Passport to Health A Comprehensive Roadmap for Patients North Shore Family Health Team The North Shore Family Health Team Serving the Northwestern Ontario Communities of Terrace Bay, Schreiber, Jackfish, Rossport and Pays Plat First Nation The North Shore Family Health Team was established March 2006 and operational February 2007. The NSFHT is playing a leadership role in the development of proactive roles for patients in managing their own health. While we provide primary prevention, screening, diagnosis and treatment, we also provide prevention of recurrence, rehabilitation and support programs and services tailored to the patients needs. Patient Care is our focus, however working together, and keeping your personal “Passport to Health” booklet up to date, will allow you to track your own health assessment. “Take care of the minutes, for the hours Will take care of themselves” Lord Chesterfield (1694-1773) North Shore Family Health Team INTRODUCTION This Health Passport encourages you to record your continuing health. It is intended to be used as a guide for ongoing health, wellness and follow-up of any Chronic Disease Process. This passport gives you information about early signs of possible concerns regarding your health that you need to discuss with your Family health Team Providers. HOW TO USE YOUR PASSPORT The Health Passport is designed to help you record important information. Keep it on hand, take it with you when you visit your Doctor or other Health Care Professional. Please makes sure all entries are made accurately and please ask for assistance if required. North Shore Family Health Team PERSONAL MEDICAL RECORDS General Information ………………………...........................................................……………. Page 7 Medical Insurance …...……………………...........................................................……………. Page 7 In Case of Emergency Contact Information ……………………..........................……………. Page 8 Allergies/Other ………….…………………...........................................................……………. Page 9 Medical History ……………………………...........................................................……………. Page 10 Surgical History …………..………………...........................................................……………. Page 11 Medical Visits …………...…………………...........................................................……………. Page 12 Annual Medical/Health Assessment Visits ………………………............................…………. Page 13 Medications ………………..………………...........................................................……………. Page 14 Immunization Records ……………………….......................................................……………. Page 13 Family History ……………..………………...........................................................……………. Page 14 My Results …………………………………...........................................................……………. Page 15 Mammogram Record ……………………….........................................................……………. Page 16 Fecal Occult Blood Record ………………………................................................……………. Page 17 Pap/PSA Record ……….…………………...........................................................……………. Page 18 Dental Health …………..…………………...........................................................……………. Page 19 Foot Care ………….………………………...........................................................……………. Page 20 Mental Health Information ……………………….................................................……………. Page 21 Pharmacy …………….……………………...........................................................……………. Page 22 North Shore Family Health Team PAGE -7- PAGE -8- GENERAL INFORMATION ____________________________________________________________ First Name Middle Name Last Name IN CASE OF EMERGENCY CONTACTS Ambulance/Fire/Police ………………………………………………….... 911 Current Address ____________________________________________________________ Street Apt. ____________________________________________________________ City/Town Province ____________________________________________________________ Country Postal Code ____________________________________________________________ Telephone (Home) Telephone (Work) Family Physicians: ____________________________________________________________ ____________________________________________________________ ______________________________________ Phone: _______________ MEDICAL INSURANCE Poison Control Centre: ____________________________________________________________ ____________________________________________________________ ______________________________________ Phone: _______________ Provincial Health Insurance Hospital Emergency Room: ____________________________________________________________ ____________________________________________________________ ______________________________________ Phone: _______________ Province: ____________________________________________________ Health Insurance Number: _______________________________________ Private Health Insurance Type of Insurance: _____________________________________________ Insurer (Name of Company): _____________________________________ Pharmacy: ____________________________________________________________ ____________________________________________________________ ______________________________________ Phone: _______________ Next of Kin: ____________________________________________________________ ____________________________________________________________ ______________________________________ Phone: _______________ Address: ____________________________________________________ Phone: __________________________ Fax: _______________________ Policy Number: _______________________________________________ Friend/Relative: ____________________________________________________________ ____________________________________________________________ ______________________________________ Phone: _______________ North Shore Family Health Team PAGE -9- PAGE - 10 - MEDICATION ALLERGIES/SENSITIVITY ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ MEDICAL HISTORY DIAGNOSIS DATE OF ONSET FOOD ALLERGIES/SENSITIVITY ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ OTHER: ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ I HAVE: Lens Implants Dentures Pacemaker/Defibrillator Artificial Joint Contact Lens Prosthetic Valves North Shore Family Health Team DATE PAGE - 11 - PAGE - 12 - SURGICAL HISTORY MEDICAL VISITS SURGEON HOSPITAL PROCEDURE DATE HEALTHCARE PROFESSIONAL COMMENTS/ACTIONS North Shore Family Health Team DATE PAGE - 13 - PAGE - 14 - ANNUAL MEDICAL VISITS MEDICAL VISITS PROVIDER COMMENTS NAME OF PRESCRIPTION DATE STARTED DATE DISCONTINUED COMMENTS HEALTH ASSESSMENT VISITS DATE PROVIDER COMMENTS North Shore Family Health Team DATE PAGE - 15 - PAGE - 16 - IMMUNIZATION RECORDS FAMILY HISTORY TYPE OF VACCINATION NOTES IMMUNIZATIONS Annual Influenza: _______________________________ Pneumococcal: _________________________________ Allergies Congenital Heart Problems Eczema Heart Attacks Asthma Early Death Tuberculosis (T.B.) High Blood Pressure Epilepsy Osteoporosis Seizures Cardiovascular Disease Learning Disorder Other Early Blindness Early Deafness Cancer Obesity Diabetes Early Death Tetanus/Diphtheria (Td): __________________________ Hepatitis: ______________________________________ Height: ____________________ Weight: ____________________ BMI: _______________________ North Shore Family Health Team DATE PAGE - 17 - PAGE - 18 - MY RESULTS MAMMOGRAM RECORD PROVIDER COMMENTS DATE RESULT North Shore Family Health Team DATE PAGE - 19 - PAGE - 20 - FECAL OCCULT BLOOD RECORD PAP/PSA RECORD (Prostate Specific Antigen) RESULT DATE RESULT North Shore Family Health Team PAGE - 21 - PAGE - 22 - DENTAL HEALTH FOOT CARE Dentist Pencil in the information so that you may update this chart regularly. Name: _____________________________________________________ Date: ____________________________ Address: ___________________________________________________ Right Left ____________________________________________________________ Sensitivity: _________________ __________________ Circulation: _________________ __________________ Oral & Overall Health A conversation with your dentist can help you understand the connection between oral health and overall health, and ensure that you are getting the best possible care. Discussing your medical history and health issues ensures that you get the specialized treatment you need. Calluses: _________________ __________________ Sores: _________________ __________________ Your dentist can also spot emerging medical problems. For example, the onset of bleeding gums might suggest the beginning of gum disease, which may also be related to adult-onset diabetes if your gums have otherwise been healthy. ____________________________________________________________ Phone: ________________________ Fax: _______________________ Through the oral exam, your dentist can see if there are any unusual signs or changes in your mouth, this might indicate more serious health problems. Oral Cancer Oral Cancer starts in the cells of the mouth, tongue or throat. Normally these cells are quite resistant to damage, but repeated injury from smoking, alcohol or even friction may create sores or painful areas where cancer can start. Comments:__________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ North Shore Family Health Team PAGE - 23 - PAGE - 24 - MENTAL HEALTH PHARMACY Social/Mental Health Worker Name: Your pharmacist may help you to manage your prescription medications and better understand how they interact with each other and other over-the-counter medication you may be taking. ____________________________________________________________ Call you local pharmacy to see what programs may be offered to you: • Medication: Review & Education • Review of high risk medications/interactions Address: ____________________________________________________________ ____________________________________________________________ PHARMACY NAME: ___________________________________________ ____________________________________________________________ PHONE: _______________________ FAX: ________________________ ____________________________________________________________ Phone: ____________________________________________________________ North Shore Family Health Team MEDICAL INFORMATION Diabetes What is Diabetes? …...……………………........................................................……………. Page 27 Blood Pressure Control/Glucose Control …....................................................……………. Page 29 Glucose Meter …….....……………………........................................................……………. Page 30 Cholesterol …………...……………………........................................................……………. Page 30 Kidney Tests ………....……………………........................................................……………. Page 31 Foot Care ………….....……………………........................................................……………. Page 32 Eye Assessment ….....……………………........................................................……………. Page 33 BMI …..........................……………………........................................................……………. Page 35 Eating Better, Feeling Better …...…………………….......................................……………. Page 37 Lab Tests …...……………………………….......................................................……………. Page 38 Travel Advice ………...……………………........................................................……………. Page 39 Travel Certificate ..…...……………………........................................................……………. Page 40 North Shore Family Health Team PAGE - 27 - PAGE - 28 - WHAT IS DIABETES? What Happens When I Eat? Usually when a person eats food, the food is broken down into smaller components and then absorbed into the blood stream. Glucose, one of these smaller components, is a sugar essential for normal body function. Once glucose is in the blood stream, the body must then store it so that over time it can use this sugar for energy. The cells, however, cannot tell that glucose is present in the blood. They need to be told this by a messenger, a hormone called Insulin, which is made by the pancreas. The insulin helps the cells recognize that glucose is available and will let it in. What Happens in Diabetes? Diabetes is when there is too much glucose in the blood because the cells won’t take it in. There are three main types of Diabetes: Type 1 – Usually diagnosed in children and adolescents, occurs when the body is unable to produce insulin because the cells of the pancreas are no longer working. Approximately 10% of people with diabetes have Type 1. Type 2 – Usually develops in adulthood, occurs when the pancreas no longer produces enough insulin or has difficulty using the insulin it does produce. Approximately 90% of people with diabetes have Type 2. Gestational – Is a temporary condition that occurs during pregnancy. Approximately 3.5% of all pregnancies are affected and both mother and child are at risk of developing diabetes. Hypoglycemia Low blood glucose or hypoglycemia is a blood sugar level less than 4.0 mmol/L and is a side effect of using insulin or oral hypoglycaemic agents (diabetes pills). This may happen if you: • Eat less than planned or delay a meal too long • • Take more medication than planned. Have alcoholic drinks without eating. Symptoms include: • Shaking • Sweating • Fast Heartbeat • Hunger The suggested treatment is to eat 10 – 15 grams of simple sugar such as: ½ cup of regular pop or juice; or 3-5 candies; or 3 glucose tablets. Follow-up with an extra snack if your usual meal is more than 1 hour away. Who is at risk? Some risk factors cannot be altered. For example, you’re at higher risk for developing type 2 diabetes if: • You are over 40 years old • You have a family history of diabetes • You are a member of a high-risk group (Aboriginal, Hispanic, Asian, South Asian or African descent) • You had gestational diabetes or gave birth to a baby weighing over 4 kg (9lbs.) You can control certain other risk factors through lifestyle changes that include: • Maintaining a healthy weight • Being more active • Healthier eating habits Making these changes can help you to: • Lower your cholesterol • Lower your blood sugar North Shore Family Health Team PAGE - 29 Blood Pressure Control High blood pressure may cause you serious health problems such as a stroke and may cause you to develop complications from the diabetes more quickly. It is easier to control your blood pressure when your weight is in a healthy range (see BMI). Blood Glucose Control PAGE - 30 Glucose Meters A blood glucose meter is an instrument that you may use to test your blood glucose levels at home. All you need is a drop of blood from your finger tip and a test strip available from your drug store. Self testing is essential if you are using insulin and is very useful if you are taking oral agents or controlling your diabetes by diet and exercise. Testing will help you to adjust your treatment. Having diabetes means having large amounts of glucose in the blood. High glucose levels over longer period of time have been proven to cause the complications of diabetes. It may be possible to delay or even prevent these problems by keeping your glucose levels within a normal range. Your glucose levels should be within 4 – 7 mmol/L before meals although not lower, which can be difficult. How often you test will vary based on your treatment and how closely you wish to control your glucose levels. You may test as few as 5 times a week or as many as 50. The accuracy of these tests depends on your meter, test strips and know-how. How well your blood glucose level is controlled can be tested in two ways: To be sure that your results are true, bring your meter to the lab when you have a lab blood glucose test and do a test yourself with your meter within 5 minutes of your lab blood test. The result of the test using your meter should be within 15% of the lab test results. It is a good idea to do this check every 4 – 6 months. 1. By having the lab test your glucose level before or after a meal. 2. By having the lab do a hemoglobin A1C test every 3 to 4 months. Hemoglobin is a large molecule which carries oxygen to your blood. When glucose hits the haemoglobin in your blood, it sticks to it. More glucose in your blood means more glucose stuck to haemoglobin. The amount of glucose stuck to hemoglobin is measured by the HbA1c test. Since each haemoglobin molecule stays in your blood 3 to 4 months before it is replaced, this test shows the average blood glucose control for that time period. What About Cholesterol? Remember that having diabetes tends to raise your cholesterol and triglyceride levels, putting you at risk of blocking arteries. Have your cholesterol levels checked at least once a year. The chart below helps you to understand your cholesterol levels: Total Cholesterol LDL Cholesterol HDL Cholesterol Triglycerides Desirable Levels for Diabetics below 4.0 below 2.0 above 0.9 below 2.0 These numbers are very general guidelines. People with multiple risk factors will need to have their personal goals discussed with their healthcare professional and desirable lipid levels determined. Cholesterol is important for many body functions. Problems arise North Shore Family Health Team PAGE - 31 when your low density lipoprotein (LDL), sometimes called “bad cholesterol”, is too high. This allows fatty deposits to line your artery walls. A stroke or heart attack may result. High density lipoprotein (HDL), also called “good cholesterol”, helps to carry cholesterol to the liver to be broken down and excreted. Serum cholesterol is the total amount of cholesterol in your blood. It includes both HDL and LDL. You can lower your serum cholesterol level by eating fewer foods that contain saturated fats . PAGE - 32 Foot Care As a complication of diabetes, blood may not flow normally to your feet. When this happens, you do not fight infections as well or heal as easily. The nerves going to your feet may also be affected by your diabetes, so you will have reduced feeling and you may experience numbness and tingling. These changes may prevent you from feeling pain or injury to your feet. Have your feet examined each year by a health care professional. These tips will help you to best protect your feet: Kidney Tests 1. DO NOT SMOKE Kidney damage from diabetes is called diabetic nephropathy. It develops slowly over many years without warning signs. Symptoms do not occur until the disease is far advanced but tests can help detect early signs. 2. Walk within your limits, but WALK. Creatinine Clearance: measures your kidneys’ ability to filter waste products; Proteinuria: measures how well the filters work; Microalbuminuria: checks for tiny amounts of protein (albumin) in your urine. These tests may require a first morning, 8, 12, or 24 hour urine sample collection. Ask your health care professional to identify your normal range, depending on the test procedure used by your local lab. It is a good idea to have one of these tests done at least once a year. If protein is found in your urine, you will need tighter control of your blood glucose levels and your blood pressure. Your doctor may give you a medication to help control your blood pressure. In this case, your healthcare professional may also recommend limiting the amount of protein that you eat. 3. Never go barefoot. Always wear socks. When you have to get up at night, turn on the lights and wear slippers. At the beach, always wear beach shoes, even when you are in the water. 4. Be sure your shoes fit properly. When your feet are less sensitive, you can no longer trust the feel of a shoe to determine proper fit. You should relay on an experienced shoe fitter to measure your foot IN THE AFTERNOON for the best fit. 5. Avoid shoes with pointed toes, high heal shoes or sandals with thongs between the toes. Choose shoes made of natural materials, like leather which breathe. Wear new shoes for only 2 – 4 hours at first. 6. Shake out your shoes each day to make sure our feet will not be hurt by small objects which may be caught inside your shoes. 7. Wash your feet and lower legs daily in warm (not hot) water with a soft face cloth and mild soap. Remember your feet may not be able to sense the temperature of the water, so test it with your elbow to avoid burns. North Shore Family Health Team PAGE - 33 your elbow to avoid burns. 8. Trim your toe nails straight across or in contour; never down to the corners or below the end of your toes. DO NOT PEEL OR PULL BACK NAILS. 9. Corns or calluses should only be treated by a health care professional. 10. Inspect your feet daily for cuts, bruises, blisters, infection or changes in skin colouring. If you find an injury, swelling, redness, sores, change in colour, or if you have pain, see your doctor or foot care specialist right away. Eye Assessment Have your eyes examined at least once a year. A thorough check-up will include an examination of the retina as well as checking for cataracts and glaucoma. Be sure to tell your optometrist or ophthalmologist that you have diabetes. PAGE - 34 3. PRE-PROLIFERATIVE/PROLIFERATIVE: damage is of concern and requires follow-up. For proper eye examination, your pupils will need to be dilated by adding special drops to your eyes. After the test, your vision may be blurred for a few hours, so make sure you do not need to drive soon after the test. Your eyes may also be more sensitive to light, so you may wish to wear sunglasses. Cataracts The lens in your eye, which is normally clear, may become cloudy and interfere with your vision. New medical techniques can remove the clouded lens and a new artificial clear lens may be implanted to help your vision. Or, special glasses may be worn to correct your vision. Glaucoma Glaucoma is the result of steady build up of pressure inside the eye. Two out of every 100 people over the age of 40 will develop it. When identified early, glaucoma can be controlled. Retinopathy As a person with diabetes, you’re at greater risk of developing retinopathy or damage to the back of your eye, the retina. This can come without warning. When detected early, laser treatment is available to help stop the disease and prevent loss of sight. Your eye care specialist may describe the condition of your retina with the following terms: 1. ABSENT: your retina is just fine. 2. BACKGROUND: mild changes common in diabetes need continued monitoring. North Shore Family Health Team PAGE - 35 What About Weight? Body Mass Index (BMI) is a useful indicator of whether your weight is within a healthy range. It’s easy to find your BMI… 1. Mark an X at your height on line A. 2. Mark an X at your weight on line B. 3. Take a ruler and join the two Xs. 4. To find your BMI, extend the line to line C. PAGE - 36 FOR EXAMPLE: * If you are 5’11” (1.8m) and weigh 190 lbs. (86.4 kg), your BMI is about 26. Under 20 A BMI under 20 may be associated with health problems for some individuals. It may be a good idea to consult a dietitian or a physician for advice. Underweight 20-25 This zone is associated with the lowest risk of illness for most people. This is the range you want to stay in. N 25-27 A BMI over 25 may be associated with health problems for some people. Caution is suggested if your BMI is in this zone. Overweight Over 27 A BMI over 27 is associated with increased risk of health problems such as heart disease, high blood pressure and diabetes. It may be a good idea to consult a dietitian or a physician for advice. Obese IF YOU FALL BELOW 20 OR ABOVE 27 ON THE BMI RANGE…It’s time to reduce your risk of developing health problems. The first and most important thing is to determine why you are not within the healthy weight range and seek the assistance of your physician and dietitian/nutritionist. North Shore Family Health Team PAGE - 37 EATING BETTER, FEELING BETTER Eating better helps you to gain better control of your blood glucose and fat levels, to reach and maintain a healthy weight and to stay healthy; you may want to speak to a dietitian to help you plan healthy meals. Eating Better Means: • Choose 3 out of the 4 key food groups at each meal: - Starch - Protein - Fruits & Vegetables - Milk • Watch portion size. • Eat at regular times. Have 3 meals a day (including breakfast) and space your meals 4 – 6 hours apart from each other. • Choose high fibre food like whole grain breads and cereals, fresh fruit, vegetables and legumes. • Make lower fat choices. Use low fat dairy products and choose lean meat. Trim fat from meat, chicken, etc., and cut down on added fat like butter and salad dressings. • • Use less salt in cooking and avoid adding salt at the table. Instead, try more herbs or spices. Reduce your intake of ketchup, chili sauce, soya sauce and bouillion cubes. Reduce your alcohol intake. PAGE - 38 How Often Should Lab tests Be Done? The following schedule may be used as a guideline to chart your routine medical/lab visits. Each time that you have one of these test done, place a check mark in the box beside the test name. Year by year, you will easily be able to see if you have had all of your tests. For information on any of these tests, see the pages in the back of this booklet. How Often? Year 1 Year 2 Year 3 Year 4 Year 5 Blood Pressure q 3-4 mths BLOOD TEST: HbA1C q 3-4 mths Lab Meter/ Glucometer Checkk q 6 mths Fasting Blood Glucose Once a yr KIDNEY: Once a yr LIPIDS: Total Cholesterol Once a yr HDL Cholesterol Once a yr LDL Cholesterol Once a yr Triglycerides Once a yr Foot Exam Once a yr Eye Exam Once a yr Microalbuminuria Remember to continue to do self-testing at home as suggested by your diabetes team in addition to the above lab tests. North Shore Family Health Team PAGE - 39 - PAGE - 40 - Travel Advice Be sure to plan your trips well. If you are using insulin, have your doctor fill out the Travel Certificate on the following page in order to avoid any troubles at Customs. Everyone who has diabetes should keep these tips in mind: • Take some food with you in case a meal is delayed, or in case the trip is longer than you thought. • Carry extras of all your drugs – those you take for your diabetes, any other drugs you usually take and any you may need at unexpected times such as antidiarrheal or pain relieving drugs. • A time difference of more than 3 hours may require that you adjust your insulin dose. Discuss this with your diabetes team. TRAVEL CERTIFICATE This document certifies that: _________________________________ has diabetes mellitus and requires insulin injections. This justifies the need to carry insulin, syringes, glucose meter and test strips at all times. Date: _____________________________________ Dr. (Signature): _____________________________ Telephone: _________________________________ North Shore Family Health Team MEDICAL INFORMATION Heart & Stroke Risk Factors ……….....…………………...........................................................……………. Page 41 Blood Pressure …………………………………………………..........................……………. Page 42 Cholesterol ……..……….………………...........................................................……………. Page 43 Immunizations Immunization …………...…………………........................................................……………. Page 45 Immunization Schedule …………………………………………............................…………. Page 46 Mental Health ……………………………………………………………………………………… Page 48 Screening Screening Information ………….……………....................................................……………. Page 51 Breast Cancer …………..………………………................................................……………. Page 52 Cervical Cancer ……….……………..…...........................................................……………. Page 52 Colon Cancer …………..…….…………...........................................................……………. Page 53 Prostate/Testicular Cancer ………….…………………….................................……………. Page 54 Skin Cancer …………….……………………….................................................……………. Page 55 North Shore Family Health Team PAGE - 41 - PAGE - 42 - HEART & STROKE • Risk Factors Cardiovascular Module • Risk factors for prevention of Heart Disease and Stroke. • Non-Modifiable: Although these risk factors cannot change for prevention of stroke or heart disease it is important to be aware of them: • Age – Women on average develop heart disease 10 years later than men; however menopausal women have an increased risk of high blood pressure and cholesterol which increases their risk of heart disease or stroke. • Ethnicity – Increased risk for persons of African American, First Nations/Aboriginal and Inuit Canadians for heart disease. Although persons of Asian descent have a lower risk for heart disease they have an increased risk for stroke. • Family History – Positive family history of heart disease or stroke at an early age may mean increased risk of developing heart disease or stroke than those individuals with no family history. • Gender – Men increased risk than females. However, post menopausal women are at increased risk of heart disease or stroke. Modifiable Risk Factors: • Blood Pressure – Get your blood pressure tested and ensure that your blood pressure is in the target range: take your blood pressure medication regularly to help control your blood pressure. • Cholesterol levels – have your cholesterol levels checked to make sure that your levels are at target range. • Diabetes – ensuring that your blood sugars are at target levels, can delay or prevent cardiovascular complications associated with diabetes. Dietary strategies – follow a low fat, low salt diet; eat a variety of fruits, vegetables, whole grains, lean meat, fish and poultry. Limit fast foods, canned foods or foods that are bought prepared. Smoking – quitting smoking can lower your risk of developing heart disease or prevent a stroke. Smoking cessation counselling is a program that is offered by the North Shore Family Health Team. Activity – regular physical activity for 30 to 60 mins. for 4 – 7 days per week. Blood Pressure Hypertension (High Blood Pressure) One of the leading causes of death in Canada. Hypertension is a risk factor for stroke, heart attacks, heart and kidney failure. What is Blood Pressure – Blood pressure consists of two measurements: the pressure in the heart when it contracts (Systolic) and when the heart relaxes and fills with blood (Diastolic). Blood pressure is measured with two numbers, for example 120/80. Systolic pressure is represented by the first number and Diastolic is the second number. Controlled blood pressure is important for it allows the blood to flow freely and deliver oxygen to the body. When the blood pressure is elevated it causes damage to the blood vessels. Damaged blood vessels lead to stroke or heart attacks. What is my target blood pressure? BP should be less than 140/90, but if you have diabetes or chronic kidney disease your target is 130/80. North Shore Family Health Team PAGE - 43 Management of blood pressure: • Physical Exercise – regular exercise 30 to 60 minutes of exercise 4-7 days per week. • Weight reduction – BMI <25. • Alcohol consumption - <2 drinks/day • Dietary strategies – variety of fruits, vegetables, low fat dietary products, high fibre, and salt reduction <100 mmol/day (1tsp) • Smoking cessation • Stress management Medications are added when the above strategies are unsuccessful in lowering the blood pressure to target goals. It is important to note that in order to reach target goals, it may be necessary to take more than one medication. Cholesterol Dyslipidemia (elevated cholesterol levels) PAGE - 44 treatment plan to lower your cholesterol. What are my target cholesterol levels? Target levels are rated according to risk factors. Risk factors are based individually and factor in age, blood pressure, total cholesterol level, HDL level (good cholesterol), smoking, genetic risk and patients with established diabetes or heart disease. Total cholesterol value should be less than 5.2 mmol/L HDL cholesterol should be greater than 0.9 mmol/L Triglycerides should be less than 2.0 mmol/L LDL and Total Cholesterol: HDL ratio is determined by calculating your individual risk factors. It is important to have your cholesterol levels assessed regularly and reviewed by your health care provider who will determine your individual target levels. Cholesterol is a waxy substance that the body makes naturally. The body does need some cholesterol to work properly and it can make what it needs. Not all cholesterol is harmful. Low density lipoprotein (LDL) is the bad cholesterol as it blocks the arteries. High density lipoprotein (HDL) is good cholesterol, as it helps remove the bad cholesterol from inside the arteries. Elevated cholesterol can be caused genetically or from a high fat diet, decreased activity, obesity, increased alcohol intake and certain medications. Elevated cholesterol can block arteries. When an artery to the heart is blocked a heart attack can occur. If an artery in the brain becomes blocked, a stroke can occur. Management of cholesterol is the same strategies for managing elevated with blood pressure. However, if the above strategies are unsuccessful, then your health care provider will have to add medications to your North Shore Family Health Team PAGE - 45 - PAGE - 46 - IMMUNIZATIONS Pneumococcal Polysaccharide Vaccine (“Pneumonia Shot”) What is it? • A vaccine used to protect people over the age of 65 years from a bacteria that can cause bacterial pneumonia or septicaemia (a bacterial infection of the blood) or meningitis (a bacterial infection of the membranes and fluid covering the brain and spinal cord). • You should receive one dose of the vaccine at 65 years and a single re-immunization is recommended after 5 years. Influenza Vaccine (“Flu Shot”) What is it? • A vaccine used to prevent infection caused by influenza viruses carried and spread among humans every year. • The “Flu” season is usually from November to April – and then stops. • Symptoms include: fever, chills, cough, runny eyes, stuffy nose, sore throat, headache, muscle aches, extreme weakness and fatigue (the elderly may not have a fever). • The “Flu” is hardest on people who don’t have a strong immune system: the very young, the very old and people with certain chronic illnesses. • Get an annual flu shot - this will prevent the infection or reduce the severity of the illness. How it is spread? • Breathing droplets that are sneezed or coughed into the air by someone with the flu, or having the droplets land on the surface of your eye. • Shaking hands with an infected person or touching a contaminated surface or objects and then touching your own eyes, nose or mouth. Tips to Prevent the Flu • Wash your hands frequently using soap and warm water. • Cover your mouth and nose with a tissue when you sneeze or cough. • If you don’t have a tissue, cough or sneeze into your upper sleevenot into your hands. • Put used tissue in the waste basket immediately. • Avoid sharing food, eating utensils, towels or handkerchiefs. • Keep an alcohol-based hand sanitizer (gel or wipes) handy at work, home and in the car. How it is spread? • The bacteria are spread from one person to another by coughing, sneezing or close face-to-face contact. It can also be spread through saliva or spit. Tetanus and Diphtheria (Td) Vaccine Adults should receive a Td booster every 10 years to protect against the Tetanus and Diphtheria diseases. What is it? • Tetanus (lockjaw) is a serious disease. The illness starts with headache and very stiff jaw muscles followed by a stiff neck, difficulty swallowing, stiff stomach muscles, inability to control muscles (spasms), sweating and fever. Tetanus kills 2 out of every 10 people who get the disease. • Diphtheria is a serious disease. The bacteria cause fever and a thick coating in the nose, throat and airway that result in breathing problems, heart failure and nerve damage. Diphtheria kills 1 out of every 10 people who get the disease. How it is spread? • Tetanus is caused by germs that enter the body through a cut or wound. The germs may be found everywhere including soil, dust and animal manure. • Diphtheria spreads when the bacteria pass from the nose, throat or skin of one person to another. North Shore Family Health Team PAGE - 47 - PAGE - 48 - Hepatitis Vaccinations Hepatitis A and B are infectious diseases caused by viruses that cause the liver to become inflamed. Immunization may be recommended if you are at risk of infection due to travel or direct contact with blood or body fluids. Talk to your health care provider for more information. MENTAL HEALTH/ADDICTIONS Recommended Immunization Schedule for Adults Vaccine Who When Influenza (flu shot) All Adults Annually Pneumococcal Polysoccharide • Individuals > 65 years • All residents of nursing homes and chronic care facilities • Individuals with certain medical conditions One dose Tetanus, Diphtheria (Td) All Adults Every 10 years Hepatitis High-Risk Individuals Follow-up with Health Care Provider Booster x1 after 5 years Mental Health involves finding a balance in all aspects of your life: physically, mentally, emotionally and spiritually. It is the ability to enjoy life and deal with the challenges you face everyday. It is natural to feel off balance at times and experience emotions such as sadness, worry and anger. However, if these feelings interfere with your daily life or relationships then there may be problems. One in five people in Canada experience a mental health problem during their lifetime. Only about 30% seek help. Would you try to deal with a heart condition on your own? Mental health problems can be just as serious as physical problems and getting medical attention and other help is just as important. The earlier you get help, the less chance of the problem coming back or getting worst. If you are not sure you need help, talk to your health care provider or social worker at the Family Health Team. What can contribute to mental health problems? Serious mental health problems involve biochemical disturbances in the brain. Various psychological, social and environmental factors can affect your mental health. The Most Common Mental Health Problems are: Anxiety Disorder – Is the most common mental health problem. Anxiety involved excessive worry that is hard to control and affects a person’s daily living. Anxiety disorders include panic disorder, obsessivecompulsive disorder (OCD), post traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Anxiety disorders affect about 12% of Canadians. North Shore Family Health Team PAGE - 49 Bipolar Disorder – Involves extreme mood swings that may have nothing to do with what is going on in the person’s life. Typically people with a bipolar disorder move between feeling “normal”, feeling very low or depressed, and feeling very high or “manic”. Bipolar disorders affect about 1% of the population. Depression – Involves feeling abnormally sad, despairing and hopeless fairly consistently for over two weeks. Other feelings could include irritability, worthlessness or guilt, or a general loss of interest in life. Often a person’s performance at work or in relationships is impaired. Sleep, energy, appetite, concentration, memory and sexual desire may be affected. Depression can lead to thoughts of suicide. About one in ten people are diagnosed with depression, however it is estimated that many people with depression go undiagnosed. At any given time, almost three million Canadians are affected by a serious depression. Personality Disorder – A person behaves and communicates in ways that are very different form what is expected in society. A person may have problems with self-image or having successful relationships. They may view themselves, others and the world in a manner that is different then most other people view things. They may also have a rigid way of thinking, feeling and acting that makes it difficult for them to get used to changes and stresses that are an unavoidable part of everyday life. PAGE - 50 Taking Care of your Mental Health: Understand Stress – 43% of adults suffer adverse health effects from stress. 75-90% of all physician office visits are for stress-related ailments and complaints. Stress is linked to the six leading causes of death: heart disease, cancer, lung ailments, accidents, cirrhosis of the liver and suicide. Think healthy – The same situation will affect people differently depending on their interpretation. Learn to interpret situations in a manner that helps you feel good. Be aware of thinking errors (patterns of thinking that help us feel bad). Monitor your automatic thinking; you might be unconsciously thinking about negative situations or events, which will affect your mood. Be social – Humans are social animals, although we are capable of solitude, we also have social needs. When these needs are not fulfilled, emotional difficulties often result. Choose a Sustaining Lifestyle – This includes eating healthy, getting plenty of exercise, sleeping regularly, limiting caffeine, alcohol and avoid drug use and most importantly making sure you have fun in life. Schizophrenia – People with schizophrenia often have difficulty figuring out what is real and what is fantasy. They may see or hear things that are not actually there. Schizophrenia affects about 1% of Canadians. Substance use disorder – Involves dependence on or abuse of substances such as alcohol, medication or illegal drugs. Substance use disorder affects about 6% of the population. North Shore Family Health Team PAGE - 51 SCREENING INFO Reducing your risk of Cancer There are many good reasons to take charge of your health. As we grow older, the risk of developing a chronic disease like cancer increases. Understanding what’s normal for your body is an important part of staying healthy. So take control of your health by getting to know your body, learning the warning signs of cancer and following a healthy lifestyle. At least 50% of cancers can be prevented through healthy living and policies that protect the public. Take these steps now to reduce your risk of developing cancer. 1. Be a non-smoker and avoid second-hand smoke. 2. Eat 5 to 10 servings of vegetables and fruit a day. Choose high fibre, lower fat foods. If you drink alcohol, limit your intake to 1 to 2 drinks a day. 3. Be physically active on a regular basis; this will also help you maintain a healthy body weight. 4. Protect yourself and your family from the sun, particularly between 11 a.m. and 4 p.m. when the sun’s rays are at their strongest, or any time of the day when the UV Index is 3 or more. Check your skin regularly and report any changes to your doctor. 5. Follow cancer screening guidelines – discuss mammograms, Pap test, breast exams and colorectal screening with a health professional. 6. Visit your doctor or dentist if you notice a change in your normal state of health. 7. Follow health and safety instructions both at home and at work when using, storing and disposing of hazardous materials. And remember: • Get to know your body. • Don’t ignore the warning signs. • Follow a healthy lifestyle. PAGE - 52 Breast Cancer Breast cancer starts in the cells of the breast and extends from the collarbone to under the armpit and across the breastbone to the center of the chest. Breast cancer is the most common cancer found in women and rarely found in men. Breast cancer can occur at any age but most cases occur over the age of 50. What can you do? • Clinical breast exam – every two years by a trained health care professional after the age of 40. • Mammograms every two years after the age of 50 years or sooner if family history of breast cancer. • Talk to you health care provider about your personal risks of breast cancer and the benefits of mammograms. • If you have a family history of breast cancer you may want to consider screening sooner. What to watch for? See your health care provider if you have: • A lump or swelling in the armpit • Changes in breast size or shape • Dimpling or puckering of the skin • Redness, swelling and increased warmth in the affected breast • Inverted nipple – nipple turned inwards • Crusting or scaling of the nipple Cervical Cancer Cervical cancer starts in the cells of the cervix and grows very slowly. Before cancer develops the cells become abnormal. These abnormal cells can be detected through routine pap tests. What can you do? • Have regular pap tests to detect changes early before cancer develops • Have a pelvic exam by your health care provider to assess any abnormalities of the organs within the pelvis and vagina. • Use a condom during sex to avoid a sexually transmitted North Shore Family Health Team PAGE - 53 • infection Consider the HPV vaccine if you are between the age of 9 and 26 years of age to protect against the strains that can cause cancer and prevent genital warts. What to watch for? See your health care provider if you have: • Abnormal bleeding from between periods • Unusually long or heavy periods • Bleeding after sex • Pain during intercourse • Watery or increased discharge from the vagina • Bleeding from the vagina after menopause Colon Cancer Colorectal cancers start in the cells that line the inside of the colon and rectum. It is the third most common cancer in Canada for both men and women. Screening tests can help find the colorectal cancer early before symptoms develop and lead to successful treatment. What can you do? • Fecal occult blood testing (FOBT) every 2 years if you are 50 years of age or over. • If you have a positive FOBT then you may be referred for a colonoscopy, sigmoidoscopy or barium enema test to look at the lining of the colon better. What to watch for? See your health care provider if you have: • General abdominal discomfort (bloating, fullness, cramps) • Change in bowel patterns, such as constipation or diarrhea • Blood in the stool • Change in stool size – narrowing • Urgent need to have a bowel movement • Feeling that the bowel has not completely emptied • Nausea or vomiting PAGE - 54 • • Fatigue Weight loss Prostate Cancer Prostate cancer starts in the cells of the prostate gland. It is the most common cancer in Canadian men over the age of 65. Family history of prostate cancer or men of African descent are at a higher risk of developing prostate cancer. Tests used for early detection of prostate cancer: • Digital rectal exam (DRE) • Prostate specific antigen (PSA) test What to watch for? See your health care provider if you have: • Increased frequency of urination, especially at night • An intense need to urinate • Difficulty stopping or starting the urine flow • An inability to urinate • Weak or decreased urine stream • Feeling that the bladder had not completely emptied • Burning or pain during urination • Blood in the urine or semen • Painful ejaculation Testicular cancer Testicular cancer starts in the cells of the testicle. Testicular cancer is rare and usually develops between the ages of 15 to 49. Treatment of testicular cancer is generally successful if found early. What can you do? • Examine testicles regularly – usually after a warm bath or shower • Have regular check ups by your health care provider that North Shore Family Health Team PAGE - 55 include a testicular exam What to watch for? See your health care provider if you have: • Lump on your testicle • Painful testicle • Feeling of heaviness in the lower abdomen or scrotum • Dull ache in the lower abdomen or groin Skin Cancer Types of skin cancer are basal cell, squamous cell and melanoma. Basal and squamous cell skin cancers are common in Canada and can be treated successfully. What can you do? • Avoid excessive exposure to sun • Use a sunscreen with a sun protection factor (SPF) of 15 or higher • Cover your arms, legs and head when out in the sun • Wear sunglasses with UVA and UVB protection • Avoid using tanning equipment • Monitor skin regularly and have your health care provider examine them if you are concerned. What to watch for? See your health care provider if you have: • Changes in the shape, colour or size of birthmarks or moles • Sores that don’t heal • Patches of skin that bleed, itch or become red and bumpy North Shore Family Health Team MEDICAL INFORMATION Smoking Cessation Facts ……………….....…………………...........................................................……………. Page 56 Benefits of Quitting Smoking …………………………………...........................……………. Page 56 How to Quit ……..……….………………...........................................................……………. Page 58 Nutrition Guidelines Healthy Eating …………...…….…………........................................................……………. Page 60 Resources Local ………………….………….……………....................................................……………. Page 63 Hours ………...…………..………………………................................................……………. Page 64 Internet ………...……….……………..…...........................................................……………. Page 65 Acknowledgements …………..…….………......................................................……………. Page 66 North Shore Family Health Team PAGE - 56 SMOKING CESSATION Facts about Smoking • Tobacco smoke contains 4000 chemicals, 50 of these are known to cause cancer. • 18% of Canadians aged 15 and over are smokers. • More than 45,000 Canadians die each year from smoking related causes. • Smoking causes most cases of chronic bronchitis and emphysema and is a major cause of heart disease and stroke. • Smoking is estimated to be responsible for 30% of all cancer deaths and is related to more than 85% of lung cancer in Canada. • It can also increase the risk of developing cancer of the bladder, cervix, colon and rectum, oesophagus, kidney, larynx, mouth and throat, pancreas and stomach. Facts about Second Hand Smoke • Regular exposure to second hand smoke is estimated to cause up to 7,800 deaths a year. • Second hand smoke is a contributing factor for SIDS (sudden infant death syndrome). • 13% of children’s ear infections are caused by second hand smoke. • Exposure to second hand smoke increases a non smoker’s chance of lung cancer by 25%. • Exposure to second hand smoke increases a non smoker’s chance of cardio vascular disease by 20-50%. BENEFITS OF QUITTING SMOKING PAGE - 57 the body begins to heal immediately after quitting may help motivate those who haven’t shown previous interest in quitting. The short-term health benefits of quitting include: Time Lapse Short-Term Health Benefits Within 20 minutes • Heart rate drops • Blood pressure and pulse rate return to normal Within 8 hours • Blood levels of nicotine and carbon monoxide drop • Oxygen levels return to normal Within 24 hours • Carbon monoxide leaves the body • Lungs start to clear out mucus Within 48 hours • Nicotine has left the body • Senses of smell and taste begin to improve Within 72 hours • Lung capacity increases and breathing becomes easier • Bronchial tubes begin to relax and energy levels increase Within 2 weeks to 3 months • Circulation improves • Lung function increases Within 6 months • Coughing, sinus congestion, tiredness and shortness of breath improve Short-Term Health Benefits MANY PEOPLE trying to quite aren’t aware that all smokers who quit reap immediate health benefits – even long-term heavy smokers. Explaining that North Shore Family Health Team PAGE - 58 - PAGE - 59 - Long-Term Health Benefits Quitting smoking for good substantially reduces the risk of serious illness for all smokers. person-to-person contact are effective”. Behavioural counselling can be used alone or to be more effective can be supported with pharmaceutical aids. The long-term health benefits of quitting include: Pharmaceutical Aids NRT (Nicotine Replacement Therapy) which includes nicotine gum, patches and nicotine inhaler helps relieve the discomfort of physical withdrawal, reduces cravings by supplying the brain with some nicotine and offers a cleaner system of delivery than cigarette smoke. Time Lapse Long-Term Health Benefits At 1 year • Excess risk of coronary heart disease is decreased to half that of a smoker At 5 to 15 years • Risk of stroke is reduced to that of people who have never smoked At 10 years • Risk of lung cancer drops to one-half that of continuing smokers • Risk of cancer of the mouth, throat, oesophagus, bladder, kidney and pancreas decreases • Risk of ulcers decreases Champix is a nicotine-free pill that can help relieve the cravings and withdrawal symptoms associated with stopping smoking. • Risk of coronary heart disease is similar to that of people who have never smoked • Risk of death returns to nearly the level of people who have never smoked Combining NRT and Bupropion appears to increase the odds of quitting more then either therapy alone. At 15 years Smoking Cessation – How to Quit Many people try to quit “cold turkey” and while this seems to work initially, may people will start smoking again. Bupropion is found under the trade mark names of Zyban or Wellbutrin and is a nicotine free pill that helps reduce the cravings caused by nicotine withdrawal. Champix can increase the odds of quitting by 4 times Bupropion can increase the odds of quitting by 2.1 times NRT can increase the odds of quitting by 1.6-2.1 times Remember your MOTIVATION is key to your ability to quit. If you are thinking of quitting, meet with a Smoking Cessation Specialist at the Family Health Team to develop a plan that is suited for you. Behavioural Counselling, which includes cognitive behavioural approaches and problem-solving skills, is very effective in smoking cessation. If you do try to quit smoking either cold turkey or with medication, you may experience the following symptoms: depression, short tempered, frustration or anger, nervousness, impatience and difficulty concentrating. Your appetite might increase and you may gain some weight. These symptoms can be discussed in counselling and will diminish over time. “There is a dose-response relationship between the intensity of tobacco Dependence counselling and its effectiveness. Treatments involving Support is available through the Smoking Cessation Specialist at the North Shore Family Health Team North Shore Family Health Team PAGE - 60 NUTRITIONAL GUIDELINES HEALTHY EATING Healthy eating is one step in improving your overall health. Achieve and maintain a healthy body weight by enjoying regular physical activity and healthy eating. Reduce fat intake. 1. Choose foods that are lower in saturated fat, trans fat and cholesterol. Saturated fat is found in animal – based foods, such as meat and dairy products, as well as tropical fats, such as coconut and palm oil. Trans fat is found in hard margarine and some processed foods, such as storebought cookies and crackers. Trans fat is also known as hydrogenated margarine or vegetable shortening. Cholesterol is found only in animal foods such as meats, eggs and dairy products. 2. Use mono- and polyunsaturated fats for flavour. These fats are found mostly in plant foods, such as canola oil and peanut butter, and can be used regularly in small amounts. Omega-3 fat, an unsaturated fat found in flax seed and fish, is also a healthy fat and should be eaten more often. 3. Choose low-fat diary products, lean meats and foods prepared with little or no fat. Increase the amount of complex carbohydrates (found in starchy foods rich in fibre). 1. Emphasize cereals, breads and other grain products. 2. Have legumes (beans, peas and lentils) instead of meat at least once per week. 3. Snack on fruits, vegetables, popcorn (without butter) instead of cakes, cookies, pies and chocolate. 4. Limit candy and sweet desserts to small amounts eaten with meals. PAGE - 61 Increase the amount of dietary fibre in your diet. 1. Aim for 35 grams of fibre daily. 2. Choose whole grain breads, cereals and pasta and brown rice more often. 3. Sprinkle wheat germ or bran on cereals, salads and yogurt. 4. Eat more fruit and vegetables every day. 5. Snack on raw fruits and vegetables and whole-grain crackers. Consume enough, but not excess protein. Limit protein to 2-3 oz. (50-70g) portion of meat, fish, poultry or low-fat cheese twice a day. Limit sodium or salt intake. 1. Limit the amount of salt that you use in cooking and at the table. 2. Reduce intake of processed meats, high-sodium condiments such as soy sauce, MSG, and convenience foods. 3. Try using spices and herbs more often in cooking. 4. Prepare fresh foods simply and enjoy the natural flavours. Limit sugar intake. 1. Limit the amount of sugar you use in cooking and add at the table. 2. Snack on fresh fruit and vegetables and limit sugary snacks and desserts to small amounts. Limit alcohol and caffeine intake. Use Canada’s Food Guide to Healthy eating to help plan meals and snacks. 1. Enjoy a variety of foods from all food groups. 2. Be willing to try new foods particularly different fruits and vegetables. North Shore Family Health Team PAGE - 62 Healthy eating is the total of all food choices made over time. It is the overall ‘pattern’ of foods eaten and not any one food, meal or even day’s meals that determine if an eating pattern is healthy. It is important to remember that no food is bad for you – all foods can fit into a healthy diet with a little planning. Enjoy favourite high energy, high fat foods BUT less often and in smaller portions. PAGE - 63 LOCAL RESOURCES Phone Numbers North Shore Family Health Team J.E. Stokes Medical Centre Aguasabon Medical Clinic Thunder Bay District Health Unit Stewart Pharmacy Optometrists Dr. D. Buckton & Dr. M. White Dentists Mountain View Dental (Schreiber) The McCausland Hospital Hospice Dietitian Lab X-Ray Northern Diabetes Health Network (NDHN) Physiotherapy Northern Acupuncture/Heritage Physiotherapy Diabetes Support Group Terrace Bay Chiropractic Foot Care Clinics Pays Plat Health Centre Reflexology Seniors Group Superior Speech Services North of Superior Programs Integrated Services for Northern Children (ISNC) Marjorie House T&HSP Early Intervention Program Mental Illness Support Network LOG ON TO: The McCausland Hospital Township of Schreiber Township of Terrace Bay 824-2934 824-2952 825-3235 824-2413 825-3666 825-2586 824-2964 825-3273 Ext. 136 Ext. 191 Ext. 156 Ext. 154 Ext. 138 825-2200 825-9006 825-3280 825-3297 825-9685 824-1112 824-3445 825-9041 824-1304 824-2867 824-2867 824-3380 824-3028 824-1362 www.mccauslandhospital.com www.schreiber.ca www.terrace-bay.com Have yourself a Healthy Day!!! North Shore Family Health Team PAGE - 64 - PAGE - 65 - LOCAL RESOURCES – Hours of Operation INTERNET RESOURCES NORTH SHORE FAMILY HEALTH TEAM J.E. Stokes Medical Centre Monday, Wednesday & Thursday 9:00 a.m. to 4:00 p.m. Lunch – 12:00 p.m. to 1:00 p.m. Arthritis - www.arthritis.ca Alzheimer’s – www.alzheimerthunderbay.ca Cancer – www.cancercare.on.ca Heart/Stroke – www.heartandstroke.ca Lung Cancer – www.lung.ca/breathworks/ Mayo Clinic – www.mayoclinic.com Patient Education – www.cfpc.ca (College of Physicians & Surgeons Click – for patients/patient education programs) Hospice Northwest – www.hospicenorthwest.ca Anxiety Disorder – www.anxietyontario.com www.mooddisorder.on.ca www.medic.ca www.schizophienia.on.ca Center for Additions and Mental Health - www.cgmh.net Canadian Mental Health Associates – www.cmha.ca Tuesday 9:00 a.m. to 6:30 p.m. Lunch – 12:00 p.m. to 1:00 p.m. Friday 9:00 a.m. to 12:00 p.m. Aguasabon Medical Clinic Monday to Thursday 9:00 a.m. to 4:00 p.m. Lunch – 12:00 p.m. to 1:00 p.m. Friday 9:00 a.m. to 12:00 p.m. THE MCCAUSLAND HOSPITAL X-Ray Department Monday to Friday 8:00 a.m. to 4:00 p.m. Lunch (Thursday & Friday) – 12:00 p.m. to 1:00 p.m. Lab Monday to Thursday 8:30 a.m. to 2:00 p.m. Friday 8:30 a.m. to 1:00 p.m. **Lab Services Available in Schreiber at the J.E. Stokes Medical Centre every Wednesday from: 8:30 a.m. to 9:30 a.m. Smokers Helpline – www.smokershelpline.ca Public Health Agency of Canada, Centre for Chronic Disease Prevention and Control – http://www.phacaspc.gc.ca/ccdpccpcmc/index_e.html National Home Care and Primary Health Care Partnership Project – http://www.cdnhomecare.ca/npp/content.php?sec=0 Group Health Centre, Sault Ste. Marie, Ontario – http://www.ghc.on.ca/home.html Chronic Disease Management in B.C. – http://www.heartbc.ca/pro/collaboratives/chf/chfindex.htm Heart B.C. – http://www.heartbc.ca/pro/collaboratives/chf/chfindex.htm Chronic Disease Management: The Calgary Conference – http://www.cdmcalgary.ca/Default.aspx?tabid=50 Ontario Dental Association – www.oda.com Canadian Diabetes Association – www.diabetes.ca Nation Aboriginal Diabetes Association – www.nada.ca Diabtetes On-Line – www.diabetes.gc.ca Diabète Quebéc – www.diabete.qc.ca North Shore Family Health Team PAGE - 66 - Special Acknowledgement to the North Shore Family Health Team for their dedication, time and commitment to the development of the “Passport to Health” booklet, a medical journal created for you. References: Thunder Bay District Health Unit The McCausland Hospital Canadian Cancer Society The Lung Association Ontario Breast Screening Foundation Heart & Stroke Foundation Ontario Dental Association LifeScan Canada Ltd. McNeil Consumer Healthcare Canadian Diabetes Association Association Diabète Québec Expert Group on Weight Standard, Health and Welfare Canada Peel Public Health Public Health Agency of Canada PAGE - 67 NOTES _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ North Shore Family Health Team PAGE - 68 - PAGE - 69 - NOTES _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ NOTES _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ _______________________________________________________ North Shore Family Health Team Special Features: ~ Front ~ Leaflet for: Appt. Cards OHIP Card , , etc… ~ Middle ~ 2 Dividers: Patient Medical Records (green) & Medical Information (orange) **Space provided for pt. identification (name). ~ Back Cover ~ Pocket for: Immunization Card, Blood Pressure Card, etc… North Shore Family Health Team The Passport to Health Booklets were Contact Information: The Print Shop Attn: Mona Donaldson Terrace Bay, ON Phone: (807) 825-9425 Fax: (807) 825-9458 North Shore Family Health Team The North Shore Family Health Team would like to Thank you for viewing our project, “The Passport to Health” – Medical Journal. If you have any questions, please feel free to contact The Team @ (807) 824-2934 & (807) 824-2952 or via e-mail schreibermed@yahoo.ca North Shore Family Health Team