Find your inspiration!

DSC04776

To make the most of this life, we must make the most of each day.

What inspires you to rise out of bed each morning, do what needs to be done, pursue your goals and give the extra effort that makes a difference? What gets you through the in between times with a mountain range of challenges between you and your destination?

From an early age, I was hooked on reading. By grade 6, I had finished reading the World Book Encyclopedia and spent hours each week at the McGill Branch Public Library in North Burnaby. Like my mom, each week, I would borrow my limit of books.

I was inspired by Norman Vincent Peale’s The Power of Positive Thinking, Dale Carnegie’s How to Win Friends and Influence people and James Allen’s As a Man Thinketh. I learned much more from countless books, and my eyes opened to an expanding horizon of possibilities.

So enriched and moved by the writing of others, I imagined how wonderful it would be to help and inspire others with my own words some day.

For ten days in grade 6, I had a flare-up of rheumatoid arthritis with rashes, fevers and painful joints. On Burnaby Hospital’s pediatric ward, I was cared for by my doctors and nurses who weren’t treating a disease but rather me as a whole person. I trusted them to do their best for me, and it was then that I decided to be a physician – to give forward the care that I had been given and to care for others when they are most in need.

An inspiration can get us started on a path, but what keeps us going?

We can be most inspired by those we serve. When I became a parent, the awesome responsibility of caring for a helpless baby, loving unconditionally and nurturing each of my children to their greatest potential was the greatest of callings.

I had to rise to this responsibility and strive to be my best to give my best. My children have made me a better person.

As a physician, I developed my golden rule of medicine: treat every patient with the same degree of care and consideration I would want for a best friend or family member. For any of my patients, I refer to the same colleagues and order the same tests in the same time frame that I would want for those in my personal life.

The needs of my patients have inspired me to be a better physician. I am inspired and supported by a few of my colleagues, including my classmate, Dr. John Law, who like me, commit to continuous quality improvement in their clinical skills and looking outside of the box, learn advanced techniques to meet the needs of our patients.

The most inspiring physicians learn from one another and from their patients.

In your personal life, whom do you serve? Look both inside and out of your own home, community and workplace. If there is a need, can you rise to meet it?

Each day presents us with infinite opportunities to make a difference big or small – to lift up the hearts of a few people and to live a meaningful life.

Celebrate Inspiration Day from 10:30 am to 1 pm on Saturday, February 6th at Century House at 620 Eight Street in New Westminster. I’ll be there to enjoy the entertainment of the Century House Singers and Comedians and give the keynote presentation. Admission is $5. Call (604) 519-1066 for more information.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Royal City Record, Richmond News and Vancouver Courier. For more on achieving your positive potential in health, see his website at www.davidicuswong.wordpress.com.

Posted in Caregiving, Love, Medical Ethics, patient-doctor relationship, Positive Potential, Purpose, Relationships, Your Calling, Your Goals | Tagged , , , , | Leave a comment

Misreading your blood pressure: 6 ways we go wrong

Aneroid BP

Once we’ve established that you’re breathing and you have a pulse, your blood pressure is a crucial vital sign. Even when you’re feeling well, that number can determine if you’re at risk for a stroke, heart attack, heart and kidney failure, vision loss, foot or toe amputations or the other dire consequences of blood vessel damage.

Getting the most accurate measurement is important.

If your real pressure is actually lower than what you measure, you might be overtreated – and suffer side effects from too much medication. If you’re relying on incorrectly low BP readings, you’ll be lulled into a false sense security while high blood pressure is silently damaging the vessels and organs of your body.

Here are six common ways to get the wrong number.

#1 Position and Posture

The ideal position for measuring your blood pressure is sitting with your back supported and your feet resting comfortably on the floor. If you cross your legs or clench your teeth, your blood pressure will go up.

The arm on which the blood pressure cuff is attached should be supported at the level of the heart. If your arm is hanging down, the reading will be higher. If you are contracting muscles, your pressure will go up. Your arm should be supported by the healthcare provider, a table or an armrest.

#2 The Setting

White coat syndrome is when your blood pressure is higher when a doctor or nurse is measuring it. Even healthcare providers can have white coat syndrome, but hopefully their own pressures don’t go up when they look in the mirror.

If I suspect white coat syndrome, I ask my patients to measure their blood pressure at home and at work with a reliable blood pressure machine. I sometimes lend out a calibrated machine from my office. You can find a list of machines tested and approved by Hypertension Canada on the website at hypertension.ca.

I often ask a patient to close his eyes and imagine that he is in his living room, but if he imagines his wife squeezing his arm and telling him to take out the trash, his pressure will be even higher.

#3 How You Breathe

You’ll get a higher reading if you hold your breath, if you are straining and when you’re talking. I politely ask my patients to stop talking and remember to breathe.

#4 Exertion or Exercise

When we exercise, the heart is working harder and both blood pressure and heart rate increase. Once we’re back to a normal resting heart rate, blood pressure is usually lower for the hour or so after exercise. The long-term effect of regular moderate physical activity, such as walking or cycling, is better blood pressure control.

If you measure your blood pressure just after running up the stairs, your reading will be higher but after five minutes, it should be back to your usual resting level. If it isn’t, you may be deconditioned. Ask your doctor to guide you in finding an appropriate level of physical activity.

#5 Equipment

A cuff too small for your upper arm will give a falsely high reading. A cuff too large will underestimate your pressure. Most cuffs have markings to indicate the correct fit.

If you are relying on an inaccurate or unreliable machine at home, you could be under or overtreating your blood pressure. This is especially important if you have a very slow or an irregular pulse rate. If the cuff deflates too quickly, it will not pick up the moment when the pressure in your artery matches the pressure in the cuff. You may get a falsely low reading.

Most pharmacies calibrate their blood pressure machines, but the cuff will not fit every individual and after a thousand people use a machine, it may need recalibration. I frequently see patients bringing in impossibly high and low blood pressure numbers.

When I recheck their pressures and find them normal, I ask them to use the drug store machine as a random number generator for the next 6/49 draw.

#6 Technique

Many patients have an auscultatory gap. In this case, the systolic pressure (the top number in the BP reading) is much higher than expected. When the doctor or nurse is listening over the arm as the cuff deflates, the pulse is heard, disappears and reappears before finally disappearing again at the diastolic pressure (the lower number).

If the cuff is not inflated high enough, the true systolic blood pressure is missed and mistaken for the reappearance of the pulse at a lower pressure.

With very high blood pressure, most machines will miss the top number and give a falsely reassuring reading. This can also happen in the doctor’s office if the cuff is not inflated high enough.

A lot of people recheck their blood pressure right after getting a high reading. They’ll repeat this until they get a number they like better, but with successive readings, they will get falsely low readings due to congestion of the veins in the arm. This muffles the volume of the pulse and results in an incorrect measurement.

It’s better to fully deflate the cuff, take your arm out and wait at least a minute before taking another reading.

Because your blood pressure has a tremendous impact on your future wellbeing, you need the most accurate measurements.

To learn more about “What You Should Know About High Blood Pressure”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series.

I’ll be speaking on Friday, January 29th at 7 p.m. at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the Eileen Dailly Pool and McGill library). Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

 

Posted in Empowering Healthcare, Healthy Living, Preventive Health, Uncategorized | Tagged , , | Leave a comment

What you should know about blood pressure

IMG_2953

Have you checked your blood pressure in the past year? Do you know your numbers?

High blood pressure – or hypertension – is an extremely common condition. When unrecognized or untreated it can cause catastrophic effects in your body.

To discover what you need to know about high blood pressure, let’s debunk 5 common myths about blood pressure.

Myth #1: It’s just a number.

Your blood pressure is one of the vital signs measured by health care providers. It is the pressure or force of blood against the inside of your blood vessels as it circulates to all the areas of your body.

The higher number on top is called the systolic pressure and it represents the pressure in blood vessels when the heart contracts. The lower number is the diastolic pressure corresponding to the heart relaxing and refilling with blood.

Pressures too high over time progressively damage blood vessels themselves and the vital tissues and organs they supply. Uncontrolled high blood pressure increases your risk for stroke, heart attacks, heart failure, dementia, kidney failure, vision loss and for men, erectile dysfunction.

Myth #2: I don’t need to worry about it.

High blood pressure is common. More than 1 in 5 adults has it, and your lifetime risk for developing hypertension is approximately 90%.

Blood pressure tends to increase with age. If your blood pressure is in the high normal range (130 to 140 over 80 to 90), you should be checked at least annually because you have a 40% risk of developing hypertension in the next two years.

Myth #3: If I feel good it can’t be high.

Most people with elevated blood pressure feel perfectly normal.

In fact, our brains are more sensitive to abnormally low blood pressure; we might feel lightheaded on standing, break out in a cold sweat, feel nauseous and faint when it’s too low.

High blood pressure often causes no symptoms until vital organs or tissues are significantly affected, such as with calf pain with walking or chest pain with activity due to narrowing of the arteries.

Myth #4: It’s only high at the doctor’s office.

With white coat syndrome, blood pressure is only high in a medical facility but normal most of the time. If you’re pressure is high in your doctor’s office, you should consider measuring your pressure with a reliable machine (See hypertension.ca for Hypertension Canada’s recommended models) not only in the quiet of your home but also at work where you spend most of your time.

When I discovered that some of my patients had higher blood pressures in their workplace than in my office, I coined the term, “white collar syndrome.”

Sometimes the presence of a spouse in the same room results in a higher reading; for others, a lower reading. You can probably guess which way it might go in your own home.

Myth #5: If I start taking medication for my blood pressure, I’m stuck on it for life.

Medications that lower blood pressure are not addictive and don’t cause dependence. But if you are already taking a drug to control blood pressure, if you stopped it or lowered the dose without medical guidance, your pressure would rise again.

The best way to manage blood pressure may be a combination of stress management, healthy lifestyle changes and medication if necessary. Each individual should work with a doctor who can find the best, most effective, custom fit.

There are proven lifestyle practices that can improve your blood pressure.

If you smoke, quit.

Limit alcohol to two or less drinks per day,14 drinks per week for men and 9 drinks per week for women. A standard drink is 1 can (341 ml) of 5% beer, 1 glass (150 ml) of 12% wine or 1.5 oz (45 ml) of 40% spirits.

Some individuals are sensitive to salt, and their blood pressure improves on a low sodium diet.

Maintain a healthy weight. For overweight individuals, a drop of 10 to 15 lbs can lower blood pressure.

Moderate dynamic physical activity (such as walking, jogging, cycling or swimming) 30 to 60 minutes 4 to 7 days a week can lower blood pressure.

The DASH diet was found to lower blood pressure. This is a diet high in fruits, vegetables, low fat dairy products, fibre, whole grains and fish, and low in saturated fats and transfats.

Dr. Herbert Benson demonstrated that the Relaxation Response common to meditation, prayer, yoga and mindful breathing can lower blood pressure.

To learn more about “What You Should Know About High Blood Pressure”, come to my next free public lecture on behalf of the Burnaby Division of Family Practice’s Empowering Patients series.

I’ll be speaking on Friday, January 29th at 7 p.m. at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the Eileen Dailly Pool and McGill library). Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Vancouver Courier, Richmond News and the Royal City Record.

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Healthy Living, Preventive Health, Uncategorized | Tagged , | Leave a comment

Bring Your Best to a New Year

IMG_4174

As we grow older, each year seems to pass more quickly.

When I was five years old, a summer seemed to last a year; now each season passes in a flash. As we accumulate years in age, each year, month, week and day becomes a relatively smaller proportion of the time we have experienced. And maybe we’re not as attentive.

Yet with each New Year as I review the old calendar, I am always surprised with what has happened in the span of just one year. The media recapitulates the big world events with retrospective spins, but what matters most to you and me are our personal experiences.

There were birthdays, anniversaries and many other celebrations; time spent with family and friends; plays and musicals seen with my wife.

There were hard times too. I looked after two dear patients who died from the most aggressive cancers. Though palliative care is a special opportunity to give my best in the worst situations and care for a whole family when they need it the most, each visit to home and hospice takes its toll. I die a little with each death.

Last year, my wonderful Aunt Cecile passed away in hospice. Though we miss her deeply, we were fortunate to have had the time to express our love and say goodbye.

There were changes in our relationships: meeting some for the first time; saying farewell to others; a deepening of some friendships; a drifting apart with others.

Taking stock of the old year is practice for looking back at one’s life.

Before moving on, I ask, “What am I most grateful for?”

I reflect on the good fortune not just the bad; the wonderful, kind actions of others; my gracious patients who entrust me with their care; my colleagues who support me in our shared calling; the many good people I have worked with to improve the health of our community; my best friends, and my family.

What have I survived? How have I been helped? How have I helped others? What have I learned? How have I grown? The answers are measures of a year and of life.

Entering this New Year, what will we do differently? What activities should we do more of? What should we reduce? What should we cut out all together? What can we create?

This life and each moment are precious. We have nothing to waste.

This year, I’ll be continuing my work with the Burnaby Division of Family Practice in our free public health lectures.

On Friday, January 29th at 7 p.m., I’ll be speaking on “What You Should Know About High Blood Pressure” at the Confederation Community Centre at 4585 Albert Street in North Burnaby (near the Eileen Dailly Pool and McGill library). Register online with lcullen@divisionsbc.ca or call Leona at (604) 259-4450.

Davidicus Wong is a family physician and his Healthwise columns appear regularly in this paper. For more on achieving your positive potential in health, see his website at www.davidicuswong.wordpress.com.

Posted in Burnaby Division of Family Practice, Coping with Loss, Emotions, Friendship, Growth, Happiness, Letting Go, Love, Positive Potential, Relationships, Your Goals | Tagged , , , | 3 Comments

Empowering Patients with Knowledge

The Future of Family Practice.jpg

When you think about the work of your family physician, you probably envision the one-on-one care he or she gives to each individual patient. It may be a clinic, hospital or – more rarely – home visit.

That still remains the priority of virtually every family physician: the wellbeing of every patient in his or her practice, but you might be surprised to hear that the circle of care is expanding. More physicians in our community care about the health of the entire community.

The Burnaby Division of Family Practice is a non-profit organization founded in 2011 and funded by the General Practices Services Committee. Its members are the family physicians who serve our community.

With the other founding board members, I wrote our organization’s vision and mission statements. Our vision for the Burnaby community: patients and physicians achieving health and happiness. Our mission: to engage, support and mobilize family physicians in co-creating a network that will support the wellbeing of all members of the Burnaby community.

Although I’ve recently stepped down from the board of directors, I continue to lead the Burnaby Division’s Empowering Patients public health education program. Recognizing that the public receives confusing and often incorrect medical information from the media, we sought to provide unbiased information

Our vision is that by raising general health literacy (public knowledge about healthy living and how best to use the healthcare system), we can improve the health of our community. We may be able to reduce the burden of chronic disease in the future.

Since we started the public education program in October 2014, we’ve delivered 11 public presentations in our community’s libraries, schools and community centres. The topics have included healthy eating, healthy relationships, emotional wellness, healthy physical activity, patient-doctor communication, making the most of your hospital stay, medical ethics and common chronic health conditions, such as diabetes.

Summaries of each of these presentations is available on the Burnaby Division of Family Practice’s website https://www.divisionsbc.ca/burnaby/empoweringpatients. There you will also find the dates for future talks in the series and links to our videos on emotional wellbeing, making the most of a hospital stay and important symptoms for which you should seek medical care.

I’ll be speaking on “Making Sense of Symptoms and Screening Tests” at 7 pm on Tuesday, December 8th at the McGill Library on 4595 Albert Street in North Burnaby. Growing up in North Burnaby, this was my “home library” close to the Eileen Dailly Pool and the Confederation Community Centre. I’ll go over the “review of systems”, the questions that physicians include in a complete physical examination. Because no one gets routine physicals anymore, most people are never asked these questions about the symptoms that may indicate important medical conditions.

When patients receive episodic care at drop-in clinics, they may not be aware of what tests they should be having and when. For this reason, I’ll also review the key screening tests that are recommended at different ages.

To register for this free talk, please contact the McGill library at (604) 299-8955 or http://www.bpl.bc.ca/events

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Happiness, Healthy Living, Medical Ethics, patient-doctor relationship, Preventive Health, Screening Tests, Self-care | Tagged , , | Leave a comment

How to think about chronic health conditions

Tapestry Talk

I’ll be giving a public presentation on “What You Should Know About Diabetes” at the Bonsor Recreation Complex at 7 pm on Wednesday, November 25th. You’ll learn if you are at risk for diabetes and how you can prevent it; how diabetes can affect your heart, circulation, nervous system and brain; and what you would need to know to effectively manage your health and avoid these complications.

To register for this free event, contact Leona Cullen at lcullen@divisionsbc.ca or (604) 259-4450. This presentation is part of the Burnaby Division of Family Practice’s Empowering Patients public education series.

An important focus of primary care is the management of chronic disease. This includes high blood pressure, diabetes, heart disease and chronic lung disease. The proactive, planned management of these conditions has been shown to reduce complications and hospitalizations, prevent premature death and improve quality of life.

The term, chronic disease carries a negative connotation. I prefer the term chronic condition. After all, each of us shares one chronic condition; it is sexually transmitted, incurable and has a 100% mortality rate. That condition is life.

On good days (and I’m hoping that for you that means most days), you recognize that it’s not all bad. We don’t choose the conditions of our lives and we don’t deserve misfortune, but we can choose to make the most of what we have.

We remain agents of positive change. We can learn and do what we can to maintain the best quality of life so that we can pursue our personal dreams and do what is most meaningful to us.

And we can be agents of positive change by helping others struggling with their own chronic conditions, providing the support that we can and empowering them to be active managers of their own lives.

That’s how I see my role as a family physician. In healthcare, we treat people not medical conditions. We help our patients manage their health in the context of their whole lives. That management has to be tailored to fit the unique life of each individual.

Doctors and nurses have traditionally had the habit of labeling patients with their conditions. They might call the first patient on the OR slate, “the 7:30 gallbladder.” There is a tendency to call people, asthmatics, diabetics or hypertensives.

Patients can label themselves when they are first diagnosed with a chronic condition. A first heart attack can sometimes be a wake-up call to finally quit smoking, start eating a healthy diet, exercise appropriately and reduce other risk factors. Some, however, become demoralized and surrender, seeing themselves as damaged goods on borrowed time.

With a new diagnosis of diabetes, some patients are in denial and fail to make lifestyle changes and monitor their condition while others take on the label of diabetes as a harbinger of impending doom. Those with a balanced approach do best. They accept the diagnosis of this chronic condition as life-preserving and life-enhancing news. They learn what areas of their health require more attention and how lifestyle changes reduce the potential for complications that would otherwise threaten their eyes and kidneys and the circulation to the heart, brain and feet. With knowledge comes power and a greater sense of control.

If you’ve been diagnosed with a chronic condition, ask your family doctor what you need to know and do to take the best care of your health. As part of the Burnaby Division of Family Practice’s Empowering Patients public health education series, we are providing free unbiased information in public presentations and online https://divisionsbc.ca/burnaby.

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Healthy Living, patient-doctor relationship, Positive Potential, Preventive Health | Tagged , , , | Leave a comment

What you need to know about diabetes

IMG_3960.JPG

November is Diabetes Awareness Month. So raise your awareness of this common condition by correcting these five common myths.

Myth #1: I don’t need to worry about diabetes.

Diabetes is a very common condition. The prevalence of diabetes in adults over age 20 is 1 in 11, and the incidence of diabetes is expected to increase as the population ages, becomes less active and more obese.

There’s a good chance that you – or someone that you care about – will develop diabetes. That’s why we all need to know more about it.

Myth #2: Diabetes is all about sugar.

Diabetes is a problem with metabolism – how your body converts food into energy. Because glucose is a source of energy for every cell in the body, diabetes has potential effects on multiple organ systems, including the nervous and circulatory systems.

Poorly controlled diabetes is a major cause of heart attacks, strokes, kidney failure, amputations and blindness. A person who has had diabetes for several years is considered by physicians to have the same risk of a heart attack as someone who has established vascular disease.

Poorly controlled diabetes is a common cause of erectile dysfunction. More bad news: Viagra doesn’t work as well for people with diabetes.

Myth #3: Diabetes is caused by being overweight or eating too much sugar.

There are two types of diabetes. Type I is insulin-dependent. For some reason, usually related to the immune system, the pancreas no longer produces sufficient insulin. Therefore, type I diabetes requires insulin injections or infusions.

90% of diabetes is type II or insulin-resistant. This is commonly a hereditary condition. You might inherit a tendency for diabetes from your mother or father. As you grow older or gain weight, your cells may become more resistant to the effects of your body’s own insulin. You become glucose intolerant, and carbohydrates, such as rice, pasta and potatoes cause a greater rise in your blood sugars than they normally should.

Not everyone who is overweight or drinks a lot of pop will develop diabetes, but if you have the genes for type II diabetes, gaining weight, getting older and consuming excessive sugar will allow diabetes to manifest.

Myth #4: All diabetics have to take insulin and check their blood sugars many times each day.

People with type I diabetes – because they do not produce enough natural insulin – are dependent on insulin injections or infusions. They have to monitor their blood sugars regularly throughout the day to keep their glucose levels in a safe range.

Most people with type II diabetes do not require insulin with the onset of their condition so they usually do not have the same need for multiple daily glucose testing. There are a variety of oral medications to control type II diabetes. Two essentials are regular exercise and smaller, more frequent meals with low glycemic index foods (carbohydrates that do not cause a sharp rise in blood sugars).

If blood sugars continue to rise with type II diabetes, insulin may be needed.

Myth #5: Everyone with diabetes will get complications.

With the careful management of diabetes, most of the complications of diabetes can be avoided. This requires optimal self-management in which individuals are given the support and education they need to be effective managers of their own health.

In addition to blood sugars, we monitor and manage blood pressure, cholesterol levels, changes in the eyes and kidney function.

I’ll be giving a public presentation on “What You Should Know About Diabetes” at the Bonsor Recreation Complex at 7 pm on Wednesday, November 25th. You’ll learn if you are at risk for diabetes and how you can prevent it; how diabetes can affect your heart, circulation, nervous system and brain; and what you would need to know to effectively manage your health and avoid these complications.

To register for this free event, contact Leona Cullen at lcullen@divisionsbc.ca or (604) 259-4450. This presentation is part of the Burnaby Division of Family Practice’s Empowering Patients public education series.

Dr. Davidicus Wong is a family physician and his Healthwise columns appear regularly in the Burnaby Now, Royal City Record, Richmond News and Vancouver Courier. For more information about diabetes, talk to your family doctor or check the Canadian Diabetes website http://www.diabetes.ca.

Posted in Burnaby Division of Family Practice, Empowering Healthcare, Healthy Living, Screening Tests, Self-care | Tagged , , , , , | Leave a comment