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Posts Tagged "Multiple"

1Sep

Real benefits to stenting multiple blocked arteries, not just the one that caused a heart attack, study says

by admin

Unblocking additional plaque or cholesterol-clogged coronary arteries with stents after a heart attack — instead of just the one that caused the heart attack — leads to a reduction in the risk of dying or having another heart attack, a multinational study involving B.C. experts and patients shows.

Experts predict the “landmark” study will have immediate implications for heart attack patients as interventional cardiologists will now stent additional coronary arteries with significant narrowing (more than 70 per cent) instead of just the culprit artery that caused the heart attack. There are three major coronary arteries and when heart attack patients have one blocked artery, it is not unusual to see blockages in the others, referred to as multi-vessel coronary artery disease.

The study began in 2013 at hospitals in 31 countries, predominately in Europe and North America. It was published in the New England Journal of Medicine and was presented as a late-breaking session at the World Congress of Cardiology in France.

The COMPLETE study, as it is called, involved 4,041 patients (200 in Vancouver) who were followed for about three years. All patients got stents in the culprit arteries as an emergency rescue measure. But in one arm of the study, half were then released from the hospital and prescribed the usual post-angioplasty medications while in the other study arm, patients had their other blocked arteries stented in what is called complete revascularization, either at the same time as the heart attack causing culprit stenting or within 45 days.


Participants in the COMPLETE trial

Deaths from heart disease, further heart attacks or related to the medical procedure occurred in 179 patients (8.9 per cent) in the complete revascularization group, compared to 339 (16.7 per cent) of those who had only one stent put in.

After a median followup of three years, the risk of a second heart attack or death from heart disease occurred in 7.8 per cent of the patients who had complete revascularization while it was 10.5 per cent in those who got one stent.

“In the past, the gestalt was you do an immediate angioplasty to open the culprit blocked artery and then do less with the other ones, put patients on meds and monitor them instead of fixing the additional blockages at the same time or right after,” said Dr. David Wood, the Vancouver co-principal investigator and director of the Vancouver General Hospital Cardiac Catheterization Lab.

“But in this study, the results show that doing more stenting, even within the first 45 days after the heart attack, was beneficial. There was a 26 per cent reduction in the patients’ risk of dying or having another heart attack.”


Dr. David Wood and Dr. John Cairns at Vancouver General Hospital. The pair participated in the COMPLETE trial, focusing on the effect of stenting additional arteries of heart attack victiims. Photo: Arlen Redekop/Postmedia

Arlen Redekop /

PNG

Dr. Shamir Mehta, the principal investigator of the study led by McMaster University and Hamilton Health Sciences, said the data shows that there are benefits to clearing all the arteries and no major downside to the additional procedures.

“Given its large size, international scope and focus on patient-centred outcomes, the COMPLETE trial will change how doctors treat this condition and prevent many thousands of recurrent heart attacks globally every year,” said Mehta, an interventional cardiologist and a senior scientist at the Population Health Research Institute.

Dr. John Cairns, a Vancouver cardiologist who is the former dean of UBC medical school and a study collaborator said: “(Additional) blockages should be fixed in the first 45 days after a patient’s initial heart attack.”

Leslie Carey was one of the trial participants. In 2015, the Burnaby resident had a heart attack while riding a bus to work,

Carey’s chest pains were so severe that he got off the bus and called 911. Paramedics quickly attended to him in a nearby parking lot, whisking him off to VGH.

Life was stressful at the time but his health was pretty good, or so he thought.

“I didn’t have high blood pressure or diabetes but I was taking meds on and off for cholesterol,” said the 58-year old marine administrator for the Royal Vancouver Yacht Club.

Right after a coronary artery was stented, Carey said he felt so much better. His chest pain was gone. Since he was randomly assigned to the trial arm of patients who would get further treatment, he then had another stent inserted into another partly blocked artery. And months later, yet another stent was added so he now has three stents propping open his major coronary arteries.

“I’m fully wired now,” said Carey.

About 20,000 B.C. residents have diagnostic angiograms and angioplasties — usually with stents — each year and another 2,000 have open heart surgery, which is indicated for more serious cases and for patients with diseases like diabetes, according to a Cardiac Services B.C. provincial registry.


Leslie Carey had a heart attack while on a bus to work at Royal Vancouver Yacht Club and had three stents put in. Photo: Arlen Redekop/Postmedia

Arlen Redekop /

PNG

Mehta said patients who had angioplasties were on the right medications to reduce their risk of a heart attack. No one should jump to the conclusion that the medications weren’t effective.

“We don’t know if the same benefit of angioplasty would be there if they were not on the medication. The angioplasty can be considered as an add-on to the medications to prevent further events.”

Mehta, Cairns and Wood agreed that doing more angioplasties on patients with heart attacks is not going to overburden the Canadian health care system. A future study may look at the economics of “front-loading” angioplasties and Cairns said he thinks there could be some cost efficiencies in addition to health benefits.

“We are well equipped in Canada to perform the additional procedures, particularly since the trial shows they can be done any time within 45 days of the index (first) heart attack,” said Mehta.

The median age of trial participants was about 62 and 80 per cent were male. Study authors said that is because more men have large heart attacks.  About 50 per cent of study participants had high blood pressure and 40 per cent were smokers. Just under 40 per cent had high cholesterol.

The study cost over $14 million; $3 million came from the Canadian Institutes of Health Research and just over $11 million from Boston Scientific and AstraZeneca. The companies had no role in trial design, analysis or manuscript writing, according to the authors.

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16May

Summerland lifeguard faces multiple sex charges involving children

by admin


Summerland lifeguard guard Edward Casavant, 54, has been charged with multiple sex crimes involving children.


RCMP handout

The long-time lifeguard at the public pool in Summerland has been arrested and charged with multiple sex offences involving children.

Penticton RCMP arrested Edward Casavant, 54, on outstanding warrant on Wednesday.

The Penticton resident has been charged with 10 counts relating to incidents that allegedly occurred between 2008 and 2014, including:

• 2 counts of making or publishing child pornography;
• 1 count of importing or distributing child pornography;
• 1 count of possession of child pornography;
• 1 count of accessing child pornography;
• 1 count of secretly observe/record nudity in private place;
• 1 count of sexual exploitation of a person with a disability;
• 1 count of sexual assault;
• 1 count of sexual interference of person under 16;
• 1 count of Invitation to sexual touching under 16.

The RCMP say Casavant, also known as Eddie Spaghetti, was employed as a lifeguard at the Summerland Aquatic & Fitness Centre for more than 30 years, beginning in the late 1980s.

Police, who began investigating Casavant last November after receiving a tip from the public, believe he used his position to gain access to school-aged children.

Casavant also volunteered as a lifeguard at various local summer camps and other community events.

“While we have identified at least two victims, we strongly believe there are additional victims who may not have already reported, or may not be aware they are a victim,” said RCMP spokesman Cpl. Chris Manseau.

Manseau is asking other potential victims to contact the Penticton RCMP tip line at 250-276-2177.


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4Feb

Visually impaired student and guide dog asked to provide ID multiple times a day

by admin

Georgia Pike is fed up being stopped in public and asked for identification.

The fourth-year student at the University of Victoria is visually impaired and relies on her service dog, Grainger, to get around.

But not everyone believes her.

“People will come up to me and say, ‘is your dog a service dog?'” she said. “I say yes and they say, ‘can we see some I.D. for it?'”

It’s become an almost daily occurrence.

Pike was recently stopped multiple times in the same mall by different security guards and, once, was asked three times for identification while trying to board a ferry.

“It’s become quite debilitating, recently, because it happens so often,” she told Gregor Craigie, the host of CBC’s On The Island.

“I’ll sometimes just opt out of trips with friends because I don’t know what’s going to happen.”

She carries a wallet stuffed full of IDs — one from the training school and one from the government for her dog and four indicating that she is visually impaired — but said constantly being asked to prove herself points to a larger issue.

“People with disabilities in B.C. … have to prove to random strangers day in and day out that they have the right to be in a public location,” she said.

“It’s constantly reminding people that they have a disability and that we’re different.”

It’s easy to prove that Grainger is a guide dog — he has two pieces of ID indicating it — but the bigger question, Pike says, is why it’s necessary to always have to keep producing them. (Gregor Craigie/CBC)

Provincewide problem

Pike is not the only one being stopped and asked to prove the legitimacy of their service animal, according to the CEO of B.C. and Alberta Guide Dogs, William Thornton.

He said he’s heard of several similar cases, recently, with at least one person being denied entry to a business.

“This subject really is more about fraudulent dogs than it is about the legitimate dogs,” Thornton said.

“There’s great abuse out there with people buying equipment online — I.D. cards and jackets and then saying that they are a legitimate dog.”

His organization runs education programs to help businesses distinguish between legitimate service dogs and fraudulent ones.

Pike agreed more education is key.

When she’s out with Grainger, she said, there are keys signs that he’s working: he’s not sniffing around or misbehaving, he doesn’t bark, and they are constantly communicating with hand signals.

“What I would love to see is that businesses are trained and educated on how to spot a service dog,” she said.

“I feel so safe being guided by him and it’s people around me who are interrupting our work and interrupting our day.”

Georgia Pike is a 4th year student at the University of Victoria, who is visually-impaired and says she is increasingly stopped in public and asked to prove that her guide dog, Grainger, is really a guide dog. Georgia has all of the proper documentation, but she says she’s asked for ID every day, sometimes multiple times a day. She tells Gregor Craigie why she’s tired of being asked, and what she would like to have done about it. 8:49

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20Nov

Multiple vials of naloxone now required to resuscitate Metro Vancouver opioid users

by admin





An ambulance races down E. Hastings Street in Vancouver, BC Wednesday, January 31, 2018.


Jason Payne / PNG

Emergency first responders, hospital physicians and others trying to revive overdosed drug users are now having to give several doses of naloxone to counteract increasingly toxic concoctions including heroin, morphine, and fentanyl, B.C.’s top public health official says.

Chief provincial health officer Dr. Bonnie Henry said even the free, Take Home Naloxone program kits are now being distributed with three vials since toxic street drugs require more intense antidotes — as many as six to 10 doses in the most challenging cases, according to ambulance paramedics.

Henry said contrary to some perceptions, it’s not that opioid drugs are becoming “resistant” to naloxone, it’s that many drug users are using not only more toxic opioids drugs like carfentanil but in multiple combinations with other drugs. Moreover, the current reality of the overdose crisis is such that users are taking drugs for which naloxone has no effect to revive them, she said. That includes cocaine, speed and GHB.


Dr. Bonnie Henry, Provincial Medical Health Officer

JONATHAN HAYWARD /

THE CANADIAN PRESS

“It’s a sad state of affairs,” Henry said.

“Some of the drugs are so toxic, and drug users are also taking opioids with sedatives like Valium, alcohol or Xanax. So yes, we’re seeing that many people require several doses,” Henry said, adding that hospital emergency departments are also requiring higher doses of naloxone in intravenous drips to save lives.

“What we’re seeing is these potent toxic drugs, even the smallest amounts cause respiratory depression, cause people to stop breathing. So we may be getting naloxone in but we may need more and more, for longer periods of time because it (naloxone) wears off quickly.”

There are an estimated 55,000 individuals in B.C. who have opioid use disorders.

Joe Acker, director of clinical practice for B.C. Emergency Health Services, said in 2017, ambulance paramedics responded to 23,400 overdoses and the number in 2018 will, in all likelihood, exceed that. (The overall number of overdoses in B.C. would be greater because the figure provided by Acker does not include overdoses attended by other emergency personnel or those not attended by such professionals).

Acker said naloxone was administered in about a quarter of cases and he acknowledged that some drug users react with anger when they are revived with naloxone because it not only “ruins their high” but can also cause nasty withdrawal symptoms.

At times, oxygen may be used instead of naloxone to prevent those effects. Paramedics are no longer required to take drug users to a hospital once they have been revived as long as their assessments show that the client is stable.

Acker said some drug users seek out the most concentrated drugs like carfentanil while others are unsuspecting. Paramedics have observed that welfare cheque days are often the busiest and most lethal.

On the worst days, ambulances have been dispatched to as many as 135 overdoses across B.C. in a 24-hour period. Public health experts are expecting between 1,400 and 1,500 deaths in 2018, similar to 2017.

While paramedics and health professionals use safety-engineered retractable needles to avoid contracting infectious diseases from those to whom they are administering drugs, Henry said public health officials have not changed their minds about distributing such needles to drug users.

The issue of used needles being discarded on city streets and parks where unsuspecting children, adults and pets can step on them came up repeatedly during the civic election campaign. Needles that retract as soon as they are used are a harm reduction strategy in some jurisdictions but Henry said they have been ruled out here because they are harder for injection drug users to handle.

Acker said BCEHS does respond to citizens reporting accidental needle-pokes on streets and in parks but he couldn’t provide a number reflecting the frequency of such calls. Henry said while such cases would be traumatizing to individuals, in B.C. there has never been a case of transmission of HIV or other serious infections caused by such incidents.

Discarded needles seen on Vancouver streets or in parks will be collected if citizens call a hotline at 604-657-6561.


Dr. Patricia Daly, medical health officer, Vancouver Coastal Health

In her presentation on the opioid overdose crisis last week to city council, Vancouver Coastal Health chief medical officer Dr. Patricia Daly said overdose prevention sites and take-home naloxone kits were saving lives; the B.C. Centre for Disease Control estimates thousands of deaths over the last two years have been prevented because of the measures.

Daly said more than 300 people have died from overdoses in Vancouver so far this year, similar to the number at this point last year.

While Canadian life expectancies are rising, in B.C., they have dropped because of opioid overdoses. Last year, drug overdoses led to more deaths than suicides, homicides and motor vehicle accidents combined.

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15Nov

Multiple sclerosis: Risk getting or have it? Load up on vitamin D

by admin

While the MS Society of Canada recommends that those with MS — or at risk of MS — take between 600 and 4,000 IU of vitamin D daily, UBC neurologist Robert Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day.



While the MS Society of Canada recommends that those with MS — or at risk of MS — take between 600 and 4,000 IU of vitamin D daily, UBC neurologist Robert Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day.


Mark Lennihan / Associated Press files

Vitamin D deficiency is a risk factor for developing multiple sclerosis, and the MS Society of Canada now says that people affected by the disease should consume up to 4,000 IU per day to decrease the risk or to potentially modify the extent of the disease.

Vitamin D is acquired by exposure to sunlight or through ingestion of vitamin D3 supplements. Small amounts are found in foods like egg yolks, fortified dairy products and oily fish.

Numerous studies have shown an association between low levels of vitamin D in the blood and the risk of getting MS as well as having relapses. One Canadian study has shown that children with low vitamin D levels were more susceptible to developing MS, as are those who’ve had a virus called Epstein-Barr or a genetic predisposition such as a family history of MS.

Canada has one of the highest rates of multiple sclerosis in the world with about 80,000 individuals diagnosed. MS is an autoimmune disease of the central nervous system that attacks myelin, the protective covering of the nerves that helps transmit nerve impulses. MS symptoms include extreme fatigue, lack of coordination, weakness, tingling, impaired sensation, vision problems, bladder problems, cognitive impairment and mood changes.

Studies have shown that MS is generally more common in countries that are less sunny and farther from the equator. Studies have also shown that MS relapses occur more frequently in winter months when vitamin D levels in the blood are lower. Genetic studies have revealed that lower levels of the nutrient are associated with higher risks of being diagnosed with MS.

The new diet and supplementation guidelines are evidence-based, according to the society. After consultations with medical experts, the recommendations have been endorsed by The Canadian Network of Multiple Sclerosis Clinics and The Consortium of Multiple Sclerosis Centers.


Dr. Robert Carruthers, neurologist, Centre for Brain Health, University of B.C.

Dr. Robert Carruthers, a neurologist in the MS clinic at the University of B.C. Centre for Brain Health, said that the recommendation from the society is sensible. While the recommendation is that individuals with MS — or at risk of MS — consume between 600 and 4,000 IU daily, Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day. (International Units, or IU, is a measurement of the potency, or biological activity of a product.)

“It’s cheap, safe, and has been shown to be helpful.”

Carruthers estimates that less than 10 per cent of patients coming to the UBC clinic for a new diagnosis are taking vitamin D supplements at the time of their first appointments. That suggests that a blanket recommendation like the one issued Wednesday is important, to get the message out more broadly.

“I encourage patients to take anywhere between 2,000 and 5,000 IU per day. We have to acknowledge we don’t exactly know the right dose but in some studies, doses as high as 10,000 units were used without any clear concerns about toxicity,” Carruthers said in an interview, adding that he also advises patients to quit smoking because it can worsen the course of the disease.

“With patients who have early or mild MS, you want those people to do everything possible to maintain that status, through modifiable risk reductions, including vitamin D3 supplementation and not smoking.”

Two ongoing trials will hopefully yield more definitive answers about the role of vitamin D as a treatment for MS. The Efficacy of Vitamin D Supplementation in MS (EVIDIMS) trial is a pilot study looking at the effects of high-dose vitamin D3 supplementation on brain lesions, inflammatory activity, disability progression and quality of life. Another study, the Vitamin D to Ameliorate MS (VIDAMS) trial, is examining the effectiveness of high-dose vitamin D3 in reducing the relapse rate and disease activity in the brain.

A recent study done at UBC by Dr. Helen Tremlett and her team showed that there may be some subtle signs of MS in the five years before people develop the first typically recognized symptoms.

Tremlett found patients eventually diagnosed with MS patients were up to four times more likely to be treated for pain or sleep problems, and 50 per cent more likely to visit a psychiatrist.

The researchers found that fibromyalgia was fairly common in people who were later diagnosed with MS, as was irritable bowel syndrome. Two other conditions with higher rates among those eventually diagnosed with MS were migraine headaches and any mood or anxiety disorder, including depression, anxiety and bipolar disorder.

The study was the biggest to document symptoms before individuals knew they had MS. It is useful for physicians so they can diagnose the disease earlier when disease-modifying drugs could potentially slow down the damage MS can cause to the brain and spinal cord.

The disease is usually confirmed by magnetic resonance imaging (MRI), tests on nerve impulses, or an examination of spinal fluid.

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14Nov

Multiple sclerosis: Risk getting or have it? Load up on vitamin D

by admin

While the MS Society of Canada recommends that those with MS — or at risk of MS — take between 600 and 4,000 IU of vitamin D daily, UBC neurologist Robert Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day.



While the MS Society of Canada recommends that those with MS — or at risk of MS — take between 600 and 4,000 IU of vitamin D daily, UBC neurologist Robert Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day.


Mark Lennihan / Associated Press files

Vitamin D deficiency is a risk factor for developing multiple sclerosis, and the MS Society of Canada now says that people affected by the disease should consume up to 4,000 IU per day to decrease the risk or to potentially modify the extent of the disease.

Vitamin D is acquired by exposure to sunlight or through ingestion of vitamin D3 supplements. Small amounts are found in foods like egg yolks, fortified dairy products and oily fish.

Numerous studies have shown an association between low levels of vitamin D in the blood and the risk of getting MS as well as having relapses. One Canadian study has shown that children with low vitamin D levels were more susceptible to developing MS, as are those who’ve had a virus called Epstein-Barr or a genetic predisposition such as a family history of MS.

Canada has one of the highest rates of multiple sclerosis in the world with about 80,000 individuals diagnosed. MS is an autoimmune disease of the central nervous system that attacks myelin, the protective covering of the nerves that helps transmit nerve impulses. MS symptoms include extreme fatigue, lack of coordination, weakness, tingling, impaired sensation, vision problems, bladder problems, cognitive impairment and mood changes.

Studies have shown that MS is generally more common in countries that are less sunny and farther from the equator. Studies have also shown that MS relapses occur more frequently in winter months when vitamin D levels in the blood are lower. Genetic studies have revealed that lower levels of the nutrient are associated with higher risks of being diagnosed with MS.

The new diet and supplementation guidelines are evidence-based, according to the society. After consultations with medical experts, the recommendations have been endorsed by The Canadian Network of Multiple Sclerosis Clinics and The Consortium of Multiple Sclerosis Centers.


Dr. Robert Carruthers, neurologist, Centre for Brain Health, University of B.C.

Dr. Robert Carruthers, a neurologist in the MS clinic at the University of B.C. Centre for Brain Health, said that the recommendation from the society is sensible. While the recommendation is that individuals with MS — or at risk of MS — consume between 600 and 4,000 IU daily, Carruthers said he advises his patients to take up to 5,000 IU of vitamin D3 per day. (International Units, or IU, is a measurement of the potency, or biological activity of a product.)

“It’s cheap, safe, and has been shown to be helpful.”

Carruthers estimates that less than 10 per cent of patients coming to the UBC clinic for a new diagnosis are taking vitamin D supplements at the time of their first appointments. That suggests that a blanket recommendation like the one issued Wednesday is important, to get the message out more broadly.

“I encourage patients to take anywhere between 2,000 and 5,000 IU per day. We have to acknowledge we don’t exactly know the right dose but in some studies, doses as high as 10,000 units were used without any clear concerns about toxicity,” Carruthers said in an interview, adding that he also advises patients to quit smoking because it can worsen the course of the disease.

“With patients who have early or mild MS, you want those people to do everything possible to maintain that status, through modifiable risk reductions, including vitamin D3 supplementation and not smoking.”

Two ongoing trials will hopefully yield more definitive answers about the role of vitamin D as a treatment for MS. The Efficacy of Vitamin D Supplementation in MS (EVIDIMS) trial is a pilot study looking at the effects of high-dose vitamin D3 supplementation on brain lesions, inflammatory activity, disability progression and quality of life. Another study, the Vitamin D to Ameliorate MS (VIDAMS) trial, is examining the effectiveness of high-dose vitamin D3 in reducing the relapse rate and disease activity in the brain.

A recent study done at UBC by Dr. Helen Tremlett and her team showed that there may be some subtle signs of MS in the five years before people develop the first typically recognized symptoms.

Tremlett found patients eventually diagnosed with MS patients were up to four times more likely to be treated for pain or sleep problems, and 50 per cent more likely to visit a psychiatrist.

The researchers found that fibromyalgia was fairly common in people who were later diagnosed with MS, as was irritable bowel syndrome. Two other conditions with higher rates among those eventually diagnosed with MS were migraine headaches and any mood or anxiety disorder, including depression, anxiety and bipolar disorder.

The study was the biggest to document symptoms before individuals knew they had MS. It is useful for physicians so they can diagnose the disease earlier when disease-modifying drugs could potentially slow down the damage MS can cause to the brain and spinal cord.

The disease is usually confirmed by magnetic resonance imaging (MRI), tests on nerve impulses, or an examination of spinal fluid.

[email protected]

twitter.com/MedicineMatters

Related

CLICK HERE to report a typo.

Is there more to this story? We’d like to hear from you about this or any other stories you think we should know about. Email [email protected].




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