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Dexmedetomidine and Esketamine and Breast Cancer | DDDT – Dove Medical Press

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Department of Anesthesiology, Bengbu Medical College, Anqing Municipal Hospital, Anqing, People’s Republic of China

Purpose: This study evaluated the effect of a combined infusion of dexmedetomidine and esketamine on the quality of recovery in patients undergoing modified radical mastectomy.
Methods: A total of 135 patients were randomly divided into three groups: dexmedetomidine group (group D) received dexmedetomidine (0.5 μg/kg loading, 0.4 μg/kg/h infusion), dexmedetomidine plus low-dose esketamine group (group DE1) received dexmedetomidine (0.5 μg/kg loading, 0.4 μg/kg/h infusion) and esketamine (0.5 mg/kg loading, 2 μg/kg/min infusion), dexmedetomidine plus high-dose esketamine group (group DE2) received dexmedetomidine (0.5 μg/kg loading, 0.4 μg/kg/h infusion) and esketamine (0.5 mg/kg loading, 4 μg/kg/min infusion). The primary outcome was the overall quality of recovery-15 (QoR-15) scores at 1 day after surgery. The secondary endpoints were total QoR-15 scores at 3 days after surgery, propofol and remifentanil requirement, awaking and extubation time, postoperative visual analogue scale (VAS) pain scores, rescue analgesic, nausea and vomiting, bradycardia, excessive sedation, nightmares, and agitation.
Results: The overall QoR-15 scores were much higher in groups DE1 and DE2 than in groups D 1 and D 3 days after surgery (P 0.05). VAS pain scores at 6, 12, 24 h postoperatively, propofol and remifentanil requirements were significantly lower in groups DE1 and DE2 than in group D (P 0.05). Compared with group D, awaking time, extubation time, and post-anesthesia care unit (PACU) stay were significantly prolonged in groups DE1 and DE2 (P 0.05) and were much longer in group DE2 than in group DE1 (P 0.05). The proportion of postoperative rescue analgesics and bradycardia was higher and the incidence of excessive sedation was lower in group D than in groups DE1 and DE2 (P 0.05).
Conclusion: Dexmedetomidine plus esketamine partly improved postoperative recovery quality and decreased the incidence of bradycardia but prolonged awaking time, extubation time, and PACU stay, especially dexmedetomidine plus 4 μg/kg/min esketamine.

Keywords: dexmedetomidine, esketamine, quality of recovery, modified radical mastectomy

Introduction

Breast cancer is a common malignancy in women. Modified radical mastectomy (MRM) is an effective intervention for patients with breast cancer. Most patients who undergo MRM experience acute postoperative pain. Moreover, if acute postoperative pain is not sufficiently controlled, it may be develop chronic pain.1 Currently, and opioids are currently the mainstay of drugs for moderate or severe postoperative pain. However, opioid-related adverse events may also affect the quality of the postoperative recovery. Multimodal analgesia is usually used in postoperative pain management to control pain and reduce opioid requirements.

Dexmedetomidine (DEX), a selective α2 adrenal receptor agonist, has sedative and analgesic effects.2 Two meta-analysis revealed that DEX administration alleviated postoperative pain and reduced postoperative nausea and vomiting (PONV).3,4 Current evidence indicates that the use of DEX enhances postoperative recovery quality.5,6 Esketamine, the dextral isomer of ketamine, is an antagonist of the N-methyl-D-aspartate (NMDA) receptor. It has higher potency, faster recovery time, and fewer adverse effects than ketamine.7,8 Some clinical studies have demonstrated that S (+)-ketamine administration can reduce the intensity of postoperative pain,9 decrease the requirement for postoperative analgesics,10 and prolong the analgesic time.11 Bornemann-Cimenti H et al found that S (+)-ketamine reduced opioid consumption and hyperalgesia after surgery.12 In addition, a clinical study showed that esketamine administration enhanced the quality of recovery by alleviating postoperative pain.13,14 However, the effect of esketamine combined with dexmedetomidine on the postoperative quality of recovery in patients undergoing MRM has not been reported. This study aimed to investigate whether the combination of esketamine and DEX administration further improves the quality of recovery after surgery in patients with MRM.

Methods and Materials

Study Participants

The present study was approved by The Ethics Committee of Anqing Municipal Hospital (2022028). The study was registered at www.clinicaltrials.gov (March 17, 2022; NO: NCT05283408) and implemented from April 2022 to March 2023. This study was conducted in compliance with the principles of the Declaration of Helsinki. Informed consent was obtained from each patient who agreed to participate in the study one day before surgery. 135 female patients undergoing MRM with ASA I-II, aged 30–65 years were participated in our trial. The exclusion criteria included a history of preoperative psychiatric, renal, or hepatic insufficiency; severe respiratory or circulatory disease; preoperative atrioventricular block; pregnant or lactating women; and preoperative bradycardia.

Randomisation and Blinding

Participants were randomly divided into the dexmedetomidine group (group D), dexmedetomidine combined with low-dose esketamine group (group DE1), and dexmedetomidine combined with high-dose esketamine group (group DE2) at a 1:1:1 ratio using a computer-generated list of random numbers. The random numbers were sealed with opaque envelopes to conceal arm allocation. Patients were given 0.5 µg/kg dexmedetomidine (a total of 20 mL with normal saline) and normal saline (20 mL) over 10 minutes before anesthesia induction, and 0.4 µg/kg/h dexmedetomidine (a total of 20 mL with normal saline) and normal saline (20 mL) were continuously infused at 20 mL/h until 20 minutes before the end of surgery in group D, respectively. Patients were given 0.5 µg/kg dexmedetomidine (a total of 20 mL with normal saline) and 0.5 mg/kg esketamine (a total of 20 mL with normal saline) over 10 minutes before anesthesia induction, and 0.4 µg/kg/h dexmedetomidine (a total of 20 mL with normal saline) and 2 µg/kg/min esketamine (a total of 20 mL with normal saline) were continuously infused at 20 mL/h until 20 minutes before the end of surgery in group DE1, respectively. Patients were given 0.5 µg/kg dexmedetomidine (a total of 20 mL with normal saline) and 0.5 mg/kg esketamine (a total of 20 mL with normal saline) over 10 minutes before anesthesia induction, and 0.4 µg/kg/h dexmedetomidine (a total of 20 mL with normal saline) and 4 µg/kg/min esketamine (a total of 20 mL with normal saline) were continuously infused at 20 mL/h until 20 minutes before the end of surgery in group DE2, respectively. Patients, anesthesia providers, surgeons, operating room nurses, and outcome assessors were blinded to the group allocation.

Anesthesia Protocol

Each participant entered the operating room, and routine monitoring including mean blood pressure (MBP), peripheral oxygen saturation (SPO2), electrocardiogram (ECG), and heart rate (HR) was established. The anesthesiologist recorded the baseline values during routine monitoring. An operating room nurse established an intravenous line to infuse the crystalloid solution. Dexamethasone 10 mg and penehyclidine 0.5 mg were given for each patient. All participants received preoxygenation with 100% oxygen for 3–5 minutes using a face mask. Midazolam 0.05 mg/kg, remifentanil 0.5 µg/kg (over 60 seconds), etomidate 0.3 mg/kg, and rocuronium 1.0 mg/kg were intravenously injected for induction of anesthesia. Tracheal intubation was performed when the patient lost consciousness and the jaw was relaxed. After tracheal intubation, a Fabius Draeger machine was attached to perform mechanical ventilation. The end-tidal CO2 pressure (PetCO2) was maintained between 35 and 45 mmHg by adjusting tidal volume (6–8 mL/kg) and respiratory rate (12–14 beat/min). The fraction of inspired oxygen was set at 50–60%. Flurbiprofen axetil 50 mg was intravenously administered before skin incision. Remifentanil 0.06–0.2 µg/kg/min and propofol 4–6 mg/kg/h were infused to maintain anesthesia during the perioperative period. cis-atracurium 1–2 mg was administered according to the surgical requirements. Hemodynamic variables were maintained within 20% of the baseline measurements. If the HR was < 50 beats/min during the intraoperative period, atropine 0.5 mg was administered intravenously. The infusion of dexmedetomidine and esketamine were stopped 20 minutes before the end of surgery, meanwhile, sufentanil 0.2 µg/kg and dezocine 0.1 mg/kg were injected for controlling postoperative pain. Propofol and remifentanil were discontinued at the end of skin suture. Ondansetron 4 mg was administered intravenously to prevent postoperative nausea and vomiting. After endotracheal tube removal, patients were transferred to the PACU and continuously observed until they left the PACU.

Primary and Secondary Outcomes

The primary outcome was the total QoR-15 score according to the QoR-15 scale at 1 day after surgery. The total QoR-15 scores were evaluated based on physical comfort (five items), emotional state (four items), psychological support (two items), physical independence (two items), and pain (two items) for QoR-15 questionnaire. The total QoR-15 score ranges from 0 to 150 points, with higher scores representing better recovery quality after operation.15

Postoperative pain intensity was assessed using the VAS pain scale at 2, 6, 12, 24, and 48 hours after surgery (0, painless; 10, worst imaginable pain). Patients were administered flurbiprofen axetil 50 mg when the postoperative VAS pain scores were ≥4. In addition, opioids are not routinely used for postoperative analgesia in patients undergoing modified radical mastectomy at our hospital. The awakening time was defined as the time when remifentanil and propofol were stopped to open the eye, and the extubation time was defined as the time when remifentanil and propofol were stopped to remove the endotracheal tube. An HR < 60 beats/min was considered indicative of bradycardia. The Ramsay Sedation Scale (RSS) was used to evaluate the level of sedation after surgery in the PACU (1 represents patient anxiety, agitation, or restlessness; 2 represents patient cooperation and orientation; 3 represents patient response to commands only; 4 represents asleep but strong response to stimulation; 5 represents asleep and slow response to stimulation; 6 represents asleep, no response). An RSS score of ≥4 was considered excessive sedation. The secondary outcomes included preoperative total QoR-15 scores; total QoR-15 scores at 3 days after surgery; perioperative remifentanil and propofol requirement; awaking time; extubation time; VAS pain scores at postoperative 2, 6, 12, 24, and 48 h; postoperative rescue analgesic; postoperative nausea and vomiting; bradycardia; excessive sedation; nightmares; and agitation within 30 min after surgery.

Sample Size Calculation

The sample size was calculated using PASS 11.0 according to the primary endpoint of the present study. The results of our pilot study showed that the mean values and standard deviations (SD) of the total QoR-15 scores in all three groups were 125.3, 128.9, 130.0, 5.8, 3.8, and 4.2, respectively. Therefore, 37 patients in each group were required with an α of 0.05, and β=0.1. Allowing for a 20% dropout rate, we selected 135 patients for the present study.

Statistical Analysis

SPSS v.20 (IBM Corp., Armonk, NY, USA) was used for data analysis. Categorical data including ASA classification, rescue analgesic use, and the incidence of bradycardia, PONV, excessive sedation, nightmares, and agitation within 30 min after surgery were analyzed using χ2 or Fisher’s exact test, as appropriate, and are shown as number (proportion, %). The Kolmogorov–Smirnov test and Levene’s test were used to evaluate the normality and homogeneity of continuous data, respectively. Normally distributed data were expressed as mean (SD) and analyzed using one-way analysis of variance (ANOVA). The total QoR-15 scores, VAS pain scores during the first 48 h after surgery, propofol dose, remifentanil dose, awaking time, extubation time, and PACU stay were reported as median (interquartile range [IQR]) and analyzed using the Kruskal–Wallis test. The level of significance was set at P < 0.05.

Results

A total of 160 participants were recruited for the study. Eighteen participants did not meet the inclusion criteria, seven refused to participate in the study, and 135 completed the study (Figure 1).

Figure 1 CONSORT flow diagram for the study.

The Comparison of the Baseline Data in Three Groups

There were no differences in age, operation time, anesthesia time, ASA grade, body mass index (BMI), fluid infusion volume, or blood loss (Table 1).

Table 1 Clinical Data of Patients

The Comparison of the Overall QoR-15 Scores Before and After Surgery

The preoperative overall QoR-15 scores did not differ among the three groups (P > 0.05). The overall QoR-15 scores were significantly higher in groups DE1 and DE2 than in group D 1 and 3 days after surgery (P = 0.000, P = 0.000, P = 0.003, P = 0.000, respectively). No significant difference was found in the overall QoR-15 scores between groups DE1 and DE2 at 1 and 3 days after surgery (P>0.05 and P > 0.05, respectively) (Table 2).

Table 2 Comparison of QoR-15 Scores at Different Time Points

The Comparison of VAS Pain Scores Within 48 h After Operation

The VAS pain scores at 6, 12, and 24 h postoperatively were significantly lower in the DE1 and DE2 groups than in the D group (all P < 0.05). The VAS pain scores at 2 and 48 h postoperatively were not significantly different among the three groups (all P > 0.05). The VAS pain scores during the first 48 postoperative hours did not differ significantly between the DE1 and DE2 groups (all P > 0.05) (Table 3).

Table 3 Comparison of VAS Pain Scores at Different Time Points

The Comparison of Intraoperative Remifentanil and Propofol Requirement, Awaking Time, Extubation Time, and PACU Stay

The intraoperative remifentanil and propofol requirements were significantly lower in groups DE1 and DE2 than in group D (all P = 0.000). There was no difference in intraoperative remifentanil requirement between the DE1 and DE2 groups (P > 0.05). Compared with group D, awakening time, extubation time, and PACU stay were significantly prolonged in the DE1 and DE2 groups (all P < 0.05). The awakening time, extubation time, and PACU stay were much longer in the group DE2 than in the group DE1 (all P = 0.000) (Table 4).

Table 4 Comparison of Propofol Dose, Remifentanil Dose, Awaking Time, Extubation Time, and PACU Stay

The Comparison of Postoperative Rescue Analgesic, Nausea and Vomiting, Bradycardia, Excessive Sedation, Nightmare, and Agitation Within 30 Min After Surgery

The proportion of postoperative rescue analgesics and bradycardia was higher in group D than in groups DE1 and DE2 (all P < 0.05). No significant difference was found with respect to bradycardia and postoperative rescue analgesic use between the DE1 and DE2 groups (P>0.05 and P > 0.05, respectively). Compared with group D, the incidence of excessive sedation was higher in groups DE1 and DE2 (P < 0.05, and P < 0.05, respectively). The incidence of PONV, nightmares, and agitation within 30 min after surgery was not significantly different among the three groups (all P > 0.05) (Table 5).

Table 5 Comparison of Postoperative Rescue Analgesic, Nausea and Vomiting, Bradycardia, Excessive Sedation, Nightmares, and Agitation Within 30 Min After Surgery

Discussion

The results of our study indicate that dexmedetomidine combined with esketamine partly improves postoperative recovery quality, alleviates postoperative pain intensity, and decreases the incidence of bradycardia and rescue analgesia compared with dexmedetomidine alone in patients undergoing modified radical mastectomy for breast cancer. However, the combination of dexmedetomidine and esketamine prolonged awakening time, extubation time, and PACU stay, especially dexmedetomidine combined with high-dose esketamine (4 µg/kg/min).

The quality of postoperative recovery was evaluated based on the total QoR-15 score, which is an effective tool in clinical practice. It was reported that ketamine with sub-anesthetic dose improved the quality of recovery after surgery in colorectal cancer patients by antidepressant and analgesic effect.16 Yu et al revealed that pectoral nerve block type II combined with esketamine enhanced postoperative recovery quality for breast cancer.17 Zhu et al demonstrated that low- or high-dose esketamine improved the quality of postoperative recovery on postoperative days 1 and 3.18 Some clinical studies proved that dexmedetomidine administration alleviated the intensity of postoperative pain, experienced lower postoperative nausea and vomiting, and improved postoperative quality of recovery.19–21 In the present study, we found that there were higher QoR-15 scores in groups DE1 and DE2 than in group D on postoperative days 1 and 3, suggesting that dexmedetomidine combined with esketamine infusion provided better quality of postoperative recovery, which may be related to lower VAS pain scores and improved QoR-15 questionnaire.

Perioperative management of analgesia minimizes the use of opioids, based on the concept of enhanced recovery after surgery. Some evidence showed that dexmedetomidine had an opioid-sparing effect and alleviated postoperative pain intensity.22,23 Zhang et al found that intravenous dexmedetomidine reduced postoperative VAS pain scores within the first 24 h of undergoing modified radical mastectomy for breast cancer.24 In addition, López et al revealed that ketamine had a lower ratio of acute postoperative pain, alleviated intensity of pain, and reduced rescue analgesia requirement in breast cancer.25 Meta analysis by Bi et al showed that ketamine effectively reduced wound pain, decreased incidence of postmastectomy pain syndrome, and improved depression after surgery.26 Dexmedetomidine combined with esketamine infusion improved postoperative analgesia.27 The results of our study found that dexmedetomidine combined with esketamine was significantly decreased postoperative VAS pain scores at 6, 12, 24 h, and the rate of postoperative rescue analgesic compared to dexmedetomidine administration. This indicates that the combination of dexmedetomidine and esketamine controlled postoperative pain better than dexmedetomidine alone, which may be related to esketamine analgesia28 or the additive analgesic effect of dexmedetomidine combined with esketamine administration.29

Dexmedetomidine and esketamine have opioid-sparing effects. Some studies have suggested that intravenous dexmedetomidine reduces intraoperative opioid requirement.22,30 Zhu et al argued that intravenous ketamine had an opioid-reducing effect.31 Our results showed that dexmedetomidine combined with esketamine further reduced intraoperative remifentanil requirement compared with dexmedetomidine alone, which implies that dexmedetomidine combined with esketamine had a better opioid-sparing effect. In addition, our results also showed that the propofol requirement was lower in groups DE1 and DE2 than in group D.

Intravenous dexmedetomidine had a longer time to awaken and extubation.32,33 Esketamine infusion may prolong recovery time.34 Chen et al reported that dexmedetomidine combined with esketamine administration lengthened awakening time in patients undergoing gynecological laparoscopic surgery.35 In the present study, we found that awake time, extubation time, and PACU stay were longer in groups DE1 and DE2 than in group D, in addition, they were longer in group DE2 than in group DE1. The results showed that dexmedetomidine plus esketamine resulted in better sedation in a dose-dependent manner.

The use of dexmedetomidine results in a higher rate of bradycardia during the perioperative period. It was reported that dexmedetomidine infusion significantly increased the incidence of bradycardia.36 Single low-dose esketamine administration experienced transient tachycardia.37 We observed that the combination of dexmedetomidine and esketamine had lower rate of bradycardia than dexmedetomidine during the perioperative period, which may be associated with tachycardia-induced esketamine and continuous infusion of esketamine.

The limitations of this study are as follows. First, we observed only a few adverse effects of esketamine, such as nightmares. However, esketamine may cause hallucinations, visual disturbances, confusion, and disorientation. However, further studies are required to confirm these adverse effects. Second, we only evaluated pain scores during the first 48 hours after surgery, which does not reflect long-term outcomes; postoperative chronic pain affects patient satisfaction and quality of life. Therefore, we need to further evaluate the effect of dexmedetomidine plus esketamine infusion on postoperative chronic pain. Third, dexmedetomidine and esketamine may affect hemodynamic changes. Therefore, the effect of their combination on hemodynamic changes should be further evaluated. Finally, the sample size was small and this was a single-center trial, and the results of this study require a multi-center and large sample for further confirmation.

Conclusion

Dexmedetomidine combined with esketamine partly improved postoperative recovery quality, alleviated postoperative pain intensity, and decreased the incidence of bradycardia and rescue analgesia compared with dexmedetomidine alone in patients undergoing modified radical mastectomy. However, the combination of dexmedetomidine and esketamine prolonged awakening time, extubation time, and PACU stay, especially dexmedetomidine combined with high-dose esketamine (4 µg/kg/min). The lower dose of esketamine infusion was better than the higher dose in combination with dexmedetomidine infusion.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Funding

This study was supported by the Clinical Research Foundation of Hubei and Chen Xiaoping Science and Technology Development Foundation (CXPJJH12000005-07-43).

Disclosure

The authors report no conflicts of interest in this work.

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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

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