SAVING LIVES, ONE INNOVATION AT A TIME

PIONEERING LESS INVASIVE CANCER SURGERY

HOW MEDICAL INVENTIONS A unique GET FROM support network for the most LAB TO vulnerable MARKETPLACE babies and their families RISE OF THE CARDIAC SURGERY ROBOTS

FALL | TWO THOUSAND AND FIFTEEN

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12 TARGETED APPROACHES IN CANCER CARE Sunnybrook’s pioneering work in less invasive ways of treating cancer is saving lives – and preserving quality of life.

16 STROKE OF GENIUS A new blood-clot-removal option is helping patients after life-threatening ischemic strokes.

20 PRECISE GUIDANCE Made-in-Ontario imaging devices seek to redefine the landscape of interventional cardiology.

107 Yorkminster Rd $4,395,000 14 Fairmeadow Ave $2,980,000 24 PREEMIES, PARENTS AND A SUPPORTING CAST In the Neonatal Intensive Care Unit, the support system caters to moms and dads, as well as their tiny newborns. SOLD SOLD

“ Minimally invasive treatment is not just a 18 Fifeshire Rd $6,998,000 98 Old Colony Rd $5,997,000 30 technique, it’s a philosophy of care at Sunnybrook.”

SOLD SOLD – Dr. Shady Ashamalla, surgical oncologist

28 HEARTS AND MINDS 40 A GOLD STANDARD Connecting the OF KIDNEY CARE dots between bipolar Already known for its 39 Old Yonge St $4,097,000 77 Northdale Rd $3,788,000 disorder and other high quality nephrology serious medical issues. care, Sunnybrook looks to the future with a new, 12 30 WHERE ARE state-of-the-art centre. THEY NOW? SOLD SOLD    Revisiting some of the 42 A FRESH START inspiring patients from FOR AT-RISK TEENS the first five years of A day program helps 5 WE ARE Sunnybrook Magazine. transition teens with SUNNYBROOK mental health issues get 35 THE back into high school. 46 RESEARCH GAME-CHANGER 76 Yorkminster Rd $3,695,000 92 Truman Rd $3,350,000 & INNOVATION How Dr. Laurence Klotz 44 PASSING MOMENTS changed the way doctors A gift made in a patient’s worldwide approach memory will help renew 48 prostate cancer treatment. our Palliative Care Unit. CALL FOR A COMPLIMENTARY MARKET EVALUATION OF YOUR HOME 38 THE AGE OF 48 THERAPIST ON ON THE COVER It takes a network of supportive health-care professionals to care for every NICU baby, including registered nurses and nurse practitioners, ROBOTIC SURGERY FOUR LEGS neonatologists, lactation consultants, respiratory therapists, dietitians, social workers, Computer-guided Meet Ivy, one of DIR: (416) 820-1020 pharmacists, clerical staff, physical and occupational therapists, radiologists, automation is at the cutting the hospital’s resident [email protected] ultrasound technicians and other specialists. PHOTOGRAPH BY TIM FRASER edge of heart surgery. therapy dogs.

Fall 2015 | Sunnybrook Magazine 1

DM151570_PgIFC_Sunnybrook_Fall_2015.indd 1 15-08-07 2:47 PM DM151570_Pg01_Sunnybrook_Fall_2015.indd 1 15-08-12 12:59 PM Mark AliassaFinal.indd 1 15-07-22 2:56 PM PUBLISHERS Craig DuHamel, Pamela Ross LORNE’S EDITOR-IN-CHIEF Simon Beck

ART DIRECTOR Frank Perito

DESIGNER Kamille Chin The Finest Fabrics in the FEATURE WRITERS Alexis Dobranowski, Marjo Johne, World, Made in Italy. Alisa Kim, Angela Pirisi

CONTRIBUTORS Laura Bristow, Natalie Chung-Sayers, Cloth Coats are Sewn Allison Dunfield, Augusta Dwyer, Precilla Edwards, Jennifer D. Foster, in a Factory in Toronto Sally Fur, Marlene Habib, Catalina Margulis, Monica Matys, Sybil Millar, Katherine Nazimek, Nadia Radovini, Making Finely Tailored Coats June Rogers, Katie Rook, Marie Sanderson Since 1948. EDITORIAL ASSISTANT Layne Davis PHOTOGRAPHY We’ve Been in the Fashion Tim Fraser, Doug Nicholson, Michelle Siu, Kevin Van Passen, Nation Wong District Since 1978. PRODUCTION MANAGER Michelle MacKay 3,000 Coats (for any Season) GLOBE EDGE Always in stock, Teena Poirier DIRECTOR, Sizes 0-24 and 36-52, CLIENT ENGAGEMENT & CUSTOM CONTENT GROUP

Sean Stanleigh Petite and Tall. MANAGING EDITOR, GLOBE CONTENT STUDIO

Liz Massicotte PROGRAM MANAGER, GLOBE EDGE Alterations, Sally Pirri DIRECTOR, PRODUCTION, THE GLOBE AND MAIL Change Lining, Isabelle Cabral Resizing and Repair. PRODUCTION CO-ORDINATOR, THE GLOBE AND MAIL

Sunnybrook Magazine is designed and produced by The Globe and Mail Custom Content Group on behalf of Sunnybrook.

25-40% OFF ALL CORRESPONDENCE Sunnybrook REGULAR PRICE 2075 Bayview Avenue, Suite D100 Lorne’s Coats ANTIQUE FURNITURE Toronto, Ontario M4N 3M5 [email protected] www.sunnybrook.ca 101 Spadina Ave. (at King) 29 Bermondsey Rd. Printed in Canada by (East of DVP & South of Eglinton East) tc • Transcontinental Printing Toronto 416-596-1058 Prepress by DM Digital+1. Mon-Sat 9-7 • Sun 10-6 416-690-5505 in partnership www.alfsantiques.com with

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 2 15-08-07 12:11 PM DM151570_Pg03_Sunnybrook_Fall_2015.indd 3 15-08-07 2:15 PM The outcome of Tiffany’s devastating faces of encounter with stroke was unimaginable. our staff and our community She survived. WE ARAREE SUSUNNYBNNYBROOK THE VETERAN Tiffany was 31 and pregnant when she had A HERO ON SEA a life-threatening stroke. AND ON LAND While she was in a coma, In the spring of 1942, just shy of 17 years Sunnybrook’s obstetrical of age and with the help of a phony letter of permission, Don Stewart enlisted in the team delivered her baby Royal Canadian Naval Volunteer Reserve. As a junior seaman and gunner, he by emergency C-section. spent three years on the defensively equipped merchant ships zigzagging Baby Clementine survived across the ocean, delivering food and supplies during the Second World War. only 10 days. Sunnybrook’s “Moving across the Atlantic Ocean, at only eight knots, we were sitting ducks for team of brain sciences the German U-boats,” says Mr. Stewart. Over a period of three years and 10 experts not only saved trips across the Atlantic, he saw more than 40 Allied ships sink. He took part in Tiffany’s life, but helped her the invasion of Italy and then was sent halfway across the world to the Ganges keep living. She gradually River in India. While based in Bombay, India, with re-learned to walk and talk. HMS Braganza, Mr. Stewart’s ship was torpedoed near Calcutta (now Kolkata), A year later, she is working India. He was taken prisoner for five again and contemplating months by the Japanese in Burma (now Myanmar). It was a time he’d rather having a child. Learn more forget. Mistakenly, his parents were notified about Sunnybrook’s Hurvitz that their son had died at sea. When Mr. Stewart returned two years later, Brain Sciences Program: he completely shocked his father, a policeman who was working at the train sunnybrook.ca/brain station. “He usually didn’t show much emotion, but that day he hugged me long and hard. I will never forget that feeling – there wasn’t much talking,” recalls Mr. Stewart. Today, as president of the Veterans & Community Residents Council, his focus is to do all that he can to enrich the lives of the veterans living at Sunnybrook, home to Canada’s largest veterans’ care facility. Originally from the Okanagan Valley in British Columbia, Mr. Stewart has been an active member of The Royal Canadian Legion for 69 years. He is the proud father of eight children, 15 grandchildren and three great-grandchildren.

Sally Fur PHOTOGRAPH BY DOUG NICHOLSON BY PHOTOGRAPH

Fall 2015 | Sunnybrook Magazine 5

SB16608_01_Tiffany_Globe.indd 1 2015-03-06 10:37 AM DM151418_Pg11_Sunnybrook_APR_2015.inddDM151570_Pg04_Sunnybrook_Fall_2015.indd 4 11 15-03-1115-08-07 11:04 2:48 PMAM DM151570_Pg05-48_Sunnybrook_Fall_2015.indd 5 15-08-10 4:25 PM SB16608_01_Tiffany_Globe 0 0 16608-01 4C Newspaper Ad 8.125” x 10.75” 100% JAW Globe & Mail 03/06/15 Sunnybrook Kendra 7.25” x 10”

PMS PMS PMS PMS PMS FOIL 8.375” x 11” 100% WE ARE SUNNYBROOK WE ARE SUNNYBROOK

THE NURSE THE COGNITIVE NEUROLOGIST A GOLD MEDAL A LOVE OF LEARNING Finding a balance between the demands of FOR CARING world-class research and patient care in a busy clinic is a challenge that Dr. Benjamin When the Pan Am/Parapan Am Lam welcomes with open arms. Games came to Toronto this summer, Originally from Hong Kong, Dr. Lam moved Sunnybrook emergency department to London, Ont., at the age of four. “Looking nurse Melissa Findlay jumped at the back, I think my father was looking for an ad- chance to experience a multisport venture. I clearly remember telling everyone event. I was going to live on another planet,” says Melissa plays elite-level ringette, Dr. Lam. a sport that is not included in interna- Luckily for Sunnybrook, Dr. Lam landed in tional multisport events. Using her ex- the right place. At the age of 16, he was a pertise as a nurse to volunteer at the Sunnybrook student volunteer in the cardio- Pan Am/Parapan Am Games Athletes’ vascular non-invasive lab. As a young “science Village medical clinic seemed like the guy,” he was intrigued by electrocardiograms next best thing. (ECGs) and how to read them. “I won’t have the opportunity Today, as a cognitive neurologist, Dr. Lam to play my sport at a global event sees patients in Sunnybrook’s Cognitive like this, since ringette isn’t in the Neurology Clinic, which treats approximately Olympics. I just love sport, and this 250 new patients a year with various types of way I can still soak in the atmosphere dementia, including Alzheimer’s disease. and be a part of it,” she says. With several research projects in progress, A ringette player since the age of Dr. Lam is also a part-time research fellow three, Melissa has played for Team working with internationally renowned senior Canada and is currently playing in scientist, Dr. Sandra Black. the National Ringette League, the He is currently completing his master’s top league in Canada. She played thesis at the Institute of Medical Science throughout her nursing studies and on the topic of clinical variation in continues to dedicate much of her Alzheimer’s disease. “There’s been a free time to her passion. Earlier lot of interest and increasing recog- this year, she travelled to Fort nition recently on atypical dementia McMurray, Alta., where her team – how it starts, progresses and, won the National Championship perhaps most importantly, whether it title. may benefit from different treatment Juggling ringette tournaments strategies than the more common across the country almost every forms of dementia.” weekend with her work as a nurse Dr. Lam is inspired by learning at Sunnybrook can be challenging, about other discoveries. “I read but Melissa wouldn’t have it any a lot and listen to informative other way. radio such as Ideas on CBC. “I thrive on unpredictability,” she I’ve also developed an says. Whether it’s on the ice or in interest in oenology, the study the emergency department, “you of wine and winemaking. learn to expect the unexpected. The Science is connected to adrenaline rush from sport is similar everything.” to how I feel when I’m able to help a patient. No two days are the same, Sally Fur which I love.”

Sybil Millar PHOTOGRAPHY BY DOUG NICHOLSON BY PHOTOGRAPHY

6 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 7

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 6 15-08-07 12:14 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 7 15-08-07 12:15 PM WE ARE SUNNYBROOK WE ARE SUNNYBROOK

THE LANDSCAPER THE PHARMACIST SOWING IT TAKES A VILLAGE It was July 17, 2002, and more than two THE SEEDS decades into her pharmacy career when Anne Karapetsas’s life and practice changed OF HEALING forever. Her teenage daughter came home Rohan Harrison has had his feet firmly after work, complaining of an excruciating planted in nature from the moment he headache, blurred vision and nausea. After was born. Growing up on a dairy farm rushing her to hospital, Anne learned that in Jamaica, he was inspired to study her 15-year-old daughter had a time bomb agriculture as a profession. “I focused explode in her head. The time bomb, it turns on agronomy, which is the study of out, was arteriovenous malformation (AVM), a plants and soil. I tell people, pretty rare condition which caused blood vessels to much, that I’m supposed to know how weaken and rupture in her brain. things grow!” Her daughter clung to life over the next Success was quick to follow several months. She endured three strokes, Rohan’s hard work ethic. He became multiple surgeries, a coma and a brain the farm manager for a large estate infection that left her paralyzed and mute. and soon after met his wife. The Anne spent the next year by her daughter’s couple moved to Brampton, Ont., in side, watching her try to regain the life she 1991 to be closer to her family. nearly lost. It was then that Rohan became “As a clinician and pharmacist who spent interested in a burgeoning area of decades in both acute care and rehabilitation research: the connection between settings, I cared about patients and could em- healing and nature. He was eager pathize with what they’re going through,” to find work that would embrace this says Anne. “But when I lived it, that’s when philosophy and allow him to sow his I truly understood.” creative seeds. In 2005, an oppor- Anne admitted to operating in her tunity to be the team leader for the own silo in the past. She’d work with her grounds department at Sunnybrook pharmacy team and focus solely on fit the bill. medication as other health-care profes- Rohan and his team care for sionals focused on their specialties. But 100 acres of land, including 32 that has since changed. acres of grass turf and more “I watched a team of occupational than 4,200 trees, day to day. therapists, physiotherapists, speech “Landscape is another import- language therapists, nurses and other ant member of the health-care specialists all work with my daughter team,” he says. to regain her mobility, her voice That includes a number and her life,” says Anne. “That of healing gardens, with one year, I not only got my daughter named in Rohan’s honour back, I got a renewed sense of following his participation compassion for patients and a in Sunnybrook’s episode of greater appreciation for everyone Undercover Boss. It was in this who makes up a health-care team.” garden where he experienced a Today, Anne works in the Falls Preven- cherished moment. tion Program at St. John’s Rehab as part of “I met a woman whose husband a close-knit interprofessional team that helps had just passed away from cancer. seniors in the community reduce their risk of She told me being in nature at that falling through exercise, home modifications moment was a huge comfort,” says and medication therapy. Rohan. “Knowing our landscape “The role of the pharmacist is changing,” helped her at that difficult time was says Anne, now 35 years into her career. my crowning moment.” “We’re not just behind the counter anymore. We’re in people’s homes; we’re on the Monica Matys front-lines, making a difference in the lives of patients, and I’m so blessed to be part of it.”

Katherine Nazimek PHOTOGRAPHY BY DOUG NICHOLSON BY PHOTOGRAPHY

8 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 9

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THE FOOT SPECIALIST WALKING IN OTHERS’ SHOES www.baskits.com Nicholas Durand, foot specialist at Sunnybrook Centre for Independent Living, spends most of his professional time treating and managing diverse foot conditions at the hospital. He sees everyone from ballerinas to veterans. But two days each week he takes his practice to the community to capture an often-forgotten population. Nicholas has been caring for homeless and at-risk clients in Toronto for more than a decade. “Many of these patients suffer from addiction and mental health issues, making access to health care difficult and daunting at times,” explains Nicholas. “Living on the street or in marginal housing often leads to neglected foot issues – diabetic or vascular complications and untreated infections.” Patients can walk in to the community health centre and be assessed and treated without the need for appointments, provincial health insurance or formal identification. His service isn’t entirely selfless. Nicholas says working with the home- less makes him a better practitioner for Sunnybrook. “Anything that expands your experience with different types of both patient and patient conditions will help,” he says. “On the streets, you see them at their worst. At Sunnybrook, you’ll see the same things, but instead of having to man- age them in a difficult environment, you can manage them in an area of excellence, where you have instant contact with the best practitioners around.” Nicholas explains that most people don’t realize that the health of their feet is connected to the rest of the body. “A person may appear absolutely togeth- Gift Service Specialists er and healthy, but as soon as they take off their shoes, you see how they’re really cop- DELIVERY ACROSS NORTH AMERICA ing – whether it’s a patient on dialysis trying to manage their underlying condition or an athlete who overtrains,” says Nicholas. 416-755-1100 [email protected] “It’s amazing what issues people will tolerate within the foot or try to self-manage until it is critical before they seek attention. Many things are preventable, and I want to keep people as mobile as possible, Congratulations Recovery Retirement regardless of their age, health condition or socio-economic status.” Celebration Sympathy Just Because Katherine Nazimek Babies & Kids Thank You Hostess PHOTOGRAPH BY DOUG NICHOLSON BY PHOTOGRAPH

10 Sunnybrook Magazine | Fall 2015 Corporate Branding Client/Employee Appreciation

DM151570_Pg05-48_Sunnybrook_Fall_2015.indd 10 15-08-10 4:25 PM DM151570_Pg11_Sunnybrook_Fall_2015.indd 11 15-08-07 2:17 PM ON FRIDAY, MICHAEL HAD MAJOR CANCER SURGERY.

ON MONDAY, HE WENT FOR A 5-KILOMETRE WALK

Patients experience better quality of life, thanks to less invasive and more targeted approaches in cancer care being pioneered at Sunnybrook

   Michael Calderone, walking with his wife Caroline, had his colorectal cancer removed

PHOTOGRAPH BY TIM FRASER BY PHOTOGRAPH without the need for an incision.

12 Sunnybrook Magazine | Fall 2015

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 12 15-08-07 12:28 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 13 15-08-07 12:28 PM with a colostomy bag.” Sunnybrook every three months for patients while delivering the same or The tea came in a little Minimally invasive plastic cup, oversteeped The Calderones then met with Dr. monitoring over the next two years. better outcomes than traditional ap- treatment is “a Shady Ashamalla, a surgical oncologist “On Monday, I went for a five-kilometre proaches. and slightly tepid. But it philosophy of care at Sunnybrook’s Odette Cancer Centre walk.” Sunnybrook offers laparoscopic sur- at Sunnybrook,” didn’t matter to Michael with expertise in minimally invasive geries, where appropriate, for the care of says surgeon Calderone. He was just laparoscopic surgery for cancers in MINIMALLY INVASIVE gastrointestinal and some gynecological Dr. Shady Ashamalla. the lower gastrointestinal tract. Dr. cancers. These procedures involve a happy to be sitting up Ashamalla suggested a “trans-anal Most treatments to remove and destroy few small incisions with ports placed and sipping tea in his minimally invasive” approach which cancer come with physical risk. through the incisions. Using a laparo- hospital bed, just one would use tiny instruments in tandem To ease the physical burden on scope as a visual guide, the surgeons with a laparoscope (tiny video camera) patients already dealing with cancer, skillfully manoeuvre long, thin surgical hour after undergoing inserted through the anus to remove the doctors and scientists at Sunnybrook instruments to remove tumours without surgery to remove a cancer. have continued to advance innovative injuring any areas of the body. cancerous growth. “There’s no incision at all,” explains treatments and approaches that are less “Our goal is to be able to offer proce- Dr. Ashamalla, who completed ad- invasive than conventional procedures. dures that can be done in the least inva- vanced fellowships in both minimally These approaches zoom in on the can- sive way, but, at the same time, achieve Things could have been very differ- invasive surgery and surgical oncology cer while sparing the rest of the body. the same oncological effect to remove all ent. Michael and his wife, Caroline, had as part of his training. For this relatively Michael’s surgery is just one example the cancer,” says Dr. Ashamalla, head of previously been advised that treating the new procedure, which is suitable for of minimally invasive cancer treatments general surgery at Sunnybrook. colorectal cancer in his rectum would removing early stage colorectal cancer offered today at Sunnybrook. Mary Abbott underwent a laparoscop- require cutting through his abdomen and non-cancerous polyps in the rec- “Minimally invasive treatment is not ic colon resection. to remove the rectum and surrounding tum, he studied with leading surgeons just a technique, it’s a philosophy of care “I was diagnosed with colon cancer in lymph glands. They would also need to in the field. “Instead of cutting through at Sunnybrook,” says Dr. Ashamalla, January 2013, and it was not early stage – create an ostomy pouch – also known as the abdomen, we go through a natural who is a member of the Odette Gastro- I had almost a full blockage,” says Mary, a permanent colostomy bag – to collect opening in the body, cut out and remove intestinal Cancer Care team. a lawyer and partner with a large Toronto his waste. the tumour, and patients can go home From pharmaceutical agents that law firm. “When Dr. Ashamalla said the DOUG NICHOLSON BY PHOTOGRAPH “And if all was to go well with the the same day.” target molecular abnormalities specific cancer could be addressed minimally surgery and my recovery, I would have In Michael’s case, he had a small, early to pancreatic cancer to using sentinel invasively, I was surprised, but definitely to come back later to get the sphincter stage colorectal cancer low in the rectum lymph node biopsy (or the removal of relieved at the idea of not having full in order to make liver surgery possible. ability to clear out toxins, any leftover and colon reattached,” says Michael, a that was removable by local excision. By only the first lymph nodes (sentinel open abdominal surgery.” Christy Pieroway of Newmarket, Ont., drugs not delivered to the cancer cells Toronto entrepreneur who runs a whole- 3 p.m. on the day he had his trans-anal nodes) into which a primary tumour Mary, a mother of two boys aged is a 43-year old mother of two and a get eliminated, leaving other parts of sale and retail fashion business. “But surgery, he got up, held his wife’s hand drains) to detect metastases in cervi- 12 and nine, went in for her laparo- former globe-trotting sales representa- the body free of the drug and related healing could take months. And there and walked out of the hospital. cal cancer, Sunnybrook is continually scopic surgery on a Wednesday and tive. She is one of a small number of par- side-effects. was a chance that reattachment would “I had the surgery on Friday,” recalls expanding its repertoire of procedures went home two days later. While she ticipants in this trial, which researchers “So most of the chemotherapy – about not be possible, and I would have to live Michael, who must now come to that minimize the physical impact on didn’t go back to work for a while, she hope to offer to more patients. 95 per cent – actually stays in the liver, to says she resumed normal activities Diagnosed with colon cancer that had treat the tumours,” he says. shortly after the procedure. spread to the liver, Christy immediately The liver-directed chemotherapy via “I continued to see my friends and had surgery in August 2013 at a local the pump is given in combination with exercise and hang out with my kids,” hospital to remove the tumour in her standard intravenous chemotherapy. To says Mary, who also received six months colon. She then underwent standard date, combined treatments have yielded of chemotherapy and now comes in for chemotherapy to limit further spread a positive response of reduced metas- regular checkups to ensure she remains and to shrink the tumours in her liver. tases of up to three times, or 75 per cancer-free. “Because you don’t have Christy was subsequently referred to cent, greater than standard second-line that pain associated with a larger inci- Sunnybrook’s Odette Cancer Centre for chemotherapy alone. sion – I probably have four tiny incisions liver surgery. In reviewing her case, the Fast-forward to the present: Christy that you can’t even notice – you forget multidisciplinary team that included and Drs. Ko and Karanicolas have seen that you just had major abdominal surgical, medical and radiation on- in the latest CAT scans a reduction in surgery, and that really allows you to get cologists, pathologists, interventional the tumours in Christy’s liver and, most back to normal quicker.” radiologists and oncology nursing, recently, indications that the cancer is recommended she would be a good can- not changing over time. TARGETED APPROACHES didate for the Hepatic Artery Infusion “We are excited about Christy’s pros- Pump trial as immediate liver surgery pects, especially now that we are also Surgical oncologist, Dr. Paul was not possible. seeing cancer control,” says Dr. Ko. Karanicolas, and medical oncologist, The Hepatic Artery Infusion Pump is “The program requires strong collab- Dr. Yooj Ko, also of the Odette Cancer a small disc-shaped device that directs oration among a large group of special- Centre Gastrointestinal Cancer Care anti-cancer drugs into the liver through ists. It offers appropriate patients a more team, have collaborated to bring to a catheter inserted into the organ’s effective and targeted treatment option, Sunnybrook a first-in-Canada Hepatic hepatic, or main, artery. The pump is and we hope to expand the program,” Artery Infusion Pump Program. This is a implanted beneath the skin just above says Dr. Karanicolas. Michael Calderone promising approach, still in clinical trial, the abdomen. Chemotherapy is infused “The pump had initial challenges for was able to leave for patients where colorectal cancer in the pump at regular intervals, at me, but the results have been encourag- hospital on the has spread to the liver, with immediate about two to six weeks apart. ing,” says Christy, “and knowing Sunny- same day he had surgery being too risky, and where first- The hepatic artery supplies most of brook’s team is behind me, helping me his cancer surgery. line chemotherapy to reduce tumour the blood to cancers in the liver, says all the way, it’s renewed our hope for the

PHOTOGRAPH BY TIM FRASER BY PHOTOGRAPH number and size is proving unsuccessful Dr. Karanicolas. Because of the liver’s longer term.”

14 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 15

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 14 15-08-07 12:29 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 15 15-08-07 12:29 PM STROKE OF GENIUS

A groundbreaking clot-removal procedure is saving the lives of stroke victims who were previously hard to treat

By Angela Pirisi

hen Karen Hwang turned 40 last artery that channels blood and oxygen clot and decide if we can get up to it and Wfall, she and her best friend, who to a number of arteries that branch out examine collateral blood flow [blood was also turning 40, decided to cele- into the brain. Karen had an ischemic flow in the area surrounding the clot] brate their birthdays by travelling to stroke, a stroke that is the result of a using advanced imaging,” explains Dr. Athens to run a marathon. Less than two blood clot. Rick Swartz, medical director of the weeks after the avid runner returned It was Sunday afternoon, and she was stroke program at Sunnybrook, who’s home, she collapsed in the shower of rushed to Sunnybrook. When the call been leading studies of the technique her Markham, Ont., home on a Friday came, Dr. David Gladstone, medical di- at Sunnybrook. “Then we put a wire in evening. Karen’s family called 911, and rector of the Regional Stroke Prevention through the groin and move up into the Karen was rushed to a nearby hospital. Clinic, made the diagnosis, co-ordinated brain, where we put it into the clot and At first, the doctors assumed that her treatment plan and mobilized the deploy a stent, which meshes with the Karen had slipped and struck her head. Code Stroke team – Karen would under- clot, then retrieves it.” “Given my age and history, there was go emergency surgery to try to remove Researchers at Sunnybrook have no reason to suspect a stroke,” she says. the clot. been working hard with collaborators “I was perfectly healthy, with no family The kind of clot Karen had is chal- around the world to troubleshoot and history of stroke.” lenging to dissolve or manually remove fine-tune ET techniques, which have An initial CT scan showed nothing, at the best of times, but many hours been in studies for almost two decades. and her only obvious injury was a badly had already passed since she collapsed. What has developed is a solution that bruised shin. When Karen regained Survival and recovery after an ischemic may drastically change the prognosis consciousness the next day, she seemed stroke depend heavily on how quickly for patients with ischemic strokes. An perfectly fine. But on Sunday morning, a the clot can be removed. Typically, the ischemic stroke is caused by a blood nurse became suspicious when she tried prognosis would be bleak, including clot that cuts off blood flow to some part to assist Karen to the bathroom and a vegetative state and, possibly, even of the brain. Ischemic strokes make up noticed her right leg and arm were bent, death. But Sunnybrook doctors had about 85 per cent of stroke cases. and that she was unable to straighten an ace up their sleeve – a clot-retriev- The ET procedure is being hailed as them. At that point, Karen discovered al procedure known as endovascular the most significant breakthrough in she could no longer walk. treatment (ET). stroke treatment in 20 years, since it “My symptoms were bilateral, so I had can greatly reduce disability and risk of a lot of weakness on my right side and death. numbness on my left side, including Sunnybrook was one of 22 sites my mouth and tongue. Luckily, it didn’t ET is a minimally invasive procedure worldwide participating in a clinical affect my speech. I had also lost some of that involves the expeditious removal of trial that involved 316 ischemic stroke the vision in my left eye,” says Karen. a blood clot, thereby restoring nor- patients who were randomly assigned to A second CT scan followed that mal blood flow to the brain. “First we either standard care (a clot-busting drug Karen Hwang is back at work as a morning, and this time revealed a blood perform a CAT scan to see how much called tPA, short for tissue plasminogen

chiropractor after undergoing endovascular TIM FRASER BY PHOTOGRAPH clot lodged in the basilar artery, a major of the brain is savable, locate the blood activator) or standard care, plus the treatment at Sunnybrook.

16 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 17

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 16 15-08-07 12:38 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 17 15-08-07 12:38 PM clot-retrieval process. Results, published in The New England Journal of Medicine in March 2015, showed that 55 per cent of patients had a positive outcome, compared with 30 per cent for those re- ceiving standard care. Death outcomes were cut in half, from 20 per cent to 10 per cent. In fact, the trial was ended ear- ly due to the overwhelming success rate shown in results, says Dr. Swartz, one of the study’s co-authors.

An ischemic stroke can be treated with tPA to dissolve clots, but some chal- lenges arise, says Dr. Swartz. A key issue is that tPA needs to be administered to a patient within about 4.5 hours of having a stroke. So people need to quickly recognize stroke symptoms and call 911 right away, but that doesn’t always happen. People who take blood thinners aren’t eligible for tPA, since the drug is a blood thinner, so it would increase the bleeding risk. Another potential issue is that tPA may not completely remove large blood clots, so surgeons may still need to manually remove what’s left of a partial- ly dissolved clot. Many patients in the clinical trial received both tPA and ET. “tPA works quite well for some patients,” says Dr. Swartz. “For this trial, we were looking at the most severe strokes that affect the big blood vessel branches that clockwise from top left: go into the brain,” he says. “These tend Dr. David Gladstone (left) and to have larger, longer clots, so tPA may Dr. Rick Swartz; Dr. Victor Yang in the OR; and Dr. Yang (foreground), dissolve half of the clot, but if the other neurosurgeon Dr. Leodante da Costa half is still blocking blood flow, you hav- and radiologist Dr. Peter Howard en’t addressed anything until you get rid discussing a stroke patient’s of all of it.” That’s where the ET proce- brain scans. dure comes in – to mechanically remove clots that are less responsive to tPA. ET has a longer window of opportu- Karen Hwang’s basilar artery flow before (left) and after (right) the clot-retrieval nity than tPA – generally up to six hours procedure. The images were taken with an angiography machine during the procedure and sometimes even longer – but only in Sunnybrook's angio suite. if the damage hasn't already been done. So people cannot delay getting to the hospital, warns Dr. Swartz: “It means possible, says that other options are still Dr. Yang. “Technology is just one piece. that now people have even more reason available for stroke patients who aren’t Stroke treatment is now what we call a to get to the hospital quickly – we have candidates for ET, but for those who are ‘team sport.’ If you have the technology, generation devices, known as stent re- Now the app keeps an automatic “score speed at which they did it, I would not more options for the worst strokes.” ET eligible, the decision is clear. “There are but it takes hours to assemble a team, trievers, are much faster, safer and more board” for the team. be here today,” says Karen. “My recovery can certainly be an option for patients emergency devices available, but this the technology will be of no benefit to effective.” has been remarkable, knowing the con- who aren’t candidates for tPA or for is older technology. The other alterna- the patient,” he says. Meanwhile, Dr. Yang has also been sequences of the type of stroke I had.” whom the clot-busting drug hasn’t been tive uses catheter tubes to disrupt and Dr. Swartz emphasizes speed as designing and developing an app that Karen is now back to work part-time completely successful. suction the broken-up clot,” he says. “It’s one key factor that has made ET a real provides a communication tool for all For Karen Hwang, the convergence as a chiropractor, steadily regaining tedious to use, and it takes a longer time game-changer for stroke treatment. key members involved. Michael Lu, a of technological innovation with the her indispensable fine motor skills, with unpredictable results; the success “We’ve built our system to be faster in process improvement engineer working interdisciplinary collaboration and including the use of her right hand. She’s rate is only about 30 per cent,” adds responding to stroke patients,” says Dr. with the stroke team, wrote the app resourcefulness of Sunnybrook’s team also slowly working up to running again, Dr. Victor Yang, a neurosurgeon at Dr. Yang. Swartz. “Candidates for ET can be iden- software. Initially, Lu tracked the team’s has made a life-saving – and brain-sav- and she is planning to participate in a Sunnybrook who performs the clot- As for ET’s breakthrough in stroke tified and treated as quickly as possible, response time from the stroke event ing – difference. five-kilometre run this fall. “I still feel removal procedure and has developed treatments, it’s not just about the tech- thanks to advanced imaging technology. to when the patient shows up in the “If it weren’t for what doctors Yang, like I have a long way to go, but things

processes to make ET as efficient as nique, but also about teamwork, says Another factor is that the latest- DOUG NICHOLSON BY PHOTOGRAPHY ER to when they have an intervention. Howard and Gladstone did, and the just keep improving each day.”

18 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 19

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 18 15-08-07 12:39 PM DM151570_Pg19_Sunnybrook_Fall_2015.indd 19 15-08-11 2:36 PM “If people get too fearful of participating If a picture is worth a thousand blood, form the upper chambers. in the innovation words, then what is the value of The lower chambers, the left and one that helps doctors navigate right ventricles, pump blood out the heart’s delicate terrain to of the heart to the rest of the body. process, then Canada repair lethal conditions? An internal wall called the septum divides the right and left sides. That’s the million-dollar ques- Atrial fibrillation (AF) is when the will not be the one to tion Dr. Brian Courtney, a clini- heart beats abnormally – too fast, cian-scientist in the Schulich Heart too slow or somehow out of sync. Research Program at Sunnybrook It affects about 250,000 Canadians, innovate, and we’ll Research Institute (SRI), is investing which makes it the most common his time and energy into answering. heart rhythm problem. It’s caused Dr. Courtney is compelled to pro- by an electrical disturbance in the be buying expensive vide better image guidance so that atria. doctors like him can manoeuvre A prolonged too-fast heartbeat through the heart and its channels can lead to heart failure when technologies from with greater safety and precision. the weakened muscle can’t pump “I love looking after patients and enough blood throughout the body. trying to provide them with some Atrial fibrillation also increases elsewhere in solution to the challenges they face. the risk of stroke five-fold. This is If I were to do clinical work 100 because the atria contract in a cha- per cent of the time, knowing how otic pattern; thus, the heart doesn’t the world.” many technical challenges we face pump effectively, causing blood to and how many conditions we’d like pool, which could lead to the fatal to be able to treat better, I’d be a bit ascent of a clot to the brain. frustrated. I studied engineering as Anti-clotting drugs and med- my initial profession – I like to go ication to control heart rate and after problems and solve them with rhythm are a first-line strategy for technical and other solutions,” he reducing the risk of stroke and says. symptoms caused by AF. If patients Dr. Courtney has spent much of can’t tolerate them, then they might his career developing devices to undergo cardiac ablation, a proce- improve outcomes of minimally dure that’s done in Canada several invasive procedures. In 2007, he thousand times annually. The aim founded Colibri Technologies to is to alter the heart muscle that ini- put these tools in the hands of tiates and propagates faulty signals those who mend ailing hearts and that cause the arrhythmia. vessels. Some electrophysiologists, Colibri’s first product is an who are cardiologists specialized ultrasound catheter that makes in treating such problems, rely 3-D pictures inside the heart in real on X-ray guidance during abla- Precise time. It’s used for intracardiac echo- tion procedures, especially if the cardiography, a technique whereby patient’s anatomy is normal. That guidance a catheter with an ultrasound often isn’t the case, though, says probe at the tip is inserted into a leg Dr. Courtney. “That’s one of the Made-in-Ontario imaging devices seek to vein and guided up into the heart. reasons why people might have redefine the landscape of interventional cardiology Intracardiac echocardiography atrial fibrillation, because they have is gaining traction in procedures something different about their

N g for structural heart disease and heart.” by alisa kim arrhythmia, when the heart beats For common heart procedures, irregularly. including AF ablation, doctors First, a primer on the heart. This move from the right side to the left fist-shaped pump is divided into by making a small hole in the atrial four chambers. The left and right septum. The left atrium is the trick- atria, which receive and collect iest chamber to enter, and where N Wo Natio P h by Photogra

Fall 2015 | Sunnybrook Magazine 21

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 20 15-08-07 12:41 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 21 15-08-07 12:42 PM Dr. Brian Courtney’s Colibri Technologies is developing tools for minimally invasive procedures, including an ultrasound catheter that makes 3-D pictures inside the heart. Staying the course Moving a medical innovation from an idea through to a saleable product takes dedication and time – lots of it. Here, a look at some milestones in Colibri’s commercialization pathway of the intracardiac echocardiography (ICE) system.

2006: Idea for The global market is paying atten- the ICE catheter is tion: Japan Lifeline, a firm specializing ’06 born. in cardiovascular medical equipment, recently agreed to become the exclusive distributor for Colibri’s intracardiac catheter in Japan. The deal gives Colibri Dr. Courtney a foothold in the world’s second-largest files for patent medical device market. ’07 protection of the The company’s dogged pursuit of device. success is remarkable against the some- what gloomy backdrop of commercial- ization of innovations in Canada. First images from A study by the C.D. Howe Institute ’08 the ICE catheter shows that per capita patent filings in are made. ultrasound guidance is advantageous, movement of the catheter that’s doing tissue and looking through blood. Dr. Courtney, who began working on the Canada are declining. Moreover, the says Dr. Courtney. the therapy,” says Dr. Courtney. Colibri’s intravascular catheter aligns technology seven years ago. In the early country’s medical device sector oper- Other companies make catheters, the ultrasound and OCT beams exactly stages, he and his team built a prototype ates at a $5-billion trade deficit; we buy but Dr. Courtney’s intracardiac catheter Welcoming the hybrid age so that they look in the same direction and did validation testing and preclini- $7-billion worth of medical equipment First major private is the only one that is forward-viewing concurrently. The design enables data cal experiments at SRI. from the rest of the world while selling investment in the and can do 2-D and 3-D imaging. Colibri’s second product, its intravascu- from both modalities to be matched Since then, Colibri has moved into just $1.8-billion of our own. ’10 company. Colibri hires The device could also transform how lar catheter, is an innovation that could precisely for a more detailed image its own space. Its 25 employees are The path to bringing his inventions to catheter-based mitral valve procedures help cardiologists to better determine inside the vessels. working to propel the technology from market has been bumpy, and the stakes its first employee. are done. Here, doctors stop leakage of the nature and extent of coronary artery The device offers hope in detecting a prototype to a market-ready product. are high, but Dr. Courtney says the cost blood from the left ventricle to the left disease, narrowing of the coronary ar- “vulnerable” plaque, which is prone The team has concentrated on image of sitting on the sidelines is even greater. atrium by attaching a clip to the mitral teries that is the leading cause of death to rupturing. If this happens, then a quality and reliability, and making the “If people get too fearful of participating Initial preclinical valve to keep it closed. It’s guided by a worldwide. The device combines two life-threatening clot forms inside the device sterile and biocompatible. In ad- in the innovation process, then Canada ’11 data are acquired. technique called transesophageal echo, complementary ways of seeing inside artery, which can lead to a heart attack dition to ensuring safety, the team has will not be the one to innovate, and which uses ultrasound to see inside the blood vessels: ultrasound and optical or stroke. Catching the buildup before it miniaturized the catheter and modified we’ll be buying expensive technologies heart, but goes in through the esoph- coherence tomography (OCT). bursts – which can be symptom-less, as the design so it can be manufactured. from elsewhere in the world, or not, and agus and requires general anesthesia. Intravascular ultrasound can identify was the case for the plaque that caused Colibri will seek regulatory approval for therefore, not treating our patients as Using intracardiac echo instead requires attributes such as plaque buildup or the death of NBC journalist Tim Russert clinical use, with an eye to doing patient effectively.” Colibri moves into its only local anesthesia, a faster, cheaper calcifications on the artery wall that are in 2008 – isn’t possible with current studies later in 2015. He’s all in. ’12 head office and R&D option. difficult to make out on an angiogram, diagnostic methods. While the first two products target facility. The company In addition to providing more ana- a picture of the coronary arteries made Dr. Courtney has presented research applications in cardiology, there are This story was originally published in receives certification tomical context, the 3-D component of using X-rays and a dye. It’s also used on the technology at conferences, which plans to expand into other clinical SRI Magazine 2015. for manufacturing. the imaging could help doctors do their to see whether a stent has been placed has generated buzz from his colleagues. domains. Colibri has acquired the rights work more handily. correctly or to determine the right-sized “It’s clear that there’s a need. We have to an ultrasound probe for imaging in Dr. Courtney’s research was supported by “When you’re doing these procedures, stent. a path to get there. It’s just a matter of the ear that was developed at Dalhousie the Canada Foundation for Innovation, you have one device that’s either burn- Optical coherence tomography, putting the fuel in the tank to get to that N g University in Halifax. The device will Canadian Institutes of Health Research, Japan Lifeline, a ing, sensing or clipping, and you have which makes pictures by sending light point.” become part of a pipeline of products. Federal Economic Development Agency ’14 medical equipment another catheter that takes pictures. If into tissue and collecting the reflec- “The philosophy is to make a company for Southern Ontario, Health Technology company, becomes you have a 3-D catheter, that gives you tions, is a newer technique that provides Nearing the finish line that has a broad technology platform so Exchange, Natural Sciences and Engi- the sole distributor of more flexibility in being able to position higher resolution and better contrast we can be the best at providing imaging neering Research Council of Canada, On- the ICE technology your imaging catheter in other locations than does ultrasound. Where ultrasound Development of the intracardiac cathe- guidance for minimally invasive proce- tario Centres of Excellence and Ontario system in Japan.

that are less likely to interfere with the prevails is being able to see deeper into ter is the company’s primary focus, says N Wo Natio P h by Photogra dures,” says Dr. Courtney. Ministry of Research and Innovation.

22 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 23

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 22 15-08-07 12:57 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 23 15-08-07 12:57 PM Dr. Brian Courtney’s Colibri Technologies is developing tools for minimally invasive procedures, including an ultrasound catheter that makes 3-D pictures inside the heart. Staying the course Moving a medical innovation from an idea through to a saleable product takes dedication and time – lots of it. Here, a look at some milestones in Colibri’s commercialization pathway of the intracardiac echocardiography (ICE) system.

2006: Idea for The global market is paying atten- the ICE catheter is tion: Japan Lifeline, a firm specializing ’06 born. in cardiovascular medical equipment, recently agreed to become the exclusive distributor for Colibri’s intracardiac catheter in Japan. The deal gives Colibri Dr. Courtney a foothold in the world’s second-largest files for patent medical device market. ’07 protection of the The company’s dogged pursuit of device. success is remarkable against the some- what gloomy backdrop of commercial- ization of innovations in Canada. First images from A study by the C.D. Howe Institute ’08 the ICE catheter shows that per capita patent filings in are made. ultrasound guidance is advantageous, movement of the catheter that’s doing tissue and looking through blood. Dr. Courtney, who began working on the Canada are declining. Moreover, the says Dr. Courtney. the therapy,” says Dr. Courtney. Colibri’s intravascular catheter aligns technology seven years ago. In the early country’s medical device sector oper- Other companies make catheters, the ultrasound and OCT beams exactly stages, he and his team built a prototype ates at a $5-billion trade deficit; we buy but Dr. Courtney’s intracardiac catheter Welcoming the hybrid age so that they look in the same direction and did validation testing and preclini- $7-billion worth of medical equipment First major private is the only one that is forward-viewing concurrently. The design enables data cal experiments at SRI. from the rest of the world while selling investment in the and can do 2-D and 3-D imaging. Colibri’s second product, its intravascu- from both modalities to be matched Since then, Colibri has moved into just $1.8-billion of our own. ’10 company. Colibri hires The device could also transform how lar catheter, is an innovation that could precisely for a more detailed image its own space. Its 25 employees are The path to bringing his inventions to catheter-based mitral valve procedures help cardiologists to better determine inside the vessels. working to propel the technology from market has been bumpy, and the stakes its first employee. are done. Here, doctors stop leakage of the nature and extent of coronary artery The device offers hope in detecting a prototype to a market-ready product. are high, but Dr. Courtney says the cost blood from the left ventricle to the left disease, narrowing of the coronary ar- “vulnerable” plaque, which is prone The team has concentrated on image of sitting on the sidelines is even greater. atrium by attaching a clip to the mitral teries that is the leading cause of death to rupturing. If this happens, then a quality and reliability, and making the “If people get too fearful of participating Initial preclinical valve to keep it closed. It’s guided by a worldwide. The device combines two life-threatening clot forms inside the device sterile and biocompatible. In ad- in the innovation process, then Canada ’11 data are acquired. technique called transesophageal echo, complementary ways of seeing inside artery, which can lead to a heart attack dition to ensuring safety, the team has will not be the one to innovate, and which uses ultrasound to see inside the blood vessels: ultrasound and optical or stroke. Catching the buildup before it miniaturized the catheter and modified we’ll be buying expensive technologies heart, but goes in through the esoph- coherence tomography (OCT). bursts – which can be symptom-less, as the design so it can be manufactured. from elsewhere in the world, or not, and agus and requires general anesthesia. Intravascular ultrasound can identify was the case for the plaque that caused Colibri will seek regulatory approval for therefore, not treating our patients as Using intracardiac echo instead requires attributes such as plaque buildup or the death of NBC journalist Tim Russert clinical use, with an eye to doing patient effectively.” Colibri moves into its only local anesthesia, a faster, cheaper calcifications on the artery wall that are in 2008 – isn’t possible with current studies later in 2015. He’s all in. ’12 head oce and R&D option. difficult to make out on an angiogram, diagnostic methods. While the first two products target facility. The company In addition to providing more ana- a picture of the coronary arteries made Dr. Courtney has presented research applications in cardiology, there are This story was originally published in receives certification tomical context, the 3-D component of using X-rays and a dye. It’s also used on the technology at conferences, which plans to expand into other clinical SRI Magazine 2015. for manufacturing. the imaging could help doctors do their to see whether a stent has been placed has generated buzz from his colleagues. domains. Colibri has acquired the rights work more handily. correctly or to determine the right-sized “It’s clear that there’s a need. We have to an ultrasound probe for imaging in Dr. Courtney’s research was supported by “When you’re doing these procedures, stent. a path to get there. It’s just a matter of the ear that was developed at Dalhousie the Canada Foundation for Innovation, you have one device that’s either burn- Optical coherence tomography, putting the fuel in the tank to get to that NG University in Halifax. The device will Canadian Institutes of Health Research, Japan Lifeline, a ing, sensing or clipping, and you have which makes pictures by sending light point.” become part of a pipeline of products. Federal Economic Development Agency ’14 medical equipment another catheter that takes pictures. If into tissue and collecting the reflec- “The philosophy is to make a company for Southern Ontario, Health Technology company, becomes you have a 3-D catheter, that gives you tions, is a newer technique that provides Nearing the nish line that has a broad technology platform so Exchange, Natural Sciences and Engi- the sole distributor of more flexibility in being able to position higher resolution and better contrast we can be the best at providing imaging neering Research Council of Canada, On- the ICE technology your imaging catheter in other locations than does ultrasound. Where ultrasound Development of the intracardiac cathe- guidance for minimally invasive proce- tario Centres of Excellence and Ontario system in Japan.

that are less likely to interfere with the prevails is being able to see deeper into ter is the company’s primary focus, says WO NATION BY PHOTOGRAPH dures,” says Dr. Courtney. Ministry of Research and Innovation.

22 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 23

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 22 15-08-07 12:57 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 23 15-08-07 12:57 PM NEONATAL CARE PREEMIES, PARENTS and a SUPPORTING CAST

Having a baby inside a neonatal intensive care unit is a nerve-racking, life-altering experience. At Sunnybrook, parents who have been through it try to give back to those in need

BY ALEXIS DOBRANOWSKI

When Irma Jules had her son at 24 weeks, she thought she was ready for what was ahead. But when Nathan suffered a brain bleed just a day later, shock, fear and disbelief set in. Doctors told her he would need to have a shunt put in his brain. She googled “shunt,” and was over- whelmed by information that amped her fear about the procedure and the possible outcomes. A mom to three other boys, Irma was used to fixing hurts when her children had them. With Nathan, she felt helpless. “I went home and I cried for the whole day and then I came back to the hospital with a new mentality,” she says. “I will do what it takes to help get my son where he needs to be. If he can’t see, I’ll see for him. If he can’t talk, I’ll talk for him. I spoke to the doctors; they Nathan Litynsky, a member of the told me he wouldn’t be able to smile at Dad’s Night group, with his daughter me. It was frightening.” Emery, who was born at only 24 weeks. DOUG NICHOLSON BY PHOTOGRAPH

24 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 25

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 24 15-08-07 12:57 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 25 15-08-07 12:58 PM Peer counsellors Ophelia Kwakye (left) and Irma Jules (right) use their experience as NICU mothers to help and support new moms in the unit, like Lise Ngandu (centre, with baby Abigail). it hard to find supports who really un- derstand.” The evenings are facilitated by Irma said what helped her most Grad Dads Dave Merriman and Zahir during that time was talking to other Keshavjee. Like other Grad Dads, Dave women in the Neonatal Intensive Care and Zahir had babies in the NICU, and Unit (NICU). “I talked to every single they now offer support to families who mom I saw,” she recalls. “In the hall, in are new to the experience. the pump room, anywhere I could meet Dave has been involved in Dads’ Night a mom. It used to make me feel better.” since the program’s inception in January Now Irma – along with fellow NICU 2012. Robson wanted to do something graduate mom Ophelia Kwakye – is a for the fathers, to recognize how import- peer counsellor in the NICU. Their role ant they are in the NICU process – and is mainly to encourage other women to because they often feel like the “forgot- pump breast milk for their babies in the ten man,” Dave recalls. NICU. But the support goes beyond that. “Fathers play such an important role “Some may not have it in their per- during this time, but may feel on the sonality to approach other moms,” Irma outside looking in at times or may be says. “We share our stories and facilitate overwhelmed by the sheer magnitude Audrina’s mobility, she says she jumped at discussion amongst them.” of the occasion,” says Dave, dad to two the chance. Irma and Ophelia host a weekly lunch, preemies. “For one night, this gives SPECIAL CARS “Audrina has a cousin around the same where women gather to talk about their them the opportunity to relax, hear from age, who has started to crawl around, and babies, their experiences and their fears. other fathers who are facing the same GET NICU If anyone isn’t coping well, the pair con- circumstances as they are and also ex- we see Audrina look at her moving as nects them with other hospital supports. press how they are feeling and coping though she wants to as well, but she can’t,” Ophelia was just 22 weeks pregnant with the moment. Sometimes it’s simply GRADS MOVING Kaitlyn says. “When Laura explained they when she was admitted to Sunnybrook. to provide an audience to listen as they would give us this little car, and Audrina will Her son Emmanuel was born at 24 weeks tell how they are feeling and reacting. Kaitlyn Chiaramida was just over four months be able to move around all by herself, we and three days. He weighed just one Other times it’s an excellent exchange pregnant when her water broke. had to get involved. We would do anything pound. of details and information.” She spent two nerve-racking months at for her.” “I didn’t want to come downstairs to Zahir and his wife, Rishma, had Sunnybrook, hoping and praying her baby The modified cars project, based on see him because I was so, so scared. I her breast milk for her baby also gave her baby names, how many weeks along twins in the NICU in 2013. The little wouldn’t come yet. Her baby daughter the Go Baby Go project by a team at the went the next day to see him, and I went hope and purpose. “They told me the their wives or partners were when the boy, Khalil, died five days later. “It was a Audrina was born at 29 weeks, weighing two University of Delaware, provides babies crazy when I went in the room. I saw breast milk will help fight all the bacte- baby came, how scary it was and how tough, tough process. I tried to support pounds, 13 ounces. with mobility issues the opportunity to move this big machine with all this big stuff ria. So I was just pumping and pumping they just feel at a total loss for words my wife and her emotions,” says Zahir. “We spent two more weeks at and explore their environment in a fun and around that I know nothing about, and and pumping.” sometimes. The men erupt in laughter “The NICU is understandably a very Sunnybrook, then got transferred to our age-appropriate way. Cooper, along with the baby was inside, so very tiny. My life In her role as peer counsellor, Oph- when one dad says there are so many female-focused environment. But being home hospital,” Kaitlyn says. “Every day, University of Toronto (U of T) occupational just changed. I just took it from there.” elia now encourages other moms to do wires in his twins’ room, it’s like they a dad inside the NICU has its own stress- there were machines coming oƒ of her; she therapy students Mallory Owen and Stefanie Ophelia says one of the people she re- the same. She tells them stories about were born into The Matrix. The dads go es and challenges. Dads’ Nights are a was doing really well.” Radia-Bramwell, and Deb Cameron, assistant members most from that time was Kate Emmanuel – now a selfie-taking, quiet and gently nod when one says he space where they can connect with each However, the doctors told Kaitlyn and her professor at U of T, take small plastic cars Robson, NICU parent co-ordinator. dance-loving four-year-old. feels scared to touch his little girl. other and offer each other some support “I was always sitting there crying. And Irma’s Nathan is now two years old. He “I was scared at first, too,” one agrees. – because it’s hard to know where to find partner, Vinnie, soon after that Audrina has and “soup” them up to fit the baby, as well as Kate would come to me and say, ‘Can I started to walk. And talk. And smile. He They talk about how it is hard going that. Dave and I share our stories, so cerebral palsy. “I was devastated,” Kaitlyn rig a button that the baby can press to make give you a hug?’ She would tell me about had the shunt put in, and Irma now talks back to work. they know where we are coming from recalls. “I felt like I did something wrong. I felt the car move. her two preemie daughters. And so to other parents about that experience. “It’s really hard to know what to say and that they aren’t alone,” he says. better when I learned it was something that “The car gives the child a chance to sit when she called me about being a peer “Talking to other moms helped me so to people,” one dad says. “It’s hard to be Dave and Zahir see themselves as was out of my control.” upright. There’s a child-friendly seat and sup- counsellor, I remembered her telling me much, so, I figure, if I get the opportunity at work at all,” his neighbour adds, to helpers for an evening, there to lis- Cerebral palsy (CP) is a diagnosis that port that’s modified to fit them,” Cooper says. those stories, and that’s what helped me to do that and help, then I will.” murmurs of agreement from the others. ten and support dads during what is a describes a brain injury early in childhood The parents set the goals for the use of most of the time. She had a 25-weeker, Nathan Litynsky’s baby girl Emery life-altering experience. that aƒects how a child’s muscles receive the cars. Audrina’s goals were independent too. That kind of gave me hope that my Dads’ Night in the NICU came at 24 weeks, he tells the group. It’s “Having had two preemies myself input from their brain and results in diŠculties mobility, increased use of her hands and son might survive.” been really hard on his wife, Jaclyn. But and going through what they are going with movement. This potentially impacts enjoyment. Ophelia says the opportunity to pump Overwhelming. Scary. Joyful. Stressful. hard on him, too, he says. through, there is almost an immediate the child’s ability to move, sit, walk, talk, eat, “It definitely helped open up her hands Helpless. A rollercoaster. “We came here on one of the cold- bond or understanding that is reached,” draw or play the way other children do, says and fingers, and to feel stuƒ,” Kaitlyn says. These words come up over and over est days of the winter. We watched the Dave says. “I tell the dads that they have Laura Cooper, an occupational therapist at “Before she would sit with her hands again at Sunnybrook’s NICU Dads’ snow come. Then it melted. Now there now joined a very special fraternity of the follow-up clinic at Sunnybrook’s Neonatal clenched. Having the button and knowing Night, a monthly event that welcomes are leaves on the trees and green grass. those who have preemies. Intensive Care Unit (NICU). she could touch it to move, there’s been a “I WAS ALWAYS men with babies inside the Neonatal In- I’ve been here awhile, guys, and so I will “These little miracles are very special, “Children with motor diŠculties such as CP huge improvement with her hands since we SITTING THERE CRYING. tensive Care Unit to share their stories give you some advice. Take it one day at and I hope the Dads’ Night program has have less opportunity to move and explore started using the car.” AND KATE WOULD and support each other. a time. Trust your baby will do the best made the fathers feel special in some Attendance waxes and wanes each she can.” small way,” he says. “Our message is their environment compared to same-age And, perhaps most importantly, Audrina COME TO ME AND SAY, month. On this particular Thursday, five It’s Nathan’s first Dads’ Night. quite strong and clear that dads matter, peers without motor delays,” Cooper says. loves it. “This can reduce their opportunities for learn- “It gives her freedom,” Kaitlyn says. She ‘CAN I GIVE YOU A HUG?’” dads gather around the kitchen table in “It was nice to talk to other dads who too, and play a vitally important part in the NICU Family Room. They talk about get it,” he says afterward. “I have found the birth and care of their new child.” ing, language and social development.” lights up when we ask her if she wants to go When Kaitlyn was approached about in her car. She even says ‘car.’ She’s definitely participating in a study that might aid in more into going than stopping!” • PHOTOGRAPHY BY DOUG NICHOLSON BY PHOTOGRAPHY

26 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 27

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 26 15-08-07 1:00 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 27 15-08-07 1:01 PM stein, director of the Centre for Youth are required to return for tests at regular and heart disease”, he says. agement at George Brown College this Bipolar Disorder at Sunnybrook and intervals, both during times of stable Another key component is cognitive fall and hopes to become a restaurant an award-winning researcher into the mood and times of bipolar episodes, behavioural therapy, Dr. Levitt says. “In or hotel manager. He sees taking part condition, has since enrolled John in over a period of two years. The blood youth, if you have bipolar [disorder], in research, such as Dr. Goldstein’s, as a five-year study he is conducting to draw is used to check for levels of spe- you need help dealing with intense critically important – not only for his “learn whether specific markers in the cific proteins in the blood (see sidebar). emotions.” future, but also for all bipolar teens. blood can help us better understand, The fingertip probe test, also called This has been especially true for “It would be great for them to have and predict, the course of symptoms peripheral arterial tonometry, mean- John. “It helps, definitely, when you are that data that could treat other pa- among adolescents with while, is done via a non-invasive clip able to talk to the therapist. You can tients.” bipolar disorder.” It may also guide placed on the index fingers. It measures actually work out what is causing your Dr. Westreich agrees. “The bottom future treatment of young people like the pulse-to-pulse blood volume several mood, why you are feeling that way.” line is, any research we have in terms of John, he says. minutes before and then after a blood He is also taking a mood stabilizer and understanding what could prevent the Bipolar disorder (BD), which is char- pressure cuff is used to prevent blood an anti-psychotic, which have worked illness, what causes the illness and how acterized by repeated episodes of mania flow for five minutes. Dr. Goldstein’s extremely well. John has been symp- we can mitigate it with the least amount and depression, affects 2 to 5 per cent team is looking at the extent to which tom-free for seven months. of side-effects is welcome, necessary of teens and adults. While risk of suicide the blood vessels dilate after blood flow Exercise, eating well and getting and could change the quality of life of so in patients is high, the leading cause is resumed with the cuff. Increased enough sleep are also crucial to success- many people in Canada.” of death is actually heart disease. The pulse volume in the fingertip reflects fully treating bipolar youths, says Dr. study, funded by the Canadian Institutes dilation, which, in turn, reflects blood Levitt. John, for his part, is now vigilant John’s name has been changed to of Health Research, will also look at how vessel function. about regular bedtimes. He does three protect confidentiality. the biomarkers in the blood and blood “A sluggish or minimal increase in workouts per week and he’s back on the vessel functioning might be related to pulse volume is a marker of potential tennis courts. future heart disease in adolescents and future cardiovascular risk. This blood “Exercise and healthy living are adults with the condition. vessel function is, in part, related to enhancing blood flow to the brains in “The fact is, people with bipolar [dis- acute circumstances, including mood those with bipolar illness, so we know order] have high rates of heart disease. episodes,” says Dr. Goldstein. that can be ‘brain-protective’ for young ON THE And they develop this extremely prema- It makes sense to study the biology people with the disorder,” says Dr. turely, 10 to 20 years earlier than expect- of otherwise healthy teens because Levitt. ed,” says Dr. Goldstein. “The question as many as two-thirds of patients first Moving forward, the big push is to HUNT FOR is, ‘Why?’ And my career is dedicated to develop the condition between the identify risk factors for the development answering that question.” ages of 13 and 19, says Dr. Goldstein. If of the condition. He continues, “If we Recent research has shown that those researchers were able to identify those can accurately identify risk factors, BIOMARKERS with the disorder experience upsurges who have biomarkers in their blood we know who’s going to develop it. [It Dr. Goldstein’s team at the Centre for Youth or decreases in certain types of proteins now, it would help physicians guide pre- would be helpful to] also recognize Bipolar Disorder at Sunnybrook will be study- in the blood, such as those related to ventative treatment when the disease is some of the vascular dangers of the dis- ing the blood samples of teens with bipolar inflammation during bipolar episodes. less entrenched. order – we know they exist, but we need disorder and healthy teens. Dr. Goldstein and his team predict that While the illness has been studied to recognize them early – so that people the spikes or dips in these proteins, fairly extensively in adults via cross- live longer, healthier lives.” They are looking to see, among other things, along with increased inflammation sectional studies, Dr. Goldstein notes, Dr. Neal Westreich, who co-heads the whether their blood contains several proteins, BIOMARKERS ohn remembers the onset of his over many years, can lead to a host of there are few studies that follow people hospital’s Adolescent Inpatient Psychi- including: Jbipolar disorder clearly. He began to diseases, such as heart disease, obesity over time, especially in teens. “There is a atry department, says that, up to this • Brain-derived neurotrophic factor (decreas- lose interest in all of the sports and ac- and arthritis. real dearth of information on this topic point, doctors are unable to use a blood es during acute depression or mania), tivities he once loved, including tennis Mapping out the biology of people in youth.” test to diagnose depression, bipolar dis- which assists in the growth, maturation and Hearts maintenance of nerve cells. It’s found in the and badminton, the summer he was 16 who are in phases of mania or depres- Current treatments for teens with bi- order or other psychological disorders. years old. sion will also allow doctors to predict polar disorder are not preventative, but, He says that the study of biomarkers brain and the blood. and minds “It got to the point where I stayed in the course of the illness, he says. rather, treat the symptoms of mania and “could help us make, in a more scientific • C-reactive protein (rises during episodes), bed all day.” “Right now, we have to wait for fully depression. They include drugs, therapy way, the diagnosis.” which is a protein produced by the liver that Why do people with bipolar Following that were the manic manifested symptoms to evolve and and lifestyle changes. Drugs include But he cautions that doctors likely indicates an increase in inflammation in the disorder have high rates episodes, like days-long road trips with present themselves. It’s a little like mood stabilizers (such as lithium), won’t simplify it to the point where “x” body. Higher levels of C-reactive protein of early heart disease and friends during which “I would do a lot saying we’re going to figure out heart anti-convulsants and anti-psychotics, biological issue causes bipolar disorder. can be a biomarker for future disease risk, of things I wouldn’t normally do, a lot disease by waiting for you to walk in says psychiatrist Dr. Anthony Levitt, “I think it’s going to be more complicat- including heart disease. other problems? The Centre of risky behaviour.” When he returned, having a heart attack. We want to pre- chief of the Hurvitz Brain Sciences Pro- ed than that,” says Dr. Westreich. • Interleukin-6 (marker of increased inflamma- for Youth Bipolar Disorder he would be unable to recall what had empt that.” gram at Sunnybrook. “In many ways, it is no different tion), which is a protein found in blood plas- is searching for clues in happened during the trips. To conduct the study, currently in its But psychiatrists have to be extremely than any other biological illness. Take ma that is produced during inflammatory proteins found in patients’ The highs and lows worsened until third year, Dr. Goldstein and his team of careful in selecting medication for those diabetes, for example. I would argue phases in the body. It is also released into they culminated in December 2013 with researchers will recruit teenagers with with bipolar disorder, the psychiatrist that it is a biological, social, psycholog- the bloodstream after a muscle contracts. blood a suicide attempt. John, then 18, was bipolar disorder, as well as a compari- adds, because most can cause side ical illness. It is dependent on lifestyle • TNF (tumour necrosis factor)-alpha (marker of increased inflammation), which is a    admitted to acute care at son group of teenagers without major effects, including weight gain. “If weight and compliance and stressors and, of Sunnybrook and was treated by Dr. psychiatric disorders. The testing con- goes up significantly, now you are at risk course, biology.” protein that appears during an acute phase Benjamin Goldstein, who diagnosed sists of blood draws and fingertip probe for other kinds of metabolic disturbanc- For his part, John is optimistic about of inflammation. • him with bipolar disorder. Dr. Gold- tests. The youth with bipolar disorder es, including diabetes, hypoglycemia his future. He is taking hospitality man-

28 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 29

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 28 15-08-07 1:01 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 29 15-08-07 1:01 PM cent of what a normal body feels.” But not long af- below left: found her wounds were contaminated. The proce- ter her recovery, she was going on walks and runs, Despite a horrific dures saved her life, but her arm was amputated and back to participating in sports. shark attack, above the elbow, and she was left with part of covered in our “A person who would meet her now would never her leg missing. She remained in hospital for two fall 2012 issue, know she had a stroke … doctors are amazed at months before going to St. John’s Rehab, now part Nicole Moore has how quickly she recovered,” says Mario. of Sunnybrook, to rebuild her life. fearlessly returned “One of the first questions I had for doctors Over the next four years, Nicole returned several to the ocean to while I was recovering was, ‘How long do I have to scuba dive. times to Sunnybrook to undergo reconstructive leg wait to have a baby?’” she says. surgeries, the last in February 2015. She hopes to “I was so close to having a baby – I got to hold below right: eventually use an arm prosthetic. her in my arms,” she adds about daughter Clem- Stan Rosenberger, “I’m now more appreciative of life and have entine, who only survived 10 days. “They told featured two more patience, and my children are remarkably me I had to wait about a year and a half” to have years ago in the sensitive to life and the preciousness of it,” says another baby, Tiffany says. She became pregnant magazine. Nicole, now 42. Her daughters are now 10 and 11 about a month and a half after getting the medical years old. green light. In 2013, Nicole returned to nursing at an Tiffany is even thinking of going back to school: Orangeville, Ont., hospital in a supervisory role “Spending six months in the hospitals, I just love because of her injuries. the nurses, and I thought becoming one would be She has also become a professional motivational so much fun.” speaker, and her story is the subject of a new book, due out in October, titled Shark Assault: An Amaz- ing Story of Survival, written by Peter Jennings and Nicole Moore and published by Dundurn Press. Every summer since her recovery, Nicole has been among hundreds of participants tackling the Warrior Dash – a 5.5-kilometre obstacle course that Tiany Scholl, featured in the magazine a year ago: takes participants through wooded lakes, mud- and with her baby Mars just days after his birth in July. filled back roads and daring heights at an Ontario resort. “I do it for myself and to show people no matter what obstacles are in the way, you can find a way to overcome it,” she says. FIFTH ANNIVERSARY Tiany Scholl Not one to let a shark have the last word, Nicole Fall 2014 issue has also returned to scuba diving, maintaining “a deep passion and respect for the ocean and the life Where Tiffany Scholl has come a long within it – a healthy fear, you could say, but respect way since going through the nonetheless.” darkest time in her life. In June are they 2013, Tiffany awoke from a coma to learn that her baby girl, Clementine, had died. Just a few Nicole now? days previously the Toronto hairdresser which causes thinning of the blood, and Moore underwent an emergency cesarean at eclampsia, a life-threatening pregnancy Fall 2012 issue     Sunnybrook after she suffered a massive complication that causes some pregnant stroke. women to develop seizures and/or fall Nicole Moore Just two years ago, doctors at Sunny- into a coma. nearly lost her Sunnybrook Magazine, which celebrates brook, one of Ontario’s regional stroke After the clot caused a hemorrhage life in a shark its fifth anniversary with this edition, is centres, saved her life from a brain within the left side of Tiffany’s brain, she, attack in Mexico only possible because of our inspiring hemorrhage that left her unconscious indeed, had a seizure before becoming in January 2011, patients and their stories of perseverance two-thirds of the way into her first unconscious. After Tiffany’s surgery, she but the nurse, and strength. pregnancy. had problems with memory, speaking athlete and The magazine has had the privilege But on July 14 of this year, Tiffany and and comprehension, and right arm and mother of two of profiling many of these patients over her husband Mario de Lima became leg paralysis. She spent four months in has come out the past five years. To commemorate the proud parents of a healthy baby boy. rehab, including two months at of that near brush with death with a renewed zest Stan Rosenberger anniversary, we’re looking back at five of At seven pounds, six ounces, Mars Sunnybrook to relearn walking and for life and a determination to encourage others to Spring 2013 issue the most dramatic stories we’ve featured, Clemente de Lima – named partly in talking. persevere through life’s challenges. updating readers on how each patient honour of the daughter the couple lost – It took a multidisciplinary approach Nicole became a patient in Sunnybrook’s Trauma You could say avid motorcyclist Stan Rosenberger

is doing today – as a testament to the was born by cesarean section. "He is so by Sunnybrook, also a leader in post- SCHOLL) ER (TIFFANY Unit a week after a shark tore away part of her left left cancer in the dust after he underwent a seam- impact they’ve had on both their own cute, and we are having so much fun," stroke psychiatric symptoms, to help leg, and after the same shark, or possibly another, less prostatectomy at Sunnybrook within days of families and the staff at Sunnybrook. Tiffany says. Doctors were especially Tiffany recover and get her back to her latched on to her left arm while she was vacation- being diagnosed with prostate cancer at age 48 in cautious when Tiffany learned she was outgoing, positive self. ing in Cancun. mid-2011. expecting again in late 2014, because She still has some memory problems She underwent surgery in Cancun, but was Over the last four years, the Bradford, Ont., her stroke was linked to two pregnan- and tends to lose her train of thought, flown to Toronto and had two lengthy emergency resident has taken on a new job, gone on long

cy complications: HELLP syndrome, and the right side of her body “is 40 per SCHOLL) (TIFFANY TIM FRASER TIM F RAS BY BY PHOTOGRAPHY PHOTOGRAPHY surgeries at Sunnybrook after plastic surgeons motorcycle rides with his buddies and purchased a

30 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 31

DM151570_Pg05-48_Sunnybrook_Fall_2015.indd 30 15-08-10 4:26 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 31 15-08-07 1:08 PM second “hog” motorcycle. In July 2013, just a below: bled a 14-member team, including obstetricians, below: With no detectable cancer today, Delaney still few weeks after his story was first profiled in Stan Rosenberger neurologists, anesthetists and two teams of three A happy gets a 30-minute infusion of T-DM1 every three Sunnybrook Magazine, Stan went on a five-day with his daughter, for the twins, to deal with the delicate situation. Janhunen family weeks at a Kitchener, Ont., hospital. Alisha, on vacation. portrait, and the hike from Skagway, Ala., back into Canada with his Myla first underwent a craniotomy (removal of a But most of her time is spent working two days a story of daughter, Alisha, and her husband. piece of the skull) to reduce pressure on her brain, week as an educational assistant in a junior kinder- right: Jan’s innovative Now 53, Stan has been married three decades and the obstetrics team then performed a cesar- garten classroom, planning time with her husband Myla Mendoza cancer treatment to Cathy, a school principal in Vaughan, Ont. They ean section. Twins Jamie, weighing just under six of 18 years, Paul, and their children (15, 13 and 10 Lopez and her from 2013. also have a 25-year-old son, Michael. family at Walt pounds, and Samantha, at just under five pounds, years old), as well as indulging in her hobbies. Thankfully, Stan says, he now has “no health Disney World were immediately ventilated and sent to the Neo- “I’m feeling great, working a bit and running af- issues.” in April 2015, and natal Intensive Care Unit (NICU). ter the kids,” says Delaney. “I don’t cling to the fact Stan was referred by his family physician to Dr. her story in the It took three days for Myla to wake up from the that I’ve beaten cancer. I go one day at a time, each Robert Nam, head of genitourinary cancer care magazine in 2013. surgery. Her memory wasn’t affected, and within day knowing God will direct my future.” at Sunnybrook’s Odette Cancer Centre, after a three weeks she was able to return home, undergo- Her advice for others battling cancer: “Consid- random prostate-specific antigen (PSA) test he ing follow-up skull surgery in November 2013, with er all your options and look at trials, which was a was given, while his wife was getting blood work little downtime. great option for me. You never know what’s going at their general practitioner’s office, produced In May 2014, about a year after the twins were to come down the pipeline.” troubling results. born, Myla went back to work as an administrative Dr. Nam ordered a biopsy, and Stan was diag- assistant at a Toronto hospital. nosed with an aggressive form of prostate cancer – “My health is very good,” the Vaughan resident even though he had no symptoms and wasn’t feel- says. “I’ve been taking the kids to swimming les- ing ill. He later learned he’s genetically predisposed sons every Sunday and I’ve been working out – on to prostate cancer, as two uncles on his mother’s my treadmill, doing DVD workouts. I’m back to a side had the disease. normal life.” Within days of Stan’s diagnosis, Dr. Nam per- formed delicate nerve-sparing surgery to remove Delaney Janhunen his prostate and surrounding tissues. “I was really Fall 2013 issue grateful for Dr. Nam’s approach – he did amazing surgery,” Stan says. “He was able to save a lot of the Gardening, reading, trying new recipes and nerves in the prostate, so I could still be sexually catching more of the travel bug are on the to-do active, which is a huge thing.” list these days of 44-year-old Delaney Janhunen, a About a year and a half after Stan’s prostatecto- mother of three who has faced breast cancer twice. my, the self-employed heating and air- At just 36 years old, Delaney was first diagnosed conditioning contractor sold his business to two with cancer in her right breast and in her liver. She of his workers, then took on a job as a fuel safety underwent a mastectomy and had ongoing drug inspector for the Technical Standards and Safety therapy, eliminating the cancer for about two and Authority (TSSA). a half years. Adventure, he says, is still in his blood. He and In 2007, Delaney was diagnosed with cancer a group of his motorcycling buddies are planning a second time, this time in the left breast. She a special trip in about two years to Europe, where learned from a friend about a clinical trial led by they’ll have motorcycles waiting for them to go on Myla Mendoza Lopez Sunnybrook’s Dr. Sunil Verma at the Odette Cancer a 10-day riding tour through the Swiss Alps and Fall 2013 issue Centre. The international study tested a new treat- several countries. ment for breast cancer called T-DM1 – a combina- Stan’s advice to other men who may think they’re Myla Mendoza Lopez and her family experienced tion of the targeted drug therapy Herceptin with too macho to have prostate problems? “Every- the trip of a lifetime – to Walt Disney World in the chemotherapy drug DM1. body’s worried about that proverbial finger in your Orlando, Fla. – in April 2015, about a month before The drug worked to kill Delaney’s cancer cells, bum, but get checked, guys, and get the blood her twin girls celebrated their second birthdays. without harming her [PSA] test.” Myla, her husband, Joel, a lab technician, their normal cells. She twins and her 20-year-old daughter Christina from experienced minimal a previous marriage are living life to the fullest side-effects like hair – more than two years after Myla survived a brain loss and fatigue. clot and swelling of the brain, just before her preg- Since Delaney’s nancy due date. participation in the “A week before that [stroke] happened, I saw the T-DM1 randomized ob-gyn and everything was fine, but pre-eclampsia clinical trial, the results can happen at any time – it can kick in just like have been published that,” Myla, who turned 44 this year, now recalls. in the prestigious New “Because of my age, I was high risk, and, secondly, England Journal of I had a twin pregnancy – so two risk factors.” Medicine, and this hy- Myla went to bed with a headache the night brid drug therapy has her husband called 911. She was taken to a local been approved for use hospital, where a doctor did a scan and doubted with these patients in whether she could recover. She was rushed to Sun- Canada and the United nybrook, where Dr. Leo da Costa quickly assem- States.

32 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 33

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 32 15-08-07 1:08 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 33 15-08-07 1:09 PM Be a hero to our heroes.

Commemorate Remembrance Day this year, by supporting Canada’s heroic veterans at Sunnybrook. Your support will help provide our veterans with community outings, continued learning opportunities and special time with family members.

PROSTATE CANCER because it challenged the prevailing view that all forms of prostate cancer Visit raiseaflag.ca on October 1, 2015 warrant immediate and aggressive to learn how you can become a hero. treatment. The game-changer “Overdiagnosis is a malady of mod- Sunnybrook’s Dr. Laurence Klotz started a worldwide ern medicine,” Dr. Klotz says. “My mes- sage to patients is: Just because you’re debate on how best to treat low-risk prostate cancer – diagnosed with this condition, doesn’t and won it necessarily mean your life is at risk. The problem with efforts to detect many    diseases early, when they are more cur- able, is that a lot of patients are found to n a good day, Dr. Laurence Klotz 16-year period. It found that among have conditions that would otherwise Ohits the club early to play tennis be- those managed with Active Surveillance not have been diagnosed during their fore heading to his office at Sunnybrook. with Selective Delayed Intervention, lifetime, and would not have affected “I feel better if I have some outlet the 15-year prostate cancer survival is them in any way. This is true of many like that,” he says. “It’s a great thing to 95 per cent, with two-thirds of patients cancers, including breast, thyroid, be able to play a game and then go to avoiding treatment entirely. and kidney cancer, as well as prostate work.” In active surveillance, men who have cancer. Some cancers, of course, are Dr. Klotz, a uro-oncologist and sur- prostate-specific antigen levels and oth- life-threatening. The challenge is to geon, has had a lot of good days lately, er factors that characterize their cancer differentiate which cancers pose a and, as reflected in the results of as low-risk can avoid overtreatment by threat and treat them aggressively, and numerous studies he’s led, so have being closely monitored and with the manage the remainder conservatively, many of his patients. Outcomes for men option to intervene with selective and monitoring for evidence of a change in with low-risk prostate cancer, who are definitive treatment, should risk levels the risk of disease progression. That is managed according to an approach increase over time. the basis for active surveillance.” Dr. Klotz helped develop, have shown The approach, developed in partner- This concept inspired years of debate impressive survival rates. ship with radiation oncologists, Dr. Cyril in the field of urology, and often re- A 2015 Journal of Clinical Oncology Danjoux and Dr. Richard Choo, was sulted in Dr. Klotz in lively panel discus- -published study led by Dr. Klotz revolutionary. It was not immediately sions with colleagues at conferences. followed 993 Canadian men over a embraced by the medical community Reflecting on what it took to persuade PHOTOGRAPH BY DOUG NICHOLSON BY PHOTOGRAPH

Fall 2015 | Sunnybrook Magazine 35

DM151570_Pg34_Sunnybrook_Fall_2015.indd 34 15-08-07 2:16 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 35 15-08-07 1:21 PM Walk in Tubs and Barrier Free Showers by others of a different way to treat low-risk prostate cancer, Dr. Klotz says he couldn’t have anticipated how central the debating skills he honed as an un- dergraduate member of the University of Toronto’s debating club would become. “For a year, I was president of the debating club. That experience was huge for me. You learn to think on your feet,” he says. “It was fortuitous that I ended up in a debate about how to manage pros- tate cancer. Everything you do in life, in some way, is grist for the mill, in some way helpful.” Eventually, evidence convinced colleagues of the merits of active surveillance, which is now the global standard in the management of localized, well-differentiated, low-risk prostate cancer. Dr. Klotz was named to the Order of Canada in 2014 for establishing that standard. “A lot of people in medicine make important contributions, but not all are recognized,” he says. “I’m a very fortunate guy. I never dreamed that things would work out this way.” Others are less surprised that Dr. Klotz is re- ceiving accolades. Dr. Larry Goldenberg, founding above: Born in Toronto, Dr. Klotz knew from an early director of the Vancouver Prostate Centre , credits Back in 1984, age that he would follow the example of his grand- Dr. Klotz with branding Canada as a leading force Dr. Klotz took part father, uncle and father, and go into medicine. The in the New York in the field. “He’s a transformative medical thinker. physical component of surgery resonated with City Marathon. He’s given it his all,” he says. “When he sees some- him, and that became the focus of his study. thing that is important or is a good idea, he’s been At the time, he says, urology seemed like a able to drive it. Every machine needs a driver, and neglected specialty in terms of research. He saw an he’s very comfortable getting into the driver’s seat.” opportunity to make a difference. “I was motivated Dr. Robert Siemens, who leads Queen’s Univer- by the desire to build something academic. The sity’s urology department and is editor-in-chief remarkable thing to me was that you could work of the Canadian Urological Association Journal, away, doing research in an area that you’re inter- a publication founded by Dr. Klotz, describes his ested in and publishing it,” he says. colleague as “a natural and tireless leader.” “It’s the magic of publishing; people actually “When you think of urology across the world, read [the findings]. If you are persistent enough, one of the people you think of is Laurie Klotz,” Dr. you develop a relationship with people who are Siemens says. “There has been a frame shift. Active interested in the same area,” says Dr. Klotz. surveillance is now considered the gold standard “I have all kinds of research projects going on for low-risk prostate cancer treatment. We have right now, and I’m enjoying every minute of it.” changed our approach.” Dr. Klotz’s enthusiasm for academia is bal- While the benefits of an active surveillance anced by passion for his wife, Ursula, and his two approach are considerable, Dr. Klotz is quick to children, Alex and Betsy, and by his love of jazz and emphasize a doctor’s role also includes finding sport. those patients in which the cancer has higher He plays three instruments, including piano potential to spread. in the band he started, and when he’s not on the “About one-third of patients who look like they tennis court, he can be found at a hockey rink or have very slow-growing non-significant cancers skiing. He’s also a prodigious reader, having just actually have cancers that are wolves in sheep’s finished Conrad Black’s Rise to Greatness: The FREE FREE FREE clothing,” he says. “The challenge is to find where History of Canada from the Vikings to the Present. the wolves are.” Dr. Klotz recently took a sailing trip in Sicily with Heated 24 jet Comfortable Current and future research focuses on the use his wife. of MRI and molecular biomarkers to assist in that Such an adventurous jaunt is typical of Dr. Klotz, Back Rest Air Massage Height Toilet pursuit, he says. Dr. Siemens jokes. “The legend would appear to be Dr. Klotz envisions a time where prediction is so true. He’ll run an all-day clinic and then get on a accurate that radical intervention for most low-risk plane to South America.” ORDER BY SEPT. 30 prostate cancer patients is no longer considered a Dr. Klotz has brought as much energy to his reasonable option. profession as he has to other aspects of his life, Dr. Dr. Klotz credits any success he’s had to his Siemens says. willingness to seize opportunities that came along. “He’s credited with bringing us together and “There was no overarching game plan. It was a setting us on a course. Most of us would point to 905-712-4251 matter of being opportunistic. Each issue present- Laurie as being the driver. He’s definitely a role ed its own opportunity,” he says. model,” says Dr. Siemens. www.carefreebathing.ca A FAMILY OWNED CANADIAN COMPANY

36 Sunnybrook Magazine | Fall 2015

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 36 15-08-07 1:21 PM DM151570_Pg37_Sunnybrook_Fall_2015.indd 37 15-08-07 2:50 PM Harvey, 72, suffers from atrial fibrillation (AF), left: 2014, as a patient of Dr. Eugene Crystal, director of a condition in which the upper chambers of the Harvey Atkin was Sunnybrook’s Schulich Heart Centre’s Arrhythmia heart race (up to 175 beats per minute) and thump one of the first Services, Harvey underwent an operation known patients to benefit erratically and out of sync with the lower cham- as a pulmonary vein isolation. This procedure is from heart surgery bers. made possible with Sunnybrook’s recent instal- using the robotic Experiencing an AF episode is very frightening, lation of a device known as a Vdrive™, the latest navigation system. says Harvey, because it can happen for no discern- addition to the Stereotaxis computerized, ible reason, day or night. “It’s like having someone magnet-guided technology. Sunnybrook is the standing in front of you and pounding hard on first hospital to install the robotic navigation your chest,” he says. system in Canada. When the heart fails to pump efficiently, symp- Instead of standing by the operating table and toms include dizziness, palpitations, shortness manually guiding the catheter, Dr. Crystal per- of breath and weakness. At worst, blood can pool forms the procedure robotically from a control and form clots, which can then block flow to other booth. “The Vdrive™ enhances access, reaching parts of the body, most dangerously to the heart the more challenging areas of the heart chambers and brain, causing a heart attack or stroke. with greater accuracy during ablation and reduced Many patients with AF can be successfully treat- risks of complications,” Dr. Crystal says. ed with medication and cardioversion, in which Recovery times are also reduced. Most patients paddles to the chest shock the heart to restore nor- can go home the same or following day. mal rhythm. However, chronic cases may require Ever since his Vdrive™ operation more than a surgery to eradicate the cluster of cells in the heart year ago, Harvey has been symptom-free. “It feels that are shooting out random electrical pulses that great,” he says. Before the procedure, he could only cause the arrhythmia. manage to walk up one flight of stairs. “Now I get a During the procedure, known as catheter abla- little winded three-quarters of the way up the CN tion, the surgeon stands by the patient and manu- Tower,” he says, joking. ally inserts a catheter into the groin, guiding it up Harvey can’t say enough about the treatment he to the heart. The catheter then delivers radio-fre- received at Sunnybrook. “Dr. Crystal and the team quency energy at temperatures reaching as high as is the best I’ve ever known. They are all very caring 50 C to ablate or “burn” the area that is triggering and conscientious.” While he is hopeful his AF is the episodes. under control, he says that there’s always a possi- Harvey has had four such operations, but each bility it could come back. “If it does, I know where time the arrhythmia returned. However, in July to go to get it fixed.”

FROM THE CONTROL BOOTH Dr. Eugene Crystal, director of Sunnybrook’s Schulich Heart Centre’s Arrhythmia Services, sits in front of a 42-inch screen, a keyboard, a mouse and a joystick-like control console known as “the puck.” But he’s not playing a video game. He’s fixing unhealthy hearts. With these tools, which are part of the newly installed Vdrive™ Stereotaxis robotic heart navigation system, Dr. Crystal is able to perform a procedure that eliminates the erratic heartbeats of his patients who suf- fer from atrial fibrillation. “Using robotic technology is better than using human hands to perform this surgery. There’s greater catheter stability,” says Dr. Crystal. CARDIAC CARE ou may have heard him on the By manipulating two one-tonne magnets in giant pods that wheel into Yradio or TV as the voice for Leon’s place on either side of his patient on the operating table, he moves a furniture. Or you may have seen him magnet-tipped, flexible, spaghetti noodle-thin catheter – or as many as in movies such as Barney’s Version or three – using the magnetic field to the deepest, innermost parts of the The age of Meatballs. But you may not know heart to administer an ablation using radio-frequency energy at tempera- Harvey Atkin, actor, comedian, in his tures as high as 50 C. “Magnets are a lot gentler and use less force.” • The flexibility and the robotic nature of the catheter make it much less robotic surgery most serious role – heart patient at The Vdrive™ offers a variety of improvements over the older mechani- likely to damage heart tissue. Sunnybrook’s Schulich Heart Centre. cal “pull-wire” system: • The electrophysiologist can move up to three catheters into place Computer-guided automation is becoming He is also one of the first to benefit • The Stereotaxis catheter is thin and flexible. from the safety of a control booth, instead of standing by the patient’s the most trusted assistant in the operating room from the hospital’s new, state-of-the-art • The catheter’s tip contains three miniscule magnets that respond to bedside and being exposed to radiation. robotic surgery navigation system to a magnetic field created by two pods containing powerful iron-ore • The amount of radiation required is reduced by more than half.

   repair his heart. TIM FRASER BY PHOTOGRAPH DOUG NICHOLSON BY PHOTOGRAPH magnets on each side of the operating table. • Patients can usually go home the same or following day. •

38 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 39

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 38 15-08-07 1:23 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 39 15-08-07 1:23 PM women on dialysis. Medical complications asso- left: contributes in our own particular areas. There are ciated with kidney disease mean that pregnancies Racquel Abalos not that many centres in the country with the kind in dialysis patients are uncommon. Typically, a (centre), pictured of expertise put together here,” says Dr. Tobe. “All with husband, pregnant woman on dialysis requires meticulous the nephrologists in our centre are either highly Randy, and care by a dedicated health-care team, including productive researchers or educators, or both. A lot Dr. Michelle nephrology, obstetrics and a full multidisciplinary of our focus is on training the next generation,” he Hladunewich, staff. Team members are available around the clock says. gave birth to baby to provide care during the pregnancy, which is Gabrielle after “Because nephrology doesn’t have that many considered to be high-risk. being carefully treatments, research is badly needed in terms of fig- Under the expert guidance of Dr. Hladunewich, managed through uring out why people develop kidney disease and and with the help of the team at Sunnybrook, a pregnancy on how you delay or – better yet – reverse the process. Racquel, who has since had a kidney transplant, dialysis. The fact that we have people involved in that makes gave birth to Gabrielle Ivy in September 2012. Sunnybrook a leader,” says Dr. Zahirieh. “Gabrielle means ‘God is my strength,’” she says. That leadership will be all the more productive “I had the best care possible,” says Racquel. “Dr. with Sunnybrook’s new Kidney Care Centre, set to Michelle and the home dialysis team, especially my open this fall. The new centre promises modern, nurse Raquel [Bersamira], cared for me 24-7. Dr. spacious facilities to help the doctors and their Michelle even checked in on me on weekends.” teams carry out their work and move forward with “We have very good success stories,” says Dr. their research. Hladunewich. “In pregnancy and kidney disease, “Once you have space, there’s the opportunity women who’ve been told they can’t have a baby or to be innovative,” says Dr. Hladunewich. “We’ll safely get through a pregnancy, that’s something have the opportunity to expand and build on our we’re quite world-renowned for – managing preg- existing research programs, [and] state-of-the-art nant women on dialysis.” facilities to teach the next generation will be criti- Dr. Hladunewich’s internationally renowned cal, as well.” pregnancy clinic is just one example of the unique No doubt patients will also appreciate the new kidney care clinics and experts available at Sun- space. And if it helps practitioners enhance their nybrook. Dr. Alireza Zahirieh’s HIV renal disease already-esteemed care, all the better. “I don’t think clinic offers care for patients with HIV infection and you could have a better team. We really have a works in conjunction with a large HIV infectious collaborative environment,” says Dr. Hladunewich. disease clinic. Dr. David Naimark focuses on pro- “We’ve always been ahead of our time. We’ve always gressive diabetic kidney disease, while Dr. Sheldon been innovative. We’re a very creative team. I think Tobe is a world expert in hypertension. His hyper- that’s good for patients.” tension clinic improves the lives of people with or at risk of developing kidney disease by focusing on the diagnosis and control of high blood pressure, a common cause of kidney disease. KIDNEY CARE CENTRE “She’s perfect.” recently led a major study that showed Beyond offering expert care, these clinics also “ONCE YOU HAVE SPACE, Those are the words all parents long to intensive dialysis treatment in pregnant play an important role in the practice-changing hear at the birth of their child, but they women with kidney failure leads to a research carried out by the nephrology division – a THERE’S THE OPPORTUNITY A gold were particularly poignant for Racquel higher proportion of live births than link that helps discoveries reach patients faster. The TO BE INNOVATIVE.” Abalos and her husband, Randy. standard dialysis care. “This study pro- clinics are also education hubs, where doctors train Racquel was just 27 when she was vides hope to young women on dialysis the kidney care specialists of tomorrow. - Dr. Michelle Hladunewich on standard diagnosed with nephropathy, or kidney who might want to consider having a “Sunnybrook’s an academic centre. Each of us Sunnybrook’s new Kidney Care Centre disease. When she became pregnant, her family,” says Dr. Hladunewich. doctor at an area hospital immediately During her pregnancy, Racquel un- of kidney referred her to Dr. Michelle derwent dialysis for six hours a day, six Hladunewich, head of Sunnybrook’s days a week, with one day of rest before nephrology and obstetrical medicine di- commencing again. There was also a THE NEW KIDNEY hypertension clinic at Sunnybrook. may require immediate access to the full range care visions. Dr. Hladunewich’s PreKiD Clinic risk the baby could be born with health In addition to 24 bright and spacious of hospital services. One grateful mother can provides care to young women with issues – the medications that Racquel hemodialysis stations, there will also be “Dialysis is not an easy journey – it’s for kidney disease or hypertension who are was taking are harmful to babies. CARE CENTRE space for education and research, aiding four hours, three to four times a week. [Now] testify to the quality of planning a pregnancy, require follow-up Dr. Hladunewich notes that pregnan- This fall, Sunnybrook hopes to cut the ribbon Sunnybrook’s clinician-researchers in their their families can be here with them,” says Dr. Sunnybrook’s nephrology during pregnancy or who need immedi- cy is often impossible in young women on a new 28,000-square-foot Kidney Care quest to improve the prevention and treatment Hladunewich. care. An all-new facility ate postpartum care. with advanced kidney disease because Centre, which will be located adjacent to of kidney disease. Although construction is already under way, To improve Racquel’s chances of a fertility declines as kidney disease pro- the Bayview campus. The centre promises The new centre will also improve their fundraising efforts continue to meet the costs promises more successes in healthy pregnancy and successful birth, gresses. “In the few women who are able state-of-the-art facilities to provide dialysis ability to teach the next generation of kidney of the new centre . research and treatment Dr. Hladunewich recommended she to conceive while on dialysis, pregnancy for research and training, and a wider array care experts by providing leading-edge “Sunnybrook is poised to transform the start treatment. “She told me I would is typically very complicated and can be of treatments for people with chronic kidney facilities that complement the skills of the services it provides to kidney patients and    have to go on dialysis,” recalls Racquel. dangerous for both mother and baby.” disease. clinician-educators and teachers. to truly become a global centre of excellence. “Frequent and longer dialysis ses- According to Dr. Hladunewich, since “We’re all looking forward to the move. The project also includes renovating and We can only achieve this with financial sions dramatically improve pregnancy 2000 there have only been 22 babies We’re going to have a much bigger, better updating the hemodialysis unit at Sunnybrook, support from the community,” says

outcomes,” says Dr. Hladunewich, who born in the Greater Toronto Area to DOUG NICHOLSON BY PHOTOGRAPH clinic space,” says Dr. Sheldon Tobe, who has a used for patients with more acute needs who Dr. Hladunewich. •

40 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 41

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 40 15-08-07 3:31 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 41 15-08-07 3:32 PM PSYCHIATRY A fresh start for at-risk teens A day program helps adolescents with psychological issues transition back into high school   

hile adolescence can be tough lor, the Fresh Start classes take place in emphasis on using projects to assess Wfor many teens, it has been a portable classroom on the grounds of learning skills, measure goals and track unusually challenging for Hannah. Like Sunnybrook’s Bayview campus. progress gave her the kind of structure other young people who are dealing Because participants may range in age she needed. “It pushes you at a certain with mental health difficulties, the now from 14 to 19 years and are in different point, and each week you have to set a 18-year-old has often felt frustrated and grades, the atmosphere is somewhat new goal,” she says. alone, and has missed a lot of school. akin to an old-fashioned one-room Her participation in Fresh Start made She has had attention deficit hyper- schoolhouse, and the academic materi- it clear, she adds, “that it’s my life, and activity disorder ever since childhood, al is tailored to each student. that I have a say. That is one of the main she says, “but when I was 13, I was “The teacher is able to individualize things that they do there. They say, ‘This diagnosed with depression, and I al- all of the programs,” Conn explains, “so is about you. This is your life, these are ready had anxiety. It was a combination that each student can earn the high- your choices and this is your treatment. of things.” Her feelings of anxiety were school credit commensurate with their This isn’t about anyone else.’” such, she adds, that it was impossible grade.” While returning to high school for her to leave her home. As a result, The program’s focus, however, is was still challenging, she felt that the she ended up losing out on a year and a less on academic progress than it is on program had laid the foundation for half of high school. therapeutic recovery. Its focus is “on making the transition. What’s more, she In November 2013, however, Hannah the process,” says Conn, “and not the says, “they help you get set up after you began attending Sunnybrook’s Fresh product.” leave. They don’t leave you in the wind.” Start program, and her life began to By taking the stress off of academic At the same time, she adds, “they change. “I had felt isolated through the advancement, she adds, the program’s don’t want us to always have to rely whole of my teenage years, until I went six-member team gets a better handle on them. They want us to, finally, by there,” she says. on how the kids are doing, “on what is the end of it, be able to say, ‘You know Together with the Toronto District getting in the way of them being able to what? I’m going to be okay.’” School Board (TDSB), Sunnybrook’s focus, to concentrate and interact with Today Hannah attends regular classes Division of Youth Psychiatry has been other students,” she says. at an alternative school, has made new running the intensive day-treatment While mornings are spent on in-class friends and is attaining A’s. “I didn’t program for almost three decades, tran- projects that highlight critical and know I could get amazing grades before sitioning troubled teens back to school. lateral thinking, afternoons are devoted I went to my new school,” she says, “but The name Fresh Start was actually to group therapy sessions. Facilitated by for me to be able to do that, I had to thought up by students who partic- a team, including the youth and child have been able to go to Fresh Start.” ipated in the program, says Linda Conn, counsellor, social workers and a psychi- For Conn, what is behind the success who has been its co-ordinator for the atrist, the themes range from life and of Fresh Start – aside from the great past 12 years. “These were kids who social skills to creative expression, and team of people she co-ordinates at Sun- were not sick enough to be in hospital, health and well-being. Once a week, nybrook – is the innovative program’s but not well enough to be in either a tra- each teen meets with the program’s holistic approach. ditional or even an alternative school,” consulting psychiatrist, Dr. David “We look at all the needs of the stu- she explains. Kreindler. dents,” she says. “Not just their mental Like Hannah, they are young people The intimate class size made her feel health needs, but their learning needs. in recovery from mental health or ad- comfortable, says Hannah, while the It is just really good wraparound care. diction issues, who need a safe learn- ing environment without the typical academic pressures of school, she adds. Rather, “the focus would be on therapy, and really helping them develop the “THEY SAY, ‘THIS IS ABOUT YOU. THIS IS skills to begin to assimilate and transi- Linda Conn, tion into school with more traditional YOUR LIFE, THESE ARE YOUR CHOICES AND co-ordinator of classrooms.” THIS IS YOUR TREATMENT. THIS ISN’T ABOUT Fresh Start, says the With courses lasting anywhere from program’s success two to three months, class sizes are ANYONE ELSE.’” stems from its small – no more than eight students - Hannah, Fresh Start participant holistic approach at a time. Taught by a qualified TDSB to care.

PHOTOGRAPH BY KEVIN VAN PASSEN KEVIN VAN BY PHOTOGRAPH teacher and a child and youth counsel-

42 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 43

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 42 15-08-07 3:30 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 43 15-08-07 1:28 PM Losing memories to Alzheimer’s is devastating enough. Now imagine losing your future.

The prospect of Alzheimer’s is terrifying for Sadie. She’s 28 years old. Her dad was just 57 when it took his life, putting her risk at an unnerving 50%. Sunnybrook’s Brain Repair Group aims to develop treatments that will help GIVING BACK As it turned out, Penny was in Palli- Sunnybrook opened in 1989 with eight ative Care for about 14 weeks. “For the beds; over time and to meet the growing restore and preserve critical first six weeks or so, despite the fact she need, we have gradually increased the cognitive functions in cases knew she was going to die, she was as number of beds to 56. The unit was Passing happy as I had seen her in a long, long originally designed for general complex of familial Alzheimer’s and time,” says Ernie. “That six weeks was a continuing care, not specifically palli- moments real bonus that none of us were expect- ative care. We recognize our physical other dementias. Learn more ing; it gave us a chance to enjoy some environment needs to be enhanced to Donors like Ernie Loch are very good time together.” best meet the needs of our patients and about Sunnybrook’s Hurvitz helping make renovations On Christmas Eve as the family was families,” says De Costa. possible for Sunnybrook’s visiting, Penny took a turn for the worse. Plans for the space include a room Brain Sciences Program: “That’s when I decided the least that I where loved ones can gather to cel- Palliative Care Unit could do was donate what would have ebrate birthdays, anniversaries and sunnybrook.ca/brain    been the cost of having her at home to cultural rituals, as well as a redesigned palliative care, because of what they had kitchen and dining area to allow fam- done for her, giving her those six weeks ilies to enjoy their meals together at a enelope Loch was just 68 years old that were so enjoyable for all of us,” says dining table. Single rooms and addi- Pwhen she finally succumbed to Ernie, a self-employed entrepreneur. tional sleeping accommodation will cancer. What started as lung cancer had “One of the reasons she was as happy be added for family members to stay spread to other parts of her body by the as she was, was the care the staff and overnight, and an office space will be time she was admitted to palliative care the nurses gave to her; it was just out- available for those who need to work at Sunnybrook two and a half years ago. standing. They were very supportive, remotely. “She was in the cancer care ward at very helpful.” The renovations are only possible Sunnybrook. We had talked about her After Penny died, Ernie donated because of donations from the com- going into palliative care, and she didn’t $50,000 to palliative care at Sunnybrook. munity, De Costa explains, as this want to go, so I made arrangements so Today, a recognition plaque in Penny’s type of renovation is not traditionally she could be at home – caregivers, hos- memory hangs outside the room she covered by government. The project pital bed, oxygen, all the details,” recalls stayed in. was launched with a gift of $1.2-million her husband, Ernie Loch. Since Penny’s death, the Palliative from McDermott House Canada. While “I was all ready for her to come home Care Unit has experienced a revival of funding for the first phase of the reno- when I got a call from the cancer care sorts, making plans for physical im- vations is almost complete, fundraising clinic that she had been transferred to provements to the centre. “Our goal is to continues for the next two phases. palliative care. I went over there and her create a premier palliative care unit that Thanks to the support of donors like first words were, ‘What a marvellous will significantly change the end-of-life Ernie and McDermott House Canada, place this is,’” says Ernie, who remem- experience for our patients and their the centre will continue to offer those bers the view she enjoyed – Penny had a families,” says Sandra De Costa, Patient with a terminal illness a comforting, room that looked out on to the court- Care Manager at Sunnybrook’s Palliative home-like environment where families yard – and how she thought the people Care Unit. can spend quality time with their were “so nice.” “The Palliative Care Unit at loved ones. PHOTOGRAPH BY MICHELLE SIU BY PHOTOGRAPH

44 Sunnybrook Magazine | Fall 2015

SB16608_01_Sadie_Globe.indd 1 2015-03-06 10:37 AM DM151570_Pg44_Sunnybrook_Fall_2015.indd 44 15-08-07 2:50 PM DM151418_Pg43_Sunnybrook_APR_2015.inddDM151570_Pg45_Sunnybrook_Fall_2015.indd 45 43 15-03-1115-08-07 11:01 2:49 PMAM SB16608_01_Sadie_Globe 0 0 16608-01 4C Newspaper Ad 8.125” x 10.75” 100% JAW Globe & Mail 03/06/15 Sunnybrook Kendra 7.25” x 10”

PMS PMS PMS PMS PMS FOIL 8.375” x 11” 100% RESEARCH & INNOVATION the latest in leading-edge developments at Sunnybrook GETTING A NEW TERRAIN SLEEP AWAY BETTER HANDLE FOR TAVI THOSE TOXINS ON SUPERBUGS Sunnybrook is breaking new Cleanses are all the rage, but Forewarned is forearmed. That’s ground on the minimally invasive how about detoxing your brain? A why Sunnybrook researchers transcatheter aortic valve Sunnybrook research team has a are helping to more frequently implantation (TAVI) procedure for simple fix: good-quality sleep. DECONSTRUCTING survey and assess the presence an entirely new group of patients “Sleep may play an important of superbugs, or antibiotic- deemed too high risk for open- role in clearing waste and toxins resistant organisms, in Canadian heart surgery. in the brain that may contribute hospitals. Their goal is to better Sunnybrook pioneered the use to the development of brain CONCUSSION inform infection prevention and of the TAVI procedure to repair the diseases,” says Dr. Mark Boulos, control programs, and to stem the aortic valve of patients who are a stroke and sleep neurologist The effects of concussion can linger after tide of antibiotic resistance, which too frail to withstand open-heart in the Hurvitz Brain Sciences a head injury, sometimes for an extended has been declared a major threat surgery. It involves loading a col- Program at Sunnybrook. period of time. Headaches, trouble con- by the Public Health Agency of lapsible replacement valve into Unlike other organs in the body, centrating, forgetfulness, unusual tiredness Canada and the World Health a catheter and sending it through the brain doesn’t have a dedi- and trouble with balance are common Organization. an artery up the leg and through cated lymphatic waste removal symptoms. Dr. Andrew Simor, chief of to the aortic valve. Here, the new system. Instead, researchers be- In some cases, a premature return to work Sunnybrook’s Microbiology valve sits inside the damaged one lieve it uses fluid-filled channels or other activity can worsen these symp- Department, and the Division of and takes over the job of regulat- that surround the brain’s blood toms and make them last longer. Infectious Diseases, and his team ing blood flow. vessels to drain toxins and waste “Unfortunately, doctors are often left to are measuring the impact of anti- Recently, Sunnybrook experts products away. do a lot of guesswork as to when an indi- biotic resistance and demonstrat- were among the first in Canada to The Sunnybrook research team vidual is best fit to return to regular activity, ing to the medical community that implant TAVI valves, made from looked at MRI brain scans and as there currently is no good objective in- careful use of antibiotics is critical artificial material and designed overnight sleep studies from 26 dicator of readiness to return to an activity, to patient health. for the aorta, inside one patient’s patients who were being eval- whether it be work, a professional sport or Dr. Simor led the first national failing artificial mitral valve and uated for stroke or a suspected recreational [in nature],” says Dr. Leodante survey of prevalence rates in inside another patient’s artificial cerebrovascular event. Using MRI da Costa, a neurosurgeon at Sunnybrook. more than 176 acute-care hospi- tricuspid valve. brain scans, researchers could Dr. da Costa and his research team tals. The 2013 report provided a These are patients whose own see that those with poor-quality wanted to find a solution to the lack of ob- much-needed baseline and more valves failed years ago and who sleep, or “choppy” sleep with fre- jective criteria to assess patients with brain detailed national picture of rates had surgery to implant replace- quent waking, had more enlarged injuries. They are using a unique technique of superbugs like MRSA (meth- ment tissue valves. But these channels around their brain’s for precisely measuring the brain’s vascular icillin-resistant Staphylococcus tissue replacement valves have a blood vessels than those with response to the stimulus of carbon dioxide aureus) and VRE (vancomycin- limited life span, says cardiovas- healthy sleep patterns. Research- (CO2) during MRI scans. resistant enterococci) and the cular surgeon, Dr. Gideon Cohen. ers believe that could be a result “The technique is similar to breathing in related CDI (Clostridium difficile They become calcified and of a buildup of toxins. a paper bag, but the inhaled and exhaled infection). degenerate over time, typically Dr. Boulos says the research gases are precisely measured,” says Dr. da His follow-up survey published lasting up to about 10 years. could potentially provide a novel Costa. “It’s a breathing challenge that acts in 2015 found that on any given “What’s different about this treatment option for patients as a stress test for the brain.” day, at least one in 11 patients new procedure is the use of TAVI living with the effects of stroke or In the study, a precise amount of CO2 is across the country carries or is in- technology to replace valves other brain diseases. given through a breathing mask while the fected with an antibiotic-resistant other than the aortic valve,” says Should you worry about the patient is still in the MRI. The CO2 causes an organism. The report identified Dr. Cohen, who performed the occasional night of bad sleep? “If increase in the size of healthy vessels, and a number of important infection new procedure with cardiologists you have a sleep problem, see a specialized imaging technique known as prevention and control practices Dr. Sam Radhakrishnan and Dr. your doctor about improving your a BOLD sequence is taken to measure the that were associated with lower Harindra Wijeysundera. “This quality of sleep,” says Dr. Boulos. changes in oxygen inside the vessels. If the antibiotic-resistance rates. is much less risky, it’s a much “Don’t just attribute poor sleep to vessels don’t react to CO2, the brain could This study was the first to pro- quicker recovery and you get the your age or an underlying health still be recovering from trauma. vide national prevalence results same result as surgery.” condition. It’s good to have it The researchers hope to develop an for multidrug-resistant superbugs All TAVI procedures at Sunny- checked out because, over the imaging marker of recovery for concussion in Canada. brook were once funded entirely years, it could have implications that doctors can use to more objectively “The more we know on a timely through the generosity of donors. for your overall health.” measure when it is safe for patients to basis about what’s happening in Convinced of its efficacy after That’s advice to sleep on. • become active again. hospitals across the country, the Sunnybrook experts saved more Dr. da Costa’s team was the only more equipped we are to stop than 150 lives with TAVI, the Canadian group to receive funding for antibiotic-resistant bugs from procedure is now funded by the their study from the GE-NFL Head Health growing and spreading,” says provincial government. • Challenge. Dr. Simor. •

46 Sunnybrook Magazine | Fall 2015 Fall 2015 | Sunnybrook Magazine 47

DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 46 15-08-07 1:53 PM DM151570_Pg01-47_Sunnybrook_Fall_2015.indd 47 15-08-07 1:53 PM DM151570_Pg05-48_Sunnybrook_Fall_2015.indd 48 48 I dogs andtheunconditional love patient toevery theybring er, Sarah Alexis, isastrong believer inthepower oftherapy fatigue, painandeven feelingsofstress andanxiety. Her own- a doublehigh-five orrolling over. connection. Other patientsprefer oneofhermany tricks, like previous visit.Sometimes, it’s justaquietmomentofphysical whattheyneedorrememberintuitively discern from a Unit, andthe in-patientpsychiatry Veterans Centre. hashermakingtheroundsvast inthePalliative portfolio Care residents thetwoyears she’s during beenatSunnybrook. Her difficult moments. job well. She makespeople happy someoftheirmost during (or portie, asherbreed is affectionatelycalled)knows her tic Paws ofCanada, thiseight-year-old Portuguese Water Dog of medicinethree timesperweek. Asamemberof Therapeu-   on fourlegs Therapist DOGS WITHJOBS Sunnybrook Magazine |Fall2015 therapy dogvolunteers totreat patientswithherown form vy swaggersontotheSunnybrook campus accompaniedby Therapy dogshave beenshown toreduce bloodpressure, And asIvy moves from patienttopatient,she’ll either Ivy hastouchedthelives ofhundreds ofpatientsand be there whenitmatters most. patients face. Andwhileshecannotcure, shecandefinitely cocoon ahandinneed. shampoo –keepIvy’s blackcoatshiny, softandready to oatmeal inomega-3s–alongwithher favourite A dietrich rewardfavourite isafishtreat. allthosetricks forperforming fur, soshedoesn’t shed.Knowing this, it’s fittingthather they are hypoallergenic. Ivy’s thick coatisactuallyhair, not her reactions tothestimuliofhospitalenvironment. She testing thatevaluated formalized easilypassedfurther grew training up inaperfect ground: ahousefullofchildren. perament andtheabilitytobesociablewithstrangers. Ivy Ivybring inforherSunnybrook shifts. theirtimeto volunteering and Carol, taketurns Alexis’s parents, Nick interaction. Sarah volunteering theirtimeto volunteering

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parents were were parents Calgary 15-08-10 4:26 PM

PHOTOGRAPH BY DOUG NICHOLSON DM151570_PgIBC_Sunnybrook_Fall_2015.indd 1 please refer to Oceania Cruiseswebsite orbrochure. airfare included from Toronto and major Canadian cities; Shipboard credits are per stateroom and not redeemable for cash. For full terms and conditions, All fares are per person based on double in US dollars; subject to availability at time of booking and include all taxes and service fees. Roundtrip Economy New Englandsailings: Baltic, Alaska &Canada/ Transatlantic, Mediterranean, Experience on2016 Select Our all-inclusive Oceania Country Club-casualambiance, OpenDining,Specialtyrestaurants at noextra charge, Free &Unlimited Softdrinks&Bottled FREE Shore Excursions- FREE Unlimited Internet 2 FOR 1CRUISEFARES plusFREEAIRFARE* Available onVeranda Staterooms andabove water, Gourmetculinaryprogram created by world –renowned master Chef Jacques Pepin andmuchmore… BONUS VALUE OFUPTO $6,600 & US$300shipboard credits perstateroom Special Offer: Free Internet, Gratuities, 4Free Shore Excursions For veranda stateroom (cat B4-282sq.ft.) at US$6699 ppbasedondouble All-inclusive from Toronto: 14 DAY SPRINGSERENADE“VENICE/BARCELONA” May 20/16 onRiviera & US$200shipboard credits perstateroom Special Offer: Free Internet, Gratuities, 4Free Shore Excursions For veranda stateroom (cat B3-282sq.ft.) at US$6199 pp based ondouble All-inclusive from Toronto: 12 DAY JEWELSOFTHEAEGEAN“ISTANBUL/ISTANBUL” Sep 21/16 onRivieraSep 21/16 MAGNIFICENT NEWEST SHIPS:RIVIERAANDMARINA FREE Pre-Paid Gratuities Toll Free:1-800-463-1512 Ext.262 ADVANTAGE NEW www.magdacruises.com Life Inquire for OtherIitneraries at OurSpecialRates! 416-733-7620 • FREE Unlimited Soft Drinks, Bottled • FREEUnlimited SoftDrinks,Bottled • Upto 5FREEShore excursions • FREERoundtrip Economy airfare from Water &SpecialtyCoffee Toronto andmajorCanadiancities

& US$300shipboard credits perstateroom Special Offer: Free Internet, Gratuities, 4Free Shore Excursions For veranda stateroom (cat B4-282sq.ft.) at US$7799 basedondouble pp All-inclusive from Toronto: 14 DAY OLDWORLD TREASURES “STOCKHOLM/LONDON” July 22/16 onMarina July 22/16 May 14/16 onMarina & US$300shipboard credits perstateroom Special Offer: Free Internet, Gratuities, 5Free Shore Excursions For veranda stateroom (cat B4-282sq.ft.) at US$4399 ppbasedondouble All-inclusive from Toronto: 15 DAY ESSENCE OFTHEATLANTIC “NEWYORK/LISBON” NEW INCLUSIVE SPECIALS IFBOOKEDBY SEP30/15!

Award-winning Mid-Size ShipsFinest Cuisineat Sea Destination Specialists Extraordinary Value

1075 Bay St.,Toronto, OnM5S2B1

[email protected] contact: • Upto US$300Shipboard credits per • FREEPrepaid Gratuities, taxes andtransfers • FREESpecialtydining • FREEUnlimited Internet (65,000 tons, 1258guests) stateroom NEW WAVETRAVEL,

Magda Newman

15-08-07 2:48 PM Ont reg. #1337762 OntTICO reg.#1337762 #50021715 ELIZABETH SCHINDLER

1912 AVENUE ROAD, TORONTO (416) 789-1919 ELIZABETH-SCHINDLER.COM *May not be exactly as shown

DM151570_PgOBC_Sunnybrook_Fall_2015.indd 1 15-08-07 2:13 PM