COVID-19 is placing stress on Canada's public health system. Our clinic is starting to offer virtual care to make sure that we can continue to care for our patients safely and effectively. This means that we will be using video and audio technologies for some patient visits rather than asking all patients to come into our office. Some of these technologies are provided by the Province. Others have been provided by vendors like Google, or Apple to help make discussions with your care provider as easy as possible during these difficult times. Some health concerns can be addressed with virtual care alone, but in some cases your doctor may ask you to visit a hospital or other health care facility if necessary, for a physical examination.

We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools. To help us keep your information safe and secure, you can:

Understand that emails, calls, or texts you receive are not secure in the same way as a private appointment in an exam room.

Use a private computer/device (i.e., not an employer's or third party's computer/device), secure accounts, and a secure internet connection. For example, using a personal and encrypted email account is more secure than an unencrypted email account, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection.

You should also understand that electronic communication is not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required).

If you are concerned about using video or audio tools for virtual care, you can ask our office to arrange for you to visit a different healthcare provider or other health care center where you can be seen in person. However, please note that visiting a health care provider in person comes with a higher risk of coming into contact with COVID-19 and the possibility of spreading the virus.

By providing your information, you agree to let us collect, use, or disclose your personal health information through video or audio communications (while following applicable privacy laws) in order to provide you with care. In particular, the following means of electronic communication may be used (identify all that apply): email, videoconferencing (including Skype, Facetime, etc.), text messaging (including instant messaging), website/portal, OnCall.

April 1, 2020

A note to our patients. We have suspended all in-office visits at this time due to COVID 19. However, if you have an appointment currently booked with our office you will receive a call 2 days prior to that appointments. We will advise you how we will be able to proceed. Wishing you and your family safety and vitality during this challenging time.

If you need a renewal your prescriptions during the COVID-19 #stayathome period, please have your pharmacy fax your renewal request. Our fax number is 905-639-7647. Be well!

Update About Our Office During This Outbreak of Corona Virus : March 15, 2020

On the advice of the Ministry of Health we are changing our office protocols to ensure minimization of risk to our patients and our staff.

Starting the week of March 16, 2020 we will try to change as many patients visits as we can to virtual electronic visits. Initially most will be by phone. There are some patients who have already made arrangements to come to the office and, if they do, we will see them, once again minimizing risks by using frequent hand washing and minimized personal contact.

For the majority of scheduled patients we will set up visits through OnCall Health. One of the problems with phone visits is that each person requires individualized attention and some visits unexpectedly may take longer than others. We will make every effort to keep on schedule but at times we may be delayed.

Dr Lawrence Komer
Medical Director
The Komer Clinics

COVID-19 Annoucement | Office Updates

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Hormones are important throughout our lifetime. When we are young, they help us grow and mature into adults. They are partially responsible for how we look, how we act, and how we feel. In many ways, they also keep us healthy. We have already discussed the tremendous effect of restoring and maintaining healthy hormones, after a brain injury, or PTSD.

During our lifetime, there are three major health issues related to aging. These are heart disease and stroke, cancer, and brain aging, also known as neurodegeneration.
We have come a long way in defining the risk factors for heart disease. There are lifestyle choices we can make to reduce these risks. We are much better at preventing heart disease by treating high blood pressure, high cholesterol levels, and diabetes. There has been a tremendous push to eliminate smoking, which will lower the risk of heart attack. We are better at treating heart attacks to minimize death rates. Better cardiac rehab has led to further improvements.

As far as cancer goes, we have found ways of preventing it. We know that decreasing smoking is a preventive measure to reduce lung cancer. We have learned that reducing the spread of human papilloma virus (HPV) can diminish gynecologic cancers, particularly cervical cancer, as well as reduce the risk of other cancers, such as oral, and anal cancer. We now have vaccines that reduce HPV infection and lower the risk of certain cancer. Exercising more, not gaining weight, and drinking less alcohol can dramatically reduce breast cancer. Earlier cancer detection leads to a higher cure rate. Our success in eradicating cancer with surgery, chemotherapy, and radiotherapy improve every year.

The next big hurdle to maintain health, and minimize the effects of aging, is to reduce brain degeneration. Rates of Alzheimer’s disease and other dementias, as well as Parkinson’s disease, appear to be increasing.

Almost everyone fears that his or her brain will degenerate with age.

We know that traumatic brain injury raises the risk of Parkinson’s disease, later in life. Brain trauma can lead to chronic traumatic encephalopathy (CTE). The movie “Concussion” has quickly spread the news that athletes are more prone to CTE. This is a form of neurodegeneration that occurs earlier in life than other dementias.

What goes wrong in the brains of young people that cause a condition like CTE?

Why do some players get it in others do not?

How can we prevent it?

Athletes in collision sports have a much higher rate of concussions, and traumatic brain injury than athletes in none collision sports and in the general population. Brain injuries appear to be a risk factor for CTE. This appears to be a risk factor for CTE. These same individuals form one of the highest risk groups we see in the Masters Men’s Clinic. We have seen athletes as young as 18, who have extremely poor hormone levels.

We know that the restoration of these levels improves their function. We do not yet know if it slows the degenerative process. However, science suggests that this may be the case. Here are some other important facts.

Almost all aging is a combination of inflammation, reduced blood supply, and in some cases, the accumulation of toxic substances.

For example, in Alzheimer’s disease, there is the development of “plaques” which are numerous, tiny, dense deposits scattered throughout the brain that becomes toxic to brain cells at excessive levels. These “tangles” interfere with vital processes, eventually choking off living cells. When brain cells degenerate, the brain markedly shrinks in some regions.

“Plaques” form when protein pieces, called beta amyloid, are clumped together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells. Beta-amyloid is chemically “sticky,” and can gradually build up into plaques. The plaques may block cell-to-cell signaling. They may also activate immune-system cells, which trigger inflammation, and devour disabled cells.
“Tangles” destroy a vital cell transport system made of proteins. The transport system is organized in orderly parallel strands, somewhat like railroad tracks. Food molecules, cell parts, and other key materials travel along these tracks. Protein called “tau protein” help keep the tracks straight. In areas where tangles are forming, tau protein collapses into twisted strands, called “tangles.” The tracks can no longer stay straight.

They fall apart and disintegrate. Nutrients and other essential supplies can no longer move through the cells, which eventually die.

Plaques and tangles tend to spread through the brain into the predictable patterns in Alzheimer’s Disease. The early changes of Alzheimer’s disease may begin 20 years before diagnosis is made. Mild to moderate Alzheimer’s disease generally lasts 2 to 10 years. Advanced Alzheimer’s disease may last from one to five years and is fatal.
The latest studies show that the tau protein accumulation leads to cell death and is the main problem with Alzheimer’s disease. Inflammation is also part of the process.
Our original question was, “Can this degeneration be prevented?”

One of the problems with brain degeneration is decreasing blood supply. We know that certain things increase blood supply. One of them is exercise. Therefore, lifelong exercise is critical. We know that for women in menopause, blood flow to the brain drops 30%. Restoration of estrogen restores blood supply to the brain. There are studies that show that estrogen replacement also reduces Alzheimer’s disease. This is not surprising, since one of the other properties of estrogen is that it is a good anti-inflammatory in the brain.

In the clinic, we have also learned that like estrogen, testosterone in men is a good vasodilator (increases blood supply.) It is also a strong anti-inflammatory. From a scientific point of view, it would seem that restoration of these hormones for a lifetime is critical in preventing neurodegeneration.

Another important fact is that both Vitamin D, and Omega-3 fish oils in high doses, are potent brain anti-inflammatories. I use both of these in the immediate treatment of concussion, and for post-concussion syndrome, since it is felt that part of the concussion process is brain inflammation.

We know that the PDE-5 inhibitors such as Cialis, Viagra, and Levitra increase blood flow, not only to the penis, but also to many other areas within the body, including the heart and brain. Spasm, or closing of blood vessels, occurs following concussions, and leads to decreased oxygen supply. Can these potent drugs help both the acute concussion, and post-concussion syndrome? Will these drugs be helpful for maintaining healthy brain function for a lifetime? We have already seen indications that low-dose daily Cialis may reduce heart attack and stroke, as well as
reduce prostate cancer rates. In time, we may see proof that these drugs are helpful in concussion and TBI and may also slow neurodegeneration.

There is exciting new information suggesting that a highly absorbable form of magnesium called magnesium-L-threonate, crosses the blood brain barrier and may reverse neurodegeneration. This substance seems to be very helpful in improving memory, which is often a feature of concussion, and TBI.

It appears that many of the treatments we use for post-concussion symptoms could work in healthy brains to continue to keep them vital throughout a lifetime.
We are learning how existing medications might be applied in new and
different ways to combat neurodegeneration. The same substances which
are helpful with TBI, and post-concussion syndrome, might also be beneficial in preventing or treating Alzheimer’s disease.

There indeed is New Hope!

Phone: 905-639-2571
Fax: 905-639-7647
Cedar Springs Medical Professional Centre 960 Cumberland Ave. Suite E
Burlington, ON Canada L7N 3J6