“It was a really difficult transition going from someone who was a redhead . . . to having no hair, no eyebrows, no eyelashes and staring [in the mirror] at someone I just didn’t know,” recalled Krahn, now the owner of Image Evolution by Freedom Wigs, during Benefits Canada’s 2023 Chronic Disease at Work conference in early February. “It was devastating and it really took me out and made me a shell of my current self.”
Alopecia areata is an autoimmune disease caused by the body’s immune system attacking the hair follicles. Affecting roughly two per cent of people globally, the disease is typically chronic in nature and can start at any age, said Jeff Donovan, dermatologist at Donovan Hair Clinic, also speaking during the session, which was supported by Pfizer Canada Inc.
There are three types of alopecia: areata, which involves small or medium patches of hair loss that eventually grow back on their own or with treatment; totalis, which means complete hair loss on the head; and universalis, which is when someone experiences complete hair loss all over their body. Roughly five to 10 per cent of patients progress to total hair loss.
People who have one autoimmune condition are more likely to also experience others, something that’s true for those living with alopecia, said Donovan, noting many alopecia patients also have autoimmune thyroid disease. Eczema or atopic dermatitis, rheumatoid arthritis and pernicious anemia also occur in smaller numbers of patients.
Alopecia can be treated with cortisone creams or injections to reduce inflammation around the hair follicles, minoxidil to stimulate hair growth and, in cases of significant hair loss, immunosuppressive medications that are also used for other autoimmune conditions like rheumatoid arthritis or inflammatory bowel disease.
But Donovan noted that, while small patches of hair loss may respond well to treatment, it’s often much harder to treat significant hair loss. “We have a long way to go to improve the outcomes that we are able to achieve, but certainly new medications are on the horizon.”
Indeed, he noted no Health Canada-approved treatments for alopecia currently exist, but treatment is key for many patients because it helps to reduce some of the psychological impacts associated with the disease. Given the profound emotional impact of hair loss, people living with alopecia face an increased risk of developing anxiety and depression.
A 2020 study in the Journal of Investigative Dermatology found 62 per cent of alopecia areata patients made “major life decisions” about their relationships, education and/or career due to their disease. Some studies have suggested more than 75 per cent have experienced a change in their quality of life after developing alopecia. And the impact is more severe for younger patients, women and patients who lose their eyebrows and eyelashes.
Alopecia may also prompt employees to take more time off work, according to multiple studies of alopecia in the workplace. One study of 5,000 adults with the disease found they also experienced an up to 12 per cent reduction in productivity while at work.
“The more feelings of self-consciousness, embarrassment, sadness or frustration [a person with alopecia reported], the more they had impairment in their productivity at work,” said Donovan, noting some studies have found alopecia patients make career decisions specifically to take on roles with less public visibility.
Krahn encouraged plan sponsors to support employees with alopecia through their benefits plans by covering the cost of wigs or hair pieces — which can range from $1,000 to $10,000 — and existing and future treatments for the condition. Some workplace benefits plans may consider hairpieces cosmetic rather than medical, she said, but argued that was the wrong approach.
“Hair is part of our identity . . . and it’s very much attached to our mental health, though you don’t realize that until it’s going and you’re experiencing all the feelings associated with that loss. Just to treat it as aesthetic would be incorrect. If we realized that, I think we’d be making [strides] and there’d be so many more people who would be [comfortable] working in the workplace.”
For Krahn, finally finding a good hair piece allowed her to feel confident again and to feel comfortable returning to her teaching career. “It’s been a difficult process to go through, but it’s been rewarding at the same time to get to the other side of that loss.”
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.
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