SY: Good morning. Welcome to Dr. Michael Gordon's Medical Narrative Podcast. I'm your host, Dr. Susanna Yanivker. I have been in practice for 25 years and have an interest in emergency medicine, intensive care and air ambulance, as well as choice in health care and end of life medicine. Today we have a very special episode. For the first time, we are doing a series of topics on Medical Assistance in Dying, otherwise known as MAiD.
SY: MAiD is sensitive and deeply personal topic. In 2016, federal legislation was introduced in Canada to allow individuals who are suffering from serious and incurable illness, disease or disability to apply for and if eligible, receive MAiD. We will be speaking to Dr. Michael Gordon, who is well known to our listeners as the host of the Medical Narratives podcast and regular contributor to Health Plexus and the Journal of Current Clinical Care.
SY: Michael is an Emeritus Professor of medicine and a member of the University of Toronto's Joint Centre for Bioethics. And this capacity is involved in ethics, education, primarily for health care providers. He has written and spoken widely in the field of medical ethics, especially in relation to the elderly and end of life care. Our special guest today also is Dr. Chantal Perrot, who's a family physician, psychotherapist in Toronto.
SY: She has been active in choice and health care for over four decades and has been providing Medical Assistance in Dying and assessments and procedures for patients since July 2016. Dr. Perrot is frequently called upon to speak about MAiD to both professional and general audiences. She's a member of Dying with Dignity Board of Directors and also Past-Chair of the Board of Directors of MAiDHouse.
SY: She's a member of the Canadian Association of MAiD Assessors and Providers and a moderator of the Camp MAiD Providers Forum. Welcome to both of you, and thank you for taking the time to speak to me today about this very important subject. So let's get started.
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Dr. Michael Gordon recently retired after a fulfilling career as a geriatrician that spanned 56 years, 44 of which he spent working at the Baycrest Center in Toronto. He is Emeritus Professor of Medicine at the University of Toronto. Dr. Gordon is a recognized ethicist and a thought leader on all topics of care of the elderly and end-of-life decisions. Currently, Dr. Gordon provides part-time professional medical consulting mainly in the domain of cognition and memory loss.
Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.
Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.
Hello and welcome to the next episode of 3P, Pills, Pearls, and Patients. I'm your host, Dr. Marina Malak, and today we're going to do a very quick episode on Review of the Liver. Now, what really sparked this kind of in-between impromptu episode is the fact that I felt we had a lot to talk about the liver, you know, there's an Approach to Fatty Liver, Approach to Elevated Liver Enzymes, but sometimes there's a little bit of confusion around certain things to do with the liver.
So, for example, what are liver function tests? What are the liver enzymes? How do you separate both of them? When do you order What? Similarly with hepatitis serologies. So this is going to kind of be a quick mixed bag episode of things about the liver. And it's an important one because we're going to need to talk about Approach to Liver Enzymes.
And we talked about Approach to Fatty Liver. So I just want to put this episode in between the two. So this episode is following the Approach to Fatty Liver, and it's going to come before or the Approach to Elevated Liver Enzymes. That will be the next episode.
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Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.
She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.
Abstract: Cervical spine injury can have life-changing consequences. At every stage of injury, we can intervene to meaningfully change patients' outcomes. On the field, a high index of suspicion is critical. Spinal immobilization prevents secondary injury, but immobilization, particularly use of a hard board, must be kept to a minimum. In the trauma bay, perfusion of the spinal cord is a priority to help prevent secondary spinal cord injury. This means addressing any cause of hypotension and understanding how to manage neurogenic shock. In the spinal-cord injured patient, hemodynamic management is an important adjunct.
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1. Minimize time in rigid immobilization as much as feasible.
2. Spinal shock is temporary flaccid paralysis and loss of reflexes. You cannot give a prognosis for a spinal cord-injured patient in spinal shock.
3. Recognize patients with stiff spines (such as in ankylosing spondylitis) and immobilize them in their natural position of comfort to avoid secondary injury.
4. What we can do to improve neurologic outcomes in spinal cord injury: Maintain spinal cord perfusion through oxygenation and blood pressure management, avoid secondary injury through immobilization, and facilitate early surgical decompression (<24hr)
1. The Canadian C-spine Rule is the preferred algorithm to clear the cervical spine after trauma.
2. X-rays are not sufficient to rule out cervical spine injury. CT scan is the gold standard.
3. Neurogenic shock is a distributive syndrome characterized by the triad of hypotension, bradycardia, and peripheral vasodilation. First line treatment is fluid resuscitation, then vasopressors.
4. Patients with stiff spines (ankylosing spondylitis or DISH) have high rates of spine fractures and non-contiguous injuries. Full spine CT scans should be obtained.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
While studying medicine, I recall being told the importance of careful and accurate documentation. This was long prior to the introduction of the electronic health record.
Welcome to 3P: Pills, Pearls, and Patients where we will discuss current events in medicine, stories from real patient-physician encounters, and gain insight into what it's like being a physician in today's society.
Please note that while the first episode is available to listen to without registration, accessing additional episodes will require you to subscribe and log in.
Hello and welcome to the next episode of 3P, Pills, Pearls and Patients. I'm your host, Dr. Marina Malak. And today's episode is on Approach to Fatty Liver.
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Dr. Marina Malak is a family physician in Mississauga, Ontario and a lecturer and faculty member at the University of Toronto. She is actively involved in medical advocacy, and is a board member of the Mississauga Primary Care Network. She is also a member of the National Committee of Continuing Professional Development at the College of Family Physicians of Ontario, and a member of the Research Ethics Board at Trillium Health Partners.
She is passionate about patient care; medical education; and promoting mental, physical, and emotional wellness. She enjoys reading, writing, public speaking, puzzles, doodling in her bullet journal, and creating drawings on Procreate.
1 Faculty of Medicine, University of British Columbia. 2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract: Cutaneous warts or verruca are benign growths of the skin that affect 30 to 70% of school-age children and has a lifetime prevalence of 10 to 22% in children. It is caused by human papillomavirus (HPV) which spreads from skin-to-skin contact or fomites and infects squamous cell in areas like the hands and feet. There are different HPV subtypes that cause different types of warts including common warts (verruca vulgaris), plantar warts (verruca plantaris), flat warts (verruca plana), mosaic warts, filiform/digitate warts, epidermodysplasia verruciformis, and condyloma acuminata (genital or venereal warts). Most warts will spontaneously clear within 2 years. Diagnosis is based on history and physical examination features which may include dermoscopy and rarely, histological confirmation. Management includes treatment with topical salicylic acid and cryotherapy, the two most common and effective modalities.
Cutaneous warts are a benign growth caused by human papillomavirus (HPV) infection that can cause discomfort. These are most common in school-aged children and in adolescents.
HPV infection is acquired through skin-to-skin contact, contact with fomites, or through maternal transmission during birth. The virus infects squamous cells on the skin and inserts its viral genome into the cells causing survival and proliferation of the virus.
History and physical examination help diagnose warts in children. Dermoscopy and histology may also aid in diagnosis, especially in more challenging presentations. A history of genital warts in children mandates ruling out sexual abuse.
There is a wide range of treatment modalities that can be used for warts. The most well-studied are destructive therapies such as salicylic acid and cryotherapy. There are side effects from treatments such as pain, blistering, scarring and dyspigmentation from cryotherapy. HPV vaccination in children is useful in preventing certain subtypes of genital warts and those that may cause cancer.
Warts often spontaneously resolve with 33% clearing within the first 6 months, 66% within the first 2 years, and 90% within the first 5 years.
Treatment can hasten resolution of warts and often involve destructive therapies such as salicylic acid and cryotherapy.
HPV subtypes causing cancer are rare. Vaccination can significantly decrease the chance of acquiring HPV subtypes that cause genital warts and cervical, anal, oropharyngeal, penile, vulvar, and vaginal cancer.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
