Author Archives: Dr. Judy

About Dr. Judy

Family Physician since 1987

Complex PTSD

Hi Readers,

I would like to share a discussion held with a group of my brave patients and mental health clinicians. I hope you find it interesting. 

What does Complex PTSD mean to you? These were the answers from the group:

Feeling misunderstood, feelings of shame, having to deal with addictions (to food, alcohol, drugs, sex addictions), torture, exhaustion, memory loss and brain fog, not knowing myself, lack of confidence, paranoia, food hoarding, feeling unsafe, inability to sleep, isolation, OCD behaviours, overthinking, fear of reaching out to others for help or to socialize, triggered by authority – police or others, accepting abusive behaviours from others, dealing with health issues relating to complex PTSD, like diabetes, hypertension, obesity, sleep apnea. 

What helps you cope with the symptoms of Complex PTSD? These were some of the responses:

Remembering that trauma has given me symptoms, but this is not who I am, this is not my personality. I am not the problem. The problem is the problem. 

Distractions: puzzle books, crafts, going for a walk, learning a new skill, going on the internet.

Breathing, 5-step grounding technique, music, pets, taking my dog for a walk, yoga, resting or sleeping, talking to a friend.

Feeding my spiritual side. Remembering I have been created kind, generous, caring and thoughtful. 

“What I think if what I feel”- trying to be mindful of my thoughts. Remembering I am good enough. 

Reach out to a counsellor. 

Eating a proper diet and exercising. Body Work – connecting my heart to my head. Body Scans.

Writing can help, journalling. 

Thank you to our wonderful group. We are all trying to help each other. 

All the best for 2021

Judy

 

 

 

 

The Reality of COVID-19

2021 is two days away. The worst is yet to come in many countries across the world. More than ever we can now see the impact of a global network, global economy, and global connections.

I wish you all safety and security in the next few months, but I realize that will not be possible for all too many of you waiting for a viable income and being faced with ignorance from too many people.

I would like to share a heartfelt story from Mika Kuyoro.

Best

Judy

https://www.marieclaire.com/culture/a35008872/waves-of-loss-and-revolution/?soc_src=social-sh&soc_trk=ma

Covid-19 Vaccine

A memorable week! The Covid-19 vaccine has been approved and the first recipients have received the vaccine. These brave people have fought in the most dangerous of areas, the ICU, the emergency rooms, and long-term care facilities. Thank you for your service. 

We must all do our duty and protect each other. Please Please Please get the vaccine. As soon as I am eligible I will get the vaccine. It provides protection as early as 12 days after the vaccine, and, after the first one, will work for 2 to 3 months, depending on the vaccine. After the second dose, the immunity is boosted. We are not sure for how long. 

Take care. Stay safe.  Judy

COVID – 19 Vaccine

Hello Readers

I hope you are all well and staying safe in the home stretch. Please don’t give up. This Christmas will not be like any other Christmas we have experienced. Experience it safely. Hugging your grandparents may mean you won’t have them with you to enjoy a normal Christmas next year. Please protect those who have diabetes or immune suppression. Take care.

Here is a useful video about vaccines. I hope it helps. I will certainly get the vaccine and hope you will consider getting immunized.

Take care.    Judy

Diabetes in Covid-19 times

Good morning dear readers

This morning I would like to urge any readers to pass news along to their relatives with diabetes that they need to be particularly careful in these difficult times. 

COVID-19 has caused universal stress and stress raises glucose. In Canada we have a help-line 1800 BANTING (18002268464) where a person can speak to a diabetes educator. There is also a Diabetes Prevention Program that can be accessed. 

I have also added education on diabetes on my site on this link – Diabetes. There is a video on foot examination and other education videos. 

Stay safe everyone. If you have symptoms you are concerned about, contact your health care provider. 

All the best

Judy

 

 

Resources for First Nations in BC

There are new virtual resources available for First Nations people in BC.

Substance Use and Psychiatry Services

Referral Guide for Physicians

Doctor of the Day

Instructions for Virtual Care

Wishing you well. Take care

Judy

Alberta Pain Conference 2020 – More on Migraines

Notes taken while attending. Please contact me to advise on errors. Thank you

Dr. Werner Becker: Migraine needs a complex and comprehensive treatment trial.

He organized CHAMP headache program.

He emphasized that avoiding Codeine is important. Tryptans have replaced Ergotamine. Eletriptan and Rizatriptan are good examples, and injectable Sumatriptan, nasal Zolmitriptan.

The future is here – south of Canada’s border. The Gepantsa and Lasmiditan that doesn’t cause vasoconstriction, although it causes sleepiness and dizziness, and may cause driving impairment. Of note, the benefit is still to be discovered. In some studies it helps about 20% compared to 10% helped with placebo.

Dr. Lara Cooke spoke about when is a headache not just a headache. She gave us fabulous Pearls.

Migraine is a primary headache because it is not caused by something else, like a tumor. Usually it’s longer than 4 hours. It is usually one one side, pulses or throbs, usually is moderately to severely painful, it can be made worse by activity. It often comes with nausea or vomiting or light sensitivity or sound. Only 20-30% of people will have auras.

Look for red flags – then may need imaging. Examples of secondary headaches include caffeine withdrawal and a post-concussion headache. Thunderclap and new daily headaches need to be investigated.

Cluster headaches are so bad they are called suicide headaches. An awful pain. I have seen these patients in my office, thank goodness not for a while. Injectable Sumatriptan can work. I have used high dose oxygen – luckily our ER is close by and costs the patient zilch. zero. nada. Got love Canada. Can’t help bragging.

SUNCT – short acting unilateral neuralgiform headache with conjunctival injection and tearing. Certain anticonvulsant medications can work. They can be associated with pituitary lesions.

Look for red flags for another cause – like headaches getting worse over time. Short lasting headaches can be from a tumor in the posterior fossa.

SNOOP4: Systemic symptoms, signs, disease, Neurologic symptoms or signs – like vision or auditory symptoms, Onset sudden, like a thunderclap, Older onset, Papilledema, Positional symptoms from changes to intracranial pressure- worse lying or standing, Precipitated by Valsalva. and if Progressive. Ask – what do you do if you have this headache.

I would also like to remind professionals to think about temporal arteritis. A simple CRP in a suspicious case can save a person’s vision.

Dr. Michael Knash focused on the clinical side of headaches and migraines. 3 Billion people have some kind of headache disorder. He reminded us that headache in pregnancy could be associated with a clot.

He reinforced acute and preventative measures for chronic migraine and how socioeconomic factors can influence migraine management. He did mention the very real risk of death associated with use of opioids over 200mg equivalent Morphine.

Canada is still waiting for approval of many drugs. I don’t mind the wait. I appreciate the need for caution. Erenumab is now available (CGRP Mabs). Also mentioned the use of Botulintoxin and Topiramate.

Such a great way to spend a Saturday.

Thank you all

Judy

More on migraine and headache – Alberta Pain Conference

Dr. William Kingston presented the Conundrum of Managing Migraine with Comorbidities.

More than 10% of people in Canada have had migraines. (I’ve had migraines when I was premenopausal and they were so painful it started my journey to healing and drove me to help my patients manage their own pain). We must not forget the stress of pregnancy and postpartum depression. Hormones and other factors are a huge load on women.

There are groups with migraines who have metabolic problems, diseases like diabetes, hypertension, dyslipidemia, hypothyroidism. There were also groups of people who suffered from anxiety, fibromyalgia, and depression. There was another group who had no co-morbities.

Choosing medications to manage migraine can be incorporated in the medications used to treat conditions like hypertension. There are safer pain medications to choose from when looking at complex patients.

He mentioned prochlorperazine for patients with resistant migraine and Gabapentin.

He spoke about the vicious cycle that results when patients suffer from migraine and depression – two separate but intersecting conditions. Treating migraine can improve your mood. Depression can often present without the typical low mood. There are other presentations of depression. Venlafaxine could be a good drug to try.

Cognitive behaviour therapy can be helpful – Kelty provides free online CBT. Other On-line resources.

PTSD is also important to address if this is present.

When everything does nothing, there may be something – I think searching for hidden trauma, hidden stress, is worthwhile. Step 1 – Rate your pain has links to forms assessing for depression or high adverse child events. Please check in with yourself for hidden triggers and consult your health care professional.

Have a great day

Judy

Alberta Pain Conference 2020 – Migraine Treatment

Dr. David Dodick gave an excellent presentation about a new approach to migraine therapy. He explained the biology of pain so that we reduce the stigma of migraine and provide more effective medications with less vascular side effects. This disease is complex and demands a complex treatment approach.

Here is a good link I think to the new type of therapy. CGRP – A new era for migraine treatment.

If usual therapy has failed in managing migraines, these new medications could be a good option to treat migraines.

He also discussed the research in the role of PACAP in migraine. Perhaps we are now looking finally at effective management of trigeminal neuralgia? Research underway.

Dr. Becker says it takes more than a molecule to treat migraine. I am looking forward to his talk later on.

Judy

Alberta Pain Conference 2020 Pain Research Networks

I have summarized the wonderful talk by Dr. Norm Buckley. Please call me on any misrepresentations so I can correct them.

Dr. Norm Buckley introduced the partners in the Chronic Pain Network and the work they are doing. It is the first research network dedicated to pain in Canada. Speaking about the opioid crisis, he says, “We realize we missed the boat”. So refreshing – Health Canada approaching the opioid health crisis differently.

It is the first time the government is recognizing pain as a priority, starting the Canadian Pain Task Force.

First time CIHR has really invested in pain research. $12.5million over 5 years plus matching funds of $24million.

A dedicated group of researchers trying to grapple the very difficult problem of chronic pain in a setting of millions of patients suffering from undertreatment of pain.

Veterans face a significant problem related to their service. They have established a life after service study. Veterans have worse health on average than other Canadians. They have worse pain. 50% of female veterans have chronic pain.

They have 3 research institutions that are working to reduce the impact of military service on health. They are even researching Cannabis – Veteran’s Canada reimburses the use of cannabis for veterans. Also PTSD and chronic pain. Measuring 7 key measures of well-being. Intergenerational – transgenerational impact of pain.

Patients are being heard! Pain has become a priority. Very Exciting. Hooray Canada!

Judy