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‘Burned out’: Saskatoon cancer doctors reveal reasons for departures

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After working nearly every day for 13 years, Dr. Christopher Giede doesn’t really know what to do with all of his free time. He plays the electric guitar and feeds his pet sheep, but he can’t stop worrying about his cancer patients.

Those concerns creep into his dreams: “Are his patients being cared for in his absence? Do they feel he abandoned them?”

In September, the 55-year old gynecologic oncologist went on medical leave.

“I’m physically unwell and can’t carry the load anymore,” Giede said, during an interview at his home near Saskatoon. “There has been a lot of psychological stress in the past couple years, and that has not helped with the physical stress.” 

The only other gynecologic oncologist in Saskatoon, Dr. Anita Agrawal, quit her job in December. She told CBC News that she was “burned out” and tired of asking for support. She accepted a job in Ontario. 

The situation in Saskatoon is being repeated in other smaller cities across Canada. 

Kingston, Ont., and Sherbrooke, Que., for example, have had a difficult time recruiting and retaining gynecologic oncologists, especially in the midst of a national shortage due to retirements, disability leaves, international competition, and growing demand from an increasing patient load, according to the Society of Gynecologic Oncologists of Canada.

Specialists are often drawn to departments in major centres with larger teams and more resources. In both Calgary and Winnipeg, for example, there are five gynecologic oncologists on staff and each is only on-call every fifth weekend. In Toronto, 21 specialists share the workload.

‘You feel in peril’

Saskatchewan is losing three of its four gynecologic oncologists by June of next year; two in Saskatoon and one in Regina.

Dr. Anita Agrawal says a lack of manpower and support made it difficult to maintain the level of care for patients that she wanted to provide. (University of Saskatchewan)

A gynecologic oncologist is a highly-trained specialist who treats ovarian, cervical, uterine, and vulvar cancers. 

It’s a unique specialty in that gynecologic oncologists not only perform complex surgeries, they also shepherd women through the entire treatment process with post-operative chemotherapy and care.

“We become very attached to our patients, and vice versa, they become attached to us,” Giede said.

Ovarian cancer patient Kimberly MacKinnon received treatment from both specialists, and isn’t comfortable with locums being flown in to Saskatoon from Ottawa to handle her case.

“How well do they know my case? It’s devastating, and frightening. You feel in peril,” she said.

Workload issues

In October, the Saskatchewan Cancer Agency sent patients a letter notifying them that Saskatoon was losing both of its specialists; Dr. Giede was on an indefinite leave and Dr. Agrawal was leaving her practice in early December.

A subsequent statement from the Saskatchewan Health Authority said the specialists were leaving for “personal reasons.”

That’s misleading, both doctors contend, because their reasons are work-related. 

Giede said they’ve been asking the health region to hire a third gynecologic oncologist and add other clinical support for at least six years. He warns that the province’s pledge to “aggressively recruit” replacements is ill-fated unless workload issues are resolved.  

‘It feels like someone opened a trap door beneath me, and let me fall through,’ said ovarian cancer patient Kimberly MacKinnon. She is upset about the departures of two gynecologic oncologists in Saskatoon whom she trusted. (CBC News)

Pleas for help

Each year, another 240 women are diagnosed with reproductive cancers in Saskatchewan. The wait time for a hysterectomy for cancer is roughly four weeks, on par with Ontario, according to health ministry data from both provinces.

The prairie province is in a chronic quandary over staffing enough specialists to avoid burn out. Its small population of 1.12 million people only warrants — in theory— a certain number of specialists in any field.

Yet, patients are spread over vast distances and timely access often requires service in both Saskatoon and Regina. Specialists need a certain critical mass to maintain a work-life balance.

When Giede accepted a job in 2005 as Saskatoon’s only gynecologic oncologist, he was on-call 24 hours a day, seven days a week. The arrival of a second gynecologic oncologist, Dr. Anita Agrawal, in 2008, provided some relief.

Still, the two doctors shared what they called a “one in two” ratio workload — meaning, each had to be on-call half of each month, on top of their normal clinical practice. If one took vacation, the other covered 24/7. 

Dr. Christopher Giede said treating gynecologic cancers is ‘intense work’ that requires respite. (Bonnie Allen/CBC News)

It wasn’t unusual for Giede to be called out of bed in the middle of the night to see a feverish chemo patient in the ER, catch a few hours sleep at the hospital, then perform a four-hour radical hysterectomy that day. 

“I could tell when we were both getting tired when we would argue over who was working more. And it was a silly argument because we were both working more than a full-time position,” Giede said. “We needed each other, and we need to work well or we would have collapsed long ago.”

As academic physicians, they were also expected to do research, teaching and administrative work.

‘You’re breaking bad news all the time’

The doctors’ started sending emails and letters requesting a third gynecologic oncologist in 2012. Their frustrations intensified when, that same year, the health region didn’t hire an eager young doctor who had been born and raised in Saskatoon and was seeking a job in the city.

“I love Saskatoon, and that was drawing me there,” Dr. Sarah Glaze told CBC News. She confirms she had multiple meetings with the university and health region, but with no job offer, she ultimately found work in Calgary.

Giede was particularly disappointed that health officials wouldn’t create a position for her, when it’s proven that homegrown doctors are more loyal.

Health officials argued that the number of patients didn’t justify adding a third specialist.

Magic number of 3

A recently published report on national best practices, called the Pan-Canadian Standards for Gynecologic Oncology, states that the magic number in any centre is a minimum of three gynecologic oncologists. That reduces surgeon fatigue and improves patient care.

“Physician burn-out is a huge problem,” said Dr. James Bentley, president of the Society of Gynecologic Oncologists of Canada. “If you’re down to two people for a long time, it’s very wearisome. We’re dealing with people who are sick, you’re breaking bad news all the time, long surgeries, complicated chemotherapy regimes. It’s not straightforward stuff.”

In Ontario, a hospital must meet that benchmark of three gynecologic oncologists on staff to be designated a Gynecologic Oncology Centre by Cancer Care Ontario.  

Dr. Christopher Giede feeds his pet sheep on his acreage south of Saskatoon. He’s on indefinite leave with disability benefits. (Bonnie Allen/CBC News)

Moncton, Halifax, and St. John’s all staff three gynecologic oncologists, but it has often proven challenging for those smaller centres, and others in Canada, to retain that number of specialists. 

There are 101 gynecologic oncologists operating in Canada, with about 85 clinical positions, as reported by the national society. Many of them only see patients part-time, and also work on research, teaching or administrative duties. 

In Giede’s case, he was expected to oversee resident physicians on top of a full patient load.

Aggressive recruitment

In 2015, the health region finally granted permission to hire a third specialist. However, Giede said, three years in a row, a potential candidate has rejected their job offer because of the work environment. 

Saskatchewan Health Minister Jim Reiter has directed the health authority “to do whatever they need to do to aggressively recruit” new gynecologic oncologists.

A job advertisement promises $467,000 – $587,000 annually, plus a $30,000 signing bonus with a three year return-of-service commitment.

The health authority is also offering to sponsor two gynecologic oncology fellowships, at roughly $200,000 each, in return for service in Saskatchewan — just as it did for Giede nearly two decades ago.

“When you have a homegrown doctor, there’s a stronger likelihood that they’ll stick around,” Reiter told CBC News. “Longer term, we think that’s going to help with retention.”  

Saskatchewan’s Health Minister Jim Reiter sat down face-to-face with Dr. Giede to listen to his concerns. (Mike Zartler/CBC News)

Giede said he is proof that the fellowship incentive is not enough, “if you then allow the person who you trained to get burned out.”

In a face-to-face meeting with Reiter, Giede made a pitch for a minimum of three gynecologic oncologists in both Saskatoon and Regina, as well as clinical associates, locum backfill, and first responder support from within the cancer agency.

The health minister confirmed that there is no plan to centralize services in just one city, and that a formal review of the program will take place shortly. Recommendations could lead to change in the program’s structure and staffing number.

‘We’ve been holding on’

This past summer, Giede’s neck pain flared up to the point he was popping anti-inflammatory pills, laying down at work, and heading straight to bed when he got home. 

Both Giede and Agrawal said they held on as long as they could, and didn’t plan their departures together.

“Our goal was to provide the best care that we could with all we had in us, despite the environment,” Agrawal said.

Giede will only return to the operating room if both his health, and the work environment, improve.

“Nobody wants a temporary fix. I’m confident that message has gotten out there.”

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Researchers warn about the severe psychological distress caused by eating junk food

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(Natural News) Does junk food make you sad? While the current state of the American food industry is more than enough to make anyone feel depressed, new research from Loma Linda University demonstrates a link between junk-laden diets and psychological distress. Based on their findings, it appears that what you eat can and does affect your mental health — and that the prepackaged garbage peddled as “food” can have a seriously deleterious effect on your emotional well-being.

Even after adjusting for other external factors, the scientists found this relationship held steady: The more junk food a person ate, the more distress they reported feeling. When you consider the physiological effects junk food has on the body, it is no wonder that people report feeling like they are more distressed: They are in distress, they just don’t know it’s because of what the “food” they’re eating is doing to them on the inside.

Estimates suggest that the average American gets 60 percent of their daily calories from processed or junk food. Junk food consumption is a widespread problem here in the United States. Now, there are questions about whether or not junk food is a driving force in the plague of insanity (and stupidity) striking the U.S.

Scientists link junk food to poor mental health

Published in the journal International Journal of Food Sciences and Nutrition in early 2019, a study from Loma Linda University scientists finds a link between poor diet and poor mental health. Even after adjusting for external factors such as gender, age, education and income level, the association between junk food intake and mental illness remained.

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Study leader Jim E. Banta, Ph.D., MPH, an associate professor at the school, says that their conclusions support the findings of previous research. To conduct their study, Banta and his team looked at data from the California Health Interview Survey (CHIS). The scientists used 240,000 phone surveys conducted by CHIS between 2005 and 2015, and included data on socio-demographics, health status and health behaviors.

“This and other studies like it could have big implications for treatments in behavorial medicine,” Banta said of the findings.

“Perhaps the time has come for us to take a closer look at the role of diet in mental health, because it could be that healthy diet choices contribute to mental health. More research is needed before we can answer definitively, but the evidence seems to be pointing in that direction,” he added.

The fact that scientists in the 21st century are only now just beginning to even consider the possibility of a relationship between nutrition and mental health is truly disturbing. Natural health practitioners have long been aware of the importance of good nutrition for total well-being, including mental state.

Is poor nutrition turning America insane?

Vitamin D deficiency is a well-known cause of depression. B vitamins, iron, selenium and magnesium also support good mental health and deficiencies in these nutrients can also cause depression and anxiety. There is a growing body of research which strongly supports poor nutrition as a causative factor not only in depression, but in other mental illnesses — including schizophrenia, bipolar disorder, OCD and more.

For example, Dr. Banta notes that some research has linked high sugar consumption to bipolar disorder, while fried foods and processed grains are linked to depression. There is no ignoring the link between diet and disease — whether it is of the body or of the mind makes no difference.

Nearly 60 percent of the American population’s diet comes from disease-causing food, and it is hard not to wonder if obesity, heart disease and death aren’t the only problems being caused by junk food diets.

Are the increasingly insane leftists just running around in a nutrient-deprived, sugar-spiked frenzy? Whether you’re talking about the inanity of “social justice” score-keeping or the rapid acceptance of censorship to silence conservatives, it’s clear that the far left is missing a few bolts upstairs. A diet of GMOs, pesticides and toxic food additives will do that to you, though.

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Eat healthier to improve your physical and mental well-being

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(Natural News) The physical health and mental well-being of a person depend a lot on nutrition and the food that he eats. Diet also influences the risk of developing chronic diseases. While the relationship between physical health and diet is well-understood, little is known about how diet and its quality influence the development of mental disorders. In a recent study, researchers from the University of Regensburg in Germany investigated the behavioral effects of a Western diet on pattern separation – the process of keeping items distinct in memory. They discovered that a diet consisting of increased amounts of sugar and saturated fatty acids, reduced levels of polyunsaturated fatty acids, and an increased ratio of omega-6/omega-3 fatty acids (Western diet) harms memory. The results of their study were published in the journal Food Science and Human Wellness.

The Western diet impairs pattern separation

In this study, researchers investigated the utility of spatial separation – a behavioral process associated with the hippocampus – in the assessment of dietary interventions and the behavioral effects of the transgenerational administration of a Western diet on pattern separation. Pattern separation is the process of keeping items distinct in memory and is mediated by the hippocampus. Previous studies have suggested that there is a relationship between hippocampal function and diet quality in both humans and animals.

To examine the association between them, the researchers used rats, feeding over seven generations a diet containing increased amounts of sugar and saturated fatty acids, reduced levels of polyunsaturated fatty acids, and an increased ratio of omega-6/omega-3 fatty acids. This diet composition is characteristic of a diet known as the Western diet. The researchers administered it transgenerationally because previous studies have shown that interventional diets need to be implemented over several generations to induce behavioral effects.

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They compared the spatial pattern separation (or local discrimination) performance of these animals with that of rats fed a standard diet. For the test, they presented the rats two locations and allowed them to learn across trials to respond to the correct location. During spatial discrimination training, they designated a location as the correct one and rewarded the rats if they touched the correct location. They reversed the correct and incorrect locations every time the rats successfully got the correct ones nine times out of 10 trials.

The researchers found a separation-dependent difference between the standard and Western diet groups in the number of discriminations performed in the pattern separation task. The rats fed with a Western diet performed fewer discriminations. Rats with lesions in the dorsal hippocampus showed impaired pattern separation when the locations were close together but not when they were far apart. The researchers associated this impairment with hippocampal dysfunctioning. Their results align with previous studies which demonstrated that consumption of a Western diet impaired cognitive functions, damaged brain regions, and contributed to the occurrence of neurodegenerative diseases. Their results confirmed that pattern separation could be negatively affected by transgenerational administration of a Western diet.

The researchers concluded that spatial pattern separation can help detect the effects of dietary interventions and that the Western diet can impair pattern separation.

How to make your diet healthier

A healthy diet can provide many benefits, the most important of which is the prevention of chronic diseases. Here are some things that you can do to make your diet healthier:

  • Eat slowly
  • Choose whole grains
  • Add probiotics to your diet
  • Increase your protein intake
  • Drink plenty of water
  • Avoid frying food and eating fast food
  • Take vitamin and mineral supplements
  • Try new and healthy recipes
  • Eat vegetables first before every meal
  • Eat fruits instead of drinking them
  • Exercise regularly
  • Stop drinking sweetened beverages
  • Get adequate sleep

Eating healthier and becoming aware of your nutritional needs will not only improve your physical health, but these will also benefit your mental and emotional well-being.

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Apples: Eat them to keep the doctor away – and boost stem cell therapy

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(Natural News) There is some truth behind the saying, “an apple a day keeps the doctor away.” Apples are superfoods, and they are good sources of antioxidants that protect cells from oxidative damage and boost the immune system. They also contain dietary fiber, which is good for digestion and the maintenance of gut microbiota. But there is more to apples than just being healthy, antioxidant fruits. In a recent study published in the journal Nutrition Research, researchers from Sungkyunkwan University in South Korea showed the beneficial effect of apple extracts on the proliferation of adult stem cells. They also identified the possible molecular mechanisms underlying apple’s pro-proliferative effects.

Apple ethanol extracts can enhance the proliferation of stem cells useful for tissue regeneration

Tissue regeneration using adult stem cells (ASCs) has significant potential in the treatment of many degenerative diseases. It also provides a promising means of repairing chronic tissue or organ failure due to injuries, congenital defects, and aging. Stem cells are essential in regenerative medicine because they can be used directly in cell replacement therapies. However, studies on their application in clinical settings suggest that age negatively affects the proliferation status and differentiation potential of ASCs. This presents a possible limitation in their therapeutic use.

In the hopes of addressing this limitation, researchers turned their attention to the pro-proliferative activity of apples. Apples are rich sources of valuable phytochemicals that are known to be beneficial to human health. They possess anti-inflammatory, antioxidant, and even anticancer activities. These antioxidants can help maintain human cells and protect them from harmful oxidation products. In addition, apples contain metabolites that could ensure longevity and increase the number of human cells in culture. (Related: Apples could hold key for increasing lifespan.)

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Because of this, researchers hypothesized that apple extracts might exert beneficial effects on ASCs. They obtained apple extracts using ethanol as the extraction solvent and tested these on human adipose tissue-derived mesenchymal stem cells (ADSCs) and human cord blood-derived mesenchymal stem cells (CB-MSCs). They also used 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and Click-iT 5-ethynyl-2?-deoxyuridine flow cytometry assays to evaluate the pro-proliferative effects of the extracts.

The researchers found that treatment with apple extracts promoted the proliferation of ADSCs and CB-MSCs. Apple extracts also induced the stepwise phosphorylation of p44/42 MAPK (ERK), mammalian target of rapamycin (mTOR), p70 S6 kinase (p70S6K), S6 ribosomal protein (S6RP), eukaryotic initiation factor (eIF) 4B, and eIF4E in ADSCs. p44/42 MAPK (ERK) is a signaling pathway involved in the regulation of cell proliferation and differentiation. Inhibition of this pathway results in cell apoptosis. mTOR is a key signaling node that coordinates cell cycle progression and cell growth. p70S6K is a cytokine that regulates cell growth by inducing protein synthesis. eIFs, on the other hand, are proteins or protein complexes involved in translation and protein biosynthesis.

The researchers also reported that apple extracts significantly induced the production of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in both ADSCs and CB-MSCs. VEGF is a potent angiogenic factor, which means it promotes the formation of blood vessels. VEGF also plays a role in other physiological functions, such as hematopoiesis, wound healing, and development. IL-6 is a promoter of proliferation. The researchers further confirmed that the apple extract-induced proliferation of ADSCs under serum-free conditions is mediated by ERK-dependent cytokine production because when they pre-treated cells with PD98059, a specific ERK inhibitor, it inhibited the phosphorylation of the mTOR/p70S6K/S6RP/eIF4B/eIF4E pathway.

Based on these findings, the researchers concluded that extracts from apples are potent pro-proliferative agents, and the beneficial effect of apple extract on the proliferation of ASCs may overcome the limitation in their therapeutic use in tissue regeneration.

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