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RESEARCH MANITOBASpecial ReportWINNIPEG’S HEALTH AND WELLNESS MAGAZINE summer 2015<strong>Picture</strong><strong>THIS</strong>UV camera HELPSrAISE AWArENESSabout skin cancerAre you at risk?Bull’s eyeHealth officials takeaim at Lyme diseasePlusSoothe your soleMCEP class of 2015Control your appetiteBreaking the male codeKids learn to cycle safely

Stay active, eat healthy and ensure you have acoverage plan that suits your family’s needs.Whether it’s health, dental or travel, see whatBLUE ® can do for you!See your agent or visit us online at:www.mb.bluecross.ca

Parents • Friends • Family • Neighbours • Teachers • Partners • SpousesIt takes avillage toraise a child.visit www.withchildwithoutalcohol.comto get tips and tools for an alcohol-free pregnancyWEST NILE VIRUSWhat you need to know to protect yourself and your familyWhat are the symptoms?• A severe case of West Nile virus (WNV)can be life-threatening and may result inlong-term disability.• Some people develop an illness with symptomssuch as fever, rash, headache, fatigue andbody aches.• Most people infected with WNV have nosymptoms and do not become ill.Who is at risk?• Everyone is at risk of coming into contact withthe virus.• Severe illness most often occurs among olderadults or people with chronic health conditions orweakened immune systems. However, severe illnesshas occurred in all age groups.When is the risk highest?• The risk of WNV infection is highest during lateJune, July, August and early September.• The risk varies from year to year based ontemperature, precipitation, mosquito populationand other factors.How do I protect against WNV?• Reduce the time you spend outside betweendusk and dawn.• Apply an appropriate mosquito repellent.• Wear light-coloured, loose-fitting clothing withlong sleeves and pant legs.• Get rid of standing water around your home.• Make sure your door and window screens fit tightlyand are free of holes.For more information, visit our website atmanitoba.ca/health/wnv. For questions about WNVhealth concerns, contact your doctor or call HealthLinks – Info Santé at 204-788-8200(in Winnipeg); toll-free 1-888-315-9257.“Chronic fatigue and bouts of depression – all from the bite of a mosquito.Please take the time to protect yourself and those you love.”- Wayne, age 60 (Diagnosed with WNV in 2005)“Mosquitos infected with West Nile virus can bite anyone – and that‘anyone’ could be you! Take precautions to cut down the risk.”- Rachel (Lost her 66-year-old father to WNV in 2007)

This issue ofis brought to you by the following major sponsors:Partners in building Canada’sPartners in building Canada’shealthiest communityhealthiest community

8IN <strong>THIS</strong> ISSUEFEATURESCLASS ACTSChildren of the Earth studentslearn about careers in health carePICTURE <strong>THIS</strong>New UV camera helps raiseawareness about skin cancer102810BULL’S EYEHealth officials take aimat Lyme disease34DEPARTMENTS & COUMNSA LETTER FROM THEWINNIPEG HEALTH REGIONHave fun in the sun – but be carefulHEALTH BEATKids learn about bike safetyRESEARCH MANITOBAPartnerships for healthBALANCEBreaking the male codeASK A NURSESoothe your soleHEALTHY EATINGLearn to control your appetite7817444648172848Summer 2015 5

YOUR GUIDE TO THE RISING TIDE OF HEALTH & WELLNESS INFORMATIONFOR HEALTH SERVICES ONLINE DIRECTORY: wrha.mb.caOR FOR 24/7 HEALTH SERVICES ASSISTANCE CALL:Summer 2015 Volume 7 Issue 4Publisher Winnipeg Regional Health AuthorityInterim President & CEO Lori LamontRegional Director, Communications, Media,Public & Government Relations Jonathan HildebrandEditor Brian ColeContributing Writers Holli Moncrieff, Sharon Chisvin,Joel Schlesinger, Susie StrachanColumnists Audra Kolesar, Nicole Neault,Cheryl OgarankoCreative Director Krista LawsonPhotography Marianne HelmIllustrator Krista LawsonOn the Cover Elizabeth Harland,photographed with a UV cameraEditorial Advisory Board Lori Lamont, Réal J. Cloutier,Dr. Wayne Hildahl, Dr. Brock Wright, Lynda Tjaden,Dr. Cheryl Rockman-GreenbergWave is published six times a year by the Winnipeg Regional HealthAuthority and distributed by the Winnipeg Free Press. It is availableat newsstands, hospitals and clinics throughout Winnipeg, as wellas McNally Robinson Books.Winnipeg Free PressPublisher Bob CoxVice-President, Sales Laurie FinleyAdvertising in WavePhone: Dayna Oulion at 204-254-7170e-mail: dayna@delcommunications.com or wave@mymts.netSubscriptionsWave is available through subscription:One year (six issues) for $18.90 ($18+GST)Payment may be made by cheque, money order,VISA, or MasterCard.To subscribe, phone: 204-925-3304Or, send an e-mail to: heather.leeson@freepress.mb.caWave Editorial OfficeWinnipeg Regional Health Authority650 Main StreetWinnipeg, MB R3B 1E2Phone: 204-926-8144e-mail: wave@mts.netA French-language version of this magazine is available onlineat www.wrha.mb.ca/lecourant. For information, call 204-926-7000.The information in this magazine is not meant to be a substitute forprofessional medical advice. Always seek advice from your physicianor another health professional regarding any medical conditionor treatment. Opinions and views expressed in this publicationdo not always represent those of the Winnipeg Health Region. Thispublication may not be reprinted or reproduced in whole or in partwithout the consent of the Winnipeg Health Region.6 WAVEPour une version françaisetéléphonez au 926.7000Rendez vous à notre site Web:www.wrha.mb.ca/lecourantHEALTH LINKS - INFO SANTE...........................................................................................204-788-8200Toll-free................................................................................................................................ 1-888-315-9257Poison Hotline......................................................................................................................1-855-776-4766Mental Health Mobile Crisis Services............................................................................ 204-940-1781TTY (Deaf Access).....................................................................................................................204-779-8902Klinic Community Health CentreManitoba Suicide Line........................................................................................................1-877-435-717024-hour Crisis Line...................................................................................................................204-786-8686Toll-free..................................................................................................................................1-888-322-3019Sexual Assault Crisis Line.......................................................................................................204-786-8631Toll-free..................................................................................................................................1-888-292-7565Deaf Access Counselling.......................................................................................................204-784-4097Regional Head Office, 650 Main General Inquiry.........................................................204-926-7000QUICKCARE CLINICS (provides after-hours health services)McGregor QuickCare, 363 McGregor, 2nd floor, Win Gardner Place....................204-940-1963St. Mary’s QuickCare, 17 St. Mary’s Rd..............................................................................204-940-4332Dakota QuickCare, Unit 3, 620 Dakota St........................................................................204-940-2211URGENT HEALTH-CARE SERVICESMisericordia Health Centre – Urgent Care, 99 Cornish Ave.....................................204-788-8188Pan Am Minor Injury Clinic, 75 Poisedon Bay................................................................204-925-4332HEALTH-CARE FACILITIES (general enquiry numbers)Concordia Hospital, 1095 Concordia Ave.......................................................................204-667-1560Deer Lodge Centre, 2109 Portage Ave.............................................................................204-837-1301Grace Hospital, 800 Booth Dr...............................................................................................204-837-8311Health Sciences Centre (HSC), 820 Sherbrook St.24-hour general inquiries......................................................................................................204-787-3661Toll-fee...................................................................................................................................1-877-499-8774Manitoba Adolescent Treatment Centre, 120 Tecumseh St....................................204-477-6391Miscericordia Health Centre, 99 Cornish, Patient/Resident Inquiry......................204-774-6581Pan Am Clinic, 75 Poisedon Bay.........................................................................................204-925-1550Riverview Health Centre, 1 Morley Ave...........................................................................204-452-3411St. Amant, 440 River Rd..........................................................................................................204-256-4301St. Boniface Hospital, 409 Tache Ave, Patient Inquiry................................................204-237-2193Seven Oaks Hospital, 2300 McPhillips St.........................................................................204-632-7133Victoria Hospital, 2340 Pembina Hwy..............................................................................204-269-3570Birth Centre, 603 St. Mary’s Rd............................................................................................204-594-0900Northern Connection Medical Centre (primary care for northern residents in Winnipeg),425 Elgin Ave...........................................................................................................................204-940-8777COMMUNITY HEALTHAboriginal Health Services....................................................................................................204-940-8880Travel Health (travel immunizations), 490 Hargrave......................................204-940-8747 (TRIP)Street Connections (496), 496 Hargrave.........................................................................204-981-0742Family Doctor Connection(Doctors accepting new patients).....................................................................................204-786-7111Breastfeeding hotline.............................................................................................................204-788-8667Dial-A-Dietitian.........................................................................................................................204-788-8248Toll-free....................................................................................................................................1-877-830-2892TeleCARE/TeleSOINS Manitoba..........................................................................................204-788-8688Toll-free....................................................................................................................................1-866-204-3737COMMUNITY OFFICES(Public Health, Home Care, Mental Health & Community Development)Assiniboine South Health & Social Services, 3401 Roblin Blvd...............................204-940-1950TTY for the deaf........................................................................................................................204-940-1955Fort Garry Community Health Office (WRHA), 2735 Pembina................................204-940-2015Inkster / NorWest Coop Community Health Centre, 785 Keewatin St.................204-940-2020River Heights Health & Social Services Centre, 6-677 Stafford St..........................204-938-5500River Heights Home Care (WRHA), 1001 Corydon Ave..............................................204-940-2005St. James Assiniboia Health & Social Services , 2015 Portage Ave........................204-940-2040Seven Oaks Health & Social Services Centre, 3-1050 Leila Ave...............................204-938-5600Point Douglas Community Office, 601 Aikins.............................................................. 204-940-2025Point Douglas Home Care, 80 Sutherland......................................................................204-940-6660St. Boniface Community Office, 240-614 Des Meurons St........................................204-940-2035St. Boniface / St. Vital Home Care Office, 640-5 Donald St.......................................204-940-2070Downtown West Health & Social Services, 755 Portage Ave..................................204-940-2236Downtown East Community Office, 2-640 Main St.....................................................204-940-8441COMMUNITY OFFICES WITH PRIMARY CARE(includes physician services)ACCESS Downtown, Health Action Centre -Primary Care Clinic, 640 Main St.......................................................................................204-940-1626ACCESS River East, 975 Henderson Hwy.........................................................................204-938-5000ACCESS Transcona, 845 Regent Ave. W...........................................................................204-938-5555ACCESS Nor’West, 785 Keewatin St...................................................................................204-938-5900Aikins Street Community Health Centre, 601 Aikins...................................................204-940-2025River Heights Primary Care Clinic, 1001 Corydon Ave...............................................204-940-2000Inkster/Nor’West Coop Health Centre, 785 Keewatin St...........................................204-940-2020BridgeCare Primary Care Clinic, 425 Elgin......................................................................204-940-4384HOME CARE SERVICESGeneral Information, Intake and Referrals......................................................................204-788-8330After Hours (4:30 p.m. to 8:30 a.m.)...................................................................................204-788-8331For the Home Care Office or Nursing Service, contact a Community Office in your area.Visit wrha.mb.ca for more health-related information.

A letter from theWinnipeg Health RegionLori Lamont,Interim President & CEOSummer. We spend all winter waiting for it.Have fun in the sun –but be carefulAnd, so far, this one appears to be wellworth waiting for.Over the last few weeks, we have beenblessed with a string of sunny days wherethe temperature has hovered around the30 C mark, which is just about as closeto perfect as you can get. And that meansmore people are heading outdoors to takeadvantage of the beautiful weather.That’s a good thing. Blue skies andsunshine are meant to be enjoyed. Indoing so, though, it is important to letmoderation be your guiding principle.That’s because all that fun in the sun canbe accompanied by certain health risks.Talk to people who work in the city’semergency departments, for example, andthey will tell you that they tend to seemore injuries during the summer than atany other time of year. In fact, health-careworkers right across the country often referto summer as “trauma season.”The reason for the surge in patientsseeking care is obvious. As the temperaturerises, more people head outdoors toparticipate in their favourite recreationalactivities. With more people cycling,driving, swimming, camping and playingall manner of sports, from tennis tofootball, it’s not surprising that morepeople end up coming to emergency witheverything from minor sprains and brokenbones to major head injuries.But trauma-related injuries are only partof the story. In recent years, Manitobanshave also had to be aware of otherpotential health issues during the summermonths. Take skin cancer, for example.While more people are learning aboutskin cancer, there are still too many peoplewho do not realize just how much damagethey can do to their skin by spending toomuch time in the sun unprotected.CancerCare Manitoba Foundationhas come up with a novel way to raiseawareness about this problem. As ourcover story explains, the foundation hasacquired a special camera that can detectskin damage caused by the sun’s harmfulultraviolet rays. As our story on page 28points out, these images will often revealthat someone has suffered some skindamage and would be well advised tomake sure they apply sunscreen beforeheading out for a day in the sun.It’s a good thought, one that more of usshould be thinking about.That’s because skin cancers of all kindsare on the rise. Melanoma, for example, isone of the fastest growing types of cancerin Canada. Between 2001 and 2010, itincreased at an annual rate of 2.3 per centfor men and 2.9 per cent for women. InManitoba, melanoma rates have increased15-fold since 1960. It is estimated thatabout 190 people will develop melanomain this province during 2015.There are things people can do toreduce their risk of skin damage and thepotential development of skin cancer.A photo taken with CancerCareManitoba Foundation’s new UV camera.Wearing sunscreen is important, butCancerCare Manitoba also recommendsthat people seek shade, wear a hat andavoid spending too much time in the sunduring the peak hours between 10 a.m.and 4 p.m. You can find more informationin our story, including tips on how toproperly apply sunscreen.Skin damage, of course, isn’t the onlysun-related health issue. The warmweather that makes summer so enjoyablecan also lead to other health problems,including dehydration and heat stroke. Tolearn more, visit www.wrha.mb.ca anddownload the Sun Safety Guide.Other summertime health risks haveemerged in recent years. For example, itwasn’t all that long ago that mosquitoeswere nothing more than a nuisance.Then, in 2002, we started to hear about amosquito-borne disease called West Nilevirus (WNv). Since 2003, there have beenmore than 900 confirmed human cases ofWNv in Manitoba, although the numbershave dropped off dramatically in recentyears. While the odds of developing WNvremain low, those who do can becomequite ill. Symptoms can include fever,rash, headache, fatigue and body aches.You’ll find more information about WNv atwww.wrha.mb.ca.In addition to West Nile virus,Manitobans must also contend withthe emergence of Lyme disease. Thispotentially debilitating illness is causedby a bacteria spread by the blackleggedtick, itself a relative newcomer to theprovince. As our story on page 34 pointsout, Manitoba has recorded 60 confirmedand 55 probable cases of Lyme diseasesince 2009.As it has done with West Nile virus,Manitoba Health has taken steps to raiseawareness about this illness. In additionto posting information online about Lymedisease, it has also created a map thatshows where significant populations ofblacklegged ticks are located. A copy ofthe map appears on page 39.While everyone is at risk for sustainingan injury or becoming infected with rarebacteria, the odds of this happening arevery small, and can be made even smallerby taking the appropriate precautions.Moreover, no one should let these risksprevent them from getting outside andtaking advantage of the great weather.After all, there is a far greater risk ofdeveloping heart disease or diabetesfrom lack of exercise than there is ofinjuring yourself while playing a game ordeveloping an illness from a bug bite. Andremember, winter is only a few monthsaway. Once it arrives, we’ll all be longingfor summer again.Summer 2015 7

health beatPhoto by Marianne HelmNice RideCity kids get a free bike &learn about riding safetyBy Holli MoncrieffKainelle Spence (left) andsister Percaioos Spence testout their bikes during a BikeTogether Winnipeg event.group of kids are lining up at a booth located in BlakeA Gardens, a housing development in Winnipeg’s NorthEnd, waiting to get fitted for free helmets to go along withtheir free bikes.But Kainelle Spence is hesitant to jointhem.The 10-year-old grips the handlebars ofa shiny white bike she has just receivedand looks up at her dad. “I’m not leaving.If I leave, someone will steal it,” she saysof her bike.Spence’s fear is understandable.Someone stole her last bike right out ofher yard – just cut the cable that washolding it to a fence and rode off with it.Eventually, though, she is able toovercome her fears, get her helmet, and8 WAVEride her new bike for the first time, happyas can be. When asked what it was aboutthe white bike that was so special, shehas an easy answer.“I was thinking it would go fast,” shesays, smiling shyly.As its name suggests, Bike TogetherWinnipeg is a true community effort.Organized by IMPACT, the WinnipegHealth Region’s injury-preventionprogram, Bike Together Winnipeg is apartnership between the Sports Medicineand Science Council, Manitoba PublicInsurance (MPI), Winnipeg PoliceServices, City of Winnipeg, WinnipegFire Paramedic Service, HeadingleyCorrectional Centre, Bike Winnipeg,Green Action Centre, and the WinnipegRepair Education and Cycling Hub(WRENCH).The goal of the bike events – therewill be five this summer – is twofold: topromote cycling as a healthy, affordablemode of recreation and transportationand to promote bike safety behaviours.“We want to get more kids on bikes and

eing safe, including wearing a helmet for every ride andfollowing the road rules,” says Wendy French, IMPACT’sInjury Prevention Co-ordinator.“Lots of organizations were doing some cyclingpromotion and safety education. Bike Together Winnipegbrought the major players together for a more co-ordinatedapproach.”The bikes are not actually new. They were abandonedbefore being brought to Headingley Correctional Centre,where trustees repaired and repainted them. Members ofWRENCH double-checks them and teaches the kids how tokeep their bikes in good repair.After the children are fitted for a helmet and a bike,they are taught the ABCs of bike maintenance: air, brakes,chains, along with basic hand signals. Then the kids headto MPI’s bike rodeo, where they guide their new bikethrough a maze of orange pylons, learning skills such asturning and signalling. Winnipeg Police Service officersand cadets are there to teach them about safety and givethem a hand, if necessary.“It’s nice to see them giving back to the community,”says Kainelle’s father, Joseph Chartrand, of theorganizations involved in the program. Chartrand broughttwo of his four children to the event. “I’m really happy thiscame along. It means a lot. The girls are excited about it.They’ll be happy to have a bike again.”IMPACT works to make Winnipeg safer for cyclists andpedestrians through education, advocating for safer policiesand promoting safety equipment. And while Winnipeg istaking measures to make roads safer for cyclists, such asadding bike lanes, riders continue to be injured.Each year in Winnipeg, approximately one or twocyclists die and another 70 are hospitalized. According toIMPACT statistics, head injuries cause 80 per cent of childcycling deaths and 28 per cent of cycling-related hospitaladmissions. A helmet, worn properly, can reduce the riskof head injury by up to 85 per cent, and brain injury byup to 88 per cent. Yet despite legislation requiring cyclistsunder the age of 18 to wear helmets, not everyone does.In 2013, for example, only 49 per cent of Winnipegcyclists wore helmets. Helmet use was highest amongchildren eight to 11 years of age, at 87.2 per cent, andlowest among youth between 16 and 19 years of age, at26.4 per cent. The Bike Together Winnipeg project wasconceived as a way to reinforce good helmet behaviour.“We’re working in areas with the lowest rate of observedhelmet use,” French says.During the June 25th event at Blake Gardens, 27children received free bikes and helmets. Bike TogetherWinnipeg hopes to give away 250 bikes, helmets and locksthis summer.The youngest rider was Hassan Abdikadir, who is justtwo years old. He was so little that he needed his dad togive him a push in order to get rolling.“He’s very active,” says his father, Ahmed Mohamud,who immigrated to Winnipeg from Somalia with his wifeand children. “The children need bikes in the summer tohave fun and be active. They’ll be healthier, stronger, getmore exercise and eat well.”His daughter, Huda Abdikadir, 12, already has plenty ofplans for her new wheels. Her first stops will be the parkand a candy shop. “It’ll be easier for me to go to schooland to have fun in the summertime,” she says.Quick access,one-on-one,athlete levelcare for all• Sport Medicine Physician• Physical Therapy• Athletic Therapy• Chiropractor• Massage Therapy• Concussion Care (Shift Accredited)Call 204-813-1031to book an appointmentwww.sportmedicinecentre.caCOME SEE US2nd Floor, 145 Pacific Ave.Winnipeg, ManitobaHolli Moncrieff is a Winnipeg writer.

Class actsChildren of the Earth studentsMCEP GRADUATES 2015look forward tocareers in health care10 WAVE

This year marks the largestgraduating class of Childrenof the Earth students sincethe inception of the MedicalCareers Exploration Program.Seven students – Bree Castel, Raven Favel,Natasha Hill-Head, Lisa Harper, Aidan Pedlar,Stephen Sward and Ocean White – hadhands-on experience in clinical settings at HealthSciences Centre, the Grace Hospital and thePan Am Clinic, with a view to helping thempursue further studies in health care. Two morein the class, Shanae Harper and Raven Traverse,will complete their high school courses this fall.Launched in 2007 by the Winnipeg HealthRegion and the Winnipeg School Division, theprogram provides Aboriginal students fromChildren of the Earth with invaluable experiencein the many options available to them, if theychoose to follow a health-care career path. Oneof the program’s goals is to address the fact thatonly three per cent of health-care workers inWinnipeg are Aboriginal.Students in the program take the samecore subjects as other Children of the Earthstudents, plus the Medical Careers Explorationcourse, which is designed to support the clinicalinternships. It includes material about the body’ssystems, anatomy, physiology, and customerservice. The students also learn traditionalAboriginal ways of healing and medicine,and work on information communicationtechnologies to enhance their computer skills.Students in the program receive $1,000 towardpost-secondary education from Bright Futures foreach year of high school they complete.Previous MCEP students have gone on tofurther their studies or are working in a healthcarefield. According to MCEP teacher StacieOnofriechuk, Colten Pratt (2013) graduatedas a paramedic, Dillon Courchene (2012) isstudying science at University of Manitoba, AmyBousquet (2013) is in second-year nursing studies,Leanne Hartley (2013) is studying science,Darian Anderson (2012) is studying social work,and Lorelei Everett (2011) is studying nursing atUniversity of Manitoba.Photographer Marianne Helm and writer SusieStrachan recently spent two days at the GraceHospital with this year’s graduating class. Theirreport appears on the following pages.The 2015 Medical Careers Exploration Program classincludes (from left): Raven Traverse, Aidan Pedlar,Raven Favel, Lisa Harper, Ocean White, Natasha Hill-Head, Bree Castel, Stephen Sward, Shanae Harper.Summer 2015 11

Gail Iwan, clinical co-ordinator of Diagnostic Imaging at the Grace, andradiological technologist Jason Lewis show students Aidan Pedlar and RavenTraverse how to take an X-ray of a wrist. Pedlar, who enjoys a good sciencejoke, says he enjoyed learning about surgery the most during his three yearsin MCEP, because of the technology used to see inside people during theprocedures. “I’d like to become a virologist,” he says, adding that he enjoyslearning about anything to do with science. Meanwhile, Traverse says sheenjoyed diagnostic imaging the most, and plans to go into radiology, aftertraining as a health-care aide to fund her way through further studies. “Ilike working one-on-one with people,” says Traverse. “Radiology is also aportable skill, and I’d really like to travel and see the world.”Registered nurse Josie Sy shows Natasha Hill-Head how to package samples and send them viathe vacuum tube to the lab for testing, while working at 5 North at the Grace Hospital. Hill-Headwill be studying at the University of Manitoba in the fall, and says her goal is to work either asa nurse or a paramedic. Hill-Head loves cooking, and has taken baking classes in the culinaryprogram at Red River. She also volunteers at Health Sciences Centre, and was instrumental insetting up the Grade 12 graduation celebration.12 WAVE

Shanae Harper and Bree Castel learn how to measure a patient’srange of motion from physiotherapist Amanda Oike in thephysiotherapy department. “We learned that she had a kneereplacement in March, and that she has to do a lot of exercise,” saysCastel about the patient. Castel, who was born in Thompson andraised in Peguis, says she came to Children of the Earth specificallyfor MCEP. “I want to go into nursing, so I’m going to enter the AccessNursing program at Red River.” Through the MCEP classes, Harperfound she enjoyed the spiritual care aspect the most. “I want tobecome a funeral director,” she says, adding that she found aconnection with the spiritual care departments at Health SciencesCentre and the Grace Hospital. “I found I like helping people dealwith grief,” says Harper.Genesis Plus & Noveon LaserTreatment for fungal nails and warts!Summer 2015 13

Registered nurse Ann Nzeruem teaches Lisa Harper and RavenFavel how to add medication to an oxygen line, while in thedispensary at 3 North at the Grace Hospital. They also askquestions about what life is like for a nurse on a ward. “Shesaid each nurse has six to eight patients, depending on howbusy it is,” says Harper. “They do more than give medicine andneedles,” adds Favel. “The nurse is the person who talks to thepatient the most.” Along with learning about how nurses work,Harper also enjoyed working with a physiotherapist in the postacuteneurosurgery ward, helping patients regainmobility after incidents like head trauma. Forher part, Favel would like to train as anX-ray technologist at Red River College,although she’s also ponderingtraining as a police officer.Stephen Sward learns how to program anIV pump under the guidance of registerednurse Chantal Packulak in the Intensive CareUnit at the Grace. Sward will be going touniversity in the fall, with the goal of studyingbiochemistry before applying to medicalschool. “I want to become a surgeon,” hesays, adding that he’s strong in math andsciences. “This program has been awesome.I’ve sat in on surgeries at Health SciencesCentre and Pan Am. I learned a lot aboutorthopedic and plastic surgery. I maychange my mind once I make it to medschool, but I like what I saw when workingwith the surgeons during the practicums.”14 WAVE

Ocean White readies a sling-lift under the guidance of health-careassistant Felino Padre on 2 North in orthopedics at the GraceHospital. White, who was born in Thunder Bay, and raised inWhitefish Bay, Ont., would like to become a family physician.She will study science at the University of Manitoba this fall.She enjoyed working in the medical areas at the Grace,the Pan Am Clinic and the Health Sciences Centre in theMCEP group. Along with her studies, White worked parttime,volunteered and played volleyball in high schooland for Team Manitoba at the Indigenous Games, and isa jingle dress dancer.Summer 2015 15

INDIVIDUALMEMBERSHIPSWORK OUT TO JUST$17/weekYouReady?AREIf you’ve been promisingyourself that it’s timeto improve your health,feel better, get stronger,or lose weight, come seeus at the Reh-Fit Centre.Whatdo youlive for?Check out our fitnessand education programsat www.reh-fit.comCentre Hours:Monday to Thursday 6 am - 10 pmFriday6 am - 9 pmSaturday & Sunday 7 am - 5 pmReh-Fit Centre 1390 Taylor AvenueCome see usand take atour today!Cancer screeningsaves lives.supported by8957-JC-Reh-Fit-WaveMagAd[AreYouReady][3.75x5]-May2015-2.indd 12015-05-13 11:42 AMSt-Boniface Hospitalis mending damaged heartswith research.Our researchers improve lives everywhere.Meet them and watch their videos at ResearchWasHere.com

S p e c i a lr E P o r tPartnershipsfor healthmanitoba researchers aim to help builda better health-care systemAdvances in the delivery of health carecome about in many different ways.In some cases, improvements can occur through thedevelopment of new drugs or surgical techniques. Inother cases, they can be attributed to changes in thesystems used to deliver care.The Canadian Institutes of Health Research andResearch Manitoba understand that both of theseapproaches can make important contributions to theongoing effort to improve care.As a result, they have joined forces through thePartnerships for Health System Improvement (PHSI)program. Launched in 2007, the program is designed tosupport researchers and decision-makers interested inconducting applied and policy-relevant health systemsand services research that strengthens this country’shealth-care system.Manitoba researchers eligible for the program aresupported by grants from the Canadian Institutesof Health Research, Canada’s primary funding bodyfor health research, and Research Manitoba, whichsupports provincial researchers working in the fields ofhealth, natural sciences, social sciences, engineeringand the humanities.This special report, sponsored by Research Manitoba,highlights some of the work being carried out byprovincial researchers under the Partnerships for HealthSystem Improvement program.r e s e a r c h M A N I T O B A 1 7

News you can trustevidencenet work.ca provides insightinto Canada’s thorniest health policyquestions By Joel SchlesingerThere was a time, a few yearsback, when Noralou Roos wouldfind herself becoming frustrated bymedia coverage of important healthpolicy issues such as fee-for-servicecare or childhood obesity.“For years, my basic job was a researcher in health policy, and I would readthings in the newspaper that would be completely counter to what the researchon a topic actually stated,” says Roos, a co-founder of the Manitoba Centre forHealth Policy.So one day Roos decided to do something about it.Over lunch with a colleague, she was encouraged to apply for a grant from thePartnerships for Health System Improvement program, funded by the CanadianInstitutes of Health Research (CIHR), to develop a mechanism to get the latesthealth policy research in the hands of media to ensure reporting was based onpeer-reviewed, scientific evidence.“At the time, I thought it sounded a little crazy because I’d never done anythinglike it, but then I thought, ‘Why not?’” says Roos, who is a professor in theFaculty of Health Sciences at the University of Manitoba and an internationallyrecognized researcher on health policy.In 2010, with funding from CIHR and Research Manitoba, she assembled asmall editorial team and launched EvidenceNetwork.ca – a website dedicated toproducing backgrounders and commentaries on a range of health policy topics.In addition to publishing these articles online, the website also distributes themto newspapers and other media outlets across the country. It also serves as aninformation clearing house where reporters can quickly find helpful, accurateinformation on a wide variety of health policy topics or connect with expertsin a particular area. As a result, researchers now have multiple ways to spreadthe word – the right word – on a variety of topics ranging from mental health tohealth-care spending.“The people that we have invited to work with us are some of the most highlyrespected scientific researchers in Canada,” says Roos. “Many are research chairs– leaders in their field. And, in addition to writing articles for us, they are alsoavailable to answer questions from journalists who are pursuing their own stories.”Working behind the scenes to ensure their work is read by as many people aspossible is an editorial team that includes Managing Editor Kathleen O’Grady, ofOttawa, journalist intern Melanie Meloche-Holubowski,of Montreal, and website Editor Eileen Boriskewich, whois based in Winnipeg. Other contributors include NanciArmstrong and Carolyn Shimmin, both from Winnipeg.Roos has also tapped a number of journalists to adviseher on the project. Former Winnipeg Free Press CommentEditor Gerald Flood advised Roos on the website fromthe beginning, and her advisory board includes Free Pressreporter Mary Agnes Welch and National Post reporterTom Blackwell, among others.EvidenceNetwork.ca’s main weapon in the battleagainst misinformation is the commentary. In addition tobeing published on the website with a creative commonslicence (which means anyone can reprint the content),these columns, which generally run about 650-words, aremade available to newspapers across the country throughindividual agreements or via Troy Media Service at no cost.“We tried to do things in a way that is interestingbecause we realized that editors won’t publish ourcommentaries otherwise,” Roos says.Manitoba researchers have been active contributors,writing about a number of controversial topics.For example, Michelle Driedger, a professor andCanada Research Chair in Environment and HealthRisk Communication in the Department of CommunityHealth Sciences at the University of Manitoba, wrote onthe importance of getting her family vaccinated againstinfluenza. Dr. Harvey Chochinov, Director of the ManitobaPalliative Care Research Unit with CancerCare Manitoba,tackled the controversial issue of assisted suicide,discussing the difficult challenges of implementing thispolicy in the health-care system.These articles and others have been well-received bynewspaper publishers across the country. The numberof commentaries published in all newspapers acrossCanada has grown from 171 in 2011 to 781 in 2014. Majornewspapers, including the Free Press, The Globe and Mail,and the Toronto Star, published more than 200 of theirarticles in 2014.Among the more important issues addressed byEvidenceNetwork.ca early on was the impact of aging onour health-care system. This was of particular interest toRoos, who thought media had been greatly exaggeratingthe problem, referring to the large demographic ofboomers – now entering retirement – as an “agingtsunami” that would overwhelm the health-care system.“You couldn’t pick up the newspaper without readingthat the whole health-care system was going to bedestroyed because of a wave of aging boomers.”The editorial team at EvidenceNetwork.ca got towork organizing their experts to write commentariesand backgrounders based on the latest research, all inan easily digestible format for news media. One of thearticles was co-written by Roos and former Free Pressr e s e a r c h M A N I T O B A 1 8

Editor Nicholas Hirst.“We really laid out what the evidencewas on this,” Roos says. “And the mainmessage was yes, a larger percentage ofthe population is aging, and yes, this willhave an impact on health care, but theevidence shows it’s about a one per centincrease a year, which is not a tsunami.”In that sense, EvidenceNetwork.cahas proven to be a valuable informationhighway for knowledge translation –ensuring that research does have animpact on public debate about variousissues, according to Kristy Wittmeier,Director of Knowledge Translation at theWinnipeg-based George and Fay YeeCentre for Healthcare Innovation.“Carefully written (commentaries)promoted through EvidenceNetwork.cahave been referenced by provincial healthministers, have been used to help informprovincial inquiries, and have had ongoinglarger health policy impacts,” she says.For example, after researcher MarniBrownell’s article about Manitoba’s highrates of taking children into protectivecare was published in the Free Press, theauthor was invited to testify before theprovincial Commission of Inquiry into thedeath of Phoenix Sinclair – a five-year-oldgirl who died of abuse while in the careher mother and boyfriend.“The recommendations made inthe Honourable Edward (Ted) Hughes’report reflected Dr. Brownell’s testimony,and the recent commitments made bythe Government of Manitoba to focuson supports to avoid taking childreninto care also reflect Dr. Brownell’swork,” says Wittmeier. It’s likely noneof that would have happened withoutEvidenceNetwork.ca, she says.Feedback from media has beenpositive. If anything, editors want the siteto expand its breadth of offerings. Videosand podcasts, for example, were addedonly recently. “We have been told by themedia that we needed to be doing thesethings because many newspapers needvideo for their websites.”Another measure of the website’ssuccess is the popularity of an annuale-book containing articles from theprevious year. About 10,000 copies havebeen downloaded in each of the last twoyears. “To be considered a bestseller inCanada, you need to sell 5,000 books, sowe’re quite pleased with the reception thework of our team is getting.”Perhaps the greatest indication ofthe website’s value has been continuedbacking from research funding agencies,including Research Manitoba. “One ofthe reasons Research Manitoba is sosupportive of what we’re doing is becauseit’s been a pretty unique and effectiveapproach to getting research into themedia, and having policymakers and thepublic get a better understanding of veryhigh-profile health topics.”With its second round of funding fromthe CIHR and the provincial agency set torun out next year, EvidenceNetwork.castands at a crossroads. “Many aresupportive of what we have been doing, sonow we’re in the process of trying to workwith the National Association of ProvincialResearch Organizations and the CIHR todevelop an ongoing funding system.”Roos says continued support fromResearch Manitoba has helped keepEvidenceNetwork.ca based in Winnipeg,and keeping it in her backyard remainsthe intention.“Fortunately, the site has beenso effective in getting evidencebasedresearch on health policyinto mainstream media that there istremendous interest in keeping itgoing,” she says. “So we hopeto keep it in Manitoba, butat the end of the day, justkeeping it going is ourtop priority – Canadiansneed the evidence.”EvidenceNetwork.cafounder Noralou Roos.PROJECT PROFILEPrincipal InvESTIgATOR: NoralouRoosProjECT: Injecting Evidence intoHealth Policy CoverageFUNDINg: 2009 to 2015: Canadian Institutesof Health Research, $768,121;Research Manitoba, $191,000.2014, 2015: The George and Fay YeeCentre for Healthcare Innovation,$192,765.

Lines of communicationBuilding better personal care homesthrough sharing information By Joel SchlesingerManitoba researcher Malcolm Doupetells a story about an effort to improvethe quality of care at a personal carehome in British Columbia a few years ago.It started when a research team met withthe staff at the home to learn more aboutwhat they thought about what could be doneto make things better for residents.After some discussion, the staff identifieda number of challenges, including theprevalence of pressure ulcers on patients.Pressure ulcers are an issue at many personalcare homes in Canada. They occur when skinis continuously pressed or rubbed againstsomething. Personal care home residents willsometimes develop pressure ulcers if they arebed-ridden.In short order, the health-care aides at thehome started to talk about the need to comeup with a system to ensure residents weremoved often enough to avoid developingpressure ulcers, says Doupe, who is a seniorresearch scientist with the Manitoba Centrefor Health Policy. One idea was to create awall chart that would specify exactly wheneach resident at the home was moved,thereby allowing everyone on the floor tomake sure no resident remained immobile fortoo long, says Doupe, who is also an assistantprofessor at the Department of CommunityHealth Sciences, College of Medicine, Facultyof Health Sciences, University of Manitoba.The creation of a wall chart is a simplething, to be sure. But it is simple things thatcan dramatically improve the lives of personalcare home residents. The real question is whathappens to the knowledge that is gainedin various ways at personal care homes likethe one in B.C.? How do these facilities shareknowledge to ensure everyone can benefitfrom one personal care home’s success?To help answer those questions, Doupe isparticipating in a multi-province study fundedthrough the Partnerships for Health SystemImprovement (PHSI) program. The program isfunded by the Canadian Institutes of HealthResearch, but also receives support fromvarious ministries health regions and agenciesacross Canada, including Research Manitoba.As the name suggests, the program wasestablished to fund teams of researchers anddecision-makers interested in looking at waysto enhance patient outcomes by improvingthe operations of health-care systems.In addition to Doupe, the Manitobateam includes Jennifer McArthur, ProgramCo-ordinator for Translating Research inElder Care (TREC); Lorraine Dacombe Dewar,Executive Director, Continuing Care Branch,Manitoba Health, Healthy Living and Seniors;Gina Trinidad, Chief Operating Officer, DeerLodge Centre, Winnipeg Health Region;Hana Forbes, Director of Long Term carefor the Winnipeg Health Region; MalcolmSmith, a researcher in the I.H. Asper School ofBusiness at the University of Manitoba; andGenevieve Thompson, a researcher in theCollege of Nursing, Faculty of Health Sciences,University of Manitoba.Essentially, the team’s goal is to work inpartnership with many of the 125 personalcare homes in the province to explore howthey grapple with issues of care and how theycommunicate with each other.“It’s really about trying to figure outwhat type of communications strategiesexist amongst the personal care homesin Manitoba,” says Doupe of the workbeing funded through PHSI. Having thatinformation will reveal whether there isan existing framework to share importantinformation among PCHs or whether a newcommunication system has to be established.And there is much to communicate.At any given time, there are dozens ofresearch projects taking place in personalcare homes across the country. Many of theseprojects, like the pressure ulcer research inB.C., are undertaken through TREC, whichincludes research teams in British Columbia,Alberta, Ontario, Manitoba and AtlanticCanada. Led by principal investigator CarolEstabrooks, of the University of Alberta’sFaculty of Nursing, TREC researcherspartner with personal care home staff andadministrators to explore common challengesthat all personal care homes face, including:* Behaviour – This can involve patients whowander, putting them at risk of falling andother dangers;* Pain management – Many residentssuffer from chronic illnessesthat also cause chronic pain.Because of their frail health,they often cannot safely bemedicated using traditionalpain managementdrugs like opiates ornon-steroidal antiinflammatorydrugs;* Pressure ulcers– These can arisewhen residents arepersistently bedbound, which isoften the case forthose who are veryill, unable to getin and out of bedwithout help;* Palliativecare – How tocare for a resident,particularly in ther e s e a r c h M A N I T O B A 2 0

last month of life.Dacombe Dewar says the researchunderway through TREC plays a pivotalrole in shaping the delivery of servicesin personal care homes. “We get veryrelevant information and evidence (fromthe researchers),” she says. This ensures thatchanges or improvements to service deliveryare evidence-based.TREC researchers have also looked at theculture of personal care homes, says Doupe.So the question becomes how do healthcareaides operate within the environment oftheir facility? Do they have a high level of jobsatisfaction, even if they are feeling burnedout? And how does a staff with high leveljob satisfaction affect the quality of care forresidents? Is there a correlation?Health-care aides provide 80 per cent ofthe care in personal care homes, but don’toften get to make key decisions. “One of thethings TREC is doing is saying, ‘No, if healthcareaides are spending all this time withresidents, they are going to know them verywell, and they should be involved in some ofthe decision-making process,” says Doupe.The lessons being learned throughresearch in these areas couldn’t be moretimely. Canada’s population is quickly aging,Gina Trinidad (left), Malcolm Doupe and LorraineDacombe Dewar are teaming up to help improve carein personal care homes.and when individuals come to personalcare homes today, they’re often facingtremendous health challenges.“The concept of a personal care home isunique. It’s not like a hospital where you stayfor a while and go home,” says Doupe, anassistant professor at the College of Medicinein the Faculty of Health Sciences at Universityof Manitoba. “This is a person’s home. In thevast majority of instances, it’s their last home.It’s really tricky to balance this philosophy ofa person’s home coupled with the complexityof medical needs a person might have.”A major problem for many personal carehomes in striking this balance is that theytend to work in isolation from each other.As a result, some may be doing things wellin some areas, but this expertise may not beshared with others. Which is where the PHSIproject comes into play.“One of the cool things about TREC is thatit develops expertise (within a personal carehome) that stays there after the project. ThePHSI (research) is kind of a step back (fromthe TREC research). Let’s say we had a facilitythat figured it out in terms of behaviourmanagement. The question is, does that juststay the best-kept secret? How does thatwonderful knowledge get spread?”The logical question that comes outof PHSI, says Doupe, is how often dodirectors of care in facilities talk toeach other and ask advice from eachother? “If you draw a map outliningconnections… you might find thatthere are three or four directorswho everyone goes to foradvice. What we need todo is make sure thatthis wonderfulknowledgethat’s beingcollectedgets to thosefacilitiesbecause thosepeople are opinionleaders.”Dacombe Dewar says thatfrom the province’s perspective,understanding these kinds ofconnections could be invaluablein rolling out new initiativesor training programs for staff.Trinidad agrees, adding:“The information there willPROJECT PROFILECO-Principal InvESTIgATOR(MANITOBA): Malcolm DoupeProjECT: Seeking Networks in ResidentialLong Term CareFUNDINg: 2013 to 2016: CanadianInstitutes of Health Research,$400,000; Research Manitoba,$50,000.help us determine what the best way isto communicate and who the leaders are,especially when we are trying to spreadinnovation and implement best practices.”Doupe says the PHSI research is only halfcomplete. Much of what has been doneto this point has involved meeting withstakeholders and gathering information. “Afundamental part of any reform strategy isto first understand where we’re at,” he says.The next step is bringing people together,and establishing regular communicationbetween stakeholders.While it’s a straightforward, commonsenseapproach, it’s addressing an incrediblycomplex aspect of the health-care systemthat will become progressively moreimportant with each passing year.“The challenge is the complexity of carewill continue to rise over the next twodecades, so this whole job of trying toprovide a high level of care to someone whois really very sick in the midst of what hasalso become their home will become moreand more difficult.”Although it is likely government will haveto invest more resources, building morehomes and hiring more staff, that is onlypart of the answer, Doupe says.The other part involves understandingwhat’s happening on the ground, andensuring that the secrets to excellent caretaking place at individual facilities aresecrets no more.“The demand and need for personalcare homes is rising, and there is no infiniteamount of resources to meet this increasingneed,” Doupe says. “So figuring this out nowis really important because the issues thatmay not seem as huge today will becomereally big challenges in the future when thesystem is under much more strain.”

MDs onlineResearch underscores value ofelectronic medical records By Sharon ChisvinHEALTH INFORMATIONDr. Alex Singer had only a singlecomplaint when he beganhis family medicine residency at St.Boniface Hospital in 2007: Why wasthe department still using pen andpaper to chart patient care whenEMRs had proved to be so much moreefficient?That complaint, voiced repeatedly during his first few months of residency, ledSinger to become one of the province’s leading experts in the field of electronicmedical records (EMR).“When I was a resident in the Department of Family Medicine, I complainedbitterly that we didn’t have an EMR,” Singer recalls good-naturedly. “This was in2007 to 2009, and I thought it was crazy we were using paper and pen for themost part, and there were charts everywhere. I complained about it and I did aresearch proposal around that, and then when I was hired as a staff physician,they said, ‘Okay, big shot, you run the implementation of our EMR.’”An EMR is a computer-based office system that is used by health-carepractitioners to record and track all patient information. Among many othertasks, an EMR can be used to make patient appointments and referrals, keeptrack of test results, prescribe medications and do billings. They make it easierfor health-care providers to share information about their patients with otherpractitioners and to access their patients’ complete health records.Singer, an assistant professor in the Department of Family Medicine, Collegeof Medicine, Faculty of Health Sciences, University of Manitoba, happily acceptedthe challenge to co-chair EMR implementation for his department’s three urbanteaching clinics. At the time, Singer says, only about 25 per cent to 30 per cent ofprimary health-care physicians in Canada were using EMRs, and most were usingthem only for the most basic functions.“Manitoba had identified that there was a gap in understanding how EMRswere actually being used,” Singer explains. “Funding was going to pay for peopleto actually adopt EMRs to start using them, but there was a lot of grey area abouthow they were using them and were they using them in meaningful ways.”With the support of Manitoba Health, Singer began studying how to assess andimprove the effectiveness of EMRs. While doing that, he stumbled upon similarresearch being conducted by family physician Dr. Morgan Price at the eHealthObservatory at the University of Victoria. Price had recently received a Partnershipsfor Health System Improvement (PHSI) grant to assess EMR adoption.Singer reached out to Price, and Price, in turn, invited Singer to join hisresearch project. Price then came to Manitoba and together the two physiciansDr. Alex Singer is helpingdoctors make better useof electronic medicalrecords.drove across the province, visiting primary health-careclinics to talk about EMR adoption and the ways in whichhealth-care providers were using, or not using, the system.“We went to a bunch of rural sites, mostly in southernManitoba, and also to some sites in the (Winnipeg HealthRegion), and we did the research using surveys and focusgroups,” Singer explains. “We then presented the researchback to the clinics, and published our findings in theCanadian Family Physician journal.”Among other outcomes, the journal article noted thatphysicians were not taking advantage of useful EMRfeatures, including:Decision support: This function is designed to helpphysicians provide better care and enhance patient safety.It incorporates a variety of functions, among them healthmaintenance alerts and reminders. These alerts andreminders, which usually appear as screen pop ups, notifyphysicians of vital information such as new lab results,allergies, unusual diagnostic readings and potential adversedrug interactions.Patient support: This feature emphasizes functions thatopen up communication between patients and physicians,and increase patients’ understanding of their conditionsand care. Among other things, it provides physicians witheasy access to resource materials that they can share withr e s e a r c h M A N I T O B A 2 2

their patients, and facilitates electroniccommunication between physicians andtheir patients, families and caregivers.Practice reporting: This tool serves as asafety net of sorts for physicians. It providesthem with the means to internally reviewthe nature and nuances of their practices,and, in so doing, identify both strengthsand areas in need of enhancement. Practicereporting helps physicians ensure thatthey are following protocol and meetingguidelines, and helps them recognizepatient trends.It was around the time that theCanadian Family Physician article wasbeing pubished that Singer’s own clinic,the Family Medical Centre at St. BonifaceHospital, went live with its EMR. His coworker,primary-care nurse Michele Allard,immediately recognized the benefits ofthe advancement. “I do a lot of telephonemedicine in my role as a primary-carenurse, whether it be triage or answeringa wide assortment of questions frompatients,” she explains. “With the old paperchart system, there was always a delay inmy responding to their concerns as I wouldhave to track down the paper chart. Now, thesecond they start speaking on the phone Iam typing in their name and have immediateaccess to their file and personal healthinformation.”Allard’s confidence and mastery of thesystem, however, was not duplicated atmost of the other clinics that Singer andPrice surveyed. Their findings revealed thatclinicians were mainly using their EMRs toreproduce paper processes, like billing, andwere not taking full advantage of the system’smany other functions.“A lot of it was a lack of knowledge,”says Singer. “They didn’t know they coulddo it this way or that way, and there wereinconsistencies within clinics. There was adefinite need for improvements.”Once the PHSI study was completed,Singer began working with Manitoba eHealthto put some of those improvements in place.He helped the agency create an optimizationprogram and develop tips and tools toincrease health-care providers’ usage of EMRs.“We built the optimization program onthe back of the protocol and the PHSI study,”Singer explains. Singer then moved on fromthe optimization program to researchingEMR data quality. “Looking at data quality isthe first step towards being able to do otherkinds of research,” he explains. “If data is of ahigher quality, we can use it to look at howpatients interact with the health system, howtheir diseases are managed, and all sorts ofother things.“As a clinician,” he adds, “my real interest isto be able to potentially use the EMR data forsecondary purposes, to better understandthe health of a larger population.”Towards this end, Singer now managesa practice-based research and surveillancenetwork that collects data from 35 Manitobaclinics, representing about 180,000 patients.“Understanding data quality is the foundationfor being able to use the EMR for things likepublic health,” he says. “It can be used forfiguring out the prevalence of a certain diseaseand figuring out how a particular disease isbeing managed on a population level, andpotentially improving that management andhaving a greater impact.”For Singer, this data quality researchhas reinforced what he learned from hisinvolvement in the PHSI study and thePROJECT PROFILEPrincipal InvESTIgATOR:Dr. Morgan PricePRINCIPAL InvESTIgATOR(MANITOBA): Dr. Alex SingerProjECT: Developing and Assessingan EMR Educational ProgramDesigned to Optimize EMR Use andImprove Clinical CareFUNDINg: 2011 to 2014: CanadianInstitutes of Health Research,$350,000; Research Manitoba,$99,500.eHealth optimization program: EMRs aretremendous tools for managing patientcare and improving patient outcomes, bothon a small and large scale.Thanks in part to his efforts, EMRadoption in Manitoba now stands at morethan 75 per cent. “Having electronic medicalrecords is all about access to information,”Singer emphasizes. “By having better accessto the information, you’re able to provide,in my opinion, better care, as opposedto having to be caught in the unenviableposition of having some level of ignoranceabout what happened in other parts of thehealth system, or not having the completerecord available,” he explains.“The other aspect is that we havedramatically increased the efficiency ofmany of the tasks that we do,” he adds.“Because we’re not spending time lookingfor charts, if I need to ask somebody toparticipate in a patient’s care in a certainway, I can do it immediately and they havefull access to the same records that I haveat the same time. It is a much more efficientway to provide care. “Allard agrees. “The EMR has definitelymade my job and workflow moreefficient with enhanced access to patientinformation,” Allard says.“One day I called one patient to advisehim about his MRI result (and) he laughedbecause he had literally just got home fromhaving had the MRI done that morning.From time of test to receiving the result inour office was less than three hours!”

Healthy mom, healthy babyPrenatal care program makes adifference in the Inner Cit y By Sharon ChisvinVanessa Boyer, pictured herewith son Jaxyn, appreciatesthe prenatal care she was ableto receive through the PIIPCproject.First-time mom Vanessa Boyer’svoice brims with pride andlove as she speaks about herone-and-a-half-year-old son, Jaxyn.That pride and love turn to extremegratitude when she speaks aboutthe midwives who helped her bringJaxyn into the world.The midwives work at Mount Carmel Clinic, where Boyer wasa client of the Partners in Inner-City Integrated Prenatal Careproject, better known as PIIPC.“It was a wonderful experience for me,” Boyer says candidly.“The midwives showed me so much kindness.”PIIPC is a collaborative project focused on reducing inequitiesin access to and use of prenatal care in Winnipeg’s inner city.The project, which began in September 2012, was fundedby the Canadian Institutes of Health Research (CIHR) andResearch Manitoba through the Partnerships for Health SystemImprovement program (PHSI). The Winnipeg Health Region andHealthy Child Manitoba also helped fund the project.The study’s principal investigator is Maureen Heaman, a CIHRr e s e a r c h M A N I T O B A 2 4

Chair in Gender and Health and a professorin the College of Nursing in the Facultyof Health Sciences at the University ofManitoba. She has devoted her career to theenhancement of maternal and child health.“The research project was built onprevious research and a few years of differentprojects, starting out with one that lookedat regional variations in use of prenatalcare across the province,” Heaman explains.“What I found in that project was that therewere high rates of inadequate prenatalcare in Winnipeg’s inner city. Many of thewomen who had inadequate prenatal careliving in these neighbourhoods identified asAboriginal or of First Nation descent.”Prenatal care is critical for a healthypregnancy and birth, as it gives health-careproviders the opportunity to identify andmonitor risks that can affect both motherand child. Among other benefits, prenatalcare can help decrease incidences ofpreterm birth and low birth weight.Heaman determined that in order toimprove the rates of prenatal care in threeinner city communities – Downtown, Inksterand Point Douglas – it was necessary tofirst find out what women living in thoseareas saw as the barriers, motivators andfacilitators to prenatal care. Her teamspent the next three years conducting thatresearch, and then invited 70 stakeholdersto a workshop to consider ways to reducethose barriers and make it easier and moredesirable for inner city women to accessprenatal care. Following that workshop, aninter-disciplinary steering committee wasformed and the PIIPC project was born. Itsmandate included four major initiatives thatwere designed to:* Add midwifery care to some of the innercity Healthy Baby/Healthy Start communitysupport programs;* Strengthen the link for pregnantwomen who access the Street Connectionsmobile van service with care providers(obstetricians, family physicians, nurses,social workers) at the out-patientdepartment of Health Sciences Centre’sWomen’s Hospital or with the midwives atMount Carmel Clinic;* Develop a flexible program of accessto prenatal care at Women’s Hospital andMount Carmel Clinic for women referredfrom a variety of sources including SageHouse, HIV clinic, Mothering Project, publichealth nurses and community physicians;* Launch a social media marketingcampaign called “This Way to a HealthyBaby” to increase awareness about theimportance of prenatal care and where toobtain it.The shared intent of these initiatives – allof which have been implemented – was tointegrate prenatal care services in the innercity and develop a collaborative approachtowards providing that care among frontlinehealth providers, clinics and Women’sHospital. This approach, in turn, would makeit easier and more likely for at-risk pregnantwomen to get the care they needed.Lisa Merrill, a clinical nurse specialist atWomen’s Hospital, which is a key partnerin PIIPC, says the project has createdpositive changes in the health-care system:“It has brought our teams together towork more collaboratively. The team atWomen’s Hospital included social workers,nurses, obstetricians, family physicians andsupport staff. The development of closeinter-professional partnerships betweenprograms and sites has been anothersuccessful outcome of the project.”Kelly Klick, who co-chaired the PIIPCcommunity-based working group and coordinatedthe involvement of Mount CarmelClinic’s midwives in the project, says PIIPCfocuses on women who face barriers tocare, such as living in a hotel and having noincome, or who are at high risk for havingunhealthy and/or apprehended babies.“Women who did not have a provider fortheir prenatal care were offered services,”explains Klick, who was also one of themidwives involved with Boyer’s care. “If theylived in the target postal codes and were atrisk of inadequate care, we invited them tobe in the study.”A total of 281 women have enrolledin the program, including 219 who haveconsented to participate in the researchcomponent. Merrill says many of the womenhad risk factors such as poverty, addictions,smoking, family violence, Child and FamilyServices involvement, and homelessness,and many of them mistrusted the healthcaresystem. “The women were identifiedas PIIPC clients,” explains Heaman, “whichhelped get them access.” Clinics and careproviders knew to be a little more flexibleabout trying to see them when they showedup and getting them additional services.Boyer became involved in the PIIPC studyafter a friend told her about the midwivesat Mount Carmel Clinic who had helped herwhen she gave birth. She approached theclinic in the first few weeks of her pregnancyand, because she lived downtown and wasat risk for inadequate care, was invited tojoin the program.Boyer admits to being nervousthroughout her pregnancy and worriedabout the health of her unborn child,but says that the midwives were alwaysaccessible, kind, supportive and reassuring.“I would go to the clinic maybe every twoweeks and sometimes they would come andsee me at my residence,” Boyer says.In addition to monitoring a woman’spregnancy, the prenatal care also involvesproviding information about health andnutrition, healthy life choices, preparing forbirth, and the importance of breastfeeding.Women in the program are also connectedto resources, including housing, financialsupport, and food banks to assist with theirneeds as required. Women also receive extraemotional support to help reduce barriersand empower them to reach their goals.Heaman stresses that PIIPC came aboutthrough the work of a lot of people. “It’s beena very big community-based initiative anda lot of people have been devoted to theproject and spending time on it,” she says.“The project is unique in involving a widerange of decision-makers and care providersfrom the Winnipeg Health Region, HealthyChild Manitoba, Manitoba Health, and FirstNations Health and Social Secretariat ofManitoba working together with researchersfrom the University of Manitoba.”Lynda Tjaden, Director of PublicHealth with the Region, says the projectunderscores the value of enhancing healthequity efforts throughout the health-caresystem. “Maureen’s previous research showsthat despite having a universal health-caresystem, gaps exist and some women arenot accessing prenatal care,” she says. “The

PIIPC project is an example of how we canaddress the inequitable social factors thatare experienced by women as barriersin accessing prenatal care. This initiativepromotes conditions in which mothersand babies can achieve their best possibleoutcomes.”Heaman’s research team is nowevaluating the program by reviewinghospital charts and analyzing interviewsand questionnaires completed by PIIPCclients. Although the results are stillpreliminary, they appear to be verypositive. “We compared the women in ourstudy to the women in the previous studywho had had inadequate prenatal care…and we are able to show that amongsimilar types of women we have improvedtheir access to and use of prenatal care,”says Heaman.As a result of PIIPC, women areinitiating their prenatal care earlier in theirpregnancies and having more prenatalvisits than similar women in similarcircumstances have in the past. As well,the results indicate that women who havehad previous pregnancies received moreprenatal care through PIIPC for their recentpregnancies and this has been associatedwith a reduction in pre-term births.The next step for the team is to visitthe Manitoba Centre for Health Policyto review data on rates of inadequateprenatal care in the inner city, and seeif those rates have been reduced on apopulation health level because of PIIPC.Heaman is hopeful that will prove tobe the case, but the reality is that neitherHeaman nor the many dedicated peopleon her team need to see the data toknow that PIIPC has made a difference inWinnipeg’s inner city. They already knowthat, because of PIIPC, 281 women whowould not have received adequate or evenany prenatal care, received compassionateand supportive care throughout theirpregnancies and, as a result, had healthypregnancies and healthy deliveries.Vanessa Boyer knows it too. Shejust needs to look at her son Jaxyn toappreciate the impact that the PIIPCprogram has made.PROJECT PROFILEPrincipal InvESTIgATOR:Maureen Heaman, RN, PhD, professorin the College of Nursing in theFaculty of Health Sciences at theUniversity of Manitoba.PRINCIPAL KnowLEDge USER:Lynda Tjaden, Director of Populationand Public Health, Winnipeg HealthRegion.ProjECT: Reducing Inequities inAccess to and Use of Prenatal Care inthe Winnipeg Health Region throughHealth System Improvement.FUNDINg: 2012 to 2015: CanadianInstitutes of Health Research,$400,000; Research Manitoba,$79,000; Winnipeg Regional HealthAuthority, $10,000; Healthy ChildManitoba, $10,000.Some members of the PIIPC team, from left:Darlene Girard, Maureen Heaman,Lynda Tjaden and Zorina Marzan Chang.

Meet the Foot Care Specialistsat Canadian FootwearWith over 90 years of combined experience, the FootHealth Centre teamwill make sure that you find that right fit for your feet.With specialized education and training in foot orthotics and footwear, Canadian CertifiedPedorthists help to alleviate pain, abnormalities and debilitating conditions of the lowerlimbs and feet. The goal of our Canadian Certified Pedorthists is to help patients achieveand maintain proper foot care and lower limb health, and live healthy, active lives.Our mission is to provide the very best footwear and footcarein a safe, healthy, and positive environment.Brian Scharfstein isa Canadian CertifiedPedorthist specializingin care of the diabeticfoot, and principalowner of CanadianFootwear and theFoothealth Centre.He has served as aboard member of theCanadian DiabetesAssociation in Manitoba,and supports manycharitable directives. Hepursued his education atNorthwestern Universityin Chicago, and BallState University, andbrings 25 years ofexperience.Amanda Bushby isa Canadian CertifiedPedorthist. She beganher professional careerin Calgary, transferringto Winnipeg in 2006.She is vice chair of theInsurance of Governance(IGR) committee for thePedorthic Associationof Canada, and serveson the Ethics committeefor the College ofPedorthics of Canada.She strives to promotethe pedorthic professionin any way she can tohelp the daily qualityof life for all of herpatients.Marianne Viau is aCanadian CertifiedPedorthist with aspecial interest indiabetic feet andvascular complication.Her expertise has beenused in consultationswith Misericordia HealthCentre, Health SciencesCentre, and MountCarmel Clinic for thelast 15 years. She brings21 years of experienceto the FootHealthCentre, and takes pridein improving the qualityof life of her patients,and educating peopleabout foot health.Laurie Dunning isa Fitting Specialist,specializing in complexfittings for people withdiabetes and arthritis.She has a certificationas a Fitting Specialistof Compression Hosieryfrom Sigvaris, and as aNew Balance “Procare”specialist. She has beenwith the FootHealthCentre since 1996and brings 18 years ofexperience with her.Sheldon Gardner is aCanadian CertifiedPedorthist. He gothis start working withKintec Footlabs inVancouver, receiving hisPedorthic Certficationin 1999. He enjoysspending his free timehiking the outdoorsand playing sports,and works hard to havehis patients enjoy thatsame quality of life.Heather Macpherson isa Canadian CertifiedPedorthist, and startedworking at the CalgaryFootHealth Centre in2001. Heather hasserved on the Board ofDirectors of the Collegeof Pedorthics of Canadaas the Chair of ExamDevelopment, certifyingnew pedorthists asan exam proctor. Shebecame certified in2005, and brings 13years of experience tothe FootHealth team.Her favourite part of herjob is creative problemsolving for clients withuncommon issues orsymptoms.www.canadianfootwear.comAppointment Required.Custom-made orthotics require a prescription.Winnipeg: 128 Adelaide St. • 1504 St. Mary’s Rd. • 1530 Regent Ave.Call 204-944-7460 or Email: fhcwreception@canadianfootwear.comNew Balance Calgary: 303, 150 Crowfoot Cr NW. Call (403) 220-1118Foothealth Shoes, Calgary: 151 86 Ave SE. Call (403) 212-8111

<strong>Picture</strong> thisCancerCare Manitoba Foundation is usinga special UV camera to show how the sun’srays can damage your skin and increaseyour risk for cancer. Are you at risk?PhotoUVDana Kreutz (above) says she wasn’t expecting CancerCare Manitoba’s UV camerato pick up as much skin damage as it did. “I was pretty surprised,” she says.28 WAVE

By Holli MONCRIEFFDana Kreutz was not happy.The 26-year-old woman had just had her photograph taken with aspecial digital UV camera during an event at Assiniboine Park.Operated by the Kick Cancer Street Team, the camera is a powerfulawareness tool provided by CancerCare Manitoba Foundation. It isdesigned to detect melanin, a brown pigment that is associated withskin damage caused by overexposure to ultraviolet radiation from thesun that cannot be seen by the naked eye. The more melanin visible inthe photo, the more damage to your skin.In Kreutz’s case, the camera revealed more skin damage than shewas expecting.“The photo showed that I had lots of sun exposure,” she says. “Therewere melanin clusters, and that’s not good. I was pretty surprised, andI wonder what the rest of my body looks like, because I’ve been prettygood about putting sunscreen on my face.”Well, perhaps not that good.Upon reflection, Kreutz admits she can be lax about reapplyingsunscreen. “You’re sitting on a patio in the sun for hours and you don’treapply. You don’t think about it at the time,” she says.That’s going to change now that Kreutz can see just how importantthat sunscreen, along with other protective measures, can be. “It’ssomething I’ll give a little more thought to,” she says.And that is the reaction CancerCare Manitoba Foundation ishoping for. Each year, it sends its UV camera team to various eventsthroughout the province in a bid to raise awareness about the potentialproblems associated with overexposure to the sun, including wrinklingskin and an increased risk for skin cancer.Summer 2015 29

How the UV camera worksThe UV camera is designed to detectmelanin, a pigment in the skin. Melaninis a defence mechanism as well as anindication of skin damage.The image at the bottom of the pageshows clusters of freckles (melanin) whichsuggests damage to the skin. The areascircled in purple represent areas withdarker freckles, signifying greater damage.There are also specks of white (circled inred) near the subject’s right eye and atthe top of the forehead. The white speckssuggest excessive damage.The UV camera is not a diagnostic tool,so the presence of freckles or whitespecks is not a predictor of skin cancer.Nonetheless, they do suggest skindamage has occurred, and underscorethe importance of taking protectivemeasures against the sun’s rays.Damage scale30 WAVELight freckle: DamageDark freckle: Greater damageWhite speck: Excessive damageAnd although the camera is nota diagnostic tool and the imagesit produces are not a predictor ofcancer, they do catch people’sattention, says Elizabeth Harland,Sun and UV Safety Co-ordinator forCancerCare Manitoba.“People really react to seeing thedamage,” she says. “Whenever Iask people if they protect their skinfrom the sun, the most commonanswer I get is, ‘Not as much as Ishould.’”Ultraviolet radiation from thesun is broken down into threecategories or frequencies: UVA,UVB and UVC.UVC rays aren’t a huge concernbecause they are largely blockedby the earth’s ozone layer. Thereal damage is caused by UVA andUVB rays.UVA rays penetrate into thedeeper layers of the skin, causingaging and wrinkling. Studiesindicate UVA rays also initiate andexacerbate the development of skincancer. Although less intense thanUVB rays, UVA rays are presentyear round and can penetrate glassand clouds.UVB rays are responsiblefor burning, tanning, and theacceleration of skin aging. Althoughthey do not penetrate as deeplyas UVA rays, they also play asignificant role in the developmentof skin cancer.The three main types of skincancer are basal cell, squamouscell and melanoma. Basal andsquamous cell cancers are the mostcommon, and the most treatable.Melanoma, while less common, isthe most deadly.“More than 90 per cent of skincancers are caused by exposure toUV radiation from the sun,” saysDr. Debjani Grenier, a medicaloncologist at CancerCare Manitoba.“Prevention is key.”Which is why people must guardagainst too much sun exposure.“There’s no such thing as ahealthy tan,” says Dr. MarniWiseman, a dermatologist andChair of the Skin Cancer DiseaseSite Group at CancerCareManitoba.People who do spend toomuch time out in the sun withoutprotection will often get sunburn,an indication that the DNA in yourskin cells has been damaged bytoo much UV radiation. A painfulsunburn just once every two yearscan triple your risk of melanoma.One of the big challenges ingetting people to recognize thepotential dangers of skin canceris that it is a relatively slowdevelopingdisease. People,especially young people, who gettoo much sun today, may not payfor it until tomorrow. The result isthat behaviours are hard to change.“Young people think skin canceris an obscure problem that won’thappen to them,” says Wiseman.Yet the statistics suggest morepeople are developing skin cancerall the time.In Manitoba, an estimated 190people will develop melanoma in2015, including 110 men and 80women. Among younger peopleacross Canada, melanoma is oneof the most common cancers.Between the years 2006 and 2010,melanoma was the fourth mostcommon cancer among 15 to 29year olds. Melanoma was also thefourth most common type of canceramong 30 to 49 year olds.Melanoma is also one of thefastest-growing cancers in Canadain terms of increasing incidence,along with thyroid and liver, risingby 2.3 per cent for men and 2.9 percent for women each year between2001 and 2010.In Manitoba, rates for basal celland squamous cell carcinomashave tripled during the last 50years, but the increase in the rate ofmelanoma is even more dramatic.Rates of melanoma have increased15-fold since 1960.A number of factors may becontributing to the rise in skincancer rates, including favourableattitudes towards sun exposure andtanning, the popularity of vacationsin tropical destinations, ozonedepletion, and an aging population,as greater sun/UV exposurehappens over time.“People have a broad idea thatUV exposure is important in skincancer development, but eventhough we have the knowledge,people still don’t practise safe sunbehaviour,” Wiseman says. “It’sso shocking when you go to thebeach and see people lying therein the sun. What they’re doing iscausing their own cancer. It’s reallyfrustrating, actually.”When it comes to protectingyourself against the sun’s harmful

PHOTOSAdozen people recently had their photograph taken by CancerCare Manitoba volunteersusing a special UV camera. Here is brief summary of what some of the participants had to saywhen they reviewed their UV images:PhotoUVAlan McTavishSkin Damage Level:moderate FRECkLING“I was a bit surprised. Mine wasn’t that bad. Ithought my face was going to be sun spotted. I’malways the one running out the door with someoneyelling, ‘Did you put sunscreen on?’ after me.”PhotoUVNancy DoddSkin Damage Level:heavy freckLING“I always did wear sunscreen, but the photo mademe more conscientious. I should always be wearingsunscreen. It’s a good idea. Melanoma can spreadso easily and so rapidly. You want to catch it early.”PhotoUVOren BinnunSkin Damage Level:Minimal FRECkLING“I wanted to see what I could do better to keepmy skin healthy. I have lots of melanin on my nose,forehead, and chin. I use sunscreen, but I still getsunburned often. I play ultimate Frisbee, so I’m outin the sun often. I’ll always put more sunscreen onand reapply it often.”How to apply sunscreenMost people do not use sunscreen properly. In fact, it is estimated that people use onlyabout one third of the sunscreen they’re supposed to use.Experts recommend using a teaspoon of sunscreen for the face, and a palm full foreach arm and leg. “If you’re using spray sunscreen, make sure you rub it in, andmake sure you reapply all sunscreens after sweating and swimming. Don’t missany spots on your skin,” says CancerCare Manitoba’s Elizabeth Harland. Watcha video on how to apply sunscreen at www.wrha.mb.ca/wave/sunscreen.Summer 2015 31

How to choosea sunscreenGenerally speaking, there are two types ofsunscreens: those with chemical filters and thosewith physical filters. Those with chemical filtersabsorb UV light, while those with physical filtersreflect it. Both can work equally well, and somesunscreens have physical and chemical filters.The important thing is to make sure the productyou purchase is a broad-spectrum or full-spectrumsunscreen. This means it can block both UVAand UVB rays. It is also important to ensure yoursunscreen has a sufficient sun protection factor(SPF rating).Experts suggest a water-resistant, broad-spectrumsunscreen with an SPF of at least 30 to provide thebest protection.The Canadian Dermatology Association has anextensive list of suitable sunscreens on its website.To learn more about how to choose a sunscreenand to review a list ofsunscreens approvedby the association,visit www.dermatology.ca/programsresources/programs/spp/rays, CancerCare Manitobarecommends a multi-prongedapproach.“Sunscreen is just one of fourways to protect yourself, saysHarland. “You should also seekshade, cover up, and avoid peakhours, which are typically from 10a.m. until 4 p.m.,” she says.Wiseman agrees, adding thatpeople should think of sunscreenas an additional protection, asopposed to a licence to spendmore time in the sun.“People know what sunscreenis, but they’re not using itappropriately. They’re using itto increase their sun exposureinstead of using it as an extra levelof protection,” she says.There are two basic types ofsunscreens: those with chemicalfilters and those with physicalfilters. Sunscreens with chemicalfilters work by absorbing UV light.Those with physical filters, such aszinc oxide and titanium dioxide,work by reflecting the light.Not all sunscreens are createdequal, says Wiseman. “Somesunscreens have better UVA andUVB filters than others, and someof these filters are more photostable than others,” she explains,adding that a broad-spectrum, orfull-spectrum, sunscreen providesprotection from both UVA andUVB rays.A key factor in choosing asunscreen is the sun protectionfactor (SPF) rating. The SPF ratingis based on how long it takesfor the sun to burn skin that’sbeen treated with sunscreen, ascompared to skin that hasn’t beentreated.Harland says if you developa burn after being in the sunfor about 20 minutes, using asunscreen with an SPF rating of30 should theoretically preventreddening for about 600 minutes(20 minutes X SPF 30), or about10 hours.But while that may be thetheory, she says no one shouldexpect sunscreen to last more thana few hours without re-application.“There are so many variablesthat affect the effectiveness ofsunscreen… On a hot day yousweat and the sun screen can getrubbed away,” she says.Choosing a sunscreen canalso be confusing because theSPF rating system doesn’t beara proportional relationship toprotection levels.For example, a sunscreen withan SPF 15 rating is theoreticallycapable of blocking about 93per cent of UV rays, accordingto the Skin Cancer Foundation.But a sunscreen with double therating – SPF 30 – will block 97 percent – only four percentage points32 WAVE

Practise safe sunWe love the sun, but the sun doesn’t always love us back. Take thesesimple precautions to protect your skin:Avoid the sun from 10 a.m. to 4 p.m. If you must be outside during thattime, protect yourself by seeking shade.When you are in the sun, wear clothing that covers your arms and legs.Put on a wide-brimmed hat and sunglasses.Apply sunscreen (SPF 30 or higher) about 30 minutesbefore you leave the house and reapplyhourly.Do not use tanning beds and sunlamps.Remember: even Manitoba’s abundantwinter sunshine can have an effect, so followthese guidelines all year.PhysiotherapyMASSAge THERAPyACUPUNCTURE• Convenient Appointments• Direct Billing to WCB and MPIC• Located near Victoria Hospital andUniversity of ManitobaSource: Guidelines from CancerCareManitoba Foundationmore, while a sunscreen with an SPF 50blocks out 98 per cent.The best advice, Harland says,is to look for a sunscreen that iswater-resistant, broad-spectrum andhas an SPF of at least 30. This typeof sunscreen includes those withchemical or physical filters. And mostsuitable sunscreens will carry theCanadian Dermatology Associationlogo, which means the product hasmet the association’s standards for sunprotection.In addition to buying the right typeof sunscreen, it is important to apply itproperly. “People use, on average, onethirdof the amount of sunscreen they’resupposed to use,” says Harland. “Youneed a teaspoon for the face and a palmfull for each arm and leg,” she says.“If you’re using spray sunscreen, makesure you rub it in, and make sure youreapply all sunscreens after sweatingand swimming. Don’t miss any spots onyour skin.”While Canadians tend to thinkof sunscreen more often during thesummer months, it should be used yearround.Sand, water, snow and concretereflect sunlight, intensifying the sun’srays 12 months a year.When it comes to protecting your kids,sunscreen can be safely used on childrenas young as six months. But it is alsoimportant to keep younger children inthe shade as much as possible.And don’t think you are totallysafe just because you are in your car.“People can get some exposure throughtheir windshields while driving, so theyshould take the same precautions as ifthey were outside,” says Wiseman.Another important point toremember is that not all people areequally vulnerable to skin cancer. Youmay have a higher risk if you weresunburned as a child, have fair skin,light-coloured eyes and blonde or redhair, freckle easily or have many moles.Those with a family history of skincancer, or who have had precancerouslesions, are also at greater risk. Apersonal history with cancer can be afactor as well.“A person with a previous melanomahas a much higher risk of anothermelanoma,” Wiseman says.She recommends schedulingregular annual check-ups with yourfamily physician, ensuring that eachappointment includes a thorough skincheck.Meantime, keep an eye out for molesand other skin growths that bleed, are ofan irregular shape, are itchy, or changein size, shape, colour, or height. Not allskin cancers are dark – some have nocolouring at all. If you see anything thatconcerns you, contact your doctor ordermatologist immediately.“The majority will turn out to bebenign, but it’s important to get checkedout,” says Wiseman. “Be diligent inassessing your skin. The majority of skincancers are curable, but some can belife-threatening.”Holli Moncrieff is a Winnipeg writer.204-275-3698308-2265 Pembina Highwaymarkhamphysiotherapy.netSmileCancerCare ManitobaFoundation staff members aretaking their UV camera on theroad over the next few months.Here is a list of events:Sept. 11 to 13Dragon Boat Festival, The Forks:Sept. 11, 6 to 8 p.m.; Sept. 12, 8:30a.m. to 6 p.m.; Sept. 13, 8:30 a.m.to 3:30 p.m.Sept. 19Beer and Bites Manitoba,University of Manitoba UniversityCentre, Fort Garry campus, 4 p.m.to 11 p.m.Oct. 14The Inside Ride, MTS Centre, 5p.m. to 9 p.m.Summer 2015 33

Bull’ s e y ewith Lyme disease on THE RISE,HEALTH OFFICIALS ARE TAKINg AIM atTHE TICK-BORNE PATHOgenBy Susie STRACHANPHOTOgRAPHy by MARIANNE HELMThe stories have a familiar ring to them. A trip to a wooded area followed by asudden illness with flu-like symptoms – fever, aches, and hot and cold sweats.In most cases, the illness isaccompanied by a red bull’s-eye rashsomewhere on the body. But not always.In other cases, the initial illnessmay be followed months later byother symptoms, including joint pain,headaches and cardiac issues.Increasingly, these bouts of illness arebeing traced back to an encounter with atick – a blacklegged tick, to be specific.The tiny bug, also called a deer tick, isknown to transmit a bacteria that causesLyme disease, a potentially debilitatingillness that is slowly, but steadily,becoming more prevalent across Canada.In 2009, the first year the PublicHealth Agency of Canada started trackingLyme disease, there were 128 confirmedand probable cases recorded across thecountry. In 2013, there were 682.The number of Lyme disease casesin Manitoba has also grown steadily.In 2009, there were five confirmed andprobable cases recorded in the province.By 2014, the number jumped to 35.Altogether, there have been 157 reportedcases of Lyme disease in Manitobasince 2009, including 60 confirmed,55 probable and 42 categorized as“other,” says Scott Graham-Derham, apolicy analyst with Manitoba Health,and one of the people who track wherethe blacklegged tick has establishedpopulations in the province. Thosenumbers do not include the manyManitobans who believe they haveLyme disease, but have not received apositive test result for the condition froma provincially-approved lab.The increase in confirmed cases, aswell as the rise in the number of peoplewho believe they have Lyme disease buthave not tested positive for the infectionin Manitoba, has raised concerns amongmembers of the public. Increasingly,they want to know more about the issuessurrounding Lyme disease. In response,provincial and federal health officialshave taken action to raise awarenessabout Lyme disease, including how itis diagnosed and treated. They are alsoinvolved in numerous efforts to helpprevent the infection from spreading.A MYSTERIOUS CONDITIONLyme disease has actually been aroundin one form or another for thousands ofyears. In fact, scientists have determinedthat Otzi, the mummified remains of34 WAVE

Veterinary entomologistKateryn Rochon with afemale blacklegged tick.a man who lived 5,000 years ago ina region near the Italian and Austrianborder, had the bacteria.But while the disease is fairly wellknown in Europe, it only started to attractattention in North America in the 1970s,after a number of people in the townof Lyme, Connecticut, were struck bya mysterious condition that left themwith odd rashes, swollen joints andunexplained neurological problems.Eventually, scientists were able toshow that their conditions were causedby Borrelia burgdorferi, which theblacklegged tick picks up from smallanimals, such as mice and birds. Sincethen, the disease has slowly spread south,west and north, infecting a number ofAmericans and Canadians along the way.In Manitoba, the first unofficial reportsof Lyme disease surfaced in the 1990s.Not surprisingly, these cases coincidedwith the arrival of the blackleggedtick, which had made its way into theprovince from the United States on thewings of migratory songbirds.Previously unknown in this part ofthe world, populations of blackleggedticks were first spotted in the southeastcorner of the province. Since then, theyhave settled into areas around St. Malo,Steinbach and Kleefeld, the southeasternshores of Lakes Winnipeg and Manitoba,the Pembina Valley, and portions of theAssiniboine River corridor as far as theBrandon Hills. The thriving blackleggedtick population can be attributed to anumber of factors that have helped makethe environment here more hospitablefor them, including climate change andthe fact that more people are living andrecreating in areas that had been relativelyuntouched.Interestingly, the blacklegged tick(Ixodes scapularis) is one of only twotypes of ticks in Canada that commonlyspread disease, according to RobbinLindsay, a research scientist of zoonoticdiseases and special pathogens at theNational Microbiology Laboratory inWinnipeg. The other trouble-maker isthe western blacklegged tick (Ixodespacificus). More common ticks, such asthe American dog tick (also known asthe wood tick), don’t transmit diseasebecause they lose the pathogens whenthey molt between larval and nymphalstages.The blacklegged tick can be found fromManitoba through to the Maritimes, whilethe western blacklegged tick is found inBritish Columbia. In addition to Lymedisease, these ticks can also transmitother less common pathogens such asAnaplasma, Babesia and Ehrlichia, whichcan also cause serious illness.Of course, it is important to rememberthat not all blacklegged ticks arecarriers of disease, according to KaterynRochon, a veterinary entomologist at theUniversity of Manitoba.As she explains, the tick must bite aSummer 2015 35

EGGSNYMPHEGGSSPRINGWINTER SUMMER LARVAFALLADULTSRisk of humaninfection greatestin late springand summerL i f e c y c l e ofa B l a c k l e ggedt i c kAs the illustration to the leftshows, the blacklegged tick’slife cycle has four stages: egg,six-legged larva, eight-leggednymph, and adult. Ticks requirea blood meal at every stage ofthe cycle.Normally, the tick’s life cyclecan last two years. ButKateryn Rochon, a veterinaryentomologist at the Universityof Manitoba, is investigatingwhether the tick’s life cycle inManitoba may extend to threeor four years, due to the factthat winters here are longer thanin other parts of the continentwhere it can be found. She isalso looking into what, if any,effect that might have on thetransmission of Lyme disease.host that has been infected with Borreliaburgdorferi or another pathogen, so muchdepends on the presence of the diseaseamong mice and other small animals inthe immediate area.“The proportion of animals infected isalways evolving,” she says. Studies in theUnited States show that in areas whereBorrelia burgdorferi is endemic in hostanimals, between 15 and 50 per cent ofblacklegged ticks will carry the bacteria.Even then, transmission of Lyme diseaseis not a sure thing. The blacklegged tickmust be attached for 24 to 36 hours beforethey transmit pathogens to their host, saysRochon. Some studies suggest that onlyone to six per cent of those bitten by aninfected tick will actually develop aninfection.Nonetheless, the potentialfor trouble can start earlyin the tick’s life cycle.Adult female blackleggedticks lay their eggs inearly spring. Larvaehatch from the eggs, andseek a blood meal froma passing mammal or36 WAVEbird, in order to make the transformationto the nymph stage. If bacteria or otherpathogens are present in the host animal,that passes into the larvae’s mid-gut, saysRochon, who is an assistant professorin the Department of Entomology at theuniversity.The nymph must also have a bloodmeal in order to transform into an adult,again giving it another chance to pick uppathogens, or to transmit these to its host.“The larvae that overwinter molt in thespring or early summer, which is whynymphs are active in the summer, andthis is when most Lyme disease cases arediagnosed,” says Rochon.SYMPTOMS OF TROUBLEThe Public Health Agencyof Canada’s criteria forcategorizing a case of Lymedisease are relativelystraightforward. Aconfirmed case requiresclinical evidence ofillness, a positive lab testand a history of exposureto an area populated by blacklegged ticks.To be considered a probable case, apatient must have a history of exposureto an area populated by blacklegged ticksand a clinician reported erythema migrans(skin rash), or clinical evidence of illnessand a positive lab test.Manitoba Health also has a categorycalled “other,” which includes cases thathave been reported to Manitoba Health bya physician or lab report, but do not meetthe national standards for a confirmed orprobable case of Lyme disease.Dr. Richard Rusk, Medical Officerof Health for Manitoba Health and theprovince’s point person on the Lymedisease file, says once infected, a personmay experience three stages of illness –early, intermediate and late.Early-stage Lyme disease is generallydiagnosed within 30 days of being bittenby a blacklegged tick. Initial indicationsof infection can include a bull’s-eyerash, which occurs in approximately70 per cent of cases and is caused bythe body’s immune system fighting thebacteria. Expanding out from the initialsite of the infection, the rash can be a

solid expanding red spot, or it can be a single red spotsurrounded by lighter red skin, resembling a bull’s eye.Early-stage Lyme disease is also associated with flulikesymptoms – fever, chills, fatigue, body aches and aheadache.If not treated immediately, Lyme disease can progressto the intermediate stage, emerging a few months afterthe infection. During this stage, the disease can spread toother parts of the body, causing a variety of symptoms,including rashes, joint pain, neurological problems,cardiac issues and temporary paralysis of one side of theface (Bell’s palsy).Late-stage Lyme disease usually occurs six or sevenmonths after the initial infection. Symptoms can includearthritis in the joints, particularly the knees.As the disease progresses, it can causea bewildering set of symptoms thatmimic other diseases, includinglupus, rheumatoid arthritis andmultiple sclerosis, all of which areautoimmune diseases. Rusk says itcan also be mistaken for menopause,Meniere’s disease or Parkinson’s. It isimportant to remember that the variousstages of Lyme disease may overlap,says Rusk.In terms of treatment, the earlier, the better. If a healthcareprovider suspects their patient has been infected,they will normally prescribe a course of the antibioticdoxycycline for two weeks. If the disease is in a laterstage, treatment changes to 28 days of doxycycline.“Oral treatment is shown to be 90 per cent effective inthe early stages,” says Rusk, adding that treatment is alsoeffective in the later stages.But diagnosing the infection is not as easy as it sounds.commitmenttocaringCONCERNS AND CONTROVERSYWhile no one questions the origins of Lyme disease orhow it is transmitted, the diagnosis and treatment of theillness has been surrounded by controversy since the firstNorth American cases started to surface in the 1970s.Over the years, numerous advocacy groups haveformed, including CanLyme (the Canadian Lyme DiseaseFoundation). They argue that many people with Lymedisease have not been properly diagnosed or treated.Ron Rudiak’s story illustrates their point. The Steinbacharea beekeeper fell ill one summer day in 2006. Heexhibited flu-like symptoms, including a fever andaches and pains throughout his body. Within a few daysof falling ill, Rudiak visited his local doctor. After anexamination, the physician decided that Rudiak should betested for Lyme disease.The theory that Rudiak may have been bitten by adisease-carrying tick was entirely reasonable. The 75-yearoldman’s bee hives are located on the edge of variousfields, often in the shade of trees, and always in longgrass – perfect tick habitat. And he certainly has had hisfair share of experience with ticks. “Over the years, I musthave pulled hundreds of ticks (of all kinds) off,” he says.There were just two problems. Rudiak did not have abull’s-eye rash and his lab test came back negative. As aresult, Rudiak was left without a diagnosis for his ailmentsand no pathway to treatment.Over the next six years, Rudiak searched for anwww.manitobanurses.caSummer 2015 37

explanation for his illness. During thattime, he suffered damage to his nervoussystem and lost the ability to walkwithout the aid of a cane. Eventually,he came under the care of an infectiousdisease specialist in Winnipeg, whoprovided him with a prescription forantibiotics.As far as Rudiak is concerned, hehas Lyme disease, and the medicationhe is taking helps him cope with it. Yetalmost a decade later, the lack of a rashduring his initial visit or a positive testby a provincially-approved lab means itremains unclear whether Rudiak actuallyhas Lyme disease or another illness withsimilar symptoms.Over the years, a number of peoplewho exhibit symptoms of Lyme diseasebut who have not tested positive for thecondition have headed to doctors andlabs in the United States, looking foranswers. But, even some people living inthe U.S. complain about not being ableto get a proper diagnosis.A high-profile exampleis Canadian poprockerAvrilLavigne. Sherecently wentpublic claimingthat doctors inLos Angeleswere unableto diagnose herLyme disease.During an interviewon ABC’s GoodMorning America in lateJune, Lavigne talked about her struggleto find a diagnosis for her condition.“They would pull up their computer andbe like, ‘chronic fatigue syndrome.’ Or,‘Why don’t you try to get out of bed,Avril, and just go play the piano?’”A COMPLICATED ISSUEThe fact that some people infectedwith Lyme disease may receive a falsenegative when tested for the disease isnot in dispute. But it is also a fact thatsome people who believe they haveLyme disease are actually suffering fromsomething else.That both of these things are truecomplicates the discussion around thediagnosis and treatment of Lyme diseasein Canada, according to Rusk.As he explains, the challenges intesting for Lyme disease can be attributedto the nature of the bacteria itself. “Thistype of bacteria is one that doesn’t playwell in the lab, and it’s a chameleon38 WAVEinside the human body,” he says. As aresult, the disease is hard to detect, butnot impossible to discover.To get the job done, the provinceuses a two-tiered approach. If Lymedisease is suspected in a patient, a bloodsample is sent to Cadham ProvincialLaboratory, which runs an enzyme-linkedimmunosorbent assay (ELISA), lookingfor antibodies against Borrelia. If thereis a positive result, the sample is thenconfirmed by the National MicrobiologyLaboratory, which uses the Western Blottest.As Lindsay explains, the second test isneeded because the first one may includepeople who actually do not have Lymedisease. “An ELISA can give you falsepositives,” he says. “So protocol ensureswe screen everyone with the ELISA andthen refine the results with the WesternBlot to eliminate people who were falselypositive on the ELISA.”The timing of the test is also tricky,adds Lindsay. A person recently bittenby a blacklegged tick may develop thered rash, but as the infection is stillspreading in their body, they may nothave developed antibodies to the Borreliainvader yet. “It’s much easier once thedisease progresses, often to the pointwhere the person feels like they havearthritis, as that’s the point where thebacteria get into the large joints,” hesays. “Typically, this is weeks to monthsafter the person develops the rash. Bythen, their body has developed theantibodies, which show up on the tests.”Rusk says the limits of the testingprocess are well known and open tomisinterpretation. “There is a period(10 to 30 days) when these initialimmunoglobulins may not havedeveloped to a measurable level yet (38to 67 per cent sensitivity). We are wellaware of that,” he says. “However, arepeat test after 30 days is consideredmore accurate, and, if there are severesymptoms, the sensitivity is consideredhigh (87 to 97 per cent),” says Rusk. “Ifthe test does not come back positive, wehave to consider the option that there isanother reason for the symptoms.”While both men express confidencein the current tests, they also point outthat they are constantly improving. “Wegive feedback to the companies thatprovide the tests, and they’re providingus with new assays that are better atdetecting the disease in its earlier stages,”says Lindsay, adding that the NationalMicrobiology Laboratory is working withdiagnostic labs across Canada to reviewcurrent diagnostic practices and qualityLymediseaser i s ka r e a sAreas with blacklegged ticks arelisted chronologically by when theywere identified, oldest to newest.Southeast CornerPopulationThe area near the bordersof Manitoba, Ontario andMinnesota has had an establishedblacklegged tick population since2006. The Lyme disease risk areahas expanded north into MooseLake Provincial Park and west intoSprague.Pembina PopulationBlacklegged tick populations withinthe Pembina Valley and along thePembina escarpment continue toexpand from the American borderto the rural municipality of SouthNorfolk in the north and west toKillarney. Ticks within this risk areaare most common in the limitedforested areas. This area includesthe Pembina Valley ProvincialPark, sections of the Trans-Canadatrail and a number of prairielakes. Ongoing surveillance hasshown high infection rates amongblacklegged ticks collected fromthis region.AssiniboinePopulationThe blacklegged tick populationwithin Beaudry Provincial Parkhas expanded west along theAssiniboine River corridor as far asthe Brandon Hills. Blacklegged tickpopulations have been identified

Blacklegged tick passive surveillance sitesLyme disease risk areasDistribution of blacklegged ticks within the riskareas is not uniform and is associated with suitablehabitat. Areas with trees that shed their leavesprovide ideal habitat for blacklegged ticks. Thereis less chance of encountering a blacklegged tickin less favourable habitats (i.e., open grasslands,agricultural fields, bog or wetlands), but they canalso be found outside the designated areas. Formore information, visit www.gov.mb.ca/health/lyme/surveillance.html.in locales between BeaudryProvincial Park and BrandonHills such as Poplar Point andSpruce Woods Provincial Park.St. Malo PopulationThe St. Malo populationconsists of two groups. Thefirst is located in the Kleefeldarea, just west of Steinbach,and may in fact connect withthe Richer/Ste. Genevievepopulation to the east. Thesecond, larger one extendssouth from the St. Malo region,through the community ofRoseau River and along theriver corridor of the same namethrough the communities ofVita and Arbakka near the U.S.border. Located southeast ofWinnipeg, this area includesa provincial park, a segmentof the Trans-Canada trail,campgrounds and a wildlifemanagement area.Richer/Ste.GenevievePopulationThis population is locatedeast of Winnipeg, outside ofthe Agassiz and Sandilandsprovincial forests, whichstraddle the Trans-CanadaHighway. As of 2013, thispopulation has now beenshown to extend north intoAnola, potentially further toBirds Hill Provincial Park, andwestward into the communityof Ste. Anne. Moreover, thispopulation may represent anorthward extension of the St.Malo population.Southern LakesPopulationThese two isolated populationsare located on thesoutheastern shores of LakeManitoba and Lake Winnipeg.First identified in 2013, theseestablished blacklegged tickpopulations are located in andaround the St. Ambroise andPatricia Beach Provincial Parks.SoutheasternWinnipegPopulationFirst identified in the southeastof the city in 2013, thispopulation was most likelyintroduced along the SeineRiver or Red River corridors.Source: Province of ManitobaSummer 2015 39

H o w t o r e m o v e a tickIf you find a tick attached to your body,you can get it removed by a health-careprovider or remove it yourself. To removean attached tick:Grasp the tick with tweezers as close to theskin as possible.Gently pull the tick straight away fromyou until it releases its hold. Pulling the tickout too quickly may tear the body fromthe mouth, leaving the mouth still in theskin. If this happens, you can try removingthe embedded mouthparts with a sterileneedle, in the way you would remove asplinter, or you can get help from yourhealth-care provider.Do not twist the tick as youpull, and try not tosqueeze its body.Squeezing orcrushing thetick couldforceinfectedfluids fromthe tickinto thesite of thebite.Afteryou haveremoved thetick, thoroughlywash your handsand the bite areawith soap and water.Put an antiseptic such asrubbing alcohol on the area whereyou were bitten.Save the tick in case you later starthaving symptoms of disease and needto know what kind of tick bit you. Put thetick in a clean, dry jar, small plastic bag,or other sealed container and keep it inthe freezer. Identification of the tick mayhelp your provider diagnose and treatyour symptoms. If you do not have anysymptoms of disease after one month, youcan discard the tick.The usual reaction to a tick bite is nothingmore than a bump on your skin thatimproves within a few days.Call your health-care provider if:• A tick has bitten you and you think thetick may be a blacklegged tick.• You develop a bull’s-eye rash or a rashwith tiny purple or red spots.• The area of the bite becomes moreswollen or painful or drains pus, or you seered streaks spreading from the wound.• You have flu-like symptoms after a bitesuch as fever, headache, muscle aches,joint pain or swelling, and a generalfeeling of illness.How can I prevent tick bites?Be aware of the areas where ticks live. Donot walk, camp, or hunt in the woods intick-infested areas without precautions.In areas of thick underbrush, try to staynear the centre of trails.When you are outdoors, wear long-sleevedshirts tucked into your pants. Wearyour pants tucked into yoursocks or boot tops ifpossible. A hatmay help, too.Wearing lightcolouredclothingmaymake iteasier tospot asmall tickbefore itreachesyour skinand bites.Use approvedtick repellentson exposedskin and clothing.Do not use more thanrecommended in the repellentdirections. Do not put repellent on openwounds or rashes. Wash the spray off yourhands. Be careful with children becausethe repellents can make them ill.Treat household pets for ticks and fleas.Check pets after they have been outdoors.Brush off clothing and pets before enteringthe house. After you have been outdoors,undress and check your body for ticks.They usually crawl around for several hoursbefore biting. Check your clothes, too.Wash them right away to remove any ticks.Shower and shampoo after your outing.Inspect any gear you have carriedoutdoors. If you spend much time hiking,you may want to include a pair of ticktweezers in your first-aid kit. The tweezersare available at many sporting goodsstores.Source: Health Linksassurance systems.And Rusk says the new ELISAtest being used at Cadham is animprovement over previous ones.“It’s more specific, which makesit much harder to get a falsepositive.”Rusk and Lindsay alsoquestion the legitimacy of sometests conducted in the U.S. Rusknotes that one lab used by anumber of Manitobans does notmeet the standards required bythe province.“Their algorithms for testingand result interpretation arecompletely different from theaccredited Western Blot tests that(local labs) carry out,” he says.“Subsequently, the Manitobaphysicians who receive theseresults from the patients areunable to interpret them andwould not necessarily start anytreatment. However, in theinterim the patient has nowreceived a result that they believeis true and will expect someform of treatment, and hence theconflict begins.”Essentially, says Rusk, theselabs are simply cashing in onLyme disease.“We have plenty of otherexamples of for-profit medicinethat recommends tests orprocedures that have beenshown to potentially havenegative outcomes. So myquestion for institutions isalways: why are they not incompliance with the nationalstandards, especially if they havesomething that they believe is asvalid as that standard?”Lindsay concurs, adding thatthe problem with some of thetests being used in the U.S. isthat they rely on an algorithmthat has not been fully validated.“In addition, it has been wellestablishedthat the approachused by some of these labsproduces a large number of falsepositives, which should be aconcern for all concerned.”In order to reduce confusion,American researchers areresearching metabolic biomarkersthat look for certainproteins that appear in the bloodof an infected person, saysLindsay, adding this will changethe course of how testing is donein the future.40 WAVE

1231. Kateryn Rochon pulls a piece of flannel alongthe grass to pick up ticks, a process known as dragsampling.2. One blacklegged tick (left) on its back, the otheron its stomach.3. Rochon and Scott Graham-Derham withblacklegged ticks in a glass vial.THE BIG PICTUREThe debate over testing practices and diagnosis hasattracted much media attention over the years. It has alsosparked a lot of activity on the Lyme disease front that couldhelp prevent transmission of the disease.Since 2006, the federal government has spent $5 millionon research into Lyme disease, a decision that was at leastin part due to concerns being raised by advocacy groups. In2014, it passed legislation – Bill C-442 – to create a federalframework for dealing with the spread of the infection. Thatled to the creation of an action plan, which is currentlybeing implemented across the country in conjunction withprovinces and territories.According to a review by scientists at the Public HealthAgency of Canada, including Lindsay, the action plan isdesigned to:• Improve understanding and awareness of Lyme diseaseby the public, health-care providers and other stakeholders;• Enhance national surveillance to pinpoint where thedisease is emerging and which populations are at risk;• Support research to generate new insights to effectivediagnosis and treatment;• Promote early diagnosis and treatment of Lyme disease.As part of the action plan, a federal official has beenworking with Manitoba Health to assess the province’sapproach to Lyme disease, according to Rusk.“The (representative) did an assessment of where we standin comparison to other provinces,” says Rusk. “While (BritishColumbia) and Nova Scotia are leaders in this area, we areahead of the other provinces where Lyme occurs.”Working with the federal official, Manitoba reviewedhow it communicated with the public and with physiciansabout Lyme disease. As a result, the province revamped itswebsite and increased its educational resources for differentaudiences, says Rusk. In one example of how communicationhas been enhanced, Rusk says he has helped the Workers’Compensation Board craft workplace messages about Lymedisease.At the same time, Winnipeg doctors have also becomequite knowledgeable about the disease within the past fiveyears, says Rusk. “Ten years ago, it was a different story.There was less general physician knowledge about thisemerging disease,” he says, explaining that somedoctors may not have tested for Lyme diseaseimmediately. “But today, education sessionshave been done with family doctors, and ourinfectious disease specialists are very goodat working on complex cases,” he says,noting that testing for Lyme has jumped 30per cent over the last five years, indicatinggreater awareness about the disease on thepart of physicians.Some of the research envisioned in theaction plan is already underway.Rochon, for example, is researching theexpansion of the blacklegged tick population inManitoba. Part of the work involves examining the tick’slife cycle. Normally, the blacklegged tick’s life cycle laststwo years. But Rochon is investigating whether its life cyclein Manitoba may extend to three or four years, due to thefact that winters here are longer than in other parts of thecontinent where it can be found.Her team of students is currently trapping small mammals(such as mice and voles) in Beaudry and Birds Hill provincialSummer 2015 41

Ron Rudiak says he has hadplenty of experience withticks over the years.parks, checking them for ticks, and takinga blood sample. The animals are thenmarked so the team can keep track ofthem, if caught again. “We’re trackingthe population of ticks, the diseases theycarry and how endemic it is in the hostpopulation of mammals,” she says.This research will also yield informationon when the blacklegged tick is mostactive. Unlike the American dog tick,which is primarily active in the spring andearly summer months, blacklegged ticksare known to be active from spring to fall.But Rochon wants to better understandprecisely how active they are at differentpoints between May and October. ThisFYIinformation will be particularly valuable tothe Manitoba Beekeepers Association.“Beekeepers are quite interested in thisproject because of where they work,” saysRochon. “Their bee hives are at the edgeof fields, which exposes the beekeepers toLyme and the other diseases. They want toknow when these ticks are active.”DON’T FEAR THE OUTDOORSAlthough blacklegged ticks can posehealth risks, they should not deter anyonefrom enjoying Manitoba’s great outdoorsthis summer.As Rochon points out, the trick is simplyFor more information on blacklegged ticks and Lyme disease, visit:www.gov.mb.ca/health/lymeOnline videos:How to remove ticks: https://youtu.be/27McsguL2OgHow to check yourself for ticks: https://youtu.be/ySoDjoZt7yIHow to avoid tick bites: https://youtu.be/QZr0qHDhLPIDifferences between tick species: https://youtu.be/sXqn_jHVWSMto check for ticks throughout the springand summer and into the fall.Dr. Bunmi Fatoye, Medical Officer ofHealth with the Winnipeg Health Region,agrees that people shouldn’t be afraidof venturing outdoors. “Keep active. Gocamping and hiking. Get out and garden,”she says. As for precautions, she suggestswearing long-sleeved shirts and pantstucked into your socks and using insectrepellent. “And when you return home,inspect your body for ticks. Inspect yourchildren and pets, too.”Have a shower within two hours ofyour return home, because it allows youto do a thorough tick check, with the aidof a mirror. “Wash your clothing, andthen put it in the dryer. Ticks can’t survivethe dryer, because they can’t handle thatlevel of desiccation,” says Fatoye.If you notice a rash that might beassociated with a tick bite, see yourhealth-care provider. “If you can’t getan appointment right away, or if youhave to travel to see your doctor, takea photo of the rash with your cameraor smartphone,” says Fatoye. “That wayyou’ll have a record of it when you do getin to see your doctor.”Susie Strachan is a communicationsadvisor with the Winnipeg Health Region.

tiny troubleThe blacklegged tick often goes unnoticed whilecrawling on your body because it is so small. Whenunfed, nymphs of the blacklegged tick are a mere 1 to1.5 millimetres in size, or about as big as a poppy seed.Unfed adults will grow to 3 to 4 mm in length, or aboutthe size of a sesame seed. By comparison, the Americandog tick (wood tick) can range from 3 to 6 mm and aremuch easier to see.4.2.1.But the best way to tell them apart is by colour. Theimage above shows two blacklegged ticks(1 and 2) and two American dog ticks (3 and 4). Inaddition to being smaller, the blacklegged ticks alsohave different colouring than the wood ticks. Male andfemale American dog ticks have white markings on theirbacks. These markings are not present on the backs ofblacklegged ticks.By the numbers3.15 to 50: The estimated percentage of blackleggedticks in areas where Borrelia burgdorferi is endemicin host animals that could be carrying the bacteria,according to some studies.24 to 36: The number of hours it takes for ablacklegged tick to transmit pathogens once it hasbitten a human being.1 to 6: The percentage of people bitten by aninfected tick who may develop an infection,according to some studies.128: Number of confirmed and probable cases ofLyme disease recorded in Canada in 2009, the firstyear Health Canada started officially tracking theinfection.Welcome Home!McClure Place – 533 Greenwood Place55+ Retirement LivingWhat’s included in each unit· Eat-in kitchen· Extra-large balconies· Spacious in-suite storage· Resident controlled security access· Free laundry facilities· 1 bedroom apartments - $665.00/month· 2 bedroom apartments - $793.00/month· All utilities included - tenant pays for cable & phoneServices and Amenities· On-site caretaker· Close to Polo Park & Downtown· Optional Meal Program – 4 nights a week· Weekly van transportation to Safeway· Hair Salon· Milkman· Regularly scheduled foot care· Weekly United Church Services· And much more …For more informationCall Manitoba Toll Free: 1-855-942Or e-mail admin@sam.mb.ca682: Number of confirmed and probable cases ofLyme disease recorded in Canada in 2013.157: The number of Lyme disease cases reportedin Manitoba since 2009, including 60 confirmed, 55probable and 42 categorized as “other.”

alanceNicole NeaultBreaking themale codeMen can achieve bettermental health by getting intouch with their emotionsNothing is wrong. I’m fine. I can handle it.Sound familiar?In western culture we encourage boysto be tough, strong and independent. Weadmire them when they can face adversitywith courage and fearlessness. Challengesin life are inevitable, regardless of ourgender; however, boys and men who havebeen socialized to accept these ideals maybelieve that experiencing or expressingfeelings of sadness, worry, or loss meansthat they are weak, needy or open toridicule.Resiliency and positive mental wellbeingare built on the ability to managechallenges in life, not ignore them. Sowhile some men may attempt to hide orignore their feelings and needs in orderto feel capable of handling them, theyactually may be putting their mental healthat greater risk. There are a variety of waysto acknowledge and cope with emotionsand challenges that do not leave menfeeling fragile or vulnerable.Traditional masculinity teaches boysthat they should not complain or showthat they are unwell or upset. Theseexpectations and the stigma that surroundsmental health issues set men up to sufferin silence when they are struggling withemotional distress. Serious symptoms maybe trivialized, and research suggests thatsome men may not even recognize thatthey are suffering until it becomes a crisis.Seeking help is seen as a last resort. Whenthey do reach out they frequently seeksupport from a female partner or closefemale acquaintance rather than seekingout professional medical or psychologicalhelp. Younger men are more likely to usetechnology and the Internet to seek outadvice or information.We will all experience some form ofstress or distress in our lives, regardless ofour gender, age or culture. Even positivechanges or transitions in life can createstress. Examples include getting a newjob, buying a home, getting married,going back to school or retiring. How wellwe navigate those challenges in life canbe dependent on our physical, mental,emotional, and spiritual health at the time.How men are socialized can also playa role in how they manage or respond,especially if they adhere to the masculinenorms of suppressing emotions.In fact, the suppression of emotions canlead to an increase in stress and negativemood. Substance abuse, irritability, angerand social withdrawal may be long-termconsequences of ignoring or minimizing44 WAVE

high levels of stress. This can then lead to poor mental health,which is also associated with poor physical health, moreabsenteeism from work and school, and decreased quality ofrelationships and participation in life. So what is a guy to do?Here are a few suggestions:Connect with other people. Why? Because people whohave close trusting relationships with others – whether it is afamily member, friend, co-worker, or friendly neighbour – areless likely to experience sadness, loneliness, low self-esteemand problems with eating and sleeping. Connecting withothers in meaningful ways can also improve your happinessand satisfaction in life.Get involved. Develop some hobbies or interests. Don’thave any? Think about things you used to enjoy when youwere younger. Learning something new is another way ofimproving your mental well-being.Get active. Not only is it good for the body but also good forthe mind and soul. There is nothing like a game of football, arun with the dog, or cycling through the park to reduce stressand improve your mood. Physical exercise has also beenproven to improve sleep, increase concentration and improveenergy levels. Numerous studies have also shown that exercisecan combat depression and anxiety symptoms.Stop and take some time to relax. Relaxing will be differentfor each person. Some great examples are listening to music,art, photography, woodworking, or fishing. Don’t let genderstereotypes get in the way of enjoying a hot bath or a yogaclass. Meditation and relaxation exercises are also good forreducing stress. You can do these in the comfort of your ownhome. Remember, stress reduction is universal; we all needtime to relax and rejuvenate.Laugh more often. Laughter releases chemicals that help toreduce stress. Enjoy spending time with someone who has agood sense of humor.Reduce or eliminate alcohol and drug use. They may help usfeel better temporarily but in the long run they can make thingsworse and can lead to symptoms of anxiety and depression.Consider getting help. Don’t wait until life seemsunmanageable or out of control. It doesn’t mean you are less ofa man. On the contrary, it shows courage and initiative to seekout help when you need it. Everyone needs a variety of toolsin their toolbox for the different situations they may encounter.Sometimes it means seeking advice from someone else in orderto address the problem.Notice the positive. Easy to say; harder to do. Researchsuggests that some of us are born with a greater amount ofoptimism than others. However, we can all work towardsa more positive frame of mind. Practise gratitude. Take thetime to think of some positive things that have occurred everyday. Mindfulness is another way to learn to live in the presentmoment and enjoy experiences more. Recognize your strengthsand talents and use them to assist you when life becomesdifficult. Re-framing challenges as opportunities can also bring asense of satisfaction.We all want to thrive and flourish in life. Sometimes for men,the way they have been socialized sets them up to respondwith either a fight or flight response in situations where they feelstressed, vulnerable, or fearful. We need to let boys and menknow that they are human. Being a man also means havingemotions and needs and it is okay to talk about them or reachout for help. This will bring health and vitality to our families,communities and society as a whole.H E A LT H S TA R T S AT H O M EVictorian Order of NursesMain Floor Winnipeg Clinic425 St. Mary Ave. Winnipeg204-775-1693Services Include:• Nursing• Corporate Wellness• Mantoux Testing• Immunizations• Flu Clinics• URIS• SMART• Home Support• Foot Care3449979 1 1/2/14 7:52:37 PMBright new image.Still deeply rooted inour community.With a colourful history and a wide-ranging operationthat remains deeply rooted in social justice, we felt it wastime to evolve our image to reflect our steady growth asan organization.With our new logo and extended tagline, it is clear that ourservices are for people of every age, background, ethnicity,gender identity, and socio-economic circumstance.Our dedication to health care, counselling and educationfor all is still our focus.From our team of diverse health care providers andadministrators, to our vision of creating healthy and engagedcommunities – at Klinic, some things will never change.Just Care. For Everyone.Nicole Neault is a mental health promotion facilitator withthe Winnipeg Health Region.Visit our new website at www.klinic.mb.ca

ask a nurseAudra Kolesarsoothe your soleWhat you need to know about thepain on the bottom of your foot.I have a pain on the bottom of myfoot. What can it be?It sounds like you may have somethingcalled plantar fasciitis, which is a painfulinflammation of the bottom of the footbetween the ball of the foot and the heel.How does it occur?There are several possible causes ofplantar fasciitis, including:• Wearing high heels• Gaining weight• Increased walking, standing, orstair-climbing.If you wear high-heeled shoes, includingwestern-style boots, for long periods oftime, the tough, tendon-like tissue of thebottom of your foot can become shorter.This layer of tissue is called fascia. Painoccurs when you stretch fascia that hasshortened. This painful stretching mighthappen, for example, when you walkbarefoot after getting out of bed in themorning.If you gain weight, you might be morelikely to have plantar fasciitis, especiallyif you walk a lot or stand in shoes withpoor heel cushioning. Normally there is apad of fatty tissue under your heel bone.Weight gain might break down this fatpad and cause heel pain.Runners may get plantar fasciitis whenthey change their workout and increasetheir mileage or frequency of workouts. Itcan also occur with a change in exercisesurface or terrain, or if your shoes areworn out and don’t provide enoughcushion for your heels.Another common cause of heel painis the heel spur, a bony growth on theunderside of the heel bone. The spur,visible by X-ray, appears as a protrusionthat can extend forward as much as halfan inch. When there is no indicationof bone enlargement, the conditionis sometimes referred to as “heel spursyndrome.”Heel spurs result from strain on themuscles and ligaments of the foot, bystretching of the long band of tissuethat connects the heel and the ball ofthe foot, and by repeated tearing awayof the lining or membrane that coversthe heel bone. These conditions mayresult from biomechanical imbalance,running or jogging, improperly fitted orexcessively worn shoes, or obesity. It isunknown if heel spurs actually causeplantar fasciitis.

What are the symptoms?The main symptom of plantar fasciitis isheel and foot pain when you walk. Youmay also feel pain when you stand andpossibly even when you are resting. Thispain typically occurs first thing in themorning after you get out of bed, whenyour foot is placed flat on the floor. Thepain occurs because you are stretchingthe plantar fascia. The pain usuallylessens with more walking, but you mayhave it again after periods of rest.You may feel no pain when you aresleeping because the position of yourfeet during rest allows the fascia toshorten and relax.How is it diagnosed?Your health-care provider will ask aboutyour symptoms. He or she will ask if thebottom of your heel is tender and if youhave pain when you stretch the bottomof your foot. An X-ray of your heel maybe done.How is it treated?Give your painful heel lots of rest. Youmay need to stay completely off yourfoot for several days when the pain issevere.Your health-care provider mayrecommend or prescribe antiinflammatorymedicines, such as aspirinor ibuprofen. These drugs decrease painand inflammation. Resting your heel onan ice pack for a few minutes severaltimes a day can also help.Try to cushion your foot. You can do thisby wearing athletic shoes, even at work,for a while. Heel cushions can also beused. The cushions should be worn inboth shoes. They are most helpful if youare overweight or elderly.An orthotic sole support may be part ofyour treatment.If your heel pain is not relieved by thetreatments described above, your healthcareprovider may recommend physicaltherapy. The goals of physical therapyare to stretch the plantar fascia and tostrengthen the lower leg muscles, whichstabilize the ankle and heel. Sometimesphysical therapists recommend athletictaping to support the bottom of the foot.A splint may be fitted to the calf of yourleg and foot, to be worn at night tokeep your foot stretched during sleep.Another possible treatment is injectionof cortisone in the heel. Surgery is rarelynecessary.How long will the effects last?You may find that the pain is sometimesworse and sometimes better over time. Ifyou get treatment soon after you noticethe pain, the symptoms should stop afterseveral weeks. If, however, you have hadplantar fasciitis for a long time, it maytake many weeks to months for the painto go away.Everyone recovers from an injury at adifferent rate. Return to your activitieswill be determined by how soon yourfoot recovers, not by how many days orweeks it has been since your injury hasoccurred. In general, the longer you havesymptoms before you start treatment,the longer it will take to get better. Thegoal of rehabilitation is to return you toyour normal activities as soon as is safelypossible. If you return too soon you mayworsen your injury.When can I return to my normalactivities?You may return to normal activitieswhen:• You have full range of motion in theinjured foot compared to the uninjuredfoot.• You have full strength of the injuredfoot compared to the uninjured foot.• You can walk straight ahead withoutsignificant pain or limping.How do I prevent plantar fasciitis?The best way to prevent plantar fasciitisis to wear shoes that are well made andfit your feet. This is especially importantwhen you exercise or walk a lot or standfor a long time on hard surfaces. Getnew athletic shoes before your old shoesstop supporting and cushioning yourfeet.You should also:• Avoid repeated jarring to the heel.• Maintain a healthy weight.Audra Kolesar is a registered nurse andmanager with Health Links - Info Santé,the Winnipeg Health Region’s telephonehealth information service.Avoid high-heeled shoesAvoid weight gainThe information for this columnis provided by Health Links -Info Santé. It is intended to beinformative and educationaland is not a replacementfor professional medicalevaluation, advice, diagnosisor treatment by a health-careprofessional. You can accesshealth information from aregistered nurse 24 hours a day,seven days a week by callingHealth Links - Info Santé.Call 204-788-8200 ortoll-free 1-888-315-9257.

healthy eatingCheryl OgarankoHUNGERG A M EL e a r n h o w t oc o n t r o l y o u r a p p e t i t eAppetite is defined as a desire to satisfy a need, suchas eating food.But as simple as that may sound,your appetite is actually governed by acomplicated process, one that can beinfluenced by a variety of factors thatdetermine how much or how little you eat.To understand how that process works,it helps to be aware of the gut-brainconnection.When your stomach is empty, itreleases a hormone called grehlin, whichsends a message to the hunger andfullness centre of the brain, called thehypothalamus. The hypothalamus hasappetite receptors that give us the urgeto eat. After eating, a hormone calledleptin is released from the stomach andintestines. Leptin suppresses appetiteby travelling to the hypothalamus inthe brain to say you are satiated or full.Normally, this feeling of fullness causesyou to stop eating and not think aboutfood for several hours.Based on this, we know that hormonesplay an important role in the ability toregulate appetite and, therefore, weight.But what other factors can drive appetite?Poor appetite can result from physicaldisease like cancer, emotions such asgrief over a loss, or mental health issuessuch as depression.Stress can also play a role in reducingappetite. Food isn’t as tempting whenyou’re anxious, worried or feelinghopeless. In these instances, there is oftenunintentional weight loss due to lack ofmotivation or energy to eat or not feelingwell enough to prepare food or eat.Many people want to know whatcauses them to have an excessiveappetite, resulting in overeating, feelingout-of-control and gaining unwantedweight. It is obvious we eat for manyother reasons besides appetite – tocelebrate, to be social, to relieve boredomand loneliness are a few examples.But, what you eat and how you eatit can also affect how much you eat.Making a few small adjustments may helpprevent overeating, and you might evenend up enjoying your food more.Here are a few things to consider:48 WAVE

CHOOSE FOODS WITH VOLUME:Studies find we tend to eat about the same amount of foodregardless of its calories. Choose foods with a lot of volumecompared to energy value. In other words, foods with morewater and fibre and less fat, such as fruits, vegetables, brothtypesoups and whole grains, will fill you up with fewer caloriesthan low-volume, calorie-dense foods such as doughnuts. Also,drinking something hot like tea or a cup of soup cools yourappetite by making you feel full.Look for pROTEINS:Make sure you are eating foods with protein like nuts, legumesand fish regularly because there is scientific evidence thatprotein foods increase satiety more than carbohydrates.Increasing intake of low-fat dairy foods is another good way ofgetting protein into your diet. In addition, some research showsthat whey and casein, the protein found in dairy products, areappetite suppressors.Try smaller pLATES AND bOWLS:Some people use visual cues rather than hunger to tell themwhen they’ve had enough to eat. In an experiment at CornellUniversity, people who ate from soup bowls that automaticallyrefilled without them knowing it consumed more food, butreported they did not feel more full than the control group. Foodand beverages served on smaller plates and bowls and tall,narrow glasses give the illusion of larger portions. Try not to eatfrom the bag or the box. Instead, put a portion into a small bowl.Chances are you won’t eat as much.Pay attention to HOW you FEEL:Satiety is when you feel ready to stop eating. As Ellyn Satterpoints out in her book Secrets to Feeding a Healthy Family, itis when all the body feelings that say you want to eat go away.Food still tastes good even after you’re not hungry anymore, buteventually your appetite disappears and you feel full. If you keepon eating past being full, you will begin to feel stuffed and won’tbe able to eat another bite. Most people don’t like that feelingbecause it is uncomfortable. Try to get in touch with your body’shunger and fullness cues and eat when hungry and stop whenfull. Infants and children are very good at this.had enough, you need to eat slowly. This gives your brain achance to catch up with your stomach and you’ll be less likelyto overeat. It also makes you more aware of the smell, tasteand texture of foods leading to more enjoyment. This is calledmindful eating.Avoid short-TERM HIGHS:Do you crave soothing comfort foods such as ice cream andcake, particularly when feeling down or lacking energy? Onereason for this is that foods high in simple carbohydrates andfat increase levels of serotonin, a brain chemical that elevatesmood and is related to pleasure. In the short term, eating foodshigh in sugar and fat may make you feel better, but a steadydiet of comfort foods may lead to weight gain and increase yourrisk of lifestyle diseases such as diabetes and heart disease. It’simportant to be able to enjoy your favourite comfort foods fromtime to time, as long as they don’t take over a balanced diet. Inthe long run, a varied diet full of whole grains, vegetables, fruits,lean meats, nuts and legumes, and low-fat dairy and substituteswill give you more energy and make you feel better.Get your SLEEp:A lack of sleep can also cause appetite changes. According toa study published in the Annals of Internal Medicine, peoplewho slept only four hours a night for two nights had a decreasein production of the fullness hormone, leptin, and an increasein the hunger hormone, grehlin, compared with those who gotmore rest. Sleep-deprived people in the study also reported anincrease in appetite. When we are exhausted we tend to cravecomfort foods that are high in simple carbohydrates and fatbecause these foods cause the release of serotonin, the brainchemical that elevates mood. To get the energy boost you need,reach for a combination of complex carbohydrates and proteinfor long-lasting energy. Fibre is digested slower than simplesugars, and adding protein keeps you fuller longer. Try to get theright amount of sleep for you because it will help control yourappetite.There are many other factors that affect appetite, and reactionscan be different depending on the person. For example, alcoholcan cause a decrease or spike in blood sugar, resulting inappetite changes. This is often why people snack on foods likenuts while drinking or sometimes feel hungry after drinking morethan usual. Stress can cause a loss of appetite in some, yet willhave the opposite effect on others. Constant stress causes yourbody to produce high amounts of hormones like cortisol, whichover time can boost appetite causing you to overeat. Yoga,meditation or going for a walk can help keep tension in check.The reasons we eat are complex and there is no right or wrongway to do it. But there are choices. Most people do well withplanned meals and snacks. Learning to pay attention to whatyour body is telling your brain will help you to eat when hungryand stop when full.Cheryl Ogaranko is a registereddietitian with the WinnipegHealth Region.Don’t get DISTRACTED:Studies also show that eating while distracted – watching TV,driving, reading, working – can make you eat more. That’sbecause you aren’t paying as much attention to your hunger andsatiety signals. Since it takes about 20 minutes for your brainto get the message your stomach is comfortable and you’veSummer 2015 49

Crustless Broccoli QuicheStudies show that people who eat a higher proteinbreakfast tend to eat less over the day. Here is a reciperich in protein and fibre to keep you satiated. A bonus isthat it can be assembled the night before and baked inthe morning.Makes 6 servingsingredientsCooking spray or oil (to grease pan)4 large eggs1¼ cups - 1% milk½ tsp dried oregano¼ tsp pepper3 slices whole wheat bread4 cups broccoli florets1 onion, small¾ cup shredded sharp cheddar cheese(square baking pan)Directions1. Turn oven to 350F.2. Grease pan.3. Steam broccoli until tender. Chop into small pieces.4. Chop onion finely.5. Remove crusts from bread and cut into cubes.6. Whisk eggs, milk and spices together in a bowl. Add breadcubes and mix lightly.7. Stir in broccoli, onion and cheese. Pour into greased pan.8. Bake 45 minutes or until knife comes out clean when inserted.9. Let stand 10 minutes before cutting.50 WAVE

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