What can history teach us?

Wednesday, August 04, 2021

We all need a break from all the COVID narration and talk.  The relationship between front line physicians, health departments, politicians, pharmaceutical companies, world health organization, center for disease control and others is a complex one.  There is no unified and correct front.  It would be nice if they could all sit around one table, discuss the evolving evidence and provide on-going advice in a scientifically approved manner, but many other issues, costs, profits, concerns etc.  make it difficult.  

  To take a break from all this, I decided to go back before my own time, and examine how the thalidomide issue evolved, and why it took so long to notice the obvious.  

Here is a link that gives a brief but interesting historic overview.   



Preventing Burnout

Wednesday, June 30, 2021

We are making some progress.   After months of pleading with our local hospital, the rest of our support staff have been scheduled for vaccination.  I am not certain why it was so difficult, and sympathize with the many similar stories shared by patients.  This is matched by a significant number that had no problem.

This will put us in line to be ready to expand from a mix of virtual and on site practice to more of what we once did, when the health department gives us the green light.

We wish you a truly wonderful and spiritual Canada Day.   We are very proud to be Canadian,  and can only wish more of the world could understand what this means.  

We will be out of the office for the first week of July, building up immunity, and making plans for the future as to how best to handle the accumulating backlog of requests, tests and appointments.  Auxillary staff members will be dealing with emergencies, and our after hour service is fully functional.

We hope to see your very soon.

After hours Urgent clinic schedule 5-8 pm

Monday July 5th  Dr. Vickers  

- Tuesday, July 6th  Dr. Agarwal

- Wednesday, July 7th  Dr. Nasir 

- Thursday, July 8th  Dr. Silver & Dr. Wong

- Saturday, July 10th - Dr. Sardana  

- Thursday, July 8th  Dr. Silver & Dr. Wong

- Saturday, July 10th - Dr. Sardana  

Pandemic Update June 21,2021

Sunday, June 20, 2021

Pandemic Update June 21,2021


  As odd as it may sound, I wandered onto the parlimentary channel  during an important but neglected  News conference.  Open debate amongst scholars and respect of each others opinions leads down a path, where vital decisions can be modified or enhanced and new better directions emerge by looking at and discussing evidence.   The youtube link to this news cast  on June 17, 2021 on parliment hill by  MP Derek Sloan is found below, should you wish to view it.  My heart felt condolences go out to the victimized and I admire their courage for simply advocated for civility in society.   At the same time, front line physicians across the country were shocked to read an editorial in our own college publication  seemingly blaming and victimizing front line physicians and stopping short of placing outright blame for the immense mess and worstening choas about to be realized by society when we pull our heads out of the covid microscope and look around. Physician depression, burn out and suicide has  rocketed during the last 18 months.  The devastating mostly non -covid but some covid health consequences that have plagued practices has not gone unnoticed by this group.



The evolution of a concept affecting entire populations and how it is handled in copy cat fashion by those in politics, media, pharma, regulatory bodies, big business, medical administration, public health etc is not new in our society. There are hidden agendas at every juncture. Public purses are drained empty.  It seems to take painfully long periods of time to recognize consequences and damage.  It simply gets forgotten when new younger generations feel they have better answers to what seem  to be new problems.  In my youth, I believed that I was an independent thinker.  It is only with age, that I sadly accepted the notion of hearing the same message over and over turns it into an accepted principle no matter which circumstance it occurrs in.  The human ego wields immense influence.


In the twilight of my career,  I still feel the burden of guilt  that blindly following concepts without good evidence, despite being trained as a scientist, can cause immense harm in society.   For most of my career  I too advocated for a healthy lifestyle based on "food guides" to prevent heart disease, obesity and diabetes. The exact opposite was the result in my generation.  We too  succumbed to fear of ridicule,  academic penalty and outright threats.  After my first cancer ordeal, I decided it was time to try and make some ammends and I finally accepted the words of my grandmother,  "sugar is bad for you".   A documentary was released last year  in 2020  entitled "FAT FICTION".   I advocate watching it and am very familiar with many of the scientists who made it.  As I viewed it, I realized vast similarities with how the covid concept is being handled.  I sincerly hope that in 50 years my grandchildren will  not be making a similar documentary about covid.



Pandemic Update

Tuesday, June 08, 2021

Pandemic Update. June 8, 2021

  Peel is still considered a hot zone by public health officials.  There is little hope that things will re-open in the same way as the rest of province. We continue to try to provide essential medical services under the guidelines issued within the emergency order.   Our team has not yet received a second dose of vaccine, so our vaccination status remains pending.  Very few details are shared with front line doctors as to the reasoning behind these decisions.  It seems to all be blamed on "numbers".   We will continue to provide urgent care as best we can.  There is a substantial backlog of routine medical care and screening accumulating that will take months to address.  Our stress levels have been quite overwhelming as you can imagine.  In order to return to providing low risk care and health care screening, we will require the following.  

   1.  A green light from public health administrators

   2.  Completion of covid immunization

   3.  Lockdown orders to be ended

   4.  Adequate supplies of protective gear.

Social distancing measures will continue to be in effect indefinitely at this time. This will substantially reduce the number of patients that we can provide direct care in clinic for.   It will limit numbers of people allowed in the clinic and eliminate the ability to drop in.    The result will unfortunately increase the wait times substantially.   Similar problems face many of our specialty colleagues, and we see similar  wait time problems.

We are unable to schedule routine clinic care as the dates keep changing.   July 14th 2021 seems to be  the soonest that politicians and administrators may consider a green light. 

When open,  we will initially attempt to concentrate on the most outstanding lapse of care.   Eg.  we may book your pap and schedule later appointment for less pressing issues.  

Industry and schools are often ignoring these rules and may compel you to ignore emergency orders to complete paperwork which is not considered urgent care. Please remind those that may do this of the emergency orders still in effect. 

Virtual care, and electronic ordering of tests and results will continue to help with the backlog.

Our plans to open a building wide covid vaccine site have not been supported and therefore no vaccines are available at this time.  Many vaccine questions arise that seemingly contradict earlier policies and advice.  We  suggest you contact peel public health for up to date advice on mixing vaccines, using expired vaccines, using non frozen vaccines , and accelerating intervals.   We can assist you in booking a vaccine apt but face the same delays and non-responses that many of you do.   We also have no access to the vaccine data base since it is not compatible with medical software  and currently rely on you reporting to us when and which vaccine your recieved.  If you could also report the lot no, it would be helpful in case of future problems.  

We hope to see your smiling face soon. Please remain positive.



Full Lockdown?

Monday, April 19, 2021

Full Lockdown?  It is a very difficult concept to properly explain.

    Check the traffic cameras and you will certainly wonder what it all means.  You should avoid your isolated work out at the gym but drop into the LCBO next door?   The vaccination backlog seems to be moving forward faster.

Golfing spreads covid far more, than having a 1000 workers in a plant at minimum wage and no sick benefit?  Children playing in the park is a crime? 

You should not work when you are sick, even though you have bills to pay and are in debt because there are no sick benefits?

Where did this concept come from?   Would you believe, it was a high school science project of a 14 y.o. girl around 2006, that played with numbers in a theoretically perfect world. Eg it assumed that cancelling school would result in "home jail" for children, when in reality children and adolescents are programmed for social contact to allow growth and maturity.  Check the hiding spots around your neighbourhood and see what a warm sunny day of virtual school really looks like.   Children do get covid but none have died yet in Ontario, unlike the more serious consequences seen in older people.  There is nothing special about children being spreaders other than they attract and receive a lot of attention, as they should.  Her poject soon became a political tool, even though it was meant to make a simple prediction during the first few weeks and not be used for years.   I provide a link that explains it far better than I can. 


It is based on mathematical principles and made up of assumptions, with very little science going in to this and which is why a lot of us on the front lines are bewildered and have difficulty explaining it to others.   Measuring the success of this endeavour by test numbers alone, and ignoring the numerous other sensible  and measurable variables, probably contributes to the dubious success claim.

The one thing certain about this endpoint is that the numbers always go down.  It is the rule of how viruses and humans co-exist.  If the numbers dont support  the original concept, a simple adjustment by creating unsubstantiated claims of "incredible invisible spread" bring results to more desirable end points.

At the end of the day the only speculation that remains would also come down to your best guess.  Would we be further ahead, less disease etc if we simply concentrated on simple measures, such as stay at home when mildly sick, wash your hands and wear a mask in crowded conditions?

We have all lost a great deal, some more tragic than others, in the last 15 mos.  Vaccination will help, but even with "re-opening" it will takes years to rebuild  and recover, and I sadly doubt that we or our basic values will be the same again.





Stay at home order April 8, 2021

Wednesday, April 07, 2021

Stay at home order  April 8, 2021

The province and some public health units have announced a stay at home order for 4 weeks. The GTA is the most populated region in the province, and makes sense that test numbers are up, and disease numbers are up.  Shelter in place applies to everyone including ESSENTIAL workers outside of regular work hours.  We will attempt to deal with your urgent problems in a remote fashion.   We hope to resume regular services in a few weeks and after our immunizations are complete.  Please keep the essence of this order in mind when you make a request.

It would be useful to recognize some of the costs that these measures bear on our health as a whole.  Wether it is the pandemic or measures to control covid there are no winners in this difficult situation.  We have seen suicides, overdoses, heart attacks, psychiatric illness, obesity, diabetes, addictions and other conditions increase significantly. 

All deaths are sad and many are tragic.  Perspective in really required.  In Ontario, the death rate has hovered with a slow increase over the years.

On average about 2300 persons die in Ontario each and every week.  About 900 are from cancer, heart disease and stroke.  About another 900 are from "other" causes which include suicide, accidents, overdoses, etc.  Lower respiratory diseases  account for about 150, and the average numbers dying from Covid or dying with a positive covid test varies from 60-100, the majority over age 60.  If we need to dwell on death numbers, than please also remember all those that are dying from all causes and the families they leave behind.

Of interest, I was surprised that I could not find a single case of a child or infant dying of covid in Ontario since the pandemic onset.  I hope this provides some assurance.  It certainly should provide us plenty of time to reflect and review the science before requiring any sort of mandatory vaccination in that group.

Another point of good news, is that we have learned more effective treatment algorithms with better outcomes in those few who progress to covid disease.

We still seem to be resistant to discuss solutions out of the box, and rely on cut and pasting policies from other parts of the world. 

We have become more obese as a society, more prone to turning to alcohol and drugs, enduring financial hardships and suffering from anxiety, depression and other illness. We have family units that have become estranged and numerous potential bonds broken and vital support networks lost.  Reach out remotely to someone.  It does not seem that things will ever be same as they were, but  a new balance of some sort will most likely emerg.



Covid vaccination April 5th,2021

Sunday, April 04, 2021

Covid vaccination April 5th,2021.   The lines are moving faster, and some confusion has been averted.  There are a lot more people who now qualify.

As of April 7, 2021, those 50 yo and above living in certain postal codes are able to get vaccinated. See the peel health website.


 Individuals 55 or older are eligible to receive their AstraZeneca Vaccine at the following pharmacies:

    Heritage Glen Pharmacy (Glen Erin/Battleford) - 6515 Glen Erin Dr
    Real Canadian Superstore Pharmacy (Argentia/Tenth Line) - 3050 Argentia Rd
    Shoppers Drug Mart (Thomas/Tenth Line) - 5602 Tenth Line W
    Shoppers Drug Mart (Creditview/Bristol) - 5425 Creditview Rd
    Shoppers Drug Mart (McLaughlin/Derry) - 7070 McLaughlin Rd
    Walmart (Erin Mills Town Centre) - 5100 Erin Mills Pkwy

For a full list of locations please visit ontario.ca/vaccinelocation.

A few primary care clinics have also been given Astra-Zeneca vaccine by the health department. Their names and locations have been withheld for some reason.

NEW: Starting April 2nd 60+ are now eligible to book appointments and receive their vaccine in Peel. To book, https://covid-19.ontario.ca/book-vaccine/These sites are using Pfeizzer or Moderna Vaccines.

Many frontline workers are eligible, see this link to see the vast list of who is included.
   front line workers.https://www.peelregion.ca/coronavirus/vaccine/getting-the-vaccine/#priority.

You will require an attestation form signed by your employer. 

If you are 18 years or older and have high risk factors listed below, Dr Kujtan now will be able to refer you to the Trillium Health Partners to receive your vaccine. Trillium health partner  will contact you to arrange for an appointment to get vaccinated.

Highest-Risk Individuals:
• Organ transplant recipients; Hematopoietic stem cell transplant recipients; People with neurological diseases in which respiratory function may be compromised (e.g. motor neuron disease, myasthenia gravis, multiple sclerosis); Haematological malignancy diagnosed less than 1 year ago; Kidney disease eGFR< 30.

High-Risk Individuals:
• Obesity (Body Mass index greater than 40); other treatments causing immunosuppression (e.g., chemotherapy, immunity-weakening medications); intellectual or developmental disabilities (e.g. Down Syndrome).


covid alert- vaccinations

Wednesday, March 24, 2021

Covid vaccine confusion. Mar25,2021.

    There are many on the market and more coming.  Here is a link that compares them and takes out all the misinformation and misuse of various terms.  Please take 5 minutes to watch it.


We do recommend  taking any available vaccine at this time.  There is a lot of confusion  and terms used.  Please keep in mind that for large companies this is a business of immense profit, so there is a lot of leaked information to both support and demote each others studies.  Unfortunately, in todays world due to time constraints, we have to take the data provided by the "car salesman"(working for vaccine company) as the only one available and therefore requires  scrutiny.

Here are some certainties.  1. Any vaccine will prevent the severe form of covid, the disease, that can put people in the ICU.

2.  All vaccines will reduce the burden of covid in the world. Doubtful that it will eliminate it. 

3.  You can still acquire mild covid illness even though you have had vaccination.  You will recover.

4.  Highly unlikely that invisible carriers are a problem and even exist to any significant degree.

5.  Not recommended for infants and children at this time.

6.  Mild side effects are common,  temperature, site soreness, fatigue.

7.  Covid is capable of causing serious  blood clots.  Vaccines probably not, the scientific evidence is poor at this time. The Astra-Zeneca vaccine may rarely be associated with a clot at the back of the nose and base of the brain, but this is being monitored currently.  Headlines often originate from competitors indirectly pointing to low value information as clinical fact, to gain a better market share. 

8.  There are numerous people who are immune, or whose system can recognize and address it like any other virus and not create problems. We just dont have a good way of identifing them.

9.  We are lobbying government and health departments to involve us, and allow us to vaccinate you, but no indication that it will happen.  It took 4 mos, for our own staff to start  immunization, despite being both high risk front line workers and working in the Canada's covid hotspot.   We will have to remain mostly virtual until the process is completed in a few months, and we obtain a suitable color designation that allows normal care to become more personal. We regret that we could not convince the gate keepers otherwise.  Please work with us in this very difficult time.  


Covid vaccine update

Sunday, March 14, 2021

Covid vaccine. Needles before bullets!  March 15,2021

We know you are hoping to get your COVID-19 vaccine as soon as possible and are seeking the latest information. Here is what we know now (March 12, 2021).

AstraZeneca Vaccine
We (have/have not) received the AstraZeneca COVID vaccine in our clinic.  The Astra Zeneca vaccine is being offered only to people ages 60-64 (if you are 60-64 as of the day of vaccination, or if you will be or have been 60-64 in 2021). It is available in pharmacies and some family doctors’ offices in certain health regions. We will let you know as soon as possible when the vaccine becomes available to us. Please do not call us to try to book an appointment. We need to keep our phone lines free for patients with immediate medical needs.

Vaccines for patients over 80 (born in 1941 or earlier):
If you are 80 or older and do not live in a care home, your local public health unit will have details about vaccinations in your area.  Also see local links in next artilcles.

Provincial online system
Eligible residents can now register for appointments starting on March 17.

For more information about COVID vaccines visit the Ministry of Health website: https://covid-19.ontario.ca/covid-19-vaccines-ontario

Please be assured that we will let you know if we have any vaccine and if you are eligible to receive it from us. Please take the first vaccine offered to you.


Thursday, March 11, 2021

Covid19 shots, Needles before bullets! March10,2021

         It is hard to believe that a year and half later, Covid19 still dominates conversation.  Once again, our phone lines lit up when some well-intentioned  government employee announced that doctors offices are giving out covid vaccine.   The frontline doctors in Peel have heard nothing about it.  It would be a good idea, but there hasn't been a shred of meeting or communication to pitch it to the local docs.  In fact several of my peers pitched the idea to politicians and health departments almost one year ago.  Nothing has happened to evolve this plan.  It would take quite some time to solve logistics, of supplies, storage, transportation, etc.   The front lines are quite overwhelmed and tired looking after all the non-covid sick that have emerged during the pandemic.  We will post updates here.

     To those caught up in current vaccine chaos, we apologize for the numbers and links provided, and turned out almost impossible to access.  Lets all take some refuge, and be glad that we are fighting this "war" with needles and not bullets. 

  Which Vaccine?   Take anyone available.  There will be at least 4 diff ones.  Drug companies spend a lot  of funds promoting the best statistics that their own studies show.  There have been no head to head trials to truly say which one is better, if any.  We are conducting the trial in real time, so that data will eventually emerg, and few will care, just as the various yearly flu vaccines arrive from multiple makers.

   Things for certain, are that all the vaccines have been shown to reduce or prevent the serious covid disease.  If you get covid illnes, you will recover, but disease sends you to hospital.

   If you have had the covid cold, dont panic about vaccination.  You are ahead of the pack and have proven that your system handles this virus normally.

  You can still take a vaccine if you wish.  Better science data will emerg.

   Pregnant women should not take the vaccine currently.

   Children were not part of any studies, so even the manufacturers suggest cut off at 16-18 year olds.   More, proper science will replace fake news.

   Problem with the older population is that these vaccines were developed and tested very fast.  Companies do this often, because a group of young, healthy 30-60 yo leads to favourable results in trials.   Despite that, the roll-out has decided that our eldest and sickest should get vaccine first.  Consider it a trial.  So far, the rumour has it that most did just fine.  I image, we will soon be giving vaccines to everyone.

   The point of vaccination is to prevent spread and lessen disease.  Our administrative elite on this planet have read the messages from front line commanders and agree, that vaccinated people should be considered as unlikely suspects to spread disease.  Consider your self a non spreader of any "hidden" or secret covid virus lerking in your body about two weeks after vaccination. 

   I do not believe or endorse a vaccine passport.

You could still get covid illnes,  (mild cold type), but this would not necessarily imply vaccine failure.