HEALTH CARE More Canadians seeking medical treatment abroad Large numbers of Canadians continue to venture abroad to seek medical care, according to a new study released by Vancouver- based Fraser Institute, an independent, non-partisan Canadian public policy think-tank. The study, Leaving Canada for Medical Care 2015, estimates 52,513 Canadians left the country to receive non-emergency medical treatment in 2014, an increase of 26 per cent compared to the previous year. “These figures are not insubstantial. They point to an increasing number of Canadians who feel their medical needs aren’t being met in Canada,” said Bacchus Barua, Fraser Institute senior economist and the study’s co-author. The study draws upon data from the Fraser Institute’s annual Waiting Your Turn study – a national survey of physicians across Canada in 12 major medical specialties. In the 2014 survey, physicians specializing in internal medicine procedures – such as colonoscopies, gastroscopies and angiographies – reported the highest number of patients leaving Canada for treatment (6,559). Meanwhile, neurosurgeons reported the highest proportion of patients (2.6 per cent) who travelled abroad for medical care. While there is no definite data on why Canadians go elsewhere for medical attention, there are several possible reasons. Some patients may have been sent abroad because of a lack of available medical resources; some may have chosen to leave Canada in response to concerns about medical quality; while others might have left because of lengthy wait times. “In 2014, the average patient in Canada could expect to wait almost 10 weeks for medically necessary treatment after seeing specialist. This wait time is more than three weeks longer than what physicians consider to be clinically reasonable,” Barua said. “Faced with long waits for treatment, it should come as little surprise that so many Canadians ultimately choose to be medical Tourists.” Estimated number of patients by province receiving treatment outside of Canada, 2014: 1. British Columbia: 9,799 2. Alberta: 5,988 3. Saskatchewan: 1,050 4. Manitoba: 1,048 5. Ontario: 26,252 6. Quebec: 6,284 7. New Brunswick: 742 8. Nova Scotia: 975 9. Newfoundland and Labrador: 327 10. Prince Edward Island: 48 For more stories on health care visit canadianchiropractor.ca Nutrition Rainbow plate as guideline to healthy eating Force-feeding kids a diet of facts and figures about the nutrients in fruits and vegetables and why they’re good for us is no way to create a generation of healthy eaters. It’s far more important and effective to encourage kids to make nutritious food choices because they want to, says Janet Nezon, a Toronto-area food educator. “Make food an adventure and help kids to realize the incredible variety of textures and colours and tastes that are available,” she says. “Then they will want to eat it, not feel they have to because we’re telling them to.” Nezon says she realized about 10 years ago that despite an explosion of information about good food choices, the message didn’t seem to be having much effect on consumer eating habits. What was needed, she thought, was an “easy way to put (theory) into practice, because that’s the big link that was missing.” And the place to start was with kids. The concept Nezon developed and the name of the company she started three years ago is Rainbow Plate. “The reality is that if you are eating a vibrant mix of colours, you’re covered (nutritionally),” she says. “So the simplest concept is to take your plate and create a rainbow plate.” At schools, daycares and summer camps, she displays fresh fruits and vegetables in the colour spectrum. (There are almost no blue foods and indigo and violet are tricky so the end of the spectrum is grouped as blue/purple.) The kids are invited to visit each “colour station” and to use all their senses to inspect the produce – seeing beautiful colours and patterns, smelling, feeling the texture, hearing a crunchy sound and, if they wish, tasting. The first step – in Nezon’s program and for parents at home – is simply exposing kids to the wide range of produce available and engaging their interest. But this is not likely to be an overnight success story, she says. Research has shown it takes an average of 15 exposures to a new food before a child will accept it. Many parents will have given up long before that. The second key is that there should be no pressure on a child to try something new or to “eat your broccoli,” Nezon says. At her presentations, adult volunteers don’t acknowledge whether a child tastes something and children are never asked if they “like” the taste of something. “You can’t push vegetables on kids. You have to make food appealing and make it visually interesting and get kids connected to it and then they just eat it, but you don’t make a big deal if they do or don’t. “It takes the power struggle out of it. It takes the pressure out of it and kids make their own discoveries – ‘Oh, this is yummy’ or ‘Oh, I didn’t notice how crunchy this is.’” Giving a child this sense of control over what they eat is central to creating good eating habits that will last a lifetime, Nezon says. As long as parents consistently provide a selection of healthy foods, eventually children will choose to eat them. But the choice of when and how much should be the child’s. Withholding or “demonizing” certain foods is a mistake, Nezon says. Kids will become obsessed and, given the chance, will eat more of them. - Susan Greer, The Canadian Press. PAIN MANAGEMENT More injured vets turning to marijuana for chronic pain The number of injured Canadian soldiers using marijuana for medical purposes, such as chronic pain and post-traumatic stress, has soared over the past year. Figures from the Veteran Affairs department indicate some 600 veterans now smoke medical marijuana, compared to just 116 in the 2013-2014 budget year. The cost of providing the pot has soared as well, from $417,000 to $4.3 million. Health Canada routinely warns against marijuana use, and the Harper Conservatives have ridiculed Liberal Leader Justin Trudeau for advocating overall legalization. A Veteran Affairs official notes marijuana is not an approved medicine in Canada, but it will fund its use if a doctor deems it appropriate for a soldier’s treatment. Clayton Goodwin, a former reservist who was injured in 2004, says the mixed government messages make it hard to get pot prescribed by a doctor. He says many veterans with chronic pain or post-traumatic stress are choosing medicinal pot over pharmaceuticals for safety and to get away from the side effects of prescription drugs. - The Canadian Press RESEARCH New study finds low risk of stroke after spinal manipulation An analysis of Medicare claims data from older Americans who sought care for neck pain from chiropractors suggests that cervical spine manipulation is unlikely to cause stroke. This new study was published in the February 2015 edition of the Journal of Manipulative and Physiological Therapeutics. According to a web post by the National Center for Complementary and Integrative Health (NCCIH), an agency of the U.S. National Institutes of Health, this is the first population-based study in the U.S. to examine the risk of stroke after spinal manipulation and the first such study on older adults. The study was conducted by researchers from Dartmouth College and the Southern California University of Health Sciences, and was supported by the NCCIH. The purpose of the study was to quantify risk of stroke after chiropractic spinal manipulation, as compared to evaluation by a primary care physician, for Medicare beneficiaries aged 66 to 99 years with neck pain. The safety of cervical spinal manipulation (i.e., manipulation of the vertebrae in the neck) for neck pain has been questioned because previous observational research found an association between visits to a health-care practitioner and subsequent vertebrobasilar stroke (VBS). VBS is an uncommon type of stroke involving the arteries that supply blood to the back of the brain. Although those researchers ultimately attributed the association between healthcare visits and VBS to the likelihood that people with torn vertebrobasilar arteries seek care for related headache and neck pain before their stroke, controversy regarding the safety of cervical spinal manipulation persists. In this new study, researchers analyzed Medicare claims on more than 1. 1 million people aged 66 to 99 who visited a chiropractor or primary care physician to treat neck pain. They then noted the occurrence of first stroke after the office visit and compared the hazard of stroke within 30 days for the two groups: patients visiting chiropractors and those visiting primary care physicians. The specific incidence of VBS was too small to report, according to the study. The researchers found that the incidence of any type of stroke among all patients was extremely low. For patients who saw a chiropractor, the risk of stroke was significantly lower at seven days compared to those patients who saw a primary care physician (1. 2 per 1,000 vs. 1.4 per 1,000); but at 30 days, there was a slight elevation in risk for the chiropractic patients (5. 1 per 1,000 vs. 2.8 per 1,000). However, the researchers noted that these small differences in risk were of doubtful clinical significance. INFRASTRUCTURE UBC gets $5 million for new sport, exercise medicine centre Dr. Chan Gunn, a pioneering Vancouver physician in the field of pain relief, is giving $5 million to the University of British Columbia for construction of a new building devoted to exercise and sport medicine teaching, research and patient care. Gunn and his wife Peggy made the gift in recognition of UBC’s efforts to investigate, apply and teach intramuscular stimulation (IMS). IMS is a non-surgical, non-pharmaceutical technique developed by Gunn for alleviating pain resulting from nerve damage. A blend of acupuncture and western medicine, it involves inserting a needle deep into muscle, causing it to relax and relieve pressure on pain-causing nerves. The 13,480-square-foot building, to be named the Chan Gunn Pavilion, will be the new home for UBC’s sport and exercise medicine centre – one of the first academic sports medicine units in the world, and the first in Canada. “Having a connection to UBC is very important for teaching and research into IMS,” Gunn said. “IMS will have a permanent home to grow.” UBC will commit $2.25 million for the first phase of the building, which will house space for community care and research activity, including IMS. UBC will continue fundraising for a second phase, which will provide additional space to conduct research. “The Chan Gunn Pavilion will create capacity to integrate IMS into the Division of Sports Medicine, and to expand research, teaching, and care into that technique and other therapies for sports injury and exercise-related health care,” said Dr. Gavin Stuart, dean of the Faculty of Medicine and UBC’s vice provost, health. The new building will be located next to the Doug Mitchell Thunderbird Sports Centre on Wesbrook Mall. Construction is scheduled to start in December 2015, following final approvals, and is expected to take two years. The centre will temporarily relocate to the Djavad Mowafaghian Centre for Brain Health in July until construction is complete. The centre’s current home for the past 35 years, situated in the middle of UBC’s athletic fields, will be torn down this summer to make way for the National Soccer Development Centre. Gunn’s donation forms part of UBC’s start an evolution campaign, the most ambitious fundraising and alumni engagement campaign in Canadian history. RESEARCH $3M funding for Canada-U.S. study on naturopathic cancer treatment Canadian and American health-care professionals will work together to study the effectiveness of advanced integrative oncology (AIO) treatment for patients with late stage cancer. AIO treatment includes elements of conventional and naturopathic medicine. The funding was announced recently by the Ottawa Integrative Cancer Centre (OICC), an arm of the Canadian College of Naturopathic Medicine (CCNM) and the Bastyr University Research Institute in Washington State. The $3 million grant, which came from an anonymous private Canadian foundation, will fund the Canadian/U.S. Integrative Oncology Study (CUSIOS). This is the largest- ever North American observational study to assess integrative oncology in late-stage cancer patients. CUSIOS will observe and measure the overall survival of a cohort of late stage (III and IV) cancer patients who receive AIO treatments, and describe integrative therapies provided by naturopathic doctors across the cohort. A total of 400 people with advanced breast, colorectal, pancreatic and ovarian cancer will be studied in seven clinics across North America over three years. Each selected site provides comprehensive, whole-person care in naturopathic oncology, applying science-based treatment for late-stage cancer patients. Integrative oncology aims to combine the best of conventional and whole-person naturopathic care seamlessly and safely to: improve survival, enhance quality of life, reduce side effects from conventional treatment and help prevent recurrence. AIO therapies used by naturopathic doctors for late-stage cancer are aimed at multiple mechanisms to slow tumour progression, prevent metastatic spread and improve survival. The therapies are variable but may include intravenous vitamin C, intravenous artemisinin , intravenous dichloroacetate, mistletoe, hyperthermia, nutritional protocols and the use of immunomodulatory, anti-cancer and anti-inflammatory natural health products. “The results of this study will provide valuable insight on the role of naturopathic medicine in cancer care and will lead to the conduct of more rigorous randomized controlled trials,” said Dugald Seely Canadian lead investigator for CUSIOS. “We have chosen to study the outcomes of naturopathic oncology because this area of integrative oncology is currently leading the field in the application of advanced natural medicine therapeutics,” said Leanna Standish, professor at Bastyr University Research Institute, and American lead investigator of CUSIOS. Standish added, “We will collect survival outcomes on late-stage cancer patients treated at multiple naturopathic oncology clinics in North America in order to address the fundamentally important question of whether or not AIO has a beneficial impact on survival.” Bob Bernhardt, president and CEO of CCNM added, “It is through exemplary research collaborations such as CUSIOS that we continue to assess the benefits and advance the clinical evidence-base for naturopathic medicine, making it more integral to our health-care system and accessible to Canadians.” Bastyr University president Daniel K. Church welcomed the collaboration with “the brightest minds in Canada on such an important study.” EDUCATION CMCC offers mental health support for staff, faculty The Canadian Memorial Chiropractic College (CMCC) has joined a growing number of Canadian organizations embracing the issue of mental health in the workplace and doing something about it. CMCC manager, staff and faculty are getting training on a Mental Health Commission of Canada program called, Mental Health First Aid, designed to provide help to an individual who might be developing a mental health problem or going through a mental health crisis. CMCC’s Drs. Craig Jacobs and Janet D’Arcy received the training in October and are now providing a seies of training sessions for staff and faculty at the college. The objective is to build a team of individuals who can ensure CMCC is well-equipped to offer mental health support to the community and even beyond, the CMCC said. “The first sessions were held in February with more scheduled for April and May,” said CMCC president Dr. David Wickes. “It’s an important part of looking after our community and extending the service we provide to students, staff and patients.” According to mental health statistics, one in three Canadians will suffer a mental health problem at some point in their lives. While thousands of people across the country know how to provide first aid to someone with a physical injury, fewer people are able to recognise the signs of someone needing mental health support, the CMCC said. “The nature of the training is much like physical first aid. The goal is to offer a person immediate assistance until they can receive appropriate professional treatment or until the crisis is over,” explained CMCC human resources director Evelyn Humphries. “It is designed to help participants define and identify signs of mental health problems and help individuals to access the professional help they may need.”