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Stepping up to prevent foot amputations – Hamilton Health Sciences

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Hamilton Health Sciences vascular surgeon Dr. Fadi Elias is helping to lead a new campaign called Socks Off, aimed at reducing the number of lower Hamilton residents who lose a foot to amputation due to diabetes and/or vascular disease.

Ontario has among the highest rates in the world for diabetes-related foot amputations, with Hamilton having one of the highest rates provincially and lower Hamilton having the highest rates locally.

Hamilton Health Sciences (HHS) together with the Greater Hamilton Health Network (GHHN) is  launching a Socks Off campaign on July 17 which aims to reduce the number of lower Hamilton residents who lose a foot to amputation due to diabetes and/or vascular disease. The GHHN is the area’s Ontario Health Team (OHT), made up of health-care providers and organizations responsible for delivering coordinated patient care in Hamilton, Haldimand and parts of Niagara.

Aimed at family doctors and other health-care providers in lower Hamilton, the campaign encourages them to routinely check the bare feet of their patients with diabetes and vascular disease. Hence the campaign’s name, Socks Off.

Getting eyes on feet

A complication of diabetes and vascular disease is poor circulation, which can lead to serious problems from something as simple as a cut or crack in the skin.

Dr. Tamar Packer and Dr. Brian McKenna are encouraging patients with diabetes and vascular disease to take their socks off for foot checks when visiting their family doctor or other health-care provider.

“Through the campaign, we’re encouraging primary care providers to routinely check these patients’ bare feet for cuts, blisters, cracks, callouses or other sores that could lead to a serious ulcer and amputation,” says Dr. Tamar Packer, chief of family medicine for complex continuing and post–acute care at HHS, and the GHHN’s clinical advisor for the hospital.

“Feet can’t be properly assessed if socks are on.”  — Dr. Tamar Packer

Campaign materials include an implementation package for family doctors and health-care providers that streamlines the steps involved in seamlessly incorporating screening, early intervention, timely referral and patient education into their workday.

Other community partners in the campaign include paramedics, diabetes care programs, research programs, home and community services as well as some private wound, chiropody (foot care) and vascular clinics. The program also includes community outreach through the Shelter Health Network,  Good Shepherd, the HRIC and Indwell.

Preventing up to 85 per cent of complications, including amputations

Socks Off promotes the HHS/GHHN OHT Lower-Limb Preservation Integrated Care Program, which aims over time to reduce the amount of lower leg and foot amputations in the city through a more coordinated, integrated and patient-centred approach. This includes regular foot checks, early identification, timely assessment, best-practice treatment, ongoing monitoring, cardiovascular risk management, wound prevention strategies, and patient education. The program is receiving $600,000 in provincial funding over a year.

Dr. Brian McKenna and Dr. Tamar Packer demonstrate a foot check. It’s quick and easy to do, and can prevent serious complications including amputations.

“By routinely checking patients’ feet we can help prevent up to 85 per cent of amputations and other complications related to poor circulation,” says Packer, adding that people with diabetes may not be aware of foot injuries because they’ve lost feeling in their feet due to poor circulation.

“Simply asking our patients how their feet are doing isn’t enough. Feet can’t be properly assessed if socks are on.”

If left too long

Dr. Fadi Elias, vascular surgeon, Hamilton Health Sciences

Hamilton Health Sciences vascular surgeon Dr. Fadi Elias sees diabetic patients in the later stages of infection, when surgery is a last resort to try and avoid amputation.

“I hear their stories and I review the treatment pathways that eventually brought them to my office,” says Elias. “Unfortunately, there are often many points in their health-care journey where the disease’s progression could have been slowed down by early intervention that didn’t happen.”

“My goal, through this campaign, is to give primary care providers the tools they need to assess patients early and regularly to avoid needing vascular surgery or an amputation.” — Dr. Fadi Elias

Health equity

A key priority of the Socks Off campaign is health equity and the need for all people to have a fair chance at achieving good health.

Diabetic foot screen test

“This campaign provides an opportunity to really impact inequities in Hamilton in terms of health and wellness, as well as to collaborate with some of the top partners in the city,” says Dr. Brian McKenna, a family doctor and deputy lead physician at the Hamilton Family Health Team, whose membership includes 165 family doctors, their practice teams, and 250 other health-care workers in the city.

“The Socks Off campaign prioritizes health equity at its core,” says McKenna. “Through this campaign, we have an incredible opportunity to prevent horrific health outcomes for our most at-risk diabetic patients with poor circulation whom, statistically, living in lower Hamilton, are more likely to need an amputation than almost anywhere else in Ontario.”

Population health is a priority for HHS, says Leslie Gillies, vice president of community medicine and population health, interprofessional development/practice and clinical education for the hospital. “We’re excited to co-launch the Socks Off campaign, which supports caring for our diabetic patients beyond our hospital walls.”

Melissa McCallum, executive director of the GHHN, adds, “This campaign has the potential to go a very long way in helping people with diabetes and/or vascular disease, avoid devastating, life-altering complications such as lower limb amputations.”

Patient education

Dr. Perry Mayer, medical director, The Mayer Institute

As part of the campaign, primary care providers are being encouraged to make their patients partners in care.

“There are three pieces of advice that primary care providers should give to their diabetic patients,” says Dr. Perry Mayer, medical director of The Mayer Institute in Hamilton, a centre of excellence in treating diabetic feet.

By following these three steps every day, 85 per cent of diabetic foot problems can be prevented, says Mayer:

Step 1 – Always wear shoes, even indoors. Shoes protect feet from wear-and-tear or cuts that could lead to infection or amputation. And shoes need to fit well so that they don’t rub against the skin, causing sores.

Patients can also play a vital role in preventing serious complications including amputations. Dr. Perry Mayer offers three steps to keep feet healthy.

Step 2 – Moisturize feet every day. “Moisturizing helps keep skin supple, so it’s less likely to crack or break,” says Mayer. “This helps prevent an ulcer from developing that could lead to a potential amputation.”

Step 3 – Check feet every day, including in between toes. “If you see any sign of a wound developing, you need to get off your feet right away and call your health-care provider for an appointment,” says Mayer, adding, “I can’t stress enough how important it is for people to get off their feet immediately. Unfortunately, if patients don’t offload right away and have their wound examined and cleaned by a health-care professional, nothing is going to work for them.”

And patients should take the initiative with their primary care provider by asking for a foot check at appointments, says Mayer. “As soon as you get into the examination room, take off your socks. It’s a reminder for the primary care provider to check your feet, and it saves time too.”

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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