The Sunday Scaries can occur when we feel overwhelmed about the week ahead. Whether it’s a big presentation or many small tasks, these feelings of stress and anxiety can negatively affect our sleep.

We sat down with Sunnybrook sleep neurologist Dr. Mark Boulos to better understand the impacts of pre-work week stress and anxiety on our sleep quality.

How do stress and anxiety impact sleep?

Stress and anxiety can significantly impact sleep duration and quality. When someone experiences heightened stress and anxiety, they may also experience rumination. Rumination is a pattern of repetitive thinking that can impact one’s ability to relax. When rumination occurs around bedtime, people can find it hard to relax before sleeping.

Stress and anxiety also impact sleep by causing delayed sleep onset and interrupted sleep. A delayed sleep onset means people may struggle to fall asleep, tossing and turning in bed. Once someone is able to fall asleep, they may find they repeatedly wake up in the night and struggle to fall back asleep.

Both delayed sleep onset and interrupted sleep can have a significant impact on our mood, and lack of sleep can cause exhaustion, confusion, impaired motor function and low mood. These impacts on our body, in turn, heighten anxiety, creating a cycle that is hard to get out of.

What is sleep hygiene, and how can it improve your sleep quality?

Sleep hygiene refers to practical habits that can help improve sleep quality. It is essential for those who experience stress and anxiety, as it allows you to create an environment conducive to going to sleep and ensures you feel as rested as possible.

Here are some practical ways to practice good sleep hygiene:

1. Avoid electronics before bed

Avoiding screens before bed is an important part of practicing good sleep hygiene. The light emitted from cellphones, televisions, and tablets impacts our circadian rhythm, the system that tells our body we are ready for sleep.

Turning off screens 30 to 60 minutes before bed allows our bodies to relax and prepare for sleep. If you must look at a screen before bed, consider purchasing blue-light blocking glasses.

2. Only use your bed for sleep and intimacy

Your bedroom should only be used for sleep or intimacy. This will ensure that our bodies associate our bedroom environment with relaxation. Try leaving all electronics outside your bedroom and avoid bringing any electronics into bed with you.

3. Maintain your sleep time and duration

Our bodies crave routine, especially when it comes to sleep. To get a good night’s sleep, make sure you go to bed and wake up around the same time every day. This helps your body anticipate when it is time to go to bed, helping you feel more relaxed. You should also aim to get eight hours of sleep per night to ensure your body has time to recharge.

Are there any lifestyle and dietary changes someone can make to improve sleep?

Lifestyle and dietary habits play a significant role in sleep quality. To avoid feeling stressed or anxious around bedtime, avoid caffeine in the evening. Caffeine can impact the quality of your sleep by interfering with your body’s circadian rhythm, making it hard to fall asleep and leaving you feeling unrested in the morning. As well, alcohol consumption near bedtime can increase the chances of sleep apnea, or intermittent pauses in breathing during sleep.

Try to avoid large meals and fluids close to bedtime. Avoiding food and drinks at least 2 hours before bedtime will help prevent you from waking up at night to use the washroom.

What should you do if you are still struggling with sleep?

If you have taken steps to improve your sleep hygiene and pre-bed habits but still struggle to fall or stay asleep, consider seeing a sleep specialist to rule out any sleep disorders. You can do this by visiting your family doctor for a referral.

The post Sunday Scaries: How to improve your sleep when feeling overwhelmed appeared first on Your Health Matters.

What is OCD?

OCD is a serious mental health condition that can cause a person to have repetitive intrusive thoughts, images, or urges known as obsessions. These can be about many different things like contamination, causing violence or harm to oneself or others, religiosity (fears of offending god), and more.

Sometimes people will say things like “I’m so OCD” when cleaning or tidying up. This, in fact, is a stereotype that’s harmful to those living with OCD.

The term OCD is also often used as a personality trait or “quirk”. By using OCD as a personality trait or quirk, it takes away from the severity of the mental health condition that over 200 million people in the world live with.

What do people living with OCD experience?

OCD triggers an individual to have compulsions: a repetitive behaviour performed to relieve anxiety about an obsession.

For example, someone living with OCD might check and re-check things like locks and stoves, excessively wash their hands or engage in counting. A person may have other compulsions and is not limited to these few. People with OCD engage in compulsions to ease their anxiety about an obsession. However, this may take away hours from the persons daily life, causing emotional and mental fatigue.

These obsessions don’t just pass as they would for someone without OCD. They are recurrent and persistent, and cause the person experiencing them extreme anxiety which they try to ease through compulsions. It’s important to be mindful of a person’s lived experience and not judge or mock them because of this.

What causes OCD?

There is a lot of research about OCD – it’s complex because there isn’t just one cause. Researchers have discovered that OCD is caused by a combination of biological, psychological, and other factors. It’s a myth to assume that OCD is caused only by a traumatic childhood and bad parenting.

What can make OCD symptoms more significant?

Stress and trauma can intensify OCD symptoms, but there is also a large biological role. OCD is linked in an imbalance in the brain chemical serotonin which regulates mood and behaviour. Researchers have also found OCD is linked with increased activity in different areas of the brain. OCD tends to run in families, it’s been found that if a close relative has OCD there is a higher likelihood of developing the mental health condition.

How common is OCD?

OCD is a very common mental health condition. There is a misconception that OCD doesn’t affect many people – it impacts millions globally. OCD can impact anyone regardless of age, race, gender, and socioeconomic status.

What resources are available for people living with OCD?

There are many resources and supports available for those living with OCD. A common form of therapeutic support a person can receive is Cognitive Behavioural Therapy (CBT). It’s always best to speak with a primary care provider to discuss treatment options, as each person’s needs are different. Online resources are also available – the International OCD Foundation helps provide education and a variety of resources for those in need.

This OCD Awareness Week, you can help break the stigma and misconceptions associated with OCD. Being mindful of how the term is used and encouraging others to use better words is important. Education on OCD and how it can impact people’s lives is a step in the right direction to promote awareness and positive change.

The post Fact or Myth? Debunking OCD Stereotypes appeared first on Your Health Matters.

She also lives with anxiety, depression, and obsessive compulsive disorder (OCD).

At the latest Sunnybrook Speaker Series, Cassie described the toll OCD took on her life — and the unique treatment program which finally helped her get better and reach her goals.

Cassie, who lives in Regina, Saskatchewan, received care at Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, as part of its innovative residential treatment program for people with severely impairing OCD. The program is the only one of its kind in Canada and open to clients from across the country as well as the United States.

According to the Centre for Addiction and Mental Health, “the main symptoms of OCD are recurrent obsessions or compulsions that interfere with a person’s life.”

Cassie shared that her anxiety and OCD first surfaced in childhood. She was often late for the school bus because she had to adjust her socks and clothing so they felt “just right”. After she once saw a spider inside the mailbox, checking it for insects each time she passed became a ritual. As a teen, she worried about everything from winter driving to what others thought of her.

“My brain would automatically go to the worst-case scenario,” Cassie said. “I started to do whatever I could to gain control and get that ‘just right’ feeling to calm the panic I felt inside.”

By the time she was in her final year of nursing school, at age 21, Cassie started to really struggle with her mental health. She sought care at her local hospital and took a medical leave from school so she could focus on her health.

Cassie credited the psychologist who she began working with during this period for having a tremendously positive impact on her life.

“It’s so important to find a psychologist or a therapist that you mesh with,” Cassie said.

Over time, however, Cassie’s anxiety, depression, and OCD got worse.

Several of the obsessions and compulsions her OCD presented revolved around the number three, or multiples of three, such as touching the light switch three times or controlling how many times her windshield wipers swiped while driving. Her OCD also told her she had to avoid stepping on cracks on the sidewalk, or could only step on certain tiles.

Soon, daily activities such as taking her dog out for a walk or driving became impossible. She stopped driving altogether, and went on long-term disability from work.

“If I did not do exactly as my OCD thought I should, I felt like a complete failure,” she explained.

Cassie’s OCD also began to involve self-harm. Over the next several years, this led to several stays in hospital. Unfortunately, the doctors treating her did not fully recognize her OCD. Instead, Cassie was misdiagnosed with borderline personality disorder – an experience she says had a negative impact on her.

“It was counterproductive towards my recovery because it put me on a treatment plan that did not fit my needs,” she said. “What I really needed was intensive and specialized OCD treatment that was not available in Saskatchewan. That’s when I found Sunnybrook’s Thompson Centre.”

Cassie described the care she received at the Thompson Centre as “life-changing”.

“Finding a whole team of professionals who specialize in OCD, who truly understand the struggles it brings without judgment, and who see you for you and not your illness, was pivotal in getting my life back.”

Photo provided by Cassie Josephson

Treatment included various form of Cognitive Behavioural Therapy, including Exposure and Response Prevention, as well as Dialectical Behaviour Therapy and Acceptance and Commitment Therapy.

Cassie said she left the program knowing her toolbox of skills and techniques to manage her OCD was fully stocked.

Now living back at home in Regina, Cassie shared that she works hard at using the skills she honed at the Thompson Centre every day. She also continues to regularly see the psychologist she first met years ago.

Cassie said she is proud of how far she has come in her journey.

“I know the mountains I had to climb and the trenches I had to dig myself out of to get where I am today,” she said.

After four years on long-term disability and recovering from a near-fatal case of Serotonin Syndrome, Cassie said she is back to work and finding new purpose and meaning in her job as a pediatric nurse – one of her lifelong dreams. And soon, she plans to purchase her first home.

She added she is now doing the things she loves in life, whether travelling to places like Los Angeles to see a Taylor Swift concert, or exploring new destinations in South America and Asia.

“I accept that in life there are so many things that ultimately we don’t have control over,” Cassie said. “I try to always do things that I love and enjoy, I keep taking steps forward, and I try my best to go with the flow and roll with the punches that life gives.”

Concluded Cassie: “I still have ups and downs and a lot of struggles. But they do not control me and they sure do not define me.”

Learn more about Cassie’s story and the special work of Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre here.

The post ‘My anxiety, depression, and OCD do not define me’ Former Sunnybrook patient shares her journey – and hopes for the future 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.

That’s the message from medical professionals who say that inclusive and affirming healthcare for transgender and gender-diverse (TGD) youth is essential to mental health and wellbeing.

Recently, there has been a lot of attention on policies and practices impacting TGD youth, whether at school, in the community, or in healthcare settings.

Clinical experts say the medical case for supportive and inclusive gender affirming practices is clear.

According to the Canadian Pediatric Society, TGD youth are at elevated risk for adverse health outcomes, including depression, anxiety, and self-harm – but the “risk may be mitigated by affirming experiences and environments…”.

Dr. Lauren Riggin is a youth and adolescent psychiatrist at Sunnybrook Health Sciences Centre. She spoke with Your Health Matters about the importance of gender-affirming care.

How would you define gender-affirming care? What does it look like?

I think it’s important to start with what is it not. It is not exclusively hormone therapy or hormone blockers. To me, gender-affirming care does includes those clinical components but it also includes treating people with basic respect and dignity, and creating an environment where they feel heard, included, and supported regardless of their gender.

An example of what I mean by that is using more gender-affirming language. For instance, instead of asking, ‘Are you male or female?’ care providers could ask, ‘What gender identity is the best match for you?’ or ‘How would you define your gender identity?’ Questions that are more broad and open-ended allow the adolescent to answer for themselves.

It also includes listening to people and treating them how they want to be treated. That means if they have a preferred pronoun or name, use it when addressing them. To me, gender- affirming care is as much about that supportive and respectful approach as hormone therapy, medication, or surgery.

What do you think people need to know about gender-affirming care involving hormones?

First, there is no pressure to pursue gender-affirming medical options. It is very much the youth’s decision based on what feels right to them. There are youth who choose to start treatment right away and others who prefer to delay it, and that doesn’t really mean anything in terms of their gender identity or gender expression. In other words, it doesn’t make young people less trans if they are not pursuing hormone treatment.

Treatment usually starts with hormone blockers which are thought to be mostly reversible with no long-term consequences – so that is good to know, especially for younger youth who are maybe more uncertain.

And gender-affirming hormone therapy (prescribed estrogen or testosterone) is a partially reversible intervention. This is often a big concern for parents who wonder, ‘What if my youth is not making the right decision for themselves?’

It is also important to note that there is a lot of evidence that suggests that physically appearing more similar to your identified gender is tremendously helpful for your mental health and reduces the risk of depression, anxiety, and suicidal behaviour.

As a youth and adolescent psychiatrist, what can you tell us about the mental health impacts of gender-affirming practices for trans and gender-diverse youth – whether at the doctor’s office, school, or home?

The research has mostly focused on what happens without gender-affirming care. What we know is that people who are not supported — who are not accepted within their home, school, or healthcare environment — have much worse mental health outcomes. That includes things like depression and anxiety, suicide attempts, and eventual suicide deaths. That evidence has been very well documented. And researchers believe it’s because of what’s called ‘minority stress’, in other words that people who experience discrimination are at much higher risk of depression and suicidal thoughts.

The opposite has been studied as well, although slightly less so. The evidence tells us that gender-affirming care does mitigate some of these problems. People are less likely to experience depression and suicidal thoughts if they are treated with gender-affirming care. A study conducted in the U.S. and published in the Journal of Adolescent Health in 2018 found that even something as simple as addressing someone by their chosen name leads to a reduction in depression, suicidal ideation, and suicidal behaviour among transgender youth.

I also point to the Canadian Pediatric Society position statement called “An affirming approach to caring for transgender and gender-diverse youth”, which describes the ‘minority stress’ effect and how affirming care can help reduce it.

“Transgender or gender-diverse (TDG) youth are at elevated risk for adverse health outcomes, including depression, anxiety, eating disorders, self-harm, and suicide. This elevated risk is thought, in part, to be attributable to ‘minority stress’, defined as the ‘distinct, chronic stressors minorities experience related to their stigmatized identities, including victimization, prejudice, and discrimination’. Consistent with this theory, Canadian TGD youth report high levels of exposure to harassment and violence. Risk may be mitigated by affirming experiences and environments, such as supportive parents, early social transition for those who express this desire, and inclusive and non-judgmental interactions with the health care system.”

–  Canadian Pediatric Society position statement, June, 2023

What do you hear from the transgender and gender-diverse youth you care for about what it feels like when they are not supported?

The youth that I see feel tremendously ostracized. They feel they are not living their authentic lives because they feel like they have to fake it in front of other people. That disconnect between the true authentic version of themselves and the masks that they show to other people is very distressing for them. Anyone can imagine how it would feel to not be treated with respect.

What are some of the common symptoms of depression and anxiety?

For youth with depression and anxiety, it means they are not able to enjoy the life they want to live. It could mean social withdrawal and spending less time with friends, spending less time doing preferred activities like sports, arts, or other extracurriculars, having a hard time focusing in school or falling asleep at night, low energy throughout the day, or appetite changes. It could also mean feeling like life is not worth living, that it’s hopeless and will never get better. And that can ultimately lead to suicidal thoughts.

Recently we are hearing a lot about gender identity policies in schools, and the debate over whether parents should be informed if students request a change to their preferred names or pronouns. It has been framed as an issue of parental rights versus children’s rights and 2SLGBTQIA+ rights. If we apply a mental health lens to this topic, how might that add to our understanding of it?

If we apply a mental health or medical lens to this, it comes down to an issue of consent and capacity. In general, in medical care we are asked to assess individual youth and decide if they have the ability themselves to ‘understand and appreciate’ the consequences of a medical decision. In other words, doctors have to decide if individual youth can literally grasp the information of, say, the side effects of a medication and apply that information to themselves.

It’s the same concept for health information. Part of our job as doctors and healthcare workers is to assess whether or not a patient has the capacity to give consent about the sharing of their health information. Obviously, a five-year-old does not have the capacity to make treatment decisions or decide if they want their parents involved in any sort of medical discussion. But most teens do have that capacity – they can share with a healthcare provider whether or not they want their parents to be involved, and ultimately they can also make their own health decisions.

That has been very clear in the medical world for decades, and yet in the school system there seems to be a different culture. It’s a very different model than the medical system where we sometimes tell parents, ‘Sorry, you are actually not involved in this decision because your youth doesn’t want you to be and because they are able to understand and appreciate the consequences of a medical decision themselves’. Most youth psychiatrists encourage a family-based model of care, but ultimately, the youth gets to decide how involved their parents are in their medical treatment.

How concerned are you about the stress associated with being caught in the middle of a public divide like this for transgender and gender-diverse youth?

My own transgender and gender-diverse patients have told me how invalidating it feels to have this very public debate over something which to them seems as basic as just calling them by their preferred name. They say it feels like suddenly there is this problem with who they are and what their name should be and that feels very invalidating. They say, ‘Really, I can’t express myself the way that I want to and that’s true to me? Why does anyone else care what I call myself?’

What message would you like to offer youth and their families who may be navigating gender identity at this time?

What I say to patients and families is that this is a process. Understanding who we are at our core is actually a very normal developmental process for teenagers, and people who are gender diverse have an extra level they have to go through to try and figure out what is their place in this world and how do they best express themselves.

For parents, my message is don’t worry, you don’t have to make any big decisions right now. This is a process and your job is simply to love and support your child. And if they ask you to use a different pronoun or name, do it. They are confiding in you about how they feel and view themselves and being able to respect that is really important.

For youth, my message is we’re here for you, we are supportive. Living an authentic life, true to your own identity, can be tremendously liberating. If you need time to figure out who you are, that is okay too. If you need help with your mental health, we are happy to help you at Sunnybrook. We have faith that we can help you to build a life with meaning, authenticity, and joy.

The post A Sunnybrook psychiatrist explains why gender-affirming care is crucial for youth mental health appeared first on Your Health Matters.

For others, difficult emotions can also arise during pregnancy and the postpartum period, including the kind of stress or worry that can often accompany a major life change. While that is not necessarily anything to be alarmed about, doctors say that if such feelings interfere with a person’s ability to enjoy or carry out their daily routines, they should speak with their healthcare provider about whether they might need additional mental health supports.

At Sunnybrook’s latest Speaker Series, leading experts in perinatal mental health discussed how depression and anxiety can affect pregnant people and those who have recently given birth — and what treatment options are available.

According to Sunnybrook psychiatrist Dr. Sophie Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions, perinatal mood disorders affect about 20 percent of women. That translates to approximately 28,000 people in Ontario each year.

Risk factors can be biological, psychological, and environmental. Experts also say there are some groups, including people who have experienced intimate partner violence, people with disabilities, people with a history of depression or anxiety, and people who have been through a birth trauma in the past, who are at greater risk of developing a perinatal mood disorder.

Symptoms of perinatal depression and anxiety — such as low mood, difficulty sleeping, or recurring anxious thoughts — can persist for several years postpartum if left untreated, Dr. Grigoriadis explained.

The good news is these mood disorders are very treatable with methods such as psychoeducation, psychotherapy, psychosocial interventions (e.g. self-care or breastfeeding support), or antidepressant medication.

New approaches such as mindfulness-based group therapy delivered online to treat anxiety in pregnancy are also being studied, said Dr. Grigoriadis, who is also a scientist with the Hurvitz Brain Sciences Program.

In addition, Dr. Grigoriadis along with research teams at Sunnybrook, Women’s College Hospital, and CAMH are recruiting patients for a clinical study into an innovative treatment called Transcranial Direct Current Stimulation for Depression in Pregnancy.

Transcranial Direct Current Stimulation is a non-drug treatment involving a small device that can be used at home. It is already approved by Health Canada – but Dr. Grigoriadis and her colleagues hope to evaluate whether it is effective in treating depression in pregnancy.

The treatment could provide a useful alternative for patients who are reluctant to take antidepressant medication during pregnancy, Dr. Grigoriadis explained. “If we can show that it is helpful, it will be revolutionary because this is a treatment you can do at home with minimal side effects,” she said.

Sunnybrook obstetrician Dr. Anne Berndl, Director of the Accessible Care Pregnancy Clinic and Associate Scientist with the DAN Women & Babies Research Program, said getting help is key to the health of the person who is pregnant as well as the baby.

Untreated depression during pregnancy significantly impacts quality of life and can lead to an increased risk of preeclampsia or substance use. There are also health risks for the baby, such as preterm birth or low birth weight.

Postpartum depression that is not treated can increase the risk of self-harm for the birth parent. It can also have a negative effect on infant attachment, breastfeeding, and development.

Dr. Berndl encourages people who are experiencing symptoms of depression or anxiety during pregnancy or postpartum – such as a feeling of hopelessness, loss of appetite, frequent irritability or tearfulness, severe sleep deprivation, or simply feeling ‘stuck’ — to reach out for help.

But the first step might be acknowledging that pregnancy and new parenthood doesn’t automatically come easily to everyone.

“One of the things that makes this really hard for people to understand are motherhood myths, which are a real barrier to accessing care,” Dr. Berndl explained.

“There are myths that once you become a mother you will have complete joy and fulfillment, or that motherhood is easy and you will naturally know what to do, or that being a mother always means sacrificing your own needs but these are all myths,” she added. “The problem with these myths is that people have a sense of shame when they feel otherwise, and it can delay asking for and receiving help.”

Mental health supports should be personalized based on a patient’s needs, Dr. Berndl said. For instance, a patient who has experienced a prior stillbirth or neonatal death might need more appointments with an interdisciplinary care team and a greater focus on birth planning.

People with disabilities, who have higher rates of depression and anxiety, also benefit from an interdisciplinary approach to perinatal care that includes medical management of the birth parent, pain management, early access to lactation consultants, psychiatry, and if needed community resources.

The take home message, Dr. Berndl said, is that “anxiety and depression during pregnancy and after birth can happen to anyone – but they are treatable so talk to your care provider about it.”

 If you are looking for more mental health resources please speak to your doctor or see some of the resources listed here.

The post Understanding depression and anxiety during and after pregnancy appeared first on Your Health Matters.

Marci Peters is grateful for the care she received after not one but two brain surgeries.

As a working single mom, the last thing Marci Peters needed was a medical mystery. So, when she noticed a lump the size of a goose egg on her forehead, she went to her family doctor in her search of answers, X-rays and other scans were inconclusive.

Marci was losing hope. That’s when Sunnybrook came into the picture.

Finding solutions

Marci was referred to Dr. Oleh Antonyshyn at Sunnybrook. Dr. Antonyshyn is one of Sunnybrook’s most esteemed craniofacial plastic surgeons in the Blake & Belinda Goldring Department of Surgery.

When Dr. Antonyshyn saw the lump, he immediately ordered new tests, including a CT scan and an MRI. He had his answer: it was a meningioma, the most common type of primary brain tumour. It occurs in the outer three layers of tissue between the skull and the brain and is typically benign but can have serious complications. It was established that the meningioma was a result of the radiation therapy she received as a part of her successful treatment for childhood leukemia.

Bringing together the best people

Diagnosing Marci’s concern was just the first step on the path toward finding a solution. Which is when Dr. Antonyshyn’s colleague Sunnybrook neurosurgeon Dr. Leo da Costa stepped in. He works in Sunnybrook’s Hurvitz Brain Sciences Program, with team members that supported Marci’s care, including Dr. Houman Khosravani, a neurologist in the stroke clinic, and Dr. Arun Sundaram, a neuro-ophthalmologist.

Working together, Marci’s care team decided surgery was necessary. She underwent her first craniotomy in August 2021, a complex procedure where Dr. da Costa temporarily removed part of the bone for her skull to access and resect the tumour. Next, Dr. Antonyshyn used his skills to place a titanium mesh implant on Marci’s forehead to cover the surgical site.

Meningiomas can cause concerns for patients by elevating pressure in the brain, and recovery can be long and arduous. But thanks to the skill, dedication and strong collaboration between Dr. Antonyshyn and Dr. da Costa, Marci was only in hospital for five days, recuperating under the supervisions of what she calls “the most amazing group of people I have ever had the privilege of being cared for.”

“Every single person – from my nurses, to housekeeping, to the patient transportation team, the caring people who brought me my meals, my occupational and physical therapist – was so kind and helpful,” says Marci. “I’ll never forget that, because it felt like everyone was committed to helping me recover.”

Marci Peters and her daughter.

Back on her feet

Team Sunnybrook is a big reason why, barely three weeks after surgery, Marci was back at work as a senior customer-relations professional and home with her daughter.

And it’s why the next year, when another meningioma tumor was discovered behind her right eye, that Marci knew exactly where to go.

Marci’s second craniotomy in November 2022 was another complete success, which she credits again to every member of Team Sunnybrook. “Everyone works together so seamlessly,” says Marci. “It’s like everyone speaks the same language.”

There was one moment Marci recalls where the nursing team gently washed her hair after surgery, combing it back to help Marci feel more like herself. “This is what compassionate care feels like,” she says. “It never felt like I was just another patient.”

It wasn’t easy undergoing two craniotomies in a little over a year, but today Marci says she feels ready to face anything. She’s grateful, too, knowing Sunnybrook, “the gold standard in compassionate care” is right behind her.

Learn more at sunnybrook.ca/brain.

The post Sunnybrook saved my life – twice appeared first on Your Health Matters.

“She had the same little button nose as my grandson,” says Fran, with a smile.

Delilah passed away in August 2018, after her mom was diagnosed with placenta previa and was bleeding heavily at 23 weeks of pregnancy. Fran felt very fortunate she was able to meet her granddaughter, and hold her, at the hospital. The meeting helped greatly with her grief process.

Fran Savelson and her grandchildren

The loss spurred Fran to support other grandparents whose children have had a miscarriage or stillbirth. As a peer counsellor at Sunnybrook’s Pregnancy and Infant Loss (PAIL) Network, she has found new meaning in Delilah’s death. On Grandparents Day, on Sunday, September 10, Fran will guide an online session called “Grandparents cry twice: Grieving the loss of a grandchild and the loss for your child”.

Fran admits losing a grandchild is a complicated mix of emotions, with worry for your own child and their partner, while also experiencing your own grief. “It is really hard not having anyone to talk to. I didn’t want to burden my daughter who was dealing with such heavy emotions herself.”

She has advice for fellow grandparents: “Don’t hide your feelings, talk about the baby and use their name! Do something positive to honour your grandchild. I visit Delilah’s grave and draw little happy faces on rocks. It’s my way of connecting with her.”

Fran also encourages that you take care of yourself and give yourself permission to do what you need to do. That may mean taking a pass on baby showers or other situations that would be difficult. Allow yourself to grieve in your own way, as everyone grieves differently.

Her work at the Pregnancy and Infant Loss (PAIL) Network has helped reframe her perspective on losing Delilah. “I feel like I’m doing something positive to honour my granddaughter’s death. I really feel like it’s my calling,” adds Fran, who has five living grandchildren, including the two pictured.

Learn more about support services offered by the Pregnancy and Infant Loss (PAIL) Network. You can sign up for the grandparents’ session here.

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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.”

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Each week, Dr. Grigoriadis, head of the Women’s Mood and Anxiety Clinic: Reproductive Transitions at Sunnybrook, sees patients who are pregnant and have depression. After reviewing general risks, like the increased likelihood of giving birth to a preterm baby at a lower birthweight, she talks with patients about treatment options.

Psychotherapy, or ‘talk therapy’, can be very helpful. “A lot of people prefer it over medication because there is no fetal drug exposure,” says Dr. Grigoriadis. “One of the problems is that therapy can take weeks to months to help with depression, so the patient and baby can be exposed to the negative impacts of depression during that time.”

Antidepressant medication can improve symptoms of depression very quickly and with very few side effects. However, medications do cross over to the baby to some extent and some patients may be hesitant to take them while pregnant.

This new approach, tDCS, uses a small electric current to locally stimulate a part of the brain that functions abnormally when an individual is depressed, requiring 30 minutes of daily treatment over three weeks. It can be done by patients at home after receiving training, while also continuing to see their regular health care team, including pregnancy care provider and psychiatrist.

“Our team has already done a small study with 20 pregnant patients with depression, which had promising results for safety and effectiveness. We’re looking for more patients for a larger study to see whether this should be offered widely during pregnancy,” adds Dr. Grigoriadis. The study is randomized, meaning patients will have a 50/50 chance of receiving tDCS or being placed in a control group which receives a similar looking device but does not deliver any electric current.

For more information and to enroll in the study, please visit https://sunnybrook.ca/content/?page=tdcs-pregnancy-depression-research-study.

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