Fall 2012 Pulse

FALL2012The Pulse

Thank you for this opportunity to serve you as President of our Medical So-ciety. I look forward to the challenges ahead but even more to what we can accomplish working together as an engaged energized body.

Many of you may know me and many of you may be relying on my reputa-tion (for better or worse) or maybe just using the stereotype of a surgeon to inform you but I want to pledge in my first words as President that before this term is up I will have made every effort possible to know each of you better in a personal way – whether in a meeting, a phone call, sitting down to a meal, or casual meeting at the farmer’s market, however I can do it - I want to listen to what you have to say and I will respect your perspective. We may not agree but I promise to consider your opinion and give it the full attention of this office.

Much is lamented about how small Prince Edward Island is as a province, especially when it comes to national health care policies and challenges; however, I believe our size in one of our greatest strengths as it positions us to have a chance to personally resolve issues and actually attack the chal-lenges in a way that larger jurisdictions can only dream about. It is our deep rich culture of connectedness that is an asset that we have not used to its full strength. And that connectedness must be nourished by communicating with each other.

I want to do the best possible job for this society and its ultimate respon-sibility of providing care for our fellow Islanders. I expect my positions will change and evolve as I hear from you the members. I take very seriously the role I now accept to be an advocate for all physicians and patients in this province. My first step toward stewardship is to let you know that I have di-vested myself of any other provincial or local office to dedicate my efforts to this job. During my tenure this role will be my only extra-curricular activity.

Working in a small province we have structures such as government, The Ministry of Health and Health PEI and patients in their communities all within arm’s length of each other; almost like a family, and in our interactions we have developed a unique system of checks and balances. The Medical Soci-ety in its role as the sole physician and patient advocacy body needs to make substantive contributions to our conversations at the local and provincial level. The provincial systems tasked with managing the delivery of health

care are still maturing and deserves our support and patiences. For me the key element of this dynamic is “Balance”. As for physician interests we have to find the balance between our needs and the system needs in the name of sustain-ability. We can “Check” all we want but if we are not contributing to finding the proper balance we will have neglected this obligation.

It is the nature of medicine to be constantly evolving and PEI has no exemp-tion. No matter how well we think we are doing there is always room for im-provement. It is my goal as President to make a contribution that leaves things better than we found it. I believe the fiscal realities of the finances of health care make it essential that we find ways to deliver the most effective care in the most efficient way possible. The message we are hearing consistently from provincial and federal government now is that there is no more money to be had to throw at our problems. That means we have to find efficiencies. We have to look critically at our processes and find better ways of doing what we do. If we look at our own practices and how we do things as a system I am confident we can find things to change and in the end deliver a better service to our pa-tients. I would challenge the membership that if they see a process that they wouldn’t accept for themselves then we need to make changes.

In our times in this province there are plenty of challenges that deserve our attention. There are plenty of issues in our developing systems that deserve a conversation and action. How we as physicians choose to lead in this work and contribute to the task of evolving our own practices and the system is critical. We know how to make adjustments in our practices as individuals to integrate new approaches and emerging knowledge. But we also can make powerful statements as a group speaking to the public and the leaders of our province about how to truly achieve “health”. We have to engage our partners in this work and recognize their important contributions. Nurses, therapists, pharma-cists, technicians and others are essential teammates which can strengthen our message and call for people to embrace the benefits of healthier lifestyles.

Finally I look forward to a conversation between our members on an emerg-ing issue that I believe Prince Edward Island is its size and connectedness is extraordinarily well positioned to embrace – that is what the physician of our future will be. The CMA at its recently completed General Council articulated a 2012

AspirAtions oF A new Mspei presidentDr. David Bannon’s Inaugural Address, September 8, 2012

2 tHe pULse - FALL 2012

AspirAtions oF A new Mspei president

Health Report Card for the nation which focused on Social Determinants of Health. The research demonstrates that the key to a healthy population goes much farther than knowing what sur-gery to perform, or what antihyper-tensive to use or which cancer treat-ment to recommend. It suggests that physicians must become advocates for cogent social policy, be aware of environmental issues, stand for strat-egies that support the Island econo-my and even consider preparing for the impact of global warming. Look-ing at this data promises a fascinat-ing debate at our dinner tables and in the hallways of hospitals and clinics – what is the scope of practice of the physicians in the future? On what is-sues will be asked to be experts? Can the journeyman hometown doctor still exist in a world which being part of a system is the only way to provide the sophisticated integrated care that standards demand? How can we

preserve the elements of the physician patient re-lationship that have im-mense intangible value? I don’t want just to have

these conversations I want to take our answers to these questions and start to evolve the system that will provide the best care we can on our Island.

I know I may be called an idealist but I assure you I am also a deeply rooted realist and pragmatic worker. I suffer no delusion about the chal-lenge of achieving a healthcare uto-pia. Nevertheless I do believe that if it is possible Prince Edward Island has the best chance of doing it. With your permission I would like to get started now.

My thanks to Sandy and Rachel, Dr Reid, of course, my wife Colleen and a special thanks to our Medical So-ciety staff for all their work and sup-port. Please enjoy your evening.

CMA HonorAry MeMber

HeALtHCAre & proMotion AwArd

CMA Honorary Member Award recipient -Dr. Roland Chiasson. Presented Sep-tember 8, 2012, by Canadian Medical Association President, Dr. Anna Reid,. Honorary membership is an honour bestowed on those who, at the age of 65, having been active members of the Association for at least 10 years, have been nominated by their provincial/territorial medical association and have had their nominations approved unanimously by the Board of Directors of the CMA. The nominees are held in high regard by their colleagues; they are humanitarians who have put into practice the aims and ideals of our profession. They are people who exemplify the words of the CMA Coat of Arms: ‘Integritate et misericordia – integ-rity and compassion’.

Much to the relief of his family practice patients in Summerside, PEI, Roland Chias-son has been quoted in a local newspaper as saying that he has never grown tired of being a doctor and is still “having fun practising medicine.”

Born in Sydney, NS, he did two years of pre-medical studies at Memorial Univer-sity in St. John’s, Nfld. In 1968 he enrolled in Dalhousie University medical school, graduating in 1973. His first practice was in Kensington, PEI, but in 1975 he began a family practice in nearby Summerside that he has maintained to the present day.

For many years his family practice was part-time because he also had a full-time position at Veterans Affairs Canada in Charlottetown, where he served as a medical advisor (1984–2010) and national medical officer (1994–2010).

A former member of the board of Prince County Family Services Bureau, he was a family life education counsellor in PEI schools and a former consultant in sexuality problems on the Island. He also served on the board of Prince County Hospital.

He was president of the PEI Medical Society in 1980 and since 2005 he has chaired the board of directors. He served as a representative to the College of Family Physicians of Canada’s national committee on patterns of practice and health care delivery, and in 2003 was secretary of the provincial CFPC chapter. He also was president of the PEI College of Physicians and Surgeons (2004–2005).

Outside medicine his hobbies are astronomy and reading.

2012 Health Award Presented to Dr. Shabbir Amanullah

Psychiatrist, Dr. Shabbir Amanullah was nominated to be this year’s recipient of the Medical Society of PEI Health Award for his instrumental role in advocating for a provincial suicide prevention strat-egy. Knowing that suicide is a major preventable cause of premature deaths, Dr. Shabbir recognized that statistical information on suicide incidents was lacking in PEI and that research data and trends in PEI could help shape priorities for PEI.

As a result of this premise, collaborating with the Epidemiology Unit and the Chief Health Office and with the cooperation of The Attorney General’s office, an epidemiological study on suicides that oc-curred over the last 10 years in PEI has begun and results will be used to develop a provincial suicide prevention strategy.

I suffer no delusion about the challenge of achieving a healthcare utopia. Nevertheless I do believe that if it is possible

Prince Edward Island has the best chance of doing it.

tHe pULse - FALL 2012 3

AnnUAL GenerAL MeetinG

in photos mill river, september 8-9, 2012

tHe kids HAd A GreAt tiMe too!

“This is the first time I have been able to attend. I certainly appreciate the MSPEI’s efforts, including family activities in the program.”

“ … a relaxed opportunity to meet other physicians who we talk to on phone all the time for consults, but to put faces to their voices was nice.”

“The Mill river location was very well set up for children’s activities. My kids have already asked if there are any other plans to have a meeting there.”

“We had a great time this year and we both could go together only because the kids’ program was in place.”

“That set up would bring me back every year... and no doubt if I keep coming I could be encouraged to stay involved. :)”

Your Society promised that this year’s AGM would not be more of the ‘same old, same old’

and from all accounts, your AGM delivered!Feedback revealed that this year’s AGM agenda

and activities were well received especially since it extended to family. This included an

enlightening two-part presentation bringing new perspective to your work and personal life

and introduced the concept of “mindfulness.”Thanks for the two thumbs up. Your input, as

always, is valued!


pHysiCiAn reCrUitMent

UpDAte JUne-september, 2012Sheila MacLean, RPR Physician Recruitment Coordinator Recruitment and Retention Secretariat Department of Health and Wellness.,

new physiciansdr. nAbeeL ALAnsAri Emergency Medicine - PCH June, 2012

dr. kristen MeAd Pathology - QEH July, 2012

dr. niCoLe FAnCy Family Medicine - Montague July, 2012

dr. JoCeLyn peterson Family Medicine - Charlottetown July, 2012

dr. AAkriti CHAwLA Family Medicine - Charlottetown July, 2012

dr. MAtHew soMMons Psychiatry July, 2012

dr. MeLAnie MCQUAid Radiology July, 2012

dr. HAL MACrAe Family Medicine - Summerside August, 2012

dr. GreGory GerMAn Medical Microbiology August, 2012

dr. JoHn HAyden Emergency Medicine - PCH September, 2012

Committed to begin practice (signed letters of offer)dr. kAtHerine bUrLeiGH Family Medicine - W est Prince October, 2012

dr. AnGie MACLAren Family Medicine - Charlottetown October, 2012

dr. sHAHid ALi syed Family Medicine - Souris Sept. 2012

dr. MoHAMMed wArsi Psychiatry November, 2012

site Visits:dr. sHAHid ALi syed Family Medicine - Souris June 2-4, 2012

dr. iAn wiLson Family Medicine - Summerside June 5-7, 2012

dr. JeFF w ACkett Family Medicine - Summerside July 16-19, 2012

dr. MoHAMMAd wArsi Psychiatry August 28-31, 2012

dr. AneitrA HeAd* Physical Medicine September, 2012

dr. CArMen bArnett General Surgery - Summerside September 10-14, 2012

dr. MoHAMMed sHosHtAri Family Medicine - Souris/Montague/O’leary/Alberton September 23-27, 2012

*DiD a clinical rotation in Physical MeDicine

new meDicAl stUDents - DAlhoUsieNew PEI Medical Students for 2012-13!This year Dalhousie Medical School welcomed 8 students from PEI into the program! Here is a little bit about them:

My name is Sara Shanahan and I am from Charlottetown, PEI. I completed my Bachelor of Science degree in Psychology at Dalhousie University in 2009. I then completed my Master of Social Work (M.S.W.) degree

in which I specialized in Health and Mental Health at the University of Toronto in 2011. My current areas of interest include geriatrics and emergency medicine.

My name is AJ Biswas. I’m originally from Montreal and I moved to PEI in 2009. My wife is from the Montague area and we have a daughter, Maya, who will be 2 in November. I did a physics degree at Mount

Allison University, followed by a masters in mechanical engineering at the University of Ottawa. For the past few years I’ve been working as a consulting engineer, most recently at Coles Associates in Charlottetown. My goal is to return to PEI to work in Emergency Medicine.

My name is Stephen Middleton. I’m from West Royalty, Prince Edward Island and am thrilled to be attending Dalhousie University for Medicine. I attended Mount Allison University in New Brunswick and

the University of Edinburgh in Scotland prior to starting at Dalhousie. Without knowing exactly what kind of medicine I’d like to practice, I’m excited to experience the diversity of medical experiences Dalhousie has to offer.

Ben Cameron Jeffrey Le Janet Martin Nicholas Mooney Daniel Walker


Dr. Brodie Lantz retires from family practice after 47 yearsHe grew his Charlottetown family medicine practice to roughly 3,500 patients, seeing on average 40 to 50 in a day. Toss in decades of delivering babies, doing rounds at nursing homes and an early stint in the emergency room, the affable physician always ensured that he had a full slate.

Being so busy, it seems, made a lengthy, well-regarded career rocket past.

“The days fly by,’’ said Lantz.“The weeks fly by. I can’t believe it’s been 47 years.’’

The 72-year-old Lantz retired from his successful family practice last month, but is not quite ready to hang the stethoscope up just yet.He plans to continue making the rounds at three nursing homes and two community care facilities once a week while being available for consultation calls from those five

facilities seven days a week.

“I can’t sit around,’’ said Lantz.“I didn’t want to ‘boom’ suddenly do nothing. It gives me something to think about when I get up in the morning.’’

As for the state of health care on P.E.I., Lantz also shows diplomacy.“There are a lot of short comings but it’s surviving,’’ he said. “People are well served here. Sometimes they wait too long for consultations.’’

He adds the provincial players are “doing all they can’’ to recruit physicians.

Lantz is certainly pleased that he chose to practice on P.E.I. He never gave any serious consideration to moving.

“It’s a great place to bring up a family,’’ he said. “It’s an easy place to practice.’’

Article from The Guardian

Dr. chArles DewAr & Dr. broDie lAntz

Congratulations to Dr. Shaun Ferguson’s Family who won our Early Bird registration

draw for the Annual Meeting.

Watch for our next Early Bird Draw!!

Happy Retirement

Payment was not always expected when Dr. Charles Dewar launched his medical career in O’Leary in 1954.

“You felt good about helping people, whether they paid you or not,” he reflected.

Dr. Charles, of course, started his career before the introduction of Medicare. At that time the standard charge for an office call was $1.50 to $2.

“We were very lenient with the poor people,” he said. “Sometimes we’d charge them a dollar; sometimes we wouldn’t charge them anything.”

Sometimes a handshake or a promise to pay was what they got.Dr. Charles has always been known in O’Leary by his first name because he was the second member of the Dewar clan to take up medicine there.

The Brudenell-born doctor first came to O’Leary in the summers of 1951 and 1952 as an intern on the invitation of his cousin, Dr. George Dewar.

He was one of 54 to graduate from Dalhousie Medical School in 1954 and immediately joined Dr. George’s O’Leary practice.

He has long been one of only a few members of his graduating class still in active practice, but that is about to change.

He retired on July 14, just shy of his 82nd birthday.

“Patients used to come in when I was working with Dr. George and say, ‘you can’t be a doctor; you’re too young to be a doctor. We want to see the older doctor,’” Dr. Charles recalls with a chuckle.

Article from Journal Pioneer


www.Mspei.orG

pAlliAtive cAre mUst improveKathy Toole is encouraging other families to speak openly about their wishes. (CBC)Delegates at the P.E.I. Palliative Care Conference in Summerside heard Friday that there are not enough services available to alleviate the suffering of the dying.

“We’re facing a tremendous increase in the amount of people that are going to die in Canada,” said Dr. Mireille Lecours, the Medical Director for palliative care. “We need to face that and increase capacity.”

Fewer than 30 per cent of dying Canadians are receiving palliative care. That statistic is about the same on P.E.I., and Health PEI says that needs to be improved.

Kathy Toole’s family depended on the Queen Elizabeth Hospital’s palliative unit

as her father was dying.

“Your wishes change. Instead of full recovery, your wish then eventually changes to no pain, peace of mind for everyone.”

She said people need to start talking about death openly.

“If you love that person, you’re kinder to let them go.”

“It’s a tough sell because nobody wants to talk about death,” said Lecours. “That pretty much is the answer. Canadians are death-denying, politicians are death-denying, we are all death-denying.”

The P.E.I. Liberals, elected to a new term in October, promised a $5.6 million palliative care centre. That centre is meant to both improve palliative care in

the province, and free up long-term care beds for seniors who are not nearing the end of life. But the project is still in the design stage, two years after it was first announced.

Article from CBCPhotos from the P.E.I. Palliative Care Conference

Dr. Gil Grimes - West Prince Palliative Care Dr. Paul Kelly - Summerside Palliative Care

Dr.Mireille Lecours Medical Director Palliative Care

First Link® is an innovative referral program designed to assist individuals diagnosed with Alzheimer’s disease and other dementias, as well as their families and caregivers. First Link® provides support from the point of diagnosis and throughout the progression of the disease.First Link® Connects People To:• A learning series offering information about diagnosis, day-to-day living, positive approaches to care, how to manage challenges and how to prepare for the future.• Support groups and opportunities for one-to-one counselling.• Additional community programs and services.

Making a referral is simple:As soon as the diagnosis is made, the health-care professional asks for permission to refer to the First Link® Program. Once consent is given, the health-care professional completes a referral form and sends it to the First Link® Coordinator at the Alzheimer Society of PEI. Within four weeks, the First Link® coordinator will call the individual with dementia, or their primary caregiver, to provide information, assess needs, and connect them directly to information and support services within their own community. To become a referring partner to the First Link Program, contact Natalie Rix-MacNeill at [email protected] or by calling (902) 370-3135. Visit www.alzheimer.ca/pei for more information about First Link for Health Professionals.

Clinician Perspective: Dr. Barb Flanagan“First Link® is an innovative program that enables me to provide more comprehensive care to my patients with Alzheimer’s and related dementias. First Link® has allowed me as a health care professional to focus more on the medical aspects of dementia care while the Alzheimer Society staff provides ongoing support, education, and help in navigating the health care system throughout the progression of the disease. I encourage all health professionals to check out First Link and become a referring partner today.”

Canadian Falls Prevention Curriculum Workshop November 23-24, 2012 in Charlottetown, PEIIf you work with older adults in long-term care, acute care, home care or in the community, this two-day course will help you and your team acquire the knowledge and skills needed to apply an evidence-based approach to the prevention of falls and fall-related injuries.Upon course completion you should be able to:• define the scope and nature of the problem of falls• identify and assess fall risk• identify a range of prevention interventions reflecting evidence-basedstrategies• understand social policy and context• apply a program planning model.All participants receive a certificate of completion form, and become members of the Canadian Fall Prevention Education Collaboration (CFPEC) after completing the workshop.Cost: $250.00 register by November 1st Early Bird Registration: $225.00 register before September 30thIncludes: Resource guide/book, Fall Prevention Programming, by Vicky Scott Participant binder with slides and handout materials Lunch and coffee/nutrition breaks over both daysOrganizers Sally Lockhart, MSW Janice Ellis, B.Sc., OT & Facilitators: Trish Helm-Neima, B.Sc., PT Judi Gosbee, B.Sc., PTSue Pettit, M.Sc., CCPEFor more information, and/or to register, contact Sue Pettit (902)439-7968 (cell), or by email at [email protected] - - - - - - - - - - - - - - - - - - - - - -


www.Mspei.orGA new Look

motions At the AnnUAl meetingPool Safety – moved by Dr. Kathy Bigsby

That MSPEI call on the PEI government to adopt a drowning prevention strategy aimed at protecting children who access back yard pools. The advocated prevention strategy is two-pronged: 1) legislation to make barriers to accessing pools mandatory and 2) a public education component. The prevention package would identify the following inclusive set of directives for pool owners: actively supervise children; create barriers; use life jackets; teach children to swim; train adults in CPR, first aid and water rescue.

RATIONALE:Traumatic injury (including drowning), in addition to being devastating to those affected, is a massive burden to the health system and the economy. Yet injury prevention is one of the most neglected aspects of our health system.

There are roughly 400 drownings in Canada each year. Almost half occur during aquatic (swimming) and non-aquatic (playing near water) activities. Sixty (60) children drown each summer – the equivalent of two primary school classrooms. Drowning remains the single biggest cause of death in children under the age of four in North America (aside from birth defects). Drowning is also the biggest killer of boys age 5 to 14 worldwide. Boys are about four times more likely to drown than girls.

Virtually every child drowning is preventable, if not predictable.

• Research shows that 40 per cent of drownings occur when an adult is not present. Drowning occurs silently, so keeping children within eyesight (not earshot) is key;• It is estimated that 70 per cent of child drownings could be prevented with proper barriers. Barriers refers to four-sided fencing at least 1.2 metres high around pools, self-closing and self-latching gates and pool alarms, along with strict rules about access to water; • Especially for young children playing near water, personal flotation devices are not a substitute for supervision, but they can keep children afloat for precious moments. Water wings are not PFDs, they are toys;• Swimming ability alone does not prevent drowning, especially in children under 5. Water-safety rules are often the most important part of swim lessons;• It’s not enough to supervise. Adults must be able to intervene in an emergency, yet only a minority of Canadians have strong swimming skills and know CPR.

Medical Society points to health impacts of food insecurity, poverty

Food security – moved by Dr. Jenni Zelin, seconder by Dr. David Bannon

Article Published on September 10, 2012 Eric McCarthy WOODSTOCK - Statistics suggest Prince Edward Island has the highest level of food insecurity of any Canadian province.

The Medical Society of Prince Edward Island wants the provincial government to do something about that, starting by reinstituting an annual food costing study.

“Poverty is at the root of food insecurity,” Dr. Jenni Zelin acknowledged in an interview following the annual

business meeting Saturday of the Medical Society Saturday at the Rodd Mill River Resort.

Zelin said no such study has been done in P.E.I. since 2007. She moved the resolution calling for an annual study.

“It’s a process used to determine how much it costs households to maintain a healthy, basic and nutritious diet. Food costing information is essential to determine the cost of a basic, nutritious diet, and to compare the cost of a basic diet at income levels and other basic costs such as shelter, and influence health and social security policy.”

The study, she said, has to be done annually and specific to P.E.I. to be effective, she said.“Any means to reduce poverty is going to reduce food insecurity and increase food security,” said Zelin who presented statistics showing that 7.7 per cent of households are moderately food insecure, and 2.9 per cent are severely food insecure. Those combined insecurities are exceeded only by the three Territories.

“We define moderate food insecurity as having an income that affects your ability to buy healthy food, but it’s affecting the quality at that point,” she said.“Severe food insecurity, which is a greater degree of it, is when quantity is compromised and children are actually being affected in the household.”

Zelin’s motion won the unanimous approval of society members.

Dr. Jerry O’Hanley, chair of the Society’s Health Promotions Committee, admitted the annual study is just a starting point.

“The number one determinant of health is wealth,” he said. “If you look at an average life span, if you’re poor, you lose three years on it.”

“I don’t think doctors have a cure for poverty. This is a societal issue - how do we distribute the large wealth of this country so that everybody gets to eat? It takes a concerted societal effort.

“It takes people in media, it takes politicians, it takes educators, people in health care, economists. It takes a society as a whole to make our society better. It’s not one particular advocacy group, but it’s all of us trying to find a common way to make it better for the rest of Islanders.”

Remarks by Dr. Anna Reid, president of the Canadian Medical Association and a Northwest Territories physician, fit in well with the motion. She told of a recent study that suggested 39 per cent of people earning less than $30,000 and 68 per cent of people earning more than $60,000 suggested they were in excellent to good health. That 29 per cent gap is up from 17 per cent just three years ago, she noted.Reid said there appears to be a growing appreciation of the impact on health outcomes of the broader societal factors such as housing, food security, employment, income and clean air and water.

The CMA, she said has tasked with developing clinical tools for physicians wishing to carry out health equality work, and to identify practice and payment models to support physicians in addressing equitable access to the delivery of health care.


prinCe edwArd isLAnd

in YellowKniFe (cmA gc)

Your Island contingent enjoying Yellowknife at the recent CMA Annual Meeting.

tUrkey

timeJust a “heads up” for physicians (and a

few hundred turkeys)

It’s time for the 6th Annual MSPEI

Turkey Dinner Drive. Once again,

you can expect to encounter MSPEI’s

“Chief Turkey Collector” (aka Dr. Charlie

Trainor) looking for donations to

help families, who may otherwise go

without, enjoy a complete-with-fixings

turkey dinner this holiday season. Last

year physicians generously donated

$12,000 – that’s 300 dinners!

Donations are made to CBC’s Annual

Turkey Drive for distribution to families

experiencing food insecurity.


MediCAL stUdent & residents

bbQ & trAining session

The Summer Education Program for first and second year medical students introduced a full day clinical education session presented by

medical residents working in PEI.


By DR. MOHSIN RASHIDCanadian Celiac Association

Gluten-related terminology is getting confusing for both health-care professionals and patients as terms like intolerance, sensitivity, and allergy are being used interchangeably.

The number of people consuming a gluten-free diet is increasing and, in 2010, global sales of gluten-free products approached $2.5 billion (US). This trend implies that many who don’t have celiac disease may be on a gluten-free diet for other perceived health benefits.

Gluten is a protein present in wheat, rye and barley and their crossbred grains. Three distinct clinical disorders of gluten intolerance are now recognized as wheat allergy (WA), celiac disease (CD) and non-celiac gluten sensitivity (GS). The mechanisms involved in each disorder are different.

Both WA and CD are mediated by the adaptive immune system. WA can cause anaphylaxis and may affect the skin (contact urticaria), gastrointestinal tract or respiratory system (rhinitis, baker’s asthma). The IgE antibodies play a key role in the pathogenesis of these diseases and a consultation with an allergist is recommended.

CD, on the other hand, is a permanent, autoimmune disorder that causes small intestinal inflammation in genetically-susceptible individuals. It affects one per cent of the population but most individuals remain undiagnosed. The patients form autoantibodies such as serum anti-tissue transglutaminase (tTG) and anti-endomysial antibodies (EMA) that play a key role in screening for CD. Biopsies of the small intestine reveal varying degrees of villous atrophy. The treatment is lifelong adherence to a strict gluten-free diet. (Dermatitis herpetiformis is “celiac disease of the skin” and is managed similarly). Poorly managed CD can lead to complications such as osteoporosis, infertility, development of other autoimmune disorders, and cancer.

In some instances, patients react to gluten in the absence of any allergic or autoimmune mechanism. This phenomenon is referred to as gluten sensitivity (GS). Patients have intestinal or non-intestinal symptoms that resolve on eliminating gluten from their diet. While the symptoms may resemble CD, there is neither villous atrophy nor production of anti-tTG or anti-EMA. Currently, the diagnosis of GS is made by excluding CD and demonstrating improvement of symptoms on a gluten-free diet. GS is believed to be a very common disorder, although precise prevalence data is lacking at present.

For patients presenting to their health-care providers with clinical features suggestive of a gluten-related disorder, CD must be excluded by appropriate serological and histological testing. Empiric treatment with a gluten-free diet isn’t recommended. The gluten-free diet will normalize the serology and intestinal lesion, making confirmation of celiac disease very problematic.

For more information on wheat allergy, celiac disease or non-celiac gluten sensitivity, contact:

Canadian Celiac Associationwww.celiac.ca

Celiac Resource Guide for Health Professionalswww.celiacguide.org

Suggested reading: Sapone A et al. Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine 2012, 10:13

(Dr. Mohsin Rashid, FRCPC, is on the Dalhousie University Faculty of Medicine, and is a member of the Canadian Celiac Association’s professional advisory board.)

Widening spectrum ofgluten-related disorders notedTerminology can be confusingfor both patients and doctors

The number of people

consuming a gluten-free diet

is increasing and, in 2010, global sales of gluten-

free products approached $2.5 billion (US). This

trend implies that many who

don’t have celiac disease may be on a gluten-free

diet for other perceived health

benefits.

http://www.celiacpei.ca/

The Canadian Celiac Association is a national organization dedicated to providing services to support persons afflicted with Celiac disease and/or Dermatitis Herpetiformis through programs of Awareness, Advocacy, Education and Research. Celiacs are served by local Chapters throughout Canada, which united, form a national body called the Canadian Celiac Association.

The PEI Chapter is one of twenty-seven chapters comprising the Canadian Celiac Association. The Charlottetown Chapter was founded in 1988, and serves all of Prince Edward Island. It has recently changed its name to the PEI Chapter to reflect this change. All Island celiacs are encouraged to become members.

The Peer Counsellor Program provides information and support to people newly diagnosed with celiac disease and dermatitis herpetiformis, through the use of an information package and personal support provided by a Canadian Celiac Association volunteer. Our goal is to ensure that every new member receives current, accurate and complete information on celiac disease and the gluten free diet, and provide support in making the adjustment to a gluten free lifestyle.Counsellors on P.E.I. are:

Jerry Muzika - Charlottetown 672-2822Jean Eldershaw - Morrell 961-2066Karen Ellis - O’Leary 859-3771 Alma MacLennan - O’Leary 853-4396Antoinette Arsenault - Summerside 854-2539 Dianne Winsor - Kensington 886-2048

Canadian Celiac Association - pei Chapter


Documents

Fall 2012 Pulse