Businesses and non-profit organizations regularly open and move in Saskatoon. Today the StarPhoenix talks to Jennifer Cameron-Turley, a licensed speech-language pathologist, who opened Saskatchewan Swallowing Diagnostics in downtown Saskatoon.
Health
Get a test for swallowing issues at Saskatchewan Swallowing Diagnostics
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Jennifer Cameron-Turley’s Fiberoptic Endoscopic Evaluation of Swallowing test is available at her Saskatoon clinic with or without a doctor’s referral.
Part of Cameron-Turley’s mission is to educate people because she has found a general lack of knowledge about what to do about swallowing issues. She is eventually hoping to offer on-site services to remote and rural areas throughout Saskatchewan. For now, she is open by appointment two days a week at Wall Street ENT Clinic.
Q: How common are swallowing problems in Canada?
A: Swallowing problems are quite prevalent in people over the age of 50, but they can happen at any age. People also might have a neurological issue or an acute or chronic disease that affects their swallowing. I would say probably 10 per cent of people over 50 have dysphagia or swallowing disorder. And the vast majority of people over 80 in nursing homes, probably 70 per cent of them have a swallowing disorder of some kind.
Q: What are some signs that someone may have a swallowing disorder?
A: Big signs are persistent coughing and choking when you’re eating and drinking, or having food get stuck in your throat. This happens to everyone once in a while, but persistent difficulties are a red flag. Changes in your voice quality while eating or drinking can also be a sign of an issue. Sometimes it can feel like a persistent lump in the throat. When we do the FEES test we can sometimes see that people might be regurgitating some stomach acid or food into their throat.
Q: What steps can people take if they notice swallowing problems?
A: A lot of people don’t know where to go. Up to this point you really did have to get a doctor’s referral to get an outpatient instrumental swallow test at an acute care hospital. But now with Saskatchewan Swallowing Diagnostics, outpatient instrumental assessments won’t need to be hospital based, and people can self-refer. It’s always a good idea to talk to your doctor anyway, because there’s more than one cause of swallowing disorders. But with FEES people can certainly self-refer if they think they are having an issue, and then I can send the report to their physician once the examination is completed. If a person is unsure if this test is for them, I can certainly discuss the situation with them over the phone and see if this is appropriate for them, or tell them if I think a different test or a different medical specialist would be more appropriate.
A: FEES involves a slender nasal endoscope that goes into the nose and allows the speech-language pathologist to clearly view the patient’s pharynx (throat) and larynx (voice box) and esophageal opening while the patient is eating and drinking to see exactly how the muscles are moving. That way we can see if there’s anything we can do in terms of manoeuvres or therapy that will make swallowing better over time. Or there might be diet recommendations for a person to alter their diet to make it safer and have them be less likely to aspirate, or have things go down into the lungs.
The test typically takes around 15 to 20 minutes, then I would talk to the person about what I found. I’d make recommendations, introduce any therapeutic exercises and do any teaching that I need to do with them or the family. The visit would be about an hour.
A: Right now there are two “gold-standard” instrumental swallowing evaluations. One of those instrumental studies is FEES, and the other is a Modified Barium Swallow study (MBS), which is done in radiology in an acute care hospital. That test is excellent for diagnosing certain types of swallowing disorders, but there’s some disadvantages to it, too. The radiation dose of an MBS is relatively low — and speech-language pathologists and radiologists are always very careful to keep the doses as low as possible — but there are situations in which it’s best to minimize one’s exposure, especially if you have a history of head and neck cancer treatment with prior radiation, for example. So I think my FEES service will really open things up to centres that do not have acute care hospitals, especially in rural and remote locations, and people in nursing homes and things like that where people might not be so mobile.
A: It stands out very favourably. There are different indications and contraindications for each test but there’s a lot of advantages to FEES for some patients. If you primarily have trouble chewing or moving food around in your mouth, or if your esophagus or food tube is the cause of your swallowing problems, doing an MBS (Modified Barium Swallow) is the preferable test for you. There are some contraindications for FEES, such as a history of facial or nasal surgery or trauma, blocked nasal passages on both sides or a history of severe nosebleeds, or a history of vasovagal episodes or fainting.
Q: What training have you had in conducting the FEES test?
A: Not many speech-language pathologists in Saskatchewan are trained to do FEES yet, but I hope to see the exam become more available over time. I went down to the United States to get trained in the technique and the interpretation. And then there was an ear, nose and throat doctor that oversaw my training in Canada for quite a few months and deemed me competent to scope and interpret results independently.
This interview has been edited and condensed.
Saskatchewan Swallowing Diagnostics
Owner: Jennifer Cameron-Turley
Address: 140 Wall Street (Wall Street ENT Clinic)
Hours: Mondays and Fridays, 9 a.m. to 5 p.m.
Email: Jennifer@swallowingdiagnostics.ca
Website: swallowingdiagnostics.ca
Check: Facebook
Have you recently started or moved a new business or non-profit organization in Saskatoon? We want to hear your story. Please email drice@postmedia.com
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A well-known, inexpensive diabetes drug appears to cut the risk of developing long COVID, hopeful-but-early new research suggests.
The study, published Thursday in the peer-reviewed journal Lancet Infectious Diseases, found outpatient treatment with the drug metformin — a common treatment for Type 2 diabetes — reduced long COVID incidence among infected patients by 41 per cent.
Roughly six per cent of those taking metformin went on to develop the condition, compared to close to 11 per cent of those in the placebo group. Participants on metformin were also less likely to be hospitalized roughly a month after infection by SARS-CoV-2, the virus that causes COVID-19.
“Metformin has clinical benefits when used as outpatient treatment for COVID-19 and is globally available, low-cost and safe,” wrote the research team.
Lead author Dr. Carolyn Bramante, a physician-scientist with the University of Minnesota in Minneapolis, told CBC News that the effect was even larger when metformin was given quickly �— in less than four days — during someone’s infection. She said metformin may be helping patients fight off the virus, or reducing inflammation, though more research is needed to figure out why the drug appears to work.
“Our data don’t suggest anything about whether metformin would treat long COVID in someone who already has it,” she said, “so that’s an important area of research where trials should be done.”
Two other drugs, ivermectin and fluvoxamine, were also studied, but neither made a difference on the incidence of long COVID.
‘Potentially landmark’ findings
The research involved randomized, quadruple-blind trials on roughly 1,400 people at six sites in the U.S., through multiple waves of the pandemic, and looked at both vaccinated and unvaccinated individuals — though only those with first-time infections.
Outside medical experts say it’s one of the more robust studies yet on a potential preventative aimed at long COVID.
“I think it’s a significant start to having a better understanding of the role of metformin in reducing the risk of long COVID,” said Dr. Isaac Bogoch, an infectious diseases specialist with the University Health Network in Toronto. “There’s been hints of data over the last couple of years … this furthers that discussion.”
If confirmed, the findings are “profound and potentially landmark on two distinct counts,” wrote Dr. Jeremy Faust, from Harvard Medical School, in an accompanying commentary in the Lancet.
The paper offers the “first high-quality evidence” showing incidence of long COVID can be reduced through a medical intervention, he wrote, and offers an important medical contribution regarding the very existence of the condition, since “a treatment can only be effective if there is something to treat.”
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New research out of Israel suggests most symptoms of long COVID clear up within a year, but some — like weakness and trouble breathing — are more likely to persist.
In a statement, Dr. Frances Williams, professor of genetic epidemiology at King’s College London, cautioned there would need to be extensive use of metformin to realize the study’s seemingly impressive outcomes.
“In total, 564 people were exposed to the drug metformin to prevent 23 hypothetical cases. This means 24 people would need to take metformin to prevent one case of [long COVID].”
Fatigue, ‘brain fog’
Marked by a variety of lingering symptoms such as fatigue, shortness of breath and feelings of ‘brain fog’, and formally known as post COVID-19 condition, long COVID is thought to be less common by this point in the pandemic, largely thanks to widespread protection from vaccinations.
But the condition can still be debilitating for some, including millions of people around the world — including many in Canada — who became infected with earlier SARS-CoV-2 variants before the arrival of vaccines.
While physicians are hopeful the new research may fuel additional study and potentially help bring down long COVID rates even further, there were some key limitations.
For one thing, it only focused on adults between age 30 and 85 who were overweight or had obesity — so the drug’s impact on individuals of other body weights isn’t yet known.
“It’s not entirely clear how generalizable this will be,” Bogoch said.
In his comment for the Lancet, Faust also noted that since the participants were given a diabetes drug, there may be reduced symptoms linked to undiagnosed diabetes among the patients. “Furthermore, the mechanism of action by which metformin might reduce the incidence of long COVID remains unclear,” he wrote.
Dr. Lynora Saxinger, a professor in the division of infectious diseases at the University of Alberta, noted the study didn’t follow long COVID patients using any “standardized criteria.”
But, she said in an email to CBC News, “it still is really positive and encouraging that a treatment in early COVID could reduce risk of prolonged symptoms: additional studies in other patient groups and with more specific long COVID symptom followup will be really helpful.”
Bogoch stressed that, while the drug shows potential, it wouldn’t “solve all of our issues with long COVID.” However, it could become an important tool given its decades-old safety profile, he said.
“If this is something that, indeed, pans out, and if metformin truly has some properties that reduce the risk of developing long COVID, that’s wonderful because it’s a cheap, widely available [drug].”
Health
Hair loss can be difficult, cancer patients say — and some want better access to options – CBC.ca
White Coat Black Art26:30Hair Loss Part I: The trouble with wigs
Cairo Gregory doesn’t think about her hair too often — anymore.
For much of her life, she says she didn’t have the “greatest” relationship with her hair. Gregory, a 16-year-old student in Toronto, had at one point straightened her hair so much, it ended up damaged. So she cut it short — “I hated it,” she said.
But eventually, as she learned to style her hair, she grew to love it. So last year, when her hair started falling out in her second week of chemotherapy for ovarian cancer, she says she found the loss difficult. Like many of those going through chemotherapy, she made the decision to completely shave her head as she started shedding.
“I think that was probably the most upsetting part for me,” she told White Coat, Black Art host Dr. Brian Goldman.
“When it fell out, it was like my entire Instagram [timeline] was just hair videos, like new hairstyles because I’d gotten really into that at that point. So it really sucked when it was like something that actually really, really became important to me at that period of time.”
Despite advances in cancer treatment, little has changed with respect to its effects on hair. Chemotherapy attacks fast-growing cells in the body — including hair. For many patients, that means losing their locks during treatment.
That can have an impact on a person’s self-confidence and how they feel about themselves during treatment. But alternatives, like wigs and cold-capping procedures that can protect a patient’s hair, are out of reach for many patients due to price and availability.
For Gregory, the problem was compounded by a lack of hospital resources and alternative hair options for people of colour, she said.
“There isn’t a pamphlet that they hand out for people with curly hair to go find wigs. There should be one,” she said.
Wigs can be pricey, but free alternatives exist
Losing hair during cancer treatment can be a shocking experience. Some patients say losing hair can make the psychological burden of chemotherapy feel heavier, given they don’t look like themselves.
“Obviously nobody wants to feel sick, but I didn’t want to look sick,” said Tammy Wegener, who was treated for breast cancer in 2022. “I wanted to feel that I had some peace of mind, that my kids had some peace of mind going through all this.”
That’s something Mona Rozdale says she hears often.
“At the end of the day, everybody wants to feel like themselves, and when you strip something that you’re so used to having, you don’t know life without it,” she said.
Rozdale is responsible for the Canadian Cancer Society’s wig and breast prosthetics bank lending program, which is free.
WATCH | U.S. task force recommends starting routine mammograms at 40:
A U.S. medical task force is recommending routine mammogram screening for breast cancer should start at 40 not 50, especially in people in high-risk categories.
She says wigs can be a helpful solution to those facing hair loss. But they can also be pricey. On average, a good quality wig made from human hair can cost around $2,500, according to Rozdale. But cheaper synthetic wigs are starting to look more realistic.
When Gregory couldn’t find a wig that fit her style — or budget of around $500 — at a hospital boutique, she opted to have her mother’s hairdresser make her one at a discount.
Scalp cooling is resource-intensive
Some people being treated for cancer have kept their natural hair with a process known as scalp cooling or cold capping.
Patients wear an intensely cold helmet before, during and after chemotherapy that constricts blood vessels in the scalp. It involves chilled caps that are swapped out regularly, or a machine that pumps cold liquid through an attached cap. In doing so, chemotherapy is less likely to reach and damage hair follicles, potentially reducing hair loss.
With limited data on its efficacy and a high price tag, however, cold capping is not widely available across Canada.
“The greatest limitation is chair time. It is a resource-rich type of use of the machine,” said Dr. Shannon Salvador, gynecologic oncologist at the Jewish General Hospital in Montreal and an associate professor at McGill University.
“When you have a patient who has to come for chemo every single week, that’s a great deal of time for them and a lot of time in the hospital to be able to come and use the machine.”
But Salvador, who has studied the effectiveness of scalp cooling, says there is evidence it does work for some patients.
In a 2021 study she co-authored, published in the journal Gynecologic Oncology Reports, over half of patients who were on a smaller weekly dose of a chemotherapy drug retained about 50 per cent of their hair when using a cold cap. The cold cap treatment didn’t work for those on a larger dose.
Cold caps limited at Canadian hospitals
Cold capping is not available to people with certain types of cancer, such as blood cancers, and those being treated with certain types of chemotherapy.
White Coat, Black Art reached out to several cancer centres in Canada, and found scalp cooling offered at just a handful of hospitals, often at the patient’s expense.
Wegener, 49, was able to access the treatment for free at Saint John Regional Hospital after a scalp cooling machine was donated by a nurse at the institution.
LISTEN | Why advocates want scalp cooling available at more hospitals:
26:30Hair Loss Part II: Cold Capping
Salvador says she expects hospitals will still rely on donations and external support for scalp cooling technology, rather than funding them directly.
“We need to acknowledge that, in Canada, we are in a socialized health-care system where we need to place the money where it’s going to do the most benefit,” she said.
“Unfortunately that does mean turning away things that are of great emotional benefit to patients, but may not play a great deal in their actual clinical care.”
Cold capping was a success for Wegener, who says during her chemotherapy treatment she noticed only some thinning of her hair and eyebrows. Based on her own experience, she hopes to see it in more places.
“Not that it’s for everybody and not everybody sees the results I saw with mine,” Wegener said. “But I think it still should be an option for everyone.”
Growing back
Gregory, the Toronto student who is still anxious about her cancer potentially returning, has become more comfortable with — and without — her wig.
She went to class bald for the first three months of the school year, in part because she also lost hair on and around her face, making the wig look unnatural. But she has since confidently worn wigs to school, and now has enough of her natural hair to add in braids.
“That took a year. It’s almost been a year since my hair started going back,” she said.
“I think by next summer I could probably wear a ponytail wig and then hopefully, like maybe a few summers after that, I won’t wear wigs anymore at all.”
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People struggling with mental health and substance abuse can access up to 12 free counselling sessions per year in a new Island Health program.
Leah Hollins, Island Health Board Chair, says “This represents a significant expansion and investment in community-based counselling services to improve access to these services on Vancouver Island.”
Virtual Island-wide services will be available through Cognito Health, and Trafalgar Addiction Treatment Centre. Services are also available in Port Hardy through North Island Crisis and Counselling Services and in Nanaimo through EHN Outpatient Services and Tillicum Lelum Aboriginal Society.
The publicly-funded, community-based counselling is intended for people with moderate challenges. The new partnership with Island health will meet the counselling needs of at least 1,500 people per year.
Access to the counselling services is via referral or self-referral through Island Health Mental Health and Substance Use locations.
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