Issue No. 3, April 2013

Community investment in Sunnybrook is advancing health care for all Ontarians, as evidenced by the recent announcement that an innovative heart procedure performed at Sunnybrook’s Schulich Heart Centre is now receiving government funding at the centre and five other sites in Ontario.

Since its inception in 2009, the centre’s trans-catheter aortic valve implantation (TAVI) program has provided access to the life-saving heart procedure for 150 elderly or frail patients not well enough to undergo traditional aortic valve replacement surgery.

TAVI addresses the narrowing of the aor-tic valve (called stenosis), a fairly common condition in today’s aging population. If left untreated, stenosis can cause the heart muscle to thicken as it works harder to pump blood through the body, potentially leading to heart failure.

TAVI at Sunnybrook is a team effort, with an interventional cardiologist, cardiac surgeon, vascular surgeon, cardiac imaging experts, cardiac anaesthesiologist, as well as Cath Lab nurses, all working together to implant a new valve without opening the patient’s chest.

Compared to more invasive options, TAVI’s benefits include reduced pain and less need for post-operative pain medication, smaller scars,

a shorter stay in hospital and faster recovery.

For patients like Margery Brennan, a 72-year-old who wasn’t able to stay by herself as she had difficulty walking, life before TAVI simply “wasn’t good.” Margery underwent TAVI in December 2012 and says her heart “went right back to normal. I felt like a brand new person. Now I’m able to do my own housework and I have a new lease on life.”

When Sunnybrook first started performing TAVI, the procedure was unfunded, but the hospital was able to develop its expertise thanks to generous donations from the com-munity to Sunnybrook Foundation (each case costs approximately $35,000).

In January, Sunnybrook was approved by the Ontario Ministry of Health and Long-Term Care to proceed with 75 fully funded proce-dures for the 2013 fiscal year. Sunnybrook is one of only six programs in Ontario to be provided with provincial TAVI funding, and the expectation is for growth of the program to 90 cases in 2014.

Under the leadership of Dr. Sam Radhakrishnan, director of Cardiac Cath Labs and physician lead of Sunnybrook’s TAVI pro-gram, and Dr. Stephen Fremes, surgical lead for the TAVI program, Sunnybrook is guiding training for other Canadian hospitals to initi-ate their own TAVI programs.Marie Sanderson

Life-saving heart procedure program expanded at Sunnybrook

For mothers of very preterm infants, produc-ing enough breast milk to feed their babies can be a challenging experience.

“Making breast milk is a complex process, especially in very preterm births. The baby is in the Neonatal Intensive Care Unit and is physically unable to breastfeed, so the trigger of a baby suckling, which helps to increase the flow of milk, is missing,” says Dr. Elizabeth Asztalos, a neonatologist in Sunnybrook’s Department of Newborn & Developmental Paediatrics.

When traditional efforts to increase milk production, such as mechanically pumping, kangaroo care and emotional support are unsuccessful, clinicians may decide on phar-macologic intervention.

Sunnybrook is leading a new trial, called

EMPOWER, on the efficacy of one of these drugs, domperidone, which enhances pro-duction of the prolactin hormone and in turn increases milk production.

“We will be comparing different approaches in doses of domperidone to establish whether or not a treatment longer than two weeks versus a two-week treatment increases breast milk production. We hope the results of EMPOWER will establish the safety of this treatment and guide clinicians regarding the

initiation, timing and duration of treatment with domperidone,” says Dr. Asztalos, who is also director of The Centre for Mother, Infant and Child Research at Sunnybrook.

Evidence suggests the use of mother’s own breast milk to feed preterm infants during initial hospitalization positively impacts their neurodevelopment during early childhood and beyond. The trial is international, with about a dozen sites in Israel, Qatar, Chile and Australia preparing to participate. Dr. Asztalos’ goal is to recruit about 20 sites in to-tal by mid-2013, with 11 of those in Canada.

EMPOWER is funded by a grant from the Canadian Institutes of Health Research, and will enroll a total of 560 mothers. Results are expected by 2015. Sybil Edmonds

Sunnybrook studying drug that increases breast milk production

The TAVI procedure involves implanting a new heart valve without opening the patient’s chest. Benefits to patients include reduced pain, smaller scars and a faster recovery.

Sunnybrook staff members are known for providing life-saving care, but they recently went above and beyond by signing up for life-saving organ and tissue donation.

In early March, Sunnybrook participated in the Trillium Gift of Life Network’s Gift of 8 Workplace initiative, which provides a way for organizations to encourage staff to be-come registered organ and tissue donors. The Gift of 8 movement is based on the fact that a single organ donor can save up to eight lives.

Over 500 visits by staff were logged on the Sunnybrook Gift of 8 web page. These indi-viduals registered their consent to organ and tissue donation or checked their registration status. This met our goal of 500 visits and demonstrated our support and commitment to saving lives in Ontario.

Gift of 8 provides a great opportunity to discuss organ and tissue donation with your

family. When given evidence of a loved one’s decision to donate, families almost always honour this desire. If there is no evidence of the decision, consent falls to 50 per cent – demonstrating just how vital it is to share your decision with your loved ones.

You can find out more about donation by

visiting beadonor.ca. If you haven’t had the chance to register, it’s not too late.

The campaign page is permanently available and you can register at any time. Take two minutes today and visit beadonor.ca/sunnybrook to do so. Laura Bristow

The answer: The neuroendocrine system is made of a network of specialized, nerve-like cells that produce and release hormones into the blood stream. Neuroendocrine tumours are relatively rare and can present anywhere in the body but more commonly in the small bowel, rectum, appendix, pancreas or stom-ach. Half of these tumours secrete hormones such as serotonin that, in turn, have the poten-tial to damage heart valves.

Since the symptoms – bloating, wheezing, flushing, diarrhea, persistent cough and loss of appetite, to name a few – can be generalized to other medical conditions, it can take up to three years before patients are accurately diag-nosed, says Sunnybrook medical oncologist Dr. Simron Singh. Sometimes there are no symptoms until a patient is seen in emergency, which is consistent with your godfather’s situation.

“Every month, we see cases just like what is being described,” says Dr. Singh, who co-leads the Odette Cancer Centre’s Susan Leslie Clinic for Neuroendocrine Tumours at Sunnybrook, the largest clinic of its kind in Canada. It sees

about 200 new patients each year, plus up to an additional 400 for follow-up.

Due to its rarity and complexity, I would sug-gest your godfather obtain an opinion from a cancer centre that has extensive expertise in the treatment of these tumours.

That does not mean he has to leave his com-munity oncologist – only that he obtains a treatment plan from an experienced cancer centre that can likely coordinate his treatment and ensure the best possible outcome. In short, there is nothing to lose and everything to gain from an extra set of expert eyes.

“For patients outside of Toronto, this one visit can allow us to create a personalized plan that the patient can share with their oncologist,” says Dr. Calvin Law, head of cancer surgery at Sunnybrook and co-leader of the Leslie Clinic. Dr. Law has operated on many patients with neuroendocrine cancer.

Your godfather may or may not need more treatment. His treatment plan will involve a detailed analysis of the pathology of the tumour, specifically reviewing the type, size, grade, plus any additional complications.

They may want to do an octreotide scan, which allows doctors to see inside the body to locate the tumour and determine if it has spread elsewhere in the body.

As well, doctors would likely do a pathologi-cal test called Ki-67, which if high, suggests the cancer is aggressive. Depending on other features, your godfather may require more surgery.

Specific diagnostic tests, pathology work and treatment must be carried out in sequence for it to be most effective. At Sunnybrook, patients have one appointment with three doctors – a radiation oncologist, medical oncologist and surgical oncologist – who then devise a treat-ment plan.

“Sometimes there is more information that we need, but at the very least we provide you with an organized plan moving forward,” Dr. Law says.

Though half of all cases of neuroendocrine cancer are detected when they have already spread, there are surgical options for cases that are “very advanced or very early,” he notes. There are also clinical trials – new treatments in the testing stage – for eligible patients.

“Not only are there a lot of options,” says Dr. Law, “the sequence and combination of treat-ments are the keys to success.” The prognosis is generally good, he adds. “If you catch it early, there is a real potential for cure.”

To have your godfather referred to Sunnybrook or a centre in London, he would need to re-quest a referral from his family physician.

The question: My godfather was recently diag-nosed with neuroendocrine cancer. He went into hospital with stomach pain and had emergency surgery for a tumour obstructing his bowel. They removed his appendix, which was full of cancer. They are still waiting on answers and a treatment plan. Here’s the problem: they’re in a small city that only has two oncologists and no specialists. The normal course of action is to wait until your file gets to the top of the pile and they bounce you to a specialist in London or Toronto. Is there any-thing my godfather can do on his own to expedite his treatment?

Lisa Priest, Sunnybrook’s Manager of Community Engagement & Patient Navigation, answers questions from patients and their families, relying heavily on medical and health experts. Email your questions to AskLisa@sunnybrook.ca

Climbing for a cure to breast cancer

Diagnosed with a rare cancer, patient needs a solid plan

Sunnybrook employees step up to deliver the Gift of Life

Dr. Bradley Strauss, chief of Sunnybrook’s Schulich Heart Centre, moderated the February 27 Speaker Series, Advances in Heart Health, which attracted several hundred people motivated to learn about the latest cardiac approaches.

Dr. Andrew Dueck, division head of vascular surgery, spoke about the newest techniques in blood vessel repair. Cardiac surgeon Dr. Gideon Cohen described an innovative technique to repair leaky heart valves called the MitraClip procedure.

Dr. Sheldon Singh, cardiology and arrhythmia consultant, provided an update on managing atrial fibrillation.

Interventional cardiologist Dr. Mina Madan explained code STEMI, which ensures heart attack patients receive timely care.

The evening was kicked off by Elizabeth Martin, a member of Sunnybrook’s Board of Directors.

To view this and other Speaker Series events, visit sunnybrook.ca/speakerseries.

“Last time I went with gravity, this time I’m going against it,” chuckles Kumar Punithavel, 67, who will climb nearly six kilometres to the top of Mount Kilimanjaro in Tanzania in mid-June to raise funds for innovative care and research at Sunnybrook’s Louise Temerty Breast Cancer Centre.

As Kumar notes, he will be travelling in the opposite direction from when he jumped out of a plane and hurtled thousands of metres during a 2011 fundraising skydive, which raised vital funds for the centre – the largest and most advanced in Canada.

It is a cause deeply personal to Kumar – his dear wife Chandra succumbed to breast cancer in 2007 and his elder sister Nageswary also lost her life to the disease. Kumar says he will be thinking about them when he reaches the mountain’s summit, as well as the future and how the money raised will lead to new and better breast cancer treatments.

“Life is a journey. Despite the challenges, we must keep striving forward,” he says.

Kumar was inspired to do the climb after reading about a fellow Torontonian, Spencer West, who completed the trek last June. Spencer, whose legs were amputated at the age of five, climbed on his hands for the vast majority of the hike.

An active person, Kumar is making sure he keeps fit in preparation for the climb. One of the biggest challenges, he says, will be contending with oxygen deprivation at such high altitude.

The hike will last six days in all, with 4.5 days slated for the ascent. “It’s a great life experi-ence,” he says, noting the climb begins in a tropical climate and ends on a glacier.

To find out more about Kumar’s climb and how to donate, please visit sunnybrook.ca/climb. Dan Birch

Kumar Punithavel plummets to the Earth during his 2011 skydiving fundraising event, which also raised money for the Louise Temerty Breast Cancer Centre.

(Left to right) Debra Carew, director of operations for Sunnybrook’s trauma program, Barry McLellan, Sunnybrook president & CEO, and Trillium Gift of Life Network volunteers/staff Linda Rumble, Tom Mitrovski and Craig Johnston at the booth in M-wing.

The Sunnybrook Rose Award recognizes vol-unteers for outstanding service to Sunnybrook in a fundraising capacity and hospital staff and physicians for outstanding work to sup-port Sunnybrook’s philanthropic objectives.

Established in 2008, the award is inspired by the spirit of compassion demonstrated by Alexandre and Jeannine Raab, long-standing donors and dedicated Sunnybrook volunteers.

The Raabs are avid horticulturists who cre-ated the Sunnybrook Rose, a hybrid tea rose that displays qualities of sturdiness, elegance and tremendous staying power in harsh con-ditions, qualities that also characterize our award winners.

Previous recipients of the prestigious Rose Award include Dr. Marvin Tile, George Fierheller, Dr. Bernard Goldman, Liz Tory, Dr. Brian W. Gilbert, Marilyn Wright, Dr. Sherif Hanna, Terry O’Sullivan, Dr. Eileen Rakovitch and Virginia McLaughlin.

Nominate someone you feel is deserving of this award.

To get a copy of a nomination form please contact Clare Wittmann, (416) 480-6100 Ext. 89376 or clare.wittmann@sunnybrook.ca

Completed nomination forms and narratives may be submitted to:

Anne Odette KayeChair, Donor Relations Committeec/o Clare WittmannSunnybrook FoundationH363-2075 Bayview Ave.Toronto, ON M4N 3M5

The deadline for making a nomination is May 31 at 5 p.m.

Know someone who has rallied support for Sunnybrook?

2012 Sunnybrook Rose Award winners Virginia McLaughlin (left) and Dr. Eileen Rakovitch (right) stand with Anne Odette Kaye (middle), chair of Sunnybrook Foundation’s Donor Relations Committee.

How to reach us:

Your Health Matters

Sunnybrook Health Sciences Centre

2075 Bayview Avenue, Suite D1 00

Toronto, ON M4N 3M5

P: 416.480.4040

E: news.articles@sunnybrook.ca

Your Health Matters is published monthly by the Communications & Stakeholder Relations Department and Sunnybrook Foundation. Submissions to Your Health Matters are welcome, however, they are subject to space availability and editorial discretion.

Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of health care please visit us online at www.sunnybrook.ca

Working on common solutions between laboratories to streamline care

With the sunny days of spring approaching, the physiotherapy team from Sunnybrook’s Holland Orthopaedic & Arthritic Centre has some tips for safe gardening:

1. To get up and down from the ground safely, you may need to use a support. This could be a chair or ledge. You may find it helpful to use a kneeler (available at garden centres or hardware stores) to assist you to get up and down from the ground and increase your comfort kneeling.

2. When lifting plants and soil, it is impor-tant to use a proper lifting technique to avoid injury. Key principles for safe lifting include:

• Lift only what you can manage. • Keep object close to your body and

face it, if possible.• Your ideal lifting posture should

be: feet shoulder width apart with one foot slightly ahead of the other, chest forward and lower back arched at all times, bend knees to lift object with legs.

• Once carrying the object, avoid twisting your back.

3. The ideal posture for gardening has your shoulder blades squeezed. Avoid rounding your shoulders and poking your chin forward.

4. To avoid discomfort in your joints, change position regularly.

5. Interrupt gardening to carefully stretch your back, thighs and neck.

6. Always wear sunscreen and a hat, and keep hydrated even if you don’t feel thirsty.

7. If you’ve been inactive, be sure to check with your health-care provider before starting physical activity.

Helpful tips for Sunnybrook’s green thumbs

Laboratory medicine staff at Sunnybrook and University Health Network (UHN) have been working together and sharing resources, including medical and administrative over-sight, for some time.

Recently, the labs have been investigating a single laboratory information system (LIS) to support both core laboratories. An LIS is an electronic management system that manages patient test orders and results and other data related to the laboratory.

Advantages of a single LIS include test ratio-nalization, seamless test ordering at either site and overall shared system functionality that reduces duplication of costs.

“This type of collaboration will allow for better use of resources and support more comprehensive data mining for clinical and research processes,” says Suzanne Waldman, LIS manager at Sunnybrook.

Peter Woo, LIS manager at UHN, says “a shared system makes sense; if Sunnybrook already has some functionality that UHN needs, it can be deployed at UHN without purchasing it separately.”

“By leveraging these opportunities for inte-gration, you create new value when you work and learn from each other, plus we save time and money by not always having to rebuild

everything,” says Brad Davis, executive direc-tor of Laboratory Medicine at Sunnybrook and UHN. “Plus a single system will provide value to patients and clinicians as it is easier to share orders, results and data without difficult and expensive work-arounds,” Davis notes.

Sam Marafioti, Sunnybrook’s vice-president of corporate strategy & development and chief information officer, says “our laboratories lead the pack in exploring ways to ensure we have a sustainable, affordable and strategic plan for moving forward in our complex health-care system. This type of integration ensures we are serving our patients, our partners and the health-care system in the best way possible.”

UHN’s director of laboratory operations, Tom Clancy, explains that “an integrated LIS will reduce waste and increase efficiencies, since the process of moving specimens and reporting back results at any of our hospital labs will be streamlined.”

Lisa Merkley, director of the Department of Laboratory Medicine at Sunnybrook, says “improved patient safety will be realized through the electronic ordering and reporting between institutions, as well as a reduction in turnaround time of the clinical decision making process, which will translate into improved patient care.”James Buttivant

Sunnybrook haematology technologist Kaw-Fatt Soon prepares samples to be analyzed by a capillary electrophoresis system, which helps in the detection of Sickle Cell disease and other conditions.