Wednesday, October 24, 2012

Should Ontario Tax Junk Food?

Ontario, the province that I live, work and eat in, is considering taxing junk food. More specifically, the Ontario Medical Association (OMA), has suggested to the government, that this should come into being.
The OMA, in a press release yesterday, made the statement, with the usual eye-opening statistics.

  • Almost 1 in every 3 children (31.5%) is classified as overweight/obese. This has almost doubled since the 1980's.
  • Costs to Ontario's health care system due to obesity complications are in the range of 2.2-2.5 Billion dollars annually.
  • Tax incentives helped reduce the number of smokers in half over the last forty years.

Their recommendations are somewhat vague and include the usual "multi-pronged" approach.

  • Increasing taxes on junk food, and decreasing tax on "healthy" foods.
  • Restricting marketing of junk food to kids.
  • Placing graphic warning labels on pop and other non-nutritional foods. (a la cigarette cartons)
  • Restricting availability of junk food at sport/recreational facilities where kids frequent.
  • Legislating listing of caloric information on menu boards.
  • Enlisting an educational campaign.
  • Making Physical Education mandatory throughout high school.

I don't mind the concept of taxing junk food, but there are soooo many problems inherently built in. What is classified as "junk food". Who decides? What gets a "graphic label" put on their product.

Also, several of their recommendations already exist. "Healthy" food already is NOT taxed. Marketing is already restricted to kids on television. Educational campaigns already exist.

What do you think? Should we tax junk food like alcohol and tobacco?
Let me know!

Here's a great infographic on the massive amount of sugar we consume. Have a great day.

Monday, October 22, 2012

Mallet Finger: What Is It And How Do I Fix It?

A patient of mine came into the office last week complaining she couldn't straighten out her finger any more.
Two weeks ago she had been playing Volleyball and took a ball off the tip of her right ring finger. She said she could still continue playing despite the pain, but since then hadn't been able to straighten the tip of that finger any longer.

Mallet Finger: What Is It?
This very pleasant lady had suffered a tear to the extensor tendon of her ring finger. The mechanism of injury was classic. People will typically describe a direct blow to the affected finger when it is fully extended (ie straightened out). This usually will be a ball striking the tip of the finger, but occasionally happens when they run into something/someone with the finger straight out. With the tip of the finger straight, the force of the blow ends up tearing the extensor tendon off the bone, and the individual can no longer lift or straighten up the last joint of the finger.

When the tendon is torn away, it takes a little chip of bone with it, and is readily seen on plain x-rays (above).

How Do I Diagnose It?
First, my suspicion is quickly aroused with the typical history of injury. Secondly, to examine the finger, the diagnosis is usually confirmed seeing the tip of the finger hanging down (looks like a mallet, thus the nickname!)

The patient, when asked, will NOT be able to lift, or extend, the tip of the finger, confirming that the tendon is ruptured. Finally, for confirmation, I will take an x-ray to both confirm the diagnosis, and ensure that not too large a piece has broken away, and that the joint is still reasonably intact.

How Do I Fix It?
For the vast majority of patients, using a splint, HYPEREXTENDING the tip of the joint for a period of about 6 weeks allows the torn extensor tendon to reattach itself and heal.

There are commercially available splints, but I find they often don't fit snugly enough, and don't hyperextend the joint far enough. Much easier, at least for me, is to cut a piece of aluminum splint to the right length, and bend it to the degree of extension I want. Most IMPORTANTLY, I make sure that the middle joint of the finger is allowed to continue moving freeely, so that it doesn't stiffen over the period of immobilization. I also tell patients that when they are changing the tape, or cleaning the finger, to keep holding the tip of the finger in hyperextension, and NOT let it fall back down, ensuring that the torn tendon remains in contact and continues healing. I will sometimes tell them that if they let this happen, their 6 week clock has to restart again!

On rare occasions, the chip of bone is too large, or the joint is out of alignment. In these cases, I will send patients on to a plastic surgeon to discuss surgically correcting the digit. I will also, on occasion, depending on the person's occupation (ie professional piano player, etc), send them for a surgical opinion irregardless.

Final Note: I like to follow up with these individuals after 4-6 weeks and get a new xray and examine them again to ensure healing.

Have you ever suffered this injury? How was it treated? How did everything turn out?
Let me know!

Tuesday, October 16, 2012

Ankle Injuries: Do I Need An X-Ray?

Even if you're not a Yankees fan, you have to feel Derek Jeter's pain. Over the weekend, Jeter broke his ankle on a routine play, will miss the rest of the playoffs and may need surgery to correct the injury. Seeing such a class act and team leader go down is tough.

All of us have turned our ankle at some time as well. Be it running the bases, coming down from a rebound, sprinting down the soccer pitch, or simply stepping off the curb, we likely have rolled an ankle at some point. Ankle sprains themselves can be extremely painful, but when is the injury bad enough we may have broken something? Should you go to the ER and get an xray to be sure?

First off, sprains and breaks can both be disabling. To define a sprain, we are talking about injuring ligaments about the ankle, usually on the lateral (outside) part of the foot. This is because these ligaments are more mobile than the inside of the ankle.

Fractures are breaks of bones in the ankle and foot, again, usually on the lateral side of the foot, because the usual mechanism of injury is rolling the ankle in this direction.

So, When Should I Go Get An X-Ray?
Deciding to go the hospital after an ankle injury can sometimes be tough. If it's just a sprain, there's not a lot to be done, other than rest, elevate, and ice. If it's broken, you may need casting, an operation, who knows?
The cost, though, of blindly x-raying every ankle injury also adds up quickly, in dollars and exposure to radiation. In Ontario, x-raying every injury versus being more selective, could cost upwards of $730,000 per 100,000 patients seen. Therefore, over 20 years ago, a group of ER docs in Ottawa came up with a set of rules to decide when someone should get an x-ray, versus knowing nothing would be broken clinically. This ground breaking study, led to the Ottawa Ankle Rules, and is an extremely useful guide for the patient trying to decide when it is necessary to get assessed.

Basically, the rules are as follows.

  • You should have an xray if you CAN NOT transfer weight to the injured ankle/foot TWICE, either immediately, OR in the ER.
  • You should have an xray if you have TENDERNESS over the POSTERIOR (back part) of the EITHER malleolus (ankle bone).
  • You should have an xray if you have TENDERNESS at the BASE of the 5th Metatarsal (baby digit), or the Navicular (bone on the instep of the foot).

That's it. If you CAN walk on the foot, no matter how sore, AND there is NO tenderness over any of the bones listed above, you can skip the x-ray. Get ice on it, keep it elevated, and give it some time.
Having said all that, of course, if things aren't settling over the next few days, get it looked at. 

These rules have been HIGHLY validated, and virtually 100% sensitive. They have gone a long way to cost savings for the health system, and have saved many unnecessary xrays.

Here's hoping Jeter is back in full form next year!

Saturday, October 13, 2012

Change - The Best Motivator.

Sometimes, I get stuck in a rut. I get comfortable with my day-to-day routines; at work, at home, at the gym, whatever. I find what works and tend to stick with it. For the most part, this is a good thing. It provides consistency, quality, and predictable results. It can also start to get awfully boring. Interest and excitement can wane, and so can one's motivation to continue on. My philosophy in life has always been to work and play hard, and to always try to keep improving. This is where change is so important.

Disneyland Aug 2010 - Main Street U.S.A.

Change can be one of the great motivators in life. Being able to respond to disruptions in any aspect of life can be a good thing. At work, stepping back and looking at your environment, looking at how things get done, looking at end results and questioning whether things can be improved is important. Changing routines every now and then often freshens things up and can give new perspectives.

Change at home is a classic area of need for motivation. I am guilty for leaving tasks undone around the house, well, just, because. We often get into the routine of cooking the same things over and over. You get the drift. Shaking up the routine by finding a new recipe online, trying a new technique out for making dessert, making a more entertaining lunch for the kids (?Bento Box anyone). Just do it.

The same goes for the gym. Workout routines are good, but it's important to switch them out every few weeks. Adding 10% more weight, hitting the same muscles with a new machine, trying out a new class all can be highly motivating and improve your overall well-being.

As we get into the colder months, we all tend to lead more sheltered and, dare I say, more boring lives. In our suburb, once November hits, the only way you know actual people live on our street is by the tire tracks in the snow on their driveways. Everyone seems to drive into their "automatic garage door opened" entryway, not to be seen again until spring. This winter, change up the routine, and get outside, do something different and stay motivated!

Let me know what you do to keep from getting bored.

Tuesday, October 9, 2012

5 Ways To Stay Fit And Active When It Gets Cold Outside

We had our first frost this weekend and it got me thinking (sadly) about the upcoming colder weather and shorter days. I think we all find it more difficult to get motivated and stay active as the number of daylight hours start shrinking. These ideas might help out a little bit.

1. Staying Dry.
This is probably the most important factor in enjoying the colder weather. If your clothing gets wet, from sweat, rain, snow, or whatever, you will not be happy. Heat loss is accelerated if your body gets wet from evaporation and conduction, and you will be cold. Find a way to stay dry at all costs. Your outermost layers should be waterproof, including jackets, pants, and especially footwear. I try to find Gore-tex or similar material for my winter running shoes as they keep my feet both warmer and dryer.

2. Layering.
No matter what the activity is, I follow the same rules for layering in the winter.

  •  Base layer - Wicking layer including tights and long sleeved shirt. I tend to prefer Under Armor's Cold Gear, but anything similar does a great job wicking sweat away, and providing a bit of warmth.
  •  Thermal layer - A thicker layer goes on next and holds in body heat. Find something that isn't too bulky and allows free movement, but still keeps you toasty. Stuff with Thinsulate, or similar type material is best.
  •  Wind/Waterproof Outer Layer - Keeping both wind and wet from touching your body is critical to enjoying the outdoors. As mentioned in point #1, Gore-tex or similar material does the best job at this. If you're going to be out at night, make sure you have reflective material incorporated as well.
3. Find More Light!
The shorter winter daylight hours can be a real downer. It can sometimes be enough to cause mild depression, or Seasonal Affective Disorder, which certainly decreases motivation. Take advantage of bright sunny days, and find a way to get sun exposure when you're at work. Get outside at coffee breaks, recess, lunchtime, whatever. Get the lights on at home, and open up the blinds to let as much natural light in as possible. Going to work in the dark, and coming home in the dark isn't much fun.

4. Take Advantage of Fall's Bounty
We often get in the mindset that summer is the time for the best food, but I actually like fall's offerings better.
This is an opportunity to get wonderful, healthy fruits and vegetables like corn, pumpkins, squash, apples, yams. Here are some amazing links to using some of these great ingredients, and here, and here.

5. Go Inside. 
I've finally admitted to myself that there are some days that even I can't go outside and get my run in. Finding a good gym, or some good quality home equipment makes up for it. 

When checking out gyms, make sure their hours work for you. Do you need a 24 hour gym? Are they excessively busy when you want to go? Look at the quality of the machines. Do they keep it well maintained? If you like the looks of the gym, ask for a short trial membership before you commit.

If you're going to the effort of buying home equipment, get the best quality you can afford. If you buy it from late night TV, or purchase without trying it out first, you have only yourself to blame.

Well, again, I want to hear from you. What else do you do to get through the colder months?
Let me know!

Tuesday, October 2, 2012

Rant: Stealing From Community Gardens Is Pretty Low.

There's a small town named Owen Sound, about 3 hours north of where I live. Usually, news about things going on there don't really make it down here, but this news item caught my eye. A community garden, behind a church, no less, was robbed of its prized vegetables last week. Some of the items included a 200 pound pumpkin, some squash and watermelon. To add insult to injury, the garden has been managed by the Canadian Mental Health Association. The garden has been used as a tool to help people with mental health disorders gain independence, self-confidence, and employable skills. They have been tending it since 2008 and watching this year's crop grow since May.

Canadian Mental Health Association Leisure Links co-ordinator Teresa Pearson and community gardener Jack Lloyd survey the community garden project’s pumpkin patch in Owen Sound on Thursday after thieves made off with the fall crop of pumpkins squash and watermelons.

To move a 200 pound pumpkin is not a spur of the moment prank, and must have been planned well in advance. To do this to anyone is pretty low, let alone to a community project. If you happen to see someone trying to pawn off a giant pumpkin, or a load of pumpkin pies Crime Stoppers is 1-800-222-8477, and the local Owen Sound Police is 519-376-1234.

Let me know what you think should happen to the people who did this.