WINNIPEG’S HEALTH & WELLNESS MAGAZINE NOV/DEC 2009

COMMITMENT TO QUALITY A Winnipeg doctor is using lessons from business to deliver better health care IN THE PINK The tale of one woman’s triumph over breast cancer

PLUS Shovel snow safely Healthy eats and festive treats Your wellness gift guide How to beat frostbite Magnificent mandarins STRIKINGSTRIKING AA BALANCEBALANCE Scott and Lia Arniel talk about life – at work and at home

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For more information on staying healthy during influenza season, please visit ... 2EDUCEYOUR Nursing in Manitoba RISKOFCANCER First Nation Communities This holiday season, — Realize your potential remember to EAT WELL Full-time, part-time and resource pool opportunities are currently available for nurses in the following areas: to reduce your • Nurse Practitioners • Registered Nurses for primary care services including treatment, emergency risk of cancer. services and public health in rural and remote nursing stations. • Public Health Nurses • Mental Health Nurses • Community Health Nurses – Immunization Requirement: Registration as an R.N. with the College of Registered Nurses of Manitoba. For more information visit: www.healthcanada.gc.ca/nursingjobs You may request an application package by contacting us at 1-866-766-6784 or writing to us at: Nurse Recruitment First Nations and Inuit Health Program Health Canada 300-391 York Avenue, 3rd floor Winnipeg, Manitoba R3C 4W1 Or Email at: [email protected]

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Aboriginal Health Programs offers interpreter services, patient advocacy, discharge planning, spiritual and cultural care, community connection, employment opportunities, youth outreach and internships, and cultural training and education within the Winnipeg health region. 38 44

Table of contents Features Striking a balance Scott and Lia Arniel talk about life – at work and at home 16

In the pink One woman’s triumph over breast cancer 24

Winterize yourself How to beat the cold-weather doldrums 38

Departments & Columns A Letter from the Winnipeg Health Region Get the shot, not the flu 7

Health Beat 12 Emergency Department wait times posted; Shovelling snow safely; Falls prevention 8

Region News Influenza clinics underway 12

Science & Research Commitment to quality 32 24 Ask a Nurse How to treat frostbite and hypothermia 42 48 In Motion Your wellness gift guide 44

Big Picture Magnificent mandarins 47

Healthy Eating Healthy eats and festive treats 48

November/December 2009 5 McPhillips Hearing & Audiology Centre Inc.

November/December 2009 Volume 1 Issue 4 www.audiology-online.com Your Ears Deserve An Audiologist Publisher Winnipeg Regional Health Authority President & CEO Dr. Brian Postl Regional Director, Communications Christine Dino, Au.D. & Public Affairs Michele Augert Doctor of Audiology Editor Brian Cole

Contributing Writers Nelle Oosterom, Joel Schlesinger, Call For A Consultation Judy Owen, Martin Zeilig Before Buying Hearing Aids Columnists Jodis McCaine, Kristine Hayward, Linda Coote

Creative Director Krista Lawson Photographers Marianne Helm, Ian McCausland Illustrator Krista Lawson

On the Cover Scott and Lia Arniel, photographed by Marianne Helm at Bella Moda Home Furnishings

Editorial Advisory Board Jan Currie, Lynda Tjaden, Dr. Michael Moffatt, Dr. Wayne Hildahl, Dr. Cheryl Rockman-Greenberg, Réal J. Cloutier Check out for our Winnipeg Free Press promotional video - type oticon delta Publisher Bob Cox VP Sales & Marketing Laurie Finley Manager, Advertising Tracy Mainland Ph. (204) 953-4200 Wave is published six times a year by the Winnipeg Regional 1399 McPhillips St. Health Authority in co-operation with the Winnipeg Free Press. It Northgate Shopping Centre is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books. Winnipeg, MB R2V 3C4

Advertising Sales Call your Winnipeg Free Press sales representative or phone 204.697.7389. Subscriptions YOU DON’T Wave is available through subscription: One year (six issues) for $12.60 ($12+GST) Payment may be made by cheque, money order, NEED A DIET. VISA, or MasterCard. To subscribe: Phone: 204.697.7122 YOU NEED Fax: 204.697.7370 Send an e-mail to: [email protected] MOMENTUM. Or write to: Wave C/O Winnipeg Free Press 1355 Mountain Avenue Winnipeg, MB R2X 3B6

Editorial Office Winnipeg Regional Health Authority 650 Main Street Winnipeg, MB R3B 1E2 Phone: 204.926.8144 E-mail: [email protected] A French-language version of this magazine is available at www.wrha.mb.ca/lacourant. You can request a printed copy by calling 204.926.7000.

The information in this magazine is not meant to be a substitute for professional medical advice. Always seek advice from your physician or another health professional regarding any medi- cal condition or treatment. Opinions and views expressed in this publication do not always represent those of the Winnipeg Regional Health Authority. This publication may not be reprinted or reproduced in whole or in part without the consent of the Winnipeg Health Region. For information on pricing, class times and locations in your area call 1-800-651-6000 or 987-7546

6 WAVE A Letter from the Winnipeg Health Region Dr. Brian Postl, President & CEO Get the shot, not the flu

s this issue of Wave goes to As our story on page 12 points out, these I’d also like to thank some of our other Aprint, the Winnipeg Health clinics have been administering vaccine partners, groups like the Red Cross, St. Region is entering the fifth week to an average of nearly 12,000 people a John’s Ambulance, Salvation Army and of its immunization campaign, day when operating at full capacity. But others for their help in the campaign. the largest mass effort of its kind we also went the extra mile to ensure Of course, an effort like this one couldn’t those most vulnerable to the effects of be successful without the co-operation of in recent memory. H1N1 are protected. For example, we you – the residents of this community who And while I am certainly not about established groups of nurses and outreach came out to the clinics and patiently stood to tempt fate and declare “Mission workers, known as equity teams, to seek in line to be immunized. The building Accomplished” at this point, the evidence out and immunize those who often fall of a healthy community is a partnership suggests that our community is weathering between the cracks in our society, such as between health-care providers and the the second wave of the H1N1 influenza the homeless, and those struggling with people they serve, and you have certainly outbreak fairly well, especially compared addiction and mental illness. We have also done your part. to other parts of Canada. reached out to those unable to attend our I had a chance to see that partnership in While we have recorded 481 lab- clinics because of mobility issues. action in another context while working confirmed H1N1 cases since Oct. 6 Organizing and running a campaign a shift in my capacity as a pediatrician (considered to be the start of the second of this kind is no simple thing. As one one Sunday at the Children’s Hospital wave), there has not been a surge in the colleague jokingly noted the other day, we H1N1satellite care centre. While the number of people requiring in-hospital had to look under every manhole cover numbers of sick children showing up for treatment. Children appear to be more in the city to find the nurses, pharmacists care remained high, the flow of patients susceptible to the virus this time around. and other staff needed to operate the 12 through the care centre ran smoothly. The rush of parents bringing their mass clinics on a daily basis. Making Many of the parents I saw were concerned children to Children’s but calm, and seemed very Hospital with flu-like appreciative of this special symptoms in November attention to the needs of prompted us to open a their children. satellite clinic to take If all goes according pressure off the pediatric to plan, we will soon be Emergency Department. entering the next phase But again, there has been of our immunization no significant increase in campaign. As our clinics the number of children wind down, we will requiring in-hospital care. be making H1N1 and So far this fall, two deaths seasonal vaccine available in Manitoba have been to all family doctors. While linked to the H1N1 virus. we appear to be managing The number of H1N1- this outbreak relatively related deaths has been well, we are not out of the higher in other parts of the woods yet. Traditionally, Dr. Brian Postl gets immunized by Geneviéve Lavallée at a Winnipeg Health Region clinic. country. Across Canada, the influenza season about 250 people have died begins in fall and ends in from H1N1-related causes since last April. this campaign work required the help of spring. That means there still is time for It’s impossible to know for sure, but I’d 400 nurses, including 80 public health the H1N1 virus to surge, or perhaps for like to think that the relatively low level of nurses; 62 pharmacists and pharmacy another strain to emerge. Virus activity may H1N1 activity has something to do with technologists, and 100 volunteers. And be subsiding, but we need to guard against our efforts to contain the spread of the that doesn’t take into account the nurses becoming complacent. The best way to virus. From a public health perspective, at Health Links - Info Santé, who provide do that is to take the time to get a flu shot, this fall’s immunization campaign has advice to the public, or the administrative either from one of our clinics or from been a tremendous success. Despite staff who manage the clinics and take your doctor. In doing so, you will not only some supply problems in the first few care of matters like renting space and protect yourself, you will also help stop the weeks of the effort, we have already organizing communications. spread of the virus to others who may be immunized more than 175,000 people and On behalf of the Winnipeg Health more vulnerable. As the gift-giving season may exceed 200,000 people before the Region, I’d like to thank everyone involved approaches, what would make a better campaign winds down in December. in making this campaign a success – the present for you and yours? Most of these vaccines were staff, as well as our human resources and On that note, I’d like to wish everyone administered through various mass clinics union leaders, who all worked to make a happy holiday season and all the best in strategically located throughout the city. things happen as efficiently as possible. the New Year.

November/December 2009 7 health beat

Seven Oaks posts ED wait times Pilot project aims to improve patient communication

he Winnipeg Health Region has launched a new Tpilot project at Seven Oaks General Hospital to improve communication and service to Emergency Lauren Kozub is a nurse in the Seven Oaks General Hospital Emergency Department. Department visitors.

“When visiting an emergency room, said it is important that people waiting for a form for patients and families to pro- patients and families want to know what to emergency help do not get frustrated and vide feedback and suggestions to further expect and how quickly they will receive leave. “No one should leave without being improve emergency care. the care they need,” Health Minister The- treated,” he said. Lori Lamont, Region Vice President and resa Oswald says. “This pilot project will The electronic information board draws Chief Nursing Officer, says the project provide patients with more information on up-to-date information from the Emer- shows how the patient experience can be and improve the communication between gency Department Information System to improved at little cost. “The physical cost patients and their health care providers.” provide details on the number of patients of the project was minimal – mostly the A new electronic information board has in the waiting room, average time patients cost of the TV screen and a computer – but been added to the patient waiting area have been waiting, longest time a patient a lot of planning and background work to provide regularly updated informa- currently in the waiting room has been took place by technical staff before it could tion on how busy the emergency depart- waiting, and the average time patients now proceed,” she says, noting the system ment is and approximate wait times. A receiving treatment waited to see a doctor. was developed internally and cost under new brochure will support ED visitors in The new information brochure includes $9,700. understanding the care they receive and information on the initial assessment and The Seven Oaks pilot will be evaluated, encourage feedback and suggestions on exam process, discusses the importance including patient feedback, and changes their experience. of not leaving before being treated, assists may be made to further enhance the “We’re working to see patients safely in answering key questions, and includes system. and quickly, and ensure that seriously ill patients are given priority for care,” says Dr. Brian Postl, President and CEO of the Winnipeg Health Region. “We also want to support the patient’s visit to the Emergency Department.” “The pilot project will prevent frustration because it helps communicate directly to A monitor in individuals and family members waiting,” the Emergency says Dr. Ricardo Lobato de Faria, Emergen- Department will cy Medicine Director for the Region. display informa- Dr. Lobato de Faria, who is also the pro- tion about wait vincial advisor on emergency patient care, times.

8 WAVE Newsline Healthy Reading A brief roundup of health and wellness These titles have been recommended from thousands of books news stories online. available at local bookstores. For more health and wellness reading recommendations, please visit the online community at You are what you eat www.mcnallyrobinson.com, or visit any McNally Robinson bookstore. A study by researchers in the United King- dom and France suggests that a diet of fruit, Dr. Susan’s Fit & Fun Family Action Plan, vegetables and fish may help guard against Dr. Susan Bartell depression in middle-aged people. To read more, visit Medical News Today at www. With an alarming number of children overweight or medicalnewstoday.com/articles/169489.php obese, parents are desperate for easy, healthy solutions – but wary of major lifestyle changes and parental guilt. It’s time for a simpler approach. This book delivers it by providing hundreds of tips and optimistic, savvy advice for raising a healthy, happy child.

Soap and Water and Common Sense: The Definitive Guide to Viruses, Bacteria, Parasites, and Disease, Dr. Bonnie Henry As a physician who has spent nearly two decades chasing bugs all over the world – from Ebola in Ugan- da, to polio in Pakistan, to SARS in Toronto – leading epidemiologist and public health physician Bonnie Henry offers three simple rules to help people avoid getting sick: clean your hands, cover your mouth when you cough, and stay at home when you have a fever. It all boils down to basic hygiene. In this com- pelling book, Dr. Henry profiles the threats and dispels some of the common myths and misinformation about Diet, exercise delay good and bad bugs, and provides readers with the most important diabetes measures needed to keep themselves and their families healthy. Diet and exercise can delay the onset of The Cancer-Fighting Kitchen, Rebecca Katz with Mat Edelson diabetes for up to a decade, according to American researchers. The study, conduct- As the executive chef-in-residence at a leading cancer wellness centre, ed by Dr. William C. Knowler of the U.S. Rebecca Katz knows that cancer patients and their caretakers want National Institute of Diabetes and Diges- science-based recipes that are tasty, healthful, and tive and Kidney Diseases, indicates that easy to prepare. This book features whole-foods and losing weight and exercising is more effec- big-flavour recipes designed to ease symptoms, along tive than some prescriptions in delaying the with customized menu plans specially formulated for onset of diabetes. The study’s findings were all treatment phases, cancer types, side effects, and published in The Lancet. To read more, flavour preferences. This book includes a full nutritional visit www.thelancet.com (search: diabetes analysis for each recipe and notes that teach readers prevention). how to build a culinary cancer-fighting pharmacy.

Fructose boosts What You Really Need to Know About Cancer, hypertension risk Dr. Robert Buckman High fructose corn syrup, a common This invaluable reference book has sold more than 200,000 copies sweetener in drinks and foods, may worldwide, 35,000 in Canada alone. The first comprehensive guide increase the risk of high blood pressure, written specifically for cancer patients and their families, this book according to new research. A study con- explains in a clear, jargon-free style what cancer is, ducted by Dr. Diana Jalal, of the University how it is caused, and how it behaves. Detailed sec- of Colorado Denver Health Sciences Cen- tions about all of the major types of cancer describe ter, suggests that individuals who consume more than 74 grams of fructose per day, how each may cause symptoms, what factors are about 2.5 sweetened soft drinks, could see important in determining progress, and what treat- their risk of high blood pressure increase ment is available. In the nearly 10 years that have between 27 and 87 per cent, depend- passed since the book was first published, numer- ing on the level of hypertension. To read ous changes have taken place in the diagnosis and more, visit www.healthday.com/Article. treatment of cancer. This fully revised and updated asp?AID=632507 edition includes all of the latest information.

November/December 2009 9 your health

Shovel Snow Safely f you have lived through a IWinnipeg winter, chances are that you are well acquainted with your snow shovel.

Winnipeg receives an average shovelling definitely counts toward of 115 centimetres of snow each that total. winter, so we have plenty of op- However, research shows that, portunity to exercise our shovelling after heavy snowfalls, there is an Here are some tips muscles. increase in the number of heart on how to shovel On the plus side, this is an excel- attacks among snow shovellers. If snow safely: lent way to stay active during the you take appropriate precautions winter. Health experts recommend and keep safety in mind, shovelling at least 30 minutes of moderate snow can be an invigorating activ- If you are not very active, don’t do physical activity every day, and ity and help keep you physically fit. heavy work regularly, or have a history of heart trouble, speak with your doctor before shovelling snow.

Begin shovelling slowly to avoid plac- ing a sudden demand on your heart. Also, pace yourself and take regular rest breaks, every five to 10 minutes.

Use a shovel that is suited to your needs and capabilities. A smaller shovel will lift less snow and put less strain on your body.

If you have concerns about your ability to shovel snow, consider delegating the task to a friend, neighbour or family member.

If you are shovelling, be alert to the signals of heart attack, which can include pain, shortness of breath, nausea, and sweating (cool, clammy skin).

If you are experiencing the warning signals of a heart attack, stop all activity and call 911 immediately, or have someone call for you.

Source: Winnipeg Health Region

10 WAVE Watch Your Step

Broken bones, a fractured hip, or a serious head trauma Falls the No. 1 reason can seriously undermine a person’s quality of life. But the goods news is that falls can be prevented. Here are some for injury hospitalizations falls-prevention tips: among older adults 1. Wear good-fitting footwear with non-slip soles, good support, grip and traction. 2. Consider wearing snow cleats or ice grippers when walking in winter weather conditions. Be sure to It can happen in the blink of an eye. remove ice grippers when coming inside.

An elderly man slips on a patch of ice on his way home 3. When venturing out, be aware of your surroundings. from the store. A woman trips on a throw rug in the hallway Pay attention to cracks in the sidewalks, potholes, as she makes her way to the kitchen. ice and snow, and any other hazard that may be in Falls can occur anytime, anywhere, often with devastat- your path. ing consequences. Consider the numbers. An estimated 30,000 adults 65 years of age or older in Winnipeg will 4. Keep walkways and steps clear of ice and snow. take a tumble this year. Of those, about 2,000 will have If you can’t manage it yourself, ask for help. to be hospitalized because of their injuries. In fact, falls are the No. 1 reason for injury hospitalizations in this age 5. Report ice or any hazardous conditions on roads or group, according to Wendy French, Injury Prevention Co- sidewalks to 311. ordinator for IMPACT, the Winnipeg Health Region’s injury prevention program. And those injured often remain in 6. Have a pharmacist review your medications every six hospital for a very long time. months to ensure dosages are correct. Clearly, falls pose a serious problem, and not just in win- ter. Statistics show that injuries from falls occur fairly evenly 7. Night lights are a good idea; falls can happen easily throughout the year. The snow and ice of winter may be in the dark. hazardous, but so is that pile of books by the doorway or that puddle 8. Wear your glasses to make sure you have a clear of water in the bathroom. view of hazards or obstacles. “Falls can happen any- where, anytime, so it’s 9. Get rid of hazards around the home, like scatter rugs. important to stay in the moment and pay at- 10. Install handrails on both sides of the stairs and clear tention,” says French. away obstacles that you can trip over, like piles of “Recognize your lim- books or newspapers. its and ask for help when needed.” 11. When weather conditions are risky – icy roads, lots of While anyone can snow or wind – consider cancelling unnecessary be injured in a fall, appointments, and staying indoors. Ask someone to statistics show older take you to crucial appointments if necessary. adults are most at risk. “People over 65 are 12. Exercise regularly to maintain good balance and nine times more likely strength. Older adults can call the Active Living Co- to be injured,” French alition for Older Adults at 632-3947 to request a free says. exercise DVD. Source: Winnipeg Health Region

November/December 2009 11 1 2

6 Hey, that didn’t hurt a bit! Winnipeggers line up for flu shots as immunization campaign kicks into high gear

9 10 11

Hand in hand with his mom, the little then above the din of the crowd. As this issue of Wave goes to print, boy walks into the Winnipeg Health Re- But the little boy is oblivious to the more than 175,000 people have been gion’s Grant Park H1N1 Influenza clinic, action around him. He’s focused on the immunized against the H1N1 virus. Most big brown eyes wide with wonder – and a nurse in front of him. people received their flu shots at one of bit of uncertainty. In a few minutes, he will become one of the Region’s mass clinics, but others were All around him, dozens of children and the thousands of Winnipeggers who have immunized through various community adults are sitting (or squirming) in their been immunized at mass clinics organized outreach programs. chairs, sleeves rolled, arms exposed, ready by the Region as part of its H1N1 influ- Unlike some other jurisdictions in the to be immunized – the cry of a child being enza campaign, one of the largest public country, Winnipeg’s H1N1 campaign jabbed with a needle rising every now and health efforts in recent memory. got off to a fast start, with nearly 60,000

12 WAVE 3 4 5

7 8 Hey, that didn’t hurt a bit! Winnipeggers line up for flu shots as immunization campaign kicks into high gear

12 13

people immunized in the first week the say enough about the nurses. We have the teaches at the Health Sciences Centre. She clinics were operating. And, although some best health care in the world,” he said after started working as an immunization nurse lineups lasted up to three hours, the vast receiving his shot. about four years ago, mostly because she majority of those waiting were patient. Savelburgh is referring to the public loves working with the public. When the “I would have liked it better if they had health nurses, people like Michele Rous- call went out for nurses to administer vac- done the screening from the start,” says Elli seau who work to ensure the vaccine is cine at the clinics, Rousseau became one of Naksmichi shortly after taking her three injected safely into the waiting arms of about 400 nurses who signed up. children for flu shots. ”But the staff was all who want it. A registered nurse for 23 For her, the job is all about helping excellent.” years, Rousseau is currently a part-time people, educating them on the benefits of Lou Savelsbergh, 78, concurred. “I can’t nursing instructor at Red River College and getting immunized against influenza. “I also

November/December 2009 13 14 15 16

19 20

22

like dealing with families and children, and boy says, flashing a wide smile and holding coloured, adjuvanted vaccine from a vial trying to make this experience as comfort- up four little fingers. at her station. Adults and children over able as possible,” she says. With the ice broken, and her little patient the age of 10 receive .5 ml of the vaccine And her passion and professionalism are relaxed, Rousseau now turns her attention while younger clients get half this amount. there for anyone to see as she greets the to Mom. She methodically goes over the In this case, Rousseau extracts .25 ml of the little boy with the big brown eyes. consent form that each person or guardian solution. “How are you?” asks Rousseau, trying to must sign. Questions concerning a person’s The vaccine, which is refrigerated, must put the boy at ease. health, how they are feeling, medical histo- be prepared with care. Once pulled from Nothing. ry, possible allergies and allergic reactions the cooler, the vaccine must be used within Rousseau tries again. “How old are you?” to the vaccine are all discussed carefully. four hours. Once loaded into the syringe, it Bingo! Then it’s show time. is administered within the hour to maxi- “I’m going to be four in November,” the Rousseau draws some of the milky- mize it’s effectiveness.

14 WAVE 17 18 By the numbers

12: The number of Winnipeg Health Region mass immunization clinics.

62: Number of pharmacists and pharmacy technologists working at the Region’s clin- ics every day.

100: Number of volunteers working at Region clinics every day. 21 Battling the bug The Winnipeg Health Region staged two influenza 399: Number of nurses work- immunization clinics this fall, one for seasonal flu and ing at Region clinics, includ- a second for the H1N1 virus. Photographer Marianne ing 80 public health nurses, Helm dropped in to some of the clinics. Here are every day. some of her photographs.

1) Angie Toutsaint receives a flu shot at the North End 7.25: Average hours worked Wellness Centre; 2) Moira Sie, 4, with her mom, Jody by nurses per shift. Sie, and cousin Edie Cuthbert, 1, get ready for a shot at Grant Park Mall; 3) Ron Evans, Grand Chief for the 52: Number of vaccine dos- Assembly of Manitoba Chiefs, gets ready for a shot es administered by a nurse at the Centre culturel franco-manitobain; 4) Suckers during an average shift. make the flu shots a bit easier to take; 5) Alice Ramsay and daughter Emmy, 13 months, wait for a flu shot at 59,282: Number of vaccine Portage Place; 6) Winnipeg Health Region volunteers doses administered during keep the clinics operating; 7) Clinic toys; 8) Louis first week of campaign. Collins gets a shot from nurse Chase Curtis-Grindell at Siloam Mission; 9) Tram Vu gets a flu shot at Portage Place ; 10) Hand sanitizer was available at all clinics; 11,856: Average number of 11) Simon Francois, 2, receives a shot at Centre cul- vaccine doses administered turel franco-manitobain; 12) Joleen McKinnon gets a each day during the first shot from nurse Maureen MacDonald; 13) St. Boniface week of the campaign. General Hospital volunteers Verna Odowichuk (L) and Therese Balamatowski wait at the door to scan forms at 49,338: Anticipated total the Centre culturel fanco-manitobain; 14) James Scott number of hours worked by gets a shot from Hessie Sookermany-Loeppky at the all nurses, based on a six- Salvation Army clinic; 15) Tamara Horbatiuk and son week campaign. Easton attend an immunization clinic; 16) Maxie Ar- nott gets a shot from nurse Trisha Boden as media look on; 17) Margaret Moshenko gets a shot at Grant Park 175,336: Number of people Mall; 18) Mobile immunization team members Wayne immunized at Region clinics Inkster, Shelley Marshall and Maureen MacDonald, as of Nov. 24. outside the New West Hotel; 19) Willem Cuthbert, 3, enjoys a sucker after a visit to the Grant Park Clinic; 20) Sheila Green is immunized by nurse Lynn Carriere For the latest information on at Siloam Mission; 21) Public health nurse Michele the H1N1 influenza situation, Rousseau; (22) People wait in line at the immunization clinic at Grant Park Mall. visit www.wrha.mb.ca

When the vaccine is ready, it is loaded up the little boy’s sleeve and searches out Once the landmark is located, Rousseau into the syringe of a hypodermic needle. the target area – usually a spot on the del- swabs the area with alcohol with one hand, Adopted as the injector of choice for the toid muscle of the arm, just below the bone and deftly sinks the needle into the arm Winnipeg Health Region about three at the top of the shoulder. In nurse-speak, with the other. As the vaccine is pushed years ago, the device features a retractable this process is called “landmarking.” into the muscle, the plunger clicks, and the needle that enhances safety by preventing Hitting the landmark – an area the size needle automatically retracts back into the needle stick injuries among health-care of a postage stamp – is critical. The H1N1 cartridge. workers. vaccine is in fact a dead virus, and it must From swab to injection, the process takes With the needle loaded and ready to de- be injected into the muscle in order to about three seconds. The little boy doesn’t liver its vaccine, Rousseau turns to the little fool the body into creating the antibodies feel a thing. boy and offers him a purple rubber toy that needed to fight off an infection of the live is intended to distract him. Next, she rolls H1N1 virus now circulating.

November/December 2009 15 Despite divergent career paths – he’s a professional hockey coach, she’s a physiotherapist with a passion for wellness – Scott and Lia Arniel have achieved a healthy equilibrium between life at work and at home

16 WAVE Despite divergent career paths – he’s a professional hockey coach, she’s a physiotherapist with a passion for wellness – Scott and Lia Arniel have achieved a healthy equilibrium between life at work and at home

November/December 2009 17 t’s Thanksgiving Day and Scott Arniel is right where you Imight not expect to find him – at the rink tutoring four Manitoba Moose centremen on the finer points of winning faceoffs. That’s the thing about being a hockey need to strike a work/life balance. mal path, but what is normal? There is no coach. It’s a wonderful life at the profes- That wasn’t always an easy thing to normal.” sional level, but sometimes it means you do. By many accounts, less dedicated Scott, now 47, had a long career as a will be at practice when friends and family and determined individuals might have pro hockey player, playing 730 games and are spending a holiday together. failed to build as healthy and supportive a scoring 338 points in the NHL over 10 Across town, meanwhile, Scott’s wife, relationship as the Arniels, considering the seasons with the Winnipeg Jets, the Buffalo Lia, is also doing something you might not circumstances. Sabres and Boston Bruins, not to mention expect – she’s taking a rare day off. Professional hockey demands a lot from another eight seasons with a few teams A physiotherapist by training, Lia has an its players and coaches, as well as their in the now-defunct International Hockey interest in one physiotherapy clinic and is spouses. The long hours, the pressure to League. the sole owner of another. Most days, you perform at a high level and the many days Today, as coach of the Moose, the Van- can find her at one of the clinics tending spent on the road can test the fortitude of couver Canucks’ farm team, he is proving to business matters, assessing patients or the most committed athlete, let alone the to be just as successful a coach as he was instructing them on how to rehab an injury. strength of a marriage. a player, maybe even more so. Last season, Given their divergent career paths, it’s no “It’s always hard. Anytime you are away the American Hockey League team had its surprise that life around the Arniel house- from your loved ones it’s tough because best regular season ever and finished first hold carries on at a pretty hectic pace. you are dealing with things on your own,” overall under his watch. The Moose even “You really have to be organized or else Scott says. “There’s no doubt that in pro made it to the Calder Cup finals in the you can’t keep up,” Lia says. sports you miss out on a lot of the average spring, their first appearance ever, only to But despite their busy schedules, the Arn- things in life.” lose in six games to the Hershey Bears. And iels have been able to find the time to build Lia concurs. “You know what? It’s give his work hasn’t gone unnoticed. After last a life together, one rooted in family and the and take. Our life hasn’t been the nor- season, he was awarded the AHL Louis A.

18 WAVE R. Pieri Memorial Award for coach of the promote healthy life habits – from exercise to figure that out,” she says. year. to eating right to finding an ideal balance When Scott’s away on the road, Stepha- But the Arniels are more than a hockey between work and family life. And in many nie is Lia’s best friend. They watch movies family. If Scott’s career as both player and ways, she, Scott, their 16-year-old daughter together on Saturday nights, and they settle coach has been a success, Lia has been Stephanie and their 19-year-old son Bren- into a comfortable, organized routine for equally exceptional in her pursuits. dan embody the wellness lifestyle. the rest of the week. As a licensed physiotherapist for more “Our son is pretty much the epitome She helps out with chores around the than 20 years, she is a partner at Whyte of health and wellness,” Lia says about home, including ensuring dinner is ready Ridge Physical Therapy & Sports Injury Brendan, who is studying at Erie College in when Lia arrives home after a long day at Clinic and the sole owner of XCEL Sport Buffalo and playing in the Ontario Junior the clinic. & Fitness Lifestyle Physiotherapy, a unique Hockey League, vying for a hockey schol- In many ways, both Stephanie and Bren- clinic that is part fitness facility and part arship in the U.S. dan are the glue that holds a tranquil home clinic. “I don’t think you could bring a person life together amidst the maelstrom of activ- “My clinic is as much about wellness as into being who is so much of his mother ity created by two career-driven parents. it is about rehabilitating a damaged knee and father combined, from his intellect, Determination is the hallmark of both Lia or ankle,” Lia says of the XCEL centre. his wherewithal to his deep-seated attitude and Scott, and it is a trait that has drawn “Physiotherapy is really about preventa- toward health and wellness.” them together. It’s also characteristic they tive medicine, and that means making the Stephanie is no slouch herself. If she’s have tried to cultivate in their children. lifestyle changes necessary to be healthy not taking ballet, hip hop, jazz or tap les- “It’s so true that no matter what you do in and avoid injury.” sons, she’s studying to maintain high marks life – or in sports, business or school – the An advocate for active lifestyles, particu- to pursue her career dream of becoming a harder you work, the better results that are larly for children, Lia works tirelessly to lawyer – or an archeologist. “I’m still trying going to come from that,” Scott says.

November/December 2009 19 That mindset can make the difference between much thought. “I wasn’t sure what I wanted to do after being a could-have-been prospect and an every- hockey. Maybe I’d retire and take up golf full-time or go day NHL player, he adds. back to school.” Throughout his career, Scott was known Then he got his first taste of coaching in Houston. “I as a heady, smart player. Some of that started going to coaching seminars in the summer,” he was due to his natural hockey sense says. “I went to see guys speak and became more knowl- – he was a star in junior, winning a edgeable, and all of a sudden, I became addicted to that.” Memorial Cup and a World Junior Scott took over the role of head coach of the Moose in Championship. But he was also a 2006 after working under Ruff in Buffalo as an assistant student and learned from veteran for four years. During that stint in Buffalo, his family often players who embodied hard flew in from Winnipeg to visit him. In the past, the family work and smart hockey. As it would have moved where his career took them, but by turned out, two of the players that time Lia had become a partner in the Whyte Ridge he admired most when he Clinic and opened the XCEL Sport & Fitness clinic. was playing, Lindy Ruff Surprisingly, physiotherapy was not her first choice. from the Sabres and Randy Since she was in grade school, she imagined herself as a Carlyle on the Jets, would doctor, but as her relationship deepened with Scott over also become his men- the years of courtship while she earned her bachelor of tors when he became a science at the University of Manitoba, she realized it coach. might be an impossible dream. “They’re two guys that “The physical therapist with the Jets suggested that I I respect a lot and two consider Scott’s profession,” she says, adding that pursu- guys that played the ing a medical degree would require as much flexibility game very honestly,” with regards to mobility as being a professional athlete. If he says. “To see them he was traded to another team, there would be no guaran- today as head coaches tee she could find a residency in the same city. is no surprise, and hav- “Basically, there’s not chance we could both be that ing the chance to work busy and still have children.” under them has helped And they did want children, but Lia wanted to ensure me learn an awful lot she had her career path established first. They were mar- about the right way to ried only after she graduated from physiotherapy in 1988, handle situations.” after six years of being together, much of that time spent When Scott’s career 1,500 kilometres apart. as a player was winding Lia is a licensed physiotherapist in Canada, but she down in the mid-90s, is also a physical therapist – the American term for her then playing for the Hous- profession – licensed in the U.S. because the early years ton Aeros in 1995, he was of her career were spent working wherever Scott was offered an assistant coach/ working. player position. Despite be- The precarious business of hockey made it tough on ing the thinking man’s hockey both of them. player, up until that point, he “Buffalo was where my first job was, but as soon as I had never given coaching too got it, Scott was traded back to the Jets, so I didn’t work

20 WAVE “It’s always hard. Anytime you are away from your loved ones it’s tough because you are dealing with things on your own. There’s no doubt that in pro sports you miss out on a lot of the average things in life.”

there long,” she says, adding she also has worked ther as he could be, Lia says. “To Scott, the few at a clinic in San Diego when he made the jump minutes he gets driving Stephanie to school every from the NHL to the former International Hockey morning means the world to him,” she says, add- League’s Diego Gulls in 1992. ing he has enjoyed coaching in Manitoba because In fact, the trade back to Winnipeg made per- it affords him more time with his family. fectly clear that while the players are treated like Because he has spent so much time away, he royalty in one respect, they sometimes can also ensures that when he is home he takes an interest be treated “like a commodity,” Lia says. in his children’s school or extra-curricular activi- Scott was thrown in at the last minute in the ties – which his daughter, Stephanie, finds very blockbuster trade that sent Dale Hawerchuk and endearing and just a little amusing. a first-round pick from the Jets to the Sabres in “My teacher was laughing that my dad exchange for defenceman Phil Housley and their had read the entire readings for our lit- first-round pick. erary circle,” says Stephanie. “He “Certainly, at the time, I was very upset be- just started reading and finished the cause I really enjoyed Buffalo – we had a home whole thing, which was several there; we had just had our son; we were married pages.” and were just starting to settle, and then we had Of course, this came as no to pack up and come back out here,” says Scott. surprise to his family. Scott is But looking back, everything happened for a a voracious reader, knocking reason, he says. Despite moving from team to off a book practically every team in the 1990s, the Arniels eventually made road trip. After a practice on Winnipeg their home base. Thanksgiving Monday, he During the many, long hockey seasons, which listed off the current books can last 10 months out of the year with only a on his digital reader, in- handful of days off, childcare primarily fell on cidentally the best birth- Lia’s shoulders. day gift he says he ever In the early days at the Whyte Ridge Clinic, the received from his family. children would come there after school and have Besides reading a dinner in the kitchen and rec lounge that was book on the psychol- built in the back. ogy of coaching, he Lia credits organization as being the secret was also reading Dan to their ability to juggle children and careers. Brown’s latest, The Her Sundays are usually spent preparing six Lost Symbol. And he days worth of meals, all portioned properly to was also working on meet her family’s nutritional needs. The menu is a non-fiction piece, heavy on fresh veggies and fruit. Ground turkey Hunting Eichmann: replaces ground beef, and lean chicken breasts How a Band of Survi- and fish are the norm. Beef is a treat, reserved vors and a Young Spy only for the summertime when Scott is home and Agency Chased Down barbecues steaks as part of his increased parental the World’s Most No- load to make up for the lost time. torious Nazi War Crimi- When he is home, Scott is as hands-on a fa- nal.

November/December 2009 21 “I do like reading a lot of history about fensive zone,” he says. “We just wanted to “I make it look easy because I do it all how things were, how companies were give them some ideas and thoughts about the time, and I have a very well established started, how things evolved over the last it, and it was also a good opportunity for core,” she says. hundreds of years,” he says, adding he es- them to talk about it as well.” The strength in her mid-section is repre- pecially likes military history. Past exploits Because of his past life as a player, he sentative of everything she believes about of famous generals, however, don’t work intimately understands the challenges his wellness. A strong core group of muscles is their way that often into his game plans as a players face. “Being an ex-player and hav- the base upon which a healthy life can be coach. “I wouldn’t go by what General Pat- ing done exactly what they’ve done, I feel built. ton did or what Winston Churchill did,” he for them – although I will say these players Because the majority of people lead says. “Every now and then I will put quotes train now 12 months a year,” he says. sedentary lives, their muscles in their hips, up on the board that can be anything from “They train a lot harder than we ever did.” abdomen, pelvis and behind are rarely Lance Armstrong to a poet or a musician And while he’s keenly aware of their used to their full potential. from a rock band.” difficulties adjusting to pro hockey on the “It’s a totally active area up until basical- It’s just one of many techniques he’s ice, he’s even more sensitive to the impact ly giving birth or sedentary job life. All of a picked up over the years to inspire his play- it can have on their personal lives and sudden you become locked up and nothing ers to work harder not just so they can put those of their loved ones, particularly their moves as freely as it should,” she says. wins in the statistics column, but so they significant others. While her clinic is geared toward sports can develop into better players, which is He holds no illusion that his wife didn’t injuries, she says most of the patients she the main reason they are with the Moose. sacrifice a lot to see him succeed, even sees are there for “life’s injuries,” largely But while some AHL clubs’ sole purpose when she was equally ambitious in wanting caused from a lack of core strength, which is development, in Winnipeg, management a career for herself. affects all other muscles, joints and liga- also cares about the team’s performance. “Lia was very driven at school to be the ments in the body. “Myself, as a coach, I wouldn’t want to best, and probably my career and having “We get a lot of patients with injuries be in this position and not go out every a family stopped her from going on to be through sport, but they’re really weekend night with the chance of winning a hockey a doctor, but she loves being a physio,” he warriors,” she says, adding her husband game,” he says. says. now fits in that category too. Although a seemingly reserved, relaxed Her love for her job is evident as she Although it’s troubling to see so many individual, whose thoughtful, soft-spoken works one Thursday afternoon at XCEL adults sliding toward inactivity, and obesity voice can barely be heard occasionally Sport & Fitness Lifestyle Physiotherapy at as a result, she’s even more concerned during media scrums, Scott can get emo- Kenaston and McGillivray. about the conditioning of children today. tional when required. “There is the odd If Scott is reserved, Lia is somewhat the “They are not developing proper move- time where I will blow up on the bench opposite. She speaks as quickly as she ment strategies that they where maybe we’re playing really badly moves. And she covers a lot of ground would have in the and I call a time out,” he says. “Maybe I’ll during a nine-hour day at the open-concept past,” she says. “They vent my frustration there, but most of the clinic, assessing one patient on his shoul- don’t climb trees or time, in the years that I played, when a der, then moving on to acupuncture for fences. They just coach does that too much, players tend to another and racing over to another patient don’t run around tune you out.” to ensure she’s doing exercises correctly on and play like they His true strength as a coach, however, is a BOSU ball. used to, so they his ability to teach, Lia says. “He’s a natural More often than not, she has to demon- are not develop- teacher, both with his players and the kids.” strate the exercise to show patients exactly ing physically His teaching skills were on display at how it’s done. And this day is no exception. in the same way the Thanksgiving Day practice. He took Lia climbs onto the BOSU ball – a large as they would aside the four centremen on the team and half of a giant, inflated ball with a circu- have in the years worked with them on their faceoff skills for lar, plastic platform on top. Designed to gone by. about 15 minutes, showing them tricks on improve core strength in the mid-section, “That’s why how to win draws in key defensive situa- the BOSU can be potentially injurious for we see a lot tions – his specialty as a player. a novice without the necessary muscle more injuries “We have all left-handed centremen and strength to maintain balance, but Lia hops it’s tough to take a draw in our right de- on as if she were on terra firma.

22 WAVE among youth.” And although her family’s rule is not could easily afford to pay someone else to take to bring work home – even going as far as having to care of the housework, and who could blame them check the cellphones and BlackBerrys at the door considering their hectic lives? But for them, it’s all – her beliefs as a practitioner are infused in every about setting the right example for their children. aspect of their home life. And that includes more “Everything that I got I had to work for, and I than just eating well and exercise. It means making know my kids both respect that process,” Scott sure their kids know the value of hard work. says, adding his son had to work two jobs, getting “The kids are well-trained,” she says, adding up at 6 a.m, while training for hockey over the Stephanie (and/or Brendan when he’s home) will summer to save money for a car. prepare dinner when she gets home from school. “It’s not just an open vault where they can get The entire family helps do chores around the anything they ask for,” he says. “That’s just a great house. “We work as a team, both on and off the lesson for later on in life – that things aren’t just ice.” handed out.” Whether it’s shovelling snow off the driveway, raking the leaves, mowing the lawn, or scrubbing the toilet, the Arniels are hands-on. They Joel Schlesinger is a Winnipeg writer.

Scott and Lia Arniel say organization is the secret to their ability to juggle children and careers.

November/December 2009 23 in the

By Judy Owen Two yearsPink ago, Barbara Ruhlen was diagnosed with breast cancer, the most common form of cancer among Canadian women and the second leading cause of death after lung cancer. Today, she is feeling better than ever, and her disease is in remission.

arbara Ruhlen sits in her Just two years ago, the 57-year-old Ruhlen was not immune to the sunny living room, a smile woman was diagnosed with breast fears and worries that come with this Bcrossing her face as she cancer, the most common form of disease, but she was able to control watches one of her cats peering out cancer among Canadian women and and overcome them. In doing so, the front window at the busy bird the second leading cause of death she has joined the growing number feeder in her yard. after lung cancer. Today, her cancer of women who have been able to In the background, her husband, is in remission, thanks in large beat breast cancer. According to a Doug, can be heard puttering measure to an early diagnosis and 2007 report by the Canadian Cancer around the house. the efforts of the health-care team at Society, the age-standardized mortal- It’s Thanksgiving Day and Ruhlen the Winnipeg Health Region’s Breast ity rate for breast cancer in Canadian has a lot to be thankful for as she re- Health Centre. women has fallen 25 per cent since calls the winding path she’s travelled But Ruhlen’s journey from diag- 1986, from 32 to 24.1 per 100,000 the past two years. nosis to treatment and recovery was cases. “Every day when I wake up, I not without challenges, difficulties Despite these gains, it is impor- think, ‘Thank you, God, I have a and even some tears. Often the word tant to remember that breast cancer choice. I can have a good day or cancer is spoken in a hushed tone, still poses a serious health threat. In I don’t have to have a good day,’’’ eliciting images of lengthy treatment Manitoba, about 790 women will Ruhlen says. “But I choose to have a and possible death. For women, be diagnosed with breast cancer this good day.” breast cancer brings the added worry year, and about 220 women will die The reasons for Ruhlen’s sense of about how treatment will affect from it. optimism are easy to understand. femininity and self-image.

24 WAVE Pink

November/December 2009 25 “Having cancer has taught me patience, it’s taught me to decide what are the most important elements of my life.” - barbara Ruhlen photo by Marianne Helm photo by

had to tell me.” the material. Malignant tumour cells can Until the day she was diagnosed in No- Although the diagnosis was unexpected, invade the tissues around them and spread vember 2007, Ruhlen did not think much it wasn’t a complete shock. In hindsight, to other parts of the body. about breast cancer. After all, she had no Ruhlen remembers being tired for about Breast cancer starts in the breast tissue, history of the disease in her family and two a year and gaining 55 pounds in four which extends up to the collarbone and previous mammograms two years apart months. She had also fractured her foot, from the armpit to the breastbone. Breasts revealed nothing suspicious. So she was even though she wasn’t sure how the are glands that make milk. Lobules make more than a little surprised when a staff injury occurred. “In the back of my mind, the milk and the milk ducts drain the milk member from a clinic where she had un- that was probably partly why I wasn’t so through the nipple. The cells that form the dergone her third mammogram called her surprised when I got my cancer diagnosis,” lobules and ducts can grow out of control at home. Something suspicious had shown she says. and become cancerous. up on the exam, according to the woman Breast cancer comes in many different Non-invasive cancers stay within the on the other end of the line. She would forms, according to information provided milk ducts or milk lobules, while invasive need a follow-up test. by the Breast Health Centre to each of its cancers spread. The most common form of Suspicions don’t always translate to a di- clients. breast cancer is invasive ductal carcinoma, agnosis for breast cancer, a fact supported The literature explains that cancer is a which begins in the milk duct but grows by statistics from the Breast Health Centre. disease that begins in cells that group to- into the surrounding normal tissue inside In 2008, for example, a total of 539 clients gether to form tissues or organs in our bod- the breast. of the centre were diagnosed with breast ies. Inside each cell are genes that order Detecting breast cancer isn’t easy, but cancer. In the same year, 1,769 of the cen- the cells to grow, work, reproduce and die. there are signs that should prompt an exam tre’s clients had benign tumours. Sometimes a cell’s instructions get mixed by a doctor. Usually breast cancer is first Ruhlen, however, had a feeling that up and they behave abnormally. Groups of discovered by feeling a painless lump she would not be one of the lucky ones. these abnormal cells can circulate in the in the breast or armpit. Other signs can “They’d already booked the appointment, blood or immune system or form lumps include swelling in the armpit, changes and then I knew,” says Ruhlen, recalling the and tumours. in a breast’s shape or size, dimpling or conversation. “I just remember thinking, Some tumour cells are benign, meaning puckering of the skin, redness, swelling ‘Oh, my gosh, I have breast cancer. I won- they stay in one place in the body and are and a warm feeling in the affected breast, a der what’s going to happen next?’ Nobody not usually life-threatening, according to nipple that turns inward or crusting or scal-

26 WAVE ing on the nipple. Breast cancer itself is not the mysterious disease Breast cancer screening it once was. Twenty years ago, breast cancer had no public profile; early diagnosis and treatment Numerous international studies have shown that population- weren’t commonly discussed or promoted. Today, based breast screening can reduce mortality by up to 25 per cent in women aged 50 to 69 if the screening is done at regular there are numerous events and fundraisers staged intervals and abnormalities are followed up in a reasonable each year to raise awareness and help finance time frame. treatment and research efforts. The scope of the awareness mirrors the fact that The Manitoba Breast Screening Program provides free breast many people will be touched by breast cancer screening every two years for all eligible Manitoba women 50 through family, friends and co-workers. For exam- years and older (breast cancer is most common in women over 50). ple, groups such as the National Hockey League and the National Football League now wear pink Eligible women include those who have no signs or symptoms during Breast Cancer Awareness Month in an ef- of breast cancer such as lumps or nipple discharge, no breast fort to raise awareness. Locally, some players from implants, no previous diagnosis of breast cancer and no mam- the American Hockey League’s Manitoba Moose mogram in the last 12 months. played with pink sticks that were raffled off, while Most women 50 and older receive a letter – names and ad- pink pucks and pink ribbons were sold at games. dresses provided by Manitoba Health – inviting them to have University of Manitoba female basketball players a breast screening, which includes a questionnaire, mammo- also did fundraisers for the Canadian Breast Can- gram and video on breast health (total visit about 30 minutes). cer Foundation. One included the team wearing Women can also make their own appointment or be referred special pink uniforms that were auctioned off. by their doctor. The rise in public knowledge has contributed to Statistics from the Breast Health Centre support the fact that improvements in screening and quality of mam- suspicions don’t always translate into a diagnosis. In 2008, for mography that have led to the detection of more example, a total of 539 clients of the centre were diagnosed breast cancers at an earlier stage, where treatment with breast cancer. In the same year, 1,769 of the centre’s is more effective. Therapies have also improved. clients had benign tumours. Indeed, it could be argued that Ruhlen’s early There are four sites for breast screening (Winnipeg, Brandon, diagnosis was a key factor in the successful treat- Thompson and Winkler) and a mobile service. For more ment of her cancer. Today, it’s recommended that information on the program, call 204-788-8633. women, especially those over the age of 50, be - Source: CancerCare Manitoba aware of changes in their breast. A lump doesn’t necessarily mean it’s cancer. That’s why it’s impor- tant to monitor a lump to see if it changes and be For more information about breast cancer, please visit: examined by a physician once a year. Since breast cancer is more common in post-menopausal Cancer Care Manitoba, includes information on prevention, women aged 50 and older, it’s recommended they screening, treatment and support. be examined by a doctor once a year and have a www.cancercare.mb.ca mammogram every two years. Mammograms are Canadian Cancer Society, includes information on female and offered free of charge through the Manitoba Breast male breast cancer. Screening Program. www.cancer.ca

About breast cancer

Breast tissue extends up to the collarbone and from the armpit to the breastbone. Cells in the lobules and the ducts within the breast can grow out of control and become cancerous. Lobules Non-invasive cancers stay within the ducts or lobules, while Fat invasive cancers spread. The most common form of breast cancer is invasive ductal carcinoma, which begins in the ducts but grows Ducts into the surrounding normal tissue inside the breast. Nipple Warning signs of cancer include: changes in a breast’s shape or size, dimpling or puckering of the skin, redness, swelling and a warm feeling in the affected breast, a nipple that turns inward, or crusting or scaling on the nipple. for hormones in the cancer cells (hormones armpits, groin and neck, may also be Once Ruhlen’s diagnosis was confirmed, such as estrogen can attach to receptors removed during any type of surgery. Lymph she was referred to the Breast Health Cen- and help the cancer grow). nodes filter extra body fluids, abnormal tre, a link that would become one of the The most common treatment for breast cells and dead cells from infections. crucial support systems in her physical and cancer is surgery, which can be combined Radiation therapy is usually given after emotional care. Located across the street with chemotherapy and/or radiation. There breast-conserving surgery as a means to de- from the St. Boniface General Hospital, the are two types of surgery: breast-conserving stroy any possible remaining cancer cells. centre offers women and men with breast surgery or a mastectomy that removes the It may also be given after a mastectomy, cancer one place where they can receive whole breast. depending on the size of the tumour and services through a multi-disciplinary ap- Breast-conserving surgery includes a other factors. proach and referrals to countless resources. lumpectomy or a partial mastectomy. The Chemotherapy drugs can also be part The centre has 25 staff, including nurses, difference in the surgeries has to do with of a treatment plan to slow or even stop mammography technologists, lymphedema how much breast tissue is removed. In a cancer cells from growing and reduce the therapists, a physiotherapist, a social work- lumpectomy – a term many people use risk of cancer coming back after surgery er or counsellor, dietitian and clerks. In to describe all breast-conserving surgery or radiation therapy. Chemotherapy is also addition, there are nine affiliated surgeons – only the tumour and a small margin of sometimes done to shrink a tumour before and three radiologists. healthy tissue around it are removed. a lumpectomy. In Ruhlen’s case, an ultrasound-guided Breast-conserving surgery may be an Side-effects from radiation can include biopsy at the Breast Health Centre revealed option if the tumour is small enough fatigue and skin changes such as tender- that she had a tumour deep inside the compared to the size of the breast and ness and itchiness. Chemotherapy may tissue of her right breast, a location that the tumour and healthy tissue can be cause fatigue, nausea, hair loss, loss of explained why the medium-sized lump safely removed. Women can also choose appetite, a change in menstrual cycles, and couldn’t be felt by touch. The cancer was breast-conserving surgery as a first step in a higher risk for getting infections. located in the milk ducts (ductal carceno- treatment. Usually it’s followed up with After discussions with her doctor, Ruhlen ma), and a number of treatment options radiation therapy and other treatments. opted for a lumpectomy. were presented to her. A mastectomy to remove the entire Ultimately, the procedure proved suc- Breast cancer treatments vary depend- breast may be recommended if the area cessful. But it was not without complica- ing on factors such as age, state of health of cancer is large compared to the breast tions. and whether the woman has been through size, the cancer is in more than one area of In these types of procedures, a dye is menopause. Consideration is also given to the breast or a previous breast-conserving injected into the breast to see if there is any the stage of the cancer (size of tumour and surgery reveals the healthy-looking tissue lymph node involvement. The dye didn’t whether it’s spread), the grade of the cancer around the removed tumour isn’t clear of move, a sign there was some type of block- (how the cancer cells compare to normal cancer. Some women also prefer a mastec- age and possibly more tumours. The origi- cells and how quickly they’re growing and tomy. nal lump was removed, but as a precaution dividing), and whether there are receptors Lymph nodes, commonly found in the all her lymph nodes were taken out rather

It takes a team Some members of the Breast Health Centre’s care team, from left: Lucy Cabral, mammography technologist; Susan Holliday, nurse; Margaret Samsoondar, clerk; Michelle Pearson, certified counselor; Jo-Anne Marion, acting director; Beth Szuck, dietitian; Catherine Russell, physiotherapist/ lymphedema therapist; Lesley Hammerback, clerk. photo by Marianne Helm photo by 28 WAVE than just the main sentinel node. hook up with who is going through the we can offer this information to women,” Ruhlen says she didn’t feel any panic, same situation as them. They also listen Marion says. “Because of the awareness, attributing that to her 36-year career in to a volunteer who has had breast cancer. I think more women are feeling comfort- health care and her personality. “I’ve al- The post-op session features a dietitian able talking about it, so they want more ways tried to look on the optimistic side of and physiotherapist from the Breast Health resources in order to educate themselves.” things and go with my gut feeling, and my centre, and a nurse educator from the It’s the little things the centre offers that gut feeling was I was not going to die from Breast Cancer Centre of Hope, which is a made it a comforting place to go, says this,” she says. resource centre of CancerCare Manitoba. Ruhlen, adding it starts with something Further investigation revealed that her Family members can attend weekly pre-op as simple as being able to park nearby for lymph nodes were clear. There’s still a risk and post-op information sessions. The free. “I was very comfortable in the sur- she may develop lymphedema – a build- Breast Health Centre also runs programs roundings,” she says. “The waiting room up of lymph fluid in the arm that causes related to bone health and healthy living. “I is wonderful. I felt really cared for and the arm and hands to swell – but it hasn’t think there are a lot of resources out there it made me feel really special, and I felt happened yet. for women and men with breast cancer,” like the whole area was dedicated to my Ruhlen wasn’t unprepared for the says Jo-Anne Marion, who was one of the wellness – complications. All the medical staff she en- centre’s nurses before taking over the role wonderful countered had thoroughly explained what of acting director. “Often what happens is chairs, could happen and what her options were, we have to assist them in navigating the lovely she says. She also had access to plenty of system to really find the proper resources maga- educational material about breast cancer. for them.” zines, Patients referred to the Breast Health The awareness and the information that’s clean Centre are placed at the centre of a process available about breast cancer has increased area, that provides education, direction and the demand for resources and services, comfort. Each person receives an informa- from more screening to more treatment tion package, is introduced to the social options to more help during recovery. “It worker and attends pre- and post-operative has led to our centre, and even the Breast information sessions so they get an over- Cancer Centre of Hope, to kind of pool view of what to expect. together all the literature, the During the pre-op session, clients hear information, the speakers such as a nurse and physiothera- support groups pist. Someone from CancerCare Manitoba’s that deal with Breast Cancer Centre of Hope program breast cancer also talks about peer support and offers to and breast find someone in the community they can health so that

Eating a balanced diet can help you manage your weight, which, in turn, can help you reduce the risk of developing breast cancer.

About the Breast Health Centre

Just over 10 years ago, a group of Barbara Shumeley, who was a mem- “More importantly, the specialists that breast cancer survivors and concerned ber of the group that originally lobbied provide these services work together in clinicians joined together to advocate for the centre, says it continues to be a the same clinic, and, when needed, can for the creation of a breast health clinic model for care. “The unique and integral make treatment decisions together with in Winnipeg. feature of the Breast Health Centre is the the patient and family on the spot rather At the time, the group envisioned a team approach that coordinates assess- than waiting to have the report typed unique facility, one that would provide a ments, diagnostic tests, treatment, edu- and sent to the respective specialist,” multitude of services and be housed in a cation and support for patients through says Shumeley. “This co-ordination and non-hospital setting. This vision came to a variety of specialized programs and centralization of services reduces wait fruition with the opening of the Winnipeg services,” says Shumeley. times and also reduces patient anxiety.” Health Region’s Breast Health Centre. On-site services include: mammog- All of the services are provided at no Now 10 years later, the Breast Health raphy, ultrasound, stereotactic biopsy, cost through Manitoba Health. Centre on Tache Avenue continues to physiotherapy and lymphedema treat- The Breast Health Centre serves clients serve women and men who have breast ment, nutrition expertise, emotional sup- from across Manitoba, Nunavut and problems or signs of breast cancer. port, and education. Northwestern Ontario.

November/December 2009 29 beautifully painted, soft colours, lovely a range of emotions as they battle breast centre’s dietitian because a new drug she’s etched glass. I didn’t feel like I was on cancer, especially those who require a on can cause dietary restrictions. display to the street. Nobody could see that mastectomy. “Breasts definitely can be Her type of hormone-receptor-positive I was there, if I had been worried about a large part of a woman’s self-esteem,” tumour grows in response to estrogen and anyone knowing I was a patient there.” Marion says, adding that the centre’s social progesterone, so the drug, called aromatase worker plays a big role in helping women inhibitor, stops her body from making es- deal with these feelings. trogen, she says. Other breast cancer drugs As she underwent treatment for breast Among other things, the Breast Cancer only target a receptor site in the estrogen. cancer, Ruhlen was understandably Centre of Hope has a prosthesis and bra She has to take the drug for at least five focused on her medical care. Lost in the bank of gently used items that are provided years, a costly treatment that adds to her shuffle was an assessment of how the expe- for free. There are also resources for wigs. worries and was an issue she also dis- rience was affecting her emotionally. She Women also deal with concerns about cussed with the social worker. thought she was keeping it together pretty how their family is going to react to the For example, drugs she took for her bone well, until she was at her doctor’s office diagnosis, how or if they can work during marrow were $3,500 for seven days worth one day and erupted into tears. treatment and recovery, and how much en- of treatment. Injections for her blood clots “I had no idea I was going to cry, it just ergy they’ll have for childcare and house- were $167 for five days’ worth happened,” Ruhlen says. “I guess it was hold responsibilities. Mothers may also and she took it for eight my breaking-down point. I had been so experience guilt that they might pass the months. The new aroma- focused on ‘doing.’ When you get cancer, disease on to their daughters, Marion says. tase inhibitor drug is your life is a progression of specialists’ Ruhlen says her “exceptionally sup- $169 per month. appointments and somebody is always di- portive” husband immediately took over While insurance recting your care. So many of the decisions running their household so she could focus has covered some of were not mine to make once I had made on her needs. One area she didn’t struggle the cost, she’s had the initial decision of how I was going to with was her appearance and losing her to dip into personal proceed with my care.” hair during chemotherapy. savings. Her husband Finished with chemotherapy, she decided “It may sound kind of silly, but I was is a dispatcher at Health it was time to concentrate on herself and thrilled to lose my hair because I felt that Sciences Centre, but she booked an appointment with the social that was a little gift to me so that I would hasn’t returned to work worker at the Breast Health Centre. The not have to waste what energy I have on as a unit clerk at HSC ongoing meetings have been invaluable. my appearance,” she says with a smile. because of memory “It’s meant the difference between me “And I knew that my hair would grow problems she believes having a life and not having a life,” Ruhlen back so I was actually quite happy to be are associated with her says. “She (the social worker) has been my bald. For me, it was a visible sign that lifeline. She’s helped me to deal with many I was indeed sick, but I was getting issues that had been unresolved in my life treatment and I was going to get prior to this that I thought I had dealt with.” better.” Marion says many women experience She also met with the

Men and breast cancer There’s one fact about breast cancer men were diagnosed with breast cancer That can lead to men not seeking most people forget or don’t know: men at the Breast Health Centre. support. get breast cancer, too. A family history of breast cancer is the “It’s difficult for them because men “It’s rare for men to have breast most common risk factor for men and don’t tend to return to their work cancer; however, it’s said to be one in it most often strikes men aged 60 and situation and say, ‘Hey, I’ve had 100 cases that turn out to be men,” says older. breast cancer,’“ Marion says. Jo-Anne Marion, acting director of the The usual symptoms for men are small, “They’re not as open about it as Winnipeg Health Region’s Breast Health painless lumps located near the nipple or women.” Centre. fluid discharge from the nipple. The Breast Health Centre has “Men don’t necessarily associate Treatment is similar to that of women, information geared toward men. themselves as having breast tissue.” but surgery for men is often more ex- “Men tend to often shy away from Men get the same kinds of breast tensive because the cancer is usually de- wanting the education also,” Marion cancer as women, but it’s usually found tected at a later stage and the breasts says. “They’re not necessarily as upfront in the breast ducts because most of a are smaller than women’s. with it. man’s breast tissue is made up of ducts. What often sets apart men from “A lot of it is the stigma attached to it.” It’s estimated 180 Canadian men will women who have breast cancer is the be diagnosed with breast cancer in 2009 stigma associated with what’s seen as and 50 will die of it. From 2006-09, two an unusual disease in men. – Judy Owen

30 WAVE The Breast Health Centre is located across the street from the St. Boniface General Hospital at 100-400 Tache Avenue. For Breast cancer facts information, call 204-235-3906, or toll free at1-888-501-5219. It’s estimated 790 new cases of The Breast Cancer Centre of Hope is located at 691 Wolseley Ave. breast cancer will be diagnosed in For information, call 204-788-8080, or toll free at 1-888-660-4866. Manitoba in 2009 and an estimated

220 women will die of the disease. treatments. take advantage of the expertise of many Breast cancer is the most common She was referred to the memory professionals, and they were there to cancer among Canadian women clinic, which has helped her know help me to be well and to live the best (excluding non-melanoma skin which areas she’s having trouble with. possible life that I can live.” cancer), but lung cancer remains the Ruhlen says one of the benefits of Although her tumour is gone, Ruhlen leading cause of cancer death for connecting with the Breast Health knows breast cancer can return at any women and men. Centre is that staff are tapped into time. resources and that saved her from using However, she feels better now than An estimated 22,700 women across up valuable energy to find ones that she has in years. “I didn’t ever feel I Canada will be diagnosed in 2009 would suit her needs. was going to die, so I don’t really feel with breast cancer and 5,400 will die She’s attended group meetings, yoga it was a close call, but it was a life- of it. In 2002, it was estimated there classes for people with cancer, a ses- changing experience,” says Ruhlen, would be 20,700 new cases of breast sion about bone health, a course on who’s been open about her illness with cancer in Canadian women and eating well and getting fit, and another friends, co-workers and family, espe- 5,400 would die of it. about looking good and how to man- cially her 36-year-old daughter who age appearance-related side-effects. lives out of town. “Every person there was exception- “And it helped me to set my priori- Approximately 180 Canadian men ally positive in their attitude,” she says. ties and get my priorities straighter. I will be diagnosed with breast cancer in 2009 and 50 will die. In 2002, it was “It was a way to make me feel very feel more settled in my life. Having estimated there would be 140 new comfortable. I didn’t feel uncomfort- cancer has taught me patience, it’s cases of breast cancer in Canadian able with the fact that I had this taught me to decide what are the most men and 40 would die of it. illness. important elements of my life.” “I felt that this was an op- portunity for me to Judy Owen is a Winnipeg writer. One in nine Canadian women is expected to develop breast cancer during her lifetime and one in 28 will Being active 30 minutes a day can help you reduce your risk die of it. of developing breast cancer.

According to a 2007 report by the Canadian Cancer Society, the age- standardized mortality rate for breast cancer in Canadian women has fallen 25 per cent since 1986, from 32 Reduce your risk to 24.1 per 100,000 cases.

Making lifestyle changes isn’t always easy and there is no guarantee that you won’t develop breast cancer. However, according to its ongoing review of the The five-year survival rate of women research, the American Institute of Cancer Research (www.aicr.org) estimates the diagnosed with breast cancer is 87 risk can be reduced by 40 per cent by making these changes. per cent; for men it’s 84 per cent.

• Be as lean as possible without becoming underweight. Less than one per cent of breast • Be physically active for at least 30 minutes every day. cancer cases occur in women aged • If you drink at all, women should limit the amount to one drink a day, and 29 or younger. Twenty per cent of men to two drinks a day. breast cancer cases occur in women • Upon giving birth, consider breastfeeding for up to six months and then add aged 30-49. other liquids and foods to the baby’s diet.

The Canadian Cancer Society suggests: Sources: CancerCare Manitoba; • Avoid taking hormone replacement therapy (HRT) if you can. Canadian Cancer Society • Don’t smoke and avoid second-hand smoke.

November/December 2009 31 process innovation

Commitment to analyze QUALITYQUALITY Dr. Gerarda Cronin uses lessons from business school to help the Winnipeg Health Region deliver better hospital care

By Nelle Oosterom And that she has done. In fact, it was the work of Cronin and her team that resulted t happens nearly every day. A child suffers a severe in improved care for asthmatic children. asthma attack and is rushed to hospital, where he or she As a result, the Children’s Hospital in I Winnipeg now has one of the lowest undergoes treatment to bring the problem under contol. average lengths of hospital stay for children with asthma anywhere in Canada. In the past, an acute asthma attack often thousands of kids in the years to come Since becoming the first Director of resulted in admission and an average and conserve scarce resources. But it also Quality and Decision Support, in 2002, of two to three days in the hospital for represents something else: a relatively new the Irish-born doctor has been engaged treatment. Some children might suffer a approach to thinking about health care, in many projects, all designed to improve relapse and have to be re-admitted within one that blends insights from the world of patient outcomes through the careful 72 hours of being discharged. business with lessons learned in medical analysis of how care is delivered and, more Not anymore. Today that same child is school. importantly, how it can be improved. more likely to respond to initial treatment In Winnipeg, this new approach is Over the years, she has played a role and go home. If admitted to hospital, he or personified by Dr. Gerarda Cronin, Director in quality improvements as diverse as she will spend a day and half, on average, of Quality and Decision Support for the developing a protocol for the investigation before going home. And, chances are he Winnipeg Health Region’s Child Health of critical incidents to reducing lung or she will not require a return visit to the Program. A neonatologist by training, damage in premature babies. Some of her hospital. Cronin is responsible for identifying ways research is conducted under the umbrella By any measure, the reduction in to enhance the delivery of hospital care of the Canadian Neonatal Network, hospital bed days and re-admissions for children in Winnipeg. To put it another which collects and compares data from represents a real improvement in care for way, you could say she is the Leader of hospitals across the country with a view children with asthma, one that will benefit Making Things Work Better for Kids. to improving neonatal outcomes. She

32 WAVE process

structure

test

analyze photo by Marianne Helm photo by

Dr. Gerarda Cronin is a pioneer in outcome Canada’s quality care movement.

is also very involved with the Canadian care and, in her quest to learn more, safety, such as the aviation and nuclear Association of Paediatric Health Centres, turned to a field more often associated industries. For instance, in the early days a recognized leader and advocate for with manufacturing than with medicine – of aviation, there were many crashes due advancing the improvement of health care quality management. to pilot error. As aircraft became more for Canada’s children and youth. Quality management was first promoted complex, the problem worsened because Cronin’s journey from neonatologist back in the 1940s by American statistician pilots had trouble remembering all the to a leader in the field of quality care W. Edwards Deming, who called his steps they had to perform during takeoff, actually began soon after arriving in system Total Quality Management (TQM). landing and flight. In 1937, American Air Winnipeg in the early 1990s. She was the Credited with improving American Corps pilots were faced with the Boeing first neonatologist to be assigned to work production during the war years, he was Model 299 – “too much airplane for one at both teaching hospitals in Winnipeg. It best known for teaching the Japanese how man to fly.” It was then that they hit upon didn’t take her long to realize that different to apply quality principles, particularly a solution for flying this ultra-complicated hospitals often had different approaches in car making. Thus, companies like machine – a pilot’s checklist. Pilots to care, which would result in different Honda and Toyota started making cars around the world have faithfully followed outcomes for patients. “When I came to that were much more reliable then their checklists ever since. Today, flying remains Winnipeg, the first thing I noticed was the American counterparts, a point not lost on safer than driving. variation between the two hospitals (St. consumers. Medicine is a relative latecomer in Boniface General Hospital and the Health He famously developed fourteen points embracing quality management, although Sciences Centre). This was a new concept of management, one of which included nursing pioneer Florence Nightingale was to me. The whole idea of benchmarking driving fear out of the workplace so that an early 19th-century champion. A brilliant and practice variation was not something I workers could freely communicate their mathematician, she was passionate about was aware of until that time,” says Cronin. concerns. using statistical data to make improvements As time progressed, Cronin became Quality management has been applied to in the field. increasingly interested in the idea of quality various fields, especially those that involve “In the 1870s, Florence Nightingale

November/December 2009 33 analyze

outcome

wrote that, in her view, every hospital Region. The protocol was designed to children, it’s a good place to go looking for should have attached to it a unit or group operate in a “blame-free environment ways to improve care. of people whose job it was to analyze what where people can report adverse Cronin helped put together a went on in that hospital, the activities and events and near misses without feeling multidisciplinary team that included the outcomes of those activities, with a threatened.” The incidents are then medical staff, such as pediatric allergist Dr. view to providing feedback and changing investigated in the same way that airline Wade Watson and pediatric respirologist systems to improve the outcomes,” says accidents are investigated, with a view to Dr. Hans Pasterkamp, asthma education Cronin. “So what she was really saying was making changes in the system to prevent co-ordinator Cathy Gillespie, and quality that every health-care institution needs a future problems. officer Leslie Galloway, as well as a quality management system. She was quite Implementing the investigation tool has parent of children with asthma. The team forward-thinking.” helped the Region develop or improve audited existing practices and made some After much reading and attending many other protocols – such as systems of checks interesting observations. One of them was workshops and seminars, Cronin took and double-checks, and making it easier that the system was slow in administering the plunge and embarked on a sabbatical for staff to do the correct thing by having steroids – a highly effective treatment – to to pursue her MBA at the University of the right equipment available, for instance. the affected children. Another observation Manitoba’s Asper School of Business. Cronin, who has been a staff was that efforts to educate families about This is becoming more common in the neonatologist at the Health Sciences asthma management were not consistent. medical field. In recent years, universities Centre and St. Boniface General Hospital Under Cronin’s leadership, the team have started offering MD/MBA combined since 1990, led Manitoba’s Neonatal developed care maps – similar to the degree programs for doctors aiming to be Resuscitation Program from 1992 to 2000 idea early pilots had about developing managers and leaders in the health-care and has held several administrative posts. checklists. The children’s asthma care maps sector. But it wasn’t until she became the – sometimes they are called clinical paths It was through her studies at the Asper Director of Quality and Decision Support or care pathways – were implemented for School of Business that Cronin gained for the Child Health Program in 2002 Emergency Department use in June 2004, new insight into management systems that she was able to work on applying the while an inpatient care map came into use and strengthened her leadership skills. “I principles of quality management in more a year later. really felt I needed more nuts and bolts than an ad hoc way. “It’s not something “A care map is a tool that basically (management/leadership) skills,” Cronin that can be done in the evening and on shows you exactly what the right thing says. “That’s what got me to the point of weekends,” says Cronin. “I lobbied for is to do,” she says. “So that rather than a doing an MBA.” During her studies, she quite some time to get the structure in pediatrician saying, ‘Maybe I will or won’t learned the importance of developing place. And quality is a team sport.” do this or that,’ the pediatrician or the processes to review the design and The treatment of asthmatic children was emergency room physician will decide, implementation of health-care treatments, one of the first projects she undertook after ‘This child is eligible for the asthma care checks that would go beyond the becoming director, and it illustrates how map, which means I must give steroids. I traditional kinds of medical reviews that the Child Health Quality Team operates. have a choice between two medications in took place in a hospital setting. Asthma is the most common chronic doses that are tailored for success.’ There One way in which she used her new disease in Canadian children. About nine are quite a few elements to it, but once knowledge and training was to launch a per cent of all visits to the Children’s they make those simple decisions, then protocol for the investigation of critical Hospital Emergency Department are due treatment proceeds immediately…. incidents. Introduced in 2001, it is now to asthma. Since asthma takes up so much “There are always the exceptional in use throughout the Winnipeg Health time and resources, and affects so many patients for whom a care map is not the

34 WAVE outcome

right strategy, but they are the exception.” care units across the country in 1996-97 at Children’s Hospital. One idea is to The team also rolled out information showed that mortality rates varied widely use engineering know-how to determine material for parents and did a lot of between hospitals – from 1.6 per cent to the optimum number of monitored and education for staff. 5.5 per cent. A major focus of the network intensive care beds – too many is wasteful “We found that we were seeing dramatic is to standardize and improve care at all of time and resources, too few results in improvements in the response of children neonatal units across Canada. too many elective surgery cancellations. to what was now a much more timely In a project carried out between They use a mathematical method Florence treatment.” 2002 and 2006, the network applied a Nightingale would have loved – Monte Following the implementation of the methodology known as EPIQ (Evidence- Carlo simulation. It’s a way of modelling asthma care map, the administration of based Practice for Improving Quality) to outcomes when the factors at play are oral corticosteroids within one hour of two groups of neonatal intensive care units largely unpredictable, such as the flow of presentation rose from 61 per cent to 92 – one group working to reduce nosocomial patients through an Emergency Department per cent. The average length of stay for (hospital-acquired) infections and one group when factors such as H1N1 are present, for children who had to remain in hospital working to reduce chronic lung disease. instance. dropped to 1.5 days from 2.3 days, thanks “The results were dramatic,” says Cronin. Needless to say, Cronin is a very busy to closer ongoing monitoring of their The incidence of nosocomial infections in person. In her work life, there is no typical condition and tailoring of their treatment the first group of NICUs decreased by 34 day. She spends some of her time practising accordingly. per cent, while the incidence of chronic neonatal medicine, and some of her time “It’s amazing how fast children get well lung disease in the second group of NICUs teaching and working on one of the many when we are responsive to their needs.” dropped by 15 per cent. As well, within the projects she is involved in. These days, she Better education meant fewer relapses as latter group, hospital acquired infections keeps a suitcase at the ready for the next parents received a written asthma discharge dropped by an astounding 44 per cent. trip to teach or present at a conference. plan to help them prevent future attacks Cronin is now playing a key role in She could not have pictured it would be through such measures as identifying a five-year project known as EPIQ 2, this way when she entered medical school. allergens in the home. which will introduce this model of quality The only child of intelligent parents with “We’ve been watching indicators such improvement in every neonatal intensive no access to post-secondary education, as the chances of children coming back care unit in the country. This involves her mother and father wanted to make to the emergency room, and basically it’s teleconferences and workshops to engage sure she had a good education, so when extremely uncommon.” staff in every province in improving she was four years old, the family bought a The emergency asthma care map was neonatal care on multiple fronts. house adjacent to University College, Cork, implemented at all Winnipeg Emergency “So the potential ramifications of this, Ireland. “They took me around the campus Departments in 2006. As well, other assuming we can be successful on a larger and told me ‘That’s where you’re going pediatric centres and community hospitals scale, are enormous because neonatal when you finish school.’” across Canada have adopted similar intensive care is one of the most expensive Attending university required travelling methods based on this model. forms of care that there is, and because a mere few footsteps. But those few steps Another project Cronin has been we’re dealing with newborn infants, they became a lifelong learning journey that involved in concerns better outcomes for have their whole lives ahead of them.” would lead her to Winnipeg, where she has premature babies. She is a member of And in yet another of Cronin’s been a rising star in the effort to improve the Canadian Neonatal Network led by endeavours, she has engaged the quality in the health-care field. Dr. Shoo Lee, who is based in Toronto. engineering department of the University Data collected from 17 neonatal intensive of Manitoba to help improve patient flow Nelle Oosterom is a Winnipeg writer.

November/December 2009 35 structure Benchmarking Quality

Here is a brief overview of the improvements in care achieved in the Winnipeg Health Region through the work of the Child Health Program’s Quality and Decision Support team.

5 Asthma average 4 length Through the development and implementation of asthma care of stay 3 2.3 maps, the average length of stay in hospital for children with (days) asthma has been reduced to less than 1.5 days from 2.3 days. 2 1.5 Enhanced asthma education information for parents has virtually 1 eliminated re-admissions of patients discharged.

before after

10 8% Bronchiolitis 8 re-admission The re-admission rate for bronchiolitis 6 rate (%) patients was reduced to four per cent from 4% eight per cent following the adoption of new 4 guidelines for treating patients. 2

before after

10 Timely treatment with antibiotics 8 Children with cancer who are treated with chemotherapy response time are very vulnerable to serious infections. In 2003, it took five 6 5 hours (hours) hours, on average, for a feverish child with a low white cell 4 count to be treated with antibiotics. After redesigning this process, the average wait is now 64 minutes, and all such 2 64 minutes children receive antibiotics within two hours of arrival at before after Children’s Hospital’s Emergency Department.

Complications of prematurity Efforts to reduce lung damage in premature babies resulted in dramatic improvements in patient outcomes. Hospital- acquired infections dropped between 34 and 44 per cent in 15% process two groups surveyed. The incidence of chronic lung disease dropped by 15 per cent, resulting in many fewer days on the reduction of chronic ventilator. lung desease

decreased median time between booking and surgery Surgery

15% All emergency surgical cases are now operated on within the two hour standard; the median time between booking and surgery decreased 15 per cent within the past year. decreased wait time for urgent surgical cases For urgent surgical cases, 86 per cent are now operated on within the expected six-hour standard; the median wait time 31% decreased 31 per cent in the past year.

36 WAVE analyze Wishing you and yours

A Happy, Healthy Holiday Season.

From the staff of the Winnipeg Health Region

Introducing Winnipeg’s newest health and wellness magazine.

Catch yours today!

Waiting for the next One year (six issues): $12.60 Two years (12 issues): $23.10 Call 697-7122 or ? send an e-mail to [email protected]

November/December 2009 37 Your Guide to a Happy, Healthy Winter By Martin Zeilig • Illustrations by Krista Lawson

Even when it is slow in arriving, winter in promotion co-ordinator with the Winnipeg Winnipeg can be intimidating. Health Region: Enjoy it. The biting winds, driving snow, sub-zero “Embrace the winter, because if we go into temperatures - it’s all enough to send a shiver something with dread, it won’t be an enjoy- down the spine of even the heartiest souls. able experience,” says McPherson. In other Some of us while away the winter months words, adapt. “Get a positive mindset that watching television or playing computer you’ll make the best of it.” games, effectively becoming couch potatoes. Of course, if you are going to take on Others seek refuge in winter getaways, taking winter, you will need some help. With that in a few weeks off to lay on a beach somewhere mind, the next three pages contain some tips tropical and warm. on how to winterize yourself in order to take But there is another way to deal with winter, better advantage of the season ahead. says Laurie McPherson, a mental health

38 WAVE Embrace the Great Outdoors

The arrival of winter tends to send many natural ice skating trail) will receive all the people into hibernation. That’s unfortunate cardiovascular benefits of an aerobic workout because outdoor exercise plays an important without the wear and tear on the body that role in maintaining one’s physical health and comes from similar activities, such as running. overall well-being, and winter offers a multi- The same can be said of cross-country skiing tude of opportunities for fun-filled activities. or snowshoeing. And what could be better for Skating, cross-country skiing, snowboard- mind and body than a brisk winter stroll. ing, downhill skiing – these are just some of A word of caution: don’t overdo it on your the exciting activities available during winter. first time out this winter. Set realistic goals for Even going for a walk can be enjoyable. activity and pace yourself. And, of course, The health benefits of a good winter remember to dress warmly by layering your workout are undeniable. For example, a clothing. For more information on outdoor person who goes for an hour-long skate on activities, visit www.winnipeg.ca/publicworks/ the Assiniboine River Trail (world’s longest parksandfields.

November/December 2009 39 Stay Connected It’s not uncommon for individuals to feel known as “cabin fever.” a little blue during the winter – and not just McPherson says people can winterize because they have spent too much time in themselves by focusing on things they can -30 C weather. control and building resiliency. For example, “People in general find that the short days try breaking up the routine of the day by going can have an effect on their mood,” says Dr. for a walk. “You’re benefitting from the sun Michael Eleff, a psychiatrist with the Winnipeg and fresh air and maximizing your outdoor Health Region. experience. You can enhance your work One condition often associated with the space by adding photographs, or paintings winter months is Seasonal Affective Disorder and flowers – little things that are reminders of (SAD). A mild form of SAD, often referred to spring and summer. as the “winter blues,” can also be a problem It’s also important to remain engaged in for some. Research in Ontario suggests that the world around you. “Make sure you have between two per cent and three per cent of something to look forward to every day, like Canadians may have SAD, while another having coffee with a friend, or reading a favou- 15 per cent may suffer from “winter blues,” rite book or magazine. according to the Canadian Mental Health As- You can also improve your mood by tak- sociation website. ing up a hobby or going out with friends to “One thing people ought to do to winter- a movie or one of the many cutural events ize themselves is to pay attention to their own taking place in the city. “Doing something moods and those of people they care about,” to maintain a more positive outlook is vital says Eleff. He also cautions people to “protect during winter.” For more information on SAD themselves” from the tendency to become iso- and other winter-related maladies, visit www. lated and locked-in during winter, a condition cmha.ca.

40 WAVE Eat Healthy Can a healthy diet make winter a little the body absorb calcium and build bones. easier to weather? However, the shorter days of winter mean The answer, according to many health less sunlight and a reduction in our vitamin experts, is yes. D levels. As a result, some people, especially Generally speaking, the number of people those over 50, may have to boost their vitamin who become sick with colds and influenza D intake. goes up as the mercury goes down. One way Good dietary sources of vitamin D include to winterize your body against these maladies milk, fortified soy beverages and certain types is to eat a healthy diet, according to Cheryl of fish, including salmon, mackerel, tuna, Ogaranko, a registered dietitian with the Win- herring and sardines. Health experts recom- nipeg Health Region. This will help ensure mend taking a vitamin D supplement during you get the vitamins and minerals you need to the winter, but check with a physician before strengthen your immune system and ward off taking any supplement. winter viruses. Health Canada recommends that in addi- “No matter what the season, you should tion to the 200 IU of vitamin D one would still follow Eating Well with Canada’s Food expect to consume daily by following Eating Guide,” says Ogaranko. Well With Canada’s Food Guide, everyone over the age of 50 should take a daily vitamin It’s also important to monitor your intake D supplement of 400 IU. For more informa- of vitamin D. Dubbed the “sunshine vitamin” tion, visit www. hc-sc.gc.ca/fn-an/food-guide- because it is derived naturally from the sun’s aliment/index-eng.php. rays, vitamin D is important because it helps

November/December 2009 41 ask a nurse

Linda Coote

learn how to protect yourself from cold weather related injuries What are some of the more seri- • Swelling may be present ous weather-related injuries that • Blisters may be present people suffer during the winter? • Area is initially cold, hard to the touch • Sensation is reduced Low temperatures, especially combined • If rewarming has occurred, area will with strong winds, can lead to frostnip, be warm and tender frostbite, and hypothermia. How are frostnip and frostbite What is frostnip? treated? Frostnip is a thermal injury to tissue Treatment for both injuries includes: caused by cold. The injury may occur • Rapidly rewarm the area by with or without freezing of the tissue. immersing in warm water at Frostnip most commonly affects the approximately 42 C for 30 minutes. hands and feet. It happens when ice • If water is not available, hold area crystals form under the skin; it’s usually between two warm hands. not painful and is easy to treat. Frostnip • Do not rub and do not use hot water initially causes cold, burning pain, with bottes or hot stoves. the area affected becoming blanched. • Rest affected limb, avoid irritation to With rewarming, the area becomes red- the skin. dened. • Continue rewarming until skin is warm, soft, pliable and flushed red. What is frostbite? • Elevate limb once it is rewarmed. • Do not break blisters. Frostbite occurs when soft tissue freezes. • Wrap loosely in soft material, protect It is a particular danger on days with a from injury and further cold exposure. high wind-chill factor. If not properly • Give the person warm fluids to drink. treated, frostbite can lead to the loss of • OfferTylenol or ibuprofen for tissues or even limbs. Symptoms include: pain if needed. • Cold, burning pain that progresses to Seek medical attention for frostnip and tingling frostbite if: • Later, numbness or heavy sensation • Area becomes pale or white • The skin is pale, feels unusually firm • Rewarming causes pain and is insensitive to touch, even after re-warming. Other physical findings for both frostbite • There are large areas of blistering, and frostnip may include: bluish discolouration that does not resolve with re-warming, or severe • Reduced body temperature pain. • Affected area may be red or white

42 WAVE What is hypothermia? Hypothermia is a potentially fatal condition that occurs when the body’s temperature drops below 35 C (95 F). A person can develop hypothermia if they have been exposed to cold temperatures for a long period of time (e.g., being stranded outside in winter because your automobile gets stuck or breaks down) or if they are im- mersed in cold water for a short period time (e.g., falling through ice on a river or pond during the winter). Alcohol is a major risk factor for hypothermia. A person who drinks too much and then spends time outside in sub-zero temperatures can misjudge how their body is reacting to the cold. Warning signs of hypothermia include: • Drowsiness • Slurred speech • Irritability and combativeness • Impaired co-ordination • Weakness and lethargy • Cool skin

How is hypothermia treated? If you suspect someone is suffering from hypothermia, call 911 im- mediately or transport them to the nearest Emergency Department. If you cannot take a person to an Emergency Department and must wait for medical help, you can treat a person suffering from hypo- thermia by bringing the person in question indoors and wrapping them up with blankets to increase body temperature. Replace wet clothes if necessary. While reflected heat from a stove can help raise body temperature, do not use direct heat, electric blankets or hot water bottles to rewarm. It is also important to not rub the skin as this increases the damage to the skin and underlying tissue. If the person is conscious, give them warm, sweet, non-alcoholic drinks. Do not give medication, alcohol or allow them to smoke.

How can I guard against cold weather-related injuries? Cold weather-related injuries usually occur when we fail to treat the cold with the respect it deserves. When going outside to cross-country ski or toboggan, remember to dress in layers with appropriate cold-weather gear. Be sure to wear a warm hat that covers your ears and a pair of loose-fitting gloves or mitts – up to 40 per cent of our body heat is lost through the head and hands. Likewise, one should always prepare for car trips, especially if you are driving through remote areas. When travelling by car, moni- tor weather conditions carefully and adhere to travel advisories. Keep a winter storm survival kit in your car. This should include extra clothing, blankets, food, flares, chains, gloves and first-aid supplies. Keep your gas tank full, and to the extent possible, avoid travelling alone. Linda Coote is a registered nurse and manager with the Winnipeg Health Region’s Health Links - Info Santé.

FYI

You can access health information from a registered nurse 24 hours a day, seven days a week by calling Health Links - Info Santé. Call 788-8200 or toll free 1-888-315-9257.

November/December 2009 43 in motion

Kristine Hayward Perfect Presents A guide to active gift giving for the holidays

very year, I stress over trying to find the perfect Epresents for my family and friends. I spend many hours wandering through Stroke Foundation of Manitoba, suggests so your loved one can learn some fun and the shops, looking for ideas on what to that a mix and match of at-home activity safe exercises to get them started.” get people on my list, especially those tools such as hand weights, resistance If you have an older adult on your gift- who appear to have everything or those bands, skipping ropes, exercise mats and buying list, Gail Pradel and Kusela Capu- who don’t seem to like anything or have exercise videos make good active gifts. long, members of the Winnipeg Health any hobbies. “You could also pair an active gift with Region’s Downtown Healthy Aging This year, I am approaching the gift- the gift of your time, so you can enjoy Resource Team, suggest a Nintendo Wii. buying season with a stress-free twist. I tobogganing, skating, skiing, or snow- ”It is a great way to be active with friends am breaking away from the traditional shoeing together,” she says. or family and a great inter-generational holiday sweaters, fruitcake covered with Kristen Braid, CSEP-Certified Exercise activity. If Wii is not in the budget, how almond paste, ornaments for the tree or Physiologist with the Wellness Institute at about a set of walking poles or traction a new tie. To show my family and friends Seven Oaks General Hospital, says there aids for their shoes or winter boots to how much I really care about them, I are so many great active gift ideas that make winter walking safer?” am planning to give gifts that promote a it is hard to pick just one. But she says Have your children been begging to get healthy, physically active lifestyle. a stability ball is a great idea for a gift, a dog? Now may be a good time to grant I am excited about all the active gift especially for someone who spends a lot their wish. Although it involves feeding, ideas that I have been coming across as of time sitting at a desk during the day. watering and some picking up after, a dog I put together my shopping list – from “There are many exercises that can be is a great way to encourage your family to stocking stuffers all the way up to the done on a stability ball to strengthen your be active. Research shows that dog own- bigger gifts. I’m pretty sure my family and core (abdominal and back) muscles to ers are more active than those who don’t friends are each going to get something improve your seated posture and balance. own a dog. Just be sure your family is that they’ll love and will help them to Just be sure to buy a quality anti-burst ready for the long-term commitment and be more active. I’ve also included lots of ball,” says Braid. lifestyle changes that come with a new active items on my own “wish list” and “A customer service representative at four-legged family member. have encouraged my two children to any fitness equipment or medical supply incorporate active items on their “wish store will be able to help you choose the Kristine Hayward is a co-ordinator list” for Santa. right ball for your loved one. And don’t with Winnipeg in motion, a partnership of Lisa Scharf, Physical Activity – Heart forget to buy an instruction manual or a the Winnipeg Health Region, the City of Health Manager with the Heart and session with a qualified personal trainer Winnipeg and the University of Manitoba.

44 WAVE Who’s on your list? No matter their current fitness level or age, an active gift is a possibility for anyone. Here are a few ideas for your shopping and gift wish lists.

Theme/Area Gift Idea Stocking Stuffers

For the whole family Twister game Skipping rope Wii or other active video games Hand weights Toboggan Frisbee Skates Set of lessons – swimming or skating Winter helmet and goggles Snow fort or snowperson kit Hoola-hoop Skate sharpening

For the new parent Jogging stroller Offer of babysitting Wagon Gift certificate for a parent and Baby backpack carrier baby exercise class Exercise Ball

For the “techie” Handheld GPS Pedometer (global positioning system) iTunes gift card MP3 player Arm band to carry your MP3 player Heart-rate monitor Workout video Training watch

For the outdoor enthusiast Set of walking poles Hand warmers Snow shoes Compass Cross country skis Head lamp

For the walker or runner Nike + iPod sport kit Blinker light Traction aids for winter walking/ Reflective arm band running – like Yaktrax or Stabilicers Water bottle

For the golfer New golf club Sleeve of golf balls Gift certificate for a golf lesson Package of golf tees

For the fashion-conscious Athletic wear store gift certificate Toque and mittens New winter boots Headband

For “the zen one” Yoga mat A trial pass to a yoga studio Yoga accessories Relaxing music to stretch by

For the reader Book on local walking trails Health and fitness magazine Fitness book subscription

Looking for a qualified exercise professional? Connect your loved one to an exercise professional to develop new skills and for added motivation. Check out the Manitoba Exercise Professional Association’s website for a complete listing of qualified personal trainers in your area. Visit www.mepa.ca.

November/December 2009 45 Holiday Giving Where Relaxation Made Simple Say it with a Gift Card & Fashion Meet for spa or fashion boutique A Wide Selection of Holiday Wear

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Magnificent mandarins

Every year about this time, local gro- cers begin to stock one of nature’s treasures: the mandarin orange. This sweet, seedless fruit originated in China centuries ago, but arrived in North America via Japan, some- time in the late 1800s. More recent- ly, mandarin oranges have been imported from China and even the United States. Always delicious, the mandarin orange owes much of its popular- ity to the fact that it is easy to peel and eat. It’s the perfect portable snack for your lunch bag, purse or briefcase. Mandarin oranges also pack a lot of nutritional punch. Two clemen- tines or one tangerine can provide as much as 87 per cent of the daily requirement of vitamin C, as well as vitamin A and soluble fibre. The white pith that so many of us prefer to peel off also contains fibre and nutrients. These oranges are bursting with flavonoids, a plant chemical with health benefits that scientists are continuing to discover. With so many reasons to choose this sweet, juicy fruit, why not bring a basket to your next holiday potluck? It’s quick, easy and a light alterna- tive to heavier holiday foods. healthy eating

Jodis McCaine

Eat, drink and be healthy

8 ways to enjoy the holidays with food, friends and family

he holiday season is filled with many fes- Ttivities and decadent food choices. Too much of that great food can wreak havoc on our health. However, there are still ways to enjoy get-togethers and not totally lose track of your healthy living goals. The 2 holidays are a time for socializing with friends and family. Go green: Fill half your plate with colourful vegetables, espe- It is important to focus on the occasion, not on the over- cially orange and green vegetables – they will fill you up with abundance of rich foods. All foods can fit – even traditional few calories and provide different tastes, colours, nutrients and holiday goodies – into a healthful eating plan, with balance textures. Another way to go green is to use fresh zucchini or cu- and moderation. Keep in mind these holiday menu tips: cumber sticks, broccoli florets, carrot sticks, and red and green peppers with a low-fat dip or spread such as hummus, yogurt with herbs, or fresh salsa. 1 3 Keep your eye on portion sizes: It’s not always what you eat, Drinks on the house: Lower-fat eggnogs, but rather how much that can lead to overindulgence – not just “virgin” Caesars, sparkling water, and during the holidays, but any time of the year. Use Eating Well cranberry juice spritzers are all great with Canada’s Food Guide to determine how much is right for choices in keeping with the season. If you. If you are at a sit-down dinner party, cut your first helping you choose to drink alcoholic beverages, in half. That way, if you are still hungry, you can enjoy seconds plan to have water or soda water with and the total amount of food you eat will be about the same as a slice of lemon or lime between each a healthy portion. drink to pace your intake.

48 WAVE Create a colourful dessert platter: When serving dessert, arrange smaller portions of calorie-laden treats with colourful exotic fruits, such as pineapple, kiwi, mango, pomegranate, strawberries or 4 6 grapes. Not only is the fruit a healthier option, it has a lot of eye- appeal. Go easy on the extras: Try using herbs, spices, lemon juice, garlic, low-sodium broths and vin- aigrettes to add flavour to potatoes, vegetables Let the holiday spirit move you: and meat dishes, instead of dressing up your Plan to participate in regular physi- foods with gravy, sour cream, butter, margarine cal activities with the whole family, or cream-based sauces. 7 such as walking, skiing, ice skating Take the edge off your hunger before a party. or tobogganing. Every bit of physi- Keep the rest of the day’s food selections cal activity you can sneak in counts healthier. Select foods like high-fibre cereals, and it may help you de-stress from non-fat milk or yogurt, vegetable soups, cut up the holiday bustle. vegetables such as red, yellow, and green pep- pers, baby carrots, and small pieces of fruit such as apples, bananas or mandarins. These foods will provide a feeling of fullness and reduce the temptation to over-eat at the party. 8 Be realistic: Holiday eating will come with its temptations and indulgences. Follow the 80/20 rule: 80 per cent of the time try your best to choose healthy 5 foods; 20 per cent of the time, splurge! Cook it healthy: Bake, grill, stir fry, steam or char-grill rather than fry. When hosting a party, Have Fun! Enjoy traditional holiday meals and party foods with family and friends while maintaining a healthy lifestyle, too! set a good example and provide lots of veg- etables, fruit and lower-fat dips. Send leftovers home with guests. Jodis McCaine is a registered dietitian with the Winnipeg Health Region.

Healthy festive foods

Cranberries: Cranberries are full of vitamin C and fibre. They also contain the antioxidant proanthocyanidins, which can prevent the adhesion of bacteria to the urinary tract sometimes causing urinary tract infections.

Green Beans: Green beans are an excellent source of vitamin C and are no doubt one of the healthiest holiday foods around. They are a good source of dietary fibre, potassium, folate, vitamin A and iron. The traditional green bean casserole is rather high in calories from the butter, cream of mushroom soup and cheese it’s made with. A healthier way of making this dish would be to use lower-fat cream of mushroom soup and less butter and cheese.

Turkey: It’s not a holiday meal without the turkey! Turkey is an excellent source of protein. Compared to other meats, turkey has the least amount of fat per serving – if you pass on the skin. Roasted turkey with the skin has 10 grams of fat per 3-ounce serving, while removing the skin saves you half the fat (and calories).

Sweet Potato: Sweet potatoes are nutritional all-stars that have a natural sweetness that intensifies during cooking. They are rich inbeta-carotene, vitamin C and are an excellent source of potassium. If you eat the skin (unlike the turkey skin) you will increase the fibre.

November/December 2009 49 Look into Nursing

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