Thursday, September 27, 2012

Time To Get Your Flu Shot Again!

Every year around this time, our family medicine clinic really starts to get busy. School is back in session, the weather starts getting cooler, the leaves start changing, and the season's flu vaccine becomes available.
Older patients wait with baited breath, like it's Christmas time, constantly phoning to see whether the serum is in yet.

We hold flu vaccine clinics for several weeks every fall, and the line ups prior to the doors opening are like that of a rock concert, or Boxing Day sale. That's great, although I wish we could get more kids in, as they tend to be most at risk and most likely to spread the flu.

What is the Flu Anyway?
When we take about the "flu", we're using the short version of influenza, a highly contagious virus. In North America, the bug causes a respiratory illness, generally peaking in fall and winter. There are 2 main strains, Influenza A and Influenza B, with the "A" strain generally being more contagious and severe. Symptoms typically are sudden in onset and include headache, fever, sore throat, cough, runny noses and itchy eyes. Often muscles are very achy, especially in the low back. The course will typically last a week to 10 days and can really knock you off your feet. Generally speaking, we distinguish influenza from the common cold by the rapid onset, the severity with which it hits you, and body aches. The common cold is usually milder. Formal diagnosis must be made by taking a nasopharyngeal (back of your nostrils into your throat) swab.

How do we Treat the Flu?
Treatment for the flu is generally symptomatic and supportive, as the symptoms, although significant, are self limiting. Lots of fluids,Tylenol or Ibuprofen for aches and fever are really all that are necessary.

There are also antiviral medications like Tamiflu  or Relenza that have been shown to shorten the course of the flu by 1-2 days if started immediately. This may be of benefit if work is time critical or an important event is imminent.

Not getting sick is always the best option if possible. Keeping hands as clean as possible, coughing into your sleeve, and avoiding contact will sick people are always good choices. Getting the Flu Vaccine is the best method of staying healthy this winter.

Every year, a prediction of the prevailing influenza strains is made and 3 vaccines are incorporated into the annual influenza vaccine. This is because the influenza virus is constantly mutating and new strains become prevalent. The vaccine always contains 2 strains of the Influenza A and 1 strain of Influenza B. This year's strains are:

  • A/California/7/2009 H1N1
  • A/Victoria/361/2011 H3N2
  • B/Wisconsin/1/2010
Who Should Get Vaccinated?
In Ontario, we vaccinate everyone from 6 months of age onward. Highest risk groups should be given priority, which include the elderly (>65), those with chronic medical conditions (diabetes, heart disease. . .), those in long term facilities, pregnant women, and those coming in contact with high risk individuals (ie, health care workers, community workers like teachers, etc.)

Overall, the benefits are large, and the risks are very low, so I strongly encourage everyone to get their flu shot again this year!

Let me know - Have you gotten your shot yet? 

Tuesday, September 25, 2012

SHOCKING NEWS: Sugary Beverages Cause Weight Gain In Children.

The New England Journal of Medicine is one the medical journals I hold in highest esteem. They publish some of the most ground breaking medical studies in the world, and it would be an honour to have a study accepted there. Often, their research helps guide best practises of physicians, and the work is always carefully reviewed and only published if it provides new knowledge.

You can thus understand my mild surprise in seeing that most of this week's journal was dedicated to research on whether sugar containing beverages contributes to weight gain in children. (full article here)
Seems fairly obvious, no?

In fact, there are two additional articles on the theme, as well as the highlight editorial, and a case study on the subject as well. Michael Bloomberg must be jumping for joy.

To briefly summarize this study though, 699 Dutch children (ages 4-11) were randomly and blindly given either an 8 ounce (250 ml) can of sugar-containing, or sugar-free drink. This would be the equivalent of about 104 extra calories per day for the sugar drink. Otherwise the groups were similar in all respects. Over the 18 months of the study, the group drinking the one can of sugar per day gained 1.01 kg (2.2 lbs) more than the sugar-free group, which was significant. Please do take note that this effect was due to only 104 extra calories per day, and the average U.S. child drinks more than 3 times this amount per day.

All kidding aside, this study does emphasize the need to avoid excess calories in not only our children's diets, but our own as well. Can we control this ourselves, or do soda bans, like those recently put in place in NYC, need to set in place for us?

Let me know what you think!

Tuesday, September 18, 2012

This Could Be The Best Way To Avoid Winter Weight Gain!

The American College of Sports Medicine recommends exercising 30 minutes at least 5 times per week. I ask my patients to do this at a Borg Scale level of exertion of 13-14. This correlates with moderate intensity, and I simplify it further by saying you should be working hard enough to get your heart rate up, but still be able to complete a full sentence without having to stop to catch your breath. Of course this should be the minimal amount to be considered exercise, and if you can I certainly encourage higher intensity!

In the summer months, this tends to be a lot easier, as most of us get outside to at least walk, garden, bike, swim or whatever. In Canada, our late fall and winter months start to get nastier, and the daylight hours get awfully short. For many North Americans, this tends to be a pretty good reason to avoid continuing good exercise habits set in the summer.

In my opinion, one of the best ways to maintain your activity level is to track it! Perhaps the simplest way of doing this is using a pedometer. These can be purchased almost anywhere, and the simplest versions do a reasonable job of monitoring the number of steps you take in a day. I recommend aiming for 10,000 steps over the course of a day, which translates into about 5 miles, or 8 kilometres.

Fitbit, a tech company based out of San Francisco, has just released an updated monitor of their tiny activity tracker. Not only does it measure your daily activity level, including stairs, it also monitors your sleep! Of course, this data can all be uploaded and shared with friends, if that's your thing.

There are several apps for your phone that do a similar thing and don't need a separate device. One of my favourites is the Nike+ Running app. The link goes to iTunes, but is also available on Android as well. The app is free and is nice in that your runs/walks are mapped out and paces are given. (It will even cheer you on!)

iPhone Screenshot 1

By having a simple way to monitor your activity, you can hold yourself accountable, and stay fit, even as the seasons change.

Do you use an activity tracker?
Do you have a favourite app or device for doing it?
Let me know!

Sunday, September 16, 2012

Korean Rice Poppers

I'll admit I'm awfully late on this trend, but I got a big kick out of seeing the rice poppers "exploding" out of the Broghies machine this morning.


Our local grocery store was kicking them out this morning, and the explosions certainly drew my attention.
I had read about them previously in the Toronto Star, but London, being the backwater town it is, only recently got a machine in house. The entertainment value is worth the cost itself, but these little treats are actually pretty tasty on their own, let alone slathered in honey, Nutella, fruit, yogurt, or even Speculoos Spread!

If you're as unfamiliar with Korean Rice Poppers, aka Broghies, "poppas" or the like, they are essentially fresh made rice cakes. The ones being made this morning were simply corn masala, salt, heat and a lot of air pressure, but taste fabulous. They have a nice airy crunch and can serve as a perfect base for almost anything - sweet or savoury.

On their own, they are a very low calorie snack, being about 20 calories each, with no fat.


Although I'm Korean by ancestry, I had no knowledge of these things. The history, so it goes, is that Korean street vendors would sell them, making them out of rice, heat and wicked air pressure. They've been fairly big in Korea since the 1980's and have been spreading across North America over the last several years.

Have you tried these things before?
Do you like them on their own?
What is your favorite topping?

Let me know if you've seen one of these machines in the wild!
Here's some live action. (great explosion at :30s)!


Thursday, September 13, 2012

Recipe: Low Fat Pumpkin Bread Pudding

The beginning of fall weather in Southwestern Ontario is always my favourite time of year. It's still beautiful out, but not quite as hot as the sweltering humid summer was. The nights are just starting to get a little crisp, and the mornings are perfect for fast paced running.

This type of weather gets me thinking about harvest foods and stuff to warm the belly a little. I pulled out an old recipe for pumpkin bread pudding, and continue to modify it, keeping treat-like, but still really, really tasty. Let me know what you think!

Low Fat Pumpkin Bread Pudding.

Prep Time: 10 minutes (+ bread soaking time)
Cooking Time: 45 minutes


1 cup Pumpkin Puree
3/4 cup brown sugar
1/4 cup pure Canadian Maple Syrup
2 cups milk (skim is fine)
2 egg whites, beaten
1/2 tsp freshly ground nutmeg
1/4 tsp cloves
2 tsp cinnamon
1 tsp vanilla

1 loaf Day old French Baguette
3/4 cup plump California Raisins

Preheat oven to 350 F. Grease an 11x17 baking dish.
Cut the loaf into 1 inch slices, and then cube as equally as possible. (I like keeping the crust!)
Put bread into a large bowl and pour milk over, mix and let bread soak for about an hour.

Combine brown sugar, pumpkin, egg whites, vanilla and spices. Mix well, then add to bread/milk along with raisins. Mix all ingredients together, and spread evenly in baking dish.

Bake for 40-45 minutes until top just gets crusty.


Let me know how you like it!

Tuesday, September 11, 2012

Is This The Best Chicago Mix Popcorn Ever?

Sometimes fate is a funny thing. I was lucky enough to visit Chicago, for the first time, with my 9 year old daughter this summer. We did the usual touristy things like visiting the Aquarium, seeing Navy Pier, Millenium Park, and of course, trying Garrett's Chicago Mix Popcorn.

If you're not familiar, Chicago Mix is a blend of sweet caramel corn and savoury cheese corn. I'm usually a strictly sweets lover, so when I first heard what the combination was, I was pretty wary. But, walking into Garrett's and smelling the freshly popped corn, I was willing to try a sample.

Experiencing the Chicago Mix is probably like what Mr. Reese first experienced when he put together  chocolate and peanut butter - a match made in heaven. Somehow the sweet and savoury create a synergy that each on its own doesn't quite reach. That bag of warm, freshly popped Chicago Mix was one of the best things we have ever had! Sadly, in Canada, the difficulty in getting Garrett's, although remotely possible, is extremely expensive, circuitous, and certainly not fresh when it arrives.

Here's where fate comes in. . .

This week, on a random trip to our local Costco, way off in the back corner, amongst pallets of bottled water and toilet paper I literally walked into a small display of Cretors Chicago Mix Popcorn!

G.H. Cretor?
Admittedly, I'd never heard of Cretor's before, so I hesitantly turned the bag over, not believing anything could come close to Garrett's. The bag and label certainly was enticing, evoking old time marketing. Cretor's also had the mandatory backstory, actually laying claim to inventing the popcorn machine in 1885. They also make their own caramel in old school copper kettles and melt their own  cheddar cheese (no artificial powder!) for the cheese corn. Finally they had all the right buzz words - Gluten free, Kosher (although I'm not Jewish), and "all natural".

How's It Taste?
With little cajoling from the kids, I threw a bag into the cart, and as soon as we got home, broke into it - for scientific research only. My initial impression was certainly positive. The kernels were all fully popped and extremely large mushroom style. In fact,  I couldn't find any unpopped kernels at the bottom of the bag.

Being a sweets guy, I tried the caramel corn on its own first. Impressive. It had a nice fresh crunch to the outside, then almost melted beneath that coating my mouth with buttery sweetness. For a bagged product, this was pretty good.

I hesitantly threw a cheese corn piece into my mouth. I looked at my hands first - NO orange powder residue! Nice. The cheese corn was just salty enough, and again nice and fresh. No sogginess to be found.

Finally I popped a combination of several of each, the way that Mr Garrett and Mr Cretor intended. The blend of sweet and savoury was just right, and evoked memories of that fresh stuff in Chicago. Of course it wasn't warm from being just popped, but came awfully close. I think I've found a new go-to snack; until I can find another excuse to visit Chicago!

Full Disclosure- I was not paid by anyone to review either product (sadly) and purchased all product on my own. (although if anyone wants to send me more Chicago Mix, I'd be happy to eat it up!)

So, which side are you on - Garrett's or Cretor's? Let me know!

Tuesday, September 4, 2012

Quick Hit For Asthmatics: A New Add on Drug?

In a new article published this week in the New England Journal of Medicine, (full article here), adding the long acting anticholinergic drug, tiotropium, or Respimat, to poorly controlled asthmatics current treatment, significantly improved their symptoms.

People with asthma can have a tough go with simple daily activities, with triggers ranging from smoke, to pets, to pollens, to household dust. They can have trouble in the cold, with exercise, and anyone who has felt their breathing feel tight on occasion can sympathize with the sensation of this disease.

Respimat is a soft mist inhaler taken twice daily, and in this study of asthmatics between the ages of  18-75, their breathing was significantly improved.

Now, these individuals had severe asthma, that was poorly controlled, despite already using long acting steroid inhalers in addition to long acting beta agonists. They were also allowed to continue using short acting rescue medications if needed.

Results showed significant improvements in FEV1 (forced expiration volume in 1sec), or how strongly they could exhaled their air out, as well as preventing severe flare ups of their disease.

Side effects of the medications were similar to the placebo group.

Bottom Line: This is an interesting addition to the regimen of asthma medications, when control is difficult despite usual therapy.

Monday, September 3, 2012

Whooping Cough: Making A Comeback?

With kids going back to school, and in close quarters with their mates, it might be worthwhile revisiting a bug making a bit of a comeback.

In our city, there was a small spike of whooping cough (pertussis) over the summer, with half of them coming from unvaccinated kids. Other reported increases have been occurring within the province, within Canada, and within the U.S.

What Is Whooping Cough?
Whooping Cough, or Pertussis, is a highly infectious bacteria. First described in the year 1679, Bordetella pertussis translates as "violent cough". The Chinese coined the phrase "the cough of 100 days" because of its chronic nature.

The classic inspiratory whoop following a paroxysmal cough in children is not always present, especially in teens and adults and may contribute to some missed diagnoses. Other typical features include a cough lasting more than 2 weeks, sudden onset coughing spells, sometimes associated with vomiting. Fever is often NOT present or low.

How Do You Catch It?
The actual bug is a gram negative coocobacillus that is slow growing and highly virulent, meaning that those people who are exposed and unvaccinated are very likely to contract the disease. Attack rates range from 90-100 percent when NOT vaccinated. Transmission is by exposure to respiratory droplets from infected individuals.

Before vaccines were given against Pertussis in the 1940's, upwards of 200,000 cases of pertussis were reported annually in the United States. Epidemics spiked every 3-4 years without respect to seasons.
Infection rates decreased 150 fold after introducing vaccines, and spikes continue to occur when vaccination rates decline. (Britain saw a huge spike several years ago when there was unwarranted concern with respect to links to autism.)

Classic Presentation
The classic presentation is in 3 stages; Catarrhal stage, Paroxysmal stage, and Convalescent stage.
In the Catarrhal stage, lasting 1-2 weeks, the individual feels rundown with mild cough, perhaps low grade fever and runny nose. (Like a common cold.)

The Paroxysmal stage can last 2-4 weeks and is when people get more concerned. The cough is defined as sudden, repetitive coughing with up to 10-30 coughs per spasm. A whoop may or may not follow, and is more common in kids than older individuals. Posttussive vomiting is not uncommon, and fever may or not accompany this phase.

The Convalescent, or recovery stage, can last months and the cough should decline, but may continue to wax and wane.

Diagnosis and Treatment
Diagnosis is often clinical, but definitive diagnosis is by having a nasopharyngeal swab done. The time to diagnosis is several days, and treatment should probably get started prior to final diagnosis. First line treatment is straight forward and effective, so see your physician sooner than later.

Finally, immunization for both kids and ongoing boosters for adults should be the critical preventive method.
Immunity against pertussis wanes, and in Ontario, we have added the acellular pertussis vaccine to our tetanus booster given every 10 years.

Epidemics in schools should prompt review of your kids boosters, as well as your own.
I strongly advocate following our immunization program.

Let me know what you think.
Have you had any local outbreaks where you are?