Tag Archive | "health"

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#RealTalk: Cultural Facts & Perspectives that will make you a better doctor-

Posted on 21 August 2016 by Tammy Wong (Meds 2018)

The #RealTalk series allows our fellow students to share their ideas about how healthcare intertwines with their cultural and/or religious background. Check out this interview with 2nd year medical student Tammy Wong:

What is your background?

I was born and raised in Canada by Chinese immigrants from Hong Kong. My parents are Buddhist and raised me with traditional Chinese values.

What aspects of your culture differ from the stereotypical norms?

Family values: Chinese families focus largely on respecting and caring for elders and often decisions are made as a family, especially in relation to healthcare plans for patients. Furthermore, it may be hard to elicit patient wishes from the family’s wishes if they differ, but if physicians were perceived to ‘go behind/around’ the family then it would cause distrust in the system.

Food: One tradition when family members are in hospital or are ill, is that families will bring lots of cultural food to the patient so physicians should keep this in mind if there are diet restrictions for inpatients (i.e. NPO, low salt, etc).

Perspective on death and dying: Many Chinese immigrants, especially elders, are very superstitious. There is an idea that you will jinx something by saying it aloud so often patients avoid talking about death or risks with procedures. As a physician, you need to talk about these so you have to elicit it somehow from the patient. There is also a feeling of duty from remaining family members that they need to do everything that they can to ensure the patient’s survival, so a discussion about palliative care may be harder to approach but is necessary, especially if it coincides with patient wishes.

Perspective on mental health: There is usually a stigma regarding mental health among Chinese families. Many Chinese people do not really believe in the concept and think that you should just ‘get over it’. They also worry about being labelled with a mental health condition and often refuse to address it. This is something that physicians should be aware about and should try to educate to reduce the stigma.

Language barriers: Like with many other cultures, there may be a language barrier when speaking with Chinese patients. Furthermore, in Chinese culture it is common to nod or make sounds of agreement as a symbol to show that the listener is paying attention and as a form of respect. However, in contrast with Western culture, ‘nodding’ doesn’t always mean understanding and agreement; it is just to show respect and listening. Ask if they need clarification and summarize to check if patients actually are understanding.

Paternalistic view of medicine: Particularly with the elderly Chinese patients, they may be used to doctors telling them what to do and not really asking questions about their wishes or opinions because this was the format they were brought up with. Patients are also taught that doctors deserve respect and should know what is best for you. It is important to ask for patients’ wishes and values and to explain risks to help them make informed decisions, rather than just having them follow what you recommend.

Tell us a bit about Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is still largely used by the Chinese community under the view that it can treat the body holistically and strengthen the body. Often patients will use TCM while also being treated with Western medications. In some cases, private insurance companies may require prescriptions for acupuncture, etc in order for the treatments to be covered. Without the prescription, the treatment can be very expensive and patients may need to go to ‘sketchier’ or unlicensed providers to save money which is more dangerous. Consider prescribing these treatments even if you don’t really believe in it to help out a patient pay for this, especially for a chronic disease that may not be curable with Western Medicine.

When performing a physical exam, what should be done that differs from what we are taught at school?

While there isn’t anything specific to ask about, many Chinese citizens are very modest so proper draping is very important, especially with elders. Ask if the patient would like anyone else in the room (i.e. spouse or family members) and explain what you are doing very clearly.

If you could give one piece of advice to us future doctors on providing care for your population, what would it be?

Always ask for clarification/understanding and take a bit of time to ask if there are any other issues when speaking with Chinese patients. They may not discuss their true fears or opinions until later on in the interview, especially if it is something embarrassing, sensitive or worrying to discuss. Mental health issues also fall into this category because it is often brushed under the rug. Be sure to ask and also suggest lots of supportive resources for these patients.

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Floating in the Bathtub of Medicine

Posted on 24 April 2015 by Erica Hoe (Meds 2016)




Having recently finished my psychiatry rotation, I have become more attuned to the importance of mental health in our profession. It’s been estimated that rates of depression are about 15-30% higher in medical students and residents compared to the general population. Adopting a healthy lifestyle can help us to stay afloat in a profession that demands much of our sanity.

I picture myself as a rubber duck. I don’t physically resemble one, at least not usually, but I think it’s a good analogy. I am floating along, happily in the bathtub. I feel weightless. I meet a few bubbles here and there. All’s good.

Once in a while, though, I have patient encounters where I find myself not only empathizing with their struggles, but also bearing their burdens. In the end, it’s like a couple of small bubbles have been added on my back, and I must carry them around on my journey in the bathtub. I carry around these bubbles, and I sink a little lower down in the water. That would be fine, however, in addition to my patient bubbles, I also have “improve your hand-writing and stop losing pens” bubbles, “don’t lose your cool at the anti-vaccinators or the crying babies” bubbles and “smile-and-nod no matter what your preceptor says” bubbles, etc. All as to say, at some point, I have taken on too much. I am expecting myself to stay afloat, when I physically cannot. I have to make some sort of change, or I sink.


There are three ways I can help myself from sinking:

  1. Inflate myself with more air and act like a floatation device.
  2. Increase my surface area so I can hold more bubbles.
  3. Just let the bubbles roll right off my back.


Let’s start with #1: Inflate myself with air.




This means, I’ll need to breathe more and increase my tidal volume. What better way to do that than through exercise?

A recent JAMA article and 2013 Cochrane review show that exercise causes a greater reduction in depression symptoms than placebo or other interventions like relaxation or meditation.1 Depression has also been found to be associated with lack of physical activity.2

Exercise may provide physiological effects such as increases in endorphin and monoamine levels, and reduction in cortisol levels.2 Exercise stimulates the growth of nerve cells and the release of brain-derived growth neurotrophic factor (BDNF), which is important for learning and memory.2,3 Exercise has the ability to improve executive function and increase neuroplasticity. In fact, neuroimaging studies show that there are changes to areas involved in higher-level cognitive functions such as the prefrontal cortex and hippocampus.3 This improvement allows for a sense of mastery, positive thoughts, and enhanced self-efficacy which all improve mood.3

Even a small amount of exercise appears to be helpful, as there is no indicated type, intensity or frequency that has been associated with alleviating depressive symptoms.2 There is even some small evidence to suggest that exercise may work as effectively as pharmacological or psychological therapy, however more studies are needed.2

Needless to say, do anything active, and your mood will be uplifted. You may even lower your risk for developing depression.4


#2: Increase my surface area.




No, this does not mean I physically increase my surface area. Though it would be fun and delicious to binge on junk food, I actually want to increase the proportion of healthy foods that I eat. By eating the right proportion of foods, we gain the energy to power through the day. A good guide is to follow these 5 tips from the Dieticians of Canada5:

  1. Go for whole grains.
  2. Load up on veggies and fruit. Making a smoothie is a good way to get 2-3 servings at once.
  3. Have 2 cups of milk or fortified-soy beverage per day. The Vitamin D is not easily found in other foods.
  4. Choose lean meats or meat alternatives (chick peas, lentils, kidney beans).
  5. Limit saturated and trans fats. Healthier unsaturated fats are found in: avocados, nuts, seeds, oils (olive, flaxseed, nuts, canola)

More tips here: http://www.dietitians.ca/Downloads/Factsheets/5-Tips-for-Healthy-Eating.aspx


I was also recently made aware of the positive effects of Vitamin D on depression. A meta-analysis published in 2013, revealed that lower serum 25-OH Vitamin D3 levels were associated with a higher risk of depression.6 In fact, another recent study found that depressed older persons had significantly lower 25-OH and 1,25-(OH)2 Vitamin D3 levels compared with non-depressed counterparts.7 Another study found that lower levels of Vitamin D3 were associated with increased severity of depression and an increased risk for depression.Proposed mechanisms for this association include that vitamin D: 1) has receptors that are distributed in neural areas involved in emotional processing and affective disorders, 2) regulates serotonin synthesis, and 3) impacts the production of pro-inflammatory cytokines that influence mood by activating the stress response.9

Despite these findings, a meta-analysis published this year in March, looks at 9 randomized controlled trials and found that there was no significant reduction in depressive symptoms after Vitamin D supplementation.10 However, these authors do identify that perhaps the duration of follow-up was not yet long enough to determine any effect.10 And, even though Vitamin D was not shown to have a significant effect in those who are already depressed, lower levels are associated with depression, and thus supplementation may play a role in prevention. Given the low cost and limited issues with toxicity, it cannot hurt to take extra Vitamin D supplementation and to incorporate foods that contain Vitamin D into our diet.9 Perhaps this is also a perfect excuse to bask in the sunlight more often.




The Family Medicine Practice Guidelines recommend 800-2000 units of Vitamin D per day in adults.12 The Canadian Cancer Society recommends 1000 units of supplementation to all adults who live in Canada, especially in the fall and winter months. The daily upper limit is 4000 units. Supplementation is contraindicated in hypercalcemia and hyperphosphatemia.12

In addition to taking big gulps of sunlight whenever you get the chance, there are some foods that have Vitamin D. These include: fish like salmon and tuna, liver, fortified milk or soy beverage, fortified orange juice, margarine, egg yolk.11 One glass of fortified milk or soy beverage has about 100 units of Vitamin D. Fish can range between 100-700 units.

For a full list of foods and number of units associated with serving size visit: http://www.dietitians.ca/Downloads/Factsheets/Food-Sources-of-Vitamin-D


#3: Let the bubbles roll off.



Finally, what better way to shake it off, than to sleep it off. A meta-analysis of 21 studies showed that non-depressed people with insomnia have a two-fold chance of developing depression compared to people with no sleep difficulties.13 Treating symptoms of insomnia may help to prevent subsequent development of mood dysfunction.13

I mean, just look at that baby.

In order to get good sleep, it’s important to practice good sleep hygiene. This includes not doing any stimulating activities 1 hour before bedtime: no exercise, no big meals, and no TV-watching or use of electronics. Limiting fluid intake before bed can help to decrease the occurrence of nocturia. It’s also really important to decrease caffeine intake especially later in the day.

Going to bed at the same time every night, and waking up at the same time every morning can help, too. Yes, even on weekends. Avoid naps if you can, they throw off your sleeping schedule.

The best way to wind down before sleep is with a good book. Not a reader? Then find another activity to help you relax, whether it’s meditation or listening to music. The worst thing is to think about all your worries before bed. Forget them, or write them down an hour before you decide to sleep. Then, let your body know it’s time to shut down, and let all your problems roll away.




And that’s it, the three ways I’m going to stay afloat in medicine – exercise, healthy eating, and sleep.

  1. Any little bit of exercise counts.
  2. Eat more healthy foods and get enough Vitamin D.
  3. Follow good sleep hygiene.

I think it’s a simple enough concept; sometimes it’s just hard to do. But when I don’t prioritize these things, I sink deeper into the bathtub of medicine and I gradually neglect my own mental health.

After all, if we don’t take care of ourselves, how can we manage to take care of others? And so, today I’ll be going for a run in the sunshine, whipping up a smoothie, and rewarding myself with a plentiful night of sleep. Every minute counts.


So, what will you do to stay afloat?



  1. Cooney G, Dwan K, Mead G. Exercise for Depression. JAMA. 2014. 311(23):2432-2433. <http://jama.jamanetwork.com.proxy1.lib.uwo.ca/article.aspx?articleID=1881295>
  2. Cooney G, Dwan K, Greig C, Lawlor D, Rimer J, Waugh F, McMurdo M, Mead G. Exercise for Depression. Cochrane Database of Systematic Reviews. 2013. <http://onlinelibrary.wiley.com.proxy1.lib.uwo.ca/doi/10.1002/14651858.CD004366.pub6/full>
  3. Erickson KI, Gildengers AG, Butters MA. Physical activity and brain plasticity in late adulthood. Dialogues in Clinical Neuroscience. 2013;15(1):99-108. <http://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pmc/articles/PMC3622473/>
  4. Mammen G, Faulkner G. Physical Activity and the Prevention of Depression: A Systematic Review of Prospective Studies. American Journal of Preventative Medicine. 2013. 45 (5): 649-657. <http://www.sciencedirect.com.proxy1.lib.uwo.ca/science/article/pii/S0749379713004510>
  5. 5 Tips for Health Eating. Dietitians of Canada. <http://www.dietitians.ca/Downloads/Factsheets/5-Tips-for-Healthy-Eating.aspx>
  6. Ju SY, Lee YJ, Jeong SN. Serum 25-hydroxyvitamin D levels and the risk of depression: a systematic review and meta-analysis. J Nutr Health Aging. 2013. 17(5): 447-455. <http://www.ncbi.nlm.nih.gov/pubmed/23636546>
  7. Voshaar R, Derks W, Comijs H, Schoevers R, Borst M, Marijnissen R. Antidepressants differentially related to 1,25-OH2 vitamin D3 and 25-OH vitamin D3 in late-life depression. Translational Psychiatry. 2014. <http://www.nature.com/tp/journal/v4/n4/full/tp201414a.html>
  8. Milaneschi Y, Hoogendijk W, Lips P, Heijboer AC, Schoevers R, van Hemert AM, Beekman ATF, Smith JH, and Penninx B. The association between low vitamin D and depressive disorders. Molecular Psychiatry. 2014. 19: 444-451. <http://www.nature.com.proxy1.lib.uwo.ca/mp/journal/v19/n4/full/mp201336a.html>
  9. Kerr D, Zava D, Piper W, Saturn S, Frei B, Combart A. Associations between vitamin D levels and depressive symptoms in healthy young adult women. Psychiatry Research. 2015. In press. <http://www.sciencedirect.com.proxy1.lib.uwo.ca/science/article/pii/S0165178115001080>
  10. Gwoda U, Mutowow M, Smith B, Wluka A, Renzaho A. Vitamin D supplementation to reduce depression in adults: Meta-analysis of randomized controlled trials. Nutrition. 31 (3):421-429. <http://www.sciencedirect.com.proxy1.lib.uwo.ca/science/article/pii/S0899900714004857>
  11. Food Sources of Vitamin D. Dieticians of Canada. <http://www.dietitians.ca/Downloads/Factsheets/Food-Sources-of-Vitamin-D>
  12. Guideline for Vitamin D testing and supplementation in adults. Toward Optimized Practice. 2012. <http://www.topalbertadoctors.org/uploads/102912_Bzds37w2W3fC57Vz_92317.pdf>
  13. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, Rieman D. Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders. 2011. 135(1-3): 10-19. <http://www.sciencedirect.com.proxy1.lib.uwo.ca/science/article/pii/S0165032711000292>

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Dine While You Dash!

Posted on 02 January 2015 by Erica Hoe (Meds 2016)

How often do you want to eat a full breakfast, but have absolutely no time to make it, let alone sit down and eat it? For me, that’s every morning. That’s why I’ve taken to making smoothies in the morning. I use my trusty blender, toss in the ingredients, press “blend” and then start getting ready for the day. By the time I’ve gotten dressed, my breakfast awaits. How perfect. I’m living the life.

Seriously though, you can guzzle it down in the car, on your walk to work, while you’re waving to passersby, or cleaning your stethoscope. Whatever. The point is, it’s the fastest breakfast and it has all the right nutrients.

The idea is to pick some of your favourite fruits (you can freeze them before they go bad so you can use them instead of ice cubes), pick a vegetable like kale or spinach, add some honey if you want it sweeter, invest in some chia seeds and almond milk, and toss them in the blender until it’s smooth. Here are a few of my favourite smoothie recipes.



Let’s start off simple. Like they say, the first five days after the weekend are always the hardest. So, let’s not get ahead of ourselves and make too many elaborate smoothie plans. This one is super simple, and you can pretend you are still out having a drink with your friends. The weekend’s not over, I refuse to believe it!


Strawberry Pina Colada Smoothie

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  • A handful of strawberries
  • ½ frozen banana (keep them in your freezer, and snap them in half when you want to use them)
  • 2 tablespoons of coconut Greek yogurt
  • 1 tablespoon chia seeds
  • 1 cup coconut almond milk (or just almond milk)
  • 1 tablespoon shredded coconut (in the smoothie and for garnish) – you fancy huh?
  • Ice cubes
  • Honey



Monday was tough. Tuesday isn’t going to be any better, so let’s just make a smoothie filled with all the most delicious berries.


Very Berry Smoothie

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  • A handful of blackberries, blueberries, raspberries, and strawberries
  • ½ frozen banana
  • 2-3 kale leaves (use the leafy green part) – The bitterness of the kale is masked by the berry medley; also the colour of your smoothie won’t be that scary green colour!
  • 2 tablespoons of Greek yogurt
  • 1 tablespoon chia seeds
  • ½ cup coconut water or orange juice
  • A few mint leaves
  • Ice cubes
  • Honey



It’s the middle of the week. That means you’ve been working really hard for the past two days and you deserve to celebrate with a tropical drink. Yes, that means mangoes. This is one of my favourites.


Mango Coco-Loco Smoothie

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  • 1 mango
  • 1 frozen banana
  • 1 tablespoon coconut Greek yogurt
  • 1 cup almond milk
  • 1 tablespoon chia seeds
  • Ice cubes
  • Honey



You might not have time to bake a cake, but this tastes just like it. It might even improve your vision without expanding your waistline.


Carrot Cake Smoothie

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  • 1 frozen banana
  • 1 carrot (chopped)
  • 1 tablespoon chopped walnuts
  • 1 tablespoon shredded coconut
  • 2 teaspoons pumpkin pie spice (cinnamon, nutmeg, ginger, cloves)
  • 1 teaspoon vanilla extract
  • 1 tablespoon chia seeds
  • 1 cup vanilla almond milk
  • Ice cubes
  • Honey



It’s Friday, treat yo self. Indulge in this chocolatey goodness. Lather your intestines in sweetness. Too visual? Too bad. This smoothie is THAT badass.


Chocolate Almond Smoothie

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  • A handful of spinach
  • 1 tablespoon almond butter
  • 1 frozen banana
  • 1 cup chocolate almond milk
  • 1 tablespoon chia seeds
  • 1 teaspoon vanilla extract
  • Cocoa powder (optional) – if you want it even more chocolatey or if you’re using plain almond milk
  • Ice cubes
  • Honey


I hope you like these just as much as I do. May you now power through the morning without your stomach growling with hunger. Bottoms up!



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Busting Coffee’s Contradictions

Posted on 02 November 2012 by Angela Smith (Meds 2016)

After water, coffee is the drink consumed most by Canadians. Sometimes it seems that during studying for exams and those early mornings that just seem way to early to be in class, I think I may drink more of it then water.  And I don’t necessarily feel alone as I see many students line up with me or bring in their own coffee concealed in their travel cup every morning.  For students caffeine is our drug of choice. But as we sip (or guzzle down) our morning coffee do you ever wonder what the health effects of coffee are? Let’s debunk some of the common myths, and look at some of the new research regarding our beloved cup of joe. Continue Reading

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