WINNIPEG’S HEALTH & WELLNESS MAGAZINE SEPT/Oct 2010

BACK TO SCHOOL 5 nutritious ideas for your child’s lunch bag BREATHING EASY One 10-year-old boy’s struggle against asthma DON’T GO VIRAL Get the shot, not the flu

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12 Table of contents Features Breathing easy One boy’s struggle to manage his asthma 12

Home sweet home Supportive housing offers seniors independence within a safe, secure environment 16 38 PRIME time Innovative centre provides full-service care for seniors with complex health issues 24

Departments & Columns A Letter from the Winnipeg Health Region Getting on track with primary care 7

Health Beat Region moves to increase organ donations 8

Your Health 44 Don’t go viral: Get the shot, not the flu 30

Balance Check it out: Make sure your kid’s busy calendar includes plenty of free time 38

Ask a Nurse Cholesterol management: What you need to know 42

Healthy Eating Back to school: 5 nutritious ideas for your kid’s lunch bag 44 24 In Motion 60 Minutes: That’s all it takes for you and your family to gain a lifetime of good health 40

September/October 2010 5 YOUR GUIDE TO THE RISING TIDE OF HEALTH & WELLNESS INFORMATION

  September/October 2010 Volume 2 Issue 5

Publisher Winnipeg Regional Health Authority President & CEO Arlene Wilgosh    Regional Director, Communications & Public Affairs Michele Augert

Editor Brian Cole > BE TOBACCO FREE

Contributing Writers Kenton Smith, Helena Cole, > EAT WELL Bob Armstrong, Joel Schlesinger Columnists Deanna Betteridge, Marni McFadden, > SHAPE UP Linda Coote, Laurie McPherson Creative Director Krista Lawson Photographer Marianne Helm > CHECK UP Illustrator Krista Lawson > COVER UP On the Cover Louisa Loeb, photographed by Marianne Helm

Editorial Advisory Board Réal J. Cloutier, Dr. Wayne Hildahl, Lynda Tjaden, Dr. Cheryl Rockman-Greenberg, Dr. Michael Moffatt

Wave is published six times a year by the Winnipeg Regional Health Authority in co-operation with the Winnipeg Free Press. It is avail- able at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

Winnipeg Free Press Publisher Bob Cox cancercarefdn.mb.ca VP Sales & Marketing Laurie Finley

Advertising/Marketing, Corporate Media Services President Larry Licharson Director of Advertising Jared Shapira Phone: 204.943.3325 e-mail: [email protected] McPhillips Hearing Sales Co-ordinator Glen Zelinsky Phone: 204.943.3325 & Audiology Centre Inc. e-mail: [email protected]

Subscriptions www.audiology-online.com Wave is available through subscription: Your Ears Deserve An Audiologist One year (six issues) for $12.60 ($12+GST) Payment may be made by cheque, money order, VISA, or MasterCard. Christine Dino, Au.D. To subscribe, phone: 204.697.7122 Or, send an e-mail to: [email protected] Doctor of Audiology Or write to: Wave Call For A Consultation C/O Winnipeg Free Press 1355 Mountain Avenue Before Buying Hearing Aids 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/lecourant. You can request a printed copy by calling 204.926.7000. Check out for our promotional video - type oticon delta The information in this magazine is not meant to be a substitute for professional medical advice. Always seek advice from your physi- cian or another health professional regarding any medical condi- tion or treatment. Opinions and views expressed in this publication Ph. (204) 953-4200 do not always represent those of the Winnipeg Regional Health 1399 McPhillips St. Authority. This publication may not be reprinted or reproduced Northgate Shopping Centre in whole or in part without the consent of the Winnipeg Health Region. Winnipeg, MB

6 WAVE Getting on track with primary care

Of course, providing ready access to health/phc/pin/index.html.) health care is easier said than done. Part Another initiative to enhance access to of the problem is that human and financial care involves the creation of community- resources are not infinite. Still, things can based Access Centres. These sites have be done to improve access to care within teams of doctors, nurses, health educators our existing budget framework. Across and counsellors – all under one roof, mak- the country, a lot of work is being done to ing it easier for people to connect with the improve primary care and ensure that ev- right individual and the right information. eryone has appropriate access In addition, Access Centres house family to the services they need. services and provide an excellent opportu- A Letter from the Winnipeg Health Region Here in Manitoba, the nity to address other issues as required. Arlene Wilgosh, President & CEO provincial government and the Access Downtown officially opened Winnipeg Health Region are this month at 640 Main Street, provid- collaborating on ways to further ing people in the community with a new hen you or someone you care develop our primary care-system. In fact, centralized place for health and social about becomes ill, where do the Region executive has just approved services. Three Access Centres (Transcona, Wyou go for medical help? If you a proposal to explore additional ways of River East and Downtown) have opened, just can’t shake a fever or you’re con- supporting the “building blocks” of our and a fourth, Access Nor’West, is set for cerned about changes in your body, who primary-care system. The goal is to support construction on Keewatin Street and will do you turn to for advice? family doctors and others in making qual- serve the residents living in the northwest Traditionally, the first point of contact ity care more accessible. Going forward, part of the city. for health care has been the family doc- our staff will work in collaboration with Part of improving access to primary care tor. Back in the day, they would even Manitoba Health and key stakeholders, also involves looking at who exactly pro- make house calls if their patient couldn’t including family physicians, to determine vides that initial connection to the health- make it to the office. While most people a plan of action. Public input has been and care system. The right provider at the right still rely on a family physician to be their will continue to be crucial in this work. time isn’t always a doctor. In some cases, primary-care provider, modern practice Fortunately, we already have many the best avenue for primary care is a nurse has changed. Most doctors no longer make health-care “pieces” to build on, including practitioner – a registered nurse who has house calls, and even finding a family a dedicated workforce of highly trained been specially trained to do many of the physician can be a bit of a challenge. health-care providers. Our focus moving things that a doctor does, such as assessing I got a first-hand look at the difficulties forward must be to co-ordinate our efforts and diagnosing patients, ordering screen- of finding a family physician a few years to enhance access and the health-care ing and diagnostic tests, prescribing drugs ago. Shortly after my daughter turned 18, experience, and create better value for the and performing minor surgical procedures she became sick with a serious case of growing health-care dollars that are spent. like suturing wounds. pneumonia. She was no longer a child and One key objective in all of this is to Nurse practitioners work with other needed to find a family doctor to replace ensure people can access the right care by health professionals, such as family physi- the pediatrician she’d had for years. the right provider in the right setting. cians and pharmacists, and are becoming I remember making trips to numerous A story in this issue of Wave about PRIME more common in Canada. There are now health-care clinics, searching for a family offers one example of how we are working about 50 nurse practitioners working in doctor for my daughter. Like many others to provide primary care to those in need. the Winnipeg Health Region, providing faced with a similar challenge, I felt like The Physician Integrated Networks primary care in places such as Access Cen- there was no one to turn to. (PIN) initiative is another example of how tres, community health centres, emergency Eventually, we found a doctor, but the we are collaborating with some family rooms, specialty clinics, personal-care experience reminded me of the impor- physician groups to improve care. Since homes and acute-care facilities. tance of primary care – and making sure 2007, approximately 130 family doctors These are just some of the ways we here all Manitobans have access to it. working in group practices throughout at the Region are working to improve ac- That point was made again earlier this Manitoba, including 62 in Winnipeg, have cess to primary care. There are more plans year by the Winnipeg Health Region’s been addressing key issues such as access in the works, and we will be telling you Community Health Advisory Councils. The to quality primary care. With this initiative, about them in the months ahead. Councils issued a report identifying some PIN group practices have access to Quality We know primary care is the founda- key expectations of the health-care system. Based Incentive Funding, which can be tion of our health-care system. It needs to On their list was the right to primary care; used to offset the costs of bringing in other be strong in order to support the health fair and timely access to specialists, diag- medical professionals to assist with various and wellness of people today and of future nostics and treatments; more resources for aspects of caring for their patients. (For generations. There is a lot of work ahead, disease prevention; and health promotion. more information, visit www.gov.mb.ca/ but we’re on the right track.

September/October 2010 7 health beat

Region aims to boost organ donations

Creation of in-hospital physician team will save lives

program to dramatically boost the number of physicians comes in. Along with providing organ donations within the Winnipeg Health medical care to patients who wish to have A their organs donated and working with the Region is expected to be up and running by the families involved, the new organ donation end of the year. specialist team will be responsible for: • Organ donor medical assessment and Dr. Peter Nickerson, Medical Director of Under current practice, health-care co-ordination. Transplant Manitoba’s Gift of Life Program, providers are able to refer potential organ • Leadership for promotion across says the initiative will help ease the lineup donors to the Gift of Life Program and provincial emergency departments and for organ transplants, a list that averages tissue donors to Tissue Bank Manitoba and intensive care units. about 200 people a year. Lions Eye Bank of Manitoba and Northwest • Education for health-care students and The program – the first of its kind in Ontario. health-care professionals to assist them Canada – calls for the creation of an in- But Nickerson says, for a variety of rea- to recognize all organ donation hospital team of physicians to spearhead sons, that doesn’t always happen. Audits opportunities while ensuring they efforts to increase organ donations from show that as many as 45 per cent of poten- approach relatives in a compassionate deceased patients. tial deceased donors may not be referred. manner. Currently, the deceased organ donation Part of the reason for the gap is that po- The program, initially announced rate for Manitoba is about 11.5 per one tential donors are rare and not all health- by Health Minister Theresa Oswald in million in population. But Nickerson says care providers may recognize suitable August, will cost about $360,000 and he hopes the new program will boost the candidates. Nickerson estimates that only could involve as many as six physicians. It rate to at least 20 per million, which would one to two per cent of people who die in builds on previous organ donation-related be in keeping with efforts in some Euro- hospital would be considered for organ do- investments by both the province and the pean countries. nation. “The likelihood of any one (health- Region totalling $4.6 million over the past The life-saving potential is enormous. care provider) encountering someone who five years. Nickerson estimates that as many as 13 is a potential donor is about one to two a Nickerson says there is good reason to Manitobans die every year waiting for an year,” says Nickerson. “So part of it is the believe the program, first developed in organ transplant. “That’s preventable,” need for physicians to just be aware and Spain, will be successful. He says Spain, Nickerson says. “We have the potential to up-to-speed as to who qualifies.” Belgium and other countries have all prevent that.” That’s where the in-hospital team of boosted their deceased donation rates to

8 WAVE Organ donations by the numbers n 2005, there were six deceased organ donors in The Winnipeg Health Region works with the IManitoba. Since then, the annual number of de- province through Transplant Manitoba and ceased donors has more than doubled, to 14 in 2009. the Gift of Life Program to oversee organ do- The recent decision to create an in-hospital physician nations and transplants. In 2006, the partners team is expected to again increase the number of de- embarked on a strategy to increase organ ceased donors, and transplant operations. The chart donations, investing a total of $4.6 million. The below shows the number of deceased organ dona- strategy was implemented in four phases: tions since 2005. Phase 1 (2006): Create the Gift of Life Organ Donation History By Year Program to give focus to organ donation activities. Year Number of Deceased Phase 2 (2008): Build capacity to fund more Multi-Organ Donors transplant surgeries. The Region now does about 50 kidney transplants a January to June 2010 12 year, but has the capacity to do as many as 70. 2009 14 Phase 3 (2009): Build capacity to look after transplant recipients. 2008 14 Phase 4 (2010): Create in-hospital physician 2007 15 organ donation team. Here is a brief statistical overview of activity 2006 13 involving organ donations and transplants:

Percentage increase in deceased 2005 6 68 kidney donor transplants (133 since January 2006 compared with 79 in the previous five years) at least 20 to 25 per million. “Italy used to be around 14 per 78 Percentage increase in lung transplants million. They adopted the model, and they are now at 25 to since 2005 28 per million.” 21 Percentage increase in Manitoba’s Arlene Wilgosh, President & CEO of the Winnipeg Health support of heart transplants since 2005 Region, says the new program is an example of how innova- (performed outside the province) tive thinking can help save lives. “The leadership of the Gift of Life Program reviewed best 91 Percentage increase in Manitoba’s support of liver transplants since 2005 practices for promoting and managing organ donations in na- (performed outside the province) tions with the highest organ donation rates in the world, then took what they learned and crafted a proposal that adopts 62 Number of Manitobans who received and integrates what they found,” she says. “Once in place, an organ transplant in 2009, either in the this new team of physicians will work with partners in the province or in another jurisdiction. health system as well as patients, families and the public to 14 Number of deceased multi-organ help further increase organ donation and life-saving trans- donors in 2009 plants.” Nickerson says the approach being taken in Winnipeg is in 20 Number of live kidney transplants in alignment with the national strategy for organ donation cur- 2009 rently under development by Canadian Blood Services. 46 Number of live and deceased And, in addition to saving lives, he says the program will kidney transplants in 2009 also save money. Patients awaiting kidney transplants, for ex- Number of Manitobans awaiting an ample, need dialysis treatment to stay alive. Over the last five 200 organ transplant in a typical year years, he says, Manitoba has increased the number of kidney transplants it has done. In doing so, he says Manitoba Health saved $6 million in dialysis costs. FYI “Investing in organ-donation specialists is not only a key You can help someone in need of an organ strategy to achieving our life-saving goals, it also aligns with transplant by signing a donation card and Manitoba’s objective of ensuring sustainable, publicly funded confirming your intentions with family mem- health care by limiting the need for more costly dialysis bers and loved ones. To learn how, please visit therapy in Manitoba,” Nickerson says. www.transplantmanitoba.ca

September/October 2010 9 Weight Watchers of Manitoba at 987-7546 or toll free at 1-800-651-6000 Community Calendar Healthy The Winnipeg Health Region is fortunate to have a number of charitable foundations working within the community to raise money in support of Reading health care and research. The following is a partial list of events spon- sored by these various foundations. These titles have been recommended from thousands of health books. For October more health and wellness reading recommendations, please visit the online community at www.mcnallyrob- Winnipeg Regional Healthy Authority AGM inson.com, or visit the McNally Robinson The Winnipeg Regional Health Authority’s Annual General Meeting will be held bookstore at the Grant Park Shopping at 4 p.m. on Tuesday, Oct. 19 at Centro Caboto Centre, 1055 Wilkes Avenue. Centre. Speakers include Dr. Alecs Chochinov, Medical Director, Emergency Program, WRHA, and Brian Bechtel, Executive Director of the Main Street Project. Park- The Most Effective Ways ing will be available on the west side of the building. to Live Longer, Jonny Chantal in concert Bowden Winnipeg’s Chantal Kreviazuk will perform alongside the Winnipeg Symphony In this book, Bowden Orchestra during a special concert on Friday, Oct. 22 to help raise funds for The explores anti-aging Concordia Foundation, Pan Am Clinic Foundation and The Arthritis Society. For strategies culled from information about tickets, please call the Concordia Foundation, 661-7326; the cutting-edge research Pan-Am Foundation, 925-7488; or the Arthritis Society, 942-4892. and lessons learned from the longest- lived people on the planet. In total, St-Boniface holds radiothon readers learn what they can eat, do, The St-Boniface Hospital Radiothon of Hope and Healing will be held on Thurs- and take to feel great, avoid illness, and day, Oct. 14. In partnership with CHUM Radio, the Radiothon will be hosted live a long life. on stations BOB FM, CURVE FM and CFRW throughout the day, with BOB FM and CURVE FM broadcasting live from the Everett Atrium between 6 a.m. and 7 The Longevity Factor, p.m. For more information, please contact Nadine Rivard at 237-2998 or e-mail [email protected]. Visit the website www.saintboniface.ca. Joseph Maroon, M.D. Noted neuroscientist and NICU Harvest Party surgeon Dr. Joseph Ma- In celebration of the graduates of the neo-natal intensive care unit who required roon offers the definitive intensive care at birth or soon after, St-Boniface Hospital Foundation invites look at recent scientific you to the first ever Harvest Party on Sunday, Oct. 17. Come and meet other breakthroughs identify- NICU graduates, reunite with doctors, nurses and hospital staff, and enjoy ing a group of natural games and goodies! Please RSVP with number of attendees to Nadine Rivard at substances that can actually activate (204) 237-2998 or e-mail [email protected]. a specific set of genes in humans that promote a longer, healthier life. These Tasty treats substances, which make red wine, dark Enjoy desserts donated by some of Winnipeg’s finest bakeshops at the Health chocolate, and green tea good for us, Sciences Centre’s Thorlakson Mall on Thursday, Oct. 7 between 11 a.m. and 1 appear to stave off a wide array of age- p.m. Desserts are $2 each, with proceeds going to Gift of Hope Radiothon. related diseases and keep us feeling young and vital.

FYI You: Staying Young, For more information about these and other events, or to learn how to Michael F. Roizen, M.D., create a community event to support health care, please contact the & Mehmet C. Oz, M.D. foundation of your choice. Most of us believe that at age 40 or so, CancerCare Manitoba Foundation: www.cancercarefdn.mb.ca our minds and bod- Health Sciences Centre Foundation: www.hscfoundation.mb.ca ies begin a slow and Children’s Hospital Foundation: www.goodbear.mb.ca Grace Hospital Foundation: www.gracehospital.ca/foundation steady decline. According St-Boniface Hospital Foundation: www.saintboniface.ca to Drs. Roizen and Oz, that’s a mistake. Seven Oaks General Hospital Foundation: www.soghfoundation.org In this book, they identify 14 biological Pan Am Clinic Foundation: www.panamclinic.org/foundation.asp processes that control your rate of aging Victoria Hospital Foundation: www.thevicfoundation.ca and how to fight their effects. Filled with Misericordia Health Centre Foundation: [email protected] You Tools, including YOU tips and meta- Deer Lodge Foundation: www.deerlodge.mb.ca phors, to help you understand the most Riverview Health Centre Foundation: www.rhcf.mb.ca fascinating machine ever created: the Concordia Hospital Foundation: www.concordiahospital.mb.ca/foundation/ human body. breathingbreathing easyeasy Something as simple as laughing at a joke would sometimes trigger an asthma attack for Hayden Keast. But now, thanks to medication and education, the 10-year-old Winnipeg boy is able to control his condition and live an active life.

By Kenton Smith

Ten-year-old Hayden Keast doesn’t ing air into his lungs, as his own breathing known, it generally surfaces in childhood, recall the night his chronic asthma almost was ineffective,” Shelley recalls. appears to run in families and can be took his life. This wasn’t the first time Hayden triggered by allergies. Exposure to tobacco “All the attacks just bleed into each required such dramatic treatment for his smoke and viral infections contributes to other,” he says, reflecting on a lifetime of asthma. But it was the first time that he did worsening asthma in children. living with the condition. “I’m pretty lucky not immediately respond. In Winnipeg, asthma attacks account for – I can’t remember the worst of it.” “It’s like he wasn’t with us,” says Shel- about 3,500 visits a year to the Winnipeg But his mother, Shelley, certainly re- ley, recalling the event. “His eyes, his Health Region’s Children’s Hospital at members. “It was unforgettable,” she says. face, were glazed over. He had gone Health Sciences Centre. September is gen- “It was scary, horrendous, unreal.” completely limp.” Even the medical staff erally considered the worst month of the It happened one evening when Hayden seemed taken off guard. Brother Taylor year for admissions, with children making and his family were camping in the and sister Shenade were beside them- 200 visits to the Children’s Hospital emer- Whiteshell. The family – Shelley, Hayden’s selves, in tears. gency in September 2009. father, Brian, and siblings Taylor and Eventually, thanks to the efforts of the Even children with mild asthma can be Shenade – were relaxing around camp emergency team, Hayden started to come at risk for having a severe attack. But for when suddenly Hayden was unable to around, the oxygen ultimately succeeding most children with asthma, visits to the breathe. in bringing his breathing under control. It Emergency Department can be prevented The asthma attack did not come as a enabled Shelley to take a breath herself. by avoiding triggers and taking controller complete surprise to Hayden or his fam- “I’d never felt so desperate in my life,” (anti-inflammatory) medicine. ily; the slightest thing – smoke in the air, she says. “In hindsight, we realize we Hayden’s story illustrates the challenges strong scents – could trigger one. almost lost him. Eventually, it was deter- involved in managing severe cases of As he normally did in these kinds of mined that Hayden’s attack that evening asthma. But it also underscores how even situations, Hayden tried to relieve the was triggered by an allergy to horse hair the most severe cases can be succsess- symptoms by inhaling his Ventolin medi- – the Keasts had been camping near a fully managed through a combination of cation through his puffer. But after initial stable. Shelley and Brian did not detail medicine and education. efforts failed to bring the asthma under the severity of the attack with Hayden Even before he was born, his parents control, Shelley and Brian took their son afterwards, but they did talk generally knew there was a chance he would have to the nearest emergency room in Kenora. about the danger posed by severe asthma asthma. While there’s no history of asthma Once the staff there got his breath- attacks, and how important it was to seek in Brian’s family, Shelley’s cousin died at ing under control, they gave Hayden the help and have trust in hospital staff. “I did the age of 17 from chronic asthma, and OK to return to the campground. Back not want him to feel hopeless,” she says. Shelley was diagnosed with the condi- at camp, however, his condition flared Hayden’s experience with asthma is not tion after she and Brian married, and she again and worsened as the night wore on, uncommon. became pregnant. necessitating a second trip to the hospital. Statistics Canada estimates that as many Her illness proved far less severe than This time, the situation called for dra- as 12 per cent of children are affected what her oldest son, Taylor, would suffer. matic action. by asthma, which is defined as a chronic Middle child and only daughter Shenade “They had to assist Hayden’s breath- inflammatory disease of the airways inside would also prove asthmatic, although to a ing by placing a mask over his face and the lungs. much lesser extent. squeezing the attached oxygen bag, forc- Although the causes of asthma are un- It would be young Hayden who would get the worst of it. His problems started in tears. “It was such hard work trying to caregivers missed less work and quality early. “When you’d hold him in your arms keep up with everyone in school - all the of life improved for children and their as an infant, you could just see the chest talking, all the out-loud reading - when he families. and surrounding muscles working so hard couldn’t breathe. It (the tears) was pure ex- Since he was a toddler, Hayden had with every breath,” Shelley says. haustion.” And when he’d get home, he’d been in the care of Dr. Allan Becker, Baby Hayden made his first trip to the want to go straight to bed, simply to avoid Medical Director of the Children’s Asthma emergency room at six months of age. He the work it took to breathe. Education Centre. was diagnosed with asthma and put on Sleep, however, did not stave off his Over time, Becker could see that medication. “We knew at that time we suffering – in fact, it was often a luxury. Hayden’s condition was worsening and were heading for trouble,” Shelley says. “There was often no sleep in this house,” required special attention. Trouble came in many forms. He would Shelley says. Hayden would have an “He (Hayden) would come in to the often come down with pneumonia, which attack almost nightly for several years, hospital regularly with his airways com- on one occasion caused his left lung to sometimes more than once in a single pletely shut down,” says Becker, who is partially collapse. His adenoids, a lumpy night. also Professor and Head of the Section of tissue mass in the back of the nose that All this inevitably affected Shelley’s Allergy and Clinical Immunology, Depart- forms part of the immune system, had to and Brian’s work lives: up until a few ment of Pediatrics and Child Health at be removed. years ago, Shelley was working half-time the University of Manitoba. At its worst, Hayden’s condition always seemed to at Grace Hospital; Brian would often go be fluctuating between the “yellow” and into the office after-hours to get caught “red” zones. The former usually requires up, after having to leave work upon an increase in medication, or making a getting a call from Hayden’s school. doctor’s appointment. The red zone re- Even holidays brought limited joy, quires a trip to the nearest hospital. with Hayden spending at least one “Hayden was never in the green zone,” Christmas in the emergency room. Shelley says. Never did he know nor- The turning point for Hayden mal breathing, normal sleep, or exercise came a few months after the without respiratory problems. Using his Whiteshell incident. The at- reliever medicine became a daily routine, tacks had already been gaining especially if he did any physical activity. in frequency and intensity. And Winter was particularly tough on there was something more. When Hayden. He could only manage short Hayden’s airways filled with walking distances outside, which meant fluid, he was now gurgling – pre- he had to be dropped off wherever he cisely what Shelley witnessed in her went. “It would be like the wind took cousin before her death. two handfuls of air out of my lungs,” he “I was sweating,” Shelley says. explains, snatching two fistfuls of air for “Brian and I finally had a discussion in emphasis. which we admitted to ourselves… that In any season, he was unable to go out- we might ultimately lose our child.” side alone, lest he got into trouble. It was By this time, Hayden’s condition was necessary to carry his inhaler kit with him so serious, that he was being referred from everywhere, at all times. Certain activities the Grace to the Children’s Hospital Emer- and experiences – like skiing, toboggan- gency Department at Health Sciences ing, or flying on a plane – were simply Centre. That would turn out to be a off-limits. blessing. Every child who visits When it came to sports, Hayden could the Children’s Hospital only participate to a very limited extent. Emergency because of In soccer games, for instance, he would asthma is automati- play goal. Even then, however, he often cally referred to the couldn’t last an entire match. Neigh- Region’s Children’s bourhood walks with his family would Asthma Education frequently have to be curtailed. Centre. Established in Hayden Keast has learned how Hayden’s asthma could seemingly be 1997, the centre has to manage his triggered by almost anything – even gig- demonstrated that asthma. gling at a joke would often be enough to families graduating prompt an attack. “He didn’t laugh,” Shel- from the CAEC’s ley says. “His friends would not tell jokes Family Asthma around him and he didn’t want to laugh.” Program had When picked up from school, Hayden fewer emergency would often greet his mom and then be room visits, it wasn’t just that Hayden struggled to The drug had an immediate effect on nurse. “We’re so well-trained now, thanks breathe; it was that struggling to breathe Hayden. His skin tone changed, his breath- to them.” just worsened things because his muscles ing became normal. Relief periods became There are various components to asthma would spasm all the more. The most he more frequent, with his Ventolin medica- education, say Nancy Ross and Jo-Anne St. could manage were “guppy breaths”: short, tion finally proving immediately effective. Vincent, asthma educators at the Children’s fish-like gulps of air. Any over-exertion, and Now, with Xolair working its magic, Asthma Education Centre. Education is his body would be set off again. Hayden and his parents could concentrate more than giving information about medi- It was now becoming clear that on learning how to better manage the boy’s cines, they say. It is also about teaching Hayden’s asthma was being exacerbated by condition. children and families to recognize changes allergies. Generally speaking, allergic asth- “Education is the key factor to managing in asthma symptoms, problem solving ma can be traced to a naturally occurring any health condition,” Becker says. “And around avoiding triggers, and working with substance in the body called Immunoglob- with asthma, that’s true in spades.” their day care or school and doctor. ulin E (IgE). When IgE binds to allergens, it For Hayden, talking with the centre’s The centre holds classes for parents, triggers the release of chemicals that can staff was an unprecedented experience. For school-age children and teens during the cause inflammation. This is what leads to the first time in his life, Hayden thought he evenings. The focus is on developing skills the constriction of airways. was really being heard. “If I tried to explain required to monitor and manage asthma In Hayden’s case, having allergies on top something, they would understand. It was day to day. This includes introducing an of his pre-existing asthma meant there was like, Wow! Someone finally gets it!” Asthma Action Plan, teaching families how now just one more ever-present trigger that Hayden also became fast friends with to respond to changes in the asthma. Edu- could set off an attack at any time. Becker. “Dr. Becker treats me like a king,” cators teach kids to listen to their bodies, In addition to ensuring that Hayden and Hayden says, his face glowing. “He has recognize the warning signs and to know his family received education about the lots of patients, but he makes you feel like when to ask for help. boy’s particular issues, Becker also enrolled you’re his only one.” “What we teach is for parents to watch Hayden in a clinical trial for a new drug It was transformative for Hayden’s family for changes in the asthma,” says Ross. One called Xolair. This drug is designed to help as well, who were educated on his condi- way of doing this is through an asthma children with allergy-related asthma by tion and its management like never before. tracker quiz, which determines whether capturing the IgE before it can bind with an “The CAEC staff started us from square a child has been staying within the green allergen and trigger the inflammation. one,” says Shelley, who is a registered zone.

What is asthma? Asthma is a chronic disease of the airways. Chronic means the asthma is always there, at least a little bit. Some days, breathing feels completely normal and it feels like the asthma is gone. But if you looked inside the airways, you would see that there is a little bit of redness and swelling. This is called inflammation. Asthma affects the airways of the lungs. Normally, airways are wide open, pink and a little bit wet. Every breath you take should be easy. But this is different when you have asthma. Three important things happen in the airways during an asthma episode: 1. The inside of the airways gets swollen and red. That means the airways are less open and it is a bit harder for air to get through. 2. The inside of the airways produces mucous. The mucous plugs up the airways, making it harder for air to get through. 3. The muscles around the outside of the airways tighten up and squeeze the airway, making it even harder for air to get through… that means trouble breathing.

This all leads to signs of asthma (some people call them symptoms) like: • Coughing • Wheezing • Being short of breath • Having a tight feeling in the chest Many people have asthma but not everyone’s asthma feels the same. Your own asthma can feel different from one day to the next.

14 WAVE How can asthma be controlled? Asthma fast facts

• See your doctor at least twice a year. Asthma is the number one • Work with your doctor to complete a non-emergency reason why written Asthma Action Plan. It tells you what children end up in hospital, with to do when your asthma is under control an average of 3,500 visits per and what to do when you have asthma year in Winnipeg. problems. • Work with an asthma educator to learn • Approximately 150 children more about controlling asthma. Contact require hospital admission per your local lung association to find an edu- year at Winnipeg’s Children’s cator in your area. Hospital. • Know your asthma triggers and stay away from them. • Asthma is more prevalent in • Know the signs of worsening asthma. boys than girls in the pre-teen • Know what your asthma medicines do years. and learn how to use them. Source: Children’s Asthma Education Centre • In the teen years, 20 to 25 per cent more girls than boys HOW DOES XOLAIR WORK? have asthma. By adulthood, XOLAIR works by capturing IgE molecules in your body that can play a major three times more females than role in your asthma. IgE is produced naturally in the body and can males have asthma. trigger the release of chemicals, which may lead to an attack. XOLAIR captures most of the IgE related to allergic asthma. For more information, • According to the Public Health please visit www.xolair.com/index.html. Agency of Canada, over three million Canadians cope with one of five serious respiratory diseases – asthma, chronic obstructive pulmonary disease, While there is plenty of information the lives of the entire Keast family. They lung cancer, tuberculosis and about asthma online, the centre does have now taken their second ski trip, cystic fibrosis. something for parents that the Internet something they could never have con- can’t do. “Anyone can pull up informa- sidered in the past. And then there are • About 12 per cent of Canadian tion about asthma online,” says Ross. “But the simple pleasures now available. For children are affected by that can’t answer every practical question example, Hayden can drink a slurpee, asthma. families might have, or allay every parental whereas previously the cold liquid would fear. “What we stress above all is that have induced spasms. “Everything’s differ- • Deaths due to asthma in asthma can be controlled. It does not have ent!” Hayden effuses, giddily summing up children and teens are to look like the emergency room.” his new life. uncommon, with less than one As Ross and St. Vincent explain, a com- Oh, and that’s another thing – the talk- per cent of deaths between mon problem is that many parents may not ing. “Oh boy, did he start talking!” Shelley the ages of birth and 14 years pick up on their child’s symptoms – often exclaims. He even started telling jokes. attributed to asthma. The because kids don’t always verbalize them. And he can laugh at them, too. numbers peak in the 65+ Hence, parents may assume their children “It’s been roughly two years that we’ve age range, particularly among don’t like sports, when in fact it’s because been in good control of Hayden’s condi- women. their kids can’t breathe. “This is why tion,” Brian says. “And there’s no sign at classes can be an opportunity for parental present of any relapse to the bad old days.” discovery,” says St. Vincent. Becker sees the improvement in his Today, thanks to medication and educa- patient as part of a continuum. “In the ‘70s FYI tion, Hayden is in a much better place. His and ‘80s, the aim was to keep patients out pulmonary functions have become normal. of the hospital; in the ‘90s, it was to keep For more information about asth- He is now in the green zone all the time. them out of the emergency room,” Becker ma and the Children’s Asthma The quiet boy whose physical activity had says. “Now it’s quality of life that’s empha- Education Centre, please call been so inhibited is now active like never sized – the objective is to help patients live 787-2551 or 1-888-554-1141. You before. Not only has he achieved a black a normal life, and achieve what they set can also visit the CAEC website belt in tae-kwan-do, he also plays basket- out to achieve.” And for that, the Keasts are at www.asthma-education.com. ball and lacrosse. People even say, “Is that almost unspeakably grateful. Hayden? The same Hayden?” His life-altering experience has changed Kenton Smith is a Winnipeg writer.

September/October 2010 15 HOME Sweet HOME

Supportive housing options offer seniors independence within a safe, secure environment

By Helena Cole As the population ages, t was the summer of 2007, and Louisa Loeb was there is an increasing Iat a bit of a crossroads. need for more housing Just a few months earlier, the Winnipeg But true to form, Louisa worked hard in options and support woman, then 81, had suffered a stroke recovery. She spent May and June of that that left her unable to talk. year at the Riverview Hospital’s stroke services for seniors. In It was a difficult time for Louisa. A rehabilitation program. Throughout the this issue of Wave, writ- former professor in the Faculty of Educa- summer, Louisa made steady progress in tion at Brandon University, she was the her recovery and as fall approached she ers Helena Cole and Joel very definition of an active woman. She was ready to move on. But the question had spent her career giving lectures, writ- was, where would she go? Schlesinger look at ing papers, and working on doctorates. Despite her recovery, Louisa could not two Winnipeg Health She even found time to compile and edit return to living alone in her own condo- a couple of books on subjects near and minium. She wasn’t able to cook for her- Region programs that dear to her heart: Ukrainian culture and self, nor was she capable of doing laundry are designed to help teaching. and other housekeeping chores. At the The stroke threatened to change all that. same time, Louisa clearly was not ready Manitoba’s elderly main- After a lifetime of helping others, Louisa for a personal care home; she could still tain their independence. was now the one who needed help. do a lot on her own, and she wasn’t about

16 WAVE to give up her independence and privacy. for his mother. “The beauty of supportive explains during a recent visit. “They came Fortunately, Louisa was able to find a housing is that it offers the security of 24/7 to Canada in 1924, three months before I housing solution, one that fell somewhere supervision, complete meals, housekeep- was born.” in between the overwhelming challenges ing, but she can still have her indepen- Louisa paid tribute to that heritage by of living alone and the controlled setting dence,” he says. editing Down Singing Centuries, the Folk of a personal care home. Through the In Louisa’s case, living at the Rosewood Literature of the Ukraine, a compilation Winnipeg Health Region’s Supportive is like living at a resort. “I enjoy life here,” of stories, poems and songs, translated by Housing Program, Louisa was able to find she says. “I feel glad to be here; I’ve got Florence Randal Livesay, that Ukrainian a suite at Rosewood Supportive Housing lots of friends, and I value being with immigrants brought with them to their by Revera, one of several supportive hous- other people. I wouldn’t have this experi- new home in Canada. She also edited ing residences in Winnipeg. ence if it weren’t for the Rosewood.” and compiled Manitoba Permit Teachers Funded through a partnership between Louisa likes the socialization and takes of World War II, a book that documents the Region and landlord sponsors, sup- part in some of the many recreational the experiences of young girls who were portive housing is a relatively new option opportunities “I enjoy going on outings or recruited out of high school to teach in for people who can no longer manage getting involved in activities,” she notes. one-room school houses all over the prov- in their own home, but are not ready to One of the interesting things about sup- ince during the Second World War. move into a personal care home. portive housing is that it draws residents Indeed, in 2005, at the age of 79, Loui- Kathy Taylor, Project Director for from all walks of life, which in itself cre- sa helped initiate a World War Two Permit Community Housing in the Region, says ates a stimulating environment in which Teachers’ Reunion. “They had never had supportive housing is a great option for to live. any recognition for their important con- people like Louisa. “It provides personal Louisa is one example. As an academic tribution,” she says. “Twenty-nine retired supports and services such as meals, and editor, she has a keen interest in teachers came to the first one; the second laundry and housekeeping in a safe and literature and the arts. “My father was year it doubled.” secure environment,” she says. “In doing Ukrainian and my mother was Russian, so Louisa has also spent a lifetime work- so, supportive housing promotes inde- our home was very multicultural,” Louisa ing for the education and well-being of pendence, encourages socialization and allows seniors to stay in the community longer.” Residents have a suite with their own belongings: furniture, art, books, photo- graphs, treasured mementos, and other personal items. Balanced meals are served in a communal dining area, ensuring that seniors are well-nourished and also have the opportunity to socialize with their neighbours. Louisa’s son, Gerald Loeb, says sup- portive housing was the perfect fit

Herbert Butcher (left) with his wife, Bev, and dog, Bonnie. Herbert recently moved into Har- mony Court.

September/October 2010 17 children, both at home and abroad. housing concept was first developed. In Awards from the Manitoba Council the last five years, the number of sup- for Exceptional Children, The Social portive housing spaces in Winnipeg has Planning Council, Aboriginal Literacy doubled to a total of 516. The number Foundation, and Manitoba’s Black com- of applications for supportive housing munity, among others, show a remark- has also increased, hitting 352 in 2009, able dedication to her volunteer work.“I compared with 230 in 2006. loved to teach and help others,” she Demand is expected to accelerate in the years to come. The average age of a Centrally located at 100 The says. “It’s very important to do work that Promenade, Fred Douglas Heritage has value.” supportive housing resident is about 85. House Supportive Housing offers: In keeping with her lifelong com- Currently, there are about 30,000 people mitment to the community, Louisa has between the ages of 75 and 84 years of found new ways to become engaged age living within Winnipeg and its sur- • 28 one-bedroom suites, all with at Rosewood Village. “I taught myself rounding communities, and that number temperature control to knit,” she explains, adding that she could reach close to 50,000 within 20 • Suites range from 550 sq.ft. to makes scarves which she donates to the years. 740 sq. ft. Christmas Cheer Board’s knitting pro- Of course, making decisions around • Wheelchair accessible gram. “It’s important to give back,” she living arrangements can be difficult, not • Tea and toast kitchen in each says emphatically. only for the individual involved, but for suite, with microwave and fridge When it comes to needing alternative the entire family. • Home-cooked meals prepared living arrangements, Louisa’s story is not Roxanne Reich, Resident Services daily, served in our dining room uncommon. As the population ages, an Manager at Rosewood Village, says • Recreation and Pastoral programs increasing number of seniors must come all families have different situations to to terms with the fact that they may no contend with, but they have one thing in For more information, please call longer be able to live alone. common. “People fear giving up inde- Fred Douglas Heritage House: The Region recognized the need for pendence,” she says. “They think of the 949-9027 more housing with support options sterile nursing home of the past.” over 10 years ago when the supportive But it doesn’t take long before they

Long Term & Continuing Care Association of Manitoba Nurturing the spirit of Manitoba seniors for over 50 years The Long Term & Continuing Care Association of Manitoba was incorporated in 1959 and is a not-for-profit corporation with over 60 members, representing over 4,000 suites and beds. Our members include not-for-profit, private and public retirement residences, supportive housing residences, and personal care homes, spanning six regional health authorities across Manitoba. Our primary objective is to advocate on behalf of seniors in Manitoba and the staff at the residences who serve them, throughout the long term care continuum.

For more information go to www.ltcam.mb.ca 2010 MEMBERSHIP LIST

Brandon Region Winnipeg Region Supportive Golden Door Geriatric Centre Guldmann Inc. Dinsdale Personal Care Home Housing Residences Heritage Lodge Personal Care Health Maintenance Enterprises Hillcrest Place ArlingtonHaus Home Manitoba Institute for Patient Valleyview Care Centre Chez Nous Kildonan Personal Care Home Safety Fred Douglas Heritage House Lions Personal Care Home Manrex Limited Burntwood Region Harmony Court Northern Spirit Manor Maples Personal Care Home QHR Software Inc. Irene Baron Eden Centre Middlechurch Home of RONA INC. Interlake Region Lions Manor Supportive Winnipeg Coinamatic Commercial Betel Home - Gimli Housing Oakview Place Laundry Inc. Betel Home - Selkirk Résidence Despins Parkview Place First Quality Products Red River Manor Riverside Lions Seniors Tudor House Personal Care Poseidon Care Centre Silver Purchasing Group Residences Home River East Personal Care Home PointClickCare Rosewood Robertson College – Winnipeg Woodland Courts Retirement St. Norbert Personal Care Home Residence Windsor Park Place Robertson College – Brandon Tuxedo Villa South Eastman Region Winnipeg Region Personal Vista Park Lodge University of Manitoba – Centre St. Adolphe Personal Care Home Care Homes for Community Oral Health Niverville Credit Union Manor Beacon Hill Lodge Commercial and Affiliate Ruban Insurance Brokers Inc. Supportive Housing Bethania Mennonite Personal Members Winnipeg Region Retirement Care Home ArjoHuntleigh Canada Inc. Special Services Residences Charleswood Care Centre Compass Group Jocelyn House The Landing Fred Douglas Lodge Complete Purchasing Services Inc. Thorvaldson Care Homes Mary Gerstmar (left) enjoys spending time with her friend, Pauline, at Lions Supportive Housing.

realize that supportive housing is noth- Mary Gerstmar, a cheery 93-year-old ing like a personal care home, she says. now living in the Lions supportive hous- Living in the Heart of St. Boniface for Seniors “Some people take two to three months ing residence on Portage Avenue, was in to settle in and some take to it like a duck her own home on Henderson Highway to water.” until about three years ago. Louisa has fit into her new lifestyle But the fact that she was living alone very well, Reich says. “She recovered posed serious issues, for both Mary and extremely well from her stroke, and she her family. Along with being severely feels that she’s stimulated here. We offer hearing impaired, Mary was facing a interesting events and activities dur- number of other challenges. Her son, ing the day – exercising, special trips, Joe Gerstmar, and his wife, Jane, noticed sometimes we go out for lunch, and we little things at first. “We knew she wasn’t host family events that are lots of fun,” feeding herself and she was forgetting she says. things,” says Joe. “She had dementia and Gerald Loeb agrees that the residents we didn’t realize it.” are certainly not starved for activity. For families coping with ailing parents “There’s always something on the go,” he on top of their own daily stresses, the says. “It bridges the gap between living in responsibility can be overwhelming. “It • 48 supportive housing units the community independently and living was really hard on my wife, she was do- • 82 independent living units in a personal care home.” ing everything for her,” he notes. • Bilingual French/English services When she wants to be alone or have Then there were safety issues. Simple • 24 hour on site security privacy with her visitors, Louisa’s suite is tasks once taken for granted suddenly very much a reflection of her personality. loomed high on the danger scale. They • On site activity co-ordinator

She is surrounded by her own comfort- worried constantly about whether Mary 151, rue Despins able furniture, plants, and walls featuring would leave the stove on or turn the heat Winnipeg, MB R2H 0L7 her favourite artwork, as well as her nu- off in winter, says Joe. (204) 480-2900 merous degrees, and community service Like many people dealing with the We offer high quality service which awards. “I’m very comfortable here,” she care of elderly parents in the community, ensure the well being and the quality says. Joe was un- of life of our residents. This comfort also extends to family aware of what members. “Her diet is much better,” says options were Gerald Loeb. “We know she’s eating available for his Lions Supportive Housing well. It’s a relief to know she’s being mother. In fact, 320 Sherbrook Street, Winnipeg, MB looked after.” it wasn’t until Enjoy a home-like setting that includes: People living in supportive housing ar- Joe’s family * Newly renovated, rive there for different reasons and under doctor referred single private suites varying circumstances, officials say. him to Home * Lounges on each floor * Planned monthly activities and outings * Roof-top garden * Meals prepared onsite

For more information, please call Margaret Coquete at: 784-2730, or e-mail: [email protected] Care, that they got some advice on what had. Whether it’s her morning stroll, hav- program is really a collaborative partner- to do. “Home Care suggested supportive ing breakfast with her friend, Pauline, or ship with the family in which they all housing,” says Joe. “We hadn’t heard any- participating in one of the activities, it’s work toward a good quality of life for thing about it. We didn’t know what we not hard to see that Mary enjoys it here. everyone involved. were going to do.” Her apartment has all of her familiar “I do my best to fit the needs of the After an eligibility assessment by Win- belongings, and the family pictures on applicant,” she says. “Our programming nipeg Health Region staff, Mary was listed the wall as she comes in the door let her is geared to the individual’s abilities, for an available opening. “We looked at know she’s home. “I just love this place,” interests and functioning levels. But family quite a few places before deciding on she says. “I like the company and I like participation is an absolute must,” she Lions,” Joe says. having somebody to talk to. It’s easy to notes. “Whether it’s taking Mom or Dad Knowing his mother is happy and well make friends here,” she says. “I can ask for to an appointment or continuing on with looked after in a safe environment has help when I need it.” extra-curricular activities, it’s important made an incredible difference to their Margaret Coquete, Program Manager that families stay involved. It offers a con- lives. His mother gets the ongoing help for Lions, says supportive housing can tinuum of the way life used to be.” she needs, and he knows that if there’s a have a huge impact on both the family And, of course, there’s uncertainty and problem, someone will be there. and the resident. fear of the unknown. “The ultimate ques- “It’s been just great, such a relief. And “Life can be in total chaos with worry tion is whether Mom or Dad is going to the staff who work there are really special and care-givers’ stress,” she explains. be happy with it,” says Coquete. “Often people,” he says. “We can’t do for her “There’s often a real transformation in the resident settles in and transitions much what they do there 24/7.” the family once they feel confident that more quickly than the family.” And with the help and support she now they’ve placed Mom in the right spot.” Worrying about doing the right thing has, Mary is still a going concern. She’s “The program has so much to offer,” she and choosing the right option for a loved got her own routine, just like she’s always says, adding that the supportive housing one is definitely a common issue, says

20 WAVE Louisa Loeb enjoys a moment in the rock garden at Rosewood Supportive Housing by Revera.

Linda Sherrin, General Manager at River- environment. Some people settle in imme- or sports with some of the fellas,” he says. wood Square’s Harmony Court supportive diately and others can take a little longer. “It’s a nice place to live, and the food is housing residence. Herbert Butcher, an energetic 83-year- good. I’m very fortunate.” “Families feel guilt and anguish – they old with a shock of white hair, is always His wife, Bev Butcher, is starting to feel feel torn about putting Mom or Dad in a quick with a quip or a joke. A newcomer a sense of relief that safety and security care setting,” she says. “There’s a fear that to Harmony Court, he says he’s still get- are no longer issues. Dealing with her it’s a personal care home.” ting used to the place. “I’m a newbie,” he husband’s Alzheimer’s for the past six People often don’t understand the jokes. years has taken its toll on the 83-year-old concept of supportive housing. “It’s not For him, the transition has been an easy woman. “It’s so much better now – I was an institution. It’s not clinical or medical,” one. His interaction with the resident at the end of my rope,” she says. “Now I she explains. “This is Mom’s or Dad’s new companion and other residents is easy can see light at the end of the tunnel.” home. It’s not an institution.” and relaxed. “Everybody is friendly and Once the family understands that their “A care plan is customized to meet the the staff is nice,” he says. “It’s a good spot loved one is in a safe environment and needs of the individual,” she says. “Some to be if you can’t be at home.” that their needs are being met on a 24- people need help with bathing or dress- His suite is as neat as a pin, much like hour basis, there’s often a huge sense ing, they may need cuing and reminding the man himself. Intricate wood carvings, of relief. Families can get back to being about pills or meds. No two people are as good as any seen in a gift shop, sit on a family without the stress of caring for the same.” top of his dresser. “It’s just a hobby,” he everyday needs, says Sherrin. “The family It’s important that life carries on as says modestly. “My wife thought they relationship blossoms,” she says. usual, says Sherrin. “A key part is daily would make me feel at home.” activities and being stimulated.” He’s taken settling into a new routine Helena Cole is a Winnipeg writer. And like any new situation, it can take a in stride. “After breakfast, I like to read while for residents to settle in to their new my newspaper and I like watching news

September/October 2010 21 What is Supportive Housing? Caring for seniors The Winnipeg Health Region’s Supportive Housing Program com- There are about 50,000 people over the age of 75 bines apartment living in a community residential setting with living within the Winnipeg Health Region. Many lead personal support services and homemaking. Each site is sponsor- healthy, active, independent lives. But there are managed and has a landlord. The sponsoring organization funds thousands of others, including those who suffer from the capital cost and acts as landlord, while the Region pays for the chronic health conditions, who require a degree of care that is offered. support. To help those in need, the Region has devel- Supportive Housing offers: oped a range of programs to offer varying degrees • A private apartment of support, from occasional visits from Home Care • Housekeeping and laundry services staff to comprehensive care, 24-hours a day, seven • Meals days a week. The underlying goal of these various • Common dining and lounge areas programs is to help seniors live as independently as • Social and recreational opportunities possible for as long as they can. Here is a brief over- • A safe and secure environment view of the supports available: • Assistance with personal supports • 24-hour on-site support and supervision Home Care: Available to all seniors who are living in • Access to professional Home Care services for eligible clients their own home or with family but may need an oc- casional visit from a health-care provider to help with What does Supportive Housing cost? medication or other health-related issues. Costs vary depending on the site. Individuals pay the sponsor (land- Supports for Seniors in Group Living (SSGL): In some lord) directly for the rent and service package. Supportive Housing seniors’ buildings, enhanced supports are available can be an affordable option, as rent can be geared to income to help people stay independent. Examples include and income-based subsidies are available. helping people make appointments, fill out forms, Who’s eligible for Supportive Housing? and access social activities. Eligibility assessment is managed through the Winnipeg Health Specialized Supports: For some people with com- Region. To determine whether you are a candidate for Supportive plex health- and personal-care needs, specialized Housing, talk to your Home Care case co-ordinator. If you do not supports may be available to help them live in the have a Home Care case co-ordinator, call central intake community. This might include people such as those (788-8330). If you are in a hospital, talk to your health-care team. living with a disability or acquired brain injury. Caring for seniors

Support Services for Seniors: This program offers commu- nity-based programs for older adults that promote health and well-being. Examples include meal programs, tenant resources, and caregiver services.

PRIME: Located at Deer Lodge Centre, this team of health- care staff work to provide and co-ordinate a full range of medical, social and supportive services in one location to support at-risk elderly who live in the community.

Personal Care Home: Personal care homes are available for people who can no longer manage in their home and require 24-hour nursing care. Eligibility assessment and ac- cess is co-ordinated through Home Care and the Winnipeg Health Region’s Long Term Care Access Centre.

Companion Care: This program is for people who can’t manage at home with supports but prefer to live in a home- like environment. Companion-care providers take people into their own homes where they provide personal support services. The Winnipeg Health Region selects and monitors companion care homes.

To learn more about housing options and supports, contact your Home Care case co-ordinator. If you do not have a home care case co-ordinator, call the Region’s Central Intake Line at 204-788-8330. For more information, visit: Winnipeg Health Region www.wrha.mb.ca (Click on long-term care) Deer Lodge Centre www.deerlodge.mb.ca Long Term & Continuing Care Association of Manitoba www.ltcam.mb.ca (Check out the interactive maps and virtual tours) For when you need us. Supportive Housing Residences Sometimes you need a bit of care, a touch Lions Supportive Irene Baron Eden of support. That’s what we’re here for. Housing Centre

320 Sherbrook Street 1385 Molson Street • unique community living approach in a Ph: 784-1240 Ph: 668-7460 charming cottage style setting ArlingtonHaus Résidence Despins • private bed-sitting rooms 880 Arlington Street 151 Despins Street • delicious meals prepared daily by our chef Ph: 480-2900 Ph: 783-3752 • exceptional recreation programs Harmony Court Riverside Lions at Riverwood Square 180 Worthington 1788 Pembina Hwy Ph: 255-8940 Call today for Ph: 275-7632 your personal tour. Rosewood Supportive Housing by Revera Chez Nous 857 Wilkes Avenue 204-487-9600 187 De La Cathedrale Ph: 487-9600 857 Wilkes Ave Ph: 233-3692 ext. 156 Winnipeg Fred Douglas Windsor Park Place Heritage House 875 Elizabeth Road 100 The Promenade reveraliving.com Ph: 233-3692 ext. 156 Ph: 949-9027 03061

Revera: Canadian owned since 1961 with over 200 locations. ARE YOU READY FOR PRIME TIME?

By Joel Schlesinger

t’s a bright, beautiful morning, and about 40 seniors are Iassembled in a room located inside the Deer Lodge Centre getting ready for their daily workout.

Recreation facilitator Karen Hart be- tia or Parkinson’s disease. Available to gins the specially designed, 40-minute seniors over the age of 65, PRIME offers routine with a warm-up to help loosen a range of services under one roof. the joints and muscles. The seniors roll Part doctor’s office, part rehabilitation their heads around slowly, then their clinic, part pharmacy, part recreation shoulders and arms before stretch- centre, part personal counselling ing their legs. After about 15 minutes, service – PRIME is all these things and they’re ready to hit the weights. more. “Grab your dumbbells,” Hart calls “PRIME truly represents a unique out enthusiastically. Some seniors are approach to care within the Winnipeg pumping one-pound weights, but a Health Region,” says program man- few are lifting eight-pounders as Hart ager Judy Ahrens-Townsend, a social carefully demonstrates how to execute worker with 30 years of experience in each move. geriatrics. “Our goal is to serve every There’s no music, but the group has aspect of a person’s needs. We provide been known to sing or march on the primary care, yes. But we’re not just spot during the workout. And there’s here to provide medical care. We’re often the sound of laughter as Hart cre- here to provide all sorts of services, atively encourages them to finish each ranging from medical care to personal two-arm row or chest press. counselling, and rehabilitation services “Hands in front of your shoulders, to nutritional advice. Do you have to palms facing out. Now put it on the alter your home environment to ac- top shelf – like you’re putting a bag of commodate a wheelchair? We can help sugar away,” she says, as the group lifts with that, too.” the dumbbells from their waists over Those enrolled in PRIME generally their heads, stretching their arms as have serious health issues, but still high as they can. “You’re doing great,” live in their own home or with family. she says encouragingly to one of the Without PRIME, many participants participants. would have no alternative but to live It’s the kind of scene one might in long-term care, says Sue Lotocki, a expect to find at any number of seniors’ case manager and occupational thera- centres across the province. But this pist at the centre. “Essentially, (PRIME) is not your typical seniors’ centre, and is an out-patient program that supports those participating in the workout are complex seniors who are living in the not your typical seniors. community, so our goal is to provide This is PRIME – a relatively new an alternative to institutionalization program designed for seniors with (placement in a personal care home),” Michael Cox works with case manager/physiotherapist Marlene Smith. complex health issues, such as demen- she says.

24 WAVE PRIME TIME?INNOVATIVE CENTRE DELIVERS FULL-SERVICE CARE FOR SENIORS WITH COMPLEX ILLNESSES

The program is modelled after a Open Monday through Friday, from similar one called PACE, which started 10 a.m. to 3 p.m., seniors can attend in San Francisco in the 1970s and PRIME as often as they like, though has now been duplicated across the they are required to show up at least United States. It is the second program once a week for health monitoring of its kind in Canada. The first – called and to pick up their medications. In CHOICE – started in one location addition, PRIME operates an after- in Edmonton in 1996, and quickly hours service. By calling one number, expanded to four locations, includ- a participant or family member can ing two specialized satellite centres discuss a range of health issues or have for individuals with mental health and someone visit to provide an assessment dementia issues. or assistance. PRIME, too, has quickly gained pop- Part of what makes PRIME so attrac- ularity. The program, opened in 2009, tive to participants is that so many ser- is based in a beautifully renovated vices can be found in one place. And wing of Deer Lodge Centre. The total while waiting to see one of the service capital cost of the facility was $3.8 mil- providers at the centre, participants lion, including a community contribu- can exercise, chat with other seniors or tion of $500,000 from the Deer Lodge learn a new hobby. Foundation. The program reached its “There are things to do, and they capacity of 90 clients in July, and has come and get you when they’re ready received more than 400 referrals in the to see you,” says Eugene Burchill, last year. a 78-year-old retired University of PRIME’s unique approach to care Manitoba chemistry professor who has starts as soon as one is enrolled in the advanced Parkinson’s disease. program. Each participant is assigned A typical day at PRIME might include a case manager, who serves as a single a workout for those who are interested, point of contact. Among other things, followed by some social time – a the case manager co-ordinates all chance for friends to catch up or play a facets of the participant’s care, includ- game of checkers. ing Home Care needs and referrals to A highlight of any day at PRIME is other PRIME service providers, such as the four-course lunch. On this day, the pharmacist, social worker, nurse, the menu included a choice of cream occupational therapist, physiotherapist, of broccoli or beef vegetable soup or dietitian. and house salad, accompanied with “These are just examples of the a choice of veal steakette or cheese variety of things we do,” says Ahrens- pizza, mashed potatoes and mixed Townsend. “The team meets daily to vegetables, or salmon salad and cheese discuss the multi-dimensional needs of sandwiches. Fresh fruit was for dessert. the participants and to problem-solve After lunch, participants can enjoy with each other and the participant and any number of activities, such as learn- family with a goal of keeping that indi- ing to paint watercolours or listening Dennis Vandale and his wife, Carol, vidual safe and in their own home.” to a lecture from a guest speaker. in the garden at PRIME.

September/October 2010 25 Recently, Josephine Cox, daughter of PRIME member Michael Cox, spoke to the group about the six weeks she spent in Afghanistan training school teachers. In addition to taking classes, participants can also lead them. Burchill, for example, is an accomplished artist who has created more than 100 intricately sewn and pieced quilts incorporating numerous themes. He is now leading a quilt-making class at the centre. A key feature of PRIME is the primary-care service. The 22-person health-care team includes Dr. Russ Albak, a family physician, and Janna Kingdon, a nurse practitioner. Case managers, such as Lotocki, work with participants to co-ordinate visits with the medical team. For the majority of PRIME’s participants, this kind of care was spotty at best before coming to the program. “A lot of our participants haven’t had any primary or preventative care for a long time,” says Lotocki, one of five case managers, all of whom come from diverse backgrounds in geriatric care, such as physiotherapy, occupational therapy, social work or nursing. Trained to diagnose and treat disease, Kingdon is the “quarterback” of the medical team and reviews all aspects of the comprehensive primary care for patients at PRIME, says Albak. “Janna sees the patients on a daily basis, unless she’s away. We consult extensively on medical issues and the team work really serves to enhance the overall care of our patients.” Albak says PRIME’s multi-faceted approach to delivering care is a huge benefit to patients. “There are just so many issues with trying to investigate the participants’ problems and formulate treatment plans, and then, of course, to implement the treatment plan,” Albak says. “It really takes a team approach and that’s one of the strengths of PRIME.” Of course, participants aren’t the only ones benefit- ing from PRIME. Caregivers also get a much-needed Dennis Vandale with respite when their loved ones are at the centre. case manager/nurse “A lot of times, the caregivers are exhausted, so part Sheena Hatton. of our program is to provide support for them here,” explains Lotocki. Burchill has been attending PRIME twice a week for eight months. While he values the enhanced medical care he receives in the program, he says the best thing about PRIME is it provides a break for his wife, Marga- ret, who is his primary caregiver. “It gives her a chance to go shopping,” he says. Carol Vandale’s husband, Dennis, was diagnosed three years ago with Multiple System Atrophy, a rare de- generative disease similar to ALS (Amyotrophic Lateral Sclerosis, often referred to as Lou Gehrig’s disease). “Pretty much every system in the body basically shuts “What PRIME has done down,” says Carol, explaining the impact of the disease. Unable to walk, Dennis has difficulty speaking and for me is it has taken can no longer perform the daily tasks many people take for granted. He needs help getting dressed, using the a huge weight off my washroom, and bathing. He is dependent on the care of his wife, Home Care visits, and their adult son, Trevor, who lives with them and is able to help during the day shoulders...” because he works evenings.

26 WAVE PRIME is located at the Deer Lodge Centre.

Dennis is unable to take a bath at worst. “I can phone or e-mail Sue, who is tor’s appointment, for years, so there is a home, and only receives a sponge bath his case manager, and say, ‘He seems real- sense of community and a level of social from Home Care staff while in his bed. ly weak today’ and they’ll take a look right support in addition to the medical care the But the facilities at PRIME allow Dennis to away,” she says. “That’s so nice, instead of program provides,” Lotocki says. take a full bath in a comfortable tub. Not having to go to work and thinking, ‘Gosh And that rapport is a pivotal component only is this important for his health, it’s he didn’t seem right this morning. I should in providing preventive care. also a quality-of-life issue. go home and check on him.’” “Through bringing people in one Ahrens-Townsend says many PRIME Carol recalls one morning when Dennis to five times per week, we are able to participants require a great deal of hands- was lethargic and weaker than usual. She notice subtle changes in them,” Ahrens- on personal care while they are attending had a meeting to attend and felt uneasy Townsend says. “An illness may not be the centre, similar to the care provided about leaving him at home. She called obvious, but often we can catch it in the in a personal care home. “Our team of PRIME, and left a message for his case early stages before it becomes a more seri- health-care aides are able to help with manager about her concerns. “When I ous problem.” personal care needs, such as bathing, came back home, the case manager and Dennis, for instance, is prone to urinary feeding, bathroom assistance, walking the nurse practitioner were both there at tract infections, which can occur quickly, and transfers. This level of care is a unique the house,” she says. “Within the hour, Carol says. Having good access to primary feature that does not exist at any other they were there just checking on him.” care at PRIME means an infection often outpatient program for seniors.” Medical needs aside, PRIME also pro- gets diagnosed early and is treated with Carol Vandale appreciates PRIME’s vides a social component often lacking in antibiotics before it festers into a serious unique offerings. “What PRIME has done participants’ lives because the nature of illness requiring hospitalization. for me is it has taken a huge weight off my their illness is often isolating. In fact, prior to coming to PRIME, many shoulders because I’m not the only one “He’s a real people person,” Carol says participants were “frequent flyers” at responsible for monitoring his condition,” of her husband. “As an optician, he al- hospital Emergency Departments. “These says Carol, who works full-time as con- ways loved working with people, and his are clients who are medically frail, having stituency assistant at an MLA’s office. store used to be a real gathering place for many hospitalizations, and they typically Like many clients, Dennis attends once all the people who worked in the building are using a multitude of health resources,” or twice a week. Vital Transit picks him up downtown.” says Lotocki. “Often they sought care only in the morning and drops him off at home And while clients make acquaintances when it became a crisis.” in the afternoon. to chat with over coffee when they arrive The need for the kind of care provided But even when he is not attending the at 10 a.m., often the most important rela- by PRIME is high within the Winnipeg program, Carol says PRIME has proven an tionship they develop is with the staff. Health Region, and it will only grow in indispensable resource when she is con- “Some of our very elderly clients the years ahead as the population ages. cerned his health has taken a turn for the haven’t left the house, unless it’s for a doc- Indeed, a study produced by the Canadian

September/October 2010 27 Alzheimer Society says the number of tastic! I’m so lucky, and she’s an RN he says. It sounds elementary, but Canadians suffering from dementia could (registered nurse),” he says. many clients have conditions that more than double in the next 20 years. But caring for him all the time is a dif- are anything but. The only way to get PRIME is still in its pilot stage and will ficult task, even for a retired nurse. Cox a firm grasp on how to help them is by be evaluated later this fall. “But I think we is dependent on the help of others to get listening to them and their caregivers care- know without even doing the evaluation out of his chair or in and out of bed. “My fully. It’s for this reason Albak believes that that it’s in demand and has been success- wife can’t handle me,” says Cox. “I’m too PRIME has had many success stories. ful,” Ahrens-Townsend says. heavy. Just a simple thing like getting me “As I say, when you see a population Michael Cox, 76, certainly believes on a toilet requires two people.” like we have here – they’re all basically PRIME needs to be emulated. “It is a Albak says many of PRIME’s participants octogenarians and have multiple system fantastic program,” says Cox, who attends face similar mobility issues that prevent problems – you have to be realistic that PRIME four days a week. them from receiving optimal medical care you’re not the fountain of youth,” he says. Having trained as a chef in England at a typical family doctor’s practice. But at the end of the day, PRIME is and Switzerland, and served as Maitre “They’re the kind of patients that are making a difference for the better in its d’ at Stockholm’s Royal Opera House in really difficult to look after in your average participants’ lives because it does more Sweden, Cox knows a thing or two about doctor’s office because of many factors: than just solve medical problems. providing exceptional care and service. the physical layout, their mobility, time,” “It’s not just medical care, it’s ‘care’ as “I have never been in a hospital where says Albak, who also has a private practice in caring for people,” Albak says. “And I the staff is so friendly,” says the retired as a family physician. “For your aver- truly believe that at PRIME that’s what they general manager of the Manitoba Club. “It age doctor’s office, a lot of these people receive.” is amazing.” couldn’t get up on the table to be exam- Joel Schlesinger is a Winnipeg writer. Cox, who is confined to a wheelchair, ined, so we have in this facility beds and receives visits from Home Care staff four examining tables that can be lowered.” times a day and his wife, Ingrid, provides Still, Albak says, PRIME is more than much of his care in the evenings and on the sum of its parts. “It all comes down to the weekends. “She’s Swedish. She’s fan- listening to what people’s issues are,”

Eugene Burchill, an artist who has created more than 100 intricately sewn and pieced quilts, works alongside recreation facilitator Karen Hart. Burchill is leading a quilt-making class at the centre.

28 WAVE Is PRIME for you?

PRIME is designed to help seniors: • Maintain independent community living while improving quality of life The PRIME care • Connect to a team of considerate health-care staff who provide holistic care team includes: • Improve health to strengthen independent lifestyle and well-being • Participate in active living through health and exercise programs • A primary-care doctor • Interact with others in the warm and caring PRIME environment – one or more • A nurse practitioner days each week • A pharmacist •Enjoy the opportunity to make friends and join in social activities – with • Case managers transportation and lunch provided • A social worker You may be eligible for PRIME if you... • An occupational therapist • A physiotherapist • Are 65 or older • A dietitian • Have multiple health problems that need a moderate degree of • A recreation facilitator monitoring or co-ordination of professional services to help you to continue • Nurses living in your own home • Health-care aides • Are able to live independently in the community • Home Care Service co-ordinator • Rehabilitation assistant Clients enrolled in the program receive the • Medical office assistants following services: • Manager • Regular visits with a doctor or nurse practitioner • After-hours support • Exercise and therapy Want to consider • Health and wellness education PRIME? • Counselling and personal care (bathing and hairdressing) For more information on PRIME, Participants attend up to five times a week, depending on their need, with talk with your Home Care case transportation being provided by the program. Referrals to the program are co-ordinator, and arrange to come accepted from family physicians, the Home Care program, hospitals or other for a trial visit or have PRIME staff meet health-care professionals involved with the participant. with you in your home by calling PRIME at 833-1700. PRIME is located at Deer A monthly fee – based on income – is charged to cover services that are Lodge Centre, 2109 Portage Avenue not covered by Manitoba Health, and participants must also cover the (PRIME entrance at 203 Duffield). cost of any medications, though PRIME staff will assist with Pharmacare applications.

PRIME is one example of a support service for seniors provided by the Winnipeg Health Region’s Rehabilitation and Geriatric program. Here are some others:

Geriatric Program Assessment Teams (GPAT): Provides outreach assessment and planning for older adults who have recently visited an Emergency Department, were recently discharged from hospi- tal, or who live in the community.

The Geriatric Mental Health Team: Provides outreach service for older adults in the community or personal care home who need assessment and planning for mental health concerns. Day Hospitals: There are four Geriatric Day Hospitals (Deer Lodge, Riverview, Seven Oaks, & St. Boni- face) to provide comprehensive geriatric assessment and episodic care for older adults. Rehabilitation: There are inpatient rehabilitation services at five sites (Deer Lodge, HSC, Riverview, Seven Oaks, & St. Boniface) providing episodic care for adults. For more information about these services, call Jo-Ann Lapointe McKenzie at 831-2529.

September/October 2010 29 Don’t go viral Get the shot, not the flu

By Bob Armstrong

It’s a familiar scenario for many. home when sick. Some of these individuals So how should someone prepare for the You wake up one morning feeling a bit go to work sick because they fear taking upcoming flu season? out of sorts. Your throat is scratchy, your time off could cost them their job or a pos- Well, the first thing is to think about re- muscles are sore and your head aches. sible promotion; others may feel the need ducing your risk of becoming infected with Naturally, your first instinct is to stay to soldier on, disregarding their aches and the influenza virus in the first place. Health home and rest. After all, it’s not as though pains, in order to ensure their team is not officials say the best way to do that is to you’re going to get much work done in this left short-handed. get vaccinated every fall before the start of condition. But then the guilt sets in: Can Whatever the reason, the fact is that influenza season. Not only does a vac- you really afford a sick day after just two some individuals may actually be doing cination reduce your risk of getting sick, it months on the job? What would your boss more harm than they realize, especially if limits the possibility that you will transmit think? After thinking about it for a few mo- they have “the flu.” That’s because a person the virus to someone else. ments, you decide to tough it out and head with influenza could infect as many as a That’s partly why Manitoba Health has to work. dozen people during the course of a day decided to make flu vaccinations available It’s a decision hundreds, if not thou- without even knowing it. at no charge to anyone who wants one this sands, of Manitobans are faced with It’s a problem that public health officials year. Previously, the seasonal vaccine was making every year, especially during the like Dr. Michael Routledge understand free only to people deemed to be most at influenza season in the late fall and winter well. “Most people are sensitive to the risk risk of becoming infected with influenza months. One study, for example, suggests of spreading influenza,” says Routledge, and their care providers. And it’s also why that as many as one in four people 18 years Medical Director of Population and Public the Winnipeg Health Region is staging 12 of age and over is infected by influenza in Health with the Winnipeg Health Region. immunization clinics throughout the city a given year. And in some cases, people “But people often go to work sick because from Oct. 19 to 23. with influenza are choosing to go to work. they feel they have to.” Routledge welcomes the move to make A story published by working.com last The problem is that when infected in- the influenza vaccine more readily avail- spring illustrates the point. It noted that dividuals go to work or attend a gathering able, and hopes people will take advantage 61 per cent of Canadian respondents to a where they come into contact with people, of the offer – especially those in the priority survey of visitors at monster.com admitted they run the risk of infecting others, includ- categories. “We need to continue to get out to going to work when sick. Only 26 per ing those who may be more susceptible to the message that there are certain popula- cent of respondents said they would stay at complications associated with the virus. tions who are at more risk of complications Flu facts

Symptoms of flu These are the symptoms of influenza: Source: Health Canada There is no such thing as the “stomach flu.” Many people use Almost always: Sometimes: Common: the terms “flu” or “stomach flu” to describe other illnesses that may Cough and fever Nausea Fatigue Headache actually be a common cold or a Vomiting Muscle aches Decreased appetite mild case of food poisoning. Diarrhea Sore throat Runny nose

30 WAVE from seasonal influenza, and those are the it came on suddenly, killed a significant gious and not even know it. In fact, some people in particular we want to protect.” number of younger people and left many studies have suggested that as many as one Canada’s National Advisory Committee others sick. Seasonal influenza also kills in five may have an influenza virus and not on Immunization encourages all Canadians a significant number of people – as many have any symptoms. over the age of six months to get a flu shot. as 4,000 a year – but many of these cases Generally speaking, the influenza Key target groups for immunization include involve those who are elderly and frail, so virus is spread among humans through care providers, and those with conditions there is less media attention. tiny droplets in the air, usually when an that put them at high risk of complica- “During a pandemic, everyone gets a lit- infected person sneezes or coughs close tions from influenza such as people over tle uptight. But when it is normal seasonal to someone else. The virus can also spread 65, young children, pregnant women, and influenza, people become complacent,” when the droplets are transmitted from people with chronic health conditions. says Dyck. The result is people sometimes one person to another by physical con- Three additional new target groups were forget that when they pass on a virus, it tact – like shaking hands – or via a surface identified this year by the advisory com- may have significant consequences. touched by the infected person, such as mittee – persons with morbid obesity, Ab- “Who knows who you will infect or bus railings, door handles, and coffee pots. original peoples and children two to four whether they may have any underlying When the infected person covers a cough years of age. The rationale for the target illnesses that might make them more sus- with his or her hand, that hand gets cov- groups is that health-care workers and oth- ceptible to complications? It’s not just you ered with influenza virus droplets. Those ers in contact with those at high risk have having the infection. It’s who you might droplets are then left on everything that the potential to infect the most vulnerable infect,” she says. hand touches, and can survive 24 to 48 people, while the other priority groups are As for those who do not get the shot and hours on a hard surface, says Routledge. most likely to have serious consequences become sick with influenza, the message is People infected with the influenza from influenza. clear. “Whether it is influenza or some oth- virus, which is an infection of the respira- Brenda Dyck, Director of Infection, er kind of infection, we don’t want people tory tract, are most contagious just before Prevention and Control for the Region, says coming out into the community, into the they have symptoms and then for several she’s worried that some people may be- workplace or schools… and transmitting days after symptoms have first appeared. come blasé about “seasonal” influenza this infection. The message is, stay home when When the non-infected person picks up year. She explains that last year’s H1N1 in- you are sick.” the droplets and touches his or her mouth, fluenza pandemic raised concerns because Of course, some people can be conta- the disease can find a new host. And if By the numbers

10 to 25 4,000 to 8,000 24 to 48 7 to 10

Estimated percentage Estimated number of Number of hours a flu Number of days on of Canadians who Canadians, mostly virus can stay alive on average it takes to could have influenza seniors in frail health, a hard surface, such fully recover from Headache in a given year. who die every year as a counter or door the flu. Decreased appetite from pneumonia. knob. Runny nose

September/October 2010 31 that new infected person has a chronic health condition, the infection can progress to viral pneumonia. Likewise, if the newly infected person visits somebody in the hospital, the virus can spread to more vulnerable people. The bottom line, Routledge says is everyone Look into needs to take influenza seriously. “If you wake up in the morning and you’re not feeling well, consider staying home,” says Routledge. “I’d say to a work supervisor, ‘If that person stays home, they aren’t infecting Nursing other people at work.’” Routledge also underscores the importance of taking precautions in the first days of sick- ness. “People who are sick are particularly infectious in the first couple of days, and the more we can get people to stay home and take care of themselves, the better for every- body.” There are signs that the message is being received. Mark Hollingsworth, Executive Director of the Human Resources Association of Manitoba, says that when it came time to updating the office computer system, he opted to have everyone outfitted with a laptop. The idea was to provide for increased op- portunities for people to work from home,

Take care of yourself If you get the flu, you should:

• Stay at home and get plenty of rest for seven to 10 days. • Increase the amount of fluids you drink (water, juice, soups). • There are also medications to treat influenza. If you take them within 48 hours of the start of your symptoms, they may reduce the length of your illness by an average of one or two days.

Source: Public Health Agency of Canada

4 quick ways to help 301 - 275 Broadway prevent influenza Winnipeg, MB R3C 4M6 You can help slow the spread of influenza. Phone: 204.942.1320 Always remember to: Fax: 204.942.0958 1. Wash your hands frequently. Email: [email protected] 2. Cover your nose and mouth when you cough or sneeze. 3. Stay home if you’re sick. 4. Get your annual influenza vaccination. www.manitobanurses.ca For further information, visit www.wrha.mb.ca or call Health Links - Info Santé at 788-8200. Source: Winnipeg Health Region ACOMMITMENTTOCARING which meant that anyone who felt under H3N2 and B components. Promoting good hand hygiene and the weather did not feel like they had to The Region is also making an effort to respiratory etiquette has value beyond make a choice between missing work or promote respiratory etiquette as a means of preventing influenza. “It could be any type infecting colleagues at the office. helping prevent the spread of influenza. of infection that’s carried on the hands. We “We talked about the idea that we are For example, the Region and other want to prevent these kind of infections.” in an enclosed environment, where we are health organizations have been urging Of course, preventing the spread of interacting with each other, (and) could people to cover their coughs by sneezing influenza is a tall order. “The reality is, it’s be spreading contagious diseases. Be- into a tissue or the crook of your elbow, such a ubiquitous virus, it’s very hard to ing that we are with the HR association, says Dyck. After coughing or sneezing, contain,” says Routledge. “But that doesn’t we thought if we have the opportunity to clean hands with soap and water or use mean we shouldn’t be doing things to try showcase what can be done, we should. an alcohol-based hand rub (sanitizer). This and prevent its spread.” At a small level, we’re just thinking through will prevent influenza droplets from ending creating a culture that is effective, efficient, up on your hand. Bob Armstrong is a Winnipeg writer. but looks after people.” Infection Prevention and Control is also The Region, meanwhile, continues to de- promoting “hand hygiene,” an approach velop new strategies to contain the spread that goes beyond keeping hands clean. of influenza. This year, for example, the Training programs for Region staff focus on Region decided to hold its influenza im- when to wash the hands and when to use munization clinics from Oct. 19 - 23 in a an alcohol-based hand rub (sanitizer). bid to reach as many people as possible at The Region has placed dispensers of the beginning of influenza season, which alcohol-based hand rub at the entrance of usually runs from November to March. every facility so that everybody coming in Each year, the seasonal influenza vac- to work or to visit can clean their hands cine includes three strains, or types, of before they enter. “There’s lots of research influenza virus. This year, the vaccine to show that alcohol-based products in includes the 2009 pandemic influenza A/ health-care settings are the first line of H1N1 component, as well as influenza A/ defence,” Dyck says.

Help when you need it Common questions about the flu You’ve done all you can to provide for Can I get the flu from the flu vaccine? your family except plan for the No. The vaccine uses a version of the virus that has been killed. It mimics an time when you may not be able to. infection and triggers the body to produce anti-bodies to the flu, but does not cause the infection. Critical illness insurance can help preserve your family’s standard of living in the event Does the flu vaccine use an adjuvant? What is an adjuvant? that you can’t. The flu vaccine this year does not use an adjuvant. An adjuvant is added to a vaccine to stimulate a more vigorous immune response. Adjuvants are included Call for a free Special Report, in common vaccines such as tetanus and hepatitis B, and were used in one of Living Benefits – Peace of mind, and finan- the 2009 H1N1 vaccines. cial security when you need them most.

What’s the difference between the flu and the common cold?

Symptoms for a cold typically are a runny nose and sneezing. Typically colds Jill Chambers, BN CFP don’t result in a lot of coughing or in a fever. Flu symptoms include a sore throat Financial Consultant (usually the first symptom), fever, muscle aches and coughing. Usually the flu doesn’t involve a lot of congestion. Call: Why do people need to keep getting the flu shot? 204-291-5998 There are two types of influenza viruses that cause outbreaks each year: Influ- 204-943-682828 enza A and B. It is necessary to be immunized each fall to make sure your body forms antibodies against the most common strains of flu viruses circulating that year. Because the flu viruses are capable of changing from year to year, the vaccine is updated annually. Each year, the World Health Organization identi- fies three strains of the influenza virus that are predicted to be the most com- mon and will have the most impact. Influenza vaccines are based on these three viruses.

34 WAVE See your agent or visit us online at: www.mb.bluecross.ca On the job Region helps injured employees return to work

Maureen Kosa benefited from the Winnipeg Health Region’s Graduated Return to Work program.

By Susie Strachan nowing there’s a safety net under you when you are requires all management to notify us when Krecovering from injury or illness is a wonderful feeling an employee has been on sick leave for for any employee fearing they might lose their job. two weeks,” says Gayle Hryshko, who is Manager of Disability Management with the Maureen Kosa knew that feeling when she disability leave for a year, while waiting for Region’s Occupational and Environmental knew she could no longer keep up with the total knee replacement surgery. After the Safety and Health Department. physical demands of being a nurse on the surgery at Concordia General Hospital, she The Region works with the employee as rehabilitation ward at Deer Lodge Centre. spent another eight months recovering. a team to identify how best to help them She had been working as a licensed “I had physio right up to the surgery, and recover from injury or illness, return them practical nurse for 30 years when arthritis then again afterwards, doing exercises and to meaningful employment and design a in her right knee and back started causing working on a stationary bike. I had to use plan for recovery specific to their medical her difficulties. She had worked at Health a walker to get around for the first month,” needs or any medical restrictions they Sciences Centre on the spinal cord floor, she says. “I was lucky to have a friend stay may have. “We work to find ways to keep and then in geriatric rehabilitation. In 1992, with me for three weeks, to help me with our employees in the work force,” says she was redeployed to Deer Lodge on the things around the house, and to help drive Hryshko. “This might include a graduated rehabilitation floor. me to appointments.” and progressive return to work, until they Kosa was having trouble with bedside She returned to work after surgery, are able to work a full day. It might mean work, when lifting and shifting patients, taking part in a Graduated Return to Work modifying the job, if the person cannot do and even when walking from room to room program. The Winnipeg Health Region all aspects of it. Or it might mean finding an on the ward. supports the practice of bringing employees alternate position.” “My knee got down to the bone-on-bone back to work as soon as they are medically The latter is what happened to Kosa. She stage, and I simply couldn’t work due to able. “The Region is gradually rolling made a graduated return to work on the the pain,” she says, adding she ended up on out a new operational procedure, which rehabilitation ward, but found it was too

36 WAVE hard on her. Her director of nursing suggested she apply for an administrative position, and, Work safe Most Manitoba health-care workers do their jobs in one of three with the aid of her union, to her surprise and workplace environments: acute, long-term or community care. Though joy, she got it. each workplace is different, they all share the common need for safety Today, she’s the Region’s Rehabilitation – and not just that of patients and clients, but also that of the caregivers and Geriatric Central Wait List co-ordinator. themselves. The job entails finding appointments for patients from acute care who need to enter SAFE Health Care is an injury-prevention strategy developed for health-care workers, by health-care workers and with health-care rehabilitation. workers’ unique safety needs in mind. It is rooted in four key principles: “When I started, I had no keyboarding or computer skills. I was given training in that, Commitment and also a counsellor to help me make the Making real change requires real commitment from every member of the transition,” she says. “Seventy per cent of my health-care team. new job is talking to people on the phone, Accountability making connections. When I started, I was Knowing what is expected of each member of the health-care team in worried people might put one over on me, but terms of safety helps keep everyone safe. I’m more assertive now, making sure they’ve Responsibility filled in the paperwork correctly. The fact I have Safe work is everyone’s responsibility – which is why everyone needs to the new job is a great relief to me. It keeps me work together to make the workplace a safer one. There are a number of in a place I love to work.” ways to help make the workplace safer for everyone. The Region’s Return to Work plan considers SAFE Plan of Action the abilities and limitations of the employee with Health-care workers work with a wide variety of potential hazards. a physical or mental disability, balanced with the Actively following the SAFE plan will help prevent problems from occurring. Region’s responsibility to manage and to meet its daily operational requirements. “For example, a nurse might have a health-related need for accommodation. We might look at another job Look out! that uses the nurse’s abilities, and if they are physically unable to do that, we might put them The four key principles aim to help health-care workers protect themselves from: into an administrative position,” says Hryshko. The Region works with the Workers 1. Physical hazards Compensation Board and various private Take care when handling sharp or hot objects, and watch out for things that insurance companies. Region employees may cause you to slip or trip (wet floors, loose carpets, snow & ice, etc.). requiring treatment or assessment from a physician or other health-care professional as a 2. Chemical hazards result of work-related injuries must report their Follow procedures and read the labels when working with industrial or injuries to the Workers Compensation Board. consumer chemicals. They also need to provide a medical note to 3. Biological hazards their employer detailing their restrictions, and need that documentation to continue when they Be aware of potential exposures to blood and body fluids, viruses, bacteria and parasites. Follow routine practices and wash your hands often. are ready to return to a modified work schedule. “There are approximately 700 workers right 4. Poor ergonomics now in the program,” says Hryshko. “No two Use proper techniques and equipment when moving heavy objects or individuals are alike, in terms of circumstances, assisting patients to move, and make sure workstations are comfortable so our disability case managers have to consider and set up properly. each case on its own merit in order to have the person return to work to the best of their 5. Psychosocial hazards abilities.” Be aware of your surroundings, observe and report changes in your For more information on this program, patients and clients, and follow procedures for “working alone” situations. please visit www.wrha.mb.ca/staff/safety.

This message is brought to you by: balance

Laurie McPherson CheckCheck itit outout

Make sure your child’s busy calendar includes plenty of free time

chool supplies – check. Dental and eye exam – also allow children the opportunity to talk check. Swim lessons, hockey, dance class, Scouts – about what’s going on for them and may check, check, check, check, check... help to develop stronger family relation- S ships. If parents have concerns around Fall is upon us and families are getting While exposing children to sports, how free time is spent, they may want to ready for another busy year of co-ordinat- music and other activities is often posi- set some age-appropriate guidelines, for ing school and after-school activities. tive, it’s important for parents to keep in example, around “screen time” activi- Parents are often faced with the challeng- mind that children benefit from maintain- ties such as television, video games and ing task of balancing their children’s school ing a healthy balance of scheduled and computer time. commitments and extra-curricular activities unscheduled activities. In other words, Sometimes problems develop when with their own goals for their children, all make sure you add some free time to your children are “over-programmed.” Chil- while keeping within the family budget. child’s activity checklist. dren who don’t learn to manage free time But how much is too much, and how does Scheduled activities can have benefits may not develop the skill of thinking and one know when they have overloaded their such as learning a new skill, building self- planning time for themselves. Children kid with too many activities? esteem, setting and reaching goals, and can experience significant stress while The answer to that question varies, fostering social connections. Think about trying to keep up with all the demands depending on the individual. But research the goals that you have for your child and of extra-curricular activities, or they may into the question offers some insights and why you support your child’s participation constantly feel that they don’t measure up guidelines. in the activity. Are you hoping they will when everything they do is somehow be- Today’s school-aged children are often gain confidence and self-esteem? Would ing judged. Children need free time to just involved in several different activities or you like to see them develop a competi- be themselves. Free time also leaves time programs after school and on weekends. tive spirit or be part of a team? for children to develop positive friendships Parents want their children to be engaged Unscheduled time also has its benefits. with their peers. Childhood development in a variety of positive experiences and Children who learn to manage “free” time research shows that the ability to develop activities. Some parents fear that their at home learn how to think for themselves healthy social connections and friendships children will lag behind others, get bored by choosing activities, enjoying social is one of the most important factors in or get into trouble if they don’t participate time with friends or exploring hobbies and children’s overall health and well-being. in daily scheduled activities. interests at their own pace. Free time can Making friends takes time and effort.

38 WAVE Things to consider when making the family schedule: Consider other things that are going on together? Set aside time every week on the in your child’s life. Is your child attending calendar for “down” time and encourage • Talk to your child about what a new school this year? Are they adapting the family to enjoy a relaxing evening activities are important to to family changes such as a new baby or together. Bake a batch of cookies. Watch them and why. family separation? Are they struggling with old family movies with a bowl of popcorn. • Explain the idea of balancing work (school) and play. their grades at school and needing as- Go for a neighbourhood walk or bike • Set a positive example by sistance with homework? These and other ride. Enjoy a board game or explore the having a healthy balance of factors may play a role in deciding how library and read books. Ask your children work and play in your own life. much time is spent on outside activities. for ideas and encourage their imagina- • Explain how a family budget Every child is unique. For example, tions. Before long, your children will look works. one child may thrive on being involved in forward to this special time spent with • Introduce compromises and several activities, while another child may their family. accept that you can’t do it all. feel overwhelmed with more than two Try to keep your eye on the big picture activities per week. Some parents have when it comes to deciding how to spend Your child may be suffering from expectations about their children follow- family time. In five or ten years, your child stress due to being too busy if he ing in their footsteps. A parent who is is more likely to remember and value or she: passionate about gymnastics, for example, the times you spent together having fun • Comes up with excuses to miss may have a difficult time accepting that as a family more than any lesson or club planned activities. their child does not enjoy that sport. they participated in. Finding the balance • Is moody, anxious or irritable. Watch for signs of imbalance in your between scheduled activities and free time • Is tired all the time or not family life. Are you stressed out every within your family paves the way for posi- sleeping well. • Hands in school work that is night, racing through the drive-through for tive family relationships and a rewarding incomplete or poorer quality. supper while you get your children to their lifestyle for everyone! • Cannot play alone or occupy lessons on time? Are the basics like a good their free time. night’s sleep and a nutritious meal taking Laurie McPherson is a mental health • Has difficulty maintaining a back seat to all the activities? Does your promotion co-ordinator with the Winnipeg friendships. family find time for a relaxed family meal Health Region. • Criticizes their own efforts and or evenings when you can just hang out strives for perfection.

September/October 2010 39 in motion

Deanna Betteridge Minutes That’s all it takes every day for you and your family to gain a lifetime of good health

t’s that time of year again. Summer’s over, Ithe kids are back at school and the television networks are about to unveil enough new “must see” TV shows to consume all of your free time. True, the luminous glow of the big screen TV and its endless hours of dramas, comedies, reality shows and sports programming can be hard to resist, especially after a hard day around the home or at work. But before you succumb to the latest episode of Glee or American Idol, take a moment and ask yourself this: Have I made time for some physical activity with my family? It’s an important question, one that could have significant implications for the long-term physical and mental health of you and your family. Here’s why. Study after study shows that being physically active 30 to 60 minutes a day has many benefits for each member of your family. Exercise can reduce the risk for chronic disease, strengthen bones and muscles, help maintain a healthy weight, increase energy, and improve sleep patterns. Physical activity can also help your child perform better in school by increasing his or her ability to focus in class. Being active can also pro- vide mental health benefits. Increased patience, improved ability to deal with stress, better emotional control, decreased anxiety and reduced risk of depression – these are just some of the benefits that can come from physical activity. It’s also important to note that you can be a good role model for your kids. Research shows that parental support and attitudes play a huge role in their children’s attitudes towards physical activity and the amount of physical activity they participate in. In other words, if you are active, your child will likely be active, and that will have a positive effect on their health as they grow older. So now that you know how important it is to be active, what can you do about it? Well, you can start by scheduling some family physical activity time. Set aside time in the calendar, just like you do for meals, homework, and appointments, for structured and unstructured active family time. Being a parent means something different to everyone, and is based on a whole host of variables. But I feel pretty confident in saying that each parent wants the best for their children. By ensuring that you and your child are physically active on a daily basis, you are doing one more thing to ensure your child lives a happy and healthy life.

Deanna Betteridge is a co-ordinator with Winnipeg in motion.

40 WAVE Quick tips for getting active

Parents of infants, preschoolers Parents of teens Parents of adult children and children Be an active-living role model by being Be an active-living role model by being Find ways to be active together and physically active yourself and supporting active together, or support them to be encourage the development of funda- your teen to find ways that he/she can active by watching their children for mental movement skills. be active. them.

Support and encourage active play Support and encourage your teen Plan multi-generation active outings • Around the house, in the yard, or with to find active ways to transport them- for your family Minutes selves to school neighbourhood kids. Start a new “active” family tradition • Playing traditional games of hide-and- • Walk, cycle, skateboard, rollerblade, That’s all it takes every day for you • Similar to Sunday family dinners, have go-seek or tag. etc. Sunday activity days. and your family to gain a lifetime Schedule family physical activity time Support continued participation in • Weekly walks together.

• Dance, go for a walk or swim, play activities or sports they participate in Register to take a physical activity of good health at your neighbourhood park, or learn • This may include financially, program together a new activity together (I recommend transportation to and from activities, • Yoga, fitness classes, boot camp, hula-hooping – it’s a great workout or just general support and encour- agement to find success in their Zumba dance. and lots of fun!). • Set up an obstacle course that every participation. Set goals together one can use (including adults). • Train to do a run or cycle together. Encourage your teen to try new • As parents of adult children your Turn story time into active story time structured or unstructured physical physical activities will tend to revolve • Act out the story. activities around social time you spend • Have everyone take turns to mimic the • If your teen is up for it, there are together. actions of the characters in the books parent-teen programs available (especially good with animal books). (check with your local recreation centre). Participate in parent and child • As parents of teenage children, For more information and ideas, visit: programming, for children of all ages you may feel like you have Winnipeg in motion • As parents of young children, the best less control www.winnipeginmotion.ca way to find time for your own physical over what activity is to work it into your play time they do with Active Healthy Kids Canada Report Card with your children – be creative and their time, www.activehealthykids.ca have fun with it! (Check with your but you City of Winnipeg Leisure Guide local recreation centre to find out definitely still www.leisureonline.ca what’s offered in your neighbour- have a strong hood). influence as a role model!

Winnipeg in motion is a partner- ship of the Winnipeg Health Region, the City of Winnipeg and the University of Manitoba.

For more information on how you and your family can be more physically active, call 940.3648 or visit www.winnipeginmotion.ca

September/October 2010 41 ask a nurse

Linda Coote

Cholesterol CONTROL Lifestyle changes are key to managing this life-threatening condition

What is cholesterol? shellfish are high in cholesterol. Plant- Why do they matter? Cholesterol is a waxy, fat-like sub- derived foods do not contain cholesterol. Elevated triglyceride levels are an inde- stance that is found in the lipids (fats) High cholesterol is primarily affected pendent coronary heart disease risk factor in the bloodstream and the body’s cells. by factors such as heredity, one’s weight and very high triglyceride levels can lead Cholesterol is essential to life, as it is control, alcohol consumption and lack to pancreatitis. High levels of triglycer- used to form cell membranes, certain of exercise. Consumption of foods high ides are often associated with high levels hormones and other vital substances. in cholesterol and transfats plays only a of cholesterol. Cholesterol does not dissolve in blood, so minor role (about 10 to 15 per cent) in it is carried by lipoproteins to the cells of high blood cholesterol levels. What causes high the body. triglyceride levels? What is good cholesterol? Factors that contribute to elevated When does cholesterol pose a Low-density lipoproteins (LDL) are triglyceride levels include: obesity, physi- health risk? commonly referred to as “bad cholester- cal inactivity, cigarette smoking, excess Most of the cholesterol in the blood- ol.” LDL carries cholesterol through the alcohol intake, high carbohydrate diets stream is manufactured in the body, body, dropping it off where it is needed (more than 60 per cent of energy intake), primarily by the liver. The body makes for cell building and leaving the unused several diseases (type 2 diabetes, chronic all the cholesterol it needs, so additional residues of cholesterol in the arterial renal failure, and nephrotic syndrome), consumption is not necessary. Too much walls. High-density lipoproteins (HDL) certain drugs (corticosteroids, estrogens, cholesterol is not beneficial. It can build are called “good cholesterol.” HDL trans- retinoids, and high doses of beta block- up in the bloodstream, accumulating in port cholesterol to the liver for reprocess- ers), and some genetic disorders. the walls of blood vessels causing ath- ing or excretion. HDL helps to keep the erosclerosis (plaques). Plaques decrease cholesterol from building up in the blood How is high cholesterol the size of the arteries, decreasing blood vessels. Simply stated, LDL brings choles- managed? flow, which then leads to the formation terol into the system, so it is often termed High cholesterol can be managed in of blood clots. This may ultimately cut off the “bad cholesterol,” and HDL called two ways. The first goal is to raise HDL the flow of blood in the coronary arteries “good cholesterol,” clears cholesterol out and reduce LDL levels through intensive leading to a heart attack, or in the cere- of the system. weight management and increased physi- bral arteries causing a stroke. cal activity. What are triglycerides? The main way one can raise HDL How does one develop high Triglycerides are a form of fat that is levels is by regular aerobic physical cholesterol? transported through the blood stream by exercise (brisk walking, running, cycling, Cholesterol is created naturally by the very low-density lipoproteins (VLDL), cross country skiing, etc.). There are body and consumed in certain types of produced by the liver, and deposited in some drugs that can have a modest effect food, including meat (especially organ tissue and muscle. Triglycerides are a of raising HDL, but the most important meats such as liver, kidney, brain), poul- storage form of energy. They are released factor is exercise. Treatment decisions try, eggs (mostly in the yolk), and dairy gradually from the tissue and muscle to are based on coronary heart disease products. Fish generally contain less be metabolized between meals according risk factors and the LDL cholesterol. The cholesterol than other meats, but some to the energy needs of the body. American Heart Association recommends

42 WAVE that everyone, of any age, with high LDL tion and increased physical exercise. If Linda Coote is a registered nurse with cholesterol be treated with therapeutic triglycerides are in the high range, drug Health Links - Info Santé, the Winnipeg lifestyle changes that can lower the LDL. therapy may be considered. Health Region’s telephone health infor- These lifestyle changes include decreas- matin service. ing intake of saturated fat (especially How can I guard against high trans fats) and cholesterol, increasing cholesterol? FYI physical activity, and controlling weight. All male adults 40 years or older The information provided is intended Diabetes is considered a coronary heart should have a fasting lipoprotein profile to be informative and educational and disease risk equivalent, so a person with done. The fasting lipoprotein profile is not a replacement for professional diabetes is treated the same way a per- includes total cholesterol, LDL, HDL, medical evaluation, advice, diagnosis or son with known coronary heart disease and triglyceride level. If the results are treatment by a health-care professional. is treated. normal, the test should be repeated You can access health information from If lifestyle changes do not bring the every two to three years. For adult a registered nurse 24 hours a day, seven LDL cholesterol to the expected levels, females, routine testing is usually done days a week by calling Health Links - drug therapy may be started. It must be after menopause or age 50, whichever Info Santé. Call 788-8200 or toll-free emphasized that cholesterol-lowering occurs first. Again, if this is normal, it is 1-888-315-9257. drugs cannot be effective without life- repeated every two to three years. style changes. The main class of drugs In males and females, testing may be used to lower LDL levels is the “statins.” done earlier if there is a strong family history of heart disease or if there is a What are statins? family history of high cholesterol or Statin drugs are the most commonly triglyceride levels. used drugs to lower cholesterol. For Prevention of elevated triglycerides every one per cent reduction in LDL is very similar to the treatment of cholesterol levels, the relative risk of high LDL levels, but without the coronary heart disease is reduced by one drug therapy. Eating a well- per cent. Individuals with high LDL cho- balanced diet that is low in lesterol may not be able to reduce the fat, with moderate intake of LDL cholesterol more than 50 per cent. carbohydrates, along with regular moderate exercise is What about triglycerides? advocated. Regular moderate Treatment of elevated triglyceride exercise is considered 30 to 45 levels depends on the severity and the minutes of walking cause. For borderline-high triglyceride most days of the week. levels, therapy includes weight reduc-

Choosing healthy foods can greatly reduce your risk of cholesterol.

September/October 2010 43 healthy eating

Marni McFadden

BROWN BAG SPECIAL

Pack a lunch that provides a nutritious punch!

he idea of having to pack school Tlunches shouldn’t cause a headache.

A little creativity, teamwork, and planning will result in tasty Get the Kids Involved lunches that your kids will enjoy, are fun to eat and will keep Kids are more likely to eat their lunches if they are included them satisfied until after school. And you can relax, knowing you in the preparation. Avoid the morning rush by taking time with are providing nutritious meals that will help your active, growing them after supper to prepare tomorrow’s healthy lunch. Leftovers kids to perform their best at school. from the evening meal can easily be portioned into containers and popped into the lunch bag. Cook extra pasta for a lunchtime Here are some tips for packing a great lunch: salad. Encourage older kids to make their own lunches. Ensure that they have access to foods from all of the food groups. Remember the Food Groups Different food groups provide different nutrients. For a power- Plan Ahead ful nutritious punch to lunch, choose foods from at least three of Take some time during the week to prepare lunch items that the four food groups: Vegetables & Fruit, Grain Products, Milk & can be frozen and easily accessed for hassle-free lunch prepara- Alternatives, and Meat & Alternatives. Studies show that children tion. A variety of hot foods such as soups and pasta dishes can be often do not get enough vegetables, fruit, milk products or whole included and kept warm until lunchtime with the use of a ther- grain foods in their diets – these are always great lunchtime mos, eliminating the need for a microwave at school to reheat. choices. Include both a vegetable and a fruit. See if your school Raw vegetables and fruits can be cut up and put into containers offers a milk program – whether it’s skim, 1%, 2% or chocolate, at the beginning of the week for easy assembly each evening. milk is a great way to ensure a source of calcium and vitamin D, Combine new foods with old favourites to help develop your which are essential for healthy, strong bones and teeth. kids’ tastes and increase acceptability of new foods. Be a role model and set a great example by trying new foods yourself. Use Sandwiches Again? an ice pack to ensure cold foods stay cold until lunchtime. Sandwiches don’t have to be boring. A little imagination and variety can really jazz up a sandwich. Try different types of whole Make It Fun! grain bread or use whole-grain buns, English muffins, pita bread Freezing foods can make them more enticing – freeze grapes, or wrap it up with a tortilla. The “Stuff That Sandwich!” table ac- quartered oranges, or any fresh fruit when it’s in season. Include companying this article lists some different types of sandwiches frozen fruit to be eaten alone, or added to yogurt. A yogurt that’s to try. As convenient as sandwiches may be, they are not the been frozen can be a fun surprise to find in a lunch bag as well. only way to have a delicious, nutritious lunch. Whether or not Presenting food in fun packages, such as coloured lunch bags, sandwiches are a hit in your house, there are many other healthy using plastic containers, special napkins, colourful straws or options to consider. Check out the “Five Great Lunch Ideas” table including stickers or notes can make lunchtime more fun. for tasty, nutrient-packed lunch ideas and follow a few simple rules when planning: Marni McFadden is a registered dietitian with the Winnipeg Health Region.

44 WAVE Five Great Lunch Ideas

Each lunch idea has been designed to provide a choice of a fruit, vegetable, grain product, milk & alternative and/or meat & alternative choice to provide at least three of the four food groups:

LUNCH 1 LUNCH 2 LUNCH 3 LUNCH 4 LUNCH 5

Chocolate chip English muffin pizza Leftover spaghetti or Pasta salad (see recipe) Homemade lunch kit: muffin (see recipe) (see recipe) chili or canned beans Chicken chunks (see Assorted raw in tomato sauce recipe) Baby carrots Cherry tomatoes vegetables Cucumber slices or Broccoli florets or red Frozen grapes, Fruit cup Apple celery sticks pepper strips blueberries or Milk Whole-wheat crackers strawberries Mandarin orange Cantaloupe or mango segments pieces Lower-fat cheese Yogurt Slice of bread or dinner Yogurt Lean meat, hummus roll (if chili or beans) or pea butter Milk

Bake ahead, wrap Bake ahead, freeze on Great way to use For chicken chunks: More cost-effective and freeze. cookie sheet and store leftovers. bake ahead, freeze on and nutritious than in container. cookie sheet and store store-bought kits. Easy to add to lunch Use a thermos to keep in container. Chicken box when in a rush. Pizza tastes good cold. hot foods hot. can be eaten cold.

Dipping Ideas for Raw Vegetables

Yogurt Dip

1 cup plain yogurt ¼ tsp dill weed 1/8 tsp garlic powder 3 green onions finely chopped dash pepper 1 tsp honey Combine all ingredients in a small bowl or blender and mix well. Refrigerate for several hours to blend flavours.

Hummus

1 can garbanzo beans (chick peas) 1-2 cloves garlic – minced 2 Tbsp lemon juice 2 Tbsp plain non-fat yogurt

Place all ingredients in a blender and mix until smooth.

September/October 2010 45 Chicken Chunks (makes 24)

1 Pre-heat oven to 400 F. Coat a baking sheet with a non-stick spray.

2 In a bag, mix together flour, ½ tsp garlic powder, ½ tsp cayenne pepper and ¼ tsp salt. On a plate, mix the bread crumbs with the rest of the garlic powder, cayenne pepper, and salt. 3 Cut each chicken breast into six chunks. 4 Shake the chicken pieces with the seasoned flour. Beat egg whites with 1 Tbsp water, and place egg mixture in a shallow 4 skinless boneless chicken breasts dish or bowl. Dip seasoned chicken in egg mixture then roll ¼ cup all-purpose flour in the seasoned bread crumb mixture. Place on prepared 1 tsp garlic powder baking sheet. 1 tsp cayenne pepper 5 Bake for eight minutes. Use tongs to turn pieces over. Bake ½ tsp salt eight minutes longer, or until chicken juices run clear. ¾ cup bread crumbs 6 Package up six to eight portions in plastic wrap, or snack- 2 egg whites, beaten size bags and freeze. Take package out of freezer the night 1 Tbsp water before and refrigerate with lunch so chicken is ready to eat at lunchtime. Put ice pack in lunch to keep cool.

Pasta Salad 1½ cups cooked tri-coloured pasta (Makes six servings) ½ cup shredded carrot ½ cup green pepper, diced 1 Place all ingredients in a container with a tight-fitting lid. 12 cherry tomatoes, sliced in half Shake until well-mixed. 2 Tbsp Italian salad dressing (or one of your choice) English Muffin Pizzas (Makes 12)

1 Place the oven rack in the top position. Turn the oven on to broil. Arrange the muffin halves on an ungreased baking sheet.

2 Combine the tomato sauce, basil, oregano, onion 6 English muffins, cut in half powder and parsley flakes in a small bowl. 7½ oz tomato sauce 3 Divide and spread the mixture over the muffin halves. ¼ tsp dried basil 4 Layer the cheese, green pepper rings, mushrooms and ¼ tsp dried oregano ham onto the muffin halves. ¼ tsp onion powder 5 Sprinkle the second amount of cheese over the ham. ¼ tsp parsley flakes 6 Heat under the broiler until the cheese is melted and 1 cup grated part-skimmed mozzarella cheese bubbly. 12 green pepper rings 7 Cool on wire rack. Once cooled, individually wrap in 12 small mushrooms, sliced plastic, stack in plastic bag or container and place in 12 pieces sliced ham freezer. Add to lunch bag the night before and keep 1/3 cup part-skim mozzarella cheese refrigerated until morning. Add ice pack to lunch bag to keep cool.

Food Major Nutrient Good For: Contribution

What a healthy Vegetables and Fruit Carbohydrate (fruit) Energy Fibre Digestion; satiety lunch can do for Folate Cell development Magnesium Bones Vitamin A Vision your child Vitamin C Immune system It is important to strive for balance when preparing a lunch for your child. The fol- Grain Products Carbohydrate Energy lowing chart shows how your child can Fibre Digestion, satiety benefit from a lunch that draws on the Folate Cell development four major food groups. Iron Blood Magnesium Bones Vitamins B1, B2, B3 Metabolic pathways Zinc Brain

Milk and Alternatives Calcium Bones, teeth, nails Carbohydrate Energy Potassium Nerve transmission Protein Building muscles; satiety Vitamin B2 Metabolic pathways Vitamin D Bones Zinc Brain

Meat and Alternatives Iron Blood Protein Building muscles, satiety Vitamins B1, B3 Metabolic pathways Vitamin B6 Carbohydrate, protein & fat Vitamin B12 Metabolism Zinc Nerve function Brain

September/October 2010 47 FLY FREE CONTEST Chocolate Chip Muffins (makes 12) (source: Flax Quick Snacks – www.flaxcouncil.ca)

1 Pre-heat oven to 350 F. 2 Combine flour, flax, chocolate chips, sugar, cocoa, baking powder and salt. Mix well. 3 In a separate bowl, mix milk, oil and vanilla. 4 Beat egg slightly and add to liquid mixture; mix well.

1¼ cups whole wheat flour 5 Add dry ingredients to liquid; gently stir until dry ingredients are thoroughly moistened. ½ cup milled flax ½ cup chocolate chips 6 Line muffin tins with papers. Fill each muffin cup with ¼ cup of batter. 1/3 cup sugar ¼ cup cocoa 7 Bake for 20 minutes or until inserted toothpick comes out clean. 2 tsp baking powder Play daily to ½ tsp salt 8 Remove from oven. Cool on wire rack. Wrap individually in plastic. Add to the lunch bag the night before. 1 cup skim or 1% milk $ 2 Tbsp canola oil WIN 1 of 6 10,000 1 egg Optional: chocolate chips can be replaced with equal amount of blueberries, WestJet Vacations travel prizes. 1 tsp vanilla cranberries or 2 mashed bananas

Go from winter blahs Stuff That Sandwich! to winter aaahhhs.

• Mix egg salad with grated carrot, diced green pepper or chopped celery September 10 to October 21, 2010. • Cucumber slices and lower-fat cheese • Add apple slices to tuna • Hummus and roasted red peppers • Pea butter - a great nut-free, protein-rich alternative to peanut butter • The old standby: choose lean meat (leftovers work well). Try to avoid processed meats.

NO PURCHASE NECESSARY. Contest is open to residents of Manitoba over the age of majority at time of entry. Contest opens on September 10, 2010 at 5:00 a.m. Central Time (CT) and closes on October 29, 2010 at 11:59 p.m. CT. To enter, obtain a game board and complete it with all five game pieces (published in the Winnipeg Free Press) and drop off or mail your entry c/o Fly Free Contest, Winnipeg Free Press, P.O. Box 1800, Winnipeg, MB R3C 3R1. Six winners will receive an $8,000 travel credit to be used towards WestJet flights or WestJet Vacations packages (winner must select) plus $2,000 cash (retail value of $10,000). Certain restrictions apply. Must correctly answer skill-testing question to win. Employees of sponsors and their agents and affiliates, and household and/or immediate family members are not eligible. Odds of winning depend on number of eligible entries received. Full contest rules are available at the Winnipeg Free Press and 48 WAVE winnipegfreepress.com/flyfree. FLYFLY FREEFREE CONTESTCONTEST

PlayPlay daily daily to to WINWIN 11 ofof 66 $$1010,,000000 WestJetWestJet Vacations Vacations travel travel prizes. prizes.

GoGo from from winter winter blahs blahs toto winter winter aaahhhs. aaahhhs. SeptemberSeptember 10 10 to to October October 21, 21, 2010 2010. .

NO PURCHASENO PURCHASE NECESSARY. NECESSARY. Contest Contest is open is open to residents to residents of Manitoba of Manitoba over overthe agethe ofage majority of majority at time at time of entry. of entry. Contest Contest opens opens on September on September 10, 2010 10, 2010 at 5:00 at 5:00a.m. a.m. Central Central Time Time (CT) (CT)and closesand closes on October on October 29, 2010 29, 2010 at 11:59 at 11:59 p.m. p.m. CT. To CT. enter, To enter, obtainobtain a game a game board board and completeand complete it with it withall five all gamefive game pieces pieces (published (published in the in Winnipegthe Winnipeg Free Free Press) Press) and dropand drop off or off mail or mail your your entry entry c/o Fly c/o Free Fly Free Contest, Contest, Winnipeg Winnipeg Free Free Press, Press, P.O. P.O.Box 1800,Box 1800, Winnipeg, Winnipeg, MB R3CMB R3C3R1. 3R1. Six winners Six winners will receivewill receive an an $8,000$8,000 travel travel credit credit to be to used be used towards towards WestJet WestJet flights flights or WestJet or WestJet Vacations Vacations packages packages (winner (winner must must select) select) plus plus$2,000 $2,000 cash cash (retail (retail value value of $10,000). of $10,000). Certain Certain restrictions restrictions apply. apply. Must Must correctly correctly answer answer skill-testing skill-testing question question to win. to win.Employees Employees of sponsorsof sponsors and theirand their agents agents and affiliates,and affiliates, and householdand household and/or and/or immediate immediate family family members members are notare eligible.not eligible. Odds Odds of winning of winning depend depend on number on number of eligible of eligible entries entries received. received. Full Fullcontest contest rules rules are availableare available at the at Winnipegthe Winnipeg Free Free Press Press and and winnipegfreepress.com/flyfree.winnipegfreepress.com/flyfree. Low-fat breakfast bars Power-Up are a delicious way to with eggs! start your day!

Eggs are a great fit for a healthy, active lifestyle.

You’ll have energy for your day and feel fuller longer with this great low-fat breakfast bar recipe! Not only does this bar contain eggs – which have the highest quality protein of any food – it also includes many other wholesome, healthy ingredients too.

Eating well is important for any family, and these easy-to-prepare, nutritious bars are a delicious way to have a great breakfast on-the-run or an energizing snack before sports or working out.

For more information about eggs or egg recipes, please visit: www.eggs.mb.ca

Low-Fat Breakfast Bars

2 cups (500 mL) rolled oats Tip: For a nut-free option, replace ½ cup (125 mL) natural bran almonds and walnuts with 4 tbsp (60 mL) ¼ cup (50 mL) wheat germ of your favourite dried fruits. ¼ cup (50 mL) all-purpose flour ¼ cup (50 mL) dried cranberries or raisins 2 tbsp (30 mL) slivered almonds (optional) 2 tbsp (30 mL) chopped walnuts (optional) 2 tsp (10 mL) baking soda 2 tsp (10 mL) ground cinnamon ½ tsp (2 mL) ground ginger ½ tsp (2 mL) ground nutmeg 1 cup (250 mL) unsweetened applesauce ½ cup (125 mL) skim milk 3 eggs 3 tbsp (45 mL) packed brown sugar

Preheat oven to 350°F (180°C). Combine oats, bran, wheat germ, flour, dried cranberries or raisins, almonds and walnuts (if using), baking soda, cinnamon, ginger and nutmeg in a large bowl. Whisk together applesauce, milk, eggs and brown sugar in another bowl. Pour over dry ingredients and mix just to combine. Spread into a greased 8-inch (20 cm) square baking pan, smoothing top. Bake until a toothpick inserted into the centre comes out clean, about 35 to 40 minutes. Let cool completely in pan on a rack before cutting into bars. Makes 8 bars.

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Injured tissue literally gets a boost at the cellular level; the chemicals needed for cells to do their job increase, as do the proteins to build new tissue, including blood vessels There are tremendous benefits to be achieved through (angiogenesis). LILT helps get to the root of the pain and injury as the body begins to regular massage therapy treatments from a Registered heal itself. Massage Therapist. Whether your need is to have a moment of relaxation, reduce muscle tension or attain • Osteoarthritis • Whiplash • Plantar Fasciitis relief from chronic pain, a therapeutic massage can • Rotator Cuff Injuries • Sports Injuries • Low Back Injuries enhance your overall sense of emotional and physical well-being as well as your quality of life. • TMJ • Tendonitis • Massage Therapy • Bursitis • Post-Surgical Healing Massage therapy benefits people of all ages. While it benefits the injured, the ill and the stressed, the strength of massage therapy in preventing illness and conditions before they develop cannot be over- looked. Massage therapy can be used in the treatment 1st laser treatment of both acute and chronic stages of conditions. is free until FREE Oct.31st, 2010 Energy that lasts.

There’s nothing better than kayaking on the Assiniboine River in the fall. Eating eggs before an endurance exercise like this one will help ensure your body has the energy to maintain strength and stamina. Just two eggs provide 12 grams of high quality protein, which helps build and repair body tissues and gives you lasting energy. www.eggs.mb.ca

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