January 2021 Newsletter

How Long Did Canadians Wait for Medical Treatment in 2020?

2020 has not been kind to many of us. Canadians endured lockdowns and shutdowns, social isolation and other unpleasant life adjustments due to COVID-19. They also endured longer medical wait times as many experienced cancellations of their scheduled elective surgeries.

According to the new report issued by Fraser Institute on December 10, 2020, it is estimated that “the total number of procedures for which people are waiting in 2020 is 1,224,198, an increase of 15% from the estimated 1,064,286 procedures in 2019.” That means that 3.2% of Canadians were waiting for their elective medically necessary treatment last year. Each province has a different percentage of their population waiting – Quebec has the lowest – 1.97% of the population and Nova Scotia is much higher – at 9.97%. Only the province of Manitoba did better in 2020 than in 2019 – their number of people waiting for medical procedures decreased.

The total waiting time between referral from a general practitioner and delivery of medically necessary elective treatment by a specialist averaged across all 12 specialities and 10 provinces surveyed, has risen from 20.9 weeks in 2019 to 22.6 in 2020. This is the longest wait time on record. It is 143% longer than in 1993, when it was just 9.3 weeks.

Each province fared differently in medical wait times, as medical care is in the hands of provincial governments. Province of Ontario had the shortest wait times overall, from GP referral to delivery of medically necessary elective treatment it takes 17.4 weeks. The Maritime provinces had more than double wait of ON – PEI at 46.5 weeks, NS at 43.8 weeks and NB at 41.3 weeks.

Each of the surveyed 12 specialities had different wait times. Plastic surgery (34.1 weeks), Ophthalmology (34.1 weeks), Neurosurgery (33.2 weeks) and Orthopedics (34.1 weeks) had the longest waits. The largest increases in waits between 2019 and 2020 occurred for neurosurgery (+7.7 weeks), ophthalmological surgery (+5.7 weeks), and plastic surgery (+5.4 weeks). There were also decreases. Wait times for patients receiving treatment in fields like orthopaedics (−5.0 weeks), and medical oncology (−0.1 week).

 

 

3 Things to Do While Waiting for Surgery

If you ever had surgery you know it can get a little stressful beforehand. Even before the pandemic, people experience an increase in stress and anxiety anticipating their procedure. Studies show that less stressed patients report better outcomes. During these uncertain times, it can become challenging dealing with all the uncertainties of life, especially if you are not well and are waiting for a medical procedure.

Everyone deserves to be seen as soon as possible. Elective surgeries only sound like a person has a choice whether to proceed or not, while in reality, what that means is that a medical procedure can be scheduled and a person can wait until the scheduled date.  However, we also know that waiting creates unneeded stress and anxiety potentially leading to worse outcomes.

Here are some things to consider while waiting:

  1. Stay in touch with your doctor, physiotherapists or chiropractor. Ask them what you can do while waiting. Depending on your mobility, it may still be possible to go for a walk or do some exercises at home. If the pain becomes unbearable you doctor may recommend another pain management plan. Most doctors can provide phone consultation, and some physiotherapist and chiropractors can help by phone or online instructions on how to exercise safely.
  2. Try to stay physically active. Going for a walk is a great stress reducer. If able, sign up for online yoga classes – some offer chair classes from the comfort of your own home. Some services like Amazon Prime offer free classes as part of your subscription.
  3. Research your private options and get your medical records reviewed. This can provide you with actionable items and you are not obligated to go the private route if your surgery is rescheduled locally in a timely manner.

 

5 Ways to Stay Active in Winter During the Pandemic

We all know that winter brings shorter days, lack of motivation and sunlight to go outside and, in general, hibernation moods. If that was not enough, we are in the middle of the second wave of COVID-19 pandemic. In many parts of Canada going to a workout facility may be out of question and winter in Canada, well, it can be limiting for outdoor activities.

It is, however, very important to stay active. Our mental and physical health are very closely intertwined. A famous Latin expression “Mens sana in corpore sano” – a healthy body can sustain a healthy mind – echoes this notion. Among many benefits of aerobic activity is that it also relieves stress and anxiety by releasing the feel-good hormones during the exercise.

Below are 5 tips to get moving in winter

  1. Bring your workouts indoor – get a virtual exercise membership. If your resources allow, set up a small area in your home where you can practice yoga, place a treadmill or a spin bike. Youtube offers a variety of free workouts such as spin and yoga.
  2. Join your kids or grandkids on their outdoor play. Some fresh air and moving around is sure to follow!
  3. Dress according to the weather and go outside – walk your dogs, have a look around your neighbourhood, observe winter changes at a local park.
  4. Get a group of friends to commit to a winter exercise routine and motivate each other to stay on track.
  5. Embrace the winter! It gives us an opportunity to ski, snowboard, skate, snowshoe, walk (yes, it is still an exercise in winter!) Pick a winter sport you might enjoy and give it a try!

October 2020 Newsletter

Breast Cancer Awareness Month

October is always reserved for the promotion of Breast Cancer Awareness.  In Canada, it accounts for approximately 25% of news cases of cancer and 13% of all cancer deaths among women.  One out of 8 women will get it and 1 in 33 will die from it.  

Breast cancers are not all the same.  There are so many varying factors such as: what part of the breast did it begin, what the cells look like under microscope, the grade and stage of the diagnosis, the genetic makeup of the cells, and if the cancer cells are fueled by hormones.  All of these component form a very complex, specific diagnosis.  The treatments available vary based on all of those factors.  

Many people enroll in clinical trials.  If you were to research all of the available clinic trials available to breast cancer patients, you would find hundreds of them for the very reasons listed above.  For the sake of time and boring you completely, we would like to highlight a couple of new advancements.

Circulating Tumor DNA in Triple Negative Breast Cancer (TNBC) – TNBC has limited treatment and prognosis options for patients.  A clinical trial was recently done to find out the effectiveness for determining recurrence and prognosis for patients with TNBC.  The results showed that recurrence could be predicted and the physician can utilize this information to identify who might be at higher risk for recurrence early on.  On the flip side, it can also identify which patients will have a good prognosis so they can apply de-escalation therapy, the reduction of exposure to therapy and its adverse effects, for some patients.  This positive research prompted a second clinical trial to refine how liquid biopsy can inform treatment for TNBC patients.  

Genomic Testing – For many years, breast cancer patients have received chemotherapy, something that has severe side effects such as hair loss, neuropathy, weight loss, fatigue and nausea.  A study published in the New England Journal of Medicine in July 2018 showed that chemotherapy would not benefit 85% of patients over the age of 50 whose breast cancer was HR+, HER and had not spread to the lymph nodes.  This study looked at 21 different genes in the patient’s primary tumor.  The goal was to determine whether they’d be responsive to chemotherapy or if a better choice would be a less invasive treatment such as Tamoxifen.  The study concluded that patients scoring in the low to mid range could safely skip chemotherapy.  This is a huge game changer for many breast cancer patients as it omits the need to subject them to a more toxic treatment.

For clinical trials and treatments pertinent to your kind of cancer, always consult with your physician.

World Spine Day

October 16th marked World Spine Day.  This is celebrated every year on every continent to highlight health and well-being with physical activity, good posture, healthy working conditions and safe lifting.  Spine pain affects an estimated 1 billion people worldwide and is the biggest, single cause of disability.  

This year, challenges from the COVID-19 pandemic have lead to a lack of physical activity by being on lock downs, loss of work that might otherwise keep you up and moving and gym closures. This can make your spine more susceptible to pain or disability.  World Spine Day 2020’s focus was about getting people ‘Back’ on Track.  They have highlighted the importance of spine health and created resources to keep your spine active and healthy. 

For tips on how to prevent back pain, download the Straighten Up Canada app for exercise videos that you can set goals on and monitor progress.  To download the app, visit Android App or Apple App.or, the videos can be seen here.  

For more information on the 2020 Back on Track campaign, go to their Facebook, Twitter or Instagram pages for the latest news and ideas.

 

 

We celebrated Thanksgiving this month.  This year especially, we’ve been tested on what really matters.  Family, friends and faith.  As Maya Angelou said “Be present in all things, and thankful for all things” 

August 2020 Newsletter

 

5 Tips If You Travel During COVID-19

Travel seemed to come to a complete halt a few months back due to the pandemic.  As restrictions have lifted and summer has arrived, people have started to slowly resume their willingness to travel.  While there is risk no matter what you do right now, traveling is one you can take a few extra precautions with to ensure you are minimizing your chances of acquiring COVID-19.

Check the local COVID-19

– All states, provinces and countries have varying restrictions right now.  Be sure to review their up to date policies on coming to their city/state/province or country before arriving.  You may be required to self quarantine for 14 days upon arrival or provide a negative COVID-19 test to enter.  Also take note of the rules your own state, province or country has on returning home.  Informing yourself about respective guidelines coming and going could prevent you from having to return home and keep you as safe as possible.

Driving vs Flying

– Many people are fearful of flying right now, however, per the US CDC, most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on airplanes.  The issue revolves around the ability to social distance, or lack there of.  There may be situations where it is a crowded flight and you are forced to sit next to someone less than 6 feet away from you that could be a carrier.  Taking a bus or driving can also pose increased risks.  There are still stops for food, gas and bathroom breaks that can put you in close contact with others and touching surfaces.  The key is to be aware of your surroundings, wear your mask and make sure you are washing or sanitizing your hands after you’ve touched public surfaces. 

Anticipate Your Travel Needs

– Wearing a mask has been proven to help reduce your chances of getting or passing along the COVID-19 virus.  Make sure you have a mask with you at all times.  It is wise to bring a couple of extra ones in case you lose one or it gets dirty.  Having a few extra zip lock bags to store them in after each use will also keep them from being set down on a surface that might have germs.  Bring your own food and drinks when possible.  This will reduce contact with others in ordering.  Make sure you also have hand sanitizer or disinfectant wipes for situations where soap and water are not available. 

Hotels and Lodging 

-Review the hotels updated policies on how they are handling the cleaning of your room and their common areas.  Many places have suspended daily room cleaning unless requested and the majority of them have provided hand sanitizer every where you turn.  All major chains are taking extra precautions to sanitize your room, however, to err on the side of caution, take your own clorox or disinfecting wipes and clean all high touch surfaces such as door knobs, light switches and faucets for good measure.  You can always request a room that has been vacant for at least 24 hours.  Many hotels are not up to 100% capacity so this might be an easy request to accommodate.  Always wear your mask in the lobby and hallways as you are moving through the hotel, especially in the elevator.  Elevators are small spaces and someone who was not masked up could have coughed or sneezed prior to you coming on and the particles might still be in the air.  Only ride with the people in your party and wait for the next elevator should there be people you don’t know already in there.  This not only protects you, it also gives the other riders their own space.

Be Patient

– Public places have been given the burden of taking extra safety measures to keep their doors open.  This can create long delays or a situation of not having access to what you traveled there for.  Try to be as patient with the employees and delays as much as possible.  They are only doing their job to make things safer for you.  Give them an extra smile or a compliment of thanks or gratitude to show your appreciation of their extra efforts for you.

 

 

5 Things An Excellent Hospital Should Have If You Travel For Medical Reasons 

Are you traveling for medical care and wonder what’s important in a hospital?  See below for some things to consider in selecting your hospital of choice.

1.The first place you should start is to research the hospital where you will have the surgery to ensure it is reputable and has appropriate accreditation.  The most recognized one is Joint Commission International (JCI). It is considered a gold standard in global healthcare.  Other organizations such as Accreditation Canada and Accreditation Association for Ambulatory Health Care (AAAHC) are a couple of others that are acceptable.

All facilities in the US and Canada are required to have these types of accreditation.  We have come across hospitals in other countries that claim they are ‘accredited’.  This can be misleading to the patient.  The accreditations they list do not have the same standards that the JCI or AAAHC has.

A hospital that has one of these accreditations will have the procedures in place that measure:

⁃patient rights and education

⁃infection control

⁃medication management to prevent medical errors

⁃the process on how the hospital verifies that its doctors, nurses and other staff qualification and competency

⁃what preparations are there for emergencies

⁃how it collects data on its performance and uses that data to improve itself 

Risks associated with a facility that does NOT have the appropriate accreditation could include: 

⁃blood not being screened for HIV or Hepatitis

⁃reuse of syringes

⁃antibody resistance 

⁃poor quality medications

⁃doctors or nurses that are not qualified

⁃higher risk of infection rate

2.Look at the hospital infection, re-admission and mortality rates and compare it to a state, province or country average. This should be available on the hospital website or you can also check with the state or provinces’ department of health. Many of them now require monitoring for serious reportable events or incidents.  

3. How do they handle your medical records and information?  In the US and Canada, hospitals must adhere to standards such as HIPAA and PIPEDA.  This is a law that protects the patients’ data and medical history.  

4. Doctors and nurses that have experience in working with International patients and speak English fluently.  This may seem obvious but not all International hospitals will have English speaking doctors and staff.  This is incredibly important because you need to be able to understand everything being said.  There needs to be an English speaking guide to get you to and from where you need to be in the hospital as well as have an English speaking doctor and nurse that will be treating you.  

5. Know what their emergency protocol is should there be one.  What precautions do they take and what type of life saving measures do they have?  Are they partnered with another larger hospital?  Is their equipment up to date?

Contact Health Vantis for more information on how to choose the right facility/hospital for you!  Your safety is important to us and we verify all 5 of these points for you.

 

 

World Humanitarian Day

World Humanitarian Day is August 19th.  This is a day to commemorate all of the aide and health care workers who provide life saving support and protection to those in need.  This year is especially important to honour them in light of the pandemic.  Thank you to all of our health care workers world wide for your time and dedication these past few months.

 

 

 

Newsletter July 2020

As medical wait times in Canada increase, more people are looking into their private options. Canada offers some private surgeries and diagnostic procedures. However, many more are available just across the border in the US.

With the current situation of rising COVID cases in parts of the US, there is understandable hesitation or outright refusal to travel across the southern border. So many things have to be considered while travelling today that many prefer to wait. Safety is of the most importance.

US considers medical travel essential. With all the necessary documentation from a medical facility, a Canadian should not experience any issues entering the US. Self-isolation requirements are not existing in the US, so hypothetically speaking, one can arrive, check into a hotel and have surgery or procedure the next day.

The real picture is a bit more complicated. Some hospitals and facilities are not open to international clients due to COVID restrictions put in place by their state. Some states are getting overwhelmed with COVID patients and are postponing their elective surgeries even to the residents of their state. And some are open and put numerous precautions in place to minimize the risk of COVID infection.

Most doctors’ offices and medical facilities cut their patient load by half so that there is no crossing in the waiting room. Oftentimes, there is no one else in the waiting room. All physicians and nurses use PPE to protect both patients and medical personnel. In most places, all patients are tested for COVID a couple of days before the procedure and are asked to quarantine during that time.

After surgery, patients are asked to wear a mask in the recovery room. Most post-op check-ups can be done virtually by video chat. While in recovery in the hotel, patients are also asked to self isolate so that the potential for contracting COVID is reduced.

We continue to monitor the developments in the US and will inform our clients of any positive changes so that they can make the best decision regarding their private surgery. If you would like to talk about your private surgery options or diagnostics in the US, we are here toll-free 1 877 344 3544.

 

 

 

 

During the uncertain times of COVID-19 pandemic, we want to avoid travelling if we can. Elective surgery, diagnostic treatment such as EGM or MRI, and non-urgent cancer treatments have all been postponed back in March. Canadians have done a good job following the Public Health guidelines and the number of new deaths and cases is going down in all provinces. In May and June, as restrictions are being gradually lifted, those Canadians that experienced medical delays are eager to get timely access to their medical treatment.

We are getting quite a few inquiries about private medical care. The request is to stay as close to home as possible, and definitely stay in Canada. While some provinces have an easy drive into the US, with many private options available we are yet to help a client who will take this option up.

Most asked questions for us right now is – can I have a private option here, in my home town or at least province? Most private medical facilities are located in BC and QC. There are a few in between, such as ON, but ON private surgeries covered by OHIP are not available to ON residents. If you are able and willing to take the risk of leaving your home province, then there are facilities that are starting to see private clients in Canada.

We would be happy to help set up a remote specialist consultation or remote second opinion for you. We charge a small administrative fee for it and collect and transfer your medical records in a secure way. If you would like to find out more information about private medical care available to you, please give us a call toll-free 877 344 3544.

 

June 2020 Newsletter

To Mask or Not to Mask?

Back on May 20th, Chief Public Health Officer Dr. Theresa Tam made the announcement that she was recommending Canadians wear a face mask/covering where physical distancing wasn’t possible.  Wearing face masks is not something Westerners are used to.  It’s almost a stigma to have one on, however, in East Asia and China, there is no shame in wearing a face mask.  In fact, it has been going on there since the pneumonic plague in 1910 and is seen as a sign of civic responsibility to do so.  If someone is seen not wearing a face mask during a public health emergency, it is greatly frowned upon and people are actually afraid of that person because they would be considered to have low civic responsibility and disrespect.

Now that things are slowly opening up, we will be exposed to more human contact than we’ve had in the past 2 months.  Social distancing is a new term for us and we are still trying to understand what is acceptable and what is not.  Based on what Dr. Tam has suggested, if you are not able to distance yourself in a situation where you will have 2 meters space, then the recommendation is to wear a non-surgical face mask.  An example would be if you routinely take the train to work.  You cannot guarantee you will be able to keep a 2 meter distance with someone else.  In a situation like this, it makes sense to wear a covering.  If you take your own car to work, you would not need to wear your mask as you were driving.

COVID-19 is a new virus.  We are learning more and more about each day.  We already know you can be asymptomatic.  Even though you feel well, you may be a carrier without even realizing it.  By wearing a face mask in situations where there will be close contact with others, the chances of spreading it are decreased significantly on both ends.  Not only are you protecting yourself, you are also protecting the more vulnerable such as a senior or immunosuppressed individual.  While it is not mandatory, it does show that you are willing to make a difference in combating this virus and are respectful of others around you.  Plus, it is a temporary inconvenience and there are some pretty cool looking face masks being made out there!

What Are The Health Benefits To The Approaching Summer?

We can feel the sun on our face and it brings excitement and joy every time we realize that summer is almost here.  It is by far our favorite season.  Being able to shed winter layers for flip flops and shorts is what I look forward to every single year.  Some of the great things about summer are of the many.  High on that list are the health benefits it offers.  Below we have shared some of those:

Fresh Fruits & Vegetables

Doesn’t it seem like we associate winter with heavy, comfort food?  But when summer approaches and we start to shed the extra layers, heavy meals suddenly don’t seem as appetizing but the colorful fruits and vegetables do. That is because the summer heat drives our hunger down as our bodies do not need to expend as much energy to keep us warm.  It tells our minds we only need something lighter to sustain us.

Fruits and vegetable look so much more vibrant in the summer.  I am more apt to grab a piece of fruit as a snack now than I would in the winter based on esthetics alone.  It’s also time for the local Farmer’s Market’s to open back up with local vendors presenting their organic, wholesome, fresh food.  While some are open during the winter, the summer months present more excitement and color.

More Opportunities for Exercise

There is nothing worse than sitting behind a desk and staring outside to the beautiful sun shinning, envious of those out there enjoying it.  The sluggish feeling of winter fades and we are suddenly energized making us more productive, even at work.  This also affects the way we exercise.

People naturally want to be outside.  Summer gives us more options on how and where to exercise.   Not everyone is a gym rat.  That can seem like a daunting, monotonous task but summer opens doors to activities that people love to do.  Things like gardening, mowing the lawn, hiking/walking, riding a bike, playing a game or sport with our children/grandchildren or swimming.  And what happens when you are in the sun and exercise or work outside?  You sweat!  Sweating detoxifies your body, which is another excellent health benefit.

More Vitamin D

Vitamin D is one of the most important vitamins in our body for optimal health.  It strengthens our immune system, can play a role in cancer prevention, strengthens our bones, speeds up metabolism and improves the overall emotional health.  The easiest way to get a significant amount of Vitamin D is through the sun.  We are meant to get 80% there and only 20% through diet.  When exposed to the sun, our Vitamin D is replenished and stored.

Over the years, with more awareness of the dangers of too much sun, we have been taught to block the rays out with sun screen.  People are also working more hours keeping them indoors and shielded them from the rays.  Due to this, many now suffer from a Vitamin D deficiency.

Having a Vitamin D deficiency can cause you to have bone pain, muscle cramps, stooped posture, loss in height and weakness and tingling.  During the summer months it is easier to store up on your Vitamin D.  We wouldn’t suggest you to disregard the yields to applying sun screen, but newer research has shown that exposing your body to a little bit of sunshine can actually be good for you.

Overall Feel Good Attitude

Have you ever wondered why you instantly feel good when you see the sun?  That is because it boosts your level of serotonin, which is the body’s natural happy hormone. Summer time offers us longer days and more opportunity for the sun to shine.  Having the extra daylight gives us more time to be outside and possibly get outdoor exercise in.  This can produce the happy endorphins more so than if you exercised indoors.  Regular sun has also been known to halt moderate depression.  There are individuals that have an illness called Seasonal Affect Disorder (SAD), which is normally present during the fall and winter months.  Once summer arrives, it magically disappears.

Vacation!

Nothing rejuvenates your spirit and mental health like a vacation.  Taking a vacation, whether it’s a quick 3-4 day weekend get-away or a week off, can be beneficial to your overall well-being.  Summer presents more time for people to take time off work and spend it with their families.  Studies have shown over and over that stress can contribute to heart disease and high blood pressure.  Making the time to take a vacation not only gives you a break from the normal stressors of daily life but it can strengthen your relationships by spending quality time together.

Summer is often a short lived season in Canada.  Make the most of it by watching less TV, putting the devices down and getting outside to explore all of the wonderful things available to us. A little bit of sunshine can go a long way!

Happy Father’s Day!

Happy Father’s Day to all of our favorite men out there!  In light of Father’s Day, Canada also celebrates Canadian Men’s Health Week (June 15-21st)  This is a time to focus on challenges men have regarding healthy lifestyles.  To find out more, visit the Canadian Men’s Health Foundation: https://menshealthfoundation.ca/campaigns/menshealthweek/

Newsletter May 2020

How Long Will You Be Waiting for Your Elective Surgery?

Canadians deal with medical wait times even with no pandemics.  In the past few weeks, all the healthcare resources were directed towards treating Covid-19 patients, rightfully so, and an estimated 100,000 patients had their elective surgeries cancelled or postponed. People are patiently waiting in pain to find out when they will be seen by a specialist or when their new surgery is going to take place.

Last week brought in some positive news. Some provinces are starting to call cancelled patients to evaluate and possibly reschedule. According to this article, BC is to restart its elective surgeries on May 18th. They estimate that it will take them up until June 15th to come back to the same capacity as they were pre-COVID-19. The province cancelled 30,000 elective surgeries. It may take up to 2 years to catch up, with maximizing their operating room capacity and extending surgeries to happen on weekends.

Ontario Ministry of Health released directives to help hospitals and regional centres plan for a gradual resumption of cancelled surgeries. Although no date was given, each hospital has a responsibility to evaluate its resources and adhere to the released framework. The emphasis was given to the word gradual. As a requirement, 15 % of acute care should be reserved (or made available on a moments notice). According to the document the surgeries are only to resume if the hospital has had a stable number of COVID-19 cases and has:

  • available space and this space was evaluated in the context of physical distancing, so no care in the hallways
  • supplies of PPE, medications, swabs and reagents are available
  • health human resources are available and are not affecting urgent and emergent care

Alberta resumed their elective surgeries on May 4th and is expecting to have 26,000 to 30,000 urgent and non-urgent surgeries performed over the next six weeks. New Brunswick started rescheduling priority elective surgeries on May 11. Manitoba and Prince Edward Island are following suit, but no certain dates have been announced.

Many news reports stated the difficulties of reopening and all the challenges that may arise with its safe implementation. In this article, the issues of asymptomatic COVID cases, the availability of PPEs, anaesthetic drugs and ventilators are raised. Everyone scheduled for surgery will have to get a negative COVID-19 test within a certain time frame prior to the surgery. So that is an additional burden on the testing centres.

All the above is promising, and one can hope that the wait will not take years. While you are waiting to hear back from your doctor’s office, there are some things you can do.

  • Reach out to your physiotherapist or chiropractor to ask them what exercises you can do at home. If your condition changed, be sure to mention all the details.
  • If your condition worsens dramatically, contact your doctor to tell them the new information. Most family doctors are able to do a phone consultation or a virtual appointment.
  • Consider your private options for the future. By getting a medical records review done with Health Vantis you are not obligated to proceed. However, should you decide that your post-COVID wait time is too long, you will be ready.

Private Surgery After Covid-19

With medical wait times most likely increasing for elective surgeries due to Covid-19, some of you may be searching for information about your potential private options. We wanted to give an update on what is being done or considered being done at the private surgical facilities we work within Canada and the US.

As you already know, some of the southern United States are lifting the COVID-19 restrictions. Depending on the state, some are allowing elective surgeries to take place. Certain provisions and requirements must be met. Those are mandated by the state’s Department of Public Health.

Each facility we work with is accredited not only by the state (which is a requirement) but by another accrediting body in the US. We reached out to two of them, AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities) and AAAHC (Accreditation Association for Ambulatory Healthcare) to ask what they have in place.

AAACH advised that they have a number of resources available to their members on their website, but that they defer to a state department of public health for further guidance on reopening as those will differ from state to state.

AAAASF offered a similar answer and added that they conduct onsite resurvey and that they ask all facilities in their resurvey year reopening to submit policies and procedures to ensure that all infection control and patient safety requirements are in place.

Health Vantis is keeping an eye on the states governments announcements and their public health departments directives. So far, we see that there are several things that are being mandated by each opening state, such as pre-op COVID testing requirement: negative Covid-19 test results within 48h or 7 days, depending on the state. Some require staff and doctors continuous testing as well.  Another one is sufficient supplies of PPE to be stocked at a facility and enhanced cleaning protocols.

We are also keeping in touch with all the facilities we work with so that we get pertinent information on their developments. It is not clear yet how soon we will be able to send someone for medical travel.

 

 

Newsletter March 2020

Weight Loss Before Total Knee Replacement

Have you been told by an orthopaedic surgeon that prior to your knee replacement you need to lose some weight? If so, you may feel disappointed or upset. When your mobility range is limited such recommendations may seem unrealistic or even absurd. Should a BMI (body mass index) of 30 or more preclude your surgeon from scheduling an operation?

There is a good reason doctors make this recommendation to their patients. Our knees are weight-bearing joints and the amount of weight we put on them matters. Studies have shown that losing weight can greatly improve arthritic pain. Every pound of excess weight puts about 4 pounds of extra pressure on the knees. Every pound you lose relieves pressure and stress on the joints.

Losing weight, in general, is healthy, not just for your joints. People that are obese often suffer from certain diseases and conditions such as diabetes, hypertension, depression and others. These conditions, or secondary diseases, are called comorbidities. The more comorbidities a person has the more risk there is in surgery.

However, a relatively new study came out and it concludes that “obesity in itself should not be a deterrent to undergoing a joint replacement to relieve symptoms”. It reports that obese patients reported excellent pain relief and substantial function gain, similar to other, non-obese patients.

Yet another review of studies for total knee replacement states that obesity still contributed to a greater risk of overall complications, such as infections rates. In addition, the need for revision surgery was higher in obese patients.

So, what is the magic number of pounds to be lost prior to surgery? This study states it is 20. The researchers found that people who were morbidly obese and lost at least 20 lbs were more likely to:

  • Have shorter hospital stays
  • Be discharged to their homes, rather than to rehabilitation facilities

Talk to your doctor about the risks of your total knee replacement. If weight loss is recommended, doing so will lower these risks and ensure a successful outcome.

 

When Is the Right Time for Your Private Knee Replacement?

If you have been experiencing knee pain and all other non-surgical methods are not helping, your doctor may recommend a total knee replacement. You may be wondering when is the right time for you to get it done. Although there is not a definite answer to this question, certain things have to be considered and discussed with your orthopaedic surgeon. Here are some questions to ask yourself and concerns to bring to your doctor.

  • Is your mobility severely compromised?

If you have been struggling to perform your daily physical activities such as walking, climbing stairs or simply moving around running errands and or getting to work, this could be a good indicator that surgery may be in order.

  • What is your pain level and does it stop when you rest?
  • Is your pain so severe that you have a hard time getting on with your daily routines?
  • Is your knee joint swollen?

Do you experience inflammation and swelling that does not improve after taking medications or resting?

  • Are you having restful sleep?

Do you experience lasting pain that continues while you are resting? Does it keep you up at night and prevents you from getting a good night sleep?

  • How much damage due to arthritis do you have according to the X-ray?

Your doctor should be able to help you answer this question by reviewing the X-ray with you. Severe arthritis damage can not be reversed and the pain can only be relieved by undergoing a total knee replacement

  • How old are you?

Your age matters, but should not be the deciding factor. In general, your knee implant should last 15-25 years, thus most people with arthritis only need one knee replacement in their lifetime. However, younger adults are now undergoing knee replacements and there is a chance that they will need revision surgery later on in life.

Although there is no perfect rule to timing waiting too long or going in too soon is not optimal. If you wait too long, your mobility is decreased and due to this, you may have a hard time exercising and start developing other health issues such as cardiovascular problems. There is a chance you will experience depression because you are unable to do things you once enjoyed. Another problem with delaying knee replacement surgery is that the surgery will be less effective because you will not get as much function back. However, having a total knee replacement too soon may mean that the benefits will be minimal and you may require a revision later on in life.

Bring up all your questions and concerns to your orthopaedic surgeon to discuss your options. If you were put on a long wait list and are seeking private total knee replacement we can help. Reach out to us and we will discuss your private options.

Dangers in Medical Travel

We hear the news reporting on the horrors of medical travel quite often. It is quite unsettling to read the details and understand how it became a harsh reality for someone. CDC periodically issues warning about infections being spread in other countries at the facilities that may see foreign patients. Several outbreaks of infectious disease among medical tourists have been documented. Recent examples include surgical site infections caused by nontuberculous mycobacteria in patients who underwent cosmetic surgery in the Dominican Republic and Q fever in patients who received fetal sheep cell injections in Germany. If you are planning to travel to get medical care, be assured that many medical facilities deliver successful outcomes. And even though all surgeries carry risks, there are certain steps you can take to minimize yours.

Dangers To Avoid

  • The facility does not have a US, Canadian or JCI Accreditation
  • You cannot verify the surgeon’s credentials and what they are certified to perform in, that they are up to date and what their actual training was in
  • The facility doesn’t publish their infection rate
  • There is no procedure in place if there is an emergency or something goes wrong during the operation

But It’s Cheaper

While cost is important it should not be your deciding factor.  Many people think it’s just breast implants or simple hernia surgery.  They do these every day.  What could go wrong?  If the right standards are not met, A LOT!  Sometimes you get what you pay for and your health should not be compromised to save a few dollars.

Having a safe, successful surgery should be your number 1 priority.  That can be achieved if you gather all the facts.  This can be incredibly time consuming but well worth the effort.  Hiring a Medical Facilitator that does all of this for you will ensure no detail or question is left unanswered.  It also gives you a guide through the entire process.  If you are in need of such knowledge and expertise, contact Health Vantis today!

February Newsletter 2020

3 Easy Steps to Working with Health Vantis

Have you ever been subject to a lengthy delay in medical services that left you looking for alternative options?  If so, you probably know how frustrating and time consuming it is trying to find a private facility to have it done sooner.  Many people do not even know where to start so their first jab at it usually involves making countless phone calls to places found on the internet, most of which lead you to dead ends.  If you do get a call back and need a price for a surgery, they will have you going in circles to get an all-inclusive price.  The whole process can be daunting and even more frustrating when you compound the emotions of already having to wait.  

By the time we get the phone call, the customer is already exhausted from all of the work they’ve spent trying to locate someone on their own. Many are incredibly frustrated and appalled by the fact they can’t be seen in a timely manner and are left to feel like no one cares about their health or situation.  It makes them feel helpless.   We understand these feelings because we’ve been in their shoes before.  

Health Vantis was created to help those left in these kinds of situations to provide them with immediate pricing and pre-vetted, leading health care professionals and facilities to meet their needs.  The countless hours you would spend doing this yourself can be achieved quickly with Health Vantis.  Our process is designed to make things seamless so all you need to do is focus on your health and recovery.  It can be broken down into 3 easy steps.

Initial Contact: Evaluation and Medical Overview

Our initial contact involves us getting details to your needs, concerns and expectations.  Most of the time we can offer an initial ballpark price.  (*Challenging or uncommon cases may require one of the doctors to review your records prior to getting a price).  If you would like to get an exact price, we would need to collect your medical records to be sent off to a couple of facilities for a medical review. To start the process, we require a $100 CAD non-refundable administrative fee to do this.  Our Consent and Release form need to be signed at this time to allow us to safely receive and transfer your medical records and facilitate obtaining information you need to make an informed decision.  You are under no obligation to proceed with a surgery or treatment.  

Decision Making:  You Are In Control

After the medical review is completed, we provide you with the accurate pricing, facility and surgeon credentials, any requirements such as blood work or EKG that might be needed prior to surgery, time frame the surgery can be done, how long you will be required to stay and any other information you may need so you can make an informed decision.  If you need to speak directly with the surgeon prior to making your decision, we can make the arrangements for that to happen.  Once you’ve made the decision to proceed, we start planning the remaining details to your surgery.  This includes your transportation, hotels, and any post-op treatment you might need.  We charge 10% of the cost of the surgery (in CAD dollars) to do this and it is collected at this time.  

Logistics:  Scheduling, Traveling and Follow Up

A personalized medical travel guide will be provided to you.  This includes every detail necessary for your surgery such as pre-op instructions, what to expect post operatively, appointment times, facility location, hotel and transportation details and any other information pertinent to your trip.  Once your surgery is complete, we continue to check in with the surgeon, you and your companion until you are fully recovered.  

It is important to note that we do not contract out any of our services.  We care a great deal about our customers and like to be involved from start to finish to ensure a successful outcome.  We are always available and spend a great deal of time walking you through the process.  

If you are considering private options, contact Health Vantis prior to investing hours of searching and making phone calls.  Your time is valuable and your health is important.  Our level of dedication and due diligence in finding the right facility for you will provide the stress free process you need to ensure a smooth and safe surgery!

The Hidden Costs Of Medical Tourism

Considering traveling abroad to get a medical treatment, diagnostics, and/or second opinion and wondering how much it costs? We addressed cost issues in several of our blogs in the past.  Today we wanted to bring to our reader’s attention the hidden costs of medical tourism.

It could be broken down into two categories – financial and non-financial. Monetary hidden costs are a bit more manageable if one prepares and asks the right questions before going.

Potential Unexpected Financial Costs

  • Unexpected medical complications.  All surgeries carry a risk of complications. Talk to your medical tourism professional about them. Arrange an interview with prospective doctors to better understand the rate of complications. We highly recommend looking into purchasing a medical complications insurance for traveling abroad to receive medical treatment such as Global Protective Solutions.
  • Hidden hospital charges. Ask how much it costs if you need a longer hospital stay.
  • Is the price you were given an all-inclusive price?  Questions you need to ask are: Does this price include the surgeon fee, facility charge, anesthesia, pre and post op medications, and pre-op testing such as blood work or EKG.  In some situations such as a GYN surgery, there might also be a biopsy required.  Would this be included?  In the case of an orthopedic surgery such as a joint replacement, is the implant included?  No one likes an unexpected bill so be sure to ask all of these questions upfront!
  • Additional testing for diagnosis such as a CT Scan or MRI.

Non-Financial Costs

  • The cost of not talking to your primary care provider in your home country can be very high and it is potentially harmful to your overall health. Your family physician has the most knowledge about your situation and if you inform her of your intended travel you will place yourself in a much better position to mitigate the risks. She will be able to talk to you about different health scenarios for your particular condition. It will be easier to consult her when you are back home. No one likes surprises and it’s not worth the risk. Sometimes it can be difficult to bring up this conversation but is well worth the efforts. All Canadian doctors are aware that medical tourism exists and for the most part are supportive of it.
  • Access to the doctor who performed your surgery or treatment can be limited. This one should be closely discussed and reviewed as you are going through your quotes and selection of medical specialists and facilities.
  • Arranging follow-up care can be challenging and costly. Find out the recovery time and what you need to do. Your medical tourism facilitator can provide you with a quote and connect you to a physiotherapist so that you can continue the recovery process when you are back home. If you have supplemental health insurance your physiotherapy may be covered.  If not, the cost of a therapist traveling to your home is about $90 per session.

All these considerations are a lot to think about and are easy to forget. Ensure you either have a good medical facilitator to keep track of these or print this list and keep it as you go through your research.

World Cancer Day

February 4th was World Cancer Day.  There are currently over 100 types of cancer people battle with every day.  Not all cancers present noticeable symptoms, however,  knowing what some of them are may provide you with the knowledge of when to have something checked out.  See the infographic above for some of the more common symptoms. *Infographic courtesy of World Cancer Day.Org

Newsletter January 2020

How Long Will You Wait for Surgery in 2020?

According to the Fraser Institute, over a million Canadians were waiting for a medical procedure in 2019. The median wait times from GP referral to treatment was reported as 20.9 weeks.

Usually, if the medical matter is urgent, one gets treated promptly here in Canada. When it does not involve a medical emergency, the provincial government health plans consider these elective procedures and/or non-urgent.  It doesn’t mean that the provincial insurance won’t cover what you need to have done, in most cases, however, you may just have to wait.

When it involves something that creates limitations in your day to day function, then it sure seems like it is urgent.  Constant pain is physically limiting and distracting with difficulties in focusing. The quality of life suffers. If you are a working adult, a decrease in your productivity or ability to work occurs.

Pain is the main indicator that something is wrong. Living with severe pain may produce a chain reaction. You may not be able to develop the coping skills required.  This may cause you to become unproductive, unable to exercise or possibly put you into a depression. Although doctors are getting more cautious with giving opioids out for pain control, they still do. This is considered a risk. Being on them in the short term may be appropriate but long-term usage will have more serious consequences such as addiction. Also, when you take an opioid it masks the pain. This could result in you to pushing yourself more than you should which can create or complicate your problem further.

The longer you have an ailment that is being untreated, the higher the chance of making things worse. For example, take a knee replacement. Our knees bear all of our weight when we walk or run, or simply are upright. They are the main hinge between the ground and the rest of our body. They allow us to get around. Waiting too long for your surgery can be counterproductive.

Your function going into surgery dictates how you will function afterwards. The longer you wait, the more muscle tone you lose which will make your recovery much longer and harder. Something spotted early may only require a minor procedure. Delaying that could cause, in the case of a knee, destruction to the knee joint to where it is so severe that a total knee replacement is now needed.

Needless to say, waiting in line to get medical help can be hurtful. To get help sooner, consider your private options. Call Health Vantis to find out the costs of private surgeries and how to obtain them in a safe and affordable manner. We are here to help. Toll-free 877 344 3544.

 

How Long Does a Private Joint Replacement Last?

Private Hip Replacement

Those suffering from arthritis in their joints are probably aware that a hip or knee replacement will relieve the pain for good. However, going through a total joint replacement surgery is undertaking a serious, albeit considered very successful surgery. If all non-surgical methods fail, your doctor will recommend a total hip or knee replacement.

One of the questions for your doctor should be “How long will my hip or knee last?”. It is an important factor to consider. Younger people are advised to wait to avoid future revisions. A standard answer to the longevity of the joint replacement has been 10-15 years.

A new study for hips and knees that came out in February 2019, tells us that joint replacements last longer. The study looked at almost 300,000 total knee replacements and over 200,000 total hip replacements. 58% of total hip replacement lasted 25 years. Total knee replacements had even longer longevity – 82% lasted 25 years.

Those numbers are encouraging for the aging population of North America. It is worth to note, however, that the study collected data from joint replacement surgeries performed in New Zealand, Australia, Denmark, Finland, Norway and Sweden. The results can differ in Canada. One of the private medical facilities we work with in the USA uses implants that are rated to last for 40 years. They also use robotics for the highest accuracy for private knee replacements.

It is ultimately your decision if you prefer to wait or get it done sooner. If you are put on a waitlist for a joint replacement and no longer can deal with waiting, Health Vantis can help access private hip or knee replacements. Give us a call to find out the details. Toll-Free 1 877 344 3544

Pre-op Testing: What Is Needed?

Once you make your decision to proceed with the surgery Health Vantis makes all the arrangements for you. One of the moving parts of preparation for surgery is pre-op testing. The requirements can be different, depending on the procedure you require and your individual health.

The two most common tests the doctors we work with ask our clients to complete are bloodwork and EKG. Blood work within the last 3 months prior to surgery is usually accepted. If more recent blood work is required, you can schedule a visit with your family doctor and ask for a requisition of what is needed. It usually takes a couple of days to get the results and those can also be picked up at your family doctor.

If you are over 65 and/or have high blood pressure or other cardiological issues, an EKG test is required. In most provinces, it is fairly easy to get. Again, this can be done through your family doctor.

If the results of the EKG are concerning, a cardiological clearance is required. This one is not as easily obtained as the EKG or blood work. Most of the facilities we work with can suggest a local cardiologist that can schedule a consult on short notice to accommodate your surgery date. The cost varies per doctor and location and will be communicated to you by Health Vantis upfront.

Sometimes, when there is a GYN surgery involved, the surgeon would like to see the results of the most recent PAP test. This is done to ensure the overall health of the client is acceptable for surgery.

If you are considering private surgery and have any questions, we are here to help! Toll-free 1 877 344 3544

December 2019 Newsletter

How Does Canada Perform On Universal Health Care Compared to Other Countries?

If you listen to some of the presidential candidates south of the border, you would hear that Canada has the greatest health care system in the world, a system to model.  But is that just an opinion or is it based on fact?  Recent data suggests something far worse than what the debaters might have you believe.

A recent study completed by the Fraser Institute compared universal health care systems to determine how well Canada’s system really ranks.  The overall conclusion was that although Canada is the most expensive system in the OECD (Organization for Economic Cooperation and Development) and the performance is modest to poor.  Below are the 5 areas in which the data was measured:

Expenditure on Health Care

Of the majority of high income OECD countries that utilize universal health care systems, Canada spends much more. After an age adjustment, it ranks 2nd highest for expenditure as a percentage of GDP and 10th highest for health care expenditure per capita.

Availability of Resources

Canada has substantially fewer human and capital resources than many like jurisdictions that spend comparable amounts of money on their health care.  Canada has significantly fewer physicians (26th out of 28 countries), acute care beds (27th out of 28 countries) and psychiatric beds (25th out of 28 countries) per capita when you compare them to the average OECD countries.  Nurses rank close to average at 15th out of 28 countries.  On medical technologies such as MRI & CT Scan, Canada again ranks very low.  For MRI it is ranked 22nd out of 26 countries, CT Scan 22nd out of 27 countries and PET Scan 17th out of 22. Canada has fewer other medical technologies than the average high income OECD county.  One area we rank high is on Gamma Cameras 2nd out of 21 countries.

Use of Resources

After age adjustment, Canada ranks 9th (out of 26th) for doctor consultations,  14th (out of 25th) for MRI examinations, 12th (out of 25) for CT Scans and last at 28th (out of 28) for hospital discharge rates.  Other areas examined were for cataract surgeries, coronary angioplasties, coronary bypass grafts, appendectomies, cholecystectomies, hernias, hip replacements and knee replacements.  Canada’s performance is mixed.  We performed well or at higher rates than the average OECD country on about half of the indicators examined but lower rates on the rest.

Access to Resources

Access to resources can be measured by the timeliness of care, ie. waiting lists.  Canada tied last place (out of 10) for percentage of patients making a same day appointment when sick, 4 (out of 10) for after hours care, 10th (out of 10) for waiting 2 months or more for a specialist appointment, and 10th (out of 10) for waiting more than 4 months for elective surgery.  These findings place them at the bottom or near the bottom on 4 out of 5 indicators.  

Quality and Clinical Performance

Canada performs 17th (out of 24) for primary care, 4th (out of 21) for acute care, 12th (out of 16) for mental health, 6th (out of 16) for cancer, and 19th (out of 19) for patient safety.  Measures of longevity was also compared.  Canada ranks 14th (out of 28) for life expectancy at birth.  

Canada is the most expensive universal health care system that participates in the OCED.  The overall performance for availability and access to resources is below the average country.  Performance for resources and quality and clinical performance is mixed.  This presents a huge imbalance in the value of health care Canadians receive when you look at how high the spending is. The spending is financed by taxes all Canadians pay. In other words, what we pay for taxes we do not get back in return for good health care – we wait, wait and wait….

 

 

Medical Travel Success – Plan and Ask Questions!

There are numerous reasons to travel outside one’s local area to receive medical treatment.  A procedure may not be available where you live, the wait for it is too long, or the price is too high. With the world becoming so well connected and easy to communicate, all one has to do is to look up a reputable hospital and hop on the plane or drive. Sounds simple right? But traveling for medical reasons is far more complicated and involved than regular travel. If you have determined that you are going to take your health matters in your hands and take a pro-active approach, this article will give you a couple of points to be aware of.

DO: Communicate and be transparent with your local family physician or specialist

First and foremost, we cannot emphasize the importance of communicating with your family doctor and/or specialist.  It matters tremendously at all stages of your medical journey, but especially before and after. Before the travel, give your doctor an opportunity to voice all of his/her concerns with your plans.  It will help you mitigate the risks associated with receiving medical care abroad. Remember, only your doctor will have the medical facts and necessary expertise to raise such concerns. You can ask for a second (or third) opinion, or do your own research, but it all starts with you and your doctor.

When you come back from your procedure, your doctor will not be surprised and unprepared to learn about your journey and if necessary, provide or advise post op care. In many, if not all surgeries, the recovery time and post op care are so important.  The success of the procedure largely depends on it and therefore, you have to have the medical support you need when you come back home.  Talk to your family doctor 4-6 weeks or earlier before you go!

DO:  Go to a hospital that is able to provide their HAI (Healthcare Associated Infection) rates and prevention mechanisms

Many internet articles and government health authority bodies warn medical travelers about accreditations and standards for out of the country hospitals and doctors, and rightfully so. Not only do you need to make sure that your hospital and doctor are properly accredited and certified, you need to make sure the hospital has an ongoing prevention plan for preventing Healthcare Associated Infections (HAI). 

Are you aware that there are multi-drug resistant bacterias in hospitals and other health care facilities around the world?  For example, there was a rapidly growing Mycobacterium outbreak among medical tourists in the Dominican Republic: 21 cases identified in 6 states, 13 of them or 62% underwent surgery. Significant time and resources were spent for recovery, including therapeutic surgical intervention, hospitalization and 3+months of antibiotic treatment.  In Jan of 2019, the American CDC placed warnings about being treated at certain hospitals in Mexico due to antibiotic resistant infections.

Outbreaks among medical tourists are inherently difficult to detect due to patients returning to broad geographical areas, non-notifiable conditions and the fact that communications between countries can impact detection of outbreaks.

The US and Canadian healthcare authorities make an effort to publish results, however, other countries’ healthcare systems may differ.  Ask your provider for a discussion of HAI rates and what is being done to prevent them.

DO: Have a plan B

Have you thought about the fact that there is a chance that your doctor may advise a different treatment plan? There are cases of “change of treatment plans”. For example, a hip replacement client may be given a less invasive, less costly alternative that would keep the quality of life for a few years before she has to have surgery.  While it doesn’t mean you cannot have your surgery, it does mean that there may be more health related decisions made on location and you have to be open and ready to discuss those. To prepare yourself, don’t be afraid to ask questions.  Work with your doctor on the plan B before you leave.  The more planning you do the less stressful your medical journey will be.

DO NOT: Make your provider selection off of price alone

While this may be the obvious one,  but we are always alarmed at the low amounts people are quoted.  Figuring out price differences may prove to be daunting.  You have to go through each quote to see why they differ and if the difference is going to affect the quality of your treatment and stay.  Ensure that all quotes are detailed and figure out what different hospitals consider extra to the quote to get a better picture of your final bill. Also, look for hidden costs and always know how the Medical Facilitator gets paid. It should not be hidden in your hospital costs.  Always remember, you get what you pay for!

In addition, be prepared for complications and what the cost may be. It is best that you talk to a medical complication insurance agent about this as this may end up being very costly. In addition, your insurance agent will be able to spot hospitals that had bad cases and will not be able to insure you at that particular facility.  That’s an additional risk management step you absolutely must take.

If you have any questions or concerns or would like to discuss any of the medical travel issues further, please reach out to us.  We are here to listen and give you the best answer today! Health Vantis specializes in making your medical travel more enjoyable by giving you our most personal support and care along the way, start to finish!

 

5 Tips For The Next 2 Weekend Holidays And Eating

This time of year is full of cheer and over indulgence.  We all love to have a good time but here are some tips to help get you through the next few weeks when you are at a party!

1. Chose fresh fruits, dark chocolate, sweet potatoes, beans, vegetables or whole grains.  All of these are natural appetite suppressants.

2. Pick foods that you don’t eat often during the year. It will give you a chance to try the special food without filling up on the typical fare

3. Overindulging in alcoholic beverages is common during this time of the year. Have a glass of water before and in between your adult beverage. Not drinking 3 hours before you go to bed can also be of benefit in affecting your sleep cycle.

4. Watch for the ‘sigh’ which is your body’s natural way of letting you know you are full.   When you ‘sigh’, you are actually making room in your stomach.  Pay attention to this to avoid overeating and know that is your body’s queue that it’s time to stop.

5. Have a strategy before you go to a party.  Set limits and know what you plan on doing.  Easier said than done, isn’t it?  If you at least think about it before you go, you may have a chance at actually following it!

Have a wonderful holiday season!