Categories
Exercise Healthy Living Physical Activity Positive Change Preventive Health

We were made to move: the health benefits of exercise

Stanley Park - Davidicus Wong

On Saturday, May 4th at 10 am, the doctors of Vancouver are inviting everyone to join them for a fun and easy 1 to 2 km Walk With Your Doc around Kitsilano Beach. Register at www.walkwithyourdoc.ca and come early to get your free pedometer. I’ll be there.

We were made to move.

It’s part of the harsh reality of evolutionary medicine.

Have you ever wondered why your doctor tells you not to eat some of your favourite foods? French fries, hamburgers, chocolates, donuts and practically anything else you can eat at the PNE.

I sometimes joke with patients that if it’s satisfying and tasty, it’s probably not good for you. Their appetites don’t get the joke.

So why do we crave what’s bad for us?

In general, most of the genetic traits modern humans share had some survival value in the distant past. Intelligence, manual dexterity, good hearing and vision allowed our ancestors to survive against predators and other dangers in a harsher world.

We are therefore hardwired to crave for sugary foods that would give our predecessors the fuel to run away from wild animals and the fatty foods that would provide them with a layer of body fat to keep warm and survive a cold winter.

But some of our inherited traits no longer provide a survival advantage with our modern way of life. We don’t need so much glucose to run away from predators, and in the warmer parts of Canada – where most of us live, we don’t need the extra fat.

For us, the extra calories and fat can contribute to greater health risks, including diabetes, heart disease, strokes and some types of cancer. You can only eat like a cave man or cave woman if you move like one, and I don’t mean the bad posture.

Our bodies have evolved to be in motion, but many of us are physically inactive throughout the day – sitting in front of desks, TVs and computers, driving or taking transit instead of walking or cycling. Many of our kids are less active than we were. Their thumbs get more exercise than their legs.

How much exercise do we need?

Though your family doctor can help you determine what’s best for you, Health Canada recommends at least 30 minutes of moderate exercise (such as brisk walking, running, swimming, cycling or Zumba dancing) five times a week. You don’t have to do it all in one go. You could do a quick 15-minute walk twice a day.

Exercise has health benefits that go beyond burning off the calories of your favourite foods. Exercise can tone and strengthen your muscles, prevent osteoporosis, maintain a good sense of balance and reduce falls, and help you maintain a good range of motion in your joints.

Exercise has been shown to improve your immune system, raise HDL (the good cholesterol) and reduce your risk for strokes and heart attacks. Regular exercise can prevent diabetes in those who are susceptible and help control blood sugars in those who do have diabetes.

Exercise is good for your mind. By improving the circulation to your brain, it can help you maintain mental fitness and reduce the risk of dementia. Cardiovascular exercise releases your body’s natural painkillers, endorphins that can promote a sense of wellbeing. For this reason, psychiatrists prescribe daily exercise to their patients with anxiety and depression.

Regular exercise may lengthen your life (by an estimated average of 7 years) and improve the quality of your life. So what are we waiting for? Let’s get moving!

Dr. Davidicus Wong is a family physician at the PrimeCare Medical Centre. His Healthwise column appears regularly in the Now newspapers and the Vancouver Courier. 

Categories
Medical Ethics patient-doctor relationship

What would you find in your medical records?

Exactly what is in your personal medical record – the paper file in your family doctor’s office or the electronic record in the clinic’s computer? What key information should you know by heart or at least have at your own fingertips?

With every medical visit, your doctor will create an entry either written in a paper chart or typed into an electronic record. In both cases, an entry must be dated and usually follows the standard SOAP format.

S stands for subjective: what you describe to the doctor. This includes the key details of the history of your symptoms, such as the type of pain you have been experiencing – its location, quality, intensity and duration, what makes it better and what makes it worse.

O stands for objective: the results of previous investigations and the findings on the physical examination. This includes what the doctor sees or measures, hears with the stethoscope and feels on palpation.

A stands for assessment: the diagnosis or multiple possible diagnoses we want to confirm or rule out.

P stands for plan: the investigations or treatment offered or recommended.

Doctors are required to write these clinical notes in such a way that it is clear what was found on examination, what the doctor was thinking and what was discussed with the patient. They should be written in such a way that another physician would be able to follow the doctor’s logic and know what the next steps would be.

Before I step into an examination room, I review the previous visit and any reports or test results that have come in since then. After each visit ends, I spend a few minutes completing the chart notes.

If there is time, I’ll complete the forms or write the letters required for more extensive investigations or referrals to specialists, but usually I’ll complete these at the end of the workday.

Also within your medical record are the results of investigations, including x-rays, scans and lab tests; admission, operative and discharge reports from hospitals; and the consultation letters from specialists. These are filed in specific sections in chronological order in both paper and electronic charts.

In every paper chart (usually the inside cover) and in every electronic record should be a summary of the key information from a patient’s medical history. This is the information you should know by heart in case you have to see another doctor in a different clinic or ER: drug allergies, current medications (their doses and directions), significant past illnesses and hospitalizations, current and chronic medical conditions (such as high blood pressure or diabetes), previous operations, significant medical procedures (including their dates) and your family history.

If you don’t have all this information, ask the staff at your family doctor’s office to help you fill in the blanks. However, be patient with them. Medical office assistants are the backbone of the clinic, working hard to support both patients and physicians, making appointments, organizing tests, arranging referrals, filing results and reports, and ensuring your records are secure.

Dr. Davidicus Wong is a family physician at the PrimeCare Medical Centre. His Healthwise column appears regularly in the Vancouver Courier, Royal City Record, Burnaby Now and Coquitlam Now. He is a regular Tuesday morning guest on Jill Krop’s AM/BC talk show on BC1 (channel 21 on Shaw). 

Categories
Medical Ethics patient-doctor relationship

Your Medical Records: What You Should Know

EMR

For a good part of my childhood, my mom would take me to almost monthly visits to my pediatrician who was treating my rheumatoid arthritis. She also accompanied me for more blood tests and x-rays than I have ever ordered on a child.

Though I’m sure I thanked my mother each time she took me out, I wish I could thank her again for all the concern I must have caused her. She would reassure me so I wouldn’t have to worry.

Curious about the results of all those tests, I requested my records after graduating and starting my own practice. Unfortunately, I learned that the pediatrician’s office had shredded my chart the month before.

In B.C., doctors are legally required to retain medical records for a minimum of 7 years after the patient is last seen or after the age of 19 (i.e. age 26) whichever is longer.

This will change on June 1st. The College of Physicians and Surgeons of B.C. has changed its requirements to reflect changes to the Limitations Act. After that date, doctors must retain medical records for a minimum of 16 years from the date last seen or the age of majority.

Adults sometimes think about their medical records as something that will always exist just as some young people may assume that what’s on the internet will always be there. But just as your old facebook and blog posts will not remain online forever, your old charts may be destroyed if sufficient time passes.

For those who have moved and haven’t found a new family doctor, your old records may be gone before you have a chance to transfer them.

Your medical records belong to the physician or the facility where you have been treated. They include consultants’ letters, surgical reports, lab results and other investigations in addition to the clinical notes of the physician.

Those clinical notes are generally written with the sometimes illegible shorthand and abbreviations of physicians. They aren’t really written to be read by a layperson. Rather they are meant to provide a summary of each patient-doctor encounter written such that another physician could clearly understand what was said (the history), what was found (on examination), what was suspected (the differential diagnosis) and what was planned (the treatment, investigation and the follow-up).

If you walked into your doctor’s office and asked for your chart, it wouldn’t immediately be handed to you. Reviewing records – particularly the clinical notes – requires assistance from someone with a medical background. For example, if you read “S.O.B.” in your chart you might feel insulted though the doctor was simply using the accepted abbreviation for shortness of breath.

Though you don’t own your medical records, you have a right to the information contained within them. You should be cautious when signing off the right to share your confidential information with a third party.

When you – or someone else such as a lawyer with your written permission – requests the copying or transfer of your records, the doctor’s office will charge a fee that is generally reasonable and proportionate to the time required to review the records and produce copies.

The main reason medical records are destroyed beyond the legal retention limit is the amount of space required by the traditional paper chart. I’ve had some patients whose charts filled three file folders.

The problem of space will eventually be resolved with the widespread adoption of electronic medical records.

Coming up: What key information should you have from your medical records? What privacy issues arise from electronic chart?

Dr. Davidicus Wong is a family physician at the PrimeCare Medical Centre.  He is a regular Tuesday morning guest on Jill Krop’s AM/BC talk show on BC1.

Categories
Healthy Living

5 Clues That You’re Not Getting Enough Sleep

This was the topic of today’s visit on Jill Krop’s AM/BC talk show on Global’s BC1:

http://globalnews.ca/video/466727/ambc-dr-dave

5 Clues That You Need More Sleep:

1. You’re asleep the moment your head hits the pillow.

2. You’re dozing off in class, at meetings or in front of the TV.

3. You’re taking micronaps at red lights.

4. You’re kids wake you up asking you to finish reading their bedtime story.

5. You feel surprisingly refreshed at the end of a school concert (You must have fallen asleep).

 7 Natural Steps to a Good Night’s Sleep

In my first month of medical school, I realized that the volume of material to master was too great to cram into an all-nighter. I arrived at my anatomy mid-term without a wink of sleep, and during the middle of the exam, I fell asleep.

My classmates were either totally focused on their own tests . . . or still in the competitive pre-med mode. No one woke me up.

Later, my dad talked to me for the first time about my career. He suggested I consider switching to dentistry where I would get a lot more sleep.

Since then, I’ve made it a priority to get sufficient sleep.

Inadequate sleep not only impairs our performance at school or work. It can affect emotions, physical wellbeing and safety. Driving without sleep can impair us as much as alcohol.

How can you tell if you’re getting enough sleep?

If you’re not, you’ll feel tired. However, there can be other causes for low energy, including an underactive thyroid, vitamin deficiencies, anemia, a poor diet, lack of exercise and depression. If you’re sleeping well . . . or sleeping excessively but still feeling tired, talk to your family doctor.

If – like many high school and college students – you’re staying up too late during the week, you might accumulate a sleep debt and need to sleep in on the weekends. Late nights studying can result in diminishing returns when you are less alert and focused in class.

Sleep can be interrupted by medical problems. Pain from arthritis may disturb sleep. Frequent urination can be a symptom of prostate and urinary tract disorders. Shortness of breath may be due to asthma or congestive heart failure. Sleep apnea – where the upper airway becomes obstructed during sleep – can make a person feel unrested in the morning and sleepy throughout the day.

If you’re having problems falling asleep consider a natural approach that respects your body’s natural circadian rhythms.

1. Exercise every day – but not close to bedtime.

2. Avoid caffeine and alcohol in the evening. Alcohol has a double effect on our brains. It initially depresses (making us feel sleepy) but later stimulates (causing anxiety or awakening).

3. Avoid stimulating activities after dinner. Couples can make an exception on date night (I recommend regular dates to all married couples – but only with their partners).

4. Choose quiet, calming evening activities, including listening to music, meditating or reading. Reading an algebra textbook or listening to a lecture from your most boring professor may be the best sleep prescription.

5. If you have to worry, do it earlier in the day . . . not at bedtime.

6. Keep the lighting low as bedtime approaches. Avoid the bright lights of television and computer monitors.

7. Develop your own bedtime rituals that might include a warm bath to relax your weary muscles.

In the minutes before I fall asleep, I mentally review the day that has passed. I reflect on what I have learned from others, the significance of my experiences and the blessings I have received. I let go of the day that has passed – and anything else I need to – in order to be present and live fully the next day.

Categories
Balance Empowering Healthcare Exercise Healthy Living Physical Activity Positive Change Positive Potential Your Calling Your Goals

Your Positive Potential for Health: The Dynamic Balance

Central Park in early spring by Davidicus Wong
Central Park in early spring by Davidicus Wong

Some parents don’t listen to their children unless they’re misbehaving, but wise parents are proactive and involved; they know what their kids are up to . . . especially when they’re quiet.

This is something we all know, but when we’re putting out fires at work, we may neglect the other important areas of our lives.

Our personal health is one of those areas.

A lot of people don’t think about their health until something goes wrong. Even then, they may neglect the body’s messages: poor sleep, chronic tiredness, nagging aches and changes in the bodily functions they take for granted.

But health isn’t defined as the absence of disease, and good health care is not just the treatment of illness.

I define health as the optimal balance of the important areas of your life and achieving your positive potential in each of those areas.

Just as your organization has mission and vision statements, I believe each of us should have a personal mission statement and a vision that serves as a compass. By looking at our compass as we go about our daily lives – rather than when we’re already lost, we are more likely to stay on track.

My personal mission is to achieve my positive potential in life and to help others achieve theirs. At work, I seek to do more than solve each patient’s list of medical problems. I seek to see the whole person, their challenges in the context of their emotional, physical and social health, and to help them achieve their personal goals.

But few of us will achieve our goals unless we articulate them. This is not unlike how executives will define their organization’s goals and their strategy to achieve them.

Each day, I look at my mandala – a large circle with 10 smaller spheres around its perimeter. Each of the spheres represents an important area of my life: my family, mental well-being, emotional health, rest & play, spiritual health, social health, physical well-being, work, financial well-being and environmental health.

Each weekday, I spend a moment to consider just two of those spheres. For example, on Monday I may think about my family and social life. I have chosen three or four goals for each sphere and I use them as guideposts during the week.

My goals for my family are to spend enough time and attention with my spouse and children, to nurture each relationship and to maintain a loving and supportive home.

On Saturdays, I reflect on an 11th circle that I place at the centre of the mandala. It represents my calling. To borrow from Jim Collins’ From Good to Great, your calling is the intersection of your passions (what you love to do), your talents (what you do better than anyone else) and the needs of the world. It is what you must do to find meaning. It is your gift to the world.

On Sunday, I reflect on how I have balanced the important spheres of my life during the week. What have I been focused on? What have I neglected?

To attend to your health and to find balance in your life, you can’t afford to wait until your next vacation or serious illness. You can’t wait for a quieter time to start eating healthier meals, catching up on sleep, cutting down on alcohol, quitting smoking or starting an exercise program. You have to recognize the priorities in your life and add them to your schedule until healthier living becomes a routine.

I get to bed by 9:30 to wake up each day at 5. I’ll swim 80 lengths at the pool and be back home in time to have breakfast with my family and drive my daughter to school.

During a busy day at work, I’ve scheduled time for a healthy lunch and a shorter rest break during the morning and the afternoon. Although I may have the occasional evening meeting for my nonprofit organization or for community education, my daily goal is to be home for dinner.

A healthy balance in your life doesn’t come naturally. We and our lives are in constant motion and change is inevitable, but to be at our best, we should strive for that dynamic balance.

Dr. Davidicus Wong is a family physician at the PrimeCare Medical Centre. 

He is a regular Tuesday morning guest on Jill Krop’s AM/BC talk show at 9 am weekdays on BC1. 

Categories
Uncategorized

Spring, the Season for Allergies

Cherry Blossoms - Davidicus Wong
Cherry Blossoms – Davidicus Wong

On Tuesday, April 2nd, I’ll be talking to Jill Krop about allergies on her AM/BC talk show (9 am on weekdays on BC1). Previous shows are on the internet at http://globalnews.ca/ (search for am/bc).

While many of us are celebrating the arrival of sunny spring weather and the Cherry Blossom Festival, those who suffer from seasonal allergies may be spending more time indoors.

Blooming flowers and trees are the outward signs that hayfever season has arrived. For those with seasonal allergies, symptoms include nasal congestion, sneezing, a watery nasal discharge, and itchy, puffy eyes.

Clues that these symptoms are allergic rather than infectious include (1) the absence of systemic symptoms such as fever (Hayfever is therefore a misnomer), (2) watery – rather than yellow or green – discharge from the nose or eyes, (3) improvement with antihistamines and (4) a clear relationship with exposure to pollen or other airborne triggers (allergens).

People with allergies to animal dander can get similar symptoms when exposed to dogs or cats. Those with allergies to dust and mold may get symptoms all year round.

The symptoms of allergic asthma include increased wheezing or coughing when exposed to respiratory allergens.

If you’re allergic to dogs, you can avoid them or consider getting a hypoallergenic breed that does not shed. What can you do if you’re allergic to other airborne allergens?

Avoidance is difficult unless you can live in a plastic bubble. HEPA filters may screen out some allergenic particles in the home.

Topical treatments may include saline or salt water rinses to remove allergens from the nose or sinuses. Prescription medications include eye drops or nasal sprays may reduce inflammation, itching and discharge.

Oral antihistamines can be effective. However, they should be used with caution as some are more sedative than others, some products contain decongestants that can increase heart rate and blood pressure, and they may interact with other medications.

If you have persistent or severe symptoms, consult with your family physician. Allergy testing or shots may be appropriate for you. Symptoms such as persistent nasal obstruction, discharge or coughing may be due to conditions other than allergies.

A potentially life-threatening class of allergic reactions is anaphylaxis. The symptoms come on suddenly within minutes to hours of exposure to allergens that may include certain foods (e.g. peanuts), insect bites or stings, medications or other foreign substances including latex.

Symptoms may include swelling of the throat, tongue or face called angioedema; shortness of breath or wheezing; lightheadedness or decreased consciousness; abdominal pain or vomiting.

Anaphylaxis requires immediate treatment by paramedics or in the emergency department. People with a history of anaphylaxis may carry epinephrine or adrenaline with them.

Dr. Davidicus Wong is a family physician at the PrimeCare Medical Centre. He is a regular Tuesday morning guest on Jill Krop’s AM/BC talk show on BC1.

Spring in Bloom - Davidicus Wong
Spring in Bloom – Davidicus Wong
Categories
Allergies

4 things you should know about anaphylaxis

On Tuesday, April 2nd, I’ll be talking to Jill Krop about allergies on her AM/BC talk show (9 am on weekdays on BC1). Previous shows are on the internet at http://globalnews.ca/ (search for am/bc).

4 things you should know about anaphylaxis:

1. Anaphylaxis is a potentially life-threatening allergic reaction occurring within minutes or hours after exposure.

2. Causes may include certain foods (such as peanuts), food additives, insect bites or stings, medications or other foreign substances including latex.

3. Symptoms may include swelling of the throat, tongue or face, shortness of breath or wheezing, lightheadedness or decreased consciousness, abdominal pain or vomiting.

4. Immediate medical attention is required. Call 911. Treatment may include epinephrine (adrenaline) and resuscitation.

If you have a history of severe allergic reactions, talk to your doctor about their management including epinephrine.

Categories
Allergies Uncategorized

4 clues that you may have seasonal allergies

On Tuesday, April 2nd, I’ll be talking to Jill Krop about allergies on her AM/BC talk show (9 am on weekdays on BC1). Previous shows are on the internet at http://globalnews.ca/ (search for am/bc).

Cherry Blossoms - Davidicus Wong
Cherry Blossoms – Davidicus Wong

4 clues that you may have seasonal rhinitis:

1. A clear, watery discharge from your nose or eyes.

2. No fever or other systemic symptoms.

3. Improvement with antihistamines.

4. Triggered by exposure.

4 ways to manage hayfever or seasonal allergies:

1. Avoidance (which is difficult unless you live in a plastic bubble).

2. Topical treatment with saline rinses of the nose and sinuses or prescription eye drops or nasal sprays.

3. Oral antihistamines (but be cautious about drowsiness, drug interactions and decongestants).

4. Consult with your family physician about allergy testing or shots.