Post Archives

Dr. Muxin (Max) Sun
March 6, 2019

Decreasing pain of osteoarthritic knees

I have decreased my frequency of giving steroid injections for decreasing pain of osteoarthritic knees. I educate patients on evidence, placebo effects and risks. I recommend less invasive therapies including physiotherapy, exercise (quadriceps and hip abductor strengthening, Tai Chi), hot compress, antiinflammatory creams, weight loss, TENS machine, orthopedic & orthotic devices, etc. read more...

Dr. Leslie Sadownik
February 13, 2019

Help – the steroids are not working – Helping women with refractory vulvar lichen sclerosus

Lichen sclerosus (LS) is a chronic skin disorder with a remitting and relapsing clinical course. Women commonly present with severe vulvar itch and an urge to scratch the skin. The recommended treatment is a course of topical steroids. Most women will improve with treatment. However, some will report, “the steroids did not help”. Here are some practice tips to help. read more...

Drs. Maysam Khalfan and Kam Shojania
January 30, 2019

Pearls and Pitfalls of Rheumatologic Lab Investigations

Patients who present with non-specific symptoms are sometimes tested with rheumatologic lab investigations as part of a ‘panel’ of tests. When these tests come back positive, it can lead to more confusion, patient anxiety, misdiagnosis or unnecessary referral. read more...

Andrea Holmes
January 16, 2019

Dietary and physical activity recommendations for cancer survivors

Breast and prostate cancer survivors want to know what to eat to prevent cancer from coming back. HealthLink BC healthy eating resources that support successful dietary and physical activity change for prostate and breast cancer survivors are available for your patients. read more...

Dr. Steve Wong
December 19, 2018

Letter from the editor

More than ever, it seems, it’s important to share opinions that are backed by facts, be willing to revisit and update what you thought you knew before, and be inspired to seek out more information about something you learned anew. read more...

Drs. Terence Yung and Steve Ham
December 5, 2018

Postoperative “troponinitis” is not benign: highlighting the importance of surveillance

All postoperative troponin elevation should be treated seriously. Troponin elevation after surgery is associated with significant mortality at 30 days. Myocardial injury after non-cardiac surgery (MINS) diagnosis is made after other causes of troponin elevation are ruled out. Up to 90% of patients with a troponin elevation postoperatively do not exhibit any symptoms, yet their outcomes are still poor. read more...

Mark W. Hull MD MHSc
November 13, 2018

HIV pre-exposure prophylaxis (PrEP) for individuals at risk for HIV infection

Over the last five years, on an ongoing basis, we have seen new HIV infections occurring in young gay, bisexual and other men who have sex with men (MSM). The majority of these individuals had had a prior negative HIV test within the last year, or were presenting with signs or symptoms supportive of an acute HIV infection, suggesting recent exposure and transmission of HIV infection, highlighting the need for novel HIV prevention strategies. read more...

Dr. Diane Villanyi
October 31, 2018

Driving assessment in older adults

Under Section 230 of the Motor Vehicle Act, in addition to physicians, registered psychologists, optometrists and nurse practitioners are obliged to report a patient who may be unfit to drive. RoadSafetyBC has a dedicated phone line for medical professionals to help with complex cases. read more...

Dr. Krishnan Ramanathan

New insight into “HFpEF” – cardiac amyloid no longer a zebra diagnosis? read more...

Michelle C. Danda, RN, BN
October 10, 2018

Learning to meet my patient where they are at – how letting go changed my practice

I realized that engagement is paramount when working with an ambivalent patient, because the change that they want to make is often important in their life, even if the clinician views it as a problem behavior. Motivational interviewing education has been shown to improve patient alliance and treatment adherence. read more...

Dr. Martha Spencer
September 19, 2018

Fecal incontinence: just ask!

Fecal incontinence (FI), defined as the involuntary passage of stool or the inability to control the expulsion of stool, is a common but under-reported condition that can affect people of all ages but has increased prevalence in older adults. read more...

Dr. Carol-Ann Saari
September 5, 2018

Trauma Informed Practice (TIP) makes perfect (or at least it is a good start)

In the general population, approximately 75% of Canadians will report having experienced an adverse and potentially traumatic experience in their lifetime, with 9.2% meeting criteria for PTSD. We have to become trauma informed. Trauma informed practice (TIP) is a way of providing services that recognizes the need for physical and emotional safety, choice and control in decisions affecting one’s treatment and an environment where patients do not experience further traumatization. read more...

Lily Zhou
September 4, 2018

Better than sex? Building mind wandering tolerant presentations

I used to feel crushed when looking up from notes during a presentation to a packed lecture hall of colleagues intensely concentrating... read more...

Dr. Colleen Varcoe and Dr. Heather Smith
August 15, 2018

Equity-oriented health care

Health equity-oriented care is now part of my daily practice; the tools created with, and provided by, the EQUIP study have helped to make health care inequity an issue that I can screen for and offer options for management. read more...

Drs. Terence Yung and Tony Wan
July 24, 2018

Baby aspirin for extended DVT prophylaxis after elective hip and knee arthroplasty

For those who had an elective hip or knee arthroplasty who have no other risk factors for VTE, after initial 5 days of DVT prophylaxis with rivaroxaban 10mg a day, I complete the remaining DVT prophylaxis with aspirin 81mg once daily for an additional 30 days for hip arthroplasty and 9 days for knee arthroplasty. Those who already were on once-daily 81mg aspirin prior to surgery will receive 162mg aspirin once daily instead in this period. read more...

Dr. Maia Love
July 4, 2018

Wellness and self-care for professional excellence

Defining yourself as a person first, and your role as a professional second, has benefits in preventing burnout and creating more personal energy. Put your own oxygen mask on first. read more...

Dr. Min S. Phang, MRCP, FRCPC and Stacey Miller, PT
June 13, 2018

Hip surveillance in children with cerebral palsy

I now refer all children with cerebral palsy, or suspected cerebral palsy, to the Child Health BC Hip Surveillance Program. Information about the program is available at, including a referral form for physicians. The incidence of hip dislocations can be significantly reduced! read more...

Dr. Kelly Luu
May 23, 2018

The power of storytelling in clinical encounters

Evidence shows that the strategy which physicians frequently employ, educating and training, is only the first step in the process of behavioural change. By helping patients shift their narratives about themselves, we can strengthen their ability to have sustained behavioural change. read more...