After Michelle Tobin-Forgrave fell and hit her head more than five years ago, she developed a constellation of symptoms that began to derail her day-to-day life.
The Miramichi, N.B., resident knew she had a concussion — her second one — and expected to have a quick recovery, just like her first experience years earlier. But this round felt different.
Tobin-Forgrave went back to her job in the education sector after taking two months off work, then realized she needed to take hourly breaks from her computer. Sometimes she’d just lay on a yoga mat in her office, wracked by fatigue. The busy mother of two also started experiencing insomnia, couldn’t remember basic words like the names of household appliances, and developed issues with her vision and depth perception.
“The symptoms just never, ever went away,” she said, “and got worse — much worse — over time.”
Michelle Tobin-Forgrave writes on a mirror to help keep track of her day-to-day life after suffering a severe concussion. (Philip Boudreau/CBC)
The latest available data suggests hundreds of thousands of Canadians get concussions every year, and federal guidance last updated in 2021 suggests while recovery times can vary, most people get better in “10 days to 4 weeks.”
Yet a growing body of research indicates that many take much longer to recover than previously thought — or don’t ever fully recover at all.
Many with concussions don’t recover quickly, if at all
A study published in the journal Brain in February found that almost half of people with concussions still show symptoms of brain injury six months later, likely due to damage in an area of the brain called the thalamus, which relays information from the senses.
Researchers analyzed the brain scans of 108 patients in Europe who had recently had a concussion to look for structural changes in the brain, and found a marked increase in the activity between the thalamus and the rest of the brain shortly after a concussion.
“It’s almost like they were doing more work than those areas normally do. They were trying to communicate harder,” said Emmanuel Stamatakis, lead author of the study and head of the Cognition and Consciousness Imaging Group at the University of Cambridge in England.
“We found that the more hyper-connected those areas were, the more likely it is that you will have one of the symptoms that are associated with concussion — such as headaches, fatigue and sleep disturbances.”
The researchers used a less-common type of scan called a resting-state functional MRI — which isn’t widely available to patients — to analyze structural changes in the brain. Stamatakis said he hoped the findings would better inform patient care in the future and potentially lead to new concussion treatments.
“What I hope this study will achieve is to have clinicians think twice or three times before they send somebody with a concussion home and tell them: ‘You’re healthy,'” he said.
Dr. Charles Tator, an internationally renowned neurosurgeon and head of the Canadian Concussion Centre at Toronto Western Hospital’s Krembil Brain Institute, said the study points to the thalamus as an important area for concussion research for the first time.
“We’ve always known that it’s a more or less waystation — it’s the Union Station for pain,” he said, referring to Toronto’s bustling downtown transit hub. “But what this paper has identified is that in concussion it’s also an important structure and we didn’t really know that beforehand.”
Dr. Charles Tator says the estimated 400,000 Canadians who experience concussions each year is a ‘phenomenal’ figure and that many ‘don’t get better.’ (Alex Lupul/CBC)
Lingering concussion symptoms can be life-altering
The long-term impacts of brain injuries — from concussions among the general population, to reports of chronic traumatic encephalopathy (CTE) among professional athletes who’ve sustained repeated hits to the head — has been a growing field of study, and concern, in recent decades.
The latest European study’s sample size was fairly small, noted Toronto-based neurologist Dr. Matthew Burke, the medical director of the Traumatic Brain Injury program at Sunnybrook Hospital Health Science Centre, and the number of patients experiencing lasting symptoms was higher than most previous estimates, which range from around 15 to 30 per cent.
But he agreed the paper shows a “strong signal” that concussions can directly cause an array of cognitive and emotional issues that “might persist longer than we anticipate.”
Those lingering impacts may also be broader, and more life-altering, than the acute injury itself.
NHL enforcers die 10 years younger than other players, study suggests
Researchers at Columbia University in New York conducted a study comparing former NHL enforcers to their peers and found the enforcers were dying a decade earlier and were more likely to die from suicide or drug overdose.
Even children aren’t immune to potential ripple effects on the brain, other Canadian research recently suggests. A population-based retrospective cohort study led by the Ottawa-based CHEO Research Institute, published in 2022 by JAMA Network Open, found young people who sustain a concussion are at a 40 per cent higher risk of mental health issues, psychiatric hospitalization, and self-harm compared to those who sustain an orthopedic injury like a broken bone.
Ongoing research is still needed, Burke added, to understand what drives lasting symptoms, and what puts some people more at risk than others — a key piece of the puzzle so medical teams can ensure patients get long-term supports.
“How can someone have all of these symptoms after this somewhat trivial head injury? Well, in a vulnerable brain, that can absolutely happen,” Burke said.
“If they’re already predisposed or at risk for mental health conditions, or already experiencing things like anxiety, depression or chronic headache or chronic pain disorders, those are known risk factors for having longer recovery periods after a concussion.”
Dr. Matthew Burke says ongoing research is still needed to understand what drives lasting concussion symptoms, and what puts some people more at risk than others. (Craig Chivers/CBC)
Over 400,000 Canadians have concussions each year
As scientists strive to understand the full mechanisms behind post-injury health issues, basic data on the true number of Canadians actually affected by concussions in the first place remains hard to find.
One 2020 study in the Journal of Head Trauma Rehabilitation analyzed Ontario medical billing records and found close to 150,000 per year from 2008 to 2016 — or 1.2 per cent of the population.
Keith Yeates, head of the psychology department and Ward Chair in pediatric brain injury at the University of Calgary, said the number is likely an underestimate because the study is based on physician visits and many concussions don’t result in medical attention.
“The ‘real’ number is undoubtedly higher,” he said. “But we don’t know how much higher because we lack some of the surveillance systems that are in place in the U.S.”
“Which is just phenomenal when you think about it,” said the Canadian Concussion Centre’s Tator. “And they all don’t get better.”
Multiple clinicians and advocates who spoke to CBC News stressed that frontline medical teams may still not be aware of those long-term risks, leaving many patients struggling to get ongoing treatment and support after their initial injury.
“Brain injuries are happening far more often than I think anybody realizes, and I think the long term consequences of brain injuries are far more severe than anybody realizes,” said Tim Fleiszer, a former professional Canadian football player who is now the executive director of Concussion Legacy Foundation Canada.
“And the system is just not caught up with that yet.”
Health Canada concussion guidelines out of date
Health Canada’s latest guidelines, which state that most people recover from a concussion within a month, also note that Canadians who get a concussion should talk to their doctor or health-care provider about when to return to work, school and sports.
But Tator said that guidance is woefully out of date and the percentage of people who recover within a month can range from as low as five per cent to as high as 35 per cent — with a generally agreed upon estimate of about 25 per cent with persistent symptoms.
“I’m surprised that it hasn’t been brought up to date,” he said of the Health Canada guidelines. “That doesn’t give it the credibility that it’s a significant problem at all.”
Dr. Charles Tator is photographed in his office at Toronto Western Hospital in Toronto on May 10. (Alex Lupul/CBC)
In a statement to CBC News, Health Canada and Public Health Agency of Canada (PHAC) spokesperson Mark Johnson said PHAC regularly tracks scientific findings on traumatic brain injury, including concussion.
“New recommendations on sport-related concussion evaluation and management are expected to be released by summer 2023, based on findings from the 6th International Consensus Conference on Concussion in Sport,” he said. “These recommendations will be taken into consideration when updating Canada’s guidance on concussion.”
Tator said current Health Canada guidelines also fail to address the fact that many family physicians aren’t up to date on the evolving research on concussion treatments and protocols and don’t know how to help their patients.
“And it plays out in the fact that when the patient goes to their family doctor they are often not directed appropriately,” he added.
Community-based resources are also lacking, particularly since patients often experience such a broad range of symptoms that don’t fit neatly into one form of treatment. “If you have a non-sports concussion, and it’s been longer than, say, 12 months… there really is just no resources out there,” Fleiszer said.
‘I couldn’t find my old self’
That’s an experience Tobin-Forgrave understands well. As the years passed following her concussion, she bounced between more than a dozen specialists. None knew how to handle her full spectrum of symptoms. Some didn’t know how to treat a concussion at all.
Certain treatments did help more than others, she said, such as specialized glasses to help mitigate a communication breakdown between her eyes and her injured brain, allowing her to walk around more safely.
But given her host of cognitive issues, Tobin-Forgrave — who is now 51-years-old — is no longer able to work, and has no clear roadmap to a full recovery. Until the medical system catches up with how to treat long-term concussion impacts, she’s had to come to peace with her challenging new reality. That process, like everything else now in her day-to-day life, hasn’t been easy.
“There was grief,” she said, “because I couldn’t find my old self.”
WINNIPEG – Some 250 coloured tacks pepper a large-scale world map among bookshelves at Whodunit Mystery Bookstore.
Estonia, Finland, Japan and even Fenwick, Ont., have pins representing places outside Winnipeg where someone has ordered a page-turner from the independent bookstore that specializes in mystery and crime fiction novels.
For 30 years, the store has been offering fans of Agatha Christie’s Hercule Poirot or Arthur Conan Doyle’s Sherlock Holmes a place to get lost in whodunits both old and new.
Jack and Wendy Bumsted bought the shop in the Crescentwood neighbourhood in 2007 from another pair of mystery lovers.
The married couple had been longtime customers of the store. Wendy Bumsted grew up reading Perry Mason novels while her husband was a historian with vast knowledge of the crime fiction genre.
At the time, Jack Bumsted was retiring from teaching at the University of Manitoba when he was looking for his next venture.
“The bookstore came up and we bought it, I think, within a week,” Wendy Bumsted said in an interview.
“It never didn’t seem like a good idea.”
In the years since the Bumsteds took ownership, the family has witnessed the decline in mail-order books, the introduction of online retailers, a relocation to a new space next to the original, a pandemic and the death of beloved co-owner Jack Bumsted in 2020.
But with all the changes that come with owning a small business, customers continue to trust their next mystery fix will come from one of the shelves at Whodunit.
Many still request to be called about books from specific authors, or want to be notified if a new book follows their favourite format. Some arrive at the shop like clockwork each week hoping to get suggestions from Wendy Bumsted or her son on the next big hit.
“She has really excellent instincts on what we should be getting and what we should be promoting,” Micheal Bumsted said of his mother.
Wendy Bumsted suggested the store stock “Thursday Murder Club,” the debut novel from British television host Richard Osman, before it became a bestseller. They ordered more copies than other bookstores in Canada knowing it had the potential to be a hit, said Michael Bumsted.
The store houses more than 18,000 new and used novels. That’s not including the boxes of books that sit in Wendy Bumsted’s tiny office, or the packages that take up space on some of the only available seating there, waiting to be added to the inventory.
Just as the genre has evolved, so has the Bumsteds’ willingness to welcome other subjects on their shelves — despite some pushback from loyal customers and initially the Bumsted patriarch.
For years, Jack Bumsted refused to sell anything outside the crime fiction genre, including his own published books. Instead, he would send potential buyers to another store, but would offer to sign the books if they came back with them.
Wendy Bumsted said that eventually changed in his later years.
Now, about 15 per cent of the store’s stock is of other genres, such as romance or children’s books.
The COVID-19 pandemic forced them to look at expanding their selection, as some customers turned to buying books through the store’s website, which is set up to allow purchasers to get anything from the publishers the Bumsteds have contracts with.
In 2019, the store sold fewer than 100 books online. That number jumped to more than 3,000 in 2020, as retailers had to deal with pandemic lockdowns.
After years of running a successful mail-order business, the store was able to quickly adapt when it had to temporarily shut its doors, said Michael Bumsted.
“We were not a store…that had to figure out how to get books to people when they weren’t here.”
He added being a community bookstore with a niche has helped the family stay in business when other retailers have struggled. Part of that has included building lasting relationships.
“Some people have put it in their wills that their books will come to us,” said Wendy Bumsted.
Some of those collections have included tips on traveling through Asia in the early 2000s or the history of Australian cricket.
Micheal Bumsted said they’ve had to learn to be patient with selling some of these more obscure titles, but eventually the time comes for them to find a new home.
“One of the great things about physical books is that they can be there for you when you are ready for them.”
This report by The Canadian Press was first published on Sept. 15, 2024.
MONTREAL – Canada’s labour minister is praising both Air Canada and the union representing about 5,200 of its pilots for averting a work stoppage that would have disrupted travel for hundreds of thousands of passengers.
Steven MacKinnon’s comments came in a statement shared to social media shortly after Canada’s largest air carrier announced it had reached a tentative labour deal with the Air Line Pilots Association.
MacKinnon thanked both sides and federal mediators, saying the airline and its pilots approached negotiations with “seriousness and a resolve to get a deal.”
The tentative agreement averts a strike or lockout that could have begun as early as Wednesday for Air Canada and Air Canada Rouge, with flight cancellations expected before then.
The airline now says flights will continue as normal while union members vote on the tentative four-year contract.
Air Canada had called on the federal government to intervene in the dispute, but Prime Minister Justin Trudeau said Friday that would only happen if it became clear no negotiated agreement was possible.
This report from The Canadian Press was first published Sept. 15, 2024.
When it comes to plant-based alternatives, Canadians have never had so many options — and nowhere is that choice more abundantly clear than in the milk section of the dairy aisle.
To meet growing demand, companies are investing in new products and technology to keep up with consumer tastes and differentiate themselves from all the other players on the shelf.
“The product mix has just expanded so fast,” said Liza Amlani, co-founder of the Retail Strategy Group.
She said younger generations in particular are driving growth in the plant-based market as they are consuming less dairy and meat.
Commercial sales of dairy milk have been weakening for years, according to research firm Mintel, likely in part because of the rise of plant-based alternatives — even though many Canadians still drink dairy.
The No. 1 reason people opt for plant-based milk is because they see it as healthier than dairy, said Joel Gregoire, Mintel’s associate director for food and drink.
“Plant-based milk, the one thing about it — it’s not new. It’s been around for quite some time. It’s pretty established,” said Gregoire.
Because of that, it serves as an “entry point” for many consumers interested in plant-based alternatives to animal products, he said.
Plant-based milk consumption is expected to continue growing in the coming years, according to Mintel research, with more options available than ever and more consumers opting for a diet that includes both dairy and non-dairy milk.
A 2023 report by Ernst & Young for Protein Industries Canada projected that the plant-based dairy market will reach US$51.3 billion in 2035, at a compound annual growth rate of 9.5 per cent.
Because of this growth opportunity, even well-established dairy or plant-based companies are stepping up their game.
It’s been more than three decades since Saint-Hyacinthe, Que.-based Natura first launched a line of soy beverages. Over the years, the company has rolled out new products to meet rising demand, and earlier this year launched a line of oat beverages that it says are the only ones with a stamp of approval from Celiac Canada.
Competition is tough, said owner and founder Nick Feldman — especially from large American brands, which have the money to ensure their products hit shelves across the country.
Natura has kept growing, though, with a focus on using organic ingredients and localized production from raw materials.
“We’re maybe not appealing to the mass market, but we’re appealing to the natural consumer, to the organic consumer,” Feldman said.
Amlani said brands are increasingly advertising the simplicity of their ingredient lists. She’s also noticing more companies offering different kinds of products, such as coffee creamers.
Companies are also looking to stand out through eye-catching packaging and marketing, added Amlani, and by competing on price.
Besides all the companies competing for shelf space, there are many different kinds of plant-based milk consumers can choose from, such as almond, soy, oat, rice, hazelnut, macadamia, pea, coconut and hemp.
However, one alternative in particular has enjoyed a recent, rapid ascendance in popularity.
“I would say oat is the big up-and-coming product,” said Feldman.
Mintel’s report found the share of Canadians who say they buy oat milk has quadrupled between 2019 and 2023 (though almond is still the most popular).
“There seems to be a very nice marriage of coffee and oat milk,” said Feldman. “The flavour combination is excellent, better than any other non-dairy alternative.”
The beverage’s surge in popularity in cafés is a big part of why it’s ascending so quickly, said Gregoire — its texture and ability to froth makes it a good alternative for lattes and cappuccinos.
It’s also a good example of companies making a strong “use case” for yet another new entrant in a competitive market, he said.
Amid the long-standing brands and new entrants, there’s another — perhaps unexpected — group of players that has been increasingly investing in plant-based milk alternatives: dairy companies.
For example, Danone has owned the Silk and So Delicious brands since an acquisition in 2014, and long-standing U.S. dairy company HP Hood LLC launched Planet Oat in 2018.
Lactalis Canada also recently converted its facility in Sudbury, Ont., to manufacture its new plant-based Enjoy! brand, with beverages made from oats, almonds and hazelnuts.
“As an organization, we obviously follow consumer trends, and have seen the amount of interest in plant-based products, particularly fluid beverages,” said Mark Taylor, president and CEO of Lactalis Canada, whose parent company Lactalis is the largest dairy products company in the world.
The facility was a milk processing plant for six decades, until Lactalis Canada began renovating it in 2022. It now manufactures not only the new brand, but also the company’s existing Sensational Soy brand, and is the company’s first dedicated plant-based facility.
“We’re predominantly a dairy company, and we’ll always predominantly be a dairy company, but we see these products as complementary,” said Taylor.
It makes sense that major dairy companies want to get in on plant-based milk, said Gregoire. The dairy business is large — a “cash cow,” if you will — but not really growing, while plant-based products are seeing a boom.
“If I’m looking for avenues of growth, I don’t want to be left behind,” he said.
Gregoire said there’s a potential for consumers to get confused with so many options, which is why it’s so important for brands to find a way to differentiate themselves, whether it’s with taste, health, or how well the drink froths for a latte.
Competition in a more crowded market is challenging, but Taylor believes it results in better products for consumers.
“It keeps you sharp, and it forces you to be really good at what you’re doing. It drives innovation,” he said.
This report by The Canadian Press was first published Sept. 15, 2024.
