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COVID-19 patient discharged into cold after 10 days on a ventilator with no instructions – West Lorne Chronicle

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5 years ago

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Rachel Newman was delivered to the exit of a Toronto hospital on a cold April night in just a hospital gown, with virtually no instructions on what to do next

Rachel Newman had just spent 10 days on a mechanical ventilator in a medically induced coma, then four days alone, scared and disoriented in a hospital ward room.

Countless studies suggest the experience could set her up for prolonged emotional distress and a steep physical recovery.

But when the COVID-19 patient was finally discharged from a Toronto hospital this month, she was delivered to the exit on a cold April night in just a hospital gown, with virtually no instructions on what to do next.

It is distressing to hear when patients and families experience any kind of gap in care

Newman’s husband, Zale, struggled to look after a wife whose stomach had shrunk and psyche had taken a beating, with health-care professionals refusing to see her in person. He had tested positive for COVID-19, too, and the couple seemed “toxic” to the medical system, Zale says. An overseas relative who had been a nurse finally gave some much-needed guidance.

“After somebody goes through something like this, there should be someone who looks after your needs,” Rachel Newman, 61, said.

Her experiences underline both the harsh after-effects of long stays in the intensive-care unit, and the impact of a pandemic on getting the required follow-up help.

Rachel stresses that she received “magnificent” medical treatment at North York General Hospital, especially in the ICU, and is well aware those health-care workers have a tough, dangerous job.

But as increasing numbers of Canadians emerge from such ordeals, the system has to do better at looking after those who survive critical bouts of COVID-19, the Newmans argue.


Rachel and Zale Newman.

Peter J. Thompson/National Post

Zale, owner of a financial services company, is a volunteer rabbi and visits the ICU at another Toronto hospital every weekend. Rachel is a social worker in children’s mental health.

“Most people are not connected like we are,” she said. “I think a lot of people come home, maybe to nobody, maybe to an old aunt who is not resourceful, who doesn’t have this information and it’s the blind leading the blind.”

Nadia Daniell-Colarossi, a North York General spokeswoman, said she cannot comment on individual patients.

But “it is distressing to hear when patients and families experience any kind of gap in care and it is important for us to know when we have not met their needs,” she said. “We of course want to have open and direct conversation with our patients and their families so we can understand and address their concerns.”

Dr. Brian Cuthbertson, critical care head at Toronto’s Sunnybrook Health Sciences Centre, said he has no knowledge of the Newmans’ situation, but suggested lack of aid for patients after they leave the ICU is not unusual.

“There’s a bit of a gap here, and the systems are not yet in place to give the sort of support these patients need,” he said.


North York General Hospital in Toronto. Rachel Newman stresses that she received “magnificent” medical treatment there.

Dave Thomas/Postmedia/File

And the “harsh reality” is that that gap has widened with the system being under pandemic lockdown, Cuthbertson said.

The Newmans’ encounter with the coronavirus began March 19, when Zale felt chills one day, and more or less fine the next. Then Rachel developed a high fever and nausea. She also had a dry, hacking cough, but that had been around for most of the winter. Acutely aware of the unfolding pandemic, they got tested for the new coronavirus. A day later, the results for both came back positive.

Rachel did not improve and a week later, on March 29, Zale took her to the hospital. By 1 a.m. the next morning, he learned that his wife had consented to being put into an induced coma – given a combination of sedatives and paralytic drugs – so staff could insert a breathing tube down her throat and attach her to a ventilator.

“That was the last time I saw my wife for two weeks,” he said.

Rachel says she recalls being asked for her consent to go on the ventilator, then has “zero” recollection of the next several days.

A week and half after the intubation, she was able to breathe on her own again. As she woke up dazed from the sedatives, staff asked if she knew the date. “Late 2019,” Newman responded.

The systems are not yet in place to give the sort of support these patients need

Conscious now, and transferred to a regular ward that seemed to have few patients or staff, Rachel says the next three or four days were also difficult.

“It was a very, very strange, surreal hospital experience,” she said. “I didn’t know if it was day, I didn’t know if it was night … You could feel completely alone.”

No one explained, Newman says, that she could be contagious and had to stay put.

“Sometimes I would just walk out of my room and say ‘Is there a nurse here?’ … Then I’d hear someone yell ‘Get back into your room now, you’re not to leave your room,’ ” said Newman. “It felt incredibly punitive.”

To make matters worse, Zale slipped and fell on some concrete steps at their house, opening a nasty cut. Back at the North York General emergency department, a doctor stitched up the laceration. The staff, knowing he had tested positive for COVID-19, gave him a pair of scissors and tweezers. He was told to remove the sutures himself so he didn’t have to return.

On April 11, Zale learned that his wife was ready to be picked up, immediately.

Research has shown that patients spending days in an ICU, especially if placed on a ventilator, often suffer from what’s called intensive-care syndrome, symptoms that can include muscle weakness, cognitive deficiencies and depression or post-traumatic stress. The Newmans say they were told none of that.

I definitely feel anxious, more anxious. It’s very lonely, isolating

Rachel was wearing a “flimsy gown” on a “freezing” night when delivered to a hospital entrance by wheelchair, Zale recalls. The hospital staff member handed over a discharge notice that listed her diagnosis, the doctors who had treated the woman, her most recent lab results and medications she’d been given.

There were also six lines of instructions on what to do next: isolate until at least 14 days after onset of symptoms and contact her family doctor to follow up on the hospital stay and her “mental health.” Because she had hypertension while in hospital, they should also monitor her blood pressure, the note said. It did not specify how they were to do that.

But there were more immediate problems. Rachel could hardly eat without feeling nauseated and could barely move. She was clearly suffering psychologically, too, at one point even expressing survivor’s guilt, says her husband.

“I definitely feel anxious, more anxious,” says Rachel. “It’s very lonely, isolating.”

As per provincial guidelines issued to physicians not involved directly in the COVID-19 campaign, neither her family physician nor any other doctor would see her in person. Nor would a physiotherapist. Worried about Rachel’s blood pressure, Zale had to call paramedics on Monday to measure her vital signs.

Finally, Zale’s sister, Judith Berger, a retired head nurse at an Israeli hospital, sent instructions noting that Rachel’s stomach would have constricted during the 10 days of feed tubing. She should eat small amounts several times a day, and exercise for only a few minutes at a time.

Rachel wonders why it took someone on another continent to provide some of the most practical advice she’s received since leaving hospital.

“I think it’s a simple thing that when you leave a hospital with an illness that’s really rampant today, there has to be some material you just hand the person,” she said. “ ‘Know that this is what to expect, and this is what you work with.’ I had none of that, none of that.”

• Email: tblackwell@postmedia.com | Twitter:

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

Published

2 weeks ago

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October 31, 2024

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
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Here is how to prepare your online accounts for when you die

Published

3 weeks ago

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October 24, 2024

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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3 weeks ago

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October 23, 2024

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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