A new study, published this week, from Sunnybrook senior scientist Dr. Donald Redelmeier explores how an available simple diagnosis can skew complex medical decision making.

“Occam’s razor is the traditional idea that simple explanations should be preferred over more convoluted theories,” says Dr. Redelmeier, who is also a Sunnybrook staff physician and Canada Research Chair in Medical Decision Making. “Yet this idea has rarely been subjected to experimental testing for evidence-based medicine.”

Dr. Redelmeier and his co-author Dr. Eldar Shafir from Princeton University were interested in testing the concept in the context of the COVID-19 pandemic. “We hypothesized that an available alternative explanation might lead individuals to underestimate the likelihood of a COVID-19 diagnosis,” says Dr. Redelmeier.

The study asked community members and health-care professionals to judge the chances of COVID-19 in a hypothetical patient through a set of different surveys. Each survey provided a succinct description of a hypothetical patient scenario, suggestive of COVID-19. Each scenario was formulated in two versions randomized to participants, differing only in whether an alternative diagnosis was present or absent.

“Through scenarios involving a spectrum of risk, we found that respondents judged the probability of COVID to be much lower in the presence of another diagnosis, such as influenza or strep throat, compared with when an alternative diagnosis was absent,” says Dr. Redelmeier. This contradicts available microbiological evidence.

“The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present. In turn, underestimating the risk of COVID infection might reduce a patient’s willingness to seek care and a clinician’s willingness to investigate a medical diagnosis.”

Dr. Redelmeier adds that the results suggest an available simple diagnosis can lead to premature closure and a failure to fully consider additional serious diseases.

“This bias occurs because risk factors such as crowded living spaces, lapses in hand hygiene, and poverty are risk factors for COVID infection, as well as for other diseases such tuberculosis. After diagnosing a patient with COVID, for example, a clinician might pause and check — is that really everything?”

He adds that as patients are living longer with multiple diagnoses occurring together, an over-reliance on Occam’s razor can contribute to misplaced complacency and discourages the search for additional contributing factors.

“The bias may be important to recognize for the COVID-19 pandemic, other diseases, and for the next disease outbreak.”

The post Can an easy excuse lead people to underestimate a COVID-19 diagnosis? appeared first on Your Health Matters.

“The beginning of the pandemic saw a decrease in sexual activity amongst young singles because the normal places where people would meet up disappeared,” says Dr. Sharon Domb, a staff physician in the Department of Family and Community Medicine at Sunnybrook. “And people were afraid to pick up COVID, so there was certainly more anxiety and stress about meeting new people.”

But with fears easing, restrictions lifting, and most activities back on, Dr. Domb says she suspects singles will return to “normal” behaviours in terms of sexual activity — which can have benefits and risks. She shares helpful insight that people should be aware of if they hope to engage in more sexual activity.

Many people, especially singles, experienced a dry spell in terms of their sexual activity throughout this pandemic. But now with things opening up again, it looks like that could be changing. Can you talk about why this is a good thing?

Sex in the right context for most people usually is a positive thing. From a psychological perspective, from a physical perspective, all of those things.

Young singles certainly suffered a lot in terms of the isolation and the change in their social behaviours and normal social interactions; it was very challenging for the demographic. So, it’s great that they can rekindle social relationships, to be able to get back to sort of normal behaviour, to interact with friends and meet people and hang out.

There’s a huge mental health benefit, not just with sex, but also with the relationships that lead to that.

As we know, the pandemic isn’t over. So, for those who are trying to get out and date and meet new people, how worried should they about COVID-19?

I think everybody sort of needs to take stake of their personal situation.

Are they living with somebody who’s immunocompromised or with an elderly relative? Is it going to be catastrophic if they get COVID? Are they immunocompromised or unwell themselves? If yes, then I think they have to be extra cautious, understanding the ramifications if they get COVID.

If they’re not particularly at risk, they’re vaccinated, and if they live by themselves or they’re not putting anybody they live with in danger, then the risk is probably not huge. I think they should take reasonable precautions, but I wouldn’t say to a 20-something, “Stay at home and never go out.”

At the end of the day, everyone needs to find a point of some moderation.

Aside from COVID, what else should singles keep in mind as they start getting out there again?

By and large, it’s going to be the same issues that demographic dealt with before: you should take precautions, both for pregnancy and for sexually transmitted infections (STIs).

STIs are fairly common. Have a conversation with whomever you’re going to be with and understand their history and what your risk is. Condoms are always a good idea, but they don’t protect from everything. Often, people use condoms for intercourse, but they don’t use condoms for oral sex — and you can certainly get an STI through oral sex.

On top of using condoms, I encourage people to ensure they’re vaccinated. HPV vaccines weren’t offered in schools until quite recently. Females in grade 8 were offered them in Ontario in 2007, and males in grade 8 weren’t offered HPV vaccines until 2016. So, unless people were on the ball and retroactively went to their doctors to get it, most people aren’t vaccinated for HPV.

Another important thing to know about STIs is that we can do a screen, but it doesn’t mean it’s a 100 per cent clear bill of health. Standard screens don’t include every STI, and some STIs can be easily missed if symptoms aren’t active.

So again, it’s important to take all the precautions you can, and have a conversation with whomever you’re going to be with.

Any final messages for those who are hoping to become more sexually active?

Go have fun, just do it responsibly.

The post Dating and sex during COVID-19: Q&A with Dr. Sharon Domb appeared first on Your Health Matters.

Do depression or anxiety impact the risk of contracting COVID?

There have been several studies looking at this question. One analyzed the electronic health records of 61 million Americans and found there was a dramatically increased risk of contracting COVID for people with the four mental health disorders they included in their analysis: depression, schizophrenia, attention deficit hyperactivity disorder (ADHD) and bipolar disorder. If these conditions were recently diagnosed, people were five to seven times more likely to contract COVID during the early stages of the pandemic.

A second study found people with depression or anxiety had a small increased risk of contracting COVID if diagnosed later in life, and that risk increased for people with both conditions. Also, people with Alzheimer’s dementia appear to have a dramatically increased risk for contracting COVID.

There are several theories around why people with mental illness appear to be more likely to contract COVID. The immune system could be negatively impacted by older age, some mental health conditions and their associated treatments. Mental illness can also affect decision making, making it more difficult to navigate risk exposure.

Do depression or anxiety affect the outcome of infection with COVID?

Yes, it does appear that people who have both depression and anxiety experience worse outcomes from COVID infection. This was the conclusion of one study in particular. We still don’t know the exact reasons why, but there could be some link to the immune system at play. Additional research is needed to shed more light on this question.

Does COVID increase the risk of an episode of depression or anxiety?

One study completed by a Sunnybrook team found that after people had tested positive for COVID, there was an increased incidence of depression, cannabis use, opioid use, alcohol misuse and anxiety.

This study is still underway during the current wave of COVID. Researchers are hoping to determine if the same holds true throughout this stage of the pandemic.

Does having depression or anxiety affect a person’s willingness to receive COVID vaccination?

Part of this Sunnybrook study looked at vaccine readiness. In January 2021, 76 per cent of people in the study were ready to get their vaccines, 15 per cent were hesitant and 7 per cent were resistant.

This study found people were more willing to get vaccinated if they had anxiety and depression. Other factors that led to wanting to get vaccinated included older age and having a higher socioeconomic status.

Have studies shown any silver linings resulting from the pandemic?

This question was also asked as part of the Sunnybrook study referenced earlier. Surprisingly, up to 60 per cent of people identified a silver lining from the pandemic. Specifically, many people said they felt more fortunate, healthy and successful. Those people who felt they were less successful, resilient and fortunate had a much higher incidence of depression and anxiety.

The post The intersection between COVID-19 and mental health appeared first on Your Health Matters.

Pre-pregnancy / Trying to conceive

Will the vaccine impact my fertility?

Dr. Dixon: The information we know is very reassuring. There is no evidence that any of the vaccines affect fertility. I encourage everyone to get their COVID-19 vaccine when they’re eligible. This includes if you’re actively trying to have a baby or even just thinking about having a baby in the future.

I am 39 and am trying to conceive. Will the vaccination decrease my chances?

Dr. Dixon: I’ve been assuring my patients, regardless of their age, that there’s no evidence the vaccine leads to loss of fertility. While fertility was not specifically studied in the clinical trials of the vaccine, no loss of fertility has been reported among trial participants who have received the vaccines since their rollout.

Is it safe to conceive while awaiting the second dose?

Dr. Dixon: It is safe if you become pregnant at any point around your vaccine doses: immediately before or after your first dose, between your first and second doses, or immediately after your second dose. I advise my patients to get vaccinated as soon as they are eligible to ensure they do not become seriously ill from COVID-19.

Timing of vaccination during pregnancy

Is there an ideal time during pregnancy to get vaccinated? First or second or third trimester?

Dr. Ladhani: The best time to get vaccinated is when you become eligible. We know that COVID-19 in pregnancy can increase your risk of being hospitalized and also cause an increased risk of preterm delivery. Statistics suggest between eight and 11 per cent of people who are pregnant who contract COVID-19 will be admitted to hospital, and between two and four per cent will need intensive care. That’s compared to about eight per cent of all COVID-19 patients who have needed hospitalization and about 1.5 per cent who needed intensive care, so pregnancy puts you at higher risk than the general population. A recent study in the American Journal of Obstetrics and Gynecology found those who were pregnant had a strong immune response after vaccination, suggesting strong protection. The study also showed that COVID-19 antibodies were transferred to babies, and we are going to see the effects of this soon. 

I’m in my third trimester. Should I get the vaccine while pregnant or when the baby is born?

Dr. Ladhani: I would advise receiving the vaccine as soon as you can. You’ll be protecting yourself, as well as your baby, once your immune response begins to kick in (usually two weeks after vaccination). Please be sure to receive your second dose at the scheduled time. The antibodies you produce will be passed on to your baby through the umbilical cord and in the breast milk.

Pregnant and patiently waiting. Is it ever too close to the due date to get the vaccine?

Dr. Ladhani: Close to your due date is absolutely fine. You’ll be protecting two people – yourself and your baby – it’s a win-win situation.

Pregnancy & the COVID-19 vaccine

Can antibodies be passed to baby if vaccinated during pregnancy?

Dr. Ladhani: A recent study showed there was immunity transferred to babies via placenta and breast milk. This evidence points to the strength of vaccination, at any stage of pregnancy, and also for those who have delivered their baby and are breastfeeding.

What effects will the vaccine have on my baby?

Dr. Ladhani: The COVID-19 vaccines available for people who are pregnant don’t contain any live virus and do not put you at increased risk for pregnancy loss or harm to your baby. They will not give you or the baby COVID-19, and will not interact with yours or the baby’s DNA. You may develop a fever after you get the vaccine, but this will not harm the baby.

Does vaccination during pregnancy mount less of an immune response compared to non-pregnant?

Dr. Ladhani: In a recent study, COVID-19 mRNA vaccines generated strong immunity in pregnant and breastfeeding people. The immune response was the same as that observed in non-pregnant individuals. Immune responses from being vaccinated were significantly greater than if you had been infected with COVID-19.

Could post-vaccine symptoms be heightened due to pregnancy?

Dr. Ladhani: There’s no indication that if you’re pregnant you will have more severe post-vaccine symptoms. The vaccine can cause fever in some people (around 16 per cent of those vaccinated) and usually takes places following the second dose. The evidence shows there is minimal risk to your or your baby. A few hours after receiving the vaccine, if you have a fever, you can treat it with acetaminophen/Tylenol.

How do we know the vaccine is safe during pregnancy if trials have just started for that group?

Dr. Ladhani: Early clinical trials for the COVID-19 deliberately did not include people who were pregnant. It’s common practice for clinical trials to exclude those who are pregnant, with concerns about fetal development cited. However, we do know that some vaccine study participants became pregnant and to date there have been no adverse effects reported during pregnancy or related to the health of babies. The COVID-19 mRNA vaccines studied in people who were pregnant, breastfeeding and trying to conceive have been found to be safe.

I received the Tdap (Tetanus, Diphtheria, Pertussis) vaccine and Rhogam today. Do I have to wait two weeks to get the COVID vaccine?

Dr. Ladhani: There is no need to wait between vaccines. You can get both vaccines on the same day or within two weeks of each other.

Will the vaccine cause birth defects, miscarriages, or any other fertility or pregnancy complications?

Dr. Ladhani: From the data we have, there is no increased risk for miscarriage, stillbirth or congenital anomalies with the COVID-19 vaccines. I assure patients that there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications. This is based on the millions who have received the vaccines to date and were trying to conceive or were pregnant.

What happens if I get COVID-19 while pregnant?

Dr. Ladhani: If you begin to feel unwell with symptoms of COVID-19, please contact your obstetrician. Most people who are pregnant will have mild-to-moderate illness if they contract COVID-19. Your obstetrician will provide you with support and resources for managing COVID-19.

High-risk pregnancy & the COVID-19 vaccine

Is the vaccine right for me if I have an autoimmune disorder, asthma and recurrent losses?

Dr. Ladhani: Yes, we would recommend that you get the COVID-19 vaccine. Being pregnant and having asthma are both risk factors for moderate to severe illness with COVID-19. People with autoimmune disorders weren’t included in the vaccine trials, and so the effectiveness and safety profiles aren’t known, but NACI and the Canadian Rheumatology Association are recommending that people with autoimmune disorders are offered the vaccine. Given your risk profile, the vaccine may protect you from the severe forms of COVID-19. It may be worth discussing this more with your health-care practitioner.

I’m having a high risk pregnancy. Should I get the vaccine?

Dr. Ladhani: Yes, in most cases people who are pregnant with high or low-risk pregnancies will benefit from receiving the COVID-19 vaccine and being protected from the disease. Please speak with your high-risk obstetrician about the specific details surrounding your pregnancy to determine if you will benefit from the vaccine.

I’m expecting twins. Is it safe to get the vaccine?

Dr. Ladhani: Yes! You’ll protect yourself and potentially protect both of your babies!

I am pregnant after experiencing a pregnancy loss. Should I get the vaccine?

Dr. Ladhani: A pregnancy loss can be devastating, and it’s understandable you may feel anxious being pregnant again. I would recommend receiving the vaccine for additional peace of mind during your pregnancy, especially as contracting COVID-19 during pregnancy can put you at higher risk of hospitalization and preterm delivery. Please remember there is always support available for pregnancy and infant loss through Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network.

Are there complications with heart arrhythmias?

Dr. Ladhani: COVID-19 can be dangerous for those who have an underlying heart condition. Both of the COVID-19 mRNA vaccines were tested in people with heart problems and found to be safe and effective.There is no evidence that the vaccine has worse side effects for people with underlying heart conditions, and having COVID-19 is much riskier than getting the vaccine, so we would recommend you get the vaccine.

Breastfeeding & the COVID-19 vaccine

Is the vaccine safe for both me and my baby while breastfeeding?

Dr. Ladhani: The vaccine is safe for your and for the baby. There is new data showing antibodies for COVID-19 in breast milk after vaccination. So you’re not only protecting yourself against COVID-19 with the vaccine, but also possibly passing along some immunity to your little one. A huge win!

Fertility treatments & the COVID-19 vaccine

Is the vaccine safe when undergoing fertility treatment, like IVF?

Dr. Dixon: I suggest speaking with your fertility specialist who knows your history and care plan, and can answer your questions to help you make an informed decision. Undergoing IVF can be a stressful time and your fertility team is a wonderful resource to help guide you. Your specialist may suggest waiting a few days between some treatment procedures (for example, egg collection in IVF) and vaccination, so that any symptoms, such as fever, might be attributed correctly to the vaccine or the treatment procedure. 

Is it safe to get the vaccine if you have a planned intrauterine insemination (IUI) or embryo transfer?

Dr. Dixon: We may consider postponing the start of assisted reproductive treatments – like IUI, ovarian stimulation and embryo transfer after your first or second vaccination. This allows time for the immune response from the COVID-19 vaccine to settle down – this recommendation is purely to help patients cope with potential side effects IF they occur. Please talk to your fertility specialist if you have any concerns about the timing of your vaccine with upcoming fertility treatments.

I did IVF and I’m still in my first trimester. How long should I wait to get the vaccine?

Dr. Dixon: You should take the vaccine as soon as it is made available to you. Please speak with your provider about the specifics of your case. This is consistent with the most recent fertility practice guidelines.

I got pregnant after my second IVF cycle, I’m on my fifth week. Is it safe to receive the vaccine?

Dr. Dixon: It is safe to receive the vaccine in your first trimester. The data from those women who became pregnant immediately after receiving both of the COVID-19 mRNA vaccines showed no adverse outcomes in the pregnancy and the vaccines have thus been deemed both safe and effective. Further, there is no evidence that the vaccine can cause birth defects, miscarriages or fertility or pregnancy complications.

Read more: Got your COVID-19 vaccine? What you need to know about infection prevention after getting vaccinated

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“Since the onset of the COVID-19 pandemic, Sunnybrook researchers have been quick to rise to the challenge, initiating more than 100 research studies related to COVID-19 that seek to make a substantive impact in better understanding the virus or proposing solutions to the many questions posed by the pandemic,” says Dr. Kullervo Hynynen, PhD, vice-president of research and innovation at Sunnybrook.

These studies were launched thanks in large part to donor support. Close to 11,500 donors from the community stepped up to help Sunnybrook’s COVID-19 response, contributing more than $7-million.

While insights into the virus are still evolving, it appears that although COVID-19 is best known as a respiratory disease, it also has repercussions elsewhere in the body. Here is a look at some of the research projects ongoing at Sunnybrook:

What impact does COVID-19 have on mental health?

Having seen the effects of the pandemic on mental health firsthand, Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program and medical director of the Family Navigation Project (FNP), was spurred to lead a formal study into its wide-ranging impact, with the FNP team.

“I do not think we yet fully understand the tremendous negative, and even positive, impact of the pandemic on the mental health of our society,” Dr. Levitt says. “Our study is designed to explore this and the specific effects of having contracted COVID on mental illness and addiction.”

At the end of the project, around 7,500 Ontarians will have been surveyed over a period of a year and a half. Early findings have revealed that people who have contracted COVID-19 are at a greater risk of having depression, anxiety and substance misuse, compared to those who have not. As well, the data shows that several factors are associated with higher risk of suicidal ideation during the pandemic, including younger age, COVID-19 exposure and reduced socio-economic status.

The study has revealed that greater long-term social support is potentially protective of people experiencing these kinds of challenges, says Dr. Levitt. He hopes the study’s results will assist the province in creating better supports for people experiencing mental health challenges not only from the COVID-19 pandemic, but also for future pandemics.

What is the impact of COVID-19 on the brain?

Neuroscientist Dr. Simon Graham, PhD, is leading a team looking at the longer-term cognitive effects of infection. “The brain effects of COVID-19 are somewhat under-appreciated, and we don’t know the full extent to which they’re occurring,” he says.

Using magnetic resonance imaging (MRI) and behavioural assessments, Dr. Graham’s study has already shown some patients who were on a ventilator before recovering suffered from brain micro-bleeds or mini-hemorrhagic strokes. Some recovered patients have also been found to have evidence of inflammation in the brain.

These discoveries are particularly important given the growing number of “long haulers,” patients who experience lingering problems from the virus like brain fog and poor memory, Dr. Graham adds.

“Even if their persistent symptoms have to do with shortness of breath or abnormal heart rate, those things are actually controlled by the brain, so it could be COVID-19’s impact on the brain is causing those problems, too.”

What is the relationship between COVID-19 and the heart?

Cardiologist Dr. Idan Roifman in the Schulich Heart Research Program at Sunnybrook is leading research examining how COVID-19 may lead to inflammation of the heart muscle or cause damage to the heart similar to a heart attack.

The study is building on considerable research globally showing COVID-19 increases the risk of blood clots.

Using magnetic resonance imaging (MRI), Dr. Roifman’s work seeks to find evidence of heart damage in patients who have recovered from COVID-19 and determine the type of damage that has occurred. The study is also investigating how risk factors like diabetes and high blood pressure may elevate the risk of developing cardiac complications like heart failure.

Already, the research has revealed heart function abnormalities in some patients in recovery. “That alerted us to follow them closely and led to a potential change in their long-term management,” Dr. Roifman says.

Why do COVID-19 symptoms persist in some people?

Sunnybrook’s Dr. Hubert Tsui, head of hematopathology, and clinical microbiologist Dr. Robert Kozak, PhD, are poring over blood tests and nasal swabs from patients with COVID-19 to understand why some individuals become so-called long haulers. “The research literature states as much as 50 per cent of people could have some long-term COVID symptoms,” says Dr. Tsui.

The researchers have been looking at early diagnostics from patients who became long haulers, while comparing them with other patients who have fully recovered to see if they have a different initial immune system response. “Some of our preliminary data is indeed showing that something very early on, even at the diagnostic point, is different – providing a clue in terms of risk to developing long COVID,” he adds.

Understanding the basic science regarding immune response to COVID-19 could lead to identifying patients who are likely to experience long-term problems early on, Dr. Kozak notes. Research could even lead to therapeutics to prevent and treat long-hauler symptoms.

“The more we can help people now, the more they will benefit down the road,” he says.

The post Sunnybrook community steps up to support critical COVID-19 research appeared first on Your Health Matters.

Dr. Peggy Richter, psychiatrist and head of Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, talks about the pandemic’s impact on OCD and what we can do to help those who may be struggling.

How has the pandemic impacted people with OCD?

For people who already have OCD, the pandemic has had very mixed effects. There are some people who, of course, are made much more anxious by it. But there are also many who say the pandemic has made things easier.

For example, during COVID, recommended public health measures have included limiting contact with items, cleaning surfaces, using sanitizer and having more frequent hand washes. For people who would call themselves “germaphobes” or who have contamination as the focus of their OCD, these actions actually reduce their anxiety. Before COVID, these individuals might have found themselves feeling anxious going into supermarkets. Now, they know that in some stores, carts have been wiped off before every use, and if they’re concerned, they can take their own wipes with them, clean their cart, and nobody notices.

Contrarily, for individuals whose OCD focuses on illness anxiety, the pandemic has been very difficult because they are ordinarily preoccupied with potentially developing a medical illness or problem. This means they are highly vigilant around any risks in their environment and are very concerned that sensations that don’t necessarily mean COVID could be COVID. I am seeing individuals in that population struggle.

Another group that may be having a hard time are those who need orderliness and things precisely in position. If you’re in a home that’s gone from people coming in and out at the start of the day to now everybody spending more time in the home, working or doing school remotely, there is a lot more chaos, which can be very difficult.

OCD is an illness that affects individuals in different ways.

Has the pandemic caused more people to develop OCD?

Though I haven’t seen the data to back it up, anecdotally, mental health colleagues in the community feel they are seeing a lot more OCD. My colleagues in child and adolescent mental health, especially, have expressed they are seeing more cases of new-onset OCD compared to past years.

OCD does very much seem to occur on a spectrum of severity, so the pandemic may also be leading to obsessions or compulsions for many that are milder than required to make a formal diagnosis, while nonetheless causing some degree of distress.

How will easing restrictions impact people with OCD or those who are experiencing symptoms?

In the case of anxiety disorders, avoidance can make symptoms worse. With the pandemic, that avoidance has been mandated, which may have felt better in the short-term, but will make re-entering the wider world that much harder.

In fact, one of our best first-line treatments for all anxiety disorders is a form of treatment called cognitive behavioural therapy (CBT), in which people are encouraged to systematically confront their fears by triggering them.

With OCD, many people have been avoiding a lot of the situations that normally would trigger them. For example, for someone whose OCD would ordinarily compel them to check the doors, lights and appliances when they leave the house, lockdown and working from home may have made things easier. However, going out to work and socialize will now trigger them like before, and may feel even harder as they have not had to challenge this fear for a while.

Returning to these triggers that have been avoided, it’s going to be hard.

When should someone seek help?

The simple answer, for any psychiatric or psychological problem, is for someone to seek help when it causes distress or when it begins to interfere with their ability to function. If it’s getting in the way of their relationships, causing problems in their work environment or in their functioning at home, that’s a clear indicator that maybe it’s worth talking to a professional.

The core features of OCD are the presence of obsessions or intrusive, recurrent anxiety-provoking thoughts and urges, as well as compulsions, which are repetitive acts the person does in response to obsessions. When these symptoms cause significant distress, impaired functioning or waste an hour or more of the day, it is considered severe enough to make the diagnosis. With that said and as mentioned before, OCD does very much seem to occur on a spectrum of severity. So, if someone is unsure if they meet the criteria for an OCD diagnosis but are still having a hard time, they shouldn’t hesitate to get help.

How can I help my loved one who’s struggling with OCD or OCD-like symptoms?

If someone you know is struggling, be supportive and non-judgemental. Just being there for someone and letting them know that you care is incredibly helpful for most people.

You can also encourage them to seek professional help. Seeing their family doctor is often a very good place to start, as they can help them find effective treatments for OCD, including drug therapy and CBT. In general, most people will greatly improve with treatment.

Also, one thing that’s happened because of the pandemic is a mushrooming of resources online, so it is much easier than in the past to find great online educational material, to find online therapy and to find support groups.

Further, help your loved ones have hope. This is a tough time, but they are not alone, help is available, and things can get better.

Resources for OCD:
OCD information and resources
OCD handbook
Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre

The post COVID-19 and its impact on obsessive-compulsive disorder appeared first on Your Health Matters.

Why did you look at this issue?

Dr. Wijeysundera: During the first wave of the COVID-19 pandemic, we kept hearing stories from patients and other doctors that there were delays in care for patients with heart disease. We decided to look deeper at the Ontario data that tracks waitlists and wait times for people living with heart disease who require a procedure or surgery.

What did you find?

Dr. Wijeysundera: The data was distressing – we learned that there was a significant decline in referrals and procedures in Ontario for common heart interventions after the pandemic started. Patients waiting for coronary bypass surgery or stenting were at a higher risk of dying while waiting for their procedure compared to before the pandemic. We found this to be consistent across patients with stable coronary artery disease, acute coronary syndrome and emergency referral.

Can you explain why this happened?

Dr. Wijeysundera: We are very interested in the “why” behind referrals decreasing so dramatically. We believe there are a number of reasons, some of which are patient factors such as fear of contracting COVID-19 in the hospital, or worries about missing work or family commitments. We suspect there are also system factors at play, such as delays in testing for heart conditions, as well as hospital bed and staffing pressures.

What is your advice for people who are noticing a change in their health?

Dr. Wijeysundera: Our biggest fear is that people are ignoring symptoms like chest tightness, or feeling lightheaded or short of breath, and not seeking care as they’re worried about placing burden on the health-care system. Or they may be afraid of contracting COVID-19 if they come to the hospital.

Hospitals are safe places to be – over a year and half into the pandemic, we have learned so much and know how to protect and care for you. Even if you feel like it’s not an emergency, please let us assess you. Yes, this may be virtually at first, but if we need to see you in person, we’ll make sure it’s done safely.

Where should patients start if they’re feeling new symptoms?

Dr. Wijeysundera: Your family doctor is always a good place, or your heart specialist if you’re already seeing one. Heart disease and stroke are time-sensitive conditions. We are committed to getting you the care you need, when you need it.

The post Noticing changes in your health? Don’t delay seeking care appeared first on Your Health Matters.

In April 2021, The New York Times reported that 8 per cent of Americans missed their second dose appointment, according to the Centre for Disease Control. The report outlines several reasons behind the no-shows, including a fear of possible side effects, overconfidence in the first shot, and a lack of supply for certain brands of the vaccine.

After a slow start, Canada has officially surpassed the United States in vaccination rates for residents who are fully vaccinated. However, despite the promising increase, Dr. Rob Kozak, clinical microbiologist and scientist at Sunnybrook says we must remain diligent.

“The worst thing that could happen would be for Canadians to refuse or delay getting vaccinated. This will lead to it taking longer to get population level immunity,” he says.

Dr. Kozak offers insight on common concerns surrounding second doses, and why getting fully vaccinated is the best way to protect yourself and the people you love.

Improvement of overall efficacy

“There are so many reasons to get both doses,” Dr. Kozak says. “The second dose of the vaccine is important for building immune memory, and robust antibody and T-cell response against the variants.”

Having both doses of the vaccine also increases overall efficacy, meaning your chance of having an infection is reduced, Dr. Kozak adds.

Furthermore, he says, if you do get infected with the virus, you are more likely to have a milder case, and less likely to spread it to those close to you when you are fully vaccinated.

Increased protection against variants

“There is data coming out that is showing that one dose provides much more limited protection against variants,” Dr. Kozak says.

As the contagious Delta variant continues to increase in prevalence across Canada, you can put yourself at risk by not getting the second dose.

“Plus, we will likely see more variants emerging in the future, and so far all our data is showing that 2 doses is more protective against variants than a single dose,” he says.

Necessary to achieve herd immunity

Herd immunity occurs when enough people have a protective immune response against the virus that will prevent them from getting very sick and reduces the chance of the virus spreading to others. In order to achieve herd immunity, Dr. Kozak says viruses needs a susceptible host to replicate and spread to others.

However, he notes that we cannot solely rely on others around us to be have their shots. In order to protect those who are more vulnerable to infections, we must also ensure we are doing our part.

“It is important to remember that the vaccine will not work perfectly in everyone. For example people who are immunocompromised may not be as well protected if they are vaccinated, and they are relying on all of us to get our shots to help keep them protected,” he says.

By continuing to increase the vaccination rate, we can all contribute to a healthier future. Of this, Dr. Kozak remains optimistic.

“This pandemic has been hard on everyone, but now we can see an end in sight.”

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“It was really, really, really great,” says Richard with lit up eyes, thinking about his first “close-contact” visit with Stephanie, which took place following her vaccination. This meant that Richard was finally able to hug his daughter after months of less frequent, distanced visits. Of that first hug, he says, “It was really magnificent. It was awesome.”

Preventing the spread of COVID-19 in Sunnybrook’s Veterans Centre

These changes to visitation were much anticipated for Richard and the rest of the Veterans Centre residents, as throughout the pandemic, provincial visitation guidelines have been changing regularly and were even put on pause to prevent the spread of COVID-19.

“It’s a little tiresome,” says Richard of the restrictions. But he adds, “We’re military. We’re used to working with changing orders on the fly. But it’s to our benefit. They’re only trying to stop the spread.”

“Understandably, restrictions are a big disruption to the Veterans,” says Lisa Cheung, the infection prevention and control coordinator for the Veterans Centre. “But I think everyone’s on the same page, understanding the high community prevalence and that these evidence-based measures will prevent the transmission.”

Lisa adds that despite many residents being fully vaccinated, with variants emerging in the community, easing the restrictions has had to be done very cautiously.

Using technology to stay connected

During those times when Richard wasn’t able to visit his family in person, the 92-year-old went virtual.

“I learned to use an iPad right here in Sunnybrook,” he says. On top of learning to use an iPad, Richard also learned how to use Zoom.

“We Zoom, my family. Right across Canada every Sunday for two hours,” he says. “It’s not quite the same; you can’t touch or anything like that. But we do all kinds of crazy things.”

Online, Richard and family from Nova Scotia to British Columbia have celebrated birthdays together, danced to music on New Year’s Eve and even played bingo.

“My son in Halifax won the $150,” he says of his family’s latest Zoom bingo session. Laughing, he adds, “I won a single line, $15.”

Richard recommends the other Veterans learn Zoom if they can, as it’s really allowed him to stay connected with family throughout this difficult time.

And while that technology’s been great, Richard is so happy that in-person visits are continuing to ramp up, with daily room visits and day/night passes now being permitted. He calls these changes an “enormous morale booster,” which enhance his already positive experience of being a Sunnybrook resident.

“We are grateful to the Canadian people who have provided us with a wonderful home and a lifestyle second to none,” he says. “We’re over 300 of the most privileged people in Canada. We’re looked after every way, every day. Can’t be any better than that.”

The post ‘First hugs’ and maintaining connections during COVID-19 at Sunnybrook’s Veterans Centre appeared first on Your Health Matters.

Dr. Matthew Burke, a cognitive neurologist and associate scientist at Sunnybrook and assistant professor at the Temerty Faculty of Medicine at the University of Toronto, shines a light on the neuropsychiatry of long COVID in a recently published commentary in The Lancet Infectious Diseases.

As a strong advocate for the border-zones between neurology and psychiatry and complex brain-body interactions, Dr. Burke says highlighting long COVID is an opportunity to better understand and research chronic unexplained medical symptoms.

What symptoms do COVID long haulers experience?

Dr. Burke: Symptoms of long COVID can include fatigue, difficulty concentrating, mood disruptions, headaches, sleep disturbances, dizziness, shortness of breath and a variety of other neurologic and physical symptoms. Some patients have described “brain fog,” a non-medical term that has been used during the pandemic when patients feel sluggish or are not able to think clearly. These symptoms are being reported by patients even with mild COVID-19 that did not require hospitalization or medical attention, sometimes long after they test negative for COVID-19. Unfortunately, for most of these symptoms, currently there are no objective findings or test results to aid in the diagnosis, which can be challenging for both patients and health-care providers.

What might explain these lingering symptoms?

Dr. Burke: There are two general possibilities that researchers are currently exploring. The first is that COVID-19 may trigger post-infectious processes that generate persisting symptoms in a unique way that we haven’t encountered before. While we generally like to have simple and unifying explanations in medicine, there have been unique aspects of COVID-19’s interaction with the brain and body and further research is needed to evaluate this possibility.

Alternatively, COVID-19 long-haulers may fit into the category of mysterious “unexplained” chronic symptoms (post-infection or not) and could operate via similar mechanisms. This group of patients already represented a relatively large segment of medicine (pre-pandemic) and proposed mechanisms to explain symptoms in this field is very controversial. At one end of this debate, there are purely “physiological” theories, and on the other end purely “psychological.” However, recent neuropsychiatry models suggest that there is not always a clear-cut explanation, that it is likely a more complex spectrum. For example, pre-existing genetic and psychosocial factors may result in dysfunction of brain or brain–body circuits that then interact with a potential triggering event (ie. infection). It is also critical to understand that there may be different sub-groups of patients with prolonged symptoms after COVID-19 with differing mechanisms between groups.

The most important thing we can do right now is continue to study long COVID without assumptions to better understand why these symptoms are being triggered.

Are these symptoms unique to COVID-19?

Dr. Burke: The clusters of symptoms reported by long-haulers are not unique or specific to long COVID and are common in many of the patients I see with medically unexplained symptoms or functional disorders. Some patients will similarly experience symptoms after an infection like COVID-19, while others report other potential triggers (such as a relatively mild injury) and for some, there are no identifiable triggers at all.

Unfortunately, this segment has been a blind spot for medicine and inadequate management and care pathways often leads to patients seeking multiple secondary opinions and unnecessary investigations, leaving them frustrated and putting strain on health-care resources.

What should patients do if they are experiencing symptoms of long COVID?

Dr. Burke: Talk to your health-care team about the symptoms you’re experiencing and how they can best be managed. It’s important for health-care professionals to listen and validate patients’ experiences, even when diagnostic testing may not reveal any abnormalities.

COVID-19 is still a new disease and we’re learning more about its impact on the body each day. Similarly, the brain is complicated and these disorders could be linked to some of the most poorly understood parts of it. It will take some time before we fully understand long COVID, but I’m hopeful that continued research will provide valuable new insights for this broader field and help patients who are searching for answers.

Read the commentary in The Lancet Infectious Diseases

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