Montreal's senior monthly since 1986

Feb '10

Columns

An advanced doctor at an advanced age

When Dr. John Schmidt began his medical practice, there were 48 states in the Union, Ike was president, and Southern drinking fountains were still labeled “White” and “Coloured.” There was no vaccine for measles, mumps or rubella, and the world of medicine was still adjusting to Jonas Salk’s polio vaccine.

Today, at 80, Dr. Schmidt administers the H1N1 vaccine and examines MRIs delivered to him electronically. Much has changed in the 50 years of his medical career, but Dr. Schmidt still has the patience and bedside manner of a man who made house calls at local farms.

Growing up in rural Illinois, Schmidt’s inspiration for becoming a physician was the doctor in his own small town. “Dr. Roberts was the only doctor I knew,” Schmidt recalls. “He was the idol of everybody—very highly thought of.”

When he was only 12, John’s mother died of a brain aneurism and when he was 22, his father was burned alive after the basement furnace erupted. John went to live with his eldest sister, Dixie, who was like a second mom to him. Dixie went on to study nursing at the University of Chicago. Seeing her work and hearing her stories only gave his medical enthusiasm a shot in the arm.

John studied human biology at the University of Illinois. He graduated in 1951 and married Barbara Crawford as soon as he was accepted to medical school at the University of Chicago. After graduation, John and Barb moved to San Bernardino, where his sister Dixie was a nursing supervisor at San Bernardino County Hospital. There, John got a plum internship, where he could experience a full range of medical training.

“In one year at a smaller hospital you may not be able to work in orthopedics or get to deliver a baby,” he explains. “My whole idea was to have a well-rounded internship.”

After his one-year internship, rather than having his studies interrupted by the Korean War draft, John enlisted in the navy. Stationed in San Diego, he practiced orthopedics at the Naval Hospital and eventually spent six months at sea on a destroyer.

After the war, John and Barb prayed for an opportunity to return to California. John received a call from an old friend from his pre-med days when they waited tables together at a girls’ dormitory. The friend had settled in Fullerton, Calif. as a pediatrician. A colleague asked if he knew any doctors interested in practicing in nearby Yorba Linda. He called John. “I hopped a plane,” John says, laughing, “came out here and decided, out of the blue, that this was the place we needed to go.” At the time, Yorba Linda had only one doctor who had been practicing 50 years and was ready to retire. In 1959, John and Barb set out for Yorba Linda.

“I was the only doctor in the area,” he says. We didn’t have freeways and the nearest hospitals were in Fullerton. I used to make rounds starting at about 5:30 a.m. to get all four hospitals there attended to.” For a year, he didn’t take a single day off and built his practice by being available when doctors typically weren’t—making house calls at any hour, any day.

John continually adapted to huge technological leaps in response, diagnosis, and treatment. “As time went on, transportation became more available, house calls became less needed, and there was a greater dependence on technology—blood studies, X-rays, EKGs, and so on. Technology became the cornerstone of our profession, and, really, it still is.”

Eventually, because of the growth of the community, it was essential for Dr. Schmidt to take on partners and form a medical group. “As I observed other doctor groups in the area, ones that had one doctor as the boss usually failed. So my philosophy was to make my new partners equal with me—I didn’t get any more salary than they did, and they had equal voice when making decisions. And that philosophy made my career very successful compared with running the show.”

Looking back, John finds much contentment while also looking forward; he has no intentions of retiring. He still drives daily to his Yorba Linda clinic. He still sets broken arms, stitches up split chins, and hits knees with a rubber hammer. And he still treats every patient like a neighbour. “As long as it keeps working up here,” he says, tapping his noggin, “I’ll keep working.”

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Staying connected with those we’ve lost

December, 2009

When we lose a loved one, the pain of loss is accompanied by a feeling of disconnection: “I will never see him again. I won’t be able to talk to him, tell him about my day, share news with him.”

However, it is not only possible but healthy and normal to maintain a sense of connection with those we love, even after the loved one has died. Close bonds, especially those forged and enriched over many years of shared experiences, are altered by death, but not necessarily severed. I’m not talking about ghosts, spirits or any specific religious beliefs, but rather about the reality that loving human relationships are enduring and continuous.

Recently, I had the opportunity to talk to a friend whose sister had died after a long illness. She was grieving this loss and commented that the most painful part was that she could no longer pick up the phone and talk to her sister. I commented that, although this was true, she could certainly write letters to her sister and maintain her connection that way. (I happened to know that this woman enjoys writing and is accustomed to sharing events, thoughts and feelings through writing.) She was initially stunned by the suggestion: many people would regard writing letters to a deceased person as “crazy.” She quickly warmed to the idea and has found both comfort and value in “staying connected” this way. It may well be that being encouraged to do this by a friend who happens to be a psychiatrist made it easier to see this as perfectly reasonable behaviour: if the psychiatrist doesn’t think it’s a sign of mental illness to remain in touch with my sister this way, I guess it is ok.

Not everyone is a writer, but everyone can maintain these important bonds. Certainly, death changes our relationships with our lost loved ones, profoundly and, at least within our usual understanding of day-to-day life in this world, permanently. However, we don’t stop loving a person just because he or she has died. Similarly, we don’t stop feeling connected with our loved ones. We can respect both the need to stay connected and the reality of enduring bonds, altered but not severed by death.

Michael Eleff is Associate Professor of Psychiatry at the University of Manitoba.

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H1N1: Hopefully, this too shall pass

Since the flu-de-jour has monopolized headlines, the smallest cough or sneeze can elicit dirty looks in a bus or supermarket. As passengers or shoppers sidle over to a hopefully less infectious spot, their “bubble” invariably reads: “I hope it’s not H1N1!”.

The perception that H1N1 is to be feared has created what one pediatrician has called “H1N1 psychosis,” as worried people swamp emergency clinics and vaccination sites.

The fact that the virus has been declared a pandemic by the World Health Organization is, in itself, not a reason to panic, says Eric Toner, senior associate with the Center for Biosecurity of the University of Pittsburgh Medical Center.

Quoted in Bioworld Today, Toner says, “ ‘Pandemic’ means a global outbreak of an infectious disease … But the word ‘pandemic’ doesn’t relate to severity of the illness. So we have a pandemic of a virus that causes mild illness, apparently much like we did in the last influenza pandemic.” Dr. Toner predicts that H1N1 will replace the seasonal flu we know starting next year.

Experts say that in most people this virus will resolve on its own, what makes the H1N1 strain somewhat sinister is that it sickens healthy younger people and there is no sure way of identifying yet who is more susceptible to severe illness. If complications develop, they are severe, especially in people with underlying medical conditions. Healthy people born before 1957 are less at risk.

Although the symptoms of a cold, the seasonal and swine flu (H1N1) are similar, here’s how to tell them apart: A sore throat, runny nose and a cough indicate a cold. The same symptoms with fever and fatigue so overwhelming that bed rest is required likely indicate the flu. H1N1 differs from the seasonal flu in that sometimes there is no fever, but vomiting and diarrhea may be present.

If the illness worsens it’s important to seek medical help, as the H1N1 virus tends to attack the cells deep in the lungs, causing rare but serious complications requiring hospitalization in about 1 out of 1,000 cases. According to the Public Health Agency of Canada, warning signs are: fever over 39.5C, rapid breathing or shortness of breath, chest pain, bloody sputum, dizziness or confusion, persistent vomiting, bluish or grey skin colour, and low blood pressure.

“We know that this is now the dominant influenza virus transmitted around the world,” said Dr. Timothy Brewer, director of global health programs for the McGill Medical School and senior advisor for the International Society for Infectious Diseases. “The good news is that since this virus has been recognized, in April, it has been stable, not become more deadly. Most people have mild disease and do well. A very small percentage of people get very sick and it’s even a smaller percentage who die.”

Since Canada’s unprecedented mass vaccination campaign started, people have flooded flu clinics and stood in line for hours waiting to be immunized. However, some are concerned about possible side effects of the vaccines. A recent Associated Press-GfK poll found that 38 per cent of U.S. parents said they were unlikely to allow their children to be immunized. The adjuvanted Canadian vaccine, manufactured by Glaxo Smith Kline, contains squalene and thimerosol, two substances anti-vaccine activists are worried about.

In the NFB documentary film Silence on Vaccine, Lina B. Moreco focuses on families who believe their children have suffered adverse reactions to vaccinations. “I did three years of research and met people who suffered from side effects,” Moreco said. “When I finished the film, the NFB hired a lawyer from outside and from the film board and someone to check the archives I used to make sure I didn’t play with the information.”

Vaccine fears may originate in a 1976 swine flu vaccination campaign when there was an increase of Guillain-Barré syndrome, a neuro-immune disorder. Experts still debate whether it was coincidental or causal that during the campaign 500 fell ill and 25 died in the U.S.

Since then, Dr. Brewer says, studies done on the seasonal vaccine have shown no increase in Guillain-Barré. As well, there are unprecedented tracking systems in the US and Canada to monitor possible adverse reactions. “We’ll have to look and follow after people start using H1N1 vaccines. It’s the only way we’re going to know for sure.”

To date, the vaccine has been tested in more than 40,000 people globally. NDP health critic Judy Wasylycia-Leis says the vaccine seems to be effective and safe. “We continue monitoring, but based on everything I’ve seen and heard, the risks from serious illness are greater than problems you might get from the vaccine.”

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Taking the heat: not a good idea

The long-awaited rays of summer sun may be too much of a good thing for small children and dogs left in parked cars.

Babies and toddlers are especially vulnerable to high temperatures, which, in a car, rise very quickly, says Dr. Catherine McLaren. The researcher’s 2005 study demonstrated that even on a sunny 72-degree day, temperatures inside a car could reach 117 degrees Fahrenheit in one hour. “Vehicles heat up rapidly with the majority of temperature rise occurring within the first 15-30 minutes,” McLaren says. Leaving the windows open 1.5 inches doesn’t make much difference. “If people knew the danger of leaving their children in the car, they probably wouldn’t do it.”

Heat stroke is also a danger for dogs left in cars, writes Joy Butler on the website suite101.com

“Contrary to what most people believe, dogs overheat more quickly than humans do. Heat inside a parked car can build, in just a few short minutes to as much as 40 degrees above the outside temperature. Never, ever, leave a dog in a parked car or without water in the sun.”

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Incontinence: nothing to sneeze at

It doesn’t kill you, but it can make your life hell. Incontinence affects 55 per cent of women over 60 and can have devastating emotional, social and physical consequences, such as falling, isolation and depression.

“One study shows it will take an average of 7 years for a woman to talk to a health professional about her incontinence,” says Chantal Dumoulin, researcher at the Institut Universitaire de Gériatrie de Montréal.

Dumoulin and her team are trying to refine and target treatments more accurately.

“If we learn to better identify those who will benefit most from pelvic floor exercises, then it will be easier to get funding from the government to treat these women,” Dumoulin said. Right now, 70 per cent of women do improve with exercise, but in the other 30 per cent, the cause may be neurological, requiring a different approach.

“My primary training is in physiotherapy,” Dumoulin explains. “I look at the patient in terms of general function. We found that incontinent women will stay home more, have less strength in their legs and are at a greater risk for falling.” Dumoulin is inviting women, both continent and incontinent, to form exercise classes that may treat or prevent this insidious problem.

“We evaluate the pelvic floor muscle and leg strength, provide training and follow up two to five years later to see if their risk of falling has diminished.”

Classes are formed as soon as there are enough participants.

To join a class call 514-340-3540 ext. 4129

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Province takes on Alzheimer’s challenge

June 2009

In a show of solidarity to the 120,000 individuals and their families across Quebec struggling with Alzheimer’s Disease, 500 walkers converged at the Quay of the Old Port for the third Rona Memory Walk organized by the Alzheimer Society of Montreal on May 31. Across the province, 20 other Alzheimer Societies organized walks as well, with the goal of raising $2,000,000 to improve the Society’s programs and services. “We make up a large family of solidarity,” said Montreal mayor Gérald Tremblay. “There is a strong message of hope; ever y step is important.” Alzheimer Montreal raised over $83,000.

The supporters of the 5km walk heard some good news as Yves Bolduc, minister of health and social services, said that Quebec will create an action plan regarding the management of Alzheimer’s Disease and other chronic illnesses. Bolduc made public a report drafted by a team of experts, led by Dr. Howard Bergman, an internationally renowned researcher in aging, titled Relever le défi de la maladie d’Alzheimer et des maladies apparentées. The recommendations in the comprehensive report, which pinpoints challenges and defines objectives, will play an integral part in the strategic plan that the health ministry will elaborate over the next six years, Bolduc said.

500 walkers joined the memory walk at the Old Port Photos: Kristine Berey

Hope came also from Marguerite Blais, the minister responsible for seniors and families, who said that the province recognizes the crucial role caregivers play in managing the illness and that funds would be available to help them. “Of a budget of $200 million over 10 years, at least 75 per cent will be devoted to people who work with patients suffering from Alzheimer’s or a related illness. The ultimate goal is to sustain, accompany, relieve and inform people who care for their loved ones in circumstances that are often very difficult.” Alzheimer’s Disease, a neuro-degenerative illness, has no known cure and no reliable method of early diagnosis. Although medications can now slow its progress, there is no treatment that can alter its course. With the aging of the population, the number of people affected is rising astronomically. “One out of five baby-boomers can expect to suffer from Alzheimer’s,” Dr. Bergman says.

While this year 100,000 Quebecers have the disease, in 20 years 160,000 will be affected. In the United States, the advanced stage of the disease is diagnosed in a patient every 70 seconds. In 2000, costs related to the illness across Canada reached $5.5 billion.

Yet, internationally, research into Alzheimer’s and related dementias remains chronically underfunded. According to Bergman’s report the funds allocated to Alzheimer’s by the Canadian Institutes of Health Research represent 3 per cent of their budget. In 2007-08, $26 million was allocated to Alzheimer’s research while $170 million was earmarked for cancer research. The impact of this disease on the health care system is underestimated, Bergman says.

Gilles Duceppe walks alongside Helen Fotopoulos and Marguerite Blais

For example, Alzheimer’s patients with another chronic illness will stay in the hospital twice as long as a person the same age and with the same illness but without Alzheimer’s. Research is also important, Dr. Bergman said, because it is conceivable that not far in the future a medication may be developed that may alter the course of the disease, in which case early diagnosis would be imperative. Recently Dr. Hemant Paudel of McGill University and the Lady Davis Research Institute at the Jewish General Hospital took one step closer to that goal. Paudel discovered that the action of a single phosphate on a particular protein in the brain is the culprit responsible for the tangles that wreak havoc in the brains of Alzheimer’s patients. “The possibility of early diagnosis now exists,” Dr. Paudel says. “The enzyme which puts this phosphate on [the protein] can be targeted by drugs, so therapies can be developed. This discovery gives us, for the first time, a clear direction towards the early diagnosis and treatment of Alzheimer’s.”

Dr. Bergman’s report is available in French at www.msss.gouv.qc.ca

For information or to donate to the Alzheimer Society of Montreal, call 514-369-0800.

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Docs talk memory loss, holiday kidproofing

McGill University Health Centre presents a model Patient Room of the Future and public health lectures at Westmount Square in November.

Monday, November 10 at 2 pm Dr Gary Inglis, MUHC Geriatric Medicine Site Director, presents Where did I put my keys?

Taking a look at memory loss and cognitive disorders, Dr Inglis reviews warning signs, prevention and treatment. “What is the evidence out there that helps us prevent memory loss?” he asks. “We know that stroke and Alzheimer's share risk factors: hypertension, diabetes, high cholesterol, and sedentary lifestyle,” each soaring in our aging population. “There’s a lot of research out there for treatment,” and his ongoing work in clinical trials for new therapies to prevent amyloid deposition, though “still experimental,” will be up for discussion.

Thursday, November 13 at 2 pm Dr Carlo Galli, MUHC Pediatric Trauma Program Coordinator, speaks on How to keep kids safe when the temperature drops.

“We’ll explain a bit about pediatric trauma and treating and preventing injuries in kids, basing it more on winter activities coming up,” says Galli. “When grandkids are coming, it’s important to child-proof the home,” with medication, electrical sockets, candles, and tree decorations meriting special attention, he notes. Toy buying guidelines, proper car seat setup, and winter playground precautions will be reviewed, and more tips on holiday safety will be available to take home.

Location: 1 Westmount Square, Mezzanine level (metro Atwater).

Info: 514-934-1934 x 71552

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Housebound seniors can stay active

Icy roads make walking treacherous for seniors during the winter months. Many of you find yourselves housebound and lacking the outdoor activity you get easily in better weather. But staying in shape at home is possible by doing a few targeted exercises. Pump up your health with a little determination and a small investment in time and equipment.

Strength, stamina, balance and flexibility are the cornerstones of any health program. As you age you may lose strength, balance and some flexibility in the extremities and joints. You may find yourself easily winded because you don’t get enough cardio training.

Strength exercises usually consist of resistance training using weights, floor exercises and swimming or water aerobics. Basic leg lifts using leg weights (which can be purchased at Canadian Tire) are good training for the quadriceps. Dumbbells can also be used to strengthen your arms (biceps). Exercise elastics (used in Pilates) are useful for resistance training.

To improve stamina a treadmill excellent choice, however a more economical alternative is to purchase a rebounder which is a small trampoline. According to NASA rebounding is 68% more efficient than jogging. There are many benefits to bouncing up and down which include: fighting fatigue, relieving neck, back and head pain, improving blood circulation and oxygen flow and promoting weight loss.

To work on improving your balance try the following exercise.

Stand perpendicular to a kitchen chair with its back facing you. Hold on to the back of the chair with your right hand for support.

Make sure your feet are side by side and a shoulder-width distance apart. Advance your left foot ahead by two feet.

Transfer your weight by pushing your right heel down into the floor and shifting your weight over to your left leg (make sure you bend your left knee). Do not lift your right heel during the transfer.

Push down on your big left toe back through your left heel and transfer the weight back to your right foot. Repeat this weight transfer movement a number of times.

Repeat weight shifting on the other leg.

To boost upper body flexibility, try this exercise. Start with your feet together. Interlace your fingers together and stretch upward by pushing your palms up to the ceiling. Do this for 3 times and then relax.

Always warm up before you start an activity and if you feel pain or you are out of breath, take a rest. Don’t over do it and don’t forget to cool down after you exercise.

If you are experiencing any health problems such as: arthritis, heart or circulatory disease, kidney disease, lung disease or osteoporosis, or have not exercised in over a year, consult your physician before starting an exercise program. Once you have been cleared for exercise keep in mind some basics: drink a lot of water, wear comfortable clothes and proper footwear.

A few good exercises are all you need to stay in shape. Look into making them part of your daily routine.

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