With the Christmas season upon Canadians, alcohol can factor into many of the seasonal parties and functions. However, for women who are pregnant alcohol consumption can cause serious defects in the unborn child. It is estimated that nine babies for every 1,000 that are born in Canada have Fetal Alcohol Spectrum Disorder which can cause birth defects and/or developmental disabilities.

Fetal Alcohol Spectrum Disorder is an umbrella term that describes the range of disabilities and/or diagnoses that are a result of alcohol consumption during pregnancy; impact of FASD varies from child to child. The degree of disability and birth defects usually depends on the amount of alcohol that was consumed, how often it was consumed and at what stage of the pregnancy it was consumed, as well as the health status of the pregnant mother. It should be noted that no amount of alcohol is considered safe for pregnant women .

It is estimated that more than 3,000 babies in Canada are born each year with FASD, and approximately 300,000 Canadians are currently living with some form of FASD. Research suggests that the cases of FASD are higher in aboriginal communities as well as rural, remote Northern communities. However, FASD has been found in all communities in Canada regardless of location as well as financial status.

FASD causes mild to severe health problems for those who suffer from it. It can impact delays in development, cause intellectual problems and well as problems learning how to socialize with others. Some common examples of FASD are:

• Learning disabilities (particularly in mathematical concepts);
• Difficulty in understanding that actions have consequences;
• Depression;
• Obsessive-compulsive disorder;
• Physical disabilities such as kidney problems and internal organ problems;
• Skeletal abnormalities, i.e. facial deformities.

FASD can also cause behavioral problems such as:

• Difficulties in handling money and/or telling time;
• Difficulties in reasoning and being able to competently think problems through;
• Difficulties in learning from past experiences and not repeating the same mistakes over and over;
• Difficulties in scheduling, i.e. remembering appointments;
• Difficulty in maintaining socially appropriate behaviors;
• Difficulties in everyday tasks, i.e. paying rent, grocery shopping, job performance.

People with FASD can also develop secondary disabilities; early diagnosis is essential for being able to access professional help and on-going supports. These secondary disabilities can include such issues as:

• Mental health issues;
• Poor performance in school or completion of education;
• Problems with the law;
• Chronic unemployment;
• Drug and/or alcohol abuse;
• Homelessness.

If FASD is suspected, it is vital that a doctor trained in this issue do a medical diagnosis in order to rule out other medical conditions that are usually treatable. A medical diagnosis of FASD involves a team of doctors who are trained to assess psychological, speech as well as everyday functioning of the person. While there is no cure for FASD, proper medical intervention can help to provide those with FASD to lead more productive and satisfying lives.

In order to prevent FASD it is recommended that all women follow these steps:

• As 50% of pregnancies are unplanned, most women do not realize they are pregnant in the early stages. Therefore, if a woman even suspects she may be pregnant, or is planning to become pregnant, cease all alcohol consumption immediately.
• For women who are not using birth control but are having sex, avoid consuming alcohol as there is no way of knowing when you may become pregnant.
• For women who are concerned about their consumption of alcohol, seek the help and advice of your healthcare professional.

It is essential that pregnancy and alcohol consumption are not mixed, since there is no safe amount of consumption during any stage of pregnancy.

When it comes to quality of lifestyle, Canada is the top destination for expats, according to HSBC Bank International. Following Canada as a desirable location for expats is Australia and Thailand in the number 2 and 3 spots. Expats rated qualities such as accommodation, food, entertainment, social and family life, education, childcare, healthcare, household goods, working hours and commuting distances, health, hobbies, among other things. Canada was also highly rated when it came to such issues as making friends and integrating easily into their new communities.

According to the study, the top ten locations for expats determined by quality of life are:

•    Canada
•    Australia
•    Thailand
•    Singapore
•    Bahrain
•    South Africa
•    France
•    United States
•    Spain
•    Hong Kong

The United Kingdom scored very poorly in the votes regarding quality of life, and was at the bottom of the list of considered countries. Canada also scored very highly when it came to:

•    Enrolling children into the Canadian public school system;
•    Being able to set up finances, utilities and healthcare in their new country;
•    Finding a new place to live;
•    Learning the local language;
•    Making friends not only with other expats, but with local residents.

Over half the expats that participated in this study have lived abroad for more than five years. Canada placed third in regards to countries for settling down; South Africa and Thailand are first and second. Expats under the age of 35 are most likely to return home at least once a year; three-quarters of those surveyed make at least an annual trip home. Those expats who live in Brazil are most likely to go home at least once a year, according to almost 94% of those surveyed. The study also showed that the longer an expat has remained in their adoptive country, the less likely they are to return home. Only one third of expats who have lived away from their original country for 10 years or more reported they have not gone home for more than 2 years.

One of the factors that expats consider when choosing a new country is the quality and cost of healthcare in their adoptive country. While Canada does provide basic, free healthcare for all of its legal residents and/or citizens, newcomers to Canada may face a 3 month waiting period when they first arrive before they are eligible to receive their provincial health card. In order to avoid costly medical bills during these 3 months, outside health insurance is recommended. In some provinces a simple visit to a walk-in clinic can start at $50.00 just for an initial examination and does not include prescription medications, further follow-up medical care, etc. Visitors to Canada insurance is an ideal health insurance plan to bridge this gap in order to have optimal health coverage during those months where the newcomer is uninsured.

The H1N1 virus is now being held responsible for the death of 31 Ontario residents; last week an apparently health 13 year old boy died within 48 hours of displaying symptoms of the swine flu. An investigation is also currently underway to determine whether or not H1N1 was also responsible for the death of a 12 year old girl from Waterloo. A total of 101 people in Canada have died as a result of this pandemic so far. As a result of the 'second wave' of swine flu in Ontario, people are now lining up to receive the H1N1 vaccine throughout the province, sometimes waiting the whole day to receive the flu shot.

Access to the vaccine is currently being limited to people who qualify as a 'priority status'. This includes all children between the ages of 6 months to less than 5 years, health care workers, pregnant women, and people who live in remote and/or isolated communities.  How the vaccine is distributed depends on the province of residence, as each province decides on how best to serve their citizens. Provincial health cards are not required at flu shot clinics, but proof of residence must be shown in order to prove that the person is indeed a resident of that province.

The H1N1 vaccine is an adjuvanted vaccine, with the exception of pregnant women who should receive a non-adjuvanted vaccine. This does not necessarily mean that the adjuvanted vaccine is harmful to pregnant women, it just simply hasn't been tested for this specific group; if there is no alternative, pregnant women can get the adjuvanted vaccine. An adjuvanted vaccine is a vaccine that includes a substance that boosts the individual's immune system as well as increases their response to the vaccine. The non-adjuvanted vaccine does not have this 'booster' element. Immunity to the H1N1 virus should begin approximately 10 days after the person has been vaccinated.

 Along with vaccinations, some regions in Ontario are also implementing swine flu screening centers in order to relieve the stresses of hospital emergency rooms. Community health units will be opening flu assessment centers; patients can receive medical advice, receive antiviral medications if necessary, and be referred to further medical help if deemed necessary. The majority of people who have already or will contract H1N1 will not need further medical treatment past a prescription, if that. Those with healthy lifestyles and a healthy immune system will simply become ill, but with no life-threatening consequences.

Check your specific region for what is available, and for vaccination centers. The vaccine is currently being distributed to physicians as well; your doctor may be able to book you an appointment for your flu shots.

As the previous article stated, there are several types of laser eye surgery: PRK, Lasik and Lasek procedures.

LASIK usually has less post-operative pain, and there is a greater risk of complication due to the cornea being cut into. This includes:

• Mild to significant dry eyes, which can affect vision;
• Poor quality of night vision due to halos and glare, thus affecting the ability to drive safely at night;
• Corneal ectasia, a serious condition caused by the weakening and bulging of the cornea. Severe cases of this condition can require a corneal transplant or implant.

Both the LASIK and PRK procedures carry the risk of corneal infection, known as infectious keratitis. This infection can result in a significant loss of vision. LASEK surgery reduces the risks such as weakening of the eye and dry eyes. As with any other surgical procedure, complication risks are increased for people with certain health conditions and/or lifestyles. When contemplating eye laser surgery, have a detailed consultation with the surgeon about:

• Your medical history and current health conditions. Make sure the surgeon is made aware of such conditions (yours and family history) as lupus, diabetes, keloid formation and any eye diseases, i.e. herpes simplex, glaucoma, dry eyes, eyelid infections, and/or previous eye surgeries.
• Your current lifestyle. For people who engage regularly in sports, where it is likely to be hit in the face, after LASIK there is a risk that the flap could dislocate. This risk remains for years after the laser surgery.
• Your career plans. Certain occupations (i.e. pilot, police officer) have specific vision requirements, most of which can be obtained through laser surgery. It is advisable to consult with not only the surgeon, but with members of the occupation to make sure the requirements are met.

As well as considering the benefits and risks of laser eye surgery, it is important that people are realistic about what they will achieve through the procedure. As people age, so do their eyes, it is possible that in the future some people may need reading glasses or other corrective eyewear again, especially those over the age of 40. There also is the possibility of having to have a second procedure if the right amount of correction is not achieved through the first surgery.

Cost is also a consideration for eye laser surgery. Before considering this option, consult with your health insurance professional to see what they cover. Most health insurance does however cover the costs of contact lenses and/or corrective eyewear. Check your group health insurance and/or individual health insurance plan.

Every year, thousands of Canadians contemplate laser eye surgery in order to correct their vision. This surgery is done in anticipation of the person no longer being required to use contact lenses and/or prescription glasses in order to have better vision. Canadians who are contemplating laser surgery should be well informed of not the benefits of these procedures, but also the risks.

Laser eye surgery is most commonly used to correct vision problems such as:

• Myopia, also known as near-sightedness;
• Hyperopia: also known as far-sightedness;
• Astigmatism: when vision is distorted when looking at objects at any distance;
• Presbyopia: when the person is unable to focus on nearby objects.

All of these vision conditions are caused by problems with the eye focuses an image on the retina (the light-sensitive layer at the back of the eye). A large part of the eye’s ability to focus is dependent on the shape of the cornea (the clear front surface of the eye). A surgeon will use a laser device to make permanent changes to the shape of the cornea. Most often used is the Excimer laser, which produces a ultraviolet light beam which vaporizes tissue, thus altering the shape of the cornea. This usually corrects mild to moderate refractive errors in the eye.

There are several types of laser eye surgery that are commonly performed in Canada:

1. PRK (Photo-Refractive Keractectomy): the outer layer of the cornea is removed with a surgical blade or blunt instrument. A computer-guided laser beam is then used to vaporize tiny amounts of tissue that are under the surface of the cornea. This procedure removes just enough tissue in order to reshape the cornea in a way that the vision is now corrected. The healing process of this procedure is usually completed within one week.
2. LASIK (Laser Assisted in situ Keratomileusis): This procedure is more complicated than PRK. A flap is cut in the cornea with either a sharp blade or a laser. The flap is then lifted and a computer-guided laser removed specific calculated amounts of tissue from the inside layers of the cornea. The flap is then put back. Wavefront technology may be used in this procedure, wherein a detailed map of the eye is produced. The healing time for this procedure is generally less than the time for PRK.
3. LASEK (Laser Epithelial Keratomileusis): This procedure is a variation of both PRK and LASIK. The outer layer of the cornea is cut and then alcohol is used to loosen and lift it in a single layer. A laser beam is then directed at the tissue under the epithelium. This procedure is best suited to people who have vision problems that require minor correction; the healing period is usually two weeks. As with any surgical procedure, there is a risk taken (though quite small), that complications can arise. Each certain procedure does carry with it a small percentage of complications. For those contemplating PRK, the risks include: • Moderate to severe pain for the first several days; • Hazy vision during the healing; this generally will clear within the first week after the surgical procedure; • Regression. In some cases the eye can regress to its previous refractive error, this usually will occur during the first 6 months. In these cases the person may need a second (enhancement) surgery, or may have to once again wear corrective eyewear or contact lenses.

See our next blog article for the conclusion about laser eye surgery.