Connecting Care - Winter 2014-15

WIN the

PAIN

GAME

Health Home, Sweet Home

Coaching to prevent chronic disease

Eating Well

How to balance your diet

cfpcn.ca Working together to strengthen the health of our communities

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Health Home, Sweet Home

Coaching to prevent chronic disease

cover story

5

WINNING THE PAIN GAME

Team brings hope 6

10

Eating Well

How to balance your diet

8

New resource helps Calgarians find a doctor

9

Healthy eating

10

Face of a doctor

Recipe: Soy ginger salmon

On a mission to make lives better: Dr. Robert Burn

Cover photo: Patient Jen walks with her boyfriend and dogs.

VOLUME 6 • NO. 2 • 2014

12

Programs and clinics

www.boehringer-ingelheim.com Calgary Foothills Primary Care Network would like to thank Boehringer Ingelheim (Canada) Ltd. for their assistance in printing this medical communication publication.

Medical director’s message

Primary Care Networks in Alberta are built to improve the access and delivery of primary health care in their communities. Calgary Foothills Primary Care Network is working with your doctor to provide you with quality primary health care in north Calgary and Cochrane.

For example, our after-hours Access 365 Clinic is there for your urgent after-hours needs and our behavioural health consultants are there to provide you with short-term mental health support, such as coping with loss. Our team of health care professionals is committed to making sure you are connected to the care that you need.

Enjoy this issue of Connecting Care, which highlights our ongoing commitment to excellence in patient care.

Editor

Paula Beauchamp Cover Photograph

Neil Zeller Photography Publisher

Jim Thornton

Sincerely,

Dr. Linda M. Slocombe Medical Director Calgary Foothills Primary Care Network

Calgary Foothills Primary Care Network

500, 1716 - 16th Avenue NW Calgary, AB T2M 0L7 P 403.284.FPCN (3726) F 403.284.9518 communications@cfpcn.ca cfpcn.ca

Published for CFPCN by

Paragon Publishing Inc.

Calgary, Alberta P 403.287.9818 ads@paragonpublish.com paragonpublish.com

Background Calgary Foothills Primary Care Network is a group of doctors who provide primary care services to patients living in north Calgary and Cochrane. Created in 2006, the PCN aims, through the leadership of family doctors, to provide enhanced access to integrated and comprehensive primary care, while engaging health teams in collaboration with the broader health care system.

What is primary care?

Primary care involves the activities provided in the community that address the everyday health needs of individuals and their families through health promotion and the prevention, diagnosis and treatment of illness and injury.

Connecting Care is a PCN publication aimed at educating patients of member doctors about health issues and programs available to them and their families.

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Connecting Care Magazine is made available free of charge to the 350,000+ north Calgary and Cochrane patients of 392 PCN member physicians at more than 80 clinics in 54 communities.

The e-magazine version is available at cfpn.ca and by free subscription at connectingcare@paragonpublish.com All rights reserved ©2014. Printed in Canada. Member of the Canadian Federation of Independent Business.

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Publisher is to insert.

Photo: Paula Beauchamp

FUTURE FOCUSED: Patient Rob Ward believes he will live a healthier, longer life thanks to his health team.

HEALTH HOME, SWEET HOME Coaching to prevent chronic disease

BY PAULA BEAUCHAMP TO say Robert Ward is happy with the care he receives at his

Robert’s body was no longer processing food as effectively as it did

health home — his doctor’s office in Capitol Hill — would be an

when he was 18. Built-in physical activity patterns were lost when he

understatement. In fact, the retired exhibition designer is thrilled with

retired. “I no longer had that big cardio workout from pedaling uphill

the changes he sees in the health system.

to get home.” Robert says his health team helped set him on a road to

“Identifying problems earlier and encouraging people to play a role in looking after their own health is so helpful,” he says. “When

mindful recovery.

Some 99.6 per cent of family physicians who are members of

everything is going in the direction of self-checkouts and self-help, it is

the Calgary Foothills Primary Care Network have at least one health

wonderful to have a human being there to actually help you.”

team member in their clinic. The teams work to improve the delivery

The health team at Robert’s doctor’s clinic includes a behavioural

of health care by increasing patient access to quality information

health consultant, health management nurse and clinical pharmacist.

and care, improving patient outcomes. Team members may include

Working together with doctors at the clinic, they regularly see patients

health management nurses, clinical pharmacists, behavioural health

who need extra information and support.

consultants, registered dietitians, diabetes educators and respiratory

Referral in-house In late 2013, Robert’s doctor, Cassandra Millar, referred him to two members of the team after routine blood tests revealed he had

educators.

Aha moments Clinical pharmacist Noorani Ramji says patients often don’t know

high sugar levels and high cholesterol. With the help of a health

what to expect because this is a new model of care. “Patients feel

management nurse and clinical pharmacist, Robert overhauled his

reassured that we are all working together with their doctor,” she says.

lifestyle habits, particularly around eating and exercise.

“They feel empowered and so much more aware of what is happening

Together they set goals for change, aiming to prevent Robert’s issues from developing into a chronic condition. Temptations such as apple fritters, pastries and chocolate bars were identified, as well as a need for more regular exercise.

with their health because of the resources devoted to them. Sometimes there is an aha moment or an epiphany.”

Robert now travels with a fold-up bike and exercises on a bouncer that he keeps in his studio. He consciously chooses the food he eats

Portion sizes and food quality were discussed — and the impact

and feels positive about the future. “The bottom line is, maybe I’ll just

changes could have on his body. “It’s like an athlete having their own

end up living longer and have more Saturday night jam sessions with

team of coaches,” Robert, 63, says. “I can do this for myself for a few

my buddies and continue to travel and go places with my wife,” he

months, but then I start to fall off the wagon. Being accountable to

says. “I certainly feel better.”

someone else helps.”

Robert, an avid guitar player, believes the knowledge he has gained from in-depth conversations with his health team will dramatically

To find out more about your health team, please talk to your family doctor.

improve his future. Although he was physically active as a youngster, cfpcn.ca

3

WINNING AGAINST PAIN TEAM BRINGS HOPE

A NEW LIFE: Jen puts her best foot forward.

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Photo: Neil Zeller Photography

WATCHING Jen walk down the street, you’d never know she is bracing against the pain with each step. The 31-yearold says that is part of the problem. “I look good on the outside. It would be easy for someone to think I am faking it,” she says. “On the inside I can be crying with pain.

Jen was 18 when she first experienced pain from endometriosis. In

On this journey to better manage her chronic pain, the team helped

years gone by, there have been times when the dark clouds of pain

Jen deal with her mental health issues that were making her pain worse.

hanging over Jen left her feeling down. By 26, the pain was having

Jen now understands that a difficult childhood prevented her from

such an impact on her life that she was ultimately forced to quit the job

developing some of the life skills she needed. “I couldn't communicate

she loved. “Pain wears on you day after day in a way you could never

before, even express that I was angry or discuss things,” she says. “The

understand if you haven’t experienced it,” she says.

mental health team talked to me and I learned so much — steps on

In 2011, Jen’s family doctor Dennis Hayes began working with her at

how to get angry, how to communicate. You don't know you are

his clinic and those feelings started to lift. He later referred Jennifer to

missing these steps until someone points them out. I learned I don't

the Calgary Foothills Primary Care Network’s Extended Team. “I honestly

have to put a smile on my face all of the time and it’s okay to cry

can’t tell you what a difference they have made to my life,” Jen says.

sometimes.”

The Extended Team offers care to patients who suffer from complex, long-term (chronic) conditions including chronic pain, irritable bowel syndrome and mental health issues, such as depression and anxiety.

“Just having someone I can call or turn to when I’m down and think I’ll never get out of the pain — and at the end of the line there’s someone so warm and open and willing to listen,” she says. “I owe them so much more than I can say.”

While many patients are referred to the Extended Team for assessment or treatment of a single condition, added complexity and other issues can be uncovered. The health team, which includes a range of health professionals such as health management nurses, pharmacists and doctors, takes a holistic approach to each patient’s needs.

Reducing pain Jen's first step towards recovery was a class on understanding pain

“Just having someone I can call or turn to when I’m down and think I’ll never get out of the pain — and at the end of the line there’s someone so warm and open and willing to listen.”

— learning how the brain and the nervous system work together to produce our emotional and physical experience of pain. She joined pacing classes, which taught her to intersperse the activities she needs to do each day with periods of rest that help reduce pain flare-ups. Jen also learned about breathing, meditation and yoga and how distracting herself can help reduce the pain.

Over time clinical pharmacist Joe Kwan helped Jen, who was taking

A team approach Jen says she feels more whole as a person thanks to the help of Dr. Bergman, behavioural health consultant Deborah McDougall, shared mental health consultant Jean Leong and the rest of the team. Jen is

pharmaceutical drugs to cope with the pain, to slowly reduce her

also more ready to accept help, such as efforts to bring specialists to the

dosage. At the same time, they worked to minimize the effects of

Extended Team's Crowfoot clinic, where Jen felt more comfortable.

withdrawal, such as cold sweats and mood swings. “The challenge is to

Jen's partner is also surprised how extensively the team has included

help patients develop other coping tools so they can rely on those tools

him in every step in her care. “I've been to a lot of the appointments.

to deal with the pain when the narcotics are removed,” Joe says. “It

I'm always invited,” he says. “They explain what is happening for Jen,

can involve working to improve mental health and providing supports in

and that's good, because I really didn't know how bad it was. I don't

their social environment that increase the ability to function.”

pressure her to go out and do something if she says she isn't feeling

Medication can reduce pain by up to 10 per cent. But opioids are no longer recommended in the treatment of chronic pain that is not

well, because I understand now.”

The couple has grown closer through shared understanding. “Just the

caused by cancer. Research now shows it is best to get support, get

fact that she is up and doing stuff is enough for me,” he says. “Before

active, get a recovery plan and get started.

Jen was taking the pain killers just to get through the day, but she'd be

Extended Team medical lead Dr. June Bergman says patients can develop a different world view because of something that happened as they first experienced chronic pain — often as a result of adverse

knocked out and couldn't go anywhere because she was sleeping all the time. I find she laughs more like she used to.”

While Jen still feels moderate pain throughout the day and occasional

events in early life. “We try to help patients shift that world view that

bouts of intense pain, she feels better able to manage and is happier.

is no longer working for them,” she says. “We help them explore new

She is looking forward to further treatments, to feeling even better in

ways of being. Once we have that shift and that buy-in, we can try

the future and getting back to the work she loves. “I know there is

something totally different.”

hope now and I am looking forward with hope,” she says. “That's a good place to be.” cfpcn.ca

5

Eating Well

How to balance your diet

By Paula Beauchamp

A dietitian’s step-by-step guide to eating well

dinner plates are 10 to 12 inches in diameter, but it is easier to achieve

IT might be your favourite pair of jeans that suddenly feels tight or

a healthy balanced plate if you replace them with 8 to 9 inch plates.

a gnawing awareness your energy levels are low. For each of us, the

Remember those small plates that come with your dinner set? Those

realization that our eating habits are spiraling out of control can come in

may be closer to the size you need. “A larger plate is a visual cue to fill it

a myriad of ways.

up and then portion sizes and calorie intake rise,” Andrea says.

Calgary Foothills Primary Care Network registered

The best way to ensure a good balance is to fill half of

dietitian Andrea Kroeker says these are perfect

your plate with vegetables of at least two kinds at

moments to take stock and review the basics of

both lunch and dinner. Fill a quarter of your

healthy eating. But first, a word of warning.

plate with whole grains (potato, whole

“It is important to take things slowly and

wheat bread, brown rice) and the

make small changes that gradually move you in the right direction,” Andrea says. “Small behaviour change, rather than a diet or radical action, helps you sustain a healthy weight longer term.”

Get started with regular meals Eating at least three well-spaced meals a day is essential before you can start worrying about portion

remaining quarter with meat or meat

"A larger plate is a visual cue to fill it up and then portion sizes and calorie intake rise"

sizes or anything else. “It is ideal to

Once you are eating regular meals, it is time to take a good hard look at your plate. Actually, take out your tape measure. Average 6

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— they give you a big boost of fibre, antioxidants, vitamins and minerals, while keeping your calorie intake down.

Andrea recommends you round lunch and dinner off with a piece of fruit and milk or a milk alternative,

vegetables and fruit, grain products, meat and

your portions and prevent overeating at your next

A healthy, balanced lunch and dinner plate

broccoli yields only 31 calories

aim is to eat three to four food groups —

“Regular meals help you control the size of

low blood sugars bring.

are low in calories — 1 cup of

fruit for a snack in-between meals. The

snacks in between if needed,” Andrea says.

hours apart also helps you avoid dips in energy and the sluggish feeling

or lentils). Because vegetables

such as yogurt. Or save the milk and

eat three meals a day with one to two

meal,” she says. Spacing meals a maximum of four to six

alternatives (lean meat, chicken

alternatives and milk and alternatives — at each meal.

Eating too much meat, meat alternatives and grain products and eating too few vegetables are the most common meal-time mistakes that lead to unwanted weight gain, Andrea says. The Handy Portion guide below illustrates an easy way to estimate healthy portion sizes.

“People most often struggle to accept the smaller portion sizes and the need to add way more fruit and vegetables,” Andrea says. “But if you

HANDY PORTION GUIDE: Canadian Diabetes Association You can use your hands to estimate appropriate portions. When planning a meal, use the following portion sizes as a guide:

ADD MORE VEGETABLES: Calgary Foothills Primary Care Network registered dietitian Kari Derbyshire discusses the keys to a healthy, balanced plate with patient John-David Malta.

are eating a 9-ounce steak each night, don’t suddenly switch it for a 3-ounce steak. Aim to reduce the portion size gradually.”

A healthy breakfast and snacks What does a healthy, balanced breakfast look like? A bowl of high fibre, low sugar cereal with low-fat milk and fruit or two pieces of whole grain toast with peanut butter and a banana are great examples. Ideas for breakfast include a quarter of a plate of grain products, vegetables or fruit. For protein, add milk or milk alternatives, yogurt, eggs, nut butters or a serving of meat and alternatives. For snacks, Andrea’s favourites include a cheese string with an apple or yogurt and berries.

Take it slowly

Thinking About Quitting Smoking?

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Try to eat slowly. Take 20 minutes to eat each meal so you have time to realize your stomach is full. Eat protein and whole grains at each meal to help your stomach feel full for longer.

“People are often surprised they don’t feel hungry when they eat healthy, nutritious food, when the portion sizes are smaller and they are eating more frequently,” Andrea says.

To learn more about healthy eating, register

Our trained tobacco reduction pharmacists can help you quit or reduce the number of cigarettes you smoke.

We work with you to develop a plan that works!

Get started today. No appointment necessary.

for a free Ask a Dietitian group appointment by calling 403-284-3726 ext 206. You can ask personal nutrition questions and book a one-onone follow-up appointment with a dietitian.

calgarycoop.com/pharmacy cfpcn.ca

7

Photo: Neil Zeller Photography

“It’s hard to find a family doctor in this city, so I was thankful for the website. It was easy to find and registering didn’t take long.”

LINKED-IN: Patient Linda Sayers is enjoying continuity of care with her new doctor, Branden Reid.

registration form as Linda did, would-be

NEW RESOURCE HELPS

CALGARIANS FIND A FAMILY DOCTOR

By Kelly Parks

patients can also take a more active role in their search for a physician.

One of the new features, a map, lists all Calgary and area physicians who are members of a Primary Care Network. It highlights those who are accepting new patients and provides contact information.

While Linda was happy to wait two months to be linked with Dr. Reid, the new resource gives people the option of finding a physician more quickly.

WHEN Linda Sayers began her search

Those who register online can expect to “Dr. Reid is very thorough and on top of

wait as little as a few weeks, or as long as

for a family doctor, her son’s pediatrician

things. He helped my family out a lot in a

recommended she register on the Find a

a few months, to hear back from a Primary

short amount of time.”

Care Network with an available physician’s

Doctor website.

Dr. Reid, who moved from Edmonton to

“I’ve never really had a family doctor,” says Linda. “I’ve just gone to walk-in clinics.”

“It’s hard to find a family doctor in this city, so I was thankful for the website. It was easy to find and registering didn’t take long.”

The Find a Doctor registry is an online service that connects residents of Calgary and surrounding areas to a family doctor who is accepting new patients.

Calgary this year, says his roster of patients is

details.

Last year, 4,370 patients found a doctor at

already close to full thanks in large part to the

Calgary Foothills PCN, one of seven PCNs in

website after 9 months.

the area, through the website.

“Many of my patients didn’t have a family

Dr Linda Slocombe, medical director with

doctor before and they are very appreciative,”

the Calgary Foothills Primary Care Network,

he says.

urges people who do not have a family doctor

“The site works very well and I am very thankful.”

to register.

Research shows having a family doctor

The Find a Doctor website was first

and seeing him or her regularly keeps you

launched by the Calgary Foothills Primary

online, Linda was contacted by the Calgary

healthier as you age, helps you live longer

Care Network in 2009 to help people living in

Foothills Primary Care Network and connected

and can aid in catching illnesses before they

north Calgary and Cochrane find a physician.

become serious.

Two months after completing the form

with Dr. Branden Reid at the Foothills Primary Care Centre.

“I was happy. I didn’t expect it to be that quick,” she said.

In 2011, it expanded to include people and physicians throughout Calgary and

If you need a family doctor, please go to

surrounding areas and before this past holiday

www.calgaryareadocs.com

season, new features were added.

While people can still use the online

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Healthy Eating

Great news: good food can be easy to prepare. The key is finding healthy ways to creatively add flavour to the food you eat — so you don’t get tired of eating the same foods over and over again.

Andrea Kroeker, a registered dietitian with the Calgary Foothills Primary Care Network, talks about flavour

Garlic and onion are staples for adding flavour to food in many cultures, without adding salt or fat.

Others you can try: 1 Dry spices (curry, cumin, turmeric, oregano) 2 Fresh spices (ginger) 3 Fresh herbs (cilantro, Italian parsley, basil, dill) 4 Juices (lemon juice, lime, orange juice) 5 Chili flakes 6 Pepper Add dry spices such as curry to soups and fresh herbs to salads or other dishes.

ADD FLAVOUR WITHOUT FAT

Heart healthy oils, such as canola and olive, are great choices for cooking. Try adding other flavourful oils such as the sesame oil used in this soy ginger salmon recipe.

The ginger and green onions used here give the fish a wonderful south Asian flavor. Enjoy!

SOY GINGER SALMON

Recipe by Kari Derbyshire and Andrea Kroeker Calgary Foothills PCN registered dietitians

Ingredients

Directions

2 lbs salmon fillets

Whisk together all marinade ingredients and pour it into a large freezer bag. Add salmon fillets. Allow to sit for 30 minutes.

Marinade: 2 tbsp olive oil 1 tbsp sesame oil 1 tbsp soy sauce 3 tbsp balsamic vinegar 1 tbsp brown sugar 2 cloves garlic crushed 1.5 tbsp grated ginger Dash of pepper

Preheat oven to 400 F. Arrange salmon fillets in a large baking dish, skin side down, and pour over marinade.

Bake time depends on salmon fillet thickness — about 10 minutes per inch or until the salmon flakes with a fork.

Remove from oven and garnish with green onion. Serve with brown rice and sautéed or steamed vegetables for a complete, balanced meal.

Tip: Try this recipe on the barbeque in the summer as well!

cfpcn.ca

9

Why did you become a family doctor?

At school I loved biological science. It was the thing I was good at. I

What is the most challenging part of being a family doctor?

was fascinated by spiders, dissecting worms. When I was introduced

It is trying to help people whose anxieties present as physical

to Darwin’s Theory of Evolution by Natural Selection I was bowled

symptoms. It is often difficult to reassure them that they don’t have a

over by the beauty of it. It led me to decide that medical science was

physical disease. It can be a challenge to help these patients redirect

the thing I wanted to do. My dad was an ophthalmic surgeon, so I

their energies towards dealing with their anxieties.

chose to specialize in surgery at first. But after 10 years, I was aware I was missing out on the human side of people’s illnesses. I decided to retrain. I spent three years training to become a family doctor, while at the same time earning a living as a surgeon. Not many people

What do you do to unwind?

Gardening. In the summer, my wife (also a family doctor) and I grow

choose that path!

strawberries, raspberries, tomatoes and flowers and try to turn our garden into a little oasis. In the winter, it is renovating the basement.

What do you enjoy most about being a family doctor?

It is relaxing because I’m using my hands, but I don’t use power

I like being able to fix people. When you have a patient who is

music. Outside my family, sailing is my passion. During summer

worried about something, it is satisfying to figure out what is wrong

holidays (over the past 19 years), I’ve sailed my boat down to Mexico

and to make it better, so they can go away with that worry lifted. It

and across to Tahiti.

tools. All the nasty injuries we see (related to handy work) are from amateurs using power tools. I also read a lot and listen to classical

is ideal if you can fix a person’s medical problem and make a good connection as well.

What is the fun part of the job?

What are you looking forward to in your retirement?

My daughter is having a baby and I’m looking forward to being

It’s the babies. I love babies. Seeing a healthy baby and watching that

a grandfather. We also plan to enjoy winters in Mexico. We have

person grow up is a delight. We’ve had lots of babies born in our

a small house in a fishing village there where we grow papayas,

practice in recent years, mostly at Riley Park.

mangoes and bananas.

Dr. Imrana Muhammad has taken over the care of Dr. Burn’s patients.

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Face of a Doctor

Photo: Neil Zeller Photography

ON A MISSION TO MAKE LIVES BETTER

Dr. Robert Burns FROM surgical wards in England to famine-ravaged Ethiopia in the 1970s and a rural doctor’s practice in Hinton, Alberta, Dr. Robert Burns has enjoyed a varied life as a family doctor. For more than 19 years, he was a family doctor to patients at The Doctors Office in Nose Hill, Ranchlands. He retired in late 2014.

SANCTUARY: Dr. Burn loves gardening — it’s his favourite place to relax. cfpcn.ca

11

Calgary Foothills PCN

Programs & Clinics Clinics and Services After Hours Clinic

Extended Team

The Access 365 Clinic runs year-round. It offers after-hours appointments for non-emergency medical care. Access the clinic by calling Health Link Alberta at 403-943-5465.

The Extended Team provides care for patients with complex, chronic diseases who are referred by member physicians. Areas of experience include chronic pain, mental health, gastrointestinal and medical musculoskeletal conditions. Help is also available for older adults.

Riley Park Maternity Clinic Care is available to low-risk pregnant women who do not have a family doctor or by referral from a family doctor. Patients must plan to deliver at Foothills Medical Centre.

Programs Patients of Calgary Foothills PCN member doctors can register for the following free programs by calling 587-774-9736.

Ask A Dietitian

TrymGym

Meet with a registered dietitian in a small group to learn nutrition basics such as Canada’s Food Guide, how to read labels and more.

This eight-week program offered by University of Calgary teaches participants to lose weight safely and keep unwanted pounds off for good. Bi-weekly classes include exercise, nutrition education and behaviour change strategies. Calgary Foothills PCN patients receive a $200 discount; call 403-220-4374.

Craving Change Most people know what they should eat, but struggle to control what they actually do eat. This series of four classes covers the relationship between food-related thoughts, emotions and behaviours, and offers empowering strategies to support change.

Happiness Basics This series of seven classes is for adults who want to learn how to be happier. Participants learn and practice simple, positive and empowering skills. Not suitable for anyone with severe depression, anxiety, suicidal thoughts or in crisis.

Walking Programs Join a peer-lead walking group weekday mornings in North Hill Mall or at Confederation Park in the summer. For Cochrane walking groups located at Mitford Park, call 403-851-2534.

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Tobacco Cessation This four-week group program is for patients who smoke and are considering quitting. Ask your doctor for a referral.

Find A Doctor website Need a family doctor?

Register at www.calgaryareadocs.com or call Health Link Alberta at 403-943-5465.

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