WINNIPEG’S HEALTH AND WELLNESS MAGAZINE nov/dec 2012

6 MYTHS ABOUT PHYSICAL ACTIVITY What you need to know about staying fit 10 SECRETS TO HEALTHY EATING Tips for upping the veggies, cutting the sweets and keeping the portions under control

PLUS When baby cries A time to be mindful Travel health insurance Nurse practitioners take on new roles What to discuss with your MD when you turn 50

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23 Table of contents Features 10 secrets to healthy eating Tips for upping veggies, cutting sweets and keeping portions under control 12 Half-century primer What to discuss with your MD when you turn 50 16 Travel insurance primer What you need to know before travelling 16 outside Manitoba 20 Special Report: A Healthy Investment Manitoba Health Research Council marks 30 years of service 23 54

Departments & Columns A Letter from the Winnipeg Health Region Better care, more efficiently 7 Health Beat Nurse practitioners take on new roles 8

Health Headlines A roundup of health research stories 10 Balance 12 A time to be mindful 54 In Motion 6 myths about physical activity 56

Ask a Nurse Hush, sweet baby 58 Recipes Banana bread 62

56

November/December 2012 5 YOUR GUIDE TO THE RISING TIDE OF HEALTH & WELLNESS INFORMATION

November/December 2012 Volume 4 Issue 6 Publisher Winnipeg Regional Health Authority re inFormation please call President & CEO Arlene Wilgosh For mo Regional Director, Communications, Media, Public & Government Relations Jonathan Hildebrand

Editor Brian Cole

Contributing Writers Joel Schlesinger, Liz Katynski, Murray McNeill, Susie Strachan

Columnists Audra Kolesar, Kristine Hayward Laurie McPherson

Creative Director Krista Lawson Photography Marianne Helm Illustrator Krista Lawson

On the Cover Joni Nikolou at the Rady Centre, photographed by Marianne Helm

Editorial Advisory Board Réal J. Cloutier, Dr. Wayne Hildahl, Dr. Michael Routledge, Dr. Peter Nickerson, Lori Lamont, Dr. Michael Moffatt, Dr. Cheryl Rockman-Greenberg, Lynda Tjaden, Ilana Simon

Wave is published six times a year by the Winnipeg Regional Health Authority in partnership with the University of Manitoba and the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

Winnipeg Free Press Publisher Bob Cox Vice-President, Sales Laurie Finley

Advertising/Marketing, Winnipeg Free Press Manager of Niche Products Edith Bonner Phone: 204-697-7389 e-mail: [email protected]

Subscriptions Wave is available through subscription: One year (six issues) for $12.60 ($12+GST) Payment may be made by cheque, money order, VISA, or MasterCard. Did you miss the last To subscribe, phone: 204-697-7598 Or, send an e-mail to: [email protected]

Wave Editorial Office ? Winnipeg Regional Health Authority 650 Main Street Pour une version française Winnipeg, MB R3B 1E2 téléphonez au 926.7000 Phone: 204.926.8144 Rendez vous à notre site Web: e-mail: [email protected] www.wrha.mb.ca/lecourant

A French-language version of this magazine is available online One year (six issues): $12.60 at www.wrha.mb.ca/lecourant. For information, call 204-926-7000. The information in this magazine is not meant to be a substitute for Call 697-7122 or professional medical advice. Always seek advice from your physi- send an e-mail to [email protected] cian or another health professional regarding any medical condi- tion or treatment. Opinions and views expressed in this publication do not always represent those of the Winnipeg Health Region. This publication may not be reprinted or reproduced in whole or in part without the consent of the Winnipeg Health Region.

6 WAVE Better care, more efficiently

A Letter from the Winnipeg Health Region Arlene Wilgosh, President & CEO

he global economic recovery is uncertain, and the costly to provide, to reduce reliance on Tprovincial government’s budget is tight. more costly hospital care. Let me explain why this last point is an important one. But even though we are facing some year, we will continue to be guided by Here at the Region, spending is allocated economic and fiscal challenges, the the things that matter most to our patients. along the following lines: public’s expectations of their health This means working to: • About 69 per cent is for acute care. system, and those who run it, remain very • Improve access to our services. • About 16 per cent is for long-term care. high. And rightfully so. • Ensure services are safe and of high • About 15 per cent is for community care. Our job here at the Winnipeg Health quality. Hospital-based care will never, ever Region is to deliver high-quality care as • Reduce wait times for services. vanish. A health system needs hospitals. efficiently as possible. But before I explain • Improve transition among services. However, I believe some services how we are going to continue doing just • Strengthen patient choice. traditionally provided in hospitals can be that, let me provide a bit of background. Safety, access, wait time, transition, and moved into community settings where As I noted at our annual general choice. All of these things are key to a they can be delivered more inexpensively. meeting last month, the Winnipeg Health well-functioning, high-performing health- A recent pilot project illustrates the Region spent just under $2.5 billion to care system, and it’s not unreasonable for point. It involved redirecting patients in provide health care in 2011/12. the public to expect the most from us in need of intravenous antibiotic therapy Of course, much of that money, about this regard. Equally important, however, from Emergency rooms to a community 75 per cent, went to wages and benefits is the need to demonstrate value in the facility for the service. As a result, the for the nurses, doctors, health-care aides, services we provide. We need to ensure average number of scheduled IV visits allied health staff, cleaning staff, security that patients and taxpayers are getting in Emergency rooms decreased 88 per guards, and others who keep the system good, or better, value for their dollar. cent. That freed up time, space, and staff operating. About seven per cent went Essentially, that means finding ways to for Emergency departments to deal with to medical supplies, and about six per deliver safer, higher-quality or additional emergency cases. cent was spent on direct patient support services at the same or lower cost. The Bell Hotel on Main Street is items, such as linens, laundry and food. To achieve this goal, we must first look another example of where we’ve been Other costs include pharmaceuticals, for ways to improve the operation of the able to provide care in the community amortization, and other assorted costs. system while reducing waste, through that reduced pressure on hospitals and The Region’s administrative costs, business process re-engineering and Emergency rooms. With our partners at which are among the lowest in the the application of LEAN management CentreVenture, the Main Street Project country, according to the Canadian practices. In other words, we must make and Manitoba Family Services and Institute for Health Information, amounted our services better and cheaper, but not at Housing, we helped turn the Bell into a to 4.22 per cent in 2011/12. That the expense of patient care or staff. home for a dozen or so of our most at-risk includes corporate costs of about 2.24 per Second, we must be innovative in clients. Since moving into the Bell, there’s cent, which are well below the 2.99 per looking for ways to do things better been a 70 to 80 per cent drop in their cent corporate cost ceiling legislated by at lower cost, taking advantage of use of ambulances, Emergency services the province. opportunities to maximize the talents and encounters with police under the What does $2.5 billion buy in terms of and skills of our workforce. A good Intoxicated Persons Detention Act. health care? Here are some examples: example of this is our effort to use nurse Of course, there are other ways to • About 287,000 Emergency room visits. practitioners to deliver primary care in control costs. A healthy community also • About 109,000 visits to urgent care certain situations. As our story on page means fewer people using the health-care centres. eight of this issue of Wave points out, system. We all can take steps to lead • Home care services for more than there is no point in paying a doctor to do healthier lives, a point underscored by the 14,000 people. something that a nurse practitioner can do articles and columns in this magazine. • The delivery of more than 11,000 at lower cost. By taking steps to improve our health babies. Third, we must further improve overall and build additional capacity within the • More than 623,000 diagnostic imaging patient flow across our hospitals to ensure community, we can address some of the procedures, including procedures such patients are not using hospital-based larger systemic challenges that we face. In as CT scans, MRIs, X-rays, ultrasounds resources unnecessarily. doing so, we can also help create a health- and mammograms. And last, we need to strengthen health care system that delivers better value to In planning our budget for the coming services in the community, which are less our patients and to taxpayers.

November/December 2012 7 Photography: Marianne Helm health beat

Primary care FOR ALL

Region supports innovative role for nurse practitioners

By Liz Katynski Nurse practitioner Angela Thable starts her day at the Grace doing rounds on the SSU.

urse practitioners are playing a larger role in Nproviding primary care to patients in hospital and community settings under a pilot project launched recently by the Winnipeg Health Region.

As part of the project, three nurse Department and are stable but not yet Essentially, nurse practitioners are practitioners are rotating through the Grace ready to go home. registered nurses with an advanced Hospital and St. James Clinic, providing Noreen Shirtliff, Emergency Program practical designation that requires a primary care services that patients might Director at the Grace, says by moving master’s degree, significant clinical otherwise receive from a family physician. patients to the care of nurse practitioners practice experience, and active registration The project – one of the first of its kind in the SSU, the hospital is able to provide through the College of Registered Nurses in Winnipeg – is designed to increase the them with non-acute care until they are of Manitoba. They practise autonomously number of primary care providers in the ready to go home. This improves patient and carry their own patient loads, referring city, according to Pat Younger, Community flow by freeing up beds in Emergency. clients to other specialists as required. Area Director for the Winnipeg Health In addition, nurse practitioners are The nurse practitioner’s scope of practice Region in St. James and Assiniboine South. providing primary care to patients visiting includes requesting diagnostic tests, The province has pledged to ensure all the St. James Clinic. They see patients diagnosing illness, prescribing medicine, Manitobans will have access to a primary much as a family physician would, and performing some procedures and ordering care provider by 2015. make referrals to specialists as required. interventions. It is estimated the nurse practitioners The trio – Angela Thable, Patty The Grace Hospital project started have provided primary care to over 90 Sudermann and Dianne Fitch – will with the nurse practitioners completing patients at the St. James Clinic since they relocate to the new ACCESS St. James an orientation in both the hospital and began their training in the fall of 2011. when it opens on the grounds of the Grace community last spring. The short-stay unit “Now, many more people have the care Hospital in the near future. at Grace opened in July 2012. and support of a primary health provider,” Historically, the role of primary care Nurse practitioner Angela Thable starts says Younger. “That’s very positive.” provider has been filled by physicians. In her day at the Grace doing rounds on the At the Grace, nurse practitioners are recent years, however, many jurisdictions SSU. She then consults the Emergency providing care at the newly-established, throughout North America have been using Department physician to determine which 10-bed short-stay unit (SSU) for patients nurse practitioners to provide some of the patients should be transferred to the unit. who have been treated in the Emergency services normally provided by physicians. Every day she meets with occupational

8 WAVE Photography: Marianne Helm

therapists and physiotherapists, the charge nurse, social worker and geriatric rehabilitation clinician to make a plan for patients on the SSU. Thable spends Healthy Reading her afternoon in community practice at St. James These titles have been recommended from thousands of health Clinic, where she sees patients from the Grace and books. For more health and wellness reading recommendations, other community clients. She ends her day doing please visit the online community at www.mcnallyrobinson.com, follow-up at the hospital. or visit the McNally Robinson bookstore at the Grant Park Shop- Thable says nurse practitioners have an important ping Centre. role to play in enhancing access to care. “Nurse practitioners have flexible schedules and Menu Confidential, Megan Ogilvie can try and deal with all of (a patient’s) issues in one visit. We offer patients alternatives and encourage This book tells the nutritional truths about them to be their own advocates,” says Thable, who Canada’s most popular foods, from delicious has a background in Emergency care. sit-down dinners to quick meals from the A major challenge is educating members of the grocery store to tasty treats from the drive- public about the role of nurse practitioners and their thru. You’ll find detailed analysis of more than scope of practice. “We are pioneering a new role at 150 favourite foods including grab-and-go the hospital,” says Thable. “We have to clarify it. We snacks and Canadian classics like butter tarts are not doctors’ assistants. We don’t do bedside care and poutine. Here are your best bets (as like the nurses.” well advice on what to avoid) for breakfast, Thable takes pride in her work. For example, she lunch, dinner and snacks. met one man who had not seen a doctor in a decade and came to Emergency because he was feeling Critical Decisions, Peter A. Ubel dizzy. Since that time, he has had a number of issues. “We diagnosed him with heart failure, put him on Dr. Ubel has been on both ends of the medication and referred him to a cardiologist. He’s stethoscope, and in this book, he shows how doing fabulously. We’re so glad he came to us.” patients and doctors can learn to become The nurse practitioners are a great addition to the partners and work together to make the right hospital team, adds Shirtliff. “There has been a lot of choices. From choosing to get surgery, to Nurse practitioner Angela Thable starts her day at the Grace doing rounds on the SSU. interest in our model. An integrated model of acute and community care is an attractive option. It’s a very discussing the side-effects of a blood pressure exciting initiative and it’s great to be a part of it.” medication, readers can discover the tools to improve communication, understand the issues, and make confident decisions for their future health and happiness. Nurse Practitioners The First 20 Minutes, Gretchen Reynolds

Nurse practitioners are independent primary and This book helps both weekend warriors acute health-care providers who: dedicated to their performance and readers • Assess your health who simply want to get fit gain the most from • Request diagnostic tests any workout. With the latest findings about • Diagnose illness the mental and physical benefits of exercise, • Prescribe medication personal stories from scientists and lay people • Perform procedures alike, as well as research-based prescriptions • Order interventions for readers, Reynolds shows what kind of exercise, and how much, is necessary to stay healthy and be fit.

Clinic accepting patients The International Traveler’s Guide to Avoiding Infections, Charles E. Davis Do you live in St. James/Assiniboia South and need a primary care provider? The St. James Community With precise, simple explanations, the author Clinic is now accepting patients. Call 204-940-8724 for offers the latest recommendations for healthy more information. travel planning to help international travellers avoid infections wherever they go. He describes the precautions travellers can take, including, pre-trip travel clinic visits; Learn more essential immunizations and medications; Get information about the nurse practitioner’s scope travel insurance and medical kits; safe food of practice by visiting the College of Registered and water practices; personal protection Nurses of Manitoba website at: www.crnm.mb.ca measures; and post-trip checkups.

November/December 2012 9 The following is a brief list of stories written and produced Health Headlines by the staff of HealthDay, a leading source of information on health research. DINNER Beans a boon for people with diabetes Study finds eating more legumes, such as beans, lentils and chickpeas, can lower blood sugar, blood pressure People with Type 2 diabetes can see better, but – and this surprised us – it had an improvement in both their blood sugar a significant effect on blood pressure,” he levels and blood pressure if they add beans said. and other legumes to their diet, Canadian Exactly why legumes have this effect CONVERSATION researchers report. on blood sugar and blood pressure isn’t Chickpeas, lentils and beans are rich in known, Jenkins said. The effect is most protein and fibre, and these may improve likely due to the protein, fibre and minerals heart health. Because they are low on the they include, he noted. glycemic index, a measure of sugar in Jenkins recommends adding more foods, they may also help control diabetes, legumes to the diet. “They will do well for the researchers explained. you,” he said. “They will help you keep DIFFICULT? “Legumes, which we always thought your blood pressure down and your blood were good for the heart, actually are good glucose under control, and help you keep for the heart in ways we didn’t expect,” your cholesterol down.” said lead researcher Dr. David Jenkins, the The report was published online Oct. 22 Maybe it’s time to get your hearing checked Canada Research Chair in Nutrition and in the Archives of Internal Medicine. Metabolism at the University of Toronto. To read the complete story, visit www. Among people with diabetes, “Not winnipeghealthregion.ca/healthday and before the holidays. only did their glucose control become search: Beans a boon

Short bursts of intense exercise can fight weight gain Hearing loss affects one in two people over the age of50. Are you one of them? Sprint-interval training burns up to 200 extra calories daily, researchers say Call today to arrange your hearing screening and ask us about Lyric, the first New research finds that just a few minutes of is used by athletes to improve performance. completely invisible, extended wear hearing aid. intense activity interspersed between less intense It seems like a reasonable strategy for weight stretches of exercise will burn excess calories all maintenance – and for those days when you just day long. can’t get in a full workout, the researchers said. Men participating in a small study burned “The harder you work, the more calories you connecthearing.ca an additional 200 calories a day by doing a will burn per minute,” said study leader Kyle workout for less than 25 minutes that included Sevits, a researcher at Colorado State University a few minutes of hard, intense exercise on a in Fort Collins. stationary bike, spaced between less intense To read the complete story, visit www. activity. winnipeghealthregion.ca/healthday and search: We are proud to recognize our national partners. The technique, called sprint-interval training, Intense exercise

For kids, eating out = more calories Healthier restaurant choices and eating at home are ways to keep calories under control, experts say Whether at fast-food places or full- food choices, rather than one that service restaurants, kids who eat out are promotes unhealthy food choices,” she likely to consume more calories, sugar, fat added. VAC,WCB accepted. and salt, researchers from the University of “We also need to change the We offer a shuttle service for all our customers. Illinois at Chicago report. environment in the restaurant so that there They also noted that kids are eating out won’t be harmful effects on diet,” Powell more, particularly in fast-food restaurants, said. This would include not offering free Winnipeg - Country Club* 130 - 3025 Portage Ave. 204.885.6422 which has helped drive the obesity refills on soda and increasing healthier epidemic among children and teens. food choices, she explained. Winnipeg - McIvor Mall 1795 Henderson Hwy. 204.582.3968 “Every day, about 40 per cent of U.S. The report was published in the Nov. 5 children eat at these restaurants,” said online edition of the Archives of Pediatrics Winnipeg - Regent 130 - 701 Regent Ave.W. 204.942.7646 lead researcher Lisa Powell, director of the & Adolescent Medicine. LYRIC available at noted* location. university’s Health Policy Center of the To read the complete story, visit Institute for Health Research and Policy. www.winnipeghealthregion.ca/healthday ®CAA and CAA logo trademarks owned by, and use is granted by, the Canadian Automobile Association. ShowYour Card & Save® is owned by, and use is granted by, the American Automobile Association. “We need policies that promote healthier and search: Eating out=more calories

10 WAVE DINNER CONVERSATION DIFFICULT? Maybe it’s time to get your hearing checked before the holidays.

Hearing loss affects one in two people over the age of50. Are you one of them? Call today to arrange your hearing screening and ask us about Lyric, the first completely invisible, extended wear hearing aid.

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We are proud to recognize our national partners.

VAC,WCB accepted. We offer a shuttle service for all our customers.

Winnipeg - Country Club* 130 - 3025 Portage Ave. 204.885.6422 Winnipeg - McIvor Mall 1795 Henderson Hwy. 204.582.3968 Winnipeg - Regent 130 - 701 Regent Ave.W. 204.942.7646 LYRIC available at noted* location.

®CAA and CAA logo trademarks owned by, and use is granted by, the Canadian Automobile Association. ShowYour Card & Save® is owned by, and use is granted by, the American Automobile Association. 10 SECRETS TO EATING HEALTHY

Winnipeg dietitians share their tricks for upping the veggies, cutting the sweets and keeping the portions under control

By Susie Strachan 1 Start your day right y the very nature of their Marni Robert believes it is She points to a study that looked Bwork, dietitians should important to start the day off with a at those who eat once or twice a day good breakfast. as compared to those who eat three be among the healthiest “There’s a lot of research showing times a day. The study concluded eaters on the planet. Seems that kids who eat breakfast perform that “those who eat less often, often better in school. They have more eat more calories overall,” she says. logical, right? energy and can concentrate more,” Robert says a healthy breakfast After all, these folks know Eating Well with she says. should include something from three Canada’s Food Guide, the bible of healthy Although some people say they to four food groups: dairy, grains, eating, inside and out. skip breakfast because they are not protein and fruit. It is important to Of course, dietitians are not just hungry or feel they don’t have time note that those who skip breakfast knowledgeable about food, they’re also big in the morning, Robert says that are missing out on certain nutrients. fans of cooking and eating. missing the first meal of the day is A typical breakfast usually includes As Colleen Rand, Manager of Clinical not a good idea. “It’s important to get a serving of milk – which contains Nutrition Community for the Winnipeg Health in the habit of eating breakfast,” says calcium and Vitamin D – along with Region, says, dietitians believe food should be Robert, a clinical dietitian with the fruit and protein. used “to express love and friendship, continue Winnipeg Health Region. Robert has a tip for those who feel tradition, preserve culture, nourish our bodies Some people may feel that rushed in the morning. She powers and spirit, celebrate, grow and heal.” they can lose weight by skipping up her day by making a smoothie Naturally, it helps if you can do all these breakfast. But Robert says this is with milk, yogurt, a banana and a things in a way that is healthy. With that in unlikely to happen. quarter cup of flax or hemp seeds. mind, we asked ten Winnipeg Health Region She says those who do skip “Some people find it’s faster to put dietitians to share their secrets for eating breakfast may find themselves that in a go-cup than making a meal healthy. In the pages that follow, they will overeating at lunch or snacking with whole-wheat toast, poached share their insights into how you can eat well constantly through the evening, eggs, a couple of slices of orange and and eat healthy at the same time. usually on food that is not healthy. a cup of milk.”

12 WAVE 2 Homecoming queen There’s a danger zone in her day day for eating mindlessly, be it just that Colleen Rand used to fall prey to: before dinner, late at night or even in a time in late afternoon, when she’s the middle of the night. “People eat hungry, and hasn’t yet made dinner. foods that are that are easiest when That’s when she’s most likely to eat, they are really hungry or a lot of mindlessly, foods that are high in sugar something they really like.” or fat, like salty taco chips and salsa. In order to give up her title as “I’m a ‘homecoming queen,’ which homecoming queen, Rand made a means I’m so hungry at the end of plan. She has a small snack at 4 p.m. my work day that the minute I’m in while still at work. “I might eat some the door at home at 5:30, I’m looking cheese and crackers, or a handful for something quick to eat,” says of nuts, a carton of yogurt or some Rand, Manager of Clinical Nutrition apple slices,” she says. “It quells the Community for the Winnipeg Health hunger, which means I’m not eating Region. “And it’s usually too much unthinkingly when I get home. Same of the wrong thing.” Her secret is to goes for when I’m watching TV, or identify the most problematic time of under stress.”

4 Sleight of hand There’s a bit of food magic amount in a short, wide glass, going on at Andrea Rodrigue’s kids invariably pick the taller house. glass. “It’s all about perception. She uses a simple illusion Kids think there’s more liquid in to convince her family they’re the tall glass, and they also think eating lots of food, when that more is better.” actually they’re getting portions Rodrigue recommends the that are perfect for their body book Mindless Eating by author size and condition. Brian Wansink, which talks Her secret? She serves dinner about plates and portion sizes, on luncheon plates. The smaller and how to change eating habits plates make food portions look in slow, thoughtful steps. 3 Power-crunching bigger. “I compared the size of “It comes down to knowing my dinner plates to ones I had ahead of time, and a bit of When Jean Helps realizes she’s short on vegetables, she years ago, and found out that planning. Put your food into reaches for a carrot. the dinner plates are bigger small bowls or plates so it Everyone likes carrots, says Helps. They’re a good source now,” says Rodrigue. “If we ate looks bigger. Your plate should of vitamins and fibre, which help reduce your risk of cancer off the bigger plates, we’d be be divided into sections, with and heart disease. They’re good for your eyesight and getting 200 to 500 calories more ¼ protein, ¼ starch and ½ complexion, too. per meal.” vegetables,” says Rodrigue, who “A carrot is portable and easy to serve. Cut it into sticks Switching to a smaller plate is is the Site Leader of Clinical and serve with a dip. While you’re at it, add other vegetables, part of her philosophy that the Nutrition at Victoria General like red pepper and sugar snap peas. Even the fussiest of kids best diet is the one you don’t Hospital. “And if you finish will go for that,” she says, noting that a daily serving of an know you’re on. eating, and are still hungry 20 orange vegetable provides needed nutrients, and a carrot fits Using dinnerware to control minutes later, then eat a little the bill (as do sweet potatoes and squash). the amount of food you eat is a more, preferably vegetables.” You may be surprised at how much you enjoy the taste hot topic for dietitians. Rodrigue and texture of other vegetables you haven’t yet tried. “People says if you offer kids 250 mL of don’t eat enough vegetables, especially the colourful ones milk in a tall, thin that give you the most nutritional bang, like carrots, tomatoes, glass and the same spinach and sweet potatoes,” she says. Other ways to fit more vegetables into your daily routine include tricks like chopping spinach and adding it to spaghetti sauce. The spinach adds to the sauce and you don’t even know it’s there, says Helps, Regional Manager of Clinical Nutrition, Long Term Care Sector. “Another idea is to add cauliflower when you’re making mashed potatoes. This way, you get two vegetables in one dish.” Helps always keeps frozen vegetables on hand, like carrots, peas and spinach. She likes these better than canned vegetables, which contain extra sodium. Frozen veggies can be added to stews, soups and stir-fries.

November/December 2012 13 5 Fibre fills you up The question of whether the cup is The reason is that people look at the half empty or full is moot for Alison daily requirement, and count up how Cummins. many vegetables it would take to hit That’s because half a cup is all she that goal. For example, it would take needs to make her happy – half a cup 2.5 cups of carrots to get the same of fibre, that is, usually in the form of amount of fibre as a 1/2 cup of high- high-fibre cereal added to her regular fibre cereal. Only Bugs Bunny would cereal in the morning. be thrilled to eat that much. That half-cup of bran gives her 12 “So it seems rather daunting, until grams of fibre, which is almost half the you know my secret,” says Cummins, daily requirement for a woman. adding that the roughage in fibre does “Women are supposed to get 25 wonderful things for your digestion and grams and men are supposed to get 38 bowel health, keeps cholesterol at bay, grams of fibre a day,” says Cummins, and a high-fibre diet helps with colon Regional Manager, Manitoba cancer, among other health concerns. Partnership Dietetic Education Program “Fibre also fills you up, so you’re not with the Winnipeg Health Region. hungry that soon after eating it.” “Most of us fall woefully short.” 6 Follow the clues

Just like a sleuth in a whodunit out sometimes misleading information about looking for clues, Kathleen Richardson what the food is supposed to do for you, has been known to take a magnifying says Richardson. glass to the grocery store. “Beware a product that boasts. She’s searching for clues to reveal the Marketing can make you think a bran true offenders: packaged and canned muffin is high in fibre and low in fat, but foods that are high in salt, sugar and fat. really, that muffin is also full of sugar.” To do so, Richardson reads the labels on To avoid this, read the percentage chart all cans, boxes and plastic wraps. on every label, she says. An important “One of the most startling places you’ll first step is to look at the serving size, find high levels of sodium – salt – is in and compare it to what you’d normally ready-to-eat foods, like frozen dinners. eat. For example, if you like to eat four I once saw a package of frozen wonton cookies, but the serving size is listed for soup that had 54 per cent of the daily two cookies, you’re getting two times suggested sodium content in it,” says everything on that nutrition facts list. Richardson, a Chief Nutrition and Food “You want to pick items that have more Services Officer with the Winnipeg vitamins, more fibre, more calcium and Health Region. “That soup went back on iron,” she says. “The facts list also is a the shelf.” guide based on the average adult calorie Labels give you information about the intake, which you should be counting, in ingredients, a nutrition facts table, and order to help yourself meet your goals.”

7 Step away from the food

Just like in real estate, location means the cookies and chips out of sight, hide the everything when it comes to arranging your candy dish and rearrange the fridge so the food at home, at work, and even where you kolbasa is at the back of the shelf. like to party. “Cut up carrot sticks, and put them in “It’s true,” says Nancy Doern-White. “If bowls in the fridge with a little water, so you stand within arm’s reach of the goodies you see them when you open the door. Put on the buffet at a holiday party, you’re out bowls of cherry tomatoes, cucumbers, going to find yourself eating mindlessly. So etc. It’s like marketing. You tend to eat what you have to position yourself away from you see first, what’s conveniently at hand,” the food. Put some treats on a plate, and go says Doern-White, the Lipid Clinic Dietitian find a good conversation to join. Or else at the I. H. Asper Institute at St-Boniface you’re going to eat more than two times Hospital. what you normally would.” The same goes for the office. Keep a “Location, location, location” is Doern- supply of apples and sugar snap peas on White’s mantra for setting up her home and hand, and avoid that trip to the junk food office for food success. Clean your house machine, she says. “I’m not saying never by getting rid of trigger foods that you eat treats, but to set yourself up for success crave, and restock with healthy treats. Put through locating the healthy food at hand.”

14 WAVE 9 Sporting strategy As your workout ends, the unusually tired for the next recovery clock begins to tick. few days. “Eating a snack full That is when a quick snack of protein, carbohydrates, and can have a major impact on fluids, like ½ cup of berries restoring your body’s energy and cup of chocolate milk, supply, repairing and building within 30 minutes of finishing muscle, and losing fat. your exercise is the best way Jeremy Amman says that to help rebuild, refuel, and your body begins to deplete rehydrate your body,” says its nutritional stores during Amman, a clinical dietitian at moderate- to high-intensity the Health Sciences Centre. activity lasting more than 20 Chocolate milk really is a minutes. This can be during post-exercise wonder food, 8 Slow it down a lunchtime exercise class, he says. “It is not only an a brisk evening walk, or a excellent source of protein, When life gets too rushed, stomach to signal your brain pick-up hockey game. carbohydrates, and fluids, but Brenda Hotson slows down that you’re full. A lot of Your carbohydrate stores also contains calcium and and savours the food on her times, you don’t realize your are burned for energy, muscle Vitamin D for bone health, plate. stomach is full, especially if proteins are damaged, and B-vitamins for producing Eating slowly not only you finish a big meal in just a fluids and other nutrients energy, and sodium and allows her to taste the few minutes, says Hotson. are lost in sweat. Improper potassium which are important flavour, but also tune into her She loves the slow food refuelling can cause sore nutrients lost in sweat,” says body’s messages about when movement, which was born muscles and make you feel Amman. she’s full. in reaction to fast food served “By eating slowly, I often by restaurant chains. Not don’t finish everything on only does the slow food my plate, especially when I movement encourage people go out to a restaurant,” says to take time when cooking, Hotson, Regional Manager but it encourages them to of Clinical Nutrition, Acute use fresh ingredients and eat Care, for the Winnipeg meals with their family. Health Region. “I have four boys, and we “We’re such a rushed eat as a family as much as society. So when we eat in we can,” says Hotson. a rush, we lose track of our “But instead of eating huge hunger, and cannot tell when meals, we take our time and we’re full.” eat realistic portions.” It takes a while for your

10 Bottoms up Making healthier drink choices is a small empty calories that are void of the nutrition change that can make a big difference to needed to stay healthy. “Some drinks have your health. as many calories as a full meal,” she says. The truth is many drinks contain a fair As a result, D’Avanti suggests that people amount of sugar, which means they also try to choose drinks with no added sugar, pack lot of calories, says Angela D’Avanti, like water or milk. Water is the refreshing Regional Manager, Operations with the and guilt-free “bottoms up,” she says. “If Winnipeg Health Region’s Nutrition and you hate plain water, add a slice of lemon Food Services. or lime or try sparkling water,” she says. Dietitians refer to the sugar found in It’s also good idea to carry a water soft drinks and the like as “added sugar.” bottle, given that women need two litres of Most people should have no more than water and men need three litres of water 13 teaspoons of added sugar per day, says each day. D’Avanti. Of course, this does not mean you need But it doesn’t take long for the added to stop visiting your barrista. Most coffee sugar to add up. “For example, a can of shop favourites can be made with low-fat pop contains 10 teaspoons of sugar and milk and sugar-free flavouring. D’Avanti, specialty coffee with syrup and whipped for example, says her favourite coffee shop cream can contain 16 teaspoons of sugar,” drink is an “Earl Grey, sugar free vanilla, she says. The problem is that these are skim milk latté.

November/December 2012 15 Half- century health primer 7 things to discuss with your doctor when you turn 50

By Joel Schlesinger

f you’ve recently turned 50 – or are about to hit Ithe half-century mark – it’s entirely likely the spring chicken feeling that has fuelled your lifestyle over the last five decades is losing a bit of its lustre.

As much as we’d all like to think we’re 50-year-olds know at least one peer who forever young, sometimes the old bones – has already suffered heart disease or the aches and pains – have something else battled cancer. And at 50 and onward, AN APPLE A to say about the state of your body. we’re increasingly at risk of finding DAY KEEPS… It’s also likely your doctor will have ourselves in a similar situation. Boyd says something to say about your overall the simple fact is humans are more likely health, too. to fall ill as they age. First and foremost, good health “Fifty is the magic age,” says Dr. Yet awareness and prevention are two begins by taking good care of ourselves. Jamie Boyd, Medical Director for family very good weapons in the fight against the This means eating right and exercising medicine at the Winnipeg Health Region. ravages of age and disease. regularly. It’s a platitude, but this advice is “It has been sort of notoriously picked as And at the front lines is your family among the best prescriptions a doctor can a time for a wide variety of screening tests physician, who will focus on a number of write, Boyd says. and other sorts of physical exams to check potential trouble spots. Here’s a look at Eating a balanced diet that’s high in for chronic diseases.” a few of the health issues you should be fresh fruits and vegetables and low in salt, Although it is just a number, most discussing with your doctor. saturated fats and processed sugars has

16 WAVE been shown to help prevent many cancers, usually go hand-in-hand with a lack of kidneys at around age 50, too, Boyd says. cardiovascular disease, osteoporosis, physical activity. “They’re doing tests called the EGFR, or dementia and Type 2 diabetes. It’s also “The more we read and learn about estimated glomerular filtration rate.” been shown to help reverse some of the exercise and its value at any age, It measures the level of creatinine, a effects of these illnesses for individuals regardless of medical condition, it makes a waste byproduct of the body. who suffer from them, he says. huge difference in outcomes,” he says. “The test determines the function of But many people, once they reach 50, It actually wouldn’t be overstating things the kidneys, and we really start testing are still living in the past when it comes to to say that regular exercise is a “fountain between 50 and 55 in men and women their lifestyle. of youth,” and most people simply aren’t who are at risk because they’ve had “They overeat and over-drink or over- taking enough sips to stay forever young. diabetes or hypertension for years.” smoke and they think they can get away The latest data shows that if you want with it like they’re 19 years old. But if to maintain optimal health, you need at you’re doing it from when you’re 19 until least 150 minutes a week of moderate to you’re 50, it’s going to catch up with you,” strenuous exercise, he says. CHECK-UPS he says. “The real issue is everything in “That’s considered to be the minimum FOR moderation.” for maintaining a good level of fitness, but WOMEN That includes alcohol. If you’re having any exercise – even just walking up the more than two drinks a day as a male or stairs instead of taking the elevators – is one drink a day as a woman, you’re at beneficial.” Age 50 and up is the breast cancer increased risk of a whole host of illnesses, danger zone. including stroke, heart attack and a Although some women are diagnosed number of cancers. with the disease before that age, “The odd time you have a few more some even in their 20s and 30s, the is not a bad thing.” But it’s important to CHECKING FOR risk increases with age. And the half- remember that you’re 50, not 20 or 30, THE SILENT KILLERS century mark has largely become the and all those bad habits will likely catch point at which most women receive a up to you – especially smoking. mammogram. “The big thing I always preach to High blood pressure and cholesterol This X-ray of the breast tissue was at patients about smoking is not everybody are often called silent killers. You don’t one time given to most women a decade that smokes gets lung cancer, but if you know you have them unless you’re tested. earlier, but it’s found to be more effective smoke and you have heart disease in your Yet what you don’t know about them is at 50 – often after menopause. family, you’re in trouble,” he says. hazardous to your health. “We don’t recommend it for women less Many smokers may hem and haw about High cholesterol and blood pressure are than 50 years of age unless there’s a strong whether they should give up that “old two leading indicators of cardiovascular family history of breast cancer at an earlier friend” and, in fact, many eventually do. disease. And once we enter our 50s, we’re age,” Boyd says. But it’s often after the damage has been at an increasingly elevated risk of heart “That’s because the density of the breast done. attack and stroke, especially if we also tissue increases with age so the screening “The most effective way for people to have both these traits. But high blood works better, whereas it’s not as useful stop smoking is when they’re in intensive pressure can also be a sign of Type 2 in young women because of the density care after a heart attack,” Boyd says. “But diabetes and kidney problems. of the breast tissue when they’re pre- everything’s out of the barn by then.” “There is a huge percentage of people menopausal.” Another problem with smoking and with hypertension, and Type 2 diabetes is Women should also continue with eating poorly an epidemic across Canada,” Boyd says. pap smears and other checks for signs is they Eating well, regular exercise, not of cervical cancer. “It starts at a much smoking and moderate alcohol younger age, but it’s a screening test that consumption all reduce the risk of high needs to be continued,” he says. “Some blood pressure, high cholesterol and women will think that because they’re past Type 2 diabetes. the child-bearing age they don’t need a The problem is, most of us pap smear anymore, but that’s not true.” don’t realize the connection Regular pelvic exams – every two until we’re age 50 and up – years – are recommended to check for not after we’re diagnosed, Boyd just cervical cancer, but also uterine and says. ovarian cancers because the risk of both “If you’ve been eating fast these cancers increases with age. Exams food for 30 years, smoking should be done until between ages 65 and overdoing it with alcohol, and 74, as well as check-ups for breast then you’re likely going to cancer. And pay special attention to post- have heart trouble earlier than menopausal bleeding. most people, for example.” “If they haven’t had a period for about Furthermore, diabetes often a year, and then they suddenly get leads to heart disease and bleeding, this is not normal and needs increased risk of stroke as well as to be investigated,” he says. “It could be kidney failure. In fact, your family something else other than cancer, but you doctor may start checking out your really need to ask your doctor.”

November/December 2012 17 needed, but it’s fairly basic: a digital rectal indicate good health in other parts of the exam. The doctor inserts a finger into the body, like the heart. The same infectious CHECK-UPS rectum to check to see if the prostate is bacteria that wreak havoc on our gums are enlarged or has a hard nodule that could the same germs that infect heart tissue, he FOR THE MEN be an indication of malignant growth. says. An enlarged prostate, however, is a “And many studies have shown that common occurrence with age and not a there may indeed be a link between bad At age 50, prostate cancer is certainly on sign of cancer either. teeth and heart disease.” the radar for most men, but they shouldn’t “If the patient had a whole bunch Furthermore, as we age we become expect their doctor to necessarily start of symptoms that are suggestive of a more prone to infections, and our mouth screening them for the disease unless screening test – getting up at night to is often an overlooked gateway to disease. there’s a family history of early diagnosis. urinate several times, losing control of the It’s as simple as this: An unattended The PSA test checks for elevated levels bladder, going to the toilet yet not being infection in your gums and teeth can lead of a protein called prostate-specific able to do so – then, you may consider to a widespread, life-threatening infection antigen, which is produced by the prostate doing a PSA and further tests.” in the rest of your body. and is alone a poor indicator of cancer. At In those instances, testing is no longer And generally, by age 50, bad oral one time, it was considered a good way considered “screening.” hygiene really starts to catch up with us, so to screen all men for prostate cancer. But “We call it ‘case finding,’” he says. “A it’s not just a good idea to see your family researchers have found that positive results patient who has these symptoms suggesting doctor regularly, but also your dentist, can lead to unneccessary medical actions. there is a prostate problem and, as Boyd adds. “Once you do a PSA, and it comes back physicians, our job is to find out why.” elevated, you end up having to do a trans- rectal ultrasound and at the same time, you HEALTH FROM have to do multiple biopsies, which are THE BOTTOM very traumatic to the patient,” Boyd says. EYES, UP “You may or may not find a tumour, EARS AND but you’ll produce a lot of scar tissue on the prostate, which will inevitably end up MOUTH having repeat PSA-elevated readings in the Screening for colon cancer starts at age future, which will be hard to interpret.” 50 and it’s a test that will continue every The fact is most men will get prostate It’s easy to become pre-occupied with two years until age 75. cancer at some point past age 50, but high blood pressure, screening for cancer Called a hemoculture test, it looks for it’s unlikely the disease will prove fatal. and all those other major health concerns “occult blood” in the stool. “This is blood In most cases, it’s slow-growing, and – so much so that even family doctors can that shouldn’t be there and incorporated aggressive treatment can do more harm overlook some of the basics: our eyesight, into the stool, which means there’s been than good. hearing and oral health. some bleeding somewhere in your bowel,” “Today, there are a lot of other less But make no mistake. These are Boyd says. invasive treatments available – as opposed important concerns. Take hearing and The test involves sampling stool for to surgery, which causes impotence and eyesight, for example. three consecutive days. If blood is found, a incontinence,” he says. “When you start “Those are two things that, as people age colonoscopy – inserting a snake-like device doing screening with a PSA and end up into their 60s and 70s, are key indicators with a camera into the rectum – is required with an abnormal result, then you end that they will do well health-wise,” Boyd to search for possible signs of colon cancer. up putting the patient through a lot of says. The colonoscopy looks for polyps, which unnecessary grief.” Still, some testing is Checking in on hearing and eyesight are little mushroom-shaped growths in the at age 50 is a good way to assess just colon. “They can bleed and can be benign, how much or how little both faculties are but they can become malignant,” he says. declining. Once a polyp is found, doctors will Most people actually lose a lot of biopsy it to test for cancer. hearing at an early age – the result While it’s standard practice to do of listening to their music at high hemoculture testing of stool at age 50 and volume. up, individuals with a family history of “This is going to be a major early diagnosis of colon cancer or polyps problem in the years to are screened earlier. come,” he says. “You usually try to do it three to five Furthermore, an years before the first-degree relative eye exam from an developed cancer.” ophthalmologist or These tests certainly aren’t the most optometrist can help convenient or pleasant of activities, but diagnose potential health they’re very necessary to our well-being, problems like high blood he says. Colon cancer is one of the most pressure and diabetes. common forms of cancer in men and And when it comes to women, and it’s the fourth leading cause oral health, studies have of cancer death behind lung, stomach and shown that healthy teeth liver cancers. These diseases are relatively CHECK UP uncommon in our early 50s, but they certainly increase with FROM THE age. About 770,000 Canadians NECK UP suffer from dementia-related disease in Canada – the result of Alzheimer’s and Parkinson’s, Look into It’s unlikely that your family among others. doctor will ask you about your And the number is expected relationship with your mother to double in the next 18 years. – a la Sigmund Freud – but he Boyd says these are debilitating Nursing or she should be asking you a conditions that progress with little bit about what’s going on age, often making it very in your noggin once you reach difficult for sufferers to manage 50. their own affairs. Yet Boyd says many doctors For that reason, he also may overlook mental health recommends that his patients as a component of our overall think about advance care well-being. So if your doctor planning. “We need to able to fails to ask, it’s up to you to talk about our advance care ask for a head check-up. Even needs before we get into an if you’re feeling fine, it’s still acute situation in a hospital,” a good idea to discuss mental Boyd says. health going forward from age Advance planning includes 50. “You can ask your doctor developing a living will that for a mini-mental status exam – addresses how you want to an MMSE – and have it on file be cared for and a power of at 50 and then five or 10 years attorney so your affairs will down the road, you can do it be managed by someone you again and use the earlier one as trust. It also addresses dealing a measure of brain health.” with the end of our lives, such Depression and anxiety do as a do-not-resuscitate order tend to increase with age, he in the event of being kept says. And in some instances, alive on life support following they can be an indicator of brain death, with no chance of serious degenerative brain recovery. disease like Parkinson’s or These are difficult issues Alzheimer’s disease. In fact, and while we can’t predict doctors do look for signs of the future, at least we can be these illnesses in their patients prepared. 50 years old and up. “Keep in mind, these plans Parkinson’s disease sufferers can always be changed, but often show symptoms in their they’re really an important late 40s to early 50s. These thing to do and shouldn’t be 301 - 275 Broadway include hand tremors while at forgotten,” he says. “You may Winnipeg, MB R3C 4M6 rest, such as shaky hands even not have needed to think about Phone: 204.942.1320 while resting on a table. this earlier in life, but at age Fax: 204.942.0958 Doctors also look for facies: 50, it’s much harder to avoid Email: [email protected] tell-tale facial expressions – or these issues – and when we more precisely, an inability do ignore them, we do so at to produce normal our own and our loved ones’ facial expressions – peril.” that often indicate Joel Schlesinger is a a degenerative Winnipeg writer. brain disease.

A COMMITMENT TO CARING www.manitobanurses.ca DON’T LEAVE HOME WITHOUT IT

Whenever you’re travelling outside Manitoba, pack some travel health insurance

20 WAVE By Joel Schlesinger

It’s often called the “losing your house” medical bill. And for those who have been unlucky litany of examples. enough to get one – and there have been • Parents with a newborn go on vacation many – it’s the last thing they had ever to Hawaii. Their child gets a fever and imagined would happen while on vacation. pneumonia and they go to Emergency at As Canadians, we rarely worry about our a hospital. Their travel insurance coverage health insurance coverage. We just take it cost $70, but their hospital bill was more for granted that we’re covered. But when we than $4,200. Travel insurance picked up the leave our home province, we need to think tab. about the limit of our health-care coverage. • A 55-year-old man walking down Even more precisely and importantly, the strip in Las Vegas trips and breaks his when we leave Canada, we shouldn’t ankle. His bill was more than $3,000, of leave home without comprehensive travel which Manitoba Health paid $98. But his insurance. additional insurance covered the rest. “When anybody contacts us, we always • A 20-year-old woman goes to California recommend that they take out additional and loses her sight in one eye. She paid $69 travel insurance, no matter where they’re for insurance coverage. Total hospitalization going,” says Deb Slobogian-Jones, Manager was $29,795. Manitoba Health paid about of Out of Province Benefits/Reciprocal $1,080, insurance paid the rest. Agreements at Manitoba Health. Slobogian-Jones says Manitoba Health Although Canadians rarely think about the does provide some coverage to travellers, cost of health care, they need to consider but it’s based on medical costs in Manitoba. this when they leave their home province. For example, Manitoba Health will Health care is terribly expensive, and in the pay between $280 and $570 a day for United States and other countries around Emergency hospital care outside of Canada. the world, as a tourist, you’re largely on For out-patient care – a visit to a hospital your own to cover the costs. “On many Emergency department for a fever, for occasions, an out-of-country physician will example – the province will pay up to $100 treat the patient and then bill the patient Canadian. directly for those services,”says Slobogian- “If the treatment is only $50 U.S., we Jones explaining how Canadians without would pay that cost equated in Canadian travel insurance are cared for at hospitals funds, but if it were $400, we would only in the United States, Mexico and other hot pay $100 Canadian,” she says. “Physician holiday destinations. “These bills should claims incurred out-of-country on an be presented to Manitoba Health for Emergency basis are paid equal to what a consideration of benefits,” she says. “Other Manitoba physician would receive for the times, out-of-country physicians won’t same service in Manitoba,” she says even treat you without a credit card pre- “We’ve seen costs in the United States that payment.” are well over $1,000 just for an Emergency The cost of health care – especially in room visit and we would only insure $100 the United States – is astronomically more Canadian for that visit.” expensive than it is in Canada. That’s And medical costs in other common because, she says, the U.S. has a for-profit vacation destinations – Cuba, Mexico and health insurance coverage system that has Jamaica – are equally expensive, so she higher costs. recommends if you leave the country, you For that reason, insiders in the travel buy travel health insurance from any number insurance business refer to large bills as of providers, including Manitoba Blue Cross, the “lose your house” claims, says Wendy a non-profit provider. Shrimpton, manager of marketing services at But even when travelling outside of Manitoba Blue Cross. Manitoba this winter, be it to Alberta for a “Those are the kinds of expenses that can ski trip or snowmobiling near Lake of the bankrupt a family,” she says. “The charges Woods, travel health insurance is a shrewd can be pretty enormous in the U.S.” decision. A reciprocal agreement is in place Shrimpton says she’s not trying to be between all the provinces and territories that alarmist. Instead, she says she only wants to provide coverage of insured services to all drive home the fact that for just a few dollars Canadians when they travel in Canada, with a family can buy travel health insurance for the exception of physician care received their two-week vacation to Disneyworld in Quebec. But just like your normal and not have to worry about getting sick or Manitoba Health coverage, it doesn’t pay injured and coming home to Canada with for uninsured services like ambulance. (In the worst souvenir of all time: a massive Quebec, no agreement is in place, so health- medical bill. To that end, she offers up a care providers give patients the bill, but

November/December 2012 21 it’s often less costly than other provinces. “pre-existing condition” means and what know full well that any condition you may Regardless, Manitoba Health will often is considered stable and controlled,” she have is going to be covered.” cover the costs.) “As an example, if I was says. “Ask, ‘Are you going to cover me if That advice also applies to the many travelling to Vancouver and I incurred I’m stable and controlled, and how long Manitobans who have group coverage any type of insured medical service cost, do I have to be stable and controlled to through their work or pension plans. “You I would not have to pay for that service,” cover the particular illness that I have?’” should always ask the limitations of the Slobogian-Jones says. “The health ministry But just because you’ve got a medical coverage,” she says. of B.C. would bill Manitoba Health for the condition, doesn’t mean you can’t find Some people may want to top up medical costs.” insurance coverage, Shrimpton says. coverage for a vacation outside Canada, Although it may seem as though you “A good example of that is someone but they need to be aware that many don’t need additional coverage – you who has had a heart attack and surgery providers, including Blue Cross, do not top likely could pay for an ambulance out of afterward,” she says. “At Blue Cross, we up group plans. “You’d have to buy the pocket – most people fail to realize that if would consider someone to be stable and coverage for the entire duration of your they fall very ill or are badly injured while controlled after one year, not including trip from us, for example,” Shrimpton says. travelling in Canada outside Manitoba, regular check-ups at the doctor where Still, the additional cost can be the cost of air ambulance can run into the nothing substantial takes place.” worth it if group coverage or coverage tens of thousands of dollars. And that’s not Then again, don’t assume you’re provided through credit card benefits isn’t covered under Manitoba Health. covered even if you are only taking high comprehensive enough. “There have been really sad cases where Even with all the bases seemingly someone has had a brain aneurysm in B.C. covered, it is important to remember to and the person has been put in a long- bring policy documents with you while term care facility there because the family on vacation. Many providers also issue ID couldn’t afford to bring their loved one cards for clients. It’s very likely you could home,” she says. “We don’t pay for that be asked for the card or other proof of person to come back to be cared for in insurance in order to receive treatment. Manitoba, and the family is responsible for “Should something happen, then you what could easily be a $25,000 bill for an have information on that documentation air ambulance.” that will tell you what to do,” Shrimpton Shrimpton says most providers of travel says. So, for example, if you’re in Mexico health insurance offer coverage for these and you fall and break your ankle, you can services when people travel outside their go to the hospital and present your card, home province in Canada, but it’s easy and the hospital will call CanAssistance for people without insurance coverage to or another intermediary that will confirm forget they may need coverage. your coverage and give the go-ahead for Many Manitobans, for example, treatment. “In severe instances, you just think nothing of spending a weekend in get medical treatment immediately, but if Northwest Ontario – cottage country. they can deal with it prior (to providing But even that trip can also turn costly if blood pressure medication, especially if treatment), the hospital will want to make something goes wrong. “Air and/or ground your medication has been altered in the sure it can get paid,” she says. ambulance costs can range from $5,000 to last year. “A lot of people think, ‘They’ve Individuals who don’t have coverage more than $25,000,” she says. reduced my medication; I’m in much may be asked to pay up front or the Nikki Makar, an individual benefits better shape,’ but the reality is if they hospital may bill Manitoba Health. consultant with Manitoba Blue Cross, says change the medication, there could be a But once the province pays its share, a even people with travel health insurance risk of a reaction.” collection agency may take over the bill coverage need to be certain their plan That person could have a stroke while and try to recover the amount owing. covers them for where they intend to travel on vacation – perhaps as a result of But Slobogian-Jones says it’s very easy for vacation – in Canada and abroad. changes to blood pressure medication to avoid this unpleasant outcome: buy And it’s also important to be certain – and the insurer may deny coverage coverage before leaving for vacation. they understand the potential limits and because the change in medication dosage “It’s always better to spend $80 ahead of exclusions in the policy. Two important is an indication the condition wasn’t stable time instead of possibly ending up with a terms to be aware of are “pre-existing and controlled. bill that could be $80,000.” conditions” and “stable and controlled.” Furthermore, it’s important to find out Joel Schlesinger is a Winnipeg writer. While Manitoba Blue Cross and other other limitations regarding coverage. insurers may not ask individuals under While Manitoba Blue Cross policies don’t age 55 about pre-existing conditions and stipulate that high blood alcohol levels whether they’re stable and under control, can make coverage null and void, other many other providers do. And it’s always insurers might have a clause that denies better to ask about your coverage before coverage under those circumstances. you leave than to find out on holiday, in The important thing is to ask before you FYI the hospital receiving care for an illness leave town, Makar says. For more information about travel that you’ll have to foot the bill because it “The key we push always is awareness,” health insurance, visit: was caused by a pre-existing condition that she says. “You have to be aware of your isn’t covered in the policy. medical condition first of all, and then you www.gov.mb.ca/health/mhsip “Whatever product they’re buying, have to be aware to ask the questions to they really need to understand what a make sure that when you’re travelling, you www.mb.bluecross.ca

22 WAVE MANITOBA HEALTH RESEARCH COUNCIL A HEALTHY INVESTMENT CELEBRATING 30 YEARS OF HEALTH RESEARCH IN MANITOBA

BIO-MEDICAL CLINICAL

HEALTH SYSTEMS POPULATION HEALTH

November/December 2012 23 Manitoba Health Research Council

The Manitoba Health Research Council provides funds for research in the health sciences through a number of grants and awards programs. Core programs are funded by grants from the Government of Manitoba. Funding for 2012/13 is $6,002,600 from the Department of Innovation, Energy and Mines. MHRC’s funding focuses on the support of new and mid-career investigators through the Manitoba Chairs Program and Operating and Establishment Grants. In addition, salary support for trainees is provided through Clinical Fellowships, Co- Ordinated Post-Doctoral Fellowships and Co-Ordinated Graduate Studentships.

MANDATE GOVERNANCE COUNCIL HISTORY

The Manitoba Health Research As a provincial agency, the The Manitoba Health Research Council has a mandate to promote Manitoba Health Research Council was created through an act of and assist basic, clinical and Council reports to the Minister of the legislature on June 30, 1982. applied research in the health Innovation, Energy and Mines. An account of the MHRC’s history sciences in Manitoba and advise The Chair of Council is Dr. Brian through excerpts from articles written the minister on such matters Postl, Dean, Faculty of Medicine, by Drs. Lyonel Israels, Frits Stevens relating to health research as the University of Manitoba. There are 12 and John Hamerton, who played minister may refer to the council council members; ten are appointed key roles in the development of the for consideration. by the provincial government and MHRC, can be found at www.mhrc. two are appointed by the University mb.ca. of Manitoba.

Reflecting on our past, planning for the future

devoted to health research in a way that health research in the province, but it is what Christina Weise, endorses excellence, nurtures researchers and, inspires the MHRC to actively support and Executive Director, in turn, provides our health-care system with celebrate these people and their life’s work. Manitoba Health the evidence on which better services, better MHRC’s 30th anniversary this year gives us a Research Council care and better outcomes can be attained. chance to reflect on and celebrate three decades Thirty years ago, the Government of The MHRC exists to foster knowledge, and of health research advances and impacts. More Manitoba consulted on a proposal to create a we have done that. The next step is to share importantly, it is also an opportunity to plan for provincial funding body dedicated to health and celebrate the achievements of Manitoba’s the next 10 years. research. researchers with the wider community. Manitobans deserve the most innovative The ideas put forward stemmed from those As each segment of this special report health research to respond to the complex range of prominent members of the health research suggests, the health research community in of health issues we currently face and those that community. The proposal focused on our Manitoba is generating knowledge and having will come. The MHRC is committed to building province’s acknowledged strengths in health an impact. From bio-medical, clinical, and and strengthening collaboration between those research and provided an ambitious solution to health systems and services to social and doing research and those who can advance the challenges we faced. There was consensus population health studies, the health research research in all sectors of the economy, so we that the creation of the Manitoba Health enterprise is contributing every day to the can all benefit from innovation and research. Research Council was the way forward. well-being of Manitobans. The stories on the Health research is part of our lives as The MHRC has delivered and continues pages that follow tell a compelling story about Manitobans and Canadians, and our future to deliver what it set out to do – promote the researchers who are trying to prevent suicide, depends on it. growth and co-ordination of the health research reduce the prevalence of diabetes and help I hope this special report is both an education enterprise in Manitoba. people die with dignity. These pages provide and an inspiration. The MHRC manages the province’s funding just a glimpse of the past, present and future of Enjoy!

24 WAVE MHRC COUNCIL

The MHRC’s Council includes membership from the health research community, provincial government, business, academic institutions and health agencies. They are: TABLE OF Dr. Brian Postl (Chair) CONTENTS Dean, Faculty of Medicine, University of Manitoba

Dr. Judith Bartlett Associate Professor, Adjunct Scientist (Manitoba Centre for Health Policy), Department of Community Health Sciences, Faculty of Medicine, University of Manitoba

Mr. Bob Brennan Former President and CEO, Manitoba Hydro (Retired) 26 Ms. Jan Currie Making a Difference Former Vice-President and Chief Nursing Officer for the Winnipeg Health Region (Retired) 29 Mr. Grant Doak (Invited Member) Deputy Minister, Department of Innovation, Energy & Mines Investing in Excellence Dr. Digvir Jayas Vice-President (Research & International), University of Manitoba 30 Mr. Kevin Kavanagh Past President, Great-West Lifeco Research for Better Health Dr. John Langstaff

Dr. Susan McClement 36 Associate Professor, Faculty of Nursing, University of Manitoba Research Associate, Manitoba Palliative Care History of Excellence Research Unit, CancerCare Manitoba Dr. Peter Nickerson 40 Associate Dean (Research), Faculty of Medicine, University of Manitoba Global Connections Ms. Cathy Nieroda Vice President, Manitoba Region, HP Enterprise Services 42 Mr. Milton Sussman (Invited Member) Deputy Minister, Manitoba Health Research Centres, Institutes Dr. Barbara L. Triggs-Raine & Groups Professor, Department of Biochemistry and Medical Genetics, University of Manitoba 44 Ms. Arlene Wilgosh President & CEO, Winnipeg Regional Health Authority Mapping the Future of Health Care MHRC STAFF 47

Ms. Christina Weise Ms. Kristen Hooper Booster Shot Executive Director Communications Officer Mr. Ambrosio P. Catalla Jr. Ms. Lesley McKenzie 48 Evaluations and Policy Analyst Administrative Assistant, Funding Programs Leading the Way Dr. Jim Davie Scientific Director Ms. Shannon Rogalski Manager, Funding Programs Ms. Liz Ford Administrative Officer

November/December 2012 25 MHRC: INVESTING IN YOUR HEALTH

Photography: Marianne Helm MAKING A DIFFERENCE

The Manitoba Health Research Council has supported more than 1,300 health researchers over the last 30 years. In doing so, it has spurred numerous improvements to the delivery of health care in this province and helped build Manitoba’s reputation as a leader in health research.

By Murray McNeill

n 1983, a man who would go on to become one of the province’s most accomplished health researchers arrived in Winnipeg, eager to establish a program in the field of epigenetics, the study of Ifactors that influence the operation of genes.

Dr. Jim Davie was born in England and obtain the extra funding he needed, his of Manitoba. He went from being a contract spent his childhood in Winnipeg before research/teaching contract at the University employee to a contingent faculty member, moving to Vancouver as a teen. He obtained of Manitoba would not be renewed, and he’d which later led to a tenure track position a Bachelor of Science degree and a PhD be looking for another job and another place with the university. from the University of British Columbia and to hang his research hat. “Going from contract to contingent was did his post-doctoral training in chromatin Fortunately, his proposal was impressive a huge step forward,” he says. “And having structure and function at Oregon State enough to land him an establishment grant that (MHRC funding) told the department University. from the newly minted research council. and the university I was a credible He was returning to his home province That provided him with the extra money researcher.” because the University of Manitoba’s Faculty needed to properly equip his lab and stock The MHRC’s help didn’t end there of Medicine had offered him a research/ it with the necessary supplies. It also helped for Davie. Some of the graduate students teaching contract. It also gave him $30,000 him land a scholarship from the Medical working in his research program have also to put toward the establishment of a research Research Council of Canada, now known as received Graduate Studentship Awards from laboratory. the Canadian Institutes of Health Research the MHRC, which meant money he would While the university money was a big help, (CIHR). have spent on student salaries could be used it wasn’t enough to cover the cost of setting Davie received MHRC funding that year, to buy more lab equipment and supplies. up a lab. That meant Davie had to find and again in fiscal 1992/93. After nearly three Davie says it’s difficult to say what would additional funding from somewhere else. So decades, he doesn’t recall exactly how much have happened if he hadn’t received MHRC he turned to the Manitoba Health Research he received from the council that first year, support. Maybe he would have found Council (MHRC), a new funding body but he does remember how important the funding somewhere else, but maybe not. created the previous year by the provincial money was to his budding research career. “All I can say is that I got it at a time when government to serve as the go-to place for “Getting the (MHRC) award made a world it was really needed. It was a critical time in health research funding in the province. of difference,” he says. “I was able to focus my research career, no question,” he says. There was a lot riding on Davie’s on my research.” There are cancer patients who, all these submission to the MHRC. If he couldn’t It also changed his status at the University years later, are also benefitting from the

26 WAVE University of Manitoba and Dean of its Faculty of Medicine from 1971 to 1981. Photography: Marianne Helm In the late 1970s, Naimark gave a speech in Winnipeg in which he urged the Manitoba government to follow the lead of other provinces and create its own health research fund. The news media picked up on the story, and the government soon began talks with him and other key industry players, including Drs. Henry Friesen and Lyonel Israels. Those talks led to the creation of the MHRC. Naimark says he originally proposed that the government allocate one-tenth of one per cent of its annual health-care budget as funding for health research – or about $2 million. At the time, that was the standard used by many jurisdictions to set health-care research funding. The province did give the MHRC about $500,000 in 1982. But it didn’t tie the funding to future increases in health-care spending, as Naimark had suggested, so the agency’s level of funding grew slowly to about $1.95 million in 1994/95, where it remained until 2002/03. By 2006, MHRC funding climbed to $6 million, where it remains today. Now as then, the question remains: Is that enough funding to support health research? Naimark says if the province had adopted his original funding formula, the council would now be receiving between $20 million Dr. Jim Davie holds a slide that has been prepared to and $25 million per year. Instead, the level of be analyzed by a gene sequencing machine. funding here ranks in the bottom one-third among the provinces per capita. Only New Brunswick, Prince Edward Island and the Territories spend less on health research. As costs rise and the number of research support Davie received from the MHRC. Canadian Society for Molecular Biosciences. applicants grows – 298 this fiscal year alone He says his research in those early years Davie is one of 1,312 researchers who – MHRC officials have asked the province for identified a group of compounds, called have received MHRC funding over the past a substantial increase in funding, in the range histone deacetylase inhibitors, which are three decades. During that time, MHRC has of $12 million, an amount first referred to in effective in inhibiting a particular enzyme funded 1,994 research projects, including 84 the MHRC’s 2006 strategy paper. that fuels the growth of cancer cells. in fiscal 2011/12. Weise says that level of funding would Preventing that enzyme from functioning In supporting these and hundreds of allow the MHRC to leverage additional properly not only stopped cancer cells from other researchers, the MHRC has helped funds from other funding partners it works growing, but eventually caused them to die. spur numerous improvements to the with, including the Canadian Institutes of Other international researchers picked up delivery of health care in this province and Health Research, the CancerCare Manitoba on his findings, and subsequently developed played a pivotal role in building Manitoba’s Foundation, the Health Sciences Foundation, new inhibitor drugs that are now being used reputation as a leader in health research. and the University of Manitoba. in the treatment of some cancers. As Christina Weise, Executive Director In 2011, for example, MHRC leveraged Davie says he would have liked to have of the Manitoba Health Research Council, an additional $2.1 million in partnership been the one who carried that particular points out, “MHRC plays a catalytic role in funding to go with the $6 million it received research through to the end, “but it was nice the province’s health research community from the province. With $12 million in to have played a role.” and gives researchers the start they need to funding from the province, Weise estimates Today, Davie is still involved in epigenetics accomplish great things in Manitoba.” the MHRC might be able to leverage an research at the University of Manitoba. He’s a As the MHRC marks 30 years of service additional $8 million, for a total of $20 professor in the Department of Biochemistry this year, Weise says much of the credit for million in funding. Researchers would then and Medical Genetics, Scientific Director the agency’s success and contributions must be able to use MHRC funding to leverage for the MHRC, and Leader of the Terry Fox go to those who helped get it off the ground. other financial contributions. Research Institute Prairie Node. He also One of the driving forces behind the Dr. Brian Postl, Dean of the University holds a Canada Research Chair in Chromatin creation of the MHRC was Dr. Arnold of Manitoba’s Faculty of Medicine and Dynamics and is past-president of the Naimark, President Emeritus of the Chair of MHRC’s Board of Directors, says

November/December 2012 27 the council’s funding acts as “seed money” fostering increased co-operation between the that researchers use to leverage additional different players within the health-research funding from other organizations, such as community. MHRC the Canadian Institutes of Health Research or The last increase in funding made a Heart and Stroke Canada. huge difference in terms of research in SUPPORTS He says, on average, every $1 of MHRC this province because it allowed MHRC research funding attracts $6 in additional to establish the Manitoba Research Chair LOCAL funding from other organizations (this Program, which provides $500,000 over five RESEARCH includes the additional contributions that years to “star” researchers. The program has researchers leverage after receiving their been used to support 11 Chairs since the initial MHRC funding). “So the more money program’s inception in 2008. the province puts in, the more money it Looking ahead, the MHRC would like to brings in.” use any additional funding to support the Here are a few facts and figures If MHRC funding was increased, it would development of “research clusters,” not just about the Manitoba Health not only help local researchers leverage in Winnipeg, but throughout the province. Research Council. additional funding from other sources, it (Research clusters are groups of researchers would also enable the council and its clients to from different backgrounds who share .5 participate in a new patient-oriented research expertise to advance research in a specific Amount in millions of dollars program recently announced by CIHR. “We area.) The additional funding would help MHRC invested in local health are going to require some matching funds Manitoba recruit and retain scientific talent, research in 1982, the year it was from the province to be able to attract some of something that is always a challenge because established. that federal money,” Postl says. many of the other provinces Manitoba The MHRC would also like to expand competes with, including the other three 6 some of its existing programs and develop western provinces, have larger health Amount in millions of dollars new initiatives. research budgets, and researchers often go MHRC invests in local health Weise notes the council’s role has evolved where the money is. research today. over the years, from that of a funding body In any case, Postl says everyone realizes to a funding/co-ordinating body that’s also that the provincial government recognizes 1,312 involved in the planning and implementation the value of Manitoba’s research community, Number of researchers supported of new health-research strategies and in not just in terms of delivering better health by MHRC over the last 30 years. care, but also as a driver of the provincial economy. The question is whether the 1,437 province will be in a position to chip in more Number of submissions MHRC has money next year. received in the last seven years. “They know we’re very interested in expanding our research activity,” says Postl. 496 “But we’ve got to wait and see how the Number of submissions approved provincial economy does. There are lots of by MHRC in the last seven years. people looking for increases (in funding) at a time when dollars are hard to come by.” 298 Total number of submissions for funding received in 2011/12.

215 Number of submissions deemed “fundable” in 2011/12.

84 Number of submissions for funding approved in fiscal year 2011/12.

Dr. Brian Postl is Dean of the University of Manitoba’s Faculty of Medicine and Chair of the Manitoba Health Research Council.

28 WAVE for up to a year while they obtain new funding. The average bridge funding amount per recipient between 2006 and 2011 was $27,375. Regional Partnership Program: This program offers up to $100,000 and is for researchers who are below the funding capacity of the Canadian Institutes of Health Research’s base budget and need another organization to jointly fund their research program. INVESTING IN So who decides who gets a research grant and who doesn’t? The MHRC uses a competitive process and EXCELLENCE peer review to evaluate and select research funding proposals for the Board’s approval. Researchers compete for Manitoba Peer review is undertaken by a committee Health Research Council funding of active health researchers and health professionals constituted appropriately to suit the nature of applications under review. Each btaining Manitoba Health funding support, on a matching basis, for committee is chaired by a respected researcher Research Council funding a period of research training for candidates from a relevant field. Manitoba Research with under-graduate medical degrees, or the Chairs are evaluated by reviewers from outside is a bit like landing a equivalent, who intend to pursue a career as a the province. MHRC board members make highlyO coveted scholarship. The clinician researcher. final approvals of all grants and awards, based competition is fierce and the Post-Doctoral Fellowships: Students can on review committee recommendations, demand far outweighs the supply. obtain up to $36,750 to help them prepare for compliance with all requirements and budget careers as independent health researchers. considerations. This year, for example, the council received Graduate Studentships: These grants, Although a certain amount of funding is 298 applications for funding, 215 of which worth $17,850, are also provided on a set aside for each program, Weise says those were deemed “fundable.” That means they matching basis to help Master’s and PhD allocations aren’t set in stone. scored above 3.5 on a scale of zero to 4.9. But trainees prepare for careers as independent “We do sometimes make adjustments and the MHRC was only able to fund 84 of them. health researchers. move money from one program to another. Statistics show the number of applicants PhD Dissertation Awards: These grants It depends on the scores and the number of has been growing steadily over the last half- of up to $5,000 each are used to support applications we have.” dozen years, climbing from 147 in fiscal graduate students in population and health- 2006/07 to 298 this year. The quality of the related social sciences who incur costs while applicants and research projects has also been working on projects not directly related to improving, making the selection process even their supervisor’s research program. Where the money goes more challenging. Operating Grants: New faculty members “This year, we had some people in the can use these grants to defray direct costs MHRC funding by Operating Grants Program who were ranked incurred in completing their post-doctoral research pillar, 2011/12 in the excellent range (4.0 to 4.4), but they training or conducting research. In 2011/2012 didn’t get any money because we didn’t have the average Operating Grant was $49,000 enough,” says Christina Weise, Executive per year. Social/Population Director of the Manitoba Health Research Establishment Grants: These 13% Council. “So it (deciding who gets funding grants assist faculty members who and who doesn’t) isn’t easy.” have recently moved to the Health Weise says MHRC provides funding for province to establish an Services four types of research: basic bio-medical, independent health research 6% clinical, health services and population health. project here, and are worth up The bulk of money goes to bio-medical to $100,000 over three years. research – laboratory work with cells and Manitoba Research Chairs: animals – because that’s where most of the These grants are worth up to research work is being done. But Weise says $500,000 in funding over five Clinical Bio-medical MHRC officials would like to see more funds years and are available to mid-career 17% allocated for the other types of research. researchers who work as independent 64% “We’re striving for a bit more of a balance.” investigators. Funding flows through nine key programs: Bridge Funding: This program offers Clinical Research Fellowships: These matching support to researchers who have fellowships are worth $35,000 and are recently lost long-standing funding from a designed to address a shortage of clinician- national funding agency. It is designed to scientists in the province. They provide enable researchers to maintain their programs

November/December 2012 29 MHRC: INVESTING IN YOUR HEALTH

RESEARCH FOR BETTER HEALTH

MHRC-funded researchers enhance care for people living in Manitoba – and beyond

By Liz Katynski

ach and every day, a small army of researchers, technicians, lab assistants and grad students arrive for work in various locales around the province with one objective: to discover new ways to improve treatments for diseasesE and conditions, thereby improving outcomes for patients. The Manitoba Health Research Council plays In doing so, the MHRC is helping to support an important role in supporting the people researchers who are working to create a who are doing this work. Through its funding healthier future for people in Manitoba and programs over the last three decades, the throughout the world. MHRC has directly or indirectly helped veteran Here are just a few of the researchers who scientists and student researchers alike achieve have received MHRC funding, along with a look their goals. at some of the work they have done.

30 WAVE REWRITING Research enhances THE RULES suicide prevention efforts

Dr. Jitender Sareen’s research has helped based interventions were developed in assess for suicide risk,” he says. save lives that might otherwise have been lost partnership with the community. As well, after considering Sareen’s to suicide. So far, the results have been positive. research, the Canadian Psychiatric His research has led to enhanced “We’ve had excellent partners in the Association recently introduced media community prevention programs, the community. Programs are aiming to reduce guidelines for the reporting of suicides creation of a new category for suicidal the risk of substance use and depression in order to minimize the contagion behaviour and new guidelines for how in youth, and to connect people who feel effect – people who follow through on FOR suicides are covered in the media. disconnected with their community,” says suicidal thoughts after seeing the suicide RESEARCH BETTER HEALTH A professor of psychiatry at the University Sareen. of a celebrity or other person reported in a of Manitoba’s Faculty of Medicine, Sareen Through his work, Sareen has been able sensational manner in the media. launched a study into suicide among residents to better understand the factors contributing “They are raising awareness of how of Swampy Cree First Nation in 2007. to suicidal behaviour. He says about 90 per important it is not to report suicide in a At the time, suicide among residents cent of people attempting suicide have a sensational manner.” of the northern Manitoba community was mental disorder, but the rest do not. His five times higher than that of the general research shows that other factors, such Canadian population. Through his research, as panic attacks and financial stress, can he discovered that issues such as substance contribute to suicidal behaviour. abuse, depression and anomie – a feeling Based in part on his work, the American of being disconnected from the community Psychiatric Association recently introduced a – all contributed to suicidal behaviour, separate condition called Suicide Behaviour especially among young people. Disorder-DSM-5. “The new category will As a result, community-based and family- increase awareness in clinicians to carefully

PERSONAL Identifying the needs of nursing CARE home residents

There are close to 10,000 Manitobans Region, dating back to 2005. get in, the right staffing levels, number and living in personal care homes today, and Doupe, an associate professor in the types of beds, and other supports that will experts predict the province will have to find Department of Community Health Sciences, be needed in order to plan to meet the needs spaces for about 6,000 more within 30 years. at the University of Manitoba’s Faculty of of an aging population. It will also help to But exactly what kinds of health care will Medicine, and a senior research scientist determine if nursing homes are the right all these residents need going forward? at MCHP, is linking the two sets of data in environment for some people, or if other, Dr. Malcolm Doupe is attempting to order to gain insights into how Manitoba’s less costly options should be put in place. answer that question. He is working on the aging population can be better served. As well, Doupe is looking at nursing home first comprehensive review of the needs of The research has the potential to influence facilities and measuring the quality of care nursing home residents, looking at both the policy, says Doupe. “Linking the data systems on an ongoing basis, and he is studying numbers and the needs of residents in order provides us with a rich research environment. nursing home residents’ use of other to understand how to plan for the future. Never before have we had such a clear picture services, including Emergency rooms. Since the 1970s, the Manitoba Centre for of the range of needs of those going into So far, Doupe has found that about Health Policy (MCHP) has been receiving nursing homes,” says Doupe. “Policy makers seven to eight per cent of people admitted administrative data on people going into can look to it when they decide to adjust their into nursing homes may be eligible for personal care homes, including names, ages, policies and criteria.” some community-based options, such as and medical conditions, from Manitoba Knowing the specific needs of people supportive housing. Nursing home residents Health for research purposes. They have going into nursing homes can help themselves have a huge range of needs, also acquired clinical data on the health-care determine better strategies for accepting highlighting complexities of providing high- needs of residents from the Winnipeg Health people into nursing homes, and once they quality care for these people.

November/December 2012 31 HEALTHY Breastfeeding study helps reduce BABIES risk of Type 2 diabetes and obesity

A research study designed to promote months, compared to a national average of in Manitoba hospitals also revealed that breastfeeding at Sagkeeng First Nation is 25 per cent for women across the country. breastfed babies lost 5.5 per cent of their leading to healthier babies at less risk for That success prompted the community body weight in the first few days of life Type 2 diabetes and obesity. to permanently fund the peer counsellor (which is normal), while formula-fed babies Dr. Patricia Martens started working program in 1998. Around that time, other lost only 2.5 per cent, implying the bottle-fed alongside members of the community in research also revealed reductions in Type 2 babies were being overfed. It is important 1992. At the time, it had been established diabetes and obesity among people breastfed not to overfeed babies because that might that breastfeeding could reduce respiratory as infants. Martens, along with other U of M predispose them to obesity and Type 2 and gastrointestinal infections in infants. The scientists, later showed the same result in diabetes later in life. Partly as a result of challenge was to encourage reluctant moms to Manitoba: First Nations teens that had been Martens’ work, Manitoba hospital protocols breastfeed their babies. breastfed as babies were less likely to have have evolved to encourage only appropriate Martens, along with research assistant early-onset Type 2 diabetes, and the longer the volumes of formula be fed to newborns, and Linda Romphf, worked with the community duration of breastfeeding, the lower the risk. only minimal supplementation be provided in 1995 to develop resources to promote “The Sagkeeng materials are now being to breastfed babies when required. breastfeeding, including an educational used in other First Nation communities to booklet and video. The community health boost breastfeeding rates,” says Martens, who unit also created a pilot peer counselling is now the Director of the Manitoba Centre support program in 1997 that encouraged for Health Policy and a professor in the breastfeeding. In two years, breastfeeding Department of Community Health Sciences rates jumped from 38 per cent to 70 per cent. at the U of M’s Faculty of Medicine. “That’s The duration rate also increased, with 40 pretty cool,” she says. per cent of moms still breastfeeding at six Another of Martens’ research studies

REDUCING Researcher’s efforts THE RISK help reduce risk of cancer

The results of two research projects discovered something new: people who take also hoping that with increased awareness, conducted by Dr. Harminder Singh are thiopurines are at much greater risk for a skin cancers are picked up early because helping to reduce the risk of cancer for more aggressive kind of skin cancer called the earlier they are caught, the better the patients with gastrointestinal issues. squamous skin cancer. outcomes.” The first study, which took place between In fact, his research suggests that people A second project, which took place between 2010 and 2012, involved people living who have IBD and take thiopurines – two 2009 to 2010, looked at the effectiveness of with inflammatory bowel disease (IBD), factors that suppress the body’s immune colonoscopies in reducing deaths due to a condition affecting more than 200,000 system – are six to 20 times more likely to colon cancer in usual clinical practice. Studies Canadians, with as many as 9,000 new cases develop squamous cell skin cancer than those have shown that having a colonoscopy does every year. without IBD and not taking the drug. reduce the risk of death from colon cancer Many people with IBD take a class of As Singh explains, IBD tends to occur located in the lower part of the bowel. But drugs called thiopurines (azathiopurine and in younger people who will need to take the protective effect appears to be less for 6 mercaptopurine) to keep their disease thiopurines over a long period of time. They tumours that develop in the upper part of under control, says Singh, an assistant need to understand that they must take the bowel. There appears to be a very large professor of medicine in the Departments of precautions to protect against skin cancer. variation in the performance of colonoscopy Internal Medicine and Community Health “They need to be cautious of exposure to by different physicians, says Singh. “Our Sciences at the University of Manitoba’s the sun,” he says, adding that any skin lesions health-care administrators now recognize the Faculty of Medicine. Studies have shown that develop should be looked at promptly. need to decrease this variation and ensure that that people with IBD are at a slightly higher “Such simple measures should help reduce everyone gets similar care, which should lead risk for skin cancer. But Singh’s study the risk of developing skin cancers. We are to lower cancer rates,” he says.

32 WAVE IMPROVING CARE Screening for Type 2 diabetes

Sandy Bay First Nation has one of the had advanced foot complications requiring “Now (people with diabetes) get a basic foot highest rates of amputation due to diabetes specialist physician care, and 26 required exam every year and referrals to a physician in the province. But that is changing, thanks regular foot care nursing. All of them had as needed,” she says. to research led by Dr. Sharon Bruce. neuropathy – nerve damage that decreases Bruce did the study with four community An associate professor in Community sensation in the foot, and an early indication research assistants as well as her graduate Health Sciences at the University of of problems to come. At the time, there was student, Dhiwya Attawar, and a Sandy Bay Manitoba’s Faculty of Medicine, Bruce one foot-care nurse visiting the community community diabetes advisory group. Their launched a study in 2002 to determine the monthly who was able to see 10 clients per work continues. “We are now developing burden of diabetes-related problems and if trip. The people identified by the study were a community-based diabetes prevention people were getting the care they needed to on a waiting list for foot-care services. program,” she says. “When research manage their condition. The study helped bring about change in information translates into action, it is very Diabetes can often lead to a number of the delivery of diabetes foot-care services. rewarding to see that information used and health complications, including circulatory The Sandy Bay Home and Community Care some good come out of it.” problems and nerve damage in the lower Program took over foot-care services and limbs. This can lead to amputation unless the now all people with diabetes have access to patient receives proper care. foot care. “We provided the information to That wasn’t happening at Sandy Bay. Of the community and they made changes to the 101 people identified with diabetes, 14 the way foot care is delivered,” says Bruce.

JUST IN Faster treatment saves TIME thousands of lives every year

Septic shock is the leading cause of death septic shock to receive antibiotics. Physicians Studies suggest that reducing the time it in intensive care units in the developed told Kumar that it generally took between 60 takes to deliver antimicrobials in cases of world. But now, thanks to the work of Dr. to 90 minutes to deliver the antibiotics. But septic shock can save tens of thousands of Anand Kumar, thousands of people every upon reviewing the data, Kumar discovered lives across North America. year are surviving this condition, which is it generally took an average of six hours. Kumar says his research was made caused by a loss of blood pressure due to “We examined the impact of the speed possible because of data collected by the severe infection. of delivery of antimicrobial therapy in Winnipeg Health Region, which was one of “We had the magic bullet, but we just the treatment of septic shock,” he says. the first health jurisdictions to code septic needed to use it correctly,” says Kumar, an “Dropping the median time from six to three shock under its own designation, starting associate professor in the Departments of hours increased the odds of survival from 38 in 1989. Other regions record it under the Medicine, Microbiology, Pharmacology and per cent to 60 per cent.” condition that led to the infection. Therapeutics at the University of Manitoba’s As a result, protocols in Winnipeg and The availability of this information, plus Faculty of Medicine. The “magic bullet” is around the world are being changed to a study of septic shock in the lab during a reference to antibiotics administered to speed up delivery of antibiotics to patients another project, prompted Kumar to look patients in septic shock. In the normal course who experience septic shock. “We are now into the effects of delays in providing of events, patients who go into septic shock saving 100 to 150 lives in Winnipeg each antibiotics to patients. “It’s very cool,” says are stabilized and then given antibiotics to year. That’s great news,” Kumar says, adding Kumar. “All doctors working in academic knock out the infection. that medical students are now taught about medicine want to make a difference. We are In 2004, Kumar launched a study to the importance of quickly administering very excited to see people who would have determine how long it took for patients in antibiotics to patients in septic shock. died going home to continue their lives.”

November/December 2012 33 KIDS Aboriginal youth mentors HELPING KIDS help children to be active

How do you encourage children to wanted to be more involved.” The Aboriginal students, in turn, are become more physically active? Dr. Joannie That’s where Rec and Read comes into learning leadership skills that may lead to a Halas believes part of the answer involves play. As Halas explains, the after-school job or further education. That’s important creating culturally relevant programs that physical activity, nutrition and education because education and employment are two promote a holistic approach to overall health. program for students Grades 4 to 6 is based key determinants of health. The Rec and Read program is a case in point. on a circle of relationships. Students from In addition to encouraging kids to be Halas, Associate Dean of the Faculty of the U of M’s Faculty of Kinesiology and physically active, the program also promotes Kinesiology and Recreation Management Recreation Management work with high cultural activities, such as sharing circles, as at the University of Manitoba, started the school students to create a program for the well as opportunities for the older mentors program 10 years ago as part of her research younger children at a nearby early-years to read and play educational games that into how to engage Aboriginal youth in school. “We call it a relationship-based promote literacy with the younger kids. physical education and physical activity. communal approach to youth mentoring “Because they have been in the gym, As a former school teacher, Halas knows through physical activity. The university they build nice relationships through that a meaningful physical activity program students are working with the high school play and laughter, then they sit down and can be used to “connect” young people to students to run the after-school program, they do some reading one-on-one, and it their school environments. But through and they are all learning from each other in just reinforces a very holistic approach to her research, she also knows that young the program.” healthy development,” she says. Since it was people aren’t always as physically active as Together, they develop a program that launched, Rec and Read has been adopted by they would like to be. In some cases, this is features games and healthy snacks, and 20 schools and continues to engage hundreds because they have a tough time fitting into ensures all kids are able to participate. of children and youth each year. the local community club or school sports This approach has two main benefits. First, scene. In other cases, it’s because they can’t the program is better suited to the needs and afford the right equipment or clothing, or desires of the kids. Second, the structure of because they just don’t feel welcome. the program means the university students, “What we found out is that some many of whom will go on to become phys-ed Aboriginal students weren’t feeling connected teachers, are learning how to work inter- in their physical education programs. They culturally with Aboriginal students.

LESSONS Research aims to help people FOR LIFE with intellectual disabilities

Dr. Melanie Gregg is looking for ways to looked at whether they were nervous, excited “It might be in the form of a workbook improve the lives of people with intellectual or fearful of the event they were playing in, or workshops,” says Gregg, adding this disabilities. And she believes athletes with and how they got through that.” could then be used by schools or health-care intellectual disabilities can help. In the first phase of her research, Gregg organizations that deal with people with An associate professor in the Kinesiology surveyed athletes with intellectual disabilities intellectual disabilities. Department at the University of Winnipeg, on a range of issues, such as what they liked “For example, an athlete uses imagery to Gregg is studying how athletes with or disliked about the pressure of competition play a sport. A non-athlete would use the intellectual disabilities cope with the pressure and how they dealt with it. same technique, imagining something like of playing sports, and how they transfer The next phase in Gregg’s study is to ask how to get to their bus stop, get on the bus those skills to everyday life. those athletes how they use their sports- and pay for their ticket, and where to get off “Some of the skills used by these athletes associated skills outside of sports. After this the bus. This imagery or visualization is done include setting goals, managing their phase is completed, Gregg says the answers before the trip even starts.” emotions before, during and after an event, will be used to form a training method to and coping under pressure,” she says. “I teach non-athletes with intellectual disabilities.

34 WAVE TACKLING Recreational program may TYPE 2 help prevent chronic condition DIABETES

Studying how physical activity can be used reduced risk of Type 2 diabetes. program of healthy snacks, physical activities to reduce the risk of Type 2 diabetes is near “Rec and Read encourages people to adopt and bonding within a traditional medicine and dear to Dr. Jon McGavock’s heart. a healthier lifestyle, get active and improve wheel concept to about 80 Grade 4 students In fact, his research focuses on the their self-esteem so they can become role in 2010/11 and 2011/12. Although it’s too cardiovascular complications in youth that models for others in their community,” early to tell whether it can help reduce are associated with Type 2 diabetes. His work says McGavock, an associate professor of Type 2 diabetes rates, the program has in this area has taken him to the Garden Hill Pediatrics and Child Health at the University had a positive effect. Teen mentors from First Nation. Located in northeast Manitoba, of Manitoba’s Faculty of Medicine, and co- Garden Hill recently shared their take on the Garden Hill has a Type 2 diabetes rate that’s leader of Diabetes Research Envisioned and program at a special presentation attended 400 to 500 times higher than the general Accomplished in Manitoba at the Manitoba by 75 members of the Faculty of Medicine. population. Institute for Child Health. Many felt inspired by their presentations, A few years ago, McGavock and key Rec and Read was developed by Dr. Joannie says McGavock. “It motivated us to see a lot stakeholders from Garden Hill set out Halas, Associate Dean, Faculty of Kinesiology of hope for the future, for people facing an to determine whether a peer mentoring and Recreation Management at the U of M, overwhelming burden of chronic disease.” program called Rec and Read could help and McGavock worked with her to expand the reduce that rate by encouraging young model for the prevention of Type 2 diabetes. people to eat healthier and become more In the Garden Hill version, local high physically active, two factors associated with school students were hired to deliver a

KNOCKING New delivery method may OUT CANCER enhance treatment

Dr. Thomas Klonisch is working on a at the University of Manitoba, Stetefeld nano-tubes and be released over time. So far, research project that could one day lead has discovered that these proteins, called the team has had success in treating brain to a cure for brain cancer, one of the most “right-handed coiled-coil proteins,” lend cancer cells in the lab. “Under the right difficult of all tumours to treat. themselves to forming “tubes” that can be conditions, these coiled protein nano-tubes In fact, the project, led by Klonisch and used to convey chemotherapy using noble with platinum are highly effective in killing Drs. Jörg Stetefeld and Jerry Krcek, has metals like platinum. “These coiled protein tumour cells,” Klonisch says. already generated positive results in early in- aggregates create little nano-tubes,” says The next phase of the project involves vitro and animal testing and could be ready Klonisch, Head of the Department of Human more testing using human brain cancer cells for clinical trials within the next few years. Anatomy and Cell Science at the University in the lab to confirm the findings. Now that The research centres on the development of Manitoba’s Faculty of Medicine. “And Klonisch knows that the platinum-laden of an efficient mechanism to deliver we use those nano-tubes as carriers for proteins can kill cancer cells under certain chemotherapy to destroy brain cancer cells. chemotherapeutics,” he says. conditions, the challenge going forward Krcek, a neurosurgeon at Health Sciences The proteins are a story all on their own. will be to determine whether the delivery Centre, identifies three ways currently used “What is really fascinating about this is system can effectively penetrate the blood- to treat brain cancer – surgery, radiotherapy the tubes come from a bacterium, and the brain barrier. “The work is all ongoing, and chemotherapy. But the success of these bacterium grows near volcano-like openings and the good thing is it is all ongoing here treatments is limited, and for certain types of at the bottom of the ocean, more than 3,000 with local experts,” says Klonisch. For brain cancer there is no cure. metres below the surface. This is a harsh example, the team is collaborating with Klonisch says he, Krcek and Stetefeld hope environment these tubes are exposed to. They experts in neurosurgery, neuropathology, to change that, with the help of a family of are very resilient,” he says, explaining why pharmacology, chemistry and anatomy to proteins that can form tubes. One of these they can handle chemotherapeutic drugs. develop ideas about how to get the platinum- proteins is found in a bacterium that grows Klonisch and his colleagues have found loaded protein nano-tubes into the brain. deep down on the sea floor. different ways to make platinum used in Other experts will be consulted once the An associate professor of biochemistry chemotherapy treatments interact with the team firms up its evidence, Klonisch says.

November/December 2012 35 anitoba has a special place in the annals of modern Mmedical research history. Over the years, this province’s researchers have made major contributions in a variety of fields, ranging from the discovery of new treatments to cure disease to the development of new approaches to HISTORY OF enhance the delivery of health care. It all started more than 40 years ago with pioneers like Drs. Bruce EXCELLENCE Chown and John Bowman. In the 1960s, this remarkable duo teamed up to develop a vaccine for Rh disease, a potentially deadly disorder for fetuses By Joel Schlesinger and newborns. Their work has benefitted thousands of women worldwide, and is often cited as the single most important medical research discovery in Manitoba’s history. Manitoba researchers These scientists and many others like them have laid the foundation for Manitoba’s rich heritage in health research. While some have been have helped change the recipients of Manitoba Health Research Council (MHRC) funding, face of health care all have demonstrated the importance of home-grown research. Their contributions underscore the benefits of supporting the scientists who follow in their footsteps. Here is list of some Manitoba researchers who have played a major role in advancing the delivery of health care, not just here in Manitoba, but around the world.

Dr. Arnold Greenberg Dr. Lyonel Israels

Dr. Arnold Greenberg helped shed new light on the role of cells in Without the work of Dr. Lyonel Israels, it’s hard to fathom where preventing disease. In doing so, he helped shape modern medicine’s clinicians’ understanding of hematology would be today. The former understanding of cancer, immunology, cardiology and genetics. professor of medicine at the University of Manitoba’s Faculty of Born in Winnipeg in 1941 and educated at the University Medicine died in 2003, yet he has left a profound legacy of research of Manitoba and Johns Hopkins Medical School in Baltimore, in Winnipeg and beyond. Greenberg helped found the Manitoba Institute of Cell Biology, A founding member of the Manitoba Institute of Cell Biology, serving as its director from 1988 to 2000. Israels conducted research to build our understanding of how blood A distinguished professor at the University of Manitoba, Greenberg works on a cellular level. He explored the role of red blood cells in was one of the first to understand the molecular mechanisms at play maintaining our health and their connection to bone marrow. when a cell became damaged, eventually leading to its death. He is His studies included groundbreaking observations on the role of renowned in the medical community for discovering that human hemoglobin – which carries oxygen to cells in the body – and blood bodies have natural defences – specific immune system cells – that clotting. Most importantly, he helped provide an understanding of identify and attack disease. how these two functions of the blood become impaired by illness. Prior to his work on cellular immunology, medicine’s Israels, who was born in Regina in 1926 and obtained a medical understanding of how the immune system selected damaged cells degree from the University of Manitoba in 1949, also studied the and then induced their death was largely a mystery. His team role of Vitamin K in fetal development and tumour formation. And found the smoking gun molecule that played a central role in the as the first director of the Manitoba Institute of Cell Biology, he set cellular biochemistry – a discovery that may lead to new vaccines, its course for decades to come, advancing its role in exploring the antibiotics and treatments for cancer, heart diseases and degenerative origins of cancer, cell biology and our understanding of how the neurological disorders, just to name a few. body heals itself. Perhaps most notably, he was a dedicated mentor Greenberg died in 2001. An obituary that ran in Nature – one of and teacher who helped build Manitoba as a medical research centre the world’s leading scientific journals – called him “a beloved and for the world, including helping to establish the Manitoba Health highly admired member of the scientific community.” Research Council.

36 WAVE Dr. John Hamerton Dr. Bruce Chown

Any discussion about Canada’s most distinguished Born in Winnipeg in 1893, Dr. Bruce Chown was one of the first medical geneticists must include Dr. John Hamerton. Manitobans to make a major contribution to the world of medical research. Born in England in 1929, he arrived in Canada to carry The son of a surgeon, Chown is best known for his work on Rh disease, a out genetic research in 1969 at Winnipeg’s Children’s potentially deadly condition affecting in utero and newborn babies. Hospital. His contributions to research include uncovering Rh – or Rhesus factor negative syndrome – is a type of blood antigen, the role genetics play in pediatric illness. He also made similar to A, B, O and AB antigens. People are born either Rh positive or significant contributions to the advancement of the Human negative. When a mother and her unborn child have different Rh factors – Genome Project, which mapped the blueprint of our genes. namely the mother is Rh negative and the fetus is Rh positive – her immune Hamerton passed away in 2006, but his legacy is alive system might attack her baby. Potentially, this could lead to all sorts of and well. He helped establish the University of Manitoba’s complications in the development of the heart, lungs and brain. In some Department of Biochemistry and Medical Genetics at the cases, it would lead to death in utero or life-threatening complications after Faculty of Medicine. And he was responsible for putting birth. Chown contributed to the elimination of this threat by showing that Winnipeg on the map as a centre for serious study of the immune system was sensitized by the fetus bleeding into the mother, and human genomics – a potential treasure trove of cures for by working with Dr. John Bowman and others to develop and test a serum many of the leading causes of disease around the world. called Rh Immune globulin, which was licensed in Canada in 1968 and used A founding member and former president of the to prevent Rh disease. But the impact of his work extends beyond bedside Canadian College of Medical Geneticists, Hamerton neo-natal care. It broke ground for Manitoba’s medical community because brought modern genetic research into the centre of the he was the first from the province to complete landmark research that led to medical establishment. Without his groundbreaking work the commercialization of a major new drug – work that ultimately laid the in the study of cytogenetics – the study of chromosomes foundation for all research in the province to follow. within the nucleus of the human cell – some of the advances Chown obtained his medical degree from the University of Manitoba today in preventing in utero genetic-related diseases would in 1922. He also trained as a pediatrician at Johns Hopkins, Cornell and not have been possible. Columbia universities before taking a position as a pathologist at the Children’s Hospital in Winnipeg.

Dr. John Bowman played an important is now marketed as WinRho SDF (The role in the development of Rh Immune “Win” stands for Winnipeg). The drug is globulin in Canada, a vaccine that was used now sold in 35 countries by the Manitoba- to prevent Rh disease. based research firm Cangene. A physician and professor at the Bowman and Chown not only helped University of Manitoba’s Faculty of form of one of Canada’s largest life sciences Medicine, Bowman helped prove that Rh firms, they set a course for future researchers immune globulin could be administered to in the province, demonstrating how a a pregnant woman to prevent Rh disease. discovery could be commercialized for the The treatment could also be administered benefit of people around the world. after pregnancy as a precaution against the Born in 1925, Bowman attended Gordon woman’s body developing an immune- Bell High School and graduated with a response factor that could be passed on degree in medicine from the University of through breastfeeding to a newborn. Manitoba in 1949. In addition to his work A founding member of the Winnipeg Rh as a researcher and teacher, Bowman also Dr. John Bowman Institute, Bowman worked with Dr. Bruce practised in the Pediatric Department at the Chown to commercialize the vaccine, which Manitoba Medical Clinic. He died in 2005.

November/December 2012 37 Dr. Allan Ronald Dr. Frank Plummer

Two aspects of science make Dr. Allan Ronald’s heart Many Canadians are familiar with Dr. Frank Plummer. sing. One is making a scientific observation no one else has During the H1N1 influenza pandemic of 2009, the head of the Public made, and subsequently having it confirmed by colleagues. Health Agency of Canada’s National Microbiology Laboratory was frequently The other is mentoring up-and-coming scientists to do the seen front and centre at news conferences on TV, informing the public about same. And his heart has had plenty to sing about over a the outbreak of the potentially deadly flu. career of more than five decades. In fact, whenever a major outbreak of infectious disease occurs in Canada Born in Portage la Prairie in 1938, Ronald is a pioneer in or anywhere in the world, Canada’s own version of the U.S.’s Centers for the study of infectious disease and microbiology. Recently Disease Control is the “go-to” team in fighting it. And Plummer has been at inducted to the Canadian Medical Hall of Fame, the the helm since its founding in 2000. professor emeritus first gained recognition for uncovering Although born in Winnipeg in 1952, the world-renowned infectious disease the reasons for recurrent urinary infections and developing microbiologist did not cut his teeth here. He established himself as a brilliant effective ways of assisting women to manage this frustrating scientist in Africa in the 1980s and 1990s. There, Plummer gained world common illness. That was in the late 1960s and 1970s. recognition as a pioneering researcher in HIV, and was among the first to A few years later, he was at the forefront of research into discover that some individuals had a natural immunity to the disease. sexually transmitted diseases. During the mid-70s when Having studied under Dr. Allan Ronald, he soon took over a leading role in Winnipeg experienced an outbreak of chancroid, a sexually fighting HIV’s spread. His work fighting the disease continues today, funded transmitted bacterial disease commonly found in Africa, his by leading national and international organizations, including the Bill & team stemmed the spread by finding a simple cure, using Melinda Gates Foundation. antibiotics. Plummer describes his team’s success as a case of being in the right place That work led to an invitation to travel to Kenya to at the right time mixed with an ability to look at the problem from a different provide advice on how to treat the disease there, a place angle. Early on, for example, most experts agreed HIV was a male disease, but where it was much more widespread and problematic. Plummer and his team proved otherwise. It was during his work in Kenya that Ronald found “We were the first on the ground in Africa when HIV became recognized himself at the front lines of the HIV pandemic. Soon he as a problem,” he says. “And we thought outside the box, not ascribing to became a leading expert on the disease in Africa and helped conventional wisdom at the time.” His work has led to many new discoveries make game-changing discoveries as well as mentoring that will one day lead to an HIV vaccine. many leading lights in HIV research, like Drs. Frank Plummer, who graduated from the University of Manitoba’s Faculty Plummer and Keith Fowke – both now based in Winnipeg. of Medicine in 1976, says he is indebted to those who came before him Among the many contributions he and his disciples here in Winnipeg, scientists such as Ronald and Dr. Henry Friesen – who have made to HIV research are the importance of sex trade helped bring the national disease lab to the city. “I inherited the National workers in the spread of the disease and how circumcision Microbiology Laboratory, and together we have made it the best or as good as prevents its transmission. any disease research lab in the world.”

Key dates in Manitoba health research history

1883 1919 1944 1946 1969 1969 Manitoba Medical Dept. of Biochemistry Dr. Bruce Chown Dept. of Clinical U of M creates Manitoba Institute College is established established at the new establishes Research created Canada’s first of Cell Biology Faculty of Medicine Rh Laboratory at U of M Dept. of Immunology established

1880 1920 1930 1940 1950 1960

38 WAVE Timeline compiled by Jordan Bass, Faculty of Medicine Archivist Dr. Henry Friesen is considered one in humans, let alone that it might affect of the godfathers of medical research in female infertility. But Friesen proved Manitoba. them wrong. After developing simple In addition to making groundbreaking tests to measure blood levels of prolactin discoveries, Friesen was also one of the he found a connection between high original founders of the Manitoba Health levels of the hormone and infertility. Research Council and helped transform His work eventually revealed that the nature of medical research in this many women with high levels of country as an architect and champion of prolactin who were infertile had small the creation of the Canadian Institutes tumours of the pituitary gland that of Health Research – the leading funding produced too much of the hormone. provider for health research in Canada. Friesen went on to collaborate with Born in Morden, Manitoba, in 1934, neurosurgeons and drug companies Friesen is best known for his research on to pioneer treatment of patients with hormones of the pituitary gland, an olive pituitary tumours and elevated prolactin Dr. Henry G. Friesen sized structure at the base of the brain. levels. Either surgical or drug therapy In the 1970s, he uncovered the identity effectively eliminated the tumours, and role of a pituitary hormone called normalized prolactin levels and cured prolactin. the disorder, enabling hundreds of Initially, the scientific community thousands of women around the world scoffed at the idea that prolactin existed who were infertile to become pregnant.

the data to find answers. care had actually not been substantially Ever since, the Rooses have been at affected. It was the first major step the forefront of analyzing health-care toward making systematic data analysis data. They have pioneered new ways to an integral piece of policy planning for use information collected by not just the health-care delivery in Manitoba. health-care system but by education and Independent from the government, the social services. Noralou was quoted once: Manitoba Centre for Health Policy – now “I’ve never met a data set I didn’t want led by Dr. Patricia Martens – provides to work with.” policy advice for many of the big issues In 1991, they were involved in that challenge the health-care system, founding the Manitoba Centre for such as wait times and the effectiveness of Health Policy, at the request of then dollars spent on programs. Drs. Leslie & Noralou Roos provincial health minister Don Orchard. But the scope of what the Rooses It was a time when the health-care created extends beyond Manitoba. system was in a state of flux. Budget Ontario, British Columbia, Alberta and When Drs. Leslie and Noralou Roos were at the cuts had forced the closing of almost a Quebec all have major centres working Massachusetts Institute of Technology in the 1960s, quarter of the hospital beds in Winnipeg, with government data generated by the they could have hardly foreseen they’d become and the government wanted to know the health-care system. More recently, both trailblazers in the world of health care. effects on care. So the Manitoba Centre the United Kingdom and Australia have The married couple both got PhDs in political went to work. “There were headlines sought the Rooses’ advice as part of their science – about as far as one can imagine from health suggesting people would be dying in commitment of millions of dollars for care. In their graduate program, they were offered the streets if they couldn’t get into a setting up their own centres that use training in using computers. hospital,” Noralou Roos says. administrative data for health research. When they arrived in Manitoba in the 1970s and What they found was counter to The Rooses have worked with leading discovered that every physician visit and every hospital the conventional wisdom at the time. researchers in clinical epidemiology, admission generated computerized records for the Instead of more people dying and having health economics, health services whole population, they told Manitoba Health: tell us complications, or being unable to get research, population health, child what you want to know and we’ll figure out how to use into hospital, access to high-quality development and knowledge transfer.

1971 1982 1991 2001 2004 2008 Children’s Hospital Province creates Manitoba Centre Manitoba Institute International Centre U of M creates Foundation of Manitoba Health for Health Policy is of Child Health for Infectious Diseases Regenerative Manitoba is created Research Council created established is founded Medicine Program

1970 1980 1990 2000 2010 2020

Timeline compiled by Jordan Bass, Faculty of Medicine Archivist November/December 2012 39 MHRC: INVESTING IN YOUR HEALTH Helm Marianne Photography:

Drs. Naranjan Dhalla (left) and Pawan Singal are two of the many top-flight researchers who have been drawn to Manitoba. GLOBAL CONNECTIONS By Joel Schlesinger Manitoba’s reputation as a centre for research has attracted scientists from around the world

aranjan Dhalla was a gangly 25-year-old with dreams of a bright and health research community, one that future when he left his home in India more than 50 years ago. continues to this day. N Over the years, Manitoba has attracted Having just graduated with a science – Dhalla has advanced the understanding of dozens of brilliant minds from around degree, Dhalla first headed to the United cardiovascular disease and helped to develop the globe, thanks in no small part to the States to study pharmacology. It would turn new treatments. He has also helped put Manitoba Health Research Council. out to be a temporary stop. Winnipeg on the map as a centre for cardiac This provincial funding body for health After a few years south of the border, sciences, attracting research dollars and research has provided incentives to attract he took a position as a professor at the mentoring talented young scientists. graduate and post-graduate students from University of Manitoba’s Faculty of His contributions have not gone India, China, France, Japan, and many other Medicine. It was a fortuitous move. unnoticed – a bust of his likeness can be countries. Many are embarking on promising Over the next four decades, the slim young found in the city’s Assiniboine Park Citizens careers in medicine and science. Their work man from northern India would go on to Hall of Fame. is helping to establish Manitoba as a leader in become one of the world’s leading cardiac But Dhalla’s story is more than a tale of research in Canada and around the world. researchers. one man’s success. It is also a prime example Now in his mid-70s, Dhalla is quick to Through his work – which has been cited of the important role immigration has played credit his adopted home as a large reason for more than 14,000 times in medical journals in helping to build Manitoba’s medical his success in health research.

40 WAVE “I had an extraordinary experience living Through his work, Singal has also at the University of Manitoba’s Faculty of in Manitoba,” says Dhalla, a principal investigated the role free radicals play in Medicine. Choy’s research has provided investigator at the Institute of Cardiovascular heart failure. Free radicals are unstable insight into how fat proteins cause Sciences at St-Boniface Hospital. “People molecules that cause oxidization in cells, atherosclerosis, the leading cause of have been so kind to me; it’s unbelievable.” which is a little bit like rust on metal. cardiovascular disease. Atherosclerosis is a He also credits the MHRC for helping Singal discovered that cell damage and buildup of fatty deposits, known as plaque, to attract the best and the brightest to death aren’t necessarily caused by a lack of in the lining of the arterial walls. Part of his the province. Not only has the council oxygen. It’s often the mishandling of oxygen research has involved the medicinal uses of helped fund Dhalla’s research, it has also by the cell during times of stress that causes Chinese herbs and other natural products to helped attract and retain some of his problems. promote arterial health. colleagues, including Dr. Pawan Singal, a Like Singal, Dhalla’s research into Although he lives and works here, Choy principal investigator specializing in cell cardiovascular disease has also been still has one foot in China. And he’s a firm pathophysiology. groundbreaking. His work helped prove believer in the exchange of ideas between Singal is also from northern India and the connection between diabetes and medical communities in both nations. originally immigrated to Edmonton to work cardiomyopathy – the medical term for heart These kinds of connections can help on his PhD in physiology. He then worked tissue infections. attract funding dollars. For example, on his post-doctoral fellowship in physiology “At one time, many scientists thought Nickerson says Choy helped attract funding at the University of Saskatchewan and landed there was no connection whatsoever,” he from successful Chinese businessman Li Ka- a position at the University of Manitoba says. “Now, we know it’s a fairly common Shing’s foundation to establish an exchange in the late 1970s as a lecturer and associate complication and understand its causes.” program between the U of M and Shantou researcher. Dhalla’s team has also studied the effects University in China. Singal was just embarking on his own of hormones on the heart tissue during heart “We’ve sent our medical students to career path in research when the MHRC attacks. As well, he has been instrumental observe and learn how medicine is practised opened its doors for business. It was a case of in understanding the role of calcium and in China and they’ve sent their students to perfect timing: its funding helped keep him oxidative stress during heart attacks and do the same here,” he says. here in the province. ischemic strokes. Similar relationships are now found all “That (MHRC) grant was my seed money This work has led to the development of over the world. HIV researchers Drs. Frank in Manitoba to set up a lab,” Singal says. early drug treatment interventions for stroke Plummer and Allan Ronald, for example, have “And indeed, that funding turned out to play and heart attack sufferers in the Emergency forged very strong ties with African nations a huge role for me to bring in more funding Department, saving several thousands of like Kenya and Uganda, as well as leading from national sources.” people from life-threatening damage to their research centres in Europe and the U.S. That’s what MHRC funding is all about – hearts, brains and other major organs. These relationships have helped Manitoba getting young investigators started. They can Both Singal and Dhalla’s research has earn a stellar reputation as a research launch their research, get some early results, had enormous impact at home and abroad. centre, and have helped attract top experts, and that promise attracts money from larger Singal organized the Winnipeg Heart including Dr. Jean-Eric Ghia. funding sources. International Conference in October 2011, Ghia is one of the world’s leading That concept worked very well for Singal. partly supported by the MHRC. The focus researchers in inflammatory bowel disease, Today, he is the Director of the Institute of the conference was to bring back former studying the role of the neuro-endocrine of Cardiovascular Sciences at St-Boniface trainees and collaborators to Winnipeg. system – basically the systems regulating the Hospital Research and a leading researcher A total of 300 delegates came from 23 brain and the body’s hormones – in digestive in cardiac cell biology. countries, representing a direct impact of disorders like colitis and Crohn’s disease. “My budget, from that start of $10,000, has their training in Winnipeg. “We’ve had students come from around grown to as high as $400,000 annually,” he Like many other researchers who have the world,” Nickerson says. “They come says, noting that much of the money comes come from other parts of the world, received here to complete their degrees and then they from sources such as the Canadian Institutes MHRC funding and established themselves go back to their home countries to set up for Health Research, Heart and Stroke as top-notch scientists, Dhalla and Singal their research labs, and certainly, we have Foundation of Canada, and Canadian Breast are also mentors, educators and benefactors. researchers in Manitoba who have research Cancer Foundation. They want to share their knowledge with the projects set up around the world.” The return on investment in both Dhalla rest of the world – and in particular, with And today, as in the past, many got their and Singal’s instances has been remarkable, their country of origin. start in part because of funding from the as they have both helped to advance This is not unusual, says Dr. Peter MHRC. It’s a pattern that will likely only medicine in their respective fields. Nickerson, Associate Dean (Research) at become more pronounced in the future as Singal, for example, has spent much of his the University of Manitoba’s Faculty of word spreads about the province’s reputation career studying how heart tissue cells die. Medicine, and a member of the MHRC’s as a place for nurturing aspiring world-class Typically, when heart muscle cells are starved board. Researchers from other countries medical scientists. of oxygen, they become damaged. They who come to Winnipeg often help build Certainly, attracting top talent is great do not regenerate and most often quickly relationships with other research centres and for our health-care system. But it’s more die. This leads to heart failure – the heart universities around the world. important than just the local effect, Singal muscle’s capacity is reduced so it’s less able He cites the example of Dr. Patrick says. “It’s about bringing up the level of health to pump blood to provide the needed supply Choy, a cardiovascular health researcher research around the world and growing the of nutrients to the rest of the body. and a former associate dean (Research) global brain capital in fighting disease.”

November/December 2012 41 MHRC: INVESTING IN YOUR HEALTH

RESEARCH CENTRES, INSTITUTES & GROUPS esearch centres, institutes and shared facilities promote the exchange of ideas and provide collaborative research environments that stimulate multidisciplinary research and development. They also afford novel training opportunities for Rstudents and are valuable resources for the community at large. Here are some of the Winnipeg health-related research centres, institutes, groups in Manitoba:

UNIVERSITY OF MANITOBA, FORT GARRY CAMPUS Richardson Centre for Functional Foods and Nutraceuticals Manitoba Centre for Nursing and Health Research (MCNHR) Brooklands The Centre on Aging

UNIVERSITY OF MANITOBA, BANNATYNE CAMPUS 180 Centre for Aboriginal Health Research (with Health Sciences Centre) Centre for Global Public Health Centre for Human Models of Disease Sargent Park Centre for Professional and Applied Ethics Manitoba Centre for Health Policy

Manitoba Institute for Child Health 85 Manitoba Centre for Proteomics and Systems Biology (with Health Sciences Centre) Centre for Regenerative Medicine Great-West Life Manitoba Breast Cancer Research and Diagnosis Centre 1 (with CancerCare Manitoba) River Health, Leisure and Human Performance Research Institute Osborne Community Acquired Infections Research Group 90 Developmental Health Research Group Gastroenterology Research Group Military and Veteran Health Sciences Research Group Mood and Anxiety Disorders Research Group 95 Palliative Care Research Group Manitoba Institute of Cell Biology (CancerCare Manitoba) Spinal Cord Research Centre Grant Park Psychiatric Neuroimaging Research Group

KLEYSEN INSTITUTE FOR ADVANCED MEDICINE, HEALTH SCIENCES CENTRE 42 UNIVERSITY OF MANITOBA IN PARTNERSHIP WITH ST-BONIFACE HOSPITAL Canadian Centre for Agri-Food Research in Health and Medicine (with St-Boniface Hospital and Agriculture and Agri-Food Canada) Institute of Cardiovascular Sciences (with St-Boniface Research) 90 Centre for the Research and Treatment of Atherosclerosis Minnetonka

CONCORDIA HIP AND KNEE INSTITUTE Waverly Heights NATIONAL MICROBIOLOGY LABORATORY

UNIVERSITY OF WINNIPEG Medical and community-based health research

BRANDON UNIVERSITY Community-based health research

42 WAVE A history of health research

The Manitoba Medical College, the first school of its kind in Western Canada, was established in Winnipeg in 1883. 52 In the years since, this little school on the prairie has evolved into the University of Manitoba’s Faculty of Medicine, one of Canada’s finest medical schools, graduating more than 7,000 physicians who have gone on to become dedicated doctors and medical leaders. In addition to training the majority of Manitoba’s doctors, the Faculty of Medicine has also blossomed into one of the most important health research centres in the country, and includes 37 Chalmers research groups approved under a regional partnership program with Kildonan the Canadian Institutes of Health Research. Crossing The commitment to health research is written into the faculty’s mission statement, which says the focus of the University of Manitoba’s Faculty of Medicine is:

• To develop, deliver and evaluate high quality educational programs for undergraduate and postgraduate students of medicine and medical rehabilitation, for graduate students and post-doctoral fellows in basic medical sciences and for physicians to practice; Norwood • To conduct research and other scholarly enquiry into the basic and River 115 59 Osborne applied medical sciences; and 52 • To provide advice, disseminate information to health professions and plan for the development and delivery of health-care services 1 and to help improve health status and service delivery to the Province of Manitoba and the wider community.

52

Research is also carried out at the Brandon following hospitals and health centres.

Rosser Ave PAN AM CLINIC Princess Ave CONCORDIA Minnetonka GRACE Victoria Ave SEVEN OAKS VICTORIA 18 th St th 18 26 th St th 26 10th St 10th DEER LODGE MISERICORDIA Park Ave RIVERVIEW 10 ST. AMANT RESEARCH CENTRE

November/December 2012 43 MAPPING THE FUTURE OF HEALTH CARE BY JOEL SCHLESINGER

MANITOBANS ARE ON THE LEADING EDGE OF HEALTH RESEARCH

hen Dr. Lorrie Kirshenbaum decided to investigate how genes affect the life and death of heart cells, he came up with Wa novel approach to study the problem. First, he developed a virus. Nothing too perhaps, how to cure it. pathway that gets switched on in the heart serious – just a run-of-the-mill cold virus. Now, nearly 20 years later, the gene-in- when the cells are deprived of oxygen is the Then he took the gene in question and a-virus technique is helping Kirshenbaum same as the one that gets switched off in inserted it into the virus. Once that was take another major step towards his ultimate cancer cells,” says Kirshenbaum, who is also done, he dropped the gene-carrying bug into goal. Earlier this year, he announced that he a professor in the Departments of Physiology the heart tissue of a lab rat. had identified a series of genes that switch on and Pharmacology and Therapeutics at the Through this process, which Kirshenbaum when the heart muscle is deprived of oxygen. University of Manitoba’s Faculty of Medicine. pioneered in 1993, he was able to observe The discovery is an intriguing one. “So this research could have a major impact in how genes affect heart cells. In fact, this Learning how to prevent the genes from the treatment for both diseases.” technology allowed Kirshenbaum to be switching on when starved of oxygen could Kirshenbaum’s ongoing investigation among the first investigators to manipulate lead to new treatments to prevent damage into the life and death of cells is considered adult heart cells with certain genes that to heart muscle cells during heart attacks, world-class, and is just one example of promoted DNA synthesis and cell growth. says Kirshenbaum, who is the University the leading edge research taking place in He has also used this approach to genetically of Manitoba’s Canada Research Chair in Manitoba today. Everywhere you look, engineer heart cells with special genes that Molecular Cardiology at St-Boniface Hospital researchers working in the lab or out in the make them resistant to injury and death Research. It could also open the door for new community are pushing the boundaries of after heart attack. In effect, he created a new approaches to treating cancer. knowledge in their respective disciplines as theatre in which to study heart disease and, “What we discovered was that the genetic they map a path for the future of health care.

44 WAVE Photography: Marianne Helm tools to help them explore whole new doctoral trainees, and research associates, frontiers of medicine, including molecular are not the only ones coming up with new biology, proteomics and stem cell research. answers to old problems. Within the last “Compared to the tools that we had then, few years, the University of Manitoba’s the tools we have now are unbelievably Faculty of Medicine has opened, directly or more sophisticated,” says Nickerson, who in partnership with other groups, a number is also a member of the Manitoba Health of labs to explore new fields of medical Research Council’s Board of Directors. research. They include: He cites the case of American researcher * The Regenerative Medicine Program: Craig Venter who decided about 10 years Headed by Dr. Geoff Hicks, this lab ago to map the human genome. “That includes eight principal investigators, 36 whole exercise took about a year,” he says. graduate students, 20 technologists and Now, with the acquisition of the latest 10 post-doctoral fellows. The objective technology in the form of the AB 5500 XL is to develop stem cell therapies to treat gene sequencer, “We can do that in a week. conditions ranging from cancer to spinal It’s an explosion of capacity and speed that cord injury. is generating genetic data in a way we never * The Manitoba Centre for Proteomics could do before.” and Systems Biology: Led by Dr. John Another example is the QStar Elite mass Wilkins, this lab has seven principal spectrometer, used by scientists to analyze investigators and about 35 support staff. the makeup of proteins. The instrument is It was created to study proteins, the based on a design developed by a group led biochemical compounds that essentially by Dr. Ken Standing, professor emeritus, build every living cell. Understand how and Dr. Werner Ens, professor, in the proteins operate and you can gain new Departments of Physics and Astronomy at insights into what happens when cells the University of Manitoba. “The earlier become infected or diseased. versions of the mass spectrometer would take These groups represent a new wave of days and give us a low level of resolution (of research that is emerging in Manitoba, all of a protein). Now that we have much more it aimed at developing better care for people sophisticated machines, they are able to go in Manitoba and beyond. through the analysis much faster and with a One of the province’s more established much higher level of sensitivity. We’re able research groups can be found at the to detect low-level proteins that, before, we Manitoba Institute for Child Health. didn’t even know were there.” As the Director of Research, Dr. Terry Nickerson likens advances in research Klassen heads one of the largest research Dr. Lorrie Kirshenbaum looks on techniques to exploration of space. “It’s like organizations of its kind with more than as a computer screen displays looking at the moon through binoculars 50 200 affiliated principal investigators. He an image of a heart cell. years ago, and now you have the Hubble says the impact of research on patients telescope,” he says. As a result, scientists can be seen every day. “When you look at are better able to piece together how cells, our major themes of Biology of Breathing proteins and genes interact with each other and the Diabetes groups, what you’ll in the human body. “And it is through find is leading researchers and clinicians that interaction that we are able to actually tackling major health problems that have a think about how we might modify that tangible benefit to care here in Manitoba,” In doing so, today’s researchers are building interaction… so that in the case of cancer, says Klassen, who is also Associate Dean on the legacies of a previous generation you shut off cancer growth, or in the case (Academic) and professor of Pediatrics of Manitoba research icons, people like of auto-immune disease, you shut off the and Child Health at the University of Drs. Bruce Chown and John Bowman, auto-immune process, and have healing and Manitoba’s Faculty of Medicine. “Asthma who developed a cure for Rh disease, and recovery of normal function. In that sense, and diabetes are both huge issues in Dr. Joseph Doupe, who is credited with it is a new world,” says Nickerson. Manitoba, and we’ve been able to bring transforming the University of Manitoba’s Kirshenbaum’s work is a case in point. together the basic bio-medical researchers medical school following the Second World In order to carry out his research, he and clinicians caring for these children.” War by emphasizing the importance of first needed to develop the technology or In health research parlance, the idea research in the delivery of care. technique of dropping the gene into a virus. of gathering researchers from different But while the quest for knowledge may be as Then, using a number of highly sophisticated backgrounds under one roof is known as old as the test tube itself, there are important molecular biology techniques coupled with “clustering.” For example, the Biology of differences in the way researchers go about a laser scanning fluorescence microscope, Breathing group at MICH includes experts their work today, says Dr. Peter Nickerson, he was able to see where the genes he from completely different backgrounds who Associate Dean (Research) for the University introduced into the heart cells were located are all working on different problems. But of Manitoba’s Faculty of Medicine. and their effects on cell growth. working side by side has its benefits. Simply For example, researchers now have access Kirshenbaum and his team of 10 put, they feed off each other’s passion, to an array of technologically advanced researchers, comprised of students, post- experiences and wealth of expertise.

November/December 2012 45 As evidence of this, Klassen cites the work can be bolstered through additional funding The idea of clustering is not limited to of Dr. Richard Keijzer, who came to work and recruitment. “For us to be successful, for the hard sciences. As Nickerson points out, at MICH from the Netherlands because us to compete for federal funding, for grant community health research has become an it offered him the opportunity to run a funding, and investment by industry, we increasingly important component of health research lab and still see patients. have to be focused. And focus means getting research overall. “There are researchers who As a pediatric surgeon, Keijzer performs groups of people to cluster together and say, are looking at how social environments affect minimally invasive laparoscopic procedures ‘We’re going to work on a challenge; this is health,” he says. “How do they put people on newborn babies. But he also conducts going to be our focus.’” at risk for disease? If you can prevent those important research on lung development In addition to the Biology of Breathing situations, then you can prevent diseases problems of the fetus in utero. His group, Nickerson says there are many other from occurring in the first place.” experimental techniques will someday examples of clustering going on in Winnipeg’s He points to the example of the Diabetes lead to a less invasive treatment for what’s research community. The Cardiac Sciences Research Envisioned and Accomplished referred to as a “diaphragmatic hernia,” a group at St-Boniface Research, which includes in Manitoba (DREAM). This group of developmental defect in utero that causes the Kirshenbaum, is one example. The HIV researchers, scientists and medical doctors is lungs of newborns to be malformed, leading research group at the National Microbiology working with community outreach workers to lifelong breathing problems. Laboratory, which includes Drs. Frank and others to tackle the growing problem of Keijzer’s innovative research involves Plummer and Keith Fowke, is another. “We Type 2 diabetes among young people, mostly nano-technology. Together with Dr. clearly have strengths, areas where we have in northeastern Manitoba. In addition to the Malcolm Xing, he developed a treatment for well-established groups leading in their lab work that will help identify biomarkers the disorder using nanoparticles – which are area and who are successful at getting grant that may signal the early warning signs of essentially engineered molecules – that has funding,” says Nickerson. Type 2 diabetes, other members of the team already shown promise in the lab. A cure is The concept of clustering can also be used are looking at how other factors, such as likely still a number of years away, but in the to link researchers in different organizations. physical activity, sleep, diet and stress may meantime, Keijzer carries on as a pediatric Take, for example, a project touted by affect a child’s health. “Why is health care surgeon, helping to improve outcomes for the MHRC that involves people from the so expensive? Because we are reacting all the mothers and newborns. “He (Keijzer) is a University of Winnipeg, Health Sciences time to the diseases we are presented with as clinician who brings a very important skill Centre and the Winnipeg Health Region. opposed to investing in prevention. Those to the province,” explains Klassen. “By As Dr. James Currie, Dean of Science investigations are looking at how to help recruiting him, with a strong commitment to at the University of Winnipeg, explains, people avoid (developing disease) in the first research, the kids in Manitoba now benefit.” scientists in the university’s Physics place,” says Nickerson. Working alongside Keijzer, who was Department are working with staff from Beyond Winnipeg, MHRC is also recently named the U of M’s Thorlakson HSC and the Region on a new method of supporting health-care research focused on Chair of Surgical Research, are Xing, an producing medical isotopes that doesn’t rural areas. “Historically, most of the funding assistant professor in the Department of require a nuclear reactor. that has been provided by MHRC is for Mechanical and Manufacturing Engineering “We are creating medical isotopes using researchers based in Winnipeg, primarily at the University of Manitoba’s Faculty of a linear accelerator,” Currie says. Someday, for the University of Manitoba,” says Dr. Engineering, and an expert in bio-engineering their work may lead to a replacement for the Dean Care, acting Vice-President, Academic and nano-medicine, and Dr. Andrew isotopes produced at Chalk River, the aging Provost at Brandon University. But in Halayko, Canada Research Chair in Airway nuclear reactor in Ontario. This new method the last few years, researchers at Brandon Cell and Molecular Biology at the University will produce little waste – unlike a nuclear University’s Faculty of Health Studies have of Manitoba, Head of the Biology of Breathing reactor. Currie calls it a “green way” of received MHRC funding, which is then used Group, and a leader in personalized medicine producing the isotopes necessary for medical to leverage more funding from the national and lung disease. imaging used in mapping cancerous tumours fund providers, such as the Canadian While they’re all focused on their own and other disease. Demand for isotopes is Institutes for Health Research. specific research, their work frequently high all over the world, so it’s likely that Care is a member of the research team intersects. For example, if Halayko is innovation here in Winnipeg will benefit that has received funding from MHRC. The trying to figure out how to regenerate lung health care everywhere. team is studying the health of rural post- tissue, he may seek out the experience The U of W is also home to several secondary students at Brandon University of Keijzer, who treats pediatric patients other MHRC-supported researchers, and the University of Saskatchewan campus with lung disorders. Or Xing may develop including those working in the field of in Prince Albert. The goal is to identify ways a new form of fibre that can serve as a environmental science. “Dr. Charles Wong is to help students avoid developing unhealthy framework to create living airway tissue in a Canada Research Chair in Environmental behaviours. Like the saying goes, an ounce of a lab that Keijzer and Halayko can use in Toxicology,” Currie says, adding that prevention is worth a pound of cure. their research. “That’s the very essence of Wong has recently received an MHRC The student health study is just the clustering,” says Klassen. establishment grant. He is studying the beginning. “The ‘M’ in MHRC stands The Manitoba Health Research Council, persistence and fate of man-made chemicals for Manitoba, but it has been seen as the which already plays an important role in on the environment – a subject obviously Winnipeg Health Research Council,” Care helping to fund new research in Manitoba, critical to human health.” Normally, when says. “Today, this funding support means sees merit in supporting the clustering people think of the MHRC, they might think there is more than just lip service being paid concept. As Nickerson explains, efforts of medical school,” Currie says. “But here’s to rural areas, and we see ourselves as part of are underway to develop core strengths a chemist who is also in the Department of the future of health-care research. That’s very throughout the research community that Environmental Studies and Sciences.” encouraging.”

46 WAVE MHRC: INVESTING IN YOUR HEALTH

BOOSTER SHOT

Medical research helps create a healthy economy

he first goal of health research is to find new ways to Timprove the health of individuals. But having a robust research community Innovation, and the Canada Research Chairs success rate from 90 per cent to 99 per cent. can also help boost the health of the local Program. The Manitoba Health Research “We made that our standard of care here economy, an important point that is often Council spends about $6 million a year on a decade ago,” says Nickerson. “But it did overlooked. local research. not get established right across this country Health research in Manitoba involves Nickerson says the economic benefits of until 2010. That’s a decade delay. I think hundreds of people working at various research are broad and varied. that shows you that if you are investing in institutes and centres located in various “The first thing research does is employ research and clinical development, it brings facilities, including the University of people,” says Nickerson. “It’s employing better patient care here to Manitobans Manitoba, the Winnipeg Health Region, knowledge workers in Manitoba who are sooner than in other places.” Health Sciences Centre and St-Boniface absolutely critical to our economy.” Occasionally, research can also lead to the Hospital Research Centre. Nickerson says the U of M’s Faculty creation of stand-alone companies. Research But most researchers are affiliated in of Medicine has approximately 300 lead by Drs. Bruce Chown and John Bowman some way with the University of Manitoba, investigators on staff, including many led to the development of a vaccine for Rh which also attracts the largest health research who also teach at the university and/or disease in pregnant women. That led to investment in the province. work within the health-care system. Those the establishment of a Winnipeg company In the fiscal year 2010/11, the U of M investigators will have a support staff of to make and distribute the vaccine. That received $167 million in total research graduate students, resulting in as many as company eventually became Cangene, which funding, according to Gary Glavin, Associate 1,000 people involved in research in the employs about 500 people in Winnipeg and Vice-President (Research) for the university. Faculty of Medicine alone. has two offices in the United States. About half that amount would flow One of the less appreciated aspects of But research helps the economy in other through the University’s Faculty of Medicine, health research is how important it is to ways as well. For example, researchers according to Dr. Peter Nickerson, Associate driving improvements in local care. were able to demonstrate that increasing Dean (Research) for the University of Nickerson cites as an example the work the number of kidney transplants done in Manitoba’s Faculty of Medicine. The done in kidney transplantation a little Manitoba could actually save money over rest would flow through other health- more than a decade ago. In the late 1990s, the longer term by reducing the need for related faculties, including kinesiology researchers and medical staff at Health those individuals to be on dialysis. And, of and recreation management, nursing, and Sciences Centre started work on developing course, improved treatments and care will science. a new way of testing the compatibility of often lead to helping people get well sooner Much of the money spent on research in kidney donors and transplant patients to and back to work quicker. “And that,” says Manitoba comes from sources outside the reduce rejection rates. Their new cross- Nickerson, “means that they are able to work province, such as the National Institute of matching approach, introduced in 2000, and contribute to the economy.” Health Research, the Canada Foundation for ended up boosting the kidney transplant

November/December 2012 47 MHRC: INVESTING IN YOUR HEALTH

LEADING THE WAY Today’s researchers focus on providing better care tomorrow

By Joel Schlesinger

anitoba researchers have made researchers is leading the way to better and cardiovascular disease. numerous contributions to the health care here in Manitoba and beyond. Many of the researchers working in world of medicine over the Their efforts are changing the way we Manitoba have been supported at one Myears. But there is more to come. create healthy communities for aging time or another by the Manitoba Health The research community in this seniors and improving the effectiveness Research Council. Here are just some province has never been as large or as of hip and knee replacement surgeries. of the Manitoba researchers who are vibrant as it is today. Throughout the And one day, research done here in working today to improve health care province, the work being done by local Manitoba may lead to cures for cancer tomorrow.

research into new treatments for diseases like experimental treatments work. Alzheimer’s disease, cancer and heart disease. “The use of imaging techniques such as Goertzen’s team, comprised of researchers hybrid PET-MRI allows the same subject to from Radiology, Engineering and Physics & be imaged at multiple time points to study the Astronomy, works on trying to find a better evolution of the disease and treatment process,” way for scientists to study disease in mice. To he says. “This use of imaging accelerates the do that, they are building a high resolution translation of basic discoveries in animal positron emission tomography machine – one models of human disease to implementation in that’s small enough for mice. More precisely, trials involving human subjects.” their research aims to develop small animal Goertzen’s approach merges magnetic imaging systems and multi-modality hybrid resonance imaging (MRI) and positron PET-MRI. Basically, it’s a way to look inside emission tomography (PET) – both expensive Dr. Andrew Goertzen lab mice to better understand how disease and complex technologies – into one device works and how experimental new treatments by allowing the PET system to fit inside At first glance, the University of Manitoba’s may or may not prevent or cure disease. conventional animal MRI systems such as the Department of Physics & Astronomy might This is important for one big reason: the one presently installed at the U of M. “Really, seem to have little in common with the mouse stays alive. “What this allows us to it’s a great example of the whole being greater advancement of health-care research. do is track a single animal over an extended than the sum of the parts because the types of But for medical physicist Dr. Andrew period of time in the same way that we information you get from the PET and MRI Goertzen, an associate professor in the monitor patients in a clinical setting,” says are highly complementary.” So while they’re Department of Radiology at the University Goertzen. Presently, researchers need large not building a better mousetrap, they’re on of Manitoba, the work being done by his numbers of animals with identical genetics to their way to developing a better research lab – research team could advance medical track the progression of disease and whether and pushing medical research years ahead.

48 WAVE Winnipeg orthopedic Nothing would please Dr. surgeon Dr. Eric Bohm Verena Menec more than says the auto industry has helping to make Manitoba the right idea. the best place on earth to But he’s not talking grow old. And she has spent about fuel efficiency much of her career trying to or safety. What really do just that. impresses Bohm is how A professor in the car manufacturers listen Department of Community to their customers. “When you buy a Dr. Verena Menec Health Sciences at the Dr. Eric Bohm University of Manitoba’s new car, you get those Faculty of Medicine, Menec questionnaires from the is considered a leader in working to make Manitoba “age-friendly,” dealership and manufacturer about whether you’re happy with the a term used to describe an approach to creating a welcoming purchase,” says the Director of Research for the Concordia Joint environment for the province’s aging population. Replacement Group at Concordia Hospital’s Hip and Knee Institute. As Menec explains, an “age-friendly” community is one that “The car manufacturer gets lots of good information on the quality of provides a wide range of supports. It’s about affordable and safe its product and makes changes when something isn’t working.” housing, accessible transportation and welcoming neighbourhoods Bohm liked the idea so much, he helped make it standard practice as much as it is about providing comprehensive health-care to track the results of patients receiving hip and knee replacements services. Without these basics, seniors are hard-pressed to live at the institute, which is Manitoba’s central hub for most joint healthy, fulfilled lives. replacement procedures. “It’s a bit embarrassing to say, but it’s sort “If you’re a senior and you don’t have transportation, you can’t of novel to ask health-care patients in the system whether they’re get to the health-care services,” says Menec, a social psychologist satisfied with their experience.” specializing in gerontology who has been studying age-friendly In some cases, that might not make as much sense. “Who wouldn’t programs in communities across the province. be gracious for successful life-saving surgery?” he asks rhetorically. What she’s found is that while many communities do some “But hip and knee replacement surgeries are elective operations that things very well, such as providing affordable housing, they may are done to improve quality of life, so you really want to maximize not do a good job of linking that housing with good transportation. the positive effects of the operation and minimize the possibility of “Many communities have fragmented services and we end up complications.” with people who aren’t healthy and don’t have as good a quality of Bohm says he was drawn to the Hip and Knee Institute 10 years life as possible,” says Menec, a Canada Research Chair in Healthy ago by the chance to work with patients and conduct research at Aging and Director of the Centre on Aging at the U of M. the same time. This offered the unique opportunity to improve Menec says her work aims to bring seniors, their families surgical techniques and the effectiveness of implants, reduce wait- and government departments together to create an age-friendly times and make the experience of patients the best it can be. Since province that will improve the well-being of aging Manitobans. It’s he arrived, the institute has set up a wear-and-tear lab to test new a multi-pronged approach for preventive health care, making sure implants, and, in 2005, a Region-wide registry was created to track every Manitoban and government department understands the patients who’ve received the procedures. All these initiatives have one connection between healthy communities and healthy seniors. overarching goal: helping knee and hip replacement recipients have “If seniors are healthier, they have a better quality of life and fewer complications from surgery and get back to enjoying their lives ultimately less use of the health-care system.” sooner.

November/December 2012 49 “We began looking at psychological issues lens on this issue, examining exactly what it and the experiential landscape of end-of-life,” means to patients and how it might be achieved says the Distinguished Professor of Psychiatry within our system of health care.” at University of Manitoba’s Faculty of Thanks to his research, dignity has become a Medicine. central part of palliative care. His research team His team’s research shone a light on the developed “Dignity Therapy,” a psychological need for a holistic approach to health care that intervention for patients facing the end of their addresses the physical, psychological, spiritual lives that allows them to discuss their thoughts Dr. Harvey Max Chochinov and existential needs of patients. His findings about the life they’ve lived. This approach has have changed the way the medical community been studied and adapted by many palliative cares for patients who are dying, while also care programs around the world. “It allows No one would question the common sense enhancing the quality of care for all patients. patients to leave a legacy, while enhancing their of treating patients with kindness and dignity. The Canadian Medical Association recognized own quality of life and providing comfort for But the question of just how compassion can his achievements this year by bestowing its those left to grieve their passing.” enhance experience in the health-care system highest honour, the F.N.G. Starr Award. Perhaps more than any accomplishment, has been difficult to answer. “We all ascribe to the idea that we ought Chochinov says he hopes his work has That is until Dr. Harvey Max Chochinov, the to be providing patients and their families provided evidence that compassion and respect only Canada Research Chair in Palliative Care care that is mindful of preserving dignity,” are foundational to quality medical care. And and one of the world’s top experts in palliative says Chochinov, Director of the Manitoba when patients are nearing the end, Chochinov care, started to answer the question almost 20 Palliative Care Research Unit with CancerCare reminds us that, “while dying is inevitable, years ago. Manitoba. “Our research focused an empirical dying poorly ought not to be.”

it’s a problem with your arteries,” says Pierce, the plaque build-up in arteries, and we think who is also a principal investigator at the it does this because it has anti-inflammatory Canadian Centre for Agri-Food Research in properties,” he says. “It also appears to stop Health and Medicine. something called ‘cell proliferation,’ which is Heart attacks and most strokes are caused when one cell divides into two, then into four, by blockages in the arteries. In the case of a then turning into eight, etc.” Cell proliferation heart attack, the coronary artery is partially leads to a build-up of plaque in the artery wall, blocked, limiting blood flow to the heart which in turn reduces blood flow. muscle. This can lead to heart failure and Pierce has been exploring on a molecular Dr. Grant Pierce death. level why this happens, and his team has Pierce, a professor of physiology at the uncovered many of the molecular mechanisms Cell biologist Dr. Grant Pierce has been University of Manitoba’s Faculty of Medicine, that lead to unhealthy arteries. It’s research studying the causes of heart disease for and his team have been trying to understand that could someday lead to new treatments. decades. But his focus hasn’t been so much on what leads to poor arterial health and what But their work’s potential benefits extend the organ itself as it has been on the roadways can be done to keep our vascular system in beyond treating cardiovascular disease. that lead away from the heart: the arteries. tip-top shape to reduce atherosclerosis, the “Cell growth is a central figure in just “I would say 80 per cent of heart disease leading cause of strokes and heart attacks. about every disease,” Pierce says, adding that is not a heart problem,” says the principal To that end, they’ve been working on a uncontrolled cell growth is cancer’s calling investigator at the Institute of Cardiovascular number of fronts, including studying the role card. “If we can find ways to prevent that cell Sciences at St-Boniface Hospital Research. of flaxseed in maintaining healthy arteries growth in arteries, we have a nice target for “It’s actually vascular problems, meaning and repairing damaged ones. “Flax reduces many different illnesses.”

Home isn’t just where the heart is. It’s also than in urban areas.” the basis for good mental health. Yet housing and access to social programs That’s certainly no surprise to leading remain challenges – even in a more urban researchers like Dr. Renee Robinson, an setting like Brandon, she says. “From a associate professor of Psychiatric Nursing at community health perspective, it’s not Brandon University’s Faculty of Health Studies. surprising that where you live and how you Her area of study is mental health services spend your time is more important than crisis in rural areas. And while many challenges exist intervention services because you’re not in a to provide care to people with ongoing, severe crisis all the time,” she says. mental illness in Manitoba’s more sparsely But programs for adequate housing and populated regions, they often do receive good recreation, which have been proven to reduce Dr. Renee Robinson care. “In some ways it’s considerably better acute health-care interventions for individuals

50 WAVE expectant and new mothers – and their possible, but they encountered several barriers newborns – get the health care they need. preventing them from doing so. “If you’re a “What we have found is there were high young, single, pregnant mom – already with rates of inadequate care in Inkster, Downtown kids – getting to prenatal care in the middle of and Point Douglas, which are essentially winter and then waiting awhile in the waiting the inner city areas of Winnipeg,” says the room is a tall order,” she says. Moreover, professor at the University of Manitoba’s many mothers in the high-risk group did not Faculty of Nursing. recognize the importance of getting regular Young mothers – teens in many cases medical visits while pregnant. – with low incomes were most at risk, her To address the problem, Heaman is Dr. Maureen Heaman research found. Typically during a healthy partnering with the Winnipeg Health pregnancy, mothers have between 12 to 14 Region and Healthy Child Manitoba, among Dr. Maureen Heaman began her career as a health-care visits during their pregnancy, but others, to implement three new initiatives to maternal health nurse in 1978. mothers in the inner city, among the at-risk improve access to prenatal care. One of these And maternal health has come a long way group, often had four or fewer visits. And initiatives involves integrating midwives into since the late 1970s, says Heaman, a Canadian many didn’t seek medical attention until the six Healthy Baby/Healthy Start community- Institutes of Health Research Chair in Gender final stages of their pregnancy. based prenatal programs in low-income and Health. But for Winnipeg’s lowest-income There is a reason why these women failed neighbourhoods. She says it’s all about mothers, there’s still a long way to go. to seek care, and it’s not because they wanted meeting women where they live. That’s the focus of Heaman’s most recent to have an unhealthy baby. Like all mothers, “It’s about being proactive, and seeing that research: finding new ways to help at-risk, most cared about getting the best care they get the care they need.”

(MCHP). But the Métis haven’t been the focus where the Métis became involved. Bartlett’s of any substantial health research in Manitoba. MMF team set out to develop Knowledge That is until Bartlett and other researchers at Network discussion tables involving Métis MCHP, Manitoba Health, and the Manitoba people and the health-care system across the Métis Federation (MMF) came together to province to illustrate the data with meaningful produce a comprehensive health study that is stories about the Métis people’s economic, also uniquely Métis. social and political situations. They also wanted The Profile of Métis Health Status and to learn how chronic diseases like diabetes were Healthcare Utilization in Manitoba: A affecting their health and well-being. “You’ve Dr. Judith Bartlett Population-based Study features health data got the data, which is one piece. Then you’ve from approximately 93,000 Métis and looks got the experience of the citizens, the regional Although the Métis are an integral part of at 80 different areas of health. Among other health authorities and MMF community Manitoba’s history, they have largely been things, the study shows health care for Métis services. It gives a really full picture,” she says. invisible when it comes to their health and people could be much better. “If you look at The study – referred to as the Métis Health well-being. That’s not to say they haven’t premature mortality, Métis are 21 percent Atlas – is just a start. Now, Bartlett and other received basic health care, says Dr. Judith higher (than the general population), so stakeholders are using Knowledge Networks to Bartlett, a Métis physician and associate they’re dying too soon,” she says. help address the Métis people’s health needs. professor in the Department of Community But Bartlett wasn’t satisfied with crunching “The goal for Métis is to contribute to the Health Sciences at the University of Manitoba’s numbers. “There’s not much point in that health system’s understanding of Métis health,” Faculty of Medicine, and adjunct scientist document if it’s going to sit on a shelf,” she she says. “Everything that’s done is a win-win at the Manitoba Centre for Health Policy says. The data needs to be explained, and that’s type of approach”

who suffer from mental illness, are often grow up in rural areas. They often must patchy in rural areas, and in Brandon, too – leave their homes for work, school and as her studies have discovered. But it’s not health reasons. That’s stressful enough. Add just those people suffering from acute mental the anxiety of not being able to find decent illness who lack adequate housing. shelter, and you’ve got a recipe for poor “We hear heartbreaking stories about mental health. That’s largely the reason why women who come seeking shelter who have Robinson has expanded her focus of research no choice but to return with their children recently, finding that affordable housing, to very unhealthy, even dangerous situations social programs and even health-care services because there’s no alternative,” she says. are not just good remedies for sufferers More broadly, leaving home is often an of severe mental illness. They’re a good unavoidable fact of life for most people who prescription for everyone’s mental health.

November/December 2012 51 mapping the genetics of human disease. Genomics Centre in Winnipeg – one of only At the time, it was widely thought it would four in the world. take years if not decades. But Hicks found a Today, the centre has stem cell models way to do it in a matter of days. And he has a to breed lab mice specifically designed for mouse to thank for his success. research on thousands of different human It’s a special kind of rodent – one called a genetic variations of disease. “knock-out mouse.” Hicks and his team didn’t “In the last four years, we’ve gone from a invent the knock-out mouse – a lab animal handful of knock-out mouse models being Dr. Geoff Hicks that has one of its 22,000 genes either muted available to one now being available for almost or expressed to emulate disease in humans. every gene,” he says. This has helped move Winnipeg has long been a leader in the What he did was find a shortcut to identify the research for cures from the test tube to living world of genetic research. Dr. Geoff Hicks is genes involved in the cause of disease. organisms – mice – with which we share most building on that tradition. He looked at gene sequences instead of of our genetic makeup. More than a decade ago, the Director of single genes, which advanced the hunt for the “We can now determine from studying the Regenerative Medicine Program at the genetic causes of disease ahead of schedule these mice that if you have this gene variation, University of Manitoba’s Faculty of Medicine by decades. In fact, Hicks’s work became you might be susceptible to this disease, or returned home from the Massachusetts a foundational part of genomic research that this particular treatment may work for Institute of Technology to do what many (studying all genes at the same time). And you or be very harmful,” he says. “It’s really others in the research community thought was that success helped lead to the foundation of helped usher in the age of personalized years away from being possible: functionally the world-renowned Mammalian Functional medicine.”

series of instructional videos for teachers to Kriellaars says most Canadians don’t even demonstrate how the basics of physical lit- come close to the minimum level of exercise. eracy – those chiefly being running, jumping, And a poor, life-long attitude toward fitness catching, throwing – should be taught in a starts early, often between Grades 3 and 6. If classroom. children don’t get in the habit of being active This may seem elementary – something before age 12, they likely won’t have the basic all kids should acquire naturally – but it’s physical literacy tools to maintain good health increasingly not the case. And that’s bad news later in life, he says. Dr. Dean Kriellaars for young children. It’s not just a glum prognosis for children, Studies have found that inactivity increases it’s an ill omen for our health-care system When it comes to grade school, numeracy the risk of developing many life-threatening overall. As our population ages, the health- and literacy are the first two items on the illnesses later in life, including cardiovascular care system will be increasingly stretched to learning to-do list. If Dr. Dean Kriellaars has disease, Type 2 diabetes and cancer. “Forty- provide services. his way, physical literacy will be number three two different diseases are related to a lack of Kriellaars says physical exercise is our silver on that list. physical activity,” says Kriellaars. bullet of prevention. And that regular exercise In fact, it’s very likely that will soon be the Studies have also demonstrated that ade- mindset has to start in the classroom because case at schools across Canada. The profes- quate exercise can dramatically reduce the risk the education system is the only framework sor at the University of Manitoba’s School of of many diseases. That’s 60 minutes of moder- that can widely promote physical literacy to Medical Rehabilitation is working with PHE ate to difficult physical exercise a day for kids maintain lifelong health. “If it can’t do the job Canada and Sport for Life to help foster phys- and 150 minutes every week for adults. “That for us, then we have no real way to reverse the ical literacy in curricula across the country. means you’re huffing and puffing, and those tide.” As part of the effort, he has developed a are the minimum amounts.”

suffering from painful wounds that are diabetes who have hard-to-heal skin ulcers. susceptible to infections. Liu says what makes the dressing unique is the Studies show the pain caused by removing infusion of two known antimicrobial agents – burn dressings is related to severe depression N-chloramine, used in swimming pools, and and post-traumatic stress disorder symptoms. quaternary ammonium salt, found in hand So Liu has engineered a new kind of polyester soaps. But he says his work extends beyond bandage that has hydrogel – a moisturizing bandages. In fact, his broader ambition is compound – chemically bonded to its fibres to making hospitals less prone to spreading Dr. Song Liu prevent it from sticking to the wound. infection, one surface at a time. “Hydrogel isn’t new, but the major Using similar innovative chemical Dr. Song Liu wants to make that old saying innovation here is I can grow hydrogel with engineering techniques, he aims to infuse “like ripping off a bandage” a phrase of the well-controlled thickness from the fibres of antimicrobial properties into just about every past. flexible knit fabrics to retain the flexibility of surface in a hospital setting, from privacy Liu isn’t a medical doctor. He is a textile the dressing. A good dressing must be flexible curtains to countertops. engineer and an assistant professor who has to conform to the contour of the body,” he At the same time, he says he is also working established the University of Manitoba’s says. on developing more biocompatible synthetic Medical Textile Surface Engineering Liu has proven the bandage is effective in materials for vascular grafting – used in Laboratory in its Department of Textile the lab, and the next step is to demonstrate surgeries like cardiac bypasses – which will Sciences at the Faculty of Human Ecology. its effectiveness in animal tests. If successful, last longer, lead to less scarring and reduce the And he is developing a better bandage to the bandage could be used in hospitals, burn risk of rejection. be used for burn victims and other patients wards and wound clinics treating people with 52 WAVE

balance

Laurie McPherson

A time to be Mindful Practising “presence” can help get you through the holiday season

The holiday season is quickly approaching. For many people, the holidays are a future. It also helps us to stay calm, even and you feel a pain on the side of your busy time filled with shopping, cooking, when things are not going our way. It is head. You start to worry about this pain, entertaining, and special events. Do you common for our attention to bounce from and think about how this pain could turn look forward to the holidays and then feel one thing to another. We are constantly out to be something very serious. You wish as though they just fly by in a blur and it’s thinking about things that have happened for it to go away and you feel frustrated. suddenly all over? to us, such as nasty traffic on our way to Your thoughts jump to the future and you Maybe you dread the holidays because work, a disagreement during a meeting or begin to see yourself getting bad news of all the extra demands and strain. Even the conversation we had with our child from the doctor and undergoing treatment if you don’t officially “celebrate” any before school. for a serious condition. upcoming holiday, the world becomes On the flip side, we also spend a great In a very short time you become highly a very busy place at this time of year. deal of time thinking about the future: stressed about this pain and now the Around this time, we often plan special making plans or trying to make a decision pain in your head is more intense. This treats and enjoy shared traditions with our on how to deal with a situation, from approach isn’t helpful. In all likelihood the family and friends. But with our already handling a co-worker to what we will pain was something minor and could have busy lives, it doesn’t take much before cook for supper. While we do need to disappeared as quickly as it appeared. we are “over the top,” which can lead think about these things, always focusing Mindfulness offers a different approach to harried, stressful times rather than the on the past or the future can rob us of to this same scenario. You still notice the cherished moments that we’d hoped for. experiencing and enjoying the present pain but instead of catastrophizing about One way to stay balanced over the moment. the pain and potentially making it worse, holiday season is to practise being mindful. Why is it so important to pay attention you acknowledge the sensation in your Mindfulness means paying attention, in the present moment? Being mindful head, accept that it bothers you, and keep in the present moment, and accepting helps us to become more aware of your thoughts on the present moment. You whatever is happening. Practising our mind and body, and how they are might choose to stop what you are doing mindfulness helps us to experience the connected – and to make use of that just for a brief period to let both your present moment rather than focusing on connection for our own well-being. body and mind pay attention to what is past events or getting caught up in the For example, let’s say you are at work happening. You take a few deep breaths

54 WAVE and relax your shoulders to help relieve the pain and stay calm. If worrisome thoughts start creeping into your Three-minute breathing consciousness, you notice them and watch them float on by. You refocus your thoughts on the here and now A simple mindfulness practice instead of worrying about what the pain might mean in the future. You may start to feel a bit of relief from the Take just three minutes to practise being mindful. If pain. By breathing, and staying calm and present you you can, find a quiet space where you can sit or lie are able to manage this situation in a way that is good down, relax, and close your eyes. For a moment, just for both your body and mind, and you are in a better let yourself settle in. Notice your body resting into the position to go about your day. chair. Take a couple of long, slow breaths and notice One technique for being mindful is to imagine yourself if you can relax a little. Now take about one minute to sitting on the bank of a river or stream and picture your do these three things: thoughts as leaves, floating by. You can imagine yourself A time to be sitting quietly on the shore, watching your thoughts come and go without latching on to them and having them take Notice your thoughts, emotions, and the sensations you down the river. 1 in your body. What is going on in your mind? Can In today’s busy world, there is very little time set you just notice what it is that you are thinking and let aside to enjoy a quiet moment like this. It is in these the thoughts come and go? What emotions are you quiet moments we gain perspective on our lives, see experiencing? Notice if you are happy, sad, excited, the solution to a problem or re-evaluate our priorities. bored. Without trying to change how you feel, just Mindful We also benefit from quiet times for the sake of simply notice your experience. What do you feel in your enjoying a peaceful moment. Experiencing these kinds body? Is it hot or cold? Are you tense or relaxed? Is of moments can help us to feel rejuvenated, or as some any part of your body uncomfortable? Are you hungry people like to think of it, as “re-charging” our batteries. or full? Maybe you don’t feel too much at all. That’s However you choose to spend your time, consider the ok. Just notice how your body feels right now. potential benefits of a few quiet moments in your day, every day. You may be thinking, “How can I possibly find the Now gather up your attention and focus on your time to be mindful over the holidays when I am already 2 breath. Notice where you feel your breath moving so busy?” The good news is that you can be mindful in your body. Maybe you feel it in your nostrils, at the while you are doing your regular activities. When you back of your throat, in your chest, or in your belly as are celebrating the holidays, keep your thoughts on the you inhale and exhale. For about a minute, just watch present moment and take note of the sights, sounds, tastes your breath move in and out. Each time your mind and smells that surround you. Being mindful can help you wanders off to something else, gently bring it back to notice when you are feeling overwhelmed, and when you your breath. need to slow down and be kind to yourself. Over the holidays, this might mean sharing some of the workload by suggesting a potluck rather than organizing a Finally, let go of paying attention to your breath and meal for a large group all by yourself. You might remind 3 broaden your awareness to your whole experience. yourself to keep your focus on sharing good times with Notice what is happening in your body and your mind. family and friends and not on finding the perfect gift or Without opening your eyes, notice what it feels like to baking the perfect cake. Notice if you can keep a sense be in the space you are in right now. Slowly, as you of humour and stay well by getting enough sleep. Plan are ready, open your eyes and return to the day. ahead and mark your calendar with “home time” or “relax time” so that every night doesn’t get booked up with commitments. Remember that you can become mindful and check While this has been a very brief introduction to in with yourself like this any time you like. It can take mindfulness, there are classes and workshops that offer three minutes, but you can take longer if you like. You a deeper understanding and practice. Jon Kabat-Zinn, can also do this almost anywhere. It’s nice to practise PhD developed the Mindfulness Based Stress Reduction in a quiet place with your eyes closed, but you could (MBSR) program at the University of Massachusetts also silently ask yourself these questions and take a Medical Center where they have studied the effect of moment to be mindful while you’re waiting in line at using the program for coping with stress, anxiety, pain the grocery store, when you’re sitting at your desk at and various illnesses for nearly 30 years. There are work, or as you’re walking down the street. You can books and CDs (available at your local library) and other practise being mindful anywhere, any time. web-based resources to guide people in the practice of mindfulness. Put aside your to-do list and take time for yourself this holiday season. Allow yourself to enjoy the simple pleasure of just being in the moment – it may be FYI the highlight of your day! For more information about Mindfulness Based Stress Reduction (MBSR) in the community visit: Laurie McPherson is a mental health promotion Canadian Mental Health Association, Winnipeg co-ordinator with the Winnipeg Health Region. Region at http://www.cmhawpg.mb.ca/mbsr.htm

November/December 2012 55 in motion

Kristine Hayward Six bigbig mythsmyths about physical activity What you need to know to get fit

MYTH: Wearing “rocker” shoes will firm, tone or lift your butt.

THE TRUTH: “Rocker” bottom shoes have been around for many years in a therapeutic rehabilitation setting, but have just recently jumped onto the mainstream market, making claims to tone, firm and lift. Recent studies have found there are no differences between a regular running shoe and any of the toning shoes when it comes to heart rate, oxygen consumption, calories burned or muscle activity. On the flip side, there is a great deal of evidence that “rocker” shoes may increase your risk of injury. Bottom line: Having proper footwear is important. But if you are looking to tone, firm and lift your butt, adding lunges, squats and cardiovascular exercises to your routine may be part of the answer.

MYTH: Weight lifting is only for people who want to “bulk up.”

THE TRUTH: The Canadian Physical Activity Guidelines recommend that adults lift weights at least two days a week. Resistance training or weight lifting does not always result in “bulking up.” It will increase lean muscle mass, bone density and decrease body fat which increases strength and endurance, improves balance and posture, and increases metabolism, which promotes healthy weight management. Bottom line: For muscular strength and endurance (“to tone”), use a weight that you can comfortably lift 12 to 15 times and then repeat the exercise two to three times. Living in the digital world means having MYTH: No pain, no gain. quick access to an ocean of information, THE TRUTH: The idea of no pain, no gain, originally made popular especially when it comes to matters in the early 1980s by Jane Fonda, suggests that in order to see results about your health and well-being. you must perform hard and painful exercise. Thirty years later, we know this is not true. Exercising at a moderate to vigorous intensity has many health benefits such as reducing your risk for heart disease For example, type in the words “physical activity benefits” and you and diabetes. But exercising to the point of pain is your body’s way will instantly generate more than 13 million hits. And that’s just on the of telling you that something is wrong. Internet. Every day, we are bombarded by feature stories and advertisements Bottom line: It is normal to experience some soreness when you from all media that promise to quickly whip us into shape. Some of this are just starting an exercise routine, but once your body gets used information may be valid and useful. But a lot of it can be misleading, to it, exercise should not be painful. A good way to figure out if you wrong or just plain harmful. are working hard enough, but not too hard, is to use the “Talk Test.” With that in mind, we have identified six of the more common myths When performing cardiovascular exercises like walking, dancing or about physical activity, and offer some tips on how to keep fit. cross-country skiing – you should be able to talk, but not sing.

56 WAVE MYTH: Exercise takes too much Bottom line: By combining a full body osteoarthritis, will not be reflected on a scale. time. exercise plan that includes cardiovascular and strength activities (Canada’s Physical Kristine Hayward is a co-ordinator with Winnipeg in motion. THE TRUTH: It doesn’t have to. Physical Activity Guidelines) with healthy eating activity can fit into your day 10 minutes at habits (Canada’s Food Guide), you will start a time. Make the most of coffee and lunch to see and feel all the physical, mental and breaks by being active. A 10-minute brisk emotional health benefits physical activity For reliable, credible, walk to a meeting, getting off the bus a few has to offer, which may include a flatter evidence-based physical Six big myths about stops early or fitting in a 30-minute exercise stomach. Taking a balanced approach to activity information, visit: class over your lunch break can all add physical activity and healthy eating will lead up – helping you to meet Canada’s Physical to longer lasting results and healthy weight Canadian Society for Exercise Activity Guidelines of 150 minutes a week. maintenance. Physiology (CSEP) www.csep.ca physical activity Bottom line: Make physical activity a Winnipeg in motion – www. priority. Just like you schedule a doctor or MYTH: I don’t need to lose winnipeginmotion.ca hair appointment, plan and schedule physical weight so I don’t need to be ParticipACTION – www.participaction. activity into your day to increase your physically active. com chances of success. THE TRUTH: Physical activity has benefits for everyone, regardless of your shape or size. If you are looking for a certified MYTH: 600 sit-ups will give me a A full-body workout that includes all of the fitness leader, certified personal flat stomach. major muscle groups, cardiovascular activity trainer (CPT) or certified exercise THE TRUTH: Performing exercises focused and flexibility will help you manage stress, physiologist (CEP), visit: on a problem area is known as “spot give you more energy and improve blood toning” and unfortunately doesn’t work. pressure and cholesterol. Improvements Manitoba Fitness Council Strengthening your abs by doing sit-ups is to your overall health are likely to happen www.manitobafitnesscouncil.ca or only one of many factors that will impact before you notice any significant changes to 204-235-1245 your physical appearance. whether you have a flat stomach or not. Canadian Society for Exercise Some factors are within your control, such Bottom line: Everyone can benefit Physiology (CSEP) as physical activity and healthy eating, while from being physical active. Some of the www.csepmembers.ca genetics, for example, are, unfortunately, out biggest benefits, such as reduced risk of your control. of cardiovascular disease, diabetes or

Thank you for your support, Manitoba! ask a nurse

Audra Kolesar

What to do when your baby cries

My baby cries a lot. What can the obvious causes such as hunger, baby’s clothes get wound around his I do? discomfort, over-stimulation, and fingers or toes and cut off circulation. boredom. • Temperature: Your baby may be too To say that crying is a key challenge to hot or too cold. early parenting is an understatement, • Diapers: Unless they have been trained especially when it is 3 a.m. and you Hunger: If it is possible that your baby is hungry, try feeding first. Newborns need to cry about dirty diapers or unless they haven’t gotten any sleep, and your baby have a bad diaper rash, babies generally is still crying! short (20-minute), frequent feedings. The feedings provide comfort and closeness, as don’t mind wet or soiled diapers. For well as keeping your baby’s tummy full. babies in cloth diapers, check to see if a With crying, there are no firm rules – both diaper pin has become loose. as to what causes it and what you can do to get your baby to stop. As you get Discomfort: Your baby may be bothered to know your baby, however, you will by one of the following: Over-stimulation: Over-stimulation from get better at understanding what causes • Illness: If your child is sick, there playing and handling can often cause your baby to cry and what will get her to are usually other signs, such as fever, overtiredness, which will result in crying. stop. Soon you will be able to distinguish vomiting, diarrhea, decreased appetite, Some babies like the secure feeling of hungry cries from boredom cries, hurt or a stuffy nose. Some illnesses cause being tightly swaddled in a blanket. If you cries from angry cries. And then, of discomfort without other obvious know your baby is not hungry, sucking on course, there are times when your baby symptoms. Sometimes a baby can get a pacifier or a finger (hers or yours) can will cry seemingly for no reason at all. scratched in the eye or get something stuck be just the thing to relax your baby and in their throat. Make sure your baby’s eyes put her to sleep. Why is my baby crying? look okay and that she can swallow. If you think your baby is not ill, your • Clothes: Check clothing to see if it baby may simply need to cry himself to When your baby cries, first check is too tight. Sometimes threads from the sleep.

58 WAVE Boredom: Crying can also mean that or that your own needs are no longer your baby wants a change in scenery or important. Your personal needs for activity. Babies can often be distracted by companionship, intimacy, recreation, and lively music, by you dancing with them in time alone need to be met. It is easier your arms, or by a noisy rattle or toy. Car to be patient, consistent and available or stroller rides often work wonders for to your baby when your own needs are a crying baby and for parents as well. A being met. A (constantly) crying baby can baby swing may also work. be quite stressful. Here are some tips to Since babies love to see the sights and to help you manage. GOT TOE be held close in someone’s arms, walking your baby from room to room is generally Maintain a healthy lifestyle: Eat well, get NAIL FUNGUS? a good cure for crying. Try using a front out of the house, do things you enjoy, Genesis Plus & Pinpointe Laser pack to free up your hands for little and do some form of exercise. Treatment for fungal nails and warts! chores while you are walking. (While this As seen on Good Morning America and The Doctors. is a good cure for crying, it can injure Get support: Family, friends, and your back – don’t overdo it!) neighbours can be good supports. From Relax! As you will notice, your baby can your support network, select people you tell when you are tense and will often trust who can look after your baby so you also become tense and cry. Quiet music, can get some rest. Having friends who are gentle rocking, soft singing, or talking parents themselves can provide you with often help, as does a warm bath or a social contact and allow you to talk about gentle massage. your ideas and share experiences. You can also support each other by sharing We offer only Health What is colic? care, such as babysitting for one another. Canada Approved Treatment. You can get additional support by joining Treatment may be covered Colic is a term used to describe a baby a community support group for parents. by Private Insurance. who cries daily for several hours at a Dr. Iain M. Palmer, Podiatrist time, usually at the same time each day. Get rest: Try to sleep or rest at the same Located in Parkview Professional Centre: There is no known cause and no sure time your baby is sleeping. If you can not 204-2110 Main Street | 204-697-0649 cure for colic other than time. Almost all sleep during the day, try to sit with your babies outgrow colic by three months of feet up for a few minutes. palmerfootclinic.com age. Take it slow: If you find it hard to make What if I get angry and time for yourself, start doing at least one frustrated? thing you enjoy each day – half an hour If at all possible, try to be relieved can make a big difference. often by a spouse, friend, neighbour, or relative. If your baby has been crying Relax: Learn to relax through deep and you are getting so angry that you are breathing and muscle relaxation. afraid you might hurt your baby, there are services available to help such as Breathe by taking slow, deep breaths Thinning through your nose, deep into your lungs. calling your health-care provider, Health or Hair Links-Info Santé, or the Triple P Parenting As you breathe in, imagine you are phone line. filling a balloon in your stomach. When Loss? you have taken a full breath, pause for When should I call my child’s a moment and then breathe out slowly through your nose or mouth. Make sure Evelyn’s Wigs health-care provider? to let out all the air. As you breathe out, Call if: allow your body to just let go. Imagine your arms and legs going loose like a rag Confidently Beautiful • Your baby seems to be ill or in pain. doll. For convenience or necessity • Your baby has cried constantly for two The First and Original Wig hours or more. Try to relax through the day by loosening Service for WOMEN of all Ages • You are feeling angry, resentful, or up any tense muscles. Find a quiet exhausted and you are afraid you might spot where you are not going to be The Ultimate in Fashion Hair hurt your baby. interrupted. Get comfortable by loosening DESIGNER Wigs, Hairpieces your clothes, removing your shoes, and and Modern Headwear It is important to take care of yourself taking off your glasses if you wear them. 28 years of Professional Consultations Empathy and Respect to Every Client to be better able to care for your baby Sit with your legs uncrossed, your feet flat Privacy and Confidentiality Assured and respond to challenging parenting on the floor, your head held straight and situations in a constructive and non- your hands resting on your thighs. Tighten hurtful way. then relax each part of your body while 204-878-2351 by appointment keeping the rest of your body relaxed. Being a good parent does not mean that When you tense one part, feel the tension www.evelynswigs.com your baby should dominate your life build up, hold it for 10 seconds and

November/December 2012 59 draft feb 14th, 2011 notice where it is particularly tense. Release the tension How to be a positive parent slowly so you can identify the muscles that are relaxing and notice how it feels, then relax for 20 seconds and enjoy the The Positive Parenting Program (Triple P) is a preventively pleasant feeling. oriented program that aims to promote positive, caring You can also try other relaxation techniques such as taking a relationships between parents and their children, and help warm bath, listening to relaxing music, etc. parents manage a variety of child behavioural problems and common developmental issues. Take care of your relationship: If you are in a two-parent family situation, take care of your relationship. Show care Triple P consists of five key parenting principles: and respect for each other, and make an effort to do the things you used to enjoy before having a baby. Make time Having a safe, interesting environment to do special things you like to do as a couple, such as Accidents in the home are the leading cause of injury in young working on a project together or going on a date. children. Recognize warning signs: Seek professional help if you Children need a safe environment to explore and play where the notice signs that show you are not coping well with a risk of accidents happening is low. crying baby or your role as a parent (e.g., frustration, losing your temper, feeling hopeless or out of control). For more Having a positive learning environment information contact the Triple P Parent Line at: 204-945- Parents need to be available to their children. This does not 4777 or 1-877-945-4777. mean being with your child all the time, but it means being available when your child needs help, care, or attention. Audra Kolesar is a registered nurse and manager with Health Responding to child-initiated interactions creates the opportunity Links - Info Santé, the Winnipeg Health Region’s telephone for parents to have brief periods of uninterrupted time for health information service. This column was written in conversation, affection, positive attention and praise. consultation with Thania Martis MHP, who is a consultant with the Triple P Program. Using assertive discipline When parents use assertive discipline children learn to accept responsibility for their behaviour, to be aware of the needs of others and to develop self-control. Having realistic expectations Parents’ expectations of their children can influence the relationship between parent and child. These expectations depend on what parents consider normal for children of different ages. Yet, children are individuals and develop at different rates. Children need to be developmentally ready before they can learn new skills. Parents who expect “too much too soon” from their child, or who strive to be perfect, can create potential problems. Taking care of yourself as a parent The information for this column is provided by Health Links Parenting is easier when personal needs are met. This may - Info Santé and the Triple P Parenting Program. It is intended require parents to be away from the parenting role from time to None of us can predict what tomorrow may bring. Make sure your to be informative and educational and is not a replacement time. health care wishes are known. Consider what’s important to you and for professional medical evaluation, advice, diagnosis or discuss it with your loved ones and your health care team to help treatment by a health-care professional. You can access health For more information on how to become a positive parent, call guide future decisions about your health care. information from a registered nurse 24 hours a day, seven days the Triple P Parent Line at: 204-945-4777 or 1-877-945-4777. a week by calling Health Links - Info Santé. Call 788-8200 or toll-free 1-888-315-9257. think about your values, your beliefs and what’s HEALTHSTARTSATHOME Convert your existingg bathtub into important to you.

Services Include: Step-in Bath • Nursing talk to your family and • Corporate Wellness • Done in one day those close to you about your • Mantoux Testing • Landlord approved future health care choices. • Immunizations • Government • Flu Clinics funding with Victorian Order of Nurses • URIS restrictions the information share for a free copy Main Floor Winnipeg Clinic • SMART 204-997-7249 with your health care team. 425 St. Mary Ave. Winnipeg • Home Support of your advanced care 204-775-1693 • Foot Care planning workbook please visit www.walkthrubathtub.com www.winnipeghealthregion.ca/acp draft feb 14th, 2011

None of us can predict what tomorrow may bring. Make sure your health care wishes are known. Consider what’s important to you and discuss it with your loved ones and your health care team to help guide future decisions about your health care.

think about your values, your beliefs and what’s important to you.

talk to your family and those close to you about your future health care choices.

the information share for a free copy with your health care team. of your advanced care planning workbook please visit

www.winnipeghealthregion.ca/acpNovember/December 2012 61 recipes LIKE Banana bread EAT Makes one loaf (12 slices) A Ingredients CHAMPION ½ cup canola oil (125 ml) ¾ cup white sugar (175 ml) Jeff Stoughton Winnipeg, MB 2 eggs World Champion 3 medium-sized bananas, mashed 1996 and 2011 1 tsp vanilla (5 ml) Curling 1 cup all purpose flour (250 ml) ½ cup whole wheat flour (125 ml) A hearty, pork-based 1 tsp baking soda (5 ml) soup or stew that’s ¼ tsp salt (1 ml) “ high in protein Pre-heat the oven to 350°F (180°C). Line a loaf pan with keeps me feeling parchment paper or grease with oil. In a large bowl, cream full longer so I can together the oil and the sugar. Add the eggs, bananas and focus on a winning vanilla and mix well. Add all the dry ingredients and mix until just combined. Do not over-mix. Pour the batter into the loaf pan and performance. bake for 1 hour and 15 minutes or until a toothpick inserted into the centre comes out clean. Lift the loaf out of the pan and put it ” on a rack to cool. Substitutions Hearty Substitutions: • Use any type of vegetable oil instead of canola oil. Italian Soup • Instead of 2 eggs, mix 2 tbsp ground flaxseed with 6 tbsp warm water in a small bowl. 1-2lb/0.5-1.0kg 1-19 oz / 540 mL can Trim roast of any visible fat; except spinach; bring Let it stand for a few minutes to gel. Canadian pork loin roast ‘no salt added’ diced cut into ¾"(1.875 cm) cubes. to a boil. Lower heat tomatoes, undrained • Use 1½ cups of all-purpose or whole-wheat flour instead of a 2 tsp / 10 mL canola oil Heat oil in a deep saucepan and allow soup to simmer, combination of the two. 1 small onion, chopped 1-19 oz / 540 mL can over medium-high heat. about 15 minutes. Stir Romano or white kidney Brown pork cubes and in shredded spinach; 1 tsp / 5 mL Italian seasoning beans, drained and rinsed Tip: Overripe bananas that have been frozen work well in baking onion. Add Italian seasoning. cook 2 minutes more. 3 cups / 750 mL 8 oz / 227 g fresh spinach loaves and muffins. When onions are soft, add sodium-reduced chicken broth leaves, shredded Serves 8-10 remaining ingredients, Nutrients per serving (1 slice) Nutrition Information: Per 1 person serving Calories: 237 Calories 174.0 kcal, Fat 4.2 g total fat (1.2 g saturated, 1.9 g monounsaturated, 0.7 g polyunsaturated), Carbohydrates: 32.1 g Carbohydrates 17.4 g, Protein 17.3 g, Fibre 4.8 g, Sodium 213.5 mg, Cholesterol 24.9 mg Calcium: 9 mg Scan for more Information Fat: 10.7 g Fibre: 1.5 g Iron: 0.9 mg Sodium: 165 mg Protein: 3.2 g Source: Winnipeg Health Region Fueling Today's Athletes

62 WAVE This symbol indicates a recipe or menu item is a healthy choice for athletes. porkforpeakperformance.ca EAT LIKE A CHAMPION Jeff Stoughton Winnipeg, MB World Champion 1996 and 2011 Curling

A hearty, pork-based “ soup or stew that’s high in protein keeps me feeling full longer so I can focus on a winning performance. ”

Hearty Italian Soup

1-2lb/0.5-1.0kg 1-19 oz / 540 mL can Trim roast of any visible fat; except spinach; bring Canadian pork loin roast ‘no salt added’ diced cut into ¾"(1.875 cm) cubes. to a boil. Lower heat tomatoes, undrained 2 tsp / 10 mL canola oil Heat oil in a deep saucepan and allow soup to simmer, 1 small onion, chopped 1-19 oz / 540 mL can over medium-high heat. about 15 minutes. Stir Romano or white kidney Brown pork cubes and in shredded spinach; 1 tsp / 5 mL Italian seasoning beans, drained and rinsed onion. Add Italian seasoning. cook 2 minutes more. 3 cups / 750 mL 8 oz / 227 g fresh spinach When onions are soft, add sodium-reduced chicken broth leaves, shredded Serves 8-10 remaining ingredients,

Nutrition Information: Per 1 person serving Calories 174.0 kcal, Fat 4.2 g total fat (1.2 g saturated, 1.9 g monounsaturated, 0.7 g polyunsaturated), Carbohydrates 17.4 g, Protein 17.3 g, Fibre 4.8 g, Sodium 213.5 mg, Cholesterol 24.9 mg Scan for more Information

Fueling Today's Athletes

This symbol indicates a recipe or menu item is a healthy choice for athletes. porkforpeakperformance.ca Pork is a powerhouse of nutrition. It provides high-quality Manitoba Pork’s generous protein, energy and many financial support of the Canadian “ Jeff Stoughton of the important vitamins Sport Centre Manitoba allows athletes Winnipeg, MB and minerals required like myself and my team to reach World Champion 1996 and 2011 for optimum health. our maximumum p potential.otential. ” CCurling

Fueling Today'soday's Atthleteshletes

This symbol indicates a recipeor menu item is a healthy choice forr athletes. porkforpeakperformanceakperformance.caca