Staying #Up2Date 🚨

1. Hypertension in pregnancy 

A Canadian study looked at trends in hypertensive disorders of pregnancy (HDP) from 2012-2021. Out of 2 million births, the rate of HDP increased from 6.1% to 8.5%, including pre-existing hypertension (0.6% to 0.9%), gestational hypertension (3.9% to 5.1%), and preeclampsia (1.6% to 2.6%). Rates of C-section rose marginally for women with HDP from 42.0% in 2012 to 44.3% in 2021, as did acute renal failure (0.4% to 0.6%). Early preterm delivery and intrauterine fetal death trended downwards.

2. Bilateral mastectomy in breast cancer 

This cohort study investigated whether bilateral (B/L) mastectomy to treat unilateral breast cancer reduces the 20-year risk of breast cancer mortality. Over 600K women with unilateral breast cancer were closely matched by treatment type and followed for 20 years. In the end, B/L mastectomy was associated with a statistically significant reduction of contralateral breast cancer risk but not breast cancer mortality. 

3. Methotrexate (MTX) for knee pain  

In this RCT, over 200 people with radiographic and symptomatic osteoarthritis (OA) were randomly assigned to oral MTX vs placebo to treat their knee pain using a numeric rating scale (NRS). In the oral MTX group, pain decreased from 6.4 (SD, 1.80) at baseline to 5.1 (SD, 2.32) and from 6.8 (SD, 1.62) to 6.2 (SD, 2.30) in the placebo group at six months follow-up. The primary intention-to-treat analysis showed a statistically significant pain reduction of 0.79 NRS points in favor of methotrexate (95% CI, 0.08 to 1.51; P = 0.030).

One Less Jab

Canada joins the list of countries lowering the amount of HPV doses administered.

What happened: Canada’s federal vaccine advisory board is recommending a single dose of the HPV vaccine for children and youth aged 9 to 20 years old instead of the previous 2 or 3 doses. 

Why it’s interesting: Over the last 10 years, research has shown that one dose of the highly effective vaccine can provide comparable protection against HPV. In a study published in the Journal of the National Cancer Institute, there were no cases of cervical cancer found in women born between 1988 and 1996 who were fully vaccinated against HPV between the ages of 12 and 13, regardless of the number of doses they received.

The Canadian Cancer Society hopes that by 2040 cervical cancer will be eliminated in Canada. They hope to do this by boosting awareness about the vaccine’s safety and effectiveness, as well as implementing at-home HPV tests. The National Committee on Immunization (NACI) still recommends that people between the ages of 21-26 get two doses of the vaccine. 

But: Protection comes at a price, and in Ontario the dose is available for free only to students from grades 7 through 12. If they wish to get vaccinated after they graduate high school, they must pay around $200.

The hefty cost has caused some outrage amongst adults in Ontario who didn’t get vaccinated in school. One woman took her frustrations to social media, where she started an online petition urging the Ontario government to make the HPV vaccine free to those under the age of 26. The petition got over 33,000 signatures, and the TikTok video that accompanied it went viral. The woman said making the vaccine more accessible to Canadians could save lives by decreasing the chance of cervical cancer.

Bottom line: Whether people decide to get vaccinated in school or on their own, the Canadian government hopes that reducing the required number of doses will encourage more people to get immunized. 

Presented by Vijay Wealth | Raymond James

Insurance 101: A Free Guide & Case Study for Doctors 🩺

Navigating insurance is daunting, especially for physicians. In fact, the insurance industry is happy to sell physicians anything they will buy. But how do you know what coverage is actually right for you?

Here are some important questions you’ll need to answer:

• What are the pros/cons of changing your medical association coverage?

• What are the tax implications of different policies if you're incorporated vs. not?

• How much coverage is appropriate for you, and potentially your partner?

Determining the right type and amount of coverage is challenging, and traditional insurance brokers can take advantage of this uncertainty. However, at Vijay Wealth, we simplify the process. As a financial planning firm—not an insurance firm—we assess your entire financial picture before recommending specific coverage to best protect your assets, family, and estate.

Download our comprehensive insurance guide to see case studies on physicians in your shoes that we’ve worked with, and what types of coverage you might consider looking into.

Hot Off The Press

1: 💊 Certain multivitamins and supplements in Canada are being recalled due to risk of “metal fibres,” including brands like Equate, Kirkland Signature, Life, and Natural Factors. The full list of products can be found here.

2: 🩺 Health Canada is warning about incorrect information in some naloxone take-home kits. A second dose of naloxone can be administered 2-3 minutes after the first dose, if necessary — NOT after 3-5 minutes, as some “save me” instructional cards say.

3: ❤️‍🩹 The US Congress is pushing bipartisan legislation — including the Kids Online Safety Act — to hold social media companies accountable for kids' mental health by enforcing a "duty of care" clause. It’s supported by health groups, but critics argue it might lead to overreach and censorship.

4: 🇺🇸 Kamala Harris’s presidential campaign is in full swing as the presumptive Democratic nominee. Early polling has suggested that she has a better chance than Biden at beating Trump in November, since the Trump campaign no longer has an “easy line of attack” (in other words, that Biden is old).

5: 👵 A study has suggested that a recently approved shingles vaccine may delay the onset of dementia. Researchers looked at more than 200,000 US cities and found that over 6 years, the risk of dementia was 17% lower in those who received the new, more effective vaccine, Shringrix, rather than Zostavax.

Notable Numbers 🔢

81%: the percentage of surveyed researchers who produced relevant negative results in their field. However, only 12.5% of respondents had the opportunity to publish these results - an article in Nature points out how this bias, over time, distorts the scientific record.

59,000: the number of participants in a meta-analysis across 25 countries that found 18.3% of doctors reported PTSD symptoms during the COVID-19 pandemic.

25,000: the number of people who have evacuated Jasper. The official estimate is that between 30-50% of the structures in Jasper, Alberta have been damaged or destroyed due to recent wildfires.

💬 In Our Community

A first-time homebuyer sought advice from fellow physicians on purchasing a $3 million home (they have no debts, no liabilities). We thought it was an interesting discussion, so we summarized it for you. Here are the main takeaways:

• Do-able, if you have $1M downpayment and household income ~$700K (in order to follow the 33% rule, where <33% of your post-tax income is spent on housing costs).

• Also, folks would generally avoid this, as the larger the home, the more unexpected expenses.

• Otherwise, folks have generally said to avoid such a big purchase early on in life.

Of course, if you’re set on living in Toronto or Vancouver, this may be unavoidable if you want a single family home at all (see: this game from 2010 that asks you to guess if a home is a mansion or a crack shack in Vancouver).

Read the comments on Facebook here. Link may not work if you’re not already part of the private FB group.

Insight of the Week

You might be getting tired of all the Marvel movies, TV shows, merch, etc. (Or you might not be, and caught the latest Deadpool vs. Wolverine installment.)

If so, you may have contributed to the almost $440 million USD that the latest Deadpool movie has brought in. Pretty fair to say that Marvel’s decision to actively engage with promising stars (like Canadian fav Ryan Reynolds) has seriously paid off.

Source: Chartr Stories

Postcall Picks

😭 Laugh: Gowning in the OR is a whole different experience from donning the white coat at the ceremony. 

📺 Watch: how tech doping is reshaping sports performance in the Olympics and take a deep dive into the balance between innovation and fairness in sports.

📚Learn: about cultural safety education, traditional practices, and critical discussions on systemic injustices impacting Indigenous health. Space is limited — register early to secure your spot.

🤑 Save: Apple Airtags are back on sale — $98.99 for 4.

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First Question: Commonly includes LLQ pain, fever, elevated WBC

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