Transcript: Show #14 | Jan 09, 2001

A slate appears with the caption "The advice given in the preceding programmes is of a general nature only viewers should consult their own medical professional for medical advice specific to their circumstances."

The title of the show appears: "Your Health." Clips of the episode are displayed behind the title sequence.

Maureen says THIS WEEK.

A clip shows a doctor say SOME OF THE DISEASES THAT
I TREAT, PARTICULARLY
INVASIVE BLADDER CANCER,
KIDNEY CANCERS AND TEST
PARTICULARLY INVASIVE BLADDER CANCER, THAT
WHEN PATIENTS WAIT THEIR
DISEASE PROGRESSES AND THEY
ARE LESS LIKELY TO BE CURED.

Maureen says THE HEALTH
RISKS OF WAITING LISTS.
AMAZING ADVANCES IN BREAST
RECONSTRUCTION.
AND JOE SCHWARCZ.

Joe says IT IS THE ROOT OF THE
ASTRAGALUS PLANT.
THEY SAY IT INCREASES THE
BODY CHI.

Maureen says WHAT MODERN
MEDICINE SAYS ABOUT AN
ANCIENT CHINESE HERB.

A clip shows a lab table full of herbs.

(music plays)
The opening sequence begins.

Clips of different people flash against a grey background. A 30-year-old woman with shoulder length black hair looks through a microscope, a 30-year-old with very short black hair holds up her 1-year-old son, a pharmacist counts and organizes red-and-yellow pills, a surgeon cuts into the abdomen of a patient and, finally, a man wearing a ted tank-top lifts weights. An animated microscope, pill bottle, syringe, and small dumbbell fly around the screen.

The title appears: "Your Health."

Maureen stands in a wood-paneled studio with T.V. screens embedded in the walls. She is in her forties, with short wavy red hair. She wears a pink blouse under a purple blazer.

Maureen says HELLO, I'M MAUREEN
TAYLOR.
WE HAD AN OVERWHELMING
RESPONSE WHEN WE RAN OUR
SPECIAL REPORT ON BREAST
CANCER EARLIER THIS SEASON.
SO FOR THOSE WHO MISSED IT
WE WANT TO REBROADCAST OUR
ITEM ON TRAN FLAPS.
ALTHOUGH THOUSANDS OF WOMEN
STILL RECEIVE MASTECTOMIES
TO TREAT THEIR BREAST CANCER
IT REMAINS A DISFIGURING AND
EMOTIONALLY SCARRING
OPERATION.
OVER THE LAST 20 YEARS
DOCTORS HAVE DEVELOPED WAYS
TO RECONSTRUCT THE BREAST.
EITHER WITH SALINE IMPLANT
ITS OR WITH LIVING TISSUE
FROM THE PATIENTS.
TWO AND A HALF YEARS AFTER
HER MASTECTOMY KAREN
ANDERSON DECIDED TO UNDERGO
AN INTRICATE PROCEDURE
CALLED A TRAN FLAP.
WE FOLLOWED HER BEFORE,
DURING AND AFTER HER
SURGERY.
AND A WARNING, SOME OF THESE
PICTURES ARE VERY GRAPHIC.
[(music plays)]

Clip shows a father playing guitar and singing for his family.

Maureen says KAREN ANDERSON WAS ONLY
38 WITH FOUR YOUNG GIRLS
WHEN SHE WAS DIAGNOSED WITH
BREAST CANCER.
HEALTHY, WITH NO MATERIAL
HISTORY OF THE DISEASE SHE
HAD DIFFICULTY CONVINCING
HER DOCTOR TO EVEN GIVE HER
A MAMMOGRAM.
BUT THE RESULTS LOOKED
SUSPICIOUS AND A BIOPSY
SHOWED SHE HAD BREAST
CANCER.

A caption reads "Karen Anderson."

Karen is in her forties, with mid-length slightly wavy blond hair in a side part. She wears a purple tank top and a delicate necklace.

She says WHENCE WHEN I FIRST HEARD,
DISBELIEF COMPLETELY BECAUSE
I WAS ALMOST 100 percent CERTAIN
THAT THE DIAGNOSIS WAS GOING
TO COME BACK NEGATIVE AND I
WAS FINALLY GOING TO HAVE
THE 100 percent SURE ANSWER THAT I
HAD NOTHING.
SO IT WAS COMPLETE AND UTTER
SHOCK.
I WAS THINKING ABOUT THE
CHILDREN.
INITIALLY THE ONLY THING I
WAS THINKING ABOUT WAS
GETTING RID OF THE CANCER.
THAT WAS THE MOST IMPORTANT
THING.
WHATEVER THE STEPS WERE
NECESSARY TO TAKE, LET'S
JUST GET RID OF THIS THING.
THE IMPACT OF IT BEING
GONE AND HOW I WAS GOING TO
FEEL ABOUT THAT WASN'T EVEN
AN ISSUE AT THE TIME.
IT WAS JUST, YOU KNOW, LET'S
GET RID OF IT.
WE CERTAINLY CONCERN OF BODY
IMAGE AND THINGS LIKE THAT.
BUT MY LIFE WAS THE
IMPORTANT PART AT THAT TIME.

Maureen says WITH CANCER
PEPPERED THROUGHOUT HER
BREAST KAREN HAD NO
CHOICE.
SHE NEEDED A COMPLETE
MASTECTOMY.

Karen says IT HAD TO GO.
THERE WERE NO CHOICES.
AND THE SOONER THE BETTER.
COMING OUT WAS ANOTHER THING.
NOW THERE IS SOMETHING TO
LOOK AT THAT IS JUST DIFFERENT.
WHEN THE BANDAGES CAME OFF
IT WAS SHOCKING.
I CRIED.
I CRIED A LOT.
I CRIED PROBABLY FOR A
COUPLE OF DAYS EVERY TIME I
LOOKED AT IT.
IT WAS JUST KIND OF LOOKING
AT IT WAS THE REALITY.
IT WAS HUGE REALITY.
MY SURGEON GAVE ME A FEW
SCENARIOS.
ONE OF THEM BEING THAT IT IS
AN OPTION TO HAVE
RECONSTRUCTION AT THE SAME
TIME AS A MASTECTOMY BUT
THAT HE DIDN'T NECESSARILY
RECOMMEND THAT AS A GOOD
OPTION.
WHAT HE HAD FOUND WITH
PREVIOUS PATIENTS IS THAT
THE WAITING PERIOD MAKES YOU
HAPPIER WITH THE RESULT IN
THE LONG RUN.
AND THAT OFTENTIMES SOME
PEOPLE FIND THAT THEY ARE
ACTUALLY QUITE HAPPY LIVING
WITHOUT IT.

Maureen says THE MOST RECENT
STATISTICS TELL US THAT
ALMOST 14,000 CANADIAN WOMEN
UNDERGO MASTECTOMY EACH
YEAR.
OF THOSE ONLY 10 percent CHOOSE
RECONSTRUCTION...
RECONSTRUCTIVE BREAST
SURGERY.
KAREN HAS WAITED TWO AND A
HALF YEARS TO HAVE THIS
SURGERY.

Karen says I HAVE A COMPLETELY CLEAR
PICTURE OF WHAT IS IMPORTANT ON
THE BROAD PICTURE.
MY FAMILY IS JUST... AND
FRIENDS AND SURROUNDING
PEOPLE AND MY LIFE HERE AND
THAT.
AND IT IS NOT MY BODY.
MY BODY IS NOT WHAT IS
MAKING ALL OF THAT HAPPEN.
BUT ON A MORE INTIMATE LEVEL
AND ON A MORE PERSONAL LEVEL,
I WASN'T SURE HOW I WOULD
FEEL.
BUT I HAVE FOUND THAT IT IS
ACTUALLY BEEN A BUILD UP TO
THE POINT WHERE I'M REALLY
NOT COMFORTABLE WITH MY
BODY.
AND I HAVE ALWAYS BEEN A
VERY COMFORTABLE PERSON WITH
MY BODY.

A picture of Karen’s breast after the surgery appears.

Karen says IT'S A MUTILATION.
YOU ARE MUTILATED AS THOUGH
YOU HAVE LOST A PART OF YOUR
BODY.
YOU HAVE HAD AN ARM CUT OFF,
YOU HAVE HAD SOMETHING THAT
MAKES A PERSON, WHAT SOCIETY,
IF YOU WANT TO PUT IT THAT I
THAT WAY, THINKS OF WHAT A
PERSON IS AND HOW THEY ARE
FORMED.
AND IT IS GONE.

Maureen says DOCTOR JOHN SEMPLE
IS A PRACTICE SURGEON AND A
SPECIALIST IN BREAST
RECONSTRUCTION...
RECONSTRUCTIVE SURGERY.
HE WILL BE KAREN'S CERTAIN.

The caption changes to "Doctor John Semple. Sunnybrook-Women’s College. Head of plastic surgery."

John is in his late forties, clean-shaven and with short wavy gray hair. He wears a white coat.

He says THE BREAST RECONSTRUCTION
IS AN OPTION FOR SOMEONE WHO
FEELS THEY WOULD LIKE TO
REPLACE THE BREAST WITH A
FACSIMILE IS THE WORD TO
HELP IN REHABILITATION IT
THERE ARE TWO BASIC CHOICES
ONE IS THEY CAN USE THEIR
OWN TISSUE FOR THE
RECONSTRUCTION AND ONE THAT
THEY CAN USE... THE OTHER IS
THAT THEY CAN USE SALINE
FILLED IMPLANT OR SALT WATER
IMPLANT.

Maureen says KAREN HAS
CHOSEN A TRAN FLAP WHICH
STANDS FOR TRANSVERSE
RECTUS ABDOMINAL
MYOCUTANEOUS FLAP.
THE OPERATION TAKES THREE TO
FIVE OURS.
KAREN WILL BE CUT OPEN FROM
HIP TO HIP.

John says WE TAKE THE TISSUE FROM
THE LOWER ABDOMEN WHICH IS
NORMALLY DISREGARD...
DISCARDED AFTER A TUMMY
TUCK.
WE LEAVE THAT SKIN... THAT
ECLIPSE OF TISSUE ATTACHED
TO ONE OF OR PART OF THE
MUSCLE IN THE ABDOMEN AND WE
CREATE A TUNNEL AND WE BRING
THAT THROUGH THE TUNNEL INTO
THE MASTECTOMY SITE.
AND WE BRING THE TISSUE OUT
THROUGH THERE AND CREATE A
BREAST OR WE SHAPE THE SKIN
AND THE FAT FROM THE LOWER
ABDOMEN INTO A BREAST SHAPE.

Maureen says A WARNING, THE
PICTURES YOU ARE ABOUT TO
SEE ARE VERY GRAPHIC.

A clip of Karen’s operation rolls.

Maureen says DURING THE FIRST STAGE OF
THE SURGERY THE DOCTORS
DETACH KAREN'S SKIN AND FAT
FROM HER MUSCLES AND INNER
ORGANS.
THAN DOCTOR SEMPLE CUTS OPEN
THE SCAR FROM KAREN'S
MASTECTOMY.
WILL BRING SKIN AND FAT FROM
HER BELLY THROUGH THE
INCISION TO BUILD A NEW
BREAST.
AFTER AN HOUR AND A HALF IN
SURGERY KAREN'S BODY LIES
CUT OPEN, READY TO BE
REBUILT.
DOCTOR SEMPLE SHOWS HOW THE
STOMACH WILL BE PUSHED
UPWARD TO FORM A NEW BREAST.

John says WHAT WE HAVE IS THE FLAP
WHICH IS... WE HAVE TRIMMED
OFF THE OTHER PART OF IT SO
WE ONLY HAVE HALF THE FLAP
AND THAT IS ALL WE NEED IN
THIS PARTICULAR CASE.
AND UNDERNEATH IT IS
ATTACHED TO THE... ONLY PART
OF THE RECTUS MUSCLE HERE.
SO THIS CAN ACTUALLY GO
ANYWHERE WE WANT IT TO.
NOW IN THIS CASE WE ARE
GOING TO PASS IT THROUGH THE
TUNNEL THAT WE HAVE MADE AND
THIS IS THE MAGICAL PART OF
THIS PARTICULAR FLAP.
WE ALWAYS FEEL THIS IS THE
ON STET RI CALL PART OF THE
PROCEDURE, COMING THROUGH
THE CANAL.
WE JUST GENTLY ENCOURAGE IT
THROUGH, JUST BY SHIFTING IT
BACK AND FORTH.
REMEMBER, THIS IS ONLY JUST
UNDER THE SKIN.
AND AS THE FLAP COMES OUT
HERE, THERE IS OUR BREAST.
AND THIS TUCKS UP UNDERNEATH
LIKE THAT.
AND WE JUST START TO SHAPE
IT IN LIKE THIS.

Maureen says HE STAPLES THE FLAP INTO
POSITION BEFORE SOWING HER
BACK TOGETHER.
AS WITH ANY SURGERY, THERE
IS THE RISK OF COMPLICATIONS.

John says COMPLICATIONS ARE RARE
BUT INFECTIONS, SMALL AREAS
OF SLOW HEALING ALONG THE
INCISIONS, COLLECTION OF
FLUID UNDER THE AREAS THAT
WE ARE WORKING ON, VERY
RARELY WE CAN HAVE PROBLEMS
WITH PART OF THE FLAP BUT
NOW WE ARE PRETTY GOOD AT
SORTING IT THAT OUT.

Maureen says IN THREE MONTHS KAREN CAN
RETURN FOR THE FINAL STAGE.
DOCTORS TATTOO AN AREOLA AND
BUILD A NIPPLE GRAFTED FROM
HER SKIN.

Pictures of Karen’s reconstructed breasts appear.

John says OVER THE PAST 12 YEARS WE
HAVE DONE OVER 400
RECONSTRUCTIONS.
THE LEVEL OF SATISFACTION
WHEN WE SENT OUT A SURVEY WE
HAD AN 80 percent OF THE PATIENTS
SENT THEIR SURVEYS BACK AND
WE HAD CLOSE TO 90 percent
SATISFACTION RATE.
WHICH IS PRETTY HIGH.

Karen says I GOT EXACTLY WHAT I
HOPED FOR.
IN A SENSE I HAVE BEEN GIVEN
A GIFT THROUGH THIS.
IT GIVES YOU A CHANCE TO
REALLY DIG DEEP AND GET A
SECOND LOOK AT YOUR LIFE AND
REALLY, HOW MUCH YOU HAVE.
AND YOU RETHINK THE FUTURE
AND I'M PROBABLY MORE
GRATEFUL FOR LITTLE THINGS.
I DON'T THINK I EVER DIDN'T
APPRECIATE MY CHILDREN OR MY
HUSBAND OR MY FAMILY AND
FRIENDS.
BUT IT GIVES YOU A DEEPER
APPRECIATION.

A slate appears with the caption "Breast reconstruction is covered by every provincial health plan across Canada. Source: Provincial Ministries of Health."

Maureen says READY FOR OUR
HEALTH QUIZ, HOW SOON AFTER
YOU QUICK SMOKING DOES YOUR
RISK OF HEART ATTACK
DECREASE.
IS IT BY THE SECOND DAY, THE
SECOND MONTH OR THE SECOND
YEAR?
THE ANSWER LATER ON YOUR
HEALTH.

Now Maureen sits in the studio with two guests.

Maureen says IF YOU WERE DIAGNOSED
WITH CANCER YOU WOULD WANT
TO BE REFERRED TO A
SPECIALIST AND START
TREATMENT RIGHT AWAY.
OR IF YOU NEEDED HEART
SURGERY OR A HIP
REPLACEMENT.
YOU WOULD WANT IT DONE AS
SOON AS POSSIBLE.
BUT IN CANADA TODAY THE
PATIENT NEEDS TO HAVE
PATIENCE.
BECAUSE NO MATTER WHAT OUR
DIAGNOSIS CHANCES ARE IT
WILL BE PUT ON A WAITING
LIST.
UP UNTIL NOW WE HAVE BEEN
TOLD THE WAIT IS NOT LIFE
THREATENING BUT SOME DOCTORS
ARE BEGINNING TO EXPRESS
CONCERN ABOUT THE LENGTH OF
TIME THEIR PATIENTS HAVE TO
WAIT.
DOCTOR LAURENCE KLOTZ IS A
UROLOGIST AND SURGEON IN
TORONTO, DOCTOR MICHAEL RACHLIS
IS A HEALTH POLICY
CONSULTANT.

Laurence is in his late forties, clean-shaven and with very short gray hair. He wears glasses and a white coat.

Michael is in his late forties, clean-shaven and bald. He wears glasses, a blue suit, white shirt and printed red tie.

Maureen says DOCTOR KLOTZ HOW LONG ARE YOUR
PATIENTS WAITING FOR CANCER
TREATMENT.

The caption changes to "Doctor Laurence Klotz. Urologist, Sunnybrook Hospital."

Laurence says WELL, THE SHORT ANSWER IS
THAT THEY WAIT UNTIL TWO
MONTHS.
AND THAT'S FROM THE TIME
THAT THE DECISION IS MADE TO
HAVE THE MAJOR OPERATION TO
THE TIME THAT THEY ACTUALLY
HAVE IT.
BUT THE PROBLEM IS THAT FROM
THE TIME THEY HAVE THEIR
FIRST SYMPTOM AND GOING TO
THEIR FAMILY DOCTOR AND ARE
REFERRED AND WAIT FOR THE
CONSULTATION AND THAN WAIT
FOR THE FIRST PROCEDURE THAT
HAS TO BE DONE TO MAKE THE
DIAGNOSIS AND THAN THE WAIT
FOR THE CT SCAN AND THE
OPERATION OFTEN IS THREE,
FOUR, FIVE, SIX MONTHS.

Maureen says DOES THAT
CONCERN YOU.

Laurence says THAT CONCERNS ME A GREAT
DEAL.
I THINK IT'S TOO LONG.
PATIENTS DON'T LIKE TO WAIT
THAT LONG.
THEY SHOULDN'T HAVE TO WAIT
THAT LONG.

Maureen says WELL, NOBODY
LIKES TO WAIT THAT LONG BUT
WOULD YOU SAY THAT WE ARE
HUTTING... PUTTING THEIR
HEALTH OR LIVES AT RISK WITH
THAT KIND OF WAIT.

Laurence says I THINK IN SOME
CIRCUMSTANCES THEIR HEALTH
IS BEING PUT AT RISK.
ONE OF THE DIFFICULTIES IS
WE DON'T HAVE HARD EVIDENCE
ABOUT SOME CANCERS THAT
WAITING MAKES A DIFFERENCE.
AND WHEN YOU THINK ABOUT IT,
NO ONE IS GOING TO DO A
STUDY COMPARING PATIENTS OR
RANDOMIZING PATIENTS WHO
WAIT A LONG TIME TO PATIENTS
WHO WAIT A SHORT TIME.
ALTHOUGH ACTUALLY CANADA IS
PROBABLY BETTER SUITED TO DO
THAT KIND OF STUDY THAN MOST
COUNTRIES BECAUSE WE HAVE
SUCH LONG WAITING LISTS.
BUT MY SENSE IS FOR SOME OF
THE DISEASES THAT I TREAT
PARTICULARLY INVASIVE
BLADDER CANCER, KIDNEY
CANCER AND TESTICULAR CANCER
THAT WHEN PATIENTS WAIT
THEIR DISEASE PROGRESSES AND
THEY ARE LESS LIKELY TO BE
CURED.

Maureen says DOCTOR RACHLIS, DO YOU
THINK THAT WAITING LISTS IN
CANADA ARE HAZARDOUS TO OUR
HEALTH.

The caption changes to "Doctor Michael Rachlis. Health Policy Consultant."

Michael says I THINK THAT THERE ARE NO
DOUBT SOME PEOPLE WHO ARE
WAITING TOO LONG AND IT MAY
BE ADVERSELY AFFECTING THEIR
HEALTH.
BUT IN GENERAL, THE... WHEN
WE LOOK AT THE WAITING LIST
ISSUES, THERE ARE PROBABLY
NOT TOO MANY PEOPLE WHO ARE
SUFFERING IN TERMS OF THEIR
HEALTH PHYSICALLY AS OPPOSED
TO PSYCHOLOGICALLY.
HOWEVER THIS ISSUE ALMOST
NEVER GETS RAISED WITHOUT
THEIR ALMOST IMMEDIATELY
BEING A SOLUTION ATTACHED.
AND THAT IS WHERE I THINK WE
HAVE TO BE CAREFUL.
WE ARE THROWING A LOT OF
MONEY AT THE HEALTH-CARE
SYSTEM THESE DAYS AFTER
TAKING MONEY OUT, WE ARE
THROWING A LOT OF MONEY AT
IT AND IF WE DON'T DO IT
PROPERLY, IF WE DON'T BETTER
IMAGINE THE ISSUES THAN WE
MAY FIND THAT THE MONEY WILL
JUST GO IN AND NOTHING WILL
HAPPEN TO THE WAITING LISTS.
ALL THE LITERATURE INDICATES
IF YOU WANT TO DO SOMETHING
ABOUT THE WAITING LISTS YOU
HAVE TO ANALYZE THE ISSUE
CAREFULLY AND MAKE SURE THAT
YOU PUT THE MONEY AND TARGET
IT TO MAKE SURE THAT IT GOES
WHERE IT IS GOING TO REMEDY
THE PROBLEM.

Maureen says ON THE SURFACE
WHERE WE HEAR ABOUT THE LACK
OF RADIOLOGISTS OR
ONCOLOGISTS OR WHATEVER AND
THE FACT MIGHT TAKE PATIENTS
A LONG TIME TO SEE YOU,
DOCTOR KLOTZ, SOUNDS LIKE THE
SOLUTION IS WE NEED MORE
SPECIALISTS, MORE DOCTORS.
IS THAT YOUR OPINION.

Laurence says WELL, THIS IS A COMPLEX
QUESTION.
THE PROBLEM IS WE HAVE AN
EXTREMELY CENTRALIZED
SYSTEM.
THE DECISION-MAKING IN OUR
SYSTEM AS TO HOW RESOURCES
ARE ALLOCATED IS VERY
CENTRALIZED.
AND THE RESULT ASK THAT YOU
GET THESE AREAS WHERE THERE
ARE SEVERE PROBLEMS.
AND THERE IS NOT THE
INFORMATION SYSTEM THAT
EXISTS TO ALLOW THE
RESOURCES TO BE ALLOCATED IN
A RATIONAL FASHION.
IT IS... SINCE THIS WHOLE
THING IS CENTRALIZED WITHIN
THE MINISTRY OF HEALTH SO MY
VIEW IS THERE HAS TO BE SOME
LOOSENING OF THIS EXTREME
CENTRALIZATION OF CONTROL.

Maureen says NOW IS THAT... ARE YOU
REFERRING HERE TO SORT OF
CENTRAL REGISTRIES.
AND I THINK DOCTOR RAD CLIFF
YOU HAVE WRITTEN ABOUT THIS
A BIT IN B.C. AND CANCER
CARE, THEY HAVE A DIFFERENT
TYPE OF SYSTEM.

Michael says WELL, ONE OF THE BEST
MODELS ANYWHERE IN THE WORLD
FOR MANAGING WAIT LISTS IS
THE ONTARIO CARDIAC SURGERY
REGISTER WHICH IS WHY, IF
YOU THINK ABOUT IT, IF YOUR
VIEWERS THINK ABOUT THEY
PROBABLY HAVEN'T HEARD THAT
MUCH ABOUT HEART SURGERY
PROBLEMS.
IT HAS BEEN CANCER AND OTHER
WAITING FOR SPECIALISTS ET
CETERA.
AND ONE OF THE REASONS IS
THAT TEN YEARS AGO THE
MINISTRY OF HEALTH CONVENED
A GROUP WITH HEART DOCTORS,
EPIDEMIOLOGISTS, FAMILY
DOCTORS AND THEY SET OUT A
PLAN WHERE THEY SET URGENCY
RATINGS.
THEY DECIDED HOW LONG
CERTAIN TYPES OF PARENTS
SHOULD WAIT AND THAN THEY
PUT IN A REGISTRY WHERE ALL
THE INFORMATION WAS
COLLECTED AND ANALYZED ABOUT
WHAT WAS HAPPENING TO
WAITING LISTS BECAUSE WE
DON'T HAVE THAT INFORMATION
NOW.
WE TALK ABOUT WAITING LISTS
AS IF THERE IS SOME CENTRAL
COMPUTER, THERE ISN'T.
WITH THE EXCEPTION OF HEART
SURGERY IN ONTARIO.
AND MAYBE HEART SURGERY IN A
FEW OTHER PLACES AND NOW WE
HAVE A JOINT SURGERY REGISTRY GOING IN
ONTARIO.
THERE ISN'T THIS CENTRAL
WAITING LIST MANAGEMENT.
TYPICALLY WHAT WE HAVE IS A
DEPARTMENT OF SURGERY WITHIN
A HOSPITAL WHERE THE CHAIR
CAN ALLOCATE THE SURGERY
PRETTY MUCH AS HE OR SHE
WANTS.
IT DEPENDS ON THE
INSTITUTION.
SOME THERE IS BETTER MEDICAL
LEADERSHIP, MORE DEMOCRACY
AND OTHERS IT CAN BE A BIT
DICTATORIAL.
ALTHOUGH THERE ARE CENTRAL
MANAGEMENT ALLOCATION ISSUES,
THAT THE PROVINCE CAN'T
MICROMANAGE, BUT WE ALSO
HAVE A PROBLEM THAT WE DON'T
HAVE ENOUGH CENTRALIZATION
WELL.
SO THAT THE ONTARIO CARDIAC
REGISTRY YOU CAN GO ON THE
WEB AND SEE WHAT WAITING
TIMES ARE IN TWO DIFFERENT
PARTS OF THE PROVINCE.
THERE ISN'T THAT INFORMATION
AVAILABLE ON OTHER TYPES OF
SURGERY.
SO THAT...

Maureen says PRESUMABLY CANCER
TREATMENT.

Michael says I THINK THAT THE PUBLIC
HAS THE IMPRESSION THAT
SOMEHOW THERE IS A
BUREAUCRATIC OR GROUP OF
DOCTORS OR SOMEBODY WHO IS
ACTUALLY LOOKING AT THIS
LIST OF PATIENTS AND MAKING
SURE THE ONES WHO NEED TO GO
NEXT ARE GOING NEXT.
THERE IS NOTHING LIKE THAT.
WITH THE EXCEPTION OF HEART
SURGERY.
SO THAT YOU OFTEN RUN INTO
SITUATIONS, PARTICULARLY
UROLOGY IS MAYBE LESS SEXY
THAN HEART SURGERY.
SO THAT WITHIN THE POLITICS
OF THE PROVINCE'S
HEALTH-CARE SYSTEM, WITHIN
THE POLITICS OF A HOSPITAL,
THAT THEY MAY NOT COMMAND AS
MUCH AS THE OTHER DOCTORS.

Maureen says YOU ARE
LAUGHING BECAUSE UROLOGY IS
VERY SEXY FROM WHAT I
UNDERSTAND.
BUT GO AHEAD.

Laurence says WELL, I THINK WE HAVE TO
MAKE IT CLEAR, THIS IS A
NATIONAL PROBLEM OF
SHORTAGES.
AND ONE OF THE PROBLEMS IS
IN MY AREA, FOR EXAMPLE,
THERE ARE ONLY A LIMITED
NUMBER OF UROLOGISTS WHO
SPECIALIZE IN CANCER OR
ONCOLOGY.
AND ACROSS THE COUNTRY EVERY
SINGLE ONE OF THEM HAS A
WAITING LIST THAT IS TOO
LONG.
SO WE HAVE A MANPOWER
SHORTAGE AND WE ALSO HAVE A
RESOURCE SHORTAGE.
ALL OF MY COLLEAGUES FEEL
THAT THEY DON'T HAVE ENOUGH
OR TIME, FOR EXAMPLE, TO
MEET THE NEEDS OF THE
POPULATION.
AREN'T IN FACT I GOT A
LETTER FROM THE HEAD AT
UNIVERSITY OF BRITISH
COLUMBIA RECENTLY ASKING IF
HE COULD SEND PATIENTS WITH
BLADDER CANCER TO TORONTO
BECAUSE HE COULDN'T OPERATE
ON THEM IN A TIMELY FASHION.
OF COURSE WE HAVE EXACTLY
THE SAME PROBLEM.
SO THIS IS REALLY A NATIONAL
AND SYSTEMIC PROBLEM MORE
THAN IT IS A LOCAL PROBLEM.
NOT JUST... IT'S NOT JUST
SURGERY.
THERE ARE LONG WAITING LISTS
FOR RADIATION.
THERE HAS BEEN AN
ATTEMPT TO RATIONALIZE THE
RESOURCE.
WE HAVE BEEN SENDING PEOPLE
TO THUNDER BAY, TO BUFFALO
FOR SIX OR SEVEN WEEKS
PAYING HUGE AMOUNTS OF MONEY
TO PUT THESE PEOPLE UP AND
SO ON.
THIS IS NOT THE WAY TO SOLVE
THE PROBLEM.

Maureen says NO.
GIVEN THOUGH THAT YOU ARE
THE GUY WHO HAS TO DECIDE
WHO GETS TREATMENT AND WHEN,
ARE YOU AT ALL WORRIED ABOUT
THE LIABILITY OF SOMEBODY
SHOULD DIE WHILE THEY ARE ON
ONE OF YOUR WAITING LISTS.

Laurence says WELL, I THINK ONE OF THE
REASONS THAT PERHAPS... ONE
OF THE OTHER REASONS THAT
CARDIAC SURGERY IS DIFFERENT
FROM CANCER SURGERY IS YOU
CAN TELL THAT IF A PATIENT
DIES ON A WAITING LIST FROM
WAITING FOR HIS HEART
SURGERY THAT THAT IS A REAL
PROBLEM.
WITH CANCER SURGERY IT
DOESN'T WORK LIKE THAT.
PEOPLE DON'T DIE ON THE
WAITING LIST.
THEY DIE FOUR OR FIVE YEARS
LATER BECAUSE THEIR SURGERY
WAS DELAYED.
AND WE NEVER KNOW IN ANY ONE
CASE WAS THIS PATIENT'S
DEATH PREVENTABLE BY EARLY
SURGERY OR NOT.
I CAN TELL YOU THAT MOST
PEOPLE IN MY FIELD FEEL THAT
THE EARLIER YOU GET THESE
THINGS OUT, THE BETTER IT
IS.

Maureen says ALL RIGHT,
DOCTOR RAD CLIFF, WHAT IS YOUR
ADVICE TO PEOPLE WHO MAY BE
WATCHING AND ARE ON A
WAITING LIST FOR TREATMENT.
WHAT CAN THEY DO.

Michael says THERE ARE TWO DIFFERENT
THINGS THAT PEOPLE CAN DO.
IF YOU HAVE AN INDIVIDUAL
PROBLEM NOW THERE IS NOT
MUCH YOU CAN DO.
I MEAN HOPE THAT... THAT
HOPEFULLY YOU HAVE GOT A
GOOD FAMILY PHYSICIAN OR
YOU'VE GOT A GOOD SOURCE OF
PRIMARY HEALTH CARE THAT CAN
ADVOCATE FOR YOU.
THAT IS EXTREMELY IMPORTANT.
WE HAVEN'T TALKED ENOUGH
ABOUT THIS.
BUT IF YOU BETTER LINK
SPECIALISTS WITH FAMILY
PHYSICIANS AND PRIMARY
HEALTH-CARE CENTRES YOU CAN
AVOID A LOT OF PEOPLE
FALLING THROUGH THE CRACKS
SO THAT YOU CAN HAVE PEOPLE
WHO ARE TRULY URGE ENT WHO
CAN GET SEEN MORE QUICKLY.
THERE IS ALSO A LOT OF
EXPERTISE THAT CAN BE
TRANSFERRED DOWN THROUGH THE
SYSTEM IF SPECIALISTS ARE IN
BETTER CONTACT WITH FAMILY
PHYSICIAN.
THEY HAVE A WONDERFUL MODEL
FOR THAT IN TORONTO AND IN
HAMILTON FOR PSYCHIATRIC
CARE WITH PSYCHIATRISTS ARE
LINKED UP WITH PRIMARY
HEALTH-CARE CENTRES TO SEE
PATIENTS DIRECTLY BUT MAINLY
TO PROVIDE ADVICE AND
CONTINUING EDUCATION.
IN TERMS OF DEALING WITH
WAITING LISTS WE NEED TO
HAVE MORE CENTRAL REGISTRIES
LIKE THE ONTARIO CARDIAC
REGISTRY.
I'M JUST SHOCKED, I HELPED
AT THE VERY BEGINNING PUSH
TO START SOMETHING WITH THE
ONTARIO CARDIAC REGISTRY
ALTHOUGH I WAS REALLY NOT
INVOLVED WITH DEVELOPING IT.
AND I THOUGHT AT THAT TIME
THAT WITHIN A FEW YEARS WE
WOULD HAVE THIS FOR
EVERYTHING.
AND WE DON'T.
AND WE ALSO NEED... THE
PRIMARY HEALTH-CARE REFORM
COULD ALSO HELP PATIENTS WHO
ARE WAITING.
BECAUSE OFTENTIMES PEOPLE
ARE WAITING.
THEY WAIT FOR MONTHS.
THEY HAVE NO CONTACT WITH
THEIR FAMILY PHYSICIAN.
THEY DON'T HAVE CONTACT WITH
THE SPECIALISTS OFFICE.
AND THEY CAN EVEN
DETERIORATE AND NEED CARE
MORE URGENTLY BUT NO ONE
KNOWS IT.
IF WE HAD A BETTER PRIMARY
HEALTH-CARE SYSTEM WE COULD
HAVE WAIT LIST MANAGERS WHO
WOULD BE IN REGULAR CONTACT
WITH PATIENTS AND MAKE THEM
FEEL BETTER LIKE THEY
WEREN'T BEING NEGLECTED AND
THEY WEREN'T DETERIORATING.
FINALLY, WHEN WE HAVE AUDITS
OF WAITING LISTS RARELY DONE
IN CANADA BUT DONE IN
BRITAIN, AUSTRALIA AND NEW
ZEALAND IT HAS BEEN FOUND
THAT 20 TO 40 percent OF PEOPLE ON
THE SO-CALLED LISTS HAVE
EITHER HAD THE PROCEDURE,
THEY ARE ON TWO DIFFERENT
LISTS OR DON'T WANT THE
PROCEDURE ANY MORE.
SO THAT THERE IS... I'M NOT
SAYING THAT THERE AREN'T
PEOPLE SUFFERING NOW, BUT I
AM DEFINITELY SAYING WE ARE
THROWING MONEY AT OUR
HEALTH-CARE SYSTEM, TALK
ABOUT WAITING LISTS.
THERE IS A WOMAN RIGHT NOW
WHO HAS JUST BEEN BEATEN UP
BY HER HUSBAND, TAKEN TO AN
EMERGENCY DEPARTMENT AND WE
ARE TELLING HER THERE IS NO
SPACE IN THE SHELTER AND
WE ARE SENDING HER BACK
HOME.
SO THAT... THERE ARE OTHER
TYPES OF WAITING LISTS TOO.

Maureen says WE HAVE TO
LEAVE IT THERE.
THANK YOU FOR AN INTERESTING
DISCUSSION.
COMING UP ON YOUR HEALTH.

A clip shows Joe say IT IS A ROOT OF THE
ASTRAGALUS PLANT.
THEY SAY IT INCREASES THE
BODY IMMUNE.

The opening slate appears again.

Now Maureen stands next to a screen with the caption "Health digest. Heart Health."

Maureen says NOW SOME RECENT
HEALTH NEWS.
VIGOROUS PHYSICAL EXERCISE
IS A DOUBLE-EDGED SWORD.
IT CAN SIMULTANEOUSLY
INCREASE THE SHORT-TERM RISK
OF HAVING A HEART ATTACK BUT
IT ALSO OFFERS LONG-TERM
PROTECTION AGAINST HEART
DISEASE.
CONFUSED?
THE A 12-YEAR STUDY OF MALE
DOCTORS MEN WHO EXERCISED
LESS THAN ONCE A WEEK WERE
SEVEN TIMES MORE LIKELY TO
DIE SUDDENLY DURING OR RIGHT
AFTER A WORKOUT THAN SOMEONE
WHO EXERCISED AT LEAST FIVE
TIMES A WEEK.
SO IN SHORT, EXERCISE
REGULARLY AND THE RISK IS
MORE THAN WORTH IT.

The caption on the screen changes to "Incontinence."

Maureen says TEENAGE GIRLS MAY SPEND A
FAIR BIT OF TIME IN THE
BATHROOM BUT APPARENTLY THEY
ARE DOING TOO MUCH MAKEUP
APPLICATION AND NOT ENOUGH
BLADDER VOIDING.
A STUDY TO BE PUBLISHED IN
AN INTERNATIONAL UROLOGY
JOURNAL SAYS MANY TEEN GIRLS
YOUR NATURE ONLY THREE TIMES
A DAY OR LESS.
BUT SOONER OR LATER THIS
PRACTICE WILL CATCH UP WITH
THEM.
INFREQUENT VOIDERS OFTEN
DEVELOP URINARY INCONTINENT...
INCONTINENCE IN THEIR 40s
AND ARE MORE PRONE TO
URINARY TRACT INFECTIONS.
WHAT IS NORMAL, WE SHOULD
ALL GO TO THE BATHROOM EVERY
THREE OR FOUR HOURS AND
DRINK EIGHT CUPS OF FLUID A
DAY.

The caption on the screen changes to "Addiction."

Maureen says THE BRITISH MAY HAVE BECOME
PHYSICALLY ADDICTED TO
CURRIES.
THE RESEARCH AT NOTTINGHAM-TRENT
UNIVERSITY FOUND BRITAIN'S
INCREASED LOVE AFFAIR WITH
INDIAN FOOD OVER THE LAST 50
YEARS HAS PERMANENTLY
AFFECTED THE ENGLISH PALATE.
RESEARCHES MONITORED THE
HEARTBEATS AND BLOOD
PRESSURE OF 100 PEOPLE.
THEY WEREN'T FED CURRIES,
JUST TALKED TO ABOUT THEM.
THE MERE MENTION OF A
CHICKEN TIKKA LITERALLY SETS
HEARTS RACES INDICATING THAT
THE COMBINATION OF
INGREDIENTS IN THE FOOD MAY
BE ADDICTIVE.

Now the quiz appears again on screen.

Maureen says WE KNOW THAT NICOTINE IS
ADDICTIVE.
BUT THERE IS GOOD NEWS IF
YOU CAN QUICK SMOKING
BECAUSE BY THE SECOND DAY
YOUR RISK OF HEART ATTACK IS
DECREASED.
IN CHINA CANCER PATIENTS
ARE GIVEN ASTRAGALUS ALONG
WITH THEIR RADIATION AND
CHEMOTHERAPY TO HELP REBUILD
THE IMMUNE SYSTEM.
BUT OUR HERB EXPERT JOE
SCHWARCZ SAYS THE STUDIES SO
FAR SHOW ASTRAGALUS IS
COMING UP SHORT.

The scene changes to Joe Schwarcz standing in a lab.

A caption reads "Doctor Joe Schwarcz, Ph.D. Professor of Chemistry."

Joe is in his mid-forties, clean-shaven and with short wavy gray hair. He wears a black suit, a gray shirt and silver tie.

Joe holds an astragalus root and says CHICKEN SOUP IS SORT OF A
UNIVERSAL REMEDY FOR THE
COMMON COLD.
EVEN IN CHINA THEY USE IT
ALTHOUGH THEY USE IT
ALONGSIDE SNAKE SOUP.
BUT WHICHEVER ONE YOU LIKE,
IN CHINA THEY ARE LIKELY TO
GRATE SOME OF THIS ROOT INTO
THE SOUP.
IT IS A ROOT OF THE
ASTRAGALUS PLANT.
AND THEY SAY IT INCREASES
THE BODY'S CHI.
SORT OF INTERNAL ENERGY.
NOW OUR MODERN WESTERN
SCIENCE DOESN'T REALLY
UNDERSTAND WHAT CHI IS, AND
NEITHER DO I.
BUT I THINK IT HAS SOMETHING
TO DO WITH IMMUNE FUNCTION.
SO WE WOULD SAY THAT
ASTRAGALUS SUPPOSEDLY
INCREASES THE BODY'S
REACTIONS, THAT IS IT
IMPROVES IMMUNE FUNCTION.
DOES IT DO THAT.
DO WE HAVE ANY EVIDENCE?
WELL, WE DO SOME INTERESTING
CHEMISTRY ON IT.
WE EXTRACT COMPOUNDS FROM
THE ROOTS AND WE FIND THAT
THEY DO HAVE PHYSIOLOGICAL
ACTIVITY.
ASTRAGALUS B INCREASES THE
ACTIVITY OF NATURAL KILLER
CELLS, INTERLEUKIN 23 ALSO
IS BOOSTED.
WHAT DOES THAT MEAN THOUGH,
IN CHINA THEY USE ASTRAGALUS
ALONGSIDE RADIATION AND
CHEMOTHERAPY FOR CANCER
PATIENTS BECAUSE THOSE
TREATMENTS REDUCE THE IMMUNE
FUNCTION OF THE BODY,
ASTRAGALUS SUPPOSEDLY
IMPROVES IT.
IN NORTH AMERICA WE HAVEN'T
DONE THAT BECAUSE WE JUST
DON'T HAVE ENOUGH CLINICAL
STUDIES.
ALTHOUGH CANCER PATIENTS CAN
CERTAINLY ASK THE PHYSICIANS
TO LOOK INTO THIS SO-TO-SEE
WHETHER OR NOT ASTRAGALUS
MAY BE BENEFICIAL.
EVEN FOR HEART DISEASE.
IN CHINA INDEED THERE IS THE
BELIEF THAT USING ASTRAGALUS
ROOTS WITHIN ABOUT 36 HOURS
OF A HEART ATTACK CAN
IMPROVE HEART FUNCTION.
IT INCREASES THE BEATING
STRENGTH OF THE HEART.
WE WILL HAVE TO WAIT AND SEE
ON THAT ONE TOO.
IN NORTH AMERICA WE LIKE TO
GO FOREIGN CAP SLATED
SUPPLEMENTS AND WE HAVE
THEM.
YOU CAN GET THESE ASTRAGALUS
PILLS 500 TO 1,000 MILLIGRAMS
SORT OF A BALLPARK GUESS FOR
WHAT MAY BE USEFUL.
BUT WE DON'T HAVE ANY
LONG-TERM STUDIES, THAT IS
THE PROBLEM.
WE DON'T KNOW IF IT WILL
INTERACT WITH OTHER
MEDICATIONS SUCH AS BLOOD
THINNERS, COUMADIN, FOR
EXAMPLE.
WE DON'T KNOW HOW IT BEHAVES
UNDER ANESTHESIA, DOES IT
INTERACT WITH THE
ANESTHETICS.
SO WE STILL HAVE A LOT TO
LEARN.
ALL OF THIS NEED TO LEARN IS
KIND OF STRESSFUL.
BUT THE CHINESE TELL US THAT
ASTRAGALUS ROOT IS THE BEST
ANTIDOTE TO STRESS.

Back in the studio, Maureen says OKAY, JOE.
YOU CAN RELAX.
AND YOU CAN GET A TRANSCRIPT
OF JOE'S HERBAL ADVICE ON
OUR WEB SITE.
VISIT WWW.TVO.ORG/YOUR
HEALTH.
THE OTHER ADDRESS IS IN A
MOMENT BUT FIRST HERE IS A
LOOK AT A STORY WE ARE
WORKING ON FOR NEXT WEEK'S
PROGRAMME.

A clip shows a woman in her fifties with short straight blond hair.

She says BY THE TIME YOU START IT
IS REALLY OUT OF CONTROL.

Maureen says THE DEVASTATING
EFFECTS OF FOETAL ALCOHOL
SYNDROME.
THAT IS ALL THE TIME WE HAVE
FOR THIS WEEK'S PROGRAMME.
I'M MAUREEN TAYLOR, THANKS
FOR WATCHING.

A slate appears with the caption "Email: yourhealth@tvo.org. Fax: 416-484-4519. Mail: Box 200, Station Q. Toronto, Ontario. M4T 2T1."

Music plays as the end credits roll.

CEP Local 72m.

A production of TVOntario.

Copyright 2000. The Ontario Educational Communications Authority.

Watch: Show #14