After living with the symptoms of depression and post-traumatic stress disorder (PTSD) for more than a decade, Sarah* had tried numerous medications, electroconvulsive therapy (ECT), and was engaged in psychotherapy, but at a certain point nothing was working.

“I did everything right and I was trying my best to live a productive life [despite my symptoms], but I was struggling,” says Sarah.

Triggers or reminders of Sarah’s past traumas would lead to feelings of crippling fear, dissociation and depression that would make it difficult to get through the day.

“I was constantly jumpy and on high alert, trying to avoid situations that would bring back memories,” says Sarah. “I consistently withdrew from people and my world became really, really small.”

A ground-breaking clinical trial: deep brain stimulation for PTSD

In early 2020, Sarah was referred to a clinical trial at Sunnybrook investigating a new approach for treatment-resistant PTSD called deep brain stimulation (DBS). DBS is a type of brain surgery that directly targets dysfunctioning brain circuits. It involves inserting thin electrodes into brain structures that are responsible for associated symptoms and electrically stimulating them with a pacemaker-like device, which is implanted in the chest.

Researchers at Sunnybrook had launched a first-in-Canada phase I trial investigating the therapy.

“When I learned about DBS, I didn’t have any hope but I was willing to try anything,” says Sarah. “I thought best case scenario – maybe this research will be able to help someone else.”

Finding hope after deep brain stimulation

During the procedure, Sarah remembers a moment when the surgical team stimulated a certain part of the brain: “it immediately seemed brighter in the room. That was the first indicator, something changed in that moment, and it gave me a little bit of hope.”

The weeks after surgery when the device was turned on, Sarah’s friends and family began noticing a change.

“I didn’t feel significantly different right away, but my family members said they saw a sparkle in my eyes like there was life in me again,” says Sarah.

In the year following surgery, she had landed a new job and applied to nursing school.

“DBS changed my life. I was finally starting to think about the future again.”

Sarah notes that she has seen significant improvement in her quality of life, but it “wasn’t magic and takes a lot of work”. She still experiences symptoms from time to time.

“I’m doing really well, but it doesn’t mean every day is perfect. Something can trigger me, but the difference is, now I notice it and move on. It doesn’t mess me up for hours. I can come back from it.”

A new lease on life

Sarah says one of the most powerful things about DBS is how it reaffirmed her mental illness as physiological. “When I would get my levels adjusted, I would see a change. It wasn’t about how hard I was trying or what was happening around me. It’s beyond my control. That was really powerful.”

Two years post-surgery, Sarah is doing well. She’s now in nursing school and this year had the opportunity to come back to Sunnybrook as part of her clinical nursing rotation.

“[Before DBS], I was frozen, living in a constant state of fear. Now, I feel free and present,” says Sarah.

“It’s so surreal. Two years ago, I would have never imagined I’d be here.”

Read more: Deep brain stimulation (DBS) shown to be safe in treating post-traumatic stress disorder

The post Patient view: How deep brain stimulation changed Sarah’s life appeared first on Your Health Matters.

Then the pandemic hit. Unexpectedly, the work slowed and eventually stopped. Allisa found she had time to reflect on her life and some terrible memories and emotions she had blocked began to surface.

She realized she had been keeping busy with work to numb the pain from repressed trauma, sexual abuse and violence. Allisa says her emotions began spiralling out of control. She knew she needed help but says it was incredibly difficult to find.

After a month of researching online, emailing and calling various organizations, someone recommended that she contact Sunnybrook’s Family Navigation Project (FNP).

Developed by families in collaboration with Sunnybrook experts, FNP is a free service that pairs youth aged 13 to 26 who have mental health and/or addictions challenges, and their families, with clinically trained navigators who connect them with the services they urgently need.

After reaching out to her FNP navigator, Allisa was connected with a therapist who specialized in cognitive behaviour therapy (CBT) and had the experience to match her unique needs.

Following her first call with her new therapist, Allisa broke down in tears of relief because she knew that she had found someone who could finally help her. And not only did her FNP navigator find a therapist for her, but she continues to check in on Allisa on a regular basis.

Allisa says that having her navigator by her side through her journey of recovery “feels like having a guardian angel.”

FNP is funded entirely by RBC Race for the Kids and other generous donors.

This is the 10th anniversary of RBC Race for the Kids in Toronto which has raised more than $18 million for FNP. Thanks to the support of race participants and the donor community, thousands of youth and their families have found the mental health services they need.

While Allisa realizes she will need to continue to work on her mental health, she is feeling positive about her future.

“I felt incredibly lost before connecting with FNP but since that first call, I have been moving forward and living life more positively. I’m grateful to RBC Race for the Kids and to donors for supporting FNP which makes it possible for youth to find help.”

RBC Race for the Kids takes place September 17 at Mel Lastman Square and virtually. To register or donate click here.

The post Allisa finds the specialized mental health care she needs appeared first on Your Health Matters.

“I loved writing her letters,” he says. “Just telling her how much I loved her.”

But, until November 2020, Andy hadn’t written Kim a note in years.

Diagnosed with essential tremor

Andy has had a tremor since he was young; his first memory of it is his lip shaking when he was 14. It got progressively worse as he got older, when his hands would start to shake and some simple tasks such as eating or writing became difficult. He was eventually diagnosed with an essential tremor in his early 20s.

“It’s scary, somebody telling you there’s something wrong with you. And then telling you it’s going to get worse; that the best you have it is right now. And there’s no cure,” says Andy.

It was difficult for Andy. He felt uncomfortable talking about the tremor and hid it from everyone but family and close friends.

“He didn’t want to do things like going out for dinner,” Kim says. “Even when we first started dating, we didn’t go out with other people that much. He didn’t want to eat in front of people because his hand shook.”

Andy, a grade 7 and 8 teacher, says he would eat lunch in his classroom instead of the staff room, would go out for drinks with co-workers on a Friday night but not eat anything — even though he was hungry — because he didn’t want people to see his hand shaking.

Finding hope with focused ultrasound

And then one day while he and Kim were watching the news, there was a segment about a procedure being performed at Sunnybrook that could help patients with essential tremor.

“I almost cried,” Andy says. “Here was something, maybe, something for me.”

Andy reached out to his family doctor, who helped Andy enroll in a focused ultrasound trial at Sunnybrook. Focused ultrasound is a non-invasive, image-guided surgical technology that uses ultrasound energy to target specific areas of the brain and body in the treatment. For treatment of essential tremor, high-intensity focused ultrasound waves lesion the brain cells responsible for the tremor, which can significantly improve symptoms for patients.

Sunnybrook is a global leader in focused ultrasound research and clinical trials.

“In May 2012, Sunnybrook was the first centre in Canada to perform a focused ultrasound procedure for essential tremor,” says Dr. Nir Lipsman, neurosurgeon and director of Sunnybrook’s Harquail Centre for Neuromodulation. “Ten years later, we’re more committed than ever to this breakthrough technology. We have expanded our clinical and research program and are investigating focused in ultrasound in several other brain disorders, including Alzheimer’s disease, major depression, ALS, and brain cancer.”

Seeing the video about a possible treatment for essential tremor was the first time Andy had thought there might be a way to stop his tremor, but it wasn’t until he got a phone call from Sunnybrook that he’d been accepted into a clinical trial that it felt real. He excitedly told Kim, who wasn’t quite as excited as he was just yet.

“He did the excitement, I did the worrying,” Kim says. She was nervous about the possible side effects of having the surgery, but Andy kept telling her it didn’t matter.

“I won the lottery that day,” Andy says. “Up until that point, there had been nothing I could do. I was tired, I was exhausted. And, suddenly, there’s hope.”

Andy had his focused ultrasound procedure on Nov. 16, 2020—he was the 200^th focused ultrasound patient at Sunnybrook—and he walked out of the operating room with a steady hand.

“After the operation finished, [Dr. Nir Lipsman] hands me a glass of water,” Andy says. “I haven’t held a glass of water with one hand in 20 years. I remember that moment because I was frightened, thinking if I move it and find out the operation didn’t work, then this is it.”

But Andy was able to drink the glass of water with one hand.

“I don’t know how to describe it,” he says. “I was back.”

Writing love notes again

It was a few weeks later, while he was home recovering, that he picked up a pen to write a note to Kim for the first time in many years. He texted it to her so she could read it at work.

“I get this ‘ding’ and I’m thinking something’s wrong because he’s home by himself after having brain surgery,” Kim says. “So I pick up my phone, see the note, and I almost cried. It was so nice because the old Andy was back, and you could just tell he was so happy.”

Andy’s note to Kim following his first FUS procedure.

As part of a clinical trial exploring focused ultrasound for bilateral essential tremor, Andy has since received treatment for his right hand as well (his non-dominant side), which was also successful. He says he has some rebound tremor, which is quite normal, but it’s minimal compared to what it was before the procedure, unnoticeable to most people.

And now, Andy says he’s much more comfortable telling his story.

“The team at Sunnybrook, the different neurosurgeons and neurologists—they’ve given me the words, the understanding that it’s not my fault,” Andy says.

He says he doesn’t mind if someone notices the tremor and asks about it. He wants to talk about it in the hopes that maybe someone else who needs it will hear about focused ultrasound.

“I love sharing my story. I want them to know, if they know somebody or it happens to them, talk to your doctor,” he says. “There’s hope.”

Following treatment, Andy can eat soup without spilling now; he’s experimenting with new baking recipes and he’s writing all the notes he wants. He doesn’t feel like he has to hide anymore, thanks to focused ultrasound and Sunnybrook.

“I owe them so much,” he says. “They’re my heroes.”

Learn more about FUS

Learn about the 10 years of FUS in Brain Sciences at Sunnybrook

The post ‘I won the lottery that day’: How focused ultrasound changed Andy Hodgson’s life appeared first on Your Health Matters.

Before that time off, I was used to a certain structure and routine. While I was in undergrad, I was busy working as a teaching assistant and a research assistant. After graduation, I went from being extremely busy to having nothing to do each day. I tried getting a job in between but nothing really worked out.

The decline in my mental health was progressive. There wasn’t anything in particular that happened, I just felt like I was getting lower and lower. Then it got to the point where I couldn’t get out of bed. I couldn’t move. At that point, I knew something was wrong – it wasn’t normal or just being upset – it was something different. That’s when I knew I had to do something. I was eventually diagnosed with anxiety disorder and depression after connecting with therapists and a psychiatrist.

I also reached out to the Family Navigation Project (FNP) at Sunnybrook. They provided me with information on how to get connected to a psychiatrist, along with other resources. I went to the psychiatrist who recommended medication and suggested academic accommodations including taking a lighter course load to focus on my health. I ended up staying with my previous therapist, but I think FNP is a good platform because they help provide you with resources.

Later, I joined FNP as a Youth Engagement Partner to help share my experiences and insights on how the mental health system can be improved. I also participated in my first RBC Race for the Kids which supports FNP and youth mental health. This is an important cause and means a lot to me.

This year, being one of the first members of FNP’s Youth Advisory Council means offering my voice to help FNP connect young people with the mental health services they need. FNP’s Youth Advisory Council brings together young people with different lived experiences. I think it’s helping to break down stigma because each person can shed a light or new perspective on mental health. We are from diverse backgrounds and want to improve mental health care for young people.

In my personal journey, there are different ways I manage my mental health. I find that physical exercise is very important. That could mean taking a walk or going to the gym.  I also focus on hobbies that I enjoy, such as being outside and exploring an area. Photography is another hobby that I enjoy. I also try to be more present. I feel like when I’m not as present or not as in tune with what’s going on, that can have a negative impact on my mental health.

Another thing that helps me is journaling. Sometimes there are so many thoughts going through my head but it’s hard to verbalize what I am thinking. Journaling helps make things clearer for me.

I feel there is still stigma in mental health. Just one example is that there is sometimes a perception that if you’re a man, you shouldn’t be upset or sad. But no matter who you are – we all have emotions and different things we’re dealing with. It’s important to learn different ways to cope with mental health and for anyone to reach out for counselling or support when they need it.

Learn more about the Family Navigation Project (FNP) at Sunnybrook – sunnybrook.ca/familynavigation

FNP is not a crisis response line. If you need help in an emergency, please call 911 or visit your local emergency department.

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

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

The post Murad’s story: Breaking down stigma in mental health appeared first on Your Health Matters.

It was November 2021, and Jenny Shin was on the way to a work assignment when it happened. Her sister was driving, and Jenny was in the passenger seat on a phone call.

“My vision became blurry. I started seeing rainbow-coloured balls in my left eye and remember thinking, ‘something’s not right’,” she recalls.

She tried to rub the blurriness away. She had a busy day ahead — a photo shoot with a client, some meetings — there was a lot to do. As a public relations professional in Toronto and a self-proclaimed workaholic, she needed to get on with her day.

Instead, the blurriness worsened and she started feeling dizzy. The 47-year-old tried to tell the person on the phone that something was wrong, and she had to end the call.

“That’s when I heard screaming on the line and the person was saying, ‘Jenny, are you okay?’’’

She soon realized that her speech was affected — instead of words, garbled sounds were coming out.

Jenny also noticed her right hand wasn’t working when she had difficulty putting her sunglasses away.

“I was sort of bracing myself for something,” she remembers.

Another unexpected injury

Jenny’s sister reacted quickly by taking her to get help. Jenny felt her symptoms escalating — she was feeling disoriented and even more dizzy.

They ended up at a near by hospital and while trying to get out of the car, she had a devastating fall and hit the pavement. The impact broke Jenny’s neck.

“My sister let out a scream, and emergency personnel came out immediately,” she remembers.

Jenny was then rushed by ambulance to Sunnybrook, which is one of nine regional stroke centres in Ontario.

“When I arrived at Sunnybrook, it was a huge relief,” says Jenny, “I saw the doctors, nurses, everyone in scrubs — it was like a well-oiled machine.”

Stroke care

“Jenny’s stroke and neck fracture both required immediate attention,” says Dr. Houman Khosravani, medical director of the inpatient stroke unit at Sunnybrook. “Her neck and spine needed to be kept immobilized, and our teams then worked very quickly to treat her stroke as the priority. We took special care to rescue the brain while maintaining mechanical and medical stability with the neck injury.”

An ischemic stroke is a medical emergency that happens when blood suddenly stops flowing to the brain. Oxygen and nutrients can no longer reach the brain and its cells begin to die.

The saying “time is brain” is a key message from stroke teams. It means when an individual starts showing symptoms of a stroke, every minute counts. The longer a stroke is left untreated, the greater chance of injury to the brain. There’s a crucial 4.5-hour window from onset of symptoms, where stroke patients can receive clot-busting medication or surgery, which can help remove blood clots that lead to stroke. Both can potentially restore blood flow and limit disability after a stroke.

Jenny arrived in time and was prepped for surgery.

“We successfully removed a clot from one of the brain blood vessels using a procedure called a mechanical thrombectomy,” explains Dr. Leo da Costa, neurosurgeon and medical director of Sunnybrook’s Centre for Neurovascular Intervention. “With any stroke case, it is important for patients and families to seek medical attention quickly.”

Facing a new reality

The stroke left Jenny paralyzed on her right side. Due to her neck injury, she had to wear a neck brace to keep her safe.

A fiercely independent person, Jenny soon realized she had to adjust to the situation.

“At one point I could not lift a finger, or move my foot or anything.”

Although her new reality was frustrating, Jenny says “I had made peace with myself and the prospect of being permanently paralyzed.”

Still, Jenny kept trying to move her muscles. After being admitted to Sunnybrook’s inpatient stroke unit, she didn’t give up. Eventually, she was able to move her fingers and toes.

“I was relieved, and cautiously optimistic.” Jenny also says the support she received from the health-care team helped make a huge difference in her recovery.

“I remember a day when I was trying to brush my hair and I was having a very hard time with it. One of the nurses noticed, but knowing my independent spirit, she stood by and kept an eye on me,” Jenny recalls. “She just helped to lift my elbow a bit to help make it easier. She didn’t take the brush away and start doing it for me. This nurse offered the most beautiful and dignified way of lending support so I could continue to do it myself. I don’t know if she’ll ever know how much I appreciated that.”

Stroke at any age

Experts say that there is a general misconception that stroke only affects the elderly but in reality, stroke can happen to anyone no matter the age.

Typical risk factors for stroke include high blood pressure, high cholesterol, history of smoking, diabetes, and/or sleep apnea.

“In general, to reduce the risk of stroke, it’s important for individuals to be active, exercise, and have healthy lifestyle habits” says Dr. Khosravani.

At 47 years old, Jenny says she’s always been aware that stroke can strike anyone, but like most people, wasn’t expecting it to happen to her.

Dr. da Costa says Jenny’s stroke appears to have been caused by an issue in a carotid artery, one of the major blood vessels in the neck that transports blood to the brain.

“There’s a tear in the wall of the blood vessel and that forms a clot,” explains Dr. da Costa. “In general, this could happen for various reasons, some patients have underlying or undetected issues with the vessels and sometimes it is related to injuries.”

Rebuilding strength and function after stroke

In the weeks and months following her stroke, Jenny worked with physical and occupational therapists in the Stroke & Neurological Rehabilitation program at St. John’s Rehab to regain use of her right hand and build strength in her right leg.

“When clients come in, we work together to help them set their goals. It’s very much a team approach,” says Vidya Umaibalan, an occupational therapist at St. John’s.

“With Jenny, we’ve been working on high level balance, her mobility and flexibility – getting the range back and coordination,” says Hina Khatri, a physical therapist.

“I’m also working on fine motor skills – typing and doing finger exercises to help the tiny muscles in my fingers remember how to do physical tasks again,” says Jenny.

In addition to rebuilding day-to-day skills, the team also helped Jenny get back on her feet. When she was strong enough, she tried walking in high heeled shoes again, which she’d worn every day for work prior to her stroke. Jenny and the team took it one step at a time. Her team also provided recommendations for alternative footwear for non-work-related situations.

“It took some getting used to again and they were so encouraging,” Jenny smiles.

“I feel truly blessed to be able to be part of someone’s life and help them get them to where they want to be,” says Hina.

“Being part of that journey with patients means so much — helping them understand that they can adjust to a new normal, and that the stroke doesn’t define them,” adds Vidya.

That’s certainly the case for Jenny, whose positivity and hard work has continued throughout her journey.

“It’s been challenging but I’m working with an incredible team. The saintly support and care I received at Sunnybrook leaves me in awe and humbled,” Jenny smiles.

“What could have turned out to be one of the most traumatic experiences of my life has instead become one of the most positive. Through the compassion and education I received at Sunnybrook, I feel empowered to flourish (versus just surviving) as I move forward with confidence in the second chapter of my life.”

The post Jenny’s story: rebuilding strength after stroke appeared first on Your Health Matters.

It took him about five seconds, he says, to decide he wanted to use his diagnosis to make a difference. But he also knew he couldn’t wage the battle alone.

During ALS Awareness Month last June, Mark rallied the support of his former NHL teammates and members of the sport media community. Thirty-three hockey greats, including former Toronto Maple Leaf captains Doug Gilmour, Wendel Clark, Darryl Sittler and Rick Vaive, each recorded a video message on Twitter encouraging people to take a stand in support of ALS research and care.

Hockey Night in Canada host Ron MacLean even waved a “Help Kirts End ALS” t-shirt during Game 7 of the televised playoff match between Toronto and the Montreal Canadiens. “The reach was enormous,” Mark remembers.

So was the support. In just two months, Mark and “Team Kirts” raised more than $100,000 for Sunnybrook and the ALS Society of Canada. At Sunnybrook, the funds are helping to advance the groundbreaking research of Dr. Lorne Zinman, Mark’s doctor and director of Sunnybrook’s ALS Clinic. Among many projects, Dr. Zinman is preparing to launch a world-first clinical trial testing the effectiveness of focused ultrasound in the delivery of a promising ALS therapeutic. The non-surgical technique has been shown to safely and temporarily open the blood-brain barrier, the cluster of cells that protects the brain from dangerous substances while also denying potential therapies access.

Knowing he has Dr. Zinman, so many friends and his beloved family – who Mark says are “my everyday heroes and have become the extension of me as I have weakened” – on his team only makes the husband and father of three want to fight even harder to change the course of the disease.

“I’m going to keep pushing,” Mark says. “Team Kirts isn’t done yet. We’re not done until there’s a breakthrough.”

The post How former NHL player Mark Kirton is using his ALS diagnosis to make a difference appeared first on Your Health Matters.

Stephanie Bergman’s first experiences with depression came from others in her family who were affected by the condition. She says it wasn’t a complete surprise when, in her early twenties, she was formally diagnosed herself. “There can be a genetic component to it. But I think I was the first and only one who was ready to accept it, and also accept some help for it,” she says.

In the 25 years since her diagnosis, Stephanie says medication has been a mainstay in her treatment plan. “For a long time, I thought I would be able to handle it on my own just with the medications, and for the most part I was successful.” But she says there were times she struggled deeply and needed more.

That led her to a gamut of other treatment approaches over the years. “I was ready to try anything to be able to support myself and be a better mom, daughter and wife. Then I learned about rTMS.”

rTMS – or repetitive transcranial magnetic stimulation – is approved by Health Canada for treatment-resistant depression and obsessive compulsive disorder (OCD). Statistics show that of the five per cent of Canadians who are diagnosed with depression every year, about one third will not get better with medication alone.

“rTMS involves the application of magnetic pulses to stimulate the brain through the skull in a non-invasive way,” says Dr. Peter Giacobbe, psychiatrist and clinical lead at Sunnybrook’s Harquail Centre for Neuromodulation. “We know in depression that some parts of the brain are underactive and others are overactive. By administering the energy to a discreet part of the brain, we’re able to rebalance the connectivity. Every patient receives a dose that is appropriate for them.”

Dr. Giacobbe says rTMS has been available at Sunnybrook since 2019, and is one of the treatment options psychiatrists consider for patients. “Side effects can include some pain or headache, but are minimal. About 80 per cent of patients experience some level of improvement,” he says. Treatments typically take between three to twenty minutes, and are done daily over the course of several weeks. Patients are able to work and drive immediately following each session.

Funding for rTMS at Sunnybrook comes through research grants as well as the Harquail Centre for Neuromodulation. Dr. Giacobbe notes that Sunnybrook is one of the largest centres in Canada for rTMS and is unique in that it offers shorter “booster” treatments when patients are in need.

“I truly wasn’t able to function on medications alone,” says Stephanie, who adds that rTMS has rebalanced her. “I do experience some pain during the treatment, but the treatment only takes two minutes. Afterwards, there are absolutely no side effects. My family often tells me that I’m back to myself. Things are so much better.”

Stephanie says her depression gets worse during the winter months, so she uses light therapy and receives some rTMS boosters at Sunnybrook to get her through. She hopes that sharing her experiences will help others learn about this hopeful treatment option. “You have to learn to cope because depression doesn’t go away.”

Learn more about rTMS at Sunnybrook.

The post Repetitive transcranial magnetic stimulation: A different treatment for managing depression appeared first on Your Health Matters.

Georgia Marianthe Mesbouris takes a moment to herself before a follow-up procedure at Sunnybrook.

One weekend in August 2020, on a morning when Georgia Marianthe Mesbouris and her family were planning to leave for a family vacation, the 42-year-old resident of Scarborough, Ont., woke up with an incredible pain at the back of her neck. Knowing how much this vacation meant to her kids, she took a pain reliever and hoped the throbbing and sensation of burning hot ears would go away.

It didn’t.

Georgia, a mother of two and a tech expert on a national TV channel, considers herself a healthy person. “I don’t have high blood pressure. I don’t smoke. I [rarely] drink,” she says. So it was a complete shock when – after a trip to the emergency room – she was told that the pain she was experiencing was the result of two aneurysms in her brain.

One was small, but the other was very large. Aneurysms occur when a blood vessel wall weakens and bulges out, and the largest ones, called “giant aneurysms,” are typically no more than 2.5 centimetres across. Georgia’s was 3.5 centimetres long – one of the biggest the team at Sunnybrook had ever seen.

As long as the aneurysms remained in her head, Georgia’s life was at risk. One quarter of people with a ruptured aneurysm die within 24 hours, while another 25 per cent die within six months. For those who survive, many are left with permanent neurological damage.

Fortunately, Georgia’s care was in the hands of a Sunnybrook neurosurgeon whose expertise and ingenuity led to a novel approach to treatment that saved her life.

 An X-ray shows the metal clips in Georgia’s brain following her crainotomy.

A problem with no easy solution

When faced with an aneurysm of this size, Sunnybrook neurosurgeon Dr. Leo da Costa knew he needed to come up with a unique treatment plan. Most aneurysms are berry-shaped, called saccular. But in Georgia’s case, the aneurysm was what’s called fusiformed – wide in the middle and tapered at both ends.

Another complication was that the larger aneurysm was located in the left hemisphere of Georgia’s brain, in the middle cerebral artery. This artery is responsible for providing much of the blood flow to the hemisphere, including the area of the brain responsible for speech. A rupture could have been devastating for Georgia, but she could not be treated using routine techniques.

“The easiest treatment for such large aneurysms is to close the vessel, which was not an option in this case. She could have a stroke on the left side of the brain and be paralyzed on the right side and unable to speak,” says Dr. da Costa, medical director of Sunnybrook’s Centre for Neurovascular Intervention.

Georgia says it was “surreal” to learn that her medical condition could be fatal or debilitating. But she felt hopeful that she would come through it all.

“My husband turned to me and he held my hand and [said], ‘Don’t die.’ So I told him, ‘I’m not going to die.’”

The neurovascular team’s initial treatment for Georgia was a craniotomy – brain surgery to reconstruct the affected blood vessel with metal clips. But while surgery was successful and Georgia went home, a month later an angiogram showed the aneurysm had grown again.

With Georgia’s life once again in jeopardy, Dr. da Costa decided that the situation called for another approach involving flow diverter stents. These special, tiny stents are made of mesh with very fine holes that change the way the blood flows around a vessel.

“If you imagine a tunnel, the blood goes mostly inside, and the [aneurysm] outside will slowly clot and shrink,” explains Dr. da Costa.

The problem with this approach was that Georgia’s aneurysm was far too long for these stents.

So, Dr. da Costa decided to try something unprecedented. He would telescope three miniscule stents into one another to bridge the distance of Georgia’s aneurysm.

Sunnybrook neurosurgeon Dr. Leo da Costa.

A unique approach

On October 2, 2020, Dr. da Costa and his team accessed Georgia’s brain through a small incision in her groin. Using a combination of catheters and wires, he navigated the tiny stents through her aorta and into the brain vessels where the aneurysm was located.

Dr. da Costa placed one stent from the edge of the healthy area of the blood vessel into the aneurysm, then placed another just inside that one to extend into the middle part of the aneurysm. Finally, a third stent was placed to complete the “bridge” to the other side.

“This has not been done before using these small stents; [we] were the first globally to telescope three flow diverters to successfully treat a small vessel middle cerebral artery aneurysm,” Dr. da Costa says.

In total, the surgery was just over an hour. Georgia woke up to hear a nurse complimenting her toenail polish. “That made me laugh, and when I laughed, they exclaimed, ‘She’s awake!’” she recalls.

She was released from the hospital shortly after the surgery and is recovering well. Last Christmas, Georgia sent Dr. da Costa a video with her two kids, thanking him for all he’d done to save her life.

“He’s so modest,” says Georgia. “He responded, ‘It wasn’t me. It was all you.’”

Less invasive and more efficient

Georgia and her children enjoy a sunny day in the park.

Dr. da Costa says the procedure will have a significant impact on how his team handles difficult aneurysms.

“Until very recently, open surgery was often the safest option for these very large aneurysms, and the procedures are often complex,” he says. “Finding out that we can add one very small stent to the other in a chain to cover longer distances will allow us to treat these aneurysms in a much less invasive and efficient manner.”

In fact, after Georgia’s treatment, Dr. da Costa said they did another similar one, using the same technique, and he is convinced more and more cases will be done in a similar fashion worldwide. That patient also did well and was discharged the next morning.

Dr. da Costa says that his team’s personalized and precise treatments work hand-in-hand with the constant evolution of technology in this space.

“Many improvements in existing devices and new, disruptive technology are launched every year, allowing us to push the boundaries of what can be treated and how we do it.”

The post Unique approach to aneurysm treatment saved this mom’s life appeared first on Your Health Matters.

“It was really scary,” she says. “It was totally new to my family. There’s no history [of bipolar disorder] in the family, so we were just fully listening to the professionals because we really did not know what we were doing.”

Cassie was later transferred to Sunnybrook. In addition to medication, doctors recommended she participate in regular therapy sessions, but the thought made her feel uncomfortable.

“At the time, I think it was just the stigma around therapy,” she says. “I didn’t want to feel like I was different from the rest of the girls in my house [at university]. I felt like I didn’t need therapy.”

One year later, though, and she says she can’t imagine not continuing with it.

“It’s become something I look forward to doing,” she says. “It’s totally non-judgemental, [the therapist] is listening to what you have to say. Even if sometimes it’s not giving you the solution to everything, it’s nice to be able to share what I’m going through and let it out to someone.”

Dr. Rachel Mitchell, a child and adolescent psychiatrist at Sunnybrook, says evidence shows that a strong relationship between therapist and patient, the “therapeutic alliance,” is key to making talk therapy successful.

“Regardless of the type of therapy, or the focus of the session, the relationship with the therapist is one of the most therapeutic aspects of the treatment,” she says. “It’s the support from that relationship. The stronger the alliance, the better it is.”

Cassie says one of the ways she’s seen a difference in her life since starting therapy is in how she handles tough emotions. She gives the example of selecting her courses for the beginning of her second year and not being able to get the ones she wanted. It was a frustrating experience for her, but she was able to handle it using some tools she’d learned in therapy.

“After emailing the person I needed to talk to, I went for a walk rather than getting very frustrated in front of my computer and freaking out,” she says. “Taking some deep breaths, realizing some things aren’t in my control, and that it will work out helped me manage how I was feeling.”

She says it’s a recognizable change from how she would have handled it before entering therapy, and she’s seeing changes in many aspects of her life.

“I’ve gained the confidence of just being me,” Cassie says.

Dr. Mitchell says while the thought of therapy might be uncomfortable, almost everyone can benefit from it.

“Therapy is an opportunity to learn about yourself,” she says. “So much of the time people feel alone and don’t feel like they have the support they need. Speaking with a mental health care professional can help individuals feel supported, and learn how to manage their emotions and cope during difficult times.”

Cassie says for someone who is new to therapy, or considering it for the first time, it’s important not to expect everything to feel better immediately, but to try and stay positive.

“Trust the process,” she says. “It’s okay to sit with those hard emotions because they will pass. Keep working at it. Things can get better, even when it totally feels like it will not.”

Dr. Mitchell says it’s important to expect therapy to be challenging.

“Therapy is hard work. You’re not going to want to go some days. But if you stick with it and stay committed, therapy can be helpful,” she says. “Sort of like exercise, you’ll feel better after you do it.”

For Cassie, her continued work in therapy, and following her doctor’s guidance for medication, is paying off.

“It’s the best I’ve been in a long time. I feel like things have just been coming into place,” she says. “I feel happy and settled and ready to just get back into the swing of things.”

If you need help in an emergency, please call 911 or visit your local emergency department.
If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources:

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

The post Finding the confidence to be me: how talk therapy helped Cassie King manage bipolar disorder appeared first on Your Health Matters.

“There’s nowhere to go. A lot of teens have been thrown off of their routines, or sleep schedules are messed up. Some people my age are terrified of getting COVID so they don’t leave their houses. Others have just lost motivation and don’t want to do anything – they just don’t care about things like they used to,” says Sterling.

“Social isolation, missed milestones, and decreased in-person interactions are some of the factors that are having a continued effect on youth mental health throughout this pandemic,” says Dr. Amy Cheung, youth psychiatrist in Sunnybrook’s Hurvitz Brain Sciences Program. “We’re seeing more youth with depression, anxiety, suicidal thoughts, among other symptoms. Young people are needing more support than ever before.”

Dr. Cheung says it is important for youth and families to reach out to their health-care teams when they need help.

“If a child is experiencing major changes in sleeping or eating habits, increased depression or anxiety, lack of motivation or enjoyment in activities over an extended period of time, for example, more than two weeks, it is time to connect with your family physician or pediatrician for support,” she says adding, “If a young person or family is in an emergency or crisis, it is important to go call 911 or go to your local hospital’s emergency department.”

Receiving mental health care virtually

The use of virtual care has grown throughout the pandemic, with many heath-care providers offering support to patients online or over the phone with physical distancing measures in place to help limit the spread of COVID-19.

“Virtual care has been a helpful tool to stay connected with patients. It can be effective in the continuation of patient care, monitoring of their treatment and the ability to adjust as needed,” says Dr. Cheung.

For Sterling, who has struggled with anxiety and depression over the years, the option for virtual care has been helpful especially during the pandemic.

“I still have support even if I can’t see my doctors in person,” says Sterling. “Plus, I don’t have to worry about driving to a bunch of places, getting stuck in traffic or parking. I am at home and it can be pretty convenient. And it’s helping.”

Preparing for your virtual care appointment: Tips & strategies

Dr. Cheung says it is beneficial for adolescents and youth to speak with their doctors privately in a virtual setting, just as they would in an office.

“Young people can get the most out of their appointment if they are able to speak openly, honestly and freely about what they’re going through,” she explains.

With families being at home during the pandemic, limited space, and other factors, it can be a challenge to find a private setting for a virtual appointment.

If finding a private room is not possible, request a phone call appointment and take your call just outside of the house. Try to find somewhere that you feel you can safely talk, for example, in the backyard or on the porch.

Parents and siblings can also wear headphones or turn on the television to create a bit of a ‘noise barrier’, to help provide the patient with more privacy during the appointment.

“It may take some planning for the patient to prepare for a virtual appointment,” says Dr. Cheung. “But for adolescents and teens the pandemic has been, and continues to be, an incredibly difficult experience. It is important to reach out for support whenever needed to help take care of your mental health.”

*Only first name is being used for patient privacy.

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

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

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

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The post COVID-19: Youth mental health and virtual care appeared first on Your Health Matters.