which would be a mistake, according to Manuel Arango, the foundation’s director of health policy.

The federal government’s proposal offers a key advantage to food makers selling sugary products, says Yoni Freedhoff, an obesity and nutrition expert based in Ottawa. Under the proposed rule, food manufacturers will be required to express the sugar content of their products as a per cent of the total daily recommended intake.

Using the Heart and Stroke and WHO recommendation of limiting added sugar to 5 per cent of daily calories, a can of Coca-Cola would account for much more than 100 per cent of the limit. But if the daily guideline is 100 grams, the makers of Coca-Cola can say one 355-millilitre can of pop only accounts for 42 per cent of a person’s recommended daily sugar consumption.

“[The federal government is] addressing sugar in a manner that is extremely friendly to the food industry,” Dr. Freedhoff said. “It really is a half-assed approach to dealing with sugar.”

Health Minister Rona Ambrose has said it’s important to look at reducing overall sugar consumption, and that’s why the government won’t focus on added versus naturally occurring.

William Yan, director of the bureau of nutritional sciences in Health Canada’s food directorate, said the department has received numerous comments questioning what the per-cent daily value will look like with the new sugar guidelines. But he added that consumers shouldn’t be using the per-cent daily value as a nutritional guide. It’s supposed to simply communicate how much sugar is in a product. He added that the department will carefully consider the foundation’s recommendations before it finalizes its proposals on sugar.

The Heart and Stroke Foundation is urging the federal government to reconsider its position and take a tougher stand by adopting its and the WHO’s recommended sugar limits. It’s also asking the food industry to consider the evidence linking sugar to chronic disease and reformulate products to have reduced sugar content.

Stephanie Baxter, senior director of communications with the Canadian Beverage Institute, said the industry would look to the federal government rather than the Heart and Stroke Foundation on the issue of sugar because it “has the research behind it.” She added that the industry also sells products that have no sugar or reduced amounts.

Concerns over sugar reached a boiling point in February, when the Journal of the American Medical Association published a study that found people who get 25 per cent or more of their daily calories from sugar are three times more likely to die from heart disease. People who consume 10 to 25 per cent of their daily calories in the form of sugar face a 30-per-cent increased risk of cardiovascular disease.

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Fall Allergies

Posted on 10 September 2014 by admin

What Causes Fall Allergies?

Ragweed is the biggest allergy trigger in the fall. Though the yellow-flowering weed usually starts releasing pollen in August, it can last into September and October. About three-quarters of people who are allergic to spring plants are also allergic to ragweed.

Ragweed pollen loves to get around. Even if it doesn’t grow where you live, it can still travel for hundreds of miles on the wind. For some people who are allergic to ragweed, foods like bananas, melon, zucchini, and certain other fruits and vegetables can also cause symptoms.

Mold is another fall trigger. You may think of mold growing in your basement or bathroom – damp areas in the house – but mold spores also love wet spots outside. Piles of damp leaves are ideal breeding grounds for mold.

Don’t forget dust mites. While they are common during the humid summer months, they can get stirred into the air the first time you turn on your heat in the fall. Dust mites can trigger sneezes, wheezes, and runny noses.

Going back to school can also trigger allergies in kids because mold and dust mites are common in schools.

What Are the Symptoms?

  • Runny nose
  • Watery eyes
  • Sneezing
  • Coughing
  • Itchy eyes and nose
  • Dark circles under the eyes

How Are Fall Allergies Diagnosed?

Your doctor or allergist can help find out exactly what’s causing your watery, itchy eyes and runny nose. He’ll talk to you about your medical history and symptoms, and may recommend a skin test.

With a skin test, the doctor places a tiny amount of the allergen on your skin — usually on your back or forearm — and then pricks or scratches the skin underneath. If you’re allergic to it, you’ll get a small, raised bump that itches like a mosquito bite.

Sometimes a blood test may be used to diagnose allergies.

How Can I Treat My Allergies?

There are many medications you can use:

  • Steroid nasal sprays – reduce inflammation in your nose
  • Antihistamines – help stop sneezing, sniffling, and itching
  • Decongestants – help clear mucus out of your nose
  • Antihistamine eye drops
  • Immunotherapy in the form of allergy shots or oral tablets or drops
  • Stay indoors with the doors and windows closed when pollen is at its peak (usually in the mornings). Check pollen counts in your area.
  • Before you turn on your heat for the first time, clean your heating vents and change the filter. Bits of mold and other allergens can get trapped in the vents over the summer and will fill the air as soon as you start the furnace.
  • Use a HEPA filter in your heating system to remove pollen, mold, and other particles from the air.
  • Use a humidifier if you need to, to keep your air at between 35% and 50% humidity.
  • Wear a mask when you rake leaves so you don’t breathe in mold spores.

Tips to Manage Symptoms

Hospitals to query patients on race, sexual orientation

Hospitals are filled with sensitive information about what ails us, but a new series of questions being rolled out in parts of Toronto aims to drill deeper into personal lives, asking patients about their race, sexual orientation and how much money they make.

The large-scale demographic data collection appears to be a first in Canadian hospitals, calling on patients to reveal whether they were born in Canada and what language they prefer to speak. Whether they have a mental illness or abuse alcohol and drugs. Whether they’re heterosexual, gay or consider themselves “two-spirit.” Whether they make less than $30,000 or more than $150,000, or somewhere in-between.

Proponents of the voluntary survey say it’s designed to help health-care planners address inequities and language barriers and improve disease-prevention programs in one of the country’s most diverse and densely populated health regions. It’s also meant to fill an information vacuum created by the federal government’s elimination of the long-form census, said Camille Orridge, chief executive of the Toronto Central Local Health Integration Network.

But as the information-gathering project expands, some patients and physicians are raising concerns, questioning whether the survey is too invasive.

The data will help “ensure we’re planning for all populations,” Ms. Orridge said. “Capturing data at the start of the patients’ journey will … help us plan for the patients’ needs.”

George Vincent, an orthopedic surgeon at St. Joseph’s Health Centre, doesn’t think it’s appropriate to ask patients such personal demographic questions while they’re waiting for hospital treatment. He worries patients will feel obligated to answer. Or they might think their doctor ordered the survey and their responses could somehow negatively affect their care.

“That’s not the forum to be asking people about their sexual persuasion and the amount of money they have in the bank,” said Dr. Vincent, who suggests the questionnaire be mailed to patients instead. “They’re focusing on a vulnerable part of someone’s care, which I think is totally inappropriate.”

The provincially funded Toronto Central health region last year directed its 17 hospitals to begin asking eight demographic questions that stemmed from a pilot study involving two hospitals, Toronto Public Health and the Centre for Addiction and Mental Health. That project is now being expanded.

At St. Joseph’s, demographic data have been collected at presurgery registration since last October. Starting Tuesday, the questionnaire will be given to more patients – in the ambulatory care centre and at the fracture and eye clinics.

The expansion is at the request of Toronto Central, which asked St. Joseph’s and its other hospitals, including Mount Sinai, Sunnybrook and St. Michael’s, to broaden their survey efforts to capture 60 per cent of patients by the end of March, 2015. The data program was reviewed by health ethicists.

Other health regions are studying Toronto Central’s experience. Collecting socio-demographic data in hospitals occurs in the United States and United Kingdom, but it’s relatively new in Canada. Toronto Central began examining the idea in 2009.

Marylin Kanee, director of human rights and health equity at Mount Sinai, said properly training staff is key to ensuring patients feel comfortable with the survey and understand the information will be used to improve medical care. Researchers will not be given names of patients. Responses will be aggregated and analyzed to detect differences in health outcomes connected to variables such as race, language and poverty.

“This is information that will help us to tailor the care that we provide to our patients,” Ms. Kanee said. “It will give us information about who are patients are and it will help us to really understand where the inequities are.”

At St. Michael’s Hospital, Fok-Han Leung has experienced the benefits of having greater demographic information at his fingertips. Data collection was tested at the hospital’s family medicine outpatient clinic, with responses gathered on tablets. The information was then instantly linked to a patient’s file.

Seeing a patient’s income, for example, helped inform Dr. Leung’s prescription decisions. In some cases, a shorter medication supply and monitoring the drug’s effectiveness was more prudent than a costly 90-day prescription.

“It can sometimes help with diagnosis, but it very much helps with [care] management,” Dr. Leung said.

Patient participation in Toronto Central’s questionnaire has been strong so far: 85 per cent. At St. Joseph’s, Mike Heenan, vice-president responsible for quality and patient experience, said he’s heard from a few staff opposed to the hospital participating in the project. But he notes 95 per cent of 14,954 presurgery patients have answered the questionnaire, while only eight have registered concerns.

“We have not had anything that has caused us concern or has made us think we might want to pause this project,” Mr. Heenan said.

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Posted on 15 May 2014 by admin

By Dr. Amitha Jocie Mundenchira


Osteoporosis is a disease that leads to low bone mass and deterioration of bone tissue. This results in weak bones and risk of fracture, particularly of the hip, spine, wrist and shoulder.

Osteoporosis is sometimes confused with osteoarthritis.  Osteoporosis is a disease of the bone; osteoarthritis is a disease of the joints and surrounding tissue.  A person can have osteoporosis and osteoarthritis at the same time.  Both diseases may cause pain and limited mobility, but an accurate diagnosis is very important because the optimal treatment for both diseases is different.

At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime.  Over 80% of all fractures in people 50+ are caused by osteoporosis.  Osteoporosis can result in disfigurement, low self-esteem, reduced/lost mobility, and decreased independence.

The following are some statistics from the INTERNATIONAL OSTEOPOROSIS FOUNDATION (

  It is projected that more than about 50% of all osteoporotic hip fractures will occur in Asia by the year 2050

  Osteoporosis is greatly underdiagnosed and undertreated in Asia.

  Nearly all Asian countries fall far below the recommendations for calcium and vitamin D intake.

  India: Expert groups project an increase in the number of osteoporosis patients to 36 million by 2013.

In a study among Indian women aged 30-60 years from low income groups, BMD at all the skeletal sites were much lower than values reported from developed countries, with a high prevalence of osteopenia (52%) and osteoporosis (29%) thought to be due to inadequate nutrition.  In India, the majority of the population lives in rural areas, where hip fractures are often treated conservatively at home instead of by surgical treatment in hospitals

  Pakistan: Osteoporosis seems to be a significant problem due to major nutritional issues as well as limited and underutilised diagnostic facilities.

No single cause for osteoporosis has been identified.  The use of certain medications increase the risk of osteoporosis because they inhibit absorption of nutrients:  synthetic glucocorticoids (e.g. prednisone), breast cancer drugs, drugs to treat prostate enlargement and cancer, “heartburn” drugs, depo-provera (injectable form of birth control), excessive thyroid hormone replacement, anti-seizure drugs, mood-altering drugs, blood pressure drugs.  Certain medical conditions increase the risk of osteoporosis:  rheumatoid arthritis and other rheumatologic conditions, malabsorption syndromes like Crohns’s disease or conditions that affect the bowel like weight loss surgery, chronic kidney disease, chronic liver disease, diabetes, chronic obstructive pulmonary disease (COPD), untreated hyperthyroidism, neurological disorders that cause immobility (e.g. stroke), poor balance/gait issues (e.g. Parkinson’s disease) or reduced sensation (e.g. nerve damage from diabetes).

Sex Hormone Deficiency is also a risk factor.  In women this generally results in the early stoppage of menstrual periods (amenorrhea) due to premature menopause (before the age of 45), eating disorders such as anorexia nervosa, exercise-induced amenorrhea (typically seen in high performance athletes and dancers), chemotherapy, chronic illness, etc.  In men low levels of testosterone can be caused by a number of conditions including liver disease, chemotherapy, chronic illness, ageing, etc.

Osteoporosis does not develop overnight.  It is “the silent thief” because bone mass loss may occur steadily for many years without experiencing any symptoms or signs until a bone fractures.  If osteoporosis is first diagnosed at the time a fracture occurs, it is already fairly advanced.  Early detection of bone loss, therefore, is critical in preventing osteoporotic fractures.

Osteoporosis is diagnosed with Bone Mineral Density (BMD) test.  Without BMD testing, 80% of patients with a history of fractures are not given osteoporosis therapies.

The following is a checklist; if you check one or more on the list, you need to talk to your healthcare provider (

Part A:

If you are over 50 and have checked one or more of this list, see a healthcare provider to see if there is a need for BMD.

If you are under 50, it is very unlikely that BMD is required unless there is a chronic medical condition or medication that increases risk for fractures.    

□ Am I 65 or older?

□ Have I broken a bone from a simple fall or bump since age 40?

□ Has either my mother or father had a hip fracture?

□ Do I smoke?

□ Do I regularly drink three or more alcoholic drinks per day?

□ Do I have a condition that requires me to use a glucocorticoid medication such as prednisone?

□ Do I take any other medication that can cause osteoporosis such as an aromatase inhibitor for breast cancer or hormonal treatment (androgen deprivation therapy) for prostate cancer?

□ Do I have a medical condition that can cause bone loss or fractures? Examples include rheumatoid arthritis, celiac disease, gastric bypass surgery, COPD (chronic obstructive pulmonary disease) or chronic liver disease.

□ Did I have an early menopause, i.e. before age 45?

□ Have my periods ever stopped for several months or more (other than for pregnancy or menopause)?

□ Have I ever suffered from impotence, lack of sexual desire or other symptoms related to low levels of testosterone (male sex hormone)?

□ Do I currently weigh less than 60 kg or 132 lbs?

□ Have I lost more than 10% of my body weight since age 25?

□ Have I recently had an X-ray that showed a spinal fracture?

□ Have I had an X-ray that showed low bone mineral density?

Part B:  

If you are over 50 and have checked one or more of this list, there is a possibility of a spine fracture and there may be a need for a regular back X-ray.

□ Have I lost 2 cm (3/4″) in height as measured by my healthcare provider annually, or 6 cm (2 1/2″) overall from when I was younger?

□ Do I have kyphosis (a forward curvature of the back)?

Part C:  

Frequent falls can lead to broken bones.

□ Have I fallen two or more times in the past year?

□ Do I have an unsteady walk and poor balance?

□ Do I need to push with my arms to get up from a chair?

□ Do I need an assistive device such as a cane, walker or wheelchair?

            Building strong bones in early life can be the best defence against developing osteoporosis later.  There are lifestyle measures that can be taken to prevent the onset or the progression of osteoporosis:

Intake of Calcium and Vitamin D

Osteoporosis Canada recommends that those who are 50 years of age or more take 1200 mg of elemental calcium daily and 800-2000 IU of a vitamin D supplement daily. Those who are under 50 also require 800 – 2000 IU of a vitamin D supplement daily and should take at least 1200 mg of elemental calcium daily. Calcium supplements should only be taken if one cannot consume sufficient calcium from the diet. On the other hand, there are few food sources of vitamin D and sun is an unreliable source, so daily vitamin D supplementation is recommended all year round for all Canadian adults. A balanced diet, following Canada’s Food Guide (, will ensure that sufficient protein and other nutrients essential for bone health.

Regular Exercise (

People who engage in regular exercise have lower rates of chronic diseases due to improved physical and mental health. In children and teens, exercise can help to increase bone strength. In older adults, certain types of exercise help to prevent bone loss. Exercise also improves balance and coordination, which helps prevent falls and reduce fractures. It is impossible to develop a “one size fits all” program for exercise; always consult the healthcare provider before starting a new exercise program.  Those with a history of spine fracture from osteoporosis should avoid high impact exercises or sports that require forward bending, heavy lifting, reaching overhead, twisting, jumping, bouncing or jerky movements.

Smoking and Alcohol

Drinking an average of three or more alcoholic beverages per day may also increase bone loss and fracture risk. Osteporosis Canada recommends no smoking and no more than an average of two alcoholic drinks daily.

For more information, visit

Osteoporosis Canada (OC) is the leading source of information on osteoporosis in Canada.

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Posted on 16 April 2014 by admin

By Dr. Amitha Jocie Mundenchira


April is Autism Awareness month – more specifically, April 2 is autism awareness day. Autism spectrum disorder (ASD) is characterized by abnormalities in social interactions, markedly unusual communication skills, and RRBs (restricted repetitive behaviors, interests, and activities).

Shah Rukh Khan in “MY NAME IS KHAN” and Priyanka Chopra in “BARFI” played characters with ASD.

On March 27, 2014, the Centers for Disease Control and Prevention (CDC) released data from a surveillance study that identified 1 in 68 children (1 in 42 boys and 1 in 189 girls) in the United States as having autism spectrum disorder (ASD). At present there is no monitoring system to provide accurate Canadian statistics but ASD is the most common form of any neurological disorder or severe developmental disability of childhood.

Reported rates of autism spectrum disorder have been rising in many countries over the past 2 decades. It is unclear whether the increase in prevalence is a result of better detection or of increased risk for autism, but it is likely a combination of both. It is unclear whether differences in autism prevalence between ethnic groups are due to differences in risk for autism or due to differences in access to appropriate diagnostic and intervention facilities.

One study showed that brain changes in autism start when the child is in the mother’s womb. Autism can reliably be diagnosed at 24 months and in some cases at 18 months – health care professionals have to be vigilant during routine children checkups. The Modified Checklist of Autism in Toddlers (M-CHAT) is a list of informative questions – the answers can indicate to the parents if their child needs further evaluation. Early detection and intervention are critical to improving outcomes of individuals with autism. A typical diagnostic evaluation involves a multi-disciplinary team consisting of a pediatrician, psychologist, speech and language pathologist and occupational therapist.

Siblings of children with autism are at higher risk for the same. Therefore, siblings should also undergo screening.

There are no blood studies or scanning tests that are specific or helpful for the diagnosis/monitoring of ASD. Behavioural and developmental features that suggest autism include the following:

  • Delays in development
  • Absence of meaningful pointing
  • Abnormal reactions to environmental stimuli
  • Abnormal social interactions
  • Absence of smiling when greeted by parents and other familiar people
  • Absence of typical responses to pain and physical injury
  • Language delays and deviations
  • Susceptibility to infections and febrile illnesses
  • Absence of symbolic play
  • Repetitive and stereotyped behavior
  • Self-injurious behaviors – e.g., picking at the skin, self-biting
  • Abnormal motor movements – e.g., clumsiness, hand flapping
  • The motion anomalies demonstrated by children with autism are often highly characteristic and noticeable. An example of a motion typical in autism occurs when the child places a hand with fingers separately outstretched before the eyes and rapidly moves the hand back and forth. Such motions may be attempts by the child to provide themselves with sensory input in a barren environment.

The causes of autism are not clear but there are some speculations about associations with genetics, with the pregnant mother’s exposure to infections/toxins, with childhood vaccinations and with diet. There is some speculation that symptoms of autistic disorder are possibly aggravated by the consumption of dairy products, chocolates, corn, sugar, apples, and bananas; however, no large population studies have confirmed this. More research is needed about definite etiologies.

Autism is not caused by a lack of warmth/affection in parents, or by any other emotional or psychological parental deficits. Blaming parents for the development of autism in their children is inappropriate.

The established therapies for ASD include intensive individual special education, speech/behavioral/occupational/physical therapies and social skills training. Autistic children should be placed in these specialized programs as soon as the diagnosis is suspected. The use of medications is in cases where the ASD patient has associated issues like tics or cormorbid disorders like anxiety.

Sometimes ASD is diagnosed later in life, often in relation to learning, social or emotional difficulties. A diagnosis can also open access to therapies and assistive technologies that can improve function in areas of difficulty and, so, improve overall quality of life.

Autistic spectrum disorder individuals are at higher risk of physical, sexual and emotional abuse by others including their family members. In some communities, superstitious beliefs about the ASD individual being possessed by supernatural powers lead to maltreatment of the individual. Regulatory agencies have expressed particular concern that the rights of individuals with ASD be carefully protected.

The prognosis in patients with autism is highly correlated with their IQ. Growing evidence suggests that a small minority of persons with ASD progress to the point where they no longer meet the criteria for a diagnosis of ASD. Low-functioning patients may never live independently; they typically need home or residential care for the rest of their lives. High-functioning patients may live independently, hold jobs successfully, and even marry and have children.

We need further research to determine what genetic, physiological or developmental factors might predict who will achieve such outcomes.

In short, with timely diagnosis and better interventions/supports, those affected by ASD can have better outcomes in all spheres of life. 

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Posted on 11 March 2014 by admin

-          Dr. Amitha Jocie Mundenchira

-          Mississauga

Our society gives a lot of importance to the ability of having children.  Unfortunately, the infertile couple especially the woman suffers from the associated stigma.  In fact, women who have children are given more importance than those who cannot; this importance is heightened if the child is a male.  A major part of the stigma results from uneducated nonscientific or superstitious beliefs.

Research by the World Health Organisation (WHO) estimated that in 2010, 48.5 million couples worldwide were unable to have a child.  Infertility refers to the inability to conceive, to maintain a pregnancy or to carry the pregnancy to live birth.

There are many factors that are involved with a successful pregnancy and birth.  An estimated 20 percent of infertility cases are unexplained. Amongst the identifiable causes, about one-third are due to male factors and about one-third are caused by female factors. Roughly one-third of infertility is couple-related.  Lack of ovulation (female factor) and sperm deficiencies (male factor) are the most common infertility problems.

Ovulation is a complicated communication process between the hormones in the brain and in the ovaries.  Ovulation problems can occur due to a lack of eggs in the ovaries or due to a breakdown of the hormonal communication cycle. Sperm deficiencies can include low sperm production, lack of sperm, poor sperm motility or abnormal sperm.

Fertility varies among populations and decreases with age.  Age is a major factor in a woman’s fertility. As the age increases, the number and the quality of eggs in the ovaries decrease; low quality eggs can also be a factor in young infertile women.  Female fertility may start to decline as early as age 35 but male fertility may not significantly decline till age 50.

Less common identifiable fertility problems for women include structural problems like uterine fibroids, or scarring of the tubes +/- uterus caused by medical conditions like pelvic inflammatory disease and endometriosis, or very rarely, birth defects.

Due to this range of possible conditions, the couple should get a general checkup and medical advice from their doctor before trying to conceive. Being prepared increases the likelihood of natural conception.

A healthy diet and exercise-involved lifestyle is important.  Both low weight (BMI 19 and less) and high weight (BMI 30 and over) can affect hormonal cycles and fertility.  Women should take folic acid 0.4mg daily and minimize seafood consumption.  Men with diets high in lycopene, the chemical that gives tomato its red color, have lower levels of abnormally shaped sperm. Lycopene can be found in other red fruit and vegetables, such as red carrots, red bell peppers, watermelon and papayas, but not strawberries or cherries.

Smoking reduces fertility in both men and women.  Studies are inconclusive regarding relationship between alcohol consumption and infertility; it may be best to avoid alcohol all together since some studies do show a negative relationship.  Guidelines suggest that for women, drinking no more than 1 or 2 units of alcohol once or twice per week and avoiding episodes of intoxication reduces the risk of harming a developing fetus.  However, there should be no alcohol consumption at all while pregnant due to the burden of fetal alcohol syndrome.  As for men, more than 3 to 4 units of alcohol per day can affect their semen quality. Greater than 5 cups of coffee per day may be associated with decreased fertility.  Studies are inconclusive about behavior modification by men to control and decrease exposure of testicles to heat.

When trying, frequency of intercourse should be no less than every 2-3 days.  The likelihood of pregnancy is higher during the “fertile window” which spans 6 days ending on the day of ovulation.  There are a few ways of determining when ovulation has occurred:

(1)   cervical/vaginal secretions become slippery and clear,

(2)   there is a rise in basal body temperature

(3)   there are over-counter ovulation prediction kits.

It is best to avoid lubricants for intercourse.  However, if there is no way to avoid it, then mineral-oil/ canola-oil/ hydroxycellulose-based lubricants are more appropriate in order to facilitate sperm transport and to prevent leakage of semen from the vagina.

Stress can affect the couple’s relationship and is likely to reduce libido & frequency of intercourse which can contribute to the fertility problems.  Stress is also known to affect hormonal balance which, in turn, can lead to breakdown of fertility communication cycle as stated above.  As a doctor, I have seen many couples in my practice who have naturally conceived while on a relaxing vacation after being unsuccessful for over a year.  Therefore, it is important to recognise stress and deal with it before trying to conceive.

If you have not been able to conceive despite 12 months of regular unprotected intercourse, it is time to consult your doctor.  If the woman is over 35 years of age, consider consultation after 6 months of trying.

85 – 90 percent of infertility cases are treated with medication or surgery. In vitro fertilization (IVF) and other types of assisted reproductive technologies (ART) account for only about 5 – 10 percent of infertility treatments.

If we take the time to educate ourselves and others, we can hope to dissolve the stigma associated with infertility.






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World AIDS Day 2013: Moving Closer to Zero

Posted on 04 December 2013 by admin

What is World AIDS Day? It is a time when we pause to celebrate community, our diversity, and our shared progress in the global fight against HIV (human immunodeficiency virus). It is a time when we stand in solidarity with people who are living with and affected by HIV, and a time when we commemorate those who we have lost in the fight. It is a time when we raise our collective voice even louder to call out, push back, and dispel the stubborn and ever-persistent myths, misperceptions and stigma that create the walls and lay the conditions driving HIV infection rates across Canada and around the world.

World AIDS Day is a time when we stoke global awareness efforts for what remains one of the world’s leading public health and development challenges of our time. It is also a time when we reflect on our activities and ask ourselves “what we can be doing better?” to finally win the race and get to zero new HIV infections, zero AIDS related deaths, and zero discrimination.

This year’s Global Report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) shows us that we are making significant headway in gaining control over the epidemic. Rates of new infection are down around the world. In fact, this past year marked one of the lowest number of annual new infections recorded since the mid-to-late 1990s. Similarly, fewer children were diagnosed with HIV with reports showing a 52 per cent drop in new infections since 2001. And, over the past decade, treatment access has increased 40-fold — meaning not only more lives saved and potential transmissions averted, but that more people are enjoying longer and healthier lives with HIV (UNAIDS, 2013). This is tremendous progress.

However, despite these historic winnings significant hurdles remain. Rates of new infection may have declined globally, but many parts of the world are still experiencing substantial spikes in their epidemics (e.g., Middle East and North Africa, and Eastern Europe and Central Asia). Vulnerable population groups including, Indigenous communities, people who inject drugs, men who have sex with men, sex workers, prison inmates, women and transgender communities, still experience considerable health, social and political inequities, confront human rights injustices, and shoulder the brunt of new HIV infections. Advances in science, technology and implementation have helped to transform HIV into a manageable disease but have they come at the price of growing complacency and waning public interest?

This has been an exciting year for global public health and international development. Heads of state, business leaders, community and civil society representatives and members of the broader public have engaged through various forums and platforms in dialogue and discussion reviewing progress made on the Millennium Development Goals (MDGs). They have joined the on-going design of a blueprint for the incoming post-2015 development framework; and, they have mobilized to ensure a robust and fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria — the leading international financing institution for HIV, TB and Malaria programming around the world. Each of these proceedings will inevitably have a direct impact on our ability to respond here at home and abroad. Canada has a vital role to play in each of these processes. Through bold global leadership, continued support and strong investment we will be able to get HIV finally under our control.

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5 tips for healthy skin

Posted on 28 November 2013 by admin

Good skin care — including sun protection and gentle cleansing — can keep your skin healthy and glowing for years to come.

Don’t have time for intensive skin care? Pamper yourself with the basics. Good skin care and healthy lifestyle choices can help delay the natural aging process and prevent various skin problems. Get started with these five no-nonsense tips.

1. Protect yourself from the sun

One of the most important ways to take care of your skin is to protect it from the sun. A lifetime of sun exposure can cause wrinkles, age spots and other skin problems — as well as increase the risk of skin cancer.

For the most complete sun protection:

  • Use sunscreen. Use a broad-spectrum sunscreen with an SPF of at least 15. When you’re outdoors, reapply sunscreen every two hours — or more often if you’re swimming or perspiring.
  • Seek shade. Avoid the sun between 10 a.m. and 4 p.m., when the sun’s rays are strongest.
  • Wear protective clothing. Cover your skin with tightly woven long-sleeved shirts, long pants and wide-brimmed hats. Also consider laundry additives, which give clothing an additional layer of ultraviolet protection for a certain number of washings, or special sun-protective clothing — which is specifically designed to block ultraviolet rays.

2. Don’t smoke

Smoking makes your skin look older and contributes to wrinkles. Smoking narrows the tiny blood vessels in the outermost layers of skin, which decreases blood flow. This depletes the skin of oxygen and nutrients that are important to skin health. Smoking also damages collagen and elastin — the fibers that give your skin its strength and elasticity. In addition, the repetitive facial expressions you make when smoking — such as pursing your lips when inhaling and squinting your eyes to keep out smoke — can contribute to wrinkles.

If you smoke, the best way to protect your skin is to quit. Ask your doctor for tips or treatments to help you stop smoking.

3. Treat your skin gently

Daily cleansing and shaving can take a toll on your skin. To keep it gentle:

  • Limit bath time. Hot water and long showers or baths remove oils from your skin. Limit your bath or shower time, and use warm — rather than hot — water.
  • Avoid strong soaps. Strong soaps and detergents can strip oil from your skin. Instead, choose mild cleansers.
  • Shave carefully. To protect and lubricate your skin, apply shaving cream, lotion or gel before shaving. For the closest shave, use a clean, sharp razor. Shave in the direction the hair grows, not against it.
  • Pat dry. After washing or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on your skin.
  • Moisturize dry skin. If your skin is dry, use a moisturizer that fits your skin type. For daily use, consider a moisturizer that contains SPF.

4. Eat a healthy diet

A healthy diet can help you look and feel your best. Eat plenty of fruits, vegetables, whole grains and lean proteins. The association between diet and acne isn’t clear — but some research suggests that a diet rich in vitamin C and low in unhealthy fats and processed or refined carbohydrates might promote younger looking skin.

5. Manage stress

Uncontrolled stress can make your skin more sensitive and trigger acne breakouts and other skin problems. To encourage healthy skin — and a healthy state of mind — take steps to manage your stress. Set reasonable limits, scale back your to-do list and make time to do the things you enjoy. The results might be more dramatic than you expect.

By Mayo Clinic staff

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