The Montreal Impact’s inability to hold individual workouts at their training facility has proved to be costly.
The MLS club reported Wednesday that midfielder Steeven Saba will be sidelined eight to 12 weeks after breaking his left foot “on a routine jog” near his home in Montreal.
The Impact are one of six MLS clubs still waiting for the green light from local health authorities to start the individual voluntary sessions outdoor at their training facility. Toronto and Montreal have already started such workouts.
Saba, a 27-year-old Haitian international, joined Montreal after attending the 2020 training camp as a trialist. He did not see any regular-season action.
MLS suspended play March 12, two weeks into the season, due to the pandemic.
Autumn Ferguson went into a Regina dental clinic with a few cavities, and left in an ambulance on life support.
The five-year-old girl’s lungs collapsed while receiving oxygen in the wrong way under general anesthesia, according to the surgical centre’s own admission.
Ferguson’s parents are still in shock that routine dental surgery could take such a bad turn, and that it would be so difficult for them to get answers.
“I find out later that it was touch-and-go and that my daughter almost didn’t make it,” Spencer Ferguson said. “It’s been absolute hell.”
In August, Autumn was getting excited to start kindergarten. But first, the little girl needed to have some teeth pulled and get a couple tooth caps. Her usual dentist attempted to freeze Autumn’s gums with a needle but “it freaked her out,” her father said.
So, she was referred to Children’s Dental World on Victoria Avenue, which operates a dental clinic and a surgical centre (CDW Surgical Solutions).
Autumn’s parents were told the surgery would take two hours at most.
From our standpoint, there was a mistake made.– Dr. Ken Ringaert, anaesthesiologist at CDW Surgical Solutions
Three hours later, Autumn’s mother, Brittany Ambrose, who was in the waiting room, was told that something had gone wrong. Shortly after, an ambulance arrived and Ambrose was told Autumn wasn’t breathing on her own.
“She was kept very much in the dark,” Ferguson said. “There was nobody there to comfort her. There was nobody there to support her.”
Ferguson says a social worker and medical staff at Regina General Hospital informed him that Autumn had suffered bilateral pneumothorax — collapsed lungs.
Autumn was airlifted to Saskatoon and has spent most of the last seven weeks in hospital and seeing specialists. Ferguson says a brain scan did not detect damage. Doctors have warned him that he’ll have to restrict Autumn’s movements while her injured lungs heal.
Medical documents show the little girl has scarring between her vocal cords and trachea. She is still having trouble breathing.
‘A pretty scary situation’
Ferguson says he called the dental clinic repeatedly to try to get answers.
On Aug. 30, Dr. Ken Ringaert, an anesthesiologist with CDW Surgical Solutions, called Ferguson to apologize for mistakes that were made in the recovery room. He said he was not in charge of the anesthesia, and was only called into the room when things took a bad turn.
He led the clinic’s investigation afterwards.
Ferguson recorded the 20-minute conversation, and CBC reviewed the recording.
Ringaert said he had ruled out equipment problems, and confirmed it was human error. The doctor said the procedure was “uneventful” except that Autumn’s lips appeared swollen so the team decided to leave a breathing tube in while the girl was taken into the recovery room.
At that point, Ringaert said, Autumn was hooked up to high pressure oxygen without a relief valve.
“Basically the oxygen went in, and it had nowhere to get out, and that’s how she got the pneumothorax,” Ringaert said.
Pneumothorax is the presence of air or gas between the lungs and the chest wall, causing lung collapse.
“From our standpoint, there was a mistake made,” Ringaert told Ferguson.
“It was pretty obvious that she had that kind of an injury, but it wasn’t really obvious as to how it happened at the time,” Ringaert told Ferguson in their phone conversation.
“I don’t want to leave you with the impression that this was, you know, like chickens running around with their heads cut off. It was a pretty scary situation for about two minutes in the recovery room when this first happened. Once we took her back into the operating room and she was stabilized very, very, very quickly.”
Ringaert said everyone at the clinic felt “horrible,” including the anesthesiologist who was in charge, Dr. Martin Weirich, and the recovery room nurse who Ringaert alleges hooked up the oxygen in the wrong way.
Ringaert told Ferguson that the clinic has handled 1,500 surgical cases in the last two years and has never had a patient admitted to hospital.
“It’s devastating to everyone in the clinic that this happened. And you know, I mean it really, really, makes you, you know, take a step back and look at everything, everything about our system, everything about our people,” Ringaert said.
When contacted by CBC News, CDW Surgical Solutions said it could not comment on specific cases because of patient confidentiality.
Ferguson says he was “caught off guard” that the clinic admitted a mistake was made. He says he’s too focused on his daughter’s healing to pursue legal action at this point, but won’t rule it out.
Autumn was allowed home on Saturday, but she is restricted to her house while the family waits for her to undergo throat surgery in Edmonton. They’re nervous about putting the little girl through another operation.
“You can tell she’s traumatized,” Ferguson said. “Before, she was running around, dancing, singing, playing. Now, she’ll come sit on the couch and cuddle with me and not move or just want to sleep. She doesn’t want to do anything anymore, just tired.”
His aunt, Joanne Ferguson, has set up a GoFundMe to help the young couple cope financially.
“Just to supplement the incomes that they’ve lost. I know if I miss a couple of days work, I worry about bills, I worry about rent. That stuff doesn’t stop coming because somebody gets sick, or because you have to stay home,” Joanne said.
Ferguson, a plumber, has had to miss a lot of work and says he’s grateful that he has an understanding boss at Comfort Mechanical. His wife works for SaskTel and didn’t submit her application for family leave before the current labour disruption.
The day after Martha Farnell celebrated her 66th wedding anniversary, her husband, Willard, officially moved to a different address 20 minutes away from the Calgary bunglow the couple has shared for decades.
It wasn’t a choice.
It was a situation many couples across Canada face: when one senior needs more care than the other, they are often separated by a long-term care system that isn’t built to handle varying needs.
“He is just going to deteriorate so fast without me,” Martha said through tears. “I do everything for him.”
Willard has had dementia for years, but Martha says the progression of the disease has been more obvious recently. After a fall landed him the hospital in March, he wasn’t able to move back home.
Martha isn’t sick enough to go into care, but she does need three surgeries in the coming months for carpal tunnel in her hands and nerve damage in her shoulder. Surgeries she put off so she could take care of her husband while he was living at home.
Even so, she’d rather still be with Willard to help take care of him, but the Alberta health system doesn’t have a care home where they can live together.
They were supposed to grow old together, but a dementia diagnosis for one of them now means this Calgary couple must live apart. Martha Farnell talks to CBC’s David Common about being separated from her husband Willard just after their 66th wedding anniversary. In Sweden, couples have the right to live together, even if one requires more care than the other, something Martha would like to see Canada do. 1:29
The Farnells are not alone. There are no statistics on how many couples are separated by the health care system in Canada, but examples aren’t difficult to find:
An elderly couple in New Brunswick was separated right before Christmas last year.
A woman in Manitoba chose to forgo care until her husband needed it too so that they could stay together.
A couple in St. Catharines, Ont., were separated for three years even though they both needed long-term care, until they were reunited recently after he was injured by another resident in his nursing home.
Across Canada the situation is varied, but most provinces do not have long-term care homes that can accommodate a spouse who does not have severe health needs. Even when both spouses need care, they can still be separated based on the availability of beds.
In B.C., the health system makes no promises either. When only one member of a couple is eligible for long-term residential care: “The health authority will explore, with the couple, those options that may help to maintain their relationship.”
Manitoba’s health minister, meanwhile, has said publicly that the province has no plans to expand the criteria to place healthy spouses in homes with patients who need long-term care, because it would reduce the number of beds for people who meet the requirements for treatment.
In the Farnells’ case, the Alberta Health Authority says it looked for options such as a separate suite at a private independent-living building offering long-term care. But when Willard was discharged from the hospital and admitted to a long-term care home, one could not be found.
Martha says the only option they had to stay together was a private care home, which would have cost about $ 9,000 a month.
A caring approach to care
The story is very different across the ocean in Sweden, where elderly couples have the right to live together when one of them goes into long-term care.
When Torsten Stavdal had a stroke that left him without the ability to talk or walk, his wife, Nancy, was able to move into a nursing home with him in Örebro where they had raised their children.
It means Torsten can see his wife, who needs no care, every day.
For Nancy, it means peace of mind.
“I would not feel calm if I was at home and Torsten was here,” she said.
Nancy is able to live independently, while still participating in her husband’s care. They spend time together in the home’s Wintergarten. They share meals together in the communal dining room, or their own room if they prefer. They do puzzles in the living room decorated with photos of family.
They are in charge of their own day, but help is always available from staff when Nancy cannot take care of Torsten alone. And if she wants to go visit a family member for a few days outside of Örebro, then the home’s caregivers can take care of Torsten while she is gone.
After 68 years together, the couple cannot imagine life any other way. And because of regulations in Sweden, they don’t have to.
The country’s Social Services Act was amended in 2012 and says elderly people who have lived together for an extended period can continue to live together even when one of them needs supportive housing.
The initiatives in Sweden don’t stop with ensuring that couples who want to stay together in their final years can live in long-term care together. Companionship has been made a priority for people with dementia.
Sweden’s Queen Silvia took a special interest in dementia after her mother was diagnosed with the disease. Now her name is attached to an organization called Silviahemmet, which trains health professionals in dementia care.
She recently lent her name to new apartments being built in a partnership with Ikea and the engineering giant Skanska. SilviaBo is a set of dementia-friendly apartments where those with the condition can live with their partners, a child or even a friend.
The apartments have no reflective surfaces, so those with dementia don’t see themselves and get confused by their own aged faces. Water faucets and outlets have timed shut-offs. Knobs on cupboards are contrasting colours to make them easier to open, reducing frustrations.
The long-term care units are designed to keep dementia patients calm. But they are also designed for companionship: they are apartments built for two.
Take a tour through specially designed apartments for people with dementia in Sweden. The apartments were developed as a partnership between a large Swedish construction company, furniture-maker IKEA, and the country’s Queen. 0:45
‘We want to be together’
Back in Canada, Martha Farnell leaves the house every morning at 7:30 a.m. to feed her husband his favourite breakfast: Cheerios. He still loves the taste of them, even though they have to be ground up to suit his required liquid diet.
“I go there in the morning and his eyes are just so open, so happy the minute he sees me.”
When I knelt down before God and said ‘until death do us part,’ I meant it.– Martha Farnell
She pays $ 30 each way every day to take a taxi to the long-care home where Willard lives. It’s not the cost that bothers her, but rather the idea Willard might wake up from a nap and she might not be there to greet him.
And each day she spends 10 to 12 hours at the nursing home. Martha stays by Willard’s side until he goes to sleep at night, so he doesn’t get agitated.
More than anything, she wants to be able to sleep next to him. The way she did for more than six decades.
“When I knelt down before God and said ‘until death do us part,’ I meant it. This is what we want. We want to be together.”
Removing wisdom teeth is considered by many as a rite of passage for teenagers and young adults. It is one of the most common surgical procedures done in young people aged 16 to 24.
Amy's 16-year-old son, Felix, recently had his wisdom teeth removed at an oral surgery clinic in Quebec. After the procedure, the surgeon's assistant advised that to "stay on top of the pain," Felix should take a Percocet right away. Percocet is a combination of the pain reliever acetaminophen, and of an opioid, oxycodone. She provided him with enough Percocet to take every three hours for the next day.
Amy knew of the possible harms associated with powerful opioid medications, especially for young people. Abuse of opioids is a national public health crisis, with growing numbers of opioid overdoses and deaths.
So, she asked the surgeon's assistant whether there was another pain management option for Felix instead. Tylenol 3 was suggested (acetaminophen with the opioid codeine), which still seemed too powerful. So Amy asked for Naproxen: — an over-the-counter pain reliever in the same drug class as Aspirin and Ibuprofen. Felix took the Naproxen as directed when the anesthesia wore off, and he did not require anything stronger. In fact, he was quite comfortable.
How did Amy know to question the advice she was given?
Amy serves as the patient advisor for the national campaign, Choosing Wisely Canada, which partners with national clinician societies to develop lists of tests, treatments and procedures that may cause unintended harm. So she knew that the Canadian Association of Hospital Dentists recommends non-opioid based pain medications to be prioritized following dental surgery and to resort to opioids only if the pain cannot be managed.
Percocet after minor oral surgery should not be an expectation of teenaged patients. Persistent opioid use after elective surgery, such wisdom teeth removal, poses a dependency risk, especially in young people whose brains are developing and are highly susceptible to the effects of opioids. Leftover opioids are equally dangerous, particularly for teens who might be tempted to experiment or share with friends and family members.
Dentists and oral surgeons have a critical role to play here as one of the leading prescribers of opioids to young people. An American study published in early December found that dentists are the leading source of opioid prescriptions for children and adolescents aged 10 to 19 years in the United States. Dental prescriptions account for over 30 per cent of all opioid prescriptions in this age group.
This study also found that young people who received opioid prescriptions after wisdom tooth extraction were more likely to be using opioids three months and one year later, as compared to their peers who did not get an opioid.
The evidence is clear: a short prescription for opioids poses a real risk of ongoing opioid use for teenagers.
For some oral surgery procedures, such as such deeply impacted wisdom teeth or jaw reconstruction, an opioid might be needed for pain control for a short time. (Mark Lennihan/Associated Press)
Many patients experience pain and swelling lasting three to four days and sometimes up to a week after wisdom teeth surgery. But the intensity and duration of these symptoms vary considerably depending on the position of the teeth, how deeply they are buried in bone and the surgical difficulty in removing them. While many oral surgeons and dentists prescribe opioids routinely after dental surgery, pain management for all patients should be handled individually.
In most cases, post-surgical dental pain can be controlled without opioids, through anti-inflammatory drugs such as ibuprofen, in combination with non-opioid pain relievers, such as acetaminophen. For some oral surgery procedures, such as such deeply impacted wisdom teeth or jaw reconstruction, an opioid might be needed for pain control for a short time.
"Might" is the key word there. Oral surgeons and dentists should not have a one-size fits all pain management strategy. Changing prescribing practices to avoid unnecessary opioid prescriptions for teenagers is a small way to potentially make a big difference in a young person's life.
In the sneak peek footage from the upcoming holiday special, the 14-year-old singer takes the stage with her pro partner, Sage Rosen, and mentor, Gleb Savchenko, for a spicy trio Cha Cha set to her own original song, “What If.”
Watch in the player above!
From sharp movements to insane lifts, Ziegler proves exactly why she has come so far in this competition. It’s an arguably flawless performance but will it be enough to get her a mirrorball trophy?
In addition to the trio dances, the remaining four contestants will also perform a festive freestyle dance before hosts Jordan Fisher and Frankie Muniz announce the first-ever DWTS: Juniors champion at the end of the show, airing Sunday at 8 p.m. ET/PT on ABC.
In the meantime, watch the video below to hear more from the finalists.
Men don’t need to receive routine digital rectal exams to screen for prostate cancer from their family doctors, a new review of the medical evidence suggests. But there are other times when the test is worth doing.
Prostate cancer is the most commonly diagnosed malignancy in men after nonmelanoma skin cancer. Deaths from prostate cancer tend to occur among those in older age groups, the Canadian Cancer Society said.
Traditionally, it was recommended that men over the age of 40 or 50 should be screened for prostate cancer by having a digital rectal exam every year.
But the evidence to support the effectiveness of such testing is poor, says a Canadian doctor who reviewed previous research on the topic involving more than 9,000 patients. The meta-analysis was published in Monday’s issue of the Annals of Family Medicine.
“What I’m suggesting and what the study has shown is not that we abandon the digital rectal exam as a clinical skill, but we should not be screening men in primary care for prostate cancer by doing a digital rectal exam if they are asymptomatic,” said study author Dr. Jason Profetto, a family and academic physician at McMaster University in Hamilton.
While there was no strong evidence to recommend the routine use of digital rectal exams in screening for prostate cancer, the test is helpful for rectal bleeding, enlarged prostate, rectal masses and other situations, Profetto said.
“I am not saying that the digital rectal exam is useless.”
‘The truth is there’s many cancers that we just don’t have good screening protocol to detect them before the individual is symptomatic and the prostate seems to be part of this group’– Dr. Jason Profetto
Profetto recalled that when he entered medical school in 2006, students were told to perform digital rectal exams whenever a man had an abdominal exam, regardless of the reason. That dogmatic practice runs contrary to the evidence-based approach that physicians are now encouraged to take, such as only doing a test to answer a specific question, such as why a patient is having symptoms, he said.
Some studies suggest that half of family doctors still do digital rectal exams, the researchers noted.
A survey of Canadian medical schools showed about half of graduating students had never performed a digital rectal exam, and only half of primary care physicians said they felt confident in their ability to detect prostate nodules.
Conflicting advice to doctors
The new review also suggested family doctors don’t have the skill to determine whether what they feel in the rectum is prostate cancer.
The Canadian Urological Association recommends screening with both digital rectal exams and the prostate specific antigen (PSA) for all men of average risk aged 50 and older who are expected to live at least another 10 years. Other Canadian and U.S. guidelines recommend against it.
Profetto said in his family practice, he has a conversation with men to outline why digital rectal exams were traditionally done, why things have changed, and what the research has shown about its routine use for prostate cancer screening.
Some men will then ask him how health-care professionals detect prostate cancer before it becomes a problem.
“The answer is simple. We don’t,” Profetto said. “The truth is there’s many cancers that we just don’t have good screening protocol to detect them before the individual is symptomatic and the prostate seems to be part of this group.”
When Profetto presented the findings to physicians twice last year, he received some pushback and he’s expecting more. Part of the difficulty with much of the criticism is it’s not based on evidence, he says. “As a result, the conversation is halted.”