Photography by Kevin Van Paassen

Marilyn Ostrander feels like she’s been given a third chance at life.

In 2010, doctors operated to give her a replacement heart valve. But eight years later, it was failing her. She was on the brink of palliative care.

“Surviving day-to-day was the biggest challenge of my life,” the 86-year-old recalls.

Marilyn’s daughters remember talking her through bouts of severe shortness of breath – a sensation so intense it felt like suffocating. Leg cramps at night made her restless, and she suffered extreme fatigue during the day. Her diet was so strictly regimented that she had to weigh and measure all her food and didn’t dream of ever eating out.

Because of Marilyn’s age and fragile condition, another open-heart surgery – like the one she’d had in 2010 for her first replacement valve – was out of the question. The risks were too great.

In June 2018, Marilyn got that third chance in the form of a replacement valve delivered to the heart through a tube inserted into her leg vein. The procedure was lower-risk and took around 60 minutes.

Describing Marilyn’s post-procedure improvement as dramatic is an understatement.

“When I first saw her in the clinic, she was essentially bed-bound. She couldn’t move, she couldn’t do anything,” recalls Dr. Andrew Czarnecki, a cardiologist at Sunnybrook and a member of Marilyn’s care team. “And then when I saw her again, she was out shopping with her daughters.” She’s now back to living independently at her home in Prince Edward County, Ont., where she cooks for herself, gardens, eats out and travels with her daughters.

Marilyn’s success story is thanks to monumental advances in heart valve repair and replacement technology. It’s also due to the innovative thinking of Sunnybrook health-care experts who have joined forces to apply the technology in creative ways – often funded by donors. In the past, she and 900,000 other Canadians with her condition typically faced a choice between inaction and high-risk surgery. Today, they have a range of options and more chances to get their lives back.

A revolutionary approach

Valve disorders affect the thin, strong flaps of tissue that separate the chambers of the heart. The flaps open to let blood flow forward through the heart when it beats and close again to stop blood flowing backwards. When the valves aren’t functioning properly, sometimes due to an infection or because calcium buildup makes the valve stiff, they begin to leak. Blood flows in the wrong direction and the heart has to work harder to provide enough oxygen-carrying blood to the body. A person can feel tired, breathless, have swollen ankles or find it hard to breathe when lying down in bed at night.

As recently as 10 years ago, the only options for patients were to do nothing, take medication or have open-heart surgery. Surgery to repair or replace the valve requires a 15-to-20-centimetre incision in the chest, stopping the heart and placing the person on a heart-lung machine.

“The challenge was not so much that the surgical treatment didn’t work. People would often have good results,” says Dr. Eric Cohen, deputy head of the cardiology division of the Schulich Heart Program at Sunnybrook. “The challenge was that it was uncertain whether a patient who was sick or elderly would get through the surgery.”

Dr. Eric Cohen (left), Dr. Gideon Cohen and Dr. Andrew Czarnecki perform a mitral valve replacement

Now those replacements and repairs can be performed by feeding a catheter up an artery or vein through a small incision in the patient’s leg. These procedures are called percutaneous implantations, or implantations through the skin. The heart remains beating and the patient can be sitting up within a few hours and go home in a few days. (One of the more well-known percutaneous implantations is TAVI, or transcatheter aortic valve implantation, which is used to treat aortic valve problems.)

“When that happened, it revolutionized our approach to valve pathology in that it opened up the realm of treatment possibilities for patients who we previously deemed inoperable,” says Dr. Gideon Cohen, division head of cardiac surgery at Sunnybrook and medical director of the Schulich Heart Program. “It’s rare now that we turn down a patient.”

Marilyn’s recent procedure was a tricuspid valve-in-valve replacement, meaning she had a new artificial valve implanted on top of her existing failing one. The old valve acts as an anchor for the new one.

New techniques like this do more than broaden the types of patients who can receive treatment. They’ve prompted the creation of a new specialty in cardiac medicine – structural heart intervention – where surgeons and cardiologists join forces to treat disease. That team approach makes Sunnybrook one of the largest and most successful intervention groups in Canada.

“We are the gold standard in this approach. Nobody really matches the collaborative program that we have between surgeons and cardiologists,” says Dr. Gideon Cohen.

Marilyn felt supported by her team throughout her treatment. “Their confidence made me confident,” she says.

Her daughter, Kim Bouma, says her mother was looked after with dignity and respect not just by the physicians but by the entire health-care team. “The environment there was so supportive,” she says. “It truly was patient-centred care.”

Changing the storyline

Now that Sunnybrook doctors have performed many valve repairs with percutaneous implantations, tackling more than 200 each year, they’re developing exciting ways to expand the use of the technology they have at their disposal.

One option for repairing the mitral valve, which separates the left heart chambers, is to secure its two leaflets together using a staple-like device called the MitraClip. This device has been in use at Sunnybrook since 2011, but Dr. Gideon Cohen and Dr. Eric Cohen recently pioneered its use as an emergency procedure, stabilizing patients until they’re well enough for surgery.

Marilyn Ostrander (Photography by Kevin Van Paassen)

In one case, a patient came in with a burst mitral valve after a heart attack. He was close to death, but his heart couldn’t tolerate the stress of an operation. The risks were extremely high, with an 80 per cent chance that he wouldn’t make it.

“We used to operate because there was no other option. A 20-per-cent chance of living was better than nothing,” says Dr. Gideon Cohen. “With the clip procedure, we’ve changed the storyline here.”

The patient underwent the minimally invasive and far less risky MitraClip procedure. A few months later, after recovering from his heart attack, he received a repair operation. In a different case, a patient avoided surgery altogether because the clip worked well enough on its own.

Because the MitraClip is being utilized in ways not originally intended, its usage isn’t funded by OHIP, but rather through donations to Sunnybrook Foundation.

Dramatic change on the way

While the ingenuity of Sunnybrook surgeons and cardiologists continue to move the field forward, Dr. Gideon Cohen explains that some challenges still remain. Mitral valve replacement (not repair) through a catheter in the leg, rather than open heart, is still in its infancy.

“The mitral space is a lot more complex,” he says. In comparison to other valves, the mitral is more difficult to anchor to and also bigger, making delivery of a new valve through a tiny catheter difficult.

Sunnybrook is testing a new technology called the Caisson device, which has been successful in two patients already. What sets the Caisson apart from the many others under development is that it can be fed up through a vein along the same path as the MitraClip. Other devices require making an incision in the chest and piercing the tip of the heart to deliver the replacement valve. While this procedure is not quite as invasive as open-heart surgery, Dr. Gideon Cohen explains, it’s still a surgery with significant risks. In contrast, the Caisson valve is a lot more delicate, he says. The Caisson is currently undergoing a redesign to make it even more effective in the long term before a new clinical trial begins.

Another challenge is replacing a tricuspid valve non-surgically in first-time patients, says Dr. Czarnecki. The valve-in-valve replacement that Marilyn had works well because the existing valve acts as an anchor. Clinical trials are underway at Sunnybrook investigating whether a form of the MitraClip can be used to repair the tricuspid valve. Elsewhere, trials of new replacement devices are ongoing.

“There’s no doubt that over the next five to 10 years, this is going to be a huge area of growth because of a very clear recognition that this is the most under-serviced population in the valve space,” says Dr. Czarnecki.

The team is optimistic that the technology in the valve space will improve even further in the next decade. When Dr. Gideon Cohen first replaced Marilyn’s tricuspid valve through open heart surgery 10 years ago, he knew there was a possibility that it would need replacing again.

But he never dreamed of the options that would be available when that time came.

“It just goes to show you how things change dramatically in a short period of time and can really change people’s lives,” he says.

Marilyn’s three daughters are still overwhelmed by the improvement they’ve seen in their mother, thanks to the procedure.

“We’re still pinching ourselves….Did this really happen?” says Kathryn Ostrander, Marilyn’s oldest daughter. They’ve gone from being caregivers to spending quality time with their mom. The four plan on many more adventures in the future, including a trip to the Okanagan
in B.C.

“I’m just so overjoyed to be home and [to be] able to do things,” says Marilyn. “It’s worth a million dollars.”

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How a tricuspid valve-in-valve replacement works

Marilyn Ostrander is the recipient of a novel procedure in which an artificial heart valve is implanted inside an existing artificial heart valve, all while the heart is still beating. Here’s how:

1. A catheter is inserted into the groin.
2. The compressed artificial valve is transported by catheter into the heart. It is placed inside the failing artificial tricuspid valve.
3. The new artificial valve is expanded and anchored to the old valve.
4. The new valve opens and closes as the heart pumps, allowing blood to flow properly.

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It was an event that captured the collective attention of 900 of the world’s leading gynecologists. On May 16, 2019, three surgeries performed at Sunnybrook were videocast live to a medical conference in Montreal – a Canadian first.  

Over three hours, this international audience at the annual meeting of the Society of Endometriosis and Uterine Disorders (SEUD) witnessed Sunnybrook’s leading approaches to operative hysteroscopy, laser treatment of endometriosis and hysterectomy. A team of surgeons wore microphones and headphones, allowing conference moderators to direct audience questions in real time to doctors in the three operating rooms.

“We were able to answer questions on our techniques and ways to reduce patient complications,” says Sunnybrook surgeon Dr. Grace Liu, part of the SEUD organizing committee. “Thanks to positive audience feedback, this could set a new precedent for future videocasts from other hospitals.”

More than 50 Sunnybrook staff from various departments worked together for almost a year to make the videocast happen.

“It was a team effort within Sunnybrook and with the event producers, to organize the technical and logistical aspects for this broadcast,” says Doug Nicholson, assistant manager in digital and visual communications at Sunnybrook. “Events like this help share the advances happening here.”

The post Toronto surgeries viewed live in Montreal for the first time appeared first on Your Health Matters.

But before Paul could get to his appointment, he woke up at 2 a.m. one morning in agony. “I had an absolutely devastating headache,” he says. “I started to vomit.”

Paul knew it was time to go to the hospital. He and his wife sped down the highway from their home in King City, Ont. to Sunnybrook, knowing it was an excellent trauma centre.

At Sunnybrook, the emergency team discovered that a large tumour was bleeding into his brain. To save his life, the team rushed Paul into brain surgery.

The news was initially encouraging: the tumour had been successfully removed. But when it was biopsied, the diagnosis was shocking. It was a glioblastoma, a highly aggressive brain tumour giving patients an average survival time of 12 to 18 months.

Suddenly, the father of two worried about his future, and that he would no longer be able to do the things he loved, such as spending time with his family – or performing music.

“I play cello in the Paskke String Quartet and the York Symphony Orchestra,” says Paul, now 53. After a day’s work as a professional engineer and an executive at an engineering firm, Paul’s evenings are typically filled with music.

“I wondered, Can I play cello?” he recalls. “Music is very important to me. It’s an incredible creative outlet. The thought of losing mobility or cognitive abilities to the point where I couldn’t play cello was quite horrifying.”

Paul Hudspith with his wife, Francine, and dog, Beau

Reeling from his diagnosis and still recovering from major brain surgery, Paul got some good news on the day he was diagnosed: he was eligible for a new, world-leading trial at Sunnybrook.

“I felt like it was meant to be,” he says of being selected for the study.

Researchers at Sunnybrook are studying focused ultrasound (FUS) as a non-invasive way to open the blood-brain barrier and deliver – or enhance – chemotherapy. The blood-brain barrier protects the brain from toxic compounds. It is semi-permeable, like a fine sieve that stops even the smallest molecules in the bloodstream from entering into the brain. While protective, this can also prevent key medications from reaching cancerous cells in the brain.

To take part in the study, patients wear a helmet-like device in an MRI machine. Tiny microscopic bubbles are also injected into the patient’s bloodstream. The helmet delivers pulses of ultrasound energy (a thousand waves of sound) to a specific area of the brain, shaking the microbubbles and causing them to open the blood-brain barrier temporarily.

“In Phase 1 of this study, we found we can safely open the blood-brain barrier. It’s quick, reversible and we don’t see any major adverse effects,” says Dr. Nir Lipsman, principal investigator and director at Sunnybrook’s Harquail Centre for Neuromodulation.

He adds that the current Phase 2 study, in which patients receive focused ultrasound on the first day of each chemotherapy cycle, will also track tumour response and involve genetically profiling the tumours. “With glioblastomas, no two tumours are alike,” Dr. Lipsman says.

The idea is to determine whether allowing chemotherapy past the blood-brain barrier can help kill cancer cells and prevent the tumour from growing. As it is non-invasive, it potentially offers patients a safer way of enhancing their chemo regimen.

Paul says that despite his anxiety over being in an MRI machine for hours, sedatives and “the incredibly compassionate and supportive” staff have helped him get through the six sessions he’s completed.

“With the support of the FUS team, the treatment is entirely doable and I never felt alone or scared,” he says. “It gives me a chance at a better prognosis and I’m proud to be one of the pioneers for this exciting new treatment.”

He’s feeling well – exercising and doing yoga. He’s also playing cello and performing again, and says that music is key to his overall wellness.

“As they say, music is good for the mind,”  he says.

The post Treating brain tumours with ultrasound: this could be the next frontier in cancer treatment appeared first on Your Health Matters.

For years, Serena Kelly had been unsuccessful in managing her severe post-traumatic stress disorder (PTSD). A survivor of multiple sexual assaults through her teens, Serena found herself in a relationship marked by cruelty and abuse in her early 20s. Although she escaped her abuser at age 25, for nearly two decades afterward she and her family continued to be stalked and harassed by him, leaving her in constant fear for her life and the lives of her children.

The years of trauma took a toll. “I was unable to regulate my emotions and engaged in reckless and impulsive behaviours, self-harm, and made multiple attempts at suicide,” says Serena, 47.

After seeking help for her symptoms, Serena was diagnosed with PTSD in 2001. Over the years, she was prescribed mood stabilizers and numerous antidepressants. She also tried several forms of psychotherapy, but her symptoms remained.

Then came the call she will never forget. In Sept. 2017, Edmonton police called Serena and her husband at their Ontario home, informing them that their youngest daughter had been killed in a motorcycle collision.

“She had been the passenger on a sport bike and was ejected from the motorcycle after it struck another vehicle travelling in the same direction, killing her on impact,” she recalls.

Losing her daughter affected Serena profoundly.

“I couldn’t sleep, barely ate, was having horrible nightmares and intrusive images whenever I closed my eyes,” she says.

The sight and sound of motorcycles became an intense trigger that would cause Serena to go into a full-blown panic state, leaving her shaking, crying and hyperventilating. She didn’t want to drive anymore and was afraid to go anywhere alone for fear of being triggered.

“The world became very small and felt more unsafe than ever for me,” she says.

In 2018, Serena learned of a clinical trial at Sunnybrook that used deep-brain stimulation to treat PTSD. After meeting with the PTSD team at Sunnybrook, she joined the trial.

“I was relieved and finally felt a sense of hope for the future,” she says.

Click the photos above to learn more
(Photography by Kevin Van Paassen)

Deep-brain stimulation has been used in the medical community for years in severe cases of depression, anorexia nervosa, Parkinson’s disease and essential tremor. With this procedure, metal electrodes are surgically implanted in the brain. Doctors can then adjust the signals the electrodes produce, which is done via a battery pack that’s implanted in the patient’s chest, just under the collarbone.

The idea is to “disrupt the activity in the circuits of the brain” that are associated with addiction and reward, says Dr. Nir Lipsman.

When people have PTSD, for example, scientists hypothesize that “fear gets stuck [in the brain],” says Dr. Peter Giacobbe, study co-principal investigator, psychiatrist and clinical head at Sunnybrook’s Harquail Centre for Neuromodulation. So, when confronted with a stressor, a person with PTSD cannot stop the distressing panic and depression.

By influencing these circuits, the hope is the brain will begin to behave differently, and the patient will notice changes in their behaviour and mood.

Watch above: Serena talks about life after DBS

The team is also involved in a study looking at the use of deep-brain stimulation to treat people with treatment-resistant alcohol use disorder (AUD). People with AUD experience powerful cravings and cannot control how much alcohol they consume. Despite treatments like psychotherapy and medication, the rate of relapse is 75 per cent. The hope is that deep-brain stimulation will disrupt the brain activity that causes these cravings.

Dr. Lipsman says the idea of using deep-brain stimulation for hard-to-treat alcoholism and PTSD had been considered for a decade before Sunnybrook’s studies – both Canadian firsts. But it only came to fruition last year after a collaborative effort between different specialties within the Hurvitz program.

Patients enrolled in the PTSD study go through a comprehensive screening process and are assessed at regular intervals every few weeks. They also receive brain scans throughout the study. Dr. Giacobbe says the treatment can take a month or two to work, but symptom relief can be dramatic, to the point that some patients are no longer affected by their PTSD triggers.

“People can go back to work and re-establish their lives,” he says. “This is an exciting time in psychiatry.”

Each person may have a different response to deep brain stimulation due to a number of factors; age, severity of PTSD and medication. Some patients may not respond, while others notice a change after several months or even longer.

“We know that it can take time,” says Dr. Lipsman. “Change may be related to the circuitry or neurochemical changes that happen in the brain.”

Serena is encouraged by her success so far. After 10 weeks of having the electrodes implanted and adjusted to deliver gradually stronger signals to her brain, she no longer had violent reactions to motorcycles. She can now pass them while driving on the highway without any sense of panic, and she has experienced no side effects from the treatment.

“I go out more and am able to spend more time with my children and grandchildren, and enjoy those moments again, instead of being consumed by constant fear and anxiety,” she says.

Serena has been accepted to university and is currently pursuing a psychology degree. She says this is now possible because she is able to drive to school.

“I have my life and my freedom back.”

The post Sunnybrook is leading ground-breaking research for PTSD and alcoholism treatment appeared first on Your Health Matters.

Imagine watching your family members develop cognitive and behavioural decline in their 40s and 50s and die prematurely from dementia. Now, imagine learning that you carry the gene mutation for this dementia, and the same fate awaits you.

“In the prime of your life, you’ll develop changes in behaviour, such as trouble controlling emotions. You may lose your inhibitions. You may shoplift or insult strangers. Eventually, you will lose the ability to communicate,” says Dr. Mario Masellis, clinician-scientist at Sunnybrook and associate professor of medicine at the University of Toronto.

“It’s gut-wrenching to know that your father had this and that your grandmother had this – and now you have the same gene mutation,” says Dr. Brad MacIntosh, neuroimaging scientist, Canadian Partnership for Stroke Recovery at Sunnybrook. “The clock is ticking.”

Dr. Mario Masellis, associate scientist at Sunnybrook’s Hurvitz Brain Sciences Research Program, wants to change that future. That’s why a team of scientists by him is analyzing the characteristics of patients with an early-onset, familial form of frontotemporal dementia in a world-first study.

Frontotemporal dementia is a term for a group of brain disorders that affect the frontal and temporal lobes of the brain, which are associated with behaviour, personality and language dysfunction.

While scientists have been able to pinpoint three major genes responsible for the development of frontotemporal dementia, there’s not a lot known about what happens in the years before symptoms become apparent, Dr. Masellis says. “The whole point is to study people in the pre-symptomatic phase. If you wait too long, the changes [will] have firmly taken hold in the brain.”

In his study, known as the Genetic Frontotemporal Dementia Initiative,  Dr. Masellis and his team are attempting to identify clear brain indicators, also known as biomarkers, that may show the onset of dementia is imminent. Through MRI, the team is tracking blood flow in different regions of the brain. They’re witnessing changes in cerebral blood flow as early as 15 years before expected disease onset.

“We’re seeing potential evidence that certain areas [in the brain] are disrupted,” he says.

Dr. MacIntosh says that during the screening, 20,000 different measurements are taken. Through a procedure called arterial spin labelling – an MRI technique – cerebral blood flow can be measured and labelled as it flows throughout the brain. It offers a very precise look at exactly what is happening on an arterial level.

“The whole focus of the study is on understanding the natural history of the disease and the way the disease progresses over time,” says Dr. Masellis.

As researchers learn more about the variability and progression of the disease, it can help them better design clinical trials for potential treatments. For example, they may have more insight into when drug therapies should be started in a patient or how they should measure the response to treatment.

The study is unique in that it involves a special group of individuals who are at risk of developing frontotemporal dementia.

“The powerful thing here is that unlike other brain disorders, we have the opportunity to study people we know will develop dementia,” Dr. MacIntosh says. “We can learn so much from these people.”

The post Gathering clues about early onset dementia appeared first on Your Health Matters.

On Aug. 7, 2018, millwright Shawn Fitzpatrick was riding his motorcycle from his Ajax home to the plant in Scarborough where he worked. At 4:40 a.m., the 54-year-old was struck at an intersection by a left-turning transport truck.

A prosthetic socket is 3D printed in the lab at St. John’s Rehab at Sunnybrook (Photography by Doug Nicholson)

“I could feel it hitting my ribs, and my face was stuck on the front headlight,” Shawn recalls. “I tried to get my motorcycle out of there, but with the impact, it must have stalled. Then I woke up with somebody holding my head.” 

Shawn was taken to the Tory Regional Trauma Centre at Sunnybrook with life-threatening injuries. 

He has almost no memory of the next few days. Later, Shawn learned that physicians had removed his damaged spleen, repaired his broken left hip, knee and lower leg bones and grafted skin onto places where he no longer had any. But the biggest concern was Shawn’s severely injured left foot.

“They kept on trying to save it, but finally they said, ‘Your foot’s started to turn black and your pulse there is really bad,’” he says.

Faced with the prospect of amputation, Shawn thought about all the things he still wanted to do with his life: playing with his grandchildren, spending time every year with his mother in their native Newfoundland, being in the outdoors and staying active. He chose to see the positive in the situation.

“I was happy getting my leg cut off because the prostheses today are amazing,” Shawn says. “I knew it was going to put me in a better spot.”

The amputation, about 20 centimetres below the knee, took place just over a month after the crash. Afterwards, Shawn began rehabilitation therapy at Sunnybrook’s St. John’s Rehab, where he stayed until going home in November. 

Joining a 3D printer study

Shawn currently returns to St. John’s Rehab twice a week to attend physiotherapy. He’s also part of a study there looking at the potential benefits of using  3D printing technology versus traditional methods to make a socket – the part of a prosthesis that connects to the residual limb.

The research is being led by Dr. Amanda Mayo, a physiatrist (physician focusing on physical medicine and rehab) at St. John’s Rehab who specializes in working with patients with limb loss. She is collaborating with the team of prosthetists at the Sunnybrook Centre for Independent Living (SCIL). Another study partner is Nia Technologies, a non-profit organization affiliated with the University of Toronto.

With a grant from MaRS, a Toronto innovation hub, the researchers are exploring whether a 3D printing system is faster, more cost-effective and more comfortable for patients than the traditional method of making sockets using plaster casting. 

They have produced “diagnostic” sockets using the innovative technique for five patients, to determine the quality of the fit. They hope to enroll another 15 patients in the study before the end of 2019. All patients, like Shawn, have below-the-knee amputations and are trying out these sockets during their therapy sessions at St. John’s Rehab. 

Like the ‘foundation  of a house’

The socket is the only part of a prosthesis that is custom-made for the patient and its fit is critical, says Shane Glasford, team lead in prosthetics at SCIL.

“I equate it to the foundation of a house. The other [prosthesis] components are built on top of that good-fitting socket,” says Glasford. “The socket has to be comfortable enough to walk on, to give enough support for the user and to hold their body weight, allowing them to do all the things they want to do.”

In the first year or two after limb loss, the shape of a patient’s residual limb changes rapidly, and the patient may go through several sockets. The 3D method may allow the prosthetist greater adaptability and versatility in the fabrication process to create better-fitting sockets.

Patient-focused research

While research into computer-aided socket design and 3D production is taking place elsewhere, few studies are looking at the potential cost savings, turn-around time and quality improvement aspects of 3D printing, Dr. Mayo says.

“We’re doing qualitative interviews to see how patients like the digital scanning process and 3D printed sockets,” she adds. “In keeping with our St. John’s Rehab research mandate, this is research focused on improving patient-centred prosthetic care.” 

Dr. Mayo notes that conventional socket-making has some challenges. In this process, prosthetists first take a cast of the residual limb. The cast is then filled with plaster to create a positive mold. Once dry, the mold is contoured by hand. Finally, thermodynamic plastic is draped over the mold to create the prosthetic socket.

It takes about eight hours of manual labour to make a socket in this way. However, because of the time required for the plaster to dry and the need to chip out the plaster inside the socket, the turnaround for a patient staying in rehab is about seven days.

Dr. Mayo says that the initial step of making the mold also requires prosthetists to physically touch patients, which can be uncomfortable if they have skin wounds or skin grafts. 

With digital scans and 3D printing, there is no need to touch the patient. The process involves a 10-to-15-minute scan using a tablet for “shape capture,” after which a trained prosthetist fine tunes the shape on a computer. The image is then transmitted to a 3D printer to produce the socket out of plastic, though the prosthetist then needs to “smooth out” its edges, Glasford says.

Studying the benefits

The team is still assessing the time and cost savings with the new method. According to Glasford, it currently takes six hours to 3D print a diagnostic socket.

“Cost-accessible 3D printers, such as the one we are using, [have shown they are] suitable for making temporary sockets for diagnostic purposes to verify fit,” Glasford says. He adds that the digital process will also become swifter as prosthetists at Sunnybrook get more comfortable with the new technology. 

The post Could 3D printing make prosthetics quicker and more comfortable for patients? appeared first on Your Health Matters.

Photography by Doug Nicholson

Michelle Jennett went from helping people save money to working on a device that could save lives.

In 2015, she was an investment banking analyst at a leading firm in New York. But she found herself drawn to another part of the city once she left the office.

“I was always volunteering Saturday nights in the emergency room,” she says. “So in the back of my mind, there was this passion for [medicine].”

Those evenings of cleaning hospital beds and giving out warm blankets to patients were fulfilling in a way the financial realm wasn’t. Jennett decided to move back to her home province of Ontario to pursue pre-medical school, a move that ultimately led her to Sunnybrook’s Medventions program.

Medventions was founded through the Schulich Heart Program in 2016 as a way to put technological innovations on the path to commercialization. The program connects aspiring medtech entrepreneurs with scientists, clinicians and engineers to develop medical devices that address very specific problems in the hospital environment.

Jennett went through the Medventions program as a fellow in 2018, and subsequently co-invented one of the program’s most promising innovations – a commercially viable medical device called RescuBeat, designed to improve life-saving measures in critical care environments.

RescuBeat has the potential to overcome a number of challenges associated with administering cardiopulmonary resuscitation (CPR) to patients in cardiac arrest in the catheterization (cath) lab.

Cath labs are specialized examination and treatment rooms equipped with diagnostic imaging equipment.

While most patients brought to the cardiac cath lab have a relatively low risk of complications, some patients, emergent cases in particular, are at a higher risk of cardiac arrest, says  Dr. Brian Courtney, an interventional cardiologist at Sunnybrook and co-inventor of RescuBeat.

CPR compresses the chest and pumps blood from the heart to the rest of the body to prevent irreparable damage to critical organs. With the right amount of pressure and consistency, compressions can save a patient on the verge of dying, but CPR is difficult and exhausting to administer by hand, even for trained health professionals.

And while mechanical CPR devices already exist, which can help eliminate human error and fatigue, “their use is unfavourable in situations like the catheterization lab for heart attack patients,” Jennett says.

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In the back of my mind, there was this passion for [medicine].”

– Michelle Jennett

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“The problem in the lab is  you do not want to have a person standing in the path of X-rays while administering manual CPR because they will get exposed to unwanted radiation,”  Dr. Courtney says.

The X-ray exposure may be necessary for a patient who may die without the help of an angiogram. During an angiogram, a hollow, thin tube called a catheter is inserted into the cardiac blood vessel through the skin, allowing doctors to examine how well the heart is working. And while one-time exposure is unlikely to lead to lasting harm, health-care providers would inevitably be exposed multiple times during the course of a career performing CPR in the lab on several occasions.

Mechanical CPR devices prevent this kind of exposure. But devices currently on the market can block X-rays that allow cardiologists from viewing the vessels of the heart during an angiogram, a necessity during a heart attack.

Jennett witnessed this problem first-hand while shadowing Dr. Courtney as part of her Medventions learning experience.

“One of the existing [CPR] devices was placed on the patient and it blocked views of the arteries during the angiogram, making it very difficult to proceed with the procedure,” she says. “That’s when we realized there must be a better way.”

The moment served as a critical juncture in the development of RescuBeat. Jennett and the team – which consisted of herself, Dr. Courtney and engineers Reniel Engelbrecht and Miles Montgomery – had identified a major problem worth solving. And that’s a key part of the Medventions process, says Ahmed Nasef, Medventions program manager.

“We immerse multi-disciplinary teams of clinicians, engineers and people from a business background in the clinical environment at Sunnybrook where they spend a substantial amount of time trying to identify challenges that impose a significant medical burden,” Nasef says.

The Medventions Internship Program gives participants the chance to find these sorts of problems by letting them shadow health-care professionals at Sunnybrook for the first half of the four-month program.

“This really is the most important phase,” Nasef says. “Because if you get this stage right, chances are you will likely develop a solution that has high commercialization potential.”

Dr. Courtney points out that medical devices comprise a multi-billion-dollar industry, yet Canada accounts for a small fraction of this economy. 

“We import $8 billion in medical devices and export $3 billion in medical devices,” he says. “We know we have great engineering talent, research infrastructure and clinicians, so why is it we don’t develop a lot of good medical technology?”

Dr. Courtney came to Sunnybrook to be part of the answer. He was driven by his experience at Stanford University as an early student in the pilot phase of the Biodesign Program, which was instrumental in building the booming medical device industry in the U.S.

Now, Medventions is becoming a blueprint for other medical centres. Sunnybrook recently received a $49 million investment from the federal government to help spearhead medical technology commercialization across Canada.

While the potential economic spinoffs are massive, even more important is the potential to solve health-care challenges and improve the lives of patients.

With a provisional patent filed earlier this year, RescuBeat is well on its way to commercialization. It’s also the first Medventions device accepted by MaRS Innovation, which provides seed funding and other supports to fledgling medical startups.

Although a work in progress, the device may one day not just save lives in the cath lab. It could be used anywhere cardiac arrest occurs.

“Our hope is to bring a device to market that will ultimately save many, many lives,” Jennett says.

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“Some people call us a well-oiled machine, but that seems very impersonal,” says operating room patient care manager Helen Vandoremalen. “I like to consider our team a well-tuned orchestra playing off the same page. The result is more harmonious as our goal is to provide excellent patient outcomes and high patient satisfaction.”

The team at the Holland Bone and Joint Program has implemented several innovative models of care. Most patients are spared a general anesthetic and given a regional instead. This helps reduce complications and gets patients back on their feet more quickly. A highly-skilled interprofessional team helps ensure smooth patient flow.

Recently, donor support has expanded and modernized the function of the operating rooms. “There is a continued high demand for knee and hip replacements, so having highly efficient spaces has increased our capacity and efficiency,” says Dr. John Murnaghan, orthopaedic surgeon and medical director of the Holland Centre.

Here, Holland Centre experts share what it takes to prepare a patient and operating room space for each procedure.

1. Each room is cleaned and prepared to meet strict aseptic (contamination-free) standards.

2. A nurse checks the patient into the “block” area, where they meet with the anesthesiologist and the patient receives a regional anesthetic. This type of localized pain control reduces complications after surgery and allows patients to mobilize and go home more quickly.

3. The operating room is prepared. Between 8 to 13 instrument pans – each containing about 40 surgical instruments – are needed for each surgery.

4. When the patient is brought into the operating room, the team reviews the surgical safety checklist together. Checking all the relevant details of each case is a critical step, reducing the risk of any adverse events. The patient is carefully positioned for surgery, which will take one to two hours to complete.

5. The surgical team verifies the size and type of components for the replacement joint, which is different for every patient. It’s one of many checks and balances that ensure safety and the best possible outcomes.

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After receiving the shocking news of her leukemia diagnosis, Lori (above) faced a gruelling chemotherapy regimen. She got the treatment she needed through Sunnybrook’s complex malignant hematology program where the most vulnerable patients get specialized care.

(Photography by Doug Nicholson)

Lori Girard wasn’t sure she needed to go to the hospital.

The 38-year-old from Scarborough, Ont., didn’t feel that bad. She had also booked a hair appointment that day to cover up her greys, and she didn’t want to cancel.

But her mom convinced her to get checked out and her fiancé, Mehran Jabbari, agreed. Within nine hours, Lori heard the shocking diagnosis. She had leukemia.

“I certainly didn’t need that hair appointment because two weeks later, I didn’t have any hair at all from the chemotherapy,” Lori says. 

“I laugh about it now. It gives you perspective.”

It’s a story that’s all too familiar for the thousands of people diagnosed each year with leukemia and other cancers of the blood. People with these types of illnesses face intensive treatment and a challenging prognosis, requiring care in a highly specialized in-patient environment. 

That’s why Sunnybrook  developed and launched its new complex malignant hematology (CMH) program last year, so that patients like Lori can get the care they need.

‘I was in disbelief’

Lori had been having mysterious pain for a couple of weeks. A fit, healthy person with a thriving career as a buyer, she could explain away her jaw pain (“I must have slept funny”) and her shoulder pain (“I shovelled the driveway”). But when the pain moved to her chest and she could feel it was swollen, Lori agreed she should go to an emergency department. She still didn’t think much could be wrong.

“At six that morning, I told Mehran to head home and get some rest,” she recalls. “Within a half an hour, a doctor came in the room and said they’d found blasts in my blood, [which are] found in people with leukemia. I was in disbelief. I called Mehran and told him to please hurry back.”

Leukemia is cancer that starts in the bone marrow, most likely caused by a series of genetic events in the DNA, says Dr. Rena Buckstein, head of the hematology site group at Sunnybrook. It causes immature blood cells (blasts) to duplicate, take over the blood and weaken the immune system. 

“These cells should develop into fully formed mature red or white blood cells and platelets, but they don’t,” explains Dr. Buckstein.

Dr. Shannon Goddard, Steffanye Michaelson and Dr. Rena Buckstein in Sunnybrook’s CMH Unit. (Photography by Kevin Van Paassen)

As a result, patients often have symptoms stemming from anemia (fatigue and shortness of breath) and low platelet counts (easy bleeding and bruising). They may also experience unexplained fevers. 

Acute leukemias can sometimes be a medical emergency, Dr. Buckstein says.

“These immature white blood cells grow and divide very quickly; they can basically multiply overnight,” she says. “If the white blood cell count gets too high, the blood gets thick and sluggish, filling the vascular system with these slow, sticky cells. This can lead to stroke, heart attack, breathing difficulties and kidney failure. The immune system is stressed, so it can also lead to infections.”

It’s important to start treatment as soon as possible, Dr. Buckstein says. In many cases, the goal is cure. In others, it’s disease control.

Preparing for treatment

Over the next two days, Lori underwent more tests – first to determine the type of leukemia she had, and next to determine if she’d be strong enough to receive the intense treatment.

The results came back that she had acute lymphoblastic leukemia (ALL), b-cell type. It’s the more rare form of adult leukemias, the other being acute myeloid leukemia (AML). 

Lori and Mehran were able to go home for just one night before her treatment began. 

“It was really strange. The Friday was overwhelming: my fiancé and I cried a lot. I called my sisters and we cried a lot. I called my mom and we cried a lot,” she says. “Then, on Saturday something switched for us and we got motivated. We were done feeling sorry for ourselves. We made a decision to have a ‘when I get out of here’ attitude rather than an ‘if I get out of here’ attitude.”

On March 17, Lori went to Sunnybrook and settled in for a 28-day stay at the new CMH Unit for inpatient chemotherapy treatment. 

“There were, of course, highs and lows,” Lori says of her time in treatment. “Some days I’d get up and be in a great mood and go on my walks and the days would fly by. Other days, I’d feel terrible, but I knew it would pass and the team did its best to manage the pain.”

More specialized, streamlined care

The inpatient CMH Unit, along with an outpatient treatment clinic, opened in Dec. 2018 after two years of intense planning, says Steffanye Michaelson, patient care manager of both units. With support from the provincial government and investment from Sunnybrook, an existing space was completely renovated to meet the care needs of this vulnerable patient population. 

“We cared for complex malignant hematology patients before, but this increases our capacity and allows for more specialized, streamlined care,” Michaelson says. “It’s been amazing watching this project go from blueprints to a fully functioning unit and clinic.”

It’s already become a well-oiled machine, Dr. Buckstein adds.

Patients can be admitted to the 15-bed CMH Unit straight from the Emergency Department, the outpatient clinic or transferred from the community.

“Our outpatient clinic allows for much faster arrangement of all the necessary tests, chemotherapy treatments, procedures and transfusions,” she says. “And we couldn’t do it without this dedicated, expert, multidisciplinary team led by nurse practitioners.” 

Staff rotates between the inpatient unit and outpatient clinic, which means they really get to know patients and their families. 

“We’ve heard from many of our families that they appreciate this continuity of care. People know them and they know their stories,” Michaelson says.

It’s something that hasn’t gone unnoticed by Lori, who says she looks forward to seeing the team each week for her ongoing treatments.

“Everything in my life changed,” she says. “I am on a leave from a career I love. Our wedding is on hold. But being here took the worst days of my life and made them better. It could have been so horrible. Having this team surrounding me made me so confident in the care I was receiving.”

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In a room at the Odette Cancer Centre, shelves of neatly arranged wigs and head coverings line the walls. They’re free for patients who’ve lost their hair from chemotherapy or other cancer-related treatment. Many of the wigs sit atop expertly handcrafted wooden wig stands, which are also available free of charge to patients.

Woodturner Allan Cooper says his wife lost her hair due to chemotherapy nine years ago. In an attempt to add something beautiful to her life, the retired lawyer made her a wig stand. Although she has since passed away, he’s been making and donating them to the hospital ever since. 

“I decided the hospital could use something more attractive than the Styrofoam heads,” he says.  

In addition to creating his own wig stands, Allan Cooper also collects stands from other woodturners across the province.

Allan also collects stands from other woodturners across the province. In the last two years, he’s collected more than 150 wig stands for donation, with no two being identical. “Wigs are very important to patients going through chemotherapy. Having a stand to place it on gives it the respect it deserves,” says Erin Di Lella, volunteer coordinator at the Odette Cancer Centre. “And these stands are beautiful works of art made with love.” 

Each stand varies in finish, from a clear lacquer that showcases the wood grain to colourful paint.  

Volunteers at the cancer centre say patients are comforted knowing that somebody took the time and energy to make such striking showpieces. 

“The object of life is to try to improve life for other people,” Allan says. “When somebody has an illness, it’s not difficult to make their life just a little bit better, [to] add something unique, make them feel special. So, if I can make them even a little bit happier, then I’m satisfied.”

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