RECENT EVENTS

APR Seminar: Age-Proofing your Brain with Dr. Elisabeth Sherman

APR Seminar: Stress Management with Dr. Lephuong Ong

APR Seminar: First-aid & CPR for infants & toddlers with Amra Dizdarevic

MAY Seminar: Mothers & Daughters with Dr. Liann Meloff

MAY Physiotherapy Month

UPCOMING EVENTS

JUN Seminar: Genetics with Katherine Hodson (Vancouver)

JUN Seminar: Genetics with Katherine Hodson (Calgary)

JULY Seminar: Diabetes Management with Nina Hirvi

AUG Seminar: Kidney Disease with Dr. Peter House

Copeman Healthcare Centre • Volume VI Issue IV

A complete guide to sunscreen and sun protection for healthy summer skin While the UV radiation from the sun provides us with many benefits, there are important risks to keep in mind with overexposure. We've put together the Top Do's & Don'ts for sunscreen. Page 4

Let the sunshine in - but know your limitsToo much of a good thing can be harmful if the right precautions to protect yourself are not taken. Finding an appropriate balance between the risks and benefits of sunlight is critical. Page 2

Want younger looking skin? Exercise might be the answerBelieve it or not, the rewards of exercise extend far beyond adding muscle tone or slimming down. Exercise also helps improve the look, feel and age of your skin. Page 3

Food on trial: How your diet makes your skin glow – or not Dietitian, Lindsay Diack, puts popular food on trial to see how they hold up. Page 5

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Medical Message With Dr. Melanie Levesque, Family Physician

Let the sunshine in - but know your limits

We’ve all done it. Whether basking in the rays on a park bench, lounging on the shores of a Caribbean beach, or feeling the sun’s warmth on our bare legs for the first time after a long winter, there’s no doubt that sunlight makes us feel good.

As the source of a number of important elements, including the formation of vitamin D, sunlight is essential to our general health, mood and well-being. Being active, enjoying the outdoors and soaking up the sun are all aspects of enjoying the summer season. However, too much of a good thing can be harmful if the right precautions to protect yourself are not taken. Finding an appropri-ate balance between the risks and benefits of sunlight is critical.

The risks of overexposure

Unprotected or excessive sun exposure has been shown to be related to multiple aesthetic, skin and health issues including hyperpigmen-tation, skin aging (wrinkles), sunburns, actinic keratosis, skin cancer and cataracts.

There is currently no specific recommen-dation for a “safe” number of hours of sun exposure per day, to avoid these skin-related complications. However, a strong correlation

has been shown between our total lifetime sun exposure and our risk of developing squamous cell and basal cell cancer.

Repeated or prolonged unprotected sun exposure, particularly if it leads to repetitive sunburns, may potentially increase your risk of developing melanoma, the most serious form of skin cancer. It is for these health related issues that awareness and precaution are necessary when enjoying the sun.

Sun protection recommendations

The best way to prevent health-related complications is to restrict our lifetime sun exposure. Sun avoidance or reduction between 10 a.m. and 3 p.m., wearing a hat, protective clothing, polarized sunglasses and regularly applying an appropriate sunscreen are essential to reducing the negative impacts of UV radiation.

Sunscreens contain filters that can absorb the harmful UVA and UVB radiation. An effective sunscreen has a broad-spectrum of protection that can absorb both types. The SPF represents the efficacy of the sunscreen to protect against harmful UV radiation. Everyone should use a sunscreen with a SPF of 30 or higher, apply it at least

15 to 30 minutes before sun exposure, and reapply both every two hours and after water exposure.

If you do happen to get a minor sunburn this summer, relieve your skin discomfort with a cool compresses or soak, calamine lotion or aloe vera-based gels.

When should you contact your health care provider?

Physicians are well trained and aware of complications and risks associated with prolonged or damaging sun exposure. If you have a skin lesion and you are uncertain if you should consult your family physician, here’s the ABCDE rule to help you identify a poten-tially dangerous lesion:

A ASYMMETRY(bisected lesion)

B BORDERirregularities (abnormal or uneven edges)

C COLOURvariegation (brown, red, black or blue/gray and white)

D DIAMETER(approximately 5mm)

E EVOLVING(lesion changing in size, shape, colour or a new lesion)

Keep in mind that the screening criteria serve only as a guide to help physicians recognize suspicious lesions. If you are in any way concerned about a mole, skin discoloration or potentially have an increased risk factor for skin cancer (i.e. high number of common nevi (moles), fair skin, excessive prolonged sun exposure, history of sunburns and a positive family history) don’t hesitate to contact your Copeman Healthcare team. We will be pleased to assist and direct you to the best possible resources for the treatment of your sun related health issues.

Now let’s all get active and enjoy the summer months!

Dr. Levesque is an energetic and accomplished physician. Prior to becoming a physician she trained as a lawyer and practised in the areas of criminal, commercial and healthcare law. Dr. Levesque has won many honours and awards, speaks 5 languages and has traveled extensively throughout the world. She enjoys continually challenging herself as evidenced by several Andean summits over 5,000 metres. In her leisure time she enjoys staying active with adventure races, running and particularly competitive cycling where she has trained and raced extensively in Europe.

A complete guide to sun-screen and sun protection for healthy summer skin can be found on page 4.

3

Fitness Forum With Sukhi Kambo, Kinesiologist

Want younger looking skin? Exercise might be the answer

As our largest organ, our skin is always on display. It comes as no surprise most of us do our utmost to keep it soft, supple and unblemished.

Often the state of our internal health is reflected on our face in the form of dark under-eye circles, acne or dull, lifeless skin, thanks to late nights, stress, poor eating habits and even sedentary behaviour.

Believe it or not, the rewards of exercise extend far beyond adding muscle tone or slimming down. Exercise also helps improve the look, feel and age of your skin.

We all know the benefits of physical activity to other organs like the heart and musculoskeletal systems, but how exactly does it keep our skin looking young?

It strengthens our collagen

Collagen is the fibrous protein that creates dermal structure. In our 30s, this structure begins to break down, causing skin to become thinner and sag. Fortunately, exercise promotes collagen in skin cells, which makes your skin age more slowly.

It reduces fine lines and wards off free radicals

Endorphins are the “feel good chemicals” released when we exercise. When we’re relaxed and happy, the fine lines around the face are reduced, as is the release of certain hormones which trigger unwanted skin conditions.

Exercise helps us deal with stress, anxiety and feelings of losing control, all of which can trigger free radical damage. Free radicals, or unpaired hydrogen ions, can be a nightmare as they damage the skin cell membranes, causing collagen breakdown, which in turn leads to wrinkles. Stress is a normal part of life, but how we choose to deal with it can determine the quality of our lives. I often recommend various forms of yoga and restorative activities, such as hiking, that put us in touch with nature. This lowers our stress hormone levels and allow our endocrine system to function optimally.

It increases circulation to the skin

When we exercise, our heart rate increases and circulates more oxygen to the skin. Drawing blood to the surface of the body trans-ports nutrients to our skin cells and helps remove toxins from the skin. Any increase to the body's circulation will boost detoxification and cell renewal.

'Life is like riding a bicycle. To keep your balance, you must keep moving.' - Albert Einstein

It prevents toxin build up

Our skin is more than just a protective covering for the body - it is also an organ of elimination. If our bowel flora are depleted, or our liver is overtaxed, then the primary organs of elimination—the liver, intestines, and kidneys—require help from the skin. The result can be eczema, pimples, rashes, and dull-looking skin.

Body toxins are expelled through the sweat glands; therefore, sweating during exercise is a great way to eliminate wastes. While sweat helps remove toxins from our skin cells, it’s important to shower after exercise to remove those toxins from the surface of our skin and avoid reabsorption and clogged pores.

If you’re looking for ways to keep your skin healthy and supple, consider adding a kinesiologist-prescribed workout routine to your beauty regimen. If you don’t already have a routine that you enjoy, please book an appointment with a knowledgeable Copeman kinesiologist.

Sukhi Kambo is registered with the American College of Sports Medicine as a Clinical Exercise Specialist and is also registered with the Cardiology Technolo-gist Association of British Columbia as a Registered Cardiology Technologist. Sukhi is certified in Functional Movement Systems (level II) and is currently finishing a series of fall prevention courses through California State University.

Remember: It’s best to drink plenty of water as we exercise so our skin does not become dehydrated!

4

Health Tips With Amra Dizdarevic, Family Health Nurse

A complete guide to sunscreen and sun protection for healthy summer skin

Everyone looks forward to the warm summer sun and the outdoor sports and activities that accompany it. While the UV radiation from the sun provides us with many benefits, there are important risks to keep in mind with overexposure.

UV radiation reaches the earth from the sun in the form of UVB and UVA rays. UVB radiation plays a key role in skin cancer while UVA rays, which penetrate the skin more deeply, are associated with wrinkling, leathering, and sagging.

Avoiding sun exposure is the best way to protect yourself from UV radiation, but this is not always possible. Clothing is our first line of defense against the sun’s harmful UV rays and protects us by absorbing or blocking much of this radiation. The more skin you cover, the better.

Don’t forget a wide-brimmed (3-inch or greater) hat and a pair of UV blocking sunglasses

Your next line of defense is sunscreen. Sun Protection Factor (SPF) is a measure of a sunscreen's ability to prevent UVB from damaging the skin.

Here's how it works: it takes 20 minutes for your unprotected skin to start turning red. Using an SPF 15 sunscreen theoretically prevents reddening 15 times longer – about five hours.

Another way to look at it is in terms of percentages: SPF 15 filters out approximately 93 per cent of all incoming UVB rays. SPF 30 keeps out 97 per cent and SPF 50 keeps out 98 per cent. The difference may seem negligible, but for light-sensitive individuals, or those with a history of skin cancer, those extra percentages will make an important difference. Furthermore, higher SPF values offer some safety margin, since most people generally do not apply enough sunscreen.

Top sunscreen Do's & Don'ts:

1. Do choose an SPF of no lower than 30 and no higher than 50, with at least three of the following active ingredients: salicylates, and/or cinnamates for UVB absorption; benzophenones (such as oxybenzone) for shorter-wavelength UVA protection; and avoben-zone, ecamsule (Mexoryl), titanium dioxide, or zinc oxide for the remaining UVA spectrum.

2. Do choose a water-resistant sunscreen that will stay put on hot days, while playing sports, or if you spend a lot of time outdoors. These sunscreens are less likely to drip into your eyes when you sweat.

3. Do use enough. To get the full SPF of a sunscreen, you need to apply one ounce – about a shot glass full. Most people apply only one-half to one-quarter of that amount, which means the actual SPF they have on their body is lower than advertised. To allow in-gredients to fully bind to the skin, apply 30 minutes before sun exposure.

4. Don’t forget to reapply. No sunscreen, regardless of strength, should be expected to stay effective longer than two hours without reapplication. It should also be reapplied immediately after swimming, toweling off, or sweating during sports.

5. Don’t rely solely on a high SPF. Products with very high SPFs can create a false sense of security, prompting individuals to stay out in the sun longer and neglect other sun-protective behaviors, like seeking the shade and wearing sun-protective clothing. However, sun damage (for example, UVA damage, which not only acceler-ates skin aging, but also contributes to skin cancers) can take place without skin-reddening doses of UV radiation.

6. Do look for the new seal of recognition for proper UVA & UVB protection. Only a sunscreen with a UVA protection factor that is one third of the UVB protection factor can possess the new seal of recognition issued by Health Canada. When buying a sunscreen ensure that it states: UVA + UVB protection or contains this new seal of recognition:

7. Do wear sunscreen daily, including cold or cloudy days - up to 40 per cent of the sun's UV radiation reaches the earth on a com-pletely cloudy day.

8. Don’t expose children under the age of six months to either the sun or to sunscreen. Shade and protective clothing are the best ways to protect infants from the sun.

Amra Dizdarevic is a Family Health Nurse Practitioner at Copeman Healthcare Centre in Vancouver. Amra graduated from UBC with a Bachelor of Science in Cell Biology & Genetics, a Bachelor of Science in Nursing and a Masters of Science in Nursing – Nurse Practitioner. Prior to joining Copeman Healthcare, Amra worked in a variety of primary care roles including women’s health, pediatrics, chronic disease management and travel medicine & vaccination.

In 2013, Health Canada announced a new monograph for UVA protection disclosure on sun care packaging. Their NEW SEAL OF RECOGNITION commu-nicates which products satisfy the new monograph requirements.

Firstly, the new monograph states that only formula with a UVA protection factor (PF) that is one third of the UVB protection factor can possess the seal of recognition. For example: If a product has an SPF of 30, then it must have a UVA PF of 10, since SPF only pertains to UVB rays.

Secondly, the formula must protect against 90% of long UVA rays that reach a critical wavelength of 370 nano metres.

5

Low glycemic index foods:

Glycemic Index (GI) describes how quickly carbohydrate-containing foods spike blood sugar levels. Low GI foods cause a small, slow rise in blood sugar.

VERDICT: Possible benefit. Small studies have shown an improve-ment in acne with lower GI diets.

BOTTOM LINE: There’s little downside to choosing low GI foods as they help control blood sugar, promote weight loss and provide con-sistent energy. Nice skin is a bonus. To lower your GI intake, choose sprouted grain breads instead of brown bread; sweet potatoes instead of white potatoes; or a fresh pear instead of apple juice.

Fruits & Vegetables

VERDICT: Possible benefit. These nutritional powerhouses definitely play a role in curbing inflammation, weight management and other factors that indirectly affect our skin.

BOTTOM LINE: It makes sense that a diet high in antioxidants, vitamins and minerals benefits our whole body - skin included. While the evidence may not pinpoint produce as skin savers, the link between fruit and vegetable intake and our overall health is unsurpassed.

Dairy

VERDICT: Recent studies have shown an association between acne and a higher intake of dairy. It has not been proven that dairy causes acne, but some people may notice a negative correlation.

BOTTOM LINE: Cutting out dairy can lower your calcium intake and pose a risk to bone health. If you go this route, be sure to include two to three servings of calcium-rich foods daily (e.g. canned salmon/sardines, tofu), and consider non-dairy alternatives (almond, soy or rice milk).

Lindsay is a Registered Dietitian whose passion is helping to support cli-ents in the areas of weight management, emotional and disordered eat-ing, digestive disorders and chronic disease prevention. She obtained her Bachelor of Science Degree in Nutritional Sciences from the University of Alberta and completed her dietetic internship with Calgary Health Region in 2007. Lindsay is committed to an interdisciplinary approach to health management to ensure clients reach their goals while feeling confident and supported along their journey to better health.

Food for Thought With Lindsay Diack, Registered Dietitian

Food on trial: How your diet makes your skin glow – or not

How diet affects skin health remains controversial, but as research progresses, certain nutrients are starting to stand out as either harmful or helpful to your skin’s glow. Let’s put popular food on trial and see how they hold up.

Chocolate

VERDICT: Great news - there is no evidence linking chocolate to increased severity of acne!

BOTTOM LINE: Chocolate is still high in sugar and saturated fat (both cause inflammation). Choose 80% dark chocolate and keep consumption to one ounce (2 - 3 small squares) per day.

Zinc & Omega-3 Fatty Acids:

VERDICT: Possible benefit with both; however, more research is needed.

BOTTOM LINE: Get your nutrients from real food. There are risks to over supplementing minerals like zinc. Speak to your Copeman dietitian if you suspect your intake is low.

Good sources of zinc include meat, oysters, wheat germ, nuts and seeds. Enjoy 8oz of oily fish (e.g. salmon, sablefish, and trout) each week for a healthy dose of omega-3s. Plant-based omega-3's include walnuts, hemp hearts, ground flax and chia seeds.

Richelle Mottosky is a Registered Clinical Psychologist practicing at Copeman Healthcare Centre in Calgary. Richelle has over 14 years of experience in the helping profession. She provides counselling to individuals experiencing a variety of difficul-ties including life transition, life stage issues, grief, stress, anxiety and depression.

Achieving healthy self-esteem

In a culture obsessed with brands, aes-thetics, image and general perfection, it’s becoming increasingly difficult to feel good about ourselves. Perhaps that’s why our internal chatter, or the way in which we speak to ourselves, often includes such harsh self-criticism.

Genetically speaking, we can’t do much to change our height, body type, or skin conditions. While we can make healthy food choices, work out, apply makeup, take medications or undergo clinical procedures, none of those efforts address the actual root of the issue.

In fact, the world-renowned plastic surgeon, Maxwell Maltz, discovered that not all his patients’ lives changed dramatically after he altered their physical appearance with surgery. The key factor that differentiated his patients was their self-image - not their reflection in the mirror or the results of their surgeries.

This is the power of healthy self-esteem: built on unconditional worth and love, it is an accurate, honest, and appreciative opinion of oneself as being whole and complete (though not yet completed).

What if, on the path toward feeling good about ourselves, we chose to focus less on our imperfections and more on cultivating what is actually working for us? Instead of doing something to change our appearance, we can instead develop the skills to identify and acknowledge our reality, accept what we have been given, and separate our sense of self from our physical attributes.

We don’t always choose the thoughts that appear in our minds, so our power comes from what we choose to focus on. Cultivat-ing mindfulness, the ability to choose the thoughts to which we attach ourselves and to re-frame our negative beliefs, is one of the most powerful personal practices we can take on. Finding enjoyment in life without over-focusing on the external allows us to feel a greater sense of self-worth, well-being and peace, regardless of our imperfections.

If you think you could benefit from a session on cultivating mindfulness within yourself, contact your Copeman Healthcare team today. A Copeman clinical psychologist can help correct the invisible handicap known as unhealthy self-esteem and put you back on track towards ultimate self-acceptance.

Live Well With Richelle Mottosky, Registered Psychologist

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Health Tips With Dr. Cathy Harvey, Family Physician

New insights on combating Rosacea

While a subtle, rosy glow to the cheeks lights up a face and reflects good health and inner radiance, the persistent ruddiness experi-enced by over 2 million Canadians with chronic rosacea is not the glow they’re looking for. The good news is that while there is no cure, there are new developments in treatment for this chronic skin condition. Typically affecting fair-skinned individuals over the age of 30 and found in women more often than men, rosacea affects the central face with redness and sometimes an acne-like outbreak. It can also affect the eyes.

The cause of rosacea is still unknown; however, immune dysfunction, ultraviolet damage, inflammatory reactions to microor-ganisms in the skin and gut, and vascular dys-function are thought to play a role in flare ups.

There are four subtypes of rosacea, with the two most common types including Erythe-matotelangiectatic Rosacea (redness) and Papluopustular Rosacea, which involves acne-like lesions.

Skincare

Skin affected by rosacea is very sensitive, so gentle skincare is essential. The skin should be cleansed with a gentle non-soap cleanser and moisturized frequently, avoiding skin-irritating toners and exfoliating agents. For redness concealment, choose a green-tinted foundation for the affected areas and layer a skin tone matching product on top. Hypoal-lergenic make-up is recommended.

Defense strategies

Smoking, sun exposure, certain foods and other environmental factors can cause rosacea to flare up. The following are defense strategies you can use:

• Avoid flushing as much as possible. Indi-viduals with rosacea flush and blush easily due to vascular dysfunction. Usual triggers include hot or cold environments, sunlight, spicy food, alcohol, exercise, emotion, some medications and menopausal hot flashes. It’s important to know your own triggers.

• Quit smoking. Smoking ages the skin and may aggravate rosacea, so smoking cessation is advised.

• Protect your skin from the elements. Use a sunscreen with an SPF of at least 30, cover up and stay out of the mid-day sun. Avoid alcohol-based sunscreens which may irritate the skin.

Treatment

Pharmaceutical treatments for rosacea have been minimally effective for simple facial redness - until now. The new once-a-day topical treatment, Brimonidine (Onreltea) became available in Canada this April. It is a potent vasoconstrictor and temporarily reverses the redness caused by dilated blood vessels. The conventional topical therapies, metronidazole and azelaic acid, do reduce redness to a degree, although their main role is in reducing the acne-like skin lesions.

Oral tetracyclines have been another corner-stone of treatment, primarily used to treat the acne-like lesions. They are antibiotics, but are thought to work via an anti-inflammatory mechanism. To avoid disruption of the gut flora or contribution to global antibiotic resis-tance, they can be given at sub-antimicrobial doses (for example, Doxycyline is used at the sub-antimicrobial dose of 40 mg instead of the usual antibiotic dose of 100 mg).

While the new Bimonidine is expected to be an important weapon in the arsenal against rosacea, energy based treatments such as vascular laser and Intense Pulsed Light (IPL) are the most powerful methods for common forms of rosacea. This method treats the tel-angiectasia (tiny spider veins), that the con-ventional methods cannot, and also reduces background redness. Repeated treatments are required for optimal improvement.

If you are affected by rosacea, talk to your Copeman Healthcare provider about new ap-proaches to treatment that could help.

Dr. Cathy Harvey received her medical degree in 1982 from the University of British Columbia along with the Hamber Gold Medal for the high-est cumulative standing that year. During almost 25 years of family practice, Dr. Harvey has served as a medical advisor for the Workers Compensa-tion Board, a sessional physician for Planned Par-enthood and as a member of important collabora-tives in chronic disease management and mental health for the Vancouver Coast Health Authority. She has taught Clinical Skills at the University of British Columbia Medical School and has served as a ward supervisor and preceptor for family practice residents and medical students.

The cause of Rosacea is still unknown; however, immune dysfunction, ultraviolet damage, inflammatory reactions to microorganisms in the skin and gut, and vascular dysfunction, are thought to play a role in flare-ups.

8

ANNOUNCEMENTS

CALGARY

Welcome new Client Services Coordina-tor, Stephanie Oshiro, and Operations Director, Susan Aldcorn, to the team.

EDMONTON

Welcome to the team new Clinical Care Coordinators, Keltie Gibb and Cindy Doyle.

VANCOUVER

We welcome back Research Assistant, Boaz Saffer and Registered Psycholo-gist, Dr. Shawnda Lanting.

WEST VANCOUVER

Registered Dietitian services with Gelina Syfchuck are available every Friday and Kinesiology services with Hedieh Hafizi are available every Tuesday at the West Vancouver Centre. Please contact your Clinical Care Coordinator to book an appointment.

Denim for the CURE

The staff at Copeman Healthcare raised over $1,000 for the CURE Foundation through Denim Days. For the past few weeks, staff have been donating $3 -$5 to wear their denim each week and raise funds for Breast Cancer Research.

Community Involvement & Achievements

Heart of Gold Gala

This year marks the 10th anniversary of the Heart & Stroke Founda-tion's Heart of Gold Gala. Over the past 10 years, guests and sup-porters of the Heart of Gold Gala have contributed $4M to advance the Foundation’s work. Copeman Healthcare is proud to continue our annual support through a donation to their silent auction.

Cinderella's Closet Foundation

Throughout the spring, the Edmonton team brought in donations of formal wear, jewelry and other attire for Cinderalla’s Closet Foundation. This organization was formed 11 years ago with the mission of providing graduation attire to students who require financial assistance.

CALGARY 4th Floor, 628 12 Ave SW Calgary, AB, T2R 0H6 403-270-CARE (2273)

EDMONTON Suite 700, 10216 124 St. Edmonton, AB, T5N 4A3 780-455-CARE (2273)

VANCOUVER 4th Floor, 1128 Hornby St. Vancouver, BC, V6Z 2L4 604-707-CARE (2273)

WEST VANCOUVER Suite 200, 545 Clyde Avenue West Vancouver, BC, V7T 1C5 604-699-CARE (2273)

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1 Don’t drink your calories. Choose water over juice or pop.

2 Plan your meals & snacks in advance as often as possible.

3 Double your vegetable intake to keep you feeling full & to cut calories.

4 Don’t become too hungry - this leads to poor food choices.

5 Slow down and eat mindfully.

6 When you are satisfied, stop eating.

7 Bulk up on healthy fibre (beans and veggies are your best choices).

8 Keep a food log for at least 1 week every season and review your (new) habits. Start today!

9 Don't reward your weight-loss progress with food.

10 Don’t dine out more than twice per week.

Get lean for summerWith Nina Hirvi, Registered Dietitian

Dr. Gelfer published in the Journal of Clinical Hypertension & the Canadian Journal of Cardiology

Due to his expertise in hypertension, Dr. Mark Gelfer was a con-tributing writer on not one, but two clinical papers focusing on the subject this May. Both papers advise on national and worldwide hy-pertension guidelines and can be found in the Canadian Journal of Cardiology and the Journal of Clinical Hypertension.