Canadian Primary Care Today

2023 Update On the Screening and Treatment of Localized Prostate Cancer

Wee Loon Ong, MD, Andrew Loblaw, MD, FRCPC — Wed, 25 Oct 2023 00:00:00 +0000

Prostate cancer represents a major burden of disease in Canada. It represents the third leading cause of cancer mortality in men with more than 24,000 individuals diagnosed in 2021. The diagnosis and management of prostate cancer is a continuously evolving area, and the aim of this article is to provide current information on various aspects of prostate cancer care, as an aid for primary care physicians (PCPs) as they guide men through the prostate cancer journey.

Practical Implementation of Lipid Lowering for Cardiovascular Risk Reduction in Primary Care

G.B. John Mancini, MD, FRCPC, FACC — Wed, 25 Oct 2023 00:00:00 +0000

With the advent of safe lipid-lowering drugs, particularly statins and non-statin agents such as ezetimibe, and with the emergence of newer therapeutics such as monoclonal antibodies and RNA technologies, it has become apparent that major adverse cardiovascular (CV) events can be reduced both in primary and secondary prevention by 20–50% through lowering of low-density lipoprotein cholesterol (LDL-C) by 1–2 mmol/L. The purpose of this paper is to provide a pragmatic approach to the implementation of the 2021 Canadian Cardiovascular Society Guideline for managing dyslipidemia in adults.

Menopause Hormone Therapy: 2023 Update

Denise Black, MD — Wed, 25 Oct 2023 00:00:00 +0000

The publication of the Women’s Health Initiative (WHI) study in 2002 caused a precipitous decline in use of menopause hormone therapy (MHT). Prior to publication, approximately 43% of women aged 45–74 used MHT; following publication, this number dropped to 11%. Fear of breast cancer was the largest motivator behind this decline. Since the WHI study, menopause medical education has been inadequate; it is estimated that 41% of medical schools do not include menopause education in their undergraduate curriculum. The same study highlighted significant knowledge gaps regarding menopause management among practicing physicians.

Menopausal women are asking questions and expecting answers. Advocacy groups such as the Menopause Foundation of Canada are empowering women to acknowledge the impact of menopausal symptoms on the workplace, personal relationships and personal health. As MHT is considered first-line therapy (in the absence of contraindications), it behooves healthcare providers to have a working knowledge of MHT.

Case Report: Allergic Rhinitis

Gina Lacuesta, MD, FRCPC — Wed, 25 Oct 2023 00:00:00 +0000

Case #1

A 32-year-old female presents to her primary healthcare professional (HCP) with a long history of intermittent nasal congestion, sneezing, rhinorrhea, and itchy eyes. She recalls experiencing these symptoms in high school, but notes that her condition has worsened over the years. Her symptoms were previously present only in the summer; however, they now extend year-round. She reports that her symptoms affect her sleep when she has complete nasal blockage, that she is forced to blow her nose throughout the night, and that the constant wakening leaves her feeling fatigued. She notes that she has “tried everything” in terms of over-the-counter (OTC) medications and that she finds the side effects bothersome. She is requesting allergy testing and has heard that there is “a shot” available.

Redefining Diabetes Strategies in Primary Care: Four New Pillars of Management

Akshay Jain, MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM — Wed, 25 Oct 2023 00:00:00 +0000

The management of Type 2 diabetes mellitus (T2DM) is possibly becoming one of the most challenging aspects of primary care. With millions of individuals worldwide living with T2DM, who are at a higher risk of developing multiple additional chronic conditions including cardiovascular disease (CVD) and renal disease, it is imperative that primary care practitioners (PCPs) around the world are comfortable with the management of T2DM. However, with dozens of T2DM medications available, many of which have associated risks of side effects such as hypoglycemia, the management of T2DM can be quite time-consuming for the busy family physician.

In light of the above, it is important that we look at T2DM through a new lens. It is imperative that clinicians view the management of T2DM not just as “blood glucose management” but rather, that they adopt a person-centric, holistic management approach that takes into account the mitigation of microvascular and macrovascular complications, in order to reduce the morbidity and mortality associated with the condition. When it comes to the management of this condition, one needs to be less of a “glucologist” and more of a “diabetologist”. In order to develop this approach, with the busy PCP in mind, I suggest four pillars on which to focus during a T2DM appointment, that are beyond the laboratory HbA1c measurement.