Less is More

In a bright and cheery east end community centre, Lauren Singleton commands the room. Dressed in slim cut workout gear, it’s obvious she makes movement a daily priority. Lauren has been teaching fitness for years, and as she leads her class through the first set of drills, exudes joy through every sweaty step. Amazingly, despite just having a hysterectomy, her hamstring curls and lunges have more chutzpa than anyone else. It’s a very cool sight.

Lauren is exactly the type of person who will go stir crazy when sidelined by a minor injury, let alone major surgery. That, alongside other criteria, made her a great candidate for minimally invasive surgery, or MIS at Sunnybrook. One day in hospital and a few short weeks of recovery later, Lauren is now hoping more women learn about MIS procedures. Sunnybrook has the highest volume of specially trained MIS surgeons who perform the most complicated cases across Canada. Lauren found herself here looking for a second opinion. “Other doctors had said things like watch and wait, and I really wanted to get on with my life.” She was happy to find there were some viable options to consider, including MIS.

MIS replaces the need to open up the abdomen to do surgery on conditions like fibroids and endometriosis. Instead, instruments are fed through tiny incisions (ranging in size from 5 millimetres to 1 centimetre) while internal images are magnified on screens in the operating room. Think of it as video-game inspired medicine. Dr. Rose Kung is a leader in the field, and says she used to practice her hand-eye coordination with the help of Nintendo. Today, her trainees spend serious time in a specialized lab, hoping to perfect their own skills through video technology. To the layperson, it looks like you’re trying to manipulate precise movement through straw-like instruments only visible on the screen in front of you. Not easy, but truly remarkable.

Robotic technology is available, but when it comes down to patient outcomes, there is no difference in the surgeon versus robot showdown. In fact, Dr. Kung says randomized studies have found the only significant difference is cost, with robotic technology being the more pricey option. Sunnybrook was the first to offer the human MIS approach for severe endometriosis, large fibroids and many other procedures. And while there is always some recovery time expected, Dr. Kung says that quite literally, many patients feel like they’ve never had surgery at all.

Lauren didn’t go quite so far, but says she was surprised how good she felt as quickly as she did. And there is one incision she can’t even find. “Overall, I’m like 100 per cent better. I’m looking forward to getting stronger.” With more than a dozen fitness classes on her schedule each week, there’s certainly no doubt of that.
To see MIS in action, click on my video.

What's Happening Up There?

Like many patients with alopecia, Mr. Pokas wasn’t the first one to notice the condition. His wife, who’s acted as his barber for decades, noticed his usually full head of salt and pepper hair was thinning in spots. Not unusual for older men, but the severe itching was another sign. Despite the daily discomfort Mr. Pokas was experiencing, it took a full year before he sought medical advice.

It’s a typical scenario for patients with scarring alopecia, a condition that many mistake for hair loss associated with aging, says Sunnybrook Dermatologist Dr. Jeff Donovan. But scarring alopecia has telltale signs, including itching and burning of the scalp. If this is your experience, don’t ignore it. The problem in waiting is that the scars left behind when the hair falls out make regrowth a near impossibility. Timely treatment won’t be able to restore lost hair, but it can prevent further hair loss from happening in up to 70% of patients.

Treatments range from cortisone creams and lotions to injections and a variety of oral medications. It all depends on the individual and their type of scarring alopecia (there are several). But Dr. Donovan, who has seen far too many patients wait far too long to seek care, urges you see your doctor to start the discussion. Not to mention, to help alleviate your discomfort.

For more information, please watch my video.

Harry's Workshop

Tucked away in a ground level corner of the Odette Cancer Centre sits an office like no other. The nondescript white door opens to reveal an expansive workshop that wraps around one corner and back down another. A gaggle of tubing, drills, heavy machinery and materials I’ve never seen before litter wooden workbenches and wall-length shelving. The smell reminds me of my grade seven shop class. But what’s being created here couldn’t be more far removed from ash trays and birdhouses. Harry Easton and his team in medical physics are busy helping patients, one invention at a time.

His office walls are a visual monument to the thought process he brings to the job everyday. Let’s just say, Harry has a certain brilliance I never will. “What’s that square thing with the holes in it?” I asked. Harry explained that was a customized grid used to make sure breast cancer patients get precise treatment. “And what about that round ball hanging over there?” I asked. That, he told me, has actually changed care for patients with inoperable brain tumours, making sure they get right dose of radiation within sub-millimeter accuracy. Okie dokie, then.

However humbling the interview was for me, Harry never held airs. In fact, he’s one of the friendliest people I’ve ever had the pleasure of talking to. And despite the average 15 projects he’s juggling at any given time, and responsibility to keep all the multi-million dollar cancer machines running smoothly, his door is always open to curious patients. And many times a day, Odette Cancer Centre staff saunter in with problems that need solving, or even crude sketches on scraps of paper, hoping Harry and his team can make them real. They always do.

“So out of all the things you’ve built, what’s your favorite?” I asked at the end of our interview. “I have a twelve string acoustic guitar that I’ve built! That’s my favorite thing!” As totally unexpected as his answer was, I was thrilled that at least it was an object I could identify! Not that I could play it, though…

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Bright Hats and Kitty Litter

There’s an old saying that if you want to get sick, go to the doctor’s office. No doubt, it’s usually a concentrated mass of coughing people within a confined square footage (not to mention whatever is lingering on those magazines). So how is it that so many doctors and nurses are able to stave off illness year in and year out? My curiosity led me to Sunnybrook’s Occupational Health & Safety Department, where frontline staff have literally seen and treated it all. What better place to arm myself with immune boosting information?

I met with Christine Ader, a lovely nurse who (true to expectation) rarely gets sick. In hand she had her top tips to stay healthy until the Sorels get officially packed away into the basement. It is the season of lists, after all. Things to do, things to buy, and now, things to help you avoid flus, falls and frenetic schedules. I sat down with my camera and started recording.

Staying well appears to be a gentle balance of lifestyle and common sense. There are the obvious methods, like frequent hand washing, regular exercise and adequate sleep. But just as critical are brightly colored scarves, shoe shopping and kitty litter. Yes, this seemingly random mix will help you tackle the season with healthy fervor (and will make much more sense after you watch my video.) And if the gift of safe sex lands under your tree, she recommends opening it without hesitation. I think that tip falls somewhere between exercise, stress relief and making the season bright…

Here’s hoping Ader’s advice helps you avoid the doctor’s office this year. Better to be reading your own magazines at home curled up by the fire. Happy holidays!

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Liquid Meals

Forty minutes north of Toronto sits a multi-acre property, complete with a small barn and two horses. There is a large garage that houses more horsepower, but this time, the Harley-Davidson variety. The owners, David and Pearl, thrive in this peaceful rural setting, spending all the time they can being active outdoors. But last summer, at a time that should have been spent doing all the things they love, an unexpected diagnosis brought them to a standstill.

After noticing a number of symptoms, David went through a series of tests before learning he had oral cancer. His full-time job as a blacksmith was put aside to focus on getting through seven weeks of radiation and three rounds of chemotherapy at Sunnybrook. It was tiring to say the least. And at a time when David needed his physical strength more than ever, he was losing weight. Treatment had made swallowing difficult and nausea a daily reality. David needed a feeding tube.

Feeding tubes, or G tubes (short for gastrostomy tubes), are placed through the abdominal wall to allow liquid feeding formula and/or medications to go directly into the stomach. They’re often used for cancer and ALS patients, as well as those who have had a stroke or trauma. They look like simple rubber tubing with a valve on one end that opens to allow liquid in through a syringe. Typically, G tubes protrude about one foot from the abdomen, leaving patients to use tape or gauze to try and tuck them away. While necessary, their design can be an inconvenience. That’s why David was thrilled to learn he would be the first patient at Sunnybrook to receive a newer type that he would barely notice.

The MIC-KEY sits flush against the abdomen and allows patients much more freedom of movement. Not only is it tiny (about the size of a dime), it comes with a detachable adapter that connects when feeding. David demonstrated in his kitchen, pulling up his shirt and connecting the rubber tube through a valve. After placing several syringes of Ensure in the tube, he flushed it with water and disconnected it. Mealtime was done in five minutes flat. Down went the shirt and off went David, able to get back to daily living without the inconvenience of typical G tube.

While it’s not ideal for everyone (like those with wider abdominal girth), it is another option for many. “Basically, you can do everything,” David told me. “The feeding tube didn’t stop me from any part of my life at all.” With his treatment complete, he is slowly weaning back to eating by mouth and hopes to have the MIC-KEY removed soon. But for the time he needed it, he’s grateful to have had a less intrusive option.

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Snap, Crackle and Replace

Warning: this video contains graphic images of surgery

I was about nine years old, decked out in my Sunday best, preparing with the rest of my grade school choir to belt out some holiday songs for the packed house of anxious and proud parents attending the Christmas concert. A quiet hush washed over the audience as we took our place on the risers and the lights dimmed. As our music teacher took her place in front of us and got ready to cue the first line of Silent Night, you could hear the proverbial pin drop. The only sound that broke it was the cracking joints of middle-aged parents bending down to capture the moment on film.

Don’t ask me why I remember that, but I do. It was simply gross to me at the time. Today, as life has a cruel way of doing, things have come full circle. My joints are increasingly verbal. And while (knock on wood) they are still functioning well, I realize that I’m smack in the middle of a demographic that is increasingly indicated for joint replacement surgery. Dr. Jeffrey Gollish, a top orthopedic surgeon at The Holland Centre says, we’re seeing a real shift in who is going under the knife. Those aged 55 used to be the exception. Today, they make up nearly a third of patients getting new parts, so to speak.

Part of the change comes from advances to the joint replacement components, with most functioning better and lasting 15 years or more The Holland Centre has also advanced the understanding of when surgery is needed, knowing that the lower people start out on the functional scale, the worse they fare even after surgery. So when your midlife crisis collides with joint replacement surgery, please don’t feel alone.

I know that crackling joints don’t mean surgery is in the cards, but a decline in your daily functioning certainly warrants an assessment. So does an increasing reliance on pain relieving medications. As one of the largest hip and knee replacement centres in Canada, The Holland recently won an award for their model of care, which cuts down on wait times and streams patients into the level of care they need: surgery, physiotherapy or otherwise. Click here to get more information on their programs and services, no matter how old or young you are.

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Rubbernecking

During a soggy week at the end of October, the usually bare grassy patch in front of Sunnybrook’s main building was transformed into a M.A.S.H-like set up. An expansive cream-colored compound had many people doing double takes and peering inside the canvas doorway to figure out what was going on (myself included). What greeted me were at least two dozen medical experts buzzing around, simulating a mock casualty exercise. They were all clad in bright red coats and baseball hats, all adorned with the Emergency Medical Assistance Team (EMAT) logo. Luckily, as I soon learned, this was just a test run. But if you ever see this scene pop up in your neighborhood, you can be sure something has gone terribly wrong.

EMAT was established post-SARS, when the province realized the need for specially trained experts who could work in situations never encountered before. From e-coli evacuations to the G8 Summit, EMAT has been there. Known as the ‘hospital on wheels’, EMAT is a first-of-its-kind mobile medical field unit that can be deployed anywhere in Ontario with road access within 24 hours. It has the capacity to hold 56 beds. In short, it’s very cool.

EMAT’s latest deployment in July 2011 included a 20-hour drive to Thunder Bay to assist with evacuees from fire-threatened communities in Northwestern Ontario. As one member of the 150-member team told me, they never know when the call will come. What follows is always an adrenaline-fueled experience that leaves staff both parts exhausted and exhilarated (but mostly the latter).

Because of the very noticeable paramilitary set up, EMAT usually elicits a fair share of rubbernecking. Tours from town mayors, city controllers and other official types are common. Good to know my reaction on the Sunnybrook campus was the norm!

To do your own virtual rubbernecking, check out more information on EMAT.

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