2020 Novel Coronavirus update:

You have probably heard by now of the new virus emerging in Wuhan China.  I would like to remind you that it is a work in progress. Information is being refined on a daily basis. We are in the middle of our flu season and there is a great deal of influenza A present in our community. In Wuhan China and surroundings,  there presently are approximately 100 million people being placed under restrictions. The risk of acquiring this virus is not considered great when you look at the entire country of Canada. However, we continue to welcome visitors by the thousands through our airports mainly Toronto and Vancouver. Just exactly how this will affect the situation appears to be a daily guess. Those visitors and travellers are appearing in our backyard and the situation will require more vigilance and care. Some countries have reacted by limiting travel from affected areas and closing their borders to these travellers while they examine the situation. There is a balance between losing commerce, tourist dollars, travel arrangements etc. However the cost to a publicly funded health care system can be staggering and possibly unsustainable as well.  It is a lesson that complicates the situation in any country without universal healthcare such as China. True numbers are difficult to obtain since many individuals do not have  the funds or desire or trust to approach the appropriate level of healthcare and screening.

More concerning is the recent observation that the virus can be transmitted by healthy carriers up to two weeks before showing any signs or symptoms. It takes close contact to get infected. The virus is not thought to be active or able to live on surfaces and temperatures below body level. This is an advantage. However, airlines recirculate their air in a closed cabin space  amongst hundreds of people for hours at a time. It is a favourable environment for incubation and transmission to occur.

We have learned a great deal already. The virus has been characterized and is similar to the SARS virus. Interestingly it is a distant cousin of the common cold. A blood test has been developed to confirm and diagnose those affected with it. Like influenza, there currently is no active treatment and there is work being done to produce vaccines.  The reality is that most people in our region who may panic and feel they have this virus will most likely be afflicted with influenza or  another respiratory virus. The problem is that you cannot tell the difference and need to await testing. Your own immune system is the key and paramount in helping you fight it. Remember, the viruses  do not exist to kill their host. They simply want a place to replicate and spread. It is the genetic mutation that becomes too overwhelming, but theoretically could put itself out of existence. The other problem is that many respiratory viruses mutate regularly to allow survival. Taking the above measures of handwashing, and extra vigilance helps a great deal.

Just to add some point of comparison. Influenza A is the bad influenza. It is composed of dozens  of different strains many of which are related and others not.. Unfortunately there is a active circulating strain that is not in the vaccine. However most people who get infected will recover quite nicely. The death rate is really very small and estimated at about 1 in a 1000 people if not less. By comparison, the atypical coronavirus has a death rate of between 5 to 15%. The exact numbers not yet known. This is a substantial difference on several orders of magnitude. As of today the atypical coronavirus has not affected the pediatric population to any great extent. Influenza a is quite active in this population.

Another question that we are  getting frequently is with regards to travel. As the situation is changing on a daily basis due to the numbers seem to be doubling every day, it is difficult  to render travel advice. It is impossible to determine which countries may choose to close their borders and impose travel restrictions. The approach is different around the world. Even China has a history of underestimating the numbers. Their population is so massive that it is a daunting task no matter who you are.  If you do travel, I suggest get up-to-date information from the Centre for disease control website and prepare for a possible response should the situation worsen very quickly.

stay tuned for reliable links and further updates as they come available:

2020 Novel Coronavirus update:

Screening for 2019-nCoV - If you are presenting with the following:

      1. Fever and acute respiratory illness, or pneumonia

AND any of the following:

      2. Travel to Wuhan, China in the 14 days before the onset of illness

OR

      Close contact with a confirmed or probable case of 2019-nCoV

OR

      Close contact with a person with acute respiratory illness who has been to Wuhan, China within 14 days prior to their illness onset

*Some people, such as the elderly and people who are immunocompromised, may not develop a fever. The presence of new/worse cough or shortness of breath may be enough to trigger further precautions.

APPLY PRECAUTIONS*, REPORT AS REQUIRED

Ask Patients to:

• Wash their hands;
• Wait in separate isolation area if possible or keep a two-metre distance from other patients and clinic staff;
• Wear a surgical mask.

Initiate Droplet and Contact Precautions for Suspected Coronavirus Cases:

• Apply vigilant hand hygiene;
• Use gloves, gowns, fit-tested, seal-checked N95 respirators and eye protection when entering the same room as the patient or when transporting or caring for the patient;
• Postpone elective procedures that generate droplets (e.g. dental care).

* For more information on Routine Practices and Additional Precautions,

Flushots 2019,,, Oct 29, 2019, the health department has finally shipped the flushots. Although again it is later in the season, they are available. We have high dose shots for our patients over 65 years of age.  If you suffer from chronic respiratory or immune conditions, you are higher risk and should receive.  We will attempt to distribute them on a drop in basis, BETWEEN regular patient appointments.    Please contact us for a good time to drop in. 

New  DNA colon cancer screening.

We want to notify you that Ontario is transitioning from the guaiac fecal occult blood test (FOBT) to the fecal immunochemical test (FIT) as the recommended screening test for people at average risk (50 to 74 years old) of developing colorectal cancer on June 24, 2019.

FIT is a more sensitive colorectal cancer screening test and detects twice as many advanced neoplasms (colorectal cancer and high risk adenomas) as gFOBT. Patients with an abnormal FIT result will then have a colonoscopy.

Key Changes:

– Only one stool sample is needed instead of the three needed for FOBT.

– No medication or dietary restrictions.

– Less contact with the stool than FOBT….so less messy!

– The kits are not available for pickup from our office. When you are due for screening, your physician will complete a requisition, send the requisition to the lab,  and the lab mails you a kit to complete. You can either: bring a completed kit either to Lifelabs (the ONLY lab that will accept it)  or you can mail the kit. The kit must arrive at Lifelabs within 14 days of completing the kit. Also, the FIT testing kit is much more expensive than the old FOBT kit, so please complete your kit when you receive it, and try not to misplace the kit or let it expire. These kits are very costly to replace, although replacement kits can be made available if needed.

Dr. Kujtan and support staff will be away during this time.   Associate support and medical staff will be reviewing messages and results from ordered tests.  Prescription renewal requests will be honoured for appropriate circumstances, otherwise assesment will be required.  Phone messages will be reviewed intermittently.   Urgent medical assistance will be available from our locum and associates on a very limited basis.  Referrals and appointment requests will be dealt with and honoured on a case by case basis.  Non urgent messages will be returned by our support staff after July 18. Appointments for Forms and letters requests will  be scheduled in the August- Sept cycle as they usually involve extensive and long appointment times, and subsequent administrative time.  Please ensure that you have all the details required for your requests.  These can be summarized on paper and provided with your request.    After hour clinics for urgent matters will continue to run as normal and up to date access will be posted on the website.   Stay healthy.

 2017 Binette Award Winner.

On behalf of the DOCS ON ICE Provincial executive, we congratulate Dr. Pete Kujtan who has been a driving force behind the success of Docs on Ice for several decades.  A tireless volunteer, leader, player and innovator,  Dr. Kujtan has advanced the tournament and helped raise large sums for local charities all around the province. His dedication as a family physician is equally inspiring. He continued to help  his patients during the initial phases of his recent cancer treatments. Docs on Ice would not exist today without the energy and enthusiasm of Dr. Peter Kujtan

Congratulations from the Provincial Executive Committee.

I would like to reach out to all of my friends,  family, colleagues and patients who have sent such warm wishes, prayers and good tidings. To be immersed in such a warm environment of spirituality and good thoughts has had a large influence on my recovery.   Surgery was performed at the Toronto General in June, and post surgical complications developed resulting in a six week hospital stay and weight loss.  To be clear, it is not a weight loss regimen that I endorse. LOL.  A sense of humour has also helped.   I have commenced follow up treatments, and am working hard to regain my health.   One of the side effects is a very weak immune system, which precludes spending large amounts of time in infectious environments. Spending 10 days a month attending hospitals seems to be the extent of accepted risk. Plainly speaking, my oncologist would not be pleased, until the go ahead is given.    Please, look after your health, stay off the sugar and think about planting a garden.  Stop smoking, in case anyone misses me saying this over and over, there you have it.  I think I am finally seeing the roses and truly enjoying the start of every new day.   I am staying in touch with Dr.Patel and Julie and together we are getting a lot of things done.  

Hope to see you soon and healthy!

you can email   julesdesk@gmail.com

Dr.K.

We apologize for  any confusion that  has arisen over the last few weeks.  Dr. Kujtan  developed health issues rather suddenly that required immediate attention and surgery.  The road has been a difficult one with complications and its own ups and downs.  Things are improving and he would like  to thank everyone for  their support, prayers and well wishes. 

    The office is open and attending to the health care needs of our patients, thanks to the collaberative efforts of colleagues and our fabulous health care team.  We hope to improve and organize further interim measures.   Dr.Remtulla and Dr.Patel are overseeing  the emergency and daily aspects of the practice, during Dr.Kujtans recovery and reintegration.

        A return to full time  has not been set yet pending some further treatment and testing.   Dr. Kujtan sends you his best wishes to stay healthy and positive. 

Walk-in clinic.    If you chose to use a regular walk-in clinic for an urgent matter and the doctor is not one of our associated after hour  physicians, then please note.    There has been an amazing increase in patients arriving at our office without proper transfer of care.   If you are seen by another clinic, then you are  essentially starting a new independent file that is NOT LINKED to your office file in any way.   Faxing raw data and results WITHOUT a proper note or phone call from the attending physician is inappropriate and not in your best interest.   Your care must be transferred in a professional manner, if you require follow up.   Please ensure that the walk in clinic or care provider is aware of this essential step in order to receive good care.  When you arrive with raw results, there is no way of your primary physician knowing wether the results you have are the complete ones ordered, and the interpretation of any results depends on the  specific reasons the initial treating physician chose to order them.  Observing this simple courtesy will enhance your health care and prevent a great deal of frustration.

If you have not yet recieved your date for a referral apointment, Please call the office. Most times patients should have some news within two weeks of the original request.  Often times, clinics and specialists notify patients directly without our awareness.