Saturday, June 30, 2012

Quick Hit: Disinfect Your Kitchen Sponge!

With the Canada Day/Independence Day Long Weekend upon us, cook-outs and hot weather are the order of the day. We want to enjoy the fresh food of summer, but just a quick reminder to keep things clean!

I don't think we need reminders to keep prep surfaces separate and clean when preparing raw meat, but I did want to put out a quick heads up about keeping the kitchen sponge clean as well!

Sponges are the ideal medium for bacteria, as they provide a moist environment for them to grow. Many pathogenic bugs like E. coli, Norovirus, and Salmonella have been found in significant numbers, and can be transferred to plates, utensils, and counter top surfaces.

A nice study done in the journal Food Control, compared several methods of disinfecting kitchen sponges.
These included soaking in a bleach solution, soaking in lemon juice, microwaving the sponge, or running the sponge through the dishwasher.

Only the microwave and the dishwasher significantly lowered bacterial counts in the sponge.


The simplest and most effective method is to put your damp ( a dry one might burn!) sponge into the microwave oven, and blast it on high for one minute. Another way to go is to pitch it in your dishwasher and run it through the full wash and dry cycle.

Have a great long weekend!!

Tuesday, June 26, 2012

Recipe: Chocolate Oatmeal Protein Bars

Those of you that know me, know I am constantly on the look-out for the perfect snack. I try to eat small amounts throughout the work day, as well as soon after training as possible. Finding something satisfying to eat quickly between seeing patients can often be difficult. These have been some of the criteria I need to be met for my perfect snack.

  • Portable.
  • Satisfying. 
  • High in Protein, high in fibre and low in fat.
  • Can't get stuck in my teeth. (I'm dealing face to face with people)
  • Can't have a strong odor. (see above)
  • Has to actually taste good.

After many years of tweaking recipes, I think I've found the perfect "on the go" snack, for work, for training, for travel, for anytime. There's just enough sweet from the maple syrup, to satisfy my sweet tooth; just enough protein and fibre to satisfy hunger; just enough brightness from the OJ and spice to pick me up.
Perfect. Let me know what you think!

Chocolate Oatmeal Protein Bars

Prep Time: 10 minutes
Baking Time: 30 minutes


3 1/2 cups Large Flake Oats ( I like Quaker)
4 scoops Chocolate Protein Powder
1/4 cup Dutch Processed Cocoa (I like Valrhona )
1 heaping tablespoon cinnamon
1/4 teaspoon nutmeg
1/4 teaspoon cloves

1 cup Canadian Maple Syrup
1/4 cup applesauce
1/4 cup O.J.
Splash of Vanilla
2 egg whites

Pre-heat oven to 325 F.
In a large mixing bowl, whisk together the first 6 dry ingredients.
In another mixing bowl, beat the egg whites until slightly foamy. Then add the other 4 wet ingredients to the egg whites.
Pour wet into dry and gently fold ingredients together, until just mixed through.

Spray an 8x8 baking dish with your favorite cooking spray, and spread mixture into dish evenly.
Sprinkle top with more cinnamon, and bake in oven for 30 minutes.
Let cool and cut into squares to enjoy.

Saturday, June 23, 2012

Quick Hit: Weight Training

I'll admit that I was a relatively late comer to the merits of weight training.
Growing up, the sports I played, like hockey and soccer, were more endurance and skill dependent, so coaches never really focused on weight training. On the field, or at the arena, practise time was devoted to either running drills, or sprinting/skating until you felt like puking. The mentality was that the more "fit" your cardiovascular system was, the better you would be able to play in the last minutes of a game. If you happened to get stronger doing it, so be it.

In University, I used to shake my head at the guys in the gym doing weights. I figured these were the fellows who didn't have enough skills to play a sport, and needed some other way to show their manhood. There were rarely any women there, and the weight machines (what ever happened to Nautilus?) were kept in horrible condition. I was focused more on long distance running, swimming, cycling at this point, and couldn't waste time adding weights.

Today, I have come full circle, and recommend weight training as part of any physical fitness regime.


The benefits are clear at this stage, and  I've listed only a few below

What Should I Do?

If you aren't already, adding weight training to your workout is worth doing. Consulting with a trainer is worthwhile, and they should clearly explain what technique to follow. They should also be able to explain the specific muscles that an exercise will target, and how the exercise achieves this. If they can't, find someone who can.

Muscles are, for the most part, fairly straight forward. When they contract, they move a joint, flexing or extending it. The more you use it, the stronger, and more toned it gets.

General Technique

  • Breathe! When lifting/pushing/pulling the weight, remind yourself to exhale. People often hold their breath when they strain, and this is not a good thing for your body for a number of reasons.
  • Aim to do 8-10 repetitions for a given exercise. Find a reasonable amount of weight that will allow you to get 8-10 reps before you are too fatigued to push more. Trying to impress people with a huge load will only get them laughing at you behind your back.
  • Good Form. Maybe the most important. Understand the purpose of the exercise you are attempting. Know how the muscle you are focusing on moves, and try to use only that muscle to achieve the movement. Keep your core (trunk) as still as possible, and go through as full a range of motion as you can comfortably do. NEVER cheat through the exercise, just to get it done. If you can't isolate the movement, lighten the weight and try again.
Hopefully, this is useful. We'll keep expanding training, and advancing if the interest is there.
Let me know if you have any specific training questions.
I love the feedback!

Tuesday, June 19, 2012

Is Chocolate Milk a Good Recovery Drink?

Personal Admission. I Love Chocolate Milk. There. Done. So, I have a bit of a bias with this topic, but let's try to get to the facts.

Chocolate Milk has become a trendy drink being touted as a "recovery drink" after working out. This is  on the basis of studies showing benefit in cyclists after training (Medicine & Science in Sport and Exercise, 2010).Is there any scientific benefit to this? Here are the stats.

1 cup (250 ml) of low fat chocolate milk has around 170 calories, 8 grams of protein, and a good source of Calcium, Vitamin D. It has around 2.5 grams of fat, and unfortunately 24 grams of sugar.

In comparison, 1 cup of Coca-cola has only 100 calories, 0 g protein, zero calcium, vitamin D. On the flip side, it also has NO fat, and a comparable 27 grams of sugar.

Alternatively, 1 cup of Orange Juice has 110 calories and an equal 27 grams of sugar.
Finally, 1 cup of Gatorade Recover Drink has 100 calories, 20 grams of sugar and some electrolytes.

Hmmmm. So, in terms of calories, chocolate milk actually has more, a similar amount of sugar relative to a can of coke or a cup of O.J. It does have significantly more protein, although not likely enough to matter if you're eating a well balanced diet.

What to do?

Unless you're training hard, (and by this I mean more than 1 hour sessions at high intensity), water is still your best choice. If you are calorie deficient, and trying to bulk up, chocolate milk might be reasonable. Just be aware of all the facts.

What do you drink after working out?
Let me know what you think!

Saturday, June 16, 2012

PSA Testing: Yea or Nay?

In the town I live in, we have an annual "Fathers' Day Prostate Cancer Walk". This year will be the 14th annual, and the disease is continuing to increase in numbers, despite ongoing research and funding. We often see advertisements to "get checked", but recently, medical studies have questioned whether PSA testing is helpful.(NEJM, March 2012). This study concluded, that although PSA screening decreased the mortality from Prostate Cancer by 21%, it did NOT reduce the overall mortality rate. In fact, to prevent ONE death from prostate cancer, you would need to screen over 900 men.

So, is this a good screening tool?

What is a Good Screening Tool?

We tend to like answers to questions to be black or white. For example, I want the answer to my prostate test to be "No, you do NOT have cancer."
I don't want to hear, "Well, you probably don't, but I'm not 100% sure." Unfortunately, NO screening test can give you a one-hundred percent guarantee.
Screening tests should do the following, in the best cases.

  • It tests for an important disease
  • There is treatment available, when given early has more benefit than if giving later in disease
  • The prevalence of the disease is relatively high
  • The test is relatively inexpensive
  • The test is consistent
  • The test is VALID (ie. can distinguish between real disease and normal state)
  • The test is easy to administer and causes little discomfort
Looking at these features, a test like measuring Blood Pressure is a good screening tool. It's easy to do, and if you treat it early, you can prevent a lot of complications.

Doing a PSA Test is a little more tricky. 

Why the Controversy?

The controversy as to whether PSA testing is a good screen is for a few reasons. Unfortunately, the lab result is NOT an absolute answer. It doesn't give that clean black/white answer we crave. You simply get back a number, and are left to interpret what it might mean. Obviously, a sky high value is worrisome for cancer, but, where should the cut-off be? We can't have it be too high, or we'll miss some cases, but if we set the cut-off too low, we start biopsying patients who don't have cancer. This causes undo stress and anxiety in patients, for no good reasons.

The other problem (although a better problem to have) is that prostate cancer tends to be a slow growing cancer. In other words, it's not uncommon that if a man was never screened, he likely would die of some other cause than the prostate cancer itself. In other other words, NOT ever knowing might have been fine.

Finally, the treatment, be it surgery, radiation, or other, is NOT without it's own complications. Infections, incontinence, impotence are possible, for a disease which might not have killed you in the first place.

All that being said, I have also seen many cases of prostate cancer with awful endings, as well.

So What Should I Tell My DAD to do?

I think the best advice, is for every man over 40, to at a minimum see their physician for an annual check up. As a family doctor, I don't see nearly enough middle aged men on any regular basis. A discussion about the pros and cons of the nowhere near perfect PSA test should take place, and irregardless, a digital rectal exam should be done. 
If after discussion, knowing the risk/benefit of the PSA lab test, I offer it to all my middle-aged men.

Definitely a complicated topic with no right answer in my opinion.
Let me know what you think, and don't forget to wish your dad a HAPPY FATHER'S DAY!

Tuesday, June 12, 2012

Customer Service: How to go the Extra Inch

I was listening to a podcast of my favorite maketing guy, Terry O'Reilly, and his CBC show called "Under the Influenece".  This week's episode was all about how companies succeed in keeping us loyal by doing the little things.

He used examples like vitamin companies leaving magnifying glasses hanging near their bottles so people could more easily read the info on labels.
He described a great story about a fellow landing at the airport tweeting a wish for a certain restaurant's steak. When the man landed, a well dressed man was standing at the gate, holding a sign up with his name on it, and a 32 oz Porterhouse steak and all the fixin's!! That's going the extra mile.

A few larger companies also manage to do "just a little bit more". Starbucks employees, (although less so than they used to, it seems) remember my name, and remember what I like to drink.
I still love going to Disney World with the kids, mainly because the service is still over and above anywhere else I can think of. I remember, fondly, telling one of the beignet makers how much my kids loved the doughnuts he was making. Minutes later, he wandered over with a fresh batch, with more powdered sugar on them than I ever thought possible!

In my "business" of medicine, this level of service sometimes isn't possible. Or is it?
What, as a doctor, can I do to make a patient's visit more palatable? What can my receptionist, nurse, manager do to help?

I need your advise!!

Sunday, June 10, 2012

Olive Oil: Are They Trying to Slip Something Past Us?

After an incredible olive oil tasting while visiting New York last month, and reading an eye opening book on the olive oil industry by Tom Mueller, called "Extra Virginity: The Sublime and Scandalous World of Olive Oil", I thought it would be worth looking at the product with a more critical eye.


At this stage, the health benefits of olive oil are unquestioned. This followed a landmark study in the New England Journal of Medicine, 2003, that found that a Mediterranean Diet was associated with a 25% drop in mortality, specifically in heart disease and cancer. Much of that benefit is thought to be due to the HIGH percentage of mono-unsaturated (heart healthy) fat in olive oil.
Olive oil also lowers LDL (bad cholesterol) and raises HDL (good), as well as providing anti-inflammatory properties, anti-thrombotic and anti-hypertensive properties.

The price range in our local grocery store is immense going from $6.00 (Canadian!) to upwards of $80.00 per litre! What accounts for this kind of discrepancy, and is it warranted?

First, I think some definitions are in order.

If we use the definitions of the International Olive Council (IOC), based in Spain, and which the USA is NOT (!) a member of, these are some important definitions.

Olive Oil : a Blend of Virgin and Regular Olive oil, with an acidity level of <2% acidity.

Virgin Olive Oil: Coming from ONLY Physical extraction of the olives, and NO heat or chemical extraction. It has an acidity of <1.5% and must be physcially pressed, or centrifuged ( in larger factories).

Extra Virgin Olive Oil: The Highest Grade Virgin Oil, with <0.8% acidity. No chemical or flavour defects are allowed, as determined by IOC testing. Best tasting, and ideal for dressings, or on its own.

Be aware, though, as the USA is NOT a member of the IOC, any bottle can label itself Extra Virgin, without meeting the above standards!
Finally, take note: Although many companies "sound" Italian, or even state "Product of Italy", this ONLY indicates that the production of the oil occurred in Italy, and is NOT necessarily the source of the olives.

In fact, most of the actual olives from Italy, STAY in Italy, for Italians to enjoy. The source of MOST Italian olive oil for export comes from other countries and are blended to produce their oil.
Other top producers to consider are from Spain, Greece, and Portugal. Australia, South Africa, Argentia, Chile and California are now also beginning to produce better quality oils.

So, What Should I Do?

Good Question. For cooking, I recommend definitely NOT using an Extra Virgin. The smoke point is too low for a lot of cooking (350 F), and if your heat is going to go higher than that, the oil is likely to burn and wreck things. Use something else. Even a cheap regular olive oil is a good choice, as the blend of oil has a higher smoking point.

For dressings, dipping bread etc, definitely the best quality Extra Virgin you can afford. Go to a reputable
specialty store, where they should allow you to taste what you are buying. Watch your labels, if you care about legitamacy, although it doesn't always correlate with taste! (see here: Cooks Illustrated Taste Testing)
Look for harvest dates on higher end bottles, and try to use it within the year, and store in a dark place away from direct sunlight.

Enjoy them like a fine wine, and save some for me!

Let me know what you think!! Do you care about where and how your olives come to you?

Wednesday, June 6, 2012

Props to Disney for Cutting Junk Food!

(photo courtesy Tom Bricker)

Congratulations to the Walt Disney Company for taking a step in the right direction.
On June 4, 2012 the Disney Corporation announced a wide spread set of guidelines to focus on childhood obesity.

They were able to partner with First Lady Michelle Obama in announcing several important changes.
These included:

  • Banning Food and Beverage products advertised on their networks including the Disney Channel, Disney XD, Radio Disney, Disney Junior and Disney Online sites that did NOT adhere to nutritional guidelines by 2015. (2015 was chosen due to pre-existing ad contracts)
  • Cutting Sodium by 25% in kids' meals at Disney Theme Parks
  • Automatically including healthier sides and beverages, such as low fat milk and carrots at Disney Parks and Resorts.
  • Adding a "Mickey Check" icon to be placed on foods that meet certain nutritional guidelines. Here are the exact guidelines (pdf)

While not perfect, this is a nice 1st step in combating childhood obesity. Being a media giant, (they reach upwards of 99 million viewers on TV networks, as well as 121 million visitors to Disney Parks worldwide,
2011 data here), their impact on advertisers can and should be substantial.

I would like to see this extend to other advertisers, and hopefully to not only kids meals, but adults too.
Good on you DISNEY !

Tell me what you think about their initiative!

Saturday, June 2, 2012

Torn Labrum: Now What?

One of the great things about using pro athletes as a jumping off point for topics is that there is an endless supply of material. One of the worst things is that these injuries often happen to my favourite players. Marian Gaborik, star player with the New York Rangers, injured his shoulder during this season's NHL playoffs.
He thinks he injured the shoulder during the 1st round of the playoffs against Ottawa, but was able to play through the pain for two more rounds until the Rangers were knocked out by cross town rivals, the New Jersey Devils. This injury was finally diagnosed as a torn labrum of his shoulder, and will require surgery to repair, with recovery time of up to 6 months!

Torn labrums in the shoulder are more commonly associated with pitchers, who stress the joint much more, and some of the notable victims include Curt SchillingChris Carpenter, and most recently Michael Pineda of the New York Yankees.

What is the Labrum?

The simplest way to think of the labrum of the shoulder is as a lip of fibrous cartilage around the glenoid; or socket part of the shoulder. This lip of cartilage serves to deepen the socket (glenoid) by up to 50%, helping keep the head of the humerus (the ball of the ball and socket), from popping out.
Unfortunately it is NOT uniformly thick all the way around and certain areas are prone to tearing, especially where the long head of the biceps tendon attaches into it.

When this cartilage tears, it can cause pain, catching, popping and limit strength and range of motion.

Mechanism of Injury

Labral injuries most commonly occur either from trauma, or repetitive overhead activity, like throwing or swimming.

Traumatic injuries are usually due to a result of a fall with the arm outstretched above. This is thought to causes a pinching mechanism of the humeral head catching the labrum.

In the case of repetitive overhead activity, it is thought that the biceps tendon chronically irritates the weak spot of the labrum where it attaches.

How do I Find out of My Labrum is Torn?

Good question. In most of medicine, a well taken history and focused physical exam can often provide a clear diagnosis, without resorting to expensive imaging. In the case of the shoulder labral tear, this unfortunately is not quite true.
Labral tears in overhead athletes can mimic rotator cuff injuries, which can often be settled down with some relative rest, review of mechanics and rehab.  The history for both is similar. The clinical tests for labral injuries, have NOT been shown to be particularly accurate, and can vary dramatically depending on who is conducting the examination!

So, for labral tears, if there is a high degree of suspicion, and a failed course of conservative management, I tend to order an MRI with dye (gadollinium), to assess the labrum specifically. Unfortunately, even the MRI can miss this diagnosis, and sometimes the definitive test is to scope the shoulder to directly visualize and repair the labrum if it is still torn.

Recovery Time

Once the diagnosis has been made, if the labrum is torn, it likely needs surgery to repair, as cartilage has a poor blood supply and tends NOT to heal.

Shoulders tend to take a relatively long time to recover, due the complex interplay of inherent instability, and the degree of freedom the joint has.

It usually take 4-6 weeks just for the initial pain to settle, then true rehab can begin on range of motion and gradual strength. This can be another 4-6 weeks just to get function back.  The next step is then trying to return to activities that caused the problem in the first place like throwing or swimming.

This is the most important part of the recovery as mechanics and strength need to be changed, or the same injury can recur again.

Going back to Marian Gaborik, my hope would be a hockey player is more likely to come back from this injury than the Yankees new pitcher. (sorry baseball fans!)

Let me know if this helps!