Carla Hindman

Communications professional and 44-year-old mother of three in TorontoI was only 41 when I had a stroke. I was at my office, and at around 1 p.m. I went to the bathroom. When I went to wash my hands, I looked at myself in the mirror and I couldnt see properly. I thought, This is really weird. When I finished washing my hands and walked back to my desk, I put my head down and started to cry. A colleague beside me was like, Whats going on? And I said, Somethings wrong with my eyes. But then I said, I think Im having an ocular migraineI had had one before. I didnt know that vision changes were also a sign of stroke.My colleagues decided to call my husband, Matt, who worked across the street. We jumped in a cab together to go to our doctors office, and by the time we got there, my face was drooping, I was slurring and I had weakness in my left side. Matt was thinking, Oh my God, this looks like a stroke. Since we were in front of my family doctors office, he decided to take me inside instead of wasting more time going all the way back downtown to the ERhe thought it would be better to get medical advice as soon as possible. But they took one look at me at the doctors office and called 911.When we were waiting for the ambulance, Matt told me to raise my hands. I raised only the right one, and he said, Both of them! I yelled back at him, I am raising both of them! but my left arm was dead at my sideI just didnt know it.I dont remember anything after that until midnight. But I had left the doctors office in an ambulance, and they had assessed me, given me clot-busting medication and put me in the ICU. My mom had flown in from Ottawa to be with me, and Matt had gone home to be with our three kids. The nurses were coming in every once in a while, showing me flashcards, asking me what the pictures were. My mom said that at midnight it was like a switch flipped, and I was back to normal.At the hospital, they found a hole in my heart, which I had no idea was there. They said that this was what caused the strokethose holes can allow blood clots to travel to the brain instead of the lungs, where they would normally go. A year later, I had a procedure to repair it, and now my risk of a stroke is as low as an average persons.I was extremely, extremely lucky: I didnt have any lasting physical deficiencies after the stroke. But I do have a few issues with short-term memory still, and sometimes I have trouble coming up with the word I want. And I was exhausted afterwardI was off work for a month and then had to do a staggered re-entry after that.I didnt know that people my age could have strokes, but now I have met so many people who have had them in their 40s. It happens all the time. I think everyone should know what the signs of a stroke are and that vision changes are one of them. If more people knew the signs, and that young people can have strokes, they might feel empowered to call 911 in situations like mine, and a lot more people could get the help they need faster.

Kathy Isaac

Cybersecurity executive and 47-year-old married mother of two in Ajax, OntarioI had a stroke two years ago while I was in the ICU, hospitalized for COVID. After about two days, I woke up with extreme nausea, and I was dizzy and vomiting for days. But my doctors didnt realize what was happening, even after my left hand started to feel strange and heavy. Eventually, I realized I couldnt hold my fork in that hand.A week later, when a physiotherapist came to prepare me to go home, she was the one who noticed the signs of stroke. They did a brain scan, and a doctor came the day before I was supposed to leave and said, I have bad newsyouve had a stroke. I thought he had the wrong person. I actually said to him, No, Im Kathy.In my head, Im thinking, Im 45 years old. Strokes are for older people. Im better, Im going home.Even after I realized something had happened, I still felt like, if Ive had a stroke, what does that mean? They started to talk to me about neuroplasticity, and they explained that the best window for recovery is the first six months.So I wasnt wasting any time. I started walking in my hospital room while I was still attached to oxygen. Then I did outpatient therapy: physical therapy, occupational therapy and a little bit of speech therapy, too. I had a singular goal: I wanted to go in one direction, to make progress. I did everything they asked. And I did wellI hit the physical milestones by about three months out.But it still all felt so heavy. I had a meltdown one day with my physiotherapist and just cried. Eventually, I was connected to the Heart and Stroke Foundation and the March of Dimes. I was in a young stroke survivors group for a long time.Just before I went into the hospital for COVID, I had graduated from Ivey Business School in London, Ontario, with my MBA. It was hard, really hardI did it while I was working as an executive, and as a wife and mother. I thought about quitting. But the motto at Ivey was trust the process. And I decided, no, Im gonna tough it out.That was an important life lesson. When I went to rehab, I knew to just put in the work, and trust the process. Im a born-again Christian and I do believe, like the Bible says, that all things work together for good. To me, the MBA prepared me.Im a few years out from the stroke now. My mobility is really good, and work is going well, tooI think I perform very well. But I have to work every day to not regressI walk or use my spin bike. And Im not the same. My balance can be a little wonky, I cant handle noisy situations and I have more anxiety. I still have precision issues in my left hand because the message from the brain to my left hand is delayed. If I type with both hands, the right hand will be fine and the left hand will be behind.One of the biggest challenges Ive had is friends and acquaintances thinking Im all better. Im not looking for sympathy, but I need people to understand that Im not 100 percent. Even when I park in a disabled parking spotwhich I need to doIve been confronted by strangers when I get out of my car. Because I dont use a cane or a walker, I dont get the understanding and help that I need.

Earle Hoyte

76-year-old retired church administrator, caregiver and grandmother in TorontoOne weekend I went on a short trip. After I got home, off the train, I said something to my granddaughter, and it felt like it wasnt coming out right. But when I asked her if she could understand what I was saying, she said yes. And I also felt very tired, so I just went to bed.In the morning, my tongue felt very heavy, and when I went to put on my lipstick, my hand kept falling down. My son-in-law and daughter-in-law were there and they said, You dont sound wellwe should take you to the hospital. I knew I wasnt fine; I felt different. But I didnt know it was a stroke. I thought only old people had strokes and I was only 75.And I didnt realize what else was happening to me. At the hospital, the nurses recognized it immediately as stroke and pushed me through. The doctors did a lot of tests. But I didnt realize the effect the stroke had on me until the doctor asked me to sign my name on a document. It was only then that I realized I couldnt. I was just scribbling.They told me my stroke was caused by atrial fibrillationan irregular heartbeat. I didnt know I had it before the stroke. They put me on blood thinners, and with atrial fibrillation, its quite easy to have another stroke. So I have to be quite careful, and take my tablets every day.After I left the hospital, I was referred to the University Centre location of Toronto Rehab. Before I went, I didnt know what to expect. I was scared. But everybody I met there was so warm to meeven the receptionist. They were very positive, and it helped very much.I went there for three months, as an outpatient. We worked on the physical: I had to walk with a walker, and up and down stairs, and practice stepping over things. They focused on my balance a lot, too.They also worked on my memory, because whenever I tried to speak, I had to think for a long time to remember what I wanted to say. And a speech therapist helped with my voiceI used to sing in the church choir, and I couldnt sing anymore. My drivers licence was suspended, and they worked on that with me. I even did a driving simulation at Toronto Rehab.At one point, I didnt want to go, because I was feeling depressed. They referred me to a social worker, and to the March of Dimes program for people with disabilities. Now I go several times a week. March of Dimes has a stroke textbook, too, that I wish I had had before, because it tells you what to expect, what questions to ask, who is going to see you and what each person will do for you.Ive improved a lotIm back to singing in the choir, and Im able to be a caregiver to my elderly sister. But there are things I cant do anymore, like baking or reaching items off the highest shelves. I had to completely rearrange my kitchen. Holding my arms down for so long, or holding something heavyits too hard.I wish everybody knew that if your body feels strange, seek help. You dont know what it isit could be anything. Especially if its something you havent experienced before. Dont say, Let me wait and seeseek help immediately. Thats the key.Next: How Heart Disease Affects Women Differently Than Men

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Why breathing out of your nose is better than mouth-breathing

Nasal breathing allows an individual to breathe more slowly and effectively. The nose is designed to filter viruses, bacteria, debris and allergens, says Sabrina Magid-Katz, a New York-based dentist who specializes in sleep dentistry and related sleep disorders. People are finally starting to think about what some ancient cultures have always knownthat breathing in and out through the nose is healthier, says Magid-Katz, referencing the nasal breathing exercises taught in yoga and Tai Chi classes.The nose humidifies the air we breathe, and also increases oxygen to the bloodstream, improves lung function, and decreases stress on the body. The bodys cells are able to get the oxygen they need more efficiently from the bloodstream, allowing the body to function optimally, the muscles to recover faster and the heart to work less hard. Who wouldnt want less stress and inflammation, and more stamina, energy and mental function? she says.On the other hand, mouth breathing causes dry mouth, according to Brian Rotenberg, a head and neck surgeon and a professor of Otolaryngology at Western University in London, Ont. This is because the mouth isnt capable of humidifying air in the same way as the nose. Saliva typically washes bacteria from the mouth when its closed, but it can more easily survive and cause issues when the mouth is open and drypotentially leading to bad breath, gum disease and cavities, he says.Breathing dry air through the mouth can also cause inflammation of the airway and further block it, says Magid-Katz. This creates an airway that is more collapsible, which can lead to Obstructive Sleep Apnea (OSA) a medical condition in which someone stops breathing while theyre sleeping, interrupting their sleep cycle and often decreasing the oxygen in their blood. This condition is associated with other medical conditions including high blood pressure, stroke and diabetes, she says, as well as chronic sleep deprivation or a sense of never feeling truly rested.

What causes mouth breathing?

There are a few different reasons why an individual might be a mouth breather, Magid-Katz says. Some people breathe through their mouth because their nasal passage is blocked as a result of allergies, and others do so due to a structural problem, such as a deviated septum. Mouth breathing often starts when were kids, she says, preventing muscular habits and dental arches from growing to properly support the nasal passage.Enlarged tonsils and adenoidsas well as whats called soft tissue trauma, often caused by snoring can also block the airway, which only further encourages mouth breathing and, in turn, creates a vicious cycle of more trauma and enlargement. Other people breathe through their mouth out of habit, she says. Interestingly, the less they breathe through their nose, the harder it may become.

Signs you might be a mouth breather

If you constantly wake up with an exceptionally dry mouth or lips, or even a sore throat, Rotenberg says theres a good chance youre breathing through your mouth at night. Since some nighttime mouth breathers also breathe through their mouths during the day, you can try looking at photos or observing yourself in the mirror. If your lips are parted or your mouth is hanging open, chances are youre breathing through it, says Magid-Katz. You can also self-assess your smile, as an extra gummy smile might mean youve been mouth breathing since childhood. Or, look at your posture from a side angle, or get someone to take a picture of you. Those with blocked airways, including mouth breathers, tend to have heads that reach forward because theyre trying to get more air. (Since most mouth breathing starts in childhood, our posture can naturally develop this way to accommodate the habit.)

How does mouth taping work?

The practice consists of using some kind of porous tapenot duct tape or masking tapeto keep the lips shut at night in order to encourage nasal breathing. Its appearance differs based on the brand, but mouth tape is often thin, transparent and can be applied horizontally, vertically or in a criss-cross shape across the lips. If youre picturing looking like a hostage with tape across your mouth, you can take comfort in knowing the tape made specifically for this purpose doesnt look quite as alarming as duct tape would although its still slightly creepy and strange-looking. And while it will be more challenging to talk to your partner or take a sip of water in the night, mouth taping fans say the benefits can outweigh these minor inconveniences.If you are going to try tape, use one that is porous and is not too adhesive so that you can still open your mouth if need be, Magid-Katz suggests. This way, she says, the tape is more of a reminder and less restrictive. Some users try basic surgical tape from the pharmacy. She recommends doing an initial trial run for a short period of time during the day or early evening, when you are awake and calm.Once you apply the tape, put your tongue to the roof of your mouth and breathe through your nose slowly. You can even do this with the help of a meditative breathing app.If it does not feel right for you, dont do it, she says. Most importantly, always make sure you are able to breathe through your nose safely.According to Magid-Katz, some people do find mouth taping combined with over-the-counter nose strips (which are worn outside the nose and help open the sinus passages) to be effective. (You can also use nasal dilators, which go inside the nostrils.)And while Magid-Katz says mouth taping could work for some, Rotenberg says hes firmly against mouth taping. Thats because mouth breathing is usually caused by some kind of obstruction, so taping the mouth shut without an understanding of what the source of obstruction is in the first place doesnt really make sense. Its not as if you can psychologically trick yourself to overcome nasal allergies or a deviated septum, he says.

What to do if youre a mouth breather

Instead of mouth taping, Rotenberg says its a better idea to go see your healthcare provider to figure out what the actual source of the obstruction is and treat that instead. There are lots of safe and proven solutions, you just need to have the correct diagnosis first, he says. Allergies, for example, can be treated with nasal steroid sprays, while surgery is an option for polyps or a deviated septum.Magid-Katz also recommends speaking to a physician or dentist who is knowledgeable when it comes to the airway. Its important to make sure the nasal passage is clear and the dental arches allow for proper nasal breathing, she says, and you can also talk to a myofunctional therapist who can help strengthen and retrain the muscles. Some dental appliances are designed to help children and adults correct the habit as well. For some people, the more they breathe through their nose the clearer and easier it gets, so the first thing to do is become more conscious of it, she says. Try setting your phone alarm periodically throughout the day as a reminder to think about whether your mouth is open and how youre breathing, or have a friend or loved one look at you periodically and note if your mouth is open. Set aside time each morning and night to practice proper breathing techniques.Next: Can a Weighted Blanket with Cooling Tech Help Me Sleep (and Not Over-Heat)?

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Why the microbiome matters

Thanks to millennia of medical literature dominated by male voices, theres a fundamental and pernicious misunderstanding of how female bodies work. For example, drawing on Ancient Greek ideas, physician and chemist Edward Jorden claimed in a 1603 text that uteruses were prone to…wandering. Then there was the 19th-century belief that women shouldnt board trains because travelling at more than 50 miles per hour could make our uteruses shoot out of our bodies (yes, really). We may now have at least basic female anatomy figured out, but womens health continues to be underexamined, and the vaginal microbiome in particular remainsunnecessarilyan enigma. Researchers still have to fight for funding and are often faced with surprising ignorance when it comes to female biology. Reviewers fundamentally did not believe me that bacterial vaginosis, or BV, is caused by bacteria, and Im like, okay, so this is 30 years of clinical research, says Sycuro. (The review panel insisted that fungi are also a major player in vaginosis, but Sycuro says thats complete nonsense.)Every year, bacterial vaginosisan infection thats intimately linked to the vaginal microbiomeaffects about 30 percent of vagina-havers worldwide and costs health-care systems billions of dollars in doctor visits and treatment. BV is more common than yeast infectionsits responsible for 40 to 50 percent of diagnosed vaginitis infectionsand its tied to both preterm births and HIV infection. (Studies show that BV increases the risk of HIV infection in women by 60 percent.) BVwhich has symptoms such as thin discharge and the occasional fishy smellis often trivialized by the scientific community, says Sycuro, because its not fatal. But its still a hugely disruptive hassle that causes discomfort and, unfortunately, the unwarranted shame that many women feel or associate with their genitalia.BV isnt the only culprit causing issues under our undies, of course. Yeast infections are to blame for another 20 to 25 percent of vaginitis casesbut they arent bacterial, theyre fungal. These infections are caused by yeast overgrowth, and are accompanied by thicker discharge and the occasional itching or burning sensation.And as for those dreaded burn-when-you-pee urinary tract infections, rather than an internal imbalance, they can be caused by a pathogen from the GI tractlike E. coligetting into the urethra and bladder.Unlike yeast infections, for which you can get over-the-counter anti-fungal creams, treatments for BV are limiteda prescription for antibiotics is the only option, and it comes with its own slew of potential issues. Once [patients] are in that loop, every time they take antibiotics, they have a 50 percent chance of needing the antibiotics again within six to 12 months, says Sycuro. Antibiotic over-prescription can also increase a persons anti-microbial resistance and alter their gut microbiome diversity. Translation? These medications clear out the bad guys, but they dont necessarily restore perfect balance, and sometimes the bad guys return. Patients end up back at square one, taking more pills that further disrupt the vaginal microbiome.

The cancer connection

Research is underway to examine the vaginal microbiomes role in protecting against sexually transmitted infections like chlamydia, gonorrhea and HIV: Sycuros lab is currently studying whether chlamydia bacteria can attach better to a receptor when certain other bacteria are present. This is especially important because some research findings suggest that chlamydia is associated with a higher risk of ovarian cancer.Compared to, say, prostate cancer, says Sycuro, female-specific diseases such as ovarian, uterine and cervical cancers are understudied, and harder to detect at early stages. While prostate cancer can be detected early through blood tests, women dont have that luxury when it comes to ovarian and uterine cancer: An estimated 1,950 of the 3,000 Canadian women diagnosed with ovarian cancer in 2022 were predicted to die, according to the Canadian Cancer Society, mostly due to it being caught too late. (Pap tests only help detect cervical cancer.)

Whats next on the horizon

When it comes to long-term solutions to chronic BV, Sycuro says there is a glimmer of hope. Inspired by fecal transplants used to improve digestive health, scientists are experimenting with transplanting fluid from healthy vaginas into ones with chronic BV. This procedure is still in the clinical trial phase, with research underway in places like the Kwon Lab in Cambridge, Massachusetts, and Sycuro estimates it might take another decade for the process to become widely accessible. In the meantime, we need to dodge the savvy marketing behind iffy products that try to fill that medical void and claim to support vaginal wellness.Next: Whats With All the Vaginal Creams, Wipes and Gummies?

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Lets start with a big one: Why do we need people to donate blood?

So that we have blood and blood products for patients who need it. That can be because of accidents or in trauma care; it can be for many kinds of surgery. There are also conditions for which regular blood transfusion or red-cell exchange is necessary for treatment. Canada has said were going to have a voluntary, unpaid system. And so to meet the needs of patients, we need people to donate blood.

What actually brings people through the door to donate?

When you ask donors why they donate blood, the vast majority say its because they want to help someone else. There is a psychological phenomenon called a warm-glow effect, where people feel good because theyve done something good. Another motivation has to do with social recognition: Its something thats valued in ones community; its considered to have social capital. And then theres a kind of reciprocitysomeone might know someone who needed blood, so they want to contribute, too.

At the very start of the pandemic, there was a surge in blood donations in Canada. Do crises tend to galvanize people?

Absolutely. Across most national emergencies, youll see an upswing in people wanting to help. In the States, after 9/11, there was a massive outpouring of people donating blood, and I know when there are bushfires in Australia, people turn out as well. A colleague and I did a small study in the early days of the pandemic to understand the experiences of people coming out to donate. We found that, for a lot of donors, this was an important opportunity for them to be able to actually interact safely with people who werent in their household. Maintaining community was important to them, and this was a way to do that.

Why dont people donate? What makes it a challengeor makes it unappealingfor them?

Right now, as restrictions have loosened, I think people have other activities they could be involved in. But more broadly, its a really interesting puzzle, and an area where I think we need more research. Its definitely easier to ask someone why do you do this? than it is to understand a phenomenon where something isnt being done. One way to study why people dont donate is to look at barriers to donation. It could be a lack of knowledge of the process of blood donationso not quite understanding how to register, what happens when blood is drawn, what happens to the blood afterward. There can be barriers at a personal level, like a fear of needles. And then there can be systemic barriers, like a lack of trust with the blood operator and a lack of trust with the health-care system, which extends to a lack of trust in the blood system.

There have also been outright bans on certain donorsfor example, men who have sex with men, or, up until 2016, anyone born in specific African countries. What impact did those restrictions have on donor engagement?

I havent studied that restriction specifically, but sometimes when eligibility criteria change, people dont necessarily know and it can take time for people affected to be aware of that change.

But when CBS changes a policy about donation, shouldnt it be responsible for outreach to the people affected?

This is kind of outside the scope of the work I do. But I think any institution or organization asking for people to come and participate voluntarily would want to make sure that the general public knows when there are changes to eligibility criteria.

Why is it important to have donors from different backgrounds?

For a condition like sickle cell disease, one of the treatments is regular blood transfusion or red-cell exchange. And for people who have more rare blood types or are frequently transfused, the closer the blood type matches with the donor, the better the health outcomes. Because blood antigens are inherited, youre more likely to find a close blood-type match with someone who shares an ethnic ancestry. This doesnt mean that you can only donate to someone of the same ethnic ancestrybut the more ethnically diverse the donor base, the better positioned Canadian Blood Services is to find close matches for the very diverse population that they serve.

How can we make donor screening as inclusive as possible?

It takes a multidisciplinary approach and a team of people to move donor screening toward inclusivity in a safe way. It requires clinicians and epidemiologists to look at the various risk factors and how to ensure the safety of the blood supply. Plus social scientists to examine the questions asked to be sure they are understandable and accessible. For example, in September, a change was made to ask about sexual behaviour regardless of gender or sexual orientation, and to be more inclusive of gay, bisexual and other men who have sex with men. But its a big challenge. And there isnt necessarily a one-size-fits-all answer.

What about just paying people for their blood?

I know theres research being done on incentives to donation, and paying donors is one of those options. I dont know what the impact of paying donors would be.

Speaking of incentives: Las Vegas just introduced a virtual-reality experience for donors. Maybe Canadian Blood Services wants to look into that?

I didnt know about Las Vegas incorporating VR, but if it was going to happen somewhere, itd be Vegas. Its important to keep in mind that the U.S. has a very different system than we have here in Canada. There has been some research looking into whether providing donors with added informationlike their cholesterol levels or blood pressuremakes a difference in donor retention, and I think the jury was out on that. I can see how exciting, attractive measures might help a very pressing blood shortage in the moment. But understanding peoples motivations and the social norms underpinning a voluntary blood-donation systemits just a vast area of research. I dont think its going to be solved through VR.Next: How Mental Illness Shapes Our Identities

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Before we get to the future of health care, are there places where AI is already being used in medicine?

Yes. Theres ChartWatch, which focuses on predictive analytics. Its an early-warning system that pulls vitals from patients in the internal-medicine ward to predict whether a transfer to the ICU or a death will occur. So the predictive power of these solutions can really lead to improved decision-making and the ability to intervene early.

What about other AI models working away in the background?

There are some, but I would say that in health care, very few models have been deployed in a clinical setting. Health care has a number of challenges, especially when were dealing with datawe have to be very stringent about security, about privacy, about confidentiality. The thing with AI algorithms is that, similar to how you and I learn, AI algorithms get better as more data is provided. But that can only happen if we can actually get access to it, which is very difficult in health care. However, weve partnered with Gemini, a data collaborative of more than 30 hospitals data in Ontario, the largest of its kind in Canada, and thats allowed Vector researchers to develop cutting-edge AI models and solutions, including studies related to COVID-19.

What are some of those projects in development right now?

Id say there are three areas worth highlighting: personalized medicine, drug discovery and creating a more efficient health system. With personalized medicine, algorithms can help us predict illness and support patients long-term. So, for example, you can use AI to predict Alzheimers disease based on changes to speech patterns. Or you could use it to discover insights within imaging data that can guide treatment and therapy decisions for patients with breast cancer. With drug discovery, AI can analyze pharmacological and health data to find different combinations of drugs that can be used to target existing and emerging viruses, or treat conditions that the drug might not have originally been prescribed for. And with health systems, it could help alleviate wait times faced by patients in hospitals, which is a big issue in Canada right now. When you bring in AI, the potential for us to better allocate resources, both in terms of staffing and funding, is fantastic and leads to better patient outcomes.

On the other hand, what isnt going to happen with AI and health care? You must hear some pretty wild theories when people find out what you do.

One thing is that AI is not going to replace a physicianit will augment clinical decision-making, but it wont replace it. Its more like a virtual second opinion, not meant to override human judgement or expertise.

So Im not going to roll up for knee surgery and find a robot about to perform it on me?

WellI cant predict the future. But I dont think thats going to happen.

What do you hear from doctors and health care practitioners when you talk to them about AI?

They really do want to know how were using AI to revolutionize health care, and they want to know not just on a theoretical level but a practical level. How can they use these solutions in a clinical setting? What does it mean for patient care overall? Thats always their number-one questionwell, actually, Ill say there are two questions. Number one, will it be disruptive to my workflow? And the second is, what are the outcomes that can be produced for a patient?

What worries them about their workflow?

What they say is: We dont want another button to press. We want it to be very seamless. And also they worry whether this all happens in a black box. Explainability in AI is very importantwe dont want to just use this blindly. So if an algorithm makes some kind of decision, we need to know how it has actually come up with that decision.

We hear a lot about bias in AI. How can bias skew an algorithms results?

You hear the expression garbage in, garbage out. AI algorithms will always reinforce bias if the data theyre trained on is biased. If were looking at a pool of health care data that is only representative of a certain segment of the population

Say, white men of a certain age?

Thats right. Then when you try to apply the AI model to a different or a more diverse population segment, it doesnt work, or it wont work in the same way. A good example is an image-recognition model that wasnt able to recognize melanoma in patients with different skin types, because the model wasnt trained on data that was representative of the whole population. I will say that theres much work being done on responsible AI, making sure that we correct for inherent biases.

And how do we do that?

By ensuring that theres access to very diverse data. And then by looking at that data to really say when it isnt representative of an entire population, so that if there are inherent biases, we can correct that at the forefront. We also want to make sure our models work for everyone. So in AI implementation, we do these silent trials, where we test out the solution in, say, a hospital, before it goes into practice. Because we dont want to just say, hey, this tool works fantastically, were gonna implement it now. Being able to pilot it is extremely important.

People are understandably quite anxious about the state of Canadian health care. What do you see as the potential for these AI programs, whenever they do get rolled out?

I truly believe that AI has transformative benefits for patients. There is a machine learning model that can create radiation therapy treatment plans for patients with prostate cancer. That can take a clinician more than a day to develop, and the model produces plans within hours that are deemed to be as good as or even better, nine times out of 10. If I were a patient, this is exactly what Id want: something that creates efficiencies and frees up resources so that I not only have a personalized treatment plan soonerbut I get to spend more time with my physician. Thats extremely beneficial to a patients quality of life and the quality of care they receive.This interview has been edited and condensed.Next: The Forces That Shape Health Care for Black Women

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When kidneys fail

There are about 4 million Canadians living with kidney disease, says Amrita Sukhi, a nephrologist with Trillium Health Partners in Mississauga, Ontario. And many of them arent even aware they have renal failure because the symptoms (fatigue, peeing less often) are analogous with other diseases.The term kidney disease describes an array of disorders and conditions, can range in severity from mild to severe and sometimes results in complete kidney failure (also called end-stage kidney disease). When people have kidney failure, they may retain too much of that stuff that the kidneys should be getting rid of and that can make people very sick, says Hesketh. But in the early stages, for the most part, the body compensates well for reduced kidney function. As with high blood pressure, kidney disease can go undetected, and many people only realize they have a problem once its quite advanced.Its unfortunate, because people dont tend to get really sick until the kidney function is down to five or 10 percent, says Hesketh. Sukki adds, By the time you get symptoms, which are vague, like poor energy, reduced appetite, some swelling, you can be on the brink of requiring dialysis. (Dialysis is a medical treatment, often done in hospital several time a week, that cleans the blood and removes waste fluids from the body.) Without treatment, full kidney failure eventually leads to death.Thats why routine screening for kidney problems is so important. The albumin/creatinine ratio (ACR) test measures the amount of protein in urine, and flags high levels that could indicate possible kidney damage. The estimated glomerular filtration rate (eGFR) blood test is another easy way to measure how well your kidneys are working. Either test can be done as part of a routine exam. Your doctor can determine your risk factors (more on that soon) and how often you should be screened.

Managing kidney disease

A lot of patients come to the clinic very scared that Im going to put them on dialysis right away, but its possible to live well with kidney disease for many years, says Sukhi. Most people will require diet and lifestyle modifications, or medications, to manage the effects of their poorly functioning kidneys and prevent conditions like high potassium or low hemoglobin levels. For most people, kidney damage cant be reversed, but it can be slowed and the effects can be managed.Most often, kidney disease occurs when a separate condition or disease impairs their function, so treating the underlying cause is also very important, says Hesketh. If someone has kidney disease due to diabetes, high blood pressure or vascular disease, those patients first treat those issues, she says. If someone has an underlying infection (like hepatitis B) or an inflammatory condition or autoimmune disease (such as lupus) that is causing their kidney failure, they can take medications to manage that issue, relieving the burden on the kidneys. Ideally, we do these things to keep the kidney function from getting worse, but inevitably chronic kidney disease will progress over time and eventually some patients may require dialysis or a kidney transplant, says Hesketh.For many, a transplant is the only way to get off dialysisa therapy that can be quite life-altering, says Hesketh. Dialysis treatment can be emotionally draining, a financial burden and an enormous time commitment. Plus, there are the physical side effects, which range from low blood pressure (for patients on hemodialysis) to high blood sugar (for people on peritoneal dialysis). Patients on dialysis need a tremendous amount of support, Hesketh says.

Know your risk factors

The risk factors for kidney disease include some you can control, like smoking, and others you cant. The most common causes of kidney disease are diabetes and hypertension, says Sukhi. Diseases of the blood vessels put a lot of pressure on kidney function, which causes damage over time. There are also structural kidney diseases that arise from things like urinary obstructions or hereditary conditions. People of Asian, South Asian, Hispanic and Caribbean descent are at higher risk for kidney disease in general for a variety of reasons. And Indigenous people in Canada are more than three times as likely to have their kidneys fail. People who take non-steroidal anti-inflammatory medications (NSAIDs)like Celebrex to treat arthritis, for examplemay also be at higher risk for this disease.

Supporting the health of your kidneys

For the most part, maintaining well-functioning kidneys comes down to a healthy lifestyle and managing other medical conditions. If you know theres a family history of [type 2] diabetes or hypertension that affects the kidneys, know that you should do everything you can to avoid it, says Sukhi. You dont want to wait until you are told you have low kidney function, because at that point they are already damaged. And, in most cases, that kidney damage cant be reversed.Next: Im Waiting for a Kidney Transplant. Again.

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What is Ozempic?

Ozempic is a brand name of semaglutide, an injectable drug manufactured by the Danish pharmaceutical company Novo Nordisk. It helps lower blood glucose levels to treat type 2 diabetes and has also been prescribed off-label to help people lose weight. (Note that off-label does not mean its illegal or illicit for non-diabeticsoff-label can mean youre using a medication based on medical evidence and expertise, but it hasnt been approved by Health Canada for that specific purpose.)Wegovy is another semaglutide brand name you may have heard about, and its been approved in both Canada and the U.S., but it isnt as readily available right now. Wegovy is the same drug as Ozempic, but it comes in a higher dose and is used for weight loss, whereas Ozempic is typically used for diabetes. But due to Wegovy shortages, my doctor has prescribed me weekly Ozempic injections instead and is adjusting the dosage for me gradually.Semaglutidewhether its Ozempic or Wegovyregulates your bodys insulin and lowers blood sugar levels, imitating a hormone we produce in our intestines called GLP1 (or glucagon-like peptide-1). This satiety hormone, explains Ali Zentner, a Vancouver-based specialist in internal medicine, diabetes, and obesity, is one of many hormones that limits your appetite and signals your stomach to empty more slowly.Zentner likens the drug to the kid in a game of street hockey whose job it is to yell Car! Ozempic, she explains, yells Full! to let your brain know that its time to stop eating. This is critical in weight loss because obesity is a state of inappropriate starvation response. “The brain no longer thinks its starving, so it stops hunting for food, says Zentner.As a result, people with obesity and accompanying health concerns have lost weight while taking Ozempic. Its considered an effective evidence-based medication that offers a 10 to 20 percent reduction in body weight.In my case, almost immediately after injecting my first needle into my inner thigh (its not a pill), all the food chatter that has been clogging my brain for decades just wentpoof.

Why is Ozempic gaining in popularity?

With 63 percent of Canadians either overweight or obese according to 2018 Statistics Canada data, its no wonder many Canadians are excited by its possibilitiesor at least theyre curious and Googling it. Obesity is a chronic condition with very few successful or sustainable treatment options. For so long, people have been given not much more than eat less, move more prescriptions by their healthcare providers.Sasha High, an Ontario-based internist and obesity physician, explains that in the last decade, there have been tremendous advances in our understanding of obesity pathophysiology and with that, better treatment targets. With Ozempic, we now have more effective tools to address the physiology behind weight regulation, she says.And it isn’t only about the scaleor being thin, she says. There may be people who want Ozempic because of the societal pressure to be thinner, but for many with obesity, it’s about improving health, function and quality of life. Yes, Ozempic causes weight loss, she says, but it also improves cardiometabolic health.For my patients, it’s about being able to engage fully in their lives. I have patients kayaking, skiing into their 70s, running after their grandkids.

Who should NOT take Ozempic?

Contrary to rumour mills and what you see on TikTok, Ozempic is not just a celebrity drug or a weight-loss magic bullet. Its also not a practical way to kickstart a crash diet. It is a prescription medication used to treat obesitya chronic diseaseunder the guidance of your doctor.High is adamant that Ozempic shouldnt be misconstrued as a fad or shortcut. This isn’t about vanitythis is about improving health and quality of life, she says.When we address obesity, she explains, we also improve the cardiometabolic conditions associated with it: diabetes, fatty liver disease, hypertension, infertility and cardiovascular disease, to name a few. Obesity is also a major risk factor for cancers like endometrial, colorectal and breast cancer.She also warns against casual on-again, off-gain use of Ozempic. We’ve seen this with every other weight-loss medication in the history of obesity medicine: When you stop the medication, the weight comes back on. She says there may be rare exceptions (e.g., people who have worked very hard to change their lifestyles), but its a fairly typical pattern. When people use Ozempic to lose weight, but discontinue it and inevitably regain, I worry that this is doing them a greater disservice than simply staying at the higher weight to begin with, given what we know about the negative metabolic effects of weight cycling.Doctors also usually do not prescribe Ozempic for those with a family history of thyroid cancer, as the medication has been proven to cause thyroid tumours and cancers in rodents during animal testing.

Are there other side effects or risks?

The most common side effects are gut-related (nausea and vomiting, reflux, constipation, diarrhea, pancreatitis). While there have been some clickbait reports of pretty horrific side effects in the media lately, the doctors I interviewed told me these side effects tend to improve as the body gets used to the medication. When the titration (starting the drug in a low dose and increasing it slowly) is done properly, the side effects should be minimal. Fewer than 4 percent of patients have significant nausea (such that they have to stop the medication) beyond three months.Personally, I was a bit terrified before my first injectionI had read about the debilitating side effects, and I hate needles. I knew that some people on Ozempic or Wegovy took their shots on a weekend, cancelling any plans and hunkering down in their bathrooms. But my doctor reassured me that those extreme side effects were not normal, and told me that if they occurred, we could discuss other options.I began Ozempic at the lowest dose (0.25 mg) with a plan to slowly increase that amount over several weeks (maxing out at 2.0 mg). My pharmacist gently encouraged me to load up my medicine cabinet with ginger Gravol, Tums and laxatives. But in the end, I only experienced mild discomfort around 24 hours after the injection. And as my dosage has slowly been increased, my side effects have remained minimal.The trick, I think, is to be patient when starting Ozempic. For the most part, the debilitating side effects are not the norm, and if you are experiencing any of them, its time to see your doctor.

What other lifestyle changes if anyare required once you start taking Ozempic?

High stresses that Ozempic should be taken in conjunction with learning behavioural and cognitive tools that empower a person to live the healthiest lifestyle that can be reasonably enjoyed and maintained.She works with her patients on understanding a phenomenon she calls wanting, a term to describe desire, cravings and the motivation for food. For many people with obesity, their brain drives increased wanting compared to lean people and this results in overeating. Medications like Ozempic decrease wanting along with hunger, which means people eat less and lose weight.Zentner believes that for the most part, its even simpler than that. The only thing you have to do is take your medication and go live your life. You want to exercise? Wonderful. Do it to celebrate what your body can do. Do it because exercise is good for cardiovascular health and aging and mood and health.

What happens when you stop taking Ozempic?

As with all obesity treatments, Ozempic needs to be continued long-term, or weight regain is very likely, High says. Obesity is like any other chronic condition. If you take medication to control your blood pressure, you need to continue that medication to keep your blood pressure in the normal range. Its the same with obesity, High explains. If you take a medication that brings your weight down and improves metabolic health, you need to continue that medication to maintain the weight loss and metabolic improvements. The duration of treatment is one of the biggest misconceptions people have about anti-obesity medications.

Is the reported Ozempic shortage real?

Though other countriesnotably Australia and the U.S.are experiencing shortages, Canada hasnt been affected yet. (At least for Ozempic. Its true that Wegovy has been harder to access here.) However, the high demand has raised the question of who should be prioritized should Canada face a shortage. Which patients deserve it more: those with diabetes or those with obesity?Zentner and High insist its not reasonable to pit one chronic medical condition against another. Both people with obesity and people with diabetes deserve effective medical treatment, High says. The shortages are a supply-chain issue and not a people depriving people issue.We were told we had an obesity epidemic on our hands and that a third of Canadians were carrying excess weight, Zentner points out. And now we have a treatment that offers 10 to 20 percent body-weight loss, an 80 percent reduction in the development of type 2 diabetes, and [we have] cardiovascular data for cardiovascular benefit in high-risk patients. Its not surprising that theres a rush on this stuff.

Can I trust what I see on social media about Ozempic?

That depends. High decided to become part of the conversation, joining TikTok to promote evidence-based medical education in a sea of (mis)information and celebrity chatter. As an obesity physician, she wants to empower women whove been shamed and blamed for their weight to understand that its not their fault, and that there are effective tools to help them manage their weight beyond #CICO (calories in, calories out).As for me, its been several months since I started Ozempic, and I’m finally over my squeamishness about needles (which is good, if Ill likely be on this medication for the rest of my life).I still struggle with feelings of guilt over not being able to lose weight with diet and exercise alone. But Zentner adamantly reminds me that no other disease has to earn its treatment like this. I did not have to explain why I deserve my hypertension meds, so why is there all this controversy and judgment for those seeking obesity treatment? As Zentner puts it, Medicine at its purest does not care how people get sick. Medicine cares how people get well.Next: How the Pandemic Helped Me Embrace Weight Gain and Intuitive Eating

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OK, sowhat do we mean by one drink?

What matters is how much pure alcohol youre ingesting, and it varies based on the concentration of alcohol (or APV alcohol per volume) in a beverage. Canada defines one standard drink as having 13.45 grams of pure alcohol, which means:

• 5 oz. for wine (12% ABV)
• 12 oz. for beer or cider (5% ABV)*
• 1.5 oz. for a shot of spirits, neat or in a cocktail (40% ABV)

Is it all bad news?

Uh, yes: the numbers dont lie:

• Three to six drinks per week increases your risk of developing certain cancers, including breast cancer and colon, and if you have more than seven drinks per week, your risk of heart disease, several more types of cancer and liver cirrhosis, among other illnesses, exponentially increases.
• The International Agency for Research on Cancer (IARC) estimates that for every drink consumed daily, womens risk of developing breast cancer goes up 7 percent. This means that if youre a one-drink-a-day imbiber, your risk is 7 percent higher than a complete teetotaler. If youre a two-drinks-a-day person, your risk is 14 percent higher.
• Just a drink or two a day may be just as hard on your health as binge drinking. New research by the IARC shows that one out of seven of newly diagnosed cancers in 2020 were linked to light to moderate alcohol consumption.
• Women are more likely to drink to copeas opposed to drinking for pleasurethan men, according to several studies. The stress of the COVID-19 pandemic, of which women bore the brunt with job loss and child-care pressures, has only exacerbated these trends. For women in mid-life, the problem can sometimes snowball, coinciding with marriage strain, increasing care for elders, kids moving out or careers slowing down.
• One American study found alcohol-related visits to the emergency room from 2006 to 2014 increased by 47 percent overall, with the rate for females increasing at 5.3 percent annually (versus 4 percent annually for men).
• A 2020 study from the National Institutes of Health in the U.S. revealed that while men continue to die at higher overall rates from alcohol, alcohol-related death rates grew by 85 percent for women between 1999 and 2017, compared to mens 35 percent increase during that same period. Researchers also found that alcohol-related death rates in women were highest for those ages 55 to 64, followed closely by those ages 45 to 54.

But the data also allow us to make informed, intentional choices about when, if and how much we choose to drink. And the low-to-zero-alcohol options on grocery shelves keep getting better. Take, for example, the non-alcoholic beers and the alcohol-free wines now available.Next: Not Drinking Alcohol? No Problem. Add These Drinks to Your Bar Cart

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Canada’s Telehealth Services

Over the past few years, we’ve seen more and more Canadians opting for virtual healthcare services for help with non-emergency concerns. And it’s easy to see why: They grant access through your tech to doctors, mental health professionals and wellness experts who can answer your questions, help you feel better and give you a prescription when needed. The services are available through websites and apps on your phone, making telehealth a super convenient, effective and affordable care option. Plus, they offer a level of privacy some people preferin one study, patients said they felt more comfortable talking to a healthcare professionalat home than in a doctors office.But, not everyone is a good candidate for telehealth. If you have an emergency, the best way to receive treatment is by visiting the emergency room, says Dr. Howard Ovens, Chief Medical Strategy Officer, Sinai Health System and staff emergency physician at Mount Sinai Hospital. Some people are really sick, either related to COVID or all the other things we always see in the emergency department (appendicitis, broken bones, heart attacks), and they need attention, he says. We want them to feel safe and come in to get assessed.For emergencies, whether physical or mental health-related, call 911 immediately. If you or someone you know is considering suicide, call Talk Suicide Canada at 1-833-456-4566 for support 24 hours a day, 7 days a week. You can also text 45645 from 4 p.m. to midnight ET for immediate care. Residents of Quebec can call 1-866-277-3553 or visit suicide.ca.Below, a list of telehealth services available in Canada.

Provincial Telehealth Services

There are a variety of free and confidential telehealth services run by public health authorities in each province and territory. Services differ slightly from province to province, but in general, these government-run programs link users with healthcare professionals (such as public health nurses) through the phone. Once on the phone, users can ask for medical advice on a range of non-emergency topics such as whether or not to handle the situation at home or if the issue requires a visit to the doctors office. Many of these provincial services also have COVID-19 self-assessments which can help determine next steps if youre experiencing symptoms of COVID-19. To learn more, visit your province or territory’s government website.

Inkblot Therapy

Inkblot is an online mental health and wellness platform that offers video counselling sessions. Through talk therapy, hundreds of licensed counsellors and life coaches are available to help you navigate through mental health concerns including depression, anxiety, bipolar disorder, post-traumatic stress disorder, grief and addiction. Costs $50 per half hour.

(Related: The Pros and Cons of Digital Therapy, According to an Expert)

Focus

Focus is an eCounselling service that allows users to access a therapist via video call, phone call, or text message at any time. It also hosts unlimited Text Therapy for $29-39 per week, so that users can have 24/7 access to their therapist and receive daily feedback and support. Hour-long phone or video call sessions cost $120-150 per hour.

Mindbeacon

This mental health app is available across Canada in both French and English and is suitable for those with mild to moderate symptoms of depression, generalized anxiety, social anxiety, panic, PTSD, and insomnia. Mindbeacon works by first assessing users through a comprehensive questionnaire and then assigning cognitive behaviour therapy-based programs that match the users needs. Mindbeacon also facilitates secure messaging with a registered therapist. The service is free for Ontario residents and is covered by employers across the country. Otherwise, rates start at $525.

Tia Health

Tia Health allows patients to connect with Canadian doctors via phone, video or messaging. You can choose your own doctor, and even one who speaks the language youre most comfortable with. Aside from prescriptions, referrals, requisitions, and mental health services, it also offers COVID-19 screening. Tia Health is covered in Ontario, Alberta and British Columbia (fees start at $30 for other provinces.)

Ontario Telemedicine Network

TheOntario Telemedicine Network(OTN) is a not-for-profit organization funded by the Government of Ontario. During your eVisit, you can speak to a healthcare provider via video using a computer, smartphone or tablet. OTN has a plethora of other services including retinal screening fordiabetics, virtual palliative care program, Indigenous services, and virtual mental health coaching. Visit otn.ca for more info.

Virtual Clinics

Like the name suggests,Virtual Clinics offer virtual appointments in which patients can connect to a doctor via phone, video or messaging. Their services include lab test results on demand as well as prescriptions and renewals delivered to your doorstep. Virtual Clinics is free for British Columbia, Alberta, and Ontario residents and starts at $30 for Canadians in other provinces. To book your virtual appointment, visit virtualclinics.ca.

Livecare

Livecare is the only telehealth company owned and operated by physicians. It offer virtual visits with a medical provider with various specialties such as mental health, cardiology, endocrinology, pain management, sleep disorders and many more. Through video, you can discuss prescription refills, lab and test results, follow-up care and general questions. Livecare also has online journals, health trackers and calendars to help you manage your health. Call Livecare at 1-855-599-8817 on weekdays from 9 to 5 p.m. PST.

Maple

WithMaple, you can talk to a doctor in less than two minutes using your smartphone, tablet or computer 24/7. Doctors can help with various medical issues such ascough/cold/flu,urinary tract infections,sexual health, mental health, general prescription renewals, and more. Maple also offers online dermatology, pediatrics, oncology, naturopathy and other specialties. Pricing starts at $69 per visit or $30 per month. To get started, visit getmaple.ca or download the Maple app.

Felix

Felix offers a way for Canadians to getlifestyle medications such as ones for birth control, acne and hair loss. First, you complete your online visit ($40 fee) by answering questions about your medical history. Then, based on your consultation, you can get a prescription within 24 hours. The medication is shipped to your door at no extra cost.

(Related: Its Time to Revisit Your Birth Control Optionsin the Name of Self-Love)

Tulip Health

Tulip Health is an Ontario-based phone service that links users with Ontario MDs. Doctors on Tulip provide a range of services including cold and flu assessments, prescription renewals, referrals to specialists, and COVID-19 assessments. The services on Tulip are free for Ontario residents with a valid OHIP card.

TELUS Health MyCare

TELUS Health MyCare is a mobile app for Canadians living in British Columbia, Alberta, Saskatchewan, and Ontario. It gives users access to virtual consultations with physicians for prescriptions (which can be sent to your pharmacy of choice), assessments, and referrals for diagnostic tests at an in-person lab or clinic. It also has a built-in symptom checker that asks users questions and provides relevant health and triage information, a health check that allows users to get a broader sense of their current health, and a monitor to track health indicators like mood and energy levels. Patients covered under provincial healthcare plans can access the services on the app for free and each consultation is $65 without insurance.

Cover Health

Powered by Telehealth Ontario, Cover Health gives users access to a same-day appointment with an Ontario doctor. Doctors on Cover are able to provide the same services as any in-person walk-in clinic like cold and flu symptoms, sick notes, medication renewals, reproductive health, prescriptions, and more. All appointments are covered for Ontario residents, even without OHIP.

GOeVisit

GOeVisit is a free app that allows users to describe their symptoms and receive a diagnosis and treatment plan from a Canadian medical practitioner. The app works best for minor illnesses like coughs, cold and flu symptoms, and minor injuries. Prices start at $10 per month for individuals and $15 per month for families.

Next: The 5 Best Apps for Soothing Your Mind

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Why did you want to explore this area in the first place?

Chris Wallis had done some earlier work that looked at differences in outcomes between male and female surgeons, using a similar dataset from Ontario health care. That paper signalled that female surgeons across different specialities are having better outcomes than their male counterparts. And we werent really sure why. To be honest, were still trying to work out why. But one of the areas of interest was whether the interaction between the sex of the physician and the sex of the patient matters.

How did you go about measuring whether it matters?

We have the luxury of lots of health care databases in Ontario, and theyre completely anonymized. We looked at the pairings between the sex of the patient and the physicianso youve got four combinationsand we looked at its impact on death, readmission to hospital, or complications after surgery within 30 days. This was on around 21 surgical procedural groups, from things that are really complex, like cardiac bypass surgeries, to common bread-and-butter stuff, like having your hip or knee replaced. We were able to adjust for a lot of things that affect outcomes, like the age of the patient or the experience of the surgeon. We jam-packed those things into the model and came out with the numbers that you see.

Lets talk about those numbers.

Theyre pretty scary.

What did you think when you first saw them?

I was personally taken aback. We had a lot of internal discussions and went through the data again. Chris had done that earlier work, so we knew there was a signal here, but we just didnt know how big the signal was going to be. Its important to understand what those numbers might mean. Theyre what we call relative numbers. Women having surgery with a male surgeon, relative to a female surgeon, had a 32 percent increased risk for death. That means if your risk for death coming in for surgery is, lets say, one percent, then its 32 percent of that one percentso the combined outcome is about 1.3 percent. Thats how to mentally compute what youre seeing.

But should there be a difference at all?

No. And that needs a deep dive. We saw this difference across a lot of surgeries, and there were 1.3 million procedures in our database. Given that volume, we dont sense that this is some technical thing in the operating room. The operating room is just one part of your surgical experience, which starts as soon as you step into the hospital and meet the team.

What do you think is going on here?

There may be differences around communication, understanding what a patient wants; perhaps theres a difference in decision-making. Very few people die in the operating room. Most things happen after surgery, and picking up on those complications early can be life-saving. Perhaps men and women physicians are communicating with their teams differently. Perhaps theyre listening to patients differently. There are a lot of subtleties, which I will say dont get taught at medical school, that might feed into some of those adverse outcomes. There are likely to be differences in style that we can all learn from.

Better communicators, better listenersnot to truck in gigantic generalizations, but that does sound like women to me. Has that been your experience working as an anesthesiologist in the operating room?

Id say I work with great people, technically and clinically, everywhere. I find women will communicate a bit more. And if Im concerned about something and we need to pause or think or go faster or whatever, I find they listen. It is a bit of a generalization. There are some men who do that really well. There are probably some women who do that really badly. But Im starting to see more women surgeonsmore women in leadership generallyfrom when I was a medical student 20 years ago. To get where they are, women often have to do much more; theyve got to tap into tons of skills, go the umpteenth mile.

And have you noticed differences in female patients, in terms of how they might discuss their symptomsor how they might be received by surgeons of the opposite sex?

I find women will ask more questions, but you know, how you ask your questions often dictates whats underneath. Maybe youre a bit nervous, or you need more reassurance about why something is important, or you may not want to do a procedure. A lot of conversation often means something else. How we perceive that information, as physicians, is so important.

How do we begin to fill this gap?

Weve highlighted an issue, and now we need different researchers to come in. Understanding more about risk might be important. Are there patients were considering operating on who can get through the operation, but perhaps run into issues more frequently after surgery? And then we need researchers with an anthropological or psychology background to really dive into differences in communication style.

What has the response to this paper been like? I imagine some people in the medical community might be a bitresistant to the findings.

Its been a mixed bag. A lot of women feel vindicated and that their work has been recognized. There have been some male surgeons who have come up to me and said, This is fantastic; youve highlighted an important area. Theres a group in the middle who are quiet. And then there are people who are angry. Weve had those emails, those messages on Twitter, where people feel their whole practice has been affected and are taking it very personally. Male surgeons in particular have taken it very personally.

Should they?

Our response has been that this is a very macro-level study. Thats what big data is really good at doingit highlights something. But its generalistic. It can never make an inference on your individual practice.

Since were on a macro level, I imagine its a long process to turn around these disparities in care.

Probably. If there was, lets say, a lot of funding, it would be easier to carve out lots of topics to start examining which would help accelerate us forward. But a subject like this, which is more embedded in the health equity and disparity space, is becoming more of a core subject. People are understanding that this isnt just dinner-party conversation. Theres real science to behold here.Next: How Heart Disease Affects Women Differently Than Men

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Rolanda Ryan

For advocating for accessible abortions

As the owner and operator of Newfoundland and Labradors only abortion clinic, Rolanda Ryan and her team are crucial to ensuring reproductive rights and bodily autonomy in the province. She opened her St. Johns clinic, Athena Health Centre, in 2010.

Her clinic provides 90 percent of the abortions in the province, and you dont need a doctors referral to access care. Athenas practitioners also run a satellite clinic once a month, alternating between central Newfoundland and Corner Brook (a seven-hour drive away on the western coast), but access in other parts of the province (including all of Labrador) is still an issue. And while provincial health insurance covers the abortion procedure itself, travel, accommodations and associated expenses are not included.

To fill the gap, Athena offers telehealth counselling appointments and mails Mifegymiso (a pill that terminates pregnancies before nine weeks) all over the province. For terminations after 15 weeks, patients must leave Newfoundland and Labrador, as hospitals in the province dont have the resources or training to provide this kind of care, Ryan explains. Ryan, who is 55, says keeping the clinic afloat during COVID shutdowns was toughabortions dropped and Athena almost closeduntil she advocated to change the provincial funding model and ensure they could keep their doors open.

In 2015 and 2016, Ryans advocacy work took her to the Supreme Court of Newfoundland and Labrador, and protesters were banned from congregating within 40 metres of abortion providers and patients. She is also one of two Canadian board members of the National Abortion Federation, a professional association for abortion providers south of the border, during a terrifying and turbulent time in the U.S. for reproductive rights. Ariel Brewster

Related:The True Cost of an Abortion in Canada, According to an Expert

Manali Mukherjee

For connecting COVID to autoimmune diseases

Medical researchers have long identified a connection between viral infections and increased risk of autoimmune problems. Measles and mumps, for example, have been linked to the onset of type 1 diabetes, while a bout of mononucleosis (caused by the Epstein-Barr Virus) seems to slightly raise the risk of developing multiple sclerosis. So when COVID-19 hit, immunologist Dr. Manali Mukherjee wondered if it also triggered autoimmune responses, particularly in the 10 percent of people experiencing long-term symptoms that are shared with autoimmune diseases.The McMaster University professor suspected that hyper-inflammation early in the infection produced rogue antibodies that persisted long after the illness onset. To test her hypothesis, she led a study that tested blood samples from 106 post-COVID patients, recruited between August 2020 and September 2021 at hospitals in Vancouver and Hamilton, and followed them for one year. Published this fall, the research identified two abnormal antibodies (autoantibodies) in up to 30 percent of patients a year after infection. Just because you have autoantibodies doesnt mean you have an autoimmune disease, she cautions. But we always consider that it might develop into an autoimmune disease. For that reason, she advises anyone diagnosed with COVID symptoms lasting more than 12 months to get their autoantibodies tested, either through a GP or a rheumatologist.Now, Mukherjee is leading a longitudinal research study that will follow 120 diagnosed long-haulers for more than a year, in part to answer the question of who develops autoimmune problems after COVID and why. The study will also look at whether the severity of long-haul COVID is related to autoimmune responses triggered by the virus and whether vaccination impacts the severity of long-haul COVID symptoms.The answers to these questions are needed to both treat patients and manage healthcare systems. The problem with long COVID, says Mukherjee, is the sheer number of people who have been affected and the magnitude of it. Caitlin Crawshaw

The Yarrow Intergenerational Society for Justice

For helping marginalized seniors access basic needs

On Monday and Friday mornings, seniors from Vancouvers Chinatown and Downtown Eastside gather at a cultural centre to socialize and get their bodies moving. The gentle exercise class is put on by the Yarrow Intergenerational Society for Justice, which connects youth volunteers with low-income immigrant seniors. After the class, they chat over snacks from a local bakery and learn about other ways the society can support their well-being.The loss of legacy Chinese-owned small businesses, the rise in anti-Asian hate crimes and pandemic lockdowns have all led to increased isolation for these seniors, many of whom dont speak English as a first language. The staff and volunteers help them get to appointments and find community resources. They read and interpret government documents, help with subsidy applications and act as interpreters for scheduled medical appointments. They even provide culturally appropriate food through a grocery delivery program. All with the aim to help these seniors age in place, with dignified affordable housing and the community connection they desperately need. Rebecca Philps(Related: Why Doctors Should Be Versed in Linguistics and Sociology)

Gill Whelan

For launching a wellness resource for Newfoundlanders

Gill Whelan had been a fitness instructor for almost a decade when she took a hiatus in 2017. While the St. Johns-based coach was passionate about fitness, she was disillusioned by the toxic messages pervasive in the industry: Often fitness is centered around making people feel like they need to change, she explains.When the world went into lockdown, Whelan saw how her family and friends were struggling to stay healthy and emotionally balanced. So, she created Whelan Wellness Virtual Bootcamp. For $52 a month, subscribers have access to daily workouts, yoga lessons, mental health discussions and workshops about mindful eating and nutrition. Within 24 hours of launching her four-week program, 121 people had signed up. At its peak, the virtual community reached 6,000.Newfoundlands many rural communities have long had limited access to wellness resources. The current shortage of health care workers makes it harder than ever to address concerns before they escalate into medical problems. While systemic issues still need to be addressed, Whelan is empowering people who want to take charge of their well-being. Its the most supportive group of like-minded individuals just wanting to feel better.Valerie Howes

Gift From the Heart

For offering dental care for those in need

6.8 million Canadians avoided seeing a dentist in 2018 because of the cost. Gift from the Heart (GFTH), an Ontario-based charity, is working to change that by offering free dental services to those in need. Their most recent endeavour had the group converting a church basement in Pincourt, Qubec, into an oral hygiene clinic, offering free cleanings, assessments and fillings to migrant workers and Ukrainian refugees.The biggest thing lacking is access to care, founder and president (and registered dental hygienist) Bev Woods said in an interview with CTV. Thats why GFTH has spent the past two years mobilizing two ambulances that have been retrofitted with dental equipment to function as preventative outreach vehicles, or clinics on wheels. Woods and GFTH Vice President Laura Iorio have personally driven the clinics across Ontario and Quebec to bring oral health care to more Canadians. There is no health without oral health, says Woods.Since 2008, theyve also been partnering with independent dental hygiene offices across the country, who dedicate full days to providing no-cost services to clients who otherwise wouldnt be able to access the care. So far, the charity has provided $1.7 million dollars worth of services via a team of 2,500 dental hygienists. Now, GFTH is going biggerwith an enclosed trailer thats currently being renovated and will provide more space for the organization to carry out procedures like emergency extractions and X-rays. Itll be wheelchair accessible and is scheduled to be complete by the end of this year.Arisa Valyear

Dodie Jordaan

For providing a safe haven for at-risk Indigenous women in Winnipeg

Dodie Jordaan is the executive director of Ka Ni Kanichihk, a non-profit that runs Velmas House, Winnipegs only no-questions-asked shelter for Indigenous women at risk of sexual violence. Winnipeg is seen as Ground Zero for murdered and missing Indigenous women and girls, and the Two Spirit community, says Jordaan. We were the only major [Canadian] city without a 24/7 safe space for women and the gender diverse community.Velmas House opened in 2021, and in October 2022, $6.9 million in federal funding was announced to expand their facilities and deepen their programming.We allow people to come in wherever theyre at in life, says Jordaan. We have people who are doing survival sex work, or leaving violent, intimate-partner relationships. Many women who come to Velmas House dont meet the criteria at traditional shelters because they have their kids with them or theyre struggling with substance use disorder.In addition to providing food and shelter, Velmas House also connects clients to services offered by Ka Ni Kanichihk, including counselling, a health clinic, addiction care and job training. They operate on an Indigenous model of care, which includes a 10-week healing program and access to elders and knowledge keepers. The federal funding will increase the number of beds from 10 to 60, and open more spaces in the Ka Ni Kanichihk daycare.Indigenous people, especially Indigenous women, dont access health care as much as they need to, because of colonization, racism and fear of the medical system. But at Ka Ni Kanichihk, says Jordaan, you see nurses, and youre also greeted by aunties and elders. Having basic needs is about more than physical health, she says. Its also about self-worth. Having a place where you can heal, where youre not being judgedis a step toward additional goals.A.B.

Janet Matheson

For caring for sexual assault survivors, and defending the nurses who treat them

Youre seeing people on the worst day of their life. You want to be everything for that personmedically, emotionally, socially. Thats how ER nurse Janet Matheson describes her mission as a sexual assault nurse examiner (SANE). So she was surprised when New Brunswick Premier Blaine Higgs disparaged SANE nurses for their lack of compassion.”In August, a woman went to Dr. Everett Chalmers Regional Hospital in Fredericton after being sexually assaulted. No SANE nurse was on call that nightat the time, there were five in the city, and between them Matheson estimates that they provided 90 percent of round-the-clock coverage. The patient says she was told to return the next morning when a nurse could examine her.While Matheson was eventually called to perform the exam, the patient was understandably distraught and went public with her story. The premier and the provincial health authority were quick to blame the service. Their comments were a slap in the face to Matheson, whos been with the hospitals SANE program since its inception. No one felt worse than we did, says Matheson.But, as she wrote in a Facebook post, what happened was the fault of a system failing under its own weight because of the governments inability to fix it. In other words, the nursing crisis. There are about 1,000 vacant nursing jobs in the province, and after Higgss comments, four New Brunswick SANE practitioners resigned. But Matheson, who has worked as a nurse for 45 years, is optimistic. I hope some good will come out of this and the SANE program will flourish. Caitlin Walsh Miller

Taylor Lindsay-Noel

For making the world a more accessible place

For many people, dining at a restaurant, going shopping or staying at a hotel isnt as welcoming of an experience as it should be: Stairs, narrow passages and tiny bathrooms are physical barriers.Taylor Lindsay-Noel, 29, who has used a wheelchair since she was 14, found that many businesses that claim to be wheelchair accessible actually arent. So she decided to document it allthe good and the badwith accessibility reviews on TikTok under the username @accessbytay. I want to show what happens when places have an inviting environment, says Lindsay-Noel. You get to see people like me out, having fun, being a part of society. Through her 37,000 followers and 170 and counting videos, she certainly achieves that.My followers arent only people in wheelchairs, but also people who want to help elderly grandparents, people whove gotten injured or new moms whove never experienced looking for an elevator instead of a flight of stairs, says Lindsay-Noel. Sometimes the anxiety around figuring out if we can go is a barrier itself.She hopes her videos will encourage businesses to step up and people to speak out. Be an advocate, says Lindsay-Noel. We all deserve to feel welcomed wherever we go. Rene Reardin(Related: These Beauty Brands Are Designing Their Products With Accessibility in Mind)

National Safer Supply Community of Practice

For providing safer opioid drug supply programs across Canada

There are about 15 opioid-related-poisoning hospitalizations a day in Canada, and between January 2016 and March of 2022, there have been almost 31,000 apparent opioid toxicity deaths. Most of these deaths and hospitalizations are caused by illegal drugs contaminated with fentanyl, a toxic pain reliever that has a high risk of accidental overdose. One prevention group, the National Safer Supply Community of Practice (NSS-CoP), is working to scale up safer supply programs across Canada. Through webinars, social media outreach and mentorship, NSS-CoP works with public health units and advocacy groups to develop more robust safer supply programs. To prevent overdoses, these programs provide people with opioid addictions with legal pharmaceutical-grade drugs. With funding from Health Canada, NSS-CoP works with local initiatives in urban, rural and remote settings to create innovative models for providing safer supply. One recent example is a pilot program that launched earlier this year in Thunder Bay, Ont., a community where, in 2021, one person died of an accidental overdose nearly every three days. The program offers lessons in basic first aid, help filling out applications for housing or social assistance and ways to navigate the justice system. New measures like these connect people with the support systems they need to stay safeone important tool in an ongoing response to Canadas overdose crisis. Rebecca Gao

Tabassum Wyne

For advocating for better treatment of Muslims in health care

As the founder and executive director of the Muslim Advisory Council of Canada (MACC), Tabassum Wyne is well-acquainted with inequities in education, employment policies and especially health care. Through surveys, the MACC has collected data on how Islamophobia in health care impacts practitioners, patients and caregivers.

Muslim women and girls seeking health care can be particularly affected. When Wyne gave birth six years ago, she experienced Islamophobia. This led her to become involved in the Family Advisory Council at McMaster Childrens Hospital, where she advocates for policy improvements to address these inequities. Wyne and MACC have also developed an Islamophobia in Healthcare training module that will launch in 2023.

In December 2021, when the Canadian Medical Association Journal published an article calling the hijab an instrument of oppression, Wyne met with CMAJs editor-in-chief to explain their concerns and advocate for its retraction. The journal took down the article and Wyne now serves as an advisor to the editor-in-chief.

If more health care organizations collected race-based data, it would create accountability when patients and staff report issues of racism. There is a gap in Canadian society in understanding Islamophobia in health care, says Wyne. And we hope to be the organization that fills that gap. Zeahaa Rehman

Next: Check out Our 2021 Health Heroes

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Can you explain to me how the product works? Ive got two little kids, and weve all had a cough we cant seem to shake. It doesnt seem serious enough to bother our family doctor about itat least not yet. But at what point would I decide to go to your website and order up a test?

Everybody gets sick at least once or twice during the typical cold and flu season, so some people are electing to purchase the test kits in advance to have them on hand. Or, if you wake up sick or your child wakes up sick, and you don’t have a family doctor or can’t get an appointment, you can order the kit. Depending on where you are, you can get either an overnight courier or a same-day DoorDash delivery. The kit comes with a barcode that you can scan and get an appointment with a telehealth practitioner who will walk you through every step of the test. Then you get your results in 20 minutes. It’s very simple.

Then what happens?

Depending on the results, we’ll provide some recommendations or information on how to manage the illness. And then if you decide you need more information or want to ask questions, we coordinate a telehealth appointment with a physician on the same day. There may be treatment availabledepending on the illnessif you get the diagnosis soon enough.

Okay, and what does it test for?

The kits include the tests for Covid, influenza A and B and strep throat. We also have an RSV product that’s in development, and that should be out in the next week.(Related: Should You Get Another COVID Vaccine?)

Are the testing methods the same ones that we’re familiar with from using at-home Covid rapid testsa cheek swab or a nasal swab, and a cartridge you drop the liquid into?

Yes, the cold and flu kits are the nasal swab and a throat swab. The RSV test is just a nasal swab. It’s very convenient. For kids especially, going to the ER or urgent care can be a scary environment, so being able to do it at home with a simple nasal swab is preferable.

Right. These days, you don’t want to be in the ER for hours and hours in the middle of the nightit’s always a judgment call whether to go in and brave it or not. And lots of family doctors, or even walk-ins, are booked up for weeks and weeks.

Its a challenge to get in, and our goal is to provide people with information and to help them make decisions. Because that’s really what’s lacking: You don’t know what’s going on. You don’t know if your kid’s going to get worse or not. And with RSV, at some hospitals, the only way you get an RSV swab is if you get admitted. Were providing people with more information.The important thing, though, is that at no point do we want people to stay home if youre really sick, or your kid is sick and needs to go to the hospital. This product shouldn’t get in the way of that. For those who can’t get to a physician, this is a way to access more information.

In a way, this also helps those with mobility challenges, childcare duties or limited access to transportationit can be very hard to drop everything, take time off work and get to the doctor, especially if the doctor is far away. Or if you get sick at night, and your family doctor isnt answering the phone.

Yes, we have people who fall ill on Friday and need to know whether they should cancel their business trip on Monday. If you’ve got a cold or sniffles, it’s probably going to get better in a day or two. But if you’ve got COVID or influenza, that’s going to be five to seven days.The other thing that people aren’t aware of is that there is treatment available for influenza [antivirals like Tamiflu], and certainly there’s treatment available for strep throat [antibiotics]. At your doctors office, the swab for strep throat takes three days to come back and by that time you’re either worse, or they’ll prescribe antibiotics whether you needed them or notand then we’re exposing people to antibiotics that they don’t need. Being able to get a proper diagnosis quickly enables more efficient and appropriate treatments.(Related: 14 Virtual Care Services in Canada You Need to Know About)

How does the telehealth appointment work? You pay for the kit, but you don’t pay for the telehealth appointment after the test?

The telehealth appointments are covered by the provincial health plans. We try really hard to work within the public systemwe’re trying to be complementary to the public system at all times. We’re providing service that’s adjacent to the system. Were facilitating you getting an appointment when maybe you can’t get one elsewhere.

Theres been a lot of talk about the privatization of the Canadian healthcare system, and how its been chronically underfunded and neglected. So some people might look at this and think, this is an equity issue. Not everyone can afford this test, and thats not okay. But theres also the inequity of what happens when you can’t access health care at all, or dont have a family doctor, or cant wait in the ER for hours. I’m sure you’ve thought about that a lot.

Absolutely. The fact that these kits are available to anyone, anywhere, anytime, I think is an equity issue. It addresses it, as opposed to making it worse. The other way to look at this, actually, is that were increasing equity. And even in remote locationssince we ship the kits across Canada. In underserviced areas, these kits are providing people with information and the knowledge that they need.

That’s increasingly important as we see rural emergency rooms closing. In a small town, it can be a long drive to the nearest hospital.

Right. Were health care peoplewe work in the public system as well. I was an ER doctor in North Vancouver for almost 30 years. Were working towards developing solutions and improved care for everybody. We’re trying to figure these things out that nobody seems to be able to figure out. For the last 50 years of public health care in Canada, the innovation just hasn’t been there. Ive witnessed a lot of the challenges in the system and been really frustrated by the inability to effect change, for Canadians who can’t get the answers they need.

Pre-pandemic, the idea of doing a self-administered test like this at home just wasn’t really something Id ever imagined. But now, when I’m packing for a trip, I throw a box of tests in my suitcase, of course. And we test ourselves and our kids at home all the time. Without COVID, do you think consumers would have been ready for this kind of product?

Yeah, I think it’s accelerated the change. But it’s not just the test: It’s the support, it’s the information around the test and the ability to take the results to a family doctor. We try to enable them to get the information and the actual care that they need.Personally, I’m not interested in just selling people tests and saying, go for it. I’m trying to provide comprehensive care that meets all of the expectations and that’s complementary and collaborative with the system. You can do a test with us and then you get an emailed result, and then you can take your test results to your doctor if that’s what people want. We’re certainly not trying to poach people from their doctors or encourage them to go with our system, versus another way. It’s just providing information and choice so that people can make their own decisions on how they manage their health. With COVID [restrictions and telehealth], people are recognizing that there’s other ways to do it, and that they don’t always need to go into the doctor in person. In some ways, we can offload the family doctors to look after the people who really need it. And if we can be part of the solution, that’s awesome.This interview has been condensed and edited for clarity.Next: The Best Over-the-Counter Cold and Flu Meds

The post Is It Covid, the Flu, or Something Else? This At-Home Test Kit Could Help You Find Out appeared first on Best Health.

When Abigail Bakan, a political science professor at the University of Toronto, had a bilateral mastectomy in 2016, she decided from the start she didnt want reconstruction. I said no. And they had it on my record, she told me. But members of her cancer care team asked her, repeatedly, if she was sure. Thats when I started thinking, Why are they are continually asking the question and theres only one right answer? The right answer is youre supposed to say yes.A social worker on Bakans cancer team recommended that she attend the Breast Reconstruction Awareness Day event in Toronto, known as BRA Day. BRA Days are held at various venues across North America, including community centres, convention centres and hospitals. It features seminars for patients about different reconstruction techniques as well as a Show and Tell Lounge where breast-reconstruction patients tell their stories (and show results) to women whove been referred to the event by their physicians.The logo for BRA Day features a pink cancer ribbon with a symmetrical pair of loops resembling breasts and the tagline Closing the loop on breast cancer. The logo reflects the idea that constructing a new breast can be a liberating alternative to wearing a prosthesis or facing potential social stigma around appearing without a prosthesis. As Toni Zhong, a Toronto-based plastic surgeon and conference organizer, put it: We now know that you dont have to live with a mastectomy defect for the rest of your life and there are options available that can restore your breast to make you feel and look good or certainly better.But what if a patient doesnt see her mastectomy or lumpectomy as awkward or a defect?The women in the Flat and Fabulous movement are pushing back against the idea that theyre not whole without their breasts, blending online organizing around breast cancer care with image galleries that bring greater visibility to women who have chosen flat closure. One organization, Not Putting on a Shirt, uses social media to provide vetted information on topics such as body image, communicating with providers, emotional health and local community supports.In this sense, the Flat and Fabulous movement has done more than introduce a new aesthetic option. Its pushed for better shared decision-making and choice (two concepts that are key in the reproductive rights movement) in breast cancer care. This shift is needed. Across Flat and Fabulous platforms, women are telling their stories of recovery from botched surgeries or of explanting implants for various reasons, including serious health issues.Yet many say that they were not made aware of risks, statements that are borne out in research. A cross-sectional survey in the U.S. in 2017 found that just 43.3 percent of breast cancer patients had made a high-quality decision (about reconstruction), defined as having knowledge of at least half of the important facts and undergoing treatment concordant with ones personal preferences. Many hospital websites and most of the major American clinical breast-reconstruction decision aids do not include the option of flat closure (a notable exception being the Breast Advocate app, developed by plastic surgeon Minas Chrysopoulo).This kind of information gap can have a negative effect on womens quality of life. A 2017 study confirmed earlier research that patients are more likely to express decision regret when they have not been engaged in shared decision-making around post-mastectomy decisions, with this being true both for women who wanted reconstruction and those who wanted a flat closure. Patients often felt pressure from their clinicians to choose one option or another, according to the study, with some feeling that bias was at play and others feeling rushed to decide on the spot.It may seem odd that some women must press their surgeons to get a flat closure, but it happens. A study of 931 women in 2021 by UCLAs Jonsson Comprehensive Cancer Center found that 18 percent of recent mastectomy patients had been told there were no options for them to choose to go flat. In five percent of cases, women were given surgical results that they didnt ask for, with the surgeons leaving additional tissue instead of a flat closure; what the researchers called intentional flat denial.According to Deanna Attai, a California-based breast surgeon who co-authored the study: Some patients were told that excess skin was intentionally left despite a preoperative agreement to perform a flat chest wall closure for use in future reconstruction, in case the patient changed her mind. Attai notes, We were surprised that some women had to struggle to receive the procedure that they desired.There is also the problem of a data gap, with little information collected on how satisfied women are when they choose to go flat. Recent data is interesting, however. A 2019 systematic review of 28 studies found that women who went without reconstruction fared no worse and sometimes better than those with reconstructed breasts, with no notable differences in terms of quality of life, body image and sexuality. Some of this was confirmed by results of the 2021 UCLA study that Attai co-authored, which showed that 75 to 90 per cent of women who underwent mastectomy without reconstruction were satisfied.But in a data-driven field, there needs to be more research to form a better understanding about navigating the decision-making process.(Related: How to Do a Self Breast Exam)

The history of breast cancer surgery is a grim chronicle of trial, error and slow progress. Lumpectomies have been performed since at least the 14th century. Rudimentary mastectomies are documented in the 19th century, including the mastectomy of Abigail Nabby Adams, the daughter of U.S. President John Adams, who underwent an early mastectomy while tied to a chair in her parents home with no anesthetic or antiseptic.In the late 19th century, American surgeon William Halsted developed the radical mastectomy, removing the whole tumour in one piece along with the pectoral muscles, lymphatic vessels and axillary lymph nodes. While the procedure saved lives, it also led to pain and disability.In the early 1930s, the modified radical mastectomy was developed, sparing some women pain by retaining muscle in the chest. Then, with advances in radiation and chemotherapy, research showed that some classes of patients who were treated with a lumpectomy (removal of tumour with an extra margin of tissue) and radiation had similar survival rates to women treated with only a mastectomy. As a result, in the late 1980s, the concept of breast-conserving surgery became more popular.Before reconstruction became commonplace, women who had mastectomies were typically offered a range of prostheses balls of cotton fabric and wool placed in the bra or bras with built in shelves and prosthesis.Although surgeons in the first half of the 20th century experimented with reconstructions that used the womans own tissue (autologous reconstructions), it wasnt until 1963 with the development of silicone breast implants that reconstruction surged in popularity. But these implants also created health risks and led to numerous recalls, explants and class action lawsuits.They still carry risks and complications. Most recently, textured breast implants, which were used in thousands of procedures, were pulled off the market by Health Canada in 2019 because of a rare risk of lymphoma. Amazingly, some women have struggled to get provincial health coverage to have them removed. Women in the U.S. are similarly battling with insurers for coverage to have various types of breast implants removed.In 1979, the first modern autologous breast reconstruction was performed, opening a door to alternatives for women choosing reconstruction. These procedures continue to carry risks, however, including limited mobility in sport as well as mastectomy skin flap necrosis (tissue death) that can cause scarring, deformity and lead to more interventions. A 2018 study of 2,300 Canadian and American women who had breast reconstruction between 2012 and 2015 found that women with autologous reconstruction experienced higher rates of complications than women with implants.

The choice to go flat has just recently begun to be normalized within the mainstream of cancer care. The term aesthetic flat closure was only adopted by the National Cancer Institute (U.S.) in 2020. And some of the loudest voices for a new approach have come from women who experienced flat denial. In Quebec, Marie-Claude Belzile wrote in 2017 that her experience inspired her to make change to health care in her community: I had to fight with my breast surgeon to be flat. Even after I told him multiple times I wanted to go flat, he wrote on my surgery form reconstruction, expanders. He finally respected my choice and did a good job, but the fight I had to go through should have never happened. Belzile, who passed away in 2020 from metastatic disease, started a Facebook page called Tout aussi femme after being diagnosed with stage IV breast cancer. She also founded a French-speaking flat support group called Les Platines.Many women (opt out) for comfort, others are athletes and many womenwant it to stay simple. Reconstruction is not a simple process, says Attai, adding that in the past few years more of her patients, especially those with smaller breasts, are opting out of reconstruction.Women who use their back muscles for work or athletics may be wary of latissimus dorsi flap surgery (which I was offered) because there is a risk it can compromise shoulder function. This and other procedures carry risks including infection and necrosis. Complications may lead to further interventions. In the U.S., one in three women develop a postoperative complication from breast-reconstruction surgery within two years and one in five require additional surgery. In five per cent of cases, reconstruction fails.While a patient can give informed consent when knowing the risks, too often breast cancer patients have not been made aware of those risks. The UCLA study found that just 14 percent of patients were aware of potential complications of reconstruction but 57 percent reported that they had been informed of the potential benefits to reconstruction procedures. The team concluded that: Implementation of uniform surgical management and improved respect for patient consent in this population would result in significantly improved patient experiences.I was interested to see the word consent in the UCLA paper. While breasts are a part of gender, sexuality and reproduction, terms like choice, consent, shared decision-making and autonomy common in the lexicon of gynecology seem less common in breast cancer care.I asked Todd Tuttle, a professor of surgery at the University of Minnesota, whether professional organizations in the field of breast cancer would be offering more guidance on fostering informed decision-making. Theyre going to have to, he said, pointing out, weve moved from paternalism, where the treatment plan was basically dictated by the surgeon often to the womans husband, toward an atmosphere of greater choice and autonomy for patients. Tuttle notes that whether patients decide to have reconstruction or go flat, one key quality of life indicator is whether they felt they were able to have a real choice in the decision.If you give them enough time and enough information, theyre more likely to be happy five years afterward and theyll feel like they made the right decision. Those people who are not satisfied often felt rushed or pushed, he says. I think time is probably one of the most important aspects of shared decision-making for breast cancer.In Canada, our underfunded systems lead to a different kind of rush. In seeking to care for everyone but with limited resources, our clinics lack capacity. Time often seems like a luxury but with reconstructive surgery, waiting can actually help mitigate risk. A 2018 study found that patients who delayed reconstruction were significantly less likely to develop complications than those who chose to do their reconstruction immediately.I think we dont talk as much with patients as we used to, says Tuttle. Theres all this documentation on electronic medical records and doctors are trying to get all that done instead of just talking to patients. The only way you can have those (important) conversations is by taking your time and listening.As we spoke, I thought back to the day of my diagnosis. I had brought a list of questions to the appointment (which I attended alone, due to COVID restrictions). My doctor pulled out a pen and wrote a series of quick notes about the specifics of my diagnosis on the rooms examining table paper. After he rushed off to see other patients and I was alone in the room, I carefully tore the examining table paper, folded it and put it in my purse to read later with my husband. When I got home, it was inscrutable an experience we would have again when results were posted in the online Patient Portal.It was all information, to be sure. But it didnt replace a conversation.I switched to a different hospital, with a doctor who scheduled an in-depth introductory Zoom meeting about my care and choices. I remember being grateful that she took the time. I also recall that this conversation took place at 8:30 p.m. My new provider was making time for her patients by working after hours. Most likely, it was the only way she could.The problem with breast cancer is you have to make these irreversible life decisions in a really short time, says Tuttle, and youre making the decisions at probably the most stressful point in your life.

Throughout breast cancer treatments, our relationship with our bodies changes. During chemo our hair falls out, our weight fluctuates, bizarre things happen to our fingernails and skin. We get sick and sometimes cant stay awake. The radiation burns us; those put into chemical menopause are doused in hot flashes. Pain and discomfort are part of the whole deal. And while there are some small decisions we have control over during treatment, most of us simply take the treatment plan handed to us if we want the best chance to get well. The choice of whether to reconstruct or go flat is different. This decision isnt about fighting cancer; its about healing from the fight.After my lumpectomies for synchronous bilateral cancer, I was offered a reconstruction. Because they removed more tissue from the right than the left, the plastic surgeons plan was to recreate a symmetry between my right and left breasts. But this choice would have involved a lot more than ticking off a box and signing a consent form (which I was offered in a flurry of papers before even seeing the consulting plastic surgeon) and after months of cancer interventions that had too often kept me away from family and work, the thought of more surgeries exhausted me. I was ready to start reconnecting with my body, which already had become a site of multiple, difficult interventions. For me, rebuilding my relationship with my body didnt involve rebuilding my breasts.I was also not convinced by BRA Days claim that I could close the loop on breast cancer with plastic surgery. As I write this, I have a 20-year prescription for preventative meds in the hopes of staving off metastasis. Breast cancer is a part of my life now. What if, instead of closure through a facsimile of my pre-cancer body, I strive to accept the myriad ways that fighting cancer has changed me? Could accepting my post-treatment body help make the reality of survivorship easier, too?Some of my concerns were like those of Isabelle (who chose not to use her last name), an Ottawa patient whose choice to go flat was supported by her health team. I made the choice to have prophylactic mastectomies because I have a high risk of developing breast cancer, and I watched my mother die from it, she told me. That part of the choice was easy. What I had not really considered was the reconstruction. In debating a post-mastectomy plan, she said, I didnt want to do anything that would require a long recovery, multiple surgeries, time away from the sports and activities I love Going flat meant that I would not take any additional risks with my health.Isabelle echoed a common theme among women who go flat: a sense of wanting to move on with life. I dont feel like I am losing my femininity, that I will look like less of a woman, she said. My breasts fed my two babies Now I want to be around for those babies for as long as I can.With all the aspects of cancer we dont have control over, the aesthetic decisions carry an extra weight; theyre personal, yet they also have cultural meaning. As Belzile wrote: My vision is that the more we speak out about our realities and our fights, the more itll change the culture and society I see a way for getting visible to each other and to others and get validated for who we are. I see a future where women are respected and taken as the only person competent on whats best for her.

Back in the waiting room, my mind travels to my visit a year ago, waiting to go down the hall for surgery. X-rays of my tumours would be taken in surgery that day and sent to me later via a secure hospital server. I opened the images late one night and was struck by their appearance, like variegated blossoms in white and black excised and sampled for cells to see if they got it all. They tried to get it all. We tried, all summer, fall and winter. Did we? I wonder: Did we get it all?I open my eyes and look around the room. Every face tells a story and everyone here is waiting for some kind of news. Here, our breasts are imaged, mapped and ultrasounded, pressed in the mammogram machine, deconstructed in biopsy. We sit patiently, hold our breath; we bleed, blink back tears. Then at the end of the appointment, we take the elevator down and step back into everyone elses world to find our way. To reconstruct, resurrect or rediscover who we are.PQ: What if a patient doesnt see her mastectomy or lumpectomy as awkward or a defect?PQ: Most of us simply take the breast cancer treatment plan handed to us if we want the best chance to get well. The choice of whether to reconstruct or go flat is different. This decision isnt about fighting cancer; its about healing from the fight.”This story was originally published on healthydebate.caNext: Jeanne Beker on Finding Community and Support Through Her Breast Cancer Diagnosis

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Through cancer journey coaching, I realized I had been feeling as though I was meant to suffer or that my suffering had a higher purpose. It dawned on me that limiting beliefs like these had been guiding much of my thoughts and decisions in life until then. This awareness sparked a fire within me. I began to gain clarity on who I was, what was truly important to me and how I wanted to live. I became more intentional. My life was infused with more gratitude. And I held a deep desire to help other women experience the beauty of this unfolding. I knew in my gut that this was my calling.Since then, I have had the privilege of working with women of all ages through various stages of their cancer, including those at the initial stages of a new diagnosis, those experiencing the vulnerability of living as a survivor and those acknowledging the reality of their mortality. I expanded my work beyond cancer and began addressing the other shades of life’s complexities. Many of my clients, despite their diverse experiences, share similar sentiments, such as low self-esteem or the pressure to meet perceived obligations, especially as women and the many hats we wear with our families and careers. Through coaching sessions and identifying skills and strengths, I help my clients define their core values and learn the strengths they already possess that they can lean on through challenging times.For each client, I have had the opportunity to witness the start of their self-discovery process. I have seen them begin to recognize their potential and the unique value they bring to the world, unlocking a power within them that they always had, but struggled to elicit. This power often looks like a renewed sense of confidence and an ability to trust their own intuition. I had one young client who hesitated to assert herself and her needs. Through cancer journey coaching, she began to advocate for herself to her care team and take charge of her own cancer management and treatment. This newfound confidence led her to make other empowering decisions in her life, like driving down a highway in a convertiblea seemingly small act, but one that was personally meaningful and liberating. Witnessing transformations like this has been my biggest accomplishment and truly feeds my soul.Cancer changes you as a person. Some like to say that conquering cancer has made them stronger. I like to be mindful of the language I use. Conquering cancer implies a battle, a struggle that requires one to warrior up or otherwise fail. Theres a lot of pressure that comes with this, and it also implies that those who ultimately die from their disease, like my dad did, somehow lost. This could not be further from the truth. Where cancer is traditionally viewed as a death sentence, for me, it became a catalyst to explore something deeper about myself. It forced me to ask myself, What can I learn from this? What am I discovering about myself? What is the meaning that I can derive here? Beyond radiation, chemotherapy and surgery, there are deeper wounds that also need healing. This is what cancer journey coaching offered to me, and this is what I now offer for my clients.Today, 10 years after the death of my father, I feel as though I am honouring his words, Dont be ashamed. Be open. I am working towards changing the narrative of cancer. My goal, and my lifes passion, is for other women to be able to do the sameto see the challenges they face as an opportunity for growth and transformation, and to have the clarity and confidence to stand in their innate strengths.Next: Jeanne Beker on Finding Community and Support Through Her Breast Cancer Diagnosis

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Give it a rub

With a firm, circular motion, massage the web of skin between the base of your thumb and your forefinger. Continue massaging for several minutes, then switch hands and repeat until the pain resolves. Acupressure experts call this fleshy area trigger point LIG4 and maintain that it is linked to areas of the brain where headaches originate.

Heat up and cool down

Believe it or not, soaking your feet in hot water will help your head feel better. By drawing blood to your feet, the hot-water footbath will ease pressure on the blood vessels in your head. For a really bad headache, add a bit of hot mustard powder to the water.For a tension headache, place a hot compress on your forehead or the back on your neck. The heat will help relax knotted-up muscles in this area.It might sound contradictory, but you can follow up the heat treatment (or substitute it) by applying a cold compress to your forehead. (Put a couple of ice cubes in a washcloth or use a bag of frozen vegetables.) Cold constricts blood vessels, and when they shrink, they stop pressing on sensitive nerves. Since headache pain sometimes originates in nerves in back of your neck, try moving the compress to the muscles at the base of your skull.Here’s an alternative to a cold compress: Soak your hands in ice water for as long as you can stand it. While your hands are submerged, repeatedly open and close your fists. This works on the same principle as an ice pack on your headthe cold narrows your dilated blood vessels.(Related: 12 Foods That Can Make Your Headaches Worse)

Try the caffeine cure

Have a cup of strong coffee. Caffeine reduces blood-vessel swelling, and thus can help relieve a headache. This is why caffeine is an ingredient in some extra-strength painkillers like Excedrin. However, if you are already a heavy coffee drinker, skip this. Caffeine withdrawal can cause headaches, creating a vicious cycle.

Do something constrictive

Tie a bandanna, scarf, or necktie around your forehead, then tighten it just to the point where you can feel pressure all around your head. By reducing the flow of blood to your scalp, this can help relieve the pain caused by swollen blood vessels. You might try soaking the bandana in vinegar, a traditional headache remedy.

Soothe with scent

Certain essential oils, especially lavender, can help ease tension and relieve the pain of a headache. Gently massage a bit of lavender oil onto your forehead and temples, then lie back and enjoy the relaxing scent. For maximum relief, slip away to a room that’s cool, dark, and quiet. The longer you can lie there quietly breathing in the aroma, the better.In addition to lavender oil, or instead of it, use peppermint oil. The menthol it contains can help dissolve away a headache. Its fragrance at first stimulates, then relaxes, the nerves that cause headache pain.If you have a vaporizer, add seven drops lavender oil and three drops peppermint oil, then breathe in the relief. If you don’t, try sprinkling a few drops of peppermint oil on a tissue. Inhale deeply several times.Try wringing out two wet peppermint tea bags and place them on your closed eyelids or forehead for five minutes.

Swallow some throb stoppers

An anti-inflammatory, ginger was traditionally used to treat headaches, and it seems to work. Grind up a half-teaspoon ginger, stir it into a glass of water, and drink this ginger juice. Or pour 1 cup hot water over 1 teaspoon freshly ground ginger, let the tea cool a bit, then drink it. Ginger is especially effective against migraines, though how it works is not well understood. Doctors do know that ginger has an effect on prostaglandins, hormone-like substances that contribute to inflammation. Ginger also helps control the nausea that so often accompanies migraines.Try drinking a cup of rosemary tea. Some people say it helps keep a headache from getting worse. Pour 1 cup boiling water over 1 teaspoon of the dried herb, steep for 10 minutes, strain, and drink.At least one grandmother counted on strong black tea with a few bruised whole cloves added. Tea contains caffeine, and cloves have anti-inflammatory properties, so the brew might indeed help a headache.Down a large glass of water and see if it helps. Dehydration can cause a headache.

The power of prevention

If you grind your teeth or clench your jaw-either when you’re awake or asleep-take steps to prevent the problem. You might need to wear a mouth guard at night.Eat at regular intervals. There’s evidence that a drop in blood sugar-the result of going too long without eating-can set the stage for headaches.At least three days a week, spend 30 minutes walking, cycling, swimming, or doing some other form of aerobic exercise. These exercises are great stress-relievers.Next: Am I Having a Headache or a Migraine? And More Migraine Questions, Answered

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Why are at-home breast self-exams so important?

Gaining awareness of whats normal for your body and noticing (either on sight or by feel) when theres been a change means you can promptly report it to your healthcare provider. You cant know theres been a change unless you know what your normal breast tissue feels like and youd only know if youre doing breast self-exams often, says Dr. Paula Gordon, a clinical professor at the University of British Columbia.That said, Gordon also emphasizes that there are many cancers that arent detectable by a self-exam and that at-home breast examinations should augment regular mammograms and other tests. Understanding your entire body and anything that changes is important, but first and foremost, discuss any changes with your doctor who is familiar with your risk factors, adds Cathy Ammendolea, the Chair of the Board of the Canadian Breast Cancer Network.

How do I examine my breasts at home?

Before jumping into the how, its good to set up the when: your breasts size, texture and lumpiness fluctuates depending on where youre at in your menstrual cycle, making it tricky to know what your norm is. If youre still menstruating, Gordon recommends doing your breast self-exam a few days after your period. Before your period, its normal for your breast tissue to feel lumpier and sore. This ensures youre comparing apples to apples each time, says Gordon. If youve gone through menopause, give yourself an exam periodically.To perform a self-exam, start with the visual check. Stand in front of your mirror, topless, and turn side to side, checking for lumps and changes in your nipples. Then, lift your hands above your head. After that, place your hands on your hips and flex your chest muscles. Both moves can help you see lumps that you wouldnt otherwise see.(Related:Sofia Vergara’s Thyroid Cancer Experience Is an Important Reminder for All)Next is the feel test. Unless you have really small breasts, you should be doing your self-exam like a breast surgeon does it: lying back at about a 30-degree angle (for example, lying down in bed with your head propped up on a few pillows). Keep your fingers flat and bent slightly at the knuckles, use the undersurface of your fingers to squish your breast tissue against your ribcage. Then, feel for lumps and any changes by going around the circumference of your breast to the nipple and then feeling the nipple as well. Finally, check your armpits, where there may be enlarged lymph nodes. Reach your hand over to hold onto the opposite shoulder and then, using your other hand, squish the tissue and fat of your armpit against your rib cage and feel for any lumps.Gordon suggests checking out this video by breast surgeon Dr. Liz ORiordan as a guide:

What sorts of breast changes should I be looking out for?

Generally, when doing a visual examination (ie., looking at yourself topless in a mirror) you should check for any lumps, redness, dimpling, skin sores, growing veins, thick skin and pores that look more prominentwe call it skin of an orange, because your skin looks like an orange peel, says Gordon. Notice if your nipple is sunken or if theres a crust on the nipple. Also, look out for any discharge that comes out on its own. Clear or bloody discharge that spontaneously seeps without your intervention should be checked out by your doctor, says Gordon. If you have discharge, but you really need to force it in order for it to come out, that usually isn’t a cause for concern.Then, when youre touching your breast, feel for any abnormal textures, lumps or areas of unusual firmness. “Everyone has texture or lumpiness in their breast, but its unique to us, says Gordon. People who do periodic breast self-exams are experts in whats normal for them. We intuitively remember what the normal texture feels like and if we notice a slight change, thats when the alarm bells go off.(Related:What Doctors Want You to Know About Breast Cancer)

What should I do if I do discover a concerning change in my breast?

If you notice something different in your breast tissue, contact your healthcare provider and ask for a mammogram or another form of testing. If you have dense breast tissue (which you can find out when you get a mammogram), itll make it harder to detect some forms of breast cancer. So, make sure you ask your doctor for an alternate form of breast cancer screening (like an ultrasound) in addition to a mammogram, depending on your age. Ultrasound would be a reasonable first test for women younger than 30-35.Next: The Canadian Provinces with the Highest Rates of Cancer

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What was the diagnosis process like?

I had just had a routine mammogramI go every two years, though I wish I had been going every year because I didn’t know that people with dense breasts really have to be checked a lot. So, a couple days after my mammogram, my doctor called and said they had discovered something. I had been feeling totally normalfine, perfect. I never felt anything lumpy in my breasts or anything. They called me back for a biopsy and an ultrasound and MRI. Then I got that call that changed my lifethat call that nobody wants to get. Those first few days, as anyone can attest to, were incredibly dark and very scary because you don’t know exactly what’s going on and how bad it is, or if they can treat it. It’s just awful, and you go down 5,000 rabbit holes.

What happened next?

I got an appointment with a doctor at the breast clinic of Princess Margaret Cancer Center. She’s a surgeon, and she immediately made me feel better by telling me that the prognosis is good and the cancer had been caught early. I had to see the oncologist the following week, who’s another rock starthey’re all rock stars at Princess Margaret. The oncologist told me it’s not only treatable, it’s curable. When I heard that, I just felt so relieved. He told me about three different treatment options, and I decided to do 12 rounds of Taxol [a form of chemo], followed by surgery and radiation, because it was a bit easier to maintain my lifestyle with that treatment route. Im glad I went that way because it was quite tolerable, and Im done chemo. My surgery will happen later in October.I’m hanging on and feeling very positive and very grateful. When I was growing up, most people [with cancer] had really bad outcomes. But the landscape has changed. Research, especially in the field of breast cancer, has progressed to such a brilliant degree. Things are changing all the time. So I just feel incredibly lucky. There’s been so many silver linings to this journey as well.

 

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Tell me about those silver linings?

One of them has been my Instagram. Social media can be the root of all evil, but when used correctly, it can also be an incredible way to communicate and touch people and be touched by people. When I decided to go public with my journey, it wasn’t a big decision at all. I was like, of course I’m going to put it on my Instagram because I’m all about authenticity. And this is something very real that I’m living with. It’s something that I know affects so many womenone in eight women are going to be diagnosed with breast cancer in their lifetime. Why wouldn’t I want to reach out and tell people who have been watching me and supporting me all these years? I felt I owed it to themand I owed it to myselfto be that open and honest.I just actually held the hand of a very dear friend of mine who, for about a year and a half, went through her own cancer journey. It was during the pandemic and she was very alone. She didn’t want to tell anybody. Shes not a public person, so I understand wanting privacy, but I thought at the time that I would never be able to do that. It was just too much of a burden.So, I started telling people about my diagnosis and the response [on social media] has been phenomenal. The positivity that I was getting back was phenomenally heart-swelling and my spirits were so lifted. Even if they just sent emojis, it was just such a joy to me.(Related:What Doctors Want You to Know About Breast Cancer)

How have your friends and family supported you since the diagnosis?

All my friends have been fantastic. They’re always texting, emailing, calling, checking up on me. Even people I didnt think I was very close to were asking if there was anything they could do for me. If I needed someone to pick me up for treatment, or go with me to the hospitalthat kind of support was just so nice. But I think most importantly, my daughters have been great. My youngest daughter lives in the Yukon and drove all the way out here to be with me. And my other daughter lives nearby and she’s just been fabulous. My sister in LA has been incredibly supportive and positive. Even though I’ve just spoken to her on the phone, she’s offered to come here.And, first and foremost, my partner. We’ve been together for seven years. He was with me when I got the phone call and without skipping a beat, he said, Don’t worry, we’ll get through this together. He comes to all my doctor appointments with me. He’s just my biggest cheerleader, and I’m so lucky to have that kind of support. And then I’ve got my big goldendoodle dog who acts as a therapy dog. He just just comes and cuddles me whenever I need it. I am really looking forward to the [CIBC Run for the Cure] on Sunday, where Ill talk and meet with other women with breast cancer.

Tell me a bit about your advocacy work around the Canadian Cancer Society CIBC Run for the Cure.

The community of women that you find [after youre diagnosed] is phenomenal. You feel like youre in some kind of special club with these women. Granted, its a club that you may not have wanted to be part of, but once you’re in it, everybody is so supportive of one another. It’s such a wonderful feeling to know that you’ve got so many hands to hold. I think the whole event is just so incredibly inspiring, besides the fact that it raises so many funds.

What do you hope that people learn from your story?

I hope that women become aware of the fact that they better go for a mammogram on a very regular basis. I think a lot of women put it off because it’s not a pleasant experience. But its really important to go in!And, I want to remind people to live your life to its fullest, as much as you canand appreciate every glorious second of it. I’ve never savored life more. I mean, the whole diagnosis just made me realize how much I was in love with my life. All of a sudden, the world seems like an even more beautiful place. I really hope to be able to stick around for a lot longer.This interview has been edited and condensed.Next: How to Do a Self Breast Exam

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Tired of feeling tired?

Feeling bone-tired, as so many people do, is disheartening, demoralizing, and frustrating. You want to race like a thoroughbred, but you feel stuck in the mud. Half the time you’re struggling just to stay awake. Life is passing by, and you can’t keep up with it. Willpower doesn’t work, so what does?Sometimes your best bet is a total energy makeover changes in the way you eat, drink, and exercise. Certain supplements can also help. Or maybe your solution is simple: sleep, beautiful sleep. Of course, it wouldn’t hurt to have your doctor test your blood for hypothyroidism, anemia, vitamin B12 deficiency, and other conditions that can cause fatigue. Scroll down for what to try.(Related: Can Allergies Make You Tired? 7 Things Allergists Need You to Know)

Eat to beat fatigue

1. Go easy on foods high in refined carbohydrates.

Bread, spaghetti, and cake are not your best choices. These foods make your blood sugar rise rapidly, then crash quickly. You’ll end up feeling weak and tired. Eat more high-fibre foods that are rich in complex carbohydrates, such as whole-grain cereals, whole-wheat bread, and vegetables. These help stabilize blood sugar.

2. Cut down on your intake of unhealthy fats.

According to a 2016 study, people who consume diets high in fat are more likely to experience fatigue throughout the day. Aim to have no more than 10 percent saturated fat in your diet.

3. Eat spinach once a day.

This is an old-time remedy for relieving fatigue, and we all know what it did for Popeye. You can’t go wrong. Spinach contains potassium as well as many B vitamins, all of which are important to energy metabolism.(Related: 16 Healthy, Energy-Boosting Breakfast Recipes You Need When Working From Home)

Supplement your energy stores

Ginseng is an age-old cure for that run-down feeling. Look for a supplement containing at least 4 percent ginsenosides, and take two 100-milligram capsules daily. This herbal remedy stimulates your nervous system and will help to protect your body from the ravages of stress. (Off-limits if you have high blood pressure.)Consider taking a magnesium supplement, as a deficiency in the mineral could have you feeling tired. Magnesium is involved in hundreds of chemical reactions in the body. It plays a role in changing protein, fat, and carbohydrates into energy sources.(Related: Are Any of Us Taking Supplements the Right Way?)

Know the best fatigue-fighting beverages

Sip water all day longat least eight glasses. Don’t wait until you’re thirsty, because your “thirst alarm” isn’t always accurate. Even a little dehydration can make you fatigued.Keep caffeinated drinks to a minimum. The caffeine in coffee and some sodas can give you a short-term burst of energy, but following that “rush,” there’s typically a “crash.” (Learn what happens to your body when you have an energy drink.)Finally, limit alcohol consumption. Alcohol depresses your central nervous system, and it reduces your blood sugar level.(Related: 23 Flavoured Water Recipes That Are Beyond Refreshing)

Exercise

Most days of the week, try to get at least 30 minutes of exerciseit’ll give you an energy boost and also help you sleep better. Consider taking up yoga or tai chi. These ancient forms of exercise allow you to get physical activity, but they also include relaxation components that can be reinvigorating.Don’t have the time for a 30-minute workout? Try just 10 minutes of low-level exercise. Usually, people with fatigue have a decreased supply of adenosine diphosphate (ADP), an intracellular “messenger” involved in energy metabolism. Translation: There’s not enough “spark” in the engine. Almost any kind of activity will help-singing, taking deep breaths, walking, or stretching.(Related: Why Exercise Can Be the Most Effective Way to Relieve Stress)

Get enough sleep

Always get up at the same time, even on weekends. Your body will eventually get the hang of the steady sleep schedule. Need extra sleep? Go to bed earlier. As long as you’re getting up at the same time every morning, it’s fine to have a flexible getting-to-bed schedule. Also, keep naps short. If you snooze more than half an hour during the day, your body will want more, and you’ll be groggy when you wake up.(Related: 3 AM and Wide Awake? Heres How to Sleep Through the Night)

A quick cure for fatigue

For a quick pick-me-up, put two drops of peppermint oil on a tissue or handkerchief, hold it to your nose, and breathe deeply. If you have more time, try adding two drops of the oil to bathwater along with four drops of rosemary oil for an invigorating soak.(Related: The Health Benefits of Peppermint)

When to see your doctor about fatigue

A long list of medical conditions and lifestyle issues can contribute to fatigue, including lack of sleep, inadequate nutrition, flu, obesity, allergies, infections, anemia, alcohol abuse, hypothyroidism, heart disease, cancer, diabetes, and AIDS. If you feel tired “all the time” even after you’ve taken steps to treat fatigue, make an appointment to see your doctor. If you have fatigue along with sudden onset of abdominal pain, shortness of breath, or severe headache, seek immediate medical attention. Other chronic symptoms that might require a doctor’s attention are muscle aches, nausea, depression, fever, or difficulty seeing.Now that you know some of the best natural home remedies for fatigue, check out these 22 guaranteed ways to boost your energy.

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Finding a trans-affirming doctor is the first test

Finding a doctor is exceptionally difficult for trans folks. Queer community centres or associations are a good place to startthey often offer resources for trans folks looking for medical care. You can also try Googling queer non-profit or reaching out to a local Pride or PFLAG group. In Ontario, for example, I recommend 2SLGBTQ+ organizations like The 519 or AIDS Committee of Toronto. They often offer resources for trans folks looking for medical care, though they can be harder to find in smaller cities or towns.In Toronto, I saw a wonderful queer doctor at a queer clinic. He connected me to a counsellor who was the first person I spoke to about transitioning. If you are trans, she asked me, would you transition? The question showed me she had an open mind and knew that not every trans person wants to medically transition. At every turn, she put me in the drivers seat; there was no pushing of any particular narrative about the right way to transition.When I moved to Montreal a few years back, I received a list of trans-friendly doctors from Action Sant Travesti(e)s et Transsexuel(le)s du Qubec. I spent a month calling every name on the list only to discover that the average wait was two years just for an appointment. When I finally landed an interview with the man who is now my doctor, I knew he wasnt the right fit, but I was tired of waiting. I needed care.

Your gender will be tested against stereotypical norms

The next test came when youve decided on your transition trajectory. In my experience, doctors expect you to reaffirm their version of what a transition should look like.When I started seeing my doctor in Montreal, he pushed back on nearly everything, from the medications I wanted to my surgery choices. But things improved drastically when I started to conform to his notions of femininity. Before appointments I would shave my arms and legs, then put on mascara, blush and a padded bra. It was performative, but it felt like my only route to care. (A 2021 Canadian study revealed that physical appearance, including gender expression, plays a factor in whether trans patients are given access to transition-related care.)Having to prove my femininity really hurt. At that moment, I had to remind myself that it didnt mean that my journey or how I want to transition isnt valid, it was just something I had to do to get through.

Even if you pass a test, your doctors advice can be harmful

My doctors neglect in understanding what my body means to me as a non-binary person has even led to harm. When I was finally prescribed a testosterone blocker, he failed to mention the impact it would have on my penis. On blockers, blood flow to your penis is stunted and if you dont exercise the muscles, such as with masturbation, you can lose the ability to have an erection.After a physically painful experience, I did my own research and found out what was going on. I also found a solution: a low dose of Cialis. When I suggested it to my doctor, he immediately brought up vaginoplasty again in a way that I felt questioned my transness. He assumed that because I was in the process of transitioning, I wouldnt want a functioning penis. His notion of transness was wrapped up in sex rather than gender and didnt allow room for me to have a healthy non-binary body on my own terms.I dug in my heels. No one was going to tell me that my body functioning healthily was incompatible with my transition. Eventually he relented, but I had to fight for myself.

When the system fails you, you have to take care of yourself

Through all these tests, theres one thing Ive learned: I have to take care of myself. My doctor wasnt providing the care I needed, so I had to learn to take care of my bodyand love itmyself.For me, that meant putting my lifelong love of exercise in a context that aligned with my gender. Ive never felt more affirmed than when I put on athletic wear and a sports bra for a run.Depression and anxiety often go hand in hand with transitioning, so my advice is to start small and, slowly, youll find whats right for you. Remember: even if the best health support you receive comes from within, youre worthy of that care.*Name has been changed to protect the identity of the author.Next: Were Not Doing a Good Enough Job: How Canadas Health Gap Is Affecting Women

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