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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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Herbal remedies: Saw palmetto for hair loss prevention

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(Natural News) Saw palmetto is a small, shrub-like palm endemic to the United States. Known for its medicinal properties, saw palmetto has been used for centuries to treat reproductive issues and hormonal imbalance.

Today, saw palmetto is used as an ingredient in many hair growth products and supplements, as it is thought to prevent hair loss. This could be due to saw palmetto’s influence on the hormones that dictate hair growth.

Saw palmetto for hair loss

There is evidence to suggest that saw palmetto can help treat hair loss and prevent its occurrence. According to a 2012 study, saw palmetto could inhibit 5-alpha reductase (5-AR). 5-AR converts testosterone, a male sex hormone, into a more potent hormone called dihydrotestosterone (DHT).

Research shows that high levels of DHT can shrink hair follicles and result in hair loss. DHT also makes it harder for hair follicles to grow new hair once the old hairs fall out. By inhibiting 5-AR, saw palmetto blocks the conversion of testosterone to DHT.

In another 2012 study, researchers evaluated the effects of saw palmetto supplementation in men with mild or moderate androgenetic alopecia, or male-pattern baldness. One group received 320 milligrams (mg) of saw palmetto every day for two years, while another group took one mg of finasteride, a conventional drug used to treat hair loss.

The results showed that 38 percent of participants who supplemented with saw palmetto experienced improvements in hair growth, compared to 68 percent of those who supplemented with finasteride.

While the experiment showed that finasteride was more effective, the researchers noted that saw palmetto may be less likely to work in people with more severe cases of hair loss. More research is needed to confirm this.

Saw palmetto is available in several forms, including oral supplements and hair care products like conditioners and shampoos.

Due to limited research on the use of saw palmetto for hair loss, there is no official recommended dosage for it. That said, a study published in the Journal of Cutaneous and Aesthetic Surgery cited a recommended dosage of 160 mg twice daily for saw palmetto tablets. Researchers often use this dosage when studying with saw palmetto.

Take note that saw palmetto has been reported to sometimes cause mild side effects, such as headaches and stomachaches. If in doubt about using saw palmetto, consult a natural health practitioner.

Other natural remedies for hair loss

Hair growth depends on several factors, including a person’s genetic makeup. Still, some home remedies might help prevent hair loss and/or encourage hair growth. These remedies include:

  • Jojoba oil – Jojoba oil helps nourish hair follicles without leaving any residue behind. It also stimulates hair cells to grow faster.
  • Aloe vera – Aloe vera helps get rid of sebum buildup in the scalp. Sebum is a natural oil that helps keep the scalp moisturized. It can build up on the scalp and clog hair follicles due to poor hair hygiene.
  • Garlic – The pungent compounds in garlic help increase blood circulation in the scalp, which stimulates hair growth. These compounds also stimulate the synthesis of collagen, a protein that gives structure to hair.
  • Onion – Like garlic, onions boost blood flow in the scalp for better hair growth.
  • Licorice root – Licorice root helps relieve dry and irritated scalp. It also strengthens weak follicles.
  • Rosemary oil – Rosemary oil has antiseptic properties. It is ideal for treating scalp issues that slow hair growth, such as dandruff and bacterial infections.
  • Coconut milk – Coconut milk helps moisturize a dry scalp, which is a leading cause of hair loss.
  • Apple cider vinegar – Apple cider vinegar works as a clarifying agent, ridding the scalp of extra sebum and other residues that can clog hair follicles and inhibit hair growth.

Some hair loss is natural. But for mild to moderate cases of hair loss, it might help to use herbal remedies, such as saw palmetto, to strengthen hair or encourage hair growth.

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Scientist that condemned coronavirus lab leak theory admits he squashed it to protect Chinese scientists

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(Natural News) An American scientist who criticized theories that the Wuhan coronavirus (COVID-19) might have accidentally escaped or leaked from a Chinese laboratory has admitted that he was denouncing the idea in order to protect Chinese scientists.

Dr. Peter Daszak, the president of the EcoHealth Alliance, a New York-based nongovernmental organization that conducts scientific and policy research regarding emerging diseases, led an endeavor in February 2020 to quash any kind of suspicion that COVID-19 might have accidentally escaped from the Wuhan Institute of Virology, a research and academic institution supported by the Chinese state.

This culminated in a statement published in the prestigious medical journal The Lancet that condemned the “conspiracy theories suggesting that COVID-19 doesn’t have a natural origin.”

The Lancet article was written during the very early stages of the global pandemic, during a time when there wasn’t any kind of rigorous research on the origins of the virus.

Daszak further reiterated his support for China in a statement released on Feb. 6, stating that he stands with other scientists to “strongly condemn conspiracy theories suggesting that 2019-nCoV does not have a natural origin. Scientific evidence overwhelmingly suggests that this virus originated in wildlife, as have so many other emerging diseases.”

In June, Daszak also wrote an opinion piece for the Guardian titled: “Ignore the conspiracy theories: scientists know COVID-19 wasn’t created in a lab.”

But on Friday, Jan. 15, Daszak’s spokesperson told the Wall Street Journal that his statement, which has been used to silence anybody with a dissenting opinion regarding the origins of the coronavirus, was published to protect Chinese scientists from criticism.

The Lancet letter was written during a time in which Chinese scientists were receiving death threats and the letter was intended as a showing of support for them as they were caught between important work trying to stop an outbreak and the crush of online harassment.”

WHO team heads to Wuhan to probe virus origin

The situation surrounding Daszak’s initial statements and his sudden retraction are being compounded by the fact that the doctor is part of an international 15-member team of experts sent by the World Health Organization (WHO)to Wuhan to figure out the origins of the coronavirus.

According to the WHO, the team’s official mission is to determine how, where and when the virus crossed from animals to humans.

Daszak has been tweeting about the mandatory quarantine period he and his team are going through. During day four of quarantine, he said that the day, like the previous days, is “packed” with virtual meetings.

Day 6 of quarantine lockdown in Wuhan & it’s that special time for our friendly health care workers to swab for our PCR tests – they go deep, but they’re very cheerful about it. Xie xie! pic.twitter.com/QvKzgC0Lng

— Peter Daszak (@PeterDaszak) January 20, 2021

Peter Ben Embarek, team leader and WHO food safety and animal diseases expert, said that the team will be granted permission “to move around and meet our Chinese counterparts in person and go to the different sites that we want to visit,” once they’re done with the mandatory quarantine period.

It is unclear whether the WHO team will be looking into the Wuhan Institute of Virology and the theory that the coronavirus was engineered. Embarek has stated his desire to visit the “famous Wuhan market” to try and determine “everything that went in and out” of there in the weeks before the first confirmed cases.

Embarek is referring to the Huanan Seafood Wholesale Market in Wuhan, where many wild animals were often sold. This place is being investigated as a likely setting for the supposed “animal-to-human jump” of the coronavirus, or a place where that jump was accelerated.

“We know the virus originated in bats at some point, and then we know that human cases appeared in Wuhan in December 2019,” said Embarek. “But what happened in between, how many other animal species were involved in between, and where, remain to be found in more detail.”

“We don’t really know what happened in that period of time, and that’s what we are looking out for.”

Questions will remain regarding the role of the institute in the initial outbreak; questions that will continue to linger if WHO team does not conduct its investigation.

Then-Secretary of State Mike Pompeo even said that the government has reason to believe that several researchers working for the institute “became sick in autumn 2019, before the first identified case of the outbreak, with symptoms consistent with both COVID-19 and common seasonal illnesses.”

Pompeo said that this calls into question the claims made by Shi Zhengli, the institute’s senior researcher on bat-related viruses, that there had been “zero [COVID-19 or SARS-related] infection” among the institute’s student body and staff.

Pompeo noted that the possibility of an “accidental infection” in a lab is more likely than people might think, especially considering that such an incident has already occurred in China. In 2004, a SARS outbreak in Beijing that infected nine people and killed one originated in a research facility.

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California healthcare workers suffer severe allergic reactions following coronavirus vaccination

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(Natural News) Six healthcare workers suffered allergic reactions after getting a shot of Moderna coronavirus vaccine in San Diego, California. Their symptoms were considered severe and required medical attention.

The doses administered to the six healthcare workers were part of the Moderna Lot 041L20A distributed to 287 providers across the state earlier this month. That batch of shipment, which arrived in California between Jan. 5 and Jan. 12, is composed of 330,000 shots.

Moderna said in a statement that it is cooperating with California’s health department to investigate the allergic reactions.

“Moderna acknowledges receiving a report from the California Department of Public Health (CDPH) that a number of individuals at one vaccination center were treated for possible allergic reactions after vaccination from one lot of Moderna’s Covid-19 vaccine,” the statement read. “The company is fully cooperating with CDPH in investigating these reported adverse events.”

Dr. Erica Pan, California’s state epidemiologist, said Sunday, Jan. 17, that providers should err on the side of caution and stop using the doses until federal, state and company officials finish an investigation.

“Out of an extreme abundance of caution and also recognizing the extremely limited supply of vaccine, we are recommending that providers use other available vaccine inventory and pause the administration of vaccines from Moderna Lot 041L20A until the investigation by the Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Moderna and the state is complete,” she said.

Monterey, Santa Clara and Santa Cruz have already paused distribution while two Covid-19 vaccine clinics have been canceled in Stanislaus County following the allergic reaction reports.

The delay was a huge blow to California’s vaccine distribution efforts. California currently has the second highest number of coronavirus cases per capita in the United States, with Los Angeles being a particular hotspot.

All cases of apparent allergic reactions occurred at San Diego County’s drive-through mass vaccination site at Petco Park. No other providers have reported allergic reactions to vaccines administered from the same batch of doses.

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