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Health

What are panic attacks and what causes them? A look at the issue

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TORONTO — Supreme Court Justice Clement Gascon, who briefly went missing in Ottawa last week, recently explained that his disappearance was caused by a panic attack. Here’s a look at the science and the stigma around the issue:

WHAT IS A PANIC ATTACK?

Andrew Jacobs, a psychologist with the Royal Ottawa Mental Health Centre, said panic attacks are “a sudden surge in anxiety or an uncomfortable feeling that go from zero to 60 within a few minutes.” Panic attacks are defined by a certain set of symptoms that can include increased heart rates, nausea, dizziness, shortness of breath, sweating and a fear the person is dying. Jacobs said a person must experience four out of 13 symptoms as defined by the Diagnostic and Statistical Manual of Mental Disorders.

WHAT CAUSES AN ATTACK?

The Canadian Mental Health Association says panic attacks can be brought on by stress, fatigue or even excessive exercise. Jacobs says there are two types of panic attacks: cued and uncued. “Cued attacks happen as a result of someone already being very worried or fearful of something that can escalate into panic,” he said. “Uncued, which feels like the panic attacks come literally out of nowhere — it can even happen in the middle of sleep.” Gascon said in his statement that on the afternoon he went missing, he was affected by both a change in medication and a “heart-rending career decision.” He announced in September he plans to retire.

HOW DOES A PERSON COPE WITH A PANIC ATTACK?

There are many options for treating anxiety and panic attacks, including medication and counselling. One in particular is called cognitive behavioural therapy, or CBT. According to St. Joseph’s Healthcare in Hamilton, CBT can include such methods as confronting a feared situation, as well as breathing techniques and replacing anxious thoughts with realistic ones. In Gascon’s case, he said his recent episode had been “taken care of and treated with the necessary medical support.” 

CAN YOU RETURN TO WORK AFTER A PANIC ATTACK?

Gascon said in his statement that he is “fully capable” of performing his duties as a judge, and Chief Justice Richard Wagner said in his own statement that Gascon continues to have his “full support and confidence.” Jordan Friesen, the national director of workplace mental health at the Canadian Mental Health Association, said it should be “relatively simple” for Gascon to return to work, given that panic attacks tend to be time-limited. “I think the question becomes, for him and for his employer, is to understand what to do if a situation like that happens again,” said Friesen. “My hope would be that if he’s experiencing symptoms of a panic attack again that he’s able to go and identify this to his employer and seek appropriate support — much like you would if you were at work and started feeling ill with the flu.”

HOW HAVE ATTITUDES TOWARD MENTAL HEALTH IN THE WORKPLACE CHANGED OVER THE YEARS?

Last year, the family of late Supreme Court justice Gerald Le Dain went public with the story of his departure from the court in 1988, saying then-chief justice Brian Dickson forced Le Dain out after he was hospitalized with depression. A former top aide to Dickson had previously written that the decision was made because the Supreme Court had a heavy load at the time and could not handle being short a judge, but Le Dain’s family told CBC he would have returned after a short time off to recuperate. In contrast to the way Le Dain was allegedly treated, the response to Gascon’s public statement has been overwhelmingly positive. Wagner said Gascon’s explanation took courage, while Independent MP Jody Wilson-Raybould thanked him for sharing his struggle. Doron Gold, a former lawyer who now works as a psychotherapist with Homewood Health, said the response illustrates the way attitudes have shifted — though he added there’s still much work to be done. “Things are so much better than they used to be, and they’re so far away from where they should be,” said Gold.

Adam Burns, The Canadian Press

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Health

Food fight: Liberals, Tories trade shots as pre-campaign battles intensify

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liberals, tories, trade shots

OTTAWA — Health Minister Ginette Petitpas Taylor is trying to distinguish the Liberals as a party of scientific, evidence-based policy while she says Conservative Leader Andrew Scheer is spreading misinformation about Canada’s new food guide.

Petitpas Taylor held a news conference in Ottawa today, along with her colleague Marco Mendicino, to say the Conservatives are willing to throw away research and evidence underpinning the creation of the new dietary guide.

In January, Health Canada released an overhauled document that did away with traditional food groups and portion sizes and focused instead on broader guidelines, including eating more plant-based protein and drinking more water.

Last Wednesday, Scheer told an annual gathering of the Dairy Farmers of Canada in Saskatoon that the process to craft the new version of the document was “flawed” and that the guide needs to reflect what “science tells us.”

He also pledged that a Conservative government would “absolutely” review the guide, adding there was a “complete lack of consultation” on the new version.

Petitpas Taylor’s news conference followed an appearance by the Conservatives’ Pierre Poilievre, attacking the Liberals for bringing back Gerald Butts as a campaign adviser following his resignation in the SNC-Lavalin affair last winter.

The Canadian Press

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Environment

Lyme-spreading ticks so common thanks to mild winters, some places stop testing

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Lyme infected ticks becoming common in Canada

OTTAWA — Lyme disease has settled so deeply into parts of Canada many public health units now just assume if you get bitten by a tick, you should be treated for Lyme disease.

In Ottawa, where more than two-thirds of the ticks tested in some neighbourhoods carry the bacteria that causes Lyme disease, the public-health unit no longer bothers to test ticks at all.

Dr. Vera Etches, the unit’s top doctor, said that in 2016 and 2017 more than one-fifth of black-legged ticks tested in Ottawa came back positive for Lyme.

“That’s a threshold,” she said. “Once you know that more than 20 per cent of the ticks in your area carry Lyme disease bacteria then we don’t need to check in on that. That is what we now call an ‘at-risk area.’ “

That means if a tick is found on a person, and is believed to have been there for more than 24 hours, then the patient should get antibiotics to prevent Lyme infection, even without any testing of the tick. It takes 24 hours before bacteria in the tick’s gut move to its salivary glands and are transferred to a person.

After three days, the preventive treatment won’t work so patients then wait for symptoms or enough time for antibodies to evolve to show up on a test. It can take more than a month before symptoms appear. They’re mostly similar to the effects of influenza, including fever and aches, as well as — usually but not always — a rash. It typically takes just about as long for the immune system’s antibodies to show up on a lab test.

If left untreated, Lyme disease can cause serious illnesses such as meningitis, but Etches is quick to point out that because it is caused by a bacteria, it’s treatable with drugs.

“It’s a good-news story, actually, that there is antibiotics that work to treat Lyme disease,” she said.

Most public-health offices in Canada used to test ticks submitted by the public, as well as conducting their own surveillance by actively seeking out tick populations and testing them. Some, including Ottawa’s, have decided now that Lyme is endemic, they should shift to public education and prevention as well as treatment.

Lyme disease was named after the town of Lyme, Conn., where the first case was diagnosed in 1975. It is caused by bacteria that are traded back and forth among black-legged ticks and migratory birds and small mammals like mice and chipmunks. Ticks bite birds and small mammals infected with the bacteria and get infected and then spread the disease when they bite their next victims.

Before 10 years ago, most of the cases diagnosed in Canada were in people bitten by ticks while travelling in the United States. But climate change has led to southern Canada seeing milder winters, which means the ticks that migrate to Canada on the backs of migratory birds are now surviving the winter in larger numbers, spreading the Lyme-causing bacteria more rapidly.

Canada started keeping track of Lyme disease cases in 2009, when 144 cases were confirmed or considered probable. Only 79 of those cases were believed to have been contracted in Canada.

In 2017, more than 1,400 cases were confirmed or probable across the country, more than two-thirds of them in Ontario and most of them believed to have been contracted locally.

National statistics for 2018 are not yet available but in Ontario, the number actually fell significantly, from 967 in 2017 to 612 in 2018. Etches said that was because 2018 was hotter and drier than 2017, and ticks thrive in wet, cool weather.

A 2014 study by the National Collaborating Centre for Infectious Diseases at the University of Manitoba suggested the Lyme-carrying ticks are expanding their territory by about 46 km a year, an expectation being borne out in health units’ mapping

In 2017 and 2018, Point Pelee National Park near Windsor, Ont., was considered to be an at-risk region but the rest of Windsor-Essex County in Ontario’s southernmost tip was not. In 2019, almost all of the county has been added as an at-risk area.

In 2017 all of Nova Scotia was declared to be at risk for Lyme Disease.

In New Brunswick, six of 15 counties were declared at-risk as of 2018.

There are also at-risk areas for Lyme in southern Manitoba, northwestern Ontario, British Columbia and Quebec. While some cases of Lyme have been found in the other four provinces, the numbers are very low and mostly contracted elsewhere.

Mia Rabson, The Canadian Press

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