The Annual Physical… - Paragon Publishing Inc.

www.cvfp.comThe Annual Physical…how it’s changing •The Prenatal Experience •Video Game Addictions •Providing comprehensive family medicine services

• Physiotherapy• Health Care/InsuranceMassage TherapyMotor Vehicle Accidents• Orthotics• Authorized WCB Provider• AcupunctureReliable, RepRoducibleand MeasuRable ResultsYour Northwest Calgary Clinic403-241-1600Fax 403-241-1647205-60 crowfoot crescent n.W.Open Monday - Friday 7:00 am - 8:00 pmSaturday 9:00 am – 1:00 pmwww.efwrad.comevery picture tells a story... TMTimely accessto care andtechnologyWe Specialize In:• Magnetic Resonance Imaging (MRI)• Advanced Spinal Care & Pain Management• Obstetrical Ultrasound & Maternal Fetal Medicine• MSK, Pediatric, Vascular & General Ultrasound• Mammography • Bone Densitometry (BMD)• Nuclear Medicine • X-RayCentral Booking 403-541-1200403-295-1880ADVANCED MEDICAL IMAGING CENTRE Fax: 403-210-8400Suite 100, 2000 Veteran’s Place N.W., Calgary, AB T3B 4N2■ MRI ■ Bone Density ■ General X-Ray ■ Mammography ■ Nuclear Medicine ■ UltrasoundADVANCED SPINAL CARE CENTRE Fax: 403-210-8382Suite 201, 2000 Veteran’s Place N.W., Calgary, AB T3B 4N2■ Facet Injections ■ Pain Management TherapyAIRDRIE CLINIC Fax: 403-912-5680Suite 204, 836 - 1st Avenue N.W., Airdrie, AB T4B 0V2■ Bone Density ■ General X-Ray ■ Mammography ■ UltrasoundBEDDINGTON TOWNE CENTRE Fax: 403-295-1693Suite 200, 8120 Beddington Blvd. N.W., Calgary, AB T3K 2A8■ Bone Density ■ General X-Ray ■ Mammography■ Maternal Fetal Medicine (Fax: 403-295-2074) ■ Nuclear Medicine ■ UltrasoundFOOTHILLS PROFESSIONAL BUILDING Fax: 403-284-0378Suite 380, 1620 - 29th Street N.W., Calgary, AB T2N 4L7■ Bone Density ■ General X-Ray ■ UltrasoundGULF CANADA SQUARE Fax: 403-221-9770Suite 300, 401 - 9th Avenue S.W., Calgary, AB T2P 3C5■ General X-RayHIGH RIVER CLINIC Fax: 403-210-9041 (Opening 2012)303 - 9th Avenue S.W., High River, AB T1V 1B3■ Bone Density ■ MammographyPROSTATE CANCER INSTITUTE Fax: 403-210-83886500, 7007 - 14th Street S.W., Calgary, AB T2V 1P9SOUTHERN ALBERTA CENTRE FOR MATERNAL FETAL MEDICINE Fax: 403-220-9059Suite 100 TRW Building, 3280 Hospital Drive N.W., Calgary, AB T2N 4N1■ Maternal Fetal MedicineSOUTHPORT ATRIUM Fax: 403-258-1846A8, 10333 Southport Road S.W., Calgary, AB T2W 3X6■ Bone Density ■ General X-Ray ■ Mammography ■ Nuclear Medicine■ Pediatric Ultrasound ■ Adult Ultrasound2 Crowfoot Village Family Practice

Suite 210, 600 Crowfoot Crescent NWCalgary, Alberta T3G 0B4Phone: 403-239-9733Fax: 403-241-8112After hours patients call:HealthLink at 403-943-LINK (403-943-5465)ww.cvfp.comContentsWelcome .................................................................. 3CVFP Physicians...................................................4CVFP Staff............................................................... 7The Prenatal Experience...................................8Constipation...........................................................11Video Game Addictions....................................12Home Blood Pressure Monitoring................13Evidence Based Exam.......................................14The Team Approach...........................................16Frequently Asked Questions...........................18Uninsured Services Summary.........................18Cover photo:Dr. Michelle Klassen checks a patient’sblood pressure.Project ManagerArt DirectorPublisherPublished for CVFP by:Paragon Publishing Inc.Calgary, AlbertaTel: 403-287-9818ads@paragonpublish.comwww.paragonpublish.comDenis MarsonTel: (250) 550-3086dm@paragonpublish.comRichart BocxeJim ThorntonAll rights reserved ©2012 Printed in CanadaMember of the Canadian Federation of Independent BusinessWelcome patients old andnew to the fourth editionof the CVFP magazineAt Crowfoot Village Family Practice, we are committed to providing a “medicalhome” for patients. Since transforming our family practice in 1999, we have beenuniquely successful in Alberta. We are proud that we remain publicly-funded, withequal access for all patients regardless of income.Health research has proven that when patients have good access to primary careservices, the quality of their care is better and the cost of their care is lower. At CVFP,we are focused on access. We track wait times and are working to achieve our targets.Our goal is to see urgent problems the same day, routine problems within two weeks,and periodic health exams within three months.For 2011, the theme of our annual staff retreat was “ The CVFP Patient Experience.”We focused on improving patient service and access. By communicating better withour patients, using new technology, and using our registered nurses and clerical stafffully, we set important goals to continue to improve patient care.An exciting new initiative at the practice this fall is the introduction of a “POET”-Proactive Office Encounter Technician - to assist physicians with patient care. OurPOET will review the chart and contact patients before they come to the office, ensuringthat they are up-to-date with recommended health procedures. The patient visitis “packed” to ensure maximum effectiveness for patients. The POET will help withmedications, assisting patients with investigation arrangements and specialist referrals,and ensuring patient follow-up. Using current guidelines, we can ensure patientsare getting all recommended care.We are proud of the improvements in care we have achieved. The Health QualityCouncil of Alberta studied ten-year outcome data on our original group of over 10,000patients. CVFP patients visited the emergency department 13% less than the Calgaryaverage and were admitted to hospital 17% less than average. This is a tremendousaccomplishment, related mostly to improved management of chronic conditions andimproved access for urgent problems.From a financial perspective, the Crowfoot model is low-cost. We are paid an averageof $220 per patient per year, or about $18 per patient per month. The cost isfixed, and it allows the province (and Alberta’s taxpayers) to stick to a fixed budget forprimary care services, while saving significantly on acute care costs. It also providesa stable amount so the physician group can budget for rent and staff, and offers theflexibility to use our health team in the most efficient way possible.The success of the CVFP has allowed us to attract new family medicine graduates,which was the reason for the office expansion last year. We are proud to provide ateaching site for five first-year and five second-year family medicine residents yearly,along with nine final year medical students (clinical clerks) yearly. This year, the practicehas grown to over 23,000 patients – this means that one in every 47 Calgariansis a Crowfoot patient!Family medicine is a tremendously rewarding career, and we are privileged to developclose relationships with our patients over time. While it is not always easy meetingcomplex and changing patient needs, we are committed to continued improvement.We want to work in partnership with you to provide the best care possible, andto remain a healthy and innovative practice for many years to come!—Dr. Peggy AufrichtFamily Physician, Crowfoot Village Family PracticeCrowfoot Village Family Practice is locatedin the bright, new Crowfoot West Business Centre.Crowfoot Village Family Practice 3

CVFP Physician ProfilesDr. Peggy AufrichtDr. Aufricht completed her medical degree at the University of Calgary in 1984, and her familymedicine residency at the Foothills Hospital in 1986. She is a Fellow of the College of FamilyPhysicians, and was the project lead for the Crowfoot primary care reform pilot project. For thepast five years, she has worked on planning and implementing new health initiatives within theCalgary Foothills Primary Network, a group of over 200 family physicians in northwest Calgary.Dr. Aufricht enjoys running, skiing, cycling and hiking with her husband; her three children arenow all grown up and off on their own adventures!Dr. Kristine BertschDr. Kristine Bertsch was born and raised in Calgary, and after her undergraduate studies at theUniversity of British Columbia and medical school at the University of Alberta, she returned toCalgary. She completed her residency at the Crowfoot Village Family Practice in 2010, and wasthe chief resident in her final year. Now, in addition to her family practice at Crowfoot VillageFamily Practice, she also works with the Northwest Maternity Group delivering babies at theFoothills Hospital. In her spare time, she and her husband enjoy hiking, running, cross-countryskiing and anything else that will get them out in the mountains.Dr. Chris BockmuehlDr. Bockmuehl was born in Switzerland and lived there, and in Germany until age 12, beforeemigrating to Vancouver. He completed medical school in Calgary in 1989 and his familymedicine residency in Vancouver and Williams Lake in 1991. He returned to Calgary andpracticed in the Southwest until joining CVFP in August of 2007. He is a fellow of the Collegeof Family Physicians of Canada and a Clinical Assistant Professor at the University of Calgary.Dr. Bockmuehl is married and has two teenagers at home. He plays cello and electric bass ina church band and occasionally enjoys flying the friendly western skies as a private pilot. Heis distraught at the recent necktie ban at numerous international medical governing bodes.Please forgive him any Windsor knot relapses in which you may discover him.Dr. Zoe ChanDr. Chan was born in Prince George, British Columbia and raised in North Vancouver, BritishColumbia. After obtaining her Bachelor of Arts at Simon Fraser University, she worked at theVancouver Coastal Health Authority for a year. Afterwards, she went on to obtain her medicaldegree at the University of British Columbia. She completed her Family Medicine training atthe University of Calgary. She brings with her a wide range of experiences: from 10 years ofworking with children at her local library; to working as a contraceptive counselor at PlannedParenthood; to building aqueducts in Costa Rica; to starting a clinic in Nepal. When she’snot working, she enjoys travel, reading, movies, painting, cooking and spending time with herhusband and daughter.Dr. Ted JablonskiDr. Ted Jablonski was born, raised and trained in Winnipeg (B.Sc. Med., MD 1984 – Universityof Manitoba, CCFP, FCFP) and has taught and practiced family medicine in rural Manitoba,Northern Saskatchewan and Northwestern Ontario before moving to Calgary in 1998. Tedis also a clinic associate at the Men’s Sexual Health Clinic at the Southern Alberta Instituteof Urology (in the Rocky View Hospital) and does consultant work in sexual medicine forSouthern Alberta. He joined CVFP at the end of 2010, bringing his large community practicealong. Ted continues to moonlight as “dr j”, a multi-instrumentalist, singer-songwriterwho has 6 indie CD releases. He is married to Monique and has two very independent“adult kids”. He successfully ran, cycled and spoke across Canada in the Fall of 2010 toraise awareness of Seasonal Affective Disorder (SAD) and inspired action to overcome it.www.SADnomore.ca4 Crowfoot Village Family Practice

CVFP Physician ProfilesDr. Dan JohnsDr. Dan Johns graduated from the University of Calgary medical school in 2003. He completedthe rural family practice residency program, also through the University of Calgary. He traveledaround Alberta as a rural locum family doctor the first few years of his career. He has beenat CVFP since 2006, after being recruited by his sister, Dr. Kathy Johns. His interests includeplaying piano and guitar. He also enjoys spending time in the mountains.Dr. Kathy JohnsAlberta born and raised, Dr. Kathy Johns graduated from the University of Alberta MedicalSchool in 1992. She completed her Family Medicine Residency at the U of A in 1994 and completedher Emergency Medicine Certificate in 1995 as Chief Resident. Returning to her home town ofCalgary, she practiced Emergency Medicine at the Foothills and Peter Lougheed Centres from1995 to 2006, with active participation in the STARS Air Ambulance Service, the PARTY Program,the EMS liaison committee and the teaching of medical students and residents. Returning to herfamily medicine roots, she joined CVFP in May 2006 and loves coming to work!Dr. Michelle KlassenDr. Michelle Klassen joined CVFP in 2010 after completing her medical degree and residency infamily medicine at the University of Calgary. She also has a Ph.D. in molecular virology and viralvaccine design from the University of Saskatchewan and a Certificate in Adult Education fromDalhousie University. Outside of CVFP, Dr. Klassen enjoys spending time with her husband, Brian,and their teenage daughter, Rachel. Dr. Klassen can often be found at home cooking, reading orlearning a new skill, at Canada Olympic Park at the luge track or in Canmore enjoying all thatthe mountains have to offer.Dr. Reid McLean WiestDr. McLean Wiest completed his family medicine training in Calgary in 2002. Before joiningCVFP as an associate, he worked as a locum in over 90 physician offices in the Calgary area. Dr.McLean Wiest has been happily married to Beth since 1997, when they decided to try somethingromantic by combining their two “maiden names” (i.e. he was “Wiest”, she was “McLean”).They are devoted Christians and parents to two boys and a girl. They also direct and performwith a choir called Harmony Through Harmony, which seeks to develop young adult leaders,build community, expand worldviews and fight for justice for the oppressed (check out http://www.HarmonyThroughHarmony.com). Dr. McLean Wiest also enjoys composing music, playingsquash, skiing, fly fishing, cooking and travel.Dr. Jessica OrrDr. Orr officially joined CVFP as an Associate Physician in 2010. After graduating from theUniversity of Alberta Medical School Dr. Orr moved to Calgary to complete her Family MedicineResidency. When not working she is busy with her adorable children, Ben (4), Savanna (3) andAlyssa (10 mos). Their favorite outings are the zoo, science centre and parks. She is 6’1” whichisn’t tall compared to her husband, Chris, who is 6’ 10”. Together, they built a customized houseto accommodate their height. Dr. Orr also enjoys teaching children’s Sunday school, painting,scrapbooking, camping, hiking and chocolate.Crowfoot Village Family Practice 5

CVFP Physician ProfilesDr. Janet ReynoldsDr. Reynolds completed her medical degree at the University of Saskatchewan in 1997. She thenmoved to Ottawa to complete her Family Medicine training at the University of Ottawa in 1999.She worked in a rural setting in Ontario for two years prior to moving to Calgary. Dr. Reynoldssits on the executive for the Alberta College of Family Physicians and is Chair of the MembershipAdvisory Committee, College of Family Physicians of Canada. Dr. Reynolds has been married toChet for sixteen years and they have two wonderful children, Caitland and Carson, and a dog,Molly. The four of them look forward to seeing the world together.Dr. Karyn RichardsonDr. Karyn Richardson joined CVFP in 2010 after completing her medical degree and residencyin family medicine at the University of Calgary. She also has a BSc in neuroscience and a lawdegree from the University of Calgary. Outside her medical practice, she is kept busy with herthree young children and their activities. She is a keen mountain biker, runner and skier, andenjoys sharing her passion for the outdoors with her husband, children and friends.Dr. Karen SeigelDr. Seigel grew up in Ottawa and completed a Master’s of Epidemiology and her medical degreeat Queen’s University in Kingston. She came to Calgary in 2002 to complete her family medicineresidency. She has been practicing in northwest Calgary since 2004 and looked forward tojoining CVFP. Aside from seeing patients, Dr. Seigel is the Physician Lead for Population Healthwith the Calgary Foothills Primary Care Network. She enjoys being involved in research and isalso a member of the Southern Alberta Primary Care Research Network. Outside of work, sheenjoys playing her violin and photography, and loves spending time with her husband and twoyoung kids.Dr. Wendy StefanekDr. Wendy Stefanek has practiced with CVFP since 2004 when she graduated from FamilyMedicine at the University of Calgary. Dr Stefanek is beginning to expand her practice to includeteaching clinical clerks and residents. Her time outside of the office is spent trying to keep up withher very active daughters, ages 6 and 9, and her husband, an avid athlete. Her other interestsinclude renovating her 100 year old house, running the occasional 10k and reading for her bookclub.Dr. Rick WardDr. Ward has been a partner at CVFP since 1988. His professional interests include preventativecardiology, chronic disease management, psychiatry and sexual medicine. Besides his activitieswith CVFP, Rick has a clinical appointment with the Faculty of Medicine at the University ofCalgary where he is a Clinical Assistant Professor. He is actively involved through the U of C withteaching at CVFP and developing educational programs for family physicians across Canada.He is married to Cindy whom he met while an undergraduate at the University of Guelph; theyhave two sons. His hobbies include travel, fishing, reading and spending time at his recreationalproperty on Vancouver Island.6 Crowfoot Village Family Practice

Crowfoot Village Family Practice StaffCrowfoot Village Family Practice 7

The Prenatal Experienceat CVFPPregnancy is an exciting time, and many women will visitthe doctor more often than they ever have in their lives.This article will help guide you through the prenatal processat CVFP.Can I stay at CVFP for my prenatal care? What are myprenatal care options?You can stay at CVFP for all of your prenatal care. Dr.Kristine Bertsch is a member of the Northwest Maternitygroup, delivering babies at the Foothills Hospital. She caresfor many Crowfoot patients in the second half of pregnancy.If your pregnancy is complicated, or if you wish to see aspecialist, your family doctor will refer you to an obstetrician.If you plan to see a midwife, you can contact them directly.We can also refer you to a physician who delivers at one ofthe other Calgary and area hospitals.What can I expect as usual prenatal care at CVFP?Once your pregnancy is confirmed, your family doctor will seeyou for a comprehensive initial visit when you are 10-12 weekspregnant. Visits are then monthly until the third trimester, or28 weeks. After this point, visits are every two weeks until 36weeks, and then weekly until delivery.Pregnancy is on average 40 weeks. Your due date will beconfirmed with an early ultrasound. Your baby is consideredto have arrived ‘on time’ if delivery occurs between threeweeks before the due date and 10 days after.What are some of the most commonly encountered problemsin pregnancy?Prenatal care offers the opportunity to detect problems inpregnancy early, to try and prevent any problems for you andyour baby. Blood pressure is checked at every visit, because8 Crowfoot Village Family Practice

high blood pressure can develop in pregnancy.Diabetes in pregnancy is a common problem that usuallydevelops in the second trimester and is detected by a bloodtest. Women are at increased risk of gestational diabetes ifthey have a family history of diabetes, if they are overweightor gain too much weight in pregnancy, or if they are amongcertain ethnic groups including Asian, African, Aboriginal,and Hispanic.Babies come in all sizes, with the average birth weightbeing 7.5 pounds. Babies who are quite small or large canexperience problems. The uterus is measured at eachprenatal visit after 20 weeks, and if your doctor is concernedthat your baby may be too small or large, an ultrasound canbe done to check.Preterm labour is when contractions start before 37weeks. Most pregnant women have ‘practice contractions’ or‘Braxton-Hicks’ during the third trimester. Signs of pretermlabour include regular painful uterine contractions before 37weeks, or the water breaking before 37 weeks. Any concernabout possible preterm labour should be assessed on thematernity ward at the hospital immediately.How much weight gain is normal in pregnancy?The amount of weight you should gain depends on your prepregnancyBMI, or body mass index. A healthy BMI is 20-25,and above this is overweight or obese. For women with anormal pre-pregnancy BMI, a weight gain of 25-35 poundsis best. Putting on too much weight is not healthy for you oryour baby. You can calculate your BMI at www.cfpcn.ca andfind out more about healthy weight gain at www.babycenter.ca/pregnancy/antenatalhealth/physicalhealth/weightgain/.What vitamins and supplements should I be taking inpregnancy?Unless your family doctor directs you otherwise, all pregnantwomen should take a prenatal multivitamin. Pregnant womenin Calgary should also take extra Vitamin D, 1000-2000 IUper day. Even the generic (non brand name) vitamins tendto be good - you don’t have to pick the most expensive one!What is the right amount of exercise during pregnancy?During pregnancy, it is important to stay active. As ageneral rule, you should maintain your usual exercise duringpregnancy. Some modifications may be necessary, such asavoiding high impact activities and contact sports. If youwere not a runner before pregnancy, now is not a good timeto start. But if you ran prior to pregnancy, you can continueto run, jog, or walk, with your body being your guide aboutwhat is too much. Staying fit during pregnancy will help youprepare for the physical challenge of labour.What are the basic things should I be doing in my pregnancy?It can be overwhelming trying to fulfill all the demands oflife during pregnancy, especially with pregnancy-relatedchallenges like nausea, fatigue, trouble sleeping, and achesand pains. Try to relax and enjoy your pregnancy. Regularexercise, adequate sleep, and a balanced diet are good foryou and your baby. Avoid alcohol and limit caffeine. Prenatalclasses and reading such as the Alberta Health Servicesbook “From Here Through Maternity” will help you to feelprepared during pregnancy, for labour, and for becoming anew parent.I hear so much advice from friends and family about what issafe in pregnancy, and I don’t know what to believe!Pregnancy is a beautiful and exciting time, but it is also scaryat times; it can be confusing deciding what to believe! Whenopinions contradict, it is often because there is no one rightanswer. Remember that pregnancy is a normal stage in ahealthy woman’s life.It can help to get information from books and websites,and we have included a list of recommended health sites.Websites:Northwest Maternity Clinic -www.rileyparkmaternityclinic.caBabyCentre.ca - www.babycenter.ca/pregnancy/Sensible Guide to a Healthy Pregnancy -www.healthycanadians.ca/pregnancyPregnancy Screening in Alberta -www.earlyriskassessment.comMedications in Pregnancy: www.motherisk.orgor call 1-877-439-2744Cord Blood Banking: www.acbb.caParenting: www.parentlinkalberta.ca andwww.calgaryhealthregion.ca/3cheersApps for your smart phone:“What to Expect: Pregnancy” (from Heidi Murkoff, author ofthe well-known and respected book)“Baby Centre: Pregnancy” (very informative on a wide rangeof pregnancy topics)“Pregnancy Companion” (tracks all sorts of things, fromcalories, water, kicks, contractions, etc.)“Pregnancy Tracker” (counts and tracks kicks as well ascontractions)Books:“What to expect when you’re expecting” (by Merkoff)“The Pregnancy Bible” (by Stone and Eddleman)“Pregnancy Day By Day” (by Herer)The AuthorDr. Kristine Bertsch works with the Northwest MaternityClinic, a group of family physicians providing low-riskobstetrical care at the Foothills Hospital. qCrowfoot Village Family Practice 9

Your experience,your choice.Calgary MRI & CTAppointments in 1-3 daysAdditional services:*Walk in X-rayUltrasoundMammographyBone DensityPain ManagementTherapyG.I. Studies*Services vary by locationSpecializing in Spinal BracesComputer Designed & Graphite Foot OrthoticsKnee, Ankle, Elbow & Wrist BracesPlus Complete Prosthetic CareCalgary, Edmonton & OkotoksToll free: 1.877.420.4CDC (4232)CanadaDiagnostics.caKen Moghadam C.O. (c) DirectorCascade Orthotics Ltd. &Cascade Prosthetic Services2636 Parkdale Blvd. NW, Calgary, ABWest of Crowchild on MemorialAppointments Recommended403-283-787210 Crowfoot Village Family Practice

Constipation:The other slow food movementOK, so the title is a bittongue in cheek, butconstipation is a commonproblem. Constipationcan be caused by manythings including lack offiber and fluid in the diet,stress, medications suchas opioids, and medical illness.It is estimated thata person needs enough fiberand fluid in their dietto result in one bowelmovement daily with theconsistency of the stoollike wet cement. This isa softer consistency andmore frequent pattern than most peopleexperience. Other authors reportthat an adult is considered constipatedif there is straining to eliminate thestool, pain, or fewer than three bowelmovements weekly. Dietary estimatesinclude greater than 20 grams dailyfiber for women and greater than 30grams daily fiber for men, with increasesfor those over age 50.Alleviating frequent constipationcan be a difficult problem to overcome.There are several approaches that canbe beneficial and your doctor can helpyou come up with a plan. Approachesmay include behavioural modificationincluding having a set time of the dayfor a bowel movement. The bowels aremost active following meals and thismight be a good time to “schedule” aregular toilet time. For busy people,sometimes “heeding the call of nature”is all that is required. If the bowels areworking smoothly a bowel movementshouldn’t take a long time.Sometimes foods like prunes andspinach are used to boost fiber in thediet. Good sources of fiber includewhole grains, fruits and vegetables,legumes, and nuts and seeds. Thereare lots of sources on the Internet thatcan help you determine which foodsare considered high fiber. Other timesyour doctor may prescribe somethingto help resolve the constipation. Thereare several classes of agents thatmight be used including:• Bulking agents such aspsyllium (Metamucil-typeproducts) or dextran (derivedfrom wheat, Benefiber-typeproducts)• Osmotic agents such asPEG-3350 (LaxADay,Restoralax, PegLyte),lactulose, sorbitol ormagnesium citrate• Stimulant laxatives suchas bisacodyl or sennaMedications might beoral, suppositories or enemas,depending on yourparticular situation.Constipation is usually an annoyingproblem, but long-term straining andconstipation can lead to hemorrhoids.You should also talk to your doctor ifyou experience any of the following: achange in your stool pattern, blood inyour stool, lots of pain, fevers or weightloss, as these signs may signify a moreserious condition. Be sure to talk toyour doctor if you have any concernsregarding your bowels. q—By Dr. Michelle KlassenFamily Physician, Crowfoot VillageFamily PracticeCrowfoot Village Family Practice 11

When to be concernedabout video gameshave to admitI that of all thetopics I’ve taught,researched, treated,and investigated,one of myfavourite has beenthe topic of videogame addictions.Why? Well, forone thing, I wouldhave to shamefullyadmit that Ilike playing them!I’ve enjoyed playingthem since myfather first bought our XT88 computer in the early 80’s, withits DOS interface and its MIDI sound. Nor is the concept ofvideo games being addictive new to me. Long before psychologistsstarted writing about it, my own father walkedinto the computer room a few months after the purchase ofsaid computer and proclaimed that I was addicted to them!I calmly explained to him that as I was getting all my workdone, getting straight A’s, and had a nice social life, I couldn’tpossibly be addicted. My father quietly contemplated hisnext argument, but decided against it and left me alone. Ididn’t know it at the time, but I had just demonstrated someaptitude for either law or psychology!Well video games have evolved since then. We thoughtTetris was addictive, but it doesn’t hold a candle up to today’simmersive, realistic worlds fully rendered with heroic representationsof live people (Avatars) that you can interact with,talk to and fight. These representations of us look better,wear cooler clothes, are faster and stronger, and get to dofantastic things. As the gaming industry has evolved, it hasalso grown into a multi-billion dollar industry.Game developers spend millionsresearching how to make games moreinteresting, desirable, and yes, evenaddictive.Observing gamers gaming, it’s easy to see what’s gottenpeople so uneasy... the focused look, the lost hours gone byunnoticed, and for some, the loss of time that should havebeen spent with friends, family, studies or work, and the increasedaggression and loss of interest in most other things.The average gamer spends several hours playing per day,and serious gamers play longer; much, much longer. RecentlyI treated a youngman who spent anaverage of sixtyhours gaming perweek. I asked himto imagine whathe could accomplishif he spentthat time doingsomething else.Like make a fulltime salary, or geta degree, or becomean accomplishedmusicianor an athlete. Helaughed...he thought it was silly to imagine spending sixtyhours per week studying or playing sports.I was on to something those many years ago when I usedthose criteria to argue why I was not an addict. We prettymuch use similar criteria today to determine if people areaddicted to stuff. Loss of interest in other tasks, emotionalor physical discomfort when the activity is stopped (in thiscase typically agitation and anger), negative consequences(health, mood, etc.), neglecting important activities (family,social, occupational, academic, etc.), inability to reduceplay time, spending significant time playing or thinking aboutplaying, and loss of a sense of time passing. Addictions aredestructive, and as fun as they are, video game addictionsare no less so. But we can’t confuse immersion or spendinglots of time on something with an addiction, at least not inthe clinical sense.Parents often complain to me or scold their kids that intheir time, they played outdoors, with handmade toys, wherethe air was fresh and everything so... well... healthy! Kids todayfind most things boring.I think we just live in an overstimulatedworld,and besides, the air isn’t quite as fresh as it used to be. Myadvice to parents (and spouses and significant others) is tobe open and talk about your concerns. Set limits and teachbalance in things early on, and if concerned, talk to a professional.Well, this article is done, now what should I do withmy time?? q—By Shervin Vakili, Ph.D., R.Psych.Clinical Psychologistwww.vakilipsychological.com12 Crowfoot Village Family Practice

Why Home BloodPressure Monitoring?By Kari Blessing RN, MN, NP, CCN(C)Hypertension, or high blood pressure, is a risk factorfor developing heart problems. Chronic high bloodpressure can put you at risk for developing blockages in thearteries that supply the heart muscle with oxygen. High bloodpressure can also lead to thickened heart muscle.Over time, this thickened heart muscle canlead to abnormal heart function, and insome people, this may cause fluid toback up into the lungs making itdifficult to breathe. High bloodpressure can also put you ata higher risk for having astroke or transient ischemicattacks, as well as, otherend organ damage such askidney disease.Traditionally, elevatedblood pressure is definedas repeated blood pressureof greater than 140 mmHgsystolic (top number) over90 mmHg diastolic (bottomnumber). There are special groupsof people with specific conditions thatwould be considered hypertensive if theirblood pressure was over 130/80 (persons withdiabetes and those with chronic kidney disease).You may be asked to monitor your blood pressure at home.There may be a number of reasons that you have been askedto do this. Getting a proper diagnosis of hypertension is veryimportant. For some, the stress of going to a physician’s officeor seeing someone in a white coat makes their blood pressurego up, but at home their blood pressure may be okay. Theopportunity for you to measure your blood pressure in yourown “stress free” environment ensures the proper diagnosisof hypertension. Alternatively, for some their blood pressureis “normal” at the doctor’s office, but in reality it is highand it goes undiagnosed. Lastly, it is essential that if youhave conditions that might put you at risk for hypertension(diabetes or chronic kidney disease) that you be diagnosedas early as possible so that with effective treatment you canreduce your risk of complications from hypertension.For those who have been diagnosed with hypertension,home monitoring of blood pressure provides your careprovider with valuable information. First of all, it helpstrack your treatment and helps your care providers knowwhat therapies or interventions are likely to be effective.This information helps guide dosage adjustments, addingmedications or making medication changes.Secondly, self monitoring of blood pressuremay motivate you to continue with thelifestyle changes you have made andto continue with the therapies thathave been recommended foryou.Home blood pressuremonitoring is a betterreflection of blood pressurethan doing it at a store.These are not bad places,but often you may be in rushand not settled, the cuff maybe the wrong size for youand the machines may nothave been calibrated recently.Most blood pressure cuffs youcan buy will come with the rightsized cuff, instructions for use, and canbe calibrated thus providing both you andyour care provider with valuable information tohelp you be as healthy as you can be.If you are diagnosed with hypertension, home monitoringis useful, but remember that there are other things you cando as well. Regular exercise - walking (150 minutes per week),eating a healthy diet high in fresh fruits, vegetables and lowfatdairy products; and low in salt and saturated fats, beingsmoke free, reducing alcohol consumption to not more than2 drinks per day (9 per week for women, and 14 per week formen), maintaining a healthy weight, and managing stress. q*Please ask your physician for more information on ServierCanada’s home blood pressure monitoring program.Crowfoot Village Family Practice Health CareMagazine would like to thank Servier Canada Inc. fortheir collaboration in this initiative.www.servier.caCrowfoot Village Family Practice 13

When you needto know. Now.The Annual Physical…how it’s changingDo you believe you need a full physical exam every year?Read on… you might not need one, or at least, not whatyou might consider “a good going over”…Historically, the physical exam was a way for yourphysician to check for any developing problems andinvolved a whole body check and a chance for you andyour doctor to discuss any concerns you might have. Forthe most part, the visit came out of an early concept ofdisease prevention and the desire to “fix any problems”before things got out of hand.The physical exam, periodic medical, annual orwhatever else you might call your preventativemedicine appointment is changing. There is a conceptin medicine called “evidence-based medicine” whichinvolves using best practices that are developedthrough research of what has been done in the pastand through randomized-controlled research studies.In the last several years, there has been much researchin preventative medicine and some of the results mightsurprise you.For example, did you know that thereis no benefit to you in having yourdoctor listen to your heart and lungsif there are no new signs or symptomsnoticed by you?Did you know that your blood pressure should bechecked frequently, even if you are feeling fine? Theseare some of the changes that you might notice as CVFPCall 403.777.4MRI (4674)www.mayfairdiagnostics.com14 Crowfoot Village Family Practice

embraces some of the new recommendations in familymedicine.CVFP is developing a new system for preventativehealth in which we are checking on a routine basisvarious items that have been shown to improveyour health (morbidity) and the length of your life(mortality). These checks might occur at one of yourregular appointments or they may occur at a specialappointment for preventative care. We anticipatethat these changes will be implemented throughoutthe coming year. As always, please communicate anyconcerns that you might have - we do want to listen andrespond.Below is a table of some of the things that your doctormay screen you for at your visits, depending upon yourage and individual medical history:Health Practice Males FemalesLifestyle (alcohol,XXexercise, smokingcessation, safety,sexual practices)Colon cancerXXscreening (formost, age 50)Blood pressure X XBreast/cervicalXcancer screeningProstate healthXAbdominalXaortic aneurysmscreeningBone health X XDepression /XXdementiaCholesterol/lipidsXXscreeningDiabetesXXscreeningChild growth andXXdevelopmentReview of yourvaccinationsXXYour doctor may add in other things, as indicatedby your personal history, or as new information onpreventative medicine becomes available.By ensuring your preventative care is done routinely,we are anticipating that more appointments willbecome available and access to see your doctor willget easier. q— By Dr. Michelle KlassenFamily Physician, Crowfoot Village Family PracticeThe newPureformRadiology ClinicsWhy wait?No or short waUltrasoundMammographyBone DensityX-RayBiopsiesWe are also introducing ourPediatric PracticePurekidswhere all images ofunder 18 year oldsare ALWAYS read bya pediatric specialistwww.pureformdiagnostics.comTelephone: 403 726 9729Touched by depression?www.DepNet.caA practical online resource.it timesfor all appointmentsSpecialists in psychiatrypioneers in neurologyCrowfoot Village Family Practice 15

The Team Approachto Primary CarePrimary care refers to the servicesyou receive for your basic, everydayhealth needs. It is your first point ofcontact within the health system andincludes the initial care, treatment andfollow-up of various health conditions,as well as referrals to the rest of thehealth system.At Crowfoot Village Family Practicewe are proud to provide primary care toour patients through a group of highlyskilled interdisciplinary professionalsworking together with our physicians.As a patient of CVFP, you have accessto a wide variety of team memberswho, led by your family doctor, can helpyou get the help you need and helpyou to make your own choices aboutmanaging your health.Our team of dedicated staffwhich include our Medical OfficeAssistants, Registered Nursing staff,Administrative Assistants and aspecialized Registered Nurse whosupports complex care planningfor patients with conditions such asHeart Failure, Chronic ObstructivePulmonary Disorder (COPD) andDiabetes. Our team approach ensuresthat our patients are seen by the mostappropriate health care provider.Recently, Mr. N.Y., a patient of ourpractice for more than 25 years,provided feedback of his on-going careprovided by our complex care nurse:“My nurse helps me feel morein control of my condition… myquestions and concerns are heardand addressed and she really16 Crowfoot Village Family Practice

understands my needs. “Several members of our team areactually staff of the Calgary FoothillsPrimary Care Network. PrimaryCare Networks (PCNs) are a made-inAlberta approach to improve access to,and better coordinate primary healthcare for Albertans province-wide. Thephysicians at CVFP are members ofthe Calgary Foothills Primary CareNetwork (CFPCN), which providesservices to the patients of familyphysicians who are practicing in thenorthwest of Calgary and the town ofCochrane.There are many benefits for patientswhose physician is a member of aPCN, including access to primarycare 24/7, integrated health servicesincluding linkages to specialty services,and support for people with complexmedical conditions. Membership withinthe CFPCN also provides access tointerdisciplinary team members tofacilitate comprehensive care. Theseadditional professionals on our careteams include:Pharmacist: Will meet with you toreview hypertension management,medication lists, home blood pressuremonitoring and answer medicationquestions.Behavioral Health Consultant: Conductsone on one or group sessions toaddress sleep problems, stress management,relationship issues, depressionand anxiety.Dietitian: Meets with patients forindividual dietary counseling, includingdiabetes, and provides dietary resourcesfor patients. The Dietitian alsoprovides group classes for a variety ofdietary questions.Diabetes Educator: Works togetherwith patients with diabetes who are insulin-dependentto manage insulin adjustmentand medication monitoring.PERSONALIZED SUPPORT AND SERVICES:• Custom Meds Compounding• Diabetes Care Centre - reviews,classes and products• Accu-Pak ® Blister Packaging• Free City-Wide Delivery• Immunization and InjectionsFind us on Facebook!“As your Medicine Shoppe pharmacist, I do more than just fill yourprescriptions – I help you make sense of the bigger health picture.I take the time to get to know you, understand your health needs,and get actively involved in improving your well-being.”– Randy Howden, B.Sc. Pharm, CDEP. (403) 455-9939Crowfoot West Business Centre#11 - 600 Crowfoot Crescent N.W. Calgary, ABLocated just downstairs by The Crowfoot Village Family Practicewww.medicineshoppecrowfoot.caRespiratory Educator: Works withasthmatic patients for on-going managementand care plan development.There is also a focus on smoking cessationand investigation, and managementof chronic cough in conjunctionwith respiratory specialists.Cognitive Assessment Nurse: Providescognitive assessments, includingscreening for dementia and depression.We are proud of this team; they helpus in achieving our overall goal whichis to ensure our patients are gettingthe best care possible from the rightprofessional with our healthcare team.q—By Shauna Wilkinson, ExecutiveDirector, Crowfoot Village FamilyPractice and Julia Mierau, PCNLiaison/ Program Manager - PopulationHealth, Calgary Foothills Primary CareNetworkMS260-RHowden-CVFP_Advert.indd 111-09-21 8:10 AMCrowfoot Village Family Practice 17

Frequently Asked Questions about Medical Teaching at CVFPQ: My doctor is also a teacher?A: Yes. Most of the doctors at CVFPare regularly involved in teachingresidents and clinical clerks.Q: What do you mean by “residents”?A: Residents are doctors that havefinished their undergraduate medicaldegree and are now training in theirchosen specialty of medicine. AtCVFP, we work with residents that aretraining to be the family physicians oftomorrow. It usually takes two yearsfor a resident to complete the familymedicine program.Q: What is a “clinical clerk”?A: A clinical clerk is a medical studentin his/her senior year, who has yetto fully complete medical school. Allclinical clerks do a mandatory rotationin family medicine, even if that is nottheir aspired career path.Q: Is medical teaching at CVFP a “newthing”?A: No. CVFP doctors have been teach-ing medical learners for many years.However, CVFP became an officialcore training site for family medicineresidents from the University of Calgaryin 2007, and for clerks in 2009. We“WHY DO I HAVE TO PAY FOR SERVICES-I THOUGHT HEALTH CARE IN CANADA WAS FREE?”Several times a day, patients comment to staff and physicians about charges forservices. The fact is, many services provided to patients are not covered by AlbertaHealth and Wellness. As many of you who are small business owners recognize, we mustrecover the cost of these services to continue to run our practice.The most common examples include notes for insurance companies or employersto cover sick time, physiotherapy, massage therapy and orthotics. Each note requiresstaff and physician time, documentation and charting, and responsibility for any futureinquiries. While it may seem like a small task for an individual patient, each teamprepares at least ten of these notes daily, with each requiring about ten minutes of staffand physician time. This represents over 1300 hours of work yearly - about three fulldays of clerical time weekly! It is clear why we need to charge for these services.Prescription refills by phone are another convenience for patients which are notcovered. Your physician provides a prescription that should last until you need to be seenagain (or one year, after which all prescriptions expire). When a pharmacist requests aprescription refill, your physician reviews your chart to see if it is appropriate, and mayask a nurse or clerical staff member to call you for required follow-up. We originally triedto include this as part of our service, but received over 800 requests a month! Once thecharges were introduced, patients made an effort to keep track of their prescriptionsand get them when in for an appointment, making the process much easier.If you have concerns about any charges, please address these with your doctor. Ourstaff follows office policy set by the physician group. While recognizing that exceptionsare sometimes required, staff members are unable to make exceptions without askingthe physician. We ask that you support and respect their role in collecting these fees.The most efficient way for the Crowfoot practice to provide these services is forpatients to pay an annual fee which includes the services they use. We encourage youto purchase a yearly package on our website at cvfp.com; it supports our practice andmakes life easier for everyone. qare now supervising up to 5 new residentsand 6 new clerks each year.Q: What are some of the benefits ofteaching residents and clerks?A: There are many benefits:- It helps address the doctor shortageby promoting family medicine to thenext generation of doctors.- Collegiality: Doctors who teach oftenenjoy practice more than those whodo not teach.- Residents and clerks are often helpfulmembers of the team - whether it’sdoing patient assessments, medicalliterature searches or chart reviews -two heads are often better than one.- It makes your doctor a better doctor.Learners often bring questions andperspectives that help us improve ourown practice.- Succession: Some of our graduatedresidents fill in for your doctor whenhe/she is away, and some others haveset up long term practices at CVFP.Q: Can I refuse to see a resident orclerk?A: Yes, you can, by informing the nursethat checks you in. However, we reallyappreciate when our patients allowlearners to be involved in their care. q—By Dr. Reid McLean WiestFamily Physician, Crowfoot VillageFamily Practice18 Crowfoot Village Family Practice

To book an appointment call 403.777.3000Relax, you’re in good hands.We have been providing expertradiology services for over 100 years.RCA has 10 clinics conveniently located across Calgarywww.radiology.caatGet yourvaccinationsIT’S EASY!today.Many vaccinations offered.Flu, shingles, meningococcal, pneumonia, Human Papillomavirus (HPV) and more.• Convenient services on a walk-in or appointment basis.*• Vaccination services available for businesses and other organizations.• See Pharmacy for details. Fee for service.* Age restrictions do apply. Available vaccinations vary by location.Crowfoot Village Family Practice 19

Monday - Friday 9 am - 9 pm • Saturday 9 am - 6 pm • Sunday 10 am - 6 pm