myOMERS Logo

Update from Dr. Aw

The Power of Music and Dance

Tuesday, October 20, 2020

During my early days at OMERS – I was warmly welcomed by colleagues Anne Soh, VP of Actuarial Services and Plan Actuary and Lisa Conway, Director of Growth Equity, who spoke to me about their exciting community work with Canada’s National Ballet School, who was doing some interesting work with Baycrest, a global leader in brain health and aging. Anne and Lisa were both very passionate about a wonderful program run by the school called “Sharing Dance Seniors.” In response to the pandemic, they shifted the program online and offered several free events providing instruction on dance and movement virtually. The broader National Ballet of Canada also offered virtual ballet lessons to front line health care workers at a hospital in Toronto. What great wellness initiatives!

Physical benefits of dancing include improved aerobic power, muscle endurance, strength, flexibility, gait (balance), bone density and reduced risk of falls and cardiovascular disease (1). This program also allows participants a healthy outlet for creativity, artistic expression and belonging to a community.

In my medical practice – I have found many of my healthy aging patients incorporate some form of creative art into their life (2). Some play instruments, sing, act in community theatre or paint. Even my parents who are both in their 80s surprised me a few years ago when they told me they started line dancing!

The link to music and wellbeing has been around for centuries – mainly in a social and cultural context. It seems intuitive that music can have a healing effect on the mind and body – but quality studies in the past have been sparse. However, the research is getting deeper on the health benefits of music interventions (playing instruments, singing, dancing).

Engagement in visual arts for adults with mental health conditions have been found to improve subjective wellbeing, reduce anxiety, improve self-esteem, enhance quality of life and prevent readmission to psychiatric hospitals (3). The impact of music therapy for cognitive improvement is still being debated. The first study to compare the effectiveness of art therapy and music reminiscence activity to prevent cognitive decline as a preventive strategy in a randomized controlled trial is being done with the National University of Singapore (4). Reminiscence therapy with music involves listening and discussing events and experiences related to music. In this trial, they will use music videos and link them to personal photographs for community living elderly individuals with mild cognitive impairment. The role of music is also being investigated in the rehabilitation of stroke, Alzheimer’s and age-related neurological diseases.

Studies (5) are also finding music interventions may be beneficial in movement disorders (Parkinson’s Disease, Huntington disease, Tourette syndrome, progressive supranuclear palsy). Evidence is emerging on the benefits of group dancing, singing and instrumental music performance particularly in Parkinson’s disease.

The social benefits of dance are many and include combating loneliness through human connection. Let’s also not forget the emotional importance of joy and play. There is lots of research on child play – but emerging studies are looking at the importance of adult “play time”. We all need to recharge and have fun as part of an overall wellness strategy. I found a study (6) from Carnegie Mellon University that elegantly defined play in adulthood as “a behaviour or activity that is carried out with the goal of amusement and fun, involves an enthusiastic and in-the-moment attitude or approach, and is highly interactive among play partners or with the activity itself) and identifies potential immediate outcomes (e.g. positive affect, feelings of being accepted and valued, reductions in daily stress) and long-term outcomes (e.g. psychological, physical and relational health) of play in adulthood, with an emphasis on play occurring within the context of close relationships.” Or stately simply. Sing and Dance!

I will leave you with lyrics from the 1987 song “Come from the Heart” by songwriters Susanna Clark and Richard Leigh:

“You’ve got to sing like you don’t need the money
Love like you’ll never get hurt
You’ve got to dance like nobody’s watchin’
It’s gotta come from the heart if you want it to work.”

Stay healthy!

References

  1. Physical Benefits of Dancing for Healthy Older Adults. https://journals.humankinetics.com/view/journals/japa/17/4/article-p479.xml

  2. Art for life’s sake. https://nationalpost.com/health/art-for-lifes-sake-the-health-benefits-of-culture

  3. Engaging in Visual Arts Improves Subjective Wellbeing for Adults with mental health conditions https://www.mcmasteroptimalaging.org/full-article/es/engagement-visual-arts-improves-subjective-wellbeing-adults-mental-health-3098?hl=art

  4. Art therapy and music reminiscence activity in the prevention of cognitive decline. https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2080-7

  5. Music therapy for Movement Disorders. https://pubmed.ncbi.nlm.nih.gov/31720865/

  6. Young at Heart. https://journals.sagepub.com/doi/10.1177/1745691615596789


September 10 marked Suicide Prevention Day

Friday, September 18, 2020

On September 10, the World Health Organization (WHO) marked Suicide Prevention Day to raise awareness that suicide can be prevented.

Mental health is one of the toughest areas of medicine to treat and losing a patient to suicide is one of the saddest experiences for a physician. My first experiences with suicide actually involved two professional colleagues. One was a medical classmate of mine who took her life during her residency training. Our classmates were shocked, as she always seemed to be the happiest and most upbeat person. In retrospect, she was probably covering up so much pain and lack of hope despite being successful in her career path. Another incident involved a physician colleague of mine who suffered quietly from postpartum depression and tragically ended her life by jumping in front of a moving subway train with her six month-old-child. She had stopped taking her anti-depressant medications as she was worried that it would harm her child during breastfeeding. We worked together at the same clinic where she was a physician psychotherapist and we shared some patients. Again – she always seemed to have her act together, never revealed sadness or despair during interactions and was a kind and caring physician. The tragic news was shocking and a chilling reminder of the depths of despair of depression. Even physicians who are trained to identify the signs and symptoms of depression and are surrounded by health care professionals daily can feel alone and helpless. Both events still haunt me today.

COVID-19 has caused an increase in mental health cases. Early during the pandemic, the media reported about a top New York emergency physician who took her life at the age of 48 after telling her family about the psychological trauma of seeing patients die of COVID. Another tragic story affecting a frontline worker.

The CDC (Centres for Disease Control) recently published data that shows that COVID related depression is disproportionately affecting young adults (aged 18-24), certain ethnic groups (Hispanic, Black), lower educated, essential workers, unpaid caregivers for adults and those who were already being treated for previously diagnosed anxiety, depression and post traumatic disorder. Uncertainty about the future (education, employment, financial independence, social network) is particularly affecting young adults. Domestic abuse and addiction (alcohol, illicit substances) have also been troubling and increasing trends. Mental health may be worsened from fear, isolation and COVID stigmatization.

Past studies have shown increases in suicide deaths during the 1918-19 influenza pandemic and more recently among older people in Hong Kong during the 2003 severe acute respiratory syndrome (SARS) epidemic. Many studies are now emerging about the mental health pandemic from COVID-19 which will have short- and long-term psychological effects.

Suicide prevention is complex because of multiple risk factors (biological, psychological, social, environmental).

Figure 1. Suicidal behavior in vulnerable populations in the COVID-19 era. Source: https://doi.org/10.1093/qjmed/hcaa202

Traditionally, the approach to suicide prevention has been split into universal, selective and individual preventive interventions. Universal preventive interventions are directed at the general public and include social media awareness campaigns, wellness campaigns, screening tools, community support services and hotlines. Selective interventions are targeted at those at risk (pre-existing psychiatric conditions, elderly, frontline workers, COVID survivors) and may involve active outreach programs, telemedicine and increased interaction with mental health professionals. Individuals in a suicidal crisis need immediate medical attention with experts. If you or someone you care about is at risk for suicide then please familiarize yourself with local and global resources through your physician, public health, social services, employer and community leaders.

Access to timely mental health services, however, has been a challenge and more studies and real time innovation (people, process, technology) will be required to cope with COVID effects.

It is worth mentioning again the risk of the infodemic and fake news. Vulnerable persons should avoid and limit excessive exposure to negative news stories through traditional and social media. Irresponsible media reporting can also be linked to suicide risk.

It is well known that social isolation is a risk factor for mental health issues. Conversely – social connectiveness is critical for emotional health. Make sure you stay connected with people. It’s OK to not be OK during this pandemic – but you need to reach out and seek help from loved ones and health care professionals to prevent a downward spiral of hopelessness if you or a loved one are at risk. Remember - there is always hope and those willing to help.

The World Health Organization has compiled a list of risk factors for suicide and actionable steps.

Do you know someone who may be considering suicide?

What you should know if you are worried about someone

  • Suicides are preventable.

  • It is okay to talk about suicide.

  • Asking about suicide does not provoke the act of suicide. It often reduces anxiety and helps people feel understood.


Warning signs that someone may be seriously thinking about suicide:

  • Threatening to kill oneself.

  • Saying things like "No-one will miss me when I am gone.

  • " Looking for ways to kill oneself, such as seeking access to pesticides, firearms or medication, or browsing the internet for means of taking one’s own life.

  • Saying goodbye to close family members and friends, giving away of valued possessions, or writing a will.


Who is at risk of suicide?

  • People who have previously tried to take their own life.

  • Someone with depression or an alcohol or drug problem.

  • Those who are suffering from severe emotional distress, for example following the loss of a loved one or a relationship break-up.

  • People suffering from chronic pain or illness.

  • People who have experienced war, violence, trauma, abuse or discrimination.

  • Those who are socially isolated.


What you can do?

  • Find an appropriate time and a quiet place to talk about suicide with the person you are worried about. Let them know that you are there to listen.

  • Encourage the person to seek help from a professional, such as a doctor, mental health professional, counsellor or social worker. Offer to accompany them to an appointment.
    If you think the person is in immediate danger, do not leave him or her alone. Seek professional help from the emergency services, a crisis line, or a health-care professional, or turn to family members.

  • If the person you are worried about lives with you, ensure that he or she does not have access to means of self-harm (for example pesticides, firearms or medication) in the home.

  • Stay in touch to check how the person is doing.

Remember: If you know someone who may be considering suicide, talk to them about it. Listen with an open mind and offer your support.

References



Stretches and tips to put your best foot forward

Join OMERS Chief Medical Officer Dr. Aw and fitness guru Brendan Fox as they discuss the common complaints when it comes to your knees, ankles and feet, and work through a series of movements that will help! (Why are there loons in a video about foot and knee stretches? Watch and find out!)

Our feet are the first point of contact with the world, do not forget about the health of them, follow along for:

  • Practical tips that you can easily do outdoors for your feet, knees, and ankles

  • All you need are your legs, and a small towel

  • Common complaints in the four foot, the midfoot and hind foot from sedentary lifestyle or extra body weight - how this can lead into osteoarthrosis, certain autoimmune diseases, and gout.

Please consult with a health care provider before engaging in any new physical activities as appropriate.


Stretches for your knees

Dr Aw and Brendan Fox - knee pain

Join Brendan as he leads Dr. Aw in another set of exercises, today's focus is on knee pain.

Loosen up your tight muscles that contribute to knee pain by doing different variations to strengthen glute medius.

You will need:

  • chair

  • small towel

Please consult with a health care provider before engaging in any new physical activities as appropriate.


Stretch it out

Dr Aw and Brendan stretching

Fitness expert Brendan Fox leads Dr. Aw in a series of movements focusing on neck pain. Today's video will go through different postural positions that you will have to try out to get the full effect. You can work your way up to the different levels of progressions. You will need: swiss ball or a bosu ball.

Please consult with a health care provider before engaging in any new physical activities as appropriate.


With the start of summer, we wondered, “Does heat impact the coronavirus?” Dr. Aw provides his perspective.


In a video Q&A, Dr. Aw provides his perspective on that topical question: Should I wear a mask?


In a video Q&A, Dr. Aw looks at the question of packages and groceries coming into your house - to disinfect or not to disinfect?


In a video filmed on May 14, Dr. Aw looks at the signs that medical and government authorities are considering as they determine their guidance.


Dr. Aw on Practicing Good Sleep Hygiene

James Aw
Chief Medical Officer

I remember speaking with Medical Director, Johns Hopkins Sleep Disorders Center, Neurologist Dr. Charlene Gamaldo who told me once that “rest is a weapon” for optimal performance and health.  Sleep can be just as important as exercise, nutrition and stress management for physical and mental health.  Poor sleep has been associated with impairment in motivation, emotion, cognitive functions and increased risk for certain medical conditions like diabetes, cardiovascular diseases and cancer.  Most studies suggest that at least 7 hours of sleep a night is optimal – but of course there is some variability and we all know some individuals that seem to function on less sleep or require more sleep. It boils down to whether you feel rested in the morning. 

As we know - sleep routines are easily disrupted during stressful life stages at work and home, raising young children, worrying about aging parents, business travel, academic pursuits and the list goes on.  We also live in a 24/7 society and it is becoming a norm of modern life. Somehow – we manage on less sleep. Life must go on.  As Darwin said – it is not the strongest, most intelligent, but the ones that adapt that survive!

All patients with insomnia should first make sure that there is no existing medical condition that is causing sleep problems. Common causes are sleep apnea, chronic pain, psychological stress or mental health conditions (depression, anxiety, etc.).  Always consult your physician to rule out treatable causes. 

However – several patients suffer from poor sleep and don’t have an existing medical condition. ​​​​​​​

The first step is to practice good “sleep hygiene”:

1.     Sleep only as much as you need to feel rested.

2.     Keep a regular sleep schedule.

3.     Avoid forcing sleep.

4.     Exercise regularly – preferably 4-5 hours before bedtime.,

5.     Avoid caffeine after lunch.

6.     Avoid alcohol near bedtime.

7.     Avoid smoking – particularly at night.

8.     Don’t go to bed hungry.

9.     Avoid prolonged use of light emitting screens before bedtime.

10.   Deal with your worries before bedtime.​​​​​​​

It is best to avoid naps that are greater than 30 minutes during the day.  However – short naps (less than 30 minutes) may be beneficial for cognitive performance, alertness and mood.

Unfortunately – sleep hygiene may not be enough for some individuals. Other interventions may require engaging your personal physician or other clinicians.  Behavioural techniques include relaxation, biofeedback, stimulus control and sleep restriction. 

Relaxation therapy includes techniques such as progressively relaxing your muscles from the head down – where biofeedback may use sensors that provide you feedback to slow down breathing to release tension.  Stimulus control therapy strives to de-program patients that associate the bedroom with staying awake rather than sleeping.  Strategies may include tips such as not spending more than 20 minutes lying in bed trying to sleep and getting up to another room to read or find another relaxing activity until you feel sleepy (while avoiding activities that “reward” staying awake like eating, doing chores, watching TV, etc.).  Sleep restriction therapy involves avoiding naps and induce sleepiness by gradually decreasing the time allowed in bed per night as long as it isn’t less than five hours.

​​​​​​​Some patients benefit from cognitive therapy and/or cognitive behavioural therapy (8-10-week sessions) with a psychologist.  Phototherapy (light therapy) and chronotherapy are other techniques which try to alter the body’s “sleep clock” (circadian rhythm) by either sitting in front of a light box (30-40 minutes) or delaying sleep by 2-3 hours on successive days to make you sleep at the desired time. 

If none of these techniques work – then it may time to review the use of medications with your personal physician. However – medications is the last resort because of concerns of side effects and dependency, other treatments for insomnia have mixed evidence of benefit –
but include melatonin, acupressure, tai chi and yoga.

Sleep is complex, and one size does not fit all.  Hopefully – one of these techniques may be helpful for you.  Sweet dreams!

Resources

Johns Hopkins Medicine
https://www.hopkinsmedicine.org/health/wellness-and-prevention/sleep

Medline Plus
https://medlineplus.gov/healthysleep.html

Canadian Sleep Society
https://css-scs.ca/resources/links

Dr. James Aw, a practicing physician, is OMERS Chief Medical Officer.


Introducing Dr. Aw

Speaking on his first day at OMERS, Dr. Aw, a physician since 1991 and son of a federal public servant and pensioner, said that what drew him to OMERS was both its reputation as a well-run organization and the opportunity to contribute across the OMERS Community.

“This is a golden age of medicine right now in terms of innovation with genetics, genomics, big data, artificial intelligence, different health care systems, molecular medicine, immunology. There are a lot of interesting things that have an impact on the big scale, but also on the local scale. It is also the age of the internet – and with way too much information, how do you connect with people to provide them with information that is impactful in language that is easy to understand.”

Dr. Aw has been a valued and trusted source of information, insight and guidance during the current COVID-19 crisis and we look forward to sharing his thoughts with you here.