Illustration by Matthew Billington Credits: Illustration by Matthew Billington
|This content is vetted by medical experts |
|This story was originally part of "Stand and Deliver" in the September 2015 issue. |
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What to ask your doctor about Angelina's cancer surgery.
When Angelina Jolie writes about her personal health struggles in the New York Times, it makes a splash. In 2013, Jolie set off a media storm by writing about her double mastectomy and genetic predisposition for cancer, then wrote about a second surgery, this time to remove her ovaries and fallopian tubes, in 2015.
High drama, yes, but it’s hard not to admire her candour. Jolie writes that she is now in full menopause and using bio-identical estrogen patches and an IUD to replace the hormones she’s lost. That’s no small reveal for anyone, let alone an actress known for her vitality and sex appeal.
Jolie also added a note of caution, knowing that the "Jolie effect" is now a recognized factor in doctor-patient conversations and that her preventative surgeries are an extreme course of action.
"I did not do this solely because I carry the BRCA1 gene mutation, and I want other women to hear this. A positive BRCA test does not mean a leap to surgery," she writes.
On this point, Canadian doctors and cancer experts agree. High drama may be a good way to start a conversation but calm heads makes the soundest decisions.
A cancer doctor weighs in
Dr. Marcus Bernardini a surgical oncologist at Toronto’s Princess Margaret Cancer Centre at University Health Network told us there are a few things Canadian women should know in the wake of Jolie’s announcement:
1. There is actually no effective general screening for high-grade serious ovarian cancer and screening is not recommended.
2. Preventative surgery is recommended for high-risk women (those who carry the BRCA1 or BRCA2 mutation).
3. Jolie mentions a scenario in which only the fallopian tubes are removed (called a salpingectomy) for women who still hope to get pregnant. Dr. Bernardini calls this "an intriguing strategy," but for now the removal of the ovaries and fallopian tubes (a salpingo-oophorectomy) is the recommended course of action.
4. There are four questions Dr. Bernardini suggests discussing with your doctor if you have concerns raised by Angelina Jolie’s story:
- Am I at risk for ovarian cancer?
- Is there a history of ovarian cancer in my family?
- How does one find out if they are eligible for testing?
- I know there are different types of ovarian cancer, are all preventable in this way?
Family history is the starting point
Responding to the Jolie news this week, Gillian Bromfield, the director of Cancer Control Policy at the Canadian Cancer Society also pointed out that it’s important that people try to learn their family health history.
The group also has information for women with a known strong family history of breast and ovarian cancer, including information on genetic testing, and preventive strategies that may be available to them, she says.
"The decision to have a preventive surgery is a very personal one that a woman would make in consultation with her healthcare provider based on her medical history and her personal preferences," she says.
Here’s hoping Jolie’s candour leads to more information being shared – not more panic.
Read on for more information on menopause and genetic testing.
How one woman realized she need time away from her social media feeds, and what to do if you need a hiatus, too.
One day last summer, I realized I needed a break. Not from a busy work schedule or family commitments—but from my Twitter feed. I would often grab my phone while I was still in bed to scroll through the morning's updates. Before I knew it, 20 minutes would pass and that lovely sleepy feeling would be replaced by the lives and news of the people in my timeline, some of it upsetting. I'd be off-centre before the day even really started.
This isn't the first time social media has got to me.
Four years ago, I quit Facebook. Between comparing myself to others and dealing with political rants I disagreed with, I felt crummy every time I was on the site. When I logged o for the last time, I turned to Twitter; I really enjoyed the short snippets of news and the interesting conversation the platform fostered. But when it started making me feel like Facebook did—gloomy—I knew I had to log off.
Facebook, Instagram, Twitter and the like have become xtures in our media landscape, changing the way we communicate. Mostly, this is a good thing; it makes it easier to meet intelligent and diverse people and to keep in touch with world-changing social movements. But its ubiquity can be overwhelming. Research is starting to show what many of us have already noticed: a link between social media and our mental health.
Pioneering research published earlier this year in the journal Depression and Anxiety looked at the relationship between depression and using one or all of the most popular social media platforms, including YouTube, Twitter, Instagram, Snapchat and LinkedIn. Researchers found that "any level of social media use was associated with an increase in the risk of depression," says the study's senior author, Dr. Brian Primack, director of the Center for Research on Media, Technology, and Health at the University of Pittsburgh. Dr. Primack, also assistant vice-chancellor for research on health and society at the university, notes that the study didn't look at causality; in other words, the question of whether increased social media usage causes depression or vice versa still needs examination. "It's very plausible that it could be a little bit of both," he says.
For most people, however, spending too much time on social media is less about a formal diagnosis and more about a general sense of well-being. A 2014 University of Michigan study about social media breaks (specifically, those who gave up Twitter for Lent) found that "three concerns surfaced with respect to social media use: spending too much time on it, trade-o s of not spending time elsewhere, and a concern about social media not being ‘real life.' "
I knew it was time for a break because Twitter had lost its vibrancy; there was too much scrolling and not enough engagement with what I was reading. Patricia Pike, an addiction and intervention specialist with private practices in both both Vancouver and the San Francisco Bay Area, says that's an important indicator. She advises asking yourself these questions: Are you neglecting interactions with loved ones? Are you distracted and unable to complete day-to-day tasks? Are you living for your next social media hit? If the answer to any of these questions is yes, it might be time to rethink your relationship with social media.
I wasn't planning to leave Twitter for good—I don't think that's possible, or even preferable, in today's connected world. Instead, I decided to take a month off. I deleted the app from my phone, logged out of my account on my laptop and prepared to white-knuckle it through the next four weeks. But it turned out to be surprisingly easy. For the first week, I was constantly reaching for my phone, used to scrolling through my feed on a work break or while wait- ing in line. But then, the desire to log on died down and, perhaps stereotypically, I began to feel more peaceful and focused. I started filling my newfound pockets of time with other interests: reading, knitting and suing my phone to call friends and family (gasp!). When my month was up, I cautiously reentered the fray, but I found I didn't feel the old urge to check in constantly.
The break allowed me to do what Dr. Primack recommends: "Learn what patterns of use are more problematic and what patterns are more beneficial." I realized some social media platforms just aren't for me. (No to Facebook, some- times to Twitter and yes to Instagram; I mostly follow knitters, so it has always felt like an oasis.) And now I know I don't have to be "on" all the time to enjoy the boons of social media; these days, my Twitter usage is much more measured.
It's clear that social media—and our increased Internet usage, in general— plays an ever-growing role in our mental health. But temporarily unplugging is a valid form of self-care, a way to minimize overstimulation and hit the reset button. Give me a break, indeed.
5 steps to a successful social media detox
1. Have a plan. Decide how long your break will be, but resist the temptation to make it permanent. "Shutting social media out of your life completely is a great way to set up failure to control your social media needs," says addiction expert Patricia Pike.
2. Write down your reasons. Think about what you want to achieve this break. Is it figuring out which platform works best for you? Or do you feel overstimualted?
3. Use technology to your advantage. Delete the social media platforms you want to avoid from your phone. (If they're not there, you can't mindlessly click on them.) And on your desktop, use time-management apps like Anti-Social or SelfControl to block sites you want to avoid for a period of time.
4. Enlist help. If you think you'll be tempted to long on prematurely, have a partner or a trusted friend change your password for the duration of your detox.
5. Set limits. When you return to social media, put limits on your usage, says Pike. And give yourself a schedule, says Dr. Brian Primack, director of the University of Pittsburgh's Center for Research on Media, Technology and Health. For example, restrict logging on to your coffee break, instead of intermittently all day long.
Cherry Chocolate Chunk Brownies<br>Photography by Jeff Coulson Credits: Cherry Chocolate Chunk Brownies<br>Photography by Jeff Coulson
Bars and squares make a fun addition to any cookie exchange.
Tested until perfect.
Get the recipe: Butter Tart Squares
The pride of Nanaimo, B.C., these bars have a crumb base layered with a creamy custard filling and a chocolaty topping. Best served at room temperature, the bars keep well refrigerated or frozen.
Get the recipe: Classic Nanaimo Bars
Enjoy these Australian squares just as they are, or dip them in a mug of hot cocoa for the ultimate treat. While they're traditionally made with sponge cake, our version uses easy-to-make chocolate pound cake instead, making them a sinfully indulgent dessert for chocolate lovers. To retain their moistness, store the squares in the fridge.
Get the recipe: Double Chocolate Lamington Squares
Sweet-tart cranberries are cooked with a hint of orange to make an easy jam-like filling, then sandwiched between layers of crisp almond pastry. Freshly ground almonds are crunchier than the storebought ground variety, so whirl whole nuts in a food processor for the ultimate nutty crust.
Get the recipe: Cranberry Almond Squares
A thick layer of creamy mint icing is sandwiched between a crumbly chocolate cookie base and smooth dark chocolate ganache in these irresistible squares.
Get the recipe: Mint Chocolate Squares
The inside-out version of this classic square offers a classy white chocolate top with a rich dark chocolate centre. Use a vegetable peeler to make the chocolate shavings.
Get the recipe: Reverse Nanaimo Bars
These layered bars are like three desserts in one! Using a candy thermometer ensures you have the right consistency of caramel (not too soft and not too hard).
Get the recipe: Gooey Peanut Butter Squares
If simplicity is your style, look no further than these six-ingredient squares, made with ingredients you'll likely already have on hand. If you prefer, use seedless raspberry jam instead of strawberry.
Get the recipe: Crumble-Topped Jam Squares
A smooth and silky no-bake filling comes together in a matter of minutes for this easy crowd-pleasing treat. Be sure to top the squares with peanuts quickly, before the chocolate sets.
Get the recipe: Peanut Butter and Chocolate Cheesecake Squares
Each layer of these bars is a delicious treat on its own; together, they become the star of any goodie tray. To make them gluten-free, be sure to use oat flour that's labelled as such. If you choose not to use pasteurized egg whites, whisk a fresh egg white until frothy and measure out one tablespoon.
Get the recipe: Sugared Pecan Fudge Squares
Vanilla wafer cookies, raspberry filling and white chocolate lighten up the traditional colour – and flavour – of the classic Nanaimo bar.
Get the recipe: Pink Berry Nanaimo Bars
Classic pecan pie gets a bite-size makeover with these crunchy pecan-packed squares. Toothsome shortbread is the perfect base, adding a delightful contrast. Chill the squares before cutting for a smooth, easy slice.
Get the recipe: Honey Pecan Pie Squares
Trust us, these easy-to-make squares will be the hit of your holiday parties and family gatherings. Wrap them in cute little boxes and hand them out as hostess gifts at all of your festive get-togethers.
Get the recipe: Chocolate Toffee Hello Dollies
Sweet glac? cherries and vivid pink icing give these sumptuous brownies a nostalgic retro look. Make them a couple of days ahead, then spread on the fruity icing just before serving.
Get the recipe: Cherry Chocolate Chunk Brownies
Sweet butterscotch squares hide a layer of crystallized ginger and velvety milk chocolate. These are pretty when packaged as gifts and are the perfect holiday treat to add to a bake sale.
Get the recipe: Ginger Butterscotch Squares