How to Read the Flow Sheet

Kristy from ultrasound and myself (Nurse Judy) are going to try to demystify the flow sheet everyone is able to access. This blog will help explain the investigative cycle monitoring. If you have any questions, please don’t hesitate to send me a message, phone or email any of the nurses for Dr. Campanaro. Kristy’s blog follows mine and will explain the columns that I haven’t.

Under the endometrium column, ultrasound measures the thickness of the endometrial lining. It’s this lining you shed every month, with your menstruation when you aren’t pregnant and is the lining a fertilized egg implants when you are pregnant. The lining increases in thickness as you get closer to ovulation to prepare the lining for a potential pregnancy.

The column under (ut art avg PI) measures the resistance to flow of the uterine artery, that feeds blood to the uterus. We like to see the measurement less than 3. If it is greater than 3 there might be less blood flow to the uterus which may cause the endometrial lining to be affected for implantation of a fertilized egg. The doctor will discuss treatment for this if the value continues to be greater than 3.

Right and Left Side Follicle columns show the number of follicles each ovary has that have the potential to becoming a mature follicle. These numbers can change with each cycle. Normally, you will only have one follicle grow with a maturing egg inside. The significance of the number seen on CD3 can be discussed with the doctor or nurse. When you return on CD9 a follicle should be measurable. This is variable, depending on the length of your cycle between periods. The follicle tends to grow, between 0.1 and 0.2cms daily. Again this is variable and will be discussed at your review appointment with the doctor.

Oocytes (eggs) are too small for ultrasound to see. The blood work we draw every day determines the presence and therefore, growth of the egg inside it. LH or luteinizing hormone matures the follicle and when that value doubles, an egg matures and within 36 -42 hours the egg is released.

FSH or follicle stimulating hormone stimulates the ovaries to produce oocytes. We like to see the level at less than 10 on CD3. Results will be reviewed by the doctor once your cycle monitoring is complete.

E2 is estradiol. This is a form of estrogen produced by the follicle. This level can indicate egg quality. The level will rise as you get closer to ovulation, then drop once ovulation has occurred. If you are pregnant the level will rise again and stay elevated. If you aren’t pregnant, the level will continue to drop which will begin another menstrual cycle.

Progesterone is the hormone responsible for preparing the lining of the uterus for implantation of the embryo. The level increases after ovulation and like estrogen will drop if you aren’t pregnant, thus bringing on your next menstrual cycle.

Prolactin is the hormone responsible for lactation when a mother is breastfeeding her infant. It stays elevated while breastfeeding and is nature’s way of preventing another pregnancy too soon. Occasionally it is elevated for reasons such as stress. This can sometimes affect ovulation. Treatment would be discussed with you at your review with the doctor.

Kristy's Blog

Endometrial Echo (echotexture)

The endometrial echotexture refers to the brightness of the endometrium (uterine lining) relative to its surrounding tissues (ie. the uterus). We use three terms to describe the echotexture:

• Hyper-echoic is the term used when the endometrium is brighter than its surrounding tissues.
• Hypo-echoic is the term used when the endometrium is darker than its surrounding tissues.
• Iso-echoic is the term used when the endometrium is the same brightness as its surrounding tissues.

Early in the cycle the endometrium appears thin and bright or hyper-echoic, as a cycle approaches ovulation the outer edges of the lining become more hypo-echoic and the inner edge closest to the cavity remains hyper-echoic. After ovulation the endometrium becomes uniformly hypo-echoic or iso-echoic as it prepares to be sloughed off.

We can relate the appearance of the endometrium with other factors throughout the cycle to determine whether or not the appearance is typical at each stage of the cycle.

Endometrial Contraction

At different stages of a cycle we may notice the endometrium contracting in different ways. Earlier in the cycle the lining will contract from the cervix all the way to the top of the uterus, or uterine fundus. This type of movement will draw the sperm in from the cervix and help them travel up toward the fundus of the uterus and out the fallopian tubes. We may also notice the endometrium moving back and forth or “to and fro” as it prepares for implantation. If a pregnancy does not occur the endometrium tends to flow from the fundus toward the cervix as it prepares to be sloughed off.

Free Fluid

Free fluid refers to fluid that is outside of the organs but still remains inside the pelvis. A small amount of fluid in the pelvis can be normal; however it has been documented that when ovulation occurs a larger amount of fluid can be seen. This is because when the follicle ruptures, the fluid from inside leaks out and accumulates in the pelvis. We document this finding as it can sometimes be helpful when trying to determine if ovulation has occurred.

IVF Funding And What It Means for Me

By: Kayla Perkel

As the prospect of funding of IVF comes closer to reality, you may be left with questions of who, what, where, when, and why? Ontario has made the decision to fund In Vitro Fertilization field by soon offering one round of IVF, covered by tax-payer dollars, to families seeking to start/build a family but are facing infertility or are an individual, same-sex couple, etc. While exact details have yet to emerge (likely because our politicians like to drag their heels), what we do know is that:

But there is a catch (why is there always a catch?!)

Patients will only be eligible for the new IVF program:

For more information on infertility, awareness, forums, discussion, etc., please visit the Infertility Awareness Association of Canada to start the conversation.

Software for your Hardware (May 20, 2015)

By: Julie Ditzend

If you could do just one thing to reduce stress, increase energy and concentration, mood, fertility…AND IT’S FREE. Would you do it?

Sleep. Yes, sleep.

Lack of sleep has become the norm. Ask yourself right now, “do I even have any idea what well rested feels like?” Why is sleep important? What are the risks?

When we sleep, our bodies are busy repairing cells and regulating hormones among other processes. Sleep increases cognitive function. Without it, we’re prone to making mistakes and having accidents. Lack of sleep affects mood (low serotonin levels) and increases stress (higher cortisol levels). This is the time the immune system is regenerated, keeping the body healthy. The king/queen of hormones, leptin, is secreted during proper sleep. Leptin is a key link between sleep and fertility. When leptin production is compromised, menstrual cycles, including ovulation are disrupted. For males, this also includes sperm motility and quality. Did you know that sperm count can drop for 3-4 months after illness? A well-rested body fends off illnesses!

Hopefully this has given you a clear picture of the importance of a good night sleep. Now, I’d like to throw you a mixed bag of tricks to increase your odds of successful rest. Let’s aim for 8 hours!

• Avoid the use of computers and tablets within three hours of bedtime. This includes any type of e-reader or tablet
• Using blackout shades to make your bedroom as dark as possible
• Increase your exposure to sunlight early in the morning and dim house lights in the evening. We want to restore natural wake/sleep cycle
• Get moving! Make it a goal to exercise a half hour each day, a stroll outside is perfect!
• Limit caffeine and other stimulants after noon hour
• The evening is a great time to practise relaxing techniques such as meditation
• Studies show listening to Classical music affects brain waves in a very calming way. Try tuning in after a busy day for a half hour before retiring
  
  

  Make a good night’s sleep a priority and reap the many benefits; both health and performance!

  
  

  References:

  
  

  American Journal of Epidemiology, Kold, T Jensen, et al. Association of Sleep Disturbances With Reduced Semen Quality. May 13, 2013.
  American Society for Reproductive Medicine: Stress and Infertility
  Americas Biggest Problem, Dr. Kirk Parsley.
  Wolf, Robb. The Paleo Solution, 2010.
  Poloquin, Charles. A Simple Trick to Improve Your Sleep. May 12, 2015.

  
  

  Roger the out of shape Blogger (April 21, 2015)

  KARMA started off fifteen years ago with three doctors sharing a single office. We still share space, but now the clinic extends over all four floors of the building, and includes not only the doctors’ offices but a fully equipped operating room, an embryology laboratory, numerous ultrasound rooms and facilities for its nurses, counsellors, administrators, technical, laboratory and clerical staff. With increasing size and complexity comes increasing challenges, not the least of which is that when there are so many more people now spread over so much space, how do we maintain the original spirit of a closely coordinated and mutually supportive team? This is the point in my blog where Julie comes in.

  
  

  A few months ago, Julie stopped by KARMA one day and dropped off her resume. She had been working as a coordinator of a local bicycle riding club. She had done some medically related work in the past but in recent years had devoted herself to serving the club in its membership by coordinating its activities and managing its social media. She had also been through a personal journey in which her life had been transformed with the help of nutrition and exercise, and she wanted to help others do the same. We hired her right away.

  
  

  When I told Julie that the KARMA staff might benefit from some “team building” experiences, she said she had just the right thing in mind. So on a chilly but sunny day in March, we all met at her gym, where for most of the afternoon, “Murph” (one of her trainers) had us running, jumping, rowing, and doing ‘burpees’ (I will get back to this later), basically pushing each of us to do better with every new challenge. Being the oldest, I figured that Murph would go easy on me, but in his first activity, he made it clear there were no favourites. He had us running around holding pizza boxes in the palm of one hand, while everyone else tried to knock the box onto the floor. I thought that, as the guy who signs the paychecks, I would be immune from attack, but my staff and co-workers came out of nowhere to knock my pizza box onto the floor, with Murph demanding that I do five pushups as a penalty for dropping mine. He demonstrated technique for us, he timed us, he took us from one task to another, correcting what we weren’t doing properly, praising those who got it right and urging all of us to try to do better. And if it hadn’t been for the accursed “burpee” (if you’ve ever done one, you know what know what I’m talking about. If you haven’t check out: How to do a burpee. I was definitely getting tired, but just as I was about to give up, I looked up and saw that Thea (one of our sonographers), who had just given birth only 3½ weeks earlier, had joined in and was keeping up with the rest of us (and way ahead of me). Coming to this event while she was on maternity leave from work, and bringing her baby with her not only inspired me to try harder, but also provided the excuse I so badly needed to take a break. While she and the rest of the KARMA team got pushed through more of Murph’s paces, I babysat baby Lincoln and rocked him in his pram for a while. Then after a few more of those awful Burpees, mercifully, our session came to an end, and we cooled down with lots of water and a few yummy but ever so healthy snacks Julie and others had brought.

  
  

  For the next couple of days, it took me about a half hour to get myself out of bed, and after all the rowing action, I couldn’t raise my arms over my head for at least a week. Happily for me, I was not the only one suffering, but the aches and pains were more than compensated for by the fact that everyone who came that day had a great time, and I think they felt better about themselves and closer to their workmates for having put in the time and effort. In fact, Kristy (another sonographer), who was fearful for the whole before that we might all be murdered that day, was so pumped up afterward that she has been talking about signing up for more!

  
  

  I’m proud and thankful to be a member of KARMA’s team. Creating a team is fairly easy. Creating a great team is hard and keeping up the commitment and mutual support over so many years is even harder. Team building is definitely a works in progress, but a big thanks goes out to Julie for the part she played in what was a very good day…a day on which I felt more part of the team for having participated, as I hope we all did. For me, it was sad for that day to end, except for one thing of course……that day, I did my first ever and certainly my last ever…Burpee.

  
  

  Why take Vitamin D and Omega 3s (Essential Fatty Acids)? (February 19, 2015)

  The effects of Vitamin D (sunshine vitamin) deficiency have been emerging study after study over the past decade. Not only are Canadians spending more time inside, but we are also slathering on sunscreen to prevent the harmful affects of sun exposure. Hence the need for supplementing this critical component of overall health.

  
  

  Vitamin D’s most important role is to keep our bones healthy and strong by helping the body absorb calcium from our dietary intake. Recent research has also demonstrated additional ways that Vitamin D deficiency factors into our overall health. It moderates immune function and it’s also critical in: fat metabolism, cancer and cardiovascular disease prevention.

  
  

  In the world of reproduction, Vitamin D acts on more than 1000 different genes and serves as a pathway for hormones such as testosterone and estrogen. The active form of Vitamin D (calcitriol) has many roles in female reproduction. For example: the uterine lining produces calcitriol as an embryo enters the uterine cavity. Calcitriol controls several genes involved in embryo implantation. Many reproductive diseases have been linked to low Vitamin D levels. For males, Vitamin D plays an important role in the maturation, appearance and motility of sperm. Vitamin D is a fat soluble vitamin and therefore must be taken with a fat to be absorbed. (coconut oil, nuts, peanut butter etc.)

  
  

  A healthy balance of Essential Fatty Acids in your diet can provide many benefits. EFA’s are deemed essential as they cannot be produced by the body, and must therefore obtained through diet. An ideal ratio of Omega 6 to Omega 3 fatty acids is between 1:1 and 4:1. Today’s traditional North American diet, the ratio is between 10:1 and 25:1. What does this mean for overall health? Many studies believe it causes high levels of inflammation, to blame for the rise of chronic conditions such as: obesity, type 2 diabetes, depression, autoimmune diseases and reproductive issues. By eating a well balanced diet and supplementing with Omega 3s, we are restoring proper systemic functions, which can aid fertility.

  
  

  The research is compelling, implicating Vitamin D and Omega 3s as crucial players in not only aiding fertility, but overall health.

  
  

  We at KARMA are proud to offer on-site nutrition and lifestyle consulting to our patients.

  
  

  References:

  • European Journal of Endocrinolocrinology, Vitamin D and fertility: a systematic review, 2012.
  • ASRM2011:Improving fertility through nutritional medicine, October 19, 2011.

  Please contact Julie via jditzend.karma.ivf@gmail.com

  
  

  Nutrition and Lifestyle Counselling (January 15, 2015)

  Julie Ditzend is currently studying the Primal Blueprint Expert Certification program. She has also been certified in numerous CrossFit programs, including Paleo Nutrition with Robb Wolf.

  
  

  She has lived a life of obesity up until 2008 when she took control of her health and well being. She has competed in CrossFit, successfully qualifying for Nationals. Julie is currently a competitive PowerLifter with several meet wins under her belt.

  
  

  In the warmer months, Julie is highly involved with the Waterloo Cycling Club as a Board of Directors member and group ride leader.

  
  

  She has had the privilege of training with extremely high level athletes of many disciplines. Through her successes, Julie continues to inspire many whom she crosses paths.

  
  

  Julie believes that real food is the key to optimal health and performance. She is a firm believer in and advocate of The Primal Diet. The Primal eating style has the ability to increase quality of life. She has observed its effects on health and performance not only in numerous friends and acquaintances, but also as an athlete herself.

  
  

  Julie understands that everyone has unique needs and responds differently to diet. Her nutrition plans and counselling techniques are tailored to meet individual needs, schedules and lifestyles. She will do everything she can to help you reach your full potential!

  
  

  Please contact Julie via jditzend.karma.ivf@gmail.com

  
  Initial Consultation - 1 hour
  • Review and evaluation of your current diet
  • Suggestions to improve or modify it to help you meet your goals
  • Includes a flexible, easy to implement meal plan that can be tailored to fit your preferences
  • You will also receive a helpful information guide detailing how to use the plan and some great, simple recipes to get you started
  • How to implement exercise and stress reducing strategies
  • Email support during business hours
  Follow Up Visit(s) - 30 minutes
  • Help you stay on track and keep going!
  • Review of any concerns
  • Email support during business hours

   

  New Clinic Start Times (July 23, 2014)

  Hello everyone, I hope you are all enjoying our new start times for cycle monitoring. Just a reminder we start at 7:00am Monday to Friday and start 7:30am on weekends and stat holidays.

  
  

  We strive to do our best to accommodate times for ultrasound that are convenient for you. However, sometimes due to scheduling it is impossible to accommodate everyone.

   

  Staffing on weekends are minimal and booking times may change as the clinic is open only for cycle monitoring. We will try to give you notice as soon as possible if there are changes in your times. Please check your answering machines for any messages we may have left you. Also please update contact numbers if there have been changes.

   

  If you have any questions or comments about your bookings please address the nurse by calling her at 519 570-0090x226 or by email at judyr@karmaobgyn.com.

   

  Thank you for your understanding,

   

  Judy Renwick, RN

   

   

  Roger the Olympic Blogger 4 (Feb 19, 2014)

  The Olympic Games are in full swing, and our athletes are once again giving us that sense of pride that comes with international recognition of excellence. It is truly amazing that at every Olympics that I can remember, Canadians have always won medals, despite being up against countries with much larger populations and deeper pockets. It says a lot about us. We are known as a people who are collectively quiet and polite, but we will speak up loud and clear whenever we are called upon to do so. If there is a job worth doing, we work diligently and put in whatever it takes in time and effort to get it done well. We excel when our motivation it to improve. We do not fear competition but embrace it, using it to make ourselves, our communities and our country stronger and better.

   

  At lunch one day last week, I walked into the patient holding area at Karma's IVF lab, I saw that everyone was huddled around their laptops and smart phones watching Olympic silver medalist Patrick Chan skate his long program. One of the staff, Rachael (our OR nurse) seemed to know a lot about the various jumps, twists and turns that he was performing. When I asked why, I learned that she had been involved in training and competing in women's figure skating for many years. And it struck me that having put in all the time, training and hard work to make the slow and often painful progress that competitive figure skating demands, no wonder she was so good at her job. After all, that's what it takes to excel, not only in figure skating but just about anything worthwhile, and especially so in women's health care.

   

  It was a little over a year ago when the KARMA's doctors were invited to meet a group of people who operate an infertility centre in the Golden Horseshoe region. They let us know that they and other groups planned to open their own infertility clinic in Kitchener, and encouraged us to join them. When I asked them why they were opening up a clinic here when they already had one in their own city, their answer was that they "want to bring high quality infertility services to the region". Really? Patients don't ovulate only on weekdays, so why aren't they open 7 days a week, like KARMA? Sometimes the patients need services that only a hospital provides. All of KARMA's gynecologists are on staff at Grand River, but why can't their doctors admit patients to our hospitals? And why do their patients have to travel to another city to get testing that KARMA provides on site? Bringing "high quality infertility services to the region" is what Rachael, and all of us at KARMA do every single day. That's why KARMA enjoys a reputation for excellence, not just locally, but even in the university centres, such as McMaster, Western and the U of T.

   

  So I don't believe for one minute that the answer I got from these guys was an honest one. In my opinion, their motivation for coming to town was more about them trying to deal with increasing competition (like Boston IVF) for a shrinking patient population in their own town, than concern for the quality of services available to the infertility patients of Kitchener/Waterloo region. For them, it's more about profit than quality. They talked about 'collaboration' on the one hand but tried to intimidate us on the other, by warning us that a steamroller was coming to town, and we could choose to either climb on board or get rolled over. The other KARMA doctors showed amazing restraint with this attitude, and although I wanted to get up and leave (or do something even more impolite), they continued to listen attentively and quietly, and eventually responded by saying effectively 'Thanks, but no thanks'.

   

  So when I think of all those young Canadians who have represented us in Sochi, I can't help but remind myself of why they put in all those hours of hard work in one of the most competitive arenas in the world......it certainly wasn't for financial gain. It came from their desire to be the best they can be, nothing more, nothing less. Karma has been serving the Tri-city area for over 15 years, and through the efforts of its doctors, nurses, technicians and clerical staff, it has earned a reputation for quality, success and excellence. Under the leadership of Dr Judy Campanaro, KARMA's fertility treatment team has become one of the most respected in the country, with more than 3,000 babies born so far to local couples who sought our help to fulfill their dreams for a family. That's more than 3,000 reasons the other clinics don't have. Are we afraid of competition? Absolutely not. We welcome it and look forward to showing the patients in our community how important they are to us and how we are different from the others. The real winners of this competition will not be KARMA or another group of doctors, but all the couples who will benefit from the efforts we all make to serve them better ñ better than we have in the past, and better than the other clinics in town. At KARMA, we will always strive to do better. That's our motivation.

   

  These days, it feels really good to be a Canadian, and I feel particularly good to be part of KARMA's team. Go Canada! Go KARMA!

   

  Roger the Blogger 3 (Aug 7, 2013)

  The President of the United States cannot stay in office more than four years without seeking the approval of the people. And so it is with KARMA's ultrasound clinic. Proclaimed in 1990, the Independent Health Facilities Act requires that in order to maintain their licenses, all diagnostic clinics in Ontario have to be assessed by the College of Physicians and Surgeons of Ontario once every 4 years. This means a review of literally everything we have in the clinic and everything we do each day ñ from making sure that all our doctors and sonographers are properly credentialed and up to date on their continuing education, to how we dispose of the trash. It takes weeks of work just to prepare for the inspection and with two of the College's most experienced and respected inspectors coming to take a look at us, I must admit that it was with some anxiety that we all welcomed them to Karma last week.

   

  We had done our homework, though. We reviewed and up-dated all our written policies, made sure all our documentation was current, went over the questionnaires we had received from our patients and referring doctors and even conducted a mock "inspection" just to make sure we were ready. But regardless of how much experience we have, how confident we are in what we do, or how prepared we are, it's still a nerve-racking experience to have someone look over your shoulder while you are doing your job, and even more so when that person has the authority to put you out of a job if they don't like what they see.

   

  Our assessors (Henry and Cathy) were exceptionally qualified and experienced professionals. They scrutinized our documents, inspected our premises, asked a lot of questions, and observed our procedures, turning over literally every leaf or stone they found. And at the end of the day, when they gave us a "wrap up" summary of their findings, they both concluded that our patients and care-givers are very well served at KARMA. All our staff contributed to this great outcome, but a special salute goes out to Melissa, Rachelle, Christine, Lorre, Karen, and Sandra. Well done, you guys. You were cool under pressure, and by doing your job the only way you know how, you exemplified the essence of what KARMA is all about. You are true professionals, and I couldn't be more proud of you.

   

  So what happens next? Well, with the College's stamp of approval, it would be tempting to just sit back and coast for a while. But the fact is that, just like at the White House or in Ottawa, the public is best served when the process of self-evaluation and improvement is continuous - and that's exactly why we will try to do better today, and each and every day until our next assessment. I'm so lucky to be part of this great team.

   

  Judy Renwick (July 2, 2013)

  Tips on making blood drawing easier

   

  No one likes to have blood drawn daily. It is sometimes quite painful and leaves "ugly" bruising. Here are some tips to help you ease through blood drawing more comfortably.

   

  1. Eat a good breakfast and drink plenty of water the day before and morning of blood testing. This causes veins to dilate and helps us find the best vein for venipuncture.

   

  2. Let us know if you are needle phobic or have fainted in the past. If we are able we will lay you down, especially if we have a number of blood tests to draw.

   

  3. Don't hold your breath. The best way to approach the procedure is to relax, sit up straight, look away from the needle or close your eyes and take slow breaths.

   

  4. Many people find talking throughout the procedure a means of distraction. Talk about the weather (we Canadians are always good at that). If you feel faint let us know and we will stop the procedure and lay you down.

   

  5. Hold the venipuncture site for 5 minutes to minimize bruising.

   

  6. Try using an EMLA patch found at pharmacy's as an over the counter local anaesthetic. Apply 15 minutes before your testing to the inside of the your elbow.

   

  Hope this is helpful. Any other suggestions are always welcome!

   

  Roger the Blogger 2 (June 3, 2013)

  “You can’t teach an old dog new tricks”, so they say. According to new regulations from the College of Physicians and Surgeons Ontario, all doctors and nurses who work in an operating room outside the hospital have to be certified in ‘advanced cardiac life support (ACLS)’. So it came as no surprise when Dr. Judy Campanaro asked if I would be attending the ACLS course she had recently organized at KARMA. Lots of us, including me, are certified in basic ‘CPR’, but the ACLS goes farther, and includes ECG interpretation and the emergency administration of very powerful drugs. While I stood there pondering my response, no doubt looking like a deer in the headlights, here were the thoughts going through my mind……..As an ultrasound specialist, I only infrequently go into the OR, and it’s unlikely that I would ever have to manage a situation calling for more than the basic course. Our building is filled with doctors and the hospital is right across the street, so qualified help is nearby. Plus, did I really want to spend a whole Saturday learning about ECG patterns and the latest drug treatments for acute cardiac problems? It has been such a long time since I wrote a prescription, let alone managed a critically ill patient. And the most honest of all……I’ll be the oldest one at the course. How will I feel if I get the answers wrong or ask a dumb question?

   

  So I thanked Dr. Judy for offering to include me, and gave her some of the reasons why I didn’t think I would be attending the course (I didn’t include the ones dealing with my insecurities, of course - after all, I do carry a Y chromosome – you know….the one which prevents us guys from asking strangers for directions when we get lost). But I had given my reasons and that was that. I thought I had sounded quite convincing. But she was neither convinced nor impressed, and for the next several days she reminded me of all the reasons why I should attend and complete the course, and none of them had to do with ultrasound, how often I go to the OR, or the chances of actually having to use what I learn, or the nearness of other doctors. And none had to do with age or ego. And in the end, I had no good reason not to go, so I studied the written material for the days leading up to the course, and there I was, on a lovely warm Saturday in May, along with my fellow KARMA doctors and nurses leaning over manikins in need of our ‘expert’ help, and whose ECGs and circumstances were dire (for the patient) and very scary (for me).

   

  And you know what? It was a great day. The instructor, Sarah was a patient, easy to talk to, very knowledgeable and very effective teacher. I was definitely the oldest student, and I’m sure I asked some dumb questions, but I learned lots, and even made a couple of good calls. And in the unlikely event that in the future, someone needs the kind of expertise I learned that day, I will be ready, willing and able to help. So I learned once again that some things are worth the effort, worth putting aside our egos and giving up some of our precious ‘down time’. And it also turns out you can indeed teach an old dog new tricks…..well, at least this old dog, anyway. Thanks Judy.

   

  Roger the Blogger (May 4, 2013)

  This is my first. It’s my debut as a blogger and the first blog for the new KARMA website. Advice from Google was that I should find a topic by looking at what’s happening right now at the clinic, and sure enough, that’s how I came up with one. From the moment we decided to expand our services, and as we get closer to opening, we have had to make lots and lots of choices, some easy, some not so easy, and it started me thinking about the process of decision making.

   

  I remember a time when making a choice was fairly simple….not necessarily easier, but simpler for sure. Buying a watch, for example – which brand? with a second hand or without? what colour face? metal or leather strap? But today, there is a dizzying array of choices for just about everything we want or need, and the process of choosing is made even more complicated because we can ask the opinion of just about anyone, anywhere in the world with just a few clicks of our smart phone.

   

  So when it comes right down to it, what prompts us to choose this or that? Many a Masters or PhD thesis has been written about this, and market and sales analysts make their living trying to find out. From the seller’s point of view, it is the features and functions, the bells and whistles that differentiate their service or product from that of their competition. But for me, it is the human factor that, in the end, tips the scale and helps me make up my mind. When the choices look similar, I go with whoever has convinced me that they are really trying to help, rather than really trying to sell. And that, I think, applies to a whole lot of choices besides which watch is the best watch for me.