In true Sunnybrook spirit, teams from every corner of the hospital and across all sites came together. A community of donors mobilized to support our work at a critical time. There was a rapid implementation of virtual patient care, the establishment of COVID-19 safety teams and a dedicated research focus on this emerging health threat. From being part of the Canadian research team that isolated SARS-CoV-2, the virus responsible for the COVID-19 pandemic, Sunnybrook has since led and participated in hundreds of COVID clinical trials.

No matter their role or position, every Sunnybrook staff member and volunteer was affected in some way, and every profession and team stepped up to do their part.

As we mark this five-year milestone, some of the voices featured in an original photo essay have offered their reflections. This small snapshot of experiences is part of the greater effort seen across Sunnybrook and our incredible staff, physicians, volunteers and donors. While it’s difficult to include all voices and experiences, acknowledging everyone’s leading and compassionate work is easy.

Thank you, Team Sunnybrook!

The novel coronavirus arrives at Sunnybrook

On an unassuming day in January, Sunnybrook’s Emergency Department would receive the first patient in Canada to have a confirmed case of COVID-19. It would mark a turning point for Sunnybrook and the country. 

Dr. Jerome Leis, Medical Director, Infection Prevention & Control: I vividly remember receiving the call. Based on their exposure risk and symptoms, we had a very strong suspicion from the get-go that this is what this patient had. We have routine protocols we’ve developed over the last 20 years since SARS, that there was nothing extraordinary that needed to be done. And yet this particular case solicited so many reactions, given the significance of what it represented for Canada and for the trajectory of the epidemic evolving toward a pandemic. 

Dr. Justin Hall, Chief of Sunnybrook’s Emergency Department: What really stood out in the beginning was the response of my colleagues who treated the first COVID patient in Canada when they arrived in the Emergency Department. 

Left: Dr. Jerome Leis, Sunnybrook’s Medical Director of Infection Prevention and Control, and Dr. Andy Smith, Sunnybrook President & CEO, spoke at a press conference alongside local and provincial health officials when the first presumptive case of the novel coronavirus was confirmed. Right: Dr. Leis today.

Dr. Jerome Leis: In retrospect, it was a historical event that we were participating in, and we were just doing our jobs. It was, ‘okay, this patient needs our care,’ just like anyone else that comes through Sunnybrook.

Dr. Samira Mubareka, microbiologist & infectious diseases physician: It felt like a major moment in time because it represented the first coronavirus pandemic, even though two other coronaviruses, SARS and MERS, were of high consequence and caused international outbreaks. At the time, though, we didn’t know whether the mortality would be as high, in the range of 10 to 30 per cent mortality. We were starting to get a sense, but there were so many unknowns in early 2020. 

Andrew Kennedy, patient care manager & head of assessment centre and vaccine clinic (then); Director, Clinical Informatics (now): Right before COVID was considered a global pandemic, I was a patient care manager at the Holland Centre, and my boss at the time called me to ask if I was interested in setting up our assessment centre. At this stage, I wasn’t expecting much of the pandemic; none of us were. Then all of a sudden it morphed into something else and the world shut down. More and more people started getting sick. We had to set up the assessment centre as a matter of urgency, which we did in a matter of days.

Julie Nardi, respiratory therapist (then); performance improvement coordinator (now): In the first few weeks of the pandemic, the urgency to keep up with the rapidly changing infection control guidance was overwhelming. As a clinical practice leader, I was especially focused on making sure the team had the most up-to-date information at all times, because everyone’s safety depended on it. We were constantly adjusting to new protocols. It required a lot of communication and quick decision-making, as we all had to stay informed and adapt quickly. 

Karen Montgomery, physiotherapist (then); acute stroke coordinator (now): Initially, the fear and uncertainty were overwhelming, especially as we faced the unknown while caring for critically ill COVID patients.

Left: Karen Montgomery with a COVID-19 patient in a critical care unit then. Right: Karen today.

Dr. Justin Hall: There was great uncertainty and some fear. The need for personal protective equipment for all patients changed how we saw them, and patients were also dealing with isolation with visitor restrictions in place.

Richard Ratcliffe, resident at Sunnybrook’s Veterans Centre: The Veterans Council has about 40 people in the group, but we didn’t have to shut down because of the pandemic. We were probably one of the first committees at Sunnybrook that went on Zoom. 

Steffanye Michaelson, Director of Operations, Odette Cancer Centre: The teams always pull together, but in the first weeks and months of the pandemic, this was on a whole different level. We were tired, but the level of commitment was brought to a new height to get our patients, families and each other through it. I wanted to be by my team’s side and work together to keep each other safe, as well as the public.

Isolating the virus

The same week that the pandemic was declared, Sunnybrook scientists announced that they had isolated SARS-CoV-2. The isolated virus would go on to help researchers in Canada and around the world develop better diagnostic testing, treatments and vaccines, and gain a better understanding of SARS-CoV-2 biology, evolution and clinical shedding.

Dr. Samira Mubareka: We were very fortunate. Because we had already been approved to work in Level 3 containment facility at the University of Toronto, we were able to get permission to work on this novel coronavirus very quickly. We essentially had three things: the infrastructure, the regulatory support and approval to do it, and most importantly, the personnel. Dr. Arinjay Banerjee, who was doing his post-doctoral research at McMaster University with Dr. Karen Mossman, came to work with us. He was one of the few people in the country who had ever worked with a high-consequence coronavirus. 

Dr. Rob Kozak, scientist and clinical microbiologist: We were really lucky to have Arinjay, because he was already doing research on coronaviruses like MERS. He was the one who did a lot of the hands-on research.

Pictured left to right: Dr. Robert Kozak, Dr. Samira Mubareka, Dr. Arinjay Banerjee after isolating the SARS-CoV-2 virus. Right: Dr. Mubareka and Kozak, who still work at Sunnybrook, today.

Dr. Samira Mubareka: He moved in with my family and I during that time. He’s become like a little brother. We still collaborate very closely. 

Dr. Rob Kozak: Being such a meticulous scientist, he didn’t jump the gun. He was like, can we do PCR testing to confirm that it’s SARS-CoV-2? Can we do some sequencing? Let’s really cross our T’s, dot our I’s, and be 100 per cent certain. 

Dr. Samira Mubareka: It felt very momentous. It was the realization of, ‘Whoa, we got it.’ Personally, it was somewhat conflicting: on the one hand, there’s this terrible virus, but at the same time, we were thrilled because now we could move the science ahead.

Dr. Rob Kozak: We isolated the virus right as things were shutting down. It was nice to have this little piece of good news to say, hey, even though things are getting worse, we have something and people can start using it for research. It was a bright spot.

Dr. Samira Mubareka: Once we had isolated the virus, it became a really key tool for scientists across Canada. I can’t even remember how many material transfer agreements we did just to share the virus. As time went on, more and more labs became approved, more and more people got trained and then we continued to isolate the different variants of concern.

The pandemic is declared

When the pandemic was declared on March 11, everyone had to pivot quickly to respond to new demands, new ways of working, and new patient care restrictions. Although there was a profound sense of uncertainty, there was no lack in people coming together to help. 

Karen Montgomery: The pandemic profoundly changed my work in the ICU, both in terms of the challenges we faced and the way we adapted. We had to quickly adjust to new protocols, staffing challenges, and a surging patient load. We also had to learn to manage the emotional strain of not being able to have family members present for support, which was especially hard for both the patients and their loved ones.

Andrew Kennedy: I have this vivid memory of when we first opened the assessment centre, which initially prioritized staff and physicians. There was this long line of Sunnybrookers waiting in the pouring rain the day we opened. This was anxiety-inducing because I was unsure we would be able to handle the sheer number of people that wanted to get tested and back to work. Seeing all those people galvanised me to act. We hired more staff for the assessment centre immediately because we needed all the support we could get. 

Left: Andrew Kennedy speaking to staff at Sunnybrook’s COVID-19 assessment centre. Right: Andrew today.

Dr. Samira Mubareka: Sunnybrook was a highly supportive environment. There was a lot going on the research and the science side, but at the same time, there were people we worked with very closely with – colleagues from infectious diseases and infection control who swung right into action. They were assessing everybody who tested positive, and managing things like virtual care, whether or not or not patients need to come into hospital, arranging for home oxygen monitors to be delivered, and more. There were some amazing infectious diseases docs and nurse practitioners who supported and sustained a lot of that.

Julie Nardi: When I think about working at Sunnybrook during the pandemic, I immediately think about the incredible sense of teamwork that defined those months. As respiratory therapists, we are rarely ever working in isolation, but during the pandemic, that collaborative spirit became even more pronounced. We all leaned on each other, and that mutual support helped us get through the toughest moments together.

Richard Ratcliffe: The Legions graciously set us up with Smart TVs in all the Veterans Centre lounges, so we were able to host Council meetings with smaller groups attending in different locations. We’re still using this approach today.

Dr. Justin Hall: There was very strong teamwork and camaraderie. Everyone came together under great uncertainty within and across programs.

Dr. Rob Kozak: It was nice to see how quickly people would jump at opportunities to help, like if we were looking for people to work or volunteer in the lab. When the call was put out, people answered. 

From the darkest days…

Julie Nardi: One of the most difficult aspects of the pandemic was the mandated safety restrictions that were in place which impacted family members wanting to visit their loved ones. For patients, especially those who were critically ill, separation from their families was heartbreaking but necessary. As health-care providers, we often found ourselves acting as the primary source of support.

Left: Julie Nardi, a respiratory therapist with a COVID-19 patient in a dedicated COVID-19 unit then. Right: Julie today.

Karen Montgomery: The hardest part was undoubtedly the visitor restrictions. Not being able to have family by a patient’s side, especially as they neared the end of their life, was heartbreaking and emotionally draining for everyone involved.

Richard Ratcliffe: In the initial stages we couldn’t do much, really, so there was some loneliness. There were a lot of restrictions in place. But I had an iPad and access to the internet, so I was able to stay busy.

Brenda Mayers, registered nurse: During the pandemic, safety comes to mind; making sure my PPE was applied properly and creating no risk of exposure to the virus. High anxiety also comes to mind. Even though we had the tools to protect ourselves, some staff became ill.

Left: Brenda Mayers, a registered nurse in a Sunnybrook critical care unit, then. Right: Brenda today.

Dr. Jerome Leis: There was a significant challenge with misinformation, and it’s actually only gotten worse over time. I think that is one of my greatest concerns with our ability to navigate the next major public health threat. 

…to glimmers of hope…

Julie Nardi: I was working with a tracheostomy patient to restore their voice. After weeks of effort, they were able to speak clearly enough to participate in a video call with their loved ones. Seeing the joy and relief on the patient’s face, and hearing the emotion in their family’s voices was incredibly rewarding. It was a reminder of how crucial human connection is, and how, even in the toughest circumstances, we found ways to bring people together.

Richard Ratcliffe: I’m a retired lay minister in the Anglican Church. When we could only meet in small groups, and didn’t have many external clergy coming into the Veterans Centre, I stepped in to conduct some morning prayers. Together with the Spiritual Care staff at the hospital, we stepped up and figured it out.

Karen Montgomery: We had a long-term, ventilated patient who was deeply depressed because his wife could not visit. In an effort to re-engage him, I reached out to his wife for help. She would come wearing a bright red sweater and stand on the grass outside M-Wing, where we could see her from the patient’s window. Requiring a lot of coordination, and with the support of the interdisciplinary team, we would mobilize the patient to a chair, wheel him over to the window to see her, and put her on speakerphone so he could hear her voice as well. Often, there was no portable ventilator available, so we would take turns manually ventilating the patient to ensure he did not miss his ‘date’ with his wife. This act was not only incredibly motivating for the patient and reassuring for the wife, but it was equally impactful for the staff involved. It was a truly special moment of connection during such an isolating time.

Dr. Justin Hall: A special moment was emerging from the pandemic and having our first departmental social in person after years of only virtual events.

Brenda Mayers: Over the course of five years, safety continues to be consistent with our staff and organization. Anxiety has diminished.

Dr. Justin Hall: It was a time of significant innovation to support new ways of assessing and supporting patients. One example is the creation of the Virtual Emergency Department to ensure access for patients in a way that was comfortable for them. Since that time, this model has been expanded into a regional program through Ontario Health.

From left to right: Steffanye Michaelson, Dr. Aikta Verma, the former chief of emergency medicine at Sunnybrook, and Dr. Justin Hall then. Right: Steffanye and Dr. Hall today.

Karen Montgomery: I also cannot forget the ‘hairstyles’ we were forced to make do with while salons were closed. I still chuckle when I think back to staff members cutting each other’s hair. I don’t think I will ever forget getting my first Sunnybrook haircut.

…Team Sunnybrook pulled together and pulled through.

Karen Montgomery: The pandemic brought out a level of teamwork and solidarity that I had never witnessed before. While the circumstances were incredibly tough, it underscored the resilience of health-care workers and the crucial role that collaboration plays in delivering patient care. It also served as a powerful reminder of just how vital empathy and clear communication are – especially during the most trying times. Even five years later, these qualities continue to guide my work and shape how I approach patient care.

Dr. Rob Kozak: We used to joke that a busy day pre-pandemic would be when you test 100 samples for influenza. During the pandemic we were doing 100 samples of COVID before coffee. At our peak, I think we did 11,000 samples in a day.

Steffanye Michaelson: Resilience, family, a sense of ‘we are in it together,’ uncertainty but also a sense of togetherness and facing it together. How each and every role in the organization got us through it. Collaboration really was the backbone of the pandemic. I was and still am in complete awe of everyone’s strength, resilience and ability to pivot on a moment’s notice.

Andrew Kennedy: We were told we needed to set up a vaccine clinic, and then seven days later we had a vaccine clinic. That was truly incredible and wouldn’t have been possible without a group of exceptional people. I remember for the first few months of the vaccine roll out, I was working 15-hour days, seven days a week. But I wasn’t alone in this. 

Left: Richard Ratcliffe was one of the first residents of Sunnybrook’s Veterans Centre to receive the COVID-19 vaccine. Right: Richard today.

Dr. Jerome Leis: There are silver linings around the successful, transformative changes that occurred as a result of the pandemic. We have worked towards several improvements that will help better integrate the whole region that Sunnybrook serves in a way that we didn’t do before the pandemic. We’re supporting infection prevention in the long-term care sector. We’re providing access to hospital services either virtually or in-person in a way that helps to bypass the emergency department. The integration between Sunnybrook and its partners is something that was greatly accelerated by the pandemic.  

Five years later, while the COVID-19 pandemic has lessened in urgency, the work is not done. Research into emerging pathogens, infectious disease mitigation, and improvements to patient care born from lessons from the pandemic are all ongoing – and the work of Sunnybrook staff, researchers, physicians and volunteers continues. 

Dr. Jerome Leis: It’s easy to try to forget a pandemic like COVID-19 and move on, but it’s so important to remember the challenges we faced and what we need to improve for next time; how do we better integrate different parts of the health-care system to respond in a coordinated way, and protect our most vulnerable populations like those who reside in long-term care. Those are all such important lessons that we need to be just as committed to addressing for years to come, just as we were in those early stages of the pandemic.

Dr. Justin Hall: The emergency department environment has become a harder yet more rewarding place to work. We are refocusing our efforts to support organizational change to decrease wait times and lengths of stay and support a better patient and provider work experience.

Julie Nardi: Since the pandemic, I’ve seen a shift toward greater integration of data to drive better care and improve patient outcomes. I can appreciate a broader impact and I’ve gained new skills in quality improvement and patient safety that continue to shape my work.

Dr. Rob Kozak: When Mpox came about, I was lucky to have people on my research team who, by virtue of COVID, were trained to work in Level 3 containment labs. We also have our eye on other emerging viruses. H5N1 is on our radar, so we’re asking questions like how do we develop a test for it, or how does this virus replicate in one set of cells versus another, those sorts of things.

Steffanye Michaelson: I am deeply humbled and fortunate to have been able to go through the pandemic with Team Sunnybrook.

Karen Montgomery: There was this unspoken bond between everyone, whether it was doctors, nurses, respiratory therapists, or support staff – we were all in it together, and that made a huge difference.

Andrew Kennedy: Although those months seem like a blur, one thing really sticks out to me – how Sunnybrookers came together for the common good. I had so much support during that time and it still amazes me what we were able to accomplish.

This article was written by Brianne Tulk, Hania Mattoo and Monica Matys, Communications Advisors at Sunnybrook Health Sciences Centre.

The post COVID-19 Five Years Later: An Oral History 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 reduce the chances of 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.

Why is hearing loss impactful?

Hearing loss can make it difficult to understand what others are saying, especially in noisy environments or when multiple people are talking. This difficulty can quickly lead to frustration and isolation from social situations. This social isolation can then further lead to anxiety, depression, and other mental health issues.

Hearing loss also affects others around you. Misunderstandings and miscommunication as a result of hearing loss can contribute to frustration and conflict, which can affect the quality of relationships over time.

Overall, untreated hearing loss can have impacts on mental health and quality of life. It is recommended that you seek assistance sooner rather than later to help mitigate these effects.

What steps can you take to prevent hearing loss through your lifetime?

One avoidable cause of hearing loss is noise exposure. Try to limit exposure to loud noise, and in situations where it is unavoidable, wear hearing protection. This can take the form of generic ear plugs from your local drug store or even custom-made ones molded to the shape of your ears. This also applies to music, so don’t set the volume too high! If you do attend concerts or play any instruments you can get specialized earplugs, referred to as musician’s plugs. Musician’s plugs maintain the same quality of sound while reducing the overall volume.

Avoid inserting anything into your ears, as it can cause irreversible damage to the structures in your ear! If you have concerns about ear wax, seek the help of a professional to help you manage it.

Certain conditions such as diabetes and heart disease have been connected to hearing loss, so maintaining a healthy lifestyle can help reduce their effects as well.

When should you have a hearing test?

You may try out our online hearing screener to see if you might have a hearing problem. If you are often asking people to repeat, or if people are having to speak up for you to hear them, it may be a good idea to get your hearing tested.

What’s the latest in the world of hearing devices?

Many hearing aids now have Bluetooth built into them, which allows you to do a few things once you have them connected to your phone. For example, you can:

• Stream audio: Any audio from phone calls, video, or music apps can be sent directly to the hearing aids like a pair of headphones.
• Use handsfree calling: Some hearing aids now allow you to use them as a handsfree headset; you can use the button on the hearing aid to pick up or hang up a call. The microphone on the hearing aid can pick up your voice, so you can engage in a phone conversation even if your phone is away (but within Bluetooth range).
• Try out remote control functions: Use the manufacturer’s app to control things such as the volume or bass/treble balance of your hearing aids.

Have virtual appointments: You can have the hearing aids adjusted remotely by your audiologist over the internet, saving you a trip to the clinic.

The post Good hearing matters: Tips from a Sunnybrook audiologist appeared first on Your Health Matters.

“Proper disposal of medications is not just about tidying up your cabinet; it’s about safeguarding our health and contributing to a healthier planet,” advises Karen Lam, Sunnybrook Ambulatory Patient Pharmacy Manager.

To address this issue, the Sunnybrook Pharmacy Green Team recommends a simple solution: regular assessment and proper disposal of unwanted or expired medications.

Here’s how you can contribute to this important endeavour in just three easy steps:

Step 1: Take inventory

Twice a year, take the time to thoroughly inspect your medication cabinet. Identify any medications that are expired or no longer needed. If you have any concerns or questions about specific medications, don’t hesitate to consult your healthcare provider or pharmacist for guidance.

Step 2: Prepare for disposal

Separate your unwanted medications, including both solid forms like tablets and capsules, and liquids or creams. Remove solid medications from the vials and place them into a clear bag, while liquids and creams can remain in their original containers. Before disposal, remember to remove any personal information from the containers. Additionally, it’s crucial to keep sharps and needles separate from other medications.

Step 3: Drop-off and recycle

Once you’ve gathered your unwanted medications, it’s time to dispose of them responsibly. Take the clear bag of medications to the Sunnybrook outpatient pharmacy or your local one for safe disposal. Notably, plastic vials can be recycled, contributing to environmental sustainability. However, it’s essential to note that medications labeled as “hazardous” or “toxic,” such as chemotherapy drugs, should remain in their original containers for safe handling. Similarly, sharps and needles must be disposed of in designated sharps containers available at pharmacies.

By following these three simple steps, you can play a significant role in ensuring the safe disposal of unwanted medications, thereby protecting both human health and the environment.

The post From Cabinets to Conservation: A Guide to Eco-Friendly Medication Disposal appeared first on Your Health Matters.

“We’ve noticed a steady increase in navigation requests among middle-school students, and also older youth,” explains Liisa Kuuter, Program Manager, Family Navigation Project. “We’re excited to be able to support more youth and their families with navigating in an ever-changing mental health and addiction system.”

We are just a call or email away:
Phone: 1-800-380-9FNP or 1-800-380-9367
Email: familynavigation@sunnybrook.ca
Please leave a message and we will be in touch with you within one to two business days.

Dr. Anthony Levitt, Medical Director of the Family Navigation Project, and Liisa answer some common questions youth and families may have about using the Family Navigation Project to get the help they need.

How do I know when to seek help?

Dr. Levitt: Families often wonder when to turn to professionals. In general, if they are not functioning as they usually do at home, at school or at work, and they have had a change in their behavior, it’s wise to seek help. Some changes in behavior might include if a person is:

• Often sad, worried, or fearful
• Having major changes in appetite or sleep needs
• Spending most of their time alone instead of with friends or family
• More impulsive or has trouble focusing
• Self-destructive or overly aggressive toward others
• Using drugs or alcohol frequently or dangerously

What’s the first thing I should do if I think I need support?

Dr. Levitt: Making an appointment with your family doctor or pediatrician is always a good first step. There are also mental health professionals in the community who can provide assessments and recommendations, like psychologists and mental health therapists. There are some excellent online resources through the Canadian Mental Health Association and some very helpful websites to find services including Help Ahead and ConnexOntario.

If you are finding that you or your loved one is not connected with the services they need, or you have tried several of these other resources unsuccessfully already, please reach out to us at the Family Navigation Project.

What does Sunnybrook’s Family Navigation Project do?

Liisa: We often say that we ‘stay in the boat’ with you until you get the help you need. Our clinically-trained system navigators work directly and intensively with you and your family to:

1. Understand and match a young person’s needs to the most
   appropriate service.
2. Coordinate care when multiple service providers are required or
   already involved.
3. Follow-up to ensure treatment is progressing as anticipated with both you and your service providers.
4. “Course correct” if the recommended services don’t work out or the situation changes for you or your loved one.

Honestly, I feel like I need help as the caregiver. What options for support are there for parents and guardians?

Liisa: Mental health and addiction issues have an impact on the entire family. In addition to providing options for the youth, we also help navigate for parents and caregivers, siblings and other family members involved in the care and or support of a youth.

The post The need for mental health support is growing: we’re here to help appeared first on Your Health Matters.

Helena didn’t realize she had a bacterial infection, which had weakened her and caused her fall. A paraplegic since a car accident in 1991, she crawled to the bathroom hoping to use accessibility handles to lift herself up, but she was too weak.

“I wasn’t panicked yet. I thought – okay, I’m tired, I haven’t had have enough sleep, so I pulled down some towels and covered myself to take a nap, thinking I’d have some strength when I woke up.”

She awoke what she thought was a few hours later to hear her friend calling from the front door. Her friend had asked the building manager to unlock the door when she hadn’t been able to reach her, but it was locked from the inside. When her friend said she was going to call the fire department to break down the door, Helena mustered what little strength she had left to crawl to the front door and unlock it, after which she passed out.

I would just see what I have that day … look at what’s around me and try to make up a story. In that limited area, with those limited materials, I just built my own joy.”

She had been on the floor for three and a half days, not a few hours. Doctors later told her that another half a day and she would likely have died. Helena was brought to Sunnybrook Veterans Centre as a community patient, as she fit the criteria for the Centre’s palliative care unit.

“When I got to Sunnybrook, they found I had bacteria in my blood and a very bad pressure sore on my back that was infected. I started to have kidney and liver failure, and the doctors and my family didn’t think I would make it,” recalls Helena.

Helena received a total of seven surgeries, mostly aimed at treating the infection in her spinal cord. She was on an IV drip for six months, getting MRI tests every six weeks to see if the infection was gone.

“I came in on May 3, and I was hoping maybe I could get home for the end of the summer … no, not happening. Then Fall comes and I think maybe I can go see the Fall colours … no, not happening. So then I was crossing my fingers thinking ‘please, please let me go home before Christmas… and I made it.”

A few months into her stay at the Sunnybrook Veterans Centre, Helena was feeling well enough to start taking advantage of the art therapy program. She had shared some photos from a birding trip to Ecuador with some of the nurses and art therapists, and they encouraged her to get creative. Her background is in photography, and she had developed a unique technique of photographing one-inch figurines placed in everyday settings to tell a story. She had her sister bring her ‘little people’ to the hospital and set to work on a new series.

Helena Chu photography series.

“You don’t need a lot … you only need one to do some storytelling. So my dinner, my table, the syringe I used every day, my pic line … unless I was in the garden, 90 per cent of the photos were done from my bed,” says Helena.

Helena’s work was featured in the Sunnybrook Veterans Centre’s Art Show, which happened in mid-November, just after she was able to go home. The series is called Live from K-Wing and subtitled Sunnybrook saved my life. Photography saved my soul. Shot with her iPhone, the images are bright and whimsical, and show no hint at all of the artist’s pain, fear and confinement to a hospital bed.

“I would just see what I have that day … look at what’s around me and try to make up a story. In that limited area, with those limited materials, I just built my own joy,” Helena recalls, adding that she was strongly supported by art therapist Ana Seara.

Helena Chu photography series.

For her part, Ana was delighted to work with Helena.

“All I do in a nutshell is I pay attention to what Helena is coming in with, what she’s feeling, and I offer opportunities. Then we build a relationship and I support her. I never say no. Dream big, and we’ll find a way to make it happen,” says Ana.

Helena still has some recovery ahead of her before she gets back to her passion of photographing birds around the world, which she does with the help of a close friend who is a very knowledgeable birding guide. She shared how his support helped her on her emotional journey.

“After my car accident, I thought everyone’s carrying their own box in their hands, which is their life. My box used to be pretty with jewelry and everything, and that day, somebody robbed me … they took my box and stuck an ugly one in my hand. I can’t give up because this is my life and I’m not brave enough to let go of my box, but I thought it’s an ugly box now, full of worms.”

When she shared this feeling with a psychologist after her accident, he told her that only fertilized land has worms, and if you work hard on it, you can plant something beautiful.

“He’s right and I told my bird guide, ‘you are one of the gems I found under the soil in my box’.”

The post A Creative Soul Proves the Value of Art Therapy appeared first on Your Health Matters.

If she moved even one, her then four-year-old son, Nathan, would notice, break down in tears, and become extremely physically agitated and upset.

“Everything had to be a certain way and we just kind of worked around it,” says Nancy. “He’d have these compulsions, but we could usually get him to understand that he needed to move on. We could move him off of being stuck and re-direct him to a new activity.”

Nathan was later diagnosed with autism and obsessive-compulsive disorder (OCD). As the years passed, and with support from his family and therapy, Nathan thrived; playing soccer and hockey, earning some honours grades in high school, working summers at the zoo, and graduating from a massage therapy program at college.

But then he became seriously ill with Celiac disease, which triggered his OCD and a life-threatening eating disorder that led to him being hospitalized twice.

“It derailed him,” says Nancy. “He couldn’t get out of bed; he could barely keep himself going and he couldn’t understand what was happening. It was very scary for him and his dad and me.”

Nathan developed a complicated relationship with the washroom; Nancy describes how he was afraid to eat because he didn’t want to end up in the washroom with a celiac reaction, yet he was afraid to leave the washroom in case he had an accident. By the time he was referred to the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook, Nathan was spending as much as 17 hours a day in the family washroom.

In March 2022, Nathan entered the Thompson Centre’s live-in program for OCD, the first program of its kind in Canada.

“Going to the Thompson Centre program reminded me of being at school. I was taught about OCD, what it is, and how it can be managed,” says Nathan. “They helped me recognize that certain things I was doing were caused by OCD. I also learned about new medications and different kinds of treatment. The staff were nice to me and helpful.” 

Nancy says she is grateful to the Thompson Centre for helping Nathan accept his diagnosis and reminding her family that they’re not alone.

“The team at the Thompson Centre were all very caring. The additional family and caregiver education sessions provided during the time Nathan was in treatment were helpful,” says Nancy. “We got to meet others who had loved ones that were in the same cohort as Nathan and share about our struggles.”

Nancy is also co-chair of the Thompson Centre’s new Patient & Family Advisory Council which brings together patients, family members, and staff to help enhance patient care and services.

She adds, raising awareness is critical to help reduce the stigma.

“Increased awareness and understanding of OCD may also help individuals and their families identify the symptoms of the disorder that they are struggling with and enable them to reach out for treatment.”

Nathan is now back at home and continues to work with the Thompson Centre team and his family on coping strategies.

“By going into the program, Nathan learned firsthand that he wasn’t the only person experiencing OCD and that there were other people who were struggling,” Nancy explains.

“We are very grateful that we have been able to become involved with the Thompson Centre and encourage those who may be suffering with OCD to reach out for help.”

The post Facing OCD as a family with the right support appeared first on Your Health Matters.

In her new book The Autumn Ghost, Sunnybrook critical care physician and researcher Dr. Hannah Wunsch describes how the polio epidemic of 1952 led to the invention of new technology — including the ventilator — that would revolutionize medical care.

In this Q & A, Dr. Wunsch discusses polio and the origin story of intensive care.

Prior to the invention of the ventilator, how were patients with life-threatening respiratory disease managed?

Dr. Wunsch: For the most part, people would have been provided with supplemental oxygen, either through a mask or a ‘tent’. Beyond that there was little that could be done for people, and so the focus was primarily on ensuring comfort, using medications such as morphine. The death rate from respiratory illnesses was therefore very high. The one exception to this was polio.

What is the iron lung and how was it used to treat patients with polio?

Dr. Wunsch: For patients with a certain type of polio that impacted the muscles used for breathing, there was a device called the iron lung. This sealed a person’s body into a tube of metal and then created negative pressure in the tube which forced the lungs open and caused air to rush in through the mouth and into the lungs. This ‘negative pressure ventilation’ was quite effective to support breathing when it was just these muscles that were impacted. But the iron lung was pretty much useless for most other types of respiratory illness, and also for the most severe form of polio, called bulbar polio, which affected the muscles that control functions like swallowing.

Why is polio described as the epidemic that invented intensive care?

Dr. Wunsch: Polio forced a lot of innovation and many of the concepts that are part of modern ICUs came from the need to provide better, safer care to polio patients. First, in 1928, was the invention of the iron lung, which was the beginning of the concept of machines that can provide organ support. However, the events in one polio epidemic in 1952, in Copenhagen, forced further innovation. They had only one iron lung, and many of their patients had bulbar polio. This led to the decision to try positive pressure ventilation using a tracheostomy (a tube inserted through the neck into the trachea) and then to blow air into the lungs. This approach was then used on hundreds of patients and was shown to be effective for supporting people with respiratory failure. Modern mechanical ventilation, with a temporary endotracheal tube through the mouth into the trachea, comes directly from this experience. Along with the actual intervention, there was a lot of recognition that you needed very skilled nurses, doctors and other healthcare team members to safely take care of these people.

Another important concept that came out of the same epidemic was ‘blood gas analysis.’ This is now a mainstay of critical care — the idea of measuring the pH of a person’s blood and the amount of carbon dioxide (as well as oxygen) in it to help guide ventilation.

How have more recent public health emergencies, like COVID-19, impacted critical care?

Dr. Wunsch: Critical care has always operated in what I think of as the shadows of medicine, but COVID-19 made the public more aware of the specialty. The importance of care in ICUs really wasn’t appreciated by most people because it’s not a specialty that people routinely interact with (unless they or someone they know gets extremely ill). COVID-19 also showed us the limitations of critical care – we could not save everyone, even with our most high-tech cutting-edge machinery. And, it showed us the limits of our providers — it was such a strain on everyone for so long that there is real concern about burnout, especially among skilled critical care nurses.

On a more positive note, COVID really brought the world’s critical care community together. There is a real sense of closeness in the global community of critical care providers, and the exchange of information has accelerated, leading to advancements in patient care.

The post How a polio epidemic led to the invention of intensive care appeared first on Your Health Matters.

Thinking I had a stomach flu, I went home. Over the next five days that “stomach flu” didn’t go away and the advice at that time was to rest and it will get better. Finally, after urging from my family, my husband drove me to Sunnybrook, thinking I likely only needed IV fluids.

That night, as my nausea was treated, I went to the bathroom and noticed blood. I called in the nurse who then called the doctor, and after checking, began to gently tell me that they could no longer find the heartbeat, and in that moment, was eight centimetres dilated.

That was an emotional rollercoaster. Within 20 minutes and with no epidural, I gave birth to my stillborn baby girl. I was heartbroken. My story doesn’t end here though, as my vitals were dropping, and I suddenly found myself being rolled into an operating room, sedated and confused. My heart stopped twice, was resuscitated twice and was on three different blood pressure medications just so I could have a pulse.

I woke up six days later, after learning I was in a medically induced coma and in the intensive care unit. Turns out, I didn’t have the stomach flu, I had necrotizing fasciitis. The condition targeted my stomach and caused toxic shock. General surgery removed my entire stomach as it was completely blackened. Dead. The only way to save the rest of my organs was to remove it and figure out the best course of action.

Three other surgeries later, within the span of six days, the decision was made to staple my esophagus and my intestines shut and do corrective surgery in the future when I become stabilized.

Since my digestive system was not intact, I had two tubes coming out of my stomach, one of which was a feeding tube. Since I was not stable, I couldn’t have the reconstruction surgery right away, and lived like this for 14 months. This timeframe was the most torturous time of my life and one that I wish no one ever endures. It was in this time that I did not eat a single thing. The feeding tube nourished me with 3,000 calories a day through a machine.

But life doesn’t stop. Thanksgiving meals don’t stop. Weddings happen. I had to continue to be a mom, and prepare meals for my family, and then sit at the dinner table watching them eat, when I could not eat. Just the smell of sautéed onions smelled so good, sometimes I had to go to the bedroom just so I wouldn’t have to smell the yummy dinner. You don’t notice how many food commercials are on TV until you can’t eat what they’re advertising. It was within this timeframe that I experienced depression and suicidal thoughts, was addicted to opioids, on a ton of medication, and was in and out of Sunnybrook’s Emergency Department for a variety of issues with the unanswered question of “why me?”

The day finally came when the team of doctors performed my reconstruction surgery. This involved attaching my small intestine to my esophagus (stomach transplants are not a thing). I experienced a huge sigh of relief when they did the ‘leak test’ to see if the connection was sealed.

Seven years later, this experience has taught me major life lessons like resilience, gratefulness, thankfulness and spirituality. I have a completely different viewpoint on life altogether. I am now a self-proclaimed foodie and enjoy eating with a different lens. I learned that the joys in life revolve around surrounding yourself with people you love and to share a meal together.

I learned that my case was a once in a lifetime “career case” for the team of surgeons, with the odds of someone getting this was one in ten million people. And the people that get this don’t survive. But I survived. I had an anesthesiologist come to my room saying “I heard a rumour you were alive and I wanted to confirm.” I was famous at Sunnybrook, anytime I went into the Emergency Department, someone was bound to say “Oh, that story was you?”

The surgery team at Sunnybrook is absolutely incredible and their skilled team gave me my life back to what it was, albeit some changes. Everyone that I and my family encountered was professional, delightful and empathetic. I want to thank all the doctor teams, nurses, porters, and administrators who provided excellent patient care. I no longer experience depression, PTSD, and my body works as it should.

I’m forever grateful. Thank you.

Note: If you or a family member have experienced a pregnancy or infant loss and live in Ontario, please consider seeking support through the Pregnancy and Infant Loss (PAIL) Network.

The post My condition happens to one in 10 million – Now I have a completely different viewpoint on life appeared first on Your Health Matters.

Learn more from Sunnybrook’s dietitians about their education, how you can access a dietitian’s services and how a dietitian might be able to support you.

“Ingredients” of a Dietitian

In order to become a registered dietitian in Canada, an individual will first finish a four-year accredited Bachelor’s degree, typically in Nutrition and Dietetics, followed by an accredited dietetic internship or an integrated Master’s program, which includes a practicum component.

During their dietetic internship or as part of an integrated Master’s degree, dietitians complete a minimum of 1250 hours of supervised practical training. The practical training provides a variety of rotations in clinical, community and food service settings that allows students to meet the requirements for their dietetic education and practice. Students learn from RDs working in a variety of inpatient and outpatient settings where they become a part of the interprofessional team gaining the hands-on experience and skills needed to provide competent patient centered care.

After completing their post-graduate internship or Master’s degree, students must pass the Canadian Dietetic Registration Exam before they officially receive their independent practice license as a registered dietitian. In Ontario, they must also pass the Jurisprudence Knowledge and Awareness Test at graduation and every 7 years. Every year, RDs must file a “self-directed learning tool” and provide evidence of ongoing learning to maintain their registration with the College of Dietitians of Ontario.

The pathway for internationally trained dietitians can be found here: https://www.collegeofdietitians.org/applicants/internationally-educated.aspx

What can a dietitian do for me?

Registered Dietitians are food and nutrition experts. There are many different ways that an RD can help support you in your health and nutrition goals. Some examples include:

• Healthy eating for health promotion and disease prevention
• Chronic disease management (diabetes, heart disease, kidney disease, cancer care, gastrointestinal disorders, and more
• Nutrition for different stages of life from prenatal nutrition to infancy and childhood, through to older adults and palliative care
• Food allergies, intolerances and sensitivities
• Eating disorders and disordered eating
• Sports nutrition

In a hospital setting, clinical RDs provide medical nutrition therapy for a variety of inpatient and outpatient medical conditions. RDs might screen patients for nutritional risk, provide nutritional assessments and develop nutrition care plans. They assess for nutrition therapy provided orally, through enteral feeding tubes and via IV. They also provide nutrition education for patients and families. 

Accessing a dietitian

Outside of the hospital setting, you may wish with work with a dietitian to learn about how to make the most of your food and nutrition.

 There are dietitians who work for public health units, diabetes education centres, community health centres and with family health teams. In some of these cases, they may accept self-referrals (e.g. this is the case for the Sunnybrook diabetes education centre), while other clinics may require a referral from your doctor. You may also be able to access a dietitian through long-term care homes or home care service agencies.

Some extended health care plans cover private dietitian services. In order to access a dietitian who works in private practice, you may be required to have a referral from your physician in order for insurance to cover their services, so check with your insurance company before booking an appointment.

You can find a dietitian in your area by visiting the Dietitians of Canada website and clicking on “Find a Dietitian.”

Finally, you can visit Health Connect Ontario’s website to speak with a local registered dietitian. This service is free and does not require a doctor’s referral. It can be a great starting point for anyone looking to speak with a dietitian since it is free for the public, and there are translators available for more than 100 languages. Dietitians at Health Connect can address many concerns related to chronic diseases and can assist in offering resources if they are not equipped to speak to a specific concern.

The post An introduction to dietitians and how they can support your nutrition goals appeared first on Your Health Matters.