Copeman Healthcare Centre • Winter 2018

Does your weight on the scale really matter? An InBody assessment could reveal the answerHave you ever wondered exactly how to assess your body composition – or why that might be important? InBody is here to help. PAGE 6

New vaccine significantly improves shingles protectionShingrix - the new shingles vaccine - has been shown to offer significantly improved protec-tion against shingles. Read more to find out if the vaccine could be of benefit to you. PAGE 2

Here’s why your Kegel exercises might not work as well as you thought they wouldPelvic floor functionality is something many women don’t think about – but perhaps more women should. PAGE 3

New glucose monitoring system hailed as a game-changer for diabetes managementFinger pricking is a thing of the past with this innovative technology. PAGE 4-5

Celebrating six years in your community, on Clyde Avenue!Copeman Healthcare is a private, primary care facility with a strong

focus on prevention and early detection. After thirteen years we are happy to say we are still growing strong in Western Canada.

As a valued member of our West Vancouver community – please enjoy this complimentary issue of Copeman Healthcare’s quarterly client Health Letter. In this edition, you’ll find a wide variety of articles written by our clinical team on the theme of innovation. Determined to be at the forefront of medicine, our team has found several new technologies and treatments for our clinics, many of which are shared in this issue.

The health letter is available each quarter by email or in our clinics. In it you will find perspectives from physi-cians, dietitians, kinesiologists (exercise specialists), neuropsychologists, and family health nurses.

If you like what you read, please sign up for the electronic version of future newsletters by visiting www.copemanhealthcare.com/wvan-health

Wishing you the best of health,The Copeman Healthcare Team

SPECIAL FEATURE

INNOVATION EDITION

THE

WESTVANCOUVER

2

MEDICAL MESSAGE WITH AMRA DIZDAREVIC, FAMILY HEALTH NURSE PRACTITIONER

New vaccine significantly improves shingles protectionShingles, also known as “herpes zoster,” is a viral disease character-ized by a painful skin rash and blisters. Nearly one in three Canadians will develop shingles at some point, and more than 130,000 diagnoses are made each year in Canada.

Luckily, a new vaccine called Shingrix has been shown to offer significantly improved protection against shingles. Before we examine how, let’s first look at the causes, symptoms, risk factors and treatment options for shingles.

Causes of shingles

Shingles is caused by the varicella-zoster virus, the same virus that causes chicken-pox. After we contract chickenpox, the virus retreats into the cells of our nervous system. There, it can remain dormant and reside undetect-ed in the body for decades. Years later, however, the varicella-zoster virus can be triggered and cause shingles.

Clinicians are often asked if shingles is contagious. The answer is no – it is not possible to catch shingles from another person who has shingles. However, individuals who have never had chickenpox (or the chickenpox vaccine) can develop chickenpox after direct (skin-to-skin) contact with a shingles blister, or by inhaling the airborne varicella-zoster virus. For example, if a grandparent has shingles, they have the ability to pass on the virus to grandchildren who have never con-tracted chickenpox or been vaccinated against it.

Signs, symptoms & treatment The first sign of shingles is an unusual sensation on the skin. You may experience itching, burning, pain or tingling on an area of your body. Within one to two days, a painful rash with blisters appears; within three to four days, the blisters can progress into open sores or ulcers. The rash usually scabs over within seven to 10 days and disappears altogether after three to four weeks. Scarring and skin discoloration may persist long after the shingles have resolved.

Treatment of shingles usually includes a combination of pain-relieving and antiviral medications. Antiviral medications stop the virus from multiplying, accelerate healing of skin lesions and reduce both the severity and duration of pain.

ComplicationsIn most individuals, shingles runs its course without resulting in any lasting health problems. However, in some individuals, complications can occur.

About one in five people with shingles will develop post-herpetic neuralgia (PHN). People with PHN continue feeling pain or discomfort, even after their rash disappears. This can last for months – or even years – and can lead to other complications such as sleep loss, weight loss and depression.

Other rare complications of shingles include pneumonia, loss of hearing or vision (if the rash is near the ear or eye), skin

infections, scarring, inflammation of the brain and, in extreme cases, death.

The Shingrix vaccine

As alluded to earlier, the misery of shingles is largely preventable by vaccination. The new vaccine — Shingrix — has been shown to reduce the risk of shingles by more than 90 per cent.

The Shingrix vaccine, which is now available in Canada, has demonstrated

advancements in both the effectiveness of prevention and the duration of time that

protection lasts. It represents a significant improvement over Zostavax, a moderately

effective shingles vaccine.

SHINGLES VACCINE COMPARISON: Shingrix vs. Zostavax

Shingrix Zostavax

Efficacy for prevention of shingles

>90% 52%

Efficacy for prevention of PHN

88% 67%

Duration of protection

4 years (possibly up to 9 years)

7 years maximum

Vaccine type Inactivated vaccine

Live attenuated vaccine

Number of doses 2 (2-6 months apart)

1

Possible side effects

Most commonly: soreness, redness and swelling

Most commonly: soreness, redness and swelling

Who should consider getting the Shingrix vaccine?Shingles can affect people of all ages but is most commonly seen in individuals above the age of 50 or in those with immune systems weakened by medication or disease.

If you’re over 50 years of age, have had a previous outbreak of shingles or have any further questions about shingles, please contact your Copeman Healthcare physician, nurse or nurse practitioner to learn more about the Shingrix vaccine.

Amra Dizdarevic is a Family Health Nurse Practitioner at the Copeman Healthcare Centre in Vancouver. Her primary areas of interest include infant, child & youth care and travel medicine.

3

FITNESS FORUM WITH LAURA SAWLER, PHYSIOTHERAPIST & PELVIC HEALTH SPECIALIST

Here’s why your Kegel exercises might not work as well as you thought they wouldPelvic floor functionality is something many women don’t think about – but perhaps more women should.

One in three women will experience urinary leakage or incontinence at some point in their lifetime. We’ll call that the bad news. The good news is that 80 per cent of pelvic floor dys-function cases can be significantly improved through physiotherapy.

Most people hear “pelvic floor physiotherapy” and automatically assume it refers to Kegels –popular strengthening exercises for the pelvic floor muscles. The truth, however, is that pelvic floor physiotherapy encompasses so much more than just Kegels. In addition to evaluat-ing and establishing the correct method for performing Kegels, pelvic floor physiotherapy is also designed to help treat many serious symptoms of pelvic floor dysfunction.

About pelvic floor dysfunction

The pelvic floor is composed of soft tissue, including muscles, ligaments, tendons and nerves. These structures play a critical role in sustaining proper functionality in terms of stability, organ support, continence, breathing and sexual function. Any type of irritation to the pelvic floor can impede these roles.

Here are three other facts about pelvic floor dysfunction:

1. Almost 80 per cent of lower back pain is directly related to pelvic floor dysfunction

2. At least 30 per cent of women attempting Kegel exercises are performing them incorrectly

3. Up to 50 per cent of women will experience a minor prolapse (a condition where the walls of the vagina push outward) after a vaginal delivery

To Kegel or not to Kegel?

Kegel exercises are not for everyone. Unfortu-nately, as stated above, many who do Kegels often aren’t performing them properly.

Unlike muscles on the outside of your body, you cannot visibly evaluate your pelvic floor muscles. That means you can’t determine on

your own whether your pelvic muscles are overdeveloped and overactive or underde-veloped and underactive. Both scenarios can ultimately lead to pelvic floor dysfunction, and you may not realize you have a problem until other symptoms are present.

Symptoms of pelvic floor dysfunction:

• Unexplained lower back pain

• Unexplained pain in the regions of your pelvis, hips or genitals

• Frequent urination, incontinence or incomplete bladder emptying

• Pain during, or after, intercourse

• Constipation or straining bowel movements

Pelvic floor physiotherapy

Pelvic floor physiotherapy assesses the state of your pelvic muscles and determines whether you are hypotonic or hypertonic. Hypotonic muscles are weak, demonstrate decreased tension and can contribute to in-continence and pelvic organ prolapse. Hyper-tonic muscles are overactive, tense and are responsible for contributing to incontinence, pelvic pain, constipation and difficulties with sexual intercourse.

Your personal lifestyle, physical activity level and stress level can each play a role in the de-velopment of pelvic floor muscle dysfunction. However, the singular most common cause is natal-related – affecting women during pregnancy, labour and delivery. It’s important to note that simply being pregnant actually increases the risk of pelvic floor dysfunction, and that women who deliver by c-section can also develop pelvic floor problems.

If you are pregnant, your Copeman Health-care physiotherapist or kinesiologist can teach you some safe, preventative pelvic floor exercises, as well as introduce you to effective techniques for potentially making your delivery easier. If you have recently given birth, scheduling a pelvic floor physiother-apy exam is recommended to ensure your muscles and ligaments have healed properly.

The final verdict

So what’s the answer to the question of “to Kegel, or not to Kegel?” It all depends on your personal circumstances.

Just like all muscles in the body, pelvic floor muscles require appropriate exercise. Phys-iotherapist's can provide you with an exercise prescription that’s designed to suit your unique needs and goals. Of course, the best time to see your pelvic floor physiotherapist is actually before symptoms are present. Prevention is key!

Laura Sawler is a physiotherapist at the Cope-man Healthcare Centre in Calgary. Laura is pas-sionate about pelvic health with a focus on re-lieving pelvic pain, incontinence and prolapse.

If you would like to learn more about pelvic floor physiotherapy, or wish to schedule a consultation, please contact your Copeman physiotherapy or kinesiology team today.

4

LIVE WELL WITH JENNIFER ROGERS, REGISTERED DIETITIAN AND CERTIFIED DIABETES EDUCATOR

New system says goodbye to finger pricking for diabetes management

For anyone living with diabetes, “finger pricking” is an all-too-familiar term.

Until recently, the only way to determine your blood glucose level was to prick your finger and measure a small sample of blood. However, with the FreeStyle Libre flash glucose monitor from Abbott Diabetes Care, Canadians with diabetes now have a more convenient – and less painful – way to obtain their blood glucose reading.

No more finger pricking!

Finger pricking is dreaded by many diabetics; both painful and annoying, it also poses a risk of infection.

With the advent of the FreeStyle Libre, however, finger pricking has become a thing of the past. The Libre is the very first glucose monitoring device available in Canada that doesn’t require its users to use a finger-stick – not even for calibration.

Not only does the Libre measure your current blood sugar level, but it can also illustrate trends in your glucose levels, making it simple to identify potential areas of concern. The device can also store up to eight hours of blood sugar activity so you can easily obtain an overnight reading when you wake. These enhanced capabilities enable you to check

your glucose measurements – including current levels and trend directions – and create a complete snapshot that’s essential for effective diabetes management.

A competitive edge for high performance athletes

The benefits of the FreeStyle Libre aren’t limited to Canadians living with diabetes. The device also offers potential rewards to those experiencing reactive hypoglycaemia or pre-diabetes, and even for endurance athletes looking to optimize their performance.

Maintaining stable blood sugar levels is important for sustaining your energy level and stamina over extended periods of time. With the Libre device, high performance athletes can more effectively monitor their nutrition during activity and avoid blood sugar crashes that can result in fatigue, cramping and dehydration.

How does it work?

The FreeStyle Libre system consists of a small sensor, roughly the size of a quarter, that is worn on the back of the arm for a period of up to 14 days. Similar to a continuous glucose monitor, it measures glucose data minute by minute. Using a special reader, users scan the

patch with near-field communication (NFC) technology to get a glucose reading quickly, painlessly and as frequently as desired.

The Libre sensor can even read glucose levels through clothing, making testing even more convenient and discreet.

How can I try the FreeStyle Libre?

If you’d like to learn more about the new FreeStyle Libre flash glucose monitor, or you’d like to try the device for yourself, speak to your physician. You can also connect with the Copeman team of diabetes profession-als, who have extensive training with this new device. You can receive hands-on training and detailed follow-ups on how to interpret its reports and better manage your blood sugar levels.

The FreeStyle Libre website also provides excellent information and instructional videos on how to apply and download reader data. (www.myfreestyle.ca)

Jennifer is a Registered Dietitian at the Cope-man Healthcare Centre in Vancouver. She is a Certified Diabetes Educator, Insulin Pump Trainer, and member of the Canadian Obesity Network.

5

COPEMAN REVIEW WITH DANA FILKOW, KINESIOLOGIST

FreeStyle Libre – A game-changer for diabetes management

I was 11 years old when I was diagnosed with type 1 diabetes. It was a day I’ll never forget, because it was the day I started having to inject myself with needles and prick my fingers six times a day to test my blood sugar levels.

I’m now approaching my 21st year with diabetes. If you do the math, that’s approximately 46,000 finger pricks – six times per day, every single day – since my initial diagnosis.

For me, finger pricking was never really a huge issue. The bigger issue was the constant fluctuation in my blood sugar level, and never knowing if I was in for a low blood sugar episode or a spike. Having diabetes can feel like you’re always playing catch-up, as you try to balance your teetering blood sugar with insulin in order to minimize any potential long-term complications.

Then along came Libre

I was first introduced to the new FreeStyle Libre glucose monitoring system in October 2017. For me, it was truly a game-changer. Not only do I no longer have to prick my fingers, but the daily struggle to keep my blood sugar within a safe range has been virtually eliminated.

The FreeStyle Libre reads and stores all of my blood sugar data, and it even shows blood sugar trends. Whereas finger pricking only provided a snapshot of my blood sugar at any given moment, Libre shows me my current blood sugar level, what levels I was at previously and the direction my sugar levels are currently trending. For the first time since I was 11, I can finally get ahead of my blood sugar levels, correct-ing dips or spikes before they occur. It also means I hardly ever have to worry about reaching dangerous levels.

Adjusting my insulin has become much easier, and I’ve been rewarded with an improvement in my A1C (average blood glucose level) within only six weeks. Personally, I've never had such consistently normal blood sugar levels, and the effect on my overall well-being has been dramatic.

As for the FreeStyle Libre sensor itself, it’s small, unobtrusive and can hardly be felt while I’m wearing it. I’ve also found the adhesive to be excellent; in fact, I’ve sometimes had a hard time getting them off they stick so well! The sensors are waterproof, sweat-resistant and incred-ibly durable, and they hold up well in both hot and cold conditions.

The Libre has significantly improved my quality of life and has virtually freed me from the daily struggles of diabetes management. For as long as I have access to it, I will certainly be using it!

Dana Filkow is a Kinesiologist at the Copeman Healthcare Centre in Cal-gary. She is a graduate of the University of Calgary’s Kinesiology program and is also certified as an ACSM Clinical Exercise Physiologist. Dana has a strong interest in juvenile diabetes research.

If you have any questions about your diabetes management or the FreeStyle Libre system, please talk to your Copeman Healthcare physician, family health nurse or certified diabetes educators.

6

PHYSICAL HEALTH WITH NADINE SINNEN, KINESIOLOGIST & BRITTANY GADZOSA, KINESIOLOGIST

Does your weight on the scale really matter? An InBody assessment could reveal the answer

Have you ever wondered exactly how to assess your body composi-tion – or why that might be important? What about learning how much fat or muscle your body is storing or finding out if your body’s water balance is normal?

If you’ve never wondered about any of these things, maybe it’s time you did. They’re actually key indicators of your overall health. Deter-mining body composition is an important concern for many athletes, models and bodybuilders – but we should all take an interest.

This is where InBody, a new body composition machine, comes into play. InBody is an innovative new technology that uses bio-electrical impedance (electric currents) to assess three distinct aspects of your body composition:

• Fat mass

• Lean body mass (muscle)

• Intra/extracellular water (water balance)

Why get an InBody composition test?

At Copeman Healthcare, we understand that attaining your health and fitness goals is important to you. To ensure you’re set up for success, we recommend you obtain accurate baseline measurements and then closely monitor your progress. The InBody machine does precisely that – it provides you with a highly detailed report of your body com-position, which you can then use to customize a health program.

Your weight as shown on a regular bathroom scale does not always reflect the effects of exercise or diet accurately. If you modify your exercise program or diet, for example, it’s often difficult to determine if changes in weight are due to losses or gains in fat or muscle mass. InBody quickly reveals the answer.

Your InBody report provides you with key insights into your body’s unique compositional strengths and weaknesses. This data can then be used to develop a custom exercise program that addresses your specific needs, enabling you to accelerate your progress and more easily achieve your health goals.

The InBody machine is also an instrumental tool for designing sophis-ticated rehabilitation programs for those recovering from injury. An InBody test targets and analyzes the location of muscle mass within the body, revealing any imbalances that may have resulted from injury or surgery. This unique insight gives your kinesiologist all of the data required to develop a tailor-made strengthening program to expedite your recovery.

Finally, InBody measures your levels of intracellular water (within your cells) and extracellular water (outside of your cells). Why is this so important? Because water balance plays an essential role in main-taining the vital functions that support overall health. The InBody test assesses your hydration levels, allowing you to address any imbal-ances and achieve optimal hydration.

The InBody test

The InBody test is completely non-invasive and pain-free. It uses elec-trical currents distributed through your hands and feet to measure the composition of the entire surface of your body. Simply stand on the machine and hold its handles, and InBody will provide you with a comprehensive body composition analysis in less than a minute.

Ranking as the world’s leader in body composition analysis technology, the InBody machine is soon to become one of the keys to developing perfectly customized health plans for each unique individual.

Nadine Sinnen is an Exercise Physiologist at the Copeman Healthcare Centre in Vancouver and Brittany Gadzosa is an Exercise Physiologist at the Copeman Healthcare Centre in Calgary.

Want to learn more about your body composition?The InBody test is now available at all Copeman Healthcare Centre locations. If you’d like more information, or you’d like to try it for yourself, contact your Copeman Healthcare physician or kinesiologist today.

7

INNOVATIVE SERVICES WITH DR. NATHAN THAKUR, FAMILY PHYSICIAN & MEDICAL DIRECTOR

PRP therapy – A new treatment for joint and tendon injuriesPlatelet rich plasma (PRP) is an all-natural form of therapy that helps speed healing of chronic injuries by harnessing your body’s innate regenerative capacity.

PRP is the first iteration of treatment in the emerging field of regenerative medicine. Previously considered experimental, PRP now boasts high-grade medical evidence to support its usage as a treatment for a wide range of joint and muscle ailments. This inno-vative new therapy involves using your body’s own blood platelets to promote the healing of chronic joint, tendon and muscle injuries – problems that were previously treatable only with rest and ice.

Made famous by pro golfer Tiger Woods, PRP is rapidly becoming a popular choice for elite athletes seeking treatment for osteo-arthritis, tendonitis and other muscle and tendon injuries.

How does PRP work?

The function of platelets in the bloodstream is to recruit and stimulate growth factors to the site of tissue injury and release signaling molecules that facilitate tissue repair.

By injecting plasma containing concen-trated platelets from your own bloodstream directly to the site of your injury, a cascading healing reaction is triggered. What’s more, this healing is effective even in areas of the body that do not normally receive adequate blood flow, such as the interior of your joints and tendons.

To ensure their accuracy, PRP injections are performed under an ultrasound; this way, the platelet-rich plasma can be guided directly to the site of tissue injury. Most patients find the procedure to be relatively painless, and the entire treatment takes about an hour.

Benefits of PRP

The healing effects of PRP have been proven to outlast those of many conventional therapies, such as cortisone or hyaluronic acid injections. An additional benefit of this all-natural treatment is that it doesn’t just

relieve pain; it actually helps to heal the un-derlying issue, with noticeable benefits within six months. Platelet rich plasma has no known negative side effects, and its healing benefits can be amplified with additional treatments, although they’re not necessarily required.

Clinical studies have shown that PRP generates significant improvements in sta-tistical and clinical outcomes, including pain, physical function and stiffness, in particular around the knee.1 Some studies indicate that improvements can occur within six weeks of the first injection.

Is PRP right for me?

A PRP treatment could be right for you if you’re experiencing:

• Mild to moderate osteoarthritis (in most joints, but especially the knees, hips or shoulders)

• Lateral and medial epicondylitis (tennis and golfer's elbow)

• Rotator cuff tendonitis or partial tears

• One of many other common tendon, muscle and ligament issues

Despite its growing popularity, not all PRP therapy is created equally. Studies have indicated that higher concentrations of PRP stimulate more efficient healing – and only a qualified specialist, using state-of-the-art medical equipment, can ensure this.

1. Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review, Arthroscopy. 2016 Mar;32(3):495-505.

Dr. Nathan Thakur is a General Practice Physician at the Copeman Healthcare Centre in Calgary. He holds a firm belief in preventative health and empowering patients to reach healthy outcomes. Dr. Thakur has a particular focus on Sports Medicine and Regenerative Medicine.

A consultation with your Copeman Healthcare physician will help you determine whether a PRP treatment is a good option for you. Platelet rich plasma therapy is currently available through physicians at our Calgary clinic, and physicians at our Vancouver clinic are slated to undergo PRP training in 2018.

ANNOUNCEMENTS

CALGARY 4th Floor, 628 12 Ave SW

Calgary, AB, T2R 0H6 403-270-CARE (2273)

EDMONTON Suite 700, 10216 124 St. Edmonton, AB, T5N 4A3

780-455-CARE (2273)

VANCOUVER Suite 300, 808 Nelson St. Vancouver, BC, V6Z 2H2

604-707-CARE (2273)

WEST VANCOUVER Suite 200, 545 Clyde Avenue West Vancouver, BC, V7T 1C5

604-669-CARE (2273)

www.copemanhealthcare.com

30th Annual Christmas Wish BreakfastThe Copeman Healthcare team in Vancouver continued its support of the Pan Pacific Hotel's Annual Christmas Wish Breakfast over the holidays. At this year's event over 22 tonnes of toys were collected.

Doctors Without BordersThe Copeman Healthcare team in Vancouver has been sporting their best denim every Friday to help raise funds for Doctors Without Borders, best known for its projects in war-torn regions and developing countries affected by endemic diseases.

CALGARY Welcomes Senior Director, Clinical Operations - Alberta, James Foster, Registered Dietitian Jessica Begg and Client Service Coordinator Degi Choijilsuren

EDMONTON Welcomes Kinesiologist Ashley Harden

VANCOUVER Welcomes Kinesiologist Hayley Kaczanowski, Registered Dietitian Gordon Ly, Nurse Practitioner Clea Bland and Client Service Coodinator Nicole Radusin

COMMUNITY INVOLVEMENT

Stay tuned for new and exciting services from our nutrition department!

Ask your dietitian for more details

Copeman dietitians!FROM YOUR

Coming this spring

Cooking classesLearn new skills and delicious

recipes with group sessions that focus on nourishing, balanced

foods while receiving dieti-tians’ advice on healthy

eating habits

Grocery toursFeeling overwhelmed by all the

food choices at the grocery store? Join a grocery tour to learn more about choosing the

best foods for you and your family

Copeman recipe booksWe want to share our favourite

seasonal recipes with you! Approved and tested by your

Copeman dietitians