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Unity Health Toronto’s 2023 Summer Safety and Wellness Guide

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Summer is officially underway and it is time to get outside and enjoy the warm weather. Alongside sunshine and bike rides, come a series of common questions about how to stay safe and healthy: How much water should I be drinking? How do I protect myself from bug bites? Do I need to be wearing sunscreen?

We reached out to a couple of physicians at Unity Health to find out how to stay protected while enjoying the outdoors this summer.

Keeping Cool

Over the past few years, Toronto has seen more extreme weather events, including heat waves. Even on a typical summer day, it is important to know how to prevent heat illnesses and dehydration.

Dr. Jessica He, a physician with the St. Joseph’s Academic Urban Family Health Team, shared her insights on how to stay cool and safe.

Dr. Jessica He is a family physician at the St. Joseph’s Academic Urban Family Health Team.

What are heat illnesses?

Heat illnesses range from mild to severe, He explains. For mild cases, known as heat syncope, you begin to feel dizzy or like you are about to faint. The next level is heat exhaustion where you begin to feel nauseous, weak or lightheaded, and you may even vomit. The final level is heat stroke where you feel lethargic, confused and delirious—which are all signs of a heat emergency. “Early recognition makes a huge difference, because there are things that you can do to intervene before it progresses all the way to heat stroke,” says He.

What can I do to protect myself from heat stroke?

“The first thing is to know yourself and whether you’re someone who is more at risk for getting heat stroke,” says He. This often includes children and elderly people. You will also be more at risk if you are doing strenuous activities outdoors, don’t drink many fluids or are on medications that influence your ability to sweat or urinate, she notes.

If you begin to feel symptoms of heat stroke, He recommends that you move to a shaded area or, if possible, an air-conditioned building. If you begin to feel dizzy or lightheaded while standing, sit or lie down – it can help to put your feet up to facilitate blood flow. He also suggests drinking water or an electrolyte drink to restore the lack of fluid in your body.

How much water should I be drinking in the summer months?

Contrary to popular belief, He states that we do not need to drink eight glasses of water a day. “Most people have regulatory mechanisms that will increase your thirst drive if you are dehydrated, so it’s important to listen to that,” she says. Unless you have a health issue that requires you to follow different rules, He encourages people to simply drink when they are thirsty and keep water nearby.

Sun Safety

While it’s great to spend time in the sun, it’s important to know how to protect yourself. In another conversation with He, she shared how using a sunscreen that has the right sun protection level (SPF) for you can protect you from sun-related injuries like sunburns and even skin cancer.

Who should wear sunscreen? Is it necessary to wear it if you have a darker skin tone? 

He notes that skin tone does play a factor in how much you are at risk for sun-related skin damage, with lighter skin tones being more at risk and darker tones being less at risk. However, she points out that it is beneficial for everyone to wear sunscreen. “Being at lesser risk doesn’t mean being at no risk,” she says.

What level of SPF do you need for your specific skin tone?

“Generally, the SPF that we recommend is 30 and above,” says He.

Re-application is also key. “Even if SPF 60 may provide more sun protection than SPF 30, if you don’t reapply it as much, then you’re probably getting better protection from an SPF 30 that reminds you to apply more often,” she says.

How many times should I re-apply sunscreen?

Every two hours, especially if you will be outside or in the water frequently, He recommends. According to He, this is most important during peak hours of sunlight between 10 a.m. and 4 p.m. “Sunscreen is beneficial, but only as long as it’s actually on your body,” she says.

Can my medication influence my sensitivity to the sun?

He states that two common ingredients that can make skin more sensitive to the sun or heat are doxycycline and topical retinoid. They are often included in medications for severe acne or hyper-pigmentation. If using them, she notes that you should stay aware of your exposure to the sun and ensure you purchase a sunscreen that gives you enough protection.

Bugs and Ticks

Due to warmer temperatures, the tick population in Ontario is increasing. We learned more from He on how to stay protected from these tiny parasites, as well as other bugs when we spend more time outdoors in the summer.

When should I look for ticks on my body?

He encourages checking for ticks during and after spending time outdoors or going on a hike. After 24 hours have passed from the time you were first exposed to a tick, you are more at risk of contracting Lyme disease, so she emphasizes that it is important to check your skin frequently.

How can I distinguish a tick bite from a mosquito bite?

Mosquito bites are typically small and localized, and will not become bigger than five centimeters, describes He. Tick bites, on the other hand, usually result in a rash or skin discoloration that can expand around the bite, she explains.

How can we protect ourselves from tick and mosquito bites?

A few tips He shares for avoiding tick and mosquito bites are to, first, wear long sleeves and pants when you know you will be outdoors for long periods, and second, use a bug repellant. “Ticks can also be prevented by sticking to the center of hiking trails, as they tend to live in bushes and shrubs,” she adds.

To avoid mosquitos, try not to be outside in the early morning or late evening when they tend to be active.

How do I treat a mosquito or tick bite?

“Generally, your body will be good at resolving mosquito bites, so it’s mainly about symptom management,” says He. “You can use an over the counter itch cream to help.”

He also advises that you see your family doctor within three days of a tick bite appearing. The doctor may be able to offer an antibiotic to prevent Lyme disease. Beyond that, she says to monitor yourself for the next 30 days to see if symptoms of Lyme disease emerge, which present a flu-like illness. “If that happens, there are antibiotics that we can give for that as well,” she notes.

Cycling Safe

In the summer months, people often use bicycles and other kinds of active transportation. However, biking accidents can be some of the most devastating.

We spoke to Dr. Sahil Gupta, an emergency physician at St. Michael’s Hospital, about how to stay safe on the roads.

Dr. Sahil Gupta is an emergency physician at St. Michael’s Hospital.

What are some of the most common injuries you treat related to bike safety?

In a downtown area, many of the injuries that Gupta and his team see are cycling-related injuries, such as head trauma, concussions or major brain injuries, as well as orthopedic injuries to the bone or soft tissue. He notes that these injuries can take weeks or months to heal, while others can be lifelong.

How can we protect ourselves from road related injuries?

Protective gear such as helmets and knee and elbow pads are the primary way to protect yourself from road related injuries, Gupta shares. He also states that the built environment plays a role in injury prevention. “Infrastructure that separates cyclists or pedestrians from cars and traffic calming measures can reduce the number of injuries,” he says.

If you could create a bike safety kit, what would you include?

In addition to protective gear like helmets, Gupta recommends making sure your brakes are in good working order and using a bike with thicker tires in the city. Thicker tires have more grip and do not fall as easily into uneven road surfaces like pavement cracks or streetcar tracks, he explains.

By: Kaela Tenn

 

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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

The Canadian Press. All rights reserved.

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