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Jeannie’s Rant…

Well, I’m still reading about COVID… but I think too many of us are “up to here” with anything COVID these days. We should be paying attention to the news telling us that, as predicted, COVID cases—and deaths—are increasing this fall. In fact, the company my daughter works for is closing their Montreal office and requiring all employees to work from home because of COVID. That’s making me pay attention! Stats in Quebec show It’s mainly one of the newer variants, BA-5, that’s driving their current surge, but other new versions are being closely watched.

So, it’s still a good idea to grab a mask on your way out the door if you’re heading to a crowded indoor place. My hubby and I have continued to do this anyway, although sometimes it felt like we were the only ones left taking precautions. I guess I’ve just been reading too much about Long COVID.

Medium COVID

But now experts are also using the term, Medium COVID, to describe those who have lingering symptoms for 3 months or so after recovering from the acute illness. They’re the folks who are still tired, coughing and get short of breath with a fairly low level of activity although they’ve recovered from the initial illness. This seems to be quite common and, although after a few weeks they’re back to their normal selves, that’s still a long time to be feeling crappy. Not my idea of fun!

Long COVID

Far more serious, is Long COVD, the folks who just don’t get better for months or sometimes years. Sadly, doctors really don’t know how to treat these unfortunate people. Some continue to have overwhelming fatigue, breathing problems, heart issues, dizziness when standing up quickly, and more. Physical therapy is one option being offered, I suppose to help people adjust to their limitations and rebuild their strength. That’s a good example of treating the symptoms, not the cause.

However, there are others who develop neurological symptoms after recovering from COVID, like brain fog, difficulty thinking, poor short-term memory, and nerve pain, leaving them unable to work or keep up with normal daily activities. I don’t know about you, but that possibility is enough to make me continue to do whatever I can to avoid catching this virus… I like being able to think clearly!

Much like Chronic Fatigue Syndrome

Many have observed that symptoms of Long COVID resemble those of Chronic Fatigue Syndrome (aka Myalgic Encephomyalitis of ME/CFS) that’s been around for many years. Like Long COVID, this syndrome develops after a viral infection, the cause is unknown, and they’re still looking for effective treatments. Too often, doctors have told these patients their problem is “all in their head” and prescribed antidepressants! But on the upside, certain antidepressants like amitriptyline can reduce nerve pain, so they’re not completely useless for a percentage of sufferers.

Another treatment being tried, is a low dose of a medication traditionally used to treat addictions, naltrexone. The treatment is referred to as “low dose naltrexone” or LDN, and a significant sub-set of patients with Long COVID and ME/CFS (but not all) find noticeable improvements with it. As the dose is about 1/10th of the commercially-available tablet, LCN needs to be prepared by a compounding pharmacist. This is something I used to do in my working days!

Other good news I also recently read about, is that the US Government is putting $1Billion into a research project called RECOVER that will test several potential treatments for Long COVID (and, hopefully, also for ME/CFS). Although only somewhere between 2 and 5% of those who have COVID will develop the long version, given the huge numbers affected by the virus, there are millions suffering from this debilitating condition world-wide. Experts fear it may become a significant drain on health systems and the economy in the future.

So, all experts are telling us that the best way to reduce your chances of developing these problems, besides avoiding the initial infection (by masking, washing hands and keeping your distance from others, especially if they’re sick!), is to stay up to date with immunizations. Studies are finding a reduced chance of Long COVID in those who’ve kept up their immunization. I have my shot #5 scheduled for next week! I’ll be getting the new bivalent vaccine that is designed to fight the Omicron family of Sars-CoV-2 as well as the older versions.

And I’ll also be taking the flu shot at the same time. Experts have determined that there’s no problem with getting them together except, I suppose, having 2 sore arms instead of just one. After a couple of slow flu seasons while we were all wearing masks and practicing physical/social distancing, chances are we may all be more susceptible to the flu virus this season. Already, hospitals across Canada are reporting high numbers of children with common viral infections, like RSV, along with the flu and COVID, resulting in swamped emergency departments.

So, here’s my rant: if you haven’t already, book an appointment at a pharmacy near you. And ask if you can get both the Flu and COVID shots while you’re there. Git ‘er done! As comedian, Rick Mercer says: “It’s just a little prick…” Watch him here for a good laugh!

PS The photo above is a sample of my latest photography experiment — “Low key photography”. And here’s my first try at drawing one of them (a selfie!):

References:

Local hospitals could face strain as early viral infections swamp pediatrics: CPS — The Abbotsford News

About ME/CFS — National Institutes of Health

#ShouldIGetACOVIDBooster #LongCOVID #MediumCOVID

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Anxiety? Depression? Is medication the answer?

Let’s talk about drugs, placebos, “talk therapy” and new research…

Too many of us are anxious, depressed and stressed these days, with COVID worries piled on top of everyday stressors. We know COVID is here for a while yet, perhaps for a long while. So, how do we cope? Is medication the best answer? New research suggests that other treatments are just as effective, except in the most severe forms of these conditions.

Let’s start with a simplified explanation of anxiety and depression:

Depression is a low mood driven by dwelling on events of the past. Anxiety is a negative mood associated with worry about future events. Mindfulness is focusing on, enjoying and appreciating what’s good about the present moment. Mindfulness, relaxation exercises (like deep breathing), meditation, and “talk therapies” (like phychotherapy, and cognitive behaviour therapy [CBT]) seek to break the cycle of repetitive unpleasant thoughts that, over time, can make us depressed or anxious. The more we focus on these thoughts, the stronger these brain thought pathways become, the more often these thoughts pop into your mind, and the more difficult it can become to enjoy the present moment.

So, this is how psychotherapy (talk therapy) works: It helps you train your brain to block negative thoughts and focus on positive ones. I’m simplifying here, of course. Psychotherapy is a complex science that requires highly trained professionals for ideal results. But it’s important to know that your “self-talk” has an influence on your mood and happiness. It’s something that many of us can learn to control.

How antidepressants work

For decades, health professionals have been taught that low levels of the neurotransmitter, serotonin, were responsible for low mood and depression. I remember learning this at an education program for practicing pharmacists many years ago, probably back in the ‘80s when Prozac first came on the market. The education session was sponsored, I’m sure, by a pharmaceutical company that manufactured a drug that influenced serotonin. Most education sessions were paid for by companies, as our professional associations were not well funded, and it was a common way for manufacturers to educate health professionals about their products in those days.

I remember how they explained that depression was caused by an imbalance in brain chemicals, and antidepressant drugs would rebalance the brain chemistry. Drugs that increase the effects of serotonin have been a mainstay in the medical treatment of depression for decades and they are also used to treat anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and other mental health conditions.

A new study says otherwise…

However, a large new study in the UK found no convincing evidence that low serotonin levels are responsible for mental illness. It seems that this was only one of several theories of the cause of depression proposed in the ‘60s. When serotonin drugs were developed beginning in the 1980s, health professionals (like me!) were taught the serotonin theory as if it were fact, when it was really just one of several unproven theories. The observation that these drugs seemed to help was used as “proof” of the serotonin theory.

But it turns out that half of the studies performed by antidepressant drug manufacturers were never published because they showed a negative result. This is called “publication bias” where study results that don’t give the desired result are simply not published. Science is not a democracy, where the majority of results “win”. In other words, any negative result should be questioned: why is the drug not producing a consistently positive result? In order to make the drug results show a significant improvement over a placebo (or sugar pill) they had to “cherry pick” the studies they published.

Another problem with the studies comparing drugs with placebo, is that they were difficult to “blind”. To make a proper comparison that eliminates bias on the part of patients, doctors and researchers, no-one involved in the study should know who actually received the drug and who took a placebo until it’s completed. But because of the side effects from the drug, it was difficult to blind the gathering of the data properly… another problem with the drug trials that could make the drug look better than placebo.

Added to publication bias, this could easily explain how manufacturers were able to sell their drugs despite the small differences found between drug and placebo in mild to moderate depression. Note that the American Medical Association (AMA) recommends using psychotherapy as first line therapy except in cases of severe depression.

But the drugs seem to work for many people…

But the drugs do work 80% of the time. It’s just that placebos were shown to work almost as well as the drugs in the studies—75% benefitted from the placebo, according to analytical researchers (but not mentioned in drug description monographs). This begs the question: why wouldn’t we use placebos as a treatment for anxiety and depression? They obviously work exceptionally well for mental health conditions, triggering our bodies to heal ourselves in the majority of cases without the side effects that drugs cause.

Note that psychotherapy/counselling has also been found to be equally effective to drug therapy in mild to moderate depression and has a longer-lasting effect than drug treatment. The exception would be in severe suicidal major depression where the emotion-numbing effect of these drugs can make a difference in the person’s safety, reducing suicide risk. Medication has been shown to work better than other therapies in more severe depression.

If you’re interested in reading more about this, check out reference #5 below… an article by Irving Kirsch, a researcher who has been examining the placebo effect for many years.

Back to the UK study…

“It’s not an evidence-based statement to say that depression is caused by low serotonin; if we were more honest and transparent with patients, we should tell them that an antidepressant might have some use in numbing their symptoms, but it’s extremely unlikely that it will be the solution or cure for their problem,” says study author, Mark Horowitz.

This seems to fit with the delay in action of these medications—it generally takes 2 or more weeks for them to start working. One researcher described it this way: emotional reactions are dulled by the drug, and begin to have less impact on mood. Eventually depression or anxiety improves because of lowered negative emotional input.

Interestingly, some experts in the field of psychiatry have stated this is nothing new… that they’ve known for years that low serotonin was not the cause of depression but that it is a complex condition with several contributing factors. However, it seems that this was not communicated to front line workers or patients, and the new study is causing quite a stir in the medical media.

Complex conditions often benefit from a combination of several treatment strategies, so simply handing a patient a prescription and advising a follow-up appointment in several weeks might not be an ideal approach to treatment. Working to change thought input can help to correct the patterns that led to a mood disorder in the first place, and could help to prevent a recurrence.

Brain “plasticity”

Meanwhile, other research into brain function has shown that our brains are much more “plastic” than was previously thought… meaning that we can change our thought patterns and the actual number and strength of connections between neurons (nerve cells in the brain) that connect thoughts, memories and emotions to our consciousness. The old statement that a person can’t think their way out of depression is likely not correct, although it could be difficult in severe depression. This suggests that “talk therapies”, like psychotherapy, cognitive behaviour therapy (CBT) and counselling, may be the preferred approach to mental health instead of medication, with medication added only in more severe cases.

And the American Medical Association (AMA) recommends psychotherapy as the first line treatment for mild to moderate depression. In more severe forms of depression, especially when there is a risk of suicide, they recommend that drugs should be included in the first choice of treatments. But, all too often, doctors reach for the prescription pad when they hear a patient describe even mild symptoms of anxiety or depression.

As well, side effects need to be considered. In addition to a long list of side effects while taking antidepressant medications (including drowsiness or insomnia, nervousness, digestive complaints, anxiety, tremor, dizziness, sexual dysfunction, and more), a rebound effect often occurs when the drug is stopped. This has often been misinterpreted as a return of symptoms of depression in the past, resulting in patients staying on medication for years. Patients are now advised to taper their medication slowly, under the supervision of their doctor to reduce rebound effects when discontinuing antidepressants.

Of course, like any ailment, mental health conditions are best treated early, before they become severe. Just like a house fire, you’re better off putting the flames out before the entire house is on fire. Seeking counselling early can give a person the tools to rewire the brain before the nerve connection pathways to negative thoughts become more strongly entrenched, leading to a more severe depression/anxiety state that has a greater effect on the person’s life and is more difficult to treat.

What about natural treatments?
Another recent study looked at the use of vitamins B6 and B12 specifically for mild anxiety symptoms. It confirmed that B6 at relatively higher doses than normally consumed in food (100mg daily) could help reduce symptoms of anxiety. Vitamin B12, in comparison, made only a small difference in this study.

“Stress formulations” containing mainly B vitamins have been available for many years on pharmacy shelves. A vitamin B Complex-100 tablet, taken once daily, would also provide the amounts used in this study. For many years I have suggested women try taking this at bedtime (for middle of the night awakening) or at suppertime (for trouble falling asleep) when they have difficulty sleeping due to mild anxiety. Improved sleep has been found helpful in overcoming mood disorders.

A final caution:
It is important not to stop taking your medication abruptly. Be sure to discuss options with your doctor before making any changes to your medical treatment.

#depression #anxiety #SSRIs #Serotonin

References:

  1. No Evidence Low Serotonin Causes Depression?–Medscape
  2. Analysis: Depression is probably not caused by a chemical imbalance in the brain – new study—University College London
  3. What has serotonin to do with depression?–World Psychiatry
  4. A Popular Theory About Depression Wasn’t “Debunked” by a New Review—Neuroscience News and Research
  5. Antidepressants and the Placebo Effect—PubMed Central
  6. Prozac (official drug monograph) (Note side effects, warnings and the lack of data on effectiveness compared to placebo)
  7. Vitamin B6 may reduce anxiety symptoms, study shows—Medical News Today
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Breast cancer… sometimes misunderstood!

Since October is Breast Cancer Awareness Month, I thought I’d dedicate a blog to this terrible disease that affects 1 in 8 women in North America, not to mention the impact it has on their families and those they love.

So here are some myths about breast cancer, and what the experts say about them…

Myth #1

A breast injury can cause breast cancer. Although a breast injury can sometimes cause changes in the breast tissue that might mimic the look of a cancer in a mammogram, it cannot cause cancer. But just to be sure, your doctor may want to do a needle biopsy, removing a small amount of breast tissue with a needle and syringe to examine in a lab, if an area looks different than usual due to a previous injury.

Myth #2

Underwire bras increase the risk of breast cancer. The wires do not cause cancer, but they can irritate the skin under the breasts, causing it to break down. Irritated skin is less resistant to bacteria and fungi which could cause an infection or abscess in the breast. Also non-wired bras are more comfy!!

Myth #3

IVF increases the risk of breast cancer. In vitro fertilization (IVF) involves the use of estrogen-like drugs to stimulate the ovaries to produce eggs. This led some experts to wonder whether the treatment could increase the risk of hormone-sensitive cancer cells developing, or at least speed the growth of any of this type of cancerous cells that might be forming. Although no studies have specifically been done to confirm this doesn’t happen, one trial compared the cancer risk of women who had had IVF with those who had not, and found no difference.

Myth #4

I won’t develop breast cancer because no-one in my family has had it. Most women who are diagnosed with breast cancer have no family history—only 5-10% of breast cancers are caused by a genetic mutation that was inherited. In fact, many diagnosed women have no known risk factors at all. Obviously, we’re missing something… (perhaps an environmental connection?) More research into the causes, please!!

Myth #5

Stress can cause breast cancer. While too much stress can certainly affect our health, there is evidence to show there is no association between stress and breast cancer. On the other hand, breast cancer most certainly causes stress! We can all benefit from learning effective ways of dealing with the stresses of modern life…

Myth #6

A healthy lifestyle eliminates breast cancer risk. A healthy lifestyle can reduce the risk of breast cancer, but it can’t eliminate it. Refer back to Myth #4… we need more research into the causes of breast cancer!

Myth #7

Breast cancer only occurs in older women. It is true that most cancers occur in older women. Age is a known risk factor—one we can’t do anything about. Screening mammograms are recommended only after age 50 in most countries, and after 40 in the US, as they are less accurate in younger women with more dense breast tissue. But about 5% of cancers are diagnosed in women under 40 years, typically in those with a strong family history of the cancer. It is recommended to watch for any unusual breast changes, like lumps, puckering of the skin or a nipple pulling inward (inverted nipple) and to see your doctor right away if any of these occur.

Myth #8

All breast lumps are cancerous. Actually, most new breast lumps are not cancer. A cyst (a pocket of liquid surrounded by a membrane) feels like a lump, and these are fairly common. However, always see your doctor right away for an evaluation if you notice a new lump or any other unusual breast change.

Myth #9

An abortion increases the risk of breast cancer. An abortion interrupts the normal hormone cycle of pregnancy (and pregnancy before age 30 is believed to reduce breast cancer risk), causing some to wonder whether it could increase the risk of a hormone dependent breast cancer. However, a large observational study in Denmark and several other smaller studies found no link between abortion and breast cancer.

Myth #10

Nipple piercings increase breast cancer risk. Piercings do not increase cancer risk, but they can lead to increased risk of infection, abscess, nerve damage, scars, cysts and difficulty breastfeeding (due to blocked ducts from scar tissue).

Myth #11

Sugar causes breast cancer. Refined sugar in excessive amounts is bad for our general health, but there is no evidence it directly causes breast cancer. I have read reports of research looking at very low sugar/high fat diets (an extreme form of the keto diet) to slow the growth of cancer cells in general, but the studies are not yet conclusive. Studies specifically looking at sugar and breast cancer have had “mixed and inconclusive” results, according to experts.

Myth #12

Men do not get breast cancer. Yes, they do! One in every 100 cases of breast cancer occurs in men. Men also should stay alert to any changes in the breast area, particularly as it can spread more quickly in males since they do not have as much breast tissue to contain it. As well, men are not screened for this cancer and tend to have less support when they are diagnosed with it.

Myth #13

Mammograms and biopsies can cause breast cancer to spread. The thinking here is that the squeezing and poking of a potential cancer could cause the cells to seed in another part of the breast. Some women also worry that the radiation of the mammogram could cause a cancer to begin. However, very low doses of radiation are used in current mammograms, and these are considered safe (although the operator, being there daily, needs to protective themselves from work-related exposure). No evidence has been found that these tests cause cancers to spread and they give valuable diagnostic and early-detection information that save many lives.

Myth #14

No lump means no cancer. Cancers that have formed “palpable” lumps (ones that can be felt with the fingers) have often been there, growing, for several years. The advantage of screening mammograms is that they can often detect a cancer before it is large enough to be palpable, greatly increasing the chance of a complete cure.

Myth #15

Anti-perspirants cause breast cancer. This myth started because many breast cancers occur in the upper outer area of the breast, the area closer to the armpit. However, very little if any of the ingredients in anti-perspirants are absorbed and there is no evidence that they would cause cancer if they were absorbed. At least one large well-conducted that compared breast cancer survivors with healthy women found no evidence of a problem with anti-perspirants or deodorants. The tiny grains of minerals left on the skin by antiperspirants do, however, show up on a mammogram, causing confusion for the radiologist interpreting the image. This is why they always insist that these products not be used on the day you are having a scan.

Myth #16

Carrying a phone in your bra can cause cancer. While most experts will say there is no evidence that cell phones cause any type of cancer, a few have reported case studies of unusual cancers that began in the same location where the woman carried her phone for several hours every day. Not proof of a cause, but one doctor was suspicious enough to publish a report after seeing several similar cases (which I linked to in my Sept 17th blog on environmental links to cancer). It might be a good idea to carry your phone in a purse or proper phone case, both to protect it and possibly also you! Cell phone manufacturers do recommend avoiding exposure of the phone to sweat, as the liquid could cause damage to the phone (as happened to my daughter, who no longer tucks hers into the waistband of her workout pants!)

So, there you go… less to worry about, right? I think the key in avoiding many diseases, including cancer, is to strive for as healthy a lifestyle as possible: eat well, exercise, limit alcohol to recommended amounts, and avoid exposure to nasty chemicals. And, since it’s Breast Cancer Awareness month, maybe make a little donation that might help researchers find the causes and cures for this disease that affects too many women…

References:

Medical Myths: 15 breast cancer misconceptions—Medical News Today

Antiperspirant Safety: Should You Sweat It?—WebMD

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Falling through the cracks…

Some patients have always fallen through the cracks of our medical system, with unnecessary delays in diagnosis. We’re all human… a significant symptom can be ignored or misinterpreted, or we can put off investigating the cause of a nagging problem that could suggest a serious condition. But during the COVID pandemic, the cracks in the system have become wider. With fewer in-person appointments, cancelled screening clinics and hesitation to seek treatment because of worry about virus exposure, experts are warning that diseases are likely being diagnosed later when they’re harder to treat.

They worry that because early-detection procedures like PAP tests, mammograms and the PSA test for prostate cancer are being postponed, we may see cases where the diseases these tests screen for are more advanced at diagnosis. This can sometimes mean more expensive treatment and worse outcomes because diseases are more likely to have spread when diagnosed. Just like a house fire, cancers and infections are best treated sooner before they have a chance to advance and spread.

It will take time for statistics to show how much of this is happening and to what extent the problem of decreased health screening is affecting our health and our chances of surviving health problems that are detected further along in the course of the disease. But, anecdotally at least, I’m seeing that this is happening.

Of course, for privacy reasons, I don’t want to describe the cases I’ve learned about amongst family and friends, but I can tell you my story. You may have noticed that I took a break from blogging this summer… but it wasn’t because I was having too much fun to write. The truth is, I haven’t been feeling well for the past several weeks. And I still don’t know the cause.

So, from my point of view, here are some of the “cracks” that it’s easy to fall through…

Crack #1: one thing at a time

In mid-May I noticed some abdominal discomfort—nothing too terrible. Then a week later a sudden severe pain sent me to Emergency… Crack #1 to avoid: try not to have 2 things going on at once (not that we really have that choice…). If you do, be sure to explain that there seem to be two unrelated things going on. Turned out I had a kidney stone (perhaps obvious from the level of pain…) but since they couldn’t see the stone on a CT scan it was diagnosed as a kidney infection. I spent the next 2 weeks on an antibiotic that made no difference. A later scan showed several smaller stones, confirming what I had suspected must be the cause at the time because the pain was so severe.

But in spite of visits with 4 doctors and a nurse practitioner, along with a series of tests, there’s still something else going on that hasn’t been diagnosed yet. At least I’ve progressed from phone appointments to in-person ones as my symptoms have gradually worsened.

Crack#2: describe symptoms clearly

I can see that the system is backed up, with longer delays than usual in getting appointments and results of tests. Crack #2: make sure the person on the phone understands your symptoms and how severe they are. Avoid the “Fine, thank you” automatic response when a health professional asks how you’re feeling—be truthful and accurate. Let them know how the symptoms are affecting your daily life.

Crack #3: know your receptionist

One important lesson I’ve learned is that the receptionist is the gatekeeper of the doctor’s time. While it may seem weird to be describing details of an illness over the phone to someone who isn’t a health professional, she is the person who decides how soon you need to be seen. So, heed Crack #3 and treat the receptionist like the important person that they are… describe what’s going on politely and carefully along with any frustration or desperation that you may be experiencing! And thank them profusely for helping you to be seen in a timely manner—it’s probably due to their actions. Usually, they’re the ones who manage the doctor’s schedule and often are the ones with the connections to the receptionists in the specialists’ offices.

Crack #4: communicate well

Crack #4 is about lack of communication. If you go to an after-hours clinic or emergency department, your doctor may or may not know about it afterward. Even if the Nurse Practitioner in your Family Doctor’s office sees you and documents her observations on your chart, your doctor may not see it until your next visit with them. Your family doctor should be the central hub of your healthcare and seeing them regularly, especially when you have a health issue, helps keep your care from various sites coordinated. Make sure they are well informed and aware of any care you receive outside their office. At least now we have electronic health records in most areas, so information about various treatments in different locations is accessible to everyone who is treating you and needs it. They just need to know it’s there and to look.

Crack#5: avoid vacations!

And Crack #5 is: don’t get sick during vacation (as if we have a choice!). Many doctors are not able to find locums to cover the office when they take vacation, leaving patients to rely on after-hours clinics and emergency departments. Even our local blood collection/lab sample drop off clinic, usually lined up daily to overcapacity, just closed up for a week to take a holiday. For many like me, we were left wondering where to go and this resulted in yet another extra week’s delay for me and many others in getting test results needed to help find a diagnosis.

My story…

So, where am I now? I just learned this week that my latest test, the one that should finally provide a diagnosis and the test I’ve waited 2 months to get, has a 2 to 3 month wait for results. I can’t believe it. I’m unbelievably frustrated that any lab could take 2 months to process a sample and that, as the receptionist told me, it could take an additional month in this age of electronic communication to send me a letter by snail mail with an appointment to hear the results. I think I cried on the phone in frustration. I’m hoping my newest favourite receptionist may be able to work some magic and expedite this process somewhat for me, the way the receptionist in my family doctor’s office was able to get me into the specialist more quickly. The words “possible carcinoma” on a June 30th test should have resulted in quick action but here I am, 2 months later, still waiting for a diagnosis. Whatever it is, I just want to know. It’s more than a little stressful and certainly not the norm in any medical system, including ours. Might be time to send an email to my local politician…

The bottom line

I guess, the bottom line is that we all need to be proactive about our health. Even in these days of the continuing pandemic, we still should insist that routine care and screening tests are completed in a timely manner. Vaccines and well-fitting masks are tools we have to make sure we stay safe from the virus while we do this. If you have unusual unexplained symptoms, insist that they be diagnosed. Keep asking for investigations until the problem is resolved. Remember that your family doctor is usually the most important healthcare professional to work with you and to coordinate and oversee your care.

So, if you’ve missed any screening tests in the past year and a half, now is the time to book an appointment. Just like a house fire, it makes a big difference if you catch it early. If something seems to be wrong with your health, check it out right away and keep pushing until you get an answer… that’s what I’m doing, even though it seems to be taking much longer than it should.