Harlan Kirshenbaum says that engaging in virtual treatment for his OCD from his home has been beneficial.

COVID-19 presented a vast challenge for medical and administrative staff at Sunnybrook: How could they deliver the programs and services their patients relied on, yet still keep everyone as safe as possible? Here are just a few examples of virtual care initiatives developed at Sunnybrook through the pandemic.

Virtual OCD treatment: A better fit for some

Harlan Kirshenbaum has battled obsessive-compulsive disorder (OCD), a chronic psychiatric illness, for most of his life. Over the years, his OCD has led to the repetition of various actions, called compulsions, which have had a dramatic impact on his life.

“At one point, I couldn’t get dressed without looking at the labels on my clothes,” Harlan explains. “In recent years, I couldn’t touch my kids or my wife because I would get bad thoughts, like I would give them cancer.”

When the COVID-19 pandemic hit, Harlan’s OCD worsened. He reached out to Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre for support through the Intensive Residential OCD Program, which had recently shifted from in-house treatment to virtual care amid the pandemic.

The six-week program includes exposure and response prevention sessions guided by a therapist through video conferencing, as well as group sessions for mindfulness and cognitive-behavioural therapy. It was an intense experience, but Harlan says that virtual treatment for his OCD was even more beneficial because he was being treated while in his home, where the majority of his triggers are.

“It’s where my OCD attacks me the hardest, and the virtual program was amazing – the most effective treatment I’ve ever had,” he says.

Dr. Peggy Richter, head of the Frederick W. Thompson Anxiety Disorders Centre and director of the Clinic for OCD and Related Disorders at Sunnybrook, says that coaching people in their home environment has, for many, been advantageous over typical live treatment on-site.

The success of the virtual program has prompted Dr. Richter and her colleagues to plan for a hybrid model of care in the future, based on the positive experience of patients like Harlan. Patients would have shorter residential stays, then migrate to a virtual environment to take advantage of coaching in their home environment.

“We see all the advantages in terms of access, what can be done and how much easier it is for patients to attend our program,” Dr. Richter says. “We don’t want to lose those wonderful improvements.”

COVIDEO: A lifeline for patients

For infectious disease physician Dr. Nisha Andany, developing a virtual care model for COVID-19 was an important part of keeping patients informed about a new and unknown disease.

“Early on, it became clear that most people with COVID-19 would not need to be admitted to hospital and could be managed at home,” Dr. Andany says. “But they might be feeling alone or uncertain in terms of what to expect, what they should do or when they should seek medical attention.”

Alongside members of the infectious diseases team at Sunnybrook, Dr. Andany developed the COVIDEO program to conduct phone and video assessments of outpatients with COVID-19.

“We [also] give patients our email address and pager number and inform them there’s a doctor on call 24 hours a day for any emergencies,” she adds. “We’re often able to reassure most patients that they can stay home and guide them in managing their symptoms.”

As the COVIDEO program was rolling out, the team also began to send out blood oxygen monitors to higher-risk patients. That way, the COVIDEO team could obtain a more objective assessment of someone’s condition from home.

“Now, patients will call us and say ‘my oxygen level is at a certain level’,” Dr. Andany says. “It allows us to more reliably determine how sick someone is. If a patient has a normal oxygen level, we will typically reassure and advise them to remain home and keep monitoring. However, for those with low oxygen levels, even if they say they feel okay, we know they actually need to come into the hospital for treatment.”

Virtual post-operative physiotherapy

For patients recovering from hip or knee replacement surgery, virtual post-operative physiotherapy offered by the Holland Centre has given patients all over the province greater choice, says Amy Wainwright, manager of the Holland Bone and Joint Program.

“For some patients, the possibility of virtual care removes some barriers to receiving care at the hospital such as arranging transportation, long travel times, paying for parking, as well as family members to accompany them,” Wainwright says.

Throughout the pandemic, physiotherapists have been hosting rehab sessions by video to safely guide patients in their post-surgical recovery.

Going forward, the Holland Bone and Joint Program will continue to offer virtual care for outpatient physiotherapy, as well as virtual options in other areas of the program such as pre-admission and post-operative follow-up clinics. Wainwright says the expansion of virtual care has been something of a silver lining among the challenges caused by COVID-19.

“We now have a virtual care model that would have taken years to get to and may have been challenging to implement if it wasn’t for the pandemic pushing us all into a new arena,” she says.

Bringing the ED to the community

When Sunnybrook physician Dr. Justin Hall saw patients avoiding the Emergency Department (ED) due to fears around contracting COVID-19, he saw the need to provide another option.

“People delayed their care and were more unwell when they eventually came in,” Dr. Hall explains. “In some cases, there was permanent or irreversible damage because of this delay.”

Along with members of ED leadership, Dr. Hall developed Sunnybrook’s Virtual ED. Focused on addressing acute but non-life-threatening issues, it launched thanks to provincial funding as a six-month pilot in December 2020, and it has since been extended with ongoing provincial and hospital support. Patients can book a same-day appointment to see a physician through video conferencing app Zoom if they’re unable to visit their regular family doctor.

“It’s not a replacement for the in-person ED,” Dr. Hall notes, as emergency departments are still open and are safe to visit. People experiencing life-threatening issues like a heart attack or stroke should still go to the hospital. But issues such as skin conditions, some mental health concerns or sprains and strains can now be assessed through a video appointment.

As with many departments at Sunnybrook, there are plans to incorporate a hybrid model of virtual and in-person care in the ED post-pandemic, says Dr. Hall, making it easier for patients to access treatment in an integrated manner.

“We estimate that 30 per cent of in-person visits could be seen virtually,” he says. “There’s an increasing recognition of the value of virtual care and that patients like it and are willing to use it.”

Learn more about the Virtual ED »

Staff members of the Virtual Emergency Department Team (from left): Toni Alevantis, patient administrative associate; Steffanye Michaelson, patient care manager; Dr. Aikta Verma, chief of emergency medicine; Dr. Justin Hall, emergency room physician and virtual emergency department lead.

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Whether it’s a flu shot or a routine immunization, there are some tried and true approaches to help ease a fear of needles. A Sunnybrook expert shares her tips for people of all age groups, from babies, to children, to adults.

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Text by David Israelson, video by Monica Matys

If you look up at the skies in Ontario’s Peel region, don’t be startled if you see a fast-moving object zipping over the tree line. It might be a drone on a life-saving mission.

This past spring, Sunnybrook launched an innovative pilot project in southern Ontario to see whether drones carrying an automated external defibrillator, or AED, can respond more quickly than emergency medical service (EMS) vehicles to cardiac arrest. An AED is an easy-to-use medical device that delivers an electric shock – or defibrillation – to re-establish a normal heart rhythm when someone is experiencing sudden cardiac arrest.

Drone delivery technology is already being deployed for everything from delivering pizzas to sending cameras down mine shafts. In reading about these applications, Dr. Sheldon Cheskes wondered: Could drones be used to improve response times for out-of-hospital cardiac arrest, particularly in rural and remote communities? 

Dr. Cheskes, medical director of the Sunnybrook Centre for Prehospital Medicine, is leading the tests in Caledon, Ont., with the help of voluntary community CPR Responders.

“Many strategies have been tried in the past to deliver help to victims of cardiac arrest faster. But in general, surviving cardiac arrest tends to be lower in rural areas, where it’s difficult to get responders with an ambulance or a fire truck to the scene rapidly,” says Dr. Cheskes, who provides medical oversight for emergency medical services in Ontario’s Peel and Halton regions.

“Every minute of delay in response time decreases the chance of survival by 7 to 10 per cent,” he says. 

Until now, the general strategy for giving people access to AEDs has been to put them in areas where people congregate, such as public buildings, stadiums, hockey rinks and restaurants. Peel Region started a program in 2014 to put defibrillators in high-traffic locations and has placed nearly 1,200 AEDs since that time.

The problem is that you can’t put defibrillators everywhere they might be needed. An area like Caledon is a mix of town, suburbs and rural areas, including the beautiful, rugged Niagara Escarpment and the Bruce and Trans Canada trails.

In addition, while it’s important to have defibrillators in public areas, “the difficulty with cardiac arrest is that 85 per cent of cardiac arrests occur in private locations where AEDs are not readily available,” Dr. Cheskes says. 

His team put together a feasibility study and received funding from the Cardiac Arrhythmia Network of Canada (CANet) for a research proposal, which led to the first test flights in May 2019. 

“We want to find out if we can use drones to save patients in cardiac arrest,” he says of the project. 

The drones being tested to deliver defibrillators are larger and more elaborate than the recreational rigs sold to consumers. 

“They are called Sparrow Emergency Response drones,” says Greg Colacitti, vice-president of business development for Drone Delivery Canada (DDC), a partner in the pilot project and supplier of the flying machines. “Each one is approximately four feet in diameter, and with its cargo – the AED – [in place], it weighs 24 kilograms.”

The Sparrow drones can reach speeds of 80 kilometres per hour. While this may not sound all that fast, they may be able to go quicker in a straight line than an EMS vehicle speeding to a scene along a twisted or congested road. 

Under the tests, when a simulated 911 call comes in, a drone is dispatched to the mock emergency by a volunteer using an app developed by the Region of Peel. The dispatcher first decides if the emergency is easier to reach by drone than by vehicle; if it is, the dispatcher taps in the location.

Dr. Cheskes says the test also sends EMS teams by vehicle, to compare their arrival time with the drone’s delivery. In the first test, the drone travelled about eight kilometres and arrived four minutes earlier than the land ambulance, he says. 

The DDC drone uses a proprietary system to take off automatically and get to the scene. Transport Canada officials are monitoring the project, and earlier this year the federal government tightened the rules for flying drones. Requirements now include mandatory licences for drone flyers, night-flight permissions and strict safety design standards for drones that fly near the public.

“Believe me, what we go through for a launch is a lot like taking off from Pearson Airport,” Dr. Cheskes says. 

During the testing, volunteers playing the role of bystanders unpack the defibrillator from the drone and simulate deploying the equipment on a patient suffering cardiac arrest.

“In our tests, our volunteer managed to administer two [defibrillator] shocks before the EMS arrived. That’s good,” Dr. Cheskes says. “Our mathematical model suggests that we could decrease response time in an urban area by six or seven minutes, and in a rural area by 11 minutes – crucial minutes in cardiac arrest.”

The project team plans to test-fly more drones to see if they can land the units more quickly. They are also exploring ways to make it easier for bystanders to use the AEDs even if they have not been trained – for example, by including a smartphone in the drop with an app that can give simple instructions.

Dr. Cheskes says he’s convinced it’s only a matter of time before it becomes commonplace to use drones for 911 responses. 

“Using it in real life, not just testing – that’s the ultimate goal of all this,” he says. 

The post How drones could help deliver life-saving treatment in rural areas appeared first on Your Health Matters.

It’s a scene that plays out every year across the country: parents dropping their kids off at colleges and universities for their freshman year. And that means many parents are now dealing with empty nests for the first time. So what’s the best way to manage this transition as a parent? Dr. Ari Zaretsky, psychiatrist-in-chief at Sunnybrook, shared five points with us to help navigate the change.

Realize there are benefits

Any big life change can evoke a flurry of emotions. But research now shows that the switch to the empty nest is a far more positive change for parents than it is negative. In particular, relationships with significant others appears to improve when children move out due to more quality time spent together. Having the freedom to focus on that relationship appears to deepen bonds and make many couples happier.

Stay busy

This stage of life is the perfect time to dive into interests and activities you may not have had time for. Whether it’s trying a new sport, learning a new language or travelling, explore new things that fulfill your interests. Staying socially engaged though club or groups can help counter feelings of loneliness and isolation. And giving back to the community through various volunteer opportunities is an incredible way to boost your happiness and self confidence, all while learning new skills.

Avoid helicopter parenting

While it can be difficult to see your children go away to school, remember that this step is an important one in their development and move towards independence. Technologies make it easier than ever to stay in touch, but don’t overdo it. Establish a mutually agreeable time frame for checking in, and remember to give your kids the time and space to adjust to their new situation.

Talk to others

You are not alone in this important life transition! It might help to talk to other parents on how they are feeling and managing through the change.

Consider the boomerang

Because of pressures in the job market, expensive real estate and the high cost of living, many children move back home after school before eventually moving out a second time. This increasingly common scenario means that it might not be as much of a “goodbye” as a “see you soon.” Don’t get too sad because your kids may end up back in their old bedrooms quicker than you think!

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These mini Canadians are celebrating Canada Day in a special way, by presenting gifts to Canada’s veteran war heroes, who are residents at Sunnybrook’s Veterans Centre.

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“Everything in moderation.” What was once my excuse to periodically indulge in some not-so-good behaviours (read: eating dessert), is now the motto too for over-indulging in those “good-for-you” things – at least when it comes to our cholesterol.

In a recent study, researchers weigh-in on the conventional wisdom that supercharging your “good” cholesterol to very high levels can help reduce the risk of heart disease. What they found instead was that both low levels of the cholesterol – known as high-density lipoprotein (HDL) – and very high levels could lead to a higher risk of death.

“It’s been thought that raising high-density lipoprotein is the holy grail of reducing or eliminating heart disease,” says Dr. Dennis Ko, cardiologist at Sunnybrook Health Sciences Centre, senior scientist at the Institute of Clinical Evaluative Sciences, and the study’s lead investigator. “But instead of seeing a linear correlation between HDL and mortality, we’re seeing a U-shape. It tells us that beyond a certain level, HDL cholesterol isn’t necessarily all that beneficial. Beyond the average values, we don’t see a lower risk of death.”

The study, which was published today in the Journal of the American College of Cardiology, looked at 631,762 individuals without pre-existing cardiovascular conditions. Individuals whose HDL cholesterol levels were very low (less than 50 mg/dL or 1.3 mmol/L in women and 40 mg/dL or 1 mmol/L in men) and very high (more than 80-90 mg/dL or 2–2.3 mmol/L) experienced a greater risk of death compared to individuals who had HDL cholesterol levels that fell within intermediate ranges.

Cholesterol isn’t about a battle between good versus evil.

Low-density lipoprotein (LDL) is the “bad” cholesterol that accumulates on the walls of our blood vessels and causes blockages. Our HDL, the “good” cholesterol, acts as a scavenger, grabbing hold of the bad cholesterol and carrying it to our liver to break it down.

One would think the more cholesterol we have cleaning out the bad, the better. And scientists are not yet sure why this is not the case.

“We can’t abandon the concept of cholesterol being a marker of health,” explains Dr. Ko, also an associate professor at the University of Toronto. “LDL cholesterol is still bad and the more you do to lower your LDL levels, whether through medication or lifestyle changes, the better your outcomes will be.”

The discovery, he says, is that the HDL cholesterol levels are not a specific indicator of heart health, but rather an indicator of general health.

“Yes, low HDL levels are associated with a higher risk of cardiovascular death,” admits Dr. Ko, “but the data tells us that the HDL level is not the modifiable risk factor that if we change, we will improve the cardiovascular outcome.”

The study found that individuals with lower HDL cholesterol levels were more likely to have lower incomes and unhealthy lifestyles like smoking, lack of physical activity, poor diet, and hypertension.

Howard Gaskin says these findings are a bit of a relief.

With a family history of heart disease, Howard eats well, stays active and pays close attention to his cholesterol levels: not only to keep his LDL cholesterol low, but also to keep his HDL cholesterol high.

Howard Gaskin strives to maintain his heart health by exercising and eating well.

“It’s certainly a number, a measure, a metric that I’ve been focused on for years,” says Howard, who takes medication to lower his LDL cholesterol and admits he’s been frustrated with trying to raise his HDL above what’s considered average levels.

“I think I will obviously focus a lot less on HDL as a measure of the success of what I’m doing,” he says.

Bottom line: It’s just a number.

Dr. Ko’s take-home message is simple: our HDL level is just a number that doesn’t necessarily warrant the attention we’ve been giving it. While low levels indicate poor health, super high levels do not necessarily mean you’re healthy. Instead, we need to maintain our cardiovascular health the way we’re told over and over again: no smoking, exercise regularly, reduce your stress, and eat your fruits and vegetables.

“It’s what you do – your exercise, your diet – that’s more important. That’s what we think is making the impact,” says Dr. Ko.

So for health-conscious Howard, little has changed. “I exercise because I enjoy it, I run because I have a good time doing that. So, I’ll still continue to focus on those strategies, but with different metrics in mind,” he says.

The post ‘Good’ cholesterol: You CAN have too much of a good thing appeared first on Your Health Matters.

The first step sounds obvious, but you have to want the change, say Sunnybrook experts. The next is making sure the change is realistic and sustainable. For example, rather than vaguely promising to eat better, start adding one fruit or vegetable to every meal. It’s a small shift but one you can see and do pretty easily. It’s also something you can track and build on over time.

Like anything lasting, build you diet plan on a solid foundation. Get your information from reputable sources, like certified websites, your doctor or a registered dietitian. While people have varying reasons for changing their diets, experts say you’ll have more success by focusing on your overall goals rather than your weight. Maybe that extra serving of veggies will help you feel fuller, meaning you may skip dessert and reap the rewards later. Call it a healthy domino effect.

Being accountable to yourself and others also boosts success. So tell a loved one or friend about your plan and check in with them regularly on your progress. Also, write everything down. It’s amazing how small things can add up – like those extra few bites — when you do you end-of-day tally.

It may also help to look to outward for some inspiration. The quotes and tips below are ones I’ve read from others along the way. While I can’t remember all the sources, the message from each point resonates with me and helps keep me on track. Hopefully you’ll find some truth in a few to help feed your inner voice.

• You can’t outrun your fork.

• Suck up the water now so you won’t have to suck it in later.

• Live by the 80/20 rule: eat well 80% of the time and give yourself 20% to cheat.

• Are you really hungry? In trying to distinguish between real hunger and a craving, ask yourself if you would be happy to eat something healthy. If you are craving chips but not that bag of veggies, you have your answer.

• If you are craving something, choose a high quality treat. Make it worth the calories.

• Hide your fruit and veggies. Load them into omelets, sandwiches, pasta and soups.

• Never go grocery shopping hungry. Or to a dinner party for that matter!

• You are what you eat, so don’t be fast, cheap, easy or fake.

The post How to stick to your healthy eating goals appeared first on Your Health Matters.

As incredible as her professional achievements have been though, she says her greatest moment yet was becoming a mom one year ago. So who better to speak to the importance of exercise in pregnancy? Here is part of my conversation with Karen, talking about her leap from the Olympics to motherhood and back again.

Q: When you were training for the Olympics, what did your average week entail?

A: When I was training for the Games, it was six days a week up to six hours a day and it included trampoline sessions, weight training, cardio, Pilates, flexibility work. Lots of different things to be in peak form.

Q: Then along comes baby!

A: As an athlete, you’re always planning everything. So after the Olympics, I planned to get pregnant. I was in great shape and already taking prenatal vitamins at the Olympics. It took about three months and I was ecstatic that it happened so quickly. Then there was a complete change of pace. You can usually continue to exercise when you’re pregnant, but with trampoline, you have to stop because of the impact. I had to find other things to stay in shape, so biking, swimming.

Q: Did you plan out your exercise strategy with your doctor?

A: My doctor advised me on what I could do when I was pregnant and of course I followed those guidelines. I had to be very careful during my pregnancy because I had gestational diabetes. I’m an elite athlete with a healthy diet and have no family history, so I was shocked when I got the diagnosis, but these things can happen to anybody. I only gained about 35 pounds during my pregnancy and had to stay active throughout because of my condition.

Q: Did staying active help keep you in a positive mood?

A: It was a huge change with my body, but you’re growing a life and that’s such a magical thing! It was more about staying healthy and being in shape to last through the labor, which mine was 27 hours, so being in shape really helped with that. I had morning sickness for 19 weeks, 24 hours a day and it’s tough to exercise when you’re feeling like that, but I tried to do as much as I physically could and I think it made me feel better actually. My second and third trimesters were great.

Q: What was your training schedule like after the birth of your daughter?

A: After her birth, I had about 5 weeks of just baby time and rest. Then I started jogging again and my body was feeling better. About two months later I started in a gym with body weight exercises, just getting fit. I didn’t come back to trampoline until 5 months after having her. I had a good three months of weight training, cardio, just to have that strong base before trying to jump 20 feet in the air!

Q: What advice to you have for other women?

A: It’s really important to talk to your doctor about what you’re going to do. It’s good to be in shape before you get pregnant. And doing some form of exercise in pregnancy and after. But enjoy your baby! I wasn’t rushing back into training. It’s a special moment when your baby arrives and that’s your focus. Then you just slowly fit exercise back in when you can. It gives you more energy to be with your baby.

Q: How does motherhood compare to the Olympics?

I always thought achieving Olympic medals and standing on the podium were those moments, but nothing can compare to my daughter being born. That’s the most amazing moment so far for me.

For more information on exercise in pregnancy, check out these resources:

• Exercise+Pregnancy Hotline: 1-800-363-9353
• Health Canada
• PARmed X for Pregnancy
• Motherisk 
• Society of Obstetricians and Gynaecologists of Canada

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Dos and Don’ts

Exercise in Pregnancy:

Advised:
• talk to your doctor
• determine safe levels of activity for you
• switch to low-impact activities
• eat proper nutrients and stay hydrated
• be aware of the guidelines

Not Advised:
• starting an exercise program without physician consent
• participating in high-risk activities
• being sedentary unless so advised
• cutting back on necessary nutrients
• continuing activity if pain or bleeding occur

Exercise May
• lower the risk of gestational diabetes
• reduce the need for interventions in labour
• help mothers maintain a healthy weight
• reduce some aches and pains of pregnancy, like back pain

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It’s mind-boggling: How can you feel pain in a limb that doesn’t exist? It’s a strange phenomenon for people with amputations, but phantom pain is real and can be hugely debilitating. While the pain is often treated with medication, an alternative method to manage the pain (believe it or not) uses a simple mirror.

“Mirror therapy” works like magic — you use a mirror to trick your brain into thinking your missing limb has reappeared and then (with a physiotherapist or occupational therapist) treat the limb as if it still exists.

Watch the video to see mirror therapy in action.

The post How using a mirror can relieve phantom pain appeared first on Your Health Matters.