... about winter woes

By Anna Byk

Most Canadians have no choice but to brave the outdoor elements. So here are a few tips on how your patients can beat the cold and keep healthy. The table below includes an outline of some of the most common conditions they should look out for and the best possible treatments.

WHEN THE WEATHER OUTSIDE IS FRIGHTFUL
• Shiver me timbers The growing popularity of outdoor winter activities has made hypothermia more of an issue these days. Dr Steven Friedman, an assistant professor at the University of Toronto and an ER physician at the Toronto University Health Network, explains that there are three classes of hypothermia victims. The first includes those who are socially disenfranchised like the homeless — these patients are hard to keep track of. The second are folks like Andrew, people who are into extreme sports. For this category prevention is key. Remind them that when they head out they need to be well rested and well nourished. They should also pack on the layers of clothing and be sure that the head, neck and wrists are covered. The third class of hypothermic victims is the elderly and chronically ill — they're less able to cope with the cold. "The elderly living at home may slowly, over weeks or months, develop hypothermia," explains Dr Friedman. He suggests that you tell these patients to keep their homes heated to 21°C and adds that you should warn them to be aware of the people around them and to not confuse the symptoms of hypothermia with friends being drunk or sleepy.

• Beating the nip Frostbite is another winter side effect that's likely to hit those who spend time outside in sub-zero weather. "The incidence [of frostbite] peaks at air temperatures between -25°C to -30°C," says Dr Gordon Searles, a dermatologist and professor at the University of Alberta. He adds that four out of five frostbite injuries occur during recreational activities. "The severity of the frostbite is graded similar to thermal burns from first to fourth degree," explains Dr Searles. What should patients be on the lookout for? Dr Searles suggests that you advise them to keep an eye out for very red or pale skin that's numb and hard. "The most common areas to watch are the nose and ears, as well as the toes and fingers," he adds.

• Poisonous air Carbon monoxide can creep up undetected from the fireplace or other appliances — it's a colourless, odourless gas. Dr Friedman explains that there are no real telltale signs and that symptoms are very non-specific. They include headache, nausea and flu-like symptoms. He adds that one red flag is when more than one family member is exhibiting symptoms. In terms of treatment Dr Friedman says that patients need to immediately get fresh air and head to the ER.

• Flu shot Dr Friedman says that between 10% and 20% of adults will pick up the influenza bug this winter season. In most cases influenza is harmless with typical flu-like symptoms lasting two to three days. You should tell your patients that weakness and fatigue may last for a few weeks. Dr Friedman suggests that you reassure patients that they can't get the flu from the flu shot — a common myth that should be debunked — and that they need to get the vaccine every year. For a full set of treatments for this very common winter bug, check out our website for our "flu remedies" table.

• Feeling SAD About 5-6% of the population suffers from seasonal affective disorder (SAD), says Dr Hani Iskandar, a SAD expert with the Douglas Hospital in Montreal. What is SAD? "We just explain to patients that it's a deregulation of our internal clock," he says. SAD is essentially a kind of depression, so what makes it different from the plain old blues? Dr Iskandar explains that patients who suffer from SAD usually start developing symptoms around October or November. These symptoms then last until March or April. Patients who exhibit this pattern for two consecutive years are usually suffering from SAD.