Strategies to help you get a good night’s sleep

There are a hundred different ways we try to fall asleep – including counting to 100 – but those restless nights are serious and if ignored can have take a major physical and emotional toll on a person’s well-being.

“We live in a society that emphasizes efficiency, and in order to be efficient, we have to sacrifice something, which often ends up being sleep,” says Dr. Jacqueline Sze, Psychiatrist at The Scarborough Hospital. “However, we must put greater emphasis on the importance of sleep for our physical and mental health.”

She adds that generally people with existing mental health issues such as depression or anxiety are more likely to suffer from sleep disorders, but everyone experiences stressful periods, which can affect the quality of our sleep. Whether you have a problem with falling asleep, staying asleep or interrupted sleep, the lack of rest can be detrimental to our overall health.

Short-term effects include irritability, difficulty paying attention, headaches, pain and nausea, while long-term, it can increase the risk of developing a mental health issue and even lead to mortality.

Some strategies suggested by Dr. Sze to improve sleep include:

• Rule out any medical problems such as sleep apnea, Restless Leg Syndrome, bladder issues and other physical conditions that can cause sleep deprivation.

• Rule out environmental issues that could be affecting the quality of your sleep such as noise or too much light. Make sure your bedroom is quiet and comfortable, and use your bed for sleep and sex only.

• Go to bed and wake up at the same time every day, even on the weekends. It’s understandable that life will interfere at times with your sleeping patterns, but trying to maintain a schedule will help your overall quality of sleep.

• If you can’t fall asleep, get up and read a relaxing book, knit or clean – something that doesn’t activate your brain. Watching television and spending time on the computer are not helpful sleep hygiene techniques.

• Develop a bedtime ritual. Humans are creatures of habit, so taking a hot bath or drinking an herbal tea every night before bed can train your body and brain to prepare for sleep.

• Stay away from caffeine, alcohol or nicotine about four hours before bedtime. You may find these can help you fall asleep, but they actually affect the quality of sleep, so chances are you won’t feel rested the next day.

• Do not overuse medication to help you sleep. Medication can become ineffective after two to four weeks of consistent use and can stop working. It’s better to develop good sleeping habits that will train your body to sleep well naturally for the long-term. Medications can also make you feel drowsy and tired the next day.

• It may be necessary to make changes to your lifestyle as certain activities such as staying up all night and sleeping during the day (unless you are a shift-worker) can lead to erratic sleep patterns.

• Keep a sleep diary and chart when you go to bed, when you wake up in the morning, the number of times you wake up during the night, any naps and other patterns you experience. This can be valuable information if and when you enlist the support of a medical professional.

It’s important to remember there are no set hours for getting a good night’s sleep. Everyone is different, and some people may need more or less sleep than others to feel rested.

Dr. Sze adds that a consistent battle with getting a good night’s sleep may be an early sign of a mental health issue such as depression. Also, people who suffer from previous sleep disorders are more likely to experience them in the future. So it’s a good idea to develop good sleep hygiene and discuss any concerns with your doctor.

Benefits of a Birth Doula

For centuries, women have given birth with the support and care of other women in an experience that focused on the psychosocial and emotional aspect of this remarkable life event.

Modern day doulas have modified this age-old concept and integrated their unique, non-medical services into many healthcare settings to enhance childbirth services for expectant mothers and their families.

“We provide a woman and her partner with ongoing comfort, encouragement and respect,” says Rean Cross, Doula and Executive Director of the Doula Program at The Scarborough Hospital. “Family support is certainly important, but a third-party person with extensive knowledge and experience in the birthing process can improve the overall satisfaction families have with their childbirth experience.”

Stefanie Atunes, Doula and Chief Operating Officer of Discover Birth Inc., which has partnered with TSH to offer doula services, adds that a doula acts as a bridge between the medical aspect of childbirth and the emotional journey that families experience as they transition into parenthood.

Rean and Stefanie share some benefits of including a doula in your childbirth experience:

1. Doulas are present throughout the entire process. When a woman goes into labour, her family contacts the doula on-call who provides 24/7 support from beginning to end. There are 18 doulas currently enrolled in the program at TSH, and they work on-call rather than in shifts so they are able to remain with the family for the duration of the birth.

2. Doulas provide support to both woman and partner. There is a misconception that doulas should only be involved in the birthing process if a woman has no other supports. In reality, doulas can help a woman’s partner be more effective in their support strategies, which leads to a better experience for everyone.

3. Doulas are experienced childbirth professionals. Historically women gave birth with the help of an extended family member such as a grandmother, mother or older sister who gained experience by being involved in many births throughout their lives. In modern times, people don’t witness many births, and so doulas provide that same level of comfort and a reassuring presence to guide the mother through her labour and delivery.

4. Doulas provide care that helps to reduce complications. The non-medical care provided by doulas includes relaxation, positioning and other techniques to focus on the health and well-being of the mother, which allows the medical team to better administer clinical care and safely deliver the baby. This interprofessional team approach can lead to reduced complications, cesareans and interventions.

5. Doulas continue to provide care after the baby is born. Families who need or want comfort measures after the baby is born benefit from the expertise of a doula who can answer questions such as how to manage visitors, or help the family to understand and appreciate the amazing event they just experienced. They also offer breastfeeding and diaper changing tips. The additional care following a birth has been shown to decrease the incidence of post-partum depression.

6. Doulas are available last minute. There is always a doula on-call at TSH. Generally, doulas become involved in the birth process in the last trimester, but if a woman arrives at the Emergency Department in labour and asks for a doula, the nurses can refer to the on-call schedule and arrange for a doula to attend the birth.

7. Doulas at TSH are affordable. Cost to include a doula in your birth at TSH is determined on a sliding scale, based on your ability to pay. This is to ensure that everyone in our community has an equal opportunity to access this remarkable service.

Stefanie and Rean add that doulas will be volunteering their services and assisting with births at TSH throughout the month of May to recognize International Doula Month. Staff, physicians and the community are welcome to visit the hospital and learn more about the role of doulas in the childbirth process and how they can benefit from a doula’s unique expertise.

Immunization; it’s not just for kids.

When you think of immunization, it’s usually in relation to children. But immunization is just as important for adults, and it’s the most effective way to protect you and your family against a number of very serious infections.

“Adults often think about travel-related immunization for exotic illnesses and what vaccines they should get before they leave,” says Teresa McCormack, Registered Nurse in the Occupational Health and Safety Department at TSH. “While these are extremely important, it’s also important for adults to ensure they have all of their routine immunizations up to date, including boosters. There are also specific vaccines available for people over 60 such as pneumococcal and shingles.”

If you’re travelling, there are certain vaccines you should get depending on the country you are visiting. You can talk to your healthcare provider, local public health office, or you can visit http://www.travelhealth.gc.ca/ for more information about specific vaccines.

Some adults may not have received common vaccines due to changes in the immunization schedule when they were children, or if they have moved to Canada from another country.

“Measles, mumps, rubella and chicken pox are given to children,” says Teresa. “But if you didn’t receive the vaccine as a child, you should ask for it. Although these diseases are rare in Canada, you could still be susceptible to them if you travel to countries where they are more common.”

Here is a list of some other vaccines you should have up to date:

Tetanus – everyone; every 10 years

Diphtheria – everyone; every 10 years

Whooping Cough (Pertussis) – everyone; once in adulthood

Influenza (Flu shot) – everyone; every year

Pneumonia (Pneumococcal) – people age 19 to 64 with specific medical conditions and everyone over age 65; once in your lifetime

Hepatitis B – People with medical, occupational or lifestyle risks and anyone who wants protection; a series of vaccines over a period of time

Hepatitis A – People with medical, occupational or lifestyle risks and anyone who wants protection; a series of vaccines over a period of time

Meningococcal – people with specific medical conditions and people living in residential accommodation including students and military personnel; there are a number of different vaccines – talk to your healthcare provider about which one is right for you

Human Papillomavirus (HPV) – females and males nine to 26 years old; three doses within six months

Shingles (Herpes zoster) – age 60 and over; once in your lifetime

The importance of oral health when expecting a child

When women become pregnant, they often pay more attention to the state of their overall health to ensure a smooth pregnancy and healthy newborn. However, one area that mothers-to-be may overlook is their oral health and how pregnancy hormones can trigger the need for additional oral care.

“Women who are expecting often see recession in their gums due to hormones, and this can lead to gingivitis,” says Dr. Aubey Banack, Dentist with The Scarborough Hospital. “The good news is women can, and should, check their own teeth for any kind of recession or other issues and contact their dentist with concerns and to discuss preventative measures.”

Dr. Banack recommends a few quick oral health tips for expectant mothers:

• Book a pre-pregnancy appointment with your dentist. When you are planning your family, it’s important to schedule a thorough visit with your dentist to address any oral health issues. Women who are trying to become pregnant may find it difficult to conceive if they have gingival conditions, a concern that could be addressed by visiting your dentist.

• Schedule an appointment in the early stages of your pregnancy. If you are already pregnant, the best time to visit your dentist is in your second trimester as dental work during the last few months of pregnancy could put unnecessary stress on the baby. It can also be uncomfortable to sit in the dental chair for an extended period of time in your last trimester.

• Conduct daily self-checks of teeth and gums. Prevention plays a major role in maintaining oral health and can save time and money in retroactive care. If you notice any irregularities, which can occur during pregnancy due to hormone changes, contact your dentist right away.

• Brush and floss your teeth three times a day. Pregnancy hormones can affect your teeth and gums, so it’s important to take extra care in your oral health routine while expecting.

• Maintain a diet rich in Vitamins B12 and C. These vitamins help to build strong teeth and gums, and can be found in red meat, chicken, liver, pork, fish, milk, yogurt, cheese, sweet potatoes, raw red peppers and oranges.

Poor dental hygiene during pregnancy can lead to conditions such pregnancy gingivitis. This occurs as the increased level of hormones alters the way a woman’s gums react to the irritants in plaque.

Symptoms of pregnancy gingivitis include red and swollen gums, bad breath and changes in bite. If detected early, this condition is easily treated, but if left untreated, it can turn into periodontal disease which can lead to other health problems for mother and fetus.

Though common, periodontal disease is a serious infectious condition that can destroy gum tissue and bone. The disease can also infiltrate the bloodstream and increase the chance of heart disease, stroke and respiratory diseases. Research has shown that periodontal disease can also result in premature births and underweight babies.

Dr. Banack adds that women should make sure to tell their dentist when they are pregnant and discuss any health concerns even if they do not seem related to oral health. Since oral health plays a major role in overall health, your dentist can be very helpful in diagnosing other healthcare issues.

The dangers in our favourite comfort foods

Homemade chicken soup, macaroni and cheese, curry and rice, bread pudding. These are comfort foods; they give us a sense of well being when sick, distressed, far from home or lonely. Each person has their own favourite comfort food, often something from childhood that is soothing and creates a sense of well being.

Although these foods bring us comfort, they are often high in sugar, fat and carbohydrates which can cause weight gain, raise blood pressure, and affect the heart and liver.

“There is actually science behind why we feel good when we eat these foods,” says Wendy Levin, Registered Dietitian and Certified Diabetes Educator at The Scarborough Hospital. “Starchy foods raise our serotonin levels, which makes us feel good. And warm foods release endorphins which can cause us to feel less pain and fewer negative effects of stress.”

But the calorie and fat count in some of these favourites can be high. For example:

• Homemade macaroni and cheese – 466 calories, 23g fat, 45g carbs
• Homemade chocolate chip cookies –330 calories, 16g fat, 46g carbs
• Beef Patty – 300 calories, 14g fat, 34g carb
• Sticky Rice Wrapped in Lotus Leaf (100 g) – 220 calories, 7g fat, 31g carbs
• Small fries – 250 calories, 13g fat, 30g carb
• Mixed Nuts (½ cup) – 400 calories, 35g fat, 15g carb

“You don’t have to stop eating your favourite comfort food altogether,” says Wendy. “But you can adjust the recipes to make them healthier, eat smaller portions, and enjoy them less often. Moderation is the key.”

Recipes can always be adjusted by reducing the fat, adding less salt, less sugar or using sweeteners in place of sugar.

Women and Heart Disease

There is a misconception that heart disease is a man’s disease, when in reality it is a leading cause of death among Canadian women.  Women are also less likely than men to survive a heart attack or recover from heart surgery, yet the basis for diagnosis and treatment of heart disease remains geared towards men.

“Physicians and the general public are being educated that women may present with symptoms of heart disease that are quite distinct from that of men,” says Dr. George Vertes, Cardiologist at The Scarborough Hospital. “The reason for this is not clear, but obviously the diagnosis of heart disease must be entertained and investigated thoroughly regardless of sex.”

Since women’s hearts differ from men’s in both their size and rhythm, it makes sense that the signs, symptoms and risk factors of heart disease between men and women differ as well.

For example, during or prior to a heart attack, women tend to experience subtle, non-severe symptoms unlike the typical crushing chest pain experienced by many men.

Some signs that a woman might be suffering a heart attack include:
• Discomfort in the upper body
• Pain in the shoulders, upper back, abdominal area or neck
• Shortness of breath
• Nausea or vomiting
• Sweating
• Light-headedness or dizziness
• Unusual fatigue

Due to the nature of heart attack symptoms associated with women, and the fact that women generally suffer heart attacks later in life, it’s common to mistake the oncoming attack for a panic disorder or an age-related illness. In some cases, the symptoms aren’t recognized as being related to heart disease at all.

Risk factors for heart disease that affect women include stress or depression, smoking, high blood pressure and high blood sugar. Women who experience low levels of estrogen following menopause can also be at risk for heart disease.

Unfortunately, women remain under-represented in heart disease related research, and more work must be done to build awareness.

Heart disease is a serious health concern for many Canadians, but there are preventative measures both men and women can take to reduce their risk:
• Exercise regularly and maintain a healthy weight
• Quit, or do not start, smoking
• Enjoy a diet low in saturated fats, cholesterol and salt

The importance of prevention and screening for cervical cancer

Worldwide, cervical cancer is the second most common type of gynaecological cancer. In North America, it is the eighth most common cancer. The incidence of cervical cancer has decreased in the developed world because of regular Pap screening. Pap tests detect abnormal cells before they become cancer and further treatments can prevent them from ever becoming cancer. 

“Sadly, not all women go for regular testing and so we continue to see this lethal disease,” said Dr. Georgina Wilcock, an Obstetrician/Gynecologist at The Scarborough Hospital. “Each year in Canada, it’s estimated there are 1,300 new cases of cervical cancer diagnosed and 390 women will die of the disease. “

For these reasons, Dr. Wilcock reminds women about the importance of regular Pap test screening, which has been shown to decrease the incidence of cervical cancer by 50 per cent.

The Pap test is a quick, simple and usually painless procedure where a doctor scrapes and removes cells from the surface of the cervix with a small brush or spatula.  The cells are then examined in a laboratory. In the event that a Pap test shows  changes or abnormalities in the cervical cells, follow-up tests or procedures may be done.

Currently in Canada, it is recommended that women between the ages of 18 and 69 (or women under 18 who are sexually active) undergo cervical screening.

“Although the cause of cancer in general remains somewhat of a mystery, the cause of cervical cancer is not. The culprit is almost always the human papilloma virus (HPV) infection, one of the most common sexually transmitted infections (STIs),” points out Dr. Wilcock.

While some types of HPV cause genital warts, other strains of the virus can infect the cervix and then cause abnormal changes within the cells that may slowly progress to cancer.

There are several other important steps women can take to minimize their risk of developing cervical cancer:

• Get the HPV vaccine – The world’s first vaccination against HPV was approved in Canada and the U.S. in 2006. The vaccination provides protection from four different types of HPV – two of which cause 70 per cent of cervical cancer. In Ontario, this vaccine is given free to girls in grade eight. It is given at this young age because it has been shown that this is the best age for young women to develop a strong immunity to the virus.
• Practice safe sex – The HPV virus is most commonly transmitted via sexual contact and intercourse. Refraining from genital contact with an infected person or using a condom will reduce the risk of HPV infection.  However, condoms are not 100 per cent effective as they only protect the covered area.
• Stop smoking – Both tobacco smoking and exposure to second hand smoke have been associated with the development of cervical cancer. Quitting smoking can reduce the chance of developing the disease.

And, of course, ensure that you are receiving regular Pap testing.

Keeping your New Year’s fitness goals

The New Year is an opportunity for fresh starts and setting new goals. Improving fitness levels continues to be one of the most popular resolutions, yet it’s also one of the most difficult for a majority of individuals to maintain.

“Research indicates that more than two-thirds of people who set fitness goals at the beginning of the year give up within two months,” says Lori Irvine, Organization and Employee Development Coordinator at The Scarborough Hospital. “However, by following some key steps, you can dramatically improve your odds of sticking to your goals.”

Lori offers the following tips when setting a New Year’s fitness plan:

• Set realistic fitness goals – Ensure you speak with your physician before beginning any fitness regimen and make an appointment with a personal trainer who can help you break your overall goals into smaller, reachable targets.
• Write down your fitness goals – Simply writing down your short-term and long-term goals and the steps involved in meeting them can increase your motivation and reduce the chance of giving up. 
• Tell your family and friends – Verbalizing your fitness plan and letting others know about it can help you feel more accountable to your goals.
• Prioritize and schedule regular exercise – You’ll be more likely to stick to your fitness routine if it’s scheduled into your calendar like any other commitment.
• Choose a gym or fitness routine that is close to your home or accessible during your commute to and from work – A convenient location means you’ll be less likely to skip your fitness routine due to factors such as bad weather, traffic, etc.
• Don’t try to be perfect! – Whether it’s missing a couple of workouts or giving in to a treat, don’t beat yourself up over the occasional slip.
• Reward yourself – Whenever you achieve or complete a part of your fitness plan, reward yourself! Buy something you’ve wanted for a while, go for a spa treatment, etc. Do whatever makes you feel good about all your hard work – you deserve it!

Incontinence myths and facts

Although millions of Canadians experience some form of incontinence on a daily basis, it’s still a condition that is often misunderstood.

“There continues to be an enormous amount of stigma associated with incontinence and it can take a serious emotional toll on those living with the condition,” said Dr. Nick Logarakis, Chief of Urology at The Scarborough Hospital.

Much of this stigma stems from the myths that surround incontinence. Dr. Logarakis offers some of the most common misconceptions about incontinence and the truth behind them.

Myth: Incontinence is a disease.
Fact: Incontinence is a symptom of something else going on in the body. It’s important to talk to your doctor, who can help to discover what’s causing the incontinence.

Myth: It’s mainly seniors who experience incontinence.
Fact: Incontinence affects men and women of all ages. For instance, it’s estimated that 10 per cent of six-year-olds have bladder control problems and at least one in three women over 40 experiences incontinence.

Myth: Incontinence is just part of aging.
Fact: Although changes that occur naturally in the aging body may contribute to incontinence, aging itself does not cause incontinence and it should not be accepted as a part of getting older.

Myth: You just have to live with it if you have incontinence.
Fact: In most instances, incontinence can be cured, treated or successfully managed. There are a variety of options for managing incontinence, but their success depends on receiving the right diagnosis and underscores the importance of speaking to your doctor.

Important facts about breast reconstruction

Many women who are facing a mastectomy may not be aware that breast reconstruction is considered part of the overall treatment plan. More awareness of breast reconstruction is needed, and that’s why October 19, 2011 has been designated the first National Breast Reconstruction Awareness Day.

“Breast reconstruction is not a luxury. It’s a part of treatment and an option that is readily available and can offer high quality results,” explains Dr. Tim Sproule, TSH Plastic Surgeon.

Dr. Sproule shares the following:

1. More than 10 per cent of women develop breast cancer in North America and other developed countries.
2. Treatment usually involves some type of ablation of the breast, which can be painful, unsightly and psychologically distressing for many women.
3. Sadly, the majority of women do not opt to have breast reconstruction despite effective treatment being readily available. 
4. Plastic and reconstructive surgeons have a large number of options to help with reconstruction of the breast post-mastectomy, which can go a long way to restoring unacceptable appearance, confidence and self-esteem for women who have needed to undergo breast cancer treatment.
5. Options include implants of various kinds, sometimes including tissue expansion or utilizing a patient’s own tissues (autogenous reconstruction). The most popular of these involves using the lower abdominal tissue and transferring this to the breast defect.  This gives the happy result of also providing a woman with a ‘free’ tummy tuck!
6.  The latest advance is to utilize microsurgery techniques to spare more of the abdominal muscle and increase the reliability of the transferred tissues.

“The Scarborough Hospital has a large and sophisticated breast reconstruction program that can provide every type of reconstruction that is presently available anywhere in the world, with the highest level of quality and safety,” Dr. Sproule adds. “A large volume of breast reconstruction procedures is performed at TSH.  In fact, TSH has the third most active microvascular breast reconstruction unit in Ontario.”

Join us on Wednesday, October 19 from 2 p.m. to 6 p.m. at The Scarborough Hospital, General campus Artists’ Walkway where the breast reconstruction group will host a drop-in information session that will include intimate and personal discussions on all aspects of breast reconstruction, including implant choices, pedicled and microvascular flaps, and ancillary procedures such as nipple reconstruction and tattooing. For more information on this TSH event, call 416-439-1718 or email jkhan@plasticos.ca.