Shemaine Caleb, a speech-language pathologist at Sunnybrook, shares insight on helping patients across the lifespan.

1. How do speech-language pathologists care for patients?

Speech-Language Pathologists, or SLPs, work to prevent, assess, diagnose and treat speech, language, social communication, cognitive-communication, and swallowing disorders in children and adults. SLPs provide education related to these areas to patients and their families, as well as other health professionals, and medical students.

At Sunnybrook, SLPs can be found helping patients in numerous programs ranging from the paediatric population in the Women and Babies Program to the geriatric population in the Veterans Program, and everything in between.

2. What might people be surprised to know about speech-language pathologists?

When many individuals hear ‘Speech-Language Pathology’ they instinctively think we only focus on communication. Many patients/families are surprised that we also assess swallowing.

SLPs, can also modify diet textures for swallowing safety while assessing patients for allowance of specific foods and drinks to enhance their quality of life.

SLPs can provide communication and swallowing assessment or intervention as a patient moves across the lifespan and even towards end of life. SLPs play an important role in providing families with communication tips to help facilitate meaningful interactions with their loved ones.

3. Are there any tips for preparing for appointments for patients and families?

 If a patient is consulted for communication difficulties, the family may want to consider how they’re already communicating with the patient and share with the SLP what strategies are effective.

If a referral is for swallowing, families are encouraged to think about whether their loved one has ever had any swallowing difficulties in the past (e.g., fatigue while chewing, coughing, throat clearing, or shortness of breath) during meals and share with the SLP what types of food and drink they are already consuming at home.

Being familiar with the scope of SLPs can help patients and families earlier in their care. If there are any concerns with communication and swallowing, SLPs can be consulted at the beginning of a patient’s hospital stay to help improve or maintain specific skills for the patient’s benefit and quality of life.

Learn more about Speech Language Therapy

The post How Speech-Language Pathologists Support Patients appeared first on Your Health Matters.

Ricky Chow, Sunnybrook audiologist, explains how the virtual hearing care service can help patients.

What is the Virtual Hearing Care Service?

The Virtual Hearing Care service is available to patients with hearing aids and a smart phone. The benefit is that, through this virtual service, patients can have the convenience of having their hearing aids checked and adjusted remotely.

How does it work?

Once the patient has been fitted with hearing aids, their audiologist can make any further adjustments to the devices over the internet.

The patient will need to connect the hearing aids to their smart phone using an app provided by the hearing aid manufacturer. The audiologist will help the patient with set up before their first virtual appointment.

If a patient needs to have adjustments made to their hearing aids, they can either come in-person or opt for virtual care instead. If they opt for virtual, we would “call” them through the manufacturer’s app, and the patient would be in a video call with the audiologist.

The audiologist will make whatever changes are necessary while talking to the patient. The new adjustments will be noticed almost instantly. Once the patient is satisfied with the settings, the hearing aids are updated, and the call is disconnected.

Who is eligible?

Patients who are interested and have a smartphone are eligible for the Virtual Hearing Service. Please check with your audiologist regarding compatibility.

How do they sign up? Is a referral needed?

The audiologist will mention this service being available, and the patient can choose to decline or consent. The patient has the option of coming in-person if they choose to. A referral is not required.

Learn more about Sunnybrook’s Audiology Services

The post What is a Virtual Hearing Care Service? appeared first on Your Health Matters.

“Post-operative delirium can impact anyone, though patients who are elderly are most at risk,” says Dr. Stephen Choi, co-director of the Perioperative Brain Health Centre. “Delirium can appear in several forms, but typically results in changes in an individual’s ability to focus, their concentration, thinking, and memory. These changes may come and go during the first few days after surgery and importantly, can occur even after all anesthetic drugs are gone.”

Dr. Choi says it is important for patients to know about delirium as it can impact their recovery. He shares some insights on delirium prevention.

What can a patient do before surgery that may help reduce the risk of delirium?

There are several things that have been demonstrated to help reduce delirium that are, in general, very good for overall health. This includes maintaining a healthy diet, getting regular physical activity, and ensuring adequate sleep.

It is important to stay hydrated right before surgery and follow guidelines about oral intake from your health-care team.

You can also help prevent delirium by doing brain exercises such as word puzzles to keep your mind active.

Before you arrive at the hospital, make sure to bring any sensory aids that are used routinely, such as glasses and hearing aids, as they can help reduce confusion after surgery.

Moving around safely after surgery, trying to maintain your routine (for example, speaking with family whether in-person or on the telephone, getting out of the hospital bed for meals), and maintaining sleep patterns, can all help reduce the risk of delirium.

Why are these actions considered to be protective measures against delirium? 

If you think of delirium as the brain being disoriented, analogous to jet lag, maintaining patterns of behaviour that you are used to can be protective and be a touchstone to anchor yourself.

Each of these actions individually make a small difference, and collectively they can add up to a lot. The goal is to try to minimize disturbances to the usual environment that your brain experienced before surgery. When an individual’s actions and surroundings are familiar to them, their brain isn’t as overwhelmed processing new information, which can help decrease the risk for confusion post-surgery.

Families can also help support their loved ones achieve the goals of mobilization, nutrition, mental stimulation etc. to try and help a patient get back to their ’normal’ life and functioning, whatever that may be.

Learn more about delirium.

The post What you can do before surgery to reduce the risk of delirium appeared first on Your Health Matters.

Complex concerns come with determining when it’s time to hang up the keys: How can this topic be approached in a respectful way with loved ones? Can a plan be created for the future so that the person with dementia can continue to enjoy activities after they’ve decided to stop driving?

Dr. Mark Rapoport, geriatric psychiatrist, acting head of Geriatric Psychiatry at Sunnybrook, and one of the researchers behind a new Canadian online resource called the Driving and Dementia Roadmap shares insight into how individuals with dementia and those close to them can face this challenge together.

What is dementia?

Dr. Rapoport: Dementia occurs when a person experiences changes or a decline in memory, and the ability to think, problem solve, or make decisions, that are significant enough to affect their daily life and everyday activities. Although dementia is most common in older adults, it is not a ‘normal’ part of aging.

The Alzheimer Society of Canada says dementia impacts more than 600,000 people in Canada. It’s estimated that by 2030, one million Canadians will be living with dementia.

When is it time for a person with dementia to stop driving?

Dr. Rapoport: Some concerns around driving that are common with dementia can include forgetfulness or getting lost in familiar places. If a person is feeling unsure or anxious while driving or if there are any safety concerns expressed by family or friends about the individual’s driving abilities, it is important to seek information and the advice of a healthcare professional for next steps.

Some individuals with mild dementia may continue to drive safely and some may have to stop driving right away. It’s important to be aware that as the disease progresses, they will inevitably have to stop driving. It can be difficult to know exactly when driving has become or will become unsafe.

After receiving a dementia diagnosis, it is critical for the individual and their family to watch for changes in that person’s driving and consider whether they can continue to drive safely.

For people with moderate or severe dementia, driving is dangerous as the brain functions needed to react quickly and make rapid decisions for safe driving have deteriorated. By these stages, driving must stop.

What is the Driving and Dementia Roadmap?

Dr. Rapoport: The Driving and Dementia Roadmap or drivinganddementia.ca, is a free, online, and Canadian resource created to help older adults living with dementia, their family, friends, and healthcare teams, and provide them with information around the decision to stop driving.

The Driving and Dementia Roadmap was developed by researchers from Sunnybrook, Baycrest, and the Canadian Consortium of Neurodegeneration in Aging.

I have been working in the field of geriatric psychiatry for many years, and over time patients and families identified the need for easily accessible and credible information about driving and dementia and driving cessation. This is the first time that helpful materials have been curated into a one-stop-shop website that includes resources useful for all provinces and territories across the country.

The Driving and Dementia Roadmap website includes information, videos, worksheets, as well as strategies to help people living with dementia and their families navigate the challenging conversations, emotions, and planning that comes with the decision to stop driving.

Making a plan for the future

Driving cessation is a major life change for a person with dementia. There are often concerns about a loss of independence or identity.

It is important to include the individual with dementia in discussions about driving. This can help in creating a plan and making alternative transportation arrangements for when the person can no longer drive. The website provides strategies to ensure that the person with dementia continues to live a fulfilling life even after driving stops.

The Driving and Dementia Roadmap website doesn’t provide individuals with recommendations about their driving. It is for educational and informational purposes. Patients and families are strongly encouraged to reach out to a qualified healthcare provider with any concerns for their guidance, advice, and support as they navigate the driving and dementia journey.

Read the news release to learn more about the Driving and Dementia Roadmap.

For more information go to: drivinganddementia.ca

The post Driving and dementia: How to know when it is time to stop driving appeared first on Your Health Matters.

Co-led by researchers at Sunnybrook Health Sciences Centre and the University of Calgary at the Foothills Medical Centre, the study’s findings that Tenecteplase (TNK), a heart attack drug, is an effective treatment for acute ischemic stroke, could lead to a change in clinical practice.

The pivotal study has recently been published in The Lancet.

Researchers also presented the ground-breaking results at the Canadian Neurological Science Federation Conference in Montreal, and the 2022 European Stroke Organization Conference in France. The results have also been published in The Lancet.

Dr. Rick Swartz, study co-principal investigator and stroke neurologist at Sunnybrook, shares insight on how this latest breakthrough could become the standard treatment for acute ischemic stroke and what it means for patients.

What is the current treatment for acute ischemic strokes?

Dr. Swartz: Currently, Alteplase, or tPA, is the standard for treatment of acute ischemic stroke. It is a clot-busting drug that has been used to treat stroke for decades. tPA is extremely effective in treating stroke.

How can a heart attack drug also treat stroke?

Dr. Swartz: Tenecteplase, or TNK, is a common medication used to treat heart attacks and works to dissolve clots to help restore blood flow. TNK is a modified version of tPA. It binds to fibrin, which is part of a blood clot, and helps to dissolve the clot, restoring blood flow to the brain. It is important to note the brain is more complicated and vulnerable to bleeding than the heart, so the dosage in this study for stroke was half the dose that is typically given for treatment of heart attacks.

Why is Tenecteplase effective in the treatment of stroke? 

Dr. Swartz: One of the reasons Tenecteplase, or TNK, is so effective is that in can be administered as a single dose directly to the patient. In contrast tPA requires an infusion over the course of an hour. The ability to give it as a one-time dose saves critical time and complication as TNK could potentially be administered wherever the patient is seen first, at a medical centre or small hospital.

What does this mean for patients?

Dr. Swartz: There are extensive implications for our study findings. This is the first time since 1995 that a new approach to emergency stroke medical treatment has been studied and found to be at least as effective and safe as the current treatment, tPA. In real-world use, it may lead to faster treatment, and could be especially helpful for people with large clots being treated and sent to centres like Sunnybrook for further interventions.

In stroke, every minute counts – the faster the treatment, the greater chance of brain recovery. Current stroke guidelines will need to be reviewed, but our findings could change the way stroke is treated in Canada and around the world.

The post Behind the Research: How the latest in stroke research at Sunnybrook could change emergency stroke treatment appeared first on Your Health Matters.

“When a Code Stroke is activated, I liaise with paramedics in real time as they are enroute to hospital with the patient,” says Anna. “I also work with our stroke team and emergency department to prepare for patient arrival and next steps.”

A stroke occurs when blood suddenly stops flowing to the brain. The longer a stroke is left untreated, the greater chance of injury to the brain. When a patient is treated quickly, with medication, surgery, or both, there is a greater chance of recovery.

“When it comes to stroke, time is of the essence,” she says. “If you suspect that you or a loved one are having a stroke, don’t wait. Seek medical attention and get help.”

Code Stroke Nurses are part of a stroke patient’s care pathway. Anna sees first-hand how stroke can be life-changing for patients.

“Some are frustrated and frightened because they can’t speak their mind or can’t move one side of their body because of a stroke. Sometimes a patient is unresponsive and requires life-saving measures,” explains Anna. “When I see patients 24 hours after receiving treatment, some are speaking and smiling again, or participating in physiotherapy. Occasionally one of them will remember me from the chaos and point me out to their family to say, ‘She was there helping me when I couldn’t walk or talk or move,’ and it makes me happy to no end to see their progress. It is extremely rewarding to see when patients recover from stroke.

Code Stroke Nurses work with multiple systems and departments on a daily basis.

“I have an extraordinary appreciation for how many systems are constantly at work to deliver quality care,” adds Anna. “The stroke team at Sunnybrook is an exceptional group of individuals who truly and sincerely provide patient care to the best of their abilities.”

June is #StrokeAwarenessMonth. To recognize the signs of stroke, think FAST – F: Is the Face drooping? A: Can you raise both Arms? S: Is the Speech slurred or jumbled? T: Time to call 9-1-1.

Learn more: sunnybrook.ca/strokecare

The post Supporting stroke patients through their journey: Meet Code Stroke Nurse Anna Liu appeared first on Your Health Matters.

Brianna Marshall is the Occupational Therapist (OT) in Sunnybrook’s ALS Clinic, which is the largest in Canada and one of the largest ALS clinics around the world.

Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease, is a progressive and debilitating neuromuscular disorder. Over time, the brain stops sending messages to voluntary muscles and people living with ALS eventually lose the ability to walk, talk, eat, move, and breathe. June is ALS Awareness Month.

“ALS is a devastating diagnosis for patients and families, and there is no known cure,” says Brianna. “Sunnybrook is at the forefront of ALS research working to change that through many ongoing studies and clinical trials. In the meantime, our patients require specialized care and supports across all areas of the healthcare system.”

Brianna works with more than 650 individuals living with ALS and related diagnoses.

“I have learned so much from our patients, their activism, creativity, kindness, and humour – even in the face of impossible odds and heartbreaking choices.”

As the ALS Clinic’s OT, Brianna helps support patients with strategies for their daily activities.

“This could be prescribing custom power wheelchairs, problem-solving home modifications, making exercise recommendations, creating individualized strategies for energy conservation, or recommending devices that compensate for decreased hand function,” she explains.

“The ALS Clinic team at Sunnybrook is nothing short of amazing – it is the most collaborative environment I have ever been a part of. Everyday that I come to work, I’m learning from experts in all of the clinic’s medical and allied health disciplines and working with these team members to improve our clinic processes and the care we provide.

I am honoured that many patients share their experiences with me and trust me with the day-to-day realities of their lives.”

Learn more about Sunnybrook’s ALS Clinic: sunnybrook.ca/ALS

The post ‘A devastating diagnosis:’ Caring for patients and families in Sunnybrook’s ALS Clinic appeared first on Your Health Matters.

“You don’t realize how often you’re saying, ‘I’m sorry. What was that?’” Larry says.

He also plays guitar in a band and would turn up the volume on his monitor on stage to try to hear the high notes better.

“Playing loudly didn’t solve the problem,” he remembers.

Larry eventually went to Sunnybrook’s Audiology Clinic which led to a turning point that helped improve his hearing.

“You don’t know what you’re not hearing,” explains Larry. “I didn’t realize how hard I was working to hear things.”

Hearing check

“It’s important to get a hearing test if you suspect you are having difficulty hearing,” says Michael Lam, a hearing instrument dispenser in Sunnybrook’s Hearing Aid Centre. “Untreated hearing loss often leads to patients avoiding social situations and conversations.”

Michael Lam is a hearing instrument dispenser in Sunnybrook’s Hearing Aid Centre.

A physician’s referral is needed for a hearing test. From there, an appointment will be made with an audiologist, who specializes in the prevention, identification and management of hearing loss and balance disorders.

“An audiologist will ask the patient about their hearing ability and how it impacts their life at home and work,” explains Juljia Adamonis, Sunnybrook audiologist. “From there it’s about working with the patient to personalize what hearing aid style and features will work best for them, and then following up in the future to help with any changes.”

Larry has been seeing the team at the Sunnybrook’s Hearing Aid Centre for several years and feels supported by the experts he has worked with, including Michael.

“It’s a diamond in the rough to have that centre,” says Larry. “The team is outstanding. There is great continuity of care. When I go there, they know who I am. It’s refreshing.”

“Hearing is crucial,” says Michael. “I am involved with fitting hearing aids and counselling patients on how to use and adapt to their hearing aids. I see them regularly to help them maintain their hearing devices and ensure they are hearing to the best of their ability.”

“He explained details in a way that was easy to understand. It was a good process,” says Larry.

How hearing aids have changed over the years

“When it came time to consider hearing aids, I first thought of the ones I saw growing up. They were big and clunky,” Larry recalls.

Michael says hearing aids today are much different than those of the past.

“Hearing technology has come a long way!  Most hearing aids are very discreet. They can easily connect and stream with phones, tablets, and televisions,” Michael explains. “They can help streamline a patient’s communication and technology use. We can also make custom fit musician plugs to help minimize noise damage to a person’s hearing.”

Larry says it took a little while to get used to the hearing aids but in the end, they made a huge difference.

“I didn’t realize how hard I was working to hear before. I was struggling trying to hear certain letters and sounds. You get tired. In social situations, it could be exhausting,” says Larry. “After getting the hearing aid, I wasn’t struggling to hear. I didn’t need the extra effort. I didn’t have to concentrate on a person’s face so hard. It’s a very subtle thing, but I could just hear better. I felt a lot better in social situations.”

“It is rewarding when you can help someone,” says Michael. “Pursuing hearing aids can help an individual engage more fully and confidently with the people in their lives. It has been exciting to help patients use new hearing aid technology to help them hear and communicate with the world.”

Larry says over the years, he has found a good fit with his hearing aids, which he adds, have made a big difference in his day-to-day life.

“They’re really comfortable and most people, even close friends, don’t know I have them,” he says. “It’s been a huge breakthrough for me.”

The post How improving your hearing can make a difference in daily life appeared first on Your Health Matters.

“You are a truly valuable person.”

Messages of support and encouragement after a time of crisis.

They’re part of an initiative called Caring Contacts, a series of emails sent to patients after they leave Sunnybrook’s Psychiatric Inpatient Unit.

“The aim is to remind patients that they’re not alone, provide them with messages of hope, and help to reduce suicidal ideation after psychiatric hospitalization,” says Dr. Rosalie Steinberg, psychiatrist. “In addition to positive messages, the Caring Contacts emails include mental health resources, such as information to crisis services which individuals can access when they are feeling distressed.”

The Caring Contacts emails have been recently implemented as part of patient care by the Department of Psychiatry at Sunnybrook. Patients can opt-out of receiving the messages at any time.

“To our knowledge Sunnybrook is the only hospital in Canada that has studied this intervention in a clinical trial and the only hospital that has included a Caring Contact email series in the standard of care for all patients who have been discharged from the Psychiatric Inpatient Unit,” says Sarah Holman, Caring Contacts research coordinator. “Other programs across the country have used different types of communications such as phone calls or letters for specific patients.”

“Caring Contacts are an evidence-based support. This means that past research has shown that it can be an effective suicide prevention strategy,” adds Dr. Steinberg.

The timing of the Caring Contacts emails is important. The first message is sent several days after a patient leaves the hospital and follow-up messages continue for about eight weeks. Experts say this is typically when mental health symptoms could worsen as a patient adjusts to being back at home.

“The risk of suicide is highest after psychiatric hospitalization,” explains Dr. Steinberg. “Psychiatric follow-up and support can help reduce this risk. The timing of the Caring Contacts emails can help remind individuals that they’re being supported in their recovery while they wait for follow-up care. These messages are shared at critical times which can help lead to better outcomes for patients.”

“Previous studies have found that Caring Contacts can help reduce suicide attempts, suicidal ideation, and loneliness, while increasing hopefulness and feelings of connection. The feedback we’ve received from patients has been positive. Common themes include feeling cared for and more connected to Sunnybrook,” says Sarah.

Suicide prevention at Sunnybrook

Caring Contacts are among a variety of support tools developed by Sunnybrook’s Department of Psychiatry in collaboration with its Patient and Family Advisory Council for suicide prevention.

Coping Cards can help patients develop an action plan when coping with emotional distress. They are available in 10 languages.

The department has also recently created a booklet with information and resources for family and friends after a loved one has attempted suicide.

“Implementing innovative and evidence-based models of care for suicide prevention in clinical settings is fulfilling work. Having Caring Contacts accessible to all Sunnybrook psychiatric patients is exciting and meaningful when we hear many say they feel supported by us even after they leave the hospital.”

If you need help in an emergency, please call 911 or visit your local emergency department.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)
• Kids Help Phone
  • Phone: 24-hour, toll-free, 1-800-668-6868
  • Text: 686868 (24 hours, 7 days a week)

Other resources:

How a Coping Card can help manage emotional distress: https://health.sunnybrook.ca/mental-health/how-a-coping-card-can-help-manage-emotional-distress/

Supporting families after a loved one’s suicide attempt: https://health.sunnybrook.ca/mental-health/supporting-families-after-a-suicide-attempt/

The post How Caring Contacts at Sunnybrook can help patients after a crisis appeared first on Your Health Matters.

In addition to supporting conflict journalists who are living with post-traumatic stress disorder or depression, Dr. Feinstein is helping to raise awareness of the stories they cover.

Dr. Feinstein has written several books on mental trauma in conflict journalism and produced the documentary Under Fire: Journalists in Combat, which was shortlisted for an Academy Award in 2012.

He is also the executive producer of a new Globe and Mail documentary, Shooting War, which will be showing at the 2022 Hot Docs Canadian International Film Festival. The documentary is based on his book of the same name published in 2018, which profiles 18 world-renowned photojournalists and the impact of covering war.

In this Q & A, Dr. Feinstein discusses the Shooting War documentary and the psychological impact of war coverage.

What makes your work meaningful to you?

Dr. Feinstein: This kind of work is relevant to the world that we find ourselves in because there’s so much conflict. It helps to keep the public informed of what’s going on and tells us about the journalists who are telling these important stories and the cost that can come from this kind of work. I think it’s never been more relevant than now. In many ways we’re globally connected — conflicts taking place far away in places like Ukraine have the ability to affect us directly in terms of our day-to-day lives, so we need to know about these things, and my work hopefully helps foster that.

Are you working with journalists who are reporting on, and from, the current conflict in Ukraine?

Dr. Feinstein: I’m hearing from people on the ground as well as newsrooms where their teams are having to process a huge amount of material, much of which is very traumatic, including images of the dead or injured, bereaved people, and terrible destruction. Journalists are often witnessing these terrible images for many hours a day.

In a more general sense, what are the different ways the public may be impacted or traumatized by images such as the current war in Ukraine? 

Dr. Feinstein: When we look at these images we experience a mix of emotions: empathy, outrage, horror at what’s going on. What we know from a traumatic event such as September 11 , where there was a lot of visual imagery on computers and television, is that there are individuals in society who are very vulnerable to this kind of news, for example those with a past psychiatric history.  But the majority of the general population in countries geographically removed from the conflict, like Canada, will not develop trauma-related emotional disorders.

What kind of therapy can help journalists dealing with mental trauma?

Dr. Feinstein: The kinds of therapies that work for trauma are cognitive behavioural therapy, cognitive processing therapy, prolonged exposure therapy, EMDR — which is eye movement desensitization and reprocessing, so there are a number of psychotherapies which are useful treatments for trauma-related mental health.

How do conflict photojournalists recover from the trauma of covering war? 

Dr. Feinstein: It’s very difficult and dangerous work and these journalists see terrible things — but the majority of journalists don’t become traumatized by this work. It’s the minority who do. The challenge from my end is to help news organizations identify the journalists who are not okay, because they’re the ones who require the therapy. There are very effective therapies for trauma, so if people can get help, get the right kind of therapy, they can recover, do well, and continue with work. The challenge is identifying the people who need it.

What would you like people to know about the Shooting War documentary?

Dr. Feinstein: I think the documentary is relevant to Canadians because of what’s going on in world around us. The Shooting War documentary helps inform people about not only conflicts, but also about the people who bring us news of war. I think that’s important — that we need to understand the nature of war journalism, how difficult it is, how dangerous it can be, and the cost that journalists may pay when they do this work. This is what my work shines a light on — it brings into focus the people that keep us informed of very important news.

If you need help in an emergency, please call 911 or visit your local emergency department.

If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)

The post The psychological cost of covering war appeared first on Your Health Matters.