saving lives, one innovation at a time

arming patients to beat breast cancer, in all its forms

how lives are saved, 24/7, inside the region’s trauma HQ page 30

centre of discovery: two new floors of research and healing page 24

battling superbugs with smarter use of antibiotics page 36 spring | two thousand and eleven contents

spring 2011 30

2 21 38 HOW YOU HELP US RUNNING FOR HIS LIFE PROSTATE CANCER RISK CHANGE LIVES Innovative heart surgery A new tool to better Letter from Campaign that allowed one patient screen men for potential Chair Jennifer Tory to go straight back to trouble running half-marathons 4 40 WE ARE SUNNYBROOK 24 A STENT IN TIME Faces of our community: Centre For Discovery Minimally invasive doctors, researchers, Two new floors in M-Wing surgery to fix dangerous nurses, fundraisers and and countless advances in aneurysms more health care 42 10 26 THE ALL-CLEAR SPECIAL DELIVERY letting go A new treatment that’s like When moms have multiple End-of-life decisions are Drano for clogged arteries births, they need special painful for both patients’ attention families and doctors 45 THE JAZZY 12 29 PHILANTHROPIST research innovation Why Mario Romano is Cutting-edge thinking, Xbox in the operating moved to give back to from an ultrasound helmet room, the ATM for Sunnybrook to using light to kill cancer medication, and more cells 48 30 A PATIENT’S LETTER 14 COVER STORY: EVERYDAY TALES OF A thank-you note from a breast TRAUMA patient who was brought Amazing stories of lives back from the brink cancer saved, and the daily drama How Sunnybrook of the region’s major tailors treatments to trauma centre fight the disease in all its forms - and saves 36 lives RESISTANCE IS FUTILE Plus: Identifying A project on the smarter breast-cancer types, use of antibiotics could and how to know if help keep superbugs at you are at risk bay

sunnybrook spring 2011 1 letter from the campaign chair chestnut park You are spring 2011 helping us publishers Craig DuHamel change lives Pamela Ross

Sunnybrook magazine is your portal into the editor Simon Beck daily life of Sunnybrook. We want to keep you up to speed on what Sunnybrook is doing art director Frank Perito to ensure you have access to the best care possible. And, we want to show you how contributors MairiAnna Bachynsky investments made in Sunnybrook are having Laura Bristow a real impact on the lives of real people. Natalie Chung-Sayers Since our last issue, I’ve heard from read- ers in a number of ways. Allison Dunfield Our stories stuck with some of you, so Sally Fur much so that hundreds made donations to Marlene Habib important projects we told you about. For Katie Hewitt this we’re so grateful. I also received many Hannah Hoag letters telling me how important Sunnybrook Marjo Johne magazine is to our community. Laurie Legere Monica Matys Here’s what some of you told me: Celia Milne Joan Ramsay “Wanted to let you know that I thoroughly Nadia Radovini enjoyed reading your magazine. It was Jennifer Schnare filled with exciting news and I read it from Christina Varga cover to cover.” – Bonnie P. photography Tim Fraser “I just received my first issue of Sunnybrook Ryan Enn Hughes Magazine. I think it’s a fantastic idea.” Doug Nicholson – Jessica V.

“I read the magazine from cover to cover senior manager, client engagement Teena Poirier and I learned more about Sunnybrook than I marketing solutions & custom content group ever knew before.” – Richard P. director, ad production services Sally Pirri In this issue, we share with you important and magazine production stories on topics that we help our patients deal with each and every day – breast cancer, production co-ordinator Isabelle Oandasan managing end-of-life issues and life-threaten- ing trauma. You’ll also read about the latest in program manager Liz Massicotte research and innovative new treatments. And don’t miss the centre spread where you’ll get advertising CMC a peek at the truly amazing work that will go on in the new research space we’re building Sunnybrook Magazine is designed and produced by at Sunnybrook. The Globe and Mail Custom Content Group As always, we thank our corporate sup- on behalf of Sunnybrook. porters who make this publication possible, ensuring that no hospital operating funds are used to bring you these important stories. all correspondence Once you’ve read through this issue of Sunnybrook Sunnybrook Magazine, please let me know 2075 Bayview Avenue, Suite D100 what you’d like to hear more about. As a Toronto, Ontario M4N 3M5 part of Sunnybrook’s community, this is your magazine. [email protected] | www.sunnybrook.ca Just e-mail me at [email protected]. Printed in Canada by Transcontinental Printing Inc. Prepress by DM Digital+1. Jennifer Tory Chair, Campaign for Sunnybrook

in conjunction with

sunnybrook 2 spring 2011 we are sunnybrook faces of our staff and our community

THE THE THE THE PHARMACOLOGIST nurse PHYSICIAN ASSISTANTS FUNDRAISER

New kids on The veteran’s Jumping for the block a cause best friend Zlata Janicijevic and department, so if I can make Maureen Taylor’s idea of that experience for patients Derek Walton, ALS patient Derek’s case is rare. The Registered practical nurse wasn’t her career path, success on the job is to get better, easier, less time con- and Sunnybrook donor, majority of ALS patients have Interaction Man Monalisa Page starts every so she joined the military patients fixed up and back suming that’s a good thing,” has been jumping out of an average lifespan of less shift at the Sunnybrook Vet- and then got the urge to home as efficiently as pos- says Ms. Janicijevic, who on planes for a cure for ALS. than three years - Derek has For over a decade, Dr. David including that some heart- erans Centre asking herself: try out nursing. She joined sible. a typical shift may handle up Amyotrophic lateral sclerosis now been living with ALS for Juurlink has been Sunny- burn medications can raise “How do I treat my veterans the Sunnybrook Veterans Ms. Janicijevic, Ms. to a dozen patients. “It really (also known as Lou Gehrig’s nine years. brook’s master in demystify- the chance of a repeat heart better?” Centre after earning her RPN Taylor and other physician shows the initiative and in- disease) is a fatal neuro- “As my arms and legs ing dangerous drug mixes. attack, that some blood Since May 2007, Ms. Page, credentials at George Brown assistants – newcomers novation at Sunnybrook as a degenerative disease that weaken, so too does my While the New Glasgow, pressure sufferers taking also a medical technician in College. to the health care scene whole, the fact it is willing to Derek says ultimately “buries energy level, but not my N.S., native works with calcium channel blockers the army reserves, has been Ms. Page, whose hus- in Canada – are trained to take on this new profession.” you alive.” heart,” says Derek. “I feel that patients, and as a clinician, could experience critical spreading joy to the war vet- band, Capt. Jason Page, support doctors in ERs. They Ms. Taylor, who spent Derek founded Jump for because ALS affects around researcher, teacher and ad- blood pressure drops while erans who become residents is an artillery officer in the conduct patient interviews, some two decades as a “PALS” (People with ALS), 3,000 Canadians only, com- ministrator, some of his most on certain antibiotics, and at the centre when they Canadian Forces, has many take medical histories and health journalist with CBC- an event that he has held pared to some other condi- vital work involves analyz- that the antidepressant Paxil can no longer live at home stories about how veterans perform exams and proce- TV’s The National and five twice, most recently this past tions which affect hundreds ing large-scale patient data may interfere with the breast independently. have touched her heart, but dures - from suturing cuts to years producing a weekly August, to benefit the ALS of thousands of Canadians, to uncover dangerous drug cancer drug tamoxifen. Ms. Page is a member of befriending one particular setting broken bones, sedat- health show for TVOntario, program at Sunnybrook, the there isn’t enough awareness interactions. “When a new drug is on an interprofessional care resident stands out. The ing patients, and advising on was looking for a new chal- largest of its kind in North or funding for this disease.” “[We] study disease on a the market, in some ways it team of nurses, physicians, hearing-impaired man in his preventive health care. lenge. At age 48, with her America. Through these Derek’s purpose is to large scale, a large number is a bit of an experiment on occupational and physio- late eighties normally kept Ms. Janicijevic was the two children grown and the events, Derek, along with raise more than money. He of patients, as opposed to the population, and we use therapists, pharmacists, au- to himself, but about three first PA hired at Sunnybrook, support of her husband, dozens of other skydivers, wants to raise awareness of patients one by one, using data available to use to see diologists, speech-language years ago Ms. Page walked in September 2009, and infectious disease specialist has raised over $150,000 the disease. With his event their health-care records,” if it's a safe or unsafe thing,” pathologists, social workers, into his room, tapped him oversees three other PAs, Dr. Donald Low of Mount by jumping out of planes at being duplicated in several says Dr. Juurlink, head of the the physician explains. “Once chaplains, dietitians, creative on the knee and said, “I just all from the first graduating Sinai Hospital, she turned in 12,500 feet. cities in North America, he division of clinical pharma- on the market, the side-ef- arts and recreation thera- wanted to say hello.” class produced by McMaster her microphone for medical “In order to have a life of is succeeding. And he has cology and toxicology. fects of drugs become more pists. “Something as simple as University – including Ms. books. Admittedly slightly purpose, you need to have every intention of continuing His work aims to ensure apparent because so many The average age of resi- making an effort to say ‘hel- Taylor, the oldest of the 21 intimidated that the other a purpose in life,” he says. his fundraising jumps with what a doctor prescribes is people are taking them. dents of the largest veter- lo’ is so important,” she says; graduates. McMaster PA applicants “I am living with ALS. I am Jumping for “PALS” 3 sched- truly what a patient gets, and “My colleagues and I … try ans- care facility in Canada after her initial exchange They are among 140 were younger and fresh from not dying of ALS. After all, uled for August this year that drugs are safe to take. to give patients and clini- is 88, and to Ms. Page, being with that veteran, he opened certified PAs in Canada, most earning their undergraduate life itself is terminal. I want where he expects over 60 A graduate of Dalhousie cians insights into the safety on the job is like being at up, and their friendship con- trained in the military, and degrees, she dove into the to leave a legacy behind skydivers to join him. Details University and with a PhD of drugs in the real world.” home. “I enjoy it because tinues today. some 70,000 in the U.S., course and joined Sunny- with Jumping for ‘PALS’, can be found on his web from University of Toronto, He adds: “Drug safety is I was raised by my grand- This summer, Ms. Page where they’ve been part of brook last fall – using the and would like this event to site, www.waltoncure4als.ca. Dr Juurlink’s research in the something that has always parents, and I still live with will become RPN co-lead for the health care system for communication skills honed continue every year after I Says Derek, “As my field of drug safety is sup- been important but it’s my grandmother,” says Ms. cognitive support for the an- six decades. The Ontario as a journalist. am gone.” symptoms progress, I remain ported by a New Investigator especially important nowa- Page, who was born in Spain nual June Camp trip to the government says PAs have “It’s a great role because He adds, “We don’t have positive that a cure will be Award from the Canadian In- days. It is a natural intersec- and raised in the Philippines Lake Joseph Centre in Mus- helped boost quality of you’re challenged to listen a Michael J. Fox for this dis- found. Maybe not in my stitutes for Health Research. tion of pharmacology and before her family moved to koka that is a highlight for care and reduce hospital to the patient’s story, do a ease because we don’t live lifetime, but one day. In the He also studies adverse drug epidemiology, but it’s not a Stouffville, Ont., in 1989. many veterans at the centre. and ER wait times, which is physical exam, come up with long enough to have one.” interim, I continue to raise events, the epidemiology of really big specialty – not a She didn’t start out with Her goal within the military is especially important at Sun- a differential diagnosis, order ALS attacks nerve cells awareness through public drug interactions, and the lot of people focus on drug the goal of becoming an to become a nursing officer nybrook – Canada’s largest the tests that need to be and pathways in the brain speaking engagements and epidemiology of suicide. safety, so there are a lot of RPN. While in the social sci- (RN), but she hopes to con- trauma centre. done and go to the physician and around the spinal cord. my annual fundraiser for ALS Dr. Juurlink has played a important contributions to ences program at McMaster tinue at Sunnybrook in some “It’s never a wonderful and see if I’m on the right Total paralysis eventually research.” • critical role in key findings, be made.” • University, she realized it capacity. • thing to be in the emergency track,” she says. • takes over.

sunnybrook sunnybrook 4 spring 2011 spring 2011 5 we are sunnybrook

THE THE THE MARRIED MEDICS EPIDEMIOLOGIST ECO-MANAGER

Accidents do happen, and he Guru of all knows why things green Dr. Donald Redelmeier could have done things earned the moniker “myth differently…I see so much buster” for a quirky, eclectic suffering and it all could have If you’re a patient undergo- over 100 acres of facil- brand of research study- been prevented.” He makes ing surgery, you’re probably ity comprised of different ing the lifespan of Academy a list: buckling up, staying off not thinking about the size departments. There are Award winners, how the of cell phones, and avoiding of your surgery’s carbon food scraps, commercial weather might alter medical unnecessary lane changes. footprint — or that the body packaging in gift shops school admissions, and the “If you were my kids you’d only absorbs about five and biohazardous materi- effects of democratic elec- have stopped me by now.” per cent of administered als. Beverley works with tions on driving habits. None of his three children anesthetic, while the rest purchasers to incorporate About 24 more people die are old enough to drive, he is sucked out of chimneys, more eco-friendly materials African adventures in medicine in car crashes on U.S. elec- says, “but I make them look making hospital operating into hospital products and tion days than on an average both ways before they cross rooms a major source of educates staff about waste Togetherness takes on a have, but it has opened their epidemiology and biostatis- The focus of Dr. Schull’s Tuesday, as it happens. the street.” greenhouse gas emissions. management strategies. whole new meaning for minds.” tics from McGill University work in Malawi was research And the Director of Clinical Dr. Redelmeier was drawn “Hospitals are up there Other key environmen- married couple Dr. Michael Born in Montreal, Ms. and a FRCPC in emergency and helping implement Epidemiology at Sunnybrook to the study of accident with factories ... We want tal strategies Beverley Schull and Dr. Josée Sar- Sarrazin trained and has medicine from the U of T, Dr. an innovative training and considers voter queues more prevention in part due to to be cognizant of that and helped implement include razin – whose 18 years since practised at the University of Schull is a staff emergency guideline program to inte- lethal for drivers than New the limitations in medical mitigate the risk,” says Bev- transportation for a large meeting in Sunnybrook’s Montreal and the University physician at Sunnybrook grate HIV/AIDS care with Year’s Eve celebrations or science to rescue trauma erley Townsend, manager of staff of commuters, and emergency room have seen of Toronto. Besides perform- and a senior scientist at the primary care. That work Super Bowl Sunday. It could victims. “In half of all road environmental sustainability energy conservation. Her numerous personal and ing abdominal and pelvic Institute for Clinical Evalua- continues today, as he col- be that drivers speed up to crashes, the patient is dead at Sunnybrook. Part of her background in chemical professional highlights. radiology, she is an assistant tive Sciences (ICES), where lects data to determine the make up for lost time lost, within five minutes, leaving green mandate is something engineering and hospital Dr. Schull, a senior professor in the department his research focus is health effectiveness of the program. take unfamiliar routes home, no opportunities for life- called gas scavenging, in management came in handy scientist, and Dr. Sarrazin, of medical imaging at U of T, services, emergency services The year in Malawi en- or become complacent on a saving heroics.” Survivors are partnership with an Ontario- when she helped draft her who works in the medical and is involved in undergrad- and quality of care. tailed many adjustments, day not normally associated often left with permanent based company, Blue-Zone. own job description that imaging department, have uate teaching and specialty He first volunteered especially for his three chil- with increased fatalities. damage. A machine installed in ORs was initially limited to energy three children, whom they exams at the Royal College abroad in 1991, in a hos- dren, but Dr. Schull says the “Driving is such a com- Over more than two now absorbs the excess management. “We decided uprooted for a year in 2009 of Physicians and Surgeons. pital in South Africa. He family sees it as a valuable monplace activity and it decades of research, first at anesthetics, which are then to expand it,” she says. Sun- to volunteer their medical While Ms. Sarrazin’s then went on missions for experience. “The kids now seems so banal…misconcep- Stanford University, where broken down to produce nybrook’s energy initiatives expertise in Zomba, Malawi. extraordinary efforts in Doctors Without Borders for have an understanding of tions abound, which leads to he did his medical residency new ones. will reduce CO2 emissions The densely-populated Africa – including working a number of years, joining poverty and Africa that they driver over-confidence and and fellowship, and then at Beverley has been the by 8,965 tonnes annually — southeast African country is with Malawi’s sole radiolo- the organization’s board of wouldn’t have had other- the failure to take preventa- the University of Toronto, green leader at the hospital comparable to taking 1,410 blighted with low life expec- gist and training ultrasound directors in 1997 and serving wise,” he adds. • tive actions,” Dr. Redelmeier Dr. Redelmeier has chal- for four years, the last two of cars off the road. tancy and a high prevalence technicians at two hospitals as president for five years. In says. lenged the way we think which saw Sunnybrook win Numbers aren’t the of HIV/AIDS. – marked her first experi- 2004, he became a member At Canada’s largest trauma about driving. He was the one of Canada’s Greenest only change Beverley has “For us as parents it’s ence volunteering abroad, of the Canadian board of centre, he meets the conse- first to study the effects of Employers awards. noticed: “It’s people’s at- important to preach by Dr. Schull has a long history Dignitas International, which quences of these inactions cell phones on drivers, and Take composting: “Some- titudes. It’s a huge behavioral example,” Dr. Sarrazin says of helping impoverished helps people affected by every day. “Unlike patients found that phone calls can thing that seems so simple change and it didn’t happen of the sabbatical. “Not only countries. HIV/AIDS in the develop- with pancreatic or uterine be as dangerous as alcohol is actually quite drastic.” It’s overnight. There’s a lot more did it teach the children Trained at Queen’s Uni- ing world, and is now the cancer, where it’s hard for consumption. • complicated with a staff awareness surrounding envi- appreciation of what they versity, with a masters in board’s chair. me to figure out where they of about 10,000 dispersed ronmental impacts.” •

sunnybrook sunnybrook 6 spring 2011 spring 2011 7 we are sunnybrook

THE THE researcher Parent Coordinator

Cancer on Mom is in her hit-list the house Dr. Chloe Milsom has fifteen might be the cause, and minutes to spare before a she’s one of the first. Kate Robson is taking the of preemies that makes her timer goes off; then the plas- “This is novel, because arduous task of a full-time eminently qualified. “I’ve had ma samples drawn from her although platelets are known mom to new levels, sanc- two different experiences at lab mice should be checked to play an important role in tioning it with an official job two gestational ages at two for protein levels. tumour progression…they description at Sunnybrook’s different hospitals. You have The award-winning scien- have not been considered Neonatal Intensive Care Unit. an idea of how it’s going to tist is doing her postdoctoral in terms of host response to Kate’s job as parent coordi- go, and it doesn’t always go fellowship at Sunnybrook treatment.” nator is a new NICU position that way, and that’s what I SUNNYBROOK - burn Research Institute on a team Administering higher dos- created just four months ago want to help people to deal under the direction of Dr. es of chemo several weeks to help relieve some of the with.” Robert Kerbel. The Kerbel apart has been standard stress from anxious fami- Kate works as a liaison group and Dr. Milsom’s practice for decades. But re- lies, making her one of the between Sunnybrook staff, experiment are part of a re- cent studies suggest a “low- first professional parents in parents, and the 1,200 babies search paradigm that might dose regular interval therapy” Canada. admitted to the NICU every one day change the way could be an alternative to Kate and her husband year. She organizes events anti-cancer treatments are conventional chemotherapy, began volunteering at Sun- for parents and advises staff administered. counteracting the tumour nybrook in 2006, after they on how to communicate Cancer is the lead- growth in the recovery stage. were discharged with their with a family in crisis. ing cause of premature At Leeds University in first daughter. Maggie, now A master’s in adult educa- death in Canada. And while the UK, Dr. Milsom did her 5, was born a micro preemie tion and studies in dispute anti-cancer drugs like undergraduate degree in at 25 weeks. Another parent resolution at York University chemotherapy are generally genetics and developed lifted Kate’s spirits after her helps Kate broach difficult effective, shrinking tumors an interest in cancer. She first few days with Mag- subjects and teach staff how significantly, the group has moved to Canada with her gie left her “full of ques- to approach fretful parents, discovered what Dr. Milsom husband ten years ago. She’s tion marks.” She says; “To many of whom are thrust calls a “counterproductive since completed her PhD at understand that tomorrow into a confusing situation. effect.” During recovery, she McMaster University, where might be very different, that She focuses on “recognizing says, “there’s an increase in her supervisor inspired her it might be wonderful…that moments of joy,” cherishing growth factors. The host’s research focus: blood vessel was life-saving.” the milestones that mark a cells are recruited to the development in tumours. When her second child, premature baby’s first weeks tumour, enabling it to grow.” She calls the meeting “life- Grace, now 3, was born pre- and months — reaching a It usually takes three changing.” mature, a “typical feeder and kilo and kangaroo carry- weeks for the body to re- Now, her work could grower,” at 33 weeks, Kate ing for the first time (each cover from the toxic dose of eventually support the worked on a parent project comes with a certificate Kate chemo, which also depletes case for low-dose chemo at Mt. Sinai, the hospital helped design), or the first healthy cells. But it’s during treatment, even if decades where Grace was born. time baby comes off of the this recovery stage that the of standard practice don’t Parent coordinator wasn’t ventilator. “We’re not talking patient’s cells mobilize to- change overnight. “You an obvious transition from or walking or getting teeth ward the tumour. Dr. Milsom see success and it triggers her job as managing edi- yet. But there’s a lot of joy is looking for the source of clinical trials, but I think it will tor at a mobile messaging in the NICU. It can be really these growth factors. She be some time before it’s ad- company, but Kate feels a wonderful.” • suspects blood platelets opted routinely in the clinic.” • special empathy for parents

sunnybrook 8 spring 2011 | multiple births | Special delivery GOT DONOR MILK? When mothers are expecting more than one baby, they need highly specialized care throughout The mantra “breast is best” is especially relevant to premature every stage of the process and critically ill babies. Immune system-boosting and nutrient-rich mother’s milk is associated with better brain development, and such high-need infants are at higher risk of developmental problems. But mothers of babies such as multiple-birth infants – who are at highest risk of feeding and health issues – can’t always provide the milk required for their little ones. As a result, pasteurized human donor milk (PHDM) is commonly used for critical, early-life feeding. may be detected earlier than normal,” regular doctors. But with the closing of nearly two says Dr. Barrett. “Women who come to the When Dr. Barrett isn’t caring for dozen human-donor banks in the clinic deliver later on, and so have a lower expectant mothers and delivering a large late 1980s because of concerns over risk of complications, and lower risk of percentage of the babies born at Sun- HIV transmission in breast milk, BC being taken to the tertiary centre at Sun- nybrook, he’s spearheading important Women’s Milk Bank housed at BC nybrook for emergency care.” research. For instance, a Twin Birth Children’s Hospital in Vancouver is Dr. Barrett notes that the generally low Study by Sunnybrook and about 120 other the only remaining source based in weight of multiple-birth babies is due to hospitals from around the world aims to Canada. the fact that only about 10 per cent of determine whether it’s best for moms to Sunnybrook – the only neonatal them go to full term – pegged at 38 weeks deliver by caesarean section or vaginally. intensive-care unit (NICU) in Ontario for twins (compared with 40 weeks for The randomized blind trial, involving using PHDM, for about 370 babies single births), and even sooner for HOM about 2,800 women giving birth at 32 to annually – needed more donor births. If an expectant mom of twins, for 38 weeks gestation, began a decade ago milk than the Vancouver facility instance, hasn’t given birth by 38 weeks, and is expected to conclude in the coming could provide, so five years ago she is induced to reduce the risk of still- months. started shipping it to Toronto from a birth and other problems. Such research is helping guide the care Columbus, Ohio, bank. “The biggest possible complication of of women like Lindsay Allen, a 32-year-old “The benefits of breast milk have having twins or another multiple birth is sourcing expert at a Canadian bank who, really come to light fairly recently; prematurity – and with that comes a big at the time of writing, was expecting twins people are really starting to rethink risk for all sorts of consequences, from as a result of IVF. breast milk,” says Dr. Eugene Ng, Ian and Kelly McLean, doting parents of Elizabeth and Abigail. cerebral palsy to significant abnormali- Lindsay, who lives in Ajax, Ont., was clinical director of Sunnybrook’s ties,” says Dr. Barrett. “The babies also referred to the multiples clinic because NICU. Dr. Ng is also a key figure in may not grow as well because they’re oc- through the five years of trying to start a the research and other work aimed New mom Kelly McLean’s twins can be man, and we didn’t think we would have “The care I got was wonderful,” Kelly cupying one womb, and there are a whole family with her husband Richard Allen, at opening a Toronto-based milk heard kicking up a fuss as she breaks from the babies at all – we thought we were go- says. lot of potential maternal illnesses, such as she has had a single-fetus miscarriage, bank that he believes would help her hectic schedule in her Toronto home ing to lose them,” recalls Kelly. “I was also Given that one-quarter of all deliver- hypertension, diabetes, bleeding.” and then carried twins who were born at cut down on potentially dangerous to discuss the unique challenges leading so sick and there were so many pregnant- ies at Sunnybrook are considered high Such complications are especially a 24.5 weeks and failed to survive after the informal sharing of breast milk outside up to giving birth to more than one baby in lady complications – morning sickness, risk, and Sunnybrook’s Level 3 neonatal concern among older mothers, who have amniotic sac burst early. hospitals. one pregnancy. acid reflux – it was the normal stuff, but intensive-care unit (NICU) cares for 20 per a higher chance of having multiple births Lindsay said care at Sunnybrook for her Lactating women donating milk But the 29-year-old Toronto marketing amplified times 10 because I had two cent of all infants in the province weighing because they more commonly get preg- latest pregnancy focused on ensuring no used by hospitals like Sunnybrook manager isn’t fazed by her daughters’ cries babies inside me. It was hard to breathe, less than three pounds, there’s great need nant through in-vitro fertilization (IVF) – a infection developed, and everything was go through strict donor screening, for attention, because she spent months hard to walk, hard to do everything.” for the specialized care that Women & reproductive technology that has boosted going according to plan. “These babies are and the milk itself must pass strict worrying about much worse. Her first But thanks to Sunnybrook, which offers Babies provides. the incidence of multiple births by about very anticipated by both sides,” she said, pasteurization and safety standards. ultrasound after discovering she was preg- personalized care for high-risk women Of the 4,250 babies born at the hospital 40 per cent since the early 1990s, accord- noting it will be her parents’ first grand- Currently, the hospital provides nant in January 2010 detected a problem and their families before, during and after annually, about 300 are multiple-birth ing to Dr. Barrett. children. donor milk to about 200 babies with the growth of one of the twins, likely pregnancy, Kelly and her 31-year-old hus- deliveries – which by nature carry a higher While the Women & Babies Program Kelly, meanwhile, not only gave birth to annually with a birth weight of under linked to a placenta issue. band, Ian McLean, are now the doting par- risk of complications than single-birth is a referral clinic for women across the healthy girls – save for some early hypo- three pounds for at least 14 days, and After seeing a specialist and at 18 weeks ents of Elizabeth, nicknamed Libby, and pregnancies, notes Dr. Barrett. Greater Toronto Area, moms-to-be also glycemia that required monitoring in the about 170 with a birth weight between into her pregnancy, Kelly was referred Abigail, affectionately called Abbey. Born For that reason, expectant moms at- come from further afield in Ontario. Many NICU shortly after birth – but in February three and 4.4 pounds for up to five to the multiples clinic in the Women & Jan. 5 by caesarean section some three tending the multiples clinic get their blood referrals have their babies at Sunnybrook; this year also passed her own post-op days, says Dr. Ng, who is also deputy Babies Program at Sunnybrook. Dozens of weeks early – about standard for twins pressure and other vitals checked, have other women only attend the multiples checkup with Dr. Barrett. chief of the department of newborn Ontario women carrying twins or higher- – Libby weighed 4 pounds 13 ounces, an ultrasound and get it assessed by Dr. clinic during pregnancy and then deliver `“He was very on the ball concerning my and developmental pediatrics. About order multiples (HOM), such as triplets while Abbey entered the world one ounce Barrett before they leave the clinic. It’s at their “home” facilities if their pregnan- case and wanted to make sure everything 90 per cent of mothers provide or quadruplets, and classified as high risk, lighter. These were hearty weights for common for clinic-goers to attend every cies remain low risk. What makes this was OK,” she says. As for the babies, consent for such feedings, he adds. receive regular special care from program multiples, especially given early concerns other week and then increase that to dual-care system work is the emphasis on “They’re eating, they’re crying, they’re Sunnybrook, Mount Sinai Hospital director Dr. Jon Barrett, nurse practitio- that Kelly may have had twin-to-twin tran- weekly visits closer to giving birth. record-sharing – all expectant mothers great, and Abbey is actually bigger than and the Hospital for Sick Children are ners and other specially-trained staff. sition syndrome, which causes too much “The beauty of [the clinic] is that for bring the medical and care files from Sun- Libby now.” discussing establishing a shared milk “I had the worst pregnancy known to nutrition to go to one fetus. women at higher risk, any complications nybrook with them when they go to their bank in Toronto.

sunnybrook 10 spring 2011 a quick look at some of the cutting edge research research happening at Sunnybrook

Sunnybrook researchers are (left) developing a space-age looking helmet to deliver ultrasound to the head and (above) studying the use of a stop clock in emergency (Above) Dr. Anthony Feinstein’s research shows stroke admissions. that long-term marijuana use significantly impairs thinking skills of MS patients. (Right) A team is looking for genetic mutations in an aggressive form of breast cancer.

Time is brain The ultrasound Spotting dementia A new weapon against Killing cancer at the How much exercise is MS: it’s no time to toke What’s in breast A stopwatch can save a brain. helmet from afar diabetes? speed of light the right amount? New Sunnybrook research cancer’s DNA? At least that’s the hope. When Sometimes there are few They might seem like fun Diabetes is a complicated Imagine if light could kill In our last issue, we told you shows that using dope is Using a next-generation a stroke stops blood from options when a brain tumour mind games, but two tests, ad- disease that causes a number cancer in bone. That’s what that physical activity in ado- dopey for multiple sclerosis genome sequencer, Sunny- getting to the brain, mil- is in a place where it can’t be ministered by professionals, of problems for sufferers. our researchers are investigat- lescent girls has lifelong brain (MS) patients. It causes even brook scientist Dr. Arun Seth lions of brain cells die by the reached with a scalpel. But have been found to predict One of the most dangerous, ing using light-sensitive drugs. benefits. Another Sunnybrook poorer performance in brain is studying the pathology of minute. Every second counts, we think we have an answer the onset of dementia up to aside from the disease itself, It’s called photodynamic ther- study says that we shouldn’t skills already affected by the triple negative breast cancer, so clot-busting drugs need to – using focused ultrasound to 10 years before it’s diagnosed. is chronic wounds, mostly on apy, where a light-sensitive over do it, though. Overly disease. The study of 25 users an aggressive form of the be administered as soon as zap tumours. Not as easy as it One test involves remember- the feet. In severe cases, this drug accumulates in a tumour, strenuous activity in women of street cannabis and 25 disease for which there is no possible. sounds. Because the skull is ing a list of random words problem can result in amputa- then light is applied to the throughout life is related to non-users, all with MS, found effective treatment. Called A new study is testing the so hard and thick, it sends ul- after a short delay between tion. cancer through a laser inside poorer performance on tests that the drug significantly the SOLiD 4, this machine will effectiveness of using a large trasound waves bouncing off when the words are heard and A Sunnybrook research a needle. This causes a form that predict dementias. worsens attention span, speed be used to find genetic muta- red LED stopwatch clock in in all directions. The solution: when they’re repeated back. team has invented a com- of oxygen to be produced that The link is thought to be of thinking and processing tions in breast cancer cell getting patients treated faster. a high-tech helmet. The other involves matching pound, vasculotide, which im- destroys the cancer cells and related to levels of estrogen, information, working memory genomes. This stopwatch, attached to Our scientists are building a symbols with numbers. itates protein and stimulates shrinks the tumour. Amaz- which are reduced by strenu- and other cognitive skills. The SOLiD 4 will allow Dr. the patient’s stretcher from new helmet to counteract that The ability to predict de- new blood vessel growth. So ingly, this therapy was also ous exercise, like marathon “What this tells us is that Seth and his team to map and the moment of arrival in the effect and hone in waves of mentia is important because it far very early studies have found to strengthen the bone running. The study suggests MS patients need to be made compare data from dozens of emergency room, serves as a ultrasound through the skull allows identification of people shown that it speeds the around the tumour. A clini- that further investigation of aware of these effects and patient biopsies. Once the ge- constant visual reminder of directly onto tumours and who could benefit from clini- healing and closing of wounds cal trial testing this therapy the effects of intense physical weigh whatever benefits with nomics of this deadly disease the urgency of the situation. other diseases in the brain. cal trials or other treatments – and keeps them closed. Vas- in tumours in the spine is activity on brain function is the very real cognitive side are understood, new therapy Seems simple, but if it proves Testing is in very early stages, as they become available. It’ll culotide holds potential hope underway. needed to figure out the opti- effects” says Dr. Anthony strategies and personalized effective, its use will become but if it works the way we also help us understand the not only for diabetics, but has mal exercise regimens. Feinstein, lead investigator of treatments can be developed, the standard of care and will expect it to, people who had long-term effects of dementia implications for treatments in the study and neuropsychia- giving new hope to women be expanded to other stroke little hope will one day have and its progression in the cancer, acute lung disease and trist at Sunnybrook. The study affected by it. centres across Ontario and a new, potentially life-saving brain, ultimately assisting in hardening of the arteries. was funded by the MS Society around the world. option for treatment. the design of future treat- of Canada. ments.

sunnybrook sunnybrook 12 spring 2011 spring 2011 13 I will

surviveWomen who receive the much-feared diagnosis are finding hope at Sunnybrook, with its menu of tailor-made programs to target specific forms of breast cancer

by Celia Milne photography by Tim Fraser

Anne Cheung: ‘This is a chapter past and I’m starting a new one.’

sunnybrook sunnybrook 14 spring 2011 spring 2011 15 breast cancer

It was November, 2007, and Toronto pharmacist Anne Cheung was planning a family holiday. She had felt a hard lump on the right side of her chest, near her sternum, and thought, “something is off there.” But, she said, “I was in a bit of denial, saying ‘It can’t be.’ ”

So, the then-44-year-old visited her GP, daylight, so the brightness helps a lot. It is Sunnybrook Foundation is raising mon- had a mammogram in December, and welcoming … not a scary place.” ey to complete the centre, with $14 million focused instead on a Christmas holiday The Odette Cancer Centre is a one-stop still to be raised from the community. “It

with her husband Ron and their children, shop for the full spectrum of care, from is going to be a wonderful resource for Breast Cancer Program clinicians of many disciplines, regularly meet to share expertise in the personalized care of each patient. 14-year-old Colin and 11-year-old Veronica. prevention and screening to imaging diag- patients for screening, diagnosis, and Dr. Eileen Rakovitch (on right), leader of the Breast Cancer Program: ‘We provide a centre that women can come to for total breast care. “We love going to New York over the holi- nostics, surgery, radiation, medical oncol- treatment,” said Dr. Rakovitch. days and shop.” ogy and post-treatment care. “The nature One of the strengths of the Odette Anne, who describes her experience in a of what we’re doing here is providing a Cancer Centre is that, alongside excel- cheerful, matter-of-fact way, recounts that, centre that women can come to for total lent clinical care, the hospital conducts right after the holiday, she learned from breast care,” said Dr. Eileen Rakovitch, internationally-recognized research and her GP that the mammogram showed the site leader in the breast program and a ra- education. Patients have access to leading lump was suspicious. diation oncologist. “We are looking at the clinical trials so they can be part of the lat- Next step: a biopsy. full spectrum. What do women with breast est in improved treatments and research. She chose Sunnybrook’s Odette Cancer cancer need that they are not getting in In Anne’s case, she qualified for a clinical Centre to have this done because she says other centres?” trial in which she would receive radiation she knew it was a great hospital and it Anne’s course of treatment was de- and chemotherapy with Taxotere before was close to her children’s schools. The signed specifically for her, as the Odette surgery to shrink her tumour. diagnosis was shocking and frightening: Cancer Centre has programs specially But the decision to participate in the She had cancer – a type called locally geared to different types of breast cancer. trial was agonizing. advanced breast cancer (LABC). “Each patient is different, and each She discussed the pros and cons with LABC is a type of cancer that may has a different path to follow,” said Dr. her medical oncologist, Dr. Rebecca Dent, spread to other areas near the Rakovitch. “Each woman will who is head of breast cancer clinical trials breast, including the lymph receive a tailored treatment at Sunnybrook, as well as her radiation nodes, but does not appear plan by a team of health oncologist, Dr. Jacqueline Spayne. “Drs. beyond the breast and lymph did yOU professionals who specialize Dent and Spayne were very good at ex- node region. Anne’s was a in the specific type of breast plaining everything to me. They explained cluster of small cancers that know? cancer.” how my cancer could be touching the together added up to close to Sunnybrook has one chest wall muscle and this approach could 5 centimetres. One in every of the largest breast cancer help tremendously.” The next eight months 15 women care centres in the country, Once Anne agreed to enrol in the clini- would be gruelling, but Anne diagnosed with with 35 physicians and grow- cal trial and a start date was set, she felt always felt comforted by the breast cancer ing. Plans are under way relieved. “Now there is a plan,” she said. care at Sunnybrook. “When in Canada is to move the breast cancer “That’s the way we explained it to the I was going through this, I treated at program into new digs. The kids.” felt I was in good hands. The Sunnybrook new breast cancer centre will Having a plan also helped her deal with doctors and nurses reinforced create 20,000 square feet of her emotions, and helped the family have that, and had a calming ef- dedicated space on two floors some kind of certainty amidst the uncer- fect. The building has lots of of M Wing. tainty, as she put it. Now it was »

sunnybrook 16 spring 2011 breast cancer

NO MORE Young, Different types of WAITING: high-risk, and breast cancers taking charge The New Rapid These are the main types of breast cancers for which Sunnybrook Diagnostic Unit provides care and expertise. • Ductal carcinoma in situ (DCIS). About 20 per cent of cancers diagnosed through mammographic screening are this type of non- Right now in many health care invasive breast cancer, according to Dr. Eileen Rakovitch at Odette systems it can take up to 42 days Cancer Centre. for a woman to get a breast-cancer diagnosis: a long wait from the time • Low risk, early stage invasive breast cancer – revolutionary Breast she finds a lump herself, herGP Brachytherapy post-operative one-hour treatment. finds one, a mammogram shows an abnormality, or an ultrasound • T riple negative. This is a subtype of breast cancer which is reveals something peculiar. “This characterized by a lack of three receptors that are usually targeted Nurse Sharon Lemon-Wong (right) guided patient Anne Cheung through her time at Sunnybrook. is not acceptable, it is stressful for in treatment. Triple-negative breast cancer is estrogen receptor- the woman, her family and the negative, progesterone receptor-negative and human epidermal make the right decision for me.” At the age of 29, Tonia Sultana of Ajax, Ont., growth factor receptor 2 (HER2) negative. Treatments that target Anne opted not to have reconstruction clinicians,” says Angela Leahey, an received the news: she has a 50-per- cent these receptors aren’t effective, but chemotherapy – especially when surgery. But for women who do pursue advanced practice nurse at chance of developing breast cancer before “I felt there was a done early and aggressively – often is. this option, Odette Cancer Centre offers Odette Cancer Centre. she reaches 50. Tonia tested positive last a program that allows them to meet their In the Fall, Sunnybrook is opening summer for the BRCA1 gene mutation linked • LABC, or locally advanced breast cancer. This is a type of cancer that surgical oncologist and plastic surgeon at with hereditary breast and ovarian cancer. Her whole team there who its new Rapid Diagnosis Unit, which may spread to other areas near the breast, including the lymph nodes, the same time, and to have their mastec- will provide a diagnosis to women aunt had died of breast cancer at 38 and her mother was ill with breast cancer twice before but does not appear beyond the breast and lymph node region. tomy and reconstruction surgeries done by the next day. The new unit is a together. Women may also choose to have she was 38. knew my case. To me, it's collaboration between the Breast • Breast cancer in young women. Odette Cancer Centre has a new the reconstruction done at a later date. Tonia and her husband have two children, a program called PYNK, supported by Rethink Breast Cancer, to address This kind of collaboration is what Cancer Program, pathology and son aged four and a two-year-old daughter. Sunnybrook is all about. And Anne felt it. imaging departments. Ms. Leahey “My aunt left behind a three-year-old. My breast cancer in the under-40 age group. Their needs are very the continuity ; you don't different from those of older women. “They work as a team. It was a collective. and the rest of the team have been mother is fine but it has been challenging. I felt there was a whole team there who working hard to compress a weeks- As a kid, I watched her get sick. The doctor • Metastatic cancer that has spread beyond the breast and lymph knew my case. To me, it’s the continuity; long process into one day. “I realize called her and told her the cancer was back. I feel like you're falling nodes: Bone Metastases Clinic. And Odette Cancer Centre has you don’t feel like you’re falling through from being an oncology nurse that watched her face. I knew it was difficult for her experts in pain management, radiation and palliative care to address the cracks.” having to wait any length of time is and it hurt me to see her this way. Today there are more things I can do so my family and I the needs of this population at the Palliative Care Clinic. through the cracks.” Anne began her treatments on Feb. 22, extremely stressful. As much as this 2008, and finished her last dose of chemo won’t have to go through that,” says Tonia. is a lot of work, I feel really good – Anne Cheung on Sept. 17 that year. Through all the ups For Tonia, these preventive measures and downs, Anne relied upon registered about the possibility of offering this included having had her ovaries and fallopian nurse Sharon Lemon-Wong, whom she to patients.” tubes removed in early February and having time, she said, to build trust with the calls “my constant contact.” her breasts removed at the end of the health care team, who mapped out a treat- Her ordeal is over, but, like many breast POST-TREATMENT CARE summer. Are you at risk? ment plan: radiation every weekday for cancer survivors, what lingers is a con- “I’m going to lose my breasts because I say Dr. Sandra Messner, an expert in breast cancer prevention at the Odette five weeks and chemotherapy on the first stant fear that the cancer has metastasized so, not because cancer tells me to,” Tonia says. Women are living a long period of Cancer Centre lists some risk factors and some risk reducing strategies day of each week for seven weeks. somewhere in her body, and will return. time after breast cancer, says Angela She has entrusted her care to doctors at the The next difficult decision was about Odette Cancer Centre at Sunnybrook, where for any woman: “That is the most feared thing,” she said. Leahey at Odette Cancer Centre. the mastectomy - whether to have one or “You feel a pain and think, ‘Oh my God, is a revolutionary new collaboration allows her While this is good news, women Main high-risk factors: both breasts removed. it cancer? Oh no, here we go again.’ ” to have a double mastectomy and breast • Family history of breast and or ovarian cancer, particularly if diagnosed “Again it was decision time,” she said. To reduce her chances of recurrence, who have survived breast cancer reconstruction surgery together. She was tempted to have both breasts Anne is now involved in a three-year have many unmet needs. They may Women like Tonia who are at elevated risk under age 50, especially if multiple cases on one side of the family removed, to remove the risk of cancer de- phase III clinical trial designed to de- be dealing with fatigue, treatment- for breast cancer receive special care and • Previous abnormal surgical biopsy (e.g. atypical cells, lobular carci- veloping in the left breast. “At that point, termine whether a class of drugs called induced menopause, loss of fertility, monitoring at Sunnybrook’s high-risk breast noma in situ) you are so aggressive in your mindset.” bisphosphonates are beneficial in prevent- body image issues, inability to clinic. Some women, in consultation with the But Dr. May Lynn Quan, her surgical on- ing the spread of cancer to other parts of concentrate, sexuality issues, bone health- care team, may choose aggressive • Previous high-dose radiation to the chest wall given before age 30 cologist, gently suggested she just go for the body. health, weight gain, and worry that preventive measures like Tonia did, and other (e.g. for Hodgkin’s lymphoma) women are comfortable with increased a single mastectomy on the right side, and Now 47, Anne is enthusiastic about her the cancer will come back. to consider later a mastectomy on the left future. She has an effervescent smile as screening. • Extremely dense breasts on mammogram To address these needs, Sunnybrook side as a preventative measure. During she describes plans to travel with Ron and “At the clinic, each woman’s individual At any level of risk it helps to: recovery, Anne was relieved she took that the kids, enjoy life and to find meaningful is developing a tailored care risk factors are assessed and doctors provide advice. “The reality is, whenever you cut ways to help others, such as volunteer- package. “We call it post-treatment recommendations for screening, risk reduction • Be moderately physically active (at least 30 minutes on most days of something off, you are losing part of you. ing at Willow Breast Cancer Support. care,” says Ms. Leahey. “We want to and ongoing surveillance,” says Dr. Sandra the week) There’s no going back and there could “Certainly there is clarity of thinking at the bridge the gap and set them on a Messner, an expert in breast cancer prevention • Achieve and maintain a healthy weight be regret in removing a healthy breast. end,” she said. “This is a chapter past and supported path.” at Sunnybrook’s Odette Cancer Centre. Dr. Quan understood this and helped me I’m starting a new one.” – Celia Milne • Minimize alcohol intake

sunnybrook sunnybrook 18 spring 2011 spring 2011 19 | heart disease | From surgery to finish line in record time An innovative new heart bypass technique made sure one man’s passion for long-distance running was only briefly put on hold

As Emil Boychuk pounded down the final stretch of the half-marathon, he picked up his pace. The adrenaline was surging, the sun was shining and hundreds of people lined the route cheering. When he hit the finish line, “it was one of the most memo- rable moments of my recent life. It was a tremendous victory.” Quite right. Only 19 months earlier, in March 2009, he was waiting for bypass surgery at Sunnybrook’s Schulich Heart Centre. The idea of running at all much less a 21.1-kilometre race wasn’t even on the chart. “One of the things that I had done quite faithfully” since 1982, Emil said in an interview from his north Toronto home, “is the Terry Fox Run every fall.” But as other priorities took more time, training dropped off. By the summer of 2008, at the age of 61, “I just felt I was out of shape and I figured, ‘Well, I have to get back to chestnut park my running schedule.’ ” Then he found out he had heart disease. A bout of angina, a trip to the emergency department and, two days later, at Sunny- brook, he had two stents put into an artery that was 90 percent blocked. “After I had my stents, I felt great. I joined the Toronto Rehab [cardiac] pro- gram and I built up my heart, my soul and my fitness to the point where I was able to start jogging.” But a midterm exam found an irregular heartbeat and an angiogram showed blockage in front of the stents. The only solution, he was told, was a single bypass. The thought of having his chest cracked open was, to say the least, unnerving. Fortunately, Dr. Fuad Moussa had other plans. He was spearheading an innova- tive procedure at Sunnybrook, minimally invasive beating-heart coronary bypass surgery, and felt Emil was a good candi- date. Instead of splitting the breastbone and stopping the heart, the surgeon makes a five-centimetre incision under the left breast and the heart keeps pumping on its own. On March 4, 2009, Dr. Moussa per- formed the surgery on Emil and another patient, the first time the procedure had been done in Toronto. Instead of the usual six to eight weeks of initial recovery, Emil says, “after two weeks I was quite comfortable walking Emil Boychuk was up and running – literally – within around … [and] about a month after » only a few months of his single bypass operation.

sunnybrook spring 2011 21 heart dISEASE

the surgery I was able to go back to work” as a guidance instructional leader with • Next, they pass a specialized the Toronto District School Board. Still, How the stabilizing device into the chest running a half-marathon “seemed to be a through a separate 1 cm. incision, to pretty lofty goal. I think for a long time I immobilize the heart in the area of was simply hoping to do a little bit of jog- surgery is the target artery. This area becomes ging again.” still while the rest of the heart beats. But he resumed the rehab program and performed in September finished the Scotiabank • The target artery is opened and Toronto Waterfront Marathon`s five-kilo- surgeons connect the internal metre walk/run in 45 minutes. New objec- thoracic artery to it using fine tive: the half-marathon. When he finished • The left lung is deflated and a stitches. the cardiac program in November he used respirator delivers oxygen to the right an online training program and organized lung only. • Once they are satisfied that runs to stay focused. It worked so well everything is good, the stabilizer is that less than two weeks before the race, • Sur geons make a 5-6 cm incision taken out, the left lung is allowed to he beat the half-marathon distance. just under the left breast and insert a expand and a drainage tube is placed On Sept. 26, 2010, armed with a heart retractor. through the 1 cm incision. monitor and watch to guide his pace, Emil • They identify the target vessel for was ready and steady along the waterfront • The incision in the chest is closed bypass. This is usually the anterior and the patient is transferred to route. Then, at the 20-km mark “there descending artery, the most the intensive care unit where the was lots of excitement, a lot of people on important vessel on the heart. breathing tube is taken out and the the sidelines doing a lot of cheering and I patient can be monitored closely. was very energized … the time just flew • Sur geons use a special retractor to Patients who have this surgery and my legs felt strong and I think the help harvest the artery on the inside generally stay in the intensive care best speed of my race was during that last of the chest. This is the left internal unit for about 12 hours and in kilometre. … My adrenaline was probably thoracic artery. hospital for about five days. at an all-time high.” His goal: 2 hours 30 minutes. His elapsed time: 2 hours 29 minutes. SUNNYBROOK - stroke

AGF | construction | A CENTRE FOR Investing in Dr. Peter Burns Sunnybrook Dr. Juan Carlos Using microscopic bubbles to deliver powerful drugs We need your help to build the hospital that Zúñiga-Pflücker to only the places they’re Find ways for you can count on when you need it most. If DISCOVERY Growing an needed in the body stem cells to immune system in a help the body you’re interested in investing in any of these petri dish Research is the engine that drives heal itself projects, please complete and send in the life-saving innovation at Sunnybrook donation form you’ll find in this magazine. You can also call us at 416-480-4483 Regenerate heart or 1-866-696-2008. You can also visit us tissue and blood at www.sunnybrook.ca/foundation to vessels find out more.

Take a tour Super- through the inside controlled of a tumour using lab space to a 3-D image make new test drugs

Invent chemicals markers that stick to hard-to-find Dr. Martin Yaffe Teams of specialists build each plan of attack, from diagnosis to diseases Dr. Dan Dumont Finding tumours Manufacturing test treatment to managing life before they get batches of cancer bigger than 1mm killing drugs Dr. Kullervo Hynynen Building a helmet that focuses ultrasound beams to kill inoperable brain Testing new breast tumours cancer treatments Quick access invented at to ultrasound Sunnybrook and digital mammography to give women a diagnosis as fast as possible

From studying the basic building Design new tools to blocks of life, to creating new drugs use in new and treatments in the lab, to studying treatments the effects of those treatments in Killing tumors with clinical trials – Sunnybrook does all drugs in of these things to improve, and often places save, the lives of patients with the where a most critical and complex medical scalpel can’t problems. Funded by both government and donors, we’re building new space to that will become the centre of innovation at Sunnybrook. A combination of research functions and equipment that will not exist Using ultrasound to activate drugs anywhere else in North America. in specific areas of Dr. Sandra Black It’s big. It’s exciting. It’s break- the body Watch drugs through. Come and take a tour of the Using ultrasound to give higher doses of clot-busting drugs to work on new space we’re building on the sixth treat stroke faster brain disease and seventh floors of M-Wing. in real-time

sunnybrook sunnybrook 24 spring 2011 spring 2011 25 | end of life | Letting go Family members are in a painful position when confronted with a terminally-ill relative. Desperately wanting their loved one to live, yet knowing that they would want to die with dignity, they face a heart-wrenching decision by Naomi Carniol

It had been a difficult year. Rob Fowler says. To be on a breathing friend, two cousins and two friends Ted Boduryan, 83, had already been machine requires a breathing tube in attended another meeting with his medi- admitted to hospitals three times for someone’s mouth or a tracheotomy. Many cal team. “It’s just going to get worse,” pneumonia. Each time, after a few days, patients aren’t well enough to be fully the doctor said. Ted’s body was shutting he recovered enough to be discharged. In conscious when in the critical care unit. down. Arthur appreciated the doctor’s June he was admitted for pneumonia Those who are awake are often too weak honesty and straightforward way of talk- again to Sunnybrook. to stand up and unable to do things for ing without medical jargon. Sunnybrook is a busy place. Each year, themselves. “We try to make it as comfort- The nurses, doctors and other staff in a about 1 million patients are cared for by able as we can,” Dr. Fowler says. critical care unit are devoted to provid- thousands of staff, including doctors, Sometimes health care teams find ing compassionate care. Sometimes that nurses, physiotherapists and other health therapies they’ve tried aren’t working. means administering pain medication to care professionals. In the midst of all this, After exhausting the therapies that could make patients more comfortable. Other there are moments of joy, and moments of realistically help a patient, “we sometimes times it means providing anxiety medica- sadness. get to a point where we know we’re not tion to take the edge off. And sometimes Sunnybrook’s critical care units provide going to get people better,” Dr. Fowler it means talking to family members about health care to patients who have, or are at says. “And that’s the most challenging part end-of-life decisions. risk of developing a life-threatening injury of being a doctor, when you are unable – Doctors encourage people to “think or disease, or who’ve had major surgery. as much as you might hope otherwise – to about what they believe the patient would These patients may need life-support, help someone recover,” he says. want, as opposed to what our personal such as a mechanical ventilator, during a At two months, Ted was still in the desires are,” Dr. Fowler says. “We all want period of acute illness. intensive care unit. Ted’s doctor called a our loved one to live and to thrive and do Most patients, such as those post-sur- meeting, explaining that despite efforts well, but it’s another question in that situ- gery, are in a critical care unit just a few to help him, he was unable to breathe on ation if the patient was able to participate days, until they are stable enough to be his own. His muscles were weak from in the discussion, what would they want transferred to another part of the hospital. eight weeks in bed. you to do?” Others stay longer, for many weeks or in Arthur had the authority to turn off Arthur thought about the busy life rare cases, many months. the ventilator, but wasn’t ready. “I said, his father had led. Even in his 80s, Ted In Ted’s first few days at Sunnybrook, ‘There’s no way I would do it. It doesn’t enjoyed attending operas and gala din- he was often awake. “He would see us feel right.’ ” The doctor respected Arthur’s ners with his girlfriend. He travelled on and he would smile,” his son Arthur decision. cruises. He was a VIP at a casino. Boduryan says. It’s difficult to tell families nothing more That September weekend Ted hadn’t Ted was connected to a ventilator for can be done to help a patient get better. opened his eyes. Arthur knew being stuck a few days. It helped. He was able to People react to the difficult news in a vari- in a bed, unable to talk and unconscious breathe on his own. “We were thrilled,” ety of ways. Some accept it. Others “have wasn’t a life his father would want. Ted’s Arthur says. “We had hope.” Ted was a very, very hard time accepting that and will made that clear. transferred out of the critical care unit. are hoping for something more that can Plans were made to turn off the venti- But soon he was unable to keep breath- be done, sometimes hoping for a miracle lator later that week. “This is what my ing on his own. He was transferred equivalent,” Dr. Fowler says. “Although dad wanted,” Arthur says. “I just never back to critical care and connected to a our primary role is to do what we can to thought I’d have to face anything like ventilator. In the weeks that followed, Ted get people better, sometimes, an equally that.” needed the ventilator more often than important job is that to make sure we End-of-life decisions can be excruciat- not. He slept more frequently. don’t set someone up for false hopes that ing for families. Those who work in a criti- Arthur visited his father every day. a miracle will happen.” cal care unit try to ensure families have “I found it really hard to be there for a In cases where the health care team is supports that can help, whether that’s long period of time,” Arthur says. It was unable to help patients recover, “we want other family members, friends, social tough to see his once-active father hooked to make sure we are focusing on keeping workers or spiritual support. up to a ventilator, looking weak and at patients as comfortable as we can and For some families, having a religious times, uncomfortable. not get into a situation where we are no ritual beside a patient’s bed provides When his father was awake, he couldn’t longer prolonging life, but are prolonging comfort. Klara Siber, a spiritual care pro- speak because of a tracheotomy. Some- a dying experience that may be uncom- vider who works in Sunnybrook’s critical times he tried to write notes to visitors. fortable,” Dr. Fowler says. care unit and cardiovascular intensive dams A After four weeks in the hospital, Ted At three months, Ted was rarely care unit, has arranged everything from teve

S wrote the word “suicide.” awake. His heart was getting weaker. His Aboriginal drumming to chanting by Bud- For some patients, the experience of kidneys started to shut down. He needed dhist monks to take place bedside. She being in the critical care can be a difficult dialysis. has a roster of clergy of different faiths one, Sunnybrook critical care physician Arthur and his partner, Ted’s girl- that she calls on, depending on patients’ l I by lustration

sunnybrook spring 2011 27 endf o lIFE

has pledged to raise $3.6 million for the latest in leading-edge Sunnybrook’s palliative care unit, which A voice for developments at Sunnybrook is located in the same building as the innovation palliative care Veterans Centre where Mr. McDermott and families’ needs. gives a holiday concert each year for The day of the family meeting, Ar- veterans and their families. Funds raised thur left the hospital. At midnight, the will transform the unit from a hospital- hospital called and said Ted was having like environment into more of a home- trouble breathing, no matter how much like setting. Common areas, including oxygen he was given. hallways, a kitchen and a lounge, will Arthur – and everyone else who had be warm and inviting with comfortable been at the family meeting – rushed back furnishings. A children’s play area will be to the hospital, including Ted’s doctor added as well as an area with comput- who wasn’t on call that night. ers and Internet access. This will allow Arthur saw his father struggling to families to remain in touch with their breathe. “As soon as I saw that, ‘I said we business and also allow patients and have to do this.’ ” A few months before his father passed families to interact with relatives who live Some families want to be present when away, singer John McDermott promised outside the city. a ventilator is turned off while others ask him that if his music career took off he It’s not just common areas that will to return after the breathing machine is would find a way to give back to the vet- get a makeover. A few years ago, when turned off. “Most families very much ap- eran community. “My dad was a World a friend of Mr. McDermott’s was dying, preciate the opportunity to be very close War II veteran. My mother’s brother, my the friend’s hospital room regularly had to their loved one in and around the time Uncle Mike, died as a PoW .... We had four or five people in it, laughing and of death,” Dr. Fowler says. three cousins killed in Vietnam. So there remembering. “It was a celebration of Curtains were drawn around Ted’s has always been a quiet respect for vet- his life,” the singer says. “It struck me you He’s got game: Dr. Calvin Law uses a Kinect system to manipulate medical images during surgery. bed. The ventilator was turned off. “If erans,” says the tenor, whose breakout are capable of doing that if you can get you are going to die, it was the most record Danny Boy has led to a career of privacy.” Funds raised will help increase beautiful way of dying,” Arthur says. more than 15 albums, including three privacy for the palliative care unit’s 32 “There were eight of us by his bedside, Canadian platinum records and five Juno beds. The unit also hopes to add built-in Xbox in the O.R. Small pill, GPS technology is The virtual holding his hand, telling him we loved nominations. beds for family members who want to Dr. Calvin Law, a liver cancer big difference closer to the heart pharmacist him.” Through the new foundation McDer- sleep over as well as showers for family surgeon at Sunnybrook’s After hip or knee replacement A new, high-tech robotic lab It’s a cool green machine mott House Canada, Mr. McDermott members. Odette Cancer Centre, is surgery, patients risk develop- is helping cardiologists at that looks like an ATM, but standing in front of an Xbox ing blood clots in their veins, Schulich Heart Centre zap instead of handing out bills, it Kinect, waving his hands in or having one of those clots away patients’ irregular heart dispenses pills. the air and having a great travel from their legs to their rhythms with exact preci- In partnership with remote- time. But Dr. Law isn’t playing lungs, which can be fatal. sion to restore normal heart health care technology provid- video games; he’s working in a Dr. John Murnaghan, asso- function. “Our new lab is er PharmaTrust, Sunnybrook’s RBC live operating room. ciate scientist at Sunnybrook home to a cutting-edge system Holland Centre is one of the It’s a clever new applica- Research Institute and Dr. W. from Stereotaxis that uses first locations to house a tion for this gaming system, Geerts of the Thromboembo- computerized, magnet-guided MedCentre kiosk. It provides allowing surgeons like Dr. lism Service have been study- technology to enhance the patients with virtual access Law to manipulate medical ing the the use of Rivaroxaban precision and safety of heart to a full range of pharmacy images, like CT scans, with (trade name Xarelto), a new procedures,” says Dr. Eugene services before they leave the the wave of a hand. And the oral anticoagulant approved Crystal, cardiologist and Di- hospital after hip or knee re- benefits are huge. Usually, a by Health Canada in 2008, but rector of Arrhythmia Services. placement surgery. The kiosk patient’s imaging is located on still not widely used. Until “It is revolutionizing how we uses advanced robotics, scan- a computer screen outside the recently, doctors used the an- treat our patients with cardiac ning, and live videoconferenc- sterile area of the OR, mean- ticoagulant Coumadin to pre- arrhythmias.” ing to connect patients to a ing surgeons can’t directly vent clot-related conditions Cardiac arrhythmias occur pharmacist in another loca- adjust the view. But thanks to such as deep vein thrombosis when the electricity that flows tion. The pharmacist, using a the creative thinking of Matt (DVT) or pulmonary embo- through the heart to trigger digital scan of a prescription, Strickland, a general surgery lism (PE). But it takes several the pumping action ‘short advises on the medication, resident and engineer who days to take effect and not all circuits’ or gets blocked – answers questions and then co-developed this innovation patients achieve a therapeutic disturbing the heart’s normal directs MedCentre to release with colleagues Jamie Tre- level of anticoagulation by the rhythm. If left untreated, it the medication to the patient. maine and Greg Brigley, that’s time they are discharged. can lead to heart attack and Due to the project’s suc- changing. Dr. Murnaghan and his stroke. cess, the collaboration is “For all surgeries, especially group has followed-up the During the procedure, set to launch version 3.0 of cancer surgeries we do today, results of Rivaroxaban on 700 powerful magnets are posi- MedCentre at the Holland, image guidance is key to help- joint-replacement patients for tioned near the patient while which will be three times ing the surgeon pinpoint the a three-month period since a cardiologist operates the faster, dispensing medication tumour and to save as much June of 2010. Early results are system from a control room. in less than a minute. The healthy tissue as possible,” promising, he says. “It seems GPS technology enables the new machine has the capacity says Dr. Law. “It’s like GPS to be minimizing the compli- physician to pinpoint the for more than 2,000 different for your car. This is going to cations we’re trying to avoid precise location of the faulty medications. change the way we inter- without creating another electrical site, position the act with our imaging in the whole group of problems.” catheter there and deliver the operating room, potentially required treatment to restore forever.” a normal heart rhythm.

sunnybrook spring 2011 29 Everyday tales of trauma A young woman who lost half her blood in a terrifying car crash, and lived. A man with a fractured skull from a simple fall on his stairs. A crack team of nurses, surgeons and specialists on call 24/7. Welcome to the daily drama of the region’s trauma HQ

by Hannah Hoag | photography by Doug Nicholson Everyone says 24-year-old Santanna Marrocco

is lucky to be alive. Left: Heather Mazurenko, RN, monitors incoming patients on the red phone. Centre: Santanna Marrocco receives a welcome visit from her mother Joanne.

It was late on a Thursday afternoon in Sunnybrook doctors. Dr. Valerie Krym was waiting for us in the trauma room for our early December last year. Santanna and outside, cleaning snow off the steps of arrival.” her mother-in-law had just finished install- their house when her husband telephoned. Santanna’s injuries were so severe, the taking off her glasses. It’s just after 5 p.m. and considered severe. “Pupils are 2, and ing a set of holiday flower arrangements He is the Medical Director at ORNGE, the health care team didn’t think she would Heather Mazurenko, and nearly 10 hours into her shift. As the reactive bilaterally,” says Dr. Engels. at a client’s house in King Township, near transport medical service provider for live. “The injuries were clearly horrific scheduled Clinical Care Leader, Ms. Mazu- Dr. Sebastian Tomescu, the on-call Nobleton, Ont. The pair planned to fit in the province of Ontario, and was on duty and life threatening. She’d lost more than RN, picks up the renko’s role is to manage the movement of orthopaedic resident, runs his hands along one more client visit before Santanna met in ORNGE’s Communication Centre that half her blood,” says Dr. Doreen Yee, the patients through the hospital’s emergency the man’s legs and flexes his knees and her husband Dan for a dinner date. evening. He’d heard about the crash and trauma team leader who directed San- department and its health care staff. “I rotates each hip, checking for broken and As they turned out of the driveway, their called home to check on his wife. tanna’s care that night. receiver of the need to know where everyone is and what dislocated bones. He moves quickly, find- truck collided with another car. Though By now it was dark. The ORNGE heli- beds are available. I run around all day— ing no injuries. both vehicles were badly damaged, no copter did not land at the scene because red phone on the I’m the rabbit. That’s why I have lunch at The team of seven rolls the man onto one was seriously injured. While Santanna these landings are not safe to do at night, Sunnybrook’s Tory Regional Trauma 7 p.m.,” she says. When the ambulance is his side so that Dr. Tomescu can check waited for the police to turn up, Santan- and there wasn’t a nearby helipad or Centre provides care for patients suffering nurses’ desk in on its way to Sunnybrook she pages the his spine. Amidst the chatter, the beeps na’s husband and her father-in-law arrived. airport available. A land ambulance was from a wide range of traumatic injury trauma surgical team. Most traumas will and the pings, there are the sounds of the About 40 minutes later, without warn- dispatched and already en route to the from motor vehicle collisions, stabbings the emergency reel in seven staff; a major trauma will patient’s flannel shirt ripping and metal ing, another car cleared the corner, slid scene. and gunshot wounds, cycling and other draw in closer to 10. hitting the floor as his belt and pants are on the ice and spun. It was followed by Dr. Krym, an emergency physician at recreational activities, and falls in the GTA At 5:40 p.m. four paramedics wheel the dropped. Discarded packaging and medi- a black truck that swerved to avoid the Sunnybrook, walked to the end of her and south central Ontario. department. “How far patient stretcher into the trauma room, a cal tape accumulate around the stretcher. car. It too struck the ice, hit Santanna long driveway. The crash scene was a When Sunnybrook receives notice that a large open space with four trauma bays. A kidney-shaped tray holds the patient’s and tossed her through the air. The truck kilometre away and Dr. Krym’s car was in trauma is en route, it activates an internal out are they?” she Metal storage racks stacked with blue dentures. They remove the neck brace, then ran over her and dragged Santanna the shop, but because there were so many network that draws the on-call trauma boxes stocked with syringes, gloves and staple shut the laceration over the man’s about four metres before it came to rest, emergency vehicles on the scene she team composed of anaesthesiologists, asks the dispatcher. other medical supplies line one wall. A right ear, and roll him back. “Let’s do a with her buried in the snow under its rear decided to walk there. orthopaedic surgeons, general surgeons, low fridge tucked against the opposite chest and a pelvis X-ray,” says Dr. Engels. wheels. When Dr. Krym arrived, neurosurgeons, respiratory therapists and A screen mounted wall holds blood. A Kodak Direct View DR It’s 5:59 p.m. “The last thing I remember she saw that Santanna was nurses to the trauma centre. 95000 system X-ray machine is suspended Less than 10 minutes later, the room is is being underneath the truck critically injured—her pelvis On a Monday afternoon in late February, on a nearby wall has from the ceiling. noticeably calmer and quieter. The trauma and having Dan dig me out. did yOU and lower legs were crushed Heather Mazurenko, a registered nurse, The man is intubated, hooked up to an team continues to check the patient’s He was crying and freaking and one of the major blood picks up the receiver of the red phone on intravenous line, sedated and attached to vitals noting the numbers in his chart, and out. I said, ‘I love you, and know? vessels in one of her legs the nurses’ desk in the emergency depart- begun to flash. a portable monitor that measures his heart tidy up the tubes and wires that connect ‘goodbye’,” recalls Santanna. had opened up. Her blood ment. “How far out are they?” she asks the rate, blood pressure and blood oxygen him to the IV bags and machines, before “I didn’t think I was going to Of the pressure was very low. Sun- dispatcher. A screen mounted on a nearby levels. Dr. Paul Engels, the on-call trauma he is wheeled a short distance down the make it.” 1,042 trauma nybrook was not the closest wall has begun to flash. An older man has team leader, leans over the table and rubs hall to the trauma centre’s dedicated CT Santanna owes her survival patients treated at hospital, but “I knew it was fallen down the stairs at his home and hit his knuckles into the centre of the man’s scanning room. to a set of coincidences, some Sunnybrook in 2010, her only chance of survival. his head. EMS has scored the injury a level chest. Ten staff lift the man from the stretcher quick thinking by an off-duty nearly half She needed a trauma centre,” 2 out of 5 on the Canadian Triage and Acu- At the scene of the crash, the man had to the narrow CT table to scan for bleeds emergency physician and a of them were recalls Dr. Krym. “While we ity Scale, where 1 is the most severe. scored an 11 on the Glasgow Coma Scale, and breaks. Dr. Martin Shoichet, a radiolo- first-rate trauma team at Sun- involved in motor were speeding down the 401, “It’s coded as a trauma, so they’ll come which assesses a patient’s eye, verbal and gist, spreads his elbows wide and leans on nybrook. vehicle collisions. I told the driver to notify to the nearest trauma centre, which is motor responses following a head injury. the desk peering at the computer screen in The crash took place not Sunnybrook’s trauma team us. We’ll treat it as such until we know The pain response was a good sign, but front of him. He spots a crescent-shaped far from the home of a pair of and tell them to be ready and what’s going on,” says Ms. Mazurenko, the patient’s score had dropped to a five, sliver of blood between the brain and the

sunnybrook sunnybrook 32 spring 2011 spring 2011 33 The trauma unit runs on a 24/7 cycle of drama, dedication and state-of-the-art care

skull. “There’s also a rib fracture, and Emergency Department, staff dressed in time going to one of the smaller hospitals probably a small hemothorax [blood in jackets and carrying coffee begin stream- that might not have had the resources to the chest cavity], maybe two,” says Dr. ing in and study a large white board to help her,” says Dr. Yee. Shoichet. Dr. Engels picks up the phone find their assignment for the night. There Santanna’s pelvis was crushed. The doc- and books an operating room. are two minutes left in Ms. Mazurenko’s tors amputated her left leg above the knee “He hit his head pretty hard if he has a shift and she has yet to eat her lunch. The and performed a through-the-knee am- fractured skull,” says Dr. Shoichet. red phone rings. She picks it up. “Tell me, putation on her right leg. But she is alive. Ginny Cosby, a registered nurse on the what’s on the ticket?” she asks. Three months after the accident, Santanna trauma team, pops into the room to speak remains in a rehabilitation hospital receiv- to Dr. Engels. “I’ve told the family he’s ing occupational and physical therapy critical and that you’ll come to see them. Santanna’s heart stopped while she was daily. “My goal is to get my prosthetic legs, hrpao I put them in the family room. They’re a in the CT scanner. “When people’s hearts so I can get back on my horses. I miss my little anxious,” she says. stop because of blood loss, it is not easy animals so much,” she says. Santanna’s A minute later, Ms. Mazurenko leans to get them back,” says Dr. Yee. The team other goal is to have a helipad built in the into the room, phone tucked under her did CPR and gave Santanna epinephrine to Nobleton region so that other trauma vic- ear. “I’ve got an OR,” she says. The trauma keep her alive and rush her up to the OR. tims don’t face the same risks she did. “If team stops the scan and moves the patient “I had an excellent trauma team that night, it wasn’t for Dr. Krym, I wouldn’t be here,” onto the elevator to take him up to an we were a well-oiled machine,” she says. says Santanna. operating room. It’s 6:51 p.m. “Dr. Krym made a good decision to bring Back at the nursing station in the Santanna to Sunnybrook and not waste

when every second counts: The Trauma, Emergency & Critical Care roof of the hospital would give patients the new helipad program treats about 54,000 patients each direct access to our trauma services in year, more than double any other hospital the shortest time,” says Dr. Homer Tien, in Ontario. About 1,200 of those will be medical director of Sunnybrook’s Tory suffering life-threatening traumas, half of Regional Trauma Centre. whom will arrive in a helicopter. The plan is to build a state-of-the-art Right now, the hospital’s helipad is helipad on top of the hospital. Once in located about half a kilometer away service, patients will be transferred from the from the trauma room. Paramedics and roof to the trauma room via an elevator, trauma staff have to coordinate with a giving our trauma teams more time to save land ambulance to transfer patients from lives. the helipad to the trauma room. This adds The project will cost $6 million and about 10 minutes to treating a medical will be entirely funded by donors. So far, crisis where every second counts. Sunnybrook Foundation has raised $3 “We’re already very good at saving million toward that goal. the lives of trauma patients - now we’re If you’re interested in helping to fund focusing on incremental growth to further the construction of the helipad, visit improve care. A new helipad on the sunnybrook.ca/helipad.

sunnybrook 34 spring 2011 | antibiotic use | Superbugs be gone Resistance is futile – or at least that’s the future goal of a Sunnybrook team working to fend off drug-resistant bacteria by cutting down on the use of antibiotics day three the team reflects on whether the patient is receiving the appropriate antibi- BACTERIA: otics. “By then,” says Dr. Simor, “we have received labs and cultures, and have much more information on how the patient is smarter than us? doing.” The infectious-disease pharmacist re- views the situation. Is there an infection? What germ is responsible? Is the patient still critically ill? Are there side effects? How is his or her kidney function? Is the dosage and frequency correct? Should we switch from intravenous to oral? Are there any allergies that might affect the choice of medication? “Based on that review,” says Dr. Simor, “the pharmacist may decide that is still the best drug. Or they may say, we know this organism can be easily treated with a narrower-spectrum antibiotic. We don’t need the big guns.” Having made this decision, the pharma- cist then reviews the case with the infec- tious disease physician, who may agree or disagree. They then communicate their Why do antibiotics stop working against certain bacteria? recommendation to the physician who Bacteria evolve quickly to survive – faster than humans can create new is attending to the patient, known as the antibiotics. “Bugs are much smarter than we are. They have been around critical care doctor. “We are only making for millions of years, whereas antibiotics have only been around for about suggestions,” says Dr. Simor. “The critical 60 years,” says Dr. Simor. care doctors should be the final arbiters; Bacteria have three ways to outfox antibiotics: by producing enzymes in our study, we found they complied with our suggestions 90 per cent of the time. that change or destroy an antibiotic, by changing their basic structure so We had excellent cooperation and buy-in.” that an antibiotic is no longer effective, or by developing an outer shield The program has thus reduced anti- against the antibiotic. “Every time we develop a new antibiotic, sooner or biotic use by more than 20 per cent and later some bug will develop resistance,” says Dr. Simor. quelled some resistant bacteria in the Broad-spectrum antibiotics, such as the newer cephalosporins and Sunnybrook Critical Care Unit. “We have fluoroquinolones, are capable of attacking many different types of bacteria. demonstrated significant overall reduction “In general, the more broad spectrum the antibiotic, the more likely they in utilization and reduction in broad spec- are to cause resistance,” says Dr. Simor. Ideally, doctors prescribe more trum antibiotic use, which has resulted in narrow-spectrum antibiotics to target the exact bacterium, such as penicil- a decrease in drug costs,” says Dr. Simor. “And, even more significantly, there is lin, amoxicillin or a sulfa drug. Once a “superbug” becomes highly resistant, doctors have to try different Sunnybrook’s test program to place closer monitoring on the delivery of antibiotics is already showing benefits. some evidence of a decrease in the mark- ers of antibiotic resistance and a decrease antibiotics until they find one that works. “It may add up to a germ being no in C. difficile, compared to other parts of longer treatable. These are still few and far between, but that’s the danger,” It happens in every hospital: a critically- specific bug. tients are sickest and potentially exposed the hospital where rates stayed the same.” says Dr. Simor. ill patient develops an infection. One “We want a drug that is active against to the most procedures, devices and infec- Dr. Simor and his team also studied example is ventilator-associated pneumo- that one bug. We don’t want to use a tions. whether tighter control over antibiotics Some of the nastiest antibiotic-resistant organisms: nia, a common and serious infection in sledgehammer when a nail file will do Antibiotic resistance has increased had any undue effects on patients. “Did • Methicillin-r esistant Staphylococcus aureus (MRSA), which causes skin critical-care patients. the job,” says Dr. Andrew Simor, head over the last many years in society and in we affect the length of stay or in-hospital and soft tissue infections, pneumonia and bloodstream infections. Not knowing which bug is causing the of the department of microbiology at hospitals, explains Dr. Simor. One of the mortality? We studied that and believe the infection, the attending physician starts Sunnybrook and a senior scientist at the drivers of this increase is excessive use of answer is no. • Vancomycin-resistant Enterococcus (VRE), a bug that lives in the bowel. the patient on one or two or possibly even Sunnybrook Research Institute. antibiotics, also known as antimicrobials. “We don’t believe we did any harm and • Clostridium difficile (C. difficile), which causes diarrhea. three broad-spectrum antibiotics, medica- Sunnybrook has been a leader in mak- To steward antibiotic use requires a we do believe we have done some good. • pseudomonas aeruginosa, an infection that is resistant to many antibiot- tions that are most likely to cover any ing sure antibiotics are used efficiently collaborative effort. The lead investigators We have been able to show with scientific ics, such as quinolones and carbapenems. Hits the bladder, lungs and potential culprits. and with precision, a practice that helps for the initiative were Dr. Simor, along elegance that it does make a difference. blood, and occurs most often in hospital. The patient’s samples are sent to the control antibiotic resistance. And an excit- with infectious-disease physician Dr. Nick I’ve been delighted at our success.” • Multidrug-r esistant Acinetobacter baumannii, which can cause pneumo- lab. Two days later, the results come back ing new initiative is improving antibiotic Daneman, pharmacy and infectious-dis- Sunnybrook’s Antimicrobial Steward- nia and infections in the urinary tract. and the bacteria responsible for the infec- prescribing even more. ease expert Dr. Sandra Walker and infec- ship Program was such a successful • new Delhi metallo-beta-lactamase (NDM-1)-producing E. coli. Resistant tion are identified. Now – in the interests The Antimicrobial Stewardship Program tious disease pharmacist Marion Elligsen. collaboration that in the fall of 2010, it to almost every available antibiotic. of reducing antibiotic resistance – it may began as a pilot study in Sunnybrook’s Here’s how the stewardship program received funding to be not only continued, be time to switch the patient to a nar- critical care unit in 2009. The unit was a works: When a patient receives antibiotic but expanded into other departments in rower, more exact antibiotic to target the good place to start, since that is where pa- treatment, the pharmacy is notified. On the hospital.

sunnybrook sunnybrook 36 spring 2011 spring 2011 37 | prostate cancer |

How the risk calculator spots trouble The numbers don’t lie that conventional screening might miss When it comes to screening for prostate cancer, the standard PSA test is good, but not enough. Enter Dr. Robert Nam with a risk-calculation tool that takes detection to a new level

The day before Barry Shiffman was to fly from Toronto to Russia to begin serving on the Violin Jury of the International Tchaikovsky Competition, the 44-year-old learned he had prostate cancer. “I was floored by the diagnosis. I sat for in the lobby of Sunnybrook for two-and-a- half hours thinking, ‘What is happening?’” recalls Barry, who is the associate dean of the Glenn Gould School at the Royal Conservatory of Music, and father of two. “But once you get over the insanity, the realization, that you have cancer, then you think, ‘I am so lucky. It could have easily been missed’,” he says. When Barry moved with his family to Toronto from Banff, Alberta in 2010, he thought he had his health under control. He had been previously diagnosed with a benign enlarged prostate, the harmless growth of the prostate often associated with aging. As a precaution, Barry had his PSA levels checked routinely, to rule out the possibility of prostate cancer. The adult prostate gland makes a protein called prostate specific antigen (PSA). A healthy prostate releases small amounts of the protein into the blood, but prostate cancer will often increase its production. Men with PSA levels greater than 4 nanograms per millilitre of blood The prostate cancer risk calculator is designed to help may be offered a needle biopsy to check detect the disease in men such as Barry Shiffman. the prostate for cancer. In December, Barry’s PSA test came back higher than normal. His physician considers age, ethnicity, family history of “The calculator empowers the patient. consulted with Sunnybrook’s Dr. Robert prostate cancer and urinary symptoms They still control what they want to Nam, a urologic oncologist at the Odette when calculating a man’s prostate cancer do, but it gives them more information Cancer Centre, and researcher behind risk. Dr. Nam and his colleagues devel- to make their decision,” says Dr. Nam. a new online tool that provides a better oped and checked the risk calculator with “That’s the bottom line.” assessment of prostate cancer risk. It over 3,100 Canadian men, including 408 “I haven’t cancelled my plans for the helps patients avoid unnecessary prostate men with normal PSA levels. It worked summer,” says Barry. “My treatment plan biopsies, but it can also detect prostate better than conventional screening meth- doesn’t include chemo or radiation, but I cancer at an earlier, more curable stage, ods. Nearly a quarter of the men with a will have surgery in April. Hopefully I’ll be and identify high-risk patients. normal PSA were diagnosed with prostate back to life as I know it soon.” Dr. Nam developed the risk calculator cancer. when he realized that the PSA blood tests doctors use to screen for prostate cancer were no longer reliable. “When it was introduced 20 years ago it was a fabulous test. It caught all the cancers out there. RAPID DIAGNOSIS: A Canadian First But it couldn’t detect the low volume pros- tate cancers—the new cases that were just starting out and didn’t have enough Sunnybrook’s Odette Cancer Centre recently launched a new clinic for rapid cancer cells to crank up that PSA. But results on prostate biopsies. Now offering results in 72 hours versus the then we realized that we knew a lot about standard two to three weeks, this is a Canadian first with results that are more the established risk factors for prostate accurate than conventional testing. Men will know sooner and more accurately. cancer,” Dr. Nam says. This is particularly critical if they are diagnosed with an aggressive form of Unlike the standard approach, the the cancer. Once results are back in 72 hours, if positive, treatment plans are new calculator (also called a nomogram) immediately evaluated.

sunnybrook sunnybrook 38 spring 2011 spring 2011 39 | aneurysm surgery | A stent in time

would now flow through the stent. She was released from the hospital EVAR: how does it work? saves Margo within two days. Her daughter was ec- static. This is how the procedure is performed for an abdominal aneurysm Chest aneurysms are highly dangerous, and the open surgery to repair them just as risky. But a “This is amazing. I couldn’t believe much less invasive technique is producing amazing results what a phenomenal response this is … to go home post-op on day two. In this age group!” says Dr. Belo. Sunnybrook introduced this surgery Margo Balanyi is a vibrant Toronto senior in 2006. At that time, it was considered who recently celebrated her 86th birthday experimental and was not funded by at a Chinese restaurant with friends and the government. Until 2009, when the family. No one would have suspected that procedure became government-funded, a few weeks before, she had a ticking time all EVAR procedures at Sunnybrook were bomb in her chest—a thoracic aortic an- paid for by donors, over $3 million worth. eurysm— requiring a life-saving operation. “I can’t really think in the last decade But her recovery from a relatively new what bigger impact there has been in and minimally invasive surgery called medicine than endovascular stents. This is endovascular aneurysm repair (EVAR) one of the situations where the treatment was so rapid that by the party, “she looked was almost as bad as the disease,” says Dr. like a million bucks,” says her daughter, Papia. Dr. Sue Belo. EVAR surgery has improved mortality Things could have turned out very rates for those who can’t handle open differently. In December, Margo’s family surgery, says Dr. Andrew Dueck, a Sun- doctor ordered a routine chest X-ray. nybrook vascular surgeon who conducted “She had no symptoms at all at that time,” Margo’s operation with Dr. Papia. In says Dr. Belo. But fortunately, the doctor abdominal aneurysms, the EVAR mortality discovered an aortic aneurysm (a bulging rate is around two per cent, compared of the main blood vessel that carries blood with four for open operations; in the chest from the heart to the rest of the body) area, it is less than 10 per cent, compared in her chest. Aortic aneurysms are most with up to 25 per cent for open surgeries, commonly found in the abdomen, but can he says. also develop in the chest or other portions Both physicians agree that while of the aorta. improved mortality rates are a positive Luckily for Margo, her daughter Sue is outcome of EVAR, a much quicker recov- an anesthesiologist at Sunnybrook who ery time is also a large benefit. Typical works with Dr. Giuseppe Papia, a vascular open surgery means a seven or eight hour and endovascular surgeon at the Schulich operation and six weeks’ to three months’ Heart Centre. recovery, while EVAR surgery takes an “I asked him what we should do,” says hour or two and patients are out of the Dr. Belo. “And he suggested we make an hospital within days. appointment for my mother to be assessed “As a surgeon who does it both ways, it in the Vascular Clinic. At which point I really is a staggering difference. When you was very reluctant—the treatment for this think you have accomplished the same is the open repair… it’s a huge surgery, thing, and two days after the operation the particularly at the age of 85,” Sue says. patients’ biggest problem is they don’t like Still, she was hopeful her mother would the coffee,” says Dr. Dueck. be a candidate for the less invasive EVAR Although EVAR is costly, (stents are Small incisions are made in the groin procedure. $10,000 to $15,000) the results — patients to access the femoral (thigh) artery At Sunnybrook, Dr. Papia discovered who survive and continue their normal that the aneurysm was 9cm — extremely activities as usual —aren’t measurable, A guide wire is inserted into the femoral large. “Usually in the chest we fix them say Drs. Papia and Dueck. artery until it reaches beyond the aneurysm in the aorta when they get to 6.5 cm because that’s a Wayne Yorke, 68, of Newmarket, Ont., very high chance of rupturing. [Nine] is another patient of Dr. Papia’s who had An X-ray or angiogram using a dye to take images a big deal.” If an aneurysm ruptures, the Margo Balanyi, 86, had an aortic aneurysm that could have been fatal. EVAR surgery a year ago, says it’s made a of the blood flow in the artery help guide the wires into place mortality rate is 85 percent. huge difference. “The day after, I was up By this point, Dr. Belo’s mother was ner- walking the halls.” His procedure went so A stent graft, a tubular device made of fabric supported vous. “[I was] very scared. I thought this replacing the ballooning part of the aorta found that Margo was a good candidate well, he was even able to return to work by metal, is fed along the wires to the site of the aneurysm was the end of my old age,” Margo, whose with a graft. But such a massive operation for EVAR. within two weeks. first language is Hungarian, said through is risky for the elderly or those who have She underwent the hour-long procedure Margo has been able to get back to Doctors use the imaging to decide exactly where to deploy the device her daughter. cardiac or respiratory problems because last Dec. 6, during which the doctors used spending time at her Hungarian club and Open surgery—still the most common it can cause bleeding, heart attack, kidney wires threaded through her femoral arter- seeing friends and family. “I am stronger The stent graft is placed across the aneurysm and keeps the aorta way to fix aortic aneurysms—requires failure, infection and death. ies to put a stent graft in her aorta so that and I have more energy … I go to the open. The blood flows through the stent graft rather than the making a large incision in the belly and Fortunately, doctors at Sunnybrook blood that was flowing into the aneurysm hairdresser and have my nails done.” aneurysm, which depressurizes it and prevents it from rupture

sunnybrook 40 spring 2011 | heart disease | The all-clear degrade and break down. Pioneered by a Sunnybrook specialist, a new treatment that unclogs blocked arteries is giving new “Collagenase enzymes are very specific life to cardiac patients in that they target collagen and break down its structure,” explains Dr. Bradley Strauss, chief of the Schulich Heart Centre at Sunnybrook and leader of the collage- nase trial. Dr. Strauss, who is also the Reichmann Chair of Cardiovascular Sciences, has been experimenting with this application of collagenase since the 1990s. In addition to proving the enzymes are effective in softening plaque in coronary arteries, he

“I never gave up on collagenase because I always felt that it made sense.”

Dr. Bradley Strauss Schulich Heart Centre

has also produced a grade of collagenase safe for use in humans. In 2008, Health Canada gave him the go-ahead to do his first patient trial. The day after John received his dose of collagenase, he was back in the operating room at Sunnybrook for an angioplasty. for what they have done,” he says. “I hope This time, the guidewire and catheter they can treat more people.” made it through easily. That’s exactly what Dr. Strauss and the “For the last two years I could not take people at Sunnybrook are hoping for, too. two steps without having angina pain, and Making collagenase available to more I was basically on medication all the time people, says Dr. Strauss, would reduce to help me cope with the pain,” says John. the need for bypass heart surgery and im- “Now two days a week I’m working out prove the quality of lives of people living for an hour-and-a-half each day, running with heart disease. Dr. Bradley on the treadmill, doing bike work, lifting “All of the patients in the trial had previ- Strauss (top) has John Balkwill: ‘It’s like a new life now, a totally new life.’ weights. ously had failed angioplasties,” he says. pioneered the use “I can basically do anything I want. It’s “Without collagenase, the only recourse of collagenase to like a new life now, a totally new life.” for some of them might be bypass surgery, unblock arteries. John Balkwill sees piles of snow when he Yet today, John is back to doing most the plaque that builds up and blocks the John isn’t the only success story to while those who aren’t good bypass can- looks out the window. But even though of the things he used to do before heart arteries of people with coronary heart emerge from the collagenase patient trial. didates would be put on medication and spring is still a few weeks away, he’s disease disrupted his life. He’s gone back disease. During an angioplasty, doctors try Next-day angioplasties on 13 of the first 15 would have significant limitations to their already planning a reunion with his golf to work at the business he co-owns, a to push a guidewire through the plaque to patients – Dr. Strauss is still finalizing his lives.” clubs. company that provides electronic controls make way for a catheter with a small bal- findings on the other five patients – were The years leading up to the patient trial “I haven’t played golf for close to two for greenhouses. He’s exercising. He’s got loon on its end. successful, with the plaque softening were not always easy, says Dr. Strauss. years,” says John, a resident of Leaming- a life again – all because of a small dose of Once the catheter is positioned prop- enough to let the guidewire through. There were many times when he was ton, Ont., who was referred to Sunny- an enzyme called collagenase. erly, the balloon is inflated, causing it to Mohsen Ghatavi is another one of these stuck on a problem, unsure about how to brook last year after an angioplasty pro- Last November, John became part of a press against the walls of the artery and success stories. After a year of sporadic go forward. cedure – one of many he has had over the clinical trial at Sunnybrook that saw col- creating blood flow. But in certain patients chest pains – one episode happened while “But I never gave up on collagenase last decade – failed to unclog the arteries lagenase – a fluid commonly used in labo- – like John – the plaque is so hard the he was on the highway driving to work – because I always felt that it made sense,” to his heart. “In fact, I haven’t been able to ratories to prepare cell cultures – injected guidewire can’t penetrate it at all. This is a Mohsen is pleased to report that he is now he says. “So to see it work on patients and do much of anything for the last two years via catheter into the blocked arteries of 20 life-threatening situation. pain- and worry-free. to know that we’ve been able to make a since I lived in pain every day and had patients. Collagenase works by softening the “I feel great and I want to thank Dr. difference in these people’s lives – well, been mostly bedridden.” Collagen is the primary component in collagen in this rigid plaque, causing it to Strauss and his nurses and research team it’s just amazing.”

sunnybrook sunnybrook 42 spring 2011 spring 2011 43 | giving back | Mario’s heartfelt song Jazzman and real estate businessman Mario Romano reveals why Sunnybrook’s ‘beautiful people’ struck a chord with him

aspin ridge

Businessman, jazz pianist and generous Sunnybrook donor, Mario Romano.

Every time Mario Romano puts his fingers an interview from his office in Markham, Real estate became his world. on the keyboard, he’s reaching for more Ont. Problem was, he couldn’t afford it. To say he was successful would be a se- than music. “It’s the hope, as you’re get- A friend had a sure thing in real estate rious understatement. He now is president ting into the piano, getting into the music, development, so Mario borrowed $6,000 and founder of the Castlepoint Group of starting to improvise. It’s reaching for that from his father to invest. But the sure real estate development companies and a moment of divinity that happens once in thing was, he recalls, “a lemon.” dedicated philanthropist who counts Sun- a blue moon. Where you fall into a space, “I could not face my father and tell nybrook as one of his causes. you fall into a world of just sheer beauty.” him.” Frantic to salvage the deal, Mario His commitment to Sunnybrook came It’s a search he gave up for 30 years all went to the mayor of the municipality several years ago, after he had a stent im- because of a Steinway piano. where the land was and learned what he planted to unblock an artery. “I loved how He was playing the jazz clubs in To- needed to make it work. He pulled it off they treated me ... and I saw that they do ronto in the mid-’70s, after studying jazz and got enough back to pay his father, great, great, great work.” Then, he says, composition and performance at Humber buy his piano and head to New York’s he realized he knew some of the board College and York University and classical jazz scene. When he returned to Toronto members and started meeting the doctors at the Royal Conservatory. “My dream was a couple of months later, broke, he knew “and they’re all beautiful people.” to just buy a Steinway piano,” he says in what he needed to do: “I dropped music.” Naturally, he says, “when you bring

sunnybrook spring 2011 45 giving bACK

people together in a situation where some- ther brought home a used one when Mario “When you one’s taking care of you, in a situation was in his late teens. of need, by its very essence you create His father was never happy that Mario bring people communion.” It’s like if you’re hungry and had swapped music for real estate. “He someone feeds you, “you go back and visit always loved me in music, never much together in a them, you bring an apple pie, you bring cared for me in business,” he says. “... something.” One of the last things he did was play the He knows the health care system is harmonica and tell me he always told me situation where under stress and Mario feels a strong need ‘play music.’ ” to give back to the people who take care So, three decades after walking away someone’s taking of him. A donor to the Schulich Heart Cen- from his hard-won Steinway, Mario took tre, Mario arranges to meet with someone his father’s advice to “follow your heart,” care of you, in from Sunnybrook Foundation every time and started practising again. He put a he has an appointment at the hospital. band together and began writing and a situation of Mario, who was born in Buenos Aires arranging music. They started performing in 1951, poured his substantial energy and in the Toronto area and did a tour in Italy need, by its very jazz-born creativity into his businesses last summer. Then, in the fall, the Mario until 2008, when the deaths of his father, Romano Quartet released a CD, Valentina, essence you create Modesto, and, several weeks later, his named for the youngest of his four chil- mother, Filomena, put him back on the dren. He’s working on another album and communion.” musical track. planning an Italian tour in August. “Death,” he explains, “causes funda- Mario now owns 10 pianos, including a Mario Romano mental dialogues.” His father worked in Fazioli grand, but still has his first Stein- construction, but music was his passion way and plays it regularly. In fact, “it’s my and the harmonica his expression. There favourite.” was “every instrument you could think of” So what inspires him to play? “It be- at home and Mario and his three siblings comes a form of prayer,” he says. “... It’s all learned to play. Mario’s instrument a language that has no definition but yet was the accordion – “I still play it once in encompasses ... all truth in the universe.” awhile” – but piano took over after his fa- sunnybrook - cervical cancer

earnest & young letters from our patients Thank you for a life saved We receive thousands of letters each year from patients and their loved ones who have been touched by the care they received. Here is one that, in turn, particularly touched us.

On July 11, 2009, I was airlifted to Sunnybrook after being brutally Lenore Wirth was attacked, strangled and stabbed over 31 times and left for dead. working alone in I received the most incredible care from the surgeons and nurses a clothing store in July 2009 when, at during my stay and although I thanked them personally, I wanted to random, she was contact Sunnybrook with my survival story and let you all know how brutally attacked by a much this hospital means to me and my family. man and left for dead. I am so grateful for living in a city that has such a fantastic trauma She was airlifted to centre. It has been a year and a half later and I have been back for two Sunnybrook, admitted for two weeks, and further surgeries to aid in the repair of my hand. returned for two Each time I have received wonderful care and support from the follow up surgeries. staff at Sunnybrook.

Thank you very much,

Lenore Wirth

sunnybrook 48 spring 2011