Solving Healthcare with Dr. Kwadwo Kyeremanteng

In this episode, Dr. K shares a lineup of updates and new initiatives. He dives into the achievements of The Huskies A2 hockey team, proudly sponsored by Crossford, the exceptional services of Kelly & Kerry Real Estate, the empowering work of Integrate - Healthcare Collective, and the upcoming Reversing Diabetes Summit. Plus some info on the importance of mental health with Better Help, the benefits of LMNT electrolyte replacements, and more! SPONSORBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"OFFERS Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode of the podcast, we speak with Meghan Walker, an Entrepologist (On-tre-polo-gist) and Naturopathic Doctor. Meghan shares her insights on delivering the best care for patients, optimizing healthcare, and the importance of personalized care. We discuss the areas we need to overcome as healthcare providers, the benefits of getting curious about our own health, and the role of innovations and technology in healthcare. Meghan emphasizes the importance of taking ownership of our health and making informed choices that align with our unique needs and goals. Tune in to this episode to learn more about how to optimize your health and well-being.SPONSORBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"OFFERSThank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we are joined by Dr. April Elliott, a life, leadership & certified executive coach. Coach April works with people nationwide to help them achieve their goals and lead fulfilling lives. Coach April shares her insights into the coaching process and how she helps her clients develop self-awareness, build confidence, and overcome obstacles in their personal and professional lives. Through her compassionate and empathetic approach, Coach April provides practical tools and strategies for her clients to transform their lives and reach their full potential. Listen more about Coach April's work as a life and leadership coach and discover how you can apply her insights to your own life.SPONSORBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"OFFERS Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we are joined by Shawna Hughes, a Canadian Registered Holistic Nutritionist who specializes in treating children with ADHD. Shawna graduated from the Canadian School of Natural Nutrition and has since been dedicated to helping children achieve optimal health through a holistic approach. Today, we discuss the relationship between nutrition, medication, and ADHD symptoms in children. Shawna shares her expertise on how diet and lifestyle changes can improve ADHD symptoms in children and discusses her approach to assessing young patients, and how she creates personalized plans that address their unique needs. Tune in to learn more about how Shawna's approach to nutrition, ADHD, and how she works with parents to support their children's health.SPONSORBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"RESOURCES OFFERS Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we speak with Karina Mackenzie, representative of Wanderlust. Karina shares her experience in leadership within the wellness industry and the origins of Wanderlust, including everything they do from hosting yoga and meditation festivals to running yoga studios, and more! We discuss the growth and success of Wanderlust, the challenges and opportunities faced in the wellness space, and the importance of mindfulness and community in today's world. Karina also shares insights into her personal journey and the lessons she has learned along the way. Join us for a thoughtful and inspiring conversation about wellness, leadership, and personal growth.FYI, signup for Total ResetSign up (it's free!) for the Total Reset, which is a 14-day course bringing together practice + functional medicine insights + plant-based recipes, and nutritional supplements.SPONSORBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"RESOURCES OFFERS Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this quick solo cast, Dr. K shares everything from the new book, 10 Optimal Health and Wellness Tips. It breaks down everything you need to get on track and maintain positive well-being. Dr. K gets into some topics from the book including, nutrition and increasing your protein intake, intermittent fasting, weightlifting, yoga, stress management, improving your sleep, meditation, and more!  SPONSORBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"RESOURCESOFFERS Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we are joined by Dr. Michelle Peris. Michelle is a naturopathic doctor with a clinical focus on women's health, pediatrics, digestive and hormone health, and fertility optimization. Michelle joins us today to speak with us about The Wild Collective and a group health approach, including some shared experiences and their focus on female empowerment. Michelle is a health advocate passionate about helping women of all ages tune into their bodies. She shares with us a bit about her background and how she now supports her patients through body literacy.SPONSORBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"RESOURCES OFFERS Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.TRANSCRIPTKK: We are on the brink of a mental health crisis. This is why I'm so appreciative of the folks over at BetterHelp everywhere the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to better help.com And use a promo code ‘solvinghealthcare' and get 10% off signup fees.SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive, but one of the blessings it has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com, reach out on Facebook at kwadcast or online at drkwadwo.ca.KK: Welcome to Solving Healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization network. We are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.KK: Kwadcast nation. Welcome back, we have another exciting episode with Michelle Peris from ‘The Wild Collective'. Why is she on the show? Number one, she's amazing human being naturopathic physician that's changing the bogey. How she's changing the bogey? by introducing group health, looking at ways that you as a patient or client, being in a group setting, to be able to learn off each other, have that shared experience, talk about ways of getting collectively healthier, almost being a cheering section for each other. Just makes so much sense, especially when we have so many shortages and issues in healthcare right now. So really excited about this, you're going to enjoy this episode. Before jumping on though, I want you to go to kwadcast.substack.com. That's our new newsletter. That's where all our information is. I'm talking podcasts, videos of our episodes, vlogs, blogs, the latest and the greatest on healthcare solutions, right on one spot. So, you got to jump on the train baby, jump on the train. Alright, so without further ado, Michelle Peris.Kwadcast nation - as usual, we got an exciting guest. I'm going to go ahead and even call Michelle, a friend. We met at the EPIC live event, and was very kind in terms of her messaging, but also reached out and expressed some of the amazing stuff she is doing with ‘The Wild Collective' and I think, honestly, can transform how we approach medicine. Really, as we like to say, ‘changing the boogey'. So, without further ado, Michelle Peris, welcome to the podcast.MP: Thanks so much for having me. I am really excited to connect with you and grateful to call you friend, you've been so inspiring to me. It's a wonderful opportunity to be here.KK: Oh, that's very kind and but I mean, this is all about you. So, you started ‘The Wild Collective' your background in naturopathic medicine. Yeah. So, maybe tell us just a bit of your background and how you landed in producing this amazing initiative.MP: I often say our mess is our message. So, you know, it goes as far back as really struggling as a young girl of feeling that, you know, magical experience of belongingness always having a difficult time as a young girl to belong, and to feel like I fit in somewhere. That really, I guess, primed what the natural evolution of this was but I fell into naturopathic medicine largely through learning the power of food and nutrition. For the first time at that point, really learned what it meant to belong with a bunch of people who are like minded and suddenly, I felt very capable and very happy and satisfied with life. That was something that stuck with me those moments and seven years into clinical practice as a naturopathic doctor loved a very successful practice loving who I was serving. But feeling really dissatisfied with the consistency of results. At the same time, there was like this growing body of information of all of these, you know, health ramifications of social isolation and loneliness. It being the leading cause of mortality, and all these things, and I really felt like I was failing my patients. First, I didn't really have a screening process for loneliness and then I didn't have support for them on the other side of that, and I think it was really, all these moments that culminated this motivation in for me to solve this problem for my patients. Through that, we created this closed group experience where there's enough time created to not only empower and teach women about body literacy, and how to prioritize their health and why they need to think critically and be the CO creators of their health with their health care providers but also give them the benefits of community medicine and all of the beautiful consequences or side effects that happen when you engage in a community. What started to happen, what started as a very small project, it turned into a global mission, because I really do think this is how we can impact healthcare in a meaningful way how we can alleviate a lot of the burden on the system, is if we are able to disseminate health information that we know is important if people knew how important it was to prioritize their health or create metabolic flexibility or understand nutrition, then they could start to take radical responsibility for the health and start to co create that with their one on one providers and really start to alleviate the system. There are many studies that have demonstrated that that's possible that there are, you know, clinics in the US that are you leveraging this, that you have to go through a group program first. Then Dr. Mark Hyman is a great example, 80% of those cohorts that go through that group program don't require his care at the end of it. So, so much of what we do, we can really empower people to do on their own, and they don't necessarily require a one-on-one care. For me, this was exciting. I think the other things too, is that we spent a lot of time and educating ourselves on all these obstacles, secure the things that get in our way. I don't think we have enough time in one-on-one care to unpack what those could possibly be. Maybe it's not feeling connected in our relationships are unfulfilled in our work, we don't necessarily have mission and purpose that drive our day. These are huge drivers to overall well being. They need to be understood, and we need to take responsibility for them to be, like transformed in that healthcare experience. I think I think group health does that beautifully. So that was a lot. But that's what I'm doing.KK: No, that's good. That's good. It paints a beautiful picture. Michelle, so maybe give us a sense of what a common topics that come up or common ailments that you see like, who what's the typical person that comes to see you?MP: I know this, everyone always wants us to define this. I really want to reach every woman, but I would say women come to us typically because they're interested in learning more. Most women who are interested in something like this have been told by someone that everything looks fine, but they don't feel fine. So usually, there's some kind of overwhelm, anxiety, stress, burnout, maybe a hormonal symptom as a result, or insomnia. Or they're aware that there's a, you know, low thyroid situation happening. That's what's really prompted them to explore naturopathic medicine and get more curious about that root cause piece. Then I think what ultimately gets them interested and what has created a whole access to a different type of, of health education is once they understand what we're doing in a group health setting, so not only are we helping them understand optimal ranges for bloodwork results, or other areas to explore, I think you do a good job of highlighting this but for many people who are just learning this it's never just one symptom or one pot. It's like one system of the body that is going on, right, like they they're all They're all interconnected. So, I think when we're looking at things in a very condensed way, and we're not expanding and helping people widen the lens on what could be going on. I think health information helps individuals do that. So, We can talk about maybe the reason they came in is that they had hot flashes. But if we can educate them on, you know how their nutrition might be impacting that, or how their stress levels might be contributing to that, I think that's what really creates a lot of interest for women to want to learn that. I think the people that we tend to attract is they want to know this information, and they feel so overwhelmed by the content on Google, I think what keeps them fascinated and why they stay in this type of work, is that we like to expand the conversation and take it one step further, and really start to unpack those other obstacles that might be getting in the way are where they're feeling like, mystified, there's so many women out there, ‘I don't know why I keep gaining weight, it's not making sense' when we start to really go a little bit deeper and look at different concepts of like speaking our truth, and trusting our intuition and just digging a little bit deeper. How our relationships are actually affecting our physical health, I think we start to make it a bit richer and more interesting for them. Now they start to see all the ways that they may have ended up in this dysfunctional health state. I think there is this growing curiosity to want to understand that I think we serve a lot of people if we're being super honest. It's probably not the thing that they come forward with, but they feel like they've checked all the boxes, and they still feel quite unfulfilled or dissatisfied. That probably comes from being lonely, or not actually being purpose driven. So, I think we tried to create a health information. So, we've done tried to do so many things, but we attract people by educating them on their health and their body. And then we take it one step further, and really get them to step into that space of also taking radical responsibility for those day-to-day things that are negatively impacting their health.KK: I would imagine in a group setting, people learn off each other? I'm curious, Does the group specifically have common complaints? Or it's a random number of women? Six women, you put them in one group? Or is it a common issue that they want to address? How do you determine this?MP: I think you can do it several ways. I think this is being successfully done in both of those fashions. So, for us, we've been more about how we're a very fundamental foundational program for women. So, there's a nonspecific attraction to it. Not, we're not like, oh, here we are for autoimmunity, those groups do happen and they're fabulous, because it gives you that opportunity to really niche down in the types of conversations you want to have. I think what I've learned for doing this for the last seven years is that there always is that unifying universal normalization of the human experience that happens in any group that you're in. I think this can work in either capacity, is there are a specific condition that one is drawn to this group for or are you there, because you want to become more empowered in your health, and you want to take that radical responsibility to that next step and be in this space. If you know, we all here you become the five people you spend most of your time with. If you start to go into that like minded, health-conscious community, how do we use things that will naturally make those habits easier to embody?KK: Mhm, it's like you get a team. When you're in a group, you want to encourage each other don't want to let each other down. So, you've got that automatic cheering squad, telling you like, Let's go!MP: My two frustrations and one on one practice where lack of support for my patients and lack of really understanding what we were doing what why we were doing their treatment plan. That's exactly it's there's that let's go energy that's happening in that group. I remember so many patients would leave my office and they'd be like, ‘I'm so excited like you've made you've given me so much hope I see why this is important. I really want to execute on this plan' and then they'd come back for their six week follow up. They'll say ‘My husband wasn't in full support. I don't want to cook all these different meals that that that that that that like all the excuses' It becomes really difficult to adhere to any plan as brilliant as it is if we lack the social support in order to override the discomfort of change and transformation. It's incredibly difficult. So, when we provide the community, that has that ‘go go rah rah rah' support. Not only that, but the safe space also to say ‘I'm really struggling today, I don't really love this ketogenic approach, I'm here today, I'm hungry, I'm missing cookies' whatever, you have this group that's like, I understand, I see you, I am you, and you've got this, you can make this one more day. Suddenly, it doesn't feel so hard to learn these new habits, because you're in a space that supports and understands you. It becomes a lot less scary or overwhelming when you're in that kind of health inspired space.KK: I mean, you're selling it, you're definitely selling it, I want a stage where we got to think about healthcare delivery, you know, and in ways that they can outside the box here, because our current models and system aren't serving enough for the public. What you're proposing is ways of addressing more patients in a group setting that maybe, as you said, it's more effective because of all the things you stated. So, I think that to me is what's exciting about is that this could be a model that we should be doing at scale. I guess one of my questions for you is, do you feel like the women that see you, do they wish they would start utilizing this technique before they have problems? Do you know what I mean? Is it fair to say that when they see you there's already some significant issues that they want to address?MP: Yeah, yeah, I agree. Where are we perfectly fit in is in that preventative phase. That's what we were well trained to talk about, and educate and empower on it's like, where we're very well suited in healthcare. Unfortunately, as it stands still because we're fighting against a system, and everyone is so primed in that way. We all think a certain way with respect to how healthcare delivery happens, and how we navigate through the system, that this is still quite a disruptive thought. So even when they're ending up in our one-on-one practice, typically there is something going on, and it's well progressed, it's well beyond the preventative phase. What I'm seeing now we've created teen programs, Mother/Daughter programs, because we to see the potential, like what if you had this information from the start?  I really do believe, and I've said this to not be so bold, I would love to support in any way, I do think this is a very viable solution that fits the gaps that are currently missing. If we're talking about disparity in health care, access to health information, a lot of the criticism with extended health care. Visits, not everyone can access and afford that. Well, Group Health really helps to solve that problem as well. So how do we get this fabulous information that we now know in terms of education, nutrition, lifestyle, or dementia, stress reduction, all these tools that will be disseminated in a very affordable fashion in a large group setting. When people have access to the information, they desire to take radical responsibility for their health, they feel supported by the collective and therefore now they can alleviate a system that is on the brink of collapse that is struggling to keep up with the pace. People are co creating their own health and they are under they understand the role that they play. That's not currently the paradigm we exist in and that was a frustration of mine. Even as a naturopathic doctor, we were still often, you know, viewed as green aloe pass like they still wanted the supplement. I still met that resistance at the very end of my one-on-one practice, you know, there are people like ‘Michelle, I just came to you for the supplement. I didn't want you to talk to me about all the things' it's like, well, I'm sorry, I can't unsee what I know now.KK: Absolutely. In terms of the nitty gritty of the programs, because you alluded to the idea that you have like mother daughter programs, for example. Two questions:  What are the programs available? What's the structure like? Is it all naturopathic physician, doctors that will run the program or do you have facilitators?  Walk me through how you navigate through this?MP: Yeah, so we have a 10-module foundational program that everyone goes through. That is delivered by anyone who is educated enough to articulate the fundamentals of health. So, under a good healthy understanding of physiology, symptom expression, how that shows up in our body testing options, and then natural interventions. So, we have collaborated with mostly naturopathic doctors, we have functional medicine doctors, we have MDs in the US who are teaching and educating the ‘Wild Collective' we have very well-educated holistic nutritionist that are capable, we have pelvic floor physios that we've partnered up with, and they teach it as their whole clinic delivers certain modules. So, their naturopath delivers a thyroid module, you know, right. So, we we've seen all ways in which this program could be used. And it runs as a closed group. Because for me, that connection piece, like once that piece was well established in my mind that that was what we really needed. I didn't want it to be open, I really wanted them to create a very strong social group that was going to support them through that. So, they these sessions occur either once a month or twice a month or every week. They're two hours in duration, we spend 50% In of the time in connection. So, we ask very curated questions that are going to stimulate a very high-level health-conscious conversation that will also normalize their own human experience, just through the absorption of like, ‘oh, my gosh, I'm not alone, her story is so similar to mine' there's just this wonderful thing that happens when people start to share and open up. That part to me is so fascinating, that has always ended up being my favorite part is that we spend so much time talking about the big T trauma, little T trauma, all these things that get in the way, you know, we can be really accelerated through a lot of those and freed up with a lot of the things that we carry, when we hear someone's story, it's so similar to our own and they overcame it, and they didn't have to hold on to it. There's just so much power and value in the story sharing part. Then we spend the other 50% in curriculum and health education. At the end of that, then they can move to other levels should they want to continue on, but that is the part that we're now making available globally, because we just want to help as many women as possible. We know that what we have is valuable. We know that it's responsible for consistent health transformation. Man, just like really helping women step up in their own life and leading others that we just wanted to make sure that whoever was capable was it was in the hands of those people and they were teaching it.KK: Beautiful, beautiful. I'm curious, in one of these sessions when you say you ask one of these standardized questions to be able to get people to open up, do you have an example of that? Not to put you on the spot but do you have an example?MP: Yeah, so I'll walk you through a little bit of it. So, we start off with our hormone module, which tends to be the most popular where we teach women about cyclical living and how we're different, we're fundamentally different at our different phases of our menstrual cycle. We will open up the circle talking  ‘what has your experience been like? If you could define it in a couple of words? open up the circle, very open-ended questions, we then move to the detoxification module. We talk all about our body's natural capacity to detoxify all the systems of detoxification, and we start to get the questions and it starts to get a little more interesting so that we open up the floor with ‘What are some other things that you need to detox from?' and I always say you can say very simple things, if you're aware of alcohol consumption, or gluten. You could also be very aware that there are certain relationships, that are no longer serving you, or there are certain parts of your life or habits that are getting in the way of you living your most aligned life. What you're really trying to do is just open up that safe space. I think where we've been very successful as, as facilitators, we see ourselves as equal, so we're equally sharing and we're setting the tone of what's safe in that space. Then leaving it totally open for them to make their own connections. Because what's really beautiful is you never really know how profound the transformation is on the inside from what they're hearing and receiving and what's going on as a result of that information sharing and it's usually quite profound. So, we really try and tie in concepts of intuition and divine feminine with that question asking period. So, the next one is my thyroid, and we have a beautiful thyroid module, but we also start talking about do you speak your truth? Where maybe is a situation where you were unsuccessful and what was the consequence or what was the situation where you were successful? And what was the consequence? And we really start to open up these concepts of ‘oh my gosh, if I'm holding all this in, how is this impacting my health?' and we really start to tie these pieces together for them so that they realize that they're holding on to things that are no longer serving them. There must be some safe space for that to move through them, so that they can really get to the real obstacles that are getting in their way of their health.KK: Wow. Certainly, you highlight the mind body connection in terms of how we need to heal, which is grand. It makes sense when you hear similar experiences from you, how that can validate and could make the experience that much more real. This sounds good. In terms of the other programs, you have a mother daughter program. Is there any other kind of unique programs that you have?MP: We have mother/daughter, we have teen, we have perimenopause, and menopause.KK: What's your most popular one?MP: Our fundamental one is our most established. So, I'd say that is the most popular and now we're stepping into like, and I'll say in my mind, I have this everybody just like gets along. I really thought that this would just attract women, no matter what diversity of age diversity of background. That necessarily wasn't the case. That's why we now are targeting certain audiences to help bring them in. Age is a big one for women, so we had to create the perimenopause, menopause, there's slightly different content, of course, that needs to be delivered. But more the real obstacle is that aging women don't necessarily feel celebrated or safe to join where there are younger women. It was a real obstacle for me, if it's going to be a barrier then we must find a different way to reach them.KK: The answer came from them.MP: Yeah, the answers definitely came from them.KK: Interesting. What's the big picture vision? You've alluded to the scaling up of such and the globalization of, ‘The Wild Collective' and I must say the idea that it could be affordable, scalable, all these things make it very attractive. Where would you love to see this goal?MP: Yeah, if I were the queen for a day, I there would be a shift, there would be a paradigm shift in our thinking that everyone understood that we took this responsibility on and I'm happy to take this on. That we were advocating and articulating the value of where group health fits in, in the health care system. That every person understood that the health, the health care experience, included community. That it was like the first step that it was concurrent with our one-on-one care, because there were other frustrations, as a clinician, that this alleviates our discomforts, too, I was exhausted at the end of my day, because I was saying the same things over and over. I was trained for strategy, and really building all these beautiful plans and I spent most of my day talking about hydration and protein. It's inefficient, we are way too educated to be hanging out in that space in that capacity. So, let's innovate the whole model. I want to disrupt the model. I want every person to understand the value that group has in their health but also in their life. I think we would see a totally different system and a different health outcome if that were the articulation and so my mission not only moving, what we're bringing forward, but really is to stand for Group Health. The thing that's most difficult, I coach and mentor other clinicians now and building their own group programs. So, I've seen autoimmunity and Lyme and all these other group programs do amazing. We all held up against the same resistance, which is that we as a population as a as a global population, we don't understand the value of it. It's not the articulation of health care, therefore we're naturally resistant to it until we've experienced it. So, I would love to, I would love to create a lot of clarity there, so that everyone understood the value and they just prioritize that as part of the house strategy. That that for me, I think we would change a whole lot with respect to public health. It would be advantageous for everybody, I think it would care for the doctors, I think it would care for public health at a greater scale. That is what I'm set out to do and I want to be of service in that capacity. However, that rolls out. I think my biggest obstacle is trying to articulate the value to people who have only seen one on one care as the only option for health delivery.KK: Well said, I reflect back, we did a episode, the names gonna escape me all of a sudden put on the spot. It was an episode on social prescribing, and the impact that has had on many patients. You're gonna go to cooking class or a yoga class and prescribing that. I remember leaving that interview saying like, ‘Yes! this is where we need to go' and a lot of the patients that would be referred, unfortunately, are deep into their ailments. I think twofold, 1. leaning on the preventative side that's at scale in a group setting, I think is grand. 2. Then also just having here in a group session, can be so powerful for the reasons you've mentioned. The reason I'm sloppy is because I'm thinking at the same time, I'm thinking even for our project with metabolic health we should make sure I think I might be in the grant, but we should emphasize the idea of having group sessions. Adding this as part of the care package that they'll receive. There's too much upside, it's more efficient. It's just as glorious.MP: I agreeKK: You've convinced me now. I love it. So, anything else that you want to give love to with ‘The Wild Collective', I just want to make sure that we're catching all the magic that you guys are doing. As we say, many times on the show ‘y'all are changing the bogey'. We want to make sure that that bogey gets amplified, so any other initiatives or, or things that you want to highlight MichelleMP: I just I just want to emphasize the importance of social connection for everybody who's listening. I think there's just been so much impact and impair from the last few years of being strongly encouraged to, to socially distance and fully understand why that happened. There's been a lot of impact and our brains are socially wired to connect and this this needs to be a must have, it ought to be prioritized. Certainly, we'd love to serve you we are always here in the ‘Wild Collective' to direct you wherever is the best fit or to welcome you into our community. Social connection, the power of that with respect to overall health, well being and longevity in terms of even living eight years longer. I mean, it's just like such a no brainer. It can be successfully done with one other person in your life. So, for me, what was so exciting is this was a free tool that everyone had access to with respect to health that had a massive impact in overall health, well being longevity, anti inflammation, increased satisfaction, decreased risk of anxiety and depression. It is such a powerful tool. I love the work that we're doing, and you can check out our website. I'll give that to you for the show notes. We have facilitators all over the world. We just want to be of service and ensure everyone who wants access to this type of healthcare support can have it I really do think it is the future of medicine. The more that we stand for that and create we normalize the conversation around that I think the easier buy in we're going to have and the more people we're going to be able to help so that's really all I have to say and if I can contribute in any way. I'm happy to because this really is my life's work now. I'm super grateful to know this information now and to have actually stuck with it long enough to see the power of it. To be brave enough to stand for it and continue to scream at the mountaintops for it.KK: This is great. You've you found your purpose, we are certainly glad you, you found your purpose. To reinforced, the lack of connection and the lack of community in the last couple of years has been significant. I could not agree more. So, thank you, Dr. Michelle Peris for coming on the Kwadcast and please let everybody know where we can get a hold of you.MP: Yeah, thank you so much for having me. I'm most social on Instagram. So, you can follow me over @drmichelleperis. I love to personally connect, like I said, and like you said the consequences over the last few years. If you're if you're looking for resources, please don't hesitate to reach out. I'm happy to give support and we are global site is www.the-wild-collective.com. I also have a podcast called ‘Wild Medicine' and I think we do a really good job not only explaining the benefits of the wild collective but community medicine at large.KK: Beautiful, beautiful. Thank you so much for joining us. This was awesome. I'm feeling inspired.MP: Thank you so much for having meKK: Kwadcast nation thanks for listening to that episode. Follow us on Instagram, YouTube, Facebook, Twitter and Tiktok @kwadcast. Leave any comments at kwadcast99@gmail.com. Leave that five-star rating. Do it, do it. We appreciate you. Go to Kwadcast.substack.com. Paid membership gets you a membership to solving wellness gets you access to video content. You guys are going to love it! Subscribe today. Stay precious, stay beautiful, peace. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we are joined by Dr. Ardelle Piper. Ardelle is an obstetrics gynecology specialist and works with the health community to help them learn more about menopause. Today she speaks with us about how she chose her career path and her work on midlife women's health, pre-menopausal and peri menopause care. We also cover safe hormone replacement therapy and dissolve a few myths surrounding the concern with some previous studies. Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.ADDITIONAL RESOURCES SPONSORBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"OFFERS Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we welcome Janette Yee to the show. Janette is a Perinatal Athletic Therapist of over 20 years and works with athletes specializing in running and rugby injuries. Janette is focused on helping mothers postpartum, today she shares how she helps pregnant athletes and provides in-home pregnancy care. We also hear about how Janette helps moms navigate postpartum rehabilitation, bridging the gaps in healthcare to take a woman safely from conception to childbirth and returning to safe exercise, cesarean birth prep, and more! Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.SPONSOR BetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up HERE for 10% off.http://betterhelp.com/solvinghealthcareUse Discount code “solvinghealthcare"OFFERS Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we welcome back Toronto-based author, nutritionist, and founder of the Academy of Culinary Nutrition, Meghan Telpner. Today Meghan shares a little about her past, her diagnosis with Chron's disease and how it affected her lifestyle. Meghan shares how she reversed her symptoms through meditation and culinary nutrition, focusing your mind, and more! We also enjoy a guided meditation presentation developed by the HeartMath Institute, showing us how to tune our breathing techniques and feel at ease and peaceful.Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we welcome Marie-Josée Forget. Marie-Josée is a bilingual Pelvic Health Physiotherapist, educator, and mentor with 18 years of clinical experience. She operates a private physiotherapy practice focused on treating pelvic floor dysfunction and teaches courses related to pelvic anatomy and health at Pelvic Health Solutions. Marie-Josée Forget speaks with us about women's health. We learn about perimenopausal, and menopausal women and their pelvic health. How your pelvic health affects your lifestyle and sexual health, Kegel exercises, navigating perimenopause, menopause, and more!SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.TRANSCRIPT KK: We are on the brink of a mental health crisis, and this is why I am so appreciative of the folks over at BetterHelp. It provides the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists that are helped make professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today. Go to betterhelp.com And use a promo code ‘solvinghealthcare' and get 10% off signup fees. SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that is given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change, the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast@gmail.com, reach out on Facebook at Kwadcast or online at drkwadwo.caKK: Welcome solving healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of ‘Resource Optimization Network' We are on a mission to transform healthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.KK: Kwadcast nation welcome back. We have a tremendous episode with MJ Forget. She is a pelvic floor specialist in physiotherapy and sees a lot of perimenopausal women and was really knowledgeable in terms of the issues that she sees firsthand. Many people can benefit from a pelvic floor physio, for example, if they're having incontinence, pain or with sexual health, this is such an important aspect of things. Then she dives into how holistic the approach must be how the physio can actually make some significant strides. How lifestyle changes can impact things. Honestly, I learned so much in this episode. So, we'll jump on it right away here. But first, I want to give a quick plug to our latest newsletter on substack kwadcast.substack.com. Where you can stay up to date with all our releases, our blogs, or blogs or guest appearances, courses all are on one site and it's all point. Check out kwadcast.substack.com and jump on the train. So, without further ado MJ Forget. KK: Welcome to the show. We we've been talking more about women's health, specifically, perimenopausal and menopausal women. One of the areas that I must say it was a bit foreign to me and I didn't realize it was such a big issue was pelvic health. So MJ you've been at this for a while, like when you started? You said over 20 Maybe 25 years? MJ: 25 years? Yeah. KK: What lured you to pelvic health and like how big of an issue has is pelvic health ben for people?MJ: When we graduate from university, you know, and the medical fields we get to find areas of interest when we graduate and that's kind of all that we do. And you know physio, some of them want to do orthopedics and work with sports teams. When I graduated, I went to the hospital system, which is a lot of what physios do, and I worked in ICU and I worked on the floors, I did orthopedics, post knee posts, hips, and it really wasn't where my passion lied by any means. But it was a really great introduction to all thing's physios working in a hospital setting. So, when I thought about where do I want to go? And what do I want to do? I always had an interest at the time what we call more women's health. Now we call it pelvic health because again, all genders have pelvic health issues. I had classmates who did their thesis on incontinence. I remember thinking at the time oh my gosh “That's something that we can do?”. It really wasn't anything we were taught in university, nobody really talked about, again pelvic health, women's health, women's health issues, menopause, that was never covered in our degree. So, I took my first course and Alberta back in 1997 and I never looked back. I had no idea how much pelvic health issues was a problem. Remember 25 years ago, nobody talked about any of that. Nobody talked about bladder control issues or bowel control issues. Certainly, nobody talked about menopause, and nobody talked about sexual health, which is a lot of what we do in pelvic health. So, I started my career, like I said, I was in my early 20s and that's all I've been doing now, for 25 years. This is where I'm at. KK: Wow. You alluded to, you didn't realize how big of a problem it was, like how big of a problem truly is it? MJ: If we talk just about incontinence in Canada, if we just talk about general stats in Canada, 3.3 million Canadians have bladder issues in Canada. When we think about gender differences, one in four women, one of one to nine men, so it's significant. It actually gets a little worse as we age. That's an issue with menopause. So, if we think about the female population, there's about a 20% to 30% incidence of incontinence in our young adulthood. Think of like your 20s and 30s. Then that spikes up to almost 40%. By the time we get into middle age, which is kind of the perimenopausal menopausal age. Then it goes up as high as 50% in our elderly, which is a really big concern. One of the main reasons that our clients get admitted into nursing homes is because of bladder issues, and fecal incontinence rate, loss of bladder and bowel control is usually kind of an event where families then have a hard time maybe coping with taking care of their of their loved ones, and that will increase admissions to nursing homes. So, we're not talking about small numbers. It's a significant number and we have an aging population in Canada. We have a lot of people going through perimenopause and menopause. One of the biggest risk factors of incontinence is actually menopause. We have a lot of people right now who are entering kind of that phase, you know, and I think in Canada, the stats are that there's 10 million of us in this age group in perimenopause, heading into menopause in Canada. That's a big number.KK: It's massive. And I think this is what's motivated us to cover some of this content because these are years of productivity, have high needs, like moms that are in that perimenopausal age where you're active with your family, your career paths, like a lot of people this is where they're starting to peak in their careers, a lot of demands just to be to be on the workforce, like when I think of health care workers. So, anything we could do to make them more functional and thrive. I think we need to really look at. I don't know if I realized that, like this is kind of like the peak or one of the main concerns during the perimenopausal perimenopausal menopausal timeline. What can you do? What do you do to help? MJ: There's so much we can talk about this for hours, but we'll try to kind of keep in to keep our timeline because I can get started. I mean, if we're just going to focus on, we'll talk the impact of perimenopause and menopause. Like you said, it's such a difficult time. You know, people going through perimenopause and menopause, like you said, are working. They are often parents, with children that still require a lot of our attention. Plus, sometimes we're taking care of our parents as well. We're kind of like in that middle group where we're busy with our careers. We may or may not have children, but we also may have parents that we help and it's a really stressful time, and quality of life really starts to take an impact. So typically, when people come to see a pelvic health physiotherapist, or a physiotherapist who's done postgraduate studies in pelvic health, what we do is we are often seeing people that come for problems of bladder control and bowel control. So that would say that's kind of when I started that was the most of what I've seen, but we also help our patients with sexual function and the ability to have pain free sexual intercourse, which is a big issue again in perimenopause and it can actually worsen and menopause as well. We help with conditions called pelvic pain, pelvic pain can be anything like you know, our patients telling me I have vaginal pain or rectal pain, and when I treat my population of men it could be prostate related type of pains. Pain in the pelvis. A lot of pain in the pelvis affects sexual function and has an impact on your bladder and bowel function. So, it's all related together. When you come and see a pelvic health physio, what's important to know is we take what they call a biopsychosocial approach to care. So that means when you come and see us, we're looking at you as a whole person. What's really great about our profession is we have the luxury of time, because when you come and see us, we have an hour on assessment with you. Follow up treatments can be half an hour, 45 minutes or even an hour. So, we have the luxury of time, and we have the luxury of talking. S o the main thing that we always want to do is let people tell us their story, you know, why are you here? What's bothering you? And how much is this bothering you? Because again, when it comes to menopause, or bladder issues, or sexual function, these are not subjects that people want to talk about easily, right? There's a lot of taboo, a lot of embarrassment. A lot of my clients think they're the only ones who cant have intercourse anymore than the only ones who are losing bladder control and can't, you know, run a marathon. Everybody thinks they're the only ones but there are in fact, not, the stats are actually quite high in terms of impact of blood, bladder, health and sexual health on our patients. So, we talk and then we address all things incontinence, bladder, bowel, sexual function, and things like constipation and pain in the pelvic area. So, we do all of that. It's quite a bit and it spans quite a lot of topics. We also talk about lifestyle because lifestyle is important. On the on, on maybe my first visit or second visit, I'm going to talk to you about are you sleeping well? Are you managing your stress well? Are you having any issues with your mental health? depression, stress, anxiety that you're not managing? Well, how are you feeling hormonally? Because part of what we do and what I've noticed during COVID a lot as well is we've kind of become a little bit of the gatekeepers, I want to see we really had to help our patients navigate the healthcare system, and a time that it was really difficult to navigate the health care system. I always tell my clients, I'm here to help build your team around you who do you need to help you navigate perimenopause and menopause so you can live your best life, because as physios, we have to stay in our scope of practice, we can't do everything. So, if I talk about nutrition, I can talk about why nutrition is important, but I'm not allowed to give you advice on nutrition because it's not in my scope. But I'll send you to the people who do that. And the biggest challenge and menopause is that for a long time, there was nobody to send people to. Right? If you think about, you know, how many menopause clinics do you know, that exist out there? Right. There's one at Mount Sinai. There's just not a lot of menopause clinics that are run by a gynecologist and maybe have a nutritionist and a psychologist all working together and maybe with a pelvic health physio, that'd be great. That could look at that whole biopsychosocial approach to care to really help our patients navigate menopause. I think that's now starting to change. I think now, you know, the tagline right now is menopause is having a moment while menopause is having a moment. I think partly because there's a lot more of us in our field talking about it on social media, there's definitely some gynecologist now that are much more vocal on social media, talking about hormones, talking about safety of hormones. When I started 25 years ago, hormones were a no go, there was so much fear around all things hormonal replacement therapy, and it was really difficult because as a physio, I could see how devastating some of the symptoms of menopause were and there wasn't really a lot of options for my patients at the time as to what to do about it. Because everybody has such a fear of hormone, whether it's topical hormones or hormonal replacement therapy, and I think that that's shifting as well. So, we talk about all of these things with our clients when they come in. Then we help navigate and say, Okay, if you're struggling with nutrition, who could we send you to? If you're really struggling with your hormones, who are the hormone, menopause, hormonal experts out there to send you to? If your mental health is an issue, who do we send you to for that so that you can kind of work on your anxiety and your depression and your stress? There's been a lot of stress, you know, in the last few years, and then as physios, we take care of more that kind of the physical kind of component of incontinence, pelvic pain, bowel health, constipation and sexual health.KK: You know, what I'm really appreciating is you're saying MJ is how holistic the approach is, it's not so just the physical aspects and the rehabilitation, you need to know how it's affecting your life, how you're doing from a lifestyle perspective, stress level, sleep, how well you're eating, and just approaching it that way. That's what I'm finding really encouraging about this is that you know, you're just not soloing the approach, it really comes down to how the person is doing as a whole. In my opinion when it comes to so many issues in medicine, this is the only way like, you need to really address so many of the needs outside the actual physical concern. Another thought just came to mind too, is just hearing all the, the symptoms that so many perimenopausal and menopausal women have to go through it, it just, it really is sad that so many people have had to go through without it go through all this without attention. You put it together, the hot flashes, the mental health concerns, weight issues,MJ: the insomnia, the anxiety KK: Then you add the pelvic pain, the incontinence on top of that MJ: It's significant, and it's all today can be a very overwhelming time and our client's life, because, again, they're so busy, they're under a lot of stress, they have a lot of obligations. Then they're dealing with, you know, ‘I can't have intercourse with my partner, it hurts too much. I'm leaking urine, I can't exercise. Now I'm gaining more weight. I am going through perimenopause, I got insomnia, I can't sleep'. That has huge repercussions on the human body. It's important that we all talk about those things. And it's important that we recognize the lane that we're in as, as health professionals and find the right people, for our clients so that they get better. I think you know, again, it's the tides, I think are changing that we're taking a little bit more of this kind of like sort of biopsychosocial approach, looking at the whole person. Also giving permission to our clients to talk to us about these things that it's okay to talk to me about your bladder issues and your sexual health concerns and, and your stressors in your life and how maybe you're having really hard time balancing work life balance and seeing how we can help with that. We can all help with that, in our own way. KK: Absolutely. Give us a sense, MJ when someone walks into the office what some of the stuff you're assessing? what do you do as a physio to help patients that's within your scope? the exercises? help me understand the potential and the things that you do to help address these issues.MJ: So, once we've listened to everybody's story, and they tell us what their main concerns are, and what their goals are, in terms of what would they like to achieve with our time together. We do a lot of education, and education can be like I said, lifestyle, sleep, how are they functioning with nutrition? Are they exercising? are they happy? Are they stressed? then we really go into the function of the pelvic floor. So, if we talk about the main concerns most of our clients are coming in with often it will be bladder issues, bowel issues, it will be sexual health issues, and maybe constipation issues, like some bowel issues, that all tends to act up in perimenopause. That's when we take out our props. I have lots of props to explain to people about the pelvis. Because again, we are not taught anything about the pelvis as human beings. And if we think about our education in our primary schools, in our high schools about pelvic health, there's none of that. So, we often don't really know about the pelvis, right? And where the pelvic what's happening to our pelvis. If we look at this wonderful pelvis has been with me for 25 years, so it's falling apart. KK: People listening, you might have to be extra descriptive, extra descriptiveMJ: Okay, so when we look at the pelvis, if I take the muscles out of the way, this is the front of your pelvis. So that's your pubic bone. By turning the pelvis around, that's your kind of your spinal column and your tailbone would be right here. And if we look at the bottom, while the bottom is all muscular, it's just muscles down there, and you have layers of muscles, and we call it because we're not very clever. We're calling it the pelvic floor muscles. There's a lot of fancy terms in anatomy, so we won't go through that but for the sake of purpose, the pelvic floor and there's layers. The first layer, which is the most superficial, so meaning that you can touch it from the outside. These muscles here go from your pubic bone to your tailbone here at the bottom, they wrap around your clitoris, and your vaginal opening, and then they also wrap around the anal opening. All of these muscles here, the main function of these little muscles are that the vaginal opening or for sexual function, which is why sometimes we can have difficulties with maybe having an orgasm, libido, desire orgasms, and maybe we have pain with intercourse. These muscles which are under voluntary control, so we can learn to use them, they must contract, but they must relax. When things go in the vagina, all these muscles must have the capacity to stretch into expand, and that should never cause us pain. So that's this first little group. We'll maybe dive into kind of sexual function a little later. But that's the first little group. Then deeper inside your pelvis, you have another group of muscles that are deeper inside your body. These muscles, they're quite big, quite large, they wrap around your vaginal opening and your anal opening all the way from your tailbone at the back to your pubic bone at the front, those are your bladder and bowel control muscles. So if I take that muscle out, just to show you how big it is, the big muscle, front to back. When you laugh, when you cough, when you sneeze, when you lift things that are heavy, these muscles tighten around your urethra, or tighten around your anal opening so that you don't lose bladder control, you should be able to hold on to those muscles to get to the bathroom on time. Then when you sit to go to the bathroom, they relax this stretch the expand to allow us to go to the bathroom. So, when people come to see us for bladder issues, bowel issues, or sexual health issues and sexual pains, what we're trying to determine is what's happening to that little group of muscles, what's happening to that pelvic floor. I always tell my clients, there's two groups of you. There's a group that come that comes to pelvic health physio, where when we evaluate the function of their pelvic floor, they just lost a lot of strength and endurance. We see that in perimenopause and menopause because this is my hormones are important. When you go through perimenopause, your hormones are starting to dip down. They're not gone yet. But your estrogens are dipping your testosterone and your DHEA, which are your androgenic hormones are decreasing. We need estrogen for muscle strength, and protein synthesis and collagen. When we have a loss of estrogen, we start to lose muscle strength, we start to have what we call sarcopenia. Right. And that starts to increase as we age if we're not moving and exercising. So, estrogen is really important for muscle function to testosterone, which we have, we don't maybe have as much as our male counterparts. We do have some in it, it is important because it helps with muscle strength and muscle tone. That impacts the pelvic floor. So, I may have someone who has never had babies never, never could not have children or decide not to have children who come to see me, and perimenopause and menopause and they'll say, Why am I having incontinence, I never got pregnant. Well, that's because even if you have not had children, you're gonna go through menopause, you're gonna have those hormonal fluctuations. You can still have some symptoms of menopause and one of them could be incontinence. And the other thing what these pelvic floor muscles do, which is really great when they're working well, and you're able to use them properly, they help decrease the sense of urgency and frequency, right. So, some people say I go to the bathroom all the time I'm peeing every half an hour, I'm getting up three, four times a night to go to the bathroom. When we help regain function of these pelvic floor muscles to reduce incontinence can also reduce urgency and frequency and the need to get up at night. So, group number one may have a lot of weakness and loss of strength in their pelvic floor. Again, that happens in menopause with the loss of our hormones. A lot of the symptoms tend to worsen about seven to 10 years after you're done having your menstrual cycles remember that you are menopausal if you've gone 12 months without your menstrual cycle, usually symptoms of menopausal peak a kind of that seven to 10 years. I's about honestly, they're saying about 50 to 65% of the population may have actually some symptoms, you know, at those seven years, post menopause. Second group of people that often come in is when we evaluate their pelvic floor, they have all the same symptoms will have bladder issues or going to the bathroom a lot. But then they tell us they have pain, they have pain with sexual activity. Then when we look at their pelvic floor, they actually have too much tension. Okay, and that's a problem because if you look at this little layer of your pelvic floor, these muscles that wrap around the vaginal opening and your clitoris, so these are your clitoral muscles. So important to have orgasms if you have too much tension in these muscles like this when things going in the vagina start to hurt. Again, that can start to be a problem in perimenopause and into menopause, again because of hormonal changes. What happens is, you're going through perimenopause, or menopause, or maybe you're in menopause, your estrogen levels have dipped down. Estrogen is like the fountain of youth, estrogen plumps up our tissues, it increases blood flow to the area, it provides elasticity to all of our tissues, and that's your labia, and at the vaginal opening. This area is really, really rich in what we call estrogen receptors. And of course, when we go through perimenopause and menopause, that's a decreasing, and so things get a little thinner, things get a little drier, and things lose the elasticity. What often can happen is, my clients will have intercourse, and it hurts, and maybe they bleed a little bit, because again, you know, when estrogen goes low, everything gets a little drier and more sensitive, and they've been prone to maybe even some tearing, well, then that pelvic floor is actually very clever, these muscles here, they're there to protect us as well. So, if you have pain, then the next time you think about engaging in sexual activity, your brain is going to say, You know what, that really hurt last time and right away, we start to tense up our pelvic floor. And then we get caught in this vicious cycle, where we have that episode of pain because of hormonal changes, then it hurts and then our pelvic floor tenses up. Then we keep trying to have intercourse, but then we keep irritating that area, then the pelvic floor just increases in tension and increases in tension. That can lead to more pain, with sexual activity as well. So, I always tell my clients that we need to figure out which of the two groups do you belong to? Do you have a pelvic floor that just needs strengthening? Or do you have a pelvic floor that maybe requires a little bit more stretching and relaxation, to help you regain proper sexual function? You know, having sexual function without pain? In everything that we do, you know, we always take that step back and go, Okay, well, you know, what are the stressors in your life that also increases muscle tension, right? So, stress and anxiety, and lack of sleep, all increase our fight or flight response. And that's why sleeping is so important to kind of really get you restorative health, you know, and to make sure that we're refreshed in the morning, managing our stress is really important, because when you're under stress through the day, and you're in that fight or flight responses, all your muscles tense up, including your pelvic floor, right? So, then what we do is we do a physical exam. This is kind of where, you know, doing a really good explanation of the pelvic floor is really important. So, I have these really great models that I've designed over the years. And what I do is I show all of the muscles, so you've got muscles at the vaginal opening, that can be the reason you have pain with sexual activity, you've got deep muscles inside that your bladder and bowel function muscles. So, when we do a pelvic exam, we do not use speculums. We don't have you in stirrups, it's not like kind of a pap, we're going in manually with one finger and we start on the outside and we just have a look at all these muscles to see are they causing you any discomfort that could actually explain some of your pain with sexual activity. If we're able to do that, then we can go in. We can look at all of these bands, all of these muscles that you see here that's colored, these are all your pelvic floor muscles. We can evaluate all these bands of muscles right side left side to determine Are any of these muscles causing you any pain, because pain with sexual activity can be pain at the opening? or some people will tell me you know, it's deep inside. ‘It's like I can't like we have to stop it hurts so much deep inside'. Then we evaluate these muscles I say, ‘Okay, if I said to you try to contract, try to squeeze those muscles, especially with people that have incontinence, bladder or bowel, I'll say try to contract your pelvic floor'. That's where we're assessing strength and endurance, okay, how strong are your muscles? You know, how much endurance and power does your muscles generate? And if that's lacking, we're gonna work on that. So that's kind of the physical exam and the physical exam is as per our client's comfort levels. So, some people on day one will say, I'm not comfortable with a pelvic exam, maybe they need a visit or two to get comfortable with the idea. You know, some people are not aware that that's what a pelvic health physio is trained to do. We are trained to do pelvic exams for the purpose of evaluating what's happening to all these layers of pelvic floor muscles. So, you can regain bladder control bowel control, and sexual function. The other thing that this pelvic floor does, it's like a shelf, it holds up our organs and so a lot of our clients will say, ‘I feel like feel like something's falling out of my vagina'. They get diagnosed with something called the ‘prolapse', which is everything kind of softening up and estrogen is important for that because estrogen is what we need to have strong ligaments and strong tendons. A lot of times heading into perimenopause or menopause, somebody may have had a prolapse when they had their, two, three children in their early 20s, and did absolutely fine. But now they're starting to have symptoms because their estrogen levels are decreasing. That's really altering kind of the function of what we call the collagen fibers in their tendons and in their ligaments. We have a lot of ligaments that hold up our organs, and everything just kind of soften. So obviously, nothing's ever going to fall out of your body. It's never going to happen but everything softens a little bit and part of what we have to do is strengthen that pelvic floor if needed to kind of create that supportive system from the bottom. It really is all about exercise. It's about exercise. KK: That was going to be my next question, maybe with that first option of picking up someone that is having issues with incontinence, assuming you're addressing the lifestyle issues, and so on. But what's an example MJ of exercises or type of exercises that they will be using to try and rectify the problem? MJ: Everybody's heard about those famous Kegels right? Everybody's heard about Kegels KK: I'm doing them right now MJ: Kegel, he was a physician; he was a gynecologist back in the 50s. Dr. Kegel and who's who had done kind of a lot of research on the field of the pelvic floor. We call them pelvic floor exercises. So yeah, we teach our clients how to properly contract their pelvic floor. What's important to know is that you can read online on how to do cables, and how to engage your pelvic floor, but they're not easy to do. It's important to see a pelvic floor physio, because a lot of people think they're doing them properly. Then they come and see us and they're confident ‘Oh, no, no, I've been doing my ‘Kegels' fantastic, I think I'm good' and we test them, and they're not doing them properly. We tend to cheat a lot. When we try to engage your pelvic floor, we're holding our breath, maybe we're squeezing your bum, or we're sucking in our belly. Really, you should be able to squeeze your pelvic floor, you can think about I was kind of give the example to my clients, I'm like, imagine a little ping pong at the opening of your vagina and just try to grab and pick up your ping pong and for my patients that have penises, I'll say try to lift up your penis, right. Those are some of the things that we explain. That's how you think about engaging your pelvic floor or think about stopping gas. The reason it's so important for us to do a pelvic exam is from the outside, I can't tell if you're doing a proper pelvic floor exercise. When we do a pelvic exam, it really tells us how well you are using those muscles. If you have pain, then we're at least kind of finding out that there's too much tension and if you have too much tension, I'm not giving you Kegels to do. That makes sense, right? So, if you're coming in just for incontinence, I evaluate your pelvic floor, there's no discomfort, when I'm palpating those muscles and you're good to go. Yeah, then we're going to work on some strengthening. If you're already here, and then you've got pain, with intercourse, maybe it hurts to go to the bathroom, you're not peeing really well. So the muscles are not relaxing, and I evaluate your pelvic floor and there's too much tension, well, I'm not going to give you more Kegels to do. So, in that case, we're doing things to relax the pelvic floor, and this is where we do breath work. And we do yoga-based movements, a lot of pelvic openers and yoga, a lot of breathing, maybe some meditative type of practices to help relax that tension. Once we relaxed that tension, once the pain goes away, then maybe we can do some strengthening, if that's what your body needs at that time. That's why it's so important for us to do an exam because again, I can look at you and I have no idea if you've got a pelvic floor that's too weak or a pelvic floor that has too much tension but when we palpate it we can see and then we can give you the proper exercisesKK: This is good because once again I think there is a lot of women that are struggling with these concerns and with that are maybe at a loss. Are there a lot of pelvic specially physios out there? for example if people want to get access to someone of your caliber and this is not something you could be doing virtually either right? MJ: I did a lot of virtual; I still do. Virtual is really good for is sometimes even just the initial assessment like the first time because we do talk so much and we do a lot of education. So during COVID we did quite a lot of virtual and I continued to do so and sometimes that day one. Maybe you know if you've got COVID You can't come into the clinic well then, I'll just do a virtual with you do all the education and then you come back in to see me for kind of an in person visit when you're feeling better you know when you're not sick, things like that. So there's a lot of us doing virtuals as well. The best place to kind of find a physio in your area that has the qualifications to do a pelvic exam and to do pelvic health, is to look at the website called pelvichealthsolutions.ca and there's a find a physio feature there. You can actually click in your area, look at people's names, it shows all the courses they've done, so then you can kind of look at, oh, this person's done a menopause course, great. This person's done a hormonal health course. That can help you choose a physio in your area. That's a really great feature that we have. pelvichealthsolutions.ca is a great resource. There's a lot because we're, when I started 20 odd years ago, there was four of us in Ontario doing pelvic health. Now we have hundreds of physios who decided to take pelvic health courses as postgraduate training. We are not without pelvic health physios out there to help anybody who has a pelvic floor, anybody who has incontinence, anybody that has any problems with sexual health, anybody with constipation, there's so much we can do. Like I said, we've become resources for our clients to help them find the right people to go see whether it's nutrition, stress management, mental health and whatnot is really part of what we do to help her patients navigate perimenopause and menopause. KK: Wow, MJ, pure gold. In terms of knowledge and resources I must say, this was some of the best explanations of the issues when it comes to pelvic health. This is the stuff as a physician, you hear about these concerns, but the way you just simplified it, using language that all of us can understand, conceptualizing it in ways that we will understand. Putting it into, for example, two frameworks, or two patient populations that you typically see, you're the GOAT. MJ: Thank you! That's why we say to people, if you're not sure at least come in for the first visit. So, you get a chance to chat, you know, and that's a nice thing about doing virtual, you're not sure about it, we'll do a virtual and we can talk through and I think a lot of people then realize, ‘Oh, there is help for me, oh, sexual, sexual dysfunctions and payment sexual activity'. That's not okay. No, it's not okay. It's not okay, that you're not sleeping through the night because of hot flashes, right. Then really talking about the research and the evidence behind what we do. And we have a fairly high level of evidence in what we do in terms of treating incontinence and prolapse and pelvic pain. Having a chance to talk to our potential clients about that is good. Again, to make everybody feel more comfortable with topics that are not comfortable to talk about. I mean, there are still a lot of taboos around bladder and bowel health. There's a lot of taboos around sexual health. There's a lot of taboos about talking about menopause. Because we've been told, while menopause is just part of life and deal with it, suck it up, right, suck it up, you know, don't complain about it, you know. I think, I think our clients are starting to get fed up with feeling so poorly, and so discouraged about their quality of life. Like I said, it's not insignificant, there's over 30 symptoms of menopause. If we can improve any one of them, I think we're doing well, to help navigate, you know, and these challenges that our clients have. We have great research, I was just reading, just to get ready for today, that strength training again, we're physios you know, we're all about exercise motion is lotion. We encourage our clients to even get out like I always tell my clients, even your pelvic floor loves to go for a walk, just walk outside. The thing with walking is that you're outdoors in the fresh air in the sunlight, you're getting your vitamin D, you're setting your circadian rhythm, there's good research to say that if you get outdoors in the morning and bright sunshine for a good walk, you're gonna sleep better at night. Right? But strength training, which we again love to encourage your patients to do reduces hot flashes by 44%. you know, again, this is kind of in the purview of a pelvic physio or any physio is we're all about, you know, strength training to help mitigate the effects of losing estrogen and testosterone, right, strength train to reduce your hot flashes by 44%. Wow, you know, strength training to reduce osteoporosis because that increases when we hit menopause as well, because of all the hormonal changes, strength training to improve your insulin resistance so that you can lose weight and strength train for your pelvic floor because when you're strong, your whole body, everything's strong, even these little muscles here, and so kind of giving permission to your clients to exercise, but it's hard, right? because, you know, it's time, you know, and part of what happens in menopause is that people are overwhelmed with stress, and people are not taking the time to do the things they, you know, that we all get told to do, you know, eat well, sleep well ,exercise. So, it's kind of helping our clients navigate, you know, where could they find time to sneak in a little bit of exercise? What can they cut out? Right? What can they let go? What's not important, you know, and, you know, talking about the importance of strength training, I think, again, it's an eye opener. So that's why the education is so important, because when we educate people go, ‘Oh, okay, well, that's a good reason to act' maybe that's the one thing you needed to hear, to allow you to go and think about strength training, and it doesn't have to be a lot, you know, just a couple of, you know, 10-15 minutes a day can maybe be a good start. Because the impact is so amazing, just like the impact of yoga and osteoporosis and yoga and constipation and it doesn't have to be an hour of yoga, you know, I can help find a video, that's like, 15 minutes, maybe you do that before you go to bed, right to help you sleep and so education is really key, and to, to really help our clients navigate all of these crazy symptoms they have and making sense of it all. Hopefully, get that buy in that motivation that something that speaks to them that says, okay, I am going to try to make a change. When it's hard, you know, you know, one of the things that happens with our clients and menopause is they stopped exercising because they're losing bladder control. KK: Yeah, that was actually one of the things you're mentioning the resistance training. To create the habit, it's not about the result always. You got there, you did your part of the process, even if you get to the gym for that five minutes, and you didn't do all the exercises you were planning to do, but you're getting that that habit developed. So, yeah, as you alluded to, it's hard to do all these things. But to develop the habits, I think is, is where, if you could develop the habits, you'll be moving in the right direction. MJ: Yeah. And I think the more information people have about the benefits, beyond what we already know, right? I mean, we kind of go, weight loss, and I gotta quit smoking, but sometimes you can actually reduce your symptoms of menopause this way or that way, you know, again, that might be enough to persuade someone to say, okay, you know what, then I do need to carve out time in my day, I need to let go of the things that maybe are not that important, and really spend time on myself, and really improved my sleep, and improved my nutrition, and improved my stress management and try to think about exercising, because again, it doesn't take a lot to make a really big change. It doesn't take a lot to go for a walk, I'm happy if you start off with 10 minutes, I'm happy. If we decide Yoga is the best way for you to manage your stress or to help with your IBS or osteoporosis that you're doing even 10 minutes of it. 10-15 minutes of it. We start small, and we build on that. We provide encouragement, because again, we all have bad days where we fall off the rails, and it's okay, we're humans, we're human beings. As long as you just keep at it, you'll start to see some changes. And, and like I said, it's building a team, because our clients need to have the right people helping because MJ can't do everything for everybody like that, you know, if we're only one person, so who are the menopause experts out there who are the nutritionists out there who have a really good interest in menopause and Hormonal Health. Who do you go see if you're having insomnia, right? Because there's CBT there's cognitive behavioral therapy for insomnia. Okay, who are the people for that? Do you want to get hooked up with a personal trainer to kind of motivate you to strength training? Okay, let's find you someone to do that. It's all about building a team and it's all about dialogue, and always talking about these things and giving our patients permission to talk about what's bothering them, and to be open about their frustrations and you know, if they're having frustrations with their weight loss and okay, let's see who's out there who can help you with that.KK: MJ, this has been grand, it's been grand! How do people get a hold of you? I am working right now, I'm in downtown Ottawa. I'm at a clinic called Killens Reid physiotherapy, killensreid.com, we're three pelvic physios at that clinic. There's myself, my lovely colleagues, Natalie and Sophie all of which can help you with menopausal issues. You can look at that pelvic health solution website to find people in your area. It's a great resource. That's the group that I'm one of the teaching instructors for pelvic health. You can see how many great pelvic health physios we have all across Canada. There are also naturopaths, who have taken our courses that are listed. So, if you want to maybe work with a naturopath who has a knowledge of pelvic health, they're listed on there as well. We have some nurse practitioners that have taken our courses, who again have developed an interest in pelvic health. You can find all those people on the pelvichealthsolutions.ca website. Killensreid.com to reach the clinic that I'm at, you can I have a website as well mjforgetpt.ca. I'm on Instagram ‘mjforget'. There's lots of different ways to find us and, and to kind of help you with all your symptoms. KK: I love it. I love it. Thank you, MJ, for the knowledge that you threw down the holistic approach the benefits of seeing the likes of you, I really appreciate you coming on. This is awesome. I appreciate any opportunity to talk about all things pelvic health, and I appreciate all of you've done again, because you've taken quite a holistic approach yourself as someone in medicine right in really thinking about nutrition or sleep or stress or you know, exercise mindfulness and it's always nice to talk to kindred spirits, I say.KK: Thank you so much. Alright, well, I hope you've enjoyed that episode. Please follow us on Instagram YouTube, Facebook, TikTok, Twitter at kwadcast. Please leave any comments kwadcast99@gmail.com. Leave a five-star rating on wherever you listen to podcasts. Leave a review. Check out our newsletter at kwacast.substack.com. Everybody stay beautiful Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we are joined by a fantastic group of employees from Bayshore HealthCare. A Canadian-owned company, Bayshore HealthCare is one of the country's leading providers of home and community healthcare services, providing customized care plans and solutions that allow clients to remain in the comfort of their own homes. Today, we get to hear from a few of their dedicated employees about their health and wellness journey, wellness in the community, personal care, challenges faced through the pandemic and more! Our panelists share with us their diverse backgrounds and how they impact their community as well as their amazing experience working with Bayshore HealthCare.Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we are joined by Dr. Alfred Atanda. Alfred is an orthopedic surgeon specializing in sports medicine. Today Alfred shares with us everything about his initiative, Sports Link MD, a telemedicine service for youth athletes, connecting them with specialists efficiently. Alfred also shares with us some of his past, how he balances work and his personal life and talks about physician wellness, physician burnout and his work to help optimize the physician experience, racism in the workplace and more.Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we welcome Neil Pasricha. Creator of ‘The Book of Awesome' Neil is a New York Times bestselling author and journalist. His work has spent over 200 weeks on bestseller lists and hit over 2,000,000 copies sold across dozens of languages worldwide. A proud Canadian, currently living in Toronto, Neil holds degrees from Queen's University and Harvard Business School, his first TED talk gained notoriety as one of the 10 Most Inspiring of all time. Today Neil shares with us his journey toward happiness and bits of his past that inspired him to focus on mental health and well-being. He gives us incredible tips on how to start and end your day and how he continues to help people live healthy, purpose-led lives through intentional living.SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode, we welcome back Dr. Lucy McBride. Lucy is a Harvard graduate with expertise in the long-term management of hypertension, heart disease, lipid disorders, diabetes, mental health issues, and more. She joins us again today to talk about women's health. We go over everything from hormone replacement therapy, to different forms of hormone replacement, perimenopause, and more. Lucy addresses the medical risks and issues with taking estrogen, and we learn about the many alternatives to hormone replacement therapy. Later in the episode, Lucy answers a few questions from our listeners and gives some great feedback!Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode we welcome critical care nurse practitioner, Kali Dayton, DNP, AGACNP. Kali is a member of the Society of Critical Care Medicine and host of the ‘Walking Home From The ICU' podcast. Kali works closely with international ICU teams to help transform patient outcomes. They focus on early mobility and management of delirium in the ICU. She joins us to chat about her early days and experience in the ICU, sedation in patients and the effects of mobility of patients in the ICU, medications, how she helps with patient healing and more. Kali tells us about what inspired her to start her podcast and shares a story about her experience with an ICU survivor.SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"TRANSCRIPTKK: We are on the brink of a mental health crisis. This is why I am so appreciative of the folks over at BetterHelp everybody the largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to better health.com And use a promo code solving healthcare and get 10% off signup fees.SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive. One of the blessings that has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com or reach out on Facebook @kwadcast or online at drkwadwo.caKK: Welcome to ‘Solving Healthcare', I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of resource optimization that one, we are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved. KK: Kwadcast nation super exciting episode I got flowing with you. We got Kali Dayton. She is a nurse practitioner that has taken ICU delirium, ICU mobility so seriously, she's got her own consulting firm. She also has her own podcast ‘Walking from the ICU'. Such a great phenomenon. So, we got her you'll hear this episode. It's a live cast that we did a couple of weeks ago. I'm just proud of her. Someone that's taken getting people healthier and out of the ICU and functional seriously, and we need more of that going on right now. We're only gonna see higher demands. So, without further ado, I'm gonna bring Kali on but first, check out our latest newsletter, kwadcast.substack.com It has everything Kwadcast, our episodes, or newsletter, guest blog appearances, guest vlog appearances, you're gonna love it. Kwadcast.substack.com Check it out. Without further ado, I want to introduce you to Kali Dayton. Welcome to the podcast.KD: Thank you so much for having me on. I've been following your podcast; I appreciate your mission. I see a lot of our objectives are in line.KK: Oh 100% 100%. So, Kali, can you walk us through your story? You're a nurse practitioner. That is, like I said, changing the outlook for critically ill patients. How did you get here?KD: Absolutely. I'm sure a lot of my listeners know my story very well. I started out as a brand-new nurse, many years ago, over a decade ago, in awake and walking ICU. That's just what I call it now. That's the term that I've coined to describe what they do there. In the interview in my naivete, I was just excited to be there. I had no idea what they were talking about when they asked, ‘Would you be willing to walk patients that are on ventilators?' and I was willing to do anything, right. I was just brand new graduate. I said yeah, of course absolutely teach me everything. I didn't understand the magnitude of that question until probably three to eight years later. Because when I started working there, no one made a big deal out of it, for decades and that ICU it's a medical surgical ICU, its high acuity, they've had a COVID ICU throughout the pandemic. They've maintained it this practice of allowing almost every patient to wake up, usually right after intubation, unless there's an actual indication for sedation. What's been intubated on mechanical ventilation is not an indication for sedation. So, unless they have an inability oxygen with movement, seizures and cranial hypertension, something like that, otherwise they are awake. They're reoriented and they're allowed to communicate, tell us what they need. We manage their pain according to what they tell us. They're usually mobilizing shortly after within hours after intubation, and throughout the day, and throughout their time on the ventilator. So that was completely normal. No one told me ‘Hey, Kali, this is the gold standard of care. This is the model for all early mobility protocols in the world' Everyone knows about this ICU. No one told me that. So, I spent a few years there thinking that that was normal critical care, medicine, knowing none the wiser. Then I became a travel nurse, and I went to other ICUs in the in the United States. My very first contract when I walked into the ICU, it just felt different. But I knew I expected things to feel different, right? It's a new environment. But everyone was in bed. Everyone looked like they were asleep. There were very few signs of life, and I got my patient assignment, and the patient was sedated and on the ventilator. I didn't know why they were sedated. I wanted to continue my routine, do a neuro exam, hopefully get the patient in the chair ready for physical therapy, because that was my routine, in the wake & walk ICU. A lot of times physical therapy comes out of that patient is in the chair waiting for the physical therapist, take them on a walk even on the ventilator. So, I asked my orientee nurse, ‘Hey, can I get this patient up and take him for a walk?' and she looked at me in horror and said, ‘No, they're on the ventilator. They're intubated' What didn't make sense to me, because I've cared for at least hundreds, maybe even 1000s of patients that were on the ventilator and were awake and walking. I had no idea what she was talking about. I said, ‘I know that they're intubated. But why are they sedated?' ‘Because they're intubated?' and I say, ‘Okay, but why are they sedated?' and we went in circles. That was the first time it ever crossed my mind that a patient would be automatically sedated, just because they were intubated. I quickly realized that that was the common perspective throughout the ICU, that I was the odd man out there. Here's the thing. Despite my years of experience, treating patients like that, I knew how to do it. I didn't know why we did it. No one had taught me what sedation actually does. No one taught me what it's actually like for patients, and how much it changes outcomes. So, in that environment, I didn't have the tools to support my approach and my practices and to advocate for my patients. I was still kind of a new nurse, and I was, you know, you just had to fit in in the ICU. There's so much peer pressure, there's the culture is such a huge part of it. I ended up just taking the ‘When in Rome' approach and I just went with what I was surrounded with, and I ended up following along sedating my patients. I didn't really obviously know the difference. I mean, I saw a difference in outcomes. I saw patients stay on the ventilator for far longer. I missed the human connection, I noticed that there were a lot of tracheostomies and nursing home and LTech discharges that I did not see the way can walk in ICU 93% of survivors from that high acuity medical surgical ICU that I came from, went straight home after the after the ICU.KK: That is nuts. That is nuts.KD: That's what I thought was normal. So, I was noticing things, but I couldn't really put my finger on it. I couldn't advocate and I just went with it. Right. I even laughed at some of the nursing jokes about yeah, I hope my patient sedated, and totally snowed today. Thinking that that was funny, and it wasn't till years later that I was in grad school. Of course, even in my acute care doctorate program, nothing was mentioned about sedation or mobility practices. It was just assumed even in our case studies, it was assumed that if a patient came in with pneumonia, they were going to be sedated if they were on a ventilator. I was on a plane ride, and I sat next to a survivor. When he heard that I was a nurse and ICU nurse, the color dropped from his face. He started telling me about his experience over four years before that moment when he was a patient. He told me what it was like to be on a ventilator. He just barely mentioned the ventilator. All he could fixate on was what it was like to be in the middle of a forest with his limbs nailed to the ground and trees were falling down on him and he couldn't run away. Demons were coming to the sky and lots of things that he still couldn't talk about, because he was so deeply traumatized. I was stranger on this plane and he's sobbing to me, telling me about what he experienced. Of course, I wanted to diagnose him and I said ‘it sounds like you had ICU delirium' but that meant nothing to him. I came to realize as I listened with real empathetic ears, that that wasn't just a nightmare. Those weren't hallucinations. Those were vivid and real. He was psychologically scarred as if he physically lived through those scenarios. I was really shaken. I really hoped that he was one in a million, because he was telling me that for year after discharge, it was really difficult to relearn how to sit, stand, walk, swallow, that was really hard. The hardest part was that for year after discharge, every time he closed his eyes, he would be lost back in that forest back in that scenario, and he could not sleep. So, the depression, anxiety, physical disability, I didn't ask about the cognitive function because I didn't enough know enough to know that he wouldn't be at high risk of having post ICU dementia. He said that he still had not returned to his career. His life was over. He said ‘I know I feel bad even telling you this, I should be grateful to the ICU to him for saving my life, but my life is over. The life I knew before the ICU is gone. I lost my life in the ICU. If I were ever to become sick, I would never cross a toe back into the ICU. He was a DNR/DNI in his 40s, with no other real comorbidities because he never wanted to live through that again. I think what he meant by that was ICU delirium. I had worked in the ICU about six years. We have never I never heard anyone talk about anything like that. So, I thought this must be a fluke, he must be one in a million. So, I went survivor groups. I thought I would have to post and ask survivors questions. No, the second I got into survivor group, I just scroll through and almost all their posts were about the trauma suffered under sedation and these medically induced comas, what it was like to not be able to balance their check book, read a book, read a clock, like they were barely able to text. These are people thinking ‘How long is this going to last? my brain is not the same'. So that is what got me into looking into the research. I was shocked to find decades of research, exposing the harm of our normal practices. Yet we continue to do those things and I was back in that awake and walk ICU. Seeing a completely different way and I've seen this contrast from what I experienced for years as a travel nurse. Then where I was currently at as a doctorate student, nurse, and then I started working as a nurse practitioner, in that same ICU. That's when I started this podcast ‘Walking home from the ICU' to show what they were doing in the ICU and now it's turned into ‘how do we revolutionize our normal practices in the ICU?'KK: I got so much here, first. I never even would have comprehended or would have thought that your initial experience, I didn't realize that your initial experience was people were able to ambulate and get out of bed and reduce the amount of sedation. KD: People are gonna say ‘Oh, well, that must have been, you know, long term mentors or not that high acuity' They were the first ICU to publish the study back in 2007, showing that it was safe and feasible to walk patients on ventilators and in that study, they had PF ratios less than 100.KK: What that means in nonmedical folk is that your lungs were extremely damaged and require a lot of supplemental oxygen to make sure your saturations are high enough that your oxygen levels are high enough. So, this is the sickest of the sick. From a breathing perspective, getting up and hustling and movement answered. So that is amazing. From a personal side, it must have been an absolute mind F that you couldn't, that you went from one extreme to the other. I'm doing tell you from my I've worked in several ICUs in my country, and the latter is the norm, people aren't getting up on a ventilator, you know, they're not getting, they're barely getting up into a chair on a ventilator. KD: They aren't even getting sedation vacations, they're snowed. KK: One of my main jobs in the ICU when I walk in is minimize the sedation and even often I've seen in practice, they're getting Dilaudid or opioid infusions for no real reason to be honest with you. They're not post op. They have no pain syndrome and we're given pain medication in infusion, which accumulates and what you're describing to amongst patients, my other job is in palliative care when they get toxic or delirium. Delirium from medication. Yeah, that can be traumatic, these memories, these images. That must have been an absolute frustrating experience to go from one version to the other.KD: I was just really confused. I mean, I was still I feel like I'm still new in my career and impressionable. No one taught me the why that's the unfortunate thing about a lot of our medical education is we're taught how we're taught task lists, but we're not taught the why that allow us to critically think and see a bigger picture. I feel like looking back I was really victim to that. I but I would still ask every ICU ‘So, shouldn't this patient get up? Can I get them up?' because it I knew that was beneficial. I wanted that and a lot of it for me was, I wanted to see my patients get better. When you're walking a patient moments later, you know that they're progressing, you get to connect with them, you get to know who your patients are, I had no idea who my patients were, they were just bodies in the bed. That's not why I got into medicine. So even just selfishly, I wanted them to be off sedation, had I known that by taking off sedation, we could decrease their seven-day mortality by 68%. Oh, I would have been all over that, but I didn't know. I did work in one ICU, where they had some level of ABCDEF bundle, which is a protocol to help guide teams to minimize sedation and get patients up. There's such a spectrum of compliance and different approaches to it. So, I was taught to do an awakening trial, which means you turned on sedation. The purpose really should be to get them off sedation, it should be sedation cessation, but I was taught. So, you know, at five o'clock in the morning, we must turn down sedation, it's super annoying, I know but just turn it down. Wait to see them thrash - that's how you know, when you see all their limbs move that they haven't had a stroke. When you can tell they can't tolerate the ventilator, then you turn the sedation back on and call it a failed trial, just chart it. I was confused. I didn't know what the objective was, I didn't know what we were doing. I didn't know why they were agitated. For her to say it's because I can't tolerate the ventilator. That was confusing to me because I'd seen so many patients tolerate the ventilator. I didn't understand delirium, and I hated awake new trials. They were laborious, they were stressful, they felt unsafe. It's hard to see patients between delirium, it's hard to see them be so uncomfortable, and you can see the terror in their eyes. But again, when in Rome, I just did what I was told, unfortunately. So, this is my journey now is almost my penance for the harm that I caused my patients during those years. KK: Well, Let's be honest, Kali, you can't be looking at it that way, man. We all remember sedation is the norm. What we're doing now is trying to advocate for change. I can't emphasize enough the change can be dramatic for people like it really comes down to function. If you in the ICU and you're paralyzed into intubated on sedation and analgesia, you're not moving, like you're not using your muscle. Then when you're trying to go back to what you want it to where you want it to be. I think a lot about our COVID patients. They were in the 40s/50s/60s, that are trying to get back to working, trying to get back to doing the activities that they love to do. When you think about this not only are you impacting their ability, like they're not getting to their functional level, but what's it doing for their family. Now you got a loved one that's got to take care of them, that might have to take off time off work too. It just is an absolute amplifier when people can't be functional.KD: For those that maybe don't work in the medical field, or even especially those that do, here's what we're not talking about the bedside, here's what we're not telling patients and families. When we go into surgery, they give us informed consent, they tell us here are the remote risk that things that could happen, right. What we don't do before intubation for patients and our families is tell them the actual risks of sedation. We don't understand ourselves that sedation is not sleep, it disrupts the brain activity so severely that they don't get real REM cycle. So, my perspective is that it's a form of torture, really, I mean, that's what we do, and war in the military, we deprive people of sleep, and that's what we're doing to our patients when we give medications that make it so they cannot get restorative sleep. Many of our study, sedatives are myotoxic, meaning that they're toxic to the muscles, so it causes more muscle breakdown. Then on top of that, if there's absolute disuse when you're stopped sleeping deeply sedated, you're not even contracting a muscle usually. So that disuse makes it so that our muscles break down more. That disruption of sleep often caught is one of the mechanisms that causes delirium, which is acute brain failure. It's an organ dysfunction. That can turn into long term post ICU, dementia, cognitive impairments. So, they cannot return to their normal lives can't take care of their families can't go back to their jobs because they can't. Cognitively their brains can't function the same way anymore. They have this post ICU PTSD because of those vivid scenarios that they live. I'm not going to call them hallucinations, because that's, that's not accurate. Those were real to them. We just don't see that big picture of sedation, and we just don't even question and I do that a lot in my life too. They're things that I'm just taught that I don't question, but we don't question whether or not sedation is necessary. Sometimes it is. When we understand how risky it is, then we can do a true risk versus benefit analysis for each patient to say, ‘they're intubated for this reason, does that necessitate sedation?' If not, let's get it off and see what they need. Let them communicate. Let's prevent delirium. Your platform is all about preventative medicine. In the ICU you come in with one acute critical illness and we sign them up for chronic conditions?KK: Absolutely, as you said, like it really is about what can we do to prevent this from becoming a chronic condition. Honestly, it's a culture change, from what I could see. What's sad about medicine, is that we have data to support how bad things are or how good things are. The amount of time we invest in create that change is limited. If you look at the data for sedation vacation, so that same principle of, turn off someone's sedation, periodically, that we know that has positive outcomes, like we know that, but you could go through an ICU, throughout any country in North America and the odds are that they're not getting it routinely. Why doesn't that happen? That's why I'm proud of Kali. Number one, being a champion of this, ICU care sucks, but a lot of us that will end up in there. So, we want to be able to optimize care, but also like just doing some about it. It's one thing to want to bring attention to it but also, being an activist. I think it helps. So, you've got the podcast, Kali, you've done some other work, how else have you been able to increase awareness? You could even get into like, what the podcast also has done for you or in the people around you?KD: So with a podcast, I started that right before COVID hit. I don't know if your god person but I, God told me to start a podcast in December 2019. I barely even listened to podcast didn't know how to start one, but I couldn't. I couldn't rest. I knew exactly that I had to start, I had to put out 32 somewhat episodes by the beginning of March of 2020. I didn't know why it had to be so fast and so furious, and survivors came out of nowhere. I interviewed my colleagues, researchers, it was just this miraculous setup that just came together, put out all these episodes, and then COVID hit. I thought ‘well now it's all gonna be all about COVID, and no one's gonna care about this'. God back handed me and said, ‘This is for COVID They're gonna be millions of people on ventilators, how is this not relevant to COVID'. So, I continue to throw out COVID Even though I recognize that the ICU community was not really in a place to revolutionize. The hard thing is that this could have been so beneficial to COVID we created more work for ourselves with the sedation practices, you talked about awakening and breathing trials. Once I just looked at only wake & breathing trial started sedation, turn it off once a day and then turn it back on. Decrease ventilator days, by 2.4 days, days in the ICU decreased by three days in that hospital decreased by 6.3 days, when we're in a staffing crisis, we need to have a process of care that's efficient actually gets patients out of the ICU. Instead, we created this bottleneck where patients are now stuck on the ventilator because they're too weak to breathe on their own. Even if their lungs are better. Now they need tracheostomies. They're stuck in a ventilator. We can't at least in the States, we couldn't get them to LTACH because LTACH's were too full of all the other COVID long term patients. So, then the ICU wasn't rehabilitating these patients, and so then they develop more hospital complications, and then they ended up needing more care. It's just we created so much more work for ourselves. It just was a hard time to really take on a new endeavor and totally change your practices. But during COVID, everyone ran back to the 90s. Not everyone but a lot of people ran back to the 90s. As far as using benzodiazepines, higher doses of sedation, deeper sedation longer times, there was so much fear. We did a lot of fear-based medicine. So, I just kept chugging along with my podcast, knowing that the community was going to need healing after all of this. We were going to need a lot of rehabilitation within our own clinicians, but also within our practices. So now, teams are coming to me saying what we're doing now. We're still doing COVID care even these are not COVID patients, we're still we're back to deeply sedated patients. Where are we lost so many seasoned clinicians, new clinicians came in during COVID. They've been trained to deep deep, deeply sedate, they don't know how to move patients they're scared to. But one team said I look on my ICU It's not an ICU, these aren't ICU patients. These are LTACH patients. These are rehab patients that we're not rehabilitating. We're bottlenecked. We can't get these patient outpatients out, we can't get new patients, we're stuck. We're creating that kind of scenario. So now, I work as a consultant and I do training with the teams, I teach them the why the reality of delirium, giving them a picture of an awake & walking ICU using real case studies, pictures, videos, so that we have a vision of what could be I feel like the ABCDEF bundle when it was rolled out in the mid 2000's good change happened, a lot of things moved forward. I do feel like we didn't explain fully the why behind it. Until every ICU clinician hears the voice of survivors, they won't be afraid of sedation, they'll still be inclined. We started, we continued this start sedation automatically, then at some subjective point down the road, start to take it off, when they come out, agitated, turn it back on, we just didn't, we didn't give them this perspective of ‘Hey, most patients should be awakened walking. Here's how to treat delirium and here's how the team works together' we put a lot of it on nurses, which is not fair, feasible or sustainable. So, as I work with teams, I tried to really give them a foundation of why, and then how, how to treat patients without automatically sedating them. When the sedation necessary. How do we navigate appropriate and safe sedation practices? When do we use it? How do we mobilize patients, I go on site with teams and I do simulation training, we do real case studies and practice and the whole team practices together. Because it's a skill set, we think about pronation, when we started printing patients, everyone was terrified. And it took so many people and it took so long, you know watching every little line and now teams flip them like pancakes, right? It becomes a skill set. So, I tried to get them opportunity to practice that on a pretend patient. So, they can think through critically think through the scenario, think through delirium, thanks for ICU acquired weakness, then practice mobilizing patients with different levels of mobility.KK: My brain is going like, the whole time, it's like you need to come see our group.KD: Let's do it. I'll hope on a plane tomorrow – I can't actually. I'm going to Kentucky tomorrow, but let me know I'll be there!KK: We would absolutely love to have you. Just knowing where a lot of clinicians lack is hearing the voice of the people that have gone through it. Clearly, that's been a motivator for you in terms of why we need to pivot and provide less sedation to our patients and mobilize our patients and avoid them from having all these secondary complications as a result of being immobile. The means are there. KD: The data is strong; the data is really powerful. I mean, decreased mortality by 68%. Who doesn't want to do that, right? So, but almost even more powerful are the voices survivors, when you hear their voices in your head when you're sitting in a patient. It's haunting COVID, there were times when patients could not oxygenate the movement. I had to sedate them. I hated it. I just felt sick because I, I just didn't know what they were experiencing. I didn't know if they were in pain. I didn't know what was going on underneath that they were going to live with us the rest of our lives, it's because of the survivors that have interviewed on my podcast, they are the educators.KK: Yeah, I have so many ideas going through my head. I would love after when we jump off, links to the some of the episodes from the survivors that we can pass along to our group, to our show in general, but our group to give a sense of what it really is like to go through this. Yeah, our patients don't come I mean, every once in a while we get a patient come back and say how they're doing but they don't give us the they don't give us the negative side, they really focus on showing some gratitude. KD: Which is good, but if they came back, it's probably because they weren't too traumatized to come back. The ones that don't come back. I mean, why would you go back to the place that you are sexually assaulted?KK: Yeah, no, yeahKD: It's like to trigger and some people can't even go the same street as that hospital. On my website under the resources tab, the clinician podcast, at the bottom, the page is organized by topics. One of those topics is survivors of sedation and mobility, as well as survivors of an awake & walk ICU. So, you can hear their different perspectives and testimonies, it's organized by different topics. KK: You're an organized cat, I'm looking at it right now. I can tell you, you're very structured and organized just by the way your website is set up. It's on point.KD: It's curriculum. This is education, this is not just a hobby. I mean, this is we've got to make sure we get the right information to the right people.KK: You're so boss. You're gonna be running an organization one day, and ICU, I don't know. I see big things for you.KD: We'll see. I mean, I have a lot of optimism for the future of critical care, going to conferences, meeting with people at the bedside podcast listeners reaching out. It's not just me that cares about this. That's why I continue is that there are so many people that I call revolutionists, sometimes as the lone voice in their ICUs. But they're bringing big changes, they're making waves there so my motivation with podcasts is to provide the ammo, the quiver the arrows in their quiver, so that they can share that with their colleagues get more buy in, so that they don't have to reinvent the wheel. It's a lot to change a perspective and change a culture. It's hard.KK: Yeah, and maybe just seeking some advice, we had Dr. Wes Ely on the show and how to create some culture change around this issue. I want to hear your perspective. Kali, how do you think you do create that culture change? Because you bring this up to many staff, and they'll be like, ‘Oh, they're gonna extubate themselves? Oh, we're short staffed. This is not gonna be able to work.' What are your thoughts?KD: Yeah, this has been a lot of my journey is figuring out what are the barriers? and how do we address them? I think we're over the checklists. I think it is important to systemize and protocolized our practices. When we implement these kinds of changes, we this can't just be “Hey, Nurse, take off the sedation' that is not going to work. They have some valid fears at all I had ever seen. With a patient coming off sedation. After days, two weeks of sedation, I would have a lot of inhibitions. When I'm busy. I don't have time to wrangle that patient. I don't have time to make sure they don't self extubate. I have a Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.whole episode on unplanned extubations, but delirium increases the chances of unplanned extubations by 11 times. So, it's just changing the perspective understanding what is delirium? why should we be panicked about it? What causes it? We are practices are some of the biggest risk factors and culprits of delirium in the ICU, and to learn doubles that are in hours required for care. So, when we're short staffed, why would we create a delirium factory? When it doubles our workload? It doesn't make sense, but when that's all we know, we don't understand that there's a better way to do it. So, my approach when I go to help a team have culture change is to, again explain the ‘why' give a perspective of what could be, here's what patients can be like, when we don't sedate them. If they when they wake up after intubation, it's like coming out of a colonoscopy. Endotracheal tubes not comfortable. Here are some tools to help make it more comfortable. Here's how we can talk to them. Give them a pen and paper, I would get agitated and panicked. I couldn't communicate. Here's how you involve the family, here's the toolbox to help you succeed and have that patient be calm & compliant. And they will protect their tubes. I've had patients write ‘please be careful my tube' That's what I need to experience. So, when you find a couple of case that isn't so easy hits, easy wins. Allow your team to see a patient awake, communicative, calm in even more while on the ventilator, the perspective starts to shift. Then they start to ask, okay, that was easy. That was fun. That changed outcomes. They walked up the ICU. Who else can we do this on and it starts to have a domino effect. So suddenly, we expect him to just shut up and do it. That's, that's not going to cut it. I don't think that I think that's partially why the ABCDEF bundle rollout, years ago was not has kind of gone away, because we didn't provide the why. We also, again, I think starting sedation, and then taking off later, is a lot of work. We should only do that if it's absolutely necessary. Otherwise, I mean, I have an episode with a hospital in Denmark, they do the same thing and that allow patients to wake up right after intubation. They are so much easier, more compliant, because they don't have delirium, we have to understand that that agitation is usually rooted in delirium, we have to come to really be terrified of delirium.KK: I'm really enjoying this, I'm really liking this because it's even at that added perspective of saying, ‘Hey, your workload is going to be worse if people are delirious, so let's avoid going delirious in the first place' Let's just get a grip on this bad boy, out of the gate.KD: You're all about preventative and it's like, Let's prevent one of the biggest culprits of mortality. Delirium doubles the risk of dying in the hospital. So, people say we don't have time to mess with all sedation practices, like let's just sedate them and like, save their lives and figure it out later. No. By doing that, by increasing the risk of delirium, we could double their chances of dying. So, if we care about mortality, then we will care about our sedation practices. We also know that ICU acquired weakness is really laborious. When people imagine mobilizing patients on ventilators. What they're imagining is taking off sedation days to weeks later when they're delirious. They can barely lift a finger and now we're trying to mobilize these, you know, 200 plus pound adults to the side of the bed. That's dangerous, laborious, it takes so many people. If a patient walks into the ICU or into the hospital, hypoxic hypotensive, whatever. We have moments later, we haven't stabilized. Why can't they walk? Did we cut their legs off? Right? So, once we have oxygenated, perfused, what's the harm in sitting outside of the bed and seeing how they do when they're not delirious, they can tell us how they're feeling. We can provide more support on the ventilator; they can probably walk better than they did come in and hypoxic. Once they're stabilized hours later, or even 24 hours later. So that is so much easier when they maintain their ability to walk. So, in the COVID ICU, many patients were standby assists to the chair with a nurse while they were on a ventilator, because they're alone in the room, right? Physical therapy could go in and work with a patient, just scoot the ventilator wall to wall as they're stuck in their rooms, help them stand or sit, step on steps, they were alone in that room with these patients, because they were strong enough to do it, because we didn't allow them to be under myotoxic sedation and I would say rot in the bed. So, all of that plays into an ease of workload. Then obviously the get off the ventilator sooner, get out of the ICU sooner. It makes the workload easier. So, it's a little bit of an exchange and efforts in some ways. Yes, you must talk to a patient. Yes, you must assess them a little bit more. But also, could during COVID, I was hearing about swapping out propofol bottles every hour, picking up to go in and out to titrate vasopressors that we were getting just because of the sedative and hypotensive effects. All of that is effort but wasn't necessary and wasn't beneficial.KK: I'm telling you, you are changing the boogie. Yeah, changing the conversation and perspective. This is something that can dramatically impact patient care. If we could get the buy in, in the culture. Wow.KD: You know, people will say ‘Well, we don't have we're trying to save $25 million this year. We can't afford to pay our payer clinician some extra time for education or whatnot' The ABCDEF bundle, even in their spectrum of compliance, decreased healthcare costs by 24 to 30%. KK: Oh, yeah. KD: ICU acquired weakness increases healthcare costs by I want to say 30-40%. Delirium increases healthcare costs by 40%. ICU acquired weakness increases healthcare costs by 30.5%. So, by having a process of care that prevent those complications with decreased healthcare costs. So why wouldn't we, right? KK: 100%. We even we had a paper out last year showing the financial impacts of ICU delirium. We always think to have the opportunity cost, that money could be diverted into more staffing, more resources for physio, optimizing nutrition, all these things can be enhanced. If we, if we make it a priority. KD: I think it's one of our one of our strongest cards to play for staff, safe staffing ratios. To say staff is better, we'll get better care in this using this protocol. We will save you so much money so it's investing thousands to save millions or billions.KK: I love it. You're speaking my language. We are definitely going to have you back in some capacity. I don't know that for some reason. It's not just gonna be the show. I really want to get you talking to our group. Maybe regional rounds, or something. I don't know what it's gonna be. It's something that we need to hear more of talked about the patient experience, your own experience and the drive like what's pushing this. Knowing my people a lot of intensivists and an ICU nurses and allied health professionals, we want to achieve this, get our patients to a point where they are better. Really better, not just alive, but thriving. This starts here. I really do believe it starts here. So I just want to give number one, Kali some mad love on what you're doing and continue to hustle, it's paying off. Second. How do people get to know you a little bit more? and about the show and the consulting and so forth?KD: So, have a website www.daytonicuconsulting.com. There's more information about consulting services available, the podcast is on there, the podcast has transcriptions and citations organized by topics. KK: So organized folks. KD: 116 episodes, and I really didn't even know how much of a what's called a rabbit hole that this would become. There's so much to learn about the science behind what we're doing as well as the patient and clinician perspective. So, check that out, find the topics. If nothing else start at the beginning. I think the beginning lays a foundation, I was very intentional about how I organized it at the beginning to lay a foundation of ‘why' and ‘how' comes later. I'm on Instagram @daytonicuconsulting, Twitter, Tik Tok. Go ahead and set up a consultation with me send me an email and we can chat about your team, your barriers, even your family members what's going on? I'm obviously obsessed. So, I'm here for you! let me know.KK: So good. So good. Thank you so much for joining us. Those on the chat group or that are watching live. You want a piece of this episode just tap NL into the chatbox will give you a copy the video and the end the podcast when it's released. Awesome work. Congratulations.KD: Thanks for caring about this.KK: 100% KK: Kwadcast nation that's exactly what I'm talking about changing the boogie right here in ICU care. Follow us on Instagram, YouTube Tiktok Facebook @Kwadcast Leave any comments at kwadcast99@gmail.com, subscribe to our newsletter. Essentially, it's like a membership you want to know more about Kwadcast nation. Go to Kwadcast.substack.com Check it out. Leave that five-star rating and continue to allow us to change boogie in unison. Take care, peace. We love you.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

In this episode we welcome Indigenous medicine woman and best selling author, Asha Frost, to speak with us about homeopathic medicine, spiritual journeys, healing, and more! Asha is a member of the Chippewas of Nawash First Nation and has a BA in Psychology from the University of Guelph and a degree in homeopathic medicine. Her book ‘You are the Medicine' is full of powerful teachings and has guided thousands. Today we learn about Asha's path through Indigenous medicine, racism, creative ways to heal yourself, spirit animals, and much more! Asha is an incredible mentor and she also leads us through a moving guided journey, and gives us some great perspective into mental health. SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use discount code “solvinghealthcare"TRANSCRIPT KK: We are on the brink of a mental health crisis. This is why I'm so appreciative of the folks over at BetterHelp. The largest online counseling platform worldwide to change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today go to betterhelp.com and use a promo code ‘solvinghealthcare' to get 10% off signup fees.SP: COVID has affected us all and with all the negativity surrounding it, it's often hard to find the positive, but one of the blessings it has given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to kwadcast99@gmail.com, reach out on Facebook @kwadcast or online at drkwadwo.caKK: Welcome to Solving Healthcare. I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physician here in Ottawa and the founder of ‘Resource Optimization Network'. We are on a mission to transform healthcare in Canada. We're going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a better health care system that's more cost effective, dignified, and just for everyone involved.KK: Kwadcast nation, welcome back! We got a great episode with Asha Frost, and I tell you this, this one was extremely moving. We talked about ways of healing thyself, looking at creative ways to not only bank on conventional methods of healing, but also looking at spirituality, looking at our mental health, the mind body connection to create healing is tremendous. We go into some of the indigenous ways that could improve our overall health, we go through a guided journey, which as you'll hear was extremely moving from my perspective, I was a little verklempt after that one. Then we talked about we talked about racism, we talked about our own experiences within healthcare, she tells her story about being treated like an animal, within the emerge our own experience not that long ago, which I think a lot of people need to hear. It's tough to hear, but it's just another reinforcing message that we got work to do. So, looking forward to you guys hearing that. Before I forget, please check out our new substack kwadcast.substack.com. We have all our jam on there. We put all our jam on there,  our newsletter, previous episodes, we're all in on substack. Video, video messages, our community chat, you could chat we have a chat community on there too. So please check it out. You guys gonna love it. It's a better way of us staying connected. So, without further ado, check it – Asha Frost. Kwadcast nation, man this is a real privilege today, folks. It's a real privilege today because we got Asha Frost, who honestly, I just met in November. We were both that ‘Impact' live, amazing event put on by Meghan Walker. Your keynote, everybody was talking about this bad boy.  I got to connect with you backstage. Show me your book, all the magical things that you're doing. I was like, she's got to come on the show folks. Asha's got to come on the show. So welcome to the kwadcast.AF: Thank you. That's quite the introduction. Thanks for having meKK: Oh, man! It's the least I could do after all the magical stuff you're doing Asha. Seriously, this is an exciting show for me. So maybe, to give context to why you're doing all these workshops, the book, the essays, I think a lot of it comes from your personal experience. So maybe just tell us a little bit about how you've gotten here.AF: Sure. So, I'd say my healing journey started when I was 17. I was diagnosed with lupus. At that time, doctors didn't really know a lot about lupus and the antibodies that were positive in my bloodwork really were like quite serious. So, they were saying ‘You're gonna have to go on medication for the rest of your life, you're might not have children, you might not live a long life' and of course, as a 17-year-old, I was really scared. At that time, I lived in a really, I'd say, non diverse town. So, there weren't a lot of indigenous people. My grandparents had been in residential school, I had been colonized away from our medicine ways or away from our ways of healing and knowing and being. So of course, I thought, oh, we'll try the medication. So, I did, and I got so many side effects from the prednisone and the anti malarial drugs. So I knew there had to be a different way. I went to university and at that time, I got really sick because of the stress of university, and somebody said, why don't you go see naturopath. That sort of opened up everything for me, I saw naturopath at about 21. Then I thought, ‘Oh, my goodness, there's a remembering of myself and my blood and my bones calling me back to these ancestral ways of knowing and the earth' and I had to uncover that. That was like the beginning of my journey just going on this. It's always just been ‘How can I heal myself?' and then, of course, as I heal myself, I share that with the world. So that was the beginning.KK: Wow, wow. So really, unfortunately, having a relatively serious diagnosis at a very tender age of 17. Going through the conventional treatments, were you finding you were getting better when you were taking the conventional meds?AF: Not really, I'd say, no, it made me so much sicker. I just I've had new symptoms that I wasn't experiencing with the lupus symptoms. So, it wasn't making me better. I thought, well, this doesn't feel like it and maybe if I tried it longer it would have, but it just didn't feel like a really good exchange of I'm taking these and I'm feeling worse in my body. So, it wasn't helpful at the time, I have subsequently taken little small doses at times that have been helpful, definitely. But at that time, it wasn't helpful.KK: So you walk through this, this journey and will really having an incentive to heal thyself, like really looking at ways to heal thyself, and going through natural paths and so forth. What came of it? what was it mostly, nonconventional medications, was it meditation was a nutrition what changed for you? And was it effective?AF: Yes, so I saw a naturopath who was amazing at homeopathy. She prescribed a remedy. It was all so new to me and I thought, this is kind of neat and she told me ‘this is going to match your physical symptoms, but also your sort of personality, your essence, your emotional body' it really looked at the whole being, and it made sense to a part of me. I remember taking that that remedy, and my hair was falling and at the time really bad, and that got better. I remember my joints were really achy and not got better. So, I got really interested in lit up by homeopathy. It actually inspired me to go to school for homeopathic medicine, because it helped me so much in my own journey that I thought ‘I want to offer this to others'KK: Wow. So basically, you wanted to help create that magic for other people. You saw how the homeopathy improved your quality of life, and improved your symptoms, and wanted to create that. That loveliness for the greater for the greater masses. How has that journey been? when it came to getting people healthier - how's that been for you?AF: I loved having a private practice. I loved sitting with people, I loved holding space for their highest vision of who they were. Everybody I feel like we are sort of conditioned to feel like there's always something wrong with us, you know that everything over the messages are always coming at us that there's something wrong with us. I believe that my private practice held space for the truth that you have this vital force, you are divine, how can we just remind your body? how can we remind your spirit? so my practice ended up turning into like a homeopathic practice. But then of course, I started to weave in indigenous ways of being and knowing and indigenous healing because that's who I am at the core. That's what I was discovering about myself. So, it was a combination of spiritual healing and then the homeopathic medicine.KK: I think that's what really attracted me to what you were what you were throwing down, was this the ‘spiritual' component adding that indigenous side. Who you are to a healing practice and delivering it to patients. I must say, as ignorant as possible. I have no idea what that would look like. I have no idea not only what it would look like, and just the impact it can have. So, walk us through the potential and what treatment would look like, what the outcomes could be. I mean, I don't know if you need to give a specific case, but just give us a sense of what the potential is from your practice?KK: Well, I tend to attract a lot of people who had anxiety or depression. That was like a lot of mental health that tended to come through my practice. So, people would want to get off meds, like anxiety meds, or depression meds, and we would just do that with their doctor, they would be tapering, and then this homeopathy would support sort of their tapering off and bring them back to sort of that truth that they do have something within the MEK and help them balance themselves and come back to that healing. So, I saw a lot of a lot of folks with that. I saw a lot of folks with autoimmune conditions because that's what I lived. So, I tended to know a lot about that. I'd say that people's arthritis got better. Their fatigue got better. They their movement was better; they just had more ease and grace in their lives. I think, on the spirit level, they felt more connected to who they were, and for some reason, that just trickled down to their physical body. So, they would feel more connected to themselves through guided journeys, or meditations, or I would do hands on healing. They would come home to that truth, but they have power, they have presence, they have medicine, and for some reason that like switching on that light bulb really helped people.KK: That's amazing. We talk a little bit about on the show, that whole mind body connection, how it's all tied, how you feel, how you're doing upstairs affects your body and your ability to heal and to get better. I'm just really interested to hear what its like to walk through the term, how did you phrase it again, you're walking journey? Your guided meditation? what does that look like?AF: Yeah, so from an indigenous perspective we really believe in the power of dreaming and visioning and quiet because that's when you can hear spirit. So, getting somebody in that state of quietness, when they're listening to their own connection to spirit was so powerful. So, what maybe animal spirits might come in to help with medicine that they want to offer, or it might be their ancestors, or their grandmothers or their guides. So, there was a lot of spirits support, helping people and then some of the sorts of techniques that were used were of a shamanic. I've taken a lot of training around like shamanic enters, there's a lot of energy healing energy work, that would shift some of the blockages maybe for a vital force to flow through more effectively. It always came back to that person, again, like sort of seeing and remembering, oh, my goodness, I can do this, like, I have sovereignty in my own being and body. I have I have power, because I think sometimes in the medical system, we can sometimes feel like we don't. Our power, we kind of give it over to say, ‘well, you have all the answers' and that might be true. They might have answers, but we have answers to.KK: Yeah, we have an ability to call on to contribute to our own healing. Right. I mean, like I said, this is not the typical approach to medicine, I've been practicing almost for 20 years. We don't often add a spiritual component and, and, and so forth. Do you like how the results been in your practice? Asha, when you add these elements, on top of everything else that they're receiving? How do you feel the response has been?AF: Well, I no longer practice privately anymore, but I had a practice for 15 years, and it was really busy. So, the word of mouth was always really, really strong. I was booked solid with a waiting list. I would say the results were really, really amazing. People tend to leave my space, just feeling uplifted and feeling better. So, I wish I could quantify that with like, you know, we had this many cures or whatever that is, but I think that's the difference between being healed and being cured. I think we look for a cure, but we kind of forget about, what kind of healing leaps have we made? how much more satisfaction do we have in life? how much more peace do we have in our heart? how much more gratitude and joy is emanating from our system and ourselves? I think those things are maybe not measurable, but they are really important.KK: Oh, man. Absolutely. I think especially now, I feel like this is so valuable coming up, post pandemic where people were from a spirituality perspective, from a mental health perspective, just beat down. We're seeing the resurgence, unfortunately, of so many ailments, which is obviously very complicated because of lack of access to care, people weren't getting screenings, and so forth. This is something that I feel like could be so valuable to so many. I think one of the magical things that you're doing ashes is, is creating that at scale now, you're really trying to make this accessible to not just a patient in front of you, to everyone. So how are you doing that right now?AF: So, I closed my private practice maybe four years ago now. At that time, I wanted to bring all these teachings online. I created like a global membership with indigenous teachings and healing. I loved doing that. So that really like scaled up the folks I was able to touch. At that same time, I got a book deal by through Hay House, and that has just expanded my reach, I think, to all the people that I can touch with my words. Writing that book is just it's so interesting, because you write this book, and this little cocoon was in the pandemic, my littlest was two, and they were home. It was kind of a disaster, but I put myself in this little cave. I wrote this book. I didn't realize I didn't really think ‘Oh, these words might actually touch people, oh, these words might actually be shared by people' I just kind of thought I'm gonna write this, put this out there. Now it's rippling out way bigger than I could have ever imagined. It's just rippling out in so many ways. That's the most important thing for me is that people remember who they are. They're touched by my words and it kind of ignites something within them. That was my intention for the book was that they could see that that presence that they are, it's called ‘You are the medicine' that they are the medicine, they carry medicine. And they can share that with other people too because we need that message shared, I think.KK: Absolutely. Absolutely. Obviously, the book is out you do public speaking engagements. I saw also you're doing workshops amongst folks, walk us through that, is it small workshops? Is it organizations? who are you seeing?AF: Yeah. So, for the longest time, when I was in my private practice, I did healing circles. That was a way that my medicine was shared. I was doing a lot of those probably hundreds and hundreds of healing circles. Then when my book came out, actually last year, it came out last March. Folks begin to ask me to come and speak to bigger audiences. So, it's lit me up. So huge, so yeah, it's some like health conferences. People really need healing right now, so people are asking me to come and do like opening ceremonies as an indigenous person to offer some messages around like cyclical living. It's really the vibe of healing. Everybody just seems to need it. So, I've been invited to do that and it's something that I've always wanted to do in like a bigger scale. So, it feels so in alignment, I hope it continues, because it's really something that lights me up. But yeah, those workshops, you know, I do smaller workshops, during the pandemic online as such, that's how we connected so I was invited to a lot of people's programs to share, and to offer that healing component to their work too. So, I love being asked into spaces.KK: What are the principles that happen there? When we're doing a healing practice or speaking to the masses is it is it a matter of ‘Hey, folks take more time to be with yourself and, and or listen to this guided meditation' what's some of the take homes people leave with when they when they hear Asha throw down?KK: So many times I speak of the medicine meal because our traditional medicine meal speaks about the importance of the whole system. So, I'll take us through the way of living seasonally and cyclically and listening because we are Earth. All of us have been colonized away from that that truth that we are we do live seasonally, and we go through our highs and our lows, and the world wants to tell us ‘no, you have to be hustling all the time'  and then we end up in burnout. So many of my messages are around because I've had to do it myself. How do I come home to the medicine of rest? How do I come home to the medicine of listening? all the things that the world pulls us out of my message tends to be around that and I love working with animal spirit medicines. The animal teachings those are brought a lot into my teachings and then we always do a guided journey. I have done this with thousands of people. I can say that almost everyone that I've ever worked with has seen an animal spirit or they're able to see sensor I do believe that I can hold a space somehow that can get people visioning and get people into that space where they're connecting to something greater than themselves.KK: Wow. Wow. So how do how do people get in more in tune with resting and listening? How do we get more in tune with our seasonal aspects of life?KK: Such a good question, I think it's really hard. I think the first question to ask ourselves is about our relationship to the systems. how has colonization impacted us? How has the patriarchy How is capitalism? just feeling the impacts of that collective energy and how we've marinated in it, it's just sort of an acknowledgement and validating ‘Oh, right, we come by this honestly' because we were born into it. And this is like the, the energy that's up all the time. There's a lot of unwinding. Especially if you have ancestral wounding, or generational trauma that is connected to a lot of the folks that I work with do have. So, we have to dive deep into that healing and say, ‘our ancestors did this so we don't have to anymore' We can take that like labor off of our back. We're allowed to invite in rest and ease and abundance and it's hard for folks of color to really lean into that, because our cells are telling us something different. It's a lot of journeying, reflecting, going into our dream time, I think it's like simple of just like rest actually going to bed earlier to say ‘Oh, my dream time is here, It's going to offer me some medicine and some wisdom' Can I allow myself to have that? So might be like sound kind of strange but to me, going to bed early during this winter season is a way that I receive so much wisdom.KK: I mean, it makes sense. It's a time to hibernate, recharge, with the sun going down that much earlier there's a lot of a lot of things pointing towards being more restful during that time. The other question? this might be a tough one. I'm putting you on the spot here. What's the guided journey? I don't know if we could do one or if that's too difficult. I want to get a sense; I think our listeners will get the chance to showcase Asha skills. You know?AF: I would love to.KK: Yeah. If you're interested, let's drill down.AF: Definitely, we're talking about rest, we're gonna set the intention for this journey, to connect with an animal being so you know, we talk about spirit animals or animal spirits. We want to do this in an appropriate way where we're appreciating this animal. So, I'm just going to start by saying whatever comes forward to you, to trust what you get, to trust if we've not worked together before, your spirit knows. Then in a way after, when the animal comes to honor it with deep gratitude, because it's an important practice and teaching. We're gonna start with closing our eyes and if you're seated, you can just feel your feet on the ground. We acknowledge the earth beneath us, the land beneath us. Just feel the land beneath you. I'm going to acknowledge that I'm on the lands of the Anishinaabe. We are still here. Feel the spirit of the land and all that it's seen and experienced, rising up through your feet, warming you comforting you, grounding you, with every breath you take. Today we ask for all of the beings that wish to support and guide and surround us to be present here. We call upon the sacred door an opening to the spirit world. The store is shining with golden light and around the light. There's this rainbow light. We feel this rainbow light spark ling and shining so bright. But as you walk towards it today, it flushes and washes upon you. Washing over you and you begin to feel sparkles of reds and purples and violets, greens and golds, pinks and turquoises in your own cells and tissues for you our prismatic being shining and sparkling here.  As you walk through, you see the land beneath your feet, your feet are bare, and you sink your feet into the soil, squishing your toes with every step. You continue walking, feeling yourself being led down this path and in the distance, there is an ancient forest. The forest looks so inviting the trees and the plants that are here are familiar to you in some way. You walk yourself over to this forest. As you step in, you breathe and the medicines that are here. The medicines that are perfect for your body and your spirit today surrounds you. With every step, you walk in deeper, the forest gets a bit darker, surrounding you with care, holding you with love. As you walk deeper, we set that intention.  That intention for the animal spirit that is helping us the most right now to appear in some way. As you are closer, there's a clearing where the sun is peeking down through the trees. As you walk closer, we asked for that animal to become clearer, more powerful, and to appear for us in some way. Notice what you see, listen to what you sense or feel. who arrives for you? Trust this animal gets closer to you. You ask them ‘why are you appearing for me right now? What are you here to remind me of that I have forgotten about myself?' and do you listen. You ask this animal ‘What is the word that I need to carry with me in my heart? The word that will remind me of who I am this year?' and you listen. This animal becomes really sparkly, it wishes to align with your energy. You step into this light, and you feel this rush of light source through your mind body and spirit. The medicine of this animal dropping in tear being you feel that message in your heart that it was just to offer you. You feel yourself walking back out of that forest with that message from that animal making your way all the way back to that path where you started carrying that animal medicine with you, honoring it with gratitude and love and moving it all the way back to the door. Taking a breath here, the animal places a gift in your hands so that you may remember them that you are walking with them. You walk through that door and then you breathe yourself back into your space. Feeling your feet on the floor feeling the lands beneath your body and when you feel ready you can open your eyes. Welcome back.KK: Wow. Wow, that was quite an experience.AF: what did you see? if anything?KK: It was some form of bird, a hawk or something like that. The message was like love, just focus on love.  Past me in terms of an object image just some rocks, but yeah, love. Bird, love, rocks. That was moving.AF: Yeah, it's always is different based on the energy that I'm sitting with. But today, the animal really said, ‘I want to come into your heart' So when you doubt your path, or you forget who you, place your hands there and just activate that energy there. I got a big moose. I got a moose. So, that was beautiful, but it was just really to remember that like they are here for us, to remind us to come home to ourselves. You can honor that Hawk in some way. Get your kids to make a little altar for it.KK: Absolutely. It's funny as you were saying, animal I was thinking Lion. I don't know why I've been thinking about lions lately. A lot, too. I thought that's where I was gonna go. But the image that came to me as you were speaking was a hawk. It was a bird was substance.AF: You know, for the listeners, I know everybody the questions ‘what does it mean?' Right? And there are different ways you can look up. The first question I'd ask myself is ‘what does it mean to you?' Right? What does that animal? How does that animal move in the wild? What strengths do you think that animal has? How does it carry itself? All those things are the medicines it's bringing you. Then of course, you can look up on Google if you want to see like, what is the animal spirit? Next year, I'm doing an Oracle deck that will have all the animal cards in it so that I can say you can look at my Oracle deck and see what they mean. But right now, there's a couple of books ‘Animal Speak' by Ted Andrews is really good, too.KK: Wow. It must be pretty powerful. Doing this in a group setting. I'm curious to hear what people like the feedback that you get after having such a amazing, guided journey.AF: Yeah, people always, it's something I know because I've practiced so many times and edit so many times that it's opening up some sort of portal to some sort of different understanding and people always come back touched. So that's a common people say they feel touched or like part of their spirits moved.KK: I mean, I'll be honest with you, that's how I'm feeling at this time. Touched. Something changed. So, thank you, Asha, for allowing me to be part of that. That was something. If you hear a little bit me being a little off. It's because I am a little off. After that, was emotion. It's a bit vulnerable. Why love? Why the hawk? It's, it's clearly something that was needed. Once again, thank you. Asha.AF: You're welcome.KK: I can't remember if it was at the conference, at the conference or, or another time, but, you know, we often talk about systemic racism and the experience of being a person of color when it comes to being treated as a patient. I wonder if some of this ties into your experience, and I don't know if you've had any, any experience that made you really concerned about how systemic racism affects our people?KK: Yes, I had one incident. It's so interesting, because I doubted myself for so long, I gaslighted myself for so long thinking of that was nothing but then when I had the capacity to think about it, it was it was definitely something.  My eldest was two at the time. I remember just, he wasn't a good sleeper. So, I was really overwhelmed and burnt out and I got a really bad pneumonia. I was caring for him, I kind of left it a little bit too long. By the time I got to the hospital, I couldn't breathe at all. It was very serious. In the wintertime, I always wear my mukluks because that's what I wear. I think I probably had beaded earrings on when I went to the hospital. They put me in a corner, which I understand lots of people have had that experience. There's not room and all of the things but I was there for a really long time considering I couldn't breathe and I was really, really struggling. Then when the doctor finally came in in the middle of  the night he said to me, he looked at me and he said to me, he knew I couldn't breathe. And he said, ‘How much alcohol have you had to drink? And do you have a home?' Those were the first things he said to me. So, he didn't ask me how I was doing or what I was struggling with. I think I was so shocked by that, that I just I froze, I said ‘Yes, I have a home with my husband and my son, and I haven't drank any alcohol' I sat with that probably for a good six months, not really knowing what that meant. Then, you know, it sticks with you. So, I started speaking about it, because at that time, that was like 2014. But indigenous, I feel like we've been so invisible across Turtle Island. That continues to happen. So, it wasn't really until the children were found her in the residential schools that people released her talking about some of these issues. So, I held on to it for quite a while before I really started writing about it and sharing about it. Of course, people are shocked and they say ‘how, like, how does this happen?' the truth is, it happens all the time, every single day. Oftentimes, I think indigenous people just feel like we just suck it up, like, well, that's just part of who we are. That's what everybody thinks we are all about. So, we don't speak on it, because it's, nobody's gonna hear and listen to us.KK: What you're describing I'm sorry, you experienced that. I've seen it firsthand. Okay, folks, I've seen this s**t firsthand whether I was med student in Edmonton, whether it was being a trainee or staff person in Ottawa, you name it. This, unfortunately, that attitude towards racialized folks was, but especially when I'm talking about with indigenous population is a reality. I talked many times, the episode we did with Mike Curlew about Sioux Lookout, not that long ago, have segregated hospitals, running out of medication, running out of sedative medications, antibiotics in our own country. Yes, we have been increasing the awareness, which is great. In terms of these issues, like George Floyd, the residential schools, you're hearing a movement and you're seeing that push towards diversity, inclusion, and equity, and so on. But I'll tell you this, this is not enough. I'll just say, we're moving in the right direction, but it is not enough. These attitudes are deep seated. They're systemic. From my perspective, maybe I've got a little bit of edge here, but it's like no more. No tolerance for this s**t. I am just done. I've been in those experiences to Asha, where you, you question? ‘Oh, maybe it's not really me, or maybe its what I was wearing' I'm now at this stage. F**k that. I'm sorry. No, enough, is enough. I hear these stories and it just breaks my heart. Folks this is one example. Picture yourself. You're relatively new mother is right, with your two-year-old. You've been fighting off going into a hospital because you want to be there for your family, you can't breathe because you have pneumonia, and some cat comes in and asks you how much you drink? Do you have a home? what part of me is screaming ‘I have a problem?' Just by the way I look you make these assumptions. How are you feeling at that time? How vulnerable do you feel you bring your life in somebody's hands, that is judging you out of the gate? This is this is not right and I hear these, I hear the naysayers ‘who gives a s**t about D&I and all that stuff' If I'm being honest, there's ways to approach it and there are ways not to approach it, and I think people are trying, but this is why diversity matters. This is why it matters. This is why you need people at the table, at your boardroom, in your exec room that look like us. So, they could so they could address these needs, they could put awareness to these needs and do all we can to prevent it from happening to some of our most vulnerable folks, enough of abandoning these people. I'm just so sick of it. I'm so tired of it. I know I'm making this about me a little bit I'm sorry, a few months ago my kid got my eldest kid got called the N word at school. I gotta say, it was very triggering for me, I look at my nine-year-old son and knowing now that his innocence to a certain degree has been taken away from him. He knows now get that sense that we've many of us have had, you and I have had that we're being judged by our appearance. He now knows what that's all about. I don't want that for my kids. I don't want that for my boys. I know it's a reality. I know are gonna have to go through talking to them about how they conduct themselves with police. I will have that conversation. But you and I shouldn't need to have that conversation. It's just heartbreaking hearing like this not that long ago. How old is he now?AF: He's ten so that was eight years ago.KK: Eight years ago, but s**t. Like enough? I just went off there unexpectedly. But it's just like I said, I get triggered by this s**t. How did that frame your practice? Do you feel like that change the way you deliver? Care? Did you like it? Was that motivating in any way? How's that shaped you?AF: Well, something I was really, really present with was the fact that I am in a privileged indigenous woman, and I have a ton of support family friends.  I have a home; I have a ton of that and it impacted me so deeply. I just think about folks who don't have that type of support system, to even go bring it to a therapist, or to even like, you know, it just keeps building up building up building up. So, it really struck me in that way. It really struck me that I need to be a voice for those who don't have a voice or a voice who don't have those who don't have the capacity to speak up. That's when I started speaking up on social media, I can't not do this. So. And then I wrote this letter called ‘Dear White woman that wants to be like me' because at the time, I would just see a ton of whiteness. I know people hate this term, white women, but it was white women, it wasn't black women, it wasn't South Asian women, it was white women taking our teachings and our beautiful things and then using them for their profit or using them for their advancement. Obviously, all these white women rising in the spiritual places on social media and in their online businesses, and I thought ‘I've been in business for 20 years. Why is this? How, like, why is this happening? What like, why am I so invisible?'  it just hurt to have these things taken and no acknowledgement of where you're taking it from, of the history of our country of indigenous people. So, when I wrote that letter, I wrote it on my blog, and I thought, oh, maybe like 20 people will read it. It went viral. And I think 25,000 people shared it. I think it was at hospital incident that just kind of led to this, like, speak up, let your voice be heard, even if it's scary, all those things. Then when that went out really wide. I said ‘there's no turning back now'. This is this is the truth. This is the truth about how our country doesn't see us. I want to be a voice for those who cannot speak it.KK: I want to really commend you Asha for being that voice, because it's not easy. You have to go to a difficult place anytime you speak up. When we speak to issues such as this, go to your own experiences. It's great to have that courage and to have that will and it's what we need. It's what we need. That's why we have a mentorship program for black youth that are aspiring to be physicians and then go into the medical field and one of the things that I'm trying to do instill in these guys is it's okay to be authentic, I want you to be you, I want you guys to be you, for your mental health your overall wellness. There are a lot of messages that being you is not safe, but I'll tell you, we're gonna change that.  We're gonna be our authentic selves walking through the door, so that you could thrive. It's similar to the Impact event just like enough of just surviving people. I want you cats to thrive. When y'all excel, I want you to get a seat at the table and realize that you could achieve your dreams. When I give that example of walking into a hospital and a young black kid was a patient and he saw me he's like ‘Wow, that's incredible. There's a black doctor here' at the time, I thought it was awesome. I'm being a role models to folks. At the same time, I was like, how? Why am I a unicorn? I shouldn't be special. There's no way I should be special. So like a lot of you know, racialized community members don't even think this is a reality. Us doing what we do, they don't think it's a reality. So, you know, putting ourselves out there being an examples, being a voice to say like enough is enough to important.AF: I realized how long I carried sort of so much responsibility over responsibility. When the, the children were discovered, I said ‘If every Canadian could take one piece of like, what's on my shoulders, you know, if you could just carry some of this with us, and really be allies for our voices' Yes, we do this and it's important and we have to and we're so tired of always having to do this. I'd rather just go dance in my living room to be honest, I want to call him that grace, ease, joy, abundance. Speaking the truth doesn't always do that. I know I'm making huge changes for the next generations. I feel like it's so impactful and also I'm tired. So, I would love to like invite folks to like, can you also just like, you know, spread some awareness and care. Just care.KK: Yeah, more importantly be that ally. I mean, just sit with it, think of the kids in that school. Think of a kid who is alone, away from their people, abused and dying alone. How can you not have compassion? Most of us are our parents, think of your own child. Really sit with it. Think of your own child being away from you and being abused and neglected. This happening in our own country, these attitudes persist, that we could treat people like animals. Still to leave that and not have a lens of compassion or not want to be an ally. Screw that, man. It's time. It's time. I'm, I'm ready to drop kick some of this racism stuff in the pelvis. I've always been a bit. You know, we need to do better but George Floyd, residential schools, seeing it in my own child. You know, for me we have no choice but to speak up. We really don't. Oh my God, this is an emotional episode, Asha. Going from love, the anger to sadness. I'm exhausted. This that's a sign of an amazing interview. So, I wholeheartedly want to thank you for all that you're doing - your courage, your voice. The ability to reach so many folks is what we need and just being creative to like, to you thinking outside the box on how I can reach more and more folks. I really want to commend you. Can you give folks the best ways of connecting with your book? ‘You are the medicine' , your website, I also want them will have a link to ‘Dear White women' tooAF: Yeah, my websites ashafrost.com and if folks are open to looking at oracle decks, I have my Oracle deck coming out the end of February. It's called ‘Sacred Medicine' Oracle. It is so beautifully illustrated. You get to choose a medicine for your day, every day. So, I invite folks into that next part of my work and then follow me on Instagram asha.frost.  I'm there most often.KK: Your IG is fresh and growing. Listen, thank you so much for joining us on the show today. You've truly moved me. I know you're gonna move many of our listeners too, thank you so much.AF: Thanks for having me.KK: Thank you so much for joining us. I hope you enjoyed that episode. Please check out all our content on Instagram YouTube, Tik Tok, Facebook, Twitter @kwadcast. Check out our Substack that's where we have everything housed now. I'm telling you changing the bogey. Leave any comments at kwadcast99@gmail.com. Leave that five-star rating. Everyone would give some love to your loved ones. Let's start healing together.Solving Healthcare Media with Dr. Kwadwo Kyeremanteng is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Thank you for reading Solving Healthcare Media with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it. Get full access to Solving Healthcare Media with Dr. Kwadwo Kyeremanteng at kwadcast.substack.com/subscribe

Episode SummaryIn this livecast episode, we welcome back Dr. Zain Chagla, Dr. Stefan Baral, and Dr. Sumon Chakrabarti to address some of the issues we've seen throughout the pandemic, new variants and what to expect with future variants, discussing what we've done well over the past few years, misinformation, the effect of social media and the messaging on Twitter, the role media plays and the influence of experts on policy, public health agencies, booster shots to combat new variants and who actually needs them, where we are at with public trust, and much more!SHOW SPONSORBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.Transcript:KK: Welcome to ‘Solving Healthcare' I'm Kwadwo Kyeremanteng. I'm an ICU and palliative care physicianhere in Ottawa and the founder of ‘Resource Optimization Network' we are on a mission to transformhealthcare in Canada. I'm going to talk with physicians, nurses, administrators, patients and theirfamilies because inefficiencies, overwork and overcrowding affects us all. I believe it's time for a betterhealth care system that's more cost effective, dignified, and just for everyone involved.KK: All right, folks, listen. This is the first live cast that we have done in a very long time, probably a year.Regarding COVID, we're gonna call it a swan song, folks, because I think this is it. I'm gonna be bold andsay, this is it, my friends. I think what motivated us to get together today was, we want to learn, wewant to make sure we learned from what's gone on in the last almost three years, we want to learn that,in a sense that moving forward the next pandemic, we don't repeat mistakes. We once again, kind ofelevate the voices of reason and balance, and so on. So, before we get started, I do want to give acouple of instructions for those that are online. If you press NL into the chat box, you will be able to getthis. This recording video and audio sent to you via email. It'll be part of our newsletter. It's ballin, you'll,you'll get the last one the last hurrah or the last dance, you know I'm saying second, secondly, I want togive a quick plug to our new initiative. Our new newsletters now on Substack. Everything is on therenow our podcasts our newsletter. So, all the updates you'll be able to get through there. I'm just goingto put a link in the chat box. Once I find it. Bam, bam, bam. Okay, there we go. There we go. That's itright there, folks. So, I feel like the crew here needs no introduction. We're gonna do it. Anyway, we gotDr. Zain Chagla, we got Dr. Stef Baral, we got Dr. Sumon Chakrabarti back in full effect. Once again, like Isaid, we were we chat a lot. We were on a on a chat group together. We were saying how like, we justneed to close this out, we need to address some of the issues that we've seen during the pandemic. Talkabout how we need to learn and deal with some of the more topical issues du jour. So, I think what we'llstart with, well get Sumon to enter the building. If you're on Twitter, you're gonna get a lot of mixedmessages on why you should be fearful of it or why not you should be fearful of it. So, from an IDperspective, Sumon what's your what's your viewpoint on? B 115?SC: Yeah, so, first of all, great to be with you guys. I agree, I love doing this as a as a swan song to kind ofmove to the next stage that doesn't involve us talking about COVID all the time. But so yeah, I think thatwe've had a bit of an alphabet soup in the last year with all these variants. And you know, the most oneof the newest ones that we're hearing about recently are BQ 1, xBB. I think that what I talked aboutwhen I was messaging on the news was taking a step back and looking at what's happened in the last 14months. What that is showing us is that we've had Omicron For this entire time, which suggests a levelof genomic stability in the virus, if you remember, variants at the very beginning, you know, that wassynonymous with oh, man, we're going to have an explosion of cases. Especially with alpha for the GTAdelta for the rest of, of Ontario, and I'm just talking about my local area. We saw massive increases inhospitalizations, health care resources, of patients having been sent all over the province. So, it was itwas awful, right. But you know, I think that was a bit of PTSD because now after anybody heard theword variant, that's what you remember. As time has gone on, you can see that the number ofhospitalizations has reduced, the number of deaths has reduced. Now when omicron came yeah, therewas an explosion of cases. But you know, when you look at the actual rate of people getting extremely illfrom it, it's much, much, much less. That was something that, you know, many of us were secretlythinking, Man, this is great when this happened. So now where we are is we're in January 2023, we'vehad nothing but Omicron, since what was in late November 2020, or 21? Maybe a bit later than that.And x BB, if you remember, be a 2x BB is an offshoot of BH two. Okay. Yeah, if you're noticing all thesenew variants are their immune evasive, they tend to be not as they're not as visually as, I see this in myown practice, like all of us do here. You know, they are, well, I'm kind of piecemeal evolution of thevirus. Now, there's not one variant that's gonna blow all the other ones out of the water, like Oh, microndid or delta. Right. I think this is a good thing. This is showing that we're reaching a different stage of thepandemic, which we've been in for almost a year now. I think that every time we hear a new one, itdoesn't mean that we're back to square one. I think that this is what viruses naturally do. And I thinkputting that into perspective, was very important.KK: Absolutely. Zain just to pick your brain to like, I got this question the other day about, like, what toexpect what future variants like, obviously, is there's no crystal ball, but someone alluded to the ideathat this is what we're to expect. You feel the same?ZC: Yeah, absolutely. It's interesting, because we have not studied a Coronavirus this much, you know, inhistory, right. Even though we've lived with coronaviruses, there probably was a plague ofcoronaviruses. What was the Russian flu is probably the emergence of one of our coronaviruses areseasonal coronaviruses. You know, I think we had some assumptions that Coronavirus is when mutate,but then as we look to SARS, cov two and then we look back to see some of the other Coronavirus has,they've also mutated quite a bit too, we just haven't, you know, put names or other expressions tothem. This is part of RNA replication of the virus is going to incorporate some mutations and survival ofthe fittest, the difference between 2020, 2021, 2022, and now 2023 is the only pathway for this virus tokeep circulating is to become more immune evasive. This is what we're seeing is more immune evasion,we're seeing a variant with a couple more mutations where antibodies may bind a little bit less. But Ithink that the big difference here is that that protection, that severe disease, right, like the COVID, thatwe saw in 2020/2021, you know, that terrible ICU itis, from the COVID, you know, for the level ofantibody T cell function, non-neutralizing antibody functioning mate cell function, all of that that's builtinto, you know, humanity now through infection, vaccine are both really, you know, the virus can evolveto evade some of the immunity to cause repeat infections and, you know, get into your mucosa andreplicate a bit, the ability for the virus to kind of, you know, cause deep tissue infection lead to ARDSlead to all of these complications is getting harder and harder and harder. That's us evolving with thevirus and that's, you know, how many of these viruses as they emerge in the population really have kindof led to stability more than anything else? So, yes, we're going to see more variants. Yes, you know, thisis probably what what the future is, there will be some more cases and there may be a slight tick inhospitalizations associated with them. But again, you know, the difference between 2020/2021/2022/2023 is a syrup prevalence of nearly 100%. One way or another, and that really does define how thisdisease goes moving forward.KK: Yeah, absolutely. Maybe Stef we could pipe it a bit on, the idea that, first of all, I just want toreinforce like as an ICU doc in Ottawa with a population of over a million we really have seen very littleCOVID pneumonia since February 2022. Very minimal and it just goes to show know exactly whatSumon and Zain were alluding to less virulent with the immunity that we've established in thecommunity, all reassuring science. One question I want to throw towards Stef, before getting into it. Youdid an interview with Mike Hart. As you were doing this interview, I was going beast mode. I was hearingStef throw down. I don't know if you were, a bit testy that day, or whatever. There was the raw motionof reflecting on the pandemic, and how we responded and far we've gone away from public healthprinciples, was just like this motivator to say, we cannot have this happen again. I gotta tell you, boys,like after hearing that episode, I was like ‘Yeah, let's do this'. Let's get on. Let's go on another, doanother show. I'm gonna leave this fairly open Stef. What has been some of the keyways we'veapproached this pandemic that has really triggered you?SB: Yeah, I mean, so I guess what I'd say is, in some ways, I wish there was nobody listening to this rightnow. I wish there was like, I don't know what the audience is. I don't know if it's 10 people or underpeople, but I think it's like, I wish nobody cared anymore. I want Public Health to care. I want doctors tocare, we're going to keep talking because you know, Kwadwo, you've had folks in the ICU we we'vewe've seen cases in the shelters, we have outbreaks, like public health is always going to care aboutCOVID, as it cares about influenza cares about RSV, and other viruses, because it needs to respond tooutbreaks among vulnerable folks. That will never stop COVID, it was just clear very early, that COVID isgoing to be with us forever. So that means tragically, people will die of COVID people. I think that, youknow, there's that that's a reality, it's sometimes it's very close to home for those of us who areproviders, as it has for me in the last week. So COVID never ends. I think the issue is that like when doesCOVID And as a matter of worthy of discussion for like the average person? The answer is a long timeago. I mean, I think for the folks that I've spoken to, and the way that we've lived our lives as a family isto focus on the things that like bring folks joy, and to kind of continue moving along, while also ensuringthat the right services are in place for folks who are experiencing who are at risk for COVID and seriousconsequences of COVID. Also just thinking about sort of broader systems issues that I think continue toput folks at risk. So, one: I think it's amazing, like how little of the systematic issues we've changed,we've not improved healthcare capacity at all. Amazingly, we've not really changed any of the structuresthat put our leg limitations on the on the pressures on the health system, none of that has changed. Allof it has been sort of offset and downloaded and just like talking about masks and endless boosterswhen we've never really gotten to any of the meaty stuff. As you said three years into it, andeverybody's like, well, it's an emergency. I'm like, it was an emergency and fine. We did whatever wasneeded, even if I didn't agree with it at the time. But irrespective of that, whatever that was done wasdone. But now it's amazing that like the federal money expires for COVID In next few months, and allwell have shown for this switch health guys got became millionaires like a bunch of people, I don't mindnaming and I don't care anymore. These folks, these Grifters went out and grabbed endless amounts ofmoney. These cash grabs that arrival, the ArriveCan app with, like these mystery contractors that theycan't track down millions of dollars. So it's like all these folks like grabbed, you know, huge amounts ofmoney. And I think there's a real question at the end of it of like, what are we as a country? Or youknow, across countries? What do you have to show for it? How are you going to better respond? Andthe answer right now is like very little, like we have very little to show for all this all these resources thathave been invested, all this work that has been done. That I think should be the conversation. That tome needs to be this next phase of it is like billions and billions and billions of dollars trillion or whatever,like 10s of billions of dollars were spent on what? and what was achieved? And what do we want to donext time? And what do we have to show for it? that, to me feels like the meat of the conversationrather than like silly names for these new variants that do nothing but scare people in a way that isn'thelpful. It does not advance health. It doesn't you know, make the response any more helpful. It justscares people in a way that I think only detracts them from seeking the care that we want them to beseeking.KK: Yeah, I think you brought up a point to about or alluded to how some of this was the distraction.That was one of the points that really stuck home is that we, we didn't really dive into the core s**t, thecore issues. This is why at the end of it all, are we that much more ready for the next pandemic that wellsee, you know, and so like maybe Sumon, what do you think in terms of another tough one, are weready for the next pandemic? Do you think we've done enough? do we think are in terms of what we'veinvested in, how we've communicated to the public. The messaging to the public. Are we learning? Is myquestion, I guess.SC: I'm a clinician and I don't work with the public health and the policy aspect as closely as Stefan does.But I will say that, obviously, I've been in this realm for quite a long time, since in ID, I think that, youknow, what that's important to remember is that for SARS 1 we actually had this document thatoutlined all of this, you know, masking, social distancing, what to do with funding and all that kind ofstuff. Basically, I was actually interviewed about this, I remember back way back in 2020, and half of itwas basically just thrown out the window. I think that a lot of what happened is that fear came indecisions were made from emotion, which is, by the way, understandable, especially in April 2020. I'veshared with you guys before that, in February 2020, I was waking up at night, like nervous, that I wasgonna die. I that that's where I was thinking I it was, it was terrible. I completely understand makingthose decisions. I think as time went on, I wish that, you know, there's a bit more of public healthprinciples. You know, making sure that we're dealing with things without, you know, stepping onpeople's bodily autonomy, for example, you know, doing things in an equitable way, where you, youknow, we all know that every intervention that you do is squeezing a balloon, you must remember theunintended consequences, I think that we did. So, kind of putting that all together. I think, right now, aswe stand in Canada if we do have another pandemic. I fear that a lot of these same mistakes are goingto be made again, I should say, a disruptive pandemic of this because it's not forgotten H1N1, thepandemic it that was a pandemic, right. It wasn't nearly as disruptive as COVID was, but I do think thatinquiry and like you mentioned at the beginning, Kwadwo was talking about what we did, well, we didn'tdo well, and making sure the good stuff happens, and the bad stuff doesn't happen again, because this islikely not the last pandemic, in the information age in our lifetimes.KK: Zain, was there anything that stuck out for you? In terms of what you'd really want to see usimprove? Or whether it is messaging, whether it is public health principles, does any of those stick out inyour mind?ZC: Yeah, I mean, I think the one unique thing about this pandemic that is a lesson moving forward andfor us to kind of deal with I think we talked about messaging. This was the first major pandemic thatoccurred with social media and the social media era, right, and where, information, misinformation,disinformation, all the things that were all over the place, you know, we're flying, right, and there doesneed to be some reconciliation of what's been we have to have some reconciliation of some of thebenefits of the social media era in pandemic management, but also the significant harms the people,you know, we're scared that people got messaging that may not have been completely accurate, thatpeople had their biases as they were out there. I will say even that social media component penetratedinto the media. This is also the first time that I think we saw experts you know, including myself andSuman and all of us you know, that you know, could be at home and do a news interview on NationalNews in five minutes and be able to deliver their opinion to a large audience very quickly. So, you know,I think all of that does need a bit of a reconciliation in terms of what worked, what doesn't how youvalidate you know, good medical knowledge versus knowledge that comes from biases how we evaluatepsi comm and people you know, using it as a platform for good but may in fact be using it you know,when or incorporating their own biases to use it for more, more disinformation and misinformationeven if they feel like they have good intentions with it. I you know, I think this is a, you know, for thesociologists and the communications professionals out there, you know, really interesting case exampleand unfortunately, I don't think we came out the other side. Social media being a positive tool, it mayhave been a positive tool, I think in the beginnings, but, you know, I think I'm finding, it's nice tocommunicate with folks, but I'm finding more harm and more dichotomy and division from social mediathese days is compared to the beginnings of the pandemics where, you know, I think, again, there's justbeen so much bias, so much misinformation so much people's clouds and careers that have been, youknow, staked on social media that it's really become much, much harder to figure out what's real andwhat's not real in that sense.KK: Absolutely, I fully agree Zain. At the beginning, in some ways, I'll tell you, ICU management, thatwhole movement for us to delay intubation, as opposed to intubation early, I really think it was pushedby in social media. So, I think it saved lives, right. But then, as we got through more and more thepandemic, wow, like it, like the amount of just straight up medieval gangster s**t that was going on thatin that circle, in that avenue was crazy. Then just like, I mean, this might be controversial to say, I don'tknow, but news agencies got lazy, they would use Twitter quotes in their articles as, evidence, or asproof of an argument. It's like, what is happening? It? Honestly, when you think about it, it was it wascrazy. It still is crazy.ZC: Yeah. And I think expertise was another issue. Right. And, you know, unfortunately, we know of, youknow, certain experts that were not experts that weren't certified that weren't frontlines and a varietyof opinions and various standpoints and epidemiology, public health, intensive care, infectious diseases,whatever is important. But, you know, there were individuals out there that had zero experience thatwere reading papers and interpreting them from a lens of someone that really didn't have medicalexperience or epidemiologic experience, that chased their clout that made money and, we know someexamples that people that eventually had the downfall from it, but you know, at the end of the day,those people were on social media, and it penetrated into real media, and then that is a real lesson forus is that validation of expertise is going to be important. You know, as much as we allow for anyone tohave an opinion, you know, as they get into kind of real media, they really have to be validated that thatopinion comes from a place that's evidence based and scientific and based on a significant amount oftraining rather than just regurgitating or applying one small skill set and being an expert in many otherthings.KK: SumonSC: So we're just gonna add really quickly is that, in addition to what Zain saying. When this stuff bledover from social media to media, the thing that I mean, at least what it seemed like is he was actuallyinfluencing policy. That's, I think that's the important thing is, so you can have 10 people 20 peopleyelling, it doesn't matter if they're extreme minority, if it's influencing policy that affects all of us, right.So, I think that's important.KK: I'll be honest with you, like, I got to the point where I really hated Twitter, I still kind of hate Twitter.Okay. It was conversation. I remember Sumon that you and I had I don't remember it was we weretexting. I think we talked about this. But the fact that policy could be impacted by what we're throwingdown the facts or the messages that we were doing on media that this can impact policy, you had tolike, especially when there was some badness happening, we had to step up. We had to be a voice oflogic, whether it was mandates, whether it was you know, lockdown school closures, whatever it mighthave been like, the politicians, we heard about this politicians looking at this, the mainstream medialooking at this, and for us not to say anything at this point, like we had, we had to do something Sorry,Stef, you're gonna jump in?SB: Yeah, I think I think what was interesting to me to see and I think a clear difference between H1N1was that in a lot of places, and including in Ontario, across the US, where this sort of emergence of theselike the science tables, these task forces, these whatever you want to call them, it was like a new bodyof people often whom had never spent a day in a public health agency. Often academics that you know,are probably good with numbers, but really don't have a lot of experience delivering services, you know,all of a sudden making decisions. So I think there's a real interesting dynamic that when you compare,for example, Ontario and British Columbia, one has this science table one does not, and just howdifferent things played out, I mean, given it's a, you know, an end of have to, or no one in each camp,but I think what you see is like, there's a place there where like public health or you know, let's say,Sweden, you know, as a public health agency that didn't strike up its own taskforce that used itstraditional public health agency. I think was in a place to make more like reasoned and measureddecisions, and just was better connected, like the relationships exist between the local healthauthorities and the provincial health authorities and the national ones. I think when you set up these,the one thing that I hope we never do, again, is that something like the science table never happensagain. That's not to sort of disparage most of the people. Actually, most of the folks on the science tableI like, and I respect, say many of them, maybe not most, but many of them, I like and respect, but it isthe case that there was it was they weren't the right group of people. They weren't representativeOntarians he was like, ten guys and two women, I think, I don't know many of them white, they weren'trepresentative socio economically, racially diverse, anything. They didn't have the right expertise onthere. I would have liked to see some like frontline nurses on there to say ‘listen, this stuff is silly' orsome frontline, whoever just some frontline folks to be say ‘listen, none of the stuff that you're sayingmakes any sense whatsoever'. And luckily, there was some reason, voices on there, but they were theminority. But luckily, they prevailed, or we would have had outdoor masking and even tougherlockdowns. I don't know how folks really; it was really close. I think we fortunately had thatrepresentation, but that should have never even happened, we should have had public health Ontario,being its agency and making recommendations to the ministry and to the government. There shouldhave never been a science table. Then second thing, I just want to say I've we've talked about thisforever and I do think we should talk about this more, not in the context of like this, this podcast, but isalso just absolutely the role of the media. I do want to say that, like historically, media had to do a lot ofwork, they had to go to universities or hospitals and ask for the right expert, and then the media orcomms team, ‘you should really talk to Zain Chagla' Because he has good example, you know, it givesgood expertise on this or you start to like, I don't know, like Dr. so and so for this or that, and they puttogether the right person, they organize the time and then they talk. Now you know that it was reallylike the story I think was more organically developed on based on what the experts had to say. Nowyou've got reporters, for people who are not from Ontario, there's a sports reporter in the city ofToronto that I looked historically, I can't see that they've ever done anything in public health suddenlybecame like the COVID reporter in the city of Toronto, for a major newspaper. It's like this person hasnot a clue of what they're talking about, just like has no clue they've never trained in. I don't disparagetheir sports reporter like why should they? but they became the voice of like public health for like theaverage person. It just it set us up where that person just had a story and then just found whateverpeople on Twitter that they could to like back up their story irrespective to drive controversy, to driveanger towards the government based on sort of political leanings. Even if maybe my political leaningsare aligned with that person, it's a relevant because it's not about politics, it's about public health. So Ithink the media, we have to think about, like, how do we manage the media's need for clicks and profit,you know, during this time, in with, like, their role as like, the responsible are an important part of like,you know, social functioning, in terms of the free press. So, I, there's no easy answers to that. But I'll justsay, I think there was a fundamentally important role that the media played here. And I have to say, itdidn't play out positively, in most places.KK: I gotta say, like, this is gonna be naive talk. But we're in a pandemic, there had to be so many of ushad a sense of duty, like, I was surprised at the lack of sense of duty, to be honest with you. Even if youare about your cliques, ask yourself, is this is this about the greater good here? Is this really gonna get usfurther ahead? I've said this a few times on my platform, I would have a balance of a mess. The balancedmessage on was usually one specific network that would bail on the interview. They would literally bailon the interview because my message might not be as fearful. What the actual f you know what I mean?Like it's crazy.(?) I will say there were some good reporters. I don't want to say that that you know, there were someincredible folks. I was talking to someone the other day, I won't mention who but I think the mark of thegood reporter was, you know, they have a story, they want to talk about it. They contacted us. And theysaid, what time can we talk this week, right? They didn't say I need to get this filed in three hours. If yousay you need to get this filed in three hours, the expert you're gonna go to is the one that's available inthe next three hours, right? They wanted to hear an opinion, they wanted to get multiple opinions onthe table, but they would carve out the time so that everyone could give their story or, what theiropinion was or what evidence they presented. They made sure it rotated around the experts rather thanthe story rotating around being filed. I think it's important and, you know, you can get a sense of certainthings that are on the need to be filed this day, or even on the 24/7 news cycle, where they may not beas well researched, they're they're a single opinion. They're quoting a Twitter tweet. Now, I think insome of these media platforms, you can just embed that Twitter tweet, you don't even have to, youknow, quote it in that sense, you just basically take a screenshot of it basically. Versus again, thosearticles where I think there was there more thought, and I think there were some great reporters inCanada, that really did go above and beyond. Health reporters, particularly that really did try to presenta picture that was well researched, and evidence based, you know, with what's available, but therecertainly are these issues and it's not a COVID specific issue, but with media ad reporting, in that sense.Yeah, it's and it's important to say like, it's not actually just the reporter, it's the editors, its editorialteams, like I had said, OTR discussions with reporters very early on, I've tried to stay away from themedia, because I think the folks who have done it, I've done it well. But it was interesting, because BobSargent, who sadly passed away, an internal medicine physician, and an amazing mentor to manyclinicians in Toronto. Put me in touch with a couple of reporters. He's like, you know, you're a publichealth person, you should really talk to these reports. We had this; can we talk to you privately? It wasso weird. This was summer of 2020. So, we had a very private discussion where I said ‘Listen, I haveconcerns about lockdowns for like, these reasons' I think it's reasoned, because it's not it, I've got noconspiracy to drive, like, I've got no, there's no angle in any of it. So, but it was just fascinating. So, theywere like we might be able to come back to you, and maybe we'll try to do a story around it. Then theycame back and said, we're not going to be able to pursue it. I said that's fine. It's no problem. It just sortof showed that I think, similar as academics, and clinicians, and all of us have been under pressure basedon everything from like CPSO complaints, the complaints to our employers, to whatever to just saw, youknow, the standard attacks on Twitter. I think there was also a lot of pressure on reporters based on thiswhole structure, and of it. So I think, I don't mean to disparage anybody, but I do think the point thatyou made is really important one is. I'll just say, in our own house, you know, my wife and I both werelike talking at the beginning of this and being like, what do we want to know that we did during thistime? So, my wife worked in person, as a clinician alter her practice all throughout her pregnancy? Shenever didn't go, you know, she did call she did all of that, obviously, I have done the work I've done interms of both clinically and vaccine related testing. But this just idea of like, what do you want toremember about the time that you would like what you did when s**t hit the fan? And, you know,because first, it'll happen again, but just also, I think it's important to sort of, to be able to reflect andthink positively about what you did. Anyways,KK: I hear you both, part of it, too, for me, I'll just straight up honesty. In some ways, I'm just pissed, I'mpissed that a lot of the efforts that were that a lot of people put into to try and get a good message outthere. The backlash. Now people reflecting saying, ‘Oh, I guess you did, you know, many of you do tohad a good point about lockdowns not working out'. I know it may be childish in some way, but it's just,you know, a lot of us have gone through a lot to just try and create a balanced approach. I think therewas a little bit of edge in this voice, but I think it comes with a bit of a bit of reason to have a bit of edge.I think in terms of the next couple questions here are areas to focus on. A lot of people in terms of like,decisions regarding mandates, boosters, and so forth, like we talk a lot about it on public health, it's thedata that helps drive decisions, right. That's really what you would think it should be all about. So, one ofthe many questions that were thrown to us, when we announced that this was happening was, the needfor like, almost like universal boosters, and Sumon, I'll put you on the spot there, at this stage in thepandemic, where I'm gonna timestamp this for people on audio, we're on January 10th, 2023. There aresome questions that we get, who really needs to push through to we all need boosters? What's yourthoughts on that?SC: So, I think that one of the things that I said this, as Zain makes fun of me throughout the pandemic, Icame up with catchphrases, and my one for immunity is the way that we've conceptualized immunity inNorth America. I think a lot of this has to do with an actual graphic from the CDC, which likens immunityto an iPhone or a battery, iPhone battery. So, iPhone immunity, where you have to constantly berecharging and updating. I think that has kind of bled into the messaging. That's what we think of it. Iremember back in I think it was October of 2021, where they were also starting to talk about the thirddose. The third dose, I think that at that time, we knew that for the higher risk people, it was probablythe people who would benefit the most from it. We had Ontario data from it was I think, was ISIS.There's vaccine efficacy against hospitalization, over 96% in Ontario in health care workers 99%, if you'reless than seventy-seven years of age, yet this went out, and everybody felt like they had to get thebooster. So, I think that the first thing that bothered me about that is that there wasn't a kind ofstratified look at the risk level and who needs it? So now we're in 2023. I think that one of the big thingsapart from what I said, you know, who's at higher risk, there's still this problem where people think thatevery six months, I need to recharge my immunity, which certainly isn't true. There wasn't a recognitionthat being exposed to COVID itself is providing you a very robust immunity against severe disease, whichis kind of it's coming out now. We've been we've all been talking about it for a long time. And you know,the other thing is that the disease itself has changed. I think that I heard this awesome expression, thefirst pass effect. So, when the COVID first came through a completely immune naive population, ofcourse, we saw death and morbidity, we saw all the other bad stuff, the rare stuff that COVIDencephalitis COVID GB GBS tons of ECMO, like 40-year old's dying. With each subsequent wave asimmunity started to accrue in the population, that didn't happen. Now we're at a different variant. Andthe thing is, do we even need to be doing widespread vaccination when you're with current variant, andyou can't be thinking about what we saw in 2021. So, putting that now, all together, we have as Zanementioned, seroprevalence, about almost 100%, you have people that are well protected against severedisease, most of the population, you have a variant that absolutely can make people sick. And yes, it cankill people. But for those of us who work on the front line, that looks very different on the on the frontlines. So, I really think that we should take a step back and say, number one: I don't think that thebooster is needed for everybody. I think number two: there are under a certain age, probably 55 andhealthy, who probably don't need any further vaccination, or at least until we have more data. Numberthree: before we make a widespread recommendation for the population. We have time now we're notin the emergency phase anymore. I really hope that we get more RCT data over the long term to seewho is it that needs the vaccine, if at all. And you know, who benefits from it. And let's continue toaccrue this data with time.KK: Thanks Sumon. Zain, are you on the along the same lines assume on in terms of who needs boostersand who doesn't?ZC: Yeah, I mean, I think number one: is the recognition that prior infection and hybrid immunityprobably are incredibly adequate. Again, people like Paul Offit, and we're not just talking about youknow, experts like us. These are people that are sitting on the FDA Advisory Committee, a man thatactually made vaccines in the United States, you know, that talks about the limitations of boosters andprobably three doses being you know, The peak of the series for most people, and even then, you know,two plus infection probably is enough is three or even one plus infection, the data may suggest maybe isas high as three. Yeah, I think, again, this is one of these things that gets diluted as it starts going downthe chain, if you actually look at the Nazi guidance for, you know, bi-Vaillant vaccines, it's actuallyincorporates a ‘should' and a ‘can consider' in all of this, so they talked about vulnerable individuals,elderly individuals should get a booster where there may be some benefits in that population, the restof the population can consider a booster in that sense, right. And I think as the boosters came out, andagain, you know, people started jumping on them, it came to everyone needs their booster. Andunfortunately, the messaging in the United States is perpetuated that quite a bit with this iPhonecharging thing, Biden tweeting that everyone over the age of six months needs a booster. Again, wereally do have to reflect on the population that we're going at. Ultimately, again, if you start pressing theissue too much in the wrong populations, you know, the uptake is, is showing itself, right, the peoplewho wanted their bi-Vaillant vaccine got it. Thankfully the right populations are being incentivized,especially in the elderly, and the very elderly, and the high risk. Uptake in most other populations hasbeen relatively low. So, people are making their decisions based on based on what they know. Again,they feel that that hesitation and what is this going to benefit me? and I think as Sumon said, theconfidence is going to be restored when we have better data. We're in a phase now where we can docluster randomized RCTs in low-risk populations and show it If you want the vaccine, you enter into acluster randomized RCT, if you're in a low-risk population, match you one to one with placebo. You wecan tell you if you got, you know, what your prognosis was at the end of the day, and that information isgoing to be important for us. I don't think that policy of boosting twice a year, or once a year is gonnaget people on the bus, every booster seems like people are getting off the bus more and more. So, wereally do have to have compelling information. Now, as we're bringing these out to start saying, youknow, is this a necessity? especially in low-risk populations? How much of a necessity is that? How muchdo you quantify it in that sense? And again, recognizing that, that people are being infected? Now, thatadds another twist in that sense.KK: Yeah, and we'll talk a little bit about public trust in a bit here. But Stef, you were among someauthors that did an essay on the booster mandates for university students. As we've both alluded toZain, and Sumon there's this need to be stratified. From an RCT booster point of view that we're not wellestablished here. When Stef's group looked at university mandates and potential harm, when we'redoing an actual cost benefit ratio there, their conclusion was that there's more room for harm thanbenefits. So, Stef I want you to speak to that paper a bit.SB: Sure. So, I will say this, I don't actually have much to add other than what Zain and Sumon said. Runa vaccine program we are offering, you know, doses as it makes sense for folks who are particularlyimmunocompromised, multiple comorbidities and remain at risk for serious consequences related toCOVID-19. We'll continue doing that. And that will, you know, get integrated, by the way into like, sortof a vaccine preventable disease program, so offering, shingles, Pneumovax, influenza COVID. And alsowe want to do a broader in terms of other hepatitis vaccines, etc. That aside, so this, this isn't about, youknow, that it was really interesting being called antivax by folks who have never gotten close to avaccine, other than being pricked by one. Having delivered literally 1000s of doses of vaccine, so it'salmost it's a joke, right? but it's an effective thing of like shutting down conversation. That aside, I thinkthere's a few things at play one as it related to that paper. I find it really interesting, particularly foryoung people, when people are like, listen, yes, they had a little bit of like, inflammation of their heart,but it's self-resolving and self-limiting, and they're gonna be fine. You don't know that. Maybe sure we'llsee what happens with these folks twenty years later. The reality is for younger men, particularly, thishappens to be a very gender dynamic. For younger men, particularly, there seems to be a dynamicwhere they are at risk of myocarditis. I don't know whether that's a controversy in any other era for anyother disease, this would not be a controversy would just be more of a factual statement, the data wereclearer in I'd say, probably April, May 2021. I think there's lots of things we could have done, we couldhave done one dose series for people who had been previously infected, we could have stopped at two.There are a million different versions of what we could have done, none of which we actually did. In thecontext of mandating boosters now for young people, including at my institution, you were mandated toget a booster, or you would no longer be working. So obviously, I got one. There's a real dynamic ofwhat is it your goal at that point? because probably about 1011 months into the vaccine programbecame increasingly clear. You can still get COVID. Nobody's surprised by that. That was clear even fromthe data. By the way, wasn't even studied. I mean, Pfizer, the way if you just look at the Pfizer, Moderna,trials, none and look to see whether you got COVID or not, they were just looking at symptomaticdisease. That aside, I think that it just became this clear thing where for younger men, one or two doseswas plenty and it seems to be that as you accumulate doses for those folks, particularly, it's alsoimportant, if somebody had a bad myocarditis, they're not even getting a third dose. So, you're alreadyselecting out, you know, some of these folks, but you are starting to see increased levels of harm, as itrelated to hospitalization. That what we basically did, there was a very simple analysis of looking ataverted hospitalization, either way, many people say that's the wrong metric. You can pick whatevermetric you want. That's the metric we picked when terms of hospitalization related to side effects of thevaccine versus benefits. What it just showed was that for people under the age of 30, you just don't seea benefit at that point, as compared to harm that's totally in fundamentally different. We weren't talkingabout the primary series, and we weren't talking about older folks. So indeed, I think, you know, thatwas that was I don't know why it was it was particularly controversial. We it was a follow up piece tomandates in general. I'll just say like, I've been running this vaccine program, I don't think mandateshave made my life easier at all. I know, there's like this common narrative of like mandates, you know,mandates work mandates work. I think at some point, and I'll just say our own study of this is like we'rereally going to have to ask two questions. One: what it mandates really get us in terms of a burdenCOVID-19, morbidity, mortality? and two: this is an important one for me. What if we caught ourselvesin terms of how much pressure we put on people, as it relates to vaccines right now, in general? Thevery common narrative that I'm getting is they're like, oh, the anti Vax is the anti Vax folks are winning.And people don't want their standard vaccines, and we're getting less uptake of like, MMR andstandard, you know, kind of childhood vaccines, I have a different opinion. I really do at least I believesome proportion of this, I don't know what proportion, it's some proportion, it's just like people beingpushed so hard, about COVID-19 vaccines that they literally don't want to be approached about anyvaccine in general. So, I just think that with in public health, there's always a cost. Part of the decisionmaking in public health as it relates to clinical medicine too. It's like you give a medication, theadvantage and then you know, the disadvantages, side effects of that medication. In public health, thereare side effects of our decisions that are sometimes anticipated and sometimes avoidable, sometimescan't be anticipated and sometimes can't be avoided. You have to kind of really give thought to each ofthem before you enact this policy or you might cost more health outcomes, then then you're actuallygaining by implementing it.KK: Yeah, number one: What was spooky to me is like even mentioning, I was afraid even to use a termmyocarditis at times. The worst part is, as you said, stuff, it's young folk that were alluding to, and for usto not be able to say, let's look at the harm and benefit in a group that's low risk was baffling. It reallywas baffling that and I'm glad we're at least more open to that now. Certainly, that's why I thought thatthe paper that you guys put together was so important because it's in the medical literature that we'reshowing, objectively what the cost benefit of some of these approaches are. Sumon: when you think ofmandates and public trust, that Stef was kind of alluding to like, every decision that we madethroughout this thing. Also has a downside, also has a cost, as Stef was mentioning. Where do you thinkwe are? In terms of the public trust? Talking about how the childhood vaccines are lower. I don't knowwhat influenza vaccine rates are like now, I wouldn't be surprised if they're the same standard, but whoknows them where they're at, currently. Based on your perspective, what do you think the public trust isright now?SC: Yeah, as physicians, we obviously still do have a lot of trust in the people we take care of. People arestill coming to see us. I wish they didn't have to because everyone was healthy but that's not the case. Ido think that over the last two and a half, we're coming up on three years, I guess right now, that peoplethat we have burned a lot of trust, I think that mandates were part of it. I do think that some of it wasunavoidable. It's just that there's a lot of uncertainty. There was back and forth. I think that one thingthat were that concern me on social media was that a lot of professionals are airing their dirty laundry tothe public. You could see these in fights, that doesn't, that's not really a good thing. We saw peoplebeing very derisive towards people who were not listening to the public health rules. You know what Imean? There's a lot of that kind of talk of othering. Yeah, I think that that certainly overtime, erodedpublic trust, that will take a long time to get back, if we do get it back. I think that the bottom line is that,I get that there are times that we have to do certain things, when you have a unknown pathogen comingat you, when you don't really know much about it. I do think that you want to do the greatest good forthe, for the population or again, you always must remember as Stefan alludes to the cost of what you'redoing. I do think that we could have done that much early on. For example, Ontario, we were lockeddown in some areas, Ontario, GTA, we were locked down in some regard for almost a year and a half. Ifyou guys remember, there was that debate on opening bars and restaurants before schools. It's just like,I remember shaking my head is, look, I get it, I know you guys are talking about people are going to beeating a burger before kids can go to school, that might ruin everything. But the problem is, is that youmust remember that restaurant is owned by someone that small gym is someone's livelihood, you'remoralizing over what this is, but in the end, it's the way somebody puts food on the table. For a yearand a half, we didn't let especially small businesses do that. I'm no economist, but I had many familymembers and friends who are impacted by this. Two of my friends unfortunately, committed suicideover this. So, you know, we had a lot of impact outside of the of the things that we did that hurt people,and certainly the trust will have to be regained over the long term.KK: It's gonna take work. I think, for me, honestly, it's, it's just about being transparent. I honestly, I putmyself in some in the shoes of the public and I just want to hear the truth. If we're not sure aboutsomething, that's okay. We're gonna weigh the evidence and this is our suggestion. This is why we'resaying this, could we be wrong? Yes, we could be wrong but this is what we think is the best pathforward, and people could get behind that. I honestly feel like people could get behind that showing alittle bit of vulnerability and saying ‘you know, we're not know it alls here' but this is what our beststrategy is based on our viewpoint on the best strategy based on the data that we have in front of usand just be open. Allowing for open dialogue and not squash it not have that dichotomous thinking ofyou're on one side, you're on the other. You're anti vax, you're pro vax, stop with the labels. You know,it's just it got crazy, and just was not a safe environment for dialogue. And how are you supposed to he'ssupposed to advance.SB: Yeah, I do want to say something given this this is this idea of our swan song. I think there was thissort of feeling like, you know, people were like ‘you gotta act hard, you gotta move fast' So I thinkeverybody on this, you guys all know I travel a lot. I like to think of myself as a traveler. In the early2020's I did like a COVID tour, I was in Japan in February, then I was in Thailand, and everywhere Ilanded, there were like, COVID here, COVID here, COVID here. Then finally, I like got home at the end ofFebruary, and I was supposed to be home for like four days, and then take off. Obviously things got shutdown. It was like obvious like COVID was the whole world had COVID by, February, there may have beena time to shut down this pandemic in September 2019. Do you know what I mean? by November 2019,we had cases. They've already seen some and Canadian Blood Services done some showing someserological evidence already at that time. There was no shutting it down. This thing's gonna suck. Thereality is promising that you can eliminate this thing by like, enacting these really like arbitrary that canonly be described as arbitrary. Shutting the border to voluntary travel, but not to truckers. Everythingfelt so arbitrary. So, when you talk about trust, if you can't explain it, if you're a good person do it. If youdon't do it, your white supremacist. Kwadwo you were part of a group that was called ‘Urgency ofNormal' you are a white supremacist. It's so ridiculous. You know what I mean? It creates this dynamicwhere you can't have any meaningful conversation. So, I really worry, unless we can start having somereally meaningful conversations, not just with folks that we agree with. Obviously, I deeply respect whateach of you have done throughout this pandemic, not just actually about what you say, but really whatyou've done. Put yourselves out there with your families in front of this thing. That aside, if we can't dothat, we will be no better off. We will go right back. People will be like ‘Oh, next pandemic, well, let'sjust get ready to lock down' but did we accomplish anything in our lock downs? I actually don't think wedid. I really don't think we got anything positive out our lock downs, and I might be alone in that. I mightbe wrong, butut that said it needs to be investigated and in a really meaningful way to answer that,before it becomes assume that acting hard and acting fast and all these b******t slogans are the truthand they'd become the truth and they become fact. All without any really meaningful evidencesupporting them.KK: I gotta say, I'll get you Sumon next here, but I gotta say the idea of abandoning logic, I think that'sthat's a key point there. Think about what we're doing in restaurants, folks. Okay, you would literallywear your mask to sit down, take off that bloody thing. Eat, chat, smooch even, I mean, and then put itback on and go in the bathroom and think this is meaningful. Where's the logic there? You're on a plane,you're gonna drink something, you're on a six hour flight, you know what I'm saying.(?) During the lockdown, by the way, you're sending like 20 Uber drivers to stand point. If you ever wentand picked up food, you would see these folks. It'd be like crowding the busy restaurants all like standingin there, like arguing which orders theirs, you know what I mean? then like people waiting for the foodto show up.KK: I mean, that's the other point. The part that people forget with the lockdowns, tons of people willwork. I'm in Ottawa, where 70% are, could stay home, right? That's a unique city. That's why we werevery sheltered from this bad boy.(?) Aren't they still fighting going back to the office?KK: Oh, my God. Folks, I'm sorry. Yeah, it's like 70% could stay home, but you're in GTA your area. That'sa lot of essential workers. You don't have that option. So, how's this lockdown? Really looking at the bigpicture? Anyway, sorry. Sumon you're gonna hit it up.SC: We just wanted to add one anecdote. I just think it kind of talks about all this is that, you know therewas a time when this thing started going to 2020. Stefan, I think you and I met online around that time.You put a couple of seeds after I was reading stuff, like you know about the idea of, you know, risktransfer risk being downloaded to other people. That's sort of kind of think of a you know, what, like,you know, a people that are working in the manufacturing industry, you're not going to receive them alot unless you live in a place like Brampton or northwest Toronto, where the manufacturing hub of, ofOntario and in many cases, central eastern Canada is right. So, I remember in, I was already starting touse this doing anything. And when I was in, I guess it would have been the second wave when it was itwas pretty bad one, I just kept seeing factory worker after factory worker, but then the thing that stuckout was tons of Amazon workers. So, I asked one of them, tell me something like, why are there so manyAmazon workers? Like are you guys? Is there a lot of sick people working that kind of thing? Inretrospect, it was very naive question. What that one woman told me that her face is burned into mymemory, she told me she goes, ‘Look, you know, every time a lockdown is called, or something happenslike that, what ends up happening is that the orders triple. So, then we end up working double and tripleshifts, and we all get COVID' That was just a light went off. I was like, excuse my language, guys, but holys**t, we're basically taking all this risk for people that can like what was it called a ‘laptop class' that canstay home and order all this stuff. Meanwhile, all that risk was going down to all these people, and I wasseeing it one, after another, after another, after another. I'm not sure if you guys saw that much, but Iwas in Mississauga, that's the hardest, Peele where the manufacturing industry is every single peanutfactory, the sheet metal, I just saw all of them. That I think was the kind of thing that turned me andrealize that we what we'll be doing. I'll shut up.ZC: Yeah, I would say I mean, I think Stefan and Sumon make great points. You know, I think that thatwas very apparent at the beginning. The other thing I would say is 2021 to 2022. Things like vaccinationand public health measures fell along political lines. That was a huge mistake. It was devastating. Iremember back to the first snap election in 2021. Initially great video of all the political partiesencouraging vaccination and putting their differences aside. Then all of a sudden, it became mudslingingabout how much public health measure you're willing to do, how much you're willing to invest in, andit's not a Canadian phenomenon. We saw this in the United States with the Biden and Trump campaignsand the contrast between the two, and then really aligning public health views to political views, andthen, you know, really making it very uncomfortable for certain people to then express counter viewswithout being considered an alternative party. It's something we need to reflect on I think we havepublic health and public health messengers and people that are agnostic to political views but are reallythere to support the health of their populations, from a health from a societal from an emotional fromthe aspects of good health in that sense. You really can't involve politics into that, because all of asudden, then you start getting counter current messaging, and you start getting people being pushed,and you start new aligning values to views and you start saying, right and left based on what peopleconsider, where again, the science doesn't necessarily follow political direction. It was a really bigmistake, and it still is pervasive. We saw every election that happened between 2021 to 2022 is publichealth and public health messaging was embedded in each one of those and it caused more harm thangood. I think it's a big lesson from this, this is that you can be proactive for effective public healthinterventions as an individual in that society that has a role, but you can't stick it on campaigns. It reallymakes it hard to deescalate measures at that point when your campaign and your identity is tied tocertain public health measures in that sense.KK: Amen. I am cognizant of the time and so I'm gonna try to rapid fire a little bit? I think, there's only acouple points that people hit up on that we haven't touched on. There was a push for mass mandates inthe last couple months because of of RSV and influenza that was happening. It still is happening in,especially in our extreme ages, really young and really old. Any viewpoint on that, I'll leave it open toalmost to throw down.(?) I think mass mandates have been useless. I don't expect to ever folks to agree with me, it's like it's aninteresting dynamic, right? When you go and you saw folks who were on the buses, I take the bus to theairport. Our subway in Toronto just for folks only starts at like, 5:50am. So, before that, you gotta jumpon buses. So the construction workers on the bus who were wearing masks during the when the maskmandates were on taking this what's called, it's like the construction line, because it goes down Bloorare basically and takes all the construction workers from Scarborough, before the subway line, get todowntown to do all the construction and build all the stuff that you know, is being built right now.Everyone is wearing this useless cloth mask. It's like probably the one thing that the anti-maskers who Ithink I probably am one at this point. The pro-maskers and all maskers can agree on is that cloth masksare useless. That's what 100% of these folks are wearing. They're wearing these reusable cloth masksthat are like barely on their face often blow their nose. So, to me, it's not so much about like, what couldthis intervention achieve, if done perfectly like saying the study you were involved with the help lead,it's like everybody's like, but all of them got COVID outside of the health care system, they didn't get itwhen they're wearing their N95. That's like, but that's the point, like public health interventions live ordie or succeed or fail in the real world. I was seeing the real world, I would love to take a photo but Idon't think these folks have been friendly to me taking a photo of them, but it was 100%, cloth masks ofall these folks in the morning all crowded, like we're literally like person to person on this bus. It's like aperfect, you know, vehicle for massive transmission. I just I just sort of put that forward of like, that'swhat a mask mandate does to me. I think to the person sitting at home calling for them, they are justimagining, they're like ‘Oh but the government should do this'. But they didn't. The government shouldbe handing out in N95's. How are you going to police them wearing a N95's and how are you gettingthem? It would be so hard to make a massive program work. I would say it's like if you gave me millionsand millions and millions of dollars, for me to design a mass program, I don't know, maybe I could pull itoff you really with an endless budget. But for what? So, I just think that like as these programs went outin the real world, I think they did nothing but burn people's energy. You know because some people itjust turns out don't like wearing a mask. Shocking to other folks. They just don't like wearing a mask.Last thing I'll say is that just as they play it out in the real world, I think we're functionally useless, otherthan burning people's energy. I'm a fervent anti masker at this point because it's just an insult to publichealth. To me everything I've trained in and everything I've worked towards, just saying these two wordsmask mandate, as the fix. That is an insult to the very thing that I want to spend my life doing .ZC: Yeah, I mean, three points, one: you know, masks are still important in clinical settings. I think we allunderstand that. We've been doing them before we've been continuing to do them. So I you know,that's one piece. Second: I mean, to go with the point that was raised here, you know, the best study wehave is Bangladesh, right? 10% relative risk reduction. It's interesting when you read the Bangladeshstudy, because with community kind of people that pump up masking that are really trying to educateand probably are also there to mask compliance. Mask's compliance people, you get to 54% compliance,when those people leave compliance drops significantly. Right. You know, I think you have to just lookaround and see what happened in this last few months, regardless of the messaging. Maybe it's thecommunities I'm in, but I didn't see mass compliance change significantly, maybe about 5%. In thecontext of the last couple of months. You must understand the value of this public health intervention,Bangladesh has actually a nice insight, not only into what we think the community based optimalmasking efficacy is, but also the fact that you really have to continue to enforce, enforce, enforce,enforce, in order to get to that even 10%. Without that enforcement, you're not getting anywhere inthat sense. That probably spells that it's probably a very poor long term public health intervention in thecontext that you really must pump it week by week by week by week in order to actually get compliancethat may actually then give you the effects that you see in a cluster randomized control trial. Again, youknow, the world we live in is showing that people don't want to mask normally. Some people can, i

Episode Summary"In this episode we welcome back to the show clinical phycologists Dr. Karen Dyck and Dr. Melissa Tiessen. This one is all about self-care. Getting in touch with yourself, wellness and more!"SHOW SPONSORBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

Episode SummaryIn this minicast Dr. K has a big announcement! A brand new initiative, reversing metabolic disease, virtual health, and more great news for 2023!Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

Episode Summary:In this minicast we welcome back retired physician Dr. Tina McInnes. Tina now coaches clients for healthier living through exercise and nutrition habits. Today Tina speaks to us about self-awareness and healthy eating habits and focusing on our food consumption. When are we eating, and what are we eating? Tina goes over the importance of placing your eating habits under a microscope and really watching what goes into your body.Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.SPONSORBETTERHELPBetterHelp is the largest online counseling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet, and affordable access to a licensed therapist. BetterHelp makes professional counseling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare" This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

Episode SummaryIn this quick mini-cast, Dr. K gives a shout-out to a few of our past guests and their recent achievements with a published essay regarding vaccines and boosters. Dr. K shares his thoughts with us about what vaccine mandates and booster mandates mean for our youth. The education system and the messages they are sending by requiring students to receive a booster to access in-person learning, what these policies mean, to our youth, and more! Notable authors are & Stefan Baral Here's a link to the paper: https://jme.bmj.com/content/early/2022/12/05/jme-2022-108449Thanks for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it.SPONSORS:BETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare" This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

Episode SummaryIn this episode, we welcome Nigel O'Quinn, founder of Higher Healths Canada to talk about optimizing your health! We discuss everything about nutrition, processed foods, better ways to grow food, organ meats, processed foods, micronutrients and more!Check out Higher Healths Canada & use code 'solvinghealthcare' at checkout  | https://www.higherhealths.ca Episode NotesSPONSORSBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comSolving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8wThanks for following Solving Healthcare with Dr. Kwadwo Kyeremanteng! Subscribe for free to receive new posts and support my work.Thank you for reading Solving Healthcare with Dr. Kwadwo Kyeremanteng. This post is public so feel free to share it. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

Higher Healths Canada use code 'solvinghealthcare' at checkout  |  https://www.higherhealths.ca SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

Episode Summary"In this episode we welcome Catherine Clark to the show. Catherine is an author, trauma therapist, and resiliency expert. Today we talk about everything from self-care, acceptance, compassion, making connections, mental health and more!"Episode NotesSOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

Solving Healthcare is a podcast series launched in September 2019 by the Resource Optimization Network. Led by Dr. Kwadwo Kyeremanteng, a palliative care & intensive care doctor based in Ottawa, these podcasts will feature interviews and discussions on the topic of improving healthcare delivery in Canada. Underpinned by the values of cost-effectiveness, dignity, and justice, these podcasts will challenge the status quo, leaving no stone unturned as we explore gaps, assumptions, and different perspectives in the pursuit of finding solutions to problems in Canada's healthcare systemNote, views expressed belong to the host only.

In this episode, we welcome Toronto-based author, nutritionist, and founder of the Academy of Culinary Nutrition, Meghan Telpner. Today we talk with Meghan about everything from breathing techniques to meditation, embodying compassion, focusing your mind, pumpkin spice and more!Episode NotesSOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

Episode NotesSOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

Can you believe it? We've hit 200 episodes! Join us for our 200th episode celebration. Dr. K sits with us to tell us about how far Solving Healthcare has come over the years. Humble origins, current projects and the future we have in store for you!Episode NotesSOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare" This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

In this episode, we welcome Joelle Lachance-Artindale, Director of Clinical Management at Bayshore HealthCare. Today we talk with Joelle about, PSWs and home care, acute care, virtual care, health promotion, providing education to families and patients and much more!SPONSORSSOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit kwadcast.substack.com

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w

SOLVINGWELLNESS: An amazing wellness platform for healthcare professionalsSOLVINGWELLNESS.COM or facebook.com/groups/solvingwellnessKEYNOTE SPEAKINGsolvinghealthcare.ca or kwadcast99@gmail.comBETTERHELPBetterHelp is the largest online counselling platform worldwide. They change the way people get help with facing life's challenges by providing convenient, discreet and affordable access to a licensed therapist. BetterHelp makes professional counselling available anytime, anywhere, through a computer, tablet or smartphone.Sign up today: http://betterhelp.com/solvinghealthcare and use Discount code “solvinghealthcare"Solving Healthcare Seminars & Merchandise.The full conference can be purchased for $9.99 at solvinghealthcare.ca/shopDepartment of Medicine site: https://ottawadom.ca/solving-healthcareResource Optimization Network website: www.resourceoptimizationnetwork.com/Follow us on twitter, TikTok & Instagram: @KwadcastLike our Facebook page:https://www.facebook.com/kwadcast/YouTube:https://www.youtube.com/channel/UCLmdmYzLnJeAFPufDy1ti8w