Hamilton Health Sciences vascular surgeon Dr. Fadi Elias is helping to lead a new campaign called Socks Off, aimed at reducing the number of lower Hamilton residents who lose a foot to amputation due to diabetes and/or vascular disease.
Ontario has among the highest rates in the world for diabetes-related foot amputations, with Hamilton having one of the highest rates provincially and lower Hamilton having the highest rates locally.
Hamilton Health Sciences (HHS) together with the Greater Hamilton Health Network (GHHN) is launching a Socks Off campaign on July 17 which aims to reduce the number of lower Hamilton residents who lose a foot to amputation due to diabetes and/or vascular disease. The GHHN is the area’s Ontario Health Team (OHT), made up of health-care providers and organizations responsible for delivering coordinated patient care in Hamilton, Haldimand and parts of Niagara.
Aimed at family doctors and other health-care providers in lower Hamilton, the campaign encourages them to routinely check the bare feet of their patients with diabetes and vascular disease. Hence the campaign’s name, Socks Off.
Getting eyes on feet
A complication of diabetes and vascular disease is poor circulation, which can lead to serious problems from something as simple as a cut or crack in the skin.
Dr. Tamar Packer and Dr. Brian McKenna are encouraging patients with diabetes and vascular disease to take their socks off for foot checks when visiting their family doctor or other health-care provider.
“Through the campaign, we’re encouraging primary care providers to routinely check these patients’ bare feet for cuts, blisters, cracks, callouses or other sores that could lead to a serious ulcer and amputation,” says Dr. Tamar Packer, chief of family medicine for complex continuing and post–acute care at HHS, and the GHHN’s clinical advisor for the hospital.
“Feet can’t be properly assessed if socks are on.” — Dr. Tamar Packer
Campaign materials include an implementation package for family doctors and health-care providers that streamlines the steps involved in seamlessly incorporating screening, early intervention, timely referral and patient education into their workday.
Other community partners in the campaign include paramedics, diabetes care programs, research programs, home and community services as well as some private wound, chiropody (foot care) and vascular clinics. The program also includes community outreach through the Shelter Health Network, Good Shepherd, the HRIC and Indwell.
Preventing up to 85 per cent of complications, including amputations
Socks Off promotes the HHS/GHHN OHT Lower-Limb Preservation Integrated Care Program, which aims over time to reduce the amount of lower leg and foot amputations in the city through a more coordinated, integrated and patient-centred approach. This includes regular foot checks, early identification, timely assessment, best-practice treatment, ongoing monitoring, cardiovascular risk management, wound prevention strategies, and patient education. The program is receiving $600,000 in provincial funding over a year.
Dr. Brian McKenna and Dr. Tamar Packer demonstrate a foot check. It’s quick and easy to do, and can prevent serious complications including amputations.
“By routinely checking patients’ feet we can help prevent up to 85 per cent of amputations and other complications related to poor circulation,” says Packer, adding that people with diabetes may not be aware of foot injuries because they’ve lost feeling in their feet due to poor circulation.
“Simply asking our patients how their feet are doing isn’t enough. Feet can’t be properly assessed if socks are on.”
If left too long
Dr. Fadi Elias, vascular surgeon, Hamilton Health Sciences
Hamilton Health Sciences vascular surgeon Dr. Fadi Elias sees diabetic patients in the later stages of infection, when surgery is a last resort to try and avoid amputation.
“I hear their stories and I review the treatment pathways that eventually brought them to my office,” says Elias. “Unfortunately, there are often many points in their health-care journey where the disease’s progression could have been slowed down by early intervention that didn’t happen.”
“My goal, through this campaign, is to give primary care providers the tools they need to assess patients early and regularly to avoid needing vascular surgery or an amputation.” — Dr. Fadi Elias
Health equity
A key priority of the Socks Off campaign is health equity and the need for all people to have a fair chance at achieving good health.
Diabetic foot screen test
“This campaign provides an opportunity to really impact inequities in Hamilton in terms of health and wellness, as well as to collaborate with some of the top partners in the city,” says Dr. Brian McKenna, a family doctor and deputy lead physician at the Hamilton Family Health Team, whose membership includes 165 family doctors, their practice teams, and 250 other health-care workers in the city.
“The Socks Off campaign prioritizes health equity at its core,” says McKenna. “Through this campaign, we have an incredible opportunity to prevent horrific health outcomes for our most at-risk diabetic patients with poor circulation whom, statistically, living in lower Hamilton, are more likely to need an amputation than almost anywhere else in Ontario.”
Population health is a priority for HHS, says Leslie Gillies, vice president of community medicine and population health, interprofessional development/practice and clinical education for the hospital. “We’re excited to co-launch the Socks Off campaign, which supports caring for our diabetic patients beyond our hospital walls.”
Melissa McCallum, executive director of the GHHN, adds, “This campaign has the potential to go a very long way in helping people with diabetes and/or vascular disease, avoid devastating, life-altering complications such as lower limb amputations.”
Patient education
Dr. Perry Mayer, medical director, The Mayer Institute
As part of the campaign, primary care providers are being encouraged to make their patients partners in care.
“There are three pieces of advice that primary care providers should give to their diabetic patients,” says Dr. Perry Mayer, medical director of The Mayer Institute in Hamilton, a centre of excellence in treating diabetic feet.
By following these three steps every day, 85 per cent of diabetic foot problems can be prevented, says Mayer:
Step 1 – Always wear shoes, even indoors. Shoes protect feet from wear-and-tear or cuts that could lead to infection or amputation. And shoes need to fit well so that they don’t rub against the skin, causing sores.
Patients can also play a vital role in preventing serious complications including amputations. Dr. Perry Mayer offers three steps to keep feet healthy.
Step 2 – Moisturize feet every day. “Moisturizing helps keep skin supple, so it’s less likely to crack or break,” says Mayer. “This helps prevent an ulcer from developing that could lead to a potential amputation.”
Step 3 – Check feet every day, including in between toes. “If you see any sign of a wound developing, you need to get off your feet right away and call your health-care provider for an appointment,” says Mayer, adding, “I can’t stress enough how important it is for people to get off their feet immediately. Unfortunately, if patients don’t offload right away and have their wound examined and cleaned by a health-care professional, nothing is going to work for them.”
And patients should take the initiative with their primary care provider by asking for a foot check at appointments, says Mayer. “As soon as you get into the examination room, take off your socks. It’s a reminder for the primary care provider to check your feet, and it saves time too.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
