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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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Health Ranger posts new microscopy photos of covid swabs, covid masks and mysterious red and blue fibers

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(Natural News) What follows is a series of microscopy photos of covid swabs (a synthetic swab, then a cotton swab), a covid mask and some zoomed-in photos of mysterious red and blue fibers found in the masks.

The magnification range for these photos is 50X to 200X. Most were taken with white light, but several (as indicated) were taken with UV light.

The images shown here are 600 pixels wide. We have higher resolution images available to researchers and indy media journalists; contact us for those hi-res images.

More microscopy investigations are under way, and new images will be posted as they are finalized.

First, this series shows the carbon fiber layer of a covid mask, illuminated with UV light:

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5,800 test positive, 74 die of coronavirus at least 14 days after getting fully vaccinated

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(Natural News) The Centers for Disease Control and Prevention (CDC) on Thursday, April 15, confirmed some 5,800 breakthrough coronavirus (COVID-19) cases in the U.S.

A breakthrough COVID-19 case is defined as someone who has detectable levels of SARS-CoV-2 – the virus that causes COVID-19 – at least 14 days after getting fully vaccinated against the disease.

Nearly 400 breakthrough cases required treatment at hospitals and 74 died. A little over 40 percent of the infections were in people 60 years and above and 65 percent were female. About 29 percent of the vaccine breakthrough infections were reportedly asymptomatic. The figures were for cases through April 13.

CDC Director Rochelle Walensky told a congressional hearing on Thursday that the causes of the breakthrough cases are being probed. “Some of these breakthroughs are, of course, failure of an immune response in the host. And then some of them we worry might be related to a variant that is circulating. So we’re looking at both,” she said.

The CDC is monitoring reported cases “for clustering by patient demographics, geographic location, time since vaccination, vaccine type or lot number, and SARS-CoV-2 lineage.” It has created a national COVID-19 vaccine breakthrough database, where state health departments can enter, store and manage data for cases in their region.

Where available, respiratory specimens that tested positive for COVID-19 will be collected for genomic sequencing “to identify the virus lineage that caused the infection.”

Positive test less than two weeks after getting fully vaccinated is not a breakthrough case

The number of cases the CDC has identified does not include people who contracted COVID-19 less than two weeks after their final dose. The two-week marker is important, said infectious disease expert Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

A human body should have enough time to develop antibodies to SARS-CoV-2 after that timeframe. Before then, a person won’t necessarily have the built-up immunity needed to fight off an infection. According to Dr. Adalja, cases that occur before the two-week mark are not considered breakthrough cases.

Dr. Adalja also noted that more research is needed to determine if highly infectious variants of the virus are behind the breakthrough cases. “It is crucial to study breakthrough cases to understand their severity, their contagiousness and what role variants may be playing,” Dr. Adalja said.

More than 78 million people have been fully vaccinated against COVID-19 in the U.S. as of April 15.

“To date, no unexpected patterns have been identified in case demographics or vaccine characteristics,” the CDC said in a statement. “COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control.”

But the CDC conceded that “thousands of vaccine breakthrough cases will occur even though the vaccine is working as expected.”

Dr. William Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agreed with the CDC. “These vaccines that we’re using are fabulous but they’re not perfect,” he said. “At best, they’re 95 percent effective in preventing serious illness, but minor illnesses can occur.”

According to U.S. drug regulators, Pfizer’s COVID-19 vaccine is 95 percent effective in preventing infection. Moderna’s was shown in a clinical trial to be 94.1 percent effective while Johnson & Johnson’s was 66.9 percent effective. Only Johnson & Johnson vaccine, which received its emergency use authorization from the Food and Drug Administration (FDA) on Feb. 27, was tested when variants were circulating.

The percentages are based on results from vaccine recipients two weeks after the final vaccination.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, stated in a briefing last week that the breakthrough cases are not a cause for concern.

“I think the important thing is to look at what the denominator of vaccinated people is. Because it is very likely that the number of breakthrough cases is not at all incompatible with the 90-plus percent vaccine efficacy,” he said. “So I don’t think that there needs to be concern about any shift or change in the efficacy of the vaccine.”

More info needed before drawing conclusions from breakthrough cases

The percentage of vaccine breakthroughs in a population depends on multiple factors, including vaccine efficacy, the amount of virus circulating and the length of time since vaccination, according to Natalie Dean, an assistant professor of biostatistics at the University of Florida.

“I love to see small numbers as much as anyone, but know that numbers like this cannot be directly interpreted as a measure of vaccine efficacy (although I have a feeling they will be). We can only interpret them against a background rate in unvaccinated people,” Dean wrote on Twitter.

“Similarly, ‘most breakthroughs have been in elderly adults’ should not be read as the vaccine is less effective in elderly adults. The majority of vaccinations (and the longest amount of follow-up time) have been in elderly adults. Again, we need more info to interpret.”

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More people died from fentanyl overdose than coronavirus in San Francisco last year

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(Natural News) More people died from fentanyl overdose than coronavirus (COVID-19) in San Francisco last year, a microcosm of a larger nationwide problem coinciding with the pandemic.

Data from San Francisco’s Office of the Chief Medical Examiner shows that 708 people were killed by fentanyl in 2020, an astonishing 118 times more since the introduction of the drug in the city just five years earlier.

That figure nearly tripled the 254 COVID-19 deaths recorded in the city for the whole of last year. More than 8 in 10 deaths were male, and just under half were white. People aged 55 to 64 made up nearly a quarter of the fatalities. Nearly 40 percent of the deaths occurred in open-air drug markets such as the Tenderloin and South of Market.

The number of overdose deaths in the city could have been far worse as more than 3,000 addicts suffering from an overdose were administered with naloxone, the lifesaving medication that reverses overdoses.

San Francisco’s death rate from fentanyl overdose continues to rise this year as 135 died by overdose in January and February, putting the city on pace for more than 800 deaths by the end of the year.

The city has become a significant part of a larger trend. The Centers for Disease Control and Prevention (CDC) released data on Wednesday, April 14, showing that more than 87,000 Americans died from drug overdose over the 12-month period that ended in September last year – the highest since the opioid epidemic began in the 1990s.

Lockdowns lead to more cases of drug overdose

The surge represents an increasingly urgent public health crisis that may be correlated to the government’s monotonous battle plan against the COVID-19 pandemic.

On March 19 last year, California became the first state in the U.S. to implement a stay-at-home order. It subsequently endured the longest lockdown of any state in the country.

The pandemic and accompanying lockdowns are believed to be partly responsible for the soaring number of drug deaths for obvious reasons. Lockdowns have badly disrupted the social services in the city, including drug addiction treatment. Drug experts say the isolation of the past 12 months is causing vulnerable residents to turn to opioids.

“We see the death and devastation getting worse right in front of us,” said Matt Haney, San Francisco Board of Supervisors member. “It’s an unprecedented spiraling, directly connected to the introduction of fentanyl in our city.”

Fentanyl first appeared on the streets of San Francisco in 2015. There were just six deaths from the synthetic opioid that year, 12 deaths in 2016 and 37 deaths in 2017. The figure skyrocketed when the drugs became widely available in the city in 2018.

Kristen Marshall, manager of the national drug harm reduction DOPE Project, noted the grim irony that while social isolation could save lives from COVID-19, it had undoubtedly contributed to the number of overdose deaths.

“Isolation is also the thing that puts people at the absolute highest risk of overdose death,” she said.

Pandemic exacerbates rise in deaths from drug overdose

The number of deaths from drug overdose started rising in the months leading up to the coronavirus pandemic, making it hard to gauge how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend. The biggest jump in overdose deaths took place in April and May when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.

Many treatment programs closed during that time while drop-in centers, which provide support, clean syringes and naloxone, cut back services.

The data released by the CDC shows a 29 percent rise in overdose deaths from October 2019 through September 2020 compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs like methamphetamine.

Unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting Black Americans disproportionately.

“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse, said at a national addiction conference last week.

“And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups.”

Dr. Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.

“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”

The Drug Enforcement Administration (DEA) supported Dr. Volkow’s claim, saying that transnational criminal organizations cause a spike in overdoses by mixing fentanyl into illicit narcotics.

According to the DEA, Mexican cartels often purchase the drug components in China and use human mules to smuggle the narcotics to lucrative drug markets north of the border.

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