December 2014 by Doctor's Review

depression antidotes

MEDICINE ON THE MOVE

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The Mickey trap Ferguson’s favourites

WHERE TO GO NEXT

sunny

escapes

P. 14

Ski Vermont Shop Rotterdam Drive Morocco

COMING SOON

salbutamol plus ipratropium

Performing

TOGETHER delivered in an SMI (Soft Mist Inhaler) 1-4

COMBIVENT RESPIMAT (ipratropium bromide and salbutamol sulfate) inhalation solution is indicated for treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). Consult the Product Monograph at www.boehringer-ingelheim.ca/content/ dam/internet/opu/ca_EN/documents/humanhealth/product_monograph/ CombiventRespimatPMEN.pdf for important information about: - Contraindications in patients with cardiac tachyarrhythmias, hypertrophic obstructive cardiomyopathy and patients with hypersensitivity to atropine or its derivatives - Relevant warnings and precautions regarding patients with uncontrolled diabetes mellitus, recent myocardial infarction, severe organic heart or vascular disorders, hyperthyroidism, pheochromocytoma, prostatic hypertrophy, urinary

retention, cardiovascular disorders, risk of deleterious cardiovascular effects with concomitant use with other sympathomimetic agents or epinephrine which is not recommended, monitoring for AE risk of acute and worsening of dyspnea, chest pain and reduced response to treatment, idiopathic hypertrophic subvalvular aortic stenosis, metabolic changes, gastric mobility issues in patients with cystic fibrosis, hypersensitivity reactions, ocular complications, paradoxical bronchospasm or being treated with other anticholinergic and/or beta-agonist containing drugs, monoamine oxidase inhibitors or tricyclic antidepressants, pregnant or nursing women, elderly patients and ability to operate vehicle or machinery - Conditions of clinical use, adverse reactions, interactions and dosing instructions The product monograph is also available by calling us at 1 (800) 263-5103 Ext. 84633.

NEW References: 1. COMBIVENT® RESPIMAT® Product Monograph. Boehringer Ingelheim (Canada) Ltd., Jan 8, 2014. 2. STRIVERDI® RESPIMAT® Product Monograph. Boehringer Ingelheim (Canada) Ltd., May 7, 2014. 3. Decramer M, Vestbo J, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of COPD (updated 2014). Global Initiative for Chronic Obstructive Lung Disease, Inc. 2014. 4. Data on file. Boehringer Ingelheim (Canada) Ltd., 2014.

Combivent® and Respimat® are registered trademarks used under license by Boehringer Ingelheim (Canada) Ltd.

Together in a mist

The joy of this and that I grew up in the sexual dark ages. In high school, my friends and I were all virgins — I’m talking about the boys. We placed the girls on such high pedestals we couldn’t even make out what was up their skirts. Their virginity was unquestioned. We fooled around, of course, and tried to get all we could, but it didn’t amount to much. Then one Friday night in May, just before graduation, Jack called and announced he’d scored a homerun. He had his Dad’s car and said he’d pick us up, tour around and tell us all about it. Each us was standing on the curb in front his house three minutes after the call. Jack refused to say anything until we were all in the car. Bill was the last guy to get in and before he even closed the door we were all yelling questions at the top of our lungs. Jack was cool. He waited until we were all quiet and said, “I guess you all want to know what it’s like, right? I can tell you it’s very, very good.” He’d clearly carefully thought out what he was going to say next, something that would convey the vastness of the experience of making love with a woman in a way we innocents might understand. He paused and said, “It’s one hundred times better than masturbation, end of story.” That good, huh! We slumped back in exhausted at the very imagining of it. This issue features Part 1 of the History of Medicine: sexuality from bonobos to Lesbos. The article takes us from the dawn of time until, roughly, the beginning of the “modern” era. Part 2, in the next issue, will cover the Dark and Middle Ages, the Renaissance and the Victorian period up to the present. Looking at sex through this long lens can be revealing. Attitudes toward human sexuality in the West didn’t change much until about 45 years ago. Since 1970, though, the dialogue, not to mention the action, has broadened considerably. Do stay tuned for Part 2. There’s also much else to enjoy in this issue. Skiing on the East Coast doesn’t get much better than on the hills of northern Vermont — either on the slopes or in the many bars and restos — and writer Margo Pfeiff knows better than most how to bring the experience to life (page 26). Jeremy Ferguson offers a gastronomic post-holiday lesson as he takes his knowledgeable taste buds on a tour of his favourite Asian restaurants in his hometown of Victoria, BC (page 42). And if you fancy adventure, intrepid artist and writer Erika Connor goes alone where few men will go without their buddies; do read her winning Desert Convoy (page 36). Been on the fence about your true feelings toward the Disney phenom? Inna Gertsberg, the mother of two boy-fans, will set you straight (page 49). Have a happy read,

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DECEMBER 2014 • Doctor’s

Review

GO WITH THE FLOW

The AstraZeneca logo is a registered trademark of AstraZeneca AB, used under license by AstraZeneca Canada Inc. ÂŠ 2014 AstraZeneca Canada Inc.

contents

DITTY_ABOUT_SUMMER / SHUTTERSTOCK.COM

DECEMBER 2014

features 26

42 49

Snow days

How a mom makes peace with Disney — sort of by Inna Gertsberg

The hottest skiing in northern Vermont from Smuggler’s Notch to Mad River Glen by Margo Pfeiff

The Mickey Mouse trap

A market like no other

The brand new Markthal in Rotterdam that’s as cool to look at as it is to browse by Karan Smith

Desert convoy A Mercedes from the past cruises through the present in Morocco’s Sahara by Erika Connor

Coming in

Victoria’s real secret

January

Indian, Tibetan and Vietnamese restaurants in BC’s capital that are the perfect antidote to holiday turkey by Jeremy Ferguson

• Take a Belize adventure complete with Mayans making chocolate • Bring the American Southwest alive with a tour of ancient sites at Mesa Verde, Chaco Canyon and the Canyon de Chelly • You’re staying in a rough area of Rio when the gunfire starts and a kid is asleep downstairs. What do you do? • For centuries, a great deal of energy went into stopping “self-abuse” — and a few decades ago, science discovered it’s good for you

36 DECEMBER 2014 • Doctor’s

Review

In major depressive disorder

“I felt down and

overwhelmed nearly every day.” Nicole*, 37

For patients like Nicole...

Trust PRISTIQ

for powerful

symptom relief No statistical difference in mean weight change vs. placebo was seen at 6 months (p=ns)†

* Fictitious case. May not represent all patients. † Results of the final on-therapy assessment in the 6-month, double-blind, placebo-controlled phase of a long-term trial in patients who had responded to PRISTIQ during an initial 12-week, open-label phase.

Indication and clinical use • PRISTIQ is indicated for the symptomatic relief of major depressive disorder • PRISTIQ is not indicated for use in children under the age of 18 • The short-term efficacy of PRISTIQ has been demonstrated in placebo-controlled trials of up to 8 weeks • The efficacy of PRISTIQ in maintaining an antidepressant response for up to 26 weeks, following response during 20 weeks of acute, open-label treatment, was demonstrated in a placebo-controlled trial Contraindications • Concomitant use with monoamine oxidase inhibitors (MAOIs) or within the preceding 14 days • Hypersensitivity to venlafaxine hydrochloride Most serious warnings and precautions • Behavioural and emotional changes, including self-harm: SSRIs and other newer antidepressants may be associated with: - Behavioural and emotional changes including an increased risk of suicidal ideation and behaviour - Severe agitation-type adverse events coupled with self-harm or harm to others - Suicidal ideation and behaviour; rigorous monitoring advised • Discontinuation symptoms: should not be discontinued abruptly. Gradual dose reduction is recommended Other relevant warnings and precautions • Concomitant use with venlafaxine not recommended • Allergic reactions such as rash, hives or a related allergic phenomenon • Bone fracture risk with SSRI/SNRI • Increases in blood pressure and heart rate (measurement prior to and regularly during treatment)

• Increases cholesterol and triglycerides (consider measurement during treatment) • Hyponatremia or Syndrome of Inappropriate Antidiuretic Hormone (SIADH) with SSRI/SNRI • Potential for GI obstruction • Abnormal bleeding with SSRI/SNRI • Interstitial lung disease and eosinophilic pneumonia with venlafaxine • Seizures • Narrow angle glaucoma • Mania/hypomania • Serotonin syndrome or neuroleptic malignant syndrome-like reactions For more information Please consult the product monograph at http://www.pfizer.ca/en/our_products/ products/monograph/226 for important information relating to adverse reactions, drug interactions and dosing information which have not been discussed in this piece. The product monograph is also available by calling 1-800-463-6001. Reference: PRISTIQ Product Monograph, Pfizer Canada Inc., July 3, 2013.

CA0113PRI023E

Count on

for powerful symptom relief

contents DECEMBER 2014

17 52

Season to taste Spark up chicken and scallop suppers with these unique spice combos from around the world by Amanda Bevill and Julie Kramis Hearne

regulars

7 LETTERS Artful thinking

PRACTICAL TRAVELLER The first Aboriginal arts hotel in Canada, Paris’ über-expensive museum renovation, new budget accommodations in Europe and more! by Camille Chin

BUDGET TRAVELLER Save on sand and sun at seven places in the Caribbean and Costa Rica by Roger White

52 17

GADGETS A pepper-shaker sized speaker that’s big on sound by Theo Sands

TOP 25 The best medical meetings happening next May

HISTORY OF MEDICINE Human sexuality, Part 1, from bonobos to Lesbos by Rose Foster

DEPRESSION POINTS Be on guard: suicide rates jump in January by Christopher Lane

PHOTO FINISH A natural wonder by Dr Jeff Allin and Lola Reid Allin

DECEMBER 2014 • Doctor’s

Review

Today he will think more about Rebecca than his diabetes.

Imagine a world where life with diabetes is a

little easier. We believe that with dedication, research and a never-quit attitude, that day will come. Itâ&#x20AC;&#x2122;s your day.

LETTERS

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David Elkins

Artful thinking

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Frank Sinatra’s Desert Modern house in Palm Springs.

DESIGNS ON PALM SPRINGS I read the story about golf in Palm Springs [A fair game, October 2014, page 46] about a month ago and then saw something online about a new architecture and design museum in town. The pictures of the properties in your story were so neat, I’d love to go to the museum if I were visiting. I won’t be heading out West anytime soon, but if anyone is, they might want to check it out. Here’s the website: psmuseum. org/architecture-design-center. Dr D. McCahill Via email

DEPRESSION ON MY MIND Thanks very much for your focus on depression in the last few issues [see the August to November issues of Doctor’s Review and our homepage for The scourge of depression]. It’s an illness I’ve had to deal with both in my family and professionally. Robin Williams’ recent suicide brought the issue to the forefront of people’s minds again, but I think it’s something we should be sensitive to all the time. I was happy to hear the Canadian government’s recent announcement that it will be dedicating some time and

money to veteran’s mental health, but would be even more impressed with a full-fledged campaign that promotes education and understanding among the general population. Amelia E. Via email

CHILD’S PLAY I enjoyed reading about the museum in Shelburne, Vermont [Fall for Vermont, October 2014, page 41]. The property and the historic buildings sound great. My kid would really love all the old circus stuff and carousel. Thanks for featuring places that are easily accessible and affordable. Annabelle Matchar Via email

DECEMBER 2014 • Doctor’s

Review

IES R E S T R A P THREE

Rise & Shine! Start the day right with a delightful breakfast recipe It is well known that breakfast is the most important meal of the day. It can provide an excellent chance for you to take in foods rich in bone-strengthening calcium, such as cereals, milk and yogurt. Add a glass of orange juice, fortified with vitamin D, to support the absorption of calcium, and improve muscle function, especially important if youâ&#x20AC;&#x2122;ve been diagnosed with osteoporosis. This three-part recipe series puts breakfast in the spotlight bringing you tasty, bone-healthy recipes.

New recipes every month!

doctorsreview.com

P R AC T I C AL T R A V E L L E R

PHOTOS THIS PAGE CRAIG MINIELLY / AURA PHOTOGRAPHICS

C a mi lle C hi n

A creative stay

Vancouver’s new Skwachàys Lodge is the first Aboriginal arts hotel in Canada and it’s being run as a social enterprise by the Vancouver Native Housing Society. Located in an early 20th-century building at the crossroads of the Gastown, Chinatown and Railtown districts, the lodge is home to 24 Aboriginal artists. In exchange for three years of low-cost housing, each artist produces pieces that are sold in the hotel’s gallery. The goal is to help each artist become financially independent at the end of their contract. When travellers overnight in one of the lodge’s 18 suites, they’re helping to subsidize the live/work studio. Each of the individually designed suites has a theme: there’s a feather suite and a hummingbird suite, a longhouse suite and a moon suite. The hotel includes a rooftop sweat lodge and smudge room for spiritual cleansing, and a kitchen complete with a handcrafted communal totem table by artist Eric Parnell. Doubleoccupancy rooms from $225 during high season. tel: (888) 998-0797; skwachays.com.

DECEMBER 2014 • Doctor’s

Review

P R AC T I C AL T R A V E L L E R

Cruise control

Women and couples travelling through New Delhi on select G Adventures tours will receive ground transportation from Women on Wheels. G Adventures’ non-profit Planeterra works with India’s Azad Foundation on the program, which trains poor women from slum regions to become certified commercial chauffeurs. The program helps local women earn an income so they’re less dependent on their partners while also providing safe transportation for women, which has become a concern given the violent assaults that have happened in India recently. The eight- to ten-month program also trains the chauffeurs-to-be in English, self-defence, CPR and women’s rights. Over 65 women have been trained so far and 11 vehicles are currently on the road. Planeterra helps with the purchase of vehicles (US$8200 to $10,200) and provides a market of travellers from the Toronto-based G Adventures outfitter.

Marriott’s new Moxy Marriott’s first Moxy Hotel recently opened near Milan’s airport. The new chain of “budget hotels” is said to be chic and modern with a focus on self-service. The inaugural hotel has 162 rooms; all Moxy rooms will have 42-inch TVs, free Wi-Fi and floor-to-ceiling art. The “lobby-turned-living room” will feature communal seating and a 24/7 self-serve café where you can buy your morning coffee, beer or wine in the evening, sandwiches, salads and even full meals daily. Rates start at €79. Germany will get four Moxy hotels in 2015, Norway will get one. Five more are planned for Europe in 2016,150 around the world within the next 10 years. moxy-hotels.marriott.com.

Doctor’s Review • DECEMBER 2014

PHOTOS THIS PAGE © MUSÉE NATIONAL PICASSO-PARIS / BÉATRICE HATALA

Picasso in Paris The Musée Picasso Paris has finally reopened following a major renovation that took five years instead of two and that blew its budget by more than $25 million. Oh — and the museum’s director of nearly a decade, Anne Baldassari, got sacked by France’s former culture minister along the way. Housed in a 17th-century baroque mansion called the Hôtel Salé in the Marais quarter, the museum, which first opened in 1985, boasts 5000 Picasso pieces from paintings and drawings to ceramics and sculptures. The redesign, which cost somewhere between €45 and €55 million — no one seems to really know — has been described by the museum’s new director, Laurent Le Bon, as austere yet luminous. It includes 3700 square metres of new gallery space so more of the museum’s collection is on display. The museum’s plan is to host one major exhibit every year. The first in mid-2015 will focus on Picasso’s sculpture and will be a collaboration with New York’s MoMA. Admission: adults €11. museepicassoparis.fr.

DECEMBER 2014 • Doctor’s

Review

P R AC T I C AL T R A V E L L E R

Flying high

The economy is fragile, but 2013’s World Airport Traffic Report doesn’t suggest that. Recently released by Airports Council International based on input from 1989 commercial airports in 160 countries, the report estimates that 6.3 billion people travelled in 2013, an increase of 4.6 percent. About 140 million of those passengers went through one of London’s six airports making the city’s system the busiest in the world. A whopping 94.4 million people went through Atlanta’s Hartsfield-Jackson International Airport alone though making it the most happening hub worldwide.

94.4 million 2. Beijing, China (PEK) 83.7 million 3. London, England (LHR, Heathrow) 72.3 million 4. Tokyo, Japan (HND) 68.9 million 5. Chicago, IL (ORD) 66.7 million 6. Los Angeles, CA (LAX) 66.6 million 7. Dubai, United Arab Emirates (DXB) 66.4 million 8. Paris, France (CDG) 62 million 9. Dallas/Forth Wort, TX (DFW) 60.4 million 10. Jakarta, Indonesia (CGK) 60.1 million 1. Atlanta, GA (ATL)

One of the fastest-growing airports was Dubai International (DXB) with 15 percent more traffic. Istanbul Atatürk Airport (IST) and Kuala Lumpur (KUL) also experienced double-digit growth with increases of 13.7 and 19.1 percent, respectively.

Patek Philippe is credited with making the first wristwatch in 1868 for a Hungarian countess, but Louis Cartier is said to have popularized it. He designed the first men’s wristwatch in 1904 for aviator Alberto Santos-Dumont to wear during flights. A 1915, leather, gold and sapphire “Santos” (pictured left) is on view now at Brilliant: Cartier in the 20th Century through March 15 at the Denver Art Museum (DAM). Cartier’s opened his first jewellery store in Paris in 1847, a London location in 1902 and one in New York in 1909. Today, the Cartier Collection — a kind of travelling art exhibit that never stays in one place — includes more than 1500 pieces; selections from 1900 and 1975 will be on view at the DAM. One highlight is the Patiala necklace (right) created for Maharaja Bhupinder Singh in 1928. It contains 2930 diamonds and a yellow diamond weighing 234 carats. Adult timed tickets with audio: US$27. tel: (720) 865-5000; denverartmuseum.org.

Doctor’s Review • DECEMBER 2014

PHOTOS: NICK WELSH, CARTIER COLLECTION © CARTIER

Watch this

FOR THE TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS ACTONEL DR SHOULD BE TAKEN IN THE MORNING WITH BREAKFAST

ON THE GO

TAKING IT SLOW

EITHER WAY, IT’S BREAKFAST AS USUAL.* Actonel DR® is the only oral bisphosphonate designed to be taken with breakfast.1†

VERE O C BY MOST

PRIVATE DRUG PLANS‡, ODB and EDS in SK

Please consult the product monograph at http://webprod5.hc-sc.gc.ca/dpd-bdpp/index-eng.jsp by searching for ACTONEL DR for additional important information including adverse reactions, drug interactions, and dosing information which have not been discussed in this piece. The product monograph is also available on request through our medical department at 1-855-892-8766. * Breakfast may include high fat foods, coffee, tea, milk, orange juice, etc. A higher incidence of upper abdominal pain was seen when ACTONEL DR was taken in a fasted state before breakfast. ACTONEL DR tablet should be swallowed whole (not chewed, cut or crushed) while in an upright position and with sufficient plain water (≥120 mL). Patients should not lie down for at least 30 minutes after taking ACTONEL DR. † Comparative clinical significance not established. ‡ Based on a coverage survey conducted by Equilibrium Health, July 2012. ODB: Ontario Drug Benefit; EDS: Exception Drug Status; SK: Saskatchewan Consult formulary for full coverage information. Reference: 1. Warner Chilcott Canada Co. ACTONEL and ACTONEL DR Product Monograph, Toronto, July 3, 2013. ACTONEL DR® is a registered trademark of Warner Chilcott Company, LLC. Marketed with sanofi-aventis Canada Inc. Copyright © 2014 Actavis Specialty Pharmaceuticals Co., Mississauga, ON. All rights reserved.

TAKE WITH BREAKFAST *

BUDGET TRAVELLER by

R og e r Whi t e

places for sun, sand and

How about a week in the Caribbean just about now? Madly impulsive and fabulously expensive? Madly impulsive, that’s for you to say; expensive, really not. We searched six islands in the Caribbean and also the Pacific Coast of Costa Rica for attractive places with kitchenettes that you could jet off to without breaking the budget. One will set you back about $140 a day; the priciest comes in at less than $200, double occupancy including airfare. The rates here are per person for seven nights, return trip, based on availability at the time of writing in early December for mid-January dates. We used Expedia.ca because of its variety and competitive pricing, but rates change so book early. If you’re used to going five star, these are not for you. If you like places where you call the staff by their first names and they can tell you where to get the best fish, you’re in luck. One caveat: we didn’t visit each hotel, though they’re all in locations we have visited. We did comb through guest comments on Expedia.ca, TripAdvisor.com and the hotel sites themselves. There is some suspicion that Internet comments have to be taken with a grain of salt. Fair enough. It’s possible that owners turn themselves inside out to get good ratings, including having their friends and relatives post glowing reviews. Maybe, maybe not. The aggregator sites themselves now make considerable effort to keep comments legit and many hotel managers now answer negative comments online. Do your research and satisfy yourself before you book. One more thing: if Internet and TV are important to you, make sure they’re offered at a speed and quality that are up to your standards.

Rondel Village, Negril, Jamaica.

Barbados The island is, once again, a favourite among Canadians and the Plum Tree Club offers excellent value. It’s on a golf course a short walk from Rockley Beach and the units have kitchenettes. A little dated perhaps, but there’s a grocery store close by and the staff is friendly. Starting at $1090 per person for seven days. plumtreeclub.com.

Antigua For white-sand beaches, Antigua can’t be beat and the Catamaran is right on such a beach. Open-plan rooms are spacious and nicely furnished. Some balconies have hammocks. There’s a restaurant on the water where the food gets good reviews. Or save the expense and cook for yourself in your own well-stocked kitchen. From $1127. catamaran-antigua.com.

Exuma

Catamaran, Antigua.

Doctor’s Review • DECEMBER 2014

Exuma in the Bahamas hosts almost as many who arrive on their own boats as it does tourists who fly in. Off the usual tourist map, there’s some sense that you’ve arrived on an island that pirates used to call home. It’s a place to do your own thing. Snorkel, scuba, kayak. Hideaways at Palm Bay is comfortable and on a protected beach across from an island that makes for great exploring. Have a meal in the restaurant now and then, but plan to use your kitchenette to prepare your own. From $1365. hideawayspalmbay.com.

savings

Compass Point Dive Resort, Grand Cayman.

St Lucia

Costa Rica

Many consider St Lucia the most beautiful island in the Caribbean. The Ginger Lily, a short stroll from Reduit Beach, is a good place to be part of that beauty. Commodious mini apartments with kitchens are kept spotless. Ground-floor units have terraces with hammocks. Shady areas in the garden around the pool are a good place to be in the heat of the afternoon. The only sound at night comes from frogs and crickets. From $1001. gingerlilyhotel.com.

Hotel La Posada at Hacienda Pinilla is on the Pacific Coast, 190 kilometres north of San Jose. It’s one of three properties set on 1820 hectares with a jungle and monkeys and a beach club nearby. Many of the units have kitchens ($30 extra a day) and are also offered as time-shares. The onsite restaurants are good, but pricey. Part of the Marriott group, the hotel offers high-speed Internet. Plan to rent a car; you’ll want to visit other parts of the country. From $1043, breakfasts included. haciendapinilla.com.

Jamaica Rondel Village is a good choice in popular Negril. There are several buildings on the lush property that open on a long beach. waves areMasciotra warm and gentle, and chairs and towels To TheClaudia are provided. Ask for a unit overlooking the pool with an ocean view. Big balconies add to the charm. The food at the onsite For Doctor’s Review December 2014 issue restaurant is good and there are other recommended places to eat in the area. You can also shop at one of the small Fax stores 1-855-861-0790 grocery and prepare your own food. Guests refer to a holiday here as “laid-back” and “off-the-beaten-track.” From $1129. rondelvillage.com.

BRITISH ISLES CME CRUISE July 15 - 27, 2015

X annual Update in Medicine

with 2 days in Edinburgh for British Open

Grand Cayman This is the best scuba-diving island in the Caribbean. Compass Point Dive Resort has four dive boats so it makes an ideal base if that’s your passion. But don’t go away if you don’t scuba. The hotel is tucked on the far side of the island and offers a truly peaceful sojourn. Many of the large units are owned by others and managed by the hotel. There are full kitchens and even washers and dryers. The small private beach caters to those who thrive on quiet. From $1268. compasspointdiveresort.com.

2015 CME CRUISES Jan 16 - 30 Feb 3 - 24 Mar 14 - 22 Mar 18 - 28 Apr 20 - May 1 May 28 - Jun 9

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call today 1-888-647-7327 DECEMBER 2014 • Doctor’s

Review

GLYCEMIC CONTROL WITH CONFIDENCE

GLYCEMIC CONTROL WITH

ONGLYZA

KOMBOGLYZE®

Demonstrated long-term HbA1c reduction vs placebo, both in combination with metformin over 102 weeks HbA1c mean change from baseline:1*



At week 24: -0.7% for ONGLYZA + metformin (n=186) vs 0.1% for placebo + metformin (n=175, 95% CI -1.0, -0.6, p≤0.0001)



At week 102: -0.7% for ONGLYZA + metformin (n=31 observed, n=184 LOCF) compared to placebo + metformin (n=15 observed, n=172 LOCF)

The convenience of a ﬁxed dose combination of saxagliptin with metformin2

KOMBOGLYZE is indicated for use: as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are already treated with saxagliptin and metformin or who are inadequately controlled on metformin alone. Consult the product monograph at www.azinfo.ca/ komboglyze/pm566 for important information about:  Contraindications in type 1 diabetes mellitus, metabolic acidosis including diabetic ketoacidosis, history of lactic acidosis, renal disease or impairment, excessive alcohol intake, moderate and severe hepatic impairment, hypoxic states, stress conditions, severe dehydration, pregnancy, breastfeeding and radiologic studies involving iodinated contrast materials  The most serious warnings and precautions regarding lactic acidosis  Other relevant warnings and precautions regarding pancreatitis, risk of hypersensitivity, patients with congestive heart failure, reduced vitamin B12, use during surgical procedures, CYP 3A4 inducers, immunocompromised patients, rash and renal function  Conditions of clinical use, adverse reactions, drug interactions and dosing instructions The product monograph is also available by calling us at 1-800-668-6000.

AstraZeneca Canada Inc. Mississauga, Ontario L4Y 1M4

There have been no clinical efﬁcacy studies conducted with KOMBOGLYZE tablets; however, bioequivalence of KOMBOGLYZE with coadministered saxagliptin and metformin hydrochloride immediate release tablets was demonstrated.

09/15

ONGLYZA is indicated in patients with type 2 diabetes mellitus to improve glycemic control in combination with: metformin when metformin used alone, with diet and exercise, does not provide adequate glycemic control. Refer to the page in the bottom right icon for additional safety information and a web link to the product monograph discussing:  Contraindications in diabetic ketoacidosis, diabetic coma/ precoma and type 1 diabetes mellitus  Relevant warnings and precautions regarding patients with congestive heart failure, exposure to stress, CYP 3A4 inducers, lactose, risk of hypersensitivity, pancreatitis, immunocompromised patients, rash, pregnant or nursing women, moderate to severe renal impairment and ESRD  Conditions of clinical use, adverse reactions, drug interactions and dosing instructions In addition, the page contains the reference list relating to this advertisement.

Seepage additional information on page XX See XX additional safety information 55 forsafety

GA D GE T S by

T he o S a n d s

Listen up now Earbuds have their place when you’re in public, but sticking things in my ears is not my favourite activity. In private spaces I want to hear the music unimpeded and share it with those in the room if they’re so inclined. I was an early adopter of mini, wireless speakers. I bought an HMDX jam when they first came out and use it all the time. The sound is solid, but battery life is lacking. It runs for as little as 2½ hours before needing to be recharged. And it doesn’t have speakerphone capabilities. The Buckshot Bluetooth Speaker by Outdoor Tech is about the size of a pepper shaker but it comes with big features. You can play music, skip songs, adjust the volume, and even answer and speak on the phone using one of three buttons. It works within a range of 9.7 metres from your phone, tablet or computer. On many of these small devices the sound gets choppy as you move away from the source, but it seems to be less of a problem on the Buckshot. Another great feature: on a full charge the lithium-ion battery can power it for a staggering 16 hours of play and talk time. Sound quality and volume are significantly better than the built-ins on cell phones and the microphone allows for clean, crisp phone conversations. It’s also a tough little guy with a waterproof, rubberized exterior that will take a lickin’ and keep on tickin’, as Timex once boasted of their watches. Strap it on your bike with the included attachment or throw it in a knapsack and sing along with “The Happy Wanderer” as you hike along those mountain trails. It comes in four colours: black, green, blue and red. $50. Check it out online at chapters.indigo.ca. Some brick-andmortar stores also carry it.

history of medicin e by

Tilke Elkins

Planet of the blues?

It seems to be human is to suffer from depression — and women suffer more “The fog is like a cage without a key.” — Elizabeth Wurtzel

epression in humans probably began shortly after Adam and Eve were cast out of the Garden of Eden

— reason enough to be depressed. By the time the Greeks showed up, withdrawal from social interaction, excessive sleeping, inadequate eating, suicidal thoughts and relentless despair were common. The condition was ascribed to an imbalance of the four humours — phlegm (water), blood (air), yellow bile (fire) and black bile (earth). An excess of black bile or malina chole — was blamed for a litany of woes, including anxiety and listless behaviour. Hippocrates, took it further by suggesting that in addition to black bile melancholia was a condition of the brain. Always early off the mark, he was also noted postpartum depression and speculated that lochial discharge — the fluid that comes from the uterus after a birth — if suppressed, could flow into the head and result in agitation. Virginia Woolf, now recognized as one of the greatest English writers of the 20th century, was overwhelmed by depression at age 59 and drowned herself in 1941.

Some men were depressed because they claimed their penises had been stolen by witches

BOdY OR SOUL?

Whether to treat the body or the soul has been a central dilemma from the beginning. Current thinking has it that both can be significant. Hippocrates would have agreed. He recommended a diet of mandrake and hellebores to eliminate an excess of yellow and black bile, but also relied on the curative properties of advice and action — and put them into practice. He cured melancholic King Perdiccas II by advising him to marry the woman he loved which he did and, we’re told, his depression disappeared. Practitioners following in his footsteps were so astute. The post-Hippocratic Philotimus, observing that his depressive patients complained of “a light head, arid, as though nothing existed,” fitted them with heavy lead helmets. Chrysippus of Cnidus promoted cauliflower as a panacea for the blues. september 2014 • D

octor’s

review

The Depression Series in Doctor’s Review AUGUST: Depression demographics SEPTEMBER: The history of depression OCTOBER: Talking to patients about depression NOVEMBER: 10 things to know about depression

FIND THEM ONLINE AT DOCTORSREVIEW.COM DECEMBER 2014 • Doctor’s

Review

For patients with type 2 diabetes

IT’S HERE. NEW JANUMET XR ®

(sitagliptin and metformin hydrochloride modified-release tablets)

The convenience of once-daily dosing

50/1000 mg

50/1000 mg Tablets are actual size.

JANUMET® XR (50 mg/1000 mg) should be taken as two tablets once daily with a meal, preferably in the evening. Please consult the JANUMET® XR Product Monograph for complete dosing information.

JANUMET® XR is indicated as an adjunct to diet and exercise to improve • Most serious warnings and precautions regarding lactic acidosis and excessive intake of alcohol. glycemic control in adult patients with type 2 diabetes mellitus inadequately controlled on metformin or in patients already being treated with the • Other relevant warnings and precautions regarding type 1 diabetes or diabetic ketoacidosis; patient selection and follow-up; pancreatitis, hypoglycemia; combination of sitagliptin and metformin. Consult the product monograph at http://www.merck.ca/assets/en/pdf/products/ JANUMET-PM_E.pdf for important information about: • Contraindications regarding Type 1 diabetes; metabolic acidosis; lactic acidosis; renal impairment; alcohol intake; hepatic dysfunction; cardiovascular collapse and hypoxemia; stress conditions; severe dehydration; hypersensitivity; pregnancy and breastfeeding; radiologic studies (iodinated contrast material) and any surgical procedure.

hypersensitivity reactions; congestive heart failure, hypoxic states; change in clinical status of previously controlled diabetes; loss of control of blood glucose; vitamin B12 levels; hepatic disease; immunocompromised patients; peri-operative consideration; renal disease; skin; caution in elderly patients; should not be used in patients <18 years of age; monitoring of glycemic and hematologic parameters and of renal function. • Conditions of clinical use, adverse reactions, drug interactions and dosing instructions.

References: 1. Data on file, Merck Canada Inc.: Product Monograph - JANUMET® XR, 27 November 2013.

® Registered Trademark of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc. Used under license. © 2014 Merck Canada Inc., a subsidiary of Merck & Co., Inc. All rights reserved. FEB-15-DIAB-1103300-0001

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the top 25 medical meetings compiled by Camille Chin

Canada Charlottetown, PEI May 20-23 36th Annual Scientific Meeting of the Canadian Pain Society canadianpainsociety.ca/en/conference_2015/ index.html

Edmonton, AB May 30-June 3 2015 Annual Conference of the Canadian Association of Emergency Physicians caep.ca/cpdcme/annual-conference

Montreal, QC April 16-18 35th Annual General Meeting of the Canadian Geriatric Society canadiangeriatrics.ca

April 22-26

May 14-16 4th Joint Annual Scientific Meeting of the International Spinal Cord Society and the American Spinal Injury Association iscosmeetings.org

May 28-30 14th Annual Meeting of the Canadian Interventional Radiology Association ciraweb.org/en/for-professionals/meetings/ our-meetings

Toronto’s Art Gallery of Ontario.

2015 Annual Scientific Meeting of the Canadian Society of Nephrology csnscn.ca

Ottawa, ON April 23-25

Vancouver, BC May 20-23

2015 Canadian Respiratory Conference lung.ca/crc/home-accueil_e.php

63rd Annual Scientific Meeting of the Canadian Association of Physical Medicine and Rehabilitation capmr.ca/annual-scientific-meeting

Toronto, ON April 22-25 38th Annual Meeting of the Society of General Internal Medicine sgim.org/meetings/future-meetings

To register and to search 2500+ conferences, visit doctorsreview.com/meetings

Amsterdam, Brasilia, Florence, Hamburg, Honolulu, Istanbul, Madrid, Milan, Paris, Quebec City, San Diego, Seoul, Shanghai, Sydney, Toronto

Go to doctorsreview.com/meetings for conferences in these cities... and many more! DECEMBER 2014 • Doctor’s

Review

doctorsreview.com/meetings access code: drcme

the top 25 medical meetings Around the world Atlanta, GA May 6-9

CRISTINAMURACA / SHUTTERSTOCK.COM

74th Annual Meeting of the Society for Investigative Dermatology sidnet.org/futuresidannualmeetings

Boston, MA April 23-25 2015 International Conference on Eating Disorders aedweb.org Valencia’s Plaza de Toros.

Cape Town, South Africa April 21-24 19th World Congress on Disaster and Emergency Medicine wcdem2015.org

Copenhagen, Denmark May 8-10 14th World Congress of the European Association for Palliative Care eapc-2015.org

Glasgow, Scotland April 17-19 2015 Conference of the European Stroke Organisation eso.kenes.com

Guilin, China May 7-10

Prague, Czech Republic May 6-9

21st World Congress on Controversies in Obstetrics, Gynecology and Infertility congressmed.com/cogichina

22nd European Congress on Obesity eco2015.easo.org

Leipzig, Germany May 12-16 33rd Annual Meeting of the European Society for Paediatric Infectious Diseases espid2015.kenes.com

Lisbon, Portugal May 14-15 EuroPRevent 2015 escardio.org/congresses/europrevent-2015/ Pages/welcome.aspx

The Li River in Guilin, China.

Nashville, TN May 13-17 24th Annual Scientific and Clinical Congress of the American Association of Clinical Endocrinologists am.aace.com

FELYUEZHANGJLE / SHUTTERSTOCK.COM

Nice, France May 14-17 5th International Congress on Neuropathic Pain neupsig.kenes.com

To register and to search 2500+ conferences, visit doctorsreview.com/meetings

Doctor’s Review • DECEMBER 2014

San Francisco, CA May 2-6 2015 Annual Clinical and Scientific Meeting of the American Congress of Obstetricians and Gynecologists acog.org/About-ACOG/ACOG-Departments/ Annual-Meeting

Tokyo, Japan April 15-18 8th International DIP Symposium on Diabetes, Hypertension, Metabolic Syndrome & Pregnancy comtecmed.com/dip/2015

Valencia, Spain May 14-17 17th Congress of the International Headache Society ihc2015.com

Vienna, Austria April 22-26 50th International Liver Congress easl.eu/_the-international-liver-congress/ general-information

May 13-15 24th European Stroke Conference eurostroke.eu

ethinyl estradiol 10 mcg/ norethindrone acetate 1 mg and ethinyl estradiol 10 mcg

Introducing Lolo ™

A new low-dose combined oral contraceptive with 10 mcg of ethinyl estradiol * 1

*Any benefits from the lower estrogen exposure provided by Lolo have not been evaluated. 1

Lolo offers the lowest ethinyl estradiol dose of any combined oral contraceptive in Canada * 2

Indication and clinical use: Lolo is indicated for the prevention of pregnancy. The safety and efficacy of Lolo have not been evaluated in women with a body mass index >35 kg/m2 or in women <18 years of age. Lolo is not indicated for use before menarche or postmenopause. Any benefits from the lower estrogen exposure provided by Lolo have not been evaluated. Contraindications: Women with: • History of (or actual) thrombophlebitis or thromboembolic disorders • History of (or actual) cerebrovascular disorders • History of (or actual) myocardial infarction or coronary artery disease • Valvular heart disease with complications • History of (or actual) prodromi of a thrombosis • Active liver disease, or history of (or actual) benign or malignant liver tumours • Known or suspected carcinoma of the breast • Carcinoma of the endometrium or other known or suspected estrogen-dependent neoplasia • Undiagnosed abnormal vaginal bleeding • Steroid-dependent jaundice, cholestatic jaundice, history of jaundice of pregnancy • Any ocular lesion arising from ophthalmic vascular disease • Known or suspected pregnancy • Current (or history of) migraine with focal aura • History of (or actual) pancreatitis if associated with severe hypertriglyceridaemia • Presence of severe/multiple risk factor(s) for arterial or venous thrombosis

08/15

Most serious warnings and precautions: Smoking: Cigarette smoking increases the risk of serious cardiovascular events associated with the use of hormonal contraceptives. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked. For this reason, Lolo should not be used by women over the age of 35 who smoke. Sexually Transmitted Infections (STIs): Patients should be counselled that birth control pills DO NOT PROTECT against sexually transmitted infections (STIs) including HIV/AIDS. For protection against STIs, it is advisable to use latex or polyurethane condoms IN COMBINATION WITH birth control pills. General: Patients should discontinue medication at the earliest manifestation of thromboembolic and cardiovascular disorders, conditions which predispose to venous stasis and vascular thrombosis, visual defects (partial or complete), papilledema or ophthalmic vascular lesions, severe headache of unknown etiology or worsening of pre-existing migraine headache, or increase in epileptic seizures. Other relevant warnings and precautions: • Potential increased risk of breast cancer, cervical cancer, hepatocellular carcinoma • Predisposing factors for coronary artery disease • Hypertension • Diabetes • Adverse lipid changes • Crohn’s disease, ulcerative colitis • Vaginal bleeding • Fibroids • Jaundice, gallbladder disease, hepatic nodules • Angioedema, ﬂuid retention • Risk of thromboembolic complications after major surgery

• History of emotional disturbances • Amenorrhea • Reduced efﬁcacy (due to missed dose, gastrointestinal disturbances or concomitant medication) • Chloasma • Pregnant women • Physical examination and follow-up For more information: Consult the Product Monograph at www.lolocanada.ca/ lolo/pm for important information regarding adverse reactions, drug interactions and dosing information (particularly in regards to dose intervals not exceeding 24 hours) not discussed in this piece. The Product Monograph is also available by calling Actavis Specialty Pharmaceuticals Co. at 1-855-892-8766. References: 1. Lolo™ Product Monograph. Warner Chilcott Canada Co. December 10, 2013. 2. 2012 Hormonal Contraception Available in Canada. The Society of Obstetricians and Gynaecologists of Canada. Available from: http://sogc.org/news_items/hormonal-contraceptioncomparative-chart-now-available-2/. Accessed May 13, 2014.

ethinyl estradiol 10 mcg/ norethindrone acetate 1 mg and ethinyl estradiol 10 mcg

H I S T O R Y O F M E DI CI N E by

R os e F os t e r

Sex: where would we be Part I: from bonobos to Lesbos

ex has a way of slipping between the cracks of recorded history, as it were, a deliciously hidden and elusive creature — and that seems to be the way we like it. As Honor Beddard, the curator of The Institute of Sexology — Undress your mind, an exhibition which opened in November in London, puts it, “Each generation likes to think that it invented sex.” She has a point. Few of us get off on images of our unsmiling, partially clad great-grandparents engaged in unspeakable acts and yet, to each generation, sex and its great power feels inherently rebellious and defiant. Exactly how sex makes it into the annals of recorded history depends very much on the eyes of the beholder. Nowhere else do historians betray their lack of impartiality as thoroughly as when describing the sexual practices of the past. Cultures oscillate between poles of prurience and excess, historians have little trouble in finding examples to fit their prejudices.

LOVE FOR ALL Bonobos make affection a way of life.

Survival depended on equal sharing of everything, perhaps sexual partners most of all

Doctor’s Review • DECEMBER 2014

An example of finding behavior to fit your prejudices is the current bestseller Sex at Dawn: The Prehistoric Origins of Modern Sexuality by Christopher Ryan and Dr Cacilda Jethá. They postulate that pleistocene man didn’t have the struggles we face today with sexual infidelity, broken homes and sky-high divorce rates. They ascribe these deficiencies to the practice of monogamy. For most of the 200,000 years of human life on this planet, they point out we lived in small communal groups of fewer than 150 where survival depended on sharing. In this one-forall, all-for-one society, there was no possessiveness, no individual ownership of anything, least of all each other so there was no cause for jealousy or distress. No woman could be sure which of her many lovers had fathered her child. The practical consequence was that men treated each child as his own. Paternity couldn’t matter less. The book continues that we human-apes are closest to chimpanzees and those other furry creatures called bonobos, known affectionately in pop culture as the “love-monkeys”

without it? for their excessive, playful promiscuity, and with whom we uniquely share oxytocin, the so-called love hormone. In such a culture, say the authors who are strong supporters of Darwinian evolution, where there is no overt competition among males for female mating, competition occurs on the cellular level in the ovaries between sperm. In the great sperm race only one winner gets to fertilize the egg. One bit of evidence they cite — and there are many — is the shape of the glans of the human penis, the ridge of which, they suggest, has evolved to suction out the semen of a previous lover.

SEX BY THE BOOK All of the world’s major religions, themselves a product of the agrarian lifestyle with its stress on individual ownership, uphold marriage as the only appropriate context for sexual relations. The first recorded information about sex comes from the ancient texts of Hinduism. Though the higher-ups in ancient India seem to have been allowed some sexual freedom, the population in general were encouraged to think of sex as exclusive to marriage where men and women were expected to pleasure each other equally. And lest they need instruction the India is the birthplace of tantric practice.

Geishas were known for their many artistic talents.

Kama Sutra, arguably the most widely read secular text in the world, provided an excellent education. India is also renowned as the birthplace of Tantra, a spiritual practice that may or may not involve sexual intercourse. Contrary to Western opinion, this path to spiritual enlightenment does not of necessity involve slow, sustained sex. One sacred text, the Yoni Tantra, states that: “there should be vigorous copulation.” Be that as it may, other spiritual seekers in India renounced sex altogether as an impediment to enlightenment, an idea also common to Buddhism and one that would resurface with the advent of Christianity.

India received its sex instruction from the Kama Sutra, perhaps the most widely read secular text in the world COMMIE PRUDES The ancient Chinese were blunt and to the point: according to the I Ching, the world began with sex, when Heaven bedded down with Earth. The history of Chinese sexuality is suitably lush and varied, filled with a rich palate of behaviours — dalliance, marital bliss, homosexual alliances, goofy bawdiness and affection. In contrast, the communist regime has been repressive on matters sexual. Citizens are encouraged to refrain from premarital sex and, especially, the “decadent capitalist phenomenon” of homosexuality. DECEMBER 2014 • Doctor’s

Review

The Greeks considered massive instruments of manhood unseemly, even barbaric

Sappho and Erinna in a garden at Mytilene by Simeon Solomon (1864).

PENIS ART Many cultures have practiced same-sex love, often without applying a label to it as such. Love between boys and men was an important part of ancient Greek society, where it was known as paiderastia, meaning “boy love.” Older men, called erastes, were mentors to their young lovers, who were usually between the ages of 12 and 17. The senior took on the responsibility of protecting, educating and providing a role model for his eromenos, as they were called. The relationship ranged from chaste to fully sexual. Intercrural sex — non-penetrative sex wherein one partner places his penis between the other partner’s thighs — was considered more noble an act than anal sex. Penises were big in Greece — figuratively, that is. The symbolic, disembodied phallus, oft referred to as a herma, was a symbol of fertility that appeared ubiquitously in art and architecture, but in the bedroom, not so much. Massive instruments of manhood were considered unseemly, even barbaric. One unfortunate minor god, Priapus, was born with a huge

member but cursed with infertility and unceremoniously chucked off Mount Olympus to be raised by shepherds. This attitude explains the discrete, almost dainty penises found in most Ancient Greek sculpture. Actual virility in an individual was correlated with a man’s moral and intellectual being. Marriage as a vehicle for bearing legitimate children was in full flower among the city states, but some women, often former slaves, played very different roles. Hetaira were financially independent, educated women who functioned as courtesans much like Japanese geishas, often admired more for intellectual rather than sexual prowess. They took part in the symposia, where their opinions were valued and respected and, like the men, they were required to pay taxes. Brothels of all kinds were seen as an integral part of Greek democracy and had many laws that governed them. The Pornai were prostitutes on the bottom of the scale and offered sex on the cheap, while temple prostitutes in Corinth were seen as servants of the gods. Hetairistrai, or “she-minions,” were women who preferred to service women. The earliest known mention of female homosexual practices globally is made in the Babylonian Code of Hammurabi, which dates from 1745 BCE. The reference is to women called the salzikrum or “daughter-men,” women who were allowed to marry other women. The Western moniker, “lesbian,” after the Greek lyric poet Sappho who made her home on the island of Lesbos, was a construct of the 19th century. Early sexologists categorized lesbians as women who did not adhere to female gender roles and deemed them mentally ill. Until then, the word lesbian referred to any derivative of the island of Lesbos, including a type of wine. Coming next issue: human sexuality, Part 2: masturbation to liberation.

Sex can be counted on as a topic that sells books.

Doctor’s Review • DECEMBER 2014

D E P R E S S I O N K E Y P OI N T S by

Christopher Lane

small “cures” for post-holiday depression

For many, the holiday season can be more depression than delight. Overeating and drinking, big spending and forced jollity combined with memories of old hurts on these festive occasions means, for some, grey weather, both inside and out, that lingers well into the new year. While suicide rates are generally lower in December, a host of studies show that there is a marked rise in January. Clearly, some of your patients struggle more than others at this time of year. Physicans and their families are not immune either. Fortunate is the doctor who has not had firsthand experience with depression or helped a colleague who has. Here are a few suggestions from the Canadian Mental Health Association and the CMA that may offer some relief. Don’t be a stranger Loneliness is a significant cause of post-holiday depression. Take a special interest in those in your practice who have recently lost someone or who live alone. The holidays are a time for friends and family, and those who don’t have people around with whom to share the season can feel it sharply. Make a point of asking those who you suspect might be lonely how their holiday went. Be sincere and probe a little, they may be reluctant to talk about it at first. Watch out for simmering disputes Family can help keep depression at bay, but they can also be the cause. Holidays often bring conflicts up that cannot be easily put back in the box. The immediate post-holiday period is not the optimum time to deal with these potentially explosive issues. Let the stress ease off a little before confronting these problems. Spring usually lifts the spirits. Eat properly Indulgence runs rampant over the holidays. Too much fat, sugar, salt and alcohol take their toll. Though it’s become such a cliché that it’s easy to discount, eating more fruit and vegetables is a simple way to combat dark moods. Encourage patients to make resolutions to eat better — and to keep them. Suggest, for example, that they reduce the number of meals they eat out and to cook more at home. The new year is also a good time to experiment with “new” diets from vegetarian to vegan to paleo to cutting out gluten and so help fight that insidious disease caused by “grain brain.”

Drink lots of water Dehydration and depression are frequently linked. Without sufficient water we become cranky, lethargic and prone to headaches. Thirst can also masquerade as hunger. Though some recent research suggests that coffee, tea and sports drinks can act as substitutes, water remains the thirst quencher of choice in the literature. Budget now The holidays are expensive. We often take the restraints off our credit cards and spend, spend, spend. The money hangover can last for months. There’s virtue in setting a budget and keeping to it. Watching where the dollars go gives individuals a sense of control and can point the way out of the debt tunnel. Say “no” Individuals who are feeling overwhelmed often don’t know how to cut back on demands on their time and energy. Encourage such individuals to do less not more, to regroup and find time for themselves to do activities they enjoy. Physicians are particularly prone to saying “yes” all too often. Exercise, what about it? It’s usually at the top of most resolution lists, but few stick with it. For someone who is suffering from depression exercise is doubly important. Easier said than done. Keep it simple and doable. One way to do it: don’t spend money on equipment or a gym membership, instead simply walk more. Just 30 minutes of brisk walking a day can make a difference in your mood. Some who have trouble sleeping report benefits from a walk and a shower before they go to bed. Take time out Setting aside time to do nothing at all can be beneficial, as can listening to calming music, walks in nature, cloud or stargazing, deep breathing exercises, meditation and yoga. Individuals who stick with any of these long enough can more easily rise above their lethargy. DECEMBER 2014 • Doctor’s

Review

Snow day Four ski resorts in Vermont for food and fun

STOWE MOUNTAIN RESORT / BROOKE KALTSAS

by Margo Pfeiff

acked. Powder. Packed. Powder. My favourite two consecutive words drummed like a mantra in time to my wipers dispersing a swirling flurry of snowflakes from the windshield. It was early

January and I was following the tail end of a monster blizzard from the laid-back lakeside university town of Burlington eastward for an hour to Stowe where my buddy and I were kicking off a week of skiing around Northern Vermont. Drawing back the curtains the next morning at Stowe Mountain Lodge, I was blinded by a “bluebird day,” fairyland forests of “snow ghosts” — alpine trees heavy with the white stuff — starkly white against an indigo sky. From a vantage point atop Mount Mansfield, Vermont’s highest peak at 1340 metres, we peered down on a zigzag network of 116 runs

Doctor’s Review • DECEMBER 2014

blanketed in packed powder and unpacked glades with views of the Adirondacks to the west and New Hampshire’s hefty White Mountains to the east. It was my first ski day of the season and by the time I tucked into a steaming, pork belly, twice-baked potato lunch at the summit Cliff House bistro, I could hear nothing over the screaming of my thighs. As an ex-West Coast Whistler ski-brat who moved to southern Quebec years ago, I soon learned to sharpen my edges for Eastern skiing from New York to Maine. Jay Peak, Vermont’s northernmost of 19 downhill resorts is just south of the border. Then

The kids’ programs at Stowe are at Spruce Peak, which will be getting a new ice rink and adventure centre soon. There’s special camaraderie among the skiers at Mad River Glen, the only cooperative-owned mountain in the US.

ALL PHOTOS MARGO PFEIFF UNLESS OTHERWISE NOTED

ys STOWE MOUNTAIN RESORT

There are 116 trails at Stowe that get blanketed with an average of seven metres of snow a year.

there’s 1425 cross-country ski kilometres in 30 Nordic networks as well as the almost 500 kilometre Catamount Trail that runs the length of the state. While my recent trip was prompted by reports of that looming blizzard, the foodie in me was also eager to head south of the border after a long absence: I had recently learned that Vermont (population: 625,000) not only has more cheesemakers and micro-breweries per capita than any other state, but that Vermonters also spend the most on locally-sourced groceries — 39 cents of every food dollar. Cheese, craft beer, local noshing and powder? Sign me up. Vermonters love their snow. It’s the number 1 state in the East for skier visits with an average of 4.1 million per season: third in the US after California and Colorado. With the highest ski resort count in New England, the hills are renowned for their diversity:

big mountains like Killington and Stowe and advanced, ungroomed terrain such as gnarly Mad River Glen and lots of toddler-friendly family resorts. OK. So they aren’t the Sierras, but they have decent descents with excellent snowmaking and grooming and, best of all, lineups are rare especially on weekdays. Recently, Vermont resorts spent more than $38 million upgrading downhill and Nordic resorts, much of it on enhanced, greener snowmaking. Eastern peaks don’t enjoy the West’s lofty altitudes to keep icy slopes at bay, nor do they wallow as often under giant powder dumps, but the skiing is good, especially fresh packed powder. For me, skiing is the icing on the cake of any Vermont visit. While the leaf-peeping season is spectacular and the state’s busiest tourist-time, I love New England when its photo-ready villages are DECEMBER 2014 • Doctor’s

Review

There are only two single chair lifts in North America. One is in Alaska, the other at Mad River Glen.

The breakfasts and lunches at the Warren Store deli feature locally produced ingredients.

I love New England when its photo-ready villages are blanketed in white, pointy church towers, covered bridges ’n’ all blanketed in white, pointy church towers, solid Yankee town halls, covered bridges ‘n’ all. In March, during spring skiing, maple sugar shacks steam during a statewide sugaring-off festival, but you can taste all things maple any time of the year from the crème brulée at Stowe’s Green Mountain Inn to Sapling’s Maple Liqueur which snatched gold at San Francisco’s 2011 World Spirits Competition. Stowe, with its speedy gondola that climbs 650 metres of vertical, is Vermont’s second biggest resort and it’s come a long way since 1933 when its trails were cut by the Civilian Conservation Corps and it established the nation’s oldest ski patrol. Environmental award-winning Stowe Mountain Lodge (SML) at the base was built in 2008 as a sustainable luxury village with a 300-room hotel, condos and a concert hall, and it’s set to become bigger. “Bostonians and New Yorkers are increasingly balking at flying to ski in the West with its stopovers and winter delays,” said Leslie Kilgore of SML. “So we’re aiming at becoming the Vail or Aspen of the East.” The base is 10 kilometres by free shuttle from Stowe Village — classic New England with a Heidi-ish feel in its Edelweiss Convenience Store, Innsbruck Inn, Matterhorn bar and Trapp Family Lodge, America’s first cross-country ski area started by the Austrian von Trapp family of The Sound of Music fame. Sam von

Doctor’s Review • DECEMBER 2014

Trapp, grandson of the original Maria, and a former Aspen and Chile-based ski instructor, runs the inn with its 60 kilometres of groomed trails — with old Slayton Pasture Cabin in the forest for hot soup — as well as backcountry and tamer “side-country” trails. Like most resorts, Trapp is into local cuisine. “The family makes its own cheese, we raise our own grain-fed cattle and,” said Sam, stoking their Nordic centre fireplace, “we have a ski-in, ski-out microbrewery.” Before leaving Stowe we stopped for lunch at Crop Bistro & Brewery, the latest of more than two dozen Vermont craft breweries. On the front door was the familiar “Vermont Fresh Network” logo, a farm/chef partnership that flags establishments dedicated to serving local products. Like almost every menu I unfolded in the state there was a roll call of artisan food producers from baker and maple sugarer to trout supplier.

e headed 50 kilometres south on scenic rural Highway 100, which travels the length of the state, through the town of Waterbury, where Ben & Jerry’s headquarters is an ice-cream theme park, and past red barns slouching with age or enjoying new careers as inns or performing arts centres. Even the base lodge of

According to the readers of SKI magazine, Smugglers’ Notch is the best overall resort in the Eastern US.

DECEMBER 2014 • Doctor’s

Review

Lift tickets were just US$5.50 when the Sugarbush Resort opened in 1958; they cost US$84 each today.

I tucked into a steaming pork belly and potato lunch, and could hear my thighs screaming Sugarbush Resort, Clay Brook, is a stylized big red barn complete with rooms in a modern silo, all built in 2008. A classic old schoolhouse is the kid’s skischool and daycare, and the locally-sourced Timbers Restaurant was fashioned after a round, 19th-century Vermont dairy barn. Sugarbush at 1212 metres tops New England’s verticals with a skiable drop of 807 metres on 111 trails over 85 kilometres of slopes, which we often had all to ourselves. There are two peaks with Castlerock offering steep, narrow, winding New-England-style routes and more wide-open Mount Ellen. We skied-onskied-off every one of its 16 lifts, but failed to encounter any of the moose sometimes spotted on the slopes. Nearby was Warren, a tiny Vermont village with a church, town hall and the unique Warren Store where a “Breakfast Club” of old timers gathered next to the pot-bellied stove in the old 1839 stagecoach stop halfway between Boston and Montreal. Manager for 33 years, Jack Garvin took me upstairs where clothing and Vermont art are sold, then through the all-things-homemade kitchen that dishes up what SKI Magazine rates one of America’s top five ski breakfasts. The former stables-turned-bakery

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Pet-friendly ski resorts in Mont-Tremblant. doctorsreview.com/features/marley-and-ski Doctor’s Review • DECEMBER 2014

out back also produces bread and desserts for the Greek-revival style Pitcher Inn, a Relais & Château lodging across the street. “Every room has a Vermont theme,” said Garvin. “The Ski Room is full of memorabilia from Mad River Glen, even the original ticket booth.”

ad River Glen, just 15 kilometres away, was our next stop and my thighs were quivering with fear. It’s an iconic ski hill that was created in 1947 by former Stowe skiers and other investors including members of the Rockefeller family. America’s only co-op-owned mountain is a haven for ski-bum purists: all natural snow through narrow glades, no grooming. Snowboarders need not apply. Of its four chairs, one is a single, one of only two in America (the other is in Alaska). After six runs ranked by SKI magazine as the East’s most challenging, I was in the retro bar that took me back to my childhood skiing days sipping a rare on-tap Lawson’s Finest Liquids international award-winning beer made in Warren. “It’s a small mountain, but it really kicks ass,” said a fellow baby-boomer beside me. No wonder Mad River’s motto is “Ski it if you can.” There was one more mountain to ski and one more hard-to-find micro-brew I needed to sample

on tap only at the Prohibition Pig resto-brewery in Waterbury. From there it was one hour north on Highway 100 past sugar shacks and farmhouses to the family-oriented Smuggler’s Notch. “Smuggs” has the second highest snowfall average in Vermont — over eight metres — after Jay Peak to the north. From the 1109-metre summit, I could see Stowe’s runs, separated by a summer-only, 18-kilometre zigzag “notch” (mountain pass) road used by smugglers since an 1807 Thomas Jefferson embargo against the British. It was also part of the Underground Railway for slaves escaping to Canada and during Prohibition. Smuggler’s Notch sprawls across three mountains and the resort is comfy, casual condo-only, perfect for countless families who bring their kids here for ski schools. There’s also a winter Via Ferrata, ice-canyoning, a Fun Zone, zip-line and babysitting to keep youngsters busy (in early 2013 SKI magazine voted Smuggs number 1 in the East for the 14th consecutive year for family programs). Meanwhile, parents can enjoy long sweeping runs on 405 hectares of terrain, night snowshoe treks and cross-country skiing. Ski conditions having warmed during a January thaw to just above freezing, we skied in sunshine one last time on a Saturday morning as the base lodge filled with excited three- to five-year-olds snapping onto their first snowboards. It was just a leisurely hour’s drive back to Burlington, but first it was time for lunch at the resort’s Morse Mountain Grille: a sustain-a-burger washed down with a luscious local Otter Creek Black IPA.

The Trapp Family Lodge was the first cross-country ski centre in the US.

Stowe has three full-day kids’ programs for ages three to 14.

SKI AND STAY A one-day lift ticket at Stowe Mountain Resort (tel: 888-2534849; stowe.com) starts at US$89 for adults. The Cliff House bistro on Mount Mansfield has great views and lunches. Solstice offers a farm-to-table dinner. The five-star Stowe Mountain Lodge (tel: 888-478-6938; stowemountainlodge.com; doubles from US$229), at the base of Mount Mansfield, has a free 10-kilometre shuttle to Stowe. In Stowe Village, the 1833 Green Mountain Inn (tel: 800253-7302; greenmountaininn.com; doubles from US$175) is classic New England style. The Whip is the inn’s cozy post-andbeam restaurant, a local favourite. The Trapp Family Lodge (tel: 800-826-7000; trappfamily.com; doubles from US$225) has 60 kilometres of groomed trails and 100 kilometres of backcountry trails. The Crop Bistro & Brewery (tel: 802-253-4765; cropvt.com) serves creative pub cuisine and has a microbrewery. Adult lifts tickets start at US$84 at Sugarbush Resort (tel: 800-583-6300; sugarbush.com). The Clay Brook base lodge is farm-themed luxury with stay/ski packages from US$160 per person per night. Check the website for more specials. The Pitcher Inn (tel: 802-496-6350; pitcherinn.com; doubles from US$375) is a Relais & Château inn in the village of Warren. The Warren Store (tel: 802-496-3864; warrenstore.com) serves breakfast from 8 to 11am, until noon on weekends. A lift ticket at Mad River Glen (tel: 802-496-3551; madriverglen.com) starts at US$60 for adults. Prohibition Pig (tel: 802-244-4120; prohibitionpig.com) serves locally sourced casual meals and has 24 beers on tap. Adult lift tickets start US$70 at Smuggler’s Notch (tel: 800-419-4615; smuggs.com). For more info on the region, visit Ski Vermont (skivermont. com) and Vermont Tourism (vermontvacation.com). DECEMBER 2014 • Doctor’s

Review

A mark

n Rotterdam, the Dutch seem to favour architecture that looks like something

Your eyes are drawn up, up, up to a ceiling covered with artwork the size of two soccer fields 32

Doctor’s Review • DECEMBER 2014

OSSIP VAN DUIVENBODE

else. Building-sized bathtubs, pencils and a mirrored flowerpots dot the skyline. The newest addition is the Markthal, a huge horseshoe-shaped covered market that’s as elegant as it is arresting. The exterior of the 12-storey arch is graced with the glass balconies of 228 apartments and is sheathed with the same grey granite used throughout the city. In this case though, the architects saved the biggest surprises for inside. Both ends of the building are walls of glass. Entering the enormous enclosed space feels as though you’ve stepped into a wonderland. More than a hundred flower, vegetable, fruit, cheese and fish stalls clamour for attention yet your eyes are drawn up, up, up to a ceiling covered with artwork the size of two soccer fields. Enormous strawberries, raspberries and cherries fashioned from 4000 panels

The $250-million project attracted more than a million visitors in the first three weeks. LEFT: “The Horn of Plenty” by Dutch artist Arno Coenen features enormous fruits and vegetables.

ket like no other

Grazing through Rotterdamâ&#x20AC;&#x2122;s new grocery wonderland by Karan Smith

One of the penthouse owners tells people “I live at the raspberry!”

Doctor’s Review • DECEMBER 2014

a mini-pancake smothered in butter and icing sugar. The classic treat arrives warm, fluffy and decadent. Munching as I go, I notice shoppers pausing at a stall named Buutegeweun, whose products echo the produce floating high above. Squash and apples share the space with traditional cookies, and around the corner there’s goat cheese and hanging cured sausage. Cod, sole and brill glisten on beds of ice. Everything here comes from a cooperative from the island of Goeree-Overflakkee, south of Rotterdam. I get in line behind two older women who purchase purple-fleshed potatoes and wait while the clerk obligingly takes the money from the customers purse. I’ve finally settled on an apple tart mix that I can take home and bake in my kitchen in Ottawa. “It’s a classic recipe, everyone’s grandmother makes it,” she explains, “and everyone says their grandmother’s tart is the best,” she adds with a twinkle.

KARAN SMITH

float in the air; a caterpillar climbs the stem of a flower; in the centre, a pineapple, a blue butterfly and a fish gleam in the rays of the sun. Dutch artist Arno Coenen created the work he calls “The Horn of Plenty” inspired by cornucopias overflowing with produce and flowers, and also by the popular kids’ movie Cloudy with a Chance of Meatballs in which food falls from the sky like rain. “We asked them to create a sky for this covered urban space,” says Anton Wubben of the Rotterdam architectural firm MVRDV, who has seen construction of the project through the five years it took to complete. The city-initiated project intended to revitalize the area, cost $250 million. “We needed to create a symbiosis between shopkeepers, apartment dwellers and those who live and work in the city surrounding the market,” explains Wubben. The commercial space has the feel of a gigantic farmer’s market, but it also includes Albert Heijn, the largest supermarket chain in Holland. “You still need a place to buy diapers,” says Wubben pointing out that it strengthens the retail mix. The Markthal opened on October 1. In the first three weeks more than a million people visited. They came to ogle the latest architectural star in this modern, cultured port city and many also took the chance to sample a slice of what’s reputedly the country’s best apple cake. Looking up I can see workmen through windows that are designed to look like grains of wheat and floating cherries. Wubben offers a tour of the unique living quarters. On the way he says one of the penthouse owners tells people “I live at the raspberry!” Wubben smiles. “I find that such a beautiful way of explaining where you live.” Living at the cherry, pea or pumpkin is an enchanting prospect but I’m hungry and anxious to explore so I return to the hive of activity below. The stalls are a mix of fruit, veggie and cheese shops, bakeries, butchers, florists and a host of take-out counters. There are towers of meticulously stacked apples; cheese wheels stored in neat shelves like art books; a row of stools at a tapas bar. Another stall sells Markthal shopping bags and a host of other products emblazoned with Horn of Plenty designs on everything from men’s shoes to beanbag chairs. In a novel use of space, short staircases throughout the mall lead to “green” dining areas. In October there was even a field of tomatoes. The smell of baking leads me to the electric-lit sign of Churros & Sweets where I order the poffertjes,

Horn of Plenty designs can be found on everything from men’s shoes to beanbag chairs.

GET SHOPPING Markthal (298 Ds. Jan Scharpstraat; markthalrotterdam.nl; open seven days a week from 10am to 8pm) offers architectural group tours through Brenda Kamphuis at BK Architecture’s delights (bk@via-bk.nl). For more info on the region, visit Rotterdam Partners (rotterdampartners.nl).

STEVEN SCHOLTEN

The innovative interior puts seating areas on top of the restaurants and cafés they serve.

Wheels of cheese are displayed like coffee-table books.

Popular poffertjes consist of a fluffy minipancake smothered in butter and icing sugar.

DARIA SCAGLIOLA AND STIJN BRAKKEE

Condos have balconies on the exterior and windows that overlook the market’s interior.

The Sahara is roughly the size of the US and stretches across 10 countries including Morocco.

Desert convoy

GERARDVHEMEREN / SHUTTERSTOCK.COM

A woman revisits Morocco’s Western Sahara where a white Mercedes comes to her rescue — again by Erika Connor

he moon is a golden crescent above us. In Morocco’s Anti-Atlas Mountains a blowing smoke and the headlights of the bus dust the edges of the banks and drop off into darkness, thousands of

feet down into clefts and canyons, then long up into the walls above. The shadow hills among us are something living, brown-pelted, knit with bone and bristle and somehow the road climbs its way through them, slowly, slowly to the pass. No barriers, nothing to keep us from falling. And then we descend. At each crest the driver releases the brakes and we are given to God and wind. No one can speak, listening to the wailing wandering song on the radio, the clapping hands and drums of the prayers. At dawn a roadside café appears like a stage set in the night, a bright-lit room of tables, plastic chairs, painted tiles, posters and knickknacks. The cook and a few young boys, a girl waitress, awaken, and the driver and passengers go in. I am not one of them, nor am I alone, standing in the doorway. “Yalla!” someone calls. Come. They are holding up their glasses of mint tea, inviting me. The sea is here, somewhere close. Salt, stench of grilled fish, two dogs skulking on the periphery, a bone in the sand. One takes it in his mouth, then drops it again, afraid. They flinch at the least movement. By morning light the cold mountains are only shadows behind us. We skim along in the heat of a flat gravel desert, riding through bleak towns partitioned off into grids of telephone lines and metal

Doctor’s Review • DECEMBER 2014

towers, cement buildings and houses, factories, desalination plants. Any gardens or colours are held back within walls. Chimneys smoke on the oceanfront, a silver pipeline snakes inland. For long hours between these outposts is the other desert: soft golden expanse patterned with wind rings, smooth as warmed skin. The dunes are the outline and sensual surfaces of giant bodies submerged, sleeping. Blue dust weed is strewn with black plastic. Shale fragments are bleached and porous as bone, some are cairns laid in long lines and patterns. Who built these? And for what? Some are statues facing out to sea. The band of the sea is always on the right shoulder with the lines of chalk cliffs and canyons sun-spotted and speckled. Two old iron ships sag in the surf abandoned. Far away, blowing on the cliffs are tent cities of plastic and cardboard. Men sit on the side of the highway or go walking and disappear over the cliffs, or come from the desert on the other side, come out from nowhere. The bus slows and comes to a stop in the dust. “Voilà, les marins,” the man beside me says as two men get on. Look, the seamen, the fishermen, their dark baked skin lined as the waves on the sea. Every year they come to live here on the desert coast, hauling in the fish from the wild sea.

Hour after hour, on the final stretch to Dakhla, southernmost town of Morocco, the highway runs dark and smooth and straight, bands of sky, sand, sea, perfectly planar, sun and light, rhythmic music moves us in and out of sleep and the desert is always there upon waking. I have been here before. Four years ago it was a bus ride with a dreaded television, some American Kung Fu movie, and people pulled the curtains shut against the sun and I felt enshrined, caught forever in the modern invasive world. When the film ended the curtains were drawn open again and the Moroccan music began, and another film began for me. I saw camels spilling onto the horizon for the first time, blue plastic floating along the ochre earth, glittering glass and locusts. Because I knew nothing then I was blessed. Don’t we always in life try to go back to find those same moments? You never find the same place twice. There were locusts, red-winged, metallic gleam, a shrill song, flying north in clouds, miles thick, hitting the glass panes. When we came to a stop I saw the bus, the shacks, the ground fluttering blood red, alive, and we crushed them underfoot. Later the swarms were gone. All along the way from Tarfaya into the old Spanish Sahara the bus stopped at the police checks, and each time a military man came on board and the driver and passengers turned to look at me. I was the only one who had to get off to show my passport. At the last check in Laâyoune, while I waited in the dust and all the passengers looked down at me through the bus windows, a new green Land Rover pulled in with two white surfboards strapped to the roof. A man came out in a wave of blue robes, head wrapped in white cloth, with dark sunglasses, a gold watch at his wrist, passport in hand. Not a muscle moved in his face as he approached the soldiers. He did not remove his glasses. He was solemn, poised as he spoke the greetings, “Salaam walaikoum,” a show of respect, and a sign that he had been here many times before. He knew what he was doing. He was a parody, a “Lawrence of Arabia” without the conquest, but with the money. He laid two Swiss passports in the hand of the policeman. He had a beautiful boy in the car. The boy smiled, asked me for a cigarette and when I gave him one, he held it to his lips and lit it against perfect white teeth, dark sunglasses, fuchsia head-cloth. Dakhla was full of night soldiers and music, smell of fish and salt, this last outpost filled with wind on the end of a spit of sand. The dark sea and the sands, 350 kilometres to the Mauritanian border and 1500 back to Casablanca. There were no rooms left. But who was here? The soldiers? The tourists? I carried my bag from place to place down the sand streets and found an open café. Sand spilled across

THIS WILL...

PHOTOS THIS PAGE ERIKA CONNOR

“That morning, I met the convoy for the first time on the outskirts of town. Vehicles, all from anoth er era... a crowd of people, mostly European, affected by the light.”

What did they think of me, the Canadian girl, hair wild and unbrushed, alone, awkward, a little lost? the doorway. The place was almost empty and echoed, lit by one bare fluorescent bulb. A man behind the counter was wrapping liquor bottles in bags and men came for them, concealing the bags deep in their hooded woolen jelebas and nylon overcoats, then left quickly. There were three European boys in the corner, their last dirham coins piled in little towers on the table, and bottles of beer. They were Germans. They went quiet and solemn when I came in. It was the North European in them and the North American in me and we hadn’t forgotten. Never trust a stranger. Funny how this feeling comes out when you are among your own kind. I worked hard against it and soon, slowly they were practicing their English and we were laughing. George was a tall Viking, with long trails of blond hair, half tied back, a beard, spectacles, rich laughter. Marcus, in the middle, was pleasant, soft-spoken, wearing Moroccan leather slippers on his bare feet that he kept losing under the table whenever he got up to buy more beer. Manfred had wild hair that looked like an afro. He was small and sour and already drunk. He lit another cigarette, played with his lighter and stared hard at me when I asked them if they were joining the convoy the next day and if I could get a lift. He was protecting this brotherhood and their initiation to the desert. They had each

Doctor’s Review • DECEMBER 2014

brought a Mercedes down from Germany. They were going to drive hard through the desert into West Africa and somewhere in Senegal or Mali, after they had spent their wildness, they would sell the cars off and go back to Europe with their stories. What did they think of me, the Canadian girl, hair wild and unbrushed, alone, awkward, a little lost? I was travelling for six months, maybe more. Where was I going, they asked. I was going to buy a horse in Senegal and ride to Mali. George smiled. Manfred said, “It will take you a long time. What is the purpose of that?” I said it was a dream of mine, for a long time. “A crazy dream,” Manfred said. “No crazier than yours.” “No, ours is different.” George had already decided there was room for me and Manfred did not argue. At midnight he drove us in his white Mercedes, down the long tarmac outside town to the campground. The moon was still high and far when I got up from the clay floor of my little rented shed. Blue luminous light on the open lot, the tents and caravan cars, and cold. The bathroom was open to the sky. I stood at the sink and palmed ice water on my face and there were stars above me in the dawn. Someone opened a camper door and a little dachshund and an old Dalmatian dog came out and sniffed the sands. A woman was sweeping the porch of her caravan, made me feel they were all holding it back, the seas of sand, and were afraid to look up and over the walls to the cliffs, the wide bays, the smooth desert beaches where no one goes because it is a place of nothing. Seas of sand and sea of seas. You could stand out there forever and nothing would ever feel or know of your presence.

I met the young boy of the green Land Rover and surfboards out on the cliffs. He came to me, charmed me for a cigarette, came too close, touched my arm. There was something in his eyes. He pretended innocence, but he knew of his own beauty. I watched him going down to swim, followed by the camp-guardian’s dog. The older man appeared then off to the left, dressed in white cloth and head-wrap. They were Swiss and he was the boy’s uncle. That was what I was told, but I wasn’t sure. He said nothing, walked out into the wind strumming a kora, a West African harp, for the boy who swam far below him into the sea off the desert, and the white dog ran lonely along the strand. All of this comes to me as our bus passes that same campground and I ride into Dakhla a second time. I find a room in the hotel where I could not find one before. And it is Ramadan, all of the shops are barred and dark, with nothing to eat until night. Everyone — only the men, there never seem to be any women — is surly and sleepy. Tourists, in the periphery of my eye, disappear into the maze of streets, distant and unknown. No one wants to be found. The tourists arrive in groups or alone, having found their own ways through the length of Morocco. They come because the Algerian route has been closed for years and this is the only desert passage to West Africa. Twice a week “the convoy” leaves from Dakhla led by a Moroccan military jeep and travels 350 kilometres of dust and desolation to the Mauritanian border across the once disputed zone of the Spanish Sahara. A war went on there for years between Morocco, Spain, Mauritania and the Sahrawi Polisario Front, desert rebels backed by Algeria, Libya and Cuba, fighting for independence. But the mines are still there. How ingenious to hide them in the sands that move in waves, are never still. The same surface cannot be found twice, but the mines do not move. That morning, years ago, I met the convoy for the first time, on the outskirts of town, not far from the campground, on the side of the highway. Thirty vehicles, Renaults, Mercedes, Land Rovers, Jeeps, a red bus, two motorbikes, all from another era, patched and repaired, and metal-worn, roof-racks roped with jerry cans, extra tires, sand-ladders. A crowd of people, mostly European, but one Japanese boy and an African man, and all the colours and styles of their clothes, a theater of army pants, desert boots, plastic sandals, stained and ripped silk shirts, camisoles, greasy T-shirts, head-wraps of black, fuchsia, orange, lime green. So many languages and accents rose from between and around the cars, and different music from sound-systems overlaid one another. Everyone was smiling, affected by the light. I was waiting for my telex to come in from the

...SOON BECOME...

Don’t we always in life try to go back to find those same moments? You never find the same place twice

Every year seamen move to the country’s desert coast to fish in its wild waters.

SHUKASAMI / SHUTTERSTOCK.COM

police station in town where I had been the night before and where the Germans and I had gone to register in the morning. I was waiting to be authorized. What purpose could a telex have here on the edge of the sea of sand? I leaned against the hood of George’s car and George shook his head. Officials were taking down license plates and registration numbers, noting who was in each car and searching the trunks. And in this I saw a secret language, glimpses of maps, packs of cigarettes, food being passed through the windows to the soldiers. Not a word. One soldier pocketed a bag of milk. Over and over they did the head-count. I thought maybe they lost count each time in the blowing numbing wind. At one in the afternoon someone gave a signal — they could have fired a gun — and cars began driving onto the tarmac, one by one in a long line. Somewhere at the head of the line was the military jeep, but I couldn’t see it. A soldier ran over

and told me to take my bag and go to the police building behind him. Others had been pulled out, a Senegalese man from France, a French man and his bus and a Dutch couple. Was there any reason? Or was it just that we were out of time and place? I got into the Dutch couple’s Land Rover, and as we turned around to go back to the campground with the red bus and a Renault behind us, the police waved us down and told us we could now all join the convoy. The Dutch woman, Lou, got out and did a dance on the highway, did it for all of us. This one great moment under the desert sky. I ran down the line of cars to find George and the white Mercedes. The police officer gave the hand signal. He smiled, “bon

Doctor’s Review • DECEMBER 2014

voyage!” and we drove off with all our colours and laden vehicles, down the tarmac and then turned off and entered the desert of rock and sand and dark sea, and cloud blue sky, all on a whim. Everything is different now. There are too many cars, 50 or more. The lot is packed with crowds of young Europeans who do not mix with the Mauritanian, and Moroccan, travellers on the other side of the highway. It is Ramadan, the holy month of fasting for the Muslims, and while the others abstain from even a drop of water, the Europeans gorge themselves on food and beer from cold chests, chainsmoke and seem armored, unforgiving. I weave among them, looking for a ride. Everyone turns me down, they have no room and I feel I’m out of luck this time. I should not have come back. But one older French man in a white Mercedes gives in, it seems out of pity, and yet he is the only one in his car and there is more than enough room. “How much baggage you have?” “Just this one.” “Pourquoi pas.” Why not? Again, a white Mercedes will carry me through the desert, but in a different way. The soldiers’ faces are shaded by suspicion. It has become a circus. I feel nothing from these people of the convoy. And as we begin the journey Allain says, “Ce n’est pas comme avant, ehn? Je suis déçu, les gens sont devenus trop individus.” It’s not like it was. I’m disappointed, people have become too individualistic. And the road is paved. But he himself is that way, an individual, racing to get ahead. The tarmac is only wide enough for one-way traffic and held between banks of red dirt and rock. “Je vais doubler maintenant, ehn?” Allain says, bent over the steering wheel. He means we are going to pass the others now. We are wavering one wheel on the tarmac and one on the bank, Allain trying to hold the car steady as we pass a Land Rover, a jeep, a truck, out of control. His “special cigarettes” are hidden in a bag behind the ashtray, to get him through. He smokes every one in the first stretch. The road is paved now all the way to Mauritania. We go too fast. He does not notice anything at all, does not speak except to curse the other cars. The desert floats past, so ethereal that if you do not watch, it becomes a dream. I am helpless, held in his world, alienated from the convoy, and I cannot feel the desert. We are all just trying to get there. Excerpted from Travelers’ Tales, The Best Travel Writing: Volume Nine (Solas House, Inc.).

...CLEARER

COMING SOON! TRINTELLIXTM is a trademark of Lundbeck Canada Inc.

Victoria’s real The best Asian restaurants in BC’s capital to go to when you’re tired of holiday turkey text and photos by Jeremy Ferguson

secret

umbug. Humbug to the Christmas frenzy that begins before Halloween.

Humbug to the new wave of consumerism driven by Facebook envy (keeping up with all those perfect lives). Humbug to the piped-in degradation of some of the most beautiful music ever written. Humbug to the lighting orgies that make suburban lawns visible on Mars. Humbug to the hymn of the cash register: profits trump prophets at this birthday party. And, oh yes, humbug to turkey, the foulest of fowl. Not because of the legendary post-feast flatulence that rocks Canadian homes with seismic fury from Dildo, Newfoundland to Tofino, BC every December 25. I have a problem eating a bird so dumb it can drown in a puddle, that’s all. This is excuse enough for me to jump on my broomstick and escape to Asia, but mine is a homeowner’s wallet and I’m stuck in the here and now. On the other hand, I’m home in Victoria and don’t need the broomstick. Victoria’s real secret is its Asian restaurants, the ones you don’t see in tourist bumf. A Christmas week with chopsticks and my battered psyche is ready for the next round. The provincial capital is fond of pointing out that it has more restaurants per capita than any other city in Canada. But this also means it has more bad and mediocre restos. When I want to eat accomplished French, Italian, seafood or fusion, I hop a ferry to Vancouver or Seattle. Vic’s Asian restaurants are its saving grace. They’re many fewer than their counterparts in Vancouver and Toronto, but for this little city, they represent a surprising diversity of Asian cuisines — Chinese, Japanese, Korean, Indian, Lao, Thai, Vietnamese, Indonesian, Himalayan — and the best deliver authenticity and big, big flavours. Try the ones that follow.

Jade Fountain

3366 Douglas Street; tel: (250) 383-8718; jadefountain.ca

The subterranean Jade Fountain occupies an elevated niche in our Chinese dining scene. Vic’s Chinatown may be the oldest in Canada, but many of its eateries haven’t changed since 1951: retro Chinese surfs out on tidal waves of grease and salt.

Dim sum packs the house at Jade Fountain.

DECEMBER 2014 • Doctor’s

Review

But under the helmsmanship of hardworking Johnny Woo (he’ll go as far as Vancouver to get his fish), Jade Fountain champions Cantonese dim sum in a room closer to Hong Kong flash and dash than Chinatown kitsch. The trolleys roll from 10:30am to 2pm, bearing masterworks of the steamer, the stir-fry and sincrusted deep-fry. How this kitchen loves shrimp: steamed dumplings come packed with shrimp and Chinese chives. Seafood rolls bring shrimp and chives wrapped in tofu skin and deep-fried to unctuous crispness. Open-face dumplings of steamed scallop and shrimp sport caps of crunchy tobiko, flying fish roe. Sundays offer a brief immersion in Chinese food culture as families of three and four generations fill round tables and commune over aromatic soups, alps of dim sum and chicken feet. We non-Asians should turn purple with envy. We have no parallels. Protein-driven Western food is too expensive to allow for such casual, happy-making get-togethers. At dinner, the clientele is 90 percent Chinese

Flame and fury over the woks at Jade Fountain.

(it does tell you something). Festive occasions call for iconic shark’s fin, but the smart money goes to Dungeness crab with black bean sauce and Peking duck: crackling skin (the highlight of the ritual) with pancakes, scallions and hoisin; then duck meat sautéed with five-spice and vegetables.

I’ve polled Cantonese chefs about this for years and although every short-order Chinese cook knows the secret, nobody spills Sherry Ieung with a plate of breaded almond chicken, fried rice and chicken chop suey at Halibut House.

Halibut House 3500 Quadra Street; tel: (250) 385-4944

Most of us grew up on Canadian Chinese that endured until the Hong Kong exodus of the 1980s. Then, suddenly, it was, bye, bye, breaded almond chicken, hello Peking duck. Well, breaded almond chicken and its retrokin hang on gloriously at this cheery family-run restaurant. I’ve been crazy for the allegedly Detroit-born breaded almond chicken since I was 15 years old. It has this indescribable flavour that surfaces only in this dish. I’ve polled Cantonese chefs and Hong Kong immigrants about this for years, and although every short-order Chinese cook in Canada knows the secret, nobody spills. Even Google can’t find it for me. The father-and-son brigade of Yuk-Chi and Wesley Ieung works feverishly in the kitchen, turning out such masterful dishes as the fluffiest shrimp dumplings in town, chili-boosted kung pao chicken, crispy ginger fried beef and salt-and-pepper squid. The human hurricane running the front of the house is Sherry Ieung who knows regulars on a first-name basis and welcomes newbies who think it’s too good to be true.

Doctor’s Review • DECEMBER 2014

I’d order Vietnamese fried rice for lunch, dinner or the afterlife, woofing it down with distant dreams of the China Seas Greenleaf Bistro 1684 Douglas Street; tel: (250) 590-8302

Barbecued dog and cobra wine aside, Vietnam boasts some of the most refined fare in Southeast Asia. Think impeccable freshness, delicate fish and seafood, and the senses rocking with lemongrass, chilies, ginger and herbs. Victoria boasts a fistful of Vietnamese eateries, all specializing in pho, the ultimate Vietnamese street food, beef-and-rice-noodle soup roaring with sweet basil and star anise. One such resto is cleverly named Pho-Ever and another, Phonomenal. The amiable Greenleaf Bistro journeys beyond its best-in-town pho with a sprawling range of vegetarian, rice and vermicelli plates spiked with nuac mam, the pungent fermented anchovy sauce that gives much of Vietnamese cooking its addictive edge. I can’t stay away from Vietnamese fried rice, the most sophisticated of all fried rices, short-grain rice lightly fried with fish sauce and Vietnamese spices, then tossed with fat shrimps, Chinese sausage, fried

Lao Vientiane

701-771 Vernon Avenue; tel: (250) 475-3522; laovientianerestaurant.com

If Thai and Vietnamese dominate Southeast Asian cuisines here, Lao has little presence at all. If Thai Bamboo rice pot and chopped duck salad speak for the hues at Lao Vientiane.

onions and a rainbow of julienned vegetables. I’d order it for lunch, dinner or the afterlife, lacing it with sriracha, the fiery Vietnamese chili sauce, and woofing it down with distant dreams of the China Seas.

Greenleaf Bistro’s Vietnamese fried rice and lemongrass chicken.

is hot and sweet, Lao is hot, sour and savoury. “Lao people don’t like sweet,” says chef-owner Jess Keoxayavong. Jess arrived in Victoria as a nanny, married Glenn Gibson and boldly decided to realize her dream of pleasuring the populace on a plate. Educating your market is a daunting challenge, but they were smart enough to bolster their menu with popular Thai dishes. Lao? Not as easy to love as Thai, but worth the effort. The flavour onslaught includes duck, lamb, dried garlic, basil leaves, creamy Lao fish sauce, lime juice and coconut milk. Jess’s most popular Lao dishes are the shar-tasting Lao-style green papaya salad (actually favoured by Victoria Thais over their own papaya salad), chopped duck salad with ground roasted rice and lovely chicken green curry. Others keep up in the new-one-on-me department: Lao tom yum talay is a sour-and-spicy soup loaded with fish and shellfish. Ped, a soup of housemade noodles with marinated roast duck, dried garlic and coriander, kicks in with pungent exoticism. Lamb turns up in three racy curries. Proceed fearlessly. DECEMBER 2014 • Doctor’s

Review

India Bistro

1245 Wharf Street; tel: 250-382-8662; indiabistro.ca

Victoria has long been short-changed by subcontinental spicemeisters. So it was a great relief when India Bistro signalled the arrival of restaurants that show respect for Mother India’s kitchen and we who crave it. The room is free of the usual kitsch: no Krishna frolicking with his gopis here. The menu covers the usual North Indian suspects (South Indian has arrived with Saaz just up the street) from mild butter chicken to seething vindaloos. Prices are higher than average, but so is the cooking. Crackling papadums with coriander-mint and tomato-chili chutneys make for a promising first nibble. Crisp onion bhajia, India’s answer to deep-fried onion rings, tops the apps. The Goan specialty chicken vindaloo lives up to its hot-and-sour reputation, vinegar and chilies howling, its gravy heavenly. The milder lamb shahi korma, in a sublime gravy of cashew nuts and spices, effortlessly enchants, a perfect intro for acolytes. Eggplant bartha, the measure of any Indian restaurant, marries the smoke of the open flame to tomatoes, onion, garlic and ginger. The gods, all 333 million of them, must be smiling.

India Bistro’s thali, a stainless steel platter containing naan, basmati rice, dal, butter chicken and chickpea curry.

It’s plenty healthy with cashew paste, not cream, in its curries, mild spices and local, organic ingredients with vegetarian and vegan options Tibetan Kitchen

680 Broughton; tel: (250) 383-5664; www.tibetankitchen.com

More pan-Himalayan than Tibetan — yak not readily available in these parts — the Tibetan Kitchen is another ground-breaker. The room itself is warmly done in the colours of the Tibetan flag with Tibetan Buddhist thankas and prayer flags hung on the walls. It’s plenty healthy with cashew paste, not cream, in its curries, mild spices and local, organic ingredients with vegetarian and vegan options. But this feisty little kitchen overseen by chef Pemba Bhatia, who was born in India’s Himalayan foothills, doesn’t shrink from the pleasure principal. Pan-fried momos — beef, pork and vegetarian dumplings — are the real Tibetan thing. Better still are Pemba’s curries of beef, local lamb, Berkshire pork or veg in rich, silken gravies that leave the mouth in a swoon; balm for refugees from turkey sandwiches and leftover Christmas pudding.

Tibetan momos, meat or vegetarian dumplings, at the Tibetan Kitchen.

MORE ONLINE

Escape, romance, luxury: four Victoria B&Bs that have it all. doctorsreview.com/features/victorias-bbs

Doctor’s Review • DECEMBER 2014

Where can you turn for help in preventing

* MENB? Serogroup B has become the most common invasive meningococcal disease (IMD) serogroup to affect Canadians (2007).1 Percentage of reported IMD cases by age and serogroup, Canada (2007)1,† AMONG INFANTS <1 year of age Other serogroups 20%

AMONG CHILDREN 1-4 years of age

AMONG ADOLESCENTS 15-19 years of age‡

Other serogroups 33%

B 80%

B 67%

Other serogroups 38%

B 62% ‡BEXSERO® is used in individuals 2 months through 17 years of age.

Introducing

BEXSERO

BEXSERO® is indicated for active immunization of individuals from 2 months through 17 years old against invasive disease caused by N. meningitidis serogroup B strains. Refer to the page in the bottom right icon for additional safety information and for a web link to the Product Monograph discussing t $POUSBJOEJDBUJPOT JO JOEJWJEVBMT XIP BSF IZQFSTFOTJUJWF to the BEXSERO® vaccine or to any ingredient in the formulation or components of the container closure.

The ﬁrst and only vaccine indicated for active immunization against invasive meningococcal disease caused by serogroup B strains.1,2,§

t 3FMFWBOU XBSOJOHT BOE QSFDBVUJPOT SFHBSEJOH temperature elevation following vaccination of infants and children (less than 2 years of age), postponement of the administration of BEXSERO ® in subjects suffering from an acute severe febrile illness, thrombocytopenia, hemophilia or any coagulation disorder that would contraindicate intramuscular injection, impaired immune responsiveness, not administering by intravascular, intravenous, subcutaneous or intradermal injection, not mixing with other vaccines in the same syringe, availability of appropriate medical treatment and supervision in

case of an anaphylactic event following administration of the vaccine, risk of apnoea in premature infants and need for respiratory monitoring, known history of hypersensitivity to latex, hypersensitivity to kanamycin, that protection against invasive meningococcal disease caused by serogroups other than serogroup B should not be assumed and that as with any vaccine, BEXSERO® may not fully protect all of those who are vaccinated. t $POEJUJPOT PG DMJOJDBM VTF BEWFSTF SFBDUJPOT ESVH interactions and dosing instructions.

*MenB: meningococcal disease caused by serogroup B. †In 2007, in infants <1 year old, 20 out of 25 reported IMD cases were caused by serogroup B, in children 1-4 years old, 18 out of 27 reported IMD cases were caused by serogroup B and in 15-19-year-olds, 18 out of 29 reported IMD cases were caused by serogroup B. §Comparative clinical signiﬁcance is unknown.

References: 1. National Advisory Committee on Immunization. Update on the use of quadrivalent conjugate meningococcal vaccines. Can Commun Dis Rep. 2013; 39(ACS-1):1-40. 2. BEXSERO ® Product Monograph. Novartis Pharmaceuticals Canada Inc. December 6, 2013. Novartis Pharmaceuticals Canada Inc. Dorval, Québec H9S 1A9 www.novartis.ca T: 514.631.6775 F: 514.631.1867

BEXSERO is a registered trademark. Product Monograph available on request. Printed in Canada ©Novartis Pharmaceuticals Canada Inc. 2014 13BEX017E

Be informed. Be immunized.

See additional safety information on page xxxx 51

NEW TO DOCTORSREVIEW.COM BEST OF THE WEB Links to articles, deals and special opportunities of interest to Doctor’s Review readers selected by the editors

Updated on our website three times a week!

Includes selections from: Guardian Travel, The Travel Magazine, National Geographic Travel, NYT Travel, Globe & Mail Travel, Spas in Canada, Budget Travel, LA Times Travel, The Frugal Traveller, Smartertravel.com, Petergreenberg.com, The Travel Guys, Travelzoo.com, Triponadeal.com, Adventurouskate.com, Dave and Deb Travel, The World Wanderer, Boston Globe Travel, Chicago Tribune Travel, Savvy Traveller, The Gypsy Nester, WSJ Health & Travel, Wanderlust, Independent Traveler, Outpost Magazine, Travel+Leisure, Outside Magazine, Go Green Travel, Washington Post Travel, National Post Travel, Vancouver Sun Travel, Backpacker, Islands, Condé Nast Traveler, Coastal Living, Caribbean Living, Camping Life… and many, many more

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The

Mickey Mouse trap A cranky mom confronts the happiest place on earth by Inna Gertsberg

was a much better parent before I had kids. I took my future kids on travel adventures and got them into art, music and math. They grew up on old-world Russian fairy tales read aloud to them

while they sipped tea, wrapped in a wool blanket. We never bought into any of those cartoon franchises, let alone visited a theme park. When we became parents Disney snuck up on us like the creepy baby doll in Toy Story. One minute we were innocently catching a Cars matinee, the next we were buying Lightning McQueen toothbrushes. Then Disney took over Star Wars, and we were trapped for good. Disney’s fairy dust was everywhere — I could almost feel it clinging to my teeth like those stubborn

shards of popcorn. Adding insult to injury was the fact that my parents’ new house was a 10-minute drive from Disneyland. So it was only a matter of convenience that our annual family trip to California included a visit to Mickey’s kingdom.

DISNEY JUNKIES

Our son practically imploded from excitement the night before his first Disneyland trip. His younger brother caught the same bug. We realized we were DECEMBER 2014 • Doctor’s

Review

MATT STROSHANE / WDWNEWS.COM

Disney has usurped many fables, even the story of King Arthur and his magical sword Excalibur.

Kids love Shrek so much, the franchise currently consists of four animated films and many video games.

There were moments when those words almost made their way out. Then, one evening after my husband had taken the boys to Disneyland (I hadn’t joined them, citing moral conflict and financial responsibility), I thumbed through the pictures he had taken during their visit. There they were fighting Darth Vader in a mass lightsaber-wielding workshop, waiting for Mark Twain’s riverboat in the merciless southern California sun, and even — gasp! — holding hands with Mickey himself.

WDWNEWS.COM

OBSCENELY HAPPY

raising Disney junkies, simply because Disney owned every fix. My plans to fill our kids’ imagination with the mystical worlds of Russian folklore died and the amazing future parent in me was silenced. Could I have stopped this vulgarity? “Kids: Disneyland is a rip-off. It’s just a big trap to loop you into buying more of their stuff. We’re not going.”

Doctor’s Review • DECEMBER 2014

The boys had spent nine hours in the park — about 8½ hours more than they would have if I had come along. I looked closely to find at least one accidental shot of boredom or fatigue. But in every single picture they were indescribably, obscenely happy. Lineups and crowds notwithstanding, they had had the most wonderful time. It was obvious that something about Disneyland had been out of my emotional reach. All I had seen in the theme park was a mass of pale and overfed people and their sugared-up, pie-eyed broods. They dressed in ridiculous outfits and dropped their life savings on bad pizza and merchandized junk. They waited forever to get on rickety rides.

“Surely, a five-year-old lacks the judgment of a university-educated, well-rounded, cultured adult” But something about that experience was invaluable to them: they loved it deeply, with absolute abandon. “It’s the happiest place on earth,” a friend reminded me when I brought it up. Then he added, with a completely straight face, how much he looked forward to taking his young daughter to Disneyland. That got me wondering. Naturally, all good parents want their children to be happy. But how do our own ideas of happiness measure against those of our children? Is there an unwritten rule somewhere that requires our kids to love what we love and not love what we don’t — because we know better?

BRAND SLAVES

As a good parent, am I responsible for instilling in my children only the cultural ideals I consider valuable, or do they get to make their own choices? Surely, a five-year-old lacks the judgment of a universityeducated, well-rounded, cultured adult. How do you explain to the boy holding his pee in a lineup at Disneyland that Mickey is an under-

Indications and clinical use: BEXSERO ® is indicated for active immunization of individuals from 2 months through 17 years old against invasive disease caused by N. meningitidis serogroup B strains. As the expression of antigens included in the vaccine is epidemiologically variable in circulating group B strains, meningococci that express them at sufficient levels are predicted to be susceptible to killing by vaccine-elicited antibodies. Contraindications: • Hypersensitivity to the BEXSERO ® vaccine or to any ingredient in the formulation or components of the container closure. Relevant warnings and precautions: • Temperature elevation following vaccination of infants and children (less than 2 years of age) • Administration of BEXSERO® should be postponed in subjects suffering from an acute severe febrile illness • Individuals with thrombocytopenia, hemophilia or any coagulation disorder that would contraindicate intramuscular injection • Subjects with impaired immune responsiveness • Do not inject intravascularly, intravenously, subcutaneously or intradermally

cover corporate agent? That Disney’s entire agenda is to turn him into a lifelong brand slave? Here’s where my high horse started to limp. Why are grownups free to choose things that make them happy without having them vetted by their kids? We shell out on team jerseys and concert T-shirts (the latter being a personal weakness of this parent). We listen to the music of the ’80s and watch Jersey Shore (being ironic is not a good enough defense). Meanwhile, we work overtime to steer our kids toward what we consider good taste and good culture. To hell with that. My kids will be going back to Disneyland. They won’t be wearing $49 Mickey ears or having lunch at the Rainforest Café, but they will line up for Jedi training. And they will go on Splash Mountain 23 times. When they come home we will read Lewis Carroll and play piano and do math. And if they’re well behaved, we’ll watch two — no, three — episodes of The Simpsons. Because I love The Simpsons, so they’d better love The Simpsons, too.

• Do not mix with other vaccines in the same syringe • Availability of appropriate medical treatment and supervision in case of an anaphylactic event following administration of the vaccine • Risk of apnoea in premature infants; need for 48-72 hours respiratory monitoring • Caution in subjects with known history of hypersensitivity to latex • Hypersensitivity to kanamycin • Protection against invasive meningococcal disease caused by serogroups other than serogroup B should not be assumed • As with any vaccine, BEXSERO® may not fully protect all of those who are vaccinated For more information: Please consult the Product Monograph at www.novar tis.ca / BexseroMonograph for important information relating to adverse reactions, drug interactions, and dosing information which have not been discussed in this piece. The Product Monograph is also available by calling Medical Information at 1-800-363-8883.

BEXSERO is a registered trademark. Product Monograph available on request. Printed in Canada ©Novartis Pharmaceuticals Canada Inc. 2014 13BEX017E Novartis Pharmaceuticals Canada Inc. Dorval, Québec H9S 1A9 www.novartis.ca T: 514.631.6775 F: 514.631.1867

Be informed. Be immunized.

DECEMBER 2014 • Doctor’s BEX_7386_PI_DoctorsReview E01.indd 1

Review

14-02-25 1:52 PM

Dukkah-encrusted scallops.

Season to taste

How to mix spices to give your suppers flavour from around the world recipes by

Amanda Bevill and Julie Kramis Hearne photos by Charity Burggraaf

pices can be exotic and mysterious so it’s no wonder that pepper once traded for a price above gold. A single whiff can evoke the spice bazaars of

Morocco, the lavender fields of Provence or the jungles of India. Herbalist Amanda Bevill, owner of World Spice Merchants on Seattle’s waterfront, knows this well and, inspired by the scents in her store, she co-authored World Spice at Home with chef Julie Kramis Hearne. Published

Doctor’s Review • DECEMBER 2014

by Sasquatch Books, the book contains 75 classic recipes that have been enhanced by 13 spice blends from around the world. Find out how to use dukkah from Egypt to perk up seafood and harissa from North Africa to fancy up roasted chicken.

DUKKAHENCRUSTED SCALLOPS The dukkah makes a perfect crust with its hints of coriander, thyme and hazelnut. You can even use it on salmon, swordfish and tuna. Serving the scallops on a bed of parsnip puree with chanterelles makes it almost too good to be true. For the puree 4 to 5 medium parsnips, peeled, ends trimmed ¼ c. (60 ml) apple juice or cider 3 tbsp. (45 ml) heavy cream salt For the mushrooms 2 tbsp. (30 ml) extra-virgin olive oil, divided 2 tbsp. (30 g) butter, divided 1 medium leek (white parts only), cleaned, halved lengthwise and cut into ¼-inch (0.5-cm) slices ½ lb. (250 g) chanterelle mushrooms, cleaned, trimmed and quartered 1 tsp. (5 ml) fresh thyme leaves salt and freshly ground black pepper

tablespoon (15 ml) each of the olive oil and butter over medium heat. Add the leeks and sauté briefly until soft and just starting to brown. Transfer to a plate. In the same pan, add the remaining 1 tablespoon (15 ml) olive oil and butter. Add the mushrooms and sauté for 3 to 4 minutes. Sprinkle with the thyme and continue to cook for 8 to 10 minutes more or until the mushrooms are dark brown around the edges (lower the heat if the mushrooms are browning too quickly). Season with salt and pepper. Transfer to the plate with the leeks, cover with foil to keep warm and set aside. Preheat the oven to 250ºF (130ºC). Meanwhile, rewarm the parsnip puree over low heat, stirring occasionally. To prepare the scallops, spread the dukkah on a plate. Lightly brush the scallops with olive oil and sprinkle with just a pinch of salt then press the scallops into the dukkah, coating the tops and bottoms. Transfer to a plate.

Heat the olive oil in a 10- to 12-inch (25- to 30-cm) skillet over mediumhigh heat. Once hot, add the scallops, dukkah-side down, taking care not to crowd the pan (do this in two or three batches). Cook the scallops for about 3 to 4 minutes without moving then use tongs to flip them over. They should release easily once a crust has formed. Cook for 3 to 4 minutes more. Remove the scallops from the pan, spread them on a baking sheet and place them in the warm oven. Add the leeks and mushrooms to the skillet, and warm briefly over medium-low heat. Place ¼ (60 ml) to ½ (125 ml) cup parsnip puree on each plate. Remove the scallops from the oven and place 3 each on top of the puree with one-quarter of the leeks and mushrooms. Season with sea salt to taste and sprinkle with the thyme. Serve immediately. Makes 4 servings.

For the scallops ¼ c. (60 ml) coarsely ground dukkah (recipe follows) 12 large sea scallops, side-muscle removed 2 tbsp. (30 ml) extra-virgin olive oil, plus more for brushing ¼ tsp. (1.25 ml) salt 1 tbsp. (15 ml) fresh thyme leaves, for garnish

To make the puree, first cut the parsnips in half lengthwise and then cut into 2-inch (5-cm) pieces. Put them in a 4-quart (4-L) saucepan, cover with water and bring to a boil. Cook for 10 to 15 minutes or until the parsnips are easy to mash with the back of a fork. Drain and transfer to a blender with the apple juice. Blend until smooth, adding a little water if the mixture is thick. Transfer the puree to a small saucepan and warm over low heat. Swirl in the cream and season with salt to taste. Turn off the heat and cover. To prepare the mushrooms, in a 10to 12-inch (25- to 30-cm) skillet, melt 1 DECEMBER 2014 • Doctor’s

Review

CHICKEN WITH HARISSA-HONEY GLAZE A simple roasted chicken is enhanced when you add a great spice glaze. The robust flavours and the smoky heat of the harissa are well balanced by the honey. You can also try using berbere, besar or za’atar instead. If you want to substitute Chinese five-spice, be sure to add 1 tablespoon (15 ml) tamarind paste to the mix. For the glaze ¼ c. (60 ml) coarsely ground harissa (recipe follows) 3 tbsp. (45 ml) extra-virgin olive oil 2 tbsp. (30 ml) honey 2 tbsp. (30 ml) freshly squeezed lemon juice 2 tsp. (10 ml) lemon zest ½ tsp. (2.5 ml) turmeric (optional) For the chicken 1 (2- to 3-pound/1- to 1.5-kg) chicken 1 lemon, halved 1 tsp. (5 ml) salt freshly ground black pepper

Chicken with harissa-honey glaze.

Tip: When buying scallops, be sure to ask for dry-packed scallops without any additives. If they are wet-packed, they have an additive called sodium tripolyphosphate (STPP), which is not our preferred type.

Dukkah This Egyptian spice blend combines toasted spices, hazelnuts and dried herbs with salt and sesame seeds. Traditionally, bread is dipped first in olive oil and then in dukkah for a simple bite packed with taste. Try using dukkah for all manner of crusts and rubs or anywhere a salty and savoury crunch would be nice. A little dukkah sprinkled on salads or as a crust for goat cheese or tuna is a simple way to enhance their inherent flavours. ¼ c. (60 ml) chopped hazelnuts 2 tbsp. (30 ml) white sesame seeds

Doctor’s Review • DECEMBER 2014

2 tbsp. (30 ml) cumin seed 1½ tbsp. (22.5 ml) coriander seed ½ tsp. (2.5 ml) black peppercorns 2 tsp. (10 ml) dried marjoram 1 tsp. (5 ml) dried thyme leaves 1 to 2 tsp. (5 to 10 ml) flake salt or kosher salt

In a dry pan over medium heat, toast the hazelnuts and sesame seeds until golden; transfer to a medium bowl and set aside to cool. In the same pan, toast the cumin, coriander and peppercorns until fragrant. Transfer to a small bowl and allow to cool. Pulse the cumin mixture in an electric mill to a medium-fine grind then combine them with the hazelnuts. Mix in the marjoram, thyme and salt. Store in an airtight container. Use as is for sprinkling on salads or grind to the desired consistency for crusts and rubs just before use. Makes ½ cup (125 ml).

For the vegetables ¾ lb. (375 g) fingerling or baby potatoes, halved lengthwise 3 medium carrots, peeled and cut at an angle into 1-inch (2.5-cm) pieces 1 sweet yellow onion, halved and cut into ½-inch (1.25-cm) slices 2 tbsp. (30 ml) extra-virgin olive oil 1 tsp. (5 ml) salt ¼ tsp. (1.25 ml) freshly ground black pepper ½ tsp. (2.5 ml) sea salt

To make the glaze, combine the harissa, olive oil, honey, lemon juice, lemon zest and turmeric in a small bowl. Position a rack in the centre of the oven and preheat the oven to 425ºF (220ºC). Remove the bag of organs from the chicken cavity, along with any excess fat or stray pinfeathers. Rinse the chicken inside and out, then pat dry. Place the lemon halves inside the chicken. Using kitchen twine, tie the legs together and tuck the wing tips under the breasts. Rub the chicken with the salt and pepper then with the glaze (work it under the skin for extra flavour).

Place the chicken in a 12-inch (30-cm) cast-iron skillet. In a large bowl, toss the potatoes, carrots and onion with the olive oil, salt and pepper. Arrange around the base of the chicken. Bake the chicken for 30 minutes, baste with its own juices and bake 30 minutes more. If the chicken is getting too much colour, cover with foil, removing it for the last 5 minutes of cooking. It’s done when the temperature in the thickest part of the thigh reaches 160ºF (70ºC). Remove the chicken from the oven and sprinkle with the sea salt. Loosely cover with foil and let rest for 10 to 15 minutes. Remove the twine, slice the meat and drizzle over more glaze. Serve with the roasted vegetables. Makes 4 servings.

Turned into a paste (with red bell pepper, garlic, vinegar and more), harissa can be used as a condiment, in sauces and glazes. It can be used on everything from the lightest white fish to the boldest beef brisket by varying the proportions according to the flavour desired. It’s also delicious on spiced nuts, deviled eggs or on a casserole.

Harissa

In a dry pan over medium heat, toast the caraway, coriander and cumin until fragrant. Transfer to a small bowl and set aside to cool. Combine with the remaining ingredients and store in an airtight container. Grind just before use. Makes ½ cup (125 ml).

This extraordinary spice blend comes from North Africa and is similar to “chili powder” used in North American cuisine, but it has more complexity and depth of flavour. Harissa is a combination of paprika, dried chilies and other spices, and ours is blended to impart mild heat and rich accents. Try this blend in all your favourite dishes calling for chili powder and you’ll be thrilled with the results.

1 tbsp. (15 ml) caraway seed 2 tsp. (10 ml) coriander seed 1 tsp. (5 ml) cumin seed 2 tbsp. (30 ml) guajillo chili flakes 2 tsp. (10 ml) chopped fresh garlic 2 tsp. (10 ml) smoked paprika 1½ tsp. (7.5 ml) Hungarian paprika 1 tsp. (5 ml) pequin chilies or African cayenne ½ tsp. (2.5 ml) ground cinnamon

ONGLYZA Contraindications:  Diabetic ketoacidosis  Diabetic coma/precoma  Type 1 diabetes mellitus Relevant warnings and precautions:  Not recommended for patients with congestive heart failure  Exposure to stress (e.g. surgery)  Interactions with potent CYP 3A4 inducers  Contains lactose  Risk of hypersensitivity  Discontinue if pancreatitis is suspected  Immunocompromised patients (consider monitoring lymphocyte count)  Rash (monitoring recommended)  Not recommended for pregnancy, should not be used by nursing women  Not recommended for patients with moderate to severe hepatic impairment (not recommended for patients with ESRD requiring hemodialysis)  Monitor renal function For more information: Please consult the product monograph at www.azinfo.ca/onglyza/pm664 for more information relating to adverse reactions, drug interactions, and dosing information not discussed in this piece. The product monograph is also available by calling us at 1-800-668-6000. * Randomized, double-blind, placebo-controlled study of 24 weeks’ duration in patients with inadequate glycemic control (HbA1c ≥7.0% and ≤10.0%) on metformin alone. Saxagliptin baseline HbA1c 8.1% (n=186), FPG 9.9 mmol/L (n=187), PPG 16.4 mmol/L (n=155). Placebo baseline HbA1c 8.1% (n=175), FPG 9.7 mmol/L (n=176), PPG 16.4 mmol/L (n=135). Patients were required to be on a stable dose of metformin (1500 mg to 2550 mg daily) for at least 8 weeks to be enrolled in the trial. Patients who completed all visits during the initial 24-week study period without need for hyperglycemia rescue therapy were eligible to enter a controlled, double-blind, long-term study extension. Patients who received saxagliptin in the initial 24-week study period maintained the same dose in the long-term extension. References: 1. Onglyza® Product Monograph. AstraZeneca Canada Inc., June 30, 2014. 2. Komboglyze® Product Monograph. AstraZeneca Canada Inc., June 30, 2014.

09/15

AstraZeneca Canada Inc. Mississauga, Ontario L4Y 1M4

DECEMBER 2014 • Doctor’s

Review

PHO T O FI NI SH by

Dr Jef f A lli n a n d L ola R e i d Alli n

A natural wonder

advertisers index ACTAVIS SPECIALTY PHARMACEUTICALS Actonel DR............................................. 13 Lolo......................................................... 21 ASTRAZENECA CANADA INC. Corporate..................................................2 Onglyza/Komboglyze............................. 16

The viewing deck of our cabin afforded spectacular views of the wildlife bathing in the Savuti Channel nine metres below. Located in northeastern Botswana, this riverine system links the Savuti Marshes with the Okavango Delta creating an oasis for wildlife herds and water birds. But the flow is occasionally interrupted — for decades — then mysteriously returns. When our guide started working for Desert & Delta Safaris, the channel was dry and an artificial oasis was created to provide water for the animals. When the water returned in 2010, a wall of water raced down the spillway, returning like a tidal bore, with a deafening roar that terrified many staff members. Savuti means “mystery” but the most probable explanation relates to tectonically unstable geologic conditions, revealed by the progressive northward shift of the Zambezi River and the frequent low-intensity earthquakes. Taken with a Nikon Coolpix L22.

MDs, submit a photo! Please send photos along with a 150- to 300-word article to: Doctor’s Review, Photo Finish, 400 McGill Street, 4th Floor, Montreal, QC H2Y 2G1.

BOEHRINGER INGELHEIM (CANADA) LTD Respimat.............................................. IBC Combivent Respimat.............................IFC ELI LILLY CANADA INC. Corporate..................................................6 LUNDBECK CANADA Trintellix.......................................37, 39, 41 MERCK CANADA INC. Januvia.................................................... 18 NOVARTIS PHARMACEUTICALS CANADA INC. Bexsero.................................................... 47 PFIZER CANADA Pristiq........................................................4 SEA COURSES INC. Corporate............................ Front cover, 15 TAKEDA CANADA INC. Dexilant...............................................OBC

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Doctor’s Review • DECEMBER 2014

FAIR BALANCE INFORMATION Bexsero.................................................... 51 Onglyza/Komboglyze.............................. 55

NEW

The rst

SMI

Soft Mist Inhaler

1-4

Ask for a demo of Placebo Respimat today ®

STRIVERDI® RESPIMAT® (olodaterol hydrochloride solution for inhalation) is a long-acting beta2-adrenergic agonist (LABA) indicated for the long term, once daily maintenance bronchodilator treatment of airﬂow obstruction in patients with Chronic Obstructive Pulmonary Disease or COPD (including chronic bronchitis and emphysema). Consult the Product Monograph at www.boehringer-ingelheim.ca/content/dam/internet/opu/ca_EN/documents/humanhealth/product_monograph/StriverdiPMEN.pdf for important information about contraindications, warnings, precautions, conditions of clinical use, adverse reactions, interactions and dosing. The Product Monograph is also available by calling us at 1 (800) 263-5103 Ext. 84633. Pr

† Comparative clinical signiﬁcance unknown

* Solution is dispensed through mechanical energy4

References: 1. STRIVERDI® RESPIMAT® Product Monograph. Boehringer Ingelheim (Canada) Ltd., May 7, 2014. 2. Decramer M, Vestbo J, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of COPD (updated 2014). Global Initiative for Chronic Obstructive Lung Disease, Inc. 2014. 3. COMBIVENT® RESPIMAT® Product Monograph. Boehringer Ingelheim (Canada) Ltd., Jan 8, 2014. 4. Data on ﬁle. Boehringer Ingelheim (Canada) Ltd., 2014. 5. ATROVENT® HFA Product Monograph. Boehringer Ingelheim (Canada) Ltd., Oct 29, 2010. 6. VENTOLIN® HFA Product Monograph. GlaxoSmithKline Inc., Dec 18, 2013. 7. ADVAIR® and ADVAIR® DISKUS® Product Monograph. GlaxoSmithKline Inc., Sep 24, 2013. 8. SPIRIVA® Product Monograph. Boehringer Ingelheim (Canada) Ltd., Aug 21, 2012.9. SEREVENT® DISKHALER® and SEREVENT® DISKUS® Product Monograph. GlaxosmithKline Inc., Oct 16, 2013. 10. FORADIL® Product Monograph. Novartis Pharmaceuticals Canada Inc., May 9, 2013. 11. ONBREZ® BREEZHALER® Product Monograph. Novartis Pharmaceuticals Canada Inc., Oct 24, 2012. 12. SEEBRI® BREEZHALER® Product Monograph. Novartis Pharmaceuticals Canada Inc., Oct 12, 2012. 13. SYMBICORT® TURBUHALER® Product Monograph. AstraZeneca Canada Inc., Jun 21, 2012. 14. TUDORZA™ GENUAIR™ Product Monograph. Almirall Ltd., Jul 26, 2013.

Striverdi® and Respimat® are registered trademarks used under license by Boehringer Ingelheim (Canada) Ltd.

Covered on RAMQ and most private plans

Help fight

heartburn associated with GERD With the demonstrated power of DEXILANT®

Visit www.DEXILANT.ca 24 hours a day to learn more

In patients maintaining healed erosive esophagitis (EE) with DEXILANT® 30 mg:

99% of nights were heartburn-free vs 72% with placebo (median; p<0.00001 secondary endpoint)1* 96% of 24-hour periods were heartburn-free vs 29% with placebo (median; p<0.00001 secondary endpoint)1*

Indications and clinical use: In adults 18 years and older, DEXILANT® is indicated for: • Healing of all grades of erosive esophagitis for up to 8 weeks • Maintenance of healed erosive esophagitis for up to 6 months • Treatment of heartburn associated with symptomatic non-erosive gastroesophageal reflux disease (GERD) for 4 weeks Contraindication: • Should not be concomitantly administered with atazanavir Other relevant warnings and precautions: • Symptomatic response does not preclude the presence of gastric malignancy • May slightly increase the risk of gastrointestinal infections such as Salmonella and Campylobacter and possibly Clostridium difficile • Concomitant methotrexate use may elevate and prolong serum levels of methotrexate and/or its metabolites

• May increase risk of osteoporosis-related fractures of the hip, wrist, or spine. Use lowest dose and shortest duration appropriate • Patients >71 years of age may already be at high risk for osteoporosisrelated fractures and should be managed carefully according to established treatment guidelines • Chronic use may lead to hypomagnesemia. For patients expected to be on prolonged treatment or concurrent treatment with digoxin or drugs that may cause hypomagnesemia (e.g., diuretics), initial and periodic monitoring of magnesium levels may be considered • May interfere with absorption of drugs for which gastric pH is important for bioavailability For more information: For important information on Contraindications, Warnings, Precautions, Adverse Reactions, Interactions, and Dosing, please consult the Product Monograph at www.DEXILANT.ca/PM. The Product Monograph is also available by calling us at 1.866.295.4636.

*Results of a 6-month, multicenter, double-blind, placebo-controlled, randomized study of patients who dosed DEXILANT® 30 mg (n=140) or placebo (n=147) once daily and had successfully completed an EE study and showed endoscopically confirmed healed EE.1,2 References: 1. DEXILANT® (dexlansoprazole) Product Monograph, Takeda Canada Inc. 2. Metz DC, et al. Clinical trial: dexlansoprazole MR, a proton pump inhibitor with dual delayed-release technology, effectively controls symptoms and prevents relapse in patients with healed erosive oesophagitis. Aliment Pharmacol Ther 2009;29:742-754. DEXILANT® is a registered trademark of Takeda Pharmaceuticals U.S.A., Inc. and used under licence by Takeda Canada Inc. ©2014 Takeda Canada Inc.