National Advisory Committee on Immunization

If you choose not to vaccinate

Rourke Baby Record Information for Parents

Meningitis B (Meningococcal Serogroup B (4CMenB) Vaccine) information

Ontario’s Routine Immunization Schedule


For patients with diabetes, your health provider encourages you to have a flu shot every year and to have a ” pneumonia” shot (Pneumovax) .    If you are not sure about these shots, ask us to review your chart to ensure you are up to date.

How many of you have had a Hepatitis B shot??  Adults with diabetes are more at risk of this liver disease.  Because your immune system is busy fighting diabetes, you could have more difficulty fighting this viral infection. Hepatitis B is spread through blood born transmission. Inadequate sterilization of medical instruments is an example of how this exposure could occur, perhaps while obtaining health care during travel.

Your liver is an important organ for detoxification and breaks down some medications. Protect your liver and consider getting  a vaccine .  Hepatitis A is spread fecal -oral route. It can be caught at salad bars with improperly washed vegetables or during travel, when we depend on workers to wash their hands during food preparation.

There are combined (Hepatitis A & B) and  single vaccines for Hepatitis B. Most private insurance plans will cover these shots. Be proactive and let us know if you are interested.  A prescription can be generated once a review is made of your chart and an appointment can be made with the registered nurse.


OHIP and Uninsured Services

The Ontario Health Insurance Plan (OHIP) pays for medically necessary services provided to patients seen in the office/hospital etc. You may require some services that are not insured by OHIP – these are considered Uninsured Services. Examples include, but are not limited to:
  • travel advice and travel immunization
  • telephone prescription renewals
  • telephone consultation – phone advice from a physician at the request of a patient to discuss symptoms or concerns, request advice, or seek treatment
  • missed/cancelled appointments – appointments which are missed or not cancelled with 24 hours notice
  • transfer of records
  • drivers physicals
  • employment physicals
  • children’s camp physicals
  • newborn circumcision
  • removal of some moles/cysts
  • ear piercing
  • completion of forms including sick notes and certificates
  • medical-legal correspondence


Please be advised: there is a $15.00 charge to authorize prescriptions by either phone or fax.

For any questions, comments or concerns please

The schedule of fees for uninsured services is set by the Ontario Medical Association. For your convenience, services not covered by OHIP can be paid for by cash, debit/Interac, MasterCard or VISA.

Looking after your feet in during the winter months

My name is Shirley and I am the Chiropodist (foot specialist) at the Markham Family Health Team. Looking after your feet is a very important part of diabetes care.

It’s the middle of winter. Skin care is very important as the weather is drier and colder. Just like you apply a moisturizer on your hands, you should remember to apply moisturizer to your feet at least once daily. By applying a moisturizer to your feet daily, you will help to prevent fissures (cracks or grooves) from occurring on your skin. This is especially important for people with diabetes to help prevent skin infections that can come from bacteria entering small breaks in your skin.

—Shirley Cheung, D.Ch.

Clothesline Campaign and a chance to WIN!

Looking to declutter? Or have clothes that don’t fit anymore (thanks to all the exercising you are doing:) Well here’s an opportunity to donate gently used clothing and also have a chance to WIN A VACATION!!!

Are you intrigued? If so, visit the CDAs website and follow the link:

It will explain all the details of the campaign and how to schedule pick up/drop off.


Don’t wait, deadline is March 31st, 2015!


Sheetal Desai, Pharmacist, Diabetes Educator

The diabetes care that is right for you

Driving to work I heard a blurb on diabetes on CBC radio (Diabetes Clip on CBC Radio). It talked about individualizing approach to chronic disease. Most of you on this blog are too young for the relaxation of targets for your A1C that they describe. However, it’s important to let your health provider know what you want to focus on in managing your disease or what concerns you. Becoming your own expert is key to self management.


—Sheri Devereaux, Nurse Practitioner

Small steps towards better health

I saw this in the Running Room magazine for January.  It was written by Tara Postnikoff , a registered nutritional consultant  on page 35 in her monthly column “Ask A Nutritionist”. The article is geared for runners but most of the suggestions would apply to all of us.  I will let Andrea, our expert dietitian, jump in with diabetes specific concerns.

I liked how she said nutrition is not “all or nothing”…..Just because you get sick and miss a day of work, that doesn’t mean you resign from your job.  Same goes for our nutrition goals.
I have put her 20 things to try in 2015 on my fridge as a daily reminder for myself.  The link for the full article can be found here: Ask A Nutritionist Article in Running Room Magazine
For quicker access, I will re-type the list here:
20 things to do in 2015:
-Drink more water
-Eat out less
-Eat more vegetables
-Reduce caffeine intake
-Choose a new food to try
-Have protein with every meal
-Reduce consumption of processed and packaged foods
-Take your supplements daily or as recommended by your health provider
-Stop eating when you are no longer hungry (vs. when you are full)
-Focus on FOOD QUALITY not quantity
-Get more sleep
-Consume breakfast daily
-Bring your lunch to work (it’s easy if you plan leftovers)
-Drink less alcohol
-Eat healthy fats like avocado, nuts, seeds, coconut oil & olive oil
-Reduce consumption of refined grains and flour products
-Fuel workouts appropriately
-Chew your food more
-Don’t eat in front of the computer, or the TV, or while driving
-Don’t eat a large meal right before bed
—Sheri Devereaux, Nurse Practitioner

Flavourful holiday recipes to lighten up your meals!

Here are some tasty side dishes to consider rather than the usuals.


Balsamic Roasted Squash and Root Vegetables:

Great option instead of mashed potatoes or a sweet potato casserole.  The flavour of the balsamic vinegar with the vegetables is sweet and tangy–delicious! Leftovers are great added to a salad of spinach with feta cheese and a balsamic vinegar dressing.


1 butternut squash, peeled and cut into 1 inch cubes (or 1-2 packages pre cut butternut squash)

4 Parsnips, peeled and cut into 1/2 inch chunks

4 medium carrots, peeled and cut into 1/2 inch chunks

1/3 cup balsamic vinegar

4 tbsp canola oil

salt and pepper


Preheat oven to 425F

Mix all ingredients together into an oven proof glass dish.

Roast in oven until tender, about 30-45 minutes, stirring once or twice while cooking.


Kale and Brussels Sprouts Salad (from

Even if you don’t love Brussels Sprouts, you will love this salad.  It’s been a big hit with all of my family, and even some co-workers who were not big fans of Brussels sprouts.


1/4 cup fresh lemon juice
2 tablespoons Dijon mustard
1 tablespoon minced shallot
1 small garlic clove, finely grated
1/4 teaspoon kosher salt plus more for seasoning
Freshly ground black pepper
2 large bunches of Tuscan kale (about 1 1/2 pounds total), center stem discarded, leaves thinly sliced
12 ounces brussels sprouts, trimmed, finely grated or shredded with a knife
1/2 cup extra-virgin olive oil, divided
1/3 cup almonds with skins, coarsely chopped
1 cup finely grated Pecorino


Combine lemon juice, Dijon mustard, shallot, garlic, 1/4 teaspoon salt, and a pinch of pepper in a small bowl. Stir to blend; set aside to let flavors meld. Mix thinly sliced kale and shredded brussels sprouts in a large bowl.

Measure 1/2 cup oil into a cup. Spoon 1 tablespoon oil from cup into a small skillet; heat oil over medium-high heat. Add almonds to skillet and stir frequently until golden brown in spots, about 2 minutes. Transfer nuts to a paper towel–lined plate. Sprinkle almonds lightly with salt.

Slowly whisk remaining olive oil in cup into lemon-juice mixture. Season dressing to taste with salt and pepper. DO AHEAD: Dressing, kale mixture, and toasted almonds can be prepared 8 hours ahead. Cover dressing and kale mixture separately and chill. Cover almonds and let stand at room temperature.

Add dressing and cheese to kale mixture; toss to coat. Season lightly with salt and pepper. Garnish with almonds.

Barley and Pomegranate Salad

A great side dish that can be made ahead of time–a nice light option with great flavours and colour.  A great option to take to potlucks!


1 cup pearl barley
6 celery sticks (leaves picked and reserved), cut into small dice
4 tbsp olive oil
3 tbsp sherry vinegar
2 small garlic cloves, crushed
2/3 tsp ground allspice
3 tbsp chopped dill
3 tbsp chopped parsley
300g pomegranate seeds (2 large pomegranates)
salt and black pepper


1. Rinse barley with cold water, the place in a medium saucepan and cover with plenty of water. Simmer for 30-35 minutes until tender, but still al dente.
2. Drain, and transfer to mixing bowl. While hot add all ingredients except for dill, parsley and pomegranate seeds which are to be added when cold


Happy Holidays and Happy Eating!

Farewell Ramona!

Mona - Collage

After 42 years of  Nursing and a long dedicated career with Markham Family Physicians and Markham Family Health Team, our Lead Nurse Ramona has decided it is time to retire.

Her family is putting together a Book of Memories highlighting her career over the years and we thought that since she has cared for so many generations of our patients, some families might like to write her a little message that would be included in this book.

If you would like to let her know how much you value the care she has provided to both you and your family over the years, please go to our website, go to Blog and choose Farewell Ramona. Please enter your name and email address (required fields) and then enter your comment and Post Comment. It is as simple as that. We promise to pass along your kind words to her family.

We ask that you help us keep this a secret until it is ready to present to her.

Mona has always been such a vital part of the day to day operations of this practice. It is hard to imagine not seeing her every day but one thing we all agree on…..she has most certainly earned some rest and relaxation.

Assess your Diabetes and Pre-Diabetes Risk

This post is for those who have not yet been diagnosed with diabetes–so you may be pre-diabetic, or have been told that your sugars are a little high.  Maybe your sugar levels are fine, but you want to check in with your health and see whether you are at risk of developing diabetes.  Maybe you are concerned about a friend or a family member and their risk for developing diabetes (especially if there is a family history).  Whatever the case, there is a handy website to visit that will help you to assess your risk of developing pre-diabetes and/or diabetes in your lifetime.

Go to this website and complete the CANRISK test (see the green box):

Don’t Be Risky

Completing the survey can help you to know if you are at risk for developing diabetes.  This knowledge can help you consider making lifestyle changes that can make you happier and healthier for longer–for example, eating more vegetables, reducing your portion sizes, quitting smoking or moving your body more.  Did you know that a 5% reduction in your weight can reduce the risk of progression from pre-diabetes to diabetes by 60% (1)–that’s huge!  Keep in mind, that for someone who weighs 200 lbs, a 5% weight loss means losing 10lbs.  This does not need to be done in the next month as even a gradual reduction over a year will pay off with big health benefits!  To help make this happen, you could skip the can of regular pop in the day, reduce the amount of cream and sugar used in your coffee, skip an evening snack if you’re not actually hungry!

The more we know about our health, our bodies and healthy behaviours, the more power we have to change our lives.  Take the test!  Send it to your loved ones!  If you have any questions about the test or the results, or if you want help with making lifestyle changes, talk to your healthcare provider or your diabetes team–support can make all the difference!




1. Ransom T, Goldenberg R, Mikalachki A et al.  Reducing the Risk of Developing Diabetes.  Can J Diabetes:2013; 37 (suppl 1): S16-S19.

Nov 5th – Diabetes Educator Day!

November 5th is Diabetes Educator Day!


Certified Diabetes Educator (CDE)®  is a health professional, committed to excellence in diabetes education and who has a sound knowledge base in diabetes care/management and education processes, as well as good communication skills and who has passed the Canadian Diabetes Educator’s Certification Board (CDECB) exam.

At the Markham Family Health Team you are lucky to have two CDE’s working at the practice, myself, Sheetal (Clinical Pharmacist) and Andrea (Registered Dietitian). We each have our own areas of expertise but overall have a good command of diabetes care and management.  We often like to see patients together so that we can provide the most comprehensive approach to diabetes care and with the help of our diabetes team which includes doctors, nurse practitioners, nurses, chiropodist, and social workers you can pretty much get all your diabetes needs met here at the practice. Keep in mind however that diabetes care can extend even beyond our walls. As a patient you may be referred to a Diabetes Education Centre (DEC), LMC clinic, endocrinologist and/or nephrologist. You may also get diabetes care through your community pharmacist. It can get confusing with all the different players that may be involved but keep in mind the most important is you!

Here are a few tips that I recommend to patients to get the most out of their diabetes care; (and a few documents to get you on your way!)

1. Be prepared for your visits.

2. Know your targets, goals and results.

3. Know your diabetes team.

4. Write things down!