Mark Opauszky exercising on the streets of Toronto (photograph by Kevin Van Paassen)

In February 2019, Mark Opauszky flew down to New York for what he thought would be a quick business trip. The Toronto-based CEO and founder of a rapidly growing marketing automation company was scheduled to present at a conference and take in a few sales meetings.

Two days in, Mark fell suddenly, severely ill. With a fever spiking and on the brink of losing consciousness, his business partner rushed him to a Manhattan hospital. Mark emerged several weeks later from a medically induced coma to discover he had developed necrotizing fasciitis, more commonly known as “flesh-eating disease,” and it had brought him to the brink of death.

“I found out later that my probability rate of survival had been in the 5 per cent range,” says Mark, now 51.

The full extent of Mark’s ordeal reads like the plot of a horror movie. Necrotizing fasciitis is a disease in which bacteria infects the connective tissue, or fascia, under the skin. The disease rapidly kills the tissue, causing it to peel, blister and turn black as it dies. Most often caused by Group A streptococcus bacteria (the same bacteria that causes strep throat), it usually enters the body through a break in the skin like a cut or scrape.

Mark’s strain of necrotizing fasciitis resulted in septic shock, a worst-case scenario where the major internal organs begin to shut down and blood pressure dips dangerously low. In order to save his life, surgeons were forced to cut away a vast quantity of Mark’s muscle and flesh to remove damaged tissue, exposing some limbs down to the bone.

The New York team had saved Mark’s life. But by the time he arrived via air ambulance at Sunnybrook’s Ross Tilley Burn Centre four weeks later, Mark says he was in extremely rough shape.

“They did what they did [in New York] and then they sort of shipped me back to Toronto in pieces,” he says.

Mark in his room at Sunnybrook’s Ross Tilley Burn Centre, a few days after his arrival.

THE JOURNEY BEGINS

Mark’s arrival at Sunnybrook was the beginning of a long healing process that would involve multiple surgeries on his limbs, extensive rehabilitation and an extreme level of determination. Mark went through eight surgeries over four weeks at the Ross Tilley Burn Centre, including the amputation of several fingers and toes. He was then transferred to Sunnybrook’s St. John’s Rehab to begin the next phase of recovery.

St. John’s Rehab is renowned in Canada for its personally tailored programs that incorporate multidisciplinary teams to treat complex medical traumas, such as burns, falls, limb loss and vehicular accidents.

Multidisciplinary teams at St. John’s Rehab include physicians, nurses, physical and occupational therapists, prosthetists, speech-language pathologists and dietitians to support patients back to previous daily functioning. Equally important are psychologists, social workers and spiritual care providers to support the mental and emotional aspects of recovery.

“We use a holistic approach to care that focuses on the mind, body and spirit of each person,” says Dr. Amanda Mayo, physiatrist (rehab specialist) at St. John’s Rehab. “It’s one thing to save a life, and it’s another to rebuild that life in a way that is meaningful for that person.”

Mark’s program involved a rigorous schedule of cardio and calisthenics designed to rebuild atrophied muscle. Physiotherapy and occupational therapy helped him start walking again and learn how to use his injured hands. He also required regular massage and stretching for his limbs due to the volume of skin grafts he’d received – an extremely painful procedure.

For the entire duration of his stay at Sunnybrook, Mark says he didn’t once turn on his phone or watch TV. A tech entrepreneur who had previously been perpetually plugged in, Mark transitioned to a near meditative state that allowed him to focus on healing.

“It was me and my brain and my time, and that’s all I did,” he says. “I would spend hours just picking one body part at a time to concentrate on. Or I would open and close my fist because I was trying to get my fingers to work again.”

Doctors anticipated Mark’s in-patient stay at St. John’s Rehab would take eight weeks. He walked out the front door two weeks later. Mark says his quick recovery time was a combination of the outstanding care he received and the extreme discipline he had maintained in his previous life as a high-functioning CEO.

“I would get up in the middle of the night, get my walker and do laps around the nurses’ station at 2 a.m.,” Mark says of his time in rehab, noting that he was motivated by his desire to get back home to his wife, Danielle, and his two children.

ONE MORE STEP

In October, Mark returned to the Ross Tilley Burn Centre for a final amputation of his lower left leg. He had a bone infection, his left foot wounds weren’t healing and despite a top-of-the-line orthotic to offload his painful foot, he was in constant pain.

Dr. Mayo says she recognized that Mark’s left leg below the knee might need to be amputated due to the extensive damage back when he first arrived at the Ross Tilley Burn Centre. But she also understood how important it was to his emotional recovery to give him the opportunity to make that decision on his own time.

“Limb loss is a life-changing event. A lot of patients with chronic infections have to go through this journey and they go through multiple treatments or surgeries that can become quite draining,” says Dr. Mayo, who led Mark’s limb-loss rehabilitation team. “And then they realize, ‘I’m actually better off not having the foot. The foot is painful. This foot has wounds. I can’t walk on this foot.’ And Mark came to that decision.”

The left below-knee amputation surgery, led by plastic surgeon Dr. Alan Rogers, proved successful and has improved his quality of life, Mark says.

He began outpatient rehab at St. John’s Rehab to learn how to use his new prosthesis. Esther Chung, Mark’s physiotherapist, says that Mark’s dedication was a key factor in his specific recovery.

“Mark is very strong mentally, and I think it helped him progress,” she says. “He also had a strong support network of family and friends, which is important to maintain motivation over the long run.”

Dr. Mayo agrees that mindset and attitude are crucial aspects of the rehab process at St. John’s Rehab.

“A patient’s perseverance is very important,” she says. “Somebody who’s very active and doesn’t have any other medical comorbidities should be going back to most of the activities they did before, [only now] wearing a prosthesis or maybe [using] some adaptive equipment.”

Today, Mark is thriving. He is adjusting to a new normal that seems much closer to his previous life than he had initially imagined.

“I lift weights. I have a treadmill. I started [martial art] Muay Thai again. I’ve been learning to be a bit more agile on my limb,” he says. “I don’t even walk with a limp anymore. Some people can’t even tell that I’ve lost a leg.”

Feeling immense gratitude to his Sunnybrook team, Mark says he is inspired to give back.

“I would very much like to transition from just being a patient to being somebody who can contribute to the [organization] in some way, shape or form,” he says.

HEALING THROUGH MINDFULNESS

How much does your state of mind dictate how well you heal?

At his Sunnybrook lab, physiatrist and researcher Dr. Robert Simpson develops mindfulness and yoga programs for patients with disabling long-term conditions, including multiple sclerosis, stroke and amputations.

“There’s now robust, high-quality evidence for mindfulness improving mental health outcomes – mainly stress, anxiety and depression. There’s also fairly robust evidence that it leads to beneficial changes in cognitive function and probably pain,” says Dr. Simpson, who is trained to teach both mindfulness and Hatha yoga.

Mindfulness can be defined as the act of paying attention to the present moment, non-judgementally. It is often taught through guided meditation practices that focus on the breath and sensations within the body.

The concept hit the North American mainstream in the late 1970’s when a program called Mindfulness-Based Stress Reduction (MBSR) began to infiltrate medical and wellness circles as a treatment for chronic pain and stress. The program had been adapted from Buddhist and Yogic principles by U.S. medical professor Jon Kabat-Zinn.

Dr. Simpson says he considers a host of factors when deciding who might benefit from a mindfulness-based intervention (MBI). For example, someone with an amputation who also has conditions like diabetes, high blood pressure and depression may face more challenges with rehab than someone without these conditions.

That’s why a combination of personalization, education and support are key to improved results, he says.

“Humanistic factors like encouragement, empathy, compassion, understanding – I think these are all really important factors, and different people likely need different ‘doses’ of these things.”

The post One man’s journey after a battle with ‘flesh-eating disease’ appeared first on Your Health Matters.

There was a time when Alan MacDonald was too traumatized to discuss some of the details surrounding the October 2018 accident that left him with severe electrical burns over 13 per cent of his body.

As part of his recovery program at Sunnybrook’s Ross Tilley Burn Centre, Alan has spent the past year in treatment with Dr. Sam Iskandar, a clinical psychologist at St. John’s Rehab.

Dr. Iskandar diagnosed him with post-traumatic stress disorder (PTSD) resulting from the event. PTSD is a condition that can cause symptoms such as recurrent flashbacks, nightmares, intrusive thoughts, extreme anxiety and depression, all manifested differently through the filter of each survivor’s individual psychology and life experiences.

Alan can now speak about his accident with an astonishing degree of openness. It’s a tribute, he says, to the work he’s done with the Sunnybrook team that took his emotional health as seriously as the repair of his body.

“You have to get to the point where the more you talk about it, the better you feel,” says the Bradford, Ont., resident.

The life-changing incident happened one morning at a strip mall in midtown Toronto. Alan, an electrician and business owner, had been called in with his team to help solve a problem resulting from a proposed electricity shutdown. A new bank branch was scheduled to go into the mall, and in order to safely install a new electrical disconnect, the power had to be shut down for four to six hours, which was not sitting well with the other mall tenants, who complained the outage would impact their businesses.

Alan agreed to inspect the site to see if they could manage the installation without shutting off the lights. Against his better judgment, he removed the electrical panel to install the new disconnect. He was alone in the room with the door closed due to the potential danger of the task.

“You have to get to the point where the more you talk about it, the better you feel.”
– Alan MacDonald on the 2018 accident that resulted in severe burns

“The next thing I knew, there was an explosion,” Alan says. “[It] knocked me into a pipe, where I hit my head pretty hard.” The culprit was a faulty disconnect, but that would only be discovered much later. At the moment, Alan had no clue what had happened and that he’d been hurt.

“I came out the door, and my guys are just staring at me; these big, broad guys were like, ‘Oh my God,’” Alan recalls. “I looked down, and my entire shirt was gone – just disintegrated. The only thing that was left was the zipper that went down halfway. The flesh was gone. My face was black. Then I had what looked like a piece of plastic stuck to my hand from the thumb down to the wrist, so I pulled it off. And that’s when I realized that wasn’t a piece of plastic. It was my skin.”

Alan’s team insisted on calling an ambulance. But Alan was in shock – he didn’t register any physical pain and, in fact, felt it was his responsibility to go right back in and fix the power outage.

He was rushed to the Ross Tilley Burn Centre. “I got in the ambulance and closed my eyes,” he says. “When I woke up, I was in a hospital room, and the doctor told me I was going to be okay.”

The surgical team treating Alan at the burn centre was led by Dr. Marc Jeschke, director of the Ross Tilley Burn Centre and a highly regarded surgeon and research scientist. Dr. Jeschke assessed Alan’s injuries, which included “significant” electrical burns, corneal abrasion due to the flash, and a torn rotator cuff.

Dr. Jeschke and his team performed multiple surgeries and skin grafts to repair the damage to Alan’s body. Dr. Jeschke also understood the mental toll the injuries would take on Alan and his family, and so he built a recovery program that went beyond the physical.

“Mental health is still completely under-appreciated,” says Dr. Jeschke. “I think that that’s something to emphasize – we are lucky we have access to psychiatry at Sunnybrook, and that we have access to psychology and psychiatry at St. John’s Rehab.”

Alan was referred to the in-patient burn rehabilitation program at St. John’s Rehab, the only such program in Canada. Its holistic approach to healing the mind, body and spirit has brought the centre international acclaim.

At St. John’s Rehab, survivors of burns, amputations and other grievous injuries have access to resources, including occupational therapy, clinical psychology and massage, that are critical to recovery. Alan worked with Dr. Iskandar, in addition to his own psychiatrist, to help him through the stages of emotional recovery and to adjust to his new life.

One of Dr. Iskandar’s main therapeutic tasks was to prevent Alan from slipping into long-term depression. He says that in many cases, even well-meaning people tend to focus on the fact that someone has physically survived a major physical trauma and are surprised to see that the person has become more taciturn and withdrawn.

“People with PTSD will continue to try and avoid people and situations that remind them of their trauma. In the case of burn injuries, that can be a barbecue, a cigarette, people associated with the event,” Dr. Iskandar says. “And then the more they avoid, the less fulfilling their life becomes, and the more depressed they may feel.”

Dr. Iskandar points out that a major injury can also have a significant impact on the survivor’s family. Someone with PTSD may not have the same capacity to deal with the daily stressors of parenting and relationships that they did before their injury, and the requirements for their care can be emotionally and physically draining for family members.

Alan says his wife, Tara, has been his “rock,” and that his three daughters have been immensely strong and supportive. But the year has brought its share of challenges at home. Once the “life of the party,” Alan became more withdrawn and occasionally angry. In March 2019, Alan spiralled into a depression while coming off his pain medications. He also experienced some mental health challenges months later, following surgery on his shoulder.

These types of setbacks are not uncommon on the road to recovery from traumatic injuries. But Dr. Iskandar notes that to the people directly affected, they can be overwhelming and trigger fear that it will be like this for the rest of their lives.

At Dr. Iskandar’s suggestion, Alan and Tara have sought out family counselling, and both are doing well. At some point in the future, Alan is planning to return to work. He says the care he has received at the Ross Tilley Burn Centre and St. John’s Rehab has given him a good shot at resuming a full life again.

“The team at Sunnybrook was just incredibly helpful,” Alan says. “The support you get there really, really makes you feel like you’re on the right track, like you’re on the road to recovery.”

The post Recovery for the body and mind: Sunnybrook’s holistic approach to PTSD treatment after traumatic injury appeared first on Your Health Matters.

When Toronto business owner Rael Herman turned 50 last year, his wife, Andrea Shugar, went all out with a gift to mark the occasion. She visited a high-end cycling shop and bought a “dream” customized bike that she knew Rael, an accomplished cyclist, would love. 

With its baby blue frame, electronic shifters and disc brakes, the bike was a huge hit.

Beyond its smooth ride and state-of-the-art lines, the bike was a crown jewel in Rael’s history with the sport. When he was first diagnosed with brain cancer at age 35, he took up cycling in order to improve his physical and mental recovery from chemotherapy. He often participated in charity rides to raise funds for cancer research. Over time, cycling would become a passionate hobby – one that he loved to share with his family. 

“Throughout the summer, we had the opportunity to cycle together [all over],” Andrea recalls. They toured through some of the country’s most beautiful landscapes – the Kawarthas and Haliburton Highlands in Ontario, the Laurentians in Quebec.

Sadly, the couple’s enjoyment was brief. Rael had been diagnosed with a brain tumour again earlier that year. By the end of the summer, the tumour was no longer responding to treatment and he was unable to ride. In March 2019, he died of brain cancer. 

First diagnosed in 2004, Rael responded well to a year of initial treatment and was able to live a full, happy life in remission. Thirteen years later, a routine MRI revealed that Rael’s cancer had returned, this time as glioblastoma. This is an aggressive, incurable form of brain cancer that is difficult to treat because the tumours are inherently resistant to radiation and chemotherapy. 

“One day, about a month before he passed away, [Rael] asked me to put his bike components onto my frame, so that he could continue riding with me even after he was gone. I promised him that I would,” Andrea says.

On June 23, Andrea brought their bike to the second annual Rael’s Ride, a fundraiser to support brain cancer research at Sunnybrook. Andrea was joined by her two children, Rael’s siblings, parents, nieces, nephews, cousins, friends and hundreds of people who signed up to ride in Rael’s honour.

The ride includes 10-kilometre, 25-kilometre and 60-kilometre circuits, starting at the North Thornhill Community Centre and ending with a kosher lunch at the finish line. The goal is to help fund research trials run by Dr. Arjun Sahgal, a scientist and radiation oncologist at Sunnybrook.

The trials involve the MR-Linac, the world’s first magnetic resonance imaging (MRI) machine that uses real-time guidance to allow surgeons to both precisely target and monitor the tumour’s response to radiation. Dr. Sahgal says the MR-Linac may offer patients with the most complicated tumours a better outcome than more traditional therapies. 

Dr. Sahgal had treated Rael with another experimental and aggressive program in 2018 after treatment elsewhere stopped working. 

“We were able to control the cancer for longer and extend Rael’s life. He had a dramatic improvement [with] the treatment,” he says.

Rael’s family hopes the $70,000 raised to date through their fundraiser can accelerate Dr. Sahgal’s experimental trials and someday propel the technology into wide use around the world. 

Rael Herman rides his bike during the first-ever Rael’s Ride fundraising event (Photography by Kevin Van Paassen).

The impetus for Rael’s Ride began after a family friend, Lauragaye Jackson, learned just how underfunded brain cancer research remains. On the night Rael shared the news that he was no longer in remission, her first reaction was one of hopeful optimism.

“I said to Rael, ‘Technology has come so far in 13 years and I’m sure your experience this time round will be so much better,’” Lauragaye recalls. “He said to me, ‘Lauragaye, nothing’s improved.’”

Rael’s response stunned Lauragaye. “It was driving me crazy that he said nothing had changed,” she says. “I’m an ideas person, so I kept thinking, We have to do something about this.”

Lauragaye suggested a sponsored bike ride, a fitting tribute to Rael’s passion for the sport and something that would amplify the fundraising he’d already done over the years. 

His family agreed. Rael and Andrea’s daughter, Gabi Herman, says cycling became central to her dad’s life as he coped with his medical reality. 

“My dad felt that with every pedal, he was helping his body get rid of the cancer cells and the toxins from the chemo,” Gabi says. 

When Lauragaye told Rael about her plans to mount the event, he burst into tears. “He said to me, ‘In a million years I never thought someone would do something like that for me,’” she recalls. “‘I’m just a regular guy, not an important person.’”

Gabi says that couldn’t have been further from the truth. She describes her father as someone so people-focused and giving that he spent his years in remission attending brain cancer support groups, so he could provide comfort to those recently diagnosed. In 2018, during the first Rael’s Ride, 300 people turned up to support him as he biked the course. 

Gabi remembers that first ride as a joyous occasion. 

“Nobody wants to have a ride that’s raising money for cancer because their dad has cancer,” Gabi says. “But to be honest, we were all pretty excited about the event. And when I heard my dad was crossing the finish line, I felt a deep gratitude to see him being active and enjoying life.”

This year, even though Rael was not there to see what his memory continues to inspire, there’s no doubt his presence was felt. 

“I know Rael [is] with me in spirit, cheering me on and encouraging me to keep pushing, even when I think I can no longer do so,” says Andrea of riding their special bike at the event.

“Rael was tenacious and patient and never gave up. That is how he lived his life and rode his bike. He inspires me to do the same.” 

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