Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Maureen McGrath RN (00:02):
Good evening and welcome to another
episode of Nurse Maureen'sHealth Show podcast.
You know it's been a very coldwinter, I have to say, in many
parts of this country and thatmakes me think about illness
quite honestly influenza, rsv,covid-19.
The Government of CanadaRespiratory Virus Surveillance
Data is showing influenza, rsvand COVID-19 are highly active
(00:26):
across our country.
Older adults living withcompromised immune systems are
at increased virus risks.
Today I'm speaking with DrChristine Palmay, a Midtown,
toronto family physician andmember of the Adult Vaccine
Alliance, about the top threerespiratory viruses and what you
can do to protect yourself andyour family.
Good evening, Dr.
Palmay.
(00:46):
Welcome to the podcast.
Dr. Christine Palmay (00:48):
Always welcome, Maureen.
It's always a delight to speakwith you.
Maureen McGrath RN (00:56):
Oh, so lovely to speak with you as well
.
You know we usually associaterespiratory viruses with the
fall flu season.
Why are we seeing spikes in themiddle of winter?
Dr. Christine Palmay (01:02):
So, to be honest, when I speak about
respiratory season, I thinkabout the Canadian winter, and
there's certainly two thingsthat are absolutes these days.
Number one we don't want anymore snow.
Toronto has no place to put anyextra snow.
You know, we don't want theseviruses.
Post COVID, everybody is,frankly, sick and tired of being
(01:24):
sick and tired.
I get it, you know.
The problem is is thatrespiratory viruses have a
heyday during the Canadianwinter, for several reasons.
So, first of all, you know it'sgenerally a time when we are
celebrating, right withChristmas, hanukkah,
thanksgiving, family Day,vacationing together, spending
(01:46):
time on planes, and that is anideal setting for viruses to
spread.
I often say that, you know,there's nothing better than
having a blessing of agrandchild.
The problem is, is thosegrandchildren often bring germs
home to grandparents who are atincreased risk of severe
(02:06):
diseases, simply based on ageand usually because they have
other comorbidities?
And the second thing is is thatbecause it is cold, from what I
would say starts what, end ofSeptember, early October and may
last until May Another reasonwhy viruses tend to linger?
Another reason why viruses tendto linger.
(02:30):
So, in my mind, you know, coughand cold season is just simply
Canadian winter, and you'reabsolutely right.
We are seeing another spike,which is not surprising, you
know, certainly after theholidays during December, for
the reasons I mentioned, myclinic was overrun with
respiratory illnesses, but it isstill being something that I
have seen regularly.
Maureen McGrath RN (02:47):
And our clinic is certainly overrun with
respiratory viruses as well,and I'm hearing so many people
saying you know I've been sickfor two or three weeks, I've
lost my voice.
You mentioned bringing theseviruses home to older adults,
and you know grandparents andalso those who might be
immunocompromised.
How can these viruses affectthose individuals?
Dr. Christine Palmay (03:11):
So when we think about patients who are
most at risk, it somewhat variesaccording to viruses, but if
you're let's call it over 65,which is a huge portion of the
Canadian population, we have anaging patient population here In
Canada.
I like to say we have an agingpatient population here In
Canada.
I like to say we are anexpensive vintage of wine, but
your immune system ages with you, your tissue ages with you.
(03:33):
So age itself, which I don'thave a solution for, you know,
puts people at increased riskand usually, as we age, we
gather baggage in the form ofdiagnoses that may further
increase your risks of thingslike COPD, diabetes, congestive
heart failure.
And you know, by virtue ofhaving diagnoses, you're also on
(03:54):
medications that may furtherchallenge your immune system.
So you can see the additiveresult that patients you know,
generally north of I would evensay 60, it'd be hard to find a
patient who I don't consider atincreased risk.
And then, of course, you haveyour patients who are dealing
with cancer treatments,struggling with the immune
(04:17):
diseases, who are onchemotherapy, immunosuppressive
medications, and that representsa huge portion of Canadians at
present time.
Maureen McGrath RN (04:27):
So government surveillance data is
showing that over 20% of thepopulation is impacted by flu.
Does this surprise you?
Dr. Christine Palmay (04:35):
Absolutely not.
So there's a couple of problems.
Generally speaking, we're notfantastic with influenza
immunizations, but if you'relooking at stats for patients
over 65, they're generally okay.
It's that middle-aged 40 to 65that unfortunately we have very
low uptakes for the influenzavaccine and I have certainly
(04:57):
seen an influenza spike in mypractice.
The tragedy is, as a communityphysician, there's no point of
care testing.
I cannot swab a patient whocomes in for influenza or RSV If
they have a COVID test that mayor may not be expired.
Potentially you can test forthat.
So you know, what I'm seeing inmy office is kind of a guessing
(05:18):
game, point being, I'm justseeing respiratory viruses.
And the greatest misfortune,maureen, is if you win the
lottery which is not a lottery,you want to win and get
co-infected by two or you knoweven less rare but tragically
three viruses.
And I certainly have a youngpatient.
I always tell this tale, forwhen patients come in and kind
(05:39):
of say nay to any sort ofimmunization, she's 40 years,
young.
Say nay to any sort ofimmunization.
She's 40 years, young, healthy,vibrant, no official risk
factors, and she got influenza Aand COVID At the same time.
I only knew about that becauseshe ended up in the hospital and
four weeks later she's still inthe hospital.
So it's you know those cases.
Yes, we need to think about themost vulnerable, our oldest of
(06:02):
the old and our youngest of theyoung patients, but you're not
zero risk if you are outsidethose age ranges.
And it's important as well tounderstand that influenza
vaccines also preventtransmission, which we come back
to the discussion, that it is ajoyful time to celebrate with
family, travel with family, bewith family.
(06:22):
But making smart choicespreventively, I think, is the
way we preserve health.
Maureen McGrath RN (06:27):
Absolutely, and there are so many
misconceptions about the fluvaccine.
But what are some of the commonflu symptoms?
Dr. Christine Palmay (06:35):
So when I talk about flu-like symptoms, I
just say respiratory symptoms ingeneral, because it's really
impossible from a clinical examto delineate whether a patient
has COVID or influenza or RSV.
You know they generally come insaying I have a cough, perhaps
a runny nose, overwhelmingfatigue, joint pain, you know
(07:00):
feeling lethargic.
Sometimes gastrointestinalissues creep in and there's a
whole bunch of GIgastrointestinal viruses that
are also spreading around.
You know we have some guidancethat perhaps a patient with RSV
has a bit more wheezing andthat's an audible whistle as a
patient is breathing out.
But you know the reality is iswe're horrible at being able to
(07:24):
differentiate because symptomssimply overlap and it isn't
until a patient tragically endsup in the hospital where you get
tested probably.
Um, you know we get tripletested for those viruses that we
had mentioned, but I'm doingeverything to prevent that from
happening, right?
Maureen McGrath RN (07:39):
right, absolutely.
Um.
So how can we protect ourselvesfrom the flu?
I I mean, you mentioned thegatherings and I have to say,
since COVID, I'm not 100%comfortable in a gathering or in
an indoor restaurant, to behonest with you.
But how can we protectourselves from the flu?
Dr. Christine Palmay (07:58):
So let's start with basics.
If you're sick, stay home untilyou feel well.
Even you know a patient who hasa COVID test that's negative if
they're still symptomatic.
Even you know a patient who hasa COVID test that's negative
they're still symptomatic.
I say, you know, be smart, stayhome.
Hand washing is not a publichealth measure strictly for
COVID.
It's a good idea in general.
Wash your hands right, mindyour P's and Q's, make sure
(08:20):
you're well hydrated, you'reeating your vegetables, you're
getting sleep, everything thatyour mama or your papa told you
to do.
And then you know taking thatone step further in terms of
prevention.
You know making sure that youget every vaccine that you are
eligible for, based on your ageand or risk factors, and
thankfully we have vaccines thatare available against influenza
(08:40):
, now newly against RSV and aswell as COVID.
And unfortunately, as I say,wash, rinse, repeat.
You know our Canadian wintercomes annually and that means
we're going to have an annualrespiratory season.
So you vaccinated yourself in2024.
(09:01):
You know, in October, inpreparation for the Canadian
winter.
Well, guess what?
It's now 2025, time to thinkabout.
You know, protecting yourself.
I talk about you know, puttingon your preventative medicine,
armor, as we go into thisCanadian winter and I always I
often mention this quote.
(09:21):
It really resonates with methat good medicine treats
disease.
So if you come into my officeand you have some sort of
respiratory illness, I'm clearlygoing to offer treatment that I
think is best for you.
But I'd be doing a better jobif I offer guidance as to
preventing vaccines.
So good medicine treats illness.
Excellent medicine tries toprevent it.
Maureen McGrath RN (09:42):
That's a great point.
Is it too late in the seasonfor people to get the flu
vaccine?
For those who thought that theywere better off not getting it?
Dr. Christine Palmay (09:51):
No, I don't think it's too late.
I mean it certainly depends onyour risk factors.
For high-risk patients,absolutely, and as we mentioned,
we have a spike in influenzalately.
For other vaccines COVIDvaccine follow public health
guidance no-transcript aboutolder patients, I tend to time
(10:27):
that right before the seasonstarts.
We definitely have two yearsworth of data coverage for the
two vaccines that are available.
That's what I provide guidanceto my patients about.
So I mean, if you're going tomaximize the coverage, you're
probably getting that vaccine.
October-ish makes more sense.
But if you are high risk andyou're going to maximize the
coverage, you're probablygetting that vaccine October-ish
makes more sense.
But if you are high risk andyou're heading somewhere and
(10:47):
you're worried about it, timingreally is inconsequential.
Just get a vaccine.
Maureen McGrath RN (10:53):
Absolutely Great advice.
You mentioned RSV and we'rehearing a lot about RSV.
This was typically common innewborns and infants and
potentially devastating to themas well, but why are we seeing
it more now in older adults?
Dr. Christine Palmay (11:09):
So we're actually really not seeing it
more.
The problem was is that wedidn't have much to do in terms
of preventing RSV, right?
So you're absolutely right RSVonce again, it affects the
youngest of the young, sotypically patients under two
years young and then olderpatients.
We did have, and we have hadfor quite a long time, treatment
(11:32):
for those infants at risk,significantly at risk, for RSV.
Things have changed since wehave new vaccines and new
monoclonal antibodies on themarket.
But now, because we havevaccines, you know it's not that
all of a sudden we have moreRSV, we just have an ability to
try to prevent it.
So it has been top of mind, topof news, because we have a new
(11:53):
tool in our toolbox.
I'm going to focus on olderadults.
We have two vaccines,relatively available, one that
is coming down the pipeline andreally, when you're thinking
about burden of disease, rsv inits severe form is horrible.
People end up with superinfections, other complications,
(12:15):
deterioration of their otherhealth diagnoses and a stat that
has always stayed with me if apatient ends up in hospital so
has severe RSV disease, 8% ofthose patients don't necessarily
leave in the state that theycome in.
So they leave the hospital butthey leave, requiring, you know,
supplemental care.
(12:36):
They leave, you know leaverequiring nursing home care.
They lose their independenceand in a society where we place
so much emphasis on wellness aswe should, when we place so much
emphasis on aging with dignityand the ability to be active and
enjoy life, we often forgetthat part of that reassurance
(12:57):
policy to maximize the chancethat you will be well later on
in life is preventing, vaccinepreventable diseases, and the
best way to do that isimmunizations.
Maureen McGrath RN (13:08):
Absolutely.
Now we're seeing the numbertrending down of RSV across the
country, but the incidence ofRSV is higher this year as
compared to last.
Are we going to see that as anemerging trend, rsv continuing
to increase across Canada?
Dr. Christine Palmay (13:23):
We don't know fully, right.
I mean you have to understandthe public health measures that
were very much in place duringCOVID have somewhat lingered.
You mentioned you are a littlebit hesitant to go to
restaurants and gatherings.
I think many patients are.
So that in itself issemi-protective.
We don't really know.
But we certainly know that RSVis seasonal.
It differs where you are in theworld.
(13:43):
In Canada we generally sayOctober maybe to late March,
with a bit of variance here andthere.
But I'd like to make a pointabout the contagious nature of
RSV.
So during COVID mostrespiratory illnesses certainly
influenza, pneumococcal, whichis a bacteria another discussion
for another day they werebarely detectable because we
(14:05):
were staying at home wearingmasks, not congregating.
The clinical trials that tookplace to approve the RSV vaccine
took place during COVID.
So even during a time whenpeople were, you know, so strict
about public health measures,we were still able to find
(14:25):
enough RSV to power the studiesand I think that's a pretty
striking point.
Maureen McGrath RN (14:32):
That is very significant.
I did not realize that at all.
You mentioned that whistling.
I did not realize that at all.
You mentioned that whistling,the upper respiratory symptoms
that are RSV, but thatdifferentiation was that
whistling, which is veryinteresting.
How can you protect yourselfagainst RSV?
Dr. Christine Palmay (14:50):
So all of the measures, you know it's not
a difficult discussion becausewhen I talk to patients, you
know you feel like you're havinga shopping list of vaccine,
preventable diseases, but theyshare a lot of commonalities.
So the preventative measuressix-day home, wash your hands,
et cetera, but RSV for adults,we have two readily available
(15:11):
and, as I mentioned, one downthe pipeline vaccine that is
effective, with officiallytwo-year data for the ones that
we have available, which is veryexciting.
And you know that thecombination of common sense,
public health measures that arelifestyle-based and vaccination,
you know that will optimizeyour chance of avoiding getting
(15:33):
RSV not a hundred percent right.
And oftentimes when people havetaken a vaccine and they come
and I think it's probably RSV,they sort of say, oh, my
goodness, I even took thevaccine and I got it.
And I say, yes, but perhaps youhave an attenuated, a mild
version of RSV.
And even you know, for patientswho aren't in hospital, maureen,
rsv is a pain, like you reallyaren't.
(15:54):
Well, it is not a pleasantexperience.
And the other huge learningpoint during COVID was
understanding and appreciatingthe precious nature of time and
the ability to spend timetraveling, not having to cancel
your travel plans.
You know, even with AirCanada's and our Pearson
(16:15):
international crisis, makingsure that you're able to join
family that concept reallyresonates with patients.
So maximizing your protectionagainst RSV in the form of
vaccine provides you the bestinsurance policy that we have at
present.
Maureen McGrath RN (16:31):
And helps those that you love as well.
Now COVID-19 is shockingly tomaybe to a lot of people, or
surprisingly, is still with us.
And what do we need to knowabout COVID-19 aside from that?
It's still here.
Dr. Christine Palmay (16:46):
It's still here, unfortunately, and it
doesn't care.
It's not going to go away, itdoesn't care that you missed
your trip to Punta Cana or youcouldn't celebrate with family.
The virus's goal is topropagate its DNA right, and
it's going to continue to do so.
So public health guidance haschanged.
I briefly mentioned that.
I really encourage you to speakto your or the viewers to and
listeners, just speak, make totheir primary care providers.
(17:09):
We're changing the way.
We recommend a vaccinationbased on risk factors, and
that's new as of this year, alittle bit different Next year,
who knows.
But you know it's a movingtarget and we obviously try to
create vaccines that are themost up to date, based on the
variants that are circulating.
So we know what's happening now.
We don't necessarily knowwhat's happening in September.
(17:31):
So ears open and certainly it'snot going away.
And, yes, you still need avaccine.
Maureen McGrath RN (17:38):
You know I love that.
You said if you're sick, stayhome.
You know basic information.
You know I'm seeing some healthcare providers coming into the
office sick, thinking well, I'lljust wear a mask, which is also
uncomfortable, I think.
You know, during COVID-19,people knew if they were sick,
stay away.
But now people are a little biteasier about that.
(17:59):
But should people still betesting for COVID-19?
Or should they assume they haveit with certain symptoms?
And you mentioned earlier thatsome of the kits are expired.
Do they actually work ifthey're expired?
Dr. Christine Palmay (18:10):
We don't know.
I mean, generally speaking, Isay a positive is a positive.
So if you do a test that'spositive, pretty sure it's
positive.
The question is is whether anegative test is negative, and
you know guidance varies.
But if you get three tests thatare done in 24 hours apart and
they're all negative, you'reprobably negative.
Probably.
We don't know fully.
(18:30):
The other reality is in terms ofyou know how to deal with COVID
and whether it matters whetheryou test positive.
It does because it willdelineate in general when you
are next most eligible for thevaccine.
You know, after a natural COVIDinfection your immune system is
naturally primed.
So it's almost like a lostopportunity If you vaccinate.
(18:51):
At that time you're already atmaximum level and you have to
wait in general the guidance isstill six months for your
natural immunity to wane and youget the vaccine to boost
yourself up again.
The other question is in termsof treatment.
So we have treatments forpatients who are at high risk.
You know those treatments areimportant for patients who have
severe potential outcomes fromCOVID, but you don't want to
(19:14):
give them willy nilly.
So I would never say you know,scratch my head.
I think possibly you have COVID, maybe, maybe not.
Here's an intense medication totake, it's better to know fully
.
This is sort of the gray zoneof medicine.
As a primary care doctor, Ilive in the gray zone.
Primary care doctor, I live inthe gray zone.
And those are, you know, reallyimportant intimate discussions
(19:37):
to have with your primary caredoctor, not necessarily what
public health is mentioning ingeneral, but what my personal
risk factors are, based on myage, my comorbidities, my
medications, my lifestylechoices, whether I'm traveling,
whether I'm not, whether I havegrandkids, whether I have not.
And that is the art of medicineand that's what we call
individualized care and, in myopinion, excellent medicine.
Maureen McGrath RN (19:56):
Dr Palmay, how can you tell the difference
between COVID, RSV and influenza?
Dr. Christine Palmay (20:02):
Well, my crystal ball marine is in the
repair shop for the next bit.
That's a short answer.
I mean, it's certainly notmeant to be snarky, but we
really can't.
I think I mentioned that RSVmay present, with more wheezing,
an audible whistle when apatient is breathing out.
You know, aside from a testthat's positive, we can't really
(20:25):
, once again, without diagnosticabilities in the community.
You know, certainly, when apatient ends up in the hospital
they get triple tested whetherthey have COVID, influenza or
RSV.
But I'm really hoping mypatients don't end up in the
hospital and actually get thattest.
So it's once again, you know,looking at a patient and just
(20:45):
saying I'm going to treat youconservatively, treat your
symptoms if I can.
But the best way to evenprevent a visit to my office is,
you know, vaccinating yourselfand being smart.
That Canadian winter is long,it's harsh, there is a heck of a
lot of snow, no more snow and,you know, hopefully no more
(21:06):
sickness to the same extent thatwe've seen, and certainly
during COVID, which was a verydark time.
Maureen McGrath RN (21:11):
And you know, people have been
misinformed and they're hearinginformation from their friends.
They're assuming things abouttheir own health.
I had a patient who felt thatthey had actually a burden about
a 15% burden of prematureventricular contractions, pvcs
and they felt that that burdenhad increased because of the flu
(21:33):
vaccine.
And they spoke to theirexercise cardiologist about this
and the cardiologist said andthe patient said you know we're
not conspiracy theorists here,but yeah, I wouldn't get the flu
vaccine if I were you.
And I thought I wasn't reallyfamiliar with that.
But I did a little research andI found that the flu vaccine
(21:55):
can actually decrease yourburden of PVCs.
What would you say to listenerswho are misinformed or on the
fence or haven't gotten theirvaccine?
What golden nugget ofinformation do you have for
patients like this?
Dr. Christine Palmay (22:15):
Look at the source of your information,
right?
I love Instagram.
I'm, you know, constantly on it.
I Google absolutely, you know.
The problem is is that it's adouble-edged sword.
We certainly have unprecedentedaccess to information, which is
wonderful.
Right, I sort of laughedbecause I was speaking to a
(22:35):
patient who really didn't haveany concept of going to a
library and taking books off theshelf.
But you know, you need to knowwhat the source is.
I generally recommend going tonational guideline bodies.
You know organizations,immunize, canada.
There's some wonderful siteswith hardworking people who
authentically care and spendhours and hours, you know, doing
(22:59):
research, provide informationthat's most up to date.
You know fear is fear and evenI make correlations that don't
necessarily make sense whenyou're anxiety ridden.
But you know you need tounderstand the correlation is
not necessarily causation andwhen people talk about vaccines
they're afraid that theircondition will worsen, whatever
(23:21):
it be PVCs, hyperthyroidism,hypothyroidism the reality is I
am much more comfortable dealingwith, you know, expected side
effects from a vaccine than I amdealing with the wild west.
If a patient gets thatparticular vaccine preventable
disease so whether it's RSV,covid or influenza I don't know
(23:45):
what that vaccine is going to doto that patient and that may be
an epic disaster.
So it's all about relative risk, putting things into context
and, you know, going to sourcesthat are reliable and up to date
.
Maureen McGrath RN (23:59):
And I think sometimes patients walk into
doctor's offices and you knowthey have one impression and the
doctor, you know, given thelimited amount of time that
doctors have to educate patients, sit down with them and, you
know, allay their fears.
You know, I think sometimesyou know health care providers I
shouldn't just say doctors, whojust go along with what the
(24:21):
patient says.
Maybe they realize they'renever going to talk the patient
into something, but it's greatadvice to look at the resources.
I recently read that Dr Googleis incorrect 65% of the time and
then the social mediainfluences are incorrect 75 to
(24:42):
80% of the time.
So it's definitely not a placeto get your information and I
really appreciate theinformation that you've provided
tonight,
Dr. Christine Palmay (24:54):
Thank you so much again for having me.
It's always a delight.
Maureen McGrath RN (24:57):
It's my pleasure.
I love having you on becauseit's such great information.
Dr. Christine Palmay (25:02):
And rally on.
We have to rally on as acommunity, and doctors
themselves and healthcareproviders themselves need to
self-rally as well.
So point well taken.
Maureen McGrath RN (25:12):
Absolutely Well.
Thank you so much.
My guest was Dr ChristinePalmay a Midtown Toronto family
physician and member of theAdult Vaccine Alliance, and we
were talking about the top threerespiratory viruses COVID FLU,
RSV and if you know somebodythat can benefit from this
(25:34):
episode, please feel free toshare.
Please send it along to them.
I'm Maureen McGrath, aregistered nurse, nurse,
continence advisor and sexualhealth educator, and you have
been listening to NurseMaureen's Health Show Podcast.
Thanks so much for tuning in.
I'm Maureen McGrath and youhave been listening to the
Sunday Night Health Show Podcast.
If you want to hear thispodcast or any other segment
again, feel free to go to iTunes, spotify or Google Play or
(25:54):
wherever you listen to yourfavorite podcasts.
You can always email me,nursetalk at hotmailcom or text
the show 604-765-9287.
That's 604-765-9287.
Or head on over to my websitefor more information,
maureenmcgrathcom.
It's been my pleasure to spendthis time with you.
(26:20):
Ladies, let's talk aboutsomething we don't often talk
about pelvic floor health.
Whether it's postpartum changes, aging or just the demands of
everyday life, many womenstruggle with bladder leaks and
a lack of self-confidence.
But what if I told you there'san effortless solution?
Meet the Emcella chair Just 30minutes, fully dressed, and it
will do thousands of Kegels foryou Strengthen your pelvic floor
(26:42):
, improve intimacy and feelconfident again.
So say no to incontinence andstart to enjoy life again
leak-free.
Ask your doctor about theEmcella chair.
For more information, go towwwemcellacom.
That's wwwemcellacom.
Good evening and welcome to another
episode of Nurse Maureen'sHealth Show podcast.
You know it's been a very coldwinter, I have to say, in many
parts of this country and thatmakes me think about illness
quite honestly influenza, rsv,covid-19.
The Government of CanadaRespiratory Virus Surveillance
Data is showing influenza, rsvand COVID-19 are highly active
(00:26):
across our country.
Older adults living withcompromised immune systems are
at increased virus risks.
Today I'm speaking with DrChristine Palmay, a Midtown,
toronto family physician andmember of the Adult Vaccine
Alliance, about the top threerespiratory viruses and what you
can do to protect yourself andyour family.
Good evening, Dr.
Palmay.
(00:46):
Welcome to the podcast.
Dr. Christine Palmay (00:48):
Always welcome, Maureen.
It's always a delight to speakwith you.
Maureen McGrath RN (00:56):
Oh, so lovely to speak with you as well
.
You know we usually associaterespiratory viruses with the
fall flu season.
Why are we seeing spikes in themiddle of winter?
Dr. Christine Palmay (01:02):
So, to be honest, when I speak about
respiratory season, I thinkabout the Canadian winter, and
there's certainly two thingsthat are absolutes these days.
Number one we don't want anymore snow.
Toronto has no place to put anyextra snow.
You know, we don't want theseviruses.
Post COVID, everybody is,frankly, sick and tired of being
(01:24):
sick and tired.
I get it, you know.
The problem is is thatrespiratory viruses have a
heyday during the Canadianwinter, for several reasons.
So, first of all, you know it'sgenerally a time when we are
celebrating, right withChristmas, hanukkah,
thanksgiving, family Day,vacationing together, spending
(01:46):
time on planes, and that is anideal setting for viruses to
spread.
I often say that, you know,there's nothing better than
having a blessing of agrandchild.
The problem is, is thosegrandchildren often bring germs
home to grandparents who are atincreased risk of severe
(02:06):
diseases, simply based on ageand usually because they have
other comorbidities?
And the second thing is is thatbecause it is cold, from what I
would say starts what, end ofSeptember, early October and may
last until May Another reasonwhy viruses tend to linger?
Another reason why viruses tendto linger.
(02:30):
So, in my mind, you know, coughand cold season is just simply
Canadian winter, and you'reabsolutely right.
We are seeing another spike,which is not surprising, you
know, certainly after theholidays during December, for
the reasons I mentioned, myclinic was overrun with
respiratory illnesses, but it isstill being something that I
have seen regularly.
Maureen McGrath RN (02:47):
And our clinic is certainly overrun with
respiratory viruses as well,and I'm hearing so many people
saying you know I've been sickfor two or three weeks, I've
lost my voice.
You mentioned bringing theseviruses home to older adults,
and you know grandparents andalso those who might be
immunocompromised.
How can these viruses affectthose individuals?
Dr. Christine Palmay (03:11):
So when we think about patients who are
most at risk, it somewhat variesaccording to viruses, but if
you're let's call it over 65,which is a huge portion of the
Canadian population, we have anaging patient population here In
Canada.
I like to say we have an agingpatient population here In
Canada.
I like to say we are anexpensive vintage of wine, but
your immune system ages with you, your tissue ages with you.
(03:33):
So age itself, which I don'thave a solution for, you know,
puts people at increased riskand usually, as we age, we
gather baggage in the form ofdiagnoses that may further
increase your risks of thingslike COPD, diabetes, congestive
heart failure.
And you know, by virtue ofhaving diagnoses, you're also on
(03:54):
medications that may furtherchallenge your immune system.
So you can see the additiveresult that patients you know,
generally north of I would evensay 60, it'd be hard to find a
patient who I don't consider atincreased risk.
And then, of course, you haveyour patients who are dealing
with cancer treatments,struggling with the immune
(04:17):
diseases, who are onchemotherapy, immunosuppressive
medications, and that representsa huge portion of Canadians at
present time.
Maureen McGrath RN (04:27):
So government surveillance data is
showing that over 20% of thepopulation is impacted by flu.
Does this surprise you?
Dr. Christine Palmay (04:35):
Absolutely not.
So there's a couple of problems.
Generally speaking, we're notfantastic with influenza
immunizations, but if you'relooking at stats for patients
over 65, they're generally okay.
It's that middle-aged 40 to 65that unfortunately we have very
low uptakes for the influenzavaccine and I have certainly
(04:57):
seen an influenza spike in mypractice.
The tragedy is, as a communityphysician, there's no point of
care testing.
I cannot swab a patient whocomes in for influenza or RSV If
they have a COVID test that mayor may not be expired.
Potentially you can test forthat.
So you know, what I'm seeing inmy office is kind of a guessing
(05:18):
game, point being, I'm justseeing respiratory viruses.
And the greatest misfortune,maureen, is if you win the
lottery which is not a lottery,you want to win and get
co-infected by two or you knoweven less rare but tragically
three viruses.
And I certainly have a youngpatient.
I always tell this tale, forwhen patients come in and kind
(05:39):
of say nay to any sort ofimmunization, she's 40 years,
young.
Say nay to any sort ofimmunization.
She's 40 years, young, healthy,vibrant, no official risk
factors, and she got influenza Aand COVID At the same time.
I only knew about that becauseshe ended up in the hospital and
four weeks later she's still inthe hospital.
So it's you know those cases.
Yes, we need to think about themost vulnerable, our oldest of
(06:02):
the old and our youngest of theyoung patients, but you're not
zero risk if you are outsidethose age ranges.
And it's important as well tounderstand that influenza
vaccines also preventtransmission, which we come back
to the discussion, that it is ajoyful time to celebrate with
family, travel with family, bewith family.
(06:22):
But making smart choicespreventively, I think, is the
way we preserve health.
Maureen McGrath RN (06:27):
Absolutely, and there are so many
misconceptions about the fluvaccine.
But what are some of the commonflu symptoms?
Dr. Christine Palmay (06:35):
So when I talk about flu-like symptoms, I
just say respiratory symptoms ingeneral, because it's really
impossible from a clinical examto delineate whether a patient
has COVID or influenza or RSV.
You know they generally come insaying I have a cough, perhaps
a runny nose, overwhelmingfatigue, joint pain, you know
(07:00):
feeling lethargic.
Sometimes gastrointestinalissues creep in and there's a
whole bunch of GIgastrointestinal viruses that
are also spreading around.
You know we have some guidancethat perhaps a patient with RSV
has a bit more wheezing andthat's an audible whistle as a
patient is breathing out.
But you know the reality is iswe're horrible at being able to
(07:24):
differentiate because symptomssimply overlap and it isn't
until a patient tragically endsup in the hospital where you get
tested probably.
Um, you know we get tripletested for those viruses that we
had mentioned, but I'm doingeverything to prevent that from
happening, right?
Maureen McGrath RN (07:39):
right, absolutely.
Um.
So how can we protect ourselvesfrom the flu?
I I mean, you mentioned thegatherings and I have to say,
since COVID, I'm not 100%comfortable in a gathering or in
an indoor restaurant, to behonest with you.
But how can we protectourselves from the flu?
Dr. Christine Palmay (07:58):
So let's start with basics.
If you're sick, stay home untilyou feel well.
Even you know a patient who hasa COVID test that's negative if
they're still symptomatic.
Even you know a patient who hasa COVID test that's negative
they're still symptomatic.
I say, you know, be smart, stayhome.
Hand washing is not a publichealth measure strictly for
COVID.
It's a good idea in general.
Wash your hands right, mindyour P's and Q's, make sure
(08:20):
you're well hydrated, you'reeating your vegetables, you're
getting sleep, everything thatyour mama or your papa told you
to do.
And then you know taking thatone step further in terms of
prevention.
You know making sure that youget every vaccine that you are
eligible for, based on your ageand or risk factors, and
thankfully we have vaccines thatare available against influenza
(08:40):
, now newly against RSV and aswell as COVID.
And unfortunately, as I say,wash, rinse, repeat.
You know our Canadian wintercomes annually and that means
we're going to have an annualrespiratory season.
So you vaccinated yourself in2024.
(09:01):
You know, in October, inpreparation for the Canadian
winter.
Well, guess what?
It's now 2025, time to thinkabout.
You know, protecting yourself.
I talk about you know, puttingon your preventative medicine,
armor, as we go into thisCanadian winter and I always I
often mention this quote.
(09:21):
It really resonates with methat good medicine treats
disease.
So if you come into my officeand you have some sort of
respiratory illness, I'm clearlygoing to offer treatment that I
think is best for you.
But I'd be doing a better jobif I offer guidance as to
preventing vaccines.
So good medicine treats illness.
Excellent medicine tries toprevent it.
Maureen McGrath RN (09:42):
That's a great point.
Is it too late in the seasonfor people to get the flu
vaccine?
For those who thought that theywere better off not getting it?
Dr. Christine Palmay (09:51):
No, I don't think it's too late.
I mean it certainly depends onyour risk factors.
For high-risk patients,absolutely, and as we mentioned,
we have a spike in influenzalately.
For other vaccines COVIDvaccine follow public health
guidance no-transcript aboutolder patients, I tend to time
(10:27):
that right before the seasonstarts.
We definitely have two yearsworth of data coverage for the
two vaccines that are available.
That's what I provide guidanceto my patients about.
So I mean, if you're going tomaximize the coverage, you're
probably getting that vaccine.
October-ish makes more sense.
But if you are high risk andyou're going to maximize the
coverage, you're probablygetting that vaccine October-ish
makes more sense.
But if you are high risk andyou're heading somewhere and
(10:47):
you're worried about it, timingreally is inconsequential.
Just get a vaccine.
Maureen McGrath RN (10:53):
Absolutely Great advice.
You mentioned RSV and we'rehearing a lot about RSV.
This was typically common innewborns and infants and
potentially devastating to themas well, but why are we seeing
it more now in older adults?
Dr. Christine Palmay (11:09):
So we're actually really not seeing it
more.
The problem was is that wedidn't have much to do in terms
of preventing RSV, right?
So you're absolutely right RSVonce again, it affects the
youngest of the young, sotypically patients under two
years young and then olderpatients.
We did have, and we have hadfor quite a long time, treatment
(11:32):
for those infants at risk,significantly at risk, for RSV.
Things have changed since wehave new vaccines and new
monoclonal antibodies on themarket.
But now, because we havevaccines, you know it's not that
all of a sudden we have moreRSV, we just have an ability to
try to prevent it.
So it has been top of mind, topof news, because we have a new
(11:53):
tool in our toolbox.
I'm going to focus on olderadults.
We have two vaccines,relatively available, one that
is coming down the pipeline andreally, when you're thinking
about burden of disease, rsv inits severe form is horrible.
People end up with superinfections, other complications,
(12:15):
deterioration of their otherhealth diagnoses and a stat that
has always stayed with me if apatient ends up in hospital so
has severe RSV disease, 8% ofthose patients don't necessarily
leave in the state that theycome in.
So they leave the hospital butthey leave, requiring, you know,
supplemental care.
(12:36):
They leave, you know leaverequiring nursing home care.
They lose their independenceand in a society where we place
so much emphasis on wellness aswe should, when we place so much
emphasis on aging with dignityand the ability to be active and
enjoy life, we often forgetthat part of that reassurance
(12:57):
policy to maximize the chancethat you will be well later on
in life is preventing, vaccinepreventable diseases, and the
best way to do that isimmunizations.
Maureen McGrath RN (13:08):
Absolutely.
Now we're seeing the numbertrending down of RSV across the
country, but the incidence ofRSV is higher this year as
compared to last.
Are we going to see that as anemerging trend, rsv continuing
to increase across Canada?
Dr. Christine Palmay (13:23):
We don't know fully, right.
I mean you have to understandthe public health measures that
were very much in place duringCOVID have somewhat lingered.
You mentioned you are a littlebit hesitant to go to
restaurants and gatherings.
I think many patients are.
So that in itself issemi-protective.
We don't really know.
But we certainly know that RSVis seasonal.
It differs where you are in theworld.
(13:43):
In Canada we generally sayOctober maybe to late March,
with a bit of variance here andthere.
But I'd like to make a pointabout the contagious nature of
RSV.
So during COVID mostrespiratory illnesses certainly
influenza, pneumococcal, whichis a bacteria another discussion
for another day they werebarely detectable because we
(14:05):
were staying at home wearingmasks, not congregating.
The clinical trials that tookplace to approve the RSV vaccine
took place during COVID.
So even during a time whenpeople were, you know, so strict
about public health measures,we were still able to find
(14:25):
enough RSV to power the studiesand I think that's a pretty
striking point.
Maureen McGrath RN (14:32):
That is very significant.
I did not realize that at all.
You mentioned that whistling.
I did not realize that at all.
You mentioned that whistling,the upper respiratory symptoms
that are RSV, but thatdifferentiation was that
whistling, which is veryinteresting.
How can you protect yourselfagainst RSV?
Dr. Christine Palmay (14:50):
So all of the measures, you know it's not
a difficult discussion becausewhen I talk to patients, you
know you feel like you're havinga shopping list of vaccine,
preventable diseases, but theyshare a lot of commonalities.
So the preventative measuressix-day home, wash your hands,
et cetera, but RSV for adults,we have two readily available
(15:11):
and, as I mentioned, one downthe pipeline vaccine that is
effective, with officiallytwo-year data for the ones that
we have available, which is veryexciting.
And you know that thecombination of common sense,
public health measures that arelifestyle-based and vaccination,
you know that will optimizeyour chance of avoiding getting
(15:33):
RSV not a hundred percent right.
And oftentimes when people havetaken a vaccine and they come
and I think it's probably RSV,they sort of say, oh, my
goodness, I even took thevaccine and I got it.
And I say, yes, but perhaps youhave an attenuated, a mild
version of RSV.
And even you know, for patientswho aren't in hospital, maureen,
rsv is a pain, like you reallyaren't.
(15:54):
Well, it is not a pleasantexperience.
And the other huge learningpoint during COVID was
understanding and appreciatingthe precious nature of time and
the ability to spend timetraveling, not having to cancel
your travel plans.
You know, even with AirCanada's and our Pearson
(16:15):
international crisis, makingsure that you're able to join
family that concept reallyresonates with patients.
So maximizing your protectionagainst RSV in the form of
vaccine provides you the bestinsurance policy that we have at
present.
Maureen McGrath RN (16:31):
And helps those that you love as well.
Now COVID-19 is shockingly tomaybe to a lot of people, or
surprisingly, is still with us.
And what do we need to knowabout COVID-19 aside from that?
It's still here.
Dr. Christine Palmay (16:46):
It's still here, unfortunately, and it
doesn't care.
It's not going to go away, itdoesn't care that you missed
your trip to Punta Cana or youcouldn't celebrate with family.
The virus's goal is topropagate its DNA right, and
it's going to continue to do so.
So public health guidance haschanged.
I briefly mentioned that.
I really encourage you to speakto your or the viewers to and
listeners, just speak, make totheir primary care providers.
(17:09):
We're changing the way.
We recommend a vaccinationbased on risk factors, and
that's new as of this year, alittle bit different Next year,
who knows.
But you know it's a movingtarget and we obviously try to
create vaccines that are themost up to date, based on the
variants that are circulating.
So we know what's happening now.
We don't necessarily knowwhat's happening in September.
(17:31):
So ears open and certainly it'snot going away.
And, yes, you still need avaccine.
Maureen McGrath RN (17:38):
You know I love that.
You said if you're sick, stayhome.
You know basic information.
You know I'm seeing some healthcare providers coming into the
office sick, thinking well, I'lljust wear a mask, which is also
uncomfortable, I think.
You know, during COVID-19,people knew if they were sick,
stay away.
But now people are a little biteasier about that.
(17:59):
But should people still betesting for COVID-19?
Or should they assume they haveit with certain symptoms?
And you mentioned earlier thatsome of the kits are expired.
Do they actually work ifthey're expired?
Dr. Christine Palmay (18:10):
We don't know.
I mean, generally speaking, Isay a positive is a positive.
So if you do a test that'spositive, pretty sure it's
positive.
The question is is whether anegative test is negative, and
you know guidance varies.
But if you get three tests thatare done in 24 hours apart and
they're all negative, you'reprobably negative.
Probably.
We don't know fully.
(18:30):
The other reality is in terms ofyou know how to deal with COVID
and whether it matters whetheryou test positive.
It does because it willdelineate in general when you
are next most eligible for thevaccine.
You know, after a natural COVIDinfection your immune system is
naturally primed.
So it's almost like a lostopportunity If you vaccinate.
(18:51):
At that time you're already atmaximum level and you have to
wait in general the guidance isstill six months for your
natural immunity to wane and youget the vaccine to boost
yourself up again.
The other question is in termsof treatment.
So we have treatments forpatients who are at high risk.
You know those treatments areimportant for patients who have
severe potential outcomes fromCOVID, but you don't want to
(19:14):
give them willy nilly.
So I would never say you know,scratch my head.
I think possibly you have COVID, maybe, maybe not.
Here's an intense medication totake, it's better to know fully
.
This is sort of the gray zoneof medicine.
As a primary care doctor, Ilive in the gray zone.
Primary care doctor, I live inthe gray zone.
And those are, you know, reallyimportant intimate discussions
(19:37):
to have with your primary caredoctor, not necessarily what
public health is mentioning ingeneral, but what my personal
risk factors are, based on myage, my comorbidities, my
medications, my lifestylechoices, whether I'm traveling,
whether I'm not, whether I havegrandkids, whether I have not.
And that is the art of medicineand that's what we call
individualized care and, in myopinion, excellent medicine.
Maureen McGrath RN (19:56):
Dr Palmay, how can you tell the difference
between COVID, RSV and influenza?
Dr. Christine Palmay (20:02):
Well, my crystal ball marine is in the
repair shop for the next bit.
That's a short answer.
I mean, it's certainly notmeant to be snarky, but we
really can't.
I think I mentioned that RSVmay present, with more wheezing,
an audible whistle when apatient is breathing out.
You know, aside from a testthat's positive, we can't really
(20:25):
, once again, without diagnosticabilities in the community.
You know, certainly, when apatient ends up in the hospital
they get triple tested whetherthey have COVID, influenza or
RSV.
But I'm really hoping mypatients don't end up in the
hospital and actually get thattest.
So it's once again, you know,looking at a patient and just
(20:45):
saying I'm going to treat youconservatively, treat your
symptoms if I can.
But the best way to evenprevent a visit to my office is,
you know, vaccinating yourselfand being smart.
That Canadian winter is long,it's harsh, there is a heck of a
lot of snow, no more snow and,you know, hopefully no more
(21:06):
sickness to the same extent thatwe've seen, and certainly
during COVID, which was a verydark time.
Maureen McGrath RN (21:11):
And you know, people have been
misinformed and they're hearinginformation from their friends.
They're assuming things abouttheir own health.
I had a patient who felt thatthey had actually a burden about
a 15% burden of prematureventricular contractions, pvcs
and they felt that that burdenhad increased because of the flu
(21:33):
vaccine.
And they spoke to theirexercise cardiologist about this
and the cardiologist said andthe patient said you know we're
not conspiracy theorists here,but yeah, I wouldn't get the flu
vaccine if I were you.
And I thought I wasn't reallyfamiliar with that.
But I did a little research andI found that the flu vaccine
(21:55):
can actually decrease yourburden of PVCs.
What would you say to listenerswho are misinformed or on the
fence or haven't gotten theirvaccine?
What golden nugget ofinformation do you have for
patients like this?
Dr. Christine Palmay (22:15):
Look at the source of your information,
right?
I love Instagram.
I'm, you know, constantly on it.
I Google absolutely, you know.
The problem is is that it's adouble-edged sword.
We certainly have unprecedentedaccess to information, which is
wonderful.
Right, I sort of laughedbecause I was speaking to a
(22:35):
patient who really didn't haveany concept of going to a
library and taking books off theshelf.
But you know, you need to knowwhat the source is.
I generally recommend going tonational guideline bodies.
You know organizations,immunize, canada.
There's some wonderful siteswith hardworking people who
authentically care and spendhours and hours, you know, doing
(22:59):
research, provide informationthat's most up to date.
You know fear is fear and evenI make correlations that don't
necessarily make sense whenyou're anxiety ridden.
But you know you need tounderstand the correlation is
not necessarily causation andwhen people talk about vaccines
they're afraid that theircondition will worsen, whatever
(23:21):
it be PVCs, hyperthyroidism,hypothyroidism the reality is I
am much more comfortable dealingwith, you know, expected side
effects from a vaccine than I amdealing with the wild west.
If a patient gets thatparticular vaccine preventable
disease so whether it's RSV,covid or influenza I don't know
(23:45):
what that vaccine is going to doto that patient and that may be
an epic disaster.
So it's all about relative risk, putting things into context
and, you know, going to sourcesthat are reliable and up to date
.
Maureen McGrath RN (23:59):
And I think sometimes patients walk into
doctor's offices and you knowthey have one impression and the
doctor, you know, given thelimited amount of time that
doctors have to educate patients, sit down with them and, you
know, allay their fears.
You know, I think sometimesyou know health care providers I
shouldn't just say doctors, whojust go along with what the
(24:21):
patient says.
Maybe they realize they'renever going to talk the patient
into something, but it's greatadvice to look at the resources.
I recently read that Dr Googleis incorrect 65% of the time and
then the social mediainfluences are incorrect 75 to
(24:42):
80% of the time.
So it's definitely not a placeto get your information and I
really appreciate theinformation that you've provided
tonight,
Dr. Christine Palmay (24:54):
Thank you so much again for having me.
It's always a delight.
Maureen McGrath RN (24:57):
It's my pleasure.
I love having you on becauseit's such great information.
Dr. Christine Palmay (25:02):
And rally on.
We have to rally on as acommunity, and doctors
themselves and healthcareproviders themselves need to
self-rally as well.
So point well taken.
Maureen McGrath RN (25:12):
Absolutely Well.
Thank you so much.
My guest was Dr ChristinePalmay a Midtown Toronto family
physician and member of theAdult Vaccine Alliance, and we
were talking about the top threerespiratory viruses COVID FLU,
RSV and if you know somebodythat can benefit from this
(25:34):
episode, please feel free toshare.
Please send it along to them.
I'm Maureen McGrath, aregistered nurse, nurse,
continence advisor and sexualhealth educator, and you have
been listening to NurseMaureen's Health Show Podcast.
Thanks so much for tuning in.
I'm Maureen McGrath and youhave been listening to the
Sunday Night Health Show Podcast.
If you want to hear thispodcast or any other segment
again, feel free to go to iTunes, spotify or Google Play or
(25:54):
wherever you listen to yourfavorite podcasts.
You can always email me,nursetalk at hotmailcom or text
the show 604-765-9287.
That's 604-765-9287.
Or head on over to my websitefor more information,
maureenmcgrathcom.
It's been my pleasure to spendthis time with you.
(26:20):
Ladies, let's talk aboutsomething we don't often talk
about pelvic floor health.
Whether it's postpartum changes, aging or just the demands of
everyday life, many womenstruggle with bladder leaks and
a lack of self-confidence.
But what if I told you there'san effortless solution?
Meet the Emcella chair Just 30minutes, fully dressed, and it
will do thousands of Kegels foryou Strengthen your pelvic floor
(26:42):
, improve intimacy and feelconfident again.
So say no to incontinence andstart to enjoy life again
leak-free.
Ask your doctor about theEmcella chair.
For more information, go towwwemcellacom.
That's wwwemcellacom.
Popular Podcasts
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.