The stroke was a surprise for the 25-year-old.

How did it happen? Should other young people be worried?

This is an age group is not typically associated with stroke, but doctors say it’s important to be aware that stroke affects people of all ages.

Dr. Mark Boulos, a Sunnybrook neurologist and stroke expert, answered our questions about TIAs, Hailey’s unexpected health event, and tips for stroke prevention.

Note: Dr. Boulos is not Hailey Bieber’s doctor. His responses are based on the comments she shared in her YouTube video about her TIA.

What is a stroke and how does it compare to a mini-stroke or TIA?

A stroke is when blood flow to the brain gets interrupted, leading to damage to the brain. This can be caused by blocked blood vessels or hemorrhaging.

A “mini-stroke” or a TIA happens when you have transient deficits due to lack of blood flow to a specific part of the brain, but when you do scans, you don’t see any damage. And while they may not leave a mark on the brain, TIAs are still important to pay attention to as they can be warning signs for future stroke.

We don’t typically associate TIAs or strokes with young people. How did this happen in Hailey Bieber’s case?

In her YouTube video, Hailey mentioned that she did have some risk factors, which wouldn’t typically be problematic on their own. But together, it looks like they created the perfect storm.

She mentioned that she was on birth control, and some forms of birth control in young women increases the risk of stroke a little bit. Not very much, but that would have been a risk factor for her. She also noted that she suffers from migraines, and the combination of using some forms of birth control and having migraines can further increase the risk of stroke.

She also recently had COVID, which can also increase your chance of blood clots.

She mentioned she had been on a plane, too. If you’re on a plane and you’re sitting in the same spot for a long time, clots can develop in your legs then travel through your body, including to your brain via something in the heart called a Patent Foramen Ovale, or PFO, which she mentioned she had in her YouTube video. That would have been a trigger as well.

To elaborate on PFOs, there is this connection between the two sides of the heart, which is supposed to naturally close when you are a fetus. In 25 per cent of the population it doesn’t close, leaving a hole in the heart, or a PFO. This isn’t typically a problem, but it can become a problem.

Clots are usually kept on the right side of the heart, which controls the circulation to the lungs. If the clot stays in there, it’s actually OK. The trouble is that a PFO could facilitate a clot going from the right side of the heart to the left. The left side of the heart pumps blood to the rest of the body, including to the brain. If a clot gets into the left side of the heart and goes up to the brain, that could lead to a stroke.

The combination of all these factors could have led to Hailey’s TIA.

These risk factors are all so common. Should young people who have these risk factors be worried about TIAs or strokes?

Statistically, TIAs and strokes are not common in young people. They do happen, but if you’re young and healthy, the risk is minimized. It is important, however, to be aware that stroke can strike at any age.

In general, while the factors mentioned are common, more context is needed around the risk of stroke.

If you’re on some forms of birth control, this can increase your risk of having a stroke, but the risk is minimal. About eight in 100,000 women who are on birth control will have a complication like a stroke. The risk of stroke in women who use some forms of oral birth control is further increased in those with migraines. If you’re worried, have a discussion with your doctor.

If you’re going to be in a plane for a long time, stroke risk prevention is very simple. Walk around, stay hydrated, move your legs to help prevent clots from developing. Just don’t sit in the same spot for a long time.

PFOs are present in about 25 per cent of people, but that doesn’t mean 25 per cent of people will have a stroke. In fact, many people with PFOs never even realize they have them.

It’s important to speak with a health-care professional if there are concerns about risk factors for stroke.

How can people reduce their risk of stroke?

There are things that always help prevent overall vascular risk factors: exercise, healthy eating, not smoking, keeping your cholesterol in check, monitoring your blood pressure, getting enough sleep every night and checking for sleep apnea. To avoid stroke, these things are important for everyone, including young people. 

And of course, knowing the warning signs of stroke to get help right away is important. The earlier a person is treated, the greater their chances of recovery. Knowing the warning signs can help you act fast to get the help needed, if you or someone you know is experiencing a stroke.

The post Hailey Bieber’s mini-stroke shines a light on stroke and young people appeared first on Your Health Matters.

According to the Canadian Dermatology Association, women make up to 75 per cent of adult acne cases, with hormonal changes like menstruation playing a big role in those numbers.

Why do hormones have such a big impact on acne, how long will it last, and what can people do to care for their skin when they’re experiencing hormonal breakouts? Dr. Jennifer Tran, a Sunnybrook dermatologist, shares her insight.

Understanding hormonal acne

People often anticipate breakouts around the time they are menstruating. What’s less talked about is that acne can be brought on by other hormonal changes, such as starting birth control, pregnancy and menopause.

“There is evidence that hormonal fluctuations in androgens, progesterone and testosterone can worsen acne,” says Dr. Tran. Though, while these changes have been linked to acne, the connection is not so straightforward.

“The exact pathogenesis of acne in these scenarios is unclear,” she says. In fact, she adds, “Some studies have looked at measuring various hormone levels in patients with acne, and in the majority of cases, these levels are within normal range.”

How long will these breakouts last?

Similar to the uncertainty surrounding the cause of hormonal acne, the length of time that these breakouts will stick around is also unclear.

“Timing depends,” says Dr. Tran. “It can be very specific to a patient’s circumstances. For example, if someone is pregnant, it can last the duration of their pregnancy. For some, hormonal acne can last for several years.”

Treatment

To manage these hormonal breakouts, Dr. Tran encourages people to speak with their doctor to discuss options.

“Topical treatments, oral medications such as spironolactone or certain oral contraceptive pills, and even antibiotics and isotretinoin can be used for hormonal acne,” she says.

And while acne is typically harmless, in some instances, it can be indicative of a bigger issue.

“Hormonal acne is sometimes associated with polycystic ovarian syndrome,” she says. “If there are other signs or symptoms of this condition, patients should be screened.”

The post Hormonal acne: Sunnybrook dermatologist explains its causes and treatment appeared first on Your Health Matters.

“The beginning of the pandemic saw a decrease in sexual activity amongst young singles because the normal places where people would meet up disappeared,” says Dr. Sharon Domb, a staff physician in the Department of Family and Community Medicine at Sunnybrook. “And people were afraid to pick up COVID, so there was certainly more anxiety and stress about meeting new people.”

But with fears easing, restrictions lifting, and most activities back on, Dr. Domb says she suspects singles will return to “normal” behaviours in terms of sexual activity — which can have benefits and risks. She shares helpful insight that people should be aware of if they hope to engage in more sexual activity.

Many people, especially singles, experienced a dry spell in terms of their sexual activity throughout this pandemic. But now with things opening up again, it looks like that could be changing. Can you talk about why this is a good thing?

Sex in the right context for most people usually is a positive thing. From a psychological perspective, from a physical perspective, all of those things.

Young singles certainly suffered a lot in terms of the isolation and the change in their social behaviours and normal social interactions; it was very challenging for the demographic. So, it’s great that they can rekindle social relationships, to be able to get back to sort of normal behaviour, to interact with friends and meet people and hang out.

There’s a huge mental health benefit, not just with sex, but also with the relationships that lead to that.

As we know, the pandemic isn’t over. So, for those who are trying to get out and date and meet new people, how worried should they about COVID-19?

I think everybody sort of needs to take stake of their personal situation.

Are they living with somebody who’s immunocompromised or with an elderly relative? Is it going to be catastrophic if they get COVID? Are they immunocompromised or unwell themselves? If yes, then I think they have to be extra cautious, understanding the ramifications if they get COVID.

If they’re not particularly at risk, they’re vaccinated, and if they live by themselves or they’re not putting anybody they live with in danger, then the risk is probably not huge. I think they should take reasonable precautions, but I wouldn’t say to a 20-something, “Stay at home and never go out.”

At the end of the day, everyone needs to find a point of some moderation.

Aside from COVID, what else should singles keep in mind as they start getting out there again?

By and large, it’s going to be the same issues that demographic dealt with before: you should take precautions, both for pregnancy and for sexually transmitted infections (STIs).

STIs are fairly common. Have a conversation with whomever you’re going to be with and understand their history and what your risk is. Condoms are always a good idea, but they don’t protect from everything. Often, people use condoms for intercourse, but they don’t use condoms for oral sex — and you can certainly get an STI through oral sex.

On top of using condoms, I encourage people to ensure they’re vaccinated. HPV vaccines weren’t offered in schools until quite recently. Females in grade 8 were offered them in Ontario in 2007, and males in grade 8 weren’t offered HPV vaccines until 2016. So, unless people were on the ball and retroactively went to their doctors to get it, most people aren’t vaccinated for HPV.

Another important thing to know about STIs is that we can do a screen, but it doesn’t mean it’s a 100 per cent clear bill of health. Standard screens don’t include every STI, and some STIs can be easily missed if symptoms aren’t active.

So again, it’s important to take all the precautions you can, and have a conversation with whomever you’re going to be with.

Any final messages for those who are hoping to become more sexually active?

Go have fun, just do it responsibly.

The post Dating and sex during COVID-19: Q&A with Dr. Sharon Domb appeared first on Your Health Matters.

“I wasn’t really raised with any of the culture or traditions. I had to discover that for myself later on,” says Sophie, a University of Toronto medical student and a participant of SPARK (the Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students).

“My mother’s grandmother was a residential school survivor and suppressed that side of her completely to protect herself,” she says, explaining the disconnect from her Indigenous background growing up.

But now as an adult and aspiring geriatrician, Sophie has been reconnecting with her roots by exploring Indigenous practices and building relationships with other Indigenous people.

“I’m at a point where I’m very proud and sure of who I am in my identity,” says Sophie. “But it’s taken a lot to come to this point, and there are still lots of challenges that I face.”

One of the challenges she has been dealing with is the emotional heaviness of the residential school graves that continue to be uncovered throughout the country.

To cope, Sophie has leaned on the relationships she’s built while reconnecting with her heritage. One of the people she’s turned to is her roommate, who happens to be the only other Indigenous person in her medical school class.

“Feeling like you have a safe place to talk can really be motivating,” says Sophie.

And while she’s grateful she has her roommate, Sophie says it’s jarring that there’s such low Indigenous representation in her class, and in medicine in general. Connected to that issue is the fact that Indigenous people are more likely to experience poor health-outcomes than non-Indigenous people.

To help address these tough realities, Sophie’s focus has been learning as much as she can—in school, from her Indigenous mentors, and through social interactions with other Indigenous individuals—so that she can inform her medical career and better support her community.

“I have a very large interest in Indigenous health, and I plan to do lots of outreach and really form my future practice around that,” she says. “I know that I can make an impact.”

The post Reconnecting with her roots and advancing Indigenous health: Meet medical student Sophie Weiss appeared first on Your Health Matters.

Despite this acknowledgement, Canadian Blood Services says blood inventory has declined by 25 per cent in the past two months, with the past few weeks seeing a shortage of O negative and B negative red blood cells.

What’s causing this shortage and why are we having trouble fixing it? Dr. Akash Gupta, a transfusion medicine specialist at Sunnybrook, helps us understand.

Why is the demand for blood so high right now?

Even in regular times, most of our blood collections in Canada are from a small minority of dedicated people. Only about 4 per cent of people go out to donate, despite the fact that one in two people are eligible.

Then with the pandemic, especially at the start of the pandemic, everyone was required to stay home and isolate. So, a lot of the regular donors didn’t come out to donate as often, just out of following the rules and for safety. So that has had an impact. Contrarily now, with limitations being lifted, a lot more people are travelling. But Health Canada has set rules based on COVID, preventing many international travellers from donating.

In short, our donor base is down.

And then as everything opens up from the hospital side, the demand for blood has gone up as we’re doing more surgeries. Plus, trauma season officially started with the May long weekend. So, demand has gone up even further, but the donor base hasn’t gone back to where it was. Thus, we have a deficit.

Does having COVID impact one’s ability to donate blood?

COVID itself is not transmissible by blood. So, there’s no risk to blood products.

Though, if you are symptomatic or actively infected with COVID, then you can’t donate blood. But that’s more for protection of staff and other donors in the clinic so you don’t transmit the disease to them.

Why else might someone be ineligible to donate?

Along with travel, low hemoglobin is the biggest deferral.

A lot of young women are iron deficient to begin with because of their monthly menstrual periods, so low hemoglobin is quite common.

If you have low hemoglobin, then you’ve been identified as having anemia, so it’s probably a good idea to see your family doctor. If you’re anemic, that can be treated. It might be as simple as taking oral iron or maybe IV iron. Then you can boost up your hemoglobin and try again once that’s been rectified.

Even aside from donation, if you’re anemic, you would probably benefit from your hemoglobin being bumped up to the normal range anyway.

What should people know before they donate blood?

Donating is generally pretty painless and pretty quick.

To determine if you’re eligible to donate, now you can do the screening online, so you don’t have to go into the clinic to find out. If you answer yes to any of the high-risk questions, it won’t let you book the appointment, so you don’t have to go in and then be turned away at the clinic itself. And now everything is by appointment because of COVID, so it’s a little more streamlined that way too.

The donation itself is less than 10 minutes. And then you get some nice treats.

Anything you’d like to add?

If people go out to donate, they can save lives.

Blood transfusion is a very common procedure in hospitals; I’m sure most people know someone who’s required a blood transfusion. And it’s often a life-saving process.

So, please go out and donate. That would be very helpful.

The post Decline in blood donor inventory: Q&A with transfusion medicine specialist Dr. Akash Gupta appeared first on Your Health Matters.

While it may look peculiar, these people are walking with purpose as they are using the Sunnybrook labyrinth, a round trail in the grass that can be followed for a moment of quiet reflection.

The Sunnybrook labyrinth

Recognizing that a hospital can be a stressful environment for staff, patients, and families, Rohan Harrison, Sunnybrook’s environmental services team leader, advocated for the labyrinth’s installation.

“It can be used symbolically as a walking meditation,” he says.

Users have told him that they use the labyrinth as a tool for self-care and mindfulness, and even to just get some physical activity.

“I’ve been really encouraged by a few comments I have been privy to receive, mostly commenting about an ‘inner relaxation,’” he says.

Staff using the Sunnybrook labyrinth. Image courtesy of Rohan Harrison.

“Having tools like labyrinths can be very helpful,” says Dr. Robert Simpson, a staff physician and associate scientist who studies mindfulness-based interventions for people with disabling long-term conditions. “If nothing else, tools can serve as a metaphor or reminder that I’m here to meditate.”

And while these tools can be great, Dr. Simpson says there’s more to meditation than the simple act of walking through a labyrinth.

“It depends on the attitude that you bring to your experience,” he says. “If you’re just zooming off into the ether, I’m not so sure that’s good for you. ‘Mind-wandering,’ in some studies, has actually been associated with worse mental health. However, if you’re focusing yourself in the present moment, that’s much healthier, especially if you are kind, patient, curious, and compassionate with yourself.”

Meditation and its impacts

Generally speaking, meditation is used to help bring calm and peace to those who use it. But, due to its many forms, understanding the practice can be confusing.

“Meditation has been conceptualized in many different ways,” says Dr. Simpson.

For some, it has philosophical and religious purposes. It can be done alone or in group settings. It can involve stillness or movement. It can be done in a class or while doing everyday activities.

To summarize the diverse practice, he says, “Typically, meditation would involve a structured set of techniques designed to access a particular mental state. It is often intended to be relaxing and restorative or to bring insight on a given focus.”

Elaborating on what may be happening in the body during this time, he continues, “Some evidence suggests meditation can affect regulation of the autonomic nervous system, dialing down the so-called ‘fight or flight’ response (sympathetic nervous system) and facilitating the ‘rest and digest’ function (parasympathetic nervous system). This leads to a relaxation type response.”

This response is one reason why Dr. Simpson and his colleagues use mediation in clinical care.

“Across many disabling long-term conditions, there are pretty consistent findings of improved stress, anxiety, depression, fatigue, and quality of life following mindfulness training,” he says. And when a patient’s mental health gets better, he says that improvements to physical symptoms often follow.

These benefits, grouped with the practices’ flexibility, diversity, and increased publicization in the mainstream media have led to meditation becoming hugely popular in recent years.

Caution when meditating

And while he’s happy more people are learning about the benefits of meditation, Dr. Simpson notes that, “It has to be applied with caution as there is some evidence that meditation can be harmful if used indiscriminately.”

For example, some research suggests negative effects of meditation on individuals with epilepsy, psychosis, and suicidal ideations. Further, if applied rigidly, some types of mediation can increase negative physical symptoms, such as pain or fatigue — for example, long bouts of seated stillness or more advanced yoga postures would be inadvisable in certain health conditions.

That is why, when Dr. Simpson suggests meditation as a health intervention for his patients, he considers an individual’s history, symptoms, impairments, disabilities, and goals, as these are important components in ensuring the modality is accessible, effective, and safe for the individual. He advocates for people with severe or unstable conditions to consult with their health-care providers before undertaking meditation training.

Getting started with meditation

In fact, Dr. Simpson says, if possible, most people should consult with their health-care providers when taking up meditation, as they can evaluate an individual’s symptoms and goals to help find services that fit the specific needs. Further, he recommends structured sessions led by an instructor with relevant clinical experience to help participants better understand and apply the practice to their unique circumstances.

Though, when that’s not possible, he suggests turning to content from credible resources, by people with formal training and certification to teach meditation. Dr. Rebecca Crane at the University of Bangor, UK is one example of someone whom he would suggest.

“If you’re tuning in to a random YouTube video, it’s more difficult to quality control and to be sure that there won’t be adverse effects,” he says. “There might not be; it might be the best thing out there. It’s just hard to know.”

Since there are so many forms of meditation and a plethora of choices, Dr. Simpson says that it’s important to ease yourself into a practice and take time to find what works for you.

“Learning to meditate is a very personal thing,” he says. “It’s about personal growth, insight, and understanding. It’s not always easy, but it is something that should be beneficial for you.”

And if you’re worried about whether or not you’re meditating correctly, he says, “Rather than thinking in terms of ‘the right way’ or ‘the wrong way,’ practice in a way that is conducive to feeling well and learning over time. Meditation shouldn’t add an additional burden that you must do this correctly. Remember that it’s a process, not an event, so be patient with yourself.”

He continues that when meditating, it can be helpful to set one’s intention, be conscious of one’s attitude, and pay attention; try to be present, and practice self-compassion.

“Take that into your exercise, take that into your time with friends, take that into your labyrinth,” he says, “and I think you’re looking at a form of mediation that can be very beneficial.”

Conclusion

For his own meditation practice, Dr. Simpson travels to India when he can, to learn from a yogi who has dedicated his life to the practice. Dr. Simpson practices meditation in both structured and unstructured settings — being in nature is one of his favourite pastimes.

“That’s my labyrinth,” he says of being in the outdoors.

For Rohan, he chooses his home labyrinth as one of his main forms of meditation.

Rohan’s home labyrinth. Image courtesy of Rohan Harrison.

“Four to five times per week, even in the winter, I walk the labyrinth I have created in my own backyard as a way of grounding, environmental re-connection, and a means to balance life,” he says. “It truly gives me the space to thankfully accentuate the positives of the day and realign the mind, body and spirit.”

Whether people are using their own labyrinth, the Sunnybrook labyrinth, or some other modality, this is the kind of well-being that both Rohan and Dr. Simpson hope people can find when they use meditation.

Thinking about the circular steps he takes on his backyard path, Rohan says, “It’s a step toward joy and peace.”

The post The Sunnybrook labyrinth, meditation, and what you need to know before you start meditating appeared first on Your Health Matters.

Climate change and health

According to infectious diseases physician and Sunnybrook Research Institute scientist Dr. Samira Mubareka, our changing environment has helped arboviruses (viruses transmitted through insects, such as West Nile) and their vectors (such as mosquitoes) to thrive.

“With climate change, we’re seeing a change in mosquito behaviour and even in mosquito populations themselves,” she says. “It’s opened up the possibility of new viruses and existing viruses to change their epidemiology.”

Longer, wetter and hotter summers have meant arboviruses and their carriers are able to multiply faster and live longer, she says. And with shorter, milder winters, mosquito vectors are overwintering more. She adds that vectors have more opportunities to feed and transmit viruses to other hosts, including humans, plus, with higher temperatures, vectors that used to only live near the equator are expanding their range and creeping north.

“We’re seeing more exotic mosquitoes that normally would not have been able to survive Canadian winters,” says the infectious diseases physician. “Some have been introduced into Southern Ontario.”

And it’s not just viruses that are on the rise, she says. Other pathogens, like the bacterium Borrelia, which can cause Lyme disease, have seen an increase in prevalence too.

“I’ve seen so much Lyme in the past year relative to the 10 years before,” she says.

Reflecting beyond infectious diseases, Dr. Mubareka points out that climate change has done more damage to our health than just increase the spread of pathogens.

In recent years, we’ve also seen negative impacts on cardiovascular health (the federal government estimates 15,300 premature deaths per year in Canada due to air pollution) and sudden death due to heat (British Columbia saw the deadliest weather event in Canadian history last summer, with 595 people killed by heat), to name a couple things.

“We are only scratching the surface. We really need to understand more,” says Dr. Mubareka.

The rise of climate change anxiety

As more work is done to unpack and address this growing problem, and as climate change becomes more visible and harder to ignore, more and more, climate change anxiety is becoming a topic of conversation.

A few years ago, Dr. Anthony Levitt, chief of the Hurvitz Brain Sciences Program at Sunnybrook, spoke briefly with the Globe and Mail about climate change anxiety.

“It got such traction,” he says of the interview. “I got emails and letters from all over the world asking about the subject.”

To better respond to those questions, Dr. Levitt conducted a survey in the United States and Canada to understand climate change anxiety and who it impacts most.

In general, he found that individuals who live in close proximity to events triggered by climate change, such as British Columbians who saw massive floods and numerous fires last year, were more likely to experience anxiety, and sometimes, even depression. Canadians, females and young people between 18 and 29 are also more vulnerable to climate change anxiety.

“They’re experiencing it, they’re seeing it, they’ve been educated in school about it,” says Dr. Levitt, explaining why young adults are feeling the pressures most. “And now, they’re getting into child rearing age; they’re seeing their children, and they’re thinking about what kind of a legacy they’re going to leave them.”

Like other forms of anxiety, Dr. Levitt says if climate change anxiety is affecting someone’s daily functioning, then they should seek help from a professional. However, he says we shouldn’t try to get rid of it altogether.

“There’s a functional part to anxiety. If you’re anxious about climate change, you’re going to mobilize your resources and do something about it. So, we don’t want to completely remove anxiety because that might remove some of the motivation,” he says. “However, we have to be careful. If you become too anxious, it becomes a barrier to effective problem solving, and you end up being paralyzed.”

What you can do

Dr. Levitt says the “antidote,” to both addressing climate change and to mitigating anxiety, is to take everyday action. Feeling that you are contributing to a solution has the dual job of helping the environment and of helping your symptoms of anxiety.

Dr. Mubareka practices this in her own life.

From biking more often to work, to eating less meat, to studying and educating about the complexities of climate change, she says, “I personally find doing something relieves my anxiety.”

And while she wants people to know how serious and multifaceted climate change is, rather than being alarmist, she says she always wants to emphasize what can be done.

“We have an opportunity right now to prevent the spread of emerging infections through mitigating climate change,” she says. “Climate change is very multilateral, very multisectoral, but that means even the small steps matter. We can all do our part.”

The post The far-reaching effects of climate change on health and anxiety appeared first on Your Health Matters.

Sunnybrook staff who work in palliative care confront the realities of death every day through the patients whom they work with. Read six stories and lessons that Sunnybrookers have learned about living while working with people who are dying.

Karen Johansen, advanced practice nurse

While there certainly is lots of sadness working in palliative care, Karen Johansen wants people to know that it’s not all “doom and gloom.”

Apart from helping people to feel comfortable in their final days, Karen and her team also aim to help patients “live until they die,” whatever that may mean for them.

“That is something I’m very passionate about,” she says.

To name a few stories, Karen has helped a patient who couldn’t leave her bed to go outside for the last time, she’s helped a patient get married on the unit before passing, and she’s helped a Toronto Maple Leafs fan attend one more game with his young son.

“Everybody who’s nearing end of life deserves the best of the best care,” says Karen. “That’s the least we can do for these folks and their families.”

A lesson Karen’s learned while working in palliative care at Sunnybrook:

“Working in the palliative care unit makes you realize on a daily basis how short life is. We have so many people admitted to our unit who, a week or two ago, were like everyone else; they were healthy, working, going on with their lives. And all of a sudden, they’re on our unit dying. And it can happen that fast. So, it just makes you realize that life is precious, and we need to be thankful for every day that we have.”

Dana Chatzitassis, environmental services partner

Dana Chatzitassis has been working at Sunnybrook for the past 24 years, with the past eight on the palliative care unit. And while she says it’s a privilege to do the work that she does, she says that working on her unit can be especially challenging.

“We don’t get to see anyone get better and go home, and we are witness to more heartache and grief in a day than most people see in a lifetime,” says the environmental services partner.

To keep things in perspective, Dana focuses on the lessons she learns from patients and the support she receives from her team.

“The kindness, bravery and empathy I see demonstrated every day in the most difficult situations offers the best education,” she says.

Speaking specifically about her coworkers, she adds, “We are truly a second family.”

A lesson Dana’s learned while working in palliative care at Sunnybrook:

“Life is short, and the most important things in life are not things. Don’t get me wrong. Shopping is normal. But, if all you are about is what you own and who you are wearing, rather than how you make others feel around you, if you take all of the flash away, who are you?”

Jill Hedican, music therapist

If you hear music being played in Sunnybrook’s palliative care unit, chances are, Jill Hedican is around.

“I play quite a bit of live music using guitar, voice and violin,” she says.

As both a certified music therapist and a registered psychotherapist, Jill plays an important and multi-faceted role on the palliative care team.

“I am able to use music as a tool to meet a wide range of patient needs,” she says.

Some of these needs include reducing pain perception, supporting emotional expression, building community during patient group sessions, promoting relaxation through individual sessions at the bedside, and creating memories by playing music with families.

Of this unique insight into patients’ “beautiful memories, tragedies, struggles and resilience,” Jill says, “I have the opportunity to witness raw emotion and the beauty and complexity of human relationships as they unfold each day.” 

A lesson Jill’s learned while working in palliative care at Sunnybrook:

“In working with patients in palliative care, offering creative and expressive outlets and opportunities for meaningful living, even as they approach death, I have learned to seek out the same opportunities for myself and my loved ones. I spend a lot of time being creative, connecting with nature, doing things I find fulfilling and trying to remember to seek support from others when I need it.”

Tricia Mills, recreation therapist

Most people don’t know that our palliative care unit offers a wide variety of recreational programs. At the heart of this important programming is Tricia Mills.

“It is a privilege to get to meet and support people at what can be a very difficult time in their lives,” says the recreation therapist.

In her role, Tricia puts on community-building programs like lunch sessions, where patients get to connect and relate with one another while enjoying a home-cooked meal. She also runs more personal programs, such as legacy work, where patients write cards and letters that are shared with their loved ones after they pass. Once, Tricia even helped a former economist, who had lost his vision, to achieve his goal of writing one last article.

“My job is very rewarding,” says Tricia. “I have learned to look for the positive in every day.”

A lesson Tricia’s learned while working in palliative care at Sunnybrook:

“One very important life lesson I have learned is not to take any day or relationship for granted. Each day is a blessing. Actions can’t always be put off until tomorrow as there isn’t a guarantee for tomorrow.”

Dr. Irene Ying, palliative care consultant

When a patient is transitioning into palliative care, Dr. Irene Ying is often the person to share that news with them.

“What I tell the medical students is: this is a skill, like doing any kind of procedure in medicine,” says Irene of the process of letting someone know they’re going to die. “It’s never going to be easy, but it does get easier when you know how to break that news in a way that’s empathetic.”

After the palliative care consultant lets patients know of their prognosis, she shifts her efforts to ensuring they feel supported as they approach end of life.

“When you give bad news, oftentimes, patients feel like their life is just spinning out of control,” she says. “So, you hold their hand through this process and give them some guidance around what’s next.”

Much of the time, “what’s next” is simply minimizing suffering. In addition, Irene likes to learn about the patient’s life and personality, to remind them that they are a human, not a disease, and she helps them enjoy their last days as much as possible.

“Most of the time, it’s really low-key goals, like going out for a coffee with friends,” Irene says of the things her palliative patients want to do. “I think it’s because you realize, all that stuff and money — what’s it going to buy me? It’s not going to buy me more time or happiness. What’s going to give me happiness? It’s going to be spending time with the people I love.”

A lesson Irene’s learned while working in palliative care at Sunnybrook:

“In one word: gratitude. There’s this pervasive sense of gratitude in my life knowing that things can change so quickly. So, I hug my kids tighter. I try to find more moments to just laugh with them and be present with them. Because time just goes by so quickly. So, I’m so grateful for everything that I have, and that contributes a lot to my general sense of meaning and satisfaction in life.”

Jordan Kerr, spiritual and religious care provider

It wasn’t until his grandmother fell ill that Jordan Kerr considered a career in spiritual care.

While in the hospital during his grandmother’s last days, the then airport worker gathered family around the bed to read one of his grandmother’s favourite bible chapters.

“Her face softened and she calmed down and relaxed,” says Jordan, of the changes he saw in his grandmother as he read to her. He adds, “It was a moment when the family came together as well.”

That moving experience prompted Jordan to change careers.

Today, the now spiritual and religious care provider works with patients and families of all faith backgrounds across the hospital as they deal with illness, death, and the uncertainties associated with these big life transitions.

“I do emotional, spiritual, religious support. When I meet with patients who are unfamiliar with spiritual care support, I will explain it by saying: ‘If you need to laugh, talk, pray, cry, yell, scream, swear or just sit quietly, that’s what I’m here for,'” says Jordan. “It’s helping someone be comfortable in spaces of uncertainty.”

A lesson Jordan’s learned while working in palliative care at Sunnybrook:

“When you encounter people making that transition into death, you become much more accepting about that spectrum of life. It brings you a consistent reminder that you are mortal too, and this is what the human experience looks like. The life lesson for me is to expect that experience. Death is no different than any other part of life.”

The post Six stories and life lessons from Sunnybrook’s palliative care staff appeared first on Your Health Matters.

PET/CT is a hybrid imaging system that combines the precise diagnostic functionality of assessing physiological functions (PET) with the anatomical assessment of various organs (CT). This combination with the scanner’s leading-edge digital PET detectors and quicker processing power, mean that image quality is enhanced and that diseases are detected with higher sensitivity (earlier) and specificity (more accurate).

“This is truly the only one of its kind in the hospital,” says Henry Sinn, Sunnybrook’s medical imaging director, who adds that there are just a handful of PET/CT scanners throughout the province. “It allows us to expand our imaging capacity at Sunnybrook, and patients are getting better service because the scanning is much faster.”

While this new scanner has and will continue to lead to exciting improvements, acquiring this equipment and creating the significant infrastructure needed to house it was no easy task.

Strong support and collaboration by Cancer Care Ontario (CCO), Sunnybrook senior leadership, corporate planning & development, and the flexibility from the medical imaging and oncology teams, were all needed before this new PET/CT scanner could call Sunnybrook home.

“We had to do a lot of re-configurations of existing space and functions, meaning we had to move people and services. It was a very complex project,” says Henry. But through thoughtful design, careful phasing, strong teamwork and dedication, he says, “We came out successful.”

This collaborative achievement is expected to have widespread and innovational impacts because, unlike older, similar scanners whose applications are solely in oncology, this new scanner can also be used for cardiac, neurological and research purposes.

Knowing the work that went in to acquiring the PET/CT scanner and knowing that it will help Team Sunnybrook invent the future of health care, Henry says, “It is a milestone investment well aligned with Sunnybrook’s strategic directions, particularly in precise and personalized treatments. It feels very good.”

The post Sunnybrook acquires new scanner that will expand imaging capacity and innovation appeared first on Your Health Matters.

Dr. Tinmouth, Amal Ga’al, Dr. Norris, Sophie Weiss, Dr. Daneman

Dr. Mireille Norris knows firsthand about the unique disadvantages Black and Indigenous students experience while pursuing careers in medicine.

“I struggled as a Black woman who navigated the medical system,” she says, citing isolation due to the lack of Black representation in the field as well as racism and its resulting sense of unworthiness as just a couple reasons for her challenging path. “I’ve been shouldering a lot more than many of my peers throughout my career, and that has affected my academic productivity.”

With just over *2 per cent of Canadian physicians identifying as Black and less than **1 per cent of physicians identifying as Indigenous, similar issues continue to manifest in the newer generation of aspiring Black and Indigenous physicians.

“They really struggled with mentorship, representation, access to research and experiencing discrimination,” says the geriatrician, speaking of the Black medical students she’s encountered in recent years. Reflecting on their circumstances, she says, “I felt that I really needed to build the pipeline.”

Introducing SPARK

After brainstorming with her colleagues and friends Dr. Jill Tinmouth and Dr. Nick Daneman, and after expedited planning and approvals, the Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students — also known as SPARK — was born.

“The idea driving SPARK is to provide various opportunities,” explains Dr. Tinmouth. “We identified strong mentors and research projects, and another key element was to provide financial support throughout the program.”

SPARK, which is in the midst of its pilot year, is providing four Black and Indigenous medical students with an opportunity to engage in meaningful and fairly-paid research externships at Sunnybrook.

Dr. Norris explains this is a unique opportunity that many Black and Indigenous students typically would not be able to access.

“Residency is very competitive. There’s a disproportionate weight given to research experience. If you have a research opportunity, it reflects well on your resume. The students more likely to access these externships are those with parents and other connections in the medical community, which is not always the case for students who are Black and Indigenous,” says Dr. Norris of medical residency applications.

She adds, students are likely to face financial strain as research externships are often unpaid positions, leaving them with the difficult decision of choosing between an unpaid or low-paying research position and a part-time job to support their education.

In addition to addressing disparities in research access and its accompanying financial barriers, SPARK also equips students with networking opportunities by providing participants with three individualized mentors, including a Black or Indigenous physician who will help the student navigate being under-represented in the field.

Mentorship, allyship and embracing the students

“Many of the challenges that may go unnoticed to other people can be shared and discussed between myself and an Indigenous physician,” says Sophie Weiss, an Indigenous SPARK participant, of the benefits of having an Indigenous mentor. “It just creates the opportunity to ask questions from another person that’s in a similar position, but who is ahead of you in terms of their career. It can really provide that guidance.”

Passionate about geriatric medicine, Sophie, who is one of just two Indigenous students in her second-year medicine class at the University of Toronto, is working with Dr. Norris and Dr. Barbara Liu to understand how the COVID-19 pandemic has impacted the geriatric fall prevention program.

“I feel very in control of my own project, which is really, really exciting,” says Sophie. She notes that one of SPARK’s goals is to support students as leaders in their research projects, which may lead to additional opportunities such as becoming co-authors of a manuscript, thus strengthening their residency applications.

Of her supervisors allowing her to have autonomy over her work, she says, “I felt like they wanted me there, rather than me really hoping they would accept me.”

Amal Ga’al, a fellow SPARK participant who is working with Dr. Daneman on the COVID-19 expansion to outpatients project (COVIDEO), shares the same sentiments as Sophie when reflecting on her project and research mentor.

When prospective SPARK supervisors applied to take part in the program, they had to submit a statement of intent, sharing their personal stories and reasons for wanting to be involved.

For example, in his submission, Dr. Daneman discussed how racial equality was always important to him. He was born in South Africa during the apartheid, but was brought to Canada by his parents as an infant so that he could be raised in a more just society. He grew up idolizing Nelson Mandela and says he’s excited to be a part of SPARK, something that will help contribute to “true, equal opportunity for justice, education, health and happiness.”

“Being able to have supervisors and physicians actually share of themselves and explain why they were excited about the program sets you up with a feeling of not just being accepted, but very much embraced and brought into the fold,” says Amal.

This sense of mutual respect and collaboration, versus the typical supervisor-to-student power imbalance you might find in other research environments, is an intentional part of this innovative program.

“There is an injury that comes from being racialized,” says Dr. Norris. “When you have faculty who say, ‘I see you, I know you, I feel for your struggle,’ it helps bridge that experience and heal the wound.”

Amal, who is a member of U of T’s Black Medical Students Association, says that with the rise of conversations surrounding anti-Black and anti-Indigenous racism, some engagement can seem performative and disingenuous. But both she and Sophie agree that the efforts made by SPARK to enhance their communities have been genuine, self-reflective and welcoming — qualities that Dr. Norris is proud to see in both racialized SPARK supervisors and allies who’ve supported the program.

Dr. Tinmouth echoes this, specifically giving kudos to all those who enthusiastically helped financially.

“We could not have pulled this without the quick support of the organization, the Sunnybrook Department of Medicine and the Sunnybrook Research Institute,” she says. “It was remarkable, and we were able to start the program this summer.”

“I think it’s really fantastic the way the Sunnybrook community answered the call,” says Dr. Norris.

The long-term impacts

While SPARK is aimed at helping students elevate their educational opportunities and medical careers, its impact will be felt beyond the program, through the work that students will go on to do in the community.

“I have a very large interest in Indigenous health, and I plan to do lots of outreach and really form my future practice around that,” says Sophie.

She also notes that Indigenous people are highly represented in the Toronto patient population but very poorly represented in the physician population — characteristics that she wants to change.

“Representation is so important,” she says. “I know that I can make an impact.”

Amal says she’s still figuring out what her medical career will look like, but she’s grateful that SPARK has exposed her to physicians with all kinds of different paths.

Regardless of where her medical career goes, Amal says, “I’m really interested in inequality — how do you address that, and why does poverty exist in society? Why are certain people marginalized?” Looking forward, she says, “I want to be involved in addressing and alleviating some of those issues.”

While Amal and Sophie move toward those goals, they will continue working on their SPARK research projects, transitioning from full-time summer hours to part-time hours throughout the school year.

As for Dr. Norris, Dr. Tinmouth, Dr. Daneman and the rest of the SPARK team, they will continue advocating for Black and Indigenous medical students by seeking to secure the support and funding to allow SPARK to continue and grow beyond this pilot year.

“My hope for SPARK is that other hospitals will follow Sunnybrook’s footsteps,” says Dr. Norris. “SPARK exemplifies transformational actions from the hospital’s leadership team that will bolster the future of Black and Indigenous learners for success in medicine, which will lead to greater representation, fairer opportunities and better care for all.”

*Black physician stats: https://www.utoronto.ca/news/we-need-ensure-cultural-shift-u-t-s-onye-nnorom-why-canada-needs-more-black-physicians 
**Indigenous physician stats: https://globalnews.ca/news/4769750/access-aboriginal-doctors-struggle-indigenous-population/

The post Introducing SPARK: The Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students appeared first on Your Health Matters.