logo.jpg - 16736 Bytes Health Corner

 Ask Your Primary Health Care Provider

Welcome to Health Corner!

This new regular column, written by health professionals working within the North Eastman Health Association,
will focus on providing health information to our communities.

Please forward health related questions to:
Box 1030, Lac du Bonnet District Health Centre; phone: 345-8647;
or Email lgmiterek@neha.mb.ca. 

The North Eastman Health Association Inc. along with Manitoba Health are focusing on Primary Health Care
as a means to improve the health status of the residents of the North Eastman Region.

What is Health Links?

Health Links is a provincial toll-free telephone service, that provides health related information, and referral service to the citizens of Manitoba.  The Health Links phone line is staffed by specially trained Registered Nurses, and is open to the public 24 hours a day, seven days a week, at no charge to the user. 
Health Links is not a service for medical emergencies.  In case of a medical emergency, call your local emergency telephone number.

When Should I Call Health Links?
You can call Health Links anytime you need health information or support, that is not an emergency.  Health Links nurses receive many health related questions ranging from “What can I use on a bee sting?” to “My baby won’t stop crying…what should I do?”  While there is no such thing as a typical Health Links question, almost anything related to physical or mental health issues would fall under the Health Links mandate.

How do I Reach Health Links?
In Manitoba call toll free 1-888-315-9257.
In Winnipeg call 788-8200
Available 24 hours/day – 7 days/week.
This service operates out of the Misericordia Health Centre in Winnipeg.

In addition to providing accurate and up-to-date health related information to individual Manitobans, this telephone service helps to reduce telephone traffic in our health care facilities, thereby allowing staff to concentrate their efforts on direct patient care.

To receive a health links card to place in your wallet, or beside your phone, please call 345-1220.

Stress, depression, and the holidays

Relationships can cause turmoil, conflict or stress at any time but tensions often heighten during the holidays.   Conflicts are bound to arise with so many different personalities, needs, and interests.  On the other hand, you many find yourself especially lonely or sad if you are facing the holidays without a loved one.  Overspending during the holidays on gifts, travel, food, and entertainment can increase stress as you try to make ends meet and ensuring that everyone is happy.  Physical demands of shopping, socializing and preparing for holiday meals can be exhausting.  Exercise and sleep are good antidotes for stress and fatigue.  High demands, stress, lack of exercise, and overindulgence in food and drink- all are ingredients for holiday illness.

Tips to help prevent holiday stress and depression

Acknowledge your feelings. Realize that it’s normal to feel sadness or grief if a loved one has recently died or you aren’t able to be with your loved one’s.  You can’t force yourself to be happy just because it’s the holiday season.

Seek Support. If you feel isolated or down, seek out family, friends, or community, religious, or social services.  Consider volunteering at a community or religious function.

Be realistic. “Norman Rockwell Christmas’” are for the movies.  As families change and grow, so do traditions and rituals.  Find new ways to celebrate together from afar – share pictures, emails or videotapes.

Set differences aside. Accept family members as they are.  Even at Christmas, they won’t always live up to your expectations.  Set grievances aside until a more appropriate time for discussion.

Plan ahead. Set aside specific days for shopping, baking, visiting, and other activities.  Remember Christmas is a season and everything doesn’t have to be done in one day.

Learn to say no. If you say yes only to what you really want to do, you’ll avoid feeling resentful, bitter, and overwhelmed.  If it’s really not possible to say no, try to remove something else from your agenda to make up for the lost time.

Don’t abandon healthy habits. Don’t let the holidays become a dietary free for all.   Overindulgence adds to stress and guilt.

Take a breather. Make time for you.  Find something that reduces stress by clearing your mind, slowing your breathing and restoring your inner calm.

Seek Professional Help if you need it.  Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable or hopeless, and unable to face routine chores.  If these feelings last for several weeks, talk to your Doctor or a mental health professional.   You may have depression.

Take back control of holiday stress and depression

Remember that one key to minimizing holiday stress and depression is the knowledge that holidays can trigger stress and depression.  Accept that things aren’t always going to go as planned.  Take steps to manage your stress and you may find that you actually enjoy this years holidays more than you thought you could.

Submitted by Debbie Devigne, Community Mental Health Worker   Source: Mayo Clinic 2007

Winter Travel - Ice and Snow? Take it slow!

Winter travel calls for extra care even under normal weather conditions.  Snow and ice on roadways can reduce tire traction, while vehicle exhaust and ice fog can reduce visibility.  The best safety precaution to take during severe winter weather conditions is to avoid traveling at all.  However, if you must drive, be prepared.
Precautions:
If Stranded:

Submitted by Carol Orvis, NEHA  Source: Environment Canada

Pedestrian Safety

The 2008 Safe Kids Canada Theme is pedestrian safety.  What does that mean for people living in rural areas?

Child & Pedestrian Safety
Children are particularly vulnerable to pedestrian injuries for many reasons.  Children may be exposed to traffic threats that exceed their cognitive, physical, sensory, and auditory development.  For examples, pre-school & school-aged children believe if they can see a car, then the driver can see them.  Have you ever had to double-check for a child in a parking lot or wondered where your child is while driving a larger farm vehicle?  Up until age 6, children are much less able to detect the direction of traffic.  Before age 11, children have a difficult time judging vehicle speed.

Children are more likely to get hit by cars in areas where there is high traffic volume, higher number of parked cars on the street, higher posted speed limits, and few alternative play areas such as parks.  Do your children cross roads alone?  Do your children play in/near ditches or beside a road?

Seven out of 10 drivers admit to exceeding the speed limit, at least occasionally, for an average (over the speed limit) of 12 km on highways, 10 km on 2 lane highways and 7 km on residential streets.  Even in the presence of children, many drivers do not reduce their speed.  Increase in speed, however, increases the risk of injury.  It is estimated that a pedestrian struck by a car traveling at 50 km/hr is 8 times more likely to be killed than someone hit at 30 km/h.

What can I do to reduce pedestrian injuries?

Reduce traffic speeds.  At speeds greater than 40 km/h, both drivers and pedestrians may be more likely to make mistakes in judging the time required to stop or cross the street safely.  Even small reductions in vehicle speed can lead to significant reductions in injury risk.  It is estimated that for each 1.6 km reduction in average speed, collision frequency is reduced by 5%.

Walk more, drive less.  Lower traffic volume can also lead to reduced injuries.  Studies have shown that the more people who are walking, the less likely pedestrian injuries will occur.  It appears that motorists adjust their behaviour to respond to the increase number of pedestrians. And of course, walking is the healthy, 'green' alternative.

Adults can walk with children and repeat the safety information every single time.  Most parents report teaching their children pedestrian safety, but they do not always practice what they know.  Safe Kids Canada recommends pedestrian safety education be repeated every time adults and children are walking together and to continue into adolescence.  Children need to practice safe traffic behaviour in a variety of road situations before they are able to travel the streets on their own.

Check the Safe Kids Canada website for information on rural community walkabouts and scoring.  Then use the Safe Kids Canada Pedestrian Safety Guide to make your community more pedestrian friendly.

Advocate for speeding reminders.  Seventy-two percent of Canadian drivers supported the idea of roadside warning signs to tell the driver when they are speeding.

Although there might not be a lot of traffic in your rural area, the roads may have higher speed limits.  This, coupled with drivers traveling above posted speed limits, increases the threat to pedestrians in rural areas.  Submitted by: Caroline McIntosh  Source: Safekidscanada.ca

Join the Free Outdoor Gym

We’re lucky in North Eastern Manitoba to have so much outdoor space full of natural resources.  With the availability of provincial parks like Bird's Hill, Whiteshell, and Nopiming, and the many local parks in towns and villages, why not translate that expanse into a free gym?  According to Health Canada's Physical Activity Guide, Canadians should accumulate 30 to 60 minutes of moderate physical activity most days.  Local parks, trails, hills, forests and bodies of water are perfect places to get the physical activity that will keep you healthy.

Here are some easy ways to use nature as your own personal gym:
  1. Try Tai Chi, yoga, or stretching in a local park.  This is a good way to get some activity on very hot days when you might not otherwise want to be doing anything outdoors.  The slow, deliberate movements of Tai Chi and yoga are relaxing, but they also build muscle tone and can help you improve your breathing – a great stress buster.
  2. Have a scavenger hunt with the kids or try Geocaching, either with family or friends. Geocaching is an outdoor activity which involves using a hand-held satellite device – global positioning system (GPS) – to search for a hidden treasure such as a small toy or message called a cache.  This can get you walking around your town or local park, or on a provincial hiking trail.
  3. Why not resurrect your garden or help your friends in their gardens?  Planting, weeding and caring for a garden is a great reason to get outside and do some activity.  Plus, you can grow tasty and healthy herbs or vegetables. Check out the Heart & Stroke monthly column by gardening expert Mark Cullen on planting vegetables. Some people find sharing a community garden with friends and neighbors is a great way to socialize and grow at the same time.
  4. Instead of using a motorboat at the cottage, try a canoe or kayak for picking up small amounts of supplies or for having some fun on the lake or river.  Make sure you wear a lifejacket.
  5. When was the last time you visited your local park or walked around the block or up the local hill in your neighborhood? When walking for exercise, use a focused pace, but one that won’t make you short of breath, so you could carry on a conversation. Using a pedometer makes counting the number of steps you take easy and fun. Many of our local North Eastman libraries have walking kits with a pedometer that you can borrow.  Work up to 5,000 to 10,000 steps per day, stopping when you need to. Try increasing the amount of walking by 5 minutes every week. All the activity you do throughout the day can really add up.
  6. Why not brush the cobwebs off your bicycle so you can ride to your local park or local store. Remember wearing a helmet while riding protects your noggin.

Stay safe in the heat!  It's easy to stay cool in the summer when you’ve got a lake or pool to jump into.  When that’s not a possibility, bring along lots of water to drink.  You can lose a lot of water through perspiration during physically activity, especially in hot weather.  Without sufficient water, your body can’t keep you cool and this can cause heat exhaustion.  Symptoms include dizziness, headache, increased heart rate and fatigue.  Resting in a cool or shady area and drinking water can help get your body cool down.  As long as you take these precautions, and talk to your doctor if you have any pre-existing health conditions, then you are set to get active – indoors or out! Submitted By: Caroline McIntosh.  Adapted from “Join the Free Outdoor Gym” – www.heartandstroke.com

Trampoline Safety

Trampolines have become increasingly popular as a backyard recreation.  This has raised health and safety concerns because they can cause serious injuries if they are not used properly.  Some minor injuries caused by trampoline use, include sprained ankles and wrists, to more serious injuries including skull fractures, to broken necks and backs.  The majority of the injuries were caused by unsupervised and inappropriate use.

Most trampoline injuries are the result of:  Submitted By: Laura Gmiterek  Source: Health Canada

Safety Tips for Winter Walking

When the winter air is crisp and the ground is covered with snow, there’s nothing like taking a walk to enjoy the beauty of the season — and walking is one of the best ways to keep fit.  However, winter can be a challenging time of year to get out and about.  Freezing rain, icy surfaces and piles of hard-packed snow pose hazards for the innocent pedestrian.  A few simple measures can make it safer to walk outdoors in the winter.  Removing snow and ice, putting sand or salt on areas where people walk, and wearing the right footwear all make a big difference.  The Canada Safety Council offers seniors some practical suggestions to stay active in winter.

Choose a good pair of winter boots.  For warmth and stability look for these features: well insulated and waterproof, thick, non-slip tread sole, wide, low heels and light in weight.  Ice grippers on footwear can help you walk on hard packed snow and ice.  But be careful! Grippers become dangerously slippery and must be removed before walking on smooth surfaces such as stone, tile and ceramic.  Before buying the grippers, be sure that you are able to attach and remove them from your boots.  This is best-done sitting down.  Use a cane to help with balance.  Have it fitted to the right height for you.  When your cane is held upside down, the end should be at wrist level.  Speak to your doctor, pharmacist or local public health department about how to use your cane properly.  Attach an ice pick at the end of your cane.  Cane picks will be slippery on hard surfaces so be sure to flip it back as you get indoors.  Picks are available at most drug stores.  Wear a hip protector (a lightweight belt or pant with shields to guard the hips).  It can help protect the hips against fractures and give added confidence.  Prevent heat loss by wearing a warm hat, scarf, and mittens or gloves.  Dressing in layers may also keep you warmer.  Also, help other road users see you by wearing bright colors or adding reflective material to clothing.  Once the snow and ice arrive, make sure your walking surfaces are safe:  Keep entranceways and sidewalks clear of ice and snow.  Contact your local community services to seniors for assistance with snow removal, transportation and grocery bus services.  Carry a small bag of grit, sand or non clumping cat litter in your jacket pocket or handbag, to sprinkle when you are confronted with icy sidewalks, steps, bus stops, etc.  Ask a passer-by to help you cross the icy surface.

Walking on Ice:  Not everyone has grippers and other safety aids.  First, slow down and think about your next move.  Keeping your body as loose as possible spread your feet to more than a foot apart to provide a base of support.  This will help stabilize you as you walk.  Keep your knees loose and don’t let them lock.  If you can, let them bend a bit.  This will keep your center of gravity lower to the ground, which further stabilizes the body.  Now you are ready to take a step.  Make the step small, placing your whole foot down at once.  Then shift your weight very slowly to this foot and bring your other foot to meet it the same way.  Keep a wide base of support.  Some people prefer to drag their feet or shuffle them.  If this feels better to you, then do so.  Just remember to place your whole foot on the ice at once and keep your base of support approximately one foot wide.  It’s always best to avoid tricky situations by being prepared and planning a safe route for your walk.  Source: Canada Safety Council, Submitted by Pat Porth, Community Resource Coordinator, Two Rivers Seniors Resource Council Inc. for Lac du Bonnet/Pinawa area. 345-1227 or tworiver@granite.mb.ca

NEHA's Nurse Practitioners

Providing a unique kind of care, Nurse Practitioners can be found at Primary Health Care Clinics, within the North Eastman Health Association.  When Manitobans need healthcare, most phone their family doctor.  Today, they have another option: a Nurse Practitioner (NP).

Nurse Practitioners have been practicing in Canada for many years.  They work in acute and general care settings, primary care (general family practice), hospitals and long term care facilities.  In 1999, the Manitoba Legislators rewrote the Registered Nurses Act to account for the NP practice.  In 2005, the first Manitoba Nurse Practitioner began her practice.  NP’s may bring a unique perspective and expertise to their roles.  They focus on patients as a whole, both physically and psychologically.  In this way, they complement, rather than substitute the roles of other health care providers.

While we recognize that NP’s are not a substitute for physicians, the greater use of NPs can reduce waiting times and minimize the demands associated with physician shortages, particularly in rural and remote communities.  As we face the largest aging population in history, the role of the NP will continue to increase and evolve.

Nurse Practitioners are Registered Nurses who have completed advanced education, typically at the Master’s Level and have passed a National Exam.  The NP Graduate Program takes two years full-time and three to four years part-time to complete. NP’s diagnose and treat common illnesses, perform invasive procedures, suture a minor cut, order and receive diagnostic tests, prescribe medications and refer patients to other health care professionals such as physicians, nutritionists, therapists.  They also use their nursing skills to focus on health promotion, disease prevention and involvement of the patient and family in their care.

An integral part of the NP’s advanced clinical practice is the family.  To improve patient outcomes, the NP ensures that all patient care needs are met in the context of the patient’s psychosocial and physical well being.  The Nurse Practitioner facilitates long-term planning with the patient, family and multidisciplinary team. Furthermore, the NP maintains dialogue with patients and families about the patient’s condition and a future plan, as well as directing or participating in family conferences as needed.

The North Eastman Health Association currently has five Nurse Practitioners within the region, practicing inside of four Primary Health Care Clinics.  Most of these NPs practice part-time.  All the NPs within the North Eastman region are women and this has given a sense of comfort to most female patients making appointments for annual physicals, pre-natal and post-natal care.  They also, are a part of providing the valid service of Teen Clinics.

In conclusion, you may be asked,  “Would you like to make your appointment with a Nurse Practitioner?”  You may in return ask the question,
“What is a NP?” The answer is as follows: A Nurse Practitioner can:  Submitted by: Laura Gmiterek

Canada’s Number One Killer

The number one killer in Canada is heart disease, also known as cardiovascular (CV) disease.  It is the most costly disease, putting the greatest burden on the health care system.  Heart disease includes diseases and injuries of the heart, the blood vessels of the heart, and the system of blood vessels (veins and arteries) throughout the body and within the brain.  Oxygen and important nutrients carried by our blood are constricted or blocked causing injury to our heart muscles.

The buildup of fat deposits in the blood supply system is called Coronary Artery Disease may lead to blocked blood vessels and arteries.  A lack of oxygen can result in a heart attack and permanent damage to heart muscles.  Several factors, alone or in combination, may result in heart disease.  One major factor is cigarette smoking. Other risk factors include:

Focus on cigarette smoking:
In 1996, cardiovascular disease accounted for 37% of all deaths in Canada. Smokers have a 70% greater chance of dying from Coronary Heart Disease than non-smokers. Smoking more than 40 cigarettes per day increases the chance of dying by 200 to 300% in comparison with non-smokers. Smoking or exposure to second-hand smoke makes the heart work harder by:

Heart Healthy Tips

For more information on symptoms and how to minimize your risk, consult your Health Care Provider or the Chronic Disease Prevention and Management (CDPM) team in your area.   Sources: Canadian Hypertension Society and Heart & Stroke Foundation Submitted by: Kelly Deveau RN BN

Food for Thought

Food!  Where would we be without it?  It is so much a part of our social fabric.  Every time we get together with family and friends it is generally around food and beverage.  Family and friends influence the way we eat.  There are the traditional foods of the many cultures we represent.  And it all looks so good … just tempting us to taste.  Then there is the way in which we get together to eat those foods. Do we sit at the table and savor our food or are we gulping on the run?

We do need to eat to keep our bodies healthy and to give us the energy to be active.  But as Canadians we face many different and sometimes conflicting messages about food everyday.  Not only that, but our busy lifestyles mean we have less time to shop for food, prepare meals and eat with our families.
We are relying more and more on pre-prepared food and meals outside the home.  It is estimated that one in three meals is eaten outside the home.

Now let’s add in the media’s incessant message about looking good, being model thin, staying young forever and this diet … this diet pill … this diet drink … this diet … diet … diet will give you all the friends, a wonderful career and put you at the top of the world.  How are we supposed to know what healthy eating is?  Well the answer is quite simple, forget all the fad diets and stick with Canada’s Food Guide.  This wonderful tool helps you chose the type of food and portions you need to eat so you can stay healthy and provide your body with the proper nutrients it needs for the energy you need to be the best you can be.  The guide encourages choices lower in fat, sugar and salt.

March is nutrition month.  This year’s promotion is focused on nutrition and healthy eating for an active lifestyle.  Using the balanced approach of Canada’s Food Guide will ensure you get enough energy to get you through your day and your physical activities.  There is no need for the expense of energy drinks and protein supplements.  Having a balance of the Guide’s four food groups and enough fluids, will keep energized and hydrated.  Water is important not only to refresh you but to replace the water lost through sweating when physically active.  Whether you’re revving up for your first 5 km run or wanting some straight talk about nutrition for physical activity, Registered Dietitians are your most trusted source for nutrition and healthy eating advice.  More information can be found at Nutrition Month 2009.

Canada’s Food Guide is the sensible solution.  Most important it is FREE.  It is available at Canada's Food Guide or see your local community health dietitian, primary healthcare nurse or wellness facilitator to get your copy.  Choose healthy, be healthy the sensible way.

Information from Healthy Together Now: Chronic Disease Prevention Initiative; Eating Well with Canada’s Food Guide Submitted by: Susan Spindler

Stroke Facts and Warning Signs

A stroke occurs when the flow of blood to a part of the brain is cut off.  It can also be called a ‘brain attack’.  This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke).  It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke).  Most strokes are caused by a blockage of the blood flow.  Without a blood supply, the brain cells in the affected area start to die.

Every year some 50,000 Canadians suffer a stroke.  Someone in Canada suffers a brain attack every ten minutes, and every 32 minutes someone dies from one.  The annual death toll of 16,000 makes stroke the third leading killer, after cancer and heart disease.

The effects of a stroke depend on which part of the brain is affected and how severe the damage is.  A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal.

It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death.  A stroke usually comes on suddenly, over a few minutes or hours.  With stroke, every minute counts ‘time is brain’.  Each minute delay in calling 9-1-1 increases the odds of permanent brain damage, disability or death.”

The warning signs of stroke include:
If you notice these symptoms, call 911 (or your emergency medical number if you do not have 911 service) immediately and tell them you think you are having a stroke.  Stroke (brain attack) is a medical emergency.

The sooner you arrive in the emergency room, the better your chance of being assessed and screened for the possibility of receiving a clot buster drug.  Clot buster drugs can be given to attempt to actually “stop a stroke in its tracks” or “reverse the stroke that is in progress.”   However, the key to this treatment is timing.

From the time the symptoms begin you only have a period of three hours to be considered for and receive treatment.

No one is immune to a stroke.  It is a life-changing event that not only affects the person who may be disabled, but the entire family and other caregivers as well.  Be sure to know the warning signs and action to take.  For more information on how to reduce your risk of having a stroke, please contact your local health care providers. References: Heart and Stroke Foundation of Manitoba and The Canadian Stroke Strategy Submitted By: Sharlene Thompson

How is asthma controlled?

Asthma is a lung condition that impairs breathing. Inflammation and airway constriction are the two mechanisms that cause the symptoms of asthma.   Inflammation is the main feature. Diagnosis can be challenging as there is no one single test that can be used.  Medical history of symptoms, spirometry and medication challenges can all be used to diagnose asthma.  Diagnosing children under 5 years old is an even greater challenge, as young children can not co-operate to perform some of the tests.  There are several levels of asthma ranging from mild the severe.

Management of asthma is based on avoidance of triggers and controlling symptoms with medications.  Education of the patient by a health care provider on triggers, medications, and monitoring and knowing what to do in a flare up is a very important part of managing asthma.  Learning what a person’s triggers are, will help in avoiding those triggers.  Some triggers may be smoking, second hand smoke, dust mites, mold, pet dander, cold air, perfume, allergens (things that cause an allergic reaction), certain medication and many more.  Infections like the common cold and influenza may cause a flare up of the asthma. Flu vaccines are recommended for people with asthma.  It appears to be critical to decrease the amount of dust mites in the house to obtain good control of asthma.  Many things can be done in the home to decrease dust mites.  Talk to a health care provider for more information. 

A person with asthma may need to use medication before going out into the cold air and/or exercising.  These are only some of the things that can be done to avoid triggers. There are 2 different medications: relievers and preventers.  Relievers work quickly and relax the airway.  Preventers work on the inflammation, they should be taken on a regular basis as prescribed by the health care provider.  Preventers work slowly and should not be taken in an emergency.

Keeping track of symptoms in a diary can be a great help to detect flare ups.  Some people may use a meter (peak flow meter) daily to measure the status of their breathing.  It is recommended that people with asthma have an action plan and use it as taught by their health care provider.  Poor control can lead to airway remodeling, may cause permanent damage. Written by Myriam Duke RN, BScN, CAE  Sources:  Canadian Asthma Consensus Report, 1999  Adult Asthma Consensus Guidelines Update, 2003  and Canadian Pediatric Asthma Consensus Guidelines, 2003 (updated to December 2004).

Hand Washing Reduces Health Risks

Germs are essential for human life.  Bacteria in our mouths and intestines help us to digest the food we eat and bacteria on our skin protect us from invading viruses and bad bacteria.  Bacteria are virtually everywhere in our environment and make up 60 per cent of living matter on earth.  Of the billions of types of bacteria only about 50 are known to cause infection.  Viruses cause far more illnesses than bad bacteria because they spread more easily.  If more than one person in your family has the same sickness, odds are it is a viral infection.  Cold and flu viruses invade our cells and rapidly grow in number causing symptoms like runny nose, cough, aches, sore throats, and diarrhea.  Hands spread an estimated 80 percent of common infectious diseases like the common cold and flu.

Washing your hands correctly with soap or using an alcohol based hand rub is the most effective thing you can do to protect yourself against a number of infectious diseases, such as the flu and the common cold.  Hand washing will not only keep you healthy, it will help prevent the spread of infectious diseases to others.  Infectious diseases are a particular risk to the very young, the elderly, those with a pre-existing disease and people with a compromised immune system.  Hand-to-hand contact can spread mild conditions, such as the common cold, but also more severe or life-threatening diseases. Even if your hands appear to be clean, they may carry germs.  Hands pick up germs in a number of ways.  When people who are sick sneeze or cough, the germs that are making them sick are expelled into the air in tiny droplets.  If these droplets get onto your hands and then your touch your mouth, eyes or nose without washing away the germs, you carry the infection.  You can also get sick if you don’t wash your hands before and after preparing food, after handling raw meat and after using the toilet.  If you had to pick the place in your house with the most disease causing germs, what would you choose? Many of us automatically think of the bathroom, but actually the kitchen is the biggest hot-zone for disease causing germs.  Foremost being the kitchen sink, followed by the dish rag or sponge.  Disinfect your kitchen sink and counters daily. Also, don’t forget the faucet and doorknobs.  Cleaning with soap removes surface dirt and grime.  Disinfecting involves the use of bleach, ammonia, alcohol, or vinegar to kill germs.  Avoid antibacterial cleaners.

Research does not support the use of antibacterial soaps and cleaning products over regular soaps and cleaners.  Plain soap has ingredients that help to remove dirt and grease from your skin.  Antibacterial soaps offer no benefit in preventing common illnesses and their widespread use can cause antibiotic resistance.  Plain soap has ingredients that help to remove dirt and grease from your skin.  Antibacterial products don’t offer any protection against viruses because antibiotics don’t kill viruses.

Although hand washing might seem like a simple task, you should follow these steps to thoroughly rid your hands of germs.  Steps for good hand washing technique are:
Submitted by: Laura Gmiterek Source Health Canada & Public Health Agency Canada

January is Alzheimer’s Awareness Month

The following are the 10 warning signs of being at risk of having Alzheimer disease:
  1. Memory loss that affects day to day function – forgetting things more often especially things that happened recently.
  2. Difficulty performing familiar tasks – having trouble with tasks that have been familiar all of your life.
  3. Problems with language – forgetting simple words or substituting words, making sentences difficult to understand.
  4. Disorientation of time and place – wandering or getting lost.
  5. Poor or decreased judgment – not recognizing a medical problem or wearing heavy clothing on a hot day.
  6. Problems with abstract thinking – having difficulty with numbers or balancing a cheque book.
  7. Misplacing things – putting items in inappropriate places.
  8. Changes in mood and behavior – from calm, to tears, to anger, for no apparent reason.
  9. Changes in personality – the feeling of apathy, fearfulness, or acting out of character.
  10. Loss of initiative – becoming very passive and requiring cues and prompts to become involved.
Alzheimer’s Disease International (ADI) has recently released the World Alzheimer Report.  It has been estimated that 35.6 million people worldwide will be living with dementia in 2010.  Also, according to this new report dementia prevalence will nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.  There are currently about a half of a million Canadians living with Alzheimer’s disease or a related dementia, or 1 in 11 over the age of 65.  In brief, our aging population is creating a rising tide of dementia that threatens our health and social support systems.  When the urgent need to start turning the tide of dementia is recognized, a series of potential interventions could help alleviate dementia’s pressure on families, the health care system, and the economy.  This intervention alone has a potential cost savings of $219 billion over the 30 year period.  This month during Alzheimer Awareness Month, the Alzheimer Society is calling on Canadian governments, and the public, to take action against the growing tide.

Alzheimer’s disease and related dementias are progressive, degenerative diseases that destroy vital brain cells.  They are not a normal part of aging.  Alzheimer is the most common form of dementia and accounts for approximately 64% of all dementias in Canada.  Unfortunately, there is no known cure for this fatal disease, but there are things people can do that may help reduce their risk (example: by increasing physical activity).  Usually, dementia is diagnosed in people over the age of 65.  Recently, it has been found that the symptoms actually start much earlier, and an increasing number of people are being diagnosed in their 50’s and 60’s.

Caregiving is a critical issue for people living with dementia.  One in five Canadians age 45 and over are providing some form of care for seniors who have long term health problems.  One-quarter of all family caregivers are seniors themselves, and one-third of them are over the age of 75.  It suggests that 40-75% of caregivers will have significant psychological illness as a result of their care giving, and 15-32% will have depression.

Diagnosing dementia is a complex and difficult process.  There is no single test that can tell that an individual has or does not have Alzheimer or a related disease.  Making a diagnosis for dementia takes the time and expertise of skilled practitioners because the diagnosis can only be made after an assessment that ensures that there may not be other possible conditions for the symptoms.  Some of these other conditions include depression, thyroid or heart disease, infections, drug interactions or alcohol abuse.  The process of diagnosing dementia therefore requires a careful history of the symptoms, physical, neurological and mental status examinations, psychiatric and psychological evaluations, laboratory tests, and where applicable imaging of the brain.  It is also required to have information from relatives and caregivers.

The first baby boomer generation will turn 65 in the year 2011.  This will increase the number of people affected by dementia.  Dementia is more than just an important health concern.  It has the potential to overwhelm Canadian families and our health care system if fundamental changes are not made in research funding and care delivery.  If you have concerns about your memory, or are concerned about someone else’s it is important that you consult with your family doctor.  
Submitted By: Laura Gmiterek Source: Health Canada & The Canadian Alzheimer Society

Crohn’s and Colitis Awareness Month

November is the Crohn’s and Colitis Awareness Month.  Crohn’s disease (CD) and ulcerative Colitis (UC) are the two most common forms of Inflammatory Bowel Disease (IBD).  These IBD disorders can cause the intestines to become inflamed and ulcerated (red and swollen). More than 200, 000 Canadians are affected by IBD.  Because the symptoms of CD and UC are similar, it is sometimes difficult to establish the diagnosis definitively.  About 10% of Colitis cases are unable to be defined as either UC or CD and are called indeterminate Colitis.  Both CD and UC are marked by an abnormal response by the body’s immune system.  The immune system is what protects the body from infection.  In individuals with IBD, it reacts inappropriately.  For unknown reasons, the immune system can mistake microbes, such as bacteria that are normally found in the intestines, as foreign or invading substances and launch an attack.  In the process, the body sends white blood cells into the lining of the intestines where they produce chronic inflammation.  These cells then generate harmful products that ultimately lead to ulcerations and bowel injury.  When this happens, the patient experiences the symptoms of IBD.  Although CD most commonly affects the lower end of the small intestine and the beginning of the large intestine (colon), it may involve any part of the gastrointestinal tract.  In UC the gastrointestinal involvement is limited to the colon.  In CD, all layers of the intestine may be involved, resulting in deep ulcers that go through the wall of the bowel completely.  These can cause complications such as abscesses in the abdomen, or can lead to the development of connections between the bowel and other organs.  CD is often discontinuous, with normal healthy bowel in between patches of diseased bowel.  UC affects only the superficial layers of the colon in a more even and continuous distribution, which starts at the level of the anus.

The symptoms and complications of Crohn’s disease differ, depending on what part of the intestinal tract is inflamed.  Persistent diarrhea, abdominal cramping pain, fever, and at times rectal bleeding are the main symptoms of CD, but they vary from person to person and make changes over time.  Loss of appetite and subsequent weight loss may also occur.  CD is a disease that is not always limited to the gastrointestinal tract. It may also affect the joints, eyes, skin, and liver.  Fatigue is another common complaint.  Children who have CD may suffer delayed growth and sexual development.  Some patients may develop fissures in the lining of the anus, which may cause pain and bleeding, especially during bowel movements.  Inflammation may also cause a fistula to develop. Fistulas occur most commonly around the anal area.  If this complication arises, the patient may notice drainage of mucus, pus, or stool from this opening.  Symptoms may range from mild to severe. Because Crohn’s is a chronic but fluctuation disease, patients will go through periods in which the disease flares up, is active, and causes symptoms.  These episodes are followed by times of remission when periods in which symptoms disappear or decrease and good health returns.  There is no cure for CD; the short term goal of medical treatment is to bring symptoms under control, by suppressing the inflammatory response to induce a remission.  Remission leads to normalization of quality of life and is hopefully associated with healing of the damaged bowel.  There are several groups of drugs used to treat CD today.  Two thirds to three quarters of patients with CD have required surgery at some point during their lives.  This becomes necessary in two situations; when medications are not working, or if complications arise such as fistulae, abscesses or scarring and narrowing of the bowel.

Ulcerative Colitis is a chronic ongoing disease of the colon.  The disease is marked by inflammation and ulceration of the colon mucosa, or innermost lining.  Tiny open sores, or ulcers, form on the surface of the lining where they bleed and produce pus and mucus.  Because the inflammation makes the colon empty frequently, symptoms typically include diarrhea (most often bloody) and often abdominal cramping pain along with urgency.  Some individuals will have false urges and pass only tiny amounts of blood and mucus.  In cases of severe bleeding anemia may also occur.  Other common symptoms include loss of appetite, subsequent weight loss, and fatigue.  There may also be skin lesions, joint pain, eye inflammation, and liver disorders.  Children with UC may fail to develop or grow properly.  Approximately half of all individuals with UC have relatively mild symptoms such as:  multiple stools a day, usually without blood, some pain and cramping, a constant feeling of the need to empty the bowel, and no fever or a low grade fever.  Severely ill individuals will experience more than six bloody stools a day, with fever and anemia.  The severity of the symptoms correlate with the extent of the colon involved with the disease. The UC symptoms seem to come and go, with fairly long periods in between the flare-ups where patients may experience no distress at all.  These remission periods can last months or even years.  However, eventually symptoms do return.  This may make it difficult for physicians to evaluate whether a particular course of treatment has been affective or not.  In many patient cases surgery may be considered.  Unlike CD, which can reoccur after surgery, UC is cured once the colon is removed.  Depending on a number of factors, including the extent of the disease and the patient’s age and overall health, one of two surgical procedures may be recommended.  The first involves the removal of the entire colon and rectum and an opening is created on the abdomen wall through which wastes are emptied into a pouch which is attached to the skin with adhesive.  A more recent procedure also calls for the removal of the colon and creating an internal pouch from the small bowel and attaching it to the anal sphincter muscle.  With this method the surgeon can preserve bowel integrity and eliminate the need for the patient to wear an external pouch.

Both Crohn’s disease and ulcerative Colitis have a significant impact on a person’s quality of life.  Inflammatory Bowel Disease is a life-long disease, usually starting in early adulthood in otherwise healthy, active individuals.  IBD has a substantial personal burden that can impact career choices, lead to reduced work hours, impact family planning decisions, and lead to disparity and depression.  Submitted By: Laura Gmiterek  Source: Crohn’s and Colitis Foundation of Canada & Health Canada

Physical Activity throughout the Lifespan

It is well known that higher levels of physical activity lower mortality and cancer rates for both young and old.  Increased activity reduces the risk of heart disease and high blood pressure.  Other substantial benefits include less stress, less anxiety and less depression.  Physical activity also increases energy and makes weight control easier.

Some medical experts claim a decline in fitness is caused by “disuse” and not by aging.  People who are physically active at a young age and continue throughout their lives retain an extremely high fitness level.  People will also have significant benefit if they take up physical activity later in life. Research shows that the lung capacity of fairly sedentary people decreases by about 10 percent per decade.  That's a 1% loss every year!  If you continue to exercise regularly, your lung capacity would only decrease by 2.5% over 20 years.

Performing strength-training exercises can increase bone density and improve overall muscle strength.  Strength-training also improves coordination and balance, thus reducing the chance of falling as we age.  The main reasons we tend to gain weight as we get older are that we tend to eat more and exercise less.  Older athletes do have more body fat than younger active people, yet they have significantly lower body-fat levels than sedentary people of similar age. 
All it takes is 30 minutes a day!  Submitted by Kelly Deveau, Primary Health Care Nurse

Get Motivated to Exercise

The benefits of exercise include but are not limited to; improving your mood;  lightening your weight;  building muscles which burn calories, even at rest;  reducing stress, anxiety and depression;  improving your sex life;  giving you more energy;  improving your sleep making you feel great;  making you look great and making you proud of yourself.  With inadequate amounts of exercise people are more likely to have heart disease, high blood pressure, high blood fat levels, excess weight, and type 2 diabetes.

You want to become more active but just don’t have the motivation.  Try these simple tips to get motivated.
  Lisa Kroeker RNBN NP, Primary Care Nurse Practitioner Phone: (204) 345-1218 E-mail: lkroeker@neha.mb.ca

Take Care of Yourself

What is Self Care? Self care is care provided “for you, by you.”   It’s about identifying your own needs and taking steps to meet them.  It is taking the time to do some of the activities that nurture you.  Self care is about taking proper care of yourself and treating yourself as kindly as you treat others.

First take care of yourself. Only when we first help ourselves can we effectively help others. Caring for yourself is one of the most important things you can do for yourself. It is also one of the easiest things to forget. But you benefit greatly from self care and so do others in your life.

When we find ourselves focusing more on others than ourselves, we become worn out, stressed out and run down.  For those of us who spend time helping and caring for others, it is too easy to neglect our own needs.  It’s like “running on empty” when we don’t take the time to re-fuel. We spend so much time and effort caring for our partners, children, pets, friends, family members, employers and employees. Add to that the numerous volunteer activities, errands, housework, family functions, meetings, etc. – and there isn’t much time left for caring for ourselves. We need to balance the stress and activity of daily life with activities that bring a sense of peace and well being to our minds and bodies. Those who neglect their own needs and forget to nurture themselves often become unhappy have low self-esteem and feel resentment.  Self care means treating yourself as a worthwhile person and showing that you are valuable, competent and deserving.

What are some examples of Self Care activities?

Practicing self care does not have to cost much.  In fact there are many things that you can do that are free or affordable:
• Talk openly with a trusted friend
• Sit outside and listen to the birds
• Practice breathing exercises
• Make room in your life for a nap. Rest awhile and “recharge”
• Make exercise a regular part of your life
• Take a warm bath/shower
• Listen to music you enjoy
• Journaling
• Read a good book
• Plant a garden
• Buy yourself a little something
• Attend a class to learn something new

Submitted By: Carol Orvis Source: Fort Garry Women’s Resource Centre

Hypertension – High Blood Pressure

If your doctor finds that your blood pressure is consistently higher than normal after several visits, you may be diagnosed with hypertension.  High blood pressure affects one in five Canadians.  It is the number one risk factor for stroke and heart disease.  43% of Canadians with high blood pressure don’t even know they have it because there are no symptoms.  You can’t see it, or feel it, but the good news is that you can control it.

Hypertension may be diagnosed during a regular physical examination.  Your doctor or healthcare provider will use a sphygmomanometer (blood pressure cuff) to check your blood pressure.  This common device should be familiar to you as it consists of a cuff that fastens around the upper arm and is attached to a bulb.  The doctor inflates the cuff by squeezing the bulb.  The doctor then releases the air from the cuff and listens with a stethoscope for the first heartbeat that can be heard.  Blood pressure is expressed as two numbers.  These numbers represent the pressure against the walls of your blood vessels as the blood moves through them.  Systolic pressure is when pressure is highest in the arteries and occurs when the heart contracts.  Diastolic pressure is the moment of minimum pressure in the arteries and occurs when the heart relaxes. Normal blood pressure is less than 120 (systolic) over 80 (diastolic), written as 120/80 mm Hg (millimeters of mercury). A high normal range is between 130/85 - 139/89 mm Hg, and if your blood pressure is consistently more than 140/90 mm Hg, or if you have diabetes, 130/80 mm Hg is considered as high. Your doctor may also check for hypertensive retinopathy, which is damage to the blood vessels in the eyes caused by high blood pressure. Since high blood pressure puts people at risk for stroke and kidney failure, the exam will also cover all the major organs, such as the brain, lungs, and kidneys for damage.  Depending on the outcome of these tests, more tests like urinalysis, blood tests, and an ECG may be necessary.  If high blood pressure is well controlled, most serious complications may be avoidable.  However, for people with very high, uncontrolled blood pressure combined with retinopathy, serious problems could develop.  Overtime high blood pressure can damage blood vessel walls causing scarring that promotes the build up of fatty plaque, which can narrow and eventually block arteries.  It also strains the heart and eventually weakens it. Very high blood pressure can cause blood vessels in the brain to burst resulting in a stroke.

For 85% to 95% of people with hypertension, the cause of their high blood pressure is unknown. It is called primary hypertension, a condition that probably is a result from a variety of causes. Some risk factors that may result in high blood pressure are:

Individuals with high blood pressure are often urged to change their diet, exercise regularly, quit smoking, limit their alcohol intake, and generally lead less stressful lives.  If changes to your lifestyle are not effective enough, your doctor may prescribe a medication.  You should know that even with medication, making healthy lifestyles choices is not only recommended to help lower your blood pressure, it may also help improve your overall health and make you feel better.
Submitted By: Laura Gmiterek Source: Manitoba Health and The Heart & Stroke Foundation

Safe Kids: Got Wheels? Get a Helmet!

Has your child ever said to you “Do I have to wear a helmet?  It’s not cool!” Or perhaps you’ve heard this one?  “But nobody else has to wear a helmet!” How do we as parents respond to that?

“Got Wheels? Get a Helmet!” is the theme this year for Safe Kids Canada.  Activities with wheels are a great way for kids to be active, get fresh air, and its fun for the whole family, too!  But how do we keep our kids safe?  Every year in Manitoba, about 150 cyclists are hospitalized and several are killed.  Cycling injuries often involve collisions of bicycles with motor vehicles.  Wearing a helmet can save lives and prevent serious injury.  In fact, in a crash, a helmet reduces the risk of head injury by up to 85 percent.

For the past few years, Manitoba Healthy Living has been working in partnership with schools and early learning child care centers to offer bike helmets for under $15.  This is not a fundraiser for schools, but rather an initiative to provide helmets to as many children as possible at an affordable price.  Your child may have brought home a letter from school, from Manitoba Healthy Living, along with an order form.  Their letter states that, “Even mild head injuries can result in long term effects”, and urges parents to take advantage of the low cost bike program.  They offer bicycle helmets, as well as “multi-sports helmets”, which they describe as being appropriate for bike riding, in-line skating and skateboarding.

When purchasing a helmet be sure to look for one that has been approved by the Canadian Standards Association (CSA), the Consumer Product Safety Commission (CPSC), or ASTM International.  For safety reasons, do not buy a secondhand helmet.  You will not know if the helmet has been in a crash, and you likely won’t know how old it is.  Helmets should be replaced after five years, as the plastic will dry out making it unsafe to use.  Also, helmets cannot protect you a second time after they have been in a crash.  Cost versus quality:  A study conducted by the Bicycle Helmet Safety Institute tested helmets ranging in price from under $20 to $200, and found no significant differences in performance, although there may be some differences in the look and graphics.  They concluded that a good helmet doesn’t have to cost a lot, and that the most important thing was to find a helmet that fits you well so that it will be positioned correctly if an impact occurs.

Safe Kids Canada offers these tips for fitting a helmet: Making sure that everyone in the family wears a bicycle helmet when riding sets a good example for all.  Older children are less likely to wear bike helmets, due to their natural tendency to challenge authority at this age, peer pressure, and concern over physical appearance.  Urge them to keep wearing their helmets – there is nothing “cool” about a head injury.

Most importantly, you should be a good role model and wear your helmet also every time you cycle. For more information on bicycle helmets or bicycle safety, visit Safe Kids Canada or call 1-888-SAFE-TIPS (723-3847). Look for displays and activities in your community during Safe Kids Week 2010 May 31 – June 5th.  Submitted By:  Marilyn Sitar, Wellness Facilitator  Source: Safe Kids Canada, Manitoba Health and Healthy Living, Manitoba Public Insurance, Bicycle Helmet Safety Institute

Coping With Stress

Stress is a fact of daily life and is the result of both good and bad occurrences that happen.  It may come from major events in life or from minor incidents.  If you did not feel stress of some sort, you would not be alive.  However, the negative effects of too much stress associated with being under pressure can affect your health.

When you find an event stressful, your body will undergo a series of responses in three stages:
  1. Stress will Mobilize Energy by releasing adrenaline. Your heart will beat faster and you start to breathe more quickly.  Both good and bad events can trigger this reaction.
  2. Consuming Energy Stores; if you remain in the mobilizing energy stage for a period of time, you will begin to consume energy when your body releases stored sugars and fats.  You will feel driven, pressured, and tired.  You may consume more coffee, alcohol, or smoke more.  You may also experience anxiety, negative thinking, or memory loss, catch a cold, or get the flu more often than normal.
  3. Draining Energy Stored; if you do not resolve your stress problem, your body’s need for energy will become greater than its ability to provide it.  At this stage, you may experience insomnia, errors in judgment and personality changes.  You may also develop a serious illness such as heart disease or be at risk of mental illness.
Signs that you are over-stressed may include:  the feeling of irritability;  sadness or guilt; change in sleep patterns;  change in weight or appetite;  difficulty in concentrating or making decisions;  negative thinking;  loss of interest, enjoyment, or energy in something you used to once enjoy;  or restlessness.

Stress is considered to be a risk factor for many diseases, including:  heart disease, some types of bowel disease, herpes, and mental illness.  Stress also makes it hard for people with diabetes to control their blood sugar.  It is also a risk factor in alcohol and substance abuse, as well as weight loss and gain.  Stress has also been identified as a possible risk factor in Alzheimer’s disease.  Severe stress can cause biochemical changes in the body, affecting the immune system, leaving your body vulnerable to disease.

You can enhance your life by getting stress under control.  Here are several strategies to help you deal with stress:
Major events in our lives can bring on stress, like a new job, getting married, getting divorced, moving your home, or coping with the death of a loved one.  There are also the long term worries such as financial problems, your children’s future, your job, or an ongoing illness that can cause a great deal of stress.  Then there are those day to day irritations such as traffic jams, rude people, or machines that don’t work.  Not all stress-provoking events have to be negative.  How we approach these events greatly affects our physical, mental, and social well-being.  We can either welcome these events as challenges enriching our lives, or we can view them as stressful, taking away from our enjoyment in life.  Submitted By: Laura Gmiterek,Source:  Health Canada & Public Health Agency of Canada

Coping with Cancer  April is Cancer Awareness Month

You may have many reactions when you first find out that you, or someone you love, has cancer.  You may have felt overwhelmed, devastated, numb, frightened, angry or a sense of disbelief.  Your reactions can be very strong, conflicting, or disturbing.  They may come and go quickly, and they may change often.  The diagnosis may raise many fears: of death, of physical change, unpleasant treatment or feeling sick, of being out of control, about how the family will react and cope, of how to handle day-to day tasks, work, or finances.  Some people feel all alone, even if friends and family are with them.  Others report a sense of watching things happen to someone else, from the outside.  Some people find it difficult to understand what the doctor is telling them, and need to be told the same information many times.  All of these responses are normal.  It is also normal for similar feelings and fears to come up a number of times throughout the cancer experience.  Many people with cancer and their loved ones search for a reason behind the illness.  Trying to find the reasons behind the cancer may interfere with your ability to cope.

Cancer is a complex disease, and it is often impossible to know why things happen the way they do.  Some people may feel guilty and blame themselves.  They may feel that something they did in the past led to getting cancer.  If you are struggling with feelings like this, it’s important to recognize that no one deserves to get cancer.  It may help to remember that you can’t change the past.  Try to focus on the present and how to best deal with the situation ahead.  If you are having a hard time moving past such feelings, it may help to talk to a counselor or someone on your healthcare team.  Almost everyone worries that cancer or cancer treatment will be painful.  While some people do experience pain, some have pain only once in a while and some people don’t have any at all.  There are many ways to control and prevent pain, and living with cancer does not have to mean living with pain.  If you are worried about pain, or if you are in pain, it’s important to tell someone on your healthcare team.  Your healthcare team is there to help you. You don’t have to face pain alone.

Finding out that you or someone you love has cancer often leads to thoughts of death.  This is a normal reaction.  These kinds of thoughts can be overwhelming, especially at first.  But more and more people are surviving this disease.  When first diagnosed, many people with cancer and their families focus on the possibility of dying of cancer.  Over time, as the reality of day-to day life with the disease settles in, many people can begin to focus instead on living with cancer.  That can mean: finding the strength and resources to cope with the challenges of the disease; adjusting to so much uncertainty;  finding new ways to appreciate the pleasures and joys of life. This change of focus can take time.

Once the initial shock of diagnosis has lessened;  people often feel a sense of hope.  Hope allows people to cope with the difficulties of the present and to imagine a positive future.  Hope is very personal.  You might find it easy to be hopeful or you might find it hard to bring hope to what is such a difficult experience.  People find hope in different ways.  You may find hope by enjoying nature or spending time with your family.  Your faith may give you hope, or you may be inspired by stories about people who have overcome cancer, or who lead active, fulfilled lives during and after treatment.  Many people find hope in the fact that cancer research has made so much progress in recent years, or in the possibility of living with certain cancers as lifelong diseases.  For some people, a cancer diagnosis brings renewed clarity and purpose to life, and this can bring hope.  Others find hope in starting new projects or making plans for the future.

As you learn to cope with cancer, you may have to experiment to find the best way to make yourself feel better, and get a sense of control over the emotions.  You might want to try venting your emotions.  Sometimes the stress of living with cancer can be overwhelming.  You may feel as though you need to get rid of some of your tension and emotions quickly before you explode.  You could try letting yourself have a good cry, hitting or throwing a pillow, putting on some loud music and screaming, or writing down your fears and worries.  Another source of relieving stress is through laughter.  It’s okay to laugh at the funny side of life.  When you laugh your brain releases chemicals that relax your muscles and make you feel good.  You may be surprised at the positive effects of watching a funny movie or TV show, enjoying the amusing things children or pets do, or laughing at a witty remark from a friend.  Creative activities such as:  drawing or painting, writing poetry or stories, singing or making music and dancing, may also safely release feelings.  Any activity that holds your attention can be useful to distract you.  Working with your hands, doing puzzles, models or even reading a book is another way to keep from thinking about your pain and worries.  Other methods to try to relieve stress are deep relaxation, imagery, and exercise.  These activities can be considered complementary therapies when they are used together with conventional cancer treatment.  Submitted By: Laura Gmiterek Source: CancerCare Manitoba

Cancer and your Healthcare Team

Cancer is a disease that starts in our cells.  Our bodies are made up of millions of cells, grouped together to form tissues and organs such as muscles and bones, the lungs, and the liver.  Genes inside each cell order it to grow, work, reproduce, and die.  Normally, our cells obey these orders and we remain healthy.  But sometimes the instructions get mixed up, causing the cells to form lumps or tumors, or spread through the bloodstream and lymphatic system to other parts of the body.  Tumors can either be benign (non-cancerous) or malignant (cancerous).  Benign tumors cells stay in one place in the body and are not usually life threatening.  Malignant tumors cells are able to invade nearby tissues and spread to other parts of the body.  Cancer cells that spread to other parts of the body are called metastases.  The first sign that a malignant tumor has spread is often swelling of nearby lymph nodes, but cancer can metastasize to almost any part of the body.  It is important to find malignant tumors as early as possible.  Cancers are named after the part of the body where they start.

When diagnosed with cancer it is important to know that you will never be alone.  Teamwork is needed to treat cancer.  Before any treatment begins you will need to meet with members of your healthcare team.  They will recommend treatment options and talk to you about your choices that are available to you.  You healthcare team will consider the type of cancer that you have, the stage and grade of your cancer, your age, your general health, and any other medical problems you might have.  The team working with you may include many different healthcare professionals. You are the most important member of your healthcare team.  Your situation is unique and your treatment will be developed just for you.  As a member of your team you should be involved in the decisions that affect you.  Learn about your cancer and your treatments in a way that feels right for you and talk to your healthcare team about your worries or concerns.  You should always keep your doctor, clinic, and hospital appointments and be sure to write down any questions that you need to ask your healthcare team, so that you won’t forget them.  Also, ask your healthcare team how you can contact them between appointments if you have any questions that need to be answered quickly.  Submitted By: Laura Gmiterek  Source: CancerCare Manitoba

Obesity

Obesity is an issue that has been identified as a priority for health care providers.  Obesity is defined as a body mass index (BMI), the ratio of weight to height that is greater than 30, overweight is a BMI over 25.  The numbers of Canadians who are overweight or obese has increased in the past 25 years.  Research has determined that obesity is a risk factor for many chronic diseases, including high blood pressure, heart disease, Type 2 diabetes, stroke, gallbladder disease, osteoarthritis, sleep apnea, and other breathing problems, some cancers such as breast, colon, and endometrial cancer and mental health problems, such as low self-esteem and depression.

Obesity has been linked to many chronic diseases but its relationship to chronic disease is a consequence of poor nutrition and a sedentary lifestyle.  The increase in the percentage of Canadians that are overweight is related to; work and play that is less physically demanding, more automated transport, less physically active employment opportunities and leisure activities that include more television and video games.  Youth are less active, they are more likely to be transported by vehicles to school and have less physical activity in their school curriculum.  Food choices have changed.  Canadians have access to inexpensive, high caloric foods and eat larger food portions in relation to the amount of physical activity participated in daily.  Obesity is a consequence of poor nutrition and a sedentary lifestyle but it is poor nutrition and a sedentary lifestyle that causes health problems.  It does not just cause health problems for obese people but in people of all sizes.

What can you do to improve your health no matter what size you are?  Look at the list above, what factors are impacting your health?  It is never too late to make lifestyle changes that will improve your health.  Start with one change and once you have mastered that change make the next.  Don’t focus on your BMI or waist circumference but focus on the minutes of physical activity performed each day or on how many fruits and vegetables eaten each day of the week.  It is a process and each improvement made will lead to better health for your body, heart, and mind!  Not sure where to start.  Talk to your doctor, nurse, dietitian, or anyone from your local healthcare team.  Submitted By: Lisa Kroeker, RNBN, NP  Adapted from Health Canada’s “It’s your Health” website

May is MS Awareness Month

The Multiple Sclerosis Society of Canada marks the month of May as MS Awareness Month.  Canadians have one of the highest rates of multiple sclerosis in the world.  An estimated 55,000–75,000 Canadians have MS.  While the exact cause of MS is not known, current research increasingly points to a complex interplay of environmental and possibly genetic risk factors.  Together these two factors may influence a risk for developing MS given a prescribed set of conditions which are yet to be discovered.

Multiple sclerosis (MS) is an often disabling disease of the central nervous system which is composed of the brain and spinal cord.  Your central nervous system (CNS) communicates with the rest of your body by sending electrical messages along your nerves.  Nerve fibers have a layer of protection around them called myelin which is crucial for transmitting these messages quickly. It is not yet understood why, but with MS, your immune system mistakenly attacks the myelin, leading to scarring or demyelination.  As well as damage to myelin, injury to the nerve itself may also occur.  As a result, messages get sent through the body too slowly or not at all.  The scarring or lesions can occur throughout the CNS and their location will have some impact on the symptoms experienced.  MS is unpredictable, affecting vision, hearing, memory, balance, and mobility.  Its effects are physical, emotional, financial, and last a lifetime.  There is no cure.

It is hard for your doctor to predict what your future holds because MS varies so much between individuals and there is no typical rate of progression or disability.  Some people with progressive MS may, at some point experience a plateau, where their progression seems to level off.  Others may become very disabled. Many people fear that they will die from their MS, but this is very unusual.  In a small percentage that have a shortened life span;  it is almost always due to complications associated with severe progression. Coping with a chronic illness such as MS takes planning and can be especially challenging if you experience fatigue, depression, cognitive difficulties, or have trouble getting around.  Below are some strategies that may be helpful:
Submitted By: Laura Gmiterek Source: MS Society of Canada

Vaccines save lives

Vaccines have saved more lives worldwide than any other health intervention in the past 100 years.

Often, adults are not aware that they may lack protection against some serious diseases. Many adults wait for their health care provider to recommend immunization, instead of taking the initiative to get the information they need.  This leaves adults of all ages vulnerable to diseases such as influenza, pertussis (whooping cough), pneumonia, and tetanus.

Not only are under-immunized adults at risk of contracting diseases themselves- they can also infect others.  For example, adults who become infected with pertussis or influenza can pass on a disease to infants who are at greater risk for diseases.

Not all vaccine-preventable diseases are passed from person to person.  A simple and enjoyable activity such as gardening can put you at risk, since the bacteria that makes tetanus toxin are found naturally in soil.  The only way to prevent tetanus is to get a tetanus booster every ten years.

Our recent experience with the H1N1 vaccine reminds us that immunization protects not only individual health but also the health of people in our community.  The more people who are immunized against vaccine-preventable diseases, the lower the risk of exposure to potentially life-threatening illnesses. It is important to keep immunizations up-to-date throughout our lives.  Recommended immunizations begin at two months of age and continue into adolescence and adulthood to provide ongoing protection.

Immunization is the safest and most effective way to protect yourself and your family from preventable diseases.  Take time to review your immunization status.
If you require immunizations contact your local Public health office or your family doctor. Immunizations Save Lives!

Article Prepared by:  Vicky Pizzey & Kari Lange (North Eastman Health Association)  Information source: Canadian Coalition for Immunization Awareness & Promotion (CCIAP), 2010.

Poison Ivy

Poison Ivy is a climbing plant of the sumac family.  It grows on sandy, stony, or rocky shores.  The plant also sprouts in a dense growth of bushes or small trees, in clearings, and along the borders of woods.  This glossy perennial can spread by seed, or by producing shoots from its extensive underground stems.

The sap of the plant contains an oily resin that causes an irritating inflammation of the skin in most people.  All parts of the plant, including the roots, contain this poisonous resin.  Most people develop symptoms 24 – 48 hours after contact.  The extent of a reaction depends on the individual’s sensitivity and the amount of sap in contact with the skin.

The compound parts of the plant consist of three pointed leaflets.  The middle leaflet has a much stronger stalk than the two side ones. The leaflet edges can be smooth, or toothed, but are rarely lobed.  The leaves vary greatly in size, from 8 - 55 mm in length.  They are reddish when they emerge in the spring, turn green during the summer, and become various shades of yellow, orange, or red in the fall.

The plants stem is woody and of two kinds.  The most common kind will grow as a trailing vine, with upright leafy stalks 10 - 80 cm high.  The second kind is an aerial vine that may climb from 6 -10 mm high on trees, posts, or rough surfaces.  The plant produces clusters of cream to yellow-green inconspicuous flowers during the months of June and July.  The berries that appear by September are clustered, globular, waxy, and a green to yellow color.  The size of the berries ranges from 3 – 7 mm in diameter.  They often remain on the low, leafless stems of the plant all winter.

Poison Ivy causes an irritating inflammation of the skin, called Rhus-dermatitis, or Poison Ivy dermatitis.  The inflamed areas frequently develop blisters which are accompanied by intense itchiness.  Contact with any broken part of the plant may cause a reaction in some individuals.  The rash spreads by exposure to the sap and not from the sores themselves.  Therefore, an individual has to actually come into contact with the sap before developing an allergic reaction.

If you suspect that areas of your skin have been contaminated, carefully wash them with soap and cold water.  Cold water should be used because hot water tends to open the pores of the epidermal layer.  The heat would increase the chances of the resin being deeply absorbed into the skin.  If soap is not available, vinegar (2 tbsps in one cup of water), or alcohol (1/2 cup to 1/2 cup of water), can be substituted.  It is important to know that these practices may not prevent a reaction but will likely prevent the infection from spreading.  If a reaction should develop, you should get the advice of your Physician, or Nurse Practitioner, for the proper treatment.  Skin irritations such as itching, red inflammation, blistering, and in severe cases oozing sores that result from exposure to Poison Ivy normally disappear in 10 days. Submitted By: Laura Gmiterek   Source: Health Canada

World Elder Abuse Awareness Day

Tuesday June 15th, 2010 will mark the fifth year that communities across Manitoba heave recognized World Elder Abuse Awareness Day.  Around the world, communities and seniors organizations will use this day to promote the vision of: My World…Your World…Our World…Free of Elder Abuse.

The International Network for the Prevention of Elder Abuse (INPEA) introduced the first World Elder Abuse Awareness Day to support the Madrid Plan of Action on Aging.  The INPEA is working with interested individuals, agencies, organizations, governments, and businesses throughout the world to promote this special day.

This special day is a time to share information, learn more, discuss the issue of abuse of older adults, and become involved. Please wear a purple ribbon during the week of June 9th to 15th as a sign of recognition that…ABUSE HURTS AT ANY AGE

If you would like information/assistance with planning an event in your community please contact:
Janelle Curtis, Elder Abuse Consultant
Manitoba Seniors and Healthy Aging Secretariat
Phone 204-945-8036 or email 1-888-896-7183

The response and recognition of this day in the past has been overwhelming, and Manitoba continues to be a leader in Canada in recognizing this inaugural event.  Please remember that raising awareness on the abuse of older adults is everyone’s responsibility.  Look for opportunities in your community to bring this issue forward and ensure that older adults know where to get assistance.  For more information on resources, events and services visit: Age & Opportunity  Submitted by Pat Porth, Community Resource Coordinator, Two Rivers Seniors Council at: 345-1227, or e: mail: tworiver@granite.mb.ca

Supportive Housing

The needs and abilities of older Manitobans change gradually over time.  The kinds of changes and when they occur vary from one person to the next.  Although many seniors can remain active and independent in their own homes, others need a little help to continue living in the community.

It isn’t always easy for seniors and their families to determine what solution will work best for them.  Although the family home may be full of memories, it may also feel empty, leading to isolation, depression and even malnutrition.  Some home-based services such as Services to Seniors and Home Care are available to eligible individuals to help with their daily activities or health needs.  However, an increasing number of older adults find themselves in need of an alternative, comfortable housing option.

The Supportive Housing concept was introduced for seniors who require 24-hour support and supervision in a secure apartment setting.  This community housing option can help seniors delay or avoid personal care home placement until an intensive level of care is required.  Living in a supportive environment offers independence while at the same time providing social interaction, personal safety and basic amenities like 3 meals per day in a community dining room, housekeeping help, laundry assistance and daily recreation programs.  If additional personal care is required, it is funded through the Regional Health Association (RHA) at no cost to the client. Eligibility for personal care services is assessed through the RHA Home Care Program.

People living in the community access Supportive Housing through Home Care.  In the North Eastman region individuals work with a Home Care Case Coordinator to complete their assessment application.  If deemed eligible for the program, they will meet with the sponsoring organization for a tour and orientation to ensure a match within the setting.

Presently there are two Supportive Housing programs within North Eastman.  They are Stony Plains Terrace in Beausejour and Ironwood in Pinawa.  If you are interested in touring Ironwood Supportive Housing, you are welcome to attend their grand opening on Sunday July 18, 2010 at 1:00 PM.

For more information on accessing Supportive Housing please contact your local Home Care Case Coordinator. Source: Manitoba Health Aging In Place / Long Term Care Strategy Submitted by: Grace Honke – Manager of Senior Support Programs

Hamburger Disease – E. coli 0157:H7

When you eat under-cooked ground beef, it may result in a type of food poisoning that is commonly known as hamburger disease.  You can minimize your risks by handling and cooking raw ground beef properly.

Hamburger disease is caused by a specific type of bacteria called E. coli 0157:H7. E. coli live in the intestines of cattle, and can be transferred to the outer surface of meat when an animal is butchered.  The process of grinding can then spread the bacteria throughout the meat.  You cannot tell the difference between contaminated ground beef by the way it looks, smells, or tastes.  Two of the most common ways to come into contact with E. coli 0157:H7 are by handling raw ground beef without taking the proper precautions, and by eating ground beef that is under-cooked.

People who have become infected with E. coli 0157:H7 experience a wide range of health effects. Some do not get sick at all, while others feel as though they have a bad case of the flu. The symptoms of hamburger disease range from severe stomach cramps, to vomiting, fever, and watery or bloody diarrhea. These symptoms usually appear within two to ten days after contact with the bacteria, and clear up within seven to ten days. There are some people who get hamburger disease that will experience life threatening symptoms, including kidney failure, seizures, and stroke. While most of these people will recover completely, others may suffer permanent health effects, such as kidney damage, and some may die.

Bacteria can grow quickly at room temperature, so when you are running errands, make grocery shopping you last stop.  At the grocery store pack raw meat separately from other products in your cart, or bags.  Always be sure to refrigerate or freeze perishable foods as soon as you get home and never defrost food at room temperature.  You should thaw food in the refrigerator, in cold water, or in the microwave if you are going to cook it immediately. Always marinate food in the refrigerator.

Here are some food safety tips when barbecuing hamburgers:
  • Wash your hands thoroughly for about 20 seconds before and after handling any raw meat, poultry, and seafood.
  • Use hot soapy water to clean all surfaces (refrigerators, counters, dishes, utensils, or thermometers) that come in contact with raw meat.
  • Make burger patties thin so that they cook all the way through.
  • Do not let ready to eat foods like lettuce, tomatoes, cheese, or other, come in contact with raw meat or its juices.
  • Pre-heat the gas barbecue before starting to cook. If you are using a charcoal barbecue, use enough charcoal and wait until it is glowing red before starting to cook.


    • Your burgers are safe to eat when:
  • The internal temperature of the patties is at 71°C (160°F).  Color alone is not considered a reliable indicator that a burger is safe to eat.  Burgers can turn brown before all the disease-causing bacteria are killed.
  • Reduce the heat or raise the height of the grill if food starts to burn during cooking.  Remember it is the internal temperature of the patty that is important.
  • Probe-type food thermometers with digital read outs work best for determining if the burger is done.  If you are cooking more than one, take the temperature in several of the thickest patties.
  • Remove the patty from the grill and insert the thermometer at least an inch through the side of the patty as close to the middle as possible.  Continue cooking your burgers if any reading is less than 71°C (160°F).
  • Remember to wash the thermometer in between temperature measurements.  Oven safe meat thermometers designed for testing whole poultry and roasts during cooking are NOT suitable for measuring the temperature of patties.
  • Use clean utensils and plates when removing cooked meats from the heat source.
  • Cover and store leftover cooked food in the refrigerator or cooler within 2 hours.
  • Reheat leftovers to 74°C (165°F).
  • By following some common sense guidelines in the way you handle and cook food, you can drastically reduce your risk of contracting hamburger disease and other food-borne illnesses.
    • Submitted By: Laura Gmiterek  Source: Health Canada.

    Healthy Indoor Living

    In this country of 4 seasons, we all have a tendency to spend a great deal of time indoors.  It is important to ensure that our homes are a safe and healthy place to live.  Home health risks come in many shapes and forms.  They can be present in our air, soil, and water.  They can be inhaled or ingested or absorbed through the skin.  Some come directly from nature itself, such as radon gas, which can enter the home through the soil beneath the foundation.  Other risks come from substances such as lead or from household products.  You probably use many chemical products in and around your home.  These products include cleaning liquids and powders, polishers, drain cleaners, or paint thinners.  Household chemicals should be used, stored, and disposed of as recommended.  Always be sure to read the label before you buy, and follow the instructions every time you use a household chemical product.  By law, the label must include instructions on how to use and store the product safely.  It must also show warnings of potential hazards.  Also, you should store chemical products in the original containers.  Try not to store products that may release harmful fumes inside your home. These items include paints, solvents, gasoline, fuels, or varnishes.  Store them in a separate building, if you can, or in an area that is well vented to the outside.  Buy only the quantity you need for the job, and discard any leftovers as directed by your municipality or township.  Never burn household chemical containers, pour the contents down the drain, or reuse empty containers for other purposes.  Make sure that your home has sufficient fresh air.  An exhaust fan that vents to the outside should be installed above your stove, open windows when painting, varnishing, or installing new carpets.

    Radon is a colorless, odorless, radioactive gas that occurs naturally in the environment.  It comes from the natural breakdown of uranium in soils and rocks.  Through small spaces in the soil and rock upon which your house is built, radon can accumulate to relatively high levels and become a health hazard.  It can seep into a home through dirt floors, cracks in the concrete, sumps, joints, basement drains, under the furnace base and jack posts if the base is buried in the floor.  Concrete block walls are particularly porous to radon and radon trapped in water from wells can be released into the air when water is used.  Human skin is thick enough to not be affected, but if you breathe in alpha particles, they can damage bronchial and lung tissue and can lead to lung cancer.  Also, take off your shoes when you come inside.  The soil outside your home can contain substances you don’t want inside.

    Mould is a type of fungus that comes in a variety of colors and can grow in damp areas inside your home.  Mould grows where there is too much humidity from water leaks, cooking, showering, and flooding.  It can grow on wood, paper, fabrics, drywall, and insulation, inside walls or above ceiling tiles.  People living in homes with mould and damp conditions are more likely to experience:  eye, nose, and throat irritation; coughing and mucous build-up;  wheezing and shortness of breath; worsening of asthma symptoms and other allergic reactions.  Inspect your home for visible signs of mould or areas with excessive moisture.  Look for stains or discoloration on floors, walls, window panes, fabrics and carpets, or a musty earthy odor.  Measure humidity and keep it low, about 50% in summer and 30% in colder weather.  If necessary, use a dehumidifier.  If contaminated surface is small, clean the mould by yourself by using water and dish detergent.  There’s no need to use bleach. If the affected area is large take precautions to protect your health.  In such a case, consider hiring a professional to clean it up.

    Lead is a highly toxic metal that occurs naturally in the earth’s crust and has may industrial uses.  Lead can cause many harmful health effects, especially to the nervous system, blood system, and kidneys.  Exposure to even low levels of lead can cause learning disabilities and other harmful effects on children’s development.  If your home was built before 1960, lead-based paint was probably used both inside and outside.  For homes built from 1960 – 1990, small amounts of lead may be in some of the paint used.  Do not use sanders, heat guns, or blowlamps to remove paint in older homes.  This can create dust and fumes that contain lead.  Use a chemical stripper, preferably one with a paste that can be applied with a brush.  Chemical strippers contain potentially harmful substances themselves, so use them carefully.  Always wear goggles, gloves, and a good quality breathing mask.  Lead can also be found in plumbing pipes.  Homes built before 1975 may have lead pipes or have solder or other plumbing parts that contain lead.  This can leach into water sitting in pipes.  You can look at the pipe entering your home, and if it is soft or easily dented when scraped with a knife, or if it is grayish-black, it is likely made of lead or contains lead.  If you have lead service lines or materials in your plumbing lines, you should look into getting your water tested for lead content.  As a precaution, you should always let tap water run until it is cold before using it for drinking or cooking.  This is particularly important when water has been sitting in the pipes for long periods of time, such as first thing in the morning.  Don’t use hot water for drinking or cooking. Submitted By:  Laura Gmiterek Source: Health Canada

    West Nile Virus

    West Nile virus is a relatively new disease in Manitoba.  The virus is transmitted by mosquitoes.  Most individuals who are bitten by an infected mosquito do not become ill and for those who do, the symptoms are usually mild.  In some cases, the virus causes serious illness and sometimes death.  Most mosquitoes do not carry West Nile disease.  In Manitoba, the main carrier of the virus is the Culex mosquito, which is usually less common than other mosquito types.  The risk of the disease varies from year to year and is influenced by precipitation, temperature, mosquito populations, and many other factors.  Manitobans are at highest risk of being bitten by an infected mosquito in July, August, and early September, but exposures have occurred in June.

    Many people infected with West Nile virus have no symptoms and do not get sick or have only mild symptoms.  When infection does cause illness, symptoms will usually appear within 2 – 15 days.  The extent and severity of symptoms may vary widely between each individual.  In mild cases, there may be flu-like symptoms, including fever, headache, and body aches.  Some people may also develop a mild rash, or swollen lymph glands.  Some people have a weaker immune system and are at greater risk of developing symptoms and health effects that are more serious, including meningitis, encephalitis, and acute flaccid paralysis.  Meningitis is inflammation of the lining of the brain or spinal cord. Encephalitis is an inflammation of the brain itself.  Acute flaccid paralysis is a polio-like syndrome that can result in the loss of function of one or more limbs.  For people with more severe illness, symptoms could include the rapid onset of severe headache, high fever, stiff neck, nausea, difficulty swallowing, vomiting, drowsiness, blurred vision, or deterioration in eyesight, confusion, loss of consciousness, lack of coordination, muscle weakness, and paralysis.  Other symptoms that have been identified include movement disorders, Parkinsonism, poliomyelitis-like syndrome and muscle degeneration. Anyone who has a sudden onset of these symptoms should seek immediate medical attention.

    Individuals of any age or health status can be at risk of developing serious health effects from West Nile virus.  People with weaker immune systems are considered to be at greater risk for serious health effects. People at higher risk for serious health effects from West Nile virus include:  individuals with chronic diseases, such as cancer, diabetes, alcoholism, or heart disease; people that require medical treatment that may weaken the immune system, i.e. chemotherapy.

    Because West Nile virus can cause severe complications for people of any age and any health status, it is extremely important to reduce the risk of getting bitten by mosquitoes.
    To reduce the places around your home where Culex mosquitoes may lay their eggs, eliminate unnecessary standing water:
    - regularly clean and empty your eavestroughs, pool covers and other items that might collect water;
    - clean and empty bird baths weekly;
    - ensure that openings in rain barrels are covered with mosquito screening or tightly sealed around the down-spout; and
    - make sure your yard is clear of old tires or other debris that collect water.

    Adult mosquitoes like to rest in long grass and sheltered shady areas.  You may reduce your exposure to mosquitoes by regularly maintaining these areas around your home.  Steps you can take include:
    - cutting the grass around your home; and
    - trimming hedges and trees around doorways and outdoor seating areas.

    If a doctor suspects that a patient has West Nile virus, a blood test will be conducted to confirm the diagnosis.  There is no specific treatment, medication, or cure for West Nile virus.  Serious cases are treated with supportive therapies to ease symptoms and prevent secondary infections.  These cases may require hospital or nursing care.  Submitted By: Laura Gmiterek Source: Health Canada & Manitoba Health

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