a measuring tape wrapped around a sandwich

Pitfalls of the lifestyle ketogenic diet

By Jennifer Fabe, registered dietitian

The therapeutic ketogenic diet has been used as a treatment for epilepsy for nearly a century. In recent years, we’ve learned even more about its potential role in treating other medical disorders. But lately, the lifestyle ketogenic diet has been getting a lot of attention for the wrong reasons. It has become a popular weight loss trend, and many people are jumping on the bandwagon without considering potential risks.

How does the ketogenic diet work?

In a typical diet, more energy comes from carbohydrates than from protein and fat. The reverse is usually true in a ketogenic diet, which is higher in fat and lower in carbohydrates.

Fortunately, our bodies can use two sources of fuel for energy—glucose, which comes from carbohydrates like bread, fruit, and rice, and ketones, which come from fats like butter, cheese, and oil. Because we typically eat more carbohydrates, our bodies use glucose as their primary fuel since it is easy to access. When there isn’t enough glucose available, our bodies will switch over and start using ketones for energy.

The therapeutic ketogenic diet is medically supervised. It intentionally deprives the body of glucose, which helps trigger a switchover to a state called ketosis. The diet prescribes fat rich food choices, often in very precise amounts. With limited access to carbohydrates and increased access to fat, the body adapts to using ketones as its primary fuel. We don’t know precisely how it works, but ketones seem to help stop or reduce seizures in many people who follow this diet strictly.

Therapeutic ketogenic diet versus lifestyle ketogenic diet

The therapeutic ketogenic diet is used to control seizures and other conditions, and is done under strict medical supervision. Just because it’s considered a “natural” therapy, doesn’t mean it doesn’t have risks. A therapeutic ketogenic diet:

• is customized for each patient, and only used when people meet certain medical criteria.
• is ideally started slowly over a period of weeks under close supervision to minimize side effects. Rapid initiation over a period of days is only done if absolutely necessary, and after serious medical consideration.
• may require a review, and/or adjustment of medications so they don’t magnify potential side effects.
• requires a commitment to daily consistency.
• is monitored regularly for effectiveness, tolerance, and side effects at home and by a medical team.
• is supplemented by vitamins and minerals needed for complete nutrition.

When people embark on a lifestyle ketogenic diet with the goal of losing weight, they often fail to consider the potential risks involved, and rarely get the medical monitoring that should accompany this diet. When it’s not being used for medical purposes, keto dieters are also more likely to “cheat.” And because it is so limiting, many people find it difficult to stay on the diet long term and maintain their weight loss.

Other potential risks

Starting the ketogenic diet without input from healthcare professionals can lead to negative effects. On websites promoting the keto diet, you may read that these side effects are normal and will go away if you persist on the diet. They are not normal, and shouldn’t occur if you are following the diet safely.

Keto “flu”?

Some people who follow a lifestyle ketogenic diet report feeling flu- like symptoms when they start, including headache, tiredness, nausea and aching. This should not happen. It is the body’s way of responding to rapid adjustment, but is unnecessary if the diet is introduced properly and under medical supervision.

Vitamin and mineral deficiencies

Fruits and vegetables, grains, and protein are important sources of vitamins and minerals in our diet. The keto diet restricts many of these foods. Without them, it’s hard to get the vitamins and minerals we need. A lack of certain vitamins and minerals can cause complications. For example, lack of selenium, a mineral that’s found in grains and some sources of protein, can cause an irregular heart rhythm.

Lack of minerals can also cause cramps, which are common when people start the keto diet without supervision. If not properly monitored, the diet can pose a risk over time for bone weakness, and can result in compromised growth in children.

a blood sugar monitor and a bottle of vitamins

Interference with medication

The ketogenic diet can also interfere with some medications, which is why patients are carefully screened before being put on this diet to control conditions like epilepsy.
The diet can interfere with some diabetes medications, causing the body to pee out too much sugar. This loss of sugar can drop blood sugars to a dangerously low level.


In a practical sense, the lifestyle ketogenic diet can add expense to your grocery list. Although you may buy less carbohydrate rich foods, purchasing high fat foods can be pricey.

Advanced Planning

Planning your groceries and meals is a great strategy for staying on track with healthy eating. The lifestyle ketogenic diet requires careful advanced planning to make sure you get the nutrients you need, and aren’t left scrambling for something to eat. Before dining at a restaurant, or accepting a friend’s dinner invitation, you should consider what you are going to eat. It’s also important to carry snacks you are able to eat on the go in case you get hungry.

But I’m losing weight on the ketogenic diet…

The ketogenic diet is a nutritionally extreme option for weight loss when implemented in its strictest form. Most lifestyle ketogenic diets, however, are less restrictive in carbohydrates than their medical counterparts and more liberal in fats. Although small amounts of ketones can sometimes be generated from this ratio of foods, it is likely not the reason for the weight loss. While some people may find it effective for this purpose, it doesn’t generally work well long-term.

Why do people lose weight then? Weight loss works on a very basic principle: calories burned exceed calories consumed. Whenever our bodies don’t get enough calories in the food we eat, they start to use other calorie sources within the body, like body fat or muscle. People who lose weight on the ketogenic diet are losing weight because they are consuming fewer calories than they are burning.

There are a few reasons for this:
• Fats tend to fill you up, so you don’t eat as much on the ketogenic diet.
• Some lower carbohydrate foods in the diet, like leafy greens, are very low in calories.
• The diet requires you to modify foods so they fit within its boundaries, which makes eating on the run difficult—therefore dieters eat fewer calories from takeout, fast food, and junk food.

Ultimately, this calorie imbalance causes weight loss, but it is difficult to maintain.

Because it restricts many important food groups, the ketogenic diet can’t provide complete nutrition without added vitamin and mineral supplements. Restrictive diets also tend to make us want what we can’t have. If we can’t have bread on a diet, we may crave it. When we give into those cravings, our body goes back to using glucose for fuel and the ketogenic diet is no longer maintained.

If you are still interested in trying the ketogenic diet, or are on the diet and want to continue, I strongly urge you to talk to your family doctor or a registered dietitian about how to follow the diet safely and sustainably.

Healthier alternatives

The best way to lose weight is by making healthy lifestyle changes you can stick with in the long run. There is no weight loss diet that ‘fits all’ for our diverse Canadian population. I recommend making healthy food choices that suit your preferences, food availability, and budget.

To work towards your weight loss goal and healthy lifestyle:

• continue to eat a variety of foods from all food groups in moderation, and make healthier choices within those food groups.
• commit time to planning your groceries, meals, and physical activity.
• be mindful of your portion sizes.
• talk to your doctor or registered dietitian for strategies and support to help you achieve your weight loss goals.

Here are some helpful resources on selecting healthy foods and appropriate serving sizes:

Jennifer Fabe is a registered dietitian in the Division of Pediatric Neurology at McMaster Children’s Hospital. She is the lead dietitian for the hospital’s ketogenic diet program, which helps kids with epilepsy use the medically supervised ketogenic diet to manage their seizures.

Don’t fall for it

Hamilton Health Sciences’ trauma team and Hamilton Paramedic Service are taking the first day of fall (September 22) as an opportunity to remind everyone to be cautious out on hiking trails and up on roofs and ladders.

“There are a lot of seasonal risks that people don’t consider,” says Dr. Tim Rice, a trauma surgeon at Hamilton Health Sciences.

“These incidents are almost always preventable.”

Falls from a height continue to be a leading cause of emergency calls and hospital visits. The trauma team sees about 100 patients a year for non-work related falls that have caused severe injury. This number does not include the many calls Hamilton paramedics respond to that require first aid and/or treatment in the emergency department.

“These incidents are almost always preventable,” says Dr. Tim Rice. “And they result in very serious injuries. We want to make sure people get the message that a fall can be life changing, even from 10-20 feet. We see patients with brain injuries, severely broken bones and major internal injuries.”

In 2016, Hamilton Paramedic Services responded to 323 falls from heights, 220 of which took place at peoples’ homes.

“When we respond to these calls, we often find that the person has put themselves in a risky position by making poor choices,” says Russell Crocker, deputy chief of Hamilton Paramedic Service. “We see people wearing inappropriate footwear, going off-trail on a hike or failing to secure a ladder before climbing it. We don’t want people to stop hiking or doing fall cleanup, we just want them to be smart about it.”

The team’s message is clear: “Don’t fall for it.” Taking a risk to capture a selfie or get a chore done more quickly just isn’t worth your life.

keys left in door

Regular aging or Alzheimer’s?

by Dr. Atul Sunny Luthra, Geriatric Psychiatry Outreach & Behavioural Health, St. Peter’s Hospital 

Alzheimer’s disease is a type of dementia that affects brain cells and, as a result, causes a slow decline in memory, thinking and reasoning skills. It eventually affects all aspects of life. Since each person is affected differently, it’s difficult to predict when the symptoms will appear, in what order or how quickly they’ll progress.

There are 10 common warning signs of Alzheimer’s disease. It’s important to understand how these signs appear in someone with Alzheimer’s disease compared to normal aging. Some of these differences are outlined below. If you notice any of these warning signs or have any questions about dementia, please speak with your doctor.


1. Memory loss affecting day-to-day function

Normal aging: Forgetting things often, but it does not affect day-to-day function, i.e. forgetting where you’ve put your keys.
Alzheimer’s disease: Forgetting and not remembering how to do daily activities, i.e. not knowing how to use the washing machine so you don’t wash your clothes.

2. Difficulty performing familiar tasks

Normal aging: Having to follow the recipe of your favourite meal, as you can no longer make it from memory.
Alzheimer’s disease: No longer knowing how to do something you’ve been doing your whole life, such as getting dressed.

3. Problems with language

Normal aging: Forgetting the word you were trying to use.
Alzheimer’s disease: Not realizing you’re using basic words in the wrong context.

4. Disorientation in time and space

Normal aging: Forgetting your way around the local shopping mall that you used to have memorized.
Alzheimer’s disease: Getting lost in the local shopping mall that you used to have memorized, as if you’ve never been in it before.

5. Impaired judgement

Normal aging: You may just forget that you need a sweater on a cold day, but then realize when you go outside that you need one.
Alzheimer’s disease: Going outside on a winter day in summer clothes and not recognizing that it’s too cold for what you’re wearing.


6. Problems with abstract thinking

Normal aging: You may just be a little slower at making a calculation on a calculator.
Alzheimer’s disease: Not understanding what numbers signify on a calculator or how they’re used.

7. Misplacing things

Normal aging: Retracing your steps to try to remember where you left what you’ve misplaced.
Alzheimer’s disease: Putting things in strange places and not recognizing that the item is even misplaced.

8. Changes in mood and behaviour

Normal aging: Recognizing and understanding that you’re having mood swings.
Alzheimer’s disease: Unknowingly exhibiting severe mood swings.

9. Changes in personality

Normal aging: This doesn’t occur unless there is an underlying issue.
Alzheimer’s disease: Behaving out of character such as feeling paranoid or threatened.

10. Loss of initiative

Normal aging: This doesn’t occur unless there is an underlying issue.
Alzheimer’s disease: Losing interest in friends, family and favourite activities without reason.

Epipen in its case

How to use an EpiPen

What is an EpiPen?

An EpiPen is an auto-injector device carried by someone at risk of having a severe allergic reaction, also called anaphylaxis, to various allergens like food, insects, medication, latex and other causes. Once administered, it automatically injects epinephrine to decrease the body’s allergic reaction. The drug works to relax the airways to help a person breathe easier, and works to reverse the dangerous decrease in blood pressure that can happen during an allergic reaction.

EpiPens are easy to use and can save a life. Four per cent of Canadians are estimated to have a food allergy. Once someone has had a severe reaction, they are at a higher risk of experiencing another. The risk is also higher for those with asthma. That’s why it’s important for those with allergies (and their caregivers) to always carry an EpiPen, in addition to having them stored in the places they frequent most: at home, work, cottage, school, camp, daycare, etc.

VIDEO: How an Epipen works

There are just two steps to using an EpiPen. Learn how to use one properly with Kirk Wong, a pharmacist at Hamilton General Hospital’s Hamilton General Drugstore.


To use an EpiPen on yourself…

  1. Hold the pen in a fist with the blue end facing up to the sky.
  2. Pull of the blue cap.
  3. If the window on the side of the pen is clear, it’s ready to use.
  4. Swing your hand back and push the pen into your thigh.
  5. When you hear a click, hold the pen for five seconds.


On someone else…

  1. Have them sit down and kneel beside them.
  2. Complete steps 1-5 from the above list, pushing the pen into their thigh.


Once the EpiPen is injected into the thigh and you hear the click sound, hold it in for several seconds. An EpiPen can be used through clothing, even jeans. Once it is pulled out, the orange cover automatically extends to ensure the needle is not exposed. After using an EpiPen, always call 9-1-1 or go directly to your closest emergency department.

Epipen in its case

When should you use it?

Use an EpiPen at the first sign of a severe allergic reaction. Don’t hesitate. Reactions can happen within minutes or hours after exposure. It’s important to know the symptoms to look out for like swelling of the throat, difficulty breathing, skin redness, and fainting – every second counts.

Do you have to go to the hospital after?

Yes, using an EpiPen does not replace going to the hospital. You could have a second reaction or the effects of the medication could wear off. You’ll need to find out if additional medication is required.

Make sure you have another EpiPen with you when you leave the hospital. You’ll want to stay close by for the next 48 hours in case of another emergency.

Children and EpiPens

Those prescribed an EpiPen should carry it with them at all times. If your child has one, ensure their teacher and school have extras and are aware of how to use it. If kids are old enough, they can carry a convenient waste pack so it’s always on their body in case of an emergency.

Remember, EpiPens do expire so know the date and set a reminder when it’s time to get a new one (the expiry date refers to the end of the month).

Storing your EpiPen

Keep your EpiPen at room temperature, not in the fridge, and away from light. EpiPens can only be exposed to temperatures between 15 and 30 degrees. Remember not to leave your EpiPen in the car during hot or cold weather.

To be sure your EpiPen has been stored safety, check the solution in the viewing window and replace it if it’s discoloured or cloudy.

Printable instructions


school buses lined up on a street

A smooth school transition for kids with special needs

by Elizabeth McAllister, clinical coordinator, school support program, McMaster Children’s Hospital

Change and transition can be hard for anyone, including children with special education needs. Re-establishing routines and building familiarity when it’s time to go back to school can be an important way to help our children succeed. Depending on your child’s needs, you may want to:

  • Visit the school to see the new classroom, meet the teacher, and play on the playground equipment
  • Read stories about school
  • Arrange playdates with classmates or other children
  • Practice skills for school (e.g., using a lunch box, backpack, walking to the bus stop)
  • Start adjusting bedtime and wakeup routine to match your school schedule
Focus on opportunities

As the school year begins, take time to think about your child’s unique abilities and needs. Help yourself plan ahead: try to anticipate opportunities for success, and areas where your child may face challenges.

Keep the lines of communication open! Teachers and school administrators are an important resource. Talk to them regularly about your child’s progress, strengths, and requirements. If your child has an Individualized Education Plan (IEP), it may be helpful to review it at the start of the school year, and talk to your child’s teacher about new or ongoing goals. If you have them, provide the school with any professional reports that can help them understand how your child learns best.

Discuss resources or accommodations that can support your child’s learning needs. For example, some children may have a difficult time with verbal explanations but respond very well to visual ones.

Choose choices

During the return to school, children, including those with special needs, may feel a loss of control, and that can be stressful. Providing them with choices can give them a sense of control. For example, they could choose their back-to-school materials or pick out a healthy snack for break time.


You can get more back to school information and tips, from our Back to School booklet.

a flatlay of back to school materials, including an iPad that says Back to School

Back to school with McMaster Children’s Hospital

Back to school can be a stressful time for parents and kids. Our experts at McMaster Children’s Hospital (MCH) want to make it easier.

Together with both school boards and the City of Hamilton, we’ve developed this downloadable booklet containing advice on a variety of topics like anxiety, vaccinations and allergies.

Wishing you a smooth transition back into the classroom!

Click the arrow in the top left corner to download your own copy.

Child at festival wearing ear muffs as hearing protection

Protecting young ears

By: Karina Chaloux, audiologist, Hamilton Health Sciences

In my role as an audiologist, I’m often asked whether babies and children should wear hearing protection. The answer is: absolutely! Noise that’s potentially damaging to an adult’s ears is even more dangerous to a child’s. And, since hearing loss from exposure to loud noises is permanent, it’s important for parents to start the habit of protecting kids’ ears while they’re young.

When should my child wear hearing protection?

Everyone, especially children and babies, should wear hearing protection when the potential for loud noises is high. We measure sound in “decibels”. Any noise below 75 decibels (about the level of a vacuum cleaner) is considered safe. Noise above 85 decibels (about the level of a lawn mower) is dangerous and can cause hearing damage and loss.

Activities that may lead to hearing loss include:

  • Attending loud events in stadiums, gymnasiums, amusement parks, theaters, auditoriums, and other entertainment facilities.
  • Attending auto races, air shows, demolition derbies, sporting events, music concerts (music lessons, rehearsals), fireworks.
  • Riding a snowmobile, all-terrain vehicle, motorcycles or farm tractor/equipment.
  • Using or in the presence of lawn mowers, leaf blowers, snow blowers, chain saws or any other loud power tools.
  • Participating in or observing shooting sports. The sound of a gunshot can reach the same level as a jet engine at takeoff. At this decibel level, noise can damage hearing immediately and permanently. Hearing protectors should be a standard part of shooting-safety gear.

If you’re unsure about whether hearing protection is necessary in a particular situation, there are mobile apps available for download which measure decibel levels to help you identify a potential risk for hearing damage.

What kind of hearing protection should children wear?

There are three common types of hearing protection products, some of which are better for babies and children.

Earplugs: Earplugs are either soft foam or hard plastic inserts that fit directly into the ear canal. They come in both disposable and reusable options. Because earplugs are usually adult sizes, they may not fit into small ears, while also posing a choking hazard for young kids.

Ear muffs: Ear muffs designed specifically for hearing protection are a good option for kids, since they fit over and form a seal around the entire ear. The ear muffs are held in place by an adjustable band and they come in kids’ sizes, making it easy to find a proper fit. Remember: try to keep hair and glasses out of the way to ensure a proper seal.

Custom earplugs: Custom earplugs are made to fit the individual’s ear, making them the best option for a proper fit. They can fit the ear and the ear canal tightly, and slightly changes shape with the ear canal when talking or chewing. Custom earplugs have advanced filters for a precise, even level of noise reduction. The earplugs can be customized to reduce volume only by the necessary amount, and can filter select kinds of sound more than others so that it’s still possible to hear music and speech. Please note that because these earplugs are custom made children can outgrow them quickly.

To learn more about hearing protection options, talk to your ear doctor or contact the Audiology clinic at Hamilton Health Sciences.

Sun protection tips with skin cancer specialist

We’ve waited a long time for sunshine. But now that it’s here, how can we enjoy it safely?

There’s no such thing as a healthy tan. Stay sun safe this summer with these quick sun protection tips from skin cancer specialist, Dr. Elaine McWhirter.

Video: Sun protection tips

Melanoma is one of the most preventable forms of cancer. When discovered early, it can also be very treatable. But wait too long and melanoma can spread to other parts of the body, growing into the deep layers of the skin and entering the lymph system. Once it spreads to other organs, it can be extremely difficult to treat.

Beyond your control

A fair complexion: If you don’t tan easily or have fair skin, you’re more susceptible to UVR (ultraviolet radiation) damage. So are people with naturally blond or red hair, or blue, green or hazel eyes. Although melanoma is somewhat rare among people with very dark skin, they’re not immune so it’s important to protect yourself.

Family history: People with a first-degree relative such as a parent, sibling or child with a history of melanoma may also have an increased risk of developing this disease. The more close relatives you have with melanoma, the higher your risk.

In your control

Sun exposure: People who spend lots of time in the sun are at increased risk of melanoma. Frequent sunburns — even if they occurred years ago — increase your risk. While you can’t change the past, you can reduce your risk moving forward.

Tanning equipment: Tanning equipment can emit stronger UVR than the sun. In fact, people who use tanning equipment have at least a 25 per cent increased risk of melanoma. The risk increases with younger age of first use, and greater frequency of use.

Moles: Reducing exposure to UVR, especially early in life, can help to reduce the chances of developing moles. Most moles aren’t cancerous. Those signaling skin cancer are typically larger, have irregular shapes and less uniform colour than most moles.

MyCancerIQ: Visit MyCancerIQ.ca. This Cancer Care Ontario website offers a personalized risk assessment and action plan with tips and resources based on your personal risk factors.

How to be sunsafe

• Apply broad spectrum sunscreen, minimum SPF 30, and re-apply every 3 hours; more frequently if swimming (every 90 minutes).
• Wear wide-brimmed hats and sunglasses with UVA/UVB protection.
• A cotton T-shirt only has an SPF of about 3; so consider SPF clothing and swim-shirts.


• Cloud cover isn’t protective – the UV rays can penetrate through
• Shade alone isn’t sufficiently protective – especially with reflective surfaces such as water, sand and concrete nearby.
• Snow reflects UV rays so you’ll need sunscreen for your face in winter.
• The high UV index days are from April to October, from 10 am to 4 pm. If possible, plan outdoor activities around these hours. Otherwise, remember to use the tips above!

Learn how to do a skin check with Dr. Elaine McWhirter to check your body for moles that exhibit warning signs of skin cancer.

Read other tips on how to be safe on vacation.

two kids swimming

Water safety for kids

Drowning is a leading cause of injury-related death for Canadian children, and it often happens quickly and silently. Almost half of all child drownings occur in backyard swimming pools.

It’s important to enjoy swimming safely. Here are some backyard pool safety tips with our Dr. Karen Bailey, pediatric surgeon.

Make sure your backyard pool is a feature to enjoy, not a dangerous hazard for your family and friends.

  • All pools must be fully fenced with a self-closing, self-latching gate.
  • Young kids and weak swimmers should wear life jackets or personal flotation devices in and around the water.
  • Ensure there is adult supervision around the pool, even if the children can swim.
  • Have some safety equipment accessible including a reaching pole or ring buoy.
  • Always have a first aid kit handy.
  • Have a phone nearby to call 9-1-1 in case of an emergency.
  • Consider a safety net or removable mesh fence for added protection when the pool is not in use.
  • Enroll kids in swimming classes when they become of age.
  • Don’t leave toys laying around the pool that could entice kids to the edge.
  • Don’t let kids dive in until parents have checked how deep the waters are.

Life jackets and personal flotation devices

It is highly recommended for everyone to wear a life jacket when boating, or doing water activities in open water as nine out of 10 people who drown in boating accidents are not wearing life jackets.

Young kids and weak swimmers should wear a life jacket or personal flotation device when near or swimming in water, including pools and at the beach.

When a child wears a life jacket in the water it not only keeps them floating but can turn them from face-down to face-up. This is can help keep your child safe if they fall into the water.

A personal flotation device also keeps your child floating, however, it doesn’t turn them if they’re face-down. Please remember that water wings and blow-up toys are not considered personal flotation devices. They aren’t approved and therefore will not necessarily keep your child floating. Puddle jumpers are a popular swimming aid, however they’re also not approved so are best to be used under careful supervision.

If your child wears a life jacket, it’s important to ensure it fits properly. Here are some fitting tips with our Dr. Karen Bailey, pediatric surgeon.

Life jacket fitting tips:

  • Ensure you have the correct size.
    • Adult sizes are based on chest measurement and weight.
    • Child sizes are based on weight.
  • Check the label to make sure it’s been approved.
  • Check the life jacket for damage and ensure the zipper still works.
  • The fit should be snug so that it doesn’t ride up over your ears.
  • Life jackets for kids should have the following features:
    • A large collar
    • An adjustable waist strap
    • A strap that buckles between the legs
    • Bright colours and reflective tape
  • Each year test the life jacket not only to ensure it still fits, but to ensure it’s still effective

What to do if you suspect a child is drowning

Children can drown in as little as one inch of water. If you suspect someone is drowning (if they have stopped breathing or have trouble breathing), call 9-1-1 immediately and follow these steps.

Take the child out of the water and place them on their back with their head tilted slightly back to open the airway. Check if the child is breathing by placing your ear near their mouth and nose. Remember, gasping for air is not considered breathing. If they are not breathing, start CPR as soon as possible. Every parent should be very familiar with how to perform CPR.

an older man kissing his wife on the cheek while they walk outside

Managing COPD flare-ups

What is COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that develops slowly over time. It is usually diagnosed after 40 years of age, and is a long-term condition. COPD cannot be cured, but it can be treated.  With proper treatment, people with COPD can lead active lives and live for many years.

COPD includes chronic bronchitis and emphysema. Some people have one or the other, but some may have both. COPD makes it hard to move new air (oxygen) into your lungs and stale air (carbon dioxide) out.

In chronic bronchitis, difficulty breathing is caused by swelling and mucus in your airways, which blocks air from passing through. This makes you cough, expel mucous, and feel short of breath.

In emphysema, difficulty breathing is caused by damage to the air sacs at the tips of your breathing tubes. These sacs are stretchy – they stretch out when you breathe in, and shrink as you breathe out. Emphysema makes them stiffer. They don’t stretch and shrink as they should, so stale air gets trapped in your lungs. This makes you work much harder to take in air, making you feel tired and short of breath.

In most cases, COPD is a result of smoking (80-90% of cases). Other causes include genetics, exposure to dust or chemicals, second-hand smoke, frequent lung infections as a child, and exposure to wood smoke.

a graphic depicting the difference between emphysema and chronic bronchitis


Managing your COPD

Getting a diagnosis early, making positive lifestyle changes, and taking appropriate medications can help you lead a normal, active life with COPD. Attending your medical appointments is very important. Ask you doctor if a Pulmonary Rehabilitation program is right for you.

If you smoke, quitting is the most important step in treating your COPD. If you need help quitting, call Smoker’s Helpline at 1-877-513-5333 or visit www.smokershelpline.ca.

Consider joining a local support group to learn more about managing your COPD. Email info@lungontario.ca for locations near you.


COPD flare-ups

A flare-up, also known as an exacerbation or “lung attack,” happens when your normal day-to-day symptoms get worse over a short period of time (a few hours to 48 hours), or when new symptoms appear. Flare-ups can be caused by a trigger, such as air pollution, scents, or allergens, or by a lung infection caused by a virus or bacteria.

Flare-ups can cause further damage to your lungs. They’re one of the main reasons people with COPD have to be hospitalized, and can be deadly.

You need to pay attention to your normal day-to-day symptoms in order to recognize a change that could indicate a flare-up.  For instance: how breathless are you on a good day, how much do you cough, if you have mucus, what is the amount, thickness, stickiness of it?

Managing COPD flare-ups

There are four main steps to managing flare-ups: preventing, recognizing, beginning treatment, and seeking professional help.

1. Preventing Flare- Ups

To reduce your risk of COPD flare ups:

• Eat healthy foods.

Exercise regularly.

• Get enough sleep.

• Find ways to make daily tasks easier.

• Avoid exposure to triggers such as air pollution, scents, and allergens whenever possible.

• Wash your hands properly before touching your eyes, nose, or mouth to avoid picking up and spreading germs.

• Stay away from people who are sick.

• Take all of the medications prescribed by your doctor.

• Practice any breathing exercises recommended by your healthcare team.

• Ask for help if you have questions about how or when to take medications or what they’re for.

• Ask your doctor for a personalized written COPD action plan.

• Get your flu shot every year.

• Ask your doctor if you need a pneumonia shot.

• Quit smoking and avoid second-hand smoke.

2. Recognizing Flare-Ups

The top three signs of a flare-up are:

• Increased cough

• Unusual increase in shortness of breath (even if just with activity)

• Increase in the amount, thickness, or stickiness of your mucus, which may be more yellow, green, or brown than usual

Other common signs include:

• Fever

• Symptoms of a cold, such as headache, sore throat, or runny nose

• Swollen ankles or unusual weight gain

• Feeling generally unwell and tired

3. How to Begin Treatment

Never wait more than one day to take action. Follow the advice written in the COPD action plan which was developed specifically for you. If you do not have written action plan similar to the example at the link above, be sure to ask your doctor for one.

4. When to call your doctor

Follow the directions in your COPD action plan, and never wait more than two days to call your doctor if you suspect a flare-up.

If you are experiencing any of these signs, call 9-1-1 immediately:

• Chest pain

• Blue lips or fingers

• Confusion, you can’t think clearly, or are very agitated or upset

• Drowsiness or sleeping a lot

• Extremely short of breath


For more information on COPD, contact the Lung Health Info Line to be connected to a certified respiratory educator. From Monday through Friday, 8:30am – 4:30pm call 1-888-344- LUNG (5864), or email info@lungontario.ca any time.


Visit the Lung Association


Visit Living Well with COPD







Tips to minimize your risk of burns outdoors

Warm weather activities bring burn risk

As the temperature outside rises, so does our risk of being seriously burned.

Every spring and summer, Hamilton General Hospital sees a number of trauma cases due to risky behaviour around campfires, brush fires and barbecues. Lightning is also a source of summer burn injuries.

Natalie Hanna, Burn Clinician, Hamilton Health Sciences
Natalie Hanna, Burn Clinician, Hamilton Health Sciences

Burn clinician at the HGH burn unit, Natalie Hanna, says, “these incidents can develop into serious situations, requiring the patient to be admitted to the burn unit for specialized burn care.” She says the severity of an injury is determined by the temperature of the source and how long the patient is exposed to it. Damage to the skin can range from mild superficial redness requiring only minor treatment to deep, full thickness injury involving muscle and bone damage. Severe injuries can require months of treatment in the burn unit.

Roughly 15% of patients admitted to Hamilton Health Sciences for burns were injured around campfires or barbecues.

Hamilton Fire Department spokesperson, Claudio Mostacci, says that both of these sources of danger tend to spike in spring and summer. He says barbecue fires are particularly common at the beginning of the season because damage that occurred over winter can allow propane or gas to leak. He says it’s important to check all connections before using your barbecue.

Mostacci adds that alcohol and drugs can increase your risk of injury around a fire. He urges everyone to, “be aware of alcohol and anything that might cause you to lose your balance and fall.” Even if you aren’t impaired, he says it’s important to keep your distance from flames because your clothes can catch fire quickly.

To stay safe this summer, make sure you have a working smoke detector on every floor of your house and a carbon monoxide detector on all floors with bedrooms. Remember the following tips to minimize your risk of fire and burns outdoors:

Brush fires and campfires:

  • Never add an accelerant (like gasoline or alcohol) to a fire
  • Never use accelerant to start a fire
  • Keep all flammable items far away from any flame, especially clothing
  • Don’t stand over a fire because the carbon monoxide can make you dizzy and lose your balance
  • Keep your distance from a fire if you’ve been drinking or using drugs
  • If your clothing catches fire, stop, drop and roll


  • Clean your barbecue lines annually
  • Make sure all connections are secure
  • Always light your barbecue with the lid open
  • Never leave the grill unattended
  • If your barbecue catches fire, don’t try to put it out. Call 9-1-1
  • If your clothing catches fire, stop, drop and roll


  • Go indoors if possible
  • Stay away from windows and doors
  • Stay off computers and keep the TV turned off
  • If your clothing catches fire, stop, drop and roll


Even a small burn can become very serious if it gets infected. Follow these steps from Dr. Chris Sulowski, deputy chief of McMaster Children’s Hospital’s Emergency Department to treat your burn the RIGHT way.

How to treat a burn with Dr. Chris Sulowski



  1.  Remove skin from hot surface immediately. If you’ve been burned by hot splashing liquid,  remove any wet clothing immediately.
  2.  Run cool tap water over burn area for at least 20 minutes to stop burning.
  3.  Do NOT apply ice, butter, milk, oil, saliva, Vaseline, or other liquid, ointment or gel onto the burn area.
  4.  Check the burn. If it:
    • appears to be deep
    • is starting to bubble up
    • is causing unmanageable pain
    • is in a particularly sensitive area (face, hands, feet, groin)
    • covers a large area of the body (>5% body surface area)
    • surrounds a body part (like a wrist)

Then a visit to the emergency department is in order. First, cover the burn with a clean cloth.

5. If the burn appears to be minor, cover it with a clean cloth or bandage and visit a doctor within three days.

The legs of two teenage girls in jeans and sneakers, standing on grass

The best birth control options for teens

portrait of Dr. Natasha Johnson

The Canadian Pediatric Society (CPS) has released new recommendations for selecting and prescribing contraceptives (birth control) for youth. The new recommendations list long acting reversible contraceptives, (LARCs) such as intrauterine contraceptives (IUCs) as the first-line option for youth.

Dr. Natasha Johnson, an adolescent medicine specialist at Hamilton Health Sciences’ McMaster Children’s Hospital, is a member of the Canadian Pediatric Society’s Adolescent Health Committee, which wrote the paper. She answers some questions about birth control and these new recommendations.

What is the significance of the CPS releasing these new recommendations?

Most people are aware of contraceptive pills, patches, injections as well as condom use to prevent pregnancy. These options continue to have a role in contraceptive care for teens. One group of contraceptives that has emerged as a good option for teens that many people are not aware of is long-acting reversible contraceptives (LARCs). LARCs include intrauterine contraceptives (IUCs) and subdermal implants. Though subdermal implants are not available in Canada, IUCs are. LARCs are the most effective method of birth control available, (see the table below) and it is important for healthcare providers, teens, and their families to be aware of them. The Canadian Pediatric Society joins a number of other societies that have endorsed LARCs as a first-line method of contraception for teens.

Sexual and reproductive health care is an important part of overall health care for all people including teenagers. We know that more than half of Canadian youth are sexually active by age 17. We also know that teenage pregnancy can have significant negative impact on many aspects of a teen’s life. It can also have negative impacts on their family, on the community and the health care system. When provided with appropriate education about the effectiveness of various birth control options and barriers like cost are removed, many teens will opt for the most effective birth control methods available. For this reason, it important for health care providers to know about various birth control options including LARCs so that they can appropriately counsel teens who wish to avoid pregnancy.

Table 1. Contraceptive failure rates (from https://www.cps.ca/en/documents/position/contraceptive-care) 
% Unintended pregnancy in first year of use
MethodTypical use*Perfect use†
No method94§94§
Condom (no spermicide)
  • Female
  • Male
Diaphragm (+ spermicide)126
Combined oral contraceptive pill90.3
Transdermal patch (i.e., Evra)90.3
Intravaginal ring (i.e., NuvaRing)90.3
Progestin-only pill90.3
Injectable contraceptive (i.e., Depo-Provera)60.2
Intrauterine contraceptive
  • Copper IUD
  • Levonorgestrel IUS (i.e., Mirena/Jaydess)
Subdermal implant (i.e., Nexplanon)¶0.050.05
Adapted from ref. [47].

IUD intrauterine devices, IUS intrauterine system.

*Among typical couples who initiate use of a method (not necessarily for the first time), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.

†Among couples who initiate use of a method (not necessarily for the first time) and who use it perfectly (both consistently and correctly), the percentage who experience an accidental pregnancy during the first year if they do not stop use for any other reason.

§This estimate is for adolescents. For adults, the estimate is 85% [9].

¶Not available in Canada.

What are some of the challenges adolescents face regarding birth control?

There are numerous barriers that teens can face regarding their sexual and reproductive health care. The first is lack of education about sexual health. It has been shown that providing youth with education about reproductive health care helps them to make better decisions around their sexual health—including using contraception when they do become sexually active. Another barrier would be if their health care providers are not aware of the various birth control options that exist. Confidentiality is also a big concern for teen health care in general, and this of course applies to sexual health. Finally, cost can be a barrier for a teen who may have trouble affording their chosen method of contraception. OHIP + is a major step forward as it relates to this issue in Ontario, but this type of access to prescribed medications is unfortunately not universal for all youth across the country.

What are the most important elements of the new recommendations?

These recommendations ask healthcare providers to talk to teens about their sexual and reproductive health—ideally before they become sexually active. Collaborate with the teen to choose a method of birth control they feel they can stick with. Talk about various methods of birth control and recommend LARCs as a first-line because they are most effective. Encourage consistent condom use regardless of contraceptive method chosen to protect against sexually transmitted infections. Discuss emergency contraception as an option. If the pill is going to be prescribed, use a “quick start” method, where the person takes their first pill the same day they receive the prescription, continues to take one pill every day at that same time, and uses backup pregnancy protection for at least 7 days after starting the pill.

How do IUCs work? Are they safe? Effective?

IUCs can be either a copper intrauterine device (IUD) or hormone containing intrauterine system (IUS). They work by either killing and damaging sperm or thickening cervical mucus so the sperm can’t reach the egg. The IUDs and IUSs are over 99% effective at preventing pregnancy. The pill is 91% effective and condoms are 82% effective. IUDs and IUSs are safe to use, including for teenagers. One major myth is that IUDs cannot be used in teens or cannot be used in someone who has never had a baby.

It’s ok if a teen chooses another method of birth control. Less effective contraception options are better than no contraception at all for those who are trying to avoid pregnancy. By providing a teen with a confidential environment to safely discuss their sexual and reproductive health care, healthcare providers can work with teens to assist them in choosing a method of contraception that works best for them.

For teens who are interested in starting birth control, I would encourage them to discuss this issue with their healthcare provider or to attend a local sexual health clinic.

The Canadian Pediatric Society’s position statement is title Contraceptive care for Canadian youth. The principal authors are Dr. Giosi Di Meglio, Dr. Colleen Crowther, and nurse practitioner, Joanne Simms.